current resident or

Non-Profit Org.U.S. Postage Paid

Princeton, MNPermit No. 14

Start with Heart . . . . . . . . . . . . . . . . . . . . 3

GNA Nursing Practice/Advocacy . . . . . 4

#notonmywatch . . . . . . . . . . . . . . . . . . 6

The Importance of Creating a Search Strategy . . . . . . . . . . . . . . . . . . . . . . . 7

GNA Legislation/Public Policy . . . . . 8

The Power of your Thoughts and Beliefs . . . . . . . . . . . . . . . . . . . . 9

Georgians for a Healthy Future . . . . . 10

The Cost of Retaliation . . . . . . . . . . . . . . 12

Yoga in Nursing – Surprisingly Simple . . . 13

Quick Fixes for Budget-Blowing Mistakes .15

Membership . . . . . . . . . . . . . . . . . . . 16-17

Patient Violence: It’s Not All in a Day’s Work . . . . . . . . . . . . . . . . . . . . . . . 18

Index

Volume 79 • Number 1 • February, March, April 2019

Georgia NursingVisit us online at www.georgianurses.org

“Nurses shaping the future of

professional nursing for a healthier Georgia.”

Brought to you by the Georgia Nurses Foundation (GNF) and the Georgia Nurses Association (GNA), whose

dues-paying members make it possible to advocate for nurses and nursing at the state and federal level.

The Official Publication of the Georgia Nurses Foundation (GNF).Quarterly publication direct mailed to approximately 130,000 RNs in Georgia.

Since 1907

GNA PRESIDENT’S MESSAGE CEO CORNERGNF PRESIDENT’S

MESSAGE

Past, Present, and Future

Richard Lamphier, RNGNA President

As I write this message, the holiday season is upon us and I hope you had a wonderful holiday season .

One of my favorite holiday stories is A Christmas Carol, by Charles Dickens . As your new President, I have thought about the past, present, and future of the Georgia Nurses Association, and what it means to me to be your President .

The Past Presidents have recruited nurses to care for wounded warriors in two World Wars, gathered and packed supplies to send to areas ravaged by natural and manmade disasters, and staffed evacuation shelters for the citizens of Georgia, while worrying about their own families’ safety .

As I think about Present day GNA, I cannot help to think about those other presidents; were they as excited and nervous to start their term?

On November 12, 2018, I became the first male to hammer the gavel and bring the Georgia Nurses Association Board of Directors to order . On that day, I asked the Board for their help .

Now, I am asking for your help . We have an opportunity to build and grow on the strengths and legacies of our past and in order to do that we need you as a member of the Georgia Nurses Association .

Richard Lamphier

GNA President’s Message continued on page 2 GNF President’s Message continued on page 2 CEO Corner continued on page 2

If You Missed the Unity Conference You Missed

Quite an EventCatherine Futch, MN, NEA-BC (R), FACHE

President Georgia Nurses Foundation

The first Unity Conference was held on October 4-6, 2018 . It was co-sponsored by the United Advanced Practice Registered Nurses of Georgia (UAPRN of GA) and GNA/GNF . More than 300 nurses were in attendance . Included were nurses from all walks of nursing life including, but not limited to, Deans, CNOs, Faculty, staff nurses, nurse practitioners and so many more . One of the most satisfying things about the Unity Conference is that we likely had someone from every walk of nursing life together in the same room for all of the joint sessions .

The first day was devoted to Nurse Practitioners who were focused on sharpening or renewing their practitioner skills . In addition, there were two Special Workshops that day . The first was a Lean Sigma Workshop presented by Jarvis Gray, CMQ-OE, PMP . The second was a Mental Health Public Policy session presented by Senator Renee Unterman, a registered nurse . The last two days had content for all as well as content for specialty areas . It was filled with something that would be well received by all who attended .

Catherine Futch

Inspired, Dedicated, and Motivated

Matt CasemanGNA Chief Executive Officer

Inspired, dedicated, and motivated! That is the best way to describe how I feel thus far as CEO of the Georgia Nurses Association and Georgia Nurses Foundation . Over the past several months I have had the privilege to work with an excellent GNA/GNF Board of Directors, along with so many other compassionate and professional nurses .

Two weeks after my start date, GNA and the United Advanced Practice Registered Nurses of Georgia had a successful Unity Conference . It was the first time the two associations partnered together on such a large scale and the behind the scenes work to pull it off was amazing . For those who could not make it, you missed out . The 2019 Unity Conference will be even better! The dates are November 7-9, 2019 .

Two themes come to mind about the energy generated from those jammed packed days . The first of which being there are 140,000 plus RNs in the state of Georgia . Imagine the impact those numbers could have at the Capitol . Additionally, it is critical we speak with one voice . The outside perception from lawmakers is nurses have the numbers, but are not unified at this point to make a difference in the halls of government .

Matt Caseman

Page 2 • Georgia Nursing February, March, April 2019

GEORGIANURSING

Volume 79 • Number 1

Managing Editor: Charlotte Báez-Díaz

GEORGIA NURSES FOUNDATION BOARD OF TRUSTEESCatherine Futch, President

Sarah Myers, Vice President Alicia Motley, SecretaryWanda Jones, Treasurer

Georgia Barkers, MemberRose Cannon, Member Mary Gullate, MemberGerald Hobbs, MemberRachel Myers, Member

Elizabeth “Beth” Bolton- Harris, MemberRichard Lamphier, MemberMaura Schlairet, Member

Dina Hewett, MemberStephan Davis, Member

GEORGIA NURSES ASSOCIATION BOARD OF DIRECTORSOFFICERS:

Richard Lamphier, PresidentVacant, President-Elect

Maura Schlairet, SecretaryDina Hewett, Treasurer

DIRECTORSStephan Davis, Director Leadership Development

Sherry Danello, Director Membership DevelopmentIris Hamilton, Director Legislation/Public Policy

Joanne Parks, Director Staff NurseEdward Adams, Director Nursing Practice and Advocacy

Elizabeth “Beth” Bolton-Harris, Director Advanced Practice Registered Nurse

Catherine Futch, GNF President

ADMINISTRATIONMatt Caseman, CEO

Tim Davis, Director of MembershipCharlotte Báez-Díaz, Communications Manager

Monica R . Dennis, Administrative Assistant W . L . Clifton Political Consulting, GNA Lobbyist

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 . GNF 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 Georgia Nurses Foundation 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 . GNF 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 GNF or those of the national or local associations .

Georgia Nursing is published quarterly every February, May, August and November for the Georgia Nurses Foundation, a constituent member of the American Nurses Association .

GNA/GNF3032 Briarcliff Road, Atlanta, GA 30329

www .georgianurses .org, gna@georgianurses .org(404) 325-5536

FOLLOW GNA@georgianurses

facebook.com/ganurses

@GeorgiaNurses

We need help from the nurses I worked with in Fitzgerald, Georgia . Fitzgerald, were the nurses treated me to some of the best biscuits and preserves a person could ask for . We need help from the nurses I worked with in Dalton, Georgia . The cafeteria at Hamilton Memorial had Sunday dinner that rivaled Mary Macs in Atlanta .

We need help from the nurses I worked with in Savannah, Albany, Columbus, Blairsville, Ringgold, Clayton, and Rome .

We need your expertise, no matter where you use it: from bedside nursing to boardroom meetings, from school clinics to classroom lectures and all the nursing in between . The citizens of Georgia need all of our specialties to join together to catapult our healthcare needs forward . And by unifying all our specialties and subspecialties together, this is how we identify the gaps in healthcare needs .

The Future depends on us . I hope at the end of my Presidency we can look back and see Georgians with increased access to healthcare and the nursing shortage, both at the bedside and in academia, being addressed . I would love to see how the nurses of Georgia worked together to provide “One Voice” to improve health and healthcare for our families, friends, and fellow citizens .

As we enter this 112th year of GNA, we need your help . Let’s take this journey together, so please join me as we continue our quest to move nursing forward and make our voice stronger .

Please go to www .georgianurses .org to join GNA or contact me at president@georgianurses .org or call 678-613-1099 .

In service to you,

Richard Lamphier, RNPresident Georgia Nurses Association

GNA President’s Message continued from page 1 GNF President’s Message continued from page 1

There were keynote speakers like Dr . Linda Burnes Bolton, DRPH, RN FAAN, Dr . Peter Buerhaus, PhD, RN, FACN and Dr . Earnest J . Grant, PhD, RN, RAAN, Vice President, American Nurses Association .

Legislators were there at various times to present their agenda for the coming election and answer questions from the audience . There were breakout sessions as well as presentations for executives with topics including, but not limited to, Transformational Leadership, the Georgia Board of Nursing Compact Licensure & Scope of Practice, Patient Safety and High Reliability Organizations, the Opioid Crisis, An LGBT Panel and a Panel Presentation on Substance Misuse Disorder . There was a Legislative Update regarding the Coalition for Advanced Practice Nurses done by Julianna McConnell, Registered Professional Lobbyist…and so much more .

The Unity Conference Planning Committee is already hard at work planning for the 2019 Unity Conference . I hope each and every one of you will consider joining us next year . If you come, I promise you will leave feeling like you left the Unity Conference with new and/or updated knowledge about a host of topics . We will keep you posted on all of the details of the 2019 Unity Conference . Plan to come . We promise to do our best to not disappoint you .

AMAZINGREMARKABLEAWESOME

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Opportunities for dialysis nurses in Augusta, Athens, Dublin, Ft. Valley,

Forsyth, Louisville, Macon, and Sandersville areas.

Email resume to Deirdra at dwillis@americanrenal.com

CEO Corner continued from page 1

That is changing and GNA, as your professional nurses association, is the facilitator for this unification . Joining forces will allow us to speak as one, and as we do, our voice will get louder and be heard by elected officials .

As I am writing this, the 2019 Legislative Session is fast approaching and GNA is in your corner . Monitoring numerous bills, tracking the complex legislative process, delivering timely reports, and navigating the cavernous halls under the Gold Dome, are our priorities representing you . Rest assured there is nothing more important to me and the GNA team than being a fierce advocate for nursing .

We are also focused on providing opportunities to help you grow professionally and network with your peers . It is our goal to be your go-to choice when seeking continuing education . Scheduling learning opportunities every month in 2019 is a top priority and the GNA team will be working to improve and grow our services in order to meet an ever changing landscape of educational requirements . Be on the lookout for our latest events that provide an excellent opportunity to learn new skills and build solid relationships with your fellow nurses .

Lastly, CNN recently posted a story on a group of nurses who won the lottery, but gave their winnings to two colleagues who needed it more . They decided to give the cash to someone whose 17-year-old son died by suicide the night of the drawing, and whose husband is battling cancer .

I make mention of this story because you and your profession deserve someone in your corner . GNA is your champion and as the new Chief Executive Officer of the Georgia Nurses Association, I am committed to providing you with the representation and services needed to enhance your career .

The dedication I have seen from Georgia’s nurses and the GNA/GNF Board of Directors has been an inspiration . I share your passion, pride and motivation and look forward to serving the nursing community in Georgia .

Please contact me with your thoughts, needs or suggestions at matt .caseman@georgianurses .org .

February, March, April 2019 Georgia Nursing • Page 3

Start with HeartGeorgia W. Barkers, EdD, MBA, MHA, BSN,

RN-BC, NEA-BC

“I expect to pass through this life but once. If, therefore, there can be any kindness I can show, or any good thing I can do to any fellow being, let me

do it now, for I shall not return this way again.” ~ William Penn

The night of November 12, 2018, my ten-year-old granddaughter suffered a burn from a hot glue gun, while working on a school project . The burn was severe enough that we took her to the Emergency Department at Egleston Hospital, Children’s Healthcare of Atlanta (CHOA) . The atmosphere and the staff gave a feeling of calm reassurance . There was a heart for the young patients and their families that could be felt the moment we entered the department and that stayed with us until we left the hospital . I watched the entire event as a grandmother and as a nurse . I was comforted on both levels as I watched a competent team care for my grandchild’s burn, and her spirit . I applaud the nurses and staff of CHOA for caring for both the visible and invisible wounds of a child and her family .

I experienced several positive lessons on attitude and communication during my encounter with this healthcare facility . The heart of this caring place extended beyond the emergency room to the cafeteria, which was open at 1:00 a .m ., for staff and patients . Everyone working in this area was helpful, demonstrating patience and understanding for an obviously injured child and the family . The environment at Egleston reflected an attitude of caring, and each encounter with staff communicated compassion . I have no connection with CHOA or its orientation, training or personnel policies but, my impression is that they care for their staff and this allows and encourages everyone to focus on patients and family… It starts with heart . I may be wrong about organizational policies, but the heart of the staff remains obvious in their behaviors, and reflects a commitment to competent, compassionate and quality care . Attitudes reflect the heart, and whether spoken or not, communicate underlying motives .

Nurses are known for honesty, compassion and patient advocacy, yet we hear of bullying and incivility within our own ranks . The challenge is to overcome the obstacles that often serve as barriers to showing our best selves, such as, on the job time pressure, difficult assignments, stressful situations, difficult co-workers, suffering patients and families . Couple all of this with personal lives that often come with complications and issues of their own . The place to start is with your own heart, knowing what you really want from your interactions with others and evaluating if your behaviors are a true reflection . The environment may not support your best intentions, but you must stay focused on what you want to project and refuse to become a victim of someone else’s poor behavior .

Not every work environment is supportive on a macro-level, but each member of the team contributes to the goals on a micro-level . It is much easier to blame the system or someone else for undesirable results, but each person must look at the contribution he or she makes . Whether you are new on the job or a seasoned employee, everyone benefits from a supportive, nurturing environment and quality care is the result . You cannot change the thoughts and actions of another person, only he or she can make that change . But you may influence another through your actions and that is something completely under your control . To change your actions, change your attitude .

A few helpful tips to consider as you think about your career and personal life are:

1 . Start with heart…know your desired results .

2 . Take responsibility for the results you are getting .

3 . Refuse to be a victim .

4 . Take action that moves you in the direction of what you want .

5 . Listen to others for understanding .

6 . Model the behavior you would like to see .

Consider the words of Viktor  Emil  Frankl  (26 March 1905 – 2 September 1997), an Austrian neurologist and psychiatrist, as well as a Holocaust survivor and founder of logotherapy . 

“When we are no longer able to change a situation, we are challenged to change ourselves. Everything can be taken from a man but one thing, the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

Georgia W . Barkers, EdD, MBA, MHA, RN-BC, NEA-BCSenior Consultant The Attitude Nurse, LLCEmail: theAttitudenurse@gmail .comPhone: 478-521-9510Website: TheAttitudeNurse .com

Georgia W. Barkers

You Can Meet a Need!

GNA is looking for volunteers for several positions.

If you’d like to meet the need, please complete the

form on page 4 and mail it to:

Georgia Nurses Association3032 Briarcliff Road NE

Atlanta, GA 30329

Or visit:http://www .georgianurses .org/page/VolunteerInterest

DREAMS. MADE REAL.

PROGRAMS: RN-BSN Completion: Dr. Jennie BergenMaster of Science in Nursing With FNP Focus: Dr. Grace NteffFor more information: Contact Christy Hicks(678) 466-4901 • ChristyHicks@clayton.edu

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Page 4 • Georgia Nursing February, March, April 2019

GNA NURSING PRACTICE and ADVOCACY UPDATEEdward Adams, MSN, RN

GNA Director Nursing Practice & Advocacy

Over the last few months, I have began to think about what it really means to advocate, as this is part of the role of my position on the GNA Board of Directors . I am reminded of one of my favorite quotes, “Be the change you wish to see in the world,” that was said by Mahatma Gandhi . As advocates, we are truly trying to create a change that we want to see in the world .

In nursing school, many of us were taught to advocate for our patients by our professors . However, I truly believe that we need to advocate for more than our patients . We need to advocate for the families of our patients, we need to advocate for our communities and we need to advocate for ourselves as nurses and for our colleagues in healthcare . Some of my colleagues’ advocate on a national and state level for various things they are passionate about . Some advocate for nursing staff ratios for patient safety, some advocate for access to healthcare in underserved areas, and

others advocate for those that are abused in the sex trafficking trade .

Some are advocating a new Unity Movement that all nurses need to remember that regardless of our credentials and specialties we are all nurses . This movement has led to a state level conference in 2018 and in 2019 it is planned to grow into a regional conference . I know many that are reading to this point are saying “This is wonderful, but I do not want to do things on a national or state level .” I agree that advocating on the national or state level is not for everyone . However, I would also suggest that it is possible to advocate on a more local level and still have a meaningful impact .

One of the nurses that I have the pleasure of knowing is Anna . She works as a PCU nurse and is a very good nurse and preceptor at her facility . She is also very passionate about advocating for the patients in her facility that are admitted with D .K .A . I was lucky enough to have a wonderful conversation with Anna, along with a few other colleagues, as she was advocating for the needs of DKA patients . She asked a question that was very important to have a good conversation regarding change . Her question was simple but powerful: “Do you understand what I am saying?” She wanted to make sure that everyone in the conversation were on the same page . This is important when advocating because you want to make sure your audience understands the points being made and can

ask clarification questions . Anna was advocating for a possible updating of a policy/protocol that could use some review .

Another nurse I am happy to have met and am getting to know better is Gia . Gia is a fellow ICU nurse and works on her unit’s Unit Council . She will come in on her days off to work with other members of the Unit Council on issues that relate directly to her unit . Some days they will work for eight or ten hours on their days off on ways to improve the unit . Gia is the person responsible for writing up the minutes of all their findings, suggestions for change in resources and protocols, and ideas to help nurses do their work better . Gia advocates for what her unit needs and is very vocal about wanting to hear from her peers about what is needed . She wants to involve everyone in her unit to try to give them a voice in the changes that occur .

I am very glad that both Gia and Anna allowed me to use them as examples that advocacy occurs at many levels . Both of these wonderful nurses are making a change in their “world” by using their talents and their voice to help others . While some are called to advocate at the national and state level, we can all advocate on a local level that goes beyond our patients, while not forgetting to advocate for them . As we start the new year, I encourage everyone to find where your passion is and find a way to be the voice that helps create the change in your world .

Edward Adams

Highlights of the 2017 National Nursing Workforce Survey

Janice J. Izlar, DNAP, CRNAPresident, Georgia Board of Nursing

janiceizlar@gmail.com

Since 2013, the National Council of State Boards of Nursing (NCSBN) and The National Forum of State Nursing Workforce Centers (Forum) have partnered to conduct a biennial national survey of nurses looking at characteristics of the nursing workforce . It is the hope to use the data to guide policy makers and leaders in nursing education and practice to assist in workforce planning . The results should provide evidence for decisions impacting the future of nursing . For the purpose of this article I will highlight a few of the results .

The survey found that 14 .6 percent of the RN respondents were 65 or older, an increase of 2 .2 percentage points over the 2015 findings . This may indicate a growing number of registered nurses nearing retirement . Additionally, 13 .2 percent of the LPN respondents were 65 or older, an increase of 3 .2 percentage points from the 2015 survey . This may signify an even larger growth in the number of LPNs nearing retirement .

In 2017 the trend toward a higher percentage of respondents pursing a Bachelor of Science in Nursing (BSN) degree as their prelicensure education path continued with 41 .7 percent of RNs reporting pursuing a BSN prior to licensure . This demonstrates a 2 .7 percentage point increase compared to 2015 and a 6 .2 percentage point increase compared to 2013 . Interestingly, the study found the number of RNs with a master’s degree in nursing has increased from 13 .8 percent in 2013 to 17 .1 percent in 2017 .

Hospitals were the primary employment setting for 55 .7 percent of RNs reporting in 2017 . This represented a slight increase compared to 54 .4 percent in 2015 but a decrease from 2013 when 56 .5 percent reported hospitals as their primary employment setting . Ambulatory care setting was the second most frequently reported primary employment setting for RNs with 9 .4 percent . Nursing home/extended care facilities was next (4 .8 percent) followed by home health (4 .3 percent) . Of note, for LPNs nursing home/extended care facilities was reported as the primary employment setting by 31 .6 percent, followed by home health settings (15 .0 percent) and hospitals (9 .0 percent) . The trends for RNs and LPNs primary work setting are consistent with the 2015 survey results .

Over half (54 .1 percent) of RNs and LPNs reported providing nursing services using telehealth technologies . These services were provided across a state border in 45 .7 percent of RNs and 44 .1 percent of LPNs . This is a significant increase (RNs 6 .3 percentage points and LPNs 10 .3 percentage points) compared to 2015 results of nurses providing services using telehealth technologies across state borders .

Overall, the survey results lay out the expectation that the nursing workforce of tomorrow will be slightly younger, highly educated, with higher numbers providing primary healthcare in the community and using technology and telehealth as a means to deliver health care . Additional details on the findings from The 2017 National Nursing Workforce Survey can be found in the Journal of Nursing Regulation Vol . 9, Issue 3, October 2018 Supplement Pages S1 – S88 .

First Name: ______________________________________ Last Name: __________________________________

Phone Number: __________________________________ E-mail Address: ______________________________

Address: _____________________________________________________________________________________

City: ______________________________________________ State: _______ Zip code: ___________________

Current Membership (Please select one): Full ANA/GNA State (GNA Only)

State Level Committeeso Bylaws/Policy - Responsible for the review/

revision of association bylaws & policies .o Finance - Responsible for the oversight of the

association’s budget development and finances .o Elections - Tabulate and report ballot results to

the biennial Membership Assemblyo History - Writing the history of GNA during the

current term then approved by Membership Assembly

o Peer Assistance Program (GNF-PAP) - Coordinate services for drug & alcohol dependent nurses .

o GN-PAC Board of Trusteeso GNF Board of Trustees

Ad Hoc Committeeso Nursing Practice & Advocacyo Legislation & Public Policy - includes Committee

on Legislationo Leadership Development

GNA Representation to Other Organizationso GNA Liaison to the Georgia Association of

Nursing Students (GANS)o GNA Liaison to the Georgia Association for

Nursing Education (GANE)

Other Volunteer Interests:

Background InformationMajor clinical, teaching, practice or research area:

Education (highest degree earned):

Current Employer:

Current title/position:

Brief description of responsibilities and work setting:

Have you ever served at the GNA STATE LEVEL?o Yeso NoIf yes, please list office and years served:

Have you ever served at the GNA CHAPTER LEVEL?o Yeso NoIf yes, please list office and years served:

Have you served in OTHER ASSOCIATIONS (specialty nursing organizations, state or national)?o Yeso NoIf yes, please list office and years served:

Involvement in community, state or national healthcare issues (Please be specific)

CertificationI understand that GNA policy requires that

no office or director of the Board or appointed Committee Member shall serve concurrently as an officer or director of a board of another association or body if such participation might result in conflict of interest to GNA or the individual as determined by the Board. I also understand that I may be requested to provide the GNA Board of Directors with additional information.

I authorize GNA to include my name, home address, cell phone and e-mail address on rosters if elected/appointed.

I certify that my signature below indicates my consent to serve, if elected or appointed, and that, in accordance with the above referenced GNA policy, I do not hold membership on a board of directors or other governing body of any other organization which could result in a conflict of interest.

I certify that the information on this form is true and accurate to the best of my knowledge.

Nominee’s Signature: ________________________

Date:____________________

Volunteer Profile Form

February, March, April 2019 Georgia Nursing • Page 5

Increasing Advocacy and Engagement of Georgia Nurses in Policy

Desireé Clement, DNP, APRN, CNM, FNP-BC, Helen Baker, PhD, MSc, FNP-BC,

Jennifer Vanderlaan, PhD, MPH, CNM and Priscilla Hall, PhD, CNM

(All authors are faculty members in the Nell Hodgson Woodruff School of Nursing, Emory University; we

received support for this article through the Thought Leader Fellowship at the Institute for Developing

Nations at Emory University)

In the last two years, nurses in Tennessee and South Carolina have successfully expanded their scope of practice and altered their collaborating relationships with physicians . Nurses in Massachusetts placed a measure on the midterm ballot to force limits on nurse-patient assignments . How did these nurses accomplish these changes? By engaging with their state legislature .

To be effective, nurses need to get to know legislators not only during the legislative session (January through March in Georgia) but more importantly throughout the year . In addition to local representatives, nurses should be in contact with legislators on the Health and Human Services Committees . These two committees have general authority over passage of most health-related policy within Georgia, including regulations related to nurse licensure, scope of practice, health care access, and protecting patient safety (Georgia House of Representatives Committees, 2018; Georgia State Senate Committees, 2018) . Currently, the HHS House

of Representatives committee consists of 36 legislators, led by Rep . Sharon Cooper, and 15 legislators in the Senate HHS committee, led by Sen . Renee Unterman (Georgia State Senate Committees, 2018) .

As nurses, we have an obligation to advocate for our patients – this includes advocating at the polls and through political engagement . Nurses make up 1 .8% of registered voters in Georgia (KFF, 2018; Niesse, 2018) . We need to make sure our voices are heard . Here are helpful links for increasing nursing engagement:

• ANA Nurses Vote pledge: https://p2a .co/zLHT16T• Register to vote/check your voter registration:

https://registertovote .sos .ga .gov/• Find out where and when you can vote (take

advantage of early voting!): https://www .mvp .sos .ga .gov/ o Make a voting plan and talk about it to your

family, friends, and colleagues . • Track legislation through Georgia General

Assembly: http://www .legis .ga .gov/Legislation/en-US/default .aspx

• Stay up to date with legislation and initiatives impacting Georgia nurses .o Georgia Nurses Association: https://www .

georgianurses .org/page/LegislativeUpdate o Coalition of APRNs of Georgia (CAPRN): http://

caprn .org/o Federal level: https://ana .aristotle .com/

SitePages/issues .aspx (nursing and health care) or https://www .govtrack .us/ (general)

• Find your elected officials: https://openstates .org/find_your_legislator/ or https://www .usa .gov/elected-officials o Contact your elected officials to let them

know what is important to you – share stories to illustrate why you care about these issues; follow them on social media .

• Nursing Now Global Campaign: https://www .nursingnow .org/o To learn about ways to increase the profile and

status of nursing worldwide .• Join nursing organizations to stay informed and

engaged .

Nurses also advocate by engaging with legislators to assist them with changes to policy that positively impacts nursing . The Kingdon Model of Multiple-Streams Framework describes how three streams must align to create a window of opportunity for legislative changes to occur . These are labeled as the Problems, Policy, and Politics streams (Kingdon, 2010) . The Problem Stream consists of currently identifiable issues within Georgia that have impact on nursing and healthcare delivery such as limited access to care,

an aging population with increasingly complex needs, nursing shortage, worsening maternal mortality rates, and restrictions on APRN scope of practice (Georgia Senate Research Office, 2007; Xue et al ., 2016) . The Policy Stream includes developing strategies to assist with setting the policy agenda such as removing barriers on APRN scope of practice to improve access to care, ensuring adequate nursing staffing ratios for safety, and incentivizing clinical preceptorship .

These solutions would help with closing gaps in healthcare delivery like increasing access to primary and prenatal care, which can result in increasing health promotion to improve health outcomes (IOM, 2010; NCSBN, 2016 .) . Lastly, the Politics Stream describes a set of circumstances such as optimal time and supportive legislative landscape that allows for favorable policy change . Once all of these streams converge then it creates a window of opportunity to move forward on these necessary legislative changes (Kingdon, 2010) .

Finally, nurses need to be leaders and engage within the community . Volunteer at local, regional, national, and international organizations . If you teach nurses, consider including advocacy and engagement as part of your classes . We must make sure our future nurses know its importance; start this process early and often . If you are working in a health facility, promote engagement, and support them in any way you can . To conclude, think about running for elected office because when nurses lead, patients win .

ReferencesInstitute of Medicine of the National Academies [IOM] .

(2011) . The future of nursing: Focus on scope of practice . [Report Brief] . Washington, DC: National Academy of Science . Retrieved from http://www .nationalacademies .org/hmd/~/media/ Files/Report%20Files/2010/The-Future-of-Nursing/Nursing% 20Scope% 20of%20 Practice%202010%20Brief .pdf

Kaiser Family Foundation [KFF] . (2018) . The Kaiser Family Foundation: State health facts, total number of professionally active nurses. [Data Source] . Retrieved from https://www .kff .org/other/state-indicator/total-registered-nurses/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Niesse, M . (2018, October 10) . Record numbers register to vote in Georgia before election . The Atlanta Journal-Constitution. Retrieved from https://www .ajc .com/news/state--regional-govt--politics/record-numbers-register-vote-georgia-before-election/15TTli3vRINYVWfqMtFK7O/

National Council of State Boards of Nursing [NCSBN] . (2016) . A changing environment: 2016 NCSBN environmental scan . Journal of Nursing Regulation, 6(4), 4-37 .

Xue, Y ., Ye, Z ., Brewer, C ., & Spetz, J . (2016) . Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review . Nursing Outlook, 64(1), 71-85 . doi: 10 .1016/j .outlook .2015 .08 .005

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Page 6 • Georgia Nursing February, March, April 2019

#notonmywatch: An Atlanta Nurse Leader’s Frustration withMaternal Mortality

Rose L. Horton, MSM, RNCExecutive Director Women & Infant

Emory Decatur HospitalRose.horton@emoryhealthcare.org

“Mothers, the newborn and children represent the wellbeing of a society and its potential future. Their health needs cannot be left unmet without harming the whole of society.” John-Wook .

I absolutely love this quote . It was written in 2005 and was the preface in the book Deadly Delivery . The book focuses on the tragic trend of maternal mortality . What was worrisome in 2010 has become a national concern and the shame of the US healthcare system . How did this happen? And why aren’t more people outraged?

The headlines are everywhere, pervasive, captivating, shocking, and alarming . Here are a few: “Nearly Dying in Childbirth: Why Preventable Complications are Growing in the US;” “Maternal Mortality is the Shame of US Healthcare .” Here is another, “The Disturbing, Shameful, History of Childbirth Deaths;” “How Racism may Cause Black Mothers to Suffer the Death of their Infant .” Do you agree that the headlines are compelling? Absolutely!

Allow me to give you a back story to my personal frustration . I worked as a Labor & Delivery nurse right out of college . To say that helping women and families during the birthing process is my passion would be an understatement . Best . Job . Ever . I felt incredibly privileged that women allowed me to be a part of one of their most memorable life events . I loved supporting women, encouraging, coaching and advocating for them . The joy that mom and her partner experienced at the first glance of their baby is amazing and indescribable .

I was asked to speak at an event this year . In preparing for my speaking engagement and doing some research, it occurred to me that women are facing significant crisis during pregnancy, labor and childbirth . Maternal mortality is not a new problem .

There are documented cases dating as far back as the 1800s . There are risks associated with pregnancy and birth, though a normal physiologic state . What is troubling is the rate and trend of morbidity and mortality . An estimated 700 women die every year during or shortly after childbirth . “Women in the United States are more likely to die from childbirth or pregnancy related causes than in women in any other high income country, and black women die at a rate three to four times that of white women .” (Mann, Hollier, McKay, & Brown) As I worked on my slide deck I had an epiphany: this cannot continue . This is not sustainable . Women should not die from preventable causes! That is when I coined the hashtag #notonmywatch . It was an emotionally charged moment for me, one with clarity and purpose .

Following that presentation, I had a meeting with my leadership team and I shared the slide deck along with my hashtag . I asked my team to make the same commitment to help mitigate maternal mortality and they did . This led to a deep dive of our processes within the women & infant service line . We had already made the commitment to be evidence based in our care and this new commitment was well aligned . What did the data reveal and how can we implement these changes and create buy in with our nurses and providers?

Rose L. Horton

I am happy to report that we are moving in the right direction . We are using the Association Women’s Health Obstetrics and Neonatal Nursing (AWHONN) Post Birth Warning Signs . We are also using the Alliance for Innovation on Maternal Health (AIM) safety bundles focusing on HTN and PPH . We joined the Georgia Perinatal Quality Collaborative (GaPQC), a group of over 45 hospitals using safety bundles, sharing data and outcomes . We took the Implicit Bias Survey (Implicit .harvard .edu) to learn about our own biases .

What I know for sure is that nurses have the ability to change the trajectory of maternal mortality. It is within our bandwidth . Nurses are the most trusted professional and have been for over a decade based on Gallup Polls . Let’s make Georgia’s birth outcomes as good if not better than California . Nurses, I implore you to partner with me and commit to decreasing and mitigating maternal morbidity and mortality . #notonmywatch

References1 . Deadly Delivery: The maternal health crisis in the USA

(2010) Amnesty International2 . Mann, S ., Hollier, L . M ., McKay, K ., Brown, H . What We

Can Do About Maternal Mortality – And how to do it quickly . N ENGL J Med 2018; 1689-1691

To access electronic copies of

Georgia Nursing, please visit

http://www.nursingald.com/publications

February, March, April 2019 Georgia Nursing • Page 7

The Importance of Creating a Search StrategyGloria Nunn, Ph.D., RN, CMSRN

Research EvidenceThe use of research

evidence is often taken from a clinical protocol that has been developed from several studies and practice guidelines that are research-based . Studies that use several findings provide the best results for scientific and clinical knowledge (Brown, 2016) . Elements that produce the best results are from those gathered from clinical expertise, which often occurs through research that has been conducted, developed and refined to enhance understanding of clinical issues . The research-practice connection is used to progress knowledge from limited certainty to more certainty . Healthcare providers use research evidence in the delivery of care (Brown, 2016) .

Polit and Beck (2017) state that it is essential to think in terms of the threat to validity in the process of interpreting the results as a characteristic of valid research . Both the internal and external validity must be satisfied for research to be accurate . With internal validity, the results are based on the legitimacy of the study . The way the data is selected, recorded or analysis performed impacts the outcome . External validity of a study focuses on the transferability to another group . With validity, there must be an integration of multiple sources of evidence .

Critical AnalysisThe critical analysis of literature by healthcare

providers may entail classification, comparison, and summary of previous research studies . This iterative process has led to identifying gaps in the literature and published evidence (Pryce-Miller, 2015) . Pryce-Miller (2015) states that the intent of a systematic review is to create guidelines that are based on experts in the field, which will improve better collaboration and clinical decisions among healthcare providers . Systematic studies are essential to evidence-based practice because it relies on the integration of research

evidence . It is a process by which information is developed, tested, and adhered to in specific protocol with guidelines for gathering data to support questions (Polit & Beck, 2017) . Articles should be evaluated for the following criteria: the purpose of the study, the sample, the measurement tool, the methodology, the research design, the results and findings, the analysis outcomes, and the limitation and discussion .

Peer-review and Clinical GuidelinesPeer-reviewed means that two or more experts on

the subject matter critique or assessed the article to locate the weaknesses and strengths of the research (Polit & Beck, 2017) . A comprehensive analysis entails the theoretical aspects, methodologic discussion, ethical issues, interpretation, and the presentation of the report . This form of critique is to cultivate critical thinking in the researcher .

Clinical practice guidelines represent efforts to extract evidence into manageable forms . The guidelines are usually based on a systemic review that support evidence-based decision-making . Clinical practice guidelines are intended to influence clinical practice and address issues related to a clinical decision . Whereas systemic reviews are evidence-based, practice guidelines are necessity-driven meaning they are developed to guide the practice of healthcare providers . The development of guidelines usually involves the consensus among health care providers

to include researchers, experts, and clinicians (Polit & Beck, 2017) .

Characteristics of a Clinical Question that is Answerable

The characteristics of a clinical question that is answerable to research evidence are one designed using the PICO question framework . According to Polit and Beck (2017), the research question should include the population, intervention, comparison, and outcome (PICO) . Davies (2011) states that it is the question that drives the research and thus the evidence . A challenging aspect of evidence-based practice lies behind the question and locating the relevant answers to the question . A clearly defined question is the roadmap to gathering relevant answers . The PICO framework for developing questions helps the researcher focus on key elements .

ReferencesBrown, S . J . (2016) . Evidence-based nursing. Retrieved from

https://ebookcentral-proquest-com .library .capella .eduDavies, K . S . (2011) . Formulating the evidence based

practice question: A review of the frameworks . Evidence Based Library and Information Practice, 6(2), 75-80 . doi:10 .18438/B8WS5N

Pryce-Miller, M . (2015) . Using systematic reviews to inform nursing practice . Nursing Standard (2014+),  29(52), 52 . http://dx .doi .org .library .capella .edu/10 .7748/ns .29 .52 .52 .e9296

Gloria Nunn

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Page 8 • Georgia Nursing February, March, April 2019

GNA LEGISLATION/PUBLIC POLICY UPDATE

Iris Hamilton, RN, MPAGNA Director Legislation/ Public Policy

On behalf of the Georgia Nurses Association, I am honored to serve as your Director of Legislation/Public Policy and I’m very excited about the 2019 Legislative Session! As a member of the Georgia Nurses Association Board of Directors, I am the chairperson of the Legislative committee and I guide the legislative efforts of the Association as directed by the GNA Membership Assembly and the Board . I am here to advocate for you as you advocate for your patients, families, communities, and other groups . 

I encourage current members to stay engaged and encourage potential members to consider joining . For both current and potential members, think about these questions - What is your commitment to your professional association? How can your skill set, your leadership style, and your power potential, working collaboratively through GNA, enable nurses to lead change to advance health? What will prompt you to be involved? How can the GNA Board assist you in moving our profession forward?

Why should nurses get involved in advocacy? We are the largest segment of health professionals four million RNs in the United States and over 150,000 nurses in the great state of Georgia . For 16 years, Gallup poll reports nurses are the most honest and ethical profession . Policy makers’ expectations same as public and believe we are the experts . Elected officials care because you have the power of the vote . Without input from constituents, leadership alone can determine whether a bill moves out of committee for a debate and vote on the floor .

Every legislative session, numerous bills are introduced at the State Capitol that directly affect the nursing profession . Tracking the complex legislative process, providing you with timely reporting on bills and determining who under the Gold Dome to speak with regarding some of our top priorities . As we head into the 2019 Legislative session, there is nothing more important to me that GNA than successfully advocating on your behalf . 

As always, I value YOUR input . As a continuing or potential member of the association, you do and can enhance the visibility and productivity of our work . Your personal skills and energies can make a difference . One of my personal goals is to connect with at least one nurse in each of Georgia’s 159 counties . My vision for the Legislative committee is to develop a network of nurses across the state for advocacy and collaboration on issues or legislation that is important to Georgia nurses and nursing practice . Please consider volunteering on the GNA Legislative Committee by completing the volunteer form on our website .

For more information, contact GNA Headquarters at 404 .325 .5536 or visit our web site at www .georgianurses .org .

Please let me know how I can help you to be involved . Be a part of GNA’s unified voice! I can be reached at hamilton .iris@yahoo .com .

As the most trusted and largest sector of health professions in the U .S ., registered nurses must have a voice in influencing the profession and health care . To that end, the American Nurses Association (ANA) is committed to growing nurses’ political leadership skills formally and informally through the American Nurses Advocacy Institute (ANAI). Launched by the ANA in 2009, the program grooms each nurse to ultimately be an effective advisor to their state nurses association in establishing legislative / regulatory priorities, recommending strategies for execution in the advancement of a policy issue, and educating colleagues about the political realities and how they too can be more effective advocates . The program is competitive, capped at 24 participants, so each individual can benefit optimally from the interactive sessions held in Washington, DC, September 30-October 2, 2018, as well as the ongoing mentoring support throughout the year . Not including the current cohort, 206 nurses have participated in the program, representing 42 states .

American Nurses Advocacy InstituteIris Hamilton, RN, MPA

GNA Director Legislation/ Public Policy

The 2018 – 2019 class of 23 represented 18 states – AZ, CO, GA, IL, IA, KS, MA, MI, MO, MT, NH, NV, NM, OH, SC, SD, TX, and WV .

While in DC, nurses hear from influential nurse leaders such as long-standing Minnesota House Representative who campaigned for Governor this year, Erin Murphy, MA, RN, FAAN; Mary Behrens, MS, RN FNP BC former Wyoming Mayor and State Legislator; and Dr . Irene Trowell-Harris, RN, Ed .D . Major General USAF, Retired, the former Director of the Department of Veterans Affairs Center for Women Veterans . Attendees learned about navigating the legislative process based on the political environmental scan and messaging for differing audiences, from leaders in the public relations arena . Application of some of these acquired skills is first exercised with visits to Congressional Offices . The learning continues throughout the year with discussion of other related topics and the ability to apply at the state level .

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February, March, April 2019 Georgia Nursing • Page 9

The POWER of YOUR THOUGHTS and BELIEFS

Sharon Reynolds, ND, RNSpeaker/Educator/Facilitator

“You don’t get what you wish for. You don’t get what you hope for. You get what you believe.”

~ Oprah Winfrey

“If you think you can do a thing or think you can’tdo a thing, you’re right.”

~ Henry Ford

Your thoughts and beliefs drive your life . They influence how you perceive your life and what happens in your life . Does every thought become a reality? No, of course not . If that were true, most of us would be millionaires . However, repeated thoughts have enormous influence over what happens . And our beliefs definitely affect our lives in major ways – whether we know we have that belief or not .

Your repeated thoughts and beliefs drive your life . They influence your perspective, perceptions, choices you make and then, what happens in your life . Often, they are unconscious, but they are still very powerful and, if they are negative, have a negative effect .

We tend to interpret events according to our usual perspectives and beliefs . Many do not realize this . Often, it’s more about our perspective about what is happening, rather than an objective reality of the positive or negative qualities of it .

It’s important to become aware of unhelpful beliefs, thoughts, and perspectives because they can prevent us from accomplishing our goals .

This is also why affirmations sometimes don’t work . If you’re telling yourself something that you don’t believe, it will not happen because your inner voice will say “no, it won’t,” “no it isn’t” and that is what you will believe and that will determine your results .

To overcome this, look for objective evidence supporting your assumption (belief) . If you can’t find any, you know your belief is false . Find a way to phrase your affirmation in a way that does not conflict with your belief while still helping you achieve your goal . Emile Coue’s affirmation is a great example: “Every day, in every way, I’m getting better and better .” That is powerful because it is general, positive and believable to most people .

Changing your thoughts, beliefs and perspective might take some time . You may need to move in

steps . Pay attention to your thoughts throughout each day . Plan ahead what phrase you will use to replace unhelpful thoughts so that when they occur, you can immediately and automatically replace them . Over time the new thought will replace the old, unhelpful one .

Look for objective evidence to support your desired belief . Even very small bits of evidence count . Keep your focus on them . You can train yourself to look for them and then you will notice more and more evidence that your belief is correct . Eventually, it will become automatic .

Much of our reaction has to do with our personal perspective and interpretation of a specific event or situation . If you are in a situation you don’t like and can’t avoid or change, write down in two columns what you like and don’t like about it . Then, make a third column of positive interpretations of the statements in the “don’t like” column . This may not be possible for everything, but is often possible for much of it . (Think of how different nurses “love” or “hate” working in different departments . Example: “I hate how much picky detail and precision is required in what I’m doing .” Positive statement: “Being precise and attentive to detail prevents errors causing serious harm to my patients .”)

Obviously, these are not objective assessments . It is all about perspective and interpretation . Then, concentrate on the positive interpretations . It can make difficult situations much easier to cope with .

There are several other exercises and techniques that are effective in enabling you to make desired changes . Changing your perspective, beliefs and thoughts can dramatically change your life .

If you have any question or comments, please contact me at:

SReynoldsAtl@gmail .com404-374-1577https://www .linkedin .com/in/sreynoldsatl

Sharon Reynolds

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Page 10 • Georgia Nursing February, March, April 2019

GEORGIANS FOR A HEALTHY FUTURE

Every Story Matters: Lifting the Voices of Georgia Health Care Consumers

This week Georgian for a Healthy Future (GHF)’s Outreach and Education Manager, Alyssa Green, takes some time to share her experiences and reflections from traveling across Georgia to collect consumer stories. As the Outreach and Education Manager, I am tasked with the responsibility of traveling around the state to collect consumer stories.

My travel and conversations with consumers provides a wonderful opportunity to better understand the health care issues many Georgians face. This past year, I’ve been to many Georgia communities and one place that has had a particularly significant impact on me has been Clay County.

Located in the Southwest region of the state, Clay County has one practicing physician, Dr. Karen Kinsell. Dr. Kinsell is a volunteer physician who provides medical care to approximately 3,000 patients in a small office building in that once served as a Tastee Freeze stand. There is a liquor store next door where patients have been known to buy alcohol while waiting to be seen.

Rural areas of the state have struggled economically for years, and Fort Gaines, the county seat, is no exception. Since 2013, two nearby hospitals have closed, the county has seen an exodus of physicians and other providers, and this year, the county’s only pharmacy closed. As a result, Clay county residents have increasingly had to seek treatment outside of their community, forcing them to travel more than an hour in one direction for doctor’s appointments and prescriptions. Limited access to transportation, job security, and limited opportunity for quality education has made recruiting and retaining health care providers and facilities nearly impossible.

These circumstances lead to community members forgoing care and relying on home remedies for serious health conditions. I’ve met a few of Dr. Kinsell’s patients and they all had distressing stories about their health and health care. They’ve told me stories about being turned away from hospitals

after experiencing a stroke, self-medicating with alcohol for severe dental problems, and hoping a suspected blood clot isn’t “that serious.” If it were not for Dr. Kinsell’s compassion and generosity, many Clay county residents would likely have to go without any medical care at all.

Seeing the statistics that come out of rural Georgia is concerning, but meeting the people behind the numbers can be heartbreaking. Each of these stories matters individually, and here at GHF, we think there is great value in lifting up the voices and experiences of individual consumers. But collectively these stories are even more powerful. They speak to the great need that exists across Georgia for an equitable, accessible, affordable health care system that provides quality care to every Georgian regardless of geography, income, or demographic.

Referenceshttp://specials.myajc.com/Kinsell/http://www.georgiahealthnews.com/2018/08/clay-county-doctor-pharmacy/http://healthyfuturega.org/2018/10/18/stories-from-georgias-coverage-gap-rural-

georgians-left-behind/http://healthyfuturega.org/2018/06/21/another-georgian-left-behind/

Green

229-253-2866conhsadvising@valdosta.eduHealth Sciences and Business Administration Building Room 4002C

Valdosta State University

February, March, April 2019 Georgia Nursing • Page 11

SAVE THE DATE

November 19, 2018

Nurse Paula Boozer was honored by Melinda Miller through the Georgia Nurses Foundation’s Honor a Nurse Program .

Nurse Boozer “was smart, funny, and compassionate – responding to every task and every situation with a smile and determination that was part of her DNA .” Ms . Boozer “did so much for her patients, their families, and her own family .”

The Foundation’s Honor a Nurse Program provides a way to let individuals recognize nursing professionals who have made a difference in the lives of others as a friend, mentor, caregiver or teacher . Proceeds from this program go to the Foundation’s scholarship programs and provide funding for nursing activities .

The Georgia Nurses Foundation salutes nurse Boozer as a member of the profession who richly deserves this recognition .

Kindest regards,

Catherine F utchCatherine FutchPresident, Board of Trustees

GNF Mission Statement: Through philanthropy, the Georgia Nurses Foundation fosters nursing’s role in the improvement of the health, well being and quality of life for Georgia’s citizens. The Foundation’s mission is fulfilled through Service, Education, and Research.

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Page 12 • Georgia Nursing February, March, April 2019

The Cost of RetaliationKimberly A. Hires, PhD, RN

Most working adults do not realize that in addition to being protected from discrimination, they are protected from retaliation . According to the U .S . Equal Employment Opportunity Commission (EEOC), retaliation occurs when an employer (organization or manager acting on behalf of the organization) punishes an employee for filing a complaint of discrimination, participating in a discrimination proceeding, or otherwise opposing discrimination . Examples of retaliation include demotion, re-assignment, promotion denials using false reasons and/or intentionally impeding professional development .

Recently, a jury in Boston awarded 70-year-old Gessy Toussaint $28 million dollars after finding that her employer (Brigham and Women’s Hospital) and her manager retaliated against her for defending another nurse from verbal abuse by a physician (Kowalczyk, 2018) . Toussaint’s attorney effectively argued that after the incident, the veteran nurse was targeted and her professional development was crippled . Acts of retaliation against the nurse include a sudden occurrence of several investigations for poor patient care and being required to take a test administered to recent graduates to assess knowledge (Toussaint earned a perfect score) (Kowalczyk, 2018) . Toussaint subsequently resigned .

Toussaint was able to link the retaliation to an occurrence of protected behavior . Retaliation is bullying and now there are legal repercussions . So does this mean that we will suddenly see a wave of law suits from nurses citing retaliation? No . National complaints to the EEOC average less than 50% (EEOC, 2014) . Nursing is only one sector of the national workforce . The sad reality is that such behaviors are so finely ingrained in nursing that it will take several years to convince all nurses that abuse while on the job is not a part of the job – that’s a different article .

When I read this case, I had two initial thoughts . One, the pain now has a price tag. Two, this all could have been prevented with good soft skills training for leaders.

The Price. For leaders, this case assigned a value to a real problem in healthcare organizations . Retaliation thrives in a culture of bullying and many healthcare organizations have this problem . I love when I get called into an organization because of nurse retention challenges and leadership tries to convince me that they ‘truly operate from the missions and values’ plastered all over the facility and the problem is the nurses . It does not matter how much talent is brought in to the organization if the culture is toxic and dysfunctional .

When a member of your team feels justified in harming another member and is permitted to do so, that’s a problem . This leads to my second thought .

Soft Skills. Leaders are often selected based on their ability to produce and achieve outcomes on paper – that’s all driven by hard skills . Leaders with well-developed soft skills do not operate from a world-view that justifies harm to a person or relationship . ‘She passed her place .’ ‘I have to get him .’ ‘How dare . . .’ ‘Who does he think he is?’ Leaders with well-developed soft skills operate from an ethos of goodwill . Soft skills are personal attributes that enable leaders to interact effectively and harmoniously with other people . Soft skills require the greatest investment and yield a much higher return than hard skills . Leaders who have good retention, healthy work environments and achieve organizational goals have well developed soft skills . These leaders recognize the importance of investing in their people . In the Toussaint case, soft skills training could have been used to teach team members how to communicate effectively, how to resolve conflict, how to address intrapersonal challenges that impact the development of healthy professional relationships, and so much more .

Let this case be a reminder to all leaders to invest in their people the right way, otherwise, it can cost you significantly in the end .

Author Bio: Nurse Scientist. Certified John Maxwell speaker, trainer and coach. Dr. Kim Hires founded and leads The Nightingale Firm. The Nightingale Firm is a coaching firm that focuses on developing leadership soft skills to improve nurse retention. She is also the DNP Program Director and Clinical Assistant Professor at Georgia State University in Atlanta, GA.

Contact: DrKim@thenightingalefirm.com

ReferencesUS Equal Employment Opportunities Commission [EEOC] (2014) . Retaliation - Making it

Personal Retrieved from https://www .eeoc .gov/laws/types/retaliation_considerations .cfm

Kowalcyzk, L . (2018, April 29) . Black nurses sue Brigham and Women’s Hospital . Boston Globe. Retrieved from https://www .bostonglobe .com/metro/2018/04/29/black-nurses-sue-brigham-and-women-hospital/O98sghoMLUQgFrr625CiQP/story .html

Kowalcyzk, L . (2018, May 24) . Jury awards black nurse $28 million in hospital retaliation suit . Boston Globe. Retrieved from https://www .bostonglobe .com/metro/2018/05/23/jury-awards-black-nurse-million-brigham-and-women-retaliation-suit/NcjyNfbtG3z2f2qFJWVLeI/story .html

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February, March, April 2019 Georgia Nursing • Page 13

Yoga in Nursing – Surprisingly SimpleChristopher “Chase” Carey, MBA,

3rd Degree Black BeltRegistered Yoga Teacher, Author, Speaker

Chase@ChasingMindfulness.com770-751-6700

www.ChasingMindfulness.com Let me ask you

something? What percentage of your shift involves providing medical treatment to patients? 60%, 70%, 80%, or even 90%? Maybe even 95% . Ask your coworkers . Do they have the same percentage? Now, if you work on a floor in a hospital ask yourself what percentage of one shift you provide medical care to just any one patient . Be careful not to include time you monitor medical conditions/reading or provide supervision to a single patient . The percentage should be way under 30% unless you are working in an ICU or equivalent .

The answer to this is significant . This provides quite an opportunity to provide complementary techniques . This quarter, I’d like to suggest considering a few Yoga techniques .

First, let’s take a moment to make sure we are all speaking the same language . Yoga is not “just” posture and breathing classes .

In fact, Yoga has eight areas of serious discipline: 1 . Yamas – things to avoid/restrain from;

2 . Niyamas – things to do in life/observances;

3 . Asanas – the physical postures;

4 . Pranayama – breathing techniques;

5 . Pratyahara – withdraw of senses/pulling away from inputs;

6 . Dharana – focused concentration;

7 . Dhyana – meditation; and 8 . Samadhi – bliss/enlightenment .

Let’s focus on just two areas and walk through how to apply these techniques to nursing . The first

is what most people in the US consider to be Yoga, the Asanas – physical postures . The first thing you should know is that there are textbook postures and then there are the postures 98% of us can really do - and should only do . Most of the people in your care will fit this bill . Postures are packed with powerful effects: Asanas warm the body, help keep synovial and other fluids moving, allow for emotional release (surprising, isn’t this?), and muscle stretching often provides missed relief and increased range of motion . This Yogi believes we all should stretch two to three times a day for two to three minutes at a time . Chair Yoga is a form of Asana practice that is taking off with the over 65 and the movement-restricted population because it provides all the benefits of Asana without having to be certified as a Cirque Du Soleil acrobat! Chair Yoga can be side-of-bed Yoga or fully bed-reclined Yoga . Popular techniques are as simple as gentle head rolls – go three or four rounds in one direction and then roll in the opposite direction . Another great movement is lateral rotation of the spine and slight forward and reverse bending – with a three second (+/-) hold at each end . These movements should be completed in a very slow and controlled way, which reduces the likelihood for injury . From a chair or bed, patients can slowly do leg lifts, with straight legs . Alternate between pulling toes back and pointing toes, again holding at the end of each movement .

Let’s explore a Pranayama technique called three-part breathing . We do this by encouraging full breaths into the belly . (I know that we do not physically breath into the belly, but stay with me on this .) Start by having your patient stand or sit tall . Have them place their right hand on their chest and their left hand on their abdomen . Instruct them to inhale and exhale just as if they were filling up and pouring out a pitcher of water . We slowly breathe in filling the bottom of our pitcher first (abdomen) then fill the top (lungs) . Hold for a moment, and the empty the pitcher from the top first (lungs) and then the bottom of the pitcher (abdomen) . Breathing should be about 1/2 - 1/3 the normal pace and should be done for three or four cycles . This technique helps oxygenate the blood, clears the mind of chatter, and releases stress .

I invite you to visit your local Yoga Center and try a class . Most are only $15-$20 a class . If you get enough of your fellow nurses interested, invite your local Yoga Center to create a class just for nurses . Many Yoga Teachers and Centers are listed on www .YogaAlliance .com .

And I guess I should close by saying, “Namaste!”

Christopher “Chase” Carey

GNANightingale Tribute

We would like to kindly request the names of your departed colleagues to recognize them at the next GNA Membership Assembly in 2019 .

Please send names to GNA at 3032 Briarcliff Road NE. Atlanta, GA 30329.

Or via e-mail to gna@georgianurses.org, Subject Line “Nightingale Tribute 2019.”

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AT EAST GEORGIA REGIONAL MEDICAL CENTER OUR COMMITMENT TO EXCELLENCE IN HEALTHCARE AND TO OUR ASSOCIATES NEVER STOPS!East Georgia Regional Medical Centerlocated in Statesboro, GA is a great place to work! We offer competitive compensation and excellent benefits! Qualified candidates interested in opportunities should apply on-line at our website

www.eastgeorgiaregional.comThis hospital is owned or invested in by Physicians.

We have an immediate need for NURSING POSITIONS (FT/PRN)Incentives available for selected applicants of FT positions. For more information, please call Susan Salvatore at 551-996-5411 or email: susan.salvatore@hackensackmeridian.org

Page 14 • Georgia Nursing February, March, April 2019

Nursing and Continuing Professional DevelopmentLynn Rhyne, MN, RNC-MNNNurse Peer Review Leader

Continuing Education Approver UnitGeorgia Nurses Association

I was a teen in the 60s trying to decide what I wanted to do with my life . Unfortunately, the Women’s Movement hadn’t taken hold yet, so there were not a lot of options for me . Teaching and nursing seemed to be the ones we were encouraged to select . I knew I did not want to teach, so nursing was my only choice .

I chose well . I was educated extremely well in a diploma nursing program and entered the profession feeling I could perform well under any given circumstance . Was I ever wrong and too cocky to “know what I didn’t know!” However, I did have an outstanding foundation to build my competency and knowledge base upon . I had enough insight to build on this foundation .

I was fortunate to have an excellent mentor when I was in the Navy, who role modeled for me how to be a good nurse, to listen to the patients, and to always strive for more knowledge in my practice . She placed the “seeds of desire” to understand not only the patient’s disease process, but why I was administering medications or treatments for those diseases . She taught me how to develop critical thinking skills .

I obtained my master’s in 1984 but could not decide what I wanted to “be when I grew up .” Inadvertently, my husband was transferred to St . Louis, Missouri

and I was hired as a nursing instructor in newborn care at Barnes Hospital School of Nursing . Oh, my goodness, I found my niche .

Why am I being rambling? To demonstrate that in my pursuit of finding what I wanted to be in nursing lead me to the one area I had no desire to be when I graduated high school – teaching! You never know which path nursing will lead you down .

I spent 27 years as a nurse educator and loved it . I have no regrets about my choice . I hope I educated students to the concepts of understanding the what, why, when and how of patient care, not just “because it’s the doctor’s order .” I like to think I taught them how to use their inherent judgement to develop critical thinking skills .

Since I retired, I still love education . I realize that nurses should never stop learning . GNA and the Continuing Education Approver Unit (CEAU) believe that nurses are life-long learners . To continue this learning, they need to have access to opportunities to foster that learning . GNA and the CEAU are here to the rescue!

The need for continuing professional development for nurses is a component of professional practice . Georgia Board of Nursing has mandated a re-licensure requirement for 30 contact hours within the license period (two years) . The Georgia Board of Nursing Rule 410-10- .01 Standards of Practice for Registered Nurses indicates that registered nurses should seek “educational resources and create learning experiences to enhance and maintain current knowledge and skills appropriate to her/his practice area .” The American Nurses Association’s Scope and Standards of Practice Standard 12 (ANA, 2015, p . 76) has a list of competencies signifying a professional registered nurse should seek knowledge and competencies that reflect current nursing practice and promotes futuristic thinking .

GNA and the CEAU want to become more active in providing those opportunities to meet professional nursing development needs . A recent survey was posted on GNA’s website (georgianurses .org) that I hope you will take to provide GNA information regarding what you consider to be your educational needs and which learning styles work best for you . Please participate in the survey .

Never stop learning to become a better nurse . You are the patient’s advocate and need to have an understanding of the impact changes in healthcare have on patient outcomes and what you can do to have a positive effect on those changes . You are the one who protects your patients . Don’t short change them . Never stop learning .

GNA will be posting a monthly e-newsletter with information related to practice and educational offerings to promote professional development . The CEAU will provide a bi-monthly newsletter that will mainly address developing CNE activities . That doesn’t mean we don’t want input from our stakeholders with insight into how we can improve service to those stakeholders .

As the Nurse Peer Review Leader for the CEAU, it is my responsibility to ensure your educational needs are met . I welcome input from stakeholders providing constructive suggestions on how the CE unit can best meet those needs . I am still in the “honeymoon” phase of this role, but I can assure you, I want GNA and the CEAU to ensure the nurses in our state they have opportunities to seek professional development activities .

My contact information is rhynelynn@yahoo .com .

References:American Nurses Credentialing Center (2013) . 2013 ANCC primary accreditation

application manual for providers and approvers, revision 3 .0 . Silver Springs, MD: Author .American Nurses Credentialing Center (ANCC) . Approver Manual, 2015 .American Nurses Credentialing Center’s Commission on Accreditation . (2014, September) .

The importance of evaluating the impact of continuing nursing education on outcomes: Professional nursing practice and patient care .

Nursing Professional Development: Scope & Standards of Practice (3rd ed .) . 2015, Association for Nursing Professional Development, Chicago, IL .

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February, March, April 2019 Georgia Nursing • Page 15

Quick Fixes for 10 Big Budget-Blowing Mistakes

If you’ve been struggling to find leaks in your budget, look at these top money mistakes … and learn  ways to avoid or fix them .

1. Estimating Income and Expenses Instead of Tracking Them

To make a realistic budget, you need to know exactly how much money you have coming in and going out every month . People tend to get the income side right, but often seriously underestimate their expenses .

To accurately measure costs, review at least six months of bills, bank statements, and credit card statements . That will help you spot expenses that don’t occur regularly . It also lets you see how much some payments vary from month to month, so you can calculate an average .

Once you have accurate numbers, use a free budgeting tool such as Kiplinger’s Household Budget Worksheet . You can easily customize online worksheets like this to match your spending . And using them will highlight any categories you overlooked .

2. Using Credit to Spend More Than You HaveUsing credit cards to make purchases that you can’t afford is a double-hit to your

budget . The best way to avoid this: Every time you use your credit card, set aside the money as if you’d used cash . That way, when the bill comes, the cash will be available to pay the full balance, and you won’t end up paying interest on everyday purchases .

3. Ignoring ‘Auto Pilot’ ExpensesEvery month, you’re paying for cable, gym membership, and other contract-type

expenses without even blinking . But these expenses can be a real drain on your budget, so taking a deeper look makes sense .

Do you have subscriptions to publications you aren’t reading anymore? Are you still paying for a landline even though you only use your mobile phone? Are you still watching cable, or have you switched to Netflix and Hulu?

Reconsidering auto-pilot expenses, and getting rid of the ones that no longer fit your life, can free up space in your budget .

4. Keeping Savings and Checking Accounts in the Same BankIt’s easy for money to flow the wrong way when savings and checking accounts

are in the same bank . If transferring money from savings into checking is as simple as a mouse click, it can happen all too often . And using savings to pay regular household bills because you over spent will quickly deplete your nest egg .

What’s more, when you need that money to cover an emergency or to fund a vacation, it won’t be there .

5. Making It Too Easy to Spend MoneyOne-click check out … Amazon Prime … Apple Pay … Speedpass … all of these

effortless payment systems — and there are dozens more — make it so easy to spend money . We don’t think twice about making purchases .

When you’re trying to stay on budget, though, adding a layer of difficulty to your spending makes you less likely to buy things you don’t really need . So, turn off one- click, don’t “store” your credit card information for online accounts, cancel memberships that don’t really benefit you, and so on .

You’ll be surprised how much less you buy when checking out is even a little more of a hassle .

6. Forgetting about EmergenciesIt’s hard to budget for unpredictable expenses, but emergencies happen all the

time . Your washing machine goes on the fritz, for example, or you need a root canal . If your budget isn’t prepared to handle the unexpected, you could find yourself in financial hot water .

The fix: Include “emergencies” as an expense category in your budget, and fund it every month .

7. Keeping Up with Technology UpgradesFrequent tech upgrades make the latest, greatest versions seem like must-haves .

But they’re really not . Anything that was working for you yesterday — your laptop, your smartphone — is just as good today, even if the tech companies say it isn’t .

Sometimes, simply updating software or adding memory can be all the upgrade you need .

8. Not Tailoring a Budget to Your LifeYour budget should reflect your finances and goals, not just follow a cookie-cutter

template . For example, if your daily Starbucks run makes life “worth living,” that’s not the expense to cut, no matter what all the experts say .

Maybe you would rather cancel your cable than go a day without your mocha latte . Your budget can and should reflect that priority .

9. Not Considering IncomeBudgeters tend to focus on cutting expenses, but it’s sometimes easier to increase

income, or at least cash flow . Some examples:

• Lower tax withholding.  According to the IRS, the average federal tax refund received in 2016 was a whopping $2,860! If your last refund was more than  $1,000, reducing your withholding taxes may be worth looking at in order to free up some extra cash . https://www .forbes .com/sites/kellyphillipserb/2017/03/06/how-does-your-tax-refund-compare/#4404dd4b36ea

• Renegotiate with vendors.  If your bank charges you for checking and ATM

usage, ask them to remove those fees . If they won’t budge, move your money to a friendlier bank . If your cable bundle has skyrocketed, ask if signing up for a new contract term would lower your rate .

• Redeem credit card points. You may be able to use them to buy gift cards, to earn savings on product purchases, and even to help pay your bills .

• Sell unwanted electronics.  There are several websites that will buy used electronics — even if they’re not in perfect shape — for cash, store credits, or gift cards .

10. Failing to Budget for Life InsuranceLife insurance often gets the axe when families are building budgets . That’s mainly

because it doesn’t impact everyday life like other household expenses . But consider this: If money is so tight you can’t fit life insurance into your budget, what happens to the family finances if you or your spouse die?

An insurance policy payout can help keep them on sturdy financial ground .

The Bottom LineYou’ll be amazed how much you can save when you plug leaks that are draining

your budget . And by fixing or avoiding these ten big mistakes, you’ll have more room in your spending for occasional splurges .

This article contains links to a site maintained by third parties. Mutual of Omaha does not endorse, warrant or approve of the content, correctness or accuracy of this site.

Mutual of Omaha and its representatives do not provide tax or legal advice. Consult the appropriate professional regarding your particular situation.

Submitted by Valerie EdwardsFinancial AdvisorMutual of OmahaValerie .Edwards@mutualofomaha .com

Val Edwards

NURSING FACULTY FULL-TIME CLINICAL TRACK ASSISTANT PROFESSOR OR CLINICAL INSTRUCTOR POSITION

ANNOUNCEMENTBerry College Division of Nursing seeks an excellent and qualified nurse educator who cares about nursing students’ learning! Located on more than 27,000 acres in northwest Georgia in a setting of great natural beauty, Berry College provides an integrated education that unites a challenging academic program with great opportunities for spiritual and moral growth, work experience, and significant service to others.

COLLEGE/DEPARTMENT: DIVISION OF NURSING

START DATE: AUGUST 2019

JOB SUMMARY The Berry College BSN program is leadership and future oriented, placing special emphasis on cultural diversity, technology, gerontology, community health promotion, and oncology. The program includes a cross-cultural immersion experience that provides Berry College students with the opportunity to serve diverse populations either domestically or abroad. The Bachelor of Science in Nursing Program is accredited by the Commission on Collegiate Nursing Education (CCNE), Southern Association of Colleges and Schools (SACS) and approved by the Georgia Board of Nursing (GBON). This clinical faculty member will be expected to participate in classroom and clinical instruction, student recruitment, academic advising, and retaining and mentoring highly qualified students. The ability to think creatively with a desire to be involved in an engaging, caring, and learner-centered teaching environment is required. Candidates must document the use of creative teaching strategies, experience in a simulation-learning environment, and be knowledgeable of the QSEN competencies and AACN standards of practice. Expertise in acute medical-surgical, critical care nursing, physical assessment, global cross-cultural experiences, and creative teaching strategies is highly desirable.

MINIMUM QUALIFICATIONSLicensure as a registered nurse in Georgia. Graduate degree in nursing with specialty areas that may include one or more of the following: medical-surgical, physical assessment, critical care, and pharmacology.

PREFERRED QUALIFICATIONSDoctorate degree or enrolled in a doctoral program in nursing with previous baccalaureate teaching. Applicants holding a doctorate or enrolled in a doctoral program will be hired as a clinical assistant professor.

MATERIALS TO INCLUDELetter expressing qualifications and interest in the position, statement describing commitment to (or experience with) diverse clients, a curriculum vita, undergraduate and graduate transcripts, a statement of teaching philosophy, and three letters of recommendation.

INSTRUCTIONS TO APPLICANTSApplicants should send materials to Nursing Faculty Search Committee, Berry College, P. O. Box 495048 Mount Berry, GA 30149. Review of applications will begin February 1, 2019 and will continue until a suitable candidate is identified. Berry College is an Equal Opportunity employer.

Page 16 • Georgia Nursing February, March, April 2019

MEMBERSHIP

GEORGIA NURSES FOUNDATION

HONOR A NURSEWe all know a special nurse who makes a difference! Honor a nurse who has touched your life as a friend, a caregiver, a mentor, an exemplary clinician, or an outstanding teacher . Now is your opportunity to tell them “thank you .”

The Georgia Nurses Foundation (GNF) has the perfect thank you with its “Honor a Nurse” program which tells the honorees that they are appreciated for their quality of care, knowledge, and contributions to the profession .

Your contribution of at least $35 .00 will honor your special nurse through the support of programs and services of the Georgia Nurses Foundation . Your honoree will receive a special acknowledgement letter in addition to a public acknowledgement through our quarterly publication, Georgia Nursing, which is distributed to more than 100,000 registered nurses and nursing students throughout Georgia . The acknowledgement will state the name of the donor and the honoree’s accomplishment, but will not include the amount of the donation .

Let someone know they make a difference by completing the form below and returning it to the following address:

Georgia Nurses Foundation 3032 Briarcliff Road, NE | Atlanta, GA 30329 FAX: (404) 325-0407 | gna@georgianurses .org (Please make checks payable to Georgia Nurses Foundation.)

I would like to Honor a Nurse:

Honoree: Name: __________________________________________________

Email: __________________________________________________

Address: ________________________________________________

State/City: ______________________________Zip: ___________

From: Donor: _________________________________________________

Email: __________________________________________________

Address: ________________________________________________

State/City: ______________________________Zip: ___________

Amount of Gift: __________________

MasterCard/Visa #: ____________________________ Exp Date: ___________

Name on Card: _____________________________________________________

My company will match my gift? _ YES (Please list employer and address below .) ___ NO

Employer: _______________________________________________

Address: ________________________________________________

The Georgia Nurses Foundation (GNF) is the charitable and philanthropic arm of GNA supporting GNA and its work to foster the welfare and well being of nurses, promote and advance the nursing profession, thereby enhancing the health of the public.

Georgia Nurses Association Political Action Committee (GN-PAC)

About GN-PAC:The Georgia Nurses Association Political Action Committee (GN-PAC) actively

and carefully reviews candidates for local, state and federal office . This consideration includes the candidate’s record on nursing issues and value as an advocate for the nursing profession . Your contribution to GN-PAC today will help GNA continue to protect your ability to practice and earn a living in Georgia . Your contribution will also support candidates for office who are strong advocates on behalf of nursing . By contributing $25 or more, you’ll become a supporting member of GN-PAC .  By contributing $65 or more, you’ll become a full member of GN-PAC!

GN-PAC Purpose:The purpose of the GN-PAC shall be to promote the improvement of the health

care of the citizens of Georgia by raising funds from within the nursing community and friends of nursing and contributing to the support of worthy candidates for State office who believe, and have demonstrated their belief, in the legislative objectives of the Georgia Nurses Association .

TO DONATE VISIT WWW.GEORGIANURSES.ORG/GNPAC

E-Store Now Open!Purchase GNA merchandise at GNA’s Café Press online store!

Cups, bags, hats, t-shirts, hoodies, and more!

www .cafepress .com/georgianursesassociation

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UF Health Jacksonville has immediate openings for nurses with surgical operating room, open heart, labor & delivery and oncology experience.

UF Health Jacksonville is a Level 1 trauma, academic health center that provides a wide range of healthcare services for residents of northeast Florida and southeast Georgia. Together with our University of Florida colleagues and affiliates we offer a fast-paced environment on the leading edge of the latest treatments and technologies.

Our knowledge and expertise are unmatched. Yours can be, too.

Apply today at UFHealthJax.org/nursing.

February, March, April 2019 Georgia Nursing • Page 17

MEMBERSHIP

Are you interested in Palliative Care? Nurse Navigation? Informatics?

Whatever your nursing passion may be, Georgia Nurses Association (GNA) can help you connect with your peers locally and across the state . Becoming involved in your professional association is the first step towards creating your personal career satisfaction and connecting with your peers . Now, GNA has made it easy for you to become involved according to your own preferences .

Through GNA’s new member-driven chapter structure, you can join multiple chapters and also create your own chapter based on shared interests where you can reap the benefits of energizing experiences, empowering insight and essential resources.

Visit http://www .georgianurses .org/?page=Chapter Chairs to view a list of current GNA Chapters and Chapters Chair contact information . Connect with

I Want to Get Involved: Joining and Creating a GNA Chapter

To become a member of GNA please

review and submit our membership

application located on the homepage of

our website at www .georgianurses .org

Chapter Chairs to find out when they will hold their next Chapter meeting!

The steps you should follow to create a NEW GNA chapter are below . If you have any questions, contact the membership development committee or GNA headquarters; specific contact information and more details may be found at www .georgianurses .org .

1 . Obtain a copy of GNA bylaws, policies and procedures from www .georgianurses .org .

2 . Gather together a minimum of 10 GNA members who share similar interests .

3 . Select a chapter chair . 4 . Chapter chair forms a roster to verify roster

as current GNA members . This is done by contacting headquarters at (404) 325-5536 .

5 . Identify and agree upon chapter purpose . 6 . Decide on chapter name . 7 . Submit information for application to become a

chapter to GNA Headquarters . Information to be submitted includes the following:

Chapter chair name and chapter contact information including an email,

Chapter name, Chapter purpose, and Chapter roster .

8 . The application will then go to the Membership Development Committee who will forward it to the Board of Directors . The Board will approve or decline the application and notify the applicant of its decision .

Member Lifestyle BenefitsWe partnered with trusted organizations to meet the needs of our members beyond the

professional scope so that at the end of a long day or week they can focus on what matters the most: enjoying life with their loved ones .

GNA Members receive exclusive access to valuable retail, hospitality and financial

planning discounts and services at:

As a GNA Member, you are part of the largest Nursing association

in the State of Georgia.Other benefits include:

• Active representation at the State Legislature by respected professional lobbyists

• Opportunity to serve as a GNA Board and/or Committee Member*

• Access to shared-interest and local chapters, and avenues to connect with leaders in the profession

• Participation in the Biennial Professional Development Conference and Membership Assembly

• Hot-off-the press legislative updates that affect the nursing profession

• Member-only access to ANA’s Nurse Space• Free access to The Online Journal of Issues

in Nursing (OJIN) • Free subscription to The American Nurse

Today - the official journal of ANA• Discounts at NursesBook .Org• Access to free and discounted webinars at

Navigate Nursing Webinars • LARGEST discount on initial ANCC

certification ($120/full members only)• LARGEST discount on ANCC re-

certification ($150/full members only)

*Serving as a GNA Board Member is subject to running in and winning the GNA Board of Directors’ Election for the position of interest.

DO YOU HAVE A NURSE LICENSE

PLATE?The Georgia Nurses Foundation (GNF) special

nurse license plate is available NOW at Georgia tag offices . Each nurse plate sold results in revenue generated

for GNF, which will be used for nursing scholarships and workforce planning and development to meet future needs . Show your support for the

nursing profession in Georgia by purchasing a special nurses license plate today! Get details at http://www .georgianurses .org/?page=LicensePlate .

Page 18 • Georgia Nursing February, March, April 2019

Lori Locke, MSN, RN, NE-BC; Gail Bromley, PhD, RN;

Karen A. Federspiel, DNP, MS, RN-BC, GCNS-BC

Reprinted from American Nurse Today, Volume 13, Number 5

Robert, a 78-year-old patient, requests help getting to the bathroom. When the nurse, Ellen, enters the room, Robert’s lying in bed, but when she introduces herself, he lunges at her, shoves her to the wall, punches her, and hits her with a footstool. Ellen gets up from the floor and leaves the patient’s room. She tells her colleagues what happened and asks for help to get the patient to the bathroom. At the end of the shift, Ellen has a swollen calf and her shoulder aches. One of her colleagues asks if she’s submitted an incident report. Ellen responds, “It’s all in a day’s work. The patient has so many medical problems and a history of alcoholism. He didn't intend to hurt me. What difference would it make if I filed a report?”

These kinds of nurse-patient interactions occur in healthcare settings across the United States, and nurses all too frequently minimize their seriousness . However, according to the National Institute for Occupational Safety and Health, “…the spectrum [of violence]…ranges from offensive language to homicide, and a reasonable working definition of workplace violence is as follows: violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty .” In other words, patient violence falls along a continuum, from verbal (harassing, threatening, yelling, bullying, and hostile sarcastic comments) to physical (slapping, punching, biting, throwing objects) . As nurses, we must change our thinking: It’s not all in a day’s work .

This article focuses on physical violence and offers strategies you can implement to minimize the risk of being victimized .

Consequences of patient violenceIn many cases, patients’ physical violence is life-

changing to the nurses assaulted and those who witness it . (See Alarming statistics .) As a result, some nurses leave the profession rather than be victimized—a major problem in this era of nursing shortages .

Too frequently, nurses consider physical violence a symptom of the patient’s illness—even if they sustain injuries—so they don’t submit incident reports, and their injuries aren’t treated . Ultimately, physical and psychological insults result in distraction, which contributes to a higher incidence of medication errors and negative patient outcomes . Other damaging consequences include moral distress, burnout, and job dissatisfaction, which can lead to increased turnover . However, when organizations encourage nurses to report violence and provide education about de-escalation and prevention, they’re able to alleviate stress .

Workplace violence prevention Therapeutic communication and assessment of

a patient’s increased agitation are among the early clinical interventions you can use to prevent workplace violence . Use what you were taught in nursing school to recognize behavioral changes, such as anxiety,

Patient Violence: It’s Not All in a Day’s WorkStrategies for reducing patient violence and creating a safe workplace

confusion, agitation, and escalation of verbal and nonverbal signs . Individually or together, these behaviors require thoughtful responses . Your calm, supportive, and responsive communication can de-escalate patients who are known to be potentially violent or those who are annoyed, angry, belligerent, demeaning, or are beginning to threaten staff .(See Communication strategies .)

Other strategies to prevent workplace violence include applying trauma-informed care, assessing for environmental risks, and recognizing patient triggers .

Trauma-informed careTrauma-informed care considers the effects of

past traumas patients experienced and encourages strategies that promote healing .

The Substance Abuse and Mental Health Services Administration says that a trauma-informed organization:

• realizes patient trauma experiences are widespread

• recognizes trauma signs and symptoms• responds by integrating knowledge and clinical

competencies about patients’ trauma• resists retraumatization by being sensitive to

interventions that may exacerbate staff-patient interactions .

This approach comprises six principles: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues . Applying these principles will enhance your competencies so that you can verbally intervene to avoid conflict and minimize patient retraumatization . For more about trauma-informed care, visit samhsa .gov/nctic/trauma-interventions .

Environmental risksTo ensure a safe environment, identify objects in

patient rooms and nursing units that might be used to injure someone . Chairs, footstools, I .V . poles, housekeeping supplies, and glass from lights or mirrors can all be used by patients to hurt themselves or others .

The statistics around patient violence against nurses are alarming.

67% of all nonfatal workplace violence injuries occur in healthcare, but healthcare represents only 11.5% of the U.S. workforce.

Emergency department (ED) and psychiatric nurses are at highest risk for patient violence.

Hitting, kicking, beating, and shoving incidents are most reported.

25% of psychiatric nurses experience disabling injuries from patient assaults.

At one regional medical center, 70% of 125 ED nurses were physically assaulted in 2014.

Sources: Emergency Nurses Association (ENA) Emergency department violence surveillance study 2011; ENA Workplace violence toolkit 2010; Gates 2011; Li 2012.

Alarming statistics

• To build trust, establish rapport and set the tone as you respond to patients.

• Meet patients’ expectations by listening, validating their feelings, and responding to their needs in a timely manner.

• Show your patients respect by introducing yourself by name and addressing them formally (Mr., Ms., Mrs.) unless they state another preference.

• Explain care before you provide it, and ask patients if they have questions.

• Be attentive to your body language, gestures, facial expressions, and tone of voice. Patients’ behavior may escalate if they perceive a loss of control, and they may not hear what you say.

• Control your emotions and maintain neutral, nonthreatening body language.

• Strive for communication that gives the patient control, when possible. Example: “Which of your home morning routines would you like to follow while you’re in the hospital? Would you like to wash your hands and face first, eat your breakfast, and then brush your teeth?”

• Offer a positive choice before offering less desirable ones. Example: “Would you prefer to talk with a nurse about why you’re upset, or do you feel as though you will be so angry that you need to have time away from others?”

• Only state consequences if you plan to follow through.

• Listen to what patients say or ask, and then validate their requests.

• Discuss patients’ major concerns and how they can be addressed to their satisfaction.

Communication strategies

Effective communication is the first line of defense against patient violence. These tips can help:

• Nonverbal communication. “I see from your facial expression that you may have something you want to say to me. It’s okay to speak directly to me.”

• Challenging verbal exchange. “My goal is to be helpful to you. If you have questions or see things differently, I’m willing to talk to you more so that we can understand each other better, even if we can’t agree with one another.”

• Perceptions of an incident or situation. “We haven’t discussed all aspects of this situation. Would you like to talk about your perceptions?”

Despite these strategies, patients may still become upset. If that occurs, try these strategies to de-escalate the situation before it turns violent.

February, March, April 2019 Georgia Nursing • Page 19

Recognizing and understanding patient triggers may help you de-escalate volatile interactions and prevent physical violence.

Common triggers• Expectations aren’t met• Perceived loss of independence or control• Upsetting diagnosis, prognosis, or

disposition • History of abuse that causes an event or

interaction to retraumatize a patient

Predisposing factors• Alcohol and substance withdrawal• Psychiatric diagnoses• Trauma• Stressors (financial, relational, situational)• History of verbal or physical violence

Remove these objects from all areas where violent patients may have access to them .

Patient triggersAwareness of patient triggers will help you

anticipate how best to interact and de-escalate . (See Patient triggers .) Share detailed information about specific patient triggers during handoffs, in interdisciplinary planning meetings, and with colleagues in safety huddles .

What should you do?You owe it to yourself and your fellow nurses to

take these steps to ensure that your physical and psychological needs and concerns are addressed:

• Know the definition of workplace violence .

• Take care of yourself if you’re assaulted by a patient or witness violence .

• Discuss and debrief the incident with your nurse manager, clinical supervisor, and colleagues .

Patient triggers • Use the healthcare setting’s incident reporting to report and document violent incidents and injuries .

• File charges based on your state’s laws .

Your organization should provide adequate support to ensure that when a nurse returns to work after a violent incident, he or she is able to care for patients . After any violent episode, staff and nurse leaders should participate in a thorough discussion of the incident to understand the dynamics and root cause and to be better prepared to minimize future risks . Effective communication about violent patient incidents includes handoffs that identify known risks with specific patients and a care plan that includes identified triggers and clinical interventions .

Influence organizational safetyYou and your nurse colleagues are well positioned

to influence your organization’s culture and advocate for a safe environment for staff and patients . Share these best practices with your organization to build a comprehensive safety infrastructure .

• Establish incident-reporting systems to capture all violent incidents .

• Create interprofessional workplace violence steering committees .

• Develop organizational policies and procedures related to safety and workplace violence, as well as human resources support .

• Provide workplace violence-prevention and safety education using evidence-based curriculum .

• Design administrative, director, and manager guidelines and responsibilities regarding communication and staff support for victims of patient violence and those who witness it .

• Use rapid response teams (including police, security, and protective services) to respond to violent behaviors .

• Delineate violence risk indicators to proactively identify patients with these behaviors .

• Create scorecards to benchmark quality indicators and outcomes .

• Post accessible resources on the organization’s intranet .

• Share human resources contacts .

Advocate for the workplace you deservePhysically violent patients create a workplace that’s

not conducive to compassionate care, creating chaos and distractions . Nurses must advocate for a culture of safety by encouraging their organization to establish violence-prevention policies and to provide support when an incident occurs .

You can access violence-prevention resources through the American Nurses Association, Emergency Nurses Association, Centers for Disease Control and Prevention, and the National Institute for Occupational Safety and Health . Most of these organizations have interactive online workplace violence-prevention modules . (See Resources.) When you advocate for safe work environments, you protect yourself and can provide the care your patients deserve .

The authors work at University Hospitals of Cleveland in Ohio. Lori Locke is the director of psychiatry service line and nursing practice. Gail Bromley is the co director of nursing research and educator. Karen A. Federspiel is a clinical nurse specialist III.

Selected referencesCafaro T, Jolley C, LaValla A, Schroeder R . Workplace

violence workgroup report . 2012 . apna .org/i4a/pages/index .cfm?pageID=4912

Emergency Nurses Association . ENA toolkit: Workplace violence . 2010 . goo .gl/oJuYsb

Emergency Nurses Association, Institute for Emergency Nursing Research . Emergency Department Violence Surveillance Study . 2011 . bit .ly/2GvbJRc

Gates DM, Gillespie GL, Succop P . Violence against nurses and its impact on stress and productivity . Nurs Econ. 2011;29(2):59-66 .

National Institute for Occupational Safety and Health . Violence in the workplace: Current intelligence bulletin 57 . Updated 2014 . cdc .gov/niosh/docs/96-100/introduction .html

Occupational Safety and Health Administration . Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. 2016 . osha .gov/Publications/osha 3148 .pdf

Speroni KG, Fitch T, Dawson E, Dugan L, Atherton M . Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors . J Emerg Nurs. 2014;40(3):218-28 .

Substance Abuse and Mental Health Services Administration . Trauma-informed approach and trauma-specific interventions . Updated 2015 . samhsa .gov/nctic/trauma-interventions

Wolf LA, Delao AM, Perhats C . Nothing changes, nobody cares: Understanding the experience of emergency nurses physically or verbally assaulted while providing care . J Emerg Nurs. 2014;40(4):305-10 .

• American Nurses Association (ANA) (goo.gl/NksbPW): Learn more about different levels of violence and laws and regulations, and access the ANA position statement on incivility, bullying, and workplace violence.

• Centers for Disease Control and Prevention (cdc.gov/niosh/topics/vio-lence/training_nurses.html): This online course (“Workplace violence prevention for nurses”) is designed to help nurses better understand workplace violence and how to prevent it.

Resources• Emergency Nurses Association (ENA)

toolkit (goo.gl/oJuYsb): This toolkit offers a five-step plan for creating a violence-prevention program.

• The Joint Commission Sentinel Event Alert: Physical and verbal violence against health care workers (bit.ly/2vrBnFw): The alert, released April 17, 2018, provides an overview of the issue along with suggested strategies.

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