Thank you for taking the time to read Nevada RNformation, the official publication of the Nevada Nurses Association (NNA). I thank the Editorial Board, who works hard to fill the quarterly issues each year with interesting and informative articles. Also included in each edition are updates on activities offered by NNA and the Nevada Nurses Foundation (NNF), which is NNA's philanthropic arm. So, please enjoy!

Nevada's Legislative Session: Stay Informed

The 83rd Nevada Legislative Session began on February 3, 2025. Now is when nurses can make a difference and communicate about the proposed legislation. All committee and session meetings can be viewed in person, virtually, or on your own time since meetings are recorded. Individuals can provide testimony on budgets and bills in Las Vegas, Carson City, or over the telephone. Visit www.leg.state.nv.us to find the following information: (1) Bill Draft Requests (BDR) filed, (2) information about committee meetings including the agenda, (3) Senate and Assembly session times along with the agenda, (4) information about the legislators, and (5) the ability to track 10 bills for free.

Nurse's Day at the Legislature -- May 20th

NNA hosts a Nurse's Day at the Legislature (NDAL) during the Legislative Session. This year's event will be held at the Capitol on May 20, 2025. Some nurses can sit on the Assembly or Senate Floor with their legislator and will be recognized and recorded in the Daily Journal. Additions this year include the requirement that attendees complete a 1 CEU course before the event. The goal is to have as many nurses attend as possible. Attend to hear from NNA's Lobbyist and learn about some bills that may impact nurses. Please visit NNA's website, www.nvnurses.org, or read the NNA Legislative Committee's article in this issue for more information about this event. Please join us and learn more about the legislative process or the bills that may impact nurses.

NNA's Conference -- Connect with Nurse Colleagues

Here is an opportunity for you to join nurse colleagues in addressing the issues and challenges facing the nursing profession in Nevada. I am so excited that NNA will be having a Conference that starts in the evening on Sunday, May 18, and continues on Monday, May 19, in Carson City. On Sunday evening, join the NNA Board for a silent auction, networking, and fun. Monday will start with breakfast and lead to some CEU presentations, including lunch and dinner. Six CEUs are available for full attendance. There will be some time in the afternoon to explore the area and join other nurses on a hike or visit a museum. The conference is the day before NDAL so that nurses can attend both events. However, you have the flexibility to participate in one or both events.

Some other in-person events will be planned by District 1 (Northern Nevada & rural) and District 3 (Southern Nevada) in the upcoming months. If you are not an NNA member but are receiving this publication, please join NNA on our website. As a member, you should receive the NNA's "Monthly E-News and Updates." If you are not receiving the e-mail, ensure NNA has your correct and preferred e-mail address.  

Now, I want to tell you what the Nevada Nurses Foundation (NNF), the charitable and philanthropic arm of NNA, is working on for 2025. NNF holds fundraising events twice a year. Money raised provides scholarships to individuals seeking initial nursing education, advanced nursing education, or grants for furthering the nursing profession. The Margaret Curly Rural and Frontier Nursing Symposium is held twice a year. This event raises funds for the Rural and Frontier Nursing Scholarship.

Another NNF annual event is the themed Big Hat, High Tea, held at the Governor's Mansion in April. This event sells out, so get your tickets early at www.nvnursesfoundation.org. A ticket includes a delicious tea and lunch, a playful ambiance, an incredible silent auction, a fun live auction, and exciting raffle prizes. You can purchase raffle tickets for exciting prizes before and at the event. Approximately a month before the event, directions to buy tickets are on www. www.nvnursesfoundation.org. Silent auction prizes can be bid on before and during the event.

The Annual Shining Stars of Nursing Gala in October or early November is the significant event that wraps up the year. This event alternates between Las Vegas and Reno. The event this year will be at the Aliante Casino, Hotel, Spa on November 8, 2025. I invite you to join these events and help raise money for nursing scholarships. Please read the NNF Column in this issue, which has more information about the most recent Margaret Curley Rural and Frontier Nursing Symposium, scholarship applications, and more.

Promote professional nursing practice -- Join NNA!

If you have questions about NNA, want to get involved, or have a general question, please e-mail NNA Executive Director Starla Gallagher at executive@nvnurses.org. She can assist you or ensure you are directed to the appropriate person. We are always looking for individuals to get involved, so please get in touch with us. I hope to meet many of you at one or more of our events in 2025.

Dear Nevada Nurses,

As you know, the nursing profession has been evolving rapidly, with nurses facing increasing challenges in terms of workload, burnout, and regulatory changes. Federal regulations, such as those imposed through the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS), have been shaping the healthcare landscape in significant ways. For instance, the implementation of the Nurse Practitioner Modernization Act (NPMA) has allowed nurse practitioners to practice to the full extent of their training in many states, but others have faced barriers due to outdated regulations, affecting their ability to provide timely care (American Association of Nurse Practitioners, 2023). Additionally, changes in reimbursement policies for healthcare services, such as value-based care initiatives, have placed increased pressure on nurses to demonstrate measurable outcomes, affecting both their workload and patient interaction time (Buerhaus et al., 2020).

The impact of these regulations, combined with the growing need for healthcare professionals due to an aging population and increasing health disparities, has made it clear that nurses require stronger advocacy and support at the local, state, and national levels. The Nevada Nurses Association is at the forefront of this advocacy, addressing state-level concerns, as well as being an influential voice in national discussions. By joining the NNA, nurses are able to participate in shaping policies that directly affect their practice, ensuring that they have a seat at the table when important decisions are made.

Membership in professional organizations like the NNA is vital for advocacy and providing ongoing education, networking opportunities, and career advancement. Nurses who are part of professional organizations are better positioned to stay informed on legislative changes, enhance their clinical skills, and connect with colleagues who share common interests and goals (American Nurses Association, 2023). The NNA's commitment to supporting nurses through educational programs, leadership development, and fostering a sense of community has a lasting impact on both individual nurses and the profession as a whole.

If you would like to join us in this one-of-a-kind opportunity to be a part of nursing advancement and advocacy, please register for both the NNA Conference and the Nurses Day at the Legislature here.

In conclusion, joining the Nevada Nurses Association is more than just a membership; it is an investment in the future of nursing. As state and federal regulations continue to evolve, it is essential that nurses unite under organizations that advocate for their needs and interests. The NNA is integral in shaping the future of nursing in Nevada and nationwide. I strongly encourage nurses to join NNA and actively engage in the collective efforts to advance the profession.

Sincerely,
Starla Gallagher BAS, NREMT

NNA -- Executive Director

It is crunch time Nevada nurses. The legislative session is in full swing. The NNA Legislative Committee is providing a proactive presence in legislative and regulatory activities for professional nursing practice. There are two Senate sponsored bills that are creating quite a stir: (a) Senate Bill No. 182 - Revises provisions relating to the staffing of health care facilities, and (b) Senate Bill No. 34 - Revises provisions relating to certain providers of health care (a.k.a., the nurse licensure compact).

Senate Bill No. 182

The first is SB 182, a bill that is generating a lot of emotion, and not just with nurses. There is stress from the hospitals and the Nevada Hospital Association. It is a bill about nurses but really pertains to the business of hospitals. I was able to testify at the hearing for the bill with the Nevada State Senate Health and Human Services Committee from their Las Vegas hearing room on March 6, 2025.

I would like to share my testimony on behalf of our members and all of the nurses in Nevada. I would hope that you will read this with an open mind. Nevada Nurses Association (NNA) went on the record as opposed to the bill AS WRITTEN. The main reason is that the Statue has minute details in it that are very precise. Senator Rochelle Nguyen has done an excellent job summarizing the issues with working for a hospital in the State of Nevada. It is our association's opinion, however, that the bill needs more editing.

As a bill pertaining to Nevada Revised Statute (NRS) it is so precise that if any portion of the bill turns out to not work as intended, it cannot be changed until the next legislative session. If, however, the content is moved to the Nevada Administrative Code (NAC) it can be edited over the next 2 years between sessions. Why does this matter? Because a Statute can only be changed by a new bill during the ODD years when Nevada holds its brief legislative session. Any problems with the bill cannot be repaired until 2027 and then only if there is a new bill sponsor to make that change. Of course, this is great if everything in the bill works as anticipated. It is of the opinion of this association that the more detailed and precise a bill is, the harder it is to anticipate any shortcomings.

Here is the summary of the testimony given due to this issue:

Chair Donate and committee,

My name is Dr Diane McGinnis. I am a Nurse Practitioner who worked 10 years in hospitals. I have been a nurse for 27 years. I am the Vice President of the Nevada Nurses Association and the Chair of their Legislative Committee.

I am sitting here today with many nurses at my back who may not understand our Associations concerns with this bill.

It is the Opinion of the Nevada Nurses Association that we cannot support this bill AS WRITTEN. We greatly appreciate the intent of the bill. And understand that it is about better working conditions for nurses in the hospital setting, which we endorse with all our heart.

• It is our opinion that this bill as written is attempting to put Administrative Code into Statute.
• it is way to detailed and precise.
• to put it simply the bill should say "Follow the golden rule"
• and then have these details in the NV Administrative code
• if the "numbers are off", As you know, 2 years can be a very long time to wait before they can be changed. If they are in the NAC they can be reworked and adjusted between sessions.

This bill, as written, requires hospitals to be able to predict the future [what staffing will I need in the next 1 hour, the next shift, the next day, the next week, the next month, etc..] Let's face it, we are in Nevada; if people could predict the future they would be pulling the handle on a lucky machine!

We are encouraged by the discussion happening today and if the precision is moved to NAC to allow for changes between sessions we will be more apt to support.

Let there be no doubt that working conditions for nurses are affecting their wellbeing, their mental health and their burnout. Nurses are less tolerant of poor working conditions and are walking after just a few years of practice.

Let's work together to improve nursing satisfaction with their careers (not a job); which should improve patient satisfaction, lower mortality, support shorter patient stays and also have less patients returning to the hospital within 30 days of discharge.

We propose the language in the statute be simplified and the details be intended for the NAC so we can make changes between legislative sessions if the original plan isn't working.

Thank you for your consideration.

Here is a video of the whole hearing: Senate Committee on Health and Human Services, March 6th, 2025

Senate Bill No. 34

The next bill we are watching closely is SB 34. It is a separate and distinct bill from the Staffing Ratio proposed law. This bill includes a Nevada compact for several health care providers, including nursing. Here is the official summary of the bill:

• AN ACT relating to health care; entering into interstate compacts that authorize the multistate practice of certain providers of health care under certain conditions; providing professionals practicing in this State under those compacts with the same legal status as persons who are licensed to practice the same professions in this State; authorizing the sharing of certain information with data systems created by those compacts; revising certain terminology; providing for a study of certain impacts of entering into certain interstate compacts; and providing other matters properly relating thereto.(NELIS,2025)

You can read the full language of the bill here.

Nurses' Survey Response

If you are a nurse, you may have recalled a request for response to a survey from the Nevada State Board of Nursing earlier this year. It was emailed out to the nurses who have their email up to date with the NV State Board of Nursing. (PRO TIP: If you didn't get the survey in January, you should log into your account with the NV Board of Nursing and double-check your contact information.)

The results are in and mirror the multiple years of surveys now on the books. This year (2025), over 12,000 nurses out of 62,000 took a survey from the Board of Nursing regarding the Nurse Licensure Compact (NLC). The result is that about 95% support Nevada joining the NLC. This statistic is very significant because about 20% of all nurses responded on time. It might be surprising to local unions, who seem to be strangely opposed to the NLC, that the majority of their members who participated in the anonymous survey were in favor of the NLC. "In addition, for nurses who specified their support or opposition, 99% of non-union members (n = 9,589) versus 94% of union members (n = 1,951) supported Nevada joining the NLC. The same trends were reported in the previous surveys."(Zhong, et al, 2025) Is the Union representing the true wishes of their members when they openly oppose SB 34? The Nurse Licensure Compact benefits nurses and really has not shown in the 43 other states (where the law has passed and been implemented) and some US Territories to be harmful to Union members.

It is important to note that we currently have out-of-state nurses already working in Nevada, who could be nurses who have a multi-state license and still pay for the Nevada single-state license. Not supporting the bill does not and will not prevent out-of-state nurses from working in Nevada. In addition, during the COVID-19 pandemic many nurses responded to work in Nevada under the state of emergency guidelines and did not hold Nevada nursing licenses.

A few other worries about "out of state" nurses working in Nevada under the NLC have been addressed multiple times by the Nevada State Board of Nursing (NSBN). One of those worries is that some nurses in other states do not have to take any continuing education credits. The NSBN has a mission to protect the public. They have done extensive research that shows this lack of credits does not endanger patients. Some have said the NLC will not increase nurses practicing in Nevada. This statement may be true, or it may not, as once again, we do not have the ability to predict the future. What we can say is that there is a larger potential for a greater pool of qualified nurses who have met the 10 criteria of getting a multi-state license, including graduating from an accredited college, passing the NCLEX, and having their fingerprints examined.

In truth, almost every Nurse in Nevada already participates in a multistate compact. The Drivers License Compact. The NLC is very simply just another license that allows nurses to practice their nursing career (drive) in other states as long as they follow the laws of their home state when they are there and the laws of the Compact State when they are not in their home state. Since the majority of Nevada nurses hold a Nevada driver's license, they can easily, and without applying for multiple single states licenses, drive across the country or even drive in Hawaii and Alaska. The nurses in Nevada, unlike those in all but 8 other states, hold a single-state license, meaning if they want to practice in any other state they have to apply for a single state RN license in the new state too. Imagine if each time you wanted to drive across state lines, you had to apply for a new driver's license. This is what happens with nurses who currently live in Nevada.

Nurses are often worried about the process of discipline with issues in either their Home State or in one of the "multi-states". If you are a nurse, please log into www.Nursys.com and you will see that almost every state, including Nevada, is already linked with discipline. Also, your NSBN already needs you to self-disclose any issues with your license in other states.

And last but not least: Get registered for the NNA 2025 Conference being held in Carson City in conjunction with Nurses Day at the Legislature (NDAL). Please go to www.NVnurses.org and register for each event separately. We have also blocked rooms at a discounted rate at the Federal Hotel, where we are holding the conference. Please head over to our NNA event website to get to the room discount link. We hope to see you at both events.

This month's educational update highlights three innovative grant initiatives and a monetary gift, making significant strides in nursing education across the state. These initiatives, supported by various foundations and organizations, aim to enhance and support nursing training, promote diversity, and address important healthcare issues.

University of Nevada, Las Vegas

Josiah Macy Jr Foundation: Disability Inclusion in Nursing, Enhancing Clinical Education Accessibility for Nursing Students with Disabilities

This grant project, funded by the Josiah Macy Jr. Foundation in collaboration with the Robert Wood Johnson Foundation, aims to create a more inclusive and supportive environment for nursing students with disabilities by addressing barriers in nursing education and clinical practice. UNLV is one of six recipients of the 2025 grant initiative, receiving $225,000 in funding over 3 years (Josiah Macy Jr. Foundation, 2025). The project aims to promote diversity, equity, and inclusion, enhance collaboration among health professionals, and prepare them to handle ethical challenges.

Inclusion and access in nursing education for nursing students with disabilities and nurses in clinical practice is a critical and complex issue. Most nursing students with disabilities face barriers in the clinical learning environment that hinder progress and professional development. These include physical inaccessibility, lack of appropriate accommodations, lack of awareness or training among nursing faculty and clinical staff, discrimination, and biases in hiring and professional evaluation. Such barriers hinder the career development process of nurses with disabilities and lead to reduced diversity and inclusivity within the nursing profession. This project aims to ensure nursing students with disabilities receive appropriate accommodations to succeed in their training and careers.

The project team includes Kayla Sullivan, DNP, APRN, FNP-BC, Angela Silvestri-Elmore, PhD, APRN, FNP-BC, CNE, and Candace Burton, PhD, AFN-BC, FAAN. "The team will work together with the UNLV Disability Resource Center and the University Medical Center (UMC) to develop a pilot faculty and staff training program aimed at fostering a more inclusive and supportive atmosphere for nursing students with disabilities" (UNLV, January 22, 2025).

Expected outcomes include a replicable training curriculum, an online toolkit, and guidelines to create accessible clinical environments. The initiative will advocate for policy changes incorporating disability accommodations into nursing education standards. The scalable design of the curriculum and toolkit ensures that these benefits can be extended to other institutions, promoting long-term inclusivity in nursing education.

National Institute of Health/National Institute of Aging: Sleep Depth and Circadian Genes as Potential Markers to Reflect Symptom Variation and Early Risk of Alzheimer's Disease in Shift Workers

This NIH/NIA supported research project, which received $226,500 in funding, aims "to investigate the potential of objective sleep quality measurements and epigenetic alterations in circadian genes as biomarkers to determine the individual differences in adapting to shift work and to predict the risk for future cognitive impairment" (UNLV, February 21, 2024).

Shift workers, particularly those who work at night, face various sleep challenges, including insufficient sleep and difficulty achieving deep, restorative sleep due to their irregular sleep-wake schedules. This disruption is associated with an increased risk of various diseases, including severe cognitive impairment such as Alzheimer's disease. However, not all shift workers develop these health issues, as there is considerable individual variation in adaptation to shift work. Currently, however, there is no indicator sensitive enough to detect ongoing sleep health difficulties or predict the risk of future cognitive impairment among shift workers. Thus, this study aims to identify early biological or physiological markers associated with variations in symptoms related to shift work tolerance and future risks for cognitive impairment. Research findings have the potential to influence policy and clinical guidelines for shift work management. By identifying early biomarkers of sleep health and cognitive risk, nurses can play a crucial role in early detection, intervention, and advocacy for workplace policies that promote better sleep hygiene and long-term well-being for shift workers.

The primary research aims to provide practical tools to help nurses assess and support shift workers more effectively, ensuring they receive the necessary interventions to maintain their sleep health and cognitive function. By integrating research-driven strategies into clinical practice, nurses can make a meaningful impact on the well-being of this vulnerable workforce. Dr. Jinyoung Kim, PhD, RN, FAAN is the primary researcher for this project, and through this study, she has been actively supporting nursing students and early-career scholars at UNLV, equipping them with the skills and knowledge needed to investigate the complex relationship between shift work, sleep health, and cognitive function.

Great Basin College

Fund for the Improvement of Postsecondary Education (FIPSE): Native American Health Science Training

The purpose of this initiative is to deliver Certified Nursing Assistant (CNA) and Medical Assisting, Phlebotomy, EKG (MAPE) education directly to Native American tribal communities, helping address critical health shortage areas. Funding of $760,000 for this initiative will support the establishment of three rural laboratory locations in tribal communities, enabling Great Basin College to offer CNA and MAPE curricula at these sites.

Great Basin College will partner with rural tribes in Northern and Eastern Nevada to prepare students with the knowledge and skills they need to launch into a career in healthcare. While students may hail from different tribes or nations, they will form part of all-Native American cohorts, which will be informed by students' unique racial, cultural, and educational needs. These educational opportunities will allow students to attain one or both postsecondary certificates, begin a new and in-demand career, and further support their communities while largely remaining close to home. Further, this program will continue to shore up Nevada's healthcare workforce in rural and remote locations that may be prone to shortages of healthcare professionals.

The eight-week (6-credit) CNA program and the two-semester (33-credit) MAPE program both include didactic instruction, lab, and clinical coursework. The Medical Assistant, Phlebotomy, EKG (MAPE) Certificate combines three important medical skills into one program- the first of its kind in Nevada. Native American students who pursue training in CNA or MAPE are on a pathway toward a career as registered nurses, helping address shortages and make a meaningful impact in the healthcare field.

University of Nevada, Reno

Grace Church Congregation: Gift to Build Mental Health Service Capacity in Northern Nevada

Grace Church congregates, located in Northwest Reno, donated $500,000 to the University of Nevada, Reno to build mental health service capacity in Northern Nevada (UNR, March 3, 2025). The generous gift comes from a congregation fundraising initiative to support the need for more mental health providers (UNR, March 3, 2025). The Orvis School of Nursing received $80,000 of the funding to support the education and training of future psychiatric-mental health nurse practitioners (PMHNPs).

By alleviating financial barriers, the funding aims to encourage more students to specialize in mental health nursing, addressing the growing demand for mental health services in our community.​ The funds are allocated to provide eight scholarships, each valued at $10,000, to students enrolled in the PMHNP program. These scholarships are intended to assist with tuition, educational materials, and other related expenses.​

Recipients of the scholarships will benefit from reduced financial stress, allowing them to focus more on their studies and clinical education.​ By increasing the number of qualified PMHNPs, these funds contribute to enhancing mental health services, benefiting patients and healthcare providers alike.​

Our impact on the California Wildfires all began when UNLV Nursing student Kayla Oseguera reached out, asking how she could help get involved. That simple question sparked a call to action within our Nursing Student Government team, and together, we set everything into motion. Knowing we had to act fast, I reached out to our peers, encouraging them to step forward and share their strengths so we could build a dynamic, dedicated team.

Together, we turned an idea into an extraordinary movement.

The success of this initiative was built on the remarkable hard work and selflessness of our entire team. Jillian Balceta, Ahmed Saleh, and Kayla Oseguera were instrumental in driving the effort forward. Their dedication, despite the intense academic workload we all face as nursing students, was nothing short of astounding.

The initiative was deeply personal to us. Every donation represented more than just supplies; it embodied hope, resilience, and the promise of a better tomorrow for those facing unimaginable hardship. Motivated by our shared desire to create a lasting impact, we mobilized rapidly. Our first drive at the Clinical Simulation Center of Las Vegas brought in over 10 pallets of essential donations. The success of that event inspired us to organize a second drive on the main campus, which added another five pallets of non-perishable food and hygiene products, along with an impressive $1,169.44 in monetary donations.

From the start, we knew that a significant impact required seamless collaboration. Many of us had just met, yet we set aside egos, assigned roles based on strengths, and worked with precision, handling logistics, volunteer coordination, and resource mobilization. This strategic approach allowed us not only to meet but also to exceed our initial hopes.

As the initiative grew, so did our need for support. Our dedicated faculty stepped in without hesitation, helping to coordinate logistics, secure storage, and ensure every donation reached those in need.

Cross-campus collaboration further amplified our efforts. The School of Dental Medicine Student Government team, led by Nathan Kent, along with partners such as OLLI, rallied to provide additional resources and support. Every contribution, no matter how small, created a wave of solidarity that was nothing short of magical.

UNLV Nursing faculty and Delivery Services staff also provided invaluable support, volunteering countless hours alongside students. They purchased a 26-foot truck and personally drove with the core student team to deliver donations.

Delivering the donations made a profound impact. As we unloaded box after box, we were met with overwhelming gratitude from the relief coordinators at the Weingart East Los Angeles YMCA. As we offloaded supplies, they shared stories of the families impacted by the crisis and expressed how urgently these essentials were needed, reinforcing just how critical our efforts had been. Knowing that our collective work had made a tangible difference was an unforgettable moment.

The magic of this initiative lies in the spirit of unity and the genuine commitment of the UNLV community. Together, we turned an idea into an extraordinary movement, a testament to what can be achieved when we all come together with purpose and passion. The unity between students, faculty, and community partners proved that when we come together with a shared purpose, our impact can be extraordinary.

Starting our careers as new graduate nurses has been an unforgettable journey. My friends Tyson, Elijah, and I, fresh graduates from the Direct Entry Master of Science in Nursing (DEMSN) program at the University of Nevada, Las Vegas (UNLV), made the leap from the familiar comfort of Nevada to the bustling Cardiovascular Intensive Care Unit (CVICU) at Cleveland Clinic. 

Burnout, Retention, and the Risk of Leaving the Profession

Burnout is a word that gets thrown around a lot in nursing, but until you feel its weight, it's hard to truly grasp its impact. In high-acuity settings like the CVICU, burnout isn't just a possibility- it's almost an inevitability. Long hours, emotional exhaustion, and the relentless demands of patient care can take a toll on even the most resilient nurse (Browning, 2019). For new graduates like us, these pressures are amplified by the steep learning curve and the constant pressure to do better for our clients.

The statistics are sobering: The first two years of practice are critical for new graduate nurses, with many leaving their positions- or even the field- due to a lack of support, role ambiguity, and sheer emotional fatigue (Mohamed & Al-Hmaimat, 2024). This isn't just a loss for individual nurses- it's a loss for patients, organizations, and the profession as a whole.

What's clear is that the solution lies in proactive support. Organizations that invest in mentorship and residency programs see measurable improvements in retention and job satisfaction (Rush et al., 2019). These programs don't just teach technical skills- they provide a safety net, helping new nurses navigate the emotional and professional challenges of their first years in practice.

Mentorship: A Lifeline for Transitioning Nurses

Mentorship has been our anchor in this transition. At Cleveland Clinic, we sought out mentors who could guide us, not just in mastering technical skills but in finding our place in the fast-paced world of critical care. The Mentorship ReSPeCT Study highlights the profound impact that mentorship can have on a new nurse's confidence and decision to remain in the profession (Gularte-Rinaldo et al., 2023). These relationships provide not only guidance but also validation- a reminder that we're not alone in this journey.

In addition to workplace mentors, there are external resources that can help forge meaningful connections.One example is the American Nurses Association (ANA) Career Mentoring Program, where I personally found an excellent mentor who provided invaluable guidance during my transition. This platform matched me with a nursing leader whose experience resonated with my goals, giving me new perspectives on clinical practice, professional development, and self-care.

But mentorship hasn't been confined to our workplace or structured programs. The networks we built organically during nursing school, particularly through the Nevada Nursing Student Association (NVNSA) and local Student Nurses Association chapters, have continued to support us across state lines. Staying in touch with professors and mentors at UNLV has been an invaluable source of advice and encouragement, grounding us in the knowledge that we're part of a larger community of nurses who want us to succeed.

The Role of Nurse Residency Programs

Our year-long nurse residency program has been a game-changer and we hope more hospitals not only implement similar programs but also continue to innovate and refine them to support the next generation of nurses effectively. These programs do more than ease us into the role of a professional nurse- they set us up for long-term success. According to Mohamed and Al-Hmaimat (2024), residency programs significantly reduce turnover by addressing common challenges like role ambiguity, stress, and lack of confidence.

What makes these programs so effective is their holistic approach. They provide structured education, regular feedback, and opportunities for reflection, which are critical for adapting to complex clinical environments like the CVICU (Rush et al., 2019). For us, this program has been the bridge between theory and practice, giving us the tools we need to thrive in one of the most challenging areas of nursing.

Wellness and Mindfulness

If there's one thing we've learned, it's that you can't care for others if you're not caring for yourself. Mindfulness has become a cornerstone of how we manage stress. A few minutes of meditation or deep breathing before a shift helps us approach our work with clarity and focus. Research shows that mindfulness-based interventions can significantly reduce psychological distress in nurses, making them an essential tool for sustaining mental health in high-stress environments (Karo et al., 2024).

Living close to one another has also been a blessing. In a new city, we've created our own support system---a place to share challenges, celebrate wins, and remind each other that we're not alone. Peer support isn't just comforting; it's crucial. Studies have shown that having a network of peers can reduce isolation and improve overall well-being (Rush et al., 2019).

Advice for Fellow New Grads

Whether you're moving a few blocks or across the country, the challenges of starting your nursing career are universal. But remember, this journey is about so much more than mastering new skills- it's about discovering the resilience you didn't know you had and embracing the humanity that lies at the heart of nursing. This profession is about connection: connecting with your patients, your peers, and yourself. While nurses are exceptional at caring for others, we must also learn to care for ourselves. Every moment we invest in our own well-being is a moment that strengthens our ability to serve.

Here's what we suggest as you step into your new role:

1. Find Mentors and Build Community: Mentorship and peer support serve as lifelines when you're feeling overwhelmed. Reach out to seasoned nurses or instructors; stay connected with classmates and professional groups. If possible, explore programs like the ANA Career Mentoring Program to find a mentor whose experience aligns with your goals.

2. Seek Supportive Employers: Look for workplaces that invest in formal nurse residency programs and promote ongoing professional development. Organizations that prioritize mentoring and peer-support initiatives are more likely to set you up for success (Rush et al., 2019).

3. Challenge Imposter syndrome: Don't shy away from challenging roles. Growth often comes when you move beyond your comfort zone.

4. Practice Self-Care: Set boundaries, practice mindfulness, and know when to step back. Boundaries, mindfulness, and self-compassion aren't PRN---they're daily necessities. A balanced mind and body are essential for giving the best care to your patients (Karo et al., 2024).

Trust yourself, rely on your community, and embrace the growth that each shift brings. Begin preparing for a sustainable career in nursing even as a student: cultivate healthy habits, connect with mentors, and advocate for robust residency programs wherever you go. These habits, when cultivated early, lay the foundation for a future in which you can continue building on the shoulders of those who came before us- reaching new heights not just for yourself but for the entire nursing profession. The future of nursing isn't just in our hands; it's in the choices we make today.

Uniform Licensure Requirements (NCSBN, 2025)

• Meets the requirements for licensure in the home state (state or residency).
• Graduated from a board-approved education program; or
• Graduated from an international education program (approved and authorized with verifiable credentials review).
• Passed an English proficiency examination (international graduate or if English is not the individual's native language).
• Passed an NCLEX-RN or NCLEX-PN exam or predecessor exam.
• Eligible for or hold an active, unencumbered license (i.e., without active discipline).
• Submitted to state and federal fingerprint-based criminal background checks.
• Nurse has not been convicted or found guilty, or has entered an agreed disposition, of a felony offense under applicable state or federal criminal law).
• Has no misdemeanor convictions related to the practice of nursing (determined on a case-by-case basis).
• Nurse is not currently a participant in an alternative program.
• Applicant is required to self-disclose current participation in an alternative program.
• Has a valid United States Social Security number 

Nurses in an NLC state do not need to possess a compact license. If a nurse practices in any state, they must hold valid licensures to practice in every state they work in. Residing in an NLC state and holding a compact license allows nurses the flexibility to practice in multiple states with a single license. For example, if Nevada enters the NLC and nurses could apply for and be granted a compact license, they would be able to practice in neighboring compact states such as Idaho, Utah, and Arizona without having to obtain a separate license for each state listed (NCSBN, 2025).

Portability is one aspect of the NLC that appeals to nurses everywhere. Health-related professions, such as travel nursing, require portability. The NLC allows travel nurses to take assignments in states without obtaining additional licenses, making this job efficient and nimble. Telehealth is an area of nursing where nurses can practice from their primary state and provide essential care to others located in NLC states without additional individual state licenses. Military and federal workers have specific laws related to federal supremacy that allow current portability from state to state in federal roles. But these same rules do not apply to military spouses or work in the civilian sector. Therefore, the NLC may be of benefit to a spouse with licensure in their primary state of residency, holds a compact license, and moves to another NLC state.

Nevada has an excellent opportunity to join the NLC this year as Senate Bill 34 navigates the Nevada Legislature. This is the year to make this important move to join the NLC to have portability of nurses to the Silver State during times of need and to serve our citizens. Nevada nurses and citizens deserve this and want the NLC. Now is the time for each licensed nurse, patient, and advocate to contact your elected officials and ask them to support Senate Bill 34. Let Us Support SB 34 to make Nevada #44 to join the NLC!

The Great Basin College Associate of Applied Science in Cardio-Respiratory Care Science Program, CoARC #200672, offered at GBC campuses in Elko, Winnemucca, and Renown Regional Medical Center (off-campus lab site), holds Provisional Accreditation from the Commission on Accreditation for Respiratory Care (www.coarc.com). 

Classes are offered at GBC campuses in Elko, Winnemucca, and at the off-campus lab site located at Renown Health in Reno. Applications are open now and are due by 1 May 2025.  There are very specific prerequisites for the program and students can visit Great Basin College: Programs - Associate of Applied Science Cardio-Respiratory Care Science for more information.

Background

Communication gaps during care transitions between urgent care (UC) facilities and emergency departments (ED) can compromise patient safety, particularly in rural settings with limited system interoperability (Bellew et al., 2017). A UC facility in Southern Nevada previously did not share any information with the accepting ED. This practice fell outside of evidence-based standards, which left room for errors that could potentially affect patient outcomes. To improve communication across the care continuum, a quality improvement project implemented a standardized Situation, Background, Assessment, Recommendation (SBAR) communication framework for high-acuity patient transfers from a rural UC to ED (Muller et al., 2018).

Methods

The project was conducted at a rural UC facility serving approximately 50,000 residents with a primary care provider shortage more than double the state average (U.S. Census Bureau, 2023); Wisconsin Population Health Institute, 2024). Guided by Meleis's Transitions Theory (Alligood, 2021), the initiative aimed to increase SBAR-formatted telephonic reports to 70% over three months for patients transferred via ambulance. Implementation included staff education sessions led by the clinic's nurses and nurse practitioner, updated transfer documentation incorporating evidence-based recommendations, and feedback opportunities. A pre-implementation audit showed no ED communication for hospital transfers. The intervention provided comprehensive training and support to all staff members responsible for transfer coordination.

Results

Over the 60-day project period, 130 total transfers occurred, with 34 requiring emergency medical services. The initiative achieved 82% SBAR compliance, exceeding the target metric of 70%. Staff survey results (63% response rate) indicated high satisfaction with the implementation, scoring 9.8/10 for effectiveness. All respondents reported a significant improvement in transfer communication, with 71% reporting they "always" use the SBAR tool. No recommendations for process improvement were received, and several staff provided unsolicited positive feedback about the tool's utility.

Implications

This project demonstrates that structured communication frameworks can be successfully implemented in rural healthcare settings despite resource limitations and system fragmentation. The high compliance rates and staff satisfaction suggest a sustainable practice change is likely. Notably, successful adoption by non-licensed staff indicates the framework's versatility and potential application across various healthcare settings. Future opportunities include expanding the protocol to non-EMS transfers and evaluating impact on patient outcomes such as length of stay and duplicate testing.

Conclusion

The project's success in a rural setting with limited resources provides a model for similar facilities seeking to improve care transitions. Furthermore, it challenges traditional assumptions about skill development in healthcare settings by demonstrating that evidence-based communication techniques can be effectively taught to various clinic staff, potentially elevating practice standards across the care team.

About the Author: Ashley N. Juste, double board certified by the AANP in family practice and emergency care, currently serves as the Medical Director of Provider Experience and Well-being for the Desert Region at Intermountain Health. After earning her master's degree from the University of South Alabama, Mobile in 2016, she has practiced in various healthcare settings and is now completing her post-master's DNP and AGACNP certification at the University of Nevada Reno's Orvis School of Nursing. Driven by the belief that everyone deserves quality healthcare, Ashley leverages her Guatemalan-Haitian heritage and Spanish fluency to deliver comprehensive care.

Column Editor: Dr. Carrie Hintz, DNP, PhD, RN, CEN. For future contributions, please send an email to rnformation@nvnurses.org or chintz@unr.edu

The Nevada Nurses Association wishes to congratulate and shine the spotlight on incredible achievements and groundbreaking contributions of Nevada nurses.

This column is compiled by the RNformation Editor & Dr. Tracey Long. Do you know a Nevada nurse to be recognized? For future contributions, please send an email to rnformation@nvnurses.org!

Plastics are ever-present and mobile in our environment. Today, plastic particles can be found in remote locations like the fresh snow in Antarctica, the deep ocean waters of the Mariana Trench, and even high in the Himalayas. Due to a culture of single-use, throw-away items, the excessive use of plastics has led to significant environmental pollution.

Tiny fragments and fibers from plastic degradation may be invisible. Yet, we unknowingly ingest them in the food and water we consume and even breathe them in, allowing them to be absorbed and accumulate in our bodies. Mounting evidence reveals plastic’s presence and harmful effects on our cardiorespiratory, nervous, reproductive, musculoskeletal, and digestive systems. This article reviews the current science of the health effects of plastics and suggests actions to decrease your exposure.

Microplastics – what are they?

The degradation of plastic is a slow process over time caused by physical (e.g., UV radiation, wind, and wave abrasion), chemical, and biological processes. The breakdown and fragmentation of plastic products produce microplastics (MPs), defined as particles < 5 mm in diameter, and include nanoplastics (NPs) ≤1 μm in diameter (Arthur et al., 2009). These particles enter and accumulate in the environment (water, soil, sediments, air) because of low recycling rates, poor waste management, and littering. Eventually, these plastic particles enter the food chain. Plastics also directly enter our bodies through the everyday use of plastic products.

Not all plastics are the same. Over 13,000 chemicals are associated with plastics and their production (United Nations Environment Programme, 2023). Plastics are polymers derived from monomers such as ethylene, propylene, styrene, formaldehyde, ethylene glycol, or vinyl chloride. There are many kinds of plastics because many different monomers can be combined in different ways. Here are some common plastic polymers and examples of their use:

• Polyethylene: plastic bags, six-pack rings, milk and juice bottles, drinking straws, netting
• Polypropylene: rope, bottle caps, netting, carpets
• Polystyrene: plastic utensils, food containers
• Polystyrene (Styrofoam): foam cups, floats, bait boxes, ice coolers, packing peanuts
• Polyethylene terephthalate (PET): plastic water/beverage bottles
• Polyvinyl chloride (PVC): plumbing pipes, plastic film, bottles, cups
• Polyurethane: Buildings and construction, foams (mattresses, cushions, furniture)
• Polycaprolactone: 3D printing, biomedical applications, drug delivery services
• Polybutylene succinate: food packaging

Plastic itself can be toxic to humans. Hazardous properties include carcinogenicity, mutagenicity, reproductive toxicity, specific target organ toxicity, and endocrine disruption. For example, plastic monomers such as bisphenol-A (BPA) or additives like poly-fluoroalkyl substances (PFAS) are known endocrine disruptors that are associated with cancer. Plastics can also adsorb (adhesion) harmful chemicals from the environment, such as pesticides, heavy metals, and persistent organic pollutants. Even the recycling process of plastic can introduce new chemicals into the new plastic product.

Exposure to Plastics

Human exposure routes for plastics include ingestion, inhalation, and dermal contact (Wu et al., 2022). Most MPs and NPs can cross the physiological barriers of our lungs, digestive tract, and skin. However, the mechanisms of translocation of plastic particles to organs are still not clearly understood.

Ingestion - Drinking water and fluids containing MPs and NPs are common sources of exposure. In addition, everyday activities like using non-stick cookware, plastic utensils and cups allow exposure. Plastic debris accumulates in the marine environment, is ingested by marine animals, from zooplankton to whales, and then enters the food chain to eventually be ingested by humans.

Inhalation - The human respiratory system effectively filters out large particles, but small MPs and NPs can easily reach the lower airways, affecting the lungs and entering the blood circulation. The small size of MPs and NPs and their relatively low density allow them to become airborne and transported over large distances to fallout in urban or remote regions. An example of atmospheric transport is MPs generated from tire and brake wear during road traffic (Evangeliou et al., 2020). These plastic particles contribute to the particle pollution common in the urban setting.

Dermal Contact – Exposure to MPs and NPs also occurs from contact with textile microfibers, personal care products (e.g., face/body scrubs, shampoo, sunscreen), and cosmetics (Tan et al., 2025). Depending on size, some NPs can penetrate the skin more easily when the skin is damaged or has impaired barrier function (e.g., atopic dermatitis) (Tan et al., 2025).

Invasive Medical Procedures -  Theoretically, invasive procedures may permit direct access of MPs into the bloodstream and tissues (Yang et al., 2023). In healthcare delivery, plastic products include gloves, syringes, intravenous and nasogastric tubes, oxygen cannulas, urinary catheters, IV and blood bags, sterile packaging, trays, basins, and many surgical supplies.

Excretion of Plastic - When plastic is not bioaccumulated in the body, it is excreted primarily in feces but also by urine, sputum, and breast milk (Zurub et al., 2024; Wu et al., 2022).

Implications for Human Health

Studies offer mounting evidence of toxic effects from the bioaccumulation of plastics in our organs and tissues, with adverse outcomes to the nervous, gastrointestinal, cardiovascular, and reproductive systems. Early research involved animal experiments and models, but today, it is evolving to include human studies of human specimens or imagery from live and deceased persons. Epidemiological studies are challenging due to universal plastic exposure in the general population. Therefore, studies first should confirm the presence of plastic in human organs and then explore causal effects such as disease endpoints in the physiological functioning of the organ or system. Undoubtedly, more science is needed to identify and better understand adverse effects on human health and guide the best clinical care to those affected.

Table 1. Selected Recent Human Studies and Findings

How to Reduce Your Exposure & Bioaccumulation of Plastic

• AVOID plastics as much as possible – reduce your use.
• Drink filtered tap water.
  • An NIH-funded study found that an average liter of bottled water included about 240,000 pieces of tiny plastic (Qian et al., 2024).
• Use a glass or steel water bottle (avoid buying plastic water bottles or cups).
• Use your own stainless steel or glass reusable coffee cup.
• Microwave food/fluids in glass or ceramic (heat makes plastic release harmful chemicals).
  • It is tempting to reheat take-out food in their plastic containers, but BPA and phthalates can leach out into the food.
• Use glass or ceramic-coated cookware.
• Store food in glass containers when possible.
• Use a wood, glass, marble, or metal cutting board.
  • A study identified plastic chopping boards as a substantial source of microplastics in human food (Yadav et al., 2023).
• Avoid using plastic straws (politely decline them at a restaurant).
• Dust and vacuum regularly.
• Use refillable linen tea bags or tea balls for steeping tea (avoid silken tea bags found in premium teas).
  • A study found that steeping a single plastic teabag at 95 °C (~200 °F) releases about 11.6 billion MPs and 3.1 billion NPs into a single cup (Hernandez et al., 2019).

How We Can Reduce Environmental Plastic

All of us can play a role in ending plastic pollution. Here are some more general actions:

1. Reduce or eliminate your use of plastic products.

• Carry your own grocery bags; decline a plastic bag unless you really need it.
• Invest in glass or stainless-steel reusable items – replace your plastic items.
• Some cities have started charging $ for a bag – it changes behavior.

1. Carry your own water bottle.
   • The National Park Service does not sell disposable water bottles – they have refill stations!
2. Recycle your plastic items.
3. Pick up plastic trash and properly discard it – we all can help!

Want to learn more?

Microplastics and our health. RNformation, November Issue 2019.

SB34 (The Nurse Licensure Compact) and SB182 (The Nurse Staffing Ratio Bill) aim to address pressing issues such as nursing shortages and patient safety. These bills will significantly affect patient outcomes, the broader community, and the healthcare workforce. The influence of unions, particularly in a right-to-work state like Nevada, presents challenges in shaping the future of healthcare delivery. This discussion will explore the economic challenges, patient outcomes, the role of the National Council of State Boards of Nursing (NCSBN), and the wider implications of nurse staffing ratios in comparison to more flexible staffing models.

SB34: The Nurse Licensure Compact (NLC)

The Nurse Licensure Compact (SB34) provides an innovative solution to Nevada's growing nurse shortage by allowing nurses licensed in other compact member states to practice in Nevada without requiring an additional state-specific license. This bill offers economic benefits for addressing staffing shortages and positively affects patient outcomes.

1. Improved Access to Care

One of the main advantages of SB34 is its potential to increase access to healthcare services, particularly in underserved areas like rural communities. By allowing out-of-state nurses to work in Nevada without the bureaucratic delays tied to obtaining new state licenses, SB34 enables hospitals to readily bring in skilled professionals where they are most needed. This can lead to improved timeliness of care for patients, especially in emergency or high-demand situations (McMenamin et al., 2020). This swift response to workforce shortages can reduce wait times and enhance patient outcomes, particularly in emergency care settings.

2. Professional Growth and Development

Senate Bill 34 (SB34) has the potential to enhance nurses' professional growth and development by offering opportunities for diverse experiences across various healthcare settings. Flexible staffing arrangements allow nurses to work in different environments, exposing them to a broader range of patient conditions, technologies, and care models. This exposure facilitates the development of new skills and expands their knowledge base, which are crucial for career advancement. Moreover, such flexibility supports a better work-life balance by granting nurses greater control over their schedules. A study by Mlambo, Silén, and McGrath (2021) highlights that nurses value continuing professional development and believe it is fundamental to professionalism and lifelong learning, contributing to job satisfaction. SB34's promotion of flexible staffing and diverse work environments aligns with evidence suggesting that such practices foster professional development, enhance job satisfaction, and support a motivated workforce. These factors collectively benefit both nurses and the healthcare system.

3. The Role of NCSBN in SB34

The National Council of State Boards of Nursing (NCSBN) plays a crucial role in facilitating the Nurse Licensure Compact. By establishing national standards for nurse licensure and ensuring a cohesive regulatory framework across participating states, the NCSBN helps to guarantee that nurses practicing under the compact are equally qualified and capable of delivering high-quality care (McMenamin et al., 2020). This regulation fosters confidence in the competency of out-of-state nurses, which directly benefits patient safety and outcomes.

Regarding economic challenges, the cost of temporary nurses might rise in the short term due to travel stipends and higher wages for out-of-state professionals. Still, the increased workforce flexibility allows for a more agile and responsive healthcare delivery system, which could ultimately benefit patients by avoiding delays in care and reducing patient safety risks.

SB182: The Nurse Staffing Ratio Bill

SB182, which mandates specific nurse-to-patient ratios, aims to enhance patient safety by ensuring nurses maintain a manageable workload. This approach reduces the risk of burnout and improves the quality of care. However, despite these intentions, as it is written the bill poses significant potential drawbacks concerning patient outcomes and the overall delivery of healthcare.

1. Impact on Flexibility in Staffing

Mandating strict nurse-patient ratios, as proposed in SB182, could reduce flexibility in staffing, which may not always correspond to actual patient demand. Hospitals may be forced to maintain fixed staffing levels even during periods of low patient volume or in cases of fluctuating acuity. This can lead to inefficiencies and increased resource waste, negatively impacting overall hospital operations and limiting the ability to allocate resources to where they are most needed. According to Aiken et al. (2022), rigid nurse-patient ratios can create inefficiencies in staffing models, especially when patient acuity does not align with fixed staffing levels.

For example, while the ratios are designed to ensure safe staffing, a more adaptable system could allow hospitals to respond more nimbly to sudden surges in patient volume (such as during flu season or a public health crisis). Maintaining rigid staffing regardless of actual patient need may create unnecessary strain on non-clinical resources and delay care during high-need periods, affecting the timeliness and quality of patient care (McMenamin et al., 2020).

2. Potential for Adverse Effects on Care in Rural and Underserved Areas

Smaller and rural hospitals may be most affected by SB182. These hospitals often face staffing shortages and have limited resources. Although they will not be subject to the mandate, they will experience adverse effects due to competition for the already limited pool of nurses. The costs associated with this impact will divert resources from other essential areas, reduce services, or even lead to closures, further restricting access to care for these vulnerable communities (Laschinger et al., 2021).

3. Economic and Workforce Impacts on Patient Care

The strict staffing ratios mandated by SB182 could also indirectly increase patient costs. Hospitals may pass on the increased labor costs associated with complying with mandated ratios through higher insurance premiums, out-of-pocket costs, or co-pays for patients. For individuals in lower-income brackets, this could exacerbate existing healthcare access disparities (Schneider et al., 2021). It may also create a situation where prohibitive costs for some patients counteract the bill's intended benefits of improving patient outcomes.

The Role of Union Involvement and Professional Autonomy in a Right-to-Work State

Nevada is a right-to-work state, meaning workers are not obligated to join or pay dues to unions as a condition of their employment. Although this can provide economic advantages for workers who choose to forgo union membership, it also weakens unions' collective bargaining power and can negatively impact the nursing workforce.

1. Undermining Professional Autonomy

Unionized nurses traditionally play an important role in advocating for their professional autonomy, including staffing levels, working conditions, and pay. In a right-to-work state, nurses' ability to collectively bargain for better working conditions under SB182's nurse-patient ratios is weakened. This undermines their ability to advocate effectively for their professional interests, which can compromise patient care if staffing levels and conditions deteriorate due to reduced union influence (Dube & McManus, 2020). With diminished bargaining power, nurses may face challenges ensuring staffing ratios align with optimal patient care standards.

2. Fragmentation and Diminished Worker Solidarity

Nevada's right-to-work environment could foster fragmentation within the nursing workforce. Unionized nurses may be at odds with non-unionized compact-licensed nurses or those from other states, leading to differing pay scales and workplace standards that could create tension and erode cohesion among healthcare workers (Sweeney & Iverson, 2019). This division could hinder the creation of unified efforts to improve patient care and working conditions.

3. Reduced Focus on Patient-Centered Advocacy

Due to unions being less able to exert their influence and relying on other non-nurse workers to increase bargaining power, nursing advocacy for patient-centered care may be compromised. A strong nurses' union presence has historically supported efforts to secure safe staffing ratios that meet patient needs. The absence of such a presence may hinder ensuring that policies like SB182 align with patient welfare and nurse well-being. Without effective union negotiations, there is a higher risk of nurse-patient ratios focusing more on compliance with mandates than enhancing care quality (Dube & McManus, 2020).

Conclusion: Balancing Workforce Flexibility with Safe Staffing for Optimal Patient Outcomes

In Nevada, the interplay between SB34 and SB182 has broad implications for patient outcomes and the healthcare system. While SB34 provides critical workforce flexibility to address nursing shortages and improve access to care, SB182's mandated nurse-patient ratios may lead to inefficiencies that ultimately harm patient outcomes, especially in rural areas. The right-to-work environment weakens union power, potentially undermining efforts to advocate for professional autonomy and patient-centered care.

To optimize patient outcomes and community health, policymakers should focus on maintaining the flexibility provided by SB34 while exploring alternative methods to ensure patient safety, such as evidence-based staffing models that prioritize quality care without imposing strict mandates. Nevada can advance toward a more sustainable and effective healthcare system that prioritizes patient well-being by empowering nurses and providing adequate resources.

District 1 Nurses, your voice matters

Advocate for innovative, flexible solutions that positively impact access to care while exploring adaptable, evidence-based staffing models. We must empower nurses, not undermine their professional autonomy. Nurses deserve a voice in shaping their work environment through collective bargaining, which is increasingly challenging in a right-to-work state like Nevada. Encourage policies that promote nurse empowerment, ongoing professional development, and better working conditions, prioritizing their ability to provide high-quality care. Educate others about these bills' economic and healthcare impacts and nurses' vital role in the community. Together, we can build a healthcare system that prioritizes patients, supports nurses, and ensures access to high-quality care for every Nevadan. Now is the time to act because the future of healthcare starts with the policies we shape today.

Join us in Carson City for the 2025 NNA Conference on May 18-19. Then, on May 20, spend the day with our D1 board members for Nurses Day at the Legislature (NDAL). Registration is now open online.

This edition's spotlight highlights the remarkable field of forensic nursing. This nursing specialty conducts medical-forensic examinations for victims of violence, maltreatment, and sexual assault, collects and preserves crucial evidence, and offers comprehensive medical and psychological care. Forensic nurses work in multiple settings, including community clinics and courtrooms, to assist in cases of sexual assault, domestic violence, and abuse across the lifespan. Their expertise bridges healthcare and legal systems while providing compassionate care.

To be a forensic nurse in Nevada, one must be a registered or advanced practice nurse and have completed the recommended 40-hour training. Training can be completed by enrolling in courses offered at the University of Nevada, Las Vegas, the International Association of Forensic Nurses, or the Academy of Forensic Nursing. There are certification options. Nurses typically need an active RN license, a minimum of 2 years of nursing experience, completion of a forensic nursing education program (usually 40+ hours), specific clinical practice hours in forensic settings, and successful completion of certification examinations.

The NIFN Mobile Unit, led by Forensic Nurse Norah Lusk, serves the remote areas across the Silver State.

NIFN's vision is to meet survivors of maltreatment and abuse of all types wherever they are in hopes of meeting their needs. Having the ability to be on the road with a mobile unit and responding anywhere is breaking barriers to forensic nursing care across the state. This approach mitigates the financial and personal burdens of traveling several hours for a medical forensic exam not only for the survivor but also for their families as well as fellow advocacy groups who may not have the manpower or funding to provide a full 8-12 hours of travel.

As forensic nursing continues to evolve in Nevada, these dedicated professionals represent a critical link in the chain of justice and healing for victims of violence across our diverse state.

The profession of nursing is undergoing a much-needed revamping of internal practices and procedures. Among these changes are the push toward establishing safe staffing ratios, prevention of workplace violence, and increasing nurse mobility through nurse licensure compacts. Every current and aspiring nurse plays a crucial role in ensuring the healthcare needs and priorities of Nevada's citizens are conveyed to state legislators as we move into the 83rd Nevada Legislature year. Nurses can accomplish this objective by raising their voices across different practice areas, offering valuable insights to the legislative process, and advocating for policies that enhance patient care, improve working conditions, and increase access to healthcare.

Comparatively, this legislative year nurses and aspiring nurses, have the unique chance to participate in historic events and gain insights into the legislative process that shapes their profession. Research provided by Maryland and Gonzalez emphasized that successful nurse advocates in the legislative field possess the ability to develop a comprehensive understanding of the issues, identify key stakeholders, and evaluate how proposed solutions will affect the problems being addressed (2012). Subsequently, nursing students need strong mentorship and chances to interact with constituents to foster meaningful and respectful dialogues. Enter the "Each One Teach One" proverb.

"Each One Teach One" is an African proverb that promotes a commitment to sharing gained knowledge and skills within a community through mentoring. This proverb became a monumental means of change for enslaved people whom authoritarians deliberately kept unaware or deceived as a means of control, isolation, and oppression (Blackhistory, n.d.). In the same vein, this philosophy can improve patient care by promoting peer learning, fostering confidence, and cultivating a supportive culture within nursing today. Therefore, as we embark on this historic journey, please take time to reflect upon the ideas in the Reflection Point and challenge yourself to action.

Reflection Point

• How have I benefitted from the guidance of others throughout my career?

• What knowledge would I like to share with other nurses to help strengthen the profession?

• What do I know about upcoming healthcare related legislation such as Senate Bill 182 or Nurse Licensure Compact?

• How can I become more knowledgeable concerning legislative healthcare issues?

• How can I promote unbiased and healthy conversations?

• What can I teach someone new today, this week, this month, or this year!

Last fall while in attendance at a conference, I was talking with a colleague following a panel discussion session. I was taken aback when the colleague, also a healthcare professional, used the phrase "committed suicide" when referring to a topic that was addressed during the panel discussion. Suicide is one of the leading causes of Death in the United States (U.S.), with over 49,000 people dying by suicide in 2022 (Centers for Disease Control and Prevention [CDC], 2024). This accounts for one death every 11 minutes (CDC, 2024). As someone whose life has been intimately affected after losing family members to suicide, I feel it is important to provide a gentle reminder to healthcare professionals that your choice of words matters.

According to Merriam-Webster (n.d.), the verb "commit" means to carry into action deliberately. The verb commit is typically associated with negative actions. For example, "commit a crime" or "commit fraud". When someone states that an individual "committed suicide", it reverts to a time in which suicide was thought of as a crime or a sin. Instead, stating that an individual "died by suicide" implies neutrality while simultaneously acknowledging the event as a tragic outcome of factors beyond the individual's control. Previously, suicide was considered to be due to moral failing as opposed to being caused by mental illness (Maris et al., 2000). The query as to whether suicide is a preventable outcome continues to be investigated in medical literature. Notably, despite substantial prevention efforts between 1999 and 2017, suicide rates continue to be on the rise globally and are increasing at an unprecedented rate in the U.S. (Martinez-Ales et al., 2020).

Given the continued increase of death by suicide globally, it is important for healthcare providers to be knowledgeable in their communication when interacting with other members of the healthcare team and patients. I recognize that when my colleague used the term "committed suicide", there was no malicious intent behind that statement. It was merely a lack of awareness on a topic that is extremely sensitive in nature. It is impossible for us to be aware of all the personal experiences an individual is going through, but what we can do is educate ourselves and others on communication strategies that support safe messaging when navigating sensitive topics such as suicide. Spencer-Thomas (2021) highlights words and phrases that can and should be used when discussing suicide:

It is my sincere hope that those of you reading this article will remember the importance and power in your choice of words. Your words matter, and they hold meaning. The words we choose to use can shape our ideas and feelings, as well as those around us. Let this be a gentle reminder to check in with yourself the next time you are going into any setting, regardless of if it is a professional environment or a personal social environment, your choice of words matters. I leave you with a quote from Lao Tzu (1996), a Chinese philosopher, who stated:

"Watch your thoughts, they become your words;

Watch your words, they become your actions;

Watch your actions, they become your habits;

Watch your habits, they become your character;

Watch your character, it becomes your destiny."

As a group of tired nurses and nursing students piled into a van to head back to their humble lodging after a long day of house visits in a developing country, the fatigue was broken by one of the nurses. They had been volunteering on a medical mission and had been walking on dusty dirt streets for hours, teaching families how to use the free first aid kits they were giving out. Always the optimist, "J" from Las Vegas, Nevada, piped up and said, "Do you wanna play a game?" Creating instant energy, she explained "the laughing animal game." Each person had to name an animal and make its animal sound as if it was laughing. A simple cow moo became "Mooo..hahahaha" in a deep bovine laugh. The van erupted in laughter at the silly game and each rendition of a laughing animal. The magical transformation from a van full of tired souls into energized and gleeful girls was astounding. The power of laughter is medicine.

What Is Laughter Therapy?

Laughter therapy, also known as humor therapy, is the intentional use of humor to promote physical and emotional health. It leverages laughter's physiological and psychological benefits, including stress reduction, improved immune function, and enhanced mood. Studies have shown that laughter decreases cortisol levels, lowers blood pressure, and increases endorphins, which are the body's natural painkillers (Mayo, 2023). In a healthcare setting, laughter therapy can be incorporated through lighthearted conversations, humor-based interventions, and even structured laughter exercises, known as laughter yoga.

What Is the History of Laughter as Medicine?

Ancient Greek physicians used to refer patients to the hall of comedians as part of the healing process (Hankinson, 2019). Early native Americans also had clowns who worked with their witch doctors as they appreciated the profound effect of laughter on healing (Johnson, 2023). In the 1300s, a surgeon Henry de Mondeville, was said to tell his patients jokes after surgery and commissioned healthcare workers and family members to be present to promote laughter (Swaminath, 2006). It is known that royalty included a court jester to help relieve the court of their stressful and serious duties. In the 1960's Norman Cousins wrote his book "Anatomy of an Illness" and explained his attempt to cure himself of a crippling inflammatory illness that was given a death sentence. Refusing his doctor's negative prognosis, he discharged himself from the hospital, hired a private nurse to give him large doses of vitamin C, and watched hours of comedy shows. He noted that 10 minutes of good deep belly laughter had an anesthetic effect that would allow him at least 2 hours of solid sleep. He recovered and then spent the next 20 years advocating for laughter medicine (Cousins, N., 1979). In 1972, Dr. Hunter Patch Adams (of the same name as the movie) founded the Gesundheit Institute, which focused on bringing laughter into the healthcare industry (Adams, 1998). Expanding on that previous work, laughter yoga clubs have sprung up across the world, bringing much-needed relief and energy to the world.

What is Laughter Yoga?

Laughter Yoga has become an international movement with an outlined instructive program, including clapping, breathing exercises, playfulness activities, and laughing exercises (Davidson, 2021). Imagine having a circle of participants lying on the floor with each person's head on another person's belly. As one person laughs, the head of the other person bobbles back and forth, producing a guaranteed laugh from the recipient, which in turn initiates a bobbling belly from the person whose head is now bouncing on their own belly. The circle becomes a domino effect of giggling and laughter for the silly ripple of bouncing heads.

How Can Nurses Apply Laughter Therapy for Patients?

Nurses play a critical role in fostering a healing environment, and incorporating laughter therapy into patient care can improve overall well-being. Here are some ways nurses can use humor professionally with patients:

1. Engage in Playful Interactions -- Using lighthearted humor (while being mindful of the patient's comfort and cultural considerations) can ease anxiety and create a more relaxed atmosphere.

2. Use Therapeutic Humor -- Sharing funny but appropriate stories or using humor in conversation can uplift a patient's spirits, especially in long-term care settings.

3. Encourage Laughter Exercises -- Guided laughter sessions, such as laughter yoga, can help patients experiencing chronic pain or stress by triggering relaxation responses.

4. Provide Humorous Distractions -- Offering joke books, comedy movies, or humorous cards can be a simple yet effective way to reduce patient stress.

5. Incorporate Laughter in Group Activities -- In hospital or nursing home settings, group laughter activities can foster a sense of community and improve emotional well-being.

How Can Nurses Use Laughter Therapy for Themselves?

Given the high demands of nursing, finding ways to incorporate laughter into daily life can serve as a self-care strategy to prevent burnout. Here's how nurses can apply laughter therapy to their own well-being:

1. Start the Day with Laughter -- Watching a funny video, listening to a comedy podcast, or sharing a joke with colleagues can set a positive tone for the day.

2. Create a Culture of Humor -- Encouraging workplace humor, such as a 'joke of the day' board, can help lighten the mood and build camaraderie among staff.

3. Practice Laughter Yoga -- Engaging in structured laughter exercises, even without external stimuli, can stimulate the same health benefits as spontaneous laughter.

4. Use Laughter as a Coping Mechanism -- Instead of internalizing stress, finding humor in challenging situations (while maintaining professionalism) can provide a healthier perspective.

5. Surround Yourself with Joy -- Spending time with family, friends, or colleagues who embrace laughter can be a natural way to recharge emotionally.

Laughter is not just a simple reaction to something funny---it is a powerful, therapeutic tool that nurses can use to enhance both patient care and personal resilience. By incorporating humor into their professional practice and self-care routines, nurses can foster a more positive, healing environment while safeguarding their own mental and emotional well-being. As the saying goes, "Laughter is the best medicine," and for nurses, it may just be the prescription for a healthier, happier career.

The Margaret Curley Rural and Frontier Nursing Symposium

Thank you to all the wonderful presenters and attendees at the Margaret Curley Rural and Frontier Nursing Symposium held on Friday, February 21st, and Saturday, February 22nd, 2025. The symposium was hosted by the Nevada Nurses Foundation (NNF) and Nevada Nurses Association (NNA), and it offered 7 CEUs at a very low rate of $35 for each NNA member! We understand your valuable time and appreciate you sharing it with us!

Spring 2025 Symposium Presenters

Plan for the Upcoming Late-Summer Symposium

Are you aware that people who have higher levels of education are likely to live longer and be healthier than those who do not? Join us as a guest presenter or a member of the audience at the next on-line synchronous Margaret Curley Rural and Frontier Nursing Symposium to be held on Friday, August 29 and Saturday, August 30, 2025.

The History of the Symposium

The first symposium was held in Elko, Nevada several years ago and was successful because of the remarkable collaboration between two NNA leaders; Dr. Heidi Johnston (Elko, NV) and Ms. Margaret Curley (Yerington, NV). Initially, the funds raised from the symposium were modest but the NNF began adding money to be able to award a $1,000 Rural & Frontier scholarship. We are deeply saddened by the passing of Ms. Curley in 2019, however, the NNF and NNA now collaborate to bring you the Margaret Curley Rural & Frontier Nursing Symposium and scholarship. The link to contribute directly to the Nevada Rural & Frontier Scholarship Fund is https://www.nvnursesfoundation.org/Donations/sch_rural_form.php

Opportunity! Get Involved with the Symposium

If you are interested in joining the Rural & Frontier Nursing sub-committee as an NNA member, please reach out directly to NNA by emailing Executivedirector@NVnurses.org or visiting their website. If you are interested in presenting at the next Margaret Curley Rural & Frontier Nursing Symposium, contact the NNF at info@nvnursesfoundation.org or call/text 775-560-1118.

Nevada Nurses Foundation 2025 Calendar of Events

• April 5, 2025 - The Great Gatsby Big Hat High Tea

• May 1, 2025 - Nominations OPEN for People's Choice, 50 Under 50, and Distinguished Nurse Leader with Lifetime Achievement to be recognized at the 2025 Shining Stars of Nursing in Nevada.

• August Scholarship Applications OPEN

• August 28-29, 2025 - Margaret Curley Rural & Frontier Nursing Symposium

• October 1, 2025 to February 1, 2026 - Grant Application OPEN

• November 8, 2025 -- The Shining Stars of Nursing in Nevada Dinner & Awards Gala; to be held at the Aliante Casino, Hotel, Spa in Las Vegas

• November 8, 2025 - Rising Stars of Nursing Symposium

Tickets for the 10th annual awards gala, Shining Stars of Nursing in Nevada, will begin on May 1, 2025 at https://www.nvnursesfoundation.org. If you are interested in being a part of the planning team, please contact us at SSON@nvnursesfoundation.org . The NNF has awarded over $250,000 in scholarships and over $10,000 in grants. Every year, more than 50 volunteers come together to coordinate and collaborate to raise funds to support the NNF mission of increasing access to quality healthcare for Nevadans!

Exhibitors and student nurses, SAVE the DATE for the 10th annual Rising Stars of Nursing Symposium on November 8th starting at 8:00 AM! Contact us if you would like to be an exhibitor at info@nvnursesfoundation.org. STUDENTS attend for FREE!

Thank you for supporting the Nevada Nurses Foundation!

Always have great days,

Sandy Olguin, DNP, MSN, APRN, FNP-BC

CEO/President, Nevada Nurses Foundation

solguin@nvnursesfoundation.org

Supporting clinical nurse educator and preceptor education has become increasingly necessary because hospitals are experiencing high turnover rates of newly graduated nurses amid a workforce characterized by low nursing tenure, exacerbated by many retirements and the recent pandemic. This situation has created a heightened need for expert nursing care precisely when experienced mentorship is crucial.

To meet this challenge, leading nursing education scholar Dr. Patricia Benner has issued an urgent call for a radical transformation in nursing education to meet the current needs of patient care and nursing practice. From this mission, Western University of Health Sciences partnered with The Benner Institute for Teaching and Learning housed within HealthImpact to create the WesternU Faculty Academy Region 9 (WUFAR9) program. WUFAR9 offerings, funded by a grant from the Health Resources and Services Administration (HRSA), offer free educational opportunities for nurses from Nevada, Arizona, California, Hawaii, and the Pacific Island Nations.

For Nursing School Faculty and Practice Educators

WUFAR9's Clinical Faculty and Educator (CFE) course allows any Nevada clinical faculty member to attend a 30-hour continuing education course designed to enhance the teaching of clinical reasoning and judgment with pre-licensure nursing students. The CFE course is based on the latest neuro and learning sciences and on the Carnegie Foundation for the Advancement of Teaching's seminal study, Educating Nurses: A Call for Radical Transformation, led by Dr. Patricia Benner. Nevada nurse faculty and educators can attend any of the 3 day in-person classes or participate virtually through six bi-weekly synchronous zoom sessions. Two virtual cohorts are offered per quarter through the fall of 2026.

For Nurse Preceptors

WUFAR9's Nurse Preceptor course allows any Nevada registered nurse who actively preceptors pre-licensure nursing students and New Graduates to attend a 16-hour continuing education course. This course further enhances the preceptor's skills in situated coaching and teaching clinical reasoning. Nevada nurse preceptors can attend any of the 2-day in-person classes or participate virtually through four bi-weekly synchronous zoom sessions. Two virtual cohorts are offered per quarter through the fall of 2026.

To learn more about these offerings, contact the WUFAR9 team at WUFAR9@westernu.edu