More than 500 nurses from 47 states, the District of Columbia, Guam, and the U. S. Virgin Islands brought key issues to federal policymakers on June 26 for the American Nurses Association’s (ANA) Hill Day.  

This high-impact advocacy effort represents more than a moment but a movement. Nurses leveraged their collective voice to ensure that policymakers hear The Power of Nurses™ loud and clear. The group of nurses, nursing students, and nurse leaders shared information, insights, and personal experiences to educate lawmakers about priority legislative issues including: 

• Preserving funding for Medicaid 
• Reauthorizing Title VIII Nursing Workforce Programs 
• Protecting nurses from workplace violence 
• Improving patients' access to care 

"This is our day to be seen and heard—and welcomed into the halls and offices of Congress—as the experts we are on nursing practice, education, and regulation, and on matters of importance to our nation's health," said ANA President Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, in her welcome message.  

At a time when norms have been shattered and there is considerable flux about policies, programs, and priorities, she emphasized "we are engaging in a fundamental act of democracy that is still valued and important."

The passionate and energized group of nurses met with 244 House of Representatives offices and 92 Senate offices.  

Reflections from ANA Hill Day 2025 with VNA’s Director-at-Large, Chapter Representative

When you think about healing, the first vision that may come to mind is a hospital, clinic, doctors’ office, nursing home, or any variety of medical facilities. But the healing power of a nurse can extend beyond any physical building. Healing comes in many forms, not just the physical. Healing can relate to a patient’s physical health, mental health or emotional health. So, when you think of a jail or a prison, have you ever thought that healing can occur there too? Or, do you envision incarceration equals punishment? 

A nurse, however, reaches behind the bars and sees a patient. Nurses are naturally drawn to people in need regardless of appearance. Even in a correctional facility, nurses gravitate to those who are hurting and seek ways to make the journey a little easier. Nurses are always searching for better or different ways to deliver care to patients and to see potential where others may not. This is what drew me to improve care delivery for pregnant incarcerated women.   

In the U.S., more than 975,000 women are under the supervision of the criminal justice system[1].  Additionally, correctional facilities are not federally mandated to track or report pregnancy related data. In a survey of 53 jails across the United States, only 38% of these correctional facilities perform routine pregnancy testing at time of admission[2].  Nationally, an average of 3% of incarcerated women are pregnant at the time of admission[3]. That is why incarcerated women, especially pregnant incarcerated women, deserve attention.

Historically, most correctional facilities and their processes have been structured to incarcerate men[4]. This perspective adds a layer of challenges to ensure unique aspects of care are addressed for incarcerated women. As a vulnerable population, incarcerated women present challenges to the criminal justice system. Adding to the complexity, when the incarcerated woman is pregnant, the pregnancy is often unplanned and complicated by lack of prenatal care, maternal trauma, poor nutrition, substance use, mental illness, chronic medical conditions, low socioeconomic status, and limited social support[2]. All of these elements put her and her pregnancy at a higher risk for poor outcomes.  

Currently, I serve at-risk expectant families in my rural community. However, I found myself drawn to this subset of women within my community that can often be overlooked and forgotten. I found myself in self-reflection because if I was being honest with myself, I had to admit that I had not given thought to the healthcare needs of incarcerated women. I then pondered, when you think about populations within our communities who are marginalized, how do incarcerated women get overlooked? I am perplexed as to why I never considered how I could be a better community partner with our correctional facilities. Had it been fear of the unknown or simply not knowing what or how we could help? When I sought guidance from nursing literature, there was a lack of research regarding this unique subset of population health within our communities. Therefore, my question then became what more could our healthcare system do to support the women and the medical teams caring for this vulnerable population, particularly the pregnant incarcerated women? This is when I saw an opportunity to make an impact in reaching a population that was at risk and deserved as much support as could be offered.

Just like traditional healthcare systems, the correctional system has its own culture and policies. Understanding the culture is critical, therefore I chose an approach of cultural humility. Cultural humility is different from cultural competence because cultural humility involves approaching with curiosity, openness, a willingness to learn from others even when it’s uncomfortable, and an openness to establishing power-balanced relationships[5]. I knew the skill set and resources I could bring to a correctional facility, but I didn’t know what they needed or if they even wanted to partner with me. Fortunately, the first facility I worked with already had a strong nurse advocate, Regina Chestnut, RN, CCHP, leading their medical team. She was the first leader I approached in hopes of forming a mutually beneficial partnership. In Regina, I found a fellow nurse who shared a passion for caring for incarcerated pregnant patients and who also wanted to be innovative in the care and support that these women were receiving. She too recognized that these women faced many struggles, often with little to no support, and had made unfortunate choices resulting in incarceration. At the same time, these women deserved compassionate care that is free of judgement. Together, we forged a partnership of support and resources for these women that begins within the walls of the jail and now extends into the community. 

Regina may have been my first mentor; however, I also learned a great deal about the struggles faced by incarcerated woman by those currently in the situation. The women were the ones who truly gave me a new perspective on the struggles they endured. By taking the time to ask the women I serve about “their story”, I learned that many of the decisions made that led to their incarceration could have just as easily been made by others given similar circumstances. They showed me that anyone can find themselves incarcerated given the right situation and similar choices. Their stories put a face to my picture of an incarcerated woman, and it impacted how I now interact with all patients. I also learned through these women that their parenting may not be traditional, but that does not mean that they don’t love their children dearly. Success in helping these women become mothers is not measured by molding them into traditional motherhood, but instead provide the resources, mentorship, and support to raise their children in a safe and loving environment in a way that is meaningful for their families. In offering them hope and believing in them, my goal is to give them a chance to break the cycle and to show them that there are others who want to support them to be successful.

What strategies do nurses have to empower and advocate for incarcerated women? It starts with showing genuine care by a desire to understand the individual’s perspective and needs. From there, respectfully ask if they will trust you enough to share their story. Then sit, listen without judgment, and maintain good eye contact. Truly listen without imposing judgement and guilt, because most of them already carry enough guilt themselves, even if it is not always apparent. This is how a nurse begins to genuinely understand the needs of this underserved population. The goal should always be to bring hope, encouragement and resources to the table then we begin building and offering opportunities to help these women achieve success, so that a moment of incarceration does not have to define who they become.

Providing resources for physical needs hasn’t been the only thing accomplished by going into the jails. When visiting with these women during incarceration and in their most vulnerable state, it enables trust to be built at an accelerated rate. By meeting on the individuals’ terms, it builds a trusting relationship and the genuine intent to help them live a future that is meaningful to them. In many of these women’s experiences, they have never had someone offer them something without an expectation in return. At first, many of the women are a bit suspicious of my intention or the role I will play in their life. That is why it is essential to remain honest, transparent, and let the individual lead the conversation so that they can share what is important to them at that moment, and we work from there. Normally, their top focus is on what will happen to their baby, which is understandable for any mother. Once their main concerns are addressed, I lead them into discussions that I recognize as important for their journey to healing. 

But the work is not done. We must use our voice and power as nurses to advocate for these individuals. We need to help others understand more about their struggles and remove biases that incarceration carries. This means educating others about the barriers incarcerated women face, the impact of the words we use, pointing out unrecognized prejudices, and striving to impact legislation at the state and national level. These women are people who deserve quality care and resources. We need to remember, every incarcerated woman is someone’s sister, mother, wife, aunt or child. Every incarcerated woman is important in someone’s life, and she deserves for us as nurses and healthcare providers to care, even if she has lost hope in herself. We can offer support and empower her through our belief that she is valuable and worthy. Nurses can leverage seeing the patient and her needs regardless of what breach in society’s law they may have committed. It is up to the criminal justice system to hold them accountable for that; our role is to attend to their physical, mental, and emotional health. This does not erase the penalty they face for their crimes, but as a nurse, we are to provide unbiased care. In fact, these patients may need grace extended to them even more so that they feel worthy of compassion and it offers them a chance to change the direction of their life. We can leverage cultural humility.

Demonstrating the power of collective advocacy and attention, this unique partnership between a healthcare system and correctional facilities, in a very short amount of time, has provided incarcerated women with resources and support that were not always available. This partnership started with a collaborative discussion and envisioning a delivery of care that we wanted to provide. Rather than focusing on the barriers, we envisioned a better way. Through partnering together, we provide support in the jails through one-on-one visits, community resource classes, prenatal education, prenatal care at the jail, labor support, supplemental protein bars, long-acting reversible contraception, and equipment to support breastfeeding women.

This is just one story of a forgotten or overlooked population, there are more. My challenge to you is to look around your own community with fresh eyes. Look for the people who are not being seen in your community. Seek people or places that you don’t understand or know about. Explore ways that you as a healthcare provider could make a difference and impact. Seek to understand and exercise cultural humility. Don’t wait until you feel you can do something BIG, even small changes can lead to big successes. If you run your race with good intention in your heart and keep a patient centered focus, you will never go wrong. I have made many friends along my journey, and I hope you will also find other like-minded nurses to walk beside you to help make the future of healthcare even better than we found it.

If you would like to contact Roxanne with questions regarding this program, such as volunteering, donating or how to start a similar initiative in your community, please reach out to her at R2Harris@augustahealth.com.              

Recently, the Virginia Nurses Foundation (VNF) and the Virginia Nurses Association (VNA) presented their 2025 Future Nurse Leader Award to 12 outstanding BSN graduates. Recipients were selected by their school’s faculty based on their leadership impact, activity in nursing associations, a history of community involvement, and significant contributions to their school’s overall excellence. Each award recipient received a one-year VNA membership, an invitation to participate on one of VNF or VNA’s commissions or workgroups, complimentary “Nurses Change Lives” license plates for their car, and a complimentary registration for our fall conference, the Nurse Staffing Summit!

Reach out to Linda McKay to learn more about this awards program. Read on to hear what their nominators had to say about our 2025 Future Nurse Leaders!

As part of our ongoing commitment to inclusive excellence, the Diversity, Equity, and Inclusion (DEI) Council continues to champion initiatives that elevate all voices in nursing who are vital to the fabric of healthcare across the commonwealth and to the communities we serve. Our primary focus areas for this year are the direction of the council and our enduring efforts to champion justice in healthcare.

Climate Action
This summer, the DEI Council continues its work in partnership with community organizations and other initiatives to raise awareness about heat-related illnesses, which disproportionately affect vulnerable populations, including outdoor workers, older adults, children, and those with chronic conditions. Educational flyers and resources were distributed across clinics and community centers, and outdoor work sites to empower community members and enable nurses to guide patients in prevention and early intervention.

In tandem, we supported advocacy efforts around the MATS Repeal, recognizing its implications for environmental justice, developmental safety, and the protection of those living with chronic diseases like asthma and cardiovascular diseases. Nurses are uniquely positioned to lead climate health conversations, and we encourage all nurses to explore the Virginia Nurses Foundation’s (VNF) Climate Health page for tools, data, and action steps.

DEI Education 
DEI education efforts continue through the Virginia Nurses Association (VNA) and other organizations to define what DEI is and isn’t. This quarter, we held collaborative conversations on continuing work to see equity in healthcare. Council meetings continue monthly. If you would like to join in the work being done, please get in touch with Elle Buck with the Virginia Nurses Association at ebuck@virginianurses.org.

LPN Council
VNF & VNA recognize that licensed practical nurses (LPNs) are essential contributors to patient care and community health. In recent years, VNA has taken steps to ensure LPNs are not only included in its initiatives but also empowered through our association. Key efforts include:

• Connecting LPNs to professional development opportunities and professional engagement. LPNs were invited to attend our Spring Conference, Empowering the Nurse, at a special introductory discounted rate. Additionally, LPNs now receive Virginia Nurses Today, VNF’s electronic newspaper.
• Exploring resources and opportunities that will empower LPNs and help them to advocate for their role. These resources and opportunities include an LPN clinical ladder, professional certifications for LPN practice, LPN to RN education programs, shared governance, membership with the National Association of Licensed Practical Nurses, and various resources.

Dermatological Diversity: A Library for All Skin Tones
One of the newest DEI initiatives aims to address a critical gap in diagnosis and training regarding the underrepresentation of skin conditions across different skin tones. The Council is exploring the development of a Dermatological Reference Library that showcases common and uncommon skin conditions in diverse skin types. This resource will empower nurses and clinicians to improve diagnostic accuracy and promote health equity through culturally competent care.

Website Enhancements
We’ve also been busy enhancing the offerings on the DEI webpages!

Explore our newly published Community Outreach page (pictured above), created for individuals to access various resources and best practices addressing these challenging issues. Community Outreach features include K-12 mental health initiatives, nurse mental health initiatives, maternal health resources, climate health education resources and more! Explore VNF’s Community Outreach page today!

Our other new webpage, A Diverse Workforce (pictured above), explores VNF’s nursing workforce initiatives as well as profession reports from the Virginia Department of Health Professions and more! Access resources such as information on our newly formed LPN Council, VNF’s annual Future Nurse Leader Awards, our health equity and public policy scholarships, VNA’s Workforce Center, and more! Learn more here!

VNA is excited to welcome several new leaders who have recently stepped into chapter roles across the state! Please join us in celebrating the following individuals for their commitment to serving and strengthening the nursing community.

Curtis Cooke, MSN, RN, PCCN is now serving as Vice President of the Piedmont Chapter. Susan Braud, DNP, RN, CCRN has taken on the role of Treasurer in the Hill City Chapter. Bessie Brown, MBA, MSN, RN, NEA-BC is the new Vice President for the Central Virginia Chapter. Kim Jarrelle, MSN, RNC-OB has joined the Central Virginia Chapter Board of Directors. In the Farmville Chapter, Paxton Knutson, RN has stepped into the Government Relations Chair position.

Thanks to the ongoing dedication of our members, we continue to make strong progress in filling leadership vacancies. Currently, we are still seeking volunteers for a few key positions. The Augusta Chapter is looking for a Government Relations Chair. The New River Valley Chapter has two open roles: Student Outreach Chair and Government Relations Chair. In the Northern Shenandoah Valley Chapter, they are looking to fill the Student Outreach Chair position.

If you’re ready to connect, lead, and make an impact in your region, we’d love to hear from you! You must hold an active VNA membership to be eligible for any open positions.

Questions? Contact Membership Manager, MJ Gearles, at mgearles@virginianurses.org today to get your VNA leadership journey started.

VNA is celebrating 125 incredible years of nursing excellence in 2025 and you’re invited to join in! To mark this major milestone, we have launched a special line of anniversary items.

This limited-edition collection includes everything from performance polos and quarter-zip windbreakers to stainless steel water bottles, day tripper duffel bags, spiral notebooks, cozy coffee mugs, and a wide range of apparel from tees, sweatshirts, hoodies, long sleeve shirts, to tank tops, and more!

Whether you're on shift, on campus, or off the clock, our 125th anniversary gear is the perfect way to show your VNA pride and be part of something historic.

Don’t miss this opportunity, shop today!

As nurses, we are trained to support individuals in achieving their health and wellness goals and to prevent diseases. In recent years, however, we’ve also become frontline responders to global health emergencies from pandemics to natural disasters. As our understanding of global health deepens, it’s increasingly clear that climate change is not just an environmental issue but a public health crisis. As nurses, we play a pivotal and unique role in preparing our communities for the health effects of a changing climate.

Climate change and rising temperatures are no longer distant threats. According to the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), climate change is already affecting health outcomes worldwide and creating barriers to overall well-being. (WHO, 2023; CDC, 2024).

Here in Virginia, we have experienced a record-breaking surge in heat-related illnesses with some locations reporting an increase in emergency department visits as much as 85% compared to previous years. (Marshall, 2025, VDH, 2025) Climate change poses significant health hazards to many Virginians, particularly for outdoor workers. Moreover, climate change intensifies existing health threats and introduces new ones in our communities. Here is how climate impacts our daily lives:

Chronic Diseases
Cardiovascular and respiratory conditions are particularly vulnerable to climate stressors. Heat, poor air quality, and wildfire smoke can exacerbate symptoms and lead to increased hospitalizations. Additionally, many medications used to manage these conditions, such as beta blockers, antivirals, antibiotics, and inhalers, can lose efficacy if stored improperly in high temperatures. (CDC, 2025).

Mental health
Meteorological events, particularly increased sunlight and heat are linked to disease exacerbation and increased hospitalization of those living with anxiety, depression, and PTSD. Prolonged exposure to heat and humidity can also lead to electrolyte imbalances and interfere with psychiatric medications, increasing the risk of hospitalization. (Montes, et al., 2021; CDC, 2024)

Heat-related illness (HRI)
HRI is now the leading cause of weather-related deaths in the U.S., and here in Virginia, we rank among the top three states for emergency service use related to heat illness (NEMSIS, 2024; VDH, 2025) As summers grow hotter, nurses must be prepared to educate their communities on how to prepare for, recognize, and respond to heat stress, particularly in vulnerable populations.

Allergies
Longer pollen seasons and higher pollen concentrations are exacerbating allergic rhinitis and asthma, particularly in areas where healthcare access is limited. (American Medical Journal, 2025). In Virginia, we’re also seeing a rise in Alpha-Gal Syndrome (AGS), a syndrome which is now among the top 10 adult food allergies. (Alpha Gal Alliance, 2025). This syndrome is created by the Lone Star Tick, whose populations are growing in warmer climates.

Infectious Diseases
In the same vein, a longer breeding season for vectors, combined with climate events such as flooding and a significantly warmer climate, promotes the growth and expansion of many vector-borne diseases (Liszewski, 2025). In Virginia, we are all too familiar with the populations of ticks and mosquitoes and the diseases they carry are spreading. Diseases such as Lyme Disease, West Nile Virus, Rocky Mountain Spotted Fever, Ehrlichiosis, and AGS are becoming increasingly prevalent. Still, funding for research and access to healthcare are not keeping pace with the spread of these diseases.

Vaccines & Healthcare Access
The health and access to healthcare of many people are also affected by floods, fires, and famine, which promote vector-borne diseases, malnutrition, and create barriers to clean, safe water and food. As these barriers become more significant, vaccines and lifesaving medications will also become a top priority to prevent diseases, and the dangers associated with inadequate healthcare access. These same weather conditions also compromise the integrity of vaccines and medications during storage, transport, and distribution, which are crucial for maintaining their efficacy. (Kim et al., 2023; Johns Hopkins Bloomberg School of Public Health & IVAC International Vaccine Access Center, 2025). August is National Immunization Awareness Month and VNA encourages healthcare providers to contiue to promote virtal education and visibilty on the importance of vaccinations.

Nurses Call to Action
The American Nurses Association (ANA) has taken the position that climate change is “…the single biggest health threat facing humanity…” and calls on nurses to continue their work of promoting health by integrating climate science into community and patient education, promoting sustainable practice, and advancing health policy. (American Nurses Enterprises , 2023). So, where do we start? Global health is a huge undertaking, but today we can commit to the following actions to support each person in our community who will be affected by climate change.

Community Education
We must educate ourselves and our communities about heat safety, air quality, and emergency preparedness. Patients need to understand how climate affects their health, how to stay cool, and how to store medications safely. We also need to understand how to best prepare outdoor workers for their sustained exposure to heat through early recognition of HRI, implementing cooling breaks, using proper gear, and ensuring adequate fluid intake. (Occupational Safety and Health Administration , 2025)

Promoting Systemic Support
Nurses are treating more patients with heat stroke, dehydration, asthma, and anxiety linked to extreme weather. We are also among those who respond during evacuations, natural disasters, and shelter operations. This means that we need support through education, disaster training, resources, and policies that recognize these climate-driven health threats.

Advocacy and Policy
Nurses can advocate for sustainable healthcare systems, green infrastructure, and workplace protections for all communities, including heat-safety education and cooling breaks. Our insights into holistic healthcare, the trust we maintain with the communities we serve, and our understanding of healthcare make us essential voices in shaping local, state, and national policy.

Climate change isn’t just an environmental issue; it’s a community issue, and therefore, it’s a nursing issue. It affects every determinant of health and our most basic needs: air, water, food, shelter, and safety. As nurses, we are called not only to treat illness but to protect health. That means stepping up, speaking out, and leading the way toward a healthier, more resilient future.

Access climate eduation resources here! If you would like to contribute to the resources provided on this page, please reach out to Elle Buck at ebuck@virginianurses.org.

Childhood lead poisoning is considered the most preventable environmental disease among young children. Many children don’t show any signs that they are sick, but thousands of children are still impacted by lead exposure every single year. In 2024, there were 1,500 confirmed childhood lead exposure cases in Virginia, and likely many more that went undetected.

There is No Safe Lead Level
Lead is a potent neurotoxin, and even a small amount of lead can be harmful. Lead exposure in young children can lead to:

• Brain and nervous system damage
• Slowed growth and development
• Learning and behavior problems
• Hearing and speech problems

Lead can also negatively impact children many years after they are exposed. Some of the long-term impacts of lead exposure include:

• Reduced IQ
• Attention-related behavioral problems
• Decreased cognitive performance
• Increased aggressive behavior

Sources of Lead Exposure
There are many different sources of lead exposure. Some of the most common are:

• Chipping and peeling paint (in homes built before 1978)
• Water from pipes and plumbing containing lead
• Contaminated soil
• Imported or antique toys and jewelry
• Imported spices and candies
• Ceramics and pottery
• Traditional folk medicines and cosmetics
• Family member occupations or hobbies (including construction, battery recycling, working at a shooting range, recycling scrap metal or electronics, welding or soldering, making stained glass)

Provider Role in Childhood Lead Poisoning Prevention and Case Management
Healthcare providers play a critical role in identifying children exposed to lead and the follow-up and case management of lead exposed children. Healthcare providers are primarily responsible for: 

• Screening high risk children for lead exposure at ages 1 and 2, or up to age 6 if they have never received a blood lead test.
• Scheduling confirmatory and follow-up blood lead tests.
  • Refer to the Virginia Blood Lead Testing and Case Management Guidelines for blood lead testing schedules and reporting guidance.
  • Confirmed BLL ≥ CDC’s blood lead reference value: A child with one venous blood test ≥ 3.5 μg/dL or two capillary blood tests ≥ 3.5 μg/dL drawn within 12 weeks of each other. The second capillary test must occur at least 48 hours after the initial capillary test.
• Providing lead poisoning education materials to the family, including information on sources of lead, exposure prevention, and nutrition.

Virginia Blood Lead Testing Criteria
The only sure way to know if a child has been exposed to lead is with a blood lead test.

Per 12VAC5-90-215 of the Code of Virginia, Virginia is a targeted blood lead testing state. Children that fall under a specified set of risk criteria should get a blood lead test.

Children in any of the following risk categories should have their blood tested at 12 and 24 months:

1. The child is eligible for or receiving benefits from Medicaid or the Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
2. The child is living in or regularly visiting a house, apartment, dwelling, structure, or childcare facility built before 1960
3. The child is living in or regularly visiting a house, apartment, dwelling, structure, or childcare facility built before 1978 that has (i) peeling or chipping paint or (ii) recent (within the last six months) ongoing or planned renovations
4. The child is living in or regularly visiting a house, apartment, dwelling, or other structure in which one or more persons have blood lead testing yielding evidence of lead exposure
5. The child is living with an adult whose job, hobby, or other activity involves exposure to lead
6. The child is living near an active lead smelter, battery recycling plant, or other industry likely to release lead
7. The child's parent, guardian, or other person standing in loco parentis requests the child's blood be tested due to any suspected exposure
8. The child is a recent refugee or immigrant or is adopted from outside of the United States

A child up to 72 months in those categories who hasn't previously been tested (or who has experienced a change that has resulted in an increased risk of exposure to lead), or the sibling of a child who has an elevated blood lead level should also be tested.

Prevention Guidance for Families
The good news is, there are some simple and effective strategies that parents and caregivers can implement to reduce the risk of lead exposure at home.

• Wash children’s hands and toys often. Frequently washing hands and toys can reduce the risk of a child ingesting any lead dust on their hands or toys during play.
• Wet-wipe and wet-mop around windowsills, doors, and entryways. Cleaning these areas frequently can reduce a child’s risk of contact with lead dust.
• Do not let children play in bare soil. If they do, immediately wash their hands and clothes. Children may accidentally ingest or inhale lead dust or lead based paint particles from contaminated soil.
• Run water for 60 seconds before use, and cook with cold water only. Hot water is more corrosive than cold water. Run water before use to flush out the water that has been sitting stagnant in the pipes.
• Cook nutrient dense meals, high in iron, calcium, and vitamin C. A healthy diet can prevent lead from being absorbed in the body.

Additional Resources
Guidance Documents

• Virginia Blood Lead Testing and Case Management Guidelines
• Medical Case Management of Childhood Blood Lead Levels

Additional Education

• VDH | Virginia Childhood Lead Poisoning Prevention Program educational materials
• CDC | Childhood lead poisoning prevention communication resources
• PEHSU | Children’s Health Issue: Lead
• AAP | Lead
• ACOG | Lead Screening During Pregnancy and Lactation

Magnet Designations & Redesignations

UVA Health University Medical Center
“UVA Health University Medical Center has again earned Magnet® recognition — the highest national honor for nursing practice — from the American Nurses Credentialing Center for delivering high-quality, collaborative and innovative care. Fewer than 10% of U.S. hospitals have received Magnet recognition.

“This is a well-earned, well-deserved honor for our nursing team at UVA Health University Medical Center,” said Mitchell H. Rosner, MD, acting executive vice president for health affairs at the University of Virginia. “In a comprehensive fashion, our nurses demonstrated the high standards they consistently and tirelessly uphold in serving our patients.” Read the full article.

VCU Medical Center
“For the fifth time, VCU Medical Center has scored the highest and most prestigious international credential a health care organization can achieve by being re-designated as a Magnet® hospital by the American Nurses Credentialing Center (ANCC). Considered the “gold standard” for nurses, the ANCC recognizes the medical center for its exceptional patient care and nursing practices.

“This is the fifth consecutive designation and reflects almost 20 years of excellence and a continued commitment to safe, high-quality care, not just at VCU Medical Center, but across our entire health system,” said Jim Willis, interim president of VCU Medical Center. “This achievement is a testament to our incredible team members whose expertise, talent and compassion are undeniable.” Read the full article.

7 VNA Members Inducted as Fellows of the American Academy of Nursing

The Virginia Nurses Association (VNA) is thrilled to share that seven VNA members have been selected as Fellows of the American Academy of Nursing (FAAN), including VNA’s Board Vice President, Dr. Jennifer Shepherd, DNP, MHA, RN, NEA-BC, NPD-BC. The Academy is a policy organization and an honorific society that recognizes nursing's most accomplished leaders in policy, research, practice, administration, and academia to advance equitable solutions to the nation’s most complex health care challenges.

Academy Fellows hold a wide variety of influential roles in health care and induction into the Fellowship represents more than recognition of one's accomplishments within the nursing profession. Fellows contribute their collective expertise to the Academy, engaging with health leaders nationally and globally to improve health and achieve health equity by impacting policy through nursing leadership, innovation, and science. Congratulations to you all!

VNA Member Virginia Inductees 

• Jeannie Corey, DNP, RN, NEA-BC, - James Madison University School of Nursing 
• Kimberly Elgin, DNP, APRN, ACNS-BC, PCCN, CMSRN, FCNS - University of Virginia Health 

VNA Member Gem Priddy Elected to ANA Committee on Nominations

VNA’s Hampton Roads Chapter President Catherine Paler Appointed to the Virginia Board of Nursing

DNP, Amy Johnson, Receives 2025 American Association of Nurse Practitioners Award for VA

Insights from NSO, a VNA Personal Benefits Partner. Visit their website at https://www.nso.com/  

A regulatory board complaint may be filed against a nurse practitioner (NP) by a patient, colleague, employer, and/or a regulatory agency, such as the State Department of Health. Complaints are subsequently investigated by the State Board of Nursing (SBON) in order to ensure that licensed NPs are practicing safely, professionally, and ethically. SBON investigations may lead to outcomes ranging from no action against the NP to revocation of the NP's license to practice.

Summary
This case involves a nurse practitioner (NP) employed by a pediatric office practice who had been working as a registered nurse (RN) for seven years before becoming an NP. She had been working as an NP for 14 years at the time of the incident.

The patient was a 10-month-old female who had been seen at the pediatric practice by our insured NP on at least once occasion before this office visit. On the day of the incident, the patient was brought in by her mother to be seen for what she described as a "bad cough." The mother explained that the patient had been experiencing fever, wheezing, and coughing with congestion and phlegm in her chest and nose for the past few days. The mother said that, in the past day, these symptoms had gotten worse.

The NP assessed the baby and diagnosed the patient with bronchitis. The NP ordered a breathing treatment with a nebulizer. The NP did not chart that the infant was wheezing, however, and later said that she would only have ordered a breathing treatment for the patient because the infant was wheezing. The NP also prescribed an albuterol inhaler, and amoxicillin and advised the mother to continue giving acetaminophen and ibuprofen until the infant's fever breaks. While the NP believed the infant to be suffering from bronchitis, she prescribed an antibiotic to prevent a possible bacterial infection. A medical assistant gave the infant the breathing treatment in the office and showed the mother how to use the nebulizer machine. The mother said the NP briefly came into the room after the breathing treatment and seemed satisfied with the results but did not provide any additional information or instructions to the mother. The NP admitted that the practice was busy that day and she did not chart the results of this post-treatment assessment of the infant after she received her breathing treatment in the office.

After the appointment, the infant and her mother returned home. There were multiple calls made by the mother to the NP and office staff after the office visit that day. The mother was repeatedly told by the office staff to "wait for the meds to take effect." She was not advised to seek care at the emergency department if symptoms continued or worsened. Later that night, while the infant was sleeping, she began choking, and her lips turned blue. Her mother called 911, and CPR was started on the infant. The infant was transported to the hospital by ambulance in full cardiac arrest. The infant remained in the hospital for two days. Sadly, the infant was declared brain dead. The death certificate stated the cause of death was respiratory syncytial virus (RSV) and anoxic brain injury.

The State Board of Nursing was informed of this case as a result of a malpractice lawsuit in which the NP settled the case with the family for an undisclosed amount.

Risk Management Comments
The State Board of Nursing (SBON) investigated this case based on the allegations against the NP of unprofessional conduct and gross negligence in the treatment and care provided to the infant. The SBON found that while the healthcare information record indicated the chief complaint as fever and wheezing, the NP noted all categories as "within normal limits" under the exam portion of the chart. Further, there were no abnormal respiratory exam findings noted; the NP did not document the infant's heartrate, her respiratory rate or her oxygen saturation level in the chart.

The SBON's investigation focused on "gross negligence" because of the extreme departure from the standard of care. In light of these allegations, the SBON reviewed the NP's actions against what actions would have ordinarily been taken by a competent NP under similar circumstances. The SBON opined that there was a repeated failure to exercise ordinary care and take standard precautions which the NP knew, or should have known, could have jeopardized the patient's health or life. Specifically, the SBON noted the NP did not meet treatment and care standards by:

• Failing to perform a complete respiratory assessment

• Failing to document a complete respiratory assessment

• Failing to chart the patient's heartrate in the healthcare information record

• Failing to chart the patient's respiratory rate in the healthcare information record

• Failing to chart the patient's oxygen saturation level in the healthcare information record

• Failing to chart that the patient was wheezing in the healthcare information record

• Failing to chart the results of a post-treatment assessment of the patient after she received her breathing treatment in the office

Resolution
After reviewing the evidence, including the NP's testimony, the SBON recommended disciplinary action against the NP. The SBON determined that, while this was an isolated incident in the NP's career, the NP's conduct was egregious as RSV is a common, and very contagious, virus that infects the respiratory tract of most children before their second birthday. It can be more serious in young infants, even life threatening. The SBON revoked the NP's license. However, the revocation was stayed, and the NP was placed on probation for three years during which time the following conditions had to be met:

• Pay a $10,000 civil penalty

• Refrain from taking a position with direct patient care for six months

• Submit performance evaluations

• Be supervised during employment

• Complete approved continuing education courses

• Participate in ongoing counseling, and

• Submit written reports verifying compliance with the Board's actions.

The disciplinary action was reported to the National Practitioner Data Bank.

This Board matter took five years to resolve, and the total incurred expenses to defend the NP in this investigation totaled just over $19,000. (Note: Monetary amounts represent the legal expenses paid solely on behalf of the insured nurse practitioner.)

Risk Control Recommendations

• Perform a patient clinical assessment and physical examination to evaluate and address the specific clinical issues under consideration.

• Utilize available clinical practice guidelines or protocols when establishing a diagnosis and providing treatment, documenting the justification for deviations from guidelines or protocols.

• Consider potential unintended consequences of pursuing a specific diagnosis, including:

  • Are factors present that do not align with the diagnosis?

  • Are there symptoms that are inconsistent with the current diagnosis?

  • Why are these symptoms not indicative of another diagnosis?

  • Is there a life-threatening condition with similar symptoms that hasn't been considered?

• Complete regular training and continuing education to serve pediatric patients, particularly nurse practitioners who work in settings that serve pediatric patients and maintain awareness of and access to organizational/facility pediatric protocols and guidance.

• Refer to RSV resources such as those on the National Association of Pediatric Nurse Practitioners (NAPNAP) website including NAPNAP's position statement on the RSV crisis. NAPNAP has created a series of micro-learning videos, each just five minutes, to break down a specific clinical aspect of RSV.

• Refer to CDC resources for healthcare providers on RSV Immunizations. CDC resources also includes information for RSV Prevention, FAQs, and an Immunization Information Statement.

• Diligently screen for, monitor and/or treat diseases known to have high morbidity and mortality, such as RSV, for infants and children under 5 years of age.

• Document the decision-making process that led to the diagnosis and treatment plan.

• Document all patient-related discussions, consultations, clinical information and actions taken, including any treatment orders that are provided.

• Discuss clinical findings, diagnostic test/procedure results, consultant findings, diagnosis, the proposed treatment plan and reasonable expectations for the desired outcome with patients, parents and/or guardians, in order to ensure their understanding of their care or treatment responsibilities. Document this process, noting the patient's response.

• Never testify in a deposition without first consulting your insurer or legal counsel. Contact your attorney or designated professional before responding to calls, emails, or requests for documents from any other party.

Resources

• CNA and NSO. 2022. Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition. 

• National Institutes of Health (NIH). 2022. Mortality Among US Infants and Children Under 5 Years of Age with Respiratory Syncytial Virus and Bronchiolitis: A Systematic Literature Review. 

• National Institutes of Health (NIH). 2017. Risk of mortality associated with respiratory syncytial virus and influenza infection in adults. 

• U.S. Centers for Disease Control and Prevention (CDC). 

• National Association of Pediatric Nurse Practitioners (NAPNAP). 

Disclaimers
These case scenarios are illustrations of actual claims that were managed by the CNA insurance companies. However, every claim arises out of its own unique set of facts which must be considered within the context of applicable state and federal laws and regulations, as well as the specific terms, conditions and exclusions of each insurance policy, their forms, and optional coverages. The information contained herein is not intended to establish any standard of care, serve as professional advice or address the circumstances of any specific entity. These statements do not constitute a risk management directive from CNA. No organization or individual should act upon this information without appropriate professional advice, including advice of legal counsel, given after a thorough examination of the individual situation, encompassing a review of relevant facts, laws and regulations. CNA assumes no responsibility for the consequences of the use or nonuse of this information.

One or more of the CNA companies provide the products and/or services described. The information is intended to present a general overview for illustrative purposes only. It is not intended to constitute a binding contract. Please remember that only the relevant insurance policy can provide the actual terms, coverages, amounts, conditions and exclusions for an insured. All products and services may not be available in all states and may be subject to change without notice. "CNA" is a registered trademark of CNA Financial Corporation. Certain CNA Financial Corporation subsidiaries use the "CNA" service mark in connection with insurance underwriting and claims activities. Copyright © 2024 CNA. All rights reserved.

This publication is intended to inform Affinity Insurance Services, Inc., customers of potential liability in their practice. This information is provided for general informational purposes only and is not intended to provide individualized guidance. All descriptions, summaries or highlights of coverage are for general informational purposes only and do not amend, alter or modify the actual terms or conditions of any insurance policy. Coverage is governed only by the terms and conditions of the relevant policy. Any references to non-Aon, AIS, NSO, HPSO websites are provided solely for convenience, and Aon, AIS, NSO and HPSO disclaims any responsibility with respect to such websites. This information is not intended to offer legal advice or to establish appropriate or acceptable standards of professional conduct. Readers should consult with a lawyer if they have specific concerns. Neither Affinity Insurance Services, Inc., HPSO, nor CNA assumes any liability for how this information is applied in practice or for the accuracy of this information.

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