Texas Nursing 2022 Issue 4

ISSUE 4, 2022

Volume 96, Number 4 EDITOR IN CHIEF: Serena Bumpus MANAGING EDITOR: Lisa Maxwell COPY EDITORS: Gabi Nintunze 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

VISION

Nurses transforming health

TEXAS NURSING (ISSN 0095-36X) is published quarterly— Winter, Spring, Summer, Fall—by the Texas Nurses Association, 4807 Spicewood Springs Rd., Bldg. 3, Suite 100, Austin, TX 78759-8444 Periodical postage is paid in Austin, Texas.

One-year subscriptions: $30 (nursing schools, libraries, hospitals, non-nurses, out-of-state nurses), foreign $35; single copy $3.00. Subscription is not available to non-member Texas nurses. Some back issues may be viewed online at texasnurses.org

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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.

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Copyright 2022 © Texas Nurses Association

BOARD OF DIRECTORS

OFFICERS:

Joyce Batcheller DNP, RN, NEA-BC, FAONL, FAAN, President jbatcheller7@yahoo.com

Colleen Marzilli, PhD, DNP, RN, CNE, NEA-BC, Secretary cmarzilli@uttyler.edu

Gloria Lorea, DNP, RN, NEA-BC, Treasurer glorialoeradnp@gmail.com

Tamara “Tammy” Eades, DNP, MSN, RN, Past President eades@uta.edu

DIRECTORS:

Patricia Freier, MSN, RN-BC, CPHQ patricia.freier@sbcglobal.net

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

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 Mar y Vitullo, MBA, MSN, RN-BC, PCCN, NE-BC, CLSBB vitullo.mary@yahoo.com

CHIEF EXECUTIVE OFFICER: Serena Bumpus, DNP, RN, NEA-BC, sbumpus@texasnurses.org

TNA DISTRICT PRESIDENTS

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, ruben.castillo@utsouthwestern.edu; tnad4.nursingnetwork.com; District Secretary Lori Batchelor, batchelorb@prodigy.net Dist. 5: Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE, FAAN, bclipper1@gmail.com, tna5.org Dist. 7: Connie Bar ker, APRN. PhD. FNP-C, crbarker1@yahoo.com, tnadistrict7@gmail.com Dist. 8: Donna R. Wallis, MBA, MSN, RN, 210-486-3089 dwallis3@alamo.edu, tna8.org Dist. 9: Nancy Yuill, PhD, RN, nyuill@yahoo.com District office: Melanie Truong, RN, Executive Secretary, tna9@tnadistrict9.com, tnadistrict9.com Dist. 17: Mari Cuellar, NEA-BC, MSN, RN, mari.cuellar@christushealth.org Dist. 18: Belinda Gallegos, belinda.gallegos@ttuhsc.edu Dist. 19: Dixie R. Rose, RN, dixiegtc@gmail.com Dist. 35: Karen Koerber-Timmons, PhD, RN, CLNC, CNE, NEA-BC, CCRN, RN-BC  mkkoerbertimmons@gmail.com

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

Join nurses from across the state of Texas and make your voice heard at the Capitol.

Returning as an in-person event for the first time since 2019, Nurse Day at the Capitol is your opportunity to learn from experts about the legislative issues that affect Texas nurses, and how to effectively communicate to your elected officials.

Registration includes a half-day CNE session, refreshments, informa tional handouts and coordinated visits with your state legislators.

For more details and to register, visit http://texasnurses.org/nurseday or follow the QR code.

President’s Notes

Joyce Batcheller DNP, RN, NEA-BC, FAONL, FAAN

THE TNA LEGACY

Reflecting on one of Texas nursing's most impactful allies

CLAIR JORDAN has left behind an in credible legacy for TNA. During her ten ure, Clair developed and guided others in terms of what policy changes were needed, who the key stakeholders were and how best to influence policymakers. She was a strong advocate for change for nurses’ key issues.

For example, I had the honor of work ing with Clair shortly after I arrived in Austin in 1994 and began my role as a chief nursing officer. When I met Clair, I realized immediately that she was highly influential and a strong advocate for the nursing profession. Clair’s vision for TNA was to strengthen the voice of nurses across the state. Clair built strong relationships and developed nurses at all levels to advance TNA’s agenda. One example is the creation of the Hospital Safe Staffing Law in 2009. The leaders for TNA, Texas Hospital Association (THA) and Texas Organization of Nurse Execu tives (now TONL) worked collaboratively to create the staffing laws and regula tions which many states have since adopted.

Clair and her team were very supportive of the American Nurses Credentialing Center’s Magnet Designation Program. She was aware that may rural and small er community hospitals could not afford the investment required to achieve this designation. She worked with her team to develop a TNA Nurse Friendly desig nation program in 2003. This designation allowed many rural and smaller com munity hospitals to demonstrate a level of excellence that reflected the Magnet standards and was more affordable.

The TNA Nurse Friendly program was ad opted by ANCC and became the Path

way to Excellence in 2009. Clair knew how to leverage ideas her team and other groups had with key stakeholders when the time was right.

Other collaborative work between TNA and the Texas Board of Nursing was evident because of Clair’s leadership as well. For example, safe patient handling, safe harbor, peer review and peer sup port for mental health are all available in part due to her efforts.

As president of TNA, I find myself reflect

ing on “what would Clair be saying now?” I think she would be telling us how critically important creating healthy work environments is to the future of nursing. Additionally, she would tell us we should think about being inclusive of other partnerships that are needed to help make needed changes from aca demia to practice and beyond.

There are more than 350,000 nurses in Texas, representing five generations and every race and ethnicity; and TNA is committed to continuing to be their voice. To do this effectively we need nurses from all levels of the work force to engage and not only share concerns but also develop innovative ideas on how to create healthy work environments for all care providers.

Think about the possibili ties we have with so many different perspectives and experiences. This is the way to honor and build on the legacy that Clair Jor dan created at TNA.

Join me as we continue to discuss and create the new strategic plan for TNA. We have a strong legacy to reinforce. i

Clair Jordan and then State Representative Lloyd Doggett.

Clair Jordan has left behind an incredible legacy for TNA. She knew how to leverage ideas her team and other groups had with key stakeholders when the time was right.

TNA MEMBER NEWS

SPOTLIGHT ON YOU

KUDOS

Norma Martinez Rogers , PhD, RN, FAAN, was named a Living Legend by the American Academy of Nursing in recogni tion of her contribu tions as a nurse leader, policy maker and advocate for the underserved, especially Latina populations. Photo courtesy UTHSCSA.

Congratulations to Texas Health Harris Methodist Hospital HurstEuless-Bedford for being conferred Magnet desig nation, and to Memorial Hermann Greater Heights Hospital , and Method ist Mansfield Medical Center, for being recertified by the ANCC's Magnet Recognition Program.

The following TNA members were rec ognized by the National League for Nursing Awards at their 2022 NLN Edu cation Summit:

Richard Lee Pullen , Jr., EdD, MSN, RN, CNE, CNE-cl, CMSRN, ANEF, director of the RN to BSN program at Texas Tech University Health Sciences Center, received The NLN Mary Adelaide Nutting Award for Outstanding Teaching or Leadership in Nursing Education.

Jessica L. Peck , DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, clinical professor of nursing at Baylor University in Dallas and expert pediatric nurse

practitioner and anti-trafficking nurse-advocate, received the NLN Lillian Wald Humanitarian Award.

Nancy Goodman , MSN, RN, was granted Emeritus status from Texas A&M Corpus Christi College of Nursing and Health Sciences (Photo courtesy CONHS ). i

If you are a TNA member and you’ve, been promoted, received an award, or been elected or appointed to a board or community organization, we’d like to hear from you. Please send submissions to editor@texasnurses.org.

Your community counts on you to check the PMP.

As a pharmacist, you protect the health of your community. When you dispense controlled substances, checking the PMP ensures that the care you provide is safe and effective. While checking the PMP for every patient, every time may add a step in your patient care routine, your diligence ensures a safer Texas. Sign on before you sign off.

txpmp.org

WHAT'S NEW AND NEXT

Be on the lookout for your invitation to Meet the Leaders in 2023. During our inaugural event in Austin, TNA CEO Serena Bumpus, President Joyce Batchellor and Director of Government Affairs Jack Frazee met with nurses from the area to discuss their top concerns, what they would like to see from TNA in the future, and to network with other nurses.

TNA REPRESENTS YOU!

In the past quarter, TNA represented you with:

Board of Nursing

› BON Quarterly Board Meeting

› TPAPN Weekly BON Meeting

Texas House of Representatives Public Health Committee

ANA

› VPP Collaboration Call

› Policy/GOVA, NPWE, Center for Ethics, and HNHN

› Listening Sessions

› Executive Director Orientation and Lobbyist Meeting

› Improving Leg Committee Advocacy

› ANA and C/SNA President and Executives Call ƒ Nursing Legislative Agenda Coalition ƒ

White House Office of Science and Technology Policy

Texans for Healthcare Access Coalition

Access to Care Learning Collaborative

American Society of Association Executives

Policyholders Stabilization Reserve Fund

CFA Action Coalition

State Nurses Associations and Environmental Health

TPHC Full Coalition

NOBC State Contacts i

TAKING THE WHEEL

Serena

Bumpus, DNP, RN, NEA-BC

Talks About Her Vision for TNA

Dr. Serena Bumpus is a long-time member of TNA and has held several volunteer roles as well as serving as the director of practice from 2020-2021. Her career spans more than 20 years, with the last 12 in nurse leader positions. Most recently, she worked as the national senior regional director of clinical surveillance for Ascension Health.

TNA: Congratulations on your recent selection as CEO! What do you see as the biggest strength of our organization right now?

BUMPUS: Thank you! I am deeply humbled and excited to be at the helm. Texas Nurses Association’s biggest strength is the engagement from its current members. We have many members asking how they can be involved and what they can do to contribute to TNA’s work. This shows that our members find value in the work we do and that is a huge strength of the organization.

TNA: What made you decide to pursue the role of CEO?

BUMPUS: Never in a million years did I think being the CEO of Texas Nurses Association is a place where I would land. I’ve al ways been an active and engaged member of the organiza tion. This was engrained in me early on in my career. It wasn’t until I began my DNP program that I started asking myself what my purpose was in the profession. While pursuing my DNP, I had the opportunity to participate in TNA’s DNP fellowship program which ultimately fed the development of my DNP

project. During my fellowship I worked closely with the TNA staff and my work ultimately informed their work. A few months after I graduated, the practice director position became vacant, and I applied. I was TNA’s practice director from March 2020 through September 2021. I stepped away from that position to go back into the practice setting. While I enjoyed my work in the new environment, I found myself asking again, what is my purpose in the profession? When Cindy’s retirement was an nounced, I did not apply initially. I had only been away for a few months and I did not think it was the right move. It wasn’t until I went to Washington, D.C. back in June that my husband asked why I had not applied for the position. He could see the excitement in my face. He asked: “If I didn’t apply, would I have regrets later?” He gave me something to think about. The next day, in a leadership retreat, I was asked to reflect on how I was doing God’s work and how is God using me to serve. That is when I realized that I would have regrets—that I needed to apply for the CEO position. My purpose and passion are advo cating for the profession. This is how God is using me to serve.

Texas Nurses Association’s biggest strength is the en gagement from its current members. We have many members asking how they can be involved and what they can do to contribute to TNA’s work. This shows that our members find value in the work we do and that is a huge strength of the organization.

TNA's director of communications, Lisa Maxwell, sat down with Bumpus to learn about her journey to TNA, her vision, and what we can expect to see in the next few years.

TNA: As you think about the next year, two years, and five years, what is your vision for TNA? What about after that?

BUMPUS: Futuristic is one of my strengths and I have big ideas for the future! A wise person recently told me, “You have to go slow if you want to go fast,” which was some of the best advice I’ve received in my career. This first year, is all about relationships and partnerships. It’s important to have strong partnerships with key stakeholders that can help us advance our agenda and support the profession. These stakeholders include Texas Board of Nursing, The Texas Medical Associa tion, Texas Hospital Association, etc. I am also working to build relationships with our members. Relationships are so important in this role, especially if I want to accomplish these big ideas in the future. I want TNA to be viewed by Texas nurses as an impact player and we will not be seen that way if I’m not out there building and strengthening our partnerships and rela tionships.

Looking ahead to the next three-five years, I want to see the organization grow. We are the largest professional nursing organization in Texas, and we are the largest constituent of the ANA enterprise, but I’m not satisfied with that. We have over 400,000 nurses in the state of Texas and less than 5% are mem bers of TNA. If we want to be a true impact player, we need to re-engage the profession with professional nursing organiza tions. We have a new generation of nurses—much like I was early in my career—that we need to capture early on. We must grow the next generation of leaders and advocates so we can continue to pass legislation that supports and advances the practice of nursing in Texas. This means enhancing the level of engagement of nurses at all levels in all settings in TNA’s work.

Looking ahead to the next three-five years, I want to see the organization grow. We are the largest professional nursing organization in Texas, and we are the largest constituent of the ANA enterprise, but I’m not satisfied with that. We have over 400,000 nurses in the state of Texas and less than 5% are members of TNA. If we want to be a true impact player, we need to re-engage the profession with professional nursing organizations.

It also means engaging our TNA districts differently and includ ing them in the organization’s strategic planning process. We have a huge opportunity to create some synergies by doing that and show the impact the organization has on the profes sion in Texas and nationally. I also want to engage more nurses in health policy. I want to create an avenue for nurses at all levels to obtain more in-depth knowledge of the policy pro cess and engage in policy development. We have an exciting future ahead and I am excited about the opportunities to grow and advance the profession of nursing in Texas.

We are trying to work through so much as a profession. The one thing that I can’t stop thinking about though is the nursing shortage. We not only need to produce more nurses, but we also need to take a holistic approach to understand why nurses are leaving the bedside. This includes taking a deep look at workforce, workload, work environment, workplace violence, well-being, and value.

TNA: How would you like to see members engage with TNA over the next year?

BUMPUS: First and foremost, I would love for Nurse Day at the Capitol be at max capacity on February 27 and 28, 2023. I want to see nurses from all areas to include frontline nurses, nurse leaders, nursing faculty and students. This is one of the most important events nurses can engage and this is a critical year for the nursing profession. Another opportunity to engage includes attending one of our “meet the leader” roadshows coming to a city near you in the next year. I and our TNA Board President, Dr. Joyce Batchellor, want to meet with and hear nurses from across the state talk about their experiences as a nurse in their communities. Our first sessions were awesome with great attendance and lively discussion. I will also add that TNA is always looking for members to participate in commit tees, task forces, be a contributor to our weekly practice tips of the week, write an article for Texas Nursing, present at a future Nurse Talks or offer to do a pre-recorded webinar that can be placed on our LMS for others to view. There are always numer ous ways for our members to engage.

TNA: What keeps you up at night?

BUMPUS: I think the question might be “what doesn’t keep me up at night?” We are trying to work through so much as a profession. The one thing that I can’t stop thinking about though is the nursing shortage. We not only need to produce more nurses, but we also need to take a holistic approach to understand why nurses are leaving the bedside. This includes taking a deep look at workforce, workload, work environment, workplace violence, well-being, and value. There is not an easy fix to our current challenges and there is not one single reason why nurses are leaving. I am not convinced it’s for more money and to see the countryside. There are a multitude of reasons causing nurses to leave. We have underlying systemic issues that need to be addressed. We need nurses to find joy in their work again and to feel good about their work rather than burdened and frustrated.

TNA: What is something you like to do outside of work that would surprise people?

BUMPUS: A few years ago, I discovered a love for refurbish ing old furniture. I love taking something old and turning it into something fresh and new again. i

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THE NURSING LEGISLATIVE AGENDA

for the 88th Regular Session

By Jack Frazee, JD

You can speak with Texas elected officials about nursing. The Nursing Legislative Agenda is your guide to TNA's state-level advocacy priorities, including discussion items and talking points.

BEFORE EVERY LEGISLATIVE SESSION , TNA leads a group of nursing organizations called the Nursing Legislative Agenda Coalition (NLAC) in creating a list of pri orities for the coming session called the Nursing Legislative Agenda. The Agenda is used to guide our advocacy for the coming session and to communicate our priorities to our membership. Any nurse interested in speaking with elected officials about nursing priorities can use this document as a guide for discussion items, talking points, and state level ad vocacy efforts.

THE NURSING LEGISLATIVE AGENDA COALITION

NLAC is a coalition of nursing organi zations in Texas that join together to share ideas, strategies, and priorities for each legislative session. NLAC’s mem ber organizations lobby the Capitol to support our priorities and advance the interests of nurses in Texas. This joint effort amplifies our collective voice on issues that would be difficult for any individual organization to tackle alone.

In 1989, during the HIV/AIDs epidemic, TNA recognized the need to join forces with other nursing organiza tions to address the health crisis in the 71st Regular Session. Heavily focused on the active epidemic, TNA enlisted eight nursing orga nizations to work together on a unified nursing agenda go ing into the session. The 71st is notable for being one of Texas’ longest legislative sessions as it extended into 1990 with six additional Special Sessions. The length of the 71st solidified the bonds of the participating nursing organizations, and by the time the 72nd Legislative Session began, the organizations formally created the coalition known as NLAC.

After its formation, NLAC’s member orga nizations suggested recruiting additional nursing organizations for the 72nd Leg islative Session giving NLAC a total of 14 members in 1991. Currently, the coalition has over 20 member organizations, in cluding many of the founding members.

NLAC meets semi-annually to discuss agenda issues and prepare for each up coming session. As the 88th Legislative Session approaches, the coalition has worked closely to create solutions for emerging issues and help nursing rebuild from the COVID-19 pandemic.

THE NURSING LEGISLATIVE AGENDA FOR THE 88 TH LEGISLATIVE SESSION

THE NURSING SHORTAGE REDUCTION PROGRAM (NSRP)

This program increases nursing schools’ capacity to train and graduate students by making capital investments in nursing schools, faculty, and preceptors. TNA is advocating for a significant increase in funding to this program, recommending a minimum of $65.5M in appropriations for the expansion of nursing education.

THE NURSING FACULTY LOAN REPAYMENT ASSISTANCE PROGRAM (NFLRP)

This program increases the number of faculty available to teach students by repaying faculty members’ student loans. Loan repayment helps bal ance salaries between educators and clinicians, which relieves the financial disincentive that sometimes prevents nurses from serving as faculty. TNA rec ommends the Legislature appropriate for the NFLRP an amount equal to 10% of the amount appropriated for the NSRP.

The Nursing Faculty Loan Repayment Assistance Program increases the number of faculty available to teach students by repaying faculty members’ student loans thereby relieving the financial disincentive that sometimes prevents nurses from serving as faculty.

TNA is advocating for a comprehensive workplace violence prevention bill. This legislation protects nurses from retaliation for reporting violent incidents, facilitating cooperation with law enforcement, and requiring standardized protections for nurses at healthcare facilities.

practice, should not be criminalized. TNA is advocating for targeted reforms to the disciplinary process to protect nurses from overzealous disciplinary authorities.

REMOVING BARRIERS FOR APRN PRACTICE

TNA is advocating for the removal of regulatory barriers to APRN practice. TNA recommends increasing access to care for Texans by removing needless barriers to practice for APRNs, such as delegation agreements.

THE NURSING INNOVATION GRANT PROGRAM (NIGP)

This program promotes innovation in the education, recruitment, and reten tion of nursing students and qualified faculty. Past awards have been used to fund simulation and skills lab capacity among institutions of higher education in Texas. This biennium’s round of grants could be used to expand simulation and clinical space, which would help clear out a potential bottleneck in the nursing education pipeline. TNA is advocating for a four-year extension of this program, which draws funds from the Texas To bacco Lawsuit Settlement Fund.

WORKPLACE VIOLENCE PREVENTION

TNA is advocating for the passage of a comprehensive workplace violence pre vention bill. This legislation is designed to address the high rates of workplace vio lence against nurses in healthcare facili ties by protecting nurses from retaliation for reporting violent incidents, facilitat ing cooperation with law enforcement, and requiring standardized protections for nurses at healthcare facilities.

JUST CULTURE AND A CULTURE OF SAFETY

TNA is advocating for changes to Texas’ disciplinary system in response to the Ra Donda Vaught case in Tennessee and similar cases in the country. The prac tice of nursing, and human errors in that

SCHEDULE II PRESCRIPTIVE AUTHORITY

TNA is advocating for statutory reforms that would allow APRNs and PAs to pre scribe schedule IIs under any circum stance and repeal the current carveout for hospital facility-based practices and hospice care.

TNA is advocating for the removal of regulatory barriers to APRN practice. TNA recommends increasing access to care for Texans by removing needless barriers to practice for APRNs, such as delegation agreements.

REMOVING BARRIERS FOR CRNA DENTAL PRACTICE

TNA is advocating for Legislative cor rection of overly restrictive permitting requirements adopted by the Texas State Board of Dental Examiners that have had the unintended consequence of also limiting the CRNA’s ability to pro vide dental anesthesia care. The Texas Legislature should remedy this by remov

Congratulations Congratulations

Awarded for his exemplary service as a peer reviewer of the Journal for Nurse Practitioners.

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.

BECOME AN

Find a way to engage that works for you!

Issue advisors are TNA members who volunteer their time for short opportunities. You could be an expert on a topic, have lived experience, or simply have a personal interest. Previous issue advisors have helped create policy documents, write practice articles, or develop mobile content.

Volunteer for what you are comfortable with. Think that TNA has missed an opportunity to address a particular health issue, nursing practice topic, or a social issue? Tell us, and help us meet your needs and the needs of the modern Texas nurse.

JNP Reviewer of the Year

Kenneth P Miller, PhD, MJ, RN, CFNP, FAAN, FAANP

ing the requirement that dentists have a permit when the CRNA provides care. This change would increase access to care by ensuring those dentists without permits are still able to treat patients who need anesthesia.

QUICK-RELIEF BREATHING MEDICATION AT SCHOOL

TNA is advocating for changes in Texas law that would align with national stan dards allowing school nurses to admin ister albuterol to students reasonably suspected to be exhibiting signs of respiratory distress. Currently, Texas law only allows unassigned albuterol to be administered to children with a written diagnosis of asthma. The state should amend its laws to align with national standards and ensure that students have access to this life-saving medication, regardless of whether they have an asth ma diagnosis on file with their school.

TNA is advocating for Texas to submit a State Medicaid Plan Amendment to CMS that would allow schools to bill Medicaid for services provided to students enrolled in Medicaid. This change would be budget-neutral for the state, and the matching funds would be available for behavioral health services.

bill for any service provided to a student who is enrolled in Medicaid. So far, 17 other states have taken advantage of this opportunity. This change would be budget-neutral for the state, and the matching funds would be available for behavioral health services as well. The legislature should instruct the Health and Human Services Commission to make this change in the upcoming legislative session.

TNA and its allies in NLAC continue to monitor emerging issues and recognize the need to be vigilant and adap tive as new issues arise. In addition to advocating for the issues listed above, NLAC will defend against bills that harm nurses’ interests or the health interests of the public. As issues arise, they may be incorporated into the nursing agenda. We’re always interested in hearing what impacts nurses on the front lines, so please continue sharing your thoughts and experiences with us, even if they do not fit neatly into our existing agen da. We will continue to take input from nurses until procedural deadlines force us to stop. We are at our best when we work together. i

Jack Frazee is TNA's Director of Government Affairs and General Council.

SCHOOL NURSING SERVICES FOR TEXAS STUDENTS

TNA is advocating for Texas to submit a State Medicaid Plan Amendment to CMS that would allow schools to bill Medicaid for services provided to students enrolled in Medicaid. Prior to a rule change by CMS in 2014, schools could only bill Medicaid for special edu cation students who had such services written into their IEP. Now, schools can

Fortifying the Profession

How Savvy TNA Members and Staff Improved the Environment for Texas Nurses

By Lisa Maxwell, TNA Staff

THE YEAR IS 1987. The first Simpsons car toon has aired as a short on the Tracy Ullman show, neon colors compete with big shoulder pads and even bigger hair for fashion statement of the year, and in a few months, Ronald Reagan will challenge Gorbachev to “tear down that wall.”

Susan Jones worked on a cardiac care unit and loved her job. However, one day she was sleep deprived and her unit was understaffed. In her rush to see all her patients she mixed up two charts and accidentally gave the wrong medi cation to a patient. Reporting this to her supervisor would result in a referral to the Board of Nursing. Fearful for her license, she said nothing. Fortunately the patient was okay.

Soon thereafter, the Professional Nursing Quality Assurance Act passed into law. This mandated the reporting of errors in nursing practice, for the protection of patients. It also provided for the creation of the nursing peer review process in Texas, one of the first states to enact the policy. This allowed healthcare institu tions the opportunity to investigate errors themselves and more importantly, look at their systems and processes to identify what had caused the mistake. It also provided protection for nurses who may have made those errors.

Flash forward to 1997. Susan has been growing out her hair (“The Rachel” was becoming outdated), and later that summer she would be stunned by the death of Princess Diana. And, although she had become a more seasoned nurse, she was surprised when – in an effort to address a shortage of nurses –the hospital assigned her to the NICU, where she was to care for the most deli cate of preemies.

She spoke with her supervisor, express ing her sincere concern that she would not be able to provide adequate care

for these patients and asking for an other assignment. Unfortunately she was forced to work the 12-hour shift under duress, scared that she might make some small error that harmed a child. Soon, however, Susan would have another way to protect herself as TNA pushed for the passage of Safe Harbor Protection. This is just one instance where TNA made a difference in the practice of Texas nurses.

Over the decades, TNA has been a key player in such legislative wins as the 1986 establishment of the Texas Peer

Assistance Program for nurses, which provided a way for nurses to keep work ing while dealing with issues of mental wellbeing and substance use disorder, and the 2009 Hospital Safe Staffing law, which required the nurse staffing committee to be a standing commit tee, responsible for evaluating the

In 2011, TNA was instrumental in the passage of SB 192, also known as a whistleblower law, which enhanced protections for nurses advocating for their patients. This was sparked by the case of two nurses in Winkler County, TX, who were terminated and indicted for reporting a physician to the medical board.

ABOVE: Clair Jordan, Ruth Stewart, Jim Willman, Betty Skaggs, Representative Rob Bird and others watch Governor Bill Clements enact changes to the Nursing Practice act in 1979.

Much of TNA’s legislative success in the 80s and 90s can be attributed to the vision of TNA’s longtime executive director Clair Jordan, who passed away in September 2022.

LEFT: Clair Jordan

adequacy of a facility’s staffing plan and reporting to the hospital board the results of its evaluation, ensuring that nurses have a strong voice in hospital staffing policies.

In 2011, TNA was instrumental in the pas sage of SB 192, also known as a whistle blower law, which enhanced protec tions for nurses advocating for their patients. This was sparked by the case of two nurses in Winkler County, TX, who were terminated and indicted for report ing a physician to the medical board.

Much of TNA’s legislative success in the 80s and 90s can be attributed to the vi sion of TNA’s longtime executive director Clair Jordan, who passed away in Sep tember 2022.

“Clair understood where nurses needed to go and how to get there,” said Jim Willman, TNA’s longtime government affairs director, who worked alongside Clair and TNA members to shepherd leg islation through about their legacy. “She

continued on page 23

“Clair understood where nurses needed to go and how to get there,” said Jim Willman, TNA’s longtime government affairs director, who worked alongside Clair and TNA members to shep herd legislation through about their legacy. “She had the ability to set and work toward long-term goals but was also ready to take advantage of opportunities when they presented themselves.”

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Without TNA

There would be fewer whistleblower protections.

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No right to request safe harbor.

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No nursing peer review.

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No safe patient handling policies to minimize manual lifting.

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No peer assistance program for nurses.

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Use of the title “nurse” would not be limited to RNs and LVNs (but open to veterinary personnel as well.)

BELOW: Clair Jordan, Lettie Lee and Betty Skaggs receive a proclamation from Governor Mark White.

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The board of nursing might not be an independent agency but wrapped up in the medical board.

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RNs would not have the authority to declare death.

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APNs would not have Prescriptive Authority and may not even be recognized.

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Nurses would not have the right to obtain a patient’s test results after an accidental exposure to Hepatitis C or HIV.

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There would not have been consistent focus on funding to reduce the nursing shortage in every session since 2001. This includes $55+ million dollars to nursing schools to increase enrollment and establishment of the Center for Nursing Workforce Studies.

HEALTH + CARE HOW INVESTING IN NURSES’ WELLBEING CAN LEAD TO STRONGER, SAFER WORKPLACES

By Roland Rodriguez, LCDC

A HEALTHY WORKPLACE takes care of the health and wellbe ing of their staff, and mental health care should be no excep tion. In a time of flux and burn out, when many nurses are either leaving the bedside or the profession, and many more are seeking different avenues of support, it’s important to have systems in place to offer nurses a way forward towards both physical and mental wellness.

When employers invest in their nurses, it benefits the work place, the nurses, and their patients in a cycle that continues towards the better. And one of the best ways for a workplace to invest in their nurses—and in so doing, the nursing profes sion—is by creating and fostering a culture that promotes wellbeing, self-care, and recovery.

As most investments do, seeing the return may take time, but will certainly be worth it, for the benefit of all involved— including patients, the health care industry, the nursing profession and the public at large. Your employees are worth the extra effort.

NURSES HELPING NURSES

If you are a nurse leader, some questions to ask yourself may be: Are we doing enough to invest in our staff’s personal and professional development? Are we setting clear expectations for each role? Are we prioritizing and promoting work-life bal ance? Are we talking about sensitive topics such as substance

If you are a nurse leader, some questions to ask yourself may be: Are we doing enough to invest in our staff’s personal and professional development? Are we setting clear expectations for each role? Are we prioritizing and promoting work-life balance? Are we talking about sensitive topics such as sub stance use disorders or mental illness?

use disorders or mental illness? Are we prepared and educated regarding the topic of substance use disorder, mental illness, burnout, and recovery? Do we have a policy in place that ad dresses, and outlines substance use disorder?

Investing in a nurse can include offering recourse in recovery from a substance use disorder or mental health condition. It can be a rewarding experience to help someone put the pieces back together on the road to recovery. The Texas Peer Assistance Program for Nurses hopes to have nursing employ ers throughout Texas to serve as local ambassadors to promote a culture that is life affirming and nurturing but with measured expectations. Supportive employers who invest in recovering nurses provide the grace and humanity necessary to embody the “Nurses Helping Nurses” slogan and help bring our recov ery-oriented vision to fruition.

SAFER NURSES, SAFER NURSING

TPAPN has a long history of helping nurses successfully re-enter practice. There is a very real fear among potential or current participants that no one will hire a nurse in a peer support program. However, among the common traits of the employers that are key to nurses in TPAPN having an opportunity to rees tablish safe nursing practices are that they are informed and proactive, ready to ask questions regarding the program and their prospective employee and communicating and gather ing the facts prior to making an informed decision on whether to hire them.

By taking the time to ask questions and find out more about the program, employers find that they are expected to treat the TPAPN nurse just like any other employee. The conditions under which they are participating in TPAPN is the nurse’s con dition; it is up to the nurse to manage it, no differently than if the nurse had diabetes.

I like to tell participants that in the almost nine years work ing with TPAPN nurses, I can count on my hand (and still have fingers leftover) the number of participants unable to find em ployment while in the program. The fact is, there are numerous employers out there who believe in second chances and are willing to work with nurses participating in a peer assistance program.

These employers judge nurses not by their mental health condi tion or involvement in TPAPN but by their work performance, ethics in practice, punctuality, and behavior towards their pa tients. They let the nurses’ work speak for itself.

When a nurse expresses trepidation regarding finding work while in a peer assistance program, I attempt to highlight the numerous supportive employers I have encountered along the way who were ready to learn more about the balance between helping the recovering nurse and protecting patients, including through workplace accommodations. Not all of them had worked with nurses under monitoring before, but all were eager to learn how they could best support a nurse in recovery.

At the end of the day, safe and supported nurses mean safe and supported patients. Self-care, as often recommended, can only go so far. Structural change and support systems can help bear some of that weight.

A JOURNEY OF HEALING

Shame, guilt, and regret are often internal consequences of addiction or mental health conditions. These can become

On

level,

I like to tell participants that in the almost nine years working with TPAPN nurses, I can count on my hand (and still have fingers leftover) the number of participants unable to find employment while in the program. The fact is, there are numerous employ ers out there who believe in second chances and are willing to work with nurses participating in a peer assistance program.

an institutional

providing an environment wherein recovery and healing is possible can lead to a stronger, healthier, and better functioning work place all around.

HEALTH + CARE

How Investing in Nurses' Wellbeing Can Lead to Stronger, Safer Workplaces

continued from page 21

internalized, leading to self-stigma—negative beliefs that are adopted from societal stigma—that are then amplified by the misinformation that surrounds substance use disorders and mental illness. Recovery is possible, and the support is there, especially when leadership also believes in the support and rehabilitation of their staff.

On an individual level, if one does the work, especially invest ing heavily in one’s early recovery, the benefits far exceed any perceived benefit the addiction provided. And on an institu tional level, providing an environment wherein recovery and healing is possible can lead to a stronger, healthier, and better functioning workplace all around. Although the investment may at times feel unpredictable, helping a nurse regain a sense of wellbeing and professional pride can be life-renewing and rewarding. i

Roland

Nurses Helping Nurses

If you, a coworker, or a family member need help with a substance use or mental health issue, call the Texas Peer Assistance Program for Nurses. TPAPN case managers provide guidance, support, and monitoring to help nurses recover and maintain their licenses. And TPAPN peer advocates provide an empathetic listening ear. You and those you care about are not alone!

www.tpapn.org

Rodriguez, LCDC, is the Case Management Team Lead at the Texas Peer Assistance Program for Nurses.

FORTIFYING THE PROFESSION

How Savvy TNA Members and Staff Improved the Environment for Texas Nurses

continued from page 19 had the ability to set and work toward long-term goals but was also ready to take advantage of opportunities when they presented themselves.”

Jordan broke down barriers at the Capi tol, developing a solid working relation ship with then-speaker of the house Billy Clayton and opening doors for women lobbyists.

“She was good at building relationships,” said Willman. “She became personal friends with the heads of TMA and THA be cause it was easier to negotiate as friends and work toward win-win situations.”

She also wisely allied TNA with other non profits, like the Texas Association of Com munity Health Centers, that were con sidered “white hats” by legislators due to being easy to support because they were for the public good and noncontro versial. This alliance cleared the way for more APN practice authority because

those centers could not afford physicians full time. “In order to support the com munity health centers, you had to let the APNs do the work,” said Willman.

As we move toward the opening of the 88th legislative session, TNA is again working hard to build alliances with other nursing and healthcare organi zations on issues of common concern. “Legislators like to see groups coming together instead of fighting each other,” Willman said. “It makes their job easier when all the parties agree on what they are asking for.”

“Clair understood that and was able to accomplish a lot,” said Willman. “But she also had the help of very savvy TNA members like Betty Skaggs and Ruth Stewart and Alexia Green who would lobby and testify and be in contact with legislators outside of the session. You can’t overstate the importance of that.” i