Texas Nursing 2024 Issue 2

TEXASNURSING MAGAZINE

ISSUE 2, 2024

Volume 98, Number 2

EDITOR IN CHIEF: Serena Bumpus, DNP, RN, NEA-BC

MANAGING EDITOR: Darrick Nicholas

COPY EDITORS: Natalie Hill, Gabi Nintunze

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MISSION

Empowering Texas Nurses to advance the profession

VISION

Nurses transforming health

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Copyright 2024 © Texas Nurses Association

BOARD OF DIRECTORS

OFFICERS:

Joyce Batcheller DNP, RN, NEA-BC, FAONL, FAAN, President jbatcheller7@yahoo.com

Amy McCarthy, DNP, RNC-MNN, NE-BC, President-elect amccarthyrn@gmail.com

Gloria Lorea, DNP, RN, NEA-BC, Treasurer glorialoeradnp@gmail.com

Missam Merchant, MBA, BSN, RN, CENP, CCRN-K, PCCN, CV-BC, GERO-BC, MEDSURG-BC, NE-BC, Secretary sam.merchant2017@gmail.com

DIRECTORS:

Jose Alejandro, PhD, RN, NEA-BC, MBA, CNE, FACHE, FAAN - Dallas josealexrn@gmail.com

Patricia “Pat” Francis-Johnson DNP, RN, CDP – Lubbock patricia.francis@ttuhsc.edu

Edtrina Moss, PhD, RN-BC edtrina@comcast.net

Brandon “Kit” Bredimus, DNP, RN, CEN, CPEN, CNML, NE-BC, CENP, NEA-BC kit.bredimus@midlandhealth.org

Mary Vitullo, MBA, MSN, RN-BC, PCCN, NE-BC, CLSBB vitullo.mary@yahoo.com

LVN REPRESENTATIVE Adam Ramirez, LVN, WCN-C, IV-C adamramirez05@hotmail.com

CHIEF EXECUTIVE OFFICER: Serena Bumpus, DNP, RN, NEA-BC sbumpus@texasnurses.org

TNA DISTRICT PRESIDENTS

Dist. 1: Sarah Yvonne Jimenez, PhD, RN syjimenez2@utep.edu

Dist. 3: Christopher Rougeux, MSN, RN, crougeux99@gmail.com; District office: Jamie R. Rivera, JamieRivera@texashealth.org

Dist. 4: Robert Castillo D.N.P., M.H.A., RN, CCRN, R.T.(R)(T)(ARRT) tnad4.nursingnetwork.com; President-Elect: Marie Lindley PhD, RN, CNE District Secretary: Lori Batchelor, batchelorb@prodigy.net

Dist. 5: Chelsea Vaughan, RN, chelseareneevaughan@gmail.com, tna5.org

Dist. 7: Connie Barker, APRN. PhD. FNP-C, crbarker1@yahoo.com, tnadistrict7@gmail.com

Dist. 8: Nelson Tuazon, DNP, DBA, RN, NEA-BC, FNAP, FACHE, FAAN, nelsonactuazon@gmail.com

Dist. 9: Marco Ollervides, MSN, RN, marco.ollervides@memorialhermann.org

District office: Melanie Truong, RN, Executive Secretary, tna9@tnadistrict9.com, tnadistrict9.com

Dist. 17: Mari Cuellar, NEA-BC, MSN, RN, mari.cuellar@christushealth.org

Dist. 18: Rebecca Clark, DNP, RN, CNE, MEDSURG-BC, rebecca.clark@ttuhsc.edu

Dist. 19: Dixie R. Rose, RN, dixiegtc@gmail.com

Dist. 35: Karen Koerber-Timmons, PhD, RN, CLNC, CNE, NEA-BC, CCRN, RN-BC  mkkoerbertimmons@gmail.com

At-Large: Contact TNA, 800-862-2022, ext. 129, brichey@texasnurses.org

By Dr. Cindy West, DNP, APRN, CRNA

BUILDING CULTURAL COMPETENCE

By Sonia Castillo

By Jack Frazee, J.D.

By JoAnn D. Long, PhD, RN, NEA-BC

Jennifer Reeves,

President’s Notes

Joyce Batcheller DNP, RN, NEA-BC, FAONL, FAAN

LISTEN. STRATEGIZE. GO! Our Leadership Year in Review

THE FIRST PRESIDENT’S MESSAGE I wrote when I began my TNA presidency was about transitions, why I decided to run for office, and the three strengths I believed I would bring to TNA. The three top strengths I brought to TNA are the ability to influence and lead large system changes, an extensive network of colleagues, and the belief that nurses have the answers and need to engage in shaping the future of the nursing profession. TNA needed to build on and create a new strategic direction since we were finally coming out of the COVID pandemic. One of the roles of the president is to lead the strategic planning with the board, CEO and TNA staff.

While I may have been ready to start, I needed to pause when the former CEO Dr. Cindy Zolnierek decided to retire. Attention was focused on finding the next CEO to lead TNA. The phrase “slow down to go fast” was absolutely true at this time. A search committee was formed comprised of Gayle Dasher, Jim Allard, Shakryn Napier, Olusola Oyewuwo and Erin Perez. This group of diverse leaders was highly engaged in helping the board select Dr. Serena Bumpus as the new CEO. Staying in the “slower” mode, while difficult for me, was still needed as the onboarding and orientation for the CEO was completed. Additionally, key vacancies needed to be filled in order to speed up again.

Part of the onboarding process included “listening tours” where the CEO, select TNA staff and I traveled to different parts of Texas to hear from nurses in varied fields about the challenges they face and how TNA could help.

Two concerns we heard consistently re -

lated to staffing and workplace violence. These issues and others were used as input and validation that the strategic planning completed by the board and staff was relevant and aligned by TNA’s key stakeholders. Other themes we heard relate to new graduates requiring longer orientations, burden of documentation and overall high complexity of patients. Collaborating with colleagues in my network also provided an opportunity to see how nursing in Texas aligned with what was happening in other parts of the country. For example, the population growth that Texas is expecting is creating a demand for more hospital beds, yet other parts of the country are looking at consolidating and closing hospitals as services continue to move out into the community and home.

We made major changes, used the network I had and created new support networks to set a definitive direction for TNA and its influence on nursing in Texas.

You may be wondering: What differences have I helped make during my presidency? I welcome the question and I'm proud to share that Dr. Bumpus and her team have synthesized the brainstorming the board did into goals, metrics, and a dashboard with timelines for completion that have been approved by the board. Each of the board members serves as a liaison to a specified committee and the energy is high. We hold quarterly meetings with the district presidents where Dr. Bumpus

shares what TNA is working on as a way to align and speed the kind of changes we desire to make. Nurse Day at the Capitol was a huge success along with many legislative wins that have been described in other publications. The annual conference has grown over the last two years with the addition of podium and poster presentations. An endowment fund has been created to honor Clair Jordan. I could go on about other accomplishments but I will stop here. I hope you can see how I used my strengths during these past two years. We made major changes, used the network I had and created new support networks to set a definitive direction for TNA and its influence on nursing in Texas. Each of you has this same opportunity. Consider what your strengths are, and how you could engage effectively with TNA and influence the future of nursing. I gained as much if not more than I gave. We are an incredible force and could make incredible differences in TNA’s goals.

I encourage all of you to engage in TNA and help to shape the future of the nursing profession. I feel privileged to have heard amazing stories where nurses are making a difference in spite of the challenges we face. I have been an RN for more than 45 years and I am proud to be a nurse and still love the profession. I hope all of you do too and will continue to support the incredible work TNA is leading. As I transition to the past president role, I want to congratulate and welcome Dr. Amy McCarthy in her role as TNA President.

Thank you. i

TNA MEMBER NEWS

SPOTLIGHT ON YOU

KUDOS

Congratulations to the following members for being named as part of the ‘2024 DFW Great 100 Nurses’:

Amy Wilkins - Baylor Scott & White Medical Center Lake Pointe

Nisha Paul - Baylor University Medical Center

Meaghen Pleasants - Baylor University Medical Center

Latieia Key – Children’s Health

Tiffany Montgomery – Children’s Health

Sara Moore – Children’s Health

Shakyryn Napier - Cook Children’s Medical Center

Sara Elliott - JPS Health Network

Bernadette Grant - JPS Health Network

Julie Moore - JPS Health Network

Elisabeth Rodgers - JPS Health Network

Kristin Stanley - JPS Health Network

Jessica Washington - JPS Health Network

Victoria Tierney - Medical City Dallas

Jenny Earls - Medical City McKinney

Sobha Fuller – Parkland Health

Amber Rogers - Texas Health Arlington Memorial Hospital

Vishia Coleman - Texas Health Harris

Methodist Cleburne

Michelle Hampton - Texas Health Harris

Methodist Fort Worth

Karla Gray - Texas Health Harris

Methodist Hurst-Euless-Bedford

Cyndi Kelley - Texas Health Presbyterian Hospital Dallas

Camille Torralba - Texas Health Presbyterian Hospital Denton

Amy Turner - Texas Health Presbyterian Hospital Flower Mound

Kambree Baxter - Texas Health Resources

Janah Hammond-Rodriguez - Texas Health Rockwall

Jennifer Thomas - Texas Health Specialty Hospital

Lucas Farris - The University of Texas at Arlington

Ruben Castillo - UT Southwestern Medical Center

Christopher McLarty - UT Southwestern Medical Center

Shinto Thomas - UT Southwestern Medical Center

David Wyatt - UT Southwestern Medical Center

Susamma Abraham - Veterans Affairs Medical Center

Congratulations to the following members for being named as part of the ‘D Magazine 2024 Excellence in Nursing’ winners:

Shontell Angrum – Parkland Health

Kathleen Blanco - Methodist Richardson Medical Center

Kiama Bryant – Medical City McKinney

Anne Fjordholm – Methodist Dallas Medical Center

Rosa Moctezuma – Methodist Dallas Medical Center

Sara Moore – Children’s Medical Center – Dallas

Lisa-Marie Rainwater – Mesquite ISD

Jennifer Summers – Texas Health HEB

Adrianne Duvall-Ingram – Baylor University Louise Herrington School of Nursing

Stephanie Fassett – Medical City Healthcare

Tracy Tyner – Parkland Health

Rency Atly – Medical City Plano

Lori Batchelor – Children’s Health

Robert Castillo Jr. – UT Southwestern Medical Center

Misty Daugherty – Children’s Health

Bradley Goettl – UT Southwestern Medical Center

Tera Holland – Children’s Health

Brennan Lewis – Children’s Medical Center – Dallas

Amy McCarthy – Texas Health HEB

Kristine Morris – Texas Woman’s University

Stefani Newberry – Methodist Dallas Medical Center

Christi Nguyen – UT Southwestern Medical Center

Nancy Palacios – UT Southwestern Medical Center

Karla Ramberger – Baylor Scott & White Medical Center – Dallas

Lauren Tuohy – Parkland Health

Tammy Webb – Children’s Health

Heather Wheaton – Baylor Scott & White Medical Center – Irving

Damita Williams – Ascension Health

Congratulations to JPS Health Network for being named ‘2024 Gallup Exceptional Workplace Award Winner’.

Congratulations to Robert Castillo D.N.P., M.H.A., RN, CCRN, R.T.(R) (T)(ARRT) for being named District 4 President.

TNA MEMBER NEWS

SPOTLIGHT ON YOU

Congratulations to the following organizations for receiving the prestigious Pathway to Excellence designation:

Covenant Children’s Hospital in Lubbock, TX

Baylor Scott & White The Heart Hospital Denton in Denton, TX

Methodist Hospital in San Antonio, TX

Congratulations to the following organizations for receiving ANCC’s Magnet redesignation:

Texas Health Arlington Memorial Hospital , Arlington, TX

Texas Health Harris Methodist Hospital Fort Worth , Fort Worth, TX

Methodist Dallas Medical Center, Dallas, TX

Congratulations to the following teams for being named as part of the new 2024-2025 Johnson & Johnson Nurse Innovation Fellowship cohort: Dr. Melissa Shemek , Ed.D/CI, MSN Ed., RNC-NIC, NEABC, and LaJuana Jones , DNP, RN, NEA-BC; Baylor Scott & White Medical Center – Hillcrest

Amy Daher, MSN, RN, NE-BC, and Nohemi Galindo, BSN, RNCOB, NPDBC, C-ONQS, C-EFM, University Medical Center of El Paso. i

If you are a TNA member and you’ve, been promoted, received an award, or been elected or appointed to a board or community organization, we’d like to hear from you. Please send submissions to editor@texasnurses.org

WHAT'S NEW AND NEXT

LET YOUR VOICES BE HEARD

CONTRIBUTE YOUR EXPERTISE AS AN AUTHOR

This year, Texas Nursing Magazine will focus on nursing priorities identified through work completed in February 2023 by the Partners for Nurse Staffing Think Tank.

In each issue, there will be articles with these thematic pillars:

ƒ Healthy work environments

ƒ Diversity, equity, and inclusion

ƒ Work schedule flexibility

ƒ Stress injury continuum

ƒ Innovative care delivery models

ƒ Total compensation

We are actively seeking members to submit articles that fall within these categories. Email us at editor@texasnurses.org.

TELL YOUR STORY ON VIDEO

One of our goals at TNA is to amplify the diverse voices of our membership. During national observances (e.g., Black History Month, Pride Month, Hispanic Heritage Month), we would like to share comments from those who identify with the group that is being recognized.

We are looking for those members to help us create 30-second videos that will be shared through our social media channels. The videos will cover how cultural identity relates to their journeys through nursing.

If you are interested, click this link to sign up

Help us tell the stories of diversity, equity, inclusion and belonging in Texas nursing.

JOIN A TNA COMMITTEE

TNA's committee members impact nurses across Texas. By joining a committee, you will lead various initiatives across disciplines or fields of interest with varied time commitments. This peer engagement offers direct opportunities to influence Texas nursing on multiple levels. The following committees are now seeking members:

ƒ Audit & Finance

ƒ Awards

ƒ Bylaws

ƒ Communications

ƒ Early Career Nurse

ƒ Government Affairs

ƒ Health Information & Technology

ƒ LVN

ƒ Nursing Practice

ƒ Nursing Professional Development

ƒ Scholarship

ƒ Policy Council

Visit the State-Level Committee Opportunities page to learn more about each committee and sign up!

ATTEND NURSE DAY AT THE CAPITOL

At TNA's Nurse Day at the Capitol, nurses from across the state come together to advocate for policy that betters the nursing profession. The event allows nurses to hear more about nursing issues, identify opportunities to influence healthcare policy, and develop a personal advocacy message. Save the date and join us in Austin, March 3 and 4, 2025! To learn more, visit texasnurses.org/NurseDay

CEO Corner

Serena Bumpus, DNP, RN, NEA-BC

TRANSFORMIING HEALTHCARE IN TEXAS Let's Influence Change Together!

GAINING TRACTION is TNA’s theme for 2024, and what incredible traction we are gaining! Over the last quarter we’ve continued to see increased engagement from our members and increased membership by an additional 380 members. Our goal is to encourage curiosity and inspiration so that more nurses will engage with and join TNA.

Did you know that less than 5% of Texas Nurses are members of a professional organization and less than 3% of them are members of TNA? If we want to influence change as a profession, we must engage with our professional organizations. It starts with the 16,000 members that are currently part of this great organization to role model that behavior and share the work of TNA. I challenge all of you to make it a personal goal of yours to recruit 5 new members every month! There is power in numbers and together, we can transform healthcare in Texas.

In January, we officially launched membership for LVNs. Since that launch we have gained 66 LVN members. We know there are more out there and that many

I challenge all of you to make it a personal goal of yours to recruit 5 new members every month!

of you work with LVNs. LVNs are nurses too and need a place to belong. Encourage your LVN peers to join TNA today.

Many of you are looking for ways to engage with TNA. On May 1, we put a call out for committee members which closes on May 31. The TNA Board of Directors will appoint committee members in June and appointments will officially begin again July 1. This is a great way for you to carry out your voice and the voice of your peers. Whether your passion is awards and recognition, leadership succession, finance, practice, nursing professional development policy, government affairs, bylaws or something else, we have a place for you. For more information and to submit your interest, please visit the TNA Website.

If volunteering at the state level is not in your sights right now, I encourage you to engage with your local area districts.

They are working hard to build community for nurses in the cities they work in. Your engagement in your local district will expand your network of colleagues and your sphere of influence. You can find your local district and chapter president on our website

I want to thank you for being a member of TNA and for your contributions to the profession. As always, we are here to support you and your practice. i

A Reputation for Excellence!

Educating nurses since 1890, UTMB SON offers undergraduate, graduate and doctoral degree tracks, designed to meet the unique needs of each nursing professional. Our graduates are skilled in providing patient-centered care and are developed to become leaders in health care.

UTMB SON’s teaching innovations have resulted in consistently high national rankings and alumni who have distinguished themselves as leaders throughout Texas and the United States. Today, informed by tradition, our vision continues to be our mission—to be the best in nursing education, research and practice in order to improve health for people around the world.

Programs Offered

• Bachelor of Science in Nursing

• Traditional BSN (on campus)

• RN-BSN (online)

• Master of Science in Nursing (online)

• Certificate (online)

• Doctor of Nursing Practice (online)

• Doctor of Philosophy in Nursing (online)

THE UNIVERSITY OF TEXAS MEDICAL BRANCH

TAKE PART IN TNA'S NURSE STAFFING SUMMIT

Your Input Is Critical to Informing Policy Change

By Jack Frazee, J.D.

TEXAS PASSED A HOSPITAL STAFFING committee statute in 2009, making it an early adopter of this policy model among the states. The COVID-19 pandemic strained nurse staffing until it neared a breaking point. Now, in the wake of the pandemic, nurses are studying staffing, reassessing the existing model, and thinking about what improvements can be made.

SHARE YOUR LIVED EXPERIENCE

TNA has been researching the nurse staffing statute in Texas and gathering as much data as possible to inform its research. TNA has identified several strengths and weaknesses in the existing system, but we lack adequate data about the lived experiences of Texas nurses. To fill this gap, we are hosting a Nurse Staffing Summit to bring together nurses, from bedside to executive management, to discuss and share their experiences with staffing in Texas facilities. The summit will use the World Café model, with a series of presentations about the policy framework in Texas, policy alternatives, workforce data, and the experience of working on a staffing committee. Between presentations, participants will discuss various topics to generate ideas about how the staffing

TNA is hosting a Nurse Staffing Summit to bring together nurses, from bedside to executive management, to discuss and share their experiences with staffing in Texas facilities.

policies in Texas are affecting nursing practice and how we might improve or change the system.

INFORM TNA'S POLICY INITIATIVES

This meeting will inform TNA’s policy work. In the last session, the Texas Legislature made the largest investment in nursing education in state history. The purpose of that investment was to alleviate the nursing shortage by expanding the capacity of our nursing schools to admit, train, and graduate students prepared to obtain their license and join the workforce. However, we increasingly hear that the workplace conditions nursing enter are so challenging that nurses are leaving the profession at an unsustainably high rate. To protect nurses’ welfare as well as the taxpayer investment in nursing education, it is critical for TNA to study workplace conditions in the here and now and recommend policy changes the Legislature can implement to alleviate the challenges nurses are facing.

We know from decades of research that nurse staffing is critical for patient outcomes. For Texans to receive high quality healthcare that is free from medical errors, we must ensure an adequate number of nurses who are practicing in environments that promote success. Often, we hear the opposite is happening — nurses are overburdened, under resourced, and asked to take on unsafe or unrealistic assignments.

We must respond to the challenges presented by the global pandemic and address the challenges that emerged or we will have failed to repair the damage inflicted by this significant health event. To successfully respond, we need your knowledge and experience. Here’s how you can help:

ƒ Join us at the Nurse Staffing Summit to inform our research;

ƒ Send us an email sharing what you’re experiencing with staffing in practice (governmentalaffairs@ texasnurses.org); and

ƒ When TNA ultimately publishes its research and associated policy position, send us your comments. Your input is critical to ensuring our policy recommendations reflect the needs and preferences of Texas nurses. Join us in assessing the status quo and charting the path forward. i

Midland Trailblazer

First LVN to Join the Texas Nurses Association in Texas

By Sonia Castillo

Reprinted with permission. This article originally appeared in the April 2024 issue of The Derrick.

IN THE DUSTY BASIN OF MIDLAND, Texas, where oil derricks dot the horizon and the wind hums stories of old through the weathered streets, there is a spirit of determination that mirrors the endless sky. A town with heart, this place is not where you’d expect to find tales of unprecedented strides in the nursing field. Yet, within the humble walls of Midland Memorial Hospital, a story unfolded—a story of a nurse named Nancy.

Nancy Ornelas’s story begins in Andrews, Texas, where the seeds of her passion for the profession were planted in the fertile soil of labor and delivery. Her hands, though new to the craft, were guided by a relentless spirit and an eagerness to serve. Her three decades within the halls of healing have not just been time spent but always with goals set on the horizon. She represents a bridge between cultures within the nursing community—a

Ornelas,

fusion of the richness of her Hispanic heritage with the progressive ideals of modern nursing.

Through the years, her title may have read Licensed Vocational Nurse (LVN), but her roles were as varied as the countless lives she touched. From the surgical buzz of the Operating Room to the watchful peace of the Post-Anesthesia Care Unit, Nancy’s path was never linear but always upward, always forward. In a career that reflects both ambition and determination, Nancy’s career whispers a call to action—to those who walk the same halls, to the LVNs whose path mirrors hers— a request

In a significant step forward for the nursing profession in Texas, the Texas Nurses Association (TNA) has made a landmark decision to include Licensed Vocational Nurses (LVNs) as members of the professional organization.

to follow her pursuit of knowledge, advocacy, and improvement by joining hands in the Texas Nursing Association. In a significant step forward for the nurs -

Nancy

the first LVN to join TNA, represents the call to action for all LVNs to seek broader horizons, united with the professionals within TNA. Photo credit: The Derrick

ing profession in Texas, the Texas Nurses Association (TNA) has made a landmark decision to include Licensed Vocational Nurses (LVNs) as members of the professional organization. This inclusion signifies a progressive move towards a more unified nursing community, recognizing the contributions and challenges LVNs face in healthcare.

TNA made strategic plans in 2023 to include LVNs in the organization.” Our Board feels strongly that LVNs are nurses, too, and that they face policy issues and practice issues that need a strong advocate, just as RNs do, and TNA wants to fill that role for them,” explained Belinda Richey, TNA’s Member Services Director. This change serves as a powerful catalyst for LVNs like Nancy Ornelas. Her diverse roles and advocacy for nurses’ professional footing make her story a symbol of the determination and excellence that the TNA aims to exemplify.

The initiative is part of a two-year pilot, signifying the start of an inclusive era under the association’s 2023-2028 strategic plan. The goal is to engage with LVNs across Texas affirmatively, hoping to seamlessly blend their membership into the TNA’s framework. Realizing the rapid changes in healthcare delivery and the essential role of LVNs, the TNA Board collaborated closely with Adam Ramirez, President of the Licensed Vocational Association of Texas, to establish a comprehensive membership offering for LVNs in Texas.

In a personalized letter to current LVNAT members, Joyce Batchellar, President of the Texas Nurses Association, wrote, “We are impressed with your existing commitment to the nursing profession through joining LVNAT and hope you will enjoy the benefits that membership in TNA offers. A TNA membership parallels an LVNAT membership at no additional charge. At the end of your current membership, you will receive an invoice for TNA membership for $60.00 per year that you can pay all at once, or you may choose a monthly payment plan of $5.50 per month.”

An LVN membership now comes with a slew of benefits and a promise for a resilient professional future at a nominal membership cost designed to encourage widespread participation. “The goal is to have more LVNs join the association by mid-summer”, according

to Darrick Nicholas, Communications Director for TNA. “Right now we have 88 LVNs that have joined TNA and we hope to have a few hundred in the coming months. TNA will run a campaign this spring on social media and its website to promote benefits, perks, and resources for LVNs across the state.

Today, Nancy’s reach extends beyond the bedside and the committee room into the broader landscape of nursing. Her passion for legislative change and her active engagement with board decisions place her at the heart of advancement for the nursing vocation in Texas. Nancy works within the Center for Advancing Professional Excellence as a Clinical QI Assistant for Midland Health. Additionally, Her voice is strong on the Workplace Violence Committee as a member and leader. Nancy has participated in initiatives across the organization that promote safety and mandate policy for safety protocols. “It’s not just about nurturing those in her care but also about shaping an environment where every nurse can thrive, safety is important, and growth is encouraged,” Ornelas explains. Nancy’s narrative is not just one of personal triumph; it is a call to action for all LVNs to seek broader horizons, united with the professionals within the TNA. Ornelas was the first in Texas to become part of TNA, with an official membership beginning in January. “Becoming an LVN member of TNA, now we have a network of over 16,000 Texas nurses to bring the nursing profession, so now we believe the importance of the LVN voice wants to be heard,” Ornelas advocates. With the inclusion of LVNs into TNA, Ornelas’s efforts and those of many compassionate LVNs will gain the support and recognition they deserve. Her trailblazing path to the TNA membership as an LVN paves the way for others. Dr. Kit Bredimus, Chief Nursing Officer for Midland Health, states, “I am so excited to see the Texas Nurses Association take this bold step in recognizing the contributions of LVNs in nursing and truly representing nurses across Texas. The inclusion of LVNs to membership is leading the way and I hope to see this progress continue on the national level. Locally, Midland Health has long recognized the key role that LVNs play in patient care, and I am proud of our work in building

Nancy Ornelas inspires every LVN to capitalize on the opportunities offered by the inclusion of the TNA. It is an invitation to advocate, lead, and elevate the profession to new heights.

our transition to practice programs (LVN Internship, Residency, Transition, and Fellowship) to support their progression into the acute care setting and beyond.”

And proudly, Ornelas, from Midland’s small but mighty community, became the first licensed vocational nurse to join the Texas Nurses Association. It was more than a membership—it was ground breaking. Nancy Ornelas inspires every LVN to capitalize on the opportunities offered by the inclusion of the TNA. It is an invitation to advocate, lead, and elevate the profession to new heights.

“Being one of the first to get invites to different webinars, events across the state, current pending legislation, and having a voice within the Texas Nurses Association is powerful. One of the biggest things you know about is professional development events, resources for publications, and engagement opportunities for new initiatives. The biggest part is that Midland Health will pay for your membership,” emphasized Ornelas.

Her story does not end at Midland Memorial Hospital’s doors. It is but an invitation for you to join her and the passionate professionals within the Texas Nurses Association. For the nurses who nurse with every dawn and stand steadfast until the stars claim the sky, you are the hidden gems of this profession. And in joining your peers in the Texas Nurses Association, your sparkle can shine even brighter, casting new lights on the path to excellence in nursing.

Are you ready to write the next chapter in the story of Texas nursing? Amplify your voice. Be the light that inspires a movement.

Join the Texas Nurses Association! i

Sonia Castillo is the recognitions program coordinator for the Center for Advancing Professional Excellence.

BUILDING CULTURAL COMPETENCE IN UNDERGRADUATE

NURSING STUDENTS

By JoAnn D. Long, PhD, RN, NEA-BC

LIVING IN THE WAKE OF THE GLOBAL PANDEMIC, images of war, political extremism, incivility, and protest call attention to our need as human beings for greater compassion, respect, and understanding of human and cultural diversity. But what does it look like to be culturally competent?

Cultural competence is understood to be a professional duty in the nursepatient relationship and has long been recognized as an ethical standard of practice in multiple disciplines (ANA, 2021; NASW, 2017). Teaching strategies and curricula which foster tolerance, respect, critical self-reflection, awareness of values, and which empower nurses to act as agents of social justice in the nurse patient relationship are needed (ANA, 2022, Gradellini, et al., 2021). In this project, we sought to design an RN to BSN course to help registered nurses returning to school to practice the skills needed for greater cultural competence. We chose to do so by using a broad, multi-disciplinary and theological lens through which to help nurses critically think about human diversity. Students, in dialogue with assigned reading, forum discussions, cultural interviews, and a movie critique of the Disney favorite Babe , engage with one another and several multi-disciplinary

conversation partners (Leninger, 1967; Hofstede, et al, 2010; Noonan, 1995; Nouwen, 2000; Volf, 2005). Exploration of diverse cultures, gender roles, values, and beliefs take place while students steadily contemplate the idea of their own “belovedness” and that of others using a theological lens (Nouwen, 2000).

DEFINE CULTURAL COMPETENCE.

T

eaching strategies and curricula which foster tolerance, respect, critical self-reflection, awareness of values, and which empower nurses to act as agents

of social justice in the nurse patient relationship are needed.

The course begins and ends with student assessment of their own level of cultural competence using (with permission) Georgetown’s Maternal Child Health (MCHC) (ncc.georgetown.edu) Cultural

Competency assessment. The Cultural Competency section of the MCHC prompts users to consider their level of knowledge and skills in the following eight areas of cultural competence:

1. The influence of conscious and unconscious (implicit) biases and assumptions has on individuals and organizations;

2. How linguistic competence requires organizational and provider capacity to respond effectively to the health literacy needs of populations served;

3. How ability, age, class, race, sex, gender identity, and sexual orientation impact health;

4. How multiple social and cultural disparities influence health and access to health care services;

5. The impact of culturally competent health care practices on individual’s access to health services, participation in health promotion and prevention programs, adherence to treatment plans, and overall health outcomes;

6. Conduct personal and/or organizational self-assessments regarding cultural competence;

7. Assess, without making assumptions, the strengths and weaknesses of individuals based on sensitivity to and respect for their diverse backgrounds; and

8. Incorporate an understanding and appreciation of differences in experiences and perspectives into professional behaviors and attitudes while maintaining awareness of the potential for implicit bias (Humphries, et al, 2015). We evaluated RN to BSN self-reported scores on the MCH Cultural Competency online measure (from beginning to the end of the eight-week course) during 2020 – 2021. We found RN to BSN student knowledge-skills scores improved significantly in all eight of the areas reflecting cultural competency (Long, 2022).

Two assignments especially seemed significant to student growth.

CULTURAL INTERVIEW

The Cultural Interview assignment provides students with the opportunity to practice while learning. Students set up an interview with a co-worker or friend with a distinctively different culture than their own and preferably away from work. Students craft their own set of interview questions. During the interview they record their observations and are asked to pay close attention to the use of their senses to describe the environment, sights, sounds, and smells experienced during the interview. Afterwards, students record how they practiced respectful communication while interacting with one whose culture, beliefs,

behaviors, and background may be different from one’s own. Moreover, they also incorporate aspects of the course reading into the interview write-up while reflecting on how such experiences may foster greater multicultural understanding when caring for diverse people and populations. Many note the process as “eye-opening,” and one which required a step outside of their comfort zone; yet was worthwhile.

LIFE OF THE BELOVED Reading theologian

Henri Nouwen’s short book Life of the Beloved underpins the course and is frequently noted by students as a particularly thought-provoking and positive experience.

ASSIGNED READING

Reading theologian Henri Nouwen’s short book Life of the Beloved underpins the course and is frequently noted by students as a particularly thought-provoking and positive experience. The following comments from an open-forum, end of course “take-away” shed light on how the reading has impacted their

thinking about themselves and their cultural competence:

“Reading Life of the Beloved helped me to realize there is beauty despite all the hardship life has thrown. It also made me think that any brokenness can help you shine a little brighter. If we do not understand ourselves, it can be difficult to understand others, so it is important to have good selfawareness when providing care to others. From now on I plan to always have an open mind when it comes to providing patient care and understand things more from the patient’s point of view rather than my own.”

“Moving forward. . . I aim to approach each patient with an open

mind, empathy, and a willingness to learn from their unique cultural perspective. By incorporating cultural humility into my practice and being mindful of differences, I hope to provide more effective and culturally competent care to all patients, ensuring that their individual needs and values are respected.”

One size may not fit all educational settings when teaching cultural competence. However, the use of a broad, multi-disciplinary approach and a theological lens may prompt registered nurses’ self-reflection on their own belovedness and that of the diverse patients for whom they care. Perhaps learning to lean into the practice of compassion,

FROM A PARTICIPANT

“Moving forward. . . I aim to approach each patient with an open mind, empathy, and a willingness to learn from their unique cultural perspective.”

respect, and understanding towards oneself and others with whom we are different is what it looks like to be culturally competent. i

JoAnn D. Long, PhD, RN, NEA-BC is a professor and the director of nursing research and development at Lubbock Christian University.

REFERENCES

ANA Scope and Standards of Practice (2021). https:// www.nursingworld.org/practice-policy/scope-ofpractice/.

ANA Position Statements (2022). The Nurse’s Role and Responsibility in Unveiling and Dismantling Racism in Nursing. https://www.nursingworld.org/ practice-policy/nursing- excellence/official-positionstatements/.

Georgetown University National Center for Cultural Competence, Maternal Child Health Assessment Cultural Competency, Section 7 https://www. mchnavigator.org/assessment/

Gradellini, C., Gómez-Cantarino, S., DominguezIsabel, P., Molina-Gallego, B., Mecugni, D., & UgarteGurrutxaga, M. I. (2021). Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review. Frontiers in psychology 12, 682920. https://doi.org/10.3389/fpsyg.2021.682920.

Hofsted, G., Hofsted, J. G., & Minkov, M. (2010). Organizations Software of the Mind: Intercultural Cooperation and Its Importance for Survival. McGraw Hill: New York.

Humphries, B. P., Couse, L. J., Sonnemneier, R. M., Kurtz, A., Russell, S. M., & Antal, P. (2015). Transforming LEND Leadership Training Curriculum through the Maternal Child Health Leadership Competencies. Maternal Child Health Journal , 19, 300-307.

Leninger, M. (1967). The Culture Concept and its Relevance to Nursing. Journal of Nursing Education pp. 27 – 37.

Long, J.D. (2022). “Broadening the Lens: Effectiveness of a Multi-Disciplinary Approach to Teaching Cultural Competence in RN-BSN Students.” Oral Presentation, Sigma Theta Tau International Research Congress , July 21, 2022, Edinburg, Scotland.

National Association of Social Workers (2017). Code of Ethics. https://www.socialworkers.org/About/ Ethics/Code-of-Ethics/Code-of-Ethics-English. Nouwen, H. J.M. (2000). Life of the Beloved: Spiritual Living in a Secular World. Crossroads: New York. Volf, M. (2005). Free of Charge: Giving and Forgiving in a Culture Stripped of Grace. Zondervan: Grand Rapids: MI.

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Inclusivity + Belonging NURSING STUDENT WELLNESS

By Cindy West, DNP, APRN, CRNA

The Big Picture

Promoting a sense of belonging and a culture of health is a formative part of nursing education as students learn to apply these principles and practices to their patients and themselves.

The University of Texas Medical Branch School of Nursing at Galveston tackles nursing student mental health wellness with a program rooted in inclusivity to systematically aid the nursing workforce.

A Call to Action

What strategies help to create and grow a culture of health, safety and belonging?

BELONGING

Inclusivity and belonging are terms that have been given significant consideration at higher education institutions over the past several years. These broad concepts, when refined and operationalized, provide the basis for implementing strategies aimed at an overall sense of belonging, a crucial component of student wellness. Promoting a sense of belonging and a culture of health is a formative part of nursing education as students learn to apply these principles and practices to their patients and themselves. According to the Future of Nursing Report 2020–2030: Charting a Path to Achieve Health Equity, the same social and structural determinants of health that shape the physical and social-emotional health and overall wellbeing of patients also impact the health of nursing students. Creating supportive spaces for students to share experiences that affect their sense of belonging in the academic environment are central to creating a culture of health for students (NASEM, 2021).

OPERATIONALIZING BELONGING

The University of Texas Medical Branch School of Nursing at Galveston (UTMB SON) is actively pursuing strategies designed to create awareness, promote mental health wellness and build a culture of health, safety, and belonging that aligns with both the American Association of Colleges of Nursing’s (AACN) call to action for nursing schools to “transition from crisis intervention to prevention by building wellness cultures” and the American Association of Critical-Care Nurses’ (AACN) Healthy

Work Environment Essential Standards of Skilled Communication and Authentic Leadership. Several of the AACN Critical Elements in these two standards reference the care, consideration, personal responsibility, and organizational structures that promote belonging and a healthy work environment through skilled communication and authentic leadership. Applying the principles of wellness culture, communication, and leadership to student belonging and mental health wellness yielded a number of strategies for consideration:

ƒ Promote awareness of mental health and readily available support resources.

ƒ Faculty development on student centered support behaviors, mental health first aid, and creating supportive learning environments (Stubin et al., 2023).

ƒ Student training for peer-to-peer facilitated discussions related to mental health wellbeing, factors impacting wellbeing and peer support.

ƒ Engaging community partners as allies in training, development, and execution of mental health and wellness strategies and as advocates for reducing the stigma associated with mental health.

SUPPORT, NOT STIGMA

Evidence shows that, within college populations, there exists a higher prevalence of mental health issues among students from lower socioeconomic backgrounds, minority sexual orien -

tations, gender identities, and particularly women (Eisenberg et al., 2013). Psychological distress can have a powerful impact on students’ physical, cognitive, emotional, and interpersonal functioning, but mental health concerns also carry with them significant stigma that often serve as barriers, real or anticipated, to seeking help. For this reason, it is especially important that faculty have the necessary skills to identify early markers of mental health issues to know when and how to appropriately support students.

Creating new opportunities for nursing students to connect through vocalizing unique perspectives on stigmatized mental

Erasing Stigma

Psychological distress can have a powerful impact on students’ physical, cognitive, emotional, and interpersonal functioning, but mental health concerns also carry with them significant stigma that often serve as barriers, real or anticipated, to seeking help.

health issues can help engage students as their authentic selves. Peer support can have a positive impact reducing selfstigma. Establishing a safe space for students experiencing, stress, anxiety, depression, discrimination or trauma not only aids peer-to-peer interactions but offers different perspectives on stigma sensitive topics (Daily Texan , 2023). The perceived impact of new processes that promote inclusivity and academic success will help maintain a culture of health.

BUILDING A SAFE HARBOR

Establishing a nursing student mental health wellness program that provides inclusivity, skills, resources, and a sense of belonging for students’ well-being as they pursue a nursing career will systematically aid the nursing workforce shortage by nurturing and maintaining healthy, well-trained nurses. Providing students with the tools to maintain mental health through the stresses, anxieties, and tumultuous work environments many will face will improve the quality of care they provide, reduce workplace burnout, and boost professional nurse job retention in the years to come. i

Dr. Cindy West, DNP, APRN, CRNA is [title] at The University of Texas Medical Branch School of Nursing.

REFERENCES

1. Eisenberg, D., Hunt, J., & Speer, N. (2013). Mental health in American colleges and universities: Variation across student subgroups and across campus. The Journal of Nervous and Mental Disease, 201(1), 60-67.

2. National Academy of Science, Engineering & Medicine (2021). The Future of Nursing 2020-2023:

Charting a Path to Achieve Health Equity. Retrieved from https://nap. nationalacademies.org/catalog/25982/the-future-of-nursing-2020-2030-chartinga-path-to

3. Stubin, Catherine A. PhD, RN, CNE, CCRN-K; Ruth-Sahd, Lisa DEd, RN, CCRN, CEN, CNE, CCFP

ANEF; Dahan, Thomas A. PhD. Promoting Nursing Student Mental Health Wellness: The Impact of Resilience-Building and Faculty Support. Nurse Educator ():10.1097/ NNE.0000000000001535, October 05, 2023. | DOI: 10.1097/NNE.0000000000001535

4. The Daily Texan. (2023, February 20). Wellness Labs provides a safe space for student dialogue about mental health. Retrieved from Wellness Labs provides a safe space for student dialogue about mental health – The Daily Texan

5. University of Texas Medical Branch at Galveston (2024). Diversity. Retrieved from https://www.utmb.edu/caps/caps-diversity

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BACKGROUND

THE HEALTHCARE SYSTEM relies heavily on nursing, which constitutes the largest sector of healthcare workers globally. Nurses spend the most time with patients and play a crucial role in patient care. Therefore, promoting diversity, equity, and inclusion (DEI) within nursing is imperative for healthcare facilities and systems. DEI has gained considerable attention in recent years, and understanding its conceptual foundations is essential. Diversity encompasses differences such as gender, race, ethnicity, language, age, religion, sexual orientation, gender identity, or political perspective. Equity emphasizes promoting justice and fairness in resource distribu -

DIVERSITY, EQUITY AND INCLUSION

Gender Equality in Nursing

By Jeffrey Williams, DNP, APRN, CCNS, CCRN and Michael Ward, MSN, APRN, AGACNP-BC

tion. Inclusion ensures that diverse individuals feel safe and welcomed in their environments (Heinz, 2024).

One aspect of this DEI within nursing is the male nurse. The data shows an increase in the percentage of male nurses from 8.9% in 2011 to 13.3% in 2021. (Johnson, 2022). (See figure 1)

The global data on the number of males in nursing for select countries can be seen in figure 2 (World Health Organization, 2022).

Why is it that males are not flocking to nursing as a professional career option? There are likely several factors that play a role in the lack of males entering the nursing profession. These barriers include stereotypes (gender, racial and ethnic)

and biases. A stereotype is a widely held and oversimplified image or idea of a particular person or thing (APA, 2018). Some of the stereotypes that often arise for male nurses include that all male nurses are homosexual, nursing is viewed as a feminine profession and black male nurses being mistaken for environmental service staff (Smith et al., 2021). Biases play a role in hindering not only client care, but the idea of males becoming nurses. Implicit bias is a form of bias that occurs automatically and unintentionally, that nevertheless affects judgements, decisions and behaviors (Payne, Niemi & Doris, 2018). When a person understands their own biases they can start to remove those biases and learn to embrace the differences that make the world so diverse.

INTERVENTION/APPROACH

The project aimed to break down barriers and develop an effective plan to increase male participation in nursing over the next 5 to 10 years. Breaking down barriers to male entry into nursing is essential for increasing their representation in the profession. The project explored various recruitment methods, such as initiating discussions about nursing in middle schools, emphasizing the impact nurses make and the stability

Figure 1

Percentage of males in the nursing profession in the USA from 2011-2021

of the profession. Personal interactions with male nurses were proposed to foster positive perceptions of the nursing role (Noordien, Hoffman and Julie, 2020). Another strategy involved leveraging campaigns like the American Association for Men in Nursing’s ‘Engaging the Future RN’ to reach young men across all geographic regions of America and inspire them to pursue nursing careers (AAMN, 2019). One aspect of this campaign utilizes local AAMN chapters to present and introduce information on the nursing profession to both middle and high school students. Discussing nursing roles and opportunities with middle and high school students can spark interest in nursing careers.

CONCLUSIONS/ IMPLICATIONS FOR PRACTICE

Implementing strategies that can help break down the barriers and decrease the biases related to the idea of males entering the nursing profession will have a positive impact on healthcare. These

impacts will have a lasting effect on the nursing profession. Males are the untapped potential that can make a great and lasting impact on the nursing profession. The number of males entering the nursing profession has not grown substantially over the last 40 years. Increasing the diversity, equity and inclusion within the nursing profession will have positive impacts within healthcare. More males in nursing would help lessen the nursing shortage and help to mirror the populations that nursing serves.

The nursing shortage is projected to reach 3.5 million by 2030 (United States DHHS, 2017). Encouraging more males to join the nursing profession could mitigate this shortfall over the next 7-10 years (Johnson, 2022). A higher representation of males in nursing would better align with the demographic of male patients seeking care. This could lead to increased client satisfaction, improved communication between male patients and their providers, and ultimately, enhanced health outcomes for men.

For more information on the American Association for Men in Nursing, visit AAMN.org. i

Jeffrey Williams, DNP, APRN, CCNS, CCRN is an associate clinical professor at Texas Woman’s University College of Nursing in Dallas, Texas. Michael Ward, MSN, APRN, AGACNP-BC is chief clinical officer at NextLevelTRT.com and ICU intensivist with Advent Health in Fort Worth, Texas.

REFERENCES

American Association for Men in Nursing. (2019). Men in nursing brochure. Retrieved from https://www. aamn.org/_files/ugd/0fcc5e_9cd95c2102784584ac151 5a51cc4743b.pdf

American Psychological Association. (2018). APA Dictionary of Psychology, Stereotype April 18, 2019. Retrieved from https://dictionary.apa.org/stereotype Heinz, K. (2024). What does DEI mean in the workplace? March 5, 2024. Retrieved from https:// builtin.com/diversity-inclusion/what-does-dei-meanin-the-workplace

Johnson, S. (2022). Amid Shortages and Burnout, Could Adding More Men Ease the Nation’s Nursing Woes? April 28, 2022. Retrieved from https://www. usnews.com/news/health-news/articles/2022-04-28/ could-adding-more-men-help-solve-the-nationsnursing-woes

Noordien, I., Hoffman, J. and Julie, H. (2020). Male students’ motivations to choose nursing as a career. African Journal of Health Professions Education, 12(4), 220-223. doi: 10.7196/AJHPE.2020.v12i4.1371

Payne, K., Niemi, L. and Doris, J. (2018). How to think about ‘Implicit Bias’. March 27, 2028. Retrieved from https://www.scientificamerican.com/article/how-tothink-about-implicit-bias/

Smith, B., Rojo, J., Everett, B, Montayre, J., & Sierra, J. (2021). Professional success of men in the nursing workforce: An integrative review. Journal of Nursing Management, 29, 2470-2488.

United States Department of Health and Human Services. (2017). Supply and Demand Projections of the Nursing Workforce: 2014-2030. July 21, 2017. Retrieved from https://bhw.hrsa.gov/sites/default/files/ bureau-health-workforce/data-research/nchwa-hrsanursing-report.pdf

World Health Organization. (2022). National Health Workforce Accounts. Data Portal: Occupation Profile. Retrieved from https://apps.who.int/nhwaportal/ Home/Index

Figure 2

By Katie Choy, DNP, RN, NEA-BC, NPD-BC

Driving Change and Inclusivity in Healthcare Personal Care Pilot Program for Diverse Patients

HAIR CARE AND PERSONALIZED CARE play an important part in one’s overall health. Providing holistic care enhances patient health and wellness by meeting their physical and psychological needs, especially when hospitalized. Patients feel good when they look good.

The Diversity, Equity & Inclusion (DEI) Councils at Baylor Scott & White – Plano and Baylor Scott & White – Lake Pointe consists of a diverse group of individuals working together to create awareness, provide education, and promote acceptance amongst the staff, patients, and the rapidly growing diverse ethnic communities we serve in North Texas. The council members at both facilities saw an opportunity in the summer of 2023 to launch a Personal Care Pilot,

which gave patients access to a selection of hair and personal care products to make their hospital stay more comfortable. The fine-tooth comb and ready-bath shower cap did not adequately meet the hygiene requirements of black, indigenous, and people of color (BIPOC) patients with afro-textured or curly hair. The stocked lotion was not suitable for patients with melanite skin, which leaves the skin dry and chaffing skin.

The DEI Personal Care Pilot began July 5, 2023, with a goal to meet our diverse patient individual care needs, thereby enhancing their patient experience. Our goal was to provide an assortment of personal care products to all hospitalized patients and gather feedback with

The DEI Personal Care Pilot began July 5, 2023, with a goal to meet our diverse patient individual care needs, thereby enhancing their patient experience.

a survey form to help us determine their satisfaction with the products used. The new products include shampoo and conditioners, shea butter body creams, satin hair caps, wide-toothed combs, and bristle brushes.

The teams worked with Baylor Scott & White’s Supply Chain who assisted in sourcing appropriate products to meet our diverse patient needs. Vendors were evaluated and the final vendor was se -

lected as a minority business with ample product availability.

During our pilot program team members rounded all patient floors to promote product availability to staff and patients. RNs and PCTs offered a menu, showing our selection of available products. Patients had a trial period with the products, followed by a care team member’s confirmation of the suitability of the products before patients were discharged.

The overall patient experience feedback in the hospital was incredible, with patient experience scores trending up. The HCAHPS Composite score was 72.7in July 2023 and FYTD as of May 2024 is 74.8 above our goal of 74.0 and 84% rank. Some of the responses we received included:

ƒ “Great program.”

ƒ “An excellent and most needed service/concept. This is a blessing.”

ƒ “Thoughtfulness is more than enough. My family appreciates you more than you could imagine.”

ƒ “Use this brand at home.”

ƒ “Great consideration for patients. Thank you.”

This program has been a part of our customer-centric focus on patient care — meeting the individual needs of our

There has been system-wide dissemination to other facilities in our large healthcare system. Several healthcare systems have added more hair care product selections for black patients.

diverse patients. There has been systemwide dissemination to other facilities in our large healthcare system. Several healthcare systems have added more hair care product selections for black patients. It is rewarding to share our success with other hospitals and health systems looking to adopt the idea. i

REFERENCES

Embracing diversity, equity, and inclusion (DEI): Considerations and opportunities for brand managers. Diversity, equity, and inclusion (DEI) is ubiquitous in today’s public discourse, underpinned by societal recognition of inequality and demands for leaders. Retrieved on 4/19/2024 from https://doi. org/10.1016/j.bushor.2022.09.005

Retrieved on 4/ 22/2024 https://www.ama-assn.org/ delivering-care/health-equity/providing-inclusivehair-care-products-bedside

Retrieved on 4/19/2024 University of Iowa to provide more inclusive hair and skin products to patients of color | Department of Psychiatry (uiowa.edu)

Retrieved on 4/19/2024 UW Hospital adds hair care products for Black patients | Madison365

Retrieved on 4/19/2024 Hospital Offers More Inclusive Hair Care Products - 21Ninety

Shared Experiences Among BSN Students

Aggression and Intimidation

in the Academic and Practice Settings

By Jennifer Reeves, DNP, APRN, FNP-BC and Cara Young, PhD, RN, FNP-C, FAANP, FAAN

What are undergraduate nursing students’ relational experiences in clinical and academic settings? Does the impact of experiences of aggression and intimidation influence student outcomes? A study seeks to find out.

UNDERGRADUATE NURSING STUDENT’S experiences are heavily influenced by interactions with their learning environment (Muenks et al., 2020). This influence can be explained through relational cultural theory and the impact that relationships provide in contributing to a person’s growth and development (Sapiro, 2020). In addition, these experiences play a part in shaping a student’s perceptions of self, overall well-being,

and professional identity (Oliveira Silva et al., 2021).  Aggressive behavior and intimidation within organizational learning has been associated with a decrease in psychological safety and poor student outcomes (Muenks et al., 2020). Understanding perceptions and the learning environment play a vital role in the success of a learner.

The authors of this study set out to explore undergraduate nursing students’

experiences with aggressive behavior and acts of intimidation in the clinical and academic settings and the impact of those experiences. Investigators developed a survey tool and distributed the survey to nursing students enrolled in five undergraduate nursing programs in Texas. Students provided socio-demographic data and reported if they had experienced aggressive behavior or acts of intimidation from: (1) a clinical preceptor, (2) another student, and/or (3) a faculty member while in school. Participants that reported acts of aggression were asked to report the frequency of these experiences, if they shared their experiences with anyone, and if they believed sharing their experi -

ence made a difference in the situation.

Students showed representation in all cohorts ranging from sophomore second semester to senior second semester of nursing school. They most commonly reported experiencing aggression and intimidation from faculty, followed by clinical preceptors and peers. Students reported substantial impact on emotional and mental well-being and selfesteem. Over 45% of students reported these experiences caused them to consider changing career paths from nursing. More than 81% of students reported they had shared their experiences with another. However, of those students who reported to a faculty member or administration, only four reported that it changed the situation. Students that did not share their experiences reported being afraid of retaliation or distrust in the ability to change the situation.

Within the survey, students were provided an opportunity to expand on their experiences with aggression and intimidation and themes were analyzed. One theme that emerged was that of “belonging.” Students expressed disappointment and discouragement when excluded from participating in their clinical settings. For example, one

“Trustworthiness” emerged as a common theme, highlighting the importance of the quality of the relationship made within the learning environment.

student shared that they were told to, “Sit down, shut up and don’t bother anybody.” Students shared feelings of being dismissed, unwanted, ditched or left behind by a preceptor.  Students described being received with eye-rolling, or “I don’t have time for a student.”

Another student reported being told, “I was wasting my time with nursing and that it is not a good profession, especially for someone like me.” Within their peer groups, students reported feeling alienated, and viewed aggression and intimidation as “calling someone out” publicly or “making others feel stupid.”

“Trustworthiness” also emerged as a common theme, highlighting the importance of the quality of the relationship made within the learning environment. With faculty, students reported feeling intimidated and scolded. Students perceived faculty as having power over their grade, and often shared feeling a lack of control or distrust over the result of a grade. They shared a perception that their grades were heavily influenced by the subjective nature of the faculty member, and also perceived failure as a threat from faculty instead of an objective result of their work. Among peers, social media was a contributing factor for students who reported negative experiences. One student described a situation when a video was posted on social media without the student’s per-

mission, resulting in the student feeling humiliated.

The learning environment of the undergraduate nursing student impacts students’ perceptions and academic success (Muenks et al., 2020). The civility of that environment and those involved must be considered when addressing the needs of undergraduate nurses. Increasing the nursing workforce is vital for meeting the healthcare needs of our growing population. Those involved in educating nurses should support more positive interactions between students and preceptors as well as promote a psychologically safe learning environment to improve overall contributions for a more positive nursing culture. i

Jennifer Reeves, DNP, APRN, FNP-BC is [title] at Sam Houston State University School of Nursing and Cara Young, PhD, RN, FNP-C, FAANP, FAAN is [title] at The University of Texas at Austin School of Nursing

REFERENCES

Muenks, K., Canning, E. A., LaCosse, J., Green, D. J., Zirkel, S., Garcia, J. A., & Murphy, M. C. (2020). Does my professor think my ability can change? students’ perceptions of their stem professors’ mindset beliefs predict their psychological vulnerability, engagement, and performance in class. Journal of Experimental Psychology: General 149 (11), 2119–2144. https://doi.org/10.1037/xge0000763

Oliveira Silva, G., Aredes, N., & Galdino-Júnior, H. (2021). Academic performance, adaptation and mental health of nursing students: A cross-sectional study. Nurse Education in Practice, 55 , 103145. https:// doi.org/10.1016/j.nepr.2021.103145

Sapiro, B. (2020). Assessing trustworthiness: Marginalized youth and the central relational paradox in treatment. Children and Youth Services Review 116 , 105178. https://doi.org/10.1016/j. childyouth.2020.105178

TPAPN Rolls Out New Strategic Plan

THE VOICE OF OUR STAKEHOLDERS was included throughout the development of this strategic plan for the Texas Peer Assistance Program for Nurses (TPAPN). Together, we can affect positive change for Texas nurses who are struggling with substance use disorders and mental health conditions. We elicited feedback to inform this plan from a variety of stakeholders including:

ƒ TPAPN Participants

ƒ TPAPN Peer Support Partners

ƒ TNF Board Members

ƒ TPAPN Advisory Committee Members

ƒ TPAPN and TNA Operations Teams

ƒ TPAPN Team

With the feedback we received, we identified three pillars of focus: Sustainability, Stigma, and Wellness. Each pillar represents an important aspect of what TPAPN will use to steer the future of our program. This plan was presented to the

We identified our three pillars of focus over the next few years that will help guide our plan: Sustainability, Stigma, and Wellness. Each pillar represents an important aspect of what TPAPN will use to steer the future of our program.

Texas Nurses Founation (TNF) Board of Directors and approved at their January 19, 2024 board meeting.

TPAPN and all supporting parties, including TNF and TNA are committed to evolving the program as healthcare continues to evolve. We believe that by listening to our stakeholders and developing a strategic plan around this, we can help affect positive change for Texas nurses struggling with substance use disorders and mental health conditions.

Nurses Helping Nurses

If you, a coworker, or a family member need help with a substance use or mental health issue, call the Texas Peer Assistance Program for Nurses. TPAPN case managers provide guidance, support, and monitoring to help nurses recover and maintain their licenses. And TPAPN peer advocates provide an empathetic listening ear. You and those you care about are not alone!

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