Virginia Nurses Today - August 2022

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The Official Publication of the Virginia Nurses Foundation

August 2022 Quarterly publication distributed to approximately 111,000 Registered Nurses

Volume 30 • No. 3

We are pleased to provide every registered nurse in Virginia with a copy of Virginia Nurses Today.

For more information on the benefits of membership in of the Virginia Nurses Association,

please visit www.virginianurses.com!

Page 3

VNF Underwrites Training of

Nearly 200 School Nurses



Nurse and



Clarke Still

Loves Nursing

Page 10 Page 18

Register now for 2023 Class!

Page 24

Dr. Loressa Cole to be honored

with the Virginia Nurses

Foundation’s 2022 Nancy

Vance Award at annual gala,

September 10

The Virginia Nurses Foundation (VNF) is pleased to

announce Dr. Loressa Cole as the 2022 Nancy Vance

Award recipient. The Nancy Vance Award is the Virginia

Nurses Foundation's highest honor and is awarded

biennially at the Virginia Nurses Foundation’s Gala.

This is the highest award given by VNA and honors

and continues the legacy of Nancy Vance’s excellence

in service. It is bestowed upon a VNA member who

has made significant contributions to our community

through their exceptional leadership, sustained

dedication and inspiring achievements.

Dr. Loressa Cole, DNP, MBA, RN, NEA-BC, FAAN is

Chief Executive Officer of the American Nurses Association (ANA) Enterprise,

which consists of the ANA membership organization representing the nation’s

4.3 million registered nurses; the American Nurses Credentialing Center

(ANCC), which promotes excellence in nursing and health care globally through

credentialing programs; and the American Nurses Foundation, ANA’s charitable

arm. Prior to assuming this role, Dr. Cole was the ANCC Executive Director and

Executive Vice President.

Dr. Cole is an accomplished health care leader with more than 30 years of

nursing and management experience. Before joining the ANA Enterprise, she

served as the Chief Nursing Executive for LewisGale Regional Health System in

Salem, Virginia, where she directed system-wide clinical operations, partnering

with other C-suite leaders on strategic and tactical planning, and execution.

Previously, she served as Chief Nursing Officer at Lewis Gale Montgomery

Hospital in Blacksburg, Virginia, where she led the hospital to achieve its initial

Magnet® designation in 2009 and its redesignation in 2013. Dr. Cole began her

career as a staff nurse in medical/surgical and critical care settings.

Active in many professional organizations, Dr. Cole served as President of

the Virginia Nurses Association from 2012 until 2014. She is a member of the

American Organization of Nurse Executives, the Virginia Organization of Nurse

Executives, and the American College of Healthcare Executives.

She has presented at a wide range of conferences, including the 2011 and

2012 ANCC National Magnet Conference. She earned her DNP at Case Western

current resident or

Dr. Loressa Cole to be honored with...continued on page 2

Non-Profit Org.

U.S. Postage Paid

Princeton, MN

Permit No. 14

US Supreme Court’s Decision

to Overturn Roe vs. Wade

is a Serious Setback for

Reproductive Health and

Human Rights

“The recent Supreme Court decision to overturn Roe v Wade is deeply

troubling,”says VNA President Linda Shepherd, MBA, BSN, RN, NEA-BC.

“Regardless of individual beliefs, political affiliations or conservative vs liberal

leanings, the decision represents a serious setback for reproductive and human

rights and runs counter to the nurse’s ethical duty to advocate for patients.”

“In the wake of this decision,” added VNA & VNF CEO Janet Wall, MS, “we

anticipate a sharp increase in the health risks associated with reproductive

health for patients with little to no economic means and an exponential

worsening in health disparities within already marginalized communities.”

According to the Pew Research Center, “A majority of Americans disapprove

of the U.S. Supreme Court’s landmark ruling overturning the Roe v. Wade

decision... Public support for legal abortion remains largely unchanged since

before the decision, with 62% saying it should be legal in all or most cases.”

The American Nurses Association, like the Virginia Nurses Association, is

deeply concerned by the Supreme Court’s decision. In a recent response to the

action, ANA states:

“The ruling removes the right of all women to access high-quality healthcare

and make personal decisions about their sexual and reproductive health care.

In doing so, it potentially paves the way for laws that will fundamentally come

between patients and health care professionals, including nurses, who must be

guided by ethical obligations to their patients and the profession.”

Past VNA President and current ANA Enterprise CEO Loressa Cole, DNP,

MBA, RN, FAAN, NEA-BC had this to say: “Nurses have an ethical obligation

to safeguard the right to privacy for individuals, families, and communities,

allowing for decision making that is based on full information without coercion.

As the largest group of healthcare professionals, nurses have for decades

assisted their patients with weighing the benefits, burdens, and available

options, including the choice of no treatment, when discussing sexual health

issues and pregnancy.

In March 2022, ANA affirmed that abortion is a reproductive health

alternative that nurses can discuss when counseling patients. Nurses have a

duty to respect the decisions of their patients, including those decisions that are

related to sexual health and pregnancy. Respect for patient decisions does not

mean that the nurse must agree or support the decision. Nurses can exercise

their right to refuse to participate in sexual and reproductive health care based

on ethical grounds, as long as patient safety is assured and care by others has

been arranged.

“No matter their philosophical differences or belief systems, all nurses must

strive to remain consummate health care professionals and display empathy

and respect to all,” said Cole. “This is a complicated issue and deeply personal

for all, including nurses. Nurses, leaders, all health care professionals, and the

public must engage on this issue with empathy and respect.”

ANA and VNA will continue to advocate for reproductive justice and sexual

health that supports a patient’s decision and rights in a just society.

Page 2 | August, September, October 2022

Join nurses from throughout Virginia for a

grand celebration of nursing!!

Virginia Nurses Today | www.VirginiaNurses.com

Please plan to join us at the Westfields Marriott

in Chantilly, VA (NOVA) on September 10 for the

much-anticipated return of our in-person awards

ceremony! Camaraderie with long-missed colleagues,

recognition of the incredible accomplishments of

nurses from throughout the commonwealth with our

“Leadership Excellence” awards and more… It’s all

on the evening’s agenda! This event is long overdue

and not-to-be-missed!

Dining tables (each of which can accommodate

10 guests) and individual tickets are now on sale at



Tables &


Tickets Here.

is the official publication of the Virginia Nurses

Foundation: PO Box 13619, Richmond, Virginia

23225, VNF’s affiliate, the Virginia Nurses

Association, is a constituent of the American

Nurses Association.



Phone: 804-282-1808

The opinions contained herein are those of the

individual authors and do not necessarily

reflect the views of the Foundation.

Virginia Nurses Today reserves the

right to edit all materials to its style

and space requirements and to

clarify presentations.

VNF Mission Statement

VNF is committed to improving the health

of Virginia’s communities by developing an

educated and diverse nursing workforce

through leadership development, research,

and innovation.

VNT Staff

Janet Wall, CEO

Elle Buck, Managing Editor

Virginia Nurses Today is published quarterly

every February, May, August and November by

the Arthur L. Davis Publishing Agency, Inc.

Copyright © 2020, ISSN #1084-4740

Subscriber rates are available, 804-282-1808.

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.

VNF 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.


We are going totally DIGITAL. This will be our

last print copy of Virginia Nurses Today. As with any

changes, we may have some growing pains as we

adjust to this new format but we are confident that this

is the right direction for VNF to take.

Under investigation

by the Virginia

Board of Nursing?

Acceptance of advertising does not imply

endorsement or approval by the Virginia

Nurses Foundation of the products advertised,

the advertisers or the claims made. Rejection

of an advertisement does not imply that 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. VNF and the Arthur

L. Davis Publishing Agency, Inc. shall not be

held liable for any consequences resulting

from purchase or use of advertisers’ products.

Articles appearing in this publication express

the opinions of the authors; they do not

necessarily reflect views of the staff, board, or

membership of VNF, or those of the national

or local chapters.

Eileen M. Talamante, Esq., R.N.

Eileen is a nurse and an attorney, and is

here to help you with licensing issues,

investigations, and disciplinary matters

before the Virginia Board of Nursing.

2020 Outstanding

Advocate Award



(804) 565-3526



Dr. Loressa Cole to be honored with...continued from page 1

Reserve University, her Master's in Business

Administration (MBA) at Averett University, and

her BSN at Virginia Commonwealth University. Dr.

Cole is ANCC board-certified as a nurse executive,

advanced, and was inducted as a fellow into the

American Academy of Nursing in 2020.

Celebrate Nursing on September 10

Dr. Cole will be honored during VNF’s annual

gala on September 10 at the Westfields Marriott

in Chantilly, VA. Camaraderie with longmissed

colleagues, recognition of the incredible

accomplishments of nurses from throughout the

commonwealth with our Leadership Excellence

awards, accolades to legislator advocates for nurses

and more… It’s all on the evening’s agenda! This

event is long overdue and not-to-be-missed!

More on Nancy Vance:

• Click here to learn more about Nancy Vance's

exceptional life and career.

• Click here to view the list of previous awards


www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2022 | Page 3

Legislative Update

Save the Date for VNA’s 2022 Virtual Legislative Summit!

Are you ready for the November 8 Election?

More information to come at:


Join us VIRTUALLY for our annual

Legislative Summit on November 15, 2022.

Learn how to be a powerful advocate for nursing and for the health of

all Virginians! Plus, you’ll want to join us as we examine the critical issues

facing nursing and healthcare and discuss the statewide impact of the

results of the November 8 election. You'll get a detailed look into upcoming

nursing legislation and nursing’s 2023 legislative priorities for next year.

We’ll be talking about legislative solutions for our nurse staffing shortage,

school nurses, APRN issues, reproductive and human rights and more!! Be

sure to check out the full agenda on our website, www.virginianurses.com/

page/LegislativeSummit, later this fall!

The conference will be professionally produced and live streamed directly

to your computer, tablet, or phone on November 15, 2022. We're providing

fantastic content related to nursing and healthcare legislative issues and

advocacy, and we’re using a variety of interactive strategies to ensure an

engaging opportunity for all participants. When you register for the live

Legislative Summit, you will also receive access to the conference recording

on-demand for three months, giving you the flexibility to view the program at

your convenience!

Make a Plan to Vote!

Election Day is November 8! Making sure you have a plan to vote is essential

for casting your ballot! Answer the questions below to make sure you're


Do you know your polling location?

If you don't know, you can find out here:

Find your polling location

What time will you vote?

Figuring out what time during your busy day to vote is essential? Will you go

before work, after work, or during lunch?

Do you need a ride?

Some political parties and local entities arrange ride services for voters who

cannot get to the polls themselves. To find a ride near you, simply do a web

search for “[your county] Virginia, rides to the polls 2022!”

Do you have young children?

Having children definitely impacts your plan to vote! Will they be in school or

daycare? Do you need to take them with you to the polls or can you drop them

off with a family member or babysitter?

Page 4 | August, September, October 2022

VNA President's Message

Disengaged Nurses Speak Out!

Virginia Nurses Today | www.VirginiaNurses.com

As we examine the staffing crisis and how to tackle this

complex issue in both the short- and long-term, it seems

obvious that we reach out to the approximately 115,000

registered nurses whose licenses are either identified as

inactive or expired in the past four years. Some of these

nurses, we knew, had left the nursing workforce during

the pandemic. We sought to understand why nurses have

left their careers, what we can learn from them and apply

to the current workforce challenges, and what it might

take – if anything – to entice them back to the workforce.

VNA recently conducted a survey of these nurses and

received 2,684 responses.

Top Reasons Why Nurses Disengaged

Nurses Working in Hospitals vs All Respondents

Who They Are

57% of the responding nurses hold licenses that have

expired in the past four years, while 35% have inactive

licenses, and another 7% continue to work under a

multistate license. Some further demographics about

our respondents:

• Age: 86% are 51+ years old, 7% are 31-40, 5% are

41-50 and nearly 2% (54) are 20-30

• 74% practiced nursing for more than 21 years,

21% had practiced 6-20 years, and 5% had only

practiced 0-5 years.

• The highest degree earned was bachelor’s (40%),

associate’s (34%), master’s (22%), and 3.5% their

doctorate. 3.5% had earned their doctorate, while

the highest degree

earned by other

respondents included:

• The vast majority

of respondents selfidentified

as caucasian

(89%), followed by

Black (5%), Asian

(2.5%) and Hispanic/Latino (2.5%)

Linda M. Shepherd,



• They most recently work in hospitals (44%),

ambulatory care (9%), long , and another 7.3%,

long term term care facilities (5%), and k-12/

academia and public health (4-4.5% each).

Answering the ‘Why”

Seventy percent have simply retired, while health

concerns unrelated to the pandemic account for another

12.2%, and family obligations rank third at 11.5%.

Interestingly, 7.3% of respondents told us they are

taking a break from nursing, but may return to the

profession, while another 7.3% sadly reported that they

are pursuing a non-nursing career. Another 6.2% are

seeking a slower career pace, and 5.2% are not working

due to mental and physical health concerns related to

the pandemic.

What would it take?

When we removed those who had indicated that they

were retired, and looked at all remaining respondents,

the top six responses they indicated for leaving nursing


1. Competitive pay

2. Greater flexibility

3. An employment contract

4. A voice in which departments I work

5. Zero-tolerance workplace violence and incivility


6. Nothing could entice me to return to work

Reasons Nurses Working in Hospitals Disengaged

Taking a deeper dive, we examined the responses

of those nurses who had most recently worked in a

hospital or acute care setting and found that, when

compared with all respondents:

• A lesser percentage (6.87%) of hospital

respondents left in order to retire

• Family Obligations topped the hospital

respondents’ list at 13.6% of reasons other than


• 9.65% of hospital respondents, compared with

7.29% of all respondents, are pursuing a nonnursing


• 9.21% of hospital respondents, compared with

7.29% of all respondents, are taking a break, but

may return to nursing

The results attest to the fact that nurses employed

in acute care, many of whom cared for patients with

COVID, have struggled significantly more with the

hospital work environment both related and unrelated

to the pandemic, including their ability to juggle work

and family obligations and maintain their mental and

physical health.

What Would it Take?

Removing from consideration those nurses who have

retired, what would nurses who have left the workforce

need in order to consider returning? The top two

issues are the same across the board. All respondents,

including those working in hospitals, expect competitive

pay and greater scheduling flexibility. They also

want a voice in which departments they work and an

employment contract that leaves no room for confusion

on these points and more. Nurses, like all healthcare

professionals, also deserve an employer that not only

doesn’t condone violence and incivility in the workplace,

but takes actions to back up their words (#5 on the list)!

Nurses are well-educated professionals who bring

tremendous knowledge and expertise to the practice

setting, and should be treated accordingly! In the

months ahead, VNA will be developing contract templates

and coaching nurses on how to negotiate a contract,

including developing messaging that will resonate with

CEOs and CFOs. We also plan to convene nurse leaders,

CFOs and other leadership from various practice settings

for a meeting of the minds. And we will take legislative

action where needed. Be sure to participate in our fall

conference, September 9-10 at the Westfields Marriott in

Chantilly (NOVA), because The Time is NOW!

Together, we have tremendous influence and can

effect change! Join us!

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Page 6 | August, September, October 2022

Virginia Nurses Today | www.VirginiaNurses.com

CEO Reflections

Positioning Nurses to be Influencers!

Every nurse is or has the ability to be a leader

in their own right. Leadership does not necessitate

a list of credentials behind your name, nor does it

require that you are part of the C-suite. Leadership

is about advocacy of your patients or clients, on

behalf of your colleagues, and for nursing as a

profession. Leadership is about using your voice,

be it at the bedside or in a legislative committee

hearing, because you have important knowledge

and perspectives to share. Because you have a voice.

Does every nurse have a responsibility to flex that

knowledge and influence pivotal conversations? I

would suggest “yes.” It is together that we can best

advance nursing to the benefit of both the profession

and the communities we serve.

Five years ago, the Nurses on Boards Coalition

was founded. Its members include the American

Nurses Association, the American Nurses

Foundation and a host of other national nursing

organizations, and its mission is to improve the

health of communities through the service of nurses

on boards.

NOBC is committed to increasing nurses’

presence and influence on boards, panels, and

commissions possessing the strategic influence to

improve the health of communities and the nation.

This includes corporate, governmental, non-profit,

advisory or governance boards or commissions that

have fiduciary or strategic responsibility.

Having already achieved the key strategy of

placing 10,000 nurses on boards, NOBC can now

measure nurses’ impact on boards and raise

broader awareness that all boards would benefit

from the unique perspective of nurses to achieve the

goals of improved health and efficient and effective

healthcare systems at the local, state, and national


The pandemic has placed a harsh spotlight

on health disparities within our marginalized

communities, as well as racism in nursing. So, in

addition to exponentially increasing the number of

all nurses participating on boards of influence, it

is particularly important that our communities are

represented in the makeup of these boards, and that

boards be inclusive so as to yield greater opportunity

for all nurses, regardless of age, gender, ethnicity,

sexual orientation, religion, etc.

As Sue Hassmiller, PhD, RN, FAAN, known for

her extensive work and leadership with the Robert

Wood Johnson Foundation and the Center to

Champion Nursing in America, once said, “Board

service can be rewarding to nurses both personally

and professionally. It not only requires them to

exercise leadership; it expands those skills and

advances their capabilities and knowledge. It gives

nurses the chance to meet people and enhance their

professional networks. And it can be inspirational

and empowering.”

Not currently serving on a board, but interested?

Add your name to the NOBC database, and review

the many resources on board service included on the


Already serving on a board or other entity that

has the ability to influence community health? Make

sure to add your name to the NOBC list so that we

can accurately track nurses progression.

Join VNA / ANA (https://www.


for $174/year and save 20% off your

Leadership Development Pre-Con

Workshop and Fall Conference rate!


Interested in honing

your leadership skills?

If you’re a new or

emerging nurse leader, Janet Wall, MS

we’ve got just the program

for you! Registration is now open for the Virginia

Nurses Foundation’s Nurse Leadership Academy.

The Academy, which offers a robust year-long

program of didactic learning and leadership project

development, consistently receives rave reviews

from participants, and will graduate its first class

of fellows this December. Learn more and register

for our 2023 class! The cost for this comprehensive

[virtual] year-long program is $1,295/registrant

or, for employers registering three or more nurses,


We’ve also planned a great Leadership

Development Pre-Conference program to

coincide with our September 9 & 10 in-person Fall

Conference, The Time for Change is Now, which

will be held at the stunning Westfields Marriott in

Chantilly, VA. The 4-hour pre-conference will be

led by Bullying & Incivility Content Expert Diane

Salter, MSN, RN, CPAN, NE-BC with the Healthy

Workforce Institute, and will examine Developing

Effective Communication for a Healthier

Workforce. Join us the morning of September 9 as

we learn how to develop assertive communication

skills among the healthcare team, incorporate

body language techniques to strengthen

team relationships, and create standards and

systems that foster collegiality. Fall Conference

registration fees are $249 for members and $295

for nonmembers. Add the leadership development

pre-conference and your total package rate will

be $300 for members and $375 for nonmembers.

Rooms at the Westfields Marriott are a very

reasonable $159/night via our room block.



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www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2022 | Page 7

Rest, Relax, Laugh:

Spending Time with Yourself

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

Reprinted with permission from

Tennessee Nurse February 2022 issue

Rest and Relax

How many times have you been told that you need

to get plenty of sleep for good physical health? Sleep

is also instrumental in maintaining sound mental

and emotional health. Rest is not only the act of

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

into your spirit simply by feeling renewed. Waking

up and feeling that you have run a marathon is a

sign of significant activity during your rest period.

Either the mind continues to cycle, or you may be

suffering from a sleep disorder. In either case, you

are not at rest.

To rest the mind, you must relax. Relaxation is

defined as the state of being free from tension and

anxiety (Google dictionary, 2022). The Cambridge

Dictionary defines relaxation as a pleasant activity

that makes you become calm and less worried. This

definition supports the concept of complementary

and alternative interventions and modalities.

Relaxation can really be a state of mind. One of

the most effective holistic modalities that promotes

relaxation is meditation. Meditation is reflected

in many forms, including guided imaginary,

mindfulness, Zen meditation, Mantra meditation,

Transcendental meditation, and Yoga meditation,

just to name a few. Mindfulness has become popular

over the last few years. Being mindful is the basic

human ability to be fully present in the moment,

aware of your surroundings, feelings, and emotions.

Try it, sit still in a quiet place. Place your hands in

your lap. Now close your eyes. What do you hear?

What do you smell? Breathe slow and steady while

maintaining the rhythm. Continue this practice for

approximately 10-15 minutes. Notice the change

in your stress level or anxiety. This simple exercise

can alleviate stress and anxiety, and if engaged in

regularly, lead to an optimistic outlook.

Laugh for a Healthier You

Have you noticed that when you laugh, you feel

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

Research has found that laughing triggers the

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

It has also been reported that laughter decreases

stress hormones and increases immune cells. We

have a natural response to infection, which helps

produce antibodies, improving our resistance to

disease and promoting our overall well-being. What

makes you laugh? Is it a funny commercial, your

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

the best medicine. In an article by Robinson, Smith,

& Segal (July 2021), learn to create opportunities

to laugh, watch a funny movie, TV show, or

YouTube video, check out a comedy club, read the

funny pages, check out the humor section in your

bookstore, play with a pet, better yet host a game

night with friends.

I would like to share with you some of the things

that make me laugh. Watching my favorite comedy

movies, even though I know the punch line, dancing

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

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

During hard times, laughter has been a saving

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

how laughter affects the brain, which may be an

explanation why giggles play an important role in

social bonding.

When you take time for yourself, you validate your

worthiness and value. Make it a point to celebrate

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

with your spouse, family, or friends. Do something

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

about butter pecan ice cream? Take care of yourself

so that you can take care of others. The first step

to self-care is accepting that you are worthy of that

care. The care you require may need to come from

a professional source, and that’s okay. There are

services available through most healthcare facilities

and organizations. Sometimes you just might need to

talk. It may be a good time to phone a friend.

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

Try to include at least one activity to cover each one

of the components. Start with resting and relaxing,

then let the laughter begin. Remember, you are

worthy, valuable, and appreciated. Self-worth can

only be measured by you. So make every moment

count, and be mindful of your value. I can sum it up

in one word, priceless!!


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

is the Best Medicine. https://www.helpguide.


Mindful: healthy mind, healthy life (2022).


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

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


Meet our newest Fall Conference

presenter, Dr. Adrianna Nava

Find your dream job now.

We’re excited to announce

Dr. Adrianna Nava, PhD,

MPA, MSN, RN, President

of the National Association

of Hispanic Nurses (NAHN),

will be joining us as a Fall

Conference presenter!

Dr. Nava is an advocate

for increasing access

to care for underserved

populations. As a registered

nurse, she witnessed

firsthand how access-related disparities led to

poor health outcomes, especially for racial/ethnic

minority groups. In serving her patients, she saw

an opportunity to contribute to decreasing Latino

health disparities by building the leadership

capabilities of nurses. She currently serves as

President of the National Association of Hispanic

Nurses (NAHN) and is focused on building the


DEAN – School of Nursing-12 Month Administrative Position-

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FACULTY – Earned Doctorate (Undergraduate and

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SUBMIT: Curriculum Vita, contact

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CONTACT: Dr. Arlene J. Montgomery, Search Committee

Hampton University School of Nursing

200 William R. Harvey Way, Hampton, VA 23668

arlene.montgomery@hamptonu.edu | 757-727-5654

leadership capacity of nurses, specifically Latino

nurses, who continue to be underrepresented in

nursing and healthcare leadership positions across

the country.

Dr. Nava will be presenting for the General

Session: Combatting Racism in Nursing. The

National Commission to Address Racism in Nursing

conducted a survey that found that 63% of nurses

surveyed had experienced an act of racism from

a peer or superior in the workplace. Dr. Adrianna

Nava, Co-Lead of the Commission, will discuss how

nurses must help combat racism in nursing by first

examining their own personal biases and beliefs and

then working together to address systemic issues.

Learn more about the work of the commission and

what you can do to improve the well-being of our

workforce by ensuring an inclusive and supportive

work environment for all nurses.

To view the full program or register for The Time

for Change is NOW! click here!

Now Hiring:

Public Health Nurse II

To Apply:


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The School Public Health Nurse works in the school health

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other software applications). Must participate in the training,

supervision and evaluation of unlicensed assistive personnel.

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Page 8 | August, September, October 2022

Virginia Nurses Today | www.VirginiaNurses.com

Report on the Statement of Racial Reckoning at the

ANA Membership Assembly

VNA Secretary




VNA President-Elect

Sherri Wilson DNP,


The 2022 American Nurses Association (ANA)

Membership Assembly was held in-person this June

in our nation’s capital. Spirited debate took place

around staffing standards, work-place violence

and climate control. Unique to any dialog is the

nurse’s ability to not only advocate for themselves,

but to maintain a clearly determined stance to also

advocate for those they serve.

One particular motion brought forward

for consideration was the Statement of Racial

Reckoning. This statement was passed

unanimously without any opposition. However, it

is worth examining what racial reckoning means,

particularly in the noble profession of nursing.

According to Merriam-Webster’s Dictionary,

reckoning is “a settling of accounts.” [1] As this

relates to the topic of race, a statement, while

hardly able to reconcile a long history of slavery and

systemic inequities in our country, is the foundation

that can begin to have great visions built upon

it. Just as developers would seek to build upon a

terrain that has long been fallow, the foundation

must be leveled and stabilized before anything can

be built. This is what this statement brings, an

opportunity for the leveling of unsettled terrain, and

the stabilizing of the foundation. The call to build on

this foundation is now an urgent one as we continue

to see the health and wellness of those we serve

being affected.

The ANA’s National Commission to address

Racism in Nursing conducted a comprehensive

report series on Racism in Nursing. [2] The report

explored the historical context of nursing’s role at

the intersection of the following events in American

history: the era of enslavement, colonialism and

the Indigenous in the United States, American

imperialism beyond the continental United States,

and imperialism and racism in Latino nursing.

The recent social and political climate has also

highlighted the public policies, institutional

practices, and cultural norms that make up

structural racism, all catalysts to health inequities.

An article published through the Journal of

Nursing Administration highlights that minority

populations, compared to white populations, have

higher incidences of avoidable health disparities,

chronic diseases, and more frequently experience

delays in care. This in turn creates higher costs

and exacerbates negative health outcomes. [3] The

answer to this health crisis may just be nurses!

The Future of Nursing 2020-2030 report clearly

identifies that nurses can be the solution to racial

health disparities through awareness, adjustment,

assistance, alignment and advocacy. [4] But the

bedside is not the only place in healthcare that

minorities need to be represented; we should also

be mirrored in administration to help make the

decisions that will affect our communities, in

academia to promote and mentor our future nurses,

and research so that a complete understanding can

be obtained from a whole population.

“Promoting health and well-being has long been an

essential role of nurses—they are bridge builders and

collaborators who engage and connect with people,

communities, and organizations to ensure people from

all backgrounds have what they need to be healthy

and well.” -Future of Nursing 2020-2030 [5]

The health of our profession, patients and

communities are dependent upon our ability to

build our visions of equity. Where are we currently

as a profession? According to the 2021 United States

Census the general profile for race consists of: 13.4%

African American/Black, 18.5% Hispanics/Latinos,

and 6.9% Asian. [6] However, according to an HRSA

National Sample Survey of Nurses, the race of our

communities is not effectively represented within

the nursing workforce, with only 7.8% African

American/Black, 10.2% Hispanics/Latinos, and

5.2% Asian. [5] A report put out by the American

College of Healthcare Executives also demonstrates

that while the population of patients that were

also minorities grew from 21-31%, the reflection of

diversity in the C-Suite remained a combined 14%

[7] according to The Minority Nurse, with 63% of

minorities in nursing being employed within hospital

settings. [8]

Here in the Commonwealth of Virginia,

nurses are 110,000+ strong [5] but even in our

great commonwealth, which does have better

representation than many other states and

commonwealths in the nation, there are disparities

among the populations represented: 19% African

American/Black, 10% Hispanic/Latino and 7%

Asian. [9]

What are the practical approaches for nurses

to build a greater future? The Commission’s

comprehensive Report on Racism in Nursing serves

as a first step in helping our profession gain a better

understanding of nursing’s role in the landscape

of systemic racism, which will in turn, lay the

foundation for healing. The Commission also seeks

to collaborate with the broader nursing community

and other stakeholders to seek to dismantle

racism in nursing through continued engagement.

Additional strategies promoted by the Commission

include using the ANA’s Scope of Practice Statement

to set antiracist behaviors and standards of practice

within healthcare institutions. In addition, The

Future of Nursing 2020-2030 report outlines a

framework for addressing social needs: awareness,

adjustment, assistance, alignment and advocacy.

Awareness is the ability for each of us to

understand the issues and to be bold enough to

hold these issues with the same respect that we

would any other area of practice. This is having a

questioning attitude in areas of discrimination and

under-representation, and diving into the research

and evidence base. Do you know and understand the

race-driven aspects of social determinants of health

and how discrimination in your service area affect

your patient populations?

Adjustment is identifying the issue and making

needed changes. When areas of discrimination and

disparity are occurring, it is never enough to just

be aware of the situation. We must be brave to call

out the issues and make the necessary adjustments

in collaboration with all those the adjustments will


Assistance is showing up and connecting the

issue with those that can remedy it. As nurses, we

can make an impact by making connections in our

profession and in our patients with services that can

help bring about change. Within nursing, we can

find toolkits for addressing race and discrimination

through organizations like the CDC, The Virginia

Department of Health and commonwealth-based

professional nursing organizations. Teaming with

these organizations will help keep you informed and

assist in the dialog for these crucial conversations

while also giving you opportunities to get involved.

Alignment is the act of supporting and being

involved with and using your resources to promote

healing and change. For nurses, this means being

involved in your area of practice, system, and

professional nursing organization, such as the

Virginia Nurses Association (VNA) and American

Nurses Association (ANA). Showing up isn’t just

about networking; it is prioritizing resources to

align with the needs for equity and inclusion. A

very important area of alignment is mentoring

which is emerging as an effective treatment to the

crippling chronic disease of racism. [10] Not only is

the mentor relationship beneficial for both parties,

but the mentee has demonstrated better long-term

projections in salaries, promotions, satisfaction and

organizational commitment. [3]

Advocacy is the powerful and meaningful action

of collaboration between nurses and communities, to

have a shared vision and then pushing that vision

to spark social change. In this case, nurses have

been granted the trust of their communities and

with our strong collective voice, we can advocate for

both the individual and the community. We can no

longer tolerate discrimination, of any sort, and this

is universally applicable for any practice setting. We

are stronger together!

As nurses, it is our duty to remove barriers to

healing and promote the health of our profession

and our communities. Just as we would speak up for

our patients and take pride in their care, we must

also speak up for our profession. We must end the

disabling disease of racism and discrimination

as it holds us back from the visions we have for

health within our communities and profession.

Collectively, we must align our voice, resources,

and positions with practices that are inclusive and

promote a healthy and diverse workforce, academia

and research. It is imperative to mentor our future

generations of nurses and show them that the

sky isn’t the limit, it is only the beginning. We are

starting this journey, but this time together, as


Works Cited

[1] Merriam-Webster, "Merriam Webster Dictionary," 18

June 2022. [Online]. Available: https://www.merriamwebster.com/dictionary/reckoning.

[2] P. D’Antonio and D. Tobbell, "Report Series: Racism

in Nursing.," National Commission to Address Racism

in Nursing , 2022. [Online]. Available: https://




19 June 2022].

[3] T. Harris, "The Reality for Minorities Exploring

Nurse," JONA, vol. 51 , no. 6, pp. E18-E19, 2021.

[4] National Academies of Sciences, Engineering, and

Medicine, "5 The Role of Nurses in Improving Health

Equity.," National Academy Press, Washington D.C.

doi: 10.17226/25982., 2021.

[5] U.S Department of Health and Human

Services, Health Resources and Services

Administration,Bureau of Health Workforce, National

Center for Health Workforce Analysis, "2018 National

Sample Survey of Registered Nurses," HRSA Health

Workforce, , Rockville, Maryland, 2019.

[6] United States Census Bureau , "United States

Department of Commerce," 2021. [Online]. Available:


PST045221. [Accessed 18 June 2022].

[7] R. Zambrano, "The Value and Imperative of

Diversity Leadership Development and Mentoring

in Healthcare," Journal of Healthcare Management,

vol. 64, no. 6, pp. p 356-358 doi: 10.1097/

JHM-D-19-00209, 2019.

[8] Minority Nurse , "Nursing Statistics," Springer

Publishing Company, 2022. [Online]. Available:


[Accessed 18 June 2022].

[9] Virginia Department of Health Professions, "Virginia’s

Registered Nurse Workforce: 2020," Healthcare

Workforce Data Center, 2020. [Online]. Available:


hwdc/nurse/0001RN2020.pdf. [Accessed 18 June


[10] C. Vassie, S. Smith and K. Leedham-Green,

"Factors impacting on retention, success and

equitable participation in clinical academic careers:

a scoping review and meta-thematic synthesis,"

BMJ Open , Vols. 10(3):e033480 doi:10.1136/

bmjopen-2019-033480, 2020.

[11] National Academies of Sciences, Engineering, and

Medicine., "The Future of Nursing 2020-2030: -

Charting a Path to Achieve Health Equity: Report

Brief," The National Academies Press. https://nap.




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Page 10 | August, September, October 2022

Virginia Nurses Today | www.VirginiaNurses.com

What’s all the buzz: Future of Nursing 2020-2030,

Charting a Path to Achieve Health Equity

The Future of Nursing, first published by the

Institute of Medicine in 2010, explores how nurses'

roles, responsibilities, and education must change

significantly to meet the increased demand for care

that will be needed to advance improvements in

America's increasingly complex health system.

In the decade since, the world has come to

understand the critical importance of health to

all aspects of life, particularly the relationship

among what are termed social determinants of

health (SDOH), health equity, and health outcomes.

In a year that was designated to honor and uplift

nursing (the International Year of the Nurse and the

Midwife 2020), nurses were placed in unimaginable

circumstances by the COVID-19 pandemic. The

decade ahead will demand a stronger, more

diversified nursing workforce that is prepared to

provide care; promote health and well-being among

nurses, individuals, and communities; and address

the systemic inequities that have fueled wide and

persistent health disparities.

The vision of the Committee on the Future of

Nursing 2020–2030, which informed the current

report, is the achievement of health equity in

the United States built on strengthened nursing

capacity and expertise. By leveraging these

attributes, nursing will help to create and contribute

comprehensively to equitable public health and

health care systems that are designed to work for

everyone. To achieve health equity, the committee

also envisions a major role for the nursing profession

in engaging in the complex work of aligning public

health, health care, social services, and public

policies to eliminate health disparities and achieve

health equity.

Specifically, with implementation of the

Future of Nursing 2020-2030 (https://nam.edu/


report recommendations, the committee envisions

10 outcomes that position the nursing profession to

contribute meaningfully to achieving health equity.

Those outcomes are identified in the chart at right.

Achieving Health Equity Through Nursing:

Desired Outcomes

Nurses are prepared to act individually,

through teams, and across sectors to meet

challenges associated with an aging population,

access to primary care, mental and behavioral

health problems, structural racism, high

maternal mortality and morbidity, and

elimination of the disproportionate disease

burden carried by specific segments of the U.S.


Nurses are fully engaged in addressing the

underlying causes of poor health. Individually

and in partnership with other disciplines and

sectors, nurses act on a wide range of factors

that influence how well and long people live,

helping to create individual- and communitytargeted

solutions, including a health in all

policies orientation.

Nurses reflect the people and communities

served throughout the nation, helping to ensure

that individuals receive culturally competent,

equitable health care services.

• Health care systems enable and support nurses

to tailor care to meet the specific medical and

social needs of diverse patients to optimize their


Nurses’ overarching contributions, especially

those found beneficial during the COVID-19

pandemic, are quantified, extended, and

strengthened, including the removal of

institutional and regulatory barriers that

have prevented nurses from working to the

full extent of their education and training.

Practice settings that were historically

undercompensated, such as public health and

school nursing, are reimbursed for nursing

services in a manner comparable to that of

other settings.

Nurses and other leaders in health care and

public health create organizational structures

and processes that facilitate the profession’s

expedited acquisition of relevant content

expertise to serve flexibly in areas of greatest

need in times of public health emergencies and


Nurses consistently incorporate a health equity

lens learned through revamped academic and

continuing education.

Nurses collaborate across their affiliated

organizations to develop and deploy a

shared agenda to contribute to substantial,

measurable improvement in health equity.

National nursing organizations reflect an

orientation of diversity, equity, and inclusion

within and across their organizations.

Nurses focus on preventive person-centered

care and have an orientation toward

innovation, always seeking new opportunities

for growth and development. They expand

their roles, work in new settings and in new

ways, and markedly expand their partnerships

connecting health and health care with all

individuals and communities.

Nurses attend to their own self-care and help

to ensure that nurse well-being is addressed

in educational and employment settings

through the implementation of evidence-based


Source: The National Academy of Sciences

The Virginia Nurses Association and Virginia

Nurses Foundation met at the end of June to

identify new three-year strategic imperatives, and

will include details of the new strategic plan in

the November issue of Virginia Nurses Today.

Source: https://campaignforaction.org/


Source: The National Academy of Sciences

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RN, NBCSN led the training

of nearly 200 school nurses in

Youth Mental Health First Aid.

This follows several smaller

training programs she has led

for the foundation. The training

was held in Roanoke as part of the Virginia Departments

of Education and Health’s Summer Institute for School

Nursing, and is a huge stride forward in VNF ensuring

that nurses and other leaders at K-12 schools are better

prepared to respond to the needs of the commonwealth’s

youth. VNF had previously supported Na-Keisha’s

participation in the instructor-level training, thanks

to funding from a Robert Wood Foundation (RWJF)

Innovations Award, and is incredibly appreciative of this

collaboration and her passion for ensuring the mental

health of our youth.


Prince William-Manassas Regional Adult Detention

Center, located in Manassas, Virginia, are hiring

Licensed Practical Nurses (LPN), Registered Nurses

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www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2022 | Page 11

The Time for Change is NOW!

By VNA & VNF DEI Council

Chair Vivienne McDaniel,


“A toxic combination of

poor social policies and

programs, unfair economic

arrangements, and bad

politics is responsible for the

fact that a majority of people

in the world do not enjoy the

good health that is biologically

possible.” - Commission on SDOH

The time for change is now! It is time for all nurse

professionals to move from thoughts, ideas, and

theories about achieving equity and health equity

to “walking the talk,” taking action, and being

intentional in their walk. There are several tools

that have been developed to help us actualize our

equity and health equity initiatives but none greater

than the seminal National Academies of Medicine

masterpiece, the Future of Nursing 2020-2030:

Charting a Path to Achieve Health Equity report.

During the 2021 National Association of

Nigerian Nurses in North America conference

I was a co-presenter with Dr. Grace Ogiehor-

Enoma. We discussed pertinent information and

recommendations from the Future of Nursing 2020-

2030: Charting a Path to Achieve Health Equity

report. Dr. Grace touched on five key messages

garnered from the report:

• Key Message 1: Policymakers need to

permanently lift unnecessary regulatory

and practice barriers that keep nurses from

practicing within the scope of their education

and training, and that restrict people’s access

to high quality care.

• Key Message 2: Public and private payers

need to establish sustainable and flexible

payment models to support nurses in health

care and public health, including school

nurses, so that they can effectively address the

medical and social needs of people, families,

and communities.

• Key Message 3: Nursing schools need to

strengthen education curricula and expand

the environments where nurses train, better

prepare nurses to work in and with diverse

communities, and diversify nursing school

classes and faculty so nurses at all levels

reflect the communities they care for and


• Key Message 4: Employers must support

nurse well-being so they can in turn support

the well-being of others.

• Key Message 5: Nurses need to leverage their

own power to advance health equity by making

sure they are well prepared to bridge medical

and social needs; taking care of their own

mental and physical health so they can care

for others; and advocating for policies that

address poverty, racism and other conditions

that stand in the way of health and well-being.

The presentation also included discussions on

the social determinants of health (SDOH). Social

determinants of health (SDOH) are the conditions in

the environments where people are born, live, learn,

work, play, worship, and age that affect a wide range

of health, functioning, and quality-of-life outcomes

and risks (Healthy People 2030, 2022). SDOH can

be grouped into five domains: economic stability,

education access and quality, healthcare access

and quality, neighborhood and built environment,

and social community context. Because SDOH

contributes significantly to health disparities

and inequities, it is pivotal that nurses become

knowledgeable about the content of the 2020-2030

Future of Nursing report. The report considers how

nurses should best address SDOH, and advance

effective, efficient, and equitable care for all across

the healthcare continuum.

Health inequities would not exist if there were no

discrimination, prejudices or racism in healthcare

(National Commission to Address Racism in Nursing,

2022). To address inequities and disparities you

must first work to dismantle inequitable ideology.

For our country to advance health equity for all, the

systems that educate, pay and employ nurses need

to permanently remove barriers to allow them to do

this work, value their contributions, prepare them to

understand and tackle issues that impede advancing

equity, and diversify the nursing workforce (Future

of Nursing Campaign for Action, 2022). Those were

among the four key takeaways suggested during a

May 2022 Campaign for Action Summit.

It is honorable to ensure that everyone gains

access to the same resources according to their

needs but true health equity requires nurses to

always address the disparities and inequities that

can prevent people from living full and healthy lives.

It is incumbent on all nurses to challenge injustices

that contribute to negative care outcomes. It will not

happen unless nurses identify system facilitators

and barriers to health equity and take action.

Examine your readiness or your organization’s

willingness to chart a path to achieve health

equity, then download the Future of Nursing 2020-

2030 report from the National Academies Sciences

Engineering Medicine website at https://nap.


In an effort to build healthier communities

through nursing and to guide you on your path to

achieve health equity, the Campaign for Action

has drafted action plans that provide a solid

foundation of actionable recommendations and subrecommendations

for organizations and for nurses

in roles of education, leadership, practice, research

and policy and advocacy. Drs. Sue Hassmiller and

Susan Reinhard suggest selecting at least two of the

Recommendations for implementation based on your

individual or organizational needs.

Draft Action Plans

• Recommendation #1: CREATING A SHARED


• Recommendation #2: SUPPORTING NURSES


• Recommendation #3: PROMOTING NURSES’


• Recommendation #4: CAPITALIZING ON


• Recommendation #5: PAYING FOR NURSING


• Recommendation #6: USING TECHNOLOGY




• Recommendation #7: STRENGTHENING


• Recommendation #8: PREPARING NURSES



• Recommendation #9: BUILDING THE


The VNA-VNF Diversity, Equity, and Inclusion

Council (DEIC) has taken the Campaign for

Action challenge and has selected two of the

recommendations/sub-recommendations to implement.

DEIC believes that nurses should mirror the population

they serve. Increasing the number of nurses from

underrepresented populations on boards is another

important goal of DEIC. Being a board member gives

nurses a seat and a voice at the decision-making

table. The DEIC is pleased at the progress being made

and encourages those in positions of decision making

to improve their diversity and inclusion efforts by

appointing nurses who are historically marginalized

and underrepresented on boards. DEIC is also

encouraging nurses to be on boards outside of nursing

and healthcare as well. Using the Future of Nursing

2020-2030: Charting a Path to Achieve Health Equity

report recommendations as a framework we can move

from thoughts, ideas, and theories about achieving

equity and health equity to intentional action. Wisdom

lies in knowing when to cease talking and start acting.

The time for change is now!


Future of Nursing Campaign for Action. (2022). The

Campaign for Action May summit webinar. https://


Healthy People 2030. (2022). Social determinants of health.


National Commission to Address Racism In Nursing.

(2022). Racism in nursing. https://www.nursingworld.



Wakefield, M. K., Williams, D. R. Le Menestrel, S., &

Flaubert, J. L. (Eds.). (2021). The future of nursing

2020-2030: Charting a path to achieve health equity.

National Academies Press.

Additional Resources

Action Coalition May 2022 Summit Deck https://


Equity Toolkit Helps Communities Take on Social

Determinants of Health https://campaignforaction.


The Future of Nursing 2020-2030: Charting

a Path to Achieve Health Equity. https://nap.


Grace Ogiehor-Enoma, DHA, MSN, MPH, NE-

BC, RN is an adjunct associate professor at Hunter

College, and the executive director of the National

Association of Nigerian Nurses in North America.

Vivienne Pierce McDaniel, DNP, MSN, RN is an

adjunct assistant professor at Aspen University

School of Nursing and Health Sciences, a diversity,

equity, and inclusion consultant for James Madison

University School of Nursing and president of the

Central Virginia Chapter of the National Black

Nurses Association.


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Page 12 | August, September, October 2022

Be a JEDI: Focus on the B

Virginia Nurses Today | www.VirginiaNurses.com

Dr. Nina Beaman

Dr. Marsha


In an October 2021 study on racism in nursing fielded by the National

Commission to Address Racism in Nursing, 94% of respondents indicated

agreement with the statement “there is some or a lot of racism in the nursing

profession;” 76% of respondents attested to witnessing racism in the workplace;

and 63% reported personally experiencing racism in the workplace, with

Black nurses (92%) reporting having experienced racism the most (National

Commission, 2021). In the recently published Racism in Nursing report,

racism is identified as a preventable harm and can be mitigated by intentional

actions to change belief systems and social and organizational practices that

contribute to dual harm from structural racism, which is invisible unless one

looks for it, as it is ingrained in the structures, beliefs, policies, and practices

of our healthcare system (Nardi et al., 2020). And there is significant research

that supports that belonging is probably one of the most powerful ways to create

an inclusive environment. Belonging is an interpretation of cues that suggests

that one fits in and is welcome in a given context; it is an inference based on

observations, interactions, values, and past events that define the culture and

environment (Walton, et al., 2017)

So, how can nurses build work environments that promote belonging along

with justice, equity, diversity, and inclusion or JEDI? Let’s unpack the acronym

JEDI first.

Social justice, put simply, is the paradigm that everyone deserves equal

rights and opportunities (American Public Health Association). Considering

your workplace, is everyone treated fairly and equally? If some need to build

more skills, are they given the opportunity? Or do some receive special benefits

because they demand them, while others do not get what they need to do their


Equity is distinguished from equality in that it refers to fairness and justice,

not just providing the same to all (National Association of Colleges and Employers).

The same source emphasized that equity acknowledges that everyone does not

start at the same place, so sometimes adjustments need to be made to account for

imbalances. According to Pat Benner’s theory, mentoring is needed to help nurses

move from novices to become experts (Thomas & Kellgren, 2017). So, each nurse

may be at a different point in their career journey, needing different resources

and guidance. There should be no stigma in nurses asking for what they need to

become better nurses.

Diversity is not just about skin tone. The true focus of diversity is

an understanding and appreciation for people who come from different

backgrounds and cultures (American Library Association). A workplace that

embraces diversity has diverse viewpoints of problem solving and ways to

communicate solutions. A diverse nursing workforce can serve a diverse patient

population in more appropriate ways.

Inclusion involves not just adding diverse individuals to the workforce,

but including them on every level to participate actively in the culture of the

organization. The NeuroLeadership Institute found data that showed that

benefits of inclusivity in the workplace included improving team collaboration,

greater efficiencies, increased performance, and higher employee engagement

(Strup, 2019). In order to reap the benefits of inclusion, you have to create an

environment of belonging. Inclusion and belonging are connected. Inclusion

involves efforts and behaviors that can be fostered by the organization or

actually by the people in it. Belonging is something that employees themselves

feel and results from your inclusion efforts.

Inclusive behaviors should result in a sense of belonging as an outcome. And

here are some of these behaviors:

• recognize that each individual has unique perspectives and talents by

amplifying these differences as strengths

• broaden your understanding of how your biases show up in your

micro behaviors and how your behaviors may advantage some while

disadvantaging others

• practice allyship by being an upstander rather than a bystander

• develop inclusive leadership skills to leverage diversity for innovative

problem solving and solution finding

Although improving JEDI at the workplace is a good strategy, the ultimate

goal for any nursing organization must be to focus on the Belonging. Other

initiatives will not promote a positive workplace unless the employees feel a

sense that they belong to the work culture. Belonging builds collaboration,

loyalty, and dedication—traits nurses are known to be able to foster if they are

in environments where their voices are heard, their contributions are noticed,

and they feel that whoever they are—they are valued.


American Library Association. (n.d.). Defining diversity—Strategic planning for diversity.

Retrieved May 22, 2022, from https://www.ala.org/advocacy/diversity/workplace/


American Public Health Association. (n.d.). Social justice and health. Retrieved May 22,

2022, from https://www.apha.org/what-is-public-health/generation-public-health/ourwork/social-justice

National Association of Colleges and Employers. (n.d.). Equity. Retrieved May 22, 2022,

from https://www.naceweb.org/about-us/equity-definition/

Nardi, D., Waite, R., Nowak, M., Hatcher, B., Hines-Martin, V., & Stacciarini, J.-M. R.

(2020). Achieving health equity through eradicating structural racism in the United

States: A call to action for nursing leadership. Journal of Nursing Scholarship: An

Official Publication of Sigma Theta Tau

International Honor Society of Nursing. 52(6), 696-704. https://doi.org/10.1111/jnu.12602.

Strup, R. (2019). Active inclusion. TD: Talent Development, 73(5), 26–28.

Thomas, C. M., & Kellgren, M. (2017). Benner’s novice to expert model: An application for

simulation facilitators. Nursing Science Quarterly, 30(3), 227–234.

Walton GM, Brady ST. Elliot AJ, Dweck CS, Yeager DS. The many questions of belonging.

In: Handbook of Competence and Motivation: Theory and Application. 2017:2nd ed.

New York, NY: Guilford Press; 272–293.

Bookmark VNA’s Website

Calendar for Virtual Legislative

Advocacy Hours

In order to accommodate both legislators’ and nurses’ busy schedules, VNA

will continue to hold the multiple [free] Legislative Advocacy Hours virtually.

The 10 anticipated Legislative Advocacy Hours will be held in all areas of

the commonwealth in the weeks following the November elections. Nurse

participants will receive their chapter’s legislative guide, a copy of VNA’s public

policy platform, and will be able to meet virtually with the legislators in their

area. Ample time will be planned for Q&A.

To find a legislative reception near you, visit our events calendar at


VNA members can expect to receive an email in the coming months with

the dates and registration links for the Legislative Advocacy Hours. This

information will also be posted to VNA’s Facebook page, www.facebook.com/

vanurses. Questions? Contact VNA Membership Manager MJ Gearles at


Page 14 | August, September, October 2022

VNF President's Message

Virginia Nurses Today | www.VirginiaNurses.com

Mental Health Roundtable:

A Special Focus on Youth Mental Health

Phyllis Whitehead, PhD, APRN/CNS, ACHPN,


I am excited to share that our special focus

on Youth Mental Health on May 5, 2022 was a

huge success with 196 participants from multiple

organizations throughout the commonwealth.

A special thanks to the Virginia Association of

School Nurses for their collaboration on this event.

Additionally, we collaborated with the Public

Health Nurses of the Commonwealth of Virginia

and the Virginia Association of Community Service


The day was packed with excellent

presentations from a variety of speakers. Angela

Ransom Jones started off the roundtable by

sharing “Themes in K-12 Mental Health, Resource

Gaps and Successes.” Dr. Jones serves as the

Director of Culture, Climate & Student Services

at Richmond City Public Schools, which has a

student population in excess of 20,000. Dr. Jones

is trained as a Psychologist both in School and

Counseling Psychology.

Dr. Jones launched offered a 5,000’ look at K-12

mental health supports, and what we can learn

from the gaps and “gold” of current trends and

infrastructure. To be clear, she said, the pandemic

has exacerbated a mental health crisis among our

children that already existed.

“Schools,” she said, “are often considered

the natural and best setting for comprehensive

prevention and early intervention services for

all students.” Recognizing that more than 75%

of children and youth do not receive the mental

health services they need,” she examined the

promising practices that DO work, including:

• Safe and welcoming school cultures

• Promoting the understanding that positive

mental health and positive physical health

are inextricably link

• intentional identification and naming of

emotions and feelings, educating parents,

teachers and staff / nursing staff.

Dr. Jones underscored the importance of the

number of nurses, psychologists, social workers,

and counselors working in schools be increased to

address the growing needs of our youth and meet

nationally recommended ratios. Concurrently, it is

essential that we lean on our community partners,

she said, such as the local community service

boards (CSBs) throughout Virginia for those

children in crisis. Doing so will enable school

staffs to better focus on early intervention and

non-crisis support of all children.

Na-Keisha White, RN, Coordinator of School

Health for Richmond City Public Schools, a

position she has held for four years, shared her

passion on the importance of amplifying the

role of the school nurse in mental healthcare. In

2019, VNF was given a Robert Wood Johnson

Foundation Innovations Fund Award to advance

our work in mental healthcare. We used some of

the grant monies to enable a nurse, Na-Keisha

White, MSN-PH, RN, NBCSN, to participate in the

Mental Health First Aid Instructor Training, Youth

Module. Na-Keisha, coordinator of health services

with Richmond Public Schools, will now serve as

instructor for three groups of RPH school nurses,

counselors, and behavioral health professionals

participating in the program in the coming

months. We’re excited to be furthering the mental

health education of these professionals and hope

to expand our reach to other school districts in the


Ms. White discussed the interventions in

place at RPS and the importance of amplifying

the school nurses role in mental healthcare and

recognizing school nurses as essential members

of the care coordination team who are able to

effectively assist students and families, meeting

them at the point of their needs. School nurses,

she added, should be positioned to facilitate the

division’s trauma responsive culture to fosters


During the afternoon session, Congresswoman

Bonnie Watson Coleman shared her vision for

equity as she is known for her advocacy work and is

serving her fourth term in the United States House

of Representatives. She has had an impressive

career in public service advocating for the needs of

New Jersey families and the equitable treatment of

all people. She is the first Black woman to represent

New Jersey in Congress and serves on several

committees as chair or co-chair and is vice chair

at large of the Congressional Progressive Caucus.

Representative Watson Coleman shared that her

work in the House centers on her belief that, in

the United States of America, there’s a floor below

which we should never allow any child, any family,

or any person to fall, therefore her legislative work

seeks to bridge the gap

for socially disadvantaged

populations, and other

vulnerable groups in our


Phyllis Whitehead,




Congresswoman Coleman introduced the

Pursuing Equity in Mental Health Act, which

addresses the disparities in access, care, and the

study of mental health issues among people of

color. On April 30, 2019, Representative Watson

Coleman established the Congressional Black

Caucus (CBC) Emergency Taskforce on Black

Youth Suicide and Mental Health, empowering

a working group of experts composed of the

country’s leading Black academic, advocacy

and practicing experts, all who had the same

passion for closing the mental health care gap

for black youth. Over the span of eight months,

the taskforce and working group held hearings,

forums, events and listening sessions to identify

both the causes and potential solutions to

this burgeoning crisis. On December 17, the

taskforce released the report, Ring the Alarm:

The Crisis of Black Youth Suicide in America,

and simultaneously introduced legislation aimed

at closing the mental health care gap for that


Much more attention and action are needed

to better care for our youth’s mental health.

Current mental health focusing on substance

abuse and early intervention strategies, selfharm,

transgender and LGBTQ+ issues (including

legal considerations), more suicide interventions

and case studies, bullying, and psychosomatic


The Virginia Nurses Foundation is committed

to improving the health of Virginia’s communities

by developing an educated and diverse nursing

workforce through leadership development,

research, and innovation. We know that nurses

are and will continue to make a crucial impact

on improving the mental health of our youth.

If you are interested in becoming involved with

the work of the Virginia Nurses Foundation

and/or the Mental Health Roundtable, please

contact VNA Membership Manager MJ Gearles

at mgearles@virginianurses.com. For more

information on the Mental Health roundtable,

visit: https://virginianurses.com/mpage/Mental



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Page 16 | August, September, October 2022

Virginia Nurses Today | www.VirginiaNurses.com

How nurses can counter health misinformation

The wealth of health information available online

can be beneficial for patients, but only if that

information is accurate. Although recent issues

on misinformation have centered on the COVID-19

pandemic, misinformation has been a problem in

many other areas related to wellness and healthcare,

such as dieting, exercise, and vitamins and

supplements. Although misinformation isn’t new,

the internet and social media have supercharged the

ability for it to spread.

Nurses and nurse practitioners have the power

to counteract misinformation, but first, they need

to understand the nature of the problem and why

people may be inclined to believe information that is

not grounded in science.

Misinformation overview

Two definitions help better understand this issue.

Misinformation refers to claims that conflict with

the best available scientific evidence. Disinformation

refers to a coordinated or deliberate effort to

spread misinformation for personal benefit, such

as to gain money, power, or influence. An example

of misinformation is the false claim that sugar

causes hyperactivity in children. An example of

disinformation is a company that makes false

scientific claims about the efficacy of their product to

boost sales. This article focuses on misinformation.

People increasingly seek health information

online through sources such as search engines,

health-related websites, YouTube videos, and apps.

Unfortunately, misinformation can occur at all these

points, as well as via blogs, social media platforms,

and user comments on articles or posts. Even when

not actively seeking health information, people can

be exposed to it through media outlets such as print,

TV, and streaming networks.

Why do people believe misinformation?

Several factors can lead to people accepting


Health literacy. Health literacy refers not

only to the ability to read and understand health

information, but the appraisal and application of

knowledge. People with lower levels of health literacy

may be less able to critically assess the quality

of online information, leading to flawed decisionmaking.

One particular problem is that content is

frequently written at a level that is too high for most


Distrust in institutions. Past experiences with

the healthcare system can influence a person’s

willingness to trust the information provided. This

includes not only experiences as an individual

but also experiences of those in groups people

affiliate with. Many people of color and those with

disabilities, for example, have had experiences with

healthcare providers where they did not feel heard

or received substandard care, eroding trust. In

some cases, healthcare providers have lied, as was

the case with the Tuskegee syphilis study of Black

men; the men were not told they had the disease or

offered treatment. In addition, some people have an

inherent distrust of government, leading them to

turn to alternative sources of information that state

government-provided facts are not correct.

Emotions. Emotions can play a role in both

the spread and acceptance of misinformation.

For example, false information tends to spread

faster than true information, possibly because of

the emotions it elicits. And Chou and colleagues

note that during a crisis when emotions are high,

people feel more secure and in control when they

have information—even when that information is


Cognitive bias. This refers to the tendency to

seek out evidence that supports a person’s own point

of view while ignoring evidence that does not. If

the misinformation supports their view, they might

accept it even when it’s incorrect.

How to combat misinformation

Recommending resources, teaching consumers

how to evaluate resources, and communicating

effectively can help reduce the negative effects of


Recommendations. In many cases, patients and

families feel they have a trusting relationship with

their healthcare providers. Nurses can leverage

that trust by recommending credible sources of

health information. Villarruel and James note

that before making a recommendation, nurses

should consider the appropriateness of the source.

For example, a source may be credible, but the

vocabulary used may be at too high a level for the

patient to understand. And someone who prefers

visual learning will not appreciate a website that

is dense with text. Kington and colleagues suggest

using these foundational principles when evaluating


• Science-based: The source provides information

consistent with the best scientific evidence

available and meets standards for creation,

review, and presentation of scientific content.

• Objective: The source takes steps to reduce

the influence of financial and other forms

of conflict of interest or bias that could

compromise or be perceived to compromise the

quality of the information provided.

• Transparent and accountable: The source

discloses limitations of the provided

information, conflicts of interest, content

errors, or procedural missteps.

• Each principle has specific attributes, which

are listed in the article available for download

at https://www.ncbi.nlm.nih.gov/pmc/articles/


Another tool for evaluating sources of health

information is the CRAAP test (Currency, Relevance,

Authority, Accuracy, and Purpose), which focuses

on evaluating the accuracy of research. It consists

of multiple questions in each category (see https://

researchguides.ben.edu/source-evaluation). For a

more concise tool, nurses can turn to the algorithm,

developed by Kington and colleagues, for assessing

the credibility of online health information.

Although the tendency is to recommend

government sources such as the Centers for Disease

Control and Prevention and National Institutes

of Health, as noted earlier, some people do not

trust the government. In this case, sources such

as MedlinePlus, World Health Organization, and

condition-specific nonprofit organizations (e.g., the

American Heart Association, American Cancer

Society, Alzheimer’s Association) might be preferred.

Education. The sheer scope of the information

found online can make it difficult for even the most

astute consumer to determine what is accurate.

Nurses can help patients by providing tools they

can use to evaluate what they read. The website

Stronger suggests a four-step process for checking

for misinformation (https://stronger.org/resources/


• Check the source. Is the website or person

known for conflating facts and opinions?

• Check the date. Is it implied that the

information is recent even though it’s not?

Is there more current information available


• Check the data and motive. What is the original

source of the information? Are they just

looking for anything that supports their own


• If still unsure, use a reputable, fact-checking site

such as Snopes.com or FactCheck.org.

UCSF Health (https://www.ucsfhealth.org/

education/evaluating-health-information) provides

a useful short overview for patients on how to

evaluate the credibility (e.g., authors’ credentials)

and accuracy (e.g., whether other sources support

the information) of health information and red flags

to watch for (e.g., outdated information, no evidence

cites, poor grammar).

Communication. Communication is the best way

to correct misinformation and stop its spread. This

starts with the nurse clearly explaining the evidence

for recommended interventions. From the start,

the nurse should establish the principle of shared

decision-making, which encourages open discussion.

A toolkit from the U.S. Surgeon General on

misinformation (https://www.hhs.gov/sites/default/


recommends that nurses take time to understand

each person’s knowledge, beliefs, and values

and to listen with empathy. It’s best to take a

proactive approach and create an environment that

encourages patients and families to share their

thoughts and concerns (see “A proactive approach”).

www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2022 | Page 17

Nurses should remain calm, unemotional, and


A proactive approach

Villarruel and James provide the following

suggestions for talking with patients about


• Acknowledge the barrage of health information

that is available online and through other

sources and the difficulty of “knowing who and

what to trust.” (“I know there’s a great deal of

information about COVID-19 and not all of it

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

and know what to trust.”)

• Assess where patients and families obtain

their health information and what sources they

trust. Keep in mind that even when a source

is credible, a person may not trust it, and a

person may trust a site that is not credible.

(“Where do you get most of your information

about COVID-19? What makes that a trusted

source for you?”)

• Provide alternative and accurate sources

of information. (“I’m not familiar with that

website, but I’ll look at it and let you know

what I think. In the meantime, here’s where I

get information and why I trust it.”)

• When correcting misinformation be

nonjudgmental. (“I’ve heard similar information

about not getting vaccinated. Here’s what I’ve

learned from the science and why I believe

getting vaccinated is important and safe.”)

Health and Human Services. 2021. https://www.hhs.


Stronger. How to spot misinformation. n.d. https://


Schulz PJ, Nakamoto K. The perils of misinformation:

When health literacy goes awry. Nat Rev Nephrol. 2022.


Swire-Thompson B, Lazer D. Public health and online

misinformation: Challenges and recommendations.

Annu Rev Public Health. 2020;41:433-451.

UCSF Health. Evaluating health information. n.d. https://


Villarruel AM, James R. Preventing the spread of

misinformation. Am Nurs J. 2022;17(2):22-26. https://


Disclaimer: The information offered within this

article reflects general principles only and does

not constitute legal advice by Nurses Service

Western State Hospital

Organization (NSO) or establish appropriate or

acceptable standards of professional conduct. Readers

should consult with an attorney if they have specific

concerns. Neither Affinity Insurance Services, Inc. nor

NSO assumes any liability for how this information

is applied in practice or for the accuracy of this

information. Please note that Internet hyperlinks cited

herein are active as of the date of publication but may

be subject to change or discontinuation.

This risk management information was provided

by Nurses Service Organization (NSO), the nation's

largest provider of nurses’ professional liability

insurance coverage for over 550,000 nurses since

1976. The individual professional liability insurance

policy administered through NSO is underwritten

by American Casualty Company of Reading,

Pennsylvania, a CNA company. Reproduction

without permission of the publisher is prohibited. For

questions, send an e-mail to service@nso.com or call

1-800-247-1500. www.nso.com.

Source: Villarruel AM, James R. Preventing the spread of

misinformation. Am Nurs J. 2022;17(2):22-26. https://


Nurses also can prepare for conversations

where they know misinformation may occur such

as vaccination. For example, the CDC has a page

on its website that addresses infant vaccination


conv-materials.html). It includes resources such as

responses to possible questions.

Listening and providing information may not

be enough. In some cases, a patient may not want

to hear what the nurse is saying. When patients

become angry or frustrated, the nurse should

remain calm. It can be helpful to acknowledge

the frustration (“I can see that you are upset.”)

Depending on the situation, it may be possible to

briefly summarize key points before reinforcing the

desire to provide information to support the patient

and then move on to another topic. The goal is to

maintain a positive nurse-patient relationship, which

leaves the door open to further conversation.


As with any patient education, it’s important to

document discussions related to misinformation

in the patient’s health record. Nurses should

objectively record what occurred and include any

education material they provided. Should the

patient experience harm as a result of following

misinformation instead of the recommended

treatment plan, this documentation would

demonstrate the nurse’s efforts and could help avoid

legal action.

A positive connection

Nurses can serve as a counterbalance to the

misinformation that is widely available online.

Providing useful resources, educating consumers,

and engaging in open dialogue will promote the

ability of patients to receive accurate information so

they can make informed decisions about their care.

By Georgia Reiner, MS, CPHRM, Risk Analyst,

Nurses Service Organization (NSO)


CDC. How to address COVID-19 vaccine misinformation.

2021. https://www.cdc.gov/vaccines/covid-19/healthdepartments/addressing-vaccine-misinformation.html

CDC. Talking with parents about vaccines for infants.

2021. https://www.cdc.gov/vaccines/hcp/conversations/


CDC. The U.S. public health service syphilis study at

Tuskegee. 2021. https://www.cdc.gov/tuskegee/index.


Chou W-YS, Gaysynsky A, Vanderpool RC. The COVID-19

misinfodemic: Moving beyond fact-checking. Health

Educ Behav. 2020;1090198120980675:1-5.

Kington RS, Arnesen S, Chou W-YS, Curry SJ, Lazer D,

and Villarruel AM. Identifying credible sources of health

information in social media: Principles and attributes.

NAM Perspect. 2021:10.31478/202107a. https://www.


Kurpiel S. Evaluating Sources: The CRAAP Test.

Benedictine University. 2022. https://researchguides.


Office of the Surgeon General. A Community Toolkit for

Addressing Health Misinformation. US Department of

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Page 18 | August, September, October 2022

Virginia Nurses Today | www.VirginiaNurses.com

Retired Registered Nurse and

Centenarian Gertrude Clarke Still Loves Nursing

By VNA & VNF DEI Council Chair Vivienne McDaniel, DNP, MSN, RN

Retired mental health professor Gertrude Clarke turned 100 years old in

June. She said, “don’t put the actual date because, you know, they have those

identity thieves out there.” Ms. Gertrude is a delightful, spry young lady and

doesn’t look or act anything like what you may expect of a centenarian. She was

a 1946 graduate of the Saint Philip School of Nursing. During the time of her

attendance, southern laws and social practices did not allow entry of “Negroes”

into nursing schools with White students.

Since healthcare facilities were segregated, the Medical College of Virginia

established a separate school of nursing for Women of Color to provide trained

nurses to serve the underserved Black patients admitted to Saint Philip

Hospital. Gertrude said, “I purchased a bus ticket to go to New York and left

immediately after graduation to go work somewhere that welcomed me.” Ms.

Gertrude credits her longevity to her serving God and humanity. She said she

still loves nursing and would do it all over again minus the segregation. Her

advice to current and future nurses is to use your voice to advocate for patients

and the profession of nursing, and to “keep God in everything you do.” Teaching

is in her DNA; at 100, Ms. Gertrude still teaches Sunday School at her church.

Learn more about Ms. Gertrude in the February 2023 issue of the Virginia

Nurses Today.

With Ms. Gertrude Clarke (in pink) from left to right are Drs. Vivienne

McDaniel, Karen Faison and Stephanie Terry, (all professors of nursing).

(Photo credit: Vivienne Pierce McDaniel)

St. Philip Hospital photo courtesy of

VCU Libraries

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www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2022 | Page 19

Reminder to VNA Members – Vote for the Leaders of

the Virginia Nurses Association by August 22!

For VNA members, voting will open June 27 -

August 22. A link to the ballot has been sent to all

members by email. Here are the slate of candidates

and profiles on each of our candidates running for

office! If you’re a member and haven’t received your

ballot by email for voting, please first check your

spam folder and if you’re still unable to locate it

contact VNA Membership Manager MJ Gearles at


The following board positions are open for the

2022 Election (2-year terms):

• Secretary

• Commissioner on Nursing Education

• Commissioner on Workforce Issues

• Commissioner on Nursing Practice*

• Director-at-Large, Frontline Nurse

• Director-at-Large, APRN**

• Three (3) members will also be elected to the

Committee on Nominations

* The Commissioner on Nursing Practice serves

ex-officio in the same position on the Virginia

Nurses Foundation Board of Trustees.

** The Director-at-Large, APRN position is a oneyear

term to conclude on December 31, 2022.

The position will be on the ballot again in 2023

for a two-year term.

Click here to review the position descriptions,

nominations policies, and Procedures Manual!

2022 Election Timeline

• Call for Nominations - April 1 - May 27

• Nominating Committee prepares slate of

candidates - June 7

• VNA Board of Directors votes to approve slate

of candidates - June 15

• Slate of Candidates published and distributed -

June 20

• Online voting begins (online and paper) -

June 27

• Deadline for ballot requests - August 12

• Voting ends - 11:59 pm on August 22

• Election results shared at VNA Membership

Assembly - date TBD

2022 Slate of Candidates


Tiffany Covarrubias-Lyttle, BS, BSN, RN, PCCN

(Incumbent) Chapter 3

Commissioner on Nursing Education

Shanna Akers, EdD, MSN/MBS-HC,

RN, CNE, NEA-BC Chapter 3

Caryn Brown, MSN, MHA, RN,

NPD-BC, NEA-BC Chapter 3

Commissioner on Workforce Issues

June Noel, MSN, RN Chapter 5

Richard Ridge, PhD, RN,

NEA-BC, CNL (Incumbent) Chapter 7

Commissioner on Nursing Practice

Mesha Jones, MSN, RN, CCRN, CWON Chapter 7

Erin Keister, MSN, CPPS,

CPHQ, NE-BC (Incumbent) Chapter 5

Director-at-Large, Frontline Nurse

Ericka Daley, BSN, RN, VAEMT-P Chapter 5

Director-at-Large, APRN

Sarah Birch, DNP, APRN, CPNP-PC Chapter 8

VNA’s Committee on Nominations

April Howell, MSN, RN, NE-BC Chapter 5

Vanessa Moore, RN, BSN, CDON, LNHA Chapter 4

Jeanell Webb-Jones, BSN, RN, RN-BC Chapter 7

Dana Woody, RN, MSN, DNP Chapter 3

Page 20 | August, September, October 2022

Virginia Nurses Today | www.VirginiaNurses.com

Occupational Stress: Definition, Impact, and Strategic Mitigation

Richard Ridge, PhD, RN, NEA-BC, CNL

Commissioner of Workforce

Virginia Nurses Association

Occupational stress is well known as a health risk

for a wide range of psychological, behavioral, and

medical disorders and diseases. The National Institute

for Occupational Safety and Health (NIOSH) established

a national priority agenda for policy and research 20

years ago that still guides efforts to better understand

occupational stress in general and to mitigate its

impact on the U.S. workforce across industries. 1 The

recent Covid-19 pandemic has uncovered and exacerbated numerous sources of

occupational stress within healthcare, including nursing. This article will define

occupational stress within a nursing context, describe the impact of this stress

on nurses as individuals and as a workforce, and identify several strategies to

mitigate its impact.

Occupational stress, like all forms of stress, may not be inherently

destructive or harmful. One of occupational health’s foundational principles

is that the response to stress is a normal and naturally occurring reaction

to stress of all types, including stress caused by work-related factors. 2 The

epidemiology of stress recognizes that the stress response manifests differently

depending on a wide variety of variables that may serve as protective or as

additional individual risk factors. Simply put, work is stressful to a harmful

extent when demands exceed the individual’s resources to effectively adapt.

Why is this important?

Two years into the Covid-19 pandemic, the nursing workforce supply is under

extreme threat. In a recent analysis, Auerbach and colleagues identified an

alarming decrease of 100,000 RNs in 2021, the greatest drop in a single year

over the past four decades. 3 Especially distressing is that the decrease stemmed

primarily from nurses younger than age 35. The overall reduction in supply

was due primarily to losses of hospital-employed RNs. This loss of younger RNs

will be felt for a generation in contrast to the attrition of nurses at retirement

age. The loss of frontline hospital RNs will not only mean a labor disruption

for hospitals, but also for many other care settings that depend on experienced

hospital nurses for specialty settings and practices.

What we know about nurses’ stress and their ability to adapt and function.

Several major recent surveys of nurses provide some insight into the recent

exodus of younger nurses and to understanding occupational stress from an

actionable perspective. The American Nurses Association Second Year Covid-19

Impact Assessment Survey received responses from 11,964 nurses in January

2022. 4 This survey built upon previous surveys and included questions on

mental health, well-being, financial impact, perceived organizational support

and intent to leave their current position. The responses to many items seem

to reflect opposing opinions. For example, for the question regarding intent to

leave your position within six months, 52% answered yes or maybe, and 48%

replied no. In another example, 30% of nurses rated their emotional health as

not or not at all healthy, and 37% rated theirs as emotionally healthy or very

healthy. While this survey identified numerous activities to strengthen wellbeing,

a similar distribution is seen in regard to nurses’ perceptions of their

organizations’ caring with respect to well-being. 43% of nurses disagreed

or strongly disagreed that their organizations cared about their well-being,

as compared to 32% who agreed or strongly agreed. Staffing shortages not

surprisingly were reported by 89% of acute care nurses, predominately at a

moderate or highly serious level. The majority of acute care nurses experienced

bullying and incivility from patients and families. And 20-25% experienced

incivility and bullying from colleagues, managers, and supervisors.

The ANA’s Mental Health and Wellness Survey compiled responses from

9,572 nurses in the early Fall of 2021. 5 On a scale of 1-10 rating the ability of

nurses to recover or adjust to the impact of Covid-19 on their well-being, the

average score was 6.2. But again, the survey showed high levels of responses to

items at each end of the spectrum with 42% of nurses reporting having had an

extremely stressful, disturbing, or traumatic experience due to COVID-19, and

52% reporting they had not experienced this. Thus, the impact of the trauma of

work during the pandemic was perceived differently, as one would expect from

the epidemiology of stress and its impact on health.

The third survey, undertaken by AMN Healthcare in Spring 2021, reported

data received from 6,562 active and practicing nurses who had provided direct

care within the previous year. 6 Focused on understanding nurses’ perspectives

during the pandemic, they reported the findings relative to whether they had

Covid, and whether they cared for Covid-19 patients. Over 50% of nurses

reported feeling burnt out to some degree, feeling emotionally drained, and that

their job was adversely impacting their health. Almost 40% felt misunderstood

by their employer, and over half reported not getting what they wanted from

their job. Many of these findings were worse for nurses who either had Covid-19

or who cared for Covid-19 patients.

Thus, based on the findings from these three surveys it is reasonable to

conclude, within the limitations of these individual studies, that many nurses

are adapting and coping well, while many are not. In terms of the nursing

workforce, it is not an overstatement to say that each nurse who leaves the

profession is one too many. System solutions must be strengthened where

already in place and introduced where they are missing.

Strategic Mitigation (Taking Action)

Recognizing occupational stress in nursing as a public health issue can

frame a comprehensive and systematic approach to address immediate, midrange,

and long-term needs. Effective mitigation of occupational stress for

nurses requires three levels of interventions: primary, secondary, and tertiary.

Primary interventions aim to prevent occupational stress harm before it

occurs. Secondary prevention aims to reduce the impact of stress once harm

has occurred, and tertiary prevention aims to lessen the long-term impact of

nurses who experience persistent harmful effects. Each of these three levels of

prevention must be addressed in a systematic way at all levels, including the

policy and population level, organization level, and by the individual nurses.

At a fundamental policy level, as envisioned in the FON report, major changes

are needed in payment systems to healthcare organizations that shift away

from incorporating nurses in the room rate. Such mechanisms incentivize

minimization of nurse resources, rather than recognizing and paying for the

value that nursing contributes to healthcare. The current pay for performance

structures may be a good beginning, but they are insufficient to fully incentivize

organizations to optimize rather than minimize nurse resources. This should

have a positive influence on nurse workload. Other policies, with associated

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www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2022 | Page 21

regulatory requirements, could strengthen and

make more consistent, organization-level programs

to promote healthy workplaces and reduce the

threats from workplace violence and lateral incivility.

Increased funding provided through national

and state level policy change would help support

organization-level efforts.

Organizations should implement programs that

address the three levels of prevention to help those

nurses not yet affected, those nurses in the early

stages of harm, and those nurses who have incurred

chronic adverse effects. One example of this is the

Stress First Aid (SFA) program, initially developed

by the U.S. military, and now available through the

Schwartz Center for Compassionate Healthcare. This

program helps leaders and staff create customized

implementation plans.

As seen from the nurse survey data, programs

are needed to address bullying, lateral incivility,

and workplace violence. Organizations can adapt

programs and toolkits already in place. For example,

the recently published VHHA Workplace Violence

Prevention Toolkit, developed with input from

the VNA, provides information about applicable

state laws, background information, and detailed

guidelines to support organizations in developing,

implementing, evaluating, and sustaining workplace

violence prevention programs. Another example

of an adaptable toolkit is the PACERS program,

funded by the Robert Wood Johnson Foundation.

This toolkit provides a systematic and multi-level

approach to create care environments of respect

and civility; both issues are specifically identified

as highly problematic in the recent nurse surveys.

Organizational guidance for developing resiliency

to prevent nurse burnout is available from many

sources. The Joint Commission published a guide

for healthcare leaders in 2019 that guides leaders

to empower employees’ ability to access resources,

information, and support needed to perform their

work and to gain the opportunity to develop. 7

Inadequate staffing is a major source of

occupational stress for nurses, which was

exacerbated by the pandemic. Minimum staff

ratios are seen as a solution by some and by

others as a solution with many unintended and

negative consequences for patients, nurses, and

other employees. But from an occupational stress

perspective, appropriate and effective nurse staffing

is a prerequisite for addressing occupational stress.

At a minimum, nurse-led groups should create unitlevel

staffing plans based on a patient population’s

acuity and needs, and matched with staff’s skills

and experience. (ANA, https://www.nursingworld.


While building resilience and promoting adaptive

coping skills are important for individual nurses, the

burden and responsibility cannot be borne solely by

the nurse. Effective occupational stress mitigation

must occur at the policy and organizational level for

individual nurses to be successful. However, several

evidence-based key strategies for nurses to prevent

stress injury emerge from the occupational stress


• Identify and understand your own

vulnerabilities and the specific sources of your

job stress.

• Regularly assess stress-levels and the presence

of stress injury signs and symptoms using an

established scale such as the Stress First Aid


• Be aware that stress injury may manifest as

medical condition, psychological distress, or

as tobacco abuse, alcohol and drug abuse,

aggression, and violence.

• Identify support resources available through a

professional organization, other peer groups,

your organization, or through your health plan.

• Identify and implement individual stress

management strategies.

• Develop and use social support, at work and

at home. (Being part of a cohesive health

workgroup and networks have significant

protective impact.)

• If injury has occurred, emphasis must be

first placed on healing in the short-term.

Discontinuing employment in the current

setting may be indicated. Use support

networks in making any critical decisions

about your employment, career, or personal


nurses, the profession, and to the overall healthcare

system. Occupational stress has become more

pronounced during the Covid-19 pandemic but the

underlying causes are not new and are generally

well-known. Systematic mitigation is required to

address underlying causes, prevent stress injury

from occurring, minimize the extent of harm to

individual nurses and the profession, and to help

nurses with significant stress injury recover and

return fully to the healthcare workforce.

1 Sauter, S.L. et al., (NORA Organization of Work Team

Members). (2002). The Changing organization of work

and the safety and health of working people: Knowledge

gaps and directions. National Institute for Occupational

Safety and Health.

2 Quick, J.C. & Henderson, D.F. (2016). Occupational

stress: Preventing suffering, enhancing wellbeing.

International Journal of Environmental Research and

Public Health, 13(4):1-11. doi:10.3390/ijerph13050459

3 Auerbach, D.I., Buerhaus, P.I., Donelan, K. &

Staiger, D.O. (2022). A worrisome drop in the

number of young nurses. Health Affairs Forefront.

https://w w w.healthaffairs.org/do/10.1377/


4 American Nurses Foundation. (2022). COVID-19 Two-

Year Impact Assessment. American Nurses Foundation

& Joslin Insight.

5 American Nurses Foundation. (2021). Mental Health

and Wellness Survey Report. American Nurses

Foundation & Joslin.

6 AMN Healthcare. (2021). Nursing and the nation:

Extreme challenges, extraordinary impact. 2021 Survey

of Registered Nurses. AMN Healthcare. https://www.



7 The Schwartz Center for Compassionate Healthcare.

Stress First Aid. Accessed 6/22/22, https://www.


The Joint Commission (2019). Developing resilience to

combat nurse burnout. Quick Safety, Issue 50. The

Joint Commission, Division of Healthcare Improvement.


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Accreditations & Certifications:


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Certified by SCH EV to operate in Virginia,

accredited by ABHES & approved by NC-SARA.

In summary, occupational stress is an emerging

public health issue that poses a significant threat to

Page 22 | August, September, October 2022

Virginia Nurses Today | www.VirginiaNurses.com




Leadership Development Pre-Conference Session

Developing Effective Communication for a Healthier Workforce

Diane Salter, MSN, RN, CPAN, NE-BC

Bullying & Incivility Content Expert, Healthy Workforce Institute

Ineffective communication is cited as the most common cause of

medical error. Yet, we don’t often teach healthcare leaders how to

develop and foster good communication skills in themselves and their


The Time for Change is NOW!

2022 VNA & VNF Fall Conference

The Virginia Nurses Association invites you to join us IN-PERSON for our 2022

Fall Conference, The Time for Change is NOW! This program will be held

September 9-10, 2022 at the Westfields Marriott in Chantilly, Virginia. We

hope you’ll join us for what will be our 1st IN-PERSON event since prepandemic!!

Nursing is at a precipice. The pandemic has debilitated an already failing

and antiquated structure. We continue to struggle with appropriate staffing,

unhealthy work environments, and developing the workforce we need for

the future. All of this leaves the nurses disengaged and our patients

disadvantaged. How can we change this?

The Time for Change is NOW! During this conference, we will address how nurses can and must lead

the next evolution of healthcare through innovation and collaboration. Dr. Oriana Beaudet, Vice

President of Innovations at the American Nurses Association Enterprise, will help us explore how

every nurse can contribute to transforming nursing so that we can better serve the people behind

our purpose. We will hear from innovators in nursing and healthcare that are taking chances, trying

new approaches, and transforming the work we do. After we learn from change makers, Dr. Oriana

Beaudet will lead conference participants through a Design Challenge where we will develop big

solutions to address nurse staffing and unhealthy work environments. Let’s work together to change

the future of nursing!



September 9 & 10

Pre-conference & Fall Conference VNA Member | $300

Pre-conference & Fall Conference Nonmember | $375

Fall Conference only VNA Member | $249

Fall Conference only Nonmember | $295

Photos courtesy of Westfields Marriott






Westfields Marriott Washington Dulles

14750 Conference Center Drive

Chantilly, VA 20151




The message is clear - communication skills may be as important, if not more important,

than clinical skills. This workshop is designed to teach healthcare leaders the essential

strategies and tactics they need to develop better communication skills for a safe and

healthy workforce.

Join the Healthy Workforce Institute’s Bullying & Incivility Expert, Diane Salter, to learn

how to develop assertive communication skills among the healthcare team, incorporate

body language techniques to strengthen team relationships, and create standards and

systems that foster collegiality.

Day 1 Keynote Address: Nurses are Positioned to Lead Healthcare’s Transformation

Oriana Beaudet, DNP, RN, PHN, Vice President of Nursing Innovation, American Nurses Association Enterprise

The dynamic nature of change happening across healthcare will impact every aspect of care-and nursing. We’ll be unpacking

system level changes to identify how barriers can be scaled to transform healthcare. The future of health is going to require the

novel thinking and holistic ecosystem perspective unique to nursing.

Day 2 Keynote Address: H.O.P.E. for Happy - Workforce Strategies from America’s Frontlines

April Hansen, MSN, RN, President of Workforce Solutions, Aya Healthcare

After helping to lead the largest deployment of healthcare workers in our nation’s history, workforce expert April Hansen leans on

lessons learned from America’s fractured frontlines to share powerful strategies for organizations to rebuild and repair their teams.

Ultimately, April’s insights allow organizations to take actionable steps towards a happy work environment where individuals thrive

and organizations grow.

General Session: Value-based Reimbursement: What Nurses Need to Know

Betty Rambur, PhD, RN, FAAN, Professor of Nursing and Routhier Endowed Chair for Practice, University of

Rhode Island

Payment reform focused on shifting reimbursement from a reactive volume-based system that is riddled with quality gaps to a

proactive value-based system holds great promise for nurses. This presentation describes the context for payment reform as well as

the economic impetus and ethical imperative for change. It details an array of payment models that can foster nurse innovation

and better population health, if nurses can seize the opportunities presented. Participants will gain enhanced understanding of

and capacity to lead value-informed nursing practice and demonstrate the value of nursing in tangible, quantifiable ways.

Additional Fall Conference Sessions:

(More info to come at www.virginianurses.com!)

Rapid Fire Innovation Presentations

Combatting Racism in Nursing

Design Challenge: Designing Innovative Possibilities for Virginia Nurses


www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2022 | Page 23

Thank you to our

2022 Fall Conference


Diamond Sponsor

Thank you to our

2022 Gala Sponsors!

Diamond Sponsors

Platinum Sponsor

Platinum Sponsor

Gold Sponsors

Gold Sponsor

President’s Reception Sponsor

Photo Booth Sponsor

Poster Session Sponsor

Page 24 | August, September, October 2022

Looking to Level Up? Join Our

Nurse Leadership Academy in 2023!

Virginia Nurses Today | www.VirginiaNurses.com

Lindsey Cardwell, MSN, RN, NPD-BC,

Director of Professional Development

As you read in Janet Wall’s CEO Report in the

February edition of Virginia Nurses Today, the Nurse

Leadership Academy kicked off its inaugural year in

January of 2022 with some fabulous presenters and


The Academy’s flagship year has continued

flawlessly with four additional virtual sessions

to develop the 39 nurse fellows. This content has

been presented by healthcare leaders with amazing

expertise and knowledge! Our fellows have examined

their personal leadership and communication styles

through a DiSC Leadership Profile assessment and

explored topics such as providing and receiving

effective feedback, authentic leadership in

healthy work environments, leading with cultural

humility, facilitating a high reliability environment

through patient safety, a spirit of inquiry, and

process improvement, and the influencer role in

change management. Fellows will participate in

a final virtual session in June focused around

examining the finances of healthcare. Following

this session, the 39 fellows will embark on their

individual applied leadership projects within their

organizations under the guidance of their chosen

mentor. In December 2022, all nurse fellows will

share their leadership projects and the outcomes

they have achieved and we plan to have an

opportunity for the Academy fellows to disseminate

their work to you!

“Most training offered by

my organization is aimed at

discussing tools or strategies

for specific programs. The NLA

reaches us on a personal level to

develop our professional skills!”

Nurse Leadership Academy fellows have shared

that the Academy goes well beyond the development

provided by their organizations and “reaches us on a

personal level to develop our professional skills!” The

feedback underscores that the program has been

meeting and exceeding professional development

needs and that all nurse leaders should attend the


If you are a new or emerging nurse leader, we

encourage you to learn more about the Nurse

Leadership Academy at https://virginianurses.com/

mpage/VNFNLA! This program was meticulously

designed by experienced nurse leaders of varying

backgrounds across the commonwealth to meet

the professional development needs of nurses

transitioning into leadership roles across ALL

healthcare practice environments. The first six

months of this year-long program are dedicated to

live virtual didactic sessions focused on the following

core topics:

• Fundamentals of effective leadership

• Organizational culture

• Facilitating a high reliability environment

• Influencing change: Driving outcomes through

strategic action

• No margin no mission – Examining the

finances of healthcare.

“I am really enjoying reflecting

on myself and seeing my

opportunities to grow and lead

my team in a positive, effective


The second six months are focused on applying

the concepts learned in an applied leadership project

in the fellow’s organization under the direction

of their mentor. The goal of this program is to

prepare emerging and new nurse leaders with the

foundational leadership skills needed to lead change

and teams in their organizations.

VNF’s Nurse Leadership Academy inaugural

launch was kicked off with ANA Enterprise CEO

and past VNA President Dr. Loressa Cole, with the

compelling story of her leadership path from her

childhood in the Appalachians of West Virginia to

her present-day success.

Next Rose Markey, senior learning and

development consultant at the University of Virginia,

discussed the four skill sets of courage during her

“Introduction to Courageous Leadership.” Rose

is also a member of the global team of Certified

Dare to Lead Facilitators based on the work of

researcher and New York Times best-selling author

Dr. Brené Brown, and the learning and dialogue

“I am absolutely enjoying every

single session and find myself

looking forward to the next.”

“It’s hitting all the topics I need

in my leadership role.”

was fascinating! We discussed “Armored vs. Daring

Leadership,” how to practice our values, not just

profess them, and why “vulnerability” has gotten a

bad rap! Rose also examined how to master difficult

conversations; a discussion the Academy’s Nurse

Fellows examined in greater depth during the

February program.

The ever-popular Dr. Eileen O’Grady closed the

day for us with a focus on how Nurse Leadership

Hinges on Well-being. Dr. O’Grady is a certified Adult

Nurse Practitioner and ICF-Certified Wellness Coach.

She is Founder of The School of Wellness, and holds

a master’s degree in public health from The George

Washington University, as well as a master’s degree

in nursing and a PhD in nursing from George Mason


“I feel that every leader should

take this course!”

Dr. O’Grady is also author and editor of six

books, most recently, Advanced Practice Nursing:

An Integrative Approach and Intentional Therapeutic

Relationships: Advancing Caring in Health Care, a

how-to book on placing relationships at the center

of health care. Her most recent book is her most

personal, Choosing Wellness: Unconventional Wisdom

for the Overwhelmed, the Discouraged, the Addicted,

the Fearful or the Stuck, (2021).

If this has piqued your curiosity, or you think a

colleague might be interested, please bookmark

our Academy web page, https://virginianurses.

com/mpage/VNFNLA. Questions? Contact our

Director of Professional Development Lindsey

Cardwell who, along with the Steering Committee,

was instrumental in creating this highly dynamic

program! lcardwell@virginianurses.com.

Register today for the 2023 virtual Nurse

Leadership Academy!

www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2022 | Page 25

Virginia Nurses Foundation Announces

2022 Award Finalists

The Virginia Nurses Foundation (VNF) announced the finalists of annual

awards honoring those in the commonwealth who made special contributions to

the nursing profession. Winners will be announced at the VNF Gala, held at the

Westfields Marriott Washington Dulles on September 10, 2022.

Chief Nursing Officer Finalists

• Yolanda Maurice, Bon Secours Mercy Health St. Mary's Hospital

• Robert Boesch, Centra Health

• Sadie Thurman, Riverside Regional Medical Center

• Christina Grabus, Sentara Northern Virginia Medical Center

Direct Patient Care Leader - Patient Experience Finalists

• Jennifer Gorman, Bon Secours Memorial Regional Medical Center

• Erin Stacy, Bon Secours St. Mary's Hospital

• Teresa Doss, Centra

• Belinda Tomlin, Centra Medical Group

• Rebekah Miller, Inova Mount Vernon Hospital

• Jennifer Redd, LewisGale Hospital Montgomery (HCA)

• Kimberly Williams, Sentara Norfolk General Hospital

• Samantha Paquette, Sentara Obici Hospital

• Stephanie Newman, UVA Culpeper Hospital

• Karri Bishop, UVA Health

Direct Patient Care Leader - Patient Safety Finalists

• Amber Sawyer, Carilion Children's

• Tamara Kelejian, Central Virginia Healthcare System

• Loretta Nisly, Culpeper Hospital / UVA Health

• Susan Breisch, Inova Mount Vernon Hospital

• Latoia Kidd, Sentara Norfolk General Hospital

• Lucy Vinson, Sentara Norfolk General Hospital

• Kristi Wilkins, UVA Health

• Tracy-Ann Clarke, Valley Health Winchester Medical Center

• Sam Rowland, VCU Medical Center

• Emily Warwick, VCU Medical Center

Nurse Educator Finalists

• Jeannie Corey, James Madison University

• Holly Buchanan, James Madison University School of Nursing

• Adrienne Hartgerink, Old Dominion University

• Ashley Chrisman, Sentara Obici Hospital

• Keshia Blakeney, Sentara Norfolk General Hospital

• Victoria Buffmire, UVA Health

• Jessica Wisecarver, VHC Health

Nurse Manager/Director Finalists

• Kristina Massey, Carilion Roanoke Memorial Hospital

• Johanna Derrenbacker, Centra

• Carrie White, Centra

• Shannon Miles, Centra

• Zewdensh Bryant, Inova Mount Vernon Hospital

• Deidre Thomas, Sentara Northern Virginia Medical Center

• Taralyn Wear, UVA Health

• Marie Wilborn, VA Medical Center / Hunter Holmes McGuire VA Medical


• Martha Brooks, VCU Health

• Nina Carter, VCU Health

• Emily League, VCU Health

• Laura Reitmeier, VCU Medical Center

Nurse Researcher Finalists

• Samantha McClure, HCA - LewisGale Hospital Montgomery

• Kathryn Reid, Sentara Martha Jefferson Hospital

• Joanne Williams-Reed, Sentara Norfolk General Hospital

• Elizabeth Epstein, University of Virginia School of Nursing

• Claiborne Miller-Davis, UVA Health

Nursing Informatics Finalists

• Jenna Lloyd Fisher, Centra

• Jenna Dziuba, Centra

• Trina Trimmer, VCU Health

Nursing School Dean/Director Finalists

• Suzanne Wright, Old Dominion University

• Deborah Sullivan-Yates, Riverside College of Health Careers

Public Health Nurse Finalists

• Student Health Nurses in Roanoke City Public Schools, Carilion Children's

• Barbara Kelly-Gibbs, Sentara Obici Hospital

• Lori White, Sentara Obici Hospital

• Vickie Southall, University of Virginia School of Nursing

• Katherine Kois, UVA Health

• Dee Dee Yoder, UVA Health

Public/State Government Service Finalists

• Board of Nursing Team: Claire Morris, Jacquelyn Wilmoth, Robin Hills and

Christina Bargdill, Virginia Board of Nursing

• Corri Miller-Hobbs, VCU Medical Center


Virginia Oncology Associates 5th Annual Nursing Conference

Trends in Oncology Nursing

Space is limited!

When: Saturday, September 17, 2022 | 7:00 AM – 2:50 PM

Where: The Westin Virginia Beach Town Center | Virginia Beach, VA

To register: virginiacancer.com/nursingconference

For more information, please call (757) 274-8847

Page 26 | August, September, October 2022

Virginia Nurses Today | www.VirginiaNurses.com

Challenges in the Nursing Workforce, Graduate Nursing

Education, and Future of Nursing

Georgianna Thomas, D.Ed., MSN, RN

Somi Nagaraj, DNP, MSN, RN, CSSGB, CONTL

Reprinted with permission from

Illinois The Nursing Voice September 2021 issue

The healthcare sector is an intricate, albeit

fundamental, part of ancient and modern societies.

It comprises a long list of agents, from the individual

seeking healthcare services to the medical staff

and nurses, all operating within a legal framework

involving providers, consumers, insurance

companies, government, medical schools, nursing

schools, and regulatory institutions (Amorim Lopes

et al., 2015).

The healthcare market is always composed

of both suppliers of health services and patients

demanding their services. On the one side is the

workforce of physicians, nurses, and remaining

clinical staff educated according to standards and

criteria, ready to assist those in need. On the other

side stand the forces that drive the demand for

medical services, strongly related to demographic,

socioeconomic, and epidemiological factors.

Analyzing these two market forces is a critical step

in assessing whether the available health care

human resources are enough in quantity and skills

to meet the current and future demand in due time

and may lay solid foundations for further research,

considering perhaps changes to the existing health

policy framework (Amorim Lopes et al., 2015).

A high degree and extent of uncertainty affect

supply and demand: asymmetric information

between physicians, nurses, and patients,

restrictions on competition, an aging workforce

in all areas, strong government interference, and

supply-induced demand are some of the most

glaring differences that can be pinpointed. These

may be relevant when assessing the impact of any

policy involving Healthcare Human Resource [HHR]

planning (Amorim Lopes et al., 2015).


Supplying human capital with the appropriate

expertise to enable workers to perform and satisfy

the demand for health care is no simple task. The

time and effort required to equip HHR, especially

physicians and advanced nurse practitioners,

exceeds most other professions. In some particular

healthcare professions, the set of necessary skills

to qualify for medical practice is acquired through

extensive academic learning, which involves

enrollment in long courses that may take up decades

to complete due to a strict licensing process. The

analysis of the medical and nurse education process

is relevant but may be insufficient, as several other

factors may affect the efficiency and effectiveness

of the care services delivered (Amorim Lopes et al.,


Despite the limitations, some measures to

overcome imbalances in the quantity (number)

of physicians and nurses have already been

identified in the health policy literature (Chopra

et al., 2008), namely the following: increasing the

number of domestic- and foreign-trained medical

graduates or increasing the number of medical and

nursing schools and classroom sizes; increasing

the enrollment limits; reducing the requirements

for entry to medical and nursing schools; raising

the wages of the medical and nursing staff, as well

as the perspectives for their future career path; or

reducing the costs of attending medical and nursing

school, which may encourage potential students to

enroll. These proposals are short-term measures to

alleviate the immediate stress put on the healthcare

system triggered by an undersupply of personnel

and may not be suitable for tackling long-term

imbalances due to huge shortages or surpluses

of medical and nursing staff (Amorim Lopes et al.,



Demand for health care is a derived demand

(Grossman, 1972), which means that people do

not seek health care services as a final good for

consumption but as an intermediate service allowing

them to be healthy and to improve their stock of

health capital (well-being). They want to improve

their health, and to do so; they seek healthcare

services (Amorim Lopes et al., 2015).

The concept of needs in health care is not

consensual in the health literature, with a semantic

confusion arising from its use in health economics

(Hall & Mejia, 2009). While the economic or effective

demand translates the actual, observed demand,

usually measured in terms of service utilization

ratios such as bed occupancy rates, number of

inpatients, the needs component tries to fully

encompass the epidemiological conditions that

characterize a given population, measured through

morbidity and mortality rates or by the opinion of

a panel of experts, and how that may translate into

a given quantity of required healthcare services.

Therefore, we see that the classical concept of

economic demand may not reflect the biological

needs of the population, as it may leave out the

necessities of the population regardless of their

ability to pay (Amorim Lopes et al., 2015).

An integrated approach uses a dynamic, systemlevel

perspective covering key drivers of supply and

demand that includes manpower planning and

workforce development is critical to overcoming such

challenges (Stordeur et al., 2010). The importance

of paying attention to needs is also continuously

stressed, as changes in the health patterns of the

populations take place (Tomblin et al., 2009). The

impact of microeconomic and organizational changes

in productivity and the skill mix, of the evolution

of demand for healthcare services, and also of

the evolution of health diseases and its potential

impact on the health system. The given quantity

of workers may provide more or less healthcare

services depending on their productivity and skill

mix, influencing the conversion from headcounts

to full-time equivalents (FTEs). Such conversion is

critical to properly assess the healthcare workforce,

as a significant number of physicians and nurses

work part-time only. For this reason, FTE is a more

accurate measure as it normalizes headcounts.

On the demand side, economic (effective) demand

can be initially measured by analyzing utilization

indicators. How this demand will evolve in the future

will then be subject to typical economic factors such

as demography and the growth of the income/GDP

(Amorim Lopes et al., 2015).

In parallel, potential needs can be assessed

by incorporating the incidence and prevalence of

diseases and then mapping a given disease to an

estimate of FTE requirements. Whether future

supply forecasts should tackle all of the estimated

needs is a decision left to the consideration of the

policymaker, as the analysis does not incorporate

financial constraints. Despite the abundance of

approaches and techniques to determine supply and

need for professionals, none of the methodologies has

ultimately proved to be superior (Ricketts, 2011).

Recent studies testing current forecasting

models show that there is still plenty of room for

improvement given the gap between projected and

actual results (Greuningen et al., 2013). It becomes

even clearer that workforce planning should be

accurate and performed in due time, given the

attritions and the delays in enacting policies in the

healthcare sector. Adapting medical and nursing

schools, altering legislation, and changing roles is an

effort that may take years to bring forth. Therefore,

planning has to target a long enough time horizon

to be useful and applicable and has to be done preemptively

(Amorim Lopes et al., 2015).

Accurate HHR planning requires an approach

that is both integrated and flexible, featuring

supply and demand (potential and effective) and

incorporating less tangible factors, such as skill mix

and productivity (Amorim Lopes et. al., 2015).


Looking at the area of academia, there are

many issues at hand that present challenges for

nursing education at the doctoral level. Having

enough faculty to provide quality education to those

interested in pursuing a doctoral degree in nursing

relies on competent individuals. Presently there are

two types of doctoral degrees one can earn, both are

terminal degrees, and both allow nurses to continue

to practice in the clinical field. The Doctor of Nursing

Practice (DNP) has a clinical focus that allows the

nurse to possess expert knowledge to influence

healthcare outcomes across direct patient care,

advocating for healthcare policy implementation, and

collaborating with organizational leadership (Leveck,

2020, Chism 2010). The Doctor of Philosophy (PhD)

focuses on research in advancing the nursing

profession and change the quality of patient care

and outcomes in the field. PhD nurses also teach

and mentor nurses at the college and university

level, growing the next cohorts of professional

nurses. There is a difference between these two

degrees in their primary foci and length of education

(registerednursing.com). However, the DNP degree

has become the more sought-after degree, and

individuals who have earned it are considered

equal at many institutions in academia in relation

to tenure attainment and administrative positions.

It was more common to see the individual with a

PhD in the academic setting. However, individuals

seeking this degree are decreasing in number, and

some individuals are having difficulty completing

their dissertation. This adds to the faculty shortage

we continue to experience in the profession. There is

a distinction between the two degrees and needs to

be recognized and valued in advancing new nurses,

however, the DNP graduate is more prepared for the

clinical arena.

According to Drs. Di Fang and Karen Kesten,

one-third of the current nursing faculty workforce

in all levels of education are expected to retire by

2025 (ANA Fact Sheet, 2020). This will certainly

have an effect on the numbers of students who will

be accepted when they apply for nursing education


Continuous changes in the nursing and

medical fields have been rapidly evolving because

of technology and studies such as the genome

project. Graduate student feedback to courses and

discussions with clinical affiliates to the college/

university are two ways that information can be

ascertained in relation to curricular issues for

content. Accreditation standard revisions and the

recently adopted Essentials with emphasis on

outcomes and competencies in learning have also

added to many of the changes schools are making to

revise overall curriculums (AACN, 2021). Learning

theories are used to expose students to various

learning experiences. Online teaching, simulation,

inter-professional learning, case studies, and other

teaching formats take much time to prepare and

grade and may not all be familiar for present faculty

to fulfill.

Interdisciplinary education (IPE) among the

various healthcare providers is expected to

be utilized in schools. This type of education

provides shared experiences that allow for better

understanding, improved engagement, and clearer

insight into cooperation in the work environment

and quality patient care. This activity in schools

with major medical affiliations has an edge in

providing this type of learning while many smaller

colleges and universities struggle to gain this

opportunity. Many IPE opportunities that do exist

are noted through simulation-enhanced activity

(Fawaz, 2018). Although simulation is helpful, realtime

situations may affect the learner differently

when exposed.

Technology has become more influential in our

lives, especially after the past year and a half of

pandemic experiences. However, online education

is not a new concept in education. Use of learning

platforms, Zoom meetings, Wiki’s, Google docs,

social media, Electronic Health Records, and so

on have not been mastered by all in education,

faculty, or student. Many students like the idea

behind online learning in that they can study

at their own pace often or at a time that is most

convenient for them. This strategy for education

allows for flexibility to view course material in

both an asynchronous and, at times, synchronous

format. Faculty find this learning takes more time

in their schedule for preparation and grading than

when classes met traditionally. Class size is not

always capped. Lack of support staff with course

development and difficulty managing technological

changes have been identified as barriers to distance

education (Iwasiw et al., 2020). This becomes

frustrating to both teacher and student in that the

partnership that develops in learning is not fully


Future of Nursing

The Future of Nursing 2020-2030: Charting a

Path to Achieve Health Equity, study sponsored by

Robert Wood Johnson Foundation identified, that

a nation cannot thrive fully until everyone can live

www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2022 | Page 27

their healthiest possible life, and helping people

live their healthiest life is and has always been

the essential role of nurses. The ultimate goal is

to achieve health equity in the United States built

on strengthened nursing capacity and expertise

(National Academies of Sciences, Engineering, and

Medicine, 2021).

The committee developed a framework identifying

the key areas for strengthening the nursing

profession to meet the challenges of the decade

ahead. These areas include the nursing workforce,

leadership, nursing education, nurse well-being, and

emergency preparedness and response, as well as

responsibilities of nursing with respect to structural

and individual determinants of health (National

Academies of Sciences, Engineering, and Medicine,


In 1998 the Pew Health Professions Commission,

a group of healthcare leaders charged with assisting

health policymakers and educators teaching

health professionals to meet the changing needs

of healthcare systems, completed a report listing

competencies healthcare providers of the future

would need. The competencies are listed in the

Fourth Report of the Pew Health Professions

Commission (O’Neal & Pew Health Professions

Commission, 1998).

The book To Err Is Human: Building a Safer

Health System (Kohn, Corrigan, & Donaldson, 1999)

brought national attention to the issue of patient

safety by discussing the number of people who

die each year from medical errors. This, in turn,

sharpened the focus of patient safety in nursing

education (Scheckel, 2008).

Despite the practice setting in which students

learn nursing care, it will include using various

technologies and knowledge of informatics to assist

with patient care. These technologies can include

but are not limited to medical devices patients will

use to provide self-care, as well as information

retrieval, clinical information management, and

documentation technologies (Scheckel, 2008).

Students’ use of these devices has important

implications for improving their clinical judgment

(Newman & Howse, 2007). Nurses are also being

exposed to the use of variety of clinical management

systems, like patient surveillance systems many of

which have implications for ensuring quality and


A significant movement that accompanied the

curriculum revolution involved using pedagogies

to ensure students could think critically in clinical

practice. Traditionally, students who learned the

nursing process were thought to be learning critical

thinking. During the past few decades, the nursing

process has been challenged as the best approach

to developing students’ critical thinking (Scheckel,

2008). However, current research in nursing

education suggests that students also need to

engage in thinking processes that promote reflective

thinking, where they build practical knowledge,

embodied thinking, where they learn the importance

of intuition and pluralistic thinking, where they

consider a clinical situation using many perspectives

(Scheckel & Ironside, 2006).


As nurses assume increasing responsibility

for patient care in primary care settings, the

combination of increased clinical and systems

knowledge, as well as the capability to apply and

evaluate evidence to practice innovations, can

only have a positive impact. The presence of DNPprepared

APRNs in primary care will expand

educational opportunities. In the short term,

the DNP-prepared APRNs can mentor the MSNprepared

APRNs within the system. Equally

important is the opportunity for enhanced

preceptor education for nursing students in

primary care (Dunbar-Jacob et al., 2013).

Indeed, the preparation of the DNP will influence

the perception of health care systems regarding the

added value of DNP education. If graduates of such

programs bring an increased depth of knowledge

and skill to the clinical arena, the DNP will likely

flourish. If graduates bring little more than what

is offered by master’s-level education, the DNP will

not be an attractive addition to the clinical arena.

Thus, the quality of the preparation of the DNP will

influence the adoption of the DNP practitioner and

administrator by health care systems (Dunbar-

Jacob et al., 2013).


Challenges in building DNP programs include the

identification of qualified faculty for each specialty,

qualified capstone advisors, and qualified clinical

preceptors. A further challenge is the simultaneous

education of master’s cohorts and DNP cohorts.

The challenges by requiring faculty to obtain a

doctoral degree, developing critical academic–

service partnerships in mentoring students for

practicum and capstone projects, and discontinuing

MSN advanced practice specialty programs while

focusing on the BSN-to-DNP and MSN-to-DNP

programs. High-quality DNP academics and

DNP clinicians are crucial to help meet these

challenges. Each educational program must assess

its challenges and strategies for addressing those

challenges. How we proceed will determine the

impact of our programs on the future of the health

care system (Dunbar-Jacob, Nativio, & Khalil,


In academia, both the PhD and DNP prepared

nurses can work together to ensure quality

education for our nursing students. Both need

an educational foundation to be learned to be

successful educators. The distinction of the PhD

concentrating on teaching theory and research to

assist nursing to maintain its scientific foundation

and the DNP concentrating on the clinical skills

and acting as preceptor/clinical educator at any

level of nursing appear to be the ideal partnership

to develop. Both nurses can assist academia and

the clinical arena in staying current and developing

innovative care measures to provide quality care

to clients. When looking at the definitions noted

at the beginning of this work, this collaboration in

teaching nurses fits what was noted.¬

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