Volume 53 • No. 3August, September,

October 2020

Nebraska Nurse

Quarterly circulation approximately 36,000 to all RNs, LPNs, and Student Nurses in Nebraska.

current resident or

Non-Profit Org.U.S. Postage Paid

Princeton, MNPermit No. 14

Sent to all Nebraska Nurses courtesy of the Nebraska Nurses Foundation in partnership

with the Nebraska Nurses Association

Feature Article2020 Membership Assembly . . . . . . . . . . . . . . . . . . . 2Inside the NNAPresident’s Column . . . . . . . . . . . . . . . . . . . . . . . . . . 3NNA State Director . . . . . . . . . . . . . . . . . . . . . . . . . . 3NNA MIG Reports . . . . . . . . . . . . . . . . . . . . . . . . . .4-5 - Evaluating Legislative Candidates . . . . . . . . . . . . . 5GFMC Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 - Member Spotlight . . . . . . . . . . . . . . . . . . . . . . . . 6Nebraska Nurses FoundationNNF 2020 Silent Auction: Pandemic Focus . . . . . . . . 7Nebraska Nurses Foundation Seeking Nurses’ Stories of the 2020 Pandemic . . . . . . . . . . 7Affiliate OrganizationsNebraska Center for Nursing . . . . . . . . . . . . . . . . . . . 8Nebraska School Nurses Association . . . . . . . . . . . . . 9Midwest MSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Membership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

In This Issue

Awards for NNA Members & Scholarships forNursing Students

Page 13

Page 4

Being a Nursing Student During a PandemicLife is chaos right now .

The coronavirus is going to be the pathogen of the century . Students right and left are in a panic about keeping up with online classes, staying in touch with their family and friends, and coping with such an unprecedented part of history . I, for one, have not quite wrapped my mind around COVID-19 and the devastation it has brought us . Being a nursing student in particular makes the whole situation that much more interesting . While it is easy for me to think that the only thing this disease will do is hurt my nursing education, I have to stop and realize the hidden lessons that I can learn from it all (and maybe even be a better nurse one day because of it!)

Being a nursing student during this time has caused many thoughts and concerns to swirl through my mind . Watching nurses out there bravely care for COVID-19 patients has left me severely impacted . Not that I didn’t think the nursing role I’ll have one day would be pertinent to so many lives, but now I am able to see even more the courage it requires when scary things like these happen . Becoming a nurse means that I silently pledge to care for the patients that walk through the doors . I have become upset reading posts from current nurses saying how they “didn’t sign up for this .” I have to strongly disagree . When I become a nurse, I’ll know in my heart that whatever situation comes my way, I did sign up for this . And then I will hold my chin up high, say a prayer, and then push right on through . COVID-19 has forever changed my view of the nurse I aspire to be and has also skyrocketed the pride I feel for my future profession .

Online nursing school is a whole other adventure . For the most part, I’ve had to rely on my strong dream of becoming the “best nurse ever” in order to sit down in my own house and study . I knew after the first few days of online homework that I’d have to dig deep in my soul to find the right mentality to be successful the rest of the semester . It is just such a different environment than what an in-person class gives you .

Pursuing success is an independent choice, but it has never felt more independent than in this exact moment! At least at NWU, a teacher can notice when you’re gone and say something about it . Here at home, I have to stop the online courses from tricking me into thinking I can’t be as successful in them than I would have otherwise been on campus . I have to exercise my abilities of being organized and flexible, proactive with some sweet nursing study buddies (via Zoom of course), and purposeful in the choices I make so that I can be a nurse in the years to come .

The skills I have had to sharpen through this adjustment will absolutely follow me into my future nursing practice . At this point, I feel like I can conquer the world if I can survive online nursing school, and that confidence will resonate within me when I’m driving to my nursing job one day . I will be more flexible too! More than anything, I will be better at leaning on my fellow nurses because we truly need each other to get through the toughest parts of it all .

Fifty years from now, when I’m nearly 70 years old (yikes!), I’ll get to turn to my family and tell them all about the blessed coronavirus . I’ll tell them that the worst part was leaving the thrill of college and feeling like a piece of my sophomore year was gone for good . Or how my younger sister didn’t get her last track season, prom, or graduation ceremony . Or how I got to watch people in the world mourn over loved ones that the coronavirus overwhelmed . BUT—I’ll be sure to bring up that even with the fear and hatred I felt towards COVID-19, there was some things to be grateful for . I was able to live at home with my family and feel safe with them—knowing everything would be okay—and also grow a million times closer with my younger sister too . I was able to get involved in the choices of our country and seek to understand them, which made me a better citizen in the long run . Lastly, I was able to further grasp the duty I had as a nurse in the making, and I was a stronger nurse because of it . In this chaotic life, there really is a purpose for everything .

Reagan Janzen is a sophomore nursing student at Nebraska Wesleyan University. This essay was written as part of a Reflections assignment in the Medical Surgical 1 course.

Reagan Janzen

Page 2 • Nebraska Nurse August, September, October 2020

The mission of the Nebraska Nurses Association is advancing our profession to improve health for all . The vision of the Nebraska Nurses Association is to be a proactive voice for nurses and an advocate for improved health for all .

C – Collaboration A – Advocacy R – Recognition E – Education

The Nebraska Nurse is the official publication of the Nebraska Nurses Association (NNA) (a constituent member of the American Nurses Association), published quarterly every February, May, August, and November. The NNA provides education, networking opportunities, publications and other products and services to its members and extends its mission to all nurses in Nebraska.

Phone: (888) 885–7025You can leave a message at any time!Email: Director@NebraskaNurses.orgWeb site: www.NebraskaNurses.org Mail: c/o Midwest Multistate Division3340 American Avenue, Suite FJefferson City, MO 65109

Questions about your nursing license?Contact the Nebraska Board of Nursing at: (402) 471–4376 . The NBON is part of the Nebraska Health and Human Services System Regulation and Licensure . Questions about stories in the Nebraska Nurse? Contact: NNA .

This newsletter is a service of the Nebraska Nurses Association and your receipt of it does not mean you are automatically a member. Your membership in support of this work is encouraged; please visit www.nebraskanurses.org.

• Any topic related to nursing will be considered for publication in the Nebraska Nurse .

• Authors are not required to be members of the NNA; however, when space is limited, preference will be given to NNA members .

• Photos are welcome, digital is preferred . NNA does not assumes responsibility for lost or damaged photos .

• Use current APA formatting for any article requiring citation .

• Provide a brief author biography indicating the author’s nursing experience and/or expertise with the paper’s content .o Limit the author’s biography to 4-sentences .

• Submitted material is due by the 2nd of the month in January, April, July, and October of each year .

• The peer-review is blinded; submit the title page separately from the article

• Submit the title page and article as Word documents to npdc@nebraskanurses .org

For advertising rates and information, please contact Arthur L . Davis Publishing Agency, Inc ., PO Box 216, Cedar Falls, Iowa 50613, (800) 626–4081, sales@aldpub .com . NNA 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 Nebraska 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 . NNA 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 NNA or those of the national or local associations .

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FEATURE ARTICLE

2020 Membership AssemblyLinda Stones

The 2020 Membership Assembly of the American Nurses Association was very unique . It was the first time that the meeting was held virtually . Due to the multiple time zone of attendees, the meeting started at 5 pm CST, allowing our colleagues in California and Hawaii to attend at a reasonable hour . While we are all getting accustomed to virtual meetings, holding a virtual meeting with over 400 attendees is nothing short of a miracle . I was truly amazed at the work that ANA staff did to orchestrate this large of a meeting in such a short amount of time . They did an amazing job! As a result of the virtual setting, the business of ANA was limited .

The meeting started with an address from the ANA President Ernest Grant . President Grant spoke about the many challenges that our profession has encountered this year . It has been a year of challenges, yet nurses have been at the forefront . Nurses have worked together to advocate for themselves, their patients and their communities . Nurses have been leading the effort in addressing the pandemic . They have been at the forefront of caring for victims of COVID 19, addressing issues related to the lack of PPE, and advocating for testing . Nurses also were present to speak out about racial injustice and health disparity in our country .

Different states shared information on how they are responding to the recent events . Some states created Nurse to Nurse hotlines, bringing nurses together to support each other with the stress of caring for COVID patients . Other states have provided nurses a venue to share their personal stories via all forms of media . We as an organization spoke of the challenges that lie ahead of us . How do we leverage the use of telehealth? What additional disaster education is needed? What will be the role of the school nurse in this new environment as schools reopen? How will schools manage nursing education with restrictions on clinical locations? So many challenges still lie in front of us but the overall consensus was that nurses working together can find their way through all of these issues .

Due to the limited nature of the meeting, only two resolutions were presented . The most important resolution was an emergent proposal . This proposal was titled Racial Justice for Communities of Color . The proposal calls for ANA to oppose and address all forms of racism and discrimination, Champion the Code of Ethics for nurses, partner with nurses to educate, advocate and collaborate to end systemic racism, particularly within nursing, advance legislative policies that promote diversity, equity inclusion and social justice for all and advocate for ending health inequities . The other was related to dues escalation . The proposal that was discussed was a 1% increase that would be implemented every five years . In the past, increases were every three years and could be up to 2% . At this writing the results of these proposals was not known, as voting was completing following the event .

As the elected representative from Nebraska, I want to first thank you for allowing me to represent the great nurses in our state . It is an honor to participate in the governing organization of our profession . I want to end this with a message and commitment .

I am very proud to be a nurse . The public has voted us the most trusted professional for over 15 years . Nurses have again, showed the public that when they are in need, nurses are there . Nurses are there willing to give of themselves to help others in their darkest times . Nurses are there willing to give of themselves for others . In my opinion, there is not a more noble profession . Nurses are the largest group of healthcare providers and with those numbers, we can use our voices to effect change . Right now we need to stand together to effect change in our Disaster responses . Nurses should have adequate PPE and support during times of national crisis . Nurses should demand to have a strong public health system . Nurses also are in the best position to point our health disparities and social injustices and advocate for change . My commitment to you, is that I will continue to advocate for nurses on a State and Federal level .

If you are not a member of the Nebraska Nurses Association, now is the time to join . Together we can make a difference . Please feel free to contact me if you have any questions, lstonesrn@gmail .com .

(NOTE: Please refer to the ANA website on all the activities ANA is doing in our favor as well as what you can do . I recommend these https://www .nursingworld .org/ana/ and https://www .nursingworld .org/practice-policy/advocacy/ .

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INSIDE THE NNA

President’s Column NNA State Director

Kim Houtwed, MBA, BSN, RNNNA State Director

Many people take time at the end of the day − and certainly at the end of the year − to reflect on what has passed and think about what is to come . Consider taking a seasonal review as we change seasons . 2020, the Year of The Nurse has certainly given us many happenings on which to reflect .

As I reflect over the past year in my position as the Nebraska Nurses Association State Director, I have become keenly aware of the actions that the Nebraska Nurses Association in partnership with the American Nurses Association are taking to advocate for ALL of America’s nurses . We have been very intentional and strategic in our advocacy of nurses .

We started by asking nurses what they needed, and we have been working at the Federal level to make it very clear that insufficient PPE’s puts our nation’s healthcare workers, our nurses, at risk . During this unprecedented time in healthcare history, we are meeting nurses needs for knowledge by providing you with multiple opportunities for education to care for this new disease . We are already working on strategies to meet the psychological trauma on nurses who are making life and death decisions at the bedside .

I am proud to be a member of the NNA and ANA . Our work to advocate for you would not be possible without your support . A sincere THANK YOU to our new and loyal members for your support of nursing through your NNA/ANA membership .

Douglass Haas, DNP, APRN-NP,FNP-BC, AGACNP-BC 

Nebraska Nurses Association President

These last few months have exemplified the 2020 Nurses Month theme of Excel, Lead, Innovate . I have heard about so many nurses who were genuinely innovative when dealing with the COVID-19 pandemic . I always knew the Registered Nurse was well equipped to lead, but the amount of ingenuity and innovation that surfaced out of necessity astounds me . The way that every practice setting with a Registered Nurse changed process and protocol pretty much overnight . They used their expertise and knowledge of infection prevention and patient triage and transport to change workflows overnight . From outpatient ambulatory settings to small critical access hospitals to large medical centers, every location had at least one Registered Nurse who could influence practice change that positively impacted patients and kept health care workers safe . Thank you for your excellence and know that I am forever grateful and in awe of your work across Nebraska .

On June 19th, I attended the first-ever Virtual ANA Membership Assembly, along with Linda Stones, as the Nebraska Representatives . Important topics were discussed and voted on, as are perfectly detailed in Linda’s write up of the event . This event is a yearly recharge for me and allows me to refocus on my professional nursing intentions . 2020 is only half over but has already been a year filled with tremendous difficulties

and an overall sense of loss . From my noted place of privilege, it can be overwhelming to try and process and understand the current state of the world . The world where cruelty is not the “new normal,” but the “finally noticed” can make anyone want to turn away and stay silent . But the ANA Membership Assembly made me reflect on the promise I made multiple times in my life, first at my White Coat Ceremony, where I promised to learn the profession of nursing . Second at my BSN Graduation, where we took the International Pledge for Nurses, and now yearly, I interact with students at the Undergraduate and Graduate level and see them recite these same words at Graduation . This overwhelming feeling of not knowing what to do or say, has been more easily managed when I realized I have tools specifically made for me as a Registered Nurse . I have ANA documents about Nursing Scope & Standards of Practice, our Social Contract, and our Code of Ethics . These documents allow me to use my current state of privilege to recognize human dignity regardless of race, culture, creed, sexual orientation, ethnicity, gender, age, experience, or any aspect of identity .

Nurses of Nebraska – I ask you to reflect on the current state of 2020 . What can you, as a Registered Nurse with the instructions provided in our guiding documents, do for the current state of our world? I plan to have the difficult conversations whenever they appear . I plan to continue to vote and be active with our governmental and political processes .

I charge you to take ownership of your Registered Nursing privilege and use it to make the last half of 2020 better than the first . We are the most trusted profession, and we must bring forth better change . Not just for ourselves, but for the patients that we serve . The world needs nurses now more than ever – please go out and heal the world .

Douglass Haas

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Page 4 • Nebraska Nurse August, September, October 2020

INSIDE THE NNA

NNA MIG ReportsRegion 1 MIG

Due to COVID-19 many of our regular events were cancelled . We plan to resume them as soon as it is safe to do so .

We sent several members to the 2019 NNA convention in Kearney in October of 2019, welcomed new members to our area, and met live two times at the Steel Grill in Scottsbluff to discuss business .

Our annual “Welcome/welcome back” picnic is scheduled for August 24 at the Scottsbluff YMCA Trails West outdoor facility .

If interested in learning more, please contact Wendy Wells BS, BSN, MSN, RN at wwells@unmc .edu .

Omaha Metro Area MIG UpdateAnna Mackevicius, BSN RN PMP

Chair, Omaha Metro Area Mutual Interest Group

The on-going effects of the COVID-19 virus has, of course, changed the remaining events planned by Omaha Metro Area Nurses Mutual Interest Group of the Nebraska Nurses Association this year . Our venue vendors have been very understanding and not holding us to cancellation requirements . While many of our events were cancelled, we were able to change our annual 5K Run/Walk to a virtual format . Our planning group has turned its attention to 2021 and looking for ways to reinvent contact and engagement while still meeting the goals and objectives of the event . More virtual meetings are likely . Maybe events come to facilities, hospitals, or colleges . It’s possible that there will be virtual meetings just to say “Hi!” Remember, all area nurses are welcome at any of our events; you do not need be a NNA member but, of course, we hope you consider becoming one .

Student Leaders Recognition The planning members for this event, led by

Beth Flott, EdD RN, Assistant Professor at Creighton University College of Nursing . The date and location of the event has not been determined; however, plans are moving forward for this event in some fashion in 2021 .

Celebrate Nursing! and Positive Image of Nursing Breakfast

Sadly, my favorite event was cancelled given Nebraska’s current Directed Health Measures, not to mention the risk of a large group of nurses gathering in one space, and/or if anyone would consider attending . However, the MIG was not going to allow a virus to be an insurmountable barrier! Nominations for the Positive Image of Nursing recognition awards remained open until July 1 . The number of nominations is down a bit from last year but I was pleased with the outcome . Certificates for each honoree were sent to their facility or to the honoree

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August, September, October 2020 Nebraska Nurse • Page 5

INSIDE THE NNA

NNA MIG Reportsand nominator (if nominated individually) . This will allow each facility to hold their own event . Look for the list of honorees in the next Nebraska Nurse issue .

A decision about the 2021 event has not been made . My crystal ball is just not working . So many questions and uncertainties . What’s our world going to look like in January 2021? The MIG will carry the tradition forward – it might look a bit different .

Nurses Political ReceptionThe restrictions in place for a large gathering did

not support the format envisioned for the Legislative Reception . Two members of our planning group, Alice Kindschuch, DNP, APRN-CNS, GCNS-BC and Echo Kohler, DNP, RN developed a great article with a short list of questions for nurses to ask any candidate in this year’s election . Please see the article in this Nebraska Nurse issue . The Thompson Alumni Center on the UNO campus was one of the generous vendors I mentioned . The Center simply allowed us to apply our deposit to our next event and no further fees were owed . As a result, the next Nurses Political Reception will be held on August 23, 2022 at the Thompson Alumni Center .

Omaha Metro Area Nurses MIG Fun Run/Walk The annual Omaha Metro Area Nurses MIG Fun

Run/Walk is on! The Fun Run/Walk was updated to a virtual format . See the flyer in this Nebraska Nurse issue . You, your family, and friends can register at https://nna .salsalabs .org/virtual5krunwalk2020 . The cost is $5 for adults (11 and up) and free for children 10 and younger . Walk or leisurely jog with your family, or competitively run by yourself . Choose your own route, run or walk any track, trail or street . . .your options are endless! Send your pictures!

Annual Dinner After a lengthy discussion, we opted to cancel

the in-person 2020 Annual Dinner . Perhaps a virtual meeting to catch up on news from members and gather input on innovative ways to connect .

Feel free to contact me at annamackevicius@gmail .com if you have any questions about the Omaha Metro MIG events or membership to NNA .

Evaluating Candidates for the2020 General Election

Echo Perlman Koehler, DNP, RNAlice Kindschuch, DNP APRN-CNS GCNS-BC Members, NNA Omaha Metro Nurses Mutual

Interest Group

Due to the safety of our nurses and candidates, NNA will not be holding the Legislative Reception in August . However, you are still able to evaluate candidates for office for the upcoming election . Health policy issues are more important than ever, from local elections that affect your community to national elections that impact the direction of the country . The League of Women Voters, a non-partisan non-profit group that does not endorse any candidate or political party, provides a 7-step process to consider when selecting a candidate:

1 . Decide what you are looking for in a candidate . What are the issues most important to you, and what leadership qualities and experience would they bring to the office?

2 . Who are the candidates running for office? The 2020 Voters Guide for state and local elections can be found on the Nebraska’s League of Women’s Voters; visit https://www .lwv-ne .org/ .

3 . Gather materials about the candidates . Most won’t be knocking on doors this fall due to COVID-19 . Now more than ever, you need to do your research . Search for candidates’ websites . Watch the news .

4 . Evaluate candidates’ stands on the issues . Do candidates address health policy issues? List your priority issues .

5 . Learn about the candidates’ leadership abilities . How well prepared for this job are they?

6 . Learn how other people view the candidate . Are they a respected member of your community? Examine endorsements . Talk to others about their opinion on candidates .

7 . Sorting it all out . Prioritize the issues . Is the choice clear? If so, pick a candidate to earn your vote .

These 7-steps can be found @ http://www .smartvoter .org/voter/judgecan .html . If you are not registered to vote, you may do so @ https://www .nebraska .gov/featured/elections-voting/ .

 Dates of interest:

• September 28: First day a vote-by-mail ballot can be mailed to voters for the 2020 general election

• October 5 – November 2: Vote early for the 2020 general election at your Election Commissioner or County Clerk’s office and return vote-by-mail ballots

• November 3: Vote at your assigned polling place from 8 a .m . - 8 p .m . CT

Visit our website at http://amhne.org

for career opportunities – or contact –

Megan Becklun, 402-887-4151, hr@amhne.org, 102 W 9th St, Neligh NE 68756

402-887-6397 (Fax)

Warm & Welcoming! –

That’s who we are!

We care like family… Join us!

Page 6 • Nebraska Nurse August, September, October 2020

GFMC UpdateHello fellow NE Nurses,

The Governance, Finance and Membership Committee (GFMC) members continue to be hard at work to find members to be on our slate for the upcoming election . We have several openings:

• Legislative, Advocacy and Representation Committee (LARC) Region 1

• LARC Region 2

• LARC – At Large

• Nursing Professional Development Committee (NPDC) – Nursing Faculty

• NPDC – Professional Educator

• GFMC – Rural

• GFMC – Urban

Visit https://nebraskanurses .org/about/leadership-opportunities/ for more information and to fill out your leadership commitment form today! Let your voice be heard!

Member SpotlightFaye Weckle, RN, CRRN

I am a Staff RN at Madonna Rehabilitation Hospital on the Traumatic Brain Injury unit . I have worked all the units here at one time or another in my 33 years here . I worked skilled care prior and loved that also . My career began in St . Louis at Barnes Hospital on Med Surg ., then I did a 12 bed hospital in MN for a short time . I have been certified in Gerontology in the past but am only keeping my rehab . certification at this time, being less than three years from retirement .

I am a diploma grad . One of my regrets is never finishing my BSN, but that will not happen now and I have moved on .

I joined ANA when I lived in MN, primarily at first for the liability insurance . When I moved to NE, I continued my membership and became active in NNA . I grew to love my fellow members, serving on committees, and going to convention . I have always appreciated how ANA fights for my needs and rights as an RN, in the legislative and political arenas . Most recently I needed a lot of CEUs for a point on my clinical ladder . Do you know I got hundreds of dollars of CEU’s for free, thanks to my membership! I stay up to date reading everything in the American Nurse magazine and the emails I get . When I took my Gerontology test, my certification was discounted due to my membership . There are many benefits; these are just a few that I have used .

When I am stressed at work, I take a deep breath or two, maybe tell someone I trust about whatever is stressing me, make sure I’m hydrated and have eaten, ask for help or delegate if applicable . A huge help to me is to remind myself “I can do ANYTHING for 12 hours!” Also to remind myself that my best is all I can do, and it is enough . When I leave work, my stress relief is to have some balance in my life: some spiritual, some physical, some emotional and some mental balance . I take good care of myself by eating good food, not smoking, getting enough sleep, little or no alcohol intake, maybe window shopping or talking to someone I care about . On a day off, I like to read a good book, and do something to create something (knit, sew, etc .) . I sing in my car with the radio (only with the windows up because I don’t sing well) . I like to watch a good movie or old TV show like The Waltons .

Here is a Gerontology “joke” I like to tell:A 96 year old woman goes to see her MD with her son . The Dr . keeps talking

only to her son, not to her . The woman finally gets fed up with this and says “Dr . do you do crossword puzzles?” He says yes . She asks “do you do them in pen or pencil?” He says “Definitely with a pencil .” She replies “I do mine in pen . You can talk to me!”

INSIDE THE NNA

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August, September, October 2020 Nebraska Nurse • Page 7

NEBRASKA NURSES FOUNDATION

NNF 2020Silent Auction:

Pandemic FocusThe Nebraska Nurses Foundation has decided

in light of the COVID-19 Pandemic to not hold its’ annual NNA Convention Silent Auction fundraiser this fall . The foundation recognizes the financial strain created by pandemic . There are financial needs within households, across our state and the beloved country . This year NNF is asking you to consider donating to a charity of your choice . There are so many opportunities to support pandemic relief . Many local food banks are seeking assistance . Charities serving the elderly or vulnerable at risk populations are searching for aide . Maybe you are able to give a financial donation or consider giving of your time . Please consider what might benefit others in your community during these unprecedented times . The NNF Silent Auction fundraiser will return in the fall 2021 . Thank you for supporting the Nebraska Nurses Foundation .

Nebraska Nurses Foundation Seeking Nurses’ Stories of the 2020 Pandemic

Celebrating Nebraska nurses has been a focus of the Nebraska Nurses Foundation since its inception . Now more than ever, the NNF wants to celebrate Nebraska Nurses by sharing their COVID-19 stories and are excited to announce our “Proud to Be a Nebraska Nurse: Stories of the 2020 Pandemic” campaign .

Do you have a personal story about the contribution of you or a fellow nurse during the COVID-19 pandemic? Would you be willing to share your story?

NNF would like to publish pandemic stories highlighting the dedication, commitment and sacrifices made by Nebraska Nurses during these challenging times . The objective of the publication is to showcase the unique gifts and talents of nurses fighting this deadly disease and to capture this defining moment in history .

COVID-19 has changed so many things about being a nurse . Whether you are employed at a medical center, critical access hospital, nursing home, extended living facility, or serve as a public health nurse you have been impacted . Wherever you are using your nursing skills during this pandemic we want to hear from you . Please share your story highlighting the impact and versatility of what it means to be a nurse .

Why are you PROUD to be a Nebraska Nurse? Do you have a powerful success story to share?

Were you working the airborne isolation units or operating phones and tablets so families could stay connected with their loved one?

Were you assisting patients/clients to the window to see family on the other side?

Were you a nursing leader making the difficult decisions to implement visitor restrictions, creating airborne isolation units, and determining staffing patterns to address the patient care needs in your community?

Did you sacrifice time with your family to serve patients and your organization?

Did you stay in a hotel, live with a friend or quarantine yourself in the basement?

Maybe it was the challenges of working your shift only to come home and be a teacher so your children were completing home school assignments?

All published stories and photos submitted become the property of the Nebraska Nurses Foundation . No materials can be returned, so submit copies of original photos or digital versions . Due to publication limitations, all submitted stories may not be published . A signed image release form is needed from anyone appearing in a published photo . Please ensure you have the appropriate permission to share your story and do not include any protected health or personal information .

How to Submit Your Story – Online or Hard CopiesSubmit your story (500 words or less) and/or photos,

with signed image releases at the NNF website www .NebraskaNursesFoundation or copy and use the image release form provided here and it mail to following address: Nebraska Nurse Foundation, 5211 Underwood Avenue, Omaha, NE 68132

Photo/Image Note: Images should at minimum be 5” x 7” at 300 dpi if submitted digitally . Hard copy photos can be scanned, but digital preferred . Either posed photos or nurses on the job (in uniform and gear, if applicable) are accepted . Keep in mind that photos should not include patients in any recognizable form to align with HIPAA laws . If multiple people are in the photo, please identify each by listing names in order from left to right as seen in the photo . Names will appear exactly as provided .

IMAGE CONSENT/ RELEASE FORM

I hereby assign and grant to the Nebraska Nurse Foundation, its affiliates (hereafter referred to as “the agencies”), the right and permission to use my name, likeness, image, and story, and to use and publish any of them in any advertising, promotion, or communications, and I hereby release the agencies from any and all liability arising from such use and publication .

I hereby authorize the reproduction, resale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs and story at the discretion of the organization, and I specifically waive any right to any compensation I may have for any of the foregoing .

This consent and release will continue in perpetuity .

Please print clearly:

Name: _______________________________________________________________________________

Address: _____________________________________________________________________________

Signature _________________________________________________ Date _____________________

If participant is a minor (under 19) this Consent Form must be signed by a parent or guardian .

Parent/ Guardian Name: ________________________________________________________________

Parent/ Guardian Address: ______________________________________________________________

Signature _________________________________________________ Date _____________________

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Page 8 • Nebraska Nurse August, September, October 2020

AFFILIATE ORGANIZATIONS

COVID-19 Pandemic Accentuates Nursing Shortage During WHO’s Designated “Year of the Nurse”

The year 2020 was designated as the “Year of the Nurse” by The World Health Organization (WHO) long before the Covid-19 pandemic . “Year of the Nurse” correlates with the 200th birthday of the founder of modern nursing, Florence Nightingale (born May 12, 1820), who is credited with the world’s original method of documenting and studying how infections spread . Influenced by her work, nurses continue to be concerned about the spread of communicable illness and infection, and work unwaveringly toward prevention and recovery on behalf of their patients and communities .

But there is a critical shortage of nurses nationwide, and the state of Nebraska is not immune .

Currently, Nebraska is understaffed by 4,062 nurses, and that number is projected to increase to 5,436 in the year 2025, according to statistics from the Nebraska Center for Nursing . Data from licensing renewal surveys indicates the total number of Registered Nurses (RNs) working in Nebraska is 23,754 which includes 1,784 Advanced Practical Registered Nurses (APRNs), with an additional 5,004 Licensed Practical Nurses (LPNs) . There are five Nebraska counties with no RNs or LPNs, and six different counties that report having only one RN . The average age of both working RNs and LPNs is 45 .

The Nebraska Center for Nursing was created by the Nebraska Legislature in 2000 to address our states’ nursing shortage . This organization is the single reliable source for analyzing nurse workforce data in Nebraska as it is collected from nurse license renewals .

Recruiting new nurses and retaining current nursing staff is vital for the prevention of illness and the overall healthcare of our state . The concern is heightened as nurses and their families risk their own lives to care for those infected with Covid-19 .

The Nebraska Center for Nursing Foundation is a not-for-profit organization that has been working diligently in to support the growth of nursing in the state . After 20 years, it is time for this organization to ask both nurses and the public to show their caring support for those in the nursing field, a role essential to individual and community well-being .

The Foundation has created a Nebraska Nurse License Plate to honor the importance of nurses in our state and to create a resource to recruit and retain nurses in the workforce . This Nebraska Nurse License Plate was made solely to promote Nursing in the state, it is not being used as a means for profit . Any Nebraskan may apply to be among the first citizens to proudly display the license plate on their vehicle .

The support of all nursing careers is vital for the prevention of illness and the overall healthcare of our state . The time seems very fitting as nurses and their families are putting their lives on the line during the current pandemic . For more information contact: lina .bostwickCFNF@gmail .com .

https://jobs.boystown.org/category/nursing-jobs/197/71794/1

August, September, October 2020 Nebraska Nurse • Page 9

AFFILIATE ORGANIZATIONS

Since the onset of COVID-19 - much has changed in the way that ALL nurses practice their specialty; and this includes school nurses . 

Currently, school nurses across Nebraska are planning for the return of staff and students to school in the fall of 2020 . School nurses will play a major role in the re-opening of schools - including early surveillance of any new wave of cases . Additionally, school nurses will be promoting health practices that can help mitigate the spread and optimize health through efforts such as, keeping up-to-date with required and recommended vaccines, routine and required child physical exams and management of chronic health conditions . 

There will be surely more to come as COVID-19 research and best practices are developed . It is important, now more than ever to assure students have daily access to a school nurse - which will require more districts to hire and utilize the expertise school nurses bring to safely returning staff and students to school . 

Please stay safe, healthy, masked and socially distant while we all work to decrease COVID-19 spread . 

Respectfully, 

Catherine S . Heck, RN, BSN, MAAssistant Supervisor of Health ServicesPresident - Nebraska School Nurses Association

Planning to provide an educational event?

Want to award contact hours?

Judi Dunn MS, CPP, RN, NPD-BC

As nurses, we all know the value of maintaining our professional competence . Healthcare is ever changing – and we need to make sure we are keeping up . Continuing nursing education can be found in many formats, offered 24/7, in-person or online, in journals or on your phone . It is also known that nurses are involved in planning education outside of their work environment . Does your local association have an annual meeting for which you would like to provide a continuing education session? Are you involved with a special project that you would like to offer nursing contact hours as a value-added incentive to nurses? You have the ability to seek approval for nursing contact hours outside of an established healthcare facility .

The Midwest Multistate Division is an accredited approver by the American Nurses Credentialing Center Commission on Accreditation (ANCC COA) and accepts Individual Education Activity applications for approval to award nursing contact hours . The application process follows ANCC and Midwest MSD criteria and guidelines to plan, implement and evaluate a high-quality continuing nursing educational event . You do not have to have expertise in education, only a sincere desire to improve nursing practice . The Midwest MSD provides extensive resources and assistance to help you throughout the process .

Completed applications, supporting documentation and the appropriate application review fee must be received by the Midwest MSD Office at least 45 days prior to the educational activity start date . Once an activity is approved, contact hours may be awarded for a two-year time frame . That is, you have the ability to repeat that educational activity anytime within the two-year period, as long as the content remains the same .

For complete details, visit the Midwest MSD website at https://midwestnurses .org/continuing-education/individual-education-activities/ .

Questions? Contact the Midwest MSD Office at 573-636-4623 or email questions@midwestnurses .org .

Page 10 • Nebraska Nurse August, September, October 2020

CBD Oil and Chronic PainSusan E. Collins, RN, BSN, MBA

Reprinted with permission from ANA-Maine Journal May 2020 issue

Thesis statement: Cannabidiol (CBD) oil is an effective means to treat chronic pain in adults .

Purpose statement: Chronic pain is a growing issue in the United States and worldwide . This paper will examine current studies completed within the last five years on the use of CBD oil, or a combination of oils to include CBD oil, for pain management (Smith 2019) of chronic pain . A brief description on the epidemic of chronic pain in relation to several conditions, such as cancer, neuropathic pain (Smith 2019), and musculoskeletal pain will be given, noting the current traditional methods of treatment . Current research will be reviewed and discussed in the use of CBD oil, or a combination treatment including CBD oil, noting findings, current results, and potentials for future studies .

AbstractChronic pain is a growing issue in the United States

and worldwide . This paper examined current studies completed within the last five years on the use of Cannabidiol oil, or a combination of oils to include Cannabidiol oil, for pain management (Smith 2019) of chronic pain . A brief description on the epidemic of chronic pain in relation to several conditions, such as cancer, neuropathic pain (Smith 2019), and musculoskeletal pain will be given, noting the current traditional methods of treatment . Current research will be reviewed and discussed in the use of Cannabidiol oil, or a combination treatment including Cannabidiol oil, noting findings, current results, and potentials for future studies .

Several current studies completed within the last five years focused on Cannabidiol oil as a

standalone or adjunct treatment for chronic pain in adults . Combinations of Cannabidiol oil and delta-9-tetrahydrocannabinol (THC) were used in most studies, however, dosing was found to be inconsistent, patient samples generally small, and repeat studies non-existent . With continued legislation changes and lack of Food and Drug Administration involvement in Cannabidiol oil products, Cannabidiol oil remains a viable option for use in the spotlight of the general public, but with little backing from the scientific community .

Keywords: cannabinoids, cannabidiol, cannabis, CBD, delta-9-tetrahydrocannabinol, THC, pain, chronic pain, pain management

IntroductionCBD oil advertisements are cropping up in window

fronts, convenience stores, video stores, the local gas station, and everywhere that people routinely shop . Amazing results are touted, by manufacturers, from “natural” CBD products and oils . CBD oil is being marketed to those with chronic pain, multiple sclerosis, seizures or epilepsy, anxiety, mental disorders, and a multitude of medical conditions, often those that are chronic . It offers a ray of hope to those who seek a more “natural” remedy and to those who are tired and feel they have few options left .

CBD oil and THC are derived from the same plant . THC is the element that causes a high, or euphoric feeling, while CBD oil typically is considered safe and non-intoxicating . Due to the individuality of plants, it is difficult for manufacturers to standardize the amounts of THC or CBD in over the counter or prescription products, since no two plants are completely identical . This has caused a significant issue with testing of these products in medical studies, as has the issue of legalization of the products in many states or countries .

CBD oil is available in a variety of forms, including oils, tinctures, edibles, gummies, rubs, lotions,

capsules, tablets, and even aerosolized . Dosing is not standardized, and there is no government recommended daily allowance available, so the consumer must either research or believe what is printed on the products or advertisements . This study hopes to shed light on some of the current research being done on the use of CBD oil, in its various forms and combinations, in an effort to educate the consumer and give support to further study in the use of CBD oil for chronic pain .

Several products that combine CBD and THC are available in various countries by prescription . These include Bedrocan (THC/CBD), Tilray (THC/CBD), Sativex (THC/ CBD), Epidiolex (CBD), Dronabinol (THC), Nabilone (THC), as well as several non-medicinal formulations . The majority are derived from the natural plant, but there are synthetic variations available .

Current research studies offer a glimpse into the use of CBD oil as a combination therapy with THC, and a few support CBD oil as a singular, standalone therapy . However, there are few follow up studies available, a lack of legalization of THC or CBD products in many countries, and a lack of standardization in dosing that has caused a delay in studies or prevented them altogether .

An Italian study conducted in 2017 (Fanelli et al .) looked at the treatment of chronic pain in 614 adults, who suffered from a variety of conditions . They used a combination of CBD and THC, in oral and vaporized forms, in patients who were running out of options and had tried numerous therapies and treatments, but with no avail . The inclusion of the CBD oil and THC therapy seemed to serve as an “effective and safe” means of treating chronic pain in this sample .

A separate study by Mondello et al . (2018) looked at an 11-patient sample, suffering from neuropathic pain at a singular Italian clinic, after being diagnosed with “failed back surgery syndrome .” The small sample group had used spinal cord stimulation with little

August, September, October 2020 Nebraska Nurse • Page 11

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success . The inclusion of a combination of CBD and THC greatly improved their pain relief when used as an adjunct to spinal cord stimulation .

A very small study with promising results was completed by Kiefer, D . (2017) . Its focus was on the use of “topical cannabis for wound pain .” The sample size was three and the treatment was an infused sunflower oil and cannabis combination applied topically to wounds . Overall results revealed that the treatment produced impressive results when looking at a decrease in overall pain scores and a decrease in opioid use . This retrospective study seeks to support the thesis statement that cannabidiol (CBD) oil is an effective means to treat chronic pain in adults .

ResultsShould CBD Be Part of My Patients Treatment was

an original research study from Dick Benson (2019) . The objective of this study was to educate the provider or practitioner on the endocannabinoid system, its importance to the human body, and its functioning and maintenance of homeostasis, while discussing various dosages that can be effective for a moderate list of medical conditions based upon research review . He wanted to emphasize the benefits of CBD oil and promote the use of it as a legitimate and legally recognized treatment in the medical community . His research findings validated the importance of the endocannabinoid system to the health of the human body and the use of CBD as an effective treatment or adjunct treatment for pain, anxiety, digestive issues, mood stabilization, and other common patient complaints .

Mondello et al . (2018) completed research on the use of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) of patients with “failed back surgery syndrome (FBSS)” and the treatment of refractory pain . The authors treated the participants with an oral combination of THC and CBD as an effective alternative treatment for chronic refractory pain in patients with FBSS when used as an adjunct to spinal cord stimulation (SCS) . The researchers performed a retrospective study on patients who were treated with a combination of THC and CBD while using SCS for twelve consecutive months, in an effort to diminish/manage pain, improve participants quality of life, and functional ability following the development of a chronic refractory pain condition post back surgery . Findings revealed a significant reduction in pain when compared to the participants initial rating of their pain and functioning with only SCS . This suggested enhanced pain relief, improved function, and an overall improved quality of life for the participant, thus

provided significant support for the use of THC and CBD as an adjunct for pain control .

Effective cannabinoid use for the treatment of chronic pain was explored by Fanelli et al . (2017) through a retrospective study of 614 Italian patients . The focus of the study was to evaluate the use of 9-tetrahydrocannabinol (THC) and CBD use for the treatment of several chronic pain conditions, after the Italian government approved the use of cannabis for legalized use for treatment . A specific pain modality of oral ingestion was the focus, as it was noted that this was the primary treatment prescribed by practitioners . Results revealed that THC and CBD were effective in treating chronic pain, but noted that many patients still continued using their previously prescribed treatment . This would suggest that THC and CBD would be a successful adjunct therapy versus a standalone treatment .

In 2016, a Canadian study was completed and published in the Journal of Pain Research by Ko, G .D ., Bober, S . L ., Mindra, S ., and Moreau, J . M ., that reviewed the barriers and concerns of THC and CBD use in the Canadian healthcare system for the treatment of chronic pain . A systematic review of available research, discussed cannabis, concerns for its use, legalization, prescribing methods, social concerns, availability of various preparations of cannabis, and medical cannabis regulations effecting or influencing Canadian citizens utilizing THC and CBD preparations from a prescribing practitioner . The authors came to the conclusion that with education and evidenced based treatment approaches, practitioners can safely and effectively utilize cannabis, THC, and CBD for the treatment of pain and reduce the use of narcotics .

In November of 2018, “unlicensed cannabis based products” were able to be prescribed in the United Kingdom, as cited in a systematic review completed by Freeman, T . P ., Hindocha, C ., Green, S . F ., & Bloomfield, M . A . P . Six available products authorized in the United Kingdom, were compared based upon prescribing standards, licensed indications, and authorized prescribers . Authors wanted to provide education and discuss the various implications associated with the six drugs with emphasis on use in the United Kingdom, but noted considerations and some comparisons with other developed countries . Much discussion was provided on legal considerations and variation in products, revealing minimal standardization requirements for those products sold over the counter . Results noted that cannabis, THC, and CBD are being used for the treatment of chronic pain, with varying degrees

CBD Oil and Chronic Pain continued on page 12

of success as cited in 14 studies with a total of 2978 participants involving a singular prescribed commercial product containing a combination of THC and CBD (Sativex) .

An interesting, yet very limited research study, completed by David Keifer in 2017, demonstrated the usefulness of a topical cannabis (a combination of THC and CBD) for the treatment of pain in three patients with gangrene . Traditional treatments, opioids, and combinations therapies, had demonstrated little benefit to the patients, so Keifer opted for a non-conventional approach experimenting with new products . Results were found to be significant in two of the three participants, with other benefits noted to be reduced opioid use in two patients . This study was small, but could possibly lead the way for further controlled studies .

The majority of studies reviewed, strongly suggested and encouraged the completion of more randomized clinical trials to be completed distinguishing the effects of THC versus CBD versus other active components of cannabis to demonstrate the best combination for treatment modalities . Several authors noted that due to legal considerations and regulations in many countries, randomized trials and research were difficult to complete . It was felt that without further study, no conclusive dosage, preparation, combination therapy, or evidence could be finalized that best supported the individual patient or treatment of chronic pain .

DiscussionThere is evidence to support that CBD oil is an

effective treatment for chronic pain in adults, however

Page 12 • Nebraska Nurse August, September, October 2020

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CBD Oil and Chronic Pain continued from page 11

not enough was found to support it as a standalone treatment . Most research has been on CBD oil combined with another oil, therapy, or substance, or used in combination with a different treatment regimen . This leads to the evidence more strongly supporting CBD oil as an adjunct therapy for chronic pain in adults .

CBD oil is available in various forms, including lotions, creams, oils, food products, vaporized oils, and oral pharmaceutical variations . There is currently no standardized dosage or one size fits all recommended amount of CBD oil to use topically, orally, or vaporized . CBD oil is extracted from the hemp plant (Cannabis sativa L) . You will not find two identical plants, thus the CBD oil extracted can have various amounts of THC present and other constituents . A limiting factor is if too much THC is present in extracted CBD oil, then it cannot be sold legally in many states or countries, for it would be considered marijuana . This would limit who could or would study it .

Another consideration that still requires further study is the influence of individual human factors and variations on plant factors that can greatly influence or deter the potential benefits of CBD oil . Groups of individuals that participated in the current research were chosen based upon a single disease or condition predominately . Considerations for human factors such as weight, genetics, metabolism, plant factors such as environment, climate, or processing factors such as inconsistent manufacturing practices or processes that go into creating a CBD product were not addressed, thus further limiting support .

Due to CBD oil popularity and “newness,” charlatans and opportunistic salesmen are promoting CBD cure-alls with little or questionable research available for the average person . CBD is proudly advertised at the local drug store, video store, health food chain, and it continues to pop up all over the country . The promise of miraculous cures, and healing properties from CBD infused foods, body products, oils, and numerous other creations, pique the curiosity of the average consumer, and offer hope to the chronic pain sufferer . Yet the

science does not support these products and research is still in its early stages predominately due to legal issues surrounding the THC portion of the Cannabis sativa L plant .

According to GOVERNING, as of June 25, 2019, in the United States, the District of Columbia and 11 states have passed laws into place that legalize marijuana for recreational use . In the past ten years, the United States and many countries, have seen a trend and felt the push, by citizens and consumers, to legalize marijuana and make it available for use by the common man for self-medication and recreation . Prior to this, research on CBD oil was very difficult to complete because it came from the same “illegal” plant known as marijuana, thus was not readily available for study and did not have the funding sources needed to complete studies that would be respected and well received by the medical community .

To sum things up, CBD oil is promising . It has been found to help relieve pain, and various other chronic symptoms in smaller studies for different types of chronic pain in adults . When combined with THC or used as a supportive therapy to an already established treatment, it has proven to be beneficial in helping to diminish pain and improve the functionality and quality of life in adults with chronic pain . It is worth consideration for further study to examine its benefits in larger adult studies, as a standalone treatment, as well as a combination treatment . Once this has been completed, hopefully a standardized dosing system or usage will be approved by the Food and Drug Administration for use to in adults to provide relief for chronic pain in its many forms . Hope for an improved quality of life with less pain is a possibility through the use of CBD oil for adults with chronic pain .

ConclusionsAlternative medicine is still a new and developing

concept to westernized medicine practitioners, but it is making head way in being accepted as a possible treatment for chronic conditions, including adult pain syndromes . With the legalization of marijuana in several states in the United States, and several countries, the use of CBD oil, THC, and cannabis has been a focus in the medical community and public . CBD oil is considered generally safe as an alternative treatment therapy which has promoted its use .

CBD oil is generally combined with THC or cannabis as an alternative treatment modality . Many participants in current studies would continue current treatments

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during the trialed CBD oil and THC or cannabis combined therapy . So, it is unclear if the CBD oil and THC or cannabis combined therapy worked well on its own or had a positive or complementary effect on the current westernized treatment already in progress . The use of a combination therapy of administered CBD oil and THC shows great promise as an effective therapy for chronic pain . However, further research needs to be completed to support the CBD oil/THC combined therapy due to a low number of participants and lack of standardized oils, dosages, and methods of administration . The legal aspects still surrounding marijuana in many countries and states, also greatly limits research . CBD oil is indeed promising, but at this time, the thesis that Cannabidiol (CBD) oil is an effective means to treat chronic pain in adults is not supported as a standalone treatment .

References:Smith, K . (2019) . What is CBD Oil … and why are we talking

about it so much? Environmental Nutrition, 42 (8), 7 . Retrieved from: https://search .proquest .com/docview/2254474489?accountid=158302

GOVERNING The States and Localities (June 25, 2019) State Marijuana Laws in 2019 Map Retrieved from: https://www .governing .com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational .html

Benson, D . (2019) . Should CBD Be Part of My Patients’ Treatment? Alternative Therapies in Health and Medicine, 25 (1), 8-11 . Retrieved from: https://search .proquest .com/docview/2261146571?accountid=158302

Mondello, E ., Quattrone, E ., Cardia, L ., Bova, G ., Mallamace, R ., Barbagallo, A .A ., Mondello, C ., Mannuccvi, C ., Di Pietro, M ., Arcoraci, V ., Calapai, G . (2018) . Cannabinoids and spinal cord stimulation for the treatment of failed back surgery syndrome refractory pain . Journal of Pain Research, 11, 1761-1767 . doi: 10 .2147/JPR .S166617

Fanelli, G ., Carolis, G . D ., Leonardi, C ., Longobardi, A ., Sarli, E ., Allegri, M ., & Schatman, M . E . (2017) . Cannabis and intractable chronic pain: An explorative retrospective analysis of Italian cohort of 614 patients . Journal of Pain Research, 10, 1217-1224 . doi:http://dx .doi .org/10 .2147/JPR .S132814

Ko, G . D ., Bober, S . L ., Mindra, S ., & Moreau, J . M . (2016) . Medical cannabis - the Canadian perspective . Journal of Pain Research, 9, 735-744 . doi:http://dx .doi .org/10 .2147/JPR .S98182

Freeman, T . P ., Hindocha, C ., Green, S . F ., & Bloomfield, M . A . P . (2019) . Medicinal use of cannabis based products and cannabinoids . BMJ: British Medical Journal (Online), 365 doi:http://dx .doi .org/10 .1136/bmj .l1141

Kiefer, D . (2017) . Topical cannabis for wound pain: A case series . Integrative Medicine Alert, 20, (12) Retrieved from: https://search .proquest .com/docview/1978189964?accountid=158302

Teitelbaum, J . (2019) . A hemp oil, CBD, and marijuana primer: Powerful pain, insomnia, and anxiety-relieving tools! Alternative Therapies in Health and Medicine, 25, 21-23 . Retrieved from https://search .proquest .com/docview/2261140637?accountid=158302

Blake, A ., Wan, B .A, Malek, L ., DeAngelis, C ., Diaz, P ., Lao, N ., Chow, E ., O’Hearn, S . (2017) . A selective review of medical cannabis in cancer pain management . Annals of palliative medicine, 6 (Suppl 2), S215-S222 . doi:10 .21037/apm .2017 .08 .05

Cicchi, R ., Sturiale, A ., Nesi, G ., Kapsokalyvas, D ., Alemanno, G ., Tonelli, F ., Pavone, F . (2013) . Multiphoton morpho-functional imaging of healthy colon mucosa, adenomatous polyp and adenocarcinoma . Biomedical Optics Express 4 (7) 1204-1213 . doi: 10 .1364/BOE .4 .001204

Freeman, T . P ., Hindocha, C ., Green, S . F ., & Bloomfield, M . A . P . (2019) . Medicinal use of cannabis based products and cannabinoids . BMJ: British Medical Journal (Online), 365 doi:http://dx .doi .org/10 .1136/bmj .l1141

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Director of Undergraduate Nursing Position

Clarkson College is currently accepting applications for the Director of Undergraduate Nursing position. This position will be dedicated to the Clarkson College campus for all undergraduate nursing programs (BSN, RN-BSN, LPN-BSN). Clarkson College is committed to offering professional advancement for nurses and this position provides that opportunity. The College is looking for a director willing to learn from and work in collaboration with the current nursing administration and will have mentorship from executive leadership in areas of budgeting, employee human resource regulations, accreditation standards, etc. The College is seeking a director also passionate about providing further development to the undergraduate nursing department in areas of assessment, program development, faculty development, and varying student needs. The Director must hold a doctoral degree and nursing license. The application and qualifications are posted here: Director of Undergraduate Nursing Clarkson College.

Additional information about our nursing programs can also be found here: Clarkson College Nursing Program Information. Thank you for your consideration of this position. Clarkson College encourages all qualified employees, who may be interested, to apply. Please feel free to forward this message to any colleagues you think may be interested. Sincerely,Dr. Andreia Nebel, PT, DPT, FNAP Dr. Aubray Orduna, EdD, MSN, RNVice President Academic Affairs Interim President/Dean of Nursing

JOIN NNA & ANA TODAY!

Awards for NNA MembersHear ye, hear ye, you have been summonsed to consider Nebraska nurses, who are

members of NNA, and nominate them for the incredible impact they have had on the nursing profession, the extraordinary achievements they have shown, and/or the impact they have made due to their nursing skills, knowledge, and expertise . Each year NNA sends out a call for nominations; it is now time to seek nominations for the following awards:

• Nurse of the Year• Extraordinary Achievement in Nursing• NNA Award for Distinguished Service

All nominees must be members of NNA in good standing . The nominator must have personal knowledge of the nominee’s abilities and contributions and reflect the information with the focus of the specific award in the nomination letter (self-nominations accepted) . Two letters of support are required with each application – a self-nomination will have three letters (self-nomination letter and two more letters of support) . Please include the nominee’s credentials in the letters of nomination . A curriculum vitae or resume is helpful but not required .

Scholarships for Nursing StudentsCalling all nursing students! NNA also has several scholarship opportunities available for

students pursuing all levels of nursing education . Consider the following scholarships: • NNA Member Scholarship – one $1000 scholarship to an NNA member seeking

higher education• Arthur L Davis – two $500 scholarships for pre-licensure nursing students• Gail Graham Higher Education Scholarship – one $500 scholarship for nurses

furthering their education

Note: The deadline for submitting scholarship applications is September 1, 2020. Access NNA’s website to read more about each award and/or scholarship, and

to retrieve a copy of the awards nomination form (http://www .nebraskanurses .org/awards-scholarships/) .

Please contact Michelle Johnson, PhD, RN, chair of the NPDC, with questions (npdc@nebraskanurses .org) .

Awards for NNA Members &

Scholarships for Nursing Students

• Notable New Nurse• Excellence in Direct Patient Care• Outstanding Nurse Educator

Page 14 • Nebraska Nurse August, September, October 2020

Celebrating the Charge Nurse RoleDavid Foley, PhD, MSN, RN-BC, CNE, MPA

Reprinted with permission from Ohio Nurse July 2020

I recently made a very deliberate decision to take a break from teaching and pursue full-time clinical practice on a busy inpatient unit . My decision to do so was largely rooted in my desire to revisit my clinical skills in preparation for a return to school for advanced studies in nursing . I wish I could report the transition has been easy, but it has not . Some shifts have been exhilarating, especially as I see the principles I teach in class come to life each day: initiating an effective nurse-patient relationship, utilizing therapeutic communication, and witnessing principles of shared governance in action . On the other hand, other shifts have been marred by toxic stress, and I now have deeper insight into the concept that teaching and “doing” are two entirely different things . The work has been physically demanding, as evidenced by the daily loud complaints from my ankles and knees . On several occasions, these physical challenges, coupled with mental stress and hypervigilance, were nearly overwhelming .

After two months and a steep learning curve behind me, I was beginning to feel somewhat comfortable . I honed my time management skills, passed medications using a bar-coded administration system, mastered the electronic medical record’s charting system, and proved myself as an effective member of the interdisciplinary team . All was going well—almost too well . The days continued to be physically demanding but I started to enjoy the freedom of working hard during my defined eight hour shifts and simply being able to leave work at work .

But as nurses well know, that sense of familiarity and comfort can change very quickly . One day I noted an innocuous-looking “CH” after my name on an upcoming schedule and realized that I was assigned to the role of charge nurse . I’m not sure why this surprised me, especially since every other registered nurse on the floor was rotated through this vital role . I had watched my colleagues be “in charge” and watched them deftly navigate the day’s many challenges . I was doing bedside nursing again, but I could never do that…could I? Given my experience in nursing, education, and administration, I instinctively knew I was facing the formidable challenge of being responsible for the first-line operations of our highly dynamic inpatient unit and would be thrust outside of my new, carefully-contrived yet hard-earned comfort zone .

Over the preceding months I had worked very hard to forge collegial, respectful relationships with many of my RN, LPN, and Nursing Assistant co-workers, but had also heard the complaining—and skirmishes—during morning report . How

would I manage the stress of handling the shift assignment and assorted scuffles scattered throughout the day and more importantly, how would being “in charge” affect these highly-valued relationships?

As with facing many other changes in my life, I began with a period of reflection to gain perspective . I worked with each of the staff as colleagues and would not be acting as the Nurse Manager, but rather the daily charge nurse who sat on the front line and in a supportive role . My RN colleagues seemed to make the role of charge nurse seem so easy . I vowed to do my best to fill their big shoes .

I arrived for work early on my first day “in charge .” In true RN fashion, I had taken a blank shift-assignment form home so I could arrive prepared with a draft of the shift’s assignment . I so much wanted everything to go well . I nervously-eyed the communication clipboard and was relieved there were no call-ins…so good . . .I would not have to ‘redo’ the assignment . I was even more relieved when I found out no one would have to ‘float’ to another unit . As most charge nurses know, no call-ins/no floats almost never happens so I considered myself to be very lucky .

But then…As co-workers arrived I was inundated with a barrage of comments like “you

know I only like to take lunch at 12 and now I can’t go with the assignment like this…” and a whispered “you know I don’t like to work with her . . .why did you put me there?” Rather than engage in a power struggle, I asked them to file by and help make the needed changes and we all left smiling–well almost anyway…

I was surprised how the unit looked so different from the charge nurse’s desk . I approached the role with reverence, as I knew from my previous days as a nurse manager starting the day off right was very important . I used to think of it as launching a play in three acts . Act I: morning report to mid-morning, Act II: mid-morning to lunches, and Act III: lunches to end of shift report . Hour by hour, I addressed the day’s challenges including patient requests and complaints, equipment needs, medical provider concerns, work orders, and of course staffing .

I was truly amazed at the intensity required by the role . I looked over at my colleagues busily charting and chatting with each other . They were focusing on providing patient care, pitching issues to the charge nurse desk only when needed . Each RN on the floor was supportive in their own unique way and offered me bits of helpful information during my first day’s baptism by fire . One RN was highly adept at navigating the politics on the floor and gave me much sage advice about how to effectively engage various members of the interdisciplinary team . Another RN had much expertise with making out the daily assignment and her insight made future assignments so much easier . Still yet another seasoned colleague knew every ‘secret’ phone extension in the medical center and was so great at helping me with communication .

And then there was Paul .Paul is one of those RN co-workers who is an outstanding role model for hard

work, collegiality, and quality patient care . Working side-by-side with him on the floor, I grew to highly respect the quiet intensity with which he approached his work and his pursuit of one standard of high quality care for all patients . One day I informed him that I considered him to be a true role model and thanked him for teaching me so much . I told him I really looked up to him and considered him to be a mentor . He seemed pleased but a bit embarrassed by the compliment but I assured him it was offered with the utmost sincerity and respect .

During my first day as charge nurse I don’t know what I would have done without him . Our floor embraces a “working” charge nurse model, meaning the daily charge nurse must assume some duties . I had assigned myself to do the hourly rounds from 1pm-2pm but just as I stood with the rounds board in hand a patient experienced a serious medical issue . As I began making phone calls to request emergency assistance, out of the corner of my eye I saw the rounds boards being whisked off the desk and heard someone say “I’ll cover your rounds” and just like that without any fanfare—and without being asked—Paul added an additional hour of duties to his assignment . It did take the entire hour to resolve the emergency and like magic the rounds board appeared back on the charge nurse desk completed and ready for the next staff member .

I thanked Paul profusely and in his modest style he just waved me away saying it was “no big deal .” It was, however, a big deal to me and in a real ‘note to self’ moment, I vowed to not only repay his remarkable display of collegiality, but to also pay it forward by finding ways of supporting other RN colleagues during their turn as charge nurse .

Over time I started to feel more comfortable in the role and actually looked forward to it . Of course there were still complaints about the daily assignment, challenging patient situations, and dealing with disgruntled members of the interdisciplinary team, but I fearlessly threw myself into the foray and learned to not only cope, but embrace each day ‘in charge .’

That sense of comfort changed, however, with the arrival of the COVID-19 pandemic . During the morning “management huddle,” a daily strategic planning group attended by the charge nurse, the medical director looked at me and said she wanted a number of changes made to the floor’s routine in order to accommodate more effective social distancing for both patients and staff . She gave very little direction other than to say “I’m sure you can do it” and then moved on to the next topic . I paged all staff members to the charge nurse desk and after everyone came to consensus, we rallied to make the needed changes . I must admit I was a bit surprised at how everyone was more than willing to assume the extra duties but in retrospect, I think my colleagues knew making the changes would not only benefit the patients, but staff as well . I was relieved to see Paul was on duty that day and recall how he threw himself into the fray and quickly formed an ad-hoc team with the nursing assistants . So much work—and so many needed changes—were accomplished that day thanks to their collective efforts .

A few days later I was in charge again . As I am sure many of you have experienced in your workplaces, we were notified one of our patients may have

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August, September, October 2020 Nebraska Nurse • Page 15

been exposed to COVID-19 and would need to be screened by the “COVID Team .” I notified the Medical Director and Nurse Manager and was informed someone would need to stay with the patient until the screening was completed and results were obtained . Very quickly a number of staff members appeared at the front desk, some of whom were shaken and nearly tearful . Working in a designated “low risk” area, we had been lulled into a false sense of security and I knew many of the staff were highly concerned about their personal well-being as well as the safety of their families .

I recognized at that moment that the charge nurse does serve in many capacities on the unit . In addition to insuring the mechanics of making the unit run smoothly, the charge nurse also fulfills another equally vital, though far more nebulous role: keeping the unit calm and in good order during periods of crisis . I spoke briefly with the staff present and asked for a volunteer to don a special negative pressure mask and stay with the patient in his room . As if on cue, at that precise moment Paul appeared carrying the device and quietly said he would do it . We had recently received training on the device and I helped him with the assembly and application .

Without further comment, three of us formed an honor guard and silently escorted Paul to the patient’s room . Each hour we asked him if he would like to be relieved and each time he declined . In the meantime, the patient was screened (thankfully negative) and Paul was ‘released’ in time to go home on time .

The drive home that evening was rather somber . That day was so different than many others . Being in charge meant not only coordinating, organizing and obtaining, but now also required communicating, motivating, and allaying… .fear . For so many, especially in Emergency Rooms, Critical Care Units and other “high risk” areas, I imagine being in charge is even far more stressful .

Each time the next staff schedule is released I quickly scan the row next to my name to see which days I have been assigned as charge nurse . Even though I was a nurse manager and administrative director with all associated responsibilities, my office was safely out of reach of the nurse’s station and I frankly had forgotten what it was like to be right there on the front lines handling issues ‘live .’ The added stress of COVID-19 has made the position even more challenging and I have developed so much respect for the charge nurse role and do my best to return the kind, thoughtful support of my colleagues when they are in charge . Moving forward, I encourage you to please also support your daily charge nurse with a sympathetic word, offer of support, or better yet, a cup of coffee .

May we all stay safe… .and be blessed with many “Pauls” in our work lives .

I Give You Permission to Fall ApartSherry Stofko, MSN, RN

Reprinted with permission from Nevada RNformation August 2020 issue

Dear fellow nurse:

I give you permission to be anxious, fearful, angry, broken-hearted . I free you of your unwavering sacrifice, loyalty, grit, and determination . I am granting you liberty to experience your brokenness, exhaustion, overwhelm, and grief . I encourage you to drop into your shadow emotions and to let them out with a death wail or Irish funeral cry in the open Nevada landscape . I give you permission to fall apart .

Our lives took an unprecedented turn in mid-March, one we never anticipated, but certainly now find as no surprise: a respiratory-spread, communicable disease passed effortlessly around our globally-connected world and “suddenly” rocking the human race . How could “we” not have had forethought and been ready for this? Clearly, we were not prepared in any way; we were not equipped with PPE, with governance and policy, or with coping mechanisms . In my 25 years as a hospital-based RN, I have never experienced such widespread risk, fear, uncertainty, misinformation, rapid change, and lack of strong leadership, let alone all of this concurrently . For many, the associated emotional roller coaster involves denial, anger, sadness, isolation, and boredom . For healthcare workers, we have the privilege of adding in several heavier emotions:

• Shock: “How is this happening in the United States in 2020?”

• Betrayal: “They want us to wear the same mask for a week?”

• Envy: “Stop complaining that you’re bored at home when I’m getting pummeled at work.”

• Frustration: “If I get one more 500-word email about another new policy, I might crack!”

• Fear: “What if I bring it home to my family?”• Exhaustion: “I can’t bear to drag myself in there

again tonight.”• Terror: “The nightmares and insomnia are killing

me.”• Grief: “What happened to my old life?”• Guilt: “I wish I could do more.”

All of these reactions are completely normal during a disaster, a global catastrophe, a pandemic, or any crisis event . The issue here is that this is not merely an incident; it’s ongoing with no clear end in sight . Our stress levels, and therefore our cortisol and epinephrine levels, are chronically elevated . We are

living in our sympathetic nervous systems - freeze, fight, or flight . We spend most of our time trapped in a limbic hijack . As nurses, we have no refuge – both work and home are incredibly stressful . It’s during times like these when we discover if our coping mechanisms and resilience are strong enough to withstand the chaos and uncertainty .

And they are . My dear healthcare brothers and sisters, we are enduring . It may not be pretty; in fact, it is probably embarrassingly messy . There should be no shame in it . Times are really tough . Nothing is ideal . But we are enduring . We are fluctuating through the stages of grief and, ever so slowly, we are moving towards acceptance and maybe even finding meaning in it all . During this time, be gentle with yourself . Reach out for help . Finally make that counseling appointment . Find a support group . Journal . Share . Practice self-compassion . Scream out loud in the woods . When I feel emotionally flooded, I find calmness in pausing for a few seconds, then incorporating the acronym “RAIN .” It stands for:

• Recognize what is happening: thoughts, behaviors, emotions .

• Allow the experience to just be there without trying to change anything .

• Investigate what you are feeling with curiosity and non-judgement .

• Nurture yourself with self-compassion and self-care (Brach, 2013) .

Perhaps all this falling apart can help us come together… together with our loved ones, with our co-workers, with other nurses nationally . It is time to prioritize our self-care and strengthen our resilience as nurses and as humans . Now, we ought to finally demand our employers recognize and mitigate the effects of work-related trauma on the mental wellbeing of their employees . We must band together, focusing on what is important in our field: safety, wellness, and solidarity of nurses, which inevitably and undeniably leads to improved safety and wellness of the patients in our care and in our communities .

Let us all give each other permission to fall apart during this time . In the falling, I encourage us to explore ways to cushion the fall . And in our collective falling apart, let us “fall forward together .”

References:Brach, T . (2013) . The RAIN of self-compassion . https://www .

tarabrach .com/wp-content/uploads/pdf/RAIN-of-Self-Compassion2 .pdf

Chisholm, C ., Personal conversation, 5/6/2020Moskowitz, M . (2020) . Emotional world of healthcare

providers . https://www .whiteboardpsychology .com/emotions-of-healthcare

Work That Works for YouColumbus Community Hospital is dedicated to creating a positive work environment that works best for our nurses. And we have the proof to back it up. We were recently designated as a Pathway to Excellence organization through the American Nurses Credentialing Center – recognizing us a preferred employer for nurses.

Come join our team. We’re recruiting full-time or part-time RNs who are licensed in the state of Nebraska. In addition to our award-winning work environment, we offer competitive wages and an excellent benefits package.

Apply online at:columbushosp.org402-562-3363

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