The Nursing Voice September 2023

The Nursing Voice

September 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 11 | NUMBER 2 | SEPTEMBER 2023

2023 ANA-ILLINOIS CANDIDATES ANNOUNCED The election for the ANA-Illinois Officers and Directors will be held online September 18th thru October 2nd.

The election will be conducted electronically. Watch your email and the ANA-Illinois website www.ana-illinois. org for the additional details. Candidates are listed in alphabetical order according to position.

All terms are for two years.

CANDIDATE FOR PRESIDENT

Elaine Hardy PhD, RN Dean of Academic Affairs St. John's College of Nursing

Diana Ortega BSN, RN Staff Nurse/ Ambulatory Rush Oak Park Hospital

CANDIDATES FOR DIRECTOR (2 to be elected)

Yolanda A. Coleman PhD, MS, RN, FACHE, NEA-BC CNO/Professor Chicago Area Hospitals and University

Armando Valdez Martinez, Jr. MSN, RN, MEDSURG-BC, CMSRN, NE-BC, CNML Nursing Supervisor Advocate Health

Pamela DiVito-Thomas PhD, RN Adjunct Professor Methodist College

CANDIDATES FOR ANA REPRESENTATIVE (2 to be elected)

W. Zeh Wellington DNP, RN, NE-BC Director of Procedural Care - Surgical Services Ann & Robert H. Lurie Children’s Hospital of Chicago

CANDIDATE FOR SECRETARY Stephanie Mendoza DNP, MSN, RNC-OB, C-EFM Clinical Nurse Consultant II UI Health

Elaine Hardy PhD, RN Dean of Academic Affairs St. John's College of Nursing

2023 ANA-ILLINOIS CANDIDATES...continued on page 3

Gloria E. Barrera MSN, RN, PEL-CSN Certified School Nurse, Visiting Clinical Associate District 99; UIC

Index current resident or

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

ANA-Illinois President’s Message . . . . . . . . 2 INF President’s Message . . . . . . . . . . . . . . . 3 Ethics in Action. . . . . . . . . . . . . . . . . . . . . . . . 4 2023 Award Winners: 40 Under 40 Emerging Nurse Leaders. . . . . . . . . . . . . . . . 4 Practice Corner. . . . . . . . . . . . . . . . . . . . . . . . 5 A Trailblazer in Nursing and a Fierce Advocate . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Climate Change and Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Honor a Nurse – Nominate Someone For The 2023 Nurse Of The Year. . . . . . . . . . 8 Targeted Temperature Management . . . . . 9 Substance Use Disorders and Drug Diversion Among Nurses: What You Need to Know. . . . . . . . . . . . . . . . . . . . . . . 11 Workarounds: How Nurse Leaders Can Minimize Their Risks. . . . . . . . . . . . . . . . . . 12 Guadalupe Hernandez: A Leader Uniting Nursing Organizations and Shaping the Future. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

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September 2023

ANA-ILLI NOIS PRESIDENT ' S M ESSAG E

Dear Illinois Nurse Colleagues, As I reflect on my final Nursing Voice article as President of ANA-Illinois, I am filled with mixed emotions.

I am humbled and grateful for the privilege to represent and advocate for the nurses of Illinois. The past four years have been a journey of dedication and honor, representing an organization that has been at the forefront Liz Aquino, PhD, RN of promoting and advancing the nursing profession in Illinois and leaving a positive impact in other states through our innovative and forward-thinking approach.

Despite the challenges posed by the pandemic, I am proud of our collective achievements, from advocating for legislative changes to enhancing education and professional development opportunities for our members. None of this would have been possible without the unwavering support and guidance of the Board of Directors, the remarkable contributions of our Executive Director, Susan Swart, and the foundational work set by past Presidents (Dr. Karen Kelly, Dr. Pam Brown, Dan Fraczkowski) along with their Board of Directors. Together, we have accomplished so much, and I would like to highlight just a few of the things

we were able to do over the years. We established the DEI Steering Committee and Advisory Board, providing essential training for nurses to address critical DEIrelated topics. We also initiated Nursing Hot Topics meetings, fostering collaboration and professional development opportunities for our nurses. Our membership growth to over 5,000 members will allow our association to make an even more significant impact on our profession and healthcare.

During my tenure, one of my key aspirations has been encouraging more nurses to actively engage with their professional nursing organizations, ensuring their voices and perspectives are heard in important decision-making processes. I have also strived to inspire and support nurses who may consider running for elected office, recognizing their powerful impact in shaping healthcare policies and practices. I partnered with ANA-Illinois to create and launch the Nurses Running for Elected Office Training Academy; we graduated the first cohort of nurses this past June and will continue to run this academy annually while also assisting other state nurses associations in replicating the program.

Looking back on our accomplishments together, I am optimistic about what lies ahead. As I pass the torch to my successor, I encourage you to continue fostering a culture of collaboration and innovation.

Together, we can break new ground, embrace change, and inspire excellence in all aspects of nursing practice.

Let us keep pushing the boundaries, advocating for the well-being of our profession and those we serve, and making a lasting impact on healthcare.

Thank you all for your trust in me and the privilege of serving as your President.

Sincerely,

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Elizabeth (Liz) Aquino, PhD, RN President, ANA-Illinois @LatinaPhDRN

The Nursing Voice

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 Elizabeth Aquino, PhD, RN President Monique Reed, PhD, MS, RN Vice President Jeannine Haberman, DNP MBA, RN, CNE Treasurer Beth Phelps, DNP, APRN, FNP, ACNP Secretary Directors Samuel Davis Jr MHA, RN, CNOR Susana Gonzalez, MHA, MSN, RN, CNML Elaine Hardy, PhD, RN Hannah Shufeldt MSHCM, BSN, RN Zeh Wellington, DNP, MSN, RN, NE-BC 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 Executive Director Susan Y. Swart, EdD, MS, RN, CAE ANA-Illinois/Illinois Nurses Foundation 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.

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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.

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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 2023 ANA-ILLINOIS CANDIDATES...continued from page 1

Diana Ortega BSN, RN Staff Nurse/ Ambulatory Rush Oak Park Hospital

Roshni Shah MSN Faculty DePaul University

Feyifunmi Sangoleye PhD, RN Administrative Nurse III University of Illinois Hospital and Healthcare System

CANDIDATE FOR NOMINATING COMMITTEE (2 to be elected)

September 2023

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INF PRESIDENT'S MESSAG E Hello, readers of the Nursing Voice! I am Amanda Oliver, the newly appointed president of the Illinois Nurses Foundation, and I'm pleased to meet you.

I've served the INF since 2018, serving on the Gala planning committee and becoming an INF board member in 2020. I became the chair of the Fund Development and Strategic Planning committees Amanda Oliver and am honored that my fellow BSN, RN, CCRN, board members have appointed CPST me as the president. I have big shoes to fill and would like to take the time to thank Dr. Cheryl Anema for her many years of service as president.

We are thrilled that she will be continuing her service on the board.

Transformationally, the INF board has been putting immense work into strategic planning. We have created new foundational pillars of Leadership, Scholarship and Grants, and Education. These pillars will help us enhance our work and keep us focused on our goals to provide opportunities to nurses across the state. Additionally, we created new core values. As a Foundation, we value integrity, inclusivity, and innovation. These are the guiding principles that will shape the decisions and partnerships we make.

Together, these pillars and values will propel the INF forward and allow us to grow our support for Illinois Nurses everywhere.

We started our new fiscal year in July and are compiling our year-in-review booklet, which will be out later this year and highlight all of the fantastic work that the INF and the nurses we support across the state have accomplished. The work is due to the many volunteer hours from our board, committees and the generosity of our donors. None of this excellent work would be possible without your steadfast support, time, knowledge, and contributions.

As our visibility and reach as a Foundation expands, we will accept applications for new board members.

Starting Aug. 10, our applications will be open. Please visit illinoisnurses. Foundation to learn about the nomination process and consider joining the INF board.

Also, The 40 Under 40 Emerging Nurse Leader event is approaching on Sept. 22 at the DoubleTree Hilton in Lisle.

I'm happy to say this was the fastest we have sold out of reserved tables, and we are close to selling out individual tickets as well! Yet, there are many opportunities to sponsor the event and receive a reserved table for ten, along with advertising opportunities in our program booklet. Visit our website or the 40 Under 40 registration page for more information.

These 40 emerging nurse leaders are incredible, and we hope you join us all in celebrating them. Thank you to our planning and advisory committees for working hard to find the best in Illinois nursing.

Finally, please save the date for our 2023 Annual Holiday Gala and Fundraiser on Dec. 2 in Lisle. Our biggest fundraiser of the year is a celebration of nursing and a fun way to end your year of giving! It's also one incredible party!

I look forward to meeting everyone at our upcoming events, serving you, and learning about your passions for the Illinois Nurses Foundation. Together, we'll continue the positive momentum of the Foundation and move nursing forward.

Sincerely, Amanda Oliver BSN, RN, CCRN, CPST Illinois Nurses Foundation President Amanda Oliver BSN, RN, CCRN American Nurses Association- Secretary Illinois Nurses Foundation- President oliver.amanda1001@gmail.com 815-342-0870

Feyifunmi Sangoleye PhD, RN Administrative Nurse III University of Illinois Hospital and Healthcare System

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

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Page 4

September 2023

The Nursing Voice

ETHICS IN ACTION Nurse Burnout, Fatigue and Mental Health Linda L. Olson, PhD, RN, NEA-BC, FAAN Surveys show that over 100,000 nurses have left the profession over the past 2 years (NCSBN, 2023) as a result of stress, burnout and retirements, a situation that also impacts the health of the public. An American Nurses Foundation (ANF) survey, “Pulse on the Nation’s Nurses Survey Series” found that nurses are struggling with mental health and wellbeing issues after the pandemic that arise from perceptions of lack of support at work, stress, and burnout (ANF, 2022). . These issues create fatigue and present a compromise to nurses’ mental health. Even before the pandemic, the National Academies of Science, Engineering, and Medicine Linda Olson PhD, (NASEM) published a report on clinician burnout (2019), RN, NEA-BC which indicated that between one-third and one-half of U.S. clinicians (nurses and physicians) experience burnout. In 2019, the World Health Organization (WHO) conceptualized burnout as an occupational phenomenon resulting from unmanaged workplace stress, and included it in the International Classification of Diseases, 11th revision. Burnout is characterized by feelings of exhaustion, lack of energy, depersonalization and a decreased feeling of work accomplishment that can impact the quality of patient care. It can also lead to nurses leaving their positions and ultimately leaving the profession.

The two provisions of the Code of Ethics for Nurses with Interpretive Statements (2015) most applicable to enhancing nurses’ mental health are Provision 5 that addresses duties to self, and Provision 6 that addresses the importance creating and maintaining ethical and healthy work environments. The ANA Position Statement on “Nurses’ Professional Responsibility to Promote Ethical Practice Environments” (2023) emphasizes the role of nurses in all roles and settings to assess and improve the work environment.

The studies on nurse burnout provide evidence of the importance of programs to support nurse well-being and to improve the work environment (Kelly, et.al., 2021).

There are individual and organizational strategies that can improve nurses’ wellbeing. An organizational strategy to develop and implement interventions is based on measuring the incidence of burnout. The Maslach Burnout Inventory for Medical Personnel measures burnout and can be used before and after interventions to improve clinician well-being (MBI). The American Nurses Foundation has a program for helping individual nurses improve their health and wellness, the “Healthy Nation

Healthy Nurse program” (ANF). The aim of this program is to improve nurses’ health in the areas of mental health, physical activity, nutrition, rest, quality of life, and safety.

The ANA (2022) also offers a Nurse Burnout Prevention Program online that includes evidence-based strategies on burnout prevention, resilience, and stress management.

A particular focus on the importance of creating a healthy work environment is the importance of peer support. When nurses feel they can discuss their issues and viewpoints with each other, as well as with their managers, they are creating connections that provide for creating perceptions of a more positive ethical climate that can in turn lead to decreased nurse turnover with an increase in retention (Olson, 1998).

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

Silver Spring, MD: Nursesbooks.org.

American Nurses Association (2022). Nurse Burnout Prevention Program. https://www. nursingworld.org/membership/member-benefits/se-healthcare-burnout-preventionprogram/ https://www.nursingworld.org/membership/member-benefits/se-healthcare-burnoutprevention-program/American Nurses Foundation (2023). ANA pulse on the nation’s nurses survey results: COVID-19 Impact Assessment Survey-The Second Year. https://www. nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/ coronavirus/what-you-need-to-know/covid-19-impact-assessment-survey---the-second-year/ American Nurses Foundation. Healthy Nurse Healthy Nation program. https:// healthynursehealthynation.org) ANA Ethics Advisory Board (2023). “ANA Position Statement: Nurses’ Professional Responsibility to Promote Ethical Practice Environments. OJIN: The Online Journal of Issues in Nursing, 28(1).

National Academy of Medicine (2020). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, D.C.: National Academies Press.

Kelly, L. A., Gee, P.M., & Butler, R.J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing Outlook (69): 96-102.

Maslach Burnout Inventory (MBI). https://pscentre.org/wp-content/uploads/2023/04/MaslachBurnout-Inventory-.pdf National Council of State Boards of Nursing (2023). The 2022 National Nursing Workforce Survey.

Journal of Nursing Regulation, Volume 14/Supplement April 2023. https://www.ncsbn.org/ news/ncsbn-research-projects-significant-nursing-workforce-shortages-and-crisis Olson, L.L. (1998). Hospital nurses’ perceptions of the ethical climate of their work setting. The Journal of Nursing Scholarship, 30(4).345-349.

World Health Organization (2019). Burn-out an “occupational phenomenon”: International Classification of Diseases. https://www.who.int/news/item/28-05-2019-burn-out-anoccupational-phenomenon-international-classification-of-diseases

2023 Award Winners: 40 Under 40 Emerging Nurse Leaders Angela Andrews Southern Illinois University Edwardsville

The Illinois Nurses Foundation is proud to announce the 2023 40 under 40 Emerging Nurse Leaders Award winners. This award was established in 2015 by the Illinois Nurses Foundation to highlight and celebrate young nurse leaders. It celebrates those who are impacting health care and the nursing profession today and who will undoubtedly shape the future of the profession in Illinois!

This year’s winners come from all over Illinois and work in a variety of health care environments—public schools, county health departments, university medical centers, children’s hospitals, ICUs, and more! No matter where they work—or their official titles—these nursing leaders teach, heal, and inspire those around them every day. Their passion, skill, and knowledge advance health care and the nursing profession in their work environments and in their communities. We know that this is only the beginning for all these amazing nursing leaders!

An event honoring the award winners will occur on September 21, 2023 starting at 5:00pm at the DoubleTree

by Hilton Lisle/Naperville. Registration is required, and tickets are available on our website at www.illinoisnurses. foundation.

Margaret Gladman Rush University Medical Group

Shannon O’Shea Rush University College of Nursing

Kate Barrett Northwestern Memorial Hospital

Colleen Haynes Rush University Medical Center/Rush Univeristy

Allison Palhegyi Advocate Children’s Hospital

Katy Behling Edward-Elmhurst Health

Brittany Judge Advocate

Karena Brown Northwestern Memorial Hospital

Katie Kean Rush University Medical Center

Dana Campbell Northwestern Memorial Hospital

Eleni Key Lakeview College of Nursing

Amanda Connoyer Springfield Clinic

Hyejin Kim Rush University

Eleanor Rivera University of Illinois Chicago College of Nursing

Sherri Crumley Loyola University Medical Center

Anne Kowalczyk DePaul University

Haley Sachs Kellogg Cancer Center

Mackenzie Daniels Advocate Illinois Masonic Medical Center

Kathleen Krawzak Advocate Children’s Hospital

Jennifer Sandoval DePaul University

Megan Kupferschmid OSF Healthcare

Roshni Shah Advocate

Annie Lally Rush University Medical Center

Jill Trzaska Northwestern Memorial Hospital

Faye Lewis Orthopedic Center of Illinois

Stephanie Zidek Advocate Aurora Health

Michael Liwanag Rush University Medical Center

Lisell Zuniga Valley View School District 365

Amy Driscoll Aurora at Home Karla Echeverria Advocate South Suburban Hospital Aaron Franklin Rush University Medical Center Shana Freehill OSF Healthcare Leticia Garcia Self Employed Jacy Ghast Eastern Illinois University

Jessica Madrigal Northern Illinois University Anne O’Boye Northwestern Memorial Healthcare

Jenna Palmisano Glen Hill Elementary School Kelly Perez Advocate Children's Hospital Carrie Quinn Advocate Children's Hospital

The Nursing Voice

September 2023

Page 5

PRACTICE CORNER

Illinois Law & Nursing Practice NANCY J. BRENT, MS, JD, RN AUTHOR NOTE: THIS PRACTICE CORNER FIRST APPEARED IN THE NURING VOICE IN JUNE 2021. THE RN’S CONCERNS ARE STILL VALID TWO YEARS AFTER ITS INITIAL PUBLICATION. THE INFORMATION IS STILL VITAL FOR YOU TO KNOW IF YOU HAVE MENTAL HEALTH ISSUES OR ARE SUFFERING FROM NURSING FATIGUE. QUESTION An RN sent in a concern that he is feeling sadder than usual since caring for patients during the Pandemic. He is also experiencing difficulty concentrating when at work and is concerned he may be depressed. He is apprehensive about seeking treatment if it will affect his license. He asks if his anxiety surrounding treatment and his license is well founded.

Nancy J. Brent, MS, JD, RN

ANSWER A qualified no. Experiencing mental suffering of any kind is not an issue under the Act and its Rules. It is an issue if it affects a nurse licensee’s safe and competent practice.

The Illinois Nurse Practice Act and its Administrative Rules underscore the importance of good mental health for nurse licensees. In fact, in order to obtain a license as a professional registered nurse (RN), an advanced practice nurse (APRN) or a licensed practical nurse (LPN) in Illinois, the applicant must be “fit”.

Although that term is not defined in the Act or rules, synonyms for the word include “healthy” and “well”. Once licensed, the Act and its Rules address “competent” practice. This term is also not specifically defined but synonyms include “capable”, “able”, and “fit”. Mental distress and the Act most clearly intersect in its section on Grounds for disciplinary action (225 ILCS 65/70-5).

If a nurse licensee is found to meet one or more of the 40 listed grounds, disciplinary action may be taken against the nurse, including, but not limited to, a refusal to renew the license, placing the nurse on probation, or suspending the license.

All of the possible connections between mental distress and the grounds in this section are beyond the scope of this article. A number of those links can be highlighted, however.

And, in the Rules Section 1300.350, Standards of Professional Conduct for Registered Professional Nurses, Section 1300.445, Standards of Conduct for APRNs, and Section 1300.260, Standards of Professional Conduct for LPNs, each is to practice nursing, advanced practice nursing, and licensed practical nursing respectively only when in functional physical and mental health.

The RN is right to be concerned about his feelings of sadness and it is in his best interest, both professionally and personally, to seek treatment as soon as possible.

Seeking treatment is a win-win for the RN and for any nurse licensee. It is especially an advantage under the Act and Rules because voluntary treatment is indirectly encouraged.

In the Section Grounds for Disciplinary Action, if the RN, or you, would be subject to an involuntary admission or a judicial admission to a hospital as provided in the Illinois Mental Health and Disabilities Code, one’s license is automatically suspended.

The suspension terminates only upon a finding by a court that the individual is no longer subject to either of the admissions to a hospital and issues an order to that effect and discharges the person. Then and only then, upon recommendation of the Board of Nursing to the Secretary of the Illinois Department of Financial and Professional Regulation (IDFPR) that the nurse licensee be allowed to return to nursing practice (225 ILCS 65/70-(c)).

And, if the RN’s mental distress is such that his continuing to practice constitutes an immediate danger to the public, the Secretary of the IDPFR can immediately suspend his license (a summary suspension) without a hearing. A hearing within 30 days must occur to determine what disciplinary action may be taken against the nurse.

So, whatever mental distress this RN or you are experiencing, seek guidance from a mental health professional as soon as you can, including a Psychiatric-Mental Health APRN, and follow through with his or her recommendations.

You can read the entire Illinois Nurse Practice Act and its Rules by going to the Illinois Nursing Workforce Center’s website at: nursing.illinois.gov/nursepracticeact.asp.

You can also access the Illinois Mental Health and Developmental Disabilities Code at: ilga.gov/legislation/icls/icls5.asp?ActID=1496&ChapterID=34 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.

They include: “(4) A pattern of practice or other behavior which demonstrates incapacity or incompetency to practice under this Act. (14) Gross negligence in the practice of practical, professional, or advanced practice registered nursing.

(19) Failure to establish and maintain records of patient care and treatment as required by law.

(30) Physical illness, mental illness, or disability that results in the inability to practice the profession with reasonable judgment, skill, or safety.”

The Administrative Rules (68 IL IAC Part 1300) also list possible connections between mental distress and its impact on safe and competent nursing practice.

In Section 1300.90 of the Rules, Unethical or Unprofessional Conduct, examples include: “2) A departure from or failure to conform to the standards of practice as set forth in the Act or this Part. Actual injury to a patient need not be established.

5) Demonstrating actual or potential inability to practice nursing with reasonable skill, safety or judgment by reason of illness, use of alcohol, drugs, chemical or any other material, or as a result of any mental or physical condition.

6) Engaging in activities that constitute a breach of the nurse’s responsibility to a patient.”

The Illinois Nurses Foundation funds grants to registered professional nurses, advanced practice registered nurses, and nursing students to advance professional nursing practice; enhance safe, quality patient care; and promote innovative solutions.

Applications will be reviewed in mid-October. Submission deadline for this round of reviews is October 1st.

Incomplete applications will not be considered.

Grant applications can be accessed at https://bit.ly/INFGRANTS Got questions? Contact the Grant Committee chairperson, Dr. Karen Kelly, at doctorkkelly@gmail.com

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Page 6

September 2023

The Nursing Voice

A Trailblazer in Nursing and a Fierce Advocate

Introducing Ashley Whitlatch, a trailblazing figure in the nursing community. Ashley holds a Bachelor’s and Master’s of Science in Registered Nursing, specializing in Family Practice, and a Doctor of Nurse Practice. In addition to her nursing degrees, she earned a Master’s in Business Administration. With more than a decade of experience in nursing, Ashley understands the importance of active engagement within the nursing community.

Ashley has embraced the role of a leader and advocate throughout her career. Being active in her community has provided the stepping stones for her career. Ashley has been honored with The 40 Under 40 Award from the Illinois Nurses Foundation and the 40 Leaders Under 40 in Peoria, Illinois, from Peoria Magazine. Additionally, Ashley’s impact on the nursing community earned her one of the first DEI Scholarships, highlighting her dedication to diversity, equity, and inclusion.

Ashley’s expertise extends beyond her extensive educational background. She has made significant contributions to her communities through her published children’s book, I Am Everything: Book of Affirmations for Children. This heartwarming 20-page story is designed to instill confidence in young children, making a positive impact on their lives.

40 UNDER 40—A SIGNIFICANT MILESTONE

In addition to receiving the 2021 40 Under 40 Award from the Illinois Nurses Foundation, Ashley was also honored with the 40 Leaders Under 40 Award by Peoria Magazine in October 2022.

MAKING A DIFFERENCE AT THE STATE LEVEL Ashley found a love for getting involved in the politics of healthcare when attending Student Nurse Political Action Day in 2012 as a Senior in College. Years later, she had the unique opportunity to experience the inner workings of politics and make a difference in healthcare when she attended the 2023 Nurses Day at the Illinois Capitol.

Accompanied by Dr. Reed, VP of ANA-Illinois, and Dr. Hardy, ANA-Illinois Board Director, she was able to explore the grounds and even ran into representative La Shawn Ford, who gave them a tour. During the tour, they were shown a room where bills were passed, and the bill being demonstrated was HB 2385, which aims to lower the age at which colonoscopies are required.

While discussing the bill, Dr. Reed pointed to Ashley and suggested that she could help with the bill and proposed that she testify. Inspired by Dr. Reed’s confidence in her, Ashley took on the challenge. During her testimony, she spoke as an expert and eloquently explained the importance of colon screenings. Today, she looks back at the experience in a positive light. “I’m so glad that they pushed me to step out of my comfort zone.”

Through her connections with ANA-Illinois, Ashley was able to help make an impact in healthcare at the state level. Vice-President of ANA-Illinois Dr. Reed’s encouragement and confidence in her pushed Ashley to take a step out of her comfort zone and be a part of making lasting change. Today, that bill has passed through the floor and is waiting to be approved.

ANA-ILLINOIS—A GREAT PLACE TO START “I love healthcare. I love nursing. I love everything about it. It’s me.” said Ashley Whitlatch.

Being a part of ANA-Illinois is an important part of Ashley’s life. Beyond her career, ANA-Illinois brings something more to the table for her—a support system offering peer and professional support, advocacy, education, practice resources, legislative updates, and networking opportunities.

Winning the 2021 40 Under 40 Emerging Nurse Leaders Award from the Illinois Nurses Foundation marked a significant milestone in Ashley’s career. She described it as a “prestigious honor” that not only recognized her contributions to the nursing field but also helped her forge connections and open doors within the nursing community. After receiving this recognition, active ANA-Illinois Board Director Susana Gonzalez reached out and encouraged Ashley to become part of the ANA-Illinos community.

Reflecting on the opportunities that have come her way, Ashley shared, “It opens doors for you when you have that 40 Under 40. I’ve had a lot of people come up to me and ask for me to be a part of a networking event or a collaboration, and they say, hey, you’re 40 Under 40.

It’d be perfect.”

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“When you’re a part of ANA-Illinois, you are a part of something that’s so much bigger. You get all these educational opportunities, these networking opportunities. You meet wonderful, wonderful people.

The work that ANA-Illinois is doing is just major. It’s important, and I’m happy to be a part of it.”

ANA-Illinois has proven to be an invaluable platform for nurses like Ashley Whitlatch to thrive and make a significant impact in their careers. Without her connections to ANA-Illinois, Ashley would not have had the opportunity to testify at the state level and help bring about change in healthcare policy. Beyond the professional development opportunities and networking advantages it offers, ANA-Illinois provides a sense of belonging and support that is crucial in the healthcare field. By being a part of this dynamic nursing community, individuals like Ashley can access a wealth of educational resources, connect with like-minded professionals, and contribute to meaningful initiatives that shape healthcare policy.

For anyone looking to embark on a fulfilling nursing career in Illinois, ANA-Illinois proves to be an excellent starting point, offering countless opportunities for personal and professional development.

CAREER THROUGH COMMUNITY Career opportunities through community involvement are at the center of Ashley’s heart. Whether its involvement in ANA-Illinois, or her hometown of Peoria, Illinois, she is always asking the question: “What are more ways that I can get involved?”

But she’s not just sitting back and waiting for those opportunities to appear. Ashley is constantly reaching out to her community and organizations to be an active member and help out in any way. As a result, Ashley sits on the planning committee of 40 Under 40 for the Illinois Nurses Foundation, as well as the board for her hometown.

Ashley is also on the ANA-Illinois DEI committee, where she is helping promote diversity and inclusion in the nursing industry.

“I’m all about helping out and giving back—I want to be a part of the future classes to come.”

In 2020, Ashley achieved another milestone by publishing her first book. I Am Everything: Book of

The Nursing Voice

September 2023 in Peoria, as well as serving as a board member for the Peoria Board of Health. Her roles in these influential organizations demonstrate her commitment to making a lasting impact in healthcare leadership.

Building her career through her community, both ANA-Illinois and her hometown, Peoria, is something that Ashley strongly promotes for anyone. By getting out and getting involved in organizations, Ashley has made connections that have provided amazing opportunities to advance her career as a nurse.

Affirmations for Children. The 20-page short story tells the tale of her two young children on the journey to selfconfidence. Following the publication, Ashley received invitations to read her book to numerous schools in District 150 as part of Read Across America Week.

Her engaging storytelling captivated young minds and inspired them to embrace their unique qualities and abilities.

Currently, Ashley holds the position of Chair on the American Heart Association Executive Leadership Team

DIVERSITY, EQUITY, AND INCLUSION Ashley’s enthusiasm for promoting diversity, equity, and inclusion (DEI) in nursing is evident in her dedication to implementing DEI practices, especially those introduced by ANA-Illinois.

For Ashley, DEI is a major and crucial aspect of nursing.

It is critical in the healthcare industry because it leads to improved patient outcomes, addresses healthcare disparities, enhances innovation and problem-solving, builds trust and patient engagement, and promotes workforce satisfaction and retention.

Her passion for DEI initiatives drives her to explore innovative ways to incorporate these practices within the nursing field, particularly through the initiatives promoted by ANA-Illinois.

Her commitment to this cause was recognized during the admissions process when she was awarded one of the first DEI scholarships from ANA-Illinois. With this scholarship funding, Ashley is excited to embark on research focused on DEI initiatives through eCornell.

ASHLEY’S FINAL WORD Ashley Whitlatch’s journey as a trailblazer in nursing and advocacy is truly inspiring. Her involvement with ANA-Illinois has provided opportunities to make a lasting impact on healthcare and has played a significant role in propelling Ashley’s career forward.

ANA-Illinois is an organization dedicated to fostering career development, providing educational resources,

INTRODUCING: The New ANA-Ilinois Career Center ANA-Illinois Career Center is here with jobs and tools just for you.

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Page 7

and creating community opportunities for nurses. Ashley Whitlatch’s membership in ANA-Illinois serves as a shining example of how the organization’s commitment to nurses can be incredibly beneficial.

For anyone wanting to get involved or wondering where to start, Ashley has this to say: “ANA-Illinois is an awesome place to start. I feel like it is my home. Everybody here is wonderful, and I feel fortunate just to be able to be involved. There are a lot of opportunities that come about just by being involved with ANA-Illinois. So for me, it has been wonderful. I would tell anybody this is the perfect place to start.”

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September 2023

The Nursing Voice

Climate Change and Cardiovascular Disease Ethan Katznelson, MD, and Dhruv S. Kazi, MD, MSc

Climate change is no longer a problem for future generations—it is already affecting our patients today.

The repercussions of a changing climate – including increasingly frequent heat waves, worsening air quality, prolonged droughts, and severe hurricanes – profoundly impact all patients but have particularly devastating consequences on patients with heart disease.

Why is the planet warming? Unprecedented concentrations of greenhouse gasses in Earth’s atmosphere—byproducts of unchecked fossil fuel production and combustion— are trapping heat near the Earth’s surface. As a result, the Earth is 1.2ºC (2.1ºF) warmer than in the late 19th Century, with 19 of the 20 warmest years on record occurring since 2001. Beyond a warming planet, climate change induces more severe and frequent extreme weather and rising sea levels. While still nascent, exploration at the intersection of climate and cardiology reveals myriad impacts on cardiovascular health and care delivery.

Patients with underlying cardiovascular and cerebrovascular disease are particularly vulnerable.

First, physiologic changes associated with extreme temperatures increase the frequency of adverse cardioand cerebrovascular events like heart attack, heart failure, arrhythmia, and stroke. Prolonged exposure to extreme heat, as would occur during heat waves, also worsens outcomes. While access to air conditioners and local cooling centers is protective, many lower income populations lack access and remain at significant risk.

Second, inhaled particulate air pollution is associated with increased cardiovascular morbidity and mortality, likely because these particles trigger local and systemic inflammation. Living near highways, highly trafficked areas, and factories increases air pollution exposure and can worsen health outcomes. Gaseous pollutants are also concerning, such as ground level ozone which forms when sunlight interacts with vehicular exhaust, a process which intensifies on extreme heat days. When inhaled, ozone can increase the risk of adverse cardiovascular events in vulnerable individuals. Some communities respond with policy advocacy to increase green spaces, electrify public transport, and block development of local power plants or factories. However, most at-risk communities lack the agency or organizing power to protect their locality and remain susceptible to these environmental risks.

Rising temperatures, changing rainfall patterns, and prolonged droughts have increased the frequency and intensity of wildfires. Wildfire smoke inhalation is associated with increased cardiovascular morbidity and mortality, which, according to numerous studies, peaks during the first three days of smoke exposure, but can extend up to a week after the smoke exposure ends.

Wind can carry smoke over long distances, adversely affecting cardiovascular health in populations living hundreds of miles downwind. In the 2018 Camp Fire in Northern California, researchers discovered smoke containing toxic metals over 150 miles from the source and saw smoke from the fire thousands of miles away in New York City.

In addition to these direct physical effects, climate change-related environmental stressors can also affect mental health, leading to increased stress, anxiety, and depression, which further intensifies cardiovascular risk. For example, risk of hospitalization or death from cardiovascular disease increased for individuals who developed Post Traumatic Stress Disorder (PTSD) after Hurricane Katrina.

Finally, climate change disrupts our ability to care for cardiovascular patients. When extreme weather events— hurricanes, dust storms, mudslides, floods—damage healthcare infrastructure or transportation, adverse health effects long outlast the acute state of emergency.

Cardiovascular hospitalizations in New York remained elevated for over 12 months after Hurricane Sandy made landfall in 2012. Similarly, Hurricane Maria’s destruction of critical intravenous fluid supply chains in Puerto Rico led to protracted nationwide shortages, affecting patients for thousands of miles. Power outages may be particularly problematic for individuals who rely on power for medical devices or medications requiring refrigeration.

One thing is increasingly clear: Climate change will affect all of us, but not equally. The field of environmental justice identifies the ways by which climate change is a regressive disaster, disproportionately affecting the most vulnerable and least culpable. Redlining—centurylong racist housing policies—limited housing mobility for people of color, resulting in these populations today living closest to highways, factory farms, heavy industry, and other environmental stressors. Often, de jure racism still limits access to healthcare and trust in the medical system, compounding susceptibility to negative climate

Congratulations to the Illinois Nurses Foundation 2023 Scholarship Winners One of the primary functions of the Illinois Nurses Foundation is to provide scholarships to students that have decided to major in nursing or to nurses who are looking to continue their education. Nine individuals were awarded scholarships totaling $12,000.

2023 Scholarship Awards Diversity, Equity & Inclusion Next Generation Scholarship Jennifer Tan Lewis University Diversity, Equity & Inclusion Next Generation Scholarship Jennifer Sandoval DePaul University Arthur L. Davis Scholarship Ashley Frederick OSF College of Nursing D2 Scholarship Anja Huettemann University of St Francis D21 Scholarship Seo-Yoon Lee University of Illinois at Chicago South Suburban Nursing Scholarship Demiah Alexander Saint Xavier University Wendy Burgess Memorial Scholarship Saja Khalil Saint Xavier University ISAPN APRN Scholarship Evan Alling Southern Illinois University at Edwardsville Alma J. Labunski Memorial Scholarship Claire Ginsberg Loyola University

health effects. Additionally, lower income individuals lack access to expensive adaptations, like air conditioners or air purifiers, crucial to mitigating dangerous effects of a changing climate.

How should we respond to this threat? Healthcare professionals must carefully consider impacts of climate change on cardiovascular health and integrate this knowledge into practice. Patients with increased risk, such as the elderly, those lacking access to air conditioners or air purifiers, those living near heavy industry, or those with underlying cardiovascular disease should be screened and provided with information on exposure reduction and contingency plans. Exposure reduction strategies include policies improving access to cooling technologies for lower income patients, staying indoors, or using high-efficiency air filters during periods of high air pollution or wildfire-smoke levels. Some traditional cardiovascular risk-reduction strategies are a win-win for planetary and cardiovascular health, such as advancing plant-based diets and replacing driving with walking or cycling whenever possible. Nurses, as trusted community members, can effectively advocate for climate change adaptation, mitigation, and improved air quality, unlocking immediate benefits for cardiovascular health.

Beyond our individual practices, the systems in which we work as healthcare professionals contribute significantly to the climate chaos that ills our patient populations. Healthcare industries in high-income countries are major greenhouse gas emitters and contribute 4.6% of all greenhouse gas emissions globally.

Reducing our contribution to global emissions requires transitioning from fossil fuel energy to renewable sources of energy, reducing the consumption and waste associated with hospitals, and divesting financial portfolios away from carbon-intensive industries.

Healthcare systems of the next century must be both climate-resilient and climate-responsible to continue providing high quality and equitable care.

Exposure to climate change-related environmental stressors increases morbidity and mortality from cardiovascular diseases. We need urgent action to identify high-risk populations, implement evidence-based interventions, and reduce greenhouse gas emissions to protect our patients—now and for generations to come.

HONOR A NURSE – NOMINATE SOMEONE FOR THE 2023 NURSE OF THE YEAR Shout it Out. In healthcare, nurses show up, they go above and beyond and they deserve to be recognized for all they do. Nurses are the steadfast heroes among us, and the Illinois Nurses Foundation knows they deserve to be celebrated.

Nurses have the most interesting stories - they witness pain and heartache one moment alongside joy and triumph the next- Nurses make the world a better place for the patients, families, and profession.

The Honor a Nurse / Nurse of the Year award is a program that gives friends, family, and colleagues a way to share the story of a nurse who has made a difference.

Make a $25 donation and honor a nurse who deserves recognition for their commitment to their patients and the work nurses do every day. Don’t forget to submit the story that makes them your hero!

The Honoree will be listed on the INF website, in the December issue of the Nursing Voice and will also be entered as a nominee for the “Nurse of the Year” award* which will be awarded during the Illinois Nurses Foundation December 2nd Holiday Gala and Fundraiser.

To be considered for the 2023 Nurse of the Year submission must be received by October 31st. *A story detailing the impact and contributions of the honoree must be submitted to be eligible for the Illinois Nurse of the Year.

In Honor donations can be made on the Illinois Nurses Foundation website www.illinoisnurses.foundation and https://bit.ly/HONORANURSE or using the QR Code

The Nursing Voice

September 2023

Targeted Temperature Management

Rick Rettke Blessing-Rieman College of Nursing & Health Sciences Targeted Temperature Management Overview Over 400,000 people in the United States experience cardiac arrest annually. The survival rate is approximately 10% for these people, per the American Heart Association.

Since 2005, the American Heart Association (AHA) has listed Targeted Temperature Management (TTM) as a recommended therapy when treating patients that have experienced cardiac arrest and have achieved return of spontaneous circulation (ROSC; AHA, 2015). Early research from 2004 had shown promising results related decreased mortality and increased overall survivability when TTM was used in the post cardiac arrest population. Initially, the target temperature recommended was to bring the patients core temperature to a range of 32-34 degrees Celsius and maintain this temperature for 24 hours. After the 24-hour period, the patient was then recommended to be rewarmed to a target temperature of 37 degrees Celsius and this temperature was to be maintained for a 24–48-hour period until clinicians could make a prognosis for the patient. In 2015, the AHA guidelines were changed to provide more choice for clinicians and allowed for a goal target range of 32-36 degrees Celsius (AHA, 2015).

More recent studies have influenced a change in practice and is steering clinicians away from the recommendations of the AHA (Dankiewicz et al., 2021).

There are many variables that enter the equation when navigating a cardiac arrest event and the care provided after ROSC has been achieved. For TTM specifically, some variables include time to target temperature, modality of cooling used, and pharmaceutical regimens used in treatment. There are concerns that are present when considering the influence that each variable has on the outcome of the study.

Regarding modality, options include using intravascular cooling and surface cooling. Intravascular cooling is done by inserting a catheter into a large central vein and circulating cold saline through it. This is a core cooling that is completed by the heat exchange catheter and provides more rapid cooling. The other option, surface cooling, promotes rapid cooling of the patient’s core temperature using gel pads that circulate cold water through the pads and cool directly through the skin decreasing the core temperature of the patient.

Rapid core cooling is essential to this therapy for the neuroprotection that this provides (Bernard et al., 2002).

Neuroprotection is the process of preserving brain function by decreasing metabolism and toxins that can harm the brain and destroy brain cells when the core body temperature rises. This study will make further strides into the management of the post cardiac arrest population using a more specific regimen of practice and cooling modalities.

Background of Research Project The survival rate for out-of-hospital cardiac arrest is 5-10% (AHA, 2015). The goal of this research project is to increase the survival rate for this patient population.

The health system resources and practices were assessed for the current state of the program. Key points were assessed such as level of competence of staff implementing the therapy, current protocols and order sets that were being used, equipment being utilized to cool the patients, and data-debriefing used to refine the process. Upon review, the staff had not completed annual competency and TTM protocols had not been updated with current research. There was a large variation noted with the current surface-cooling device performance, and no data was being abstracted from the device and used for feedback related to patient outcomes.

Funding for Zoll Thermoguard was secured from the health system’s Foundation. The Zoll Thermoguard is a new modality used to control a patient’s core body temperature with an intravascular heat exchange catheter. This technology has shown to decrease side effects of TTM therapy such as variations in temperature control and shivering. The decision was made to reformulate the program for the health system due to the implementation of this new device.

Literature Review Early modern research in the field of TTM started when Bernard et al. (2002) conducted a quasiexperimental study of 77 cardiac arrest patients in Australia. This study included two groups of patients that had experienced cardiac arrest with one group receiving a target temperature of 34 degrees Celsius and the other group receiving no therapy. In this study, the group receiving no TTM therapy was 55%, while the group receiving TTM therapy was 41%. The TTM

group also showed a that 55% of the patients had favorable neurological and functional outcome post discharge, while 33% of the group receiving no therapy had favorable neurological and functional outcome post discharge. However, the medical community showed some skepticism of this study due to the low sample size.

Dankiewicz et al. (2021) conducted a randomized control trial in nine centers across five European countries. There were 275 patients enrolled in this trial that suffered cardiac arrest caused by a shockable heart rhythm of pulseless ventricular tachycardia or ventricular fibrillation. The results of this study resulted in favorable neurological and functional outcome upon discharge of 49% versus 26% in favor of the TTM group. This study also showed a decrease in mortality from 68% to 51%, also in favor of the TTM group. Critics concluded some of the same limitations as they noted in Bernard et al.

(2002) study. However, a limitation in this study of fever prevention not being provided for the control group may lead to the belief that the staggering results achieved from the TTM group could have been achieved merely by having the control group experience hyperthermia.

Nielsen (2013) conducted a large study of 950 patients that had experienced cardiac arrest. The participants were divided into 2 groups; a target temperature of 33 degrees Celsius and a target temperature of 36 degrees Celsius. The same duration of therapy was used in each group; however, different methods of cooling were used.

The results of this study concluded that there was no statistically significant difference in outcomes related to either group. There is fault in the study due to delays in patients reaching the target temperature and the use of different modalities among the participants in each group.

Although both groups experienced TTM, the results were misinterpreted by clinicians, as they believed there was no longer a need to cool patients after cardiac arrest.

Lascarrou et al. (2019) conducted a randomized control trial that included 584 patients experiencing cardiac arrest that was preceded by a non-shockable rhythm. The primary rhythm was asystole, and the major causes was asphyxia. The increase in favorable neurological and functional outcome increased from 5%-10% in favor of the TTM group, but there was no change in the overall mortality rate when comparing both groups. This was the first study that focused on the population of patients that had experienced nonshockable rhythms.

Dankiewicz et al. (2021) performed the most recent study comparing hypothermia versus normothermia after out-of-hospital cardiac arrest. This study divided the cardiac arrest patients into two groups with the target temperature goal of 33 degrees Celsius versus 37 degrees Celsius. This study was formulated in this fashion to clarify the difference between active patient cooling versus fever prevention. The results of this study showed no difference in overall neurological and functional outcome. It also indicated no difference in mortality among the two groups. These results have created an even larger divide among clinicians in the health care community. One limitation of this study is that the majority of patients in both groups were males that had a preceding shockable rhythm and had received bystander CPR after a witnessed cardiac arrest. This is a very specific situation that applies to a targeted group though the results are generalized over every group of cardiac arrest patients all over the world.

Implementation The preliminary work for this research project was done during the planning phase. This is when the data for patient outcomes and device performance information was abstracted from prior patients. All recommended changes for order sets, policies and procedures were drafted and taken to the Critical Care Committee for approval. Upon approval, these changes were reviewed with informatics for integration of the changes into the electronic medical record and paper downtime forms were modified.

The project was implemented in two phases. The first phase was to update the order sets and protocols.

Updated pharmaceutical management was put into place. The protocol was modified to allow for more rapid cooling and a smaller window of time to get the therapy started. After this was completed, staff training was completed. This was done several times per staff member over the course of two months. Staff members were taught by both didactic education and hands on skills practice with the device.

After this phase was complete, the device was put into service. Patient selection was completed in real time using the AHA guidelines for inclusion/exclusion criteria.

Once the patient presented with ROSC after cardiac arrest, they were transferred to the ICU for placement

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of the intravascular heat exchange catheter and TTM was implemented without delay. The nurse- to-patient ratio remained at 1:1 for the next 36-48 hours until the patient’s core temperature was returned to 37 degrees Celsius. For this trial, 33 degrees Celsius was chosen as the goal target temperature.

Due to the smaller numbers of patients that present with cardiac arrest, there were 10 patients selected for TTM during this trial. The patient had delineated treatments given to prevent/manage pain, sedation, and shivering. The initial phase of cooling to prescribed goal core temp was completed as fast as possible, and the patient had the goal core temperature maintained for the next 24 consecutive hours. After the prescribed time, the patient was rewarmed to a goal of 37 degrees Celsius at a rate of 0.2 degrees Celsius per hour. Upon reaching the normothermic temperature of 37 degrees Celsius the patient maintained the temperature for the last 48 hours of therapy. All other medical management was completed following current evidence-based practice. After the therapy had concluded, the temperature control device was downloaded onto a secure laptop and the actual/ target temperatures were graphed to display accuracy of temperature during treatment.

Conclusion The changes instituted were embraced by the staff and compliance with the policies and procedures were excellent. Leadership was attentive to this process to ensure understanding and compliance with the changes.

There were six out of the 10 patients that received TTM during this trial that survived and maintained a positive functional status. Other areas of marked improvement were the initiation to achieve the goal target temperature decreasing from 2.87 hours with the surface cooling device to 1.25 hours with the intravascular cooling machine. There was also a significant increase with the percentage time that the temperature was held within +/- 0.5 degree Celsius of the ordered temperature.

With surface cooling, the device data reported 89% accuracy. There was a 97% accuracy achieved with the intravascular device. Another notable change was the reported decrease in nursing workload when using the intravascular device.

American Nurses Association Elects New National Leaders at Its 2023 Membership Assembly SILVER SPRING, MD – On June 17th, the voting representatives of the American Nurses Association (ANA) Membership Assembly elected leaders to serve on the board of directors and nominations and elections committee. All terms of office begin on January 1, 2024.

ANA’s Membership Assembly elected the following members to serve on the 9-member board of directors: Vice President Anita Girard, DNP, RN, CNL, CPHQ, NEABC, of ANA\California; Treasurer Joan Widmer, MS, MSBA, RN, of New Hampshire Nurses Association; Directorat-Large Khaliah Fisher-Grace, PhD, RN, CPHQ, PCCN-K, of the Individual Member Division; Director-at-Large, Recent Graduate Nikule Abel, BSN, RN, of the Minnesota Organization of Registered Nurses.

Those continuing their terms on the ANA board in 2024 are: ANA President Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN of the Oregon Nurses Association; Secretary Amanda Oliver, BSN, RN, of ANA – Illinois; Director-at-Large Edward Briggs, DNP, MS, APRN, of the Florida Nurses Association; Director-at-Large, Staff Nurse Jacob Garcia, MSN, MBA, BSN, PCCN, RN, of the Washington State Nurses Association; Director-at-Large Jennifer Gil, MSN, RN, of the New Jersey State Nurses Association.

Elected to serve on the Nominations and Elections Committee are: Liz Aquino, PhD, RN, of ANA-Illinois; Kaitlin Cuas, MSN, RN-BC, CDP, of the Connecticut Nurses Association; Linda Taft, RN, of ANA-Michigan; and Nelson Tuazon, DNP, DBA, RN, NEC-BC, CENP, CPHQ, CPPS, FACHE, FNAP, FAAN, of the Texas Nurses Association.

CONTACT: Keziah Proctor, keziah.proctor@ana.org

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September 2023

The Nursing Voice

The IDFPR/Illinois Nursing Workforce Center (INWC) Advisory Board and the Illinois Board of Higher Education (IBHE) are proud to acknowledge the FY23 Nurse Educator Fellow recipients. Fellowships were awarded to nurse educators with strong commitments to use fellowship funds to enhance their professional practice in their area of specialty as well as remain in higher education. Each fellowship was awarded $10,000. The funds are salary supplements that are used for expenses related to professional development and continuing education to enhance the fellow’s practice as a nurse educator, as well as the fellow's nursing program. In FY23 forty educators were selected from 28 institutions and were awarded the Fellowships through the IBHE. The IDFPR/INWC Advisory Board hosted the virtual recognition award on May 10, 2023. During the recognition event, the FY23 Nurse Educator Fellows were welcomed and congratulated by IDFPR Division of Professional Regulation (DPR) Director Cecilia Abundis and IBHE Assistant Director Brook Stewart. Thank you to the Illinois Nursing Workforce Center Advisory Board of Directors and to IBHE for this continued partnership.

The Fellows completed a short survey and they provided individual comments about changes to their practice which include primarily implementing information and lessons learned from a conference or research into practice. Some included learning and incorporating NCSBN Next Gen tools into teaching students, exposing to more opportunities, support of research for DNP degree, and support of lifelong learning.

The majority (85%/34) of the Fellows indicated that they plan to use the award to attend conferences or other educational events. A total of 33 percent (13) responded that they would use the award to help pay for tuition and 20 percent (8) will use funds for skills acquisition. A total of 38 percent (15) answered that the award will be used toward a special project and 43 percent (17) indicated that funds would be used to acquire certification such as Certified Nurse Educator (CNE). Please note that respondents could choose more than one answer, so the percentage totals are more than 100%.

The final survey question about how educating nurses post COVID-19 pandemic might change elicited comments in a few areas: the transition to online teaching; the future to include continued flexibility with didactic and online teaching; clinical settings that will broaden to include more non acute care, community settings; and the need to include educating students regarding self-care. Additional details will be available after the INWC Advisory Board approves the May 10, 2023, minutes. The minutes will be posted on the IDFPR/INWC website, Section: About Us, sub section: Current Meeting Notices and Minutes: https://www.nursing.illinois.gov

MORE REWARDING THAN EVER ENHANCED COMPETITIVE COMPENSATION SCHEDULING FLEXIBILITY ADVANCEMENT OPPORTUNITIES

BJCOPPORTUNITY.ORG

The Illinois Nursing Workforce Center was established by legislation in 2006, Nurse Practice Act Section 75-10. The Mission of the Illinois Center for Nursing (ICN) is to advocate and ensure appropriate nursing resources necessary to meet the healthcare needs of the citizens of Illinois. Past reports, data and minutes are on the website https://www.nursing.illinois.gov The IBHE FY23 Nurse Educator Fellows Nurse Educator Fellow

Affiliation

Malina Campos MSN, APRN, FNP-C

Ambria College of Nursing

Andrea Kilroy MSN, RNC-MNN

Ambria College of Nursing

Tracey Stilley MSN, RN

Aurora University

Kathryn “Katie” Vanderzwan DNP, APRNBC, CHSE

University of Illinois at Chicago

Matthey Yau MSN, FNP-BC, APRN, RN

Chamberlain College of Nursing

Maricruz “Mari” Diaz-Boylan MSN, RN, CLC

City Colleges of Chicago

Talargie Tafesse MSN, DVM

City Colleges of Chicago

Anne Kowalczyk DNP, MS, APRN, FNP-BC, AMB-BC, CPN, CNE

DePaul University

Richard Clapp DNP, APRN

Eastern Illinois University

Jacy N. Ghast DNP, RN

Eastern Illinois University

Margaret “Peggy” LeMoyne DNP, RN, CNE, PMH-BC

Elgin Community College

Laury Westbury EdD, RN, CHSE, RN-BC (NI), CNOR, RNFA

Elmhurst University

Julie Carr MSN, RN

Heartland Community College

Dameron D. Beverly MSN, RN-BC, CNE

Heartland Community College

Theresa Adelman-Mullally PhD, RN, CNE

Illinois State University

Theresa Novy, DNP, GERO-BC, CNEcl, CWON

Illinois State University

Megan Rappleyea MSN, RN, OCN, CNE

Illinois State University

Katie King MSN, RN, CPN, CNEcl

Lakeview College of Nursing

Leslie Catalano MSN, RN, CHSE, NPD-BC

Lincoln Land Community College

Bridgette Hudson MSN, RN, CCRN

Lincoln Land Community College

Amy Kiefer PhD, MSN, RN

Loyola University of Chicago

Yeyin Yi DNP, APRN, AGACNP-BC

Loyola University of Chicago

Julia K. Auton APRN, FNP-BC

Millikin University

Gail Fyke DNP, APRN-BC

Millikin University

James Travis Whisman

Millikin University

Leslie Moyar EdD, MSN, APRN, AGACNP

Moraine Valley Community College

Meredith Watkins DNPc, MSN-Ed., RNCEN

Morton College

Stephanie Uhr PhD, RN, IBCLC

Northern Illinois University

Reem Azhari, PhD, RN, CNOR

Oak Point University

Monique Reed PhD, RN, FAAN

Rush University

Judith April Dollins, EdD, MSN, RN, CLC, C-EFM

Shawnee Community College

Sherry Haley, MSN, RN

Kishwaukee College

Kelli Whittington PhD, RN, CNE

Southern Illinois University at Carbondale

Myjal Garner DNP, APRN, FNP-C

Southern Illinois University at Edwardsville

Elizabeth Alvarez DNP, RN

Southwestern Illinois College

Cynthia Winfield DNP, RN

Southwestern Illinois College

Ife Muyiwa-Ojo DNP, MSN-Ed, MBA, NPC, CCRN, CNE

St. John’s College of Nursing

Lorna J. Scoggins MSN, RN, PMH-BC

University of Illinois at Chicago

Amanda Sperry MSN, RN, PEL-CSN, NCSN

University of Illinois at Chicago

Courtney Pritchard MSN, RN, CCRN-K

University of St. Francis

The Nursing Voice

September 2023

Page 11

Substance Use Disorders and Drug Diversion Among Nurses: What You Need to Know

Drug diversion occurs when a healthcare clinician diverts a drug intended for a patient for their own purposes. Clinicians steal drugs to sell or use themselves because they are suffering from substance use disorder (SUD).

As clinicians, nurses aren’t immune to SUD or drug diversion. Statistics from the U.S. Substance Abuse and Mental Health Services Administration and American Nurses Association suggest that about 10 percent of healthcare workers abuse drugs. And the 2021 Diversion Digest Report from Protenus, a healthcare compliance analytics platform, found that nurses were responsible for 31 percent of publicly reported drug diversion incidents in 2020. Both SUD and drug diversion have significant professional implications that nurses need to understand.

SUD and drug diversion Unfortunately, incidences of SUD and drug diversion have risen in recent years. And drug diversion is likely underreported because a significant number of diverters go undetected despite warning signs.

The Diversion Digest Report notes that the COVID-19 pandemic also has likely contributed to underreporting.

According to the Drug Enforcement Administration (DEA), the most common classes of drug that are abused are opioids, depressants, hallucinogens, stimulants, and anabolic steroids. Opioids are the most common class of diverted drugs, with oxycodone, fentanyl, and hydrocodone leading the way, according to the Diversion Digest Report.

Methods for diverting drugs include obtaining drugs by not “wasting” them in situations where they would normally be disposed of (for example, drawing up too much medication), not administering drugs to patients, and administering a substitute substance such as water or saline.

Consequences of SUD and drug diversion The consequences of drug diversion are many, including criminal and civil legal action against the diverter. Not only can nurses be charged with a felony, but they also can be sued by patients who experience inadequate pain relief or infection as a result of tampering. (When clinicians with hepatitis C virus or another bloodborne infection tamper with an injectable drug, they can contaminate equipment, resulting in subsequent infection.) In addition, nurses with a SUD may make errors that cause patient harm and subsequent legal action. And, of course, these nurses experience significant physical and psychological harm to themselves.

Drug diversion and suboptimal practice due to SUD also can prompt colleagues or patients to file reports with the state board of nursing, which can result in loss of license—and a career.

SUD and drug diversion also violate multiple provisions in the Code of Ethics for Nurses with Interpretive Statements. For example, provision 2 states “the nurse’s primary commitment is to the patient…” and drug diversion puts the nurse’s interests over the patient’s. Provision 3 requires nurses to promote, advocate for, and protect the rights, health, and safety (emphasis added) of the patient. And provision 5 states the nurse “owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity…” SUD does not promote self-care, and those who divert drugs do not act with integrity.

Identifying and reporting To protect patients, nurses should report those they suspect of diversion (see sidebar: Signs of drug diversion) to their supervisor; the organization then has the responsibility to investigate the claim. If action is not taken, Healthcare Diversion Network suggests reporting the incident on its website, filing a report with the state board of nursing, or, in the case of theft of controlled substances, submitting Form DEA-106, available at: www.deadiversion.usdoj.gov/Reporting. html.

Preventing drug diversion The following strategies reduce the risk of drug diversion: • Use controlled substances in dose sizes that minimize waste.

• Avoid range orders for controlled substances because they promote waste.

• Only remove controlled substances from automated dispensing cabinets right before they are to be administered.

• Waste immediately; delays can increase the risk of diversion.

• Know your organization’s wasting policies.

• Understand the symptoms of substance use disorder and what to do when you see it.

• Dispose of drugs safely per EPA requirements.

• Speak up when you suspect diversion.

In cases where SUD is suspected as the cause of the diversion, reporting ensures nurses receive the help they need. As the 2019 Quick Safety on drug diversion from The Joint Commission notes, “see something, say something.”

Nurses also have an ethical responsibility to report suspected SUD. Within provision 3 of the Code of Ethics is an entire section related to impaired practice and the need to act to “protect patients and ensure that the impaired individual receives assistance.” The code further notes that nurses must take “appropriate action” when “incompetent, unethical, illegal, impaired practice or actions” put the best interests of the patient “in jeopardy”. They are to report concerns to their manager or the appropriate higher authority in the organization.

Nurses concerned about the negative consequences that the nurse they are reporting may face can take comfort in knowing that SUD is now widely acknowledged as a disease, with punitive actions replaced with treatment geared toward addressing the issue and enabling the nurse to safely return to work. For example, many state boards of nursing now have voluntary alternative-to-discipline programs in place that emphasize treatment. Nurses typically don’t practice while undergoing treatment, but they retain their license and ultimately return to work, although initially, there may be some restrictions such as limits on hours worked and not administering narcotics.

Monitoring continues, and restrictions are gradually lifted. These programs have been successful in keeping nurses in the profession, so their expertise is not loss.

Nurses also should keep in mind that failing to report a colleague who is diverting drugs has ethical and professional consequences. The Code of Ethics states that if the reported practice is not corrected and continues to jeopardize patients, nurses “must report the problem to the appropriate external authorities” such as licensing boards and regulatory agencies.

According to the Code of Federal Regulations Title 21, the DEA’s “position” is that employees who know about drug diversion must report it to the appropriate person in the organization. Failure to report “will be considered in determining the feasibility of continuing to allow an employee to work in a drug security area.”

In other words, it may affect your own employment.

The organization needs to maintain confidentiality of those reporting.

Protecting patients, helping colleagues SUD and drug diversion can cause serious consequences for patients and the nurse diverting.

Nurses can strive to prevent drug diversion (see sidebar: Preventing drug diversion) and report those diverting drugs to protect patients and help those with SUD obtain needed assistance.

Signs of drug diversion Nurses and organizations should be alert to the signs of drug diversion to protect patients and ensure diverters receive help. Here are examples of behaviors that may indicate a SUD and/or diversion, however, keep in mind that anyone can be affected by SUD and the signs can be subtle.

• Patients stating they didn’t receive medications that have been documented as having been administered • Atypical drug wasting patterns such as – heavy wasting – lack of documentation related to wasting – frequent wasting of drugs that never reach the patient (for example, patient refusal, discontinued orders) – holding waste until the end of the shift – frequent requests for colleagues to sign off on wasting they did not witness

• Reviewing medication orders of patients not assigned to them, helping colleagues medicate their patients, or volunteering to administer narcotics to patients.

• Frequently asking for supplemental orders for controlled substances • Altering telephone or verbal medication orders • Changes in job performance • Recurrent mistakes, poor judgment, variable work performance, blaming others or the environment for errors • Forgetfulness, drowsiness, malaise, euphoria, anxiety, depression, insomnia, paranoia • Deteriorating personal relationships, frequent personal crises, isolation, volatility, or sullenness • Taking many sick days, arriving late to work, or frequent no-shows • Extended or frequent breaks and disappearances during shift • Volunteering for overtime or coming to work on days off • Arriving late or leaving early • Inappropriate verbal or emotional responses • Diminished alertness, confusion, or memory lapses • Physical signs of SUD, for example, opioid use disorder is associated with constricted pupils, sweating, chills, runny nose, anorexia, itching and scratching, vomiting, diarrhea, or needle tracks.

By: Cynthia Saver, MS, RN, is president of CLS Development, Inc., in Columbia, Md. References American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. 2015. https://www. nursingworld.org/practice-policy/nursing-excellence/ ethics/code-of-ethics-for-nurses/ Centers for Disease Control and Prevention. Drug diversion. 2019. https://www.cdc.gov/injectionsafety/ drugdiversion/index.html 212 CFR § 1301.91 (1975/2021). https://www.ecfr.gov/ current/title-21/chapter-II/par t-1301/subject-groupECFRbf5f8d39b8823bb/section-1301.91 Health Diversion Network. Reporting suspected drug diversion: How to report (and why it matters). n.d. h t t p s : // h e a l t h c a r e d i v e r s i o n . o r g /r e p o r t i n g - d r u g diversion-how-to-report-and-why-it-matters/ National Counsel of State Boards of Nursing. Alternative to Discipline Programs for Substance Use Disorder. n.d. https://www.ncsbn.org/nursing-regulation/discipline/ board-proceedings/alternative-to-discipline.page Perry J, Vandenhouten C. Drug diversion detection. Nursing Management. 2019;50(2):16-21. https://journals.lww. com/nursingmanagement/Fulltext/2019/02000/Drug _ diversion_detection.5.aspx Protenus. 2021 Diversion Digest. 2021. https://www. protenus.com/resources/2021-drug-diversion-digest The Joint Commission. Drug diversion and impaired health care workers. Quick Safety. 2019;48. https://www. jointcommission.org/-/media/tjc/newsletters/quick _ safety_drug_diversion_final2pdf.pdf Stobbe S, Crowley M. Substance use among nurses and nursing students. J Addict Nurs. 2017;28(2):104-106. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/ cfcfr/CFRSearch.cfm?fr=1301.91

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 12

September 2023

Workarounds: How Nurse Leaders Can Minimize Their Risks

Nurses must contend with many competing demands during a typical shift (delivering care to patients, educating families, communicating with other members of the healthcare team, to name just a few), often causing them to seek ways to compress everything they must do into a short time frame.

In these situations, it can be tempting to engage in “workarounds”, subverting policies, procedures, and even standards of care to pick up precious minutes.

The goal is a worthy one — more time with patients.

But workarounds are potentially dangerous to patients and nurses, with some leading to serious consequences such as harm to patients and subsequent legal actions against nurses — and the organizations that employ them.

Nurse leaders and healthcare administrators can protect nurses, themselves, and their organizations from legal jeopardy by understanding the nature of workarounds and creating an environment that minimizes them.

Causes of workarounds Debono and colleagues provide this useful definition of workarounds: “Observed or described behaviors that may differ from organizationally prescribed or intended procedures in which workers ‘circumvent’ or temporarily ‘fix’ an evident or perceived workflow hindrance to meet a goal or to achieve it more readily.”

In essence, a workaround occurs when a nurse takes action that deviates from established policies and procedures to accomplish the work they need to do — delivering patient care.

Nurses may engage in workarounds when they encounter barriers to their ability to deliver care.

Time is a frequently cited barrier, but many causes lie behind this one word. In a scoping review, Debono and colleagues categorized factors contributing to workarounds as organizational (such as insufficient staffing, productivity pressures), work process (such as new technology not matching workflow), patientrelated (such as the need to ensure patients receive timely care, or policies not in the best interest of the patient), individual clinician (such as fatigue), and social and professional (such as poor communication between clinicians). A key factor to remember is that in most cases, nurses engage in the behavior because they feel it is important to overcome obstacles and deliver needed care to patients.

Workarounds can be viewed on a continuum. For example, they can be innovative when, perhaps, a more efficient workflow is identified. On the other hand, they can be harmful, resulting in patient morbidity and mortality. (Deutsch notes that in addition to immediate danger to patients, workarounds

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make it less likely that an underlying problem will be identified and addressed.) Certainly, some workarounds pose less potential harm to patients than others, but in general, workarounds are something to be avoided because of patient safety risks.

Avoiding workarounds Nursing and other organizational leaders can take several steps to reduce workarounds (see sidebar).

Engage in dialogue. Leaders and staff should collaborate when implementing new technology or practices to ensure they fit into nurses’ workflow.

A systematic review found that workarounds most frequently occurred when new technology was implemented and when medications were administered.

Leaders also should regularly ask staff about problems in workflows and to share any workarounds they have engaged in. It can be helpful to observe care directly, since nurses may not be conscious of workarounds they use. Be aware of situations particularly vulnerable to workarounds, such as when a new process is implemented. In addition to considering the reason for the workaround, those that do not put patients in harm’s way should be evaluated to see if they could result in positive practice changes.

Promote a culture of safety. Leaders need to communicate to staff that the primary goal of the organization is to deliver safe, quality patient care.

While that may be stating the obvious, too often nurses perceive that the goal is to complete all the work in the allotted time; this message is reinforced when organizations don’t provide needed support such as adequate staffing.

Another component of a safety culture is a just culture, where there is open communication and a blame-free environment. Errors should be investigated with the goal of identifying root causes, rather than assigning blame. Steven Spear, a senior fellow at the Institute for Healthcare Improvement, suggests that when an error occurs because of a workaround, helpful questions include: What went wrong? What got in my way? Why did it get in my way? What can I — what can we — do differently going forward that will address the causal factors and remove the bad experience?

Hold staff accountable. A just culture does not preclude holding staff accountable for their actions. Nurses who engage in reckless behaviors should be counseled and disciplined. A behavior is considered reckless when the person consciously engages in it while knowing that there is substantial and unjustifiable risk. Leaders can work with human resources departments to establish procedures to follow in these situations.

Provide needed resources. Nurses will engage in workarounds when they don’t have the resources they need to care for patients. These resources include adequate staff, equipment, and supplies. For example, a study found that understaffing during the COVID-19 pandemic led to greater use of safety workarounds.

Provide education. Education about the potential dangers of workarounds should include reasons for it and the importance of speaking up when the nurse feels a workaround is necessary. It also can be helpful to discuss normalization of deviance. When someone chooses to use a workaround and no negative consequences occur, there is the tendency to repeat the workaround and drift away from the standard of behavior, resulting in deviance that can result in harm.

Ensure a user-friendly electronic health record (EHR). Cumbersome EHRs are a frequent source of workarounds, which can lead to patient harm, including medication errors. For example, a study found that 46 percent to 64 percent of nurses used workarounds related to EHRs. Including staff when selecting an EHR and soliciting their input on a regular basis to detect ways the EHR can be made more userfriendly can help reduce workarounds.

Protecting patients, nurses, and organizations While sometimes helpful in illuminating ways processes can be improved, workarounds more often result in an increased risk of patient harm. This harm can lead to legal action for caregivers, leaders, and

The Nursing Voice

organizations. By minimizing workarounds, nursing leaders can help keep patients safe and reduce the risk of liability.

Reducing workarounds It may not be possible to eliminate workarounds, but the following strategies can reduce them.

▪ Engage in dialogue before implementing new technology and practices to determine how they fit into current workflow.

▪ Ask staff to share workarounds and the reasons for them.

▪ Promote a culture of safety and a just culture.

▪ Ensure adequate staffing and supplies.

▪ Provide sufficient equipment and a user-friendly EHR. ▪ Educate staff about workarounds, including normalization of deviance.

By: Cynthia Saver, MS, RN, is president of CLS Development, Inc., in Columbia, Md. References American Association of Post-Acute Care Nursing.

Resident safety and nurse workarounds. 2022. https:// w w w.aapacn.org /ar ticle/resident-safet y-and-nurseworkarounds/ Andel SA, Tedone AM, Shen W, Arvan ML. Safety implications of different forms of understaffing among nurses during the COVID-19 pandemic. J Adv Nurs. 2022;78(1):121130. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC8450811/ Debono DS, Greenfield D, Travaglia JF, et al. Nurses’ workarounds in acute healthcare settings: A scoping review. BMC Health Serv Res. 2013;13:175. https://link. springer.com/article/10.1186/1472-6963-13-175 Deutsch ES. Workarounds: Trash or treasure? Pa Patient Saf Advis. 2017;14(3). http://patientsafety.pa.gov/ ADVISORIES/Pages/201709_Workarounds.aspx Institute for Safe Medication Practices (ISMP). The differences between human error, at-risk behavior, and reckless behavior are key to a just culture. ISMP Medication Safety Alert! Acute care edition. June 18, 2020;25(12). https://www.ismp.org/resources/ differences-between-human-error-risk-behavior-andreckless-behavior-are-key-just-culture Lee S, Lee M-S. Nurses’ electronic medical record workarounds in a tertiary teaching hospital. Comput Inform Nurs. 2021;39(7):367-374. https://journals. lw w.com/cinjournal/Abstrac t/2021/070 0 0/Nurses _ _ Electronic_Medical_Record_Workarounds_in_a.6.aspx McCord JL, Lippincott CR, Abreu E, Schmer C. A systematic review of nursing practice workarounds. Dimens Crit Care Nurs. 2022;41(6):347-356. https://journals.lww. com/dccnjournal/Abstract/2022/11000/A_Systematic_ Review_of_Nursing_Practice.11.aspx Spear S. Solving workarounds. Institute for Healthcare Improvement. n.d. https://www.ihi.org/education/ I H I O p e n S c h o o l /r e s o u r c e s / P a ge s /A c t i v i t i e s / SteveSpearSolvingWorkarounds.aspx Wright MI, Polivka B, Odom-Forren J, Christiann BJ. Normalization of deviance: Concept analysis. ANS Adv Nurs Sci. 2021;44(2):171-180. https://journals.lww. com/advancesinnursingscience/Abstract/2021/04000/ Normalization_of_Deviance__Concept_Analysis.8.aspx

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

September 2023

Page 13

idfpr.illinois.gov JB PRITZKER Governor

MARIO TRETO, JR. Acting Secretary

CECILIA ABUNDIS Acting Director

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

• 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 implicit bias awareness training. 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 Acts and Rules and 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 • 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/applications/ LicenseReprint/ • IDFPR knows how critical it is to military families to begin working as soon as they come to the Prairie State. Illinois law includes several provisions designed to help military Service • 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 here: https://idfpr.illinois.gov/ military.html You may also email the Military Liaison using this email address: fpr.militarylicense@illinois.gov • 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.

• Learn more about the nursing profession in Illinois on IDFPR’s Nurses webpage: https://idfpr.illinois.gov/ PROFS/Nursing.asp

• 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 IDFPR website, https:// idfpr.illinois.gov or on the Illinois Nursing Workforce Center’s website: https://nursing.illinois.gov/nursinglicensure/nursing-act-rules.html • To print your license or download an electronic copy to your phone, just head to the IDFPR website https:// idfpr.illinois.gov/applications/getmylicense/LoginProf. asp?ViewOption=ind • IDFPR is providing renewal assistance for individuals and businesses that are having difficulty with the online renewal process. These steps will help licensees better navigate the account matching process on the Department's updated online portal. For those requiring additional assistance, please email: fpr.lmu@illinois.gov o Assistance for Individuals: https://bit.ly/3mb8C7U o Assistance for Businesses: https://bit.ly/3E5Fll8 • 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.

• 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 2105/2105117), 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 COVID-19 Resources and Information Governor JB Pritzker announced the state's public health emergency will end on May 11, 2023, aligning the state with the federal government's decision to end the national public health emergency. Learn more here: https://www.illinois.gov/news/press-release.25998.html • The Division of Professional Regulation (“DPR”) has been notifying COVID-19 temporary practice permit holders via email of the expiration date and providing information on the process of applying for Illinois licensure by endorsement or reinstatement. A proclamation has extended the application deadline to July 11, 2023: To learn more: ehttps://idfpr.illinois. gov/content/dam/soi/en/web/idfpr/forms/covid19/hd17871-proclamation-for-extension.pdf • Public Act 103-001, formerly HB559, provides that any person who was issued a temporary out-of-state permit by the Department of Financial and Professional Regulation in response to the COVID-19 pandemic may continue to practice under a temporary out-of-state permit if they apply for licensure by endorsement to the Department on or before July 11, 2023. Any such person may continue to practice under their temporary out-of-state permit until the license is issued or the application is denied, at which time the temporary outof-state permit shall expire. If the license application is not decided by May 11, 2024, the temporary outof-state permit shall expire. The same terms apply to the temporary reinstatement permit. This applies to licensed professions, including RNs, LPNs, and APRNs. • Frequently Asked Questions (FAQs) with information about what’s next for COVID-19 Temporary Practice Permit Holders may be found here: https://idfpr. illinois.gov/content/dam/soi/en/web/idfpr/forms/ covid19/IDFPR%20COVID -19%20Temporar y %20 Practice%20Permit%20FAQs.pdf • The list of health care professional temporary practice permits granted in Illinois may be found here: https://www.idfpr.com/Forms/COVID19/Temp%20 Practice%20Permits.pdf • 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/

Key Findings 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. https://nursing.illinois.gov 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 in each 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 than in the past biennium.

• Age: approximately 55% of Illinois RNs are over 55 years of age.

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

Diversity • 64% of Hispanic/Latinx nurses 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.

• 57% of nurses that identify as Multiracial are 44 years of age or younger.

Age of the RN Workforce • 55% of the RN workforce is 55 years of age and older.

• 35% are between the ages of 55-64 years.

• 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 the younger age cohorts. The hospital is the most common acutecare employment setting where nurses have different roles.

• 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.

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

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

• 3% Identify as nursing faculty.

In Illinois the average staff nurse acute care salary ranges from $65,000-$85,000 (31%), $85,001$105,000 (23%, $105,001-$145,000 16.3%); the average administrator/manager’s salary ranges from $75,000$185,000; the average nursing faculty salary ranges from $65,000-$85,000 (20%) *APRNs and FPA-APRN’s who are also licensed as RNs were not included in the survey data.

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September 2023

The Nursing Voice

Guadalupe Hernandez: A Leader Uniting Nursing Organizations and Shaping the Future

When it comes to mentoring in the nursing field, there is no one who understands the benefits better than Guadalupe (Lupe) Hernandez, a winner of the Illinois Nurses Foundation 40 Under 40 Emerging Nurse Leaders Award. Hernandez, a Care Connections Nurse Practitioner for Molina Healthcare and adjunct professor at Dominican University, is deeply passionate about nursing, both in practice and in the academic setting.

In addition to her nursing career, Hernandez is a thriving entrepreneur. She owns and operates her own life- and leadership-coaching business, with mentoring serving as the focal point of her professional endeavors.

A DRIVING FORCE IN NURSING ORGANIZATIONS “It’s a big connection, a big family of nursing organizations coming together.”

Since 2014, Lupe Hernandez has been an active member of ANA-Illinois but her involvement extends beyond ANA, as she has also joined several other nursing organizations. She has previously served on the Illinois Nurses Foundation Board in 2015. She also has held the positions of vice president and president in the National Association of Hispanic Nurses (NAHN). NAHN is an organization dedicated to bringing together healthcare professionals of a hispanic background. The organization is dedicated to bringing awareness to the needs of hispanic health professionals.

Hernandez’s dedication to various nursing organizations was acknowledged when she received the prestigious 2015 Illinois Nurses Foundation 40 Under 40 Award. Not only is this award an honor for any nurse to receive, but Hernandez was a member of the first class to receive it and was the first ever Hispanic nurse to be awarded with a 40 Under 40. Her nomination was put forward by Susan Gonzales, who served as president of NAHN while Hernandez held her position of vice president.

BUILDING CAREERS THROUGH PERSONAL CONNECTIONS Lupe Hernandez has emerged as a prominent leader in the ANA-Illinois nursing community, and she attributes her success to the mentorship of Elizabeth Aquino, the current president of ANAIllinois.

“I’ll never forget the day we met.”

Hernandez replied when asked about how she met Elizabeth Aquino.

While working as an ICU nurse at West Suburban, Hernandez first encountered Aquino when she was serving as a professor. During a shadowing experience with one of Aquino’s students, Hernandez found herself attending to a patient who experienced a Code Blue. Aquino and the student walked in at the exact moment of the emergency.

Hernandez recalls, “Since then, we really developed a friendship and a professional relationship. She pushed me to be ambitious and inspired me to get out and get involved in everything.”

Personal relationships play a crucial role in advancing careers in the nursing profession, and ANA-Illinois places a strong emphasis on mentorship within nursing.

“Elizabeth inspired me to assume the role of president in NAHN and become a member of INF. It was through her guidance that I expanded my involvement within the ANA-Illinois organization.”

Lupe is following Elizabeth’s lead today. Because of the inspiration the mentor provided her, Lupe has become president of NAHN, and become an active board member of INF. Elizabeth’s encouragement helped push Lupe into taking risks and chances with her career and is also inspiring her to help others do the same.

FROM NURSING STUDIES TO EMPOWERING CAREERS Lupe Hernandez and her son Maximo at her graduation from Johns Hopkins School of Nursing and Johns Hopkins Carey Business School While completing her nursing studies at Johns Hopkins University, Hernandez had the opportunity to participate in a free leadership coaching program through Wisdom of the Whole. During which she discovered that she has a true passion for helping others. Finding the program inspiring, Lupe dedicated two years to working with leadership coaching at Johns Hopkins, and ultimately made the decision to pursue it as her career.

Studying nursing is stressful. “Doing a dual degree program, even one that you are passionate about, is tiring. Mental health is important, especially as a healthcare professional. I wanted to start my career right, so I took some time off to take care of myself.” Hernandez took the year off after she completed her studies, then embarked on the gradual process of building her life and career coaching business. She recalls, “I slowly started engaging in conversations about what I do and began taking on clients.”

Her business goals are centered around assisting individuals in becoming leaders within their respective fields and challenging the prevailing perception of what a leadership and career coach truly entails.

Hernandez also addressed common misconceptions surrounding leadership coaching. “One misconception is that a coach will come in and provide all the answers, pointing out what you’re doing wrong or what you need to do to fix it. In reality, our role is to act as a mirror, helping individuals identify incongruencies or cognitive dissonance within themselves.”

A TESTAMENT TO MENTORSHIP AND PERSONAL CONNECTIONS IN ADVANCING NURSING CAREERS Mentoring plays a crucial role in the nursing profession, providing invaluable support and guidance to aspiring nurses as well as those already established in their careers.

Lupe Hernandez exemplifies the power of mentorship, personal connections, and passion in the nursing profession.

The mentor-mentee relationship fosters the transfer of knowledge, skills, and professional values from experienced nurses to novice or less-experienced nurses.

ANA-Illinois knows how important the relationship between mentor and mentee is.

Mentoring in nursing not only enhances clinical skills but also promotes personal and professional growth. Mentors serve as role models, inspiring mentees to strive for excellence and guiding them in setting and achieving career goals. Even before the official start of the mentor-mentee program, Elizabeth Aquino and Lupe Hernandez were taking advantage of the mentor mentee relationship ANA-Illinois can provide.

Today, Lupe is paying it forward with her life- and career-coaching business. By helping nurses find what they value the most in their profession, and planning their career around that, Hernandez is helping nurses achieve their goals. Beyond just career coaching, Lupe also helps her clients make lasting positive health changes by not only educating them, but providing a support system where they feel capable of helping themselves. By fostering a supportive and nurturing environment, mentoring contributes to the retention and job satisfaction of nurses, ultimately improving the quality of patient care.

The Nursing Voice

September 2023

Page 15

Nurses want to provide quality care for their patients.

The Nurses Political Action Committee (Nurses- PAC) makes sure Springfield gives them the resources to do that.

Help the Nurses-PAC, help YOU! So. . . . . . . if you think nurses need more visibility . . . . . . . . . if you think nurses united can speak more effectively in the political arena . . . . . . . . . if you think involvement in the political process is every citizen’s responsibility.

Become a Nurses-PAC contributor TODAY!

info@ilnursesfoundation.com

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I wish to make my contribution via personal check (Make check payable to Nurses-PAC).

❑

I wish to make a monthly contribution to NursesPAC via my checking account. By signing this form, I authorize the charge of the specified amount payable to Nurses-PAC be withdrawn from my account on or after the 15th of each month.

(PLEASE INCLUDE A VOIDED CHECK WITH FORM)

❑

I wish to make my monthly Nurses-PAC contribution via credit card. By signing this form, I authorize the charge of the specified contribution to Nurses-PAC on or after the 15th of each month.

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I wish to make my annual lump sum Nurses-PAC contribution via a credit or debit card. By signing this form, I authorize ANA-Illinois to charge the specified contribution to Nurses-PAC via a ONE TIME credit/debit card charge.

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Mastercard ❑

VISA

________________________ ____________ _________ Credit card number Expires CVV  Signature:______________________________________ Date:__________________________________________ Printed Name:___________________________________ E-Mail:________________________________________ Address:_______________________________________ City, State, Zip Code:_____________________________ Preferred Phone Number:__________________________ Please mail completed form & check to: ANA-Illinois Atten: Nurses-PAC PO Box 636 Manteno, Illinois 60950

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