Future of Nursing in MI - August 2022
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THE FUTURE OF NURSING IN <strong>MI</strong>CHIGAN<br />
The Official Publication <strong>of</strong> the<br />
American Nurses Association Michigan<br />
The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan will<br />
reach over 145,000 Michigan nurses<br />
by email distribution.<br />
Volume 8 • Number 3 • <strong>August</strong> <strong>2022</strong><br />
PRESIDENT’S MESSAGE<br />
ANA-Michigan is launch<strong>in</strong>g its <strong>in</strong>augural Empowered Leader Series this fall. The program will<br />
be held virtually over the course <strong>of</strong> six Tuesday even<strong>in</strong>gs <strong>in</strong> September and October from<br />
6:30 pm – 8:30 pm EST beg<strong>in</strong>n<strong>in</strong>g on September 13.<br />
Empowered Leader Series<br />
Takeaways from this series <strong>in</strong>clude 12 CEs, leadership strategies you can immediately<br />
<strong>in</strong>corporate <strong>in</strong>to your current role as well as exclusive access to thought leaders <strong>in</strong> Michigan<br />
nurs<strong>in</strong>g. In addition you will also receive the book “Emotional Intelligence 2.0,” by Travis<br />
Bradberry and Jean Greaves as well as an onl<strong>in</strong>e assessment on your emotional <strong>in</strong>telligence<br />
(EQ) .<br />
Page 2<br />
Sessions will feature several ANA-<strong>MI</strong> members as speakers who will present and lead<br />
discussions throughout the series. This is your opportunity to learn from, connect with, and<br />
build your network with these Michigan nurs<strong>in</strong>g leaders whose knowledge and experience will<br />
be <strong>in</strong>valuable <strong>in</strong> your nurs<strong>in</strong>g pr<strong>of</strong>essional development.<br />
Week 1: Becom<strong>in</strong>g a Leader<br />
Register today as space is limited for this first-time event!<br />
Register<br />
Week 1 will br<strong>in</strong>g valuable <strong>in</strong>sight <strong>in</strong>to how you can move from a “manag<strong>in</strong>g” to a “lead<strong>in</strong>g” m<strong>in</strong>dset.<br />
You will discover <strong>in</strong>sights <strong>in</strong>to emotional <strong>in</strong>telligence, your own EQ abilities and how to grow through<br />
areas <strong>of</strong> challenge. Additionally, you will hear from a lead<strong>in</strong>g nurse pr<strong>of</strong>essional on the future vision <strong>of</strong><br />
the nurs<strong>in</strong>g pr<strong>of</strong>ession. F<strong>in</strong>ally, you will be <strong>in</strong>troduced to your FORUM group that you will work with for<br />
the duration <strong>of</strong> the program.<br />
Learn<strong>in</strong>g Objectives:<br />
Complimentary Virtual Town Hall<br />
Learn how to change your m<strong>in</strong>dset and actions to align with key leadership pr<strong>in</strong>ciples<br />
Understand the essence <strong>of</strong> Emotional Intelligence and how it can improve your leadership<br />
abilities, and career potential<br />
Develop the ability to plan for your career based on how the nurs<strong>in</strong>g pr<strong>of</strong>ession is evolv<strong>in</strong>g <strong>in</strong><br />
<strong>2022</strong> and beyond<br />
al Town Hall<br />
lusion <strong>in</strong> <strong>Nurs<strong>in</strong>g</strong><br />
e Listen<br />
Featured Speakers for Sessions 1 and 2<br />
ANA-Michigan <strong>2022</strong> ANA<br />
Membership Assembly Report<br />
ANA-Michigan Are Nurses Suffer<strong>in</strong>g <strong>2022</strong> ANA<br />
Membership from Moral Assembly Injury? Report<br />
Page 3<br />
View the featured speakers for sessions 1 and 2 below. Additional speakers will be announced <strong>in</strong> the<br />
com<strong>in</strong>g weeks.<br />
0 pm- 5:00 pm EST<br />
ke to engage with you to share <strong>in</strong>formation<br />
rtant topic <strong>of</strong> Diversity, Equality & Inclusion<br />
The virtual town hall is designed as an<br />
jo<strong>in</strong> the conversation and to share your<br />
ng <strong>in</strong> Michigan. Our objective is to provide<br />
ls and future <strong>in</strong>itiatives that align with ANA-<br />
Michigan.<br />
ce as a strong community <strong>of</strong> nurses <strong>in</strong><br />
ractice. Our strength is our solution-focused<br />
g pr<strong>of</strong>ession <strong>in</strong> a dynamic healthcare<br />
tient safety.<br />
es <strong>in</strong> Michigan. If you are not currently a<br />
n hall and see what ANA-<strong>MI</strong> is do<strong>in</strong>g to<br />
today to reserve your spot <strong>in</strong> this<br />
<br />
Page 4<br />
Page 14<br />
Michigan nurses, it is<br />
our time to Be Powerful on<br />
Purpose! I hope all <strong>of</strong> you<br />
are tak<strong>in</strong>g time to enjoy the<br />
beautiful summer we are<br />
hav<strong>in</strong>g, as it’s important to<br />
take time to stop and smell<br />
the roses because it allows<br />
us to be rejuvenated. This<br />
summer, I’ve taken the time<br />
to participate <strong>in</strong> several<br />
conferences that I feel are<br />
Bridget Leonard<br />
DNP, MBA-HCM,<br />
RN, CRRN,<br />
NEA-BC<br />
vital to our progression as a pr<strong>of</strong>ession. Florence<br />
Night<strong>in</strong>gale stated, “Let us consider ourselves<br />
unf<strong>in</strong>ished nurses…we must be learn<strong>in</strong>g all our<br />
lives.” Allow me to share some highlights that will<br />
have positive impacts on our pr<strong>of</strong>ession.<br />
In early June, approximately 100 ANA nurses<br />
from around the country had the opportunity to<br />
attend the ANA Hill Day <strong>in</strong> Wash<strong>in</strong>gton D.C. for a<br />
full day. We had the opportunity to visit the <strong>of</strong>fices<br />
<strong>of</strong> Senators Gary Peters and Debbie Stabenow,<br />
as well as Congresswoman Elissa Slotk<strong>in</strong>,<br />
Congressman Jack Bergman, and Congressman<br />
Tim Wahlberg from our congressional districts<br />
to discuss the follow<strong>in</strong>g topics (unfortunately,<br />
we ran out <strong>of</strong> time <strong>in</strong> our attempt to meet with<br />
Congresswoman Brenda Lawrence):<br />
• Valu<strong>in</strong>g the nurs<strong>in</strong>g workforce<br />
• Enhanc<strong>in</strong>g the scope <strong>of</strong> the Advanced<br />
Practice RNs<br />
• Improv<strong>in</strong>g senior citizens timely access to<br />
care<br />
I am happy to report that they were receptive<br />
to support<strong>in</strong>g legislative solutions for our<br />
concerns, and I was also impressed by the number<br />
<strong>of</strong> those that reported they had nurses <strong>in</strong> their<br />
families who had already brought some <strong>of</strong> the<br />
issues to their attention. I challenge you to also<br />
follow up with your district representatives via<br />
letters, town halls, and/or district meet<strong>in</strong>gs on<br />
these topics as our voices carry more weight <strong>in</strong><br />
multiples, rather than s<strong>in</strong>gles.<br />
In <strong>August</strong>, I had the privilege to attend the<br />
Accreditation Commission for Education <strong>in</strong> <strong>Nurs<strong>in</strong>g</strong><br />
(ACEN) annual conference <strong>in</strong> Atlanta, Georgia. The<br />
goal <strong>of</strong> this conference was to share concepts<br />
that enhance the educational quality <strong>of</strong> nurs<strong>in</strong>g<br />
programs and contribute to organizational<br />
growth. Throughout the conference there was<br />
a consensus that students have the skills and<br />
resources needed to succeed, ensur<strong>in</strong>g mental<br />
health and self-care is on the forefront to help<br />
them cope with school and real-life issues.<br />
There was also discussion on the need to ensure<br />
nurs<strong>in</strong>g faculty development is a priority both <strong>in</strong><br />
the classroom and cl<strong>in</strong>ical sett<strong>in</strong>g, while f<strong>in</strong>d<strong>in</strong>g<br />
creative ways to recruit and reta<strong>in</strong> faculty. We had<br />
opportunities to discuss the types <strong>of</strong> questions<br />
that will be appear<strong>in</strong>g on the new version <strong>of</strong> the<br />
NCLEX <strong>in</strong> April 2023. You may have heard <strong>of</strong> the<br />
Next Generation NCLEX, which features a case<br />
study type format and fifteen new question types.<br />
For more <strong>in</strong>formation, visit www.ncsbn.org.<br />
Lastly, we discussed the current and future ACEN<br />
standards needed for colleges and universities to<br />
receive and/or ma<strong>in</strong>ta<strong>in</strong> their ACEN accreditation.<br />
ANA-<strong>MI</strong> is committed to help<strong>in</strong>g you Be<br />
Powerful on Purpose. Allow me to <strong>in</strong>vite you to<br />
two great upcom<strong>in</strong>g events that will assist you <strong>in</strong><br />
meet<strong>in</strong>g personal and/or pr<strong>of</strong>essional goals:<br />
Shar<strong>in</strong>g Our Strengths: You Talk, We Listen on<br />
<strong>August</strong> 18, <strong>2022</strong>, 4p-5p<br />
How are you feel<strong>in</strong>g about diversity, equality,<br />
and <strong>in</strong>clusion? ANA-<strong>MI</strong> will be discuss<strong>in</strong>g this<br />
topic with several staff nurses and CEOs <strong>in</strong> a<br />
safe space where thoughts can be shared freely.<br />
Our objective is to provide support to Michigan<br />
nurses, as well as develop goals and <strong>in</strong>itiatives that<br />
support the needs <strong>of</strong> nurses that align with ANA-<br />
<strong>MI</strong>’s mission and vision. ANA-<strong>MI</strong> is the voice for<br />
Michigan nurses, so jo<strong>in</strong> us at this town hall and<br />
let your voice be heard (audience participants have<br />
the ability to be a part <strong>of</strong> the discussion). Spread<br />
the word and register at: www.anamichigan.<br />
nurs<strong>in</strong>gnetwork.com.<br />
Empowered Leader Series beg<strong>in</strong>n<strong>in</strong>g<br />
September 13, <strong>2022</strong>, 6:30p-8:30p (Every Tuesday<br />
even<strong>in</strong>g for six consecutive weeks)<br />
ANA-<strong>MI</strong> is launch<strong>in</strong>g its <strong>in</strong>augural leadership<br />
tra<strong>in</strong><strong>in</strong>g program and wants YOU to be <strong>in</strong><br />
attendance. This six-week program is geared<br />
toward ALL nurses to “lead from where you<br />
stand” to help build leadership acumen and<br />
skills focus<strong>in</strong>g on the critical areas <strong>of</strong> leadership<br />
<strong>in</strong> healthcare and nurs<strong>in</strong>g. The program is<br />
designed for ALL nurses, whether at the bedside,<br />
management, adm<strong>in</strong>istration, academia, and/<br />
or any practice sett<strong>in</strong>g where leadership skills<br />
will allow you to excel <strong>in</strong> the workplace and<br />
President’s Message cont<strong>in</strong>ued on page 2
Page 2 The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan <strong>August</strong>, September, October <strong>2022</strong><br />
Attend the ANA-<strong>MI</strong> Empowered Leader Series<br />
ANA-Michigan’s <strong>in</strong>augural Empowered Leader Series was created with nurses <strong>in</strong> m<strong>in</strong>d to help them<br />
uncover and develop leadership traits that will allow them to excel <strong>in</strong> the workplace and build stronger<br />
relationships with co-workers, supervisors, patients, families, and others.<br />
Register<br />
Throughout the series, you will have engag<strong>in</strong>g conversations and learn from some <strong>of</strong> Michigan’s<br />
knowledgeable and experienced nurse leaders, <strong>in</strong>clud<strong>in</strong>g:<br />
CONTACT INFORMATION<br />
ANA-Michigan<br />
2501 Jolly Road, Suite 110<br />
Okemos, <strong>MI</strong> 48864<br />
517-325-5306<br />
nurse@ana-michigan.org<br />
EXECUTIVE DIRECTOR<br />
Tobi Lyon, MBA, CAE<br />
The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan is published<br />
quarterly every February, May, <strong>August</strong> and<br />
November by the Arthur L. Davis Publish<strong>in</strong>g<br />
Agency, Inc. Subscriber rates are available for<br />
$25.<br />
ANA-<strong>MI</strong> President<br />
Bridget Leonard, DNP, MBA,<br />
RN, CRRN, NEA-BC<br />
L<strong>in</strong>da Dunmore, MSN, RN, NE-<br />
BC, CPHQ, CHSP<br />
Remy Bruder, DNP, RN<br />
For advertis<strong>in</strong>g rates and <strong>in</strong>formation, please<br />
contact Arthur L. Davis Publish<strong>in</strong>g Agency,<br />
Inc., PO Box 216, Cedar Falls, Iowa 50613. (800)<br />
626-4081, sales@aldpub.com.<br />
ANA-Michigan and the Arthur L. Davis<br />
Publish<strong>in</strong>g Agency, Inc. reserve the right to<br />
reject any advertisement. Responsibility for<br />
errors <strong>in</strong> advertis<strong>in</strong>g is limited to corrections<br />
<strong>in</strong> the next issue or refund <strong>of</strong> price <strong>of</strong><br />
advertisement.<br />
Jonnie Hamilton, DNP, MSHSA,<br />
PNP-BC, NE-BC, RN<br />
Margaret Calarco<br />
PhD, RN, NEA-BC<br />
Barbara Medvec, DNP, MSA,<br />
MSN, NEA-BC<br />
Dr. L<strong>in</strong>da Buck<br />
DNP, MSN/ED, RN<br />
You can also earn 12 cont<strong>in</strong>u<strong>in</strong>g education hours for complet<strong>in</strong>g this series.<br />
Gerardo “Gerry” Infante,<br />
BSN, RN<br />
Evelyn “Evie” Sweeney<br />
Lobbyist, MHSA<br />
The Empowered Leader Series takes place on six Tuesday even<strong>in</strong>gs <strong>in</strong> September and October<br />
from 6:30pm – 8:30pm EST beg<strong>in</strong>n<strong>in</strong>g on September 13. Read more about the series! Space is<br />
limited for this first-time event.<br />
Acceptance <strong>of</strong> advertis<strong>in</strong>g does not imply<br />
endorsement or approval by the American<br />
Nurses Association Michigan <strong>of</strong> the products<br />
advertised, the advertisers or the claims<br />
made. Rejection <strong>of</strong> an advertisement<br />
does not imply that a product <strong>of</strong>fered for<br />
advertis<strong>in</strong>g is without merit, or that the<br />
manufacturer lacks <strong>in</strong>tegrity, or that this<br />
association disapproves <strong>of</strong> the product<br />
or its use. American Nurses Association<br />
Michigan and the Arthur L. Davis Publish<strong>in</strong>g<br />
Agency, Inc. shall not be held liable for any<br />
consequences result<strong>in</strong>g from purchase or use<br />
<strong>of</strong> advertisers’ products. Articles appear<strong>in</strong>g<br />
<strong>in</strong> this publication express the op<strong>in</strong>ions <strong>of</strong><br />
the authors; they do not necessarily reflect<br />
views <strong>of</strong> the staff, board, or membership <strong>of</strong><br />
American Nurses Association Michigan, or<br />
those <strong>of</strong> the American Nurses Association.<br />
Register<br />
This event <strong>of</strong>fers 12.0 contact hours to attendees. Accreditation Info: This activity will be submitted to the Ohio Nurses Association for approval<br />
to award contact hours. The Ohio Nurses Association is accredited as an approver <strong>of</strong> nurs<strong>in</strong>g cont<strong>in</strong>u<strong>in</strong>g pr<strong>of</strong>essional development by the<br />
American Nurses Credential<strong>in</strong>g Center’s Commission on Accreditation. (OBN-001-91).<br />
ANA-Michigan | ana-michigan.org<br />
<br />
have thousands<br />
We<br />
nurs<strong>in</strong>g jobs!<br />
<strong>of</strong><br />
President’s Message cont<strong>in</strong>ued from page 1<br />
build stronger pr<strong>of</strong>essional relationships. Spread<br />
the word and register at www.anamichigan.<br />
nurs<strong>in</strong>gnetwork.com.<br />
As I conclude this letter to you, I want to<br />
stress that this role is more than just a title;<br />
it is a commitment to needed changes and<br />
Be<strong>in</strong>g Powerful on Purpose. If you have any<br />
suggestions to help improve nurs<strong>in</strong>g practice for<br />
Michigan nurses, feel free to send me an email<br />
at president@ana-michigan.org. We are <strong>in</strong> this<br />
TOGETHER. Maya Angelou stated, “We may<br />
encounter many defeats, but we must not be<br />
defeated.”<br />
F<strong>in</strong>d your dream job now.
<strong>August</strong>, September, October <strong>2022</strong> The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan Page 3<br />
MESSAGE FROM THE EXECUTIVE DIRECTOR<br />
“Inclusion is not a matter <strong>of</strong> political correctness. It’s the<br />
key to growth.” – Jesse Jackson<br />
As we look to the recent past, there has been a need<br />
for resiliency and a theme <strong>of</strong> overcom<strong>in</strong>g. As we look<br />
forward and imag<strong>in</strong>e our future, I recognize a desire for<br />
more <strong>in</strong>clusivity and a necessity for unity. Fortunately,<br />
ANA-Michigan’s members and leaders cont<strong>in</strong>ue to drive<br />
<strong>in</strong>itiatives and design policies and procedures to restore<br />
what has been and forge a stronger future. We have<br />
learned much through the pandemic, <strong>in</strong>clud<strong>in</strong>g what<br />
Tobi Lyon,<br />
MBA, CAE<br />
we need to unlearn. Like anyth<strong>in</strong>g else, I am hopeful that through listen<strong>in</strong>g,<br />
deliberation, action, and advocacy, our nurses will leverage their compassion<br />
and commitment to their pr<strong>of</strong>ession to see and hear one another so that<br />
the next generation can go further. Manag<strong>in</strong>g the complexities <strong>of</strong> modern<br />
healthcare while try<strong>in</strong>g to leave th<strong>in</strong>gs and each other better than we found<br />
them is no small undertak<strong>in</strong>g – but neither is nurs<strong>in</strong>g. So, let’s keep go<strong>in</strong>g.<br />
This is where your ANA membership comes <strong>in</strong>; you and your colleagues<br />
br<strong>in</strong>g your voices to the issues nurses face through the opportunities ANA<br />
<strong>of</strong>fers. By serv<strong>in</strong>g on committees and other leadership roles, you impact the<br />
topics discussed that affect nurses <strong>in</strong> Michigan. I encourage you to cont<strong>in</strong>ue<br />
this work and to urge your fellow nurses who are not yet members to add<br />
their voices to the critical nurs<strong>in</strong>g issues <strong>in</strong> <strong>2022</strong> and beyond.<br />
You can read the ANA Membership Assembly’s full report. Still, I want<br />
to reiterate the success <strong>of</strong> what was accomplished and commend all<br />
participants, representatives, and constituents for their efforts, dialogue,<br />
and strategy <strong>in</strong>fluenc<strong>in</strong>g solutions and outcomes. Much <strong>of</strong> what we are<br />
focused on <strong>in</strong> our current <strong>in</strong>itiatives is a byproduct <strong>of</strong> what was determ<strong>in</strong>ed<br />
dur<strong>in</strong>g this time together.<br />
From tribut<strong>in</strong>g board members and those lost to COVID-19 to tackl<strong>in</strong>g<br />
workplace violence issues and President Grant’s annual report, our<br />
community came together <strong>in</strong> person to honor, challenge, and support<br />
one another. The next Town Hall on <strong>August</strong> 18 has been designed with the<br />
Membership Assembly’s objectives <strong>in</strong> m<strong>in</strong>d and will serve as an open forum<br />
for our nurses to jo<strong>in</strong> the conversation about DEI and what we can do to<br />
honor ANA’s Racial Reckon<strong>in</strong>g Statement. If you can’t jo<strong>in</strong> this Town Hall,<br />
which is free to members and non-members, make sure you follow our event<br />
page on our website or look for them <strong>in</strong> our weekly e-newsletter sent every<br />
Friday.<br />
Do you want to develop additional leadership skills that will help you excel<br />
<strong>in</strong> the workplace? If so, attend our newly launched virtual Empowered Leader<br />
Series, which starts on September 13 and occurs once a week for six weeks<br />
<strong>in</strong> the even<strong>in</strong>gs. If you don’t, others <strong>in</strong> your network may benefit from this<br />
series, so consider pass<strong>in</strong>g this <strong>in</strong>formation on to them and encourage them<br />
to register. I promise you this will be like no other educational opportunity<br />
you have ever attended before and will push you <strong>in</strong> new ways that will<br />
empower your future.<br />
Our Education Committee is excited about the upcom<strong>in</strong>g annual<br />
conference, which will be held on February 23 and 24, 2023, at the Blue<br />
Water Convention Center <strong>in</strong> Port Huron. Have you added these dates to<br />
your calendar? If not, make sure you do, as this will be a great time to shake<br />
<strong>of</strong>f those w<strong>in</strong>ter blues and re-energize with your colleagues. This will be an<br />
opportunity for Michigan nurses to connect and discuss key topics, <strong>in</strong>clud<strong>in</strong>g<br />
restor<strong>in</strong>g passion for nurs<strong>in</strong>g, <strong>in</strong>novation, DEI, full practice authority,<br />
workplace violence, and safe staff<strong>in</strong>g levels <strong>in</strong> all care sett<strong>in</strong>gs. Save the date<br />
and plan to attend!<br />
Fall is just around the corner, which means we will soon be putt<strong>in</strong>g out the<br />
call for complet<strong>in</strong>g a consent to serve form to jo<strong>in</strong> one <strong>of</strong> our committees<br />
or to serve on the board <strong>of</strong> directors. This is a great way to expand your<br />
network connections and share your talents with the association by be<strong>in</strong>g a<br />
part <strong>of</strong> driv<strong>in</strong>g the future <strong>of</strong> nurs<strong>in</strong>g <strong>in</strong> Michigan. This call will be com<strong>in</strong>g out<br />
to you <strong>in</strong> September and October.<br />
Fun fact for this issue: Did you know that more than 75 <strong>in</strong>dividuals applied<br />
for scholarships and grants that are available for those plann<strong>in</strong>g to enter<br />
nurs<strong>in</strong>g? I am proud that the ANA-Michigan Foundation is always look<strong>in</strong>g<br />
toward the future by support<strong>in</strong>g nurs<strong>in</strong>g through f<strong>in</strong>ancial assistance. You<br />
can f<strong>in</strong>d more <strong>in</strong>formation about the scholarships on the ANA-<strong>MI</strong> Foundation<br />
website.<br />
We should cont<strong>in</strong>ue to embody all those we represent (or, <strong>in</strong> our case, care<br />
for), and that is everyone. While I could go on and on about the work <strong>of</strong> nurses,<br />
the efforts <strong>of</strong> ANA-Michigan, and the shift<strong>in</strong>g tide and reckon<strong>in</strong>g that is upon us,<br />
it is time to listen. So, I am sett<strong>in</strong>g even my highest esteem and com<strong>in</strong>g to the<br />
table with ears open and a whole heart. I encourage each <strong>of</strong> you to do the same.
Page 4 The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan <strong>August</strong>, September, October <strong>2022</strong><br />
ANA-<strong>MI</strong>CHIGAN<br />
<strong>2022</strong> ANA Membership Assembly Report<br />
Bridget Leonard, Barbara Medvec and Anne Kreft<br />
On Friday June 10, <strong>2022</strong>, the ANA <strong>2022</strong><br />
Membership Assembly meet<strong>in</strong>g began at the<br />
Grand Hyatt <strong>in</strong> Wash<strong>in</strong>gton D.C. This was the<br />
first live Membership Assembly held s<strong>in</strong>ce the<br />
beg<strong>in</strong>n<strong>in</strong>g <strong>of</strong> the pandemic <strong>in</strong> 2020.<br />
President Bridget Leonard, President-Elect<br />
Barbara Medvec, Membership Assembly<br />
Representative Anne Kreft and Past-President<br />
Julia Stocker Schneider attended. In addition,<br />
ANA Nom<strong>in</strong>at<strong>in</strong>g Committee members MaryLee<br />
Pakieser (also NEC candidate for <strong>2022</strong>) and L<strong>in</strong>da<br />
Taft attended the <strong>2022</strong> Membership Assembly<br />
meet<strong>in</strong>g. It was excit<strong>in</strong>g to gather and see<br />
colleagues from across the country <strong>in</strong> person.<br />
Prior to the start <strong>of</strong> the meet<strong>in</strong>g, ANA Hill<br />
Day occurred on Thursday June 9, <strong>2022</strong>. ANA-<br />
<strong>MI</strong> members Leonard, Medvec, Kreft, Stocker<br />
Schnieder and Pakieser participated <strong>in</strong> meet<strong>in</strong>gs<br />
with Congressional Representatives, Rep. Jack<br />
Bergman <strong>MI</strong>-01 (R), Rep. Tim Walberg <strong>MI</strong>-07<br />
(R), Rep. Brenda Lawrence <strong>MI</strong>-14(D), Rep. Elissa<br />
Slotk<strong>in</strong> <strong>MI</strong>-08 (D), as well as Senators Gary Peters<br />
<strong>MI</strong>-S (D) and Debbie Stabenow <strong>MI</strong>-S (D). Issues<br />
carried to the elected <strong>of</strong>ficials <strong>in</strong>cluded support<strong>in</strong>g<br />
the full practice authority <strong>of</strong> Advanced Practice<br />
Registered Nurses (APRNs), Improv<strong>in</strong>g Seniors’<br />
Timely Access to Care Act <strong>of</strong> 2021 (S.3018/H.R.3173)<br />
and talk<strong>in</strong>g po<strong>in</strong>ts around valu<strong>in</strong>g the nurs<strong>in</strong>g<br />
workforce through reduction <strong>in</strong> workplace<br />
violence and mandatory overtime.<br />
The ANA President’s and National Awards<br />
Ceremony were also held on the even<strong>in</strong>g <strong>of</strong> June<br />
9, <strong>2022</strong>, and recognized Michigan’s own Jonnie<br />
Hamilton, DNP, PhD, MS, BSN, RN as the Mary<br />
Mahoney Award w<strong>in</strong>ner which acknowledges<br />
significant contributions made by an <strong>in</strong>dividual<br />
registered nurse or a group <strong>of</strong> registered nurses to<br />
<strong>in</strong>tegration with<strong>in</strong> the nurs<strong>in</strong>g pr<strong>of</strong>ession.<br />
President Ernest Grant, through his annual<br />
report to the organization, presented the work <strong>of</strong><br />
the ANA’s Racial Reckon<strong>in</strong>g Statement. President<br />
Grant then held the membership hear<strong>in</strong>g on the<br />
statement. In 2021, the ANA began an <strong>in</strong>tense<br />
effort to understand its own history <strong>in</strong> relation<br />
to racism <strong>in</strong> nurs<strong>in</strong>g. The outcome <strong>of</strong> this<br />
exam<strong>in</strong>ation was an <strong>in</strong>itial reckon<strong>in</strong>g statement<br />
that serves as an apology to nurses <strong>of</strong> color who<br />
have been harmed by decisions and omissions<br />
made by the ANA that contributed to racism <strong>in</strong><br />
the pr<strong>of</strong>ession. Through this statement, ANA<br />
has launched a susta<strong>in</strong>ed effort dedicated to<br />
ongo<strong>in</strong>g reckon<strong>in</strong>g and reconciliation. Through<br />
this hear<strong>in</strong>g, there was overwhelm<strong>in</strong>g gratitude<br />
and praise for the reckon<strong>in</strong>g statement. There was<br />
acknowledgement that this work is long overdue.<br />
Discussion around quotes <strong>in</strong> the document were<br />
identified and discussion that ANA must “walk the<br />
talk” through planned action steps. Next steps<br />
<strong>in</strong>clude review<strong>in</strong>g policies for bias. <strong>Future</strong> work<br />
<strong>in</strong>cludes look<strong>in</strong>g at harms, as well as <strong>in</strong>clud<strong>in</strong>g<br />
considerations for global, spiritual, and ethical<br />
perspectives.<br />
Debbie Hatmaker reported on the ANA<br />
Enterprise and the strategic goals to elevate<br />
the pr<strong>of</strong>ession <strong>of</strong> nurs<strong>in</strong>g globally, to engage all<br />
nurses to ensure pr<strong>of</strong>essional success, to evolve<br />
the practice <strong>of</strong> nurs<strong>in</strong>g to transform health and<br />
healthcare, and to enable transformational<br />
capabilities through operational excellence. It was<br />
noted ANA Enterprise has cont<strong>in</strong>ued to exceed its<br />
growth and revenue operations. This allows for<br />
cont<strong>in</strong>ued focus on improv<strong>in</strong>g the practices with<strong>in</strong><br />
our nurs<strong>in</strong>g pr<strong>of</strong>ession.<br />
Pr<strong>of</strong>essional Policy Committee facilitated the<br />
three dialogue forums for the <strong>2022</strong> Membership<br />
Assembly.<br />
Dialogue Forum #1: Impact <strong>of</strong> Climate Change<br />
on Health was submitted by members from<br />
ANA Board <strong>of</strong> Directors, New Hampshire Nurses<br />
Association, ANA-Michigan, ANA-Vermont,<br />
M<strong>in</strong>nesota Organization <strong>of</strong> Registered Nurses,<br />
Alliance <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> for Health Environments<br />
and with assistance from Michigan Cl<strong>in</strong>icians for<br />
Climate Action. Recommendations and additions<br />
to this proposal were discussed and additional<br />
actions presented.<br />
Dialogue Forum #2: Advanc<strong>in</strong>g Solutions to<br />
Address Verbal Abuse and Workplace Violence<br />
Across the Cont<strong>in</strong>uum <strong>of</strong> Care. Often, healthcare<br />
stakeholders’ approaches to workplace violence<br />
(WPC) <strong>in</strong> healthcare focuses on responses to,<br />
and prevention <strong>of</strong>, physical assaults <strong>in</strong> hospitals.<br />
Discussions <strong>of</strong>ten overlook verbal abuse, which<br />
Friday, June 10, <strong>2022</strong><br />
The first day <strong>of</strong> the Membership Assembly<br />
<strong>in</strong>cluded participants and representatives from<br />
ANA's constituent and state nurses associations,<br />
the Individual Member Division, and specialty<br />
nurs<strong>in</strong>g organizational affiliates, as well as the ANA<br />
Board <strong>of</strong> Directors. Annual updates and reports<br />
were presented by the President, ANA Subsidiaries<br />
and Constituent Associations (American Academy<br />
<strong>of</strong> <strong>Nurs<strong>in</strong>g</strong>, American <strong>Nurs<strong>in</strong>g</strong> Credential<strong>in</strong>g<br />
Center, American Nurses Foundation and National<br />
Student Nurses Association), as well as the<br />
ANA Chief <strong>Nurs<strong>in</strong>g</strong> Officer, and ANA Treasurer.<br />
Attendees participated through discussion, poll<strong>in</strong>g,<br />
network<strong>in</strong>g, and tabletop work<strong>in</strong>g sessions.<br />
Left to Right: Julia Stocker Schneider, Bridget<br />
Leonard and MaryLee Pakieser enjoy the<br />
sunsh<strong>in</strong>e <strong>of</strong> a June day at the Capitol Build<strong>in</strong>g <strong>in</strong><br />
Wash<strong>in</strong>gton, D.C.<br />
Want to Do More to<br />
Support Your Association?<br />
Left to Right: Bridget Leonard, MaryLee<br />
Pakieser, Julia Stocker Schneider and Anne Kreft<br />
make their way to Membership Assembly events<br />
<strong>in</strong> June.<br />
Consider all the ways you can become an<br />
engaged ANA-Michigan member!<br />
- Run for an open board position<br />
- Jo<strong>in</strong> a committee<br />
- Write an article for the weekly or quarterly<br />
newsletter<br />
- Participate <strong>in</strong> ANA-Michigan events<br />
- Let us know if there are th<strong>in</strong>gs we should be<br />
aware <strong>of</strong> and promot<strong>in</strong>g on your behalf<br />
Left to Right: Bridget Leonard, Anne Kreft,<br />
MaryLee Pakieser, Julia Stocker Schneider and<br />
Barb Medvec meet with congressional staffers at<br />
Senator Gary Peters' <strong>of</strong>fice <strong>in</strong> Wash<strong>in</strong>gton, D.C.<br />
AMERICAN NURSES ASSOCIATION<br />
<strong>MI</strong>CHIGAN
<strong>August</strong>, September, October <strong>2022</strong> The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan Page 5<br />
can be a risk factor for physical violence. In<br />
addition, practice and policy recommendations<br />
developed for <strong>in</strong>patient sett<strong>in</strong>gs may not be<br />
appropriate or helpful <strong>in</strong> community sett<strong>in</strong>gs,<br />
such as schools, community health centers, public<br />
health facilities, and similar places where WPV can<br />
occur. To safeguard all nurses from risks <strong>of</strong> harm<br />
and abuse, the nurs<strong>in</strong>g community must assume<br />
a culture <strong>of</strong> safety and zero-tolerance stance and<br />
provide action steps <strong>in</strong> all sett<strong>in</strong>gs that recognize<br />
diverse forms <strong>of</strong> abuse and threat. This was<br />
submitted to the ANA Board by the New Jersey<br />
State Nurses Association, National Association <strong>of</strong><br />
School Nurses. Feedback <strong>in</strong>cluded implement<strong>in</strong>g<br />
those actions to promote a culture <strong>of</strong> safety and<br />
zero tolerance at the constituent, state and IMD<br />
associations.<br />
Dialogue Forum #3: Nurse Staff<strong>in</strong>g. This<br />
forum was established by the Pr<strong>of</strong>essional<br />
Policy Committee <strong>of</strong> the ANA. The discussion<br />
focused on ANA’s current policy and approach<br />
to nurse staff<strong>in</strong>g, along with several other state<br />
and specialty-level strategies. With the stress <strong>of</strong><br />
the COVID-19 pandemic, which highlighted and<br />
exacerbated long stand<strong>in</strong>g nurse staff<strong>in</strong>g issues,<br />
this was determ<strong>in</strong>ed to be a good time to take a<br />
pulse check on where ANA, the C/SNAs and IMD<br />
stand on this pa<strong>in</strong> po<strong>in</strong>t for nurs<strong>in</strong>g. The goal<br />
was to provide any direction for change that may<br />
be needed, particularly about ANA’s position<strong>in</strong>g<br />
related to nurse-to-patient ratios. Any revision<strong>in</strong>g<br />
<strong>of</strong> ANA’s policy should be developed between July<br />
and December <strong>2022</strong>.<br />
The day ended with the Candidate Forum<br />
presentations and Regional Meet<strong>in</strong>gs, as well as<br />
the ANA PAC Reception.<br />
Saturday, June 11, <strong>2022</strong><br />
This session began with Membership Assembly<br />
vot<strong>in</strong>g for the vacancies <strong>of</strong> Board President,<br />
Secretary, Director-At-Large, Director-At-<br />
Large Staff Nurse and Nom<strong>in</strong>ations & Elections<br />
Committee.<br />
President Ernest Grant opened the session<br />
and greet<strong>in</strong>gs from the International Council <strong>of</strong><br />
<strong>Nurs<strong>in</strong>g</strong> (ICN) were presented. ANA CEO Pam<br />
Cipriano provided an overview and update on<br />
the directions for ANA and nurs<strong>in</strong>g mov<strong>in</strong>g <strong>in</strong>to<br />
the future <strong>of</strong> healthcare. Outgo<strong>in</strong>g members<br />
<strong>of</strong> the ANA Board were recognized. In addition,<br />
a tribute to ANA members who had passed<br />
away <strong>in</strong> 2021/<strong>2022</strong> were provided through the<br />
Night<strong>in</strong>gale Tribute, with members lost to<br />
COVID-19 highlighted. Network<strong>in</strong>g sessions for the<br />
day focused on Amplify<strong>in</strong>g the Voice <strong>of</strong> the Nurse,<br />
What is the Value <strong>of</strong> a Nurse?, Understand<strong>in</strong>g and<br />
Fulfill<strong>in</strong>g Member Needs, Address<strong>in</strong>g the U.S.<br />
Opioid Crisis, State Based Innovation Incubators<br />
and Feedback on Revision <strong>of</strong> the <strong>Nurs<strong>in</strong>g</strong><br />
Adm<strong>in</strong>istration: Scope and Standards <strong>of</strong> Practice.<br />
The Membership Assembly cont<strong>in</strong>ued with<br />
the report <strong>of</strong> the ANA Pr<strong>of</strong>essional Policy<br />
Committee with the unanimous support for<br />
the Racial Reckon<strong>in</strong>g Statement. The Dialogue<br />
Forum Statements for Impact <strong>of</strong> Climate Change<br />
on Health, Advanc<strong>in</strong>g Solutions to Address<br />
Verbal Abuse and Workplace Violence Across<br />
the Cont<strong>in</strong>uum <strong>of</strong> Care, and Nurse Staff<strong>in</strong>g were<br />
adopted with revisions by the Assembly. The<br />
report <strong>of</strong> the Head Teller announced the newly<br />
elected ANA <strong>of</strong>ficials as: President: Jennifer Mensik<br />
Kennedy; Secretary: Amanda Oliver; Director-At-<br />
Large: Edward Briggs, and Jennifer Gil; Director-At-<br />
Large Staff Nurse: David Garcia and Nom<strong>in</strong>at<strong>in</strong>g and<br />
Elections Committee: MaryLee Pakieser, Patricia<br />
Travis, and Kimberly Velez.<br />
Clos<strong>in</strong>g comments were provided by President<br />
Grant regard<strong>in</strong>g the end <strong>of</strong> his term as ANA<br />
President and the meet<strong>in</strong>g was then adjourned.<br />
Left to Right; Julia Stocker Schneider, MaryLee<br />
Pakieser, Barb Medvec, Anne Kreft, and<br />
Bridget Leonard get ready to head out to their<br />
congressional <strong>of</strong>fice visits.<br />
Left to Right: Julia Stocker Schneider, Bridget<br />
Leonard, Anne Kreft, Barb Medvec, and MaryLee<br />
Pakieser get ready to knock on Congressman<br />
Jack Bergman's door dur<strong>in</strong>g ANA Hill Day.<br />
The U.S. Capitol Build<strong>in</strong>g on the day the ANA-<strong>MI</strong><br />
nurses visited congressional <strong>of</strong>fices.
Page 6 The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan <strong>August</strong>, September, October <strong>2022</strong><br />
ANA-Michigan<br />
Foundation Welcomes<br />
Two New Board<br />
Members<br />
The ANA-Michigan Foundation is pleased to<br />
welcome two new <strong>in</strong>dividuals to its Board <strong>of</strong><br />
Directors. We are thrilled to have their time,<br />
dedication and leadership on the board as the<br />
foundation works to further its goals <strong>in</strong> <strong>2022</strong>.<br />
Look<strong>in</strong>g for a way to give back to nurses as they<br />
cont<strong>in</strong>ue to battle the pandemic on the front l<strong>in</strong>es?<br />
Make a donation to the ANA-Michigan Nurses Foundation<br />
and support the future <strong>of</strong> nurs<strong>in</strong>g.<br />
Nancy C. Mart<strong>in</strong>,<br />
DNP, RN<br />
Director 3-Year Term<br />
Cheri Wollack,<br />
RN<br />
Director 2-Year Term<br />
Hir<strong>in</strong>g LPNs and RNs to<br />
Jo<strong>in</strong> our Team<br />
Lenawee Medical Care<br />
Facility is proud to serve<br />
senior care patients through<br />
a holistic approach. Our<br />
nurs<strong>in</strong>g home is set up <strong>in</strong><br />
m<strong>in</strong>i-communities that<br />
are clean, vibrant and<br />
active, exhibit<strong>in</strong>g an at-home atmosphere that is personalized<br />
for each resident. We <strong>of</strong>fer traditional nurs<strong>in</strong>g services such<br />
as therapy, hospice care, long-term care, and skilled nurs<strong>in</strong>g.<br />
Our rehabilitative therapy services <strong>in</strong>clude physical therapy,<br />
occupational therapy, and speech therapy, along with therapeutic<br />
recreation.<br />
Our mission: It is our commitment to provide quality care that<br />
respects each <strong>in</strong>dividual, honors dignity and promotes the highest<br />
level <strong>of</strong> well-be<strong>in</strong>g.<br />
• $10,000 Sign On Bonus<br />
• Tuition Assistance Program<br />
• Excellent Benefits Package - <strong>in</strong>clud<strong>in</strong>g Medical, Dental,<br />
Vision, Short-Term Disability, Life Insurance<br />
• Retirement Plan with employer match<strong>in</strong>g<br />
• 12- hour shifts with flexibility <strong>in</strong> schedul<strong>in</strong>g<br />
• Opportunity for growth and cont<strong>in</strong>ued learn<strong>in</strong>g<br />
For more <strong>in</strong>formation, contact:<br />
Lenawee Medical Care Facility<br />
Adrian,<strong>MI</strong><br />
517-263-6794<br />
www.lenaweemedicalcarefacility.org<br />
Donations can be made onl<strong>in</strong>e or via<br />
personal check. You can even set up<br />
reccur<strong>in</strong>g donations!<br />
Please visit www.ana-michigan.foundation to<br />
make an onl<strong>in</strong>e donation and to learn more about<br />
the mission, vision and goals <strong>of</strong> the foundation.<br />
Checks can be made payable to:<br />
ANA-Michigan Nurses Foundation<br />
They can be mailed to:<br />
2501 Jolly Road, Suite 110, Okemos, <strong>MI</strong> 48864<br />
The ANA-Michigan Nurses Foundation is a 501(c)3 organization,<br />
and all donations are tax deductible.<br />
$<br />
Aleda E. Lutz VA Medical Center is<br />
NOW HIRING<br />
Registered Nurse - Community Liv<strong>in</strong>g Center<br />
(Geriatric and Extended Care)<br />
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(Grayl<strong>in</strong>g, Cadillac, Oscoda, Traverse City)<br />
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RN Educator (Staff) Sag<strong>in</strong>aw<br />
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Contact<br />
Phone: 989-497-2500 ext: 11469<br />
Email: vhasagnurserecruiter@va.gov
<strong>August</strong>, September, October <strong>2022</strong> The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan Page 7<br />
Michigan Approves ADN to<br />
BSN Program at Community<br />
Colleges <strong>in</strong> Partnership with<br />
Four-Year Schools<br />
By Evelyn Zois Sweeney <strong>of</strong> Muchmore Harr<strong>in</strong>gton Smalley Associates<br />
The state legislature has passed a sweep<strong>in</strong>g $76 billion fiscal year <strong>2022</strong>-<br />
2023 budget which <strong>in</strong>cludes transformative <strong>in</strong>vestments across education,<br />
healthcare, and workforce tra<strong>in</strong><strong>in</strong>g. This year’s budget was bolstered by<br />
unprecedented w<strong>in</strong>dfalls <strong>in</strong> the state’s general fund and federal COVIDrelated<br />
relief dollars. Included <strong>in</strong> the school aid and higher education budget,<br />
Senate Bill 845 has $56 million appropriated for the “Michigan ADN to BSN<br />
completion grant program,” signify<strong>in</strong>g the first-time higher education<br />
universities and community colleges have reached a compromise on this<br />
important workforce effort.<br />
The crux <strong>of</strong> the legislative effort <strong>in</strong>cludes award<strong>in</strong>g each eligible<br />
community college a m<strong>in</strong>imum <strong>of</strong> $2 million to support the creation and<br />
execution <strong>of</strong> a program that would allow an <strong>in</strong>dividual <strong>in</strong> the state who<br />
has atta<strong>in</strong>ed an associate degree <strong>in</strong> nurs<strong>in</strong>g to complete a bachelor’s <strong>of</strong><br />
science degree <strong>in</strong> nurs<strong>in</strong>g. The <strong>in</strong>itiative requires a partnership between the<br />
community college and a BSN-grant<strong>in</strong>g public university or a not-for-pr<strong>of</strong>it<br />
<strong>in</strong>dependent four-year college or university.<br />
The BSN-grant<strong>in</strong>g <strong>in</strong>stitution would be responsible for design<strong>in</strong>g,<br />
deliver<strong>in</strong>g, and ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g the completion program, <strong>in</strong>clud<strong>in</strong>g admissions,<br />
curriculum design and accreditation, with strategic <strong>in</strong>put from employers<br />
and community colleges. The BSN completion courses would need to be<br />
taught at least partially <strong>in</strong> person on community college campuses, but<br />
course delivery methods would need to be <strong>in</strong>formed by the expressed needs<br />
<strong>of</strong> the learners <strong>in</strong> that community.<br />
The legislation also encourages opportunities for jo<strong>in</strong>t faculty<br />
appo<strong>in</strong>tments for qualified community college faculty to teach BSN<br />
completion courses as adjunct or part-time faculty at the BSN-grant<strong>in</strong>g<br />
<strong>in</strong>stitution. The legislation is also <strong>in</strong>tentional about bolster<strong>in</strong>g student<br />
success by ensur<strong>in</strong>g the community college or BSN-grant<strong>in</strong>g <strong>in</strong>stitutions <strong>of</strong>fer<br />
career service, f<strong>in</strong>ancial aid, mental health counsel<strong>in</strong>g and academic advis<strong>in</strong>g<br />
support. The bill also <strong>in</strong>dicates the collaborat<strong>in</strong>g entities should assume a<br />
m<strong>in</strong>imum five-year agreement unless adequate data and evidence support<br />
discont<strong>in</strong>u<strong>in</strong>g the partnership before five years has elapsed.<br />
The appropriation bill was signed by the Governor on July 14, but does<br />
not take effect until October 1, <strong>2022</strong>. The agreement between the 4-year<br />
degree grant<strong>in</strong>g <strong>in</strong>stitutions and community colleges is be<strong>in</strong>g heralded as<br />
a major breakthrough <strong>in</strong> negotiations, mitigat<strong>in</strong>g the need for separate<br />
legislation (House Bills 5556 and 5557) that had proved contentious with<strong>in</strong><br />
the legislature. All <strong>in</strong>terested parties are hopeful the legislation can prove<br />
impactful, both for nurs<strong>in</strong>g students and the communities they hope to<br />
practice <strong>in</strong>.<br />
Just Say No;<br />
How to Prevent Burnout<br />
By Nad<strong>in</strong>e K. Wodwaski <strong>in</strong> collaboration with the ANA-Michigan <strong>Nurs<strong>in</strong>g</strong> &<br />
Health Policy Committee Members<br />
Did you know that overworked nurses are at risk for fatigue that<br />
can lead to burnout? They can jeopardize patients' health and possibly<br />
damage their own mental and physical well-be<strong>in</strong>g. Many nurses like to<br />
go above and beyond to be the best nurses. We want to do a good job,<br />
and we say yes to almost everyth<strong>in</strong>g, from pick<strong>in</strong>g up shifts, to work<strong>in</strong>g<br />
late, and float<strong>in</strong>g, etc. That means we say yes to everyth<strong>in</strong>g except<br />
ourselves. We have the power to say NO, but say<strong>in</strong>g NO is a skill that is<br />
hard to acquire. It is an <strong>in</strong>herently uncomfortable word to say. However,<br />
we need to advocate for ourselves and contribute to our greater good.<br />
By say<strong>in</strong>g NO, you are say<strong>in</strong>g YES to you. So, let us learn how to set<br />
healthy boundaries for ourselves <strong>in</strong> our pr<strong>of</strong>ession.<br />
There is an art <strong>of</strong> say<strong>in</strong>g NO without sound<strong>in</strong>g awkward, damag<strong>in</strong>g<br />
relationships, or feel<strong>in</strong>g guilty. NO can be a standalone sentence. Keep it<br />
short! Many times we use far too many words when all we mean to say<br />
is, "No, thanks!" Conciseness is the essence <strong>of</strong> confidence. If you sound<br />
sure, people usually will accept that your m<strong>in</strong>d is made up and will not<br />
try to talk you out <strong>of</strong> your decision. That means you should not expla<strong>in</strong><br />
when say<strong>in</strong>g NO. Once you realize that you need time for yourself, it is<br />
relatively easy (yes, I said pretty easy) to say NO without an explanation<br />
or excuse. If you are afraid <strong>of</strong> com<strong>in</strong>g <strong>of</strong>f as robotic or unnatural, it<br />
helps to rehearse say<strong>in</strong>g NO <strong>in</strong> front <strong>of</strong> a mirror.<br />
Decl<strong>in</strong><strong>in</strong>g tactfully and thoughtfully conveys respect for the other<br />
person and yourself. Another piece <strong>of</strong> advice: add NO to your body<br />
language. When you decide to say NO, turn your torso away so you are<br />
not fac<strong>in</strong>g them. Cross your arms to cut <strong>of</strong>f communication further.<br />
This is a natural defense mechanism and an un<strong>in</strong>vit<strong>in</strong>g posture. Po<strong>in</strong>t<br />
your toes away, towards where you want to go signal<strong>in</strong>g your <strong>in</strong>terest is<br />
elsewhere. Once you signal NO with your body, it is easier for you to say<br />
no.<br />
While say<strong>in</strong>g NO is exceed<strong>in</strong>gly helpful, NO one will reap the benefits<br />
unless you say NO gracefully. Yes, say<strong>in</strong>g NO is a practiced skill and helps<br />
you advocate for yourself <strong>in</strong> nurs<strong>in</strong>g, which is necessary for your selfcare.<br />
No nurse wants to feel burned out like a burned-out lightbulb. By<br />
say<strong>in</strong>g NO, you are putt<strong>in</strong>g yourself first, keep<strong>in</strong>g yourself strong and<br />
whole so you can take care <strong>of</strong> others. Say<strong>in</strong>g NO is declar<strong>in</strong>g YES to<br />
what matters; a healthy and fulfill<strong>in</strong>g life. Make yourself priority #1!
Page 8 The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan <strong>August</strong>, September, October <strong>2022</strong><br />
<strong>Nurs<strong>in</strong>g</strong> Crisis Fatigue and the Hope for Change<br />
By Beth Ammerman, the ANA-<strong>MI</strong> <strong>Nurs<strong>in</strong>g</strong> & Health<br />
Policy Committee Chair, and committee members:<br />
Alexa Andersen, Mar<strong>in</strong>a Andriyakhova, Debbie<br />
Bach-Stante, Ramona Berry, Wanda Chukwu, Sarah<br />
Jenn<strong>in</strong>gs, Holly Thalman, and Nad<strong>in</strong>e Wodwaski<br />
Nurses are <strong>in</strong> crisis! As the rest <strong>of</strong> the world is<br />
bounc<strong>in</strong>g back from the COVID-19 pandemic and<br />
return<strong>in</strong>g to normalcy with relaxed workplace<br />
rules <strong>in</strong>clud<strong>in</strong>g no longer mask<strong>in</strong>g, no pre-entry<br />
question<strong>in</strong>g, and a general feel<strong>in</strong>g that the<br />
pandemic is near<strong>in</strong>g the end, for nurses and other<br />
healthcare workers, COVID-19 is still very real. We<br />
are still wear<strong>in</strong>g masks and personal protective<br />
equipment at work, which is most <strong>of</strong> our wak<strong>in</strong>g<br />
hours, and we are still car<strong>in</strong>g for very ill patients.<br />
We are still liv<strong>in</strong>g <strong>in</strong> the COVID-19 pandemic, and<br />
it l<strong>in</strong>gers on… and on… and is tak<strong>in</strong>g a toll on<br />
us. A study by Sriharan, West, Almost & Hamza<br />
(2021) reported evidence from both the COVID-19<br />
pandemic and previous pandemics and shows<br />
that “nurses experience the highest levels <strong>of</strong><br />
psychological distress compared with other health<br />
pr<strong>of</strong>essionals.”<br />
Crisis fatigue is a very real concept that “people<br />
<strong>of</strong>ten experience when faced with a chronic<br />
stressor that creates cont<strong>in</strong>uous challenges <strong>in</strong><br />
their life.” (Caldwell-Harvey & Coelho, 2020). Crisis<br />
fatigue is a feel<strong>in</strong>g experienced by many nurses <strong>in</strong><br />
healthcare systems today result<strong>in</strong>g <strong>in</strong> low morale,<br />
feel<strong>in</strong>gs <strong>of</strong> <strong>in</strong>adequacy, frustration, and despair.<br />
Many nurses are leav<strong>in</strong>g their jobs <strong>in</strong> hospitals and<br />
healthcare systems due to crisis fatigue. For some,<br />
it results <strong>in</strong> more than chang<strong>in</strong>g jobs as nurses are<br />
deal<strong>in</strong>g with crisis fatigue <strong>in</strong> various ways. While<br />
some nurses are flee<strong>in</strong>g organized healthcare<br />
to pursue other careers, others are turn<strong>in</strong>g to<br />
travel nurs<strong>in</strong>g for better pay. Those left beh<strong>in</strong>d<br />
are struggl<strong>in</strong>g with the idea that they are work<strong>in</strong>g<br />
alongside travel nurses and do<strong>in</strong>g the same job<br />
for less pay. The morale they ga<strong>in</strong>ed from hav<strong>in</strong>g a<br />
cohesive team <strong>of</strong> supportive coworkers <strong>in</strong> the past<br />
is now disrupted due to <strong>in</strong>creased work demands,<br />
transient coworkers, and staff vacancies. So, what<br />
lies ahead for nurs<strong>in</strong>g?<br />
In a time when nurses are desperately needed<br />
<strong>in</strong> acute care (hospital) sett<strong>in</strong>gs, they are be<strong>in</strong>g<br />
drawn away from different nurs<strong>in</strong>g opportunities<br />
<strong>in</strong> search <strong>of</strong> a better work/life balance. The appeal<br />
for employment that better matches nurses’<br />
expectations have furthered the challenge to<br />
f<strong>in</strong>d nurses will<strong>in</strong>g to care for the most acutely ill<br />
patients. Five ma<strong>in</strong> factors shift nurses away from<br />
acute care nurs<strong>in</strong>g: workplace environment and<br />
demands, overutilization <strong>of</strong> staff, the appeal <strong>of</strong><br />
non-acute care options, imposter syndrome, and<br />
the <strong>in</strong>tent <strong>of</strong> many nurses to further their degrees<br />
<strong>of</strong>ten lead<strong>in</strong>g them to adm<strong>in</strong>istrative or other nonacute<br />
care work. This has led to changes <strong>in</strong> how<br />
nurses <strong>in</strong>teract <strong>in</strong> the workplace and the need to<br />
place additional demands on the nurses.<br />
Workplace Environment and Demands<br />
The COVID-19 pandemic brought changes <strong>in</strong><br />
the schedule, culture, and comfort <strong>of</strong> the acute<br />
care nurs<strong>in</strong>g workplace. The schedule <strong>of</strong> a nurse<br />
work<strong>in</strong>g three 12-hour shifts per week used to<br />
be the envy <strong>of</strong> many other pr<strong>of</strong>essionals; get the<br />
work done, and still have four days to spend with<br />
family and personal life. Dur<strong>in</strong>g the pandemic,<br />
many pr<strong>of</strong>essionals <strong>in</strong> other careers shifted from<br />
work<strong>in</strong>g five 8–10-hour days per week <strong>in</strong> an <strong>of</strong>fice<br />
to the flexibility <strong>of</strong> work<strong>in</strong>g from home, and they<br />
have never returned to the brick-and-mortar<br />
workplace. Dur<strong>in</strong>g the pandemic, nurses were not<br />
only required to leave their homes, but to enter<br />
sett<strong>in</strong>gs with a new deadly virus and work longer<br />
hours, with mandated overtime, to compensate<br />
for the lack <strong>of</strong> human resources (nurses and other<br />
hospital employees).<br />
Additionally, nurses were gowned, gloved, and<br />
masked for long shifts, becom<strong>in</strong>g physically and<br />
emotionally dra<strong>in</strong>ed while car<strong>in</strong>g for consistently<br />
overflow<strong>in</strong>g patient counts. The ration<strong>in</strong>g <strong>of</strong><br />
personal protective equipment, comb<strong>in</strong>ed with<br />
staff<strong>in</strong>g shortages and other <strong>in</strong>patient staff<br />
fearful to enter rooms, led to non-nurs<strong>in</strong>g tasks<br />
becom<strong>in</strong>g the responsibility <strong>of</strong> direct care nurses.<br />
S<strong>in</strong>ce nurses were masked and gowned and <strong>in</strong><br />
the patients’ rooms already, they were now also<br />
empty<strong>in</strong>g trash cans, deliver<strong>in</strong>g food trays, and<br />
hold<strong>in</strong>g tablets so the patients could communicate<br />
electronically with family and physicians. Ongo<strong>in</strong>g<br />
staff<strong>in</strong>g shortages among all levels <strong>of</strong> <strong>in</strong>patient<br />
staff have led to the cont<strong>in</strong>uation <strong>of</strong> these work<br />
conditions. Nurses are weary and crisis fatigue has<br />
set <strong>in</strong>.<br />
One solution is to have transformational nurse<br />
leaders which can have a positive <strong>in</strong>fluence on<br />
manag<strong>in</strong>g these challenges.<br />
Today’s nurse leader will have to understand<br />
the impact <strong>of</strong> nurs<strong>in</strong>g on a global level. The<br />
current pandemic has caused a f<strong>in</strong>ancial stra<strong>in</strong> on<br />
America’s health care system. Stamps et al. (2021)<br />
noted that nurses reported feel<strong>in</strong>g unsupported<br />
by un<strong>in</strong>formed or mis<strong>in</strong>formed peers and family,<br />
as well as lonely when car<strong>in</strong>g for a client diagnosed<br />
with COVID-19. Many nurses dur<strong>in</strong>g COVID-19 have<br />
taken early retirement packages or decided to<br />
work as travel nurses because <strong>of</strong> the <strong>in</strong>creased<br />
payments received from the agencies hir<strong>in</strong>g. The<br />
current nurs<strong>in</strong>g shortage, workload imbalances,<br />
and nurses’ burnout dur<strong>in</strong>g the pandemic have<br />
also contributed to many nurses fac<strong>in</strong>g emotional<br />
and physical stra<strong>in</strong> while work<strong>in</strong>g.<br />
The added layer <strong>of</strong> stress while work<strong>in</strong>g dur<strong>in</strong>g<br />
a pandemic has led nurses to be <strong>in</strong> crisis mode. To<br />
help address the issue concern<strong>in</strong>g nurses’ fatigue,<br />
retention, onboard<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g, and tra<strong>in</strong><strong>in</strong>g new<br />
graduates, many healthcare facilities are reach<strong>in</strong>g<br />
out to foreign nurses to help fill <strong>in</strong> the gaps due to<br />
challenges with staff<strong>in</strong>g.<br />
Accord<strong>in</strong>g to the American Nurses Association<br />
(2020), there is a national nurs<strong>in</strong>g shortage. With<br />
ris<strong>in</strong>g open<strong>in</strong>gs and employment, the U.S. Bureau<br />
<strong>of</strong> Labor Statistics projects 194,500 average annual<br />
open<strong>in</strong>gs for registered nurses between 2020 and<br />
2030, with employment projected to grow by 9%.<br />
This shortage has led to many healthcare facilities<br />
return<strong>in</strong>g to utiliz<strong>in</strong>g nurs<strong>in</strong>g agencies and nurses<br />
from different countries to fill the gaps. There is<br />
a need for all nurses - <strong>in</strong>clud<strong>in</strong>g those with titles<br />
such as chief nurs<strong>in</strong>g <strong>of</strong>ficer, nurse manager, and<br />
charge nurse, as well as frontl<strong>in</strong>e nurses, to act as<br />
transformational leaders. Accord<strong>in</strong>g to Boamah<br />
(<strong>2022</strong>), nurse leaders practic<strong>in</strong>g transformational<br />
leadership can be an effective way to improve<br />
workplace culture and improve retention.<br />
Accord<strong>in</strong>g to Stamps et al. (2021), “nurse<br />
leaders” support is essential to creat<strong>in</strong>g a safe<br />
workplace <strong>in</strong> which nurs<strong>in</strong>g staff are protected,<br />
supported, educated, and empowered. Nurse<br />
leaders can first ensure that they are advocat<strong>in</strong>g<br />
for nurs<strong>in</strong>g staff members by <strong>in</strong>volv<strong>in</strong>g nurses<br />
<strong>in</strong> the decisions that impact their practice<br />
environment. This collaborative approach would<br />
create a communicative plan that <strong>in</strong>cludes<br />
everyone <strong>in</strong>volved <strong>in</strong> provid<strong>in</strong>g patient-centered<br />
care. Nurse leaders and all staff members can<br />
promote advocacy by agree<strong>in</strong>g to treat support<br />
staff, new graduates, and visit<strong>in</strong>g nurses as<br />
pr<strong>of</strong>essionals and equals. The commitment to<br />
open communication and collaboration will lead<br />
to nurses develop<strong>in</strong>g additional conflict resolution<br />
skills while work<strong>in</strong>g under duress. Nurse leaders<br />
and staff members feel<strong>in</strong>g empowered to act as<br />
leaders will assist <strong>in</strong> the commitment to provid<strong>in</strong>g<br />
quality service and care to our patients dur<strong>in</strong>g<br />
these times <strong>of</strong> transition. There is a need to create<br />
a workplace culture where staff members feel<br />
supported and empowered, as well as know<strong>in</strong>g<br />
how to care for themselves.<br />
Overutilization <strong>of</strong> Staff<br />
Exhaustion and illness have led to a human<br />
resources crisis <strong>in</strong> nurs<strong>in</strong>g. Furthermore, 21%<br />
percent <strong>of</strong> nurses polled <strong>in</strong> a national survey<br />
reported the <strong>in</strong>tention to leave their job with<strong>in</strong><br />
a year (Koehler & Olds, <strong>2022</strong>). Other studies have<br />
shown even higher rates <strong>of</strong> <strong>in</strong>tent to leave. Those<br />
who were will<strong>in</strong>g and able have persevered, but<br />
the seem<strong>in</strong>gly few that covered for the many have<br />
reached their break<strong>in</strong>g po<strong>in</strong>t. The overutilization<br />
<strong>of</strong> acute care staff through mandated overtime<br />
and refusal <strong>of</strong> requests for leave is a complex issue<br />
and clearly, the demand for the scarce resource<br />
<strong>of</strong> nurses is driv<strong>in</strong>g complicated decision-mak<strong>in</strong>g.<br />
However, refus<strong>in</strong>g nurses breaks that are essential<br />
to their health and wellbe<strong>in</strong>g is accelerat<strong>in</strong>g their<br />
rapid exits. A research study found two common<br />
<strong>in</strong>terests for bedside nurses across generations:<br />
reasonable workload and manageable staff<strong>in</strong>g<br />
(Koehler & Olds, <strong>2022</strong>). Focus<strong>in</strong>g on these areas is<br />
imperative to improv<strong>in</strong>g retention.<br />
Appeal <strong>of</strong> Non-Acute Care Options<br />
When nurses leave the bedside, where do<br />
they go? Many nurses are seek<strong>in</strong>g employment<br />
<strong>in</strong> non-acute care (non-hospital) sett<strong>in</strong>gs. In<br />
addition to the drive to leave bedside nurs<strong>in</strong>g for<br />
the reasons already listed, the decrease <strong>in</strong> pay to<br />
step away from the hospital is no longer a barrier.<br />
Traditionally, pay for work<strong>in</strong>g <strong>in</strong> a hospital was<br />
better than work<strong>in</strong>g <strong>in</strong> an <strong>of</strong>fice. However, nurses<br />
are <strong>in</strong> demand, which has <strong>in</strong>creased compensation.<br />
Registered nurs<strong>in</strong>g jobs adm<strong>in</strong>ister<strong>in</strong>g aesthetic<br />
<strong>in</strong>jection treatments such as Botox Cosmetic<br />
(onabotul<strong>in</strong>umtox<strong>in</strong>A) provides nurses with<br />
compensation just as well, if not better, along with<br />
the added bonus <strong>of</strong> “normal bus<strong>in</strong>ess hours” and<br />
<strong>of</strong>ten less stress and physical demand. Nurses<br />
have recognized that they can make the same<br />
amount <strong>of</strong> money <strong>in</strong> a less stressful, healthier<br />
environment, work<strong>in</strong>g a regular schedule.<br />
Imposter Syndrome<br />
In every new role, there is an adjustment period<br />
where pr<strong>of</strong>essional standards, responsibilities,<br />
and expectations are identified. Unfortunately,<br />
when high achievers fail to fully <strong>in</strong>ternalize their<br />
accomplishments despite their obvious successes,<br />
it leaves them with a sense <strong>of</strong> self-doubt and fear<br />
<strong>of</strong> exposure as a fraud lead<strong>in</strong>g them to believe<br />
they are fool<strong>in</strong>g others <strong>in</strong>to th<strong>in</strong>k<strong>in</strong>g they are more<br />
capable than they are (Clance and Imes, 1978). This<br />
is called Imposter Syndrome. Imposter Syndrome<br />
<strong>in</strong> nurs<strong>in</strong>g is common and can occur <strong>in</strong> up to 82%<br />
<strong>of</strong> <strong>in</strong>dividuals (Bravata et al., 2020). It can be very<br />
distress<strong>in</strong>g and have consequential effects on<br />
job satisfaction and personal performance. In<br />
nurs<strong>in</strong>g, the novice nurse is vulnerable to feel<strong>in</strong>gs<br />
<strong>of</strong> doubt when it comes to feel<strong>in</strong>g ready to meet<br />
the expectations <strong>of</strong> their patients, colleagues, and<br />
themselves. This <strong>of</strong>ten destroys self-confidence<br />
and a sense <strong>of</strong> belong<strong>in</strong>g, and can lead to burnout<br />
and decreased job satisfaction. This cascade then<br />
leads them to work outside their comfort level,<br />
ultimately feel<strong>in</strong>g the need to leave the nurs<strong>in</strong>g<br />
pr<strong>of</strong>ession. This also leads to crisis fatigue <strong>in</strong> many<br />
new nurses.
<strong>August</strong>, September, October <strong>2022</strong> The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan Page 9<br />
The COVID-19 pandemic left many organizations<br />
adapt<strong>in</strong>g to a reduced workforce while many<br />
were forced <strong>in</strong>to a work-from-home life <strong>in</strong>stead<br />
<strong>of</strong> the <strong>of</strong>fice. Everyth<strong>in</strong>g from higher education,<br />
appo<strong>in</strong>tments, and meet<strong>in</strong>gs became remote<br />
with the use <strong>of</strong> platforms such as Zoom and<br />
Micros<strong>of</strong>t Teams. The pressures to meet<br />
performance expectations left a toxic taste with<br />
many (Plotnik<strong>of</strong> & Ut<strong>of</strong>, 2021). Additionally, be<strong>in</strong>g<br />
isolated led to more social media scroll<strong>in</strong>g and<br />
compar<strong>in</strong>g filtered lives <strong>of</strong> others, seem<strong>in</strong>gly full <strong>of</strong><br />
accomplishments, with their own. This led to those<br />
who reported work<strong>in</strong>g with more responsibilities<br />
and less supervision, ultimately <strong>in</strong>creas<strong>in</strong>g<br />
thoughts <strong>of</strong> self-doubt and fear <strong>of</strong> exposure as a<br />
fraud.<br />
There is not a lot <strong>of</strong> consensuses around<br />
evidence-based treatments for Imposter Syndrome;<br />
however, it is suggested that rais<strong>in</strong>g awareness<br />
helps to manage Imposter Syndrome both<br />
personally and with<strong>in</strong> an organizational sett<strong>in</strong>g.<br />
Imposter Syndrome can be difficult to identify,<br />
as many conceal their perceived <strong>in</strong>adequacies.<br />
Hav<strong>in</strong>g open communication and discussions <strong>of</strong><br />
performance between managers, preceptors,<br />
and new nurses helps to highlight the differences<br />
<strong>of</strong> feel<strong>in</strong>g <strong>in</strong>competent and be<strong>in</strong>g <strong>in</strong>competent,<br />
as they are two very different th<strong>in</strong>gs. Whether<br />
employees are work<strong>in</strong>g on-site or work<strong>in</strong>g from<br />
a home <strong>of</strong>fice, <strong>of</strong>fer<strong>in</strong>g career development<br />
activities and hav<strong>in</strong>g access to resources such<br />
as resilience tra<strong>in</strong><strong>in</strong>g helps to reduce symptoms<br />
<strong>of</strong> Imposter Syndrome (Bravata et al., 2020).<br />
Effects can also be mitigated by sett<strong>in</strong>g healthy<br />
expectations and creat<strong>in</strong>g cultures where<br />
employees’ accomplishments are acknowledged<br />
and celebrated.<br />
As we know nurses are leav<strong>in</strong>g for a variety <strong>of</strong><br />
reasons, and those who are left beh<strong>in</strong>d are <strong>of</strong>ten<br />
stressed, overworked, underappreciated, and<br />
understaffed; where do we turn to get more help?<br />
There is a need to revisit the way nurses deliver<br />
care <strong>in</strong> the acute care sett<strong>in</strong>g.<br />
Role <strong>of</strong> LPNs <strong>in</strong> Acute Care<br />
In light <strong>of</strong> the recent decrease <strong>in</strong> the registered<br />
nurse (RN) workforce <strong>in</strong> acute care, licensed<br />
practical nurses (LPN) are be<strong>in</strong>g brought back<br />
to the field. Several hospital systems across<br />
the country are expand<strong>in</strong>g new graduate RN<br />
programs and br<strong>in</strong>g<strong>in</strong>g back the RN-LPN team<br />
nurs<strong>in</strong>g. Over the last two decades, Magnet status<br />
has been a goal for the standard <strong>of</strong> practice for<br />
healthcare systems. Magnet status is an award<br />
for the highest rank<strong>in</strong>g <strong>of</strong> nurs<strong>in</strong>g whereby<br />
education and development <strong>of</strong> nurses is stressed:<br />
“throughout every career stage, lead<strong>in</strong>g to greater<br />
autonomy at the bedside” (ANCC, <strong>2022</strong>). Evidencebased<br />
sources steered Magnet designations<br />
toward creat<strong>in</strong>g and ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g a nurs<strong>in</strong>g<br />
workforce that is Bachelor <strong>of</strong> Science (BSN)-<br />
prepared. This trend has nearly elim<strong>in</strong>ated LPNs<br />
from the <strong>in</strong>-patient departments, but with the<br />
shortage <strong>of</strong> RNs, is now the time to br<strong>in</strong>g these<br />
nurs<strong>in</strong>g pr<strong>of</strong>essionals back on board?<br />
Currently, 584 out <strong>of</strong> 6,093 hospitals <strong>in</strong> the<br />
United States have designated Magnet status, or<br />
9.3% (ANCC, <strong>2022</strong>). The Bureau <strong>of</strong> Labor Statistics<br />
projects the need for both RN and LPN jobs to<br />
<strong>in</strong>crease by 9% from 2020 to 2030 (Bureau <strong>of</strong> Labor<br />
Statistics, U.S. Department <strong>of</strong> Labor, <strong>2022</strong>). What<br />
does it mean for LPNs? What would it mean for<br />
hospital systems that “phased out” non-BSNprepared<br />
nurses? The answers are not the same<br />
for everyone, but there are options. Incorporat<strong>in</strong>g<br />
LPNs <strong>in</strong>to the acute care sett<strong>in</strong>g decreases the<br />
staff<strong>in</strong>g shortage; however, clear policies on<br />
the role, duties, and responsibilities consistent<br />
with the scope <strong>of</strong> practice <strong>in</strong> a specific state are<br />
necessary.<br />
While LPNs were once actively work<strong>in</strong>g <strong>in</strong><br />
hospital sett<strong>in</strong>gs, the push for an all-RN workforce<br />
left many LPNs work<strong>in</strong>g <strong>in</strong> alternative sett<strong>in</strong>gs like<br />
outpatient cl<strong>in</strong>ics and long-term care facilities.<br />
With the severe RN shortage that we as a country<br />
are now experienc<strong>in</strong>g, is this the time to br<strong>in</strong>g<br />
the LPN back <strong>in</strong>to the acute care sett<strong>in</strong>g to help<br />
alleviate this shortage? What would the care<br />
model look like? Would this be temporary with the<br />
LPNs present only for the crisis, only to be sent<br />
back out <strong>of</strong> the hospitals aga<strong>in</strong> <strong>in</strong> a few years?<br />
LPN to RN transition programs and<br />
<strong>in</strong>centives should be clearly def<strong>in</strong>ed to provide<br />
opportunities for pr<strong>of</strong>essional growth and longterm<br />
employment should the hospital consider<br />
apply<strong>in</strong>g for Magnet status. The time when LPNs<br />
were “phased out” <strong>of</strong> the acute care is fresh <strong>in</strong><br />
our memory; therefore, it is imperative to be<br />
straightforward <strong>in</strong> describ<strong>in</strong>g the sett<strong>in</strong>g <strong>in</strong> which<br />
the role might only be temporary. One way is a<br />
short-term contract for LPNs not pursu<strong>in</strong>g the<br />
RN-BSN path, and another is monetary <strong>in</strong>centives<br />
for “seasoned” LPNs that previously worked<br />
<strong>in</strong> comparable sett<strong>in</strong>gs. In addition, it is fair to<br />
expect that each hospital considers ways to <strong>of</strong>fer<br />
LPNs to practice with<strong>in</strong> their scope <strong>of</strong> practice<br />
<strong>in</strong> acute care. This will allow more skilled nurs<strong>in</strong>g<br />
pr<strong>of</strong>essionals to assist <strong>in</strong> the current staff<strong>in</strong>g<br />
shortage crisis.<br />
<strong>Nurs<strong>in</strong>g</strong> Crisis Fatigue and the..cont<strong>in</strong>ued on page 10
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F<strong>in</strong>d<br />
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Page 10 The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan <strong>August</strong>, September, October <strong>2022</strong><br />
<strong>Nurs<strong>in</strong>g</strong> Crisis Fatigue and the..cont<strong>in</strong>ued from page 9<br />
Newly hired nurses <strong>of</strong>ten volunteer to demonstrate team spirit. Often,<br />
short-lived when it is pa<strong>in</strong>fully obvious no one else is volunteer<strong>in</strong>g. Next, they<br />
realize volunteer<strong>in</strong>g does not exempt mandates to work over, extra days,<br />
and holidays, and that approved planned time <strong>of</strong>f may be compromised.<br />
The nurses that assert themselves and decl<strong>in</strong>e extra assignments may face<br />
retaliation. The managers have an obligation to safely staff their areas; their<br />
job description <strong>in</strong>cludes implement<strong>in</strong>g necessary measures to accomplish<br />
safe staff<strong>in</strong>g. Third-party staff<strong>in</strong>g (“the pool”) is not an option. If critically<br />
necessary, managers assign themselves to fill the void. The common<br />
denom<strong>in</strong>ator for staff<strong>in</strong>g is the nurse managers. How they accomplish this<br />
feat depends on their personality and management style. It is essential for<br />
managers to establish staff<strong>in</strong>g standards that are fair and equitable to their<br />
team. Examples <strong>in</strong>clude: the “pull list,” establish<strong>in</strong>g standards to address<br />
breeched assignments, discussions with feedback from staff to improve<br />
staff<strong>in</strong>g issues; otherwise, staff that disagrees with the unit practices will<br />
consider leav<strong>in</strong>g.<br />
Intent <strong>of</strong> Many Nurses to Further Their Degrees or Seek Non-Inpatient Care<br />
Options<br />
The appeal <strong>of</strong> advanced degrees and the opportunities away from the<br />
bedside that those degrees present are factors that impact nurses. Some<br />
faculty report that nurs<strong>in</strong>g students already have their sights on advanced<br />
degrees, even before graduat<strong>in</strong>g with their BSN degree. At this time, it is<br />
easier than ever to pursue advanced degrees that will lead to adm<strong>in</strong>istrative<br />
roles or Advanced Practice RN (APRN) careers with more regular schedules<br />
and <strong>of</strong>ten <strong>in</strong> outpatient <strong>of</strong>fice environments. There are approximately<br />
400 nurse practitioner programs currently <strong>in</strong> the United States (American<br />
Association <strong>of</strong> Nurse Practitioners, <strong>2022</strong>). In addition to a large number <strong>of</strong><br />
schools, there are flexible options for learn<strong>in</strong>g, such as onl<strong>in</strong>e or face-to-face<br />
programs. APRNs (<strong>in</strong>patient and outpatient) are fac<strong>in</strong>g crisis fatigue as well,<br />
and those RNs seek<strong>in</strong>g to become Nurse Practitioners (NP) are sometimes<br />
disillusioned once they get the degree and are leav<strong>in</strong>g the APRN role, too.<br />
It is not just advanced degrees that nurs<strong>in</strong>g students are eye<strong>in</strong>g; however,<br />
it is careers <strong>in</strong> aesthetics and population health careers, as well. Some<br />
students are request<strong>in</strong>g additional time <strong>in</strong> non-acute sett<strong>in</strong>gs for their f<strong>in</strong>al<br />
projects or transition experiences dur<strong>in</strong>g their f<strong>in</strong>al days <strong>in</strong> undergraduate<br />
programs, as opposed to the traditional acute care rotations. Some nurs<strong>in</strong>g<br />
students are request<strong>in</strong>g that the full complement <strong>of</strong> their cl<strong>in</strong>ical placement<br />
experiences occur outside the acute care sett<strong>in</strong>g. Students cite the appeal<br />
<strong>of</strong> the environment and want a schedule conducive to work/life balance or<br />
family life. Recogniz<strong>in</strong>g the new and different expectations for work/life<br />
balance will be crucial to <strong>in</strong>novative change that effectively redevelops and<br />
susta<strong>in</strong>s a solid workforce at the bedside.<br />
Conclusion<br />
Today’s nurses are fac<strong>in</strong>g many challenges. Address<strong>in</strong>g these issues will<br />
require ongo<strong>in</strong>g support, and collaborat<strong>in</strong>g together will ensure that patientcentered<br />
care, teamwork & collaboration, safety, and quality improvement<br />
are ma<strong>in</strong>ta<strong>in</strong>ed dur<strong>in</strong>g these uncerta<strong>in</strong> times. Nurses will still be committed<br />
to improv<strong>in</strong>g positive cl<strong>in</strong>ical outcomes, act<strong>in</strong>g as transformational leaders <strong>in</strong><br />
our healthcare communities.<br />
References<br />
American Nurse Association (2020). Nurses <strong>in</strong> Workforce. Retrieved from https://www.<br />
nurs<strong>in</strong>gworld.org/practice-policy/workforce/<br />
American Association <strong>of</strong> Nurse Practitioners. (<strong>2022</strong>, April). NP Fact Sheet. https://www.aanp.<br />
org/about/all-about-nps/np-fact-sheet<br />
Boamah SA. The impact <strong>of</strong> transformational leadership on nurse faculty satisfaction and<br />
burnout dur<strong>in</strong>g the COVID-19 pandemic: A moderated mediated analysis. J Adv Nurs. <strong>2022</strong><br />
Mar 17:10.1111/jan.15198. doi: 10.1111/jan.15198. Epub ahead <strong>of</strong> pr<strong>in</strong>t. P<strong>MI</strong>D: 35301738; PMCID:<br />
PMC9111819.<br />
Bravata D.M., Madhusudhan D.K., Bor<strong>of</strong>f M., Cokley K.O. (2020). Commentary: Prevalence,<br />
Predictors, and Treatment <strong>of</strong> Imposter Syndrome: A Systematic Review. Journal <strong>of</strong> Mental<br />
Health Cl<strong>in</strong>ical Psychology, 4(3), 12-16.<br />
Bureau <strong>of</strong> Labor Statistics, U.S. Department <strong>of</strong> Labor. (April, <strong>2022</strong>). Occupational Outlook<br />
Handbook. https://www.bls.gov/ooh/healthcare/registered-nurses.htm<br />
Caldwell-Harvey, Taisha, and Steph Coelho. “Crisis Fatigue: Def<strong>in</strong>ition, Symptoms, and How<br />
to Cope.” Medical News Today, MediLexicon International, 6 Nov. 2020, https://www.<br />
medicalnewstoday.com/articles/crisis-fatigue.<br />
Clance P.R. & Imes S.A. (1978). The imposter phenomenon <strong>in</strong> high achiev<strong>in</strong>g women:<br />
dynamics and therapeutic <strong>in</strong>tervention. Psychotherapy: Theory, Research and Practice;<br />
15(3), 241-247.<br />
John, S. (2019). IMPOSTER SYNDROME: Why nurses question their competence. The <strong>Nurs<strong>in</strong>g</strong><br />
Times, 115(2), 23-24.<br />
Koehler, T., & Olds, D. (<strong>2022</strong>). Generational differences <strong>in</strong> nurses’ <strong>in</strong>tention to leave. Western<br />
Journal <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> Research, 44(5), 446–455. https://doi.org/10.1177/0193945921999608<br />
Plotnik<strong>of</strong>,M. & Ut<strong>of</strong>t E.H. (2021). The “new normal” <strong>of</strong> academia <strong>in</strong> pandemic times:<br />
Resist<strong>in</strong>g toxicity through care. Gender, Work, & Organization, 1-13. https://doi.org/10.1111/<br />
gwao.12778<br />
Sriharan, A., West, K. J., Almost, J., & Hamza, A. (2021). COVID-19-Related Occupational<br />
Burnout and Moral Distress among Nurses: A Rapid Scop<strong>in</strong>g Review. <strong>Nurs<strong>in</strong>g</strong> Leadership<br />
(1910-622X), 34(1), 7–19. https://doi-org.proxy.lib.umich.edu/10.12927/cjnl.2021.26459<br />
Stamps, D. C., Foley, S. M., Gales, J., Lovetro, C., Alley, R., Opett, K., Glessner, T., & Faggiano,<br />
S. (2021). Nurse Leaders Advocate for Nurses Across a Health Care System: COVID-19.<br />
Nurse leader, 19(2), 159–164. https://doi.org/10.1016/j.mnl.2020.07.011 https://www.ncbi.<br />
nlm.nih.gov/pmc/articles/PMC7386289/<br />
The American <strong>Nurs<strong>in</strong>g</strong> Credential<strong>in</strong>g Center. (April, <strong>2022</strong>). F<strong>in</strong>d a Magnet Organization. F<strong>in</strong>d a<br />
Magnet Organization | ANCC | ANA Enterprise (nurs<strong>in</strong>gworld.org)
<strong>August</strong>, September, October <strong>2022</strong> The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan Page 11<br />
Meet<strong>in</strong>g the Nurse Staff<strong>in</strong>g Challenge, Part Two: Retention Tips<br />
Georgia Re<strong>in</strong>er, MS, CPHRM, Risk Specialist, NSO<br />
As discussed <strong>in</strong> the first article <strong>in</strong> this<br />
two-part series on nurs<strong>in</strong>g recruitment and<br />
retention, ensur<strong>in</strong>g appropriate nurse staff<strong>in</strong>g<br />
levels is key to the f<strong>in</strong>ancial health <strong>of</strong> healthcare<br />
organizations like hospitals and skilled nurs<strong>in</strong>g<br />
facilities. High-quality nurs<strong>in</strong>g care helps to<br />
reduce the likelihood <strong>of</strong> patient safety events<br />
and costly medical malpractice lawsuits related<br />
to missed errors. This means it is critical<br />
for leaders to engage <strong>in</strong> effective retention<br />
strategies.<br />
The second <strong>of</strong> a two-part series, this article<br />
addresses effective retention strategies that<br />
leaders can utilize to help reduce turnover <strong>of</strong><br />
nurs<strong>in</strong>g staff.<br />
Retention<br />
The 2021 National Health Care Retention and<br />
RN Staff<strong>in</strong>g Report notes that the average cost<br />
<strong>of</strong> turnover for a hospital-based RN was $44,400<br />
<strong>in</strong> 2020. This makes retention a key part <strong>of</strong> an<br />
organization’s staff<strong>in</strong>g strategies. You need<br />
to work closely with human resources staff<br />
to ensure retention strategies are efficient,<br />
effective, and <strong>in</strong>-l<strong>in</strong>e with organizational<br />
strategies.<br />
Conduct “stay” <strong>in</strong>terviews. Stay <strong>in</strong>terviews<br />
help you identify employees who might be<br />
th<strong>in</strong>k<strong>in</strong>g about leav<strong>in</strong>g the organization and<br />
identify what factors are most important for<br />
stay<strong>in</strong>g. You can use the <strong>in</strong>formation to create<br />
an <strong>in</strong>dividual retention plan and to <strong>in</strong>form your<br />
larger retention efforts for the unit. Here are<br />
some examples <strong>of</strong> questions you can use to help<br />
elicit useful <strong>in</strong>formation dur<strong>in</strong>g stay <strong>in</strong>terviews:<br />
• What do you look forward to each day<br />
when you commute to work?<br />
• What are you learn<strong>in</strong>g here, and what do<br />
you want to learn?<br />
• Why do you stay here?<br />
• When is the last time you thought about<br />
leav<strong>in</strong>g and what prompted it?<br />
• What can I do to make your job better for<br />
you?<br />
them to the <strong>in</strong>dividual’s <strong>in</strong>terest. For example, a<br />
nurse who dr<strong>in</strong>ks c<strong>of</strong>fee every day may enjoy a<br />
Starbucks card, but one who loves to read might<br />
prefer a card from Barnes & Noble.<br />
Support career development. Explore nurses’<br />
pr<strong>of</strong>essional goals and how you can help meet<br />
them dur<strong>in</strong>g stay <strong>in</strong>terviews and other ongo<strong>in</strong>g<br />
pr<strong>of</strong>essional development conversations. It’s a<br />
good idea to keep a mental list <strong>of</strong> options such<br />
as serv<strong>in</strong>g on committees, act<strong>in</strong>g as a preceptor,<br />
and lead<strong>in</strong>g project teams. Offer mean<strong>in</strong>gful<br />
opportunities for pr<strong>of</strong>essional growth based<br />
on performance, rather than solely based on<br />
tenure. Outl<strong>in</strong>e for your staff the types <strong>of</strong><br />
experiences or skills that are most valuable for<br />
advancement and re<strong>in</strong>force the value <strong>of</strong> bedside<br />
nurs<strong>in</strong>g experience for nurses’ long-term career<br />
growth.<br />
Consider a job embeddedness approach.<br />
Job embeddedness (JE) focuses on why people<br />
stay <strong>in</strong> their jobs as opposed to why they leave.<br />
A study by Reitz and colleagues found it’s a<br />
good predictor <strong>of</strong> nurses’ <strong>in</strong>tent to stay. JE<br />
looks at ties related to organizations and the<br />
community where they exist. These ties are<br />
considered <strong>in</strong> three dimensions: l<strong>in</strong>ks (formal<br />
and <strong>in</strong>formal connections people have with<br />
their organizations or communities), fit (how<br />
compatible people feel with their organizations<br />
or communities), and sacrifice (material and<br />
psychological losses people would experience<br />
by leav<strong>in</strong>g their organizations or communities).<br />
You can leverage these dimensions to promote<br />
retention. For example, to help promote JE with<br />
the organization:<br />
• L<strong>in</strong>ks: Involve nurses <strong>in</strong> committees and<br />
shared governance.<br />
• Fit: Recruit nurses whose goals align with<br />
the organization’s goals.<br />
• Sacrifice: Align vacation time and<br />
retirement plans with the time <strong>of</strong> service.<br />
A multifaceted approach<br />
Nurse staff<strong>in</strong>g challenges are unlikely to<br />
ease anytime soon. Leaders will need to be<br />
creative and take a multifaceted approach to<br />
recruitment and retention. These efforts will<br />
help ga<strong>in</strong>—and keep—staff. Do<strong>in</strong>g so helps<br />
reduce the costs <strong>of</strong> lawsuits related to errors,<br />
but, most importantly, provides optimal patient<br />
outcomes.<br />
References<br />
Advisory Board. Struggl<strong>in</strong>g to keep entry-level staff<br />
engaged? Try a performance-based career ladder. 2017.<br />
https://www.advisory.com/blog/2017/02/pef-careerladder<br />
CNA & NSO. Nurse Pr<strong>of</strong>essional Liability Exposure Claim<br />
Report: 4th Edition: M<strong>in</strong>imiz<strong>in</strong>g Risk, Achiev<strong>in</strong>g<br />
Excellence. 2020. https://www.nso.com/Learn<strong>in</strong>g/<br />
Artifacts/Claim-Reports/M<strong>in</strong>imiz<strong>in</strong>g-Risk-Achiev<strong>in</strong>g-<br />
Excellence<br />
Malliaris AP, Phillips J, Bakerjian, D. <strong>Nurs<strong>in</strong>g</strong> and Patient<br />
Safety. Agency for Healthcare Research and Quality.<br />
2021. https://psnet.ahrq.gov/primer/nurs<strong>in</strong>g-andpatient-safety<br />
NSI <strong>Nurs<strong>in</strong>g</strong> Solutions, Inc. 2021 National health care<br />
retention and RN staff<strong>in</strong>g report. 2021. https://www.<br />
ns<strong>in</strong>urs<strong>in</strong>gsolutions.com/Documents/Library/NSI_<br />
National_Health_Care_Retention_Report.pdf<br />
Reitz O, Anderson M, Hill PD. Job embeddedness and<br />
nurse retention. Nurs Adm<strong>in</strong> Q. 2010;34(3):190-200.<br />
Saver C. Reta<strong>in</strong><strong>in</strong>g nurses <strong>in</strong> a post-pandemic era—Part 1.<br />
OR Manager. 2021;37(9):12-15.<br />
Sherman RO. The Nuts and Bolts <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> Leadership: Your<br />
Toolkit for Success. Rose. O. Sherman; 2021.<br />
Disclaimer: The <strong>in</strong>formation <strong>of</strong>fered with<strong>in</strong> this<br />
article reflects general pr<strong>in</strong>ciples only and does not<br />
constitute legal advice by Nurses Service Organization<br />
(NSO) or establish appropriate or acceptable standards<br />
<strong>of</strong> pr<strong>of</strong>essional conduct. Readers should consult with an<br />
attorney if they have specific concerns. Neither Aff<strong>in</strong>ity<br />
Insurance Services, Inc. nor NSO assumes any liability<br />
for how this <strong>in</strong>formation is applied <strong>in</strong> practice or for the<br />
accuracy <strong>of</strong> this <strong>in</strong>formation.<br />
This risk management <strong>in</strong>formation was provided<br />
by Nurses Service Organization (NSO), the nation's<br />
largest provider <strong>of</strong> nurses’ pr<strong>of</strong>essional liability<br />
<strong>in</strong>surance coverage for over 550,000 nurses s<strong>in</strong>ce 1976.<br />
The <strong>in</strong>dividual pr<strong>of</strong>essional liability <strong>in</strong>surance policy<br />
adm<strong>in</strong>istered through NSO is underwritten by American<br />
Casualty Company <strong>of</strong> Read<strong>in</strong>g, Pennsylvania, a CNA<br />
company. Reproduction without permission <strong>of</strong> the<br />
publisher is prohibited. For questions, send an e-mail to<br />
service@nso.com or call 1-800-247-1500. www.nso.com.<br />
Promote a healthy work environment. For<br />
example, implement zero tolerance policies for<br />
patient or visitor violence aga<strong>in</strong>st nurses and<br />
policies that discourage providers from bully<strong>in</strong>g<br />
their colleagues. Beyond policies, it is also<br />
important to ensure l<strong>in</strong>es <strong>of</strong> communication are<br />
open, so your staff feel comfortable speak<strong>in</strong>g<br />
with you when they identify problem areas.<br />
Make rounds daily and listen to staff closely. Ask<br />
them questions such as, “What do you need to<br />
do your job more effectively?” If it’s someth<strong>in</strong>g<br />
that you can take care <strong>of</strong>, do so and let them<br />
know it’s been done. If you can’t address the<br />
issue, expla<strong>in</strong> why and, if appropriate, note that<br />
it may be able to be addressed <strong>in</strong> the future.<br />
Avoid sign-on bonuses. Sign-on bonuses<br />
may help to ease staff<strong>in</strong>g woes short term, but<br />
don’t ensure commitment, and can even lead to<br />
resentment from current staff. Instead, focus<br />
on improv<strong>in</strong>g nurses’ pay scales or <strong>of</strong>fer<strong>in</strong>g<br />
retention bonuses to show appreciation for your<br />
nurs<strong>in</strong>g staff’s commitment to the organization.<br />
Recognize employees. Recognition is an easy,<br />
but <strong>of</strong>ten underutilized, retention tactic. Take<br />
every opportunity to <strong>of</strong>fer words <strong>of</strong> praise. To<br />
re<strong>in</strong>force the behavior, specify what specifically<br />
was done to earn praise. Small rewards such as<br />
gift cards can also be effective, but try to match<br />
April 15, 2024<br />
4<br />
October 15, 2023
Page 12 The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan <strong>August</strong>, September, October <strong>2022</strong><br />
Compar<strong>in</strong>g, Criticiz<strong>in</strong>g and Compla<strong>in</strong><strong>in</strong>g:<br />
The Detrimental Effects <strong>of</strong> Gossip<br />
By Nicole Cerr<strong>in</strong>i, BSN, RN,<br />
Owner <strong>of</strong> Nicole Cerr<strong>in</strong>i Health<br />
& Wellness<br />
While I was attempt<strong>in</strong>g<br />
to eat my breakfast <strong>in</strong> peace<br />
at work, I found myself<br />
surrounded by others who<br />
were either compla<strong>in</strong><strong>in</strong>g about<br />
their neighbors, demoraliz<strong>in</strong>g their colleagues or<br />
express<strong>in</strong>g general disda<strong>in</strong> for their life situations.<br />
It was extremely hard to cont<strong>in</strong>ue to listen to all<br />
<strong>of</strong> this, and even harder not to try to redirect their<br />
conversations.<br />
This life is way too short to constantly be<br />
gossip<strong>in</strong>g and welcom<strong>in</strong>g negativity with open<br />
arms. I recently listened to a podcast by Jay<br />
Shetty (On Purpose) and he discusses the three<br />
C’s: Compar<strong>in</strong>g, Criticiz<strong>in</strong>g and Compla<strong>in</strong><strong>in</strong>g. It is<br />
overwhelm<strong>in</strong>g when you are able to take a step<br />
back and observe yourself from this standpo<strong>in</strong>t.<br />
Even smaller compla<strong>in</strong>ts or “simple” gossip can<br />
largely affect your daily life and how certa<strong>in</strong> th<strong>in</strong>gs<br />
affect you. It’s extremely dra<strong>in</strong><strong>in</strong>g when you are<br />
surrounded by negativity, and once you’re selfaware<br />
<strong>of</strong> this issue, it becomes toxic be<strong>in</strong>g around<br />
those who cont<strong>in</strong>uously put down others or<br />
themselves.<br />
Compar<strong>in</strong>g yourself to others is one <strong>of</strong> the<br />
most common thoughts we have. Whether<br />
you’re compar<strong>in</strong>g life circumstances, weight,<br />
friendships, spouses, etc., it all plays a part <strong>in</strong><br />
how you generally feel about yourself and <strong>in</strong> turn<br />
affects your relationships with others. I am guilty<br />
<strong>of</strong> compar<strong>in</strong>g myself <strong>in</strong> certa<strong>in</strong> situations, but now<br />
that I am aware <strong>of</strong> it, I’m able to not only catch<br />
myself <strong>in</strong> the moment, but also put a positive<br />
sp<strong>in</strong> on it. The next time you observe yourself<br />
compar<strong>in</strong>g <strong>in</strong> any way, try to recognize that it’s<br />
simply your way <strong>of</strong> realiz<strong>in</strong>g what you desire and<br />
figur<strong>in</strong>g out what that means for you.<br />
Criticiz<strong>in</strong>g is another huge habit that leads<br />
to general problems with yourself and your<br />
relationships. Whether you are be<strong>in</strong>g critical <strong>of</strong><br />
yourself or others, you <strong>in</strong>still the stigma that<br />
someth<strong>in</strong>g isn’t good enough for you. It’s very<br />
possible that you are likely criticiz<strong>in</strong>g those close<br />
to you and may not even be aware <strong>of</strong> it. Petty<br />
gossip, such as talk<strong>in</strong>g about a family member<br />
beh<strong>in</strong>d their back or judg<strong>in</strong>g the person <strong>in</strong> l<strong>in</strong>e<br />
<strong>in</strong> front <strong>of</strong> you at the grocery store, are both<br />
examples <strong>of</strong> how criticism can creep up <strong>in</strong> your<br />
daily life and put a negative twist on your values.<br />
Once you really beg<strong>in</strong> to see how <strong>of</strong>ten this<br />
happens, it’s <strong>in</strong>credible to feel the shift as you<br />
start to create new habits that steer clear from<br />
judgment.<br />
Compla<strong>in</strong><strong>in</strong>g is probably one <strong>of</strong> the harder<br />
habits to break when it comes to the three C’s.<br />
There are a few people <strong>in</strong> my life who always seem<br />
to be compla<strong>in</strong><strong>in</strong>g about someth<strong>in</strong>g/someone at<br />
all times. It’s exhaust<strong>in</strong>g listen<strong>in</strong>g to it, and even<br />
more exhaust<strong>in</strong>g try<strong>in</strong>g to get them to see a<br />
different perspective. If you compare compla<strong>in</strong><strong>in</strong>g<br />
to the Law <strong>of</strong> Attraction, it makes a lot <strong>of</strong> sense<br />
that the compla<strong>in</strong>ts seem to never end. What you<br />
put out, you always get back! Very few people<br />
can take a step back and realize that they are<br />
the common denom<strong>in</strong>ator <strong>in</strong> their problems.<br />
Every s<strong>in</strong>gle situation can always be viewed <strong>in</strong><br />
a positive light, even if it may seem impossible.<br />
The m<strong>in</strong>ute you decide to replace your compla<strong>in</strong>t<br />
with someth<strong>in</strong>g you're thankful for, you will<br />
immediately feel better and those around you will<br />
notice this shift as well.<br />
It’s not easy to turn the magnify<strong>in</strong>g glass on<br />
yourself and realize the negative habits you have<br />
made your norm. But once you really make an<br />
effort to notice when you're compar<strong>in</strong>g, criticiz<strong>in</strong>g<br />
or compla<strong>in</strong><strong>in</strong>g, the easier it will become to not<br />
only notice these habits, but to break them. You<br />
are the only one <strong>in</strong> control <strong>of</strong> your life and how<br />
you react to it. No one else can take the wheel for<br />
you and steer you <strong>in</strong> a positive direction. You have<br />
to want it for yourself, but once you do decide<br />
to make this shift, you will be amazed at the<br />
opportunities that open for you.<br />
Michigan Department <strong>of</strong> Corrections<br />
NOW HIRING<br />
REGISTERED NURSES<br />
AND<br />
GRADUATE NURSES!<br />
$5,000 sign on bonus*<br />
$250 retention bonus pilot*<br />
Great pay and Benefits<br />
Opportunities for advancement<br />
13 paid Holidays (14 every other year)<br />
To apply, visit www.michigan.gov/mdocjobs.<br />
*For RN/approved locations only
<strong>August</strong>, September, October <strong>2022</strong> The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan Page 13<br />
Innovat<strong>in</strong>g Toward an Improved <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong><br />
Innovation is the current<br />
buzz word <strong>in</strong> health care.<br />
When hear<strong>in</strong>g this term,<br />
what immediately comes<br />
to m<strong>in</strong>d is the application<br />
<strong>of</strong> new technologies and<br />
reorganization <strong>of</strong> current<br />
structures. The Michigan<br />
Department <strong>of</strong> Health and<br />
Human Services, Office <strong>of</strong><br />
<strong>Nurs<strong>in</strong>g</strong> Programs: <strong>Nurs<strong>in</strong>g</strong><br />
Safety and Workforce Plann<strong>in</strong>g<br />
Deborah Bach-<br />
Stante, BSN,<br />
MPH, MSW<br />
(MDHHS-ONP) is excited to support <strong>in</strong>novation<br />
through technology, data, and cont<strong>in</strong>uous<br />
improvement <strong>of</strong> our efforts through engagement<br />
with nurs<strong>in</strong>g stakeholders throughout Michigan.<br />
MDHHS-ONP has spent the past several years<br />
support<strong>in</strong>g efforts to <strong>in</strong>crease and dissem<strong>in</strong>ate<br />
virtual cl<strong>in</strong>ical education resources throughout the<br />
state. These resources were developed through<br />
nurs<strong>in</strong>g academic and practice partnerships with<br />
community organizations serv<strong>in</strong>g <strong>in</strong>dividuals<br />
who encounter barriers to access<strong>in</strong>g culturally<br />
competent and accessible healthcare services <strong>in</strong><br />
Michigan. In addition, the ONP has supported and<br />
dissem<strong>in</strong>ated tra<strong>in</strong><strong>in</strong>g for faculty on best practices<br />
and resources for virtual nurs<strong>in</strong>g education.<br />
The virtual cl<strong>in</strong>ical education resources are<br />
designed to improve nurses’ understand<strong>in</strong>g <strong>of</strong><br />
the impacts <strong>of</strong> social determ<strong>in</strong>ants <strong>of</strong> health and<br />
<strong>in</strong>equities on <strong>in</strong>dividuals <strong>in</strong> Michigan.<br />
These resources are freely available us<strong>in</strong>g the<br />
follow<strong>in</strong>g l<strong>in</strong>k:<br />
Virtual <strong>Nurs<strong>in</strong>g</strong> Cl<strong>in</strong>ical Education Resources<br />
(michigan.gov)<br />
The virtual cl<strong>in</strong>ical education tra<strong>in</strong><strong>in</strong>g may be<br />
accessed us<strong>in</strong>g the follow<strong>in</strong>g l<strong>in</strong>k:<br />
Navigat<strong>in</strong>g the Way Forward: Resources and<br />
Best Practices to Embed Virtual Resources <strong>in</strong><br />
Cl<strong>in</strong>ical Education Web<strong>in</strong>ar (michigan.gov)<br />
While <strong>in</strong>novation <strong>in</strong>cludes these th<strong>in</strong>gs, the<br />
broader def<strong>in</strong>ition <strong>of</strong> this term also encompasses<br />
a more comprehensive renewal. Labor shortages,<br />
new technologies, and acknowledgement <strong>of</strong><br />
the impacts <strong>of</strong> implicit bias, racism and societal<br />
<strong>in</strong>equities are plac<strong>in</strong>g <strong>in</strong>creas<strong>in</strong>g pressure on<br />
the systems that provide services affect<strong>in</strong>g the<br />
health and wellness <strong>of</strong> the population. To address<br />
these pressures, the nurs<strong>in</strong>g pr<strong>of</strong>ession needs to<br />
leverage available <strong>in</strong>formation and resources to<br />
take a bold stance on <strong>in</strong>novat<strong>in</strong>g for the future.<br />
In addition to <strong>in</strong>corporat<strong>in</strong>g new and important<br />
data, structures and resources, it is time to rid<br />
ourselves <strong>of</strong> vestigial structures, <strong>in</strong>clud<strong>in</strong>g those<br />
practices, policies and processes that only serve to<br />
ma<strong>in</strong>ta<strong>in</strong> the status quo. We stand on a precipice<br />
as bold leaders throughout all areas and levels <strong>of</strong><br />
nurs<strong>in</strong>g to strive to move the pr<strong>of</strong>ession forward<br />
<strong>in</strong>to a better future for both the pr<strong>of</strong>ession and<br />
the <strong>in</strong>dividuals, families and communities that we<br />
serve. To clarify, <strong>in</strong> this context, the word leader<br />
does not reference only those who hold certa<strong>in</strong><br />
pr<strong>of</strong>essional titles or serve <strong>in</strong> specifically def<strong>in</strong>ed<br />
leadership roles <strong>in</strong> nurs<strong>in</strong>g or other healthcare<br />
organizations that are design<strong>in</strong>g strategies to<br />
address these issues. The word leader is used<br />
to refer to the pr<strong>of</strong>essional leadership taught <strong>in</strong><br />
nurs<strong>in</strong>g educational programs throughout the<br />
state that is <strong>in</strong>herent to all nurs<strong>in</strong>g roles and<br />
responsibilities.<br />
Thus, nurses and nurs<strong>in</strong>g stakeholders<br />
throughout the state are encouraged to view<br />
the longitud<strong>in</strong>al analysis <strong>of</strong> diversity data,<br />
currently <strong>in</strong> process, that will appear <strong>in</strong> the<br />
<strong>2022</strong> Michigan <strong>Nurs<strong>in</strong>g</strong> Licensure Survey Report<br />
and the associated analysis <strong>of</strong> workplace<br />
violence data collected over the past three<br />
years. This data, while limited by the number<br />
and representativeness <strong>of</strong> respondents, is<br />
not <strong>in</strong>tended as an endpo<strong>in</strong>t, to serve as<br />
documentation <strong>of</strong> the current state <strong>of</strong> the<br />
pr<strong>of</strong>ession, to be viewed once and put on a shelf,<br />
or only used as a citation <strong>in</strong> grant proposals<br />
and research efforts. This data will serve as<br />
a tool to <strong>in</strong>form a larger dialogue regard<strong>in</strong>g a<br />
comprehensive renewal <strong>of</strong> the nurs<strong>in</strong>g pr<strong>of</strong>ession<br />
<strong>in</strong> Michigan.<br />
The ONP would like to <strong>in</strong>vite nurs<strong>in</strong>g<br />
stakeholders throughout Michigan to participate<br />
<strong>in</strong> the collaborative process <strong>of</strong> dialogue to be<br />
embarked upon <strong>in</strong> the fall <strong>of</strong> <strong>2022</strong>. Armed with<br />
the available data, <strong>in</strong>dividuals who choose to<br />
participate <strong>in</strong> this process will collaborate on<br />
identify<strong>in</strong>g long and short-term priorities to be<br />
used <strong>in</strong> the design <strong>of</strong> an action plan for how the<br />
ONP will cont<strong>in</strong>ue promot<strong>in</strong>g safe patient care<br />
<strong>in</strong> all nurs<strong>in</strong>g practice environments, advanc<strong>in</strong>g<br />
the safe practice <strong>of</strong> the nurs<strong>in</strong>g pr<strong>of</strong>ession,<br />
and ensur<strong>in</strong>g a cont<strong>in</strong>uous supply <strong>of</strong> highquality<br />
direct care nurses, nurs<strong>in</strong>g faculty and<br />
nurs<strong>in</strong>g educational programs. Individuals who<br />
are <strong>in</strong>terested <strong>in</strong> engag<strong>in</strong>g <strong>in</strong> this constructive<br />
dialogue are encouraged to email Casey Kle<strong>in</strong><br />
at kle<strong>in</strong>c7@michigan.gov to have their name<br />
and contact <strong>in</strong>formation added to the list <strong>of</strong><br />
stakeholders to be <strong>in</strong>vited to participate <strong>in</strong> this<br />
process. It is only through the collective efforts <strong>of</strong><br />
all facets <strong>of</strong> nurs<strong>in</strong>g stakeholders that embark<strong>in</strong>g<br />
upon the path forged through a collaborative<br />
process may assist <strong>in</strong> usher<strong>in</strong>g <strong>in</strong> a future <strong>of</strong><br />
nurs<strong>in</strong>g that can be embraced by current and<br />
future nurs<strong>in</strong>g pr<strong>of</strong>essionals and nurs<strong>in</strong>g students<br />
throughout Michigan.<br />
ANA-<strong>MI</strong> Foundation Awards<br />
First Annual Grants and Scholarships<br />
By Myrna Holland, MSN, RN, ANA-<strong>MI</strong> Foundation<br />
President<br />
As this newsletter is go<strong>in</strong>g to press, the ANA-<br />
<strong>MI</strong> Foundation board members are select<strong>in</strong>g the<br />
first recipients <strong>of</strong> the foundation’s <strong>in</strong>itial round <strong>of</strong><br />
scholarships and grants. When you have f<strong>in</strong>ished<br />
read<strong>in</strong>g this article, you can visit the foundation’s<br />
website, www.ana-mi.foundation, to learn about<br />
the awardees.<br />
The awards were established for pre-licensure<br />
students who have completed two semesters<br />
<strong>of</strong> nurs<strong>in</strong>g courses. Our goal is to support timely<br />
graduation and entry <strong>in</strong>to the pr<strong>of</strong>essional work<br />
force. For this first round, the two scholarships<br />
be<strong>in</strong>g granted are for $2,500 each. One is the<br />
Dorothea Milbrandt Leadership Scholarship and<br />
the other is the Academic Excellence Scholarship.<br />
The additional $2,500 is be<strong>in</strong>g distributed <strong>in</strong><br />
amounts up to $500 to address specific f<strong>in</strong>ancial<br />
obstacles which <strong>in</strong>terfere with an <strong>in</strong>dividual’s<br />
ability to complete their education <strong>in</strong> a timely and<br />
less challeng<strong>in</strong>g manner.<br />
There were many worthy applicants and mak<strong>in</strong>g<br />
the f<strong>in</strong>al selections is not go<strong>in</strong>g to be easy. We plan<br />
to share some <strong>of</strong> their goals and achievements<br />
with you, because we are sure their stories will<br />
enhance your positive feel<strong>in</strong>gs about the future <strong>of</strong><br />
nurs<strong>in</strong>g.<br />
The Foundation Board will be work<strong>in</strong>g to<br />
cont<strong>in</strong>ue and expand this scholarship program,<br />
as well as prioritize the other purposes <strong>of</strong> our<br />
foundation. Of course, these goals require<br />
consistent fund<strong>in</strong>g, so we hope that all <strong>of</strong> our<br />
members will f<strong>in</strong>d a way to make a tax-deductible<br />
donation to help us grow. There are several<br />
ways to do that. When you visit www.ana-mi.<br />
foundation there are l<strong>in</strong>ks to donate by PayPal or<br />
by credit or debit card on a monthly or one time<br />
basis, as well as <strong>in</strong>formation on where to send a<br />
check. For <strong>in</strong>dividuals who have IRA mandatory<br />
distributions, talk to your f<strong>in</strong>ancial advisor about<br />
your contribution prior to pay<strong>in</strong>g federal taxes. Or<br />
you can consider a foundation donation as a part<br />
<strong>of</strong> your estate plann<strong>in</strong>g. This was how Dorothea’s<br />
foresight helped establish our foundation.<br />
Remember that contribut<strong>in</strong>g to the foundation<br />
doesn’t just have to come from you. How many<br />
times have you had a family member or friends<br />
talk about their positive experiences with nurses?<br />
How many times have you heard people rave<br />
about how much the nurses’ care, compassion<br />
and skills meant to them and their loved ones’<br />
health and well-be<strong>in</strong>g? Talk to them aga<strong>in</strong> about it<br />
or next time, use that opportunity to suggest that<br />
they honor and support those nurses through a<br />
donation to the ANA-Michigan Foundation. It is yet<br />
another way that we can support “Nurses Help<strong>in</strong>g<br />
Nurses.”
Page 14 The <strong>Future</strong> <strong>of</strong> <strong>Nurs<strong>in</strong>g</strong> <strong>in</strong> Michigan <strong>August</strong>, September, October <strong>2022</strong><br />
Are Nurses Suffer<strong>in</strong>g from Moral Injury?<br />
By Donna Craig, RN, JD<br />
S<strong>in</strong>ce January 2020,<br />
the United States has<br />
documented close to 90<br />
million cases <strong>of</strong> COVID,<br />
result<strong>in</strong>g <strong>in</strong> more than one<br />
million deaths. 1 Dur<strong>in</strong>g the<br />
same time period, Michigan<br />
experienced more than 2.6<br />
million COVID cases, result<strong>in</strong>g<br />
<strong>in</strong> more than 37,000 deaths. 2<br />
While the number <strong>of</strong> COVID<br />
Donna J. Craig,<br />
RN, JD<br />
cases cont<strong>in</strong>ues to decrease, there is no doubt<br />
that the mental impact on nurses who cared for<br />
COVID patients will be felt for some time. This<br />
mental effect has sometimes been described as<br />
“burnout” or a “Post-Traumatic Stress Disorder”<br />
reaction. Perhaps a more accurate description<br />
would be described as “moral <strong>in</strong>jury.”<br />
What Is Moral Injury? The term “moral <strong>in</strong>jury”<br />
refers to the last<strong>in</strong>g emotional, psychological,<br />
social, behavioral, and spiritual impacts <strong>of</strong><br />
actions that violate a person’s core moral<br />
values and behavioral expectations. 3 This occurs<br />
when <strong>in</strong>dividuals are unable to contextualize<br />
their actions or other’s actions with their core<br />
values. 4 The research on how and why moral<br />
<strong>in</strong>jury occurs was <strong>in</strong>itially associated with the<br />
moral conflicts faced by the military dur<strong>in</strong>g<br />
wartime, particularly dur<strong>in</strong>g the Vietnam War. 5<br />
While moral <strong>in</strong>jury is not currently considered<br />
a mental disorder, it shares common symptoms<br />
with Post-Traumatic Stress Disorder (“PTSD”),<br />
<strong>in</strong>clud<strong>in</strong>g avoidance, hypervigilance, <strong>in</strong>trusive<br />
thoughts, distress<strong>in</strong>g dreams related to the<br />
event, and social problems. 6 Moral <strong>in</strong>jury can<br />
occur when an <strong>in</strong>dividual f<strong>in</strong>ds himself <strong>in</strong> a<br />
high-stakes situation with no good choices. For<br />
nurses that may mean dol<strong>in</strong>g out patient care <strong>in</strong><br />
such a way that not everyone’s medical needs<br />
can be addressed even though nurses truly want<br />
to provide the best care possible. Nurses are<br />
faced with decid<strong>in</strong>g who to treat first; which<br />
patients receive limited resources; and how<br />
do nurses best use limited time when multiple<br />
patients need help. Added to that are nurses<br />
who found themselves without the right tools,<br />
equipment or tra<strong>in</strong><strong>in</strong>g to save a patient’s life,<br />
leav<strong>in</strong>g them feel<strong>in</strong>g helpless and <strong>in</strong>adequate <strong>in</strong><br />
a pr<strong>of</strong>ession dedicated to car<strong>in</strong>g for patients.<br />
Moral Injury Is Not Burnout - Moral <strong>in</strong>jury<br />
affects a person’s sense <strong>of</strong> right and wrong,<br />
which is different than what is characterized as<br />
“burnout.” The term moral <strong>in</strong>jury represents a<br />
situation <strong>of</strong> witness<strong>in</strong>g care or <strong>of</strong>fer<strong>in</strong>g care that<br />
conflicts with one’s <strong>in</strong>ternal compass <strong>of</strong> right<br />
and wrong. 7 Burnout is a state <strong>of</strong> emotional,<br />
mental, and <strong>of</strong>ten physical exhaustion brought<br />
on by prolonged or repeated stress. 8 Burnout is<br />
not associated with a person’s core values.<br />
Moral Injury Versus PTSD – While there is<br />
overlap between the symptoms <strong>of</strong> moral <strong>in</strong>jury<br />
and PTSD, such as guilt, shame, betrayal and<br />
loss <strong>of</strong> trust, unlike PTSD, <strong>in</strong>dividuals don’t<br />
necessarily experience hyperarousal (senses are<br />
on high alert as a result <strong>of</strong> trauma) with moral<br />
<strong>in</strong>jury. 9 The trigger<strong>in</strong>g event(s) for PTSD results<br />
from a life-threaten<strong>in</strong>g experience that leads<br />
to chronic hypervigilance and fear; it is difficult<br />
to ever feel safe. 10 Moral <strong>in</strong>jury <strong>in</strong>volves loss<br />
<strong>of</strong> trust; it is not a disorder, but a reasonable<br />
response to hav<strong>in</strong>g one’s ethical compass<br />
thrown <strong>of</strong>f track. 11 How events result <strong>in</strong> moral<br />
<strong>in</strong>jury is demonstrated <strong>in</strong> Figure 1. 12<br />
Assess<strong>in</strong>g and Address<strong>in</strong>g Moral Injury<br />
– While some studies have shown traumafocused<br />
PTSD treatment such as Prolonged<br />
Exposure (PE) [use <strong>of</strong> imag<strong>in</strong>al exposures<br />
to reduce the <strong>in</strong>tensity and frequency <strong>of</strong><br />
symptoms] and Cognitive Process<strong>in</strong>g Therapy<br />
(CPT) [emotional process<strong>in</strong>g by replac<strong>in</strong>g<br />
fears with accurate <strong>in</strong>formation] effectively<br />
reduce trauma-related guilt and shame, PE<br />
and CPT may not be sufficient for treatment <strong>of</strong><br />
<strong>in</strong>dividuals with moral <strong>in</strong>juries. 13 On the bright<br />
side, there are some emerg<strong>in</strong>g treatments that<br />
are meant to specifically target moral <strong>in</strong>jury<br />
and its core components, such as “Acceptance<br />
and Commitment Therapy,” which focuses<br />
on help<strong>in</strong>g <strong>in</strong>dividuals live <strong>in</strong> accordance with<br />
their values. 14 Another treatment is “Adaptive<br />
Disclosure,” which assists <strong>in</strong>dividuals with<br />
process<strong>in</strong>g moral <strong>in</strong>jury through imag<strong>in</strong>ary<br />
dialogue and apportion<strong>in</strong>g blame, mak<strong>in</strong>g<br />
amends and <strong>in</strong> some versions, self-compassion<br />
and m<strong>in</strong>dfulness meditations. 15 For moral<br />
<strong>in</strong>juries result<strong>in</strong>g from religious or spiritual<br />
core value conflicts, the “Build<strong>in</strong>g Spiritual<br />
Strength” program addresses concerns about<br />
the relationship with a Higher Power, as well<br />
as challenges with forgiveness. 16 In addition<br />
to <strong>in</strong>-person therapy and counsel<strong>in</strong>g, mobile<br />
apps have been developed to help <strong>in</strong>dividuals<br />
address the symptoms <strong>of</strong> moral <strong>in</strong>jury. Those<br />
mobile apps <strong>in</strong>clude: “COVID Coach” 17 and<br />
“Provider Resilience from the National Center<br />
for Telehealth & Technology.” 18<br />
Nurses need not suffer from long-term<br />
negative outcomes from car<strong>in</strong>g for COVID<br />
patients. With assistance, nurses may be able<br />
to <strong>in</strong>corporate their experiences for their own<br />
growth and to help others. Management <strong>in</strong><br />
health care sett<strong>in</strong>gs can also be <strong>in</strong>strumental<br />
<strong>in</strong> car<strong>in</strong>g for nurses <strong>in</strong> the workplace. But, for<br />
those who cannot overcome the result<strong>in</strong>g<br />
effects <strong>of</strong> moral <strong>in</strong>juries, there is hope that<br />
counsel<strong>in</strong>g and/or mobile apps may be useful<br />
tools for a brighter future.<br />
Donna J. Craig, RN, JD, is legal counsel to the<br />
ANA-Michigan Chapter and the Michigan Council<br />
<strong>of</strong> Nurse Practitioners. She practiced as a cardiac<br />
care nurse for several years before a chance<br />
opportunity to audit a graduate course <strong>in</strong> health<br />
care law and ethics changed her career path. That<br />
course propelled her to earn her law degree. After<br />
law school, Ms. Craig jo<strong>in</strong>ed a medical malpractice<br />
defense law firm before transition<strong>in</strong>g her focus<br />
to health care corporate and adm<strong>in</strong>istrative law<br />
matters. For over 20 years she has ma<strong>in</strong>ta<strong>in</strong>ed her<br />
private health law practice, represent<strong>in</strong>g health<br />
care providers and facilities <strong>in</strong> bus<strong>in</strong>ess, licensure<br />
and compliance matters. For her expertise and<br />
accomplishments, Detroit’s dbus<strong>in</strong>ess Magaz<strong>in</strong>e<br />
awarded Ms. Craig its Top Lawyer <strong>in</strong> Health Care<br />
Law award on three occasions. Ms. Craig has the<br />
dist<strong>in</strong>ction and is proud <strong>of</strong> be<strong>in</strong>g a bar member<br />
<strong>of</strong> the Supreme Court <strong>of</strong> the United States <strong>of</strong><br />
America. For more <strong>in</strong>formation about The Health<br />
Law Center, go to www.healthlawcenterplc.com.<br />
1 COVID Data Tracker, Centers for Disease Control<br />
and Prevention; https://covid.cdc.gov/covid-datatracker/#datatracker-home<br />
2 Id.<br />
3 What is Moral Injury, The Moral Injury Project, Syracuse<br />
University; www.moral<strong>in</strong>juryproject.syredu/aboutmoral-<strong>in</strong>jury/<br />
4 Id.<br />
5 Barnes, H. et.al. 2016. Moral Injury and PTSD: Often Cooccurr<strong>in</strong>g<br />
Yet Mechanistically Different, Psychiatry<br />
Onl<strong>in</strong>e, (2016); https://neuro.psychiatryonl<strong>in</strong>e.org/<br />
doi/10.1176/appi.neuropsych.19020036<br />
6 Id.<br />
7 Id.<br />
8 Burnout, Psychology Today; https://www.<br />
psychologytoday.com/us/basics/burnout<br />
9 Norman, S.B., Maguen, S., Moral Injury, PTSD:<br />
National Centers for PTSD; https://www.ptsd.va.gov/<br />
pr<strong>of</strong>essional/treat/cooccurr<strong>in</strong>g/moral_<strong>in</strong>jury.asp<br />
10 Moral Injury, Psychology Today, https://www.<br />
psychologytoday.com/us/basics/moral-<strong>in</strong>jury<br />
11 Id.<br />
12 Equipp<strong>in</strong>g Individuals, Leaders, & Organizations Fac<strong>in</strong>g<br />
Challenge and Change, The Resilience Resource, https://<br />
theresilienceresource.org/moral-<strong>in</strong>jury/<br />
13 Held, P., Klassen, B.J., Brennan, M.P, Zalter, A.K, Us<strong>in</strong>g<br />
Prolonged Expressive and Cognitive Process<strong>in</strong>g Therapy<br />
to Treat Veterans with Moral Injury Based PTSD: Two Case<br />
Examples, National Library <strong>of</strong> Medic<strong>in</strong>e, (2017) https://<br />
www.ncbi.nlm.nih.gov/pmc/articles/PMC6103315/<br />
14 Farmsworth, J.K., Drescher, K.D., Evans, W., & Walser,<br />
R.D. (2017) A Functional Approach to Understand<strong>in</strong>g<br />
and Treat<strong>in</strong>g Military-Related Moral Injury, Journal <strong>of</strong><br />
Contextual Behavioral Science, 6(4), 391-397 (2017);<br />
https://www.sciencedirect.com/science/article/abs/pii/<br />
S2212144717300601<br />
15 Gray, M.J., Schorr, Y., Nash, W, Lebowitz, L., Amidon, A.,<br />
Lans<strong>in</strong>g, A., Maglion, J.< Lang, A.J., & Litz, B.T. Adaptive<br />
Disclosure: An Open Trail <strong>of</strong> a Novel Exposure-Based<br />
Intervention for Service Members with Combat-Related<br />
Psychological Stress Injuries, Behavior Therapy, 43(2,<br />
407-415, (2012); https://doi.org/10.1016/j.beth.2011.09.001<br />
16 Harris, J.K., Usset, T., Voecks, C., Thuras, P., Currieer,<br />
J., & Erbes, C., Spiritually Integrated Care for PTSD:<br />
A Randomized Controlled Trial <strong>of</strong> “Build<strong>in</strong>g Spiritual<br />
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