The Nursing Voice December 2023

The Nursing Voice

December 2023

Page 1

The Official Publication of the Illinois Nurses Foundation Quarterly publication direct mailed to approximately 4,500 RNs and electronically via email to 96,000+ RNs in Illinois.

VOLUME 10 | NUMBER 4 | DECEMBER 2023

Illinois Nurses Foundation Celebrates 9th Annual Emerging Nurse Leader Event The 9th Annual 40 under 40 Emerging Nurse Leader event recognized 40 outstanding nurses in Illinois under 40. Those who receive the recognition are impacting health care delivery and the nursing profession and will undoubtedly shape the future of the profession.

The Emerging Nurse Leaders Planning planning committee began their review of the nominations in April of this year and awardees were notified in June. As seen since the awards first started, there was an abundance of worthy candidates nominated for the 2023 honors.

Nominations were received from patients, friends, family, coworkers, employers, students, etc. Award recognition recipients reflected leadership success, exemplary leadership qualities, participation in professional associations and community service.

The event was led by INF Vice President Brandon Hauer MSN, RN, CNEcl, CCRN. The advisory committee team members included Susana Gonzalez MHA, MSN, RN, CNML, Linda B Roberts MSN, RN, Stephanie Mendoza MSN, RN and Kim Ramos MSN, RN, MEDSURG-BC, NPDBC. The planning committee included Brandon Hauer MSN, RN, CNEcl, CCRN who served as chair and Abby Falbo MSN, MBA, RN, CMSRN, NE-BC, Dan Fraczkowski MSN, RN-BC, Molly Gabaldo BSN, DNP-C, RN, Nate Karch DNP, RN, PCCN-K, Rebecca Murphy DNP, MBA, RN, CNOR, Tiffany Ponder MSN, RN, Ashley Whitlatch DNP MBA, APRN, FNP-BC, Aisha Badla BSN, RN, CPN, Anthony Davila DNP, MBA, RN-BC, Dana Merk MSN, RNC-OB, CBC, Erika Ohlendorf MSN, MBA, RN, CCRN-K, and Rocio Sanchez BSN RN PCCN.

One of the primary purposes of the 40 Under 40 Award is to engage, support and develop the next generation of Illinois Nurse Leaders. The committee was genuinely moved to have the honor of acknowledging fellow nurses who are known change agents that help shape health care statewide and beyond. Their efforts have served to expand and grow nursing practice as well as to empower our communities. Award recipients were proudly celebrated by members of their own cohort as well as Illinois nursing leaders, and of course their family members.

Angela Andrews PhD, RN-BC, CNE

Kate Barrett MSN, RN, NE-BC

Katy Behling MBA, MSN, RN

Karena Brown MSN, RN, CMSRN

Dana Campbell MSN, RN, CNRN, SCRN

Amanda Connoyer DNP, APRN, FNP-C

Sherri Crumley MSN, RN, CNOR, NE-BC

Mackenzie Daniels BSN, RN

Amy Driscoll DNP, RN, GCNS-BC, CDP

Karla Echeverria RN

Aaron Franklin DNP, RN, NEA-BC

Shana Freehill DNP, RN, NPD-BC

Leticia Garcia BA, RN

Jacy Ghast DNP, RN

Photos continued on page 3

Index current resident or

Non-Profit Org. U.S. Postage Paid Princeton, MN Permit No. 14

INF President’s Message. . . . . . . . . . . . . . . . . . . 2 ANA-Illinois President’s Message . . . . . . . . . . . 2 Ethics in Action. . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ANA-Illinois’ 2023 Professional Issues Conference: Human First, Nurse Second. . . 5 ANA-Illinois Elects New Board Members . . . . 6 Illinois Advanced Practice Registered Nurses Elect New Board Members. . . . . . . . . . . . . . . 7 ANA-Illinois Announces the 2023 Award Winners. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Practice Corner. . . . . . . . . . . . . . . . . . . . . . . . . . 10

How Alternative Medicine is Successfully Treating Long COVID. . . . . . . . . . . . . . . . . . . . 11 The Illinois Department of Financial and Professional Regulation (IDFPR) has online nurse resources available!. . . . . . . . . . . . . . . 12 New Continuing Education (CE) Requirement for Illinois LPN, RN, APRN and FPA-APRN License Renewal Beginning in 2024. . . . . . 13 IL Nursing Workforce Center Advanced Practice Registered Nurse (APRN) Survey 2022. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

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December 2023

INF PRESIDENT'S MESSAG E Our New Mission, Vision, and Values

Earlier this month, the Board of Directors of the Illinois Nurses Foundation finalized an update to our mission and vision statements and identified our core values. This is the first time the mission has been updated in our 22-year history.

We are excited about capturing the evolution of our foundation and setting our sights on a bold vision for the future. The Amanda Oliver INF board met on November BSN, RN, CCRN, 10th, 2023 at Loyola University CPST Medical Center for a full day board retreat to create the amazing new mission and vision.

The Illinois Nurses Foundation team is deepening our commitment to the following statements:

While we began this work in early 2022, the workforce shortage crisis we currently face in Illinois underscores the need for bold action to ensure Illinois and its nurses are prepared to advance sustainable solutions to ensure equitable healthcare is available across Illinois. We are leaning into our clarified mission, vision, and values as we respond to the moment. To ensure the board is equipped to handle the demand, the board has appointed four new members to our board.

These individuals bring a diversity of thought, practice expertise, and a commitment to philanthropy, and we are excited to introduce them at our 2023 Holiday Gala & Fundraiser on December 2 in Lisle, Illinois.

Colleen Morley DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM Lisa Connolly MSN, RN, CCM Dawn Vollers MSN, RN, NEA-BC, NPD-BC Katherine de los Trinos-Ocampo MAT, MSN, APRN, FNP-C

Mission Statement The Illinois Nurses Foundation elevates, transforms, and inspires the nursing profession and healthcare in Illinois.

We accomplish this through awarding scholarships and grants, professional development/education, and recognizing nurses and their contributions to the profession and their community.

We are excited about our new guiding principles and new board members and look forward to working to deliver on our updated mission.

The Nursing Voice INF Board of Directors Officers Amanda Oliver, BSN, RN, CCRN, CPST President Brandon Hauer, MSN, RN Vice President Karen Egenes, EdD, RN Treasurer Directors Maureen Shekleton, PhD, RN, DPNAP, FAAN Linda Olson, PhD, RN, NEA-BC Amanda Oliver, BSN, RN, CCRN ANA-Illinois Board Rep Susana Gonzalez, MHA, MSN, RN, CNML Jeannine Haberman DNP, MBA, RN, CNE Zeh Wellington, DNP, MSN, RN, NE-BC

ANA-Illinois Board of Directors Officers W. Zeh Wellington DNP, MSN, RN, NE-BC President Monique Reed, PhD, MS, RN Vice President Jeannine Haberman, DNP MBA, RN, CNE Treasurer Gloria E. Barrera MSN, RN, PEL-CSN Secretary Directors Samuel Davis Jr MHA, RN, CNOR Armando Valdez Martinez Jr. MSN, RN, MEDSURG-BC, CMSRN Diana Ortega BSN, RN Hannah Shufeldt MSHCM, BSN, RN Stephanie Mendoza DNP, MSN, RNC-OB, C-EFM Editorial Committee Chief Editor Lisa Anderson-Shaw, DrPH, MA, MSN Members Cheryl Anema PhD, RN Deborah S. Adelman, PhD, RN, NE-BC Linda Anders, MBA, MSN, RN Ellen Bollino MSN, RN, ED, CEN Nancy Brent, RN, MS, JD Pamela DiVito-Thomas PhD, RN Amanda Hannan MSN, RN Irene McCarron, MSN, RN, NPD-BC Linda Olson, PhD, RN, NEA-BC

Vision Statement To build a preferred inclusive future where all nurses and the nursing profession are recognized and rewarded for our unique contributions to Illinois healthcare.

Core Values Integrity - Transparency in all our philanthropic endeavors Inclusivity - Embrace an inclusive culture that celebrates our common yet diverse backgrounds Innovation - Empower and enhance forward-thinking approaches and advancement of the discipline of nursing.

Executive Director Susan Y. Swart, EdD, MS, RN, CAE ANA-Illinois/Illinois Nurses Foundation

ANA-ILLI NOIS PRESIDENT ' S M ESSAG E Dear Esteemed Illinois Nurse Colleagues, As your newly elected ANAIllinois President, I am honored and proud to represent you with the understanding of the gravity of this prestigious opportunity. I want to extend my sincere appreciation to each of you for placing your trust in me. This role comes with significant responsibilities, W. Zeh Wellington and I am fully committed to living up to the expectations.

The election results symbolizes togetherness, unity, and a belief that all nurses of Illinois, under my presidency, will have a voice that will be heard. I understand the importance of representing the nurses of Illinois while pushing forward our profession to help every patient that is entrusted in our care.

The election has shown our strength in unity and the shared belief in our ability to make a difference. My promise to you is a leadership that listens, represents your interests, and advocates for the advancement of our profession to benefit both nurses and patients in Illinois.

I would like to take a moment to express my gratitude to Dr. Elizabeth Aquino, our past president. Her leadership has laid a strong foundation for us to build upon, and her commitment to our community has set a high standard for us all.

Looking ahead, I am excited about the opportunities and challenges that come with this role. We have a lot to be proud of, but there is still work to be done. As nurses,

The Nursing Voice

we don’t just dream – we do. We see what has been done and what we can accomplish together. We are listeners and problem solvers.

As your president, I am ready to hit the ground

running, working alongside each of you to continue our journey of progress and innovation. Together, we have the power to shape the future of nursing in Illinois.

Thank you for this opportunity to serve.

W. Zeh Wellington, DNP, RN, NE-BC ANA – Illinois President

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Article Submission • Subject to editing by the INF Executive Director & Editorial Committee • Electronic submissions ONLY as an attachment (word document preferred) • Email: syswart@ana-illinois.org • Subject Line: Nursing Voice Submission: Name of the article • Must include the name of the author and a title.

• INF reserves the right to pull or edit any article / news submission for space and availability and/or deadlines • If requested, notification will be given to authors once the final draft of the Nursing Voice has been submitted.

• INF does not accept monetary payment for articles.

Article submissions, deadline information and all other inquiries regarding the Nursing Voice please email: syswart@ana-illinois.org Article Submission Dates (submissions by end of the business day) January 1st, April 1st, July 1st, October 1st Advertising: for advertising rates and information please contact Health eCareers, HEC_Nursing_Info@healthecareers.com.

ANA-Illinois and Health eCareers 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 ANA-Illinois and Illinois 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. ANA-Illinois and Health eCareers 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 ANA-Illinois or those of the national or local associations.

The Nursing Voice

December 2023

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Photos continued from page 1

Margaret Gladman DNP, RN, CBCN, CMSRN

Colleen Haynes MSN, RN, CMSRN

Brittany Judge MSN, RN

Katie Kean B SN, RN, OCN

Eleni Key MSN-Ed, RN

Hyejin Kim PhD, RN

Anne Kowalczyk NP, APRN, FNP-BC, D AMB-BC, CPN, CNE

Kathleen Krawzak DNP, APRN, CPNP-AC

Megan Kupferschmid MSN, RN, CCRN-K, NE-BC

Annie Lally BSN, RN

Faye Lewis MSN, RN

Michael Liwanag DNP, MBA, RN-BC, NEA-BC

Jessica Madrigal MSN, RN, CHSE

Anne O’Boye MSN, RN, CCTC

Shannon O’Shea MSN, RN, CNE, CNL

Allison Palhegyi MSN, RN

Jenna Palmisano BSN, RN, PEL-CSN

Kelly Perez DNP, APRN, CPNP-PC

Carrie Quinn MSN, RN

Eleanor Rivera PhD, RN

Haley Sachs BSN, RN, PEL-CSN

Jennifer Sandoval DNP, MSN, RN

Roshni Shah MSN, RN

Jill Trzaska M SN, RN, BMTCN, OCN, CNL

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December 2023

The Nursing Voice

ETHICS IN ACTION Homelessness and Health Disparities: Ethical Considerations Linda L. Olson, PhD, RN, NEA-BC, FAAN Lisa Anderson-Shaw, DrPH, MA, MSN It is estimated that 68,440 Chicagoans are experiencing homelessness and are living in shelters, transitional housing programs, in parks or in abandoned buildings, or in their cars (Chicago Coalition for the Homeless, 2023). The National Alliance to End Homelessness reports that over 500,000 people are homeless In the USA (2023). Homelessness harms not only those who experience it, but also harms the health care system and health care professionals (Watts, 2021).

Health care professionals who feel they cannot provide the quality of health care for patients or feel constrained from Linda Olson PhD, doing what they believe is the right care, often experience RN, NEA-BC moral distress.

The ANA Code of Ethics for Nurses with Interpretive Statements (2015), in Provision 8, discusses the role of the nurse in collaboration with other health professionals and the public “to protect human rights, promote health diplomacy, and reduce health disparities” (p. 31). Homelessness and unstable housing represents a violation of human rights, which include the right to housing, sanitation, and security, and is considered a social determinant of health.

Social determinants of health are the “conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-or-life outcomes and risks (Healthy Lisa Anderson People 2030). These include safe housing, access to food Shaw DrPH, MA, and water, education, and employment opportunities.

MSN Homelessness is also a social issue and a public health issue which can lead to the stigmatization of the person who experiences it. In addition, Provision 1 states that “the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person” (p. 1).

A case study: Mr. A. Joseph, a 34 year old man, was taken to the nearest emergency department after he was found unconscious lying on the side of the road. After being assessed, he was found to have pneumonia and was admitted for treatment per protocol. He also had several infected leg wounds from a recent fall. He had no identification on him and was minimally responsive for the first 24 hours.

On the second day of admission he was able to communicate with staff by his name and birthday. He stated he was homeless and did not have any contact information for family or friends. Social work was consulted to assist with discharge plans and to help the patient with obtaining identification and services at discharge.

Because of his lack of insurance it was difficult to find a safe place for his discharge and for follow up nursing care for wound dressings.

After several multidisciplinary care conferences it was decided that the patient would be discharged to a city shelter for unhoused people. He was taught how to change his dressings and given some supplies at discharge. The hospital social worker spoke with the shelter social worker and a follow up appointment with a physician was made.

Many people experiencing homelessness enter the health care system with frequent visits to the emergency rooms, and with conditions that have been untreated. Homeless people have higher rates of illness, are often uninsured, have been marginalized and stigmatized, and are vulnerable. Emergency departments can’t house these vulnerable patients, resulting in them being discharged back to the streets or in some cases to a temporary shelter. It is important that nurses assess the patient’s safety needs, access to medications and medical supplies, physical and cognitive abilities, and follow-up needs after discharge. This case addresses all aspects of ethics, especially the principles of autonomy and social justice. Patients often need help in making informed decisions and may not have a decision-maker. They also need help in accessing resources such as housing, food, medications, and shelter.

Nurses can help address the human rights issues associated with homelessness by advocating for safe discharges of homeless people, and by participating in legislative action that can lead to access to housing (Jenkins, 2023). Partnerships with academic and/or hospital organizations can improve the health of the homeless population by increasing access to healthcare, addressing the social determinants of health and removing barriers to achieving housing (Lee, Jagasla, & Wilson, 2023). One such program to improve the health of the community is the partnership between UI Health and the Center for Housing and Health, called Better Health Through Housing (2023).

The Night Ministry (2023) is another resource that provides ongoing relationships with the homeless population, housing, and free health care through meeting the homeless where they are at. As key advocates for patients and safe quality patient care, nurses can promote the health of people experiencing homelessness by participating in initiatives to improve access to health care through influencing health policy and legislation. Nurses can also advocate for those experiencing homelessness by promoting access to resources, and by treating them with respect, compassion, and with dignity.

References American Nurses Association (2015). Code of Ethics for Nurses with Interpretive Statements.

Silver Spring, MD: Nursesbooks.org Chicago Coalition for the Homeless (2023). https://www.chicagohomeless.org/estimate/ Accessed 8/15/23 Jenkins, D. (2023). Implementing safe discharges for patients without homes. American Nurse: Ethics Advisory Board Ethics Inbox: ethics@ana.org https://www.myamericannurse.com/ implementing-safe-discharges-for-patients-without-homes/ Lee, J.J., Jagasia, E., & Wilson, P.R. (2023). Addressing health disparities of individuals experiencing homelessness in the U.S. with community institutional partnerships: An integrative review. Journal of Advanced Nursing, 79, 1678-1690.

National Alliance to End Homelessness (2023). State of Homelessness: 2023 Edition. https:// endhomelessness.org/homelessness-in-america/homelessness-statistics/state-ofhomelessness/ The Night Ministry (2023). https://www.thenightministry.org/ Accessed 9/28/23 University of Illinois Hospital & Health Sciences System (2023). Improving the health of our community through housing and support. https://hospital.uillinois.edu/about-ui-health/ community-relations/better-health-through-housing Accessed 9/28/23 Healthy People 2030 (2023). What are social determinants of health? https://health. gov/healthypeople/priorit y-areas/social- determinants-health#:~:tex t=Social%20 determinants%20of%20health%20(SDOH,of%2Dlife%20outcomes%20and%20risks.

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The Nursing Voice

December 2023

ANA-Illinois’ 2023 Professional Issues Conference: Human First, Nurse Second

The Professional Issues Conference (PIC), hosted by ANA-Illinois, was November 4, 2023, in Urbana, Illinois.

Along with inspirational and empowering sessions for nurses, the conference included exhibitors, board elections, and recognition awards.

And, of course, attendees enjoyed networking with nurses across Illinois.

2023 Sessions PIC’s 2023 theme was “Human First, Nurse Second.”

Sessions covered a range of topics with an element of selfcare for nurses. Topics covered ranged from navigating social media as a nurse to coping with holiday stress in healthcare. Each was designed to help nurses advance their careers and elevate their workplaces for a one-of-kind nursing conference.

Sessions included: • Social Media for Nurses • Promoting Self-Assessment and Self Care for Nurses Using the R.E.S.T. Framework • Mindfulness and Self Compassion to Improve Burnout

• A Qualitative Exploration of a Black Nurses’ Experience Practicing During the First Wave of the COVID-19 Pandemic • Sleighing the Holiday Stress: A Nurse’s Survival Guide • Exhibitors & Poster Presentations Innovative Exhibitors & Poster Presenters Exhibitor booths and poster presentations were another way to learn and share knowledge from all areas of the state.

Thank you to the following exhibitors: Chamberlain University, Hospital Sisters Health System, Illinois Nurses Foundation, Lewis University & Western Governors University.

Thank you to the following poster presenters: Emily Ahmed, Sheri Compton-McBride, Alani Frederick, Anne Hocking, Linda B. Roberts & Rachel Woods.

Uplifting Annual Meeting The conference also served as an opportunity to hold an ANA-Illinois Annual Meeting, which included a President address, Treasurer report, board elections, and recognition awards.

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Welcome to the new ANA-Illinois board members!

President: W. Zeh Wellington DNP, RN, NE-B Secretary: Gloria E. Barrera MSN, RN, PEL-CSN Director: Armando Valdez Martinez, Jr MSN, RN, MEDSURG-BC, CMSRN, NE-BC, CNML & Dr. Stephanie Mendoza DNP, MSN, RNC-OB, C-EFM Director: The Board of Directors appointed Diana Ortega BSN, RN to serve as Director to fill the 1-year vacancy left by Dr. Wellington.

Nominations: Feyifunmi Sangoleye PhD, RN ANA Representatives: Elaine Hardy PhD, RN, Roshni Shah MSN, RN & Diana Ortega BSN, RN (Alternate) Congratulations to the inspiring nurses who were recognized at this year’s conference.

Clinical Practice Award Winner: Rocio Sanchez BSN, RN, PCCN Nurse Influencer Award Winner: Gloria E. Barrera MSN, RN, PEL-CSN Student Nurse of the Year Award Winner: Liliana Trespalacios Diversity, Equity, and Inclusion Leadership Scholarship Award Winner: Jennifer Sandoval DNP, MSN, RN Thank you to everyone who attended this wonderful event and thank you to all who worked tirelessly to make the conference a success!

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December 2023

ANA-Illinois Elects New Board Members

The Nursing Voice

Members of the ANA-Illinois elect new leadership The American Nurses Association - Illinois (ANAIllinois), the state’s largest professional nursing association for registered nurses in all practice settings, has elected new leadership.

ANA-Illinois leadership includes nurse leaders from across the state and with a variety of backgrounds. The elected leaders’ unique experiences are sure to enhance the work of ANA-Illinois and its vision of being the recognized leader of professional nursing and nurses in Illinois.

###ANA-Illinois, a constituent member of the American Nurses Association, is a powerful network of registered nurses committed to advancing nursing through education, political action, and workplace advocacy. ANA-Illinois is the leading voice of the approximately 187,000 professional registered nurses in Illinois.

The newly elected board members are as follows: President: W. Zeh Wellington DNP, RN, NE-BC, Director of Procedural Care – Surgical Services, Ann & Robert H. Lurie Children’s Hospital of Chicago Secretary: Gloria E. Barrera MSN, RN, PEL-CSN, Certified School Nurse, Visiting Clinical Associate, District 99; UIC Director: Stephanie Mendoza DNP, MSN, RNC-OB, C-EFM, Clinical Nurse Consultant ll, UI Health Director: Armando Valdez Martinez MSN, RN, MEDSURG-BC, CMSRN, NE-BC, CNML, Nursing Supervisor, Advocate Health Nominations Committee: Feyifunmi Sangoleye PhD, RN, Administrative Nurse ll, University of Illinois Hospital and Healthcare System ANA Representative: Elaine Hardy PhD, RN, Dean of Academic Affairs, St. John’s College of Nursing ANA Representative: Roshni Shah MSN, RN, Faculty, DePaul University ANA Representative (Alternate): Diana Ortega BSN, RN, Staff Nurse/Ambulatory, Rush Oak Park Hospital

I N D I A N A W E S L E YA N U N I V E R S I T Y

The new board members will join the following directors whose terms continue through October of 2024: Monique Reed PhD, MS, RN – Vice President Jeannine Haberman DNP, MBA, RN, CNE – Treasurer Samuel Davis Jr. MHA, RN, CNOR – Director Hannah Shufeldt MSHCM, BSN, RN – Director (Recent Grad)

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Illinois Advanced Practice Registered Nurses Elect New Board Members

MANTENO – The Illinois Society for Advanced Practice Nursing announced the election results during the association’s 2023 annual meeting during the APRN Midwest Conference held on October 7th.

The new leadership includes advanced practice registered nurse leaders from across the state and from a variety of backgrounds.

The newly elected board members are as follows: President Elect April Odom APRN, FNP-BC Treasurer Debra Lowrance DNP, APRN, CNM, WHNP, IBCLC Program Committee Chair Yvonne Tumbali DNP, APRN, ACNP-BC CNM Rep Leta Vega DNP, APRN, CNM CNP Rep Misty Kirby-Nolan DNP, MSN, APRN-CNP West Central (WC) Region Chair Doug McKain DNP, APRN-FPA, FNP-C Northwest (NW) Region Chair Mary McNamera DNP, APRN, CNP, FAANP Northeast/South (NE/S) Region Chair Jenise Farano DNP, APRN-FPA, FNP-BC, PMHNP-BC The new board members will join the following directors whose terms end in October 2024: President Stephanie Crawford DNP, APRN, CNP Secretary Alyssa Smolen DNP, APRN, FNP-BC GR/PAC Chair Raechel Ferry-Rooney DNP, APRN, ANP-BC CNS Rep Christine Somberg MS, APRN, CNS, ACNS-BC, NE-BC CRNA Rep Ryan Lewandowski DNP, APRN, CRNA Northeast/North (NE/N) Region Chair April DeMito DNP, APRN, FNP B-C East Central (EC) Region Chair Wamaitha Sullivan DNP, APRN-FPA, PMHNP-BC Student Rep Alexis Manning BSN, RN About ISAPN: Formed in 2002, the Illinois Society for Advanced Practice Nursing is a powerful network of advanced practice registered nurses who are committed to advancing the profession through education and political action. ISAPN is the leading voice of the approximately 14,000 advanced practice registered nurses in Illinois.

To become a member of the Illinois Society for Advanced Practice Nursing, visit www.isapn.org.

December 2023

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School Nurses Supporting Youth Behavioral Health in Schools

by Gloria E. Barrera, MSN, RN, PEL-CSN

According to the Centers for Disease Control (2022) the number of students experiencing poor mental health is growing, especially among LGBTQ+, female, and Black students. Youth who have mental health problems are more likely to experience violence, engage in risky behavior, and struggle with school, which we know can have long-term impacts on their schooling, career, and life trajectories. In the wake of the pandemic, it became even clearer that schools need additional structures, and supports to identify, triage, and address student needs. School nurses are in a unique position to provide a range of support not only to these students, but also to our school communities. School nurses are often the initial access point to identify behavioral concerns, determine interventions, and link families to school and community resources. It is important for school nurses to have the necessary knowledge and skills to advocate for their role as part of the school-based behavioral team. The National Association of School Nurses [NASN] (2023) launched a new no-cost NCPD program, Elevating the Role of School Nurses of School Behavioral Healthcare Teams, which aims to help school nurses: • Understand the best practices for creating an integrated, comprehensive, and effective school-based behavioral healthcare team.

• Clearly articulate their role as part of the school-based behavioral healthcare team.

• Collaborate effectively with other school staff, specialized instructional support personnel, and school administrators to create a comprehensive network of support for students and staff.

Members can find the NCPD program on the NASN website under the course catalog (NASN, 2023) References NASN. (2023). Elevating the Role of School Nurses in School-Based Mental and Elevating the Role of School Nurses in School- Based Mental and Behavioral Health. https://higherlogicdownload. s3.amazonaws.com/NASN/8575d1b7-94ad-45ab-808e-d45019cc5c08/UploadedImages/ PDFs/Advocacy/CDC-03_SBMH_Consensus_Document_edited_6-14-23-2.pdf

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December 2023

The Nursing Voice

ANA-Illinois Announces the 2023 Award Winners

Pictured left to right – Jennifer Sandoval, Liliana Trespalacios, Rocio Sanchez, Gloria E. Barrera

During the Membership Assembly on November 4th held in Urbana, Illinois nurses from across the state celebrated the achievements of 4 ANA-Illinois members.

Annual awards include Clinical Practice Award; Nurse Influencer Award;

The Clinical Practice Award recognizes an exemplary nurse who provides evidence of a high level of skill in in-patient care through improving clinical practice and patient-centered outcomes. The 2023 Clinical Practice Award Winner – Rocio Sanchez. Rocio is an amazing skilled nurse offering stellar patient care in a fast-paced facility. Advocate Condell Medical Center has been her home for almost 15 years. She divides her clinical practice between the intensive care unit and emergency department settings. Her clinical skills are such that she precepts, inspires, mentors’ nurses to perform their best care in these acute care settings. As an engaged exemplar role model in a strong magnet institution, she is now president of the midwest region of shared governance structure where she represents thousands of nurse staff and leads the professional development course.

Her passion and enthusiasm for nursing is unparalleled and exemplified by her deep commitment to academic success, transformational patient care and exemplary community engagement.

The Nurse Influencer Award recognizes an exemplary nurse who has influenced the science of nursing practice or care delivery system, a group/community/population (patient or other care providers), sick or well. Contributes to health or its recovery (or to peaceful death) in any care or community setting (at any level, local, regional or national level) or nursing profession through education, advocacy, policy, or practice. Mariam webster defines an influencer (noun) as "one who exerts influence, a person who inspires or guides the actions of others." This year’s Nurse Influencer Award winner is Gloria E. Barrera.

Gloria E. Barrera took office as president of the Illinois association of school in 2020, becoming the first Latina president of IASN, and served for two years, at the height of the pandemic. Her leadership has demonstrated positive influence within the specialty of school nursing locally, regionally, and nationally. During her presidency, she was the voice of school nurses in Illinois and provided many opportunities for IASN members to amplify their own voice and leadership. She promoted wellness and educational success of school communities by supporting,

developing and advocating for all professional school nurse leaders. She led the development of a school nurse toolkit on vaccine with the ICAAP. Barrera believes that all students have a right to have their physical and mental health needs safely met while in the school setting, no matter their zip code. She spearheaded the work to promote legislation to appropriate funding for a school nurse capacity study since January 2022 and ignited the idea for the inaugural annual school nurse lobby day in 2023. She made it clear that the data collected from the school nurse capacity study would help drive action for our work in optimizing student health and learning for the future. The influence she generated behind HB5601 and HR817 led to the Illinois State Board of Education allocating a school nurse capacity study and provide funding of $350,000. Her dedication to the nursing profession, strong involvement with other nursing organizations, leadership roles within nursing, and commitment to the improvement of public health is unwavering and most deserving of the nurse influencer award.

The 2023 Student Nurse of the Year Award was presented to Liliana Trespalacios. The student nurse of the year award recognizes an outstanding student nurse who exemplifies compassion, exceptional promise in clinical expertise, and academic achievement- the underpinnings of nursing excellence. Liliana is an ideal student nurse who has resilience and dedication in this world, filled with challenges. She has been on an amazing journey at Herzing university. Despite the financial burden and the demands of balancing two jobs, she made the courageous decision to return to school amidst a global pandemic after a decade-long absence from the academic world. She has been a certified medical assistant for over a decade pre-covid. She is an active student member of an ANA-Illinois affiliate, the Hispanic Nurses Illinois chapter, NAHN-Illinois. Despite the post-covid-19 challenges, she approached her academic responsibilities with unwavering seriousness and dedication. Through countless hours of studying and perseverance, she embraced her nursing curriculum

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The Nursing Voice

December 2023

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and consistently excelled, proudly earning a place on the president’s and dean’s lists. This commitment to excellence in academia has been recognized by several scholarships, such as the strive scholarship awarded by Herzing university and the NAHN Illinois scholarship in 2022, followed by the honor of being named an Abbott scholar by National in July 2023. She is a mentee of an incredible network of individuals who believe in her, support her, and carry her when needed. Liliana has a heart for service beyond the classroom, she has a passion for serving and giving back to the community.

Jennifer Sandoval was presented the Diversity, Equity, and Inclusion Leadership Scholarship Award was created to intentionally invest in the professional development of nurse leaders that have been historically and systematically marginalized in nursing. As the 2023 Award recipient, Jennifer will receive funding to support her attendance at the DEI Leadership Institute American Association of Colleges of Nursing.

The Hearts of Nursing By: Irene McCarron, RN Some years ago, the INf President facilitated a “Thank You Nurses” activity which aimed to celebrate the other talents of nurses. We were to paint the RN caduceus. Many signed up and a basic painting packet arrived at our doors several weeks before the 2021 Nurses Week. BYOB was allowed to enhance the camaraderie and enjoy the afternoon during the virtual painting party, this was the COVID19 season. Most of the participants did not have any previous painting experience. The activity lasted for about two hours. It was a fun evening of discovering hidden talents that probably should stay hidden! More importantly, it was an evening of appreciating colleagues, laughter, and realizing other positive energies we can apply when we go back to our bedside assignments.

I am sharing a “masterpiece” that came out of that event. What it depicts is the journey of a nurse through Benner’s novice to expert levels. The white canvass facing me represented the novice phase, the blank slate when one starts a nursing career. Fresh off NCLEX and then through new employee orientation, one does not even know what one does not know. The instruction sheet, brushes, and paints represented the tools in the form of directives, SOPs, policies and procedures, preceptors and mentors that help one navigate through advanced beginner to competent, and on to expert, the finished canvas. One day, this masterpiece will be gone but throughout my continuum of learning, it is a gentle reminder that learning never stops, let alone the challenges we face, but at the end of the day, the journey can be fun!

Editor’s note: Not only are they adept at patient care but many also excel in fine arts, performing arts, culinary arts, and other activities that only confirm the many “hearts” of nurses. This new column features activities that showcase what is also meaningful to them. We invite you to contribute an article about a play you starred/ participated in, a poem you composed, a recipe, a musical instrument you play, and other talents that must tell the world, nurses do not have a “heart” for patient care only, but also in all aspects of human interaction. Please submit your contribution via this link: info@ilnursesfoundation. com.

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December 2023

The Nursing Voice

PRACTICE CORNER

Illinois Law & Nursing Practice Nancy J. Brent, MS, JD, RN QUESTION: An RN reader submitted a question about her potential liability when providing care to the homeless or those who cannot afford medical care due to finances or not having medical insurance. She stated that she feels an ethical duty to volunteer to provide such care but does not want to expose herself or her family to a lawsuit should a patient sue her for negligence. She wonders if she should volunteer or find other ways to help these populations.

ANSWER: Nancy J. Brent, The reader can go forward with volunteering. The Illinois MS, JD, RN legislature has provided protection for Illinois citizens who volunteer to help others in numerous statutes and those protections have been recodified in the Illinois Good Samaritan Statute (GSS). Furthermore, the protections in the GSS are to be “liberally construed” to encourage volunteering by Illinois citizens.

The GSS provides for immunity from a civil lawsuit alleging “ordinary” professional negligence for acts or omissions of care voluntarily given by licensed nurses (and other health care providers) unless the conduct of the nurse constitutes willful (deliberate) or wanton (malicious) misconduct.

There are specific conditions that must be met for the GSS protections to apply to volunteer care, however. They include: • The care must be done in good faith (honesty of purpose) • No compensation or fee for care provided Because the reader, and any RN, might volunteer in many settings and in many situations, the GSS lists where and under which circumstances the GSS attaches. They include: • The provision of emergency cardiopulmonary resuscitation (in accordance with standards of the American Red Cross or the American Heart Association) • The use of an automated external defibrillator in an emergency in accordance with training • Provision of medical treatment, diagnosis, or advice in an established free medical clinic for care not requiring the services of a licensed hospital or ambulatory surgical treatment center, and to nurses (and other health care providers) who provide further medical treatment, diagnosis, or advice upon referral from the established free medical clinic. The GSS’s immunity provisions must be posted in a “conspicuous place on the premises”.

• Care in a free medical clinic that does not have a physical location so long as the immunity provisions of the GSS are provided in writing (clearly, concisely, and understandably) to a patient or a minor’s parent or guardian and signed by the patient or parent or guardian “Free medical clinic” is defined in the GSS as an organized community based program where the care provided does not include the use of general anesthesia or require an overnight stay in a health care facility, or a program organized by a certified local health department using members of the Volunteer Medical Reserve Corps (a federal organization) and which care does not require an overnight stay in a health care facility.

There is additional, general information the RN should know about volunteering her nursing services.

Immunity from a civil lawsuit for ordinary negligence would not occur if the RN provided care that was outside her scope of practice. As a result, any nurse volunteer must know of, and conform to, the state nurse practice act’s definition of the scope of nursing practice.

The RN is not protected under the GSS if she is responsible for the injury to a patient to whom he or she then provides care for that injury.

For example, suppose the RN administered the wrong medication to a patient in a free clinic and the patient suffers a sudden cardiac arrest. She begins cardiopulmonary resuscitation. The patient recovers and sues the RN. The GSS would not apply.

Consent for treatment is also necessary when volunteering nursing services. Most often, it is the physician who explains the elements of informed consent and obtains the informed consent from a patient. For advanced practice registered nurses (APRN), however, the informed consent of the patient must be obtained by the APRN who diagnoses, orders, and provides care. This consent includes: • The name of the procedure, treatment, or medication • An explanation of the procedure, treatment, or medication • The necessity of the procedure, treatment, or medication • The benefits expected (not guaranteed) with the procedure, treatment, or medication • The significant risks of the procedure, treatment, or medication, if any • The prognosis if the recommended procedure, treatment, or medication is refused.

Keep in mind that informed consent is presumed if the patient’s condition is such that delaying treatment for the purposes of obtaining consent would result in the patient’s death. This is true for adults as well as minors.

Also, if the patient is a minor (under 18 years of age), informed consent must be obtained from the parent or guardian (with exceptions not discussed here).

The RN, and any RN, also need to know that the Illinois GSS provides for immunity for licensed nurses who provide health care services as a disaster relief volunteer when an earthquake, hurricane, tornado, nuclear or terrorist attack, epidemic or pandemic strikes.

In addition, the GSS provides immunity “to any person” in situations that don’t involve nurses per se, including aiding a food choking victim occurring at a food-service establishment, at the scene of an emergency that requires the evacuation of a building, first aid providers certified by the American Red Cross, the American Heart Association, or the National Safety Council, and “to any” person who provides emergency instructions under the Emergency Telephone System Act (9-1-1) to those rendering services at another location or to any person rendering those services.

The entire GSS can be read by placing The Illinois Good Samaritan Act in the browser search bar.

This information is for educational purposes only and is not to be taken as specific legal or any other advice by the reader. If legal or other advice is needed, the reader is encouraged to seek such advice from a nurse attorney, attorney or other professional.

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The Nursing Voice

December 2023

How Alternative Medicine is Successfully Treating Long COVID

By Dr. Jennifer Green Although COVID-19 cases are winding down and dropping out of the news, it still remains an ongoing health challenge for millions of Americans. Research shows that more than 1 out of 3 people who contract COVID-19 continue to suffer from a condition called Long COVID. With few conventional medicine options, many patients are seeking relief from complementary and alternative medicine services offered at the Whole Health Center clinic of the National University of Health Sciences (NUHS) in Lombard, Illinois.

What is Long COVID? Those suffering from Long COVID continue to experience symptoms weeks, months or even years after contracting COVID-19. Since the early days of the pandemic, clinicians and student interns at the NUHS Whole Health Center have seen symptoms that include fatigue, digestive symptoms such as loss of appetite, nausea, vomiting, etc., and respiratory symptoms such as shortness of breath and cough. Post-exertional malaise, fatigue and brain fog are among the most commonly reported symptoms of Long COVID (Thaweethai et al., 2023).

Through various natural, noninvasive treatments, naturopathic medicine interns have found success improving and lessening the severity of these symptoms.

Today they continue to see patients with Long COVID as a primary concern or in connection to a chief complaint.

The following is a few of the ways NUHS naturopathic medicine clinicians and interns are treating Long COVID. Similarities in Treatment to Post-viral Syndrome COVID-19 is not the only virus that can cause longterm symptoms. Post-viral syndrome is a complex condition that occurs after the body fights off any viral infection such as the common cold, flu, pneumonia, Epstein-Barr virus, herpes, and HIV (“What to Know,” 2019).

Post-viral syndrome can cause multi-organ effects or autoimmune conditions that involve many body systems, including the heart, lung, kidney, skin, and brain (“Long COVID or Post-COVID Conditions,” 2023).

This may make those who have had COVID-19 more likely to develop new health concerns such as diabetes, heart conditions, blood clots, or neurological issues. Therefore, it’s crucial that those who have symptoms of Long COVID seek treatment.

Since COVID-19 is a virus, NUHS clinicians treat Long COVID similar to how they might treat post-viral syndrome. Overall treatment focuses on reducing inflammation, supporting the immune system, balancing the nervous system, and supporting the body’s stress response. This can be through a number of modalities and recommendations such as proper nutrition, increased sleep, exercising or receiving a massage.

Restoring Nutrient Deficiencies Long COVID is associated with some specific nutrient deficiencies. This can vary among individual patients.

Clinicians will usually provide a personalized plan that will help restore these deficient nutrient levels. Depending on the plan, the treatment may come in the form of dietary

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recommendations or nutraceuticals. Unlike supplements, nutraceuticals are made up of whole foods/ingredients.

This may include omega 3 fatty acids, vitamin D, probiotics and CBD oil (Schloss, 2023), (Bose, 2022).

Low Level Laser Therapy for Loss of Taste and Smell Loss of taste and smell is commonly reported among those with COVID-19. In fact, it’s one of the COVID symptoms that many find to be the most challenging.

Even after recovering from COVID-19 patients can continue to experience this issue. At the Whole Health Center, clinicians have found that utilizing low level laser therapy (cold laser) can improve a loss or impaired taste and smell. This type of therapy uses photons at a nonthermal irradiance to alter biological activity through the use of lasers, filtered lamps and LEDs. Low level laser therapy can help stimulate healing, reduce inflammation and increase skin rejuvenation (Gupta et al., 2013). The therapy also has the added benefit of causing few adverse reactions or side effects.

Hydrotherapy Hydrotherapy can also be effective for treating Long COVID. Since the NUHS Whole Health Center opened a new hydrotherapy suite in 2017, clinicians and interns have been utilizing the therapeutic benefits of water to treat several types of ailments and boost various body systems and functions.

There are several forms of hydrotherapy (“Types and Health Benefits of Hydrotherapy,” 2021). Depending on the patient’s health history and specific symptoms, clinicians may recommend: • Constitutional Treatments: A one-hour series of alternating hot and cold compresses to the abdomen and thorax to support digestion and elimination, relieve stress, and boost immunity.

• Far infrared (FIR) saunas: The use of infrared heat, which penetrates the body more deeply than warmed air. This type of treatment has a variety of health benefits. It can help detoxify heavy metals, promote weight loss, improve sleep, reduce chronic pain, and reduce systolic hypertension.

• Peat Immersion Baths: A 10-20 minute soak in a hot tub infused with a special mixture that promotes detoxification, followed by a 20-minute “perspiration phase” where the patient is wrapped up and allowed to relax on the treatment table.

At National University of Health Sciences, the modern hydrotherapy suite includes a room dedicated to constitutional treatments, Hubbard tank and steam cabinet, allowing interns to learn and perform a dozen different hydrotherapy treatments.

Botanical Medicine Botanical medicine, or natural, organic, non-synthetic plant based-medicine, is another one of the tools that naturopathic medicine doctors use for therapeutic purposes. Various herbs and tonics can have profound effects on Long COVID symptoms with few adverse side effects. For example, gingko (Tao et al., 2019) and ginger (Ballester et al., 2022) can be used to reduce inflammation while echinacea can provide an immune system boost (Zhai et al., 2007).

How the Clinic is Preparing Students to Treat Long COVID Long COVID is an ailment current students can expect to see in practice well into the future. At the Whole Health Center, students are able to gain valuable experience before they even graduate. With each patient, students learn what symptoms to look for, the most pertinent history questions to ask, how to fine-tune their physical exam skills, and what is the most appropriate laboratory testing and medical work-up. Additionally, although naturopathic treatment protocols are based on individual needs, there are common themes/areas. When students learn these areas, it helps them focus on what is needed for treatment. This way, they are prepared to confidently treat Long COVID at their future practice.

To learn more about the NUHS Whole Health Center visit the NUHS website. To set up an appointment at the Lombard, Illinois location, including virtual visits, call (630) 629-9664.

Dr. Jennifer Green Jennifer Green, ND, DC, is Chief Clinician of Naturopathic Medicine at National University of Health Sciences’ Whole Health Center clinic in Lombard, Illinois.

Dr. Green previously served as an ND clinician for

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nearly 10 years. She earned her Doctor of Naturopathic Medicine degree from NUHS in 2010 and her Doctor of Chiropractic degree from NUHS in 2021.

Dr. Green specializes in women’s health, pediatrics, autoimmune and endocrine disorders, lab diagnostics, Neurostructural Integration Technique (NST), general naturopathic practice, and has a strong determination for finding the root cause of symptoms and individualizing treatments for each person.

Thaweethai, T., Jolley, S. E., Karlson, E. W., Levitan, E. B., Levy, B., McComsey, G. A., McCorkell, L., Nadkarni, G. N., Parthasarathy, S., Singh, U., Walker, T. A., Selvaggi, C. A., Shinnick, D. J., Schulte, C. C. M., Atchley-Challenner, R., Alba, G. A., Alicic, R., Altman, N., Anglin, K., Argueta, U., …

RECOVER Consortium (2023). Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA, 329(22), 1934–1946. https://doi.org/10.1001/jama.2023.8823 What to know about post-viral syndrome. (2019, October 10).

Retrieved from https://www.medicalnewstoday.com/ articles/326619#summary Long COVID or Post-COVID Conditions. (2023, July 20).

Retrieved from: https://www.cdc.gov/coronavirus/2019ncov/long-term-effects/index.html Schloss J. V. (2023). Nutritional deficiencies that may predispose to long COVID. Inflammopharmacology, 31(2), 573–583. https://doi.org/10.1007/s10787-023-01183-3 Bose P. (2022, July 28). The effects of CBD in the treatment of COVID-19–related inflammatory symptoms. News Medical. https://www.news-medical.net/news/20220728/ T h e - e f f e c t s - o f - C B D - i n - t h e - t r e a t m e n t- o f - C O V I D 19e28093related-inflammatory-symptoms.aspx Avci, P., Gupta, A., Sadasivam, M., Vecchio, D., Pam, Z., Pam, N., & Hamblin, M. R. (2013). Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. Seminars in cutaneous medicine and surgery, 32(1), 41–52.

Types and Health Benefits of Hydrotherapy. (2021, November 5). Retrieved from: https://health.clevelandclinic.org/whatis-hydrotherapy/ Tao, Z., , Jin, W., , Ao, M., , Zhai, S., , Xu, H., , & Yu, L., (2019).

Evaluation of the anti-inflammatory properties of the active constituents in Ginkgo biloba for the treatment of pulmonary diseases. Food & function, 10(4), 2209–2220. https://doi.org/10.1039/c8fo02506a Ballester, P., Cerdá, B., Arcusa, R., Marhuenda, J., Yamedjeu, K., & Zafrilla, P. (2022). Effect of Ginger on Inflammatory Diseases. Molecules (Basel, Switzerland), 27(21), 7223. https://doi.org/10.3390/molecules27217223 Zhai, Z., Liu, Y., Wu, L., Senchina, D. S., Wurtele, E. S., Murphy, P. A., Kohut, M. L., & Cunnick, J. E. (2007). Enhancement of innate and adaptive immune functions by multiple Echinacea species. Journal of medicinal food, 10(3), 423– 434. https://doi.org/10.1089/jmf.2006.257

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December 2023

The Nursing Voice

idfpr.illinois.gov JB PRITZKER Governor

MARIO TRETO, JR. Secretary

CAMILE LINDSAY Acting Director

The Illinois Department of Financial and Professional Regulation (IDFPR) has online nurse resources available!

• IDFPR has announced as new Acting Director of Professional Regulation, Camile Lindsay (pending confirmation by the Illinois Senate). Appointed by Governor JB Pritzker, Lindsay previously served in the Pritzker Administration as First Assistant Deputy Governor for infrastructure, public safety, environment, and energy. https://idfpr.illinois.gov/ news/2023/idfprnewprofessionalregulationdirector. html.

• As required by the Illinois Nurse Practice Act, all nurses shall complete continuing education prior to license renewal. There are new requirements beginning in 2024, including completing implicit bias awareness training. The Division of Professional Regulation (DPR) webpage has implicit bias awareness CE information: https://idfpr.illinois.gov/ dpr.html. Implicit bias is a form of bias that occurs automatically and unintentionally, that nevertheless affects judgments, decisions and behaviors.

• The CE requirement for implicit bias awareness training and the CE requirement for sexual harassment prevention training is included in the number of hours already required under the individual Nurse Practice Act and Rules. This does not increase the number of hours required to renew a license. For details, please see the CEU FAQ sheets on the Nursing Workforce Center website: https://nursing.illinois.gov/nursing-licensure/ continuing-education.html.

• The Illinois Department of Financial and Professional Regulation (IDFPR) is providing renewal assistance for individuals and businesses that are having difficulty with the online renewal process: https://idfpr.illinois.gov/dpr.html. These steps will help licensees better navigate the account matching process on the Department's updated online portal.

• For US residents with an Illinois nurses license, to change your email address, U.S. mailing address or phone number, please click on this link to update the information: https://idfpr.illinois.gov/fprapplications/licensereprint.html. This form is not for international residents who must download a paper form found on that same page.

• Military families: Members and Spouses who are an active duty member or whose active duty service concluded within the preceding two years before application. In addition to expedited review of your application (30 days), the Department’s dedicated Military Liaison will work with you and your military installation’s military and family support center to help you through the licensing process. Learn more

Empowering the hands that heal

We’re hiring nurses! Join our nursing team and find a rewarding career at one of our long-term acute care hospitals.

Please visit jobs.ScionHealth.com to view our current openings and apply.

here: https://idfpr.illinois.gov/military.html. You may also email the Military Liaison using this email address: fpr.militarylicense@illinois.gov.

• To print your license or download an electronic copy to your phone, just head to the IDFPR website https://idfpr.illinois.gov/fpr-applications/ getmylicense/loginprof.html.

• The IDFPR “Requirements of an Internationally Educated Nurse” document is available online here: https://idfpr.illinois.gov/content/dam/soi/ en/web/idfpr/renewals/apply/forms/cgfns-02.pdf.

Resources on this document include the names of Board of Nursing approved vendors for items required to apply for an Illinois nurse license. o Information includes that endorsing an active license from another state requires: an application by Endorsement. o If the state of original licensure required a Credential Evaluation Service (CES) report at the time of original licensure, a (CES) report is not required for the licensure endorsement process. o An English equivalency test is not required as long as the nurse applying for endorsement took and passed the NCLEX® licensure examination.

• On the IDFPR Nurses web page ,there is a list of all 138 Illinois Board of Nursing approved RN/ Registered Nurse and LPN/Licensed Practical Nurse pre-licensure nursing education programs: https:// idfpr.illinois.gov/content/dam/soi/en/web/idfpr/ forms/dpr/nurseschools.pdf.

• A complete copy of the Illinois Nurse Practice Act and the Rules may be found on the Division of Professional Regulation (DPR) Nurses webpage: https://idfpr.illinois.gov/profs/nursing.html. or on the Illinois Nursing Workforce Center’s website: https://nursing.illinois.gov/nursinglicensure/nursing-act-rules.html.

• Tips for first time registration for individual online account matching process found here: https://idfpr. illinois.gov/Forms/Online/Renewal%20Tips%20 Individual%20Accounts%202021-12-15.pdf.

For most licensees, this will be the first time logging into your IDFPR Online Services Portal Account. You will need to Register and MATCH to your existing license record. If you applied for your initial license via the IDFPR portal, you can use the username and password created at that time. For those requiring additional assistance with the login process, please contact IDFPR by emailing fpr.lmu@illinois.gov.

Please enter "RENEWAL" in the subject line of your e-mail.

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• Complaints against any individual or entity regulated by the Division of Professional Regulation may be filed by contacting the Complaint Intake Unit. For a complete list of professions regulated by DPR, please click https://idfpr.illinois.gov/content/ dam/soi/en/web/idfpr/forms/brochures/dpr.pdf.

• Please note: Pursuant to Illinois law (20 ILCS 2105/2105-117), all information collected by the Department during an examination or investigation of a licensee, registrant, or applicant is confidential and cannot be publicly disclosed. This includes complaints and any information collected during an investigation. Exceptions to this law exist only for law enforcement, other regulatory agencies with appropriate regulatory interest, or a party presenting a lawful subpoena. The Division of Professional Regulation online complaint form may be found here: https://idfpr.illinois.gov/admin/dpr/ complaint.html.

End COVID-19 Public Health Emergency May 11, 2023 • On May 11, 2023, Governor Pritzker ended the state of Illinois' public health emergency. All Variances, Proclamations, and Guidance issued by IDFPR for the duration of the Gubernatorial COVID-19 Proclamation have now ended. Find the latest information at: https://idfpr.illinois.gov/covid-19. html.

• Governor JB Pritzker declared May 11 "Illinois Public Health & Health Care Hero Day." Governor Pritzker aligned the conclusion of the state's disaster proclamation with the conclusion of the federal government's COVID-19 public health emergency, to ensure enhanced federal benefits in SNAP and Medicaid remained in place for vulnerable families for as long as possible https://idfpr.illinois.gov/ covid-19.html.

"With the heroic efforts of our healthcare workers and institutions, the perseverance and grit of the people of Illinois, and with 26 million vaccine doses administered, I couldn't be happier to announce today that all national and state COVID-19 related emergency declarations have finally come to an end," said Governor JB Pritzker.

• The State of Illinois Coronavirus Response Site: The COVID-19 Vaccine Plan, up-to-date information on what Illinois is doing protecting the health, safety, and well-being of Illinoisans can be found at https://coronavirus.illinois.gov/s/.

Submitted by October 25, 2023 for publication in Nursing Voice, distribution December 2023.

To access electronic copies of the Nursing Voice, please visit https://www.healthecareers.com/nurseresources/nursing-publications/illinois

The Nursing Voice

December 2023

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New Continuing Education (CE) Requirement for Illinois LPN, RN, APRN and FPA-APRN License Renewal Beginning in 2024 The Department continues to receive inquiries regarding continuing education required by the Registered Professional Nurse (RN) by the license renewal deadline of May 31, 2024. The questions and answers listed below will hopefully provide some clarification.

Please note that a complete copy of the Illinois Nurse Practice Act and the Rules may be found on the IDFPR website (https://nursing.illinois.gov/nursing-licensure/ nursing-act-rules.html).

Nursing re-licensure CE information is available on the Illinois Nursing Workforce Center’s website at https://nursing.illinois.gov/nursinglicensure/continuing-education.html.

New 2024 Requirements: The implicit bias awareness training CE requirement is required of all persons who hold a professional license issued by the Division of Professional Regulation (DPR) and are subject to a continuing education (CE) requirement beginning after January 1, 2024. The DPR webpage has implicit bias awareness CE information https://idfpr.illinois.gov/dpr.html.

Implicit bias is a form of bias that occurs automatically and unintentionally, that nevertheless affects judgment, decisions, and behaviors. Any training on implicit bias awareness applied to meet any other State licensure requirement, professional accreditation or certification requirement, or health care institutional practice agreement may count toward the one-hour implicit bias awareness training requirement for license renewal.

A licensee may count the one-hour completion of this course towards meeting the credit hours required for re-licensure continuing education (Public Act 102-004, Admin Code Title 68: Section 1130.500 https://www.ilga.gov/commission/jcar/ admincode/068/068011300E05000R.html).

This requirement shall become effective for all applicable license renewals occurring on or after January 1, 2024. Use this link to the DPR webpage with implicit bias awareness CE information: https://idfpr.illinois.gov/ dpr.html.

Alzheimer’s Disease: Beginning with the 2024 RN renewal, Illinois RNs who provide health care services to and have direct patient interaction with adults 26 years of age and older will be required to complete a one-hour course in diagnosis, treatment and care of Alzheimer's disease, along with other dementia types. CE Curriculum will involve how to identify and diagnose Alzheimer's, effective communication strategies and management and care planning. This course may count toward the regular CE requirements (Public Act 102-0399, 20 ILCS 2105/2105-365).

Sexual harassment prevention training CE requirement. A law went into effect on January 1, 2020, which requires individuals with licenses issued by the Illinois Division of Professional Regulation (DPR) that require continuing education (CE) to renew their license, to also complete one hour of CE on the topic of sexual harassment prevention training.

How many hours of Continuing Education (CE) will I need for 2024 license renewal?

• This new one hour of implicit bias awareness training CE course is intended to fit into the licensee’s regular CE requirements. RNs will be renewing their licenses in 2024, with one of the 20 hours of required CE to be an implicit bias awareness training course, while another one of the 20 hours of required CE must be sexual harassment prevention training.

• For APRNs and FPA-APRNs will be renewing their licenses in 2024, one of the 80 hours of required CE must be this new one hour of implicit bias awareness training course, while 1 of the 80 hours of required CE must be sexual harassment prevention training.

• LPNs will begin renewing their licenses in late Fall 2024, and one of the 20 hours of required CE must be this new implicit bias awareness training course.

Another one of the 20 hours must be a sexual harassment prevention training course.

What are the CE Course Rules for Illinois LPNs, RNs, APRNs and FPA-APRNs renewing their licenses in 2024?

The NPA Rules regarding CE requirements indicate that courses shall only be provided by existing Divisionapproved continuing education providers or sponsors or by persons or entities who become Division-approved continuing education sponsors.

How do I know if the sponsor is approved or licensed?

Is there a list of approved CE Sponsors and Programs for Illinois nurse license renewal in 2024?

CE sponsors must either be pre-approved per Nurse Practice Act Rule 1300.130 or must have a CE sponsor license. The list of pre-approved CE Sponsors and Programs is in the Rules for the Administration of the Nurse Practice Act, Section 1300.130: https://www.ilga.gov/commission/jcar/ admincode/068/068013000A01300R.html. c) Pre-Approved CE Sponsors and Programs 1) Sponsor, as used in this Section, shall mean: A) Approved providers of recognized certification bodies as outlined in Section 1300.400(a).

B) Any conference that provides approved Continuing Medical Education (CME) as authorized by the Illinois Medical Practice Act. C) American Nurses Credentialing Center (ANCC) accredited or approved providers.

D) Illinois Society for Advanced Practice Nursing (ISAPN).

E) American Academy of Nurse Practitioners (AANP).

F) Nurse Practitioner Association for Continuing Education (NPACE).

G) American Association of Nurse Anesthetists, or National Board of Certification and Recertification for Nurse Anesthetists (NBCNA).

H) National Association of Clinical Nurse Specialists (NACNS).

I) American College of Nurse Midwives (ACNM).

J) American Nurses Association-Illinois (ANAIllinois).

K) Illinois Nurses Association or its affiliates (INA).

L) Providers approved by another state's board of nursing.

M) Nursing education programs approved under Section 1300.230 or 1300.340 wishing to offer CE courses or programs.

N) Employees licensed under the Hospital Licensing Act (210 ILCS 85) or the Ambulatory Surgical Treatment Center Act (210 ILCS 5) O) Any other accredited school, college or university, State agency, federal agency, county agency or municipality that provides CE in a form & manner consistent with this Section.

Please note that this is not a complete list. In addition, organizations may obtain CE sponsor licenses issued by the Department. Use IDFPR’s License Lookup tool at https://www.idfpr.com/LicenseLookUp/LicenseLookup. asp (be sure to use “Nurse CE Sponsor” as the profession).

This is my first time renewing my Illinois LPN, RN, APRN or FPA-APRN license – do I need to complete the one hour of implicit bias awareness training CE prior to license renewal in 2024?

No, a renewal applicant shall not be required to complete one hour of implicit bias awareness training prior to the first renewal of an Illinois LPN, RN, APRN or FPA-APRN license.

What is the fee for Illinois LPN, RN, APRN or FPA-APRN license renewal in 2024?

The fee for the Illinois RN, APRN or FPA-APRN license renewal in 2024 shall be calculated at the rate of $40 per year or $80 at the time of renewal. For Illinois LPNs whose license renewal begins in late Fall 2024 and ends January 31, 2025, the fee for the renewal shall be calculated at the rate of $40 per year or $80 at the time of renewal.

Additional Continuing Nursing Education information, including a FAQ sheet and a list of pre-approved CE sponsors is available on the Illinois Nursing Workforce Center Website https://nursing.illinois.gov/nursinglicensure/continuing-education.html

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December 2023

The Nursing Voice

idfpr.illinois.gov JB PRITZKER Governor

MARIO TRETO, JR. Secretary

IL Nursing Workforce Center Advanced Practice Registered Nurse (APRN) Survey 2022 Voluntary survey participation was offered to Illinois APRNs through two eblasts, on October 5 and October 17, 2022. The data portal remained open from October 5 through November 15, 2022. A total of 4,268 APRNs completed the survey for a survey response rate of 24% APRNs. The data quantifies the services APRNs provide, the diversity of APRN specialty areas, the process that is used to bill for these services, the variety of settings where patients receive these specialized services and reimbursement for services.

Key Findings • Employment: 68% of APRNs work one job full-time (68%), 94% provide direct patient care.

• Employment setting: more (52%) APRNs work in ambulatory non-acute outpatient settings than in hospital acute care settings (32%) settings.

• Diversity: there is more racial and ethnic diversity of APRNs under the age of 45 years in the Illinois workforce.

• Age: The IDFPR Active Licensee database has 18.34% APRNs age 55 years and older. Approximately 32% of APRNs responding to the survey indicated they are over 55 years of age; survey age cohorts for Illinois APRNs in 2022 are similar to those reported 2018, 2020.

• Education: 83% of APRNs have a masters’ degree, 18% have a doctoral degree (DNP or PhD).

APRN Workplace Settings 52% Practice in an ambulatory setting – outpatient clinic, private APRN practice, private physician practice, hospital outpatient clinic, etc.

29% Practice in hospital acute care settings, an inpatient unit, the emergency room, etc.

5% Practice in Long Term Care, 5% in public or community settings, 2% palliative care Diversity More APRNs under the age of 55 years are from ethnic and racially diverse backgrounds.

More than half of the APRNs with Latinx ethnicity are under 45 years of age.

Approximately half of APRNS with Asian heritage are under 45 years of age.

Approximately forty percent of African American or Black APRNs are under 45 years of age.

APRN Billing/Reimbursement 42% Manage a panel of patients.

43% Bill exclusively under their National Provider Identifier (NPI) number.

Reimbursement for services is Medicare (34%), Medicaid (25%), Private Insurance (33%).

Summary The majority of APRNs are employed full-time in one position providing direct patient care.

The majority of APRNs are under 55 years of age, with more ethnic and racial diversity amongst these young APRNs. Reimbursement for services is divided amongst Medicare, Medicaid and Private Insurance.

The full report with additional details will be available after December 15, 2023 on the INWC website https://nursing.illinois.gov/resources/data-reports.html.

CAMILE LINDSAY Acting Director

Key Findings IL Nursing Workforce Center Full Practice Authority - Advanced Practice Registered Nurse (FPAAPRN) Survey 2022 Voluntary survey participation was offered to Illinois FPA-APRNs through two eblasts, on October 5 and October 17, 2022. The data portal remained open from October 5 through November 15, 2022. A total of 896 FPA-APRNs completed the survey, a 41% survey response rate.

The data quantifies the services FPA-APRNs provide, the diversity of FPA-APRN specialty areas, the process that is used to bill for these services, the variety of settings where patients receive these specialized services and reimbursement for services.

Key Findings • The majority of FPA-APRNs are a salaried employee working one job full-time, 31-50 hours per week, providing direct patient care, the median nnual income is $100,000-110,000.

• Employment setting: fifty-five per cent practice in an ambulatory setting – hospital outpatient clinic, private physician or nurse-run practice, urgent care, retail-based clinic, etc.

• Diversity: there is more racial and ethnic diversity of FPA-APRNs under the age of 54 years.

• Age: The IDFPR Active Licensee database has 24% of the FPA-APRNs age 55 and older. Approximately 40% of the FPA-APRN survey respondents indicated that they are 55 years of age or older. Survey respondents and the IDFPR Active Licensee Database both have approximately 29% of FPA-APRNs between 45 and 54 years of age.

• Education: 24% of FPA-APRNs have a doctoral degree, 21% of the doctoral degrees are a Doctorate of Nursing Practice (DNP).

Workplace Settings 55% Practice in an ambulatory care setting, such as a private physician or nurse-run private practice, hospital outpatient clinic, urgent care, retail-based care, etc.

15% Practice in hospital acute care settings, an inpatient unit, the emergency room, etc.

7% Practice in long term care, 7% public health, 2% palliative care, 12% other Diversity Most Illinois FPA-APRNs are between 35-54 years of age.

The racial, ethnic and gender diversity of FPA-APRN licensees is similar to that of the APRN licensees, with slightly more African American (11%) and Male (8%) FPA-APRNs. The racial and ethnic diversity of FPA-APRNs is more robust in FPA-APRNs under 44 years.

APRN Billing/Reimbursement 56% Manage a panel of patients and 48% bill exclusively under their individual National Provider Identifier (NPI) number, 18% bill under the clinic/facility NPI number.

Most FPA-APRNs see between 11 - 20 patients per day, with reimbursement for services from Medicare (23%), Medicaid (26%), Private Insurance (39%).

The full report is available on the INWC website after December 15, 2023. https:// nursing.illinois.gov/resources/data-reports.html.

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The Nursing Voice

December 2023

Page 15

idfpr.illinois.gov JB PRITZKER Governor

MARIO TRETO, JR. Secretary

CAMILE LINDSAY Acting Director

Illinois Nursing Workforce Center Registered Nurse (RN) Survey 2022 Voluntary survey participation was offered to Illinois RNs through two eblasts, October 5 and October 18, 2022. The data portal remained open from October 5 through November 15, 2022. A total of 58,385 RNs completed the survey for a survey response rate of 25% RNs. Key Findings: - Employment: 91% of nurses work full-time at one job and are actively employed in nursing.

- Employment setting: approximately half of Illinois RNs, 50%, work in an acute care setting such as a hospital; in 2020 52% worked in an acute care setting such as a hospital; 10% are employed in ambulatory care, non-acute, outpatient settings.

RN positions vary per setting.

- Diversity: consistent with the increase in ethnic and racial diversity in Illinois, there is a slight increase in the diversity of the Illinois RN nurse workforce.

There is more racial, ethnic and gender diversity of RNs under the age of 45 years in the Illinois workforce.

- Education: 73% of RNs have either a bachelors, masters, or doctorate as the highest nursing education degree.

Diversity - 64% of Hispanic/Latinx nurses are 44 years of age or younger.

- 50% of nurses that are male are 44 years of age or younger.

- 52% of Asian nurses are 44 years of age or younger.

Age of the RN Workforce - 43% of the RN survey respondents are 55 years of age and older, while the Active Licensee database indicates that only 28% of RNs are 55 years of age or older.

- 59% of nursing faculty are 55 years of age and older.

RN Employment Settings - 51% of RNs practice in a hospital/acute care setting–especially nurses in younger age cohorts.

The hospital is the most common acute-care employment setting.

- 13% of RNs practice in ambulatory care, non-acute, outpatient settings, including outpatient clinics, private practice, doctor offices, etc.

- 7% of RNs practice in a nursing home/extended care/assisted living setting.

- 4% of RNs are school nurses; 6% are home health nurses, 3% are public health nurses.

RN Position Role - 63% of RNs provide direct patient care as staff nurses in acute and non-acute care settings.

- 14% Identify as a nurse manager, administrator, executive or patient care coordinator.

- 3% Identify as nursing faculty.

- The average staff nurse acute care salary ranges from $65,000-$85,000 (31%), $85,001-$105,000 (23%); $105,001-$145,000 (16%); the average administrator/manager’s salary ranges from $75,000-$185,000; the average nursing faculty salary ranges from $65,000-$85,000.

The full report is available on the INWC website after December 18, 2023 https://nursing.illinois.gov/resources/ data-reports.html.

Food Insecurity: What it Means for the Patient and the Nurse Linda Anders, MBA, MSN, RN, CSRN, NPD-BC As patients become more complicated with complex health conditions, the expectations placed on them in all facets of the healthcare continuum also change. As healthcare professionals, nurses play a pivotal role in educating the patient and being an advocate for them.

For the patients to be able to meet the expectations for their chronic health conditions and to be their healthiest, they need to feel safe and secure, and that they have basic needs fulfilled.

Looking at the needs of the patient, it would be prudent to focus on Maslow’s Hierarchy of Needs.

According to Maslow (1943), "one must satisfy lower-level needs before addressing those needs that occur higher in the pyramid” (University of Central Florida, n.d., para.

3). The base of Maslow’s are the physiological needs which include food, water, shelter, and warmth (Maslow, 1943). Patients need to know that they have their basic needs met before they can embrace safety, employment, relationships, development of their self-worth, etc.

So, what does this mean for our patients? Food insecurity is when an individual lacks regular access to adequate nutritious food for healthy growth and development to be able to live an active and healthy lifestyle (United Nations, 2023). Food insecurity has been identified as potentially the most impactful Social Determinant of Health (SDOH) according to the National Academies of Sciences, Engineering, and Medicine (2019).

It is not just an American issue as food insecurity is a global issue both recognized in the social determinants of health under the pillar of economic stability and is also addressed by the United Nations Sustainable Development Goal 2 (United Nations, n.d.). 2.37 billion people are without food or are unable to eat a healthy balanced diet worldwide according to the 2020 statistics from the United Nations. Food insecurity is a global issue, thus affecting nurses and the patients they care for globally. According to the United Nations (2022, para.

1), “Between 2014 and the onset of the pandemic, the number of people going hungry and suffering from food insecurity had been gradually rising. And now with the war in Ukraine disrupting the global food supply chains and the COVID-19 pandemic, all forms of malnutrition are exacerbated”.

In the state of Illinois in 2020, 8.3% of the population were food insecure with the average meal cost in the state being $3.19 (Feeding America, 2023). As anticipated, the food insecurity rate increased in 2021 to 9.5% with the average meal cost in the state of Illinois being $3.58 (Feeding America, 2023). So, what does this mean to the nurse in Illinois? As a nurse, it is important to keep in mind Maslow’s pyramid when interacting with patients in all areas of the clinical places and spaces. Chances are they will interact with patients that do not always have access to food. According to the American Academy of Pediatrics (2021, p. 3), "as many as 1 in 4 children live in households that are food insecure".

Best practice includes incorporating SDOH screening at clinic appointments and at admission to the hospital setting. Some electronic medical records have various SDOH screenings built into the admission and rooming processes. However, if the electronic medical record does not have such, utilization of paper screenings can occur.

Once screening occurs, it is imperative that the nurse openly communicate the findings with the provider so that appropriate follow-up can occur. As a nurse, one should become familiar with resources that are available in their personal community as they vary, but resources include, and are not limited to, social workers, outreach facilities, and food banks.

In conclusion, rates of food insecurity nationally and globally are high. In the state of Illinois, approximately 10% of the population is food insecure. These individuals will be present in all clinical spaces and places and the nurse needs to know how to best care for these vulnerable patients.

References American Academy of Pediatrics. (2021). Screen and intervene: A Toolkit for pediatricians to address food insecurity. Food Research & Action Center. https://frac.org/wp-content/ uploads/FRAC_AAP_Toolkit_2021_032122.pdf Feeding America. (2023). Map the meal gap. https://map. feedingamerica.org/county/2021/overall/illinois Maslow, A. H. (1943). A theory of human motivation.

Psychological Review, 50(4), 370–396. https://doi. org/10.1037/h0054346 National Academies of Sciences, Engineering, and Medicine.

(2019). Investing in interventions that address non-medical health-related social needs: Proceedings of a workshop. The

National Academies Process. doi:10.17226/25544 United Nations. (2022). Sustainable development. Department of Economic and Social Affairs. Goal 2 | Department of Economic and Social Affairs (un.org) https://sdgs.un.org/ goals/goal2 United Nations. (2023). Hunger and food insecurity. Food and Agriculture Organization of the United Nations. https:// www.fao.org/hunger/en/

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December 2023

The Nursing Voice

Do’s and Dont’s of Defensive Documentation Documenting care is a basic nursing responsibility, but it’s one that nurses often struggle with because of time constraints and challenges associated with electronic health records (EHRs), such as poor user interfaces that leave nurses unclear as to where to document findings.

However, taking time to document correctly and completely provides the first line of defense should you be named in a lawsuit.

Consequences of poor documentation Documentation issues can have serious legal consequences. The NSO/CNA Nurse Liability Claim Report (4th Ed.) found that failure to document or falsifying documentation increased in frequency and severity in 2020, compared to 2015 and 2021. The average total incurred professional liability claims by documentation allegations rose from $139,920 in 2015 to $210,513 in 2020.

Documentation issues also can impact your license; the board of nursing may take disciplinary action or even rescind a license in the case of documentation maleficence. The NSO/CNA report noted that about half (49.6 percent) of all license protection matters related to documentation involved fraudulent or falsified patient care or billing records. Most nurses would not knowingly engage in these practices, but keep in mind that this category includes situations such as failing to document care as required by a regulatory agency. Thus, simply omitting information can lead to punitive action.

Finally, deliberately falsifying documentation (such as submitting false claims to Medicare) can subject nurses to sanctions under the federal False Claims Act. Here are some strategies to follow to ensure your documentation is effective: Do’s • Follow organizational policies and local, state, and federal regulations related to documentation.

Failure to do so is a red flag to an attorney.

• Ensure you are in the correct patient record.

• Be accurate. This may seem obvious, but a 2020 study by Bell and colleagues found that 21 percent of patients who reviewed EHR ambulatory care notes about them reported an error, with 42 percent labeling the error as serious.

• Use accepted abbreviations and medical terminology. One resource is The Joint Commission’s list of “do not use” abbreviations, published in 2018. For example, it states to write out “unit” instead of using “U” or “u.” Another resource is the Institute for Safe Medication Practices’ “List of Error-Prone Abbreviations, Symbols, and Dose Designations.”

• Document positive and negative findings.

Negative findings may be overlooked. For example, nurses know to document signs and symptoms of infection, but they may forget to note the absence of them.

• Record all care, even if it’s “routine.” For instance, regular checks for signs of skin injury around an endotracheal tube should documented.

• Document in real time to help ensure accuracy. In some organizations, you can access the EHR from a secure mobile device you carry with you.

• Note when you notified other healthcare providers of a change in a patient’s condition.

You’ll also want to note the response. If the response is inadequate or not appropriate, document that you followed up with another person, such as your supervisor.

• Document communications with patients and their families/caregivers. This includes providing education (both verbal and written): If a patient suffers harm as a direct result of not following instructions, this information can protect you.

• Use checklists appropriately. Checklists can save time, but it’s easy to move too quickly, accidentally selecting “yes” because several of the previous answers were “yes,” when “no” is correct. In addition, remember that checklists are not all-

•

• •

•

•

inclusive, so avoid relying too much on them.

For instance, an assessment checklist doesn’t necessarily cover everything you need to check on a patient.

Be cautious of templates. Templates can help reduce missed care and save time, particularly for routine assessments; however, they are simply a starting point. You still need to ensure you completely assess patients and document care provided.

Pay attention to alerts. Overriding a valid EHR alert can lead to practice errors.

Review entries before submitting and sign and date each entry. In EHRs, signatures are generally automatic, but you should verify the information is correct.

Make documentation changes and corrections per organizational policy. It’s helpful to provide a reason for the change, if possible. Make changes and corrections as soon as possible.

Speak up about what’s not working. This is particularly important for the EHR. A well-designed EHR can save time, but one that is not well designed can rob you of time. Even the best EHRs can benefit from tweaking. In some cases, forms can be created or refined to make it easier to document care, or the number of false alerts can be reduced. The IT staff can sometimes make a simple adjustment such as including a new option for recording sputum findings. Although these simple changes may only save a few seconds, those seconds add up over the course of a day, week, month, and year.

Don’ts • Don’t share your password for EHR records.

• Don’t leave blanks in forms. Use N/A (not applicable) if something does not apply.

• Don’t be subjective. State only the facts. For example, “patient slurring words, eyes bloodshot” rather than “drunk”. In addition to creating potential legal issues, keep in mind that many patients are now requesting their medical records and will see what you have written.

• Don’t be judgmental. Avoid negative descriptors such as “non-compliant.” Be particularly sensitive to possible racial biases. For example, a 2022 study

by Sun and colleagues found that black patients had 2.54 times the odds of having at least one negative descriptor in the history and physical.

• Don’t prechart. (for example, entering information into the EHR before the start of a routine procedure). Situations can change and you may forget to amend the record. For example, during a procedure, a medical device different from what was originally planned may be used. In addition, the EHR keeps track of entries, so anyone reviewing the entry would know the timing was not correct.

• Don’t copy and paste text from one patient record to another. If you do decide to do this, be sure to carefully review the text and make changes as necessary. Otherwise, you may introduce errors.

• Don’t make late entries. If you must, be sure to make the late entry per your organization’s policy.

Remember that the EHR will have a record of each entry, including date and time.

• Don’t assume you have to be the one to document something. When a new piece of information must be obtained on a regular basis, organizations often automatically turn to nurses. However, someone else in the organization may be able to collect the data, which helps avoid additional time demands on you, reducing the potential for documentation errors.

Protection through documentation Your documentation should include clinical information (such as assessments and responses to medications); patient education; and diagnostic tests, referrals, and consultations. Following the tips in this article will help ensure you cover these areas, thus protecting yourself from legal action and promoting

optimal patient care (sidebar). As you document, you may want to keep in mind some of the characteristics of high-quality documentation from the American Nurses Association: accurate, relevant, consistent, clear, concise, complete, thoughtful, timely, and reflective of the nursing process.

Value of documentation It can be easy to focus on documenting in the health care record as an onerous task, but in addition to being a legal document, the record provides a tool to: • Document services provided to patients, their responses to treatments, and caregiver decisions.

• Communicate information about the plan of care and outcomes to other members of the health care team.

• Demonstrate nurses’ contribution to patient care outcomes. It also helps nurses meet standards of professional practice. For example, to meet standards related to evaluating a patient’s progress towards goals, the nurse and others on the health care team need to review past documentation.

• Identify areas that need improvement; nurses can work with a team to address quality issues to enhance patient care.

• Provide evidence that an organization is meeting standards set by accrediting bodies that are protecting patients.

• Provide information to ensure proper billing coding so that organizations receive the reimbursement they are entitled to. Proper reimbursement promotes an organization’s financial health, enabling it to deliver quality care to patients.

Article by: Cynthia Saver, MS, RN, is president of CLS Development, Inc., in Columbia, MD. REFERENCES American Nurses Association. Principles for nursing documentation: Guidance for registered nurses. 2010 American Nurses Association. Nursing: Scope and Standards of Practice, 4th Ed. 2021.

CNA, NSO. Nurse spotlight: Healthcare documentation. 2020.

Bell SK, Elmore JG, Fitzgerald PS, et al. Frequency and types of patient-reported errors in electronic health record ambulatory care notes. JAMA Netw Open.

2020;3(6):e205867.

Institute for Safe Medication Practices. List of error-prone abbreviations, symbols, and dose designations. 2021. https://www.ismp.org/recommendations/error-proneabbreviations-list Saver C. Easing the pain of electronic health records: Part 1. OR Manager. 2022;19-22.

Sun M, Oliwa T, Peek ME, Tung EL. Negative patient descriptors: Documenting racial biases in the electronic health record.

Health Aff. 2022;41(2):203-2011.

The Joint Commission. Official “do not use” list. 2018. https:// w w w.jointcommission.org /-/media/tjc/document s/ resources/patientsafety-topics/patient-safety/do_not_use_ list_9_14_18.pdf

Disclaimer: The information offered within this article reflects general principles only and does not constitute legal advice by Nurses Service Organization (NSO) or establish appropriate or acceptable standards of professional conduct. Readers should consult with an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for how this information is applied in practice or for the accuracy of this information. Please note that Internet hyperlinks cited herein are active as of the date of publication but may be subject to change or discontinuation.

This risk management information was provided

by Nurses Service Organization (NSO), the nation's largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976.

The individual professional liability insurance policy administered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247-1500. www.nso.com.

The Nursing Voice

December 2023

Page 17

Incident Reports: A Safety Tool Nurses tend to cringe when they think about completing an incident report. Reasons for this reaction include the distress that occurs when something untoward has happened, anticipated loss of precious time to complete the report (particularly if the organization’s reporting system is cumbersome), and fear of being blamed for the incident or becoming embroiled in a court case. In this situation, it’s easy to forget that incident reports are a valuable resource for keeping patients safe. They also can keep employees safe by identifying system-wide problems such as insufficient staffing or equipment to move patients, which often contributes to staff injuries.

So that patients and employees can benefit from an incident report, nurses need to understand their use.

They also need to know how to complete and file a report correctly to protect themselves and their organization from the report being used as part of legal action in a lawsuit brought by a patient.

A safety tool Incident reports provide a record of an unexpected occurrence, such as a fall or administration of a wrong medication dose, that involved a patient, a family member, or an employee. These reports can be used to identify areas of safety improvement and to educate others about how to avoid similar events in the future.

Nurses should think of the incident report as a safety tool, not a method of assigning blame. Organizations should view these reports through the lens of a culture of safety, which The Joint Commission defines as “the product of individual and group beliefs, values, attitudes, perceptions, competencies, and patterns of behavior that determine the organization’s commitment to quality and patient safety.” One tenet of a just culture is to take a non-punitive approach to reporting and learning from adverse events.

When to file Nurses should check their organization’s policy and procedure related to when to file an incident report.

In general, a report should be filed when something unexpected occurs that results in harm. Sometimes nurses may be unsure whether an event warrants reporting. In this case, it’s best to go ahead and complete a report. Even if the event did not result in harm (for example, the patient did not suffer ill effects after receiving a wrong medication), it’s still important to have a record of the event so that the organization can learn from the event and the risk of a similar event can be reduced.

Typically, a licensed professional, such as a nurse or nurse practitioner, who was part of or witnessed the event completes the form. However, nonlicensed clinicians should report events and provide information as needed for the report. If the event wasn’t witnessed (e.g., the patient fell out of bed when alone in the room), generally the first licensed person who becomes aware of the event should file the report.

Reports should be completed as soon as possible after the event (and within 24 hours) and submitted to the designated person/department. Many organizations now allow employees to file reports online, with the risk management department and the appropriate manager receiving notification. Hospitals, clinics, and other health care organizations should make reporting as easy as possible to encourage staff participation.

Traditionally, incident reports have focused on situations where harm occurred, but many organizations now also encourage employees to file reports about “near misses” or “close calls”—events that could have resulted in harm but did not because someone became aware of the problem. An example of a near miss is the nurse who misreads a label on a medication mixed by the pharmacy department and almost administers an incorrect dose. These reports can be reviewed by risk managers and clinicians to determine changes that can be made to avoid future harm. In the case of the medication label, for instance, it might mean making the print on the

label larger, so it is easier to read. The Joint Commission calls on organizations to recognize employees for reporting both adverse events and close calls, so lessons can be learned and shared.

Incident reports and legal action In general, incident reports, which should not be part of a patient’s health record, cannot be used in legal action. Support for this comes from the Patient Safety and Quality Improvement Act of 2005, which established a voluntary reporting system designed to encourage data sharing so that health care quality could be improved. The act “provides Federal privilege and confidentiality protections for patient safety information, called patient safety work product.” (To be eligible for these protections, hospitals establish a patient safety evaluation system that provides data to a patient safety organization.)

However, if the report is not completed correctly, it may end up in court. For example, in a Michigan case, the hospital was arguing that it didn’t know the cause of the injury, but a report contained an opinion about how an injury occurred (even though opinions should not be included in incident reports). The report was allowed to be included in the case, and the court issued sanctions against the hospital and its counsel for raising defenses “not well-grounded in fact.”

In addition, a few state rulings have noted that incident reports are not always exempt from use in legal action. For instance, an Illinois court ruled that a “qualityrelated event report” was not privileged and that a patient suing the hospital should have access to it.

Nurses can lessen the likelihood of an incident report being part of a lawsuit by correctly completing it (see sidebar). If the report ends up in court, an accurate document can help provide evidence that the nurse and organization were not at fault for what occurred.

Completing the report The report should include a detailed description of what happened. Most organizations have a standard form designed to capture key information such as date, time, and location of the event; name of the person who was affected; names of witnesses to the event; names of those who were notified (e.g., the patient’s physician); the condition of the person affected (e.g., any visible breaks in the skin after a fall); and actions taken in response (e.g., radiograph obtained, malfunctioning equipment sent to biomedical engineering).

Objectivity is key. Any relevant statements made by the person affected by the event or witnesses should be recorded verbatim. It’s also important to note who assessed the patient and the results of that assessment.

Although the incident report is not part of the patient’s health record, nurses should still objectively document the event, including what happened, assessment results, interventions, and follow-up (such as physician notification), in the record.

A helpful tool Incident reports are often seen as something to be avoided. However, if completed properly, they can provide useful information that can help keep patients and staff safe.

How to complete an incident report Here are some do’s and don’ts for completing an incident report: Do… • complete the report as soon as possible after the event (but after the safety of the person affected has been ensured and immediate necessary followup is completed).

• state only the objective facts that you witnessed or know for certain. For example: “The patient was found on the floor next to his bed.” (NOT “The patient fell out of bed.” This is an assumption.)

• include a clear, detailed (but concise) description of what happened.

• include relevant direct quotes (use quotation marks) from witnesses and those affected by the event. For example, a family member may have said, “He didn’t want to wear his non-skid slippers and slipped on the floor.”

• note interventions done in response to protect the person affected by the incident.

• provide a timeline for the event and responses.

Don’t…

• include subjective information such as assumptions, opinions, or suggestions for how similar events can be avoided in the future.

• document in a patient’s health record that an incident report was completed.

• use abbreviations that aren’t readily understood.

For example, instead of COPD, spell out chronic obstructive pulmonary disease.

Article by: Cynthia Saver, MS, RN, is president of CLS Development, Inc., in Columbia, MD. REFERENCES Albert Henry T. Court should respect privilege tied to qualityrelated event report. AMA. December 29, 2021. https:// w w w.ama-assn.org /deliveringcare/patient-suppor tadvocacy/court-should-respect-privilege-tied-qualityrelated-event Engel EVM. Discoverability of workplace incident reports.

American Bar Association. June 9, 2020. https://www. americanbar.org/groups/litigation/committees/productsliability/practice/2020/discoverability-of-workplaceincident-reports/ HHS. Patient Safety and Quality Improvement Act of 2005 statute and rule. HHS.gov. 2017. https://www.hhs.gov/ hipaa/for-professionals/patientsafety/statute-and-rule/ index.html Kelly C, Gross S. Do hospitals have an adequate patient safety system> MedCity News. March 30, 2020. https:// medcitynews.com/2020/03/dohospitals-have-an-adequatepatient-safety-system/ Kelly C, Gross S. Pennsylvania court interprets scope of Patient Safety Act privileges protections. MedCity News. August 7, 2020. https://medcitynews.com/2020/08/pennsylvaniacourt-interprets-scope-of-patient-safety-act-privilegeprotections/ Schub T, Woten M. Incident report: writing. Nursing practice & skill. Cinahl Information Systems. 2015.

The Joint Commission. The essential role of leadership in developing a safety culture. Sentinel Event Alert. Revised June 18, 2021.

Waranch L. What?! Incident reports can be discoverable?

Waranch + Brown. January 25, 2017. https://waranchbrown.com/wait-incident-reports-candiscoverable/

Disclaimer: The information offered within this article reflects general principles only and does not constitute legal advice by Nurses Service Organization (NSO) or establish appropriate or acceptable standards of professional conduct. Readers should consult with an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for how this information is applied in practice or for the accuracy of this information. Please note that Internet hyperlinks cited herein are active as of the date of publication but may be subject to change or discontinuation.

This risk management information was provided

by Nurses Service Organization (NSO), the nation's largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976.

The individual professional liability insurance policy administered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247-1500. www.nso.com.

Page 18

December 2023

The Nursing Voice

Nurse Practitioner Case Study: Failure to Screen and Test For Lead Poisoning, Leading to a Delay in Diagnosis

Medical malpractice claims may be asserted against any healthcare provider, including nurse practitioners.

This medical malpractice case study with risk management strategies, presented by NSO and CNA, involves a Certified Pediatric Nurse Practitioner-Primary Care (CPNP-PC) working in a pediatric practice.

Summary A pediatric clinic in a large urban city had been caring for a patient since she was two days old. The mother reported no problems during the pregnancy or birth of the patient. The patient lived with her parents and three older siblings in a two-story house a few minutes from the clinic. The three older siblings also were patients at the clinic and, apart from the occasional ear infection or viral illness, were healthy and meeting all of their developmental milestones. Over the course of two years, the patient was treated by several of the providers in the practice for both well and sick visits.

The patient had met all of her developmental milestones for the first year of her life. At the 12-month wellness visit, the patient was seen by one of the three CPNP-PC (co-defendant) working in the clinic. The mother testified that during this visit she asked the CPNP-PC if any blood work needed to be performed, as her other children had blood work drawn at their 12-month well child visit. The CPNP-PC reported that she discussed milestones and vaccines with the mother. However, there was no record in the patient’s healthcare information record of this discussion or of the query regarding lab work. The only note related to lab work was “deferred”, written by the provider next to the topic of lead screening on the form, but no explanation as to the reason for this notation.

Three months later, the patient presented to the office with symptoms of a cold and a runny nose. This was the first time the insured CPNP-PC (defendant) saw the patient. The insured CPNP-PC testified that she did not conduct a risk assessment for any needed wellness lab work or vaccinations because this was a "focused sick visit". She diagnosed and treated the patient for an upper respiratory infection.

The insured CPNP-PC saw the patient again for her 15-month well visit. The intake nurse documented that the mother has "new concerns because she doesn’t feel like the child is talking much." The intake nurse checked the box indicating the patient was meeting the 15-month milestone of saying "single words," but added "sometimes" beside the check box. The mother reported that she did not believe that her daughter was talking appropriately for a 15-month-old. The mother stated the child was not stringing words together and frequently pointed to items, rather than verbalizing.

The mother contended that the CPNP-PC responded by stating that a response of single words was normal for a 15-month-old. The mother testified that she verbalized a concern with the issue of lead exposure and a lack of blood work during the visit. She stated that she was familiar with such testing due to her other children having been tested, as well as based upon her prior employment as a medical assistant at a pediatric practice. The CPNPPC asked if they "lived in an old house," to which the mother responded that she did not know the year that house was built, as it was owned by her parents. The mother testified that the CPNP-PC stated, "She's probably fine."

The healthcare information record did not reflect any reference to an inquiry regarding lead exposure or lead testing. On the section of the healthcare information record labeled "Lead Test," the CPNP-PC wrote that the patient was "Ø at high risk," which she testified as meaning that she had reviewed the risk factors with the parent.

The CPNP-PC also testified that her customary practice was to review the last two progress notes before a wellness visit, if time permitted. The insured further testified that, if the patient was new to her, she would typically consult with the last provider that saw the patient in order to obtain an informal intake report.

However, she could not recall if she had taken these actions with this patient at her 15-month-old wellness check. Moreover, no documentation existed to that effect.

The insured testified that, during the 15-month wellness visit, she was unaware that the test had been deferred at the 12-month visit. She could not confirm whether she would have expected the triage nurse to flag the deferral for her as part of the intake process.

The insured saw and treated the patient on three additional occasions over the next four months. The visits

were "focused sick visits", which included gastroenteritis and upper respiratory infections. The insured did not perform lead exposure assessments on the patient as these were characterized as “focused sick visits.”

For her 18-month-old wellness visit, the mother took the patient to the pediatric practice where she was previously employed. As part of the visit, the mother completed a risk assessment questionnaire on which she checked a box indicating her daughter "frequently puts things in her mouth." The mother testified that her daughter had never had blood drawn for a lead test or a complete blood count (CBC). A finger prick sample was tested and came back elevated at 47 µg/dL. Venous blood was ordered to confirm the level, revealing a level of 48 µg/dL. The mother testified that her house was built in 1963. Per state reporting requirements, the State Health Department was notified of the patient’s elevated serum lead level. During a home inspection, the State Health Department inspectors found large amounts of lead in the basement, hall closet and exterior paint of the home.

She stated that she never saw the child eat paint chips.

Her father repainted the house exterior and remodeled the basement and closet himself.

At the 24-month wellness visit, the current treating pediatrician recommended that a repeated venous blood level be performed. He also ordered a special education evaluation to include evaluation of speech and motor skill delays. The evaluation revealed a speech delay, with a vocabulary of only six to eight words, as well as a fine motor skills delay. Speech and occupational therapy also were started. The repeat venous blood lead level remained elevated at 23 µg/dL. The patient did not receive chelation therapy, but ongoing monitoring was conducted.

Over time, monitoring revealed her lead testing levels had returned to normal. However, the parents asserted that the patient experienced global development delays as a result of the high lead levels in her blood. The treating pediatrician confirmed difficulty with language processing, speech, attention, and memory. He advised that the patient’s intellectual abilities were borderline, core academic skills were below average, phonological processing and attention were limited, and her spelling and computational math were exceptionally low for her age. It was noted that the deficiencies were not unusual and typical for many children with developmental disorders, even without intervening disease. The parents also confirmed that the child had been participating in virtual learning and had not been in a school setting for approximately a year.

Risk Control Comments When the child was six-years old, her parents (plaintiffs) filed a malpractice lawsuit against our insured CPNP-PC, as well as the CPNP-PC who treated the patient at her 12-month wellness check visit, the practice and the collaborating pediatrician. The allegations against the insured included: Failure to screen and test for lead poisoning leading to a delay in diagnosis.

Failure to provide anticipatory guidance to educate the patient’s mother on lead paint exposure risk.

The state screening guidelines require all children ages 6-72 months to be screened for lead poisoning if the child lives in or regularly visits a house or childcare center built before 1978. Plaintiff’s counsel contended that because the insured was a CPNP-PC, she should have been conversant with the state requirements for lead testing.

While the insured’s collaborating physician and defense experts were supportive of the treatment provided during the sick visits, neither could support the missed lead screening during the well visits.

Resolution The co-defendant CPNP-PC who treated the patient at her 12-month wellness check visit left the country and would not participate in the case. While she was employed as an independent contractor at the clinic and required to have her own malpractice insurance, the defense counsel investigation revealed that her policy had expired prior to the treatment of the patient. Thus, the insured became the primary defendant in the claim.

Defense counsel believed that, based upon the significantly elevated lead levels at the time of diagnosis, it would be difficult to present a strong causation defense. The experts concurred that it would be impossible to definitively state that the lead exposure at 12 months and thereafter did not have a negative effect on the infant plaintiff.

The claim was settled on behalf of the insured CPNPPC prior to a jury trial. The practice and the collaborating physician also settled with the plaintiffs, but the amount of the settlement is unknown.

Total Incurred: $550,000 (Monetary amounts represent the payments made solely on behalf of the individually insured CPNP-PC and do not reflect payments made on behalf of the other parties involved in the claim. Amounts paid on behalf of the co-defendants named in the case are not available.)

Risk Management Recommendations • Remain current regarding state requirements, clinical practice, medication, treatment, and equipment utilized for the diagnosis and treatment of acute and chronic illnesses and conditions related to clinical specialty.

• Utilize evidence-based clinical practice guidelines or protocols when establishing a diagnosis and providing treatment and document the clinical justification for deviations in protocols.

• Document all patient-related discussions, consultations, clinical information, and actions taken, including any treatment orders that are provided.

• Compile, document and utilize appropriate comprehensive patient clinical history, as well as relevant social and family history.

• Perform a physical examination to determine the patient’s health status and evaluate the patient’s current symptoms/complaints.

• Engage in timely and proactive discussions with physicians and other members of the care team to ensure that the team is educated about the patient’s treatment plan.

• Prescribe medication in compliance with state nurse practice act, state prescriptive authority, authority for nurse practitioners and employer policies and protocols.

• Order and follow up with all indicated monitoring tests and document results in the patient healthcare information record.

• Educate and document education given to patients and/or their parents regarding their responsibilities for adhering to medication and treatment regiments, including lifestyle modifications as well as the risk of noncompliance.

Disclaimers These are illustrations of actual claims that were managed by the CNA insurance companies. However, every claim arises out of its own unique set of facts which must be considered within the context of applicable state and federal laws and regulations, as well as the specific terms, conditions and exclusions of each insurance policy, their forms, and optional coverages. The information contained herein is not intended to establish any standard of care, serve as professional advice or address the circumstances of any specific entity. These statements do not constitute a risk management directive from CNA. No organization or individual should act upon this information without appropriate professional advice, including advice of legal counsel, given after a thorough examination of the individual situation, encompassing a review of relevant facts, laws and regulations. CNA assumes no responsibility for the consequences of the use or nonuse of this information.

This publication is intended to inform Affinity Insurance Services, Inc., customers of potential liability in their practice.

This information is provided for general informational purposes only and is not intended to provide individualized guidance.

All descriptions, summaries or highlights of coverage are for general informational purposes only and do not amend, alter or modify the actual terms or conditions of any insurance policy. Coverage is governed only by the terms and conditions of the relevant policy. Any references to non-Aon, AIS, NSO, NSO websites are provided solely for convenience, and Aon, AIS, NSO and NSO disclaims any responsibility with respect to such websites. This information is not intended to offer legal advice or to establish appropriate or acceptable standards of professional conduct. Readers should consult with a lawyer if they have specific concerns. Neither Affinity Insurance Services, Inc., NSO, nor CNA assumes any liability for how this information is applied in practice or for the accuracy of this information.

Nurses Service Organization is a registered trade name of Affinity Insurance Services, Inc., a licensed producer in all states (TX 13695); (AR 100106022); in CA, MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services, Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency.

The Nursing Voice

December 2023

Page 19

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