Texas Nursing 2020 Issue 4

texa s nu r s e s .o rg

TEXASNURSING M A G A Z I N E

LEARNING AS WE GO

Reflections, Observations, Data, and a Call-to-Action

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 4 , 2 0 2 0

ISSUE 4, 2020 Volume 94, Number 4 EDITOR IN CHIEF: Cindy Zolnierek, PhD, RN, CAE MANAGING EDITOR: Kanaka Sathasivan, MPH COPY EDITORS: Serena Bumpus, DNP, RN, NEA-BC and Shanna Howard 4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin, TX 78759-8444 P: 800.TNA.2022 or 512.452.0645; F: 512.452.0648 tna@texasnurses.org | texasnurses.org

MISSION Empowering Texas Nurses to advance the profession

BOARD OF DIRECTORS OFFICERS:

Tamara “Tammy” Eades, DNP, MSN, RN, President

Jeff Watson, DNP, RN, NEA-BC, Past President

Amy McCarthy, MSN, RNC-MNN, NE-BC, Secretary Gayle Dasher, PhD, RN, ANP-BC, Treasurer DIRECTORS:

Melinda Hester, DNP, RN-BC

Donna Wallis, MBA, MSN, RN

Patricia Freier, MSN, RN-BC, CPHQ

Ernestine "Tina" Cuellar, PhD, RN, PMHCNS-BC

Lucindra Campbell-Law, PhD, APRN, ANP, PMHNP-BC EXECUTIVE DIRECTOR:

Cindy Zolnierek, PhD, RN, CAE

VISION Nurses transforming health

TNA DISTRICT AND PRESIDENT Dist.1:

Clarissa Silva, PhD, MSN, BSN, RN clarissa.silva@ttuhsc.edu

Dist. 3:

Margie Dorman-O’Donnell, MSN, RN margiedo@sbcglobal.net; District office: Jamie R. Rivera, JamieRivera@texashealth.org

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.

Dist. 4:

Natalie D. Garry, MSN, APRN, GNP-BC Ngarry1617@gmail.com, tnad4.nursingnetwork.com

Dist. 5:

Leah Koen May, MSN, RN, NE-BC President.TNAd5@gmail.com, tna5.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.

Dist. 7:

Stacy Cooper, MSN, RN staycoop@yahoo.com, tnadistrict7@gmail.com

Dist. 8:

Patricia E. Alvoet, EdD, MSN, RN-BC pe.alvoet@gmail.com

Dist. 9:

Juliana Brixey, PhD, MPH, MSN, RN jjbrixey@hotmail.com; District office: Melanie Truong, RN, Executive Secretary, tna9@tnadistrict9.com, tnadistrict9.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.

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

Dist. 17: Mari Cuellar, NEA-BC, MSN, RN mgrace2329@yahoo.com Dist. 18: Janice L. Miller, MSN, RN, ACM janice.miller@umchealthsystem.com Dist. 19: Anita Lowe, MSN, RN alowe@uttyler.edu Dist. 35: Chrystal G. Brown, MSN, RN

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.

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

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.

CORRECTIONS In the last issue, the American Academy of Nursing 2020 Class of Fellows list omitted Susan Lee, PhD, RN, CNE, CPXP, and Kelly Brassil, PhD, RN. Congratulations to Dr. Lee and Dr. Brassil.

Copyright 2020 © Texas Nurses Association

In addition, the COVID-19 Task Force has added Sandra Petersen, DNP, APRN, FNP/GNP-BC, PMHNP.

T E X A S N U R S I N G M AGA Z I N E | I S S U E 4 , 2 0 2 0

PAGE 2

10

8 NEW YEAR, NEW STATE LEADERSHIP,

9

NEW ADVOCACY PLAN

plus,

12

NURSE DAY

AT THE CAPITOL

SCHOOL

16

22

NURSES More Important Now Than Ever

The Pandemic within the Pandemic The Spread of Burnout in Nursing

Contents IN EVERY ISSUE

FEATURES

5

9

14

19

20

PRESIDENT’S NOTES

THE #1 HOSPITAL IN DALLAS-FORT WORTH IS GROWING

TRANSITIONS IN NURSING CLINICAL EDUCATION DUE TO COVID-19

ISOLATION + STRESS = A RECIPE FOR RELAPSE

TEXAS NEEDS NEARLY 70,000 MORE LVNs, RNs, AND APRNs BY 2032

Advertorial

How Houston Baptist University Transformed its Nursing Program

Reflections and Preparations

12

Increasing Pressure on Nurses can Increase Risk of Substance Use

Supply and Demand Modeling Predicts High Workforce Deficit

NURSE DAY AT THE CAPITOL Caring for Texas, Advocating for Texans: February 8, 2021

PAGE 3

I S S U E 4 , 2 0 2 0 | T E X A S N U R S I N G M AGA Z I N E

WHAT STARTS HERE CHANGES THE WORLD! You can transform health care as you enrich your career with a graduate degree or a new 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) Doctor of Nursing Practice Doctor of Philosophy in Nursing Post-Master’s (FNP, PCPNP, PMHNP, CNS) Acute Care Pediatric Nurse Practitioner program — New! Certificate in Teaching Nursing — New!

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

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

REFLECTIONS AND PREPARATIONS Celebrating 2020 and Looking Forward to 2021 WELCOME TO THE LAST QUARTER OF 2020.

As I think about the final few weeks of this historic year, the idea of reflection comes to mind. While many consider 2020 to be one of the hardest years in recent history, reflection allows us to realize the good things we have done while upholding the highest integrity of the nursing profession. By reflecting on the what we did right, on our successes, we can celebrate our little triumphs.

We as nurses have stepped up during these trying times, handling COVID-19, hurricanes, wildfires, and anything else that has come our way in order to take care of our patients. The public has seen nurse stories and gained insight into what nurses do. Our successes also include “Year of the Nurse” celebrations at every level, from the hospital to the community to the city, state, country, and entire world. Nurses are on the public stage like never before.

Without reflection it is easy to forget these things and just focus on the failures. Reflection also helps us see what we have been neglecting.

“Self-care is giving the world the best of you, instead of what’s left of you.”

—Katie Reed Self-care is hard for us nurses to do daily. I encourage you to continue to take care of yourself during these times so that you can be your best. Burnout, PTSD, and compassion fatigue are real and rampant now. Please take care of yourselves. You are important.

As we progress into 2021, we will bring our 87th legislative year into focus. We

By empowering our nurses to influence the legislative process, we will begin to shift the culture. are looking forward to advocating for Texans and adding our nursing voice to any bills that involve health care, nurses, nursing care, our communities, and our patients. One in every four voters in Texas is a nurse. This makes us a huge influence.

We are busy preparing for Nurse Day at the Capitol in just a few months. This is always an exciting time. This gives us the opportunity to shine and be a nursing voice. Please plan to attend this year’s Nurse Day at the Capitol! I promise you will not regret it.

TNA’s new strategic plan consists of building foundations, empowering nurses, and shifting culture. Nurses can apply these same goals to the session in the spring. First, build foundations; get out there to your local legislators and tell your stories. You as the nurse are the expert, and they need to hear from you.

TNA is here to empower you to support all nursing topics at the Capitol. By empowering our nurses to influence the legislative process, we will begin to shift the culture.

As we go into the holidays, I want to wish each and every one of you Happy Holidays, and I hope you get to spend quality time with your family, friends, and loved ones. Take some time to reflect on your accomplishments in 2020 and your progression into 2021. I cannot stress how grateful I am for you being a nurse and my hero.

PAGE 5

Stay safe, healthy, and happy.

Tammy i

I S S U E 4 , 2 0 2 0 | T E X A S N U R S I N G M AGA Z I N E

Improve your practice No matter where you are in your nursing career, Texas Nurses Association has several useful offerings that can help you advance, protect, and hone your nursing practice!

Free Live virtual CNE

On-Demand CNE

Join us in 2021 for four free CNE events:

Get CNE when and where you want it, on your phone, tablet, or computer:

• January 14 – Implicit Bias • February 11 – Health Care Disparities • April 8 – Mental Health – Post-Traumatic Stress and the Impact on Nursing • May 13 – Long-Term Health Effects of COVID-19

• Identifying, Responding to Human Trafficking • Nursing Peer Review: The Positive Side to a Scary Situation • Using Data to Inform the COVID-19 Response

An introduction to Texas nursing practice Every nurse should know their legal rights and responsibilities! This book breaks down complicated laws with easy-to-understand explanations, including examples, charts, tables, and practice notes!

• • • • •

Safe harbor and incident-based nursing peer review Safe staffing law The process of reporting to the Board of Nursing When to report peers and coworkers How to protect yourself when you’ve been reported

Visit texasnurses.org/store to learn more!

Nuts & bolts of nursing peer review If you are in a position of leadership or involved in your nursing peer review committee, join one of TNA’s upcoming workshops.

• January 15, 2021 • April 30, 2021

Visit texasnurses.org/events to learn more!

Our Mission: Our Mission:

Providing quality care.

Providing quality care.

Delivering innovative services.

Delivering innovative services.

Exceeding expectations.

Exceeding expectations.

WE’RE WE’RE HIRING! HIRING!

90 90 Nurses Nurses in in 90 90 Days Days Come Come join join our our team! team!

Committed to Quality and Growth Committed to Quality and Growth

Three designated Critical Care units: a 38-bed Critical Care Stepdown, a Three units: a 38-bed Critical Care Stepdown, a 32-beddesignated ICU and a Critical 20-bedCare CVICU 32-bed ICU and a 20-bed CVICU 48-bed ED 48-bed ED Comprehensive Heart Program including ECMO, Open Heart, TAVR and Comprehensive Heart Program including ECMO, Open Heart, TAVR and WATCHMAN™™ services WATCHMAN services Accredited Heart, Trauma, Ortho, Bariatric, NICU and Stroke programs Accredited Heart, Trauma, Ortho, Bariatric, NICU and Stroke programs 24-hour Intensivist coverage 24-hour Intensivist coverage Hiring in MS, NICU, Cath Lab, PACU, Rehab and Behavioral Health Hiring in MS, NICU, Cath Lab, PACU, Rehab and Behavioral Health

$10,000 $10,000 Sign-on Sign-on Bonus Bonus for for experienced experienced ED, ED, ICU ICU and and CVICU CVICU RNs RNs Full-Time Seasonal Assignments available at $50/hr Full-Time Seasonal Assignments available at $50/hr Apply online at www.texomamedicalcenter.net Apply online at www.texomamedicalcenter.net If you have questions, please call HR at 903.416.4050 or email wchidester@thcs.org If you have questions, please call HR at 903.416.4050 or email wchidester@thcs.org 5016 South US Highway 75 5016 South US Highway 75

Denison, TX 75020 Denison, TX 75020

Anti-Racism Call to Action How Nurses Can Fight Inequality THE TEXAS NURSES ASSOCIATION (TNA) supports nurses' efforts to transform health in communities across Texas (read our full value statement on Race and Social Justice at texasnurses.org/ nursingpolicy). TNA endorses the American Academy of Nursing and American Nurses Association call for social justice to address racism and health equity in communities of color.1 We denounce racism and are committed to inclusion, diversity, and equity in our work. Racism can occur at the individual, institutional and structural levels and is a public health crisis.2,3,4,5,6 To undo racism, we must ask the hard questions, engage in hard dialogue, and sustain the hard work to rid our society of this horrible system, which robs people of their vitality, their livelihood, and too often, their very lives.7 Join our call to action as we share how we can all be a part of the solution.

Here are a few suggested ways to begin conversations and work on undoing racism: 1.

2.

3.

4.

Speak up when you see racism at play. Be an ally in the fight for social justice.8 Practice self-reflection; assess for implicit or unconscious biases (visit implicit.harvard.edu for free online assessments).9,10 Recognize your own privilege and leverage it to advocate for social justice and diversity in the workplace.

Volunteer where your strengths lie.

5.

6.

7.

Contribute to peace-building activities that will need to happen consistently.

Exercise your right to vote and encourage others to do so (visit votetexas.gov). Commit to civic engagement.

Utilize teachable moments that are happening all around us. Educators can specifically incorporate analysis of racial disparities and inequality, as well as the history of colonialism and nursing into their courses.11,12

The Institute for Perinatal Quality Improvement, dedicated to reducing mortality in black people giving birth, has developed a tool called SPEAK UP.13 S: Set limits and only allow racially respectful dialogue and actions in your workspace.

P: Practice and prepare. Plan how you will act if you see or hear someone being treated or referred to disrespectfully.

E: Express your concerns. Discuss, but do not blame others.

A: Apologize if you said or did something that others find hurtful.

K: Keep improving. Be mindful and willing to become aware of your unconscious biases.

U: Uncover and learn from disrespectful comments and actions, including jokes.

P: Persuade others to SPEAK UP! i Developed by TNA's Workplace Advocacy and Practice Committee. View more resources at texasnurses.org/news.

T E X A S N U R S I N G M AGA Z I N E | I S S U E 4 , 2 0 2 0

PAGE 8

REFERENCES 1 The American Academy of Nursing and The American Nurses Association. (2020). Call for social justice to address racism and health equity in communities of color.

2 Race and Social Justice Initiative. (n.d.). Defining Racism. City of Seattle.

3 Jones, C. (2000). Levels of racism: A theoretic framework and a gardner’s tale. American Journal of Public Health, 90(8): 1212-1215.

4 Bailey, Z., Kridger, N., Agenor, M., Graves, J., Linos, N. & Bassett, M. (2017). Structural racism and health inequities in the USA: Evidence and interventions.

Lancet. 389(10077):1453-1463.

5 Hardeman, R. R., Murphy, K. A., Karbeah, J., & Kozhimannil, K. B. (2018). Naming Institutionalized Racism in the Public Health Literature: A Systematic Literature Review. Public Health Reports, 133(3), 240–249.

6 Thurman WA, Johnson KE, Sumpter DF. (2019). Words matter: An integrative review of institutionalized racism in nursing literature. Advances in Nursing Science, 42(2):89-108.

7 Morrley, C., Darbyshire, P., Serrant, L., Mohamed, J., Ali, P., DeSouza, R. (2020). Dismantling structural racism: Nursing must not be caught on the wrong side of history. Journal of Advanced Nursing, July 21st 8 Weitzel, J., Luebke, L., Wesp, L., Graf, D., Ruiz, M. de la Paz, M., Dressel, A., Mkandawire-Valhmu, L. (2020). The role of nurses as allies against racism and discrimination: An analysis of the key resistance movements of our time. Advances in Nursing Science, 43(2): 102-113.

9 Division of Health Care Improvement. (2016). Implicit bias in health care. The Joint Commission.

10 Narayan, M. (2019). Address in implicit bias in nursing: A review. American Journal of Nursing, 119(7):36-43.

11 Bennett, C., Hamilton, E., Rochari, H. (2019).

Exploring race in nursing: Teaching nursing students about racial inequality using an historical lens. OJIN: The Online Journal of Issues in Nursing, 24(2).

12 Waite, R. & Nardi, D. (2017). Nursing colonialism in America: Implications for nursing leadership. Journal of Professional Nursing, 35: 18-25. doi.org/10.1016/j. profnurs.2017.12.013.

13 Bingham, D. (2020). SPEAK UP For black women.

Institute for Perinatal Quality Improvement.

ADVERTORIAL

The #1 Hospital in Dallas-Fort Worth is Growing THE BEST HOSPITAL IN DALLAS-FORT WORTH is building the best teams in patient care.

work more closely together to care for patients.

UT Southwestern Clements University Hospital is adding a third 12-story tower.

Clements University Hospital is a hub of biomedical education, innovation, and healing. With the upcoming opening of this new tower, our team is looking to hire hundreds of career-oriented healthcare professionals to help support our mission.

It will be the inpatient home for the Peter O’Donnell, Jr. Brain Institute and house expanded inpatient facilities for the Harold C. Simmons Comprehensive Cancer Center, the only National Cancer InUT Southwestern Clements University Hospital tower addition stitute designated center in North Texas. to expand your healthcare career and

The new tower will add 291 beds and 600,000 square feet of the latest technologies in diagnostics and therapeutics, resulting in a 1.8 million square foot, 750 bed, state-of-the-art hospital.

It brings together all of the University inpatient services in one location on the UT Southwestern campus. Skilled healthcare professionals will be able to

We are looking for dedicated individuals to join our caring, customer-serviceoriented teams to provide our patients the most advanced treatments and compassionate care. If you’re looking

be a part of a new level of care, join our Magnet-recognized, award-winning team. This is the place. Now is your time.

Learn more: jobs.utsouthwestern.edu/ hospital-jobs/ i

RN to BSN Tuition Only

$8,068

The online RN to BSN program at University of Houston-Victoria emphasizes the quality and safety of patient care providing you with the knowledge and skills to better the lives of others.

CCNE accredited • 100% online coursework • Complete in 12 months • 5 starts per year

Celebrating the Year of the Nurse in 2020!

Get started today!

UHVNurses.com | 888-728-6625

PAGE 9

I S S U E 4 , 2 0 2 0 | T E X A S N U R S I N G M AGA Z I N E

NEW YEAR, NEW STATE LEADERSHIP,

NEW ADVOCACY PLAN Predictions and Priorities for the 2021 Legislative Session

By Cindy Zolnierek, PhD, RN, CAE

“As an architect, you design for the present, with an awareness of the past, for a future which is essentially unknown.” — Norman Foster, architect

A KEY FUNCTION OF TEXAS NURSES ASSOCIATION (TNA) is to advance the quality and safety of patient care through policy initiatives that optimize professional nursing practice, advance positive nursing practice environments, and promote full use of the knowledge and skills of nurses.

TNA’s Policy Council and committees on Workplace Advocacy and Practice, Regulation and Practice Authority, and Education and Workforce are tasked with developing policy positions, value statements, and issue briefs on topics of interest to nurses. This year, hundreds of nurses engaged in this policy development process, preparing over 20 documents on policies ranging from workplace violence to occupational licensure and the nursing shortage. Visit texasnurses.org/ nursingpolicy to read more.

“As an architect, you design for the present, with an awareness of the past, for a future which is essentially unknown.”

— Norman Foster, architect With an unknown future, designing an advocacy platform and strategy for the upcoming legislative session presents a challenge. The legislature will likely consider new rules for conducting the session as the usual crowded corridors and committee hearing rooms are contraindicated by the pandemic. They may decide legislators must attend in person.

Or they may choose to only hold hearings in person in a large room or to hold all hearings virtually. These unknown rules will determine how TNA and others can engage in the legislative process.

STRATEGIZING FOR THE UNKNOWN

PRIORITIZING UNDER UNUSUAL CIRCUMSTANCES

With the completion of the policy positions, TNA’s Governmental Affairs Committee (GAC) will develop strategies and tactics for the 87th legislative session. However, those plans are largely unknown due to the need to mitigate COVID-19 transmission. While TNA’s Policy Council and committees have conducted business as usual in developing policy, the GAC has to plan for several contingencies this year.

TNA is the convener of the Nursing Legislative Agenda Coalition, a group of over 20 state nursing organizations who collaborate to advance an agenda on nursing issues with one voice. As a member of several other coalitions, such as the Texas Public Health Coalition, Texas Coalition for Healthy Minds, and the Coalition for Health Care Access, TNA will support legislation on health issues such

T E X A S N U R S I N G M AGA Z I N E | I S S U E 4 , 2 0 2 0

PAGE 10

as public health infrastructure, immunizations, and mental health care.

TNA’s 2021 legislative priorities include:

Removing APRN practice barriers Adding workplace violence protections Fully funding the Nursing Shortage Reduction Program and Nursing Faculty Loan Repayment Program Ensuring nurses who contract COVID-19 are able to access employee benefits Expanding reimbursement for telehealth and telemedicine Drawing down additional federal funds for school health services

The state budget and redistricting will be priorities for the legislature. There is also likely to be a focus on disaster-related initiatives. What other issues will be of interest is uncertain, though the legislature is likely to consider a fewer rather than a greater number of bills.

PREDICTING UPCOMING CHANGES Despite a strong effort from Texas Democrats in the November election, the House of Representatives will continue to have a Republican majority next session and will lead selection of a new speaker of the House. This role determines com-

THANK YOU GOVERNMENT AFFAIRS COMMITTEE Todd Bailey, Chair

Anita Lowe

Stan Harmon Mary Vitullo

Sandi GarzaEscamilla

Maria Faison

Laura Kidd

Lisa Boss

Pat Morrell

Steven Powell

Olusola "Sola" Oyewuwo

Amy Anderson Kelley Renee Yarbrough-Yale

Monica Alleman Britney Cumm ings

POLICY COUNCIL Shakyryn Napier, Chair

Stephanie Morgan

Norma Teran

Catherine Robichaux

Beth Mancini

Lisa A. Campbell

Robert C. Coghlan, III

Stephanie Huckaby

Linda Harrington

Nikki Roux

Edtrina Moss

Marlene Meador

Jim Allard

Debbie Pena

Dru Riddle

Nancy Fahrenwald

Erin Perez

Nancy Crider

mittees and assignments. Committee leadership plays a key role in determining what bills progress and these influential legislators remain unknown until the speaker is selected.

After the election, potential speaker candidates began to emerge. Currently, the two frontrunners are Rep. Dade Phelan and Rep. Geanie Morrison.

Phelan announced early that he had the votes necessary to become speaker, but some Republicans prefer to give the full caucus an opportunity to select someone, potentially Morrison.

The Senate will have fewer personnel changes, but the few new legislators will have a large impact. As Senator

Pete Flores lost his election bid, Republicans no longer have the supermajority they need to bring bills to the floor of the Senate, meaning Republicans will have to work across the aisle on certain issues. Alternatively, they could change the rules so that a simple majority can bring a bill to the floor. The supermajority requirement has been a long-standing Senate tradition, so efforts to change that will be controversial.

Ultimately, in addition to the influence of the pandemic, the budget, and redistricting, we predict a hectic session.

However, our members are hard at work to provide a voice for nurses and advance nursing priorities. i

Colleen Marzilli

NURSING WORKFORCE AND EDUCATION COMMITTEE Edtrina Moss, Chair Beth Mancini

Catherine Mbango Organ

Marlene Meador

Bethany Callaway

Helen Reid

Renae Schumann

Patricia Francis Johnson

Rachel Ellis

With an innovating

Lydia, Med-Surg/Telemetry RN

invigorating spirit

REGULATION AND PRACTICE AUTHORITY COMMITTEE Colleen Marzilli, Chair

Linda Harrington

Nancy Crider

Stan Harmon

Robert C. Coghlan, III

Yvette Cheeks

Erin Perez

Dru Riddle

Kay Sanders

Prescott National Forest, Prescott, AZ

WORKPLACE ADVOCACY AND PRACTICE COMMITTEE Jim Allard, Chair

Sueanne Cantamessa

Lisa Campbell

Tiffany M. Benita

Stephanie Huckaby

Lee Mathew

Catherine Robichaux

Alaina M. Tellson

Lygia Dunsworth

Jocelyn A. Blount

GAC WISDOM COUNCIL Margie DormanO’Donnell Jennifer Cook

Ron Hilliard Karen KoerberTimmons

Cindy Strzelecki

POLICY WISDOM COUNCIL Marla ErbinRoesemann

Sandy Tovar

Joyce Batcheller

Sally Gillam

Lolly Lockhart

Carson A. Easley

Barbara Cherry

NURSES THRIVE AT

YRMC

If you would love to work in a dynamic professional environment balanced by an amazing lifestyle, you’ll thrive at Yavapai Regional Medical Center. Beautiful Prescott, Arizona offers clean, fresh air, breathtaking scenery and 300+ days of sunshine each year.

With an easy, relaxed commute, you’ll start your day stress-free and ready to roll. Not yet ready to make a permanent commitment? Need more flexibility in your life right now?

Come explore what it is like to work with the YRMC nursing team, where Seasonal RNs (13 weeks or longer) earn rates up to $50 per hour with weekend/night differentials and $2,500 per month stipend! A variety of full-time and part-time regular RN positions are also available and relocation assistance is offered.

Prescott and Prescott Valley offer everything you want for an exceptional standard of living. Here, you will find the largest stand of Ponderosa pine trees in the world, majestic mountains and pristine blue lakes. Prescott also has the distinction of being recognized as one of the “Happiest and Healthiest Places to Live” by Time magazine.

Are you ready to thrive? Explore our RN opportunities and join us!

careers.yrmc.org/Creative/Nursing

Equal Opportunity Employer

PAGE 11

I S S U E 4 , 2 0 2 0 | T E X A S N U R S I N G M AGA Z I N E

NURSE DAY

AT THE CAPITOL CARING FOR TEXAS, ADVOCATING FOR TEXANS

FEBRUARY 8, 2021 FROM 1 TO 4:30 P.M.

texasnurses.org/event/nurseday2021

WHEN IS VIRTUAL BETTER? When there are no limits on how many nurses may participate! Join us for the 2021 Nurse Day at the Capitol.

TNA members cite Nurse Day as one of the most pivotal experiences of their professional lives. Don’t miss this opportunity to learn about the legislative process and influence issues that affect you!

Nurse Day will include three key components:

Recorded advocacy training

A live webcast with updates on the state of health care in Texas

Live discussions with legislators from across the state

Because it is virtual, we welcome as many nurses and nursing students as possible to participate. Whether you are a seasoned veteran of Nurse Day or this will be your first time, there is something for everyone!

Don’t miss this opportunity to learn about the legislative process and influence issues that affect you!

Our recorded advocacy sessions are divided into two tracks: a basics overview for novices and advanced strategy for experts. Registered participants can view them any time starting in February.

We encourage you to view them prior to the other events.

The live webcast of health care updates is February 8 from 1 to 4:30 p.m., featuring a keynote presentation on the state of public health in Texas by Commissioner John Hellerstedt, MD. Hellerstedt has led the state’s response to the COVID-19 pandemic and will provide a timely update on the response as well as current public health priorities across the state.

Additional speakers include nursing lob-

T E X A S N U R S I N G M AGA Z I N E | I S S U E 4 , 2 0 2 0

PAGE 12

byist Kevin Stewart, JD, and TNA Director of Practice, Serena Bumpus, DNP, RN, NEA-BC. Finally, the legislative discussions will enable nurses to engage directly with representatives and senators from their region. You will hear about their policy priorities as well as their responses to the nursing legislative agenda. You will have an opportunity to ask questions about issues that are important to you. Because you are their constituents, the legislators will be especially interested in your perspectives.

Because it is virtual, we welcome as many nurses and nursing students as possible to participate.

The registration fee for this 2021 virtual event is only $45 for TNA members and

$55 for non-members. The registration fee includes a one-year subscription to The Learning Curve, giving you access to a constantly growing library of on-demand continuing nursing education—a value of $29 for TNA members and $39 for non-members! i

Transform Your Tomorrow

NURSE DAY AT THE CAPITOL LIVE WEBCAST Welcome, Review of the Day – Tammy Eades, DNP, RN The State of Public Health in Texas, John Hellerstedt, MD Nursing’s Role in Health Policy – Serena Bumpus, DNP, RN, NEA-BC Nursing’s Legislative Agenda, Kevin Stewart, JD Legislative Panel – Moderated by Todd Bailey, MSN, RN, NEA-BC Closing Comments – Cindy Zolnierek, PhD, RN, CAE

VIRTUAL LEGISLATIVE VISITS Monday, February 1, 2021 6:00 p.m. CST – Public Health Region 1

Tuesday, February 2, 2021 6:00 p.m. MST/7:00 p.m. CST – Public Health Regions 9/10

Monday, February 8, 2021 6:00 p.m. CST – Public Health Regions 2/3

Tuesday, February 9, 2021 6:00 p.m. CST – Public Health Regions 4/5N

Monday, February 15, 2021 6:00 p.m. CST – Public Health Regions 5S/6

Online RN to BSN and MSN Nursing Programs Earning your nursing degree online at Lamar University is the perfect start to transform your nursing career.

Our online degrees are designed especially for working nurses.

You will successfully gain the knowledge, skills and credentials you need to move into higher level nursing roles.

For those interested in public health policy, we offer an online Master of Public Health.

Tuesday, February 16, 2021 6:00 p.m. CST – Public Health Region 8

Get started today!

Monday, February 22, 2021 6:00 p.m. CST – Public Health Region 7

Tuesday, February 23, 2021 6:00 p.m. CST – Public Health Region 11

Call: 866-223-7675 Visit: Lamarnursing.com PAGE 13

I S S U E 4 , 2 0 2 0 | T E X A S N U R S I N G M AGA Z I N E

Transitions in Nursing Clinical Education due to COVID-19

How Houston Baptist University Transformed its Nursing Program

By Renae Schumann, PhD, RN, CNE

THE COVID-19 PANDEMIC AND SUBSEQUENT LOCKDOWN of nursing schools and clinical agencies forced schools to reassess and re-implement their programs to meet the needs of today’s nursing students. Online classrooms, clinical simulation, and virtual interaction can all affect the quality of education.

The lack of face-to-face clinical opportunities experienced by some programs caused faculty to rethink how students could meet clinical objectives and complete their nursing programs in order to graduate on time and become safe practitioners.

SIMULATION AND VIRTUAL TRAINING Many schools already incorporate some form of clinical simulation in their standard curriculum. Programs may use up to 50% simulation activities in each clinical course.1 In 2020 however, by mid-March schools faced moving all students out of hospitals and into the simulation lab, when the physical space was still open to students, or into a virtual format if the school’s simulation labs were not available. Texas Governor Greg Abbott issued a waiver of the 50% simulation rule for nursing students in their final year of the program, allowing schools to incorporate enough simulation hours for students to graduate.

Since colleges and universities moved online into synchronous or asynchronous methodologies, faculty and students struggled to stay connected literally and figuratively. “Zoom Fa-

Even after the risk of COVID-19 is gone, some faculty and students may find continued use for simulation and virtual learning, and the pandemic provided great opportunity to learn and strengthen programs and resources.

T E X A S N U R S I N G M AGA Z I N E | I S S U E 4 , 2 0 2 0

tigue” became a prominent discussion topic. Were nursing students missing something good and important by not attending in-person lectures and clinicals? Were faculty, self-described as unprepared to teach virtually, less effective in helping students learn the necessary concepts?

RISKS AND REWARDS In the summer and fall, some acute care, hospital-based student placements began to open, but not in the same quantities as pre-pandemic. Faculty had to decide who could use those slots. Students and their family members had to decide whether the benefits of being in hospitals was worth the risk of exposure to the virus.

Nursing deans, faculty, and other administrators received calls from students and family members expressing their fear and displeasure that the student would either (1) go to clinical, therefore putting the entire family at risk, or (2) not be scheduled to attend clinical, therefore having a disadvantage when taking the NCLEX or finding a job.

We know nursing programs with more in-person clinicals than simulated clinicals demonstrate higher quality.2 Though simulation and virtual products provide a temporary solution, it is best for students to participate in some capacity with live patients.

However, even after the risk of COVID-19 is gone, some faculty and students may find continued use for simulation and virtual learning, and the pandemic provided great opportunity to learn and strengthen programs and resources.

SOLUTIONS AND CHALLENGES The lack of opportunities for clinical placements led to partnerships between hospitals, schools, and outside placement agencies where students were hired as paid

PAGE 14

Though this pandemic upended traditional college experiences for nursing students, the challenges have been met with fortitude and grace by faculty, administrators, and students. professional assistants to complete clinical hours. Faculty organized community setting experiences such as COVID-19 contact tracing, flu shot clinics, and additional projects based on agency needs assessments.

Overall, the staff and patients were eager to have student helpers, and faculty learned that clinical training does not always have to occur in an acute care setting. Future clinical placements will include greater focus on community settings, which is consistent with the changing nature of health care.

However, outside of the hospital, there may not always be enough staff to serve as preceptors in a strict preceptor model.

Managing schedules and resources for virtual learning was also a challenge with limited solutions. In households with more than one user of internet resources, students had to schedule times for Wi-Fi or computer use with other residents. Synchronous courses limited flexibility, and students often experienced lost connections because of the lack of bandwidth. In addition, faculty were concerned with the ease of cheating in a virtual testing environment.

When school reopened, the new challenge was management of simulation lab space and supplies. Students were now in the lab more often and for longer periods. Additional staff were hired to manage lab scheduling using distancing guidelines and cleaning of non-disposable equipment. Course sections were timed to allow for cleaning. Donors were sought to fund or donate more equipment and supplies.

Throughout this stressful time of transitions and unknowns, students also faced financial burdens due to furloughs and layoffs.

Some students could pay for tuition costs with scholarships and grants, but the additional costs of maintaining insurance cards, updating CPR certification, getting vaccinated, and meeting other requirements was often more than a family could manage.

Faculty, staff, and local TNA chapter members looked for resources to help students so they could continue their education.

Though this pandemic upended traditional college experiences for nursing students, the challenges have been met with fortitude and grace by faculty, administrators, and students.

No matter what circumstances we face, we will continue to strive to provide the best education and training possible for all future nurses. i ENDNOTES 1. Texas Administrative Code, Examining Boards Texas Board of Nursing, Professional Nursing Education Rule 215.10 Clinical Learning Experiences.

2. Spector, N., Silvestre, J., Alexander, M., Martin, B., Hooper, J., Squires, A., & Ojemeni, M. (2020). NCSBN regulatory guidelines and evidenced-based quality indicators for nursing education programs. Journal of Nursing Regulation, 11(2), S3-S64.

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

Nurses, complete your

RN to BSN—100% Online In as few as 8 months

Apply at UTPBNurses.com PAGE 15

I S S U E 4 , 2 0 2 0 | T E X A S N U R S I N G M AGA Z I N E

SCHOOL

NURSES

More Important Now Than Ever

By Karen S. Schwind, BSN, RN, NCSN

Utilizing the Framework for the 21st Century School Nursing Practice, school nurses address care coordination, community health, leadership, and quality improvement.

T E X A S N U R S I N G M AGA Z I N E | I S S U E 4 , 2 0 2 0

FOR MANY, it is hard to imagine sending children to school without a licensed health professional on campus. The school nurse is the expert in health and COVID-19 case management that schools need. Schools must better utilize school nurses in planning. However, without advocacy and education, the school nurse will continue to be undervalued.

During planning in the summer of 2020, Texas school districts were preparing for the unimaginable task of returning to school during a pandemic. Since we have not experienced a pandemic in our lifetimes, we found ourselves in unchartered waters. Many schools and districts across the nation turned to their expert in school health, which is the school nurse. Others utilized experts from local and regional health departments.

Ultimately, inclusion of both resulted in optimal plans for returning students to inperson and remote instruction.

A CHILD’S ADVOCATE School nurses are often the only licensed health care provider in a school district.

However, not all schools in Texas have a nurse. Some have one nurse per district, shared between campuses, while others may not even have a district nurse. Without school nurse involvement, health care decisions are made by administrators and other unlicensed employees— this is obviously not in the best interest of students and their families.

Utilizing the Framework for the 21st Century School Nursing Practice, school nurses address care coordination, community health, leadership, and quality improvement.1 According to the National Association of School Nurses website, “These principles are surrounded by the fifth principle, Standards of Practice, which is foundational for evidence-based, clinically competent, quality care. School nurses daily use the skills outlined in the practice components of each principle to help students be healthy, safe, and ready to learn.”

In addition to the nurse, the students, family, and school community are central to the Whole School, Whole Community, Whole Child model, a framework provided by the Centers for Disease Control and Prevention for addressing health in schools. From first aid and emergency care to management of chronic

PAGE 16

conditions, the model relies on nurses for health promotion, referral to services, and student and parent education. For some students, school nurses may be the only provider they have access to.

A COMMUNITY ASSET School nurses are well respected in their communities for a wide range of health and medical information and resources.

School nurses interact daily with parents and educational professionals. As the campus resource, the school nurse can also be a valuable asset for community support regarding mental wellness, immunizations, and educational preparation.

This year, school nurses were instrumental in shaping how schools reopened, ensuring the safety of students, parents, and other school employees. However, their role is limited unless they are at the table, as we saw when a number of school districts omitted nurses from their COVID-19 response teams.

When it comes to one student’s health, nurses can provide expertise on processes for education, health and wellness, immunization, safety, mental wellbeing, and more. At a campus level, they best understand the details of chronic illness, medication management, attendance, safety, organization, and collaboration.

A HEALTH CHAMPION Now more than ever, it is critical that the voices of school nurses are heard. School nurses not only need to advocate at the

legislature and within state agencies but do their part at the local level as well.

School health advisory councils, county health departments, immunization coalitions, and city-level health planning— consistent advocacy can make a seat for school nurses at the table. Nurse involvement can shift funding priorities, curriculum, and strategic initiatives to better address health and wellness.

The 2020-2021 school year was like no other in recent history. Even with a seat at the table to prepare for student and staff return, we had no guide on how to proceed. How does one plan to bring our children back into school safely while national, state, and local experts continue to change best recommendations, sometimes weekly?

However, what I offer as a nurse is my own knowledge and expert medical guidance. District administrators relied on me and other school nurses to develop the guidance needed in record time to safely start the Fall semester. We helped them understand new health terminology—personal protective equipment, N95s, fit testing, contact tracing, close contact, quarantine, isolation—and we had to learn new educational terms—inperson, face-to-face, remote, virtual.

Above all, we are in this together: educators, parents, and nurses. We can and we will get through this! i ENDNOTES 1 Framework for 21st Century School Nursing Practice. (n.d.). Retrieved October 15, 2020, from www.nasn.org/ nasn/nasn-resources/professional-topics/framework

NURSING COMPLAINT HELP NURSINGCOMPLAINTHELP.COM IS THE #1 MOST AFFORDABLE AND EFFECTIVE RESOURCE TO HELP YOU TO DEVELOP A PLAN AND RESPOND TO COMPLAINTS AGAINST YOUR LICENSE.

This site is for nurses in ANY STATE and it offers videos, advice, suggestions, and downloadable real responses to use as guides in responding to any BOARD COMPLAINT or INVESTIGATION.

www.NursingComplaintHelp.com PAGE 17

I S S U E 4 , 2 0 2 0 | T E X A S N U R S I N G M AGA Z I N E

You Care.

Make it a career.

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

n

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

Find an exciting and challenging career in one of 23 HHS Health and Specialty Care System facilities across Texas.

Nurses, get your RN to BSN or MSN Nursing Admin — 100% online Affordable Tuition | Six Starts Per Year

Apply at TAMIUNurses.com

20D0625

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

TAKE THE

LEAD ON YOUR NURSING CAREER. SM

Earn a MSN or DNP at your pace and keep your day job with one of TCU’s highly ranked programs.

• Design a program that fits your schedule by choosing from full-time or part-time options — ALL ONLINE • Make your transition to graduate work easier with seamless BSN entry to DNP • Choose from multiple speciality areas, like the new

Psychiatric Mental Health Nurse Practitioner program

T E X A S N U R S I N G M AGA Z I N E | I S S U E 4 , 2 0 2 0

LEARN MORE OR APPLY TODAY NURSING.TCU.EDU/ONLINE

PAGE 18

Isolation + Stress = A Recipe for Relapse Increasing Pressure on Nurses can Increase Risk of Substance Use

By Dawn Webb, MSN, RN-BC

THE CHALLENGES OF THE COVID-19 pandemic have been overwhelming and taking care of oneself has been difficult, especially for those affected by substance use disorders, including nurses.

The pandemic has had a significant impact on human behavior; interestingly the behaviors that society has had to adopt are the exact behavioral changes seen when someone relapses: taking on more than one can handle, overextending oneself at the expense of one’s recovery and coping activities, withdrawing from recovery support (people and meetings) and isolation.1 For people, including nurses, familiar coping behaviors may have included substance use in the past, so there is an increased risk of returning to that behavior.

THE PERFECT STORM The climate of the pandemic is the perfect storm for relapse, and nurses are in the middle of that storm. Nurses have had to step up and take on the responsibility of caring for patients diagnosed with COVID-19 who are scared, very sick, and alone. The nurse is often the patient’s only connection to the outside world. Along with taking care of patients, nurses fear the unknowns of the virus, their own safety, and the safety of their families, often isolating themselves to protect those they love. On the opposite side of this are nurses who have lost

their jobs, their identity as a nurse, and are now isolated from the world. In either situation, isolation occurs, and this is one of the leading causes for relapse.

To add to the storm, access to recovery and self-care activities during the pandemic are limited. Recovery programs have been working to adapt to the virtual world, but nothing can replace in-person recovery groups and faceto-face support from a sponsor, good friend, or family member. This lack of support increases the nurse’s vulnerability and may lead to unhealthy coping or dysfunctional behaviors, including the misuse or abuse of substances.

In all these scenarios, the stress and isolation may become unbearable and returning to substance use may seem like the only way to relieve it.

ALTERNATIVE TO DISCIPLINE PROGRAMS The consequences of the pandemic have resulted in an increase in positive drug and alcohol screenings for nurses participating in the Texas Peer Assistance Program for Nurses (TPAPN). To be clear, a positive drug or alcohol test does not always mean the nurse has fully relapsed, the use could be a “slip” or one-time incident.

Nurses participating in TPAPN and other recovery-oriented programs have the

PAGE 19

benefit of existing and immediate connections to support—a critical factor in a successful recovery. The support of programs like TPAPN help to prevent “slips” and relapses as well as assist nurses experiencing “slips” or relapses get back on track with their recovery journey. In addition to supporting nurses, programs like TPAPN work with employers when a nurse tests positive for drugs or alcohol. This immediate intervention not only helps the nurse, it keeps the public safe.

SUPPORTING NURSES IN RECOVERY Nurses are people and susceptible to substance use issues just like anyone else.

Nurses are valuable and health care organizations must educate personnel on how to identify the signs of a peer who may be experiencing a substance use issue. Reporting a peer is an act of compassion that could not only save the nurse’s career but also their life. Health care organizations must also work to reduce stigma and put systems in place to support nurses through their recovery while keeping the public safe. i REFERENCES 1 National Council of State Boards of Nursing (NCSBN).

(2011). Substance use disorder in nursing: A resource manual and guidelines for alternative and disciplinary monitoring programs.

I S S U E 4 , 2 0 2 0 | T E X A S N U R S I N G M AGA Z I N E

Texas Needs Nearly 70,000 More LVNs, RNs, and APRNs by 2032 Supply and Demand Modeling Predicts High Workforce Deficit

By Kayla Davis, Texas Center for Nursing Workforce Studies THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES just completed nurse supply and demand projections through 2032.

The projections are meant to be used as a planning tool for adequately preparing the future workforce to meet the needs of the Texas population. This model highlights the importance for immediate and swift action to address the projected nursing shortages that will add up to a 47,453 deficit to the nursing workforce (measured as full-time equivalent, or FTEs) in the Texas health care sector by 2032. Texas needs to act to ensure a secure nursing workforce in the future.

the 25% decline of LVN graduates from 2011 to 2019.

The TCNWSAC recommends establishing more LVN education programs in underserved areas and increasing partnerships with K-12 schools and local colleges. They also recommend that LVN programs budget for resources needed to increase enrollment. Increased funding and access is also necessary for LVN programs to have enough clinical and simulation practice to produce more graduates.

APRNS

RNS Overall, the demand of most nurse types is projected to exceed the supply in every year between 2018 and 2032. There is a projected shortage of 57,012 registered nurses (RNs) FTEs by 2032 with RNs in inpatient hospital settings accounting for more than half of the growth in demand across all settings. Nursing home, residential care, and home health settings are projected to see the fastest rates of growth in demand for RNs. In response to the projected nursing shortages, the Texas Center for Nursing Workforce Studies’ Advisory Committee (TCNWSAC) recommends that more nurses need to be prepared to become faculty and the funding used for nursing faculty loan repayment programs needs to be increased.

LVNS The shortage of licensed vocational nurses (LVNs) will also affect home health, nursing homes, and residential care settings the most with a projected shortage of 12,572 LVN FTEs by 2032.

This is concerning considering the higher needs of an aging population. While the demand for LVNs is projected to grow by 46%, the supply is only projected to grow by 14% which follows

T E X A S N U R S I N G M AGA Z I N E | I S S U E 4 , 2 0 2 0

As for advanced practice registered nurses (APRNs), the supply of certified nurse midwives and clinical nurse specialists is projected to not meet the demand by 2032, while nurse practitioners and certified registered nurse anesthetists are projected to be in higher supply than demanded between 2018 and 2032.

The TCNWSAC recommends that the legislature continue funding the Nursing Shortage Reduction Program and reprioritize funding of APRNs to focus on the roles that are experiencing shortages, rather than general funding for all types of APRNs. The TCNWSAC also recommends creating opportunities to increase understanding of the different advanced practice roles, specifically nurse practitioners and clinical nurse specialists and their respective roles in hospital-based practice. Increased understanding will help employers recruit and hire the most appropriate practitioners for their positions and improve understanding of future APRN workforce needs.

For more reports and technical information concerning the projections, visit: dshs.texas.gov/chs/cnws/Nursing-WorkforceReports/.

For more data, including projections by geographic region and nurse type, visit: healthdata.dshs.texas.gov. i

PAGE 20

If not now, when?

The faculty team at Cizik School of Nursing are nurse educators, practitioners, scholars, and internationally recognized researchers committed to educating tomorrow's nurse leaders. Educated in many of the nation's leading hospitals, our students receive one of the finest nursing educations and experiences available in the world.

Academic Offerings

BSN to DNP - Nurse Practitioner

RN to BSN RN to MSN

Family Nurse Practitioner Adult/Gerontology Acute Care Nurse Practitioner Adult/Gerontology Primary Care Nurse Practitioner Psychiatric/Mental Health Nurse Practitioner

Family Nurse Practitioner Nursing Leadership

MSN/Post-Master's Family Nurse Practictioner Adult/Gerontology Acute Care Nurse Practitioner Adult/Gerontology Primary Care Nurse Practitioner Psychiatric/Mental Health Nurse Practitioner Nursing Leadership Emergency/Trauma Care (post-master's only) Nursing Education (post-master's only)

BSN to DNP - Nurse Anesthesia Post-Master's DNP Nurse Executive NP/CNS Nursing Informatics CRNA

PhD

PAGE 21

Learn more and apply online today at nursing.uth.edu I S S U E 4 , 2 0 2 0 | T E X A S N U R S I N G M AGA Z I N E

The Pandemic within the Pandemic The Spread of Burnout in Nursing

By Serena Bumpus, DNP, RN, NEA-BC

DEBRA, A NURSE with 19-years experience in various health care settings, found herself struggling over the past few years without any real answer as to why. She arrived at work every day, on time, had meaningful engagements with staff, patients, and other colleagues. Yet each day felt like an uphill battle.

She consistently experienced increasing pressures to achieve outcomes that seemed impossible, taking on additional work without validation or encouragement. Each day she felt an innate compulsion to prove herself and worked with no ability to turn off. “I just need to work harder. I’m not working hard enough.” Eventually, Debra’s inability to turn her work off left her neglecting her own personal self-care.

She found herself waking up every night at 3 a.m., unable to go back to sleep. Her eating habits were sporadic—grabbing something from the hospital cafeteria. Rarely was she fully present for her family and friends at home. Debra was withdrawing from the world around her. She felt like nothing she did was good enough and nobody saw the value in her. Debra could no longer see the value in herself. Feeling empty inside, she began to question her purpose and if nursing was her calling. “Would people care if I were no longer around?”

She needed to talk with someone, but no one in her organization made her feel safe talking about how she felt. She did not trust that her nursing leaders would understand what she was going through. She did not want to burden her co-workers because they were under the same pressures. Her family would not understand. So she kept to herself until she no longer could, leaving the profession a few months later.

NURSING’S NEXT PANDEMIC

perform, low levels of staffing, an aging population, and rapid changes in the health care environment. Their workloads were heavier and more demanding than ever before. Doing more with less was an uphill battle.

The 2019 Annual Patient Safety and Quality Outlook report revealed that burnout is one of the leading patient safety and quality concerns in organizations.1 When rating their organization’s strategies to deal with burnout, only 39% indicated their organizations were slightly effective in dealing with burnout, while 36% indicated their organizations were slightly ineffective and 20% indicated their organizations were highly ineffective.

The incidence of burnout in registered nurses (RNs) before COVID-19 was as high as 70%.2,3 Then COVID-19 increased the physical and emotional demands on nurses, exacerbating nurse burnout to the point of calling it a “parallel pandemic.” Nurses never managed to figure out how to deal with the challenges before COVID-19, and now the strain on nurses has increased tenfold.

BURNOUT AND ITS CAUSES Burnout is now considered a medical diagnosis, included in the 11th revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon.4 Defined as a syndrome resulting from chronic workplace stress that has not been properly managed, it is considered to be a state of emotional exhaustion caused by work to the point where an individual feels fatigued, becomes mentally distanced, and experiences negativism or cynicism with reduced professional efficacy and an inability to effectively engage with others.1 Causes of burnout can be placed into four categories: individual, management, organizational, and work.2,5

Stories like Debra’s are too common. Across the state and country, nurses are experiencing burnout at exponential rates.

Even before COVID-19, nurses faced increased pressure to

T E X A S N U R S I N G M AGA Z I N E | I S S U E 4 , 2 0 2 0

PAGE 22

Individual: demographic variables, lack of self-control, being too self-critical, engaging in unhelpful coping strategies, sleep deprivation, cognitive distortions such as idealism, perfectionism, and over-commitment

While health care organizations have provided health care workers with support systems such as counseling services, employee assistance programs, ethics committees, peer support programs, and debriefing sessions, they are not preventing burnout from occurring.

Management: lack of leadership support, insufficient rewards and validation, failure to provide resources, organizational mistrust

Organizational: excessive workload, staffing shortages, high nurse-to-patient ratios

Work: the environment, team relationships, availability of supplies, long shift hours, availability of ancillary support

Texas Nurses Association (TNA) recently surveyed nurses across the state asking about their own personal well-being and support provided in their organizations. The data from this member survey aligns with the literature on preventing burnout. While health care organizations have provided health care workers with support systems such as counseling services, employee assistance programs, ethics committees, peer support programs, and debriefing sessions, they are not preventing burnout from occurring.

The most common factors related to burnout are exclusion from decision-making processes, loss of autonomy, security risks, and staffing challenges.6 Nurses burnout and lose their resilience because they are faced with the emotional conflict of being forced to align with the organizational “spin” when there are serious issues to address that they cannot negotiate. Layered with their emotional burden, these administrative and operational obstacles prevent nurses from feeling good about their work.

WHAT NURSES NEED

process is critical to preventing nurse burnout.

In addition, nursing workflow and workload should be evaluated for efficiency. Staffing alone will not solve the problem if there are poor workflows and workloads with unnecessary tasks. What is the most burdensome task frontline workers experience inside your organization? How can you strategically reduce the burden?

For example, when nurses consistently stay after their shift to finish documenting, organizations should consider electronic health record changes that can reduce documentation burden and allow real-time documentation. Understanding challenges and engaging frontline workers to solve these challenges creates a supportive work environment and mutual accountability.

Lavender rooms, employee assistant programs, and self-care reminders alone cannot help prevent burnout. Nurses have explicitly stated that what they need is leadership support, validation, presence, empathy, and understanding. They want transparency, authenticity, and grace. They want a practice environment free of gossip, backstabbing, and backbiting.

They want to see the same level of caring and compassion from their peers and leaders as they are expected to provide their patients. These are the characteristics of a healthy work environment and the key to preventing nurse burnout. i To learn more about the findings of TNA's survey, visit texasnurses.org/news.

REFERENCES 1 Patient Safety and Quality Healthcare (2019). 2019 Annual patient safety and quality industry outlook.

2 Bakhamis, L., Smith, H., & Coustasse, A. (2019). Still an epidemic. The burnout syndrome in hospital registered nurses. The Health Care Manager, 38(1), 3-10.

3 Lyndon, A. (2016). Burnout among Health Professionals and Its Effect on Patient Safety. Agency of Healthcare Research and Quality.

4 World Health Organization. (n.d.). Burnout, an “Occupational Phenomenon”: International Classification Diseases.

5 El-Aswad, N. (2017). Burnout Among Nurses: Prevalence, Impact and Intervention.

Vital Signs Vital Skills.

6 The Joint Commission. (2019). Developing resilience to combat nurse burnout.

Health care leaders play a critical role in reducing nurse burnout and helping direct care nurses navigate the complex work environment.7 Adopting authentic and transformational leadership styles can assist leaders in demonstrating self-awareness and high moral standards which lead to a genuine relationship with frontline workers.8 Leaders must promote strong nurse engagement, offer support, encouragement, and validation, as well as build trusting relationships among team members. Otherwise, burnout is inevitable. Nurses need to know their leaders and their team members will have their back. They need to know they can speak up for safety without fear of retaliation. In addition, they need to play a role in shaping their own work environments.

7 Reith, T. (2018). Burnout in united states healthcare professionals. A narrative review. Cureus, 10(12).

8 Wei, H., King, A., Jiang, Y., Sewell, K.A., & Lake, D.M. (2020). The impact of nurse leadership styles on nurse burnout: A systematic literature review. Nurse Leader, 18(5), 439-450.

9 Halm, M. (2019). The influence of appropriate staffing and healthy work environments on patient and nurse outcomes. American Journal of Critical Care Nursing, 28(2), 152-156.

Texas law requires frontline nurses in hospitals have a voice in their organization’s staffing models. These models should be based on patient outcomes such as patient falls, patient satisfaction scores, and hospital-acquired injuries. With the financial strain on employers due to COVID-19, staffing should not be sacrificed, but rather strengthened. Increasing patient acuities, ever changing skill mixes, and constant shifts in policies significantly influence the way nursing departments are staffed, and leaders should respond accordingly with flexible staffing models that engage direct care nurses.9 Addressing staffing needs based on patient outcomes and engaging nurses in that

PAGE 23

You take care of your patients.

I’ll take care of your license.

Yong J. An, Attorney Represented over 100 nurses before the Texas Board of Nursing since 2006 Former State and Federal Prosecutor State-wide nursing licensure defense practice

Available 24/7. Call or Text 832-428-5679.

AnLawFirm@gmail.com

I S S U E 4 , 2 0 2 0 | T E X A S N U R S I N G M AGA Z I N E

4807 Spicewood Springs Rd. Bldg 3, Suite 100 Austin, TX 78759

Nominate Your Colleagues for the Year of the Nurse Awards 2020 has been an unprecedented year. Nurses had to learn new skills quickly, lead during rapid changes, advocate for patients and families, and transition into new roles under a tight timeline. We want to honor those nurses who create a culture of care, nurses who play a vital role in supporting health and wellness, nursing innovators, community contributors, and frontline heroes.

The 2020 Year of the Nurse Awards will recognize the contributions of 20 registered nurses from throughout Texas.

All nurses are eligible for nomination.

Learn more: texasnurses.org/YearoftheNurseAwards

Nursing Degrees For

Wherever You Want

To Go

Give your career a first-class upgrade As your nursing practice keeps you on the move, we are with you every step of the way. The University of Texas at Arlington is a national leader and innovator in online education, offering more than 20 CCNE-accredited nursing degree and certificate programs with 100% online coursework and affordable, pay-as-you-go tuition. Start your career-changing journey today.

Degrees for here, there, everywhere!

UTAnursing.com | 682-888-0775

The UTA College of Nursing and Health Innovation has been named a Center of Excellence in Nursing Education by the National League for Nursing.