ANA-Illinois’ 2022 Professional Issues Conference Empowers Nurses
The Professional Issues Conference (PIC), hosted by ANA-Illinois, was held on November 5, 2022, in Lisle, Illinois. Along with inspirational and empowering sessions for nurses, the conference included exhibitors, board elections, and recognition awards.
And, of course, attendees enjoyed networking with nurses across Illinois.
“ANA-Illinois has worked really hard to build a community of nurses where we can come together and support each other. The Professional Issues Conference is an ideal opportunity for nurses to do that,” says Susan Swart, Executive Director of ANA-Illinois.
Empowering Sessions
PIC’s 2022 theme was “Empower Yourself.” Sessions covered a range of topics with an empowering element for nurses. Topics covered ranged from current regulatory issues to emotional intelligence. Each was designed to help nurses advance their careers and elevate their workplaces for a one-of-kind nursing conference.
“The uniqueness about the programs that ANAIllinois brings forward is that we really focus on career development, and we focus on the regulatory environment that is absolutely essential for nurses to understand,” says Swart. “It is a unique professional development opportunity for nurses in Illinois.”
Sessions included:
• Empower Yourself: How Do You Take Care of Others if You Don’t Take Care of Yourself
• Hospital at Home – Innovation for Patient Care & Opportunities for Nurses
• The Criminalization of Nursing Practice: A Risk Management and Regulatory Perspective
• Nurses Driving Change with Staffing – Legislative Implementation in Practice
• Emotional Intelligence
• Exhibitors & Poster Presentations
Innovative Exhibitors & Poster Presenters
Exhibitor booths and poster presentations were another way to learn and share knowledge from all areas of the state.
Thank you to the following exhibitors: Chamberlain University, Illinois Public Health Association, Indiana Wesleyan University & Lewis University.
Thank you to the following poster presenters: Barbra Moens, Hannah Shufeldt, Jennie Smith-Pariola, Jessica Prothe, Katrina Joyce Cudal, Linda Anders, M. Gail Stotler & Pam DiVito-Thomas.
Uplifting Annual Meeting
The conference also served as an opportunity to hold an ANA-Illinois Annual Meeting, which included a President address, Treasurer report, board elections, and recognition awards.
Welcome to the new ANA-Illinois board members!
Vice President: Dr. Monique Reed PhD, MS, RN, FAAN
Treasurer: Dr. Jeannine Haberman DNP, MBA, CNE
Director: Samuel Davis Jr. MHA, RN, CNOR & Dr. Zeh
Wellington DNP, RN, NE-BC
Director – Recent Graduate: Hannah Shufeldt MSHCM, BSN, RN
Nominations: M Cecilia Wendler RN, PhD, NE-BC
ANA Representatives: Gloria E. Barrera MSN, RN, PELCSN & Feyifunmi Sangoleye PhD, RN (Alternate)
Congratulations to the inspiring nurses who were recognized at this year’s conference.
Clinical Practice Award Winner: Dr. Stephanie Mendoza DNP, MSN, RN-C
Nurse Influencer Award Winner: Dr. Tamara Bland EdD, MSN, RN
Student Nurse of the Year Award Winner: Monica Terrazas
Diversity, Equity, and Inclusion Leadership Scholarship Award Winner: Ashley Whitlatch DNP, MBA, APRN, FNP-BC
Thank you to everyone who attended this wonderful event and thank you to all who worked tirelessly to make the conference a success!
More photos on page 7
ETHICS IN ACTION
The role of nurses in identifying and advocating for victims of Human Trafficking and Domestic Violence
Linda L. Olson, PhD, RN, NEA-BC, FAAN
Lisa Anderson-Shaw, DrPH, MA, MSN
Throughout O’Hare international airport there are signs that state, “Can you see me?,” and “If you suspect it, report it.” Also stating that “modern day slavery exists,” it provides a phone number for reporting Human Trafficking.
also notes that domestic violence can happen to anyone and occurs in both opposite and same-sex relationships.
Studies show that 88% of human trafficking victims are seen in a health care system at some point in time (Tiller & Reynolds, 2020). Many of these encounters are in a hospital emergency department (ED). Similarly, many victims of domestic violence are often seen in the ED. The CDC reports that about one in three women and one in four men in the United States experienced severe physical violence from an intimate partner in their lifetime (CDC, 2022).
The Nursing Voice
INF Board of Directors
Officers
Cheryl Anema, PhD, RN
Brandon Hauer, MSN, RN
Karen Egenes, EdD, RN
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
ANA-Illinois Board of Directors
Nurses and other healthcare professionals are often the first to encounter victims of either human trafficking and/ or domestic violence (intimate partner violence) in the course of their work, thereby serving as first respondents. These two healthcare problems are often inter-related. The ANA Code of Ethics for Nurses with Interpretive Statements (2015), in Provision 3 states that the nurse promotes, advocates for, and protects the rights, health and safety of the patient (p. 9). Since the incidence of both Human Trafficking and domestic violence are global in nature, Provision 8, which addresses the promotion of community and world health, is applicable. It states that the nurse collaborates with other health professionals and the public to protect human rights (p. 31), and that nurses “must bring attention to human rights violations in all settings and contexts” (p. 33). Both Human Trafficking and domestic violence are human rights violations that affect millions of people worldwide. Although there are no defining characteristics, those characteristics most vulnerable to Human Trafficking include poverty, lack of stable housing, and limited English proficiency. Victims can be anyone from anywhere. Migrants and those with lack of lawful immigration status are also affected (U.S. Department of Justice, Sept. 2022). The U.S. Department of Justice (2022)
Full-time and part-time nursing faculty positions open now in all areas
Apply at https://academics.depaul.edu/faculty-jobs/ Pages/default.aspx
What are the ethical considerations for responding to instances of Human Trafficking and domestic abuse, both of which are crimes that are potentially life-threatening. Developing an awareness of the signs and to identify victims is the first step. The next is to connect victims to appropriate resources and referrals they can access to help themselves. Some non-threatening questions that may help in identifying victims include: “Where are you from? How did you arrive here? Do you know where you are now? Do you have enough food to eat? Do you feel safe where you sleep? Are you able to freely come and go from your home? Are you forced to do things you don’t want to do? “(Casey, 2017, p. 37).
Nurses and all health care professionals are considered mandatory reporters and ethically required to be educated about and to report suspected violations of human rights. Additional information about human trafficking and domestic abuse is included at the end of this article. Also, additional information will be forthcoming in a future article.
References Casey, D. (2017). Identifying and advocating for human trafficking victims. From the Ethics Inbox. American Nurse Today 12(12), 37. Centers for Disease Control and Prevention (Reviewed Oct. 11, 2022). Fast Facts: Preventing Intimate Partner Violence. https:// www.cdc.gov/violenceprevention/intimatepartnerviolence/ fastfact.html
Macias-Konstantopoulos, W.L. (2017). Caring for the trafficked patient: Ethical challenges and recommendations for health care professionals. AMA Journal of Ethics 19(1), 80-90. Tiller, J., & Reynolds, S. (2020). Human Trafficking in the Emergency Department: Improving Our Response to a Vulnerable Population. West J. Emerg. Med. 21(3), 549-554. U.S. Department of Justice (Updated 9/28/22). What is Human Trafficking? https://www.justice.gov/humantrafficking/ what-is-human-trafficking
U.S. Department of Justice (2022). What is Domestic Violence? https://www.justice.gov/ovw/domestic-violence
Resources
HEAL Trafficking: Because Human Trafficking is a Health Issue. https://healtrafficking.org/
The National Human Trafficking Hotline https:// humantraffickinghotline.org/
The National Human Trafficking Resource Center https://www.eeoc.gov/national-human-traffickingresource-center
National Resource Center on Domestic Violence https://www.nrcdv.org/
National Domestic Violence Hotline https://www. thehotline.org/
Officers
Elizabeth Aquino, PhD, RN
Monique Reed, PhD, MS, RN
Jeannine Haberman, DNP MBA, RN, CNE
Beth Phelps, DNP, APRN, FNP, ACNP
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
Lanette Stuckey, PhD, MSN, RN, CNE, CMSRN, CNEcl, NEA-BC
Executive Director
Susan Y. Swart, EdD, MS, RN, CAE
ANA-Illinois/Illinois Nurses Foundation
Article Submission
• Electronic submissions only as a word document attachment using current APA guidelines.
• Email: info@ilnursesfoundation.com
• Subject Line: Nursing Voice Submission: Name of the article
• Must include the name of the author and a title.
• INF reserves the right to pull or edit any article / news submission for space and availability and/or deadlines.
• If requested, notification will be given to authors once the final draft of the Nursing Voice has been submitted.
• INF does not accept monetary payment for articles.
Article submissions, deadline information and all other inquiries regarding the Nursing Voice please email: info@ilnursesfoundation.com
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, katie.miller@healthecareers.com or 319-2433940. 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.
Nursing Career Path
At Amedisys, we build on skills throughout our careers and provide opportunities for growth with ongoing training and support. Join our family and see how you can step into a new role and make a difference today! Learn more at amedisys.com/careers.
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.
Lisa Anderson Shaw DrPH, MA, MSN
Linda Olson PhD, RN, NEA-BC
ANA-ILLINOIS PRESIDENT'S MESSAGE
Dear Illinois Nurse Colleagues, As we move into the holiday season, I am wishing you and your families a happy and healthy new year. Once again, it’s the perfect time to reflect on what we are grateful for and remind ourselves of what we achieved in 2022. I am grateful for all of you and the many ways in which we all contribute to advancing the nursing profession.
Liz Aquino, PhD, RN
Congratulations to our newly elected ANA-Illinois Board of Directors and ANA reps. Thank you to Dr. Holly Farley and Dorothy Kane for your service and contributions over the years. Congratulations to ANA-Illinois Executive Director, Dr. Susan Y. Swart, on being the distinguished honoree of the Joan L. Shaver Outstanding Illinois Nurse Leader Award presented at the 25th annual Power of Nursing Leadership. Thank you to all who were able to participate in our in-person annual Professional Issues Conference in November. And as we think about the new year, we look forward to continuing our advocacy efforts throughout the new legislative session and we are excited to launch our inaugural class participating in the Nurses Running for Elected Office (NREO) training academy with the goal of getting more nurses in elected office!
To stay up to date on the latest ANA-Illinois programing and announcements, please follow ANAIllinois on Facebook, Instagram, and LinkedIn.
As always, I appreciate you for all you have done and continue to do to advance our profession. I look forward to working with you to transform nursing and healthcare in Illinois.
Sincerely,
Elizabeth (Liz) Aquino, PhD, RN
President, ANA-Illinois
INF PRESIDENT'S MESSAGE
Here we are in the midst of the Holiday Season. No matter what we each believe, it seems someone is celebrating a holiday. The holiday season usually brings happy memories and family gatherings. But for some people, it is a sad or a depressing time. I think of this time as a time to think of others and how to make others happy. I set my own pains aside to try and find ways to bless others.
These thoughts fit with the mission of the IL Nurses Foundation (INF). The INF is a philanthropic organization that looks for help from others in order to bless nursing students and nurses and help them reach their goals and further the nursing science through research.
2022 has been a good year for the INF. The Board of Directors have continued to work on short- and long-term goals, and strategies to reach these goals. We were also able to award many student scholarships and continue with our Grant program. In the fall we celebrated, in person, 40 emerging nurse leaders under the age of 40. The room was “filled” with supporters of our awardees. Tables were filled with family members, colleagues, and employers. It was a great night of celebration.
At the time of this writing, the last plans are in the workings for our Annual Holiday Gala & Fundraiser Dec 3, 2022. The donations have been coming in and we hope for a great night of networking, celebration of Nurse of the Year, a message from INF Scholarship winners, a full course dinner, a room full of Raffles, a Giving Tree, a 50/50 raffle, a photo opportunity, and further entertainment of dancers. We have nurses and nursing students demonstrating modern dance, a group of students presenting African dance, and Latin dance. In addition, we sponsored an online virtual silent auction the week before the Gala. If you missed this year’s Gala, please put the first Saturday in December 2023 on your calendar and join us next year.
We have expanded many of our committees, and continue to look for new volunteers to help the INF. It is through our volunteers that we are able to complete the many projects and work of the INF. I want to thank each of our volunteers for the hours of dedication to the Foundation.
If you have been thinking about how you can give back to nursing, please consider the INF. You can contact our Executive Director Susan Swart (susan@ sysconsultingsolutions.com) or myself (tccnurse@aol. com) to discuss your interests and opportunities to volunteer.
As 2022 comes to a close, many of us are also reviewing our own finances and thinking about our charitable donations to 501C3 organizations, before calculating our taxes. The INF is a 501C3 and would love to receive any donations, small or large, before the end of the year. If you are at a time in your life where you need to take required minimum distributions (RMD), you may be able to save on taxes if you donate them directly to the INF. We can also assist you in that process if you are interested or talk to your tax accountant.
Once again – thank you to every nurse and supporter of nursing. For without you, healthcare in IL would be in crisis. Nurses make a difference!
Cheryl Anema PhD, RN
PhD, RN; President, INF
The 2022 ANA-Illinois Award Winners Announced
On November 5th at the Membership Assembly during the Professional Issues Conference in Lisle, the American Nurses Association-Illinois (ANA-Illinois) announced the winners of the 2022 Recognition Award and Diversity, Equity, & Inclusion Leadership Award.
The Clinical Practice Award recognizes an exemplary nurse who provides evidence of a high level of skill in-patient care through improving clinical practice and patient-centered outcomes. Nominations must demonstrate the evidence-based ability to design, implement, and evaluate evidence-based practice changes and/or quality improvement initiatives to promote improved patient outcomes.
2022 Clinical Practice Award winner – Stephanie Mendoza DNP, RN, RNC-OB, C-EFM
The nomination statement stated that Dr. Stephanie Mendoza is currently employed at the University of Illinois hospital as an OB ER and High-risk antepartum unit. She is a remarkable individual who demonstrates the leadership skills to succeed in anything she wishes to do. Stephanie is passionate about Labor and Delivery and the women's services department areas. Stephanie's outstanding clinical excellence in the workplace is demonstrated in her commitment to improving the health and wellness of mothers and babies.
She is a leader and active role model and co-chairs the UI Health Labor and Delivery Unit Advisory Committee and the ILPQC promoting vaginal birth team. Most recently, the project implemented by her and her team reduced surgical site infection to below the national level! Her work has led to her being awarded the Daisy Award twice, one for clinical and the other for faculty.
She supports, encourages, and coaches all nurses with creative and innovative teaching materials that center on women's and children's excellence.
Her accountability to the development of her peers demonstrates her innovative and visionary leadership to serve as an example of her exemplary professional practice. She is always full of energy, with a smile on her face, and ready to assist anyone in maximizing their understanding of clinical and didactic concepts.
Stephanie has always believed that nursing is a gift one must share. It must be freely and eagerly given before acquiring skills, education, and expertise. She believes that once the education has been acquired, it is to be shared with others. This is one characteristic that makes her a stellar clinical nurse—an amazing role model for excellence in caring for mothers and babies.
The Nurse Influencer Award recognizes an exemplary nurse who has influenced the science of nursing practice or care delivery system, a group/community/population (patient or other care providers), sick or well. Contributes to health or its recovery (or to peaceful death) in any care or community setting (at any level, local, regional or national level) or nursing profession through education, advocacy, policy, or practice.
Mariam Webster defines an Influencer (noun) as "one who exerts influence, a person who inspires or guides the actions of others."
Nominations must demonstrate evidence of the nurse's influence over the science of nursing practice or care delivery system, a group/community/population (patient or other care providers) sick or well, contributes to health or its recovery (or to peaceful death) in any care or community setting (at any level, local, regional or national level), or the profession of nursing through education, advocacy, policy or practice.
2022 Nurse Influencer Award winner – Tamara Bland EdD, MSN, BSN, RN
Dr. Bland's nominators stated, "Tamara Bland is a full-time Assistant Professor in Nursing and Executive Director of the Nursing Program at Dominican University. She has spent many years as a staff nurse in medical/ surgical and cardiac intensive care units. A proponent of giving back to the profession of nursing, Tamara served as an Assistant Professor and Assistant Dean of Undergraduate Programs in nursing, facilitating learning for undergraduate nursing students. As a nurse, she focuses on working with marginalized communities providing patient education, empowering families to participate in their plan of care, and health equity for the BIPOC community. Her passion is working to increase diversity in Higher Education, both among faculty and students, to benefit academia and the profession of nursing.
In 2020, Tamara was elected to the Board of Directors of the Illinois - National League for Nursing (NLN) as President-elect. As an active member of the ANA-Illinois, she is dedicated to advocating for the profession of nursing and the health of Illinois residents. Tamara also serves as Co-chair on ANA-Illinois' Diversity, Equity, and Inclusion Expert Panel Steering Committee. She also serves as a Core Team Member of Dominican University's
Truth, Racial Healing and transformation committee serving to build interfaith, intergenerational, and diverse communities that work to erase barriers to equity and inclusion. Dr. Bland is a 2021 Educational Network for Active Civic Transformation (ENACT) fellow. ENACT is a national, nonpartisan program engaging undergraduates at colleges and universities in state-level legislative change by learning to work with legislators, staffers, and community organizations to advance policy. Dr. Bland is working to empower nurses who are advocating for change, specifically related to health reform and health community issues that can affect marginalized communities unequally.
In 2022, Dr. Bland worked with community partners at Rush University to bring learning opportunities to Dominican University students, faculty, staff, stakeholders, and community partners to discuss Racism as a public health crisis. This opened the conversation about Racism within nursing, academia, and the city of Chicago. I have been so inspired to be working next to Tamara Bland. She is a blessing to the Borra College of Health Sciences. Another nominator shared, "The Health Disparity Learning Community panel that Dr. Bland organized was a frank discussion of how patients in inner city Chicago have suffered during the Covid-19 pandemic due to living in nutrition and healthcare deserts. The discussion struck a chord in all who attended; it was not politically correct, nor should it have been. Dr. Bland, as the organizer, established a foundation for healthy dialogue about uncomfortable problems within our community that no one could close their eyes to. The problems were vividly illustrated, solutions were discussed, and everyone left feeling inspired to be part of the solution. Dr. Bland is truly a warrior for change. She is someone that is shaping nursing education for the better." Yet another nominator praised Dr. Bland with the following statement, "She advocates quality and inclusion for our students who are non-traditional underrepresented populations in nursing. This is also carried into the community by Dr. Bland's commitment to promoting service to underserved populations by encouraging faculty and students to become involved in promoting quality healthcare within the community, primarily through service activities. The COVID-19 vaccination core partnership with Rush University is just one example. Other service activities include participation with Catholic Charities and the WGN Backto-School events that serve underserved communities. Influencing faculty and staff participation in service activities enhance the profession of nursing. I believe Dr. Bland represents the values of the art and science of nursing while influencing others, both novice nurses and nursing faculty, to uphold standards of quality and excellence in all aspects of nursing."
The Student Nurse of the Year Award recognizes an outstanding student nurse who exemplifies compassion, exceptional promise in clinical expertise, and academic achievement – the underpinnings of nursing excellence.
Nominees for this award are recognized for outstanding achievement, exceptional academic or clinical ability, or exemplary compassion and caring toward their clients and peers during their years of study.
2022 Student Nurse of the Year Award winner –Monica Terrazas
Ms. Monica Terrazas is a current nursing student at DePaul University's Master's Entry to Nursing Practice (MENP) program. Her nominator stated, "Monica is a stellar student and a leading exemplar of caring and compassion in the future of nursing. Her love of learning and helping others has allowed her to be successful in her role as a student who seeks higher education. I have witnessed a true role model of persistence and tenacity in the pursuit of higher education and someone committed to serving our underserved communities in the future."
Another faculty member wrote, "She is the definition of an excellent nursing student and is an inspiration to the Hispanic community. Monica has demonstrated that she is a compassionate, intellectual, and caring person. Monica ensured that her patients and peers always received her undivided attention by approaching each clinical encounter with a positive attitude, dependability, excitement, and a focus on patient safety. Monica made a point of seeking out new growth possibilities both on and off the unit. As Monica became more aware of the significance of disparities in nursing and the significance of patient advocacy, she discovered that there was always a lesson to be learned. Monica always assisted with any tasks to help provide excellent patient care. Patients and family members expressed gratitude for her support since she significantly influenced their lives. As a nursing student, she went above and beyond her call of duty and acquired vital lessons along the way. Monica always provided me with a comprehensive report on her
patients as she took the time to truly get to know them, demonstrating the compassion that nursing's future must continue.
Monica also aspires to make a difference in all spheres. She is an enthusiastic volunteer who constantly seeks ways to serve her community. She serves as a role model for her classmates and future nursing students, particularly those of Hispanic ancestry interested in pursuing careers in nursing. I am incredibly proud of her perseverance. Monica exemplifies leadership abilities and cultural sensitivity via academics, professional organization involvement, and professional experience. Monica is highly adaptive to any condition, including this pandemic of COVID-19, and continues to aspire to be an outstanding future nurse. She continues to thrive as a nursing student, and I am confident she will achieve her ultimate goal of becoming a nurse who advocates for her patients and future student nurses."
Diversity, Equity, and Inclusion Leadership Award was created to intentionally invest in the professional development of nurse leaders that have been historically and systematically marginalized in nursing.
Nominees must be a member of ANA-Illinois from a historically and systematically marginalized community as defined by the Diversity, Equity, and Inclusion Expert Panel's mission statement, employed in nursing for a minimum of two (2) years as a licensed nurse (APRN, RN, LPN), and provide a personal statement that includes how the selected program will support the applicant to advance the mission of ANA-Illinois' DEI Expert Panel and commit to an oral or written presentation of the leadership program overview within six months of completion.
For the inaugural year of this award, two individuals have been identified for the award.
2022 Diversity, Equity, and Inclusion Leadership Award Winners Ashley Whitlatch MSN, APRN, FNP-BC –Ashley Whitlatch will receive a cash prize to support her attendance at eCornell's 'Diversity and Inclusion: Cornell Certification Program.' The certificate program helps participants make their organizations a more supportive and engaging place to work by understanding the perceptual, institutional, and psychological processes that impact the ways people interact with each other. Focus areas include improving engagement, counteracting unconscious bias, diversity, and inclusion at work, and fostering an inclusive climate. The program also includes access to diversity and inclusion symposiums, which explore equity, psychological safety, inclusive leadership, and cross-cultural conversations.
PRACTICE CORNER Illinois Law & Nursing Practice
It goes without saying that sexual assaults occur in many circumstances, including domestic violence, human trafficking, and in conventional relationships gone array. Regardless of the circumstances, recovery after a sexual assault is a long and challenging path.
And, in the December 2020 edition of The Nursing Voice, I wrote about amendments to Illinois’ Sexual Assault Services Emergency Treatment Act (SASETA). Among other changes, it included a “Qualified Medical Provider” under the Act an RN or an APRN who completed a Sexual Assault Nurse Examiner (SANE) training program which incorporated guidelines established by the International Association of Forensic Nurses (IAFN).
Nancy J. Brent, MS, JD, RN
Illinois RNs and APRNs who are SANEs and complete a SANE training program provide medical forensic services as defined in the Act to a patient who presents to a hospital, an approved pediatric health care facility, out-patient facility, and hospital free standing ER centers.
An interesting 2021 research study on the experiences of women sexual assault survivors with the emergency care they received from SANEs is worth mentioning.
The research team’s objective was to better understand the lives of female sexual assault survivors during and after emergency care so SANEs and other health care providers do not create additional challenges for survivors and also help in identifying outpatient resources for them.
The researchers established a prospective, longitudinal multi-site observational study with a research sample of 590 English speaking adult women who received an evaluation by a SANE within 72 hours of a sexual assault in 13 geographically distributed U.S. emergency care facilities.
They analyzed responses to the open-ended question: “What do you think is most important for researchers to understand about your experience since the assault?” This question was asked at one week, six weeks, six months, and one year after enrollment in the study.
From the results of the study participants, the researchers also proposed a brief acronym to help SANEs and other ED practitioners provide important messages for sexual assault survivors.
Twelve categories of responses of the women in the study were identified:
• Daily life
• Justice
• Medical and social services
• Mental health
• Physical health
• Prior trauma
• Recovery
• Romantic relationships
• Safety
• Self
• Shame
• Social interactions
Focusing on the medical and social services responses, 102 found that barriers and/or challenges were experienced in receiving health care after the sexual assault, including high cost or lack of reimbursement for care received.
Other barriers to health care included long wait lists for services, difficulty following through with medical care while others (n=16) described “negative experiences” when trying to access care, including being treated insensitively.”
However, others had positive experiences with aftercare, with 22 stating that counseling was helpful.
Not surprising, 12 of the respondents praised particular services or emergency care practitioners, including a SANE as “phenomenal.”
Based on the respondents’ answers to the study questions, the researchers developed an acronym that summarizes vital messages to share with sexual assault survivors in the ED. Interestingly, the acronym is SANE.
How a SANE or other ED health care provider shares these messages is up to each of them, but the researchers spelled out their examples:
S= “Your safety is important to me. Do you have a safe place to go?”
A= ”Ain’t your fault!”
N= ”Normal to have posttraumatic symptoms”
E=”Everybody going through something like this would benefit from seeing a mental health expert."
The study was not conducted in any health care facility in Illinois. Even so, as was discussed in the December 2020 article, Illinois’ SASETA has already established fundamentals for quality care of sexual assault survivors in the ED and the role of Illinois SANEs.
Many of these fundamentals can eliminate the concerns expressed by the participants in the study.
For example, in addition to adding a SANE in the definition of a qualified medical provider, APRNs, RNs, and LPNs who were not a qualified medical examiner had to receive a minimum of two hours of sexual assault training by July 1, 2020.
And, after July 1, 2020, these nurses, and other ED clinical staff, must complete a minimum of two hours of continuing education on responding to survivors every two years.
Moreover, since January 2022, qualified medical examiners, including a SANE, must initiate medical forensic services to a sexual assault survivor within 90 minutes after the person presents in the facility.
Additional protections for survivors included in the Illinois SASETA include, but are not limited to, offering the survivor the option of a referral to an appropriate counseling service after ED treatment, providing oral and written information about any medications ordered after treatment, and the eligibility to have free follow-up care for 90 days by returning to the ED or by the sexual emergency treatment program “voucher.”
Providing quality, compassionate, accessible, and supportive care, both in the ED and in aftercare, is essential, as this study indicated. Illinois has established, and will continue to foster, this type of care for sexual assault survivors.
You can read the entire study at https://onlinelibrary.wiley.com/doi/full/10.1002/ emp2.12464
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.
The Public Health Response to COVID-19 – Nurses
Dr. Sandra Martell, Public Health Administrator Winnebago County Health Department
While much has been published on the role of front-line nurses in the care of individuals with COVID-19 in the hospital acute-care setting, there has been minimal attention focused on the role of nurses in the public health response. School Nurses, Long-term Care Nurses, Correctional Nurses and Public Health Nurses have been critical assets in the public health response viewed from the three (3) core functions –assessment, policy, and assurance.
School Nurses have been the key health team personnel in assuring that schools were safe for in-person learning throughout the pandemic. School Nurses were responsible for assessing students and staff for signs and symptoms of COVID-19, testing for COVID-19, and identifying close contacts to positive cases within the school setting. In partnership with local health departments, ill students and staff were isolated and close contacts were quarantined. School Nurses were responsible for oversight of layered mitigations and enforcing adherence to the sometimes unpopular policies outlined in Executive Orders and endorsed by local school boards. Through their public health efforts, transmission of COVID-19 in school was minimized and schools remained open to address the academic, social, and emotional learning needs of students. The impact of their work while measurable in the short-term with public health metrics around disease rates and secondary cases is not fully measurable or appreciated in the long-term.
Long-term Care Nurses (LTCN) demonstrated extreme tenacity and compassion in caring for individuals in long-term care facilities (LTCF). They were responsible for assuring high level infection control practices to exceptionally vulnerable populations under extreme conditions of shortages of Personal Protective Equipment (PPE) and staff while addressing the social isolation of residents and their families. LTCF nurses were charged with enforcing policy that resulted in visitor restrictions and prolonged separation from loved ones. Levels of care increased within the LTCF to provide for frequent assessments as residents struggled through the viral infection. Death rates among LTCF residents was disproportionately high resulting in significant levels of grief. LTCN stepped up to provide therapeutics routinely administered in hospitals. The impact of their work in protecting the environment and protecting the health of vulnerable and medically fragile individuals minimized the death rate.
Correctional Care Nurses (CCN) were responsible for preventing the transmission of COVID-19 among detained/incarcerated populations. Similar to their LTCN colleagues, these nurses were responsible for the health and safety of vulnerable populations including medically fragile. They, too, administered care under extreme duress without bias and with compassion in a setting where individuals exhibited high levels of anxiety and fear of contracting COVID. Correctional Care Nurses addressed vaccine hesitancy in a population with distrust of governmental systems and provided education around vaccination, administered the vaccine, and provided therapeutics as appropriate.
Public Health Nurses in local health departments have also played a key role in the pandemic response. In many LHDs, Public Health Nurses have applied the nursing process at the population level. They have assessed and analyzed epidemiological data, conducted case investigations and contact tracing, issued isolation and quarantine orders, provided case management and support to individuals infected and/or exposed, planned and implemented mass vaccination efforts, and administered therapeutics. They adapted home visiting strategies to ensure ongoing care to at-risk communities, developed communication campaigns, and addressed vaccine hesitancy. They have served on Boards of Health and been responsible for implementation of often politicized policies to protect the public’s health.
Nurses who have focused on population health have been pivotal in the public health response to COVID-19 at every level of prevention – primary, secondary, and tertiary and protecting health at all levels.
Nurses want to provide quality care for their patients.
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An Opportunity for Nursing Outreach with Chicago Street Medicine
By Saara-Anne Azizi, Phillip S. Ang, and Meredith Hollender
There are approximately 580,000 people without homes or access to stable housing in the United States (The Department of Housing and Urban Development, 2020). With lack of housing comes a significant health burden - the lifespan of individuals experiencing homelessness can be shortened by 3040 years (Bernstein et al., 2015; Hwang et al., 2009). This is underscored by increases in disease prevalence, morbidity, and mortality (Bernstein et al., 2015; Raad et al., 2020). People experiencing homelessness exhibit higher rates of infectious disease (Gioseffi et al., 2022; Gelberg et al., 2012), are more likely to die from cardiovascular disease (Baggett et al., 2015), and more likely to present with a psychiatric emergency (Lamparter et al., 2019). The reasons for these disparities are myriad. Not only are people experiencing homelessness more vulnerable to trauma, comorbid substance use, and the physical elements, critically, they also face inadequate access to the healthcare system (Trick et al., 2017). Lack of documentation, no insurance, limited access to communication, and simply more pressing needs (food, shelter) all can make access to the traditional healthcare infrastructure challenging.
Led by students and driven by volunteers, Chicago Street Medicine (CSM) was founded in 2016 by medical trainees at the University of Illinois Chicago (UIC) to address this challenge within Chicago. Now grown to include additional chapters (Loyola University Stritch School of Medicine, University of Chicago Pritzker School of Medicine, and Northwestern Feinberg School of Medicine), CSM works to provide medical care and connections to healthcare for people experiencing homelessness. Several times each week, CSM teams - composed of health professionals across a range of training spheres and training levels - head out on mobile “street runs” to connect with individuals who are living in encampments, beneath underpasses, on trains, and in parks and streets across the city of Chicago. At the core
of our work is not just medical care, but the provision of basic resources (food, clothing, hygiene supplies, bus passes), social and housing resources, and a consistent presence. This outreach allows CSM to build trust and continuity with the community; sometimes we work with patients for months, simply sharing resources, before there is the confidence and trust to open a therapeutic relationship. Moreover, since CSM teams are based at four geographically distant academic medical centers across Chicago and are supported by partnerships with nonprofits like the Night Ministry, we are able to provide care across the city. CSM’s model of reaching individuals experiencing homelessness where they live overcomes many of the barriers of traditional healthcare encounters, including lack of insurance, limited transportation, high cost, and minimal free time.
Given the importance of nursing in traditional healthcare settings, the integration of nurses - RNs, APRNs, and Psychiatric Mental Health Nurse Practitioners (PMHNPs) - into street medicine teams has the potential to improve the care delivered to individuals experiencing homelessness. As noted above, CSM is a volunteerrun organization. The additional support of nursing professionals would enable us to provide better care for our patients, improving communication, assessment, and continuity. Finally, individuals experiencing homelessness who interact with the healthcare system often face discrimination and limited understanding and flexibility from providers about their needs and priorities. The exposure of nurses (who often lead patient-facing interactions) and other healthcare providers to the people experiencing homelessness in the community has the potential to increase understanding and trust between patients and providers in the traditional healthcare system.
More information can be found at our website: www. chicagostreetmedicine.org. If you want to be involved with Chicago Street Medicine, but do not have the time, please consider making a donation to support our efforts (https://donorbox.org/chicagostreetmedicine). Our program is dependent upon the generous donations of
our supporters to provide outreach and medical care to the unsheltered population of Chicago.
References
1. The Department of Housing and Urban Development. The 2020 Annual Homeless Assessment Report (AHAR) to Congress. (January, 2021) Retrieved from: https://www. huduser.gov/portal/sites/default/files/pdf/2020-AHARPart-1.pdf
2. Bernstein RS, Meurer LN, Plumb EJ, Jackson JL. Diabetes and Hypertension Prevalence in Homeless Adults in the United States: A Systematic Review and Meta-Analysis. Am J Public Health. 2015;105(2):e46-e60. doi:10.2105/AJPH.2014.302330
3. Hwang SW, Wilkins R, Tjepkema M, O’Campo PJ, Dunn JR. Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study. BMJ 2009;339(oct26 3):b4036-b4036. doi:10.1136/bmj.b4036
4. Raad JH, Tarlov E, Kho AN, French DD. Health Care Utilization Among Homeless Veterans in Chicago. Military Medicine 2020;185(3-4):e335-e339. doi:10.1093/milmed/usz264
5. Gioseffi JR, Batista R, Brignol SM. Tuberculose, vulnerabilidades e HIV em pessoas em situação de rua: revisão sistemática. Rev saúde pública. 2022;56:43. doi:10.11606/s1518-8787.2022056003964
6. Gelberg L, Robertson MJ, Arangua L, et al. Prevalence, Distribution, and Correlates of Hepatitis C Virus Infection among Homeless Adults in Los Angeles. Public Health Rep. 2012;127(4):407-421. doi:10.1177/003335491212700409
7. Baggett TP, Liauw SS, Hwang SW. Cardiovascular Disease and Homelessness. Journal of the American College of Cardiology 2018;71(22):2585-2597. doi:10.1016/j.jacc.2018.02.077
8. Lamparter LE, Rech MA, Nguyen TM. Homeless patients tend to have greater psychiatric needs when presenting to the emergency department. The American Journal of Emergency Medicine. 2020;38(7):1315-1318. doi:10.1016/j. ajem.2019.10.012
9. Trick WE, Hill JC, Toepfer P, Rachman F, Horwitz B, Kho A. Joining Health Care and Homeless Data Systems Using Privacy-Preserving Record-Linkage Software. Am J Public Health. 2021;111(8):1400-1403. doi:10.2105/ AJPH.2021.306304
Illinois Advanced Practice Registered Nurses Elect New Board Members
MANTENO – The Illinois Society for Advanced Practice Nursing announced the election results during the association’s 2022 annual meeting during the APRN Midwest Conference held on October 29th.
The new leadership includes advanced practice registered nurse leaders from across the state and from a variety of backgrounds.
The newly elected board members are as follows:
President Stephanie Crawford DNP, APRN, CNP
Secretary Alyssa Smolen DNP, APRN, FNP-BC
GR/PAC Chair
Membership Committee Chair
Raechel Ferry-Rooney DNP, APRN
Hannah Holmes MS, APRN, FNP-BC CNS Rep
Christine Somberg MSN, APRN, CNS, ACNSBC, NE-BC CRNA Rep
Northeast/North (NE/N) Region Chair
Ryan Lewandowski DNP, APRN, CRNA
Andrea Fuller APRN, FNP-BC East Central (EC) Region Chair
Wamaitha Sullivan DNP, APRN, FNP South (S) Region Chair Valerie Griffin, DP, APRN, PPCNP-BC, FNP-BC
The new board members will join the following directors whose terms end in October 2023:
Vice President
Treasurer
Program Chair
April Odom APRN, FNP-BC
Debra Lowrance DNP, APRN, CNM, WHNP, IBCLC
Yvonne Tumbali DNP, APRN, ACNP-BC CNM Rep Cathy Cook DNP, APRN, CNM CNP Rep Amir W. Raad DNP, APRN, PMHNP-BC, RN Northwest (NW) Region Chair VACANT West Central (WC) Region Chair Debra Myers, APRN, FNP-BC Northeast/South (NE/S) Region Chair Jenise Farano DNP(c), APRN-FPA, FNP-BC, PMHNP-BC
About ISAPN: Formed in 2002, the Illinois Society for Advanced Practice Nursing is a powerful network of advanced practice registered nurses who are committed to advancing the profession through education and political action. ISAPN is the leading voice of the approximately 14,000 advanced practice registered nurses in Illinois. To become a member of the Illinois Society for Advanced Practice Nursing, visit www. isapn.org
To access electronic copies of The Nursing Voice, please visit https://www.healthecareers.com/nurse-resources/nursing-publications
The Chicago Nurse Expo Inaugural Debut!
Ebony Scott BSN, RN
On August 15, 2022, myself and a team of amazing nurses from the Chicagoland area held the first ever Chicago Nurse Expo (CNE) at The Tinley Park Convention Center. Nurses near and far attended this wonderful event highlighting nurse entrepreneurship and honoring nurse educators.
We had an amazing CORE planning committee who met week after week for an entire year to plan this successful CNE initiative which will become an annual event for hereafter!
The 2022 CNE highlighted nurse entrepreneurship, nurse educators, and overall nursing excellence. What better way to educate the community on issues in healthcare as well as celebrate the most trusted profession in America? Our goal was to bring awareness to important discussions that are going on in the nursing community such as diversity, equity, and inclusion led by Susie Gonzalez RN, maternal health led by Fallon Flowers, MSN, BS, RN, WHNP-BC, and Tahlor Mattison, RN, as well as mental health lead by Jalinia Joy, LPN. Jamia Hawkins, DNP-RN and Ashley Whitlatch, DNP, MSN, APRN, FNP-BC shared the gracious honor of celebrating nurse educators with an appreciation ceremony and hosting the nurses in education panel.
Keynote speaker, Janice Phillips Ph.D., RN, CENP, FAAN, Director of Nursing Research and Health Equity from
Rush University Medical Center, spoke on the turbulence that we face in nursing and how we come together to overcome it. It was an amazing display that contrasted barriers in healthcare and flight turbulence. There was great audience participation and even a sing-a-long. Dr. Phillips really knows how to get a point across.
There were two dynamic hosts from the Chicagoland area in attendance. WGCI’s radio personality, Kendra G, hosted the main stage while “The First Lady of Comedy” Dominique Golphin brought the humor and held her own on stage 2. The fitness demonstration brought to us by Chicago’s own Raquel Wells, CEO of H.I.P.S (Happiness in Perfect Skin) was an audience favorite. Vincent Mykal, the Chef extraordinaire and founder of the Vincent Mykal Experience prepared a fabulous vegan dish for audience members right in front of our eyes!
The men’s panel, led by Julio Santiago, DNP, RN, CCRN, VA-BC, included Dan Franczkowski, MSN, RN, Samuel Chinn, RN, Dr. Jose Alejandro, and the President of The National American Association of Men in Nursing, Mr. Blake Smith. A very intimate discussion was held, involving the future of healthcare and how to get more men to enter into the profession.
This event was beneficial to Illinois in more ways than one, from the much-needed exposure and the relevance of all of the topics addressed to the connections that individuals in and out of the healthcare field were able to create.
The Chicago Nurse Expo is an avenue for aspiring nurses to come out and learn more about what nurses do and why. The Chicago Nurse Expo will continue to shed a light on the shortage of nurse educators in the field, the
lack of the diversity of nurses entering the field and will attract a great deal of individuals that desire entry into the nursing profession.
Nurses traveled from all over the United States to be present for the first ever CNE. The nurse entrepreneurship panel, led by Chakika Williams, MBAHCM, FPA-APRN, FNP-BC, PMHNP-BC, attracted nurses from places like California and even Texas, who flew in to showcase their businesses, speak about their products, and assist others in understanding how to start their own businesses.
The 2022 CNE was a model event and a major success, however without our sponsors, none of what we accomplished could have happened. A special thank you to Diamond Sponsors, Dr. Kiiyonna Jones, CEO of Luxe Beauty Academy, who flew in from California, and Chicago’s own, Chakika Williams, MBA-HCM, FPAAPRN, FNP-BC, PMHNP-BC, CEO and founder of Skyrose Rejuvenation Clinic and Spa located in Orland Park Illinois. We would also like to acknowledge our Gold Sponsor –The Symphony Network, Silver Sponsors – Scott School of Careers, Live savers Training Center, Necole’s Learning Center, and Bronze Sponsor – Accellacare.
A huge thank you to the panelists, vendors, production members, every attendee, our stage managers Renee Dyson, BS, RN, Gemina Thomas, and our extraordinary project manager Angel D. Allen, Founder of Agency A2. Looking forward to seeing you all at The Chicago Nurse Expo August 12, 2023!
Website: www.chicagonurseexpo.com
Instagram: @nurseexpo_chicago
Facebook: The Chicago Nurse Expo
Email: contact@chicagonurseexpo.com
Human Trafficking: Modern Day Slavery
Laura Kay Wood, DNP, RN, CMCN LauWood528@gmail.com
Human trafficking is a domestic and global crime involving the recruitment, transportation, transfer, harboring or receipt of people using force, fraud, or deception. It is the second highest grossing crime around the world involving victims of any age, race, gender, or nationality. Also known as modern slavery, it affects an estimated 40.3 million people globally (Stop the Traffik, 2022). The financial upshot is an industry of $150 billion annually for trafficker’s making it one of the world’s most profitable crimes (World101, 2022). Human trafficking takes many forms such as sexual exploitation, forced labor, debt bondage, domestic servitude, organ removal, forced begging, child soldiers, and forced marriages. Nurse victim recognition, a trauma-informed and patientcentered approach, knowledge of state and federal laws, and continued education and training reduces the likelihood of victim re-traumatization occurrence during conversations both in and outside of clinical settings.
Globally
Human trafficking follows different patterns in different regions around the world. For instance, Africa has the world’s highest detected rate of forced marriages. Whereas Western and Southern Europe mainly report cases of traffickers forcing victims to commit crimes of shoplifting, petty theft, and the transport, trafficking, or selling of drugs. In the Asia-Pacific region most commonly identified cases are forced labor. With the presence of terrorists and violent extremist groups recruitment and exploitation of children, cases revealed forced participation in murderous or violent acts of extremism. The ramifications of global human trafficking are incalculable. Victimization is a problem undermining world peace and security, threatens human rights, uproots, and destabilizes communities’ global development, and weakens the global economy (World101, 2022).
For nurses assisting victims of human trafficking, assessment of victim vulnerability includes an evaluation of social, cultural, political, and economic contexts in the effort to identify a root cause. For instance, children are a vulnerable population for they are not physically able to protect themselves and are under the authority of parents, family, and teachers. Lack of finances impact hunger and contribute to malnutrition when linked to illness, homelessness, social discrimination, and exclusion resulting in increased mortality and morbidity. Social and cultural exclusion in education from discriminatory practices and employment opportunities impacts access to social services such as health care. Limited finances lessen income-generating opportunities. Political impacts of war and conflict disrupts traditional community life and the protective frameworks in place creating an exodus of refugees or asylum seekers in need of basic survivor necessities. The economic principle of demand is observed when trafficking recruiters capitalize on their victims. Traffickers are driven by profits producing a trafficking chain resulting in the exploitation of men, women, and children (United Nations, 2020).
United States
The United States two primary forms of human trafficking consist of forced labor and sex trafficking. Under the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, the FBI established the Uniform Crime Reporting (UCR-HT) which identifies only human-trafficking offenses and arrests submitted by states and agencies with the ability to record and report. The Bureau of Justice Statistics (2021) number of arrests reported for human trafficking involuntary servitude confirmed 92 in 2020 and commercial sex acts reported 301 in 2020.
Human traffickers in the United States use mental, emotional, and/or physical means upon their victims. Exploitation of victims occurs in a variety of industries, for instance it has been reported to occur in escort services, illicit massage parlors, nail salons, domestic work, residential brothels, hotel construction, truck stops, restaurants, strip clubs, agriculture, cleaning services, major sporting events, and carnivals (Center for Prevention of Abuse, 2022). Most trafficked persons in the United States identify to our most vulnerable populations. For instance victims can be persons with disabilities, children in child welfare, foster homes, runaways, unaccompanied foreign national children without lawful immigrations status, those seeking asylum, American Indians, Alaskan Natives, LGBTQ+ individuals, and victims of intimate partner or domestic violence. Language barriers, fear of their trafficker and law enforcement frequently keep victims from seeking help
positioning human trafficking as a hidden crime (United Nations Office on Drugs and Crime, 2020b).
Illinois
Ranking
Illinois ranks 10th in the nation for human trafficking (National Human Trafficking Hotline, 2021a) with 252 cases reported (National Human Trafficking Hotline, 2021b). Today’s health care providers are at the forefront of this issue with studies identifying approximately 88% of trafficking victims accessing health care at some point during their captivity (Polaris, 2022). Data identified sex victims within hotels at 22, illicit massage and spa business at 18, online at 17, residence-based commercial sex at 15, pornography at 12, street-based at 6, escort at 4, and truck stop-based at 3. Human trafficking victimbased demographics identify adults at 176, minors at 5, females at 218, males at 19, gender minorities consisting of cisgender male or female at 4 (National Human Trafficking Hotline, 2020c).
Shared Hope International (2021), a nonprofit group, developed the nation’s first legal framework with their mission to challenge states to enact laws that comprehensively address the crime of child and youth sex trafficking. The report is broken down into six categories of which each is provided a grade. Illinois’s report was an overall grade of “F” broken down as criminal provisions a “B,” identification of and response to victims an “F,” continuum of care an “F,” access to justice for trafficking survivors a “D,” tools for a victim-centered criminal justice response an “F,” and prevention and training an “F” (Shared Hope International, 2021).
Location
In rural areas, human trafficking can be seen on farms with non-English speaking migrant workers, sex trafficking at truck stops off the adjoining interstates, recruitment and transportation of illegal drugs within areas of low income and employment opportunities. In the city, human and sex trafficking can be seen at major sporting events, hotels and airports, nail salons, escort services, and strip clubs, to forced begging in the streets. Though these examples can and are seen in cities or rural areas alike, other types of human trafficking, such as the use of social media platforms, are used to lure children, especially teenage girls, into sex slavery.
The United States Department of Justice (2022) released a federal grand jury nine-count indictment to an Illinois family charged with kidnapping, forced labor, conspiracy for coercing minors into forced labor. The family of traffickers used false promises of a better life and education to a mother in Guatemala. The move to the United Stated saw the outcome of female minors isolated in the home, restricted communication with family, subjected to physical, verbal, and psychological abuse, among other coercive means (United States Attorney’s Office Norther District of Illinois (2021). In Normal, Illinois, a man was sentenced to prison for the sex trafficking of a child. The trafficker used online advertisements to solicit men to rented hotel rooms for sex with the minor female victim (United States Attorney’s Office Central District of Illinois, 2022).
Human Trafficking
Human trafficking can be seen in many forms such as sexual exploitation, forced labor, debt bondage, domestic servitude, organ removal, forced begging, child soldiers, forced marriage. Multiple locations, it can take place in a victim’s home country, during migration or in a foreign country (U.S. Department of Health & Human Services, 2020). It can be found in small and large businesses alike (U.S. Department of Health & Human Services, 2020). Two primary forms of human trafficking in persons: forced labor and sex trafficking.
Forced Labor
Forced labor, referred to as “labor trafficking,” categorized as domestic servitude or forced child labor, encompasses activities in which a person uses force, fraud, or coercion to obtain the labor or services of another person. Domestic servitude is a form of forced labor in which the trafficker requires a victim to perform work in a private residence. Domestic workers are often isolated or may work alone in a house and their employer often controls access to their food, transportation, and housing. Forced child labor, is another form of forced labor which targets children, a vulnerable population, recognized as the sale of children, forced or compulsory child labor, debt bondage and serfdom. Forced child labor indicators include situations in which a child appears to be in the custody of a non-family member and the child’s work financially benefits someone outside the child’s family as well as the denial of food, rest, or
schooling (United States Department of State, 2021). Serfdom occurs most often within private residence areas, free from public attention or scrutiny which results in barriers to victim identification.
Sex Trafficking
Sex trafficking refers to the range of activities involved when a trafficker uses force, fraud, or coercion to compel either an adult or child to engage in a commercial sex act. Exploitation of victims occurs in various settings such as forced prostitution in residential or commercial brothels, truck stops, hotels, or at major sporting events as well as online such as pornography and stripping.
The crime of sex trafficking consists of three elements: the act, the means, and the purpose. All three elements are required to establish a sex trafficking crime apart from child sex trafficking where the “means” element is does not pertain. The first element, act, is met when the trafficker recruits, harbors, transports, transfers, receives, patronizes, or solicits another person to engage in commercials sex. The second element, means, occurs when a trafficker uses force, fraud, deception, abduction, and/or coercion. Coercion such as threats of physical harm, psychological harm, reputational harm, threats to others, and debt manipulation. The third element, purpose, identifies to a commercial sex act which can take place in a variety of locations such as private homes, massage parlors, hotels, as well as on the internet (United Nations Office on Drugs and Crime, 2020b). Child sex trafficking refers to an individual engaging in any acts with a child regardless of evidence of force, fraud, or coercion. The use of children in commercial sex is prohibited by law in the United States and most countries around the world (United States Department of State, 2021).
Indicators
Indicators focus upon victims physical and mental warning signs. In Polaris (2018) in the health care setting the following physical, behavioral, and environmental indicators can serve as a guide to identify patients potentially at-risk. Any indicators listed may or may not disprove the occurrence of human trafficking is taking place. Physical indicators identified to a victim could present with one or more symptoms such as malnourished, poor hygiene, broken teeth, burns, cuts, fractures at various stages of healing, vertigo, respiratory issues from prolonged exposure to industrial or agricultural chemicals, to reproductive issues such as sexually transmitted infections, genital trauma, and addiction to drugs/alcohol. Behavioral indicators identified to a victim could present as fearful, sad, irritable, hostile, exhibit memory loss, to a lack of emotional responsiveness. Environmental indicators are identified to climate change. Extreme weather conditions such as the aftermath of natural disasters, flooding, and earthquakes impact security and work making them more vulnerable to human trafficking (Yan, 2018).
As a nurse, in a clinical setting victims would present with multiple identifiers of abuse. Some examples are displayed in untreated sexually transmitted infections, a history of repetitive abortions or miscarriages, trauma injuries presenting to many areas of the body such as burns, lacerations or missing or broken teeth. Signs of behavioral abuse in victims can be seen as symptoms of depression, anxiety, and posttraumatic stress disorder.
Response
Nurses must know federal and state law requirements for mandated reporting. When suspected, remember to go ahead, and report it. It is important to be aware of how HIPPA regulations impact reporting and confidentiality. Accurately document all information about the patient’s injuries, illness, and treatment in the patient chart. Understand your institutions policies and procedures. A nurse must be trained in the safety needs of this population and how to interview possible victims consistently. Patients in immediate and life-threatening danger must be protected. Follow your organization’s policy for reporting. Involve the patient whenever possible in the decision-making process to report to law enforcement. Offer options for services, resources, or reporting that would ensure safety.
Communication
Communication with victims of abuse includes incorporating verbal and nonverbal communication skills, active listening, and patient teach-back techniques. Dialogue which promotes clarity, accuracy, and honesty with open questions, demonstrating interest, and actively listening are critical in helping victims feel safe and comfortable. It is meaningful connections which influence patients’ outcomes. Building relationships of
trust and empathetic care facilitates a willingness of the victim to share their experiences.
Education
Education should extend toward addressing anonymity, confidentiality, and informed consent as appropriate, and the incorporation of trauma-informed care. The key goal of trauma-informed care is to prevent any re-traumatization that could prevent patients from continuing to seek care. When applied, this will ensure that the healthcare process, procedures, and setting protect the patient from further re-traumatization. Six principles which focused on patient and nurse care: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, voice and choice, and cultural issues (SAMHSA, 2014).
Education ensuring inclusivity and diversity should extend toward various cultural aspects and norms into the nurse’s plan of care for the victim. Recognition of one’s perceptions and personal bias toward victims of human trafficking promotes awareness of inadvertently imposing perceptions upon the victim leaving the individual feeling more victimized. Ensuring inclusivity and diversity is essential to the application and success of victim of human trafficking. Always respect and acknowledge the cultural identity of every victim while reinforcing their dignity and potential, not assuming victims with the same ethnic background have the same beliefs or cultural practices.
Interview
Before the interview starts, address concerns of safety. Respect and nonjudgment actions are key components of the interview process and care provided to the victim impacting the victim’s perception of support and participation. Interviewing a victim poses a safety concern for the victim, others close to the victim, and to the interviewer. Nurses need to establish boundaries appropriate to maintain their personal safety. Recognize that each situation is unique, and the interview technique must be specific to the situation to avoid causing harm.
Asking the individual if they are a trafficking victim usually isn’t helpful. Many victims are unfamiliar with the term, don’t know that trafficking is illegal in the United States, and may blame themselves for their situation. Victims can be wary of strangers not knowing who they can and cannot trust, fearful of law enforcement and healthcare personnel for traffickers play on their victims inciting mistrust. Some victims will decline offers of assistance out of concern for the safety of their family and friends for often the trafficker has lied to the victim, through treats of arrest for prostitution or deportation. Victims of human trafficking rarely self-identify, due to the extreme psychological trauma, physical violence, and coercion they have encountered. When conducting an interview, it is vital to demonstrate empathy. Victims may not identify their trafficker as a trafficker, pimp, or abuser. They may refer to the person controlling them as their boyfriend, daddy, employer, or boss. As the interviewer, mirror the language of the victim avoiding terms that may be offensive to them, such as “pimp,” “traffickers,” “prostitute,” and “victim.”
Victims often demonstrate symptoms of posttraumatic stress disorder or trauma-bonding demonstrated in loyalty or affection for their trafficker believing their trafficker truly cares for them and their situation will improve over time. Victims may be hesitant to accuse their trafficker or have witnessed physical violence to others and withhold accusation out for fear of repercussions.
When interviewing the victim, it is essential to talk with the person alone. Asking questions in the presence of the trafficker is unproductive and could make matters worse. If the person doesn’t speak English, bring in the assistance of a translator who would have no connection to the suspected trafficker. The following are a few questions a nurse might ask the victim:
• Where are you from and with whom do you live?
• Do you have identification (ID) on you? If not, why not? Who has your ID or other documents?
• What type of work do you do? Do you have a set schedule? Are you paid for your work? How much do you earn?
• Are you being forced to do what you’re doing?
• Are you allowed to go out on your own?
• Do you have to ask permission to eat, sleep, go to the bathroom, or talk with others?
• Are there locks on the doors and windows so that you can’t get out?
Training/Tools
Training concerning safety needs and recognition of the available and appropriate resources immediate and follow-up care is essential for the victim. There are many screening tools to support victims of human trafficking. Screening tools are used for identification
and reducing adverse outcomes to improve health outcomes. Cities also have structures in place to address support of community members (City of Chicago, 2020). The National Human Trafficking Hotline (2011) provides a tracking assessment for professionals to identify and assist victims. The Administration for Children & Families: Office on Trafficking in Persons. (2018) is a guide for the usage of trauma-informed and survivor-informed practices, assessments, and risk. HEAL Trafficking (2022) provides an assessment tool which builds upon HEAL training and education.
Nurses need to establish boundaries appropriate to maintain their personal safety for nurses can experience emotional distress themselves. Awareness of professional resources, debriefing and counseling support of health and mental wellbeing. Advocate at your institution to address education and training. Over 14 medical societies have created policies on trafficking with several states with mandated education and training for health professionals on human trafficking (Polaris, 2022). Currently the state of Illinois does not regulate anti-trafficking education of health care providers. On a Federal level, the Stop, Observe, Ask, and Respond (SOAR) to Health and Wellness Training program (42 U.S.C.A. § 300d-54) was developed to provide human trafficking training to healthcare professionals.
Federal Law
The Department of Justice (DOJ), Department of Homeland Security (DHS), and Department of State (State) are the primary investigating agencies for federal human trafficking and other related offenses, and the Department of Defense (DoD) enforces the U.S. military code to prosecute sex trafficking-related offenses. DOJ prosecutes federal human trafficking cases. The DOJ, DHS, and State support victims by engaging law enforcement victim assistance specialists during trafficking investigations and prosecutions by connecting identified victims to victim providers (United States Department of State, 2021). Reporting child abuse, the federal Child Abuse Prevention and Treatment Act of 1974 (42 U.S.C.A. 9 5106a) requires states to have child abuse reporting laws as a condition of receiving federal funds for child abuse and neglect prevention and treatment programs. The Trafficking Victims Protection Act of 2000 (22 U.S.C.A. 7101-7114) focuses on prevention through public awareness programs, both domestically and abroad, and prosecution through federal criminal statutes.
Illinois Law
Illinois law (720 ILLCS 5/10-9 (2010) (Illinois Human Trafficking Act, 2020), is broken down into 3 categories. They include: involuntary servitude, involuntary sexual servitude of a minor, and trafficking in persons. The law defines these each in the following way:
• Involuntary Servitude: Exploits the labor (sexual or otherwise) of a person by force or coercion
• Involuntary Sexual Servitude of a Minor: Knowingly subjects a person under 18 years old to Commercial Sexual Activity
• Trafficking in Persons: Participates or profits from an enterprise that does either #1 or #2 above
Child abuse reporting is identified to the 325 ILL. Comp. Stat. Ann. 5/4 (a)(1) requiring an immediate report to the Illinois Department of Children and Family Services when they have reasonable cause to believe that a child know to them in their official capacities has been abused or neglected. Child sex and/ or labor trafficking reporting is identified to 325 ILL Comp. Stat. Ann. 5/3 (h) which includes the definition of “abused child.” Mandated reporters are required to alert the Illinois Department of Children and Family Services (DCFS) if they are working with or identified a minor who is exchanging sex for something of value (e.g., money, shelter, food, clothing, drugs) or has experienced involuntary servitude. Adult sex and/ or labor trafficking reporting is identified to 320 ILL. Comp. Stat. Ann. 20/4, which requires mandatory reporting within 24 hours of suspicion of sexual abuse to eligible adults.
Healthcare Industry Recommendations
When considering ways to deal with human trafficking, the healthcare industry must focus on human resource training and education. There are eight areas that should be addressed.
1. Education completion of Human Trafficking Training for all staff at health care facilities. A comprehensive online option is SOAR Online which is a free series of self-paced online training modules which healthcare professionals can receive CEUs or CMEs. This could go through the Human Resource department of your facility. Additional resources are available through HHS National Human Trafficking Training and Technical Assistance (NHTTAC) @ https://nhttac.acf.hhs.gov/
in addition to Health, Education, Advocacy, Linkage (HEAL) Trafficking’s Essential Components for a Health Professional Trafficking Training located @ https://healtrafficking.org/publications/essentialcomponents-for-a-health-professional-traffickingtraining/
2. Seek out resources to address implicit bias addressing microaggression and victim-blaming to dismantle barriers and power dynamics to promote trusting interactions between health care providers and patients. This could be added into harassment and diversity training within an organization through the human resource department.
3. Create human trafficking identification and response protocols and/or adapt existing protocols integrated within intimate partner violence, sexual abuse, or child abuse protocols.
4. Facilitate trauma-informed care practice
5. Participate in health campaign: Support Human Trafficking Awareness in the month of January.
6. Participate in World Day Against Trafficking in Persons July 30th.
7. Educate staff on Signal For Help, launched by the Canadian Women’s Foundation (n. d.), a onehanded sign alerting others of the need for help.
8. Download the STOP APP the first of its kind enabling people anywhere in the world to report suspicious incidents of human trafficking securely and anonymously.
Additional resources that are available for nurses can be found in Tables 1 and 2 with Table 2 providing agency information at the international, federal, state, and local levels.
Conclusion
Human trafficking is a serious crime, it is the illegal exploitation affecting up to 40 million men, women, and children bought and sold using violence, manipulation, recruitment, and false promises. Human trafficking must not be tolerated. It is a stain upon society and the world. It erodes the safety of our communities, the strength of our economy, and the rule of law. Nurses are at the forefront in providing care to victims. Nurses can and do make a difference. It is vital that nursing as a profession make one of our highest priorities to learn the signs and how to safely intervene making one of our highest priorities to combat human trafficking.
References
Administration for Children & Families: Office on Trafficking in Persons. (2018, January). Adult Human Trafficking Screening Tools and Guide. https://www.acf.hhs.gov/sites/default/ files/documents/otip/adult_human_trafficking_screening_ tool_and_guide.pdf Bureau of Justice Statistics. (2021). Human Trafficking Data Collection Activities, 2021. https://bjs.ojp.gov/library/ publications/human-trafficking-data-collection-activities2021#:~:text=The%20number%20of%20arrests%20 reported,declining%20to%20301%20in%202020. Canadian Women’s Foundation. (n. d.). Signal For Help. https:// canadianwomen.org/signal-for-help/
Human Trafficking: Modern Day...continued on page 14
City of Chicago. (2020). Protocol Toolkit. https://www.chicago.gov/content/dam/city/sites/ human-trafficking/pdfs/Protocol-Toolkit.pdf
Center for Prevention of Abuse. (2022). Human Trafficking Services. https://www. centerforpreventionofabuse.org/lets-start-the-conversation/human-traffickingservices/#reporting
HEAL Trafficking. (2022). Assessment Tool. https://healtrafficking.org/2018/12/assessment-toolfor-health-care-provider-human-trafficking-training/ Illinois Human Trafficking Act, 720 ILCS 5/10-9 (2020). https://www.ilga.gov/legislation/ilcs/ documents/072000050k10-9.htm
National Human Trafficking Hotline. (2021a). Hotline Statistics. https://humantraffickinghotline. org/states
National Human Trafficking Hotline. (2021b). Illinois. https://humantraffickinghotline.org/state/ illinois
National Human Trafficking Hotline. (2020c). National Human Trafficking Hotline Data Report: Illinois State Report: 1/1/2020-12-31/2020. https://humantraffickinghotline.org/sites/default/ files/Illinois%20State%20Report%20For%202020.pdf
Polaris. (2022). Human Trafficking and The Health Care Industry. https://polarisproject.org/ human-trafficking-and-the-health-care-industry/ Polaris. (2018, July). On-Ramps, Intersections, and Exit Routes: A Roadmap for Systems and Industries to Prevent and Disrupt Human Trafficking. https://polarisproject.org/wp-content/ uploads/2018/08/A-Roadmap-for-Systems-and-Industries-to-Prevent-and-Disrupt-HumanTrafficking-Health-Care.pdf
SAMHSA. (2014). SAMHSA’s Concepts of Trauma and Guidance for a Trauma-Informed Approach. https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4884.pdf Shared Hope International. (2021). Illinois Report Card. https://reportcards.sharedhope.org/ illinois/
Stop The Traffik. (2022). Human Traffiking, https://www.stopthetraffik.org/what-is-humantrafficking/defintion-and-scale/ United Nations. (2020). Global Report on Trafficking in Persons 2020. https://www.unodc.org/ documents/data-and-analysis/tip/2021/GLOTiP_2020_15jan_web.pdf
United Nations: Office on Drugs and Crime. (2020a). The Crime. https://www.unodc.org/unodc/ en/human-trafficking/crime.html
United Nations.: Office on Drugs and Crime. (2020b). Human Trafficking. https://www.unodc. org/unodc/en/human-trafficking/human-trafficking.html
United States Attorney’s Office Northern District of Illinois. (2021, November 4). Federal Jury Convicts Chicago Man of Sex Trafficking Several Children. https://www.justice.gov/usao-ndil/ pr/federal-jury-convicts-chicago-man-sex-trafficking-several-children
United States Attorney’s Office Central District of Illinois. (2022). Normal, Illinois Man Sentenced to 120 Months in Prison for Child Sex Trafficking. https://www.justice.gov/usao-cdil/pr/ normal-illinois-man-sentenced-120-months-prison-child-sex-trafficking
United States Department of Justice. (2022, August 18). Justice News: Illinois Family Charged with Kidnapping, forced Labor, and Conspiracy for Coercing Two Minors and a Third Victim in Years-Long Forced Labor Scheme. https://www.justice.gov/opa/pr/illinois-family-chargedkidnapping-forced-labor-and-conspiracy-coercing-two-minors-and-third United States Department of State. (2021, June). Trafficking In Persons Report. https://www. state.gov/wp-content/uploads/2021/09/TIPR-GPA-upload-07222021.pdf
U. S. Department of Health & Human Services. (2020). What is human trafficking? https://www. acf.hhs.gov/otip/about/what-human-trafficking World101. (2022). Human Trafficking in the Global Era. https://world101.cfr.org/global-eraissues/globalization/human-trafficking-global-era Yan, W. (2018, May 7). The Surprising Link Between Climate Change and Human Trafficking. The Revelator. https://therevelator.org/climate-change-human-trafficking/ Tables
Table 1
Hotlines Related to Human Trafficking Agency
Department of Children and Family Services
National Human Trafficking Resource Center (NHTRC)
National Sexual Assault Hotline
Contact Information
1-800-252-2873 (Voice); 1-800-524-2606 (TYY)
1-888-373-7888
1-800-656-4673
STOP-IT Initiative Against Human Trafficking Hotline 1-877-606-3158
Table 2
Resources and Training Agency by Governmental Level Contact Information International
Male Sexual Assault & Abuse Support for Men https://malesurvivor.org/ Polaris Project https://polarisproject.org/ Shared Hope International https://sharedhope.org/resources/ Stop the Traffik https://www.stopthetraffik.org/ Federal
Blue Campaign https://www.dhs.gov/blue-campaign Coalition to Abolish Slavery and Trafficking https://www.castla.org/
FAIR Girls https://fairgirls.org/ Heartland Alliance Freedom from Trafficking https://www.heartlandalliance.org/ program/freedom-from-trafficking/ Homeland Security https://www.dhs.gov/ National Center for Missing and Exploited Children https://www.missingkids.org/HOME
National Human Trafficking Resource https://humantraffickinghotline.org/ National Human Trafficking Resource Center (2011, January) Comprehensive Human Trafficking Assessment https://humantraffickinghotline.org/ sites/default/files/Comprehensive%20 Trafficking%20Assessment.pdf
National Sexual Violence Resource Center https://www.nsvrc.org/
U.S. Department of Health & Human Services https://www.acf.hhs.gov/orr/rescuecampaign
U.S. Department of Health & Human Services: Office on Trafficking in Persons
https://healtrafficking.org/resources/ department-of-health-and-humanservices/ State
Illinois Coalition Against Sexual Assault www.icasa.org
Illinois Department of Children and Family Services https://www.illinois.gov/agencies/agency. dcfs.html
Illinois Coalition Against Sexual Assault https://icasa.org/ Local
Center for Prevention of Abuse (Peoria) https://www. centerforpreventionofabuse.org/ lets-start-the-conversation/humantrafficking-services/ https://www.domesticshelters.org/ help/il/peoria/61612-3855/center-forprevention-of-abuse
Cook County Human Trafficking Taskforce https://www.cookcountytaskforce.org/ Dreamcatcher Foundation (Chicago) https://thedreamcatcherfoundation.org/ Legal Aid (Chicago) https://www.legalaidchicago.org/ Life Span (Chicago) https://life-span.org
Metropolitan Family Services (Chicago) https://www.metrofamily.org/legal-aidsociety/about-las/
STOP-IT Initiative Against Human Trafficking (Chicago) https://centralusa.salvationarmy.org/ stopit/
Questions
1. Which of the following are examples of human trafficking?
a. Forced labor
b. debt bondage
c. sex trafficking
d. all of the above
2. The crime of sex trafficking consist of what three elements?
a. the act, the means, the purpose
b. force, fraud, or coercion
c. recruitment, transportation, and transfer
d. violence, abduction, and abuse of power
3. Assessment of victims would include which of the following?
a. evaluation of social, cultural, political, and economic contexts
b. social and cultural
c. political and economic contexts
d. All of the above
4. As a nurse, in a clinical setting victims of human trafficking would present which identifiers of abuse?
a. Outgoing
b. Lack of personal possessions
c. Freedom of movement
d. Stable living situation
5. Which of the following is a key goal of trauma-informed care?
a. Prevent victim re-traumatization.
b. trustworthiness
c. empowerment
d. collaboration
6. Before the interview starts, what should the nurse address?
a. concerns of safety for victim, others close to the victim, and to the interviewer.
b. address empowerment and choice
c. Seek peer support and collaboration
d. Provide transparency and trustworthiness
7. Which of the following ensures inclusivity and diversity into the nurse’s plan of care for the victim?
a. respect and acknowledge the cultural identity of every victim.
b. organizational sustainability
c. justice system partners as resources
d. safety protocols
8. Which of the following is a question a nurse might ask a victim?
a. Where are you from?
b. Can you come and go as you please?
c. Have you been threatened or harmed in any way?
d. all of the above
9. Child abuse reporting in Illinois occurs?
a. Immediately to the Illinois Department Children Family Services Child Abuse Hotline
b. immediately to the state of Illinois
c. immediately to the federal government Department of Justice
d. immediately to the Illinois state attorney office
10. Most trafficked persons in the United Stated identify to which population?
a. Individuals with disabilities
b. undocumented migrants
c. lesbian-gay-bisexual-transgender-questioning individuals
d all of the above
The Role of Sexual Assault Nurse Examiners in Illinois
Kristen DiBenedetto MSN, RN, CEN, SANE-A SANE Coordinator - Advocate Aurora Health System
From January to June of 2022, 2,676 patients presented to Emergency Departments (EDs) in Illinois seeking treatment after sexual assault (SA) (Illinois Department of Public Health, 2022). The most qualified nurses to care for these patients are Sexual Assault Nurse Examiners (SANEs). "SANEs are Registered Nurses or Advanced Practice Nurses specially trained to provide comprehensive care to sexual assault patients in a medical setting” (Raoul, 2021). Per the Illinois Attorney General, “Sexual Assault Nurse Examiners are crucial in ensuring that sexual assault patients receive more compassionate care; SANEs are able to reduce re-traumatization of patients and improve the quality of forensic evidence collection, which in turn increases prosecution rates of offenders” (Raoul).
SANEs perform what is referred to as a medical forensic examination (MFE). An MFE is an “exam performed to collect evidence for law enforcement and assess victims for potential injuries and health needs” (Rape, Abuse and Incest National Network, 2022). Essentially, the SANE performs a medical assessment on the patient and collects potential DNA evidence for the State of Illinois Evidence Collection Kit, formerly known as a “rape kit.”
SANEs work in collaboration with law enforcement, legal entities, advocacy groups and help to provide education and community awareness.
Sexual Assault Treatment in Illinois
The law in Illinois that guides the care and treatment of victims of sexual violence is known as the Sexual Assault Survivors Emergency Treatment Act (SASETA). Regulated by the Illinois Department of Public Health (IDPH), SASETA outlines the level of care offered to any SA victim, so no matter where the patient seeks medical attention in the state of Illinois, they will receive the same standard of care.
Per SASETA, each SA victim who presents to the ED will be offered a medical screening, access to a rape advocate, an MFE with evidence collection, as well as testing and prophylactic medication for pregnancy, sexually transmitted infections, and HIV. Urine toxicology testing is also offered, if the patient and/or SANE suspects drugfacilitated sexual assault (DFSA), in which a medication or substance may have been used to incapacitate the patient. In addition, each patient is offered the right to have forensic photographs of injuries taken by the nurse. The patient decides which options are right for him or her based on the events of the assault and personal preference.
In Illinois, SA victims do not pay for the treatment they receive in the ED related to the assault, which includes the MFE and evidence collection, medication, laboratory testing, and any diagnostic tests/imaging and treatments that may be required to address injuries. If the patient does not currently receive public aid from the state, they also qualify for a voucher from the Illinois Department of Healthcare and Family Services (HFS) to pay for services up to 180-days from the assault, including, but not limited to, medical follow-up, laboratory testing, prescription medication, and counseling services. Beyond the 180-day period, the victim can apply for Crime Victim’s Compensation for up to $45,000 to cover expenses directly related to the assault.
Medical Forensic Examination and Evidence Collection
During the MFE, the SANE performs a head-to-toe inspection, an assessment of injuries, and identifies potential areas of DNA evidence. Once that assessment is completed, any medical issues should be tended to first, prior to evidence collection. For instance, a CT scan should be the priority for a patient who experienced a head injury during the assault. Once the results of the scan are reviewed and the patient is medically cleared, the SANE can offer the patient evidence collection and photography based on his or her findings. The items that may be collected as part of DNA evidence for the State of Illinois Evidence Collection Kit are as follows:
• Miscellaneous debris from clothing
• Clothing worn during the assault / Underwear / Bra
• Fingernail scrapings / Head hair combings / Oral swabs
• Swabs from bites, bruises, lacerations, any locations where foreign body fluids are present
• Pubic hair combings / Genital swabs / Cervical swabs /Anal swabs
• Reference DNA sample from the patient
The patient is offered each one of these items and may consent to or decline any step, even if he or she previously consented to the evidence collection kit. The patient should be provided a rationale for each step and allowed to make a decision that is appropriate for him or her.
Safety planning is also an essential piece of the discharge process. The SANE discusses the patient’s current living situation and potential exposure to the assailant. If necessary, the SANE will consult with a social worker, case manager, and rape advocates to locate a safe living space for the patient and determine if orders of protection or other legal interventions are necessary.
SANE Training in Illinois
Illinois has a very robust training program for SANEs. Nurses are required to attend a 40-hour didactic training through the Illinois Attorney General’s Office, based on the standards of the International Association of Forensic Nurses. Once that training is completed, the nurse is considered “SANE Trained” and has one year to complete the SANE Training Clinical Log, which includes the completion of clinical and non-clinical items.
Clinical requirements include three medical forensic examinations, 15 genital examinations with anatomy identification, forensic photography, and specialized equipment training. Non-clinical requirements entail education and partnership with rape advocacy services, law enforcement, and the Illinois State Crime Lab to understand the roles of the different disciplines that assist the victims, as well as completion of a workbook containing case studies and genitalia identification, and expert witness testimony. The nurse in training works with a mentor or SANE Coordinator to assist in fulfilling these requirements. Mentors are Adult/Adolescent or Pediatric/Adolescent SANEs and are typically certified in their specialty area through the International Association of Forensic Nurses. The mentor ensures appropriate training and provides feedback on MFE completion and documentation within the evidence collection kit. Upon completion of the training requirements, the nurse submits the log to the
Illinois Attorney General’s Office for review and approval. If approved, the nurse becomes either an “AA SANE” or “PA SANE,” Adult/Adolescent SANE (able to treat patients aged 13 and up) or Pediatric/Adolescent SANE (able to care for patients aged 0 to 18), respectively. Recognition as a SANE in Illinois allows the nurse to perform the MFE independently.
Role of the SANE Coordinator
SANE Coordinators are employed by hospitals or healthcare systems to provide oversite for the care and treatment of SA victims. Typically, their primary responsibilities involve assuring compliance with SASETA through the development of policies specific to the care and treatment of these patients, as well as the development of order sets, and documentation compliance.
Coordinators also assist in recruiting nurses who are interested in becoming a SANE and work with the nurse to ensure that he or she is successful in completing both their clinical and non-clinical requirements. They also perform hands-on training with the nurses to educate them on the specific methods of forensic evidence collection and validate the nurse’s competency, which may be completed by shadowing the nurse during an MFE or through simulation.
Supporting our Patients
At the foundation of SANE Nursing is a concept referred to as, “Start by Believing,” created by the organization, End Violence Against Women International. The global campaign was developed in 2011 to “increase awareness of sexual assault and improve societal responses to victims” (End Violence Against Women International, 2022) by establishing a supportive dialogue of trust between the patient and SANE. Examples of responses include, “I believe you, I’m sorry this happened to you and I am here for you.”
Rape advocates also assist in supporting the patient, both in the ED and after discharge. The advocate can be as much or as little involved as the patient wants. The advocate can accompany the patient to appointments, both medical and legal, assist with obtaining prescriptions, and work through their emotions and trauma. Advocacy groups also offer free counseling through their organizations and some hospitals also provide free counseling services upon discharge, as well.
Since the bond of patient and SANE is so strong, SANEs are encouraged to make follow up phone calls with their patients to check in with them and answer any questions that have arisen. The SANE can also help navigate any difficulties the patient may be experiencing.
Supporting our SANEs
SANEs are at high risk of developing vicarious trauma (VT). VT is defined as the “indirect trauma that can occur when we are exposed to difficult or disturbing images and stories second-hand” (Tend Academy, 2022). SANEs consistently hear details of assaults and inhumane acts and see the results of those on the patient in front of them through their emotions, body language, and physical injuries. Ways in which SANE Coordinators can assist in preventing VT from occurring with the SANEs they work with is by providing services in which SANEs can speak freely, such as peer support arenas, and by offering them a “break” from caring for victims for a period of time. Having an open and honest mentor/SANE relationship is essential to preventing compassion fatigue and burn out.
If you are interested in becoming a SANE in Illinois, please reach out to your hospital SANE Coordinator and/or refer to the Illinois Attorney General’s Office for information on SANE training.
References
End Violence Against Women. (2022). What To say – Start By believing. https://startbybelieving. org/what-to-say/
Illinois Attorney General Kwame Raoul. (October, 2021). Illinois sexual assault nurse examiner (IL SANE) program. SANE.pdf (illinoisattorneygeneral.gov)
Illinois Department of Public Health. (2022). SASETA data January – June 2022. https://dph. illinois.gov/covid19/community-guidance/emergency-departments-sexual-assault-domesticviolence-services.html
Rape, Abuse, and Incest National Network. (2022). What is a sexual assault forensic exam? https://www.rainn.org/articles/rape-kit
Tend Academy. (2022). Defining vicarious trauma and secondary traumatic stress. https://www. tendacademy.ca/resources-2/defining-vicarious-trauma-and-secondary-traumatic-stress/
Find Your Dream Nursing Job Now!
JB PRITZKER
The Illinois Department of Financial and Professional Regulation (IDFPR) has online nurse resources available!
• 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
• To change your email address, address or phone number, please click on this link to update the information https://idfpr.illinois.gov/applications/ LicenseReprint/
• On the IDFPR Division of Professional Regulation Nurses webpage, the “Requirements of an Internationally Educated Nurse” document has been updated. Resources on this document include the names of Board of Nursing approved vendors for items required to apply for an Illinois nurse license. Information includes that endorsing an active license from another state requires: an application by Endorsement. A Credential Evaluation Service (CES) Report is not required if the state of original licensure required a report at the time of original licensure. An English equivalency test is not required as long as the nurse applying for endorsement took and passed the NCLEX® licensure examination.
• On the IDFPR Nurses web page there is a list of all Illinois Board of Nursing approved pre-licensure nursing education programs https://idfpr.illinois.gov/ Forms/DPR/NurseSchools.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
• IDFPR’s Division of Professional Regulation has issued a notice, “Notice that Advice or Treatment Regarding Covid-19 Must conform with Evidence-Based Medicine and Standards of Care,” to remind physicians and other healthcare professionals that any advice or treatment provided to a patient must conform with evidence-
based medicine and standards of care and that failure to do so may subject the individual to disciplinary action. Licensed healthcare professionals have an ethical and professional duty to the public and are entrusted to protect the public health and the safety of patients. IDFPR is aware of licensed healthcare professionals providing misinformation regarding COVID-19 mitigations and treatment. https://www. idfpr.com/Forms/COVID19/IDFPR%20statementphysicians.pdf
• Variance: The Healthcare License Reinstatement Application is specific to the COVID-19 Pandemic and limited to prior State of Illinois licensees who were in good standing, including: Licensed Practical Nurse, Advanced Practice Registered Nurse, and Registered Nurse. The license must have been on an “inactive” status for less than five years. The COVID-19 license will have an expiration date of May 31, 2022 or until the expiration of the Gubernatorial COVID-19 Disaster Proclamations. There is no fee to apply https://idfpr. com/Renewals/Apply/Forms/F2396.pdf
• In 2021, IDFPR’s Military Liaison increased the number of military service members and spouses assisted compared to 2020. In total, IDFPR received more than 500 applications for licensure from military and military spouse applicants in 2021. The military liaison directly works with service members and their spouses, as well as members of military installations based in Illinois, to expedite and assist their professional licensure process. We wish to thank them for their service for our country! For a copy of the report, 2021 Expedited Licensure Review for Military Service Members and Spouses, use this link: https:// idfpr.com/Forms/2021%20Annual%20Military%20 Report.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/. This page includes the CDC’s new vaccine finder tool which shows you the closest location to get a vaccination; with this finder you can filter by manufacturer, which makes it easy to protect children who are not eligible for the Pfizer vaccine.
• 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/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. Division of Professional Regulation online complaint form: https://idfpr.illinois. gov/Admin/DPR/Complaint.asp
• A complete copy of the Nurse Practice Act and the Rules may be found on the IDFPR website www.idfpr. com or on the Illinois Nursing Workforce Center’s website http://nursing.illinois.gov/nursepracticeact.asp
• The Illinois Department of Financial and Professional Regulation (IDFPR) is providing renewal assistance for individuals and businesses that are having difficulty with the online renewal process. 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
Are you a nurse wanting to educate future nurses?
Are you a Reginstered Nurse (RN) licensed in Illinois who is looking for an opportunity to share your knowledge and experience with future nurses?
The Illinois Nursing Workforce Center (INWC) is teaming up with higher education institutions across the Land of Lincoln to bring YOU a series of FREE webinars about the graduate faculty nursing programs in Illinois for you to consider!
The Wednesday December 7 webinar features University of Illinois Urbana-Champaign, Loyola University Marcella Niehoff School of Nursing, Mennonite College of Nursing-Illinois State University, and Lewis University. Explore the programs and find the right one for you by signing up for the webinar. Signup is limited to the first 100 registrants.
University -Edwardsville School of Nursing, and St. Xavier University-DE School of Nursing and Health Sciences. All webinars are available on IDFPR’s YouTube page https:// www.youtube.com/user/IDFPRmedia
Each webinar panel member shares essentials such as program entry requirements, per cent of classes online, balance of current work, classes and requirements with family and professional development. These webinars will continue every other month through at least June 2023. Each webinar will present a panel of faculty from graduate nursing education programs across the state. Please join us in preparing future nurses.
The Illinois Nursing Workforce Center website includes links to:
• Grid of graduate nursing education programs https://nursing.illinois.gov/Gradeducation.asp
• Grid of graduate nursing education programs with focus areas leading to systems focused roles https://nursing.illinois.gov/PDF/2022-06-08a_ INWC_Grad_NsgEd_FocusAreaLeadSystFocusRole_ Ltrhd.pdf
• Established relations with community colleges across the state, useful for transfer of credits to the graduate program https://nursing.illinois.gov/ PDF/2020-05-06_ILBSNcPgms_Partnerships_Final. pdf
• IDFPR nurse page https://idfpr.illinois.gov/PROFS/ Nursing.asp
Reducing legal risks in retirement
By Cynthia Saver, MS, RN, President, CLS Development, Columbia, Maryland
Retirement. The word conjures up an image of relaxation and a leisurely lifestyle. But for many nursing professionals, the picture is one of a life nearly as busy as when they were working full-time. Many retirees choose to volunteer, whether it’s responding to disasters, working at a pop-up clinic in an underserved area, answering questions for members of the community, or something else.
When engaging in these activities, nursing professionals can easily forget that they still need legal protection for their actions. However, if you have a nursing license, you need both professional liability and license protection insurance coverage. That’s also the case if you are working part-time or per diem, for example, teaching a course or two at the local community college, as you transition to retirement. And it’s the case if you are summoned to give a deposition as a witnesseven if you did not provide direct patient care.
Liability and license protection coverage
Professional liability insurance is needed for protection in the event you are accused of malpractice. Even those who routinely adhere to best practices can make a mistake that results in patient harm or find themselves named in a lawsuit. In addition, even if you are cleared of any liability in a legal case, you will still incur legal fees; professional liability insurance will help cover those costs.
There are two types of liability insurance coverage: occurrence and claims-made. Occurrence policies are usually preferred because they provide greater coverage: If the incident occurred while the policy was in force, coverage is available even if the policy has expired or been canceled. With claims-made policies, coverage is only available for claims that occurred and are reported while the policy is in force.
License protection coverage is also needed as part of professional liability insurance coverage so you have the resources to protect yourself against actions related to a state board of nursing (BON) investigation. For instance, if you are investigated for a complaint related to something you posted on social media, license protection coverage will help pay for legal representation during the investigative process. Nursing professionals should know that a BON disciplinary action in one state can also lead to BON action in other states where they hold a license, referred to as reciprocal enforcement. According to nurse attorney Edith Brous, you can be at risk for discipline even if your license is not current. That’s because licenses in some jurisdictions are issued for the lifetime of the licensee. In addition, nursing professionals can be disciplined by agencies other than the BON, such as a state health department. These risks make it critical that you have appropriate insurance coverage.
Weighing options
Some states offer different types of licenses based on practice. For example, Maryland offers the option of a “volunteer” license for those who are practicing nursing but not receiving compensation (for example, volunteering at a community center). The volunteer in this case is still subject to the state-required criminal background check. Another option is “inactive” status, which means the individual cannot practice nursing with or without compensation. Check your state BON for similar options.
As you change the type of practice activities you are involved in, you will want to ensure you have the necessary education to qualify you for completing any tasks. It is also a good idea to discuss your licensure status and insurance coverage with your insurer to ensure you have adequate coverage and are taking advantage of any discounts that may be available.
Cutting ties
At some point, you may decide that you will not be providing nursing care in any capacity and choose not to renew your license. In this case, notify the BON of your decision; you likely will need to complete a form and pay a fee to convert to inactive status. It is best to complete this process rather than simply let your license lapse, because it makes it easier to reactivate your license should your situation change.
Be aware that you still must address insurance coverage if you have a claims-made policy. You will need to obtain “tail” coverage, which protects you against legal action related to your practice before you dropped your license.
Peace of mind
Retirement should result in less, not more, stress in your life. If you retain your license after retiring, be sure to continue liability and license protection coverage to reduce the financial damage and emotional upheaval associated with litigation. With that peace of mind, you will be ready to enjoy life in retirement.
Getting ready to retire
Retirement involves more than licensure status. Here’s a checklist for nursing professionals getting ready to retire.
Licensure and certification
• plans for continued licensure and certification with corresponding board of nursing and certification organization information
• cross-training for proposed position changes and transitions
• attendance at employer-based training programs (e.g., basic life support).
Legal
• a signed durable power of attorney for healthcare, living will, and financial power of attorney
• a will or living revocable trust
• professional liability insurance coverage that includes coverage for incidents before retirement
Financial
• an appointment with your facility’s human resources team to learn all you can about retirement savings plans and options, postretirement health coverage, and post-retirement insurance benefits (life insurance, disability, professional liability)
• an appointment with a professional certified independent financial planner
• a carefully crafted month-by-month savings plan and budget based on retirement goals and options
• emergency savings that could cover your financial needs for up to 8 months
• insurance (such as long-term care, disability, health, term life, home, auto, professional liability)
Personal and lifestyle considerations
• an appointment with your facility’s human resources representative or nursing manager to learn all you can about position and hourly change options
• a daily exercise and nutrition routine
• an appointment with your employee health nurse to discuss needed titer levels or immunizations (updated TB screening, tetanus, hepatitis)
• obtain and secure all your immunization records, for future reference, in case these are needed for volunteer, consultant, or part-time work.
RESOURCES
Brous E. The BON discipline cascade. Am Nurs Today. 2019;14(11):26-28.
Evans J, Tabloski P. Redefining Retirement for Nurses: Finding Meaning After Retirement. Indianapolis, IN: Sigma Theta Tau International; 2017.
Maryland Board of Nursing. FAQ – Inactive versus volunteer status. 2016. https://mbon.maryland.gov/Pages/faqlicensing-inactive-vs-volunteer-status.aspx NSO. Claims made vs. occurrence coverage. www.nso.com/ Learning/Artifacts/Articles/Claims-Made-Vs-OccurrenceCoverage.
Smith LS. Deciding if and when to retire. Nursing. 2019;46(8):45-49.
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.
ANA-Illinois Elects New Board Members
Members of the ANA-Illinois elect new leadership
The American Nurses Association - Illinois (ANAIllinois), the state’s largest professional nursing association for registered nurses in all practice settings, has elected new leadership.
ANA-Illinois leadership includes nurse leaders from across the state and with a variety of backgrounds. The elected leaders’ unique experiences are sure to enhance the work of ANA-Illinois and its vision of being the recognized leader of professional nursing and nurses in Illinois.
The newly elected board members are as follows: Vice President: Monique Reed PhD, MS, RN, FAAN, Associate Professor, Assistant Dean of Generalist Education, Rush University Medical Center
Treasurer: Jeannine Haberman DNP, MBA, CNE, Chair, Undergraduate Nursing Programs Lewis University
Director: Samuel Davis Jr. MHA, RN, CNOR, Associate Vice President, Rush University Medical Center
Director: Zeh Wellington DNP, RN, NE-BC, Director of Procedural Care – Surgical Services, Ann & Robert H. Lurie Children’s Hospital of Chicago
Director - Recent Graduate: Hannah Shufeldt MSHCM, BSN, RN, Nurse Manager, Springfield Memorial Hospital
The new board members will join the following directors whose terms continue through October of 2023:
Elizabeth Aquino PhD, RN – President Beth Phelps DNP, APRN, FNP, ACNP – Secretary Susana Gonzalez MHA, MSN, RN, CNML – Director Elaine Hardy PhD, RN – Director
The 2022 ballot also included the election of members to the Nominations Committee and representatives to the ANA Membership Assembly. We are happy to welcome these individuals as part of the ANA-Illinois leadership team. As we move forward, these individuals will be instrumental in helping the association advance the profession.
Nominations Committee: M Cecilia Wendler RN, PhD, NE-BC
Representatives to the ANA Membership Assembly: Gloria E. Barrera MSN, RN, PEL-CSN Feyifunmi Sangoleye PhD, RN
###
ANA-Illinois, a constituent member of the American Nurses Association, is a powerful network of registered nurses committed to advancing nursing through education, political action, and workplace advocacy. ANAIllinois is the leading voice of the approximately 187,000 professional registered nurses in Illinois.
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Advancing your career – and minimizing risk
By Cynthia Saver, MS, RN, President, CLS Development, Columbia, Maryland
You just landed your first leadership role as a nurse manager. Or perhaps you’re shifting your career from bedside, hospital-based nursing to home care nursing because you’re ready for a new challenge. Congratulations! Advancing your career, whether by taking a leadership position or exploring a new specialty, can lead to enhanced job satisfaction and a bigger paycheck.
But career changes also can put you at greater legal risk as you take on more or new responsibilities. For example, as a preceptor you are legally responsible for making appropriate assignments for your preceptee. If a new nurse harms a patient who had needs too complex for the nurse’s level of expertise, you could be held liable.
By understanding the potential for liability and taking steps to protect yourself, such as notifying your insurance provider when you have a change in role or responsibilities to ensure your coverage is adequate, you can reduce the risk of legal action as you advance your career.
Liability, role, and specialty
According to the 2020 CNA/NSO Nurse Professional Liability Exposure Claim Report: 4th Edition, the number and amount of claims vary by role and by specialty. For example, home care, which includes home health, hospice, and palliative care, topped the list of the most common closed claims by specialty at 20.7%, up from 12.4% in the 2015 report. It should be noted, however, that this doesn’t necessarily mean home care nurses are more likely to be sued; rather, the increase may reflect the overall trend of care shifting from hospital to home.
The report noted that the highest average total incurred amount (defined as the costs or financial obligations resulting from the resolution of a claim, divided by the total number of closed claims), was for obstetrics claims, likely because some of these cases can result in the need for the patient to receive extensive or even lifelong one-on-one nursing care. This was followed by postanesthesia care unit and behavioral health claims.
Whether you’re taking on a leadership role or changing specialties, the following strategies can help you to mitigate the risks of a claim.
Becoming a leader
The nurse leader role can be rewarding as you mentor others and advocate for quality patient care. In addition to formal roles such as charge nurse, nurse manager, and director of nursing, leaders also serve as educators and preceptors.
As you take on additional responsibilities, however, keep in mind that you have new legal risks because lawsuits have named leaders based on their actions related to duties such as hiring and educating staff and making patient care assignments. The CNA/NSO report found that the greatest average total incurred amount for nurses in leadership roles was for those in correctional health, followed by the postanesthesia care unit and aging services. In fact, 38.7% of closed claims related to leaders in aging services settings, while 32.3% were related to care delivered in the patient’s home.
As a new leader, be sure you understand the expectations for the role. Carefully review your job description (and the job descriptions for those reporting to you) and don’t be afraid to ask questions. Consider putting a plan in place to help you make a smooth transition (see New leader action plan).
New leader action plan
Rose Sherman, a leadership expert, recommends creating a 100-day plan to ease the transition from staff nurse to leader. The plan should include strategies related to six competency areas: personal mastery, interpersonal effectiveness, human resources (HR) management, financial management, systems thinking, and caring for self/staff/patients. Several of Sherman’s suggested strategies can help you avoid legal pitfalls.
• Review your position description and evaluation criteria. You need to know what is expected of you.
• Review the position descriptions for each staff position and evaluation criteria. You need to know what you can expect from staff.
• Meet 1:1 with each direct report. In additional to finding their strengths, this can help you identify competency and skill levels to consider when making assignments and planning education programs so staff can care for patients effectively.
• Learn about the HR recruitment process to fill vacancies. Be sure you understand what you are legally able to ask during an interview.
• Determine the HR process for managing performance issues and challenges. You’ll want to follow these closely to reduce the risk of lawsuits by disgruntled employees.
• Review the organizational chart. This will help you understand whom you should contact with questions and problems.
Check your state’s nurse practice act and board of nursing position statements for any relevant information. A 2018 study by L’Ecuyer and colleagues found that some state boards of nursing had specific requirements related to preceptors and student nurses. An example of a position statement of interest to new leaders is the one on floating from the New York State Nurses Association, which states that employers are responsible for providing appropriate orientation and training of staff who float to other units.
Also be aware of competencies, both required and suggested. For example, local and state regulations may require certain competencies, while associations may suggest ones. For example, the American Nurses Association’s (ANA) Nursing: Scope and Standards of Practice, 4th Edition includes several leadership competencies. In addition, the American Organization for Nursing Leadership has developed suggested competencies in three areas: the science, the art, and the leader within. Competency in these three areas can help you avoid legal action. For instance, a human resource management competency under the science section is: “Match staff competency with patient acuity.” By doing so, you can reduce the risk of a claim that could occur. For example, you could be held responsible if harm results when you assign a nurse who is not competent in negative pressure wound therapy to a patient receiving it. Even recommended or suggested competencies can play a role in a lawsuit because they indicate what is accepted practice.
Finally, you’ll want to be aware of any local, state, and federal laws related to your role. Some states have nurse-patient ratios that you’ll need to consider when making assignments.
A change in specialty
Changing specialties can be an excellent way to rejuvenate your career, but specialty also can affect the number of claims and the amounts paid to close claims. In addition to obstetrics, other specialties with high average total incurred amounts are the postanesthesia care unit, behavioral health, correctional health, and critical care, according to the CNA/NSO report.
After home care, specialties with the highest percentage of closed claims were adult medical/ surgical (18.5%), gerontology in an aging services facility (10.5%), emergency and urgent care (9.7%), obstetrics (6.2%), and adult critical care (5.9%).
As with a leadership role, you can take steps to lessen your legal risk. The first source to turn to is your state’s nurse practice act and any position statements related to your new specialty and scope of practice. For example, the Texas Board of Nursing’s position statement on nurses reinserting permanently placed feeding tubes states that nurses must complete a training course and follow various guidelines before performing this procedure. If you were a new home care nurse and reinserted the tube without meeting these requirements, you could be held liable if the patient developed a complication.
Also check with national nursing associations for resources. The ANA publishes books on the scope and standards of practice for a variety of specialties, such as cardiovascular nursing. Specialty organizations, like the Association of periOperative Nurses, also publish standards that you should review and adhere to. Failure to do so puts you at risk for legal action should patient harm occur. In addition, specialty associations are a source for competencies related to the role; meeting these competencies helps you deliver safe, effective care.
A positive career move
Don’t let a positive career opportunity become a negative by failing to prepare yourself for your new role or not having adequate liability coverage. By taking a few steps (see Advancing your career checklist), you can ensure your career stays on track.
Advancing your career checklist
Use these strategies to help avoid possible legal problems related to a career change:
• Ask for a mentor.
• Be sure your orientation is sufficient.
• Read your job description and policies and procedures.
• Review your state’s nurse practice act and any position statements related to your new role.
• Access standards from the ANA and specialty associations.
• Review required and suggested competencies from local, state, and federal organizations and from national associations.
• Conduct a self-assessment to determine what skills you have and what skills you need to develop.
• Ask for help as needed.
• Explore online resources such as websites for associations and boards of nursing. For example, board of nursing websites often have answers to commonly asked questions about scope of practice.
• Notify your insurance provider of any change in role and responsibilities to ensure you have adequate coverage.
• Once you gain some experience, consider becoming certified. Studying for the certification test can help boost your expertise and your confidence.
RESOURCES
American Nurses Association. Nursing: Scope and Standards of Practice. 4th ed. Silver Spring, MD: American Nurses Association; 2021.
CNA, NSO. Nurse Professional Liability Exposure Claim Report: 4th Edition. 2020. www.nso.com/ nurseclaimreport.
American Organization for Nursing Leadership. Nurse Manager Competencies. 2015. www.aonl.org/resources/ nurse-leader-competencies.
L’Ecuyer KM, von der Lancken S, Mallow D, Meyer G, Hyde MJ. Review of state boards of nursing rules and regulations for nurse preceptors. J Nurs Educ. 2018;57(3):134-141. https://journals.healio.com/ doi/10.3928/01484834-20180221-02
New York State Nurses Association. Position statement on floating. 2018. www.nysna.org/position-statementfloating. Sherman RO. The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success. 2021.
Texas State Board of Nursing. 15.23: Nurses engaging in reinsertion of permanently placed feeding tubes. Position Statement. www.bon.texas.gov/practice_bon_position_ statements_content.asp#15.24.
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.
How nurses can counter health misinformation
By Georgia Reiner, MS, CPHRM, Risk Analyst, Nurses Service Organization (NSO)
The wealth of health information available online can be beneficial for patients, but only if that information is accurate. Although recent issues on misinformation have centered on the COVID-19 pandemic, misinformation has been a problem in many other areas related to wellness and healthcare, such as dieting, exercise, and vitamins and supplements. Although misinformation isn’t new, the internet and social media have supercharged the ability for it to spread.
Nurses and nurse practitioners have the power to counteract misinformation, but first, they need to understand the nature of the problem and why people may be inclined to believe information that is not grounded in science.
Misinformation overview
Two definitions help better understand this issue. Misinformation refers to claims that conflict with the best available scientific evidence. Disinformation refers to a coordinated or deliberate effort to spread misinformation for personal benefit, such as to gain money, power, or influence. An example of misinformation is the false claim that sugar causes hyperactivity in children. An example of disinformation is a company that makes false scientific claims about the efficacy of their product to boost sales. This article focuses on misinformation.
People increasingly seek health information online through sources such as search engines, health-related websites, YouTube videos, and apps. Unfortunately, misinformation can occur at all these points, as well as via blogs, social media platforms, and user comments on articles or posts. Even when not actively seeking health information, people can be exposed to it through media outlets such as print, TV, and streaming networks.
Why do people believe misinformation?
Several factors can lead to people accepting misinformation:
Health literacy. Health literacy refers not only to the ability to read and understand health information, but the appraisal and application of knowledge. People with lower levels of health literacy may be less able to critically assess the quality of online information, leading to flawed decision-making. One particular problem is that content is frequently written at a level that is too high for most consumers.
Distrust in institutions. Past experiences with the healthcare system can influence a person’s willingness to trust the information provided. This includes not only experiences as an individual but also experiences of those in groups people affiliate with. Many people of color and those with disabilities, for example, have had experiences with healthcare providers where they did not feel heard or received substandard care, eroding trust. In some cases, healthcare providers have lied, as was the case with the Tuskegee syphilis study of Black men; the men were not told they had the disease or offered treatment. In addition, some people have an inherent distrust of government, leading them to turn to alternative sources of information that state government-provided facts are not correct.
Emotions. Emotions can play a role in both the spread and acceptance of misinformation. For example, false information tends to spread faster than true information, possibly because of the emotions it elicits. And Chou and colleagues note that during a crisis when emotions are high, people feel more secure and in control when they have information—even when that information is incorrect.
Cognitive bias. This refers to the tendency to seek out evidence that supports a person’s own point of view while ignoring evidence that does not. If the misinformation supports their view, they might accept it even when it’s incorrect.
How to combat misinformation
Recommending resources, teaching consumers how to evaluate resources, and communicating effectively can help reduce the negative effects of misinformation. Recommendations. In many cases, patients and families feel they have a trusting relationship with their healthcare providers. Nurses can leverage that trust by recommending credible sources of health information. Villarruel and James note that before making a recommendation, nurses should consider the appropriateness of the source. For example, a source may be credible, but the vocabulary used may
be at too high a level for the patient to understand. And someone who prefers visual learning will not appreciate a website that is dense with text. Kington and colleagues suggest using these foundational principles when evaluating sources:
• Science-based: The source provides information consistent with the best scientific evidence available and meets standards for creation, review, and presentation of scientific content.
• Objective: The source takes steps to reduce the influence of financial and other forms of conflict of interest or bias that could compromise or be perceived to compromise the quality of the information provided.
A proactive approach
Villarruel and James provide the following suggestions for talking with patients about misinformation:
• Acknowledge the barrage of health information that is available online and through other sources and the difficulty of “knowing who and what to trust.” (“I know there’s a great deal of information about COVID-19 and not all of it is the same. Sometimes, it’s hard to sort it out and know what to trust.”)
• Assess where patients and families obtain their health information and what sources they trust. Keep in mind that even when a source is credible, a person may not trust it, and a person may trust a site that is not credible. (“Where do you get most of your information about COVID-19? What makes that a trusted source for you?”)
• Provide alternative and accurate sources of information. (“I’m not familiar with that website, but I’ll look at it and let you know what I think. In the meantime, here’s where I get information and why I trust it.”)
• When correcting misinformation be nonjudgmental. (“I’ve heard similar information about not getting vaccinated. Here’s what I’ve learned from the science and why I believe getting vaccinated is important and safe.”)
Source: Villarruel AM, James R. Preventing the spread of misinformation. Am Nurs J. 2022;17(2):22-26. https://www.myamericannurse. com/preventing-the-spread-of-misinformation/
• Transparent and accountable: The source discloses limitations of the provided information, conflicts of interest, content errors, or procedural missteps.
• Each principle has specific attributes, which are listed in the article available for download at https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC8486420/.
Another tool for evaluating sources of health information is the CRAAP test (Currency, Relevance, Authority, Accuracy, and Purpose), which focuses on evaluating the accuracy of research. It consists of multiple questions in each category (see https:// researchguides.ben.edu/source-evaluation). For a more concise tool, nurses can turn to the algorithm, developed by Kington and colleagues, for assessing the credibility of online health information.
Although the tendency is to recommend government sources such as the Centers for Disease Control and Prevention and National Institutes of Health, as noted earlier, some people do not trust the government. In this case, sources such as MedlinePlus, World Health Organization, and condition-specific nonprofit organizations (e.g., the American Heart Association, American Cancer Society, Alzheimer’s Association) might be preferred.
Education. The sheer scope of the information found online can make it difficult for even the most astute consumer to determine what is accurate. Nurses can help patients by providing tools they can use to evaluate what they read. The website Stronger suggests a four-step process for checking for misinformation (https://stronger.org/resources/howto-spot-misinformation).
• Check the source. Is the website or person known for conflating facts and opinions?
• Check the date. Is it implied that the information is recent even though it’s not? Is there more current information available elsewhere?
• Check the data and motive. What is the original source of the information? Are they just looking for anything that supports their own worldview?
• If still unsure, use a reputable, fact-checking site such as Snopes.com or FactCheck.org.
UCSF Health (https://www.ucsfhealth.org/education/ evaluating-health-information) provides a useful short overview for patients on how to evaluate the credibility (e.g., authors’ credentials) and accuracy (e.g., whether other sources support the information) of health information and red flags to watch for (e.g., outdated information, no evidence cites, poor grammar).
Communication. Communication is the best way to correct misinformation and stop its spread. This starts with the nurse clearly explaining the evidence for recommended interventions. From the start, the nurse should establish the principle of shared decisionmaking, which encourages open discussion.
A toolkit from the U.S. Surgeon General on misinformation (https://www.hhs.gov/sites/default/ files/health-misinformation-toolkit-english.pdf) recommends that nurses take time to understand each person’s knowledge, beliefs, and values and to listen with empathy. It’s best to take a proactive approach and create an environment that encourages patients and families to share their thoughts and concerns (see “A proactive approach”). Nurses should remain calm, unemotional, and nonjudgmental.
Nurses also can prepare for conversations where they know misinformation may occur such as vaccination. For example, the CDC has a page on its website that addresses infant vaccination (https:// www.cdc.gov/vaccines/hcp/conversations/convmaterials.html). It includes resources such as responses to possible questions.
Listening and providing information may not be enough. In some cases, a patient may not want to hear what the nurse is saying. When patients become angry or frustrated, the nurse should remain calm. It can be helpful to acknowledge the frustration (“I can see that you are upset.”) Depending on the situation, it may be possible to briefly summarize key points before reinforcing the desire to provide information to support the patient and then move on to another topic. The goal is to maintain a positive nurse-patient relationship, which leaves the door open to further conversation.
Documentation
As with any patient education, it’s important to document discussions related to misinformation in the patient’s health record. Nurses should objectively record what occurred and include any education material they provided. Should the patient experience harm as a result of following misinformation instead of the recommended treatment plan, this documentation would demonstrate the nurse’s efforts and could help avoid legal action.
A positive connection
Nurses can serve as a counterbalance to the misinformation that is widely available online.
How nurses can counter health...continued on page 20
Providing useful resources, educating consumers, and engaging in open dialogue will promote the ability of patients to receive accurate information so they can make informed decisions about their care.
References
CDC. How to address COVID-19 vaccine misinformation. 2021. https://www.cdc.gov/vaccines/covid-19/healthdepartments/addressing-vaccine-misinformation.html
CDC. Talking with parents about vaccines for infants. 2021. https://www.cdc.gov/vaccines/hcp/conversations/convmaterials.html
CDC. The U.S. public health service syphilis study at Tuskegee. 2021. https://www.cdc.gov/tuskegee/index. html
Chou W-YS, Gaysynsky A, Vanderpool RC. The COVID-19 misinfodemic: Moving beyond fact-checking. Health Educ Behav. 2020;1090198120980675:1-5.
Kington RS, Arnesen S, Chou W-YS, Curry SJ, Lazer D, and Villarruel AM. Identifying credible sources of health information in social media: Principles and attributes. NAM Perspect. 2021:10.31478/202107a. https://www. ncbi.nlm.nih.gov/pmc/articles/PMC8486420/ Kurpiel S. Evaluating Sources: The CRAAP Test. Benedictine University. 2022. https://researchguides.ben.edu/sourceevaluation
Office of the Surgeon General. A Community Toolkit for Addressing Health Misinformation. US Department of Health and Human Services. 2021. https://www.hhs.gov/ sites/default/files/health-misinformation-toolkit-english. pdf
Stronger. How to spot misinformation. n.d. https://stronger. org/resources/how-to-spot-misinformation
Schulz PJ, Nakamoto K. The perils of misinformation: When health literacy goes awry. Nat Rev Nephrol. 2022. https:// www.nature.com/articles/s41581-021-00534-z Swire-Thompson B, Lazer D. Public health and online misinformation: Challenges and recommendations. Annu Rev Public Health. 2020;41:433-451. UCSF Health. Evaluating health information. n.d. https:// www.ucsfhealth.org/education/evaluating-healthinformation Villarruel AM, James R. Preventing the spread of misinformation. Am Nurs J. 2022;17(2):22-26. https:// www.myamericannurse.com/preventing-the-spread-ofmisinformation/
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.
Nurse License Protection Case Study: Administering medication without an order
Nurses and License Protection Case Study with Risk Management Strategies, Presented by NSO
A State Board of Nursing (SBON) complaint may be filed against a nurse by a patient, colleague, employer, and/or other regulatory agency, such as the Department of Health. Complaints are subsequently investigated by the SBON in order to ensure that licensed nurses are practicing safely, professionally, and ethically. SBON investigations can lead to outcomes ranging from no action against the nurse to revocation of the nurse’s license to practice. This case study involves a registered nurse (RN) who was working as the clinical director of a small, rural emergency care center.
Summary
The insured RN was employed as the clinical director of a small, rural emergency care center when they responded to a Code Blue, arriving just as the patient was being intubated. The patient was fighting the intubation, so a physician gave a verbal order for propofol. The RN asked the pharmacy technician to withdraw a 100cc bottle of propofol from the medication dispensing machine and asked another nurse to administer the medication to the patient. Shortly after the other nurse began administering the propofol, the patient’s blood pressure dropped, so the nurse was ordered to stop the propofol infusion.
The patient continued to decompensate and suffered respiratory collapse/arrest. Following some delay, the patient was eventually intubated, then emergently transferred to a higher acuity hospital for further treatment. The patient ultimately suffered anoxic encephalopathy while he was in respiratory arrest.
A recorder was present documenting the Code, and, afterwards, another nurse transcribed the recorder’s notes into the patient’s healthcare information record. The recorder noted that it was the insured RN who advised the pharmacy technician to remove propofol from the medication dispensing machine and instructed a nurse to administer the medication. However, the recorder failed to note that the physician gave a verbal order for the propofol. The insured RN failed to review the notes that the recorder and nurse entered into the patient’s healthcare information record and failed to note this error. The physician who was present during the Code also failed to catch this error in the record.
Approximately six months later, the patient’s family filed a lawsuit against the emergency care center. During a review of the Code record in response to the lawsuit, it was noted that, during the Code, the RN instructed another nurse to administer propofol. However, there wasn’t any indication in the record that a physician had ordered the medication. The emergency care center dismissed the RN from employment and reported the incident to the SBON. The SBON opened its own investigation into the RN’s conduct.
Resolution
While the insured RN denied ordering another nurse to administer propofol without a verbal order from the physician, the RN could not deny failing to ensure that the
propofol administration was documented in the patient's healthcare information record.
The RN entered into a stipulation agreement with the SBON, under which:
• the RN’s multi-state licensure privileges were revoked;
• the RN was required to complete coursework on nursing jurisprudence and ethics, medication administration, documentation, and professional accountability; and
• the RN was required to work under direct supervision for one year and submit quarterly nursing performance evaluations to the SBON.
The total incurred expenses to defend the insured RN in this case exceeded $16,600.
Risk Control Recommendations
• Know the parameters of your state’s nursing scope of practice act, and your facility’s policies and procedures, related to medication administration.
• Only accept verbal drug orders from practitioners during emergencies or sterile procedures. Before carrying out a verbal order, repeat it back to the prescriber. During a Code Blue, be sure to communicate all procedures, medications, treatments to the recorder.
• Review Code Blue records for completeness and process of care after each Code. Report any concerns and provide feedback through proper channels to ensure that any errors in the record or areas of improvement are identified and addressed.
• Document simultaneously with medication administration, whenever possible, in order to prevent critical gaps or oversights.
Disclaimers
These are illustrations of actual claims that were managed by the CNA insurance companies. However, every claim arises out of its own unique set of facts which must be considered within the context of applicable state and federal laws and regulations, as well as the specific terms, conditions and exclusions of each insurance policy, their forms, and optional coverages. The information contained herein is not intended to establish any standard of care, serve as professional advice or address the circumstances of any specific entity. These statements do not constitute a risk management directive from CNA. No organization or individual should act upon this information without appropriate professional advice, including advice of legal counsel, given after a thorough examination of the individual situation, encompassing a review of relevant facts, laws and regulations. CNA assumes no responsibility for the consequences of the use or nonuse of this information.
This publication is intended to inform Affinity Insurance Services, Inc., customers of potential liability in their practice. This information is provided for general informational purposes only and is not intended to provide individualized guidance. All descriptions, summaries or highlights of coverage are for general informational purposes only and do not amend, alter or modify the actual terms or conditions of any insurance policy. Coverage is governed only by the terms and conditions of the relevant policy. Any references to non-Aon, AIS, NSO, NSO websites are provided solely for convenience, and Aon, AIS, NSO and NSO disclaims any responsibility with respect to such websites. This information is not intended to offer legal advice or to establish appropriate or acceptable standards of professional conduct. Readers should consult with a lawyer if they have specific concerns. Neither Affinity Insurance Services, Inc., NSO, nor CNA assumes any liability for how this information is applied in practice or for the accuracy of this information.
Nurses Service Organization is a registered trade name of Affinity Insurance Services, Inc., a licensed producer in all states (TX 13695); (AR 100106022); in CA, MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services, Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency.
Nurse Malpractice Case Study: Administering improper, excessive medication dose and disregard of medication safety
Nurse Medical Malpractice Case Study with Risk Management Strategies, Presented by CNA and NSO
Medical malpractice claims may be asserted against any healthcare practitioner, including registered nurses (RNs). This case study involves an RN working in a home healthcare setting.
Summary
The insured registered nurse (RN) was working for a home healthcare agency. The RN was caring for a 19-year-old female patient who was essentially unresponsive due to malignant neoplasm of multiple sites of her brain. These sites were initially diagnosed when she was 15 years old and resulted in multiple surgical and chemotherapeutic treatments.
The patient was neurologically devastated, non-communicative, had a tracheotomy, and was ventilator dependent. The patient’s prior medical history was extensive and included diabetes mellitus type I, epilepsy/seizures, kidney disease, bowel/ bladder incontinence, cortical blindness, dysphagia, contractures, convulsions, central sleep apnea, paralysis of vocal cords and larynx, obstructive hydrocephalus, hypothyroidism, panhypopituitarism and adrenal disorder.
Most recently, the patient was admitted to the hospital after experiencing atrial flutter and cardiac arrest at home but recovered and had mostly returned to baseline. During her hospital admission, she was placed on Nadolol (a beta blocker) 30 mg twice a day (BID) and Flecainide (an anti-arrhythmic) 25 mg (1.3 mL) BID via gastrostomy tube (G-tube). At discharge, the hospitalist ordered her to wear a transtelephonic Holter monitor to evaluate any additional arrhythmias. Upon discharge from the hospital, the patient was admitted to the home healthcare agency for 24-hour continuous home nursing care. During the home healthcare admission, the mother (patient’s guardian) changed the patient’s code status from a Do Not Resuscitate (DNR) to a Full Code. The mother’s rationale for updating the patient’s code status was her belief that her daughter was now medically stable and had been cancer-free for almost a year. The code status was changed despite the mother being told during the previous hospital admission that the patient’s life expectancy would be less than six months. The home healthcare agency’s admission assessment, completed by the clinical supervisor, noted the patient’s rehabilitation potential to be “poor” and that her overall prognosis was “poor” as well.
The insured RN reported to the patient’s home the morning following the patient’s admission to home healthcare. The RN had cared for the patient previously and was familiar with her medications and daily routines. Prior to starting his shift, the night nurse gave him a report on the patient’s current status and the updated plan of care, including the new medications. The RN correctly noted the new medication orders for Nadolol 10 mg BID and Flecainide 25 mg (1.3 mL) BID via G-tube. At 8:00 a.m., the RN administered routine medications to the patient and performed her morning care. Between 9:45 a.m. and 11:45 a.m., the RN continued to provide routine patient care. At 12:00 p.m., the RN administered Flecainide and Nadolol, as well as other routine medications. However, instead of administering 25 mg (1.3 mL) of Flecainide as ordered, he administered 25 mL, which was approximately 19 times the prescribed dosage.
At approximately 2:00 p.m., the RN identified changes in the patient’s heart rate and vital signs. He noted that the patient was bradycardic with a weak pulse and unable to be aroused. The RN called the patient’s mother at work to report the changes in her condition. The mother advised him to call the patient’s cardiologist about the change. The RN contacted the cardiologist and was advised to call 911 for an ambulance to take her to the emergency department (ED).
When the ambulance arrived, the RN gave a brief report of the patient’s medical history and the medications he had given the patient that morning, which included Flecainide 1.3 mL. At this time, the RN realized that he had administered the incorrect dosage. The RN called the patient’s mother and advised her of the medication error (administering 25
mL of Flecainide instead of 1.3 mL). The RN proceeded to the ED and arrived approximately 10 minutes after the ambulance. The RN informed the ED providers of the medication error, and a serum toxicology test was ordered to confirm the error. The patient was admitted to the intensive care unit, and despite all life-saving efforts, she died soon thereafter.
Following the patient’s death, the mother (plaintiff) filed a lawsuit against the insured RN and the home healthcare agency. The allegations against the RN included:
• Failure to properly administer the correct and prescribed dosage of Flecainide to the patient and a conscious disregard of the known risk of Flecainide toxicity and overdose;
• Administering an improper, excessive dose of Flecainide medication in an amount more than 19 times the prescribed dosage and with a conscious disregard of the known risk of Flecainide toxicity and overdose;
• Failure to review, confirm and/or adhere to the prescribed documentation regarding the medications;
• Failing to confirm and/or verify the correct dosage of Flecainide that was prescribed to be administered to the patient; and
• Failure to adhere to proper policies, procedures, and/or guidelines regarding the administration of prescribed medications to the patient.
Risk Management Comments
The cardiology expert for the defense opined that the life expectancy of the patient was six months or less due to her severe hemodynamic instability. The defense’s neuro-oncology expert testified that there was no chance for the patient’s full recovery due to the extensive treatment of her metastatic cancer and estimated that the patient’s life expectancy was much less than six months.
Irrespective of the patient’s life expectancy, it was determined that defense of the RN would be difficult due to the egregious nature of the medication error.
An additional concern arose that the RN was a poor witness at his deposition. Despite being prepared by the defense team, the RN lacked confidence during his testimony and contradicted himself many times. At one point in the deposition, the RN testified to knowing that he was administering an excessive amount of Flecainide, but proceeded to do so anyway.
Resolution
The plaintiff was represented by a high-powered and aggressive law firm. The defense believed that when a jury learned of the RN’s disregard of medication safety, they may choose to award a large verdict to the plaintiff for the emotional loss of a beloved daughter, despite the patient’s pre-existing, severe condition. Therefore, the decision was made to settle the case on behalf of the insured RN.
The indemnity payment and legal expenses totaled more than $1,000,000. (Monetary amounts represent the expenses made solely on behalf of the individually insured RN and do not reflect payments made on behalf of any other parties who may have been involved in the claim. Amounts paid on behalf of other co-defendants named in the case are not available.)
Risk Control Recommendations
Medication safety has become a highly prominent issue, as national patient safety initiatives focus upon practitioners’ attention regarding the necessity to improve medication management and error reporting processes. However, dispensing and administration lapses, which are often difficult to defend in the event of a malpractice claim, continue to occur. By following the suggested actions, among others, nurses can assist in reducing the liability associated with medication errors:
• Follow established medication protocols. If “work-arounds” persist, consult with the facility’s nursing leadership about opportunities to improve medication protocols and systems, and methods to enhance staff monitoring and compliance.
• Understand that while bar-code scanning can reduce medication errors, this and other medication safety methods are not foolproof. Consistently verify the “six rights” when administering medications to patients:
o Right patient;
o Right drug;
o Right dose;
o Right route;
o Right time; and
o Right documentation
• Know the medication(s) being administered to the patient. While nurses do not prescribe, and only rarely dispense medications, they are responsible for administration. Nurses are the last line of defense to prevent medication errors from reaching the patient. Therefore, they must understand why the patient is taking a particular medication, as well as interactions, side effects, or adverse reactions that may occur.
Medication administration errors represent a significant concern, especially in high stress/high patient acuity locations. Whether in an acute care facility or their own home, patients have the right to safe care. For this reason, nurses must be cognizant of the medications they are administering, their side effects, and the potential drug-to-drug interactions.
DISCLAIMERS
These are illustrations of actual claims that were managed by the CNA insurance companies. However, every claim arises out of its own unique set of facts which must be considered within the context of applicable state and federal laws and regulations, as well as the specific terms, conditions and exclusions of each insurance policy, their forms, and optional coverages. The information contained herein is not intended to establish any standard of care, serve as professional advice or address the circumstances of any specific entity. These statements do not constitute a risk management directive from CNA. No organization or individual should act upon this information without appropriate professional advice, including advice of legal counsel, given after a thorough examination of the individual situation, encompassing a review of relevant facts, laws and regulations. CNA assumes no responsibility for the consequences of the use or nonuse of this information. This publication is intended to inform Affinity Insurance Services, Inc., customers of potential liability in their practice. This information is provided for general informational purposes only and is not intended to provide individualized guidance. All descriptions, summaries or highlights of coverage are for general informational purposes only and do not amend, alter or modify the actual terms or conditions of any insurance policy. Coverage is governed only by the terms and conditions of the relevant policy. Any references to non-Aon, AIS, NSO, NSO websites are provided solely for convenience, and Aon, AIS, NSO and NSO disclaims any responsibility with respect to such websites. This information is not intended to offer legal advice or to establish appropriate or acceptable standards of professional conduct. Readers should consult with a lawyer if they have specific concerns. Neither Affinity Insurance Services, Inc., NSO, nor CNA assumes any liability for how this information is applied in practice or for the accuracy of this information.
Nurses Service Organization is a registered trade name of Affinity Insurance Services, Inc., a licensed producer in all states (TX 13695); (AR 100106022); in CA, MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services, Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency.
Illinois Nurses Foundation Celebrates 8th Annual Emerging Nurse Leader Event
The 8th Annual 40 under 40 Emerging Nurse Leader event recognized 40 outstanding nurses in Illinois under 40. Those who receive the recognition are impacting health care delivery and the nursing profession and will undoubtedly shape the future of the profession.
The Emerging Nurse Leaders Planning planning committee began their review of the nominations in April of this year and awardees were notified in June. As seen since the awards first started, there was an abundance of worthy candidates nominated for the 2022 honors.
Nominations were received from patients, friends, family, coworkers, employers, students, etc. Award recognition recipients reflected leadership success, exemplary leadership qualities, participation in professional associations and community service.
The event was led by INF Vice President Brandon Hauer MSN, RN, CNEcl. The advisory committee team members included Susana Gonzalez MHA, MSN, RN, CNML, Linda B Roberts MSN, RN and Stephanie Yohannan DNP, MA, RN, NE-BC. The planning committee included Brandon Hauer MSN, RN, CNEcl who served as chair and Abby Falbo MSN, MBA, RN, CMSRN, NE-BC, Dan Fraczkowski MSN, RN-BC, Molly Gabaldo DNP, RN, Nate Karch DNP, RN, PCCN-K, Stephanie Mendoza DNP, RNC-OB, C-EFM, Rebecca Murphy DNP, MBA, RN, CNOR, Tiffany Ponder MSN, RN, Kim Ramos MSN, RN, MEDSURG-BC, NPD-BC, Katie Soso MSN, RN, CPSN-R, CNE, ISPAN-F, Kelly Ulrich BSN, RN, Ashley Whitlatch DNP MBA, APRN, FNP-BC.
One of the primary purposes of the 40 Under 40 Award is to engage, support and develop the next generation of Illinois Nurse Leaders. The committee was genuinely moved to have the honor of acknowledging fellow nurses who are known change agents that help shape health care statewide and beyond. Their efforts have served to expand and grow nursing practice as well as to empower our communities. Award recipients were proudly celebrated by members of their own cohort as well as Illinois nursing leaders, and of course their family members.
Next year, this recognition event will take place in Lisle at the DoubleTree on September 21, 2023. Nominations will open in February 2023.
Abraham RN, BSN
Justine Alipio MSN, APRN, ACCNS-AG,
Tintu
CCRN-K
Ashley Anderson MSN, RN, CCRN
Aisha Badla DNP(s), MJHealth Law (s), BSN, RN, CPN
Jinsun Baek MSN, RN, PELCSN, NCSN
Stephanie Bradley MSN, APRN, FNP-BC
Katherine Dato DNP, APRN, FNP-BC
Kateri Evans RN, BSN, MPH
Brandon Hauer MSN, RN, CNEcl
Lisa Lehner RN, MSN, CNOR
Erika Ohlendorf RN, MSN, MBA, CCRN
Rocio Sanchez BSN, RN, PCCN
Camille Brownlee MSN, RN, CNL
Anthony Davila DNP, MBA, RN, CEN
Angelina Fakhoury Siverts MSN, RN
Jasmyn Hernandez BA, BSN, RN
Chase Lodico MBA, BSN, RN, CEN-BCEN
Diana Ortega BSN, RN
Kimberly Swinford RN
Quinn Butler MSN, RN
Tina Decker DNP, APRN, CNS, RN
Patty Fiore BSN, RN, PEL-IL, NCSN
Mathew Huidobro BSN, RN, CCRN
Jenna Maloney MSN, RN, BA, CNL
Wendy Pierce MPH, BSN, RN
Norah Vo BSN, RN, PMH-BC, Pro-Act Professional Assault Crisis Trainer
Brianna Butts BSN, RN-BC, P-MHN, SANE-A, PA SANE
Albertina DiMartino MSN, RN, CMSRN
Marygrace Garcia MHA-INF, BSN, RN
Elizabeth Johnson BSN, RN, CCRN
Dana Merk MSN, RN, CBC
Samantha Rodriguez MBA, MSN, RN
Colleen Wallek MSN, RN, CNL, CMSRN
Colleen Chierici DNP (conferring as FNP May of 2022 via Rush CON), BSN, RN, CMSRN
Erin Dowding MSN, APRN, ACNS-BC, OCN
Tiffany Goralczyk MSN, RN, CNL
Will Jones DNP, RN, CNML, CNL
Craig Minor DNP, RN
Rheannon Rae Rzucidlo MSN, MBA, RN, CNML
Ashley Wittler DNP, APRN, WHNP-BC
NURSING IS MORE THAN JUST A CAREER—IT’S A LIFE OF SERVICE TO OTHERS.
Nurses across Illinois—and across the country—are joining nurse honor guards to commemorate nurses’ service at funerals and memorial services.
Pam Brown, Ph.D., RN, ANA-Illinois member, attended a service with an honor guard and was impressed by the service. “I thought it was a very meaningful way to honor the nurse, and the families were extremely touched by it.”
WHAT IS AN HONOR GUARD & HOW DID THEY START?
Nurse volunteers attend a funeral or memorial service for a nurse who has passed away. They present a short ceremony at the service. The number of volunteers at each service varies but can be as many as the family would like.
In 2002, the Nurses Honor Guard started in Kansas as a way to pay tribute to nurses who lived their lives in service to others through the nursing profession.
“Nursing is a calling, a way of life. Nursing is a service profession that cannot be lived in isolation. Nurses rely on each other for the synergistic effect of teamwork in our efforts of care giving. It is appropriate that we honor our colleagues not only during their career, but also at the end of life’s journey,” writes the Kansas State Nurses Association.
From Kansas, honor guards were formed across the country.
WHAT IS THE TRIBUTE?
Ceremonies vary, but many use “The Nightingale Tribute,” which includes candles, a lamp, poem, and a certificate. Many honor guards dress in ceremonial capes, caps, and gowns for the service.
“The entire tribute takes only a few minutes. It can be placed anywhere within the service, appropriate to the traditions and beliefs of the family,” says Brown.
Part of the ceremony includes this lovely poem:
She Was There
When a calming, quiet presence was all that was needed, She was there.
In the excitement and miracle of birth or in the mystery and loss of life,
She was there.
When a silent glance could uplift a patient, family member or friend, She was there.
At those times when the unexplainable needed to be explained,
She was there.
When the situation demanded a swift foot and sharp mind,
She was there.
When a gentle touch, a firm push, or an encouraging word was needed,
She was there.
In choosing the best one from a family’s “Thank You” box of chocolates, She was there.
To witness humanity—its beauty, in good times and bad, without judgment,
She was there. To embrace the woes of the world, willingly, and offer hope,
She was there
And now, that it is time to be at the Greater One’s side, She is there.
©2004 Duane Jaeger, RN, MSN [Note: pronoun can be changed.]
HOW TO JOIN
Illinois honor guards are organized by counties. Talk to nurses in your area to learn about an honor guard in your county.
“I think one of the telling things is that I’m from Adams County, a small county, and Brown County is even smaller than we are. And yet, those two counties have over 100 volunteers. Nurses are very willing to volunteer in this way. They’re very willing to honor another nurse,” says Brown, who joined the honor guard in Adams County.
ANA-Illinois is hoping to become a statewide resource for honor guards, with a web page on county contact information to help connect nurses to their county’s honor guard.
Brown recently submitted a proposal to ANA-Illinois for grant funding as well. She hopes that honor guards could apply for grant money to purchase lamps, capes, certificate frames, and other items to make the tribute special for families. The Membership Committee is reviewing the proposal and is exploring how ANAIllinois can be a resource for Illinois’ honor guards. Stay tuned!
HOW TO REQUEST AN HONOR GUARD
The funeral home can help work with families to make arrangements for an honor guard.
“Visit with a funeral home director, contact a registered nurse, and you can get in touch with an honor guard,” recommends Brown.
Nurses deserve to be celebrated for their service to others. Including an honor guard at a funeral or memorial service is a meaningful way to pay tribute to all they’ve given to their community and to their profession.
Become a Rush Nurse
Rush Oak Park Hospital received five stars in a quality rating system by the federal Centers for Medicare and Medicaid Services (CMS) and has been named a top teaching hospital by The Leapfrog Group. Rush is one of 36 hospitals to receive this designation, and one of three in Illinois.
Rush nurses are passionate about their work, and their reach extends beyond the hospital to community initiatives and volunteer activities. Our ambitious, focused nursing community is devoted to providing care that’s relevant and responsive to the needs of our patients, community and organization. We truly care, and we make a difference in the lives of everyone we touch.
