Future of Nursing in MI - August 2022

THE FUTURE OF NURSING IN MICHIGAN
The Official Publication of the
American Nurses Association Michigan
The Future of Nursing in Michigan will
reach over 145,000 Michigan nurses
by email distribution.
Volume 8 • Number 3 • August 2022
PRESIDENT’S MESSAGE
ANA-Michigan is launching its inaugural Empowered Leader Series this fall. The program will
be held virtually over the course of six Tuesday evenings in September and October from
6:30 pm – 8:30 pm EST beginning on September 13.
Empowered Leader Series
Takeaways from this series include 12 CEs, leadership strategies you can immediately
incorporate into your current role as well as exclusive access to thought leaders in Michigan
nursing. In addition you will also receive the book “Emotional Intelligence 2.0,” by Travis
Bradberry and Jean Greaves as well as an online assessment on your emotional intelligence
(EQ) .
Page 2
Sessions will feature several ANA-MI members as speakers who will present and lead
discussions throughout the series. This is your opportunity to learn from, connect with, and
build your network with these Michigan nursing leaders whose knowledge and experience will
be invaluable in your nursing professional development.
Week 1: Becoming a Leader
Register today as space is limited for this first-time event!
Register
Week 1 will bring valuable insight into how you can move from a “managing” to a “leading” mindset.
You will discover insights into emotional intelligence, your own EQ abilities and how to grow through
areas of challenge. Additionally, you will hear from a leading nurse professional on the future vision of
the nursing profession. Finally, you will be introduced to your FORUM group that you will work with for
the duration of the program.
Learning Objectives:
Complimentary Virtual Town Hall
Learn how to change your mindset and actions to align with key leadership principles
Understand the essence of Emotional Intelligence and how it can improve your leadership
abilities, and career potential
Develop the ability to plan for your career based on how the nursing profession is evolving in
2022 and beyond
al Town Hall
lusion in Nursing
e Listen
Featured Speakers for Sessions 1 and 2
ANA-Michigan 2022 ANA
Membership Assembly Report
ANA-Michigan Are Nurses Suffering 2022 ANA
Membership from Moral Assembly Injury? Report
Page 3
View the featured speakers for sessions 1 and 2 below. Additional speakers will be announced in the
coming weeks.
0 pm- 5:00 pm EST
ke to engage with you to share information
rtant topic of Diversity, Equality & Inclusion
The virtual town hall is designed as an
join the conversation and to share your
ng in Michigan. Our objective is to provide
ls and future initiatives that align with ANA-
Michigan.
ce as a strong community of nurses in
ractice. Our strength is our solution-focused
g profession in a dynamic healthcare
tient safety.
es in Michigan. If you are not currently a
n hall and see what ANA-MI is doing to
today to reserve your spot in this
​ ​ ​ ​
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Page 14
Michigan nurses, it is
our time to Be Powerful on
Purpose! I hope all of you
are taking time to enjoy the
beautiful summer we are
having, as it’s important to
take time to stop and smell
the roses because it allows
us to be rejuvenated. This
summer, I’ve taken the time
to participate in several
conferences that I feel are
Bridget Leonard
DNP, MBA-HCM,
RN, CRRN,
NEA-BC
vital to our progression as a profession. Florence
Nightingale stated, “Let us consider ourselves
unfinished nurses…we must be learning all our
lives.” Allow me to share some highlights that will
have positive impacts on our profession.
In early June, approximately 100 ANA nurses
from around the country had the opportunity to
attend the ANA Hill Day in Washington D.C. for a
full day. We had the opportunity to visit the offices
of Senators Gary Peters and Debbie Stabenow,
as well as Congresswoman Elissa Slotkin,
Congressman Jack Bergman, and Congressman
Tim Wahlberg from our congressional districts
to discuss the following topics (unfortunately,
we ran out of time in our attempt to meet with
Congresswoman Brenda Lawrence):
• Valuing the nursing workforce
• Enhancing the scope of the Advanced
Practice RNs
• Improving senior citizens timely access to
care
I am happy to report that they were receptive
to supporting legislative solutions for our
concerns, and I was also impressed by the number
of those that reported they had nurses in their
families who had already brought some of the
issues to their attention. I challenge you to also
follow up with your district representatives via
letters, town halls, and/or district meetings on
these topics as our voices carry more weight in
multiples, rather than singles.
In August, I had the privilege to attend the
Accreditation Commission for Education in Nursing
(ACEN) annual conference in Atlanta, Georgia. The
goal of this conference was to share concepts
that enhance the educational quality of nursing
programs and contribute to organizational
growth. Throughout the conference there was
a consensus that students have the skills and
resources needed to succeed, ensuring mental
health and self-care is on the forefront to help
them cope with school and real-life issues.
There was also discussion on the need to ensure
nursing faculty development is a priority both in
the classroom and clinical setting, while finding
creative ways to recruit and retain faculty. We had
opportunities to discuss the types of questions
that will be appearing on the new version of the
NCLEX in April 2023. You may have heard of the
Next Generation NCLEX, which features a case
study type format and fifteen new question types.
For more information, visit www.ncsbn.org.
Lastly, we discussed the current and future ACEN
standards needed for colleges and universities to
receive and/or maintain their ACEN accreditation.
ANA-MI is committed to helping you Be
Powerful on Purpose. Allow me to invite you to
two great upcoming events that will assist you in
meeting personal and/or professional goals:
Sharing Our Strengths: You Talk, We Listen on
August 18, 2022, 4p-5p
How are you feeling about diversity, equality,
and inclusion? ANA-MI will be discussing this
topic with several staff nurses and CEOs in a
safe space where thoughts can be shared freely.
Our objective is to provide support to Michigan
nurses, as well as develop goals and initiatives that
support the needs of nurses that align with ANA-
MI’s mission and vision. ANA-MI is the voice for
Michigan nurses, so join us at this town hall and
let your voice be heard (audience participants have
the ability to be a part of the discussion). Spread
the word and register at: www.anamichigan.
nursingnetwork.com.
Empowered Leader Series beginning
September 13, 2022, 6:30p-8:30p (Every Tuesday
evening for six consecutive weeks)
ANA-MI is launching its inaugural leadership
training program and wants YOU to be in
attendance. This six-week program is geared
toward ALL nurses to “lead from where you
stand” to help build leadership acumen and
skills focusing on the critical areas of leadership
in healthcare and nursing. The program is
designed for ALL nurses, whether at the bedside,
management, administration, academia, and/
or any practice setting where leadership skills
will allow you to excel in the workplace and
President’s Message continued on page 2

Page 2 The Future of Nursing in Michigan August, September, October 2022
Attend the ANA-MI Empowered Leader Series
ANA-Michigan’s inaugural Empowered Leader Series was created with nurses in mind to help them
uncover and develop leadership traits that will allow them to excel in the workplace and build stronger
relationships with co-workers, supervisors, patients, families, and others.
Register
Throughout the series, you will have engaging conversations and learn from some of Michigan’s
knowledgeable and experienced nurse leaders, including:
CONTACT INFORMATION
ANA-Michigan
2501 Jolly Road, Suite 110
Okemos, MI 48864
517-325-5306
nurse@ana-michigan.org
EXECUTIVE DIRECTOR
Tobi Lyon, MBA, CAE
The Future of Nursing in Michigan is published
quarterly every February, May, August and
November by the Arthur L. Davis Publishing
Agency, Inc. Subscriber rates are available for
$25.
ANA-MI President
Bridget Leonard, DNP, MBA,
RN, CRRN, NEA-BC
Linda Dunmore, MSN, RN, NE-
BC, CPHQ, CHSP
Remy Bruder, DNP, RN
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.
ANA-Michigan 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.
Jonnie Hamilton, DNP, MSHSA,
PNP-BC, NE-BC, RN
Margaret Calarco
PhD, RN, NEA-BC
Barbara Medvec, DNP, MSA,
MSN, NEA-BC
Dr. Linda Buck
DNP, MSN/ED, RN
You can also earn 12 continuing education hours for completing this series.
Gerardo “Gerry” Infante,
​BSN, RN
Evelyn “Evie” Sweeney
Lobbyist, MHSA
The Empowered Leader Series takes place on six Tuesday evenings in September and October
from 6:30pm – 8:30pm EST beginning on September 13. Read more about the series! Space is
limited for this first-time event.
Acceptance of advertising does not imply
endorsement or approval by the American
Nurses Association Michigan 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. American Nurses Association
Michigan 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
American Nurses Association Michigan, or
those of the American Nurses Association.
Register
This event offers 12.0 contact hours to attendees. Accreditation Info: This activity will be submitted to the Ohio Nurses Association for approval
to award contact hours. The Ohio Nurses Association is accredited as an approver of nursing continuing professional development by the
American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91).
ANA-Michigan | ana-michigan.org
​ ​ ​ ​
have thousands
We
nursing jobs!
of
President’s Message continued from page 1
build stronger professional relationships. Spread
the word and register at www.anamichigan.
nursingnetwork.com.
As I conclude this letter to you, I want to
stress that this role is more than just a title;
it is a commitment to needed changes and
Being Powerful on Purpose. If you have any
suggestions to help improve nursing practice for
Michigan nurses, feel free to send me an email
at president@ana-michigan.org. We are in this
TOGETHER. Maya Angelou stated, “We may
encounter many defeats, but we must not be
defeated.”
Find your dream job now.

August, September, October 2022 The Future of Nursing in Michigan Page 3
MESSAGE FROM THE EXECUTIVE DIRECTOR
“Inclusion is not a matter of political correctness. It’s the
key to growth.” – Jesse Jackson
As we look to the recent past, there has been a need
for resiliency and a theme of overcoming. As we look
forward and imagine our future, I recognize a desire for
more inclusivity and a necessity for unity. Fortunately,
ANA-Michigan’s members and leaders continue to drive
initiatives and design policies and procedures to restore
what has been and forge a stronger future. We have
learned much through the pandemic, including what
Tobi Lyon,
MBA, CAE
we need to unlearn. Like anything else, I am hopeful that through listening,
deliberation, action, and advocacy, our nurses will leverage their compassion
and commitment to their profession to see and hear one another so that
the next generation can go further. Managing the complexities of modern
healthcare while trying to leave things and each other better than we found
them is no small undertaking – but neither is nursing. So, let’s keep going.
This is where your ANA membership comes in; you and your colleagues
bring your voices to the issues nurses face through the opportunities ANA
offers. By serving on committees and other leadership roles, you impact the
topics discussed that affect nurses in Michigan. I encourage you to continue
this work and to urge your fellow nurses who are not yet members to add
their voices to the critical nursing issues in 2022 and beyond.
You can read the ANA Membership Assembly’s full report. Still, I want
to reiterate the success of what was accomplished and commend all
participants, representatives, and constituents for their efforts, dialogue,
and strategy influencing solutions and outcomes. Much of what we are
focused on in our current initiatives is a byproduct of what was determined
during this time together.
From tributing board members and those lost to COVID-19 to tackling
workplace violence issues and President Grant’s annual report, our
community came together in person to honor, challenge, and support
one another. The next Town Hall on August 18 has been designed with the
Membership Assembly’s objectives in mind and will serve as an open forum
for our nurses to join the conversation about DEI and what we can do to
honor ANA’s Racial Reckoning Statement. If you can’t join this Town Hall,
which is free to members and non-members, make sure you follow our event
page on our website or look for them in our weekly e-newsletter sent every
Friday.
Do you want to develop additional leadership skills that will help you excel
in the workplace? If so, attend our newly launched virtual Empowered Leader
Series, which starts on September 13 and occurs once a week for six weeks
in the evenings. If you don’t, others in your network may benefit from this
series, so consider passing this information on to them and encourage them
to register. I promise you this will be like no other educational opportunity
you have ever attended before and will push you in new ways that will
empower your future.
Our Education Committee is excited about the upcoming annual
conference, which will be held on February 23 and 24, 2023, at the Blue
Water Convention Center in Port Huron. Have you added these dates to
your calendar? If not, make sure you do, as this will be a great time to shake
off those winter blues and re-energize with your colleagues. This will be an
opportunity for Michigan nurses to connect and discuss key topics, including
restoring passion for nursing, innovation, DEI, full practice authority,
workplace violence, and safe staffing levels in all care settings. Save the date
and plan to attend!
Fall is just around the corner, which means we will soon be putting out the
call for completing a consent to serve form to join one of our committees
or to serve on the board of directors. This is a great way to expand your
network connections and share your talents with the association by being a
part of driving the future of nursing in Michigan. This call will be coming out
to you in September and October.
Fun fact for this issue: Did you know that more than 75 individuals applied
for scholarships and grants that are available for those planning to enter
nursing? I am proud that the ANA-Michigan Foundation is always looking
toward the future by supporting nursing through financial assistance. You
can find more information about the scholarships on the ANA-MI Foundation
website.
We should continue to embody all those we represent (or, in our case, care
for), and that is everyone. While I could go on and on about the work of nurses,
the efforts of ANA-Michigan, and the shifting tide and reckoning that is upon us,
it is time to listen. So, I am setting even my highest esteem and coming to the
table with ears open and a whole heart. I encourage each of you to do the same.

Page 4 The Future of Nursing in Michigan August, September, October 2022
ANA-MICHIGAN
2022 ANA Membership Assembly Report
Bridget Leonard, Barbara Medvec and Anne Kreft
On Friday June 10, 2022, the ANA 2022
Membership Assembly meeting began at the
Grand Hyatt in Washington D.C. This was the
first live Membership Assembly held since the
beginning of the pandemic in 2020.
President Bridget Leonard, President-Elect
Barbara Medvec, Membership Assembly
Representative Anne Kreft and Past-President
Julia Stocker Schneider attended. In addition,
ANA Nominating Committee members MaryLee
Pakieser (also NEC candidate for 2022) and Linda
Taft attended the 2022 Membership Assembly
meeting. It was exciting to gather and see
colleagues from across the country in person.
Prior to the start of the meeting, ANA Hill
Day occurred on Thursday June 9, 2022. ANA-
MI members Leonard, Medvec, Kreft, Stocker
Schnieder and Pakieser participated in meetings
with Congressional Representatives, Rep. Jack
Bergman MI-01 (R), Rep. Tim Walberg MI-07
(R), Rep. Brenda Lawrence MI-14(D), Rep. Elissa
Slotkin MI-08 (D), as well as Senators Gary Peters
MI-S (D) and Debbie Stabenow MI-S (D). Issues
carried to the elected officials included supporting
the full practice authority of Advanced Practice
Registered Nurses (APRNs), Improving Seniors’
Timely Access to Care Act of 2021 (S.3018/H.R.3173)
and talking points around valuing the nursing
workforce through reduction in workplace
violence and mandatory overtime.
The ANA President’s and National Awards
Ceremony were also held on the evening of June
9, 2022, and recognized Michigan’s own Jonnie
Hamilton, DNP, PhD, MS, BSN, RN as the Mary
Mahoney Award winner which acknowledges
significant contributions made by an individual
registered nurse or a group of registered nurses to
integration within the nursing profession.
President Ernest Grant, through his annual
report to the organization, presented the work of
the ANA’s Racial Reckoning Statement. President
Grant then held the membership hearing on the
statement. In 2021, the ANA began an intense
effort to understand its own history in relation
to racism in nursing. The outcome of this
examination was an initial reckoning statement
that serves as an apology to nurses of color who
have been harmed by decisions and omissions
made by the ANA that contributed to racism in
the profession. Through this statement, ANA
has launched a sustained effort dedicated to
ongoing reckoning and reconciliation. Through
this hearing, there was overwhelming gratitude
and praise for the reckoning statement. There was
acknowledgement that this work is long overdue.
Discussion around quotes in the document were
identified and discussion that ANA must “walk the
talk” through planned action steps. Next steps
include reviewing policies for bias. Future work
includes looking at harms, as well as including
considerations for global, spiritual, and ethical
perspectives.
Debbie Hatmaker reported on the ANA
Enterprise and the strategic goals to elevate
the profession of nursing globally, to engage all
nurses to ensure professional success, to evolve
the practice of nursing to transform health and
healthcare, and to enable transformational
capabilities through operational excellence. It was
noted ANA Enterprise has continued to exceed its
growth and revenue operations. This allows for
continued focus on improving the practices within
our nursing profession.
Professional Policy Committee facilitated the
three dialogue forums for the 2022 Membership
Assembly.
Dialogue Forum #1: Impact of Climate Change
on Health was submitted by members from
ANA Board of Directors, New Hampshire Nurses
Association, ANA-Michigan, ANA-Vermont,
Minnesota Organization of Registered Nurses,
Alliance of Nursing for Health Environments
and with assistance from Michigan Clinicians for
Climate Action. Recommendations and additions
to this proposal were discussed and additional
actions presented.
Dialogue Forum #2: Advancing Solutions to
Address Verbal Abuse and Workplace Violence
Across the Continuum of Care. Often, healthcare
stakeholders’ approaches to workplace violence
(WPC) in healthcare focuses on responses to,
and prevention of, physical assaults in hospitals.
Discussions often overlook verbal abuse, which
Friday, June 10, 2022
The first day of the Membership Assembly
included participants and representatives from
ANA's constituent and state nurses associations,
the Individual Member Division, and specialty
nursing organizational affiliates, as well as the ANA
Board of Directors. Annual updates and reports
were presented by the President, ANA Subsidiaries
and Constituent Associations (American Academy
of Nursing, American Nursing Credentialing
Center, American Nurses Foundation and National
Student Nurses Association), as well as the
ANA Chief Nursing Officer, and ANA Treasurer.
Attendees participated through discussion, polling,
networking, and tabletop working sessions.
Left to Right: Julia Stocker Schneider, Bridget
Leonard and MaryLee Pakieser enjoy the
sunshine of a June day at the Capitol Building in
Washington, D.C.
Want to Do More to
Support Your Association?
Left to Right: Bridget Leonard, MaryLee
Pakieser, Julia Stocker Schneider and Anne Kreft
make their way to Membership Assembly events
in June.
Consider all the ways you can become an
engaged ANA-Michigan member!
- Run for an open board position
- Join a committee
- Write an article for the weekly or quarterly
newsletter
- Participate in ANA-Michigan events
- Let us know if there are things we should be
aware of and promoting on your behalf
Left to Right: Bridget Leonard, Anne Kreft,
MaryLee Pakieser, Julia Stocker Schneider and
Barb Medvec meet with congressional staffers at
Senator Gary Peters' office in Washington, D.C.
AMERICAN NURSES ASSOCIATION
MICHIGAN

August, September, October 2022 The Future of Nursing in Michigan Page 5
can be a risk factor for physical violence. In
addition, practice and policy recommendations
developed for inpatient settings may not be
appropriate or helpful in community settings,
such as schools, community health centers, public
health facilities, and similar places where WPV can
occur. To safeguard all nurses from risks of harm
and abuse, the nursing community must assume
a culture of safety and zero-tolerance stance and
provide action steps in all settings that recognize
diverse forms of abuse and threat. This was
submitted to the ANA Board by the New Jersey
State Nurses Association, National Association of
School Nurses. Feedback included implementing
those actions to promote a culture of safety and
zero tolerance at the constituent, state and IMD
associations.
Dialogue Forum #3: Nurse Staffing. This
forum was established by the Professional
Policy Committee of the ANA. The discussion
focused on ANA’s current policy and approach
to nurse staffing, along with several other state
and specialty-level strategies. With the stress of
the COVID-19 pandemic, which highlighted and
exacerbated long standing nurse staffing issues,
this was determined to be a good time to take a
pulse check on where ANA, the C/SNAs and IMD
stand on this pain point for nursing. The goal
was to provide any direction for change that may
be needed, particularly about ANA’s positioning
related to nurse-to-patient ratios. Any revisioning
of ANA’s policy should be developed between July
and December 2022.
The day ended with the Candidate Forum
presentations and Regional Meetings, as well as
the ANA PAC Reception.
Saturday, June 11, 2022
This session began with Membership Assembly
voting for the vacancies of Board President,
Secretary, Director-At-Large, Director-At-
Large Staff Nurse and Nominations & Elections
Committee.
President Ernest Grant opened the session
and greetings from the International Council of
Nursing (ICN) were presented. ANA CEO Pam
Cipriano provided an overview and update on
the directions for ANA and nursing moving into
the future of healthcare. Outgoing members
of the ANA Board were recognized. In addition,
a tribute to ANA members who had passed
away in 2021/2022 were provided through the
Nightingale Tribute, with members lost to
COVID-19 highlighted. Networking sessions for the
day focused on Amplifying the Voice of the Nurse,
What is the Value of a Nurse?, Understanding and
Fulfilling Member Needs, Addressing the U.S.
Opioid Crisis, State Based Innovation Incubators
and Feedback on Revision of the Nursing
Administration: Scope and Standards of Practice.
The Membership Assembly continued with
the report of the ANA Professional Policy
Committee with the unanimous support for
the Racial Reckoning Statement. The Dialogue
Forum Statements for Impact of Climate Change
on Health, Advancing Solutions to Address
Verbal Abuse and Workplace Violence Across
the Continuum of Care, and Nurse Staffing were
adopted with revisions by the Assembly. The
report of the Head Teller announced the newly
elected ANA officials as: President: Jennifer Mensik
Kennedy; Secretary: Amanda Oliver; Director-At-
Large: Edward Briggs, and Jennifer Gil; Director-At-
Large Staff Nurse: David Garcia and Nominating and
Elections Committee: MaryLee Pakieser, Patricia
Travis, and Kimberly Velez.
Closing comments were provided by President
Grant regarding the end of his term as ANA
President and the meeting was then adjourned.
Left to Right; Julia Stocker Schneider, MaryLee
Pakieser, Barb Medvec, Anne Kreft, and
Bridget Leonard get ready to head out to their
congressional office visits.
Left to Right: Julia Stocker Schneider, Bridget
Leonard, Anne Kreft, Barb Medvec, and MaryLee
Pakieser get ready to knock on Congressman
Jack Bergman's door during ANA Hill Day.
The U.S. Capitol Building on the day the ANA-MI
nurses visited congressional offices.

Page 6 The Future of Nursing in Michigan August, September, October 2022
ANA-Michigan
Foundation Welcomes
Two New Board
Members
The ANA-Michigan Foundation is pleased to
welcome two new individuals to its Board of
Directors. We are thrilled to have their time,
dedication and leadership on the board as the
foundation works to further its goals in 2022.
Looking for a way to give back to nurses as they
continue to battle the pandemic on the front lines?
Make a donation to the ANA-Michigan Nurses Foundation
and support the future of nursing.
Nancy C. Martin,
DNP, RN
Director 3-Year Term
Cheri Wollack,
RN
Director 2-Year Term
Hiring LPNs and RNs to
Join our Team
Lenawee Medical Care
Facility is proud to serve
senior care patients through
a holistic approach. Our
nursing home is set up in
mini-communities that
are clean, vibrant and
active, exhibiting an at-home atmosphere that is personalized
for each resident. We offer traditional nursing services such
as therapy, hospice care, long-term care, and skilled nursing.
Our rehabilitative therapy services include physical therapy,
occupational therapy, and speech therapy, along with therapeutic
recreation.
Our mission: It is our commitment to provide quality care that
respects each individual, honors dignity and promotes the highest
level of well-being.
• $10,000 Sign On Bonus
• Tuition Assistance Program
• Excellent Benefits Package - including Medical, Dental,
Vision, Short-Term Disability, Life Insurance
• Retirement Plan with employer matching
• 12- hour shifts with flexibility in scheduling
• Opportunity for growth and continued learning
For more information, contact:
Lenawee Medical Care Facility
Adrian,MI
517-263-6794
www.lenaweemedicalcarefacility.org
Donations can be made online or via
personal check. You can even set up
reccuring donations!
Please visit www.ana-michigan.foundation to
make an online donation and to learn more about
the mission, vision and goals of the foundation.
Checks can be made payable to:
ANA-Michigan Nurses Foundation
They can be mailed to:
2501 Jolly Road, Suite 110, Okemos, MI 48864
The ANA-Michigan Nurses Foundation is a 501(c)3 organization,
and all donations are tax deductible.
$
Aleda E. Lutz VA Medical Center is
NOW HIRING
Registered Nurse - Community Living Center
(Geriatric and Extended Care)
Registered Nurse Specialty Care
Licensed Practical Nurse - Primary Care
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RN Educator (Staff) Saginaw
1 RN Educator (staff) Gaylord and CBOCs
1 RN Veteran Health Education Coordinator (Veterans)
Contact
Phone: 989-497-2500 ext: 11469
Email: vhasagnurserecruiter@va.gov

August, September, October 2022 The Future of Nursing in Michigan Page 7
Michigan Approves ADN to
BSN Program at Community
Colleges in Partnership with
Four-Year Schools
By Evelyn Zois Sweeney of Muchmore Harrington Smalley Associates
The state legislature has passed a sweeping $76 billion fiscal year 2022-
2023 budget which includes transformative investments across education,
healthcare, and workforce training. This year’s budget was bolstered by
unprecedented windfalls in the state’s general fund and federal COVIDrelated
relief dollars. Included in the school aid and higher education budget,
Senate Bill 845 has $56 million appropriated for the “Michigan ADN to BSN
completion grant program,” signifying the first-time higher education
universities and community colleges have reached a compromise on this
important workforce effort.
The crux of the legislative effort includes awarding each eligible
community college a minimum of $2 million to support the creation and
execution of a program that would allow an individual in the state who
has attained an associate degree in nursing to complete a bachelor’s of
science degree in nursing. The initiative requires a partnership between the
community college and a BSN-granting public university or a not-for-profit
independent four-year college or university.
The BSN-granting institution would be responsible for designing,
delivering, and maintaining the completion program, including admissions,
curriculum design and accreditation, with strategic input from employers
and community colleges. The BSN completion courses would need to be
taught at least partially in person on community college campuses, but
course delivery methods would need to be informed by the expressed needs
of the learners in that community.
The legislation also encourages opportunities for joint faculty
appointments for qualified community college faculty to teach BSN
completion courses as adjunct or part-time faculty at the BSN-granting
institution. The legislation is also intentional about bolstering student
success by ensuring the community college or BSN-granting institutions offer
career service, financial aid, mental health counseling and academic advising
support. The bill also indicates the collaborating entities should assume a
minimum five-year agreement unless adequate data and evidence support
discontinuing the partnership before five years has elapsed.
The appropriation bill was signed by the Governor on July 14, but does
not take effect until October 1, 2022. The agreement between the 4-year
degree granting institutions and community colleges is being heralded as
a major breakthrough in negotiations, mitigating the need for separate
legislation (House Bills 5556 and 5557) that had proved contentious within
the legislature. All interested parties are hopeful the legislation can prove
impactful, both for nursing students and the communities they hope to
practice in.
Just Say No;
How to Prevent Burnout
By Nadine K. Wodwaski in collaboration with the ANA-Michigan Nursing &
Health Policy Committee Members
Did you know that overworked nurses are at risk for fatigue that
can lead to burnout? They can jeopardize patients' health and possibly
damage their own mental and physical well-being. Many nurses like to
go above and beyond to be the best nurses. We want to do a good job,
and we say yes to almost everything, from picking up shifts, to working
late, and floating, etc. That means we say yes to everything except
ourselves. We have the power to say NO, but saying NO is a skill that is
hard to acquire. It is an inherently uncomfortable word to say. However,
we need to advocate for ourselves and contribute to our greater good.
By saying NO, you are saying YES to you. So, let us learn how to set
healthy boundaries for ourselves in our profession.
There is an art of saying NO without sounding awkward, damaging
relationships, or feeling guilty. NO can be a standalone sentence. Keep it
short! Many times we use far too many words when all we mean to say
is, "No, thanks!" Conciseness is the essence of confidence. If you sound
sure, people usually will accept that your mind is made up and will not
try to talk you out of your decision. That means you should not explain
when saying NO. Once you realize that you need time for yourself, it is
relatively easy (yes, I said pretty easy) to say NO without an explanation
or excuse. If you are afraid of coming off as robotic or unnatural, it
helps to rehearse saying NO in front of a mirror.
Declining tactfully and thoughtfully conveys respect for the other
person and yourself. Another piece of advice: add NO to your body
language. When you decide to say NO, turn your torso away so you are
not facing them. Cross your arms to cut off communication further.
This is a natural defense mechanism and an uninviting posture. Point
your toes away, towards where you want to go signaling your interest is
elsewhere. Once you signal NO with your body, it is easier for you to say
no.
While saying NO is exceedingly helpful, NO one will reap the benefits
unless you say NO gracefully. Yes, saying NO is a practiced skill and helps
you advocate for yourself in nursing, which is necessary for your selfcare.
No nurse wants to feel burned out like a burned-out lightbulb. By
saying NO, you are putting yourself first, keeping yourself strong and
whole so you can take care of others. Saying NO is declaring YES to
what matters; a healthy and fulfilling life. Make yourself priority #1!

Page 8 The Future of Nursing in Michigan August, September, October 2022
Nursing Crisis Fatigue and the Hope for Change
By Beth Ammerman, the ANA-MI Nursing & Health
Policy Committee Chair, and committee members:
Alexa Andersen, Marina Andriyakhova, Debbie
Bach-Stante, Ramona Berry, Wanda Chukwu, Sarah
Jennings, Holly Thalman, and Nadine Wodwaski
Nurses are in crisis! As the rest of the world is
bouncing back from the COVID-19 pandemic and
returning to normalcy with relaxed workplace
rules including no longer masking, no pre-entry
questioning, and a general feeling that the
pandemic is nearing the end, for nurses and other
healthcare workers, COVID-19 is still very real. We
are still wearing masks and personal protective
equipment at work, which is most of our waking
hours, and we are still caring for very ill patients.
We are still living in the COVID-19 pandemic, and
it lingers on… and on… and is taking a toll on
us. A study by Sriharan, West, Almost & Hamza
(2021) reported evidence from both the COVID-19
pandemic and previous pandemics and shows
that “nurses experience the highest levels of
psychological distress compared with other health
professionals.”
Crisis fatigue is a very real concept that “people
often experience when faced with a chronic
stressor that creates continuous challenges in
their life.” (Caldwell-Harvey & Coelho, 2020). Crisis
fatigue is a feeling experienced by many nurses in
healthcare systems today resulting in low morale,
feelings of inadequacy, frustration, and despair.
Many nurses are leaving their jobs in hospitals and
healthcare systems due to crisis fatigue. For some,
it results in more than changing jobs as nurses are
dealing with crisis fatigue in various ways. While
some nurses are fleeing organized healthcare
to pursue other careers, others are turning to
travel nursing for better pay. Those left behind
are struggling with the idea that they are working
alongside travel nurses and doing the same job
for less pay. The morale they gained from having a
cohesive team of supportive coworkers in the past
is now disrupted due to increased work demands,
transient coworkers, and staff vacancies. So, what
lies ahead for nursing?
In a time when nurses are desperately needed
in acute care (hospital) settings, they are being
drawn away from different nursing opportunities
in search of a better work/life balance. The appeal
for employment that better matches nurses’
expectations have furthered the challenge to
find nurses willing to care for the most acutely ill
patients. Five main factors shift nurses away from
acute care nursing: workplace environment and
demands, overutilization of staff, the appeal of
non-acute care options, imposter syndrome, and
the intent of many nurses to further their degrees
often leading them to administrative or other nonacute
care work. This has led to changes in how
nurses interact in the workplace and the need to
place additional demands on the nurses.
Workplace Environment and Demands
The COVID-19 pandemic brought changes in
the schedule, culture, and comfort of the acute
care nursing workplace. The schedule of a nurse
working three 12-hour shifts per week used to
be the envy of many other professionals; get the
work done, and still have four days to spend with
family and personal life. During the pandemic,
many professionals in other careers shifted from
working five 8–10-hour days per week in an office
to the flexibility of working from home, and they
have never returned to the brick-and-mortar
workplace. During the pandemic, nurses were not
only required to leave their homes, but to enter
settings with a new deadly virus and work longer
hours, with mandated overtime, to compensate
for the lack of human resources (nurses and other
hospital employees).
Additionally, nurses were gowned, gloved, and
masked for long shifts, becoming physically and
emotionally drained while caring for consistently
overflowing patient counts. The rationing of
personal protective equipment, combined with
staffing shortages and other inpatient staff
fearful to enter rooms, led to non-nursing tasks
becoming the responsibility of direct care nurses.
Since nurses were masked and gowned and in
the patients’ rooms already, they were now also
emptying trash cans, delivering food trays, and
holding tablets so the patients could communicate
electronically with family and physicians. Ongoing
staffing shortages among all levels of inpatient
staff have led to the continuation of these work
conditions. Nurses are weary and crisis fatigue has
set in.
One solution is to have transformational nurse
leaders which can have a positive influence on
managing these challenges.
Today’s nurse leader will have to understand
the impact of nursing on a global level. The
current pandemic has caused a financial strain on
America’s health care system. Stamps et al. (2021)
noted that nurses reported feeling unsupported
by uninformed or misinformed peers and family,
as well as lonely when caring for a client diagnosed
with COVID-19. Many nurses during COVID-19 have
taken early retirement packages or decided to
work as travel nurses because of the increased
payments received from the agencies hiring. The
current nursing shortage, workload imbalances,
and nurses’ burnout during the pandemic have
also contributed to many nurses facing emotional
and physical strain while working.
The added layer of stress while working during
a pandemic has led nurses to be in crisis mode. To
help address the issue concerning nurses’ fatigue,
retention, onboarding training, and training new
graduates, many healthcare facilities are reaching
out to foreign nurses to help fill in the gaps due to
challenges with staffing.
According to the American Nurses Association
(2020), there is a national nursing shortage. With
rising openings and employment, the U.S. Bureau
of Labor Statistics projects 194,500 average annual
openings for registered nurses between 2020 and
2030, with employment projected to grow by 9%.
This shortage has led to many healthcare facilities
returning to utilizing nursing agencies and nurses
from different countries to fill the gaps. There is
a need for all nurses - including those with titles
such as chief nursing officer, nurse manager, and
charge nurse, as well as frontline nurses, to act as
transformational leaders. According to Boamah
(2022), nurse leaders practicing transformational
leadership can be an effective way to improve
workplace culture and improve retention.
According to Stamps et al. (2021), “nurse
leaders” support is essential to creating a safe
workplace in which nursing staff are protected,
supported, educated, and empowered. Nurse
leaders can first ensure that they are advocating
for nursing staff members by involving nurses
in the decisions that impact their practice
environment. This collaborative approach would
create a communicative plan that includes
everyone involved in providing patient-centered
care. Nurse leaders and all staff members can
promote advocacy by agreeing to treat support
staff, new graduates, and visiting nurses as
professionals and equals. The commitment to
open communication and collaboration will lead
to nurses developing additional conflict resolution
skills while working under duress. Nurse leaders
and staff members feeling empowered to act as
leaders will assist in the commitment to providing
quality service and care to our patients during
these times of transition. There is a need to create
a workplace culture where staff members feel
supported and empowered, as well as knowing
how to care for themselves.
Overutilization of Staff
Exhaustion and illness have led to a human
resources crisis in nursing. Furthermore, 21%
percent of nurses polled in a national survey
reported the intention to leave their job within
a year (Koehler & Olds, 2022). Other studies have
shown even higher rates of intent to leave. Those
who were willing and able have persevered, but
the seemingly few that covered for the many have
reached their breaking point. The overutilization
of acute care staff through mandated overtime
and refusal of requests for leave is a complex issue
and clearly, the demand for the scarce resource
of nurses is driving complicated decision-making.
However, refusing nurses breaks that are essential
to their health and wellbeing is accelerating their
rapid exits. A research study found two common
interests for bedside nurses across generations:
reasonable workload and manageable staffing
(Koehler & Olds, 2022). Focusing on these areas is
imperative to improving retention.
Appeal of Non-Acute Care Options
When nurses leave the bedside, where do
they go? Many nurses are seeking employment
in non-acute care (non-hospital) settings. In
addition to the drive to leave bedside nursing for
the reasons already listed, the decrease in pay to
step away from the hospital is no longer a barrier.
Traditionally, pay for working in a hospital was
better than working in an office. However, nurses
are in demand, which has increased compensation.
Registered nursing jobs administering aesthetic
injection treatments such as Botox Cosmetic
(onabotulinumtoxinA) provides nurses with
compensation just as well, if not better, along with
the added bonus of “normal business hours” and
often less stress and physical demand. Nurses
have recognized that they can make the same
amount of money in a less stressful, healthier
environment, working a regular schedule.
Imposter Syndrome
In every new role, there is an adjustment period
where professional standards, responsibilities,
and expectations are identified. Unfortunately,
when high achievers fail to fully internalize their
accomplishments despite their obvious successes,
it leaves them with a sense of self-doubt and fear
of exposure as a fraud leading them to believe
they are fooling others into thinking they are more
capable than they are (Clance and Imes, 1978). This
is called Imposter Syndrome. Imposter Syndrome
in nursing is common and can occur in up to 82%
of individuals (Bravata et al., 2020). It can be very
distressing and have consequential effects on
job satisfaction and personal performance. In
nursing, the novice nurse is vulnerable to feelings
of doubt when it comes to feeling ready to meet
the expectations of their patients, colleagues, and
themselves. This often destroys self-confidence
and a sense of belonging, and can lead to burnout
and decreased job satisfaction. This cascade then
leads them to work outside their comfort level,
ultimately feeling the need to leave the nursing
profession. This also leads to crisis fatigue in many
new nurses.

August, September, October 2022 The Future of Nursing in Michigan Page 9
The COVID-19 pandemic left many organizations
adapting to a reduced workforce while many
were forced into a work-from-home life instead
of the office. Everything from higher education,
appointments, and meetings became remote
with the use of platforms such as Zoom and
Microsoft Teams. The pressures to meet
performance expectations left a toxic taste with
many (Plotnikof & Utof, 2021). Additionally, being
isolated led to more social media scrolling and
comparing filtered lives of others, seemingly full of
accomplishments, with their own. This led to those
who reported working with more responsibilities
and less supervision, ultimately increasing
thoughts of self-doubt and fear of exposure as a
fraud.
There is not a lot of consensuses around
evidence-based treatments for Imposter Syndrome;
however, it is suggested that raising awareness
helps to manage Imposter Syndrome both
personally and within an organizational setting.
Imposter Syndrome can be difficult to identify,
as many conceal their perceived inadequacies.
Having open communication and discussions of
performance between managers, preceptors,
and new nurses helps to highlight the differences
of feeling incompetent and being incompetent,
as they are two very different things. Whether
employees are working on-site or working from
a home office, offering career development
activities and having access to resources such
as resilience training helps to reduce symptoms
of Imposter Syndrome (Bravata et al., 2020).
Effects can also be mitigated by setting healthy
expectations and creating cultures where
employees’ accomplishments are acknowledged
and celebrated.
As we know nurses are leaving for a variety of
reasons, and those who are left behind are often
stressed, overworked, underappreciated, and
understaffed; where do we turn to get more help?
There is a need to revisit the way nurses deliver
care in the acute care setting.
Role of LPNs in Acute Care
In light of the recent decrease in the registered
nurse (RN) workforce in acute care, licensed
practical nurses (LPN) are being brought back
to the field. Several hospital systems across
the country are expanding new graduate RN
programs and bringing back the RN-LPN team
nursing. Over the last two decades, Magnet status
has been a goal for the standard of practice for
healthcare systems. Magnet status is an award
for the highest ranking of nursing whereby
education and development of nurses is stressed:
“throughout every career stage, leading to greater
autonomy at the bedside” (ANCC, 2022). Evidencebased
sources steered Magnet designations
toward creating and maintaining a nursing
workforce that is Bachelor of Science (BSN)-
prepared. This trend has nearly eliminated LPNs
from the in-patient departments, but with the
shortage of RNs, is now the time to bring these
nursing professionals back on board?
Currently, 584 out of 6,093 hospitals in the
United States have designated Magnet status, or
9.3% (ANCC, 2022). The Bureau of Labor Statistics
projects the need for both RN and LPN jobs to
increase by 9% from 2020 to 2030 (Bureau of Labor
Statistics, U.S. Department of Labor, 2022). What
does it mean for LPNs? What would it mean for
hospital systems that “phased out” non-BSNprepared
nurses? The answers are not the same
for everyone, but there are options. Incorporating
LPNs into the acute care setting decreases the
staffing shortage; however, clear policies on
the role, duties, and responsibilities consistent
with the scope of practice in a specific state are
necessary.
While LPNs were once actively working in
hospital settings, the push for an all-RN workforce
left many LPNs working in alternative settings like
outpatient clinics and long-term care facilities.
With the severe RN shortage that we as a country
are now experiencing, is this the time to bring
the LPN back into the acute care setting to help
alleviate this shortage? What would the care
model look like? Would this be temporary with the
LPNs present only for the crisis, only to be sent
back out of the hospitals again in a few years?
LPN to RN transition programs and
incentives should be clearly defined to provide
opportunities for professional growth and longterm
employment should the hospital consider
applying for Magnet status. The time when LPNs
were “phased out” of the acute care is fresh in
our memory; therefore, it is imperative to be
straightforward in describing the setting in which
the role might only be temporary. One way is a
short-term contract for LPNs not pursuing the
RN-BSN path, and another is monetary incentives
for “seasoned” LPNs that previously worked
in comparable settings. In addition, it is fair to
expect that each hospital considers ways to offer
LPNs to practice within their scope of practice
in acute care. This will allow more skilled nursing
professionals to assist in the current staffing
shortage crisis.
Nursing Crisis Fatigue and the..continued on page 10

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Page 10 The Future of Nursing in Michigan August, September, October 2022
Nursing Crisis Fatigue and the..continued from page 9
Newly hired nurses often volunteer to demonstrate team spirit. Often,
short-lived when it is painfully obvious no one else is volunteering. Next, they
realize volunteering does not exempt mandates to work over, extra days,
and holidays, and that approved planned time off may be compromised.
The nurses that assert themselves and decline extra assignments may face
retaliation. The managers have an obligation to safely staff their areas; their
job description includes implementing necessary measures to accomplish
safe staffing. Third-party staffing (“the pool”) is not an option. If critically
necessary, managers assign themselves to fill the void. The common
denominator for staffing is the nurse managers. How they accomplish this
feat depends on their personality and management style. It is essential for
managers to establish staffing standards that are fair and equitable to their
team. Examples include: the “pull list,” establishing standards to address
breeched assignments, discussions with feedback from staff to improve
staffing issues; otherwise, staff that disagrees with the unit practices will
consider leaving.
Intent of Many Nurses to Further Their Degrees or Seek Non-Inpatient Care
Options
The appeal of advanced degrees and the opportunities away from the
bedside that those degrees present are factors that impact nurses. Some
faculty report that nursing students already have their sights on advanced
degrees, even before graduating with their BSN degree. At this time, it is
easier than ever to pursue advanced degrees that will lead to administrative
roles or Advanced Practice RN (APRN) careers with more regular schedules
and often in outpatient office environments. There are approximately
400 nurse practitioner programs currently in the United States (American
Association of Nurse Practitioners, 2022). In addition to a large number of
schools, there are flexible options for learning, such as online or face-to-face
programs. APRNs (inpatient and outpatient) are facing crisis fatigue as well,
and those RNs seeking to become Nurse Practitioners (NP) are sometimes
disillusioned once they get the degree and are leaving the APRN role, too.
It is not just advanced degrees that nursing students are eyeing; however,
it is careers in aesthetics and population health careers, as well. Some
students are requesting additional time in non-acute settings for their final
projects or transition experiences during their final days in undergraduate
programs, as opposed to the traditional acute care rotations. Some nursing
students are requesting that the full complement of their clinical placement
experiences occur outside the acute care setting. Students cite the appeal
of the environment and want a schedule conducive to work/life balance or
family life. Recognizing the new and different expectations for work/life
balance will be crucial to innovative change that effectively redevelops and
sustains a solid workforce at the bedside.
Conclusion
Today’s nurses are facing many challenges. Addressing these issues will
require ongoing support, and collaborating together will ensure that patientcentered
care, teamwork & collaboration, safety, and quality improvement
are maintained during these uncertain times. Nurses will still be committed
to improving positive clinical outcomes, acting as transformational leaders in
our healthcare communities.
References
American Nurse Association (2020). Nurses in Workforce. Retrieved from https://www.
nursingworld.org/practice-policy/workforce/
American Association of Nurse Practitioners. (2022, April). NP Fact Sheet. https://www.aanp.
org/about/all-about-nps/np-fact-sheet
Boamah SA. The impact of transformational leadership on nurse faculty satisfaction and
burnout during the COVID-19 pandemic: A moderated mediated analysis. J Adv Nurs. 2022
Mar 17:10.1111/jan.15198. doi: 10.1111/jan.15198. Epub ahead of print. PMID: 35301738; PMCID:
PMC9111819.
Bravata D.M., Madhusudhan D.K., Boroff M., Cokley K.O. (2020). Commentary: Prevalence,
Predictors, and Treatment of Imposter Syndrome: A Systematic Review. Journal of Mental
Health Clinical Psychology, 4(3), 12-16.
Bureau of Labor Statistics, U.S. Department of Labor. (April, 2022). Occupational Outlook
Handbook. https://www.bls.gov/ooh/healthcare/registered-nurses.htm
Caldwell-Harvey, Taisha, and Steph Coelho. “Crisis Fatigue: Definition, Symptoms, and How
to Cope.” Medical News Today, MediLexicon International, 6 Nov. 2020, https://www.
medicalnewstoday.com/articles/crisis-fatigue.
Clance P.R. & Imes S.A. (1978). The imposter phenomenon in high achieving women:
dynamics and therapeutic intervention. Psychotherapy: Theory, Research and Practice;
15(3), 241-247.
John, S. (2019). IMPOSTER SYNDROME: Why nurses question their competence. The Nursing
Times, 115(2), 23-24.
Koehler, T., & Olds, D. (2022). Generational differences in nurses’ intention to leave. Western
Journal of Nursing Research, 44(5), 446–455. https://doi.org/10.1177/0193945921999608
Plotnikof,M. & Utoft E.H. (2021). The “new normal” of academia in pandemic times:
Resisting toxicity through care. Gender, Work, & Organization, 1-13. https://doi.org/10.1111/
gwao.12778
Sriharan, A., West, K. J., Almost, J., & Hamza, A. (2021). COVID-19-Related Occupational
Burnout and Moral Distress among Nurses: A Rapid Scoping Review. Nursing Leadership
(1910-622X), 34(1), 7–19. https://doi-org.proxy.lib.umich.edu/10.12927/cjnl.2021.26459
Stamps, D. C., Foley, S. M., Gales, J., Lovetro, C., Alley, R., Opett, K., Glessner, T., & Faggiano,
S. (2021). Nurse Leaders Advocate for Nurses Across a Health Care System: COVID-19.
Nurse leader, 19(2), 159–164. https://doi.org/10.1016/j.mnl.2020.07.011 https://www.ncbi.
nlm.nih.gov/pmc/articles/PMC7386289/
The American Nursing Credentialing Center. (April, 2022). Find a Magnet Organization. Find a
Magnet Organization | ANCC | ANA Enterprise (nursingworld.org)

August, September, October 2022 The Future of Nursing in Michigan Page 11
Meeting the Nurse Staffing Challenge, Part Two: Retention Tips
Georgia Reiner, MS, CPHRM, Risk Specialist, NSO
As discussed in the first article in this
two-part series on nursing recruitment and
retention, ensuring appropriate nurse staffing
levels is key to the financial health of healthcare
organizations like hospitals and skilled nursing
facilities. High-quality nursing care helps to
reduce the likelihood of patient safety events
and costly medical malpractice lawsuits related
to missed errors. This means it is critical
for leaders to engage in effective retention
strategies.
The second of a two-part series, this article
addresses effective retention strategies that
leaders can utilize to help reduce turnover of
nursing staff.
Retention
The 2021 National Health Care Retention and
RN Staffing Report notes that the average cost
of turnover for a hospital-based RN was $44,400
in 2020. This makes retention a key part of an
organization’s staffing strategies. You need
to work closely with human resources staff
to ensure retention strategies are efficient,
effective, and in-line with organizational
strategies.
Conduct “stay” interviews. Stay interviews
help you identify employees who might be
thinking about leaving the organization and
identify what factors are most important for
staying. You can use the information to create
an individual retention plan and to inform your
larger retention efforts for the unit. Here are
some examples of questions you can use to help
elicit useful information during stay interviews:
• What do you look forward to each day
when you commute to work?
• What are you learning here, and what do
you want to learn?
• Why do you stay here?
• When is the last time you thought about
leaving and what prompted it?
• What can I do to make your job better for
you?
them to the individual’s interest. For example, a
nurse who drinks coffee every day may enjoy a
Starbucks card, but one who loves to read might
prefer a card from Barnes & Noble.
Support career development. Explore nurses’
professional goals and how you can help meet
them during stay interviews and other ongoing
professional development conversations. It’s a
good idea to keep a mental list of options such
as serving on committees, acting as a preceptor,
and leading project teams. Offer meaningful
opportunities for professional growth based
on performance, rather than solely based on
tenure. Outline for your staff the types of
experiences or skills that are most valuable for
advancement and reinforce the value of bedside
nursing experience for nurses’ long-term career
growth.
Consider a job embeddedness approach.
Job embeddedness (JE) focuses on why people
stay in their jobs as opposed to why they leave.
A study by Reitz and colleagues found it’s a
good predictor of nurses’ intent to stay. JE
looks at ties related to organizations and the
community where they exist. These ties are
considered in three dimensions: links (formal
and informal connections people have with
their organizations or communities), fit (how
compatible people feel with their organizations
or communities), and sacrifice (material and
psychological losses people would experience
by leaving their organizations or communities).
You can leverage these dimensions to promote
retention. For example, to help promote JE with
the organization:
• Links: Involve nurses in committees and
shared governance.
• Fit: Recruit nurses whose goals align with
the organization’s goals.
• Sacrifice: Align vacation time and
retirement plans with the time of service.
A multifaceted approach
Nurse staffing challenges are unlikely to
ease anytime soon. Leaders will need to be
creative and take a multifaceted approach to
recruitment and retention. These efforts will
help gain—and keep—staff. Doing so helps
reduce the costs of lawsuits related to errors,
but, most importantly, provides optimal patient
outcomes.
References
Advisory Board. Struggling to keep entry-level staff
engaged? Try a performance-based career ladder. 2017.
https://www.advisory.com/blog/2017/02/pef-careerladder
CNA & NSO. Nurse Professional Liability Exposure Claim
Report: 4th Edition: Minimizing Risk, Achieving
Excellence. 2020. https://www.nso.com/Learning/
Artifacts/Claim-Reports/Minimizing-Risk-Achieving-
Excellence
Malliaris AP, Phillips J, Bakerjian, D. Nursing and Patient
Safety. Agency for Healthcare Research and Quality.
2021. https://psnet.ahrq.gov/primer/nursing-andpatient-safety
NSI Nursing Solutions, Inc. 2021 National health care
retention and RN staffing report. 2021. https://www.
nsinursingsolutions.com/Documents/Library/NSI_
National_Health_Care_Retention_Report.pdf
Reitz O, Anderson M, Hill PD. Job embeddedness and
nurse retention. Nurs Admin Q. 2010;34(3):190-200.
Saver C. Retaining nurses in a post-pandemic era—Part 1.
OR Manager. 2021;37(9):12-15.
Sherman RO. The Nuts and Bolts of Nursing Leadership: Your
Toolkit for Success. Rose. O. Sherman; 2021.
Disclaimer: The information offered within this
article reflects general principles only and does not
constitute legal advice by Nurses Service Organization
(NSO) or establish appropriate or acceptable standards
of professional conduct. Readers should consult with an
attorney if they have specific concerns. Neither Affinity
Insurance Services, Inc. nor NSO assumes any liability
for how this information is applied in practice or for the
accuracy of this information.
This risk management information was provided
by Nurses Service Organization (NSO), the nation's
largest provider of nurses’ professional liability
insurance coverage for over 550,000 nurses since 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.
Promote a healthy work environment. For
example, implement zero tolerance policies for
patient or visitor violence against nurses and
policies that discourage providers from bullying
their colleagues. Beyond policies, it is also
important to ensure lines of communication are
open, so your staff feel comfortable speaking
with you when they identify problem areas.
Make rounds daily and listen to staff closely. Ask
them questions such as, “What do you need to
do your job more effectively?” If it’s something
that you can take care of, do so and let them
know it’s been done. If you can’t address the
issue, explain why and, if appropriate, note that
it may be able to be addressed in the future.
Avoid sign-on bonuses. Sign-on bonuses
may help to ease staffing woes short term, but
don’t ensure commitment, and can even lead to
resentment from current staff. Instead, focus
on improving nurses’ pay scales or offering
retention bonuses to show appreciation for your
nursing staff’s commitment to the organization.
Recognize employees. Recognition is an easy,
but often underutilized, retention tactic. Take
every opportunity to offer words of praise. To
reinforce the behavior, specify what specifically
was done to earn praise. Small rewards such as
gift cards can also be effective, but try to match
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October 15, 2023

Page 12 The Future of Nursing in Michigan August, September, October 2022
Comparing, Criticizing and Complaining:
The Detrimental Effects of Gossip
By Nicole Cerrini, BSN, RN,
Owner of Nicole Cerrini Health
& Wellness
While I was attempting
to eat my breakfast in peace
at work, I found myself
surrounded by others who
were either complaining about
their neighbors, demoralizing their colleagues or
expressing general disdain for their life situations.
It was extremely hard to continue to listen to all
of this, and even harder not to try to redirect their
conversations.
This life is way too short to constantly be
gossiping and welcoming negativity with open
arms. I recently listened to a podcast by Jay
Shetty (On Purpose) and he discusses the three
C’s: Comparing, Criticizing and Complaining. It is
overwhelming when you are able to take a step
back and observe yourself from this standpoint.
Even smaller complaints or “simple” gossip can
largely affect your daily life and how certain things
affect you. It’s extremely draining when you are
surrounded by negativity, and once you’re selfaware
of this issue, it becomes toxic being around
those who continuously put down others or
themselves.
Comparing yourself to others is one of the
most common thoughts we have. Whether
you’re comparing life circumstances, weight,
friendships, spouses, etc., it all plays a part in
how you generally feel about yourself and in turn
affects your relationships with others. I am guilty
of comparing myself in certain situations, but now
that I am aware of it, I’m able to not only catch
myself in the moment, but also put a positive
spin on it. The next time you observe yourself
comparing in any way, try to recognize that it’s
simply your way of realizing what you desire and
figuring out what that means for you.
Criticizing is another huge habit that leads
to general problems with yourself and your
relationships. Whether you are being critical of
yourself or others, you instill the stigma that
something isn’t good enough for you. It’s very
possible that you are likely criticizing those close
to you and may not even be aware of it. Petty
gossip, such as talking about a family member
behind their back or judging the person in line
in front of you at the grocery store, are both
examples of how criticism can creep up in your
daily life and put a negative twist on your values.
Once you really begin to see how often this
happens, it’s incredible to feel the shift as you
start to create new habits that steer clear from
judgment.
Complaining is probably one of the harder
habits to break when it comes to the three C’s.
There are a few people in my life who always seem
to be complaining about something/someone at
all times. It’s exhausting listening to it, and even
more exhausting trying to get them to see a
different perspective. If you compare complaining
to the Law of Attraction, it makes a lot of sense
that the complaints seem to never end. What you
put out, you always get back! Very few people
can take a step back and realize that they are
the common denominator in their problems.
Every single situation can always be viewed in
a positive light, even if it may seem impossible.
The minute you decide to replace your complaint
with something you're thankful for, you will
immediately feel better and those around you will
notice this shift as well.
It’s not easy to turn the magnifying glass on
yourself and realize the negative habits you have
made your norm. But once you really make an
effort to notice when you're comparing, criticizing
or complaining, the easier it will become to not
only notice these habits, but to break them. You
are the only one in control of your life and how
you react to it. No one else can take the wheel for
you and steer you in a positive direction. You have
to want it for yourself, but once you do decide
to make this shift, you will be amazed at the
opportunities that open for you.
Michigan Department of Corrections
NOW HIRING
REGISTERED NURSES
AND
GRADUATE NURSES!
$5,000 sign on bonus*
$250 retention bonus pilot*
Great pay and Benefits
Opportunities for advancement
13 paid Holidays (14 every other year)
To apply, visit www.michigan.gov/mdocjobs.
*For RN/approved locations only

August, September, October 2022 The Future of Nursing in Michigan Page 13
Innovating Toward an Improved Future of Nursing
Innovation is the current
buzz word in health care.
When hearing this term,
what immediately comes
to mind is the application
of new technologies and
reorganization of current
structures. The Michigan
Department of Health and
Human Services, Office of
Nursing Programs: Nursing
Safety and Workforce Planning
Deborah Bach-
Stante, BSN,
MPH, MSW
(MDHHS-ONP) is excited to support innovation
through technology, data, and continuous
improvement of our efforts through engagement
with nursing stakeholders throughout Michigan.
MDHHS-ONP has spent the past several years
supporting efforts to increase and disseminate
virtual clinical education resources throughout the
state. These resources were developed through
nursing academic and practice partnerships with
community organizations serving individuals
who encounter barriers to accessing culturally
competent and accessible healthcare services in
Michigan. In addition, the ONP has supported and
disseminated training for faculty on best practices
and resources for virtual nursing education.
The virtual clinical education resources are
designed to improve nurses’ understanding of
the impacts of social determinants of health and
inequities on individuals in Michigan.
These resources are freely available using the
following link:
Virtual Nursing Clinical Education Resources
(michigan.gov)
The virtual clinical education training may be
accessed using the following link:
Navigating the Way Forward: Resources and
Best Practices to Embed Virtual Resources in
Clinical Education Webinar (michigan.gov)
While innovation includes these things, the
broader definition of this term also encompasses
a more comprehensive renewal. Labor shortages,
new technologies, and acknowledgement of
the impacts of implicit bias, racism and societal
inequities are placing increasing pressure on
the systems that provide services affecting the
health and wellness of the population. To address
these pressures, the nursing profession needs to
leverage available information and resources to
take a bold stance on innovating for the future.
In addition to incorporating new and important
data, structures and resources, it is time to rid
ourselves of vestigial structures, including those
practices, policies and processes that only serve to
maintain the status quo. We stand on a precipice
as bold leaders throughout all areas and levels of
nursing to strive to move the profession forward
into a better future for both the profession and
the individuals, families and communities that we
serve. To clarify, in this context, the word leader
does not reference only those who hold certain
professional titles or serve in specifically defined
leadership roles in nursing or other healthcare
organizations that are designing strategies to
address these issues. The word leader is used
to refer to the professional leadership taught in
nursing educational programs throughout the
state that is inherent to all nursing roles and
responsibilities.
Thus, nurses and nursing stakeholders
throughout the state are encouraged to view
the longitudinal analysis of diversity data,
currently in process, that will appear in the
2022 Michigan Nursing Licensure Survey Report
and the associated analysis of workplace
violence data collected over the past three
years. This data, while limited by the number
and representativeness of respondents, is
not intended as an endpoint, to serve as
documentation of the current state of the
profession, to be viewed once and put on a shelf,
or only used as a citation in grant proposals
and research efforts. This data will serve as
a tool to inform a larger dialogue regarding a
comprehensive renewal of the nursing profession
in Michigan.
The ONP would like to invite nursing
stakeholders throughout Michigan to participate
in the collaborative process of dialogue to be
embarked upon in the fall of 2022. Armed with
the available data, individuals who choose to
participate in this process will collaborate on
identifying long and short-term priorities to be
used in the design of an action plan for how the
ONP will continue promoting safe patient care
in all nursing practice environments, advancing
the safe practice of the nursing profession,
and ensuring a continuous supply of highquality
direct care nurses, nursing faculty and
nursing educational programs. Individuals who
are interested in engaging in this constructive
dialogue are encouraged to email Casey Klein
at kleinc7@michigan.gov to have their name
and contact information added to the list of
stakeholders to be invited to participate in this
process. It is only through the collective efforts of
all facets of nursing stakeholders that embarking
upon the path forged through a collaborative
process may assist in ushering in a future of
nursing that can be embraced by current and
future nursing professionals and nursing students
throughout Michigan.
ANA-MI Foundation Awards
First Annual Grants and Scholarships
By Myrna Holland, MSN, RN, ANA-MI Foundation
President
As this newsletter is going to press, the ANA-
MI Foundation board members are selecting the
first recipients of the foundation’s initial round of
scholarships and grants. When you have finished
reading this article, you can visit the foundation’s
website, www.ana-mi.foundation, to learn about
the awardees.
The awards were established for pre-licensure
students who have completed two semesters
of nursing courses. Our goal is to support timely
graduation and entry into the professional work
force. For this first round, the two scholarships
being granted are for $2,500 each. One is the
Dorothea Milbrandt Leadership Scholarship and
the other is the Academic Excellence Scholarship.
The additional $2,500 is being distributed in
amounts up to $500 to address specific financial
obstacles which interfere with an individual’s
ability to complete their education in a timely and
less challenging manner.
There were many worthy applicants and making
the final selections is not going to be easy. We plan
to share some of their goals and achievements
with you, because we are sure their stories will
enhance your positive feelings about the future of
nursing.
The Foundation Board will be working to
continue and expand this scholarship program,
as well as prioritize the other purposes of our
foundation. Of course, these goals require
consistent funding, so we hope that all of our
members will find a way to make a tax-deductible
donation to help us grow. There are several
ways to do that. When you visit www.ana-mi.
foundation there are links to donate by PayPal or
by credit or debit card on a monthly or one time
basis, as well as information on where to send a
check. For individuals who have IRA mandatory
distributions, talk to your financial advisor about
your contribution prior to paying federal taxes. Or
you can consider a foundation donation as a part
of your estate planning. This was how Dorothea’s
foresight helped establish our foundation.
Remember that contributing to the foundation
doesn’t just have to come from you. How many
times have you had a family member or friends
talk about their positive experiences with nurses?
How many times have you heard people rave
about how much the nurses’ care, compassion
and skills meant to them and their loved ones’
health and well-being? Talk to them again about it
or next time, use that opportunity to suggest that
they honor and support those nurses through a
donation to the ANA-Michigan Foundation. It is yet
another way that we can support “Nurses Helping
Nurses.”

Page 14 The Future of Nursing in Michigan August, September, October 2022
Are Nurses Suffering from Moral Injury?
By Donna Craig, RN, JD
Since January 2020,
the United States has
documented close to 90
million cases of COVID,
resulting in more than one
million deaths. 1 During the
same time period, Michigan
experienced more than 2.6
million COVID cases, resulting
in more than 37,000 deaths. 2
While the number of COVID
Donna J. Craig,
RN, JD
cases continues to decrease, there is no doubt
that the mental impact on nurses who cared for
COVID patients will be felt for some time. This
mental effect has sometimes been described as
“burnout” or a “Post-Traumatic Stress Disorder”
reaction. Perhaps a more accurate description
would be described as “moral injury.”
What Is Moral Injury? The term “moral injury”
refers to the lasting emotional, psychological,
social, behavioral, and spiritual impacts of
actions that violate a person’s core moral
values and behavioral expectations. 3 This occurs
when individuals are unable to contextualize
their actions or other’s actions with their core
values. 4 The research on how and why moral
injury occurs was initially associated with the
moral conflicts faced by the military during
wartime, particularly during the Vietnam War. 5
While moral injury is not currently considered
a mental disorder, it shares common symptoms
with Post-Traumatic Stress Disorder (“PTSD”),
including avoidance, hypervigilance, intrusive
thoughts, distressing dreams related to the
event, and social problems. 6 Moral injury can
occur when an individual finds himself in a
high-stakes situation with no good choices. For
nurses that may mean doling out patient care in
such a way that not everyone’s medical needs
can be addressed even though nurses truly want
to provide the best care possible. Nurses are
faced with deciding who to treat first; which
patients receive limited resources; and how
do nurses best use limited time when multiple
patients need help. Added to that are nurses
who found themselves without the right tools,
equipment or training to save a patient’s life,
leaving them feeling helpless and inadequate in
a profession dedicated to caring for patients.
Moral Injury Is Not Burnout - Moral injury
affects a person’s sense of right and wrong,
which is different than what is characterized as
“burnout.” The term moral injury represents a
situation of witnessing care or offering care that
conflicts with one’s internal compass of right
and wrong. 7 Burnout is a state of emotional,
mental, and often physical exhaustion brought
on by prolonged or repeated stress. 8 Burnout is
not associated with a person’s core values.
Moral Injury Versus PTSD – While there is
overlap between the symptoms of moral injury
and PTSD, such as guilt, shame, betrayal and
loss of trust, unlike PTSD, individuals don’t
necessarily experience hyperarousal (senses are
on high alert as a result of trauma) with moral
injury. 9 The triggering event(s) for PTSD results
from a life-threatening experience that leads
to chronic hypervigilance and fear; it is difficult
to ever feel safe. 10 Moral injury involves loss
of trust; it is not a disorder, but a reasonable
response to having one’s ethical compass
thrown off track. 11 How events result in moral
injury is demonstrated in Figure 1. 12
Assessing and Addressing Moral Injury
– While some studies have shown traumafocused
PTSD treatment such as Prolonged
Exposure (PE) [use of imaginal exposures
to reduce the intensity and frequency of
symptoms] and Cognitive Processing Therapy
(CPT) [emotional processing by replacing
fears with accurate information] effectively
reduce trauma-related guilt and shame, PE
and CPT may not be sufficient for treatment of
individuals with moral injuries. 13 On the bright
side, there are some emerging treatments that
are meant to specifically target moral injury
and its core components, such as “Acceptance
and Commitment Therapy,” which focuses
on helping individuals live in accordance with
their values. 14 Another treatment is “Adaptive
Disclosure,” which assists individuals with
processing moral injury through imaginary
dialogue and apportioning blame, making
amends and in some versions, self-compassion
and mindfulness meditations. 15 For moral
injuries resulting from religious or spiritual
core value conflicts, the “Building Spiritual
Strength” program addresses concerns about
the relationship with a Higher Power, as well
as challenges with forgiveness. 16 In addition
to in-person therapy and counseling, mobile
apps have been developed to help individuals
address the symptoms of moral injury. Those
mobile apps include: “COVID Coach” 17 and
“Provider Resilience from the National Center
for Telehealth & Technology.” 18
Nurses need not suffer from long-term
negative outcomes from caring for COVID
patients. With assistance, nurses may be able
to incorporate their experiences for their own
growth and to help others. Management in
health care settings can also be instrumental
in caring for nurses in the workplace. But, for
those who cannot overcome the resulting
effects of moral injuries, there is hope that
counseling and/or mobile apps may be useful
tools for a brighter future.
Donna J. Craig, RN, JD, is legal counsel to the
ANA-Michigan Chapter and the Michigan Council
of Nurse Practitioners. She practiced as a cardiac
care nurse for several years before a chance
opportunity to audit a graduate course in health
care law and ethics changed her career path. That
course propelled her to earn her law degree. After
law school, Ms. Craig joined a medical malpractice
defense law firm before transitioning her focus
to health care corporate and administrative law
matters. For over 20 years she has maintained her
private health law practice, representing health
care providers and facilities in business, licensure
and compliance matters. For her expertise and
accomplishments, Detroit’s dbusiness Magazine
awarded Ms. Craig its Top Lawyer in Health Care
Law award on three occasions. Ms. Craig has the
distinction and is proud of being a bar member
of the Supreme Court of the United States of
America. For more information about The Health
Law Center, go to www.healthlawcenterplc.com.
1 COVID Data Tracker, Centers for Disease Control
and Prevention; https://covid.cdc.gov/covid-datatracker/#datatracker-home
2 Id.
3 What is Moral Injury, The Moral Injury Project, Syracuse
University; www.moralinjuryproject.syredu/aboutmoral-injury/
4 Id.
5 Barnes, H. et.al. 2016. Moral Injury and PTSD: Often Cooccurring
Yet Mechanistically Different, Psychiatry
Online, (2016); https://neuro.psychiatryonline.org/
doi/10.1176/appi.neuropsych.19020036
6 Id.
7 Id.
8 Burnout, Psychology Today; https://www.
psychologytoday.com/us/basics/burnout
9 Norman, S.B., Maguen, S., Moral Injury, PTSD:
National Centers for PTSD; https://www.ptsd.va.gov/
professional/treat/cooccurring/moral_injury.asp
10 Moral Injury, Psychology Today, https://www.
psychologytoday.com/us/basics/moral-injury
11 Id.
12 Equipping Individuals, Leaders, & Organizations Facing
Challenge and Change, The Resilience Resource, https://
theresilienceresource.org/moral-injury/
13 Held, P., Klassen, B.J., Brennan, M.P, Zalter, A.K, Using
Prolonged Expressive and Cognitive Processing Therapy
to Treat Veterans with Moral Injury Based PTSD: Two Case
Examples, National Library of Medicine, (2017) https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC6103315/
14 Farmsworth, J.K., Drescher, K.D., Evans, W., & Walser,
R.D. (2017) A Functional Approach to Understanding
and Treating Military-Related Moral Injury, Journal of
Contextual Behavioral Science, 6(4), 391-397 (2017);
https://www.sciencedirect.com/science/article/abs/pii/
S2212144717300601
15 Gray, M.J., Schorr, Y., Nash, W, Lebowitz, L., Amidon, A.,
Lansing, A., Maglion, J.< Lang, A.J., & Litz, B.T. Adaptive
Disclosure: An Open Trail of a Novel Exposure-Based
Intervention for Service Members with Combat-Related
Psychological Stress Injuries, Behavior Therapy, 43(2,
407-415, (2012); https://doi.org/10.1016/j.beth.2011.09.001
16 Harris, J.K., Usset, T., Voecks, C., Thuras, P., Currieer,
J., & Erbes, C., Spiritually Integrated Care for PTSD:
A Randomized Controlled Trial of “Building Spiritual
Strength”. Psychiatry Research, 267, 420-428, (2018);
https://pubmed.ncbi.nlm.nih.gov/29980120/
17 COVID Coach Mobile App; U.S. Department of Veteran
Affairs; https://mobile.va.gov/app/covid-coach
18 Provider Resilience Mobile App; Health IT Outcomes,
(2013); https://www.healthitoutcomes.com/doc/
resilience-mobile-military-health-care-providers-0001