Texas Nursing 2024 Issue 4

texa s nu r s e s .o rg

TEXASNURSING M A G A Z I N E Gaining

TRACTION WHERE WE'VE BEEN AND WHERE WE'RE GOING FROM CODE BLUE

TO CODE YOU A RAPID RESPONSE TO REVIVE YOUR TEAM'S WELLBEING

A PERSONAL ACCOUNT OF LIFE-ALTERING NURSING A Medical Malpractice Lawyer Gets Leukemia 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 4

ISSUE 4, 2024 Volume 98, Number 4 EDITOR IN CHIEF: Serena Bumpus, DNP, RN, NEA-BC MANAGING EDITOR: Darrick Nicholas COPY EDITORS: Natalie Hill, Gabi Nintunze

BOARD OF DIRECTORS OFFICERS: Amy McCarthy, DNP, RNC-MNN, NE-BC, CENP, President Joyce Batcheller DNP, RN, NEA-BC, FAONL, FAAN, Past President Gloria Lorea, DNP, RN, NEA-BC, Treasurer

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

Missam Merchant, MBA, BSN, RN, CENP, CCRN-K, PCCN, CV-BC, GERO-BC, MEDSURG-BC, NE-BC, Secretary DIRECTORS: Kit Bredimus, DNP, RN, CNML, NE-BC, CENP, NEA-BC, FACHE, FAONL, FNAP

Empowering Texas Nurses to advance the profession

Lucindra Campbell-Law Ph.D., APRN, ANP, PMHCNS, BC Patricia “Pat” Francis-Johnson DNP, RN, CDP – Lubbock Edtrina Moss, Ph.D., RN, NE-BC, AMB-BC, LSSGB Mary Vitullo, MBA, MSN, RN, CV-BC, PCCN, NE-BC, CLSSBB

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.

LVN REPRESENTATIVE Adam Ramirez, LVN, WCN-C, IV-C CHIEF EXECUTIVE OFFICER: Serena Bumpus, DNP, RN, NEA-BC

TNA DISTRICT PRESIDENTS Dist. 1:

Sarah Yvonne Jimenez, PhD, RN, syspellings@gmail.com

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.

Dist. 3:

Christopher Rougeux, MSN, RN, NEA-BC, crougeux99@gmail.com; District office: Jamie R. Rivera, JamieRivera@texashealth.org

Dist. 4:

Robert Castillo D.N.P., M.H.A., RN, CCRN, R.T.(R)(T)(ARRT), tnad4.nursingnetwork.com;

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Terry Throckmorton, Ph.D., RN, tathrockmorton@gmail.com District office: tna9@tnadistrict9.com, tnadistrict9.com

Dist. 17:

Renae Schumann, Interim Volunteer President renaeschumann20@gmail.com

Dist. 18:

Rebecca Clark, DNP, RN, CNE, MEDSURG-BC, rebecca.clark@ttuhsc.edu

POSTMASTER Send address changes to TEXAS NURSING, 4807 Spicewood Springs Rd., Bldg. 3, Suite 100, Austin, TX 78759-8444.

Dist. 19:

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Dist. 35:

Karen Koerber-Timmons, Ph.D., RN, CLNC, CNE, NEA-BC, CCRN, RN-BC, mkkoerbertimmons@gmail.com

ARE YOU MOVING? Need to change your address? If so, provide it quickly and easily in the Members Only section of the TNA website, texasnurses.org.

Or mail your new address—at least six weeks prior to your move— to Texas Nurses Association headquarters. We’ll make sure your TEXAS NURSING makes the move with you.

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

TEXAS NURSING is indexed in The Cumulative Index to Nursing and Allied Health Literature and in the International Nursing Index.

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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 2024 © Texas Nurses Association

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DISRUPTIVE

HEALERS

By Stephanie H. Hoelscher, DNP, RN, NI-BC, AIMP, CPHIMS, CHISP, FHIMSS

10

From Code Blue to CODE YOU

18 A Medical Malpractice Lawyer

Gets Leukemia

A Personal Account of Life-altering Nursing

By John Polewski

26

By Phyllis Mortin MSN, RN, SD and N. Tamara Ramirez MASF, BSN, RN, SD

Contents IN EVERY ISSUE

ARTICLES AND FEATURES

5

8

22

PRESIDENT’S NOTES

CEO CORNER

TNA'S PRIORITIES FOR THE 89TH REGULAR SESSION

Nurses: A Powerful Voice for Change

7

The Power of Engagement

By Serena Bumpus, DNP, RN, NEA-BC

TNA MEMBERS GET FREE CNE tna.ce21.com Our growing online catalog is your one-stop shop for continuing education! Explore dozens of modules relevant to your practice and current nursing issues, and stay tuned as more are added.

Legislative Update

By Jack Frazee, J.D.

TNA MEMBER NEWS Kudos In Memoriam

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President’s Notes Amy McCarthy, DNP, RNC-MNN, NE-BC

NURSES: A POWERFUL VOICE FOR CHANGE HELLO TEXAS NURSES! This edition of Texas Nurses magazine marks our final one under the theme of “Gaining Traction: Nurses Driving Change” This theme perfectly reflects the journey the Texas Nurses Association has been on this past year. We are seeing the signs of an association moving forward with intentionality and purpose, creating spaces that are inclusive and welcoming to all Texas nurses. Over the past year, we've seen new faces at our events and meetings, more energy in our districts, and a sharing of ideas across our states. Nurses are becoming more engaged and are realizing the power of their voice at decision-making tables. They are seeing how united they can be in creating better spaces for themselves and their patients. Nurses are feeling empowered to have the hard conversations that spark change.

Self-efficacy—believing in oneself—is crucial in our evolution as a profession.

To enact real change, we must first believe that we have the power and knowledge to do so. It takes courage and perseverance to speak up, especially when we may be the only nurse at the table. It can mean facing judgment, isolation, and discomfort. Yet, it's essential.

Over the past two months, I transitioned into a new role as Chief Nursing Officer at a healthcare tech company. Often, I find myself as the only nurse—often, the only woman—in the room. While I am no stranger to advocacy, I admit there have been moments where I have hesitated to insert myself into conversations. But in those instances, I have had to remind myself that when I speak up, I

am speaking up for nursing, and for safe patient care. Advocacy becomes even more crucial in these spaces – failure to engage and share clinical expertise can lead to products and solutions that increase clinician burden and cause potential harm to patients.

Every day, I remind myself to lean in, to learn, and, most importantly, to listen.

Change takes time, and many industries don’t have a good understanding of what nursing truly encompasses. Nurses are not just people in blue scrubs—we are innovators, scientists, advocates, and community experts. We have a unique perspective and understanding of populations, operations, and workflow. This experience is invaluable in reinventing our healthcare systems.

As intimidating as it can be to stand up and speak out, the only way to create more inclusive healthcare systems, is to participate in their re-development. We cannot sit back and expect someone else to take care of it.

As we continue building momentum, it’s important that we also focus on the internal work required to grow as a profession. Too often, we focus on our differences instead of what connects us.

With over 4 million nurses in the U.S., we could be a powerful force for change if we supported one another and opened ourselves to different viewpoints. Every voice at the table—whether a nurse in a hospital, industry, academia, or community—has a role to play. The more diverse the table, the more inclusive the solution.

With over 4 million nurses in the U.S., we could be a powerful force for change if we supported one another and opened ourselves to different viewpoints. Every voice at the table—whether a nurse in a hospital, industry, academia, or community—has a role to play.

The more diverse the table, the more inclusive the solution. of nursing. The compassion and empathy we show our patients must extend to those who may not fully understand what nursing is today. Just as we educate patients, we must teach the public about the true scope of our profession.

I challenge all of you to advocate not just at the bedside, but for nursing as a whole. We, as nurses, know the breadth of our roles and the impact we have— it’s crucial that the world understands this too. If we don’t tell our own story, we can’t blame others for misunderstanding our potential.

There may be many unknowns in the world, but one thing is certain: Texas nurses have the power to shape the future of healthcare, both in our state and nationally. It’s time we rewrite our narrative and move full speed ahead! i

We must also embrace perspectives from other disciplines and industries, recognizing our role in shaping the narrative

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TNA MEMBER NEWS SPOTLIGHT ON YOU KUDOS Congratulations to the following organizations for achieving the prestigious Pathway to Excellence designation and redesignation:

Congratulations to the following members for being named to Becker’s Hospital Review ‘2024 ‘CNOs to Know’:

Pathway to Excellence designation

Ascension Seton Smithville Pathway to Excellence redesignation:

HCA Houston Healthcare Northwest

Texas Health Presbyterian Hospital Kaufman

Texas Health Presbyterian Hospital Allen

Congratulations to Parkland Health in Dallas for receiving the ‘2024 ANCC Pathway Award’.

Congratulations to the following organizations for receiving ANCC’s Magnet designation and redesignation.

Magnet with Distinction designation:

Memorial Hermann Cypress Hospital Magnet with Distinction redesignation:

Memorial Hermann Texas Medical Center

Baylor Scott & White Medical Center-Waxahachie Congratulations to Linda Yoder, PhD, MBA, RN, AOCN, FAAN named Professor Emeritus after 17 years of dedicated service to The University of Texas at Austin School of Nursing.

Top Row from left:

Bottom Row from left:

Jim Allard, DNP, RN

Bryan W. Sisk, DNP, RN

Kit Bredimus DNP, RN

Gail Vozzella, DNP, RN

Carol Porter, DNP, RN

Jackie Ward, DNP, RN

Karla Ramberger, DNP, RN

Tammy Webb, PhD, RN

Mary Robinson, PhD, RN

Heidi Wolf, MSN, RN

Congratulations to Donna Beecroft, MSN, NE-BC, RN, VP named to Women We Admire’s ‘The Top 50 Women Chief Nursing Officers of 2024’ list.

Congratulations to Cole Edmonson, DNP, RN, NEA-BC, FNAP, FACHE, FAONL, FAAN appointed Chief Executive Officer for the Nurses on Boards Coalition.

Congratulations to Kit Bredimus, DNP, RN, CNML, NE-BC for being awarded the Texas Tech HSC Distinguished Alumni Award.

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IN MEMORIAM TNA would like to offer its condolences to the family of longtime member Karlene Kerfoot, PhD, RN, FAAN who passed away earlier this month. 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.

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CEO Corner Serena Bumpus, DNP, RN, NEA-BC

THE POWER OF ENGAGEMENT

Bringing Nurses Together in Meaningful Ways JANUARY 2024 FEELS LIKE A LIFETIME AGO. As I reflect on the last year, I can’t help but feel a sense of pride in what TNA has accomplished and excitement for what’s ahead in 2025. The engagement we’ve seen from our members and their enthusiasm for TNA has contributed greatly to our successes.

Our five-year strategic plan was developed two years ago with a vision to create meaningful ways to re-engage current members and add new members.

In 2023 we launched the five-year plan and focused on laying the foundation for engagement. This foundation set us up to begin 2024 with a plan to execute.

A LOOK BACK ON THE FOUR PILLARS

Sustainability The Sustainability pillar’s objective is to demonstrate organizational excellence through stewardship of human, fiscal, organizational, community and environmental resources. This requires fiscal responsibility, good governance structures and efficiencies, including operational resources, to be effective. In the last year, TNA was able to achieve a 15% reduction in the budget deficit and members voted to change the bylaws to allow for the development of competency-based board positions.

Membership Our objective is to grow membership by acquiring, engaging and retaining members through analysis of our value proposition, creating new partnerships, establishing new member categories, enhanced communication efforts and evaluating member benefits.

Did you know that there are 400,000 nurses in Texas and that less than 7% of Texas

nurses are members of a professional nursing organization. When you break that down to TNA membership, less than 3% of Texas nurses belong to TNA. That is a huge gap in my mind, and we are heavily focused on growing TNA membership each year by 5%. While we did not fully reach this goal in year 2, we did make significant progress. Our goal was 16,480 members and we ended the year with 16,119. In January 2024, we launched state-only LVN membership and will end the year with 69 LVN members.

We also hit the road to engage with our members and potential new members across the state. We traveled to Lubbock, Amarillo, El Paso, Midland, Odessa, Brownsville, Harlingen and Corpus Christi.

We engaged approximately 1,000 nurses and hundreds of nursing students.

Other foundational work was done in this pillar to prepare for a late 2024/early

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25 launch of a student nurse hub, evaluation of member benefits, new member orientation sessions and media training.

Policy While policy work is a large portion of what TNA does, it’s important that nurses engage with us in this process. The objective is to advance the quality and safety of patient care through policy initiatives that optimize professional nursing practice environments and promote the use of the knowledge and skills of nurses. We are specifically focused on our legislative initiatives, building coalitions, engaging members and building relationships with stakeholders.

In the last year, we have spent a great deal of time preparing for the upcoming 89th legislative session. This required engagement with various stakeholders to discuss policy issues that impact nurses.

Stakeholders included health systems

plus the growing Nursing Legislative Agenda Coalition. The Policy Council and its subcommittees have been creating policy positions for the coming year. We are also preparing to launch the Capital Nurse Corps in anticipation of the session. Learn what it means to advocate and where to start by taking our Advocacy education series in our learning management system. Last, we created the Nursing Student Policy Summit where we educated hundreds of nursing students on the value of being engaged in advocacy early.

We increased the number of poster presentations and added podium presentations at the annual conference.

TNA engaged in partnerships with the Special Olympics, March of Dimes and Red Cross to create local community engagement opportunities for nurses.

We developed an outreach toolkit for public speaking and community engagement.

We partnered with for-profit organizations to offer nurses gifts and discounts during nurses’ week.

TAN honored the Leaders and Legends of Texas Nursing and the Outstanding 25 Texas Nurses of 2024 at the Celebration Gala during the annual conference.

Profession TNA is uniquely positioned and poised to guide and lead nursing in Texas. Our objective is to optimize TNA’s ability to lead the advancement of the profession through engagement with nurses and others. This requires us to focus on our education, events, publications, recognition and the products and programs offered.

We achieved a lot in this pillar last year!

TNA embarked on our organizational DEIB journey in January and launched the DEIB committee in July.

We developed a workplace violence implementation toolkit in partnership with the Texas Hospital Association.

TNA increased educational offerings in our online Learning Management Center by 20 learning activities.

We launched a mentorship program for TNA members.

We increased the number of in-person Nursing Peer Review Workshops.

TNA exceeded our goal for annual conference registrations with 421.

WHAT’S ON THE HORIZON? Great opportunities for additional growth are in our sights. We will continue to focus on fiscal responsibility and a balanced budget. TNA is on target to reduce the budget deficit by 20% while also developing plans to diversify our revenue streams.

We head into 2025 with a goal to increase membership by 5% which will get us to 16,925 members. At the time of this writing, (October 2024), we sit at 16,345 members. We have 580 to go in order to reach our goal by June 30, 2025! In addition to adding new members, we are also focused on member retention. On average, we lose around 300 members a month. Over 50% of that loss is attributed to bad credit cards on file or those on the annual renewal cycle who forget to renew their membership. You can help us

exceed our goal by making sure you are renewing your membership in a timely manner and updating your credit card when you get a new one. Our goal is to reduce member turnover by 5% this year.

Our goal is to increase LVN membership to 120 members. We think this is achievable by engaging LVN programs and employers of LVNs. Consider gifting an LVN membership—it’s only $60 annually or $5.50/month!

Are you a new member or have been a member for a while but never really taken advantage of your membership?

Join us for one of our monthly membership orientations to learn more.

The 89th legislative session begins January 14. We are busy preparing to ensure a successful session for nurses. Please join us for Nurse Day at the Capital on March 3-4 in Austin. In 2023, we had 600+ nurses join us. They made a huge impact on our success. We hope to see 800 at Nurse Day in 2025!

Did you miss our annual conference last year? Having a little bit of FOMO as a result? Attend our 2025 conference in Austin June 5-7! This year’s theme is "The Power of Us. Advancing our Profession Together." The call for abstracts is now open and will close December 1.

In 2024, we exceeded our attendance target and in 2026 we hope to do the same with 600 attendees! Make a plan to attend. Registration is open!

Thank you for being a member of TNA! Our members make TNA an amazing organization. If you have an idea for how we can continue to capitalize on our success and appeal to a wider audience, please send your ideas to tna@texasnurses.org. I hope to see you soon! i

THE UNIVERSITY OF TEXAS MEDICAL BRANCH A Reputation for Excellence!

As a nationally ranked program, our teaching innovations result in graduates who are leaders in providing patient-centered care. Today, our vision continues to be our mission—to be the best in nursing education, research and practice in order to improve health for people around the world.

Programs Offered • Bachelor of Science in Nursing • Traditional BSN (on campus) • RN-BSN (online) • Master of Science in Nursing (online) • Certificate (online) • Doctor of Nursing Practice (online) • Doctor of Philosophy in Nursing (online)

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DISRUPTIVE HEALERS How Texas Nurses Can Navigate the AI Frontier

By Stephanie H. Hoelscher, DNP, RN, NI-BC, AIMP, CPHIMS, CHISP, FHIMSS

AS TEXAS NURSES CONTINUE TO ADAPT to the evolving technological landscape of healthcare, a new “digital health” player has fully emerged: Artificial Intelligence (AI). You might have heard the term ‘AI’ tossed around in webinars and conferences or seen it in the latest healthcare journals or podcasts. You might be experiencing the early stages of “AI fatigue,” having heard the term thrown around ad nauseam over the past two years. But what does it truly mean for you in the nursing profession? With all the other healthcare hot topics in the news, like virtual nursing, clinician burden, and the worsening nursing shortage, the AI explosion is proving to be a pivotal moment in history where healthcare and nursing will change forever. But will it be for the better?

In this article, we will discuss the basics of AI, breaking down its core concepts and exploring how it transforms nursing practice in the Lone Star State. Whether you are tech-savvy or just looking to increase your AI literacy, this introduction is your gateway to understanding how AI is reshaping the future of nursing.

UNPACKING THE BASICS Before diving into AI and clinical practice, the basics to consider are what AI is and how can nurses use it. Let us

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start by asking the former: What is AI? Through the National Artificial Intelligence Act of 2020, the definition provided to us is as follows: “The term ’artificial intelligence’ means a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations or decisions influencing real or virtual environments” (para. 2).

AI, specifically a subset called generative AI (GenAI), refers to computer systems that mimic human intelligence, human thought patterns, human speech, and human writing (amongst a few other human things). AI can analyze data, recognize patterns, and make decisions. GenAI can create content, such as text, graphics, music, or code, by learning from vast amounts of existing data (Hoelscher et al., 2024). GenAI, like OpenAI’s ChatGPT, is trained on profoundly large amounts of data (think trillions and trillions of data points) and is powered by large language models (LLMs). The LLMs can be used as predictors of patient outcomes for critical metrics such as readmission rates, mortality rates, and hospital-acquired injuries and infections (Siwicki, 2023). For Texas nurses, this means tools that can help with clinical decision-making, care plan development, electronic documentation, treatment planning, and

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patient care management by providing insights drawn from extensive patient data. See Figure 1 for more key AI concepts and applications.

THE IMPACT OF AI ON NURSING PRACTICE One of the most significant impacts is already underway, though nurses might not yet realize it. Several electronic health record (EHR) vendors, such as Epic and Oracle Cerner, are already working on using GenAI within their platforms and patient portals to help improve patient care, clinical workflow, and decision-making (Bruce, 2024a; Nelson, 2023). This includes multiple Texas health systems. Joining forces with GenAI vendors (e.g., Google, OpenAI, Microsoft), the integration of AI functionality in healthcare is expanding rapidly. This is beyond the daily clinical decision support (CDS) nurses use within EHRs, such as “pop-ups” or reference text. The goal is to enhance the overall end-user (clinician) experience by integrating a more natural language into the EHR conversation, automating administrative and repetitive tasks, and sometimes even providing AI-dictation services—or what we would call ambient listening applications (Bruce, 2024b; Galloway et al., 2024; Nelson, 2023; Shah, 2023).

Vendors are also working on using GenAI for burden-reduction issues like inbox maintenance, which is often the bane of both physicians’ and nurses’ existence. Using the natural language processing (NLP) ability of GenAI—well-written, easy-to-understand, and applicable responses could be written for patient questions via a patient portal. After the clinician reviews and amends the AI output, the message could then be sent to the patient. Another popular, time-saving functionality is the speedy review and summarization GenAI can provide nurses regarding the contents of a patient’s chart. At the touch of a button, GenAI could crawl through the entire patient record and review the latest and greatest regarding your patient’s current health status—as succinct or detailed as you need. In less than five seconds, laboratory results, radiology reads, provider notes, and messages—you name it—GenAI can create a report for your viewing pleasure.

PATIENT EDUCATION Speaking of patient portals, another usage of GenAI that nurses would find of great benefit while helping to address health literacy is the ability for patient education to be translated into a more digestible, easy-to-understand version

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BENEFITS TO NURSES AI-enabled devices, sensors, and wearables also allow for continuous remote monitoring of patient’s health status, leading to early identification of issues and interventions and preventing adverse events.

(Hoelscher et al., 2024). Cannot quite find the right words to explain a new diagnosis to a patient? Ask GenAI. Not sure how to put new medication instructions into the most straightforward terms for a young child? Ask GenAI. Have trouble effectively teaching wound care to a non-English speaking patient? GenAI can translate languages, too. Personalized, customized education and responses to patients’ questions will greatly enhance the patient experiences while lessening some tasks that often fall to nursing.

ations from the patient’s data, let you know, and suggest interventions and proactive care.

REDUCING BURDEN Burden reduction is one of the key areas where the nursing profession anticipates significant benefits from AI implementation, particularly in reducing overall administrative workload and electronic documentation. A few instances of burden reduction have already been mentioned, but here are a few more in-depth descriptions (Byrne, 2023; Hoelscher et al., 2024; OpenAI, 2024):

Documentation automation. Whether the AI is listening to nurses or providers talking to the patient and transcribing the conversation or creating a note based on data in the EHR for your review and approval, automation can help reduce “screen time” and allow nurses to get back to what we are there for, the patients.

Resource allocation. Nurse leaders can use GenAI to help with staffing shortages and finance reallocation. Texas facilities are also working to use it to help with supply chain issues.

Remote patient monitoring. GenAI can review remote device data and alert nurses if there is a critical status change in the patient’s condition. AI-enabled devices, sensors, and wearables also allow for continuous remote monitoring of patient’s health status, leading to early identification of issues and interventions and preventing adverse events.

Virtual nursing assistant. Not to replace nursing care, but to supplement as assistants, virtual AI-enabled nursing assistants can interact with patients, answer questions, provide advice (supervised), and help monitor symptoms remotely for home care.

Predictive models and analytics. Leaping beyond the traditional “sepsis alerts,” GenAI can scout out high-risk situ-

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With helpful tools like weekly usage reports and smart thermostats, TriEagle Energy gives you the power to take control of your electricity usage and save money month after month, year after year.

SMART Energy plans come with a smart Wi-Fi thermostat and Home Optimization which work together to increase energy efficiency in your home.

To learn more or enroll today, visit: trieagleenergy.com/tna

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Figure 1

All this and more, including the aforementioned CDS, personalized care plans, and patient education.

IMPACT ON NURSING EDUCATION EDUCATION FOR NURSES IN THE CLASSROOM Part of the issue with the nursing shortage is related to nursing education. Nursing schools have difficulty with having enough nursing faculty, which trends down to being able to educate the next generation of nurses. De Gagne (2023) discusses some of the concerns and controversies surrounding the adoption of AI in nursing education. An essential worry with utilizing AI tools like GenAI and chatbots for academic purposes is their potential to unintentionally promote violations of academic integrity, ethics, and intellectual property rights. There are concerns about how students’ use of the advanced capabilities of these systems might lead to inappropriate copying or plagiarism without proper attribution (Anthropic, 2023; De Gagne, 2023; Sun & Hoelscher, 2023). Currently, there is no foolproof method

of detecting AI-generated writing (Sun & Hoelscher, 2023).

Educators have to make a tough decision on whether they support student use of GenAI with established parameters or are against it and are in the never-ending fight to try to catch students using it. Organizational policies and syllabi verbiage need to be updated or created. Many Texas higher education organizations already utilize AI-centric policies and syllabi to help faculty and students use AI in the classroom.

There are various other factors, good and bad, to consider in education. There is concern about protecting student privacy, as AI sometimes requires access to personal information. Ethical issues related to GenAI, data bias, lack of equal student AI application access, and blatant inaccuracies of AI output (such as hallucinations) can exacerbate existing inequities (De Gagne, 2023; Sun & Hoelscher, 2023). Not unlike using AI to personalize patient education, GenAI’s versatile functionality can assist with administrative work and facilitate customized plans to address each student’s learning requirements. By automating routine tasks, such as rubric development, grading,

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case scenario development, note-taking, and student progress tracking, nurse educators could gain time to focus on more complex teaching tasks requiring unique insight and expertise and that human, personal touch. AI technology can also create more sophisticated and complex simulations that:

Overreliance on AI technology. This is a big one. As with CDS, there is the potential to ignore AI recommendations. Alternatively, rely on them without thought. AI output should always be reviewed. This will be directly tied to one of the most essential nursing skills: critical thinking.

“…help nursing students develop critical thinking skills and prepare for real-world patient care situations. Such simulations can provide students with realistic scenarios that mimic patient care situations, allowing them to practice their clinical skills” and decision-making in a safe environment (De Gagne, 2023, p. 4884).

CDS/predictive analytics tools. CDS is not new, but AI-enhanced CDS is. Nurses already in the profession and those who work to keep them informed will benefit greatly by being proactive and transparent about new AI tools being introduced into the workplace.

Continuous learning. Nurses are lifelong learners. This will be another competency from here on out that you can add to your list of nursing skills to develop and maintain.

Overall, this helps to maintain your AI literacy.

Cool new toys. Finances permitting, this is an excellent opportunity to introduce new learning methods like simulation and virtual or augmented reality.

As GenAI becomes increasingly intelligent and well-trained, its abilities to provide realistic and engaging learning experiences will also be enhanced. The further development of GenAI’s capabilities will permit it to offer more detailed, life-like simulations and interactions for education.

EDUCATION FOR NURSES IN PRACTICE

THE GROWING ADOPTION OF AI IN TEXAS NURSING

Much of the focus of AI education has been on new nurses or the academic lens. Priority must also be given to bedside nurses or nurses already in practice. Recommendations do not differ too much from nursing student’s learning experiences. A significant shift will be to update your knowledge and stay up to date, which, of course, can be challenging. Some items to focus on for nursing professionals include (Glauberman et al., 2023; Hoelscher et al., 2024):

Improved AI literacy. At a minimum, it is vital to have a basic understanding of AI and AI tools being used at the workplace and their impact on professional and patient care.

Ethical use of AI tools. Working with nursing organizations to develop toolkits, policies, and overall guidance around AI usage (ANA, 2022).

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Nurses in Texas have often taken the lead on issues such as health information technology. This has been clear during the pandemic, with multiple efforts to help investigate and reduce the burden, including the Texas Nurses Association, Texas Organization for Nursing Leadership, and others (Holub & Giegerich, 2023; Hoelscher, McBride, et al., 2024; McBride et al., 2021; Padden, 2020). Between nurses exiting the workforce due to dissatisfaction and retiring, the shortage outlook does not look to improve soon. Aside from this, it is also important to note the issues with AI and its rapid development in healthcare. There are biased data issues, a lack of transparency with vendors and organizations, a lack of AI literacy with clinicians, and data

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SPONSORED CONTENT Sul Ross State University (SRSU) offers an RN to BSN program designed to empower registered nurses (RNs) with enhanced skills and knowledge to advance their careers in nursing. This program is tailored to meet the needs of working professionals, providing flexibility and accessibility through online coursework. In as little as 10 months and for an estimated total cost of just over $7,800, RNs can begin coursework in January, June or August.

The RN to BSN program at SRSU is structured to accommodate the busy schedules of nurses already in the workforce. With all courses available online, students have the flexibility to balance their studies with professional and personal commitments.

This format allows RNs from diverse geographic locations to pursue their BSN without needing to relocate or disrupt their current employment.

One of the key advantages of the RN to BSN program at SRSU is its focus on expanding the RN’s scope of practice. The curriculum is designed to deepen understanding in areas such as evidence-based practice, leadership, community health, and healthcare informatics. By integrating theoretical knowledge with practical applications, the program equips graduates to deliver high-quality patient care and take on leadership roles in various healthcare settings.

Faculty at SRSU are experienced professionals in the field of nursing, committed to supporting students throughout their academic journey. They bring real-world insights into the virtual classroom, fostering an engaging learning environment that encourages critical thinking and professional growth. Students benefit from personalized attention and mentorship, ensuring they develop the necessary skills to excel in their careers.

Moreover, the RN to BSN program emphasizes the importance of lifelong learning and professional development. Graduates are prepared not only to meet current healthcare challenges but also to adapt to future trends and advancements in the field.

This commitment to continuous learning enhances the value of the BSN credential and prepares nurses for advanced practice or graduate education if desired.

SRSU’s RN to BSN program welcomes students from various backgrounds and experiences, fostering a rich learning environment that promotes cultural competence and sensitivity in healthcare delivery. This holistic approach prepares graduates to serve diverse patient populations effectively and advocate for health equity.

In conclusion, SRSU’s RN to BSN program stands out for its flexibility, quality education, and commitment to preparing nurses for leadership roles in healthcare. By offering a convenient online format, a comprehensive curriculum, and dedicated faculty support, the program equips RNs with the skills and knowledge needed to advance their careers and make a meaningful impact in the field of nursing.

For more information about the RN to BSN program at Sul Ross State University, visit www.sulross.edu/rn-bsn, email nursing@sulross.edu or call 432.837.8337.

REMOTE NURSING CAREERS With Utilization Review-101, you’ll learn how to review patient care, determine medical necessity, and collaborate with healthcare teams—all from the comfort of home!

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A SHIFT IN THE PROFESSION “In the bustling hospitals of Texas, the Moxi robot and its counterparts are not just machines; they symbolize a paradigm shift in nursing care, offering a helping hand to the compassionate heroes in scrubs.”

Bruce, G. (2024a). What health system leaders think of Epic’s latest moves. Becker’s HealthIT. https://www.beckershospitalreview.com/ehrs/what-health-systemleaders-think-of-epics-latest-moves.html Bruce, G. (2024b). Mayo clinic, Epic collaborate on generative AI for nurses.

Becker’s Health IT. https://www.beckershospitalreview.com/ehrs/mayo-clinic-epiccollaborate-on-generative-ai-for-nurses.html Byrne, M. (2023). The disruptive impacts of next-generation generative artificial intelligence. CIN: Computers, Informatics, Nursing, 41(7), 479–481. https:// doi:10.1097/CIN.0000000000001044 De Gagne J. C. (2023). The State of Artificial Intelligence in Nursing Education: Past, Present, and Future Directions. International journal of environmental research and public health, 20(6), 4884. https://doi.org/10.3390/ijerph20064884 Fiore K. (2024). The language of AI: Defining the most common terms. Medpage Today. https://www.medpagetoday.com/special-reports/features/108692 Galloway, J.L., Munroe, D., Vohra-Khullar, P.D., Holland, C., Solis, M.A., Moore, M.A., & Dbouk, R. H. (2024). Impact of an artificial intelligence-based solution on clinicians’ clinical documentation experience: Initial findings using ambient listening technology. Journal of General Internal Medicine, 2024. https://doi. org/10.1007/s11606-024-08924-2

privacy/security issues to contend with—all impacting Texas very much this year alone.

So, without losing the “nurse” part of healthcare, how can we use technology to maintain and improve patient safety and outcomes while lessening the nursing burden? After asking a chatbot what they thought readers would want to know in the end about the future of AI in Texas healthcare, ChatGPT replied with the following (OpenAI, 2024): “As the sun sets over the Lone Star State, a new dawn in healthcare and education rises, powered by the relentless march of AI technology. In the bustling hospitals of Texas, the Moxi robot and its counterparts are not just machines; they symbolize a paradigm shift in nursing care, offering a helping hand to the compassionate heroes in scrubs.

Meanwhile, similar initiatives are redefining how nurses are trained, blending traditional care with cutting-edge simulation and AI. This fusion of human touch and artificial intelligence is revolutionizing patient care and opening doors to a world of AI-driven job opportunities. As Texas leads the charge, its educational institutions are equally dynamic, crafting new AI programs and curricula to equip the nurses of tomorrow. The future is here, and it is being written in the heart of Texas, where tradition meets innovation and where nursing care is being reimagined for a brighter, smarter world.”

I could not have said it better myself. i

Glauberman, G., Ito-Fujita, A., Katz, S., & Callahan, J. (2023). Artificial Intelligence in Nursing Education: Opportunities and Challenges. Hawai’i journal of health & social welfare, 82(12), 302–305.

Holub, M. & Giegerich, C. A. (2023). Decreasing the nursing documentation burden during the Covid-19 surge. Nurse Leader, 21(1), 38-41. https://doi.org/10.1016/j. mnl.2022.11.006 Hoelscher, S. H., McBride, S., Bumpus, S., Gilder, R. E., & Elkind, E. (2024). A Study to Determine Consensus for Nursing Documentation Reduction in Times of Crisis.

Computers, Informatics, Nursing: CIN, 10.1097/CIN.0000000000001180. Advanced online publication. https://doi.org/10.1097/CIN.0000000000001180 Hoelscher, S. H., Taylor-Pearson, K., & Wei, S. (2024). Charting the path: Nursing leadership in artificial intelligence integration into healthcare. Nurse Leader.

Advanced online publication. https://doi.org/10.1016/j.mnl.2024.07.011 McBride, S., Hoelscher, S. H., Bumpus, S., Mitchell, M. B., & Tietze, M. (2021). Crisis Documentation Strategies to Reduce Burden of Documentation During the Pandemic: Texas’ Pilot to Generate Consensus. Computers, Informatics, Nursing: CIN, 39(10), 524–526. https://doi.org/10.1097/CIN.0000000000000842 Nelson, H. (2023). How 4 EHR vendors are leveraging generative AI in clinical workflows. EHR Intelligence. https://ehrintelligence.com/features/how-4-ehrvendors-are-leveraging-generative-ai-in-clinical-workflows OpenAI. (2024). ChatGPT [Large language model]. https://chat.openai.com Padden J. S. (2020). Informatics X-Men Evolution to Combat COVID-19. Nurse leader, 18(6), 557–560. https://doi.org/10.1016/j.mnl.2020.09.005 Shah, B. (2023). eClinicalWorks brings ChatGPT and AI models into EHR and practice management solutions. Businesswire. https://www.businesswire.com/news/ home/20230417005291/en/eClinicalWorks-Brings-ChatGPT-and-AI-Models-into-EHRand-Practice-Management-Solution Siwicki, B. (2023). Generative AI can be applied to nearly every healthcare use case you can think of. HealthcareITNews. https://www.healthcareitnews.com/ news/generative-ai-can-be-applied-nearly-every-healthcare-use-case-you-canthink Sun, G. & Hoelscher, S. H. (2023). The ChatGPT storm and what faculty can do.

Nurse Educator, 48(3), 119-124. https://doi:10.1097/NNE.0000000000001390

REFERENCES ANA Center for Ethics and Human Rights [ANA]. (2022). The ethical use of artificial intelligence in nursing practice [Position statement]. https://www.nursingworld. org/~48f653/globalassets/practiceandpolicy/nursing-excellence/ana-positionstatements/the-ethical-use-of-artificial-intelligence-in-nursing-practice_bodapproved-12_20_22.pdf Anthropic. (2024). Claude 3 [Large language model]. https://claude.ai/chat/

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PROTECT YOUR PRACTICE A TNA Member Benefit

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

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

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

Don’t be caught without protection.

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As a malpractice lawyer I knew too much for my own good: It was apparent that I was dying.

IN MID-DECEMBER OF 2023, I was diagnosed with leukemia—a cancer of the blood which causes a spectacular proliferation of white blood cells. So many, in fact, that my blood became unable to carry sufficient oxygen, and became a “sludge” of white blood cells crowding out other blood components.

I had been short of breath for a couple of weeks, thought I may have had the flu or covid.

My PCP had a chest Xray done, but my lungs were clear. Then one morning I woke up with huge dark purple bruises all over my body, and even more trouble breathing. I called my PCP and he sent me to the ER at Baylor Medical Center in downtown Dallas. And he told me to pack a bag.

Uh oh.

PICKENS SEVEN There the diagnosis was made almost immediately with blood testing, and I was admitted to the Pickens Cancer Hospital on the Baylor campus for just under six weeks of treatment. First stop was the seventh floor, known as “Pickens Seven.” I came to realize in my time there how incredibly fortunate I was to get a place there, and to be cared for by those nurses.

They saved my life through the application of great skill, state of the art laboratory and blood centers, and most of all

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A Medical Malpractice Lawyer

Gets Leukemia

A Personal Account of Life-altering Nursing

By John Polewski

caring. Because none of the equipment or science or laboratory work—and none of the doctors, by the way—would have mattered a damn without the nurses who missed nothing, and cared so deeply.

As a malpractice lawyer I knew too much for my own good: It was apparent that I was dying. Much of my time on Seven I don’t remember clearly, but I do remember that the nurses were always exceptionally focused and thorough.

There was no chance, for example, of infection in my IV lines. No chance that I would miss my medications. No chance that I would have the wrong dose or type of chemotherapy infused.

No chance at all.

They were exceptionally knowledgeable about my disease and its treatment.

And exceptionally kind.

A DIFFERENT PERSPECTIVE Over my 30-plus years doing what I do, I have handled dozens of cases where people were hurt or killed because of poorly trained or apathetic nurses, and because doctors didn’t pay attention.

I know what good medical care looks like, and my clients have told me many times what bad medical care feels like.

I’m telling everyone what exceptional care feels like from my perspective: it feels calming, and warm and peaceful.

John Polewski

When four nurses and staff come into your room at four in the morning—every morning—and do things to and for you as a superbly drilled team, you can feel irritated at the loss of sleep and yet another blood draw and vitals check. But I knew exactly why they were there so early, and exactly why they were doing what they were doing.

single thing—that could be done to save me was being done. I always made sure to say “thank you” to the nurses and techs and make them know I meant it.

They were always surprised: I gather they deal with a lot of very crabby patients.

But these are patients without the proper perspective, people who don’t know what I know.

I felt such peace of mind and gratitude it is hard to express. I knew I was very sick. I also knew that everything--every

I knew then, and I know now, that everything they did had a purpose, and that purpose was to save my life. If you know

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that, and you know why they are taking your blood at four every morning, then it is really hard not to be grateful. It’s four in the morning for them, too, after all—and they are going to be just fine whether or not I get the platelets I need to survive another day.

I would talk to them and ask them how they got to be a nurse on Seven, and discuss how they felt about their time on Seven. Any patient who heard the answers couldn’t doubt that these were

people at war with blood cancer. At war, no exaggeration. I wonder how many patients ask.

At first, I needed a lot of care—blood products and medications every day all day and all night at first. Then I gradually got better. My mind, which had been dulled by the disease and the drugs, woke up again. I was able to eat normally again, and to start moving around with my IV pole instead of sitting all day.

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VOTED OFF THE ISLAND And one day, one of the nurses on Seven came to tell me it was time to go. I still needed to be in the cancer hospital, but they had saved me on Pickens Seven and now needed my place there to save someone else. Because that’s what they do on Seven: they are the frontline.

I didn’t like it. I joked about having been “voted off the island” like in the TV show “Survivor”. I knew they had saved me,

People ask me if it feels wrong to pursue medical malpractice cases involving poor nursing care after the spectacular care that saved me. I don’t think so. I saw what can be done. I live because nurses did their jobs right. and I knew that somebody else really needed my place, but...I didn’t like it.

“Off the island” wasn’t far away: just

one floor down on Pickens Six. I received more great care there, from other very professional and kind nurses. But the intensity of Pickens Seven was absent: I was going to live, everybody knew it, and they were getting me ready to go, not battling to save my life.

When I finally got out of the hospital two weeks later, I had two months of daily chemotherapy infusions at another building on the Baylor campus.

More kind and skilled nurses there, but this time I was better off than almost all the other patients around me. My infusions were unpleasant, but nothing like as bad as others I saw. And I was going to live.

As we sat in our recliners with various poisons infusing into our veins, I saw and spoke with people who pretty obviously were not.

It would have been so easy for me to die of my leukemia. If there hadn’t been a place for me on Pickens Seven. If even one of the dozens of nurses who cared for me had screwed up on sterile technique when the chemotherapy killed off all my white blood cells. If they hadn’t

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made sure I got platelets and blood when I needed them in the middle of the night. If, if, if.

WHAT HAS CHANGED? I’m back to work now, representing people who were hurt or lost a loved one due to malpractice. My time with leukemia has hopefully made me a better man. I am so much more grateful and appreciative for things and people now.

I am going to live. My daughter says I am giving off “positive energy” all the time. I hope so. I hope it lasts.

People ask me if it feels wrong to pursue medical malpractice cases involving poor nursing care after the spectacular care that saved me. I don’t think so. I saw what can be done. I live because nurses did their jobs right.

What nurses do is too important not to have a deterrent to bad performance.

The consequences of malpractice are too grave not to have an avenue to compensate those hurt by it. But know that nurses who do their best have nothing to fear from me or lawyers like me. i

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TNA's Priorities for the 89th Regular Session

By Jack Frazee, J.D.

IT’S THAT TIME AGAIN! We are heading into the 89th Regular Session of the Texas Legislature, and there are several exciting issues on TNA’s list of priorities.

This article will highlight the top issues we are asking the Legislature to address and will note some broader issues we are monitoring.

STAFFING In 2009, the Legislature enacted Chapters 257 and 258 of the Health and Safety Code, which are the nurse staffing statute and the prohibition on mandatory overtime for nurses.

These statutes are meant to work in tandem. By prohibiting mandatory overtime for nurses, the Legislature established a practical limit to how much hospital employers could ask their nurse professionals to work. That requires the hospital to use its nurse staffing committee to create policies and staffing plans to meet the needs of their patient population.

During the COVID-19 pandemic, we observed this system break down. The prohibition on mandatory overtime contains an exception that is triggered by a public health emergency. Typically,

that emergency would be brief (such as in response to a hurricane on the Texas coast). However, the pandemic meant we were in a state of public health emergency response for three years. As a result, nurses did not enjoy the labor protections they typically would enjoy for three years.

We have heard from our members that the staffing regulatory system broke down during this period and never got back on the right track after the public health emergency declaration was lifted. We will advocate for the Legislature to fix this broken regulatory system and ensure the laws on the books are properly enforced.

I encourage you to read our research and recommendations here.

EDUCATION FUNDING Last session, the Texas Legislature made the largest investment in nursing education in state history.

TNA advocated for significant improvements to nurse education funding programs and the Legislature responded in a big way.

Nurses in Texas now have access to

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TNA will advocate for dedicated scholarships, loan repayment, and grant programs to be funded to continue the effort to grow the nursing workforce, reduce the pressures of the nursing shortage, and ensure adequate access to nursing services for our growing population. dedicated scholarships, loan repayment to assist with student debt, and grant programs to stimulate innovative nursing education programs as well as prevent workplace violence.

The legislation that enacted all these new programs and restructured existing programs also created a new set of clinical education programs that were not funded in the state budget.

TNA will advocate for these programs to be funded to continue the effort to grow the nursing workforce, reduce the pressures of the nursing shortage, and ensure adequate access to nursing services for our growing population.

Nurses must be empowered to speak up when errors occur or healthcare systems break down.

When we empower nurses to speak up, we improve patient outcomes and ensure that errors are prevented for future patients.

You can read more about our education funding research and recommendations here.

PREVENTING THE CRIMINALIZATION OF MEDICAL ERRORS I suspect you have already heard about the RaDonda Vaught case and understand the concerns nurses are raising about the potential criminalization of practice errors.

For decades the healthcare industry has operated under an informal legal framework: Practice errors are addressed by licensing agencies while intentional harm to patients may be addressed by

PAC DONATION HAVE YOU MET THE $25 CHALLENGE YET? TEXAS NURSE PAC is the officially sponsored political action committee (PAC) of the Texas Nurses Association.

We contribute to candidates on both sides of the aisle.

Help TNA refresh its financial PAC resources to help candidates who support nursing and health care.

If every member donated just $25, we could have a fighting chance at the Capitol!

Give at texasnurses.org/PAC. Contributions to TEXAS NURSE PAC are not deductible as charitable contributions for federal tax income purposes.

Every once in a while we see a case like RaDonda Vaught’s where a practice error is treated the same as an intentional, criminal act toward a patient.

It is a dangerous precedent. Nurses must be empowered to speak up when errors occur or healthcare systems break down. When we empower nurses to speak up, we improve patient outcomes and ensure that errors are prevented for future patients.

We are advocating that this informal legal framework be codified in state law.

You can read more about our research and recommendations here.

BROADER TRENDS AND ISSUES In the past several months, Governor Abbott created a healthcare workforce task force to study opportunities to improve the use of government resources to grow the healthcare workforce in Texas.

The task force recently released its report and it includes a number of issues TNA considers priorities.

We expect this report to lead to the introduction of relevant legislation in the next session and will be monitoring and advising members of the Legislature on how to implement these recommendations.

If you become aware of legislation in the next session that you think TNA should be monitoring, please do not hesitate to contact our government affairs team and share your concerns.

We also continue to monitor a broad range of public health issues, women’s health issues, and access to care initiatives. If you become aware of legislation in the next session that you think TNA should be monitoring, please do not hesitate to contact our government affairs team and share your concerns.

Together, we will work to continue to improve the nursing practice environment and the delivery of healthcare in our state. i

TEXAS

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the criminal justice system.

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From Code Blue to CODE YOU 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 4

A RAPID RESPONSE TO REVIVE YOUR TEAM’S WELLBEING

By Phyllis Mortin MSN, RN, SD and N. Tamara Ramirez MASF, BSN, RN, SD, Co-Executive Directors of CODE YOU

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Take a second.

Reflect on your team.

Is anyone on your team coding? How would you know?

INTRODUCTION Imagine you’re working on a bustling surgical unit. It’s late, and the team is already stretched thin due to weekend staffing cuts. Suddenly, the dreaded announcement pierces the air: “Code Blue.” Adrenaline surges as you rush to the scene, where chaos reigns. The patient appears to have been unresponsive for a significant amount of time. A resident frantically performs compressions, shouting contradictory orders; nurses scramble for equipment, and a medical student struggles with the Ambu bag. You step in, attempting to bring order to the uproar and calling anesthesia for IV assistance. This scenario, all too familiar, underscores the critical importance of Code Blue training, where every second counts, and every action can mean the difference between life and death.

IDENTIFY, ASSESS, RESPOND What if the emergency isn’t a patient in cardiac or respiratory arrest? What if it’s a team member silently coding under the weight of trauma, compassion fatigue, moral injury, or burnout—a “Code You?” In this article, we invite healthcare leaders like you to consider being equally prepared to identify, assess, and respond to “Code You.”

IDENTIFY A CODE YOU

What if the emergency isn’t a patient in cardiac or respiratory arrest? What if it’s a team member silently coding under the weight of trauma, compassion fatigue, moral injury, or burnout—a “Code You?”

Consider the opening story. How effective was the Code Team? Consider your team. Would you know if someone was coding from compassion fatigue, burnout, or trauma? Reflecting on my (Tamara) experience as a hospice nurse, working 1700-0800, seven nights on and seven off while homeschooling my daughters, one struggling with self-harm and an eating disorder, I was overwhelmed and exhausted. One night, after a patient’s death, I did something I had never done before—I left a message for her daughter, notifying her of the death. I didn’t think twice about it until I was called into my supervisor’s office a few days later, where she told me a complaint had been made. I had no excuse; I knew it was terrible, and yet I felt numb. My heart still breaks for that family and the harm I caused. In retrospect, I can see that I was experiencing classic symptoms of what some might call compassion fatigue.

I was experiencing significant stress from working too many hours and trauma in my personal life, yet I told no one—not even my supervisor. I was Coding and needed someone to identify, assess and to respond to my “CODE YOU.” Meanwhile,

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my team just thought I was a good nurse who “made an error in judgment.”

So, we ask you again to reflect on your team. Is anyone on your team Coding? How would you know?

Much like a CODE BLUE has clear, definable realities, such as the patient not breathing, there are clear symptoms healthcare leaders can use to identify a CODE YOU situation. We put them into two categories—Silent But Deadly and Tribalist. Examples of The Silent But Deadly symptoms/behaviors are apathy, distraction, substance use, passive-aggressive behavior, sick calls, and resistance to change. Did you notice my (Tamara) symptoms listed there—distracted and apathetic? Critical signs of Tribalism are gossip, bullying, triangulation, micromanagement, and blaming.

Have you noticed any of these behaviors in your workplace?

How have you responded?

ASSESS A CODE YOU It is often a protective instinct that leads nurse managers to focus on controlling the identified behaviors. However, to be

effective leaders in what we call brave healing spaces (healthy workplace cultures), one must assess the underlying needs of their colleagues rather than just focusing on behavior management.

In much the same way that before moving into action in a Code Blue, healthcare professionals know to check for a clear airway—you can’t pump life-giving air into someone with an obstructed airway. Assessment involves looking for the root cause of a CODE YOU symptom. Root causes could include undefined roles, poor communication, lack of accountability, unclear goals, trauma, lack of team connection and attunement, and short-staffing.

For instance, a nurse leader recently told us about a time when there were increased signs of tribalism among her nurses. After several deep listening conversations, she discovered that poor communication about whose responsibility it was to change an IV was at the root of the problem, causing tension between nurses.

RESPOND TO A CODE YOU Finally, we invite you to consider what tools your organization has in place for an effective and rapid response to an identified and assessed CODE YOU. Does your workplace culture prepare its staff for a fast and effective response to a struggling team member? Are you leading in a brave, healing workplace culture where your staff feels brave (safe), connected, and empowered?

Brave cultures are psychologically safe for all team members, practicing inclusion and learner safety, encouraging idea contribution, and supporting open, respectful communication. In brave spaces, nurses know leaders value honesty and openness, ensuring team members have each other’s backs. For example, I (Phyllis) remember transitioning from being postpartum nurse to labor and delivery. I was eight months pregnant, and it was my 2nd day in the delivery area when, while applying the fetal monitor to a new admission, I realized something was wrong—my first fetal demise. I began to panic so I turned to my supervisor for support. The supervisor listened attentively, and we discerned whether I should stay with this patient or change assignments.

Connected cultures offer a healthy social environment with respect, support, and positivity. Leaders foster emotional and intellectual connections, which elicit deeper compassion, empathy, and trust. Emotional connections come from shared

In much the same way that before moving into action in a Code Blue, healthcare professionals know to check for a clear airway—you can’t pump life-giving air into someone with an obstructed airway.

Assessment involves looking for the root cause of a CODE YOU symptom.

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experiences and interests, while intellectual connections offer a shared mission and values. Nurses experience transparent communication, respect for differences, and well-defined roles and goals in connected cultures. Team members support one another and listen actively.

passion fatigue or burnout? Are you prepared to lead them through a “Code You” and create a supportive environment where they can thrive?

Finally, an empowered workplace culture offers healthcare professionals the environment, tools, and support needed to become their best selves in the care of others. Research has shown that leadership is integral to creating a workplace culture where nurses feel empowered to be autonomous and exercise their agency.

Code Blue training ensures nurses are prepared to identify, assess, and respond swiftly to save lives. This article extends this concept to “Code You,” a framework for recognizing and addressing compassion fatigue, burnout, and trauma among nurses. Through narrative examples and practical strategies, the article emphasizes the importance of creating brave, connected, and empowered workplace cultures. It outlines how leaders can identify signs of distress, assess underlying issues, and implement effective responses to support their teams. By fostering environments that prioritize psychological safety, emotional connection, and empowerment, healthcare organizations can enhance patient care and their staff’s well-being. i

Empowerment improves job satisfaction, affecting employees’ decisions to remain within their organizations and the profession. It also enhances safety and the quality of patient and family care.

CONCLUSION In conclusion, just as healthcare organizations prioritize Code Blue training, it is equally vital to be prepared to identify, assess, and respond to a “Code You.” By fostering brave, connected, and empowered cultures, healthcare leaders can ensure their teams are prepared to identify, assess, and respond to personal crises, ultimately enhancing the quality of patient care and the well-being of healthcare professionals.

Again, we encourage you to pause and reflect on your team. Is anyone showing symptoms of coding under the weight of com-

ABSTRACT

REFERENCES American Association of Critical-Care Nurses. (n.d.). Nursing Excellence: Healthy Work Environments. Retrieved from https://www.aacn.org/nursing-excellence/ healthy-work-environments Clark, T. R. (2020). The 4 Stages of Psychological Safety: Defining the path to Inclusion and Innovation. Oakland, CA: Berrett-Koehler Publishing.

Swensen, S. (2022). Assessing Unit Culture. My American Nurse. Retrieved from https://www.myamericannurse.com/assessing-unit-culture/

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