August 2022 • Vol. 59 • No. 3
THE OFFICIAL PUBLICATION OF THE MONTANA NURSES ASSOCIATION FOUNDATION
Quarterly publication distributed to approximately 13,000 RNs and LPNs in Montana.
Executive Director Report
Sneak Peek at MNA
Hiring Related to Age
As CEO of MNA, I care,
I advocate, I show up, and
I fight for MT nurses, our
nursing profession, and the
patients they care for.
I am a professional MT
nurse. I have been a MT
Registered Nurse (RN) for 33
years, my entire career. The
first 26 years as an acute care
pediatric oncology staff nurse
and the last seven years as
the nurse leader (CEO) at
MNA. At year 30, I went
Vicky Byrd, MSN, RN
back to school and obtained my Master of Science in
Nursing with program study in Nurse Leadership and
Management, with the goal of bringing more relevance
and credibility to this role I still dearly love.
Please hope, and pray, with all your belief (no
matter what that looks like), that our nurses’ passion,
commitment, and joy from this profession can be
salvaged through our “calling” as a nurse.
Our patients (MT citizens), nurses, and healthcare
workers have been politicized and emotionalized over a
public health issue all the while our nursing profession
is fighting to keep their profession, desire, and
compassion to serve, alive.
MNA will support evidence-based science and data
and will advocate and speak up for our professional
nurses even when:
• disinformation leads to misinformation and costs
many of our patients and nurses their lives,
• our profession is under attack from lawmakers
and the public, to include nurses and our own
members, because we practice evidence-based
• nurses are misinformed from social media,
pod casts, lawmakers, YouTube, snap chat,
magazines, or the news,
• our association witnesses such a distrust and
attempted rewrite of our public health profession
and practice, by non-medical, non-nursing, and
non-healthcare state lawmakers and leaders
to fit political agendas trying to justify their
“interpretation” of public health nursing and
medical recommendations and guidelines,
• nurses are devalued and working at such a pace
that it is leading to early retirement, moral injury,
burnout, and suicide and our nursing profession
is suffering greatly because of it,
• our governing leaders are unable to put aside
politics and lead collaboratively with nurses,
physicians, medical and public health experts to
care for our patients.
MNA will also continue to:
• be honest, open, and transparent, moreover,
embrace scientific and evidence-based data,
remaining credible and defendable,
• continue to communicate a consistent evidencebased
• partner with other healthcare stakeholders
to advocate for and care for our nurses and
• stand up and advocate for what is right for their
nurses working conditions and for their patients to
be fully informed, with proper scientific resources,
• witness their MNA staff fiercely advocate for their
nurse members, providing quality continuing
education and professional development and
working above and beyond to ensure the
professional nurses’ right to collectively bargain
in MT is protected.
MNA, through the voice of their professional nurse
members, is the sought-after voice for the professional
nurse in Montana!
Vicky Byrd, MSN, RN
current resident or
U.S. Postage Paid
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Page 2 Montana Nurses Association Pulse August, September, October 2022
& AD RATES
Circulation 18,000. Provided to every registered
nurse, licensed practical nurse, nursing student
and nurse-related employer in Montana. The
Pulse is published quarterly each February, May,
August and November by Arthur L. Davis Publishing
Agency, Inc. for Montana Nurses Association, 20 Old
Montana State Highway, Montana City, MT 59634,
a constituent member of the American Nurses
For advertising rates and information, please
contact Arthur L. Davis Publishing Agency, Inc.,
517 Washington Street, PO Box 216, Cedar Falls,
Iowa 50613, (800) 626-4081, firstname.lastname@example.org.
MNA and the Arthur L. Davis Publishing Agency,
Inc. reserve the right to reject any advertisement.
Responsibility for errors in advertising is limited to
corrections in the next issue or refund of price of
Acceptance of advertising does not imply
endorsement or approval by the Montana 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. MNA 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 MNA or those of the national or local
MNA welcomes the submission of articles and
editorials related to nursing or about Montana nurses
for publication in The PULSE. Please limit word size
between 500 – 1000 words and provide resources
and references. MNA has the Right to accept, edit or
reject proposed material. Please send articles to:
If you wish to no longer receive
The Pulse please contact Monique:
If your address has changed please
contact Montana Board of Nursing
We are gathering articles that are relevant
and appealing to YOU as a nurse. What
is happening in your world today? Is there
information we can provide that would be
helpful to you? The Pulse is YOUR publication,
and we want to present you with content that
pertains to your interests.
Please submit your ideas and
suggestions to Jennifer.
Please visit MNA’s
constantly updated website!
Enjoy a user friendly layout and access to more
information, including membership material,
labor resources, Independent Study Library,
a new Career Center for Job Seekers &
Employers, and more downloadable information.
Montana Nurses Association
20 Old Montana State Highway, Clancy, MT 59634
Phone (406) 442-6710 | Fax (406) 442-1841
Email: email@example.com | Website: www.mtnurses.org
Office Hours: 7:30 a.m.-4:00 p.m. | Monday through Friday
VOICE OF NURSES IN MONTANA
MNA is a non-profit, membership organization that advocates for nurse
competency, scope of practice, patient safety, continuing education, and
improved healthcare delivery and access. MNA members serve on the
following Councils and other committees to achieve our mission:
• Council on Practice & Government Affairs (CPGA)
• Council on Economic & General Welfare (E&GW)
• Council on Professional Development (CPD)
• Council on Advanced Practice (CAP)
The Montana Nurses Association promotes professional nursing practice,
standards and education; represents professional nurses; and provides
nursing leadership in promoting high quality health care.
Montana Nurses Association is accredited with distinction as an approver
of nursing continuing professional development by the American Nurses
Credentialing Center’s Commission on Accreditation.
Montana Nurses Association is accredited with distinction as a provider
of nursing continuing professional development by the American Nurses
Credentialing Center’s Commission on Accreditation.
Vicky Byrd, MSN, RN, Chief Executive Officer
Kelly Hunt, MN, RN, CNL, Director of Professional Development
Jennifer Hamilton, Professional Development Associate
Megan Hamilton, MSN, RN CFRN, NR-P, Nurse Planner & Professional
Robin Haux, BS, Labor Program Director
Amy Hauschild, BSN, RN, Labor Representative
Leslie Shepherd, BSN,RN, Labor Representative
Emily Peterson, Labor Representative
Makenna Sellers, Labor Organizer
Jill Hindoien, BS, Chief Financial Officer
Board of Directors President
Board of Directors Vice President
Board of Directors Secretary
Board of Directors Treasurer
Board of Directors Member at Large
Board of Directors CPGA
Board of Directors PD
Board of Directors CAP
Board of Directors EGW
MNA Board of Directors
Anna Svendson Ammons, BSN, RN, PCCN
Rachel Clark, BSN, RN
Melissa Anderson, BSN, RN
Audrey Dee, RN
Deborah Kalarchik, MSN, BSN, RN
Deborah Lee, BSN, RN-BC, CCRP
Deanna Babb, APRN, FNP-BC, FAANP
Brandi Breth, BSN, RN-BC
Council on Practice & Government Affairs (CPGA)
Lucy Ednie, BA, MBA, ASN, RN-BC Charlotte Skinner, BSN, RN-C
Loni Conley, BSN, RN
Melissa Anderson, BSN, RN
Paul Lee, CCRN
Council on Professional Development (PD)
Joe Poole, BSN, RN, CHSE
Brenda Donaldson, BA, RN, CAPA
Gwyn Palchak, BSN, RN-BC, ACM Janet Smith, MN, MSHS, RN
Rachel Huleatt-Baer, MN, RN, CNL, OCN, Sally (Lisa) Sluder, DNP, APRN,
Charlotte Skinner, BSN, RN-C AGACNP-BC
Stephanie Corder, RN, ND, CHCP
Council on Advanced Practice (CAP)
Margaret Hammersla, BSN, MS, PhD,
Ann Galloway, PhD, FNP-C
Member at Large-CAP
Sally (Lisa) Sluder, DNP, APRN,
Member at Large-CAP
Deven Robinson, MSN, FNP, PMHNP
Council on Economic & General Welfare (E&GW)
Delayne Stahl, RN, OCN
Adrianne Harrison, RN
Stacey Sheehan, BSN, RN
Robin Foley, BSN, RN CEN
Questions about your nursing license?
Contact Montana Board of Nursing at: www.nurse.mt.gov
August, September, October 2022 Montana Nurses Association Pulse Page 3
Please check your membership status.
If you fall into any of the below categories, you could qualify for
the ‘Professional Reduced Rate’ $38.65/month. Your rate will not
automatically change. You must let us know.
• You are a new graduate. You must apply within the first six months
after receiving your initial RN licensure and this rate is good for one
• You are an RN in a full-time study program working towards a higher
degree. You will need to provide proof of enrollment and you could
receive this rate for up to three years.
• You are an RN 65+ year of age who is licensed and working. You
could receive this rate for the remainder of your employment.
• If you are a retired RN and are no longer working or hold an RN
licensure you could be eligible for the retired rate of $13.07/month.
If you are working in a collective bargaining position and move into a
non-collective bargaining position, please contact the Montana Nurses
Association to let us know. Your membership dues will continue to be
paid until you authorize them to be discontinued. Please remember, only
you can cancel your membership and membership payments.
To provide MNA with information on your status or to receive
additional information on MNA membership please e-mail Jill Hindoien at
CONGRATULATIONS TO THE FOLLOWING NURSES WHO HAVE
TAKEN ADVANTAGE OF THE SUCCESS PAYS OFFERING BY ANCC
TO MNA MEMBERS!
1. Anna Moate, RN-BC-Medical Surgical Nursing
2. Amy Buxbaum, RN-BC Ambulatory Care Nursing
3. Kurt Prond, RN-BC-Medical Surgical Nursing
4. Amy Gardner, RN-BC-Cardiac/Vascular Nursing
New Member Benefit: MNA now offers certification
through ANCC’s Success Pays ® Program
> Reduced fee for MNA Members to obtain initial certification
> No cost if you don’t pass the exam; you can also take the
exam a second time at no cost
> Pay only when you pass!
> Identify your specialty practice area
How Success Pays ® Works
> Visit nursingworld.org/our-certifications/ to:
• Make sure you’re eligible to sit for the exam
• Look at the test blueprint and test preparation materials
• Make the decision to move forward
> Visit www.mtnurses.org and click on Success Pays ® option
to the left and sign up for the program!
> MNA will contact you regarding how to get the benefit.
Page 4 Montana Nurses Association Pulse August, September, October 2022
ADO – Assignment Despite Objection forms can often be
treated like a horrible complaint form used to put blame on
someone for an unsafe situation. It seems that in history, tools
and agents for change were also viewed with the same sort of
disdain. From my perspective, the first step in fixing a problem
is identifying that there is one. Without documented evidence
of recurring short staffing, lack of training, or unsafe conditions,
how can anyone advocate for change?
Assignment Despite Objection or ADO is a form used to
document any unsafe conditions for you or your patients.
Completing an ADO Form helps to make the problem known to
management, which creates an opportunity for the problem to
be addressed. We use ADO’s to document the facts about an
issue or situation, bring it to the attention of your supervisor(s),
initiate conversations to collaborate on potential solutions.
Labor Reports and News
Understanding the “ADO”
BSN, RN, Labor
Lets say, you’ve just received your assignment. You have a patient with an insulin drip.
Wait, what? An insulin drip, but you’ve never had a patient with an insulin drip. In fact,
insulin drips have NEVER been on your unit before. What do you do?
While there are several answers to this question, in this particular hypothetical you go to
your charge nurse.
You go to your charge RN with concerns. They listen, they empathize, and they realize
how inappropriate this assignment is. Now in a perfect world, this patient would not be
on your unit, but here we are. The charge RN, as amazing as they are, is not a magical
being with unlimited power. They do often, however, have a semi-direct line to the decision
makers (whether that be a house supervisor, manager, or administrator on call).
This scenario can go two (possibly more) ways. Either your amazing charge nurse finds
a solution to this oversight, or they don’t. If they do, then your advocacy for patient safety
was effective, and at times, this is what you experience. But in a less than perfect world
it is possible that there is no fix. Likely because there is no solution to be had. ‘All the
beds are full. There is no-one more experienced to take the patient. But it’s a stable insulin
drip.’ The excuses are sometimes endless, but sadly it is the reality that nurses can find
So what to do? Beyond educating your self as best as possible and consulting with
other RNs on your department or in your facility. You do your very best, because that’s
what nurses do. You double check everything and ask your peers to check you. You are
nervous and frustrated, possibly the whole shift. Possibly even after.
How do you prevent this from happening again? From happening to someone else?
While no one can control exactly what the future brings, bringing attention to the situation
that just occurred can help propel your facility towards a solution. Insert ADO forms!
How do we use ADO’s:
1. Actually verbally object to the assignment or situation you are being asked to work
in. Notify your direct supervisor (Charge RN, House Supervisor, Manager) that you
will take your assignment, but you are objecting to it (let them know why) and that
you will be filling out an ADO.
2. If a change in assignment or additional help to improve the situation is not provided,
get an ADO form and fill out all the pertinent information regarding your situation
and what you are objecting to. Feel free to write on the back or use multiple pages
to capture the facts of the situation.
3. Provide a copy of your ADO to your direct supervisor (Charge RN, House
Supervisor, and/or Manager), keep a copy to yourself, give a copy to one of your
union reps (Unit Rep, Officer, and/or Labor Rep).
At a lot of facilities, ADO’s should be reviewed at PCC or with your Union Reps and
management, each month. If this is the case in your facility, please plan to attend PCC
and discuss your ADO. You can meet with an officer or Labor Rep in preparation. If you
are unable to attend PCC, please make sure to discuss your ADO with a Union Officer or
have someone from your unit who can speak to the situation.
In facilities where an ADO process has yet to be established, I encourage you to reach
out to your union officers and/or Labor Representative to help get this process created. A
few things to remember:
• ADO’s are not used to blame anyone for the situation, but used as a tool to capture
what is happening and allow for discussion on ways to prevent it in the future
• ADO’s are considered discoverable documents: in a situation where there is a
negative outcome, this document (when used appropriately) can be used to show
that an RN voiced their concerns to leadership, thus demonstrating use of critical
nursing judgement and advocacy for patient safety
• YOU MUST ACTUALLY OBJECT TO THE ASSIGNMENT IN REAL TIME by
communicating the issues up the chain of command, though the form may be
completed after the fact.
New RN Member Orientation
Each year, your MNA Labor Department works with our
member bargaining teams to negotiate new contracts. One
of the most effective ways to improve our contracts through
bargaining is to add or improve allowing New Employee
Orientation (NEO) language to your contracts. The more
engaged your members are, the STRONGER your local will be
and this strength….will impact positive change!
Increasing membership and union education through early
engagement is the easiest way to begin building strength.
Catching nurses early to educate them on understanding what
it means to be a union nurse at YOUR facility and what their
rights are, is key to improving engagement. Education equals
engagement, and this requires a plan for communication.
The Labor Department wants to assist all our local
bargaining units in creating New Hire Orientation programs that
Robin Haux, BS
can provide you with better tools to educate your new members. We want to update our
new member packets with the most relevant information and to assist you with training
on tough questions you may be asked, scripts to use during orientation presentations,
and a follow-up plan. Our department would LOVE to bring this to you and assist to tailor
a program that works best for your Local unit.
Call the MNA office or your labor representative for more information!
ADO forms are available online (or on each unit in some facilities) and I encourage any
RN who experiences a myriad of unsafe working conditions to document these situations.
If this discussion could in any way lead to my being
disciplined or terminated, or affect my personal
working conditions, I respectfully request that my
Union/Unit Representative or Nurse Advocate be
present at this meeting.
Until my representative arrives, I choose not to
participate in this discussion
When Your Employer Notifies You of a Meeting...
*Immediately ask your Supervisor/Manager/Director:
• “What is the purpose of the meeting?”
• “Is the meeting investigatory?”
• “Will I be asked questions which may possibly lead to discipline?”
• “Will I be asked questions which require me to defend my conduct?”
If the meeting is investigatory or answers may
lead to discipline:
_ #1 – Respectfully inform your employer you are invoking
your Weingarten Rights & will need to have your Union/Unit
Representative or Nurse Advocate present during questioning.
_ #2 – Quickly arrange for your Union/Unit Representative or
Nurses Advocate to attend the meeting.
August, September, October 2022 Montana Nurses Association Pulse Page 5
Labor Reports and News
Shared Space Makes a Difference for Nursing Profession
Before we know it, the MNA Convention will be
days around the corner on October 6-7 at the Delta
Marriott in Helena. While on a personal level this
will be my first fully in person convention as staff, I
have heard from many MNA members and staff alike
on the importance of reconnection and establishing
community at the MNA Convention every year. It is the
annual opportunity to come together as nurses from
all corners of the Big Sky State, from Plentywood to
Polson. The diversity of skills, age, and professional
backgrounds makes the Montana Nurses Association
Annual Convention a uniquely memorable space to
listen, learn, and grow alongside our colleagues. Now
picture a world in which all 17,000 nurses in Montana
attended their professional association’s statewide gathering for the year; that
would be a sight for the record books. How would our association adapt? What
would we accomplish? And how would we address critical issues like staffing,
workplace violence, and mentoring the next generation of nurses in Montana?
I encourage each and every one of us who are part of Montana Nurses
Association to visualize 100% engagement with nurses across the state, and
imagine what that would look like.
While a 17,000-person MNA convention may be better suited for a stadium
than a convention center (!), it is important to remember that decisions are
made by those who show up. In the words of Margaret Mead, “Never doubt
that a small group of thoughtful committed citizens can change the world:
indeed it’s the only thing that ever has.” Community is created by those who
show up. The future of nursing practice in Montana is influenced by those who
show up. These truths apply no matter if you are a union nurse, a nurse leader,
or a nursing student. We want your voice to be part of the shared space and
community that is created at the MNA convention.
See you in October.
Congratulations MNA Local #2 RNs!
Local #2 bargaining team secured a tentative
agreement on a new two-year collective bargaining
agreement CBA in late June which was ratified by the
membership. Negotiations were long and difficult and the
Local #2 team did a great job representing their nurses.
The teams received assistance from the Federal Mediation
and Conciliation Service FMCS during their eleventh
bargaining session which assisted the parties in reaching
an agreement. To make wages more competitive, the
2022 wage scale was increased to begin in July; generally,
wage scale adjustments occur in January. The team also
secured increases to differentials; they also take effect in
July. The agreement also provides for scale enhancements
and step movements in January 2023 and January 2024.
BSN, RN, Labor
2021-2022 MNA Government Relations Platform –
Montana Nurses’ Association (MNA) is the nonprofit professional association
representing the voice of nearly 18,000 Registered Nurses (RNs) in Montana
including more than 1000 licensed as Advanced Practice Registered Nurses
(APRNs). MNA is the recognized professional organization, which lobbies for
nursing practice issues to protect the practice of professional nurses and also
protect the public in all areas of health care.
MNA is the recognized leader and advocate for the professional nurse in
MNA Mission Statement: The Montana Nurses Association promotes professional
nursing practice, standards and education; represents professional nurses; and
provides nursing leadership in promoting high quality health care.
1. Improve the quality of nursing practice by:
a. Providing educational and professional development opportunities that
contribute to improving practice competency and quality of patient care.
b. Identifying and pursuing funding opportunities to assist in providing
continuing nursing education and nursing continuing professional
c. Identifying and pursuing funding sources that support research/projects to
develop evidence based and innovative nursing practice.
d. Promoting national certification of Registered Nurses.
e. Active representation on local, state and national advisory committees/
f. Supporting the regulatory authority of and collaborating with the Montana
Board of Nursing (BON) on nursing practice and regulatory issues.
g. Encouraging transparency and promoting communication from the
Montana Board of Nursing regarding relationship with NCSBN (National
Council of State Boards of Nursing) and votes/legislation/regulatory policy
changes affecting regulation of registered nurses.
h. Providing input into the implementation and enforcement of NCSBN Nurse
Licensure Compact (NLC).
i. Opposing the NCSBN APRN Nurse Licensure Compact legislation.
2. Protect the economic and general welfare of nurses by:
a. Actively engaging in legislation and campaigns that positively contribute to
the economic and general welfare of RNs.
b. Ensuring the right of RNs to engage in collective bargaining in Montana.
c. Opposing any “Right to Work” (anti-collective bargaining, anti-labor)
legislation to uphold the “Blue Eyed Nurse” bill from 1967, authored by the
late Mary Munger, RN, and former MNA member.
d. Addressing workplace environment issues including violence against
healthcare workers, safe staffing, infectious disease, and patient safety.
e. Advocating for legislation prohibiting mandatory overtime.
3. Improve access to quality, cost effective health care by developing and/or
supporting public policies which:
a. Identify the nurse’s primary commitment is to the patient, whether an
individual, family, group, community, or population.
b. Respond to the needs of the unserved and underserved populations by
promoting access to health care and healthcare coverage.
c. Identify or develop alternative health care delivery systems that are costeffective
and provide quality health care.
d. Mandate third party reimbursements directly to RNs from public and
e. Remove barriers (financial, governmental, regulatory, and/or institutional)
that deny access to appropriate/qualified health care providers and
approved medical standard of care treatments.
f. Advocate for legislation that is transparent and bipartisan and support
policies that can achieve evidence based real healthcare reform.
g. Promote community and world health by collaborating with other health
professionals to promote health diplomacy and reduce health disparities.
4. Protect human rights by developing and/or supporting public policies which:
a. Promote access to appropriate health services.
b. Preserve individual rights to privacy.
c. Promote, debate and have consideration of ethical dilemmas in health care
d. Protect nurses, healthcare employees, and the patient (MT community)
from public health emergencies.
5. Protect the environmental health of individuals and communities through:
a. Acknowledging, supporting and addressing environmental impacts on the
health of Montanans.
b. Actively engaging with national organizational affiliates in addressing
environmental health issues in our nation.
c. Supporting and promoting the work, data, and evidence from our public
6. Protecting and promoting the future of healthcare and nursing practice
a. Actively engaging in legislation that supports professional scope of
nursing practice to the fullest extent of the nurses’ education, professional
development, and training.
b. Actively promoting programs and efforts that encourage professional
development and educational progression of professional nursing practice
at local, state, and national levels.
c. Representation on boards, committees and advisory groups which
influence the future of the nursing profession and the future of our state
and national healthcare system.
d. Engaging with healthcare partners and associations to work collaboratively
to ensure healthcare as a right for all American populations.
e. Actively support science and evidence based data to drive strong
investment in safe quality public health programs at state and national
Page 6 Montana Nurses Association Pulse August, September, October 2022
Professional Development Department
Sneak Peek at MNA 2022 Convention
The Professional Development team at MNA is
busy working with our planning committee to build
an exciting and valuable day of learning for the
attendees of our annual convention this fall. After
listening to the feedback from Montana nurses, we
are excited to be planning an in-person event this
year to be held at the Delta Marriott in Helena, MT
on October 6-7, 2022. Registration is open now at
Convention - CNE by MNA
We are working to finalize our speaker list and
are excited to offer a couple of different learning
formats from what we have seen in the past. We
are also presenting nurses and nursing students
(undergraduate or graduate level students) with
Kelly Hunt, MN, RN, CNL
Director of Professional
the opportunity to submit their work to be considered for a presentation at
convention. Nurses and nursing students do exciting and innovative work
every day to advance the profession of nursing, and all that work is made
even more powerful when it is shared with our peers.
We have a confirmed keynote speaker that we are honored to have at
MNA annual convention in Gloria Donnelly, PhD, RN, FAAN, FCPP, who will
be presenting on Healing and Humor in Nursing. Dr. Donnelly is the editor in
chief for Holistic Nursing Practice and Dean and Professor Emerita and found
Dean of the College of Nursing and Health Professions at Drexel University.
Additionally, after resoundingly positive feedback from last year’s
presentation, we are thrilled to announce that Dr. Eric Arzubi, MD will be
returning to wrap up the day of learning with what we are sure will be another
engaging and rejuvenating session. Other topics that you can expect to see
covered at convention this fall include, but are not limited to professional
boundaries, trauma informed care, gender affirming care, palliative care,
ethics in nursing and patient safety/just culture. We look forward to seeing
many of you there in person in October! As always, please feel free to reach
out with any questions regarding nursing professional development at kelly@
Montana Nurses Association
MNA thanks all of the Approved Provider Units we work with for their
commitment to advancing and promoting quality nursing practice through
continuing nursing education.
Alaska Native Tribal Health Consortium
Alaska Nurses Association
Alzheimer’s Resource of Alaska
Midland Memorial Hospital
Montana Health Network
Miles City, MT
Bartlett Regional Hospital
Montana VA Health Care System
Montana’s Healthcare Mutual Aid System (MHMAS) is the Emergency System for the
Advance Registration of medical professionals and non-medical responders for the state of
Montana. MHMAS is a secure, web-based online registration system used to register, verify,
and credential volunteers before a major disaster or public health emergency occurs.
Registration is open to health and medical professionals, as well as non-medical volunteers
who would like the opportunity to volunteer to respond to “all-hazards” incidents. Your
involvement as a responder will help ensure that people affected by a disaster will receive the
public health and medical care they need. You will be able to update this information at any
time as changes occur. If approved, you will receive notification of your acceptance into the
system. You will from time to time receive notifications for upcoming educational and training
Please remember that “volunteer” truly means volunteer. You can choose, at any time,
to decline any request that you may receive for your deployment. Even though you are
volunteering your time, a majority of the deployment requests will be paid positions. The pay
for each deployment varies and will be announced at the time of the request.
Thank you for your interest in lending your skills and expertise to assist Montana during an
If you would like more information or to register, please visit our web page:
Benefis Healthcare Systems
Great Falls, MT
Caring for Hawai’i Neonates
Central Montana Medical Center
Lewistown, MT | Boise, ID
Central Peninsula General Hospital
Community Medical Center
East Wenatchee, WA
Mountain Pacific Quality Health
Office of Professional Nursing Development-
University of Florida
Pacific Lutheran University
South Dakota Nurses Association
South Peninsula Hospital
St. Luke’s Health System
St. Peter’s Health
St. Vincent Healthcare
UF Health Shands Hospital
Western State Hospital
Foundation Health Partners
Wisconsin Nurses Association
Coeur d’Alene, ID
August, September, October 2022 Montana Nurses Association Pulse Page 7
Page 8 Montana Nurses Association Pulse August, September, October 2022
Where Do I Go From Here?
Sharon Broscious, PhD, RN
Program Director South University RN-BSN
Reprinted with permission from Virginia Nurses Today,
August 2021 issue
As the COVID-19 pandemic winds down, you may
be asking yourself questions about your professional
future. What’s my next career step? What does my
professional future hold for me? The stress of the
COVID-19 pandemic may have created these nagging
questions for you, and you might be unsure what
steps you should take to answer them. The physical,
emotional, psychological, and financial impact of the
pandemic on nurses has been well documented. A
plethora of publications in professional journals and on
websites as well as newspaper and television reports
have discussed the impact of the COVID-19 pandemic
on nurses. Terms such as burnout, compassion fatigue,
moral injury, PTSD, and healthcare worker exhaustion
are used to describe the physical and mental effects of
COVID-19 on healthcare providers (Chan, 2021; ICN,
2021). In an interview on NPR, the phrase “crushing
stress” of the COVID-19 pandemic was used (Fortier,
Not only did the nursing workload change –
increased number of patients per assignment,
increased number of shifts, increased length of
workday due to insufficient staff – but also other factors
compounded the stress on staff. Lack of equipment
such as PPE, the unknowns about the disease itself
with policies changing almost daily, and perceived
lack of support from leadership have also contributed
to the COVID effect (ICN, 2021) on nurses. Some
facilities attempted to prepare and support staff for
the pandemic surges, to varying levels of successful
impact. While providing meals to nurses who could not
take time for a meal break was helpful, as the pandemic
persisted, nurses needed more support from their
The recent COVID-19 report released by the
International Council of Nurses (ICN) (2021) describes
the exacerbation of burnout and exhaustion of nurses
during 2020. National nursing associations reported
approximately 80% of their members identified as
feeling stressed. In a survey of healthcare workers
conducted by Mental Health America (Lagasse, 2020),
93% indicated feeling stressed, and 76% reported
feeling burned out with 55% questioning their career
focus. Similar results were found in a survey from Brexi
(2020) with 84% of responding healthcare workers
identifying some burnout and 18% reporting total
burnout. In addition, almost half had considered quitting
their job, retiring, or changing their career focus. The
top five stressors that respondents identified, in order,
were “fear of getting COVID-19, long hours/shifts,
general state of the world, fear of spreading COVID-19,
and family responsibilities/issues” (Berxi, 2020, para 2).
Additional stressors identified by Shun (2021) include
physical, emotional and moral distress related to ethical
issues faced by nurses such as dealing with patient
deaths, scarce resources, and forced changes in
The 2021 Frontline Nurse Mental Health and Well
Being Survey (Trusted Health, 2021) revealed for nurses
under age 40, 22% indicated they were less committed
to nursing. Ninety-five percent of the nurses responding
indicated their physical and mental health were not a
priority in their workplace or the support received from
leadership was inadequate. Finally, 66% of respondents
indicated they were experiencing depression and a
decline in their physical health. A poll by the Washington
Post-Kaiser Family Foundation (2021) indicated 62%
of healthcare workers felt mentally stressed from the
pandemic with their greatest fears of them getting
infected, infecting their families, or other patients.
Another challenge identified was working while wearing
PPE (Kirzinger et al., 2021).
Prior to the pandemic, Shah, et al. (2021) reported
burnout was the third leading cause of nurses leaving
their jobs. However, the pandemic intensified levels of
stress and burnout. From the perspective of Maslow’s
hierarchy, Virkstis (2021) described the need for
leadership to focus on basic needs of staff, not high
level self-actualization. The basic needs were identified
as: a safe working environment, clear mission, time to
reflect on what was happening, and time to connect
Considering the factors identified here, it is no
surprise that you may be asking what is the next
step for you in handling stress, burnout, and career
Step 1 – Do I stay where I am?
You may be asking the following: Do I leave my job
as other nurses have? Do I want to, or can I continue
working where I am? Do I just need some time off?
The first step to take is self-reflection or selfevaluation.
If you are unsure about a change, pause
and take some time to think about it. Consider staying
where you are to determine how your workday has
changed after COVID-19 and whether factors such as
workload, staffing, and equipment, for example, have
improved. Remember wherever you go, everyone will
be rebuilding after the pandemic and trying to return to
a previous level of normalcy, or an improved level based
on lessons learned from the pandemic.
Before making a decision, reflect on your job prior to
the pandemic. Was this job a good fit for you? Were you
happy with your job? Answers to these questions can
guide you to remain in your current job to see if those
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August, September, October 2022 Montana Nurses Association Pulse Page 9
same positive feelings come back after the pandemic. The area you work in may
not be exactly the same as it was, but it could be even better. Other reasons leading
you to consider a change may include the work environment, the leadership of your
current unit, or lack of potential for growth in your current position. This introspective
evaluation provides time to think about other opportunities or make plans for change
if that is your final decision.
Step 2 – Do I change my career path?
There are numerous websites that provide steps to take when changing your
specialty or your role, but the first step should be:
1. Identify your passion. What makes you happy? Self-reflection and serious
thought can help provide this answer.
Additional steps to consider include:
2. Complete a SWOT analysis. Guidelines for completing a SWOT analysis can
be found on the internet.
• Identify your strengths: skills, experiences, education, support from peers/
• Identify weaknesses: communication skills, leadership skills, skills needed
for a new path.
• Identify opportunities: What specialty areas might be of interest? Do
you want to be in a hospital or in the community? Do you want to move
to administration or education and have less direct patient contact? What
works for your family? The Johnson & Johnson Campaign for Nursing’s
Future, provides information about 96 nursing specialties; this might be a
good place to start looking for new opportunities as it may present some
potential employment ideas you had not previously considered. A list of
more than 100 nursing organizations is available at https://nurse.org/orgs.
shtml In addition, the Illinois Nursing Workforce Center web page includes
a list of professional nursing organizations (http://nursing.illinois.gov/
• Identify threats. What barriers exist that might keep you from making this
change – family responsibilities, work hours desired, access to a new role
in your geographic area, skills or specific educational background needed.
A threat such as educational level may turn into an opportunity to return to
3. What are your goals in five or ten years?
4. When you have decided on a new role – develop an action plan or timeline
to establish your transition to the new role. What steps do you need to take
to make this change?
5. Refresh your resume. While you may consider that a move from pediatrics
to geriatrics would not provide you with appropriate skills, there are many
skills you have that are transferable – your assessment skills for example,
understanding lab results, providing care to someone who may be unable
to describe how they feel, or organization skills.
6. Network. Talk to someone who currently works in the specialty you are
considering. If the specialty has a professional organization, peruse
their website, attend a local meeting, or read their journals and social
media networks to help you connect with nurses in the specialty you are
7. Draw on your support system and mentors to overcome any barriers/
challenges that may be keeping you from making a change.
8. Resources on the VNA/ANA websites provide information about available
jobs, resume writing, and interviewing. Scheduling a live meeting with a
career coach is also available.
9. After you have made a specialty change, give yourself a chance to get
acclimated to the new path you have chosen.
10. Consider staying on good terms with your current employer. A reference will
be needed when applying for a new position. Staying on good terms may
also be beneficial if the new specialty or organization change does not work
Berxi. (December 8, 2020). State of healthcare workers in 2020. Business Wire. https://www.
Chan, G.K., Bitton, J.R., Allgeyer, R.L., Elliott, D., Hudson, L.R., Moulton Burwell, P. (May 31, 2021)
The impact of COVID-19 on the nursing workforce: A national overview OJIN: The Online
Journal of Issues in Nursing 26 (2), Manuscript 2. DOI:10.3912/OJIN.Vol26No02Man02
Fortier, J. (December 16, 2020). ICU Workers are quitting due to crushing stress from COVID-19
surge. (Radio broadcast) Morning Edition – NPR.
International Council of Nurses. (January 13, 2021). The COVID-19 Effect: World’s nurses facing
mass trauma, an immediate danger to the profession and future of our health systems.
Jobs, S. (June 12, 2005), Stanford Commencement Address. https://news.stanford.
Kirzinger, A, Kearney, A, Hamel, L., & Brodie M. (April 6, 2021). KFF/The Washington Post Frontline
Health Care Workers Survey. https://www.kff.org/report-section/kff-the-washington-
Lagasse, J. ed (December 8, 2020) Healthcare workers experiencing burnout, stress due to
COVID-19 pandemic. Healthcare Finance News https://www.healthcarefinancenews.com/
Shun, S.C. (2021). COVID-19 Pandemic: The challenge to the professional identity or nurses
and nursing education. The Journal of Nursing Research 29(2), e138. doi: 10.1097/
Shah, M.K., Gandrakota, N., Cimiotti, J.P., Ghose, N., Moore, M., & Ali, M. (2021). Prevalence of
and factors associated with nurse burnout in the US. JAMA Network Open 4(2), e2036469
Trusted Health. (2021). 2021 Frontline Nurse Mental Health & Well- Being Survey https://www.
Virkstis, K. (March 11, 2021). Nurse burnout didn’t start with Covid-19. (And it won’t end with
Covid-19, either.). Advisory Board https://www.advisory.com/daily-briefing/2021/03/11/nurseburnout
*NEW MEMBER BENEFIT* FOR APRN’s
If you are an APRN, membership to Montana Nurses Association (MNA) includes
three professional memberships for one low membership rate.
o MNA – Montana Nurses Association
o ANA – American Nurses Association
o AANP – American Association of Nurse Practitioners
If you are currently an MNA member who is also an APRN, please e-mail Jill at
firstname.lastname@example.org so she can sign you up for your AANP membership or if you have
Step 3 – Do I leave nursing and change my profession?
Your reflection may lead you to leaving the nursing profession. Many of the steps
in this process are the same or similar to the steps above in changing your career
1. Begin again with self-reflection/evaluation. What makes you feel fulfilled?
What would you like to do? What are your interests?
2. Identify areas of interest. There are a number of free aptitude tests available
on the internet that can guide you in identifying a new career or attend
a career fair. New careers could be with pharmaceutical companies,
insurance companies, the government, or in education for example.
3. Complete a SWOT analysis
4. What are your goals?
5. Identify the skills/education needed for the new career
6. Develop action plan
8. Career counseling – obtain a career coach, see the VNA/ANA websites
9. Connect with your support system
10. Keep your license current, you may decide at some point in time you want
to return to nursing.
The COVID-19 pandemic has likely changed you personally and professionally,
has certainly changed healthcare, and has without a doubt changed the world.
What you do to fulfill your life is a priority, so take time to carefully consider what
you want to do and where you want to be.
As Steve Jobs (2005) said, “Your work is going to fill a large part of your life,
and the only way to be truly satisfied is to do what you believe is great work. And
the only way to do great work is to love what you do. If you haven’t found it yet,
keep looking. Don’t settle. As with all matters of the heart, you’ll know when you
Page 10 Montana Nurses Association Pulse 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, 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). Dr. Renee Thompson
• 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
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
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 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.
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
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.
To access electronic copies of The Pulse, please visit
August, September, October 2022 Montana Nurses Association Pulse Page 11
Consider a Tax-Deductible
Foundation – (MNAF)
➢ Donations to the MNAF foundation
are 100% tax deductible.
➢ MNAF mission statement: “The
Montana Nurses Association
Foundation (MNAF) is the charitable
and philanthropic branch of the
Montana Nurses Association (MNA),
with a mission to preserve the
history of nursing in Montana and
contribute, support and empower the
professional nurse in Montana.”
➢ The purposes for which the
Corporation is organized are as
“(a) charitable; (b) educational; (c) to
accept healthcare/nursing research
and educational grants; (d) to provide
continuing educational grants to
licensed registered nurses; and (e)
to award scholarships to qualifying
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Page 12 Montana Nurses Association Pulse August, September, October 2022
State Wide Nursing News
Hiring Related to Age
Applying for a job can be
an epiphany! The hidden
message might be, “we want
a younger (hmmm) person in
Age and experience
are important factors that
determine leadership style,
and age is one of the most
important factors! It is
commonly believed that
experiential aging is an
important contributor when
determining behavior displayed
Ed.D, MN, RN
by a leader. Numerous complex and contradictory findings
on the relationship between leadership ability and age
In 1997, the research found that younger leaders
were perceived to be more effective than older leaders.
However, about 2003, increased leader age and follower
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satisfaction were positively related to more senior leaders,
and negative satisfaction was associated with younger
Intelligent administrators/leaders understand that
a significant research finding is intended to augment
our understanding of a researched topic. There is an
awareness that there are exceptions to every research
finding. However, significant research findings should
cause a pause in our thinking to the point of (at least)
increased awareness of the past, present, and intended
future job hiring behaviors as leaders.
Significant research finding merely means there is
a preponderance of evidence to indicate the research
finding’s correctness. Combining these external research
findings with an organization’s nondiscriminatory policies
and procedures, applicant information, and an unbiased
job description provides a broad-spectrum professional
perspective for employment consideration.
Published Significant Research Findings Related to the
Leadership Qualities of Older People.
Older people more often than younger people –
1. Experience positive feelings and avoid negative
2. Have learned to comprehend better and resolve
3. Predict emotions elicited by future events more
4. Have a high control over their feelings.
5. Exhibit more positive and stable emotions.
6. Show positive feelings and emotions.
7. Exhibit less anger.
8. Have low arousal of negative feelings causing more
9. Have low arousal of negative feelings related to
10. Have less anger, a low incident of sadness, and a
high state of enthusiasm.
11. Prioritize positive information over negative
12. Pay greater attention to positive social cues, which
positively affect emotions.
13. Have more experience and, therefore, less
dependent on outside information.
14. Analyze a situation to comprehend and resolve
15. Use Transformational Leadership (considered
“superior leadership” characterized by the
“four I’s” — idealized influence, Inspirational
motivation, Individual consideration, and Intellectual
16. Have the traits of empathy, collaboration, and
17. Exhibit more positive leadership behaviors.
Experientially-aged professional leaders require
university/college academic leadership preparation and
administrative/leadership ability. The experienced and
academically prepared leader supports and promotes
highly successful and effective employees. This
preparation of experience and education is a predominant
happening of successful leadership.
Society expects (in many cases) that successful
leadership is associated with masculinity, and females
are often associated with caregiving, social work, and
educational roles. Regardless, research findings confirm
that age is a far more significant consideration in both
genders in determining leadership abilities.
The skills of accomplishing a successful administrative/
leadership role include “having been there” as an
employee. Age, with all its implications, has its unspoken
positive place. The administrator/leader who can harness
a lifetime of experience on behalf of a leadership role
provides an advantage. Life experience prepares a person
for leadership. Life teaches lessons that cannot be learned
sitting at a desk, and life also teaches from the “school
of hard knocks.” Life lessons are often painful, but the
lessons are not forgotten, and the leadership role success
is the product of true grit--Passion and Perseverance.
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Need Help Managing Your Student Loan Debt?
Join MNA and our national union, the American Federation of
Teachers, Nurses, and Health Professionals (AFT-NHP) for our
student debt clinics this summer, exclusively for MNA members!
WHEN: August 25, 9 - 10:30 pm MT | WHERE: Zoom
TO Register: https://aft.zoom.us/meeting/register/
Over 45 million people in the United States are struggling to
make their monthly student loan payments, and millions more see
economic and personal opportunities pass as they prioritize paying
down their debt. Does this sound like you or someone you know?
Many of these people may qualify for free federal programs that can help reduce their monthly payments and
eventually lead to student loan forgiveness, but these lifeline programs are significantly under-enrolled. Thanks to
new rules just put in place by the Department of Education, many folks who thought loan forgiveness was out
of reach are now finding that it is finally within grasp. To help our members get access to these programs and
understand these new rules, MNA and AFT-NHP are proud to host Student Debt Clinics this summer which will
provide information and resources that will help you enroll in Income-Driven Repayment plans and Public Service
Loan Forgiveness, both of which are available to health care professionals working public and non-profit settings!
Managing your student loan debt is the first step in taking on the inequities which plague our system of higher
education, and we look forward to seeing you at the Student Debt Clinic and working together to find a collective
solution to the problems of student debt and college affordability!
NEED EXTRA INCOME?
Apply online at: www.montanahealthnetwork.com
or contact David Perry, RN - Staff Coordinator/Director of Nursing Services
406-852-6361 or 406-228-8044 | email@example.com
August, September, October 2022 Montana Nurses Association Pulse Page 13
The DPHHS EMS and
Trauma System Section
• EMS data on Opioid Overdose 2021 describes
volume/demographic data on opioid related
overdoses recorded by Montana EMS providers
• EMS QI report Q3-Q4 2021 is a serialized report
that describes Montana and US performance
on selected EMS quality improvement measures
for the second half of 2021. Each EMS agency
that submits data to the Montana EMS Registry is
provided a corresponding agency-level report.
• Naloxone administration by EMS 2021 describes
EMS events with Naloxone administration from 2021.
• Trauma annual report 2022 is a serialized report
describing severe injury in Montana as recorded in
the State Trauma Registry. The information includes
demographic, geographic, cause, severity and
target injury information.
For information on any of these reports, please contact
Hannah Yang (Hannah.firstname.lastname@example.org 406-444-3746)
Added Support for
Quit Line Participants
with Behavioral Health
On average, people with a serious mental illness
die fifteen years earlier than the general population
largely due to conditions caused or worsened by
smoking, according to the Centers for Disease Control
and Prevention. On July 1, the Montana Tobacco
Quit Line launched a new program to better support
participants with behavioral health conditions on
their journey toward successfully quitting all forms of
commercial tobacco. Participants in the behavioral
health program will benefit from:
• Seven scheduled telephone coaching sessions
that focus on developing and practicing coping
skills to manage stress while quitting;
• Specially trained tobacco treatment coaches
who understand behavioral health conditions;
• Eight-weeks of FREE Nicotine Replacement
Therapies (NRT) with combinations of patch,
gum, or lozenge; or
• Three-months of FREE prescription cessation
medications like Bupropion.
For more information, visit QuitNowMontana.com or
*The Montana Cancer Coalition developed online
maps to help cancer patients, health care providers,
and caregivers locate the closest cancer access
services that are key to improving quality of life for all
Montanans on the cancer journey.
At McKenzie-Willamette Medical Center,
we take caring for people very personally.
Join our MWMC family today in the
beautiful Pacific NW!
We have RN positions available in our
Operating Room and Cath Lab.
The Cath, Hybrid, EP, and Operating Rooms are more than just
procedural areas at MWMC. While collaboratively working
to promote operational efficiency, fiscal responsibility, and
purposeful change, we strive to empower each individual with the
tools necessary to foster learning and growth while enhancing
patient, staff, and physician satisfaction.
Sign-on bonuses up to $20,000 available!
Explore our Nursing Opportunities:
The Missoula College – UM ASN
program in beautiful Missoula, MT
is looking for a full-time adjunct instructor to
teach Adult Nursing I, Adult Nursing II, and
Managing Client Care.
Qualified applicants must possess a BSN
or higher. Teaching experience desired
but not mandatory.
We offer a competitive salary and excellent
For more information, please contact
Linda Barnes, Nursing Program Director at
(406) 243-7875 or email@example.com
Page 14 Montana Nurses Association Pulse August, September, October 2022
Sleep and Your Health
Cynthia Meyer, MSN, RN, CHSE
Debra Rose Wilson, PhD, MSN, RN, IBCLC,
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 self-care 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 pro-inflammatory
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
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.
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 sleepwake
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.
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
• Maintain a consistent sleep schedule
o Keep the same sleep-wake cycle on days off
o Sleep directly after a shift or adopt a split-nap schedule
o Take a short nap prior to shift on workdays but avoid naps longer than 30
• 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.
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.
August, September, October 2022 Montana Nurses Association Pulse Page 15
Montana Nurses Association would like to
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