February-March 2014 issue of Imprint by Todd Anderson

FEBRUARY/MARCH 2014

Imprint The Professional Magazine for Student Nurses

FEBRUARY/MARCH 2014 • VOL. 61, NO. 2

National Student Nurses’ Association®

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Departments & Columns

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Editorial……………………………………………………………

Slate of Candidates and Bylaws Amendment

Membership Benefits & Highlights………………………………… News: Slate of 2014 Candidates…………………………………… Convention Updates…………………………………………

Nominating and Elections Committee ……………………………… Foundation of the NSNA………………………………………… Global Initiatives in Nursing………………………………………… Finance Committee……………………………………………… Breakthrough to Nursing…………………………………………… Legislation/Education……………………………………………… Happenings……………………………………………………… NSNA Code of Ethics………………………………………………

6 10 12 15 17 18 19 21 23 24 28 43

Feature Articles

pg. 32 Reflections on Disclosure

credits:

A Look Inside: The ANA Code of Ethics Task Force………………… By Margaret Ngai Reflections on Disclosure and the Nurse-Patient Relationship……… By Maureen Mahon Whistleblowers: Troublemakers or Virtuouos Nurses?……………… By Vicki D. Lachman Experiencing Moral Distress as a Student Nurse…………………… By April Grady

31 32 36 40

Cover by Anderson Design, Ozark, Missouri.

All published material in IMPRINT® is protected by copyright. n Material, including illustrations and artwork, may not be reprinted without permission from the National Student Nurses’ Association. n NSNA Encourages its readers to submit original articles for publication to IMPRINT but reserves the right to edit for style clarity, and length. n IMPRINT (USPS #899-300, ISSN #0019-3062) is published quarterly by the National Student Nurses’ Association in the months of February/March, April/ May, September/October and November/December. The annual Career Planning Guide issue is produced online-only in the month of January. n IMPRINT is indexed in the International Nursing Index. n Three dollars of NSNA dues is for subscription to IMPRINT. Other interested persons may subscribe at $18 annually. Mexico and foreign subscriptions are $30 annually. n The views expressed in IMPRINT

are solely those of the authors or persons quoted and do not necessarily reflect the views of NSNA. Statements made by authors are not statements of NSNA policy unless adopted by NSNA resolution. The appearance of advertising in this publication in no way implies endorsement or approval by NSNA of any advertising claims or of the advertiser, its product, or services. NSNA does not attempt to investigate or verify the accuracy of claims made by its advertisers, and NSNA specifically disclaims any liability in connection with advertising appearing herein. © National Student Nurses’ Association, Inc. 2011, 45 Main Street, Suite 606, Brooklyn, NY, 11201. n IMPRINT was formerly published as the NSNA NEWSLETTER. n Periodical postage paid at Brooklyn, NY and additional mailing offices. POSTMASTER: Send address changes to National Student Nurses’ Association, Box 789, Wilmington, OH, 45177.

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Imprint

The Professional Magazine for Student Nurses

National Student Nurses’ Association®

2013-2014 Board of Directors President

Jesse Kennedy

Vice President

Kelsea Bice

Secretary/Treasurer

Christine Shuffield

Imprint ® Editor

Carson Applewhite

Breakthrough to Nursing® Director

TJ Tekesky

Directors

Jamie Allen Matthew Oppert Katerina Raiser Katrina Stell

Ex-Officio, Chair COSP Planning Committee

Forrest Pogue

Consultants

Rebecca M. Patton, MSN, RN, CNOR, FAAN Appointed by the American Nurses Association Cheryl Taylor, PhD, RN, FAAN Appointed by the National League for Nursing

Staff Executive Director

Diane Mancino, EdD, RN, CAE, FAAN

Membership Development Director

Susan Wong, BS, CAE

FNSNA Scholarship and Grants Administrator

Jasmine Melendez, MA

Director of Finance and Administration

Dev Persaud, MA

Imprint Staff ®

Managing Editor Editorial Consultant Editorial Assistant Design Firm

Editorial Office

National Advertising Representative

Conference and Program Planning Consultant

Jonathan Buttrick, MPW Thelma Schorr, BSN, FAAN Maisha Hollis Anderson Design of Ozark, Inc. 2909 West Trevor Trail Ozark, Missouri 65721-8438 (417) 581-2961 Fax (417) 485-2987 www.toddanderson.info National Student Nurses’ Association, Inc.® 45 Main Street, Suite 606 Brooklyn, New York 11201 (718) 210-0705 Fax (718) 797-1186 www.nsna.org Anthony J. Jannetti, Inc. East Holly Avenue, Box 56 Pitman, NJ 08071-0056 (856) 236-2300 Fax (856) 589-7463 www.ajj.com Judith Tyler, MA, RN

Published by the National Student Nurses’ Association, Inc.®

NSNA® is a membership organization representing students in associate degree, diploma, baccalaureate, generic masters and generic doctorate programs preparing students for Registered Nurse licensure, as well as RNs in BSN completion programs. ®

Logo Policy The name National Student Nurses’ Association, Inc. (NSNA)® may be used only by official NSNA school and state constituents with the following wording: (Insert name of school or state association) is an official constituent of the National Student Nurses’ Association, Inc.® No other wording is acceptable without NSNA’s® permission. The NSNA® logo may not be used by anyone, including members of school or state chapters.

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FEBRUARY/MARCH 2014

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EDITORIAL

Carson Applewhite Imprint Editor

Not Just Another Classroom Topic Greetings, NSNA Members and Sustaining Members! With 2014 well underway, it is a great time to reflect on an issue that affects us every day. This is near and dear to my heart—ethics in nursing. We all know this is something drilled into our heads year after year while we are in nursing school. So, if this topic would normally make you groan or roll your eyes, I implore you to open your mind and read on. While we all understand the importance of discussing ethics, it might be difficult to have a genuine appreciation for opportunities to engage in discussion about ethical standards and decision making. As patient advocates, nurses actively spotlight the topic of ethics to uphold a moral code that is the foundation of nursing. Don’t think of it as just another topic for our classes. Consider it for just a moment. Try adding some perspective. Imagine what we, as nurses, would do without ethical guidance and whistleblower protection. Look back to the 2009 case of two Texas nurses who anonymously reported a continuous display of unsafe practices by a physician. In this unusual situation, their jobs and lives were jeopardized when the nurses were investigated by the county sheriff (a personal friend and patient of the physician). Eventually, they were charged with third-degree misuse of official information. The prosecutor (also the personal attorney of the physician in question) dropped charges for one nurse but took the case all the way to trial for the second nurse. Thankfully, justice prevailed when the jury took less than an hour to return a “not guilty” verdict (Sack, 2010). Ultimately, the sheriff, prosecutor and physician were given jail sentences for retaliation, misuse of information and other charges (ANA, 2011).

FEBRUARY/MARCH 2014

This may have been an uncommon set of circumstances, but it reinforces the importance of a continuous dialogue about understanding ethics codes and whistleblowing policies in nursing. See “Whistleblowing: Troublemakers or Virtuous Nurses?” on page 36 for more about whistleblowing. As a voice of ethical guidelines of nursing practice, the American Nurses Association (ANA) had publicly supported the two Texas nurses. ANA continues to revisit the Code of Ethics. I encourage you to check out page 31 to read more about the ANA with an update on the Code of Ethics Task Force. Also, see pages 43-47 for the NSNA Code of Ethics Part II: Code of Academic and Clinical Conduct and Interpretive Statements. I hope this issue of Imprint encourages you to become more informed about ethics and more active in ethics conversations outside of class. Advocating for patients does not only mean using our voices to stand up for what’s right. It also means that we must weave ethics into every decision we make in health care delivery. G References American Nurses Association (ANA). (2011). Justice Is Served: Texas Physician Pleads Guilty. ANA Gratified by Convictions in ‘Winkler County’ Nurses Whistleblower Case [Press release]. Retrieved from http://nursingworld. org/FunctionalMenuCategories/MediaResources/ PressReleases/2011-PR/Justice-is-Served-TexasPhysician-Pleads-Guilty.pdf Sack, K. (2010, February 11). Whistle-Blowing Nurse Is Acquitted in Texas. The New York Times. Retrieved February 16, 2014 from: http://www.nytimes.com/2010/02/12/us/12nurses. html?_r=0

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L E T T E R S to the editor

The “Write On” column is intended as a forum for readers to respond to articles in Imprint® as well as issues in nursing today. Please send your letters to nsna@nsna.org attn: WRITE ON.

Dear NSNA,

On behalf of the Connecticut Student Nurses’ Association, I would like to thank you sincerely and immensely for donating the table to our organization at the 2013 NSNA Annual Convention in Charlotte, NC, in April 2013. The awareness and impact we were able to make at Convention, bringing together states from across the country to support the Sandy Hook Elementary School, was incredible. We raised over $900 in our endeavors. We were both moved and impressed by the amount of donations we saw by the end of Convention week. The funds will be donated to the school nurse from the Sandy Hook Elementary School. Many of those in attendance at Convention had not previously thought about the school nurse and ended up supporting our endeavors. We are delighted that so many were impressed by our decision to support a school nurse who is now helping students every day—trying to help them move past their experiences during the tragedy—and continues to take care of them when their parents are not around. Our organization was and still is extremely grateful for your wonderful support of such a great cause. We thank you again whole-heartedly for all your help.

Thank you for coordinating the Friday, November 8, 2013 blood drive during the NSNA MidYear Conference in Louisville, Kentucky. We were very pleased with the drive overall, and the willingness of the donors to share this life saving gift.

Sincerely, Mellissa LaParre 2012-2013 Secretary, Connecticut Student Nurses Association

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The efforts of National Student Nurses’ Association have always been greatly appreciated and their support of the community blood program will go a long way toward replenishing blood supplies and ultimately saving lives. In addition, we very much appreciate your efforts during this crucial time. You may be interested to know that 40 donors registered, 4 donors were deferred and 33 units were collected! We also registered 30 first time donors! Again, thank you for your contribution and ongoing support of this important community program. I look forward to working with you again on an upcoming blood drive. Bart Draper Donor Recruitment Representative, American Red Cross

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MEMBERSHIP Spread the Word

By Kelsea Bice, Vice President and Chair, Membership Committee, vicepresident@nsna.org

I would like to thank all the members who have worked hard to keep NSNA’s membership so strong! Please help us to continue building a strong membership by spreading the word to your fellow students, classmates, and friends. Take advantage of today’s technology and encourage your friends and classmates to join NSNA, renew their membership, and register for meetings on NSNA’s website www.nsna.org. The end of the semester will be here before you know it, so remember to update your membership and contact information with Member Services at nsnamembership.org. Spring is the perfect time to introduce new students to the benefits of NSNA membership. Try focusing on some of the common reasons that members decide to join, including: a passion for the profession; having a voice; broadening their knowledge; leadership opportunities; exploring new specialties; career building; shared governance; networking with professional mentors and role models; community outreach; and more. The best way to get members to join NSNA is to make it personal for them; help them find what gets them excited. Be willing to share your story with them, particularly why you are so passionate about NSNA and what enticed you to become a member. I know, from experience, there are opportunities for everyone to grow within this organization. I know I now have the confidence to be a great patient and nurse advocate because of my leadership experiences with NSNA, and that’s just one of the many reasons why I believe all nursing students should join this organization. Do not forget NSNA videos like Catch the Wave with NSNA and Nursing— The Career of a Lifetime are great recruitment tools to share with potential members and are always available at www.nsna.org. See You in Nashville! Register now for the NSNA 62nd Annual Convention in Nashville, TN, April 9-13, 2014! I will be moderating the Membership Recruitment Association Activity Seminar on April 9, 2014. This workshop is for NSNA members interested in membership recruitment and chapter development. Hear all about the extensive NSNA membership benefit program and how to develop a recruitment campaign to strengthen the membership of your own chapter. Also, many NSNA leaders, just like you, will be recognized for their membership recruitment efforts during the Annual Convention. The Project InTouch Grand Prize Award will be presented on Thursday, April 10, 2014 at 9:00 am, just prior to the morning Plenary Session. I look forward to meeting all of you there! G

NSNA Partnerships with Specialty Nursing Organizations One of the main objectives of NSNA is to prepare students to play active and vital roles in the nursing profession. NSNA socializes students into the world of professional organizations and provides opportunities to gain invaluable skills and experiences that enhance professional development. NSNA strives to build and strengthen the bridge between education and practice. NSNA members are informed about professional organizations and encouraged to learn about them – even as students. Through a Partnership Program, NSNA members may join the specialty nursing organizations below at a reduced rate available only to NSNA members. Visit www.nsna.org for contact links.

Academy of Neonatal Nursing American Assembly for Men in Nursing American Holistic Nurses Association American Nephrology Nurses’ Association American Organization of Nurse Executives Association of PeriOperative Registered Nurses

Association of Pediatric Hematology/Oncology Nurses The Council for the Advancement of Nursing Science Dermatology Nurses’ Association Emergency Nurses Association International Association of Forensic Nurses National Association of Neonatal Nurses Oncology Nursing Society

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BENEFITS & HIGHLIGHTS

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N E W S : NSNA

2014 Slate of Candidates Released!

2014 Slate of Candidates ©Thinkstock

By Chelsea Sawyer, Chair, Nominating and Elections Committee The National Student Nurses’ Association Nominating and Elections Committee (NEC) is pleased to announce the 2014 Slate of Candidates for Board of Directors and Nominating and Elections Committee. DelSawyer egates vote for the candidates at the upcoming NSNA 62nd Annual Convention in Nashville, Tennesseee. Candidates may also be nominated from the floor of the House of Delegates. I encourage you to read up on running for national office at www. nsna.me/nationaloffice. Bringing your unique perspective and ambition to the table not only benefits NSNA and the student nurse community, but it also provides a once in a lifetime opportunity to develop your leadership skills while still in nursing school. If you would like information about running from the floor, send an email with your name, complete mailing address, phone number, email address and the position you are planning to run for to nsna@nsna.org attn: NEC Packet or call (718) 210-0705. If you plan to run from the floor of the House of Delegates, I urge you to have your application completed and mailed in time to be received at NSNA Headquarters by 5:00 pm EST, March 21, 2014. Send in the application by this date and a candidate’s packet will be mailed to you. Presented here is 2014 Slate of Candidates. G

Stated for Board of Directors: President: Kelly Hunt University of North Florida, Jacksonville, Florida Katerina Raiser Drexel University, Philadelphia, Pennsylvania Vice President: Elizabeth Long Villanova University, Villanova, Pennsylvania Melissa Thompson Georgia Baptist College of Nursing of Mercer University, Atlanta, Georgia Secretary/Treasurer: Rebeka Rivera Georgia Baptist College of Nursing of Mercer University, Atlanta, Georgia Kristina Woods Tyler Junior College Tyler, Texas Imprint Editor: Kimberly Korn Adelphi University, Garden City, New York Breakthrough to Nursing Director: Alisha Hightower Georgia State University, Atlanta, Georgia Martin W. Rivera-Salas University of Michigan-Flint, Flint, Michigan

Director (North): Thomas Lewandowski - Viterbo University, La Crosse, Wisconsin Director (South): Jordan Wilson Covenant School of Nursing, Lubbock, Texas Director (East): Caroline Miller Duquesne University, Pittsburgh, Pennsylvania Director (West): Janna Mae Boren Oregon Health & Science University, Portland, Oregon (Withdrew) Jenna Bowles Brigham Young University, Provo, Utah Zack Huddleston California State University, Fresno, California

Nominating and Elections Committee: NEC (North): Angela Mamat Ivy Tech Community College, Evansville, Indiana NEC (East): James Connolly Farmingdale State College, Farmingdale, New York Monika Spangenberg Duquesne University, Pittsburgh, Pennsylvania NEC (South): Vacant NEC (West): Vacant

FEBRUARY/MARCH 2014

Proposed bylaws amendments are voted on at the 2014 NSNA House of Delegates, which convenes in Nashville, Tennessee, April 9-12, 2014. The following proposed amendments (and rationale) to the NSNA Bylaws were submitted by the California Nursing Studentsâ&#x20AC;&#x2122; Association Board of Directors by the January 29, 2014 deadline.

PROPOSED AMENDMENT Changes in blue

CURRENT BYLAWS Section 2. Categories of Constituent Membership: Members of the constituent associations shall be:

Section 2. Categories of Constituent Membership: Members of the constituent associations shall be:

1. Active members: a) Students enrolled in state approved programs leading to licensure as a registered nurse. b) Registered nurses enrolled in programs leading to a baccalaureate degree with a major in nursing. c) Active members shall have all of the privileges of membership.

2. Associate members: a) Prenursing students, including registered nurses, enrolled in college or university programs designed as preparation for entrance into a program leading to an associate degree, diploma or baccalaureate degree in nursing. b) Associate members shall have all of the privileges of membership except the right to hold office of president and vice president at state and national levels.

3. Individual Members: Individual membership shall be open at the national level to any eligible student when membership in a constituent association is not available. Individual members shall have the privileges of membership as prescribed in Article IV, Section 2, items 1 and 2. 4. Recent Graduate Individual Members: Recent Graduate Individual Membership is open to recent graduates of a prelicensure program for up to two years following graduation providing that the individual: 1) was a member of NSNA at the time of graduation; 2) maintains continuous NSNA membership; 3) continues to actively pursue higher education in nursing; and 4) is enrolled into an approved program leading to a degree in nursing higher than their initial pre-licensure degree within 16 months following graduation. Recent Graduate Individual members shall have all the privileges of membership.

RATIONALE Although nursing students graduating with an Associate Degree or diploma in nursing have the opportunity to maintain membership in NSNA (as provided for in Article IV, Section 2) while continuing their education to complete their baccalaureate degree in nursing, other new graduates of the same programs who continue their education directly into graduate degree programs are unable to maintain membership in NSNA. Individuals who continue in the role of student rather than feel a part of the environment of the professional nurse in practice may desire to continue membership in the student-focused organization. Some of these students discover the benefits of NSNA membership late in their pre-licensure program and would like to avail themselves of the opportunities to further develop skills in leadership, activism, and involvement afforded by NSNA membership that more closely align with their student role. With the current availability of AD-BSN, AD-MSN, and even AD-Doctorate program, it is not logical to offer the option of continued membership in NSNA to the individual who chooses to pursue the AD-BSN program while that personâ&#x20AC;&#x2122;s classmates who choose to pursue one of the other programs may not continue NSNA membership, even though they all continue in the role of the student in nursing. (Continued on page 14) NSNA IMPRINTÂŽ y www.nsna.org

RATIONALE (Continued from page 13)

The Institute of Medicine 2010 report on the Future of Nursing recommends an increase in the number of higher degrees in nursing. Universities have begun to offer a variety of educational pathways in recent years to meet changing student demands/interests. In a survey of 4,110 new graduates done in September 2012, Diane Mancino (2013) reported, “Seventy-six percent responded, ‘yes,’ to the question: ‘Do you plan to return to school for another degree?’ Five percent stated, ‘no,’ and 20% were ‘unsure.’ Twenty-three percent (n=384) of associate degree and diploma graduates indicated that they were currently enrolled in nursing school (fall 2012 semester); 28% (n=471) of associate degree and diploma graduates responded that they would return to school for the spring 2013 semester. Twenty-four percent (n=392) of associate degree and diploma graduates responded that they would return to school in fall 2013” (p. 2). These data demonstrates that many students are continuing in the student role following graduation from their pre-licensure program. The proposed membership category addresses an inequality in the current bylaws and provides an option to nursing graduates that opt to continue in the role of student nurse. Any individual graduating from any state approved pre-licensure program who chooses to continue in the nursing student role should have the opportunity to continue to enjoy the benefits of membership in the nursing student organization of NSNA if they so choose. The wording of this proposed amendment provides for NSNA membership only in the circumstance of continued pursuit of nursing education for a specified time following initial licensure. It does not provide for membership status to be granted to any Registered Nurse who has been in practice and returns to school for a higher degree after more than 16 months away from an educational program and the student role. Reference Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: Institute of Medicine and National Academies Press. Mancino, D. (January/February 2013). Recalculating: The “Nursing Shortage” Needs New Direction. Dean’s Notes, v34, n3, 1-4.

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NCSBN Introduces a New Brochure NCSBN now offers seven outreach brochures for nurses, educators, the public and nursing students, free of charge! In the newest brochure, “What You Need to Know About Substance Use Disorder in Nursing,” you’ll learn how to recognize the warning signs of substance use and what to do to get a colleague help. Order your free brochures at http://bit.ly/1bPx0lw. G

N E W S : CONVENTION UPDATE

DEADLINE:

MARCH 26, 2014

Pre-Registration (online) - Members save $10-$15 when pre-registering! Register on NSNA Member Services at nsnamembership.org

62 nd Anniversary Convention April 9-13, 2104 · Nashville, Tennessee

Delegate Information

Will you represent your school or state as a delegate at Convention? A webpage with important information for Delegates is available at: www.nsna.me/delegate-info. It is mandatory that delegates or their alternates attend all of the House of Delegates meetings, the parliamentary procedure briefing, resolutions hearings, finance forum, candidates’ forums, and elections. Please refer to the Convention Schedule for Delegates on the Delegate webpage to plan your travel accordingly. Once you have registered and picked up your badge, you must be credentialed as a Delegate. Credentialing hours are open Tuesday evening and Wednesday morning. If you arrive after 12:30 pm on Wednesday you may sit in the gallery of the opening House of Delegate meeting and get credentialed later in the week.

Keynote & Endnote Speakers Keynote Speaker Gloria Ferraro Donnelly, PhD, RN, FAAN, kicks off the event on Wednesday, April 9, 2014, during the traditional Opening Ceremony. Dr. Donnelly is the Dean of the College of Nursing and Health Professions at Drexel University in Philadelphia, PA. Her keynote presentation— What’s Your Hunch? Ideas that Changed Nursing and Healthcare—discusses ideas that have changed the direction of nursing/healthcare for the better, and how contributions of future nurses will improve healthcare. From thinking differently to detecting patterns to innovating from the weeds of healthcare—this discourse spotlights the intuition of future nurses! On Saturday, April 12, 2014, the Annual Convention comes to a close with the Closing Ceremony and Endnote Speaker, Virginia Trotter Betts, MSN, JD, RN, FAAN, Professor, Department of Advanced Practice & Doctoral Studies Program, University of Tennessee Health Science Center, Memphis, TN. Her Endnote presentation, Your Voice/Your Dream/Nursing’s Future, challenges attendees to be the change that nursing needs. Leave empowered and recognize the substantial contribution you are about to make.

8-Hour NCLEX Review

Be prepared for the most important test you will ever pass! This review course is spread across three days and is presented by the incomparable Judith Miller, MS, RN, President of Nursing Tutorial and Consulting Services, Henniker, NH. Only $20 extra for NSNA members who pre-register! Sponsored by Delmar, Cengage Learning.

Career Development Center

Plan your nursing career! Before you arrive, prepare a list of interests, needs, priorities and goals. Bring your resume to review with a Career Counselor. Learn and discuss the basic steps for career success. We are pleased to bring back the leadership of Lois Marshall, PhD, RN, author of “Take Charge of Your Nursing Career,” published by Sigma Theta Tau International (2010).

Donnelly

Betts

Exhibit Hall Grand Opening: Thursday, April 10

Speak to healthcare agencies and college recruiters; learn about the newest books and products; and prepare to network! Exhibitors are eager to speak with you. Ask about summer internships and residency opportunities. Locate the perfect college or university to continue your education.

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More Convention update info?

FEBRUARY/MARCH 2014

NOMINATING AND ELECTIONS COMMITTEE

By Susannah Marshall, Western Election Area Representative

Running for Office During Convention What happens at Convention? Convention week (April 9-13, 2013) is quickly approaching! This is your opportunity to make your nursing field of dreams a reality. There will be opportunities for you to connect with other nursing students, network with nursing professionals, and learn new ways to make a difference in healthcare both locally and globally! If you have never been to the NSNA Annual Convention, the atmosphere will be new, exciting and may be overwhelming especially if you are running for office. But don’t worry, you will have plenty of support and the Nominating and Elections Committee (NEC) is always there to answer any questions you may have. Preparing Yourself Even if you haven’t actually decided to run for office, but might be considering the option, I encourage you to be in contact with the NEC prior to Convention. We are here to address your questions about the different positions available and the campaigning process. Be sure to read “How to Run for National Office” under the Elected Officials menu on www.nsna. org, specifically the Campaign Regulations, Digest of Information, and NSNA Bylaws. The Digest of Information and NSNA Bylaws are essential because they provide information about NSNA and focus on the responsibilities, eligibility, and requirements of each position in the organization. Make sure you study the candidate questions, prepare a speech, and develop some creative ideas that you can share with all of the delegates! Remember: If you wait until you get to Nashville to decide, it is not too late to run for office! You still have the option to “run from the floor,” which many candidates have done successfully in the past. Be sure to contact the NEC as soon as possible

during Convention so that we can walk you through the process and answer any questions or concerns that you may have about running for office. The committee will be available in Campaign Headquarters, or you can stop us in our tracks if you see us out and about during Convention. During Convention Candidates may be nominated from the floor of the House of Delegates on Wednesday, April 9 for any position; and on Friday, April 11 for any position with less than two slated candidates. A credentialed delegate must nominate you from the floor after your application packet has been submitted and verified. If you make the decision to run for office after you arrive in Nashville, you may see other pre-slated candidates with professionally printed posters, campaign buttons, or other materials. Don’t focus on what you don’t have. The key to grabbing people’s attention is your motivation, drive and commitment to the future of NSNA. Demonstrate your leadership qualities. Be confident but approachable. And remember to smile! Be prepared to answer questions for delegates or NSNA members that may approach you with questions about your campaign and goals for NSNA. These moments allow you more personal connections with the voting delegates. Make sure to find a campaign manager who will be an asset to your campaign. You and your campaign manager will be each other’s resource throughout the whole experience. Your campaign manager gives you the opportunity to be in two places in once! He or she

will be an asset to your campaign as your representative in campaign headquarters or at caucuses while you are in the House of Delegates or campaigning elsewhere. Having a campaign manager is beneficial, but is not a requirement to run for a NSNA national office. Campaign boundaries are present at every Convention and it is important for you to know these boundaries. Campaigning outside these boundaries is prohibited and can result in forfeiting your candidacy. There will be signs posted outlining the campaign boundaries, which includes no campaigning during meetings of the House of Delegates. States will have caucuses, either open or closed, and I encourage both you and your campaign manager to attend as many as you can. Caucuses can go late into the evening so be sure to get ample rest when you can. It is essential for all candidates to attend the practice session held on Friday, April 11, 2014 during Convention (see Candidates’ schedule). This helpful session will give you the opportunity to feel comfortable when speaking with a microphone. The question and answer portion will also be covered during this session. Good luck! I sincerely hope you consider this opportunity to run for national office. You don’t have to be an established student leader to be a part of NSNA’s Board of Directors or Nominating and Elections Committee. Just be prepared, available, and knowledgeable. And be yourself! Running for a NSNA position is an incredible experience, and gives you opportunity to grow as a future leader. Be confident in yourself! Run for national office! G

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F O U N D A T I O N of the NSNA® In Memory of Frances Tompkins The Foundation was created in honor of Frances Tompkins, NSNA’s first Executive Director.

Upcoming FNSNA Events at Annual Convention The Foundation of the NSNA (FNSNA) has planned exciting events for you while attending the NSNA 62nd Annual Convention! During the Convention, the FNSNA Board of Trustees will be represented by Jenna Sanders, President, during the Opening Ceremony; Lola Fehr, Treasurer, as the NSNA Parliamentarian during the House of Delegates. Opening Recognition The Opening Ceremony on Wednesday, April 9, 2014 features special recognition of scholarship sponsors that continue to provide key support for the scholarship program. The FNSNA will also honor scholarship recipients for their outstanding achievements in nursing school. Additionally, one deserving school is awarded the Marilyn Bagwell Leadership Development Grant to be used for the purposes of increasing school involvement in NSNA. Terrence Keenan Leadership Lecture The 13th Annual Terrence Keenan Nursing Leadership lecture, takes place Thursday, April 10, 2014. If you are interested in gaining leadership experience throughout your career, don’t miss this special program. The Robert Wood Johnson Executive Nurse Fellows Program established the Leadership Legacy Fund, which supports the Terrance Keenan Annual Leadership Lecture at the NSNA Convention. This lecture fosters the connection between experienced and emerging nurse leaders.

Music City Auction The Music City Auction is a live auction on Friday, April 11, 2014 at 1:45 pm. This popular yearly event not only supports student nurses but also delivers a good time in the form of competitive yet friendly bidding wars. It is not to be missed! Student nurses, faculty, and exhibitors bid on items that often range from valuable nursing textbooks to nursing memorabilia, jewelry and electronics. All auction items will be on display at the NSNA Convention Office in the days leading up to the auction. Proceeds support the Mary Ann Tuft Scholarship Fund. If you would like to donate an item for the auction, contact the FNSNA by emailing nsna@nsna.org attn: FNSNA. Annual Challenge During the House of Delegates break on Saturday, April 12, 2014, the FNSNA challenges all Convention attendees to raise funds for the undergraduate scholarship program. Anyone can walk up to the microphone and declare their contribution (or donation commitment) while challenging others to match it. A state president might challenge other state presidents to match his or her donation. A school chapter might challenge other school chapters. State associations vs state associations, seniors vs seniors, faculty vs faculty… all rise to the occasion in this spirited and fun challenge. The Annual Challenge is a great way for attendees to come together as a community supporting the future of nursing. Don’t miss it! G The FNSNA would like to thank Saint Joseph’s College for donating a $100 Amazon.com Gift Certificate to be auctioned off at the Music City Auction on April 11, 2014.

FEBRUARY/MARCH 2014

The Global Initiatives in Nursing column explores and addresses issues relevant to international and global nursing

GLOBAL INITIATIVES in Nursing

Carson Applewhite, Imprint Editor and Chair, Global Initiatives in Nursing Committee

The February/March Global Initiatives in Nursing column comes from guest author, Asma Agad!

Providing Care and Health Education in Eleuthera By Asma Agad, Emory University, Atlanta, GA We have become increasingly dependent on technology in the modern world we live in. Although we have had the privilege to be born in a society with highly advanced technology, many people across the world (and even within our own country) do not even have access to the basic necessities of life. There are still people who die or suffer due to a lack of access to potable water, inadequate healthcare facilities, and scarcity of physicians and nurses. As nurses, it is our responsibility to be culturally aware and informed of both international and domestic issues. In January 2014, I had the privilege to be one of 14 students to experience a global health trip to Eleuthera, Bahamas. We were selected from 300 undergraduate and graduate nursing students at Emory University. Working in collaboration with a mission organization, we provided medical care and health education. The population we served had problems with hypertension, diabetes, and obesity. However, we came to soon realize that they were also noncompliant with their medications and uneducated about their health conditions. We spent seven days in Eleuthera visiting different clinics and schools to help educate and assess patients. Additionally, we made home visits to the patients who were unable to visit the clinics. Due to the short

timeframe that we were there, we had to make the most of our time. I was able to provide health education to patients as well as their families in the waiting room. By simply starting a health discussion with everyone in the waiting room, I provided education about their own health. After meeting nurses in Eleuthera, I quickly realized that the end of a 12-hour shift does not mean that our job, as nurses, is over for the day. The nurses of Eleuthera do not only care for patients while working; after work hours, they often stop by other clinics to pick up medications and drop them off at their patients’ homes. They also make home visits after hours for emergencies. Even when a patient recognizes them while they are shopping for groceries, these nurses take time out from their personal lives and listen to the patient’s health concerns. I was deeply impressed with the nurses in Eleuthera. Essentially, they are the center of Eleuthera’s healthcare. They do not have an electronic medical record system; everything is written by hand and filed into a folder. Nurses act as the primary care provider for six days out of the week because physicians are available in clinics for only 1-2 times per week. Nurses act as the pharmacists, dispensing medication and educating

Asma Agad in Eleuthera, Bahamas the patient about pharmacology, pathophysiology, and dosages. Lastly, the nurses are very personal with each patient. They all seem to know every patient’s medical history by heart. They are an impressive, closeknit community of nurses and I felt honored to have visited and learned from them. (Continued on page 27) 2

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F I N A N C E COMMITTEE

By Christine Shuffield, Secretary/Treasurer and Chair, Finance Committee

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The Role of Treasurer: Structured and Straightforward The responsibility of the treasurer does not have to be complicated. It may seem daunting at first, and you may not know where to start; this is normal. The duties do not change much from year to year. If you are transitioning into a well-organized association, you will be in great shape. But if you are inheriting a financial nightmare, please know that it is possible to gain stable financial practices while maintaining sanity. On a personal level, serving as the treasurer of an association provides practical experience for life after nursing school. It can help prepare you for taking care of your family’s income, savings, and retirement. On a professional level, it can prepare you to run for treasurer positions on professional Boards. Students in extracurricular activities involving monetary responsibilities will stand out to future employers. The following is basic information to help transition into a treasurer position and help treasurers already in the role. Familiarize Yourself With the Role Your predecessor is the best place to start. Ask questions to the previoius treasurer. Ask them to go over the budget and about additional responsibilities of the position. For various reasons, there are times when an association might not

have a treasurer and you are filling a vacant seat. You may have to ask the association’s advisors, or a previous board member who took on the treasurer responsibilities. Another essential place to familiarize yourself with your elected position is the association’s bylaws, policies and the past board meeting minutes. Find out if the association has descriptions of responsibilities for each position. This is a wonderful resource to have, especially if it’s a designated folder or file with a list duties, dates, and ongoing activities to pass onto the incoming board members. If your association does not have this resource, it would be a wonderful thing to implement during your term, so consider making this suggestion (especially for the role of Treasurer). Begin creating a folder/file during your term so that you can provide continuity to your successor. As the association implements or discontinues activities, be sure to make those changes to the file so that it is current and complete when your term ends. The Association’s Status An organization may qualify for exemption from federal income tax, accept donations, and avoid paying sales tax. It is important to know the status of the association.

Has the association stayed current on annual tax filing with the IRS? Hopefully the outgoing board can give you this information, if not, the IRS website (IRS.gov) is full of helpful information. There is more information about IRS status on the NSNA website located in the Treasurers Handbook (download directly at www.nsna.me/treasurershandbook). Paperwork and Records What is the state of the records you inherited? Are the financial paperwork, receipts, tax returns, and bank statements shoved in a shoebox or are they filed a file box with labeled dividers? Are there password protected electronic records, and who else has access to them? If everything is organized (i.e., you have ending balances, your predecessor used a detailed budget spreadsheet, etc.), then all you will need to do is familiarize yourself with the paperwork. Use the prior budget as a template for a new one; you do not have to reinvent the wheel. It is a good idea to have a balanced budget as soon as possible to present to your board. When your board votes on (and approves) the budget, attach it to your minutes. The budget will help guide decisions that will need to be made by the board. (Continued on page 27) 2

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B R E A K T H R O U G H to Nursing

The Breakthrough to Nursing column presents ideas and perspectives about the importance of cultural diversity in nursing and general recruitment into nursing.

by TJ Tekesky, Breakthrough to Nursing Director

Operation Hygiene is a service project that has proven to be successful in reaching out to the underrepresented populations in nursing. Nursing students collect hygiene items, along with non-perishable goodies and Johnson & Johnson Discover Nursing materials, and send them overseas to our deployed service members. I am proud to say that after working closely with Lindsey Bronikowski, the Breakthrough to Nursing Director for Georgia Baptist College of Nursing, the first shipment of care packages arrived in Afghanistan on September 11, 2013! Lindsey is the February/ March guest author for the BTN column.

Operation Hygiene By Lindsey Bronikowski, Breakthrough to Nursing Director, Georgia Baptist College of Nursing

How often do you take cleanliness for granted? Think about it. Every day you are taking a shower, washing your hands, perhaps using hand-sanitizer Bronikowski after pumping gas into your car. What if small, everyday items like soap, shampoo and hand-sanitizer were not easily accessible to you? This is actually a reality for many of our servicemen and women overseas. Some of the simplest things that can prevent the spread of illness and infection are not readily available to those who are deployed around the world.

collect goods such as baby wipes, handsanitizer, toothbrushes, feminine hygiene products and nonperishable food items to send to our soldiers. This program is extremely easy to participate in, yet is hugely beneficial. Our students fill large collection bins with items to prevent infection and illness, as well as small comforts and reminders of home—who doesn’t love Oreos? Every few months, these items are packaged up and sent to our soldiers abroad. With the gracious help of our local American Legion Post 66, a halfdozen large care packages were shipped to Afghanistan at the beginning of September. Our most recent shipment was sent out this past November, so that the soldiers were able to receive their deliveries by Christmas.

The student nurses at Georgia Baptist College of Nursing of Mercer University made it a priority to see that items that In addition to sending hygiene supplies, prevent infection and illness get to our information was also included on what troops overseas. Operation Hygiene is a the profession of nursing can offer program that was created specifically to these veterans when they separate from

the military. Johnson & Johnson© provides excellent, free nursing literature that was included in these care packages. Students at Georgia Baptist College of Nursing encourage ALL nursing students across America to join us in this opportunity. Consider partnering up with a local American Legion Post to collect hygiene items that can be sent to servicemen and women who are deployed throughout the world defending the freedom of the American people. This project is extremely easy to implement, and the benefits are substantial. Troops are extremely thankful when they receive their packages. It is extremely rewarding to know that our school is doing its part to prevent infection and illness, as well as promote the nursing profession. This is exactly what Breakthrough to Nursing embodies! G

For more information, download the BTN Operation Hygiene slide show at: www.nsna.me/btn-oh

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The Legislation/ Education column informs members of important legislative and education issues, healthcare policy, and political activism.

LEGISLATION EDUCATION

Katerina Raiser, NSNA Director and Chair, Legislation/Education Committee

Prevention through Regulation Legislation/Education extends to many topics in the nursing profession. For example, an important topic for student nurses to discuss is infectious disease, because it relates to many nurses as well as to patients. When we think of infectious disease in healthcare, our next thought might be the Center for Disease Control and Prevention (CDC). This regulatory agency’s mission is to, “Promote health and quality of life by preventing and controlling disease, injury, and disability” (CDC). The CDC works 24/7 to ensure that not only is disease being tracked and controlled, but also prevented. Even though there is an entire organization dedicated to this, we should care and be familiar with this issue as it affects each and every one of our patients. How many patients did you see last winter that were on isolation precautions? Those precautions were designed by the CDC in order to protect the patient as well as everyone else in the hospital. The CDC monitors isolation precautions in addition to their efforts surrounding healthcare prevention. It’s imperative to teach people the concept of maintaining good health by preventing acute illness. Another hot topic of debate for many people is immunization. Should new parents vaccinate their children? What are the major side effects? Is the flu shot essential or just a precaution? Vaccinations have a major impact on the prevention of chronic illness later in life. It is important to understand all of the facts related to immunization so that we can help convey correct information about the importance of preventing many communicable diseases. In addition to immunization education, it is also important to inform the community about the need to be regularly checked for health issues that affect certain populations. For exmple, are your patients sexually active? If they are at risk for sexually transmitted diseases, early detection is essential in helping prevent illness in the individual affected as well as others they have been in contact with.

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In addition to looking at a patient’s behavior, is also important to be knowledgeable of other factors that may affect a person’s health through prevention. For example, even though anyone can be susceptible to contracting Hepatitis C, people born between 1945 and 1965 (i.e., the “baby boomers”) are five times more likely to become infected. The longer a person lives with untreated Hepatitis C—a disease that can hurt the body silently for years—the more damage it will cause. It is important for nurses to stay up-to-date on the latest news related to infection prevention and control. New laws and regulations are passed frequently in order to help protect the public. If infection prevent and control is something you are passionate about, then make an effort to become aware of how different or new regulations might affect these issues. Many other diseases will be prevented with more support from, and education by, nurses with a passion for effecting change. Legislation/Education is not simply healthcare reform; and it is not just for people interested in politics or the government. Legislation/Education relates to numerous issues that need advocates to voice their concerns. By actively participating in the education of legislative concerns about your passionate issues, you can help ensure that laws and regulations coincide with evidence-based practices being implemented. Find your voice in legislation and get involved today! G Reference: Center for Disease Control and Prevention (CDC). Hepatitis C: Why Baby Boomers Should Get Tested. Retreived February 1, 2014 from: http://www.cdc.gov/knowmorehepatitis/Media/ PDFs/FactSheet-boomers.pdf This article champions the 2013 NSNA Resolution: “In support of increased awareness of expanded testing recommendations for the identification of Hepatitis C virus infection among the 1945-1965 birth cohort (Baby Boomers).”

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The Role of Treasurer: Structured and Straightforward (Continued from page 21) If you find that all the paperwork and records are crumpled and/or disorganized (and you have no access to a previous treasurer), don’t get discouraged. It’s okay; this happens sometimes. Now is the time to set up a good system for future officers, which will help strengthen the future of your association. Set up a filing system for the coming term and stay organized. Find the current bank balance, review the check registry for outstanding checks (i.e., checks that have not cleared the bank yet and still need to be subtracted from your balance), and look through your board minutes (or ask prior board members) for any outstanding monies that are owed to your association. Ask your advisors or even past board members if they know of anything outstanding that you should be aware of. Change the signature cards at the bank so the new officers are authorized to sign checks. Review bank account fees. If bank fees are high, it might be time to switch banks. If you are unsure of the process of signature cards, the bank will help guide you through the process. Resources for You The NSNA Treasurers Handbook details different items to be aware of. It is a wonderful resource. Another great resource are your pre-professional meetings: your state convention, the NSNA Annual Convention, and the NSNA MidYear Conference. Use these opportunities to network with other treasurers to see what is working for them. NSNA holds Treasurer Workshops at Annual Convention and the MidYear Conference. If you have an association that is running smoothly, please attend these workshops and share your knowledge and experience with those who might be looking for new or better ideas. Be a Resource The most important duty of a treasurer is custodian of the money. The financial information you provide at meetings will aid the board’s decision making, including: how many student representatives can be sent to Annual Convention; how many t-shirts (or other items) can be purchased for fundraisers; how much can be budgeted for food & beverage at membership meetings; and so on. Remember, the treasurer provides financial information but does not have the responsibility of making decisions alone; it is the responsibility of the board to represent the members in the decisions that are made. Stand Strong Just as we learn with hospitals and patient care, the treasurer’s

duties depend on policies and procedures. Adhere to the financial policies. If your policy requires two authorized signatures, don’t bend the rules because the president is not around. Firmly remind committee members of their limited budgets if they want to spend more than their budget allows. Consistency with financial policies will reduce the risk of mismanagement, error, confusion, and favoritism. With consistency, everyone will learn the procedures and come to appreciate your professionalism. Over time, the rules will become a natural part of how the group operates. The learned skills are priceless and can be applied to any field your career ventures to go. Pay it Forward Your term will come to an end and you will pass on information to the incoming treasurer. At that point, you may know from experience that this could be someone feeling overwhelmed or a little anxious. Use this opportunity to help make their transition a smooth and rewarding one!. G

Providing Care and Health Education in Eleuthera (Continued from page 19)

Asma Agad providing care during a home visit.) I highly recommend global health trip like this for other nursing students. It is a great opportunity to appreciate what we have at home by gaining a deeper understanding that not everyone is as privileged as we might be. As the future of healthcare, we have a social responsibility towards areas like Eleuthera. This does not mean that every nurse has to travel to different countries to be able to help; we can help by getting in touch with mission organizations in those countries and help set up donation services. We can even help provide health education pamphlets to send to global clinics so that the nurses there can educate their patients. I encourage you all to find a global health issue that you are highly passionate about and becoming involved in contributing to positive change. G NSNA IMPRINT® y www.nsna.org

HAPPENINGS The “Happenings” column highlights chapter activities and accomplishments. Submit your activities to nsna@nsna.org attn: Happenings.

By Laura Clark, Happenings Reporter

New York Physically Contributing for Causes Members of the Nursing Students’ Association of New York State (NSANYS) have been extremely active throughout their community this past fall. And when I say active, I mean physically! NSANYS attended multiple athletic fundraising events in New York this past year. Members of the NSANYS assembled a volunteer team to support the walkers of the “Making Strides Against Breast Cancer” walk. This event provided opportunities to raise awareness about breast cancer, honor breast cancer survivors, remember those we have lost, and support fundraising. To learn more about the American Cancer Society, visit MakingStrides.acsevents.org In addition to supporting the fight against breast cancer, NSANYS showed support for another prominent disease— diabetes. Students from the Hunter-Bellevue Student Nurses Association (HBSNA), along with the NSANYS Board of Directors, participated in the “Step Out Walk to Stop Diabetes.” More than 120,000 participants from 120 walk events across the country came together last year to raise over $24 million to help fight the disease (stepout.diabetes.org). NSANYS didn’t stop there! The Board of Directors also coordinated a volunteer team for the “Run 10 Feed 10” event. For every person that signed up for the 10k run, 10 meals were instantly provided to hungry children throughout community. Go to run10feed10.com to find out how you can help stop hunger! Lastly, Vice President Alisa Jaganjac and Community Health Director Darren Panicelli volunteered overnight at the first ever Moon Walk in Randalls, New York. This is a half marathon or marathon walk that started late at night where all proceeds went towards breast cancer causes. Visit, Walkthewalkamerica.com for information about next year’s walk!

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Above: The NSANYS Volunteer Team at the Making Strides Against Breast Cancer walk in Central Park! Below, top to bottom: The NSANYS Board of Directors at Run 10 Feed 10 Event; NSANYS Community Health Director, Darren Panicelli (seated, 2nd from left), with Nursing Student Volunteers from the Hunter-Bellevue School of Nursing (HBSON)

At Left: The 2013 promotional poster for the WNC Dancing With the Stars. The next event takes place on February 22, 2014. Below, Top to Bottom: Finalists Shelby Hunt (Carson Tahoe Hospital nursing manager) and her dance partner, Armando Nevarez, took home the third place prize; Student nurses and faculty club advisor at WND (left to right): Summer Black, Lindsey DiMartino, Michelle Azevedo, Amanda Kent, Lacey Kluck, Deborah Ingraffia-Strong, Shannon Wentz, Robyn Conn, Mariane Ortiz, Emily Weaver

Nevada Dancing with Student Nurses Students in the Western Nevada College (WNC) Nursing Program have made great strides to bring back the NSNA organization to their school! According to faculty club advisor, Debi Ingraffia-Strong, the NSNA chapter at WNC was disbanded due to financial cutbacks and constraints two years ago. In December 2013, the students brought it back, motivated by a very energetic nursing class. “As the faculty advisor, I am very proud of them. They raised $14,000 for 13 students to attend the Annual Convention. Their membership is flourishing, and it really is amazing what nurses, and future nurses can do!” These students decided to create a fundraiser that would be entertaining and enticing to the entire community. And what better way than to base it on one the nation’s most popular shows, “Dancing with the Stars.” Lindsey DiMartino, the president of the WNC student nurses association, kicked the planning off by sending out letters to “stars” of the community explaining their desire to attend the upcoming NSNA National Convention. (Continued on page 30) 2

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(Continued from page 29) These “stars” included: the police sheriff, district attorney, hospital CEO, nursing professor, nursing manager, high school teacher, City-Clerk Recorder, Miss Carson City, etc. And then, just like the television show, these “stars” were paired up with dancers from dance studios and then practiced for six weeks up to the big show in March 2013. These students were able to draw in a lot of publicity to gain interest in the event. They took to social media, made the front page of a newspaper, and even made an appearance on the local news! The spectacle was held at a local high school where they served food at VIP tables and then had over 1000 people come watch the performance! The show had everything from lights to fancy costumes to dance troop performances! The local fire chief served as “Master of Ceremonies” and the mayor and previous mayor as commentators. The dancers were judged on a scale of 0-10 by expert dancers and trophies were awarded to 1st, 2nd, and 3rd place winners. The mayor even requested that the chapter make this an annual event for the community! The next event happens on February 22, 2014. Says Lindsey DiMartino, “I hope we will attract at least 2,000 people. I continue to be amazed by the students. They were very responsive to calls for assistance. If something came up or tasks needed to be done, the members jumped into action. I am not only impressed with the students, but with our advisor.” New Jersey Council of School Participants Show They C.A.R.E. The New Jersey’s Council of School Participants (COSP) held a meeting for the nursing students of New Jersey to provide guidance and encouragement as they continue their journey of becoming a nurse. The focus of this annual meeting was on camaraderie, attitude, respect, and encouragement (C.A.R.E). These are characteristics the COSP feel every future nurse should possess and took it upon themselves to make sure that message gets through to New Jersey nursing students. At the event, a panel of nurses covered a wide range of topics including mentoring, healthy habits, educational paths, preventing burnout, and study techniques. They even included lunch, door prizes and scholarships at the meeting! New Jersey Nursing Students, First Vice President, Cassandra Bowman explains, “The goal is to focus on students, make their nursing school journey a little easier and, most importantly, provide ways to remain healthy along the way.”

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Mississippi Promoting the Career of Nursing Members of Mississippi’s Association of Nursing Students created and implemented a Breakthrough to Nursing project each year. This year they decided to educate and encourage high school students about nursing careers. The director of Breakthrough to Nursing, Lauren Radcliff, explains, “I was truly and deeply passionate about this project. My vision and goal for the BTN project this year was to assist high school students at diverse public schools to make informed decisions about their future. When I was in high school, I knew I wanted to pursue a career in the medical field, but I did not know about the vast options a degree in nursing provides. By working one-on-one with high school students, nursing students were provided the opportunity to teach and mentor students that may not have had access to the information otherwise.” The goal for this project was to promote high school students’ interest in nursing and also to provide a mentorship for those intrigued by the profession. The high school students from Columbus High School were matched up with a nursing student based on fields of interest and were able to use them as resources for any questions or concerns. The nursing organization also held a “skills day” where they taught multiple nursing skills including: blood pressure checks, pulse, respirations, temperature, hand washing, and patient communication. They also plan to implement future events for the high schoolers, such as demonstrations of catheter care, transfer and ambulation of patient, college application process, field trip to health care facility, and a graduation celebration for the students! G

NSNA Member Services Log on to NSNA Member Services to renew your membership, print out a replacement membership card, and update your contact information, including the email address you prefer to receive email updates and other news. You can also register for the NSNA Annual Convention through the Member Services website. Visit today at: nsnamembership.org

A Look Inside: The ANA Code of Ethics Task Force By Margaret Ngai

The Code of Ethics for Nurses with Interpretive Statements is the American Nurses Association (ANA) guide for delivering high quality nursing care that is consistent with the ethics of the nursing profession. There is a long, rich history of ethics in nursing. In the early 20th century, Isabel Hampton Robb laid the foundation with her work, Nursing Ethics: For Hospital and Private Use. The Nightingale Pledge and its revisions have also been referenced by nurses for ethical guidance. When the American Nurses Association (ANA) was founded in 1896, in their articles of incorporation, their first listed purpose was to establish and maintain a code of ethics. A preliminary and tentative code, entitled A Suggested Code, was published in the August, 1926 edition of the American Journal of Nursing. In 1940, an updated revision, entitled A Tentative Code, was published. Finally, The Code for Professional Nurses was accepted unanimously at the 1950 ANA House of Delegates, becoming the profession’s first official code of ethics. Since its inception, the document has been periodically reviewed, and changes made. The Code also includes Interpretive Statements. Because nursing practice issues and cultural norms change over time, it is imperative to review the code periodically so that it remains a useful resource for nurses. The Code was last revised in 2001 by a committee appointed by ANA. In 2011, a task force was selected to review the Code again, seek public feedback, and determine if more revisions were warranted. After the review, the task force— consisting of nurses from a variety of practice settings (including NSNA Executive Director, Diane Mancino, and myself)—indicated that the Code would benefit from further revisions. ANA began assembling the Code of Ethics Revision Professional Issues Panel Steering Committee, which will make recommended changes to be submitted to the ANA Board of Directors and then on to the Membership Assembly for approval. The members of the steering committee (see list of committee members at www.nursingworld.org/codeofethics) include ethicists, nursing faculty, nurse researchers, and nurses in a wide range of practice settings. The steering committee also includes members that were present for the 2001 revisions, ensuring continuity. I represent the voice of staff nurses, new graduates (nurses early in their career), and psychiatric-mental health nurses. In addition to an inperson meeting at ANA headquarters in 2014, we meet via conference call a few times a month, focusing intently on each provision and interpretive statement. We take comments/feedback into serious consideration and we look forward to producing a document that will be a great resource for all. Margaret Ngai, BSN, RN, is a staff nurse at Cascadia Behavioral Healthcare. Since her term as the 2011-2012 NSNA Vice President, she has remained active in the nursing profession as a new nursing graduate advisor for the Oregon Nurses Association Bylaws Committee. In addition to her appointment to the American Nurses Association Code of Ethics Revision Professional Issues Panel Steering Committee, she is also a member of the Oregon Center for Nursing Board of Directors. The Code of Ethics for Nurses can be accessed for free on the ANA website at www.nursingworld.org/codeofethics. G

See pages 43-47 for NSNA’s Code of Ethics: Part II, Code of Academic and Clinical Conduct with Interpretive Statements. NSNA IMPRINT® y www.nsna.org

Reflections on Disclosure and the Nurse-Patient Relationship By Maureen Mahon During the summer of 2013, I had the privilege of working on a neurology floor as a student nurse extern. The floor to which I was assigned holds a special place in my heart because it is where I first experienced the compassion of nurses as a patient.

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Being diagnosed with epilepsy turned my life around, and in the time that it takes you to read this article, I lost the ability to drive, to live alone, my independence, and became dependent on lifelong medication to keep my seizures under control. Epilepsy became the center of my life at a time when I should have been just being an adolescent and spending time with friends.

In the ANA Code for Nurses with Interpretive Statements (American Nurses Association, 2013), Section 4.2 speaks to the accountability of the nurse in practice. If a personal experience shared by a nurse affects the patient’s decision-making, it could be interpreted that a nurse is partially or fully responsible for adverse outcomes in a patient who utilized the nurse’s past experience. Section 5.1, addresses the I was extremely worried about my externship placement. preservation of self through moral self-respect. If a nurse chooses to continually self-disclose past personal Most of the patients on this floor have epilepsy either as their primary or a secondary diagnosis. I wondered if history to patients as a form of “self-care,” then harm is possible to both the nurse, who is being neglectful this placement was going to touch too close to home; I to self, and to the patient, who is not experiencing a still struggle with many of the limitations surrounding professional nurse-patient relationship. Section 2.4 does my diagnosis. Not driving, being continually vigilant establish that nurse-patient relationships vary from about taking medications, and struggling with the ever nurse-colleague relationships because nurse-colleague present stigma are daily issues. Most importantly, I was relationships are unstructured implying more leniency still unsure of with whom and how I should share this with personal disclosure within nurse-colleague information. relationship (American Nurses Association, 2013). My mentor knew that I had epilepsy; I had disclosed it on the first day, so if anything happened while I worked, Arguments for Personal Disclosure One potential benefit of self-disclosure might occur she would not be alarmed. She was quite comfortable when the disclosure is framed in a positive way and with this, and never discussed it again. One night the the patient and family experience increased hope and charge nurse noticed my medical alert bracelet, and motivation (Sheets, 2001). If a nurse is able to share it led to a discussion about my epilepsy. In the next a similar experience and then use the connection to couple of weeks, I had very similar conversations with redirect the patient to a positive coping strategy it might most of the nurses on the floor. They wanted to know be appropriate (College of Registered Nurses of British what the everyday life experience of a person with Columbia, 2006). For example, I could disclose that epilepsy was like. It gave them the chance to speak to I was about the same age when I was diagnosed with someone who was living a relatively healthy life despite epilepsy, and I felt alone, but I found great resources epilepsy. This was a rare opportunity for them, because and support through my local Epilepsy Foundation many of the children on the floor had complicated and encourage the patient to explore that resource. diagnoses and uncontrolled seizures. I was able to provide the nurses with an image of what a person who had epilepsy could look like and could be capable of with successful medical management and effective Arguments Against Personal Disclosure psychosocial support. I had to give acknowledgement There are concerns about disclosure due to the nature that epilepsy is a spectrum disorders with wide variance of the nurse-patient relationship. The patient exists in how individuals are affected. I was fortunately given in a vulnerable state when seeking healthcare. Some a relatively positive prognosis. consider sharing to be abuse of power, since it can unduly influence a patient and their healthcare decisions (Griffith & Tengnah, 2013). Disclosure can Every nurse brings personal experiences to the profession and could potentially be placed in a situation blur boundaries; maintaining boundaries can protect the patient who is susceptible and keep the nurse from they can relate to on a personal level. I gave this much abusing their power in the nurse-patient relationship thought and searched to better understand if there is (Sheets, 2001). The patient may feel inclined to a well-defined position on personal disclosure in the comfort the nurse or even follow options that the nurse professional setting. chose even if they not necessarily beneficial or safe for the patient. (Continued on page 34 2)

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(Continued from page 33) Nurses can also accidentally create role reversal when self-disclosing by venting and asking the patient to be therapeutic for them (Sheets, 2001). For example, if I were to disclose which medication I took, then patients may assume that they should choose that medication, because it works for me. When it comes to the personal issues of children and driving, I have chosen to consider adoption and have made the personal choice to use public transit. If I were to share this information, patients and their families may incorrectly assume that they will have only that option. Implications A limited amount of nursing research exists on selfdisclosure and ramifications for both nurses and patients. Clearly, this is an area for further exploration and discussion. Nurses who have personal health issues that relate to their professional practice need to engage in careful consideration as to how they will balance their practice and their health. It may be possible to avoid selfdisclosure by redirecting the patient to reflect upon their own feelings and opinions for care and reduce unintended influence by saying something such as “many individuals worry about not being able to drive – has that been a problem for you?” pulling from a personal experience but not disclosing that it is the nurse’s personal experience (Lachman, 2009). Advocacy and volunteering are two venues through which personal health experiences can be utilized to encourage institutional or local changes to benefit patients without possibly jeopardizing the nurse-patient relationship (Picard, Agretelis, & DeMarco, 2004). For example, I have found it helpful to volunteer with my local Epilepsy Foundation. I have helped advocate for national and state legislation by sharing my experiences with representatives and senators. Being a volunteer support in my local affiliate allows me to open up positively about my personal experiences without affecting healthcare decisions of other people in similar situations. In both of these roles, I am acting not as a nurse, but rather in a peer support role. Self-disclosure should be addressed in the educational setting. Students need to think about possible issues where disclosure might occur and how it might be best managed. Although students may not experience a situation in the academic setting, addressing this topic in the classroom could prevent problems or distress later in professional practice. It could also help them to be aware of personal issues that could affect the way they act within their nurseclient relationships both positively and negatively. 34

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Conclusion Over the course of my externship, I utilized my previous knowledge and personal experience of epilepsy to provide education that was beneficial. Sharing with my colleagues at my externship was an appropriate disclosure, since it was for the safety and benefit of the nursing staff. If anything were to happen while I was working, they would be prepared. This disclosure varies greatly from personal disclosure to patients. My own personal experience with epilepsy, though relatable for patients, is not their experience. By falsely giving hope or medical information that only pertains to my situation and my diagnosis, I could potentially lead a patient in a direction or skew their understanding of their own prognosis and self-management. I experienced many emotions surrounding my diagnosis, and I recognized that I needed to address these feelings if my patients or families were experiencing them. Many times this involved taking a step back before giving information or engaging in a conversation to ensure that I had taken into consideration what this patient and family could possibly be experiencing. This “step back” gave me the opportunity to recognize that my job was to prepare the family and not for me to “share” my story. I found that I started a conversation with a phrase such as “some patients experience some anger or frustration,” then families and patients opened up if they were experiencing issues. I also could prepare the family by framing the information and education in a manner that showed a level of comfort and “normalness” with the aspects of epilepsy that they would possibly have to confront and manage to help set the tone for how the family would approach their child. In addition to the externship, I also continued my efforts with the local Epilepsy Foundation affiliate to provide mentorship and assist with an educational program being run in community. This allowed me to positively share my story and become an influence for local changes in programs and advocacy efforts. I have also written about my experiences to share with patients (Mahon 2013 Summer; Mahon 2013 Spring) and colleagues (Mahon, 2013). Whenever possible, I did share with families and patients that these resources exist in the community and provided the family with more information about how to manage school and social difficulties that resulted from having a diagnosis of epilepsy. I am trying to find a balance. G

References American Nurses Association. (2013). Code of Ethics for Nurses With Interpretive Statements, from http://www.nursing world.org MainMenuCategories/EthicsStandards/Code ofEthicsforNurses/Code-of-Ethics.pdf College of Registered Nurses of British Columbia. (2006). Nurse-Client Relationships. Vancouver, BC: College of Registered Nurses of British Columbia. Griffith, R., & Tengnah, C. (2013). Maintaining professional boundaries: keep your distance. Br J Community Nurs, 18(1), 43-46. Lachman, V. D. (2009). Practical use of the nursing Code of Ethics: part II. [Review]. Medsurg Nurs, 18(3), 191-194. Mahon, M. (2013, July 19). [Web blog message]. Retrieved from http://connect.ons.org/ons-connect-blog/a nurse’s-place-in-public-health Maureen, M. (2013, Spring). Bonding over transition. National Center for Project Access: Epilepsy and My Child, 1(2), 3. Retrieved from http://www.epilepsyfoundation.org/ projectaccess/newsandevents/upload/EMC-newsletter_ Spring_2013.pdf Maureen, M. (2013, Summer). How epilepsy paved my career. National Center for Project Access: Epilepsy and My Child, 1(3), 3. Retrieved from http://www.epilepsy foundation.org/projectaccess/newsandevents/upload/ Epilepsy-My-Child-Summer-2013.pdf Picard, C., Agretelis, J., & DeMarco, R. F. (2004). Nurse experiences as cancer survivors: part II—professional. [Research Support, N.I.H., Extramural Research Support, U.S. Gov’t, P.H.S.]. Oncol Nurs Forum, 31(3), 537-542. doi: 10.1188/04.ONF.537-542 Sheets, V. R. (2001). Professional boundaries: Staying in the lines. Dimens Crit Care Nurs, 20(5), 36-40.

Maureen Mahon is a senior nursing student eagerly looking forward to graduation in May 2014. Her future goals include working in the non-profit sector to improve the quality of healthcare and education within the community for those living with a diagnosis of epilepsy. She has worked on both national and state level legislation for rights for those living with disabilities and has testified on the senate floor for healthcare reform.

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Whistleblowers:

Troublemakers or Virtuous Nurses? by Vicki D. Lachman Regrettably, whistleblowing is still necessary in today’s health care environment — one that is weighed down with fraud, incompetent practitioners, and patient safety issues. It is an action seen in movies and heard about in organizations, yet distant from nursing. Nurses are left with a question, “Could I stand up for what is right like that courageous person?” The focus of this article is to provide ethical justifications for the action of whistleblowing as well as information on legal protections and ways to reduce the risks and negative consequences often experienced by the whistleblower. What Is Whistleblowing? Whistleblowing is an attempt by a member or former member of an organization to issue a warning to the public about a serious wrongdoing or danger created or concealed by the organization (Ahern & McDonald, 2002; Bolsin, Faunce, & Oakley, 2005; Davis & Konishi, 2007). Numerous definitions of whistle-blowing appear in health care and business literature, but all point to the importance of advocacy, that is, protecting someone who will likely be harmed. For this article, the definition will differentiate between reporting the problem within the organization and whistleblowing to an external agency (Fletcher, Sorrell, & Silva, 1998; Sellin, 1995). To define the terms further within the scope of nursing, whistleblowing is the action taken by a nurse who goes outside the organization for the public’s best interest when it is unresponsive to reporting the danger through the organization’s proper channels. Reporting is the action taken by the nurse inside the channels of his or her organization to correct a dangerous situation. Examples of reporting include incident reports and verbal reporting to line managers (Firtko & Jackson, 2005). These definitions indicate that whistleblowing re¬sults from a failure of the ethical climate of the organization to address accountability for the safety and welfare of the patients. The nurse feels compelled in the face of inaction to take a stand against the wrong-doing in the organization. Because staff nurses have an increasing responsibility to maintain an ethical practice environment, it is important to 36

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cover the organizational ethics issues and solutions as well. A discussion of what both the organization and the nurses in leadership roles within the organization can do to help maintain the business’ moral compass will be discussed in an upcoming Ethics, Law, & Policy column. When Is Whistleblowing Morally Required? The ethical theories used in this article to justify whistleblowing are Kantian (duty), virtue, and utilitarian (Bolsin et al., 2005; Grant, 2002; Kline, 2006). Kantian theory instructs people to act in harmony with universally accepted rules. Telling the truth is at the heart of this deontological theory (Kant, 1996). Though Kant had no way of knowing the self-sacrifice that is often required in whistleblowing, I believe that Kant would want an individual to stand firm in telling the truth, regardless of personal outcome. Virtue theory requires an individual to personify integrity and courage (Adams, 2006; Bolsin et al., 2005). Reporting unethical colleagues, patient safety violations, or health care fraud requires the integrity found in professional character. For example, a primary goal is to remain loyal to providing relief to a patient in suffering. Turning a blind eye to practices that go against that primary aim would not only breach the nursing Code of Ethics (duty) (American Nurses Association [ANA], 2001), but it would also violate the basic virtues of honesty and courage. The ethical theory of consequentialism (utilitarian) provides a powerful justification for whistleblowing: maximizing the human benefit and minimizing the harm. Below is the standards theory summarized by Davis (2003, pp. 89-90) and describing when whistle-blowing is morally required for the greatest good of society. • The organization to which the would-be whistle-blower belongs will, through its product or policy, do serious considerable harm to the public (whether to users of its product, to innocent bystanders, or to the public at large). • The would-be whistleblower has identified that threat of harm, reported it to the immediate supervisor, making clear both the threat itself and the objection to it, and concluded that the superior will do nothing effective.

• The would-be whistleblower has exhausted other internal procedures within the organization (for example, by going up the organizational ladder as far as allowed), or at least make use of as many internal procedures as the danger to others and his or her own safety make reasonable. • The would-be whistleblower has (or has accessible) evidence that would convince a reasonable, impartial observer that his or her view of the threat is correct. • The would-be whistleblower has good reason to believe that revealing the threat will (probably) prevent the harm at reasonable cost (all things considered). Sometimes the threat to the safety or health of patients is so immediate that going through the channels of a hierarchical structure could cost patients’ lives. If the immediate supervisor is the source of the problem, the nurse has no choice but to leap up a level above him or her in the organization. Unfortunately, not following the chain of command could be the resulting focus of the retaliation rather than the identified ethical issue. If blindness to the danger extends to the next level in the hierarchy, the individual’s loyalty to the organization or his or her naiveté on how a health care organization functions could become the issue. This is because whistleblowing challenges the amoral view of the organization; from the organization’s point of view, the nurse was unable to resolve ethical concerns internally (Grant, 2002). Who Are Whistleblowers? Whistleblowers are generally seen as brave individuals who take a stand against the practices of an organization. Whether in business or health care, the cases are similar to the examinations of 64 whistle-blowers by Glazer and Glazer (1989). They are parallel to the movie The Insider, which depicted the tactics of the tobacco industry to hide the addictiveness of its product. Many stories indicate that whistleblowers face adversity when standing up to an organization, including that of Barry Adams, RN (Fletcher et al., 1998). Barry Adams worked in a sub-acute unit in a New England hospital in 1996. As the hospital implemented staffing cuts and cost-containment actions, he became increasingly distressed about the quality and safety of the patient care. His careful documentation revealed that inadequate staffing and lack of supervision of new staff correlated not only with patient falls, but also with incomplete treatments and serious medication errors. For 3 months, Mr. Adams documented and communicated his concerns up the chain of command within the hospital. He was fired eventually for his actions. He sued the health care organization and won; upon appeal, the hospital lost a second time. For Mr. Adams, like most other whistleblowers, personal and professional reputation was above reproach.

Iliffe (2002) identified whistleblowing as an obliga¬tory rather than a chosen state. From that point of view, whistleblowers find themselves in a position either to speak out or to remain silent. At those moments, the situation and the virtue of courage col¬lide. Some nurses choose to maintain standards they have as personal and/or professional. Like Barry Adams, they are often not average performers. They are above-average performers committed to the organization with a strong belief in moral principles (Grant, 2002). What Are the Negative Consequences to the Whistleblower? Comprehending the public character of whistle-blowing is crucial to appreciating the risks associated with the action. When whistleblowing is interpreted as I have defined it, the action requires moral courage. Malcontents who file frivolous lawsuits or draw attention to themselves in public media are not the focus of this article. Those scattered individuals undermine the courageous nurses who risk so much to honor their Code of Ethics and alert someone to wrongdoing and neglect within a health care organization. In the case of Barry Adams, 21 individuals came forward in the suit to attest to his integrity and protest his termination (Fletcher et al, 1998). The list of negative consequences to whistleblow¬ing seems endless: broken promises to fix the problem, disillusionment, isolation, humiliation, formation of an “anti-you” group, loss of job, questioning of the whistleblower’s mental health, vindictive tactics to make the individual’s work more difficult and/or insignificant, assassination of character, formal reprimand, and difficult court proceedings (Ahern & McDonald, 2002; Brodie, 1998; Fletcher et al., 1998; Wilmot, 2000). As Barry Adams learned, blowing the whistle can be a life-altering incident. Even though Mr. Adams lost his job, he must have felt a sense of achievement for speaking out about patient safety issues. What Legislation Provides Support to Whistleblower? Under the 1st and 14th Amendments to the U.S. Constitution, state and local government officials are prohibited from retaliating against whistleblowers (Faunce, 2007). Federal regulations offer legislative protection for reasonable allegations of whistleblowers who acted in good faith for public interest because of a substantial and imminent threat to public good. Additionally, more than two-thirds of U.S. states have passed legislation to protect whistleblowers from retaliation (Grant, 2002). However, who is covered, what is covered, and how and when individuals are to report incidents vary from state to state (Drew & Garrahan, 2005). A person would be wise to know his or her rights and the procedures required before deciding to blow the whistle on an organization.

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TABLE 1. A Guide for Moral Decision Making 1. What are the moral dimension(s)? 2. Who are the interested parties? What are their relationships? 3. What values are involved? 4. What are the benefits and burdens that need to be examined? 5. Are there any analagous cases? 6. Who are the relevant others with whom you could discuss the issue? 7. Does the decision accord with legal and organizational rules? 8. Am I comfortable with this decision? Source: MacDonald, 2002 Two Web sites provide information, books, blogs, Internet links, and other guidance. The National Whistleblower Center is a nonprofit, tax-exempt, educational and advocacy organization dedicated to helping whistleblowers (http:// whistleblowers.org/index.html). Since 1988, this organization has used whistleblowers’ disclosures to improve government and corporate accountability, environmental protection, and nuclear safety. Though not specifically focused on health care, the center’s Web site provides a wealth of information. The second Web site, Freedom to Care, does have a health care component. However, it is focused on issues in Great Britain (http://www.freedomtocare.org/). A link on this Web site connects nurses and nursing students to the International Association for Nursing Ethics and information on the ethical issues involved in whistle-blowing (http://www. freedomtocare.org/contents.htm# healthcare). The False Claims Amendment Act of 1986 primarily focused on prohibiting any false claim for reimbursement to the United States, but it did include a whistleblower provision (qui tam) (http://www.taf.org/whyfca.htm). This regulation protects whistleblowers who disclose violations that involve fraudulent use of federal funds. The whistleblower can be a current or former employee, a patient, a competitor, or any person who obtains firsthand knowledge of fraudulent behavior. This person can file suit on behalf of an entity and recover 15%-30% of any settlement. If the government wins the case, then the whistleblower could win a substantial amount of money. For example, in fiscal year 2006, the U.S. government recovered a record $3.1 billion in cases of fraud (DoBias, 2007). Tenet Healthcare Corp’s $920 million settlement accounted for the largest percentage of the $2.2 billion from recoveries in health care. Is There a Moral Guide to Solve the Whistle-blower Dilemma? If effective and well-communicated internal structures are available to ensure employees’ concerns are addressed, the need for whistleblowing does not exist. However, in a less than idealistic world, the nurse needs a model on how and when to voice a concern that helps reduce the risk as much as is feasible. MacDonald (2002) provided such a guide to moral 38

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decision making. The model is outlined with slight alteration in Table 1. An example to exemplify this model could be the continuous violation of an advance directive for a patient who is in the terminal phases of illness, or who is unconscious and therefore unable to voice his or her choices. By choosing to remain silent, the nurse would be complicit in violating the moral dimension of the patient’s autonomy asserted in the advance directive. The interested parties would include all other health care professionals caring for the patient, the patient’s surrogate decision maker, and the nurse managers responsible for the unit. By speaking up in such a situation, a nurse would be in danger of undermining the status quo of the organization and breeching loyalty to the “conspiracy of silence,” and could be seen as a troublemaker. The issues of values, benefits versus burdens, and legal cases need reflection. The values espoused through the Code of Ethics (ANA, 2001) address the autonomy of the patient as well as the responsibility of the surrogate to speak for the patient. The burdens on the patient are more obvious than those on the nurse who speaks for the patient. The preceding negative consequences (burdens) outlined for the whistleblower may seem out of proportion to the benefits of integrity. Barry Adams, RN, could be an analogous case (Fletcher, 1998), but so could other nurses who refused to violate the patient’s right to self-determination. MacDonald and Ahern (1999) found that talking to a respected friend or relative about the dilemma is an effective way to cope with whistleblowing. Violating the patients’ advance directives violates not only the Code of Ethics, but other legal and organizational rules. The Patient’s Self Determination Act (Galambos, 1998) and policies with the organization relative to advance directives also would be violated. Finally, the nurse needs to ask, “Am I comfortable with this decision?” MacDonald (2002) offered some questions that can help the nurse address this question. The nurse may not be “comfortable” because often situations requiring the virtue of integrity and courage are not comfortable at the time. However, it is imperative that the nurse ask the following questions to determine if, in the long term, he or she could continue in the profession while maintaining a high level of integrity. Questions could include: 1. If I carry out this decision, would I be comfortable telling my family about it? 2. Would I want my children to take my behavior as an example? 3. Is this decision one which a wise, informed, virtuous person would make? 4. Can I live with my decision?

Conclusion I believe that the ends do justify the means of whistleblowing, when the ends are increased patient safety, change in misconduct, and/or an ethical climate that supports professional nursing. As a professional, every nurse needs to champion whistleblowing rather than ostracizing nurses with the moral courage to speak out on unethical practices. Encouragement is needed for the nurses who risk their own well-being for the sake of the patient (Peternelj-Taylor, 2003). G Vicki D. Lachman, PhD, MBE, APRN, is a Clinical Associate Professor, Drexel University, Philadelphia, PA. References American Nurses Association (ANA). (2001). Code for ethics for nurses with interpretative statements. Silver Spring, MD: American Nurses Publishing. Adams, R.M. (2006). The theory of virtue. New York: Oxford University Press. Ahern, K.M., & McDonald, S. (2002). The beliefs of nurses who were involved in a whistleblowing event. Journal of Advanced Nursing, 38(3), 303-309. Bolsin, S., Faunce, T., & Oakley, J. (2005). Practical virtue ethics: Healthcare whistleblowing and portable digital technology. Journal of Medical Ethics, 31(10), 612-618. Brodie, P. (1998). Ethics. Whistleblowing: A moral dilemma. Plastic Surgical Nursing, 18(1), 56-58. Davis, A.J. & Konishi, E. (2007). Whistleblowing in Japan. Nursing Ethics, 4(2), 194-2001. Davis, M. (2003). Some paradoxes of whistleblowing. In W.H. Shaw (Ed.), Ethics at work (pp. 85-99). New York: Oxford University Press. DoBias, M. (2007). Whistle-blower law tightened: Ruling demands firsthand knowledge of wrongdoing. Modern Healthcare, 37(14), 8. Drew, M.G., & Garrahan, K. (2005). Whistleblower protection for nurses and other healthcare professionals. Journal of Nursing Law, 10(2), 79-87. False Claims Act Legal Center, The. (n.d.). Why the False Claims Act? Retrieved January 27, 2008, from http://www.taf.org/ whyfca.htm Faunce, T.A. (2007). Whistleblowing and scientific misconduct: Renewing legal and virtue ethics foundations. Medicine and Law, 26(3), 567-584. Firtko, A.J., & Jackson, D. (2005). Do the ends justify the means? Nursing and the dilemma of whistleblowing. Australian Journal of Advanced Nursing, 23(1), 51-57. Fletcher, J.J., Sorrell, J.M., & Silva, M.C.(1998).Whistleblowing as a failure of organizational ethics. The Online Journal of Issues in Nursing, 3(3). Retrieved January 27, 2008, from http://www.nursingworld.org/MainMenu Categories/ANAMarketplace/ANAPeriodicals OJIN/ Tableof Contents/Vol31998/No3Vol31998/ Whistleblowing.aspx Freedom to Care. (n.d.). Promoting public accountability. Retrieved January 17, 2008, from http://www. freedomtocare.org/

Galambos, C.M. (1998). Preserving end-of-life autonomy: The Patient Self-Determination Act and the Uniform Health Care Decisions Act. Health and Social Work, 23(4), 275-281. Glazer, M.P., & Glazer, P.M. (1989). The whistleblowers: Exposing corruption in government and industry. New York: Basic Books. Grant, C. (2002). Whistle blowers: Saints of secular culture. Journal of Business Ethics, 39, 391-399. Iliffe, J. (2002). Whistleblowing: A difficult decision. Australian Nursing Journal, 9(7), 1. Kant, I. (1996). Practical philosophy. Gregor, M.J. (Trans., Ed.). Cambridge, NY: Cambridge University Press. Kline, A.D. (2006). On complicity theory. Science and Engineering Ethics, 12(2), 257-264. MacDonald, D. (2002). A guide to moral decision making. Retrieved January 27, 2008, from http://www.ethicsweb. ca/guide/ McDonald, S., & Ahern, K. (1999). Whistleblowing: Effective and ineffective coping responses. Nursing Forum, 34, 5-13 National Whistleblowers Center. (n.d.). News from the center. Retrieved January 27, 2008, from http://www. whistleblowers.org/ Peternelj-Taylor, C. (2003). Whistleblowing and boundary violations: Exposing a colleague in forensic milieu. Nursing Ethics, 10(5), 526-537. Sellin, S.C. (1995). Out on a limb: A qualitative study of patient advocacy in institutional nursing. Nursing Ethics, 2(1), 19-29. Wilmot, S. (2000). Nurses and whistleblowing: The ethical issues. Journal of Advanced Nursing, 32(5), 1051-1057. Reprinted from MEDSURG Nursing, 2008, Volume 17, Number 2, pp. 126-128,134. Reprinted with permission of the publisher, Jannetti Publications, Inc., East Holly Avenue, Box 56, Pitman, NJ 08071-0056; Phone (856) 256-2300; FAX (856) 589-7463. (For a sample issue of the journal, visit www.medsurgnursing.net - Learn more about the Academy of Medical-Surgical Nurses [AMSN] at www. amsn.org)

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Experiencing

Moral Distress as a Student Nurse

By April Grady

“Moral distress occurs when one knows the ethic ally correct action to take but feels powerless to take that action” (Epstein & Delgado, 2010). Nursing students often experience moral distress. We are witnesses to poor nursing practice. Although we are taug ht patient advocacy, sometimes we have to weigh the risks of advocatin g for patients against the repercussions we could face as stud ents. This is the awful truth. If we reported every small infraction we witnessed, we wouldn’t make it very far in clinicals. We depend on the nurses to teach us. Nurses are capable of ignoring us or blocking learning opportunities, as well as teaching us and creating opportunities. For this reason, we must choose our battles. We may ignore small lapses in best practice; however, when we witness something that is threatening to a patient’s safety, we must act. I witnessed two major incidences of poor prac tice as a nursing student. In one instance, I witnessed a certified nursing assistant (CNA) assigned to the psychiatric unit who cont inually mocked patients and laughed at their agitation. One patie nt in particular was a frequent victim. The patient had dementi a and the CNA would talk gibberish until the patient became confused and walk away. The CNA found this hysterical and showed off this “skill” to me and two other students. We reported the behavior, and continued to report incidences until that person was transferred to a different unit. This was a clear case of patient advocacy. In this case, there was no moral distress. We saw a wrong and had recourse to report it.

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The second incidence of poor practice that I witnessed as a student nurse was not as clear-cut, and this was an event that caused moral distress.

my nurse—who, at this point, had not been in his room once during the entire shift—she became angry and told me I was wasting time and I was no longer allowed in that patient’s room. I was forbidden from giving him quality care, but I knew she wasn’t going to provide care for him either.

On my second medical-surgical rotation, I was assigned to a trauma step-down unit. One morning I arrived and was assigned to a particular nurse that I I spent the rest of my 12-hour shift fuming. I had not did not care for. I had witnessed her poor practice on many occasions. She was rude to patients and families, been “wasting time,” nor had I fallen behind on any of my other patients. Every time I tried to advocate she routinely took short cuts in her patient care and for this patient, I was cut off. At the end of my shift, I she started fights among other nurses. Everyone snuck into his room to say goodbye to him and his wife. was afraid of her and no one ever questioned her. I He smiled and tried to wave to me. His wife and I were dreaded working with her because she would get both amazed! impatient with students for doing things the right way, and she would encourage us next day I made the decision to take her short cuts. For example, …when we The to report the day’s incidences to my if I tried to look up a medication clinical instructor, and she insisted I was unfamiliar with, she would witness I report it to the nurse manager. get angry and demand that I just something Ithat was hesitant to do so because I did “hurry up and give it.” I was often not want to stir up any more trouble that is butting heads with her. On this with this nurse. She already tried to particular day, I received a report threatening make my clinical hours as difficult as from the night shift about a man to our possible. However, patient advocacy with a traumatic brain injury who is far more important. I was assured had been hit by a train. The night patient’s anonymity in my report. shift nurse told her, “Don’t worry safety, about him, he’s pretty much a I met with the nurse manager and vegetable.” They both laughed reported everything, including specific about this, skipped the report on words said by my night nurse as well him, and went on with the other as the night nurse, and specific times patients. When I went in to do my of different incidences. I reported that initial assessment on this patient, it I was forbidden from going back into was clear he was not “a vegetable.” his room to care for him. He followed me with his eyes and attempted to communicate. I felt better after the meeting. However, the following week, the nurse I was working with cornered me and Throughout my shift, each time I went into his room, screamed in my face about “tattling” and accusing my nurse would yell at me for “wasting time.” She me of lying about her to the nurse manager. She insisted that he did not need turning, oral care, or any repeated many of the things I had told the nurse other routine care because he was “already going to manager, verbatim. Obviously, my report was not die.” I will never forget her words, or this patient. In anonymous. I had had a terrible morning, personally, the afternoon, the patient’s wife visited. She washed and I was completely caught off guard. I maintained his hair (it was still full of blood from the accident my composure, got out of the corner she trapped me in, more than 48 hours previously), she gave him a and ran for the bathroom. I was either going to let out sponge bath and she brought a CD player to play the frustration by screaming back, or take a moment some of his favorite music. From the moment she of personal time out in the bathroom. My clinical arrived, he became more and more alert. Not only was he following us with his eyes, he tried to smile and instructor had seen me run past and followed me. I tried to control the tears but I just couldn’t. It was so even tried to vocalize an answer to a question. Pretty frustrating! (Continued on page 42 2) impressive for a “vegetable.” When I reported this to

we must act.

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(Continued from page 41) Crying in the bathroom seemed to be the less confrontational choice. After giving myself a few minutes to let off steam and splash water on my face, I emerged and explained everything to the clinical instructor. I asked her not to say anything to the nurse manager right away; I was at the beginning of a 12hour day and didn’t need any more drama. This was interfering with my learning. The patient had been discharged to a different unit, so at this point it felt like the matter was no longer about patient advocacy but rather drama and politics. The clinical instructor agreed to wait until the following day to talk to the nurse manager. Fortunately, the nurse’s screaming episode when she confronted me did not go unnoticed. By lunch, everyone knew what had happened. Almost every nurse came up to me and whispered encouraging words. I was very surprised becaue the nurse who had yelled at me seemed to be very powerful with many friends on the unit. As it turns out, almost every nurse said something about wanting to report her for years and applauded me for doing so. It was very eye opening. The ANA Code of Ethics for Nurses states in Provision 1: “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual…” That nurse had clearly violated this provision by treating the patient as a “vegetable” and refusing him quality care. She also failed to treat me in a respectful manner. Epstein and Delgado (2010) define moral distress as knowing the ethically correct action to take, but being unable to take that action. At the time of this incident, I had never heard of moral distress. When I learned of it, this incident came to mind. My hands were tied; the nurse barred me from the patient’s room. This caused me significant distress. The American Association of Critical-Care Nurses (AACN) suggests using the Four A’s: Ask, Affirm, Assess and Act, when confronted with moral distress. Although I was unaware of it at the time, I did follow the Four A’s. I went home and asked myself how I felt about the patient’s care. I affirmed that in my role as student, I had limited recourse. I assessed and wrote down a timeline of events, and I acted by reporting the incident to my clinical instructor and the nurse manager. It was not easy, and I did suffer repercussions, but I know I feel better about the way the situation played out than I would have had I not acted. 42

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Browning (2013) discussed the relationship between psychological empowerment and moral distress. As nurses feel more empowered, they become more active in collaborating with the health team, and they experience less moral distress. I know a lot of my moral distress was related to how powerless I felt as a student nurse. Although I knew the patient was not receiving adequate care, a small part of me still doubted my self. When confronted by the nurse, I was scared and frustrated. I knew my grade and my progression in the nursing program depended on my care and behavior in the clinical setting. I had to step carefully and make sure I was professional and honest in my handling and reporting of the situation. I feel I did well, but I will never forget the patient who was not receiving proper care, or the nurse that made me cry. I hope I carry this experience with me for my whole career. G References Browning, A.M., (2013). Moral distress and psychological empowerment in critical care nurses caring for adults at end of life. American Journal of Critical Care, 22(2). 143-151. Epstein, E.G., & Delgado, S. (2010). Understanding and addressing moral distress. The Online Journal of Issues in Nursing, Sept 30. April N. Grady, BSN, RN, is a recent graduate from San Jose State University. She currently works on a Neonatal Intensive Care Unit and intends to pursue graduate education to become a pediatric nurse practitioner. Her passion is working with families and children.

National Student Nurses’ Association, Inc.® Code of Ethics: Part II Code of Academic and Clinical Conduct and Interpretive Statements Adopted by the NSNA Board of Directors, October 27, 2009 in Phoenix, AZ As students are involved in clinical and academic environments we believe that ethical principles are a necessary guide to professional development. The following Interpretive Statements are offered as a framework to help guide nursing students in ethical analysis of responsibilities, professional conduct, and decision making in academic and clinical settings as they adhere to the NSNA Code of Ethics for Nursing Students. ** Indicates sections taken directly from the NSNA Code of Ethics: Part II: Code of Academic and Clinical Conduct Part 2: Code of Academic and Clinical Conduct ** Students of nursing have a responsibility to society in learning the academic theory and clinical skills needed to provide safe, quality nursing care. The clinical setting presents unique challenges and responsibilities for the nursing student while caring for human beings in a variety of health care environments. ** The Code of Academic and Clinical Conduct is based on an understanding that to practice nursing as a student is an agreement to uphold the trust society has placed in us. The statements of the code provide guidance for nursing students in their personal development of an ethical foundation and need not be limited strictly to the academic or clinical environment, but can assist in the holistic development of the person. ** As students are involved in the clinical and academic environments we believe that ethical principles are a necessary guide to professional development. Therefore, within these environments we: ** 1. Advocate for the rights of all clients. 1.1 Advocacy: A responsibility of nursing students is to advocate for the rights of all clients. This requires the nursing student to understand the client’s rights and responsibilities, the scope and applicable standards of nursing practice to meet the client needs, and the relevant federal (e.g. Health Insurance Portability and Accountability Act (HIPAA), Patient SelfDetermination Act, etc), state (e.g. Nurse Practice Act, etc.), and local laws in accordance with the health care institution’s policies and procedures. This knowledge enables the nursing student to function as an advocate for the rights of all clients in collaboration with nursing faculty and members of the health care team. 1.2 Rights of clients: Nursing students provide care for persons who have rights both as human beings and as clients. As such, nursing students must be cognizant of public, professional and institutional policies concerning patients’ rights and access to resources across the care continuum. For example, nursing students help ensure that these fundamental rights of clients to receive culturally and linguistically appropriate services are protected and maintained. ** 2. Maintain client confidentiality. 2.1 Confidentiality: Access to and sharing of information that identifies a specific client, their condition, and other information must be guarded with the best interests of the client in mind. Access to and sharing of such information must be limited to only those personnel with the medical need to know and family members who are authorized by institutional policy and patient consent (according to HIPAA guidelines). 2.2 Academic Setting: In discussing client cases in the academic setting, care must be taken to avoid breeching confidentiality and violating HIPAA regulations; this includes appropriate selection of the time and place of discussion, people attending the discussion, and omitting data that is not necessary to the purpose of the discussion or that discloses the client’s personal identity. 2.3 Special Circumstances: In order to protect the safety of the patient, other parties, and in cases of mandatory disclosure for public health reasons there may by times where the nursing student is obligated to report confidential information. The nursing student must immediately share these concerns in a confidential setting with the nursing faculty or clinical preceptor and with the registered nurse in charge of the patient’s care who will provide appropriate guidance.

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** 3. Take appropriate action to ensure the safety of clients, self, and others. 3.1 Appropriate action to ensure safety of clients: The nursing student must be able to identify hazardous conditions which may include faulty equipment, an unsafe environment, incompetent practices of other healthcare team members and colleagues, suspicious persons and activities, and self limitations. If an unsafe condition or incident becomes apparent, the nursing student should use good judgment and follow institutional policies and procedures for emergencies, reporting hazardous conditions and incidents. The nursing student should be aware of personnel responsible for directing patient and personnel safety and immediately share these concerns with the registered nurse in charge of the patient’s care and with the nursing faculty or clinical preceptor. 3.2 Safety of self: Nursing students cannot be expected to work in unsafe conditions or in situations where they are incompetent to practice. Academic and clinical environments should allow for a nursing student to voice concerns about safety to self without retribution. Nursing students have the responsibility to come prepared to meet the objectives assigned in caring for clients in clinical settings and to ask questions. 3.3 Safety of others: Nursing students should not condone or participate in lateral violence or incivility towards other professionals, students, or faculty. Further, students observing such behavior should take appropriate steps to remove her/ himself from the situation and report to the nursing faculty or clinical preceptor. ** 4. Provide care for the client in a timely, compassionate and professional manner. 4.1 Timely care: Client care is time sensitive. Therefore, nursing students should be aware that adhering to the schedule set forth by the health care team is important and discharge planning should begin upon the client’s admission to the clinical environment. By prioritizing tasks, patient education, treatments and procedures the nursing student will ensure that they are utilizing time in the most effective and efficient way. 4.2 Compassionate care: Providing care with compassion creates a better nursing student-client relationship. It reflects the nursing student’s desire to respect the client as an individual, to help the client maintain their safety and dignity, to provide support and comfort , to assist the client to achieve optimal independence and meet their health goals. 4.3 Professional care: Professional communication, appearance, and behavior by the nursing student demonstrates respect for the client and for self. The nursing student has the responsibility to be prepared to meet the objectives assigned in caring for clients and to demonstrate safe, quality nursing care. These professional actions by the nursing student enhance the image of nursing and contribute to building a trusting relationship between the nursing student and the client, and between the nursing student andst the health care team. An essential component of professional care by the nursing student and the health care team in the 21 century is to assure that the client receives culturally and linguistically appropriate health education and services (NSNA Resolution #15, 2009). ** 5. Communicate client care in a truthful, timely and accurate manner. 5.1 Truthful communication: Veracity is key to developing trusting relationships in academic and clinical environments. Truthful and thorough communication between nursing students and nursing faculty or preceptors, and between nursing students and healthcare professionals is a key component to providing safe, quality care within an optimal clinical learning environment. 5.2 Timely communication: Communicating client care information at the appropriate time is a duty of nursing students. Timely communication allows for assessments, interventions, and that changes to the plan of care be initiated and completed in a timely manner. 5.3 Accurate communication: Accurate communication is a responsibility of the nursing student. The nursing student, by providing an accurate, concise and timely report on the client’s assessment and status changes helps the nurse in charge of the client’s care and the primary care provider to make informed client care decisions and follow-up with further assessment as required. ** 6. Actively promote the highest level of moral and ethical principles and accept responsibility for our actions. 6.1 Promote the highest level of moral and ethical principles: Nursing students should be familiar with the NSNA Student Bill of Rights and Responsibilities and the NSNA Code of Ethics for Nursing Students (Part I: Code of Professional Conduct and Part II: Code of Academic and Clinical Conduct) and supporting documents. Being well informed and encouraging others to read and adhere to the NSNA Code of Ethics for Nursing Students and the ANA Code of Ethics for Nurses (ANA House of Delegates, 2001) actively promotes the values and ethics of the nursing profession. Acting under ethical principles ensures that the care being provided does not jeopardize the client’s basic rights or endanger professional relationships.

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6.2 Accepting responsibility for our actions: Nursing students are accountable to the educational institution, the health care institution that provides the clinical learning environment, and above all to clients and society as a whole. The nursing student must function within the state’s Nurse Practice Act, the Scope and Standards of Nursing Practice (American Nurses’ Association, 2004) and the Policies and Procedures of the health care institution. The nursing student will care for clients only under the supervision of the nursing faculty or preceptor. Supervision must be completed in accordance with the clinical education agreement between the nursing program and the health institution providing a clinical learning environment to meet the student’s clinical learning objectives. ** 7. Promote excellence in nursing by encouraging lifelong learning and professional development. 7.1 Excellence in Nursing: Nursing is a profession that demands a nursing student’s commitment to evidence-based practice and to the health, well-being, and safety of clients. The client willingly gives the nursing student their trust in her/his ability to provide nursing care in accordance with their clinical education objectives. 7.2 Encouraging lifelong learning: The health care environment is ever changing. Nursing students, after attaining licensure as a registered nurse, have a responsibility to continue to educate themselves formally and informally throughout their careers to remain clinically competent to meet the health care needs of an increasingly diverse client population across an ever changing health care environment. 7.3 Professional development: Professionalism is a key factor for gaining the trust of others. Participation in professional organizations is imperative to one’s professional development. It begins by nursing students becoming active members and participants in NSNA; participants in nursing research utilization to advance evidence-based practice (NSNA Resolution #3, 2009); and in advocating for interdisciplinary education opportunities (NSNA Resolution # 13, 2009). Professional development continues for registered nurses as evidenced by membership in state nurses association (ANA) and specialty nursing organizations, and through continuing formal education. ** 8. Treat others with respect and promote an environment that respects human rights, values and choice of cultural and spiritual beliefs. 8.1 Treat others with respect: Nursing is based on client care that is supported by a foundation of respect and trust. Respect should be a fundamental component of intra-professional and inter-professional collaboration in which the nursing student participates (Nursing’s Social Policy Statement, ANA, 2003). 8.2 Promote an environment that respects human rights: As members of NSNA, nursing students pledge to refuse to engage in, or condone discrimination on the basis of race, color, creed, national origin, ethnicity, age, gender, marital status, lifestyle, disability, or economic status (NSNA Code of Ethics: Part One, 1999; NSNA Bylaws, Article III Purpose and Functions, Section 2, item f, 2007). By providing an atmosphere that allows clients to voice their needs, and to collaborate with the health care team, clients are empowered to meet their health care goals. 8.3 Values: All clients have a unique set of beliefs that form their values. Nursing students are obligated to holistically provide care to clients in ways that respect the client’s belief system and empowers them to attain their heath goals. 8.4 Choice of cultural and spiritual beliefs: All individuals have a unique set of values that are influenced by their culture and spirituality. Nursing students have a responsibility to demonstrate respect for the client by seeking to understand the client’s health care goals, their strengths and values, their cultural and spiritual beliefs, and how they influence and support the client’s care. ** 9. Collaborate in every reasonable manner with the academic faculty and clinical staff to ensure the highest quality of client care. 9.1 Collaborate in every reasonable manner: Clinical learning environments are places for applying the skills that nursing students have learned in the classroom and nursing lab. Nursing students are compelled to deliver the highest quality of care possible in these clinical learning environments. If the student has questions or needs clarification on a procedure or nursing intervention they are obligated to refer those questions to the nursing faculty or preceptor assigned to manage the student’s clinical learning experience. The client’s safety is the highest priority and the student should not let their questions go unanswered. ** 10. Use every opportunity to improve faculty and clinical staff understanding of the learning needs of nursing students. 10.1 Nursing is a fast paced ever-changing field that leaves little or no room for error. It is imperative for nursing students to communicate what they are learning as well as the need for further education in a clinical practice area through any means possible such as, verbal conferences and written evaluations. Learning as a process may vary for each individual student. However, each student shares responsibility for ongoing evaluation of their clinical learning and participates as an active learner by demonstrating and documenting that their clinical learning objectives have been met and maintained.

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** 11. Encourage faculty, clinical staff, and peers to mentor nursing students. 11.1 Encourage faculty: Nursing faculty are an important and readily available source of information and serve as role models for professional practice .By encouraging faculty to mentor students in evidence-based practice, in professional involvement in NSNA as a student, and in other nursing organizations after graduation, nursing programs prepare students to advocate for clients and to provide safe quality nursing care. 11.2 Encourage staff: Clinical staff and clinical preceptors are important sources of information about safe quality nursing practice and evidence-based Policies and Procedures in the clinical practice environment. By encouraging staff to mentor nursing students and to role model professional behaviors, health care institutions can create welcoming and effective learning environments. 11.3 Encourage peers: Peer mentoring has a unique advantage because of the shared experience of being a nursing student. Peers provide a different perspective on a nursing student’s performance than faculty or staff, which can be facilitated through peer reviews and discussions. These reviews promote a career-long activity of collaborative learning and peer mentoring, and should be practiced as a component of clinical learning. ** 12. Refrain from performing any technique or procedure for which the student has not been adequately trained. 12.1 Operating within appropriate scope of practice: The client’s well being is the highest priority. By performing procedures or interventions that the student is not ready to perform, the student and faculty are placing the client’s well being in jeopardy. The student must inform the faculty or clinical preceptor assigned to supervise the clinical experience whenever they are unprepared to safely provide an assigned intervention or procedure. This allows the faculty or clinical preceptor to provide the needed information for safely conducting the procedure. ** 13. Refrain from any deliberate action or omission of care in the academic or clinical setting that creates unnecessary risk of injury to the client, self or others. 13.1 Academic or clinical setting: Nursing students must recognize that actions influence the reputation of the nursing program and the profession of nursing. Therefore, whether on campus or in clinical settings, nursing students have a responsibility to come prepared to provide safe quality nursing care under the direction of the faculty or preceptor. By not engaging as an active learner or violating the nursing program’s code of conduct (i.e. not coming prepared to class, missing a significant amount of class time, cheating or condoning other student’s actions to cheat on exams, etc.) violates ethical and academic responsibilities of nursing students and future nurses. As an NSNA member, nursing students pledge in the NSNA Code of Professional Conduct (1999) to refrain from any form of cheating or dishonesty, and take action to report dishonorable practices to proper authorities using established channels. 13.2 Creating unnecessary risk of injury to the client, self, or others: Nursing students have shared responsibility with the health care team for maintaining the safety of clients, themselves, and others in the academic and clinical learning environment. Any action that creates the potential for harm or increases the risk for failure to maintain and support the physical or mental integrity of clients, self, or others is contradictory to these responsibilities. Competent delegation and supervision is a shared responsibility between the registered nurses and the health care team to control for unnecessary risks of injury to the client, self, or others. Nursing education should provide nursing students with opportunities to develop competencies related to delegation, including assessment and planning, communication, surveillance and supervision, evaluation and feedback (National Council of State Boards of Nursing (NCSBN), 2005; NCSBN & ANA, 2006). 13.3 Refraining from any deliberate action or omission of care that creates unnecessary risk to the client, self, or others: Knowingly withholding action, acts of omission of care, and deliberate actions that create unnecessary risk to the client, self, or others is a violation of the ethical and professional responsibilities of nursing students. Such acts are subject to review by the academic institution, and others as deemed appropriate. ** 14. Assist the staff nurse or preceptor in ensuring that there is a full disclosure and that proper authorizations are obtained from clients regarding any form of treatment or research. 14.1 Assist staff or preceptor: While the nursing student may observe and assist the staff nurse or preceptor with the education and care of the client, primary responsibility for informed consent and managing and implementing the plan of care/research protocols remains with the physician/primary care provider/researcher in collaboration with the client, the staff nurse, and health care team. 14.2 Ensuring that there is full disclosure: The nursing student should immediately, in a confidential setting, make full disclosure of any questions the client verbalizes and any concerns pertaining to the client’s safety, privacy, or informed consent to the nursing faculty or preceptor as well as to the staff nurse assigned to the client.

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14.3 Proper authorizations are obtained from clients: The staff nurse assigned to provide the client’s care has the responsibility with the physician/primary care provider/researcher to assure that the client understands the treatment and/or research being provided and that proper authorizations are obtained from client after all of the client’s questions are answered (National Institutes of Health (NIH), 2006). 14.4 Regarding any from of treatment or research: Human subject research requires that participants be given full disclosure of the purpose and procedures in the research study, including the potential benefits and risks. The client maintains the right to decide to participate or not to participate in the research (NIH, 2006). ** 15. Abstain from the use of alcoholic beverages or any substances in the academic and clinical setting that impair judgment. 15.1 Abstain from the use of alcoholic beverages or any substances that impair judgment: Nursing students strive to promote client, family, co-worker, and self safety in academic and clinical settings. This cannot be accomplished when health professionals or nursing students are under the influence of any substance, legal or illegal, which impairs judgment. Impaired decision-making can contribute to poor patient outcomes and can lead to disciplinary action. 15.2 In the academic and clinical setting: In classroom and clinical settings nursing students gain opportunities to build their critical thinking skills and learn to make sound clinical judgments. Nursing students should hold their colleagues and peers to this same standard. In that regard, if one suspects a colleague of alcohol or substance intake, he or she should discuss the situation in a confidential setting with the nursing faculty or preceptor. ** 16. Strive to achieve and maintain an optimal level of personal health. 16.1 Optimal level of personal health: As agents of a research-based industry we must remember the objective and scientific guidelines of optimal health. Taking care of one’s self is important to providing good nursing care. Personal health encompasses both physical and mental health. 16.2 Striving to achieve and maintain: It is important for nursing students to be familiar with and routinely practice a healthy lifestyle. Nursing students and nurses are ambassadors, role models, and health educators for clients. It is an important responsibility for nursing students to maintain their own physical and mental health to provide safe quality nursing care to clients. ** 17. Support access to treatment and rehabilitation for students who are experiencing impairments related to substance abuse and mental or physical health issues. 17.1 Support access to treatment and rehabilitation for students experiencing impairment: Nursing students should be familiar with the established policies and regulations related to substance abuse. Nursing students who are substance abusers must seek assistance to address this issue. By not doing so places both the student and clients in jeopardy and may result in dismissal from the program; disqualification for taking the licensure examination; and in the case of professional misconduct or malpractice, may result in legal action. 17.2 Mental or physical health issues: Nursing students suffering from mental and/or physical health issues must address these issues as soon as they become known. Assistance may be available at the student health center or other providers either on or off campus. By maintaining a high level of mental and physical health, nursing students will have the capacity to help others. ** 18. Uphold school policies and regulations related to academic and clinical performance, reserving the right to challenge and critique rules and regulations as per school grievance policy. 18.1 Uphold school policies and regulations related to academic and clinical performance: Adherence to the rules and regulations that are established for students including honesty, integrity, and professionalism within all academic and clinical settings is imperative. Nursing students must hold themselves and others accountable to these high standards. Being aware of the rules, regulations, and policies is part of this accountability; ignorance is not an excuse for violations. 18.2 Reserving right to challenge and critique rules and regulations as per school grievance policy: Nursing students have the right to challenge and critique rules and regulations following the process outlined in the school’s grievance policy. Student perspectives and evaluations should be integral components of quality improvement for classroom and clinical learning environments, and the curriculum. NSNA adopted the Student Bill of Rights and Responsibilities (NSNA House of Delegates, 1975, 1991, 2006) and Grievance Procedures (NSNA Board of Directors, 1975, 1991) to provide nursing students, faculty, and nursing programs a resource for developing and revising school grievance policies. Nursing students have a responsibility for adequate preparation for participation in academic classroom and nursing lab environments, and for safe quality clinical practice under the direction and supervision of nursing faculty and clinical preceptors.

For references, see www.nsna.me/clinical-conduct NSNA IMPRINT® y www.nsna.org

A D V E R T I S I N G Index American PUBLIC UNIVERSITY……………………… 26 DELMAR, CENGAGE LEARNING………………………… 1 CHAMBERLAIN COLLEGE OF NURSING………………

FEDERAL BUREAU OF PRISONS………………………… 22 NCSBN LEARNING EXTENSION………………………… 25 NURSING EDUCATION CONSULTANTS……………… 48 ROBERTS WESLEYAN COLLEGE………………………… 48 THOMAS EDISON STATE COLLEGE…………………… 26 UCLA……………………………………………………… 14 VANDERBILT SCHOOL OF NURSING …………………

VILLANOVA UNIVERSITY COLLEGE OF NURSING…… 7 WOLTERS KLUWER HEALTH……………………………

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