Fluent Essays

• Sally A. Weiss and Ruth M. Tappen • • • • • • • • • • • ••• • ••• • ••• •••••••••• • •••• • • • • • • • • • • • • • • • •• • •• • •• • • • • • • . Essentials of Nursing Leadership and Management • • • • • • • I • •• Essentials of Nursing Leadership and Management SIXTH EDITION 3663_FM_i-xii.indd i3663_FM_i-xii.indd i 9/17/2014 3:01:42 PM9/17/2014 3:01:42 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 3663_Unit I_0001-0002.indd 23663_Unit I_0001-0002.indd 2 9/16/2014 11:25:22 AM9/16/2014 11:25:22 AM Essentials of Nursing Leadership and Management SIXTH EDITION Sally A. Weiss, MSN, EdD, RN, CNE, ANEF Professor of Nursing Nova Southeastern University Nursing Department Fort Lauderdale, Florida Ruth M. Tappen, EdD, RN, FAAN Christine E. Lynn Eminent Scholar and Professor Florida Atlantic University College of Nursing Boca Raton, Florida 3663_FM_i-xii.indd iii3663_FM_i-xii.indd iii 9/17/2014 3:01:43 PM9/17/2014 3:01:43 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2015 by F. A. Davis Company Copyright © 2015, 2010, 2007, 2004, 2001, 1998 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor, Nursing: Megan Klim Developmental Editor: Laurie Sparks Director of Content Development: Darlene D. Pedersen Content Project Manager: Echo Gerhart Electronic Project Editor: Katherine Crowley Design and Illustration Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treat- ments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from appli- cation of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infre- quently ordered drugs. Library of Congress Control Number: 2014945714 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rose- wood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Report- ing Service is: 978-0-8036-3663-7/15 0 + $.25. 3663_FM_i-xii.indd iv3663_FM_i-xii.indd iv 9/17/2014 3:01:45 PM9/17/2014 3:01:45 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black v Dedication To my granddaughter Sydni and my grandson Logan, who remind me how important it is to nurture our young nurses and help them learn and grow. —SALLY A. WEISS To students, colleagues, family, and friends, who have taught me so much about leadership. —RUTH M. TAPPEN 3663_FM_i-xii.indd v3663_FM_i-xii.indd v 9/17/2014 3:01:45 PM9/17/2014 3:01:45 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 3663_Unit I_0001-0002.indd 23663_Unit I_0001-0002.indd 2 9/16/2014 11:25:22 AM9/16/2014 11:25:22 AM vii Preface We are delighted to bring our readers this Sixth Edition of Essentials of Nursing Leadership and Management. This new edition has been updated to reflect the dynamic health care environment, safety initiatives, and changes in nursing practice. As in our previous editions, the content, examples, and diagrams were designed with the goal of assisting the new graduate to make the transition to professional nursing practice. The Sixth Edition of Essentials of Nursing Leadership and Management focuses on the necessary knowledge and skills needed by the staff nurse as an integral member of the interprofessional health- care team and manager of patient care. Issues related to setting priorities, delegation, quality improve- ment, legal parameters of nursing practice, and ethical issues are updated for this edition. This edition focuses on the current quality and safety issues and initiatives impacting the current health-care environment. We continue to bring you comprehensive, practical information on develop- ing a nursing career. Updated information on leading, managing, followership, and workplace issues continue to be included. Essentials of Nursing Leadership and Management provides a strong foundation for the beginning nurse leader. We would like to thank the people at F. A. Davis for their assistance and our contribu- tors, reviewers, and students for their guidance and support. —SALLY A. WEISS —RUTH M. TAPPEN 3663_FM_i-xii.indd vii3663_FM_i-xii.indd vii 9/17/2014 3:01:46 PM9/17/2014 3:01:46 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 3663_Unit I_0001-0002.indd 23663_Unit I_0001-0002.indd 2 9/16/2014 11:25:22 AM9/16/2014 11:25:22 AM ix Contributor PATRICIA BRADLEY, MED, PHD, RN Coordinator, Internationally Educated Nurses Program Faculty, Nursing Department York University Toronto, Ontario, Canada Reviewers WENDY GREENSPAN, MSN, RN, CCRN, CNE Assistant Professor Rockland Community College Suffem, New York PAULA HOPPER, MSN, RN, CNE Professor of Nursing Jackson Community College Jackson, Mississippi CLAIRE MEGGS, MSN, RN Associate Professor Lincoln Memorial University Harrogate, Tennessee LUISE SPEAKMAN, PHD, RN Adjunct Faculty, Nursing Cape Cod Community College West Barnstable, Massachusetts JENNIFER SUGG, RN, BSN, MSN, CCRN Nursing Instructor Wayne Community College Goldsboro, North Carolina 3663_FM_i-xii.indd ix3663_FM_i-xii.indd ix 9/17/2014 3:01:46 PM9/17/2014 3:01:46 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 3663_Unit I_0001-0002.indd 23663_Unit I_0001-0002.indd 2 9/16/2014 11:25:22 AM9/16/2014 11:25:22 AM xi Table of Contents unit 1 Professional Considerations 1 chapter 1 Leadership and Followership 3 chapter 2 Manager 17 chapter 3 Nursing Practice and the Law 27 chapter 4 Questions of Values and Ethics 49 unit 2 Working Within an Organization 69 chapter 5 Organizations, Power, and Empowerment 71 chapter 6 Communicating With Others and Working With the Interprofessional Team 87 chapter 7 Delegation and Prioritization of Client Care 103 chapter 8 Dealing With Problems and Conflict 121 chapter 9 People and the Process of Change 133 unit 3 Career Considerations 145 chapter 10 Issues of Quality and Safety 147 chapter 11 Promoting a Healthy Work Environment 173 unit 4 Professional Issues 203 chapter 12 Your Nursing Career 205 chapter 13 Evolution of Nursing as a Profession 225 chapter 14 Looking to the Future 235 3663_FM_i-xii.indd xi3663_FM_i-xii.indd xi 9/17/2014 3:01:46 PM9/17/2014 3:01:46 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black xii ■ Table of Contents Appendices appendix 1 Codes of Ethics for Nurses 247 American Nurses Association Code of Ethics for Nurses Canadian Nurse Association Code of Ethics for Registered Nurses The International Council of Nurses Code of Ethics for Nurses appendix 2 Standards Published by the American Nurses Association 249 appendix 3 Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment 251 3663_FM_i-xii.indd xii3663_FM_i-xii.indd xii 9/17/2014 3:01:46 PM9/17/2014 3:01:46 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black unit 1 Professional Considerations chapter 1 Leadership and Followership chapter 2 Manager chapter 3 Nursing Practice and the Law chapter 4 Questions of Values and Ethics 3663_Unit I_0001-0002.indd 13663_Unit I_0001-0002.indd 1 9/15/2014 4:37:34 PM9/15/2014 4:37:34 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 3663_Unit I_0001-0002.indd 23663_Unit I_0001-0002.indd 2 9/16/2014 11:25:22 AM9/16/2014 11:25:22 AM 3 chapter 1 Leadership and Followership OBJECTIVES After reading this chapter, the student should be able to: ■ Define the terms leadership and followership. ■ Discuss the importance of effective leadership and followership for the new nurse. ■ Discuss the qualities and behaviors that contribute to effective leadership. ■ Discuss the qualities and behaviors that contribute to effective followership. OUTLINE Leadership Are You Ready to Be a Leader? Leadership Defined What Makes a Person a Leader? Leadership Theories Trait Theories Behavioral Theories Task Versus Relationship Motivation Theories Emotional Intelligence Situational Theories Transformational Leadership Moral Leadership Caring Leadership Qualities of an Effective Leader Behaviors of an Effective Leader Followership Followership Defined Becoming a Better Follower Managing Up Conclusion Nurses study leadership to learn how to work well with other people. We work with an extraordinary variety of people: technicians, aides, unit managers, housekeepers, patients, patients’ families, physi- cians, respiratory therapists, physical therapists, social workers, psychologists, and more. In this chapter, the most prominent leadership theories are introduced. Then, the characteristics and behaviors that can make you, a new nurse, an effective leader and follower are discussed. Leadership Are You Ready to Be a Leader? You may be thinking, “I’m just beginning my career in nursing. How can I be expected to be a leader now?” This is an important question. You will need time to refine your clinical skills and learn how to function in a new environment. But you can begin to assume some leadership functions right away within your new nursing roles. In fact, leadership should be seen as a dimension of nursing practice (Scott & Miles, 2013). Consider the following example: Billie Thomas was a new staff nurse at Green Valley Nursing Care Center. After orientation, she was assigned to a rehabilitation unit with high ad- mission and discharge rates. Billie noticed that admissions and discharges were assigned rather hap- hazardly. Anyone who was “free” at the moment was directed to handle them. Sometimes, unlicensed as- sistant personnel were directed to admit or discharge residents. Billie believed that this was inappropriate because they are not prepared to do assessments and they had no preparation for discharge planning. Billie had an idea how discharge planning could be improved but was not sure that she should bring it up because she was so new. “Maybe they’ve already thought of this,” she said to a former classmate. They began to talk about what they had learned in their leadership course before graduation. “I just keep hearing our instructor saying, ‘There’s only one manager, but anyone can be a leader.’ ” “If you want to be a leader, you have to act on your idea. Why don’t you talk with your nurse manager?” her friend asked. “Maybe I will,” Billie replied. Billie decided to speak with her nurse manager, an experienced rehabilitation nurse who seemed not 3663_Chapter 1_0003-0016.indd 33663_Chapter 1_0003-0016.indd 3 9/15/2014 4:36:35 PM9/15/2014 4:36:35 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 4 unit 1 ■ Professional Considerations only approachable but also open to new ideas. “I have been so busy getting our new electronic health record system on line before the surveyors come that I wasn’t paying attention to that,” the nurse manager told her. “I’m glad you brought it to my attention.” Billie’s nurse manager raised the issue at the next executive meeting, giving credit to Billie for having brought it to her attention. The other nurse manag- ers had the same response. “We were so focused on the new electronic health record system that we overlooked that. We need to take care of this situa- tion as soon as possible. Billie Thomas has leadership potential.” Leadership Defined Successful nurse leaders are those who engage others to work together effectively in pursuit of a shared goal. Examples of shared goals in nursing would be providing excellent care, reducing infec- tion rates, designing cost-saving procedures, or challenging the ethics of a new policy. Leadership is a much broader concept than is management. Although managers need to be leaders, management itself is focused specifically on achievement of organizational goals. Leadership, on the other hand: . . . occurs whenever one person attempts to influence the behavior of an individual or group—up, down, or sideways in the organization—regardless of the reason. It may be for personal goals or for the goals of others, and these goals may or may not be congru- ent with organizational goals. Leadership is influ- ence (Hersey & Campbell, 2004, p. 12). In order to lead, one must develop three important competencies: (1) diagnose: ability to understand the situation you want to influence, (2) adapt: make changes that will close the gap between the current situation and what you are hoping to achieve, and (3) communicate. No matter how much you diag- nose or adapt, if you cannot communicate effec- tively, you will probably not meet your goal (Hersey & Campbell, 2004). What Makes a Person a Leader? Leadership Theories There are many different ideas about how a person becomes a good leader. Despite years of research on this subject, no one idea has emerged as the clear winner. The reason for this may be that different qualities and behaviors are most important in dif- ferent situations. In nursing, for example, some situations require quick thinking and fast action. Others require time to figure out the best solution to a complicated problem. Different leadership qualities and behaviors are needed in these two instances. The result is that there is not yet a single best answer to the question, “What makes a person a leader?” Consider some of the best-known leadership theories and the many qualities and behaviors that have been identified as those of the effective nurse leader (Pavitt, 1999; Tappen, 2001): Trait Theories At one time or another, you have probably heard someone say, “She’s a born leader.” Many believe that some people are natural leaders, while others are not. It is true that leadership may come more easily to some than to others, but everyone can be a leader, given the necessary knowledge and skill. An important 5-year study of 90 outstanding leaders by Warren Bennis published in 1984 identi- fied four common traits. These traits hold true today: 1. Management of attention. These leaders communicated a sense of goal direction that attracted followers. 2. Management of meaning. These leaders created and communicated meaning and purpose. 3. Management of trust. These leaders demonstrated reliability and consistency. 4. Management of self. These leaders knew themselves well and worked within their strengths and weaknesses (Bennis, 1984). Behavioral Theories The behavioral theories focus on what the leader does. One of the most influential behavioral theo- ries is concerned with leadership style (White & Lippitt, 1960) (Table 1-1). The three styles are: 1. Autocratic leadership (also called directive, controlling, or authoritarian). The autocratic leader gives orders and makes decisions for the group. For example, when a decision needs to be made, an autocratic leader says, “I’ve decided that this is the way we’re going to solve our 3663_Chapter 1_0003-0016.indd 43663_Chapter 1_0003-0016.indd 4 9/15/2014 4:36:37 PM9/15/2014 4:36:37 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black chapter 1 ■ Leadership and Followership 5 problem.” Although this is an efficient way to run things, it squelches creativity and may reduce team member motivation. 2. Democratic leadership (also called participative). Democratic leaders share leadership. Important plans and decisions are made with the team (Chrispeels, 2004). Although this appears to be a less efficient way to run things, it is more flexible and usually increases motivation and creativity. In fact, involving team members, giving them “permission to think, speak and act” brings out the best in them and makes them more productive, not less (Wiseman & McKeown, 2010, p. 3). Decisions may take longer to make, but once made everyone supports them (Buchanan, 2011). 3. Laissez-faire leadership (also called permissive or nondirective). The laissez-faire (“let someone do”) leader does very little planning or decision making and fails to encourage others to do it. It is really a lack of leadership. For example, when a decision needs to be made, a laissez- faire leader may postpone making the decision or never make the decision at all. In most instances, the laissez-faire leader leaves people feeling confused and frustrated because there is no goal, no guidance, and no direction. Some mature, self-motivated individuals thrive under laissez-faire leadership because they need little direction. Most people, however, flounder under this kind of leadership. Pavitt summed up the differences among these three styles: a democratic leader tries to move the group toward its goals; an autocratic leader tries to move the group toward the leader’s goals; and a laissez-faire leader makes no attempt to move the group (1999, pp. 330ff ). Task Versus Relationship Another important distinction is between a task focus and a relationship focus (Blake, Mouton, & Tapper, 1981). Some nurses emphasize the tasks (e.g., administering medication, completing patient records) and fail to recognize that interpersonal relationships (e.g., attitude of physicians toward nursing staff, treatment of housekeeping staff by nurses) affect the morale and productivity of employees. Others focus on the interpersonal aspects and ignore the quality of the job being done as long as people get along with each other. The most effective leader is able to balance the two, attending to both the task and the relationship aspects of working together. Motivation Theories The concept of motivation seems simple: we will act to get what we want but avoid whatever we don’t want to do. However, motivation is still sur- rounded in mystery. The study of motivation as a focus of leadership began in the 1920s with the historic Hawthorne studies. Several experi- ments were conducted to see if increasing light and, later, improving other working conditions would increase the productivity of workers in the Haw- thorne, Illinois, electrical plant. This proved to be true, but then something curious happened: when the improvements were taken away, the workers continued to show increased productivity. The researchers concluded that the explanation was found not in the conditions of the experiments but in the attention given to the workers by the experimenters. table 1-1 Comparison of Autocratic, Democratic, and Laissez-Faire Leadership Styles Autocratic Democratic Laissez-Faire Amount of freedom Little freedom Moderate freedom Much freedom Amount of control High control Moderate control Little control Decision making By the leader Leader and group together By the group or by no one Leader activity level High High Minimal Assumption of responsibility Leader Shared Abdicated Output of the group High quantity, good quality Creative, high quality Variable, may be poor quality Efficiency Very efficient Less efficient than autocratic style Inefficient Source: Adapted from White, R.K., & Lippitt, R. (1960). Autocracy and democracy: An experimental inquiry. New York: Harper & Row. 3663_Chapter 1_0003-0016.indd 53663_Chapter 1_0003-0016.indd 5 9/15/2014 4:36:37 PM9/15/2014 4:36:37 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 6 unit 1 ■ Professional Considerations Frederick Herzberg and David McClelland also studied factors that motivated workers in the work- place. Their findings are similar to the elements in Maslow’s Hierarchy of Needs. Table 1-2 summa- rizes these three historical motivation theories that continue to be used by leaders today (Herzberg, 1966; Herzberg, Mausner, & Snyderman, 1959; Maslow, 1970; McClelland, 1961). Emotional Intelligence The relationship aspects of leadership are also the focus of the work on emotional intelligence and leadership (Goleman, Boyatzes, & McKee, 2002). From the perspective of emotional intelligence, what distinguishes ordinary leaders from leadership “stars” is that the “stars” are consciously addressing the effect of people’s feelings on the team’s emo- tional reality. How is this done? First, the emotionally intel- ligent leader recognizes and understands his or her own emotions. When a crisis occurs, he or she is able to manage them, channel them, stay calm and clearheaded, and suspend judgment until all the facts are in (Baggett & Baggett, 2005). Second, the emotionally intelligent leader welcomes constructive criticism, asks for help when needed, can juggle multiple demands with- out losing focus, and can turn problems into opportunities. Third, the emotionally intelligent leader listens attentively to others, recognizes unspoken concerns, acknowledges others’ perspectives, and brings people together in an atmosphere of respect, coop- eration, collegiality, and helpfulness so they can direct their energies toward achieving the team’s goals. “The enthusiastic, caring, and supportive leader generates those same feelings throughout the team,” wrote Porter-O’Grady of the emotionally intelligent leader (2003, p. 109). Situational Theories People and leadership situations are far more complex than the early theories recognized. Situa- tions can also change rapidly, requiring more complex theories to explain leadership (Bennis, Spreitzer, & Cummings, 2001). Instead of assuming that one particular approach works in all situations, situational theories recog- nize the complexity of work situations and encour- age the leader to consider many factors when deciding what action to take. Adaptability is the key to the situational approach (McNichol, 2000). Situational theories emphasize the importance of understanding all the factors that affect a par- ticular group of people in a particular environment. The most well-known is the Situational Leader- ship Model by Dr. Paul Hersey. The appeal of this model is that it focuses on the task and the follower. table 1-2 Leading Motivation Theories Theory Summary of Motivation Requirements Maslow, 1954 Categories of Need: Lower needs (listed first below) must be fulfilled before others are activated. Physiological Safety Belongingness Esteem Self-actualization Herzberg, 1959 Two factors that influence motivation. The absence of hygiene factors can create job dissatisfaction, but their presence does not motivate or increase satisfaction. 1. Hygiene factors: Company policy, supervision, interpersonal relations, working conditions, salary 2. Motivators: Achievement, recognition, the work itself, responsibility, advancement McClelland, 1961 Motivation results from three dominant needs. Usually all three needs are present in each individual but vary in importance depending on the position a person has in the workplace. Needs are also shaped over time by culture and experience. 1. Need for achievement: Performing tasks on a challenging and high level 2. Need for affiliation: Good relationships with others 3. Need for power: Being in charge Source: Adapted from Hersey, P., & Campbell, R. (2004). Leadership: A behavioral science approach. Calif.: Leadership Studies Publishing. 3663_Chapter 1_0003-0016.indd 63663_Chapter 1_0003-0016.indd 6 9/15/2014 4:36:37 PM9/15/2014 4:36:37 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black chapter 1 ■ Leadership and Followership 7 The key is to marry the readiness of the follower with the tasks at hand. “Readiness is defined as the extent to which a follower demonstrates the ability and willingness to accomplish a specific task” (Hersey & Campbell, 2004, p. 114). “The leader needs to spell out the duties and responsibilities of the individual and the group” (Hersey & Campbell, 2004). Followers’ readiness levels can range from unable, unwilling, and insecure to able, willing, and confi- dent. The leader’s behavior will focus on appropri- ately fulfilling the followers’ needs, which are identified by their readiness level and the task. Leader behaviors will range from telling, guid- ing, and directing to delegating, observing, and monitoring. Where did you fall in this model during your first clinical rotation? Compare this with where you are now. In the beginning, the clinical instructor gave you clear instructions, closely guiding and directing you. Now, she or he is most likely delegat- ing, observing, and monitoring. As you move into your first nursing position, you may return to the needing, guiding, and directing stage. But, you may soon become a leader/instructor for new nursing students, guiding and directing them. Transformational Leadership Although the situational theories were an improve- ment over earlier theories, there was still something missing. Meaning, inspiration, and vision were not given enough attention (Tappen, 2001). These are the distinguishing features of transformational leadership. The transformational theory of leadership emphasizes that people need a sense of mission that goes beyond good interpersonal relationships or an appropriate reward for a job well done (Bass & Avolio, 1993). This is especially true in nursing. Caring for people, sick or well, is the goal of the profession. Most people chose nursing in order to do something for the good of humankind; this is their vision. One responsibility of nursing leader- ship is to help nurses see how their work helps them achieve their vision. Transformational leaders can communicate their vision in a manner that is so meaningful and excit- ing that it reduces negativity (Leach, 2005) and inspires commitment in the people with whom they work (Trofino, 1995). Dr. Martin Luther King Jr. had a vision for America: “I have a dream that one day my children will be judged by the content of their character, not the color of their skin” (quoted by Blanchard & Miller, 2007, p. 1). A great leader shares his or her vision with his followers. You can do the same with your colleagues and team. If suc- cessful, the goals of the leader and staff will “become fused, creating unity, wholeness, and a collective purpose” (Barker, 1992, p. 42). See Box 1-1 for an example of a leader with visionary goals. Moral Leadership A series of highly publicized corporate scandals redirected attention to the values and ethics that underlie the practice of leadership as well as that of patient care (Dantley, 2005). Moral leadership involves deciding how one ought to remain … Health systems and nursing in the future Top of Form Critical thinking and reflection: Having listened to at least one episode or more of the podcast series The Future of Nursing 2020-2030 by the National Academy of Medicine, please respond to the following questions: 1. Which podcast(s) did you listen to and why did you choose these topics? What are two things from the podcast(s) that were new information to you? 2. How did the podcast(s) you listened to change your perspective on your future in the nursing profession? How will you change your clinical practice or your plans for a future career based on what you learned? 3. Do you feel hopeful for the impact on nursing on health equity and the improvement of health outcomes? If yes, what makes you hopeful? If no, why not? Bottom of Form INSTRUCTIONS: ANSWER QUESTIONS 1,2,3, USING THE PODCAST (EPISODE 7) AND THE BOOK. PLEASE USE THE BOOK TO CITE 6th edition: Weiss & Tappen (2015) pp. 151-158, 162-166, 239-244. (please cite using APA 7th edition) Please use only my references for in text citation thanks FON Strengthen-Final Transcript Page 1 of 8 The Future of Nursing Podcast - National Academy of Medicine (nam.edu) Dr. Sharmaine Lawson (00:15): West Virginia has a history of poor health outcomes. Many people experience food insecurity and financial instability. West Virginia is rural, and this makes it difficult for people to find transportation that allows them to access care. The COVID-19 pandemic only magnified these problems. Angela Gray is a public health nurse whos worked in West Virginia for over 15 years. Shes now the Nursing Director for the Berkeley and Morgan County Health Departments. Angela grew up in Morgan County, West Virginia, and shes seen these poor health outcomes unfold, but she had never seen an emergency quite like the global pandemic. Angela Gray (00:58): I felt that we had done all these drills. Ive been through H1N1, through mass vaccination in the past, but nothing compared to this. There were several key points that I know where I thought they didnt prepare us for this. When New York got hit so hard and you saw the refrigerator trucks come out for the bodies, I knew that would happen. That was in our training to expect that. It was very surreal to see it happen, believe me. Dr. Sharmaine Lawson (01:30): From the start of 2020 up through 2021, nurses underwent some of the most intense moments in nursing history with the COVID-19 pandemic. They worked hours upon hours to protect the public, and often at risk of their own physical and mental health. In this episode, we are going to hear from frontline nurses about their experiences and together, we are going to explore how nurses can be strengthened, prepared, and protected for when the next emergency strikes. This is the Future of Nursing, a series from the National Academy of Medicine, based on the recently published report, The Future of Nursing 2020 to 2030, charting a path to achieve health equity. Im Dr. Sharmaine Lawson. At first, when the pandemic began, Angela Gray saw glimpses of hope. Angela Gray (02:33): In the beginning, it was ... really restored your faith in humanity as you saw the country come together. People were so grateful, and we were calling people who were positive for COVID and helping them and their families through it. Then at one point after a couple months, it was like somebody turned a switch and then people became very angry. We got cussed more in a day just for trying to do our jobs and collect the data points that was required for us to report. Dr. Sharmaine Lawson (03:02): When Angela saw this shift in the public, she knew it would take a big toll on the nursing workforce. Angela Gray (03:09): It was very tough in that transition of, oh my gosh, were the people here that are trying to help you, and theyre blaming us because were the ones that are out there trying to make sure the guidelines are being met and the recommendations are being met. So yeah, it was very difficult and it really hit our mental health. By October of 2020, I had four staff members that disclosed that they had to go to their EPISODE 7 https://nam.edu/the-future-of-nursing-podcast/ https://www.rev.com/transcript-editor/Edit?token=zkwhBwwk7lu8zyYn4xJ31aLY-qxuaMsvvmHULHZQ6LD6KSsQJIJV5weZtfe2071qsnnTy6L1fRw3nXAnSNpfOaM4CQY&loadFrom=DocumentDeeplink&ts=15.77 https://www.rev.com/transcript-editor/Edit?token=x4X4DH4EXtqWr77h2vrSyZjuF557kuDHnzbAVlkbdm-nyglXUJsiFGsXQRSMh6PTngZQ_Y5nuvdlsK_AWRwv4dtwhFU&loadFrom=DocumentDeeplink&ts=58.26 https://www.rev.com/transcript-editor/Edit?token=NXDcnVIJ9adxdgZSKMo1X0l8LSEXvUe7z7dUlaWQ7SO3bNt9sG-M5z-AMOpM2HAFz_9Ty7yaZzzUBALqhOKZzwW9rnc&loadFrom=DocumentDeeplink&ts=90 https://www.rev.com/transcript-editor/Edit?token=ukeqwnoXn0Khi4dNE3a8RsqSEcEnyRPclDMP2qAAU6rNPnLGR4ROCeV2f0HEoIAXt2L1U46mriQe16b157sivQAP-z0&loadFrom=DocumentDeeplink&ts=153.82 https://www.rev.com/transcript-editor/Edit?token=wtl7Lja6Ju2F1R1c05xPg-iPDvD55Y2OmQcVD6sQfFPmqy94l0dZ4EGM9PuEUeLwft_GFkpjmLbVDlbXqF7d71XSB9o&loadFrom=DocumentDeeplink&ts=182.97 https://www.rev.com/transcript-editor/Edit?token=5vluf4DtmPOD-igpNjiyhtyRYTHv9P-ikk4L9Iv3hGmKrupKbily2XMC9FcWP9lhrENA5gY-Yy5CXO-PyWnrvEklXRY&loadFrom=DocumentDeeplink&ts=189.68 FON Strengthen-Final Transcript Page 2 of 8 physician to get on anti-anxiety medication or medications to help them sleep. That was just the staff members that disclosed to me. So I try to advocate for us here. Dr. Sharmaine Lawson (03:48): Backlash from the public was one reason why nurses mental health suffered. It wasnt just their mental health that suffered, but their physical health as well. Angela Gray (03:58): By that time in September, they had mandated that our National Guard be off two days a week because they had already seen the stress under them, but nobody was advocating for us. Im like, Look, were working seven days a week for months on end, 12 and 16 plus hour shifts. Were taking on so much. I said we cant continue these long stretches like this. Youre not going to have any of us left. So then they, our administrator, stuck up for us and said, okay, Im going to mandate everybody have off two days. So some people got that. Some of us didnt because even if you were supposed to be off, your phone never stopped. You just could not get away from it. It was literally consumed every aspect of your life. Dr. Sharmaine Lawson (04:44): Nurses across the country were fatigued. They couldnt always just rest from their duties. They put their own health and wellbeing at risk to protect the public. Dr. Michael McGinnis is the Leonard D. Schaeffer Executive Officer of the National Academy of Medicine. We heard from him in an earlier episode. Dr. McGinnis watched as nurses, Physical and mental health went under extreme pressure, and he discovered something that was concerning. Most nurses did not feel prepared for this. Dr. Michael McGinnis (05:16): Nurses were thrown quite abruptly during the COVID-19 pandemic onto very front lines in very hazardous conditions. The effective function of the system was fundamentally anchored to their effectiveness. Yet four out of five nurses, when asked whether they felt equipped and trained adequately to be able to contend with emergency circumstances, whether related to the COVID-19 pandemic, or related to other external threats to the nation, or emergent situations, felt that they didnt have the training. Dr. Sharmaine Lawson (05:56): Public health emergencies can be caused by transmissible diseases, but can also be caused by environmental disasters and mass casualty events. In the past decade, 2.6 billion people around the world have been affected by earthquakes, floods, hurricanes, and other natural disasters. The COVID-19 pandemic is just one example of a public health emergency. When disasters strike, nurses can engage the community and build trust with them. They can educate and protect them. They can also help people prepare and respond. When its time for the community to recover, nurses can help people to foster resilience. Nurses may go through training that prepares them to respond to these emergencies, but often it isnt enough, and many are left unprepared. Dr. Roberta Lavin is a nurse practitioner who spent much of her career on disaster preparedness and response. Shes recognized that there are some https://www.rev.com/transcript-editor/Edit?token=2CEN8-pgrgQNWTl0BpDWQ6TuWogFSDnkNld1JjmriXOr_pnXdoebRpnyHm7ilQws2jpND1eU17sGibqjA-DEG_3gyjI&loadFrom=DocumentDeeplink&ts=228.67 https://www.rev.com/transcript-editor/Edit?token=80F4uqSo21BdSeXUkIPrbzXf7bID7b9eWeKILkU9iP3tb6tcKdPCA4vMFa3YoM_6UZZlJho3claueGHuOyrqsVgDu48&loadFrom=DocumentDeeplink&ts=238.64 https://www.rev.com/transcript-editor/Edit?token=ulIc334Spbnx9SoZ7HgW2-VETyGsqf1M3mpIvzLKOW_S2_dMlipwwyJb3YVFFqu4qgddTB8cYM_5o-N1tLmNKbMWeTU&loadFrom=DocumentDeeplink&ts=284.96 https://www.rev.com/transcript-editor/Edit?token=RuTwjiJgirb4cCZ_lVFn-TfJtuxnBTkrJRpn2MgU0WTo7cUMxOnmc4t1sUmXwcSrXe6GXgXTsNJF1o2JKHYZHzpubho&loadFrom=DocumentDeeplink&ts=316.42 https://www.rev.com/transcript-editor/Edit?token=hBTFVIH4ajcieGlt1LGX3VLM0GaXKhI7GzlDYuNJ3Ez1VvAsjkAkAS7E3M-WFcEjj5Kk9AsU1sHHpq_Ky94IIrBPVgg&loadFrom=DocumentDeeplink&ts=356.93 FON Strengthen-Final Transcript Page 3 of 8 areas in nurses training that demonstrate a lack of preparedness among nurses when it comes to public health emergencies. Dr. Roberta Lavin (07:05): In my discussions with many nurses, Ive been told that theyve had little to no training after graduation from nursing school, and much of the training is provided to those in the emergency department and to administrators, and not to the average nurse on a unit. The second area is lack of serious disaster preparedness planning that involves nurses. The quote that struck me was one that said, We train people to put out a fire, but not how to evacuate the patients during the fire. The same can be said for how we handle infectious diseases. We train people what they should do to handle infectious diseases, but we never have them practice donning and doffing of the PPE that they need to use. Dr. Sharmaine Lawson (08:00): According to Dr. Lavin, we have to act now to really prepare the nursing workforce for disaster response. Dr. Roberta Lavin (08:07): We know that weve always said that this is the time we have learned the lessons from the pandemic. We do after actions and we put the things together and then we say were going to fix them. We said after 9/11 and the anthrax attacks, never again. Then Katrina and Rita came, and we werent prepared. Again, we said never again, and Puerto Rico came, and we werent prepared. We said, never again, and then this pandemic came. Maybe this will be the time that we take the lessons we learn. Dr. Sharmaine Lawson (08:44): Its imperative that we do learn from these lessons because natural and environmental disasters are happening more frequently. Public health emergencies, like the COVID-19 pandemic are inevitable, and our nursing workforce must be prepared, along with our health system, to protect our nurses as they work to protect us. Public health emergencies can take many forms. They can be global, national, or contained in a local community. Prior to the COVID-19 pandemic, Angela Gray had her own experience with other public health emergencies in West Virginia. While these cases happen in West Virginia, they also frequently happen all across the nation. Angela Gray (09:33): Sure, I think the opioid epidemic is a perfect example of a public health crisis in this country, versus something communicable like COVID virus and pandemic. So were always looking at these emergencies, and depending on the research and the data of where the numbers are and the stats are and whats happening, chronic disease in West Virginia is huge rates higher than other parts of the country. Even in the same country, you may be working on different needs based upon your community and what the threats are in your individual communities. It might be the same all the way through the nation. Its just, it can be very different in different areas of the nation. Here in West Virginia, teen pregnancy, chronic disease and illness, diabetes, substance use disorder. We had a huge hepatitis A outbreak that the country usually sees less than 1500 cases in a year. West Virginia usually sees less than 15 cases, and we ended up with 2,500 cases in West Virginia in one year. So that triggers our response of getting out and trying to vaccinate, getting ahead of it, trying to https://www.rev.com/transcript-editor/Edit?token=w0z8H5LJJ4V6LlBhrwKY63-IY6yNGVYQ-2tFPpbwy_zf8LFr_9_rDBhW4lKcGgTb8i-mcYzqq0rX594i7sjKRpASOtA&loadFrom=DocumentDeeplink&ts=425.63 https://www.rev.com/transcript-editor/Edit?token=7SdMtAM3YQ25hTHth-WehsR_w2vaxuEdEMMUuLVGKyxxh-ude8Tn5f8aaL7e_2csduccS7WYzk_5fnK1q1QyIHQBcxs&loadFrom=DocumentDeeplink&ts=480.29 https://www.rev.com/transcript-editor/Edit?token=LFr_SpI0_ELj3CNlYOczBppKB468QH4UQh8bAFdLnnMEJifa85FDT0fbwMl99RLCQNmIWme_0NX0fRMSIscPMFvVYMg&loadFrom=DocumentDeeplink&ts=487.63 https://www.rev.com/transcript-editor/Edit?token=GO6EjwTRB-JXpKPVkbKiCL0oP_kDnQ1K_3xUrHnLK-GQbi1fQSs8L8261kRDj_iD3KRMHZHT7fDQjKzHKM8JCjQkuJs&loadFrom=DocumentDeeplink&ts=524.17 https://www.rev.com/transcript-editor/Edit?token=H9E8xtTSh9bRewLjh_rO_y2tUBE02Hb6CjsIovq-l1NSKYcj8f0k_AcmwS4rkDX1KTvb8cE5-764-STKQSdVEj6pUPU&loadFrom=DocumentDeeplink&ts=573.76 FON Strengthen-Final Transcript Page 4 of 8 contain it. So lots of emergencies, and then also down to we would respond and support our other community entities if it would be a water spill or a contamination of water on the environmental side of public health. Theres multiple things that were doing behind the scenes every day, protecting our communities so everybody can go about their way and feel safe. Dr. Sharmaine Lawson (10:59): When nurses are equipped to respond to disasters and other public health emergencies, communities can become safer and care can be delivered even in the midst of a crisis. But as of right now, many nurses admit they do not feel equipped to respond to these kinds of events. Because they are not prepared for disaster and public health emergency response, rapid action is needed. So what can be done? First nurses and nursing leaders must understand what their roles are in public health emergencies and natural disasters, training programs should consistently address what these roles are, so that when a public emergency occurs, nurses can be confident of how they are expected to respond. We also need reform in nursing education, practice, policy, and research to address the gaps in nursing disaster preparedness. We need experts from nurses to researchers to develop a national strategic plan that then addresses these gaps, figures out how they can be solved, and whose responsibility it is to implement new strategies. This action is especially important as nurses are often addressing health inequities while responding to public emergencies. With preparation, nurses may feel more confident in their ability to respond to crises. We can never fully mitigate the stress that public health emergencies can cause for nurses, but we can work to lessen the trauma they may experience due to the disaster. Derek DeSilva is a young intensive care unit nurse who practices at a hospital in Austin. Derek had begun working on the ICU floor just a few months before the COVID-19 pandemic began. He felt like he had a good grasp on how the floor worked. He had even gone through some emergency preparedness curriculum in nursing school. But then everything changed and he realized he wasnt prepared for this at all. Derek DeSilva (13:05): Whether that be in nursing school, hospital staff, people, disaster management organizers, the idea of a widespread pandemic wasnt something that we were prepared for, really coached about, or given any extra resources. Dr. Sharmaine Lawson (13:20): Positive cases of COVID began increasing. As the ICU began to fill with COVID patients, Derek watched as existing health inequities were magnified. Derek DeSilva (13:31): I definitely noticed quite a few of these health disparities. Typically, they surround around having health insurance. Some patients would massively benefit from being able to transfer to more specific facilities, or being able to be eligible for certain medical treatments that they simply did not get access to because they didnt have health insurance. Where we had them, as as much of their health that we could rebuild in in our unit, thats as good as they were going to get, because without insurance, they werent going to be able to transfer to that facility. So these patients were basically stuck in our ICU. They couldnt progress to the level of care that they absolutely could and would need simply because they did not have health insurance, and it would not approve for these life bettering, life saving procedures. https://www.rev.com/transcript-editor/Edit?token=5YgTWJXk9CUlIkhqNq0UP37IgbsimoPCf8lrWuqJyUAzElPo4VoTpL18jEHsk9_SO-LgsBv3cbyBk_2qndZ9YIoEqdI&loadFrom=DocumentDeeplink&ts=659.12 https://www.rev.com/transcript-editor/Edit?token=AyKml67Qngrb-06pMtURXVCyZjrZbrDgl_9ClThVeADm0pwmmUzpdwBmhMavj9enK9qRSUKh53y2FxswSo4mbN6eVjM&loadFrom=DocumentDeeplink&ts=785.97 https://www.rev.com/transcript-editor/Edit?token=tbhSS5HGO-kAfaQd0dhoiH5oX_V9j12PuJbTt81syFLxlkaeJ0ro3JDrbCX10S2jMI2HGzhYu_h82rTNpH0s_Cgg-wQ&loadFrom=DocumentDeeplink&ts=800.17 https://www.rev.com/transcript-editor/Edit?token=kbtJjoMnVp5O_tpaNOmyanj-azwMH9mhkRW6fwrOx6h5qLakD_ETcSQeEw4msLDMZyG2XUHlc4uG08szbubId00pFqY&loadFrom=DocumentDeeplink&ts=811.33 FON Strengthen-Final Transcript Page 5 of 8 Before maybe not having insurance would be missing out on an opportunity to maybe gain more mobility, or have some specialized training to maybe learn how to eat again after a stroke. But during the COVID-19 pandemic, not having insurance for some people meant that they were going to die. Dr. Sharmaine Lawson (14:49): Derek and nurses across the world witnessed devastating outcomes due to this pandemic. Many nurses were often the ones who held the hand of a dying individual. Theyd call family members of patients so they could say their last goodbyes. Some nurses even sang a last song for the patients who would not be leaving the hospital. These were often just short, significant moments, and nurses often had to quickly move on to assist another individual. Nurses were not prepared for the trauma that came from witnessing these terrible outcomes. Health systems quickly realized that their nurses were under incredible pressure. They worked to provide resources to support their nurses through these intense and very sad moments. Derek DeSilva (15:37): Our hospital system was actually really good about providing some mental health services, about providing some outlets. We got free basically telehealth counseling sessions to be able to talk about it. A lot of people, a lot of nurses, a lot of medical professionals were able to just get together after some shifts and talk about some things, but it was nice to know that there was at least some support and it was totally free. You got to use those, and Ive got quite a few colleagues who were able to use these telehealth counseling sessions or mental health sessions, or so to be able to just decompress and talk about some of the things, talk about everything that happened. Dr. Sharmaine Lawson (16:27): This support was helpful and helped to ease some of the burden nurses experienced. But it didnt take this burden completely away, and not all health systems and employers were prepared or equipped to guide nurses through this time long term. Derek DeSilva (16:43): It was good to get some support from management, but at the same time, it wasnt like management could give you a break. It wasnt like the hospital suddenly stopped when you got burnt out. They were still asking for extra shifts. They were still asking for people to come in and pick up extra, like I said, all the way to even January of 2021. So it was good that there was some support. There was some ways to talk about things, but getting burned out was a very real thing for a lot of nurses. It almost seems like thats the kind of support that we needed more. But things changed early on, early March to July, March to August. Having someone to talk to that was the biggest thing after that second wave. Like I said, at least in Austin area, a second wave happened around July. Having more resources and more personnel wouldve been the next kind of support, I think, that a lot of people were looking for, just because of how burned out everyone was getting from picking up so much extra. Maybe during these situations, people are going to be dying every day. Thats the reality, and I feel like we are so desensitized to that now. Were ready for a situation like that. But talking about it, I mean, we in nursing school, in hospital orientation, I think we get some information about make sure you do self-care, make sure youre checking in with yourself, but even going to the ICU, it doesnt seem like theres a lot of real preparation. I think the same could be said for the emergency department https://www.rev.com/transcript-editor/Edit?token=H7ds3NOwVQfgcSSVX1QE0-peAP1ahcBJIryhQBAMiVGjxHXL-LPvg-JiS3bhKgM_xWQ7T1U22TNPQUAZtQV4rXV_Zhw&loadFrom=DocumentDeeplink&ts=889.04 https://www.rev.com/transcript-editor/Edit?token=uPcX1kYJplNR6enM80C41hqH5O0Nrn6WIGMTxXoyEdQCyGnWlf7lhi2dLlmxfC5mdErXqcJ8lscTIbN8UkfA8g2q4HQ&loadFrom=DocumentDeeplink&ts=937.42 https://www.rev.com/transcript-editor/Edit?token=_JNRLUVPJjQ_LNVkGpL1F0XWk4YwFtiAUEL7D2rr-q0fnWV4uCC9mgdf5z6t8MAgpIlbi-WJIQGpUV1bLn8FehB6Jmo&loadFrom=DocumentDeeplink&ts=987.38 https://www.rev.com/transcript-editor/Edit?token=UhIIYysp-xKvsPgaovBKQis8V7cDCk2ftTKH7N_Xgr8NXq757qtpVjnQ55nmqmCzINulLDfWPFYewKlAs6o5qRs8t54&loadFrom=DocumentDeeplink&ts=1003.23 FON Strengthen-Final Transcript Page 6 of 8 as well. Theres some stuff youre going to see there, and people are going to die in those places. Is there really a way to prepare you for that? Dr. Sharmaine Lawson (18:38): Providing resources for counseling and support is beneficial, but hospitals and health systems must also have a systematic approach to support their nurses when a public health emergency begins. In an earlier episode, we talked with Frank Boz. Frank is a nurse in the cardiothoracic intensive care unit. In our episode on supporting nurses, Frank shared how the leadership at his hospital supported him in an unexpected way. This kind of support may have cost the hospital resources, or required them to change policies, but it gave nurses a voice. It gave them a chance to better understand what to expect as procedures shifted. In our supporting nurses episode, we also talk with Marcus Henderson, who is a practicing psychiatric mental health nurse and member of The Future of Nursing 2020-2030 consensus study committee. During the pandemic, Marcus saw that it was critical for hospitals to invest resources in finding creative solutions to protect and support nurses during public health emergencies. Marcus Henderson (19:42): Theres a lot of work to be done if less than 10\% of hospitals have bit the bullet to say, Were going to show that we invest in nursing. So I think there is still a lot of work to be done. It comes in pockets, and I think COVID has shown us that these workforce issues related to staffing shortages, burnout, resourcing have not gone away, and in some places have exacerbated greatly because of the challenges that COVID has imposed. But I think it has shown us the creative solutions that can be developed. But I do think there is much work to be done. I mean, its crazy to think that when a nurse reaches out for help and support, for example, reaching out for mental health support, that theyre penalized and their ability to function at as a nurse is called into question. Rather than providing that nurse with the support that they reached out for to do their job better and to progress. So we have to change the whole framework and the whole culture around support and wellbeing, because people see nurses that reach out for support as a deficiency and not an area for growth. Dr. Sharmaine Lawson (20:57): Derek DeSilva found that there was yet another specific kind of support nurses really needed, especially since for many nurses, a public health emergency is only one example of a situation that might cause trauma for nurses. Outside of emergencies, nurses still encounter emotional and difficult situations, whether in the ICU or another floor in the hospital or in a public health setting. Derek DeSilva (21:21): I think the biggest thing that would help nurses is other nurses. I think the biggest way that I learned, and for a lot of other nurses as well, is getting to talk with some nurses who have experience, who have lived through some of these situations. Saying, Yeah, I was working, like I said, 50, 60 hour weeks for an entire month, and I got ... I started getting burned out, and talking about burnout. This is something that happens with new nurses all the time. Being able to talk with someone who had the same experience, who was a young nurse at one point as well, and have seen many other nurses make similar mistakes or go down a similar path, and I found that to be valuable. Having other nurses, having experienced nurses who have gone through similar situations talk to you, or talk to newer nurses and https://www.rev.com/transcript-editor/Edit?token=EUHBycPnf41TbH1x69WEAQ-W5U5L2y0SZ8gMgKPiV8NOtYnUD_HW7kEqwt2Ta2nvziwzWROD3DmN6ROvrXsjj8zvgoE&loadFrom=DocumentDeeplink&ts=1118.33 https://www.rev.com/transcript-editor/Edit?token=IS4T9TWTIX79-LRiKPYYGwQL5_VTk_QsskZX0t1ECPWLNKcQ8LiUXim07b0gfSXx2IBY274tHVQ4iL7wlIKTWflIB58&loadFrom=DocumentDeeplink&ts=1182.31 https://www.rev.com/transcript-editor/Edit?token=KPuYzZrQoHUPqwjO6jHD0MmH0flJADoQ_uF1j8Wqfp67erEHY0A4OCqquhZVX9QOEQW7S72jtRgq1-_Vw3v4oSmWbAo&loadFrom=DocumentDeeplink&ts=1257.61 https://www.rev.com/transcript-editor/Edit?token=fo9AYU00sPEd9jKsMh3DYbPngEWxUNFn-pYC7gmmr7YzIy9rO27WzYt_x8csnJAQ9wCss1CBQ4qqpEAbdpw1J7Wx8kg&loadFrom=DocumentDeeplink&ts=1281.49 FON Strengthen-Final Transcript Page 7 of 8 say, Hey, these are the things to look out for. Watch out when you feel yourself starting to feel more upset or not excited to come into work. Be mindful that its more about the patients. I think in one sense, maybe in nursing school, having nursing students talk with individuals who have gone some of those situations, some of those public health emergencies, I think it would be extremely valuable. Dr. Sharmaine Lawson (22:35): Or Derek, this was one way he knew nurses could be protected through public health emergencies specifically by supporting each other. But there was something else nurses needed, especially during the pandemic, as policies and guidelines frequently shifted. Derek DeSilva (22:51): A lot of what we do, pretty much everything we do has 10, 20 years, quite a few decades of best practices that have only been improved upon as the years, as the decades have gone on. To have something that we dont have best practices for, that it seems like were making and things up as were going along, I think that scared people. I think what could be done in the future to mitigate the fear that nurses had with all of these changing procedures is to use what weve learned from this last pandemic. To be honest that when something new comes up, when something outside of our scope of expectation and preparation comes up, that they need to expect some of the procedures to change as the science evolves. Dr. Sharmaine Lawson (23:38): Nurses around the nation, even around the world now understand that when an emergency like a pandemic is occurring, procedures are guaranteed to change. Education and training should prepare nurses for these changes so they can know to expect them and move forward with confidence. This is just one example of the many lessons learned from the COVID-19 pandemic. Like Dr. Lavin mentioned earlier, this time, we must take these lessons into consideration and act on them. Derek DeSilva (24:09): Hey, if this happens, were going to try to call and retain these nurses, or something to that extent, giving a little bit more importance on the fact that something like this could be possible. We do CPR training every two year years. We re-up that CPR training every two years, and we stay keen. We know exactly what were looking for, and we get a refresher. We do fire drills now almost monthly. So I think incorporating this, and talking to newer nurses, and incorporating this in hospital orientation could have the chance to just make it seem a little less scary and give people a little bit more understanding as far as the expectations. Youre not going to have 100\% premonition of whats going to happen, but at least having some idea of expectations going in, I think might do wonders for the new generation of nurses who are just coming to the field. Dr. Sharmaine Lawson (25:07): We have to understand that by strengthening and preparing nurses to respond to the next emergency, we are also protecting them. The physical risk cant always be taken away, but they can be mitigated when we equip our nurses to be confident in their knowledge, skills, and resilience. https://www.rev.com/transcript-editor/Edit?token=FlWNdBCXJUZfMiJC2HaZe47VhR59SG6pR4TjLzfGhDe8mOs06mTHWMDBhhOnPvTnScabBaHlTqPH3U7HgYqMN1qq7Nw&loadFrom=DocumentDeeplink&ts=1355.2 https://www.rev.com/transcript-editor/Edit?token=W2Pc3v1RkGA3jTcHDG8RieQA4JiyNevQynmvw4QsO1GOV_F797b8gyKxwcrd1ev8ob26SW1jDoVrOSJRc7k5bOKZwUY&loadFrom=DocumentDeeplink&ts=1371.61 …