Texas Nursing 2021 Issue 3

texa s nu r s e s .o rg

TEXASNURSING M A G A Z I N E NO TURNING BACK — NURSING MOVING FORWARD

THE INTERIM, THE FUTURE: HEALTHY ENVIRONMENTS — PROFESSIONALLY & ECOLOGICALLY

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 3 , 2 0 2 1

ISSUE 3, 2021 Volume 95, Number 3 EDITOR IN CHIEF: Cindy Zolnierek, PhD, RN, CAE MANAGING EDITOR: Kanaka Sathasivan, MPH COPY EDITORS: Serena Bumpus, DNP, RN, NEA-BC and Gabi Nintunze

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

Nelson Tuazon, DNP, DBA, RN, NEA-BC, CENP, CPPS, CPHQ, FANP, FACHE, FAAN, Treasurer Nelson.Tuazon@uhs-sa.com

MISSION Empowering Texas Nurses to advance the profession

DIRECTORS:

Patricia Freier, MSN, RN-BC, CPHQ pfreier@covhs.org

VISION

Lucindra Campbell-Law, PhD, ANP, APRN, PMHNP, BC campbel1@stthom.edu

Nurses transforming health

Edtrina Moss, PhD, RN-BC edtrina@comcast.net

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

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.

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

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.

Dist. 17: Mari Cuellar, NEA-BC, MSN, RN mgrace2329@yahoo.com

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.

Dist. 35: Karen Koerber-Timmons, PhD, RN, CLNC, CNE, NEA-BC, CCRN, RN-BC mkkoerbertimmons@gmail.com

Copyright 2021 © Texas Nurses Association

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Dist. 18: Janice L. Miller, MSN janice.miller@umchealthsystem.com Dist. 19: Anita Lowe, RN alowe@uttyler.edu

At-Large: Contact TNA, 800-862-2022, ext. 129 brichey@texasnurses.org

CORRECTIONS In Texas Nursing 2021 Issue 2 on Pages 10 and 11, Lorenza “Lori” Guerrero was incorrectly listed twice, once as “Lorry Guerrero” and once as “Lorenza Guerrero.”

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The 2020-2030

FUTURE

Stormy Session Produces Wins and Losses for Nursing

Report

Outcomes of the 87 th Texas Legislature

OF NURSING Implications for Texas Nurses

10

12

The Fight for HEALTHY Environments

ONE MEMBER, ONE VOTE:

19

Outcomes of the 2021 House of Delegates

16

Contents IN EVERY ISSUE

FEATURES

5

14

22

PRESIDENT’S NOTES

Looking Forward: Policy and Relationships

Nurse Wellbeing After COVID

Stay the Course and Carry On

6

Interim Work for TNA

The Urgent Need for a Cultural Shift in the Workplace

TNA MEMBER NEWS Kudos, In Memoriam and Appointments

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Read on the Go: View this issue and past issues of Texas Nursing in the Texas Nurses app for iPhone and Android. Sign in with your TNA login for free access.

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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A moment checking the PMP could save a lifetime.

As of March 1, 2020, Texas prescribers are required to check the PMP prior to prescribing opioids, benzodiazepines, barbiturates, or carisoprodol. To comply with the mandate, prescribers must document in the patient’s medical record that they checked the PMP. Help end this crisis. Sign on before you sign off.

txpmp.org

President’s Notes Tammy Eades, DNP, MSN, RN

STAY THE COURSE AND CARRY ON Changes, Progress, and Momentum

HAPPY SUMMER! We said goodbye to our board members that ended their term on June 30, 2021. Past President Jeff Watson, Secretary Amy McCarthy, Treasurer Gail Dasher, and Board Directors Melinda Hester, Donna Wallace, and Tina Cuellar. Thank you for your service!

We welcomed our new board July 1, 2021: President-Elect Joyce Batcheller, Secretary Colleen Marzilli, Treasurer Nelson Tuazon, and Board Directors Patty Freier, Lucindra Campbell-Law, Kit Bredimus, Mary Vitullo, and Edtrina Moss.

Welcome and congratulations!

Also, a huge congratulations to former Secretary Amy McCarthy for being elected to the ANA Board of Directors and Nelson Tuazon for being elected to the ANA Nominations and Elections Committee! These Texas Nurses representing the profession on the national stage will continue to move the profession forward.

Many of you may know that I was in the Navy Reserves (Navy Nurse Corp) for several years and picked up military terms like “Carry On.” In the days of sailing, the officer of the deck was attuned to the slightest change in wind and would let the sailors know when sail could be added to ensure the fastest progression.

A good breeze meant the officer would give the order to “Carry On,” or hoist every bit of canvas possible to make the best use of the circumstances.

“Carry On” does not mean that nurses will stop fighting or accept the status quo.

We need to hoist every bit of our voice to take care of our nurses, and we need to “Stay the Course,” another term often used in the military, that means to continue forward to the end. We have the 87th

Legislative Session in our rearview mirrors, as well as COVID-19 vaccines widely available, and now is the time for us to Stay the Course and Carry On being the nursing voice in Texas.

Even though regular session is over, we can set our heading towards visiting our legislators in our hometowns to speak up about nursing concerns. Health care issues are changing constantly, and we need to be looking ahead and moving our sail to ensure the fastest headway to our legislators. Our GAC committee is hard at work with our liaisons and legislators, but we need each and every one of you to Stay the Course and Carry On. We also need nurses taking care of our nurses. Now is the time to get nurses on boards. If you are not on a board, please consider applying to one. You can make a difference at the local level. We also need more nurses in elected office. Even serving on a library or school board brings nursing awareness to front. We have great momentum behind us from COVID, and this is the time for nurses to keep on the course and carry the goodwill forward.

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In addition, with the tremendous work we accomplished with personal protective equipment, proactive safety guidelines, and sanitation, we cannot lose our pace or fall back until we win the marathon against COVID. We may never get back to what we knew as normal and will likely always be cautious with safe distancing, hand hygiene, and staying well. Regardless, nurses will be ready for the next headwind that comes our way.

Lastly, we are seeing a tremendous amount of nursing burnout. We must take care of ourselves and our fellow co-workers. You make a difference. We need each and every one of you. It’s hard to “Carry On” when you are burnt out. Take some much needed time for yourself. When you see your fellow colleagues getting burnt out, see what you can do to help them. Get away and enjoy Mother Nature at its finest.

I wish you all a nice, safe summer. Please take time for yourselves. You deserve it.

Stay the Course and Carry On. Tammy i

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TNA MEMBER NEWS SPOTLIGHT ON YOU KUDOS Peggy Luna, DNP, RN, NEA-BC, has been named chief nursing officer of Lake Granbury Medical Center. Luna is an experienced healthcare leader, serving in many nursing leadership roles over the past 27 years. Most recently, she was vice president of Critical Care Services at Baylor, Scott & White Health in Temple.

Modern Healthcare named Mary Robinson, PhD, RN, NEA-BC, one of 2021’s Most Influential Clinical Executives in the United States. Robinson is the senior vice president and chief nursing officer of Reliable Health at Texas Health Resources. The prestigious recognition honors leaders deemed by their peers and the senior editors of Modern Healthcare to be paving the way to better health through their executive responsibility, leadership qualities, innovation, community service and achievements inside and outside of their organizations. Barclay Berdan, FACHE, chief executive officer of Texas Health Resources said: “During the COVID-19 pandemic, Mary was unwavering in her commitment to safe, quality care; the mental health and well-being of nurses; and the need to consider the patient experience in every decision.”

Denise Neill, PhD, RN, department head and director at A&M Commerce School of Nursing, was recognized as a Notable Nurse of East Texas in May 2021. Neill is part of the second cohort of Notable Nurse of East Texas Nurses being recognized by TNA District 19.

Christian Page Owen, MSN, RN, CEN, doctoral student at Cizik School of Nursing at the University of Texas Health Sciences Center at Houston, is one of 75 Jonas Scholars selected from 49 universities nationwide for the 2021-2023 cohort.

Jonas Philanthropies is a leading national philanthropic funder of graduate nursing education. The Jonas Scholars at Cizik School of Nursing are made possible by a grant from Jonas Nursing and Veterans Healthcare. Each $15,000 grant will be matched by Cizik School of Nursing.

Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAAN, received the prestigious AANP State Award for Excellence. The award is comprised of two separate awards for clinical practice and advocacy and is granted annually to deserving nurse practitioners (NPs) and NP advocates.

Susan D. Ruppert, PhD, RN, FNP-C, ANP-BC, received the Minnie Stevens Piper Professor award. Ruppert is associate dean for graduate studies at Cizik School of Nursing at the University of Texas Health Science Center at Houston, where she is also a PARTNERS Endowed Professor in Nursing.

Ten Piper Professors are selected each year from among educators nominated by colleges and universities throughout Texas. Each receives an honorarium in recognition of their effectiveness and dedication to teaching. Ruppert is the first Cizik School of Nursing faculty member to be honored.

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Eloisa Tamez, PhD, RN, FAAN, professor of nursing at the University of Texas Rio Grande Valley, is a newly appointed member of the national advisory board to aid veterans. Tamez, who is a veteran and former chief nurse executive at various Department of Veterans Affairs Medical Centers, will serve on the U.S. Department of Veterans Affairs Advisory Committee on Disability Compensation.

TNA’s outgoing Board Secretary, Amy McCarthy, MSN, RNCMNN, NE-BC, was elected as Director-atLarge of the American Nurses Association (ANA) during their July 2021 Membership Assembly. McCarthy is director of Nursing, Women, and Infants Specialty Services at Parkland Hospital.

She ran for office on a platform of fostering creativity and innovation to improve work environments for nurses.

TNA Board Treasurer Nelson Tuazon, DNP, DBA, RN, NEA-BC, CENP, CPHQ, CPPS, CPHQ, FANP, FACHE, FAAN, was elected to the American Nurses Association Nominations and Elections Committee. Tuazon is vice president and associate chief nursing officer at University Health System in San Antonio; he is also the founding chair of the San Antonio Nursing Consortium, which brings together nursing organizations in an innovative new collaborative model.

More Member News on page 8

UTA has debuted a new graduate certificate program focused on health care of older adults.

You Care.

Make it a career.

n n n

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New higher starting salaries for RNs Health and retirement benefits Paid vacation leave and up to 15 paid holidays a year Shift differential pay

COLLEGE OF NURSING AND HEALTH INNOVATION

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Contact a recruiter at healthcareers@hhsc.state.tx.us

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We offer predictable work schedules, set caseloads and an excellent benefits package, including:

Tailor to meet your needs in areas such as advanced clinical management, health policy, or population health.

PROTECT YOUR PRACTICE A TNA Member Benefit

At Texas Nurses Association, one of our priorities is helping nurses protect their practice. It’s why we advocated for laws like Nursing Peer Review. It’s also why we’ve had a longtime partnership with Nurses Service Organization (NSO).

NSO LIABILITY INSURANCE NSO is the largest provider of nurse malpractice insurance in the country.

NSO helps you defend your license in case of a lawsuit, and 96% of people with a claim recommend them. The strenuous circumstances of COVID-19 mean nurses are asked to handle more patients than ever before, putting you at greater risk.

Don’t be caught without protection.

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Member News continued from page 6

KUDOS Fellows of the American Academy of Nursing The American Academy of Nursing has selected 225 distinguished nurse leaders to be inducted into the 2021 Class of Fellows. The inductees will be recognized for their significant contributions to health and health care at the Academy’s annual Health Policy Conference, October 7-9, 2021, offered in a hybrid format. The newest fellows represent 38 states, the District of Columbia, and 17 countries. Congratulations to the TNA Members who were selected.

Fedricker Diane Barber, PhD, ANPBC, AOCNP, FAANP – MD Anderson Cancer Center

Adelita Cantu, PhD, RN – UT Health San Antonio

Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE – Wambi

Valerie Danesh, PhD, RN, FCCM – Baylor Scott & White Health

Wyona Freysteinson, PhD, MN, RN – Texas Woman's University

Donna Scott Tilley, PhD, RN, CA, SANE – Texas Woman's University

Cara C. Young, PhD, RN, APRN, FAANP – The University of Texas at Austin

Pat Cochran, MSN, RN, TNA District 13 member, passed away in April 2021. Her nursing accomplishments included stints as an ICU nurse at McCuistion Regional Medical Center and St. Joseph’s Hospital. She later served as an instructor at the Paris Junior College nursing program followed by a position as coordinator of the University of Texas at Arlington BSN program. Her last nursing endeavor was the community liaison for the NIH Children’s study.

Please send member news (e.g., promotions, awards, board or committee appointments) to editor@texasnurses.org.

PROGRAM FOR NURSES

Volunteer for TPAPN

BECOME A PEER SUPPORT PARTNER Texas Peer Assistance Program for Nurses (TPAPN) peer support partners provide an empathetic listening ear to TPAPN participants.

Start advocating today!

tpapn.org

Bright outlook.

Beautiful setting.

IN MEMORIUM Mary Louise Waddill, PhD, RN, passed away on June 11, 2021, at the age of 90. Waddill became the educational secretary of the Board of Nurse Examiners for the State of Texas, now the Texas Board of Nursing, in 1973 and was appointed as the executive director of the Board of Nurse Examiners in 1987, where she served until her retirement in 1995. Waddill served with many professional nursing organizations including various National Council of State Boards of Nursing Committees (NCSBN). Under her tenure, the NCSBN named the Texas Board of Nursing the Most Outstanding State Nursing Regulatory Agency in the US. She also held membership in the Executive Women in Texas Government and was a Trustee of the Graduates of Foreign Nursing Schools Board.

TE X A S PEER ASSISTANCE

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Our fresh perspective comes from our recent affiliation with Dignity Health, which will allow us to scale best-in-class clinical services, build our team of top providers and bring even more innovative medical technologies and treatments to Yavapai County to effectively serve and advocate for all people.

For your lifestyle, Prescott offers a beautiful setting with four mild seasons, clear and sunny skies, stress-free commutes and recreational opportunities as limitless as your imagination. We’re one of the “Happiest and Healthiest Places to Live,” according to Time.

• We offer a variety of full-time regular RN positions • Generous relocation package • Some seasonal opportunities (13 weeks) are still available Ready to learn how you can thrive as an RN on our team? Visit our site for all the details and to apply.

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careers.yrmc.org/creative/nursing

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Now more than ever, UT Austin nurses are leading the way in the fight against deadly diseases such as COVID-19 through treatment, vaccinations and research. You, too, can transform health care as you enrich your career with a graduate or post-master’s degree or teaching certificate from The UT Austin School of Nursing.

Master of Science in Nursing (FNP, PCPNP, PMHNP, CNS, Leadership in Diverse Settings)

Post-Master’s (FNP, PCPNP, PMHNP, CNS) Acute Care Pediatric Nurse Practitioner program — New!

Doctor of Nursing Practice

Certificate in Teaching Nursing — New!

Doctor of Philosophy in Nursing

For more information on programs and application deadlines, visit nursing.utexas.edu/graduate or call 512-471-7927

The 2020-2030

FUTURE

OF NURSING

Report

Implications for Texas Nurses

By Cindy Zolnierek, PhD, RN, CAE, and Serena Bumpus, DNP, RN, NEA-BC

ON MAY 11, 2021, THE FUTURE OF NURSING Campaign for Action, a joint initiative of Robert Wood Johnson Foundation and AARP, celebrated the release of a consensus study from the National Academy of Medicine (NAM): The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.1

HEALTH FOR ALL

Texas Team was relaunched in Spring 2021 utilizing a collaboration framework which aligns organizational expertise, desired outcomes, and strategies to accomplish shared objectives.4 This model is especially well suited to the first recommendation of the report, which calls for (national) nursing organizations to “initiate work to develop a shared agenda for addressing SDoH and achieving health equity.”

The report released this year is the third in a series of reports produced by NAM, with previous reports being published in 2011 and 2016.2,3 The previous reports have served as a blueprint for the nursing profession and charted a path for nurses to improve the health of people, strengthen the nursing workforce, and increase capacity of nursing education.

need to place a heavier emphasis on addressing health equity and workforce development.1 The goal is to achieve health equity in the United States through expanding the knowledge and expertise of the nursing workforce.

While the third report continues to focus on promoting a culture of health for all, the COVID-19 pandemic highlighted the

The report outlines key areas to meet this goal, including the nursing workforce, leadership, education, nurse well-being,

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emergency preparedness and response, and social determinants of health (SDoH) and health equity.

The next ten years will require all of us to think differently, but that process starts now. The new report provides us with a blueprint to lead the charge and improve the health of our nation.

The 2020-2030 FON report also has implications internally for TNA, starting with the inclusion of a health equity and SDoH lens on all the work we do. Members can already access published Texas Nursing articles and online practice tips on fighting inequality and promoting social justice.

COALITION REVIVAL Texas Nurses Association (TNA) is taking initial steps to dissect the report and begin shaping organizational priorities around the charges listed in the report.

This will include engaging our board of directors, policy committees, and individual members to consider the best approach to incorporating diversity, equity, and inclusion discussions.

The Texas Team Action Coalition—a partnership of diverse stakeholders sponsored by the Texas Nurses Foundation with Blue Cross Blue Shield—came together in 2011 to address the recommendations of an earlier report The Future of Nursing: Leading Change Advancing Health. On the heels of the 2021 report, Texas Team is now organizing around new recommendations.

Texas Team was relaunched in Spring 2021 utilizing a collaboration framework which aligns organizational expertise, desired outcomes, and strategies to accomplish shared objectives.4 This model is especially well suited to the first recommendation of the report, which calls for national nursing organizations to “initiate work to develop a shared agenda for addressing SDoH and achieving health equity.”

EQUITY AND BEYOND The 2020-2030 FON report also has implications internally for TNA, starting with the inclusion of a health equity and SDoH lens on all the work we do. Members can already access published Texas Nursing articles and online practice tips on fighting inequality and promoting social justice. In addition, our 2020 panel discussion Perspectives on Nursing from the Black Community is available for anyone to view on Facebook or listen to in the Texas Nurses podcast.

TEXAS TEAM CONVENER: Texas Nurses Foundation

ADVISORY COUNCIL: Pat Yoder-Wise, EdD, RN, co-chair

access to equitable care. With the help of issue advisors, TNA’s Policy Council published a value statement and issue brief on Race and Social Justice this past spring, as well as a value statement with forthcoming issue brief on GenderAffirming Health Care. Several of the other policy publications also include an equity lens and framing around the SDoH. In addition, the Education and Workforce Committee is considering a recommendation resulting from a statewide summit sponsored by the Texas Board of Nursing and Texas Organization for Nursing Leadership to explore how SDoH can be incorporated into school curricula.5 Finally, at its July meeting, the TNA Board considered commissioning a task force on diversity, equity, and inclusion to facilitate further work in this area.

Ray Perryman, PhD, co-chair Jeff Watson, DNP, RN Joyce Batcheller, DNP, RN Cindy Zolnierek, PhD, RN

ORGANIZATIONAL MEMBERS: Texas Nurses Association: Tammy Eades, DNP, RN Texas Board of Nursing: Kathy Thomas, MN, RN Texas Organization for Nursing Leadership: Jane McCurley, DNP, RN Texas Organization of Baccalaureate and Graduate Nursing Education: Stephanie Woods, PhD, RN Texas Organization for Associate Degree Nursing: Jennifer McWha, PhD, RN

Please keep an eye out for more information coming coming soon, including opportunities for members to contribute. i

Texas School Nurses Organization: Karen Schwind, MSN, RN

REFERENCES

Texas Nursing Student Association: Danny Diaz

Committee on the Future of Nursing 2020–2030.

(2021). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. National Academies of Sciences, Engineering, and Medicine.

1

Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. Institute of Medicine.

2

3 Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine Report The Future of Nursing: Leading Change, Advancing Health (2016). Assessing Progress on the Institute of Medicine Report The Future of Nursing.

Institute of Medicine.

4

Collaboration Multiplier. (n.d.) Prevention Institute.

5 Texas Organization for Nursing Leadership & Texas Board of Nursing. (2020). The Future of Nursing in Texas: Moving Stakeholders Toward Alignment.

Texas Nurse Practitioners, Emily Eastin, BA

American Psychiatric Nurses Association: Audrey Voss, MSN, RN National Black Nurses Association of Central Texas: Mack Parker, LVN National Association of Hispanic Nurses – Texas Chapter It’s Time Texas: Ben Clutter, BA Texas Health Institute: Ankit Sanghavi, MPH Leading Age Texas: George Linial, MPH Texas Department of State Health Services: Angel H. Angco-Barrera, MBA, BSN, RN Texas Public Health Nursing Section of APHA: Lynette Williams, BAN, RN

Beyond education for nurses, TNA is also advocating for all Texans to increase

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Stormy Session Produces Wins and Losses for Nursing Outcomes of the 87 th Texas Legislature

By Kevin C. Stewart II, JD, and Catherine White

THE 87TH TEXAS LEGISLATURE CONCLUDED May 31 with very little accomplished.

It was a difficult legislative session all around given the pandemic, a restrictive budget, and the fallout from winter storm Uri. However, there were some bright spots this session and, while the scope of issues addressed in the Special Session that started July 8 was limited, Texas nursing organizations continued to advocate for pertinent issues.

BILLS, BILLS, BILLS While many bills died in process, some important bills made it through the Texas Legislature to Gov. Abbott’s desk. On the telemedicine and telehealth front, the legislature passed HB 4, which took

effect immediately when Gov. Abbott signed it on June 15. The bill instructs Texas Health and Human Services Commission to reimburse for more telemedicine and telehealth services generally and specifically instructs the agency to allow home telemonitoring and audioonly behavioral health services.

SB 437, signed into law on June 16 and effective immediately, requires the Department of State Health Services to create a reserve of personal protective equipment for health care workers. Finally, HB 133, signed June 15 and effective Sept. 1, extends Medicaid coverage to women for 12 months after delivery or miscarriage.

The advanced practice registered

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SB 437, signed into law on June 16 and effective immediately, requires the Department of State Health Services to create a reserve of personal protective equipment for health care workers. nurse (APRN) death certificate bill (HB 4048) was one of the few APRN bills that made it through both chambers and was signed by the governor on June

15. It became effective immediately.

Finally, the school nurse asthma bill (HB 3819) made it all the way through the House, and then the Senate committee, but time ran out before it could be heard on the Senate floor.

Despite very few bills making it across the finish line to the governor’s desk, the progress nursing legislation made this session is notable. Nurses had strong allies at the capitol and advocates across the state who fought for them.

PROGRESS, FAILURE, CONTROVERSY While many nursing-specific bills did not pass—like the full practice authority bill (HB 2029)—almost every bill on the Nursing Legislative Agenda Coalition’s (NLAC) agenda made it farther along in the process than ever before. The workplace violence bill (HB 326) made it all the way through the House, as did the Nursing Faculty Loan Repayment Program flexibility bill (HB 546).

Despite very few bills making it across the finish line to the governor’s desk, the progress nursing legislation made this session is notable. Nurses had strong allies at the capitol and advocates across the state who fought for them.

Following the end of session, disappointment over the lack of progress in the legislature caused outcry from many organizations and groups looking to state lawmakers for help on a variety of concerns facing Texas. Additionally, Gov. Abbott publicly called out the legislature for not passing the omnibus election and bail reform bills. He retaliated with a line-item veto of Article 10 of the budget, which funds the legislature and its employees.

Some Texas House Democrats and legislative staff responded by filing a petition with the Texas Supreme Court to override Gov. Abbott’s recent veto. A

group of Democrats then later fled the state to prevent a quorum for a vote on a voter restrictions bill, after which Gov. Abbott promised more special sessions for his agenda.

ENGAGEMENT, ADVOCACY, EDUCATION The regular legislative session may be over, but Texas nurses have plenty of work to do engaging their state senators and representatives to educate them on the importance of passing legislation like a workplace violence bill to protect nurses at work or full practice authority so APRNs may practice to the full extent of their education.

Misinformation about some nursing issues spread around the Capitol this session during testimony, and, as many of the legislators who attended TNA’s 2021 virtual Nurse Day at the Capitol said, state lawmakers need the expertise and guidance of their nursing constituents when legislation that impacts the profession comes up.

The 2022 elections are also looming and it looks like there will be some changes in the Senate as some major politicians, like Sen. Jane Nelson, won’t seek another term. TNA’s Government Affairs Committee (GAC) and District GAC Liaisons will be contacting state legislators and those campaigning for state office in 2022, to find out where they stand on nursing issues and educate them to dispel misinformation.

The regular legislative session may be over, but Texas nurses have plenty of work to do engaging their state senators and representatives to educate them on the importance of passing legislation like a workplace violence bill to protect nurses at work or full practice authority so APRNs may practice to the full extent of their education.

Texas nurses interested in getting more involved in legislative advocacy are encouraged to reach out to their TNA District GAC Liaison or email governmentalaffairs@texasnurses.com.

There are also plenty of resources on TNA’s website, including materials on legislative issues, podcasts about nursing policy, and an Advocacy Toolkit to help nurses that are new to grassroots activism. Stay tuned to NurseWatch on the website (texasnurses. org/NLAC) or Twitter (@txnurseslege) for the latest legislative and regulatory updates and action, as well as opportunities to improve nursing in Texas. i

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Looking Forward: Policy and Relationships Interim Work for TNA

WHILE THE 87TH REGULAR SESSION of the Texas Legislature concluded in May, legislative activity is far from over as the governor called a special session and hinted at another. While Texas Nurses Association (TNA) will continue to look for opportunities to advance our priorities as the legislators meet, most of our attention over the next year will be focused on policy development and strategy for the 2023 session and beyond.

The Government Affairs Committee (GAC) finished a busy year advising TNA on strategy with weekly meetings during the regular legislative session to stay abreast of political dynamics affecting our agenda. Now, during the interim—the period of time between the conclusion of one legislative session and the commencing of the next—our work shifts to the Policy Council.

POLICY AT TNA TNA’s Board of Directors selected Secretary Colleen Marzilli, PhD, DNP, MBA, RN to chair the Policy Council and will appoint members to that committee in August. The Policy Council will meet this fall, consider emerging policy issues of interest to nursing, and appoint members to the Workplace Advocacy and Practice, Regulation and Practice Authority, and Education and Workforce Committees.

As the Policy Council prioritizes issues, they may commission special task forces to support committee work or address a specific issue. Through task forces and ad hoc groups, issue advisors contribute by researching, advising, and authoring policy documents.

While Policy Council and committee members are formally appointed, any member can volunteer as an issue advisor to share their expertise, lived experience, or passion through a micro-volunteer opportunity that works around their schedule.

Learn more and sign up at texasnurses.org/involved.

RELATIONSHIPS AT THE CAPITOL The interim is a critical time for GAC members and liaisons to build relationships with legislators in their legislative districts— that is, developing grassroots advocacy. Members will be interviewing their senators and representatives about their views on health care issues and advising the Texas NURSE PAC Board regarding financial contributions.

In addition, during the interim, the Speaker of the House and the Lieutenant Governor, chair of the Senate, identify priorities to be addressed and charge committees with addressing these priorities. TNA works with legislators to get our interests included within the priorities and, if not included, we look for opportunities to insert ourselves by offering related testimony

The Policy Process: HOW TNA DEVELOPS POSITIONS Hundreds of Texas nurses contribute The TNA Board of Directors (BoD) appoints members to Policy Council (PC) and Government Affairs Committee (GAC) and approves final policy positions. BoD selects former PC and GAC members for wisdom councils to provide mentorship.

PC: Vets and approves positions for consideration and final approval by the BoD, determines how committee and workgroup efforts should be enacted (legislative, regulatory, position or statement changes). Committees draft positions with input from issue advisors and Doctor of Nursing Practice student fellows. Small workgroups tackle focused topics and develop member materials.

GAC: Takes positions from PC and enacts them into policies at the state level. District and at-large liaisons communicate local priorities to the GAC and GAC priorities back to local members. Members can take action in their communities to enact local policies and meet with their representatives during the interim.

TNA Board of Directors

Association action

Local priorities and action

Individual action, grassroots advocacy

Governmental Affairs Committee

Policy Council

State priorities and action

Standing committees

NURSE PAC

District and at-large liaisons

Workgroups and issue advisors

Workgroups and issue advisors

Policy Creation

Members

Policy Enaction © Texas Nurses Association 2021

to committees addressing areas related to our interests.

All Texas representatives and about half of Texas senators will be running for re-election this year. One in 44 nurses is a registered voter, so this is a great opportunity for nurses to contact their

legislators or candidates, introduce themselves, offer to be a resource, and inform them of policy matters important to you.

If you have a personal story—share it! Find more advocacy resources at texasnurses.org/policy. i

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ONE MEMBER, ONE VOTE: REFLECTING BACK TO LOOK FORWARD Outcomes of the 2021 House of Delegates

Visit texasnurses.org/House to view recordings of the 2021 House of Delegates, including:

HOD proceedings

President Tammy Eades’ annual address

Chief Executive Officer Cindy Zolnierek’s year-end report

Treasure Gayle Dasher’s financial report

ORIGINS OF THE HOUSE In 1979, Texas Nurses Association (TNA) members gathered at the brand-new Lowes Anatole Hotel in Dallas for the association’s annual convention that included days of educational sessions as well as the annual business meeting.

Only members attending the annual business meeting had the opportunity to vote on resolutions and bylaws amendments and elect board members and representatives.

The group adopted 17 resolutions, including approving the decertification of TNA as a collective bargaining representative, supporting mandatory continuing

We look forward to implementing and finetuning this new—but also traditional—model of governance with all our members. education for nurses, supporting legislation that would define standing orders, and directing districts to assess the level of health care available to incarcerated Texans and inform TNA so appropriate standards could be recommended to cities, counties, and the state.

Members also passed six bylaws amendments, specifically creating a House of Delegates (HOD). The HOD model was recommended by TNA’s auditing firm to ensure the association had a governing body that afforded every member a proportionate vote. A House of Delegates governing structure was deemed an equitable way for the association to conduct business.

TRANSFORMATION OF GOVERNANCE The world has changed since the HOD model was implemented over 40 years

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ago. Currently, around 85-90% of the Texas nursing population is located within 27 population centers. Where TNA once had 35 active districts, we now have only 11 plus one at-large district. Nurses no longer need to attend a meeting in person to get the latest information.

Finally, TNA has experienced an exponential increase in the number of nurses wanting to be directly involved.

Responding to these shifts in membership, TNA led delegates through a guided workshop at the 2019 House of Delegates that allowed groups to put forth their own ideas about governance. The overwhelming results of the workshop were to move away from the delegate structure to a one-member, one-vote structure.

This new structure was codified and voted in at the 2021 HOD, held virtually on Saturday, June 12. While the bylaws now dictate TNA hosts an annual business

This new structure was codified and voted in at the 2021 HOD, held virtually on Saturday, June 12. meeting and that all members will have the opportunity to vote, details of the annual meeting need to be established.

TNA hosted a meeting with district leaders on July 31 to begin dialogue regarding future opportunities and the important role of districts in local engagement.

Conversations with district leadership will be incorporated into a plan for the board of directors to consider.

We look forward to implementing and finetuning this new—but also traditional—model of governance with all our members. Hope to see you there at the first annual meeting in Spring 2022.

RESOLUTIONS PASSED BY THE 2022 HOUSE OF DELEGATES Read the full resolution text at texasnurses.org/house.

Population Health Management and Critical Needs for Community and Public Health Nursing RESOLVED, that Texas Nurses Association monitor and communicate opportunities for involvement of community and public health nurses in forums that address expanding public health services.

RESOLVED, that Texas Nurses Association monitor and communicate opportunities for involvement of public health nurses in forums that examine lessons learned from the management of COVID-19 pandemic.

RESOLVED, that Texas Nurses Association advocate for resources to bolster public infrastructure with an emphasis on collaborative practice models that includes public health nurses.

Health Information Technology in Nursing Practice RESOLVED, that Texas Nurses Association will explore relationships of e-iatrogenic errors associated with EHR functionality and nursing errors and regulation/discipline.

RESOLVED, that Texas Nurses Association address the documentation burden and stress associated with EHRs and digital technologies.

RESOLVED, that Texas Nurses Association participate in the planning, development, implementation and use of digital technology for the state of Texas.

RESOLVED, that Texas Nurses Association disseminate results of the Statewide Survey of Nurses Experience with their Clinical Information System to administrators, information technology departments and vendors to deploy an evidencebased approach to improvement strategies to support nurses and improve satisfaction with EHRs. RESOLVED that Texas Nurses Association promote interprofessional collaboration in re-design of the EHR to effectively communicate and provide safe, effective patient care. i

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The Fight for HEALTHY Environments Nurses Drawdown Empowers Nurses to Make a Difference

By Katheren Koehn MA, RN, FAAN Executive Director, Minnesota Organization of Registered Nurses

WHILE THE POLITICAL DEBATE CONTINUES about climate change, its impact, and what governments can do, nurses do not have to wait to take action. The Nurses Drawdown initiative helps individual nurses and nurse organizations collectively work to decrease the impact of climate change.

Nurses must act now to make a difference in the future. While each action may seem small within the scope of the enormity of the challenge, everyone can make a difference. As Florence Nightingale famously said, “So never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself.”

Nurses Drawdown is just this—a practical beginning.

ORIGINS AND GOALS In atmospheric terms, drawdown is that point in time at which greenhouse gases peak and begin to decline on a year-toyear basis. The goal of Project Drawdown would be to identify, measure, and model one hundred substantive solutions to determine how much we could accomplish within three decades towards that end.

Nurses Drawdown is based on Drawdown, the work of Paul Hawkins, over 70 Drawdown Fellows from 22 countries, and a 120-member advisory board of scientists, engineers, climatolo-

Nurses Drawdown is based on Drawdown, the work of Paul Hawkins, over 70 Drawdown Fellows from 22 countries, and a 120-member advisory board of scientists, engineers, climatologists, botanists, economists, and others. gists, botanists, economists, and others. Their resulting book, Drawdown: The Most Comprehensive Plan Ever Proposed to Reverse Global Warming organizes a growing list of practical solutions for energy; food; women and girls; buildings and cities; land use; transport; and materials.1 Nurses Drawdown selected five key Drawdown areas to focus on:

ENERGY: Supporting a clean energy future by promoting energy efficiency and advocating for a transition to renewable energy

FOOD: Committing to a plant-based diet, use of clean cook stoves, and reduced food waste

MOBILITY: Creating bike infrastructure, walkable cities, and mass transit

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The power of nurses to implement change is based on three essential assets:5

Nurses comprise about 60% of worldwide health care professionals, working in clinical and public health sectors.

Nurses are trusted, as evidenced year-after-year in Gallop Poll findings.

Nurses are close to the people most vulnerable to climate change, including people who are underserved, marginalized, or both.

A first step for individual nurses is to join Nurses Drawdown. Nursing organizations can also become Nurses Drawdown Partners. There is no charge for individuals or organizations to become involved.

ACTION AND CHANGE Nurses Drawdown believes that nurses are in the right place and at the right time to make a significant contribution to drawing down greenhouse gases. A project of the Alliance of Nurses for Healthy Environments and Project Drawdown, Nurse Drawdown involves nurses from around the globe. The website, Nurses Drawdown, has a list of current organizational partners, including the International Council of Nurses, the Irish Nurses and Midwives, and several state nurses associations of the American Nurses Association.

As nurses, we know the impact of the environment on health. We know that health depends on good nutrition, clean air, the ability to get exercise safely. As nurses, we are called to take action to protect the environment.

A first step for individual nurses is to join Nurses Drawdown. Nursing organizations can also become Nurses Drawdown Partners.

There is no charge for individuals or organizations to become involved. On the website, nurses can learn about several actions they can take and access media, including YouTube videos, of how other nurses have gotten involved. Learn more at nursesdrawdown.org.

Hear more about the value nurses bring to addressing climate change in the See You Now podcast, episode 51 at seeyounowpodcast.com. i

GENDER EQUITY: Educating girls and engaging in family planning

NATURE-BASED SOLUTIONS: Planting trees, protecting tropical forests, and championing forest protection

REFERENCES Hawken, Paul. Drawdown: the Most Comprehensive Plan Ever Proposed to Reverse Global Warming. Penguin Books, 2017.

1

Department of Economic and Social Affairs. (2015). Sustainable Development: The 17 Goals. United Nations. https://sdgs.un.org/goals

2

These goals relate closely to the United Nations Sustainable Development Goals and the Social Determinants of Health.2,3

3 Healthy People 2030. (n.d.). Social Determinants of Health. U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-anddata/social-determinants-health

EXPERTISE AND TRUST

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

4

Why nurses? As nurses, we know the impact of the environment on health. We know that health depends on good nutrition, clean air, the ability to get exercise safely. As nurses, we are called to take action to protect the environment.

5 Butterfield, P., Leffers, J., Vásquez, M.D.. (2021). Nursing’s pivotal role in global climate action. BMJ 373:n1049.

The Code of Ethics for Nurses says, in part, that nursing must "advocate for policies, programs, and practices within the health care environment that maintain, sustain, and repair the natural world. As nursing seeks to promote and restore health, prevent illness and injury, and alleviate pain and suffering, it does so within the holistic context of healing the world.”4

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Nurse Wellbeing After COVID The Urgent Need for a Cultural Shift in the Workplace

By Dawn Webb, MSN, RN, PMH-BC and Gabi Nintunze

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IN MEDICAL INSTITUTIONS ACROSS TEXAS, nurses are still recovering from the aftereffects of the pandemic. From lives lost to insufficient protections in the workplace, Texas Peer Assistance Program for Nurses (TPAPN) Director Dawn Webb, MSN, RN, PMH-BC, is concerned by a visible lack of support from both employers and the government at large through a time of crisis.

“While the first wave of the pandemic is behind us, the trauma nurses experienced remains,” says Webb. That lingering trauma can reveal itself in unexpected ways: intrusive thoughts, feelings of re-experience, hyper-vigilance, or symptoms of depression. Webb encourages nurses and leadership to watch for these signs of traumatic stress and to stay aware of symptoms that may present as time goes on.

Many articles have been published since mid-2020 chronicling the adverse mental and emotional effects the pandemic has had on nurses and other frontline health care workers. As COVID variant cases rise, it’s important to consider what nurses and their leadership have experienced and what strategies can be employed to protect nurses as we move forward.

EMPTY WORDS While the public showed love for health care workers, nurses did not necessarily receive the same support in the workplace.

Webb points out that “nurses may feel undervalued while at the same time feeling held to very high expectations.” Not receiving the support needed to succeed in high stress environments can lead to burnout, an exit from the profession, and other negative effects on the self.

“I worry about the long-term consequences of nurses not getting help after these experiences unless employers recognize and address the problems that their teams are likely experiencing. I am also concerned that nurses won’t reach out for help,” Webb said. “Nurses are known for being tough but sometimes it is to their detriment.” She calls on employers to educate their nurses about traumatic stress and provide them with the resources to manage it.

“Now is the time for employers to step forward and explore what their team may need and how they can support them— for example, being aware of the stigma and attitudes toward mental health conditions and substance use disorders, as well as signs of a nurse under these stresses.”

Developing a culture of transparency and support is one way to show that an organization values their employees. This can also help to decrease the stigma around discussing mental health. Often this involves leadership taking care to incorporate models of healthy communication and team building into their leadership strategies.

NEW CULTURE Nurse leaders have the ability to create an environment that encourages health care workers to approach each other about their concerns without fear or shame. They can work to

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increase camaraderie and trust, create tools to navigate tough moments, and encourage their team to lean on each other, as well as exercise self-awareness and self-care.

A check-in system, encouraging participation in wellness activities, and increased education around methods of self-monitoring can help strengthen relationships and improve team communication. Employers can also encourage their teams to exercise self-compassion, take time for their mental health, and to remember the anagram HALT to recognize that the need to take care when hungry, angry, lonely, or tired.

A culture of safety would also mean that health care workers can candidly approach each other about their concerns and be more comfortable seeking or reporting for help if needed.1 Although managing stress is not a replacement for the organized support required to keep nurses safe, taking care of your health, creating ongoing supportive connections, and seeking out a trained mental health professional for support may assist with moving through this period.

In the long term, a workplace culture that recognizes nurses as individuals and remains aware of both physical and mental difficulties in the aftermath of a traumatic event can lead to a healthier and more comfortable environment—and one that retains nurses both in the profession and in the workplace.

Webb said management may find that interacting with team members on an individual level—asking questions, listening, and working together one-on-one—can lead to a steadier, happier, and more loyal employee base.

Likewise, the strength of a team can flourish when care is put into teammates and patients alike. Nurses call in less, and levels of both burnout and turnover reduced. Modelling happiness and health to both peers and patients can lead to a calmer and safer environment.

Webb expressed a hope that nurses will take time to reflect on the last year and figure out what they need to do to get or stay healthy. “Workplaces need to provide easily accessible tools to allow nurses to recover from the trauma and stress of the last year and not simply expect them to bear through it. Texas Nurses Association and TPAPN are focused on the well-being of nurses, both during the pandemic as well as after nurses have had time to process all they have been through. People in leadership positions must strive to understand that success requires care—and that team leaders and those around them are in this together.” i REFERENCES 1 Maxfield, D., Grenny, J., McMillian, R., Patterson, K., & Switzler, Al. (2005). Silence Kills. The seven crucial conversations for healthcare. VitalSmarts.

2 Buckingham, M. & Coffman, C. (2016). First, Break all the Rules: What the world’s greatest managers do differently. Gallup Press.

BETTER SYSTEM

3 Kreisman, B.J. (2002). Identification of the drivers of employee dissatisfaction and turnover. Unpublished Doctoral Dissertation. Austin, TX: University of Texas.

Research shows that workplace satisfaction plays a large role in an employee’s decision to stay or leave an organization.2,3,4

4 Kaye, B. & Jordan-Evans, S. (1999). Love ‘em or lose ‘em—Getting good people to stay. San Francisco: Berrett-Koehler Publishers, Inc.

Signs of Traumatic Stress Intrusive thoughts about a traumatic event Feelings of re-experiencing the event Avoiding any scenario that might remind you of the event Negative feelings and thoughts that weren’t there before An overall negative worldview Hyper-arousal Hyper-vigilance Being unusually down on yourself Questioning your nursing abilities Physical symptoms like difficulty concentrating Non-specific somatic complaints Calling in sick more often

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