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Non-Profit Org.U.S. Postage Paid

Princeton, MNPermit No. 14

Volume 80 • Number 1 • February, March, April 2020

Georgia NursingVisit us online at www.georgianurses.org

“Nurses shaping the future of

professional nursing for a healthier Georgia.”

Brought to you by the Georgia Nurses Foundation (GNF) and the Georgia Nurses Association (GNA), whose

dues-paying members make it possible to advocate for nurses and nursing at the state and federal level.

The Official Publication of the Georgia Nurses Foundation (GNF).Quarterly publication to approximately 58,100 RNs in Georgia.

Since 1907

GNA PRESIDENT’S MESSAGE CEO CORNERGNF PRESIDENT’S

MESSAGE

Is the Action Within Your Nursing Scope

of Practice? . . . . . . . . . . . . . . . . . . . . . . . 3

Ensuring Effective Communication with

Patients with Developmental Disabilities . . 4

Continuing Education . . . . . . . . . . . . . 6

Message from the APRN Director . . . . 7

Something is Missing . . . . . . . . . . . . 8

GNA Peer Assistance Program . . . . . 9

Ask a Nurse Attorney . . . . . . . . . . . . . . . 11

Is your Community Age-Friendly? . . . . . . 12

Quick Fixes for Budget-Blowing Mistakes . . .13

Membership . . . . . . . . . . . . . . . . . . . . 14-15

Calling for Appropriate Staffing . . . . . . . 16

Workplace Violence . . . . . . . . . . . . . . . . 17

Incivility in the Classroom . . . . . . . . . . . . 17

Year of the Nurse in 2020 . . . . . . . . . . . . 19

Index

What’s Coming Upat GNA

Richard Lamphier, RN

The World Health Organization has deemed 2020 the Year of the Nurse. 2020 marks the 200th birthday of Florence Nightingale and a brand-new upgrade for the Georgia Nurses Association .

GNA has the 2019-2021 Board of Directors in place, a newly approved strategic plan, and we are well equipped to draft off of the momentum of our past Boards . Membership is growing towards our goal of having twenty two percent of the 130,000 registered nurses in Georgia by the year 2022 . We are utilizing the hashtag #22by2022 .

As always, GNA will be advocating for nursing on your behalf 24/7 . We will be under the Gold Dome every day of the 2020 Legislative Session fighting for issues that include improving Patient Safety and Safe Staffing for nurses, eliminating barriers that prohibit nurses from practicing to the full extent of their education and training, and tackling harmful surgical smoke concerns for our Operating Room nurses .

You can rest assured that, once again, GNA will be there to stop any legislation seeking to hijack the title nurse . Nursing is consistently ranked the most trusted profession . This distinction has been earned

GNA President’s Message continued on page 2 GNF President’s Message continued on page 2 CEO Corner continued on page 2

Looking Forward…Wanda Jones, BSN, RN, MSN, FNP-BC

As your new president for the Georgia Nurses Foundation (GNF), I am looking forward to continuing Catherine Futch’s legacy of building a strong foundation for the nurses in the state of Georgia . I anticipate that the next two years will be exciting and demanding as we think outside of the box for ways to enhance the mission and goals of the GNF .

An important initiative of the Foundation is to provide scholarships to nursing students . In the past, the Foundation has awarded scholarships to deserving students on a bi-annual basis—it is my goal going forward to award scholarships annually and to increase the amount and number of scholarships given each year . You can help the Foundation reach this goal by your participation in our third annual GNF Golf tournament, to be held in the Spring of 2020 . This annual event provides the funds needed to award these highly competitive scholarships . Additionally, we anticipate holding a second fundraising event—a walk/run in the Fall of 2020 .

Another Foundation initiative is our Peer Assistance Program (GNF-PAP) . This program offers nurses the opportunity to turn their life around, have access to support for recovery from substance use disorder, and preserve their employment .

Georgia Nurses Association and Matchwell form

PartnershipMatt Caseman, GNA CEO

“Empowering Georgia Nurses to Lead Change and Improve Health” is our new mission statement agreed upon at our Strategic Planning Meeting over the Summer . Much thought and deliberation went into its development and here at the Georgia Nurses Association, we are working every day to fulfill that mission .

One way to do this is by providing solid, valuable services that empower Georgia’s nurses, which is why we are excited to announce our partnership with Matchwell .

We all know about burnout in the profession, and how it is contributing to the state’s nursing shortage . Today’s nurses:

• Feel overworked

• Do not enjoy their job as much

• Don’t have enough time with the patient

• Must do too much paperwork

• Or they simply want something new

Page 2 • Georgia Nursing February, March, April 2020

GEORGIANURSING

Volume 80 • Number 1

Managing Editor: Charlotte Báez-Díaz

GEORGIA NURSES FOUNDATION BOARD OF TRUSTEESWanda Jones, President

Elizabeth “Beth” Bolton-Harris, Vice President Alicia Motley, SecretaryShawn Little, Treasurer

Catherine Futch, Immediate Past PresidentGeorgia W . Barkers, Member

Mary Gullate, MemberDina Hewett, MemberGerald Hobbs, Member

Richard Lamphier, MemberSherry Sims, Member

Matt Caseman, Ex-Officio Member

GEORGIA NURSES ASSOCIATION BOARD OF DIRECTORSOFFICERS:

Richard Lamphier, PresidentDina M . Hewett, President-Elect

Barbara Austin, SecretaryRachel E . Myers Treasurer

DIRECTORSPhyllis Wright, Director Leadership DevelopmentPaula Tucker, Director Membership Development

Erica Mills, Director Legislation/Public Policy Linda Morrow, Director Staff Nurse

Joy King-Mark, Director Nursing Practice & Advocacy Molly Bachtel,

Director Advanced Practice Registered Nurse

ADMINISTRATIONMatt Caseman, CEO

Tim Davis, Senior Director of Membership andGovernment Affairs

Charlotte Báez-Díaz, Communications ManagerMonica R . Dennis, Administrative Assistant

W . L . Clifton Political Consulting, GNA Lobbyist

For advertising rates and information, please contact Arthur L . Davis Publishing Agency, Inc ., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081 . GNF and the Arthur L . Davis Publishing Agency, Inc . reserve the right to reject any advertisement . Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement .

Acceptance of advertising does not imply endorsement or approval by the Georgia Nurses Foundation of products advertised, the advertisers, or the claims made . Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use . GNF and the Arthur L . Davis Publishing Agency, Inc . shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product . Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of GNF or those of the national or local associations .

Georgia Nursing is published quarterly every February, May, August and November for the Georgia Nurses Foundation, a constituent member of the American Nurses Association .

GNA/GNF3032 Briarcliff Road, Atlanta, GA 30329

www .georgianurses .org, gna@georgianurses .org(404) 325-5536

FOLLOW GNA@georgianurses

facebook.com/ganurses

@GeorgiaNurses

Georgia Nurses Association

through the work of treating patients for over 100 years . Nurses treat humans, period .

With that said, join us for our Day at the Capitol in February . Your presence will help us continue the momentum of unifying Georgia’s Nurses and promoting our adopted Legislative Platform to state lawmakers . This annual event is vital to making our voices heard loud and clear to the critical decision makers in the state .

Providing quality learning opportunities is a top priority as well and those on the horizon for 2020 are diverse in topics and locations . One example, in the Spring GNA is planning to have our post legislative debriefing conference in Savannah in order to begin reaching more areas of the state and showcase our government affairs operation . We have also renewed our goal to be the preferred approver of CE activities which allows us to offer the contact hours nurses need annually . Please visit our website to learn about our upcoming events (www .georgianurses .org) .

We have also entered into a partnership with the American Red Cross, providing their suite of Basic Life Support (provider, Instructor), Advance Life Support and Pediatric Advanced Life Support, thereby delivering valuable educational opportunities throughout the year . Additionally, the Georgia Nurses Foundation’s Peer Assistance Program (GNF-PAP) has an approved presentation on Substance Use Disorder in Nursing available for Nurse Administrators and Educators .

Our advocacy efforts at the Capitol, learning opportunities to gain contact hours, and implementation of our strategic plan, adheres to our new stated Mission, Vision and Values which is:

Our Mission: Empowering Georgia nurses to lead change and improve health .

Our Vision: To be the prominent association in Georgia transforming health through advancing the practice and profession of nursing .

Our Values: GNA L .E .A .D .S . through: Leadership / Excellence / Advocacy / Diversity / Service

To say the least, we are excited and enthused about GNA’s new direction, and believe it coincides perfectly with 2020 being the “Year of the Nurse .” Please join us for what is sure to be a great year!

GNA President’s Message continued from page 1 GNF President’s Message continued from page 1

Unfortunately, this program continues to grow as more nurses seek assistance . The Foundation hopes that increased fundraising initiatives including new grant opportunities will ensure that every nurse seeking help will receive it .

I am looking forward to serving as your President for the next two years and am excited about the strong partnership between the Georgia Nurses Foundation and the Georgia Nurses Association (GNA) . As the charitable arm of the GNA, the Foundation hopes to improve the lives of nurses through professional education and scholarship opportunities, as well as enhance the visibility and dedication of the nursing profession in the state of Georgia .

This is not a one-person job—advancing our profession can only be done if we all participate . You can participate in many ways:

• Attend a fundraising event

• Take a CE class

• Join the Georgia Nurses Association

• Make a donation to GNF

• Nominate a deserving student for scholarship

• Network with other nurses through the website and social media pages

So let’s leap forward in 2020 toward a bright and healthy future .

So how can we help? Well, imagine being able to access an online clinician marketplace, specifically for nurses, and having the ability to choose when and where YOU want to work, that best fits YOUR schedule, and YOUR desire for a true work life balance .

Matchwell is an innovative cloud-based marketplace powered by recruiting experts who pre-qualify facilities and clinicians to create ideal matches . No middleman – only healthcare facilities and clinicians dealing directly with one another on their own terms .

You can “store and manage your credentials for free, set your preferred pay rate, and communicate directly with hiring managers . No agency middleman – just a better way to work .”

Better yet, there is no cost to you . Matchwell launched in the metro-Atlanta area in

March of 2019 and is quickly expanding its footprint across Georgia . We believe in its mission which is “…to save the healthcare industry one billion dollars by revolutionizing the way facilities and clinicians come together for flexible work,” according to Robert Crowe, founder and chief executive officer at Matchwell .

A few reasons to join include:

1 . It’s 100% free for nurses and only takes seconds to start your account .

2 . You can store and manage your credentials at no additional cost .

3 . You get access to all opening and shift types – from per diem to full time .

4 . You can directly communicate with hiring managers in the platform .

5 . You have the ability to select the jobs that work for you based on your schedule and preferred pay rate .

6 . Every match made results in a vaccine being donated to someone in need .

7 . Healthcare facilities can easily connect with flex work clinicians in order to fill openings and care for more patients .

8 . By removing the middleman, we can save the healthcare industry $1 billion in agency fees .

9 . This is your chance to be part of the solution that is revolutionizing the way healthcare work happens in order to positively impact millions .

We are excited about this partnership because this is one way we can “Empower Georgia Nurses to Lead Change and Improve Health .”

Learn more and join for free at wematchwell .com/gna .

CEO Corner continued from page 1

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February, March, April 2020 Georgia Nursing • Page 3

Resilient Nurses: Resilient SystemsTim Cunningham, RN, DrPH, FAAN

What keeps you in the game? What keeps you bouncing back? What do you do and what can health systems do to better support you, your unique, wise and courageous self? How do you stay resilient?

Activist and renown author, Audre Lorde once wrote: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare” (1988) . Think about the hospitals in which you work, and I’d argue that they’re likely not the most efficient, nor best designed for your own well-being . Literature on burnout—a rising tide among nurses and physicians across the U .S .—tells us that the systems in which we work do not inherently provide the human support we need to be our best selves and to do our jobs well (Liu et al ., 2018) . Consider those times that you’ve really needed to take a break, but your unit was short-staffed, or you didn’t feel safe leaving your patient in the hands of someone else . Consider all of the 30-minute lunches that you’ve sacrificed because you were just too busy . I’ve been there many times—and it’s exhausting . Evidence tells us that this kind of non-stop workload, in addition to new technology requirements (think of all the clicking you have to do in the Electronic Health Record), and our ever-increasing ability to keep patients alive (though perhaps to the detriment of their own well-being) can combine to lead towards our own deleterious health outcomes, and saddest of all, in some cases, the deaths or suicides of nurses (Davidson et al ., 2019) . Burnout is nothing new to nurses, nor is stress . But we need to—and we can—change some things to better support ourselves and each other .

Building resilience requires a two-sided approach . Panagiotti et al . (2017) tell us that it takes an individual-focused approach concurrent with a systems-level approach . Practices like exercise, prayer, meditation, spending time with loved ones and good sleep hygiene are all excellent forms of individual self-care and resilience building . Leaders in healthcare, like me, are also tasked with examining our work cultures to find ways to improve on staffing, time off for our colleagues, decreasing the burden of the EHR and improving patient flow . And both of us, clinicians and administrators, can rely on the wisdom of mentors who have been in this field for decades and have learned the critical and challenging balance of work and of life .

When I worked in emergency departments, full-time as a clinical staff nurse, I was only able to survive the stress by learning from nurses who stayed by my side, answered my questions and gave me support . This camaraderie keeps us all going . My new friend and mentor Florence Lansana, who is a nurse leader here at Emory, has reminded me that to be resilient, we should first remember why we chose to become a nurse—go back to that original inspiration, remember why you are here in the first place and rely on your mentors .

Literature and anecdote combine to tell us the many ways that we can remain resilient and be our best selves . It is for us to listen, at all levels of healthcare, to the needs of ourselves and others so that we can bring health . Self-care can make you more resilient, that much is clear . There is nothing indulgent about self-care then; it’s the best way that we can be ready to care for our patients with compassion and wisdom .

References:Davidson, J . E ., Proudfoot, J ., Lee, K ., & Zisook, S . (2019) . Nurse suicide in the United States:

Analysis of the Center for Disease Control 2014 National Violent Death Reporting System dataset . Archives of Psychiatric Nursing.

Liu, X ., Zheng, J ., Liu, K ., Baggs, J . G ., Liu, J ., Wu, Y ., & You, L . (2018) . Hospital nursing organizational factors, nursing care left undone, and nurse burnout as predictors of patient safety: A structural equation modeling analysis .  International journal of nursing studies, 86, 82-89 .

Lorde, A . (1988) . A burst of light: Essays. Firebrand Books .Panagioti, M ., Panagopoulou, E ., Bower, P ., Lewith, G ., Kontopantelis, E ., Chew-Graham, C ., . . . &

Esmail, A . (2017) . Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis . Jama internal medicine, 177(2), 195-205 .

Is the Action Within Your Nursing Scope of Practice?

Janice J. Izlar, DNAP, CRNAPresident, Georgia Board of Nursing

janiceizlar@gmail.com

Have you ever been asked by your employer to perform a task and you question if the task is within your nursing scope of practice? How did you handle the situation? You might be surprised to learn as President of the Georgia Board of Nursing questions related to scope of practice are the most frequently asked by nurses and nursing employers . The Board has a standard response, “The Board does not provide legal advice regarding specific scope of practice questions . Please visit the Board’s website and view the Scope of Practice Decision Tree . When used in conjunction with Georgia Law and Board Rules most individuals are able to answer their questions easily .”

However, many times when I provide the standard response, I receive the comment, “I tried that and cannot understand the document or how to answer the questions .” Because of this frequent occurrence, the Board decided to retool the document to assist nurses and nursing employers in defining nursing scope of practice in their facility .

Nursing is a dynamic, ever-changing practice . Because each nurse has a different background, knowledge, and level of competence, it is up to each individual nurse to use sound judgment when deciding whether or not to perform any particular activity, task, procedure, role or intervention .

First, the nurse should identify the activity, task, procedure, role or intervention under consideration . Next, ask if the activity is prohibited by the Georgia Nurse Practice Act, O .C .G .A . §43-26-3(6), (7), (8), Board Rule Chapter 410-10 Standards of Practice and Unprofessional Conduct, or any other law, rule, guideline or position statement . If the action is not prohibited by law, the nurse should ask if there is a valid order, if it is consistent with current facility policies, if it is supported by evidence-based practice, and if he or she has the competence to perform the action .

The Board’s revised Scope of Practice Decision-Making Model includes seven questions in common language to guide the process . The model is designed to be used in sequence, beginning at the top with question number one . Reflective questions are asked and, depending on how they are answered, the nurse is directed to continue to the next question or stop . At any point, if a nurse reaches a Stop Sign, he or she should consider the activity in question beyond his or her scope of practice .

Furthermore, the Board added explanations, lists of examples and links to documents and resources for each of the questions to assist in understanding and answering the questions . This is not the only model to determine a nurses’s scope of practice and presented only as a helpful tool . A nurse always has a duty to ensure safe patient care . One of the most important actions a nurse can take toward fulfilling that responsibility is making sure that he or she only accepts nursing assignments that are consistent with his or her education, experience, knowledge, training, skill competencies, and physical and emotional abilities .

The revised Georgia Board of Nursing Scope of Practice Decision-Making Model will be available on the Board’s website, https://sos .ga .gov/index .php/licensing/plb/45, under Laws, Rules and Policies . Please take a look and let us know what you think .

Page 4 • Georgia Nursing February, March, April 2020

Ensuring Effective Communication with Patients Who Have Developmental Disabilities

Georgia Reiner, Risk Specialist, Nurses Service Organization

It has been well documented that people who have developmental disabilities, such as Down syndrome or autism spectrum disorder, face significant barriers to health care . These include financing, access to culturally and clinically appropriate care, and inadequate communication between the patient and their health care providers .1 Poor communication can lead to failure to get regular health screenings, poor management of chronic diseases, failure to take medications as prescribed, and other potentially harmful outcomes . In addition to harming the patient and creating emotional distress for families and caregivers, nurses can find themselves the target of a licensing board complaint or legal action in certain cases . However, there are steps nurses can take to ensure their patients receive quality care .

Fulfilling legal and ethical responsibilitiesToo often, patients with developmental disabilities

may find that preventive services are neglected, and chronic diseases aren’t managed effectively . Such experiences are not consistent with health care providers’ legal and ethical responsibilities .

The Americans with Disabilities Act requires health care providers to ensure effective communication with patients who have disabilities; this includes providing services, such as translation or assistive

devices .2 If the patient’s caregiver has a disability or language barrier that affects communication, health care providers must provide services or assistive devices to the caregiver .

Nurses should also understand their ethical responsibilities when caring for patients with developmental disabilities . Provision 1 of the American Nurses Association’s Code of Ethics for Nurses states: “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person .”3 By being knowledgeable on how to effectively communicate with patients who have developmental disabilities, and practicing different communication strategies, nurses can become more confident and provide patient-centered care .

Assessing communication skillsNot every patient who has a developmental

disability has communication challenges . Start by determining if the patient has speech, hearing, or vision impairments that will make communication challenges more likely . Keep in mind that patients may have stronger receptive, or understanding, communication skills than expressive skills, or vice versa .4 For example, patients’ expressive speech might seem to indicate they understand what you’re saying when, in fact, they are having difficulty processing auditory information .

Based on your assessment, establish the patient’s communication strengths and challenges and tailor your approach . Be sure to document preferences in the patient’s health record so that the information is accessible to all members of the team .

Communication basicsOne resource, the “Health Care for Adults with

Intellectual and Developmental Disabilities Toolkit for Primary Providers” identifies several goals for communicating effectively and provides tips for achieving each one .4 Below are some of the goals, along with sample tips .

• Establish rapport. Speak directly to the patient and avoid talking to an adult as if he or she were a child .

• Choose appropriate language. Use concrete words and avoid medical jargon . Nurses must make their messages and instructions clear-cut and specific to avoid confusion . For example, ask “Are you tired?” instead of “How do you feel?”

• Listen. Allow enough time to listen and understand that interactions will likely take longer . Know that differences in muscle tone for some patients may complicate reading their facial expressions or body language, so validate your perceptions .

• Use non-verbal communication. Show your patient the equipment you’re going to use and give demonstrations showing what a patient can expect . Illustrations, photos, or other visual aids may help convey your message .

• Focus on your patient’s abilities. Despite the challenges your patient may face, it’s important to have a positive outlook on the things they are capable of and emphasize their strengths .

Working as a teamPatients who have developmental disabilities

deserve the best possible care from health care providers . Nurses are only one segment of the interprofessional team, but they are frequently the strongest patient advocate . Through thoughtful communication and collaboration with the health care team, patients, and their caregivers and family members, nurses can gain more confidence with caring for patients who have developmental disabilities and achieve the goal of optimal care and outcomes .

References1 . Krahn GL, Kelin Walker D, Correa-De-Araujo

R . Persons with disabilities as an unrecognized health disparity population . Am J Public Health. 2015;105(S2):S198-S206 .

2 . Dunlap, JJ . Interacting with individuals on the autism spectrum . Am Nurs Today. 2018;13(4);

3 . American Nurses Association . Code of ethics for nurses with interpretive statements . https://www .nursingworld .org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/ . Published 2015 . Accessed October 15, 2018 .

4 . Surrey Place Centre . Health care for adults with intellectual and developmental disabilities: toolkit for primary care providers . Communicating effectively . Adapted for use in the US by the Developmental Disabilities Health Care E-Toolkit Project . Vanderbilt Kennedy Center for Excellence in Developmental Disabilities website . https://vkc .mc .vanderbilt .edu/etoolkit/general-issues/communicating-effectively/ . Published 2011 . Accessed October 15, 2018 .

Georgia Reiner, Risk Specialist, Nurses Service Organization, Healthcare Division, Aon Affinity, Philadelphia. Phone: (215) 773-1178. Email: Georgia.Reiner@aon.com.

This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for more than 550,000 nurses since 1976. Georgia Nurses Association (GNA) endorses the individual professional liability insurance policy administered through NSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an email to service@nso.com, call (800) 247-1500, or visit www.nso.com.

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February, March, April 2020 Georgia Nursing • Page 5

To Lead Well, One Must Lead Themselves FirstPhyllis Wright

Georgia Board of NursingEmory University

As the new director of leadership for GNA, sharing my personal philosophy of leadership is something I owe you . I truly believe leadership is a skill . It can be learned, refined and perfected . True there are some traits of a charismatic leader that one who has a more introverted personality will quite likely not display, but every one of us is a leader and an influencer . Our leadership spheres of influence may differ, but the potential to expand this dynamic force within us, and collectively among us is yet to be maximized .

Before you or I can lead others, we must lead ourselves . We must, as individuals, discover our “why .” As Simon Sinek proposes in one of the most highly rated TED talks ever presented, “How Great Leaders Inspire Action,”1 the Golden circle of why, what and how can serve as our guiding light . Why we do what we do is at the center of everything—every decision we make, every action we undertake and even every

thought we may think . What is my WHY? Why I am here; why do I do what I do; why do I love whom I love; why am I a nurse? This why drives our actions for an organization, a business, a product and by discovering your why, your sphere of leadership influence begins to clear and come into focus . Thus, my ask of you is to spend some time this year, examining your why, and develop a clear and articulate answer to your “why” personally .

The second work self-leadership, after clarifying your why, is to develop the foundation upon which you will build leadership skill and expand your leadership influence . Identifying one’s individualized and inherent strengths develops insight that fosters growth for self-awareness, self-knowledge, and self-direction . Multiple venues (audio, books, online) offers opportunity of inter personal and intra personal inventory discoveries known as strengths finders . There are formal books (short and sweet) that explain these results, and online applications that give an overview of where one stands in their talents and gifts of internal strengths as they apply to leadership and influence .

The third work of self-leadership is to recognize one’s current status as leader . It may not be in the official positional sense, but each one of the Georgia nurses represented by GNA are first and foremost servant leaders . We are identified as the most trusted profession and have earned that trust position from

our dedicated service to others . A servant leader is one who “enriches the lives of individuals, builds better organizations and ultimately creates a more just and caring world .”2 What nurse doesn’t, on a daily basis, with her dedication to her patients, students, children, neighbors enrich their lives through a caring touch, a timely medication, a listening ear, or a well spoken word . The vulnerability we witness with our patient populations in birth, illness, recovery and death and the desire we hold enrich their lives in these spaces truly represents the servant leadership we offer in our licensure roles .

As your newly elected voice of leadership development I want to be an even greater servant leader, to empower you personally and professionally . As 2020 has been officially declared the “Year of the Nurse,” may we journey together to collectively expand our connected circles of influence not with a simply loud voice but an influential one for patients, facilities, communities, and our nation .

References1 Sinek, Simon . Ted Talks, Puget Sound (March 10, 2014) .

How great leaders inspire action . Retrieved from: https://www .ted .com/talks/simon_sinek_how_great_leaders_inspire_action/up-next?language=en

2 Greenleaf, Robert K . (1970) The Servant Leader . The Center for Servant Leadership . Retrieved from: https://www .greenleaf .org/what-is-servant-leadership/

The Atlanta VA Has a Permanent Nurses Week Planning Group!

The Associate Director of Patient Care Services, Dr . Connie Hampton, is proud to announce the Atlanta VA Health Care System (AVAHCS) has a permanent Nurses Week planning group named the “Atlanta VA Nurses Week Squad!” These nurses are the core leaders for the strategic planning and logistics in producing Nurses Week activities . The Squad includes nurses who

Meet the “Atlanta VA Nurses Week Squad

Left to Right: Christi Laurent, Ruth Thomas-Nance, Deborah Gill, Connie Hampton, Esohe Osaghae (Grace), Kenya Barbour, Lyn Brown, Chanda Harrison

worked together on Nurses Week 2018, are full time Atlanta VA employees .

The Squad includes representation from the education department: Chanda Harrison and Christi Laurent; outpatient services: Esohe (Grace) Osaghae, Ruth Thomas-Nance, and Deborah Gill; inpatient and night shift: Lyn Brown . The squad is the brain-child of

the Chairperson, Lyn Brown, a seasoned event planner who spearheaded Nurses week 2018 to a phenomenal success! Ms . Brown identified evidenced-based practice for a successful Nurses Week starts with a fixed cohesive planning group versus each year returning to the drawing board with hope for compatibility with new people . The members of the Nurses Week Squad are quick to point out it is the volunteer operators, and the diverse department consultants in the AVAHCS that make Nurses Week a whooping success! The Squad considers the operators all employees that pitch in to help, not just the nursing staff that improves the morale in the entire AVAHCS . With Dr . Hampton as the facilitator the Nurses Week Squad has been instructed to “think outside the box” for innovations and creativity to enhance every year . The Squad will be gathering all talents, including but not limited to: entertainment (singing, dancing, musical instruments, and comedy acts), crafts (big things and small things, foodies (cooking, sample presentation, catering), especially those who just want to help wherever needed . Recruitment events for volunteers are now being planned for Nurses Week 2020!

The Point of Contact is Lyn Brown via email lyn .brown@va .gov . Please use subject title Nurses Week Squad .

Page 6 • Georgia Nursing February, March, April 2020

CONTINUING EDUCATIONLynn Rhyne, MN, RNC-MNN, Nurse Peer Review

Leader and Primary Nurse Planner GNA

GNA Nursing Continuing Professional Development Units (NCPDU) is now comprised of an Accredited Approver Unit and an Approved Provider Unit for continued professional development activities for our stakeholders in Georgia . We take these responsibilities very seriously to ensure nurses are provided opportunities for professional growth .

In the months to come, many opportunities exist to support professional development activities that focus on the identified cause for the month . February is American Heart Month, March is Red Cross month, April is Sexual Assault Awareness Month and April 16 is National Stress Awareness Day . Let us know what we can do to support these causes!

The Approved Provider Unit has developed several professional development activities to provide much needed information for nurses and healthcare organizations in Georgia . Sherry Sims and Barbara Austin have updated the Peer Assistance Program to promote awareness of the importance of recognizing

Substance Abuse Disorders in our population . Christopher “Chase” Carey will be providing a series of offerings for Stressed Nurses to assist them to develop techniques to reduce their own stress levels so they can provide better care to their patients . Jarvis Gray continues to provide the Lean Six Sigma professional development activity to support our healthcare leaders with their administrative duties .

I will be circulating a Learning Needs Assessment to assess our stakeholders’ professional development needs . If you don’t receive one, please email me and I will send one to you . It is important for the Nursing Continuing Professional Development Unit to know what you need so we can ensure we are providing it .

I have been providing educational offerings to healthcare organizations outside Atlanta since we know not everyone lives in the Metro Atlanta area . I will be developing activities focusing on Incivility and Bullying in the Workplace and Suicide in Nurses . I am willing to provide these professional development activities for your organization or chapter . Please let me know what you feel you need to support your own practice . The NCPDU would also like to start developing webinars

and/or Zoom presentations for certain educational activities so the activities are available to provide contact hours for nurses via different modalities .

I am looking forward to becoming more visible to nurses within the state as I provide professional development activities to support our stakeholders . Please don’t hesitate to contact me via email .

GNA wants to become the premier association in Georgia transforming health through advancing the practice and profession of nursing . Our new mission is to empower Georgia nurses to lead change and improve health . We achieve this by leadership, excellence, advocacy, diversity and service . To promote change, we must become involved in our association and participate in professional development activities .

What can the Nursing Continuing Professional Development Units do the make you become a power and voice in the state to effect change and promote better patient outcomes while supporting each other as we travel this path to excellence? We are here for you .

My email is rhynelynn@yahoo .com or ce@georgianurses .org . If you have a need let me know .

February, March, April 2020 Georgia Nursing • Page 7

Molly Bachtel, APRN, DNP, FNP-CAPRN Director, Georgia Nurses Association

Let me not mince words here . Georgia needs to move towards becoming a Full Practice Authority (FPA) state . Now your state legislator may not know what FPA means exactly, so better to simply communicate we need to “remove barriers to APRN practice” to stakeholder . Is this a “mission impossible?” No, it is not! We just need to reach a tipping point of APRNs willing to advocate . While Georgia certainly has a small and mighty group of passionate nurses who have dedicated many hours, days, months, and years to these efforts, we need many more nurses, and family and friends of nurses to take the time to connect with their legislators .

Now to be honest, I just have to shake my head a bit when a Georgia APRN complains to me about Georgia’s restrictive practice environment, who also admits, they have never actually reached out to their own State Senator or State Representatives to introduce themselves . Introducing yourself with a hand written note, a phone call or an email only takes a few minutes, Of course an in person meeting at the Capitol, or in the home district takes a bit longer, but not by much . We do need to personally reach out and mention the direction we would like our state to move in by modernizing outdated APRN practice laws . You can go to www .openstates .org to look up your Georgia legislators . You can invite your Georgia legislators to your practice or to your local APRNs professional meetings .

MESSAGE FROM THE APRN DIRECTORSo after you muster up your courage to actually

reach out, what do you say? This is the easy part . It is easy, because the facts are on our side for removing barriers . Simply bring a copy of one of the numerous landmark white papers that call for removing barriers . You could bring one or all of the following:

• The U .S . Department of Health and Human Services, U .S . Department of the Treasury, U .S . Department of Labor report entitled ‘Reforming America’s Healthcare System through Choice and Competition” (2018)

• Georgia Watch  Report:  “Perspectives on Advanced Practiced Registered Nursing in Georgia” (2015)

• Federal Trade Commission “Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses” (2014)

• National Governors Association Report “The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care” (2012)

There are several items that could come up in the current legislative session that started a couple weeks ago for which you could request support . There are bills in play (list bill numbers) introduced last year, that if passed as introduced, would remove the current restrictions on APRNs ordering advanced radiological imaging (such as CTs and MRIs) . Georgia is the only state in the country imposing this barrier on APRNs . Be sure to reach out and tell your legislator any personal stories of how this barrier has caused delays in care for your patients . Two study committees (SR 202) Evaluating and Simplifying Physician Oversight of APRNs and PA and (HR 589) Maternal Mortality wrapped up late in the fall and

legislation . APRNs need to stay tuned for calls to action on any potential legislation arising from committee final recommendations .

In closing let me say, if you are a NP, CNM, CNS, CRNA, a current Georgia APRN or a future/aspiring APRN, I am here to serve you in the GNA APRN Director role . I have a deep appreciation for the fact that each APRN specialty has unique elements to their practice and also unique needs and possible issues to with their current practice environment in Georgia . In my term as APRN director, I will aim to connect APRNs leaders across the state by hosting GNA Roundtable meetings on a regular basis throughout the year, so that GNA can do an excellent job of representing APRN interests and offering valuable membership services that are needed and desired by APRNs of Georgia .

References: U .S . Department of Health and Human Services, U .S .

Department of the Treasury, U .S . Department of Labor . (2018) . Reforming America’s Healthcare System through Choice and Competition. Retrieved from https://www .hhs .gov/sites/default/files/Reforming-Americas-Healthcare-System-ThroughChoice-and-Competition .pdf

Georgia Watch  (2015) . Perspectives on Advanced Practiced Registered Nursing in Georgia. http://www .georgiawatch .org/wp-content/uploads/2015/01/APRN01072015WEB .pdf

Federal Trade Commission (2014) . Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses . Retrieved from https://www .ftc .gov/system/files/documents/reports/policy-perspectivescompetition-regulation-advanced-practice-nurses/140307aprnpolicypaper .pdf

National Governors Association Report (2012) . The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care. Retrieved from https://www .mag .org/georgia/UploadedFiles/nga-nurse-paper .pdf

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Page 8 • Georgia Nursing February, March, April 2020

Something is Missing…Tim Davis, Sr. Director of Membership &

Government Affairs

Team! Webster defines the term team as, “A number of persons associated together in work or activity .” This is how I view the nurses of Georgia . Undoubtedly, you are all connected by a shared commitment to providing the utmost quality care to patients, and to educating our community on the importance of making healthy choices and leading long healthy lives . Given that nursing is annually rated by American consumers as THE most trusted profession, it is evident that you are doing a great job of fulfilling this commitment .

We know that we can do more; more to educate, more to facilitate, more to propel the nursing profession forward in the state of Georgia and thereby to provide quality care and produce better outcomes for healthcare consumers . The fact is that nursing is very nearly the most populous profession in Georgia, second only to teachers . This begs a question; why is it that in a time when nurse numbers are so vast, we cannot secure more wins to advance the profession forward? The answer, on its face, is very simple- organization .

2020 will afford us another opportunity to participate in the electoral process in Georgia . During campaign season, candidates offer their

positions on a myriad of topics, one of which always includes healthcare . And while we are able to decide how said positions will or will not impact healthcare outcomes, we know that what is often absent from these positions are any reverence for the impact that nurses can play, much less, an official position of the advancement of the profession . What we are guaranteed to hear from candidates is a stance on education . A pointed and fully developed position on the teaching profession and the ways by which they plan to support teachers in doing the all too important job of educating our future generations .

The work of propelling an entire workforce population to the forefront of political discourse is not done overnight or even year to year . It requires resources, stability and most importantly the unwavering commitment of all vested parties, speaking in conjunction, early, often and repeatedly to push a shared narrative .

Teachers have mastered the art of political messaging by doing one thing at the individual level that does most to serve the interests of their profession . They join their professional organizations . They join early on in their careers and remain members even after they are retired . Even if they lack the time to participate fully in the discussions or take part in the advocacy work, they join! They join knowing that by doing so they are empowering those available, inclined and equipped to do the work of advocating with the much-needed resources that are required in order to be effective and secure wins for the whole of the profession. They have mastered the art of teamwork.

We at GNA, have a vision for the nursing profession in Georgia . We have a new Chief Executive Officer, a new President and a newly elected Board of Directors that are committed to acting upon the ideas prescribed in our newly minted strategic plan . I encourage you to watch all of the new and exciting offerings that are set to roll out during 2020, which is by the way, the year of the NURSE, as we work to increase the value of a GNA membership to you . With more of you in our ranks and as our messaging is allowed to coalesce, we will be prepared to force our positions on the forefront of the political discourse and take our rightful place as the second most populous profession in the state of Georgia .

As we seek to grow our team and increase our impact my hope is that you will consider joining the Georgia Nurses Association by visiting www .georgianurses .org . If you are a member currently, attend your local chapter meetings and consider completing the volunteer interest form on our website where you can define for us how you can best service our call, the option to join our legislative committee is there if legislative engagement is of specific interest to you .

I understand that there are many who, for whatever reason, may not be ready to join the association in a membership capacity . Consider visiting our website and contributing to the Georgia Nurses Political Action Committee (GN-PAC), GN-PAC contributions allow us to support political candidates that are friendly to nursing thereby ensuring that we can have as many champions under the gold dome as possible . Finally, I encourage you download to your mobile device an application called “EMPOWRD” and follow the Georgia Nurses Association, by doing so you will receive real time legislative updates from us as we do the work of advancing nursing legislation and will be afforded the opportunity to let your voice be heard in a manner that is easy and seamless for you .

It was the writer Thomas Merton that said, “The deepest level of communication is not communication, but communion . It is wordless . . . beyond speech . . . beyond concept .” GNA will remain committed to being the place where nurses can convene, commune, coordinate and collaborate . We hope that you will stand with us, knowing that the strength afforded to us as our numbers grow can and will be leveraged towards the advancement on nursing in Georgia .

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February, March, April 2020 Georgia Nursing • Page 9

Over 30 Years of Nurses Helping Nurses in GeorgiaGeorgia Nurses Association Peer Assistance Program

Edward Adams, MSN, RN, Immediate Past GNA Director of Nursing Practice & Advocacy

During the 1980’s nursing began to see movement at the state and national level to address the issue of nurses that were, at that time, termed “impaired .” Georgia was the first state to acknowledge the need to treat, support and retain nurses that had Substance Use Disorder (SUD) . The Peer Assistance Program (PAP) in Georgia has undergone many transformations during the last 30+ years . Both the Georgia Nurses Association (GNA) and Georgia Nurses Foundation (GNF) became involved in order to best accomplish the primary goal of helping nurses remain in the profession and support recovery efforts . Names and ways to achieve goals of the program would change over the years . However, the philosophy has remained constant since the official beginning of the Georgia Nurses Association Peer Assistance Program (GNA-PAP) . It has always been important to maintain a program of ‘nurses helping nurses’ while protecting the safety of patients under the care of nurses .

As the 1990’s began, the GNA–PAP expanded to cover much of the State . Nurses who completed the program, then called GNA Nurse Advocate Program, often wanted to volunteer to help colleagues with Substance Use Disorder . By the 2000’s the GNA-PAP continued to establish more groups across Georgia . For the first time, PAP volunteers attended the National Organization of Alternative Programs (NOAP) . Also, during this time period, Georgia implemented benchmarks to help evaluate the effectiveness of the program and ways to improve the program .

In the early part of 2010’s the GNA began the process of lobbying for mandatory reporting in Georgia . GNA-PAP also began to use a third-party administrator to provide support and assistance in tracking and with monitoring program compliance .  At the same time GNA-PAP established a fee schedule to help to offset the costs of the program . The intention was for program to be self-sustaining and have funds available to pay for staff to work as case manager(s) . In 2013 the Mandatory Reporting law passed the Georgia legislature, and during the next legislative session the Mandatory Reporting law was given a funded mandate and

went into effect on July 1, 2014 . This was an important step for helping to identify nurses that have Substance Use Disorder, to keep patients safe, and for the nurses to receive the help and support they need .

The next significant change occurred in 2018 when the GNA Board of Directors voted to allow Certified Addiction Councilors (CACs) to facilitate groups to increase group coverage of the state . This change to the program helped establish groups in underserved areas, especially in rural Georgia . Some areas in Georgia previously had no coverage and the nearest group was a one-way drive of more than two hours . Funds were made available to pay for a case manager and a relief case manager to help organize the intake and enrollment of new nurses into the program . In June of 2018 there were 13 groups led by 24 facilitators who provided services for 140 nurses . By August 2019 the program grew to 31 facilitators, and over 210 nurses enrolled in 31 groups .

SuccessesOne of the greatest successes for the GNA-PAP

program is that for the last several years we have a 96% successful completion rate among the nurses in our program . Consent orders in Georgia include five years of documented sobriety which is in line with national recommendations of three to five years (Strobbe & Crowley, 2017) . The use of a third-party administrator to assist with toxicology monitoring has helped to collect data and provide support on technical issues related to testing . The administrator also helps to provide the necessary documentations of the nurse’s recovery journey to the Georgia BON . As mentioned above, the mandatory reporting that went into law in Georgia in 2014 was a significant step forward in identifying nurses with Substance Use Disorder . Suzanne Alunni-Kinkle states that nurses are often enabled by their peers because colleagues do not want to report a nurse with SUD either out of loyalty or not wanting to be labeled a

Nurses Helping Nurses continued on page 10

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whistle-blower (2015) . The new law helps to make it clear that mandatory reporting is for the safety of patients and the nurse that might have SUD .

Georgia is fortunate that the professional organization (GNA) and the Georgia BON have a long history of collaboration . Since the inception of the GNA-PAP program, the Georgia Board of Nursing has been supportive of the program . The BON has presented at the annual GNA-PAP training and been available for questions .

In 2019 we were able to successfully lobby to have a line item included in the state budget that will budget $150,000 annually to the GNA-PAP . These funds will help with program expansion and an education initiative to help educate current nurses and nursing students to the risks of SUD and available options for treatment and support .

ChallengesOne of the largest issues in Georgia, and

nationally, is a lack of education and knowledge about SUD in nursing and options available for nurses that have SUD (Stewart & Mueller, 2018) . According to statistics 10-15% of nurses have SUD . These numbers are the same as in the general population of the United States (Alunni-Kinkle, 2015) . In Georgia we have approximately 150,000 Registered Nurses, including ADN, BSN, MSN, and Doctoral nurses, which means that as many as 15,000-22,500 nurses may develop a substance use disorder . Currently there are less than 5,000 in treatment, which means many, many nurses are not getting the help and support they need . This places nurses and the patients they care for at risk .

Georgia has large geographic areas made up of rural counties so not every nurse has the availability of a group within an hour’s drive . Efforts are being made to expand the number of groups which will

ensure access to GNA-PAP groups for more nurses . Some participants of the GNA-PAP program continue to drive over two hours one way to attend group meetings .

Prior to this year, lack of funding has also been a challenge for GNA-PAP . There was a desire to educate nurses on the scope of the problem along with the resources that are available but without funding, there was little ability to reach large audiences within the nursing community . While that will change in the near future, it continues to be a challenge currently . In Georgia we do not have an Alternative to Discipline (ATD) model . Alternative to Discipline and Discipline are the two major models for nurses with SUD for addressing impaired practice or the diversion of drugs (Strobbe & Crowley, 2017) . Kunyk has stated that Discipline programs are not effective in the long-term recovery of a nurse and that Aftercare programs are more effective (2015) . Strobbe and Crowley went further to state that Alternative to Discipline programs with supervised monitoring are effective in the treatment of SUD and are a standard for recovery (2017) . However, due to lack of funding, an Alternative to Discipline (ATD) program has not yet been established . The GNA-PAP is hopeful that funding will be established and an ATD program created .

Looking to the FutureThe future could be said to be the seeds of

lessons learned from the past that are planted in the present . Throughout the years, the GNA-PAP has learned many valuable lessons which have facilitated improvement and growth of the program . Going forward, the PAP will continue to collaborate with nursing organizations and supporters to strengthen advocacy for an ATD program in Georgia . The GNA-PAP is on the precipice of implementing a statewide campaign to increase education for nurses and nursing students on the issue of SUD and available resources . The PAP program supports Tierney’s belief that education is the best way to change attitudes of nurses from a negative to a positive in general when dealing with individuals with SUD (2016) . There are plans to increase the number of support groups available for nurses which will further decrease the barrier of travel distance . As the number of groups increase, there is also an expectation that the number of facilitators will increase . New technology and a new generation of nurses make apps and online resources an area to explore in order to reach more tech savvy nurses and those in remote areas . There will also be more discussions with health systems across the state of Georgia to educate them on what GNA-PAP can do for nurses in their organization that have SUD .

ReferencesGeorgia Nurses Association/Foundation n .d . Retrieved from:

https://georgianurses .nursingnetwork .com/page/75651-gnf-peer-assistance-program

Alunni-Kinkle, S . (2015) . Performace potential . Identifying substance use disorder in nursing .  Nursing Management, 46(12), 53–54 . https://doi .org/10 .1097/01 .NUMA .0000473512 .38679 .ca

Kunyk, D . (2015) . Substance use disorders among registered nurses: Prevalence, risks and perceptions in a disciplinary jurisdiction . Journal of Nursing Management, 23(1), 54–64 . https://doi .org/10 .1111/jonm .12081

Strobbe, S ., & Crowley, M . (2017) . Substance use among nurses and nursing students: A joint position statement of the Emergency Nurses Association and the International Nurses Society on Addictions .  Journal of Addictions Nursing,  28(2), 104–106 . https://doi .org/10 .1097/JAN .0000000000000150

Stewart, D . M ., & Mueller, C . A . (2018) . Substance Use Disorder Among Nurses: A Curriculum Improvement Initiative .  Nurse Educator,  43(3), 132–135 . https://doi .org/10 .1097/NNE .0000000000000466

Tierney, M . (2016) . Improving nurses’ attitudes toward patients with substance use disorders .  American Nurse Today,  11(11), 6–9 . Retrieved from https://search .ebscohost .com/login .aspx?direct=true&db=ccm&AN=119394307

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February, March, April 2020 Georgia Nursing • Page 11

Putting Our Best Fork Forwardfor 2020

Joy King-Mark, DNP, MBA, APRN, NP-CGNA Director of Nursing Practice & Advocacy

joy.kingmark@gmail.com

As nurses, we often advocate for the health and wellbeing of our patients but how often do we stop and explore whether we are taking the proper precautions to ensure our own health and wellness? With February signifying American Heart Month and March being National Nutrition Month, it is important to highlight the significance of managing a healthy lifestyle for our patients as well as ourselves . Heart disease is the leading cause of death for men and women in the United States with someone experiencing a heart attack every 40 seconds (Morbidity and Mortality Weekly Report, 2019) . With increased awareness and education, we as nurses can work together to prevent conditions such as obesity and hypertension that lead to heart disease . Currently, the Centers for Disease Control (CDC) recommends making heart-healthy eating choices, such as consuming foods low in trans-fat, saturated fat, added sugar, and sodium (Centers for Disease Control, 2018) . Despite a 32 percent decrease over the past two decades, heart disease remains the primary cause of death in both men and women (Nutty, 2014) . As nurses, we have the opportunity to participate in health promotion outreach events and provide vital education to our patients and become role models of this behavior . Additionally, expanding our thought process from identifying risk factors to exploring why our patients engage in these behaviors will also help our future efforts of tailoring health promotion interventions . We can also demonstrate our dedication to heart health by participating in National Wear Red Day, which will be on Friday, February 7, 2020 .

March is National Nutrition Month and goes hand and hand with American Heart Month . It was first established in 1973 as an opportunity to share the importance of proper nutrition with patients and health care professionals (Beseler, 2017) . As nurses, we understand the role healthy diet plays to improve overall health, but it’s also our responsibility to educate patients on what eating well means . When we discuss nutrition with our patients, we should keep three determinants in mind: motivation, ability, and environmental opportunity (Brug, 2018) . The importance of social support and modeling of positive health behaviors are areas we can aid our patients in . When discussing health behaviors with my patients, I often utilize online resources such as the U .S . Department of Agriculture website (choosemyplate .gov) . There are numerous resources for healthcare providers with the ability to adapt information based on your patient population . Other considerations include identifying sources for availability and accessibility of healthy and less healthy foods as well as socioeconomic status are important for nutrition behaviors (Brug, 2018) . Remember to also seek out opportunities to collaborate with nutritionist and dietarian to further advocate for our patients and reduce poor health outcomes . Together we can improve our patient’s health as well as our own . We hold the tools to make 2020 our healthiest year yet . May this year bring happiness and health to our patients, their families, and our nursing profession .

Reference:American Heart Month - February 2019 . (2019) . MMWR . Morbidity And Mortality

Weekly Report, 68(5), 101 . https://doi-org .wgu .idm .oclc .org/10 .15585/mmwr .mm6805a1

Beseler, L . (2017) . Gradual Shift toward Healthier Eating Styles: National Nutrition Month . Journal Of The Academy Of Nutrition And Dietetics, 117(3), 345 . https://doi-org .wgu .idm .oclc .org/10 .1016/j .jand .2017 .01 .003

Heart Disease: It Can Happen at Any Age . (2018) . Retrieved from https://www .cdc .gov/features/heartmonth/index .html .

Brug, J . (2018) Determinants of healthy eating: motivation, abilities and environmental opportunities . Family Practice 25(1), 50–55, https://doi .org/10 .1093/fampra/cmn063

Nutty, A . (2014) . Nurses Support Heart Health . Alaska Nurse, 64(2), 12–15 . Retrieved from http://search .ebscohost .com .wgu .idm .oclc .org/login .aspx?direct=true&db=ccm&AN=107842412&site=eds-live&scope=site

Surrendering a License Due to A Board Investigation (December 2, 2019)

Dear Hahnah,

I was wondering about the effect of voluntarily surrendering my Georgia nursing license due to a discipline investigation. I heard that I could just surrender my license instead of going through the discipline process and get my license reinstated later.

Thanks, JDS

Dear JDS,

Based on your question, it seems that the Board has presented you with the option of voluntarily surrendering your license in lieu of license revocation . If this is the case, then you should understand that a with a voluntary surrender, you will surrender your license and the privilege to practice nursing in Georgia . Voluntary surrenders in Georgia have the same effect as a license revocation . A voluntary surrender and license revocation are considered disciplinary actions that are public information . They are permanent parts of your nursing record . The Federal Office of Inspector General (OIG) has discretion to exclude individuals when their license has been suspended, revoked, or surrendered for reasons bearing on professional competence, professional performance, or financial integrity. The OIG will send a letter first advising you that they are considering putting you on the OIG exclusion list . You will then have 30 days to write a letter explaining any mitigating circumstances and hopefully persuade them not to put you on the list . An attorney can help you with this process . If you do end up on this list, you have the right to appeal . The exclusion period will be for a certain amount of time .

Placement on the Federal OIG exclusion list will exclude you from working in any facility that receives funding from Medicare . In other words, OIG prohibits the facility from hiring anyone who is placed on the OIG Exclusion List in any capacity . Therefore, in reality, if you are placed on the OIG Exclusion List due to a surrendered or revoked licensed, you will very likely not be able to work in any capacity, with any license in any healthcare field because most hospitals, clinics and patient care facilities receive Federal Medicare funding or work with private insurance companies that require the facility to be eligible to receive the funding . Therefore, if you decide to surrender your license or if your license is revoked, you must respond to OIG’s letter within 30 days to try to avoid placement on the OIG Exclusion List .

In addition, voluntary surrenders will likely be reported to the National Practitioner Databank and the National Council of State Boards of Nursing Disciplinary Data Bank . These databanks are web-based repository of reports containing information on certain adverse licensure actions related to health care providers . Therefore, the surrendering of your license will very likely negatively impact your ability to obtain a healthcare license in other states and, it may negatively impact any other healthcare licenses that you hold in other states .

You are correct that the Board may reinstate a revoked or surrendered license at its sole discretion upon written request . If the Board decides to reinstate the license, it may impose disciplinary sanctions in doing so . Importantly, the Board’s denial of a request for license reinstatement is not considered a “contested case” meaning that you will not be afforded the opportunity to an OSAH hearing before an Administrative Law Judge . However, you will be allowed to appear before the Board if you request to do so . Therefore, reinstatement of your license is not guaranteed . In addition, the reinstatement process can be very long (up to five years in some instances) and expensive (attorney fees) .

The decision to surrender your license due to a Board professional discipline investigation is very serious and should not be taken lightly. Therefore, I highly advise that you make this decision in consultation with an attorney who practices professional license defense .

Best of luck JDS!Hahnah

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Page 12 • Georgia Nursing February, March, April 2020

Katherine Pope Scholarship Recipients 2019

The Georgia Nurses Foundation (GNF) awarded two Katherine Pope Scholarships of $1,000 this year .

Congratulations to Katherine Carruth and Adalynn Rath!

The Georgia Nurses Foundation and Georgia Nurses Association Nursing Scholarship Awards provide financial assistance to qualified applicants who may be enrolled full- or part-time in an accredited nursing program. Interested students must have a GPA of at least a 2.5 (undergraduate) or 3.0 (graduate) on a 4.0 scale in prior nursing education. For more information, visit GeorgiaNurses.org.

GNF NEWS

Katherine Carruth

Adalynn Rath

Is Your Community Age-Friendly?

Melissa Austin

An AARP survey1 shows that three out of four adults age 50 and older want to stay in their homes and communities as they age—yet many don’t see that happening for them . While 76% of Americans age 50 and older say they prefer to remain in their current residence and 77% would like to live in their community as long as possible, just 59% anticipate they will be able to do so, either in their current home (46%) or a different home still within their community (13%) .

When surveying adults 18 and older, similarities arose in what respondents valued in a community . While adults age 50 and older report greater frequencies of driving, and adults age 18-49 report greater frequencies of almost all other forms of transportation, both groups cited transportation as an important factor in their community .

Among all adults surveyed, street and sidewalk features that rank high in importance are well-maintained streets and easy-to-read traffic signs . When it comes to outdoor spaces and buildings, well-maintained and conveniently located hospitals and health care facilities and safe parks are features identified as the most important in the community .

We know that these are important components for a community, but are these features available where you live? Are your local elected officials working to ensure that the community meets the needs of its residents? One way in which AARP works to ensure these needs are met is through our Network of Age-Friendly States and Communities .

Employing standards established in 2007 by the World Health Organization, membership in AARP’s Network of Age-Friendly States and Communities means that a community’s elected leadership has made a commitment to actively work with residents and local advocates to make their town, city, county or state an age-friendly place to live .

AARP’s participation in the program advances efforts to help people live easily and comfortably in their homes and communities as they age and encourages older adults to take a more active role in their communities and have their voices heard . Initiatives focus on areas such as housing, caregiving, community engagement, volunteering, social inclusion and combating isolation among older citizens .

AARP works with local officials and partner organizations around the country to identify communities for membership in the Age-Friendly Network . AARP facilitates the community’s enrollment and guides its representatives through the network’s implementation and assessment process .

There is no fee to join the AARP Network of Age-Friendly States and Communities . Communities enroll individually, as part of a region or as a state . All towns, villages, townships, boroughs, cities, counties and states seeking to enroll in the AARP age-friendly network are required to submit a membership application . In addition, the community must provide a letter of commitment signed by the jurisdiction’s highest elected official (e .g ., a governor, mayor, or county executive) . Communities with council or commission forms of government typically pass a resolution in support of membership in the network .

Georgia has a unique distinction of being home to the first community in the country to receive Age-Friendly designation; Macon-Bibb in 2012 . At the time of print, other Age-Friendly communities include:

• Athens-Clarke County (2019)

• Atlanta (2014)

• Augusta (2014)

• East Point (2019)

• Macon-Bibb (2012) 

• Norcross (2018) 

• Tucker (2018) 

AARP Georgia is currently undertaking efforts to achieve Age-Friendly statewide designation for Georgia . If you believe your community might have an interest in membership within our network, please let us know (GAAARP@aarp .org) and we would be happy to assist with any next steps . This important work stands to benefit residents of all ages around the state .

Melissa Austin is the Advocacy Manager for AARP Georgia

1 Binette, Joanne and Kerri Vasold . 2018 Home and Community Preferences: A National Survey of Adults Age 18-Plus . Washington, DC: AARP Research, August 2018 .

*State enrollment in the network does not confer automatic membership on that state’s local communities .

February, March, April 2020 Georgia Nursing • Page 13

Quick Fixes for 10 Big Budget-Blowing MistakesValerie Edwards

Mutual of Omaha AdvisorValerie.edwards@mutualofomaha.com

678-672-0301

Look at these top money mistakes…and learn ways to avoid or fix them .

1. Estimating Income and Expenses Instead of Tracking ThemTo make a realistic budget, you need to know exactly how much money you have coming in and going out every month .

To accurately measure costs, review at least six months of bills, bank statements, and credit card statements . That will help you spot expenses that don’t occur regularly . It lets you see how much some payments vary from month to month, so you can calculate an average .

2. Using Credit to Spend More Than You HaveUsing credit cards to make purchases that you can’t afford is a double-hit to your budget . Fix: Every time you use your credit card, set aside the money  as if you’d used cash.  When the bill comes, you’ll have cash to pay the full balance and you won’t end up paying interest on everyday purchases .

3. Ignoring ‘Auto Pilot’ ExpensesDo you have subscriptions to publications you aren’t reading anymore? Are you still watching cable, or have you switched to Netflix?

Getting rid of auto-expenses that no longer fit your life, can free up space in your budget .

4. Keeping Savings and Checking Accounts in the Same BankIt’s easy for money to flow the wrong way when savings and checking accounts are in the same bank . If transferring money from savings into checking is as simple as a mouse click, it can happen all too often . And using savings to pay regular household bills because you over spent will quickly deplete your nest egg .

5. Making It Too Easy to Spend MoneyOne-click check out … Amazon Prime … Apple Pay… all of these effortless payment systems — make it so easy to spend money .

When you’re trying to stay on budget, adding a layer of difficulty to your spending makes you less likely to buy things you don’t need . So, turn off one-click, don’t “store” your credit card information for online accounts .

6. Forgetting about EmergenciesEmergencies happen all the time . Your washing machine goes on the fritz, for example . If your budget isn’t prepared to handle the unexpected, you could find yourself in financial hot water .

The fix: Include “emergencies” as an expense category in your budget every month .

7. Keeping Up with Technology UpgradesFrequent tech upgrades make the latest, greatest versions seem like must-haves . Anything that was working for you yesterday — your laptop, your smartphone — is just as good today, even if the tech companies say it isn’t .

Sometimes, simply updating software or adding memory can be all the upgrade you need .

8. Not Tailoring a Budget to Your LifeYour budget should reflect  your  finances and goals . For example, if your daily Starbucks run makes life “worth living,” that’s not the expense to cut, no matter what all the experts say .

9. Not Considering IncomeBudgeters tend to focus on cutting expenses . It’s sometimes easier to increase income, or cash flow . Some examples:

• Lower tax withholding. If your last refund was more than  $1,000, reducing your withholding taxes may be worth looking at in order to free up some extra cash .

• Renegotiate with vendors.  If your bank charges you for checking and ATM usage, ask them to remove those fees . If they won’t budge, move your money to a friendlier bank .

10. Failing to Budget for Life InsuranceLife insurance often gets the axe when families are building budgets . But consider this: If money is too tight to fit life insurance into your budget, what happens to the family finances if you or your spouse die?

The Bottom LineYou’ll be amazed how much you can save when you plug leaks that are draining your budget . And by fixing or avoiding these ten big mistakes, you’ll have more room in your spending for occasional splurges .

Page 14 • Georgia Nursing February, March, April 2020

Georgia Nurses Association Political Action Committee (GN-PAC)

About GN-PAC:The Georgia Nurses Association Political Action Committee (GN-PAC)

actively and carefully reviews candidates for local, state and federal office . This consideration includes the candidate’s record on nursing issues and value as an advocate for the nursing profession . Your contribution to GN-PAC today will help GNA continue to protect your ability to practice and earn a living in Georgia . Your contribution will also support candidates for office who are strong advocates on behalf of nursing . By contributing $25 or more, you’ll become a supporting member of GN-PAC . By contributing $100 or more, you’ll become a full member of GN-PAC! The purpose of the GN-PAC shall be to promote the improvement of the health care of the citizens of Georgia by raising funds from within the nursing community and friends of nursing and contributing to the support of worthy candidates for State office who believe, and have demonstrated their belief, in the legislative objectives of the Georgia Nurses Association .

TO DONATE VISIT:https://georgianurses.nursingnetwork.com/page/

75371-gn-pac

GEORGIA NURSES FOUNDATION

HONOR A NURSEWe all know a special nurse who makes a difference! Honor a nurse who has touched your life as a friend, a caregiver, a mentor, an exemplary clinician, or an outstanding teacher . Now is your opportunity to tell them “thank you .”

The Georgia Nurses Foundation (GNF) has the perfect thank you with its “Honor a Nurse” program which tells the honorees that they are appreciated for their quality of care, knowledge, and contributions to the profession .

Your contribution of at least $35 .00 will honor your special nurse through the support of programs and services of the Georgia Nurses Foundation . Your honoree will receive a special acknowledgement letter in addition to a public acknowledgement through our quarterly publication, Georgia Nursing, which is distributed to more than 100,000 registered nurses and nursing students throughout Georgia . The acknowledgement will state the name of the donor and the honoree’s accomplishment, but will not include the amount of the donation .

Let someone know they make a difference by completing the form below and returning it to the following address:

Georgia Nurses Foundation 3032 Briarcliff Road, NE | Atlanta, GA 30329 FAX: (404) 325-0407 | gna@georgianurses .org (Please make checks payable to Georgia Nurses Foundation.)

I would like to Honor a Nurse:

Honoree: Name: __________________________________________________

Email: __________________________________________________

Address: ________________________________________________

State/City: ______________________________Zip: ___________

From: Donor: _________________________________________________

Email: __________________________________________________

Address: ________________________________________________

State/City: ______________________________Zip: ___________

Amount of Gift: __________________

MasterCard/Visa #: ____________________________ Exp Date: ___________

Name on Card: _____________________________________________________

My company will match my gift? _ YES (Please list employer and address below .) ___ NO

Employer: _______________________________________________

Address: ________________________________________________

The Georgia Nurses Foundation (GNF) is the charitable and philanthropic arm of GNA supporting GNA and its work to foster the welfare and well being of nurses, promote and advance the nursing profession, thereby enhancing the health of the public.

E-Store Now Open!Purchase GNA merchandise at GNA’s Café Press online store!

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CONTACT:www.jeffdavishospital.org/getpage.php?name=employment&sub=Careers

February, March, April 2020 Georgia Nursing • Page 15

Are you interested in Palliative Care? Nurse Navigation? Informatics?

Whatever your nursing passion may be, Georgia Nurses Association (GNA) can help you connect with your peers locally and across the state . Becoming involved in your professional association is the first step towards creating your personal career satisfaction and connecting with your peers . Now, GNA has made it easy for you to become involved according to your own preferences .

Through GNA’s new member-driven chapter structure, you can join multiple chapters and also create your own chapter based on shared interests where you can reap the benefits of energizing experiences, empowering insight and essential resources.

Visit http://www .georgianurses .org/?page= Chapter Chairs to view a list of current GNA Chapters and Chapters Chair contact information . Connect with Chapter Chairs to find out when they will hold their next Chapter meeting!

I Want to Get Involved: Joining and Creating a GNA ChapterThe steps you should follow to create a NEW

GNA chapter are below . If you have any questions, contact the membership development committee or GNA headquarters; specific contact information and more details may be found at www .georgianurses .org .

1 . Obtain a copy of GNA bylaws, policies and procedures from www .georgianurses .org .

2 . Gather together a minimum of 10 GNA members who share similar interests .

3 . Select a chapter chair .

4 . Chapter chair forms a roster to verify roster as current GNA members . This is done by contacting headquarters at (404) 325-5536 .

5 . Identify and agree upon chapter purpose .

6 . Decide on chapter name .

7 . Submit information for application to become a chapter to GNA Headquarters . Information to be submitted includes the following:

Chapter chair name and chapter contact information including an email,

Chapter name, Chapter purpose, and Chapter roster .

8 . The application will then go to the Membership Development Committee who will forward it to the Board of Directors . The Board will approve or decline the application and notify the applicant of its decision .

MEMBERSHIP

To become a member of GNA please

review and submit our membership

application located on the homepage of

our website at www .georgianurses .org

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The Georgia Nurses Foundation (GNF) special nurse license plate is available NOW at Georgia tag offices . Each nurse plate

sold results in revenue generated for GNF, which will be used for nursing scholarships and workforce planning and development to meet future needs . Show

your support for the nursing profession in Georgia by purchasing a special nurses license plate today! Get details at http://www .georgianurses .org/?page=LicensePlate .

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Page 16 • Georgia Nursing February, March, April 2020

Calling for Appropriate StaffingSusan Trossman, RN

When asked why appropriate staffing was so important, Tracy Viers, MSN, RN, CCRN, didn’t hesitate for a second .

“The bottom line is it’s all about patient safety and positive outcomes,” said Viers, an ANA-Illinois member and intensive care unit (ICU) staff nurse at Blessing Hospital in Quincy, Illinois . “Good patient outcomes are dependent upon nurses, who can’t do their best when they have too many patients and tasks .”

And that inability to provide every patient with the best possible care also causes nurses, no matter where they work, incredible physical and emotional stress, she added .

The American Nurses Association (ANA) wants appropriate staffing to be the rule—not the exception—across care settings . To that end, the association continues to increase and widen its efforts, knowing that complex problems require a multipronged approach .

One effort involves pursuing a unified legislative and regulatory approach to achieve ANA’s staffing goal . Another is an educational and outreach campaign launching this fall to provide nurses with guidance and tools to help them make an immediate case for appropriate staffing and implement practical, comprehensive staffing plans . Among these resources is ANA’s Principles for Nurse Staffing, which was recently revised to make it more applicable to all settings and to emphasize nurses’ critical role in ensuring healthcare facilities meet their mission of providing patients and communities with quality, safe, and cost-effective care .

Assessing the problemIn a 2019 ANA membership survey of more

than 6,700 nurses, 93% identified staffing as an important issue, with 72% identifying it as “extremely important .” And when asked to name their top three nursing issues, “early career” nurses (0-4 years of experience) and “up and comers” (5-14 years of experience) named staffing as a priority far more than any other issue .

Texas Nurses Association member Bob Dent, DNP, NEA-BC, FAAN, FACHE, FAONL, who helped revise ANA’s staffing principles, pointed to years of research showing that appropriate nurse staffing leads to better patient outcomes and fewer adverse events . Studies also have linked appropriate staffing to cost savings that result from preventing complications and readmissions .

Yet findings from an ANA Enterprise HealthyNurse® Survey gathered between February 2017 and May 2019 revealed that more than a quarter of the 18,500-plus respondents said they were often assigned a higher workload than they felt comfortable with . About 52% responded that they frequently must work through their breaks to complete their assigned workload and 53% often have to arrive early or stay late to get their work done .

Speaking to staffing as a national issue, Washington State Nurses Association (WSNA) member and neuro-trauma ICU staff nurse Danielle O’Toole, BSN, RN, CCRN, said, “Nurses are continually being asked to do more and more and more with less .”

She also affirmed the ANA’s survey findings about nurses working nonstop . For years, nurses

in her facility didn’t take rest and meal breaks for fear of overburdening their coworkers and putting their patients at risk . “Anything can happen in 30 minutes, especially in an ICU where you have critical I .V . drips,” O’Toole said .

Looking at the principlesAlthough ANA’s revised principles include

additional information, such as referencing the Institute for Healthcare Improvement’s triple aim efforts to improve health system performance, this resource continues to provide nurses with an important framework to help them develop, implement, and evaluate appropriate nurse staffing plans and activities . It includes core components of appropriate staffing such as:

• RNs at all levels within a healthcare system must have a substantive and active role in staffing decisions to ensure they have the necessary time to meet patients’ care needs and their overall nursing responsibilities .

• All settings should have well-developed staffing guidelines with measurable nurse-sensitive outcomes specific to that setting and the healthcare consumer population they are serving that are used as evidence to guide daily staffing .

• Staffing needs must be based on an analysis of the patient’s or consumer’s healthcare status, such as acuity and intensity, and the environment in which care is provided .

Other considerations include RNs’ competencies, experience, and skill set; staff mix; and previous staffing patterns that have shown to improve care outcomes .

Dent reinforced the importance of nurse involvement and collaboration—such as through the implementation of staffing advisory committees—to attain appropriate staffing and good patient experiences and care .

“It’s important that nurses aren’t questioning whether they are really making a positive difference for their patients,” said Dent, who recently left his long-time leadership role at Midland Memorial Hospital in Texas and is now vice president and chief nursing officer of three facilities within the Emory Healthcare system . “I’ve found that if nurses have a positive and healthy work environment—and appropriate staffing is a component of that—then their patients are getting good care and having great experiences .”

The ANA document also outlines specific principles related to healthcare consumers, RNs and other staff, the organization and workplace culture, the practice environment, and staffing plan evaluation—all of which can guide direct care nurses and those at other levels in making sound staffing decisions and plans .

For example, staffing decisions should take into account factors such as the age and functional ability of patients and healthcare consumers, as well as their cultural and linguistic diversities, scheduled procedures or treatments, and complexity of care needs .

On the other side of the equation, nurses’ level of overall experience (novice to expert), educational preparation, language capabilities, and experience with the population being served should be among the factors considered .

“Staffing is complex,” said Deborah Maust Martin, DNP, MBA, RN, NE-BC, FACHE, who also contributed to the revised principles . “We need to look at patient outcomes and how we get the best match of patients and nurses .”

The principles of staffing document also emphasizes other key points, such as calling mandatory overtime an unacceptable solution to achieving appropriate staffing, ensuring that nursing students aren’t counted as staff, creating a workplace culture that leads to retention, and identifying costs of nursing care in patient billing and reimbursement requests to provide visibility to the value of nurses and nursing services .

Maust Martin, a Wisconsin Nurses Association member, noted that the principles are designed to be applicable to nurses working in all settings, from acute care to school and community-based practices . The term “healthcare consumers” instead of “patients” shows the broad reach of nurses’ roles and the populations they serve .

Pursuing other effortsMany state nurses associations and specialty-

focused organizational affiliates also are engaging in a range of efforts to address this priority issue .

In Washington State, O’Toole testified before legislators about nurses’ inability to take needed rest and meal breaks and the impact it has on nurses and patients . Her advocacy and that of other WSNA nurses and staff led to the passage of a state law providing breaks and overtime protections for nurses, effective in January 2020 . Her facility, Tacoma General Hospital, hired “break relief” staff to cover nurses during those times as a result of legal action by WSNA, and the new law reinforces the hospital’s obligation to ensure nurses get breaks .

“I’m taking my first breaks since the law passed,” said O’Toole, who also is chair of her WSNA local . “We also have a robust staffing committee that meets once a month that is 50-50 staff nurses and management to address staffing issues .” The committee additionally reviews the efficacy of every unit’s staffing plan, including negotiated standards, every 6 months to determine if any changes are needed .

ANA-Illinois Executive Director Susan Swart, EdD, MS, RN, CAE, said the association plans to introduce legislation to strengthen the state’s existing staffing law, which went into effect in 2008 and was based on ANA’s earlier staffing principles . The law requires healthcare facilities to have staffing committees made up of at least 50% direct care nurses and that staffing decisions are based on patient acuity, skill mix, and other key factors .

“We want to put some teeth in the law so the committee isn’t advisory but has real pull,” Swart said . “We know from our recent member survey that nurses continue to struggle with staffing and workplace issues that are connected with understaffing .”

ANA-Illinois also is working with the Illinois Hospital Association’s new chief nursing officers group to more immediately strengthen and raise the profile of staffing committees . Part of their strategy is to include information about staffing committees, including their purpose, as a routine part of orientation in all facilities, Swart said .

“We want nurses to feel empowered and that their participation is valued and respected,” Swart said . That requires an institutional culture that supports nurses, as well as nurses at all levels working together to implement staffing solutions .

One staffing solution that Viers believes can be instrumental is having a dedicated charge nurse on every unit who doesn’t have to carry a patient assignment . That would leave the charge nurse free to mentor new nurses and handle all the other issues that routinely crop up during the course of a shift . (Her Illinois facility has a professional practice committee that addresses staffing issues .)

ANA-Illinois board member and staff nurse Lauren Martin, RN, CEN, also thinks it’s critical that nurses from all shifts are represented on staffing committees .

“Night shifts tend to not be staffed as well as day shifts, and oftentimes it’s new nurses, who are just learning the job, working those shifts,” said Martin, who works in a specialty long-term care facility . “So, we really need to increase nurses’ involvement on committees and in other ways to solve staffing issues . That includes looking at all the factors that are causing inappropriate staffing .”

Both Dent and Maust Martin added that nurses must think about new ways to manage staffing needs—whether it’s adjusting shift length, having long-time nurses support novice nurses through ongoing, virtual mentoring, or piloting new models of care .

Noted Dent, “We all have a piece of the pie when it comes to addressing nurse staffing .”

— Susan Trossman is a writer-editor at ANA.

ResourceAccess ANA’s new staffing webpage for key

documents and tools at www .nursingworld .org/PrinciplesForNurseStaffing .

Reprinted with permission from ANA on the Frontline, as seen in American Nurse Today.

AUBURN UNIVERSITY SCHOOL OF NURSINGNow Hiring: Assistant/Associate/ Full Professor - Tenure Track

2 positions

Minimum Qualifications for Tenure Track:Requires an earned doctorate (Ph.D. or equivalent) in a relevant discipline and a graduate degree in nursing with evidence of scholarly productivity.

Successful candidates(s) must have an active and unencumbered Alabama Registered Nurse (RN) license or eligibility for obtaining an Alabama RN license. Alabama RN license required prior to start date.

http://aufacultypositions.peopleadmin.com/postings/3914http://www.auburn.edu/academic/provost/facultyjobs/

Auburn University is an EEO/Vet/Disability employer.

“Auburn University is understanding of and sensitive to the family needs of faculty, including dual-career couples.”

February, March, April 2020 Georgia Nursing • Page 17

Workplace Violence: How Can We Feel Safe at WorkJessica Vos, BSN

Reprinted with permission from North Dakota Nurse November 2019 issue

No one should have to go to work with fear of physical violence, verbal threats, or threatening behavior . Unfortunately, many nurses do . According to the American Nurses Association, one in four nurses are assaulted . Of those one in four, only 20-60% of those incidents are reported . Nurse abuse, also known as workplace violence, attributes to 13% of missed worked days (American Nurses Association, n .d .)

In order to address work place violence, we need to first be able to identify what it is . According to Joint Commission’s Sentinel Event from April 2018, workplace violence can be described as intimidating, harassing behavior, physical assaults or threats of assaults and verbal, written, or physical aggression intended to control or cause death, serious bodily injury or damage to property (Joint Commission, 2018 .) According to the American Nurses Association (ANA), the violence includes incidences by patients, patients’ family members and external individuals and includes physical, sexual and psychological assaults (ANA, 2019) . Workplace violence can be further dissected into sub groups of bullying and incivility by co-workers, but for the sake of this article, we will be discussing workplace violence and nurse abuse from other sources other than co-workers .

Some of us may never personally experience workplace violence and that is a good thing, but “workers in health care settings are four times more likely to be victimized than workers in private industry” (Joint Commission, 2018 .) The Joint Commission also has 68 reported sentinel event incidences of homicide, rape, or assault of hospital staff members over an eight-year period, (Joint Commission, 2018 .) This is outrageous! There is no better time than now to raise awareness and support for safe work environments, especially for the most trusted profession taking care of the most vulnerable populations .

It is the nurses’ caring nature to feel empathy for their patients . With this empathy comes a downside

as nurses tend to underreport workplace violence “because they often believe that their assailants are not responsible for their actions due to conditions affecting their mental state . The most common characteristic exhibited by perpetrator of workplace violence is altered mental status associated with dementia, delirium, substance intoxication, or decompensated mental illness,” (Joint Commission, 2018 .) The empathy nurses feel for their patients can overwhelm their rational senses and may brush off the violent act as “the patient didn’t know what they were doing” as justification for the abuse . According to ANA’s 2019 issue brief on reporting incidents of workplace violence other barriers to reporting include:

• A health care culture that considers workplace violence as part of the job

• A perception that violent incidents are routine• A lack of agreement on definitions of violence;

e .g . does it include verbal harassment?• Fear of being accused of inadequate

performance or of being blamed for the incident• Lack of awareness of the reporting system• A belief that reporting will not change the

current systems or decrease the potential for future incidents of violence

• A belief that the incident was not serious enough to report

• A practice of not reporting unintentional violence; e .g ., incidents involving Alzheimer’s patients

• Lack of manager and employer support• Lack of training related to reporting and

managing workplace violence• A fear of reporting supervisory workplace

violence

With this list of barriers to reporting workplace violence, it can almost be guaranteed that incidents happen at a substantially higher number than we anticipated . It is especially difficult if nurses don’t know when or even how to report these incidents .

No matter who inflicts the act of violence, it is the nurses duty to report any and all acts of workplace

violence . It is the organizations duty to train nurses to identify workplace violence and have an effective reporting system that is continually addressed . No one benefits from workplace violence as it “results in low staff morale, lawsuits, and high worker turnover,” (Joint Commission, 2018 .) This is no good for the nurses, the organization, or the patients . Organizations should also be responsible to provide training to employees in preparation for disruptive behaviors, self-defense/self-protection, and de-escalation of these incidents . Being proactive and having staff be able to identify escalation of events that could lead to violence, could greatly help in de-escalation before the violent acts can occur . Organizations should also debrief with employees after these disruptive events occur to better determine what went well, what didn’t go well, and how things could be handled more effectively in the future .

Everyone needs to feel safe at work and we need to be able to report acts of violence no matter how small; if the incident causes physical or mental distress, or makes the nurse feel unsafe in any way, the incident should be reported and followed up with by management or the security team . Nurses should not feel shame for reporting workplace violence, the concerns should not be minimized by management . Workplace safety is everyone’s job and collaboration between management, security and staff is a must if we are to provide sustainable culture of safety .

American Nurses Association (2019) . Issue Brief Reporting Incidents of Workplace Violence . https://www .nursingworld .org/~495349/globalassets/docs/ana/ethics/endabuse-issue-brief-final .pdf . (Retrieved August 27, 2019 .)

American Nurses Association (n .d .) End Nurse Abuse . https://www .nursingworld .org/practice-policy/work-environment/end-nurse-abuse/ . (Retrieved August 27, 2019 .)

Joint Commission (April, 2018 .) Sentinel Event Alert Physical and verbal violence against health care workers . https://www .jointcommission .org/assets/1/18/SEA_59_Workplace_violence_4_13_18_FINAL .pdf

Students Testing the Waters:Incivility in the Classroom – What is the Novice Nursing Faculty to Do?

Dr. Erica Edfort, DNP, MSN, NVRN-BC, RN-BC, FAHA

Dr. Susan Rux, PhD, MSN, RN, PHN, ACNS-BC, CHEP, CNE, CPRW, NEA-BC

Reprinted with permission from New Jersey Nuse, January 2020

Classroom incivility involves students and faculty alike . Overt behaviors that are demonstrated by students include disruptive talking while instruction is occurring; arriving late to class; exhibiting distractive behaviors, such as texting or in severe instances sleeping in class . Faculty may also exhibit uncivil behaviors such as persistent attempts at redirecting a student who needs clarification; arguing with students in an attempt to take a positional authoritative approach in a discussion . Students or faculty may also express negative nonverbal behaviors, such as eye-rolling, disrespectful actions or communication or blatant arguing . Is this a one-sided dilemma or a two-fold situation? Who is to blame?

Overwhelming evidence regarding student and faculty incivility exist in the literature . So let’s examine the novice nursing faculty and the relationship of incivility in the classroom . In the academic setting, novice faculty are vulnerable to being on the receiving end as well as being the aggressor, if the novice faculty is not aware of how to respond to the uncivil situation . Rawlins (2017) recognized that incivility incites incivility stating rude or discourteous behavior will, in turn, perpetuate uncivil behavior . Responses to incivility from both students and faculty may be negative in nature due an underlying lack of respect .

Rad & Moonaghi (2016) acknowledged strategies such as “threatening to give lower marks, and sending the case to disciplinary committee are among the last resort management actions from educator’s perspective” as being more common in novice educators who don’t have sufficient

management skills . Students may view constructive criticism from faculty as belittling which may cause students to respond in an uncivil manner . Mieres (2018) also identified how student incivility may be purposeful, such as “to get what they want – a better grade, adjusted assignment .” These tactics may be used if students “perceive difficult assignments to be a form of punishment and bully faculty as a defense mechanism .”

Nursing faculty entering academia from the clinical setting are oftentimes unfamiliar with the holistic responsibilities of their new position . Due to the regulatory requirements within higher education organizations, such as developing course material; committee involvement; attending conferences or developing publications to continue certifications or for rank advancement; as well as organization and/or board membership may cause undue stress to novice faculty leading to emotional/physical health issues (Green, 2018) . However, there is limited evidence detailing the lived experiences of faculty related to student incivility . Thomas, Bantz & McIntosh (2019) conducted a case study which revealed faculty feeling less tolerance for students who do not follow the rules and especially those who are not prepared at the level expected . The case study also revealed “increasing complaints of feeling overwhelmed to peers, being tired all the time and not getting adequate sleep .” In addition, the case study identified “feeling guilty about the lack of family time available and the nurse finding herself reflecting on the career that was once fulfilling but now often thinks about resigning .” This case study included a nursing faculty with more than 20 years of experience – imagine how a novice nursing faculty may react when subjected to incivility in the classroom .

As nurses make the transition from bedside to classroom, we must be mindful of the needs to ensure that the transition is successful – some nursing faculty have not had prior teaching experience . Providing mentors to new faculty as

support assist the novice nursing faculty to evolve into his/her new role achieving a better work/life balance, setting realistic professional goals and assisting with the multitude of inquiries that the novice nursing faculty will likely experience is critical to their success . As nursing faculty, mindfulness must occur in managing stressors, not only in the classroom but stressors in general .

References:Green, C . (2018), New Nursing Faculty and Incivility:

Applying Mindfulness-Based Strategies . Holistic Nursing Practice. 32(1), 4-7 .

Meires, J . (2018) . Workplace Incivility: When Students Bully Faculty . UROLOGIC NURSING. 38(5) . 251-255 .

Rad, M . & Moonaghi, H . K . (2016), Strategies for Managing Nursing Students’ Incivility as Experienced by Nursing Educators: a Qualitative Study. Journal of Caring Sciences, 2016, 5(1), 23-32

Rawlins, L . (2017) . Faculty and Student Incivility in Undergraduate Nursing Education: An Integrative Review . Journal of Nursing Education. 7, 56(12), 709-716

Thomas, C . M ., Bantz, D . L . & McIntosh, C . E . (2019) . Nurse Faculty Burnout and Strategies to Avoid it . Teaching and Learning in Nursing. 14(2), 111-116 .

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Page 18 • Georgia Nursing February, March, April 2020

When Nurses Speak: Advocacy DescribedPatricia Abbott, RN, PhD

Reprinted with permission

Nurses Can and Should Leverage Their Expertise to Inform and Influence Healthcare Policy

All Registered Nurse (RN) licensees have immense insight on healthcare and a voice to use that expertise to inform and influence healthcare policy . According to the American Nurses Association (ANA, 2019) there are approximately four million nurses in the United States (US), the largest part of the US healthcare workforce . Now is the time for the nursing profession to use its strength in numbers, it’s expertise from their frontline roles and use their voices to positively influence healthcare policy .

Nurses are at the very center of healthcare, and what the nursing profession says matters to policy makers at all levels . Registered nurses by the nature of their education/training have well developed advocacy skills and with every patient a nurse encounters, they advocate for patients . Research confirms NPs are adept at advocating for patients and patients value this advocacy . It is essential that nurses also use these advocacy skills to inform and influence healthcare policy that directly affects what

they do as healthcare providers and the care they provide .

There are three levels of advocacy where nurses can impact healthcare: (1) direct care, (2) organizational, and (3) policymaking . As a profession nurses have made strides to positively influence direct care and organizational policy, but there remains a perceived reluctance to inform policy makers at the state and federal levels, thought to be due to lack of knowledge and confidence . Nurse advocates need to become more politically astute and pay more attention to health-related politics . To do so, nurses must have the will and energy to be “players” in the political arena to determine strategic action with a unified voice .

Nurses can influence policy only if they share their expertise and wisdom by using their voices . Where does the busy nurse begin?

How to Inform and Influence 1 . Have confidence – You can positively influence

healthcare; value the expertise you have.2 . Join professional organizations – There is greater

influence in numbers and a unified message.3 . Interact with policy makers at all levels – Educate

them on barriers and issues that face nurses and patients. Tell them your personal stories from the frontline of healthcare.

Tips for Your Next Job SearchMelissa Marrero MSN, RN, CWCN

Reprinted with permission from New Jersey Nurse October 2019 issue

Today’s nursing job search heavily relies on online applications and networking strategies . In larger organizations, before the recruiter, you need to get through the recruitment assistant and the software platform to get your foot in the door . Here are some basic tips from the recruitment perspective to help your next job hunt:

PERSONALIZE YOUR APPLICATION The most valuable advice I received when

starting my job search was that résumés are not meant to get you a job, they get you an interview . Nurses that are looking for a new position need to remember each job is unique, so your application and résumé cannot be “one size fits all .” Read the job description carefully . Make sure eligibility requirements are covered in your résumé . With hundreds of applicants, you won’t be getting a call to double check your GPA or certifications, make

sure it is clear you have what they are asking for . Use key phrases from the job description in your résumé; this will pull your application higher on the software match list .

HONESTY Do not lie . It may seem like common sense, but

it happens surprisingly often . Embellishment easily shifts to falsehood . Familiarity with a language and fluency are two different things . If you were a Customer Service Representative, do not give yourself a new title of Vice President of Patient Experience because it sounds better . Recruiters will be performing reference checks and background checks and eventually you will have a conversation face-to-face where your skills may be put to the test .

STRONG REFERENCES Ask people if they will act as a reference before

you share their contact information and let them know the jobs you have applied for and why you are interested in the position . Be self-aware of your

performance when you worked with that person; will they say the things that a new employer will want to hear?

OPPORTUNITIES TO NETWORKSeek out opportunities for face-to-face

engagement . This does not mean show up at Human Resources without an appointment or trying to connect to every employee on LinkedIn! Take advantage of offerings that allow you to mingle with current employees (walk-in career fairs, volunteer events, lectures open to the public) and strike up conversations, then strategically build your online connections with people in the organization .

IF YOU GET AN INTERVIEW, SHOW UP OR HAVE THE COURTESY TO CALL

Interview “no shows” are on the rise; this is a huge strain on time, energy, and resources . The recruiter you snub will remember your name the next time you are looking for a move . Managers and supervisors all attend the same meetings and vacancies and candidates come up in conversation quite frequently . You do not want your reputation to include being inconsiderate or unreliable in a profession built on trust and compassion . If you get another offer or your plans for employment change, any reasonable recruiter will understand, pick up the phone and call!

4 . Know your legislators – They want your vote & need your insight and wisdom.

5 . Policy/legislative websites – Become familiar with these websites which provide information on current trends and bills.

6 . Make your voice heard – Provide expert testimony at public hearings, give presentations, write editorials/articles/policy briefs.

Conclusions • Nurses offer a unique perspective that influences

every aspect of the healthcare system . It is time to share that perspective to influence healthcare policy .

• Now is the time for the nursing profession to use it’s strength in numbers, it’s expertise from their frontline roles and use their voices to positively inform healthcare policy

• By speaking through a unified voice on healthcare issues and supporting all nurses to work to the full extent of their licenses and education, nurses will improve healthcare for all (ANA website) https://www .nursingworld .org/practice-policy/

• This future of quality healthcare is dependent on RNs using their voices to inform and influence healthcare .

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February, March, April 2020 Georgia Nursing • Page 19

Nursing Home Nurses Lack Time and Resources for Complete CareFor years, extensive evidence from hospitals

has shown that nurses are more likely to leave necessary patient care unfinished  when employed in settings with insufficient staff and resources .  This “missed care” has been linked to poor care quality, increased adverse events, and decreased satisfaction with the health system . New research—from Penn Nursing’s Center for Health Outcomes and Policy Research  (CHOPR)—finds similar evidence in nursing homes specifically, and identifies the strong relationship between missed care, nurse burnout, and job dissatisfaction . 

The CHOPR team used data from 540 nursing homes in California, Florida, New Jersey, and Pennsylvania to examine the relationship between job burnout, dissatisfaction and incidence of missed care reported by registered nurses (RNs) . The  results  are  published in the  Journal of the American Geriatrics Society (JAGS).

In the study, led by  Elizabeth White, PhD,  Linda Aiken, PhD, RN, FAAN, FRCN, and  Matthew McHugh, PhD, JD, MPH, RN, CRNP, FAAN, (Aiken and McHugh are Pennsylvania State Nurses Association members), researchers found that

72% of RNs reported missing one or more necessary care tasks on their last shift due to lack of time or resources . One in five RNs reported frequently being unable to complete necessary patient care . The activity most often skipped: comforting  patients, talking with them, and performing adequate patient surveillance, teaching patients and families, and developing care plans . 

Missed care was significantly more common among nursing home RNs who were dissatisfied with their jobs or experiencing burnout . Across all RNs, 31 percent were dissatisfied, and 30 percent exhibited burnout . Nurses with burnout were five times more likely than their colleagues to miss needed care, whereas RNs who were dissatisfied were 2 .6 times more likely to miss care than RNs who were satisfied with their jobs .

The team discussed how organizational factors contribute to missed care and clinician well-being . They note that “work environments that provide adequate staff and resources, involve RNs in quality improvement processes, and support RNs through career pathways and leadership opportunities could help to promote employee engagement, reduce

missed care, and improve patient safety in nursing homes .” Additionally, the researchers emphasize that creating a culture emphasizing the need to find a root-cause for systemic problems, rather than punishing staff for individual mistakes, can help identify organizational inefficiencies that result in missed care . 

While the data did not establish a causal link between burnout, job dissatisfaction, and missed care, the researchers point to a rich body of existing evidence that “RNs are more satisfied and experience less burnout when they have adequate staff and resources, supportive managers, productive colleague relationships, input into organizational affairs, and opportunities for advancement .” Even under tight fiscal constraints, the researchers observe, “nursing home leaders can take steps to improve work environments through a variety of evidence-based interventions .”

Reprinted with permission from ANA on the Frontline, as seen in American Nurse Today.

ANA Enterprise Gears Up for Global‘Year of The Nurse’ in 2020

Silver Spring, MD – The ANA Enterprise announced its intent to elevate and celebrate the essential, robust contributions of nurses as the world recognizes 2020 as the “Year of the Nurse .”

The ANA Enterprise is the family of organizations that is composed of the American Nurses Association (ANA), the American Nurses Credentialing Center (ANCC), and the American Nurses Foundation . ANA Enterprise will celebrate Year of the Nurse by engaging with nurses, thought leaders and consumers in a variety of ways that promote nursing excellence, infuse leadership and foster innovation .

“As the largest group of health care professionals in the U .S . and the most trusted profession, nurses are with patients 24/7 and from the beginning of life to the end . Nurses practice in all healthcare settings and are filling new roles to meet the ever-growing demand for health and health care services,” said ANA President Ernest J . Grant, PhD, RN, FAAN . “Despite the major role nurses play in health care delivery and community outreach, there are opportunities to increase understanding of the value of nursing in order to expand investment in education, practice and research, as well as increase the numbers of nurses who serve in leadership positions .”

“We look forward to working with partner organizations to communicate a contemporary and accurate view of nurses and the critical work they do, as well as challenge boards and other influencers to commit to nursing and nursing leaders in order to improve the nation’s health,” said Grant .

Given the wide range of nursing roles in the U .S ., ANA Enterprise will promote inclusivity and wide engagement of all nurses throughout Year of the Nurse . As an example, during 2020, ANA Enterprise will expand National Nurses Week, traditionally celebrated from May 6 to May 12 each year to a month-long celebration in May to expand opportunities to elevate and celebrate nursing .

The World Health Assembly, the governing body of the World Health Organization, declared 2020 the International Year of the Nurse and Midwife, in honor of the 200th anniversary of Florence Nightingale’s birth . The celebration offers a platform to recognize past and present nurse leaders globally, raise the visibility of the nursing profession in policy dialogue and invest in the development and increased capacity of the nursing workforce . This declaration is an extension of work initiated by the Nursing Now campaign to elevate the profession and ensure nurses are leading efforts to improve health and health care . ANA Enterprise is leading Nursing Now USA along with the Chief Nurse, U .S . Public Health Service; the University of North Carolina Chapel Hill; and the University of Washington, School of Nursing .

Nurses are encouraged to use #yearofthenurse and follow us on social media as we celebrate nurses in 2020 .

The ANA Enterprise is the organizing platform of the American Nurses Association (ANA), the American Nurses Credentialing Center (ANCC), and the American Nurses Foundation. The ANA Enterprise leverages the combined strength of each to drive excellence in practice and ensure nurses’ voice and vision are recognized by policy leaders, industry influencers and employers. From professional development and advocacy, credentialing and grants, and products and services, the ANA Enterprise is the leading resource for nurses to arm themselves with the tools, information, and network they need to excel in their individual practices. In helping individual nurses succeed—across all practices and specialties, and at each stage of their careers—the ANA Enterprise is lighting the way for the entire profession to succeed.

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