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 />


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 />


ANA-Michigan<br />

2501 Jolly Road, Suite 110<br />

Okemos, <strong>MI</strong> 48864<br />

517-325-5306<br />

nurse@ana-michigan.org<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 />


“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 />



<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 />


Registered Nurse - Community Liv<strong>in</strong>g Center<br />

(Geriatric and Extended Care)<br />

Registered Nurse Specialty Care<br />

Licensed Practical Nurse - Primary Care<br />

(Grayl<strong>in</strong>g, Cadillac, Oscoda, Traverse City)<br />

Licensed Practical Nurse - Specialty Care (Ortho, Pa<strong>in</strong>)<br />

RN Educator (Staff) Sag<strong>in</strong>aw<br />

1 RN Educator (staff) Gaylord and CBOCs<br />

1 RN Veteran Health Education Coord<strong>in</strong>ator (Veterans)<br />

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

Your Dream<br />

F<strong>in</strong>d<br />

Job Now!<br />

<strong>Nurs<strong>in</strong>g</strong><br />

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 />



AND<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 />


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 />

Strength”. Psychiatry Research, 267, 420-428, (2018);<br />

https://pubmed.ncbi.nlm.nih.gov/29980120/<br />

17 COVID Coach Mobile App; U.S. Department <strong>of</strong> Veteran<br />

Affairs; https://mobile.va.gov/app/covid-coach<br />

18 Provider Resilience Mobile App; Health IT Outcomes,<br />

(2013); https://www.healthitoutcomes.com/doc/<br />


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