WNA FAQ: Nurse Safety and Duty to Render Aid

A printable PDF is available here.

This FAQ is offered by WNA to provide clarity and reassurance to nurses who have questions about their responsibility if involved in dangerous or armed situations.  It is important that we recognize that situations involving mechanical, industrial, weapons, active law enforcement or other unpredictable situations can be unsafe and perhaps dangerous.  This information is provided for nurses, who are off-duty, and may find themselves in or who are affected by situations of physical and/or moral distress.

• Legal clarity for Wisconsin nurses
• Regulatory engagement and protections
• Nurse safety and well-being
• Trauma-informed support for members

Do Wisconsin nurses have a legal duty to render aid when off duty?

No. There is no Wisconsin law, statute, or Board of Nursing rule that requires off-duty nurses to render aid or otherwise intervene in emergencies, particularly when there is a credible risk to personal safety.

What is Wisconsin’s Good Samaritan law?

Wisconsin’s Good Samaritan law^[i]

• Provides civil liability protection for individuals, including nurses, who choose to render emergency assistance in good faith
• Does not require anyone to intervene, so choosing not to intervene is not punishable under this law
• Does not eliminate the right to prioritize personal safety

 Definition of Emergency Care

The phrase, "emergency care," refers to the initial evaluation and immediate assistance, treatment, and intervention rendered to an injured person during the period before care can be transferred to professional medical personnel.^[ii]

Does being a nurse create a professional obligation to intervene?

No. Again, there is no Wisconsin law, statute, or Board of Nursing rule that requires off-duty nurses to render aid or otherwise intervene in emergencies, particularly when there is a credible risk to personal safety. Professional ethics guide nursing values, but do not remove a nurse’s right to self-preservation.^[iii]

Could a nurse be disciplined for choosing not to intervene?

• WNA’s position is that nurses should not face discipline for prioritizing safety.
• WNA has not found any evidence of nurses declining to intervene due to credible safety concerns being disciplined by the Wisconsin Board of Nursing for unprofessional conduct.
• WNA supports adherence to HIPAA regulations regarding patient confidentiality.

What if I begin helping and then realize the situation is unsafe?

Initiating assistance does not obligate a nurse to remain in a situation that becomes dangerous; you may disengage.

Professional Liability Insurance

Your employer’s malpractice insurance coverage may or may not extend coverage for you. In the event of a medical incident that you were a part of, which resulted in an insurance or civil lawsuit, you may be covered under your employer if you were found to be practicing safely. In most cases the employer’s malpractice insurance coverage does not cover instances that occur off duty. You should check with your malpractice insurance company to see if you are covered.  For more information on professional malpractice insurance go to: https://www.wisconsinnurses.org/member-benefits/ ANA and WNA may receive a benefit when members purchase insurance through endorsed partners.

Bottom line

Nursing licensure does not create a legal or professional obligation to intervene in dangerous or armed situations.  Wisconsin nurses retain the right to prioritize personal safety.

WNA’s priority is ensuring clarity, protection, and support for nurses—now and in the future.

[i] Wisconsin State Statute Chapter 895.48. (December 19, 2025). Civil liability exemption; emergency medical care. Updated 2023-24 Wisconsin Statutes & Annotations. https://docs.legis.wisconsin.gov/statutes/statutes/895/ii/48?view=section

[ii]Wisconsin Supreme Court. (2006) Definition of emergency care. Mueller v. McMillan Warner Insurance Co. WI 54 (290 Wis. 2d 571), pgs. 13-14.

https://www.wicourts.gov/sc/opinion/DisplayDocument.pdf?content=pdf&seqNo=25290

[iii] American Nurses Association. (2025). Code of ethics for nurses. Provision 5; 5.1. https://codeofethics.ana.org/home

Filtering the Facts: Kidney Care Tips Every Nurse Should Know

By Jess Modjewski, MSN, RN

March is recognized as National Kidney Month, a time dedicated to increasing awareness of kidney disease and promoting strategies that support kidney health. For registered nurses working across all clinical settings, understanding kidney disease risk factors, early indicators, medication considerations, and prevention strategies essential for improving patient outcomes.

Why Kidney Health Matters

Chronic kidney disease (CKD) affects more than 1 in 7 U.S. adults, with nearly 90% of those affected unaware of their condition until it reaches advanced stages (NIDDKD, 2024). The kidneys maintain physiological balance by:

• Filtering metabolic waste products
• Regulating fluid balance and electrolytes
• Supporting blood pressure regulation
• Contributing to erythropoiesis and vitamin D activation

Declining kidney function can lead to cardiovascular complications, anemia, metabolic acidosis, electrolyte disturbances, and fluid overload. Because CKD is frequently asymptomatic in early stages, nurses are essential in early identification and patient education.

Common Risk Factors for Kidney Disease

Nurses should be particularly attentive to patients with:

• Diabetes mellitus
• Hypertension
• Cardiovascular disease
• Obesity
• Family history of kidney disease
• Older age (>60)
• Chronic use of nephrotoxic medications

Key indicators of kidney dysfunction may include:

• Elevated serum creatinine
• Decreased estimated glomerular filtration rate (eGFR)
• Proteinuria or albuminuria
• Electrolyte abnormalities

Early recognition allows providers to initiate interventions that slow CKD progression and prevent complications.

Medications Commonly Prescribed for Kidney Disease

Patients with CKD are frequently prescribed medications that help protect kidney function and manage complications.

Common medication classes include:

1. ACE inhibitors or ARBs (e.g., lisinopril, losartan) Reduce proteinuria andprotect kidney function
2. SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin)

Increasingly used to slow CKD progression in patients with diabetes or heart disease

3. Diuretics (e.g., furosemide, torsemide)

Manage fluid overload and hypertension

4. Phosphate binders (e.g., sevelamer, calcium acetate) Preventhyperphosphatemia in advanced CKD
5. Erythropoiesis-stimulating agents (ESAs) (e.g., epoetin alfa) Treat CKD-related anemia
6. Vitamin D analogs (e.g., calcitriol)

Manage CKD-related mineral and bone disorders

Nurses should monitor for dose adjustments, as many medications require renal dosing based on eGFR.

Medications Kidney Patients Should Avoid or Use with Caution

Certain medications may worsen kidney function or accumulate due to reduced renal clearance. Top Medication Classes of Concern

1. Non-steroidal Anti-Inflammatory Drugs (NSAIDs) Examples: ibuprofen, naproxen, ketorolac

Can reduce renal blood flow and worsen kidney injury.

2. Contrast Agents (Iodinated Contrast) Used in CT imaging

Associated with contrast-induced nephropathy, particularly in patients with existing CKD.

3. Certain Antibiotics

Examples: aminoglycosides (gentamicin), vancomycin (high levels), trimethoprim-sulfamethoxazole

Require renal dosing and monitoring.

4. Potassium-Increasing Medications

Examples: potassium supplements, spironolactone, some ACE inhibitors/ARBs Can cause dangerous hyperkalemia in CKD patients.

5. Magnesium- or Aluminum-Containing Antacids/Laxatives Examples: magnesium hydroxide, aluminum hydroxide

Accumulate in CKD due to reduced renal clearance.

Nurses should encourage patients to consult providers before starting over-the-counter medications or supplements.

Clinical Pearls for Nurses

Quick bedside reminders for kidney health awareness

✔ Monitor renal labs closely

Trend creatinine, eGFR, potassium, and urine albumin in high-risk patients.

✔ Review medications during every reconciliation

Look for nephrotoxic drugs or medications requiring renal dosing adjustments.

✔ Ask about OTC medication use

Patients frequently take NSAIDs for pain without realizing the kidney risk.

✔ Watch fluid status carefully

Daily weights and intake/output monitoring are essential for patients with kidney impairment.

✔ Encourage preventative screenings

Patients with diabetes or hypertension should receive routine kidney function testing.

✔ Educate patients about lifestyle factors

Healthy diet, sodium reduction, blood pressure control, and glucose management significantly reduce CKD progression.

“Nurse-led care provides notable benefits in managing certain aspects of CKD, including symptom control, sleep disturbances, energy levels, and overall health (Arooj et al., 2025).”

Fun Filter Fact: A Nurse Helped Shape Modern Dialysis Care

One of the most influential leaders in nephrology nursing is Barbara A. Prowant, a nurse who helped transform how patients receive dialysis care. During the early development of dialysis programs in the United States, Dr. Prowant played a key role in advancing peritoneal dialysis (PD) and establishing structured patient education programs for home dialysis. Her work emphasized teaching patients how to safely perform dialysis treatments, recognize complications such as infection, and manage their care independently.

These patient-centered education models are now widely used in dialysis programs worldwide. Through her clinical leadership, research, and involvement with the American Nephrology Nurses Association, Dr. Prowant helped define standards for nephrology nursing practice and improve the quality of life for patients with kidney failure.

Fun fact: The emphasis on patient education, infection prevention, and self-management in dialysis care today reflects the foundational work of nurse leaders like Dr. Prowant.

References

Arooj, H., Aman, M., Hashmi, M. U., Nasir, Z., Zahid, M., Abbas, J., Amjad, N., Maryam, S., & Farhan, K. (2025).The impact of nurse-led care in chronic kidney disease management: A systematic review and meta-analysis. BMC Nursing, 24, 188. https://doi.org/10.1186/s12912-025-02829-z

National Institute of Diabetes and Digestive and Kidney Diseases. (2024, September). Kidney disease statistics forthe United States. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/health-statistics/kidneydisease#:~:text=Fast%20Facts%20on%20Kidney%20Disease,a%20kidne y%20transplant%20or%20dialysis.

American Heart Health & Black History Month  

Kamia Monet Beasley, DNP, RN, NE-BC

Cardiovascular disease persists as a leading cause of death in the United States with Black Americans disproportionately affected. Among Black American adults, approximately 60 % have a form of cardiovascular (heart) disease (AHA, 2025). Despite advances in medicine and nursing, Black Americans continue to experience disparities related to heart disease. Hypertension, or high blood pressure, is a significant contributor to heart disease and is highest among Black Americans at 58.4% and 57.5% for women and men respectively (AHA, 2025).

American Heart Month & Black History Month

In February, we recognize American Heart and Black History Months. Prevalence of heart disease among Black Americans underscores the opportunity of nurses to raise awareness and foster collaborative efforts to reduce disparities. Nurses have long advocated for the health of patients through education, personalized care, and referrals.

In Honor of Black History Month: Jessie Sleet Scales (1865-1956)

As the first Black public health nurse in America, Jessie Sleet Scales embodied bravery, compassion, and dedication. Born in Ontario, Canada, Scales is regarded as one of the most influential nursing pioneers in American history. Scales moved to Chicago, Illinois in her late 20’s to pursue a career in nursing. In Chicago, she attended and graduated from Provident Hospital School of Nursing. Determined to expand her nursing expertise, Scales then advanced her education by completing a 6-month course at Freedman’s Hospital in Washington, D.C. (Hutchinson, 2025).

After working for 2 years at a winter health resort in Lakewood, New Jersy, Scales felt compelled to serve in District Nursing, now known as public health nursing, in New York. As a Black nurse, she faced adversity- racism and rejection by multiple employers. In 1900, Scales was finally hired by Dr. T. Devine, the general secretary of the Charity Organization Society of New York City. Dr. Edward T. Devine recognized Scales’ potential to overcome racial barriers and gain access to Black neighborhoods (Milwaukee Health Department, n. d.).

Scales was thus deployed into New York City Black neighborhoods to treat families afflicted with tuberculosis. Scales gained the trust of patients by demonstrating an attention to holistic health and selflessly entering their homes, risking exposure to tuberculosis. Within a 2-month period, Scales conducted 156 home visits to forty-one different families and published a report of her experience in the American Journal of Nursing in 1901. Scales’ district nursing visits included care for mothers and newborns, care of people with cancer, chicken pox, and heart disease (Milwaukee Health Department, n. d.).

Nursing & Heart Health

The USPSTF recognizes heart disease among Black Americans as a major disparity in prevalence and mortality. Nurses are well-positioned to promote education, screenings, and prompt treatment of heart disease for Black patients through trusting partnerships.

Visits with patients can contribute to positive or negative health outcomes. Three key concepts can impact the visits between patients and nurses, inclusion, trust, and communication. Building trust is imperative to facilitate open communication. Nurses include patients in their heart health plan of care to ensure alignment with their goals and preferences.

Educate & Empower

Determine what patients know about heart disease and proceed with education/re-education.

Ask patients, “what do you know about heart disease?” Nurses can educate patients on risk factors such as diet, family history, high sodium intake, sedentary living, smoking, and high blood pressure.

Patients should be screened for high blood pressure at each visit. Discuss the results with patients, teach proper blood pressure measurement, and encourage self-monitoring at home (Hannan et al., 2022). Acknowledge patients’ risk factors and provide information about modifications to lifestyle such as increasing physical activity, cutting back on salt intake, and smoking cessation. Seek patients’ input to show respect to cultural preferences.

Involve patients in their heart health care planning, ask open-ended questions and inclusive statements:

• What is important to you related to your heart health?
• What are your blood pressure goals?
• How can you make changes in your life to reach your goals?
• What stands in the way between you and your goals?
• What can we do to reduce these barriers?
• Let’s make a list of ways you can accomplish your goal.

P.A.R.T.N.E.R

Nurses:

P: Present yourself as being present; make good eye contact, listen actively, and demonstrate the value of patient engagement by asking open-ended questions.

A: Acknowledge Patient’s Concern(s)

R: Recognize Patient’s Strengths

T: Talk about Barriers to Goals

N: Needs- Discuss What Patient Needs to Overcome Barriers

E: Emphasize Patient’s Strengths

R: Restate Goals and Plans to Ensure Understanding, Review Care Plans at Each Visit, Revise as needed, Refer Patient to Specialists and/or Support Groups

Nurses should encourage Black patients to share what they learn about heart disease with others- family members, friends, neighbors, co-workers/peers to help raise awareness on the importance of blood pressure screenings and lifestyle changes to reduce the heart disease disparity among Black Americans (ANA, 2025).

References

American Heart Association (2026). American Heart Month. Retrieved from https://www.heart.org/en/american-heart-month

American Heart Association (2025). Cardiovascular health risks continue to grow within Black communities, action needed: CPR training and heart health education remain critical to closing the survival gap and advancing equitable health solutions in Black communities. Retrieved from https://newsroom.heart.org/news/cardiovascular-health-risks-continue-to-grow-within-black-communities-action-needed

American Heart Association (2025). Heart disease remains leading cause of death as key health risk factors continue to rise. Retrieved from https://newsroom.heart.org/news/heart-disease-remains-leading-cause-of-death-as-key-health-risk-factors-continue-to-rise

Beasley, K. (2023). P.A.R.T.N.E.R: Patient-provider partnerships: A tool to enhance the patient/person provider relationship.

Gagnon, K. W., Quinn, K., Walsh, J. L., Amirkhanian, Y. A., & Kelly, J. A. (2025). Characteristics of healthcare providers, healthcare systems, and patient strategies related to medical mistrust among black and African Americans. BMC primary care, 26(1), 203. https://doi.org/10.1186/s12875-025-02900-3

Hannan, J. A., Commodore-Mensah, Y., Tokieda, N., Smith, A. P., Gawlik, K. S., Murakami, L., Cooper, J., Koob, S., Wright, K. D., Cassarino, D., Arslanian-Engoren, C., & Melnyk, B. M. (2022). Improving hypertension control and cardiovascular health: An urgent call to action for nursing. Worldviews on evidence-based nursing, 19(1), 6–15. https://doi.org/10.1111/wvn.12560

 Hutchinson, G. B. (2025). From the Desk of the Historian: What a Difference -- Because of These Nursing Heroes! New York Nurse, 9(3), 5–6.

Mosley M. O. (1994). Jessie Sleet Scales: first black public health nurse. The ABNF journal : official journal of the Association of Black Nursing Faculty in Higher Education, Inc, 5(2), 45–51.

Milwaukee Health Department (n.d.) Honoring Jessie Sleet Scales. Retrieved from https://city.milwaukee.gov/Health/News-and-Events/Blog/Honoring-Jessie-Sleet-Scales-A-Trailblazer-in-Public-Health-Nursing----and-the-Inspiration-Behind-MHDs-Neighborhood-Nursing-Program

United States Preventive Services Task Force Retrieved from (2020). Final recommendation statement healthy diet and physical activity for cardiovascular disease prevention in adults with cCardiovascular risk factors: Behavioral counseling interventions. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/healthy-diet-and-physical-activity-counseling-adults-with-high-risk-of-cvd

Season for Increased Stress: Supporting Nurse Well-Being During the Holidays
By: Jess Modjewski, MSN, RN

Nursing is truly a gift. Every day, we offer our patients the gift of service, compassion, and skilled care, work that brings meaning and fulfillment to our lives. While others gather around the tree or wait for Santa, many of us wait at the bedside, monitoring vital signs, comforting families, and supporting patients through moments filled with uncertainty. The holidays can shine brightly, but they can also be heavy; as nurses, we know all too well that not every shift is merry and bright. We miss dinners and celebrations while holding hands with those who will not make it home for the holidays.

ANA Code Ethics for Nurses Provision 5: 

Our Code of Ethics for nurses contains a provision that reflects on the importance of self-care: The nurse has moral duties to self as a person of inherent dignity and worth including an expectation of a safe place to work that fosters flourishing, authenticity of self at work, and self-respect through integrity and professional competence. (ANA, 2025)

So, how do we care for ourselves while caring for everyone else? How do we protect our mental health, manage stress, and experience joy during this season? Here are a few supportive strategies to help nurses and all healthcare professionals make the most wonderful time of the year feel a little more wonderful.

1. Prioritize Self-Care

Honor your days off and make time for the things that genuinely bring you joy, things that are just for you. Maintain a healthy routine by protecting your sleep, eating nourishing foods, staying hydrated, and engaging in movement or hobbies that ground you. While at work, take your breaks away from the floor to recharge. A refreshed nurse is a safer, stronger, and happier caregiver.

2. Set Boundaries and Manage Expectations

It's okay to say no, whether to an extra shift, an event you’re too exhausted to attend, or pressure to create the perfect holiday. Protecting your energy isn't selfish; it's essential. Focus on what you can control, keep traditions that are realistic, and create new ones if your schedule needs flexibility. Joy doesn't depend on the calendar date.

3. Build and Lean on Your Support System

Stay connected with family, friends, and coworkers who understand our world and can help lighten the load. If things feel heavy, reach out for additional support through resources such as your Employee Assistance Program, Nurses Caring for Nurses, or the Wisconsin Peer Alliance for Nurses, all of which offer confidential, professional mental health support, often at no cost. Work with your support network to celebrate the holiday on a day that works for you, even if it’s not the actual holiday.

4. Spread Holiday Cheer at Work

If you’re scheduled to work during the holidays, find small ways to make the shift festive and meaningful. Nurse leaders can help foster joy by encouraging tasteful decorations, holiday potlucks, themed activities, or shared meals. When appropriate, staff may dress in accordance with role-appropriate guidelines to bring smiles and lift spirits for both patients and coworkers. A little cheer can go a long way.

Nursing is a demanding yet rewarding profession, but it’s not always convenient or glamorous. The holiday season can increase stress from overtime, financial burdens, missing family gatherings, and emotional exhaustion. Prioritizing self-care helps us continue providing exceptional care to others while safeguarding our own health, happiness, and holiday cheer. Take care of yourselves and each other. Be well, stay safe, and may this season bring peace, joy, and rest.

Warmest Holiday Wishes from the Tri-Council and the Wisconsin Nurses Association.

Measuring What Matters for Effective QI Initiatives

Florine Ndakuya-Fitzgerald, PhD, RN, NPD-BC

Nurses are key drivers and implementers of change in healthcare, influencing improvements at the local, system-wide, and national levels every day. A key component of implementing change is the ability to measure its impact—without measurement; it’s impossible to determine whether meaningful improvement has occurred. Therefore, identifying appropriate measures is a critical part of the Quality Improvement (QI) process.

The three most common types of measures in QI are:

1. Outcome measure: This is the so what of the quality initiative. It measures the overall impact of the intervention to healthcare consumers
2. Process measure: Assesses how the system or process in place is working to achieve the intended outcome measure.
3. Balancing measure: Captures the unintended result(s) of the new process.

Case study: As the new year approaches Ms. Joan sets a goal to reduce her stress level to improve her overall quality of life. During conversations with her nurse, she is introduced to several evidence-based stress reduction methods. Ms. Joan decides to limit screen time to 10 hours per day, meditate for 10 minutes three times a week and go for a 15 minute walk three times a week.

SMART aim: By June 2026, Ms. Joan’s stress level will decrease by 50% as measured by the perceived stress scale. Based on the smart aim, identified measures are:

Outcome measure: Change in Stress level as measured by the perceived stress scale in January 2026 (pre) and June 2026 (post)

Process Measure(s): (Tracked daily or weekly)

• Number of minutes meditated per day
• Number of hours of screen time per day
• Number of minutes spent walking per day
• Number of days per week Ms. Joan went for a walk.

Balancing measure(s): Ms. Joan will need to track

• Costs associated with walking (e.g., exercise shoes/clothes/gym membership)
• Time away from other activities.

By consistently tracking the process measures, Ms. Joan can identify patterns that support long-term adherence to her new habits, increasing the likelihood of achieving her goal within six months.

Takeaway: Like Ms. Joan’s case study, it is important for QI initiatives to include:

• 1-2 outcome measures
• 4-10 process measures that can be monitored on a frequent basis
• At least 1 balancing measure.

Click here to view an image that summarizes QI measures definitions and provides some relevant examples.

Reference:

Institute of Healthcare Improvement. (n.d). Model for Improvement: Establishing Measures https://www.ihi.org/library/model-for-improvement/establishing-measures

‘Tis  the Season

 Influenza, also known as flu, is a contagious respiratory illness derived from influenzas viruses and spread by those infected via droplets produced when they speak, sneeze, or cough. Flu season typically emerges from October through March each year. The person-to-person transmission of influenza is preventable by avoiding close contact with the sick, staying home unwell, and practicing respiratory etiquette. Examples of respiratory etiquette include coughing and sneezing into a tissue and promptly discarding the tissue or coughing and sneezing into the bend of one’s elbow.

Symptoms of influenza include chills, cough, sore throat, nasal congestion or runny nose, fatigue, and muscle aches. Influenza can be spread by a person during the first 3 days they are sick. Symptoms may manifest 1 to 4 days after exposure/infection. People at higher risk for influenza include older adults, 65 years of age and higher, those with chronic health problems such as diabetes and heart disease, health care workers, pregnant women, and children 5 years old and younger. Most people experience influenza symptoms for a few days, no longer than 2 weeks. However, complications of influenza include pneumonia and ear and sinus infections.

Influenza can be treated with antiviral medications which are most effective if initiated within the first 2 days of illness.

An effective intervention for preventing influenza is through annual influenza vaccination. Preventing the spread of influenza and other infectious illnesses is through proper hand hygiene. Handwashing should also take place after blowing one’s nose, coughing, and sneezing.

People should wash their hands with clean, running water, and soap or use hand sanitizer with at least 60% alcohol. When people wash their hands with soap and water, they should follow these steps:

1. Wet both hands with clean, running water (cold or warm)
2. Apply soap
3. Rub hands together, producing a nice lather, pay attention to fingertips and between fingers for at least 20 seconds (sing the Happy Birthday song twice while rubbing).
4. Rinse both hands and dry with a clean towel or an air dryer.

Handwashing with soap and water is advised over using hand sanitizer after using the bathroom or assisting another person with clean-up after a bowel movement. People should also wash their hands before and after preparing meals, eating, caring for someone sick, and caring for an open area of the skin.

Hand sanitizer should only be used if hands are not visibly soiled. When using hand sanitizer, follow these steps:

1. Rub hand sanitizer onto both hands, covering all surfaces, until dry (for about 20 seconds).
2. Do not rinse or wipe off hand sanitizer, doing so will decrease it’s effectivenss.

For Nurses:  

Nurses should respond to influenza through a combination of personal protective measures, patient care and symptom management, and education and prevention efforts, following guidelines from public health organizations like the CDC and OSHA

References

Centers for Disease Control and Prevention. (2024, April 17). Handwashing facts. Retrieved from https://www.cdc.gov/clean-hands/data-research/facts-stats/index.html

Centers for Disease Control and Prevention. (2024, August 13). About influenza. Retrieved from https://www.cdc.gov/flu/about/index.html

The Hidden Hazards of Surgical Smoke in the OR

Mary Cejka-Rivet, MSN, RN

On October 22nd 2025 Wisconsin Nurses Association Gina Dennik-Champion testified in support of Senate Bill 442(SB 442) which would require hospitals and ambulatory surgical centers (ASCs) to use smoke evacuation during procedures that generate vertical smoke. The bill directs DHS to ensure facilities adopt policies to capture, and filter and remove surgical smoke plume at the source, a control that protects both patients and the operating room team.

Why the urgency?

Surgical smoke is more than just an unpleasant odor from the thermal destruction of tissue. Surgical smoke is a biohazard, a plume (also called aerosol) includes mostly water vapor, and toxic byproducts that include gases and vapors produced from energy generating lasers or electrosurgical units (ESUs) to cut or coagulate tissue. These devices increase the intracellular temperature to boiling (100°C/212°F), vaporizing the tissue at high temperature, thereby producing an invisible surgical smoke. At least 500,000 healthcare workers are exposed each year to benzene, hydrogen cyanide, formaldehyde, bioaerosols, viable and non-viable cellular material, human aerosolized blood and blood fragments, and viruses. Exposure to fine particles and volatile compounds can upper respiratory irritation, hinder visualization of the surgical field, carry the potential to cause changes in DNA, and cause malignant cancers (Benaim & Jaspers, 2024; Occupational Safety and Health Administration, n.d.); Mahdood et al., 2024).

Why it’s dangerous?

The American Operating Room Nurses Association (AORN) reports that about 90% of surgical procedures generate smoke, and perioperative nurses report higher rates of respiratory symptoms emphasizing the occupational burden and hazard. Peer reviewed studies show particulate counts in operating rooms can exceed the Air Quality Index (AQI) standards during smoke generating surgical cases, and plume has been found to contain carcinogenic compounds such as formaldehyde and benzene.  Of the 150 hazardous chemicals identified in surgical smoke, 16 appear on the EPA Priority Pollutant List (Association of periOperative Registered Nurses, 2025). Viral DNA, including human papillomavirus (HPV), hepatitis, and human coronavirus has also been detected in surgical smoke (Fox-Lewis et al., 2020; Steel, Horridge, Awni, & Adams, 2024).

What about N95 masks?

A fit-tested N95 can help reduce residual particulate exposure that escapes evacuation, but N95 respirators do not filter gases and vapors. In other words, PPE is not a substitute for surgical smoke evacuation and control.

What works?

Airborne contaminants can be captured and effectively controlled to eliminate particulate exposure. SB 442 aligns with long-standing best practice: use local smoke evacuation to remove ultrafine particles and volatile chemicals.

What action can I take?

The prudent approach is to assume surgical smoke may be infectious (Fox-Lewis, Allum, Vokes, & Roberts, 2020). During smoke-generating procedures, use (1) local exhaust or source capture, (2) effective surgical room ventilation, and (3) highly protective masks such as N95. SB 442 is a practical evidence-based step to standardize smoke-free operating rooms statewide and nationwide while encouraging clinical judgment when use is not advisable. It addresses hazards and how we safeguard patients, protect nurses, and keep the surgical environment safe.

References

Association of periOperative Registered Nurses. (2025). Everyone Deserves A Smoke Free OR. AORN. Retrieved on 11/3/2025 from https://www.aorn.org/docs/default-source/get-involved-rev/government-affairs/policy-agenda/AORNSmoke-092025.pdf

Benaim, E. H., & Jaspers, I. (2024). Surgical smoke and its components, effects, and mitigation: a contemporary review. Toxicological Sciences : an Official Journal of the Society of Toxicology, 198(2), 157–168. https://doi.org/10.1093/toxsci/kfae005

Fox-Lewis, A., Allum, C., Vokes, D., & Roberts, S. (2020). Human papillomavirus and surgical smoke: A systematic review. Occupational and Environmental Medicine, 77(12), 809–817. https://doi.org/10.1136/oemed-2019-106333

Mahdood, B., Merajikhah, A., Mirzaiee, M., Bastami, M., & Banoueizadeh, S. (2024). Virus and viral components transmitted through surgical smoke; a silent danger in operating room: a systematic review. BMC Surgery, 24, 227. https://doi.org/10.1186/s12893-024-02514-z

Occupational Safety and Health Administration. (n.d.). Laser/electrosurgery plume. U.S. Department of Labor. Retrieved on November 3, 2025 from https://www.osha.gov/laser-electrosurgery-plume

Ogg, M. J. (2020). Surgical Smoke Inhalation: Dangerous Consequences for the Surgical Team. CDC: NIOSH Science Blog.  https://blogs.cdc.gov/niosh-science-blog/2020/06/18/surgical-smoke/

Steel, B. J., Horridge, C., Awni, S., & Adams, J. R. (2024). Chemical constituents, viable micro-organism and malignant cell content in ultrasonic scalpel plume: A literature review. Journal of Perioperative Practice, 34(1–2), 47–56. https://doi.org/10.1177/17504589221140990

November is Epilepsy Awareness Month: Supporting Nurses in Patient-Centered Care

Epilepsy affects over 3.4 million people in the United States, making it one of the most common neurological disorders. During Epilepsy Awareness Month, the Wisconsin Nurses Association (WNA) encourages nurses across all care settings to deepen their understanding of epilepsy and strengthen their role in patient education and advocacy.

Whether you're working in hospitals, clinics, schools, or rehabilitation centers, nurses are often the first line of support for individuals living with epilepsy. Here are key tips to help guide your practice:

Tips for Nurses: Epilepsy Education & Support

1. Know the Types of Seizures

• Not all seizures look the same. Familiarize yourself with focal, generalized, and absence seizures to better recognize and respond appropriately.

2. Respond Calmly and Safely

• During a seizure, ensure the patient is safe from injury. Time the seizure, protect the head, and avoid restraining movements. Call for emergency help if it lasts longer than 5 minutes.

3. Educate Patients and Families

• Provide clear, compassionate information about seizure triggers, medication adherence, and lifestyle modifications.
• Encourage the use of seizure action plans and medical alert identification.

4. Address Stigma and Mental Health

• Be aware of the emotional toll epilepsy can take. Offer resources for counseling and support groups and advocate for inclusive care.

5. Collaborate Across Disciplines

• Work with neurologists, pharmacists, and social workers to ensure comprehensive care and medication management.

SAVE THE DATE!! Upcoming Webinar December 8^th, 2025: Enhancing Epilepsy Care

November is Diabetes Awareness Month: Empowering Nurses to Educate and Support

Diabetes affects over 38 million Americans, and nurses play a critical role in helping patients manage this chronic condition. Whether you're working in a hospital, clinic, or rehabilitation center, your guidance can make a lasting impact on patients’ health outcomes and quality of life.

This Diabetes Awareness Month, the Wisconsin Nurses Association (WNA) encourages nurses to take an active role in diabetes education. Here are practical tips to help you support patients across care settings:

Tips for Nurses to Educate Patients About Diabetes

1. Normalize the Conversation

• Create a safe, nonjudgmental space for patients to talk about their challenges.
• Use open-ended questions to explore their understanding and feelings about diabetes.

2. Focus on Small, Achievable Goals

• Help patients set realistic goals for blood sugar monitoring, nutrition, and physical activity.
• Reinforce progress and celebrate small wins to build confidence.

3. Address Emotional Well-being

• Be alert to signs of diabetes distress, burnout, or stigma.
• Offer coping strategies and refer to behavioral health specialists when needed.

4. Use Visuals and Hands-On Tools

• Demonstrate how to use glucose monitors, insulin pens, or pumps.
• Provide printed materials or digital resources patients can take home.

5. Collaborate Across Disciplines

• Work with dietitians, pharmacists, and social workers to create a holistic care plan.
• Encourage family involvement when appropriate to support lifestyle changes.

Access Expert Insights from the Diabetes Care & Education Conference

To support your ongoing education, WNA has made recordings available from the Diabetes Care & Education Conference, including powerful plenary sessions on burnout, stigma, and patient-centered strategies.

  Click here for more information and access to the videos

Let’s continue to elevate diabetes care—one patient, one conversation, one nurse at a time.

The purpose of Breast Cancer Awareness Month is to educate the public about the disease, encourage early detection through screenings like mammograms, and raise funds for research and treatment advancements. 

As nurses we can play a critical role in promoting Breast Cancer Awareness Month. Our different roles include support and engagement in prevention, early detection, education, and patient care. 

Consider engaging in one of the following activities:

1. Promoting early detection
   • Educating patients about the importance of mammograms, clinical breast exams, and self-awareness for early detection.
   • Supporting early detection significantly increases survival rates and reduces treatment intensity.
2. Educating your community
   • Sharing important health information as we are identified as trusted source of sharing knowledge.
   • Being a “myth buster” by correcting misconceptions, explain risk factors, and guide individuals on when and how to get screened—especially women with dense breast tissue or family history risks.
   • Learning and demonstrating evidence-based screenings, diagnosing, treating and caring.
3. Addressing health disparities
   • Reaching out to underserved or high-risk populations that are facing barriers to accessing screening or care.
   • Promoting awareness helps close gaps in access to preventive services.
4. Empowering patients
   • Encouraging women to take charge of their health through understanding personal risks and engaging in shared decision-making with healthcare providers.
5. Supporting patients and families
   • Promoting awareness campaigns is a great way of honoring survivors and supporting those undergoing treatment.
   • Providing emotional support, connecting patients with resources, and fostering hope.
6. Advocating for public health
   • Contributing to a culture of prevention and demonstrating the value of public health nursing.
   • Participating strengthens community and neighborhood outreach events, workplace wellness programs, health fairs, mobile units that will travel to specific areas.
7. Demonstrating nurses’ visibility, value and vital role supporting health promotion, disease prevention, assessment, interventions including the delivery of compassionate care related to breast cancer.

Included in this issue of the Wisconsin Nurse is the testimony that was provided about supporting legislation that requires Medicaid and health insurance plans to cover supplemental breast cancer screenings for women identified as having dense breast tissue. The testimony was delivered to the Assembly Health, Aging and Long-Term Care Committee on Wednesday October 15, 2025, by Gina Dennik-Champion, WNA Executive Director. The testimony is located under the Legislative Update section.

September is the Sepsis Awareness Month: Recognizing the Silent Emergency

By Josee Gill, DNP, RN, CPHQ

September is the Sepsis Awareness Month, a time where we focus on one of the most urgent health crises affecting patients throughout the world.  Sepsis is a life-threatening emergency that happens when your body’s response to an infection damages vital organs and can cause death.  Like stroke and heart attacks sepsis is a medical emergency that requires rapid diagnosis and treatment.  Sepsis can lead to severe sepsis and septic shock.  Sepsis has impacted more than 1.7 million Americans every year and has caused 350,000 lives.

Some people are at higher risk of developing sepsis due to a higher risk of contracting an infection, these are infants, older patients, patients with chronic disease, weakened or impaired immune system and it can also affect malnourished patients.    Sepsis is not diagnosed based on infection alone, it is based on other symptoms. The Sepsis alliance created an acronym around other symptoms called:  TIME – T – Temperature- I Infection- M- mental decline and E – extremely ill.

Many hospitals Emergency Department have created Code Sepsis just like a Code Stroke or Code STEMI to mobilize a team at patient’s bedside to address a potential case of sepsis with nurse driven protocols to quickly activate time-sensitive process for rapid, coordinated care and begin treatment if necessary. The time sensitive interventions include drawing blood for laboratory tests, including blood cultures, the medical staff work to control the infection with broad-spectrum antibiotics order and rapid fluid resuscitation may be initiated.

How to Prevent infections:

• Hand Washing
• Flu vaccinations
• Caring for wounds
• Treating bacterial infections

Sepsis can occur quickly, early recognition is important, symptoms like fever, chills, rapid breathing, confusion, or extreme discomfort should never be ignored. It is important to increase awareness among patients, families, health professional, to ensure timely treatment and reduce preventable death.

References: Sepsis Alliance, 2025 What Is Sepsis | Sepsis Alliance

September: Suicide Prevention and Awareness Month Don’t Forget About our Nurse Colleagues

 If you are in crisis, help is available through the 988 Suicide & Crisis Lifeline.  https://www.dhs.wisconsin.gov/crisis/988.htm

As nurses, we are trained to care for patients experiencing a mental health crisis or suicidal thoughts. Nurses are the largest component of the US health care workforce. “Recent research suggests that nurses may be at high risk for suicide; however, few studies on this topic exist. The suicide risk compared with the general population was significantly increased for nurses but not for physicians.”[i]

We keep them safe, evaluate their physical and mental health, and coordinate the best possible care plan for their overall well-being. However, we sometimes forget to care for ourselves during our darkest moments, especially when we are at our breaking point. Nursing can be bleak, depressing, and traumatic at times, among other challenges. Sometimes, we can't even find the words to describe how we are feeling, but we know that the pit continues to deepen with every shift we work, patient we lose, or stress we face. The breaking point often feels unavoidable, as if we have no way out. Please know, Wisconsin nurses and the Wisconsin Nurses Association (WNA) are here to help.

WNA’s Nurses Caring for Nurses Program provides an online dedicated space where nurses can access peer support programs, resources, and a supportive community aimed at promoting nurse well-being, preventing burnout, and fostering a healthy work environment by addressing the specific stressors of our profession. It offers information, training, and various initiatives to help nurses navigate challenges, manage stress, and maintain their mental and physical health, ultimately enhancing their ability to provide high-quality patient care. In a career field where we are constantly in demand to care for others, it is comforting to know that the WNA is looking out for the mental and physical health of all nurses. No nurse has to struggle in silence or alone.[ii]

 If you are a nurse or know one who needs mental health support, please visit the Nurses Caring for Nurses website at https://www.wisconsinnurses.org/nurses-caring-for-nurses/

The American Nurses Association has information related to suicide awareness which applies to our nurses. “Using the acronym AIR (Awareness/Identify/Recognize) will assist you in identifying someone at risk of suicide.

Awareness

• Talking, writing or creating art about wanting to die or to kill themselves
• Looking for a way to kill themselves; searching online for a method/plan
• Talking about feeling hopeless or having no reason to live
• Talking about feeling trapped or in unbearable pain
• Talking about being a burden to others
• Increasing the use of alcohol or drugs
• Acting anxious or agitated
• Sleeping too little or too much
• Rumination: Cannot get bad thoughts out of their head
• Withdrawing or isolating themselves
• Showing rage or talking about seeking revenge
• Giving away belongings
• Extreme mood swings
• Reckless behavior
• Self-injurious behavior such as cutting
• It feels like this person needs more help than a friend can provide

Note that someone can be suicidal and not overtly demonstrate any signs or symptoms of suicidal intention. Self-injury is sometimes, but not always a precursor to suicidal behavior and warrants mental health evaluation.”

Identify & Recognize

The most important thing to do is start a conversation with the person. Empathy makes a powerful connection to reduce loneliness and risk. Direct questions can be life-saving.  However, do not put your own self at risk.  Do’s: Have the moral courage to say “Are you thinking of suicide?” “Are you feeling so bad that you are thinking of killing yourself?” Don’ts: Don’t attempt to minimize their feelings by saying things like: “It is not that bad” “I know exactly how you feel”

Key components to having the conversation:

• Scan the environment and practice situational awareness before initiation.
• If you feel you are at risk, call EMS first.
• Ask if they feel suicidal, if yes, ask if they have a plan, if yes stay with them until they get help.
• Do not leave the person alone if they admit to thoughts of harm. Get help right away
• Provide authentic presence that shows you care and provide empathy.
• Be curious: “Tell me more.”
• When person in crisis reaches out, show up if it is safe to do so.
• Name the emotions and paraphrase back what you have heard.
• Ask if it is OK to work with them to get help.
• While honoring the person’s rights, acknowledge that their intent makes you worried.
• Know your resources and connect.
• Don’t fall into the expert trap, be a colleague, not a teacher.
• No judgement: Do not try to make them feel anything other than what they feel.
• Create an opportunity for the person to be willing to follow up with you again. Before leaving, discuss when to checkback. Make a follow-up safety plan.” [iii]

[i] Davis MA, Cher BAY, Friese CR, Bynum JPW. association of US nurse and physician occupation with risk of suicide. JAMA Psychiatry. 2021;78(6):651–658. doi:10.1001/jamapsychiatry.2021.0154. Retrieved from the world wide web https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2778209

[ii] Bell S, Waite-Labott K, Wojnar C.  Creation and implementation of the "nurses caring for nurses" Initiative by the wisconsin nurses association (WNA). 2025. Retrieved from the world wide web https://www.wisconsinnurses.org/nurses-caring-for-nurses/

[iii] American Nurses Association. nurse suicide prevention/resilience. Retrieved from the world wide web. 2025.                https://www.nursingworld.org/practice-policy/nurse-suicide-prevention/

World Breast Feeding Week

By Josee Gill, DNP, RN, CPHQ

World Breast Feeding Week by the World Alliance for Breastfeeding Action (WABA) will be held August 1^st to 7^th to encourage breastfeeding and improve the health of babies around the world.

The theme for 2025 is “Prioritize Breastfeeding: Create Sustainable Support Systems”.  The goal of this theme is to emphasize the need to strengthen support systems for breastfeeding mothers across communities and workplace settings.

What are the most beneficial weeks of breastfeeding? Four to six weeks.  This is a critical time for building a baby’s immune system. Breast milk can adapt to baby’s needs and provide nutrients that are essential to your baby’s development.

The first week of breast feeding is always the hardest, it can feel like climbing a mountain barefoot.  Your body is healing and recovering from the delivery and milk is not there yet.  The first few days, most moms start with colostrum, a nutrient -rich pre-milk.  Miilk usually start on days two to five, which can cause anxiety if the baby seems hungry. Babies need to learn to latch, both moms and babies are learning!

Here are some Wisconsin resources for breast feeding support including programs like:

• WIC (Women, Infants and Children)- provides support for breastfeeding mothers, including education, personalized feeding plans and access to pumps. https://www.dhs.wisconsin.gov/wic/breastfeeding-support.htm#:~:text=Vendor%20Information-,WIC%20(Women%2C%20Infants%2C%20and%20Children),WIC%20breastfeeding%20peer%20counseling
• Wisconsin Breastfeeding Coalition- brings together breast feeding advocates and supporters to share knowledge and best practices https://www.wibreastfeeding.com/
• Native Breastfeeding Coalition of Wisconsin- strengthening and encouraging traditional breastfeeding practices within Native communities. https://www.glitc.org/programs/family-health-services/native-breastfeeding-coalition-of-wi/overview/
• Western Wisconsin Breastfeeding Coalition: Foster community acceptance of breastfeeding and support within healthcare systems. https://wwbcoalition.org/
• Wisco Lactation – provides lactation services and support from International Board Certified Lactation Consultant (IBLC’s) and Certified Lactation Counselor (CLC’s) https://www.wiscolactation.com/

What is the 4-4-6-12 rule for breast milk?

The CDC 4-4-6-12 rule for breast milk refers to a storage guideline for expressed milk:

Recommendations for storage of expressed milk:

• Store at room temperature for 4 hours
• Store in the refrigerator for 4 days
• Store in freezer for 6-12 months

However, proper storage is crucial to maintain quality and safety of breast milk for your baby. https://www.cdc.gov/breastfeeding/breast-milk-preparation-and-storage/handling-breastmilk.html

This week is celebrated in more than 120 countries!

WHO and UNICEF Recommendation for Optimal Infant and Young Child Feeding (IYCF) Practices

1. Early initiation of breastfeeding within one hour of birth
2. Exclusive breastfeeding for the first six months of life
3. Continued breastfeeding up to two years of age or beyond, with the introduction of nutritionally adequate and safe complementary (solid) foods at six months

References:

Center for Disease prevention and control – Breast Milk storage and preparation https://www.cdc.gov/breastfeeding/breast-milk-preparation-and-storage/handling-breastmilk.html

World Alliance for Breastfeeding Action https://waba.org.my/

World Health Organization WHO World breastfeeding Week website

August 30th is National Grief Awareness Day

Submitted by Kamia Monet Beasley, DNP, RN, NE-BC

WNA Tri Council

August 30th is National Grief Awareness Day and offers an opportunity to reflect on the impact of loss and grief on health and wellness. Nurses can promote positive coping strategies by offering support to grieving patients.

What is grief?  

Grief is described as an intense feeling of sadness experienced during an anticipated loss or after an actual loss. In either case, the loss can significantly impact the person’s mental health. A death of a loved one, severed ties with an employer, or the end of a relationship can be perceived as a personal loss. Grieving can pose a threat to a person’s health and wellness.

How can nurses support people through grief?

Firstly, it is important to identify whether a person is grieving. Nurses can include open-ended questions aimed at eliciting truly subjective responses during assessment. Nurses can also quietly observe non-verbal communication.

• What losses have you experienced in your life recently or in the past?

It is important to recognize loss is subjective and may include loss of a loved one through death, the loss of a job, or the loss of a home. Once loss has been identified, nurses can assist people through grief by listening attentively and acknowledging the importance of the loss for the person, and providing education on the stages of grief, expressions of grief, symptoms of grief, and risk factors for complicated grief.

• Nurses may observe tearfulness and/or sighing as non-verbal communication.

Stages of Grief

• Denial- Avoids discussing loss
• Anger- Blames others for loss
• Bargaining- Expresses guilt and regret related to loss
• Depression- Reports symptoms such as lack of energy, sleeplessness; appears agitated, changes in weight
• Acceptance- Expresses positive memories related to loss and/or how they have moved forward despite loss

Physical Expressions of Grief Include

• Crying
• Sighing

Physical Symptoms of Grief Include

• Lack of appetite
• Lack of energy
• Pain: headaches, muscle aches
• Sleeplessness 

Risk Factors for Complicated Grief Include

• Loss was sudden, unexpected
• Pre-existing mental health diagnosis(es)
• Lack of resources and support
• Strong attachment to loss

Symptoms of Complicated Grief

• Difficulty with accepting loss
• Difficulty with enjoying accepting loss
• Feelings of hopelessness
• Focused on little else outside of loss 

Person-centered Care Plan

• Identification of loss: person shared they have experienced the loss of someone or something of value to them
• Identification of grief stage and risk for complicated grieving: educate person on stages of grief
• Help them determine what stage they are in
• Ask questions about the nature of the loss to determine if the loss places the person at risk for complicated grieving
• Identification of coping strategies and support: find out how the person has been coping and what resources and/or support the person has access to
• What do you do to feel better?
• Who can you call when you are struggling?
• Plan: identify effective coping strategies and provide information on accessible referrals and resources that will promote health and wellness
• Effective coping strategies may include seeking out family members to openly share feelings with and/or joining a support group
• Referrals to a mental health professional and access to online tools such as those found at Mental Health America Wisconsin online at https://www.mhawisconsin.org/lossandgrief.aspx#resources can also provide support to people as they grieve

Grief is a deep, personal experience and unique to each person. Nurses can lend an empathetic ear and ask meaningful questions to identify loss. Listening attentively to the responses facilitates the development of person-centered plans to navigate the grief journey.

References & Resources

1. Fischer, J. (2023, December 12). 5 Stages of grief: Coping with the loss of a loved one. Harvard Health Publishing/Harvard Medical School.
2. Froedtert and Medical College of Wisconsin: Grief words: Resources for mourners and caregivers.
3. Mayo Clinic (2022, December 13). Complicated grief.
4. Mental Health America of Wisconsin. (2025). Loss and grief.

Nadira Osman Ali, RN, BSN

Observed annually on July 22, World Brain Day is a global initiative led by the World Federation of Neurology (WFN) to raise awareness about brain health and neurological disorders.

Why Brain Health Matters

Nearly 1 in 3 people will experience a neurological disorder in their lifetime. These range from developmental disorders in children to dementia in older adults. Despite their widespread impact, neurological conditions remain under-recognized and underfunded.

World Brain Day promotes equitable healthcare access and supports prevention, education, and early intervention. Nurses play a vital role in advancing brain health through education, screenings, and culturally competent care.

Brain Health Across the Lifespan

Children (Ages 0–12)

Over 90% of brain development occurs before age five, making early childhood a critical period for long-term well-being.

Key Priorities:

• Proper nutrition

• Stimulating play

• Limiting screen time

• Developing secure attachments

• Language exposure

• Positive reinforcement and coping skills

Teens & Adolescents (Ages 13–19)

This stage is marked by brain remodeling that influences decision-making and emotional regulation. Teens are particularly vulnerable to mental health issues such as:

• Depression

• Anxiety

• Eating disorders

• Suicidal ideation

Key Priorities:

• Prioritize sleep

• Foster a sense of belonging

• Normalize mental health support and screening

Adults (Ages 20–64)

Career demands, caregiving responsibilities, and health challenges make brain health a high priority during adulthood.

Key Priorities:

• Balanced nutrition and regular exercise

• Stress management

• Mental stimulation

• Sleep hygiene

• Healthy work-life balance

Older Adults (Ages 65+)

Aging increases the risk of Alzheimer’s, Parkinson’s, and stroke—but healthy habits can preserve cognitive function.

Key Priorities:

• Physical activity for memory and mood

• Social connections to reduce isolation

• Routine screenings for early intervention

• Continued mental engagement

• Mental health support

Advocacy & Action

Over 1 in 3 people globally will face a neurological condition during their lifetime. As nurses and healthcare professionals, we must advocate for:

• Prevention

• Early intervention

• Culturally inclusive care

How You Can Help

• Support caregivers, especially those caring for individuals with dementia

• Advocate for policy changes to fund neurological research and care

• Share awareness messages within your community

• Model healthy habits (sleep, nutrition, exercise)

• Volunteer with or donate to brain health organizations

• Normalize mental health check-ins and help-seeking

• Promote regular screenings, especially for high-risk populations

Resources

• World Federation of Neurology – World Brain Day

• American Nurses Association (ANA)

• CDC: Brain Health

• Harvard Center on the Developing Child

Why Eye Exams are Important  

Josee Gill, DNP, RN, CPHQ

Eye exams are more than just reading letters on a chart. 

According to CDC, 2025, 11 millions Americans over age 12 need vison correction.

Here is why it is important- early detection can prevent serious eye conditions like glaucoma, macular degeneration, and diabetic retinopathy which develop silently and with no early symptoms.  By having a yearly comprehensive eye exam, one can catch these issues early, and treatment is more effective early on. 

Eye doctors can spot signs of diabetes, high blood pressure and even brain tumors during an exam by examining blood vessels and nerves in the eye.

Even if you think your vision is fine, subtle changes can go unnoticed.  Regular exams ensure your vision is correct and you may need glasses and/or contact lenses. 

Common eye problems:

Cataracts: which cause clouding of the lens, are the leading cause of vision loss in the United States.

Diabetic retinopathy causes damage to blood vessels in the back of the eye. It's the leading cause of blindness in American adults. Diabetic retinopathy is one of the most preventable causes of vision loss and blindness. Early detection and treatment can prevent or delay blindness from diabetic retinopathy in 90% of people with diabetes. Diabetes can also increase the risk of other eye problems like cataracts or glaucoma.

Glaucoma is a group of diseases that damages the optic nerve.

Age-related macular degeneration causes gradual breakdown of light-sensitive tissue in the eye.

Only half of people at high risk of vision loss visit an eye doctor every year. Regular eye care can have a life-changing impact on preserving the vision of millions of people.

Development and Learning for Children:

Vision p[robles can affect reading, focus, and classroom performance.  Early exams help detect issues like lazy eye (Amblyopia), which is treatable if caught early.

When and how often should you take an eye exam?

Children- At least once between the age of 3 to 5 years old and then regularly as recommended

Adults every 1 to 2 years or more often if you have risk factors like diabetes or a family history of eye disease. Some people are at a higher risk for glaucoma and should have a dilated eye exam every 2 years:

• Black Americans 40 years and older.
• All adults older than 60, especially Mexican American adults.
• People with a family history of glaucoma.

Other reasons to see an eye doctor

If you have any of the following eye problems, don't wait for your next appointment. Visit your eye doctor as soon as possible:

• Decreased vision.
• Draining or redness of the eye.
• Eye pain.
• Double vision.
• Floaters (tiny specks that appear to float before your eyes).
• Circles (halos) around lights.
• Flashes of light.

Reference:

Centers for Disease Control and Prevention, (2024).  Vision and Eye Health.  Why eye exams are important.

Alzheimer’s and Brain Awareness
Xochitl Halstead

Positive changes can make a long-lasting difference on your brain health, lowering your risk of cognitive decline and possibly Alzheimer’s and dementia. Here are some easy, tangible tips to maintain your brain health.

1. Challenge your mind: Stay curious and learn a new skill!
2. Continuing education: Encourage youth to stay in school and pursue highest level of training possible in their area of interest. This has shown to reduce the risk of cognitive decline.
3. Get moving: engage in regular exercise that raises your heart rat and increases blood flow to the brain. Move in a way that feels good to you. It can be something as simple as taking a walk or working in the garden. Don’t forget that social activities are also beneficial in reduced rates of disability and mortality.
4. Protect your head: Injury prevention is key to reduce cognitive decline! Wear a helmet when riding a bike and work to prevent falls in the elderly.
5. Be smoke free: Smoking can increase your risk of cognitive decline. It’s never too late to stop and your brain will thank you later!
6. Eat Well: Aim for fresh fruits and veggie and lean protein. Eating healthy foods can reduce your risk of cognitive decline.
7. Sleep well: Ensure you practice healthy sleep habits such as reducing screen time before bed and make your sleep space as comfortable as possible. Talk to your healthcare provider if sleep issues exist!

Alzheimer’s Association. (2025). 10 Healthy Habits for Your Brain. https://www.alz.org/help-support/brain_health/10-healthy-habits-for-your-brain.

Definition:

The month of May is Blood Pressure Awareness Month. Blood Pressure is defined as the physical force exerted by the blood as it pushes against the walls of the arteries. Systolic blood pressure is the pressure in the arteries as the heart contracts pushing the blood forward. Diastolic pressure is the pressure in the arteries as the heart relaxes. Uncontrolled high blood pressure poses significant risks for several medical problems including but not limited to angina, heart attack, heart failure, irregular heartbeat, stroke, and kidney damage or kidney failure.

Demographics & Data:

Hypertension affects approximately 50 million individuals in the United States and many people don’t even know they have it. The only way to know if you have high blood pressure is to have your blood pressure checked. A diagnosis of high blood pressure will need to be made by a health care professional.

Target BP Readings:

As a rule, all patients will have a blood pressure of less than 120/80. This is standard in all primary care setting. However, some medical conditions show benefit to lower goals.

Pharmacologic Treatment:

Generally, medications should be prescribed when the diagnosis of hypertension is made, titrated up when needed, and used in combination with other appropriate medications when indicated.

May Include:

ACE-I Monitoring and Side Effects

• Weakness or dizziness
• Reduction in GFR and/or Acute Kidney Injury. Check GRF after initiation and periodically. Generally, a bump in serum creatinine 30% or more from baseline is significant
• Hyperkalemia - Mild 0.5 mEq/L bump usually within 1-2 weeks after initiation. Lower threshold for monitoring in high -risk patient (CKD, older adults, patients on NSAIDs, K-sparing diuretics, Acute Heart Failure)
• Cough - Dry, hacky, bothersome, due to accumulation of bradykinin which causes reflex bronchoconstriction. Can be found in up to 20% of patients
• Angioedema

Thiazide Diuretics

Tend to improve antihypertensive effect when used with other hypertensive drugs.

Calcium Channel Blockers

• Prefer Dihyropyridines
• Recommend against non- dihydropyridines (Diltiazem and Verapamil) alone for hypertension

Beta Blockers

Helpful if history of MI, heart failure, LV dysfunction

Follow-Up:

• General disease management guidelines state that patients with chronic conditions like hypertension should be evaluated at least two times a year. Generally, if not at goal, the patient should have a reevaluation within 1 month. Options for follow-up would include:
• Appointment with physician or APC
• Appointment with Care Team RN
• Virtual follow-up if validated home BP monitor
• MA/LPN only BP check (nurse care visit) often used if low suspicion of HTN but need to confirm normal reading
• Every patient with an elevated BP reading at an encounter, needs to have an appointment for some sort of follow-up scheduled within one month.

What is White Coat Hypertension?

• Blood pressure that is consistently elevated in the clinic setting but normal or near normal at home or outside of the clinic setting. Generally, more common in the elderly population.
• Definition: Office SBP/DBPs are >20/10 mm Hg higher than home readings
• Home BP Monitoring: Consider confirming with validated home BP monitoring
• Home BP readings are better predictors of CVD risk due to elevated BP than are in-office BP measurements
• The incidence of white coat hypertension converting to sustained hypertension is 1% to 5% per year
• The patient should be followed until a normal reading is recorded, and they should be treated if BP remains elevated.

What is Secondary Hypertension?

90% of hypertension is Essential hypertension – elevated BP with no identifiable cause. In the remaining 10%, a specific, remediable cause of hypertension can be identified. This is called Secondary hypertension.

When to consider:

1. Difficult to control BP on 3 or more medications
2. Severe elevation of BP
3. Significant elevation in younger patients
4. Sudden onset of hypertension
5. Increased BP in patients with hypertension previously controlled on drug therapy
6. Onset of diastolic hypertension in older adults
7. Significant hypokalemia or decreasing GFR

Common causes of secondary HTN include Renal artery stenosis, chronic kidney disease, primary aldosteronism, drug or alcohol abuse. Depending on the clinical situation, these patients could be referred to nephrology, cardiology, or the Vascular Institute (Gundersen).

What is an Hypertensive Emergency?

1. Asymptomatic hypertension (no symptoms or maybe mild headache) almost never needs to be referred to ED.
2. Severe hypertension, defined as a systolic BP > 180 (also known as hypertensive urgency) can be alarming to patients and providers.
3. High BP readings are common in the ED, since that is a very stressful environment.
4. If the PCP gets a very high reading in the office, a good strategy is to reassure the patient, and to let them lay down in a quiet environment, then recheck the BP in 15-30 minutes. This is a strategy used in the ED and is often successful in getting significantly lover readings. A similar approach can be used when patients call in to report significantly elevated readings.

The primary goal in the assessment of severe asymptomatic hypertension is the determination if acute end organ damage is present. Examples of end organ damage would include:

1. Encephalopathy, with symptoms such as agitation, stupor, seizures.
2. Focal neurologic symptoms that could be due to an ischemic or hemorrhagic stroke.
3. Dyspnea, which could be due to acute pulmonary edema.
4. Ongoing chest pain.
5. Acute head trauma; intracranial hemorrhage.
6. Severe back pain, might be due to aortic dissection.
7. Hypertension induced Acute Kidney Injury.
8. Nausea and vomiting, which may be a sign of increased intracranial pressure.
9. Preeclampsia/eclampsia.

If end organ damage is suspected, then emergent reduction of severe hypertension is indicated. The goal is BP reduction over hours to days. In these cases, ED referral would be appropriate.

1. For asymptomatic significant elevations, it is reasonable to make a medication adjustment and arrange for follow-up within a day or two.
2. Generally, office staff triaging calls should check in with the primary care physician or APC before sending the patient to the ED.
3. ED referral for incidentally noted hypertension without symptoms or end organ damage creates a highly suboptimal encounter for both the clinician and patient, particularly when a treatment expectation has been set.
4. Up to date contains an excellent summary under the sections “Management of severe asymptomatic hypertension in adults” and “Evaluation and treatment of hypertensive emergencies in adults.”

Referral to Specialty Care:

1. Most of the patients with hypertension are appropriately managed in primary care. Prior to referring, make sure that the patient is adhering to the current BP treatment regimen. Referrals should be considered when:
2. Blood pressure not at goal with three or four medications
3. Decreasing eGFR
4. Readings over 180/120 despite treatment
5. Suspicions of a second cause

References:

American Hear Association. High Blood Pressure: ACC/AHA Releases Updated Guideline. May 23, 2024

Up To Date. Overview of Hypertension in adults. March 2025 Overview of hypertension in adults - UpToDate

April is National Donate Life Month

Author: Julie DeLisle, RN, MSN and member of the WNA Tri Council

National Donate Life Month (NDLM) was established by Donate Life America and its partnering organizations in 2003. Observed in April each year, National Donate Life Month helps raise awareness about donation, encourages Americans to register as organ, eye and tissue donors and to honor those who have saved lives through the gift of donation.

Let Life Sing

In 2025, let life sing! Birds are known across many cultures as one of the most welcomed and visible signs of spring. They represent both new beginnings and visits from loved ones who have passed away. The yearly return of birds and their songs offer us a sense of peace and hope.

National Donate Life Month is a time to educate about organ, eye and tissue donation, and to honor and remember donors and the lives they have saved and healed. Your decision to be an organ, eye and tissue donor gives hope to the 100,000 people on the national organ transplant waiting list who are waiting for a second chance at life.

The Need is Great

The U.S. surpassed 48,000 transplants in 2024, and 104,834 Americans are waiting on a lifesaving organ transplant.The U.S. has performed more organ transplants than any other country. In 2023, there were more than 39,000 organ transplants from deceased donors. This represents an 8.9 percent increase over 2022 and marks the eleventh consecutive record-setting year.

Nurse Role in Organ Procurement

Nurses play a crucial role in organ procurement by identifying potential donors, providing care to both donors and recipients, and supporting families through the donation process, ensuring optimal organ quality and maximizing the number of successful transplants. Below are some activities where nurse engagement can occur:

• Identifying Potential Donors; early identification, contacts with transplant coordinators, and initiating family communication.
• Caring for Donors; maintaining organ viability, monitoring and management of the donor, deceased donor care and/or living donor care.
• Supporting Transplant Recipients; pre- and post-surgical care, monitoring for complications, and medication management.
• Key Skills and Responsibilities; communication with key stakeholders, critical thinking, teamwork, empathy and compassion and knowledge of organ donation.

How to Get Involved
You can register as an organ, tissue, and eye donor, learn more about the need for donors and the donation process, and celebrate National Donate Life Month in April.

Sources:

• Donate Life America: https://donatelife.net/how-you-can-help/national-observances-celebrations/ndlm/
• National Organ Donor Registry: https://registerme.org
• United Network for Organ Sharing: https://unos.org
• Health Resources & Services Administration: https://www.organdonor.gov
• International Transplant Nurses Society. https://itns.memberclicks.net/about

April is Alcohol Awareness Month

Create a nursing plan of care in anticipation of your patients’ alcohol abuse.  Alcohol consumption has been linked to many deaths and health conditions. Researchers estimate that each year there are more than 178,000 alcohol-related deaths, making alcohol a leading preventable cause of death in the United States. In addition, more than 200 disease and injury-related conditions are associated with alcohol misuse. National Institute on Alcohol Abuse and Alcoholism. Of the 50 states, Wisconsin currently ranks third highest for adult alcohol consumption (64.4%) and is the highest in the nation for excessive alcohol use which includes binge drinking, drinking while pregnant, heavy drinking and underage drinking.  https://www.dhs.wisconsin.gov/scaoda/alcohol-prevention-report.pdf

Alcohol Use Disorder (AUD) affects people from all backgrounds.  According to the 2023 National Survey on Drug Use and Health (NSDUH), 28.9 million people ages 12 and older (10.2% in this age group) had AUD in the past year. National Institute on Alcohol Abuse and Alcoholism.

SCAODA Report

The State Council on Alcohol and Other Drug Abuse (SCAODA) released a comprehensive report looking at ways to reduce excessive alcohol consumption in Wisconsin. Alcohol-related death rates for Wisconsinites have been rising (disease related deaths and poisonings) as well as other alcohol related fatalities, including car crashes, suicide, and unintentional injury. Excessive alcohol use can cause harm to others due to assaults, batteries, domestic violence, as well as cause many health-related issues.  Wisconsin State Council on Alcohol and Other Drug Abuse (SCAODA), 2021)

Top 10 Wisconsin counties with highest % excessive drinking:

Nurses play a crucial role in addressing alcohol abuse, from screening and assessing patients to providing education, interventions, and referrals, often serving as a vital link between patients and specialized addiction services.

What can you do to raise awareness of the dangers of alcohol?  As stated on  Healthline.com

• Talk with kids and teens about alcohol: Talking about alcohol can help prevent underage drinking, and Alcohol Awareness Month is a great time to get the conversation started. The Substance Abuse and Mental Health Services Administration has resources on its website to help you have conversations with kids as young as age 9, high schoolers, and teens heading off to college about the risks of alcohol.
• Talk with family and friends about alcohol: Starting a conversation about alcohol misuse with a loved one can be tough, but it can also be lifesaving. If you’ve been concerned about a loved one’s drinking, Alcohol Awareness Month is a good time to check in with them.
• Look at your own relationship with alcohol: Make time for some self-reflection, too. Alcohol Awareness Month can be a great time to monitor and track how much alcohol you drink, which can allow you to spot potential overuse.

The infographic below can be used to begin a conversation and start support for access to educational efforts

 April is National Stress Awareness Month: Prioritizing Nurse Well-Being

Submitted by Nadira Osman Ali, BSN, RN

WNA Tri Council

April is National Stress Awareness Month, a time to recognize the impact of stress on health and well-being. As nurses, managing stress is essential, not only for our personal health but also for ensuring safe, high-quality patient care.

Why Stress Management Matters

National Stress Awareness Month aims to raise awareness about the causes and effects of stress while encouraging individuals and organizations to take proactive steps in managing it. This is especially important for healthcare workers, who face significant stressors daily.

Addressing stress directly benefits nurses' well-being and patient care quality. Stress, whether physical or mental, can lead to burnout, decreased job satisfaction, and even compromised patient safety. A 2024 survey revealed that 49% of healthcare workers reported experiencing burnout in their role contributing to high turnover rates and reduced patient care quality. By acknowledging workplace stress and implementing effective stress management strategies, the nursing profession can foster a healthier, more sustainable work environment. Nurses play a critical role in healthcare, and prioritizing mental well being is essential for sustaining a long, fulfilling career. By taking small, intentional steps toward stress management, we can create a healthier future for both ourselves and our patients. In response to the stress that is reported by nurses, the Wisconsin Nurses Association developed an online Nurses Caring for Nurses program which can be found by logging onto: https://www.wisconsinnurses.org/nurses-caring-for-nurses/ .

Other information about nurse’s stress

Risk Factors for Nurse Stress & Burnout

Nurses experience unique stressors that impact both their mental and physical health

Lack of Support: Insufficient resources and poor organizational support can lead to feelings of isolation and increased stress.

Unprofessional Work Environments: Exposure to unprofessional behaviors can negatively affect job satisfaction and workplace morale.

High Workload & Staffing Shortages: Long shifts and national staffing shortages place significant physical and emotional demands on nurses.

Emotional Strain: Regular exposure to patient suffering and critical situations can lead to compassion fatigue, a state of emotional exhaustion and detachment.

Signs of Stress & Burnout

Recognizing the signs of stress and burnout is crucial for early intervention.

Emotional Changes: Feelings of hopelessness, detachment, irritability, anxiety, or being overwhelmed. Cognitive & Behavioral Changes: Decreased motivation, difficulty concentrating, withdrawal from colleagues and loved ones, and absenteeism.

Physical Symptoms: Chronic fatigue, headaches, gastrointestinal issues, and sleep disturbances.

How Nurses Can Incorporate Stress-Relief Strategies

Prioritize Rest: Ensure adequate sleep and rest between shifts.

Focus on Physical Health: Incorporate regular exercise and a balanced diet.

Develop Healthy Coping Mechanisms: Engage in mindfulness, journaling, or meditation. Take Short Breaks: Brief moments of rest during shifts can help reset the mind.

Set Boundaries: Delegate tasks when appropriate and avoid excessive overtime.

To foster a healthier work environment, nurses should:

Seek Support: Connect with peers, mentors, or counseling services.

Utilize Wellness Programs: Take advantage of hospital provided resources for stress management. Advocate for Change: Promote policies that prioritize nurse well-being.

Foster a Supportive Workplace: Acknowledge stress and challenges within the nursing field to create a culture of openness and resilience.

Resources/References

1. National Alliance on Mental Illness (NAMI). (2024, February 10). Mental health and burnout: Resources for healthcare workers.
2. GlobeNewswire. (2023, March 23). National survey finds majority of healthcare workers have considered leaving their roles or the industry altogether in the past year as burnout intensifies.
3. NY Post. (2024, September 5). Here are the five careers with the highest risk of burnout. 4. Centers for Disease Control and Prevention (CDC). (2024, May 15). Supporting the mental health and well-being of healthcare workers.
4. American Medical Association (AMA). (2024, March 28). Addressing burnout and improving well-being in healthcare professionals.
5. American Nurses Association: Nurse Burnout Prevention & Recovery
6. American Psychological Association: Stress in America
7. National Alliance on Mental Illness (NAMI): Stress Prevention Resources
8. Centers for Disease Control (CDC): Support for Public Health Workers

To honor Malignant Hyperthermia Awareness Month, there is no better time to review what malignant hyperthermia (MH) is and how to prepare for a crisis. Although this is primarily common in the perioperative setting, a malignant hyperthermic crisis episode can occur up to 24 hours after the administration of a triggering agent (Duchene, 2024). This is a rare, hereditary, but life-threatening condition that causes a reaction due to accelerated metabolism and uncontrolled release of calcium in the skeletal muscle caused by anesthetic gases, those typically ending in -fluane, and succinylcholine, resulting in sustained muscle contraction, increased carbon dioxide and heat production, and cell content leakage, such as potassium, CK, and myoglobin (Watt & McAllister, 2023). Therefore, all nurses must understand what causes MH, the signs and symptoms of an MH crisis, and how to successfully treat a reaction. With more surgical patients going home the same day as their procedure, this could be a reality for anyone caring for those patients.

Risk Factors for Developing MH and Triggering Agents

MH is a genetic disorder, so there will be other people in the patient’s family who have had a reaction. There are regions in the United States where there are higher incidence areas, with Wisconsin being one of them. The gold standard for diagnosing an MH allergy is through a muscle biopsy, so it is important to gather a clear family history before any surgical procedure. Triggering agents include halothane, isoflurane, sevoflurane, desflurane, enflurane, and succinylcholine (Rosenberg et al., 2007).

Signs and Symptoms of MH

Early identification of MH is vital to successful symptom management and the prevention of complications. Early signs and symptoms include unexplained tachycardia, tachypnea, muscle rigidity, masseter muscle rigidity, a sudden increase in end-tidal carbon dioxide, and metabolic acidosis. Later signs and symptoms are fever, rhabdomyolysis, mottled skin, and myoglobinuria (Duchene, 2024).

Treatment Plan for MH

As a rule of thumb, you must abide by your facility’s policies and procedures for MH. However, here are some guidelines recommended by the American Association of Critical Care Nurses that generally encompass most MH crisis plans.

1. Call an MH code, rapid response, or the method used by your facility to get extra help, especially if the MH cart is not in your department.
2. Stop the triggering agents if surgery is still underway.
3. Hyperventilate the patient with a bag-valve-mask to lower the end-tidal CO2.
4. Prepare dantrolene as ordered and per your facility guidelines and immediately administer it to the patient. This typically reverses the signs of MH and is crucial in this situation.
5. Cool the patient with ice packs, lavages, and IV fluids as needed until their body temperature reaches less than 38C or 100.5F.
6. Insert extra lines: large bore IVs, urinary catheter, nasogastric or orogastric tube, and an arterial line as necessary.
7. Transfer the patient to the ICU as soon as possible.

To reiterate, make sure to review your facility’s policies and procedures on MH management and emergency treatment, especially if you work in a non-critical care area. Familiarize yourself with your facility’s protocol for dosing dantrolene as this is the life-saving agent in this case. If your facility does not address your department in its MH policy, please reach out to your leadership to get clarification on what to do if a patient shows signs of symptoms of MH in your department. Also, be an advocate for yourself and others and partake in MH drills or ask that an MH be conducted in your department. As nurses, we should be prepared to care for any patient that comes our way. Although cases are rare and chances may be low, it is essential to prepare ourselves for MH and how to best save our patients as quickly as possible.

References

Duchene, A. (2024, May). “It’s getting hot in here”: A discussion on malignant hyperthermia. AACN. https://www.aacn.org/blog/its-getting-hot-in-here-a-discussion-on-malignant-hyperthermia

Rosenberg, H., Davis, M., James, D., Pollock, N., & Stowell, K. (2007). Malignant hyperthermia. Orphanet Journal of Rare Diseases, 2, 21. https://doi.org/10.1186/1750-1172-2-21

Watt, S. & McAllister, R. (2023, August). Malignant hyperthermia. In StatPearls. StatPearls Publishing. Retrieved March 2, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK430828/#:~:text=The%20earliest%20signs%20of%20malignant,few%20of%20the%20usual%20signs.

February is Heart Health Awareness Month

Heart disease is very common. According to the CDC, heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. In 2022, 1 in every 5 deaths in the United States was caused by heart disease.

How can nurses make a difference

Nurses can promote lifestyle changes, provide heart disease screening, remind patients to be aware of their family history, educate patients on how to manage their medications, and encourage action.

• Lifestyle changes: Nurses can advise patients on how to reduce their risk of heart disease through lifestyle changes, such as eating a healthy diet, exercising, and managing stress. 
• Screenings: Nurses can encourage patients to get screened for blood pressure, cholesterol, blood sugar, and body mass index (BMI). 
• Family history: Nurses can remind patients to be aware of their family history. 
• Medications: Nurses can help patients understand how to manage their medications. 

Encourage action

• National Wear Red Day: Nurses can encourage patients to wear red on National Wear Red Day, which is the first Friday in February. 
• Spread the word: Nurses can encourage patients to spread the word about the importance of physical activity and heart health. 
• Learn CPR: Nurses can encourage patients to learn CPR. 

To see more ideas on how to make an impact, check out the National Heart, Lung, and Blood Institutes flier on 25 Ways to Take Part in Heart Month.

Traumatic Brain Injury (TBI) is caused by a sudden and rapid head acceleration or deceleration, blow to the head or skull penetration. TBI can damage neural fibers causing intracranial hematoma, increased intracranial pressure and midline shift (Alouani & Elfouly, 2022). Based on clinical presentation can be characterized as Mild, moderate, and severe. Mild TBI, also called concussion, is the most common type of TBI in the US accounting for 70-90 percent of all TBI cases. Sports injuries and falls are the main causes of mild TBI. It is manifested as a brief loss of consciousness or mild change in mental status. Patients may show signs days or weeks after injury (Institute of Medicine [IOM] 2009; Kundu & Singh, 2023).

Moderate and severe TBI are characterized by an extended period of unconsciousness or amnesia. Common causes are a blow to the head or penetrating injury. Moderate and severe TBI can lead to death or long term disabilities. According to Centers for Disease Control and prevention, falls, firearm-related suicide, motor vehicle crashes and assaults account for the majority of moderate and severe TBIs (https://www.cdc.gov/traumatic-brain-injury/about/moderate-severe-tbi.html).

Who is at risk for TBI?

TBI can affect anyone, but higher cases have been reported among children 0-4 years of age, adolescent and young adults ages 15-24, those >65 years of age and among military combats. 7000 Americans are admitted to military and Veteran hospitals each year for TBI (IOM, 2009).

In Wisconsin, there were 1500 deaths involving TBI in 2020, 9800 emergency room visits and 4200 hospitalizations during the same time. Adolescents ages 15-19 had the highest rate of emergency room visits while patients aged 85 and over had the highest hospitalizations (https://www.dhs.wisconsin.gov/injury-prevention/traumatic-brain-injury.htm)

How is TBI diagnosed?

• Neurological assessment such as Glasgow Coma Scale (GCS)-Used for early detection. The score ranges from 3 (comatose/unresponsive) to 15 (no deficits).
• Neuroimages such as computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and electroencephalogram (EEG)

Prevention and early detection are most effective ways to tackle TBI. Nurses should:

• Educate patients on the signs and symptoms of TBI such as headaches, nausea or vomiting, dizziness, vision issues, foggy or groggy memory, and interrupted sleep. For more resources, visit: https://www.cdc.gov/traumatic-brain-injury/signs-symptoms/index.html
• Encourage children, caregivers, and parents to always wear a seat belt when riding in a motor vehicle (even short distances).
• Continue fall prevention.
• Advocate for safe living and playing spaces for children.
• Educate/Encourage wearing a helmet and other appropriate head gear when:
• riding a bike, scooter, hoverboard, unicycle, horse
• Playing contact sport
• Skating, skateboarding, or snowboarding.

References/Resources

Alouani, A. T., & Elfouly, T. (2022). Traumatic brain injury (TBI) detection: past, present, and future. Biomedicines, 10(10), 2472. https://doi.org/10.3390/biomedicines10102472

Institute of Medicine (IOM). 2009. Gulf War and Health, Volume 7: Long-term Consequences of Traumatic Brain Injury. Washington, DC: The National Academies Press.

Kundu, S., & Singh, S. (2023). What happens in TBI? A wide talk on animal models and future perspective. Current neuropharmacology, 21(5), 1139–1164. https://doi.org/10.2174/1570159X20666220706094248

Wisconsin Department of Health Services. https://www.dhs.wisconsin.gov/injury-prevention/traumatic-brain-injury.htm

Centers for Disease Prevention. Preventing TBI | Traumatic Brain Injury & Concussion | CDC

Cervical cancer is one of the lesser-discussed female cancers that is one of the most easily preventable. In 2024, it was estimated that 13,820 new cases of invasive cervical cancer were to be diagnosed, and approximately 4,360 women would succumb to the disease (ACS, 2024). Cervical cancer is unique in that it is primarily caused by a persistent viral infection by the human papillomavirus (HPV). Although this is a large and common family of viruses, a persistent infection with a high-risk strain of HPV can significantly increase a woman’s chance of developing cervical cancer (IARC, 2025). As nurses, we must discuss the importance of cervical cancer prevention with all our patients who are assigned female at birth, regardless of their sexual orientation or gender identity. The two most effective ways to prevent cervical cancer are to vaccinate early and screen regularly.

Prevention through vaccination

The Centers for Disease Control and Prevention (CDC) recommends that all boys and girls get the HPV vaccine at age 11 or 12 due to the more vigorous immune response produced by the vaccine during the preteen years (CDC, 2021). If the vaccine series is started before the patient’s 15^th birthday, they will only be required to receive two doses. Patients ages 15 through 26 receiving the vaccine must complete a three-dose vaccine series.

The HPV vaccine can be given to patients up to age 45 if they were not adequately vaccinated when they were younger. Discussing vaccine administration over the CDC recommended age of 26 with a healthcare provider is best to determine the best course of action.

Prevention through screening

The traditional screening exam for cervical cancer is the Pap test. Current screen guidelines suggest women should begin receiving Pap tests at age 21 (NCCC, n.d.). This test looks for any abnormal cells on the cervix. More frequent OBGYN monitoring or further testing will occur if abnormalities or dysplasia are noted. This is to prevent the progression of further cervical changes and early detection of neoplasms.

At age 30, there are three available screening options: a Pap test every three years, a Pap and HPV test every five years, or an HPV test alone every five years (NCCC, n.d.). This screening schedule heavily depends on past medical history, previous Pap results, and  new Pap findings. After 65, women are no longer required to receive screening Pap tests if their medical history allows (NCCC, n.d.). Any patient who has had a hysterectomy with complete cervix removal does not need to be screened at any age unless they have a history of high-grade precancerous lesions or a change in sexual partners and wish to have a vaginal swab completed.

References

American Cancer Society. (2024, June). Cervical cancer statistics: Key facts about cervical cancer. Cervical Cancer Statistics | Key Facts About Cervical Cancer | American Cancer Society. https://www.cancer.org/cancer/types/cervical-cancer/about/key statistics.html

Centers for Disease Control and Prevention. (2021, November 16). HPV vaccination recommendations. Centers for Disease Control and Prevention.

https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html International

Agency for Research on Cancer. (2025, January 3). IARC marks Cervical Cancer Awareness Month 2025. Featured News. https://www.iarc.who.int/featured news/iarc-marks-cervical-cancer-awareness-month-2025/

National Cervical Cancer Coalition. (n.d.). Cervical cancer screening: Pap and HPV tests.  NCCC. https://www.nccc-online.org/cervical-cancer-screening/

Why is this event important?

According to the American Cancer Society, cigarette smoking remains the most preventable cause of serious illness and death.

• Smoking and exposure to secondhand smoke cause more than 480,000 deaths in the US every year.
• Smoking cigarettes increases the risk of at least 12 different cancers.
• In the US, cigarette smoking causes about 3 of every 10 cancer deaths. This number is higher in parts of the South and Appalachia.
• Some groups of people smoke more heavily or at higher rates. These populations tend to be those who face barriers to care and inequities in multiple areas of their lives, including:
  • People at lower socioeconomic levels
  • Those without college degrees
  • American Indians/Alaska natives
  • African American/Black communities
  • LGBTQ+ communities
  • People serving in the military
  • People with mental health conditions

It’s never too late to quit using tobacco.

No matter your age or how long you've been smoking, quitting can improve your health—both immediately and over the long term.

While giving up smoking is challenging, having a solid plan and support system can greatly increase your chances of success. In fact, seeking help through counseling and medications can double or even triple your likelihood of quitting for good.

Take the first step today—your health and well-being are worth

How to Quit

Below are some guides to assist in the process of quitting smoking provided by the American Cancer Society.

• Making a Plan to Quit and Preparing for Your Quit Day
• Quitting Smoking or Smokeless Tobacco
• Quitting E-cigarettes (Vapes, Vape Pens)
• Dealing with the Mental Part of Tobacco Addiction
• Nicotine Replacement Therapy to Help You Quit Tobacco
• Prescription Medicines to Help You Quit Tobacco
• Are There Other Ways to Quit Tobacco?
• Staying Tobacco-free After You Quit
• Help for Cravings and Tough Situations While You're Quitting Tobacco
• Talking With Your Cancer Care Team About Tobacco Use

Additional resources and information on quitting tobacco use.

• Reasons to Quit Smoking
• Health Benefits of Quitting Smoking Over Time
• Empowered to Quit (Tobacco Cessation Program)
• The Great American Smokeout
• 1-800-QUIT-NOW [CDC]
• Learn About the Quit2Heal Study to Help People With Cancer Quit Smoking

This information and more can be found on the American Cancer Society website.

November is Diabetes Awareness Month

The Wisconsin Nurses Association held the Annual WNA Diabetes Care and Education Conference September 28-27, 2024 at the Kalahari Resort & Convention Center.

The purpose of the conference was to provide the most recent evidence-based practices on diabetes care and management for healthcare professionals. The activities included 15 educational topics, three product theaters, 28 exhibitors, eight poster displays with three live presentations, and the opportunity to apply and wear a glucose monitoring sensor.

Background

WNA was an active partner in a CDC, Wisconsin DHS Bureau of Public Health chronic disease and prevent grant from 2018 – 2021.  One of the areas of focus was increasing nurse awareness of the latest clinical information on diabetes, promoting diabetes self-management education programs in primary care and community projects.  WNA’s first diabetes conference was supported by the CDC/DHS/DPH grant funds. WNA remains committed to working with diabetes-related organizations and experts in providing an annual diabetes conference for all health care providers. 

What the data shows about diabetes:

• 4 million Americans—or about 11.6% of the U.S. population—have diabetes.[1]
• 7 million Americans are unaware that they have diabetes.
• Approximately 97.6 million people ages 18 or older have prediabetes, a condition in which blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes.
• More than 8 in 10 adults living with prediabetes don’t know they have it.[2]
• About half of women with gestational diabetes go on to develop type 2 diabetes. Gestational diabetes is a type of diabetes that women develop when they are pregnant.[3]
• For Wisconsin 1 in 11 people in Wisconsin have diabetes, further breakdown on this data shows:
  • 1 in 10 Native American people have diabetes
  • 1 in 7 African American people have diabetes
  • 1 in 5 Hispanic American people have diabetes

The risk for developing pre-diabetes includes the following conditions

Nurses Role in Diabetes Care and Education

WNA Resources

WNA recorded four sessions from the 2024 Conference that offers continuing education credit.

COMING SOON!

The self-study offerings are:

Beyond Type 1 and Type 2: Genetic causes of diabetes and new categories of classification.

Kidneys and Kale: Preventative kidney care associated with diabetes-related implications.

Treating Obesity vs Treating Type 2 Diabetes: are they one in the same?

Pediatric Type 2 Diabetes - Not Your Grandma's Diabetes

[1] National Diabetes Statistics Report. Centers for Disease Control and Prevention website. Updated November 29, 2023. Accessed January 22, 2024. www.cdc.gov/diabetes/data/statistics-report/index.htm

[2]  Centers for Disease Control and Prevention. The surprising truth about prediabetes. Updated July 7, 2022. Accessed January, 22 2024. www.cdc.gov/diabetes/library/features/truth-about-prediabetes.html External link

[3] Centers for Disease Control and Prevention. Gestational diabetes. Updated December 30, 2022. Accessed January 22, 2024. www.cdc.gov/diabetes/basics/gestational.html

[4] Diabetes. State of Wisconsin Department of Health Services. Accessed November 10, 2024.

https://www.dhs.wisconsin.gov/diabetes/index.htm

[5]Dickinson JK, Guzman SJ, Maryniuk MD, O'Brian CA, Kadohiro JK, Jackson RA, D'Hondt N, Montgomery B, Close KL, Funnell MM. The Use of Language in Diabetes Care and Education. Diabetes Care. 2017 Dec;40(12):1790-1799. doi: 10.2337/dci17-0041. Epub 2017 Oct 17. PMID: 29042412.

Definition

Breast cancer is the most common cancer diagnosed among women in the United States. It is the 2nd leading cause of death from cancer among women. Only lung cancer kills more women each year.

Five Important Statistics:

1. Breast cancer rates are increasing (but deaths from breast cancer have been decreasing). 

2. White women are slightly more likely to be diagnosed with breast cancer than women of other races or ethnicities, but Non-Hispanic Black women are significantly more likely to die from breast cancer than women of other races or ethnicities.

3. Breast cancer is most often diagnosed in women in their 60s.
4. Breast cancer survival rates have improved in recent years.

5. The number of breast cancer survivors in the United States is more than 4 million.

2024 Screening Recommendations for Breast Cancer from the U.S. Preventative Task Force

What’s New in Breast Cancer Research? https://www.cancer.org/cancer/types/breast-cancer/about/whats-new-in-breast-cancer-research.html

• Research studies
• Breast cancer causes
• Breast cancer prevention
• New tests to personalize treatment
• New imaging tests
• Breast cancer treatment
• Supportive care

References

https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html

https://www.cancertherapyadvisor.com/features/breast-cancer-statistics/

Ways for nurses to improve their practice during Minority Mental Health Awareness Month• Educate patients

Talk with patients about mental health regarding how it can impact physical health and normalize discussing emotions.

 Provide resources

Have visible signage about mental health in appointment rooms, in waiting rooms, and online.

Screen Patients

Screen patients for depression using PHQ-9 form, screen for anxiety using GAD-7 form, and refer patients to accessible mental health services.

Communicate effectively 

Use non-stigmatizing language when referring to or speaking with patients. Review Preferred Terms forSelect Population Groups & Communities from the CDC for more information.

Attend further training

Consider attending cultural sensitivity training to better serve minority populations. Review CulturalCompetence In Health And Human Services from the CDC for more information.

Advocate for policy change

Write to your local representatives to advocate for improving mental health policies and funding for minority communities. Review “The US Playbook to Address Social Determinants of Health” to review current approaches from the government.

Citations

CDC. (2024). Support for public health workers and health professionals. Retrieved from:https://www.cdc.gov/mentalhealth/public-health-workers/index.html

El Centro de Corazon. (2018). July is mental health minority month. Retrieved from:

https://www.elcentrodecorazon.org/july-is-minority-mental-health-awareness-month/

Nursing Considerations: How to Positively Impact Your Nursing Care for the LGBTQ+ Community.

Author: Faleasha Gallagher, MPH, RN, PCCN, TNCC

WNA Tri-council member

• Educate yourself:Learn about LGBTQ+ history, culture, and current issues.
  • Learn how pride month came to be: The History of Pride: How Activists Fought to Create LGBTQ+ Pride
  • Learn where same-sex marriage is legal: Same-Sex Marriage Around the World
  • Learn about LGBTQ+ experiences: CAP Survey Data on LGBTQI+ Experiences

Use the correct terminology: When caring for patients, use the correct LGBTQ+ terminology.

***A patient’s sexual orientation does not inherently define their gender or gender expression or that of the patient’s partner(s).

(NurseJournal Staff, 2024)

 (LGBTQIA Resource Center, 2024)

• Ask questions:Ask questions that focus on behaviors that impact health instead of sexual orientation.
  • Review language to talk about sexual history: Taking A Sexual History
  • Use resources to enhance your knowledge on the LGBTQ+ community.
    • CDC Healthcare Provider Training
    • LGBTQ Equity Learning Modules
  • Promote a welcoming environment: Help promote a welcoming environment for LGBTQ+ patients by wearing pride swag.
  • Support policies:Support and promote policies and practices that reduce harm and improve affirmative care.
    • Policies and bans for LQBTQ+ community in WI ACLU LGBTQIA Rights
  • Attend events:Participate in local Pride events, such as parades, marches, or festivals.
    • June 6-8^th, 2024 Milwaukee's Pride Fest

Resources:

LGBTQIA Resource Center, (April, 2024). Pronouns & inclusive language. Retrieved from: https://lgbtqia.ucdavis.edu/educated/pronouns-inclusive-language

NurseJournal Staff, (April, 2024). Nurse Journal. Nursing care for LGBTQ+ patients: Tips and resources. Retrieved from: https://nursejournal.org/articles/nursing-care-lgbtq-patients/

April:  Autism Spectrum Disorder

Every month, organizations spotlight health conditions to increase awareness. As noted in allnurses.com, April is the month to spotlight Autism. Here’s a bit of information nurses should know about Autism.

Accelerating Science to Improve Early Autism Screening

Today, thanks to research focused on embedding routine screening in well-baby checkups, the early signs of autism can be identified in children as young as 12–14 months. These efforts, many supported by the National Institute of Mental Health (NIMH), show that making early autism screening part of routine health care can have a significant impact on children and families, helping connect them to support and services as early as possible.

• Autism is a neurodevelopmental disorder that affects how people interact, communicate, and learn.
• Making early autism screening part of routine health care helps connect families to support and services as early as possible.
• Despite American Academy of Pediatrics guidelines, only a small fraction of pediatricians reported screening for autism at well-child visits.
• NIMH-supported efforts to close the gap between science and practice have yielded key insights into effective strategies for expanding early autism screening.
• Researchers are identifying new tools for detection, new models for delivering services, and new strategies for embedding early autism screening and rapid referral into routine health care.

Every month, different organizations spotlight different health conditions to increase awareness. According to the Centers for Disease Control and Prevention, March is a month to spotlight colorectal cancer and endometriosis. What should nurses know about these two health conditions?