By Cornelius Metili BSN, RN, PMH-BC 

“Once my loved ones accepted the diagnosis, healing began for the entire family, but it took too long. It took years.”1 

Bebe Moore Campbell spoke those words in 2005. She was referring to her daughter, to bipolar disorder, and to the years it took her own family to find its way to a conversation it did not know how to have. Campbell was an acclaimed author and journalist, but the work that would outlast everything she ever published began at home. Her family was navigating a mental health care system that was not prepared to meet them where they were, and a silence inside the family that made it harder to ask for help. 

Like many caregivers, Campbell searched for help in crisis. What she found first was not a policy or program, but other mothers carrying the same grief and fighting the same battles with insurance, stigma, and fear. Those connections led her to National Alliance on Mental Illness (NAMI)’s Family-to-Family program, a free, evidence-based course for families navigating mental illness.2 She completed the course and became an instructor. But for Campbell, teaching was not enough. She wanted the course in Black communities, in spaces free from the compounding weight of racial stigma. As she told TIME magazine: “African Americans and people of color already feel stigmatized by virtue of our race. Therefore, we really don’t want to own up to something else that could be used against us.”3 

Mental illness can be marginalizing on its own. A diagnosis may carry stigma, fear, and silence before race, culture, sexuality, immigration status, or housing instability are even considered. For minority communities, those burdens compound, making distress harder to name, care harder to seek, and suffering easier to misunderstand. 

Campbell co-founded NAMI Inglewood in a predominantly Black Los Angeles community. What began as a space for Black families grew to serve multiple minority communities, and the chapter became NAMI Urban Los Angeles to reflect the diversity of the population it served.4 

What Campbell was building in 2003 was peer support and cultural responsiveness. The Substance Abuse and Mental Health Services Administration would not formally recognize these as foundational pillars of trauma-informed care until 2014, eleven years later.5 She died in 2006 before those principles were formally named. 

In 2008, July was designated as Bebe Moore Campbell National Minority Mental Health Awareness Month.6 That designation was not ceremonial. It was a call to action, one that the nursing profession is uniquely positioned to answer. 

In 2021, three leading national organizations in pediatric medicine — the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association — declared a national state of emergency in child and adolescent mental health, naming racial inequity as a contributing factor.7 The declaration did not begin the crisis; it named what years of data had already made clear. Nearly five years later, the emergency persists. Suicide rates among Black youth ages 10 to 17 rose 144% between 2007 and 2020.8 By 2022, the gun-suicide rate among Black teens surpassed that of White teens for the first time on record.9 Among Black children under 13, suicide rates have been reported at twice the rate of their White peers.10 

Campbell’s advocacy began with Black families, but the pattern she named was not confined to one community. For youth living at the intersection of multiple marginalized identities, the risk compounds. Although LGBTQ+ youth represent a minority of the general youth population, they are disproportionately represented among youth experiencing homelessness, with some estimates as high as 40%.11 Housing instability is associated with more than three times the odds of a past-year suicide attempt.12 Among Black LGBTQ youth, 44% reported seriously considering suicide in the past year.13,14 Among Black transgender and nonbinary young people, just over one in four reported a past-year suicide attempt.13,14 

Researchers are now studying marginalized youth with greater specificity than the field has historically provided. This is progress that is both welcome and overdue. Black youth, LGBTQ youth, immigrant youth, Latina youth, and youth experiencing housing instability do not experience risk as a single, uniform category. Nursing practice must be broad enough to recognize disparity and specific enough to respond to the person in front of us. When Black youth enter clinical settings, what may be distress is sometimes treated first as defiance or noncompliance rather than fully assessed as depression, trauma, grief, or unmet need.15 

The barriers to minority mental health extend beyond access to care. Research consistently identifies stigma, self-reliance, mistrust, social network influences, and other cultural and structural obstacles to mental health help-seeking in Black communities.16 

These are not deficits. They are survival patterns. But silence functions as its own form of instruction. When emotional honesty and vulnerability are absent at home, children internalize the message that these experiences are not to be discussed. They learn to conceal their distress, to manage their needs independently, and to repeat the patterns they observe. 

The ED-STARS study gives empirical weight to this concern. Conducted across 14 pediatric emergency departments with 5,514 youth ages 12 to 17, it found that family connectedness — one of the strongest known protective factors against suicide — remained protective for Black youth but was significantly less protective than for White youth.17 When stigma renders mental illness unspeakable within close family relationships, the resulting isolation may compound the very risk connectedness is expected to mitigate. 

Stated plainly: children are struggling in loving homes. This is not a new phenomenon. It is Campbell’s story. It is her daughter’s story. The diagnosis may differ, but the silence is the same. 

Family-to-Family has been validated through randomized controlled trials as an evidence-based intervention,18,19 but its importance in Campbell’s story is more than methodological. It offers families what silence takes away: a space to name mental illness, build skills, and practice acceptance together. The research and Campbell’s instinct are not separate narratives. They are the same narrative, separated by twenty years. Families cannot support what they have never been given space to understand. 

The silence described here is not generationally contained. It is present in parents who cannot name what is happening to their children, in grandparents who respond with prayer but were never given the language to pair faith with honest conversation, and in the young man who has known he is gay since he was fourteen and has never said it out loud because he is not sure his family’s love will survive the truth. Nurses across all specialties and settings will encounter patients carrying this silence. Cultural competence can guide us, but cultural humility is what  prevents us from assuming we already know the patient’s story. Minority Mental Health Awareness Month is not symbolic. It is not performative. It exists because Bebe Moore Campbell helped name a crisis that communities had been carrying long before institutions formally declared it. The 2021 national emergency declaration did not create that urgency; it confirmed that the need remains unresolved. 

Nursing has always been both a science and an art. The science trains the profession to assess, intervene, evaluate, and act with clinical competence. The art asks something different: to listen for what is not being said, to recognize when certainty becomes assumption, and to remain open to the patient’s lived experience. Cultural humility lives in that space. It does not replace clinical knowledge. It deepens it by affirming that the patient remains the expert on their own life. 

This kind of self-reflection may be the most underutilized clinical tool in our profession. It asks us to sit with what we do not know, to question what we assume, and to let what we learn change how we practice. 

In my own practice as a psychiatric-mental health nurse, these are some commitments/takeaways I return to at the bedside: 

1. Treat irritability, withdrawal, and silence as clinical information before labeling them as behavioral problems. 

2. Reframe the power dynamic and position the patient as the expert and authority on their own life. Try and guide the patient through difficult moments without taking ownership of their story. 

3. If you share your patient’s cultural background, name the weight of that. You may be the only person in the room who understands what the family is carrying, and that understanding is both your strength and your vulnerability. It is ok to give yourself permission to set boundaries around it. 

4. Build a habit of reflecting on the experiences that stay with you and process them with intention. A thoughtful debrief is not gossip; it is a professional practice that helps nurses make meaning, strengthen judgment, and care for themselves and their patients more effectively. 

5. Add to your repertoire. One in five people will experience a mental health condition. That means every specialty, every unit, every setting. Pursue evidence-based education in suicide prevention, trauma-informed care, and cultural humility through organizations like the American Psychiatric Nurses Association. These are not niche competencies. They are foundational ones. 

Campbell’s legacy was built on love, community, and leadership. She responded to her daughter’s diagnosis by creating what other families needed: language, support, and a place to be understood. This year marks twenty years since her death. We honor her not only by remembering her name, but by carrying her urgency into our practice and by doing the work that helps us meet our patients where they are. 

REFERENCES  

1. National Alliance on Mental Illness. (n.d.). About Bebe Moore Campbell National Minority Mental Health Awareness Month. https://www.nami.org/stay-connected/events/awareness-events/bebe-moore-campbell-national-minority-mental-health-awareness-month/about-bebe-moore-campbell-national-minority-mental-health-awareness-month/ 

2. National Alliance on Mental Illness. (n.d.). Family-to-Family. https://www.nami.org/Support-Education/Mental-Health-Education/NAMI-Family-to-Family/ 

3. Campbell, B. M. (2005). Between the lines with Bebe Moore Campbell. TIME Magazine. https://time.com/archive/6918760/between-the-lines-with-bebe-moore-campbell/ 

4. National Alliance on Mental Illness. (2023). Honoring and upholding Bebe Moore Campbell’s legacy. https://www.nami.org/blog/honoring-and-upholding-bebe-moore-campbells-legacy/ 

5. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884). https://library.samhsa.gov/product/samhsas-concept-trauma-and-guidance-trauma-informed-approach/sma14-4884 

6. H. Con. Res. 134, 110th Cong. (2008). Expressing the sense of the Congress that there should be established a Bebe Moore Campbell National Minority Mental Health Awareness Month. https://www.congress.gov/bill/110th-congress/house-concurrent-resolution/134 

7. American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, & Children’s Hospital Association. (2021). Declaration of a national emergency in child and adolescent mental health. https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/ 

8. Cubbage, J., & Adams, L. (2023). Still ringing the alarm: An enduring call to action for Black youth suicide prevention. Johns Hopkins Center for Gun Violence Solutions, Bloomberg School of Public Health. https://publichealth.jhu.edu/sites/default/files/2023-08/2023-august-still-ringing-alarm.pdf 

9. Johns Hopkins Center for Gun Violence Solutions. (2024). Gun violence in the United States 2022: Examining the burden among children and teens. Johns Hopkins Bloomberg School of Public Health. https://hub.jhu.edu/2024/09/12/gun-deaths-us-children-and-teens/ 

10. Sheftall, A. H., Vakil, F., Ruch, D. A., Boyd, R. C., Lindsey, M. A., & Bridge, J. A. (2022). Black youth suicide: Investigation of current trends and precipitating circumstances. Journal of the American Academy of Child & Adolescent Psychiatry, 61(5), 662–675. https://doi.org/10.1016/j.jaac.2021.08.021 

11. Durso, L. E., & Gates, G. J. (2012). Serving our youth: Findings from a National Survey of Service Providers Working with LGBT Youth who are Homeless or At Risk of Becoming Homeless. Williams Institute with True Colors Fund and The Palette Fund. https://williamsinstitute.law.ucla.edu/publications/serving-our-youth-lgbtq/ 

12. The Trevor Project. (2022). Homelessness and housing instability among LGBTQ youth. https://www.thetrevorproject.org/research-briefs/homelessness-and-housing-instability-among-lgbtq-youth-feb-2022/ 

13. Siff, L., & Molock, S. (2025). Pathways to hope: Redefining suicide prevention for Black LGBTQ youth. Mental Health Science, 3(1), e70004. https://doi.org/10.1002/mhs2.70004 

14. The Trevor Project. (2021). All Black Lives Matter: Mental health of Black LGBTQ youth. https://www.thetrevorproject.org/wp-content/uploads/2021/07/All-Black-Lives-Matter-Mental-Health-of-Black-LGBTQ-Youth.pdf 

15. Child Mind Institute. (n.d.). Misdiagnosis of mood disorders in Black teenagers. https://childmind.org/article/misdiagnosis-mood-disorders-black-teenagers/ 

16. Planey, A. M., Smith, S. M., Moore, S., & Walker, T. D. (2019). Barriers and facilitators to mental health help-seeking among African American youth and their families: A systematic review study. Children and Youth Services Review, 101, 190–200. https://doi.org/10.1016/j.childyouth.2019.04.004 

17. Merai, R., Shi, T., Wei, A. X., Ruch, D. A., Bridge, J. A., Pao, M., & Horowitz, L. M. (2025). The moderating role of race/ethnicity in suicide risk and family connectedness in youth presenting to the emergency department. JAACAP Open, 3(3), 448–454. https://doi.org/10.1016/j.jaacop.2024.10.009 

18. Dixon, L., Lucksted, A., Medoff, D., Burland, J., Stewart, B., Lehman, A. F., Fang, L. J., Sturm, V., Brown, C., & Murray-Swank, A. (2011). Outcomes of a randomized study of a peer-taught Family-to-Family education program for mental illness. Psychiatric Services, 62(6), 591–597. https://doi.org/10.1176/appi.ps.62.6.591 

19. Mercado, M., Fuss, A. A., Sawano, N., Gensemer, A., Brennan, W., McManus, K., Dixon, L. B., Haselden, M., & Cleek, A. F. (2016). Generalizability of the NAMI Family-to-Family education program: Evidence from an efficacy study. Psychiatric Services, 67(6), 591–593. https://doi.org/10.1176/appi.ps.201500519 

• Ebony S. Gebrehawariat, BSN, RN – Temple  
• Gina Alvarez, MSN, RN, CNEn – San Antonio   
• Serena Tobar, MSN, RN, NPD-BC – Dickinson (Houston)   
• Halli Carr, DNP, APRN, ACNP-BC, CNE – Rockwall   
• Veronica Ceaser, MSN, MBA, RN, GERO-BC, CMGT-BC, NE-BC – Lewisville (DFW)   
• Lori Forbus DNP, RN, NEA-BC, CENP – Midland  
• Daniel Cabrera, DNP, MBA, RN – Laredo  

Prior to traveling to Washington, D.C., these representatives reviewed key issues, topics, and proposed bylaw changes to ensure they were prepared to vote on behalf of TNA members. Upon arrival they were able to hear the issues discussed and debated prior to voting. MA representatives also met with congressional offices to advocate for nursing and discuss issues affecting the profession. This milestone represents the culmination of efforts that began in 2017, when the Membership Assembly voted to allow LVNs and LPNs to participate in state nurses associations. Over the past decade, many state associations have gradually amended their bylaws to include LVN and LPN membership. 

What’s Next? 

As ANA fully integrates LVNs and LPNs into national membership, current TNA LVN members will maintain their membership status. One anticipated change is that ANA membership dues for LVNs and LPNs will align with RN membership rates. While final implementation details are still being determined, ANA expects to provide additional information as it works toward full implementation by July 1, 2027. ANA has asked those interested to complete the LPN/LVN membership interest form so they can better plan for implementation.  

From a TNA perspective, we will continue to be the voice of all Texas nurses and invite LVNs to join today If you have not already done so, please encourage your LVN colleagues across Texas to join TNA. Membership is $60 per year for LVNs and they can pay monthly or on an annual basis. Within TNA districts, members can become involved through leadership roles, volunteer activities, educational programs, and committee service. In the next year the TNA LVN statewide committee looks forward to continuing to elevate LVN practice through educational and networking events.  

Final Thoughts 

Texas has approximately 70,000 LVNs who provide essential care in hospitals, clinics, long-term care facilities, schools, and other community settings. This bylaw change strengthens nursing’s collective voice and creates greater opportunities for collaboration across all levels of nursing practice. The inaugural LVN Director of the TNA Board of Directors stated, “This is an exciting time for LVNs in Texas. Now more than ever nurses need to work together to learn and grow so we can take care of all Texans,” Adam Ramirez, LVN. As Adam transitions out of his role on the TNA Board of Directors, Nancy Ornelas, LVN will take his place on the board of directors. Ornelas looks forward to LVNs “owning their profession in a new way while participating in meetings and events across the state.” When asked about the next two years of LVN practice Ornelas responds, “the future is bright for LVNs and I have a goal to increase engagement and participation of LVNs across the state.” As TNA and ANA work together to ensure an equal voice for ALL nurses, we hope each of our members will invite their nursing colleagues to join in on the discussion.  

REFERENCES 

American Nurses Association. (2026, June 27). American Nurses Association Membership Assembly votes to approve landmark bylaws change to include LPNs/LVNs. https://www.nursingworld.org/news/news-releases/2026-news-releases/american-nurses-association-membership-assembly-votes-to-approve-landmark-bylaws-change-to-include-lpnslvns/  

Texas Department of State Health Services, Texas Center for Nursing Workforce Studies. (2024, March). 2022–2036 nurse supply and demand projection executive summary. https://www.dshs.texas.gov/sites/default/files/chs/cnws/2023_SupplyDemandReport_ExecutiveSummary.pdf 

 

 

Most nurses have a “why,” the story of what brought them to the profession. My story began December 17th, 1983. Until that day, I was a “normal” 17-month-old—other than losing a lot of weight, regressing on my milestones, and laying on a cold floor and crying most of the time. While my family fought for me, a pediatrician told them that I was too young to have diabetes. After seeing my blood glucose, and admitting that I might have diabetes after all, said provider gave me intravenous dextrose and sent me on a 30-minute-ambulance ride, at the end of which I would present to a pediatric facility with a blood sugar over 1400 mg/dL. I was in active diabetic ketoacidosis (DKA).  

Most individuals who are diagnosed with type 1 diabetes present in DKA—a dangerous and costly complication with cumulative effects (Bell & Lain, 2025). In the emergent phase, DKA is traumatizing and debilitating. At the same time, approximately 50-60% of new diagnoses of type 1 diabetes are in the adult population. Juvenile-onset and adult-onset diabetes no longer exist (American Diabetes Association [ADA], n.d.). Approximately 50-60% of newly-diagnosed patients are adults ages 20 and above (Fang et al., 2023). Given the current health state of the nation, as many as two-thirds of patients with type 1 are considered overweight or obese (Fang et al., 2023). Type 1 diabetes does not discriminate by age or size. I cannot stress enough the importance of discarding these stereotypes. Many patients have been misdiagnosed—almost to their demise—because of these preconceived notions.  

Did you know that it is now possible to screen individuals for autoantibodies associated with type 1 diabetes so that they are aware before they can reach a DKA state? Type 1 diabetes is now identified by three separate stages (Insel et al., 2015). The third stage is clinical diabetes, the stage in which type 1 is confirmed—usually in a DKA stage (Fang et al., 2023). Not only is screening available, there are also medications available to be given in stage 2 that can delay the need for insulin and preserve insulin-making cells for years before they actually need injected insulin. All it takes is a simple blood test. While these can be done in screening centers nationwide, outside labs, or even at home, Breakthrough T1D (formerly Juvenile Diabetes Research Foundation [JDRF], n.d.) has an excellent screening decision tool that assists care providers and families in determining their screening options.  

Why is it important? As a long-term patient, it would be easy for me to say, “They’re going to develop autoimmune diabetes—it doesn’t matter when they find out.” If the prevention of DKA and its associated complications aren’t enough to convince you, let me tell you a little more of my story: I grew up in a rural setting in a situation for which Medicaid wasn’t possible, even though my single-parent household income was below the poverty line. As pre-existing conditions as they pertained to health insurance were in effect, I did not qualify for coverage. As a result, my mother spent half her income every month buying the supplies necessary to keep me alive. No child should ever learn to divide by watching their parent spend most of their income on their medical condition.  

When I think about that, I wonder, “What if I knew I would have time to plan for this?” Type 1 diabetes is a costly condition accompanied by continuous financial hurdles. As of right now, it’s a lifelong process. This is for a condition they never asked for and they couldn’t have stopped. Yes, it is true that patients with two or more antibodies will almost certainly develop clinical autoimmune type 1 diabetes (Ziegler et al., 2013). However, if patients had time to plan, isn’t that worth it? We as nurses would have more time to advocate for our patients and provide education that can prevent costly episodes of DKA.  

The good news is that screening is easier than ever. At a basic level, all you have to do is plant the seed simply by making families aware that this a possibility within their reach. These conversations can be had at the bedside, in the clinic setting, or even over coffee. If a family is still unsure of whether or not they should be screened, you can direct patients to this link that will provide information about the benefits of screening, next steps, and general answers to frequently asked questions. One of the most important things you can do is honor an individual’s wishes if they ask to be screened. Direct them to a screening center or an at-home kit.  

At a higher level, you can make families aware of screening centers, or provide information regarding how to obtain an at-home screening kit. When you’re providing an introduction to this concept, it is very important that you don’t make promises or guarantees. For example, just because a potential patient exhibits one autoantibody does not mean they will develop additional antibodies or clinical autoimmune diabetes.  

In the landscape that is type 1 diabetes, these are exciting times. What was an almost guaranteed scenario at diagnosis is now becoming a memory. Nurses have the opportunity to be at the forefront of these efforts.

What can you do? Recommend screening of all first-degree relatives in your setting, regardless of age. This is one of the easiest things you can do in your practice to ease financial, physical, and emotional burden. What a powerful place to be. If I had to guess, these are things that fulfill the why that brought us to this forward-facing profession in the first place.  

As for me? My story has been full of successes and setbacks—and I am proud to have used all of those to help others rewrite their story. You are in a powerful position to do the same.  

 

REFERENCES


American Diabetes Association. (n.d.). Diabetes related common terms. https://diabetes.org/about-diabetes/common-terms  

Bell, K. J., & Lain, S. J. (2025). The changing epidemiology of type 1 diabetes: A global perspective. Diabetes, Obesity and Metabolism, 27(Supp. 6), 3-14. https://doi.org/10.1111/dom.16501  

Breakthrough T1D. (n.d.). Detecting type 1 diabetes. https://www.breakthrought1d.org/early-detection/  

Fang, M., Jeon, Y., Echouffo-Tcheugui, J. B., & Selvin, E. (2023). Prevalence and management of obesity in U.S. adults with type 1 diabetes. Annals of Internal Medicine, 176(4), 427-429. https://doi.org/10.7326/m22-3078  

Fang, M., Wang, D., & Echouffo-Tcheugui. (2023). Age at diagnosis in U.S. adults with type 1 diabetes. Annals of Internal Medicine, 176(11), 1567-1568. https://doi.org10.7326/m23-1707  

Insel, R. A., Dunne, J. L., Atkinson, M. A., Chiang, J. L., Dabelea, D., Gottlieb, P. A., Greenbaum, C. J., Herold, K. C., Krischer, J. P., Lernmark, A., Ratner, R. E., Rewers, M. J., Schatz, D. A., Skyler, J. S., Sosenko, J. M., & Ziegler, A-. G. (2015). Staging presymptomatic type 1 diabetes: A scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care, 38(10), 1964-1974. https://doi.org/10.2337/dc15-1419  

Ziegler, A. G., Rewers, M., & Simell, O. (2013). Seroconversion to multiple islet autoantibodies and risk of progression to diabetes. JAMA, 309(23), 2473-2479. https://doi.org/10.1001/jama.2013.6285  

REFERENCES

American Association of Critical-Care Nurses. (2023). AACN scope and standards for acute and critical care nursing practice. AACN.  

National Association of Neonatal Nurses. (2022). Neonatal nursing: Scope and standards of practice (3rd ed.). HealthCom Media. 

• Association of PeriOperative RNs, Greater Houston
• Association of Operating Room Nurses North Harris Montgomery County
• Consortium of Texas Certified Nurse Midwives
• Houston Chapter of Oncology Nursing Society
• Houston Texas Association of Occupation Health Nurses
• Houston Organization for Nursing Leadership
• Psychiatric Advanced Practice Nurses of Austin
• Psychiatric Advanced Practice Nurses of Texas
• Texas Association of Deans & Directors of Professional Nursing Programs
• Texas DNPs
• Texas Association for Home Care and Hospice
• Texas Association of Vocational Nurse Educators
• Texas Collaboration of periOperative Nurses
• Texas Nurses Association
• Texas Nurse Practitioners
• Texas Nursing Students Association
• Texas Organization for Associate Degree Nursing
• Organization of Baccalaureate and Graduate Nursing Education
• Texas Organization for Nursing Leadership
• Texas School Nurses Organization
• Texas Association of Nurse Anesthetists
• Texas Clinical Nurse Specialists
• Texas Emergency Nurses Association

During the May convening, coalition members discussed a variety of timely topics, including the results of a recent vaccine survey, election outcomes and their implications for healthcare policy, changes in federal policies affecting nurses, and preparations for the coalition’s fall meeting scheduled for November. One of the most significant discussions centered on findings from a vaccine survey conducted by Rational 360. The survey sought to better understand prevailing attitudes, beliefs, and perceptions regarding vaccines among Republican voters in Texas and to assess how the recent Texas measles outbreak may be influencing those views. 

Key findings revealed a strong pro-vaccine consensus among Texas Republicans, widespread support for lawmakers taking steps to prevent future outbreaks, and a high level of trust in medical expertise when compared to political authority on matters related to public health. These findings provide important context for future legislative discussions and highlight opportunities for nurses to serve as trusted voices in public health education and advocacy. The results also reinforced the importance of the Texas Nurses Association’s Vaccine Task Force and ongoing policy work as the profession prepares for the next legislative session. 

Elections continue to play an integral role in shaping how NLAC approaches legislative advocacy. While several runoff elections took place in May, attention is already turning toward the general election in November. Policymakers elected this year will help shape the environment in which nursing priorities are considered during the 2027 legislative session. For that reason, civic engagement remains critically important. All TNA members are encouraged to ensure they are registered to vote and prepared to participate in upcoming elections. To learn more about voter registration requirements and eligibility criteria, visit https://www.votetexas.gov/ for more information. 

At the federal level, nurses across the country have become increasingly aware of ongoing congressional discussions regarding professional degree designations and the potential implications for the nursing profession. In response, the American Nurses Association is actively engaging with lawmakers and key stakeholders to address concerns raised by nurses and nursing organizations nationwide. The status of these discussions continues to evolve, and ANA is closely monitoring developments while advocating on behalf of the profession. Nurses are encouraged to stay informed, review available resources, and participate in advocacy efforts by sharing their perspectives and responding to requests for feedback. The status of the professional degrees dialogue is actively being reviewed, and nurses can learn more and take action by submitting a response.  

As preparations for the 2027 legislative session continue, the work of NLAC demonstrates the power of collaboration among nursing organizations. By engaging early, building consensus, and maintaining a strong presence in policy discussions, Texas nurses are helping shape a legislative agenda that advances the profession, strengthens healthcare systems, and improves the health of Texans across the state. If you would like to learn more about how your organization can join the coalition email us at tna@texasnurses.org. 

REFERENCES

American Nurses Association. (n.d.). Health policy. ANA. Retrieved June 2, 2026, from https://www.nursingworld.org/practice-policy/health-policy/ 

Chiu, P., Villeneuve, M. J., Cummings, G. G., & Benton, D. C. (2021). Policy advocacy and nursing organizations: A scoping review. Policy, Politics, & Nursing Practice, 22(4), 271–293. https://doi.org/10.1177/15271544211051062  

Han, N. K., Kim, S., & Park, H. (2024). The barriers and facilitators influencing nurses’ political participation and healthcare policy engagement: An integrative review. Healthcare, 13(5), 533. https://doi.org/10.3390/healthcare13050533

By Laura Kincheloe, Ed.D., MSN, RN, NE-BC and Elaina Diaz, MSN, RN, NPD-BC, CMSRN 

To the Licensed Vocational Nurse (LVN) who taught me every tip and trick while working as a nurse tech, thank you. I remember how excited I was to be working while in nursing school. I was nervous about getting into a good routine, but you were always there with a smile and an opportunity. It was the first time I really understood how LVNs and Registered Nurses (RN) could work so harmoniously together. I can’t thank you enough for showing me the tricks and tips with activities of daily living (ADLs) and how to put on compression stockings.  

To the nurse preceptor who I still look up to today, even after all these years, thank you. You welcomed me into this profession and encouraged me in each phase of my learning. You set goals with me and validated me and ensured that we had a policy for the actions we took. You sat next to me for my first call to the doctor and then provided me with feedback when I had to call them right back because I forgot to read back the order I was given. You probably don’t remember that, but it was a monumental moment for me. You were there for me when I lost both my parents, when I accepted a charge nurse role, and when I left for new opportunities. You have remained a huge encourager from afar and for that, I thank you.  

To the nursing student who helped me survive nursing school and became one of my lifelong friends, thank you. You may have thought my dreams and aspirations were crazy, but you always cheered me on. We were student leaders together in nursing school and learned to be adults together. You taught me about the importance of sleep and exercise while also ensuring we took time for laughing and fun. I became who I am today because of your friendship and for that, I am eternally grateful.  

To the nursing instructor who believed me when I was too shy to take those first steps into the role of the nurse, I thank you. Your gentle introduction, step back, and presence remained long after you left the room and stayed with me in the next, and the next. Over and over the light bulb moments came on sparking confidence in those steps. You set a foundation of strength designed to grow over a lifetime, thank you.  

To the orientee who helped me remember who I am as a nurse and nurse I want to be every day, thank you. Your excitement, nervous energy (at times), and will to do your best reminded me that you are looking at me to channel these newfound responsibilities into your identity as a professional nurse. The care, the charting, the tasks, and the unexpected turn of events will always be there, it’s how we approach them that makes us who we are as nurses. The difference you have made in my life will never be forgotten.  

To the nurse leader who pushed my boundaries of success beyond what I could see myself accomplish in my career, thank you. Encouraging me to move past what if they no, to what if they say yes. I have learned a no is not an end but an opportunity to keep looking for the next one. Every opportunity to share, collaborate, teach, or lead with one nurse, or hundreds, is a golden moment of connection. Thank you for your grace and patience.  
 

Happy National Nurses Week, to all of the amazing nurses out there! 

To learn more about Nurses Week 2026, please visit our Nurses Week webpage, the easiest way for you to learn what TNA, ANA and others are doing to recognize your work. 

As I lay in bed, I check the time. It’s 11:07 pm. I need to be up at six o’clock in the morning to get my kids ready for school and myself ready for work. I hate nothing more than being tardy. I know I have already cut into an hour of the generalized prescription of eight hours of sleep I am told is best for me. But I don’t stop myself. I keep doom scrolling or reading on my kindle until my eyes won’t stay open.  

What is wrong with me? I am intelligent enough to know this isn’t good for me, yet I live in this pattern most nights, getting five to six hours of sleep (also thanks to the inevitable middle of the night wake-ups from my dogs or kids). I’m chronically tired and pretend I don’t know why.

 This sleep resistance is also known as an emerging concept in sleep medicine called revenge bedtime procrastination. It’s something more and more of us (children and adults) are falling into as our days become more stressful and demanding. We just want time to ourselves, time to get our mind numbingly entertained by our phones and get that quick dopamine hit from a funny video. But of course, this dopamine hit comes at a cost. Participants in this are chronically tired. According to the sleep foundation, those that are chronically sleep deprived are also more likely to have reduced thinking skills, memory,  and ability to make decisions,  all skills nurses require for optimal patient care. They are also putting themselves at a higher risk for metabolic an cardiovascular disorders. While research is just starting on his particular phenomenon, the poor effects of lack of sleep are well known.   

So why aren’t nurses talking about it more? When thinking about all the damage poor sleep can have on people, we should be addressing this with our patients regularly. Sleep hygiene might seem obvious to some, but sometimes people don’t truly know the damage they are doing to themselves by procrastinating sleep, and assume their inability to focus on work or school is a mental health disorder or behavioral problem only.   

The American Academy of Sleep Medicine has a wonderful educational site for patients to use that lists some simple but powerful sleep recommendations to attain the sleep we need. Some recommendations they list include:   

• Limited Screens: Screens and our endless access to them are not helping. Askyourself and your patients to put them down at a certain time (about 30 minutes before bedtime).  
• Get on a sleep schedule:  A consistent schedule for sleep is also an important step; it helps your brain and body start to expect sleep to happen.  
• Foods to avoid:  Avoid large meals, caffeine, or alcohol right before bed.   

Especially in the current stressful political landscape we are all navigating ourselves through, it is necessary to demand priority on sleep. Demand it of ourselves, demand it of others.  

We need sleep to clear our brains of all the junk—literally! Our brain has a lymphatic system, the glymphatic system, that only works well when we are getting appropriate sleep. So don’t hesitate to discuss sleep with your patients, encourage better sleep, or send them to a sleep specialist when they are really struggling.   

Nurses’ ability to rest is an important part of how they are able to manage all of the many key details surrounding patient care needs. Despite having a chaotic work environment, nurses should implement changes in their daily environment to encourage more restful sleep, avoiding negatively impacting habits, so they can provide high quality, focused care to patients.  

Sleep is not a luxury, it is a necessity. Nurses may openly celebrate when five or six hours of sleep revitalizes them, but the fact is that all humans, regardless of nursing superhuman strength, need eight hours of sleep every night.   

REFERENCES

American Academy of Sleep Medicine, (2020, August) Healthy Sleep Habits. Sleep Education.  https://sleepeducation.org/healthy-sleep/healthy-sleep-habits/  

Suni, E. (2025, July 15). Revenge Bedtime Procrastination. Sleep Foundation.  https://www.sleepfoundation.org/sleep-hygiene/revenge-bedtime-procrastination 

Cardiovascular disease (CVD) and heart failure (HF) are chronic conditions impacting hundreds of thousands of people every year. In 2023 alone, an estimated 920,000 people died from cardiovascular disease, which equates to approximately 1 in every 3 deaths (CDC, 2025). The most common type of heart disease is coronary artery disease, which kills more than 370,000 each year (CDC, 2022). In Texas, heart disease and stroke remain in the top three causes of death. 

Problem and Purpose

Gaps in home health clinician knowledge, skills, confidence, and care coordination practicesmay limit timely recognition of worsening heartfailure and appropriate intervention. The purpose of this project is to assesshow a comprehensive heart failure (HF) education program, compared with no program, can affect clinician knowledge, skills, attitudes, and practice behaviors in HF carea mong home health Licensed Vocational Nurses (LVN ) and Registered Nurse (RN) clinicians.

The goal  of the project is to improve patient outcomes by reducing potentially preventable hospitalizations (PPH) and unplanned emergency room visits. The educational resources emphasize d include:

While there was a targeted purpose and aim to the overall project, educational  objectives included: 

The Johns Hopkins Evidence-Based Practice (JHNEBP) Model guided this project through the Practice Question, Evidence, and Translation (PET) process. This framework  facilitated the systematic identification of the practice problem, appraisal of the best available evidence, and  translation of evidence into a clinically meaningful educational intervention for home health clinicians.

Literature Search & Appraisal

A comprehensive literature search was conducted using databases including CINAHL, PubMed, and Google Scholar. Search terms included heart failure, home health , early recognition , fluid overload , care coordination , SBAR, and preventable hospitalizations. Evidence was limited to peer-reviewed articles, clinical guidelines, and systematic reviews published within the last 5–10 years. The 2022 AHA/ACC/HFSA Guideline for the Management of  Heart Failu re served as the primary clinical reference. Articles were appraised for quality and relevance using the Johns Hopkins Evidence Appraisal Tool

The literature consistently  demonstrated that early recognition of worsening heart f ailure  symptoms, structured communication, patient education, and timely intervention are key strategies for reducing hospital readmissions. Evidence supported  the use of standardized assessments, daily weight monitoring, SBAR communication, and multidisciplinary care coordination as effective components of heart failure management in post-acute and community-based settings. Educational interventions targeting clinician knowledge and confidence were shown to improve adherence to evidence-based practices and clinical decision-making.

Implementation

This project was implemented in a home health setting, where LVN/RN clinicians provide skilled nursing care to patients with chronic  heart failu re. Home health clinicians are uniquely positioned to detect early clinical changes; however, variability in experience, assessment practices, and access to structured HF education may  impacttimely  escalation of care. This setting was selected due to its critical role in preventing potentially preventable hospitalizations.

The intervention consisted of a novel, interactivesuperhero-themed educational experience (“Heart Heroes: Saving Mr. Heartwell”), delivered over a three-month period. The program emphasized:

Education was delivered using a gamified escape-room format, incorporating case-based scenarios, riddles, and decision-making challenges. Clinician outcomes were evaluated using paired pre- and post-surveys measuring knowledge, skills, attitudes, and self-reported practice behaviors.

Results

Participation in a comprehensive superhero- themed, escape-room educational intervention resulted in statistically significant improvements across clinicianconfidence, knowledge, skills, and attitudes related to heart f ailure  management. Post-intervention survey results demonstrated a consistent shift toward higher confidence and agreement scores (4–5) across all measured domains:

The greatest mean improvements were  observed in early recognition of worsening heart f ailure and baseline determination, indicating enhanced clinical vigilance and assessment accuracy. Improvements across all domains suggest strengthened readiness for timely intervention and escalation, which may reduce delays in care associated with potentially preventable hospitalizations (PPH).

Key Findings (Paired Pre–Post Analysis)

Participation in a superhero-themed, escape-room educational intervention resulted in statistically significant improvements across clinician confidence, knowledge, skills, and attitudes related to  heart failu re management. Confidence in determining a patient’s heart fai lure baseline improved significantly (mean increase +1.2, p < .01), reflecting enhanced ability to identify stability and deviations from baseline. Focused cardiac assessment skills demonstrated a significant increase (+1.1, p < .01), supporting improved bedside assessment in the home health setting. The largest improvement was observed in early recognition of worsening  heart failu re (+1.3, p < .01), indicating strengthened clinical vigilance and timely identification of decompensation. Clinician advocacy for escalation and intervention improved (+1.0, p < .05), suggesting increased confidence in SBAR communication and recommending evidence-based actions. Knowledge and skills related to heart fai lure pathophysiology, self-management education, and guideline-based care improved overall (+1.1, p < .01). Attitudes related to professional responsibility and motivation showed moderate-to-large improvement (+0.7, p < .05), reinforcing clinician ownership in preventing potentially preventable hospitalizations. Large effect sizes (Cohen’s d ≥ 0.8) across most domains indicate meaningful and practical educational impact beyond statistical significance.

Implications for practice

The use of an interactive, gamified educational format suggests that innovative delivery methods may be effective in improving clinician engagement, knowledge retention, and translation of evidence into practice. These findings support the scalability of this educational intervention as a low-cost, adaptable strategy for improving  heart failu re management practices in home health settings. Future implications include integrating structured chart audits and outcome tracking to evaluate the sustained impact of improved clinician behaviors on PPH and emergency department utilization.

References

Brockway, Kaelee (2024) . Leveraging Gamification and Social Media to Teach Heart Failure Clinical Practice Guidelines in Entry-Level Physical Therapist Education. Journal of Innovation in Health Sciences Education : Vol. 1: Iss. 3, Article 2.

Centers for Disease Control and Prevention. (2024, October 24).  Heart disease facts. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.htm

Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A.,  Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E.,  Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., … Yancy, C. W. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of  Heart Failu re. Journal of the American College of  Cardiology , 79 (17). https://doi.org/10.1016/j.jacc.2021.12.012

Lukey, A., Mackay, M., Hasan, K., & Rush, K. L. (2023). Clinical Perspectives on the Development of a Gamified  Heart Failu re Patient Education Web Site. Computers, informatics,  nursing : CIN, 41 (8), 615–620. https://doi.org/10.1097/CIN.0000000000000983

Malicki, A., Vergara, F. H., Van de Castle, B., Goyeneche, P., Mann, S., Preston Scott, M., Seiler, J., Meneses, M. Z., & Whalen, M. (2020). Gamification in Nursing Education: An Integrative Literature Review.  Journal of continuing education in nursing,  51(11), 509–515. https://doi.org/10.3928/00220124-20201014-07

Verma, A., Heidenreich, P. A., &  Ziaeian, B. (2023). Opportunities for change in home health care in heart failure. JACC:  Heart Failu re , 11(10), 1449–1453. https://doi.org/10.1016/j.jchf.2023.02.018

Download PDF here

By Laura Kincheloe, Ed.D., MSN, RN, NE-BC

In January, fourteen nurses completed the inaugural cohort of the Texas Nurses Association's Evidence Based Practice (EBP) Fellowship program. Nurses from across Texas gathered in Austin to present their projects and reflect on their learning experiences. Overwhelmingly, participants expressed gratitude for their time in the program. 
TNA has officially opened applications for Cohort 2 of the EBP Fellowship Program. For nurses who may not be as familiar with EBP, this article provides an overview of the program, application process, and overall experience. 

Program

TNA’s EBP Fellowship program is transitioning to a 10-month intensive experience in which nurses learn, innovate, and implement evidence in their practice settings. The program includes six educational modules that follow the EBP steps adapted from the Johns Hopkins EBP Model:

1. Formulate a practice question;
2. Conduct a literature search;
3. Critically appraise and synthesize evidence;
4. Develop practice recommendations and an implementation plan;
5. Implement and evaluate EBP project; and
6. Establish a dissemination plan.

The EBP Fellowship program is open to TNA members and is designed to be inclusive of nurses in all practice settings, regardless of license type or educational background. In the inaugural cohort, two Licensed Vocational Nurses (LVNs) completed the program, both working to implement sustainable projects in their workplaces. LVNs are encouraged to apply and are supported by an RN champion within their organization, along with mentorship and faculty guidance throughout the program. The first cohort also included several doctoral-prepared nurses who sought to advance their EBP expertise and integrate sustainable projects into their workplaces to strengthen the future of evidence-based nursing practice.  

Process

Applications are open through April 29, 2026. An informational session will be held during the lunch hour on April 7, 2026, for those who are interested in the program and have questions about the process. We invite all interested nurses to register for this free session. Once applications close, submission will undergo a blinded review process. Only complete applications will be considered, and decisions will be announced in May. 

Applicants must acknowledge the following prerequisites before beginning the application:
1) Letter of Support 
2) Attendance Commitment

The letter of support serves as a formal acknowledgement from the Chief Nurse Executive, Chief Nursing Officer, or nurse leader within the applicant’s employing organization. This letter confirms organizational support for the fellowship, including an onsite nurse champion, time allotted for in-person and virtual meetings, and access to internal tools and resources needed to implement their project. Fellows have consistently identified organizational support as one of the most significant drivers of successful program completion. Letters of support should be emailed to Dr. Laura Kincheloe at lkincheloe@texasnurses.org.

The Attendance Commitment outlines all meeting dates and times in advance of the application.  While TNA understands emergencies may arise, fellows are expected to acknowledge the importance of full participation and commit to attending all meetings. 

Meeting days and times for Cohort 2 are as follows:
In-Person (TNA, Austin): 10:00 AM – 5:00 PM

• August 7, 2026
• May 7, 2027  

Virtual (Zoom): 11 a.m. - 1 p.m.

• September 4, 2026  
  
• October 2, 2026  
  
• November 6, 2026  
  
• December 4, 2026  
  
• January 8, 2027  
  
• February 5, 2027  
  
• March 5, 2027  
  
• April 2, 2027  

The program fee of $400 covers books and meeting materials. Travel expenses for the two in-person sessions are the responsibility of the fellows. Invoices can be sent directly to the fellow or to their employing organization for those organizations who are covering the cost of the program. 

Experience

The EBP Fellowship experience is transformative, offering nurses the opportunity to engage in meaningful, sustainable work while advancing their professional growth. In addition to the valuable networking opportunities inherent in the cohort model, fellows earn Continuing Nursing Education (CNE) hours for all in- person and virtual meetings. Additional CNE hours are available through online modules completed prior to each session. Fellows may earn up to thirty (30) CNE hours with full engagement and participation in the program. 

Upon completion of the fellowship, graduates are invited to return as mentors for future cohorts. This role provides continued professional development and prepares nurses to pursue advanced credentials, including the Evidence-Based Practice Certification (EBP-C) program through Ohio State University or the Certificate Holder (EBP-CH) credential. Mentoring emeritus faculty continue to advise and consult with TNA to ensure fellows are well prepared for certification or certificate-holder opportunities. 

Nurses who are eager to advance the profession and deepen their understanding of evidence-based practice are encouraged to join the next cohort of the TNA EBP Fellow Program. To learn more about the program, application process, and experience, visit us at https://www.texasnurses.org/page/EBPFellowship.

REFERENCES

Bissett, K., Ascenzi, J., & Whalen, M. (2025). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model & guidelines (5th ed.). Sigma Theta Tau International Honor Society of Nursing.

Melnyk, B.M. & Hsieh, A.P. (2025). Making the business case for evidence-based practice and nurse/clinician well-being to improve health care quality, safety, patient outcomes, and costs. Nurse Leader, 23(3), 244-248. DOI: 10.1016/j.mnl.2025.01.006

Melnyk, B.M., Tan, A., Hsieh, A.P., & Gallagher-Ford, L. (2021a). Evidence-based practice culture and mentorship predict EBP implementation, nurse job satisfaction, and intent to stay: Support for the ARCC© Model. Worldviews on Evidence-Based Nursing, 18(4), 272-281. DOI 10.1111/wvn.12524

Heart failure (HF) is a clinical syndrome associated with structural and/or functional cardiac abnormalities that impair ventricular filling or cardiac output (Fraser et al., 2024; Heidenreich et al., 2022). Nurses are uniquely positioned to identify early decompensation by detecting changes in respiratory status, fluid balance, perfusion, and functional tolerance before severe deterioration occurs (Fraser et al., 2024; Harrington et al., 2023). This article provides a guideline-aligned framework for nursing identification of HF, including focused assessment of congestion and hypoperfusion, escalation triggers, documentation strategies, and patient education priorities (Heidenreich et al., 2022; NursingCenter, 2024).

Introduction

Heart failure contributes substantially to morbidity, mortality, and healthcare utilization, with a large proportion of costs attributed to HF hospitalizations and readmissions (Fraser et al., 2024). Contemporary guidance emphasizes patient-centered prevention, diagnosis, and management across the HF continuum, including early stages where symptoms may be mild or absent (Heidenreich et al., 2022; Harrington et al., 2023). Nurses, who perform continuous bedside assessment, are well positioned to recognize early indicators of congestion, reduced perfusion, and clinical instability and to escalate concerns promptly (Fraser et al., 2024).

Definition and Classification of Heart Failure

Heart failure is defined as a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion (Fraser et al., 2024). Current guidelines classify HF using both stages (A–D) describing disease progression and ejection fraction phenotypes (e.g., HFrEF, HFmrEF, HFpEF) describing ventricular function and filling pressures (Heidenreich et al., 2022; NursingCenter, 2024). Understanding these classifications helps nurses interpret assessment findings and anticipate risk, particularly for patients in Stage A (at risk) or Stage B (pre-HF) who may not yet have classic symptoms (Heidenreich et al., 2022; Harrington et al., 2023).

Nursing Assessment Framework for Identifying Heart Failure

Bedside identification of worsening HF is supported by a structured nursing approach that assesses two overlapping domains: (a) congestion/volume overload and (b) reduced cardiac output/hypoperfusion (Harrington et al., 2023; NursingCenter, 2024). Expert nursing guidance emphasizes trending objective measures—such as weight, intake and output, oxygen requirements, lung sounds, and hemodynamics—rather than relying on isolated values (Fraser et al., 2024).

Congestion: Indicators of Fluid Overload

Congestion often presents with exertional dyspnea, orthopnea, and fatigue, reflecting increased filling pressures and pulmonary fluid accumulation (Harrington et al., 2023; NursingCenter, 2024). Physical assessment may reveal rales/crackles and diminished breath sounds, and imaging may identify pleural effusions in more advanced congestion (Harrington et al., 2023). Systemic congestion may manifest as peripheral edema, abdominal distention/ascites, hepatomegaly, and jugular venous distention (JVD) (Harrington et al., 2023). Daily weight monitoring and accurate intake and output measurement support detection of fluid retention and evaluation of response to therapy, including diuresis (Fraser et al., 2024; Wagner & Lukey, 2025).

Low Perfusion: Indicators of Reduced Cardiac Output

Reduced forward flow can produce fatigue, weakness, and decreased activity tolerance, which may be more apparent with exertion (NursingCenter, 2024). Declining renal perfusion can be reflected by decreased urine output, particularly when paired with hypotension or worsening symptoms (Harrington et al., 2023). Telemetry trends are also clinically relevant; new or worsening tachyarrhythmias may accompany decompensation and can exacerbate symptoms (Wagner & Lukey, 2025).

Clinical Red Flags Requiring Escalation

Evidence-based guidance supports immediate escalation for signs of acute decompensation, including worsening hypoxemia, rapidly increasing oxygen needs, significant respiratory distress, or findings concerning for pulmonary edema (Harrington et al., 2023; Heidenreich et al., 2022). Hemodynamic instability (e.g., symptomatic hypotension), markedly decreased urine output, and new clinically significant arrhythmias warrant urgent provider evaluation (Heidenreich et al., 2022; Fraser et al., 2024).

Documentation, Communication, and Trend Recognition

High-quality nursing documentation emphasizes trends in weight, fluid balance, oxygen requirements, respiratory assessment, and hemodynamics to support timely decision-making and evaluation of treatment response (Fraser et al., 2024). Clear communication that links symptom changes with objective findings strengthens interprofessional response and supports guideline-directed care (Heidenreich et al., 2022).

Patient Education as a Component of Early Identification

Guidelines and nursing education resources emphasize self-monitoring and early reporting of symptoms to prevent progression and reduce avoidable hospitalization (Heidenreich et al., 2022; Harrington et al., 2023). Nurses should reinforce daily weights, symptom recognition, medication adherence, and diet and fluid guidance as part of discharge readiness and transitions of care (Fraser et al., 2024; Harrington et al., 2023).

Conclusion

Nursing identification of HF relies on systematic assessment of congestion and perfusion, strong trend recognition, and timely escalation of red flags. Alignment with AAHFN and AHA/ACC guidance supports early intervention, improves safety, and strengthens transitions across the HF continuum (Fraser et al., 2024; Heidenreich et al., 2022).

Nursing Practice Tips for Early Identification of Heart Failure

HF is a clinical syndrome caused by structural or functional cardiac abnormalities leading to congestion and/or low perfusion.

1. Key Assessment Focus Areas
   1. Assess congestion and perfusion every shift; compare to prior trends
2. Indicators of Congestion (Fluid Overload)
   1. Dyspnea on exertion, orthopnea, increased O2 needs.
   2. Crackles/rales, diminished breath sounds.
   3. Rapid weight gain (≥2 lbs/24 hr or ≥5 lbs/week).
   4. Peripheral edema, JVD, ascites.
3. Indicators of Low Perfusion
   1. Fatigue, weakness, reduced activity tolerance.
   2. Decreased urine output, cool/clammy skin.
   3. Confusion or altered mentation.
   4. Tachyarrhythmias or new rhythm changes.
4. Red Flags Requiring Immediate Escalation
   1. Worsening respiratory distress or SpO2 decline.
   2. Pink frothy sputum (pulmonary edema).
   3. SBP < 90 mmHg or symptomatic hypotension.
   4. New rapid arrhythmias or sharp drop in urine output.
5. Documentation & Communication
   1. Document trends: weights, I&O, lung sounds, O2 needs, telemetry.
   2. Report objective changes with symptom descriptions.
6. Patient Education
   1. Teach daily weights and symptom recognition.
   2. Reinforce medication adherence and sodium/fluid limits.
   3. Encourage early reporting of worsening symptoms.

References

Fraser, M., Barnes, S. G., Barsness, C., et al. (2024). Nursing care of the patient hospitalized with heart failure: A scientific statement from the American Association of Heart Failure Nurses. Heart & Lung, 64, e1–e16.

Harrington, D., Lenahan, C. M., & Beacom, R. (2023). Heart failure management: Updated guidelines. American Nurse.

Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., Milano, C. A., Nnacheta, L. C., Sandhu, A. T., Stevenson, L. W., Vardeny, O., Vest, A. R., & Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation.

NursingCenter. (2024). Assessment and diagnosis of heart failure (Pocket Card).

Wagner, M., & Lukey, A. (2025). Heart failure (CHF): Nursing diagnoses, care plans, assessment & interventions. NurseTogether.

• Recognize signs of trauma (see SAMHSA Guidance) 
• Prioritize emotional safety, choice, and trust
• Use clear, consent-based communication
• Offer resources and hope

Experiences with Human Trafficking 

The following interview occurred with registered nurse Laura Malone (LM), who shared personal nursing experiences when caring for victims of human trafficking.  

Can you share an experience where you suspected or identified that a patient was being trafficked? 

LM: It was identified during our intake assessment. The patient mentioned a history of sex work and disclosed that it began with sex trafficking by a romantic partner when they were younger. The patient stated they had several untreated STIs, which prompted the nursing staff to ask more about their sexual health needs. 

How did you approach the patient in a way that balanced safety, compassion, and professional boundaries? 

We let the patient lead the assessment. If nursing staff was going to use their stethoscope on the patient's chest, they informed the patient and held up the stethoscope and allowed the patient to lean into the stethoscope rather than putting it on the patient directly. This allowed the patient to move forward when they were ready. For abdominal exams,  nursing staff used clear, consent-based phrasing such as:  “Are you comfortable with me putting my stethoscope on your abdomen?” Nursing staff used hand gestures to show the patient in the nurses own body where the medical equipment would be placed. The nurse staffing then stated, “'ell me when you’re ready.”  The patient's hair was extremely matted from being in a catatonic state in a sleeping bag for weeks, causing severe scalp pain. The nurse team arranged for a trauma-informed hairdresser to detangle and cut knots at the patient’s hair at the patient's pace. It took 2–3 hours because the hairdresser worked entirely at the patient’s comfort level. 

What advice would you give other nurses to help them feel prepared and supported when caring for patients who may be survivors of trafficking? 

Survivors of sex trafficking often have somatic symptom disorders (like vulvodynia) and may need extra pain or anxiety medication for invasive exams. My colleague Carmen, a doctor specializing in trauma-informed care, always suggested patient-led exams. For example, during a PAP smear, the patient lowers onto the speculum at her own pace rather than the provider inserting it. 

All nurses have a requirement around human trafficking education according to the Texas Board of Nursing, but nurses shouldn’t wait to learn more. Healthcare is a human right, and it should be individualized to meet the needs of patients while ensuring a psychologically safe environment for care to be delivered.  

 

REFERENCES 

Bowen EA, & Murshid NS (2016). Trauma-informed social policy: A conceptual framework for policy analysis and advocacy. American Journal of Public Health, 106, 223–229. [DOI] [PMC free article] [PubMed] [Google Scholar] 

Harris M, & Fallot RD (2001). Envisioning a trauma-informed service system: A vital paradigm shift. New Directions for Mental Health Services, 2001, 3–22. [DOI] [PubMed] [Google Scholar] 

Haynes DF (2006). (Not) Found chained to a bed in a brothel: Conceptual, legal, and procedural failures to fullfill the promise of the trafficking victims protection act. Georgetown Immigration Law Journal, 21, 337. [Google Scholar] 

Heffernan K, & Blythe B (2014). Evidence-based practice: Developing a trauma-informed lens to case management for victims of human trafficking. Global Social Welfare, 1, 169–177. [Google Scholar] 

Hopper EK (2017). Trauma-informed psychological assessment of human trafficking survivors. Women and Therapy, 40, 12–30. [Google Scholar] 

Huang LN, Flatow R, Biggs T, Afayee S, Smith K, & Clark T (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Substance abuse and mental health. Washington, DC: Substance Abuse and Mental Health Services Administration. [Google Scholar] 

Sheldon-Sherman JA (2012). The Missing P: Prosecution, prevention, protection, and partnership in the trafficking victims protection act. Penn State Law Review, 117, 443. [Google Scholar] 

Zimmerman C, Hossain M, & Watts C (2011). Human trafficking and health: A conceptual model to inform policy, intervention and research. Social Science and Medicine, 73, 327–335. [DOI] [PubMed] [Google Scholar] 

Polaris Project (2025). Texas Human Trafficking Data.

Nurse Medical License Protection Case Study with Risk Management Strategies Presented by NSO and CNA 
 

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

Summary 

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

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

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

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

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

Risk Management Comments 

The State Board of Nursing (SBON) investigated this case based on the allegations against the NP of unprofessional conduct and gross negligence in the treatment and care provided to the infant. The SBON found that while the healthcare information record indicated the chief complaint as fever and wheezing, the NP noted all categories as “within normal limits” under the exam portion of the chart. Further, there were no abnormal respiratory exam findings noted; the NP did not document the infant’s heartrate, her respiratory rate or her oxygen saturation level in the chart.  
The SBON’s investigation focused on "gross negligence" because of the extreme departure from the standard of care. In light of these allegations, the SBON reviewed the NP’s actions against what actions would have ordinarily been taken by a competent NP under similar circumstances. The SBON opined that there was a repeated failure to exercise ordinary care and take standard precautions which the NP knew, or should have known, could have jeopardized the patient’s health or life. Specifically, the SBON noted the NP did not meet treatment and care standards by:  

• Failing to perform a complete respiratory assessment 
• Failing to document a complete respiratory assessment 
• Failing to chart the patient’s heartrate in the healthcare information record 
• Failing to chart the patient’s respiratory rate in the healthcare information record
• Failing to chart the patient’s oxygen saturation level in the healthcare information record 
• Failing to chart that the patient was wheezing in the healthcare information record
• Failing to chart the results of a post-treatment assessment of the patient after she received her breathing treatment in the office 

Resolution 

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

• Pay a $10,000 civil penalty 
• Refrain from taking a position with direct patient care for six months 
• Submit performance evaluations 
• Be supervised during employment 
• Complete approved continuing education courses
• Participate in ongoing counseling, and
• Submit written reports verifying compliance with the Board’s actions. 

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

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

Risk Control Recommendations 

• Perform a patient clinical assessment and physical examination to evaluate and address the specific clinical issues under consideration.
• Utilize available clinical practice guidelines or protocols when establishing a diagnosis and providing treatment, documenting the justification for deviations from guidelines or protocols.
• Consider potential unintended consequences of pursuing a specific diagnosis, including:  
  • Are factors present that do not align with the diagnosis? 
  • Are there symptoms that are inconsistent with the current diagnosis? 
  • Why are these symptoms not indicative of another diagnosis? 
  • Is there a life-threatening condition with similar symptoms that hasn’t been considered? 
• Complete regular training and continuing education to serve pediatric patients, particularly nurse practitioners who work in settings that serve pediatric patients and maintain awareness of and access to organizational/facility pediatric protocols and guidance. 
• Refer to RSV resources such as those on the National Association of Pediatric Nurse Practitioners (NAPNAP) website including NAPNAP’s position statement on the RSV crisis.  NAPNAP has created a series of micro-learning videos, each just five minutes, to break down a specific clinical aspect of RSV. 
• Refer to CDC resources for healthcare providers on RSV Immunizations. CDC resources also includes information for RSV Prevention, FAQs, and an Immunization Information Statement. 
• Diligently screen for, monitor and/or treat diseases known to have high morbidity and mortality, such as RSV, for infants and children under 5 years of age. 
• Document the decision-making process that led to the diagnosis and treatment plan. 
• Document all patient-related discussions, consultations, clinical information and actions taken, including any treatment orders that are provided. 
• Discuss clinical findings, diagnostic test/procedure results, consultant findings, diagnosis, the proposed treatment plan and reasonable expectations for the desired outcome with patients, parents and/or guardians, in order to ensure their understanding of their care or treatment responsibilities. Document this process, noting the patient’s response. 
• Never testify in a deposition without first consulting your insurer or legal counsel. Contact your attorney or designated professional before responding to calls, emails, or requests for documents from any other party. 
  

Resources 

 CNA and NSO. 2022. Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition. https://www.nso.com/npclaimreport

National Institutes of Health (NIH). 2022. Mortality Among US Infants and Children Under 5 Years of Age with Respiratory Syncytial Virus and Bronchiolitis: A Systematic Literature Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9377034/ 

National Institutes of Health (NIH). 2017. Risk of mortality associated with respiratory syncytial virus and influenza infection in adults. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738863/ 

U.S. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/ 

National Association of Pediatric Nurse Practitioners (NAPNAP). https://www.napnap.org/

Disclaimers 

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

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

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

Nurses Service Organization is a registered trade name of Affinity Insurance Services, Inc., a licensed producer in all states (TX 13695); (AR 100106022); in CA, MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services, Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency. 

• “The session on workplace civility directly supports our current healthy work environment initiative.”
• “The leadership track aligns with our charge nurse development plan.”
  

Tip: Specificity demonstrates intentionality and shows that your requested investment is purposeful, not exploratory. These should be included in the accompanying justification letter.

3. Specificity and Evidence Driven Before the Final Agenda is Release

The abstract review process is currently underway. The conference theme and subthemes are available on the conference webpage. These themes can be linked to organizational needs.

Tip: Subthemes for the annual conference are interprofessional collaboration and unity, advancing innovation and teaching integration in nursing practice and education, strengthening leadership and advocacy skills at all levels of practice, workforce sustainability, professional growth, career transitions, ethical practice, professional accountability, reflective leadership, and transformation in patient care and health systems.

4. Highlight How the Organization Will Benefit After You Return

Use the worksheet to outline how you plan to disseminate knowledge, such as:

• Leading an in-service
• Updating policy or education materials
• Creating a micro-learning series for staff
• Presenting at a staff meeting or council

Tip: Include a simple timeline in the accompanying justification letter. Leaders appreciate knowing exactly how the learning will be applied.

5. Provide a Realistic and Transparent Expense Estimate

In the “Estimate the Costs” section, list all anticipated costs. Be thorough but realistic, rounding up slightly ensures you don’t underestimate but avoid appearing excessive.

Tip: If you are willing to cover part of the cost (e.g., meals, travel), note this. It signals partnership and shared investment.

6. Use the Customizable Justification Letter to Tell a Concise Story

The accompanying justification letter is designed to communicate your request professionally and efficiently. Tailor it using language familiar to your leaders. Keep it focused on organizational impact, not personal preference.

Tip: Attach your completed worksheet to the letter so your leader can see your rationale at a glance.

7. Submit Your Request Early and Follow Any Internal Procedures

Many organizations have deadlines, approval hierarchies, or budget cycles. Submitting early shows responsibility and increases your chances of being included in educational allocations.

Final Thoughts

The TNA Justification Worksheet is a practical tool to help you advocate for your professional development while demonstrating clear value to your organization. While approval can never be guaranteed, a well-prepared, thoughtful justification increases the likelihood of support and strengthens your professional credibility along the way.

Submitting an abstract can be the most important step in getting your research, idea, or project noticed at a conference, journal, or academic event. It’s your first opportunity to make an impression, and a strong abstract can be the key to unlocking a spot in your desired program or publication. But with so many submissions flooding in, how do you ensure that yours stands out from the crowd?

Mastering the abstract is more than just summarizing your work in a few sentences—it’s about crafting a compelling snapshot that highlights the significance, originality, and relevance of your topic. Whether you're a seasoned academic or submitting for the first time, understanding the art of writing an abstract that grabs attention and effectively conveys your message is crucial.

In this article, we'll walk you through essential tips and strategies to help you create an abstract that not only meets the submission criteria but also piques the interest of reviewers. From focusing your content to perfecting your language, you’ll learn how to elevate your submission and increase your chances of success. 

Tip #1: Understand the Abstract Guidelines 

Before you start writing, carefully read through the conference’s submission guidelines. Most conferences provided a detailed description of the submission, including: 

Tip #2: Choose a Relevant Topic 

The topic you choose for your abstract should be both timely and relevant to the conference theme. Consider the potential audience for the conference. Think about what would interest them and what challenges they might be facing in their practice. Choose a topic that addresses an issue or gap that aligns with the mission and goals of the conference.

Tip #3: Craft a Clear and Engaging Title

Your abstract title is the first thing reviewers will see, so it should be concise, specific, and informative. The title should clearly reflect the focus of your presentation and grab the reader’s attention. For example:

Weak Title: "Nursing Leadership"

Stronger Title: "Building Resilient Nursing Leaders: A Professional Development Program for Crisis Management"

The second title provides a clear idea of what your presentation will cover and highlights its relevance to the audience.

Tip #4: Structure the Abstract 

Although different conferences may have slightly different formatting requirements, a well-organized abstract generally includes the following components:

Tip #5: Keep it Clear and Concise

Clarity is key when writing an abstract. Use plain language, avoid jargon, and keep sentences concise. Reviewers often read many abstracts, so your abstract should be easy to understand at a glance. Organize the content logically, ensuring that the flow of information is seamless. Avoid long paragraphs and instead use short, digestible sections.

Tip #6: Use Active Voice and Present Tense 

While writing the abstract, aim to use active voice and present tense where possible. Active voice is more direct and engaging, making your abstract more impactful.

Tip #7: Proofread and Edit

This cannot be stressed enough! An abstract is a formal submission, so spelling, grammar, and punctuation matter. Review your work for clarity and ensure there are no errors. Consider asking a colleague or mentor to review your abstract, as fresh eyes may catch errors you missed.

Tip #8: Prepare for Acceptance (or Rejection) 

After submission, you’ll typically hear back within a few weeks or months. If your abstract is accepted for a podium presentation, you’ll need to prepare your full presentation, which may include slides, handouts, or other materials. If your abstract is selected for a poster presentation, you’ll need to create a professional poster to display and prepare to spend time speaking to conference attendees about your work. If your abstract is not accepted, don’t be discouraged. Use the feedback to improve and try submitting it to another conference.

Writing and submitting an abstract for a podium or poster presentation at a conference is an important step in sharing your knowledge and making an impact on the nursing community. By following the guidelines, choosing a relevant topic, and crafting a well-structured and compelling abstract, you increase your chances of being selected to present. Additionally, presenting at conferences provides invaluable opportunities for professional growth, networking, and contributing to the advancement of nursing practice.

REFERENCES 

Ferreira, J. C., & Patino, C. M. (2018). Twelve tips to write an abstract for a conference: advice for young and experienced investigators. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 44(4), 260. https://doi.org/10.1590/S1806-37562018000000217

Foster, C., Wager, E., Marchington, J. et al. (2019). Good Practice for Conference Abstracts and Presentations: GPCAP. Res Integr Peer Rev 4, 11. https://doi.org/10.1186/s41073-019-0070-x

The Problem

CAUTIs remain a persistent challenge in healthcare settings due to their high prevalence and the complications that often arise as a result—such as increased patient morbidity, longer hospital stays, and higher healthcare costs. While evidence-based protocols for prevention are well established, many hospitals continue to face difficulties with consistent and effective implementation. To address this gap, a multimodal educational strategy targeting both new and existing staff was explored as a potential solution to reduce the incidence of CAUTIs. 

What We Know 

Rising Concern & Response: In 2023, an increase in catheter line days at the facility correlated with a rise in CAUTI cases, highlighting the need for effective interventions to reduce infection rates (Werneburg, 2022). 

Educational Strategy Implemented: A comprehensive education-based approach was deployed, including enhanced training for both new hires and experienced staff, supported by signed attestations to reinforce understanding and accountability. 

Positive Outcomes Achieved: These targeted strategies resulted in a significant reduction in CAUTI rates, improving patient outcomes, strengthening patient safety, and advancing the quality of care delivered. 

Methods 

The intervention involved two key components. New team members joining the organization received initial CAUTI education during general nursing orientation, which included case studies, visual aids, and demonstrations. For existing personnel, a CAUTI Roadshow was organized. The best practice team members provided information on essential topics, including two-person catheter insertion, dependent loops, catheter maintenance, and ensuring that patients had the appropriate orders for their indwelling foley catheters. Nurses were also required to complete an attestation confirming their understanding of the educational material.  

Implementation 

The project implementation included education on dependent loop management, The implementation of a two-person catheter insertion procedure has been shown to significantly reduce the incidence of catheter-associated urinary tract infections (Rahmawati, Tamaela, Anika, & Wicaksana, 2021), proper catheter maintenance, and verification of indwelling foley catheter orders. 

Results

Preliminary findings suggest this comprehensive educational approach has had a significant impact on reducing CAUTIs. In 2023, nine CAUTIs were reported at this time, whereas in 2024, that number has dropped to just two, resulting in improved patient outcomes and better overall healthcare quality. Compliance with Indwelling Urinary Catheter (IUC) orders increased dramatically from 50.5% in 2023 to 95% in 2024 following the introduction of educational initiatives. Additionally, the two-person catheter insertion rate rose from 63.6% to 76.5%. Compliance with proper management of dependent loops also showed improvement, increasing from 66% to 74%.  

Recommendations: Adopt a multimodal teaching strategy hospital-wide. Regularly reinforce education through mobile training models. Track compliance metrics and tie them to staff evaluations or quality dashboards. 

Conclusion 
One of the most impactful moments in this journey came when a night shift nurse shared that she paused a procedure mid-way to ensure a second nurse was present, saying, “I remembered the roadshow.” That moment marked a turning point—a visible shift in culture and mindset. 

Today, with compliance rates at an all-time high and CAUTIs reduced to just three, the team feels empowered and unified. They not only understand the 'what' but also the 'why' behind every protocol, which has transformed behavior from obligation to ownership. This sense of accountability has fostered a culture of safety, collaboration, and shared purpose throughout the organization. 

Regular Best Practice meetings now serve as dynamic spaces for celebrating wins, exchanging insights, and reinforcing a collective commitment to excellence. Through education, engagement, and empowerment, we've not only improved outcomes—we've ignited a movement. 

Editor's Note: For more work on CAUTI prevention, check out this previously published Practice Tip: A Journey to Zero Harm.

 

REFERENCES 

Rahmawati, L., Mariana Tamaela, J., Anika, L., & Wicaksana, A. L. (2021). The two-person catheter insertion procedure reduces catheter-associated urinary tract infections. Enfermería Clínica, 31, 478–482. https://doi.org/10.1016/j.enfcli.2020.10.047   

Werneburg G. T. (2022Urinary Tract Infections: Current Challe). Catheter-Associated nges and Future Prospects. Research and reports in urology, 14, 109–133. https://doi.org/10.2147/RRU.S273663 

How many TNA Conferences have you previously attended? 

I have been to two different TNA conferences. 

How was this year’s conference different for you? 

This year just felt different. I have grown a lot in the last year. I viewed the concurrent sessions with a different perspective this year than I have previously. This year networking was more about reconnecting with nurses I have seen at other events or conferences and following up with them on their programs and projects to see how they have grown. I strategically went into sessions with programs or projects I wanted to learn about. It was exciting this year. 

This year something new happened to you: a news station showed up and wanted to interview you about your session. You mentioned you didn’t know ahead of time but wanted to answer the call. What was that like for you? 

I didn’t have anything prepared. It wasn’t about what my topic was but other important issues. Being able to talk about your profession in a way you can be proud of and push it out there to the public. I really had to listen to the questions being asked. I felt like at times the interviewer wanted me to talk about the negative parts of nursing. I wanted to talk about what I love about the profession and how we work to address some of the challenges we faced. It was a good experience, and I felt supported, but it is something nurses definitely need more training for. 

Following your news interview, you had quite a packed house in your concurrent session room. So much so that TNA staff unfortunately had to ask some to attend another session because of concerns with room capacity. Describe that experience. 

It was incredible! It was kind of sad that they had to kick people out. I felt honored to have so many people there and many who reached out to me after the presentation. I felt very seen. If I can take my work and share it with you so you can grow yourself or your department or organization, that’s what it is all about. That is where we thrive. 

What advice do you have for nurses who are considering coming to a TNA conference in the future? How should they engage? 

Don’t be afraid to submit an abstract for the next conference. It can be really scary, and you must learn to be okay with rejection. Even if you don’t get selected there is a review committee somewhere who is still looking at your abstract and your work. You need to get exposure for your work, that is how you make an impact. Find a mentor to help you or go to a presentation workshop where you can learn to write an abstract or prepare for a poster or podium presentation. And don’t forget to use the resources you have. Seek out those opportunities. Learn to get uncomfortable. Channeling what I have learned during a keynote presentation: don’t forget the lobster analysis (if you know, you know)! 

Who has been your guiding light, mentor, or biggest encourager for leaning into professional growth and networking at this conference? 

Kate Williams has been a rock star for me. She has encouraged me to find other ways to grow and learn more. She trusts me with running with ideas, and she continues to push me to achieve my potential. I am here because of her. 

Our conference theme this year was The Power of Us: Advancing our Profession Together. How did the theme of the conference resonate with you now that you have had time to reflect on the post-conference? 

I see the power of us. We are only as strong as the next person we lift up. Our leaders are the embodiment of power of us. I came out of my podium presentation and someone I pointed to me and said, “You! I want you to know I have been a nurse for a long time and that’s one of the best concurrent sessions I have ever seen. As a bachelor’s degree nurse (BSN) nurse who is dual certified, I am so impressed.” Hearing her say this gave me pause.  She saw me. Deeply. That empowered me so much more than anything. I would have never had that experience if I hadn’t gone to the conference. Overall, each nurse there was ready to empower the next nurse and lift each other up. 

Attending any conference can seem like a daunting task. When you lean into the experience, great things are possible. There are so many ways to engage into a conference from submitting an abstract for a podium or poster presentation, to attending a networking event, or even glamming up go to the Foundation Gala. Every conference attendee starts somewhere. We look forward to seeing you in Grapevine next year! 

It’s Conference Week – Are You Ready? 

We’ve waited all year to join you in Austin for the Texas Nurses Association Annual Conference, and it’s finally here! This year’s theme, The Power of Us: Advancing Our Profession Together, speaks to the heart of who we are as nurses and as a profession. Together, our voices are amplified. Together, we solve complex challenges. Together, we lead change and advance nursing. 

This week’s Practice Tip is a member-exclusive preview of the incredible events planned and a guide to help you prepare and get the most from your experience. 

What to Bring 

Gala Attire 

Pack your best dress or suit for the Texas Nurses Foundation Gala; a night of celebration, recognition, and giving back. Tickets are required. If you haven’t secured yours yet, stop by registration early Thursday afternoon. A limited number of seats may still be available, but they will sell out. The Gala is lively, inspiring, and a highlight of the weekend. 

Comfortable Shoes 

You’ll want them! From the Friday morning energy walk hosted by the Wilderness Medicine Society to impromptu networking strolls and endurance activities, your feet will thank you. Austin offers excellent restaurants, live music, and local shops within walking distance of the venue—perfect for post-conference outings. 

 Books for a Cause 

Join us in supporting NICU families through our book drive and letter-writing campaign, in partnership with the March of Dimes. Bring new or gently used children’s books or stop by their booth to write a heartfelt letter to a NICU family. It’s a small act with big impact. 

Download the WHOVA App 

WHOVA is your all-access pass to the conference. Find your personalized agenda, participate in live chats and polls, and stay in the loop with real-time updates. The app also hosts our scavenger hunt, exhibitor guide, and key announcements. Download it early and explore the interface to stay ahead. 

 

 Bonus Tips for a Powerful Conference Experience 

Plan Your Agenda Early 

Sessions fill quickly—highlight your must-attend events, breakout sessions, and networking opportunities. Use WHOVA to bookmark your favorites. 

Bring Business Cards or Digital Contact Info 

Networking is a major part of this experience. Don’t miss your chance to make lasting professional connections. Consider preparing a short personal pitch or “elevator speech” to introduce yourself confidently. 

Hydrate and Rest 

Conferences are exciting but also physically demanding. Bring a reusable water bottle and take breaks when needed. You’ll get more out of the event if you stay energized and well-rested. 

Engage on Social Media 

Use the official conference hashtag  #ThePowerOfUs to join the digital conversation. Share your insights, tag new friends, and connect with speakers and vendors online. 

We can’t wait to see you in Austin. You are part of a movement—powerful, passionate, and purposeful. Let’s make this year’s conference unforgettable. 

REFERENCES

Centers for Disease Control and Prevention. (2020). Catheter-associated urinary tract infections (CAUTI). https://www.cdc.gov/hai/ca_uti/uti.html 

Faulkner, K., & Franks, M. (2013). Preventing CAUTI: Engaging Clinicians and Senior Leadership to Implement Change (webinar). AHRQ. https://www.ahrq.gov/hai/cauti-tools/archived-webinars/preventing-cauti-engaging-clinicians-transcript.html 

Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., ... & Yokoe, D. S. (2014). Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35 (5), 464-479. https://doi.org/10.1086/675718 

Medina, M., & Castillo-Pino, E. (2019). An introduction to the epidemiology and burden of urinary tract infections. Therapeutic Advances in Urology, 11, 1756287219832172. https://doi.org/10.1177/1756287219832172 

The restructuring and redesign of the Central Staffing Office (CSO) float pool aimed to enhance nurse satisfaction, retention, and operational efficiency across an extensive healthcare system. With over 400 nurses floating between 15 hospitals, the pre-existing system assigned nurses to managers based on alphabetical order. The former assignment often negatively affected nurses with mismatched and unfamiliar leaders of their clinical backgrounds.

The review of the literature and best practices especially highlighted the importance of manager-nurse assignments (Keyes, Hamdayi & Alsaadi, 2025). Using the Plan-Do-Study-Act (PDSA) model, this author developed a policy. It reassigned float pool nurses based on clinical specialties, such as critical care, medical-surgical, and perioperative.

Five nurse managers participated in evaluating the new policy through surveys. Their positive response confirmed that clinical assignments between nurses and managers improved performance management, communication, and satisfaction (Church & Grubaugh, 2025). This author's leadership formally adopted the policy, laying a basic structure for better handling float pool resources. The CSO redesign helped reduce the dependence on contract labor and excessive overtime and aligned financial and staffing purposes. 

Implementing the new assignment project revealed that float pool operations presented unique communication, consistency, and engagement challenges. One of the most critical lessons was the power of aligning nurses with managers who understood their clinical scope and could advocate appropriately. Float pool nurses often felt underutilized due to the transient nature of their work (Ryu & Jiang, 2025). The author's leadership assisted the nurses in assigning leaders with the same clinical background. Consequently, the result was increased employee retention and improved job satisfaction.

Additionally, it was essential to have leadership buy-in (McDonald et al., 2019). Without CSO managers' support, the project implementation could have encountered obstacles. Applying regular feedback loops, such as monthly meetings and post-survey follow-ups, was critical in maintaining accuracy and adjustment as required.

A significant challenge was the lack of initial data on nurse-managing assignments from the research literature, making baseline measurements difficult. This process also highlighted the inequalities in how float pool operations were seen in hospitals, requiring a culture change to see float nurses instead of temporary nursing help (Jones et al., 2023).

Finally, continuous improvement demands continuous evaluation. Future stages will include tracking retention rates and optimizing the manager-to-nurse ratio. Overall, this project emphasized that CSO success depends on staffing logistics, fostering meaningful professional relationships, and long-term engagement. 

 

To the Licensed Vocational Nurse (LVN) who taught me every tip and trick while working as a nurse tech, thank you. I remember how excited I was to be working while in nursing school. I was nervous about getting into a good routine, but you were always there with a smile and an opportunity. It was the first time I really understood how LVNs and Registered Nurses (RN) could work so harmoniously together. I can’t thank you enough for showing me the tricks and tips with activities of daily living (ADLs) and how to put on compression stockings.  

To the nurse preceptor who I still look up to today, even after all these years, thank you. You welcomed me into this profession and encouraged me in each phase of my learning. You set goals with me and validated me and ensured that we had a policy for the actions we took. You sat next to me for my first call to the doctor and then provided me with feedback when I had to call them right back because I forgot to read back the order I was given. You probably don’t remember that, but it was a monumental moment for me. You were there for me when I lost both my parents, when I accepted a charge nurse role, and when I left for new opportunities. You have remained a huge encourager from afar and for that, I thank you.  

To the nursing student who helped me survive nursing school and became one of my lifelong friends, thank you. You may have thought my dreams and aspirations were crazy, but you always cheered me on. We were student leaders together in nursing school and learned to be adults together. You taught me about the importance of sleep and exercise while also ensuring we took time for laughing and fun. I became who I am today because of your friendship and for that, I am eternally grateful.  

To the nursing instructor who believed me when I was too shy to take those first steps into the role of the nurse, I thank you. Your gentle introduction, step back, and presence remained long after you left the room and stayed with me in the next, and the next. Over and over the light bulb moments came on sparking confidence in those steps. You set a foundation of strength designed to grow over a lifetime, thank you.  

To the orientee who helped me remember who I am as a nurse and nurse I want to be every day, thank you. Your excitement, nervous energy (at times), and will to do your best reminded me that you are looking at me to channel these newfound responsibilities into your identity as a professional nurse. The care, the charting, the tasks, and the unexpected turn of events will always be there, it’s how we approach them that makes us who we are as nurses. The difference you have made in my life will never be forgotten.  

To the nurse leader who pushed my boundaries of success beyond what I could see myself accomplish in my career, thank you. Encouraging me to move past what if they no, to what if they say yes. I have learned a no is not an end but an opportunity to keep looking for the next one. Every opportunity to share, collaborate, teach, or lead with one nurse, or hundreds, is a golden moment of connection. Thank you for your grace and patience.  
 

We want to extend a heartfelt HAPPY NURSES WEEK to all of the amazing nurses out there. To learn more about Nurses Week 2025, please visit us at the Nurses Week website.  

The COVID-19 pandemic has prompted nurses to rethink their careers and reinforced the need for healthcare and nursing leaders to shift their approach to nurse recruitment and retention. A 2021 survey by the American Nurses Foundation found that 18 percent of 22,316 respondents planned to leave their current position in the next 6 months. When the data are sorted by nurses working in hospitals (8,524), that percentage rises to 21 percent. These pandemic-related staffing problems are intensified by factors that existed before COVID-19 and that still plague leaders. For example, hospitals in rural areas continue to struggle more with nurse staffing than those in urban locations. Generational differences also exist, with Generation Zers and Millennials more likely to leave positions compared to Generation Xers and Baby Boomers. The exodus of bedside nurses takes its toll on remaining staff and, in some cases, quality of care. 

Too often, organizations have viewed nurses primarily as an expense, failing to understand that investing in this workforce yields financial rewards. High-quality nursing care helps to reduce the likelihood of patient safety events and costly medical malpractice lawsuits related to missed errors. Savvy leaders know that ensuring appropriate staffing levels is key to the financial health of the organization, which means engaging in effective recruitment and retention strategies. This article, the first in a two-part series on nursing recruitment and retention, will address recruitment strategies that leaders can utilize to help attract new nurses to their organization. 

Recruitment 

Nursing and other organizational leaders need to work closely with human resources staff to ensure recruitment processes are efficient and effective: 

Craft ads that work. First impressions count. Everyone is your competitor for a limited pool of nursing talent, so do what you can to make your organization stand out as an attractive place to work. Be sure images in recruitment ads reflect the organization, particularly when it comes to diversity. Many organizations feature their own nurses in ads, which has the additional benefit of employee recognition. Try to make your messaging as personalized as possible, emphasizing your organization’s culture and authentically communicating why nurses should want to be a part of your organization. 

Reach out early. Ask staff who work with students completing clinical rotations to identify those who might make good employees when they graduate. Then get to know the students and encourage them to apply when the time comes. If you lead a specialty unit, invite students to attend meetings (onsite or virtual) of local chapters of the national specialty nursing association so they can learn more about the role. You also may want to partner with local schools to teach a class or workshop so you can connect with students. 

Promote digital efforts. Organizations’ websites often miss the opportunity to feature nurses. Your facility’s website should have a special section highlighting nursing, including stories that feature individual nurses. You can ask staff to record video testimonials that highlight what they enjoy about working for your organization. In addition, your organization’s job portal and job application process should not be so cumbersome that potential employees give up in frustration.  

Individualize benefits. Avoid a “one size fits all” approach to benefits. Instead, offer a menu that nurses can choose from. For example, a late-career nurse may be more interested in retirement-matching funds, but a newer-to-practice nurse may be attracted to a flexible schedule, tuition or student loan assistance, or child-care benefits.  

Obtain Magnet® status. Becoming a Magnet®-designated facility can be expensive, but many nurses prefer organizations with this designation, so it can be well worth the investment. Magnet® status also may help 
reduce turnover and decrease patient morbidity and mortality. 

Provide optimal onboarding. This is often discussed as a retention tool, but it also falls under the recruitment category, as potential employees want to know how supported they will be in their new role. This is particularly 
true of new graduate nurses, who have seen their recently graduated colleagues rushed into practice as a 
result of the pandemic. Many organizations are being shortsighted in cutting back on nurse residency programs, which not only attract staff, but also promote a smoother transition into practice, thus increasing 
retention.   

Preceptors should be chosen based not only on their level of expertise, but their effectiveness as educators. 
Orientees (and preceptors) should know that they can speak up if the match isn’t working.  

Be sure staff feel warmly welcomed. For example, some organizations send a signed welcome card to the employee’s home before their start date. Others post the employee’s name and photo in a visible location on 
the unit.  

Check in regularly with new staff to see how they are adjusting, such as weekly for a month, then every other 
month or so, and then after 6 months.  

Meeting the challenge 

Finding creative solutions to recruit nurses is more important than ever. However, it is only the first piece of the puzzle to building a robust nursing team. Creating a safe, supportive work environment that recognizes nurses’ 
meaningful contributions is essential to encourage nurses to want to keep working for your organization. Part 
two will discuss retention strategies that healthcare and nursing leaders can employ to help increase the 
likelihood that they retain current nursing staff.  

REFERENCES

American Nurses Credentialing Center. Magnet benefits. n.d. https://www.nursingworld.org/organizational-programs/magnet/about-magnet/why-become-magnet/benefits/  
American Nurses Foundation. COVID-19 impact assessment survey – the first year. 2021. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/year-one-covid-19-impact-assessment-survey/ 
CNA & NSO. Nurse Professional Liability Exposure Claim Report: 4th Edition: Minimizing Risk, Achieving Excellence. 2020. 
https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence  
Malliaris AP, Phillips J, Bakerjian, D. Nursing and Patient Safety. Agency for Healthcare Research and Quality. 2021. 
https://psnet.ahrq.gov/primer/nursing-and-patient-safety  
Pink D. When: The Scientific Secrets of Perfect Timing. Riverhead Books; 2019. 
Reitz O, Anderson M, Hill PD. Job embeddedness and nurse retention. Nurs Admin Q. 2010;34(3):190-200. 
Sherman RO. The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success. Rose. O. Sherman; 2021.  
Wolters Kluwer. Ten recruiting strategies to attract nurses. 2019. https://www.wolterskluwer.com/en/expert-insights/ten-recruiting-strategies-to-attract-nurses  

Disclaimer: The information offered within this article reflects general principles only and does not constitute legal advice by Nurses Service Organization (NSO) or establish appropriate or acceptable standards of professional conduct. Readers should consult with an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for how this information is applied in practice or for the accuracy of this information. 

This risk management information was provided by Nurses Service Organization (NSO), the nation's largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. The individual professional liability insurance policy administered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247-1500. www.nso.com.