A Passion for Breast Cancer Advocacy and Unique Perspective on Survivorship: Meet The Pink Warrior 

A Passion for Breast Cancer Advocacy and Unique Perspective on Survivorship: Meet The Pink Warrior 

Being one of 240,000 are great odds if you’re playing the billion-dollar Powerball, but not when those odds are for being diagnosed with breast cancer.

According to the CDC, close to 240,000 cases of breast cancer  are diagnosed in women and about 2,100 in men each year, and Courtney Shihabuddin DNP, APRN-CNP, was one of those women in 2020.

Shihabuddin was diagnosed with breast cancer on February 13, 2020. Since her diagnosis, she’s become an educator and advocate for others, creating and founding The Pink Warrior to advocate for young women with breast cancer by sharing her personal story and working with national breast cancer organizations.

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Courtney Shihabuddin DNP, APRN-CNP, is a member of the American Association of Nurse Practitioners, educator and breast cancer survivor.

Daily Nurse spoke with Shihabuddin about her deep passion for breast cancer advocacy and her unique perspective on survivorship. What follows is our interview, edited for length and clarity.

Talk about what you do in your role as a certified nurse practitioner.

I work primarily as an assistant clinical professor at The Ohio State University’s College of Nursing. I teach in the graduate nursing program and am the specialty track director for the Adult-Gerontology Primary Care NP program and the Adult-Gerontology Clinical Nurse Specialist Program. So, I help run those two programs and teach the Adult Gerontology Primary Care Nurse Practitioner Program. I practice clinically at the Columbus Free Clinic on Thursday evenings, which is a clinic that serves the uninsured and underinsured population of the Columbus, Ohio area, providing primary care services and specialty services, including gynecology, urology, neurology, and psychiatry. We recently founded a Rainbow Clinic as well that exclusively serves members of the LGBTQ population. And so while I’m there, I’m precepting my nurse practitioner students and first and fourth-year medical students. And it’s just been a great experience. I love working there. I’ve been there for four years and serve on their board. I’m the medical director of quality, and it’s a big part of my job, work, and daily life.

Talk about being diagnosed with breast cancer in February 2020.

I have to start a little bit before that. My mom is a three-time breast cancer survivor, three separate new-growth breast cancers, not recurrence. And my father’s sister has had breast cancer twice. And so they both had genetic testing, and they’re both negative for any genetic abnormality that could indicate a genetic propensity to breast cancer. But when I was 24, I found my first one. And so, knowing my family history, I didn’t mess around with that at all. I had just started nursing school at that point. I did nursing as a second career. And so I didn’t have the level of knowledge that I have now. I knew something was wrong and wanted to get it checked out. And so I did, and it was a benign fibroadenoma, a benign fibrous growth. It was followed for a couple of years, and then I relocated, and my OBGYN recommended that I enroll myself in a high-risk screening program offered at the medical center. So I went into that program, which did surveillance every six months, either with a mammogram or an MRI. I stayed in that program when I lived in Oklahoma. Then, in 2018, when we moved to Columbus, I transitioned into the program that we have here at the James (The James Cancer Hospital and Solove Research Institute), our cancer hospital. And I went every six months as scheduled in August 2019. I had a normal mammogram. Then, in February of 2020, I had a grossly abnormal MRI compared to previous imaging. And so they did an ultrasound and biopsy. So we did all of that. I was diagnosed on February 13, 2020, with invasive lobular carcinoma in my right breast. In my left breast, I was diagnosed with lobular carcinoma in situ (LCIS), which is a pre-cancerous finding. According to the MRI imaging, the lobular carcinoma in situ was made up of greater than 50% of the breast tissue on my left side, so my only surgical option for treatment was a double mastectomy, which I was planning on doing anyway because I didn’t want to have to go through cancer more than once. Seeing that two of my first-degree relatives had had to do it more than once, I knew I didn’t want that option. And then, of course, COVID happened and complicated things tremendously. On March 31, 2020, my surgical oncologist called me and told me that my mastectomy was canceled because it was considered an elective procedure. And I nearly about lost my mind. My oncologist also felt that that was not an adequate treatment plan. My surgeon wanted me to start tamoxifen because I had hormone-positive cancer, and said then we’ll revisit this when this COVID thing is over. My oncologist said, ‘Absolutely not you need surgery. Your entire treatment plan is based on testing that we want to do on your tissue. And without surgery, you don’t have your tissue.’ So she moved it up to the following Monday. And I had my double mastectomy. I was very lucky because of the high-risk screening program that I was in. It was caught quite early. My tumor was just over two centimeters but had not spread into any of my lymph nodes. And so I was stage 1B. My treatment plan was surgery and then hormone suppression for ten years with tamoxifen. So, I’m currently three years into that ten-year journey on hormone suppression. I follow up every six months with my oncologist and pray that I never have any recurrence. I’ve had eight surgeries in the last three years, which is never fun being a mom. My husband is also an emergency room physician, so that meant going through treatment during a pandemic with an ER physician husband who can’t take any time off to take care of you when I had a one-year-old and a five-year-old was quite an experience. But we got through it. They say whatever doesn’t kill you makes you stronger. Now, I work hard to teach my students and patients about the risks that young women can have with breast cancer, being that I was 35 when I was diagnosed. I know many other women under the age of 40, who I know personally or who I’ve read about or interacted with on the internet, who have also been diagnosed at a much younger age and have often had care delayed because they’re too young. Or that’s not what breast cancer feels like. Or it’s probably benign. And we’ll check it in six months or something to that effect. Much of my advocacy work has to talk about self-advocacy as a patient and knowing your own body and what your normal is so that if you find something abnormal, you go to your provider, insist on some imaging, and advocate for yourself. In my personal and professional opinion, it’s always better to over-order than miss a potentially lethal diagnosis.

You have a full plate professionally and at home with two kids, but you’ve been busy advocating for others since your diagnosis. Talk about The Pink Warrior and your work with other national breast cancer organizations.

In October 2022, I launched The Pink Warrior, a website where I share my story. I offer resources for other people who may be caregivers or patients themselves, working through treatment, or how to talk to your family and tell your children. I also offer many external resources to assist them wherever they are throughout their treatment. I also created a small shop. That was my goal as a young woman with breast cancer. There wasn’t much geared towards a younger woman with cancer. Everything you see on television or read in popular culture about breast cancer is really for postmenopausal women. And there wasn’t this place where I felt I belonged in the breast cancer narrative. So, I tried to create that and inject some levity into the gravity of a cancer diagnosis. So I have snarky cards, a candle for tits and gigglesand fun little thingsI partner with an organization, and it changes every quarter. I donate 10% of the entire shop to that organization at the end of the quarter. So, for Q4, we’re partnering with the PSF Foundation, and they work to help people who cannot afford breast reconstruction find surgeons and then pay for their reconstruction because so much of treatment is what comes after so much.

Survivorship is that part that no one prepares you for. So many things happen in survivorship that are unaccounted for what I feel as a survivor and nurse practitioner. My oncologist certainly didn’t prepare me for hot flashes, menstrual abnormalities, intimacy with my husband, body image disorders, or any of the things that come with amputation of your breasts and multiple surgeries. And getting thrown into menopause at 35 and what that looks like. So that’s what I strive to do, to help normalize with the Pink Warrior. You have a place to go if you know somebody who has been diagnosed and you want to send them something that shows that you care that’s loosely related to breast cancer, but also to have conversations. People email or chat with me on Instagram in direct messages, constantly saying, ‘I’m so glad that I found your page, or thank you for sharing your story.’ Or ‘I was just diagnosed, and I feel like I’m drinking from a firehose,’ what questions should I ask? Even if I help one person, that’s so rewarding for me because I was completely lost. I had all of the medical knowledge, and I still felt like I was drinking from a firehose with a pandemic on top of it.

I was at an event with somebody who had their mastectomy two weeks ago, and they had just gotten their pathology results. And they had no idea what it meant and how to interpret it. They were told that they had ductal carcinoma. They showed me their path report, and they no longer had ductal carcinoma in situ; they had invasive ductal carcinoma, which spread to their lymph nodes, and no one had explained it to them. As a provider, I can’t imagine releasing a path report like that and not having a conversation with the patient but also not ensuring that by the time I hung up that phone, I knew my patient understood what that meant. Even if it wasn’t breast cancer and it was something else, I would want to make sure that my patient understood their diagnosis and give them time to ask questions. As a patient, you could ask all the questions at that moment and completely black out without recollection of that conversation. So, the benefit of the doubt to this person’s provider. So I sat down with her, and I explained what everything meant. I gave them my phone number and said if you have any questions or want me to come to an appointment with you, I’m happy to do that because that’s what advocacy is to me. It’s helping somebody else through their struggles in a way you can relate to.

Talk about nurse practitioners’ work in helping screen and treat women with breast cancer.

So, the program I teach in which I operate is primary care. Our goal as primary care providers is for prevention and screening. We should be counseling all of our patients over 40 that they should be getting annual mammograms, and we should be ordering those exams. We should be having conversations with our patients about their risks. And suppose they do have a family history. In that case, we should be screening them before age 40 and evaluating whether that be genetic testing, a screening, an ultrasound, or a referral into a high-risk program. That is our role. Their primary care is prevention, and we are there to help them stay in tune with their body, know their body, empower them, be aware of what they’re looking for, educate them, and help steer them in a path that is here towards the best possible outcome. And that means early detection.

Please share some insight about what women need to know or should be asking. 

Breast cancer, in general, can be abstract. You can tell somebody what they’re looking for. You can tell somebody what’s normal or what’s abnormal. But to me, a picture’s worth 1000 words. And it’s so much easier to give somebody a visual than to explain something, especially if your patient’s first language is not English. There could be some misunderstanding or lack of knowledge from your communication. There is a charitable organization called Know Your Lemons. And they have a free app that teaches you how to perform a breast self-exam. It shows you how to do it feeling from just under your collarbone down over your sternum, all of your breast tissue, and up into your armpit, and it tracks your cycles and helps you equate anything that you may find with where you are in your cycle. It reminds you to do your self-exam. And the most important thing I think about the app is that it visually shows you the 12 Signs of Breast Cancer on lemons.

So it shows you what it would look like if there were warmth or a red spot, or what it would look like if there was an inverted nipple, or dimpling, or thickening of the skin, or discharge from the nipple. It visually shows you what all these things would look like. But on lemons, that makes it much more real to a layperson or a medical person, but a picture is much easier to understand. Oh, my breast looks like that lemon. I should get that checked out. It also helps translate. When you’re feeling your breasts, what if you feel something hard, like a lemon seed that’s fixed in the flesh of the lemon and hard to move around? That’s something that you want to be concerned about and get evaluated. Those are usually benign findings if you feel something that’s soft, like a pea or a kidney bean. They’re typically movable within the tissue. They’re usually soft and not as concerning as something hard like a lemon seed. And that’s how I explained it to my patients: here’s what you’re looking for. And I can always see this lightbulb moment. When you accept that you’re looking for something that’s hard, fixed, and doesn’t move, they have no idea what that means. But if you tell them, it’s like when you slice into a lemon, and that seed is like you can’t get that seed out. And it’s hard. That’s what you’re looking for. That’s what we’re worried about. It’s seeing their understanding and knowing, okay, I’ve empowered this person, and they know what they’re looking for now. My job here, I’ve accomplished that education. And I know now that I can move on to my next patient and do the same thing, knowing that they’ll know when to come to me if they find something abnormal.

Is there anything else to add about breast cancer and the need for early detection?

We must recognize our BIPOC community because our Black women are at a much higher risk and have a 40% higher chance of mortality from breast cancer. And that’s not because they have more breast cancer. It’s because of various health disparities. They’re often diagnosed when their cancers are later. Their cancers are usually quite aggressive. And, whether that’s because they didn’t seek care, or because they sought care and weren’t believed, or they were too young, or whatever it was, there is a problem with that statistic. We need to be better as healthcare providers in trusting our patients so that when they say, ‘This doesn’t feel right,’ we are taking them at their word, doing our exam, and ordering the necessary imaging to ensure that if this patient is telling me that they felt a lump, that we’re examining that lump because 40% risk of higher mortality is just unacceptable.

The other thing is that 80% of women under 40 find their breast cancer. That’s a pretty significant number, and that’s because we are saying there’s not a great screening for young women. Our breasts are dense, and mammograms don’t catch much. And so if you’re not feeling your breasts, if you’re not checking yourself, if you don’t know what’s normal for you, how do you know what’s abnormal? So, feel your breasts. I tell people to feel them on the first. It’s easy to remember the first of every month. It’s the same time every month, so you’re traditionally in the same part of your cycle because you’ll be the first one to tell if there’s something different.

New License Option Expands Nursing Care in Ohio

New License Option Expands Nursing Care in Ohio

As the need for nursing care continues to grow, the Ohio Board of Nursing and the Nurse Licensure Compact (NLC) are expanding nursing career opportunities in the state with the option for a multistate license (MSL).

An MSL allows Ohio nurses to practice in the current 37 NLC states and opens up job opportunities in Ohio to experienced nurses from across the country.

By converting their existing Ohio license to an MSL, Ohio nurses can rapidly provide critical care during a disaster or medical emergency in a nearby NLC state, pursue opportunities in the growing telehealth field, and grow their careers in new and exciting ways. With consistent standards in every MSL state, experienced nurses from across the country can easily join Ohio’s nursing workforce.

“Patients will be welcoming new faces onto their care teams soon. That’s exciting news for them and Ohio ,” says Marlene Anielski, Executive Director of the Ohio Board of Nursing. “A multistate license gives Ohio nurses the power to pursue the careers of their dreams and makes it easier to fill professional nursing jobs in our state. The licensing innovation will give Ohioans more of the high-quality nursing care they deserve.”

In addition to opening up exciting career opportunities for Ohio nurses, the new license will streamline the complicated process of providing care across state lines. That’s especially important for nurses like Missy Smith, who works close to Ohio’s Southern border and provides care to patients in Ohio, Kentucky, and West Virginia.

“I am five minutes from Kentucky. I am probably 30 minutes from West Virginia. We do have and service patients in both of those areas,” says Smith. “It would be nice not to have to get a separate license every time one of our nurses has to go into that area.”

To convert their existing single-state nursing license into an MSL, nurses must meet a set of uniform licensing standards, meeting all of Ohio’s licensure requirements and clearing state and federal criminal background checks.

The multistate license, offered through the National Council of State Boards of Nursing’s Nurse Licensure Compact, is available to Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and nursing students who can begin applying for an MSL on Jan. 1, 2023

“We at OBN welcome nurses to come to Ohio with their multistate license, and we hope you find a fulfilling career here,” says Anielski.

Answer: This Nurse of the Week Made Her Grandma Very Happy

Answer: This Nurse of the Week Made Her Grandma Very Happy

And the question is, “Who is Joanne Mercer, BSN?”

Okay, our Nurse of the Week did not win Jeopardy! on Monday night, but she made an impressive showing in a battle of Ohio natives. The 21-year-old nurse faced a now-famous Jeopardy! juggernaut, the seemingly unbeatable Amy Schneider—a transgender engineering manager who amassed the second-highest number of consecutive wins in the show’s history. And even if your mother always dismissed second-place Jeopardy! contestants because they don’t collect any winnings, it was Mercer, NOT Schneider, who scribbled the correct Final Jeopardy question in the end.  Because a cool-headed nurse is going to get a lot of correct answers, even when competing against a record-breaking champion.

Prior to the game, Mercer added a Jeopardy! logo, a photo of late host Alex Trebek and a trademark Jeopardy! answer and question (“This person just graduated nursing school.” “Who is… Joanne Mercer, BSN?”) to her graduation cap.  She’s currently dividing her time between working as a Unit Clerk/Nurse Aide at ProMedica Russell J. Ebeid Children’s Hospital in Ohio and studying hard to attain her goal of becoming an RN in a neonatal ICU (NICU). “I had to miss a couple of my exams to be able to do this [i.e., go on Jeopardy],” Mercer told local interviewer Jaden Jefferson. As game shows tend to be Top Secret before they air, the young nurse couldn’t even provide an explanation. “I had to be like, ‘Hey, Dr. M. I have something going on – and I can’t tell you about it…'” Mercer had three balls to juggle, as Jeopardy competed for time with her duties at the hospital and nursing school, but at least she can now reveal all to Dr. M.

“It’s the biggest adrenalin rush that I’ve ever had!”

Mercer has dreamed of being on Jeopardy! for “a long time,” she says, but she had figured that it would remain a dream. In her case, the inspiring figure was not a mom, though. It was a grandma! “I watched it a lot with my grandma,” she recalled. “I’m an only grandchild, so I spent all my time with her, and we would always watch it as I was growing up. So I thought it would be super-cool to go on one of my grandma’s favorite TV shows.” Is grandma proud? Well, “she was telling strangers about it at the grocery store,” according to Mercer.

Her sorority sisters were psyched as well. “I’m usually a homebody,” Mercer said, so when she went missing for a couple of days – and returned carrying a big suitcase – they knew something funny must be going on. Her co-workers at the hospital would try to trip her up with questions about the show and her nursing manager begged for inside dope on what happened, but she remained mum until the producers finally allowed her to share the news.

What was it like to be ON the show? “It’s the biggest adrenalin rush that I’ve ever had!” The iconic set that she’d seen since grade school almost gave her goosebumps.

So, BSN student Joanne Mercer made her grandma happy, had a fine showing on a historic game show episode, overcame her acrophobia enough to board a plane (travel nursing is probably not in her future), and was so clearly pleased just to be there that the audience couldn’t help but feel the same way. AND she was the only contestant to come up with the correct question for the Final Jeopardy answer, so her grandma will have bragging rights for a very long time.

Congratulations, Joanne!

And we hope you made up those exams you had to miss!


In case you are wondering what the answer and questions were in her Final Jeopardy round, by the way, here they are…

Answer: Named for a benefactor, it was established in 1893 to house artifacts from the nearby World’s Columbian Exposition.

For Joanne’s correct response, click here.

 
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RN-BSN Students Use Tech to Gain Skills

RN-BSN Students Use Tech to Gain Skills

As the COVID-19 pandemic swept through the country and universities shifted to online learning, nursing programs needed a new way of providing clinical experiences to students. Taking a cue from longtime online nursing programs like the RN to BSN, universities turned to technology for assistance.

What is a virtual simulation in nursing?

Throughout the years, traditional nursing programs have utilized in-person clinical simulations, which place students in a real-to-life learning experience using interactive mannequins or standardized patients (actors who portray patients), with many variations in between. However, the pandemic changed all of that and nursing programs came to rely on virtual reality simulations in place of their regular clinical simulations to provide meaningful educational opportunities.

Virtual simulations are valuable educational tools that not only provide nurses with practical experiences in a safe environment – they also allow students to effectively apply critical thinking skills and theoretical nursing care principles to better prepare them for a career in a real-world, acute care clinical setting.

Taking a cue from 100% Online RN to BSN programs

Online programs like Ohio University’s RN to BSN program have been using virtual patient platforms such as Shadow Health for years with great success. Shadow Health is included in two of the nine nursing classes required for the OHIO program.

These RN to BSN simulations allow online learners to participate in lifelike, conversational interactions with a wide variety of virtual patients. Learners advance their clinical and communication skills by interviewing, examining and treating virtual patients. According to Dr. Sherleena Buchman, assistant professor in OHIO’s College of Health Sciences and Professions School of Nursing, a variety of technologies can be used for virtual experiences.

VR simulations or vSim in nursing courses

VSim nurse training technology.Often universities have clinical simulation programs built directly into their nursing curriculum. Virtual simulations in nursing (vSim) is a platform that more universities embraced during the pandemic to helps to build clinical judgement skills through a realistic virtual environment, according to Dr. Buchman.

Cine-VR, a virtual reality 360 video simulation experience that uses the same principles of clinical simulation is a popular nursing tool. This way, students are able to see and hear a person in need, rather than using a mannequin.

“One example is the administration of NARCAN to a college student who has overdosed in a dorm setting,” said Dr. Buchman. “The learners are immersed in the virtual dorm room, which is viewed through virtual reality goggles, and are able to turn a full 360 degrees and see what is going on all around them. Additional Cine-VR simulations include two other opioid-related scenarios and a three-part experience related to providing care to a patient with Parkinson’s Disease.”

Why is simulation important in nursing?

Simulation is important to nursing because it provides the needed safe learning environment for students. “They are able to ask questions, make mistakes and learn from them without causing harm to a patient,” Dr. Buchman highlights.

“There are many opportunities for virtual and augmented realities to be utilized in nursing education. Our profession as a whole is just beginning to understand the potential for this type of learning,” Dr. Buchman explained. “vSim helps learners to develop confidence in their knowledge, skills and the attitudes of their profession, which is extremely important in the field of nursing.”

Nursing simulated electronic health records (EHR)

A critical part of simulations are electronic health records. Nursing students earning their BSN degree online or in-person can expect to not only learn about electronic health records, but to put that into practice. Nurses must document everything they do on a daily basis.

“There is a famous saying in nursing, ‘If it was not documented then it did not happen.’ As vSim and Cine-VR are realistic nursing scenarios, it is important that learners develop the skills of charting and understanding the electronic health record,” Buchman said.

What to expect from a BSN curriculum

Course requirements for BSN students, whether online or on-campus, are guided by the National Council of State Boards of Nursing, Quality Safety, Education in Nursing, and are built around the American Academy of Colleges of Nursing’s nine BSN Essentials. Ohio University’s RN to BSN degree is designed for working adults and offers 100% online coursework, 5-week sessions, and affordable tuition at less than $7,600 for the program’s nine required nursing courses.

Interested in learning more about an online RN to BSN degree? Visit ohio.edu/rn-to-bsn.

Elected Officials in 26 States Have Successfully Neutered Public Health Departments

Elected Officials in 26 States Have Successfully Neutered Public Health Departments

Republican legislators in more than half of U.S. states, spurred on by voters angry about lockdowns and mask mandates, are taking away the powers state and local officials use to protect the public against infectious diseases.

A KHN review of hundreds of pieces of legislation found that, in all 50 states, legislators have proposed bills to curb such public health powers since the covid-19 pandemic began. While some governors vetoed bills that passed, at least 26 states pushed through laws that permanently weaken government authority to protect public health. In three additional states, an executive order, ballot initiative or state Supreme Court ruling limited long-held public health powers. More bills are pending in a handful of states whose legislatures are still in session.Originally published in Kaiser Health News.

In Arkansas, legislators banned mask mandates except in private businesses or state-run health care settings, calling them “a burden on the public peace, health, and safety of the citizens of this state.” In Idaho, county commissioners, who typically have no public health expertise, can veto countywide public health orders. And in Kansas and Tennessee, school boards, rather than health officials, have the power to close schools.

President Joe Biden last Thursday announced sweeping vaccination mandates and other covid measures, saying he was forced to act partly because of such legislation: “My plan also takes on elected officials in states that are undermining you and these lifesaving actions.”

All told:

  • In at least 16 states, legislators have limited the power of public health officials to order mask mandates, or quarantines or isolation. In some cases, they gave themselves or local elected politicians the authority to prevent the spread of infectious disease.
  • At least 17 states passed laws banning covid vaccine mandates or passports, or made it easier to get around vaccine requirements.
  • At least nine states have new laws banning or limiting mask mandates. Executive orders or a court ruling limit mask requirements in five more.

Much of this legislation takes effect as covid hospitalizations in some areas are climbing to the highest numbers at any point in the pandemic, and children are back in school.

“We really could see more people sick, hurt, hospitalized or even die, depending on the extremity of the legislation and curtailing of the authority,” said Lori Tremmel Freeman, head of the National Association of County and City Health Officials.

Public health academics and officials are frustrated that they, instead of the virus, have become the enemy. They argue this will have consequences that last long beyond this pandemic, diminishing their ability to fight the latest covid surge and future disease outbreaks, such as being able to quarantine people during a measles outbreak.

“It’s kind of like having your hands tied in the middle of a boxing match,” said Kelley Vollmar, executive director of the Jefferson County Health Department in Missouri.

But proponents of the new limits say they are a necessary check on executive powers and give lawmakers a voice in prolonged emergencies. Arkansas state Sen. Trent Garner, a Republican who co-sponsored his state’s successful bill to ban mask mandates, said he was trying to reflect the will of the people.

“What the people of Arkansas want is the decision to be left in their hands, to them and their family,” Garner said. “It’s time to take the power away from the so-called experts, whose ideas have been woefully inadequate.”

After initially signing the bill, Republican Gov. Asa Hutchinson expressed regret, calling a special legislative session in early August to ask lawmakers to carve out an exception for schools. They declined. The law is currently blocked by an Arkansas judge who deemed it unconstitutional. Legal battles are ongoing in other states as well.

A Deluge of Bills

In Ohio, legislators gave themselves the power to overturn health orders and weakened school vaccine mandates. In Utah and Iowa, schools cannot require masks. In Alabama, state and local governments cannot issue vaccine passports and schools cannot require covid vaccinations.

Montana’s legislature passed some of the most restrictive laws of all, severely curbing public health’s quarantine and isolation powers, increasing local elected officials’ power over local health boards, preventing limits on religious gatherings and banning employers — including in health care settings — from requiring vaccinations for covid, the flu or anything else.

Legislators there also passed limits on local officials: If jurisdictions add public health rules stronger than state public health measures, they could lose 20% of some grants.

Losing the ability to order quarantines has left Karen Sullivan, health officer for Montana’s Butte-Silver Bow department, terrified about what’s to come — not only during the covid pandemic but for future measles and whooping cough outbreaks.

“In the midst of delta and other variants that are out there, we’re quite frankly a nervous wreck about it,” Sullivan said. “Relying on morality and goodwill is not a good public health practice.”

While some public health officials tried to fight the national wave of legislation, the underfunded public health workforce was consumed by trying to implement the largest vaccination campaign in U.S. history and had little time for political action.

Freeman said her city and county health officials’ group has meager influence and resources, especially in comparison with the American Legislative Exchange Council, a corporate-backed conservative group that promoted a model bill to restrict the emergency powers of governors and other officials. The draft legislation appears to have inspired dozens of state-level bills, according to the KHN review. At least 15 states passed laws limiting emergency powers. In some states, governors can no longer institute mask mandates or close businesses, and their executive orders can be overturned by legislators.

When North Dakota’s legislative session began in January, a long slate of bills sought to rein in public health powers, including one with language similar to ALEC’s. The state didn’t have a health director to argue against the new limits because three had resigned in 2020.

Fighting the bills not only took time, but also seemed dangerous, said Renae Moch, public health director for Bismarck, who testified against a measure prohibiting mask mandates. She then received an onslaught of hate mail and demands for her to be fired.

Lawmakers overrode the governor’s veto to pass the bill into law. The North Dakota legislature also banned businesses from asking whether patrons are vaccinated against or infected with the coronavirus and curbed the governor’s emergency powers.

The new laws are meant to reduce the power of governors and restore the balance of power between states’ executive branches and legislatures, said Jonathon Hauenschild, director of the ALEC task force on communications and technology. “Governors are elected, but they were delegating a lot of authority to the public health official, often that they had appointed,” Hauenschild said.

‘Like Turning Off a Light Switch’

When the Indiana legislature overrode the governor’s veto to pass a bill that gave county commissioners the power to review public health orders, it was devastating for Dr. David Welsh, the public health officer in rural Ripley County.

People immediately stopped calling him to report covid violations, because they knew the county commissioners could overturn his authority. It was “like turning off a light switch,” Welsh said.

Another county in Indiana has already seen its health department’s mask mandate overridden by the local commissioners, Welsh said.

He’s considering stepping down after more than a quarter century in the role. If he does, he’ll join at least 303 public health leaders who have retired, resigned or been fired since the pandemic began, according to an ongoing KHN and AP analysis. That means 1 in 5 Americans have lost a local health leader during the pandemic.

“This is a deathblow,” said Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health. He called the legislative assault the last straw for many seasoned public health officials who have battled the pandemic without sufficient resources, while also being vilified.

Public health groups expect further combative legislation. ALEC’s Hauenschild said the group is looking into a Michigan law that allowed the legislature to limit the governor’s emergency powers without Democratic Gov. Gretchen Whitmer’s signature.

Curbing the authority of public health officials has also become campaign fodder, particularly among Republican candidates running further on the right. While Republican Idaho Gov. Brad Little was traveling out of state, Lt. Gov. Janice McGeachin signed a surprise executive order banning mask mandates that she later promoted for her upcoming campaign against him. He later reversed the ban, tweeting, “I do not like petty politics. I do not like political stunts over the rule of law.”

At least one former lawmaker — former Oregon Democratic state Sen. Wayne Fawbush— said some of today’s politicians may come to regret these laws.

Fawbush was a sponsor of 1989 legislation during the AIDS crisis. It banned employers from requiring health care workers, as a condition of employment, to get an HIV vaccine, if one became available.

But 32 years later, that means Oregon cannot require health care workers to be vaccinated against covid. Calling lawmaking a “messy business,” Fawbush said he certainly wouldn’t have pushed the bill through if he had known then what he does now.

“Legislators need to obviously deal with immediate situations,” Fawbush said. “But we have to look over the horizon. It’s part of the job responsibility to look at consequences.”

OSU’s Tim Raderstorf on Innovation, Leadership, and his Award-Winning Textbook – Part 2

OSU’s Tim Raderstorf on Innovation, Leadership, and his Award-Winning Textbook – Part 2

It’s not every day that one’s textbook wins a Book of the Year Award from the Amerian Journal of Nursing. In Part 2 of the DailyNurse interview with Tim Raderstorf, Chief Innovation Officer at the Ohio State University College of Nursing  and Center for Healthcare Innovation and Wellness, Tim spoke about his win and discussed the impact of Covid-19 on nurse leaders everywhere. (Read Part 1 here).​

DailyNurse: Congratulations on your first place Book of the Year award! [Raderstorf and Bernadette Melnyk’s textbook is Evidence-Based Leadership, Innovation, and Entrepreneurship in Nursing and Healthcare: A Practical Guide for Success].

Dr. Tim Raderstorf: Thank you!

DN: The judge commented that “What I loved about this book is that the authors made complex leadership and business topics accessible and interesting by sharing leaders’ personal stories… Provides actionable and practical strategies students can use to further their own development… Readable and clear, it is sure to be a favorite among students.”

Award-winning textbook: Evidence-Based Leadership, Innovation, and Entrepreneurship in Nursing and Healthcare

TR: “I love hearing that, by the way. I’m so grateful for the comment about the book. Because you know, when I went into academia, I committed to never writing a book, because I don’t learn particularly well through reading books. It’s just how my brain is wired.

And two, I’ve never, I have never heard anyone say ‘I love a textbook’ before. One thing that I think is missing from all academia is storytelling. So we said, if we’re going to write this book, we’re going to lean heavily on not just our stories, but the stories of people who’ve succeeded and failed at putting these evidence-based innovation leadership and entrepreneurship tactics in the place. And so it’s great to hear that shine through from the reviewer because that’s exactly what we were trying to do: create a type of textbook that students would enjoy, and they can actually be engaging with the content and be able to put that into practice.”

DN: How does the Innovation Studio connect with your book’s study of nursing leadership, innovation, and entrepreneurship?

TR: “I actually teach in our masters of healthcare innovation program and is fully founded on innovation leadership, which adopts what we like to refer to as the entrepreneurial mindset. So if you are in charge of leading people, and that may be in a small capacity to large capacity formally or informally, but you’re always doing a few things.

One new favorite term that I have is building a culture of ambition. And I mean ambition in a way that you’re striving for excellence. So what we teach our team—and what’s in the book—is teaching people to find out what stories resonate most effectively with their co-workers and teammates in the population they engage in, and have that be the driving force that your team unifies around to make significant and substantial change. So by building this culture of ambition, you’re taking on ownership for your actions, you’re taking on ownership for the things that surround you, and the system that you work in.

And that doesn’t mean that you are saying that your system is perfect. But it’s saying that we are in the system, and we’re going to do the best that we can with it. That’s what we’re trying to get people to recognize. And when you come into that with an entrepreneurial mindset, you think about what resources are available to you, what are your key performance indicators, and how you can maximize those, and you let the things that are noise filter out.

So you focus on what’s important, you develop a ‘yes, and’ culture, you empower people to bring their ideas forward, incentivize them, provide them the permission to be innovative, and validate them when they engage in those behaviors. And you build a structure of innovation that lasts beyond your tenure within the organization.

Those are all things that are built into the textbook. And those are all things that we try to get the people engaged in the innovation studio to buy into because we know that if that happens, eventually we’ll find the success that we’re looking for.”

DN: 2020 was a big year for nurse leaders. They’ve been finding innovative ways to cope with shortages, fight burnout, and manage other pain points, and have made a huge impact.

TR: “And you know what, I’m very hopeful. I’m not one of those leaders right now, but I am very hopeful that through the exercises that you just mentioned, people are taking notes and debriefing and finding out what works well.

Because I do think that the exceptional leadership that’s occurring throughout health systems now needs to be the norm. Those things about celebrating our wins, focusing on what’s important today. ‘What’s important now’ — you know, that’s an acronym for ‘win’. How do we win today? What are we going to focus on?

A big component of leadership is making sure that your team is all aligned on the same goals. And, you know, creating the value that you commit to create so that that’s where innovation and leadership all come together.”

OhioNurse by DailyNurse.com

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