Nurses Week May 2020

MAY 6-12

2020 NURSE’S WEEK Saluting Arizona’s nurses: Heroes on the front line of healthcare

Nurses: The heart and soul of healthcare Celebrating and honoring nurses for their hard work and dedication

By Susan Fuchs

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rizona’s 117,000-plus nurses who provide care from conception to death in dozens of diverse facilities all have a vital and unique role in the healthcare delivery system: We are the eyes and ears that sense how patients are. We are their voice, advocating for their needs. We are the human touch.

We are the heart and soul of healthcare.

Nurses treat the whole patient physically, psychologically, socially, spiritually and culturally,” explains Arizona Nurses Association executive director Robin Schaeffer, RN, MSN, CAE. “Nursing is a calling. Patients don’t care how much you know until they know how much you care.”

The essence of their role hasn’t changed over centuries.

In the mid-1800s Florence Nightingale set the standard by demanding data driven practices to fight infectious disease in the Crimean War, says Joey Ridenour, RN, MN, FAAN, executive director of the Arizona State Board of Nursing. Today, nurses continue Nightingale’s legacy, utilizing evidence-based practices to achieve the best outcomes, Ridenour says.

“COVID-19 reminds me of the beginning of my nursing career, when AIDS first came on the scene,” Schaeffer says. Because so much then was not known about AIDS, “Nurses and other healthcare workers were afraid of being infected – but, as now, we continued to care for our patients.”

Schaeffer’s belief is backed up by a recent AzNA survey that showed: • 80 percent of nurses feel they don’t have sufficient personal protective equipment; • 80 percent of respondents were afraid they will contract COVID-19 or pass it to their families; and • 75 percent said even knowing that, they would return to work.

FACING FEAR

Bravery in the face of fear is one of the reasons Gallup Poll has rated nursing as America’s most trusted profession for 18 years. “Being ranked the best for our honesty and ethics means we have an unwritten contract with society to be there,” Schaeffer says.

“Coronavirus is just a small speck in the greater picture,” explains Sherry Weiss, RN, CHPN, case manager for Banner Home Care and Hospice. “We have always provided care for everybody.“ “It’s what we do,” agrees Jadonn Sands, RN, ACLS, interim clinical coordinator in the telemetry unit at Abrazo Scottsdale Hospital. “We put ourselves out there. We advocate, mediate, communicate. We offer hope, healing and comfort.”

Obviously healthcare procedures today are different.

STAYING CONNECTED

“Six months ago, families were allowed in,” says Liz Mullican, RN, BSN, at Abrazo West in Goodyear. “Now we facilitate family contact through phone calls, and we are the ones who are there for patients.”

“We’re doing much more education about infectious disease and how to prevent its transmission,” says Weiss.

Nurses may protect themselves with multiple layers of personal protective equipment, gowns, gloves, face masks and face shields before entering a COVID-19 patient’s room. Their concern is not only being personally infected, like 10,000 other healthcare workers across America. It’s also the fear of infecting loved ones.

Many choose not to go home, isolating themselves in hotel rooms or sharing apartments with colleagues.

Those who do go home have elaborate infection control rituals. “You have to protect your family,” says Celina Acevedo-Adams RN, MSN, CCRN, CSC, at HonorHealth John C. Lincoln Medical Center.

STAYING CONNECTED

Nurses say they are more connected and proactively support each other.

“Twelve-hour shifts are exhausting, but I’m part of a good group of people,” Sands says. “We rely on each other more than ever before.”

Colleagues are offering to shop for each other, Sands says, and are bringing in sandwiches or donuts.

Some are making each other personalized surgical hats. Mullican has a hat with an EKG strip in recognition of her pre-RN years as a monitor tech. Disney fan AcevedoAdams received a Mickey Mouse hat

SAVING LIVES

That human connection with colleagues and patients compensates for stress, says Acevedo-Adams, who’s been a nurse for 16 years. “My greatest satisfaction was watching my COVID-19 patient FaceTime his wife after a 10-day medically induced coma; he could see and hear her and mouth words back.”

It was particularly meaningful, she notes, because her patient was Arizona’s first to be saved with extracorporeal membrane oxygenation (ECMO), after he failed to respond adequately to standard intubation and a respirator.

Ingenious ECMO use illustrates one of nursing’s strengths. “Nurses are innovative thinkers, excellent problem solvers and detectives,” Schaeffer says.

“Nurses can always figure out a way,” agrees Sandy Severson, vice president for Care Improvement at the Arizona Hospital and Healthcare Association.

Looking into the future of nursing What’s on the horizon for Arizona nurses, healthcare

By Susan Fuchs For nurses themselves, coronavirus-inspired substitution of technology for personal contact not only saves travel time, but also makes it easier to share data, notes Sandy Severson, vice president for Care Improvement at the Arizona Hospital and Healthcare Association. “Meetings are more productive, a change that will last.”

COMPUTER TRAINING

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t’s ironic, says Joey Ridenour, RN, MN, FAAN, executive director of the Arizona State Board of Nursing, that changes generated to cope with COVID-19 are helping nursing move from where we were to where we want to be.

Many trends for 2020-2025 compiled by the Nursing Board last year are already emerging. For example, Ridenour says, “Digital technology has been on our horizon for years, but more patients now want in-home connections to access primary and specialty care.”

EMBRACING TEAHNOLOGY

Nurses must be tech savvy or risk being left behind.

They see patients who have already researched their symptoms online, used in-home tech to monitor their conditions, and ask for medication they’ve seen in ads. Nurses must synthesize their patients’ information with their own expertise, Ridenour says.

“With telemedicine we can assess patients and reach more people in less time,” says Sherry Weiss, RN, CHPN, case manager for Banner Home Care and Hospice, many of whose patients live at home.

“That’s a real positive.”

Creative computer communications has expanded nurse training, Ridenour says. Program directors use artificial intelligence in clinical simulations, so students can learn through virtual reality. Patient conditions and complications can be adjusted to test students in ways impossible with real people.

The Board predicts online education will grow, providing a way for nurses to obtain advanced degrees without sacrificing work or family.

According to Ridenour, Arizona nurses with bachelors, masters or doctorate degrees currently comprise about 70 percent of the profession, compared to 56 percent nationwide.

Advanced Practice Nurses are prepared to work in specialized healthcare arenas outside traditional nursing, and they will be prepared to fill growing nationwide MD/DO shortages, Ridenour says.

NEW OPPORTUNITIES

Without enough primary care physicians, opportunities for Family Nurse Practitioners will rise, especially in states like Arizona where, thanks to advocacy of the Arizona Nurses Association, they have full practice authority.

But challenges remain. Baby Boomer retirement, transition to leadership positions outside of nursing and limited nurse education opportunities all combine to create a current shortage of nurses,

in Arizona, in the U.S. and globally.

According to a 2016-2017 American Association of Colleges of Nursing (AACN) report on Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, qualified applicants have had to be turned away. “There are not enough experienced nurse leaders, including faculty,” Severson says.

The AACN sees a bright spot -- recent initiatives have made faculty positions more attractive.

That’s good, because the federal Bureau of Labor Statistics says nursing jobs will grow by 12 percent in the next five years.

INCREASED DEMAND, SALARIES

The Nursing Board expects in response to demand, future salaries for Registered Nurses will increase and, in states like Arizona, bilingual nurses will be more valued.

Robin Schaeffer, RN, MSN, CAE, executive director of the Arizona Nurses Association believes nursing’s future will be influenced by a grant to develop innovative ideas secured by AzNA’s Foundation for the Future of Nursing.

As a result, Schaeffer believes, “The healthcare system will emerge stronger and more resilient, with a deeper understanding of how all stakeholders can work together.”

Nurses will also be able to fill a vacuum in the public healthcare discourse, Severson says.

“Nurses bring a different viewpoint to the process.

Yet right now, less than 3 percent of nurses sit on boards, compared with 25 percent of physicians who serve in policy-making organizations. Society needs us to have a stronger voice to maximize our impact on healthcare delivery, patient outcomes and well-being.”

Training nurses in unprecedented times Local universities quickly pivoted to change curricula as pandemic became evident

By Debra Gelbart

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magine you’re a nursing student and your opportunity to provide hands-on care for actual patients suddenly disappears.

That’s been the reality for nursing students at both Arizona State University’s downtown Phoenix campus and Grand Canyon University in Phoenix as part of the fallout from the coronavirus pandemic. Since approximately the first week in March of this year, administrators at both universities had to quickly develop “plan b” for their students when local hospitals temporarily stopped allowing the students to work inside the facilities, in part because of the unknown demand for personal protective equipment.

CLINICAL TRAINING CHALLENGES “Our curriculum had to change very abruptly this semester, like every other school, because of the COVID-19 outbreak,” said Dr. Lisa Smith, dean of the College of Nursing

Photo credit: Christina Maddaluna

and Health Care Professions at Grand Canyon University. “Mentally we had already started to prepare—if we can’t finish out those clinical hours, what will that look like?”

Fortunately for GCU nursing students and staff, the nursing program already has a sophisticated online component. “Transitioning to the online environment involved no delay and no issues, because the students are used to doing some online work anyway.”

The bigger challenge was giving

and students in the doctoral nursing program to become nurse practitioners took turns conducting telehealth exams and taking medical histories with the patients over Zoom. “Because the students couldn’t physically touch the patients, they had to ask even better questions (about their history and any medical concerns),” Karshmer said.

LOOKING TO THE FUTURE

the students access to clinical experience, since they could no longer see patients in hospitals. The GCU program includes an immersive simulation lab, with about 27 percent of students’ clinical experience in the lab. So professors took previous video-recorded simulations and presented them to students on Zoom video conferences. “We kept our clinical groups the same with clinical faculty, and students interacted just like they would if they were physically there,” Smith said.

It’s a similar story at Arizona State University, where Dr. Judith Karshmer is the dean of the Edson College of Nursing and Health Innovation. Part of the college is the Grace Center, which provides thousands of hours each year of simulation and clinical lab experiences for students in undergraduate, post-graduate and doctoral nurse practitioner programs. “It’s an important place to wed your critical thinking to skill development,” Karshmer said.

HANDS-ON EXPERIENCES

Because undergraduate students were no longer permitted in hospitals in March due to COVID-19, those

students were brought into the Grace Center to have hands-on experiences they were missing. “We finished out the clinical experiences there, bringing in the students in small groups,” Karshmer said. “But then we couldn’t bring in even small groups of students, so our faculty converted the entire Grace Center experience to virtual simulations using Zoom.

The director of the undergraduate program told me the students were

Photo credit: The Grace Center in the Edson College of Nursing and Health Innovation at Arizona State University

on Zoom at 7 a.m., dressed in their nursing uniforms, ready to learn while sitting in their homes.”

In another instance, actual healthy individuals serving as standardized patients came to the Grace Center accompanied by a nursing instructor

No students at either university will be delayed graduating this spring, both Karshmer and Smith said.

Smith anticipates that other seniorlevel nursing students planning to graduate later this year will be able to complete their residency experience in some hospitals during summer courses. “The worst thing we could do is delay graduation,” Smith said. “There was already a nursing shortage (when the pandemic began) and now there’s an even greater demand for nurses.”

For continuing students, inperson clinical experience can’t be put off indefinitely, both deans emphasized. “They need that handson experience,” Smith said. Local hospitals both colleges partner with have told the colleges they’re willing to host students again as soon as it’s responsible to do so.

By this fall, in-person classes may resume. “Our plan is all about making it safe,” Karshmer said. “When it’s safe, we’ll be ready to welcome the students back to campus. And as soon as our colleagues give us the okay, we’ll be back in the hospitals.”

And no matter what changes, delays or interruptions in coursework and practical experience may occur as a result of the coronavirus in the future or how job opportunities in nursing may be impacted, one constant remains. “There will always be a need for nurses,” Dr. Smith said, “because people will always need health care.”

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Thank You, Nurses and All of Our Frontline Heroes FOR ALL YOU DO

Valleywise Health honors our nurses and other healthcare providers during National Nurses Month in May, and National Hospital Week, May 10-16. We are truly amazed at the compassion and dedication of these heroes who provide exceptional patient care every day under unprecedented circumstances. Their commitment to healing inspires us all during these uncertain times.

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Nursing Profiles ADAPTING QUICKLY

Nurse practitioner at ASU shifts to telemedicine

By Debra Gelbart One of the hallmarks of a nurse is being able to adjust to current circumstances almost instantaneously.

That can occur in a hospital or in an urgent care or primary care setting. And it can happen on a college campus.

Just because Arizona State University students haven’t been on campus during half of the spring semester doesn’t mean they don’t have health concerns or need medical attention. The difference is now students are likelier to see a health professional at ASU Health Services via Zoom rather than face-to-face.

And one of the health professionals they may speak with is Dr. David Eisenbise, a nurse practitioner who works in the acute or urgent care section of the student health clinic. That’s where both undergraduate and graduate students walk in for urgent medical care, rather than make an appointment for a wellness exam or a minor medical complaint.

MAKING A TRANSITION

Typically, Eisenbise, who holds a Doctor of Nursing Practice degree, will diagnose and treat students’ infections, anxiety and depression, broken bones and allergies, among many other conditions.

In March, as students moved to online classes, Eisenbise transitioned from in-person appointments to telemedicine consultations through video conferencing.

And he’s hearing about many of the same medical conditions he saw in person before March. Students access these telemedicine visits through an online patient portal, which allows students to either request a consultation right away or set an appointment. A typical telemedicine appointment lasts about 20 minutes.

Eisenbise, 31, enjoys working with college students. “I love health care and the culture of learning and I feel like I get both working at ASU. I work with a great team that’s helping me learn and grow so each day I feel like an even better health care provider than the day before.”

STAYING UP TO DATE

He said one of his greatest professional challenges these days is staying up to date with new information about the novel coronavirus. “Medical decisions involve weighing benefits and risks,” he said. “COVID-19 has added a new complexity that must be considered in each of our decisions.”

Eisenbise doesn’t know when mostly inperson appointments will be phased back in, but he’s looking forward to it. Because of the influence of telemedicine now, he said, he and other providers may be able to assess the patient to a significant degree online before they’re even seen in the clinic. What providers are learning through the pandemic, Eisenbise said, is that “telemedicine combined with face-toface appointments may be the best of all worlds in health care.”

LEARNING MODE

RN says challenges presented by COVID-19 offer lessons to health care professionals As with so many healthcare professionals, COVID-19 has changed the day-to-day experience of Kaitlin Nicholas, R.N. She has worked in the Care Unit at Banner Casa Grande Medical Center for most of the eight years she’s been at that location since she and her husband moved to Pinal County from Buffalo, New York. The Care Unit is a combination of med-surg, telemetry (sophisticated electronic monitoring) and orthopedics.

Banner Del E. Webb Medical Center in Sun City West in the intensive care unit in 2011 and she’s been there ever since.

“I discovered that when a highly specialized group of people from all disciplines work together, we can formulate individualized plans of care for patients and it really leads to phenomenal outcomes for patients. The passion I have for healing people is coupled with science and it’s so fulfilling.”

CARING FOR COVID PATIENTS

But since mid-March, Nicholas, 34, has spent two-thirds of her shifts in a unit that cares for COVID-19 patients. The unit can accommodate up to 20 patients right now, but so far, it hasn’t been full at any given time.

“We all had the opportunity to volunteer and I told them I didn’t mind working down there,” said Nicholas, who has earned a master’s degree in nursing from Chamberlain University College of Nursing in Phoenix. “I had already been taking care of some of the ‘rule-out’ patients prior to opening that unit so I decided to continue.”

THE UNKNOWN CAN BE UNSETTLING

She says her greatest professional challenge these days is the unknown.

“We don’t know whether we’re going to have a peak or surge in patients or an unbearable number of people who come it at one time. Not knowing what the next step will be or how Pinal County will end up (in this pandemic)” has been daunting, she said.

Nicholas especially appreciates her co-workers “and the leaders of the facility. “I feel like they’re family. We get along really well and they’re my number one support. I like working in a small community like Casa Grande. You really get to know the patients and I like caring for them.”

Half of the ICU where Fender works (which is split between two floors) now cares for COVID-19 patients. Patients aren’t able to have a family member in the room with them right now, part of a hospital-wide policy to prevent infection. “We as nurses are kind of their everything right now,” said Fender, 43, who recently was named nurse of the year on her unit by her peers.”

It’s a little emotional for me, because you develop a love for people you don’t even know. When the family can’t be there, we are there. It’s a priority on our unit. We’re committed to keeping the patient and the family informed. You just do the best you can to help the patient feel better.”

And helping a patient feel better can be an unforgettable experience. “When you walk into a patient’s room and you see that sadness or despair in their eyes turn into hope, it’s something indescribable,” she said.

THE PRIVILEGE OF CARING RN at Banner Boswell shifts focus to COVID-19 patients

NURSING’S OPPORTUNITIES ESPECIALLY REWARDING

She encourages people to look into nursing as a career.

“We’re all getting the chance to learn something different,” she said. “Even though we don’t know the future, we’re getting an opportunity to experience something that we may never have thought we would and experience how the hospital comes together with the community and how we come up with back-up plans for the future. If people are considering nursing as a profession, what we’re living through right now is a really good example of why someone should become a nurse.”

‘WE ARE THEIR EVERYTHING’ RN says nurses stand in for family not allowed to be with hospitalized patients

Chelsea Pruitt, R.N. works on a specialized neurology unit at Banner Boswell Medical Center in Sun City, often as a charge nurse overseeing other nurses on her shift. Around March 1, that unit was converted for COVID-19 patients almost exclusively, in part because it can easily be closed off as a designated 24bed unit.

Despite the risks, Pruitt didn’t hesitate to agree to care for those patients.

“Everybody was a little nervous at first,” she said. “But because I know the team I work with, I knew it was going to be okay. I’d rather play a role in helping prevent the spread and taking care of people who are sick with it, than just stand back and hope for the best.”

Taking care of these patients “is a privilege,” said Pruitt, 32. “They’re so scared and their families are scared because loved ones can’t be with patients (visitors at most hospitals these days can’t be in patient rooms because of the risk of infection). Being a support person for those patients and family members truly is an honor.”

GRATITUDE DESPITE EMOTIONAL FATIGUE

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Joyce Fender, R.N. says it was the labor and delivery nurses at what is now Banner Thunderbird Medical Center who inspired her to go to college to become a registered nurse—even though for most of her life she had been scared of needles and hospitals.

Yet she began her career as a registration clerk and birth recorder at two Banner hospitals, respectively.

“Once I was around the labor and delivery nurses and saw how passionate they are and how wonderful it is to watch them work, I realized how much of a difference a nurse can make,” she said. Though she was interested in labor and delivery, she chose a different specialty after she earned her two-year degree in nursing because at that time, employment opportunities for labor and delivery nurses were scarce.

A CAREER IN CRITICAL CARE

While working in hospice care, she realized she had a lot to learn. “I really loved it there, but I felt like I needed to become a better resource for patients,” she said. “So I started researching critical care opportunities.” She was hired at

She’s grateful to be able to help patients feel better emotionally and physically, but it can be a draining experience.

“It’s so hard to see what your patients go through and hear their families react,” she said. “You can feel the fear they have.

It’s hard to know that even though you’re doing your best to talk to them and stand in as a family member, a lot of times they can’t really hear you under all of our protective equipment.”

TAKING ON MORE ROLES

And she’s busier than she’s been before during her shifts. In addition to making sure she’s employing best clinical practices for these COVID patients, Pruitt said she’s doing much of the work of a dietary technician who would typically deliver meal trays to each patient but can’t anymore because of the risk of infection. She’s also performing many of the tasks housekeeping typically would provide, for the same reason.

“This pandemic has been a reminder of how appreciated and how important every member of the health care team,” she said.

To connect the patient with family members, Pruitt sometimes makes FaceTime calls for the patient. “When you see their eyes light up or hear the tone of relief in the family’s voice, it’s amazing.

It’s a gift to be able to positively impact the patient when you know they need it the most.”

Your communities love you. And so do we.

To all our nurses and hospital workers: Thank you for giving us hope.

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