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Volume 29 • Number 2

May, June, July 2020

UTAH NURSEMany Roles. One Profession.

Quarterly publication distributed to approximately 38,000 RNs and LPNs in Utah.

www.utnurse.org

Musings of Caring

Page 8

A Voice for Nursing

Page 6

Inside

Being the Nurse in the Family

Page 10

The Official Publication of the Utah Nurses Association

Co

nte

nt

2 From the Editor2 Nurses, Ethics and the Response

to the COVID–19 Pandemic3-4 President’s Message5 From the Membership Committee 6 A Voice for Nursing6 Martha Ballard and Patty Sessions:

Two Midwives in History7 Utah Nightingales – Utah’s First Honor Guard

7 Nurses Climate Challenge: Educating 50,000 Health Professionals by 2022

8 Musings of Caring9 GRC Report9 2020: Year of the Nurse and the

Midwife!!!10 Healthy Nurse Healthy Nation11 Forensic nursing: Overview of a

growing profession

Dear Utah Nurse Colleagues,

Words cannot express our admiration and appreciation for your commitment, expertise and sacrifice in addressing the COVID-19 pandemic. Thank you to the 1,565 Utah nurses who took the time to thoughtfully reply to UNA’s COVID-19 Survey the week of March 23rd. We highlight the results of this survey below and plan to release additional details on the UNA website and to the public.

We have already been busy making sure the results of the survey are distributed and discussed publicly in as many venues as possible. We were able relay significant preliminary results in a supportive news piece done by KSL reporter Jed Boal on Wednesday, April 1st. A link to that broadcast is available at www.utnurse.org.

UNA will continue to advocate for nurses in all areas of practice and all locations during this crisis. Our message to the Utah public is to help nurses and all health care providers and to limit spread of the virus in Utah:

A MESSAGE FROM UNA• “Stay at Home – We are staying at work for you.

Please stay at home for us!”• Commit to physical distancing (“social distancing”)

from others as much as possible• Wash Your Hands and clean/disinfect surfaces• Call your health care provider before going to the

office and be clear and honest about the symptoms you are experiencing – do not try to self-diagnose. But if your symptoms are severe … go to an Emergency Room!

UNA applauds our nurse colleagues for dedication and valor exhibited every day in every way. We will get through this together!

Liz Close, PhD, RN Sharon Dingman, DNP, MS, RNUNA Executive Director UNA President

UNA conducted a statewide survey of Utah nurses the week of March 23-March 29. The purpose of the survey was to determine Utah nurses’ challenges in the work environment and how UNA could best support all with the resources and information needed for self-protection, for protection of others and for constraining virus spread. We heard from 1,565 Utah nurses within that one week period. The findings indicate:

Nearly all nurses who responded to the survey are confident they know how to prevent the spread of infectious diseases and most feel knowledgeable about COVID-19. The majority of respondents indicate their employers support them in protecting themselves and others from COVID-19 but express some concern about availability and use of Personal Protective Equipment (PPE) particularly if in short supply to their institutions.

One third of respondents are not certain that their workplace is “equipped to handle” the pandemic.

The following is a summary analysis of answers to the open-ended question “What challenges are you facing in your work environment to protect yourself and prevent spread of the virus?”

The shortage, or complete lack of OSHA approved, Personal Protective Equipment (PPE), hand sanitizers and disinfecting wipes is a serious concern in a great number of responses from nurses. Some health care service locations in Utah appeared able to meet the current demand [the week of the survey] but nurses are concerned about whether that would remain the case as the virus spreads. Nurses are troubled by the rules for proper infectious disease control

procedures changing as the availability of PPE

Utah Nurses Spoke and We Listened!!changes endangering the healthcare workforce as well as Utah citizens.

Nurses are feeling vulnerable for themselves and others with whom they have contact not knowing whether they have been exposed and are asymptomatic carriers spreading the virus to other health care workers, patients, and their own families, some of whom are immunocompromised. Lack of expeditious COVID-19 testing and timely results contribute to this sense of vulnerability. Protection protocols and information about the virus are constantly changing and are not always well communicated. Many Utah nurses are concerned over impending staff shortages especially in the areas requiring critical care nursing experience should there be significant illness among the nursing workforce.

Nurses in environments that do not care for the acutely ill, for example, behavioral health units, long-term care facilities, home health, hospice, and renal dialysis units express concern about trying to contain the spread of infection without adequate current and future supplies of OSHA approved PPE.

Nurses communicated grave concerns that the general public is not taking this as seriously as they need to. The general public is not following directives to stay home and not congregate in even small groups, to call before coming to health care facilities, wear masks as advised by health care workers, wash hands frequently and limit physical contact as much as possible outside of family. They are very troubled that patients are not being completely truthful about symptoms and possible exposures which creates the situation that health care providers are unable to adequately assess the risk of exposure to themselves and to others.

Utah Nurse • Page 2 May, June, July 2020

The Utah Nurse Publication Schedule for 2020

Issue Material Due to UNA OfficeAugust, September, October, 2020 Edition - June 4th, 2020

Guidelines for Article DevelopmentThe UNA welcomes articles for publication. There is no payment for articles published in the Utah Nurse.1. Articles should be Microsoft Word using a

12 point font.2. Article length should not exceed five (5) pages

8 x 113. All references should be cited at the end

of the article.4. Articles (if possible) should be submitted electronically.

Submissions should be sent to: uneditor@utnurse.org or Attn: Editorial Committee | Utah Nurses Association

4505 S. Wasatch Blvd., Suite 330BSalt Lake City, UT 84124 | Phone: 801-272-4510

To submit a Letter to the Editor, include your name and contact information. (Due to sensitive issues the UNA can elect to publish anonymously.)

PUBLICATION

2020 BOARD OF DIRECTORSPresident Sharon K. Dingman, DNP, MS, RNFirst Vice President Stacey Shelley, RN, MSN, MBA-HCM, NE-BCSecond Vice President Andrew Nydegger, DNP, RN, CNESecretary Peggy Anderson, DNP, MS, RN Treasurer Linda Hofmann, PhD, RN, NEA-BC, NE-BCDirector At Large Angela Kaplar York, RN, BSN, C-AL Blaine Winters, DNP, ACNP-BC Claire L. Schupbach, BSN, RN, CPC

STAFF MEMBERSExecutive Director Liz Close, PhD, RNEditor Claire LeAnn Schupbach, BSN, RN, CPC

COMMITTEECHAIRS & LIAISONSBy-Laws Liz Close, PhD, RN Finance Linda Hoffman, PhD, RN, NEA-BC, NE-BCGovernment Relations CJ Ewell, MS, APRN-BC Diane Forster Burke, MS, RN Kathleen Kaufman, MS, RN,Membership Anmy Mayfield, DNP, APRN, FNP-C Nominating Janelle Macintosh, PhD, RNEducation Committee Blaine Winters, DNP, ACNP-BC

UTAH NURSES FOUNDATIONPresident Marianne Craven, PhD, RN

ANA MEMBERSHIPASSEMBLY REPRESENTATIVESAimee McLean, MSN, RNSharon K. Dingman, DNP, MS, RN

PRODUCTIONPublisher Arthur L. Davis Publishing Agency, Inc.

Editor and Publisher are not responsible nor liable for editorial or news content.

Utah Nurse is published four times a year, February, May, August, November, for the Utah Nurses Association, a constituent member of the American Nurses Association. Utah Nurse provides a forum for members to express their opinions. Views expressed are the responsibility of the authors and are not necessarily those of the members of the UNA.

Articles and letters for publication are welcomed by the editorial committee. UNA Editorial Committee reserves the right to accept of reject articles, advertisements, editorials, and letters for the Utah Nurse. The editorial committee reserves the right to edit articles, editorials, and letters.

Address editorial comments and inquiries to the following address: Utah Nurses Association, Attn: Editorial Committee 4505 S. Wasatch Blvd., Suite 330B Salt Lake City, UT 84124 office@utnurse.org, 801-272-4510

No parts of this publication may be reproduced without permission.

Subscription to the print version of the Utah Nurse is included with membership to the Utah Nurses Association/American Nurses Association. Complimentary electronic copies are sent to all Utah nurses and posted on the Utah Nurses Association website at www.utnurse.org. Subscription to the print version is available for $25/year. Address such requests to the UNA Office at the address above or email office@utnurse.org. Circulation 39,000. Per Utah state regulation, any licensee address change should be reported to the Board of Nursing at DOPL at (801) 530-6628 or via their website at https://doppl.utah.gov/licensing/nursing.html.

All address changes should be directed to DOPL at (801) 530-6628.

For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.com. UNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the Utah Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. UNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of UNA or those of the national or local associations.

FROM THE EDITORAndrew Nydegger DNP RN CNE

2020 has proven to be a year no one will forget. 2020 has brought us COVID-19, earthquakes and a frustrating legislative session. These events highlight the ever-increasing importance of nurses. Although many of the celebratory events surrounding 2020 year of the Nurse and Midwife celebrations are cancelled or changed, it is important that we band together as a profession and celebrate each other.

There are many challenges that face the profession of nursing and each nurse has a cause they are passionate about. As individuals, we can make our voices heard, but as a group we can create a lasting change and impact the health and safety of the great people here in Utah. I highly encourage each of you to join a professional organization and participate in it as much as possible. Members of organizations have louder voices and are stronger advocates for both their profession and their patients.

Celebrate the year of the nurse and midwife by strengthening your voice.

Reprinted with permission from the American Nurses Association

The American Nurses Association's Code of Ethics for Nurses with Interpretive Statements (2015) is the nursing profession's nonnegotiable ethical practice standard. Provision 2 of the Code states that “the nurse’s primary commitment is to the patient.” Provision 5 of the Code states that the nurse owes the same duty to self as to others. These equal obligations can conflict during pandemics when nurses must continually care for critically ill infectious patients, often under extreme circumstances including insufficient or inadequate resources and uncontained contagion. During pandemics, nurses and their colleagues must decide how much care they can provide to others while also taking care of themselves. They must be supported in these heart-wrenching decisions by the systems in which they provide care and by society.

Professional nurses historically bring compassionate competent care to disaster response but are challenged to provide care when the nature of their work puts them

NURSES, ETHICS AND THE RESPONSE TO THE COVID–19 PANDEMIC

at increased risk. Nurses struggle with feeling physically unsafe in the response situation, such as in times of scarce resources where supplies of such items as personal protective equipment (PPE) may be inadequate. Nurses are concerned about professional, ethical, and legal protection when asked to provide care in such high-risk situations, such as the COVID-19 pandemic.

Given the Practice Environment of the COVID-19 Pandemic, Nurses Should Consider These Points:

• the Code of Ethics for Nurses with Interpretive Statements (2015) provides guidance for nurses in situations of crisis, such as responding to pandemics

• during pandemics nurses must decide how much high-quality care they can provide to others while also taking care of themselves and their loved ones

• there may be times when a registered nurse must make a choice based on moral grounds in order to maintain professional integrity. Hospitals, institutions, managers, administrators, and health care providers need to understand employer and employee expectations during times of pandemic

• nurses may struggle with the call to volunteer and respond in a pandemic. Nurses may choose not to respond if: o they are in a vulnerable group, o the nurse feels physically unsafe in the response

situation due to a lack of personal protective equipment or inadequate testing,

o there is inadequate support for meeting the nurse’s personal and family needs, or

o the nurse is concerned about professional, ethical, and legal protection for providing nursing care in the COVID-19 pandemic

• organizational support for the registered nurse is a non-negotiable necessity. Effective communication between registered nurses and organizational management regarding a nurse’s ability to provide care to patients is essential and must be heard and valued at all organizational levels. Nurses must not be retaliated against for raising concerns.

• the registered nurse is responsible for being knowledgeable about state law under which they practice during a pandemic. Questions nurses should seek answers to include: o Does the law mandate that nurses must provide

care in all situations, regardless of the danger nurses face providing that care?

o How is the nurse’s license protected during crisis standards of care during pandemics?

o What protections exist against lawsuits for negligence or malpractice, especially in circumstances of scarce resources or where practicing outside of the normal specialty area?

• as front-line healthcare professionals, nurses are key stakeholders in developing and implementing policies regarding standards of care during the COVID-19 pandemic

• employers have the responsibility to create, maintain, and provide practice environments that help meet the medical needs of the community within a system that protects nurses and other employees or volunteers. This should include the provision of sufficient, appropriate personal protective equipment, immunizations, physical security, and operational protocols. Individual nurses are critical participants in this work.

Nurses, Ethics and the Response to the COVID–19 Pandemic

The Code of Ethics for Nurses With Interpretive Statements (2015) is the promise that nurses are doing their best to provide care for their patients and their communities and are supporting each other in the process so that all nurses can fulfill their ethical and professional obligations.

In considering the nursing profession’s duty to society, Interpretive Statement 8.4 of the Code of Ethics for Nurses with Interpretive Statements (2015) states, “All actions, and omissions risk unintended consequences with implications for human rights. Thus, nurses must engage in discernment, carefully assessing their intentions, reflectively weighing all possible options and rationales, and formulating a clear moral justification for their actions. Only under extreme and exceptional conditions, while conforming to international standards and engaging in an appropriate and transparent process of authorization, may nurses subordinate human rights concerns to other considerations.” Nurses must continue to advocate for systems and protocols that protect their ethical obligations as nurses, as well as ensure equity and fairness to all concerned in times of pandemics.

Questions ? Email corona@ana.orgFor more information please visit

www.nursingworld.org/coronavirus

May, June, July 2020 Utah Nurse • Page 3

PRESIDENT’S MESSAGE

Sharon K. Dingman, DNP, MS, RN

The first week in the month of May traditionally provides nurses an opportunity to pause, reflect, and celebrate why they became a nurse. Around the world nurses are reminded of their valuable expertise used to provide care to patients and their families. Many patients will recall a nurse who helped them at a time needed for recovery, reflection, solace, information, and understanding of them as a person.

For the year 2020, the celebration of nurses that is usually one week May 6-12 has been expanded to be a month long with a theme of “You Make a Difference.” You can access these through: www.nursingworld.org/ana/

We invite you to join “Celebrating Nurses Month in 2020 on the dates below:

Week One (May 1-9) Self-Care Week; Week Two (May10-16) Recognition Week; Week Three (May 17-23) Professional Development Week;Week Four (May 24-31) Community Engagement.

In the March 2020 edition of the American Nurse Journal, President Earnest J. Grant, PhD, RN, FAAN shared the perspective of the public in the value of a nurse. Nurses were recognized again for the 18th year in a row by Gallup poll that “patients trust nurses to provide clinical care they need.” and “they count on us to always do the right thing for them and others in their community”…and he concludes by saying, “What an enormous honor and responsibility.”

Dr. Grant’s message continues to highlight opportunities for nurses to speak to social issues in our communities by “being aware of the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements, “clearly states that nurses must practice with respect for the dignity, worth, and unique attributes of all our patients.” Enjoy reading this challenge to all nurses.

Citation: Grant, E. J. (March 2020). Nurses and the public trust. American Nurse Journal, March 20, Vol. 15 Number 3, pg. 15.

In the same edition, Oriana Beaudet, President of Innovation for the ANA Enterprise; which is composed of the American Nurses Association, the American Nurses

Credentialing Center, and the American Nurses Foundation, believes “that all nurses can create solutions to some of the greatest challenges of our time. We can think of innovations that have changed the world. My sincere belief is that nurses can create solutions to some of the greatest challenges of our time. As a nurse, how are you already innovating.” Enjoy reading her vision of making innovation “no longer invisible. Make 2020 the year you tap into your inner innovator.”

Citation: Beaudet, C. (March 2020). Leading the Way. Year of the Nurse 2020: Advancing Professional Innovation. American Nurse Journal, March 20, Vol. 15 N0. 3, pg. 26.

President’s Message continued on page 4

Utah Nurse • Page 4 May, June, July 2020

Overview and Summary: THE YEAR OF THE NURSE IN 2020: Nurse Lead Initiatives in Policy, Practice, and Education.

Citation: Reynolds, N., (January 31, 2020) "Overview and Summary: The Year of the Nurse in 2020: Nurse Led Initiatives in Policy, Practice, and Education" OJIN: The Online Journal of Issues in Nursing Vol. 25, No. 1, Overview and Summary.

Around the world nurses are in the midst of the “Year of the Nurse 2020 celebrations in anticipation of what this year will bring. The World Health Organization (WHO) designated “The Year of the Nurse and Midwife” in tribute to their vital position in upholding and transforming healthcare around the world. WHO will release the first report on the State of the World’s Nursing report on World Health Day in April 2020, just ahead of the of the 73rd World Health Assembly (WHO, 2020b).

This is a critical time in the world of how “health and well-being of people and populations can be enhanced and improved by nurses” (WHO, 2020b). “This may be in clinical practice; working with individuals and their families; through community support and development programs; national health initiatives and policy; conducting research and evaluating program effectiveness; or implementing international commitments and agreements to improve access to and quality of healthcare.

Nurses and midwives account for nearly 50% of the global health workforce and are often the first and only point of care in their communities (WHO, 2020b). At every level, nurses have a significant role to play, including fulfilling the need for a far more holistic and person-centered healthcare system and advocating for vulnerable populations, each commensurate with the ethical mandate and competencies of nurses.”

URL:http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-25-2020/No1-Jan-2020/Year-of-the-Nurse-in-2020.html#WHOb

The articles listed below are part of the above article and include the topics listed below. These articles can be found through access to the article above or by using the URLs attached below for each article one through six below.

The articles sited below are a must read for ongoing information focused on The Year of the Nurse 2020 Celebrations! A special thanks to the journal editors and authors of the articles listed below and referenced for the readers’ use and enjoyment.. May you enjoy the Year of the Nurse 2020!

1. Nurses Leading the Way to Better Support Family Caregivers

Citation: Reinhard, S.C., Brassard, A., (January 31, 2020) "Nurses Leading the Way to Better Support Family Caregivers" OJIN: The Online Journal of Issues in Nursing Vol. 25, No. 1, Manuscript 1.

“The authors summarize current evidence to provide guidance to nurses and other providers about how to educate family caregivers, highlight useful resources and discuss proactive outreach strategies that can help family care givers manage complex care.”

URL: http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-25-2020/No1-Jan-2020/Nurses-Leading-the-Way.html

2. Beyond the Nurse Practice Act: Making a Difference Through Advocacy

Citation: Martin, E., Zolnierek, C., (January 31, 2020) "Beyond the Nurse Practice Act: Making a Difference through Advocacy" OJIN: The Online Journal of Issues in Nursing Vol. 25, No. 1, Manuscript 2.

“The authors provide examples of how the advocacy of nurses can make an important difference in the quality and safety of patient care as well as the potential negative effects when advocacy fails.”

URL: http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-25-2020/No1-Jan-2020/Beyond-the-Nurse-Practice-Act.html

3. A Nursing Approach to the Largest Measles Outbreak in Recent U.S. History: Lessons Learned Battling Homegrown Vaccine Hesitancy.

Citation: Marcus, B., (January 31, 2020) "A Nursing Approach to the Largest Measles Outbreak in Recent U.S. History: Lessons Learned Battling Homegrown Vaccine Hesitancy" OJIN: The Online Journal of Issues in Nursing Vol. 25, No. 1, Manuscript 3.

“While immunization is widely lauded as public health’s greatest achievement, it has been identified by the World Health Organization as one of the top ten threats to global health for 2019. The role of nurses in addressing vaccine hesitancy is addressed and offers practical guidance for addressing this important problem.”

URL: http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-25-2020/No1-Jan-2020/Nursing-Approach-to-Largest-Measles-Outbreak.html.

4. Nurses at the Table: Action Now! for Nursing Education.

Citation: Aragon, S.A., Babbo, G.M., Bear, S.J., Schaffner, M.L., (January 31, 2020) "Nurses at the Table: Action Now! for Nursing Education" OJIN: The Online Journal of Issues in Nursing Vol. 25, No. 1, Manuscript 4.

“The program, led by the Washington Center for Nursing, the Washington Board Of Nursing, and the Council on Nursing Education in Washington State shows how a diverse coalition of nursing organizations collaborated with key stakeholders to address this implementation of the Action Now! program, an overview of the successes and lessons learned, and efforts to move forward with ongoing challenges to identify and address barriers in nursing education.”

URL: http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-25-2020/No1-Jan-2020/Nurses-at-the-Table-Action-Now-for-Nursing-Education.html

5. Learning About Rurality: From Classroom to Community

Citation: Mielke, R., Robertson, S., Olphen Fehr, J. van, (January 31, 2020) "Learning about Rurality: From Classroom to Community" OJIN: The Online Journal of Issues in Nursing Vol. 25, No. 1, Manuscript 5.

“The importance of advanced practice registered nurses (APRNs) in meeting health needs in rural America and how they can be educated to best fulfill this need is discussed.

President’s Message continued from page 3

ATTENTION RNs & LPNs

licensed in Utah

https://umec-nursing.utah.gov/

Have you completed your 2020 Workforce Supply Survey?

It’s very important we hear from you!

Information from this study is used to support healthcare workforce policy and planning

across the State of Utah.

For those who have not yet responded, be on the lookout for a reminder that was mailed out on March 23rd. A third mailing will be

sent around the beginning of May.

The authors posit that it is important to prepare students for this role with both didactic and experiential learning experiences so that they may gain a fuller understanding of the health disparities and the strengths of the community.”

URL: http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-25-2020/No1-Jan-2020/Learning-about-Rurality.html

6. Nursing, Nursing Associations, and Health Systems Evolution

Citation: Villeneuve, M., Betker, C., (January 31, 2020) "Nurses, Nursing Associations, and Health Systems Evolution in Canada" OJIN: The Online Journal of Issues in Nursing Vol. 25, No. 1, Manuscript

Systems Evolution in Canada (Applicability for the United States is included)

Health studies in North America, with a focus on Canada, “provide an overview of the history of health system development and reform and consider nursing policy and advocacy in the 21st century and examples are provided of nurse-led solutions that have been used to overhaul and improve health systems and influence health policy in Canada.

URL: http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-25-2020/No1-Jan-2020/Nurses-Nursing-Associations-and-Health-Systems-Evolution-in-Canada.html

Suicide Assessment and Nurses: What Does the Evidence Show

Citation: Bolster, C., Holliday, C., Oneal, G., Shaw, M., (January 31, 2015) "Suicide Assessment and Nurses: What Does the Evidence Show?" OJIN: The Online Journal of Issues in Nursing Vol. 20, No. 1, Manuscript 2.

“Suicide is at epidemic proportions both in the United States and across the globe. Yet, it is a preventable public health problem. Nurses practice on the front-lines and have the greatest number of opportunities to identify and intervene with suicidal patients. Most registered nurses (RNs) have little or no training in how to assess, evaluate, treat, or refer a suicidal patient. Because of this lack of training, RNs feel ill-prepared and afraid to talk to patients about suicide.”

The authors recommend nurses to be prepared for suicidal patient care through initial education and annual reviews. “Training RNs in how to assess, evaluate, treat, and refer a suicidal patient is key to suicide prevention. Research suggests that once RNs are trained in suicide assessment, they realize it is no different than assessing for any other type of illness and are then able to help those with suicidal tendencies. Nurses routinely treat patients that are considering suicide, but these patients are rarely identified as at-risk. Perhaps as a result, suicide is the second leading sentinel event in hospitals.”

The implications for education, research, and practice within healthcare settings and identifies the need for nurses to have “educational offerings to provide them with the necessary assessment tools required to successfully identify patients who may be at risk for suicide, and programs that would teach skills needed to prevent further suicide attempts” (C. Bolster, C. Holliday, G.Oneal & M. Shaw, 2015).

“Four themes identified from the review of suicide training and prevention literature for the training includes: beliefs and attitude of nurses; lack of education in suicide prevention for nurses, training programs for nurses; and examples of successful training programs.” Suicide preventions assessment guidelines for nurses includes necessary assessment tools to successfully identify patients who are at risk for suicide and skills to prevent further suicide attempts. RN’s are in a prime position to provide this preventative care.

“Increased education in suicide prevention is encouraged by professional nursing organizations but it has not been implemented in many higher learning organizations; this needs to be changed. Suicide prevention education in undergraduate, graduate, and post graduate programs needs to be evaluated and enhanced as needed. With simulation becoming a standard educational delivery modality in nursing programs, scenarios involving suicide should become routine for skills development. In addition, continuing education requirements need to include suicide assessment, evaluation, and referral skills for all RNs, regardless of specialty practice. Annual review with training for suicide screening would continue to provide nurses a way to update skills, in the same manner as cardiopulmonary resuscitation review and practice.”

Conclusion:Wishing all nurses in Utah a HAPPY NURSES MONTH

in the Year of the Nurse and Midwife 2020 for the care you individually and collectively provide to people each day. Thanks to the UNA Board for their work in behalf of nurses and patients in Utah and to their families that support them. The celebration of the 200th birth anniversary of Florence Nightingale is part of this celebration. May we continue to take the opportunity to promote an understanding and awareness of this great nursing profession, to encourage young people to consider nursing as a career and recognize the vast contributions of nurses in Utah. Take good care!

Utah Nurse PractitionersJoin us @ UNP.ORG$90 Full Members

$45 Student

Building Bridges

Bridging gaps

Bringing Utah Together

Benefits of MembershipMy UNP Discount ProgramDiscounted AANP Fees & UNP Pharmacology Event

Your Fees go to NP Advocacy

May, June, July 2020 Utah Nurse • Page 5

FROM THE MEMBERSHIP COMMITTEE

Welcome to our new members and renewing members. Please encourage your colleagues to join UNA this year (nursing students can join for free!)

The 2020 goals for the Membership Committee include the following: (1) Increase UNA member acquisition; (2) Provide services and maintain communication with members; and (3) Increase extent and quality of UNA relationships with professional nursing organizations in Utah.

Here is what we do: The UNA Membership Committee assists the Board and Executive Director (in alignment with ANA) in creating value for membership, nurse engagement, nurse excellence support, nurse health and well-being, and healthy work environments. The Membership Committee is responsible to recruit, retain, and increase Utah nurse awareness about the benefits of ANA/UNA membership and their active participation with the organization.

Along with increasing membership, we would like to “grow” our Membership Committee!

We are seeking three (3) registered nurse members from different geographical areas in the state to join the UNA Membership Committee from inpatient/outpatient clinical care, education, and management. For questions about joining the Membership Committee, please contact:

• Dr. Peggy Anderson, or Dr. Anmy Mayfield, UNA Membership Committee Co-Chairs, at membership@utnurse.org

• Dr. Liz Close, UNA Executive Director at execdirector@utnurse.org

• Contact the UNA Office at (801) 272-4510.

Membership Benefit Information Online Being a member of ANA/UNA makes a powerful

statement about you and your commitment to nursing.

Membership provides a way for nurses across the United States and Utah to speak on behalf of nurses and patients for safe and consistent quality care. Continuing Education and member programs provide access to learning opportunities keeping nurses up-to-date on nursing knowledge and career advancement. Membership provides information about personal health and healthy work environments that are safe, empowering, and satisfying.

As a member, you have access to up-to-date journals and publications such as The American Nurse Journal; The Online Journal of Issues in Nursing (OJIN) by using a member log-in; E-News Letters: ANA SmartBrief, ANA Nurse CareerBrief, Nursing Insider, and Member News. You can also network and connect through social media with your state and national associations by visiting the UNA Website http://www.utnurse.org.

Please take a few minutes to review the current benefits of ANA/UNA Membership Information online.

Peggy H. Anderson, DNP, MS, RN

Anmy T. Mayfield, DNP, APRN, FNP-C

Join or access through your MyANA account at https://www.nursingworld.org

Visit Utah Nurses Association at: www.utnurse.org

IMPORTANT LINKS/CONTACTS AT-A-GLANCE • ANA Membership Services: 1-800-923-7709,

FAX: 1-301-628-5355, Mail: American Nurses Association, 8515 Georgia Avenue, Suite 400, Silver Spring. MD 20910

o Update your Profile: https://ebiz.nursingworld.org/Login/

o ANA E-mail Address: Membership: memberinfo@ana.org

• ANA-PAC: https://ana.aristotle.com/SitePages/pac.aspx

• Ethics Issues: https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/

• Lobbying – Federal and State: https://www.nursingworld.org/practice-policy/advocacy/federal/

Professional Development and Networking Resources Online:

• ANA Careers Center: https://www.nursingworld.org/education-events/career-center/

• Navigate Nursing: https://offers.wherenurseslearn.org/anamembers/

• American Nurses Credentialing Center: https://www.nursingworld.org/ancc/

• For additional local information contact UNA via the website: www.utnurse.org or send correspondence to Utah Nurse Association, 4505 S. Wasatch Blvd. Suite 330B, Salt Lake City, UT 84124.

Utah Nurse • Page 6 May, June, July 2020

UNA leaders represent your interests in a wide variety of meetings, coalitions, conferences and work groups throughout the year, anticipating and responding to the issues the membership has identified as priorities. In addition to many meetings with legislators, regulators, policy makers and leaders of other health care and nursing organizations, the following is a partial list of the many places and meetings where you were represented during the past three months....

UNA Capitol Nurses Day at the Legislature - Feb 28UNA Executive Committee MeetingUtah State Board of NursingDr. Liz Close represented UNA on KSL News 04/01/2020Utah-SNA 69th ConventionC/SNA Executive Enterprise MeetingANA Health Policy/GOVA/CSNA Bi-monthly Conference CallAcademic Leadership Council of UONUtah Chapter of AORN ConferenceBYU Professionalism ConferenceUHPP - Health Care Round Table (Capitol) Weekly meetingsUtah Health and Human Services Legislative Meetings - State CapitolUtah Senate Legislative Meetings - State CapitolUONL-ALC Meeting on Feb 20 - Met with ALC group

A Voicefor NursingWritten by Kathleen Kaufman MS, RN and Dianne Knorr BS, RN,

partially published in The Utah Nurse in November, 2011

On September 9, 2011, Laurel Thatcher Ulrich opened the American Association for the History of Nursing’s annual conference with this familiar quote that she originally made in an academic paper almost 30 years before and which she used as a title of a subsequent book. She has more recently stated that “the real drama is in the humdrum.” These seemingly contradictory statements illustrate the lives of two early midwives who did make history. Ulrich, a historian from Harvard University, went on to discuss the lives and contributions of Martha Ballard and Patty Sessions. Both women were born in Maine and lived their lives as midwives in service to their communities.

Ulrich introduced Martha Ballard to the world in A Midwife’s Tale: The Life of Martha Ballard based on her diary, 1785–1812. Ballard was born in the mid-1700s and began writing her terse yet clear diary at age 50; continuing this diary until she closed it three days before her death at age 77. She lived, practiced, and died in the state of Maine. Less well known across the country, Patty Sessions is an early heroine in Utah. She traveled over the Mormon pioneer trail in the mid-1800s to the Salt Lake Valley—delivering babies in cold camps and swaying wagons. Sessions’ nearly monosyllabic journal began in her 51st year and ended when she was 93 years old—five years before her death. The very existence of their diaries set these two women apart from other lay midwives of the early American era.

Both women “sustained their communities: delivering babies, laying out the dead and attending the sick.” They documented weather conditions and their daily trials with clarity and a certain degree of “ordinariness.” Their no-doubt harrowing lives are recorded with simple phrases and a lack of detail that whets the imagination. They did not write details of specific cases they attended. Given that they each delivered more than 1000 babies in their lives, they had excellent outcomes. Martha Ballard had no women die in childbirth while Patty Sessions had only a few die.

Ulrich noted that “without these diaries, the history of the times would only be that of physicians who were starting schools and hospitals. These physicians were threatened by successful lay midwives.” She also stated that historians have not yet learned to find and write about women who have not broken laws (and who therefore are NOT depicted in court records) or who were illiterate. Ballard and Sessions clearly were not illiterate; their “terse” presentations intermixed important caregiving (nursing) with the trivia of everyday life. These very short descriptions give us the context and relationship of society to healthcare in their rural frontier communities.

Ulrich goes on to note another similarity between Sessions and Ballard. They were both highly valued in their own time. They each expected to be paid for their services, and they were paid for their expertise whenever possible. Sessions would even mark her diary with an “X” when she was paid for a case. Details rarely appear in these journals. However an occasional note about the new mother who delivers after traveling 13 miles on horseback while in labor or the midwife who crosses a flooded river on a log at night does give a hint of drama to all the “humdrum” entries. Both women cared for their communities with courage, perseverance and skill.

This year’s recognition of the nurse midwife needs to be based on the historical reality of midwives throughout time. The pioneer midwives noted above did superb work given the conditions in which they worked. They generally learned by doing with occasional informal education along the way.

Today’s professional midwife in Utah is the certified nurse midwife (CNM). The move to formalize midwifery education in the United States began in 1939 with Mary Breckinridge in the Frontier School for Midwifery and Family Nursing in Hyden County, Kentucky. That program continues today as the Frontier Nursing University with multiple nurse practitioner programs, including midwifery.

Mary Breckinridge’s vision was to have her program replicated across the United States. In 1965, The University of Utah’s College of Nursing instituted the longest continually existing nurse-midwifery program west of the Mississippi. To date, over 500 nurse midwives have graduated from the University’s program with approximately 150 CNMs practicing in Utah today. Unlike some states, Utah does have direct entry midwives (DEM) who are also licensed.

Note: Dr. Ellis Reynolds Shipp was one of the first female doctors in Utah and west of the Mississippi. In 1879, she established the School of Nursing and Obstetrics in Salt Lake City. This was a relatively short-lived program. The Ellis R. Shipp Community Health Center on 5600 West in West Valley City is named in her honor for all the work she did in medicine throughout Utah.

Laurel Thatcher Ulrich asked her audience: “Where are our records? We need to record events in our lives.” This question jogged much discussion over the weekend conference about writing and sharing the history of nurses more fully with our colleagues and the public. This newsletter invites you to participate in sharing your stories with your peers. We welcome submissions for possible publication from our readers. See the UNA website for deadlines for submission. Document the drama of the “humdrum!”

Martha Ballard and Patty Sessions: Two Midwives in History

“Well-behaved women seldom make history.”

Kathleen Kaufman and Dr. Sharon Dingman address nurses and lawmakers at the State Capitol

Nurses gather at the State Capitol to advocate for the nursing profession

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Beth Schenk, PhD, MHI, RN-BC, FAANProvidence-WSU Nurse

Scientist/Sustainability CoordinatorProvidence St. Patrick Hospital Assistant Research Professor

Washington State University College of NursingElizabeth.schenk@wsu.edu

Cara Cook, MS, RN, AHN-BC

Climate Change Program CoordinatorAlliance of Nurses for Healthy Environments

cara@envirn.org

Shanda L. Demorest, DNP, RN-BC, PHNMember Engagement Manager

Practice GreenHealthsdemorest@practicegreenhealth.org

There is increasing interest and engagement among

the nursing community around environmental matters that influence human health, such as climate change. Nurses are trusted health professionals and make up nearly 40% of the healthcare workforce, serving as catalysts of change in their institutions and practice settings.

To activate nurses, the Alliance of Nurses for Healthy Environments (ANHE) and Health Care Without Harm (HCWH), launched the Nurses Climate Challenge (the Challenge) in May 2018. The Nurses Climate Challenge is a national campaign to educate health professionals on climate and health, with nurses leading the education. The Challenge started with the original goal to educate 5,000 health professionals and was quickly surpassed in less than a year due to the combined efforts of Nurses Climate Champions around the world.

The response to the Nurses Climate Challenge has been robust. There are nearly 1000 nurse climate champions from close to 50 states, with over 12,000 health professionals educated since the launch. In addition, nurses from 16

countries outside the United States are registered as Nurse Climate Champions. However, there are nearly four million nurses and 18 million workers in the healthcare sector in the US alone; therefore there is an opportunity to exponentially scale the impact of the Challenge. To do this, we are aiming to educate 50,000 health professionals by 2022.

The Nurses Climate Challenge offers a comprehensive toolkit with all the resources nurses need to educate colleagues on climate and health and engage in climate-smart practices in health settings and at home. Nurses using the Challenge resources are highlighted through profiles (https://nursesclimatechallenge.org/champion-profiles) published on the Challenge website, shared in newsletters, and posted on social media to showcase the work being done and to inspire others to join.

The Challenge also calls on nurses to be advocates for climate and health. Leading within a nursing organization, health institution, or academic center to spearhead initiatives to address climate change is an example of how nurses can move health professionals from education to action. The Challenge resources include a guide to taking action within workplace and home settings and provide other points to get started.

As a nurse, you can also educate policymakers and the public about the connection between climate and health and how to take action by writing a letter to the editor in a local newspaper, meeting with elected officials, or talking with patients, friends and family members, and/or your community about the health impacts of climate change. The Challenge website includes sample talking points and template letter to the editors in the resources section.

Further, the CHANT: Climate, Health, and Nursing Tool 2020 is now available. CHANT is 10-minute voluntary survey asking respondents about awareness, motivation, and behaviors related to climate and health. Nurses and other health professions are encouraged to take the survey every year. Access CHANT here: http://bit.ly/30riTR9.

Learn more and join the Nurses Climate Challenge by visiting nursesclimatechallenge.org.

Nurses Climate Challenge: Educating 50,000 Health Professionals by 2022

Utah Nightingales is a Nursing Honor Guard to honor and recognize men and women who have dedicated their lives to the nursing profession. The Nursing Honor Guard pays tribute to individuals at the time of their death who dedicated their lives to helping others.

Active and retired nurses volunteer their time to travel the area and honor their fellow nurses. It is a privilege for the members of the Honor Guard to recognize nurses and help bring peace to mourners and family during their time of loss. Our volunteers serve any Registered Nurse, Licensed Practical Nurse, or Advanced Practiced Registered Nurse in the State of Utah.

The families choose what service will be performed by the Honor Guard but includes a group of at least three to six nurses dressed in the honor guard uniform. The uniform consists of the traditional white uniform, blue cape, and nurses cap. The honor guard can stand guard at the nurse’s casket or simply provide a presence at the visitation. “A Nurse’s Prayer” is recited at the funeral or during a special service and a Florence Nightingale nursing lamp is presented to the family. A white rose is placed on the nurse’s casket or next to the urn at the end of the service, which signifies the nurse’s devotion to his or her profession. The nurse is officially released from their duties at the end of the ceremony.

Utah Nightingales is being registered as a 501 C Non-profit organization. We are asking for a membership fee of $20.00 to become a Utah Nightingale. This fee will provide the oil lamp, white roses given to the family and pay for the website. The service we provide is free to the family. Our goal is to eventually sponsor a scholarship opportunity for a single parent trying to obtain their nursing degree.

For more information, please find us on our Facebook Page: Utah Nightingales. Our website is www.utahnightingales.org. Or you can email us at utahnightingales@hotmail.com

Utah Nightingales – Utah’s First

Honor Guard

SEEKING LPNs & CNAs

In 2010, the Institute of Medicine released a landmark report, The Future of Nursing: Leading Change, Advancing Health, which recommended increasing the number of nurse leaders in pivotal decision-making roles on boards and commissions that work to improve the health of everyone in America. The Nurses on Boards Coalition (NOBC) was created in response to this, as a way to help recruit and engage nurses to step into leadership roles.

The NOBC represents nursing and other organizations working to build healthier communities in America by increasing nurses’ presence on corporate, health-related, and other boards, panels, and commissions. The coalition’s goal is to help ensure that at least 10,000 nurses are on boards by 2020, as well as raise awareness that all boards would benefit from the unique perspective of nurses to achieve the goals of improved health in the United States.

We encourage each and every one of you, over three million strong, to visit www.nursesonboardscoalition.org, sign up to be counted if you are on a board and read more about the efforts being made to help build the future of our profession.

Utah Nurse • Page 8 May, June, July 2020

“MUSINGS OF CARING” Self-Reflective Moments From Nursing “Students”

Sharon K. Dingman, DNP, MS, RN

In this edition of the Utah Nurse, Board Members of the Utah Nurses Student Nursing Association (UT-NSA) share self-reflections of why they chose nursing as a profession. From their stories, we learn the value of others influences in their decisions that guide their student experiences in shaping their future as a nurse. The personal attributes of caring in these stories are universal and yet very specific to their individual experiences.

Thank You to each of you for sharing your “Musing” story and for choosing to become a nurse.

Musing of Caring Story #1: Jessica Daynes, Utah Student Nurses Association (SNA) President

Growing up, I always knew my mom was an incredible woman and I knew nursing played a huge role in that. I remember a day when my brother had an accident requiring stitches, and I watched from a distance as my mom assessed his leg and made the correct judgments to get him the care he needed. More importantly, she empathized with and advocated for him. I’ve watched as she has done this same thing for others out of compassion.

Compassion drives our nursing field, and I realized that nursing is part of who she is and it’s a part of who I am. I want to help care for others, bind up wounds, and help people heal physically, emotionally, and holistically. I want to become the best nurse I can be!

One way for every nursing student to get involved in this journey to reaching our potential as nurses is to become a member of the ANA, which is free for students! Click “student subscriber” to get more information, and opportunities and doors will open to enhance our ability to become better nurses!

Musing of Caring Story #2: Gabriel Joy, Utah SNA Vice President

My decision to become a nurse started long before I was consciously aware of the capacity with which I can hold space

for others. Growing up I was one of two daughters and my mother worked as a nurse. Witnessing her commitment and dedication shed light on the interweaving of the beauty and complexities of caring for others. Her role as a nurse extended far beyond the reaches of the surgery center she worked at. When my sister was diagnosed with cancer my mother put on her Danskos and walked boldly through the process of hours of chemotherapy, radiation and Broviac dressing changes. She was able to do all that was necessary for my sister while caring for me and continuing to work.

Those moments opened my eyes to the innate strength and composure necessary to face the hardest moments we as humans endure. I paid witness to her nursing role entering our lives at each turn in the road. She was bedside serving with hospice when my aunt took her last breath and held composure and grace when my grandfather left this earth. Each opportunity for strength, grace and nursing skill that arose in our lives my mother stood fast.

As I made my way into adulthood, I often found myself reflecting on the moments of hardship that shaped development of understanding of sickness, health and the ability to persevere. I was learning to be a nurse firsthand;

in my critical thinking, emotions and desire to speak where others could not.

Today the driving force of my practice is advocacy, integrity and building on the foundations nurses before me have created. Experience is the greatest teacher and I am here to learn. My hope moving forward in my professional practice is to serve others with depth and understanding of the beauty is it to be human.

Musings of Caring Story #3: Genevieve Antoine, Utah SNA Secretary

Growing up, the medical field was like a second home to me being that both of my parents were doctors and we had an in-home clinic that provided care for the community. However, I did not truly gain the respect I have today for nurses until recently.

Five years ago, I was stricken ill by a vaso-occlusive episode from Sickle Cell Anemia Disease S.S. I was placed in an intensive care unit and was unconscious for three days. Upon awakening I met this amazing male nurse who went above and beyond to care for both me and my family. When I was especially suffering, he would take time to talk to me about various things to keep my mind off my pain and he would share stories with my family in order to ease their anxiety. That nurse made such an impression on me that the very same day I was discharged from the hospital I asked my fiancé to take me to a close by nursing school and applied that same day.

Knowing what it is like to be the patient and seeing what great nursing care can do has changed my perception and gave me the hope that I could someday be that same great nurse to a person in need.

Musings of Caring Story #4 Sophia Almeida, Utah SNA Region 3 Director

I chose nursing because of my love of science and learning about the human body as well as my desire to practice the healer’s art. [I want to] comfort those who stand in need of comfort. I cannot think of a career path that better represents all I care about and stand for.

Musings of Caring Story #5 Shawntae, Utah SNA Region 4 Director

I chose nursing because nursing gives me the opportunity to interact with patients in a way that no other career does. I love the idea of living a life that is full of helping those who can’t heal alone.

Musings of Caring Story #6 Bianca Bowes, Breakthrough to Nursing Director and Treasurer for Eagle Gate College Chapter of NSNA

My reason for becoming a nurse lies with something my late Grandmother told me. She told me that I have a huge heart and that I would make a wonderful nurse. As a young person, I did not listen to her the way I should have and follow her footsteps. She, after all, was a charge nurse in a nursing home and she was amazing.

It wasn’t until she passed and after my son was born that I realized she was trying to help me make a better life for myself and for all those I touch. My son’s birth and all the dreams I want him to have has given me the motivation every day to ensure that he gets to have all the opportunities I did not have. I want to be a safe place for him and any other children I have. To be a nurse means to help all people with all your heart and that is what I truly want to do with my life. I want to help as many people as I can.

I have one more year to complete my BSN at Eagle Gate College where I am the Chapter Treasurer for the NSNA. I hope to eventually become a Nurse Practitioner in Family Practice. I see my role as continuing to encourage others to keep pushing forward toward their dreams and to influence change through in a position to help uplift and motivate the lives of others.

SummaryThanks to each of you for sharing your caring stories

and for your contribution to your self-reflective moments as student nurses. This year as we celebrate the YEAR OF THE NURSE 2020 with ANA and our State Organization, may we be mindful of the care we will and do provide as professionals in the role of nurses every day. As we each celebrate the Year of the Nurse 2020, may we be reminded of our own contributions to nursing by sharing our Musings with one another. We all have experiences to share that have been defining moments of caring in behalf of another.

Selected References:Dingman, S. K. (2019). “Musings of caring” self-reflective

moments by nurses. Nurses enhance patient care interactions in moments of connection. UTAH NURSE, 29(2) February, March, April 2020 ed. Utah Nurses Association, SLC, Utah, 12.

Utah Student Nurse association board members: Dakota Venegas, Taylor Noyes, Bianca Bowes,

Jennifer Salazar, Sophia Almeida, Jessica Daynes, Shawntae Gagnon, Genevieve Antoine, Gabriel Joy,

Kristen Wheelhouse

May, June, July 2020 Utah Nurse • Page 9

GRC REPORTDiane Forster-Burke MS, RN &

Kathleen Kaufman MS, RN

The legislative session is in the final two weeks as the deadline for the Utah Nurse arrives. It has been a difficult session for the UNA. Despite the profession of nursing continuing to be the most trusted profession, many legislators are listening to other voices that influence their votes.

Kathleen Kaufman, Diane Forster-Burke, Sharon Dingman, and Liz Close have represented UNA at the Capitol this session. We have been joined by other nursing professionals depending on the bill being heard. Our bill tracker was updated twice a week and monitored over 60 bills. We had a very successful Nurses’ Day at the Legislature on Feb 28 with about 260 participants. We welcomed many nursing students and also had several groups of registered nurses (school nurses, and hospital clinical educators). We heard about several bills that UNA supports as well as heard reports from Steve Grant (AORN), Clay Watson and Stephanie Puffer (Home Health & Hospice Association), and Carrie Butler (Action Utah). Legislators stopped by to speak about their bills. We thank Rep. Joel Briscoe, Rep. Marie Poulson, Rep. Andrew Stoddard, Rep. Susan Pulsipher, Sen. Kathleen Riebe, and Sen. Derek Kitchen.

One of our main bills of interest was SB 105 Surgical Smoke Free ORs sponsored by Kathleen Riebe. Once introduced in the Senate, this bill was assigned to Senate Business & Labor. The committee room was filled with nurses; many of whom were in their OR scrubs. We provided expert testimony from AORN national as well as several from AORN Utah. The only opposing testimony was from Dave Gessell of the Utah Hospital Association who reported that administrators of hospitals knew nothing of these hazards. This bill was sent for further study in Interim Session.

Rep. Ray Ward has been working with families of disabled individuals who are in need of respite care for their family members. He convened a group with representatives from these families, Medicaid officials, and nursing representatives. Rep. Ward opened the Nurse Practice Act (HB 274 Nurse Practice Act Amendments) to add language about these family members delegating tasks to unlicensed care givers. Rep. Ward feels that this is an example of our NPA’s “exemption from license.” The licensed nurse will not be involved in this delegation and has no responsibility for this care giver. Rep. Ward is trying to get Medicaid to cover the cost of this care performed by the care giver. This bill has passed the House and is nearly through the Senate.

Midway into the session, we learned of SB 127 Nursing Licensing Amendments (Buxton). Currently in the NPA, all state approved non-nationally accredited nursing education programs were given five years to achieve national accreditation with a

deadline of December 2020. All have met this deadline except one. Sen. Buxton is opening our NPA to allow this program two additional years to achieve accreditation. This bill was assigned to Senate Business & Labor where UNA opposed this. Our opposition was ignored. The committee members decided to pass it out favorably. It passed the Senate with Sen. Buxton making emotional pleas for the students in this program to be able to complete their education without closing this school. Once in the House, it was assigned to House Health & Human Services where UNA, Academic Leadership, and UONL vehemently opposed it. We feel that it is not appropriate to give more time to one program while others have met the deadline. The committee voted 8-4 to shorten the time frame to 18 months and passed it out favorably. Rep. Ray Ward was able to amend it to say no more admitted students in Nov 2020 if that school had not set an accreditation site visit to happen by spring 2021. It was passed in the House 3/4.

Please see the bill tracker on our website for other bills we followed. We invite any interested member to join the Government Relations Committee where you can read the bills we are particularly involved in and give us your ideas for support or opposition.

We also urge you to ask questions of incumbents who want your vote in November. See how well they respect our nursing profession. You can see how they voted on bills by going to the bill and clicking on the status tab on the legislative web site. www.le.utah.gov. Look at the numbers of votes “for” and “against” and then click on the numbers. Then you can see if your representative or senator voted for or against a bill that interested you. Be informed and let them know you are a nurse!

2020: Year of the Nurse and the Midwife!!!

This Nurses’ Week recognizes that 2020 is the Year of the Nurse and the Midwife. Within this issue we present nurse midwifery in Utah and beyond. In coming issues we will present other aspects of nursing history – To remind all of us just what a diverse and strong past we have had and what a promising future awaits for all engaged professional nurses. We have much to celebrate and to commemorate.

Throughout the year we will look at the wide variety of nursing settings, nursing educational programs, and nursing contributions to our state and to our citizens.

To achieve best results, we need YOUR involvement. Can you describe your specialty, your favorite aspect of the work you do, or how you contribute to your community. Just two or three paragraphs is enough to give us the flavor of nursing throughout Utah. (A good photograph might possibly be used, so send one in.)

We’re always excited to hear from smart,

independent nurses that love rural nursing.

For all the long shifts, for your compassion, and for your dedication to our patients: Thank You, Nurses!

To learn more about joining the MRH Nursing Team, please visit www.mrhmoab.org/career-opportunities/

Moab Regional Hospital is an independent, non-profit,

Level IV, Critical Access Hospital located in the high

desert of Utah.

Utah Nurse • Page 10 May, June, July 2020

Being the nurse in the family Roberta Young, MSN, RN, CENP, and

Teresa (Terry) Anderson, EdD, MSN, NE-BC

Define your role when a family member is ill, and then apply that experience in your practice.

Takeaways:• Most nurses experience being the “nurse

in the family” when a loved one is ill, which can be a struggle and an opportunity to learn and grow.

• When a nurse is caring for a loved one, the nurse must articulate how his or her actions are grounded in the practice roles of professional nursing.

• Nurses can promote and improve their own professional practice when caring for a loved one with intentional, humble reflection and being open to self-healing.

My mother had experienced sudden-onset pulmonary edema after a complex cardiac procedure. I felt that her caregivers didn’t assess her accurately and acted on assumptions. We had previously negotiated very rough waters balancing her medications. The day after a transfer to a step-down unit, a well-intentioned but ill-informed provider stopped her cardiac medications, stating that “too many meds for old people often cause more problems.” This was done without consulting the specialists or communicating with her family. Within 24 hours, she was back on a ventilator in the intensive care unit. I was livid, a reaction interpreted by my kind, humble father as questioning the doctor’s authority and being haughty, a characteristic considered poorly in my family.

—Roberta Young

At one time or another in our careers, we become the “nurse in the family,” and sometimes we’re disappointed with our colleagues as we advocate on behalf of a parent or child. Other times, though, we’re in awe of the compassion and expertise we witness. Underneath it all may be turbulent emotions of love, conviction, and uncertainty mixed with our professional capacity as nurses to listen and react smartly while being held to unknown expectations.

Navigating this situation requires understanding nurse practice roles, defining your role with the family member, and learning from the experience. Taking these actions not only will help family members but also can help you cope with your emotions and improve your practice.

Nurse practice rolesIn Relationship-Based Care: A Model for Transforming

Practice, the authors define six practice roles of professional nursing: sentry, healer, guide, teacher, collaborator, and leader.

• Sentries watch over and protect others. • Healers care for another’s body, mind, and spirit and

help him or her improve health. • Guides lead or direct another’s way through

unfamiliar circumstances and possess intimate knowledge of the way.

• Teachers impart knowledge and help another learn a skill.

• Collaborators work cooperatively with others to achieve a common purpose.

• Leaders have the authority to act on behalf of others and possess the capacity to effect change and influence direction.

Family expectations frequently are diverse, hard to discern, and sometimes unrealistic. Nurses are tasked by the American Nurses Association’s Code of Ethics for Nurses with Interpretive Statements to promote health, ensure care in a dignified manner, and protect patient safety. This is hard work and may lead to conflict, feelings of failure or inadequacy, or being labeled as arrogant or a “know it all” by family members when you try to explain medical speak. Clarifying the inner conflict between your nursing and family roles and acknowledging that struggle to yourself and family members can enhance your ability to cope and your family’s understanding.

Your role as the nurse in the family extends beyond the high-risk, acute episodes of chronic disease exacerbations

that become a reality with older family members. You’re also called upon to assist in ongoing care planning and coordination.

My mother was a retired nurse and very reluctant to delegate her health decision-making, even though she knew that her worsening cognitive functioning required her to have a safety net. Over her later years, my role encompassed teacher, guide, and collaborator. As her physical and mental status deteriorated, I was forced to navigate a shift to sentry and leader. The decisions I made as the daughter/care partner with ultimate responsibility for moves to assisted living, and subsequently memory care and hospice, were the most difficult of my 37-year nursing career.

—Terry Anderson

Take actionThe situations described here are no doubt familiar to

nurses across the country. And although the role of nurses in the family probably won’t change, what can change is how you accept the role and take action to prepare yourself to be the best advocate for your family. Positive actions include defining your role and learning from the experience.

Define your rolePreparing before acute situations occur makes it possible

to implement a plan quickly and efficiently. Start by defining for yourself and your loved ones how you might practice each of the six professional practice roles as the nurse in the family. Your family may have an idea of what you do as a nurse, but they may not understand how you intentionally think and act. Explaining these processing and decision patterns can improve communication and help family members become more informed caregivers.

Determine the touchpoints or decision moments (for example, death of a spouse, fall or medication error, move from home, or change in financial/insurance situation) when roles might shift or be expanded. And be clear about your expertise. In some areas, you’re fully qualified to be the “know it all,” but in others you may be exploring options and needs along with the rest of the family. Keep the lines of communication open with the person receiving care and others (family members and healthcare team) involved.

Learn from the experienceBeing the nurse in the family is exhausting and stressful,

but it’s also an opportunity to learn empathy and compassion for the nurses who are family members and advocates of future patients you’ll care for. Understanding that nurses as family members are navigating a slippery slope with the extended family will create a path for collaboration. Include these nurses in care planning and implementation to enhance confidence in their decisions, which in turn can improve trust within the family and trust in your care.

The experience of being the nurse in the family also can be a catalyst to examine and improve your own practice. Ask yourself these questions and answer honestly:

• Was there a time that you let your assumptions cloud your assessment?

• Was there a time you received a report that labeled the patient in a poor light and you acted on that view rather than your own professional assessment?

• Was there a time that you skipped an intentional pause to learn the patient’s lived experience in their illness, which led to inappropriate treatment?

To grow professionally and continue to hone your practice, you have to be willing to ask yourself the hard questions and then humbly listen and improve. Patients, families, and your value as a nurse deserve this. Out of love, you care for your family with a heart and mind that wants to do the right thing. The experience also can make you a better nurse.

Roberta Young is a nursing and healthcare consultant in Fargo, North Dakota. Teresa (Terry) Anderson is an independent nursing practice consultant and chief nursing officer at Nobl Health in Lincoln, Nebraska.

ReferencesAmerican Nurses Association (ANA). Code of Ethics for

Nurses with Interpretive Statements. Silver Spring, MD.: ANA; 2015.

Koloroutis M, ed. Relationship-Based Care: A Model for Transforming Practice. Minneapolis, MN: Creative Health Care Management; 2004. 3/2/2020 Being the nurse in the family - American Nurse

HEALTHY NURSE HEALTHY NATION

Earning a Bachelor’s in nursing online, becoming a gerontologist, or getting a PhD without having to quit your job or move. The Institute of Medicine recommends that nurses practice at the top of their degree. At the University of Utah, the “top” has no limit.

College of Nursing | 801.587.3194 admissions@nurs.utah.edu |

nursing.utah.edu/programs

Nursing Education at Home: RN to BS

Interdisciplinary Gerontology Master’s PhD

May, June, July 2020 Utah Nurse • Page 11

Forensic nursing: Overview of a growing professionJulie L. Valentine,

PhD, RN, CNE, SANE-A

Reprinted with permission from author and American Nurse Today

Combine your nursing skills withforensic science to help victims ofviolence and trauma

IN THE CURRENT ERA of the #MeToo movement and prominent sexual assault disclosures, these types of crimes are finally receiving the attention they deserve. Our society is acknowledging what research has been telling us for years about the high incidence of sexual violence in the United States. According to a recent Centers for Disease Control and Prevention (CDC) report, more than 36% of women have experienced contact sexual violence in their lifetime and 19% have experienced attempted or completed rape. Men also report high rates of sexual violence; more than 17% have experienced some form of contact sexual violence in their lifetime and nearly 2% have experienced attempted or completed rape.

A benefit of the increased media and cultural attention on sexual assault crimes is that in many areas of the United States more victims are reporting the crimes to receive forensic medical examinations by sexual assault nurse examiners (SANEs).

Many healthcare personnel and nurses are familiar with SANEs but may not realize that forensic nursing is a much broader nursing specialty that encompasses caring for patients who’ve experienced all kinds of violence and trauma.

Forensic nursing scope and specialtiesForensic nursing combines nursing care with the legal

system and forensic sciences. Forensic nurses care for patients who’ve experienced violence and other traumas, such as natural disasters. Patients include living and deceased victims as well as perpetrators of violence. The patient population also extends to communities and society at large. Forensic nurses collaborate with other professionals outside of healthcare, but they’re nurses first and use the nursing process to provide compassionate, holistic care. This distinction clearly defines forensic nurses as healthcare professionals rather than criminal justice or forensic science professionals.

As forensic nursing grows, subspecialties will advance to meet healthcare and societal needs. (See Forensic nursing subspecialties.) But regardless of the subspecialty, forensic nurses focus on improving patient and legal system outcomes. They address the bio-psycho-social-spiritual needs of patients affected by violence and trauma to promote physical and psychological health and recovery. Additionally, forensic nurses use proper evidence documentation, collection, and preservation practices to ensure optimal analysis findings.

Only RNs can take specialized forensic nursing education, but forensic nurses come from a variety of educational backgrounds—from associate to doctoral degrees.

Many forensic nurses have experience in emergency departments, intensive care units, women’s health, medical surgical units, or mental health/psychiatric units.

SANEs make up the largest group of forensic nurses in the United States. In fact, about 72% of the International Association of Forensic Nursing (IAFN) members are SANEs. IAFN provides online education for SANE training and sponsors the certification examinations for both adolescent and adult SANEs (SANE-A) and pediatric SANEs (SANE-P) as recognized by the American Nurses Credentialing Center’s Magnet Recognition Program®. Nurses must meet the eligibility requirements before taking the credentialing examination.

In some parts of the United States, the SANE role has

expanded to include providing nursing care and examinations for patients affected by interpersonal violence, strangulation, torture, physical child abuse, child neglect, and elder abuse. They also care for the suspects of violent crimes.

Employment settingsForensic nurses work in a variety of healthcare settings:

hospitals, emergency departments, clinics, correctional health centers, and medical examiners’ or coroners’ offices. (See Forensic nursing care settings.) Many forensic nurses work on-call, ready to respond when a patient needs their specialized care, while others are employed as full-time forensic nurses. States, jurisdictions, and healthcare facilities vary on their payment structure for forensic nursing services, providing oncall, case-by-case, hourly, or salaried wages.

Educational optionsForensic nursing education is holistic, ranging from

learning about assessment of the psychological impact of trauma to documenting physical injuries and preserving evidence. As forensic nurses intersect with the criminal justice system, education also is provided on expert testimony. A variety of online forensic nursing education programs are available through IAFN. Several universities offer courses specific for SANEs or death investigators, and graduate forensic nursing programs range from master’s to doctoral degrees. When exploring SANE education opportunities, look for programs that meet IAFN guidelines. And keep in mind that to practice as a forensic nurse, you need both classroom education and clinical experience.

Key forensic nursing conceptsRNs already practice many forensic nursing

concepts, including compassionate, patient-centered, objective, culturally sensitive, and evidence-based care. However, forensics’ education expands on these key concepts to incorporate a thorough understanding of trauma-informed care, including knowledge of the neurobiology of trauma and interventions to promote healing and restore power and control to patients who’ve experienced violence and other trauma.

ObjectivityObjectivity is critical to forensic nursing, both in

terms of nonjudgmental care when documenting findings and facts and in interactions with the legal system when serving as an expert witness or consulting for prosecuting and defense attorneys.

Cultural sensitivityCulturally sensitive forensic nursing care involves an

awareness of cultural and societal influences on violence, abuse, and trauma. It also requires a commitment to social justice and access to care.

EvidenceAll aspects of forensic nursing care—from patient

assessment to evidence collection and documentation of injuries—must be based on research and best practice guidelines.

Violence preventionViolence prevention is also a foundational concept within

forensic nursing. Under IAFN’s Vision of Ethical Practice, the scope of forensic nursing practice includes a responsibility to address violence prevention to promote healthier communities and nations.

Learn more about forensic nursingNurses have always provided care to victims and

perpetrators of violence. Forensic nursing expands that role to individuals and communities to promote recovery, health, and justice.

To learn more about forensic nursing, visit the IAFN website (IAFN.org). Note that many states have IAFN chapters with contact information. You also can read more about forensic nursing in the official peer-reviewed journal of IAFN, Journal of Forensic Nursing, and in American Nurse Today (americannursetoday.com/forensic-nurses-strides-social-justice/).

Julie L. Valentine is an assistant professor at Brigham Young University College of Nursing in Provo, Utah, and a forensic nurse with Wasatch Forensic Nurses in Salt Lake City, Utah.

Selected referencesAmar A, Sekula LK. A Practical Guide to Forensic Nursing:

Incorporating Forensic Principles into Nursing Practice. Indianapolis, IN: Sigma Theta Tau International; 2016.

American Nurses Association and International Association of Forensic Nurses. Forensic Nursing: Scope and Standards of Practice. 2nd ed. Silver Spring, MD: American Nurses Association; 2017.

Price B, Maguire K, eds. Core Curriculum for Forensic Nursing. Elkridge, MD: International Association of Forensic Nurses; 2016.

Smith S, Zhang X, Basile K, et al. The national intimate partner and sexual violence survey: 2015 data brief. Centers for Disease Control and Prevention; 2017. www.cdc.gov/violenceprevention/pdf/NISVSStateReportBook.pdf

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