< Previous38 American Nurse Journal Volume 15, Number 3 IN BRIEF T he Centers for Disease Control and Prevention (CDC) is closely monitoring an ongoing out- break of 2019 Novel Coronavirus (2019-nCoV) in Wuhan, China. Cases have been identified in multi- ple countries, including the United States. The American Nurses Association (ANA) affirms the current CDC guidelines on the interim recommenda- tions for healthcare professionals to protect the pub- lic and themselves. For guidance, visit cdc.gov/ coronavirus/2019-nCoV/index.html. In addition, ANA also developed resources available at nursingworld. org/coronavirus. Coronaviruses are not a new family of viruses and are common in different species of animals; howev- er, it’s rare for animal coro- naviruses to evolve and spread to people. There are multiple strains that can cause mild respiratory symptoms or even the common cold. In previous years, other strains have been associated with se- vere acute respiratory syn- drome (SARS) and Middle East respiratory syndrome (MERS). Transmission of 2019-nCoV can occur person to per- son, but it’s unclear how and how easily the virus is transmitted. Symptoms associated with 2019-nCoV include mild to severe respiratory illness with symp- toms of fever, cough, and shortness of breath. The CDC believes the incubation period lasts 2 to 14 days after exposure based on what has been seen previ- ously as the incubation period of MERS viruses. Cur- rently, no vaccine is available to consumers. Older adults and people with underlying medical conditions are at increased risk. Nurses should develop and educate staff on a pre- paredness plan that provides infection prevention procedures and proto- cols used within their healthcare facility for the early identification and care of patients with symptoms associated with 2019-nCoV. Facilities should provide updated training and guidelines on the use of personal pro- tective equipment, such as gloves, gowns, masks, eye protection, and a face shield. Consistent use of proper hand hy- giene, standard precau- tions, contact precautions, and airborne precautions, along with the proper use of a National Institute for Occupational Safety and Health-approved N-95 respi- rator or higher, is recommended. Coronavirus: What you need to know T he ANA Center for Ethics and Human Rights has been a leader in healthcare ethics, nursing ethics, bioethics and human rights for 30 years. In collaboration with constituents, the center has tire- lessly provided ethical guidance, both theoretical and practical, at the state, national, and international level. The center responds to and also creates policy on is- sues including the protection of human rights, end of life care, medical marijuana, social justice, assisted suicide, use of patient restraints, genetics, torture, capital punishment, racism, discrimination, social me- dia, and ethical work environments. At the core of its mission, the Code of Ethics for Nurses with Interpretive Statements drives the cen- ter’s responsiveness to the nursing profession and addresses the fundamental duty to improve the qual- ity of care for all persons, patients, families, commu- nities, and populations. ANA established the center in 1990 to help nurses obtain a better understanding of ethical issues in practice in a rapidly changing landscape. Some key highlights through the years include the following: • Published an ANA position for nurses regarding ethics and assisted suicide in 1994. • Revised the Code of Ethics to include nurses’ mor- al duty to self-respect and ethical decision-making in 2001. • Elevated nurses’ ethical obligations during disas- ters, pandemics, and extreme emergencies follow- ing September 11, 2001, and Hurricane Katrina (2005) and the Ebola crisis (2014). • Advocated at the national level for a Navy nurse who refused to force-feed Guantanamo Bay de- tainees in 2013. • Celebrated the Year of Ethics in 2015 and revised the Code to extend nurses’ obligations to popula- tions and activism in social justice. • Received American Society for Bioethics and Hu- manities Cornerstone Award in 2017. Learn more about the center and download an info- graphic recognizing the 30th anniversary at nursing- world.org/practice-policy/nursing-excellence/ethics. ANA Center for Ethics and Human Rights celebrates 30 years March 2020 American Nurse Journal 39 To: Ethics Advisory Board From: Overworked RN Subject: Freelance nursing I ’m exhausted. My unit is always short staffed. I’m asked to work longer hours and come in on my day off. I need more control over my life and schedule. I wish there was an Uber-like employment option for nurses. How does the Code of Ethics for Nurses with Interpretive Statements (the Code ) apply to freelance work? From: ANA Center for Ethics and Human Rights Free agent or freelance work is a part of the gig economy (job-to-job employment). Several technolo- gy sites enable nurses to browse open shifts, sign up, work, and get paid the same day. The more common model is for nurses to serve as full-time, semi-perma- nent employees in a single organization. Layoffs, downsizing, mergers, acquisitions, and nurs- ing shortages have resulted in nurses exploring dif- ferent employment and career options. The days of benevolent organizations providing career advance- ment and educational opportunities are dwindling. Individual nurses are relying on themselves to devel- op their skills and expertise to grow their careers. Free agency is incredibly empowering because nurses build their reputations based on their own knowledge, skills, contributions, and outcomes. Nurses have long enjoyed the flexibility of transfer- rable skills, providing the ability to move among or- ganizations, cities, and states with confidence that they’ll secure a good job. Freelance work enables nurses to have full control over their schedules, work in care areas they enjoy, and optimize their work-life balance. Skill variety offers a competitive edge. A nurse who’s competent across multiple care continuums is highly sought. The free agent model is mutually beneficial. Organi- zations benefit from having a more flexible staffing model with the ability to staff up when census and acuity rise, and staff down as it falls. The freelance nurse takes responsibility for his or her own profes- sional and career development and can be more in- dependent and resilient. Free agency isn’t limited to frontline, direct care po- sitions. Consider the needs of an organization adopting a new electronic health record or com- pleting annual training and competency educa- tion. Freelance nurse educators can support or- ganizational transformation. The opportunities are endless. The freelance mindset might be uncomfortable for some. The skills associated with marketing yourself, networking, collaboratively working in a team where relationships are shorter term, and building your career portfolio are new skills for some nurses. And the security of full-time employment and benefits remains an attractive option for many. Others embrace flexibility and are less risk-averse. Advance preparation for un- certainties can mitigate concerns and raise con- fidence. The Code (nursingworld.org/coe-view-only) es- tablishes the ethical standard for the profession and guides nurses in decision making. The nurs- ing profession “encompasses the protection, pro- motion and restoration of health and well-being; the prevention of illness and injury; and the alleviation of suffering in the care of individuals, families, groups, communities, and populations.” The Code explicitly states the primary obligations, values, and ideals of the profession. In every work environment, adherence to the nine provisions of the Code en- sures the nurse is practicing ethically. There’s no conflict between the freelance model and the Code . The gig economy offers exciting possibilities for nursing to advance independent practice, individual accountability, and self-care. — Response by Donna Casey, member of the ANA Center for Ethics and Human Rights Advisory Board. Nursing ethics for a gig economy Reference Caulfield C. Forbes The gig economy has arrived in the world of nursing. Forbes. September 27, 2019. forbes.com/sites/for- bestechcouncil/2019/09/27/the-gig-economy-has-arrived-in- the-world-of-nursing/#407841b16274 Do you have a question for the Ethics Inbox? Submit at ethics@ana.org. FROM THE ETHICS INBOX40 American Nurse Journal Volume 15, Number 3 A merican Nurses Associa- tion (ANA) membership includes a variety of pro- grams and products created spe- cifically for RNs, including many that are free or offer member savings. The 2020 Navigate Nursing webinar bundle features expert speakers on topics de- signed to enhance your career and work-life balance. The bun- dle is free for ANA members ($75 for non-members). Upcoming webinars include: March 25 Innovations by nurses for nurses: Self-care every nurse needs Presented by Kathleen C. Attonito, MSN, RN-BC, an ANA-New York member, and Nicole D. Benincasa, MS, LMHC, this webinar focuses on how one organi- zation gathered input from frontline nurses and ex- perts to design innovative programs and structures to meet the complex self-care needs of individuals and nursing teams. May 20 Nurses Month webinar: Magnify your voice— Use storytelling to advance nursing This webinar offers techniques on how to share your nursing story, presented by Carolyn Jones, producer and director of the documentaries The American Nurse and Defining Hope . You’ll learn how to con- struct a narrative that communi- cates your motivations, the value of your work, and the challenges you face every day. August 19 Mental health of nurses: Supporting your nursing colleagues when they need it most Presented by LaKeetra Josey, PhD, APRN, PMHNP-BC, a Dela- ware Nurses Association mem- ber, this webinar examines the impact nursing has on mental health and shows you how to im- prove your skills in identifying and offering support for mental health challenges in your colleagues and your yourself. November 11 Real solutions for workplace bullying and incivility If you’re a nurse, a significant chance exists that you’ve experienced or witnessed bullying in the workplace. ANA has developed a position statement and the #EndNurseAbuse campaign to address issues like bullying and incivility on the job. You’ll learn how organizations can take this issue from concept to action. Learn more about the series and register for all four webinars at nursingworld.org/continuing-education/ 2020-navigate-nursing. T he Individual Membership Division (IMD) of the American Nurses Association (ANA) was es- tablished by an amendment to the ANA Bylaws on June 26, 2003. The purpose of the IMD is to pro- vide the organizational structure to permit ANA-Only Members (those who elect to join ANA directly at the national level only) to participate in ANA governance, as well as the programmatic work of ANA as expressed in the ANA Bylaws. The IMD is soliciting nominations for chairperson and secretary. To review the roles and responsibilities of each posi- tion, please access the IMD Operating Policies and Procedures, under the resources tab at nursingworld. org/membership/individual-member-division. The terms of office for each position are 2 years, from July 1, 2020 through June 30, 2022. This is the official notice of the 2020 election. To qualify as a candidate for office, the nominee must be a member of the ANA IMD (ANA-Only member- ship category). Emails with information for the nomi- nation process and criteria will be sent starting April 15. If you don’t have an email on file with ANA, you’ll receive print notifications. The due date for nomina- tions is May 15. 2020 Navigate Nursing webinar series IMD call for nominations for 2020 ANA elections ANA MEMBERSHIP ELECTIONS42 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com T HE American Nurses Association (ANA) In- novation Awards, powered by support from BD, highlight, recognize, and celebrate exem- plary nurse-led innovation that improves pa- tient safety and outcomes. Here’s an update from the inaugural recipients. Individual award Fitsi, developed by Kathleen Puri, MSN, RN, a Tennessee Nurses Association member, is a portable bedside caddy designed to help patients clean their hands without caregiver assistance. It attaches to bedrails, stands alone, and keeps personal items safe and easily accessible. Since receiving the Innovation Award, Fitsi Health (founded by Puri) has been focused on developing tools to build industry-wide stan- dards for patient hand hygiene. Most hospitals have protocols related to healthcare worker hand hygiene, but few have an established process for patients. Research indicates that patients don’t clean their hands enough while in the hospital; frequently, they’re the “missing piece” in infection prevention efforts. Regular patient hand hygiene is the simple solution. Creating tools to help hospitals increase patient hand hygiene frequency is the first step to systematic improvement. To this end, Fitsi Health is working with the Patient Safety Movement Foundation and other safety or- ganizations to develop, distribute, and pro- mote tools for patient hand hygiene. Fitsi also collaborates with the Healthcare Infections Transmissions Systems Consortium to educate the industry on the importance of patient hand hygiene. A white paper is cur- rently in development and will be the foun- dation for presentations at conferences. Team award Inspiren’s vision is to revolutionize patient care by empowering providers with unprece- dented clinical insight intelligently derived from a patient’s digital and physical environ- ment. The company was founded by Paul Coyne, DNP, RN, AGPCNP-BC, a New Jersey State Nurses Association member, Michael Wang, MBA, RN, and Vincent Cocito, BS. In- spiren’s wall-mounted device, called iN, is placed directly behind the patient’s bed and uses multiple advanced sensors to detect clin- ically significant activity and identify patient risk. Inspiren’s platform aggregates data from iN, internet of things (IoT) devices, and other clin- ical systems to help hospitals achieve a 360- degree view of care delivery. Visibility into re- al-time staff activity, patient behavior, and trending data helps organizations implement focused initiatives that drive behavior and measure execution. Inspiren automates round- ing, bedside reporting, and other clinical activ- ity documentation to ensure staff focus their time on what matters most—the patient. Inspiren technology was implemented as a pilot on two units within a leading hospital network. Throughout the 8-month pilot, re- search was conducted to test for statistically significant improvements in outcome measures (Sun and colleagues, manuscript in prepara- tion). The results suggest: •increases in hourly rounding and bedside reporting •reductions in call bell volume due to in- creased rounding •improved call bell response times due to call bell alerts on mobile devices •substantial decreases in falls on both units •increases in percentage of patients respond- ing “always” to the follow-up survey ques- tion, “Call button help soon as wanted it.” The ANA Innovation Award funding was used to install hardware, test software, train nursing staff, and continue to enhance product features based on nursing feedback. AN 2019 ANA Innovation Award winners update Nurse-led innovation continues to unfold. PRACTICE MATTERS Inspiren’s wall- mounted device, called iN Fitsi, a bedside caddy to help with patient hand hygiene, developed by Kathleen Puri44 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com Frequently asked questions about the Nurse Licensure Compact Learn more about how the compact affects you and your practice. By Rebecca Fotsch, JD I F YOU HAVE QUESTIONS about the Nurse Li- censure Compact (NLC), you’re not alone. Here are answers to some of the most fre- quently asked questions. What is the NLC? The NLC is an interstate agreement that allows nurses to have one license issued by their home state that they can use to practice in any state that’s a member of the NLC. Think of it as similar to your driver’s license. Just like you can drive anywhere in the country under your state-issued driver’s license, the NLC allows you to practice nursing in any NLC state under one state-issued multistate nursing license. And just as you must follow the rules of the road for each state you drive in, you must fol- low the nursing practice laws of each state in which you practice (physically, telephonically, or electronically). The original NLC was established in 2000 when Texas, Wisconsin, and Utah became the first states to implement it. By 2013, the NLC had 24 participating states, but further partici- pation had stalled. In 2015, the National Council of State Boards of Nursing’s (NCS- BN’s) membership decided revisions to the compact were necessary to achieve nation- wide participation. The revisions included a requirement for fingerprint-based criminal background checks and additional uniform li- censure requirements (ULRs) clearly defined in the NLC. (See Uniform licensure require- ments.) ULRs allow NLC states to feel confi- dent that nurses who are issued a multistate li- cense have met standard eligibility criteria. At the discretion of each board of nursing, nurses who don’t meet the ULRs still may be eligible for a single-state license. What will practice and licensure look like tomorrow if my state joins the NLC today? Practice in your state will remain the same for you, and licensure will be similar, too. You’ll still need to apply for a license in your home state, but if you want to obtain a mul- tistate license, you’ll need to meet the ULRs LIFE AT WORKMyAmericanNurse.com March 2020 American Nurse Journal 45 outlined in the NLC, most of which are prob- ably already required under your existing state law. If you can’t meet the ULRs, you still may be eligible for a single-state license that grants you the privilege to practice in only that state. I don’t cross state borders when I practice. Will I still benefit from the NLC? Yes. In addition to helping nurses working near state borders to practice seamlessly in both NLC states, the NLC also helps nurses practicing telephonically and electronically. When a patient receives care and then crosses the border to return home, all follow-up nurs- ing care, including phone calls, must be pro- vided by a health professional who’s licensed to practice in the state where the patient is physically located. The NLC also helps facilitate telehealth, which expands access to care for patients across the country. Under the NLC, a nurse holding a multistate license can practice tele- health in all NLC-member states without need- ing a separate nursing license in each state. The compact also facilitates online nursing education. Students participating in a distance learning program may be scattered across the country. Because nursing faculty generally are required to hold a nursing license in each state in which they have students, the NLC sig- nificantly eases the burdens on schools and nursing faculty who are able to acquire a mul- tistate license issued by their home state. In addition, the NLC can help in times of disaster. It allows nurses who hold multistate licenses to immediately cross borders and pro- vide care to those in need without having to wait for a formal declaration of disaster or is- suance of a license by the affected state. I’ve heard that the NLC reduces nurse licensure standards. Is this true? No. The 11 ULRs ensure that all nurses from NLC states who are issued a multistate license have met specific nursing standards. However, states can continue to go beyond the ULRs to license their nurses. For example, they can continue to require any continuing education that’s already a part of their licensure require- ments. States have complete autonomy when it comes to their state licensure; the NLC ap- plies only when determining whether an ap- plicant is able to receive a multistate license. Is nursing the only profession with a licensing compact? No, although nursing was the first health pro- fession to begin a licensing compact. Since then, many other professions—including physicians, physical therapists, psychologists, and emergency medical technicians—have recognized the need for licensure compacts to facilitate borderless practice. How many states belong to the NLC? Currently, 34 states are NLC members. Of The Nurse Licensure Compact requires that all applicants for a multi- state license must meet 11 uniform licensure requirements. They must: 4 meet the requirements for licensure in the home state (state of residency) 4 graduate from a board-approved nursing education program or an international nursing education program (approved by the author- ized accrediting body in the applicable country and verified by an independent credentials review agency) 4 pass an English-proficiency examination (applies to graduates of an international education program not taught in English or if English is not the individual’s first language) 4 pass an NCLEX-RN®, NCLEX-PN®, or predecessor exam 4 be eligible for or hold an active, unencumbered license without active discipline 4 submit to state and federal fingerprint-based criminal background checks 4 not be convicted of, found guilty of, or have entered into an agreed disposition of a felony offense under applicable state or federal criminal law 4 have no misdemeanor convictions related to the practice of nurs- ing (determined on a case-by-case basis) 4 not currently participate in an alternative-to-discipline program 4 self-disclose current participation in an alternative-to-discipline program 4 have a valid U.S. social security number. Uniform licensure requirements46 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com those, two have enacted the legislation but are preparing for implementation. As of January 2020, seven jurisdictions have pending NLC legislation. A compact is most effective when every state is a member, so the goal is for every state to join the NLC. Imagine if the Driver License Compact included only half of the states in the country! How does my state join the NLC? First, check the map on nursecompact.com; your state already may be a member. If your state is one of the 17 not part of the NLC, it will need to enact model NLC legis- lation through its legislature. A compact is essentially a contract between states, so every state must enact substantially the same legislation to join. You can find the model NLC lan guage as well as other re- sources at nursecompact.com , or contact your state board of nursing for further in- formation. My state is already in the NLC, but I don’t fully understand how it operates. Is there a way to find more information? Yes. The NLC and NCSBN have many online resources that explain how the NLC operates and how it affects your nursing license. The NLC Toolkit ( ncsbn.org/nlc-toolkit.htm ) is a helpful resource for all nurses. AN Rebecca Fotsch is the director of state advocacy and legislative affairs at the NCSBN in Chicago. Disclosure: The NCSBN drafted the NLC guidelines. This article underwent peer review and no bias was found. References Evans S. The Nurse Licensure Compact: A historical per- spective. J Nurs Reg. 2015;6(3):11-6. National Council of State Boards of Nursing. The En- hanced NLC: Unlocking Interstate Nursing Practice in the 21st Century. Leader to Leader. Spring 2016. ncsbn.org/ L2L_Spring2016.pdf National Council of State Boards of Nursing. Nurse Li- censure Compact. May 4, 2015. nursecompact.com/ NLC_Final_050415.pdf National Council of State Boards of Nursing. Nurse Li- censure Compact. 2018. Nursecompact.com/updated_ Legislator_FAQ.pdf way of doing things as the only path to goal achievement. Jackie will need to shift her thinking and accept that different approaches can lead to successful outcomes. Her inability to fully delegate projects costs the organiza- tion because she’s not meeting other respon- sibilities. She’ll need to reduce her unnecessar- ily high expectations of others and recognize that criticism isn’t a motivator. 5. Find an accountability partner. Changing deeply rooted behaviors can be ex- tremely difficult. After Jackie develops her ac- tion plan, she should find a trusted colleague who can observe her new behaviors and of- fer feedback. This will require vulnerability when seeking help to avoid reverting to de- structive behaviors. Perfectionism rehab If you’re a perfectionist like Jackie, recognize that it’s a double-edged sword. While perfec- tionism may have contributed to your career success, it can result in leadership derailment. Pay attention to your perfectionist tendencies and work hard to moderate them. Recognize the difference between excellence and per- fection and acknowledge that a goal can be achieved in many ways; your approach may not be the best option. Practice patience and recog- nize that perfectionism is likely to emerge when you’re under stress. An accountability partner can help you when you’re being unrealistic. Strive to be a recovering perfectionist. AN Rose O. Sherman is adjunct professor at the Marian K. Shaughnessy Nurse Leadership Academy, Case Western Reserve University in Cleveland, Ohio, and author of the book The Nurse Leader Coach: Become the Boss No One Wants to Leave. You can read her blog at emergingrnleader.com. *Name is fictitious. References Brown B. The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You Are. Center City, MN: Hazelden Publishing; 2010. Goldsmith M. What Got You Here Won't Get You There: How Successful People Become Even More Successful. London: Profile Books; 2010. Martin S. The CBT Workbook for Perfectionism: Evidence- Based Skills to Help You Let Go of Self-Criticism, Build Self-Esteem, and Find Balance. Oakland, CA: New Har- binger Publications; 2019. Roger D, Petrie N. Work without Stress: Building a Re- silient Mindset for Lasting Success. New York, NY: Mc- Graw-Hill Education; 2017. (continued from page 25)Next >