The Oklahoma Nurse - August 2022

THE
OKLAHOMA
NURSE
The Official Publication of the Oklahoma Nurses Association
Quarterly publication delivered to approximately 64,000 Registered Nurses and LPNs in Oklahoma
Volume 67 • Number 3
August 2022
Register Today for ONA 2022 Annual Conference
The Oklahoma Nurses Association is pleased to
announce that the 2022 ONA Annual Convention,
Power of Nursing, Educate. Innovate. Celebrate,
will be held in-person at the Hyatt Regency Tulsa
Downtown in Tulsa, Oklahoma, on September
28-29, 2022. Our goal for this event is to focus on
the power nurses have and ways to leverage that
power. We have the Power to redefine and reimagine
nursing. Come learn how to use our power to be
innovative, to change one’s environment and to
move nursing forward.
To take advantage of
our Power, we need to
incorporate all that we have
learned over the last couple
of years so that we become
stronger, more resilient, and
maintain our compassion.
Our first speaker on
Thursday is Oriana
Beaudet, DNP RN, PHN,
Vice President of Nursing
Innovation for the American
Oriana Beaudet
Nurses Association
Enterprise. She will help us redefine and reimagine
the future role of nursing. In addition to her keynote,
we are creating an incubator session. We also have
a second general session, What’s Science Got to
Do with It? Nurses’ Work Life and Environments
focused on ways to apply current research findings
and theories to create healthier work environments.
Register now to take part in unique, timely and hardhitting
topics and sessions with Oklahoma nurses in
mind. Currently scheduled content and activities for
attendees include:
• Opening General Session: Innovation – Be
a Gutsy Nurse, Oriana Beaudet, DNP, PHN,
ANA VP of Nursing Innovation
• Second General Session: What’s Science
Got to Do with It? Nurses’ Work Life and
Environments
• Panel Discussion on: Trends in Nursing: Just
Culture and Non-Punitive Error Reporting
• A meeting of the Oklahoma House of
Delegates
• Power of Nursing Celebratory Reception
• Power of Nursing Awards Luncheon
• Sample Breakout Sessions Include:
o Understanding the Sexual Assault Kit
Tracking System
o Diabetic Care Management - Leveraging
Technology
o Increasing Nursing Confidence and
Safety: The Conundrum of Caring for
Pediatric Mental Health Patients in the
Medical Setting
REGISTER NOW!
2022 ONA ANNUAL CONVENTION
EDUCATE • INNOVATE • CELEBRATE
o
o
o
Developing a Transitional Care
Management Program in a Value-Based
System
The Journey of the First Native American
Nurse
Advanced Directives: The Important Topic
No One Likes to Discuss.
Other professional development areas touched on
at this year’s event will include leadership, individual
well-being, emergency response, embracing
diversity, patient care and advancing the discipline.
Register today for the 2022 ONA Annual
Conference, September 28-29, 2022, at www.
oklahomanurses.org!
SEPTEMBER 28 - 29, 2022 | TULSA, OK
www.oklahomanurses.org
current resident or
Presort Standard
US Postage
PAID
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INSIDE
CEO Report. ....................... 2
President’s Message. ................ 3
ONA Candidates to be Elected ........ 4
We are on Holy Ground .............. 6
RN2LEADER ....................... 7
Meeting the nurse staffing challenge,
part two: Retention tips ............ 8
An Inestimable Loss ................. 9
The Case of Nurse RaDonda Vaught ... 10
EDUCATORS CORNER. ............. 13
Burned Out on Burnout? Strategies to
Combat Compassion Fatigue in Nursing.. 14
EMERGING NURSES. ............... 17
Sleep and Your Health. .............. 19

2
The Oklahoma Nurse August, September, October 2022
Oklahoma Nurses Association Regions and Regional Presidents
Region 1:
President: Lucas Richardson-
Walker
Region 2:
President: Emma Kientz
CEO REPORT
Jane Nelson, CAE
CEO, Oklahoma Nurses
Association
Region 3:
President: Mindy Thompson
Region 4:
Vacant
Last year nurses
were exhausted and
overwhelmed. This year
you are stressed and
frustrated according to
the ANF COVID-19 Two
Year Impact Assessment.
Add undervalued and Jane Nelson
overworked to that list.
However, in that impact assessment there are some
positive answers too, such as 31% are grateful,
23% hopeful, 21% supported and 9% empowered.
Burnout is high as is bullying and incivility all of
which provide challenges to our workplaces. Not
only do each of us need to deal with these issues
on an individual level, but employers are seeking
solutions as well. The survey also indicates that only
24% have sought mental health support and 36%
feel that you should be able to manage your mental
well-being yourself.
Both ONA and ANA are working to provide
resources to assist you as you continue to move
forward on a daily basis. Time away from work, and
spending time with family are all great solutions,
but we need to figure out something on a day-today
basis. On ONA’s website we have just posted a
service called Emotional PPE that is free counseling,
and we are getting ready to launch a stress-release
course called Terra Firma. This Stress-Release
course has a cost to it but it also has 15 hours of
JOIN OUR TEAM AS A
Clinical Health Facility Surveyor (ll, lll, lV)
and make difference in the loves of Oklahomans.
May be eligible for
PAY INCENTIVES
TRAVEL OPPORTUNITIES
TUITION REIMBURSEMENTS
Region 5:
President: Nakeda Hall
Region 6:
President: Viki Saidleman
Contact information available at www.oklahomanurses.org
What is ONA Doing?
Find out more:
jobs.ok.gov
Filter by keyword using
“Surveyor”
Competitive Salary and
Benefits Package
We Have More Information For You!
Call: 405-426-8080
Email: PHSWorkforce@health.ok.gov
CE along with other resources. We hope that you
will also take advantage of the other resources that
ONA and ANA have to offer that can be found on
the ONA website, www.oklahomanurses.org under
Nurse Well-Being.
Take a Breath...it changes your brain chemistry!
Just about the time things feel like they are
getting back to normal…we hit a spike. Breathe
again. Hopefully with vaccines, boosters and
treatments such as Paxlovid those affected with
COVID will not have hospital stays, so, potentially
focus can shift back to ways to build a positive work
environment that includes tools such as shared
governance and a just culture. ONA wants to get
back to working on these issues so at the ONA
Convention, we will have a session prior to the ONA
House of Delegates on Trends in Nursing: Just
Culture and Non-Punitive Error Reporting. This will
include a panel of nurse leaders discussing how
Just Culture, Culture of Safety, Shared Governance,
and non-punitive error reporting are all part of where
nursing is headed. During the House of Delegates,
we will have a conversation around these same
issues that will provide feedback to leaders on
what is missing, what do we need to change to truly
accomplish Just Culture and what does ONA need
to do.
For this to work, we need your engagement.
Every ONA Member has an opportunity to
participate in the House of Delegates. As you
HIRING
NURSES!
APPLY HERE
CEO Report continued on page 7
10240 Broadway Ext.
Oklahoma City, OK 73114
or contact
Nathan, CNO
at
405-900-8766
today!
Oklahoma Nurses Association
Editor: brendan@teamngage.com
ONA 2021-2022 BOARD OF DIRECTORS:
President - Shelly Wells, PhD, MBA, APRN-CNS, ANEF
Vice President - Angela Martindale, PhD, RN
Secretary/Treasurer - Michele Bradshaw, MSN, RN
President-Elect - Angie Kamermayer, DNP, APRN-CNS, NEA-BC
Education Director - Vanessa Wright, PhD, MSN, RN
Emerging Nurse Director - Rachael Bachhofer Kleckner,
MSN, RN, CCRN-CMC-CSC
Membership Development Director - Amy Hutchens, PhD, RN, CNE
Political Activities Director - Cassy Abbott Eng, PhD, RN, LNC, CNE
Practice Director - LaTonya Mason-Wilson, DNP, MS, RN, NE-BC
Consultant to ONSA - Dean Prentice, Colonel, USAF (Ret),
DHA, MA, BSN, NE-BC
Region 1 President & Rep - Lucas Richardson-Walker, BSN, RN
Region 2 President - Emma Kientz, DNP, RN
Region 2 Rep & PE - April Loeffler, MSN, RN
Region 3 President - Mindy Thompson, DNP, APRN, FNP-D, CNE
Region 3 Representative - Julie Nevins, MS, RN
Region 4 Representative - Leslie Collins, DNP, MS, RN
Region 5 President & Rep - Nakeda Hall, DNP,APRN-CNP
Region 6 President & Rep - Viki Saidleman, MSN, RN
ONA STAFF:
Jane Nelson, CAE — CEO
Amber Feldpausch, CMP— Event Planner
Katie Searl, Publications Editor
Mariam Robinson, Membership Manager
Tiffany Wilkinson, Member Services Specialist
MAILING ADDRESS:
Oklahoma Nurses Association
6608 N Western, #627, Oklahoma City, OK 73116
405/840-3476
Subscriptions:
The subscription rate is $20 per year.
THE OKLAHOMA NURSE (0030-1787), is published
quarterly every February, May, August and November by
the Oklahoma Nurses Association (a constituent member
of the American Nurses Association) and Arthur L. Davis
Publishing Agency, Inc. All rights reserved by copyright.
Views expressed herein are not necessarily those of
Oklahoma Nurses Association.
INDEXED BY
International Nursing Index and Cumulative Index to Nursing
and Allied Health Literature.
Copies of articles from this publication are available from the UMI
Article Clearinghouse. Mail requests to: University Microfilms
International, 300 N. Zeeb Road, Ann Arbor, MI 48106.
ADVERTISING
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. ONA and
the Arthur L. Davis Publishing Agency, Inc. reserve the right
to reject any advertisement. Responsibility for errors in
advertising is limited to corrections in the next issue or refund
of price of advertisement.
Acceptance of advertising does not imply endorsement or
approval by the Oklahoma 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. ONA 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 ONA or those
of the national or local associations.
CONTACT THE ONA
Phone: 405.840.3476
E-mail: ona@oklahomanurses.org
Web site: www.oklahomanurses.org
Mail: 6608 N Western, #627, Oklahoma City, OK 73116
Questions about your nursing license?
Contact the Oklahoma Board of Nursing at 405.962.1800.
Want to advertise in The Oklahoma Nurse?
Contact Arthur L. Davis Publishing Agency, Inc.
at 800.626.4081 or email at sales@aldpub.com.
ONA CORE VALUES
ONA believes that organizations are value driven
and therefore has adopted the following core values:
• Diversity
• Safe Quality Care
• Ethical Care
• Health Parity
• Integrity and Accountability
• Practice Competence
• Professional Development
• Educational Advancement
ONA MISSION STATEMENT
The Mission of the Oklahoma Nurses Association is to empower
nurses to improve health care in all specialties and practice
settings by working as a community of professional nurses.
VISION
Creating opportunities through advocacy, education and
collaboration to become the leading voice for the nursing
profession in the State of Oklahoma.
BRAND PROMISE
Engaging Nurses to make a difference!

August, September, October 2022 The Oklahoma Nurse 3
PRESIDENT’S MESSAGE
Shelly Wells, PhD, MBA,
MS, APRN-CNS, ANEF
As the hot summer starts
to wind down, we start
to think about Fall – my
favorite season of the year!
Fall is when the weather
finally breaks, the leaves
on the trees turn those
gorgeous shades of yellow,
red, orange, and purple, Shelly Wells
the pumpkin spice aroma
and flavor take their places on store shelves, and
Oklahoma football season kicks into high gear. I
am reminded that with the changing of seasons
come new beginnings. Along with these seasonal
changes, come changes within our nursing
organization with the culmination of our officer
elections and the naming of the new ONA Board
Members at the Annual ONA Convention every
fall.
The past four years as your President
-Elect and President of the Oklahoma Nurses
Association have been amazing, challenging, and
frustrating all rolled into one! Who would have
ever predicted the shifting of priorities we would
see in nursing, health care, and policies because
of a pandemic? Issues surrounding public health,
safe staffing, workplace violence, and nurse wellbeing
have been at the forefront of my term in
office with the ONA Board.
This has been such an important time for
nurses to step forward to advocate for their
profession, patients, and communities. As the
most trusted profession in the United States,
every individual nurse must be actively influencing
health-related decisions and policies – not only
for their patients and families, but also for their
communities and our profession. As stated in
the Nurses’ Bill of Rights, we must continue
to advocate for “safe work environments
that prioritize and protect nurses’ well-being
and provide support, resources, and tools to
stay psychologically and physically whole”
in order for us to provide for others (https://
www.nursingworld.org/practice-policy/workenvironment/health-safety/bill-of-rights/).
We
accomplish this work through our effective
leadership.
Leadership does not require a title. In fact,
every nurse is a leader. Leadership is a privilege
that we must appreciate. Leadership can be
challenging, but when you think about it, leading
people can be one of the most fulfilling and
rewarding experiences anyone can have since
it affords the opportunity to change the lives of
people every day. It is important that every nurse
embraces their role as a leader to take the lead in
activities and decisions in our work environments,
communities, and policy making arenas. We must
be heard in order to do the right thing to move
forward. Attending the ONA convention: Power
of Nursing: Educate, Innovate, Celebrate is a
great way to recharge and learn about the many
opportunities for nurses to engage in leadership
activities. You can do this – lead by example and
ask others to join in!
I am optimistic about the future of nursing in
Oklahoma. With over 52,000 registered nurses in
the state, we collectively have the opportunity to
lead Oklahoma and the profession of nursing to a
place of excellence. We just have to “do it!” I look
forward to your contributions!
Thank you for placing your trust and confidence
in me to serve as your President these past 2
years. And thank you for your commitment to
nursing and those we serve every day.
JOIN OUR TEAM AS A
Public Health Nurse
and make a difference in the lives of Oklahomans.
May be eligible for the
NURSE CORPS LOAN
REPAYMENT PROGRAM
Find out more:
jobs.ok.gov
Filter by Agency g State
Department of Health
Competitive Salary and Benefits Package
Questions? Call: 405-426-8080
HumanResources@health.ok.gov
An opportunity
you may not
know exists!
Join the FBI in Oklahoma. We’re hiring
skilled nurses to become Special Agents.
For more information, please contact
cslandolt@fbi.gov.
The best care starts with the best team.
NOW HIRING FOR RN POSITIONS THROUGHOUT
SAINT FRANCIS HEALTH SYSTEM!
As a rapidly growing, locally owned, not-for-profit organization, Saint Francis
is dedicated to the health and well-being of our patients and the entire
community. We believe the best care starts with the best team, so we offer
excellent benefits, competitive pay, career growth opportunities, a healthy
work-life balance and an outstanding work environment.
Learn more about available registered nurse positions and benefits,
visit saintfrancis.com/nursing or call 918-502-8300 option 1.
WHY NOW IS
A GREAT TIME TO
JOIN OUR TEAM:
Generous
sign-on bonus*
Full comprehensive
benefits package
Generous relocation
assistance*
Clinical ladder
program
Tuition
reimbursement
CE opportunities
On-site day care**
EOE Protected Veterans/Disability
*Some restrictions apply.
See recruiter for details.
**Only at select locations.

4
The Oklahoma Nurse August, September, October 2022
ONA Candidates to be Elected
This year ONA members will elect the following
positions, all for a two-year term:
• Nominating Committee Members
• Education Director
• Membership Development Director
• Secretary/Treasurer
• President -Elect (serves 2 years as P-E and 2
years as President)
All candidates are listed below as well as on the
ONA website. Voting will be conducted online and
ballots will be available August 15 – September 9.
ONA members will be emailed a username and
password. If you prefer a paper ballot, one will be
provided.
Election results will be announced at the
ONA House of Delegates, which will be held on
September 28, 2022.
President-Elect (2 yrs as PE and 2 yrs as
President) (Elect One)
Cassy Abbott Eng, PhD,
RN, CNE, LNC
Educational Background:
PhD Nursing Education
The University of Northern
CO Greeley, CO; MS
Nursing UNC BS Nursing
Marymount University; Legal
Nurse Consultant Duke
University; and Certified
Nurse educator National
League of Nursing
Activities: ONA Political Activities Dir; Current
Sigma Theta Tau President Zeta Delta at Large
(July 2020-2022); National Charity League; Faculty
Senate; and Strategic Planning Committee for
Health Sciences
Personal Statement: I firmly believe we, as
nurses, have the ethical obligation and professional
duty to advocate for the health and well-being
of every individual. We are charged to protect
human life and to ensure equality and justice for
all. As nurses, we advocate for our patients and
populations by becoming politically active and
lobbying for policies that can be implemented.
These policies can potentially change the landscape
of healthcare in our state. As nurses, we are charged
to move beyond the point of recognizing current
societal concerns and blaze the trail to promote
change through active engagement and undeniable
passion. We are the trusted voice for our patients
and the vehicle for advancement. Now more
than ever, we must advocate for all people while
embracing and supporting their unique differences.
Stagnation and complacency are not an option. We
must embrace a plan of action that is patient driven
not politically influenced. In addition, it is imperative
nurses fight to increase resources in aiding optimal
health and wellness of all citizens across our state.
While the nation is burdened by a fog of chaos, as
nurses we must cling to clarity and transparency.
A rural hospital that is strong in its community.
We are unique and one of a kind.
We have a total of 26 beds with an occupancy rate of nearly 75%
Once you join our team, you never want to leave!
Opportunities for RNs and LPNs.
New Graduates Welcome
Full-Time, Flex & Double Time Available
Competitive Pay with Benefits
For more information and to apply contact Human Resources:
Tammy White, HR Manager
twhite@lindsaymunicipalhospital.com
1305 W. Cherokee, Lindsay, Oklahoma
405-756-1404 phone • 405-756-1802 fax
lindsayhospital.com
EOE
Optimal outcomes for the patient and honorable
advancement of the profession must remain at
the helm as our primary goal. Commitment to
traveling the high road even if it's a lonely road at
times. Acknowledging a challenge is the FIRST
step. Fighting for the person and population that
face that challenge ... is the RIGHT step. In doing
so, we rightfully earn our title as the most trusted
profession.
Lucas Richardson-Walker,
BSN, RN
Educational Background:
Rose State College ADN
2002; and Oklahoma City
University BSN 2017
Activities: ONA, Region
1 President ANA, Member
Sigma Theta Tau, Member
Founder of the Facebook
Group "Nurses Helping
Nurses" Reconciling Ministries Co-Chair St
Stephens UMC Norman Youth Group Adult Sponsor
St Stephens UMC Norman Administration Council St
Stephens UMC
Personal Statement: My name is Lucas
Richardson-Walker BSN, RN. I am running for
President-Elect. I have been a member of ONA
for many years. I have served our profession on
the ONA Board and represented our great state
on the national stage as a Membership Assembly
Representative at the ANA Membership Assembly
in Washington D.C. I currently work as a Staff Nurse
in dialysis. As such, I have seen first-hand the
pain and stress that our profession has struggled
through during this trying pandemic. Too many
have reached that breaking point. We have people
leaving the profession at an alarming rate, in all
areas of nursing! Seeing the struggle and knowing
the power of the Professional Nurse is why I started
the Facebook group “Nurses Helping Nurses”.
As President-Elect, I will continue and expand on
the current board’s focus of helping our essential
profession through this hard time. I believe we
will come out the other end of this pandemic a
profession that is stronger and more resilient than
ever! I am proud to be an Oklahoma nurse and
member of ONA! I ask for your support to allow me
to help lead our profession to the next level - coming
out stronger and prepared for the challenging times
ahead.
Nathan Richmond, MSHA,
BSN, RN
Educational Background:
OSU, Tulsa- MSHA, 2019
OCU, OKC- BSN, 2016
Activities: Member of
ANA, ONA
Member of ACHE
Personal Statement:
Nurses represent the largest
workforce in the healthcare
sector to present date. Nurses are also considered
one of the most ethical professionals and most
trusted not only in healthcare but out of all careers.
Oklahoma also has some of the highest rates of
health disparities and health outcomes in the nation.
Oklahoma nurses are in a unique position to educate
and help communicate healthy living strategies and
the importance of over all health and well being to
the communities we serve. I believe we need to
increase the number of active members in ONA,
so that the largest and most trusted workforce in
healthcare is adequately represented and has a seat
at the table in local and state policy making and
reform.
Secretary/Treasurer
(2 yrs Term) (Elect One)
Michele Bradshaw, MSN,
RN
Educational Background:
Oklahoma City University,
Oklahoma City, OK-
Master’s in Nursing
Administration (MSN)
2019 Oklahoma Wesleyan
University, Bartlesville, OK-
Bachelors Nursing Science
(BSN) 2005 Rose State
College, Midwest City, OK- Associate Degree in
Nursing Science (AAS) 1997 Metro Area Vocational
School, Oklahoma City, OK- Practical Nursing
Diploma- 1994
Activities: ANA, ONA, OONE, AACN, Sigma-
Theta Tau
Oklahoma Christian Nurse Advisory Board
Member Tri- City Youth and Family Services Board
Member Nursing Education and Nursing Practice
Advisory Committee
Personal Statement: Nurses have faced the
greatest adversity of our careers in the last two
years. We have shown innovation and resilience. I
believe it is important for all nurses to be informed,
and to have a strong voice on matters concerning
nursing practice. With the predicted nursing
shortage, I feel that we need to continue to seek
innovative ways to recruit students to choose
nursing as a career. We need to continue to
advocate for safety for nurses with matters such as
workplace violence and medical errors. It would be
my honor to advocate for you and with you.
Education Director
(2 yr Term) (Elect One)
Mindy Thompson, DNP,
APRN, FNP-C, CNE
Educational Background:
Post-Masters Certificate,
Family Nurse Practitioner:
2019 Maryville University
- St Louis, MO Doctor of
Nursing Practice: Nursing
Practice- Leadership and
Innovation, Healthcare
Nursing, 2017 University
of Missouri - Columbia - Columbia, MO Master
of Science: Nursing-Education Nursing, 2012
Northeastern State University School of Nursing -
Tahlequah, OK Bachelor of Science: Nursing, 2011
Northeastern State University School of Nursing -
Tahlequah, OK Associate: Applied Science Nursing,
1998 Amarillo College School of Nursing - Amarillo,
TX
Activities: Dr. Thompson has been an active
member of ONA for the past several years and over
the past year has been the president of ONA Region
3. She has served ONA Board of Directors by
participating on ad-hoc committees. Dr. Thompson
has served as an officer of other professional
organizations such as two different chapters of
Sigma Theta Tau-International.
Dr. Thompson serves as a volunteer provider for
Cura for the World providing primary care services
for the uninsured of Creek County.
Personal Statement: Advocacy is at the core of
nursing and the values we embody. In recent events
over the last couple of years from a global pandemic
to changes impacting women's health and rights,
advocacy is gaining even more importance. In
order to be an effective advocate, we must take
educated actions. Through maintaining current
medical knowledge, we are better equipped to
also protect the ethics we embody as a profession:
nonmaleficence, beneficence, autonomy, justice,
and privacy/confidentiality.

August, September, October 2022 The Oklahoma Nurse 5
Membership Development Director
(Elect One)
Amy Hutchens, Ph.D., RN
Educational Background:
Arizona State University,
Ph.D., December, 2017
Nursing and Health
Innovation The University
of Oklahoma M.S., May,
2010 Nursing Education
Health Sciences Center,
The University of Oklahoma,
B.S.N. May, 2003 Nursing
Health Sciences Center Oklahoma City Community
College A.D.N. December, 2001 Nursing
Activities: From 2017-2018 Amy served as
the director of education on the ONA Board of
Directors. Dr. Hutchens developed educational
initiatives put forth by the ONA. As an Oklahoma
Nurses Association delegate representing Region 1,
Amy supported the resolutions to define nurses as
coordinators of care, and evaluated ONA bylaws.
Dr. Hutchens also supported and advocated
for full practice authority for APRNs through the
Oklahoma Legislature. Amy served as Membership
development director for the 2021-2021 term, and
has presented multiple presentations across the
state educating nurses and students on the benefits
of ONA membership.
Personal Statement: The nursing shortage has
been and continues to be one of the most important
issues facing ONA. Education, increasing availability,
and resources for nursing students and faculty can
contribute to alleviating this issue. I have and will
continue to advocate for improved conditions at the
bedside to recruit and retain nurses.
Nominating Committee Representative
(Elect Three)
Monica Bowie, MSN, RN
Educational Background:
OSU-OKC, OKC, ADN,
1997 Southern Nazarene
University, Bethany, OK,
BSN, 2001 Oklahoma
Wesleyan University (OKWU),
Bartlesville, OK, MSN, 2020
OKWU, Bartlesville, OK, DNP
Student
Activities: ANA, ONA
Epidemiologist and Preventionists in Infection
Control (EPIC) Oncology Nursing Society (ONS)
Honor Society of Nursing, Sigma Theta Tau
International (STTI), Beta Delta Chapter National
League for Nursing (NLN) Association of Black
Nursing Faculty, Inc (ABNF)
Personal Statement: My views on nursing
and issues facing ONA are to ensure nurses can
practice their profession in a safe environment
and to ensure nurses are compensated for their
education and levels of expertise. I feel Advanced
Practice Registered Nurses (APRN) should be able
to practice to the full extent of their education as
independent practitioners. In addition, we should
play a more active role in preventive healthcare.
This includes patient education, increased access
to healthcare, and elimination of food deserts and
food insecurities. Finally, we should bring healthcare
to the communities. This is where APRNs would be
better utilized.
Debra Johnston, RN, BSN,
CEN, MBA
Educational Background:
ADN-Tarleton University
Stephenville, TX 1994 BSN-
OKWU 2012 MBA-OKWU
2014
Activities: ONA ANA ENA
Personal Statement: The
field of nursing is harder than
ever with COVID, resulting in many nurses moving to
another career field and staffing issues. I have been
in a leadership position for a few years and I want to
make more of a positive impact on nursing.
Nathan Richmond, MSHA, BSN, RN
– See Bio Above
Membership Assembly Representative
(Elect Three)
Cassy Abbott Eng, PhD,
RN, CNE, LNC
– See Bio Above
Denise Barnett, MSN, RN
Educational Background:
OKCCC ADN 1989 OKWU
MSN 2020
Activities:
ANA
membership assembly rep
ONA nominations committee
Personal Statement: I have a MSN in nursing
administration and am expected to graduate in Dec.
2022 with a MLS in Healthcare Law. My educational
background combined with more than three
decades of nursing experience puts me in a unique
position for successfully expressing the concerns of
our nurses to our legislators. It would be an honor to
continue to serve Oklahoma nurses in this capacity.
Thank you for supporting me as a representative for
you at our next ANA membership assembly.
Monica Bowie, MSN, RN
– See Bio Above
Debra Johnston, RN, BSN, CEN, MBA
– See Bio Above
Angie Kamermayer, DNP,
APRN-CNS, NEA-BC
Currently Serving as ONA
President – Elect (ONA
President 2022 – 2024)
Rosalind Sims, RN BSN
MBA PCCN
Educational Background:
Langston University -BSN
2000 University of Phoenix
MBA/HCM 2004
Activities: ANA and ONA
committees. Serving as
nominee committee member
Personal Statement:
As we continue to advance
into the 21st Century, the role of nurses continues
to be a vital component of the success of our
healthcare system. We are facing many challenges
today in healthcare and our nursing profession.
Some of the key challenges that we are facing are
staff shortages, workplace hazards/violence, pay/
salary compensation, working long hours and
personal healthcare. To tackle these challenges,
we need to have open dialogue discussions within
our profession, focusing on a strategic plan with
collaboration from our community leaders and
healthcare professionals. I am committed to face
these challenges as opportunities for our profession.
Rachel Risner, Ph.D., DNP,
APRN, C-FNP, CNE
Educational Background:
Oklahoma City University,
Oklahoma City, OK, Ph.D.
Nursing Education, 2016
Oklahoma City University,
Oklahoma City, OK, DNP,
2013 Frontier Nursing
University, Hyden, KY, MSN
FNP, 2010 Oklahoma City
University, Oklahoma City, OK, BSN 2007 Oklahoma
City Community College, Oklahoma City, OK, ASN,
2005
Activities: Nominating Committee
Association of Oklahoma Nurse Practitioner
Secretary National League for Nursing Nominations
committee member (2) Oklahoma Indigenous
Nurse Association President-elect Oklahoma
Nurses Association Nominations Committee
Chair NLN AARP representative for the American
Indian/Alaska Native workgroup NLN AARP
representative for the American Indian/Alaska
Native Curriculum committee member NLN AARP
representative for the American Indian/Alaska
Native Webinar committee member and presenter
NLN AARP representative for the American Indian/
Alaska Native Workshop Development committee
member presenter NLN AARP representative for
the American Indian/Alaska Native Diversifying the
Nursing Workforce: Mentoring for Student Retention
and NCLEX Success at American Indian/Alaska
Native-serving Institutions Toolkit contributor NLN
Taking Aim Series committee member NLN Taking
Aim Series Workshop Development Chair NLN
Taking Aim Series Webinar committee member
NLN Taking Aim Series Beyond Diversity and
Between Equity and Inclusion webinar co-presenter
NLN STEP into Leadership Coach NLN Strategic
Action Group Accreditation Commission for
Education in Nursing Peer Evaluator Accreditation
Commission for Education in Nursing Evaluation
Review Panel member American Academy of
Nurse Practitioners Item Writer American Institute
of Healthcare Quality teaching international nurses
the Certified Professional in Infection Control
course American Gulf International Consulting as an
International Healthcare Consultant The American
Association of Colleges of Nursing created the land
acknowledgment Frontier Nursing University created
the land acknowledgment American Leadership
Academy participant Oklahoma State Plan to
Decrease Prescription Drug Abuse committee
member and contributor
Personal Statement: My career has been
guided by a mission to build an innovative, robust,
and diverse nursing workforce that is responsive to
stakeholders' needs. My educational background,
leadership experience, and professional
experiences have prepared me for the position of
ANA Membership Assembly Representative. The
nursing profession is faced with a rapidly evolving
healthcare landscape that must be addressed with
innovation and bravery. Leaders in nursing must
meet national and global healthcare needs while
maintaining a commitment to the core nursing
principles of compassionate care, honesty, and
strong moral principles. It is our work as nurses to
continue building a strong diverse, inclusive, and
equitable nursing workforce.
Lucas Richardson-Walker, BSN, RN
– See Bio Above
Nathan Richmond, MSHA, BSN, RN
– See Bio Above

6
The Oklahoma Nurse August, September, October 2022
We are on Holy Ground
Catherine White, MA, RN, FCN-BC Faith
Community Nurse Coordinator Mental Health
Coach, First Responder
In the past several issues of THE OKLAHOMA
NURSE there have been several articles about selfcare,
wellness, holistic health care, faith-based
care along with articles instructing nurses how to
deal with stress – stress from academic pursuits,
stress from pandemic situations of short staffing,
insufficient or unavailable supplies, environmental
hazards (e.g., incivility and conflict in the workplace)
and the list goes on with topics about how to handle
life’s difficulties. Authors did their best to write
articles with optimism and actions to minimize if
not eliminate the many problems nurses face in
providing care while maintaining ethical standards.
The articles were insightful but would lead the
reader to wonder if there might be an option yet to
be considered. The most recent article that made
me want to answer the author's question "Where
Do I Go From Here?" is in the May-July 2022 issue
of THE OKLAHOMA NURSE publication by Sharon
Broscious, page 22. There is an answer.
There is indeed an option that needs to be
shared. Traditional nursing care has been seen
as meeting the patient's physical, mental and
emotional, and to some extent spiritual needs. But
over the years more attention has been given to the
aspect of "spiritual care.” In the 1980s two efforts
arose to address spiritual care from two different
perspectives: holistic vs wholistic. It is interesting to
note that these are different yet similar.
The similarities are in the two organizations being
founded. Holistic nursing as a clinical specialty
came into being January 17, 1981, in Houston,
Texas, when 33 nurses from eight states met to
share their stories and implement a vision using
a variety of healing and integrative therapies
from a humanistic worldview such as imagery,
visualization, relaxation, deep-breathing techniques,
stress management, aromatherapy, subtle energy
therapies (therapeutic touch) for patients in hospitals
and in private practice. The faith-based or wholistic
nursing, also an ANA clinical specialty, was
founded in Chicago, Illinois, in the mid-1980s (1984)
by a Lutheran Minister – Hospital Chaplain and
medical doctor, Rev. Dr. Granger Westberg. Both
organizations attempted to address the patient's
needs for care of the body, soul and spirit but Dr.
Westberg's efforts were to be based on the Judea-
Christian worldview.
Rev. Dr. Westberg made rounds daily at the
hospital where he served and concluded that while
the physical nursing care was excellent, there
seemed to be a lack of attention to caring for the
whole person spiritually. Intentionally using spiritual
and religious practices such as prayer, anointing,
religious and inspiring materials along with using
one's presence helped the patient (and family) to
know that healing as a desired healthcare outcome
is from a right relationship with one's Creator, God.
When people with diseases, disabilities, or mental
illness manifestations approached Jesus, He, by
word, touch, and presence, made them whole. He
imparted the Shalom, or supernatural peace, healing
and wholeness, that led to a healing only He could
give them. The "Higher Power" Dr. Westberg saw as
needed for health recovery was based on Biblical
principles. As he taught these concepts to nursing
staff at the hospital where he served, he helped
them learn ways to provide self-care spiritually along
with using skills to include in patient care providing
a benefit to both giver and to receiver. The hospital
administration was in full support of this education
and, as word spread to other nursing staff at other
hospitals in his community, he taught other medical
staffs how to provide what he called "wholistic care"
to enhance "traditional care.” He reminded the staff
that one cannot give or use what one does not have
or that one has not learned, so he taught the staff
to use an in-filling of power to perform the tasks of
caring – for self-first and then for others.
Originally, the faith-based nursing organization
was called Parish Nursing because denominations
that are more formal in their ministries – Lutheran,
Catholic, Episcopalian – have geographic
boundaries called parishes for their congregations.
As this type of faith-based nursing ministry
expanded over the years, the name has been
changed to Faith Community Nursing in order to
include denominations of other groups. According
to the Parliament of the World Religions, over 50
world religions recognize the basic core values of
faith nursing, which include respect for life and the
promotion of charitable service to others (Kung &
Kuschel, 1993).
Originally, religious orders were known for caring
for the sick, poor, widows, orphans, prisoners and
other vulnerable populations as an expression
of God's love and power toward mankind. While
holistic principles and the inclusion of natural
therapies (oils, liniments, salves, ointments, teas,
plasters, poultices, compresses) were foundational
in the early practice of nursing, they were largely
abandoned by the mid to later part of the 1900s. In
the later part of the 1900s technology superseded
the human connection and the God-connection
and healthcare began to change from a "service
profession" to a "for-profit business.” The caring and
healing connection that was fundamental to nursing
was subdued by an emerging culture that valued
efficiency and profit margins. Nursing early on had
been seen as a calling of God and servanthood, but
that view changed causing nurses to be frustrated
by their inability to provide what they considered
quality care and tend to the needs of the person as
a whole entity. It was out of this milieu that these two
organizations emerged, each with its own unique
perspective on how to restore that care.
There is another organization that works
collaboratively with the Faith Community Nurse
organization and that is Nurses Christian
Fellowship. This organization was founded in
Chicago, Illinois, in early 1935 when three nurses
met to pray at Children's Hospital about forming
an organization intent on meeting the spiritual
needs of nurses. Students in Chicago discovered
this group and returned to their home school
(diploma) and started a group like the one they had
encountered. NCF reaches out to nurses needing
their spiritual needs met while serving in various
roles: faculty, administrators of nursing programs
and departments of nursing in healthcare settings,
staff nurses, nursing students, for example. Both
organizations rely on the concept of wholeness that
occurs when a person has a personal relationship
with Jesus so that quality of nursing care is a reality
even in the midst of indescribable and unbearable
stress. Wholeness as a concept occurs in Matthew
9: 1-13 with Jesus meeting a man with palsy, then
in verse 22 with a woman who had a chronic
hemorrhagic condition for 12 years to whom Jesus
said, "Daughter, be of good comfort; your faith has
made you whole. And the woman was made whole
from that hour." (See also Mark 5:25-34). Other
scenarios of supernatural healings – a 40-year-old
crippled man – are recorded in the book of Acts 3:10
and Acts 4: 5-10. People with seizures, self-cutting
and mental illness, blind, deaf, dumb, dead, a
withered hand and – the list goes on – all were made
alive or well - whole - having had an encounter with
Jesus.
As a member of three organizations – Faith
Community Nurse ministry, Nurses Christian
Fellowship and the Mental Health Coach First
Responder ministry – I want to leave some passages
of scripture that may lead a nurse colleague with the
answer to Dr. Broscious question "Where Do I Go
From Here?" The answer is found in the manual for
life, i.e., the Holy Scriptures aka the Bible. Start your
day with Psalm 5: 3, 8- "My voice shall You hear in
the morning, O Lord; in the morning will I direct my
prayer unto You and will look up...Lead me, O Lord...
make Your way straight before my face." Add Psalm
143:8- "Cause me to hear Your lovingkindness in the
morning for in You do I trust; cause me to know the
way wherein I should walk for I lift up my soul unto
You."
How about Psalm 37: 23 – ''The steps of a
good man (person) are ordered of the Lord and
He delights in his way." Isaiah 30: 21- "And your
ears shall hear a word behind you saying, 'This is
the way, walk you in it, when you turn to the right
hand and when you turn to the left." Proverbs 3:
S, 6 - "Trust in the Lord with all your heart and do
not lean on your own under-standing. In all your
ways acknowledge Him and He shall direct your
paths." How about this one? 2 Chronicles 16:9a -
"The eyes of the Lord run to and fro throughout the
whole earth to show Himself mighty on behalf of
those whose hearts are perfect (loyal) to Him." No
one needs to be told that the times in which we live
today are perilous and troublesome, so one needs
Help From Above to live out one day. Our world is in
chaos and spiritual warfare abounds. We need tools
that are a match for such warfare and these tools
(weapons) come from the Lord. See Isaiah 40:29 -
"He gives power to the faint and to them that have
no might He increases strength...they that wait upon
the Lord shall renew their strength; they shall mount
up with wings as eagles; they shall run and not be
weary and they shall walk and not faint." Isaiah 41:
10, 13a, 14a - "Fear not (DO NOT BE AFRAID) for I
am with you; be not dismayed for I am your God. I
will strengthen you; I will help you; yes, I will uphold
you with the right hand of my righteousness...For I
the Lord, your God will hold your right hand saying
to you, 'Fear not; I will help you...Fear not...' ". See
Micah 7:7 - "I will look unto the Lord and I will wait
for the God of my salvation; my God will hear me...
when I fall, I shall arise; when I sit in darkness, the
Lord shall be a light unto me." Jeremiah 33:3 -" "Call
unto Me and I will answer you and show you great
and mighty things that you do not know."
In answer to Dr. Broscious' question "Where Do I
Go From Here?" - how about this answer: Matthew
11:28-30 - "Come unto Me all you who are weary
and heavy laden (burdened) and I will give you rest.
Take My yoke upon you and learn of Me and you
shall find rest unto your souls. For My yoke is easy
and My burden is light." Then when the workday or
shift is done, try this for encouragement. The 23rd
Psalm which can be a form of prayer. "The Lord
is my Shepherd. I shall not want (lack anything).
He makes me to lie down in green pastures; He
leads me beside still waters. He restores my soul;
He leads me in the paths of righteousness for His
name's sake. Yes, though I walk through the Valley
of the Shadow of Death, I will fear no evil (harm) for
You are with me and Your rod and Your staff they
comfort me. You prepare a table in the presence of
my enemies; You anoint my head with oil; my cup (of
water) runs over. Surely goodness and mercy shall
follow me all the days of my life and I shall dwell in
the house of the Lord (heaven) forever (eternally)."
Amen

August, September, October 2022 The Oklahoma Nurse 7
How Stress Affects the
Physical Body
Nicole Cerrini BSN, RN
We are often consumed with how stress can cause us to experience mood
changes, sleep pattern disruptions and overall anxiety. But what about the
physical symptoms that appear and become chronic? Gastrointestinal (GI)
distress, headaches, back pain, TMJ, hormonal imbalances and extreme
fatigue, just to name a few, can all be the result of stress.
So how do we know if our physical ailments are the result of stress, and how
do we treat it? Learning to listen to your body is the first step in understanding
if what you’re experiencing is directly related to stress. Do you find that your
stomach gets upset when you have a lot going on, or you tend to lose your
appetite (or eat more) when you feel overwhelmed? These are both signs that
your body is battling an internal imbalance, not a stomach bug. We’ve been
conditioned to believe that all physical symptoms must be attributed to a true
medical condition, instead of looking at it from a holistic perspective.
There are circumstances where you may in fact have a medical condition and
may need specific treatment, but it should become a habit to analyze outside
factors that may be contributing to your symptoms. The dreaded culprit of
back pain is another good example. There are millions of people suffering from
back pain in our country, and a lot of times physicians are quick to recommend
invasive procedures or prescription medication to help alleviate their symptoms.
Chemical and physical reactions take place in your body when you are under
stress, causing an involuntary tightening of your muscles due to an increase
in cortisol and adrenaline levels. This can present as back pain in certain
individuals and may branch out to include other physical symptoms.
Becoming aware of physical symptoms that may be related to stress is the
first step in treating these ailments. Once you're able to reflect and listen to
your body, the next step is to make it a priority to listen to your needs! Holistic
therapies are often ignored as a primary means of treatment. Analyzing the
body through this perspective allows for a unique approach focusing on
physical, emotional and spiritual health resulting in a plan to align and balance
the body.
Specific therapies for treating physical symptoms caused by stress include
nutrition plans, mindset exercises, meditation, breathwork, hypnosis, reiki and
many other modalities. Nutrition is one of the most important variables in your
health, especially as it relates to stress and overall wellness. The term “food is
medicine” was coined for a reason; how you fuel your body can have a direct
impact on preventing and treating physical ailments.
Try to keep an open mind when it comes to your health, and consider
alternative therapies in your quest for relief of physical symptoms.
CEO Report continued from page 2
can see on the Call to the ONA House on the pages of this publication, every
Region has representatives that are based on the number of members in each
Region. We need nurses to volunteer and serve as Delegates to the House of
Delegates.
Breathe again…smile, another brain chemistry shift.
RN2LEADER
Joyful Noise
Dr. Dean L. Prentice, Colonel (Ret), USAF, NC, DHA, MA, BSN, NE-BC
Do you find joy in your job? I’m not asking if you like
your job, but if you find joy in the basic heart of your job.
When you started your professional life, I bet there was
a part of you that really desired or even felt that being
joyful, positive, or happy about going to work was what
you wanted. You worked hard to earn that license, were
proud of the accomplishment, and you were ready to
take on the world.
The positive outlook and desire to go to work is
essential for ultimate job satisfaction. It increases your
productivity, innovation, and performance at work.
How you get to that joy at work can take many paths Dr. Dean Prentice
which will require you to do some self-reflection on your
current job. Then you will have to do some work if where you are currently is not
where you want to be ultimately.
People feel once they become successful, they will be happy. I am not sure
that thought is entirely correct. Yes, becoming successful in your position does
bring a sense of pride, of accomplishment, of fulfilling a need to be valued. That
alone, I believe, is not going to guarantee joy at work.
First you set out to create a work environment where you like going to work.
This may include building a great team, defining the roles, looking for the right
people for the team, and setting a vision all of which will encourage positive
work environments. You also need to foster or create a work environment where
you know you will enjoy working. Dreading coming to work, or facing daily
challenges and not being able to improve them does not support your goal.
Choosing to work for the right organization is another aspect of finding joy
at work. The simple task of finding an organization whose mission, core values,
and culture agree with yours can seem impossible at times. Networking with
colleagues, talking with other professionals in the organization other than
nurses, looking at the strategic plan of the organization, and observing where
they invest their resources are great indicators of what the organization values.
If what you see is not what you want, then look for another organization.
Building strong interpersonal relationships helps build better feelings of joy at
work. When you start to build stronger relationships with peers, both in and out
of your profession, you have a sense of connectedness with the organization.
Likewise these relationships help during times of crisis or disagreements.
When challenges arise and you have an established positive relationship with
another colleague, it is easier to walk through the resolution process to solve
the problem. You are more confident in what you know and in the knowledge
that you and your colleague are on the same team.
Another great aspect about having a positive outlook on your job and finding
joy at work is that your attitude spreads. A joyful attitude can positively affect
your fellow workers and organization. You can be the change in your unit or
organization that it needs to take it to the next level of excellence. Imagine if you
and your fellow leaders looked forward to coming into work.
So what is your next step to create joy at work? Don’t forget to take a
colleague along for this journey. Working on this habit together can really pay
dividends.
FIVE-STAR RATED
On another front, ONA has been advocating for nurses at the State Capitol.
Our work has focused on solutions to our nursing shortage by supporting
nursing education and other policy issues. Often Legislators have their own
solutions, and we work to educate them on better solutions. One of the ways
we are working to educate Legislators is to request an interim study focused
on the nursing shortage. We want to highlight the current data, nursing’s
educational needs, and the skills and education necessary for registered
nurses as they deliver the highly skilled care required in todays’ patient care
settings. This will take all of us to educate Legislators, both those running for
election or reelection and those without elections this cycle. I encourage you to
get involved…talk to those candidates knocking on your door, get involved in a
campaign by volunteering or just voting. Voting is the most important thing you
can do.
Breathe again…smile you’re shifting your brain again
I hope to see you at the ONA Annual Convention, The Power of Nursing, at
the Hyatt Regency Tulsa Downtown in Tulsa, Oklahoma on September 28 - 29,
2022. Look for more details on the ONA Convention in this newspaper and on
the ONA website. ONA takes guidance from our members on where to focus
our efforts. To ensure you have a voice in providing direction you need to be
a member. We hope that you will become a member and get involved so that
collectively we can make a difference in Oklahoma.
Breathe again…you should be a different place then when you started!
LEADERSHIP OPPORTUNITIES
• RN, System Chief Nursing Officer
• RN, Quality Director
NURSING OPPORTUNITIES
Community Hospital South:
RN, FT*: ICU/Med Surg Days/Nights,
Circulator, Med-Surg Days/Nights, ER Weekend
PRIME Mid/Nights
RN, PRN: ER Days/Nights, Med-Surg Nights,
PACU, Pre-Admission Testing
ADDITIONAL OPPORTUNITIES
Paramedics, FT: Med-Surg
*Sign On Bonus
Community Hospital North:
RN, FT*: Circulator, Pre-Admission
Testing, PreOp/Phase II,
Med-Surg Days/Nights
RN, PRN: Med-Surg Days/Nights,
PACU, Circulators
$10,000 for FT Circulator • $10,000 for FT Med-Surg Nights
$10,000 for FT Emergency • $7,500 for FT Med-Surg Days
$5,000 for FT PACU • $3,000 for FT Pre-Admission Testing
$3,000 for FT PreOp/PhaseII • $2,000 for FT Paramedics
Learn about our benefits
Northwest Surgical Hospital:
RN, FT*: Med-Surg Days/Nights
PACU
RN, PRN: Med-Surg Days/Nights,
PACU, PreOP/Phase II
Come join our award winning team!
3 LOCATIONS IN OKLAHOMA CITY!
COMMUNITY HOSPITAL SOUTH
COMMUNITY HOSPITAL NORTH
NORTHWEST SURGICAL HOSPITAL
Community Hospital/Northwest Surgical Hospital complies
with Federal Civil Rights laws and doesn’t discriminate on the
basis of race, color, age, disability or nationality. Community
Hospital and Northwest Surgical Hospital are facilities in which
physicians have an ownership or investment interest. The list
of physician owners is available upon request.
To apply, please visit www.communityhospitalokc.com or www.nwsurgicalokc.com.

8
The Oklahoma Nurse August, September, October 2022
Meeting the nurse staffing challenge, part two: Retention tips
By Georgia Reiner, MS, CPHRM,
Risk Specialist, NSO
As discussed in the first article in this two-part
series on nursing recruitment and retention, ensuring
appropriate nurse staffing levels is key to the financial
health of healthcare organizations like hospitals and
skilled nursing facilities. High-quality nursing care
helps to reduce the likelihood of patient safety events
and costly medical malpractice lawsuits related to
missed errors. This means it is critical for leaders to
engage in effective retention strategies.
The second of a two-part series, this article
addresses effective retention strategies that leaders
can utilize to help reduce turnover of nursing staff.
Retention
The 2021 National Health Care Retention and
RN Staffing Report notes that the average cost
of turnover for a hospital-based RN was $44,400
in 2020. This makes retention a key part of an
organization’s staffing strategies. You need to
work closely with human resources staff to ensure
retention strategies are efficient, effective, and inline
with organizational strategies.
Conduct “stay” interviews. Stay interviews
help you identify employees who might be thinking
about leaving the organization and identify what
factors are most important for staying. You can
use the information to create an individual retention
plan and to inform your larger retention efforts for
the unit. Here are some examples of questions you
can use to help elicit useful information during stay
interviews:
• What do you look forward to each day when
you commute to work?
• What are you learning here, and what do you
want to learn?
• Why do you stay here?
• When is the last time you thought about
leaving and what prompted it?
• What can I do to make your job better for you?
Promote a healthy work environment. For
example, implement zero tolerance policies for
patient or visitor violence against nurses and
policies that discourage providers from bullying their
colleagues. Beyond policies, it is also important to
ensure lines of communication are open, so your
staff feel comfortable speaking with you when they
identify problem areas. Make rounds daily and listen
to staff closely. Ask them questions such as, “What
do you need to do your job more effectively?” If it’s
something that you can take care of, do so and let
them know it’s been done. If you can’t address the
issue, explain why and, if appropriate, note that it
may be able to be addressed in the future.
Avoid sign-on bonuses. Sign-on bonuses
may help to ease staffing woes short term, but
don’t ensure commitment, and can even lead to
resentment from current staff. Instead, focus on
improving nurses’ pay scales or offering retention
bonuses to show appreciation for your nursing
staff’s commitment to the organization.
Recognize employees. Recognition is an easy,
but often underutilized, retention tactic. Take every
opportunity to offer words of praise. To reinforce the
behavior, specify what specifically was done to earn
praise. Small rewards such as gift cards can also be
effective, but try to match them to the individual’s
interest. For example, a nurse who drinks coffee
every day may enjoy a Starbucks card, but one who
loves to read might prefer a card from Barnes &
Noble.
Support career development. Explore nurses’
professional goals and how you can help meet
them during stay interviews and other ongoing
professional development conversations. It’s a good
idea to keep a mental list of options such as serving
on committees, acting as a preceptor, and leading
project teams. Offer meaningful opportunities for
professional growth based on performance, rather
than solely based on tenure. Outline for your staff
the types of experiences or skills that are most
valuable for advancement and reinforce the value
of bedside nursing experience for nurses’ long-term
career growth.
Consider a job embeddedness approach. Job
embeddedness (JE) focuses on why people stay in
their jobs as opposed to why they leave. A study
by Reitz and colleagues found it’s a good predictor
of nurses’ intent to stay. JE looks at ties related to
organizations and the community where they exist.
These ties are considered in three dimensions:
links (formal and informal connections people have
with their organizations or communities), fit (how
compatible people feel with their organizations
or communities), and sacrifice (material and
psychological losses people would experience by
leaving their organizations or communities). You can
leverage these dimensions to promote retention. For
example, to help promote JE with the organization:
• Links: Involve nurses in committees and
shared governance.
• Fit: Recruit nurses whose goals align with the
organization’s goals.
• Sacrifice: Align vacation time and retirement
plans with the time of service.
A multifaceted approach
Nurse staffing challenges are unlikely to ease
anytime soon. Leaders will need to be creative and
take a multifaceted approach to recruitment and
retention. These efforts will help gain—and keep—
staff. Doing so helps reduce the costs of lawsuits
related to errors, but, most importantly, provides
optimal patient outcomes.
References
Advisory Board. Struggling to keep entry-level staff
engaged? Try a performance-based career
ladder. 2017. https://www.advisory.com/
blog/2017/02/pef-career-ladder
CNA & NSO. Nurse Professional Liability Exposure Claim
Report: 4th Edition: Minimizing Risk, Achieving
Excellence. 2020. https://www.nso.com/
Learning/Artifacts/Claim-Reports/Minimizing-
Risk-Achieving-Excellence
Malliaris AP, Phillips J, Bakerjian, D. Nursing and Patient
Safety. Agency for Healthcare Research and
Quality. 2021. https://psnet.ahrq.gov/primer/
nursing-and-patient-safety
NSI Nursing Solutions, Inc. 2021 National health care
retention and RN staffing report. 2021. https://
www.nsinursingsolutions.com/Documents/
Library/NSI_National_Health_Care_Retention_
Report.pdf
Reitz O, Anderson M, Hill PD. Job embeddedness and
nurse retention. Nurs Admin Q. 2010;34(3):190-
200.
Saver C. Retaining nurses in a post-pandemic era—Part 1.
OR Manager. 2021;37(9):12-15.
Sherman RO. The Nuts and Bolts of Nursing Leadership:
Your Toolkit for Success. Rose. O. Sherman;
2021.
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.
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
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a CNA company. Reproduction without permission of the
publisher is prohibited. For questions, send an e-mail to
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August, September, October 2022 The Oklahoma Nurse 9
An Inestimable Loss
Nancy J Vitali, MS, DCSc, Caritas Coach
Every arrival foretells a leave-taking: every birth a death. Yet each death and
departure come to us as a surprise, a sorrow never anticipated. Life is a long
series of farewells; only their circumstances should surprise us.
Jessamyn West
The Life I Really Lived
The pandemic has proved to be an unprecedented challenge for nurses,
with 52% of nurses considering a change in profession after two years of the
pandemic (American Nurses Foundation, 2022) and a surprising 30% reporting
poor emotional health across all age categories, with younger nurses having
a much higher rate of 46%. The comprehensive impact of the past two-plus
years on the profession of nursing is not measurable, with nurses reporting the
overwhelming demoralization of witnessing deaths of patients in which families
were not allowed to be present, doing their best to connect electronically and
to act as proxy for their dying patients’ loved ones. This writer listened to the
experiences of Oklahoma nurses who described the moral injury resulting from
caring for several dying patients per shift on COVID units, day after day, during
the worst of the pandemic. These situations, combined with other stressors
that were endemic in health care delivery, such as staffing shortages and
inadequate equipment and supplies, multiply the distress to the level of trauma,
whose effects will be a real presence in some nurses’ lives for years to come.
Not mentioned yet are the pressures their families shouldered, such as home
schooling and caring for their children, and the possibilities of contracting the
illness themselves.
Amid this climate of unprecedented distress, some of these nurses took their
own lives. Early this year, Michael O’Dell of Muskogee was one of those nurses.
He and several other nurses from Oklahoma had taken traveling contracts in
different states over the previous several years, had coincidentally met in the
workplace on the east coast, and had agreed to head to California. In California
during the pandemic, they became each other’s support network, and even
roommates, as Michael moved in with friend Joshua Paredes, a Tulsa nursing
graduate. Friend Michael Walujo, also from Tulsa, worked in Southern California
at Cedars-Sinai Medical Center. They were in the habit of doing weekly mental
health “check-ins” with one another and other friends. They understood the
combined vulnerabilities of being travelers and away from home, being part of a
marginalized (LGBTQ+) community and working during the pandemic.
Michael’s friends have shared that he was the life of their circle of friends,
planning group trips to music festivals and abroad between contracts. He
had been a precocious and inquisitive child, teaching himself the Swedish
language at the age of 11. As an adult, he travelled to Spain, Italy, and Portugal
to immerse himself in the languages and cultures of those countries. He also
traveled to Iceland with a nurse friend between contracts. When he wasn’t at
work in his travel positions, he hiked and attended electronic music festivals
with friends, often as the orchestrator of the adventures for his companions. He
was engaged in and in love with life and with the richness, diversity, and beauty
of humanity. Michael was also recognized as an exceptionally caring nursing
professional and patient advocate. Despite all of these attributes, the truth is
that Michael also battled depression, and was experiencing the challenge
of connecting with needed mental health services in the Bay Area when the
tragedy of his death occurred.
While working in an ICU at Stanford University Hospital on January 18
of this year, Michael spoke to his supervisor, saying he needed to retrieve
something from his car, and that he would return momentarily. Michael did not
return. At their apartment in San Francisco, Joshua began to worry when he
didn’t return from his shift at the expected time. A search began after his car
was found on the Dumbarton Bridge (the southernmost bridge over the San
Francisco Bay). Michael’s body was pulled from the bay several days later.
Two months later, another nurse died by suicide/gunshot in the utility room of
a Kaiser-Permanente facility in nearby Santa Clara. These two deaths left Bay
Area nurses and health care personnel in shock and disbelief, and galvanized
Michael’s friends to reach out to other nurses to organize a peer-support
organization for the purpose of preventing any further tragic events and loss of
life. Not unrelated to this tragedy was the walkout of over 5,000 nurses from
Stanford University Hospital and Lucille Packard Children’s Hospital on April
25 over issues of better pay, more staffing, and more support for their mental
health (NPR, April 2022).
The organization founded by Paredes, Walujo and others is currently
seeking nurse volunteers. Its name is Don’t Clock Out.org and can be located
at: www.dontclockout.org. Their mission is “to provide a research-based peer
support network for bedside nurses and nursing assistants; to share common
experiences and emotional reactions with others who have had similar
experiences, and to bridge the gap between bedside nursing caregivers and
mental health treatment.” We who understand the nature of trauma and primary
and secondary post-traumatic stress know that the pressure on health care
workers has only begun. As the pandemic wanes, memories and experiential
flashbacks are returning to plague our colleagues. Nightmares are undoubtedly
a routine part of many nurses lives right now. Nurses are generous with advice
to those who are returning from war to avail themselves of mental health care
services that specialize in trauma treatment, and may benefit from that same
advice, for this pandemic is a war like no other that has been fought in health
care organizations across the world. Ever.
Peer support has been found to be advantageous as a community support
net for the mental health of those affected by the COVID-19 pandemic,
including health care workers. In a study by Suresh, Alam, and Karkossa (2021)
it was found that peer support during the current pandemic can be a safe
and beneficial resource, and that more research is needed. Individual peer
support… “has been shown to provide beneficial practical, emotional, and
social supports in a non-treatment based, normalizing relationship and lack
evidence regarding the necessary duration, quality, or intensity to maximize
its effectiveness.” (92). Individual peer support has also been electronically
accessible during these times of isolation.
As nurses from Stanford have said by their collective bargaining actions, the
life of nursing depends on health care organizations investing in the profession’s
well-being. This may include a well-researched approach that has had multiple
successful applications in the past 50 years: mindfulness-based stressed
reduction (Craigie, et al, 2016). In a recent address to the Fourth International
Integrative Nursing Symposium, Billy Rosa, PhD, MBE, NP-BC, FAANP, FAAN
stated that this responsibility is incumbent upon those organizations where
work assignments place nurses’ health in dire risk. “Heroes work here!” signs
and pizzas and gift bags and admonishments to self-care are not the answer
to the problem of post-traumatic stress that in some health care workers is
complicated by pre-existing human problems, membership in marginalized
communities, and neurodiversity. These realities of human existence deserve to
be accepted and appropriately addressed in workers of all disciplines, without
judgment or recrimination. As ANA’s Code of Ethics states in Provision 5: “The
nurse owes the same duties to self as to others; including the responsibility
to promote health and safety, preserve wholeness of character and integrity,
maintain competence, and continue personal and professional growth.” (ANA,
2015). It follows that health care organizations ought not impede the nurses’
progress to those ends but should provide protection during vulnerable times
and encourage recovery, growth, and resiliency. Thoughtful and possibly costly
investment that is informed by research is needed to preserve what we know
that nursing is to humankind: a whole-human spiritual, emotional, and physical
healing force and brilliant light in our clinics, hospitals, higher education, and
communities. In the words of Dr. Jean Watson, American Academy of Nursing’s
living legend, “We heal in community.” (Watson, 2022).
References
American Nurses Association. (2015). Code of ethics with interpretive statements. Silver
Spring, MD.
American Nurses Foundation. (2022). Pulse on the nation’s nurses survey series:
COVID-19 two-year impact assessment survey.
Craigie, M., Slatyer, S., Hegney, D. et al. A pilot evaluation of a mindful self-care and
resiliency (MCSR) intervention for nurses. Mindfulness 7, 764-774. (2016). DOI:
https://doi.org/10.1007/s12671-016-0516-x
Don’t Clock Out. www.dontclockout.org
NPR. (March 31, 2022). A nurse’s death raises the alarm about the profession’s
mental health crisis. Retrieved from https://www.npr.org/sections/healthshots/2022/03/31/1088672446/a-nurses-death-raises-the-alarm-about-theprofessions-mental-health-crisis
NPR. (April 25, 2022). Thousands of nurses at Stanford Hospitals are striking
over wages and mental health. Retrieved from https://www.npr.
org/2022/04/25/1094689736/stanford-hospital-nurses-strike
Rosa, Billy. (April 27, 2022). Nurses and health equity. 4th International integrative
nursing symposium. Conference proceedings.
Serrano, J., Hassamal, S., Hassamai, S., Dong, F., Neeki, M. (June, 2021). Depression
and anxiety prevalence in nursing staff during the COVID-19 pandemic. Nursing
Management. Volume52, issue 6. P 24-32.
Suresh, R., Armaghan, A., and Karkossa, Z. (2021). Using peer support to strengthen
mental health during the COVID-19 pandemic: A review. Frontiers in Psychiatry:
Public mental health. July 12, 2021. https://doi.org/10.3389/fpsyt.2021.714181-
Watson, J. (2022). Caring Community Conference. Boulder, CO. May 22, 2022.

10
The Oklahoma Nurse August, September, October 2022
The Case of Nurse RaDonda Vaught – How Administering the
Wrong Medication Resulted in a Criminal Conviction
Nurses across the country have followed and
are now responding to the criminal prosecution and
conviction of a Tennessee nurse who mistakenly
injected a patient with a paralytic medication,
resulting in her death. There have been strong
reactions to the guilty verdicts handed down against
Ms. Vaught. Since not all material facts in this
case were covered by the media, a more thorough
discussion is provided below.
Timeline of Events –
12/26/2017 – Nurse Vaught mistakenly
administered vecuronium (brand name Norcuron)
instead of the prescribed Versed to a 75-year-old
patient, Charlene Murphey, prior to a PET scan. In
the PET scanning room, the patient arrested and
was placed on a ventilator.
12/27/2017 – The patient was declared brain
dead and removed from the ventilator.
12/27/2017 – Vanderbilt University Medical
Center (“Vanderbilt”) reported the patient’s death to
the county medical examiner. Vanderbilt’s report did
not mention the medication error.
12/27/2017 – The medical examiner determined
the cause of death as “natural”.
1/2018 – Vanderbilt did not report the patient’s
death to state or federal officials, as required by
law. Ms. Vaught’s employment at Vanderbilt was
terminated.
Early 2018 – Vanderbilt negotiated an out-ofcourt
confidential settlement with the patient’s
family.
10/3/2018 – An anonymous tipster advised state
and federal officials of the medication error which
resulted in the patient’s death.
10/23/2018 – The Tennessee Department of
Health which oversees health professional licensing
determined there was no violation by Ms. Vaught
and issued her a letter indicating “this matter did not
meet further action”.
10/31/2018 – The Centers for Medicare
and Medicaid Services (“CMS”) conducted an
unannounced inspection of Vanderbilt.
11/8/2018 – CMS confirmed the patient’s death
was due to an accidental dose of vecuronium and
that Vanderbilt did not report the medication error to
the medical examiner and state officials.
11/16/2018 – In response to CMS’s inspection
Vanderbilt developed a plan of correction. No other
action was taken against Vanderbilt or it’s Medicare
provider status.
2/4/2019 – Ms. Vaught is arrested and criminally
charged with reckless homicide and impaired adult
abuse.
2/5/2019 – The CEO for Vanderbilt appeared
before the Tennessee Board of Licensing for
Health Care Facilities and admitted the death
of Ms. Murphey was not reported and admitted
the hospital’s response was “too limited”. The
Tennessee Board of Licensing for Health Care
Facilities took no action against Vanderbilt.
2/20/2019 – Ms. Vaught entered not guilty pleas
to the criminal charges brought against her.
8/20/2019 -- Law enforcement requested the
medical examiner re-examine the circumstances of
Ms. Murphey’s death. The medical examiner now
with knowledge of the medication error, changed the
official manner of death to “accidental”.
9/27/2019 – The Tennessee Health Department
overseeing the Board of Nursing re-opened Nurse
Vaught’s licensing case.
3/22/2022 – Criminal trial of Ms. Vaught began
3/25/2022 – After a three-day trial and 4 hours of
deliberations the jury returns guilty verdicts against
Ms. Vaught.
5/13/2022 – Sentencing of Ms. Vaught is
scheduled to be held on May 13, 2022.
Facts – Nurse RaDonda Vaught became
employed by Vanderbilt in October 2015. On
December 26, 2017 she was working as a “help all
nurse” for the Neuro ICU, step down and the 6th
floor nursing units. 1 At that time Charlene Murphey,
a 75 year woman with a subdural hematoma was a
patient in the Neuro ICU. The patient was scheduled
to undergo a full body PET scan at 2:00 pm. It is
not clear when the patient arrived in radiology since
there was no documentation of her arrival time. She
was noted to be alert and oriented when she arrived
in radiology. Prior to undergoing the PET scan the
patient requested something to reduce her anxiety
as she suffered from claustrophobia.
The physician ordered 2 mg of Versed IV. 2 The
AcuDose report showed the order was entered
at 2:47 pm and verified by pharmacy at 2:49
pm. 3 The report also shows at 2:59 pm Nurse
Vaught removed 10 mg of vecuronium from the
AcuDose cabinet, using an override. 4 There was
no order for vecuronium for this patient. There
was no override verified by pharmacy and there
was no documentation by Nurse Vaught that she
administered vecuronium. 5 At some time after the
incident the family was told of a possible medication
error. 6
A physician’s note at 3:45 pm on 12/26/2017 7
indicates a code was called in the PET scan area.
Upon the physician’s arrival the patient was found
to be pulseless and unresponsive. The patient
was intubated and regained circulation after 2 – 3
attempts at chest compressions. The patient was
readmitted to the Neuro ICU.
The next day, on December 27, 2017, a
physician’s note 8 (time not specified) stated “I
discussed the case with the neurology team and it
is felt that these changes in exam likely represent
progression towards but not complete brain
death…very low likelihood of neurological recovery,
we made the decision to pursue comfort care
measures”.
Hospital’s Actions after the Patient’s Death
– The patient’s death was reported to the county
medical examiner. The amended report from
the county medical examiner’s office contains
conflicting statements 9 as to the cause of death.
The report indicates that the physician “will attest
to the death as natural causes of complications
of the intra-cerebral hemorrhage”. The cause of
death is listed as “acute vecuronium intoxication”,
contributing factors of death “intracerebral
hemorrhage” and the manner of death as
“accidental”. The medical examiner originally
determined that the cause of death to be “natural”
then after more information was made available,
changed the cause of death to “acute vecuronium
intoxication”.
Vanderbilt did not report the medication error to
either state or federal officials, as required by law.
It appears that the only actions taken by Vanderbilt
in January 2018 was to terminate Nurse Vaught’s
employment and to negotiate an out-of-court
settlement with Ms. Murphey’s family. The terms of
the settlement are confidential.
Anonymous Tip to State and Federal Health
Officials – On October 3, 2018 an anonymous
tipster advised state and federal health officials 10 of
the unreported medication error that resulted in the
patient’s death. The tipster reported Nurse Vaugh
was orienting a new registered nurse when the
patient’s nurse asked Nurse Vaught to give Versed
to the patient. The report goes on to state that Nurse
Vaught removed the incorrect drug, did not read
the label, and accidently administered vecuronium
instead of Versed.
Tennessee’s Board of Nursing Initial
Determination -- The Tennessee Department
of Health (“Department”) is responsible for the
licensing of healthcare professionals. After receiving
information from Vanderbilt the Department
conducted an investigation which was reviewed
by the Department’s nursing consultant and staff
attorney. On October 23, 2018 the Department
closed its files and issued letters to Vanderbilt and
Nurse Vaught. 11
A letter from the director of investigations to
Vanderbilt stated in part, “the complaint received
about Nurse Vaught has been reviewed by
the nurse consultant and staff attorney for the
Department and forwarded for investigation. As
a result of the investigation and the review by
the nursing consultant and staff attorney their
determination was that the acts of the practitioner
did not constitute a violation of statutes and/or
rules governing the profession.” 12 On the same day
Nurse Vaught was issued a similar letter indicating
a “review of the complaint by the Board’s nursing
consultant and staff attorney a decision was made
that this matter did not merit further action”. 13
Investigation by Centers for Medicare
and Medicaid Services and State Officials –
Interview of RaDonda Vaught -- Investigators
conducted a surprise inspection at Vanderbilt. As
part of this inspection investigators interviewed
Nurse Vaught by telephone. According to the
investigative report, Nurse Vaught stated, 14 “I was
in a patient care role. I was the help-all nurse. As
explained in the report a help-all nurse is a resource
nurse. 15 Nurse Vaught was also orienting a new
nurse.
The patient’s primary care asked Nurse Vaught
to go to the Radiology PET scanning room and
administer Versed to the patient because she was
not able to tolerate the PET scan procedure. Nurse
Vaught searched for the Versed under the patient’s
AcuDose profile which she could not find. She then
chose the override setting and searched for Versed.
At the time she indicated she was talking to the
orientee while she was searching for Versed and
typed in the first two letters of Versed which are
“VE” and chose the first medication on the list.
According to the investigative report 16 , Nurse
Vaught could not remember the reason she gave
for the override. The investigation also revealed
there was no scanner in the radiology unit. 17 When
Nurse Vaught discussed her medication error with
the unit manager she was instructed not to scan the
medication after the fact as the MAR would note it.
Nurse Vaught also admitted that she was distracted
by talking to the orientee about a swallow test they
were going to do. She also admitted it struck her
“as a little odd” that she had to reconstitute the
medication and should have called the pharmacy.
Nurse Vaught told the investigator 18 that she took
out the medication vial and looked at the back of
the vial for the directions on how to reconstitute it.
She admitted she did not re-check the medication’s
name on the vial. Nurse Vaught went on to say she
grabbed a sticker from the patient’s file, a handful of
flushes, alcohol swabs, and a blunt tip needle. She
placed the medication vial in a baggie and wrote
on the baggie, “PET scan, Versed 1-2 mg” and
went to the radiology department to administer the
medication to the patient. The medication was given
but there is no documentation as to when it was
administered.
Once in the radiology department Nurse Vaught
went to the patient, checked her identity and told
her she was there to help her relax. She then
proceeded to reconstitute the medication and
measured what she needed. 19 When asked how
much she gave the patient she indicated “I can’t
remember. I am pretty sure I gave her 1 millimeter”. 20
She put the left over medication in the baggie and
gave it to another nurse [not identified]. 21 When
asked her next actions Nurse Vaught indicated she
left the radiology unit and did not monitor the patient
after giving the medication. 22
Nurse Vaught went on to tell the investigator that
the family was standing outside in the hallway…”we
heard a rapid response call for PET scan. That
was a red flag since that patient was ours”. 23 The
investigative report indicates the rapid response
team call occurred at 3:29 pm. Nurse Vaught went
back into the PET scan area and saw that the
patient was intubated and had regained a heartbeat.
She told the physician, “I had given Versed a few

August, September, October 2022 The Oklahoma Nurse 11
minutes ago.” 24 The nurse who was present when
Nurse Vaught administered the medication showed
her the baggie and asked if this is what was given
to the patient, Nurse Vaught responded “yes”. 25 The
other nurse in response said, “This isn’t Versed. Its
vecuronium” 26 Other staff interviewed indicated the
patient was estimated to be alone in the room for
about 30 minutes once she was put in the scanning
room. 27
The investigation also revealed that in the days
after the incident Nurse Vaught spoke with her nurse
manager and risk management at Vanderbilt. 28
Nurse Vaught indicated immediately after the events
she spoke to several people in management and
also completed a Veritas report around 4:00 pm on
December 26th. 29
Interview of the Vanderbilt Pharmacist – The
pharmacist reported the following events: 30 On
December 26th a PET scan was ordered at 2:00
pm, the Versed was ordered at 2:47 pm, and the
vecuronium was removed from the AcuDose at 2:59
pm. The pharmacist confirmed that the letters “VE”
were entered in AcuDose which defaults to generic
medications. That is why Versed did not show up.
When vecuronium popped up a warning in the red
box was visible for an override stating that is should
be for STAT orders. The time of administration of the
vecuronium was not documented.
What the Baggie Contained – Nurse Vaught
told the investigator that she labeled and placed the
administration set up in a baggie bag before going
to the Radiology department. The baggie contained
the following: 31
• Clear zip lock baggie with an orange
biohazard label had “Versed 1 mg – 2 mg PET
1251 handwritten in pink colored marker on it.
• Inside the baggie was a vial with a few drops
of clear liquid remaining in the vial. The vial
was labeled as “Vecuronium Bromide 10
mg. 1mg/ml when reconstituted to 10 ml.
reconstitute with bacteriostatic water”.
• The vial had a red top that said “WARNING:
PARALYZING AGENT”.
• There was a 10 ml syringe labeled “Normal
Saline” with a capped needle attached, with
1.5 ml of a clear liquid remaining in it and
caped with a white cap with no needle.
• There was also a 2-inch alcohol prep pad in
the baggie.
Vanderbilt Issues a Correct Action Plan -
Following CMS’s investigation, Vanderbilt issued
a corrective action plan in November 2018. The
corrective action plan included, among other
actions: 32
• Revising its medication administration policy;
• Updating the transportation of critical
care patient policy to require appropriate
staff to accompany, monitor, and support
patients’ needs, and document the
handover of patients between nursing staff.
If a no handover can be accomplished the
transporting staff is to remain with the patient;
• Revising high alert medication policy;
• Establishing a work group to review paralyzing
agents; and
• Chief nursing officers conducting weekly
chart reviews (5 patient/unit) for a total of 3
months
Criminal Charges Filed Against RaDonda
Vaught -- On February 4, 2019 Nurse Vaught is
arrested on a criminal indictment for her role in
Ms. Murphey’s death, and charged with reckless
homicide and abuse of an impaired adult. This is
the first time Ms. Vaught is publicly identified. On
February 20, 2019 Ms. Vaught enters not guilty pleas
to both charges.
Tennessee Board of Licensing Health Care
Facilities – On February 5, 2019 the CEO of
Vanderbilt appeared before the Tennessee Board
of Licensing for Health Care Facilities. The CEO
admitted the patient’s death was not reported
to state regulators and admitted the hospital’s
response was “too limited”. Officials also confirmed
that they negotiated a confidential settlement
with the family. The Board of Licensing for Health
Care Facilities took no disciplinary action against
Vanderbilt.
The Licensing Board Reexamines Prior
Licensing Decision Involving RaDonda Vaught –
On September 27, 2019 the Tennessee Department
of Health re-opened its prior decision not to pursue
disciplinary action against Ms. Vaught’s license.
She is charged with three violations, including
unprofessional conduct, abandoning or neglecting a
patient that required care, and failing to maintain an
accurate patient record. 33
The licensing violations brought against Nurse
Vaught included 34 :
• Failure to follow the five rights of medication
administration, right patient, right medication,
right dose, right route, and right time;
• After administrating the medication she failed
to monitor the patient; and
• Failed to document in the medical record that
she administered vecuronium
Licensing Hearing -- The licensing hearing
began on July 22, 2021. At the hearing Ms. Vaught
testified that the medication error was “completely
my fault” because she did not double check
the medicine she administered. 35 In addition to
admitting to her error, Ms. Vaught argues, through
her attorney, that there were flawed procedures at
Vanderbilt. 36 They argued that there was a problem
that prevented communication between Vanderbilt’s
electronic health records, medication cabinets and
the hospital pharmacy. This flaw caused delays in
accessing medications and the hospital’s short term
workaround was to override the safeguards on the
cabinets so they could remove drugs quickly.
Ms. Vaught testified that “overriding was
something we did as a part of our practice every
day. 37 You couldn’t get a bag of fluids for a patient
without using an override function”. Nurse Vaught
testified that she allowed herself to become
“complacent” and “distracted” while using the
medication cabinet and did not double-check
which drug she had withdrawn despite multiple
opportunities. On July 23, 2021 the Tennessee
Board of Nursing unanimously revokes Vaught’s
nursing license.
Ms. Vaught testified that overrides were common
at Vanderbilt and that a 2017 upgrade to the
hospital’s electronic health record system was
causing rampant delays at medication cabinets.
Because of that flaw Vanderbilt instructed nurses to
use overrides to circumvent delays and get medicine
as needed. A state investigator also told the board
of nursing to her knowledge that computer issues
caused problems with medication cabinets at
Vanderbilt in 2017.
Criminal Proceedings – As part of discovery
process prosecutors reveal that Ms. Vaught
made 10 separate errors when giving the wrong
medication to the patient, including overlooking
multiple warning signs. Court records state that
Vaught would have had to look directly at a warning
on the cap, saying “WARNING: PARALYZING
AGENT” before injecting the drug.
The State argued Ms. Vaught failed to scan
the medication against the patient’s medical
identification bracelet. 38 She also pointed out
that vecuronium is a powder that needs to be
reconstituted unlike Versed which is already in liquid
form. 39
The prosecution’s nursing expert testified that
Ms. Vaught failed to meet the standard of care by: 40
• Being distracted when administering the
medication;
• Not looking up the generic name for Versed;
• Failing to read the name of the drug, not
noticing a red warning on the top of the
vial, and not staying with the patient after
medication administration.
• Administering the medication when a patient
scanner was not available in the Radiology
unit;
• Not double checking the medication with a
colleague; and
• Not monitoring the patient even if she thought
she was giving Versed.
A lead investigator in the criminal trial
testified that Vanderbilt had a “heavy burden
of responsibility” for a grievous drug error…but
pursued penalties and criminal charges only against
the nurse and not the hospital itself. 41 Vanderbilt
received no punishment for the fatal drug error.
After three days of trial followed by four hours of
deliberations the jury rendered its verdict. The jury
was made up of six men and six women, with one
juror being a practicing registered nurse and another
a former respiratory therapist.
The Verdict – The jury found Ms. Vaught guilty of
criminal negligent homicide (a lesser charge under
reckless homicide) and gross neglect of an impaired
adult. She was acquitted of reckless homicide. The
neglect charge stemmed from the allegation that
Ms. Vaught did not properly monitor Ms. Murphey
after she was injected with the wrong drug.
Stay Tuned -- RaDonda Vaught, a convicted
felon, is scheduled to be sentenced on May 13,
2022.
Other Source Documents –
• Kelman, Brett; The RaDonda Vaught case
is confusing. This timeline will help. (msn.
com); Nashville Tennessean; March 22, 2022;
https://www.msn.com/en-us/news/crime/
the-radonda-vaught-case-is-confusing-thistimeline-will-help/ar-BB10EVFV
• Kelman, Brett; Ex-Vanderbilt nurse RaDonda
Vaught loses Nursing License for fatal
drug error; Nashville Tennessean; July 23,
2021; https://www.tennessean.com/story/
news/health/2021/07/23/ex-vanderbiltnurse-radonda-vaught-loses-license-fatalerror/8069185002/
• Timms, Mariah; Prosecutors, defense lay out
framework in homicide trial of ex-Vanderbilt
nurse RaDonda Vaught; March 22, 2022;
https://news.yahoo.com/prosecutorsdefense-lay-framework-homicide-193942097.
html?fr=sycsrp_catchall
• Kelman, Brett; In nurse’s trial, witness says
hospital bears ‘heavy’ responsibility for
patient death; Kaiser Health News; March
24, 2022; https://health.wusf.usf.edu/nprhealth/2022-03-24/in-nurses-trial-witnesssays-hospital-bears-heavy-responsibility-forpatient-death
• Fruen, Lauren; Inside the trial of ex-nurse
RaDonda Vaught who ‘killed a patient by
giving her the wrong drug; March 24, 2022;
https://www.thesun.co.uk/news/18055626/
nurse-radonda-vaught-trial-killed-patient/
The Case of Nurse RaDonda...continued on page 12

12
The Oklahoma Nurse August, September, October 2022
The Case of Nurse RaDonda...continued from page 11
• Sutton, Caroline, West, Emily, Davis, Chris;
Trial of RaDonda Vaught: Jury to deliberate
case starting Friday; March 25, 2022; https://
www.newschannel5.com/news/trial-ofradonda-vaught-former-vanderbilt-medicalcenter-nurse-continues-into-third-day
• Kelman, Brett; Nurse Convicted of Neglect
and Negligent Homicide for Fatal Drug Error;
Nashville Tennessean; March 25, 2022;
https://khn.org/news/article/radonda-vaughtnurse-drug-error-vanderbilt-guilty-verdict/
• Levine, Zachary, McClendon, Shannon;
Statement in Response to the Conviction of
Nurse RaDonda Vaught; American Nurses
Association, March 25, 2022; https://www.
nursingworld.org/news/news-releases/2022-
news-releases/statement-in-response-to-theconviction-of-nurse-radonda-vaught/
• Timms, Mariah; Former Vanderbilt nurse
RaDonda Vaught found guilty on 2 charges in
2017 death of patient; Nashville Tennessean;
March 25, 2022; https://www.yahoo.com/
now/former-vanderbilt-nurse-radondavaught-184322536.html
• Loller, Travis; Former nurse guilty of homicide
in medication error death; Associated Press;
March 25, 2022; https://kstp.com/associatedpress/ap-us-international/former-nurse-guiltyof-homicide-in-medication-error-death/
• Timms, Mariah; Ex-Nurse RaDonda Vaught
found guilty on two charges in death of
patient; Nashville Tennessean; March 29,
2022; https://currently.att.yahoo.com/att/exnurse-radonda-vaught-found-175845609.html
• Kelman, Brett, Norman, Hannah; Why
Nurses Are Raging and Quitting after the
RaDonda Vaught Verdict; Kaiser Health; April
5, 2022; https://health.wusf.usf.edu/nprhealth/2022-04-05/why-nurses-are-ragingand-quitting-after-the-radonda-vaught-verdict
Donna J. Craig, RN, JD is legal counsel to the
ANA-Michigan Chapter and the Michigan Council
of Nurse Practitioners. She practiced as a cardiac
care nurse for several years before a chance
opportunity to audit a graduate course in health
care law and ethics changed her career path. That
course propelled her to earn her law degree. After
law school Ms. Craig joined a medical malpractice
defense law firm before transitioning her focus
to health care corporate and administrative law
matters. For over 20 years she has maintained her
private health law practice, representing health
care providers and facilities in business, licensure
and compliance matters. For her expertise and
accomplishments, Detroit’s dbusiness Magazine
awarded Ms. Craig its Top Lawyer in Health Care
Law award on three occasions. Ms. Craig has the
distinction and is proud of being a bar member of
the Supreme Court of the United States of America.
For more information about The Health Law Center,
go to www.healthlawcenterplc.com.
1 Anonymous Complaint, page 1 of 3 pages at: https://
www.documentcloud.org/documents/6542003-
CMS-Complaint-Intake.html
2 Corrective Action Plan by Vanderbilt, page 7 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html.
3 Id.
4 Id.
5 Id.
6 Corrective Action Plan by Vanderbilt, page 33 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
7 Corrective Action Plan by Vanderbilt, page 8 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
8 Id.
9 Amended County Medical Examiner Investigator’s
Report, at: https://www.documentcloud.org/
documents/6540657-Charlene-Murphey-ME-
Investigation.html
10 Report From the Anonymous Tipster at: https://www.
documentcloud.org/documents/6542003-CMS-
Complaint-Intake.html
11 Closing Letters From Tennessee Department of
Health at: https://www.documentcloud.org/
documents/6785898-RaDonda-Vaught-Letters.
html
12 Id.
13 Id.
14 Corrective Action Plan by Vanderbilt, page 9 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
15 Id.
16 Prosecutorial Discovery Documents, page 5 of 51
pages at: https://www.documentcloud.org/
documents/6785652-RaDonda-Vaught-DA-
Discovery.html
17 Prosecutorial Discovery Documents, page 6 of
51 at: https://www.documentcloud.org/
documents/6785652-RaDonda-Vaught-DA-
Discovery.html
18 Corrective Action Plan by Vanderbilt, page 9 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
19 Corrective Action Plan by Vanderbilt, page 10 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
20 Id.
21 Id.
22 Id.
23 Id.
24 Id.
25 Corrective Action Plan by Vanderbilt, page 11 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
26 Id.
27 Corrective Action Plan by Vanderbilt, page 12 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
28 Corrective Action Plan by Vanderbilt, page 11 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
29 Corrective Action Plan by Vanderbilt, page 25 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
30 Corrective Action Plan by Vanderbilt, page 33 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
31 Corrective Action Plan by Vanderbilt, page 35 of 105
pages at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
32 Corrective Action Plan by Vanderbilt, pages 1 –
105 at: https://www.documentcloud.org/
documents/6535181-Vanderbilt-Corrective-Plan.
html
33 Licensing Charges Filed by the Board of Nursing
at:
https://www.documentcloud.org/
documents/6483588 -Vaught-RaDonda-
NOC-9-27-19.html
34 xxxiv Id.
35 Kelman, Brett; Ex-Vanderbilt nurse RaDonda
Vaught loses Nursing License for fatal drug
error; Nashville Tennessean; July 23, 2021;
https://www.tennessean.com/story/news/
health/2021/07/23/ex-vanderbilt-nurse-radondavaught-loses-license-fatal-error/8069185002/
36 Id.
37 Id.
38 Fruen, Lauren; Inside the trial of ex-nurse RaDonda
Vaught who ‘killed a patient by giving her the
wrong drug; March 24, 2022; https://www.
thesun.co.uk/news/18055626/nurse-radondavaught-trial-killed-patient/
39 Id.
40 Sutton, Caroline, West, Emily, Davis, Chris; Trial
of RaDonda Vaught: Jury to deliberate case
starting Friday; March 25, 2022; https://www.
newschannel5.com/news/trial-of-radondavaught-former-vanderbilt-medical-center-nursecontinues-into-third-day
41 Kelman, Brett; In nurse’s trial, witness says hospital
bears ‘heavy’ responsibility for patient death;
Kaiser Health News; March 24, 2022; https://
health.wusf.usf.edu/npr-health/2022-03-24/innurses-trial-witness-says-hospital-bears-heavyresponsibility-for-patient-death.

August, September, October 2022 The Oklahoma Nurse 13
Now for The Rest of the Story -
The Sentencing of
RaDonda Vaught
On May 13th RaDonda Vaught, a former ICU nurse at Vanderbilt University
Medical Center, was sentenced after being convicted of criminally negligent
homicide and gross neglect of an impaired adult. Ms. Vaught lost her nursing
license and was criminally prosecuted after she mistakenly administered the
wrong medication to 75-year-old patient Charlene Murphey, resulting in her
death. Ms. Vaught mistakenly gave Ms. Murphey vecuronium, a paralytic agent,
instead of the ordered Versed, a sedative. Since the Vaught case has been the
subject of discussion by nurses and nursing associations it is important that her
sentencing be reported now.
Hundreds of nurses from around the country were present in the courtroom,
along with an overflow crowd outside the courthouse where they listened
to the sentencing hearing over a public address system. Nurses came to
Tennessee and gathered in support of Ms. Vaught and wore “Nurse Strong”,
#IAmRaDonda”, and “Seeking Justice for Nurses and Patients in a BROKEN
system” T-shirts to show their support.
Before Judge Jennifer Smith handed down the sentence the prosecution and
defense made sentencing arguments to the Judge. Ms. Vaught and the relatives
of Charlene Murphey also addressed the court. The prosecution sought a
prison term of 3 – 6 years, which was less than the 8 years Ms. Vaught was
facing. Ms. Vaught’s attorney argued that probation, not jail time, was called for.
Ms. Charlene Murphey’s son spoke of the toll his mother’s death has had on
the family. He and his wife also said Charlene Murphey was a forgiving person
and she wouldn’t have wanted jail time for Ms. Vaught. They told the judge that
they personally “didn’t want jail time, we just wanted to make sure she didn’t
do this to anyone else”. It is reported that Ms. Murphey’s husband wanted the
maximum sentence possible.
When Ms. Vaught was given an opportunity to speak before being
sentenced, she spoke directly to the family. She told them “Saying I'm sorry
doesn’t seem like enough but you deserve to hear that and know that I am very
sorry for what happened. When Ms. Murphey died, a part of me died with her.”
Before announcing the sentence, Judge Smith addressed the family, telling
them, “My hope that changes in the practices and protocols in the medical
setting that have arisen since this event may at least be some positive aspect
that has arisen. I recognize however, that will never be enough to heal your
wounds.”
In announcing the sentence Judge Smith acknowledged that the criminal
charges warranted three years of prison, but then went on to say RaDonda
Vaught wouldn’t face jail time. Judge Smith sentenced Vaught to three years
supervised probation and then diverted that sentence which would allow her
record to be expunged after successfully completing the terms of her probation.
Prosecutors had argued against diversion, although they were not opposed to
probation. In weighing whether to grant Vaught judicial diversion, Judge Smith
cited Vaught's remorse, this being her first criminal offense, as well as her
honesty about her medication error.
Donna J. Craig, RN, JD is legal counsel to the ANA-Michigan Chapter and
the Michigan Council of Nurse Practitioners. She practiced as a cardiac
care nurse for several years before a chance opportunity to audit a graduate
course in health care law and ethics changed her career path. That course
propelled her to earn her law degree. After law school Ms. Craig joined a
medical malpractice defense law firm before transitioning her focus to health
care corporate and administrative law matters. For over 20 years she has
maintained her private health law practice, representing health care providers
and facilities in business, licensure and compliance matters. For her expertise
and accomplishments, Detroit’s dbusiness Magazine awarded Ms. Craig its
Top Lawyer in Health Care Law award on three occasions. Ms. Craig has the
distinction and is proud of being a bar member of the Supreme Court of the
United States of America. For more information about The Health Law Center,
go to www.healthlawcenterplc.com.
EDUCATORS
CORNER
Aligning Aristotle and Knowles
Aristotle, known as a great public speaker and educator, once said (kind of)
that educators should know their audience. https://www.cnbc.com/2021/01/12/
aristotles-3-most-important-rules-for-being-more-persuasive-in-publicspeaking.html.
What does our latest student nurse population look like?
• 82% female and 18% male
• 68.5% white, 10.7% black, 10.5% Asian, 8.2% Hispanic/Latino, 0.8%
American Indian/Alaska Native
• Average age 44
• 67% stay less than one year at their first job
https://www.zippia.com/student-nurse-jobs/demographics/
Looking at the data, we realize that we have adult learners in a pedagogical
setting. Malcolm Knowles is the Father of the Andragogical/Adult Learning
Theory. Adapting what we teach could and frequently does look like:
• Students need to know why specific areas are being taught – we need to
emphasize the application.
• Instruction should be application oriented instead of memorized — we
need to provide learning activities that support areas studied.
• Encourage adult learning and responsibility – identify an understood
framework to demonstrate an area of learning when possible and allow
students to fail and reflect when possible.
• Understand the student population using a diverse architecture
of experiences, learning materials, and activities to reinforce new
information
https://www.instructionaldesign.org/theories/andragogy/
Other ideas? Send in your thoughts on how we can
help our students prepare for the future.
Marla Peixotto-Smith, MSN, PhD, RN, CNE, is an
Associate Professor & Coordinator of the RN2BSN
Program at Rogers State University. Marla invites
you to contribute to the “Educators Corner.” Please
send your thoughts, experiences, or strategies to
marlasmith@rsu.edu.
Marla Peixotto-
Smith
Timms, Mariah, et al; RaDonda Vaught Sentenced to Three Years’ Probation on a
Diverted Sentence, Could See Record Wiped; Nashville Tennessean; May
13, 2022; https://finance.yahoo.com/news/radonda-vaught-sentenced-threeyears-194115731.html?fr=sycsrp_catchall
Loller, Travis; Ex-Nurse Sentenced to Probation in Patient Medication Death; Associated
Press; May 13, 2022; https://apnews.com/article/health-homicide-tennesseenashville-1e196d4e4358a20141385494426cdbe7
Timms, Mariah, et al; RaDonda Vaught Sentenced to Three Years’ Probation on a
Diverted Sentence, Could See Record Wiped; Nashville Tennessean; May
13, 2022; https://finance.yahoo.com/news/radonda-vaught-sentenced-threeyears-194115731.html?fr=sycsrp_catchall
RaDonda Vaught Receives Three Years’ Probation on Diverted Sentence; USA Today,
May 13, 2022; https://www.usatoday.com/story/news/crime/2022/05/13/
radonda-vaught-vanderbilt-nurse-sentencing-live-updates/9717397002/
Former Nurse RaDonda Vaught, Whose Medical Error Killed a Patient, Sentenced
to Probation in Controversial Case; CBS News, May 13, 2022; https://www.
cbsnews.com/news/radonda-vaught-sentencing-nurse-whose-medical-errorkilled-a-patient-sentenced-to-probation-in-controversial-case/
Id.
PAM Health
Specialty Hospital
of Oklahoma City
1407 North Robinson Ave
Oklahoma City, OK 73103
www.PAMHealth.com/jobs

14
The Oklahoma Nurse August, September, October 2022
Burned Out on Burnout?
Strategies to Combat Compassion Fatigue in Nursing.
David Barron, DBA
Saint Leo University
For all the work and energy that nurses bring to
their jobs, it is their compassion that is recognized
internationally as one of the five professional values
all nurses must demonstrate (Durkin et al., 2018).
In healing professionals, compassion entails an
aptitude to comprehend the distress of another,
the familiarity of the sources and treatments of the
distress, and the desire to help lessen the suffering
(Godlaski, 2015). Researchers have described
compassion as caring for someone suffering, the
emotional feeling accompanying the care, and the
desire to reduce and alleviate suffering (Greenberg
& Turksma, 2015; Ledoux, 2015). However, there may
be a ‘cost of caring’ which could unfortunately lead
to compassion fatigue if not addressed early (Boyle,
2015).
In Stamm’s (2010) professional quality of
life model compassion fatigue (Figure 1) stems
from interactions with patients that leave the
health professional preoccupied with the trauma
experienced by the patient and enhanced emotional
arousal or avoidance behaviors associated with
the patient (Ray et al., 2013). Compassion fatigue
has two parts. The first is burnout, which concerns
issues such as exhaustion, hostility, frustration,
anger, depression (Stamm, 2010), detachment,
isolation, irritability, failure, despair, cynicism, and
apathy (Circenis et al., 2013).
Figure 1
Diagram of Professional Quality of Life
The second part is secondary traumatic stress,
a negative feeling driven by fear and work-related
trauma (Stamm, 2010). Some traumas at work
can be direct (primary) trauma; therefore, workrelated
trauma can be a combination of primary
and secondary trauma (Stamm, 2010). Secondary
traumatic stress can be viewed as an occupational
hazard for persons who provide direct patient
care to traumatized victims (Circenis et al., 2013).
Witnessing traumatic experiences, such as providing
end-of-life care, working with less experienced
nursing staff, caring for young patients, and nursing
insufficiency may all contribute to secondary
traumatic stress (Partlak Gunusen et al., 2019).
Together, burnout and secondary traumatic stress
reflect the negative results of interactions with
patients. These aspects of the working life of nurses
have been topics of great interest in academic
bridget.bridger@rollinghillshospital.com
Ada, Oklahoma
literature, linking several personal and work-relevant
outcomes (Heritage et al., 2018).
According to Lombardo and Eyre (2011; Table
1), compassion fatigue symptoms can include
work-related physical and emotional symptoms.
However, it is important to note that generally
more than one symptom is demonstrated before a
nurse is identified as having compassion fatigue.
With increasing numbers of nurses suffering from
compassion fatigue, there is a negative impact
on the quality of patient care, increased attrition
of nurses, and enormous pressure placed on
remaining health care providers (Figley, 2002;
McMullen, 2007; Sprang et al., 2011). Compassion
fatigue that is unrecognized and untreated may
have serious detrimental effects on professional and
personal functioning of nurses (Benoit et al., 2007);
therefore, failure to provide support and assistance
to those with symptoms of compassion fatigue
can undermine an organization’s provision of care,
especially if they lose talented nurses (Figley, 2002).
Table 1
Symptoms of Compassion Fatigue
Work-Related Emotional Physical
Avoidance
or dread of
working with
certain patients
Reduced ability
to feel empathy
toward patients
or families
Lack of
joyfulness
Frequent use of
sick days
Excessive use
of substances:
nicotine,
alcohol, illicit
drugs
Restlessness
Oversensitivity
Irritability
Anxiety
Mood swings
Depression
Anger and
resentment
Loss of
objectivity
Memory issues
Poor
concentration,
focus, and
judgment
Cardiac
symptoms:
chest pain/
pressure,
palpitations,
tachycardia
Sleep
disturbances:
inability
to sleep,
insomnia, too
much sleep
Digestive
problems:
diarrhea,
constipation,
upset stomach
Fatigue
Headaches
Muscle tension
On the positive side of the professional quality of
life model is compassion satisfaction. Compassion
satisfaction is about the pleasure you derive from
being able to do your work well. You may feel like it
is a pleasure to help others through your work. You
may feel positively about your colleagues or your
ability to contribute to the work setting or even the
greater good of society (Stamm, 2010). Compassion
satisfaction is considered a protective factor against
compassion fatigue (Ruiz-Fernandez et al., 2020).
It should come as no surprise that a balance
between compassion satisfaction and compassion
fatigue will ultimately determine the level of the
professional’s quality of life. One such example
was uncovered with my recent dissertation which
included 202 registered nurses from seven South
Florida counties during the height of the COVID-19
pandemic, including the Delta virus outbreak in
the summer of 2021. The research uncovered
that one independent variable out of four showed
statistical significance when determining nursing
turnover intentions and this was burnout (p < .001),
meaning that there is an imbalance in this cohort’s
professional quality of life (Barron, 2022). This is
consistent withother research. For example, The
National Academy of Sciences, Engineering, and
Medicine (2019) stated at least 50% of caretakers
across medical fields reported symptoms of
burnout, including emotional exhaustion, cynicism,
and a low sense of professional accomplishment.
Janeway (2020) stated that the prevalence of
burnout among registered nurses in the United
States ranged from 35-45%. Even in Oklahoma,
nurses from across the state marched at the
Capitol demanding better pay and a solution to
staffing shortages leading to burnout (Arata, 2022),
highlighting the need for immediate attention by
health care leaders.
Consequently, due to existing nursing shortages,
the aging of the nursing workforce, and the growing
COVID-19 effect, the International Council of Nurses
(2021) estimate that up to 13 million nurses will be
needed to fill the global nurse shortage gap in the
future. Since nurses are considered the most trusted
professionals among the general population, it is
imperative health care organizations advocate for
nurse well-being strategies to deliver optimal care
for the patients.
Strategies to Reduce Nursing Compassion
Fatigue
The Mayo Clinic (Shanafelt & Noseworthy, 2017)
developed nine evidence-based organizational
strategies that health system leaders could
use to assess strengths and challenges in their
organizations tohelp eliminate compassion fatigue,
particularly burnout:
• Acknowledge and assess the problem.
Staff respond to sincere discussions with
health system leaders and managers that
reflect a genuine commitment to solving the
problem of burnout and fostering well-being.
• Harness the power of effective leadership.
The impact of toxic leadership on worker
burnout and well-being is proven. Effective
leaders need to be developed and receive
evaluative feedback about their leadership
behaviors from those they lead. Health
boards need to “have the courage” to make
leadership changes when required.
• Develop and implement targeted
interventions. External compliance factors
can increase pressure on health system
leaders, managers, and practice leaders.
Expectations of increased productivity,
excessive documentation, and administrative
burden are drivers of burnout. Factors
requiring improvement must be identified
in each department. Targeted interventions
can then be developed and implemented
to ensure maximum local impact and
effectiveness.
• Cultivate community at work. Formal
and informal peer support is important to
physicians and nurses. However, structural
changes, such as loss of dedicated spaces
to share ideas with colleagues, have resulted
in the loss of relationships and connections
as well as eroded peer support and sense
of community. “The pause” is another
strategy practiced in emergency and
other clinical settings to honor the work of
caring for patients who die. It is a minute of
stillness when clinicians pause, listen to their
breathing, focus, and prepare to care for the
next patient with calmness and compassion
(Bartels, 2014). This strategy could be a
comforting balm for nurses caring for patients
dying of COVID-19.
• Greater work-life flexibility. Now more
than ever during the COVID-19 crisis, leaders
should collaborate with staff to identify ways
to acknowledge and reward effort (Rosen,
2015). Productivity-based compensation

August, September, October 2022 The Oklahoma Nurse 15
can encourage overwork, over-servicing
and increasing burnout risk. Greater worklife
flexibility (strategy seven) has been
considered a valued reward. Today, flexibility
is a necessity. Rewards and incentives convey
respect, appreciation, and encourage work to
fulfill organizational caring goals.
• Align values and strengthen culture. The
triple bottom line model evaluates alignment
between “what we say we do” (mission,
values), “what we do” (actions and culture),
and “what others say we do” (i.e., patients,
families, community stakeholders). The
question is whether the values and actions
are aligned to foster a healthy culture, staff
well-being, optimal practice environments,
and quality care delivery which requires
collaborative dialogue and deliberate action to
address any barriers undermining this goal.
• Promote flexibility and work-life
integration. The drivers of burnout can be
embedded in rigid and out-of-date policies.
It is wise to promote flexible, family-friendly
work environments that meet the needs of a
diverse workforce (Drury et al., 2014). Leaders
need to be sincere about understanding
what motivates their staff to do their best
work and support work-life integration.
Leaders need to promote flexibility so staff
can adapt their work hours to accommodate
personal obligations, and provide coverage for
vacation, studying, and important life or family
events.
• Provide resources to promote resilience
and self-care. Leaders can work with staff
to co-create essential resources to cope with
work-related stress, prevent burnout, and
promote well-being and self-care. Meditation
can improve emotion regulation and resilience
(Singer & Klimecki, 2014). Staff members
who are committed to self-care and worklife
integration are better prepared to care for
patients and fulfill the organization’s mission.
• Facilitate and fund organizational science.
Leading health care organizations (i.e.,
Mayo Clinic) have the added responsibility
to contribute to organizational science to
generate robust scientific evidence to inform
national benchmarks and evidence-based
instruments that other organizations can
implement to reduce burnout and promote
staff well-being and engagement.
References
Arata, K. (2022, May 17). OKC medical facility battling
health care worker burnout with a ‘culture of
care’. https://ktul.com/local/okc-metro-medicalfacility-battling-healthcare-worker-burnout-valirnursing-shortage-covid-19-pandemic-culture-ofcare-hospital
Barron, D. (2022). Professional Quality of Life and Fear of
COVID-19 Moderated By Perceived Job Market
Outlook: Predicting Registered Nurse Turnover
Intentions In South Florida During the COVID-19
Pandemic. [Doctoral dissertation, Saint Leo
University]. https://www.proquest.com/openview
/149726083d6a5f68f1a425627e5f2433/1
Bartels, J. B. (2014). The pause. Critical Care Nurse, 34(1),
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Benoit, L. G., Veach, P. M., & LeRoy, B. S. (2007). When
you care enough to do your very best: Genetic
counselor experiences of compassion fatigue.
Journal of Genetic Counseling, 6(3), 299-312.
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NURSE.0000461857.48809.a1
Circenis, K., Millere, I., & Deklava, L. (2013). Measuring the
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Godlaski, T. M. (2015). On compassion. Substance Use
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Gonzalez, A. R. (2014). Approaches to approaching
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Greenberg, M. T., & Turksma, C. (2015). Understanding
and watering the seeds of compassion.
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doi:10.1080/15427609.2015.1068060
Heritage, B., Rees, C. S., & Hegney, D. G. (2018).
The PROQOL-21: A revised version of the
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International Council of Nurses. (2021). The global nursing
shortage and nurse retention. [Policy brief].
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and%20Retention_0.pdf
Janeway, D. (2020). The role of psychiatry in treating
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Ledoux, D. G. (2015). Understanding compassion
fatigue: Understanding compassion. Journal
of Advanced Nursing, 71(9), 20141-2050.
doi:10.1111/jan.12686
Lombardo, B., & Eyre, C. (2011). Compassion fatigue: A
nurses’ primer. Online of Issues in Nursing, 16(1),
18. doi:10.3912/OJIN.Vol16No01Man03
McMullen, L. (2007). Oncology nursing and compassion
fatigue: Caring until it hurts. Who is caring for the
caregiver? Oncology Nursing Forum, 34(2), 491-
492. web.a.ebscohost.com/abstract?direct=true
&profile=ehost&scope=site&authtype=crawler&jr
nl=0190535X&AN=28835250&h=HPOSBZva3W7
Jw
National Academy of Sciences, Engineering, and
Medicine. (2019). Taking actions against clinician
burnout: A systems approach to professional
well-being. The National Academies Press.
doi:10.17226/25521
Partlak Gunusen, N., Ustun, B., Sercekus, P., &
Buyukkaya, D. (2019). Secondary traumatic
stress experiences of nurses caring for cancer
patients. International Journal of Nursing
Practice, 25(e12717). doi:10.1111/ijn.12717
Ray, S. L., Wong, C., White, D., & Heaslip, K. (2013).
Compassion satisfaction, compassion fatigue,
work-life conditions, and burnout among frontline
mental health care professionals. Traumatology,
19(4), 255-267. doi:10.1177/1534765612471144
Rosen, J. (2015, May 30). Establishing a strong culture
of compassion improves quality of care,
bottom line. Modern Healthcare. https://www.
modernhealthcare.com/article/20150530/
magazine/305309976/establishing-a-strongculture-of-compassion-improves-quality-ofcare-bottom-line
Ruiz-Fernandez, M. D., Perez-Garcia, E., & Ortega-
Galan, A. M. (2020). Quality of life in nursing
professionals: Burnout, fatigue, and compassion
satisfaction. International Journal of
Environmental Research and Public Health, 17(4),
1253. doi:10.3390/ijerph17041253
Shanafelt, T. D., & Noseworthy, J. H. (2017). Executive
leadership and physician well-being: Nine
organizational strategies to promote engagement
and reduce burnout. Mayo Clinic Proceedings,
92(1), 129-146. doi:10.1016/j.mayocp.2016.10.004
Singer, T., & Klimecki, O. M. (2014). Empathy and
compassion. Current Biology, 24(18), R875-R878.
doi:10.1016/j.cub.2014.06.054
Sprang, G., Craig, C., & Clark, J. J. (2011). Secondary
traumatic stress and burnout in child welfare
workers: A comparative analysis of occupational
distress across professional groups. Child
Welfare, 90(6), 149-168. doi:10.1037/a0021730
Stamm, B. H. (2010). The Concise ProQOL Manual (2nd
ed.) Pocatello, ID: https://www.proqol.org
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16
The Oklahoma Nurse August, September, October 2022
Courage in Everyday Nursing Practice
Carol Dobos PhD, RN-BC, NEA-BC
Reprinted with permission from Arizona Nurse, July 2021 issue
Courage is an important attribute in life and in your nursing practice. As Helen Keller
said,
“Security is mostly a superstition. It does not exist in nature nor do the children of
men as a whole experience it. Avoiding danger is no safer in the long run than outright
exposure. Life is either a daring adventure, or nothing.”
Nursing is a noble profession that is not for the faint of heart. Opportunities to
choose courageous acts present themselves on a regular basis because risk is
everywhere. You can attempt to minimize the risks by playing it safe. However, there are
risks to yourself, your colleagues, your profession, and those you serve when you don’t
take risks in showing up, speaking up, or practicing according to the highest standards
of evidence-based practice.
Choosing to practice courageously, consistent with your personal and professional
values, will cause some discomfort, bumps, and bruises to you and your career. It will
also bring professional and personal fulfillment, strengthen the profession, and improve
patient outcomes. You will know that you are making a difference in your daily practice
and throughout your nursing career.
One way to cultivate courageous behavior is through personal risk-taking (PRT),
but first you need to understand the nature of risk and its related concept, positive
deviance.
What is Risk?
Risk is defined as the possibility of losing something of value, which could be
physical, psychological, or economic. Common risks include falling out of favor with
others in authority, losing support, or damaging essential relationships. Any of these
events could lead to losing status or influence at work, or even losing one’s position or
employment.
A related concept called “positive deviance” refers to an intentional act of breaking
the rules to serve the greater good. Positive deviance is intentional and honorable
behavior that departs or differs from an established norm. It contains elements of
innovation, creativity, adaptability, or a combination thereof; and it involves risk for the
nurse.
For most nurses, whether a particular action is right or wrong will often be judged
by others in charge of rules enforcement. The decision to engage in positive deviance,
however, lies entirely with the nurse.
Personal Risk-Taking
PRT is behavior that is consciously and freely chosen among available alternatives,
some of which are known to incur less risk than the chosen action. It is supported by
the strength and belief of personal convictions. Courageous action upholds principles.
Calculated inaction due to fear leaves one powerless, with values compromised.
Nurses promote courageous action by sharing courageous behavior, also called
hero stories. This can be done formally and informally, verbally and in writing, one on
one or in groups, during staff meetings, during change of shift report, or rounds. We
create a culture based on what we talk about, what we value, and what we support and
reward. Sometimes we stand alone, and sometimes we influence others to follow our
lead and take their own personal risks. In one study, risk taking was found to be one
of the key elements in attaining expert nursing practice, which supports effective and
quality-based healthcare outcomes. Risk taking also was found to enhance clinical and
professional development.
Rather than sitting on the sidelines and hurling judgment or advice at others (for
example, “Someone needs to do something about this.”), we must dare to show up
and let ourselves be seen, which can result in change. (See Success story.)
Success story
When residents were not interacting appropriately with pediatric patients,
risking psychological harm, I discussed this with the chief and arranged
education. I advised our team that in identifying this issue, relationships
might become strained, but we had an obligation to our patients to address
this problem. I often used the mantra “I am doing the right thing for the right
reason” stating it over and over in my head to help me stay the course and
follow through with my convictions. As feared, the residents and even an
attending physician demonstrated passive aggressive behavior towards us.
The care of the children did improve, however, and we knew we had made the
right call.
We pay a price when we shut down and disengage, failing to take action. I have
heard nurses talk about “staying under the radar.” In doing so they pay a dear price.
Their talents, wisdom, knowledge, and values are not being shared to positively
influence care and support the development of new nurse graduates and other
colleagues through courageous role modeling. Vulnerability occurs in sharing an
unpopular opinion, standing up for oneself or others such as a colleague who is
being bullied, being accountable, asking for help, trying something new, admitting
uncertainty, and asking for forgiveness. When courage and fear meet, it often feels

August, September, October 2022 The Oklahoma Nurse 17
awkward and scary; however, “being all in” is to be alive. To act in alignment with your
values is key to personal and professional happiness.
PRT and Promoting Patient Safety
Failing to take risks and practice courageously can lead to threats to patient safety.
Focusing on my obligation to “First do no harm,” I made the decision not to deploy
a transport team until all the team members demonstrated competency. I was
transparent in discussing my concern and contingency plan to send another team with
my medical and administrative colleagues. I was told that this was a “career-limiting
move.” I simply stated, “I have to be able to sleep at night.”
In another organization, I disagreed with a plan to move critically ill patients multiple
times to accommodate unit renovation. I identified an alternative that required only one
move. Although my plan was successfully implemented, my action caused me to fall
out of favor with the administrator and eventually resulted in my having to move on
to another position. In both instances, I had to put my patients first because when I
became a member of the nursing profession, I made a promise to protect them.
Why We May Not Take Personal Risks
Understanding scarcity is key to understanding why nurses may not take justified
risks. The three components of scarcity are shame, comparison, and disengagement.
Shame is the fear of ridicule and belittling often used to control people and to keep
them in line. Shame-based cultures are very unhealthy for nurses and patients. The
killer of innovation is shame. In these cultures, covert or sometimes overt messages
are common, such as to dare not, you’re not good enough, who do you think you
are, don’t you dare get too big for your britches.” Shame becomes fear, fear leads to
risk aversion, and risk aversion kills innovation and can lead to unsafe patient care.
Shame is the intensely painful feeling or experience of believing that we are flawed
and therefore unworthy of belonging. Shame makes us feel unworthy of connection.
Resilience to shame occurs when recognizing and speaking openly about shame,
practicing critical awareness, and reaching out to others.
Healthy competition can be beneficial, but constant overt or covert comparing and
ranking suffocates creativity and risk taking. If nurses are held to one narrow standard,
they may not question the relevance of a course of action to a specific situation and
embrace evidence- based practice.
Disengagement occurs when people are afraid to take risks and try new things.
Too often it is easier to stay quiet than to share stories, experiences, and ideas. It is
important to do what is right, not what is easy. The best way through a difficult situation
is to address the situation directly with honesty and integrity, sharing your story and
asking for what you need. An excellent resource for nurses is the book Crucial
Conversations. Often what we fear does not happen, but even if it does, we have
retained our self-respect and commitment to professional values.
Courageous Practice
I hope you choose to practice courageously, doing the right things for the right
reasons. As Theodore Roosevelt said,
“Far better it is to dare mighty things, to win glorious triumphs, even though
checkered by failure, than to take rank with those poor spirits who neither enjoy much
nor suffer much, because they live in the gray twilight that knows not victory nor
defeat.”
Selected references
Dobos C. Defining risk from the perspective of nurses in clinical roles. J Adv Nur.
1992;17:1303-9.
Dobos C. Understanding personal risk taking among staff nurses: critical information
for nurse executives. J Nurs Adm. 1997;27(1):1-2.
Gary JC, Exploring the concept and use of positive deviance in nursing. Am J Nurs.
2013;113(8):26-34. Haag-Heitman B. The development of expert performance
in nursing. J Nurses Staff Dev. 2008;24(5):203-11.
Brown B. Daring Greatly: How the Courage to be Vulnerable Transforms the Way We
Live, Love, Parent, and Lead. Gotham Books; 2012.
Patterson K, Grenny J, McMillan R, et al. Crucial Conversations: Tools for Talking When
Stakes are High, 2nd ed. New York, NY: McGraw-Hill; 2011.
Carol Dobos lives in Phoenix Arizona and is the past-president of the Arizona
Association for Nursing Professional Development, a state affiliate of the
Association for Nursing Professional Development.
EMERGING
NURSES
Coming to a Coffee Shop
Near You
Rachael Kleckner, MSN, RN, CCRN-CNC-CSC
With a dynamical healthcare climate, it’s no
surprise that the typical new graduate is evolving
alongside the profession. As your Emerging Nurse
Director, I have spent the past several months
talking with you to identify what this looks like in
order to best support you. One of the ways I chose
to reach out is through the creation of the Oklahoma
Emerging Nurses Facebook group, a page dedicated
to students and those with less than five years of
licensed experience.
Rachael Bachhofer
Through this page, many of you have identified Kleckner
that you are already seeking advanced practice roles due to burnout,
pay, scheduling, and lack of a work-life balance. With this in mind, I am
now determining how to best represent you and ensure those new to the
profession have a voice within our professional organization.
There will be networking events held later this year where you will have
the opportunity to share your practice experience and learn how we plan to
address your needs. Please request to join the above Facebook group so
that you know when and where to join us — several group members have
suggested that coffee may be the way to your heart and I couldn’t agree
more!
To access electronic copies of
The Oklahoma Nurse, please visit
http://www.nursingALD.com/publications
The Oklahoma Nurses Association has many members whose outstanding contributions should be
recognized. We hope you will consider nominating a colleague, a coworker, or a friend for one of the
ONA awards categories below:
EXCELLENCE IN NURSING
NURSING RESEARCH AWARD
NURSING IMPACT ON PUBLIC POLICY AWARD
NIGHTINGALE AWARD OF EXCELLENCE
FRIEND OF NURSING AWARD
EXCELLENCE IN THE WORKPLACE ENVIRONMENT
The deadline for submission nominations is August 1, 2022.
NOMINATE SOMEONE TODAY AT:
surveymonkey.com/r/ONAAWARDS22

18
The Oklahoma Nurse August, September, October 2022
Getting Clear on Bullying Versus Incivility
Renee Thompson, DNP, RN, CSP
Reprinted with permission
from The Florida Nurse,
February 2022 issue
Numerous studies show the
prevalence and devastating
impact disruptive behaviors
have on nurse retention and
satisfaction, patient safety
and the financial health of an
organization. Today, more
than ever, the unpredictable, Dr. Renee Thompson
life-and-death nature of the
pandemic has created an environment that is ripe for an
increase in workplace bullying and incivility. Research at
the Healthy Workforce Institute shows an uptick in bad
behavior and nurses are experiencing greater workplace
incivility now more than ever before. Additional studies
show:
• 45.7% of nurses said they witnessed more
incivility than before the pandemic (El Ghaziri
et al., 2021).
• 14.3% of surgery patients had higher
complications with surgeons who had one
to three reports of unprofessional behaviors
compared to those surgeons who had no
reports of disruptive behaviors (Cooper et al.,
2019).
• 94% of individuals have worked with a toxic
person in the last five years; 51% of the
targets stated they are likely to quit as a result
(Kusy, 2017).
Developing successful, targeted interventions
to reduce bullying and incivility among nurses
will require that leaders develop awareness and
understanding of nurses’ unique experiences with
disruptive behavior. One of the biggest areas of
confusion that makes it difficult to address and
eliminate bad behavior is a misunderstanding about
the differences between bullying and incivility.
An important first step to educating yourself and
your employees is to get clear on those differences.
This will help you raise awareness, set expectations,
and develop appropriate strategies to eliminate each
type of disruptive behavior. Bullying should be a
NEVER event, but not everything is bullying and when
we call everything bullying, we lessen our chances of
identifying and addressing true bullying behavior.
BULLYING
For a behavior to be considered bullying, it must
include three things:
A Target-This target can be a single person or
group of people. Group targets can include the
opposite shift, new nurses, or nurses who have a
particular ethnic background.
Harmful-The behavior must be harmful in some
way. This harm can be to the target or harmful to a
patient.
Repeated-The most important element of
bullying. The behavior can’t be just a one-time
event, it must be repeated over time.
INCIVILITY
Incivility is different from bullying but tends to
be much more pervasive. While the behaviors can
be similar, they tend to be lower level. Incivility
shows up as your typical rude, unprofessional,
inconsiderate behaviors: eye-rolling, condescension,
favoritism, alienation, gossiping, mocking, cursing.
Make no mistake about it, incivility is a healthy
and professional workplace killer, and needs to be
addressed.
The Bottom Line
Bullying and incivility can destroy work
environments and impact patients in a negative way.
The key is to get very clear on the behavior – is it
bullying (target, harmful, repeated) or incivility (low
level, rude, and unprofessional). We are hemorrhaging
nurses due to bad behavior and it’s time we get
educated on how to recognize and address bullying
and incivility so that we can cultivate a more
respectful and professional work culture.
References
Cooper, W., Spain, D., Guillamondegui, O., et
al. (2019, June). Association of Coworker Reports
About Unprofessional Behavior by Surgeons
with Surgical Complications in Their Patients.
JAMA Surgery, 154(9), 828–834. doi:10.1001/
jamasurg.2019.1738
El Ghaziri, M., Johnson, S., Purpora, C.,
Simons, S. and Taylor, R. (2021, July). Registered
Nurses’ Experiences with Incivility During the
Early Phase of COVID-19 Pandemic: Results of a
Multi-State Survey. Workplace Health & Safety.
doi:10.1177/21650799211024867
Kusy, M. (2017). Why I don’t work here anymore:
A leader’s guide to offset the financial and emotional
cost of toxic employees. Boca Raton, FL: CRC Press
Bio:
As an international speaker and consultant, Dr.
Renee Thompson tackles the challenges facing
healthcare leaders today. With 30 years as a nurse,
Renee is an expert on creating healthy workforces
by eradicating bullying & incivility. She is in demand
as a keynote speaker and has authored several
books on bullying.
HOUSE OF DELEGATES
MEETING
Official Call to the Delegates To Attend a Meeting of the ONA House of Delegates
Hyatt Regency, Tulsa, Oklahoma | Wednesday, September 28, 2022, 3:00 - 5:00 pm
From— Michele Bradshaw, MSN, RN, ONA Secretary/Treasurer
This notice constitutes the official call to meeting of the Meeting of the ONA House of
Delegates. The House session will be held Wednesday, September 28, 2022. The House of
Delegates will convene at 3:00 p.m. adjourning at 5:00 p.m. Credentialing closes at 2:45
p.m. so that we may start promptly at 3:00 p.m.
Prior to the House we will have a session focused on issues facing nurses and nursing
practice related to the work of the association. For more details regarding the agenda
for the Annual Convention, please see the 2022 Convention schedule. The Agenda, 2021
Minutes, and Registration for the ONA Convention are posted on the ONA website,
oklahomanurses.org.
Members of the ONA House of Delegates have a crucial role in providing direction and
support for the work of the state organization. The House of Delegates also provides a
courtesy seat to all Past ONA Presidents and one registered nurse participant from each
organizational affiliate. These delegates come to the House to work towards the growth
and improvement of ONA and its constituencies. This requires a professional commitment
to the preservation and creative growth of the professional society at all levels of the
organization. Such a commitment will benefit the individual delegate, the Association
and the nursing profession. The representation for each Regional Nurses Association
established for the 2022 House is below.
Each delegate must study the issues thoroughly and is encouraged to participate in
Region sponsored meetings prior to the ONA Annual Convention and the Issue Forum
held prior to the House so that they may engage in open-minded debate, practice active
listening and use the extensive resources and collective knowledge made available
throughout these meetings to assist them in making informed decisions.
If you are interested in having an issue considered by the ONA House, please submit a
reference to be heard using the reference guidelines posted on the ONA website. Please
refer to the Policies and Procedures posted on the website for guidance.
Region #01....................................................43
Region #02...................................................34
Region #03...................................................35
Region #04...................................................22
Region #05...................................................20
Region #06...................................................21
ONA Board of Directors...........................16
ONA Affiliates...............................................6
Past ONA Presidents

August, September, October 2022 The Oklahoma Nurse 19
Sleep and Your Health
Cynthia Meyer, MSN, RN, CHSE
Debra Rose Wilson,
PhD, MSN, RN, IBCLC, AHN-BC, CHT
Reprinted with permission from Tennessee Nurse
May 2022 issue
To sleep, perchance to dream. – Shakespeare
One in three adults do not get the uninterrupted
sleep that is recommended, and inadequate
sleep has a direct effect on the functioning of the
immune system. Nurses and other health care
workers are part of the 18 to 20% of Americans
who work alternating shift schedules. Sleep is
essential, not only as restorative but because of its
role in the regulation of immune response. There
has been some interesting research in the last
20 years that explored the connections between
sleep, inflammation, and immune function. With
this information at hand, a nurse can improve selfcare
and appreciate the importance of teaching
sleep hygiene as part of holistic patient health care
system.
The sleep-wake cycle balances biological health,
mental well-being, and helps the immune system
adapt as needed. The sleep-wake is based on the
24-hour circadian clock that regulates complex
bodily functions, including the cardiovascular
system, inflammation, and immune response.
Cytokines are messenger proteins that can be
pro-inflammatory or anti-inflammatory, triggering
a response to infection or injury. People with
chronic inflammatory disease, sleep problems, and
depression have higher levels of circulating proinflammatory
cytokines.
While the body is awake, the immune system
is protecting the body against foreign pathogens.
Anti-inflammatory cytokines (IL-4, IL-10, IL-13,
and TGF-β) are active. Natural killer (NK) cells act
by stopping the growth of mutating cells such as
cancer, and increase production during the wakeful
state. These immune cells are very responsive to
stress and lower or discontinue production when
the sympathetic nervous system spills the stress
hormones. The longer you are stressed during
wakeful periods, the less opportunity NK cells have
to increase in numbers and the greater the chance
that rogue cells will continue to mutate. The body
can’t do maintenance work on immune function
when the resources are being transferred to first aid
and alarm response systems when stressed. For
those who experience a great deal of stress, sleep
is even more important. Once asleep, the body is
put back into balance as CD4+ T cells and Th1 and
Th2 respond, and production is higher. Natural killer
cells, melatonin, and stress hormones can replenish
themselves.
Sleep Deprivation
Both short-term and long-term sleep
deprivation disrupts the 24-hour circadian clock
and immunological functions. Sleep deprivation
increases inflammation, so those with a pre-existing
inflammatory disease (such as RA, depression,
or bowel disease) need consistent sleep even
more than others. With increased inflammation
and decreased melatonin risk for CVD, breast
cancer, and other inflammatory diseases rise.
Thermoregulation, insulin levels, vaccine response,
and cognitive flexibility are impaired with inadequate
sleep. Those with sleep apnea are at higher risk for
diabetes, hypertension, coronary issues related
to the increased inflammation. For those who are
significantly stressed, quality sleep is difficult to
achieve. The sleep-wake cycle is disrupted when
pro-inflammatory cytokines and stress hormones
(e.g., cortisol, epinephrine, and norepinephrine) are
released.
Shift work
Current estimates are that about 20% or one-fifth
of the workforce currently participate in shift work.
Of those working in the healthcare sector, 52%
report short sleep duration. Studies also showed
that those working the night shift reported poorer
quality sleep and sleep deprivation. The general
recommendation is for individuals to get between
seven to nine hours of sleep, but shift workers get
less than six hours daily or one to four hours less
per week. Those working the night shift may not be
able to make up for lost sleep which is needed for
relaxation and physical restoration.
Shift work is essential for healthcare. Nurses
must work hours that may not be conducive to sleep
to provide round-the-clock care for patients. These
hours may cause a disruption in sleep. Circadian
rhythms are what regulate the sleep-wake cycle, and
these cycles rely on light to direct the cycle. Daylight
causes us to become more alert and awake, while
darkness leads to melatonin production, which
prepares the body for sleep. Shift work disrupts the
natural sleep-wake cycle, and research has shown
that over time the physical and mental health of
those who participate in shift work may be impacted
by the disruption in sleep.
Shift work has been shown to have a negative
impact on the psychological and social health of
the individuals working those hours. Shift work
sleep disorder (SWSD) occurs when work schedules
disrupt the natural circadian rhythms, and the
disruptions cause excessive sleepiness, fatigue, or
insomnia. Eventually, these symptoms may result
in distress or impairment in mental, physical, and
social functioning. Furthermore, sleep deprivation
can lead to increased stress which in turn can lead
to decreased job satisfaction for nurses. Studies
showed that health professionals who worked night
shifts had higher levels of psychological and mental
health problems than their day shift counterparts.
This included higher levels of depression, irritability,
stress, OCD, and mood disorders. Shift workers
also exhibited negative feelings, isolation, and
difficulty in relationships.
Sleep allows the body to heal itself, and it helps
boost immune function. Nurses who do shift
work are not exempt from the negative effects of
inadequate sleep. Obesity is more common in shift
workers, and there is an increased risk of metabolic
syndrome and diabetes. Shift work compromises
immune function and places individuals at an
increased risk for breast and colorectal cancer.
When compared to day shift workers, those doing
shift work have an increased risk of cardiovascular
disease. Continued alterations in the circadian
rhythms have also been linked to gastrointestinal
issues such as gastritis, indigestion, appetite
disorders, irregular bowel movements, constipation,
heartburn, and pain. Since nursing is predominantly
a female profession, it is worth noting the correlation
between shift work and reproductive issues such
as decreased fertility, altered menstrual cycles, and
other reproductive issues.
Tips
Shift work can have negative effects on health;
however, these crazy hours are necessary for the
nursing profession. There are things workers can do
to improve sleep and maintain adequate rest. The
following tips are included for surviving shift work:
• Maintain a consistent sleep schedule
o Keep the same sleep-wake cycle on days
off
o Sleep directly after a shift or adopt a splitnap
schedule
o Take a short nap prior to shift on workdays
but avoid naps longer than 30 minutes
• Maintain an ideal sleep environment
o Cool environment between 68-72 degrees
Fahrenheit
o Limit noise using white noise or earplugs
o Limit light using an eye mask or blackout
curtains
o Stay away from electronic devices such
as a computer screen or cell phone in the
two hours prior to sleep.
• Promote sleep
o Take a hot shower, go for a walk, or use
meditation for relaxation
o Limit strenuous exercise
o Limit caffeine, alcohol, nicotine three to
four hours before bed
o Maintain a healthy diet and avoid fatty,
spicy foods before bed
o If you tend to be cold, wear socks to bed
• Things to do at work
o Eat healthy
o Use caffeine in moderation and avoid 4 to
6 hours before sleep
o Take short, frequent breaks
o Keep the work environment well lit
o Schedule wisely with no more than three
consecutive 12-hour shifts and have 11
hours off to ensure adequate rest time
o Nap before driving home if needed
o Get out into the sunshine on your breaks
when possible
o Give yourself stress management breaks
where you rest, meditate, or practice
breath work.
Conclusion
Shift work is part of our profession, but changes
in sleep rhythms have a negative impact. Lack
of sleep in nurses not only increases the chance
of error but leads to health issues. This is a global
issue for nurses. Assess your own sleep. The
National Sleep Foundation (NSF; sleepfoundation.
org) has a Sleepiness Test that examines sleep
patterns over the past 2 weeks. There is the Epworth
Sleepiness Scale that assesses daytime sleepiness
and STOP BANG screening questions for sleep
apnea. If you aren’t sure about your sleeping habits,
try a sleep diary. The NSF can guide you through
keeping a week of journaling with quality of sleep,
caffeine intake, bedroom environment, and sleep
hygiene. What are you going to do to improve your
quality of sleep?
References Available Upon Request
Cynthia Meyer, MSN, RN, CHSE – Cindy is
an Assistant Professor and the Simulation Lab
Coordinator at Austin Peay State University,
currently working on her PhD at East Tennessee
State University.
Debra Rose Wilson, PhD, MSN, RN, IBCLC,
AHN-BC, CHT – Dr. Wilson is a Health Psychologist
and a Professor of Nursing at Austin Peay State
University and was the 2017-18 American Holistic
Nurse of the year. She has been educating nurses
in Tennessee for over 20 years, and has a private
hypnosis practice in the Nashville area, and teaches
hypnosis to nurses and psychologists.