Texas Nursing Magazine - Spring 2018

texa s nu r s e s .o rg

TEXASNURSING M A G A Z I N E

2018 LEADERS AND LEGENDS OF TEXAS NURSING Honorees: Lucy Norris, Carolyn Gunning, Elizabeth Sjoberg, and Patricia Yoder-Wise (pictured left) 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 | S P R I N G 2 0 1 8

SPRING 2018 Volume 92, Number 2 EDITOR IN CHIEF: Cindy Zolnierek, PhD, RN MANAGING EDITOR: Kanaka Sathasivan, MPH 4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin, TX 78759-8444 P: 800.TNA.2022 or 512.452.0645; F: 512.452.0648 tna@texasnurses.org | texasnurses.org

MISSION Empowering Texas Nurses to advance the profession

BOARD OF DIRECTORS OFFICERS:

Jeff Watson, DNP, RN-BC, NEA-BC, NE-BC, CRRN, President

Kim Belcik, PhD, RN-BC, CNE, Vice President

Kleanthe Caruso, RN, MSN, NEA-BC, Secretary

Gayle Dasher, RN, PhD, ANP-BC, Treasurer DIRECTORS:

Rhonda Winegar, DNP, RN, FNP-BC, CCRN, CPN

Tamara “Tammy” Eades, DNP, MSN, RN

Pam Greene, PhD, RN

Patricia Freier, MSN, RN-BC, RCIS

Shakyryn Napier, DHSc, MSN, RN, CPN

TNA DISTRICT AND PRESIDENT Dist.1:

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

One-year subscriptions: $25 (nursing schools, libraries, hospitals, non-nurses, out-of-state nurses), foreign $30; single copy $2.50.

Subscription is not available to non-member Texas nurses.

Some back issues may be viewed online at texasnurses.org.

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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.

Clarissa Silva, clarissa2277@att.net; Terry Acosta, shadowmon@sbcglobal.net

Dist. 3: Linda Dunn, linda.dunn@usoncology.com; District office: Jamie Gilbert, jamiegilbert@texashealth.org Dist. 4: Jackie Michael, michaels@uta.edu; District office: Pat Pollock, P.O. Box 764468, Dallas, TX 75376, 972.435.2216, d4tna@flash.net, tnad4.org Dist. 5: El Burley, d4tna@flash.net Dist. 7: Patricia Phelps, psphelps1993@gmail.com; District office: P.O. Box 1482, Belton, TX 76513, tnadistrict7@gmail.com Dist. 8: Linda Juenke, 830.739.7028, ljsoaringeagle3@gmail.com Dist. 9: Lisa Boss, lisa.boss@uth.tmc.edu; District office: Melanie Truong, 7324 Southwest Freeway, Suite 2-1453, Houston, TX 77074, 713.523.3619, tna9@tnadistrict9.com, tnadistrict9.com Dist. 11: Paula Parks, 940.224.3533, wfparksdept@gmail.com Dist. 12: Piper Hale, piperhale@earthlink.net; Gregory Friesz, gfriesz@mac.com Dist. 13: Nannette Kelley, nannettekelley@msn.com Dist. 15: Andrea Kerley, 325.670.4230, akerley@hendrickhealth.org Dist. 17: Cindy Keese, 361.332.1643, cakeese@aol.com Dist. 18: Darla Smith, darla.smith3@stjoe.org Dist. 19: Kleanthe Caruso; Secretary Colleen Marzilli, cmarzilli@uttyler.edu Dist. 21: Jessica Tully, 432.254.1949, jessica.tully@midland-memorial.com

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

Dist. 22: Toni McDonald, 936.544.8823, t.mcdonald323@yahoo.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.

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FEEDBACK EMAIL OR LETTER GUIDELINES TEXAS NURSING will select emails/letters on the basis of readership interest and relevance to current nursing/health care events. TEXAS NURSING reserves the right to edit all letters. Guide: Limit to 200 words; focus on single issue; include writer’s name, mailing address, and daytime phone. Send to: editor@texasnurses.org.

Copyright 2018 © Texas Nurses Association

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TraumaInformed Care Are We There Yet?

8 ONE STORM;

TWO STORIES; ONE LESSON.

Two TNA members tell their stories of loss while caring for others.

Trauma Bay Ballet

14

a poem by Marissa Ives

Contents 5

12

PRESIDENT’S NOTES

16

19

20

22

THE PERSONAL AND PROFESSIONAL CHALLENGES OF RESPONDING TO A DISASTER

LEADERS AND LEGENDS OF TEXAS NURSING

POLICY SUMMIT ENERGIZES TEXAS NURSES

2018 HOUSE OF DELEGATES

TNA POLICY COUNCIL TO MEET IN JUNE

2018 Legacy Banquet

TNA Members Weigh In on Important Issues

Are You Listening?

Meaningful Conversations Fuel Progress

6

TNA MEMBER NEWS

for 2018-2019

Developing a Self-Help Toolkit for Nurses

Empowered Texas Nurses Advancing the Profession

Council to Hear Recommendations

23 NURSES WEEK TNA Celebrates Members, Nurses

Kudos, Committee Advocates

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Nurses: Thank you for all you do!

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President’s Notes Jeff Watson, DNP, RN-BC, NEA-BC, NE-BC, CRRN

ARE YOU LISTENING? Meaningful Conversations Fuel Progress

RECENTLY, I OPENED UP MY EMAIL and read this comment from a friend: “Birds singing outside my office window.” It reminded me of an old morning blessing that I hadn’t thought about in a very long time.

“I opened two gifts this morning. They were my ears.”

As I work today, I hear normal office sounds: phones ringing, doors opening and closing, muted conversations, a jackhammer from the construction on a new building next door, and—thankfully—someone’s tuned into a disco radio station. However, all I have to do to hear the birds is to find the right space and intentionally listen.

The pace of our busy lives often distracts us from hearing the most meaningful sounds of the day, like birds singing outside the windows. In our recent legislative planning discussions with other organizations, I was reminded of the relevance of our recent focus on conversations that matter. It is imperative that we not only tell our stories but that we are also intentional in hearing the broader exchange.

As many of you know, this time of year is when fostering relationships with our state representatives is vital for the association to be fully prepared for the 2019 legislative session. I recall the first time, many years ago, that I made an office visit to my legislator—I was terrified. However, I was determined to communicate with the legislator. After all, that was my primary reason for being there.

I had a story, a patient story that needed to be heard. I was so intent on telling the story that the space where meaningful conversation could be had was never found. The legislative aide and I

A single perspective alone cannot create change— it takes many voices. simply talked past one another.

What I failed to realize at that time is that humanity is not limited to a single ideology. I failed to recognize that there were compelling stories across the continuum.

Yes, I had a perspective that needed to be heard. However, that perspective had to fit into the complex tapestry of human experience from which policy would be derived. A single perspective alone cannot create change—it takes many voices.

As you prepare to build relationships with your state legislative representatives throughout the summer and fall, I encourage you to engage in conversations that matter. I encourage you to tell the stories of the professional registered nurse in practice. Be passionate and bold in your presentations. At the same time, I encourage you to listen for the complexity of decision making that is involved in creating and moving policies forward. Be

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purposeful in participating in conversations that grow strong working relationships. As noted author Susan Scott says, “The conversation is the relationship.”

When you meet with your legislator, what will you choose to hear? The sound of political machinery? Political ideologies? The sounds of distraction? Or, will you consciously listen for the place where the conversation becomes a relationship?

My hope is that you are reminded of birds singing and that you forge a relationship where progress can be made for the health and well-being of those we serve in Texas.

Peace, Jeff i REFERENCE: Scott, S. (2009). Fierce leadership: A bold alternative to the worst best practices of business today. New York, NY: Random House, Inc.

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TEX AS NURS ES AS SOCIATION

TNA MEMBER NEWS SPOTLIGHT ON YOU KUDOS Gail Acuna, DNP, MA, BSN, RN, division assistant vice president for clinical education at St. David’s HealthCare in Austin and Las Palmas Del Sol Healthcare in El Paso, has been named the 2017 Leadership in Health Care Award honoree for the Texas Tech University Health Sciences Center (TTUHSC) School of Nursing. Annually since 1999, TTUHSC has recognized and honored its alumni who have achieved significant professional accomplishments or made noteworthy contributions to society. The Distinguished Alumni Award is the highest honor that a school can award one of its graduates. The nominators and selection committees are made up of colleagues and peers. All who have worked with Acuna recognize how deserving she is of this award.

Patricia Carter, PhD, RN, CNS, associate professor at The University of Texas at Austin, received two teaching awards in the spring. UT’s Sigma Theta Tau chapter presented her with the 2018 Janis Carelock Award for Excellence in Teaching after she was nominated by a colleague. Patricia was also selected as one of the top 10 faculty at UT by the Alumni Association, marking the first time that faculty from the School of Nursing has been selected for the award. She appreciated being nominated by an alumni, saying “if I’ve played some small role in helping

them be better nurses, that’s a pretty great thing to get to do every day.”

Congratulations to Dr. Carter!

Leigh Goldstein, PhD, APRN, ANP-BC, of The University of Texas at Austin School of Nursing, was announced as the Recognizing Nurses 2018 Celebration winner. See her picture on page 23.

At the second annual Recognizing Nurses event, the Austin-American Statesman and Texas Nurses Association District 5 recognized five Austin-area nurses for outstanding service to the community.

COMMITTEE ADVOCATES Several TNA members have been appointed to ANA's Professional Issues Panel to #EndNurseAbuse.

Both groups will work to identify the barriers to effective reporting of violent and abusive incidents. The Steering Committee is comprised of a small group of experts leading the work and advised by the larger and broader Advisory Committee tasked with providing input and feedback.

Committee members were selected from nearly 300 applicants and will ensure sufficient rigor while allowing for broad feedback from a full range of practice arenas. Congratulations to the TNA members below, and thank you for your contribution to this important topic. #EndNurseAbuse Professional Issues Panel – Steering Committee Deborah Antai-Otong, MS, APRN-CNS-BC, FAAN

#EndNurseAbuse Professional Issues Panel – Advisory Committee Janell Bennett, PhD, RN Sandra Brannan, PhD, RN Kristi Burns, MSN, RN, PCCN Shawan Carr, MSN, RN Christina Coyle, MBA, BSN, RN Amanda Donahue, BSN, RN

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Mary Ervi, MSN, RN, CNE Sally Gillam, DNP, MAHS, RN, NEA-BC Amy Hart, MSN, RN, NE-BC Karri Lewis, MBA, MSN, RN, CCRN Patricia Lewis, PhD, RN, NEA-BC, CNML Carl Long, PhD, RN, SCRN Judy Martin-Morgan, MSN, RN Colleen Marzilli, PhD, DNP, MBA, RN-BC, CCM, PHNA-BC, CNE, NEA-BC Thomas "Thom" Mendez, PhD, RN-BC, PMHCNS Deborah Morales, ADN Tanja Morgan, DNP, RN, FNP-C Edtrina Moss, PhD(c), MSN, RN-BC, NE-BC Kim Nielsen, BSN, RN Yolanda Olveda, RN Margaret Ortiz, MSN, RN Omobola Oyeleye, EdD, JD, MSN, M.Ed. BSN, RN-BC, CNE, CHSE, CPHQ Martin Perez Escamilla, RN Patricia Phelps, MSN-ED, RN-BC Carlo Piraino, DNP, RN, CMSRN, NE-BC, FACHE Christa Potter, BSN, RN Jessica Roth, MHA, BSN, RN Donna Scott Tilley, PhD, RN, CNE, CA SANE Marvella Starlin, MSN, RN, LNC Roberta Tremper, DNP, RN Sheryl Turner, RN, MSN, CNE Gabriela Veasey, BSN, RN Christine Walker, DNP, RN Lidiaty Wright, RN, BSN, CVRN, BC

If you are a Texas Nurses Association member and you’ve changed employers, been promoted, received an award, or been elected or appointed to a board or community organization, we’d like to hear from you. Announcements for TNA News should include all pertinent information including employer name, email, and contact numbers. Please send submissions to editor@texasnurses.org.

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texas.wgu.edu © 2017 Western Governors University. All Rights Reserved.

TraumaInformed Care Are We There Yet?

By Pam Greene, PhD, RN Director, TNA Board

DO YOU PROVIDE TRAUMA-INFORMED CARE? When this question was posed to two dozen highly skilled, well-educated nurses from a variety of practice specialties, answers were unsurprisingly mixed.

Several nurses clearly understood what trauma-informed care (TIC) meant and described how TIC had been incorporated into their respective practices. Others assumed “trauma� was limited to caring for people with extreme physical injuries. Some nurses thought TIC related specifically to understanding and providing care to people with posttraumatic stress disorder. More than half of the nurses questioned indicated they had never heard of TIC and were not sure if they were using TIC in practice.

Trauma-Informed Care is a form of care that takes the whole person into account. The framework incorporates the realization of how widespread trauma is, knowledge about different kinds of trauma, and how trauma can manifest.

DEFINITIONS AND DESCRIPTIONS

Integrated health care has been implemented slowly and inconsistently (Beeber, 2018), making it hard for nurses to even become familiar with TIC.

Trauma can be defined in many ways.

For the purpose of TIC implementation, trauma is an event or series of events that involve a direct or perceived threat of death, severe bodily harm, or psychological injury that the person finds deeply distressing at the time. Trauma can also be experienced by being a witness to trauma, such as when a child sees domestic violence. Trauma can occur at any point in the lifespan (Huckshorn & Lebel, 2013; TIC Resource Guide, 2017).

The first step toward implementing TIC universally is understanding what implementation involves and making good use of existing resources for implementation.

TIC is a form of care that takes the whole person into account. The framework incorporates the realization of how widespread trauma is, knowledge about

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different kinds of trauma, and how trauma can manifest. The TIC-approach to healthcare is strengths-based and congruent with person-centered care: collaborative, supportive, and focused on helping the person reclaim control (Isobel & Delgado, 2017; National Center for TIC, 2015). TIC can be implemented in any healthcare setting.

BACKGROUND In 1985, a doctor by the name of Vincent Felitti tried to get at the root cause of participants dropping out of a weightloss program when they were on a path to success. He ultimately found a link to 10 types of adverse childhood experi-

ences, or traumas, now called ACEs (Stevens, 2012).

The ACEs screening tool shows that people with elevated ACE scores are more likely to have marital discord, autoimmune diseases, broken bones, cardiovascular disease, and cancer (Purkey, Patel & Phillips, 2018). Further research reveals the stress of severe, chronic childhood trauma—such as watching a parent hit their partner or being bullied repeatedly—causes a release of hormones that physically damages the developing child’s brain. These health outcomes affect how people with elevated ACE scores use human services systems throughout their lifespans.

Research with ACEs is ongoing and has launched more investigations into the manifestations of trauma across the lifespan and the impact of trauma on health.

To put it into perspective, from one year’s worth of confirmed cases of child abuse, an estimated $124 billion is spent on healthcare, special education, productivity loss, criminal justice, and welfare over the lifetime of those children (Stevens, 2012). Research with ACEs is ongoing and has launched more investigations into the manifestations of trauma across the lifespan and the impact of trauma on health. It is important to emphasize trauma can come in many forms and can occur at any age. No matter when it occurred, trauma can have a lasting effect. Epidemiological studies show an estimated 36 to 81 percent of the general population have experienced trauma (Huckshorn & Lebel, 2013). It is challenging to accurately determine the extent of trauma within the population if it is unassessed and allowed to remain invisible.

Not all who experienced trauma will have the same manifestations.

PRINCIPLES OF TIC TIC is not trauma-specific care. TIC does not heal trauma nor address trauma directly. However, all those who work in

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Of the evidencebased models for TIC, many are trauma specific or designed for a specific age group. Try to find a model that aligns with the population you serve and the type of care provided.

healthcare, from the receptionist and the nurse to allied health professionals and physicians, should understand and apply the principles of TIC as universal precautions (Purkey et al., 2018; Bruce et al., 2018).

The process of providing TIC begins with acknowledging the ongoing effect of trauma, validating its current relevance, and understanding how past experiences impact present functioning.

The process of providing TIC begins with acknowledging the ongoing effects of trauma, validating its current relevance, and understanding how past experiences affect present functioning. External forces shape internal functioning and can trigger traumatic experiences. Past adverse experiences or trauma are often invisible in the present yet can invade the physical and emotional state, upsetting the allostatic balance, resulting in a range of illnesses or maladaptive coping: coping which once may have been adaptive (Purkey et al., 2018). For some people, that acknowledgement and the experience of being understood, perhaps for the first time, can be life-changing.

The second step in TIC is recognizing the need for physical and emotional safety. This may be more challenging than initially imagined. The environment for care must be clean, soothing and uncluttered with attention to seating arrangements in waiting areas and even signage. Consistency and predictability are necessary, especially in anticipating and explaining procedures.

Trust, respect, and acceptance are always vital to establishing and maintaining therapeutic interpersonal relationships.

cess of providing person-centered care for all people. Nurses already build trust and use the strategies above, but when demands increase, even the best healthcare providers can become task-focused and rushed, unintentionally falling short of what is needed to promote TIC. Giving control and choice to the patient and building a collaborative alliance with them is the third step (Purkey et al., 2018).

The fourth step focuses on helping patients build skills and believing in patients’ strength and resilience, and the incorporation of culture and ethnicity is the fifth step.

INTERVENTIONS AND RESOURCES Of the evidence-based models for TIC, many are trauma specific or designed for a specific age group. The resources

Representing nurses and healthcare professionals who have dedicated their life to helping people.

In TIC, the care provider must understand the sensitivity trauma survivors have for nuances in the environment and in interpersonal interactions. Since trauma-related issues may not have been identified in every person that enters a care environment, it is important to intentionally integrate TIC as part of the pro-

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provided below are intended as a starting point to provide additional information. Try to find a model that aligns with the population you serve and the type of care provided.

Trauma-Informed Care Resources Guide (2017) is from Crisis Prevention Intervention. Adapted from SAMHSA’s Roadmap to Seclusion and Restraint-Free Mental Health Services (2006), this guide describes types of trauma and addresses secondary trauma along with compassion fatigue, both of which can be common for nurses. A de-escalation preferences form is also included with tips on preventing re-traumatization, especially when the initial trauma occurred in a healthcare setting. For instance, if a child had to be physically restrained for an injection and experienced this as trauma, he or she may experience negative reactions when future injections are indicated. Understanding past experiences helps with developing an individualized approach through collaborative planning and considering another form of the medication to mitigate a recurrence of trauma. Visit www.crisisprevention.com/Resources/ to download the ebook.

D-E-F Protocol for Trauma-Informed Pediatric Care (2018) is part of an overall healthcare toolbox aimed at helping children and families cope with illness and injury. There are links to additional

As a nation, we have a long way to go to incorporate TIC into all care. As nurses, we can leverage our position with patients, families, healthcare organizations, and communities to partner and make Trauma-Informed Care universal. resources including a free one-hour continuing education course for nurses. Visit healthcaretoolbox.org to learn more.

Trauma-Informed Approach and Trauma Specific Interventions provides bulleted information about TIC principles and approaches with descriptions of eight models of care. There are links to each of those models. This resource is provided by SAMHSA. Visit samhsa.gov/nctic to find resources.

ARE WE THERE YET? How would you answer if asked: Do you provide Trauma-Informed Care? Now, if not before, you have a little bit of an idea of what is being asked. TIC tends to be more common in behavioral health treatment facilities. As a nation, we have a long way to go to incorporate TIC into all care. As nurses, we can leverage our position with patients, families, healthcare organizations, and communities to partner and make trauma-informed care universal. i

REFERENCES Beeber, L. (2018). Somebody help! Journal of the American Psychiatric Nurses Association, 24(1) 87-88 doi: 101.1177/1078390317746332.

Bruce, M.M., Kassam-Adams, N., Rogers, M., Anderson, K., Sluys, K.P., & Richmond, T.S. (2018).

Trauma provider’s knowledge, views, and practice of trauma-informed care. Journal of Trauma Nursing.

Huckshorn, K., & Lebel, J. (2013). Trauma-informed care In Yeager, et al. (Eds) Modern community mental health: An interdisciplinary approach (pp. 6283). Oxford, UK:Oxford University Press.

Isobel, S., & Delgado, C. (2017). Safe and collaborative communication skills: A step towards mental health nurses implementing trauma informed care. Archives of Psychiatric Nursing, 32, 291-296.

National Center Trauma Informed Care (2015).

Trauma-informed approach and trauma-specific interventions. Accessed: https://www.samhsa.gov/ nctic/trauma-interventions Purkey, E., Patel, R., & Phillips, S.P. (2018). Traumainformed care: Better for everyone. Canadian Family Physician, 64, 170-173.

Stevens, J. E. (2012). ACE study, child abuse, child trauma, chronic disease, neurobiology comments.

Daily Archives: October 3,2012, Accessed: https:// acestoohigh.com/2012/10/03/

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The Johnson & Johnson Foundation wanted to help nurses who respond in disaster situations and awarded a grant to Texas Nurses Association and the Texas Organization of Nurse Executives to develop resources that would address the traumatic stress nurses experience.

THE PERSONAL AND PROFESSIONAL CHALLENGES OF RESPONDING TO A DISASTER: Developing a Self-Help Toolkit for Nurses

By Cindy Zolnierek, PhD, RN Executive Director, TNA

NURSES ARE LIKELY TO BE PROFOUNDLY AFFECTED BY NATURAL DISASTERS. Nurses are disaster responders. They participate in operationalizing and implementing emergency preparedness plans within their organizations. They work additional hours; they volunteer at shelters for displaced medically fragile persons; they coordinate medical supplies, blood donations and other vital resources. Dur-

Resources to help people cope with the trauma of disasters can be effective. But resources directed toward nurses are scarce.

The Johnson & Johnson Foundation wanted to help nurses who respond in disaster situations and awarded a grant to Texas Nurses Association and the Texas Organization of Nurse Executives to develop resources that would address the traumatic stress nurses experience. TNA Executive Director Cindy Zolnierek, PhD, RN, and TONE President Paula Webb, DNP, RN, NEA-BC, serve as project directors of the grant, which is administered by the Texas Nurses Foundation.

Out of 35 applications, four individuals were selected to serve as subject matter experts to develop a self-help toolkit for nurses dealing with potential or actual natural disaster situations:

ing disaster situations, nurses often find themselves dealing with the challenges and potentially undesirable outcomes of providing care in compromised environments: lack of staff and supplies, loss of utilities such as electricity and water.

Compelled by a duty to care for others, nurses may sacrifice care for themselves as they too are personally affected by the disaster situation. Ethical challeng-

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es arising from conflicting values and obligations inherent in the disaster work environment may lead to moral distress.

Further, nurses working in compromised environments may experience compassion fatigue, which has been described as secondary traumatic stress.

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The SMEs are currently working on developing resources which will be posted online for open access. Stay tuned! i

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ONE STORM;

TWO STORIES; ONE LESSON.

By Laura Lerma, MSN, RN TNA Continuing Nursing Education Program Manager

WHEN HURRICANE HARVEY HIT the Texas gulf coast on August 25, 2017, it hit as a category 4 hurricane. It made three landfalls in six days, affecting close to 13 million people from Texas to Kentucky.

Around 10,000 people were rescued, and 88 people lost their lives to the storm. Harvey caused an estimated $125 billion worth of damage—203,000 homes were damaged, of which 12,700 were destroyed. One million vehicles were ruined beyond repair.

The most valuable lesson both nurses learned is that nurses will rise to any challenge and, through passion and teamwork, will get the job done.

It was a 1,000-year flood event.

Staggering statistics aside, to be in the middle of it all, losing your home while also caring for your neighbors, was a lifechanging scenario. Just ask TNA members Cindy Stinson, PhD, MSN, APRN, CNS, RN-BC, of Lumberton and Candice Herman, MSN, RN, NEA-BC, of Houston.

Stinson, chair of a nursing program in the Beaumont area, had already experienced Hurricane Rita. But when Harvey came through, she lost her home, most of her personal belongings, her vehicles, and her beloved father-in-law. Alongside her personal loss, she also faced the professional situation of being chair of a nursing program with 800 nursing students and 35 faculty members—including many affected by the storm— and an accreditation visit planned for October 2017.

Stinson depended on her nursing prepa-

ration to help her manage the crisis. She was able to reach out to students and faculty via social media. Together, they established a store stocked with books, stethoscopes, and uniforms donated by former students and nursing schools across the country. They also pulled together and passed the accreditation visit! "I am more empathetic," Stinson said, reflecting on the experience. "And I don't take the little things for granted. I

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enjoy today!"

Stinson advises other nurses in her situation to "be able to accept help." She said, "I appreciate the volunteers who left their families to help me, and I am more thankful for my family now." She is proud of the students, faculty, and community and their resiliency during this very stressful time—not just during the actual hurricane but even eight months later.

TRAUMA BAY BALLET

By Marissa Ives, RN I woke up thinking it would be just a regular Sunday clinical, I had no idea I’d find myself around so many with injuries that critical.

What happened that day was unimaginably horrific, There is no possible way I ever will forget it.

Take care of yourself by staying healthy, getting enough rest, and recognizing—and addressing—your stress.

Herman, at the Medical Center in Houston, was part of the hospital’s command center during the hurricane. While she did not experience any property loss, she was able to see nurses in action during a crisis situation.

In one small church outside of town, Shots were fired, the congregation hit the ground.

Those bullets didn’t discriminate, As a trigger was pulled with inconceivable hate.

Some were old and some were young, Too many were hit whose lives had just begun.

You were coming from so far away, We stood primed and ready in the bright trauma bay.

It seemed like eternity before you finally arrived, So each one of us could join you in your battle to survive.

One by one, first responders brought you here, Only once did we lock eyes, but I instantly saw and felt your fear.

My head remained clear and awkwardly silent, While I witnessed the consequence of pure hate and violence.

Hand off report was rapidly said As you were effortlessly transferred onto a bed.

Bloody clothes were cut off, falling to the ground, The doctors reported vital signs and injuries as they were found.

Techs worked with diligent dedication, Promptly moving in to assist without hesitation Torn flesh and blood were seen everywhere, Bone fragments were found tangled in a little girl’s hair.

Assessments were done while IVs were effortlessly begun, Then to the stat lab is where I would run.

Each time I ran with those tubes of blood I prayed, These victims would soon be healed and saved.

Next, off to CT or the OR your were taken, While we stayed behind with no time to be shaken.

Out of nowhere purple shirts began to suddenly appear, Quickly picking up the mess and mopping up bloody smears.

Then again, just as swiftly as the last one left, Through the trauma bay doors another GSW victim was swept.

I’m honored I was able to do my part in one small way, In what felt like a choreographed and chaotic trauma bay ballet.

Marissa Ives, RN, is the third generation of nurses in her family. Shortly after the Sutherland Springs shooting—during which Marissa was finishing a clinical shift in the emergency department— she started her career as a trauma nurse in the the trauma ICU at University Hospital in San Antonio.

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They had learned valuable lessons from Hurricane Alice in 1954. The hospital had updated structurally with emergency flood gates. They ramped up supplies when they knew the hurricane was coming. Everyone had a common goal— take care of the patients.

She found that many of the nurses had lived through this experience before and knew what to expect. Overall, the hospital was filled with a calmness and a positive attitude that they could adapt to and handle whatever came their way. An internal resilience grew based on their shared experience—but also a shared anxiety as they watched the TVs and saw the destruction that was occurring all around them. Herman’s proudest moments were watching the nurses volunteer to work at an evacuation center after their 14-hour shift and raise money to help a co-worker afford a hotel after she was flooded out of her home.

Although Stinson's and Herman’s stories are different, both women had similar advice to give to nurses who find themselves in these types of situations: Take care of yourself by staying healthy, getting enough rest, and recognizing— and addressing—your stress. Laugh when you can. Don’t be too hard on yourself: No one is super-human. Give yourself and others an opportunity to grieve, but then move on. Focus on what you can do, fix, and nurture—not on what you can’t.

But, the most valuable lesson both nurses learned is that nurses will rise to any challenge and, through passion and teamwork, will get the job done.

Thank you, Cindy Stinson and Candice Herman, for sharing your stories. Thank you, nurses, for a job well done! i

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Leaders and Legends of Texas Nursing

2018 LEADERS AND LEGENDS OF TEXAS NURSING Honorees: Lucy Norris, MSN, RN, CENP; Carolyn Gunning, PhD, RN; Elizabeth Sjoberg, JD, RN; and Patricia S. Yoder Wise, RN, EdD, NEA-BC, ANEF, FAAN (not in attendance, pictured below)

ADVANCING THE PROFESSION

2018 LEGACY BANQUET THE LEGAL SCOPE OF PRACTICE defined in The Texas Nursing Practice Act and enjoyed by Texas nurses did not always exist. It is the result of decades of effort on the part of nurses who, through their foresight and political advocacy, worked to achieve and protect education and practice standards for the profession.

The license you receive now is an inherited privilege made possible by the vision and tenacity of the nurses who

The license you receive now is an inherited privilege made possible by the vision and tenacity of the nurses who came before you. It is a gift—something precious that should be cherished and nurtured. came before you. It is a gift—something precious that should be cherished and nurtured.

More than 150 nurses, family, and friends

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gathered to honor the 2018 Leaders and Legends of Texas Nursing—nurses who paved a path for all Texas nurses by advocating for professional, educational and ethical nursing standards. i

1

2

3

4

5

2018 HONOREES Elizabeth Sjoberg, JD, RN Former Associate General Counsel Texas Hospital Association

Lucy Norris, MSN, RN, CENP Chief Nurse Executive Multicare Health System, South King Region

6

Carolyn Gunning, PhD, RN Dean and Professor Emerita, Texas Woman’s University

Patricia Yoder-Wise, RN, ED, NEA-BC, ANEF, FAAN President, The Wise Group Editor in Chief, The Journal of Continuing Education in Nursing Editor in Chief, Nursing Forum Dean Emerita and Professor Emerita, Texas Tech University Health Sciences Center School of Nursing

Honored Posthumously

Brigadier General Lillian Dunlap, USA (1922-2003) 14th Chief of the United States Army Nurse Corps 7

Mildred O. Hogstel, PhD, RN (1929-2011) Professor Emerita Texas Christian University

Shirley Sharpe Finn, EdD, RN (1932-2013) Director, Texarkana College Associate Degree Nursing Program

1 From left: Sandy Tovar, TNA Executive Director Cindy Zolnierek, Ron Hilliard, Lolly Lockhart; 2 Tiffani Wise and Past TNA President Michael Evans; 3 From left: Pat Morrell, TNA President Jeff Watson, Candice Herman; 4 TNA Vice President Kim Belcik talks with attendees; 5 From left: Carson Easley and Frankie-Sue Allison-Hernandez 6 Glen Jones, Melinda Mitchell Jones, Kristie Brown, and Rhonda Mint-Binder giving the Texas Tech University “GunsUp” Salute; 7 Susan Ramnarine-Singh (foreground) and others look over the raffle items during the reception—proceeds benefited the Texas Nurses Foundation.

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POLICY SUMMIT ENERGIZES TEXAS NURSES ADVANCING THE PROFESSION

2018 HOUSE OF DELEGATES

THE INAUGURAL POLICY SUMMIT gave nurses a chance to engage in dialogue on the key issues identified by the seven policy committees of the TNA Policy Council:

APRN Nursing Education End of Life Maternal Mortality and Morbidity Mental Health Nursing Regulation Workplace Advocacy

The day started with a historical perspective on the importance of engaging in the policy process by Jeff Watson, president, followed by an overview of the evolution of the policy development structure by Cindy Zolnierek, executive director. The new policy development structure has dramatically increased the number of nurses who are engaged in policy development from several dozen to several hundred.

The latest innovation in TNA policy development is “Projects with a

The latest innovation in TNA policy development is “Projects with a Purpose,” where Doctorate of Nursing Practice students in policy courses can commit to being a TNA Policy Fellow.

Anita Hufft, chair of the Education Committee discusses potential education policies. Back, from left: Donna Wallis, Renae Schumann, Marlene Meador; Front, from left: Shawn Tindell, Rhonda Winegar

Purpose,” where Doctorate of Nursing Practice students in policy courses can commit to being a TNA Policy Fellow. This program allows students to develop a policy brief white paper for class credit.

Currently 35 students from seven schools are participating in this program and several were in attendance at the Policy Summit.

The Policy Summit was a dynamic work session. Leaders from each committee started with a brief overview of the committee work and then led dialogue sessions at stations. Participants rotated through four of the seven committee stations that best matched areas of interest to learn more about the issues and provide feedback on draft policies.

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There were lively discussions at the stations and participant comments were recorded on flip charts. The comments were shared with the committees.

During lunch, Janet Haebler, senior associate director, American Nurses Association State Government Affairs, shared some of the current issues on ANA's radar such as proposed federal nurse staffing regulations and scope of practice for paramedics working in community health and hospital emergency department settings.

Overall, the summit was an energizing time for networking as participants shared their perspectives on important issues. i

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TEX AS NURS ES AS SOCIATION

2018 HOUSE OF DELEGATES

ADVANCING THE PROFESSION

2018 HOUSE OF DELEGATES

THE 2018 TNA DELEGATES successfully completed association business during an exciting, informative, and fun House of Delegates. The 159 delegates and 10 observers attending started the day off with a networking breakfast with time to visit with the eight candidates vying for three at-large board seats and two positions on the TNA Nominating Committee.

Once the informal session started, each candidate presented their platform for addressing the needs of the association.

Delegates then voted and elected the following new Board members:

Donna R. Wallis, MBA, MSN, RN – San Antonio

Melinda Hester, DNP, RN – Round Rock

Ernestine “Tina” Cuellar, PhD, RN, PMHCNS-BC – Houston

2018-2019 TNA Board. Top row: Tina Cuellar, Melinda Hester, Gayle Dasher, Donna Wallis, Kleanthe Caruso, Patricia Freier; Bottom row: Tammy Eades, Jeff Watson, Shakyryn Napier

They also elected two new members of the TNA Nominating Committee:

for Nursing. Watson ended his presentation with a call to action for TNA members:

Colleen Marzilli, PHD, DNP, MBA, RNBC, NEA-BC – Tyler

Be bold!

Margie Dorman-O’Donnell, MSN, RN – North Richland Hills

Be present!

TNA President Jeff Watson, DNP, RNBC, NEA-BC, NE-BC, CRRN, spoke to the audience about TNA’s work toward community collaboration. He shared stories of successful relationships developed during the past year such as leadership in the APRN Alliance, cosponsorship of a staffing conference with the Texas Organization of Nurse Executives, and connections with the Texas League

Be compassionate!

provides superior value to its members.

She reviewed the association's progress on each of the four goals of TNA’s 5-year strategic plan (2015-2020): 1.

Enhance local engagement opportunities for members. This goal originally focused on the means to the end—supporting TNA’s local structure (districts) through enhanced services and options to engage members. Many districts have struggled to remain active and additional options are being explored.

2.

Grow membership through engagement and retention. We have reached a record number of mem-

Be genuine!

Be inclusive!

Be an investor in people and in life!

Be fierce!

In her 2018 address to the House of Delegates, TNA Executive Director Cindy Zolnierek, PhD, RN, reminded the delegates of TNA’s mission, vision, and strategic objective: To position TNA as a vibrant and growing membership organization that

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Above: The 2018 candidates prepare to present their platforms at the TNA House of Delegates.

Right: Nurses from across Texas came to represent their districts. From left: Tamatha Dayberry, Andrea Kerley. Seated: Tonya McVay

bers (more than 12,000) and retention has stabilized at 75 percent.

We need to ensure we continue to attract nurses to TNA. 3.

4.

Advance the quality and safety of patient care through policy initiatives. More than 600 members plus 35 graduate students have been involved in policy development through the TNA committee structure this year.

Eliminate annual budgeted deficit.

NACES Plus Foundation contributions made up almost 30 percent of TNA’s operational budget. This program ceased operations in 2017. TNA is on track with its three-year plan— including expense reduction, membership growth, and non-dues revenue programs—to achieve a balanced budget without reliance on NACES funds by fiscal year 2020/21.

Following the morning session of presentations and elections, delegates adopted bylaws amendments to establish a president-elect (1-year term), president (2-year term), and past-president (1-year term) model to best prepare and support presidents in their important role of leading the association.

Delegates proposed and passed an additional amendment requiring election of apportioned ANA Membership Assembly representatives.

TNA’s apportioned representatives

Zolnierek reminded the delegates of TNA’s mission, vision, and strategic objective: To position TNA as a vibrant and growing membership organization that provides superior value to its members. to this annual meeting of ANA was increased at the 2017 Membership Assembly; 2018 representatives were appointed by the Board. Delegates also voted to change the name of the TNA Nominating Committee to Leadership Succession to better characterize the role of the committee in planning for the association’s future.

The day ended by recognizing out-going TNA Board members Vice President Kim Belcik, PhD, RN-BC, CNE and Directors Tammy Eades, DNP, MSN, RN; Pam Greene, PhD, RN; and Rhonda Winegar, DNP, RN, FNP-BC, CCRN, CPN. This was immediately followed by the installation of the three new directors as well as Jeff Watson as president and Tammy Eades as vice president, who were elected by the full TNA membership in a February 2018 election. i

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Legislative Resolution Delegates adopted a Level II Legislative Resolution on TNA Engagement in End-of-Life and Palliative Care-Related Legislation and Regulation.

RESOLVED, that TNA will engage in end-of-life/palliative care related education, legislation, regulation, and testimony by: »» Including the end-of-life/ palliative care legislative action in monitoring and reporting activities through the usual channels of communication with the Board of Directors, Policy Council, and GAC. »» Aligning with other organizations to provide education and resources for end-of-life and palliative care. »» Collaborating with other organizations to endorse (or oppose if indicated) legislation/ regulation related to end-of-life/ palliative care. »» Providing expert testimony as needed.

Position Statement to be developed and presented by EOL Task Force.

Supported by ANA/HPNA Call for Action.

Budget to be assessed by TNA Financial Department.

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TNA POLICY COUNCIL MEETS IN JUNE TO HEAR POLICY RECOMMENDATIONS TNA’S POLICY COUNCIL will meet on June 28 to hear policy recommendations from its seven committees and determine its recommendations to TNA’s Board of Directors for consideration at its July meeting.

Since the fall of 2017, TNA’s policy committees have met monthly to explore a variety of nursing and health care issues to determine the concerns that TNA should address through policy initiatives and legislation. With input from hundreds of TNA members through its policy expert advisors, the TNA Policy Student Fellowship program, and our inaugural Policy Summit, the committees examined topics ranging from mental and behavioral health care to advance directives to the effects of technology and artificial intelligence, to APRN Full Practice Authority and much more.

On June 28, the Policy Council will convene at TNA’s new offices in Austin to re-

TNA POLICY COUNCIL: JUST THE BASICS In July 2017, the second Policy Council was appointed to serve through the 2019 legislative session. TNA’s Policy Council met in September to determine its committees and committee chairs, based on current nursing concerns.

The seven committees established were: APRN Nursing Education End of Life Maternal Mortality and Morbidity Mental Health Nursing Regulation Workplace Advocacy The work of this council and its committees will become the foundation for TNA’s 2019 legislative agenda and the focus of the 2018-2019 TNA Policy Book.

view its committee chairs’ suggestions and determine policies to recommend to TNA’s Board of Directors.

For more details on the TNA Policy Council, please visit www.texasnurses. org. i

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NURSES WEEK — MAY 6 – 12 TNA Celebrates Members, Nurses NURSES WEEK RUNS EACH YEAR from May 6 to May 12, Florence Nightingale’s birthday. All week, TNA posted on social

media and districts held member events to celebrate nurses! i

DO A WORLD OF GOOD AS A NURSE. YOU DECIDE HOW YOU SERVE There are different ways that you can commit to practicing nursing in America’s Navy. Active Duty Nurse Corps Officers serve full-time. Reserve Nurse Corps Officers serve part-time. And the initial service requirement could be as few as three years.

Top left: Nurses on the TNA staff (from left) Ellen Martin, Laura Lerma, Michele Wieckowski, Cindy Zolnierek, Madeliene Lamarche, and Jonathan Wolfarth; Top right: Florence Nightingale doll on display in the TNA lobby; Middle left: Stephanie Garcia, BSN, RN, receives her scholarship from Darla Smith, MSN, RN-BC, at the District 18 Nurse's Week Banquet, where she was one of 10 members receiving scholarships; Middle right: During the 2018 Recognizing Nurses Celebration, attended by over 400 healthcare professionals, their families, friends, and fans, Leigh Goldstein accepts her award as one of the Austin-American Statesman's Fab5; Bottom: Leigh Goldstein (right) stands with the other award winners, from left: Avi Santos, Pflugerville ISD; Zachary Rios, St. David’s Medical Center, Suzanne Ledbetter, Austin State Hospital, and Bethany Miller, Hospice Austin.

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