American Nurse - July 2020

< Previous28 American Nurse Journal Volume 15, Number 7 By Elizabeth Moore, MFA W hen Ann O’Sullivan, MSN, RN, CNE, NE-BC, ANEF, provides conﬂict management train- ing for nurses, she discovers that even the most educated nurses can have trouble with effective communication. “We teach nurses how to chart, start I.V.s, and do assessments,” she said, but not necessari- ly how to communicate. Combine that with the fast- paced, high-stress environment of nursing (which gets even more intense in times of crisis), and incivili- ty and conﬂict can occur. And although nurses can improve their interpersonal skills, it’s up to nurse leaders to set the tone with proven methods to promote conﬂict management in the workplace, O’Sullivan said. Better communication for better care Along with increased stress for nurses, breakdowns in communication and collaboration can potentially lead to patient care errors. “A nurse leader can iden- tify and address these potential breakdowns by fos- tering a team collaboration envi- ronment,” said Mary L. Johansen, PhD, RN, NE-BC, FAAN, a clinical associate professor at Rutgers University School of Nursing who has published several articles on conﬂict management for nurse managers. The ﬁrst step is to in- crease the team’s awareness of each member’s unique knowl- edge and skills. This in turn will lead to improvement in decision making and feelings of mutual respect and trust. One of the basic tenets of conﬂict management is that conﬂict itself isn’t necessarily a bad thing, said O’Sullivan, who is an adjunct professor at Illinois College and an American Nurses Association-Illinois member. Conﬂict is just differences, and we need different opin- ions and strategies to deal with workplace issues. Rath- er than trying to resolve conﬂict, nurse leaders should manage it in a way that recognizes the shared goal of the healthcare team—doing what’s best for the patient. Johansen offers four recommendations for effective conﬂict management, which she identiﬁed in her arti- cle “Keeping the peace: Conﬂict management strate- gies for nurse managers” in Nursing Management . • Engage in dialogue. When a conﬂict arises, de- brief with staff to provide reﬂective learning and remove frustration. This can lead to trust, openness, and effective conﬂict management in the future. • Engage in coaching. Nurse managers frequent- ly learn about conﬂict between nurses after it happens. Educating staff on ways to resolve disputes and disagreements can lead to a healthy work environment. • Identify potential con昀icts. Develop procedures and processes to identify potential common conﬂicts and transform them into opportunities for growth and learning. • Provide education and training. Empower nurses with conﬂict management strategies to resolve conﬂict early and inﬂuence the work environment in which they deliver patient care. These approaches may sound simple, but they re- quire time and effort. Nurses may be surprised at the power of approaching colleagues directly, voicing optimism about outcomes, and taking responsibility for their part in conﬂict, said O’Sullivan, who is a co- presenter of “Navigate and negotiate conﬂict,” an ANA webinar designed in collaboration with Capella University. (In)civil society Incivility frequently is a symptom of a bigger issue. “Many people don’t know how to communicate assertively to get their needs met,” O’Sullivan said. And when they don’t get what they need, they may be- come disrespectful, yell, or choose not to engage, keeping their frustrations inside. She emphasizes that the ﬁrst rule of conﬂict management is knowing that people can change Healthy con昀ict management starts at the top Nurse leaders must model standards of behavior. WORK ENVIRONMENT Mary Johansen Ann O’Sullivan July 2020 American Nurse Journal 29 only their own behavior. O’Sullivan advises nurses to look at their own behavior and thinking and ask themselves, “What role am I playing in this conﬂict?” Johansen, a New Jersey State Nurses Association member, offers nurse managers these strategies: • Learn how to recognize conﬂict early and ad- dress it right away. • Pay attention to body language and be cogni- zant of staff moods. • Remain calm. While actively listening, focus your attention on the speaker. Try to understand, in- terpret, and evaluate what’s being said. After hearing from all sides, clearly deﬁne the prob- lem before seeking a solution that’s acceptable to all parties. Modeling positive conﬂict engagement should lead to staff members feeling capable of solving interper- sonal conﬂicts on their own. However, nurse manag- ers should be open to hearing conﬂict issues and ad- dressing them when needed, Johansen said. Conﬂict avoidance Research suggests that nurses in inpatient acute-care envi- ronments tend to avoid con- ﬂict rather than risk a confron- tation. Breaking out of the avoidance conﬂict manage- ment style can be challenging, Johansen said. Nurse manag- ers should provide opportuni- ties for education and act as role models to help nursing staff understand that when working toward conﬂict resolution—whether with nursing colleagues, physicians, other healthcare pro- fessionals, or patients—remaining calm and positive and staying focused on the situation at hand is impor- tant. Some suggestions include: • Separate your feelings for the person involved in the conﬂict from the issue. • Come prepared with proposed solutions that focus on the problem and not the person. • Keep an open mind and reach out to the person involved and speak with them in private. In other instances, nurses may choose not to speak up at all when it’s important. Fear of retaliation can make nurses reluctant to report colleagues’ errors or poor behavior. Or they may have seen that even when issues are reported, they aren’t addressed. “If I get up the nerve to tell my director that someone isn’t following procedure,” O’Sullivan said, “but noth- ing is done about it, why would I speak up again?” Setting the standard “If incivility is allowed in the organization or on the unit, and there are no standards of behavior about how to communicate with respect, then it’s very hard to hold people accountable,” O’Sullivan said. Leaders will ﬁnd it difﬁcult to address behavior or educate staff if standards of behavior, along with conse- quences for not following those stan- dards, aren’t clearly outlined. O’Sullivan believes such standards should be part of every job description and recom- mends using the ANA Nursing Scope and Standards of Practice for guidance. Johansen emphasized that in a healthy work environment, a just culture is re- quired for positive communication to thrive. “Nurses and nursing students need to be aware of what a just culture is—it’s a blameless culture, where mem- bers of the healthcare team are em- powered to address conﬂict directly.” People can disagree, but they must learn to do it re- spectfully and professionally, Johansen said. “You have to resolve the conﬂict so that it doesn’t affect the patient’s care.” — Elizabeth Moore is a writer at ANA. ANA resources Navigate and negotiate conﬂict—In collaboration with Capella University webinar. nursingworld.org/ continuing-education/webinars/navigate-and-ne- gotiate-conﬂict---in-collaboration-with-capella-uni- versity-5430d0ad/ American Nurses Association. Nursing: Scope and Standards of Practice, 3rd Ed. nursingworld.org/ nurses-books/nursing-scope-and-standards-of- practice-3rd-ed/30 American Nurse Journal Volume 15, Number 7 HEALTH POLICY By Lisa Stand C OVID-19 is shining a light on nursing care and the extraordinary efforts of nurses in emer- gency departments and critical care units, fre- quently without the resources they need to be safe. The American Nurses Association (ANA) has been at the forefront advocating for adequate protections, and Congress and the Trump Administration have heard nurses’ voices loud and clear through our legis- lative, regulatory, and grassroots activities. COVID-19 also has revealed gaps in the healthcare system and the need for deeper public health investments. It’s impossible to predict precisely how the COVID-19 experience will transform healthcare in the long run. But the time is right to recognize that nurses have an enormous role, and enormous stakes, in what hap- pens next in terms of addressing the speciﬁc realities of COVID-19 and the larger issue of supporting ac- cess to healthcare. Lasting impact COVID-19 will have lasting effects for nurses. They’ll be caring for new inpatient cases and responding to the pandemic beyond hospital walls. Survivors will rely on nurses to help them with recovery, some with long-term issues, after they resume their lives. Nurses also are being deployed to support testing and con- tact tracing as communities learn how to reduce vi- rus spread. Value of nursing As policymakers and stakeholders look to reform healthcare and ﬁll public health gaps, nurses must be at decision-making tables. Federal healthcare pro- grams should be funded to ensure adequate training, recruitment, and compensation for the nursing work- force. In healthcare delivery, the value of nursing care shouldn’t be left out of value-based solutions. In fact, Congress, the Administration, and private payers should make nursing a focal point when designing new care models that can meet future pandemics and public health emergencies. Addressing disparities A critical ﬁrst step is to address health inequities. Historic health disparities made COVID-19 especially deadly in groups with a high incidence of chronic dis- eases such as diabetes and hypertension. In April 2020, ANA and key partners called on national lead- ers to direct COVID-19 resources appropriately to communities with higher risks. At that time, in cities like Atlanta and Milwaukee, African American patients accounted for nearly three-quarters of COVID-19 deaths, although they were less than one-third of res- idents. During and after the pandemic, healthcare leaders and stakeholders must address the underlying inequities that led to these results. The same in- equities, due in part to discrimination and lack of access to healthcare, are associated with health disparities in the U.S. population at large. The nursing workforce can play a tre- mendous role in efforts to create a more equitable healthcare system. Nurses provide the type of care and coordination that can help people manage their chronic conditions, in- cluding links to community resources they need to be healthy. Registered nurses and advanced practice regis- tered nurses frequently are the main source of healthcare delivery in rural and underserved areas, providing ac- cess to primary care, maternity care, and prevention. These roles should be strengthened through mean- ingful reforms. ANA will continue to engage with policymakers on healthcare reform that appropriately recognizes the value of nursing, consistent with ANA’s 2016 Princi- ples for Health System Transformation. These princi- ples call for expanded coverage and access to high- quality, cost-effective, and affordable care as well as steps to strengthen the nursing workforce to meet healthcare needs. Visit rnaction.org to learn more about ANA’s advoca- cy for nursing priorities. — Lisa Stand is senior policy advisor in Policy and Government Affairs at the American Nurses Association. Nurses at the table for healthcare reform after COVID-19 July 2020 American Nurse Journal 31 To: Ethics Inbox From: Uneasy RN Subject: Political advocacy I recently saw a political ad featuring a nurse using her name and licensed credentials to support a particular candidate and his views on healthcare. I was instructed that nurses shouldn’t make speciﬁc politician or policy endorsements. I know we have the right to free speech, but is using our credentials to advocate ethical? I’m considering the appropriate way to become involved in advocacy. From: ANA Center for Ethics and Human Rights Thank you for your question. In this election year, many nurses may be asking themselves the same questions about how to balance freedom of speech, their professional identity, and their personal beliefs. As members of the most honest and ethical profes- sion and the largest segment of the healthcare work- force, nurses certainly have a role in advocacy. Provision 5 of the Code of Ethics for Nurses with In- terpretive Statements (the Code ) (nursingworld.org/ coe-view-only) acknowledges that the nurse’s per- sonal and professional identities are integrated. Be- cause you’re an RN, certain issues may compel you to speak out. It’s your right to do so, even if others disagree with your perspective. Your interest in being involved in politics and policy is supported by the Code . Provision 8 states that health is a universal right and that nurses must ad- dress the context of health to advance human rights and reduce disparities. The Code guides nurses to lead partnerships for legislation, policies, and pro- grams that promote health, and the American Nurses Association’s (ANA’s) RNAction website (ana.aristot- le.com/sitepages/homepage.aspx) features stories of some of these nurses. For instance, Razvan Preda, DNP, RN, a New Mexico Nurses Association member, introduced a memorial in his state legislature to raise awareness around the lack of funding for the trauma system. It was passed unanimously. Kathy Luzmoor, MS, RN, CNE, of the Wyoming Nurses Asso- ciation, saw a need for nursing representa- tion on her county health board. She now serves as chair of the board and is able to impact the health of her local community. Our profession belongs at the table, and we need your voice in these conversations. A nurse’s employer may have speciﬁc poli- cies in place about staff participation in po- litical advocacy as a representative of their organization. Check the policies of your workplace to fully understand the implica- tions of engaging in advocacy and consider asking about such policies when seeking employment. Fulﬁlling your ethical obligations as a nurse may compel you to advocate for a political candidate, elected representative, policy, or platform, and you can do that in many ways beyond appearing in political ads. Nurses can speak with colleagues, meet with legis- lators, sign petitions, or write letters to the editor. Through RNAction.org, ANA pro- vides updates on key nursing issues to keep you informed and offers opportunities to take action. ANA encourages RNs to be well informed and politi- cally engaged as nurse advocates during the 2020 elections by visiting nursesvote.org. More broadly, nurses are encouraged to engage in their communi- ties. For example, join the library board or local homeowners association, attend parent-teacher as- sociation meetings, or volunteer in your community. Whatever way you choose to serve, you have a valu- able and respected perspective to share. — Response by Andrea van der Hoek, BSN, BA, RN, CPEN, intern, ANA Center for Ethics and Human Rights, and Liz Stokes, JD, MA, RN, director, ANA Center for Ethics and Human Rights. Is political advocacy ethical for nurses? Do you have a question for the Ethics Inbox? Submit at ethics@ana.org. FROM THE ETHICS INBOX32 American Nurse Journal Volume 15, Number 7 T he American Nurses Associa- tion (ANA) announced its 2020 National Awards recipients in May. ANA’s National Awards honor outstanding nurses and champions whose dedication and achievements have contributed signiﬁcantly to the nursing profession and healthcare. Globally, the nursing profession marks a milestone in 2020, as the World Health Organization has de- clared it the International Year of the Nurse and Midwife in honor of the 200th anniversary of the birth of Florence Nightingale. “ANA is honored to celebrate the achievements of these nurses and champions, who are exemplary leaders and advocates, and whose contributions have advanced the ﬁeld of nursing,” said ANA President Ernest J. Grant, PhD, RN, FAAN. “As we navigate the challenges of this pandemic, now more than ever, we need to recognize the vast contributions of nurses.” This year’s recipients embody the characteristics chosen to signify the Year of the Nurse: excellence, leadership, and innovation. Three RNs are being inducted into ANA’s Hall of Fame. Nine RNs and one nurse champion are receiving ANA’s Honorary Awards. A ceremony to honor the 13 award recipients will be held later this year. Hall of Fame Award ANA established the nursing Hall of Fame Award to recognize individual nurses’ commitments to the nursing ﬁeld and their impact on the health and so- cial history of the United States. ANA is honored to induct three individuals into the Hall of Fame in 2020: • Rose Constantino, PhD, JD, RN, FAAN, FACFE Pennsylvania State Nurses Association • Jeri Milstead, PhD, RN, NEA-BC, FAAN Ohio Nurses Association • Tim Porter-O’Grady, DM, EdD, APRN, FAAN, FACCWS Georgia Nurses Association Honorary Awards The Honorary Award recipients are highly accom- plished RNs who are recognized for their outstanding service to the profession in categories ranging from diversity to patient advocacy to legislative success. Distinguished Practice in Nursing Awards The Distinguished Direct Patient Care Award recog- nizes an individual RN who provides exemplary direct patient care and contributes to the advancement of nursing practice. • Vicki Freedenberg, PhD, RN Maryland Nurses Association The Foundations of Nursing Practice Award recog- nizes an individual RN for achieving outstanding ac- complishments in nursing research, nursing educa- tion, or nursing practice. • Kimberly Bagley, DNP, RN, AGPCNP-BC, AGACNP-BC, CCRN North Carolina Nurses Association The Public Health Service Award recognizes the outstanding contribution by an individual to public health. • William E. Rosa, PhD, AGPCNP-BC, FAAN, FAANP ANA-New York Diversity in Nursing Awards The Diversity Award recognizes an individual RN or a group of RNs for long-standing commitment and sig- niﬁcant contributions to the advancement of diversi- ty and inclusion within the nursing profession. • Brigit Carter, PhD, RN, CCRN Individual Member Division • Ronald Lee Hickman Jr., PhD, RN, ACNP-BC, FAAN, FNAP Ohio Nurses Association Nurse Exemplars Awards The Leadership in Ethics Award recognizes an indi- vidual RN who has authentically demonstrated the highest standards of ethics and leadership in their daily nursing practice. • Laurie Badzek, LLM, JD, MS, RN, FAAN, FNAP Pennsylvania State Nurses Association • Jeanie Sauerland, MA, BSN, RN Texas Nurses Association Nursing Champions Awards The Advocacy Award recognizes an individual RN who embraces the role of advocate as part of their professional identity. • Patricia La Brosse, MS, RN, PMHCNS-BC Louisiana State Nurses Association • Cynthia Zolnierek, PhD, RN, CAE Texas Nurses Association The Champion of Nursing Award recognizes an ex- traordinary leader who is not a member of the nurs- ing profession but has demonstrated a commitment to ANA’s mission through distinguished service. • Michael Singer Chief Executive Of昀cer, Careismatic Brands, Inc., formerly Strategic Partners, Inc. RECOGNITION ANA names 2020 National Awards Recipients 13 honorees recognized for their exceptional leadership in healthcare July 2020 American Nurse Journal 33 HEALTHY NURSE A ccording to the National Council of State Boards of Nursing’s National Nursing Work- force Study, about 91% of RNs are women, and their average age is 50. In fact, almost half of the full-time and part-time RNs in the U.S. are 50 years of age or older. As female nurses age, they face new challenges, including menopause. The American College of Obstetricians and Gynecolo- gists reports that the average age women go through menopause is 51 years. That means many working RNs aren’t dealing only with stressors of a nursing career—long shifts, difﬁcult situations, grief—they’re also dealing with unpleasant side effects associated with menopause, such as: • hot ﬂashes and night sweats • chills • sleep problems • mood changes • bone density loss • weight gain and slowed metabolism • thinning hair and dry skin. On the upside, there’s a natural way to reduce or re- lieve menopause symptoms like weight gain and loss of muscle mass: exercise. Always consult your health- care provider be- fore starting a new exercise regimen. Physical activity options Are you looking for the right exercise to help combat menopause side effects? Here are a few options: • Walking: Getting your steps in is ideal for main- taining healthy bones, especially among women who can’t do high-impact activities. Walking also is a great way to slowly incorporate more physical activity into your lifestyle before turning to aero- bic exercise or strength training. Start with moder- ate intensity walking, around 3.5 mph. • Strength training: Strength training and other higher impact activities like jogging can help re- duce the decline of bone mineral density and pre- vent osteoporosis. Bonus: Strength training also can rev up decreasing metabolism and burn more fat, even while resting. Try lifting weights, using elastic bands or weight machines, or performing exercises that use your own body weight (like squats, push-ups, or lunges). • Yoga: This ﬂexibility exercise helps stretch the mus- cles and promote better muscle function. Use yoga after an aerobic or strength training exercise to calm the body and mind. Or incorporate it into your bedtime routine to help prepare yourself for sleep. • Dancing: This higher impact activity is best for women who don’t have low bone mass and aren’t frail. It promotes better balance, stronger muscles and bones, reduced anxiety, and improved mood. Try a dance style that suits your personality—salsa, tap, swing, line dancing, belly dancing, and hip- hop are a few examples. You also can try a dance exercise class like Zumba or barre. Look online for teachers or group classes near you. • Biking: Cycling is a non-weight bearing, lower impact activity that many women enjoy. Biking outside allows you to explore new ar- eas, breathe fresh air, and enjoy na- ture. Indoor group cycling classes are another fun option you can do with friends. Either way, biking gets your heart pumping, works your mus- cles without too much stress on the joints, and burns calories. Time to get moving No matter which form of exercise you decide to try, the point is to keep moving. Start small and increase the length and frequency over time. Another tip? Find an accountability partner who will motivate you and encourage your healthy, active life- style. Even better—ﬁnd an exercise buddy who will hold you accountable and make the process more social and fun. It’s never too late (or early for you youngsters!) to start working out, especially when it can help reduce symptoms of menopause. Physical activity is a cru- cial part of self-care for all nurses, regardless of age. There’s something out there for everyone. Content developed in association with Healthy Nurse, Healthy Nation™ and Aha Media. Why exercise is so important during menopause34 American Nurse Journal Volume 15, Number 7 FOUNDATION NEWS I n only 2 months, the American Nurses Foundation Coronavirus Response Fund for Nurses has done much to support our colleagues by providing: • more than $2 million in direct ﬁnancial assis- tance to nurses through a partnership with Nurses House, Inc. • mental health support through the Well-Being Initiative • real-time information crucial to nurses via on- demand webinars from the American Nurses Association. The fund is the result of contributions—large and small—from over 17,000 individuals, organizations, foundations, and associations. While created as a place where the public can make a donation to help nurses, a number of nurses also have contributed to support their fellow RNs. The need for support is great, so the Foundation continues to gather funds on nurses’ behalf. Learn more about the resources available through the Coronavirus Response Fund for Nurses at nursingworld.org/foundation/programs/ coronavirus-response-fund. “In my two decades of working alongside nurses, I have had a deep desire for nurses to be truly seen and appreciated by the public,” said Kate Judge, ex- ecutive director, American Nurses Foundation. “In this ‘Year of the Nurse,’ it is our work at the American Nurses Foundation to make sure that nurses stay seen and appreciated.” Here are some of the messages people have sent us to share with you: From nurses “Being a nurse and having my oldest daughter a nurse on the frontlines has made me so proud of our selﬂess attitudes to always be there for others!” — Genevieve Adams “I’m a retired RN; my health took me out of the career I thought I’d still have. I am heartbroken that I can’t be with you. My heart is, always.” — Nikki Berry From families of nurses “My mother is a nurse and throughout my entire life she has inspired me, and to the thousands of nurses out there you inspire me as well!” — Marcus Bates-Bustos “My wife is a nurse of ~30 years; she recently com- pleted her NP degree and is a most outstanding nurse. This is to honor her and others just like her.” — Mnason Plumb “This donation is in honor of my son, Brian Craig, BSN, RN, who is a frontline worker on a COVID-19 unit. I’m so proud of him.” — Carol Craig From grateful patients and their families “Two years ago, nurses saved my life when I was in respiratory failure. Now, I want to give something back as a remembrance of their dedication.” — Harmony Brenner “In honor of Mark Gordon and the excellent nurses who cared for him.” — Mimi Wright “Thank you to all the amazing nurses at IU Health who helped David Nee!” — Julie Sievert “This donation is in the name of the ER nurses at JFK North in West Palm Beach, Florida. Thank you all for your service on the front lines.” — Emma Bayles From well wishers “Grateful for the care nurses provide each & every day but especially during COVID-19 where they truly put themselves in harm’s way to care for others.” — Patricia Barrett “I give because I am inspired by the caring, compas- sion, and authentic way in which they do their jobs, in good times and in bad.” — Nick Rebholz In memory “I am giving in the name of Priscilla Larochelle who passed away on May 6th from COVID-19. Thank you to all nurses, especially those who cared for my aunt.” — Catherine Contreras “In memory of Celia Banago. For her bravery and in appreciation for her selﬂess care and dedication to her patients.” — From the Glessner family “My 91-year-old Nana sadly passed away yesterday and was one of the greatest people/nurses I knew. As a fellow healthcare worker I wanted to help.” — Molly Awiszus Sharing messages of thanks to nurses Learn about the Well-Being Initiative at nursingworld.org/ thewellbeinginitiativeFREE DOWNLOAD! ANA's Principles for Nurse Staﬃng | THIRD EDITION This updated edi琀on iden琀ﬁes the major elements needed to achieve op琀mal staﬃng. The Principles will guide nurses and key decision-makers in iden琀fying and developing processes and policies to improve nurse staﬃng at every level and in any se�ng. Under 25 Pages Download and print ANA's Principles for Nurse Staﬃng infographic to learn about the 5 Principles for Nurse Staﬃng. BONUS DOWNLOAD! Principles for Nurse Staﬃng Infographic! Nurse staﬃng decisions are based on the number and needs of the pa琀ents, families, groups, communi琀es, and popula琀ons served. Principle #1 HEALTH CARE CONSUMER All nursing care delivery systems must provide the necessary resources to meet each health care consumer’s individual needs and the demands of the unit. Principle #4 PRACTICE ENVIRONMENT Organiza琀ons must have appropriate nurse staﬃng plans. All se�ngs need well-developed staﬃng guidelines with measurable nurse-sensi琀ve outcomes. Principle #5 EVALUATION Nurse staﬃng is an asset to ever-evolving health care systems. Appropriate nurse staﬃng, with suﬃcient numbers of nurses, improves the health of the popula琀ons. Nurses at all levels within a health care system must have a substan琀ve and ac琀ve role in staﬃng decisions. Principles for Nurse Staﬃng Op琀mal care is achieved through individual ac琀ons and collabora琀on with other health care team members. Nurses are full partners in the delivery of safe, quality health care. Principle #2 INTERPROFESSIONAL TEAMS Organiza琀onal leaders must create a workplace environment that values nurses as cri琀cal members of the health care team. Principle #3 WORKPLACE CULTURE To download both your FREE eBook and infographic go to: h琀p://bit.ly/StaﬃngAd36 American Nurse Journal Volume 15, Number 7 MyAmericanNurse.com U NDOUBTEDLY , we’re navigating in unprece- dented times. At a rapid pace, we’ve borne witness to a virus that’s overtaken every as- pect of our lives on a global scale. Amid mass shutdowns, shortages, and economic crum- bling, the healthcare workforce has risen to the call to respond, caring for the sickest and most vulnerable while risking their own per- sonal safety in the process. As we begin to see morbidity and mortality in some of the hardest- hit states begin to decline, we search for glim- mers of hope in the idea of landing “on the other side” of a pandemic. To get to a stronger healthcare system, nurses must work with leadership to strength- en the resilience of their organizations and build an effective recovery plan that meets the multidimensional needs of staff and the populations they serve now and in the long term. Key to this plan is developing effective strategies to address staff mental health, well- being, and resilience. The American Nurses Foundation, in partnership with the American Nurses Association and three of our affiliated specialty organizations, created The Well-be- ing Initiative to help address these needs ( nursingworld.org/thewellbeinginitiative ). The National Academy of Medicine also of- fers resilience-building strategies for health- care leaders and clinicians ( nam.edu/initia- tives/clinician-resilience-and-well-being ). Looking at the broader picture, COVID-19 has transformed how we provide patient care. From starting up telehealth programs to triag- ing in parking lots and implementing team- based advanced practice RN–led models for acute care, our healthcare system has adopted care delivery models some health profession- als once doubted were possible. And lives are being saved as a result. So when nurses are working with their organization’s leadership, they should consider the successes during the pandemic that can lead to more resilient, stronger organizations. Another factor to con- sider: What lessons are learned from resource allocation and what resources and training are needed to avoid the same pitfalls? Organizational resilience takes collabora- tion and alignment. Every healthcare organ- ization should have a designated workgroup that includes clinical and nonclinical team members who can analyze strengths and weaknesses within the response plan to de- termine what can be done differently for a better future response. Evaluate the clini- cal lessons learned regarding patient care, staffing, personal protective equipment allo- cation, and overall preparedness to develop a comprehensive plan for the future. During times of crisis and response, organ- izations build partnerships, such as with gov- ernment agencies and community groups, to extend their capacity and achieve the greater goal of reduced morbidity and mortality. Once the crisis is over, healthcare organizations must leverage those partnerships to continue to strengthen patient care and preparedness measures. Nurses—with their resourcefulness and astute critical reasoning—are crucial to these efforts. Looking ahead, we must acknowledge our new normal as a starting point in our recov- ery. Enduring a pandemic has changed both our lives and our outlook. The question that remains now is how can you take hold of this change to bolster not only healthcare professionals’ individual resilience but also the resilience and strength of our healthcare system? AN Kendra McMillan is senior policy advisor for the American Nurses Association, Nursing Practice and Work Environment Department. COVID-19 resilience and recovery Resilience takes collaboration and alignment. By Kendra McMillan, MPH, RN PRACTICE MATTERS Enduring a pandemic has changed both our lives and our outlook.MyAmericanNurse.com July 2020 American Nurse Journal 37 LIFE AT WORK Nurse preceptors and new graduate success Use these strategies to enhance new nurse clinical reasoning skills. By Kelly Powers, PhD, RN, CNE; Julie Pagel, MSN, RN, CCRN, SCRN, CNE-cl; and Elizabeth K. Herron, PhD, RN, CNE, CHSE T RANSITION to practice for new graduate nurses is challenging. The stress associated with learning the full scope of their new role can lead them to leave the profession, and lack of experience can result in errors. A fo- cus on new nurse success is essential to im- proving retention rates and ensuring patient safety. Enter nurse preceptors, who can help promote new nurse success by providing support and using strategies to enhance clin- ical reasoning. The preceptor role Nurse preceptors play a vital role in promot- ing new graduate nurse success. By offering support and feedback (including positive re- inforcement), preceptors can help reduce new nurses’ anxiety and increase their self- confidence so they can become progressively more independent and successfully adjust to their new role. Preceptors begin providing support by getting to know the new nurses they’re precepting. What are their prior expe- riences (school, work, life)? What are their goals for orientation and beyond? Each new graduate will come to practice with different experiences and learning needs, so they’ll progress through orientation at different paces. Next, preceptors should socialize their pre- ceptees to their new role as members of the unit’s intra- and interprofessional teams and connect them with others they can reach out to for additional support and assistance when needed. Because preceptors have an ongo- ing, close working relationship with their precep tees, they can watch for signs of tran- sition shock (sleeplessness, exhaustion, doubts about their abilities, and fear of failure or disappointing others) and implement addi- tional support strategies in collaboration with unit managers and educators. Another crucial component of the precep- tor role is helping new graduate nurses devel- op their clinical reasoning skills so they can recognize changes in a patient’s condition and determine the best way to respond. (See What is clinical reasoning?) Strategies to build clinical reasoning skills Preceptors can use various strategies to help new graduate nurses develop their clinical reasoning skills and as a result prevent fail- ure-to-rescue events that occur when signs of patient deterioration aren’t recognized or are acted upon too late or not at all. (See Precept- ing in action .) Next >