The North Dakota Nurse
Table of Contents
President's Feature Why I Love Being a North Dakota Nurse: A Personal Reflection NDNA Board of Directors 2025
Feature Article of the Quarter Heartview Foundation
Membership Welcome New Members This Quarter Thank You Student Subscribers Membership Info: Premier and Standard Memberships
Advocacy North Dakota Nurses Association Secures Key Legislative Wins for Healthcare Professionals
Awards and Recognitions NDNA Awards and Recognitions - Nominate Your Colleague During Nurses Week!
Articles Three Words of Wisdom How to Become a Forensic Nurse Growth Mindset
Nurses Week Celebrating Nurses Week 2025: The Power of Nurses You Make a Difference! From NDNA's Director of Education & Practice: When the Moment Chooses You: A Nurse Leader’s Journey to Finding Her Voice and Unleashing Her Impact
Sponsorships
NSO Article Nurse Spotlight: Healthcare Documentation
Interprofessional Conference "Strengthening Healthcare Through Interprofessional Collaboration"
Collaboration 2025 GOLDEN GRAINS Award
Annual Meeting & Fall Conference - Early Registration is OPEN!
Honor Guard Nurse Honor Guard Red River Valley
Articles Enhancing Communication with Native American Elders for Nurses Recipe for Success: Multi-Site Research in a Rural Health System Read Back and Verify (RBAV) Combine technology and practical interventions to reduce burnout. Purpose as a Business Game-Changer Code Blue Simulation Literature Review Recognizing When Your Loved One Needs In-Home Care
Join NDNA Join ANA & NDNA
April 2025

The North Dakota Nurses Association (NDNA) is the only professional organization representing all nurses in North Dakota. The mission of NDNA is to advance the nursing profession by promoting the professional development of nurses, fostering high standards of nursing practice, promoting the safety and well-being of nurses in the workplace, and advocating on health care issues affecting nurses and the public.

President's Feature
Why I Love Being a North Dakota Nurse: A Personal Reflection
Dr. Beth Sanford, DNP, MSN, RN, ACN, CLC, LNC - NDNA President

As the President of the North Dakota Nurses Association (NDNA), I have the honor of representing the voices of nurses across our state. 

But today, I want to take a step back and share with you why I love being a North Dakota nurse, both in the field and in my leadership role. The connections we foster, the impact we have on our communities, and the incredible strength of our nursing community make this profession unlike any other.

A Deep-Rooted Connection to Community

Nursing is more than just a job to me---it's a calling. It's about being a part of something bigger, something that shapes the lives of individuals and entire communities. In North Dakota, where our communities are close-knit and strong, nurses play a pivotal role. We not only care for our patients but also serve as community advocates, educators, and healers. That's what makes being a nurse in North Dakota so special: the relationships we build with patients and colleagues are lasting. Wherever we practice the art and science of nursing, the bonds we form are what drive me to continue pushing forward.

A Personal Reminder: My Mother's Health

These past few months, my mother's health has been declining, and she has been hospitalized several times. It has been a vivid reminder of just how essential nurses are to the healthcare system, especially in rural North Dakota. My mother's care took place at McKenzie Health in Watford City and eventually Sanford Health in Bismarck. Throughout her hospitalizations, I witnessed firsthand the incredible dedication of the nurses who cared for her. It reminded me not only of their skill and professionalism but also of the compassion they bring to their work. The nurses were there every step of the way, advocating for her needs and ensuring she received the best care possible. And I remember one internationally educated nurse, Brian from McKenzie Health, who showed me compassion and kindness when I was overwhelmed seeing my loved one in a compromised state. In that moment, the roles were switched, and I was on the receiving end of true nursing care.

This experience also highlighted the challenges we face in our state, particularly in rural areas where the demand for healthcare services is often high, and resources can be stretched. It was clear to me that without our nurses, especially in these critical areas, our healthcare system would be even more strained. This moment reinforced my commitment to ensuring that nurses in North Dakota are supported, recognized, and empowered to continue doing the incredible work they do.

Advocacy and Change in Our Profession

My work with the North Dakota Nurses Association has allowed me to witness firsthand the incredible impact nurses have on healthcare policy. From advocating for better working conditions with supporting the Workplace Violence Bill to expanding tuition assistance and local forgiveness for MSNs to addressing environmental determinants of health in advocating for addressing vitamin D deficiency, NDNA gives nurses a powerful voice in shaping healthcare. As I shared in my interview with Barry Franklin, Digital Publisher for Sechel Ventures, the opportunities for nurses in North Dakota to be part of the healthcare solution are unique and essential in creating the change our profession needs to thrive.

In the interview, I spoke about how North Dakota nurses are vital to the healthcare system, especially given the challenges we face in a largely rural state. By working together through organizations like NDNA, we can not only address these challenges but also promote a culture of health and wellness that goes beyond facilities to our communities. Caring for our communities in the spirit of collaboration is key to our success. You can read the full article here: Digital Publication

The Power of Digital and Social Media in Nursing

We live in an era where digital platforms and social media are not just tools for communication, they're also platforms for advocacy, education, and connection. As a nurse, I love how we can use social media to share our stories, raise awareness about important issues, and empower fellow nurses. We can also use social media to attract nurses to the state.

One of the things that excites me about the future of North Dakota nursing is the opportunity to connect and share what we love about North Dakota nursing through these platforms. In my recent podcast interview on The Conversing Nurse, I had the chance to speak with host Michelle Harris about vitamin D deficiency and give a shout-out to North Dakota nursing. Whether it's sharing patient stories (with appropriate privacy considerations, of course) or supporting one another in our personal and professional growth, the digital landscape has transformed the way we engage as a nursing community. You can listen to the full podcast here: The Conversing Nurse Podcast.

Why It's an Honor to Lead North Dakota's Nurses

As I reflect on my journey, I am reminded of how truly privileged I am to be in this role. As the President of NDNA, I've seen firsthand the strength, resilience, and passion of nurses across our state. I'm constantly inspired by the dedication and compassion that my fellow nurses bring to their work every single day. Whether we are working in long-term care facilities, urban hospitals, rural critical access hospitals, school health offices, or private clinics, the impact we make is immeasurable.

Being a nurse in North Dakota means being part of a community that supports and uplifts each other. The collaborative spirit that defines our nursing culture is something I hold dear, and I'm proud to advocate for our profession both locally and nationally. From discussing policy changes to encouraging new nurses to enter the field to mentoring a nursing student, I am committed to ensuring that nursing continues to grow and evolve under the blue prairie skies.

A Call to Action: Join Me in Celebrating North Dakota Nursing

As we look to the future, I encourage all of our members to continue to be vocal advocates for North Dakota nursing. Whether through social media, advocacy efforts, or personal stories, we all have a role in shaping the future of nursing in North Dakota. Together, we can continue to make a difference, one patient, one community at a time.

I invite you to join in promoting your nursing passions, facilities, and North Dakota nursing on social media and tag #NDNA. Also, follow the NDNA where we post updates, stories, and resources to help you stay connected to the nursing community. Let's keep the conversation going!

Like us on Facebook: HERE

Follow us on LinkedIn: HERE

Check out the NDNA website: HERE

Thank you for allowing me the honor of serving you. Let's continue to work together to elevate nursing in North Dakota!

Dr. Beth Sanford

DNP, MSN, RN, ACN, CLC, LNC
President, North Dakota Nurses Association

NDNA Board of Directors 2025

President -  Beth Sanford, DNP, RN

President-Elect - Shila Blend, PhD, MSN, RN-BC

Vice President of Finance - Richelle Johnson, DNP, RN

Director of Membership -  Amy S. Lee, DNP, RN, CNE

Director of Education and Practice - Ashley DeMakis, MSN, RN

Director of Advocacy - Penny Briese, PhD, RN, CHSE

Director at Large - Sarita Wanner, BSN, RN

Affiliate Member Representative (LPN) - OPEN POSITION

NDNA Staff:

Executive Director - Sherri Miller, BS, BSN, RN

Feature Article of the Quarter
Heartview Foundation
Building Trust Through Compassionate Care

105,007 people in the United States died in 2023 from drug overdoses, the equivalent of a commercial plane crashing every single day. In North Dakota, approximately one in five people has a substance use disorder, making it essential for nurses in every healthcare setting- whether in nursing homes, clinics, hospitals, or family medicine- to understand addiction and provide compassionate care.

Many individuals with a substance use treatment disorder have had negative experiences with the healthcare system, which makes them less likely to seek treatment for SUD or even other medical conditions such as diabetes or heart conditions. Healthcare staff may see SUD patients as "drug-seeking" and dismiss real pain and conditions that need treatment.

This cycle of mistrust can be devastating. When individuals with SUD feel unheard or mistreated, they are less likely to engage with healthcare providers, worsening both their addiction and overall health. Nurses, as frontline caregivers, have a unique opportunity to break this cycle by providing compassionate, informed, and proactive care.

Building Trust Through Compassionate Care.

Substance use disorder is a treatable medical condition, not a moral failing. 

Nurses, through their daily interactions with patients have the power to change the stigma around addiction. Substance use disorder is a real medical condition that is treatable, just like any other medical condition. Addiction causes real, measurable changes in brain function, particularly in areas that control judgment, impulse regulation, and decision-making. These neurological changes can make it extremely difficult for individuals to "just quit," even when they recognize the harm their substance use is causing.

Patients with SUD may present at a clinic, hospital, or emergency department with legitimate medical needs unrelated to their substance use. They may be experiencing chronic pain, infections, heart disease, or other serious conditions that deserve the same level of compassionate, evidence-based care as any other patient.

However, bias within the healthcare system sometimes results in assumptions that patients with SUD are exaggerating pain or seeking drugs, leading to inadequate treatment. This can be particularly harmful in cases where a patient genuinely requires pain management or urgent medical intervention. When nurses take the time to listen, assess, and advocate for their patients, they can break this cycle of mistrust and ensure that individuals with SUD receive the care they deserve.

Navigating Treatment

Seeking substance use treatment can feel overwhelming for both patients and healthcare providers. Concerns about cost, wait times, and navigating the treatment process often create barriers to care.

The Heartview Foundation, established in 1964, has been a leader in drug and alcohol treatment, serving over 31,000 patients and their families. With 61 residential treatment beds, outpatient services, and medications for addiction treatment, Heartview provides comprehensive care.

Across its Bismarck, Cando, and Dickinson locations, more than 600 individuals are enrolled in residential, outpatient, or medications for addiction treatment on any given day.

To make access to treatment as seamless as possible, Heartview follows a "one-stop shop" approach. Nurses, medical professionals, and individuals seeking treatment can call Heartview's intake office at 701-751-6129, where dedicated staff handle the next steps. For those without insurance or facing high deductibles, Heartview's specialists assist with enrollment in Medicaid Expansion or the North Dakota SUD voucher. Additionally, counselors work closely with each patient to determine the most appropriate level of care, while case managers provide support for sober living, transportation, and employment.

In Bismarck, Heartview has partnered with local clinics to create a rapid-response program for patients in need of immediate SUD treatment. If a clinic identifies a patient requiring help, they can call Heartview, and a peer support specialist will either come to the clinic in person or connect with the patient remotely to guide them through the process. If a Bismarck-Mandan healthcare organization is interested in connecting with this program, they can contact Cathy at 701-751-5797.

Beyond clinical settings, Heartview is also reaching vulnerable populations directly. In collaboration with Ministry on the Margins and Bismarck-Burleigh Public Health, Heartview has launched a street outreach team to engage with homeless individuals and connect them to vital services.

Heartview's services are available to anyone in North Dakota, regardless of location. In 2023 alone, patients came from 47 of the state's 53 counties, demonstrating the foundation's extensive reach and commitment to accessible care.

For anyone struggling with substance use or for healthcare providers seeking support for their patients, Heartview offers a direct, compassionate path to treatment and recovery.

Membership
Welcome New Members This Quarter
January 7th - April 1st, 2025

Amanda Landphere - Minot
Joelle Keepseagle - Fort Yates
Mindy Becker - Bismarck
Tracy Larson - Willow City
John Kent - West Fargo
Jillian Grey - Fargo
Christina Cannon - Mandan
Joylyn Anderson - West Fargo
Oluwafunmilayo Adekiitan - Fargo
Davida Wreah - Horace
Andrew Hidalgo - Fargo
Jose Maon - Fargo
Danica Calderon - Fargo
Cassidy Bjerke - Fargo
Benjamin Anderson - Minot
Carrie Wolff - Bismarck

Timothy Etonde - Fargo
Haleigh Wahl - Bismarck
Alycia Coutts - Minot
Nicole Schlenk - Grand Forks
Andrea Bushaw - Manvel
Ferlice Evenson - Mandan
Victoria Weinand - Mandan
Allie Gowan - Manvel
Felisa Roselle Barrientos - Williston
Czarina Canicula - Mandan
Jessa Rafferty - Minot
Jennica Torres - Fargo
Beverly Kirkland - Watford City
Maddie Hibma - West Fargo
Amber Rice - Minot
Stephanie Kritzberger - West Fargo
Paola Lopez - Williston

Thank You Student Subscribers

Brooklynne Cook - Fargo
Sarah Maju - Fargo
Sayee Zulu - Fargo
Keiana Halstad - Grand Forks
Jamesetta Miller - Fargo
Spencer Lade - Grand Forks
Edmore Muzirwa - Fargo
Lauryn Larson - Grand Forks
Roxie Volesky - Bismarck
Tabatha Mahlstedt - Enderlin
Terrence Seneh - Fargo
Taqweisha Jones - Grand Forks
Skya Brandon - Hatton
Catherine Clark - Minot
Aprill Lawrence - Minot
Mariah Anhorn - Grand Forks
Esther Simon - Fargo
Tara Stevens - Fargo
Samantha Prentice - Devils Lake
Lacey Knight - New Salem
Haley  Jones - Antler
Rebecca Kubler - Minot

Tanuja Kafle - Fargo
Sushmita Shrestha - Fargo
Amy Martinez - Fargo
Mellisa Phillips - Mandan
Hannah Hagen - Lansford
Elizabeth Danula - Mekinock
Leslie Castellano Gonzalez - Minot Afb
Peaches Woyeh - West Fargo
Elizabeth Totaye - Fargo
Dolapo Raji - Grand Forks
Gabriel Neufville - West Fargo
Valerie Gonzalez - Fargo
Sharlynn Knutson - Fargo
Jennifer Lefforge - Ellendale
Bento Reeves - Fargo
Bethany Hansey - West Fargo
Mei Li Weil - Park River
Audra Marlette-Schwendemann -Mapleton
Princess    Smith - Fargo
Christopher Denten - Dickinson
Shelley Wittrock - West Fargo
Tamesha Denbleyker - Minot Afb
Breana Buringrud - Fargo

Membership Info: Premier and Standard Memberships

Advocacy
North Dakota Nurses Association Secures Key Legislative Wins for Healthcare Professionals

The North Dakota Nurses Association has made significant strides this legislative session, successfully advancing three key bills: HB 1341, SB 2221, and HCR 3014. Through dedicated lobbying, testimony, and strategic leadership, NDNA's efforts have ensured stronger protections for nurses, improvements in workforce, and increased awareness of vitamin D's role in health.

The North Dakota Nurses Association is proud to announce the passage and signing of House Bill 1341 (HB 1341)---a landmark piece of legislation aimed at protecting healthcare workers from assault. Signed into law by Governor Armstrong on April 18, 2025, this bill marks a critical step in reinforcing workplace safety across hospital settings.

HB 1341 ensures that penalties for assaulting healthcare professionals extend beyond emergency departments, offering equal protections to all hospital staff engaged in essential care.

 As workplace violence in healthcare settings continues to rise, this legislation underscores the need to safeguard those who dedicate their lives to patient care. While it is understood that violence can occur in any and all healthcare settings, HB 1341 is a vital step forward in addressing this growing concern. By acknowledging the risks healthcare professionals face, this law fosters a safer environment---one where nurses and medical staff can focus on delivering quality care without fear of violence or harm.

The passage of HB 1341 would not have been possible without the tireless efforts of key healthcare advocates. NDNA extends its heartfelt congratulations to the North Dakota Medical Association (NDMA), the North Dakota Hospital Association (NDHA), Sanford Health, the Nursing Students' Association of North Dakota (NSAND), and Altru Health System, along with many individuals and organizations committed to advancing healthcare worker protections.

This achievement highlights the power of collaboration, advocacy, and a shared commitment to the well-being of those who serve on the front lines of healthcare.

NDNA applauds the North Dakota Legislature and Governor Armstrong for recognizing the importance of healthcare worker safety. This legislation is more than just a policy---it's a statement that those who provide essential care deserve to work in environments free from violence and fear.

SB 2221: Supporting Nursing Workforce Recruitment and Retention

Senate Bill 2221 (SB 2221) was also signed into law by Governor Armstrong on April 18, 2025. This legislation, championed by nurse legislator and dedicated advocate Senator Kristin Roers, BSN, MS, RN, CPPS, marks a transformative investment in the future of nursing in North Dakota.

SB 2221 is designed to address critical challenges in nursing education by providing state-funded tuition scholarships and loan reimbursement for nurses pursuing Master's in Nursing (MSN) degrees. This initiative is a game-changer in strengthening healthcare systems and ensuring the sustainability of a skilled nursing workforce for years to come.

Key benefits of SB 2221 include:

  • Broadening access to advanced nursing education across North Dakota.

  • Addressing faculty shortages by creating a pipeline of highly skilled nursing educators.

  • Encouraging career growth and professional advancement within the nursing workforce.

  • Providing financial relief for nurses committed to serving communities throughout the state.

Dr. Beth Sanford, President of NDNA, Executive Director Sherri Miller, and the NDNA Board of Directors, commend the passage of SB 2221 as a powerful statement of support for nursing professionals. The NDNA extends heartfelt gratitude to Senator Kristin Roers for her unwavering leadership, as well as to the North Dakota Legislature and Governor Armstrong for their commitment to advancing nursing education.

This milestone not only strengthens the pathway for future nurse educators but also ensures a lasting impact on patient care and healthcare excellence in North Dakota.

As NDNA continues to advocate for nursing workforce development and education, SB 2221 stands as a testament to the progress that is possible when healthcare leaders, policymakers, and dedicated nursing professionals come together to create meaningful change.

HCR 3014: Raising Awareness of Vitamin D and Public Health

HCR 3014, the vitamin D bill, promotes education and awareness surrounding the role of vitamin D in overall health and disease prevention. NDNA President Dr. Beth Sanford led efforts in championing this resolution, recognizing the importance of advocating on the benefits of vitamin D.

The bill is sponsored by the incredible Representative Karen Rohr, also a PhD, NP, who has been a steadfast advocate for improving public health in North Dakota. HCR 3014 urges public health, healthcare systems, and providers to prioritize primary prevention in addressing vitamin D deficiency. This resolution champions multifaceted precision public health and medicine approaches to tackle this important issue.

NDNA advocated for HCR 3014 because, as Dr. Sanford stated:

"Why put forth a concurrent resolution? Increasing awareness of vitamin D deficiency can enhance public health and educate both the public and healthcare professionals. Additionally, research indicates that vitamin D deficiency is closely linked to higher healthcare costs. As early as the 2000s, the Veterans Administration identified that addressing vitamin D deficiency reduced inpatient healthcare costs by 39-50% (Peiris et al., 2008; Bailey et al., 2012). Therefore, tackling vitamin D deficiency has the potential to significantly lower state Medicaid and NDPERS costs, preserve healthcare funding for North Dakotans, and reduce human suffering."

Through testimony and lobbying, Dr. Sanford and Sherri Miller worked to highlight the economic and health benefits of addressing vitamin D deficiency statewide. NDNA encourages healthcare professionals and policymakers to support ongoing awareness and education efforts related to vitamin D and preventive care.

Read the full resolution here: HCR 3014

Huge thanks to Dr. Sanford and Representative Rohr for their dedication to improving the health and well-being of North Dakotans! Let's get more sunshine and Vitamin D awareness!

NDNA's Commitment to Advocacy and Progress

NDNA's efforts this session highlights our commitment to nursing advocacy. Through testimony, strategic lobbying, and leadership collaboration, we felt we've reinforced the importance of protecting healthcare workers, advancing workforce policies, and promoting public health awareness. These victories not only benefit nurses but also strengthen North Dakota's healthcare system as a whole.

These legislative wins serve as a reminder that nurses' voices matter---and they can drive meaningful change. As the session winds down, NDNA would like to thank everyone who attended our biweekly nursing calls. Your engagement and collaboration make a difference, and we know that as nurses, we all need to work together!

Awards and Recognitions
NDNA Awards and Recognitions - Nominate Your Colleague During Nurses Week!

Articles
Three Words of Wisdom
Kent Julian, CSP

Success is often defined by things like position, prestige, and prosperity. Yet many people who achieve such status eventually ask: Is this all there is?

While there is nothing wrong with these things, the truth is they do not make for a good definition of success. Moreover, how disappointing it must be for people to invest all their time and energy to achieve these results only to realize later on that their ladder of success has been leaning up against the wrong wall the entire time.

With this in mind, I want to share three words of wisdom about success. To be clear, this article doesn’t attempt to define success (it’s much too short for that). Instead, it shares three attitudes that will make success more possible for you.

Additionally, the ideas you are about to read are not original with me. During my teenage and young-adult years, I was blessed to have a mentor pour into my life. Because of his guidance, I enjoyed what I consider a truly successful life early on, even though by outward appearances I didn’t seem all that successful. Additionally, as I started to experience “upgrades” in areas like position, prestige, and prosperity, I remained grounded in my understanding that these things have little to do with true success. Once again, this is because of the wise counsel I received years earlier.

So here are three words of wisdom from my mentor. I hope they help you experience
true success in your life, relationships, leadership, and career, just as they have for me.

1. BIG Is Little and Little Is BIG 

Everyone wants the big things in life, like meaningful relationships, a great career, and financial success. The secret to experiencing these big things, however, is not found in making massive changes or taking crazy risks. It is found, rather, in getting the little things right day in and day out. This is why my mentor continually encouraged me to get my head “out of the clouds” and to instead focus on taking the right little actions each day. He helped me understand that little steps, taken over an extended period of time, are what would move me closer to my big goals. 

2. Hard Work Beats Talent

“Hard work beats talent every time talent doesn't work hard.” Practically every modern-day athlete utters these words, but I first heard this concept from my mentor when I was facing my first giant-sized goal. I was passionate about basketball and wanted to be a starter for our school's team. There was only one problem. My natural athletic ability didn't really support this goal. My mentor knew how much this goal meant to me, so he challenged me to invest ten times more sweat equity during the offseason than anyone else on the team. Moreover, he helped me understand that even if I didn't accomplish the goal of becoming a starter, I'd still benefit because the lessons I’d learn through the process would be more valuable than the end result. To make a long story short, not only did I start, but I led the team in scoring that next year. But more importantly, my mentor was right—the lessons learned from that experience continue to pay huge dividends in my life and work.

3. Excellence, Not Perfectionism 

The most liberating words of wisdom gained from my mentor is that excellence does not equal perfection. My mentor defined excellence as doing your absolute best with the time and resources you have. He always said, “Once you've accomplished excellence, move on. Don't get stuck in the mud of perfectionism.” As I said, liberating! In conclusion, what is best about these three words of wisdom is the fact that each is doable. No advanced degree or secret knowledge needed. And once you start applying them to your life, you will be well on your way to experiencing a new—and more meaningful—level of success.

How to Become a Forensic Nurse
American Nurses Association

From the ANA Nursing Resources Hub - May, 17 2023

If you're interested in both nursing and the criminal justice system, a career in forensic nursing could be the right fit. As with other nursing specialties, forensic nurse requirements vary, and there are additional steps beyond becoming a registered nurse. You'll usually need a few years of relevant clinical experience. Depending on the opportunities available in your area, you may also need an advanced degree or special forensic nursing certification.

What Is a Forensic Nurse?

A forensic nurse works at the intersection of nursing and the criminal justice system to provide nursing care to victims. Forensic nurses also provide emotional and psychological support, collect evidence, and may perform evaluations of alleged perpetrators when necessary. In cases involving a deceased victim, forensic nurses may work with a coroner to establish the cause of death and to prepare and report statistics.

Forensic nurses are responsible for providing compassionate care for all facets of a victim's well-being. They may even help provide support for families of people targeted in violent crimes.

Forensic nurses commonly see victims of domestic violence or sexual abuse. They may also work in cases regarding child abuse, psychiatric patients, and in situations that don't involve direct patient care, such as determining the cause of death.

Where Do Forensic Nurses Work?

Due to the nature of their work, forensic nurses are found both in hospitals and in environments like legal criminal justice institutions (coroners' offices or prisons), domestic violence centers, and psychiatric facilities. They may even work in response to emergencies such as mass casualty events and natural disasters. Forensic nurses may work in a variety of settings throughout their careers, thanks to the varied competencies required to succeed.

Forensic Nursing Certification, Experience, and Other Requirements

In some states and situations, forensic nurse qualifications may simply include relevant clinical experience as an RN. But forensic nursing certificate courses can help you prepare for the role. These programs typically offer a mix of classroom hours and clinical training and may focus on specific areas of forensic nursing, such as Sexual Assault Nurse Examiner (SANE) certifications.

Some employers may prefer candidates with an advanced degree, such as a Master of Science in Nursing (MSN). If you're equally committed to nursing and the law, some degree programs focus specifically on forensic nursing and offer a double master's degree in nursing and criminal justice.

Whether or not you pursue certification or an advanced degree, you'll need to gain clinical experience before looking for forensic nursing jobs. Medical-surgical nursing, pediatric nursing, or psychiatric nursing are all areas that can provide relevant clinical experience while working with populations that you might see as a forensic nurse.

Forensic Nursing Salary and Career Prospects

Career prospects for forensic nurses are positive. The nursing field is growing thanks to increased demand for health care services as the baby boomer generation ages. The Bureau of Labor Statistics expects the employment of nurses to increase by 6% from 2021 to 2031.

Forensic nursing salaries are similar to, or slightly lower than salaries for generalist RNs. Some estimates place forensic nurse salaries at about $73,000 per year, compared to an average of $77,600 for registered nurses overall. However, salary ranges vary by state, with some states and sources reporting forensic nurse salaries around $95,000, so it's important to check on average salaries in your area.

If you have an Advanced Forensic Nursing Certification offered by ANCC, learn how to renew it. If you're seeking a forensic nursing certification for the first time, consider certification from the International Association of Forensic Nurses.

Growth Mindset
Marianne Renner

Why is it that some people thrive in the face of challenges, while others throw in the towel? Why will some celebrate new ways of learning, while others instinctively resist?

That’s what psychologist Carol Dweck set out to determine when she published her groundbreaking book, Mindset, in 2006.

Dweck observed how people approach learning and found that they fall into two categories: a growth mindset and a fixed mindset.

Those with a growth mindset have a belief that skills, talents, and abilities can be developed through hard work, good strategies, and good mentorship from others. Therefore, this group keeps trying, perseveres through setbacks, and welcomes the opportunity to learn from others.

Those with a fixed mindset hold the belief that we have a certain amount of skills, talents, and abilities that can’t be changed. This group avoids challenges, gives up easily, and even feels threatened by others who might appear smarter or more talented 

Reasons for a fixed mindset.

There are many reasons someone may have a fixed mindset. No matter where you are on the growth mindset journey, we all have times when a fixed mindset can be triggered.

This can happen when we feel overwhelmed or threatened in some way. We may feel our jobs or reputation are at stake. Perhaps it feels safer to stay within our comfort zones.

That’s when we might hear phrases like, “Why do we have to change? Let’s just do it the way we’ve always done it.”

Why this matters.

When people feel their skills and abilities can’t be developed, they worry about looking smart. Internally, they’re asking themselves, “What will people think of me? What if I sound stupid?” That makes this group less likely to work collaboratively and more likely to create roadblocks to solving problems.

When a growth mindset is prevalent among teams, organizations thrive. People feel empowered, and greater innovation takes place.

The good news.

A growth mindset can be developed. Like any skill, all it takes is a bit of practice.

A fixed mindset is a belief system. It comes from old, habitual thought patterns that can be changed like any other habit. 

A fixed mindset begins when you adopt negative thoughts about the ability to succeed. Those thoughts repeated over and over eventually become beliefs. Those beliefs take hold like deep-rooted weeds in a garden, resulting in negative outcomes that impact our work and other important areas of our lives. This can be reversed with consistent practice. 

Action steps.

Here’s a great exercise to root out old habitual thought patterns and replace them with new empowering thoughts that support a growth mindset.

Follow the instructions below to use the worksheet that follows:

  1. Old habitual thoughts. Identify and write out the old thought. Example: “There’s no way I’ll ever recover from this setback.”
  2. Empowering thought. Next to the old thought, write a new, empowering one. Example: “I’m resilient and resourceful and can overcome any obstacle.”
  3. Evidence. Identify the evidence or reason for your new thinking. Example: “I remember a particular setback I experienced. I thought I would never get through it. But I came out even stronger.” This is perhaps the most critical step. It might seem hard for your mind to accept the new thought. Writing evidence helps your brain to actualize the new reality.
  4. Read Repeatedly. Practice reading and repeating your new thoughts to create new habitual thought patterns. Replacing any old habit with a new one takes time, attention, and repetition.

Example: 

Limiting Thought Worksheet For a Growth Mindset

Learn more about how to bring Marianne to your next event Here.

Nurses Week
Celebrating Nurses Week 2025: The Power of Nurses
The Power of Nurses

As Nurses Week 2025 soon approaches, NDNA is thrilled to honor the dedication, skill, and resilience of nurses across North Dakota. This year's theme, "The Power of Nurses," highlights the incredible impact nurses have on patient care, advocacy, and innovation in healthcare. From May 6-12, we invite you to join us in celebrating this profession with special events, discounts, and opportunities to recognize outstanding nurses. Watch for more info to come on our website and social media channels!

Awards Nominations -- Recognizing Excellence

Know an exceptional nurse who deserves recognition? NDNA is now accepting nominations for our annual nursing awards! Help us celebrate those who go above and beyond in their profession. Nominees will be honored at our upcoming conference. Stay tuned for details on how to submit your nomination.

Conference Discounts -- Keep an Eye on Emails & Social Media!

Planning to attend NDNA's Annual Fall Conference? Keep an eye on your inbox and social media for exclusive conference registration discounts during Nurses Week (May 6th -12th ). This is a great opportunity to invest in professional development while connecting with fellow nurses!

Highlight a Nurse -- Gift Card Giveaway

We want to spotlight outstanding nurses who make a difference! Share an about a nurse who has inspired you (or share yourself), and they'll be entered into our gift card giveaway, which will be given away the week of May 12th. Let's take this time to appreciate and celebrate the heroes of healthcare. Click here to submit your Highlight.

ANA Webinars -- Learn & Grow

The American Nurses Association (ANA) is offering free webinars throughout Nurses Week to support professional growth and education. Topics include leadership strategies, wellness in nursing, and policy advocacy. Take advantage of these insightful sessions to expand your knowledge and skills.

Exclusive Discounts -- Skechers & More!

Nurses give so much to their communities, and during Nurses Week, it's time to give back to them! Be sure to take advantage of special discounts on Skechers footwear and other exclusive offers available for nurses. Comfortable shoes make all the difference in long shifts, so don't miss these deals!

Impact Stories -- Share Your Nursing Journey

Throughout the week, NDNA will be sharing impact stories from nurses across North Dakota. If you have a story of perseverance, leadership, or a moment that reinforced your passion for nursing, we'd love to hear from you! Your experiences inspire and strengthen our community. Click here to share a story.

"Light Up the Sky" -- Honoring Nurses

A special tribute to nurses will take place at Sanford Fargo, where the building will light up red in recognition of Nurses Week. This symbolic gesture acknowledges the dedication and contributions of nurses to healthcare and their communities. We may have more sites lit up -- so stay tuned!

Stay connected for more surprises, events, and recognitions throughout Nurses Week 2025! Follow NDNA on social media, check your email for announcements, and join us in celebrating the power of nurses.

You Make a Difference!
Kathleen Swanson, DNP, RN
Sharon Nelson, PhD, RN

We are gearing up for Nurses Week 2025, but please enjoy this piece, which reflects on the theme of making a difference in 2024. Authored by Kathleen Swanson, DNP, RN & Sharon Nelson, PhD, RN (Pictured Below).

Kathleen Swanson, DNP, RN

Sharon Nelson, PhD, RN

"You Make a Difference" was selected by the American Nurses Association (2024) as the 2024 Nurses Week theme to celebrate the diverse roles of nurses and their profound impact on healthcare and society. As trusted advocates, nurses play a vital role in ensuring that individuals, families, and communities receive high-quality care, health education, and essential health services.

Nurses represent the largest group of healthcare professionals, working across a broad range of settings, including long-term care, clinics, hospitals, correctional facilities, home health agencies, military services, population health, and educational settings such as school nursing and higher education. 

Nursing has long been recognized as the pivotal force in healthcare delivery in the United States. This year the Gallup poll reaffirmed that nurses remain the most trusted profession---a recognition received for 25 of the last 26 years (Saad, 2025). With strength in numbers and influence, nurses continue to play an essential role in shaping healthcare in the United States.

As experienced registered nurses with a combined 75 years in the field, the two of us have dedicated our careers to providing quality patient care, and educating and supporting the next generation of healthcare professionals. As we reflect on the difference nurses make, we encourage all nursing professionals to take time to think about the significance of their contributions in their nursing practice. 

Dr. Joanne Disch and Nanne Finis (2022), accomplished nurse leaders, emphasized the importance of nurses taking pride in their work and appreciating the value of their daily efforts. In their article "What Difference Do I Make?" Disch and Finis articulated that nurses themselves often undervalue the full value they bring to healthcare. The impact of nursing practice on the healthcare system is immense, even if it is not always quantified. Without nurses, where would healthcare be?

It is essential for nurses to take time to recognize and acknowledge the significance of their work. Amid the demands of daily responsibilities, it's easy to lose sight of the value of our efforts. Nursing extends far beyond completing tasks---it is about delivering safe, quality care and improving patient outcomes. It is also being empathetic, offering support and understanding, and advocating for those in need. Many of us still remember the small yet meaningful gestures from those who supported us early in our careers. A heartfelt smile, a gentle reminder to take a break, sharing valuable wisdom, or offering calm reassurance during a challenging situation---these simple acts leave a lasting impact. 

We invite you to take a moment to reflect on your nursing practice and the meaningful contributions you make each day. Think about your most recent shift or workday---who were the individuals you engaged with? Perhaps you provided comfort and care to patients, offered guidance to their families, collaborated with colleagues, mentored students, or worked alongside support staff to ensure seamless patient care. In what ways did your efforts lead to positive outcomes---whether by promoting a patient's well-being, enhancing the efficiency of care, or fostering a supportive environment for those around you? Every interaction and decision you make has an impact. 

Despite challenges such as staffing shortages, limited resources, unpredictable patient loads, and emergencies, nurses continue to provide care during some of the most vulnerable moments in people's lives. 

Now is the time to acknowledge and celebrate the profound beauty and value of our work---even the seemingly small acts that make a lasting impression on someone's heart and soul. Take pride in your invaluable role and recognize the difference you make each day in shaping healthcare.

Nurses truly make a difference. You make a difference!

We would love to hear your stories about the meaningful differences you have made in your nursing practice---whether with patients, families, colleagues, or communities. Please share your HIPAA-compliant stories by emailing kathleen.b.swanson@ndsu.edu.

Kathleen Swanson, DNP, RN, Assistant Professor of Practice, teaches in the RN to BSN Program at North Dakota State University, School of Nursing. Kathleen remembers a nurse caring for her who took a moment in the middle of the night to straighten her bedsheets---a small act that meant everything in a moment of pain. 

Sharon Nelson, Ph.D., RN, Assistant Professor of Practice, teaches both in the Undergraduate BSN and Accelerated BSN Programs at North Dakota State University, at Sanford Health in Bismarck. Sharon warmly recalls when her brother with cerebral palsy beamed with happiness when a nurse took the time to visit with him about his beloved high school and favorite activities. That simple conversation brought him immense joy and the biggest smile to his face.

Article references 

American Nurses Association (2024). You make a difference. https://www.nursingworld.org/ana-enterprise/nurses-week/

Saad, L. (2025, January 13). Americans' ratings of U.S. professions remain historically low. https://news.gallup.com/poll/655106/americans-ratings-professions-stay-historically-low.aspx

From NDNA's Director of Education & Practice:
Nurses Week is May 6th - 12th, 2025
Ashley Demakis, MSN, RN

Nurses' Week is more than just a celebration---it's a heartfelt tribute to the dedication, resilience, and compassion that define the nursing profession. Every day, nurses stand at the forefront of patient care, advocating for those in need, offering comfort in moments of uncertainty, and making a difference in ways that often go unseen.

Nursing is not just a job; it is a calling that requires skill, intelligence, and an unwavering commitment to others. From the bedside to the boardroom, from classrooms to communities, nurses shape the future of healthcare with their knowledge and compassion.

During Nurses ' Week, we pause to express our deepest gratitude. We see your sacrifices, your long hours, and your tireless dedication. We recognize the emotional and physical demands of this work, and we honor the incredible impact you make in every life you touch.

To all nurses---Thank You! You are the backbone of healthcare, the voice of advocacy, and the heart of healing. This week is for you! 💙

What are you doing for Nurse's Week?? If you live near Minot, ND, you are welcome to attend the Nurse's Day Wine and Cheese event on Tuesday, May 6th, 2025, at the Northwest Arts Center on Minot State University Campus (the lower level of the Gordon B. Olson Library). This event is sponsored by the Omicron Tau chapter of Sigma, and will be held from 5pm-7pm.  

To read more about the history of Nurses Week visit:

https://www.nursingworld.org/education-events/national-nurses-week/history/

When the Moment Chooses You: A Nurse Leader’s Journey to Finding Her Voice and Unleashing Her Impact
Charlene Johnson, MSN, RN, Caritas Coach, HeartMath Trainer

As a nurse leader with over 30 years of experience, I’ve walked through defining moments that have challenged, shaped, and ultimately strengthened me. Moments where I questioned my path, moments that tested my resilience, and moments where I had to choose whether to stay silent or step forward.

These moments led me to write my new
book, When the Moment Chooses You: From Silence to Strength – A Nurse Leader’s Journey to Finding Her Voice and Unleashing Her Impact. 

This book is not just about my journey—it’s about yours, too. 

Nurses and healthcare workers across the country have faced unprecedented challenges, from burnout to moral distress, and many are still navigating the emotional toll of caring for others in an evolving healthcare landscape. I wrote this book to serve as a beacon of hope—a reminder that every experience, every challenge, and every hardship can be transformed into purpose, leadership, and impact.

Nurses and healthcare workers across the country have faced unprecedented challenges, from burnout to moral distress, and many are still navigating the emotional toll of caring for others in an evolving healthcare landscape. I wrote this book to serve as a beacon of hope—a reminder that every experience, every challenge, and every hardship can be transformed into purpose, leadership, and impact.

At the heart of this book is a single question: What will you do when the moment chooses you?

Whether you are at the bedside, in leadership, or at a crossroads in your career, this book is
a guide to recognizing the defining moments that shape your purpose. It will help you:

✔ Find and use your voice with confidence
✔ Turn adversity into fuel for purpose and transformation
✔ Move from burnout to fulfillment by realigning with your ‘why’

I’ve had the privilege of integrating Jean Watson’s Caring Science and HeartMath techniques into my leadership journey, and these practices have been instrumental in helping me navigate moments of self-doubt, systemic challenges, and personal breakthroughs. I share these insights throughout the book to help others cultivate resilience, embrace their purpose, and step into their calling.

What Readers Are Saying

“This book itself is a destiny moment—don’t miss it!” – Johanne

“When the Moment Chooses You is more than a story—it’s a powerful reminder that we all have defining moments that shape our lives. Charlene’s experiences as a nurse leader, especially during difficult times, are both inspiring and deeply relatable.” – Starlin Santos Cruz

“This book is for anyone feeling the need for change or seeking more meaning and purpose in life. Coach Charlene invites us to reflect on those key moments where we are called to make a difference. It’s an inspiring guide for anyone ready to answer that call.” – Jan Anderson, EdD, RN, AHN-BC, Caritas Coach

A Personal Invitation

To my fellow nurses, leaders, and healthcare professionals: This book is for you. It is for those who feel unseen, unheard, or unsure of their next step. It is for those searching for a way to make a lasting impact—not only in their careers but in their lives. Your voice, your presence, and your leadership matter now m ore than ever.

I invite you to read When the Moment Chooses You, reflect on your defining moments, and step forward with renewed strength and purpose.

 Available now on Amazon ➡ Amazon Link
I would love to hear from you! If this book resonates with you, please connect with me on LinkedIn, Instagram, or Facebook, and leave a review on Amazon to help others find inspiration through these pages.

Together, let’s rise, lead, and transform healthcare—one moment at a time.

With gratitude,
Charlene Johnson, MSN, RN, Caritas Coach
Founder, The Wellness Whisperer Coaching & Consulting
Podcast Host, When the Moment Chooses You & The Whispers of Wellness

SPONSORED
Elks Camp Grassick Now Hiring RN or LPN to work with children & adults with disabilities.
Seeking camp nurse for full season (6/2- 8/7) or individual sessions. Position requires living on camp. Duties include medication administration and treating minor illnesses and injuries.
Learn more
Sponsorships

We are seeking organizational sponsorships to help us continue our mission. In addition to specific sponsorship packages for events, we offer an exclusive Platinum Sponsorship package that covers all NDNA conferences and events for a year. This comprehensive package includes prominent recognition throughout each event, prominent company logo placement on event materials, announcements, emails, website, and social media postings, as well as a featured article or announcement in our quarterly publication that reaches all nurses in North Dakota. It also includes two complimentary registrations for all NDNA events and prominent exhibit booths.

There are a variety of packages that may fit your organization.

We hope you'll be willing to consider partnering with us!  Click here for more info!

NSO Article
Nurse Spotlight: Healthcare Documentation
Nurses Service Organization

Nurses Service Organization (NSO), in collaboration with CNA, has published our 4th Edition of the NSO/CNA Nurse Liability Claim Report. It includes statistical data and case scenarios from CNA claim files, as well as risk management recommendations designed to help nurses reduce their malpractice exposures and improve patient safety.

You may access the complete report, and additional Risk Control Spotlights, at: www.nso.com/nurseclaimreport.

This Nurse Spotlight focuses the analysis and risk recommendations regarding one of the most significant topics in the report and for nursing professionals: Healthcare Documentation.

Nursing Allegations Related to Healthcare Documentation

While documenting care represents a critical component of nursing processes and standards, the electronic health record [EHR] has posed a level of complexity for nurses who are often challenged with why, how, what and where to document in a patient’s EHR.

Documentation deficiencies are contributing factors to many nurse professional liability claims, as well as license protection matters. However, in the 4th Edition of the NSO/CNA Nurse Liability Claim Report, failure to document or falsifying documentation closed claims, as an allegation of professional liability, increased in distribution and severity when compared to the 2011 closed claim report and the 2015 closed claim report. Below is an example of a professional liability claim asserted against a nurse due to the failure to document:

Nurse Legal Case Study: Absence of documentation in violation of nursing standard of care

The patient was admitted to a rehabilitation facility after undergoing a right hip arthroplasty. Due to the patient’s other co-morbidities, her rehabilitation and recovery was slow and difficult. The patient’s health continued to deteriorate during her admission, until her death four months following admission. After the death of the patient, the family (plaintiffs) filed a complaint with the Department of Health (DOH) regarding the patient’s care at the facility.

The DOH investigated the complaint and cited 13 violations in the nursing standard of care. In particular, the DOH was critical of the absence of documentation related to care plans for the Foley catheter, the patient’s weight loss (from 93 to 77 pounds over four months), and neither shower nor self-care was documented for a timespan of more than five weeks. The insured registered nurse (RN) was the facility’s wound care nurse, and the DOH’s investigation found several violations of the nursing standard of care specific to the RN’s lack of documentation. First, the DON found a lack of documentation regarding a nursing incision wound for a period of approximately three weeks. The RN told the DOH surveyor that daily assessments were performed during that time, but since the wound care orders were to leave the right hip incision wound open to air, no treatment was performed, so the RN did not document anything. The patient also had a left heel pressure injury that was not healing, and the RN agreed that this non-healing injury had not been appropriately assessed or documented. Moreover, the director of nursing informed the DOH surveyor that the RN was required to perform weekly assessments on all patients in the facility. However, none were noted in the patient’s healthcare information records during a three-month period.

After seeing the DOH report, the family sued the facility and sued the insured RN separately. Knowing the challenges of the missing documentation and the negative DOH report, mediation was proposed with the plaintiffs. The total incurred amount to defend and settle this case on behalf of the insured RN was greater than $270,000.

In the 2011 closed claim report, 0.2 percent ($31,250) of all closed claims were related to inadequate or inappropriate documentation as the primary allegation. This data increased slightly to 0.5 percent ($139,920) in the 2015 closed claim report. Respectively, in the 2020 closed claim report, documentation allegations represent 2.0 percent ($238,761) of all closed claims.

Figure 1 demonstrates the increase in severity of professional liability claims related to documentation allegations. While these professional liability claims occur infrequently in the 2011, 2015 and 2020 closed claim analyses, allegations related to documentation failures can be difficult to defend and often result in a license protection defense matter against the nurse.

License Protection Allegations Related to Documentation Errors and Omissions

A license protection matter and a professional liability claim reflect a number of differences. First, a license protection matter only involves the cost of providing legal representation to defend the nurse before a regulatory agency or State Board of Nursing (SBON). On the other hand, professional liability claims include an indemnity or settlement payment. Second, license protection matters asserted against a nurse’s license to practice may or may not involve allegations related to patient treatment and care. The Nurse Spotlight: Defending Your License provides an overview of the role of the State Board of Nursing in the legal/regulatory system, describes the disciplinary process, and imparts helpful recommendations on defending yourself if you were to receive a complaint summons.

Figure 2 displays license protection matters with defense expense payments that involve allegations related to documentation. Documentation as a primary allegation comprises 9.7 percent of all license protection matters in the Nurse Liability Claim Report: 4th Edition. Approximately half of the license protection matters related to documentation involve an allegation of fraudulent or falsified patient care or billing records (4.8 percent).

A nurse’s license is one’s livelihood, and its protection is paramount. A nurse’s practice and behavior is expected to be safe, competent, ethical and in compliance with applicable laws and rules. However, when a complaint is filed, nurses must be equipped with the resources to adequately defend themselves. Being unprepared may represent the difference between a nurse retaining or losing the license to practice, a suspension or fine.

The False Claims Act

While documentation deficiencies may result in a professional liability claim and/or a license protections matter, nurses also may be subject to federal and state sanctions for knowingly falsifying healthcare documentation under the federal False Claims Act (FCA). The FCA imposes liability on any person who submits a claim to the federal government that they know (or should have known) is false. An example may be a healthcare provider who submits a bill to Medicare for medical services they know they have not provided. The False Claims Act also imposes liability on an individual who may knowingly submit a false record in order to obtain payment from the government. For additional information on fraud and abuse laws, please see the Office of Inspector General’s provider education materials on Fraud & Abuse Laws.

Healthcare Documentation: Minimizing Risks, Maximizing Benefits

NSO/CNA is often asked about documentation risks and recommendations to minimize those risks. Nurses are certainly aware that there are patient healthcare documenting fundamentals. The healthcare information record is a legal document that is an essential tool to:

  • Document the services provided regarding the patient’s illness or injury, response to treatment, and caregiver decisions;
  • Communicate documented information about the patient’s plan of care and outcomes to the health care team
  • Communicate information to other nursing professionals and healthcare providers;
  • Support the appropriate information for billing coding; and
  • Serve as the organization’s business and legal

Because complete, accurate and legible healthcare records constitute an essential risk management measure, nurses should maintain proper documentation practices and follow facility policies and procedures governing appropriate and comprehensive records documentation. The facility’s healthcare record documentation policies and procedures should address, at a minimum:

  • Correcting documentation errors;
  • Delineating appropriate use of the copy and paste function in the electronic healthcare record;
  • Documenting practices during electronic system failures or outages (“down-time”);
  • Maintaining patient confidentiality;
  • Releasing patient healthcare information records and auditing practices; and

Risk Management Recommendations: Documentation

Maintaining a consistent, professional patient healthcare information record is integral to providing quality patient care, ensuring consistent communication among all professionals caring for the patient, documenting patient care outcomes and response and establishing the basis for an effective defense in the event of litigation. The following guidelines can help reduce risk:

Documentation – Clinical Content

  • Document nursing actions in accordance with facility requirements and patient needs, capturing the following information as clinically indicated:
    • results of each nursing assessment
    • pertinent nursing observations
    • patient complaints or concerns
    • significant changes in the patient’s condition
    • any change in the patient’s care plan
    • relevant monitoring findings, treatment or episode of care, as well as the patient’s response to that care
    • facts relating to any patient accident or incident, including evidence of any injury, all parties notified, nursing care provided and patient’s condition after care is rendered
    • laboratory and diagnostic test results, especially those that are abnormal and require provider notification and/or intervention
    • referral and consultation requests and results
    • telephone, face-to-face and electronic contacts with other members of the healthcare team, including the content of discussions and agreed-upon follow-up.
  • Document discussions with the patient about medical issues that require additional explanation by any healthcare practitioners and provider(s).
  • Record medications administered, including injections, ointments and infusions, as well as a description of the patient’s response as Also record self- administered medications.
  • Detail nursing observations during patient
  • Specify patient’s questions and answers given regarding the nursing care/service plan, as well as the goals and methods of treatment.
  • Describe the patient’s response to nursing
  • Note the review of current problems and plan of
  • Assess skin and wound condition, including clinical findings and observations, and interventions, the nursing care/service plan and the patient’s response to treatment.
  • Document practitioner notification of a change in condition, symptoms, or patient concerns and document the practitioner’s response and/or orders, as well as any changes in the treatment plan
  • Summarize communications with practitioners, including those via telephone, facsimile and e-mail, text messages and patient portal communication and note any subsequent orders and nursing interventions.
  • Note use of an interpreter, including the interpreter’s contact information, as well as the patient or family member’s willingness to communicate with an interpreter.
Interprofessional Conference
"Strengthening Healthcare Through Interprofessional Collaboration"
Advancing Education, Research, Quality Improvement, and Best Practices

Mark your calendars—November 7, 2025!

Call for Abstracts: Submissions are open until July 11, 2025—don’t miss your chance to be a part of this event!! Submit abstract

This event brings together researchers, clinicians, and educators across disciplines to explore the power of collaborative research. Expect thought-provoking keynote speakers, interactive workshops, insightful poster presentations, and networking opportunities designed to strengthen interprofessional teamwork and improve health outcomes.

Be part of this transformative event—expand your research skills, connect with experts, and help shape the future of healthcare. Register today!

Please share with your interprofessional colleagues.

Collaboration
2025 GOLDEN GRAINS Award

NDNA was so excited to accept the 2025 GOLDEN GRAINS Award from the North Dakota Academy of Nutrition and Dietetics at their Annual Meeting and Symposium in March! Dr. Penny Briese was able to accept this honor on behalf of NDNA.

The purpose of this award is to recognize individuals or organizations that have supported the dietetics practice. The nominators stated that the North Dakota Nurses Association has been an excellent partner, helping to connect healthcare professionals and their respective associations.

We thank NDAND for this award, and we love the collaboration. Excited for more to come!

Honor Guard
Nurse Honor Guard Red River Valley
Karen R. Robinson, PhD, RN, FAAN

Founding Members of the Nurse Honor Guard Red River Valley: Jamie Astrup, Ruth Blilie, Wanda Borchert, Kate Gausman, Carla Hansen, Deb Magnuson, Evelyn Quigley, Karen Robinson, Bonnie Vangerud, and Amy Vogt

The Nurse Honor Guard Red River Valley (NHGRRV) is a dedicated group of volunteer nurses who pay tribute to colleagues at their time of passing with a goal of serving a 50 mile radius of Fargo-Moorhead. Their mission is to display the last full measure of honor and tribute, with pride, respect, dignity, and integrity, at funeral and/or memorial services for active or retired nursing colleagues while providing comfort, compassion, and support to the families of the decedent. It became an official, formal nonprofit organization, Nurse Honor Guard Red River Valley, on February 20, 2025.

For decades, military and police departments through their respective honor guard programs have answered the call to pay tribute to a fallen fellow soldier or police officer. In 2004, nurses in the state of Kansas, aware of the distinguished and respectful military and police ceremonies, discovered the nursing profession did not have a similar ceremony to pay respect to fellow nurses at the end of their life’s journey. Springing into action, nurses developed a similar, nurse-specific, memorial for nurse colleagues which was subsequently approved by the Kansas State Nurses Association (KSNA) Board of Directors in April 2004.1,2  Over the past 20 years, Nurse Honor Guards have been established across the country. To date, there are more than 219 active Nurse Honor Guard chapters in 49 states to include ND, MN, SD, IA, WI, and NE.2 

Nurse Honor Guards provide ceremonial services, lasting about 5-10 minutes, at a nurse’s funeral or memorial. The members typically dress in traditional nursing attire to include a cape, pin, and cap. A symbolic Nightingale lamp is lit which represents a nurse’s dedication to caring for others, and is carried by one of the nurses. At the end of the ceremony, the lamp is extinguished and presented to the family with personal condolences made. A white rose is placed near the deceased nurse. The nurse’s name is called 3 times and a triangle is rung after each call of the name to signify a nurse’s final duty. All nurses in attendance are asked to stand for the deceased nurse’s final call to duty. Standing together as a Nurse Honor Guard promotes reflection on the profession and the sacrifices nurses make while caring for patients each and every day. In order to participate in the ceremony, Nurse Honor Guard members must have been a nurse at some point in their life.

If you want to contact the Nurse Honor Guard Red River Valley in the Fargo/Moorhead area to perform a ceremony for a family member or colleague who is a nurse or you would like to become involved, you can visit this website, or contact:

In Fargo/Moorhead area: contactus@NHGRRV.or 

Facebook page - you can contact them or join by entering “Nurse Honor Guard Red River Valley”

Articles
Enhancing Communication with Native American Elders for Nurses
DW
Danielle Woodman, Elder Justice Associate

Effective communication is a cornerstone of quality nursing care, especially when addressing the unique needs of Native American elders. Respectful and culturally sensitive communication not only enhances the care experience but also fosters trust and rapport between nurses and elders.

Native American elders hold a revered status within their communities, often seen as keepers of wisdom and tradition. It's essential for nurses to understand and respect these cultural values. Elders may prefer to communicate in their Indigenous language and may value spiritual practices such as smudging, singing, and other forms of prayer. ⁴ Here are some considerations for nurses serving Native American elders:

Consent and Capacity: An elder's ability to make decisions is influenced by their cognitive and functional capacities. Nurses should be aware of the factors affecting consent and capacity, including medical conditions, cognitive functioning, and the risk of undue influence. ⁵ It is important to ensure that elders can make informed decisions freely and voluntarily. ³

Elder-Focused Assessments: Conducting thorough and culturally sensitive assessments is vital in providing appropriate care for Native American elders. These assessments should ensure that the elder's choices are consistent with their values, preferences, and patterns, respecting their lifetime values and preferences, even if they differ from the norm. ¹

To effectively communicate with Native American elders, we encourage nurses to:

  • Use Respectful and Gentle Language. Avoid terms that may be perceived as disrespectful or dismissive. Be mindful of the tone and volume of your voice
  • Pay Attention to Non-verbal Communication. Observe body language and facial expressions. Maintain appropriate eye contact, as it can vary in significance across different cultures. Be patient and give elders time to express themselves. ⁴
  • Build Trust and Rapport. Show genuine interest in the elder's life and experiences. Engage in active listening and validate their feelings and concerns. Respect their autonomy and involve them in decision-making processes
  • Identify and Report Abuse. Familiarize yourself with the common signs of abuse for elders. ⁴ Conduct thorough screenings using tools like the Hwalek-Sengstock Elder Abuse Screening Test and the Native Elder Life Scale. ⁴

Elder abuse can manifest in various forms, including physical, emotional, sexual abuse, neglect, and spiritual abuse. ² Most tribes have special jurisdiction or policies for elder abuse cases through their elder abuse codes. ² Report suspected abuse to appropriate authorities, such as Adult Protective Services (APS) or tribal law enforcement. To learn more, visit our webpage Elder Abuse Codes.

By being mindful of how we communicate with Native American elders and understanding the factors affecting their consent, capacity, and potential abuse, we can provide effective,  compassionate, and culturally conscious care. Continuous learning is vital in ensuring that our interactions are respectful and meaningful.

For more information on serving and caring for Native American Elders, we welcome you to visit our website at iasquared.org.

The International Association for Indigenous Aging (IA2) is a 501(c)3 non-profit educational association dedicated to improving the lives of indigenous elders. Our mission is to ensure the provision of quality services and resources, expand opportunities for community involvement, and protect the rights of elders, including their freedom from abuse and neglect.

Article references 

¹ Consent and Capacity in Indian Country

https://iasquared.org/wp-content/uploads/2023/11/consent-and-capacity.pdf

² Elder Justice in Tribal Communities

https://iasquared.org/wp-content/uploads/2024/10/Elder-Justice-in-Tribal-Communities.pdf

³ Financial Abuse & Exploitation of Elders in Indian Country

https://iasquared.org/wp-content/uploads/2023/11/financial-abuse.pdf

⁴ Health Care and Elder Abuse in Indian Country

https://iasquared.org/wp-content/uploads/2023/11/health-care-and-elder-abuse.pdf

⁵ Social Services for Elders in Indian Country

https://iasquared.org/wp-content/uploads/2023/11/social-services.pdf

Recipe for Success: Multi-Site Research in a Rural Health System
Michelle Gierach, EdD, RN, CNE
Karen R. Robinson, PhD, RN, FAAN
Samantha Bartelt, MSN, RN, PMHNP-BC
Brenda Wolles, MS, RN, OCN, CNL
Coreen McClellan, DNP, FNP-C

During the COVID-19 pandemic, all hands were needed to support patient care in health systems. Across the world, non-essential work was put on hold to provide as much assistance as possible to the frontline staff caring for patients experiencing the COVID-19 virus. Despite limited resources and multiple barriers to engaging in research, the spirit of inquiry was alive in the largest rural health system in the country. This paper provides an overview of a strategic initiative that took place in the health system during COVID to engage clinical nurses in a multi-site research study. Interestingly, our process aligned with The American Nurses Credentialing Center's (ANCC) multi-site research playbook recommendations which was published the following year (Shirley et al., 2021). The major investments identified by ANCC are used in the manuscript as an outline for the health system's strategic initiative.

The health system is the largest rural health system in the country, with the majority of employees located in two of the least densely populated states deep in America's interior having a combined population of just over 1.5 million (Chaffin, 2020). Within the health system, the nursing leadership valued the importance of engaging clinical nurses in research despite multiple obstacles, limited resources, and hundreds of miles that separated the research team. The nurse scientists gathered a study team a study team including an academic partner and clinical nurses to conduct a multi-site research study focused on the lived experience of frontline nurses during COVID-19 in rural America (Robinson, Jensen et al., 2022). In spite of being in the middle of a pandemic, the study team persevered in providing new, meaningful knowledge about the experiences of frontline nurses which contributed to the larger body of nursing science.

Literature Review and Our Challenge

Engaging nurses in research was challenging in healthcare institutions even before the pandemic. Despite challenges, there were benefits for engaging rural frontline nurses in nursing inquiry within a multi-site study design. The ANCC's Research Council published a multi-site research playbook outlining the return-on-investment healthcare institutions receive from engaging clinical nurses in multi-site research studies (Shirey et al., 2021):

  • Promoting nursing science

  • Benefiting the organization by meeting Magnet criteria

  • Building capacity for future research studies

  • Improving collaboration across geographical locations

  • Aiding in the dissemination of research

  • Increasing the generalizability of study results

Even though the ANCC multi-site research study playbook had not been published when we conducted our study in 2020, our process aligned with the recommendations identified in the playbook. Because the study sites were located in the rural upper Midwest, not all of the locations were large enough to have a doctoral-prepared nurse available to mentor clinical nurses. The health system's partnership with an academic doctoral-prepared nurse provided additional mentoring leadership.

The academic and practice collaboration to engage in nursing inquiry has benefits strongly supported by the literature (Heitschmidt et al., 2021; Shirey et al., 2021). When academic faculty and clinical practice partner together to engage in research, the generalizability and dissemination of the research study are enhanced (Shirey et al., 2021). In addition, the collaborative partnership closes the gap that is often seen between practice and academia (Albert et al., 2019). When these strengths are synergized, the impact can be seen in organizational and patient care outcomes (Davis et al., 2019).

Recipe for Success

When engaging in a multi-site study, ANCC identified the major investments to consider (Shirey et al., 2021). The following narrative uses the ANCC major investments to outline how the study team worked together to engage in a multi-site research study at three tertiary medical centers in the rural upper Midwest.

Getting Started (Study Leadership, Team Members, Departmental Support)

This strategic initiative process was started because of the impact COVID-19 was having on the nursing workforce. Early in the pandemic, there was no known cure or vaccination available which meant frontline nurses had to set aside their own personal fears and fight the battle against the coronavirus (Robinson, 2020). Because nurses were on the frontlines, nurse researchers from the clinical organization deemed it important to partner with an academic nurse researcher to develop a qualitative research study that captured the essence of rural nurses' lived experiences caring for COVID-19 patients.

Study team members were recruited from each site's Nursing Research Councils, with clinical nurses assuming the role of site-PI at their hospital. In addition to conducting this study, it was important to provide clinical nurses with an opportunity to gain experience in designing and conducting an investigation. The long-term goal was growing the health system's capacity for qualitative nursing inquiry.

It was crucial to receive support from nursing leadership in the development stage so they were aware of the study topic and knew what resources the study team members needed. Approval was received from the health system's Nursing Research Strategic Planning Group, chaired by the Chief Nursing Officer and including the Vice Presidents for Nursing and Patient Services of the study sites. Team members presented the study proposal to their Nursing Senate and Research Council for approval to proceed. It was imperative that team members at each of the sites had the necessary resources to conduct the study (e.g., computer, audio recorder, authorized time to participate in conducting the study and disseminating the findings). The multi-site PI was able to secure funding from the organization's foundation fund for team member education, study participation, transcription of interviews, analysis software, and dissemination.

IRB Protocol Development, Study Materials

Face-to-face meetings were impossible because of the pandemic and team members living in two of the least densely populated states with a combined population of just over 1.5 million (Chaffin, 2020). Therefore, all team meetings were held virtually throughout the entire study process. The multi-site-PI developed a "COVID-19 Study to Do List" for the team, which detailed study tasks, responsible person(s) for the task, target date for completion, and date of completion. Emails were routinely sent to all team members with meeting agendas, study progress updates, and feedback requests for draft documents (e.g., interview guide). This study was reviewed and approved by the Institutional Review Board (IRB) of the health system (Exempt: Category 2i).

During the recruitment and interviewing of frontline nurse participants, consistency among team members was imperative. All messaging and potential study participant interactions by team members had to be uniform. To accomplish this, the team developed study materials that included scripts for an email approach and a follow-up email in which the potential participant and the interviewer would briefly meet for a discussion about the study. Additionally, an interview guide, informed consent, interviewing tips, avoiding the pitfalls of interviewing, and use of the transcription service were available to support the study team members.

Training

A significant piece of the process was to engage the team in training that provided a consistent message for all study team members, regardless of their experience with qualitative research methodology. The academic nurse educator provided support with training the team in qualitative methodology as well as how to conduct one-on-one interviews. The training sessions were recorded to accommodate the clinical nurses who had a conflict with a scheduled team meeting. Since the site-PIs never engaged in interviews as part of a research study in the past, there were opportunities provided to practice interviewing techniques. After a presentation of best practices and utilizing the interview guide, the team engaged in virtual role play with scenarios created to stimulate discussion and questions within the group.

Study Procedure

Throughout the entire process, the site-PIs and team members were mentored through research procedures to ensure study integrity. Each doctoral-prepared nurse was assigned as a mentor to a study site. This included frequent check-ins with the clinical nurses to support study recruitment and interviews of study participants. A contact list of participants for each site was provided for study recruitment. After collaboration with the mentor, the site-PIs sent an email to nurses who were potential participants. If the nurse expressed interest, the site-PI met one-on-one with the potential participant to discuss the study and screen for inclusion criteria.

Interviews

The site-PIs conducted the face-to-face interviews after obtaining informed consent by using the interview guide and recording the interview on a digital recorder. After the interview, the site-PI uploaded the MP3 file to Rev.com for transcription. When the transcription was complete, the interviewers validated the accuracy of the transcript using a number rating system to ensure the trustworthiness of the transcript before it was included in the analysis. After each interview, the assigned mentor would review the transcript to identify areas of strength and growth for the interviewer and would meet one-on-one to provide feedback that could be incorporated into future interviews. Using this process allowed the mentors to monitor protocol fidelity and help to develop the interview skills of the site-PIs.

Data Analysis

The three doctoral nurses (study mentors) conducted the initial data analysis using an iterative process individually, then by meeting in a small group virtually to discuss their findings. During these meetings, a large whiteboard was used to capture the discussion and themes of the data. After the meetings, the data on the whiteboard was typed and shared with the study mentors to read for further reflection. The large study team then met virtually with all members to discuss and validate findings with the interviewers and site-PIs. Additional analysis was then conducted to solidify themes and ensure the trustworthiness of the data.

Immediately following the final study analysis, the investigators met with the health system's nursing leadership team to review the findings. This meeting resulted in implementation of interventions (e.g., group huddles, increased advertising of Employee Assistance Programs (EAP), promoting mental health services, and a going-home checklist to include checking on colleagues to see if they were OK).

Dissemination

Dissemination of study findings was a key step in the research process. The team was fortunate to have funding from the health system's foundation to provide reimbursement for conference presentation registration costs, while each study site covered the expenses of travel for their respective team member. This provided an opportunity for three members of the team to present at a national conference in Washington, D.C., when they actually met face-to-face for the first time. For the rural clinical nurse who participated, it was their first time attending and first presentation at a national conference, which provided an opportunity for professional growth for this team member while under the mentoring of experienced nurses.

In addition to multiple local, regional, national, and international conference presentations, the team also used the study as an ANCC Magnet exemplar and presented to the site visit team when the specific site was awarded their 5th ANCC Magnet redesignation. Manuscripts have been published to share the study results to make sure the voice of the frontline nurse is heard (Robinson, Jensen et al., 2022; Robinson, Gierach et al., 2022; Robinson et al., 2023). For many of the team members, this was the first time they participated in drafting, editing, and publishing a manuscript. It provided an excellent opportunity to mentor clinical nurses in the process of scholarly dissemination.

An important step of the process was internal dissemination among approximately 5,400 nurses working at the rural study sites. In addition to presentations at leadership and at council meetings, and providing information in nursing newsletters, the team created a 1-page summary of the study results. This summary document was distributed at the council meetings to post on clinical units where the frontline nurses would have access to read a summary of the study results. The site-PIs also hand delivered the document to clinical units. This method of dissemination allowed for mass communication of a consistent message across two rural states without significant cost.

What is most notable is the interest in the study findings among non-medical audiences. Many health systems may only consider dissemination to audiences that are affiliated with healthcare. However, it is also important to consider how to educate a variety of stakeholders about the knowledge gained from the study. Realizing that not every research study applies to the general public, the impact of COVID-19 on the nursing population was well received among local audiences (i.e Rotary Clubs). Wherever the dissemination took place, the foremost goal was to communicate the voice of the rural nurse who had been on the frontline during the COVID-19 pandemic.

In addition to the dissemination of the research study findings, the team has disseminated the best practices for engaging clinical nurses in multi-site research both internally to the health system, and externally to a national audience at the ANCC Research Symposium. The dissemination of our research process engages multiple stakeholders not only in the research findings, but also in the development of the structure required to conduct rigorous research that produces trustworthy results. It is important for nursing professionals to support each other as research scholars while we work together to build the body of nursing science. This is especially key for rural organizations with limited resources, allowing them to participate in scientific inquiry in collaboration with a larger organization.

Table 1: Dissemination Opportunities

Lessons Learned

This study was the first time the rural health system's nurses conducted a research study that involved multiple sites and involved clinical nurses in the whole research process. Not only were the research study results significant, but the learning that took place within the research team and the health system was extremely meaningful (see Table 2).

Table 2: Lessons Learned

The team learned significant lessons of how nurses novice to research can engage and make a purposeful impact on the research process and outcome. One example of this was the skill that the interviewers demonstrated when developing rapport with the study participants and leading the interviews. They quickly moved from novice to proficient in this skill after training and mentor feedback. They also made a significant impact on validating the themes of the data as a result of their experience with the study participants. The study had a significant impact on the clinical nurses that participated on the research team. Some exemplars from the team member experiences are located in Table 3.

Table 3: Clinical Nurse Exemplars

Clinical RN 1: When I volunteered to be on the COVID-19 Nursing study research team, I had no idea what a large impact it would have on me personally as well as on my career.  I think that I had one of the best roles in the study as the interviewer.  I had never facilitated a research study interview prior, so it was very helpful to have training from the other members of the study team as well as doing practice interviews, even if they were virtual.  I felt very supported by the study team leads and could always ask questions if I was unsure. While doing the interviews and listening to the pain these nurses experienced and were still actively dealing with months later, I realized it was time for me to make a change in my career.  By the time we were presenting our study at various conferences, I was in my first semester to become a Psychiatric Mental Health Nurse Practitioner with a goal of being able to provide help to healthcare workers at a higher scope.  As a research team member, I also learned a tremendous amount about dissemination and was given the opportunity to speak at multiple conferences at a national level. I was handed a team of experienced nursing mentors that have remained valuable resources in practice and in life. I would encourage nurses to participate in research at some point during their career because you never know where it will take you. 

Clinical RN 2: Participating with a group of experienced nurse researchers from across our healthcare system was perhaps a career-changing opportunity to learn more about carrying out high-quality research. I had learned the basics in school, but in this group, I experienced collaborative, professional nursing research for the first time.

For me, the benefits went beyond research. I got to know nurses at other facilities, which made the other institutions come alive for me. Not only was I working in a system-wide research group, but I was also hearing the voices of the participants from each facility. I felt a new sense of cohesion with nurses across the system that I hadn't experienced before.

The opportunity to present the research in a number of settings has opened my eyes to new professional opportunities I had not previously understood were out there. Due in part to my experiences with this research group, I have augmented my clinical practice by accepting a part-time role in an academic setting where I will have support for ongoing research.

Clinical RN 3: Before the COVID-19 study, I had some experience with quantitative research, but none with qualitative. I was eager to be part of this project, yet somewhat hesitant about my own abilities. The doctoral nurses prepared us with virtual education and practice to understand and fulfill the role of the research interviewer. Even though our meetings were strictly virtual due to COVID-19 restrictions, I felt the meetings fostered learning and connection.

When I was interviewing staff, it was easy to connect and listen to the experiences of each person I was interviewing. I would often only have to cue a person to "tell me more" about the encounter they were sharing to get to the raw emotion and poignant detail of the experience. Nurses shared stories of loss and grief, fear and frustration, and absolute exhaustion, some voicing their experiences out loud for the first time. Both the nurse interviewed, and I often grabbed a Kleenex to wipe away tears shed. After an interview, I would often find myself exhausted and drained in a different way than I had ever before been, but each interview also affirmed the importance of the study.

Upon completion of all the interviews, our team was asked to affirm the themes identified by the mentor team who analyzed the transcribed interviews. This process was also done virtually and yet it felt to me like we were all just as close as if we were in the same room. I was amazed to how profoundly similar and emotionally raw the experiences were in all locations. We compiled the narratives and have presented our work both in presentations and publications. I am honored to be part of this work and to give a voice to the nurses who fought this battle. 

Even though two members of the team transitioned to other roles outside of the health system during the study, a core team of nurses maintained strong engagement. The mentor team was grateful that they recruited two to three nurses from each rural site to allow for study team attrition. The research study made a significant impact on the organization by growing the mentor team of doctoral-prepared nurses engaging in multiple studies, educating more rural clinical nurses about the research process, identifying future research topics to pursue, and establishing a strong academic and practice collaboration.

Conclusion

Despite the barriers for engaging in research during the COVID-19 pandemic, the largest rural health system in the country was able to overcome the obstacles to successfully conduct a multi-site research study that added to the body of nursing science. Additionally, the research had a significant impact on the study participants, the research team and the broader community. The ANCC's playbook for multi-site research studies provides a framework for study teams to implement best practices in their approach to designing and conducting research. Through the research process and dissemination of study findings, this research team was able to see the multiple successes that came from implementing evidence-based strategies into each step of the process. The lessons learned are meaningful and will have an impact not only on the research team and rural health system, but on the nursing profession for years to come.

Article references 

Albert, N. M., Chipps, E., Falkenberg Olson, A. C., Hand, L. L., Harmon, M., Heitschmidt, M., G., Klein, C. J., Lefaiver, C., & Wood, T. (2019). Fostering academic-clinical research partnerships. Journal of Nursing Administration, 49(5), 234-251. https://doi.org/10.1097/nna.0000000000000744

Chaffin, J. (2020, Nov. 27). "It's finally got to rural America:" Coronavirus surges in the Dakotas. Financial Times. https://www.ft.com/content/82311cae-7775-4359-9c47-c13ea1e4bee7

Davis, K. F., Harris, M. M., & Boland, M. G. (2019). Ten years and counting: A successful academic-practice partnership to develop nursing research capacity. Journal of Professional Nursing, 35(6), 473-479. https://doi.org/10.1016/j.profnurs.2019.04.013

Heitschmidt, M., Staffileno, B. A., & Kleinpell, R. (2021). Implementing a faculty mentoring process to improve academic-clinical partnerships for nurse led evidence-based practice and research projects. Journal of Professional Nursing, 37(2), 399--403. https://doi.org/10.1016/j.profnurs.2020.04.015

National Academies of Sciences, Engineering, and Medicine. (2021). The Future of Nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982 .

Robinson, K.R. (2020). Comparing the Spanish flu and COVID-19 pandemics: Lessons to carry forward. Nursing Forum, 2020, 1-8. https://doi.org/10.1111/nuf.12534

Robinson, K.R., Jensen, G.A., Gierach, M., McClellan, C., Wolles, B., Bartelt, S., & Hodge, J. (2022a). The lived experience of frontline nurses: COVID-19 in rural America. Nursing Forum, 57(4), 640-49. https://doi.org/10.1111/nuf.12727

Robinson, K. R., Gierach, M., Wolles, B., McClellan, C., Bartelt, S., & Hodge, J. (2022b). Future catastrophic event preparation: Recommendations from clinical nurses aligning with the Future of Nursing 2020-2030 Report. Journal of Nursing Administration, 52(11), 574-576. https://doi.org/10.1097/nna.0000000000001212

Robinson, K., Gierach, M., Bartelt, S., Wolles, B., McClellan, C., Hodge, J., & Lovro, J. (2023). Battle of COVID-19: Frontline nurses feel abandoned during the pandemic. American Nurse Journal, 18(3), 12-16. https://www.myamericannurse.com/battle-of-covid-19-frontline-nurses-feel-abandoned-during-the-pandemic/

Shirey, M.R., Bonamer, J., Clarke, C., Hass, S., Ivory, C., Kitto, S., Price, D., Weiss, M., Yakusheva, O., Chappell, K., & Johantgen, M. (Ed). (2021). Multi-site research playbook: A practical guide to support multi-site research studies for greater impact. American Nurses Credentialing Center's Research Council. American Nurses Credentialing Center. https://4850206.fs1.hubspotusercontent-na1.net/hubfs/4850206/ANCC%20Multi-Site%20Research%20Playbook/ANCC%20Research%20Council%20Multi-Site%20Research%20Playbook.pdf

Author Affiliations

Dr. Michelle Gierach -- Associate Professor, Augustana University, Sioux Falls, SD

Dr. Karen R. Robinson -- Nurse Scientist, Sanford Health, Fargo, ND

Samantha Bartelt -- Behavioral Health Nurse Practitioner, Sanford Health, Fargo, ND

Brenda Wolles -- Clinical Standardization Administrator, Sanford Health, Sioux Falls, SD

Dr. Coreen McClellan -- Family Nurse Practitioner, Health & Vitality, Orem, Utah

Read Back and Verify (RBAV)
Ashley Demakis, MSN, RN
MB
Megan Bartsch
MB
Maxwell Boeckel
AC
Alyssa Chandler
AM
Ana Morelli
KV
Kyley Van Dyke

In this review, AI-driven tools were employed to streamline the synthesis of relevant literature. Using a language model, we analyzed and integrated key findings from a wide range of academic sources. The AI system helped to identify common themes, extract pertinent data, and consolidate the information into cohesive, summarized paragraphs. This process not only enhanced the efficiency of the review but also ensured that the resulting synthesis was comprehensive and consistent with the research objectives (OpenAI, 2025).

Medication errors remain a critical concern in healthcare, contributing to significant morbidity and mortality worldwide. Among the various types of medication errors, those resulting from verbal orders and automated dispensing cabinet (ADC) overrides are particularly dangerous, especially in high-pressure environments like emergency departments (EDs). Several strategies have been developed to address these challenges, with "read-back and verify" emerging as an effective tool in preventing errors related to communication breakdowns in medication orders. This literature review explores the impact of verbal orders, ADC overrides, and the role of "read-back and verify" in mitigating medication errors, with a focus on the necessity of clear communication and systemic safeguards to improve patient safety.

Verbal orders, often used in emergencies, carry significant risks for miscommunication. Unlike written or electronic orders, verbal orders are subject to environmental stressors such as background noise, distractions, and individual differences in pronunciation or accent, which can result in misunderstandings between healthcare providers. Errors arising from verbal orders can occur in various forms, including misheard drug names, incorrect dosages, or inappropriate routes of administration. Such errors have been linked to serious adverse events, such as respiratory arrest and hemodynamic instability, highlighting the life-threatening consequences of verbal miscommunications in healthcare (Coelho et al., 2024; Asadi et al., 2024).

While verbal orders are sometimes necessary in urgent situations, they present a major vulnerability in medication safety, particularly in environments like EDs where time, pressure, and high patient volumes exacerbate the potential for errors (Asadi et al., 2024). The risks associated with verbal orders are compounded when healthcare providers fail to follow clear communication practices. As a result, improving communication around verbal orders has become a priority for healthcare institutions aiming to reduce medication errors.

Automated dispensing cabinets (ADCs), widely used in hospitals to streamline medication delivery, also pose significant risks for medication errors, particularly when overrides are employed. ADC overrides allow nurses and other clinicians to access medications without prior pharmacist verification, which can lead to the retrieval of the wrong medication or incorrect dosage. While ADCs have been designed to improve medication access in critical situations, the ability to bypass safeguards increases the likelihood of mistakes. In the reviewed case, an ADC override allowed the administration of an incorrect medication, which contributed to the error involving midazolam administration (Mueller et al., 2024).

To mitigate risks associated with ADC overrides, the literature recommends implementing strict guidelines for when overrides should be used and ensuring that override actions are thoroughly documented and reviewed (Mueller et al., 2024). Healthcare systems are urged to limit override access to only essential medications and to configure ADCs to restrict access to drugs based on patient-specific profiles. Regular reviews of override activities are also crucial in identifying patterns of misuse and improving safety protocols.

One of the most widely recommended practices for reducing communication errors in healthcare is the use of "read-back and verify." This technique, commonly referred to as RBAV, involves having the recipient of a verbal order repeat back the medication details to confirm accuracy, thereby reducing the chance of miscommunication. Research has shown that the read-back method significantly improves the accuracy of information transfer, especially in high-stakes environments, such as emergency situations or intensive care units (Boyd et al., 2014).

A study by Boyd et al. (2014) demonstrated that the use of read-back in simulated clinical crises enhanced the clarity and accuracy of communication between healthcare providers, reducing the likelihood of medication errors. By requiring healthcare professionals to confirm the details of verbal orders, the read-back method ensures that both the prescribing and administering parties are aligned on critical information such as drug name, dosage, and administration route. This is particularly important in high-pressure scenarios, where distractions and misinterpretations can easily occur.

Beyond its role in verbal orders, the read-back technique is also effective in situations where complex clinical information, such as lab results or diagnostic orders, needs to be communicated. In emergency departments, where rapid decision-making is often necessary, implementing a consistent read-back protocol can prevent the transmission of incorrect information and enhance patient safety. Some institutions have incorporated read-back into computerized prescriber order entry (CPOE) systems, with significant reductions in error rates observed when the process is followed rigorously (Coelho et al., 2024).

Nurses play a central role in the medication administration process, yet they face significant legal and organizational pressures when it comes to implementing medical orders. High patient-to-nurse ratios, fatigue, stress, and unclear communication from prescribing physicians contribute to an environment where errors are more likely to occur. In some cases, nurses may engage in "selective order implementation," where they adjust or omit details in order to protect themselves from legal or professional consequences (Coelho et al., 2024). Such behaviors, driven by the fear of legal repercussions, can compromise patient care and lead to unsafe practices (Coelho et al., 2024).

The introduction of a robust read-back and verify system can help address some of these challenges. By ensuring that medication orders are clearly understood and confirmed, read-back techniques reduce the likelihood of mistakes and provide legal protection for nurses who follow the correct procedures. Furthermore, it promotes a culture of transparency, where errors are more likely to be identified and corrected before they reach the patient.

In addition to the factors contributing to medication errors such as verbal orders and ADC overrides, communication errors among healthcare providers themselves are a major source of medical mistakes. Medical errors more often result from miscommunication between providers than from a lack of medical knowledge (Kirschbaum & McAuliffe, 2018). The consequences of these communication failures are well documented, but the specific factors contributing to such errors are less frequently explored. A study of 3,000 nurse anesthetists revealed that latent cultural factors significantly influence communication behaviors and contribute to miscommunication in the operating room (Kirschbaum & McAuliffe, 2018). These findings highlight the need to better understand the underlying communication patterns that lead to errors, particularly in high-pressure environments like operating rooms. By identifying these latent variables, the study provides valuable insight into how communication behaviors can be better understood and addressed. Training protocols that incorporate these findings could ultimately improve communication practices and reduce errors in interprofessional healthcare settings, including the operating room.

Medication errors, particularly those arising from verbal orders and ADC overrides, remain a significant threat to patient safety in healthcare settings (Mueller et al., 2024). The adoption of "read-back and verify" techniques has proven to be a crucial strategy in mitigating these risks, improving the accuracy of verbal orders, and ensuring clear communication between healthcare providers (Boyd et al., 2014). While ADC overrides and verbal orders are sometimes unavoidable in urgent situations, healthcare organizations must implement strict policies and protocols to minimize the potential for errors (Mueller et al., 2024). As healthcare continues to evolve, ongoing research and systemic improvements are essential to developing effective strategies that safeguard both patients and healthcare professionals.

Article references 

Asadi, M., Ahmadi, F., Mohammadi, E., & Vaismoradi, M. (2024). A grounded theory of the

implementation of medical orders by clinical nurses. BMC Nursing, 23(1), 1--13.

https://doi.org/10.1186/s12912-024-01775-6

Boyd, M., Cumin, D., Lombard, B., Torrie, J., Civil, N., & Weller, J. (2014). Read-back improves information transfer in simulated clinical crises. BMJ quality & safety, 23(12), 989--993. https://doi.org/10.1136/bmjqs-2014-003096

Coelho, F., Furtado, L., Mendonça, N., Soares, H., Duarte, H., Costeira, C., Santos, C., & Sousa, J. P. (2024). Predisposing Factors to Medication Errors by Nurses and Prevention Strategies: A Scoping Review of Recent Literature. Nursing Reports, 14(3), 1553--1569. https://doi.org/10.3390/nursrep14030117

Kirschbaum, K., & McAuliffe, M. S. (2018). Team Communication in the Operating Room: A Measure of Latent Factors From a National Sample of Nurse Anesthetists. AANA Journal, 86(1), 11--18.

Mueller, C., MacDowell, P., & Bourgeois, J. A. (2024, April 24). PSNet. Verbal Orders and Medication Overrides: A Dangerous Combination. https://psnet.ahrq.gov/web-mm/verbal-orders-and-medication-overrides-dangerous-combination

OpenAI. (2025, February 12). ChatGPT (Version GPT-4) [Large language model]. https://chat.openai.com/

Combine technology and practical interventions to reduce burnout.
Lillee Gelinas, DNP, RN, CPPS, FAAN

This month’s article about burnout by Jocelyn Perez, MSN, RN, PCCN reminded me of a column I wrote a couple of years ago about the use of artificial intelligence (AI) to detect signs of staff burnout. Unfortunately, although 2 years have passed since I wrote that column, burnout remains a significant issue within nursing. As Perez notes, almost 18% of newly graduated nurses, citing stress and lack of staffing, leave the profession within 1 year. In addition, 69% of young nurses (under 25 years) report experiencing burnout.

Perez outlines a practical approach to applying mindfulness in the workplace as a strategy for addressing burnout. Knowing that staff burnout exists within an organization and identifying its root cause also offers opportunities for mitigation. As I described in my previous article, AI can help detect signs of staff burn­out using a range of methods and tools.

For example, data sources that healthcare organizations already use every day can analyze patterns of overtime, frequency of sick leave, and other workload-related data. Subtle trends in some performance indicators—such as increased error rates, reduced patient interaction time, or frequent tardiness—also may suggest burnout.

In addition, combining AI with employee engagement and satisfaction surveys can provide a window into stress levels. For instance, natural language processing can help analyze open-ended survey responses for signs of stress or discontent within a nursing unit.

Many hospital human resource (HR) departments have personnel who scan social media looking for various issues. With the appropriate ethical considerations and permissions in place, they can use AI to monitor and analyze public social media activity of staff for indications of burnout. In addition, text analytics and sentiment analysis applied to written or spoken communication can help gauge emotional tone, which also may indicate stress or burnout.

Individual nurses can use their wearable devices as sources of information. Biofeedback from smartwatches or similar devices can provide data on stress levels, sleep quality, and other health metrics, which nurses can then use to self-correct before issues become serious problems.

Researchers are training machine learning models to predict burnout based on workload, hours worked, and personal well-being metrics. This predictive analytics approach may prove one of the most valuable strategies for identifying the drivers of burnout and implementing interventions before it occurs.

The use of AI comes with some caveats, including data privacy. Whatever technology an organization uses to help detect and address burnout must comply with privacy laws and ethical guidelines. Organizations also want to work collaboratively with their information technology and HR personnel as well as with staff and leaders to ensure whatever approach they take meets the needs of the workers they want to support.

When burnout is detected among staff members, organization leaders must look for effective and practical interventions that nurses can apply in the workplace. The approach Perez and her team took at their organization offers promise and can easily be applied elsewhere. They even offer a budget justification—a useful tool for acquiring stakeholder buy-in. Ultimately, ethically applying the appropriate technologies and interventions can help organizations detect areas of concern, address them, and support nurses as they manage workplace stress.

American Nurse Journal. 2025; 20(3). Doi: 10.51256/ANJ032504

Purpose as a Business Game-Changer
Introducing the Concept of Business Purpose
Joshua M Evans

Understanding business purpose isn't just about having a mission statement on paper; it's about infusing that mission into the very heartbeat of your company. It's the difference between merely existing and thriving. A powerful purpose gives every team member a reason to jump out of bed in the morning and bring their best self to work. It's the magnetic force that attracts not just any talent, but the right talent---people who are passionate about what they do and why they do it.

Think of purpose as the foundation of a building. Without it, everything else is shaky and uncertain. With it, you have the strength to weather any storm. Purpose-driven companies are built to last because they operate from a place of conviction. They know what they stand for and make decisions that align with their core values. This clarity empowers teams to push boundaries and strive for excellence, creating a culture where innovation and resilience are the norms.

It's also about connection---connecting with your customers on a deeper level by showing them that your business stands for something meaningful. When your purpose is genuine and clearly communicated, it creates a bond of trust and loyalty that goes beyond transactions. This emotional connection is what turns casual customers into passionate advocates for your brand. So, embrace purpose not as a buzzword, but as the driving force that powers your business to new heights.

Influence on Financial Outcomes

A clear purpose isn't just a moral compass; it's a financial powerhouse. Companies that anchor their operations in a strong purpose see remarkable financial gains. They're not just chasing profits; they're creating value that resonates with their audience. This alignment attracts customers who not only buy products but buy into the brand's vision. This isn't just theory---it's backed by data. Firms with a defined purpose show higher sales growth and profitability.

When your business stands for something more than just revenue, you build a community of loyal customers who are willing to pay a premium for your products or services. Look at brands like Patagonia or Ben & Jerry's. Their unwavering commitment to environmental and social causes has translated into robust financial performance. Customers flock to them not just for what they sell but for what they represent.

Purpose-driven businesses also enjoy a halo effect on their financial metrics. Investors are increasingly looking for companies that are sustainable and responsible. By embedding purpose into your business DNA, you make your company more attractive to ethically-minded investors. They see long-term value in companies that are committed to making a positive impact.

Purpose isn't an optional add-on; it's a strategic asset. It helps you stand out in a crowded market, fosters customer loyalty, and ultimately drives financial success. This synergy between purpose and profit creates a resilient business model ready to thrive in any economic climate.

About the Author:
Joshua M. Evans is on a quest to fundamentally change the way people view their work by bringing deeper purpose into the workplace. Joshua uniquely combines his life experiences and corporate knowledge to craft immersive moments with all audiences.
Visit Joshua's Website HERE
Code Blue Simulation Literature Review
GK
Gloria Kennedy
EM
Emma Muhlenkamp
LR
Leelah Ramirez
JU
Jelina Urgel
TV
Thea Vogel
Ashley Demakis, MSN, RN

Introduction

Cardiopulmonary resuscitation (CPR) is a critical skill for healthcare professionals, as cardiac arrest can occur in any age group, and timely interventions can save lives. Simulation-based training has emerged as a highly effective tool to equip healthcare providers, particularly nursing staff, with the skills, knowledge, and confidence necessary to manage critical situations such as cardiac arrest. Simulation training enables participants to practice complex procedures and clinical decision-making without compromising patient safety by providing a safe and controlled environment. This review evaluates the impact of simulation-based training on CPR performance, identifies gaps in current research, and highlights recommendations for improving training methods. Through a synthesis of evidence, using AI as a tool of summary, this review also shows the importance of simulation-based training as a vital component of CPR education and its potential to enhance patient outcomes during a code blue.

Effectiveness of Simulation-Based Training

Simulation training significantly enhances both technical and non-technical skills among healthcare providers. A study of 65 final-year nursing students demonstrated improvements in knowledge, clinical reasoning, and confidence after structured programs (Sherif et al., 2021). Simulation provides opportunities to practice complex procedures and decision-making in a controlled, risk-free environment. To maximize its effectiveness, real-world settings and broader emergency scenarios should be incorporated into training programs, offering participants a more practical and comprehensive learning experience.

Impact on CPR Performance

Simulation training improves key CPR performance metrics, including response times, epinephrine administration, teamwork, and communication. A study at King Abdullah Specialized Children's Hospital, involving 82 mock code sessions, emphasized enhanced communication and problem-solving skills, particularly for teams with limited exposure to real-life cardiac emergencies (Hazwani et al., 2020). The replication of hospital scenarios during training also fostered confidence and competency, preventing skill deterioration over time (Neelanjana et al., 2023; Knipe et al., 2020). These findings show the importance of integrating simulation into regular CPR training to improve outcomes during a code blue situation.

5-Step Method

Traditional CPR training methods, while effective, often have limitations in long-term retention and application. The 5-step method addresses these gaps by emphasizing hands-on practice and immediate feedback, fostering engagement and skill acquisition (Kim & Ahn, 2019). This method includes theoretical instruction, demonstration, guided practice, independent practice, and performance assessment. A study involving 61 nursing students showed statistically significant improvements in CPR performance and attitudes following this method. Results emphasize the need for follow-up evaluations to ensure sustained competency. Further research into this approach could improve outcomes for pediatric and infant patients in emergencies.

Research Gaps

Despite its benefits, simulation-based training faces several limitations. Small sample sizes in many studies restrict generalizability (Neelanjana et al., 2023). Additionally, much of the research focuses on short-term outcomes, such as knowledge and skill retention immediately after training, rather than long-term effects on clinical behaviour and patient outcomes. Stress experienced by participants during simulations, although noted, remains underexplored, leaving gaps in understanding its impact on learning and performance (Sherif et al., 2021). Expanding the diversity of scenarios beyond standard cardiac arrests could further enhance training relevance.

Recommendations for Future Research

To address these gaps, future studies should prioritize larger, multi-institutional cohorts to improve generalizability. Including control groups would allow for more robust comparisons between simulation-based training and other methods. Long-term follow-up studies are essential to assess the sustained impact of training on clinical practice and patient outcomes (Hazwani et al., 2020). Additionally, incorporating diverse emergency scenarios and investigating the role of stress in simulation settings would improve the learning experience and better prepare participants for high-pressure clinical environments.

Conclusion

Simulation-based training has proven to be a transformative approach to CPR education, enhancing technical skills, teamwork, and confidence among healthcare providers. By addressing current research gaps through expanded studies, diversified scenarios, and long-term evaluations, simulation can further establish its role as a cornerstone of healthcare education. These efforts will ensure providers, nurses, student nurses, and all healthcare team members are well-equipped to manage real-world emergencies, ultimately improving patient safety and outcomes.

Article references 

Hazwani, T. R., Harder, N., Shaheen, N. A., Al Hassan, Z., Antar, M., Alshehri, A., Alali, H., & Kazzaz, Y. M. (2020). Effect of a pediatric mock code simulation program on resuscitation skills and team performance. Clinical Simulation in Nursing, 44, 42--49. https://doi.org/10.1016/j.ecns.2020.01.004

Kim, J. Y., & Ahn, H. Y. (2019, January 29). The effects of the 5-step method for infant cardiopulmonary resuscitation training on nursing students' knowledge, attitude, and performance ability. NIH. https://pmc.ncbi.nlm.nih.gov/articles/PMC8650898/

Knipe, G. A., Fox, S. D., & Donatello, R. A. (2020). Deliberate practice in simulation: Evaluation of repetitive code training on nursing students' BLS team skills. Clinical Simulation in Nursing, 48, 8-14. https://doi.org/10.1016/j.ecns.2020.08.001

Neelanjana, Pargaien, M., & Dubi, S. K. (2023). Efficacy of cardiopulmonary resuscitation training program on knowledge and practice of nursing students. International Journal of Nursing Education, 15(1). https://doi.org/10.37506/ijone.v15i1.18991

OpenAI. (2023). ChatGPT (Mar 14 version) [Large language model]. https://chat.openai.com/chat

Sherif, L., D\'Cunha, R. J., & Fernandes, S. F. (2021). Utility of simulation as a teaching tool for nursing staff involved in code blue management. Indian Journal of Critical Care Medicine, 25(8), 878--880. https://doi.org/10.5005/jp-journals-10071-23912

Recognizing When Your Loved One Needs In-Home Care

Determining whether a loved one needs in-home care can be a difficult decision, but recognizing the signs early can ensure they receive the support they need to maintain their well-being and independence. At Dakota Home Care, we specialize in compassionate, personalized in-home care to help your loved ones thrive in the comfort of their homes.

Here are some key indicators that suggest in-home care may be beneficial:

1. Decline in Physical Health

  • Difficulty with daily activities: If your loved one struggles with tasks like bathing, dressing, cooking, or getting in and out of bed, it may be time to consider professional assistance. Dakota Home Care’s team can help with these daily needs, ensuring your loved one stays safe and comfortable.
  • Frequent falls or balance issues: If they are at risk of falling or have experienced multiple falls, our caregivers can provide supervision and support to reduce these risks.
  • Mobility challenges: Whether it’s difficulty moving around the house or navigating stairs, our care team can assist with mobility and ensure their living environment is safe and accessible.

2. Cognitive Changes

  • Memory loss or confusion: Forgetting to take medications, missing appointments, or getting lost in familiar places may signal cognitive decline, such as dementia or Alzheimer’s. Dakota Home Care provides specialized memory care tailored to these needs.
  • Difficulty with decision-making: If decision-making has become challenging, our caregivers can help manage daily tasks, keeping your loved one organized and stress-free. 

3. Changes in Mental Health

  • Depression or withdrawal: Isolation and lack of interest in activities are common signs of emotional struggles. Our caregivers provide companionship and engage your loved one in
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4. Safety Concerns

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5. Increased Dependence

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6. Health Conditions or Chronic Illnesses

  • Managing chronic conditions: For individuals with chronic diseases such as dementia, diabetes, heart disease, COPD, or other debilitating conditions, Dakota Home Care offers skilled nursing in addition to home health aide services to monitor and manage their healthcare needs effectively.
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7. Unexplained Weight Loss or Poor Nutrition

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8. Financial or Legal Concerns

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Next Steps

  1. Start the conversation: Discuss your concerns with your loved one, expressing care and understanding. Introduce in-home care as a way to enhance their quality of life.
  2. Assess their needs: Consult a doctor, nurse, or geriatric care specialist to determine the level of care required.
  3. Reach out to Dakota Home Care: As a trusted in-home care provider in North Dakota, we offer a range of services tailored to your loved one’s needs, from companion care to skilled nursing support.

If you’ve noticed any of these signs, Dakota Home Care is here to help. Our dedicated caregivers provide personalized care that prioritizes safety, comfort, and dignity. Call us today at (877) 691-0015 or visit our website at www.dakotahomecare.com to learn more about how we can support your family. 

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