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INSIDER

JANUARY/FEBRUARY 2021

T H E O F F I C I A L M E M B E R S H I P N E W S P U B L I C AT I O N O F I N F U S I O N N U R S E S S O C I E T Y

Reflections on COVID-19

Embracing Diversity, Equity, and Inclusion

The Role of Limited English Proficiency in Health Disparities

SEPTEMBER/OCTOBER 2021

Volunteer Committee & Speaking Opportunities VOLUME 4

INFUSION NURSES SOCIETY

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ISSUE 5

*Ig=immunoglobulin

Hizentra is an Ig* therapy that provides proven PI protection and CIDP relapse prevention, with the convenience of self-administration, so you can focus on everyday living.

Important Safety Information Hizentra®, Immune Globulin Subcutaneous (Human), 20% Liquid, is a prescription medicine used to treat: • Primary immune deficiency (PI) in patients 2 years and older • Chronic inflammatory demyelinating polyneuropathy (CIDP) in adults WARNING: Thrombosis (blood clots) can occur with immune globulin products, including Hizentra. Risk factors can include: advanced age, prolonged immobilization, a history of blood clotting or hyperviscosity (blood thickness), use of estrogens, installed vascular catheters, and cardiovascular risk factors. If you are at high risk of blood clots, your doctor will prescribe Hizentra at the minimum dose and infusion rate practicable and will monitor for signs of clotting events and hyperviscosity. Always drink sufficient fluids before infusing Hizentra. See your doctor for a full explanation, and the full prescribing information for complete boxed warning.

Treatment with Hizentra might not be possible if your doctor determines you have hyperprolinemia (too much proline in the blood), or are IgA-deficient with antibodies to IgA and a history of hypersensitivity. Tell your doctor if you have previously had a severe allergic reaction (including anaphylaxis) to the administration of human immune globulin. Tell your doctor right away or go to the emergency room if you have hives, trouble breathing, wheezing, dizziness, or fainting. These could be signs of a bad allergic reaction. Inform your doctor of any medications you are taking, as well as any medical conditions you may have had, especially if you have a history of diseases related to the heart or blood vessels, or have been immobile for some time. Inform your physician if you are pregnant or nursing, or plan to become pregnant. Infuse Hizentra under your skin only; do not inject into a blood vessel. Self-administer Hizentra only after having been taught to do so by your doctor or other healthcare professional, and having received dosing instructions for treating your condition.

Please see Brief Summary of full Prescribing Information on reverse.

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Immediately report to your physician any of the following symptoms, which could be signs of serious adverse reactions to Hizentra: • Reduced urination, sudden weight gain, or swelling in your legs (possible signs of a kidney problem). • Pain and/or swelling or discoloration of an arm or leg, unexplained shortness of breath, chest pain or discomfort that worsens on deep breathing, unexplained rapid pulse, or numbness/weakness on one side of the body (possible signs of a blood clot). • Bad headache with nausea; vomiting; stiff neck; fever; and sensitivity to light (possible signs of meningitis). • Brown or red urine; rapid heart rate; yellowing of the skin or eyes; chest pains or breathing trouble; fever over 100°F (possible symptoms of other conditions that require prompt treatment). Hizentra is made from human blood. The risk of transmission of infectious agents, including viruses and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent and its variant (vCJD), cannot be completely eliminated.

The most common side effects in the clinical trials for Hizentra include redness, swelling, itching, and/or bruising at the infusion site; headache; chest, joint or back pain; diarrhea; tiredness; cough; rash; itching; fever, nausea, and vomiting. These are not the only side effects possible. Tell your doctor about any side effect that bothers you or does not go away. Before receiving any vaccine, tell immunizing physician if you have had recent therapy with Hizentra, as effectiveness of the vaccine could be compromised. Please see full prescribing information for Hizentra, including boxed warning and the patient product information. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. You can also report side effects to CSL Behring’s Pharmacovigilance Department at 1-866-915-6958.

Only Hizentra offers the freedom and flexibility of self-administration with prefilled syringes for both PI and CIDP “I used to struggle with drawing Hizentra out of vials, and often I would need to have my husband help me. Now, with prefilled syringes, I can prepare the infusion myself, giving me a greater sense of independence.” —Lynne, Hizentra Patient & Voice2Voice® Advocate* *Voice2Voice advocates are not healthcare professionals or medical experts. For medical questions, please contact your physician. Voice2Voice advocates are compensated by CSL Behring LLC for their time and/or expenses.

Hizentra Connect brings together all our Ig patient support resources under one roof. Get the guidance and support you need with a single phone call today.

Call 1-877-355-4447, Mon–Fri, 8 AM–8 PM ET or learn more at HizentraConnect.com

HIZENTRA®, Immune Globulin Subcutaneous (Human), 20% Liquid Initial US Approval: 2010 BRIEF SUMMARY OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use HIZENTRA safely and effectively. Please see full prescribing information for HIZENTRA, which has a section with information directed specifically to patients. What is HIZENTRA? HIZENTRA is a prescription medicine used to treat primary immune deficiency (PI) and chronic inflammatory demyelinating polyneuropathy (CIDP). Infuse HIZENTRA only after you have been trained by your doctor or healthcare professional. HIZENTRA is to be infused under your skin only. DO NOT inject HIZENTRA into a blood vessel (vein or artery). Who should NOT take HIZENTRA? Do not take HIZENTRA if you have too much proline in your blood (called “hyperprolinemia”) or if you have had reactions to polysorbate 80. Tell your doctor if you have had a serious reaction to other immune globulin medicines or have been told that you have a deficiency of the immunoglobulin called IgA. Tell your doctor if you have a history of heart or blood vessel disease or blood clots, have thick blood, or have been immobile for some time. These things may increase your risk of having a blood clot after using HIZENTRA. Also tell your doctor what drugs you are using, as some drugs, such as those that contain the hormone estrogen (for example, birth control pills), may increase your risk of developing a blood clot. What are possible side effects of HIZENTRA? The most common side effects with HIZENTRA are: • Redness, swelling, itching, and/or bruising at the infusion site • Headache/migraine • Nausea and/or vomiting • Pain (including pain in the chest, back, joints, arms, legs) • Fatigue • Diarrhea • Stomach ache/bloating • Cough, cold or flu symptoms • Rash (including hives)

• Itching • Fever and/or chills • Shortness of breath • Dizziness • Fall • Runny or stuffy nose Tell your doctor right away or go to the emergency room if you have hives, trouble breathing, wheezing, dizziness, or fainting. These could be signs of a bad allergic reaction. Tell your doctor right away if you have any of the following symptoms. They could be signs of a serious problem. • Reduced urination, sudden weight gain, or swelling in your legs. These could be signs of a kidney problem. • Pain and/or swelling of an arm or leg with warmth over the affected area, discoloration of an arm or leg, unexplained shortness of breath, chest pain or discomfort that worsens on deep breathing, unexplained rapid pulse, or numbness or weakness on one side of the body. These could be signs of a blood clot. • Bad headache with nausea, vomiting, stiff neck, fever, and sensitivity to light. These could be signs of a brain swelling called meningitis. • Brown or red urine, fast heart rate, yellow skin or eyes. These could be signs of a blood problem. • Chest pains or trouble breathing. • Fever over 100ºF. This could be a sign of an infection. Tell your doctor about any side effects that concern you. You can ask your doctor to give you more information that is available to healthcare professionals. Please see full prescribing information, including full boxed warning and FDAapproved patient product information. For more information, visit Hizentra.com. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. You can also report side effects to CSL Behring’s Pharmacovigilance Department at 1-866-915-6958.

Based on April 2021 version. Hizentra is manufactured by CSL Behring AG and distributed by CSL Behring LLC. Hizentra® is a registered trademark of CSL Behring AG. Biotherapies for Life® is a registered trademark of CSL Behring LLC. Hizentra ConnectSM is a service mark of CSL Behring LLC. Voice2Voice® is a registered trademark of CSL Behring GmbH. ©2021 CSL Behring LLC 1020 First Avenue, PO Box 61501, King of Prussia, PA 19406-0901 USA www.CSLBehring.com www.Hizentra.com HIZ-0141-MAY21

INS BOARD OF DIRECTORS 2021-2022 PRESIDENT

Sue Weaver, PhD, RN, CRNI®, NEA-BC PRESIDENT-ELECT

Max Holder, MSN, RN, CRNI®, NE-BC SECRETARY/TREASURER

Joan Couden, BSN, RN, CRNI®

INSIDER T H E O F F I C I A L M E M B E R S H I P N E W S P U B L I C AT I O N

PRESIDENTIAL ADVISOR

OF INFUSION NURSES SOCIETY

Angelia Sims, MSN, RN, CRNI®, OCN® DIRECTORS-AT LARGE

Nancy Bowles, MHA, RN, OCN®, CRNI®, NEA-BE, CPC-A Angela Skelton, BSN, RN, CRNI®

INSider encourages the submission of articles, press releases, and other materials for editorial consideration, which are subject to editing and/or

PUBLIC MEMBER

condensation. Such submissions do

John S. Garrett, MD, FACEP

not guarantee publication. If you are

CHIEF EXECUTIVE OFFICER

Mary Alexander, MA, RN, CRNI®, CAE, FAAN

interested in contributing to INSider, please contact the INS Publications Department. Photos become the property of INSider; return requests must be in writing. INSider is an official bimonthly publication of the Infusion Nurses Society.

I N S S TA F F Chief Executive Officer: Mary Alexander, MA, RN, CRNI®, CAE, FAAN Executive Vice President: Chris Hunt Director of Operations and Member Services: Maria Connors, CAE Clinical Education & Publications Manager: Dawn Berndt, DNP, RN, CRNI® Managing Editor: Leslie Nikou Editorial Production Coordinator: Rachel King Director of Clinical Education: Marlene Steinheiser, PhD, RN, CRNI®

INFUSION NURSES SOCIETY

Senior Member Services & Conference Coordinator: Jill Cavanaugh Meetings Manager: Meghan Trupiano, CMP Marketing Project Manager: Whitney Wilkins Hall Certification Manager: Adrienne Segundo, IOM Certification Administrator: Bill Taylor

Senior Certification & Member Services Associate: Maureen Fertitta

Norwood, MA 02062

Member Services Associate: Susan Richberg

(781) 440-9408

Bookkeeper: Cheryl Sylvia

rachel.king@ins1.org

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In this Issue President’s Message: Future of Nursing 2020-2030 Report Recommends Self-Care for Nurses

Embracing Diversity, Equity, and Inclusion to Advance Equal and Effective Care Cover Story: Reflections on COVID-19

Poetry Jennifer (Jen) Reich PhD, MA, RN, NC-BC

CRNI Connection: ®

It’s been a busy summer!

Volunteer Committee Opportunity 2021 Call for NCOE Applicants

Using Malpractice Claims Data to Identify Risks in Nursing Practice to Enhance Patient Safety, Part 2

Speaking Opportunities at the INS 2022 Annual Meeting and Exhibition INSide Scoop: A closer look at what’s going on within INS

Welcome New INS Members: Domestic and International

The Role of Limited English Proficiency in Health Disparities Considerations for Infusion Providers

P R E S I D E N T ’ S

M E S S A G E

Future of Nursing 2020-2030 Report Recommends Self-Care for Nurses Last year began with the World Health Organization (WHO) designating 2020 as the International Year of the Nurse and the Midwife. Then on January 21, 2020, the first case of the 2019 novel coronavirus (COVID-19) was announced in the United States. On March 11, 2020, the WHO declared the COVID-19 outbreak a pandemic. In a year meant to honor nurses and celebrate the bicentennial of Florence Nightingale’s birth, nurses were thrust into caring for patients infected with COVID-19 in unimaginable circumstances.

difference in the lives of patients, health care colleagues, and in the community. Working for their first time in a pandemic, nurses continued to provide quality patient care while often compartmentalizing personal fear and anxiety. As this pandemic unfolded, infusion nurses shared their stories about caring for patients during this unprecedented time:

I was called to the emergency department to place a PICC line in an elderly COVID-19 positive who was a DNR. After we obtained Susan H. Weaver telephone consent from her daughter, we PhD, RN, CRNI®, NEA-BC Infusion nurses in the United States and around donned our PPE and went into the room. Then, the world answered the call to care for patients as I was placing the PICC line the patient’s with COVID-19 in varied settings including hospitals, monitor showed asystole, my colleague checked the homes, outpatient clinics, long-term care facilities, and patient, and I stopped the procedure and removed the testing sites. All nursing roles, including direct care staff, catheter. We stayed with her, and she died within minutes. managers, nurse educators, and researchers, made a We were there.

INSider

One day I went into the room of an IV access patient who had already been in the hospital for two weeks with COVID-19, and now due to complications he would be in the hospital at least another week. As I was working, I began to chat with him like I always do. When I was all done, he looked at me and in his most sincere and thankful voice said, “It’s so nice to talk to someone.” He was lonely! That was it for me. Despite the risks of extended exposure, I hung out with him for another 20 minutes just chatting and laughing. The power of human contact is so important and amazing. This pandemic reminded me how much we need people. The essence of truly caring for patients is so evident in these two stories, published in the May/June 2020 INSider, and in many of the stories contained in this issue of the INSider. But now nurses must address the impact that caring for patients during the COVID-19 pandemic has had on their health and well-being and make self-care a priority. According to the newly released The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report, nursing in the next 10 years will demand a larger, more diversified workforce prepared to provide care in different settings, address the lasting effects of the COVID-19 pandemic, break down structural racism and the root causes of poor health, and respond to future public health emergencies. This report, sponsored by the Robert Wood Johnson Foundation, asserts the importance of nurses’ health and well-being and the impact their wellbeing has on the patient care they provide. The National Academies of Sciences, Engineering, and Medicine Committee in The Future of Nursing 2020–2030 envisioned, “Nurses attend to their own self-care and help to ensure that nurse well-being is addressed in educational and employment settings through the implementation of evidence-based strategies” as one of the ten desired outcomes from this report. Although it may be challenging to follow the American Nurses Association (ANA) code of ethics to “eat a healthy diet, exercise, get sufficient rest, maintain family and personal relationships, engage in adequate leisure and recreational activities, and attend to spiritual or religious needs,” we can start our self-care by focusing on one area. The ANA has a well-being initiative with free tools and apps to support the mental health and resilience of ALL nurses. Additionally, as I mentioned in the July/August 2021 issue of the INSider, INS has partnered with HNHN and encourages infusion nurses to join Healthy Nurse Healthy Nation, which has an abundance of resources and is FREE for all nurses. You do NOT need to be an ANA member to join. During the first wave of the pandemic, in New Jersey we held weekly Zoom meetings for nurses to talk about their experiences caring for patients with COVID-19. A psychiatrist attended each session and reminded us every

week about the importance of self-care, to put on our oxygen mask first, and had us repeat after each session, “I did the best I could during a horrific time.”

In this issue of the INSider, our fellow INS members have shared the following on how they have been practicing self-care and are being KIND to themselves during the pandemic. – Do things you enjoy – Unplug from social media – Get more sleep – Read a good book – Play a musical instrument – Soak in a bubble bath – Spend time outdoors—go for a walk – Being kind to others is being kind to yourself

Enjoy the fall and I hope you can take some time for self-care.

References American Nurses Association (ANA). Code of Ethics for Nurses With Interpretive Statements. 2nd ed. American Nurses Association. 2015. https://www.nursingworld.org/coe-view-only. National Academies of Sciences, Engineering, and Medicine (NASEM). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. The National Academies Press: Washington, DC; 2021. https://doi.org/10.17226/25982. Infusion Nurses Society. INSider. May/June 2020. Washington State Department of Health (DOH). 2019 novel coronavirus outbreak (COVID-19). https://www.doh.wa.gov/emergencies/coronavirus. Published date unknown. World Health Organization (WHO). WHO timeline—COVID-19. https://www.who.int/news-room/detail/08-04-2020-who-timeline--covid-19. Published date unknown.

September/October 2021

Embracing Diversity, Equity, and Inclusion to Advance Equal and Effective Care by Ludy Aquino-Lasam, MHA, BSN, RN IV, CRNI®, Jennah Helal, RN, and Danielle R Jenkins, BSN, RN, CRNI® Since 1973, INS has been at the forefront in infusion nursing practice. With an active membership spanning 6 continents, INS serves as a community of infusion nurses around the world, providing a forum for discussion, education, and promotion of best practices. In an effort to ensure as many of these voices as possible are heard, INS developed the Diversity, Equity, and Inclusion Task Force (DEI Task Force).

what we can do as an organization to address issues around diversity, equity, and inclusion. The DEI Task Force recently surveyed INS members on racial prejudice as the first attempt to begin the sometimes-uncomfortable conversation on racism. The goal of this enquiry was to take the first fundamental step in the nursing process, an assessment with open-ended questions.

The DEI Task Force was formed to promote diversity, equity, and inclusiveness as an organization and in the larger community. We want to embrace and accept our differences, to respect all people without prejudice, to do what is fair in order to achieve the best outcome, and to ensure that our organization honors all thoughts and ideas, respects uniqueness, and brings a sense of belonging to the INS community. Inclusiveness is one of the core values of INS; we are committed to listening to the diverse voices within the infusion nursing community.

In the survey, we asked, “How has racial prejudice impacted you personally and/or professionally?” Answers from INS members ranged from anger to candid reflection to baring of painful memories to snide comments. There were several angry reactions, and some even questioned how this question has anything to do with infusion nursing. 43% of responses were negative, 31% were neutral, 13% positive, and 13% mixed.

The DEI Task Force would like to create programs that service and address areas that negatively impact our members and the communities we serve. Advocating for the public, including those in marginalized communities, is part of our mission. In following the ANA Code of Ethics (2015), we as nurses are obligated “to practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person” (Provision 1) and to collaborate “with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities” (Provision 8).

We would like to thank everyone who submitted a response. We respect each and every voice. We also want to let you know that whether or not one is affected, we cannot deny that racial prejudice has happened, is happening, and will continue to happen if we will not acknowledge it and act against it. Sometimes from a fear that arises out of a risk of perceived loss, we cover up racism, call it “fixed” like it never happened or happens. As a nursing organization, it is incumbent upon us to explore what this kind of fear is trying to teach us: it should not silence us out of fear of losing customers or members, but rather invite us to further examination and discussion. The DEI Task Force will continue to prepare, to uncover whether our members have experienced racial prejudice and to address health care disparities that impact the communities we serve nationally and internationally. It is our responsibility to discover, understand, and respect one another regardless of color, age, status, and religion. Confronting weaknesses is how we grow. Albert Einstein said, “Problems cannot be solved at the same level of awareness that created them.”

In the wake of the death of George Floyd and many other incidents of racial injustice and health care disparities, INS wanted to do our part, to look at our organization to examine whether we are ignoring issues impacting our members and the communities we serve, and to identify

At the same time, cultural competency is nothing new to nursing. We as nurses have recognized discrepancies in health care access and delivery for many years, and have been instrumental in driving patient-centric, culturally sensitive care long before it became the social hot button

The DEI Task Force is comprised of members from multiple countries and various walks of life—different races, different religions, different genders, different orientations, different countries, and different viewpoints—but all with the same goal: to improve the experiences of infusion nurses in order to have a positive impact on infusion patient care.

INSider

it is today. The current heightened social awareness on prejudice and inequality provides the perfect opportunity for us as nurses to advance the cause of cultural competency that we have often longed for. Part of this process needs to be ensuring that our own house is in order. Are there medical staff members who reflect the patient populations they care for? Many patients in marginalized groups are more likely to respond positively to providers who look like them or have a similar background. Are there health care team members who speak languages patients understand? Who understand patients’ spiritual needs and how that impacts their medical beliefs? Who understand the unique biological or social risk factors that may impact patients due to their ethnicity or lifestyle? If we, as the health care provider community, are not ensuring that this diversity exists in our workforce, then the answer is no. When we better serve our own nursing community, we in turn better serve our patients. You can help by utilizing the tools provided by the INS—network with nurses of different backgrounds, read and educate yourself on cultural competency issues impacting the patient populations you encounter, or just be supportive of your coworkers by ensuring a positive and inclusive work environment. A more inclusive and diverse medical and nursing workforce will lend itself to a higher level of cultural competency, trust in health care professionals by marginalized patients, and better patient outcomes. These goals supersede politics, fads, and buzz words. As an advocacy organization that serves a diverse community of practitioners who care for people of all different ethnic and socioeconomic backgrounds, INS is committed to advancing the cause of equality and to join in raising our voices against bias and intolerance. The DEI Task Force wants to ensure that the doors of opportunity in the INS are opened for nurses from marginalized and underserved communities. As we continue to create INS educational assets, we will look for opportunities to address bias and intolerance in health care, and plan and execute meaningful actions. We are professional, educated, and cultured members of an international organization. We network with one another to say discrimination is our past and inclusion is our future! Thank you again for answering our survey and taking the first step toward a conversation on racial prejudice. If you would like to learn more about our DEI Task Force, please contact us at ins@ins1.org. We look forward to an even better Infusion Nurses Society!

INS DEI Task Force Members: Crystal Miller, co-chair

Felicia Schaps, co-chair

Jeanette Adams

Ludy Aquino-Lasam

Marcela Beatty

Tracy Davis

Melanie Eld

Jennifer Helal

Max Holder

Danielle Jenkins

Yvonnie Love

Julio Santiago

Larry Sisei

Jannifer Stovall

Debra Toney

Sue Weaver

INS Convenes a Diversity, Equity, and Inclusion Task Force INS affirms our belief that all people deserve to be treated with dignity and respect. Further, we acknowledge and embrace our obligation to advance equal and effective care for all people. Inclusiveness is one of INS’ core values. We are committed to listening to the diverse voices within the infusion nursing community and we look for opportunities to address bias and intolerance in health care. To ensure that INS is supporting and promoting diversity and inclusion within the infusion community, we have established a standing Diversity, Equity, and Inclusion (DEI) Task Force. Our goal is to plan and execute meaningful actions. The DEI Task Force has identified what Diversity, Equity, and Inclusion means to INS.

Diversity:

Embracing and accepting our differences, respecting all people without prejudice, and practicing health care with reverence for each unique individual.

Equity:

Doing what is fair and just to achieve the best outcome for all people.

Inclusion:

Ensuring that our organization honors the thoughts, ideas and perspectives of each person

September/October 2021

C O V E R

S T O R Y

Reflections on COVID-19 Editor’s Note: This survey was conducted with INS members in late June/early July. As clinicians currently care for patients infected with the Delta variant, some of these answers from only two months ago seem to have come from a more hopeful period. We have confidence cases again will fall, and we appreciate you continuing to share about this pivotal and difficult time.

How did you adjust your practices for COVID-19? And/or how did your workplace adjust their practices and/or regulations? Tracey Campbell, Clinical Specialist: We wore a mask and used additional PPE for protection. If exposed, we required a negative COVID test to return to work or quarantine for 14 days. Lisa Rioux, Nurse Manager: We brought IV pumps outside the patient rooms in the critical-care areas to reduce the number of times and [number of] people who would need to enter the rooms. Anonymous: We took more time to prepare for visits in the home. We assessed from the car and spent minimal time in the home. We donned PPE and prepared prior to the visit. Richelle Hamblin, Director of Nursing: The hospital established specific units for patients diagnosed with COVID. They also had SICU and MICU. The goal was to keep sicker patients in MICU. We also needed overflow for both critical and noncritical patients. Our ER was frequently back-logged and staffing issues were a major concern. Mangers and anyone who could assist were called upon to work at the bedside. I was forced to work a 24-hour shift, 12 hours in management followed by another 12-hour shift in patient care. I did receive an hour break between shifts—I should say I took an hour to eat and prepare myself. Bonuses were paid to staff to work extra hours. We rotated staff to the COVID units, but there was a great deal of pushback from staff and an exemption list was put into place, a short list of staff who were immunocompromised or in direct care of a family member who was immunocompromised. We have a PICC team but their hours did not change. We had no coverage at night or weekends for IV access. Anonymous, Veteran Affairs Nurse: The reuse of PPE and lack of equipment was shocking. Like many, my workplace moved nurses around to work in situation that they were not trained in.

INSider

Julie Ketelhut, Home Infusion Nurse: We screened clients over the phone before we would even consider home visits. Robin Huneke Rosenberg, Nurse/Clinical Investigator: Because I work in a research lab, modifications to my work environment were mandated by executive management level and employee occupational health. Company employees were expected to maintain social-distance. As an employee who still worked in the buildings on campus, I was expected to perform hand hygiene frequently and to always mask and to stay home if any COVID symptoms were to develop. Meeting rooms and cafeterias were closed and most importantly, 75% of the work force began to work remote (and many still do). Our office spaces continue to remain in eerily suspended in a time warp as wall calendars still show "March 2020," and sadly, plants have died from lack of watering. Jennifer Helal, Director of Nursing: Some of us rotated working remotely, and there was a lot of fear in the patient population to contend with. We did phone pre-screening, and PPE became a huge deal. Anonymous: Followed CDC Guidelines. Offered COVID PTO (and negative balances) if staff required to be off for required quarantine. Judith Kay Fogg, Nurse Manager Med/Surg: In the beginning, PPE guided many of our practices. It was ever-changing depending on the supply of each item. Sometimes the amount of time each item could be used changed daily. The good news was we never ran out, and it was effective, as our staff was not getting sick. Available quantities of all items continue to be reported to staff and leadership weekly. At the start of the pandemic, I worked every day for the first 3 months. Staff were anxious and some were totally afraid. I came in to see both shifts daily to reassure my staff. I made rounds on every patient every day including the COVID patients. Staff never needed my support more. I had 2 nurses who were not able to get through and left acute care; however, the rest came through and are stronger for the journey. Susan Knapp, Director of Nurses: We wore masks the entire time inside and outside the office, and N95 and gowns/gloves if we had a COVID-positive patient. Delivery drivers left the delivery on the porch for a “no touch” delivery for all COVID-positive patients. Melissa Reep, Home Care Case Manager: Certainly the use of PPE and wearing masks became more strict. All of our in-home visits were challenging. We also were able to do telehealth visits for patients in home care. Also, some of the regulations with supervisory visits changed, relating to when a patient needed to be seen by their doctor or how often we had to supervise the nurse’s aide. Wanda Rakes, PICC/Vascular Service Nurse: Weekly COVID testing, filled out COVID survey at each facility, strict adherence to mask wearing while inside building. Linda Breckle, Infusion Nurse: We were constantly changing how many patients we could infuse at one time and how many could be in the room at one time. Nobody could wait in the waiting room. Patients had to come right on time and call ahead of time, when they were in the parking lot. Doctors were doing virtual appointments so we used exam rooms for infusions. Anonymous, Director of Professional Services: We didn’t have to make many adjustments. We developed a screening tool; we stopped giving gloves to home-infusion patients to conserve supply; we held emergency management meetings initially weekly then backed down as adjustments were made. But our general safety protocols and practices were primarily the same, with additional PPE available as needed/required. September/October 2021

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Anonymous, Vascular Access Nurse: It was a fight in the beginning for adequate supplies and the right equipment! PAPRs should have been mandatory and not have mattered whether they were hospital property or your own! Joyce Stephens, Infusion Nurse: Masks, eye protection for all face-to-face contact. Instituted virtual visits whenever possible/appropriate for therapy. Full isolation procedures for any patient with positive exposure. Anonymous, Home Care Clinical Manager: All clinicians were provided with masks, gloves, and goggles to see non-COVID patients and full head-to-toe PPE for COVID patients. Peggy Link, Endoscopy/Vascular Access Nurse: We have screened all people who enter the hospital, tested all patients before their procedures (endoscopy), and wore extra PPE all of the time! Also, we restricted visitors to either none, or one, and no one under 18. Patricia Lammers: Our workplace initiated COVID screening and PPE protection practices early. We ensured everyone had supply and were N95 mask fitted. We also increased the use of virtual-care platforms. Casey Schuller, Vascular Access/Rapid Response Team: Increased our responsibilities—added placing acute CVCs and HD caths on all COVID patients. Anonymous, Chief Clinical Officer: At one point we stopped following the guidance from the CDC because they were downplaying the risk to staff and patients. We started offering face masks to the staff, and ramped up infection-control education. Tony West, Nursing Operations Manager: In our standalone infusion-center settings, we had some temporary closures. When care was given, a variety of strategies were employed. Staff had to wear N95 masks at all times, and . . . meds . . . were delivered to cars in the parking lot. Patients called from the parking lot and could not come in until called. We had screening questions for all patients, and no visitors. In many sites, chair count was reduced to achieve social distancing, and in some locations, physical solid barriers were installed between chairs. Out of an abundance of caution, any staff person potentially exposed, even asymptomatic, was quarantined at home for 14 days. Most of our exposures came from family members or friends outside of the work environment. Anonymous: We followed CDC guidelines strictly. New policies were written and taught. Our home health/staffing company was very innovative during this past 18 months. We have improved several processes and have new lines of business. Danielle R. Jenkins, Insite Operations Manager: We began phone-screening our patients, and requested the nurses do a daily temperature check. Patient temperatures are being checked at the door along with hand sanitizing. We limited the number of patients scheduled per day, moved to telehealth to cover the gaps, and used alternative routes to bring patient in one way and exit via a different door to avoid exposure. Anonymous from Malaysia: Adjusting was not the issue. It was that we had no choice or face the consequences of what we had seen in other countries. Throughout the hospital, there was hardly anyone who had a hard time adjusting. I guess fear may be the motivating point. Sue Simo, Director of Clinical Education: Almost too many ways to mention. Restricted all visitors. Patients only were allowed in. Re-assigned staff to become full-time screeners of patients/staff. Blocked off seating throughout the building to provide safe distancing. Required masks for all patients/staff. Increased daily huddles/information shared with staff. Created policies/procedures around staff attendance. Required time off while waiting for results, and didn’t track absences during COVID. Restricted all food/potlucks, number of staff in work rooms, etc. 12

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Were/are there any ethical deliberations or trade-offs that you’ve made in your practice during the pandemic that you didn’t consider in a pre-COVID-19 world? Editor’s Note: Seventeen people simply wrote “no.” Christina Buxton, IV team RN: As practitioners in a COVID world, we are told to protect others but protect ourselves first. So when responding to a rapid or code, you PPE up first and then go in. Even little things like not sitting and talking with the patient as long as I normally would have because I’ve already been in their room a while getting their line in. I do really need to leave, but I might be the only contact they’ve had in a while, and maybe they’re lonely, scared, confused, or all of the above. And you walk out of the room feeling terrible that you can’t stay. Anonymous, Veteran Affairs Nurse: Yes, reuse of PPE, not enough PPE/protection. Also, there was a personal risk to myself/family. I would have walked away from nursing if I could support my family in another way. Melissa Reep, Home Care Case Manager: Early on in the pandemic our agency made the decision not to do our annual supervisory evaluations in the home in order to limit the number of people in and out of the home, but the decision to do that quickly changed and we resumed having these supervisory visits in the home. It was a difficult thing for me to understand: I am telling my patients over and over to limit their visiting hours and their contact with other people, and yet I myself was inviting more people into their home. Jennifer Helal, Director of Nursing: Extended wear of surgical masks, cancelling “non-essential” patient visits. Richelle Hamblin, Director of Nursing: Visitations were a big part of this. We did not want family members isolated from a dying loved one or having someone die alone for any reason. We established guidelines for this purpose. They were strict and we had a lot of family members try to break rules and became angry. There were times we needed to involve security. I was the one who had to speak with family and deal with these issues. It is truly the most difficult dilemma I have dealt with in my career. Family was updated by phone, and we needed to be sure we had no HIPAA violations. It was also hard getting random calls all day from family when you were trying to work shorthanded and get all your patient care done. Greg Laukhuf: The infection precaution changes to meet the COVID patient’s and health care providers needs that may not have been considered pre–COVID include extended mask wearing and on-site mask decontamination. Robin Huneke Rosenberg, Nurse/Clinical Investigator: More aware of space/distance between myself and subjects; not allowing for COVID exposures to be “incidental” but instead implementing full study removal if positive or exposed until June 1st. Also aware of the bureaucracy of corporate world versus CDC versus nursing judgment. Anonymous, Infusion Nurse/Educator/Consultant: I have looked at colleagues differently for choosing not to vaccinate and have distanced myself from the ones that spread vaccine-conspiracy theories. Anonymous: Are we overly cautious with staff and patient contact? We always followed CDC guidelines for health care workers. Sometime we erred on the side of putting too many safety measures in place, but I know we kept everyone safe. September/October 2021

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Wanda Rakes, PICC/Vascular Service Nurse: I do procedures. With all the vetting, I do less cases per day. Jessica Ash, Clinical Nurse: [It was difficult not] allowing a guest to accompany a patient for their infusion, especially for first-time infusions. It has been challenging to feel that we are remaining patient- and familycentered while also saying no to family being at a patient’s side. Anonymous, Director of Professional Services: We discussed delaying PICC dressing changes for COVIDpositive patients discharging from the hospital. We discussed having dressings changed day of discharge and then waiting until patient was 14 days past diagnosis and then going into the home for the dressing change at that time. Thankfully we were not ever put in the situation to make that call. Most patients had their dressing changed at discharge and within a week were close enough to 14 days past a positive test that we didn’t have to worry about it. We would never have considered going past 7 days for a PICC dressing change prior to COVID. I’m thankful that was never put into practice. Anonymous, Home Care Clinical Manager: Yes, turning down COVID patients due to not wanting to be exposed. Peggy Link, Endoscopy/Vascular Access Nurse: Yes, we have to treat everyone the same, whether or not they choose to get vaccinated. We are in a very low-vaccination rate county and it is quite distressing, but we keep our ethical obligation to not judge and simply treat. Patricia Lammers: We have needed to make decisions to refuse many new patient referrals. People require care but we do not have the capacity to provide care safely so have made some decisions to refuse patients inspite of pressure by our local LHIN/ HCCSS to take all referrals—especially palliative. Anonymous, Infusion and Chemotherapy Charge Nurse: Reuse of PPE. Sue Simo, Director of Clinical Education: Restriction of family/visitors was previously unlimited. It was very difficult to not allow them in, especially when we were providing new cancer diagnosis, etc. Anonymous, Chief Clinical Officer: I don’t feel I made any trade-offs; I do feel remorse for following the CDC in the early stages of the pandemic because a great deal of information was held back that could have saved more patients. Anonymous, Vascular Access: Family visit restrictions as per patient’s clinical condition. Anonymous: PPE was not always available as needed. Especially in our supplemental staffing of facilities, which were responsible for providing PPE and being honest and upfront about the status of their patients. There are cases of nursing homes not being honest about having active COVID-19 patients in-house and failing to provide staff with PPE as required. Danielle R. Jenkins, Insite Operations Manager: I would have to say that would be moving employees to teleworking environment. The pandemic forced us to think outside the box. Now we have employees who can function in and out of the clinic setting. Tony West, Nursing Operations Manager: While some creative adaptations had to be made, such as bringing COVID patients in at the end of day, separate from other patients, with a terminal cleaning of the infusion suite, we were able to treat all patients without significant issue. Casey Schuller, Vascular Access/Rapid Response Team: Yes. Selectively made poor prognosis patients comfort care/DNR due to limited resources/vents/ICU beds. Anonymous: It was terrible seeing people dying alone in the ICU.

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Are there pandemic-era precautions you or your workplace plans to keep in place even after COVID-19 cases significantly decrease? Anonymous: Wearing masks is probably always going to remain. Ruth Souter, Manager of Clinical Practices, Nursing: Definitely—we will continue with extra precautions— hand hygiene, etc. Richelle Hamblin, Director of Nursing: None that I am aware of with the exception of our pandemic emergency plan. Robin Huneke Rosenberg, Nurse/Clinical Investigator: Yes! We are still actively screening for symptoms if a subject feels ill; we are wearing masks and scrubs not just lab jackets. Jennifer Helal, Director of Nursing: Backup PPE supplies, more stringent handwashing protocols. We’re still requiring mask wearing by staff as well. Anonymous: I honestly don’t see the removal of masks any time soon, which is sad. Anonymous: Increased handwashing. Judith Kay Fogg, Nurse Manager Med/Surg: Wearing of surgical masks for all staff continues even though currently we have no COVID patients on the inpatient units. Susan Knapp, Director of Nurses: We will continue no-touch deliveries for anyone positive or suspected. Anonymous: Currently, we’re still requiring masks in the workplace. We may unmask at our desk/work area. Individuals can choose to mask/unmask with another vaccinated person, following CDC guideline compliance when in meetings. Melissa Reep, Home Care Case Manager: We are hopeful that telehealth visits will continue to happen and that the home care nurses will be involved in those to assist patients in communicating with their doctor. Prepandemic we were not privy to those visits and what was being discussed. Being able to be there even remotely has helped greatly in communicating what we are doing as home care clinicians and what we are seeing in the home that the patient may not think to report or want to report. Orah Toni Linzer, Infusion Nurse: I am still sticking to all the same protocols. Ana Carolina Sachs, Director of Nursing: We still wear masks to visits that are positive for COVID or exposure. Jessica Ash, Clinical Nurse: It has been a moving target so I am not clear on what precautions are planned to be kept in place. Currently for providers we are continuing to mask and wear eye protection and maintain single occupancy in infusion rooms. Anonymous, Director of Professional Services: For the time being, masks will continue to be required in our facility and when our team is in patient homes. Anonymous, Home Care Clinical Manager: We’ll continue to screen patients, and wear masks in patients’ homes. September/October 2021

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Peggy Link, Endoscopy/Vascular Access Nurse: Probably screening and wearing extra PPE. Patricia Lammers: Reduce office capacity and encourage social distancing. We might continue to provide education virtually and encourage use of technology to communicate with health team members and virtual visits with patients. Sue Simo, Director of Clinical Education: Many. Increased/improved quality of handwashing, use of PPE. Early recognition of staff with any symptoms of illness will be taken more seriously than previously. Isolating patients with symptoms of illnesses. No more cohorting, etc. Casey Schuller, Vascular Access/Rapid Response Team: Yes. VAT placing most CVC and HD catheters. Anonymous, Chief Clinical Officer: Yes, infection control audits and education will continue to be a high priority. Anonymous: I think we have changed primarily in attitudes but not sure what precautions will continue. Danielle R. Jenkins, Insite Operations Manager: Telehealth was a huge factor in allowing us to cover our patients in the pandemic. We are hoping that telehealth options will remain viable for all areas of health care to allow patients to be serviced with minimal interruptions. We will continue our practice of hand sanitizer in our lobbies and request patients who are symptomatic to wear a mask during their visit to the clinic. Agnes E. Bayer, Director of Nursing: In general, we will all be more infection-control conscious. Tony West, Nursing Operations Manager: At this point we have already relaxed continuous N95 wear to only in patient-care areas. Chair capacity has been returned to pre-COVID levels in most cases. With the Delta variant impending, it is unlikely we will relax much more until we see what this brings.

How have you been kind to yourself during the pandemic? Editor’s Note: A dozen people answered a simple “no” to this question. One person just wrote “ha.” Richelle Hamblin, Director of Nursing: I cried as my heart broke for so many people. I was so tired from working. Just getting sleep was a treat. I also contracted COVID. I had lingering symptoms that lasted 6 months. I was so run-down from working so many hours. We would admit people to our non-COVID unit that slipped through the testing and ended up COVID-positive. Although we would wear masks, it was not enough in these situations. Kathleen Brown, Rural Hospital RN: I did everything I could to keep myself from getting sick, and to keep my family from getting sick. Anonymous, Veteran Affairs Nurse: It was impossible to be kind to self with ethical decisions and working conditions. Anonymous, Director of Professional Services: In the beginning, that was a struggle. Being in the position in our facility of being in charge of safety and compliance during this time was extremely stressful. My company thankfully had all we needed during the early days, and I still felt like I wanted to leave the profession. As things settled down, I definitely tried to have firm boundaries with work time and non-work time for myself and my team to try to prevent burnout. Ana Carolina Sachs, Director of Nursing: I work out and take time to do the things I enjoy.

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Ruth Souter, Manager of Clinical Practices, Nursing: Working from home is really not best in the long run. You need socialization, as prepandemic. Being out on a drive in a good weather has been good to the soul. Robin Huneke Rosenberg, Nurse/Clinical Investigator: I am recovering from a mental-health breakdown related to the preferred isolation I am used to. I am having a hard time working with others when I would usually work alone at home. I am working with a therapist on this. Jennifer Helal, Director of Nursing: I really haven’t been. I’ve been working too much overtime and haven’t taken time off. Melissa Bond, Infusion Nurse: More time for self, eating more, cooking more, relaxing. More treadmill and elliptical in-home use. Danielle R. Jenkins, Insite Operations Manager: Giving myself permission to unplug from social media; scheduling downtime in my calendar for planning; allowing myself more time to sleep; exercising more regularly due to availability of time given by not commuting to and from the office. Judith Kay Fogg, Nurse Manager Med/Surg: I do take a day now and then to do something fun or to pamper myself. Anonymous: I have not. I am working more than I ever have. I got a haircut after about a year! Melissa Reep, Home Care Case Manager: I have started exercising more. With all the downtime of not going out and visiting family and friends, I found more exercise time. I also made more money during the pandemic. There were work bonuses and incentives from the government. So I have bought myself some things I may not have bought otherwise. Orah Toni Linzer, Infusion Nurse: Taking more time to read for pleasure and play musical instruments for relaxation. Christina Buxton, IV Team RN: I distract myself with really good fictional stories that are far, far away from my normal world. Sometimes I’ll soak in a bubble bath and make my tired back happy. Anonymous: I was lucky to be able to partially retire in October 2020. I enjoy my back porch most days. Jessica Ash, Clinical Nurse: I remained positive and tried to take it all in stride. I decorated my face shield to make myself and my patients smile. I took it all one day at a time. Wanda Rakes, PICC/Vascular Service Nurse: I slowed down a lot. Anonymous, Vascular Access Nurse: As well as I could be, but working all the time didn’t allow as much time as I’d hoped. Joyce Stephens, Infusion Nurse: Maintaining a good diet/exercise regime to maintain healthy weight. Taking time away even if it’s a staycation, with phones, tablets, and TV off to step away from the COVID craziness. Anonymous, Clinical Manager: I got a puppy after my 8-year-old dog passed in the beginning of COVID. Peggy Link, Endoscopy/Vascular Access Nurse: I try to get outside to exercise and have some quality time outdoors to refresh myself. September/October 2021

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Patricia Lammers: I have needed to admit that I cannot keep doing and working at the feverish pace I am presently. My family does not see much of me, and I am developing health problems. The harder I work the more tired and discouraged I become. I need to turn off my pager when I am not on-call. Anonymous, Infusion and Chemotherapy Charge Nurse: Taking advantage of the short breaks from the chaos that we can find. Sue Simo, Director of Clinical Education: Taking time to rest on weekends without feeling guilty. Increasing meditation/self-recovery time. Anonymous, Chief Clinical Officer: I still carry a lot of pain from the enormous loss of life. Tony West, Nursing Operations Manager: Haven’t really. Life as usual at home with far fewer gatherings of friends. Greg Laukhuf: I cannot say that I have. Anonymous from Malaysia: I feel that we are very lucky. Compared to India, Brazil, and Europe, we in Southeast Asia have done way better than most developed countries. We acted accordingly with speed and precision, thereby reducing mortality and morbidity. Because of this, it is not the time for us to be kind to ourselves. We have to be kind to those who need us. The tear-jerking and heartwarming sensations we get when we have helped someone is priceless. Being kind to others is being kind to ourselves. Don’t you agree?

Do you have any other comments or stories you’d like to share? Jennifer Helal, Director of Nursing: I am so proud of my nurses for their fearlessness and resiliency during this unprecedented time. Patricia Lammers: Some of our nurses have been absolutely amazingly tough this time, going above and beyond. However, we cannot continue to be stretched like this too much longer. We will lose more nurses not only from our agency but from the profession. For the first time in 30 years, I am questioning my place in this profession. Anonymous: People don’t realize that although things are better, we still need to be aware and follow all guidelines. Many died. Many are still getting sick. It affected my family personally so I am a bit overcautious still. Peggy Link, Endoscopy/Vascular Access Nurse: Please get vaccinated! Vaccine hesitancy is not just a personal choice, but affects all people of your community! Danielle R. Jenkins, Insite Operations Manager: The pandemic was an eye-opening experience at just how fast life can change and how precious life truly is. This time has allowed social disconnection, which gave time for thinking outside of work and busy routines. It gave me time to connect with my inner self and allowed for more self-discovery. The pandemic has also heightened my awareness as a provider to educate the patients on selfcare and preventive measures to help boost the immune system. The world of video calling taught us just how effective we can be across the nation, handling meetings and performing events via these channels. We will never be the same. Anonymous, Critical Care Educator: When COVID first came on the radar, our administration threatened to fire staff for wearing masks in areas where masks were not normally required with the rationale of “you’re frightening patients and visitors.”

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Anonymous, Chief Clinical Officer: Too many people died due to political interference in the information distributed to the health care industry. I still have a lot of anger over that. Anonymous: As an infusion specialist, it is my duty as a nurse to see my homebound patients infused as scheduled. The post office has nothing on us. “Through rain, sleet, hail, snow we always service our patients!” Anonymous: I was responsible for an in-house phone follow-up of staff members with possibly or actual COVID-19. I spoke to many health care workers daily not only about their symptoms but how it impacted their lives. Many told me they thought they were dying with the acute disease, and there are a percentage who have long-term negative consequences from the virus such as dialysis or diabetes. One nurse in her thirties has cognitive decreases that make it impossible for her to return to work. She is divorced and has children at home; what will become of them? One of our nurses in her sixties living with her husband who had early dementia had a particularly bad time as they both got COVID and he became violent, almost strangling her. He is now living in a facility and she has come back to work but suffers from depression and shortness of breath. Anonymous: The lockdowns and fear instilled by the government and media outlets have had far worse effects on the population than COVID itself. It is horrible that so many people died from COVID and from mental health issues during this time. I hope we learn from this—there must be a balance between safe practices, physical health, and mental health. And, for the love, leave treatment and science out of the hands of the government. Anonymous, Vascular Access: COVID-19 is devastating to all of us. I felt helpless during COVID-19 surge period. Anonymous, Vascular Access Nurse: I have since quit the hospital and work where I’m protected more! Anonymous: I was written up because I called employee health regarding the vaccine. It had just come out, and while I was completely behind ED and ICU getting shots first, my manager didn’t advocate for us at all. We were told they didn’t have any idea when we’d receive it. I also asked if the administrator had had his shot. They said they weren’t allowed to give out that info. I have asthma and an autoimmune illness. We were bent over COVID patients placing PICCs for over an hour [at a time]. Going to work every day in fear due to COVID was hard. I was mine and my department’s only advocate. And I’d do it again in a heartbeat. Jothi Clara J. Michael, Country Director of Nursing, India: My team was extremely supportive and excelled in delighting patients. Richelle Hamblin, Director of Nursing: So many nurses opted to take higher paying travel position during this time. I don’t blame them; the salaries were phenomenal! But it took staff from low-paying rural hospitals to bigger city locations in most cases. My story ends with me getting laid off as a business decision due to operational deficits in lost revenue. I was fortunate to find a new position and have a great opportunity ahead of me. I never thought about quitting. I wished I could have done more. I only hope the patients in my care had the best outcome in a very difficult time in health care.

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Robin Huneke Rosenberg, Nurse/Clinical Investigator: I admire all of the health care workers who faced so many challenges in their personal and professional lives over the past 15 months. While still a nurse, I had a few of my own; but they are heroes in my mind. I did help vaccinate coworkers when the company was shipped supplies. I also felt proud of my company’s response to mask production and other resources produced during these trying times. Anonymous from Malaysia: With stress and trauma of deaths and grave illness resulting from this, we see much better compliance to standard infection control practices which I have not seen in many years of service. We see a dramatic drop in MRSA, influenza, Hand, Foot, and Mouth Disease; in short, transmittable diseases are so few in comparison. Hand hygiene practices are at high compliance rates, better than it had ever been. I see families bonding closer to each other, having been through an emotional roller coaster not knowing whether their loved one would pull through. And lastly, off-topic, I see our earth, cleaner and healing. That we see dolphins swimming in Venice where they have never been for the foul water. With all the trauma, stress, selfishness, and other negatives that we have all been through this last year, we also see little and big things, all good, that come to light in such a time. Agnes E. Bayer, Director of Nursing: I urge all health care workers in the strongest terms to inform themselves on this website about how the world will be able to beat COVID-19. Please share this information far and wide so it can save lives: https://covid19criticalcare.com/. Thank you. Kathleen Brown, Rural Hospital RN: A patient was admitted who claimed COVID-19 was a hoax, but still died from it. Tony West, Nursing Operations Manager: Our greatest enemy is misinformation and the states’ inability to act cohesively. Politics has no place in public health and national security. All compounded by those who have a “right” to not wear a mask and therefore a “right” to put others at risk. Ana Carolina Sachs, Director of Nursing: I wish there was some verbiage that I could attain to help those hesitant to get vaccinated. Ruth Souter, Manager of Clinical Practices, Nursing: I can’t wait for this pandemic to be over.

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Jennifer (Jen) Reich PhD, MA, RN, NC-BC is a board-certified Nurse Coach, educator, author, and poet. She is core faculty in the Holistic Nursing Program at Pacific College of Health and Science. Jen is the author of eight books of poetry. She is also the author of When Miss Bluebird Died, a children’s book about celebrating life. Jen’s poems and stories are inspired by people, animals, nature, and all aspects of our shared human experience. She is a passionate explorer of the healing potential of the creative arts. She has incorporated these diverse experiences to design wellness programs and teach self-care strategies to healthcare professionals, caregivers, and students throughout the country. Jen resides in Arizona and loves swimming and spending time on the trails with her partner and two spoiled pups.

POETRY FOR NURSES In Healing Now A Letter to Coronavirus You’re such a tiny uninvited guest That hides behind a shell And multiplies relentlessly By hijacking a cellAnd I’d like to share a nice word Yet you’re not so very kind And for something without any brains You stump the greatest mindsBut someday you’ll be disrupted Like you’ve disrupted our field And I sense we’ll come out stronger With mind, body, spirit, healedAnd so I’ll ask you at this point

A year built on many years Revealing wounds below The pages of our stories Where we still need to growA grief we feel collectively The sense of being lost Our insight we are vulnerable Yet love is worth the costRelief and hope unfolding Inspiring us to rise Acknowledging our sacred truth And dropping our disguise Phoenix, AZ 12-22-20

To cut us all some slack For while we have our issues We have each other’s backs Phoenix, AZ 3-25-20

Her writing can be found at: https://www.facebook.com/Jenreichpoetry/ Instagram @jenreichpoetry Amazon Author page: amazon.com/author/jenreich Poetry-not-poverty.blogspot.com www.whenmissbluebirddied.com

September/October 2021

It’s been a busy summer! Some of us are preparing for the September CRNI® Exam, and some of us just returned from the INS 2021, Annual Meeting in Las Vegas.

For those preparing for the exam, by now you have probably gone through the Exam Checklist. You’ve studied and are now ready. We know, however, that life happens, and you may not be able to take the exam in September. If necessary, you may transfer your application to take either the March exam or the exam next September. Complete and submit the transfer application by September 30, and include a $100 payment (the standard $50 administrative fee plus a $50 late fee, since the due date for transfer was August 1).

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For those who attended INS 2021, and are recertifying by RUs, please remember: • 40 RUs can be earned by attending the INS Annual Meeting. • RUs earned at the INS Annual Meeting count toward your INS meeting requirement. • A maximum of 40 RUs can be applied to a certification period. • A copy of your certificate of completion will be automatically added to your transcripts in your account.

To finish your recertification process by CE, you must submit three items: 1. A recertification by CEU application 2. Payment for your recertification fee 3. 40 Recertification units (RUs) Please note: Additional RUs earned over 40 will not roll over to subsequent cycles. Applying for the recertification by CE is simple: 1. Log in to your INS account. Click on the Certification tab at the top, then click on Certification Management in the drop-down tab. 2. Select Click to Register, choose the Recertification by CEU link, then complete the Recertification by CEU Application. 3. Submit certificates of completion for all external RUs (non-INS) through your CRNI® Certification Profile. INS RUs are automatically recorded in your Certification Profile. (External RUs are reviewed by an INCC staff member and approved in the order they are received.)

For those of you recertifying, explore the recertification page for the most up-to-date information on the CRNI® recertification process. We hope these tips are helpful. If you have questions, go to the certification page on the INS website. If you can’t find your answer there, please click the chat (the green arrow points to it below) on the INS home page. From 8:30am-5:00pm EST INS staff are available to chat with you. If you’re up later studying, and you have a question, you can still leave a message. Your question will be answered when staff are available. Great job to those who are recertifying and best of luck to those taking the exam!

September/October 2021

Volunteer Committee Opportunity: 2021 Call for NCOE Applicants Are you interested in promoting the mission of INS by providing professional development opportunities and quality education? Read more about the INS National Council on Education (NCOE) to decide whether being a member of this council is your next career goal. What Are the Responsibilities of NCOE? The NCOE works with the INS Education Department to develop programs which address the latest methodology, current trends, most prevalent issues, and subjects of general interest to infusion nurses. Council members, who have three-year terms: • Attend quarterly virtual meetings, including an annual conference planning meeting • Review submissions from the call for abstracts • Plan and contribute to the development of educational topics, learning objectives, and content outline for presentations • Collaborate with speakers to foster high quality and engaging educational content • Implement and evaluate educational sessions

Who Are the NCOE Members? NCOE members are active members of INS with a bachelor's degree, a minimum of two years clinical experience in infusion nursing, and experience in the development of educational programs. Council selection is based on, but not limited to, diverse geographical location, practice environment, educational program expertise, and clinical and educational credentials. NCOE is comprised of content experts in the field of infusion nursing; council members are active practitioners in the specialty area and are well versed in the clinical aspect of the profession. Members of NCOE, the INS Director of Clinical Education, the INS Clinical Education and Publications Manager, and the INS Conference Education Coordinator are all part of the INS Education Team. Because the INS Education Team believes that educational content must continually evolve to reflect changes in the science of professional nursing, the Team works diligently to ensure that the latest evidence-based education is available to INS members and to the infusion community.

Education Team Goals 1. To provide educational programs that will improve the delivery of health care and the practice of infusion nursing. 2. To disseminate knowledge by providing educational opportunities for infusion nurse specialists and members of allied health care specialties and professions to exchange information and clinical practice expertise and to explore collaborative practice. 3. To promote high quality professional practice through education.

What do current NCOE members say about their volunteer role? “Being part of this committee has been one of the most memorable experiences of my career. I have learned so much and have been very proud to let others know of my work with INS. Attending the conferences to actually hear a session that I helped to develop is well worth all the time involved. Seeing a published article in the Journal brings everything full circle.” “Being on NCOE is something that I am most proud of in my long nursing career. Planning and working on this most impressive team to develop the learning content for the INS national conferences has been a true labor of love. It has been a privilege to serve on this council.” We are grateful to our NCOE members for their dedication to the infusion nursing profession. If you are interested in being considered for a position as a NCOE member, please apply by September 20, 2021. If you have questions about the position, please email Marlene M. Steinheiser, PhD, RN, CRNI®, Director of Clinical Education at marlene.steinheiser@ins1.org. 24

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INS is seeking members to serve on its National Council on Education (NCOE)

Apply T To oday!

You will work with the Yo INS Education T Te eam to determine professional practice gaps, plan educational sessions to address these gaps, recruit speakers, and develop and evaluate the educational sessions.

Applicationss must be received d by Monday, September 20, 202 21

September/October 2021

Using Malpractice Claims Data to Identify Risks in Nursing Practice to Enhance Patient Safety, by Jennifer Flynn, CPHRM, Risk Manager, Nurses Service Organization (NSO)

The Nurse Professional Liability Exposure Claim Report, 4th Edition is a study by CNA and NSO analyzing registered nurse (RN), licensed practical nurse (LPN), and licensed vocational nurse (LVN) closed professional liability claims over a 5-year period. The study identifies current liability patterns and trends and provides risk control recommendations to enhance patient safety and minimize liability exposure. The study, as well as the information in this article, which was obtained through the study, can help nurses, nurse educators, administrators, health care employers, and health care leaders identify and manage the risk exposures most likely to affect nursing practice.

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The first part of this article appeared in the July/August 2021 issue of INSider.

Risk Management Recommendations Using malpractice claim data, nurses can examine top areas of liability through the experiences of their colleagues to help enhance their own clinical practices. The following basic risk control recommendations can serve as a starting point for nurses seeking to evaluate and enhance their patient safety and risk management practices.

Scope of Practice Nurses are required to practice within the scope of their state’s practice act, as well as their employer’s policies, procedures, and their own job descriptions. Ongoing attention to regulatory requirements and developing enhancing core competencies can increase patient safety while minimizing nurse’s liability exposure. Additional strategies to help reduce the likelihood of practice-related allegations include: • Contact organizational leadership if a job description, contract, or set of policies and procedures appears to violate your legal scope of practice. • Clearly state your unwillingness to risk license revocation and potential legal action by failing to comply with the scope of practice delineated within the state nurse practice act.

Maintaining a patient health information record that is consistent and professional is essential to providing quality patient care, ensuring consistent communication among all professionals caring for the patient, and establishing the basis for an effective defense should litigation arise. The following guidelines can help reduce risk: Documentation – Clinical Content • Document nursing actions in accordance with facility requirements, capturing, at a minimum, the following information: ‒ results of each and every nursing assessment ‒ nursing observations ‒ patient complaints or concerns ‒ significant changes in the patient’s condition ‒ any change in the patient’s care plan ‒ every monitoring finding, treatment, or episode of care, as well as the patient’s response to that care ‒ facts relating to any patient accident or incident, including evidence of any injury, all parties notified, nursing care provided, and patient’s condition after care is rendered ‒ laboratory and diagnostic test results ‒ referral and consultation requests and results

Documentation The healthcare record is a legal document. A welldocumented paper or electronic patient health care information record serves several major purposes in liability lawsuits: it provides an accurate reflection of nursing assessments, changes in clinical state, and care provided; it may guard against miscommunication and misunderstanding among the interdisciplinary team members; it can demonstrate your competence as a provider to help bolster your credibility; and it may help to guard against a lengthy litigation process. It would be a good idea to ensure your facility has a written policy governing documentation issues and all staff members are trained in proper documentation practices. The policy should address, among other issues: health care information record contents, patient confidentiality, release and retention of patient health care information records, and general documentation guidelines.

‒ telephone, face-to-face, and electronic contacts with other members of the health care team, including the content of discussions and agreed-upon follow-up. • Document discussions with the patient about medical issues that require additional explanation by the physician/licensed independent practitioner or other health care provider. • Record medications administered, including injections, ointments, and infusions, as well as a description of the patient’s response. • Detail nursing observations during patient contacts. • Specify patient’s questions and answers given regarding the nursing care/service plan, as well as the goals and methods of treatment. • Describe patient’s response to nursing care. • Note the review of current problems or symptoms.

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• Assess skin and wound conditions, including clinical findings and observations, the nursing care/service plan, and the patient’s response to treatment. • Document practitioner notification of a change in condition, symptoms, or patient concerns and document the practitioner’s response and/or orders. • Summarize communications with practitioners, including those via telephone, facsimile and email, and note any subsequent nursing actions taken. • Note use of an interpreter, including the interpreter’s contact information. Documentation – Medications and Prescriptions • Review and update the current medication list and patient’s reported compliance with prescribing orders. List should include both prescribed and over-the-counter medications, including supplements and holistic/alternative remedies.

Documentation – Patient Education • Describe patient and family healthcare education encounters, listing the presence of specific family members and their relationship to the patient. • Provide a written assessment of the patient’s ability to comprehend and repeat information provided, both immediately and after three or more minutes have elapsed. • Maintain a copy of written materials provided and document references to standard educational tools. • Retain patient-signed receipts for any educational materials provided.

• Perform the appropriate medication reconciliation process following patient admission, changes in care or treatment, transfer from one service to another (e.g., after surgery or delivery), or post-discharge return to care.

• Document the use of interpreters, if needed, and include the interpreter’s contact information.

• Clearly describe patient responses to medications, positive or negative.

Communication Basics

• Document signs or symptoms of adverse drug reactions, contact with physicians/licensed independent practitioners, and subsequent follow-up. Documentation – Diagnostic Tests, Referrals, Consultations • Contact the patient’s healthcare provider to report abnormal test results and any provider orders for additional testing or follow-up and document the interaction. • Contact consulting physicians/licensed independent practitioners to confirm that the consulting provider was notified of the consultation request and to facilitate the timely provision of the consultation and receipt of the results. Document these actions in the patient’s health information record. • Utilize the chain of command to report abnormal laboratory results and the results of consultations if the ordering/primary care physician is not available or does not respond to messages.

• Initiate additional steps, if necessary, to ensure timely patient care. These may include reporting to the supervisor/nurse manager, administrators, attending or covering physician, licensed independent practitioner, and/or medical staff leadership until the abnormal result is addressed.

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Interpersonal skills, which promote a good relationship between individuals, do not come naturally to all health care professionals. Individual methods and styles of communication are primarily learned responses to how we have communicated in the past. Fortunately, communication skills can be improved at any age through education and practice. The following suggestions can help nurses enhance efforts to communicate effectively: • Set aside any personal judgments about patients and build each patient relationship with as much empathy as possible. • When listening to what a patient is saying, concentrate on both the verbal and nonverbal messages. • Maintain good eye contact, focusing on the patient’s eyes whenever you are speaking or listening. • Pay attention to your facial expressions and gestures. Do your best to be relaxed and natural. Nonverbal communication works best when it’s done automatically, which requires practice to feel comfortable. • Be a patient listener. Avoid interrupting and limit your own talking until the person speaking has finished what they are saying.

• Suspend judgment. Don’t dismiss the value or importance of what is said by a person speaking in a monotone voice, or with a foreign accent. • Listen for the feelings behind the facts. Using the patient’s behavioral cues, facial expressions, and word choices, infer what emotions they may be feeling. • Respond in a way that indicates your awareness and validation of the patient’s feelings and concerns. • Clarify by asking questions and paraphrasing. Try to reflect the feelings and thoughts the patient is expressing by rephrasing questions and comments using their own words. • Nurses can develop these and other communication skills by including coursework on communication as part of their regular nursing continuing education coursework.

Home Care The following guidance is designed to assist nurses and their employers in evaluating risk control exposures associated with their practice in home health settings. Patient screening. The screening process commences with an interview of the prospective patient and the family or primary provider(s). An experienced staff member who is knowledgeable about the services the organization is capable of providing should conduct the interview prior to contracting for services. The screening process should focus on the following areas, among others: • Health care and cognitive status, including medical diagnoses, allergies, presence and stage of Alzheimer’s disease/dementia, behavioral patterns, recent surgeries/hospitalizations, presence of indwelling devices (e.g., catheters and endotracheal tubes), standing provider orders, ability to comprehend information and instructions, and existence and level of pain.

• Fall risk and fall history, including near falls and those with and without injury. • Physical limitations, including limits on activities of daily living, bladder and bowel continence, toileting assistance requirements, ambulation/transfer needs, assistive devices and tele-monitoring equipment used, extremity weaknesses, and deficits to vision, hearing, or speech. • Medications, including the current drug regimen. • Skin integrity, including a detailed description of wounds or other skin-related issues and notation of any specific wound-care needs. • Safety of the home environment and necessary modifications for patient safety and functionality. Patient assessments. After screening but prior to commencement of services, a qualified staff member should visit the patient’s home in order to complete a comprehensive initial assessment, determine care needs, identify home environment limitations and concerns, verify the patient’s suitability for services, and obtain information necessary for developing an individualized service plan. A reassessment should occur at least every six months or anytime that the patient’s condition or needs change. All assessments and reassessments must be documented, including the names of the assessor and individuals participating in the screening/assessment process, as well as the date of completion. Care planning. Individualized, realistically achievable goals should be established for each patient, supported by thoroughly documented monitoring of the patient’s response to treatment, care, and therapy. Data compiled during the screening and assessment phases serve to identify the specific interventions needed to improve a patient’s quality of life. A care/service plan should delineate goals and objectives, services to be provided, and patient-monitoring guidelines. Changes in a patient’s condition should elicit a revision to the service plan. A commitment to ongoing, open communication among all parties helps ensure that patient and supportive individuals are kept informed of the services being provided as well as any changes in the patient’s condition that may necessitate a revision of the service plan. Medication administration. Medication safety has become a prominent issue, as national patient safety initiatives have focused practitioners’ attention on the need to improve medication management and error reporting processes. However, dispensing and administration lapses, which are often difficult to defend in the event of a malpractice claim,

September/October 2021

continue to occur. Nurses can reduce liability associated with medication errors by following suggested actions: • Comply with policies and protocols related to medication administration. • Understand why the patient is taking a medication as well as interactions, side effects, or adverse reactions that may occur. • Consistently use the “six rights” when administering medication to patients: right patient, right drug, right dose, right route, right time, and right documentation. • Eliminate sources of distraction and interruption as much as possible when administering medication. • Listen to patient concerns. If a patient questions the need for a medication or treatment, listen to their concerns and verify the order in the health record and/or with the ordering practitioner. Delegation and supervision. Special attention should be given to delegation of duties by licensed healthcare staff, in order to ensure that unlicensed assistive personnel do not provide clinical care beyond their training or regulatory limits. Some key risk control recommendations related to delegation and supervision include: • Know your employer’s policies and procedures related to clinical practices and delegation. Unfamiliarity with established policies and protocols is not a defense. • Prior to delegating tasks, be aware of the knowledge and skills, training, diversity awareness, and experience of the individual to whom you are delegating elements of care. Use good clinical judgment, which includes considering the complexity of the patient and the availability and competence of the unlicensed assistive personnel, prior to delegating patient care. • Monitor implementation of the delegated task, as appropriate, to the overall patient plan of care. • Evaluate overall patient condition and the patient’s response to the delegated task. • Evaluate the skills and performance of unlicensed assistive personnel and provide feedback. For more information regarding nursing delegation, it is recommended that nursing professionals review the NCSBN and American Nurses Association (ANA) National Guidelines for Nursing Delegation.1

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Conclusion This analysis of nurse professional liability and license protection closed claims reveals that, while there have been advances in clinical practice and patient safety, many claims continue to develop as a result of a failure to provide proper treatment and care, communication and documentations errors, and not conducting oneself as a licensed professional. It is anticipated that the data, analysis, and risk control recommendations contained in the full report2 will inspire nurses nationwide to examine their practices carefully and focus their risk control efforts on the areas of statistically demonstrated error and loss. For more detailed analysis, view the full report from NSO at www.nso.com/nurseclaimreport.

References 1. NCSBN and American Nurses Association (ANA). National Guidelines for Nursing Delegation. https://www.ncsbn.org/NGND-PosPaper_06.pdf?refID=iiWLTNPi. Accessed May 4, 2021. 2. CNA and Nurses Service Organization. Nurse Professional Liability Exposure Claim Report, 4th edition: Minimizing Risk, Achieving Excellence. https://aonaffinity-blobcdn.azureedge.net/affinitytemplate-dev/media/nso/claimreports/cna_cls_nurse20_061120p2_cf_prod_online_sec.pdf. Accessed May 4, 2021.

The purpose of this article is to provide information rather than advice or opinion. It is accurate to the best of the author’s knowledge as of the date of the article. Accordingly, this article should not be viewed as a substitute for the guidance and recommendation of a retained professional. For the full report visit www.nso.com/nurseclaimreport. Nurses Service Organization (NSO), the nation’s largest administrator of professional liability insurance coverage to individual nursing professionals, also maintains a variety of online materials for nurses, including articles, legal cases, and useful clinical and risk control resources. For more information, contact NSO at (800) 247-1500 or visit NSO online at www.nso.com.

View these webinars and more on-demand: www.learningcenter.ins1.org/webinars Incorporating the INS Infusion Therapy Standards of Practice into Patient Care

Managing Osteomyelitis

Aseptic Non Touch Technique (ANTT®) Clinical Practice Framework

Listen to these podcasts and more on-demand: www.learningcenter.ins1.org/podcasts Smileyscope: Pain Management with Venipuncture and Vascular Access Procedures

Discussing Health Work Environment and Nurses’ Health with the New INS President

Tips and Tricks for Effective Educational Programs

September/October 2021

Speaking Opportunities at the INS 2022 Annual Meeting and Exhibition INS invites health care clinicians and non-clinicians, INS members and non-members to submit an abstract for INS 2022. Those who are selected will have the opportunity to reach an international audience; bolster their curriculum vitae by speaking at a conference developed by THE organization that sets the standards for infusion therapy practice; and submit a manuscript to the Journal of Infusion Nursing. INS assesses for educational gaps in clinical practice and strives to close those gaps with interactive, engaging, high-quality educational sessions. The Annual Meeting is one of the venues where INS provides professional development programs that will improve the delivery of health care and the practice of infusion nursing. Interact with colleagues, share experiences, and learn from other experts as you contribute your expertise to INS 2022. Consider submitting an abstract on an infusion therapy–related topic.

INS 2022 will take place June 4-7 at the Rosen Shingle Creek Hotel in sunny Orlando, Florida! The luxury hotel has countless amenities and will provide attendees and speakers with easy access to everything Orlando has to offer. INS provides 1 complimentary guest room night for all speakers, and if they want to extend their stay, the hotel is offering a discounted room rate of $179 per night plus tax. INS also assists speakers with travel expenses. 32

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Are you interested in speaking at a national conference? Infusion Nurses Society (INS) is recognized as the global authority in infusion therapy and is dedicated to exceeding the public’s expectations of excellence by setting the standard for infusion care. INS is also dedicated to providing professional development opportunities and quality education, and to advancing best practice through evidence-based practice and research. We are accepting abstract submissions for 50-minute podium presentations. Content must be evidence-based and reflect the current state of the science or be based upon research-driven results contributing to the science. Presentations must be free of commercial bias and adhere to the criteria set by the California Board of Nursing for awarding contact hours.

2022 Annual Meeting abstract submissions are due by November 3, 2021 Virtual and/or webinar abstract submissions are continually accepted separate from this call Session proposals/abstracts on the following infusion therapy–related topics may be submitted: • Vascular access device (VAD) technology – Products (eg, infusion control devices, dressings, vein visualization) – Use and management – Complications • Infection prevention • Patient education • Special populations — for example: – Pediatrics – Older adults – Pregnancy • Alternative care settings, including but not limited to: – Home care – Outpatient infusion centers – Skilled nursing facilities • Disease states

• Infusion therapies – Fluid and electrolyte balance – Pharmacology – Transfusion therapy – Parenteral nutrition – Antineoplastic and biologic therapy – Pain management • Quality improvement and patient safety • Nursing professional development • Clinician health and wellness • Current affairs, social science, and global concerns • Emerging evidence • Health care ethics • Professional liability and legal considerations • Diversity, equity, and inclusion

Apply Now: http://ins1.org/call-for-abstracts Guidelines: To be eligible, your abstract must be your original work; subsequent presentation of this content is acceptable, provided you have an original title with a different view, perspective, or focus.

Important Dates and Information:

To submit your abstract, please be prepared to enter the following information: – Name and credentials—current employer, job title, and CV/resume – Paid consultant roles (title and company) – Proposed topic (including): 1. Original title 2. Session description/abstract 3. Brief session introduction for program agenda 4. Learning objectives 5. Content outline 6. References – Speaking experience

February 11, 2022: Presentation date to be determined by the INS Education Department

November 3, 2021: Abstract submissions close January 4, 2022: Selected speakers will be notified

Organizing Committee: Marlene Steinheiser, PhD, RN, CRNI® INS Director of Clinical Education Dawn Berndt, DNP, RN, CRNI® INS Clinical Education and Publications Manager

Contact INS (ins@ins1.org) with any questions

INSide Scoop Our recurring feature, INSide Scoop, serves to keep you informed on things happening within INS as well as upcoming events, items of interest, new educational deliverables, certification news, and other current information. Here we communicate directly with our membership as well as with the larger infusion nursing community to keep you informed on topics—in real time.

Membership News The Policies and Procedures were recently updated due to the revised 2021 Standards, then they were ordered, printed, and shipped. Once they arrived at the national office, we had to find a place for the many boxes before they were shipped out. We inventoried them, then made room in the shipping room. Within the first 3 weeks of their arrival, almost 300 Policies and Procedures were sold. As the orders began to flood in, it was all hands on deck. We shipped them out quickly— we ran reports, printed out packing slips, packed each order, and printed each label. It takes the whole team to realize an educational product from idea to sale to shipment.

Policies and Procedures for

Infusion Therapy: Acute Care

Policies and Procedures for

Infusion Therapy: Older Adult

Infusion Therapy: Ambulatory Infusion Centers

Policies and Procedures for

Infusion Therapy: Neonate to Adolescent

Infusion Therapy: Home Infusion

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6th edition

4th edition

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3rd edition

Publication News The publications department has been updating and revising the Point of Care reference cards in order to align their contents with the updated and revised versions of the INS Infusion Therapy Standards of Practice and the INS Policies and Procedures for Infusion Therapy. The Point of Care reference cards are a tool that combines essential practice information from both the Standards and the Policies and Procedures on a laminated and fully cleansable card set created for use at the patient’s side—at the point of care. The cards are applicable for clinicians managing IV access, infusion therapy, and infusion-related procedures in all patient care settings. The revised cards are available now in the store on the INS website!

INS Point of Care Reference Cards

INCC News With summer coming to an end, it’s the perfect time to be thinking about what you need to recertify your CRNI® credential if you are due to recertify this year. Whether you need to recertify by September 30 or December 31, it’s a good idea for you to explore what you need. Recertification requires that you obtain 40 Recertification Units (RUs), of which 30 must be from an INS in-person or virtual meeting. If you need additional RUs, check out the many educational programs available in the INS Learning Center. If you’re uncertain of whether you are eligible or what the process is, please review the recertification page on the INS website. Here you’ll find everything from the recertification basics to eligibility requirements as well as all your recertifications options. NOW is the time to apply, to get recertification out of the way! Lastly, a quick shout-out to all the candidates taking the CRNI® Exam this September. GOOD LUCK! You got this!

September/October 2021

Welcome New Members! NEW DOMESTIC MEMBERS

Mahalia Daniel

Jesse Hocking

Diane Davey

Sharise Hodges

Charvimane Albano

Dorothy DeCastro

Angela Holder

Patricia Allen

Suellen Demaline

Stacey Hopson

Loretta Anderson

Gerald Denny

Cynthia Hotaling

Will Asch

Ellie Doolin

Nathan Huhn

Kelly Ato

Kellen Downing

Michelle Hutchinson

Janet Azulay

Deanna Drabant

Linsey Ittyipe

Tyler Bacon

Nurse Educator

Kirby Jacobs

Tara Bagby

Deborah Enicke

Lisa Janetos

Richmond Bagorio

Eduardo Esquivel

Angela Jeong

Morgan Becker

Lori Eustis

Robert Kallen

Sarah Benson

Carol Evrard

Kayla Keenan

Catherine Bentley

Megan Fehrenbacher

Elizabeth Keene

Huifang Berger

Lin Feng

Angela Kigathi

Jody Billips

Eileen Fernandez

Anise Kiger

Catherine Blankenship

Angela Fierro

Sodam Kim

Donna Bonfanti

Randi Forgie

Kim-Uyen Lam

Danielle Boyle

Ami Forrester

Kristine Lawrence

Cassidy Brent

Claudine Fortner

Shirley Lawrence

Shannon Bronson

Delaney Fox

Aileen Lee

Kami Brown

Rebekah Frantz

Britney Lee

Shannon Brummitt

Courtney Fuller

Miya Leonard

Sydney Bryant

Rosalio Gallegos

Jeffrey Lertdilok

Sheila Buchanan

Ivan Mosses Garcia

Liberty Lindgren

Andrew Burt

Malina Garris

Eboni Lowery

Stephanie Burwell

Katie Gill

Jennifer MacDonald

Alyssa Cain

Catherine Greep

Kelsey Machado

Dona Campos

Tammi Gregor

Carla Macmillan

Jennee Canavesio

Sharron Griffith

Anne Macy

Kimberly Cannon

Tina Haas

Sarah Mar

Cheri Caraway

Amy Hall

Marcone Margute

Sondra Champagne

Ashley Harder

Roxanne Marlar

Diana Colon

April Harlan

Brooke Martin

Mary Conroy

Eleonora Harness

Kelley Martinez

Wilmarie Cordero

Shannan Harris

Rebecca Martinez

Candyce Crawford

Jeneanne Hawkins

Sue Mathews

Russell Cuenca

Gloria Heeringa

Stephanie Matteson

Patricia Curtin

Rocedeelyn Herbert

Colleen May

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Ogechi Mbakwe

Heather Rhodes

Cassi Vanderjagt

Audra McBee

Patrick Rimmer

Bo Vanis

Karen McCain

Sharon Robertson

Cindy Vogelpohl

Madison McCalip

Scott Rochelle

Lorie Ann Voight

Allison McCune

Nicole Rode

Michelle Wait

Amanda McDonald

Angela Rodriguez

Elizabeth Walker

Karen McLeod

Shirley Rodriguez

Alistair Walker

Rebecca McMahon

Angie Roschewski

Shelly Watts-Dognazzi

Gaaj Meyer

Virginia Ryan

Brittany Wheelock

Matthew Milewski

Lauren Saavedra

Kylie Wiens

Nicole Mironi

Jimmy Sainville

Andrea Wilford

Anastasia Mironova

Nicole Sardinas

Archie Bryan Williams

Racquel Mock

Thomasina Savage-McDowell

Shawntel Willis

Khristine Morin

Lisa Schultz

Katheryn Windley

Patrice Morrow

Udomporn Schwartz

Jayna Wood

Jennifer Mosley

Maria Sheriff

Sioban Wynne

Brea Myers

Kelly Shirley

Vadim Zaslavsky

Stephanie Neumayer

Kevin Shores

Pamela Zentner

Vera Nguyen

Amanda Siecke

Karen Okodugha

Linda Slagel

Patty OLexey

Kristen Smith

Julie Osborne

Ladona Smith

Sarah Overstreet

Tina Spruell

Troy Palmer

Ceseleigh Stanley

Patricia Panarese

Elizabeth Steward

Haeyeon Park

Anita Stokes

Jimin Choi – South Korea

Michelle Parr

Madison Suokas

Paul Culley – United Kingdom

Carolyn Patterson

Dawn Szczepanek

Mary Pauly

Stephanie Szlosek

Tammy Pennington

Cara Tanner

Catherine Greep – New Zealand

Emily Petermeier

Pamela Taylor

Sodam Kim – South Korea

Lauren Pica

Jeff Terry

Heather Pigg

William Teufel

Sunni Pitts

Erica Thorson

Carla Macmillan – New Zealand

Alexis Prempeh

Mariol Torres

Sarah Mar – New Zealand

Brandy Preston

Laura Towne

Patty Reining

Shannon Turner

Sarah Reynolds

Alisa Van Horn

Jamie Rhoades

Nicole VanDenBoom

N E W I N T E R N AT I O N A L M E M B E R S

Sunita Arora – India

Ivan Mosses Garcia – Canada

Jennifer MacDonald – Canada

Haeyeon Park – South Korea

September/October 2021

The Role of Limited English Proficiency in Health Disparities:

Considerations for Infusion Providers by the NICA team

Did you know that one in five people in the United States speak a language other than English at home, and that this number is expected to grow in the coming years?1 Medical jargon can be confusing even to someone who is a native English speaker, so it is important to consider the 10% of the population that reports having limited English proficiency (LEP)2— that is, difficulty speaking, writing, reading, and understanding English — in order to provide the highest quality of care to all patients.

Let’s look at the facts: Compared to patients who are proficient in English, patients with LEP receive a lower quality of care, experience poorer health outcomes, and utilize fewer primary care services.3 One study examined the nature and frequency of adverse events affecting patients with LEP versus native English speakers and found that “[a]bout 49.1% of limited Englishproficient patient-adverse events involved some physical harm whereas only 29.5% of adverse events for patients who speak English resulted in physical harm.” These events were more likely to be correlated with miscommunication for LEP patients than with English-speaking patients.4 The challenges of providing quality health care to individuals with LEP are well-known, and yet measures taken to address this major cause of health disparities have neglected to reach the provider-administered patient population. Many small, private practices are left to their own devices in determining what constitutes linguistically competent care, as well as how to find and implement such services. Furthermore, the financial burden of providing such services falls on the providers, as health insurance typically does not reimburse language interpretation services. So why go to the trouble? Effective communication is key to providing safe, high-quality health care, and infusion therapy services are no exception. Prior to administration of complex biologics, patients require counseling and education regarding their disease state and their prescribed treatment. To assess for safety concerns such as contraindications to the prescribed treatment or infusion-related reactions, clinicians must be able to exchange information with patients quickly, easily, and accurately. Obtaining informed consent and providing effective discharge teaching are other situations where communication barriers pose risks to patient safety and care quality. When patients and providers do not speak the same language, it is exceedingly difficult—if not impossible—to meet standards of care. Let’s take it a step further. What is the cost of this miscommunication? To name a few, LEP patients will experience a higher risk for medical errors, fewer routine screenings, fewer physician visits, limited or poor interactions with providers, less access to community support services, and worse health outcomes. 38

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So, what can you do to ensure that you can effectively communicate with LEP patients? Learn to identify when a language gap is present There are some simple signs to look for when you have an initial encounter with a patient who you suspect might have limited English proficiency. They may appear confused or speak in short sentences or single words: these are good signs that there is a communication barrier. Noticing these signs right off the bat can allow you as the clinician to take extra care to help the patient with filling out forms, getting settled before a treatment, and just generally make them more at ease. Pay attention to nonverbal cues and be compassionate It is important to pay attention to your facial expressions and your tone of voice. Nonverbal communication is always a helpful tool in your communications, but even more so when communicating with LEP patients. Be sure to smile and keep your voice level, but project enough so that the patient can hear, and remember to be patient. Take a continuing education course on communicating with LEP patients NICA has developed a solution for providers and patients. Our program “The Role of Limited English Proficiency in Health Disparities: Considerations for Infusion Providers” is an accredited digital LEP training program. Help your practice communicate with all patients. Sign up today and learn how LEP can complicate care and what your practice can do about it: https://infusioncenter.org/lep/. Questions? Please email advocacy@infusioncenter.org. 1 LanguageLine Solutions. https://www.languageline.com/. July 29, 2019. Retrieved November 09, 2020. 2 US Census Bureau. Detailed Languages Spoken at Home and Ability to Speak English for the Population 5 Years and Over for United States: 2009-2013. 2015. 3 Canfield D, Diamond L, Gany F et al. A systematic review of the impact of patient-physician non-english language concordance on quality of care and outcomes. J Gen Intern Med. 2019; 34(8):1591. 4 https://academic.oup.com/intqhc/article/19/2/60/1803865.

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