texa s nu r s e s .o rg
TEXASNURSING M A G A Z I N E Rediscover
Nursing
Your Distinctive Journey
T N A : E m p o w e r i n g Te x a s N u r s e s t o a d v a n c e t h e p r o f e s s i o n | I s s u e 1 , 2 0 2 2
ISSUE 1, 2022 Volume 96, Number 1 EDITOR IN CHIEF: Cindy Zolnierek, PhD, RN, CAE MANAGING EDITOR: Lisa Maxwell COPY EDITORS: Gabi Nintunze; Hannah Holder
BOARD OF DIRECTORS OFFICERS: Tamara “Tammy” Eades, DNP, MSN, RN, President eades@uta.edu Joyce Batcheller, DNP, RN, NEA-BC, FAONL, FAAN, President-elect jbatcheller7@yahoo.com
4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin, TX 78759-8444 P: 800.TNA.2022 or 512.452.0645; F: 512.452.0648
Colleen Marzilli, PhD, DNP, RN, CNE, NEA-BC, Secretary cmarzilli@uttyler.edu
tna@texasnurses.org | texasnurses.org
MISSION Empowering Texas Nurses to advance the profession
Steven J. Jewell, BSN, RN, CEN, CPEN, USN (ret.), Treasurer jst4jstn@gmail.com DIRECTORS: Patricia Freier, MSN, RN-BC, CPHQ pfreier@covhs.org Lucindra Campbell-Law, PhD, ANP, APRN, PMHNP, BC campbel1@stthom.edu Edtrina Moss, PhD, RN-BC edtrina@comcast.net
VISION Nurses transforming health TEXAS NURSING (ISSN 0095-36X) is published quarterly— Winter, Spring, Summer, Fall—by the Texas Nurses Association, 4807 Spicewood Springs Rd., Bldg. 3, Suite 100, Austin, TX 78759-8444 Periodical postage is paid in Austin, Texas. One-year subscriptions: $25 (nursing schools, libraries, hospitals, non-nurses, out-of-state nurses), foreign $30; single copy $2.50. Subscription is not available to non-member Texas nurses. Some back issues may be viewed online at texasnurses.org. PUBLISHING PARTNER Monarch Media & Consulting, Inc. P: 512.680.3989 or 512.293.9277; F: 866.328.7199 monarchmediainc.com | chellie@monarchmediainc.com Advertising inquiries: call Chellie Thompson at 512.293.9277. TEXAS NURSING is indexed in The Cumulative Index to Nursing and Allied Health Literature and in the International Nursing Index. 16mm, 35mm microfilm, 105mm microfiche, article copies available from University Microfilms International: 1.800.521.3044. Statements of fact and opinion are made on the responsibility of the authors alone and do not imply an opinion on the part of the officers or the membership of TNA. POSTMASTER Send address changes to TEXAS NURSING, 4807 Spicewood Springs Rd., Bldg. 3, Suite 100, Austin, TX 78759-8444. ARE YOU MOVING? Need to change your address? If so, provide it quickly and easily in the Members Only section of the TNA website, texasnurses.org. Or mail your new address—at least six weeks prior to your move— to Texas Nurses Association headquarters. We’ll make sure your TEXAS NURSING makes the move with you. FEEDBACK EMAIL OR LETTER GUIDELINES TEXAS NURSING will select emails/letters on the basis of readership interest and relevance to current nursing/health care events. TEXAS NURSING reserves the right to edit all letters. Guide: Limit to 200 words; focus on single issue; include writer’s name, mailing address, and daytime phone. Send to: editor@texasnurses.org.
Brandon “Kit” Bredimus, DNP, RN, CEN, CPEN, CNML, NE-BC, CENP, NEA-BC kit.bredimus@midlandhealth.org Mary Vitullo, BA, BSN, RN-BC vitullo.mary@yahoo.com CHIEF EXECUTIVE OFFICER: Cindy Zolnierek, PhD, RN, CAE
TNA DISTRICT AND PRESIDENT Dist.1:
Teresa Acosta, RN shadowmon@sbcglobal.net
Dist. 3:
K. Renee’ Yarbrough-Yale, DNP, APRN, ACCNS-AG, CDCES tnad3president@gmail.com; District office: Jamie R. Rivera, JamieRivera@texashealth.org
Dist. 4:
Ruben Castillo, RN, MSN, CCRN, NE-BC 817-229-6478, tnad4.nursingnetwork.com
Dist. 5:
Michael Turturro, MBA, MHSA, MSM, BSN, RN-BC President.TNAd5@gmail.com, tna5.org
Dist. 7:
Lisa Kelly, lisakelly0212@yahoo.com tnadistrict7@gmail.com
Dist. 8:
Donna R. Wallis, MBA, MSN, RN tna8.org
Dist. 9:
Renae Schumann renaeschumann20@gmail.com; District office: Melanie Truong, RN, Executive Secretary, tna9@tnadistrict9.com, tnadistrict9.com
Dist. 17:
Mari Cuellar, NEA-BC, MSN, RN mgrace2329@yahoo.com
Dist. 18:
Janice L. Miller, MSN janice.miller@umchealthsystem.com
Dist. 19:
Anita Lowe, RN alowe@uttyler.edu
Dist. 35:
Karen Koerber-Timmons, PhD, RN, CLNC, CNE, NEA-BC, CCRN, RN-BC mkkoerbertimmons@gmail.com
At-Large: Contact TNA, 800-862-2022, ext. 129 brichey@texasnurses.org
Copyright 2022 © Texas Nurses Association
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NJourneys ursing Distinctive Paths to Nursing Careers
From unexpected turns to nontraditional settings, we learn from nine nurses’ unique journeys as they lend advice for traversing career transitions and finding your calling.
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Contents IN EVERY ISSUE
ARTICLES AND FEATURES
5
11
20
22
PRESIDENT’S NOTES
TNA NEWS What's New and Next
Reflections from My Journey
The Societal Benefits Gained from Associations
It's Not What We Do— It's Who We Are
TNA CEO Cindy Zolneirek Announces her Retirement
8 TNA MEMBER NEWS Kudos and Welcome
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Associations Provide Expertise That Promote Its Members’ Ability to Engage
Read more at texasnurses.org. TNA members receive stories, news, and practice tips every Tuesday in the Check Up e-newsletter. If you haven't been getting your Check Up, see your email spam filter or contact us at tna@texasnurses.org.
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President’s Notes Tammy Eades, DNP, MSN, RN
IT’S NOT WHAT WE DO—IT’S WHO WE ARE Reflections on Nursing AS WE HEAD INTO 2022, I am going to encourage you to take some time and remember why you became a nurse. It is time we take a step back and “Rediscover Nursing.” But to do this we must first reflect on why we became a nurse. Remember the excitement and satisfaction you had in the early days? “Nurses are the heart of healthcare.” – Unknown This quote resonates with me as I think about all my fellow nurses and what they have experienced the past two years and how we keep going in spite of burnout and exhaustion. We do it because we care about our patients and their families. I strongly believe we are the heart of healthcare and without us our patients and families would suffer. Healthcare depends on us. Your professional organizations depend on you to be the nursing voice for your fellow nurses. Now more than ever we need to step up with our professional nursing organizations and let our voices be heard. “Nurses are a unique kind. They have this insatiable need to care for others, which is both their greatest strength and fatal flaw.” – Jean Watson Jean Watson’s statement is so true. There are many needs for nurses: school nurses, educators, telehealth, home health, and many more. If bedside nursing is no longer your calling, then find another nursing career. You have spent too much time, cost, and education to let it go by the wayside. “As a nurse we have the opportunity to heal the mind, soul, heart, and body of
our patients, their families, and ourselves. They may forget your name, but they will never forget how you made them feel.” – Maya Angelou First, we need to stop saying we are “just” a nurse. Instead, proudly say “I AM A NURSE!.” Educating the public about a nurse’s job is extremely important to the nursing profession to prevent misconception. We are the most trusted profession, and we should be proud of that. Sincerely accept gratitude from people because you make a difference. Take advantage of opportunities to promote nursing. Most importantly, do not suppress your enthusiasm about being a nurse. Regarding legislation, we need to communicate to our state and local lawmakers about the importance of maintaining Nurse Faculty Loan Repayment and
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Nursing Shortage Reduction programs. Each year we lose a little more money for support of these critical programs. We need to think outside the box about how we can increase the number of practicing nurses and nursing faculty. Be the nursing voice and get involved to improve our profession. The future holds many opportunities for nurses, so we need to have the foresight to be prepared for what our future as Texas nurses holds. Step up to those challenges. “I am a Nurse. It’s not what I do, it’s who I am.” – Unknown I hope each and everyone of you have a wonderful 2022 and find some time to take care of yourself. Thank you so much for all you. i
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The words you use impact your patient’s health. The evidence is clear. Peer-reviewed studies demonstrate that patient-centered language builds trust, reduces stigma, and increases positive health outcomes. Learn more from evidence-based guidelines, talking points, and videos designed to support you in having productive and satisfying patient conversations at txpmp.org. Sign on before you sign off.
txpmp.org
Foresight, Futures and Innovation TEXA S N URSES
ANNUAL MEETING
ASSOCIAT IO N
2022
Reimagine Nursing
June 24-25 Georgetown, TX
Program
The coronavirus pandemic has caused massive disruption across all aspects of our world. This disruption impacted social, technological and scientific, economic, political, and business domains, accelerating change and innovation in unimagined and unrealized ways. How can nurses capture the opportunity within disruption to envision and create our new, preferred future? This workshop will introduce nurses to the process of foresight (a “systematic, multi-stepped process for discerning, analyzing, and acting on potential futures”) and provide an opportunity to begin imagining possible and preferred futures in practice, education, and policy. Attendees will learn about how foresight informs innovation and about opportunities to engage with American Nurses Association in building a culture of innovation across the profession.
Speakers Honors
DANIEL PESUT, PHD, RN, FAAN
ORIANA BEAUDET, DNP, RN, PHN
Principal Consultant at Strategic Foresight Consulting and Coaching
VP of Innovation ANA Enterprise
THURSDAY, JUNE 23 5:00 – 7:00 p.m.
Welcome Networking Reception
FRIDAY, JUNE 24 7:00 a.m. 8:00 a.m. 11:30 a.m. 1:30 – 4:00 p.m. 5:00 p.m. 6:00 p.m.
Breakfast Buffet Welcome, Daniel Pesut Presentation Annual Meeting and Lunch Presentation, continued Cocktails and Silent Auction Leaders & Ledgends of Texas Nursing Foundation Gala
SATURDAY, JUNE 25 8:00 a.m.
Oriana Beaudet
TNA MEMBER NEWS SPOTLIGHT ON YOU KUDOS Floating on Air It was short notice but when the annual Dallas Holiday Parade came up short on giant balloon handlers, Texas nurses jumped at the chance to help. More than 20 nurse volunteers, including TNA members from districts three and four, alongside family, friends, and colleagues, showed up to shepherd the gingerbread boy and girl balloons and the Dallas Holiday Parade red ball ornament balloon. The parade was held Dec. 4, 2021 in downtown Dallas. Thousands of people attended. Jim Allard, DNP, RN, NEA-BC, FACHE, was selected by the Dallas Business Journal as an honoree for the 2022 Leaders in Diversity Award. The award honors individuals who have shown remarkable commitment to promoting practices in advancing diversity and inclusion within the workplace. Allard is an assistant chief nursing officer serving the Dallas community. Valerie Kiper, DNP, RN, has been named regional dean of the Texas Tech University Health Sciences Center’s (TTUHSC) School of Nursing in Amarillo. Kiper has more than four decades of nursing experience and currently serves as an associate professor of nursing at TTUHSC.
Joell Tadlock, BSN, RN, CCRN, was one of the two awardees selected by the American Nurses Credentialing Center for the 2021 Pathway Nurse of the Year award. Tadlock was recognized for her role as a direct care nurse at Texas Health Harris Methodist Hospital in Stephenville. The following members were recognized by the American Nurses Association: Denise McNulty, DNP, MSN, NE-BC, RN-BC, received the Foundations of Nursing Practice Award, recognizing a registered nurse for outstanding accomplishments in nursing research, education or practice. McNulty is the director for the centers of excellence at the Houston Methodist Willowbrook Hospital. Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, received the Advocacy Award recognizing a registered nurse who embraces the role of advocacy as part of their professional identity. Peck serves as President for the National Association of Pediatric Nurse Practitioners and is a clinical professor at Baylor University Louise Herrington School of Nursing.
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Anumol Thomas, DNP, FNP-C, CCRN, received the Public Health Service Award recognzing exceptional leadership and outstanding professional contributions of
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a public health nurse in shaping the role and advancing the practice of public health nursing. Thomas is a nurse practitioner at The University of Texas at MD Anderson Cancer Center in Houston.
WELCOME TNA welcomes Jack Frazee, J.D., to staff as Director of Government Affairs and General Counsel. He began his legal career in the Texas Legislature where he served as a healthcare policy analyst for Rep. Garnet Coleman. After leaving the Legislature, Jack advised various healthcare non-profits and elected officials on emerging policy issues pertaining to disaster management, drug development, and vaccination programs. His appellate work has received the support of the Texas Attorney General’s Office through amicus briefing and shaped the interpretation of various laws by litigating issues of first impression. He is excited to join TNA and help advance the interests of nurses throughout the state. Frazee is a graduate of the University of Houston Law Center. TNA welcomes Dawn Webb, MSN, RN, PMH-BC to the Director of Nursing Practice and Professional Development role. Dawn is Board Certified as a Psychiatric Mental Health Registered Nurse and has spent her entire career working in the mental health field. Dawn most recently worked as the Program Director for the Texas Peer Assistance Program for Nurses (TPAPN). In her time as Program Director, Dawn made significant changes in the quality of
TPAPN’s programming and implemented changes to turn TPAPN into a valuable resource for the nursing profession. Dawn is an experienced leader and served as RN Supervisor and Chair of the Incident Based Nursing Peer Review Committee at Integral Care, overseeing multiple multi-disciplinary teams, including outpatient mental health clinics, community outreach teams, respite programs and a homeless shelter for veterans. Dawn is a graduate of the University of Texas at Arlington. i
TEXAS PEER ASSISTANCE
PROGRAM FOR NURSES
Volunteer for TPAPN
Twitter: @TexasNursesAssn
Instagram: @texasnursesassociation If you are a TNA member and you’ve been promoted, received an award, or been elected or appointed to a board or community organization, we’d like to hear from you. Please send submissions to editor@texasnurses.org.
Commerce Bank! Unlimited rewards
BECOME A PEER SUPPORT PARTNER
Follow TNA on social media:
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Texas Peer Assistance Program for Nurses (TPAPN) peer support partners provide an empathetic listening ear to TPAPN participants.
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support for nursing in Texas.
Become a peer support partner and start advocating today!
tpapn.org
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The most affordable and effective resource to help you develop a plan and respond to Board complaints against your license. This site is for nurses in ANY STATE and provides videos, advice, suggestions, and downloadable real responses to use as guides in responding to any BOARD COMPLAINT or INVESTIGATION.
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Learn more at texasnurses.org/MemberBenefits
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[CAREGIVER ] CARE FOR THE
Nurses are experts at responding to a crisis. To help nurses in crisis situations, Texas Nurses Association and the Texas Organization of Nurse Leaders created Care for the Caregiver, with the support of Johnson & Johnson.
These easily viewable webinars and resources can help nurses prepare for crisis situations, build resiliency, and recover after a crisis. As the COVID-19 pandemic continues, nurses need to prioritize self-care and understand the signs of posttraumatic stress disorder.
ADVANCE YOUR
EDUCATION. BECOME AN AGGIE NURSE.
PAC DONATION HAVE YOU MET THE $20 CHALLENGE YET? TEXAS NURSE PAC is the officially sponsored political action committee (PAC) of the Texas Nurses Association. We contribute to candidates on both sides of the aisle. Help TNA refresh its financial PAC resources to help candidates who support nursing and health care. If every member donated just $20, we could have a fighting chance at the Capitol!
Give at texasnurses.org/PAC. nursing.tamu.edu
Contributions to TEXAS NURSE PAC are not deductible as charitable contributions for federal tax income purposes.
TEXAS @tamunursing
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TNA NEWS WHAT'S NEW AND NEXT SAVE THE DATE!
TNA REPRESENTS YOU!
Mark your calendar for the following TNA events!
In the past quarter, TNA represented you with:
June 24−25, 2022
TNA Annual Meeting
TEXA S N URSES
ANNUAL MEETING
ASSOC IATIO N
2022
FORESIGHT, FUTURE & INNOVATION Sheraton Hotel and Conference Center Georgetown, TX
Learn a new model for future thinking and help envision a better world for nurses with futurist Daniel Pesut, PhD, RN, FAAN and learn hear from your national association. Join us at the annual business meeting to hear updates on finances, policy and programs and give input on issues that are moved forward through TNA's policy development process.
The American Nurses Association › › › ›
HRSA Focused Discussion on the Nursing Workforce RWJF/CCNA Campaign for Action Texas Center for Nursing Workforce Studies › › ›
Leadership Summit ANA Policy and Nursing Practice Statement of Racial Reckoning Feedback Board of Directors
COVID-19 Survey Task Force Workplace Violence Survey Task Force Quarterly Advisory Committee
Health and Human Services › › › › ›
Workplace Violence Grant Program Quarterly Quality Provider Committee Value-Based Payment Quality Improvement Advisory Committee Texas Health Steps Advisory Panel Governor’s EMS and Trauma Advisory Council
REGISTER TODAY!
Get more information and register: www.texasnurses.org/mpage/AnnualMeeting
Texas Board of Nursing Board of Directors Texas Hospital Association APRN Alliance TxANA Convention Texas Public Health Coalition Steering Committee Texas Association of Deans and Directors of Professional Nursing Programs
Texas State of Reform Conference
You can also purchase tickets to the Leaders and Legends Awards gala event recognizing some of the most influential nurses in Texas history.
If you have received: Letter of Investigation from the Texas Board of Nursing Notice of Peer Review
Joyce Stamp Lilly RN JD Registered Nurse and Attorney
713.759.6430 jslilly@me.com www.nurse-lawyer.com
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NJourneys ursing Distinctive Paths to Nursing Careers Compiled by Gabi Nintunze and Hannah Holder
We talked to nurses whose careers have taken an unexpected turn, or who practice in a nontraditional setting, to learn more about their nursing journeys. We asked them about the effects of the pandemic, future plans and to weigh in on transitions in nursing careers.
DAWN WEBB, MSN, RN, PMH-BC PROGRAM DIRECTOR, TPAPN Nursing is a second career for me. Prior to nursing school, I worked as a substance abuse counselor and case manager. When I decided on nursing school, my initial goal was to work as an operating room nurse. All those episodes of Grey’s Anatomy made it look exciting, but after passing out during my OR clinical I quickly decided the OR was not for me. Later, as I experienced other clinicals, I realized that my experience and skills as a counselor made me a great psychiatric nurse, and because I had specialized in substance abuse, working in a detox unit was a natural fit. After working in detox and on psychiatric units, I moved into a role as a community-based nurse at a local mental health organization. I started my MSN in Nursing Administration, worked my way into a managerial role, and opened a clinic that serves individuals experiencing homelessness, addressing both physical and mental health. I began supervising multiple clinics and a homeless shelter across the city. I found that I
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was skilled at building relationships and serving as a mediator in difficult situations, so as I got closer to completing my MSN I began looking for a role that checked all those boxes. Becoming Program Director at TPAPN has brought all my skills together: my love for leadership, my understanding of the Nursing Practice Act (NPA) and nursing laws and regulations, my experience with and compassion for individuals experiencing substance use disorder or mental health conditions, and my ability to build relationships and mediate when necessary. The pandemic has brought out the hero in nurses, but it has also shone a light on the issues nurses face on the job, including the stresses that lead to burnout. It has exhausted an already stressed nursing workforce, causing some nurses to question their career choice. Some nurses have left to try something new, some have retired, and others feel stuck in their current job despite feelings of extreme stress and fatigue. I wish I had known how important overall wellness is for nurses when I entered the field. It is one factor to consider when choosing a career specialization, along with personal growth, new skills, advancement, compensation, and more. It is important to keep in mind that all nurses are taught a basic set of skills that can be transferred across many specialties and job settings. The basic skills nurses are taught pave the way to changing specialties or seeking a new job. Though it may be a challenge, the foundation is already set. There are an abundance of opportunities and resources to help nurses determine the next steps in their career journey. An excellent place to begin is by viewing the nursing specialties listed on the Johnson & Johnson website, which may help narrow down choices.1 The American Nurses Credentialing Center provides certification testing for different specialties and lists the resources available to learn about the specialty and the skill set needed for each certification. Many nurses would be surprised the number of skills they possess that apply toward certification qualifications or would help them get their foot in the door to start on the journey to a new specialty and future certification. When looking to change specialties or seek a new career path, be sure to identify skills that are transferable to the new position or specialty of interest. For example, skills learned from working in the Intensive Care Unit can easily be transferred to pre- or post-operative settings, such as a dialysis unit or plasma donation center. Some transitions are just a matter of on-the-job training and utilizing current nursing skills. Keep in mind the high demand for nurses and identify organizations that are willing to train nurses in a new specialty area while paying competitive wages. Being a nurse is more than a job. By its nature it can become overwhelming, even without a pandemic. But with some exploration and planning you can find the role that best fits your needs now, taking into account your mental and physical health, professional growth, work-life balance, compensation, personal fulfillment, life experiences, and more. There are many paths to consider—which is the right one for you? Editor's note: after providing this story, Dawn added a new chapter to her career by accepting the Director of Practice role at TNA.
DEANNA COCHRAN, RN END-OF-LIFE DOULA, TRAINER In my second semester of nursing school I was bored enough to stop— then I had the opportunity to shadow a hospice nurse. Quality of life was paramount to her, and I admired the way she would think about how to support her patients. At one point, she took me on a trip to Home Depot with her to build one of her patients an occupational therapy tool by hand. She would get ideas that she thought would help and then follow through with them, no matter how crazy they might seem. She was my hero. There were two other major influences on my career. The first was my homebirth with my daughter. The midwives changed the way I thought of mothering, saved my and my daughter’s life, and profoundly impacted me. It was a beautiful, healing experience, and I believe we need that same kind of healing at the end of life.
“My goal (and my calling) was to help reduce suffering before the end of a patient’s life.” – DEANNA COCHRAN The second was my mother’s terminal cancer. I worked in hospice for fifteen years and when she became ill, I was able to support her. My experience taught me the importance of both a curative plan and a palliative care plan, so that patients don’t suffer while trying to heal and live. My goal (and my calling) was to help reduce suffering before the end of a patient’s life. I took several years building my end-of-life care practice – focusing on getting the word out through public education, through blogging and so on—and the more I put myself out there, the more people wanted to know what I was doing and how I was doing it. I had people asking me to train them, and I thought, “There’s no way I can do that. I’m not at that level.” There was no board, no certification process—I didn’t even have a master’s degree. A friend reminded me that I was already doing the work and asked me why I would say no to something that I considered my purpose. So, I took my years as a palliative consultant, all the non-medical parts of what I had been doing, and started my first program in 2010. I ultimately built the premiere education program for end-oflife doulas in the U.S. I teach certified healthcare professionals about death, dying, and associated services; and I teach nonmedical professionals how to accompany these people, how to be there as a supportive, practical, advocative presence. I teach them how to dive into themselves, to explore the parts that need healing—just like those midwives did for me—so that they can be empowered as I was to provide healing for others, to aspire to that responsibility, and to enable them to be their own advocates. The National Hospice and Palliative Care Organization (NHPCO) got involved early with me, recognizing that doulas can contribute to the care that hospices provide. In the mid-2010s, they invited us to have an end-of-life doula advisory council. I served
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as their chair for two and a half years and focused on teaching hospices how to use doulas in their practice. Now we have two entities working to establish professional standards and teach hospitals how to use doulas in the healthcare industry: the NHPCO and the National End-of-Life Doula Alliance (NEDA), of which I am a founding member. There are all kinds of professions that can and have benefited from what we do: attorneys, insurance agents, chaplains, psychotherapists and more that are using this expertise, and bringing the things they learn through our training into their practice. The more people are out there being advocates, the more we can push for end-of-life social change. The more we do that, the more people die well.
ERIN PEREZ, DNP, APRN, ANP-C, AGNP-C, ACHPN CITY COUNCIL WOMAN, LIVE OAK, TX I didn’t always want to be a nurse. My mother has been disabled most of my life, with many surgeries, treatments and care in between. After being the family nurse at such a young age, I didn’t want to pursue nursing, but God had other plans for me. It was nurses who helped me learn and understand how to help care for my mother. Then it was a nurse practitioner who inspired me when she cared for my daughter in the prenatal care unit. The nursing care model is holistic: good at listening, addressing problems, as well as bringing solutions. During the Texas winter storm last year, we needed people with a public health background because most government leadership is just that—government leaders. There need to be nurses at the table because a nurse can bring forth a different perspective. Nurses are uniquely suited to be in public office with their experience in the nursing model of care and team collaboration.
One in 44 voters is a nurse. Given how many nurses there are in Texas, we should have more representation in office. It’s not about political parties, it’s about the nursing party. Nurses can be a voice of change in various roles—from city council to Congress, or any public leadership role. I was thinking about running for office for a few years before COVID-19, but that gave me the push to be there to serve as a voice of reason and science for my community. During my campaign, there was a strong group campaigning against me claiming that I was overqualified because I was a public health provider. There was divisiveness over COVID, with the same group hosting large gatherings with no masks and going against what public health officials advised during that time. Nonetheless, I ended up winning by 60% of the vote. After I assumed a seat on city council, I attended a beginner leadership conference. I learned a lot about innovative programs for business owners in Texas, and realized how NPs could benefit from the information discussed. It has been beneficial
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as a nurse to pause and discuss before making decisions that affect the community, because a city council member has a powerful voice. My goal is to keep the Live Oak community beautiful, healthy, and prosperous for generations to come. I have been looking into a Master of Jurisprudence program with an emphasis in health. I would love to entertain the idea of being a state representative in the House or Senate one day. In leadership and politics, we must get more nurses in office, more nurses in our Capitol who know what it means to provide better public health. Texas healthcare consistently ranks low nationwide; if we had more nurses at the Capitol, we would have a healthier and more physically sound state. One in 44 voters is a nurse. Given how many nurses there are in Texas, we should have more representation in office. It’s not about political parties, it’s about the nursing party. Nurses can be a voice of change in various roles—from city council to Congress, or any public leadership role.
SHANNON MCKEOWN, APRN, FNP-C CORRECTIONAL NURSE I was looking for a better schedule, pay, and benefits while working as a paramedic when a friend told me about a medical department inside the Denton County Jail. Correctional medicine is a microcosm of the larger health community, designed to meet the unique needs of incarcerated persons. Correctional nursing practice includes aspects of emergency practice as well as routine care such as acute minor illnesses and management of chronic illnesses including psychiatric conditions. There are also specialty clinics, such as those focused on gynecology or infectious diseases. There are daily medication rounds, attention to wound care, and anything else that people must access in the community—just in the confines of a jail.
I originally thought of correctional health as a small entity meeting basic needs, but quickly realized that this was a complex, multidimensional healthcare operation. EMS was a great place to start, but I soon realized that nursing was the next logical step. After talking with several nurses working in the correctional health department and making my own inquiries into the profession, I found the nursing process and core values resonated with how I believe patient care should be accomplished. I was able to go back to school with the help of a tuition reimbursement plan through Denton County and received my Associate of Science in Nursing. Later, I decided to advance my education further and enrolled into a family nurse practitioner program at Texas Woman’s University. I’m now working with Denton County Public Health as a family nurse practitioner in their primary care clinic and continue to see patients at the Denton County Jail on a weekly basis. I originally thought of correctional health as a small entity continued on page 16
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continued from page 14 meeting basic needs, but quickly realized that this was a complex, multidimensional health care operation. The experience in the correctional health field has been invaluable. Being a frontline nurse in the correctional facility has allowed me the opportunity to hone my assessment and treatment skills. Incarcerated patients generally have more complex medical and psychological conditions than those found in the regular community; sometimes due, in large part, to undertreated or undiagnosed medical or psychological problems. I plan on continuing my nursing career in the public health field for years to come, as well as venturing into rural healthcare services.
CITY COUNCILMEMBER, WINDCREST, TX I’ve been a nurse for more than 40 years. Currently, I use my expertise as a part-time faculty member in a vocational nursing program and as a city council member in Windcrest, Texas. I married before I finished nursing school, and the idea at the time was that I would be a refrigerator nurse—I would work enough to put food in the fridge. Boy was I naïve! Even now, most of the nurses I know are breadwinners regardless of what their spouse does. I began my career as a staff nurse in critical care. My first position outside of bedside was as a unit educator, leading orientation for new nurses and the clinical side of the internship program. I moved from unit education to management because I was frustrated by the limits of my authority as an educator. I went into management and administration to make things better for the nursing staff. If the staff is happy, the patients are happy; if the patients are happy, the physicians are happy.
When we moved to Windcrest in the late 2010s, I got involved in city council meetings and a few committees. My work in compliance and TNA’s government affairs committee kept me busy, but I took a break of a few months from my position and had more time on my hands. I ran for a council seat because I was frustrated by the lack of progress by the council members that preceded me. I saw them tabling simple issues and not getting as much done in the community as they could have. I wanted to make a difference in my city. My husband and I grew up in a small factory town; if your parents didn’t work at the factory, they worked in the school district, and there was a strong sense of community. We don’t have that anymore, so you find other ways to bring people together, whether by amenities, public events or something else. My hope is that I can help my town hold onto the things we’re proud of—like our annual Christmas Light Up, that brings around two thousand cars a night through our area. From candidates who assumed that nurses became nurses only on their way to becoming doctors, to those who recognized my expertise—“You had me at I’m a nurse!”—I am reminded that, just like at beside, it’s not what we’re trying to teach patients but what they’re ready to learn. It takes longer than you expect it to, but change can and does happen.
Around that time, I became involved in TNA and other professional organizations. I was active with the TNA Government Affairs Committee and interviewing politicians on their stance and support of issues that affected nurses and nursing.
I ran for a council seat because I was frustrated by the lack of progress by the council members that preceded me. I saw them tabling simple issues and not getting as much done in the community as they could have.
CHASITY SHAW, RN, BSN, MSN (C) CLINICAL DOCUMENTATION IMPROVEMENT SPECIALIST
At the time, politicians were less clued in to what it meant to be a nurse—one candidate said that he was sure that most of the nurses there one day wanted to become doctors. I remember looking around at my colleagues—some of them faculty members with doctorates—thinking, wow. That person really had no clue. I’m glad to say that now, the candidates tend to know much more about healthcare and nurse issues, and that’s thanks to TNA and individual nurses’ activities in and around politics.
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network within your nursing associations, but also within the places you work—other people, other departments. Learn from the people around you and keep your perspectives open. That’s how I ended up becoming a compliance officer. At the time, I was the vice president of nursing at a hospital. We had a compliance department and I thought it sounded interesting. I got a master’s in business instead of nursing to be bilingual—I could speak to doctors and nurses, and to people in finance, lawyers and other compliance officers.
CINDY STRZELECKI, MBA, RN, BSN
Being a part of professional associations across my career led not only to education, but also to career and networking opportunities. That’s one thing I recommend to newer nurses—
“I’m glad to say that now, the candidates tend to know much more about healthcare and nurse issues, and that’s thanks to TNA and individual nurses’ activities in and around politics.” – CINDY STRZELECKI
I was a critical care nurse for five years and a travel nurse for about three. Normally, when you get a travel contract, you work in your specialty position. But from mid-2020 on, it was COVID-19. I was a “COVID nurse” now: it became my unofficial specialty. I loved travel nursing because of being able to explore new places, but once COVID hit, you didn’t really get to experience the new places you went to, you were just there to work. I knew that I wanted to dip my toes into other areas of
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nursing, and I was already in graduate school for my MSN. Last summer I took a medical leave of absence due to the way my mental health was impacted by the things I was seeing while working bedside. At that time, Delta was the dominant variant, and we were losing patients who had been otherwise young and healthy. It happened over and over again, to the point where I realized that it was my mental health and wellbeing versus staying in the ICU. I chose to leave.
There’s a different kind of mental stamina required for digging and investigating through charts; the learning curve is different, and I feel like a better nurse doing it because I have the time to dig into a diagnosis, to learn something new and then apply that clinical knowledge when communicating with physicians.
Amusement Park Recreational Camps Cruise Ship or Yacht Offshore Oil Rig Professional Sports Movie and Television Sets Large Corporations
What did we miss? Let us know about your unique nursing journey: editor@texasnurses.org.
can; it’s just a matter of finding your new niche and what can make you happy. I wish I had known that this position existed when I was in nursing school. Instead of feeling backed into a corner by a crisis, scrambling to figure out my other options, I might have had a plan. I’ve noticed that a lot of social media channels now are talking about more options for nursing, but you still find in nursing culture the idea that, if you’re not at bedside, you’re not a “real” nurse; that your work may not be as important or as valued. That stigma needs to be broken. Nurses can be in leadership, in a board room, in a field or a hospital: you are still a nurse.
LOREE LACHANCE, DNP, MHA, RN, NCSN SCHOOL NURSE I began my nursing career in labor and delivery in 1989 while in Maryland, then switched to school nursing in 2003 when I was in Illinois. Prior to then, I spent much of my career working nights and as a pro re nata due to my husband’s military career, moving about every three years or so. One night in Illinois, I noticed an opening for a school nurse position down the road from my home.
Now, I’m a clinical documentation improvement specialist. I’m essentially a bridge between coders and physicians. My job is to translate a patient’s medical records so that it’s clear and concise for the purpose of coding. That data is then used for reimbursement, but also for research and other avenues of care. It makes for a clear clinical picture of why that patient was hospitalized and what their care team did for them. I work from home, and one of the biggest surprises was the shift in work-life balance. That, along with a shift from hourly to salaried, means that some workdays are longer than others, but I also get to do it in sweatpants. It’s also a different kind of mental challenge. This job requires me to be on my toes and work on my critical thinking skills. There’s a different kind of mental stamina required for digging and investigating through charts; the learning curve is different, and I feel like a better nurse doing it because I have the time to dig into a diagnosis, to learn something new and then apply that clinical knowledge when communicating with physicians. Most of my colleagues have decades more experience than I do. When I applied for my current position, I didn’t think I would get it, but I did! It was proof—especially for younger nurses— that you are not stuck at the bedside, or suffering through any position you don’t want to be in. With your license, degree, and expertise, there is so much you can do. The question isn’t if you
After transitioning to school nursing, I joined the National Association of School Nurses (NASN) and signed up for their mailing list. I talked with several newly hired school nurses to find out what challenges they had when they stepped into the position. I read the policies, procedures, and journals, and asked the district nurse questions. I signed up for professional development related specifically to school nursing and negotiated with my administration to be able to attend local, state, and national school nursing conferences. I used the same strategies when moving to Texas in 2011 to continue as a school nurse. I’m still learning and searching out ways to become a better school nurse leader. When I started nursing, I was only focused on my practice in relation to my care, one patient at a time. My position now means I must consider my practice on a broader scale. The most significant challenge to my expectations about school nursing was the level of clear communication needed at every level of practice, at every interaction and patient touchpoint.
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When I started nursing, I was only focused on my practice in relation to my care, one patient at a time. My position now means I must consider my practice on a broader scale. The most significant challenge to my expectations about school nursing was the level of clear communication needed at every level of practice, at every interaction and patient touchpoint. There have been times when I’m tired of the requirements of the pandemic, especially considering the complicated nature of health, education, business, and politics, but I have not yet considered being done with school nursing. We all have those days where we want to quit, but my passion for this specialty has remained strong enough to get me to the next day and the next challenge.
to provide them with proper medical care so that when they leave our facility, they will be in a healthier state. The pandemic has affected how we handle patients, especially those who are presumed or confirmed positive with COVID-19. We’re wearing more personal protective equipment and taking extra precautions. In the clinical aspect we must be more vigilant of patient signs and symptoms with COVID such as their oxygen saturations and breathing. Once I finish up my FNP, I plan to work in rural areas to help provide care to people who don’t have the same access as those who live in urban areas.
CHRISTINE ROBERTS, MSN, RN, PCCN ASSISTANT PROFESSOR I began my nursing career as a nurse tech in the progressive care unit (PCU), then became a registered nurse upon graduation. I worked in the PCU until I transferred into the education department as the PCU telemetry professional development specialist. I worked in education for three years, but transferred back to the PCU as a bedside nurse to complete my Master’s in Nursing Education at the University of Texas
I completed my Doctor of Nurse Practice with a leadership focus on school nursing in May 2021 and started a School Law Certification program so I may be a more effective school nurse and advocate for students, families, and community. I’m driven to help others see the value of school nursing as I do, as a connector between inpatient and outpatient healthcare, and to positively affect educational and other social outcomes.
SHANNON SPRABARY, RN, BSN, EMTP, CCHP CORRECTIONAL NURSE
at Arlington (UTA).
I’ve been working at a correctional facility for 22 years now, first as a paramedic and then as a correctional nurse for the past three years. I was already in the correctional field, but I wanted to focus on the nursing aspect. I did a paramedic-registered nurse bridge program to become a RN. Being a paramedic helped me understand the pharmaceutical side, as well as the hands-on clinical aspect in an emergency setting. The biggest difference between paramedicine and nursing is learning all the nursing theories. My job as a paramedic was more emergency-focused, compared to my current work which is more theory and evidencebased in practice. When you’re a paramedic, you’re limited to what you can do, whereas nursing provides more clinical care.
Mental illness is a big concern in the correctional setting as a third of our population is on mental health medications. It is more challenging when you’re working in a correctional environment because it is a completely different environment than traditional bedside nursing. Mental illness is a big concern in the correctional setting as a third of our population is on mental health medications. Patients receive proper medical care and treatment; however, they could often benefit more from an inpatient treatment center. A lot of the patients that come to jail have had little to no medical care, and it is our job
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When I started my clinical practicum hours at UTA, I found a similar fulfillment with the new nursing students in the lab and clinicals. I was lucky to be offered a job after my practicum as a clinical instructor teaching the same lab and clinicals I worked on during my practicum. It was such a natural transition, being able to combine both loves of nursing and academia. Seven years later, I continue teaching as a clinical instructor for that same course I once took at UTA.
I’m getting to share my love for patient care with future generations of nurses while they begin their journey into the profession during nursing school. I always knew I wanted to work in education someday; I loved being a preceptor to new graduate nurses and a mentor to the nursing students when they visited on their clinical rounds. I wanted to help bring change to nursing school and make improvements for future students. However, I was not ready to completely leave bedside nursing after being offered the clinical instructor position. It took six years and a pandemic to make me re-evaluate my life and priorities to make the full transition away from bedside after juggling both jobs. I am fortunate to get to work with post-COVID patients in a
“Squash the beast”—the little voice inside their head that gives them fears, worries and doubt. The sky is the limit with nursing; don’t be afraid to branch out or try something new. – CHRISTINE ROBERTS
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long-term acute care facility with my students during clinicals. This helped with my transition guilt after switching from bedside nursing to academia. I’m still at bedside, just in a different way now. I’m getting to share my love for patient care with future generations of nurses while they begin their journey into the profession during nursing school.
You Care.
Make it a career.
I frequently tell my students to “squash the beast”—the little voice inside their head that gives them fears, worries and doubt. The sky is the limit with nursing; don’t be afraid to branch out or try something new.
CASE MANAGER, TPAPN I started my career in the hematology and oncology unit. I found it fascinating because of the connections you develop with your patients. It’s sad to work on the cancer floor, but you want to be there for your patients, especially if they don’t have family with them during those difficult moments. When a psychiatric unit opened in my area, I jumped at the opportunity. Psychiatric nursing is all about the brain and mind. The brain is probably the most fascinating organ in the body. It’s our computer for thinking, moving, body regulating and processing emotions. When the brain isn’t well it can cause distress, disease or conditions that affect one’s whole self. Caring for those who have a need for mental health or substance use support is very rewarding when you’re able to see someone who is at rock bottom reach all the way to the top.
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The biggest elephant in the room around discussing mental health is stigma. I first learned about TPAPN in nursing school, and after learning more about what TPAPN and TNA do, I thought it would be a great opportunity to help nurses. I started working as a case manager with TPAPN before the pandemic hit. It was an eyeopening experience to realize that mental health and substance-use issues are just as prevalent among nurses and physicians as in the general population. Those who are taking care of others need help too. My position made me realize that the biggest elephant in the room around discussing mental health is stigma, and my goals are to educate nurses about stigma and to eventually create a wellness series about reaching out for help, learning to place boundaries, and seeing a counselor. I want other nurses to know that it’s okay to investigate other avenues of nursing. If you’re working in a position you find stressful, it’s okay to find another position without feeling like you must give up on your career due to the pandemic. Don’t give up: Nurses can go anywhere. i REFERENCES 1. Nursing specialties: Johnson & Johnson Nursing. Discover Nursing. (n.d.). https:// nursing.jnj.com/specialty
Get Involved BECOME AN ISSUE ADVISOR Find a way to engage that works for you! Issue advisors are TNA members who volunteer their time for short opportunities. You could be an expert on a topic, have lived experience, or simply have a personal interest. Previous issue advisors have helped create policy documents, write practice articles, or develop mobile content. Volunteer for what you are comfortable with. Think that TNA has missed an opportunity to address a particular health issue, nursing practice topic, or a social issue? Tell us, and help us meet your needs and the needs of the modern Texas nurse.
We hope to work with you very soon! texasnurses.org/involved
2. The American Board of Nursing Specialties (ABNS). (n.d.). 2020 ABNS Nursing Specialty Certification Board Survey. https://www.nursingcertification.org/ resources/Documents/research/infographic.pdf Deanna Cochran, RN – Palliative Care Consultant, End-of-Life Doula Trainer, “Death Doula”
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Reflections from my journey… “What lies behind us and what lies before us are tiny matters compared to what lies within us.”
TNA CEO Cindy Zolneirek announced her retirement beginning in March of 2022 after serving in the position since 2013.
THIS QUOTE, attributed to Ralph Waldo Emerson (and others) has always been a favorite of mine as it speaks to opportunity and possibility. As I prepared to write this reflection, I looked back on my experiences with TNA and was not all that surprised when I found that I referred to this quote in my first presentation to TNA’s House of Delegates in 2014 as we transitioned into a World Café considering the future of TNA. That event launched an iterative strategic planning process resulting in a mission focused on policy that empowers nurses, new committee structures engaging of hundreds of nurses, new opportunities for districts, and unprecedented membership growth. TNA is now the largest state nursing organization and constituency of the American Nurses Association. We are just shy of 16,000 members.
These are not my achievements. They are TNA’s—accomplished through members and staff. In 2014 we spent a year crafting a strategic plan for the organization that would ensure our relevancy. We established a new committee structure, including a Policy Council that would appoint committees to do the deep thinking and develop policy positions, value statements, and issue briefs to inform our responses to issues and enable us to engage in policy issues as never before. By involving issue advisors in this work, we extended opportunities for nurse involvement from a few dozen to several hundred! We added committees to advise our awards process, communications strategies, nursing professional development offerings. We implemented new options and resources for districts to support their success.
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We ensured a nursing media presence during two infectious disease incidents – Ebola in 2014 and most recently COVID-19 with hundreds of interviews. Media relationships are now central to our strategic plan, ensuring that the most trusted profession is available and responsive to media inquiries about health matters. Communications is a critical function of TNA—for our members and the public. We have elevated the quality of Texas Nursing (have you noticed?), utilizing member submissions and stories. We launched a weekly newsletter, TNA CheckUp, and established active Facebook, LinkedIn, Instagram, and Twitter accounts to disseminate information and engage nurses. A library of podcasts is also available. We continue to support nurse professional development as an accredited
provider of NPD (CNE) by the American Nursing Credentialing Center and offer regular education through our Nurse Talks, Nursing Peer Review, and Texas Peer Assistance Program for Nurses programs as well as on-demand education through the TNA Learning Curve. In 2017, TNA purchased a building to be a forever home for the association. This investment enables us to control our operational costs as well as secure nondues revenue to support association work (because we are able to lease out approximately 50% of the building).
“…within us.” Within TNA is the incredible power of nurses—the most trusted profession—to lead the way to better care and better health for all. I believe in you, and I trust you to move us forward. Thank you for the opportunity to join you on this journey as TNA CEO for the past eight years.
When I interviewed for this position, I was asked, “This position comes with a power base—how will you use it?” I remember responding that I hoped to contribute to and better the practice of nursing and the profession. I hope I have accomplished that intent. “…within us.” Within TNA is the incredible power of nurses—the most trusted profession—to lead the way to better care and better health for all. I believe in you, and I trust you to move us forward. Thank you for the opportunity to join you on this journey as TNA CEO for the past eight years. i
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THE SOCIETAL BENEFITS GAINED FROM
Associations By Jack Frazee, JD
CONSIDER THE FACT that in our representative democracy, elected officials are selected from all walks of life. Your representative or senator, prior to their election, may have been an exterminator, a public-school teacher, a lawyer —all professions with little or no training in evidence-based health care. These same people are then asked to consider complex questions about how we ought to design our public health systems and policies. That is a significant task, and in the democratic system we foist it upon people with skills that sometimes do not match the assignment. To make informed decisions about these issues, elected officials rely on input from people with specialized knowledge. Specialized knowledge is difficult and time consuming to obtain. We invest time, money, and our professional reputations in the pursuit of it. And for our system of government to work, we must find ways of consistently sharing this knowledge with elected officials when they are considering specialized issues. This is the power of professional associations like TNA. Through association, members create an institution that can present their collective knowledge to elected officials when elected officials
YOUR PROFESSIONAL CONDUIT The association provides expertise that promote its members’ ability to engage elected officials, seek relief from societal problems, and participate in the political process. need it most. When associations share knowledge with elected officials, there is no benefit to being rude, aggressive, or hostile. The association therefore serves a moderating function in an otherwise combative political dialogue. For people who find the political system too coarse, meanspirited, and vindictive, their professional association is a means of engaging in more reasoned discourse. Moreover, there is an inherent benefit to the public when we create institutions that share high quality information on specialized issues with elected officials, because otherwise, elected officials would lack the resources necessary to make informed decisions. Elected officials don’t have to be stupid to make poor choices; even intelligent
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people can be ill informed. There’s simply not enough time to become an expert in everything, and so we all rely on one another to make better choices as a collective. The association serves another important function: Much like elected officials may lack knowledge of nursing and evidence-based medicine, nurses may lack knowledge of the political and legal systems. These systems, like the practice of medicine, require study, experience, and the accumulation of knowledge to navigate effectively. The association provides expertise that promote its members’ ability to engage elected officials, seek relief from societal problems, and participate in the political process. The freedom to associate and participate in government is rooted in the First Amendment of the Constitution of the United States of America, which protects “the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.” By exercising this right, Texas nurses promote good government and the public’s interest in an effective healthcare system. i
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ALLMAN & ASSOCIATES, INC. CERTIFIED PUBLIC ACCOUNTANTS INDEPENDENT AUDITORS' REPORT OPINION: In our opinion, the financial statements referred to [in the audit] present fairly, in all material respects, the financial position of the Texas Nurses Association, Inc., as of June 30, 2021, and the changes in its net assets and cash flows for the year then ended in accordance with accounting principles generally accepted in the United States of America.
Current members can log in to view the audit at texasnurses.org/aboutus.
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