Cindy Campbell, LP, SN
President, TNSA

I hope as this semesters end draws near that we have all learned a lot, and are looking to our futures as a positive, rewarding experience. I look forward to the day of my graduation, as I am sure each of you does as well.

I have recently been hearing of “that JAMA article”, and after many conversations with various leaders in our nursing profession have finally taken time from my studies to read the abstract. I also read an article in Medscape online.

Now my question is “why all the fuss?” We all know that education is a wonderful opportunity. We also know that there is a nursing shortage and that SHORTAGE is the most critical issue facing nurses today.

What I hope we as students can learn to do is to LEAD BY EXAMPLE! Some of you are saying, “what do you mean?” Well let me tell you, I hope that we can all learn to work together as nurses, not as ADNs or BSNs or MSNs, but as NURSES!! Through the years there have been discussions and yes even some down right rude remarks about the various levels of education of nurses. These discussions have proven to interfere with our Professionalism. WE as students can set the example by not letting this article start yet another round of such discussions.

We can accept the article for what it is, an opportunity. I believe that we all have our personal opinions, and our personal reasons for obtaining the degree we are seeking. Some of us are going to graduate soon with our Associate Degree in Nursing, while still others of us will obtain our BSN. What we need to understand is that there is an opportunity for all of us to continue on with our educational level. We need more education and this article should give us the fuel our fire needs for funding issues.

There is a place in our profession for every level of nursing, and every degree that we can obtain. We should not let this article divide our Profession, nor do we need to let our patients feel a lack of confidence in any level of nurse that cares for them. We have some truly critical issues facing us today. Let us look to solving those issues and not be sidetracked by what degree the person with a good idea holds.

I hope that each of you look to your future with enthusiasm, and a positive attitude. What a truly remarkable PROFESSION we have chosen!


A Nurse’s Life
The following is a job description for a hospital bedside nurse in the 1890’s.

  1. In addition to caring for your 50 patients, each bedside nurse will follow these regulations:
  2. Maintain an even temperature in your ward by bringing a scuttle of coal for the day’s business.
  3. Daily sweep the floors of your ward. Dust the patient’s furniture and window sills.
  4. Light is important to observe the patient’s condition. Therefore, each day fill kerosene lamps, clean chimneys and trim wicks. Wash windows once a week.
  5. Each nurse will report every day at 7 a.m. and leave at 8 p.m., except on the Sabbath, on which day you will be off from 12 noon to 2 p.m.
  6. Graduated nurses in good standing will be given an evening off each week for courting purposes… or two evenings a week if you go to church regularly.
  7. Each nurse who smokes, uses liquor in any form, gets her hair done at a beauty shop, or frequents dance halls, will give the director good reason to suspect her worth, intentions, and integrity.
  8. Each nurse should lay aside from each pay day a goodly sum of her earnings for her benefits during her declining years, so she will not become a burden.
  9. The nurse who performs her labors, serves her patients and doctors faithfully and without fault for a period of five years, will be given an increase of five cents a day.


K. Lynn Wieck, RN, Ph.D.
President, Texas Nurses Association

Hail to my nursing student colleagues. I hope your semester is going well, and you are thriving in this exciting time in professional nursing. It is a great time to be a nurse! Welcome to the fold.

I am writing to seek your assistance in providing some much-needed leadership in the world of Texas nurses. It is a time of great opportunity for us as we see the nursing shortage looming out there. Many important groups are asking what nurses think and listening to what we say. Now, more than ever before, the opportunity for leadership is here for nurses.

The actions we take in the next few years will influence your nursing practice for decades. Your ability to practice to your fullest potential in a user-friendly environment where you are safe and satisfied depends on the leadership that is provided now. We are looking at ways for nurses to work smarter, to be a vital and well-compensated member of the healthcare team, to engage in activities that are truly relevant and not just busy-work. No more doing things just because that is the way we have always done them, we are truly seeking to reinvent nursing practice and education so you can optimize your career. These are important goals, and they deserve our full attention and energy.

When I say “Sissies need not apply,” I mean that leadership in these times takes courage and patience. Texas Needs Leaders – Texas needs you! Therefore, I am asking for your leadership in stopping a divisive issue from becoming a runaway locomotive that sidetracks all of our important work to assure that your future in nursing is long and positive. I am talking about the recent article by Dr. Linda Aiken regarding the relationship between level of nursing education and patient outcomes (1). There is a lot of anger, passion, and misinformation out there. I want to share the real facts with you, and then ask you think about them, make up your own mind, and take some leadership in this issue.

In September, the Aiken article was published in the Journal of the American Medical Association showing a relationship between nursing education levels and patient mortality. Some of my colleagues are arguing that the methodology is unsound and the findings are not to be trusted. JAMA was chosen because it is a prestigious journal with extremely high standards of accuracy, and exacting methodology is demanded in order to be accepted for publication. So arguing that the methods are weak or questionable is a fairly disingenuous effort.

This article reported findings from a study that included over a quarter of a million patients in Pennsylvania hospitals. They were patients on "medical-surgical" units who had orthopedic, cholecystectomy and vascular types surgeries. Here is the Cliff’s Notes version of what she found:

Some nurses are blasting Dr. Aiken for doing the research and for reporting the findings. First, she is a nurse, so I find personal attacks on her to be highly unprofessional. Second, she is a noted researcher who has provided many previous studies which have been embraced by nurses to help us move policy forward in a positive way that has helped nurses at all levels. In fact, these same methods she used in this article were welcomed just a few short months earlier when Dr. Aiken presented research from this same study that showed that giving nurses more than 4 patients increased patient mortality by 7% and increased nurse stress and burnout. This article was hailed by all levels of nursing education as evidence that simply adding more patients to a nurse’s workload was not a good idea. While I value the need to reasonably question research methods, to vilify the researcher seems counter-productive.

Some are saying that the researchers did not consider experience of the nurse, hospital competency, availability of equipment, and other issues. You can see by the findings that Dr. Aiken did indeed control for these variables. Dr. Aiken does say in the article that she measured BSN and higher in looking at the outcomes. Her goal was not to show that BSN grads were better or worse than ADN grads, she simply looked at the effect of educational levels (all levels) on patient outcomes (death). Since the patients she tested were surgical patients with cholecystectomy, vascular, and orthopedic surgeries, it could safely be assumed that their major care-givers on a general med-surg units were probably RNs without advanced degrees. But it does not matter. Her findings show that increased education levels improve outcomes.
So how do we use this research and what does it mean to you as students and to us as nurses. I propose that we use this research just as we use all research. It should be considered, weighed, and discussed – but it is not the ice berg that is going to sink the ship of professional nursing in this country. What is the positive message in this research for ALL nurses? Continuing one’s education is important and useful – we already knew that.
At our recent Fall Forum of the Texas Nurses Association, I asked nurses to do three things with this information. 1) We need to call for more research into the optimal utilization of nurses with various levels of educational preparation in the clinical setting; 2) We must use this research in a positive way to encourage hospitals to invest funds and to allow release time for all levels of nurses to continue their education to graduate levels and beyond; and 3) We should focus on the contributions that all providers make (Nurse Assistants, Licensed Vocational Nurses, Associate Degree Nurses, Baccalaureate Nurses, Advance Practice Nurses, and Doctoral Nurses) to the positive outcomes of health promotion and restoration and prevention of illness in the public we serve.

I am asking you to join me in using this information in a positive way. The goal is NOT to close ADN programs – we need all nurses. The goal is not to discredit ADN graduates – there is a place for everyone, and each nurse is valued and appreciated. As leaders, we must use this information in a positive way to try to ensure that funding is there for all of you when you decide to go back for more education, no matter what the level. As leaders, we must assure that everyone focuses on the value that each nurse brings to the healthcare environment. As leaders, we must demonstrate with our acts and our deeds that we are professionals and as such, we will not resort to temper tantrums to take the place of sound discussion and good-faith collaboration toward solving the real issues of nursing, i.e. the shortage of nurses, access to care for our patients, a healthy work environment, and a safe world. Those are the professional issues that demand our time and energy.
I have had the privilege of working closely with students for the past twenty-plus years. I am continually awed by your insights and your boundless optimism. I know that you will listen to all parties, including me, and will then make up your own minds. I am simply asking you to take a leadership approach to this situation, not the reactive, angry approach as some of my nurse colleagues have chosen. I have confidence that you can lead us into this century in a profoundly positive way. You cannot let people sidetrack you from the really important issues in nursing, and those issue are focused on the recipients of our care, our patients. The education level of the nurse is NOT the most critical issue facing nursing today. If we let it become the most critical issue, we will lose the confidence of the public we serve, and rightly so. They need our attention to their health problems.
I hope we will focus on the exciting positive things that are happening for nurses in Texas. I hope we will focus on how we help and complement each other, not on how we differ. We have work to do. Texas needs nurses. We must be leaders and innovators in solving health care problems, not in creating them. Please join me in leading professional nursing into a positive future. It is a great time to be a nurse in Texas, and no research article can stop the positive progress that is being made. I have total confidence in you. Thank you for being nurses.

Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003, September 24). Educational levels of hospital nurses and surgical patient mortality, Journal of the American Medical Association, 290, 1617-1623.


Nick Strittmatter
Vice President, TNSA

I know that we have all wondered what is around the next corner. Personally, I like to know what to expect, and clarification on how things work. The easiest way have this great insight, short of being a pseudo-psychic, is to have a mentor. Webster’s defines a mentor as, “a wise and trusted guide and advisor.” This is something that we all need, especially in the field that we’ve chosen. Mentors play an integral part in nursing, but for some, their first mentor is actually a preceptor. We as a whole should start this process earlier.

As upperclassmen, your knowledge base has greatly expanded since the first day you walked through the hallowed halls of your nursing school. You can now spout off the renin-angiotension system at the bat of an eye, or lab values for a pediatric or an adult patient. This vast extension of what used to be finely tuned party machine is now a well-oiled piece of critically thinking machinery. How great would it be to watch another person go through that transformation? By answering questions, explaining, and drawing pictures, you can hone your knowledge as well as pass it on. Throush your past experiences, the younger students will gain that insight and be better equipped to deal with situations. This is also an easy way to retain that student who is pondering what it would be like to be a professional finger paint artist because they have failed a test or two, because they didn’t understand a topic.

If you think that you can put aside some of that precious TV time to help a hardworking individual who, for some reason, is having trouble understanding a topic, be a mentor. At my school, I have implemented a plan that seems to work. Upperclassmen sign up on a list to be a mentor. Once the new class comes in, you pair them up. After that, the upperclassmen call the new students to let them know that they can help them with whatever they need. Set up a party for them to meet, and sit back and watch the new influx of energy. You have now made the new students more comfortable, and the upperclassmen feel like they have accomplished something. So be a mentor, it’s the easiest way to change a life.



Rebecca Self
South Plains College

I was not too excited about going to Council of Schools. Emily Rider, our senior advisor, kept insisting that we needed to go. Devin Carpenter, our local vice-president and I agreed to go, as long as we didn’t miss anything important at clinical. Plans and reservations were made at the last minute and we were off on an adventure with Miss Em.

At dinner the first night, we met several hundred of our fellow nursing students for a delicious meal and a lighthearted but informative talk by Professor Sharon Decker of Texas Tech. Ms. Decker had a tough crowd; We were all still in school mode and wondering if we should be taking notes and was this testable material? I was tickled pink with the obviously uncontrived method Ms. Decker used to get a standing ovation. She asked all the students to stand, addressed us, and then concluded her speech with us standing. Of course, we clapped and the effect was a standing ovation. Her obvious discomfiture was priceless.

After dinner, I was blessed to be allowed to sit in the president’s meeting with Devin. The number of great ideas that came out of that round-robin sharing session was amazing. So much was shared in so little time. Devin made a list of ideas as the speakers proceeded, in turn, about the room, but for an hour or more afterward he was saying, “I wish I had thought to mention….” There was not a sense of braggadocio, nor a spirit of competitiveness. These were people saying, “Our chapter had success with this and yours may also, but watch out for these potential complications.”

As an official morning person, I was up before the crack of dawn the next day. Truth be known, I felt it only fair to let Em sleep for a bit without me in the room, as it has been rumored that I snore. I don’t fully believe the rumor, but it comes from such a credible source, my husband of 30 plus years, that I felt obliged to give the dear lady a bit of solitude, just in case.

After a walk around the premises, I went back to awaken Em at the assigned time. She soon was awake enough to tease me about “schmoozing” with the Western Regional Director. Upon registration the evening before Stormy Klan, our regional director, had mentioned that she would like a moment to speak with me over breakfast. In our part of Texas it sometimes seems as if there is quite a communication chasm between the Lubbock chapters and the Levelland chapter. I know how easy it is to leave state functions with the best of intentions to break that barrier down but then we so quickly get reabsorbed in our day to day lives that those plans get set aside. I have often thought it amusing that we live less than thirty miles apart but we only see members of the other area chapters at state functions. By the way, I didn’t “schmooze” with Stormy over Danish. We did that later.

The Officers’ Breakout Sessions were next. Each region met with their director, and among other things, were encouraged to run for office at the state level, to introduce resolutions at the convention and to challenge another region concerning the state service project, Leader Dogs for the Blind.

When we met for the morning’s general session, Cindy Campbell wound up committed to dying her hair the color of the winning region’s ribbon, wearing a dog collar and singing, “How Much is the Doggie in the Window”, if the state’s Leader Dogs’ $5000 statewide goal is met. Now, if you want to see this sight, you will have to give your quarters for Leader Dogs and come to state convention in February. (Cindy should look charming in green hair. Right, Western Region?)

There was one breakout session before lunch, and several others that followed it. Emily, Devin and I were hard pressed to map out a plan to cover all the topics that we felt would be of interest and/or of use to our local organization. Lots of good information was presented. We decided on the various sessions that were specifically for our offices, and the ones on writing and presenting resolutions, applying for TNSA and NSNA awards, and campaigning and running for state office. I attended the Secretary-Treasurer/Editor workshop. Bel Garcia and Danielle Collins, the TNSA Secretary-Treasurer and Editor, respectively, were totally accessible, gave great information, and made the workshop enjoyable. It contained information I had not heard before, concerning the office of the TNSA Editor, and the Central Line Online Newsletter.

At lunch, the Board of Directors held the drawing for the raffle. This is one place where I want to assert that the TNSA excels. I have been to two state functions and have won two prizes. I would like to encourage everyone to attend convention, if for no other reason than greed. The first was $50 in gift certificates and the second was a free registration to the state convention, in Austin in February. I hope to see you there!

Ms. Jo Carol Claborn, Director/Owner, Nursing Education Consultants, spoke with fond regard for nursing, saying that it could be what you want it to be. She encouraged those who have been beaten down by the education system to get up, dust themselves off and take another run at it. She told uproariously funny stories that had us near rolling on the floor. “When you are a nursing student sleep is like sex—you never know when it is going to happen or how long it will last. Then when you do have that intimate moment, you find yourself doing a physical assessment of your partner.” Her advice to us as students and future nurses included, “Stop and take care of yourself, no one else will.” and “Use laughter to heal yourself and your clients.” Even terminally ill patients can find soul healing in laughter. Like the little cancer patient who, holding a handful of sloughed hair, quipped, “Chemo gives you a whole new perspective on having a bad hair day.”

So what is Council of Schools all about? It is about all the things you wish someone had told you before you got to state convention. It is about networking with others from your region and state. It is about getting to know your officers, and enjoying a day or two away from the grind of school. It is about laughing, and learning, and relaxing. It is about our professional organization, and what we want to do to it, for it, or through it. Is it a worthwhile experience? Definitely. Will I want to go next year? Without a doubt. Hope to see you there.


Tobie Watkins
Southern Regional Director, TNSA

Since the beginning of time, nurses have served within the Armed Forces. Florence Nightingale was one of the pioneering armed forces nurses, serving during the Crimean War. In the past, nurses have served primarily during a time of war to aid wounded soldiers. Today, nurses still serve that same purpose. However, the Armed Forces in the United States have developed numerous opportunities for nurses.

The Army, Navy, and Air Force will commission nurses upon completion of an accredited bachelor’s program in nursing. Upon completion of nursing school and receiving your license, you will embark on a four to six week course called Officer Training School (Air Force) or Officer Indoctrination School (Navy). During these courses, you will learn about the policies and procedures of the individual service, leadership and management skills, and military customs and courtesies. Upon completion of this course, the new nurse will be provided training and a preceptor in a military hospital.
The military provides comparable salaries and benefits for their nurses. All individuals of the same rank are paid the same salary regardless of the branch of service that you decide to join. Benefits include a competitive salary with regular promotions and annual pay raises, 30 days of paid vacation each year (starting with the first year of service), and medical and dental care is provided free to active duty service members. For individuals that have a family or dependents, medical and dental care are provided at minimal cost. An example of the salary comparison is as follows:

Single: Starting Income Civilian O-1 (Military) Taxable
Taxable Salary $45,206 $26,204
Federal Income Tax -$9,056 -$3,776
Social Security (7.65%) -$3,458 -$1,925
Basic Allowance for Subsistence (grocery) 0 +$1,920

Basic Allowance for Housing (rent/mortgage)
-depends on area stationed

0 +$9,746
After Tax Income $32,692 $32,179

The military does provide numerous benefits. Other than all of the pay, insurance, and vacation benefits, the military also provides a way of life that enables a person to see the world and fulfill dreams. The different branches of the military also provide opportunities for nurses to continue their education. There are fully funded graduate school programs available. If enrolled in one of these programs, the military nurse will received full pay and allowances, plus 75% tuition assistance for the courses that you are enrolled in. Also, the military provides opportunities for specialty training. The training is fully funded by the military, including the classes that you attend and the specialty area tests that are taken at the end. The military also offers promotion potential. Every promotion is accompanied by an increase in pay; also, an increase in responsibility and leadership opportunities.

Nurses serving in the military work as part of an interdisciplinary team to care for their patients. They provide care to military service members, their families, and retired veterans. Military nurses work in the hospital settings, including critical care areas, medical/surgical units, labor and delivery units, and the emergency department. Military nurses also work within different clinics in the hospital to serve people in other than a hospital setting. Nurses are also deployed to remote locations to provide care to our fallen comrades that have come to harm protecting the rights that we have in the United States. Military nurses are called upon to utilize their skills in numerous ways and in various areas. Thus, the military ensures that their nurses are well trained and ready to answer the call to arms when necessary. No matter what the situation, military nurses, like all other nurses, are prepared to use their skills to ensure that the patient is receiving the best possible care that they deserve and require.

When you decide to serve in one of the Armed Forces, you are required to provide a commitment to the military. The commitment required is a four year contract. By the end of that time, the individual will be an O-3 and making approximately $57,000 per year. At the end of their contract, the individual has the right to either get out of the service and embark upon a career as a civilian, or they may choose to continue their military adventure and sign another contract and commit to another set amount of time.

Personally, I have been on active duty service with the Air Force for over 8 years. The military has provided me with the opportunity to attend nursing school. While obtaining my degree, I have received my full salary and medical insurance. The Air Force has also paid 100% of my tuition. I was lucky enough to be able to go from being an enlisted member of the military to obtaining my degree and getting commissioned. In the Air Force, the program is called Air Education Commissioning Program (AECP). The military has provided numerous opportunities for me and my family. I encourage each of you to contact a recruiter near you if you have an interest in joining any of the military services. If you have any questions that I may answer, please do not hesitate to contact me. The last 8 years have been very rewarding for me. I look forward to the next 12 years that I will serve in the Air Force as a nurse.



Danielle Collins
Editor, TNSA

Recently, I found myself involved in a familiar conversation with a fellow nursing student. He was tired, burned out, worried about his grades… In short, he was a nursing student. As the discussion worked its way around to extracurricular activities, I began to see a possible cause of his exhaustion. This friend has found something to which he can commit nearly every minute of his time. From serving on several nursing-related boards and committees, to volunteering his time for various community services, this student fills countless different roles. When asked why he volunteered so much of his time, his answer was one that we have all heard before: “It will look great on my resumé.”

It got me thinking. How often do we commit time that we may not actually have to a worthy (or semi-worthy) cause, simply because it looks good? And is it really helping us?

In hopes of evaluating the importance of resumé-boosting activities, I spoke with Rhonda Collins, RN,C, MSN, former Vice President of Women’s and Children’s services at Baylor University Medical Center, and current senior manager of clinical professional services for Alaris Medical Systems. According to Ms. Collins, “We would rather know you’re doing two things really well, than see that you’re doing five or six things moderately well.” She offers this advice for students choosing activities: “When volunteering to be a part of an organization, make sure it is applicable to your future. Community service activities can be anything from teaching a Sunday school class to feeding stray dogs at the SPCA. As a general rule, anything you do more than four times per year qualifies. Varying types of community service participation show that you are balanced. This is key. Employers are constantly on the lookout for a well balanced person with a commitment to outside activities, but we also want to know that you’re going to use some of your off-time for yourself.”

So, it would seem that, in the question of quality vs. quantity of extracurricular involvement, quality wins again. This is definitely something to ponder… But I can’t right now. I’m due at the soup kitchen in half an hour, and I’ve got to finish delivering these Meals on Wheels first. It will look great on my resumé.




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