March, April, May 2021 Vol. 34 • No. 1 WYOMING The Official Publication of The Wyoming Nurses Association Quarterly publication distributed to approximately 10,000 NURSE RNs and LPNs in Wyoming.

President’s Message

As our second virtual event Our keynote speaker, Meryl Fury, MSN, RN was meeting as an association, I phenomenal in her presentation of, “Nurses Save thought that the Nurses Day at Lives.” All of the content was “spot-on” in self-care, the Legislature on January 29th but my biggest take-away was if we just keep that one went smoothly and was very promise that we made to ourselves how life changing informative and meaningful. it would be for us and the world. Let’s put some good Governor Mark Gordon took vibes out there in the universe! Thank you to all of our time out of his busy schedule presenters, including David Bodily, and thanks to all of to greet us in a recorded our exhibitors. We had 270 nurses and nursing students message. He is very appreciative join us for this memorable day! and supportive of the services Recently Sue Howard (WSBON President) and I were we all provide to the State of Marianne able to have a forward-thinking conversation in regard Wyoming’s healthcare needs. Madariaga, MSN, to our respective boards. Sue and I go way back to Senator Fred Baldwin and when we met at WNLYI, I as her student and she my 3 RN, CNE Representative mentor. We discussed what visions we would like to provided an educational session on, “How Can Nurses see happen during our terms and we talked about 2021 Nurses Day at the Engage Professionally in the Legislative Process.” It was wanting to be more in alignment with the future of Legislature Recap great to hear that they truly want and need to hear nursing in our state. We are living in such a polarized from their constituents. As always, our lobbyist, Toni society that neither of us can see any room for that in Decklever guided us through the process of navigating the stride of “growing our own.” The rest of the world the legislative webpage and how to follow a bill. can argue about their opposing views but for the sake The breakout sessions were very informative as well. of our dedicated profession of nursing, we must band I attended, “Perspectives on Issues Facing Wyoming together. Sure, there will be moments that we may have Nursing Students During a Pandemic” led by Marnee to “agree to disagree,” but we can do so respectfully. Crawford, PhD, RN, CNE. The discussion was rich and After all, we have been voted the number one trusted very much appreciated by the students. I do not think profession now for 17 years in a row! We would not be they have been formally recognized as the champion in this profession if we were not problem solvers that students that they have become. They are not the care a great deal about people. “Covid-Class.” They have already dedicated themselves 6 to an ever-changing profession built on care. “Too often we underestimate the power of a I also attended, “The Truth about Vaccinations Today” touch, a smile, a kind word, a listening ear, an honest led by Melissa Ohnstad, RN, BSN. I thought she did a great accomplishment or the smallest act of caring, all of COVID-19 and Mental Health: job of giving us the latest and most up to date information, which have the potential to turn a life around.” Self-care for Nursing Staff as we are all in the midst of getting our own vaccinations. – Leo Buscaglia

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In the February edition of American Nurse, WNA Executive Director, Tobi Lyon, authored the article, “Uplifting Nurses.” In the article, she shares how WNA was able to quickly respond to our members’ needs during the early days by providing virtual support via the Networks of Support sessions and webinars on self-care and offering advice to nurses on how to take care of themselves. Page 2 • Wyoming Nurse March, April, May 2021 Executive Director’s Message Uplifting Nurses The “WYOMING NURSE” is the official publication of the Wyoming Nurses’ Association, Associations respond to member needs a constituent member of the American Nurses Association, published quarterly every March, in a pandemic. June, September, and December. WNA Executive Director Tobi Lyon In 2020, what kept me up and engaging with frontline nurses and potential 301 Thelma Drive #200, Casper, WY 82609 at night was nurses’ well- association members. Phone: 307-462-2600 being and how they’ve been How did we learn what our members’ needs were Email: [email protected] dealing with the impact of during the crisis? We asked, listened, and prioritized. For advertising rates and information, please COVID-19. Despite the loss We heard firsthand how vulnerable nurses are to the contact Arthur L. Davis Publishing Agency, of more than 1,400 frontline negative mental health effects related to working Inc., PO Box 216, Cedar Falls, Iowa 50613, workers who have died of under such extreme conditions and went into motion (800) 626-4081, [email protected]. WNA this illness, nurses continue to provide a resource. In Iowa, we started a 24/7 and the Arthur L. Davis Publishing Agency, Inc. to work long hours caring Nurse to Nurse Warm Line to allow nurses to reach reserve the right to reject any advertisement. for their patients. They fear out to other nurses to talk and have someone listen. Responsibility for errors in advertising is limited contracting the virus and We also offered a complimentary storytellers’ to corrections in the next issue or refund the bringing it home to their Tobi Lyon, workshop to teach nurses how they can effectively price of advertisement. loved ones. On days off, they MBA, CAE share their countless stories and drive conversations Acceptance of advertising does not adhere to infection prevention during the pandemic. imply endorsement or approval by the and control guidelines and limit physical contact, Giving members a platform to have their voices Wyoming Nurses Association of products putting the needs of others first. If you asked advertised, the advertisers, or the claims heard is essential. We held several virtual town halls made. Rejection of an advertisement does anyone in healthcare why they keep going, their with elected officials so they could hear firsthand the not imply a product offered for advertising is answer would probably be “because I care.” many issues nurses in their districts were facing. This without merit, or that the manufacturer lacks Facing the new year with an ongoing pandemic, drove direct care and hero pay to our frontline nurses. integrity, or that this association disapproves we as leaders must continue to offer stability, We created a virtual platform for connecting of the product or its use. WNA and the reliable information, and useful resources to nurses. nurses across the state with our Networks of Support Arthur L. Davis Publishing Agency, Inc. shall The American Nurses Association (ANA) and our series. We offered webinars addressing stress not be held liable for any consequences constituent/state nurses associations have played a management and burnout, which provided self-care resulting from the purchase or use of an critical role in serving an emerging and diverse set of tools and referral information to professionals for advertiser’s product. Articles appearing in member needs during the pandemic. This also has expert assistance. These recorded webinars are part this publication express the opinions of the authors; they do not necessarily reflect views been a time of opportunity to explore new modes of of several resources for members and their nursing of the staff, board, or membership of WNA member engagement. colleagues offered on our websites. ANA-Michigan or those of the national or local associations. We knew the only way to make a difference responded to community needs and activated nurse would be to keep our associations relevant to all experts to offer a COVID-19 Training Program for K-12 that our members were experiencing in 2020. schools. We had to act quickly and responsively. At ANA- To all the nurses putting one foot in front of the Michigan, we restructured our association a few other, know that you’re helping to save lives every years ago, which proved critical to our ability to day. However, I’m asking you to please take care of • Let people help. Some people take joy in pivot operations overnight and respond to nurses’ yourself with these steps: helping frontline workers. Let them help you. needs during this time of uncertainty. We set • Pace yourself as much as possible. aside routine, daily operations, and the status quo. • Acknowledge your frustrations because holding Tobi Lyon is the CEO of Ngage Management, Our innovative and proactive approach has been in your feelings can lead to depression and which manages ANA-Michigan and the Iowa, nationally recognized for establishing new practices anxiety. Oklahoma, and Wyoming Nurses Associations. March, April, May 2021 Wyoming Nurse • Page 3 2021 Nurses Day at the Legislature Recap

Andrea Starmer, CMP After a short break to visit exhibitors and the WNA Director of Education & Membership discussion forum, attendees could choose one of four breakout sessions which offered an informative While we weren’t able to be together in person at presentation followed by open discussion on each the capitol this year for the Nurses Day at the Legislature, topic: attendees enjoyed a rich, interactive virtual experience! 1. How a Bill Becomes a Law and Legislative Q&A The day opened with a greeting to Wyoming nurses -Toni Decklever, MA, RN and nursing students from Governor Mark Gordon, 2. The Truth about Vaccinations Today - Melissa followed by an interview with Wyoming State Senator Ohnstad, RN, BSN Fred Baldwin and Wyoming State Representative Sue 3. Telehealth Nursing - K. David Bodily, MSN, RN, CHSE Wilson. With some great questions by WNA President 4. Perspectives on Issues Facing Wyoming Nursing Marianne Madariaga, the legislators offered a lot of useful Students During a Pandemic - Marnee Crawford, information on how nurses can engage in the legislative PhD, RN, CNE process. WNA lobbyist Toni Decklever followed with an in-depth tour of the Wyoming State Legislature website (https://www.wyoleg.gov/) and tips on how to reach out to representatives from state government. WNA thanks all who participated: our 260+ attendees, presenters and exhibitors. We can’t wait to get together in person next year!

The breakout sessions were repeated after a short lunch break, where attendees could attend exhibitor zoom sessions. Our closing keynote sessions was, “Nurses Save Lives,” by Meryl Fury, MS, RN. Meryl shared with attendees the importance of self-care and provided take-aways and tips for nurses to prioritize themselves and maintain balanced well-being. Attendees were inspired and energized by her session.

Legislative Update

The allowing remote participation. I am thankful for the met virtually in January and thoughtful work of our Legislature and look forward to February to work numerous working with them on the significant challenges facing committee bills. Starting Wyoming.” March 1, state lawmakers While details could change, the steps agreed to by will convene a hybrid in- the Governor, the Senate President and the Speaker of person and remote session. the House will include: To ensure the safest possible o The Governor will direct all Executive Branch experience for those who employees to participate in the legislative process must participate, Governor virtually. Mark Gordon, President of o Both branches agree to continue the preference the Senate Dan Dockstader of virtual meetings between branches. If an in- and Speaker of the House Eric person meeting must be held, COVID-19 safety Barlow have committed to a Toni Decklever, protocols will be followed. joint plan to ensure increased MA, RN o Legislative bodies will limit the number of non- safety for the session. legislator presentations on the floors of the House The approach for the March session will still allow and Senate. remote participation by lawmakers, the public and o The Legislature will take precautions in its physical the Executive Branch. However, many people are environment. These precautions will include the participating from the Capitol building now for the following direction: virtual session and more are expected during the hybrid o Do not attend in-person if you are feeling ill or session in March. To allow for public access and to keep believe you have had recent COVID exposure. people safe during the March hybrid session there will o Mask usage by legislative members is required in be requirements to socially distance and to wear masks legislative spaces unless the member is seated at in public spaces. their desk or when proper social distancing can The three leaders agreed that a legislative session be maintained. this spring is necessary to define the state’s budget o Masks are required in other parts of the Capitol and work together on Wyoming’s path to recovery. per state health orders. They agreed to these steps to ensure that every state o Mask usage is required for the public in legislative House and Senate district has equal opportunity for spaces. representation; to reduce the risk of having to halt o Social distancing will be required in all committee legislative or executive operations; and to set out rooms, galleries and hallways. options for abundant and vigorous public engagement. o Hand sanitizer, masks and temperature scanners “In order for this session to proceed safely and will be placed throughout the Capitol Complex. successfully, it is important that all Wyoming legislators o The public participating in-person during the are able to fully and completely attend to their session will be required to comply with public legislative responsibilities. Wyoming citizens expect health orders in place at the time of the session. nothing less,” Governor Gordon said. “Committing these resources to this purpose is an important step The Legislature and the Governor will make every to preserving equal representation for our citizens. I effort to ensure robust public engagement be allowed by want to acknowledge the work of the Speaker and virtual means. All legislative meetings will be broadcast the President in accommodating virtual access for all online and include a feature allowing public comment citizens and their respect for the Executive Branch by remotely. Information can be found at wyoleg.gov. Page 4 • Wyoming Nurse March, April, May 2021 Region News

Southeast Region News Barb lives in Rawlins, where she was born and raised. members were grateful and joyous to receive the Shawn Wise, RN She received her BSN and MS from the University vaccine. They were hopeful that it will bring some Southeast Region President of Wyoming. Barb has been a Wyoming Nurses level of normalcy back in their lives. I am blessed to Association member for a number of years and has have been taught nursing skills during this historic I hope you are all staying held a few officer positions. She believes, “Being a time in order to help contain the spread and protect healthy. We had open officer member of such an important organization promotes my community.” – Andrea Sanchez-Walk positions in our region and a nurses to help each other.” Barb is a Nursing As we move forward in the extended Year of the few write in candidates and I am educator, and she enjoys watching her students Nurse, Southwest Region WNA would like to express so happy to announce that Toni succeed. She teaches CNA classes for Western our gratitude to all the nurses who continue to show Decklever has stepped up to Wyoming Community College/CCHEC in Rawlins. up every day to care for the residents of our region. serve as Regional Secretary. Toni She is an Adjunct Clinical Instructor for the University has been an RN for 37 of Wyoming BRAND Program and a Diabetic years. She started her nursing Educator for Memorial Hospital of Carbon County. Northeast Region News career at Memorial Hospital of She loves being a nurse and helping her patients and Lacey Johnson, MSN, RN Laramie County - now Cheyenne students. She looks forward to her role as Southeast Northeast Region President Regional Medical Center. After a few years working Vice President and recruiting new members! Barb, the medical floor and Labor and Delivery, Toni took a we are so lucky to have you share your experience The Northeast Region had an Officer job at Life Care Center of Cheyenne as the Assistant with our members! Meeting in January to discuss several Director of Nursing. One of her duties was to I wanted to share my experiences with testing for topics including the current NE develop and teach the CNA program at the COVID-19 in several areas of the US. I have found President Position, current finances, facility. She also became one of the evaluators for that there is still a great lack of understanding scholarships, legislature agenda and the CNA exam. both about COVID-19 and the importance of safety membership. Toni left Life Care to take a job with East High guidelines. I have run into several people who have We welcomed our new officers School as a Health Occupations teacher. During her said, “oh my friend is positive, and I don’t feel Tommi Ritterbusch as Vice President time in public education, she worked with Career and well so I thought I should get tested,” while they and Amber Jackson-Jordan as Technical Education Teachers and students around the are standing less than six feet from me, coughing Secretary. Tommi is the Nurse state. She was the state director for the student without a mask on. I’ve also seen people come to Manager at Welch Cancer Center in organization, Wyoming SkillsUSA for 12 years. She test sites several days in a row, or they get a positive Sheridan. Amber is a nurse at Campbell County Healthcare still works with the National SkillsUSA organization at one site and then come test again at another site and works in the Quality Department. putting together Healthcare related competitions. the same day, instead of quarantining and following I am our current NE Region President as well as new Toni has been the WNA lobbyist for 13 years and guidelines. I think it is important we continue to President Elect of WNA. I will be resigning my NE Region enjoys working with legislators and many groups educate the general public on safety measures and President position. This position will be opened up for around the state that are developing policies to guidelines. Thank you for all you do!! nominations with another Region that has openings. The improve healthcare for the citizens of Wyoming. She NE Region Officers were pleased to report a lot of interest owns an American Heart Association Training center in the position. in Cheyenne and teaches many classes to folks Southwest Region News The NE Region has not yet awarded scholarships for this around the state. She has also served as a consultant Carla Lee, MS, RN, CNE graduating class but is in process of getting information and worked on projects with UW and the Wyoming Southwest Region President delivered to the schools in the Region. More to come on Department of Health. the winners this spring! Toni currently is board president for the Wyoming Southwest Region community- If you are a member, reside in the NE Region, and do Health Resources Network, sits on the Board of based nurses have been busy not receive email communications please contact Amber Occupational Therapists and is a member of the administering COVID-19 Jackson-Jordan to update your information with the NE Wyoming Prevention Action Alliance. Thank you vaccinations to residents in the Region. Toni, we are so fortunate to have you! phase of 1a and 1b. The task of We hope that everyone is continuing to stay safe. I am also excited to announce that Barbara James vaccinating county residents has has agreed to serve as our Region Vice President. overwhelmed public health nurses across the state. Many Northwest Region News volunteers have shown up to Linette Johnson, MSN, RN assist with this process including Northwest Region President students of Western Wyoming Community College. Western Nursing students have Did you know that the ANA volunteered at Memorial Hospital of Sweetwater extended The Year of the Nurse County, Castle Rock Medical Center in Green River into 2021? That’s because of and Carbon County Public Health in Rawlins. This YOU! Thank you for all that you experience has given students exposure to clients do every day to benefit our when clinical opportunities in their nursing education communities! has been sparse. It has also allowed them to give back Northwest Region membership to the agencies that continually support nursing update as of January 2021: student education. 91 active members, 2 new “Participating in the COVID vaccine clinic was members, 3 cancelled members, a humbling and uplifting experience. Community 0 reinstated members - We thank you for your continued membership; your dues help our region fund scholarships! Updates regarding the Healthcare Partnership of Fremont County (HPFC): NextGen Healthcare Partnership of Fremont County (HPFC) is a grassroots initiative stemming from the Next Generation Sector Partnerships (NGSP). The HPFC

Come make a difference and Join our Family. We are hiring! RNs, LPNs, CNAs Contact our HR Director for more information: [email protected] Cheyenne Regional is looking for individuals who want to make a difference in Wyoming. Here, you’ll be part of a strong, stable healthcare organization–one with big plans and a clear direction for growth. For information about job opportunities with Cheyenne Regional, please visit: We look forward to hearing from you! cheyenneregional.org/careers. www.northfieldretirement.net INSPIRE GREAT HEALTH WITH US. March, April, May 2021 Wyoming Nurse • Page 5 Region News has recently secured a grant via Central Wyoming 1) Know your legislators Once you access the website, it’s as easy as finding College, to fund education for over 150 Certified The Central Region consists of five counties: Natrona, your legislator’s name and clicking on it. This will bring Nursing Assistants! They are also working on forming Converse, Niobrara, Platte and Goshen you to his or her profile. Across the top of each profile, a strategic pipeline for increasing the nursing workforce you will see four tabs: General Information, Committees, in Fremont County, from CNAs-RNs-BSNs-MSNs, etc. If Legislators by County: Sponsored Bills and Contact Me. you are interested in volunteering, or just want to learn Choose the “Contact Me” tab and you will find an more, please check out these links: Senators email address, phone number and home address so that Follow HPFC on Facebook at https://www. Natrona: Senator Jim Anderson (R), you can contact them in the way that works best for you. facebook.com/Healthcare-Partnership-of-Fremont- Senator Bill Landen (R), Last but definitely not least… County-108642353830423 Senator Drew Perkins (R), Opportunities for Engagement: Senator Charles Scott (R) 3) Know how to find bills that affect healthcare and If you are interested in any of these opportunities, Converse: Senator Brian Boner (R), nursing. There are two ways to do this: or if you would like more information please email Senator Jeff Wasserburger (R) Go directly to the Wyoming Legislative Website at: [email protected] Platte: Senator Brian Boner (R) https://www.wyoleg.gov/Legislation/2021 Exciting News! Our Northwest Region has been Goshen: Senator Cheri Steinmetz (R), Or you can find this specific information on the WNA chosen to pilot an engagement app! The goal of this Senator Anthony Bouchard (R) website under Advocacy, Legislative Updates at: WNA pilot is to have a platform where members can safely Niobrara: Senator Cheri Steinmetz (R) Legislative Updates | Wyoming Nurses Association | connect with each other, share ideas, participate in Nursing Network activities and receive WNA information. The platform Representatives The first web address will bring you to a page that lists promises a multitude of ways for members to interact. Natrona: Representative Chuck Gray (R), all the bills that are currently being considered. It does take We are looking for a small group of volunteers for an Representative (R), a few minutes to weed through them but it’s well worth initial pilot test as the platform is being developed. Representative Joe MacGuire (R), the time. The second web address will give you a summary Liaisons/Representatives – To arrange and execute Representative Kevin O’Hearn (R), of legislative activities on bills the WNA is watching. Nurses’ Activities at local facilities to promote WNA Representative Jeremy Obermueller (R), and recognize Wyoming nurses for their hard work and Representative (R), Your Senators and Representatives want to hear from dedication. Representative Tom Walters (R), you. Give them your feedback and let your voice be Nurse “experts” – Conduct mini-educational Representative (R) heard. Even if you have an idea for future legislation, your sessions/discussions (15-30 minutes) at regional Converse: Representative (R), senators and representatives want to hear from you. meetings regarding topics of interest. Representative (R), Your single voice can have a HUGE impact and when Fun Run – There are discussions about an upcoming Representative Jeremy Haroldson (R) we all work together, our voices are unified and stronger Fun Run on behalf of WNA. If you are interested in Platte: Representative Jeremy Haroldson (R) than ever. Region members, if you have questions or need participating with the group to organize or arrange this Niobrara: Representative (R) help navigating the site, please feel free to reach out to engagement activity, let us know! Goshen: Representative (R), me: [email protected]. If you have any stories to share for upcoming Representative John Eklund (R), publications, please reach out to Tina King, NW Region Hans Hunt (R) Secretary, at [email protected]. 2) Know how to find your representatives contact Central Region News information: Aubrey Bremer, MSN, RN https://www.wyoleg.gov/Legislators/2021/S Central Region President

Nurses Call to Action! I hope that anyone that had Worland Healthcare and Rehabilitation has the the opportunity to attend Nurse’s Day at the Legislature enjoyed following open positions: it as much as I did! As many of you know, the Wyoming State • Full-time Registered Nurse (RN) or Legislature is now in Session. The Licensed Practical Nurse (LPN) 2021 session started January 12th and lasts until adjournment on Please apply online through Five Star Senior Living’s February 26th. website: http://careers.fivestarseniorliving.com/ Why is this important?! Because our nation gives us the incredible opportunity to be a part Feel free to call us with any of the legislative process by communicating directly with questions, 307-347-4285. our representatives and it’s as easy as 1,2,3!

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BY Gráinne Ráinne Clancy, BN, MIACP; D’Arcy D. Gaisser, DNP, MS, RN, • Chronic stress. Nurses are continuously fearful of contracting COVID-19, ANP-BC; and Grace Wlasowicz, PhD, RN, PMHNP-BC, ANCC NP infecting others, encountering prejudice from the public due to working as a nurse, and dealing with inadequate supplies of PPE.1 Stress becomes This article has been adapted for space and originally appeared in the September chronic when it is overwhelming and cannot be resolved, resulting in 2020 issue of Nursing © 2020 Wolters Kluwer Health, Inc. relationship, health, and sleep problems.2-5 People with chronic stress experience intense emotions that can feel overwhelming and result Along with incalculable loss, the coronavirus (COVID-19) outbreak has had in thinking negatively.6 Nurses on the front lines in COVID-19 hotspots devastating effects on the mental health of people with COVID-19, their families, report feeling like a graduate nurse again, filled with uncertainty and and the community at large. Healthcare workers face tremendous stress, both worry.7 emotionally and physically, from the grueling work hours and the threat of • Acute stress disorder. Nurses with acute stress disorder may have trouble contracting the virus at work. sleeping, worry constantly, and experience persistent negative thoughts This article addresses the potential mental health issues for healthcare workers about their role in the traumatic event, such as thinking “I should have that may emerge from this pandemic as well as treatment options and self-care done more to help.”8 When we experience trauma, we detach from activities that promote recovery. the memory. We ignore our emotions to protect against the pain, but these emotions reappear over time and impact our lives.9 The nurse may COVID-19 and mental health respond to a minor irritation as if it were a life-threatening event.10 Nurses Nurses working on the front lines of the COVID-19 pandemic may experience may feel they are in a dreamlike state that impacts their ability to think, various mental health problems. Here are a few examples: process their emotions, and respond appropriately to situations.11 If signs and symptoms of acute stress disorder persist for more than a month, posttraumatic stress disorder (PTSD) may be diagnosed.12 • PTSD. Nurses are not strangers to caring for critically ill patients who die.8 However, the number of patients dying amid a surge in COVID-19 cases is causing healthcare workers to feel powerless, which can lead to PTSD. PTSD can develop after direct or indirect exposure to a traumatic event, such as hearing about a traumatic event involving a family member, friend, or colleagues. Those with PTSD experience recurrent intense and disturbing thoughts and feelings stemming from one or more traumatic events.10,13,14 Nurses with PTSD may relive an event through flashbacks or nightmares, and they may feel sadness, fear, anger, guilt, shame and detachment or estrangement from other people.14 Many traumatized individuals have a robust and unconscious inclination to go inward, often to re-experience their distressing thoughts, painful memories, and uncomfortable sensations.15 They may have an exaggerated, startled response to certain situations and develop problems with concentration and sleep.5

The nursing team’s role When nurses struggle personally, we tend to be critical of our colleagues or management and withdraw from others. Such a change in personality is often an indicator of struggle. It is often a team member who will notice that you are not your usual self and may be struggling with anxiety and stress. Asking March, April, May 2021 Wyoming Nurse • Page 7

yourself or a colleague three simple questions can REFERENCES raise awareness about a possible problem: 1. Wann W. America is running short on masks, gowns 14. American Psychiatric Association. What is • Am I ok? Are you ok? and gloves. Again. The Washington Post. 2020. posttraumatic stress disorder? 2020. www.psychiatry. • Do you feel you cannot give anymore? www.washingtonpost.com/health/2020/07/08/ppe- org/patients-families/ptsd/what-is-ptsd. • Do you feel your work is ineffective?16 shortage-masks-gloves-gowns. 15. Levine P, Blakeslee A, Sylvae J. Reintegrating 2. Mariotti A. The effects of chronic stress on health: fragmentation of the primitive self: discussion If you are struggling, speak with your colleagues, new insights into the molecular mechanisms of brain- of “somatic experiencing.” Psychoanal acknowledging those feelings and thoughts in the body communication. Future Sci OA. 2015;1(3):FSO23. Dialogues.2018;28(5):620-628. first instant. If you feel you are not performing 3 American Psychological Association. How stress 16. Highfield J. Am I OK? Intensive Care Society. 2020. effectively in your workplace, talk with your affects your health. 2019. www.apa.org/helpcenter/ www.ics.ac.uk/ICS/Education/Wellbeing/ICS/ stress-facts. manager and state your opinions on being Wellbeing.aspx. 4. Heidt T, Sager HB, Courties G, et al. Chronic variable ineffective. Everyone has limits, and sometimes just 17. World Health Organization. Coronavirus disease stress activates hematopoietic stem cells. Nat Med. (COVID-19) outbreak: rights, roles and responsibilities taking a week off might be sufficient. 2014;20(7):754-758. of health workers, including key considerations for Nurses who continue to feel this way should 5. Kabat-Zinn J. Full Catastrophe Living. 15th anniversary occupational safety and health. 2020. www.who.int/ discuss it with their primary healthcare provider and ed. New York, NY: Piatkus; 2004:249. publications/i/item/coronavirus-disease-(covid-19)- their employer and review the options available. 6. Newman MG, Llera SJ, Erickson TM, Przeworski outbreak-rights-roles-and-responsibilities-ofhealth- A range of supports may be available from your A, Castonguay LG. Worry and generalized anxiety workers-including-key-considerations-foroccupational- 17,18 employer or your professional organization. Some disorder: a review and theoretical synthesis of safety-and-health. nurses may want the support of a counselor. It is a evidence on nature, etiology, mechanisms, and 18. American Association of Critical-Care Nurses. strength to realize that you are struggling with your treatment. Annu Rev Clin Psychol. 2013;9:275-297. Well-being Initiative. 2020. www.aacn.org/ mental health and need help. 7. Gonzalez D, Nasseri S. ‘Patients have panic nursingexcellence/well-being-initiative. Early psychological intervention does make a in their eyes’: voices from a Covid-19 unit. 19. World Health Organization. WHO guidelines on difference.19 Each of us has a limit to stress, and it The New York Times. 2020. www.nytimes. conditions specifically related to stress. 2013. www. is important not to compare your stress levels to com/2020/04/29/nyregion/coronavirus-nyc-hospitals. who.int/mental_health/emergencies/stress_guidelines/ those of another person. There is strength in being html?searchResultPosition=1. en. vulnerable and showing our thoughts and emotions. 8. Hayes C. Coronavirus: front-line NHS staff ‘at risk of 20. Brené Brown. Vulnerability. 2020. www.brenebrown. Brené Brown defines vulnerability as uncertainty, PTSD’. BBC News. 2020. www.bbc.com/news/uk- com/definitions. risk, and emotional exposure.20 52258217. 21. Frank S. As coronavirus slams Houston hospitals, it’s 9. Muller R. Trauma and the Struggle to Open Up. New like New York “all over again.” The New York Times. Topping off emotional reserves York, NY: WW Norton & Company; 2018:33. 2020. www.nytimes.com/2020/07/04/us/coronavirus- Nurses on the COVID-19 front lines are plagued 10. Van Der Kolk B. The Body Keeps the Score. London: houston-newyork.html. Penguin; 2014:156-157, 166. by drained emotions loneliness, and fear. These 11. Bolton EE, Jordan AH, Lubin RE, Litz BT. Prevention This risk management information was provided are normal reactions to an unfamiliar, uncertain of posttraumatic stress disorder. In: Gold SN, ed. by Nurses Service Organization (NSO), the nation’s environment. Transitioning away from work at the APA Handbooks in Psychology. APA Handbook of largest provider of nurses’ professional liability end of the day is essential for nurses to top off their Trauma Psychology: Trauma Practice. Washington, DC: insurance coverage for over 550,000 nurses since emotional reserves. American Psychological Association; 2017:483-497. 1976. The individual professional liability insurance If you have had a particularly stressful day, 12. Psychology Today. Acute stress disorder. 2019. www. policy administered through NSO is underwritten acknowledging and discarding any negative psychologytoday.com/ie/conditions/acutestress- by American Casualty Company of Reading, thoughts or feelings can help improve sleep quality. disorder. Pennsylvania, a CNA company. Reproduction Having a ritual to signal the end of work is essential. 13. American Psychiatric Association. Diagnostic and without permission of the publisher is prohibited. For Here are some suggestions: Statistical Manual of Mental Disorders. 5th ed. questions, send an e-mail to [email protected] or call • Take a shower. Visualize all the worries of the Arlington, VA: American Psychiatric Association; 2013. 1-800-247-1500. www.nso.com. day disappearing down the drain. • Write down any thoughts or feelings in a notepad. • Watch a favorite TV program. • Read a book. • Listen to your favorite music. • Contact a friend. • Write down three things you were grateful for today.

Final thoughts The COVID-19 pandemic is an unprecedented event in our lifetimes that will have untold mental health implications for nurses and other healthcare professionals on the front lines, both in the short and long term. Although scientists and healthcare professionals know more about the disease and how to treat it now, nurses in current COVID-19 hotspots will still be treating patients with a serious and rapidly spreading disease while possibly contending with shortages of PPE, equipment, and treatments.21 Nurses will need to receive support from their team, practice optimal self-care strategies, take measures to replenish their emotional reserves, and learn how to transition mentally from work to home after their shift. Recognizing stress and learning how to cope will help nurses protect their mental health as we move forward during this pandemic.

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Provide comprehensive skilled nursing services to individuals and families in the community and influence and motivate Native American people to adopt healthy lifestyles. Bachelors or Associate degree in nursing with a current WY RN license. One year nursing experience with case/care management, three years managerial work experience in healthcare administration. Contact David Meyers, Eastern Shoshone Tribal Health Director Call or email: (307) 332-6805 | [email protected] WWW.ESTHEALTH.ORG/HOME Page 8 • Wyoming Nurse March, April, May 2021

Keeping Wyoming Nurses Workforce Strong

From the Nurses on Boards Coalition current statistics: Which are: Wyoming, Arkansas, Georgia, Kentucky, We did it! Nebraska, North Carolina, Pennsylvania, Tennessee, • We have 10,000 nurses on boards. 21,812 individuals Washington, West Virginia and Wisconsin. registered The Wyoming Center for Nursing (WCN) which is the • 12,915 total board entries Action Coalition for Wyoming is working with its partners, • 10,023 counting boards The Wyoming Institute for Disabilities (WIND) that is helping • 14,066 nurses want to serve to address Nursing’s role in building health equity, well-being • 4,689 nurses already on boards who are interested in and promoting a culture of health. So, Jeannie Niemoller Vice serving on an additional board President of WCN shared that Wyoming has chosen to focus on social isolation for seniors in Albany County due to the Wyoming progress as of January 2021: increase of isolation with COVID-19. It is offering classes on • Total Board Service: 77 how to use the internet, provide devices they can learn to use • Board Service & Want to Serve: 21 for purchasing groceries and telehealth for health care. “With • Want to Serve: 32 Mary Behrens, this funding opportunity, WIND will focus on the development Jeannie Niemoller • Counting Board Service: 53 MS,FNP-BC,FAANP of technical training of older Americans to use broadband services and devices to decrease social isolation and increase the use of telehealth Wyoming reached 230% of its goal: Wyoming Nurses Rock! service,” says Canyon Hardesty, director of community education and training at WIND. In addition, WCN will partner with the Fay W. Whitney School of Nursing at the University We are now involved in Three Grants: of Wyoming so that Nursing Students can assist seniors who are struggling with medical 1. The Next 50 Initiative and the Colorado Nursing Center appointments and access to services during COVID-19. has partnered with the Wyoming Center for Nursing in bringing We also want to thank our organizations in Wyoming that helped us raise the matching a Virtual Dementia Tour kit to Wyoming. This kit allows people funds for the grant. We are thankful for the support of the Wyoming Nurses Association, who are caring for dementia patients to feel and experience The Wyoming Community Foundation, the Fay W. Whitney School of Nursing, Ivinson what these individuals are going through. It temporally alters Memorial Hospital and Wyoming AARP. This generosity allowed us to gain the necessary ones physical and sensory abilities. We have used this kit in funds to make this grant possible. Rawlins under the direction of Barbara James MS, BSN, RN. Training for this grant has started and we will keep you updated on our progress. We Barbara James said this about the experience, “Doing the hope if this works in Albany County, we can bring this assistance to other parts of the state. Dementia Tour was absolutely PRICELESS! Doing it myself opened my eyes as a nurse. I thought I knew how these 3. SANE Nurses in Wyoming: This is a 5-State HRSA Grant Application with Colorado, patients felt. Doing the tour helped me understand, that I didn’t Barbara James New Mexico, Oregon and Washington State. The application will be submitted soon. If we understand. are able to get this grant, we will be working closely with the Wyoming Coalition Against Watching students’ reactions during the tour reminded me, that these patients need Domestic Violence and Sexual Assault to improve education of Sexual Assault Nurses in our help and understanding. This is an amazing opportunity to educate!” Wyoming. One of our goals will be to increase our numbers in rural areas of Wyoming If you are interested in using this tool contact Jeannie Niemoller at: jeanine.niemoller@ and work for national certification for these Nurses. outlook.com Finally, Wyoming Nurses Leadership Institute will be starting again soon. There are 2. Robert Wood Johnson/AARP Nursing innovation grant: Only 10 States received regular Advisory Board Meetings, as well as class schedules developed virtually and in this Grant person, with mentorships for each student. Thanks to Marcella Wright, graduate student at UW Laramie, for all her hard work on this project. March, April, May 2021 Wyoming Nurse • Page 9 The Value of Grit and Resilience During a Global Pandemic

Heather M. Humphreys, DNP, RN, CNE, and per year from now until 2026; this is just projected for The time is now Dana S. Woody, DNP, RN one country. Your gifts and talents are needed and Evidence supports the association of grit and appreciated. The statistics sound daunting, but consider resilience with feelings of well-being, career Reprinted with permission from American Nurse these characteristics of grit and resilience as you grow in satisfaction, decreased emotional distress, and the profession of nursing. decreased attrition rates. The time is now to consider COVID-19 has changed these characteristics in your professional mindset and the landscape of the How to thrive ensure you have the grit and resilience to thrive in your healthcare industry. In fact, Do you know what it takes to thrive in the new nursing career. it has warped an already healthcare landscape? Literature provides insight intense environment and regarding the need for grit and resilience in nursing. Heather M. Humphreys is associate professor and made for one that breeds Consider these strategies in your nursing practice: Dana S. Woody is associate professor at the Liberty higher levels of stress and Realize that mindset does matter. Though nurses University School of Nursing in Lynchburg, Virginia. anxiety than ever before. are educated using a generalist approach, our clinical Do you know what is practice usually focuses on a single specialty area. References needed to not only survive, After becoming accustomed to one specialty, it can be American Nurses Association. Code of ethics with but to thrive, as a nurse intimidating to work in a new and unfamiliar setting or interpretive statements. https://www.nursingworld.org/ practice-policy/nursing-excellence/ethics/code-of-ethics- during this time of crisis? with a different patient population—reverting back to the novice nurse. If we approach recent changes in healthcare for-nurses/ In 2006, the Robert American Nurses Association. What is nursing? n.d. Wood Johnson Project brought increased awareness of with a growth mindset, realizing we are capable of nursingworld.org/practice-policy/workforce/whatis- nurse attitudes and turnover rates with The RN Work learning new things, we are more likely to have a positive nursing/ Project. Data indicated that around 18% of new nurses experience. Duckworth A. Grit: The Power of Passion and Perseverance. leave their first nursing job within one year, and 26.2% Let learning renew your passion. Florence Scriber; 2016. leave within two years. Recent (2019) data from NSI Nightingale defined the art and science of the nursing Duckworth A. 2020. Angela Duckworth Q&A: What is grit? Nursing Solutions indicates an increasing trend, with profession; this includes a life-long commitment to angeladuckworth.com/qa/#faq-125 approximately 23% of new RNs leaving their jobs in the learning. Nurses working in a time of crisis can build on Dweck C. Mindset: The New Psychology of Success: How first year and one-third leaving within two years. Overall, their existing skills and learn new ones to deepen their We Can Learn to Fulfill our Potential. The Random House Publishing Group; 2006. bedside RN turnover ranges from 4.5% to 43.9%, and passion for the profession. Get your game on, renew your passion, and find your inner “Flo.” Lai J, Ma S, Wang Y, et al. Factors associated with national RN vacancy rates are of concern at about 9%. mental health outcomes among health care workers Sadly, many nurses also report feeling burnt out and Remember your purpose. Perhaps you started your exposed to coronavirus disease. JAMA Netw Open. being disengaged. nursing career with the “dream job” mindset; now you 2020;3(3):e203976. Though we have yet to see the full impact of are questioning your purpose. According to the American Mealer M, Jones J, Meek P. Factors affecting resilience and COVID-19 on nurses in the United States, a recent Nurses Association, nursing is the protection, promotion, development of posttraumatic stress disorder in critical study published in JAMA Network Open indicates that and optimization of health and abilities, prevention of care nurses. Am J Crit Care. 2017;26(3):184-92. healthcare professionals in China involved in direct illness and injury, alleviation of suffering, and advocacy in NSI Nursing Solutions, Inc. 2019 NSI National health care care of COVID-19 patients experienced symptoms of the delivery of care. This is YOU—remind yourself of your retention & RN staffing report. 2019. nsinursingsolutions. depression and increased anxiety, insomnia, and distress. purpose. com/Documents/Library/NSI_National_Health_Care_ Retention_Report.pdf What are we waiting for? The time is now to address Maintain “wholeness of character.” As nurses, we know the importance of providing holistic care O’Keefe PA, Dweck CS, Walton, GM. Implicit theories of what nurses need to remain on the frontlines and interest: Finding your passion or developing it? Psychol maintain their passion for the nursing profession. for our patients, but we frequently neglect self-care. Sci. 2018;29(10):1653-64. The ANA Code of Ethics tells us that we owe the same Pines EW, Rauschhuber ML, Norgan GH, et al. Stress Grit and resilience duties to ourselves as to others, including maintaining resiliency, psychological empowerment and conflict Angela Duckworth defines grit as passion and “wholeness of character.” One essential aspect of self- management styles among baccalaureate nursing perseverance to achieve long-term goals. Individuals care is spiritual self-care, which can involve a variety of students. J Adv Nurs. 2012;68(7):1482-93. who are “gritty” are engaged in their work and able to activities such as attending religious services, prayer, and PRC. National nursing engagement report. 2019. persevere in spite of negative or difficult life events. They reflective journaling. Spiritual care promotes spiritual prccustomresearch.com/wpcontent/uploads/2019/PRC_ are motivated and flexible in using a variety of strategies well-being, which is associated with resilience among Nursing_Engagement_Report/PRC-NurseReport-Final- 031819-Secure.pdf to reach goals, which cushions them against the impact nurses, supporting a decrease in emotional exhaustion that is often associated with working in a high-stress Rushton C, Batcheller J, Schroeder K, Donohue P. Burnout of hardships. Resilience is defined as the ability to and resilience among nurses practicing in high-intensity bounce back after adversity or failure. Grit and resilience environment. settings. Am J Crit Care. 2015;24(5):412-20. increase well-being and decrease burnout. Cultivate a strong support system. The support of Salles A, Cohen G, Mueller C. The relationship between grit Globally, the nursing profession is celebrating “The family, friends, and co-workers is integral to building grit and resident well-being. Am J Surg. 2014;207(2):251-54. Year of the Nurse and the Midwife.” Nurses make up the and resilience. Staying connected and avoiding feelings Suzuki Y, Tamesue D, Asahi K, Ishikawa Y. Grit and work majority of the worldwide healthcare workforce and are of isolation are pivotal. Recent literature suggests that engagement: A cross-sectional study. PLoS ONE. now recognized as “essential workers” and “heroes.” COVID-19 has greatly impacted the mental health of the 2015;10(9):e0137501. Despite positive public opinion and the rewarding nursing workforce, and steps need to be taken to ensure World Health Organization. The international year of the nature of the profession, we are experiencing a nursing mental well-being in this time of uncertainty and chaos. nurse and the midwife. 2020. https://www.who.int/ Surround yourself with support, keep up the social news-room/campaigns/year-of-the-nurse-and-the- shortage. The Bureau of Labor Statistics predicts that midwife-2020 the United States will need an additional 200,000 nurses distancing norm, and find ways to take care of YOU.

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Apply Today: www.southlincolnmedical.com Page 10 • Wyoming Nurse March, April, May 2021 Why Your Nurses Should Serve on Community Health Boards

By Laurie Benson, B.S.N., Nurses on Boards Coalition, and Kimberly J. Harper, M.S., RN, Indiana Center for Nursing

Reprinted with permission from the North Dakota Nurse April 2020 Issue

Although the fate of the Affordable Care Act (ACA) is uncertain, this landmark legislation, and its accompanying regulations, has placed a renewed focus on community and population health. Nurse leaders are able to impact the health of the communities they serve not only though their roles as clinicians, but also through service on non-profit and community boards of directors. Despite being the largest health profession with 3.6 million registered nurses across the nation, nurses comprise less than one percent of voting members on hospital and health system boards.1 This trend, unfortunately, carries over to the governance of community health efforts. According to a 2014 study examining a dozen successful community health partnerships, nurses comprised only four percent of the direction-setting bodies.2 in a row, and are thus best positioned to leverage health is echoed by Susan Orsega, M.S.N., FNP-BC, In contrast with this low representation, public the trust of the communities they serve to improve FAANP, FAAN, Rear Admiral, United States Public 5 health nurses specialize in “community-building, health health. Health Service (USPHS), Assistant Surgeon General, promotion, policy reform, and system-level changes “I have seen the impact that it is possible to and USPHS Chief Nurse Officer, who leads a team of to promote and protect the health of populations” to have by moving beyond the bedside to serve 1,500 nurse commissioned officers. “Commissioned improve health and promote health equity.3 Further, in a broader, more far-reaching capacity,” says Corps nurses play a vital role in reaching the board service, conducting community needs assessments, Christine Schuster, RN, M.B.A., President and CEO population where they work, play, and pray,” said and participating in community groups are all of Emerson Hospital in Concord, Massachusetts. Orsega. “Population health is a staple of what we competencies required for nurses to receive the American “Emerson nurses are working in collaboration with do in our varied assignments across the country. Nurses Credentialing Center’s Advanced Public Health our community agencies, such as Councils on Aging The Commissioned Corps nurses fulfill critical roles Nursing Certification.4 Clearly, nurses are well positioned and regional senior care assistance organizations, in clinics, hospitals, and public health outreach to positively impact community and population health. to develop best practices in reducing readmissions. programs and policies that are vital to the health of There are major benefits for all parties— These collaborations improve patient quality of life, families and communities across the nation.” community members served by a healthcare lower costs, and advance patient care quality. I am “The involvement of their nurse executives in organization, the nurses these organizations employ, very proud to see our nurses stepping forward to high-profile community boards builds credibility and the hospitals and health systems themselves— achieve measurable goals in enhancing patient care and enhances the reputation for the organizations when nurse executives are encouraged to serve on by working outside the walls of our hospital.” that employ them. Serving on community boards, boards of community health organizations. nurses are extending the reach and reputation of the Key Board Takeaways hospital beyond the clinical environment in helping Benefits for Communities Everybody wins when nurse executives serve on shape policy and strategy decisions that impact these Nurse leaders provide assets to the communities the boards of non-profit and community health critical areas of patient care across the continuum of in which they live and serve in areas that reach organizations. Communities experience improved care.” beyond their formal employment. Through their health; nurses increase their job satisfaction and –Lawrence W. Vernaglia, Foley & Lardner LLP volunteer appointments on community boards, grow professionally; and healthcare organizations philanthropic organizations, governmental task reap the benefit of new insights, best practices, and “The Commissioned Corps community outreach, forces, and commissions, nurse leaders carry enhanced reputation. It is therefore beneficial to as an outside activity, to support a culture of their substantial expertise into the boardrooms of healthcare organizations to support the volunteer health is ever present,” Orsega continued. “Our community organizations across the nation. Further, efforts of their nurse executives in community nurses lead community events that bring together nurses have been rated by consumers as the most service, including board service. several organizations to organizing community runs honest and ethical profession in the nation 15 years The power of nurses to improve community to serving on church boards and school activity boards. We also bridge federal resources to the community, whether state, local, or tribal, providing an exceptional opportunity for the promotion and support of the Surgeon General’s priorities, calls to action, or public health initiatives. My nurse team impacts the health of every American using a model of care centered on population health, wellness, and prevention. We want to create a culture and world where good health is in the reach of every person.”

Benefits for Nurses Nurses gain a valuable professional development opportunity when they serve on community and non-profit boards. The Center for Creative Leadership’s 70-20-10 rule for leadership development states that leaders need to have three types of experience, using a 70-20-10 ratio: challenging assignments (70 percent), developmental relationships (20 percent), and coursework and training (10 percent).6 Board service is an excellent way for employers to expose nurse leaders to developmental relationships and thus foster the leadership of its nursing workforce. Additionally, serving on community boards often has a positive impact on job satisfaction.

Benefits for Healthcare Organizations Healthcare organizations stand to gain when they promote nurses participating in community service. As Lawrence W. Vernaglia, Partner and Chair, Healthcare Practice, Foley & Lardner LLP, states: “The involvement of their nurse executives in high-profile community boards builds credibility and enhances the reputation for the organizations that employ them. Serving on community boards, nurses are extending the reach and reputation of the hospital beyond the clinical environment in helping shape policy and strategy decisions that impact these critical areas of patient care across the continuum of care.” March, April, May 2021 Wyoming Nurse • Page 11

Leadership Visited and Revisited

Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, FNAP, FAANP (hon) Director, Marian K. Shaughnessy Nurse Leadership Academy Elizabeth Brooks Ford Profession of Nursing | Frances Payne Bolton School of Nursing Distinguished University Professor | Case Western Reserve University

“So what is leadership?” This is the simple (yet Leadership is professionalism, understanding the complex) question that I am often asked. social contract that we as nurses have with the public, upholding our ethical obligations to all in our Here are the answers I provide: care, and living our professional nursing standards.

Leadership is part of your being, the moral Leadership is assuming responsibility for our own compass that permeates all that you do, say and actions, being accountable for our actions and believe. understanding the consequences. Leadership is an attribute that is reflected in your Leadership is pushing the boundaries when the everyday interactions with everyone in your orbit, boundaries need to change. your family and friends, your co-workers, and Leadership is investing in others’ greatness. those who you barely know, but with whom you have contact. Leadership is identifying needed change and creating the vision and processes to initiate change. Leadership is being authentic in the way you behave with others, the communication that you Leadership is providing guidance, to individuals, share and the feelings and thoughts that you groups, and organizations. Nurses’ service in community governance roles have. also helps them bring back new ideas, best practices, Leadership is active and decisive decision-making to and even professional connections gained through Leadership is also a set of skills, learned behaviors achieve shared goals. board service to their places of employment. “The that encourage others toward a shared vision, experiences gained by the nurses on community common goals, and a greater purpose. Leadership is taking a risk, to implement a vision boards is often reflected back through the evidence- and achieve goals. Leadership is finding meaning and purpose in your based learning that they apply within their own Leadership is understanding yourself, being aware hospitals as a result of their community board roles,” work. of your potential and the power of intentional Vernaglia adds. communication. Finally, by remaining “in touch” with the Leadership is modeling the way in everything that you do and say. community, nurses can also conduct environmental Leadership is building relationships with those who scans, alerting hospitals and health systems to new Leadership is self-awareness, listening to yourself, can help you and those you can help, building and emerging healthcare issues. reflecting on your own beliefs, your knowledge relationships for the purpose of helping others to It is increasingly beneficial—to communities, and skills. actualize their potential. nurses, and healthcare organizations—when hospitals and health systems support the volunteer Leadership is doing what you can to actualize your Leadership is mentoring others, and allowing efforts of their nurse executives serving in board and unused potential. yourself to be mentored. other leadership roles in their communities. Leadership is managing conflict to create true win- Leadership is promoting collaboration and building The Governance Institute thanks Laurie Benson, win situations. community. B.S.N., Executive Director, Nurses on Boards Coalition, and Kimberly J. Harper, M.S., RN, Chief Leadership is learning from others, the children Leadership is knowing when to step back, when Executive Officer, Indiana Center for Nursing, in the playground who are spontaneous in their there is an affront to your integrity. support of each other, and the board members in Nursing Lead, Indiana Action Coalition—National Leadership is being transformational. Future of Nursing Campaign for Action, and the meeting who are supportive in their own way. National Co-Chair, Nurses on Boards Coalition, for Leadership is humility, knowing that none of us is Leadership is being an advocate, for patients, for contributing this article. They can be reached at colleagues, and for the public health. [email protected] and [email protected]. infallible. Leadership is a belief in the power of our collective Leadership is being a trusted professional. 1 Kathryn C. Peisert, 21st-Century Care Delivery: Governing in the New Healthcare Industry, The humanity, working together for the good of all. Leadership is motivating others to act. Governance Institute’s 2015 Biennial Survey of Hospitals Leadership is sharing your deepest convictions and Healthcare Systems. Leadership is embracing change and effecting 2 Lawrence Prybil et al., Improving Community Health about the way that nursing and health can and change as needed. through Hospital–Public Health Collaboration: Insights should be, reaching for the stars that promote and Lessons Learned from Successful Partnerships, health as a right and not a privilege. Leadership is acclaiming others’ successes and Commonwealth Center for Governance Studies, Inc., assisting them to achieve their highest potential. November 2014. Leadership is caring for those most vulnerable, 3 American Public Health Association, Public Health the neglected, the ill, the down-trodden, the Leadership is YOU! Nursing Section, “The Definition and Practice of Public marginalized…just as nurses do every day in every How many of these leadership attributes describe Health Nursing: A Statement of the Public Health organization. Nursing Section,” 2013. you? 4 ANCC’s Advanced Public Health Nursing Leadership is listening to those whose views are Which of these leadership attributes do you want to Certification (see http://nursecredentialing.org/ radically different from yours and trying to find a develop or strengthen? AdvPublicHealthNursing-PCO). common purpose and a common ground for the 5 Jim Norman, “Americans Rate Healthcare Providers High on Honesty, Ethics,” Gallup, December 19, 2016. good of all. What is your plan to make it happen? 6 Ron Rabin, Blended Learning for Leadership: The CCL Approach, Center for Creative Leadership, 2014. MANLOVE BRAIN + BODY HEALTH PATIENT-FOCUSED CARE FOR ALL PSYCHIATRIC NEEDS Through a combination of traditional psychiatric practice, genetics, laboratory analysis, and innovative treatment methods, we treat all psychiatric conditions. Specializing in Treatment esistant epression, our team is here to help healthcare professionals provide their patients with the expert care they need to improve their brain health. all today to learn how we can provide relief for your patients through Transcranial agnetic Stimulation (TS), etamine, setamine (Spravato), or other personalized treatment options. VIRTUAL APPOINTMENTS manlovehealth.com (605) 348-8000 office@manloveo.com AVAILABLE

The CDC recently updated the treatment recommendations for gonorrhea. Adult UNCOMPLICATED GC, under 300lbs (150kg), with CT excluded: • 500mg Ceftriaxone IM, single dose • 300lbs (150kg) or more: 1g Ceftriaxone IM, single dose • Cephalosporin allergy: 240mg Gentamicin IM, single dose PLUS 2gm Azithromycin, oral, single dose. • EPT: 800mg Cefixime, oral, single dose Adult GC, under 300lbs (150kg), with CT or CT not excluded: • 500mg Ceftriaxone IM, single dose PLUS 100mg Doxycycline, oral, twice a day, x 7 days • 300lbs (150kg) or more: 1g Ceftriaxone IM, single dose PLUS 100mg Doxycycline, oral, twice a day, x 7 days • Cephalosporin allergy: 240mg Gentamicin IM, single dose PLUS 2gm Azithromycin, oral, single dose • EPT: 800mg Cefixime, oral, single dose PLUS 100mg Doxycycline, oral, twice a day, x 7 days • Pregnancy: Replace Doxycycline with 1gm Azithromycin, oral, in a single dose, in all dosing options

Suspected treatment failure: culture, consult ID or STD specialist All Pharyngeal GC: Test for cure with culture or NAAT 7-14 days after initial treatment regardless of treatment regime All +GC: Retest in 3mo due to 7-12% reinfection rate Beta-lactam allergy: A thorough assessment of the reaction is recommended Please contact our Wyoming Communicable Disease Unit (CDU) Prevention Program Manager, Leslie Fowler, BSN, RN, at [email protected] for additional information.

https://www.cdc.gov/std/treatment/default.htm