Nurses Teaching Nurses, Part Two: Faculty, Preceptors, and Mentors… Support Is An Amazing Thing

Nurses Teaching Nurses, Part Two: Faculty, Preceptors, and Mentors… Support Is An Amazing Thing

This is the second part of a special two-part article on the importance of nurse preceptorship and mentoring. Click here to read Part One.

Ethical Standards, Just Culture, and the Faculty/Mentor/Preceptor – Student Relationship

Ethics and standards in nursing are principles associated with values, human conduct, and consideration for others. Nursing ethics, in particular, are ethical principles that guide practice. The principles related to nursing ethics and bioethics overall are beneficence, nonmaleficence, autonomy, justice, and fidelity. Each of these principles contributes to the foundation of nursing education and practice principles, and standards of practice devised by organizations, such as the American Nurses Association (ANA), the International Council of Nurses (ICN), and the American Association of University Professors (AAUP).

According to the ANA Code of Ethics 6.3, the nurse has a responsibility to contribute to an environment that encourages transparency, support, effective interpersonal communication, and respect.11 The National League for Nursing (NLN) indicated that another component of the guiding principles for nursing education is integrity. To exhibit integrity, it requires one to treat others respectfully while communicating courteously and positively.11 Additionally, the NLN identified diversity as an important guiding principle. The NLN position on diversity maintained that the faculty/mentor/preceptor member supports open communication, fosters uniqueness, utilizes innovative teaching strategies regardless of race, gender, religion, age, financial status, physical abilities, or other belief systems.11 The NLN indicated that to create an environment that supports diversity, inclusion, and just culture. All persons should provide open and respectful exchanges.11 This is not limited to the faculty/mentor/preceptor member.

Some of the ways that faculty/mentor/preceptor can achieve creating a just culture is to encourage the students to engage in self-reflection, promote professional practice standards within the curriculum, and be effective role models for collegial.1 Intimidation and disruptive behaviors foster medical error and create poor patient satisfaction, increase the cost of care, and cause knowledgeable clinicians to leave the workforce in search of new professions, thus increasing turnover and shortage rates. Therefore, the faculty/mentor/preceptor can engage and empower the student by creating a culture that is free from intimidation and punitive sanctions.11

Ten best practices to be used to incorporate standards into nursing practice and nursing education, which are: 1) support the nursing code of ethics; 2) offer ongoing education; 3) create an environment where nurses can vocalize concerns; 4) employ interdisciplinary and interprofessional learning; 5) enlist nurse ethicists to speak to nurses; 6) provide unit-based ethics mentors (for practice); 7) hold a family conference (in the practice setting); 8) sponsor an ethics journal or club; 9) reach out to other professional associations for resources; and, 10) offer employee or student counseling services.12 The ANA Code of Ethics, for instance, is a framework for nursing practice.11 Therefore, nurses should be familiar with this code and utilize it as a personal framework for practice.11, 12  

The Impact of Negative Role Models

Negative role-modeling, horizontal violence, and aggression on the part of faculty or nurses in the clinical setting each serve to promote barriers in effective precepting and mentoring for the student or trainee. A study performed identified that barriers related to negative role modeling, such as passive-aggressive and threatening behavior and negative faculty and clinical staff attitudes, impede learning and threaten student progression and retention in nursing programs.13 Low retention rates of nursing students directly impact the matriculation of more nurses into the nursing profession, where a shortage already. Students who cannot identify with the nursing profession or fail to become socialized within the profession would eventually leave.13

Negative role models infringe upon the students’ ability to learn and contribute to a negative psychosocial learning environment.13 As the need for new nurses grows concerning an encroaching nursing shortage, effective management of the clinical setting related to students’ ability to think and effectively learn critically is vital. Negative role modeling and horizontal violence occur in both the clinical and classroom settings and have a deleterious impact on the nursing student’s ability to learn and critically think.

The Continuous Need

There is a driving need to develop the knowledge and skills necessary to meet the demands and interpersonal issues evident in today’s patient populations.14 Today’s faculty members, mentors, and preceptors will need to address the needs of a changing society, act as change agents for progress, and be skilled and knowledgeable of technological advances. Further, today’s students need creative learning environments that encourage ethical standards, promote effective interpersonal behaviors, and educate students in rendering multidisciplinary care. The future of health care delivery systems will rely on a multidisciplinary approach to rendering safe and effective care. With the management of care serving to emerge as a critical component in health care delivery, nurses must exhibit leadership and skill in interdisciplinary and collaborative practice to improve health care delivery and quality.

Thus, the faculty mentor and clinical preceptor must incorporate methods to increase interdisciplinary collaboration, education, practice, and exchanges. Furthermore, both are charged with preparing current and future nurses for growth in their respective roles as members of the interdisciplinary health care team. Nurses are being called upon to fill expanding roles and to master technological tools, information management systems while collaborating and coordinating care across teams of health professionals. Therefore, they must work diligently to prepare future nurses for the challenging clinical environment that awaits them.

References

11American Nurses Association (ANA). (2001). Code of ethics with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

12Wood, D. (2014). 10 best practices for addressing ethical issues and moral distress. Retrieved from http://www.amnhealthcare.com/latest-healthcare-news/10-best-practices-addressing-ethical-issues-moral-distress/

13Hawthorn, D., Machtmes, K., & Tillman, K. (2009). The lived experience of nurses working with student nurses in the clinical environment. The Qualitative Report, 14(2), 227-244. Retrieved from https://nsuworks.nova.edu/tqr/vol14/iss2/2

14Wilcock, P. M., Janes, G., & Chambers, A. (2009). Health care improvement and continuing interprofessional education: Continuing interprofessional development to improve patient outcomes. Journal of Continuing Education in the Health Professions, 29(2), 84-90. doi:10.1002/chp.20016

Nurses Teaching Nurses, Part One: Faculty, Preceptors, and Mentors… Support Is An Amazing Thing

Nurses Teaching Nurses, Part One: Faculty, Preceptors, and Mentors… Support Is An Amazing Thing

Teaching, precepting, mentoring, guiding, or instructing are all used interchangeably when describing the role that one takes to teach another in any setting. Effective and passionate role models, who are willing to guide another to learn in the work or school environment, are pivotal to the success of an organization.

Mentoring or teaching in the academic nursing setting serves to promote the advancement of nurses in both clinical and academic work environments.  Precepting in nursing, which most often occurs in the clinical setting, promotes the use of role modeling and shadowing to build specific skill-sets required for the specialized field of nursing. Guiding and instructing in the nursing academic and work settings consist of mentoring, precepting, role modeling, and input from staff in administrative positions.

Nurses Teaching Nurses

            As an operating room nurse, I was blessed to have a wonderful nurse preceptor. She was extremely generous with the knowledge that she had gained over a very long nursing career. Her willingness to spell out each procedure using visual diagrams and thorough explanations helped me to excel. She taught me the surgical procedures, the instruments to be used, the technique to follow, the descriptions of the temperaments of the surgeons for whom I would work, and the way to deal with difficult personalities of the environment. She approached each surgical case with a tenacity of spirit and a drive to provide the very best possible care for each patient…every time. To this day, she embodies the truly compassionate art associated with nurses teaching nurses.

            I have been blessed with learning the challenging and unique aspects of nursing from some incredible nurses. I have also learned valuable lessons from those who gave credence to the adage that nurses eat their young.  Despite the challenges of navigating the stress associated with those lessons, I have continually modeled the positive behavior of strong nursing preceptors to contribute to the profession. Part of being a strong nursing preceptor or educator is having the ability to recognize the talent around us. When I was working as a clinical educator, I knew that there was a plethora of talent around me. There was a proverbial treasure trove of experience and untapped potential everywhere I went. It was my job to provide education and guidance while ensuring that competencies were met. However, I also felt that it was my responsibility to tap into the potential around me. I encouraged nurses to develop short presentations to share with the staff on topics that impacted their work environments and patient populations. The unofficial program was called simply, “Nurses Teaching Nurses.” Who better to speak to the department about significant issues and patient concerns, than the nurses who had to deal with it every day?

            We have so very much to learn from one another. It is so important that we are open to sharing our experiences and to be willing to teach others. Not only does the simple act of sharing what we know serve to help the patients that we serve; it improves the work environment.

When Should We Seek Guidance?

            Asking for help and guidance is an important component of learning. The relationship between the student and the faculty member or clinical preceptor should find its foundation in open communication and mutual respect. The faculty member, academic administration, clinical preceptors, and leaders are required to facilitate a learning environment that promotes a just culture, is conducive to learning, and aids students achieve desired didactic and clinical outcomes.1 Likewise, the nursing profession is required to abide by professional standards and a code of ethics. These standards and codes of ethics serve as a guiding force throughout the nursing career. In all of the interactions, nurses have while caring for patients and representing an institution.

What About Mentoring?

Students require strong mentoring to understand his or her potential role as a nurse. Further, faculty members, mentors, and preceptors also require mentoring to be effective leaders in the classroom and clinical areas. Providing active mentorship during the novice educator’s transitioning phase is a helpful strategy that is useful for enhancing effective transitioning for the new educator.2 Therefore, effective mentoring programs provide a strategy for improving retention in nursing.2 Further, equal importance is placed upon the facilitation of positive mentor/preceptor-to-student relationships while they transition into the role.

The National League for Nursing (NLN) created an excellence model to identify eight core elements necessary to attain and maintain excellence in the nursing profession. Additionally, the NLN stressed that the nurses need to understand the principles that are fundamental to their profession, use technology to manage and find information, and be leaders and agents for change.3

The American Association for the Colleges of Nursing (AACN) indicated that the United States faces a major nursing shortage and increased workforce opportunities in the next eight years.4  In 2011, the National Academy of Medicine (NAM) (formerly the Institute of Medicine (IOM)) recommended that all nurses have a Bachelor’s of Science in Nursing (BSN) by the year 2020.5​  The NAM’s recommendations create an emergent need to increase the nursing faculty and staff nursing workforce. Nursing is one of the many vocations in which a growing need for improvement of workforce retention exists. 

In the wake of a nursing faculty shortage, there is a need to retain current faculty and recruit new faculty. Academic institutions and health care facilities are responsible for the retention of nursing faculty. An important component of maintaining work environments conducive to retention of the nursing faculty workforce is associated with the provision of adequate mentorship. The Health Resources and Services Administration (HRSA) indicated that the primary problems facing healthcare are: financial constraints, healthcare workforce shortages, the changing needs of an aging population, which have prompted a national dialogue on the need for new healthcare models to meet the healthcare demands of the 21st century, facilitation of working nurses’ abilities to participate in continuing education programs and increasing healthcare information technology demands.  Medical schools, institutions, practitioners, and students will be required to create strategies for coping with the increased volume of new information and changing patient demographics.6

Improving the Student-Faculty/Mentor/Preceptor Member Relationship through Mentoring

            Mentoring is a critical component to the success of a program and the nurse. Mentoring is a relationship between a seasoned and novice professional that aids in developing the novice individual to be a productive component of the team. The goals of mentoring are to assist the novice faculty member in overcoming obstacles encountered in daily work, improving individual productivity, and increase employee satisfaction.7 Mentoring is effective for the faculty member and contributes to the increased awareness on the part of the student via interaction, sharing of enthusiasm, and formulation of new insights that contribute to the advancement of teaching styles.

There are many issues to consider when mentoring or receiving mentorship. The nursing profession has a responsibility to remain vigilant regarding influences that change the direction of not only the profession but in nursing education.  Further, nursing educators must work to adapt the changes in a curriculum to model the changes that occur in society, political climate, demographics, economics, workforce trends, and any external or internal issues that may influence change in the way nurses deliver care.8 For change to occur in a curriculum and to build meaningful learning experiences for students, nursing educators need to prepare the nursing student by continually analyzing those forces that impose change and encouraging interpersonal dialogue between students and in the student-faculty/mentor/preceptor relationship.8 Therefore, there is a need for academic administration to construct methods for assessment and to provide the tools to monitor changes as they relate to curriculum design and redesign. Imposing change without assessment and communication will create an ineffective learning environment.

Types of Mentoring Processes and Strategies

Other researchers contend that mentoring effectively enhances cultural diversity in the profession of nursing and academia. Four effective mentoring strategies to encourage academic success consist of communication, professional leadership, confidence-building activities, and students. Further, successful mentoring programs are dependent upon a strong organizational infrastructure.9 Shadowing is another method of mentoring. The literature indicated that shadowing is now a tool for medical residents. The assignment of medical residents to nursing staff, as each makes patient rounds, serves to educate the resident about the role of the nurse.10 Sternszus et al. ‘s 2012 study served to identify the importance of residents as role models, and the impact role modeling had on undergraduate medical students.10

References

1National League for Nursing (NLN). (2021). Core values. http://www.nln.org/about/core-values

2Culleiton, A. L., & Shellenbarger, T. (2007). Transition of a bedside clinician to a nurse educator. MEDSURG Nursing, 16(4), 253-257.

3National League For Nursing (NLN). (2006). Excellence in nursing education model. http://www.nln.org/newsroom/news-releases/news-release/2006/11/03/excellence-in-nursing-education-model-unveiled-at-2006-nln-education-summit-230

4American Association of the Colleges of Nursing (AACN). (2014). Nursing shortage fact sheet. Retrieved from http://www.aacn.nche.edu/media-relations/NrsgShortageFS.pdf

5Institute of Medicine (IOM). (2011). The future of nursing: Leading change, advancing health. (pp. 221-254). Washington, DC: The National Academies Press. Retrieved from http://books.nap.edu/openbook.php?record_id=12956&page=221

6Health Resources and Services Administration (HRSA). (2010). Addressing new challenges facing nursing education: Solutions for a transforming healthcare environment. Retrieved from: http://www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Reports/eighthreport.pdf

7Kapustin, J.F. & Murphy, L.S. (2008). Faculty mentoring in nursing. Topics in Advanced Practice Nursing 8(4).

8Veltri, L. M., & Warner, J. R. (2012). Forces and issues influencing curriculum development. In In D.M. Billings & J.A. Halstead (Eds.), Teaching in nursing: A guide for faculty (4th Ed., pp. 92-104). St. Louis, MO: Elsevier Saunders.

9Wilson, V., Andrews, M., & Leners, D. (2006). Mentoring as a strategy for retaining racial and ethnically diverse students in nursing programs. Journal of Multicultural Nursing & Health (JMCNH)12(3), 17-23.

10Sternszus, R., Cruess, S., Cruess, R., Young, M., & Steinert, Y. (2012). Residents as role models: Impact on undergraduate trainees. Academic Medicine, 87(9), p 1282–1287. doi: 10.1097/ACM.0b013e3182624c53

Part Two of this article will publish tomorrow.

Improving Nurse Leadership Through Stewardship, Shared Governance, and Advocacy

Improving Nurse Leadership Through Stewardship, Shared Governance, and Advocacy

The image of nursing has changed since the days of its founder, Florence Nightingale; however, the devotion is the same. Nursing as a profession, coupled with the men and women who make up its numbers, function as the first line of defense for their patients. Therefore, stewardship, governance, and advocacy for the profession must be employed by nursing leaders for its protection and progression.

Importance of Stewardship

               The nursing profession is a vital component in functioning society, and nurses fill the roles of an educator, facilitator of care, administrator, counselor, and advocate. Nursing leaders have a pivotal role in the process of progress and change for the profession. They are the representatives and the face of their departments. They must exercise stewardship at the point of service while working to advocate for respectful interactions with patients and promote a just culture (Murphy, 2009). Stewardship is a concept that includes the philosophy of practical analysis and practice of serving others in such a way as to provide leadership while observing the shared values of the staff for which they are in charge. The staff is the intrinsic force in a department; therefore, its steward’s goal is to serve, protect, and perpetuate its growth and function (Murphy, 2009).

               The steward at the point of service must be aware of challenges and differences while cultivating these aspects into objective and impartial practices. Nurse leaders and staff members can promote their practice while creating change by the effective communication of ideas and observations made on patient care. Further, the transformation of current practice into a more efficient delivery of care can be facilitated by open collaboration with nursing leaders and physicians. A realization that we are all in this together would serve to impact nursing in such a positive way.

Improving Nursing Through Shared Governance

               Shared governance is a term that was introduced over twenty years ago and was used to provide actionable strategies to provide nurses with power over their practice. Shared governance is a collaborative strategy used by organizations to encourage nursing staff to manage their practice with a high level of commitment to practice (Green & Jordan, 2004). Further, the process of shared governance works to stimulate workplace advocacy, which operates at the local, state, and national levels of government.  Without nurse leaders, staff participation, and the use of collective knowledge of patient care implications related to poor staffing ratios, policies will not change. Simply put, shared governance provides nursing with a vehicle to promote their collective voice.

The Leader and Advocacy

               Nurses and nursing leaders are already aware that health care reform is needed. They are the first to see a breakdown in the efficiency and efficacy of patient care;  therefore, it is the nursing profession’s collective responsibility to promote change (Abood, 2007). Further, to be an effective advocate for change, one must possess the desire, will, time, and energy required to engage in reform at the legislative level. There are a growing number of uninsured patients, a rise in the costs associated with providing quality care, and a continual decrease in the healthcare workforce. These problems impose a great strain on the nurses currently in practice. The strain further imposes the numbers of those who choose to be involved in reform. The current workforce is under excessive stress, which directly corresponds to a lack of interest in representing themselves or sharing their collective voice. Work stress aside, Abood asserts that nurses find it difficult to leave the comfort of their practice to engage in the battle to be heard by their legislators (Abood, 2007).  However, without representation from the nursing leadership in practice, policies cannot be changed. It is the combined knowledge and field experience held by the nursing profession that is needed to influence those who make policies for change to occur.

                Nursing leadership will encounter greater challenges in the near future. The management of human capital, digital technology advancement, and cost control are three of the major challenges and opportunities that nursing leaders will face in the 21st Century (Lee, Daugherty, and Hamelin, 2017). Nursing leaders will play a critical role in transforming healthcare through active participation on the nursing units and in executive boardrooms. Critical issues, such as an aging population and the nursing shortage, continue to be prevalent in the United States and globally. Therefore, nursing leaders will need to address issues that affect retention and create new ways to promote the profession.

               Nursing leaders need to expand upon the foundation created by nursing pioneers such as Florence Nightingale. The integration of shared governance into the workplace begins with the nursing leader. There also needs to be a collective effort to revise and reform policies at all levels of administration within an institution and our state and national governing bodies. There is a legacy to uphold. By joining state nursing associations and showing solidarity, the profession can serve the public in a much larger capacity. The nurse leader has many challenges ahead. In taking pride at the bedside, the nurse has the power to impact not just those that he or she serves, but to the families, administrators, and peers alike. Our presence can be our voice, as well.

Sources

Abood, S. (2007). Influencing health care in the legislative arena. The online journal of issues in nursing, 12(1).Retrieved September 14, 2020 from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/tpc32_216091.aspx

Alexander, K. L. (2019). Florence Nightingale. Retrieved September 14, 2020 from https://www.womenshistory.org/education-resources/biographies/florence-nightingale

Green, A. & Jordan, C. (2004). Common denominators: Shared governance and workplace advocacy – strategies for nurses to gain control over their practice. The online journal of issues in nursing, 9(1). Retrieved September 14, 2020 from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/SharedGovernanceandWorkPlaceAdvocacy.html

Lee, E., Daugherty, J., & Hamelin, T. (2019). Reimagine health care leadership, challenges and opportunities in the 21st Century. Journal of PeriAnesthesia Nursing, 34(1), 27–38. https://doi-org.ezproxy.umgc.edu/10.1016/j.jopan.2017.11.007

Murphy N. S. (2009). Nurse leaders as stewards: the beginning of change. The open nursing journal, 3, 39–44. https://doi.org/10.2174/1874434600903010039. Retrieved September 14, 2020 from  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737121/

Nightingale, F. (1946). Notes on nursing: What it is, and what it is not. Philadelphia: J.B. Lippincott.

Summers, S. J. & Summers, H. J. (2004). Media ‘nursing’: Retiring the handmaiden. Retrieved from https://www.nursingcenter.com/pdfjournal?AID=483200&an=00000446-200402000-00002&Journal_ID=54030&Issue_ID=483197

Nurse of the Week: NP Icon Loretta C. Ford Awarded Surgeon General’s Medallion

Nurse of the Week: NP Icon Loretta C. Ford Awarded Surgeon General’s Medallion

Our first Nurse of the Week in 2021 is a nursing icon. On December 27—the day before her 100th birthday—AAN Living Legend Loretta C. Ford, EdD, RN, PNP, NP-C, CRNP, FAAN, FAANP was awarded the Surgeon General’s Medallion for exceptional achievement in the cause of public health and medicine.

Dr. Ford, who helped to create the first NP program at the University of Colorado in 1965, is regarded as a co-founder of the Nurse Practitioner (NP) profession. As a public health nurse in the 1940s and 1950s, she became concerned about Colorado’s underserved rural communities, and came to believe that with specialized training, nurses could help to fill the gap. Ultimately, Ford and pediatrician Henry Silver joined forces to found the University of Colorado pediatric NP program and the NP profession itself. Ford’s pathblazing role has led to numerous honors. She was the inaugural member of the Fellows of the AANP (FAANP), a special title reserved for providers that have made a lasting impact on the NP profession, and in 2003, she received a Lifetime Achievement Award from the journal Nurse Practitioner. In 2011, she was inducted into the National Women’s Hall of Fame, which acclaimed her for having “transformed the profession of nursing and made health care more accessible to the general public.”

NP cofounder Loretta Ford received the Surgeon General's Medallion on December 27, 2020.
The Surgeon General’s Medallion

Ford’s latest award, the Surgeon General’s Medallion, is the highest honor granted to a civilian by the Public Health Service and the U.S. Public Health Service Commissioned Corps. AANP President, Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP commented, “Dr. Ford has received this recognition for her vision and commitment to the health of our nation. Thanks to her trailblazing efforts, millions of patients have access to high-quality health care from NPs, the provider of their choice, and the profession has grown to more than 290,000 strong.”

David Hebert, JD, Chief Executive Officer of AANP, added, “As we celebrate Dr. Ford’s 100th birthday, I can’t think of a more fitting tribute to this titan of American health care. From co-creating the NP profession to advocating for patient access to NP care, she has played a profound role in strengthening health care access and choice for America’s patients.”

For more details on Ford’s life and achievements, see this article in Scrubs magazine.

Vaccinating a Nation: a Guide to Achieving Herd Immunity

Vaccinating a Nation: a Guide to Achieving Herd Immunity

Flu season is here, and the media is filled with news about the new Covid vaccines, so this is a good time to have a sort of primer explaining the profound importance of vaccination for communities as well as individuals. [email protected], the online MSN program from the School of Nursing and Health Studies at Georgetown University, has kindly allowed DailyNurse to share their guide to the essentials of herd immunity and tips for addressing vaccine-hesitant patients and loved ones.

What is Herd Immunity?

Also referred to as “community immunity,” herd immunity is a public health term used to describe a case in which the potential for person-to-person spread is significantly reduced due to the broader community’s resistance against a particular pathogen.

A Glossary of Important Vaccination-Related Terms

  • Active immunity: Immunity as a result of the body’s antibody creation after exposure to disease-causing pathogens, either through natural infection or vaccination.
  • Herd immunity threshold: Also called the “critical vaccination level,” this is the approximate percentage of a population that needs to be vaccinated in order to reach herd immunity status.
  • Immunity: Resistance to a particular pathogen, or disease-causing bacteria, through antibodies.
  • Inactivated vaccine: A vaccine using a killed form of the disease-causing germ. This vaccine usually requires multiple doses over time to form immunity. Examples include the DPT and Hepatitis A vaccines and the flu shot.
  • Live attenuated vaccine: A vaccine using a weakened form of a germ to produce an asymptomatic infection and generate an immune response similar to a natural infection, without sickness. Examples include the MMR and chickenpox vaccines.
  • Natural infection: Contraction of a disease through person-to-person transmission or interaction with disease-causing bacteria.
  • Passive immunity: Immunity after receiving disease-fighting antibodies from an external source.
  • R0 (Pronounced “r-naught” or “r-zero”): The reproductive number of a disease that describes the average number of additional cases a single infected person creates.
  • Subunit vaccine: A vaccine using a component of the germ (such as a specific protein) to produce an immune response. This vaccine does not contain a live germ. Examples include the shingles and HPV vaccines.
  • Vaccine: A controlled simulation of natural infection meant to trigger antibody creation that helps fight against the disease later, without sickness.

Why is Herd Immunity So Important?

When enough community members are immune to a virus so that it inhibits spread, even those who are not vaccinated will be protected. The “herd” collectively provides insulated safety to all members, which is important for those who are too high-risk for certain vaccinations.

For example, the yellow fever vaccine should not be administered to individuals who are pregnant, have a weakened immune system, or have specific allergies, according to the CDC guidelines on who should not be vaccinated.

For these individuals, it is important that their community has built an immune response to the yellow fever so they are not at risk of infection and transmission. Individuals who are too high-risk to get a vaccination are often more likely to contract the illness and experience serious symptoms.

Some other reasons why people cannot get certain vaccinations include:

  • Age
  • Allergies
  • Pregnancy
  • Recent blood transfusion
  • Underlying medical conditions like lung or heart disease
  • Weakened immune system

Elke Jones Zschaebitz, DNP, ARPN, FNP-BC, and faculty member at Georgetown University School of Nursing & Health Studies, likens herd immunity to a perimeter fence that ensures the safety of the broader community.

“It’s like a little nuclear circle,” she said. “So that our babies that can’t get vaccinated yet, or our pregnant mothers, or our elderly with immune systems [that] are not as robust, or people who have certain kinds of conditions that they don’t have the correct immunity, will have protection from the active pathogen that could possibly harm or kill them.”

HITs and R0s: the Science Behind Herd Immunity

Herd Immunity: Few vaccinated
Herd Immunity: all vaccinated

In a community where no one is immune to a virus, a disease can spread rapidly and lead to an outbreak. As individuals acquire immunity, either through infection or a vaccine, the disease spreads more slowly because fewer people can pass it on.

In a community where enough members are vaccinated, the disease will stop spreading because the virus will not be able to find susceptible hosts.

The herd immunity threshold (HIT) varies depending on a variety of epidemiological factors. The primary consideration is the infectiousness of a disease. Infectiousness is measured by the Basic Reproduction Number or reproductive ratio—often referred to as R0 (“r-zero”). R0 refers to the number of cases expected to occur on average in a susceptible population as a result of infection by a single individual at the start of an epidemic before widespread immunity starts to develop. So if one person develops the infection and passes it on to two others, the R0 is 2. Herd immunity helps R0 drop below 1.

Here are some examples of R0s for a few well-known infectious diseases:

  • Measles R0: 12-18
  • Polio R0: 5-7
  • Ebola R0: ~2

Numbers for COVID-19’s R0 vary —The Atlantic reported a range of about 1.5 to 5.5 in February, while more recent estimates from WHO place COVID-19’s R0somewhere between 2 and 4 (PDF, 2 MB). The herd immunity threshold (HIT) varies depending on a variety of epidemiological factors. The primary consideration is the infectiousness of a disease, often referred to as R0; herd immunity helps R0 drop below 1.

“The higher R0 is, you’ll have to have really, really high [levels of active immunity], or it’s still transmissible and the vulnerable population will still get it,” Thompson-Brazill said.

A September 2020 report in Nature Reviews Immunology expects COVID-19’s herd immunity threshold to equal 67%, if R0 is 3. However, the Government Accountability Office cautioned researchers against reaching any conclusions regarding herd immunity for COVID-19 (PDF, 276 KB), as much is still unknown about the contagiousness of the disease.

The Role Clinicians Play in Herd Immunity and Vaccination

Zschaebitz and Thompson-Brazill have years of experience in various health care settings— from travel clinics and trauma units to international research. Some of the ways that clinicians increase herd immunity and vaccination include:

  • participating in global research to genotype communities and help produce viable vaccines.
  • administering vaccines so patients can stay up-to-date on immunization schedules and travel requirements.
  • educating patients on the importance of vaccination and specific information related to different vaccines.

How to Talk to Patients, Family, and Friends About Vaccination

Thompson-Brazill shared her experience speaking with patients who are vaccine-hesitant and said she has learned that one of the roles clinicians play in herd immunity is educating patients about why vaccines are safe and normative for society.

Zschaebitz also shares the importance of herd immunity with patients — often through the retelling of her own experiences genotyping Maasai tribal women for an HPV vaccine.

“We were interested in preventing deaths of cervical cancer because in certain countries women just die,” she said. “Declining a vaccination is sort of a first-world problem because people in other nations would walk for miles to get what we have and what we take advantage of.”

Thompson-Brazill and Zschaebitz’s tips for speaking to vaccine-hesitant friends and family:

Tip #1: Avoid pointed questions that could make someone defensive.

Instead of: “Why wouldn’t you get the shot?” Try: “What about the shot worries you?”

Tip #2: Use storytelling as a way to share your experience.

Instead of: “I can’t believe you are not going to vaccinate your children” Try: “I chose to vaccinate my kids because…”

Tip #3: Refer people to credible, reliable sources.

Instead of: “Why would you believe that? That’s just a hoax!” Try: “The CDC has a lot of useful information about vaccines and potential risks. Have you read what they have to say?”

Tip #4: If you do not know how to respond, recommend an expert who does.

Instead of: “I can’t talk to you about this; we will never agree.” Try: “Have you shared your concerns with your clinician? They will be able to answer your questions.”

A Herd Immunity FAQ

Is it possible to achieve herd immunity without a vaccine?

Because the herd immunity threshold is so high, achieving herd immunity without a vaccine is unlikely, according to the American Lung Association. The likelihood depends on the disease’s R0, because a lower threshold would be easier to reach naturally. However, the severity of a disease could also mean that many individuals in a community would succumb to a disease before broader immunity is obtained.

Is herd immunity effective against all diseases?

No, not all diseases can be overcome with herd immunity. For example, herd immunity cannot be achieved for Clostridium tetani, the bacteria that causes tetanus. Although infection is avoidable via individual vaccination, the “herd” cannot provide protection. For example, the immunity of others will not prevent an individual from contracting tetanus after stepping on a rusty nail.

Can you still get the flu after a flu shot?

It is possible to become sick with a strain of influenza that the vaccine was not developed to protect against. However, the CDC says that the flu vaccine will minimize the severity of symptoms among those who do get sick. Other reasons someone could experience flu-like symptoms after getting a flu shot include contracting a different respiratory illness and exposure to the flu virus shortly before vaccination.

Why do I need to get vaccinated for diseases we already have herd immunity for?

Some immune responses weaken over time, which is why booster shots are so important. Additionally, vaccine refusal can lead to waning community immunity. For example, in 2019, measles outbreaks in New York and Oregon threatened the United States’ 20-year measles elimination status, according to a press release from HHS on measles outbreaks in 2019.

Is immunity from a natural infection stronger than immunity from a vaccination?

Yes. Natural immunity, the result of antibody production after natural infection, is often more effective and longer-lasting than acquired immunity via a vaccine. However, acquired immunity is safer. Some cases of natural infection can be accompanied by symptomatic illness and severe outcomes like pneumonia, liver cancer, and even death, according to an article on vaccine safety from the Children’s Hospital of Philadelphia.

Reliable Information Sources on Vaccines and Vaccination

Both Zschaebitz and Thompson-Brazill recommend using nationally recognized, expert-led sources to learn more about vaccines, like the CDC, FDA, and NIH. Some of the additional resources available include:

  • CDC Immunization Schedules External link : The CDC-recommended vaccination series and timing schedule for children, adolescents, and adults.
  • The CDC Yellow Book External link : A set of travel health guidelines, including country-specific vaccine recommendations and requirements.
  • Questions About Vaccines, FDA External link : The FDA’s collection of information regarding specific vaccines and approvals.
  • The Power of Herd Immunity, TED Talk by Romina Libster External link : Health researcher Romina Libster tells the story of an H1N1 outbreak in her town and the role of herd immunity.
  • Vaccines by Disease, HHS External link : Vaccine-specific answers to questions such as: “Why is this vaccine important?” and “What are the side effects of this vaccine?”

DailyNurse would like to thank the Georgetown School of Nursing and Health Studies and the [email protected] site for allowing us to share this guide.

2020 NSNA Virtual MidYear Conference Starts Next Week

2020 NSNA Virtual MidYear Conference Starts Next Week

ANA president Dr. Ernest Grant is the keynote speaker at the National Student Nurses Association (NSNA) Virtual 68th MidYear Conference: The Challenge of Change this year. The virtual conference takes place October 29-31, 2020

In addition to Dr. Grant’s keynote address, the conference (which is being hosted online by SpringerPassport) will feature poster presentations, a live NCLEX-RN Review, networking opportunities with prospective employers and schools in the Exhibit Hall/Career Development Center, special discounts at publisher and NCLEX vendor exhibit booths, a virtual yoga session, and more. Live interaction in the Exhibit Hall begins at 7pm EDT on October 29; visit the schedule for details on all live event times. Attendees can also take advantage of the virtual format to access video recordings of programs and exhibits at their convenience (recordings will be available for three months post-conference).

Tips for a Successful NSNA MidYear Virtual Conference

Poster presentations featuring school and state projects by NSNA Chapters and individual members will be available through the online Project Showcase. Presenters can apply here. The application deadline is October 25, 5:00pm EDT.

Registration for the NSNA’s 38th MidYear Conference is open through October 31, 11.30pm EDT. Members who register by or before October 13will receive a $15 Early-Bird Registration Discount. Prior to registering you will need to have your membership number and/or credit card handy. NSNA members and sustaining members must provide their membership number when they pre-register for verification purposes.

The NSNA fosters the professional development of undergraduate nursing students and provides them with opportunities to develop their leadership skills and prepare for lifelong involvement and continuing education in the nursing profession. The association currently has over 60,000 members in 1,500 nursing programs across the US. Visit NSNA.org for information on membership, scholarships, the NSNA Career Center, and association activities.

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