The Career and Education Resource for the Minority Nursing Professional • Fall 2018
Nurse Legal Rights in the
Workplace
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Table of Contents
In This Issue 3
Editor’s Notebook
4
Vital Signs
9
Making Rounds
43
The Funny Bone
Academic Forum 33 Formal Mentoring for Novice Academic Nurse Administrators
10 Nurse Legal Rights in the Workplace By Jebra Turner Find out why it’s not enough to know your patients’ rights
Features 18 Are For-Profit Nursing Schools a Good Choice?
By Carol DeLilly, PhD, MSN, RN
By Denene Brox
A nursing program director makes the case for formal mentorship to combat the challenges ANAs are currently facing
On a tight budget? Do your homework before you apply for a
Degrees of Success 36 Becoming a Mentee: Tips on How to Establish a Mentee-Mentor Relationship
nursing program
22 The Latest Technology in Health Care By Michele Wojciechowski Conquer your fears of the unknown and learn how the latest technology can improve quality of care
By Kelly Brittain, PhD, RN
Seeking a mentor? Learn how to set the foundation for a rewarding mentorship experience 39 Nursing Students Reaching Out Globally and Making a Difference By Denise Gasalberti, PhD, RN, and Edna Aurelus, DNP, FNP-BC, RN-BC, APRN Volunteering is the experience of a lifetime
Health Policy 40 Reversing the Rise in Maternal Death Rates: Implications for Nursing Awareness and Advocacy
2
Cover Story
By Janice M. Phillips, PhD, FAAN, RN
I mproving maternal outcomes in the United States requires a multifaceted approach
Minority Nurse | FALL 2018
29 Tales of Transitioning from the RN to NP Role By Jhaurel R.F. Johnson White, MSN, PMHNP-BC, PCCN A psychiatric-mental health nurse practitioner shares what she learned during her orientation period to help you succeed in your own transition
Editor’s Notebook:
CORPORATE HEADQUARTERS/ EDITORIAL OFFICE
Ignorance is the Enemy
I
t’s universally known that nurses tend to put their patients first when it comes to care, but what about when a liability issue arises? The stakes are high when things go wrong in the hospital, so it’s vitally important for nurses to educate themselves about their own legal rights and be prepared to advocate for what’s right when necessary. In our cover story, Jebra Turner talks with working nurses and legal experts about common issues plaguing the nursing profession—such as nurse-patient ratios, workplace violence, and scope of practice—to give you the knowledge and strength you need to protect your patients and yourself (page 10). Often, the best way to protect yourself is through education. In theory, adding another degree to your list of credentials should lead to a higher salary, but some students have learned the hard way when they don’t attend an accredited college and their job prospects aren’t what they expected. Denene Brox investigates for-profit colleges to help you decide whether it’s worth the investment in time and money (page 18). One thing that is unquestionably worth the investment? Technology. While there is always a learning curve with learning any new system, technology can (and will) save you time in the long run and help improve patient care simultaneously. Michele Wojciechowski chats with tech experts on current trends—and what’s in store for the future—to help you stay ahead of the curve (page 22). While it’s important to do your homework before starting a new position, nothing can fully prepare you for what you will actually encounter on the job. Jhaurel R.F. Johnson White describes the “hardcore truths” she learned during her recent transition into a psychiatric-mental health nurse practitioner role to help you ground your expectations and succeed in your own transitions (page 29). A nurse should always be learning, whether it’s through on-the-job training, a mentorship, or volunteering abroad. In this issue’s columns, Carol DeLilly makes her case for formal mentorship training (page 33) while Kelly Brittain offers advice for anyone considering becoming a mentee (page 36). Meanwhile, Wagner College professors Denise Gasalberti and Edna Aurelus recap their students’ lifechanging volunteer experience in Haiti (page 39) and Janice Phillips sheds light on the issue of poor maternal outcomes in the United States in an effort to rally nurses to the cause (page 40). As White says, “you get out of it what you put into it.” Imagine what nurses could accomplish collectively if they all heeded her advice. —Megan Larkin
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Minority Nurse (ISSN: 1076-7223) is published four times per year by Springer Publishing Company, LLC, New York. Articles and columns published in Minority Nurse represent the viewpoints of the authors and not necessarily those of the editorial staff. The publisher is not responsible for unsolicited manuscripts or other materials. This publication is designed to provide accurate information in regard to its subject matter. It is distributed with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice or other expert assistance is required, the services of a competent professional person should be sought. The publisher does not control and is not responsible for the content of advertising material in this publication, nor for the recruitment or employment practices of the employers placing advertisements herein. Throughout this issue we use trademarked names. Instead of using a trademark symbol with each occurrence, we state that we are using the names in an editorial fashion to the benefit of the trademark owner, with no intention of infringement of the trademark.
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Vital Signs
Adherence to Healthy Diets Associated with Lower Cancer Risk A diet that encourages both healthy eating and physical activity and discourages alcohol consumption was associated with a reduced overall cancer risk, as well as lower breast, prostate, and colorectal cancer risks, according to an analysis published in Cancer Research, a journal of the American Association for Cancer Research.
T
he study evaluated three previously validated nutritional recommendations: The WCRF/AICR score; the Alternate Healthy Eating Index; and the French Nutrition and Health Program-Guidelines Score, plus one relatively new index, the MEDI-LITE score, which measures adherence to a Mediterranean diet. Researchers found that all the diets were associated with some reduced risk, but the WCRF/AICR recommendations, developed specifi-
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cally with cancer prevention in mind, had the strongest association with reduced risk. “Among all risk factors for cancer (besides tobacco), nutrition and physical activity are modifiable lifestyle factors which can contribute to cancer risk,” says the study’s senior author, Mathilde Touvier, MSc, MPH, PhD, head of the Nutritional Epidemiology Research Team (EREN) of the French National Institute of Health and Medical Research (Inserm), University of Paris 13. “The World Cancer Research
Fund/American Institute for Cancer Research (WCRF/AICR) estimated that in developed countries, around 35% of breast cancers and 45% of colorectal cancers could be avoided by better adherence to nutritional recommendations. It is, therefore, very important to investigate the role of nutrition in cancer prevention,” adds Bernard Srour, PharmD, MPH, and PhD candidate in nutritional epidemiology at EREN-Inserm. In order to examine links between the four nutritional
indices and cancer risk, Srour, Touvier, and colleagues drew data from the NutriNet-Santé study, launched in 2009 to investigate associations between nutrition and health in a French cohort. This study included a large sample of 41,543 participants aged 40 or older, who had never been diagnosed with cancer prior to inclusion in the study. The participants completed webbased dietary records every six months, in which they detailed all foods and beverages consumed during a 24-hour period. The researchers then calculated their adherence to each of the four nutritional scores in the study. Between May 2009 and Jan 1, 2017, 1,489 cancer cases were diagnosed in the study
Vital Signs participants, including 488 breast cancers, 222 prostate cancers, and 118 colorectal cancers. The researchers used multivariable Cox proportional hazard models to characterize the associations between each nutritional score and cancer risk. The study showed that a one-point increase in the WCRF/AICR score was associated with a 12% decrease in overall cancer risk; a 14% decrease in breast cancer risk, and a 12% decrease in prostate cancer risk. Adherence to the other diets was also associated with reduced cancer risk, but the WCRF/AICR index demonstrated greater statistical strength and a better predictive performance, Srour and Touvier say. For that reason, and because the other three diets were not specifically designed for cancer prevention,
the researchers conducted further analysis on the WCRF/ AICR scores, excluding certain components to evaluate the relative importance of each one. They concluded that the “synergistic contribution” of a healthy diet was more significant than any single dietary recommendation. For example, antioxidants from fruits and vegetables may contribute to counteract some of the oxidative damage to the DNA caused by red meat and processed meat, and exercise could lower blood pressure, partly counteracting the effects of high-sodium foods. “This emphasizes the role of an overall healthy lifestyle— nutrition and physical activity and alcohol avoidance— in cancer prevention,” Srour says. “It is, therefore, important to keep in mind that every lifestyle factor counts and
it is never too late to adopt a healthy lifestyle.” Srour and Touvier say the WCRF/AICR recommendation to avoid alcohol most likely contributed to that diet’s role in reducing cancer risk. They said the findings in this study augment recent research that implicates alcohol as a risk factor in many cancers. “In its last report, the WCRF stated that there is now strong, convincing evidence that alcohol consumption increases the risks of oropharyngeal, esophagus, liver, colorectal, and post-menopausal breast cancers,” Touvier says, adding that there are also apparent links to stomach and premenopausal breast cancers. The authors say the study’s main limitation is that, as a volunteer-based study, it may have overrepresented wom-
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en, people with health-conscious behaviors, and those with higher socioeconomic and educational levels. As a result, some unhealthy behaviors may have been underrepresented, and the associations between healthy diets and cancer prevention may be stronger than indicated. Because previous research has shown that the French consume more fruits and vegetables and fewer sugary beverages and processed foods than the American population, the authors say adhering to the WCRF/AICR recommendations would likely yield more dramatic results in an American population.
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Vital Signs
Suicide Rates Rising Across the United States Suicide rates have been rising in nearly every state, according to the latest Vital Signs report by the Centers for Disease Control and Prevention (CDC). In 2016, nearly 45,000 Americans age 10 or older died by suicide. Suicide is the 10th leading cause of death and is one of just three leading causes that are on the rise.
S
uicide is rarely caused by a single factor. Although suicide prevention efforts largely focus on identifying and providing treatment for people with mental health conditions, there are many additional opportunities for prevention. “Suicide is a leading cause of death for Americans—and it’s a tragedy for families and communities across the country,” says CDC Principal Deputy Director Anne Schuchat, MD. “From individuals and communities to employers and health care professionals, everyone can play a role in efforts to help save lives and reverse this troubling rise in suicide.”
Many Factors Contribute to Suicide For this Vital Signs report, CDC researchers examined state-level trends in suicide rates from 1999-2016. In addition, they used 2015 data from CDC’s National Violent Death Reporting System, which covered 27 states, to look at the circumstances of suicide among people with and without known mental health conditions. Researchers found that more than half of people who died by suicide did not have a known diagnosed mental health condition at the time of death. Relationship prob-
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lems or loss, substance misuse; physical health problems; and job, money, legal, or housing stress often contributed to risk for suicide. Firearms were the most common method of suicide used by those with and without a known diagnosed mental health condition.
State Suicide Rates Vary Widely The most recent overall suicide rates (2014-2016) varied four-fold; from 6.9 per 100,000 residents per year in Washing-
ton, D.C. to 29.2 per 100,000 residents in Montana. Across the study period, rates increased in nearly all states. Percentage increases in suicide rates ranged from just under 6% in Delaware to over 57% in North Dakota. Twenty-five states had suicide rate increases of more than 30%.
Wide Range of Prevention Activities Needed The report recommends that states take a comprehensive public health approach to suicide prevention and address the range of factors contributing to suicide. This requires coordination and cooperation from every sector of society: government, public health, health care, employers, education, media, and community organizations. To help states with this important work, in 2017 CDC released a technical package
on suicide prevention that describes strategies and approaches based on the best available evidence. This can help inform states and communities as they make decisions about prevention activities and priorities. Everyone can help prevent suicide: • Learn the warning signs of suicide to identify and appropriately respond to people at risk. Find out how this can save a life by visiting: www.BeThe1to.com • Reduce access to lethal means—such as medications and firearms—among people at risk of suicide. • Contact the National Suicide Prevention Lifeline for help: 1-800-273-TALK (8255). https://suicidepreventionlife line.org For more information, visit www.cdc.gov.
Vital Signs
Protein Affected by Rare Parkinson’s Mutation May Lurk Behind Many Cases of the Disease
Mutations in the gene LRRK2 have been linked to about 3% of Parkinson’s disease cases. Researchers have now found evidence that the activity of LRRK2 protein might be affected in many more patients with Parkinson’s disease, even when the LRRK2 gene itself is not mutated. The study was published in Science Translational Medicine and was supported in part by the National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health (NIH).
“T
his is a striking finding that shows how normal LRRK2 may contribute to the development of Parkinson’s disease,” says Beth-Anne Sieber, PhD, program director at NINDS. “This study also identifies LRRK2 as an integral protein in the neurobiological pathways affected by the disease.” More than 10 years ago, researchers linked mutations in the LRRK2 gene with an increased risk for developing Parkinson’s disease. Those mutations produce a version of LRRK2 protein that behaves abnormally and is much more active than it would be normally. Despite its importance in Parkinson’s disease, the very
small amount of normal LRRK2 protein in nerve cells has made it difficult to study. In the current study, the authors developed a new method for observing LRRK2 cells that makes them glow fluorescently only when LRRK2 is in its activated state. They have also used detection of fluorescent signals to demonstrate loss of binding of an inhibitor protein to LRRK2 when LRRK2 is activated. The researchers looked first at postmortem brain tissue from Parkinson’s disease patients who did not have mutations in LRRK2. Compared to healthy individuals of similar ages, there was a striking increase in LRRK2 activity in the dopamine-containing neurons
of the substantia nigra, the area of the brain most affected in Parkinson’s disease. This suggested that increased LRRK2 activity could be a common feature of the disease. “This finding provided strong evidence that something is causing LRRK2 activity to increase in Parkinson’s disease patients, specifically in the area of the brain we would expect based on what we know of the disease,” says J. Timothy Greenamyre, MD, PhD, Love Family Professor of Neurology in the University of Pittsburgh’s School of Medicine, director of the Pittsburgh Institute for Neurodegenerative Diseases (PIND), and senior author of this study. To get a closer look at how LRRK2 activity is related to Parkinson’s disease, the researchers next turned to rodent models of the disorder. The sensitivity of their new technique allowed for the direct study of LRRK2 activity, which until now could not be done. “Much of what we have known previously about LRRK2 comes from overexpression studies, where cells are forced to make much more of the protein than they would normally,” says Greenamyre. “Our fluorescent assay reveals where LRRK2 is active in the brain and the relative level of activity without potential side effects from overexpression.” By injecting rodents with the environmental toxin rotenone and studying the effect on LRRK2, the researchers linked increased LRRK2 activity with the accumulation of alpha-synuclein, a process that leads to the formation of Lewy
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bodies in the brain, a hallmark of Parkinson’s disease. In another model of the disease, where synuclein was present in much higher amounts than normal, LRRK2 activity was increased. In contrast, when the animals were treated with a drug that blocks LRRK2 activity, the accumulation of alpha-synuclein and Lewy body formation were both prevented. Finally, additional links were found between LRRK2 activity and the potentially damaging consequences of Parkinson’s disease. Reactive oxygen species (ROS) are compounds that can interact and affect other components within cells, and ROS were increased in the brains of both rodent models. ROS were seen to increase the activity of LRRK2, and when ROS production was blocked, LRRK2 activation was not observed. “Our findings suggest that both genetic and environmental causes of Parkinson’s disease can be tied back to the activity of LRRK2 protein,” says Greenamyre. “This is important, because it suggests that the drugs being developed for patients with the LRRK2 mutation, which represent a very small percentage of the affected population, could benefit a much greater number of people with the disease.” Greenamyre and his research team plan to further study whether the neurodegeneration that occurs due to LRRK2 overactivity can be prevented and to identify the mechanisms that connect environmental stressors to LRRK2 activation.
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Making Rounds
October
February/March
May/June
4–6
February 27–March 1
May 29–June 1
33rd Annual Convention Rosen Centre Hotel Orlando, Florida Info: 800-454-4362 E-mail: info@snrs.org Website: www.snrs.org
2019 Spring Advanced Practice Neonatal Nurses Conference Hyatt Regency Indian Wells Greater Palm Springs, California Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org
The American Assembly for Men in Nursing 2018 Annual Conference Hyatt Regency Milwaukee Milwaukee, Wisconsin Info: 859-977-7453 E-mail: info@aamn.org Website: www.aamn.org
17–20
Transcultural Nursing Society 44th Annual Conference Embassy Suites on the Riverwalk San Antonio, Texas Info: 888-432-5470 E-mail: staff@tcns.org Website: www.tcns.org
24–27
American Psychiatric Nurses Association 32nd Annual Conference Greater Columbus Convention Center Columbus, Ohio Info: 855-863-2762 E-mail: inform@apna.org Website: www.apna.org
November
Southern Nursing Research Society
February 27–March 2
Dermatology Nurses’ Association 37th Annual Convention Marriott Wardman Park Washington, District of Columbia Info: 800-454-4362 E-mail: dna@dnanurse.org Website: www.dnanurse.org
March 6–9
National Association of Clinical Nurse Specialists 2019 Annual Conference Renaissance Orlando Orlando, Florida Info: 215-320-3881 E-mail: info@nacns.org Website: http://nacns.org
1–3
April
Annual Conference on Transforming Health, Driving Policy Marriott Marquis Washington, District of Columbia Info: 202-777-1170 E-mail: info@AANnet.org Website: www.aannet.org
3–7
American Academy of Nursing
9–11
Organization for Associate Degree Nursing 2018 National Convention Loews Philadelphia Hotel Philadelphia, Pennsylvania Info: 877-966-6236 E-mail: oadn@oadn.org Website: www.oadn.org
National Student Nurses’ Association 67th Annual Convention Salt Palace Convention Center Salt Lake City, Utah Info: 718-210-0705 E-mail: nsna@nsna.org Website: www.nsna.org
11–13
American Nursing Informatics Association
Academy of Neonatal Nursing
June 6–12
Association of Women’s Health, Obstetric and Neonatal Nurses 2019 Annual Convention Georgia World Congress Center Atlanta, Georgia Info: 800-673-8499 E-mail: customerservice@awhonn.org Website: www.awhonn.org
18–23
American Association of Nurse Practitioners 2019 National Conference Indiana Convention Center Indianapolis, Indiana Info: 512-442-4262 E-mail: conference@aanp.org Website: www.aanp.org
July 24–28
Philippine Nurses Association of America 2019 Annual Convention Atlanta Marriott Marquis Atlanta, Georgia E-mail: infomypnaa@gmail.com Website: www.mypnaa.org
2019 Annual Conference Rio All Suite Hotel Las Vegas, Nevada Info: 866-552-6404 E-mail: ania@ajj.com Website: www.ania.org
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Nurse Legal Rights in the Workplace BY JEBRA TURNER Most registered nurses are familiar with the rights of patients under their care and work hard to alleviate suffering and maintain respect for human dignity. They advocate on behalf of patients, their families, the community, and society as a whole. But many nurses do not know their own legal rights and responsibilities as health care professionals.
N
urses with knowledge of whistle-blower laws, for instance, may be more likely to press administrators to end patient-care abuses or fiscal fraud. Standing up for what’s right is tough in any case, but especially for women and minorities, who make up a majority of the profession. Yet, minority nurses have historically demonstrated hero-
ic activism for community health and social justice, during the civil rights era and the AIDS epidemic, for instance. Nurses face the same legal issues as many other employees, such as sexual harassment in the workplace. But they also must protect against careerspecific liabilities, such as being accused of violating the nurse practice act or similar regulations.
“There are three major concerns for nurses,” according to Gerard Brogan, RN, lead nursing practice representative at California Nurses Association and National Nurses United. “I travel and talk to nurses across the country and union or not, I hear the same things. The first concern is nurse-topatient ratio, two is violence in workplace, and three is scope of practice.”
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This article, then, will focus on legal issues that are unique to nurses.
Nurse-Patient Ratios Nurses across the country have expressed overwhelming concerns regarding these roadblocks to patient care and safety: short staffing on overcrowded units, limited ability to take even short breaks due to scheduling gaps, floating
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nurses without the proper training for certain departments, and so on. According to Brogan, California is the only state in the country that has nurse-to-patient ratios. “Massachusetts and Arizona have them for the ICU only,” he says. “Nurses are working in understaffed hospitals, which are dangerous for patients and everyone else. We now have two nurse-to-patient bills in Washington. One is a house bill and one is a senate bill. They would require every hospital to adhere to ratios similar to the California bill.”
include how hospital plans are created and implemented allowing direct-care nurses to play a role. “The Oregon Hospital Nurse Staffing Law gives power to the hospital staffing committee,” says David Baca, BSN, RN, an emergency room nurse at Asante Rogue Regional Medical Center in Medford, Oregon. The law is also a legal measure regarding rest-breaks and specialized staffing on specific units and departments. “The phrase ‘A nurse is a nurse is a nurse is a nurse’ is common, but that kind of thought pro-
Brogan says that he often sees on social media the phrase “nurses should not be political.” But he believes that’s a naïve and possibly dangerous position.
Brittney Wilson, BSN, RN
Brogan says that he often sees on social media the phrase “nurses should not be political.” But he believes that’s a naïve and possibly dangerous position. “Health care employers are heavily involved in politics, so as an organization and profession we have to also be involved in politics ourselves.” Other aspects of staffing
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cess needs to go away as it becomes clear that appropriate education and training are needed,” says Baca. The nurses at his hospital also recently won a new contractual right: break-relief nurses on units, when necessary, to allow nurses to schedule earned breaks and meals. Baca estimates that only 3040% of nurses at his hospital know about the new staffing laws. “A little more education is needed,” including the hospital and individual nurse’s unit. “Standards and practices in the ER should be something we’re aware of. If not, we should be asking: ‘What does the ENA say about staffing and nurse patient ratios?’”
Workplace Violence “When it comes to workplace violence, nurses have been in the top five forever,” says Baca. According to an
David Baca, BSN, RN
U.S. Bureau of Labor Statistics analysis, 52% of all incidents of workplace violence in 2014 involved workers in the health care and social service industry. “The ER is open to everybody. We serve everyone, including the intoxicated or those with mental issues, so nurses are assaulted. It happens on almost a daily basis.” “A few years ago, we had a huge problem with psychiatric crisis patients. We couldn’t secure them in appropriate rooms for their own safety and ours. They’d either elope or assault. That’s a huge risk, so the hospital invested a million dollars into ER security for the safety of everybody,” says Baca. “Most assaults in the ER go
almost no legal ramifications for patients who assault. We need to change the workplace culture that accepts violence.” In 2014, California enacted a trailblazing law to reduce workplace violence incidents in health care facilities. “Every hospital has to develop
“Most assaults in the ER go unreported. If you regularly see colleagues assaulted, it becomes the norm,” warns Baca. unreported. If you regularly see colleagues assaulted, it becomes the norm,” warns Baca. “Maybe we need to prosecute more patients who assault nurses, medics on ambulances, or technicians. There’s a very low prosecution rate and
a comprehensive workplace violence program to protect the safety of patients and employees,” Brogan explains. “We’re not just interested in working on the welfare of nurses in California or nurses in the union. Our efforts are
for nurses across the nation.” Then there’s the more common, less intense form of violence: bullying… Brittney Wilson, BSN, RN, a social media influencer also known as The Nerdy Nurse, started blogging as a response to the stress of nurse-on-nurse bullying as a newly graduated floor nurse. “What I learned from my experience with lateral violence is that in a right-towork state it is very difficult to make a stand for yourself,” Wilson explains. “I did learn that in order to build a strong case for yourself you should keep notes including dates/ times/names of incidences. You should also report incidences as soon as they occur. But if your hospital does not have a union, it is pretty
much your word against another employee.” In Wilson’s case, the nurses who witnessed the bullying weren’t her allies, and neither was management. “My employer didn’t support me and believe me enough to address the work environment, pursuing the issue just made things more difficult for me and lead to me being forced to take a different position and a pay cut until I ultimately left the organization,” she adds. Though nurses have a right to be treated with dignity, respect, and civility, they sometimes must fight just for an environment that isn’t downright hostile. Wilson advises nurses in that situation to “find new employment and an organization that will support and value them. We are
living in an economy where there are more jobs than there are nurses. If you aren’t being treated respectfully, you owe it to yourself to remove yourself from a damaging situation.” That’s just what Wilson did, parlaying her newly accrued digital skills into a well-paying and satisfying career in nurse informatics and technology product development. It goes without saying, but nurses must themselves also avoid those types of uncivil, hostile, bullying, or intimidating behaviors that show disrespect for patients or colleagues. Otherwise, they put themselves at risk of censure for trampling the rights of others.
Scope of Practice “There are fifty states and 50
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different nurse practice acts,” says Brogan. “Hospitals don’t really educate employees on the legal scope of practice. I’ve
Gerard Brogan, RN
been educating nurses for 20 years and find that hospitals see nurses as a unit of labor, not as a professional.” In today’s fiscally-focused
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Jeffrey Edelson, JD
health care landscape, there is always a concern that the scope of professional nursing practice is at risk from understaffing, de-skilling, and other encroachment, warns Brogan.
sionals with independent judgment,” he says. “If they are given too many patients to care for, as is often the case in non-unionized hospitals, they have to take them or they can be fired.”
Though nurses have a right to be treated with dignity, respect, and civility, they sometimes must fight just for an environment that isn’t downright hostile.
“The hospital industry is trying to expand the scope of nurse’s aides and medical assistants. Nurses are profes-
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All nurses need to remain current, competent, and within their scope of practice, or risk losing their license—and
their career. Protect yourself by taking continuing education courses in nursing (online or in-class) or enrolling in an advanced degree program. If further formal education is problematic, you can learn informally through a professional nursing association, either for your particular minority group or one in your specific area of practice. Rachel Seidelman, RN, a direct care nurse at Providence Health & Services in Portland, Oregon, has been a nurse for eight years and continually updates her understanding of
the law. She knows her state nurse practice act rules and reviews them regularly to ensure she protects her practice and her license. “The biggest thing that’s helped guide me comes through my union; there’s a branch for practice. I know state and federal law and the overlap. I make sure I know who I can delegate to, because it’s all on me if a colleague messes up under my umbrella.” “How I was precepted really helped me as a young nurse without much work experience,” Seidelman says. “Part of the onboarding process is to ensure they understand the wage scale, the contract and their rights within it, and a lot of other things, too. I’m a preceptor now and will never stop because I learn so much from doing it.” One example of how Seidelman expands her knowledge of issues related to nursing practice concerns the opioid epidemic. After reading a series about it in the state’s major newspaper, she wondered what her response should be as an off-duty nurse encountering a stranger overdosing. Should she carry the opioid antidote naloxone as a precaution? “That question led
me to the Oregon Nurses Association, my employer, and discussions with pharmacists and mentors.” She couldn’t obtain the antidote without a prescription, but new laws enacted in 47 states make it more freely available. The surgeon general recently urged opioid users, concerned family members, and professionals to keep it on hand. “In this day and age, it’s important to protect our own license and also protect our patients and colleagues. I advise fellow nurses to ask good questions, be curious, find answers, and then tell others,” says Seidelman.
Advocating for Your Patients, Community, and Profession Nurses have long participated in the political process and sought to shape health care legislation that supports nurses as well as benefiting patients and communities. Martese Chism, RN, a Chicago nurse, is inspired by the
Martese Chism, RN
example of her great-grandmother, Birdia Keglar, a civil rights activist in the 1960s. “She marched in Selma with Rev. Martin Luther King Jr. and lost her life because of it.
Dr. King, in his speech, said he would like to have a long life, but that wish didn’t stop him from protesting,” she says. Chism explains that her first college degree was in ac-
I’ve been speaking out in public for a long time and I could never get a promotion. If it wasn’t for the support of my patients, and union, I wouldn’t have lasted this
All nurses need to remain current, competent, and within their scope of practice, or risk losing their license—and their career.
counting, but she discovered “my calling is advocating for patients,” so she went back to school to become a nurse. “We’re supposed to advocate for our patients… I believe my fiduciary duty is to my patients, not the hospital. I advocate for my patients, but in the back of my mind, I worried about job security. I was single and didn’t have a family to support, but if I had, I wouldn’t have been so vocal without my union,” she explains. One matter that Chism has spoken out about is the closure of public hospitals and other health care facilities in minority communities. “When elderly patients with no insurance need skilled nursing care our hands are tied [because of the closures] so now our uninsured patients have nowhere to go,” she says. Some of Chism’s patients were retired public employees who aren’t eligible for Medicaid or Medicare. “They’re now turning 70 or 80 and they have no insurance. That’s why I’m fighting for Medicare for all,” she says. “As nurses, we’re supposed to advocate for our patients, but I don’t feel like I can without union protection. If I do, I’m branded a troublemaker.
long on the job.” According to The Code of Ethics for Nurses (2001), nurses do have the right to advocate for themselves and their patients, and to do so without fear of retribution. Each state’s nurse practice act varies, but Chism was outraged when Illinois tried to remove “advocacy” from its nurse act. “They tried to say that your duty is to your employer, but our union fought to stop that. We don’t know about the future, though, especially with the recent [Supreme Court] Janus decision. The union movement might be weakened even more.”
land, Oregon. “They’re often divided by union and nonunion. The tradeoff with collective bargaining is that an agreement could be in conflict with state law.” If facing disciplinary action with the nurse licensing board, you may require an attorney who specializes in licensure protection. Or your case may call for an attorney with experience in an entirely different area of practice. “For example, in the case of the Utah nurse [Alex Wubbels refused to draw blood from an unconscious patient], you’d need a criminal lawyer,” he explains. Or, if you work at a state hospital
Finding an Attorney to Explain Your Rights or Represent You
Rachel Seidelman, RN
Even though you do your best to learn the laws related to nursing, you can’t always avert legal trouble. There may be a claim of professional negligence, say, and then you’d need to retain a qualified attorney in your area to defend you. “Generally, look for an employment lawyer, they will understand the federal and local laws on wages, overtime, discrimination,” says Jeffrey M. Edelson, JD, attorney at Markowitz Herbold in Port-
and are fired for expressing an opinion or acting on a matter of conscious, “you may need a constitutional lawyer in that you may have additional first amendment rights, versus if you’d worked at a private clinic,” Edelson adds. A common way to find an employment lawyer is to checking profiles in listings such as “Best Lawyers in American,” he suggests. Or use your personal network of nurse colleagues, friends, or family to find an attorney. “Call your
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In today’s fiscally-focused health care landscape, there is always a concern that the scope of professional nursing practice is at risk from understaffing, de-skilling, and other encroachment, warns Brogan. family lawyer, the one who does wills, and ask ‘do you know an employment lawyer?’” You’ll likely be referred to an appropriate attorney. Plus, “you’ll get that lawyer’s
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ear because you’ve been referred,” says Edelson, and they’ll each want to protect their professional relationship. Ask about their experience with your type of legal trou-
ble or concern. Then inquire about fee structure. Some will charge for an initial consultation, while others won’t, and most work on a retainer basis, though some will take a case on a contingency basis. Other resources for finding local attorneys: your professional nursing organization or union, the American Association of Nurse Attorneys (TAANA), and the State Bar Association.
In addition, you may want to purchase malpractice insurance (including license defense coverage) in advance of any need. Some professional nursing associations even offer a discounted rate, making it a prudent and affordable option. Jebra Turner is a freelance health writer living in Portland, Oregon.
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Are For-Profit Nursing Schools a Good Choice?
BY DENENE BROX
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Students across the country say they have been shamed by for-profit colleges promising a great education and career prospects. Here’s what nursing students should know before enrolling in any degree program to ensure it is a wise investment.
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magine spending years in nursing school only to learn that a degree from the college you’re attending won’t actually qualify you for the nursing job of your dreams. Unfortunately, this can be a devastating reality for many students across the United States who attend forprofit colleges. For-profit colleges have received a lot of negative headlines in recent years. There have been several cases of forprofit colleges shutting down without notice to enrolled students—leaving them without options for continuing their education. Others have faced lawsuits by students claiming they were shamed and their degrees are worthless in the job market. Many for-profit college programs advertise flexible class schedules, accelerated learning, and high job placement. However, with so much controversy surrounding these colleges, it’s smart to thoroughly investigate if the college you are considering will provide you with the education and job prospects you seek. A growing number of nursing students have found out the hard way the true cost of some for-profit colleges. They are left with massive student loan debt
and useless degrees that won’t get them a job. And to make matters worse, traditional colleges and universities won’t accept their transfer credits. A November 2017 study
more flexible education programs and want to enter into a certain field or industry such as nursing. But some college advisors steer students away from such colleges.
Also, look for nursing school programs that are regionally accredited (e.g., accredited by a state board of nursing), as this is an indication that other colleges/universities are more likely to accept transfer credits. published by The Century Foundation found that forprofit college students accounted for a staggering 99% of applications for student “loan relief from students who maintain that they have been defrauded or misled by federally approved colleges and universities.” Like many students, you may be enticed by what some for-profit colleges offer in terms of flexible class schedules, online learning options, accelerated degree programs, and less competitive admissions requirements. Public colleges and universities are more competitive, and a forprofit program can seem like an easier path. For-profit colleges are known for targeting nontraditional students who desire
“Our general advice about for-profit colleges is to avoid them if at all possible,” says Evelyn Alexander, founder/ owner of Magellan College Counseling, an independent service that helps students with the college admissions process. The first step to a successful nursing career is to do your research for any degree program you are considering prior to enrolling. It’s smart to do due diligence to ensure you are making a wise investment of time and money in your education. Here are some tips to help you determine if the college you’re considering is a good choice for a successful nursing career.
Know the Status You should always know up-
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front the status of the college you’re considering. Colleges and universities can be state, nonprofit, or for-profit. This is the first thing to know when deciding on a nursing program. “I started poking around several college websites, and it’s very difficult to determine if a college is for-profit, because they generally don’t announce it,” Alexander says. “I think the best way to deal with this is to ask, upfront, immediately, if the college is nonprofit. Just come out and ask, and if it is not nonprofit, see if there are other options available to you.” Alexander notes that a private college can be either forprofit or nonprofit, while public colleges/universities are publicly owned and always nonprofit. Alexander almost exclusively guides her clients toward nonprofit colleges and universities.
Seek Out Accredited Programs One of the major problems that many for-profit students encounter is that their college program doesn’t have the industry-recognized accreditation that employers want. Many students find this out only after they have spent time and money on a degree and begin job hunting. While most for-profit col-
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grams with the proper accreditation will likely have a more competitive admissions process—and that’s a good thing.
Reputation Matters
leges do have accreditations, they may not be the specific accreditations employers look for in nursing job candidates.
programs that don’t meet these criteria. You can also contact other nonprofit/state colleges/uni-
If the admissions reps are using pressure tactics or making big promises about job prospects, beware.
In addition, without the right accreditations, your credits won’t transfer to another school. For nursing programs, look specifically for schools with Accreditation Commission for Education in Nursing (ACEN) accreditation. Also, look for nursing school programs that are regionally accredited (e.g., accredited by a state board of nursing), as this is an indication that other colleges/universities are more likely to accept transfer credits. Beware of nursing
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versities in your area and ask if they accept transfer credits from the college in question. You want to keep your options open for transferring to another college in case it is necessary. So, it’s best to know from the start if your credits will transfer.
admissions and financial aid guidance. If the admissions reps are using pressure tactics or making big promises about job prospects, beware. Admissions reps should be enthusiastic about what their school has to offer, but they shouldn’t be like a pushy car salesman. For-profit colleges usually have an easier admissions process than nonprofit/state colleges and often do not require test scores such as the SAT/ ACT, a certain GPA, or the like. This makes enrollment easy;
Do graduates of the nursing program you’re considering actually get nursing jobs in your area? An easy way to start researching actual job placement success for a college is to utilize online resources such as LinkedIn to search for graduates of the program you’re considering and take note of their job history. Are graduates working for reputable health care organizations in your area? Or do they have non-nursing jobs? While this is anecdotal research, it’s a good way to get an idea of job prospects. While you’re online, do a Google search for the school and read student reviews and ratings. Are there a lot of complaints or low ratings? Your online search may also bring up news articles that mention the college, which could p rovide information about pending lawsuits filed by previous students. You don’t want to enroll in a college in legal or financial jeopardy. If there are no red flags from your online research, pick up the phone and call large employers, such as hospitals and clinics in your area, to speak with an HR representative to see if they consider graduates
Don’t Fall for Pressure Tactics
However, nursing programs with the proper accreditation will likely have a more competitive admissions process—and that’s a good thing.
One common complaint about for-profit colleges is that admissions staff pressure potential students into enrolling or don’t offer sound
especially for nontraditional students or those working fulltime. However, nursing pro-
from the college for job openings. Or attend a local job fair and make a point to speak
directly with health care recruiters to ask if they regularly recruit or hire graduates from the college you’re considering. Don’t just take the college ad-
“They may run into a problem ensuring that all of their credits transfer to another institution; but I would say it’s probably better to get out in
An easy way to start researching actual job placement success for a college is to utilize online resources such as LinkedIn to search for graduates of the program you’re considering and take note of their job history. missions advisor’s word that employers hire their graduates.
Already Enrolled in a ForProfit Nursing Program? What if you are already enrolled in a for-profit program? If you’ve already started a program it’s not too late to check on the school’s accreditation and reputation among employers. You may discover that your school meets the industry-recognized criteria for nursing education such as ACEN and has solid regional accreditations. If you do find some red flags with your current college, first assess what exactly is causing you alarm. For instance, is the only red flag some negative student reviews online? That in itself should not be cause for much concern. However, if you find your college isn’t ACEN and regionally accredited or there are rumors about the school closing or facing legal action, you should reconsider what your realistic job prospects are going to be if you continue with the program. Alexander says if one of her clients was enrolled in a forprofit institution she would likely advise them to start looking for another program.
the middle than to wait until they finish, when they may hit a barrier in finding a job.”
Choose Wisely Choosing a good nursing
school is vitally important to your nursing career. All students should be knowledgeable about industry education standards and not rely on admissions representatives who have enrollment quotas to meet and don’t always have your best interest at heart. And if a program sounds too good to be true, it may lead to major disappointment down the line. “What seems like a good idea for certain reasons may be overshadowed by much larger drawbacks,” Alexander warns. “This is why we advise against for-profits. It’s not really a good investment if your degree doesn’t get you
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a job or if you end up owing money on student loans, you haven’t finished your degree, and the next school you attend doesn’t recognize your credits.” Denene Brox is a freelance writer based in Kansas City, Kansas.
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THE LATEST TECHNOLOGY IN HEALTH CARE BY MICHELE WOJCIECHOWSKI
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Technology in health care is always changing and improving—this means faster, more accurate, and safer ways to do your job. Here’s the scoop on the latest and what’s coming in the not-too-distant future. www.minoritynurse.com
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T
echnology has been making our lives easier throughout history. While some people are concerned that more efficient technology prevents nurses from spending time with patients, experts say that this couldn’t be further from the truth. “There is a fear that technology takes nurses away from the patient to spend time at the
Get Ready, ‘Cause Here it Comes Remember when you were a kid and you wondered if eventually robots would take over the world? That’s not happening exactly, but robots are being implemented in health care. And don’t worry; your job is safe. Both large and small technologies are revolutionizing the nursing practice in
take patient vital signs, deliver food to patient rooms, or transport linens throughout the hospital,” says Grossman. Robots, though, are just a small part of what is going on technologically in health care. Grossman says that mobile technologies, used by themselves or with other technologies, can reduce clinical errors, improve quality and safety, and reduce the physical burden of care for bedside nurses. “Hand-held devices like iPhones with different apps can be used for accessing and charting patient information at the point of care; linking barcoded drugs, treatments, and patients accurately; communicating between patients and nurses across different rooms or areas; remotely detecting motion in bed of patients at risk for falls; and obtaining diagnostic test results at the bedside are a few examples,” explains Grossman. “The tasks of lifting, positioning, and moving patients— which historically have caused frequent back strain and phys-
“There is a fear that technology takes nurses away from the patient to spend time at the computer. As interface capabilities increase, more time can be spent with the patient,” argues Nikkia Whitaker, MSN, RN, CCRN, clinical technology integration manager at Dayton Children’s Hospital. computer. As interface capabilities increase, more time can be spent with the patient,” argues Nikkia Whitaker, MSN, RN, CCRN, clinical technology integration manager at Dayton Children’s Hospital. “Having systems work together to decrease multiple workflows and eliminate manual processes is what will help nurses appreciate the emergence of technology.”
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so many ways, says Divina Grossman, PhD, RN, FAAN, president and chief academic officer at University of St. Augustine for Health Sciences. “One example is the deployment of robots, such as those that deliver patient medications from the pharmacy to hospital units, automate the preparation of chemotherapy and other drug admixtures,
ical injuries for nurses—can now be done using smart technology systems and can even be operated remotely.” Cathy Turner, BSN, MBA, RN-BC, associate vice president of MEDITECH, agrees that the use of smartphones is part of an ongoing trend to help support nurses in their delivery of care. “Nurses do many different things during
a shift of care, and they interact with patients in different ways. Sometimes a device such as a Workstation on Wheels is the appropriate vehicle for the workflow, but there may be times where something smaller may be less intrusive,” Turner explains. “Smartphone devices are able to deliver that flexibility. The smaller devices may be something nurses are already using for calls, secure texting, etc. Why not be able to do a quick medication administration using scanning and documentation tools fully integrated into the Electronic Health Record [EHR]? The other advantage to this type of device is that it is similar to a patient’s use of their portal from an app on their phone. This provides a nice opportunity to share what they are doing on their device on behalf of the patient and provides a teachable moment for the patient using the portal.” But there are even more types of technology that can directly help nurses who are working with patients. “Wearable technology, telephone monitoring, and nanotechnology further expand the ability to monitor patients’ physiologic parameters—not just episodically as snapshots, but continuously for diagnostic, therapeutic, and clinical evaluation purposes,” says Grossman. For example, “with a noncompliant patient, a sensor can detect whether and when a patient took their medication and have the information transmitted electronically to a nurse through an app on a mobile device. Medication dosages can be adjusted commensurate with serum levels throughout the day; these can also be correlated
with levels of blood pressure, heart rate, oxygen saturation, stress or anxiety measured by the same wearable devices, or sensors.”
EHR, an Oldie, but a Goodie While EHRs aren’t exactly from the stone age, they are the most familiar and most widely used technologies in health care today. But they have also come a long way. “[EHRs] and Point of Care documentation devices are probably among the most adopted technologies,” says Majd Alwan, PhD, senior vice president of technology at LeadingAge, as well as the executive director of the LeadingAge Center for Aging Services Technologies. “What is new: over the past couple of years, many of these tech-
nologies have undergone significant improvement through successive upgrades. They are now much more user-friendly, touch- and even voiceenabled, mobile friendly (to provide access through tablets and smart phones), and have better clinical decision support system, information exchange, and analytics capabilities.”
team. While this entails a lot of responsibility, there is also a lot of flexibility and freedom that comes from using an integrated EHR solution. An effective EHR gives nurses more meaningful time back with their patients, and results in less time on documentation,” says Turner. “While there is perception that EHRs are too
and the quality of care that the nurse can provide.” Turner also says that nurses no longer just enter information and observations into their patients’ EHRs. In fact, EHRs actually give back to the nursing field. “[EHRs are] providing actionable data, clinical decision support, and surveillance tools that allow
“Wearable technology, telephone monitoring, and nanotechnology further expand the ability to monitor patients’ physiologic parameters—not just episodically as snapshots, but continuously for diagnostic, therapeutic, and clinical evaluation purposes,” says Grossman. “Nurses typically spend more time with patients and contribute more information to the patient record than any other member on the care
complex and impede the patient/provider relationship, an EHR designed to support nursing workflows improves both the patient experience
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nurses to proactively meet the needs of their patients,” says Turner. In addition, says Turner, EHRs can suggest problems to be ad-
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dressed as well as the actions that can then be taken. “They can ensure that patient safety protocols are in place, allowing the nurse to focus on more of their time and energy on the patient,” she says. “Surveillance tools monitor EHR data and identify patients at risk. Nurs-
es spend a great deal of time documenting the care a patient receives. The surveillance tools analyze that documentation along with lab results and other data, and push notifications and actionable items to the nurses, giving them that time back.”
These surveillance tools are also able to monitor many patients through watchlists and let nurses know who needs immediate attention. “Watchlists can be built around fall risk, sepsis, CLABSI, VTE, or other potential risks that may affect a patient’s health. These lists
“Nurses typically spend more time with patients and contribute more information to the patient record than any other member on the care team. While this entails a lot of responsibility, there is also a lot of flexibility and freedom that comes from using an integrated EHR solution. An effective EHR gives nurses more meaningful time back with their patients, and results in less time on documentation,” says Turner.
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give back to nurses, saving them time and giving them the most up-to-date information needed to effectively treat their patients,” says Turner. “I remember reading a heartbreaking story of a parent who lost their child to sepsis. The words that stuck with me: the parent implored that clinicians ask: ‘What if it’s sepsis?’ Surveillance will ask. And direct, appropriate care actions can be taken.”
Learning Via Simulation While nursing students will always work directly with actual patients before they grad-
uate, the use of simulations beforehand enables them to practice different procedures safely and to learn about rare procedures or cases that they
physical features. Through computer-based scenarios, simulated patients can become hypotensive, tachycardic, or hypoxemic, and nursing stu-
Emerging Technology An even more advanced type of simulation is coming—virtual reality—and both student nurses and ex-
“Watchlists can be built around fall risk, sepsis, CLABSI, VTE, or other potential risks that may affect a patient’s health. These lists give back to nurses, saving them time and giving them the most up-to-date information needed to effectively treat their patients,” says Turner. may not often see. “Students are able to learn in a safe environment and can pace their learning activities; not all students learn the same way,” says Nadia Sultana, DNP, MBA, RN-BC, clinical assistant professor and nursing informatics program director at NYU Rory Meyers College of Nursing. “Simulation centers have been planned to include technology that is similar to the work environment.” Grossman gives an example of how simulation can help nurses learn without an increased risk for patients. “Nurse practitioner students can learn complex skills such as suturing or draining wounds, placing central lines, or inserting of chest tubes before they perform these procedures on live patients in real health care environments. Faculty also have the ability to create dynamic computerbased simulation scenarios to enable nursing students to learn how to adapt their clinical treatment decisions to fluctuations in the patient’s condition,” she says. “With simulation, the ‘patient’ can be of any age and racial background since human patient simulators can be infants, children, or adults and come in different skin tones and
dents can learn how to tailor or adapt clinical treatment decision accordingly.” Students can also be acquainted with rare conditions via simulation. “They can learn how to assess those patients using simulators. For example, a student may not be able to encounter a live patient with Tetralogy of Fallot in the clinic during the semester, but he or she can auscultate, palpate, and assess the relevant findings using the Harvey cardiology simulator. This simulator can mimic 50 different cardiac conditions and also simulate any cardiac disease in a realistic way,” Grossman explains. “The ability to learn interprofessional practice and teamwork using simulated case scenarios like a post-disaster situation or an acute stroke patient in the ER with teams of students from multiple programs—nursing, medicine, PA, et cetera—is also possible with simulation. Thus, nursing and other health care students can learn how to communicate with each other and collaborate in the care management of an individual patient or groups of patients through simulation before they are assigned to care for live patients.”
perienced ones are going to be stunned with how realistic it will be. “Virtual reality or augmented reality simulation…depart from the conventional treatment simulation with threedimensional image data and computer software. Implementation of virtual simulation requires the ability to trans-
teract with the patient and others, carry out tests and treatments, and learn from their mistakes while in the lab or simulation center without compromising patient safety.”
Have no Fear If the thoughts of working with some of this technology scares you, don’t worry. The facility will provide you with the training you need, and the technology will make health care safer and allow you more time with patients. “It is easy to be afraid of change, but you must always keep in mind what is best for the patient. Put yourself in the patient’s position and imagine how much safer they must feel to know that so many systems are working to support their care,” says Whitaker.
“Do not be afraid to advance. A nurse’s touch will always be valued and needed, but technology can help bring nursing care to the highest level.”
fer the planned treatment geometry from the computer to the treatment room in a way which is accurate, reproducible, and efficient enough for routine use,” says Grossman. “Haptics are an example of virtual reality technology where the nursing student can do patient assessment and examination and feel the virtual patient’s skin and body, with the ability to perform clinical interventions. Using engaging and immersive technology like Google Glass or HoloLens, the student can feel being in the real-world health environment, move around freely, in-
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“Do not be afraid to advance. A nurse’s touch will always be valued and needed, but technology can help bring nursing care to the highest level.” Michele Wojciechowski is an award-winning writer and author of the humor book, Next Time I Move, They’ll Carry Me Out in a Box.
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Discover all that we can accomplish together.
Community Medical Center At Community Medical Center (CMC), an affiliate of RWJBarnabas Health System, we’re building something special on the Jersey Shore. Every day, talented nurses like you make a real difference by providing sophisticated care in a comprehensive range of specialty services — and, in the process, build a brighter future for themselves and the communities we call home. We are a 592-bed, fully accredited acute care hospital offering area residents world-class medical treatment with the comforts of hometown care. Opened in 1961, CMC has evolved into the state’s largest non-teaching hospital and Ocean County’s largest and most active healthcare facility—caring for over 24,200 inpatients, 142,500 outpatients and 81,400 emergency department patients each year. Community Medical Center is dedicated to advancing the quality of life and health of our community. Exciting opportunities are available for experienced RN’s in Telemetry, Critical Care and the Operating Room! There are a variety of M/S & Telemetry Units, MICU & SICU and a 10-Suite Operating Room with all specialties including Robotics. Enjoy a great quality of life working near the beach in a warm and friendly community environment. Here, nurses enjoy a supportive, collaborative workplace and multiple programs to recognize their contributions to our hospital and the community. We take great pride in being a truly welcoming workplace where you’ll be challenged as you learn every day, grow professionally and build friendships. We are proud of our talented, diverse workforce that reflects the vibrant, dynamic communities we serve.
Come join our Great Team! For more information and to apply online at: rwjbarnabashealthcareers.org or email our nurse recruiter at patricia.chirumbolo@rwjbh.org
Equal Employment Opportunity
Tales of Transitioning from the RN to NP Role BY JHAUREL R.F. JOHNSON WHITE, MSN, PMHNP-BC, PCCN
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waited five years for this day: my first day as a psychiatricmental health nurse practitioner. Mental health is a specialty with the highest demand and lowest supply in the United States. I filled one of seven vacancies, so the staff welcome was warm and inviting to say the least. The outpatient setting was grandeur. It was a far cry from what I am accustomed to. The air was fresh, the bathrooms were clean, and I even scored a corner office! It is a shared space, but who cares? The office has a large window showcasing the mountains and orange trees. The desks are height-adjustable, giving the option to sit or stand. I was excited and prepared for whatever came my way. There was just one problem: It does not seem like they were prepared for me. After a week and a half of hospital orientation, a nursing mental health supervisor invited me on a tour of my work area. It was my first day actually seeing the clinic and meeting my coworkers. After copious introductions, he invited me to his office. He began the conversation with an oh-so-familiar precursor in nursing: “I have to be honest with you.” I knew I was in for some hardcore truth. Here are the highlights of his honesty
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about orientation: (a) This is not the nursing you know; (b) there are no checklists or competency fairs for you; (c) you will shadow people who do not have your experience; (d) be a skeptical sponge; and (e) you will only get out of it what you put in to it.
practice level, learn the workflow and learn the system, all while maintaining your nurse identity. Work through it. Do not give up. Here are some tips that will help you transition successfully from the RN to NP role.
Poor mentorship is detrimental to your professional growth and work environment. It often results in disappointment, isolation, and poor job satisfaction. To avoid a bad experience, try to find a mentor whose experience resembles your own.
do not offer nurse practitioner training programs. Do not be discouraged. Consider investing your time in a mentorship instead. Mentorship is a powerful tool to ease your transition. Mentors are reliable resources, safety nets, so to speak. They will assist in developing your knowledge base, clinical skills, and overall confidence. If you do not feel comfortable searching for a mentor, do not worry. It is likely your supervisor will assign a mentor to you being that you are a new graduate. Be advised: Mentorship is a
Mentoring is a skill not everyone is able or willing to do. Poor mentorship is detrimental to your professional growth and work environment. It often results in disappointment, isolation, and poor job satisfaction. To avoid a bad experience, try to find a mentor whose experience resembles your own. If there is discord between you and an assigned mentor, or if you feel the mentorship hit a glass ceiling, request another mentor. There is no rule against it, and you do not want to stifle your growth.
Don’t Have a Plan? Develop One If your employer does not have a program or plan for you, create your own. It is important to set deadlines and expectations for yourself and communicate those with your mentor and supervisor. If you fail to do so, you may find yourself practicing independently too soon. Orient yourself by reading standard operating procedures of your work area and shadowing different providers. Pay attention to the workflow, the workload, and interdisciplinary interactions. Once you are familiar with the system and feel comfortable, I recommend the sink or swim approach. It builds confidence I want to assure you everything the mental health supervisor said rings true. The following weeks were an emotional rollercoaster. There were times I would feel challenged, confused, frustrated, bored, excited, and disappointed all before lunch hour. If you feel this way, this is normal. Experiencing a barrage of emotions is not unusual in your quest to function at the advanced
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Find a Mentor Many new graduate nurse practitioners identify mentorship and structured orientations (i.e., residencies and fellowships) as most important in considering job prospects. If your employer is one-ina-million and offers a nurse practitioner residency/fellowship program, I encourage you to apply. However, the truth is many employers
Ease into first-time assessments and interviews by seeing patients with a clinician shadowing you. Invite constructive criticism and feedback. It can only benefit you.
partnership in which both you and the mentor are responsible for your professional growth. Remember, you get out of it what you put into it.
from the start, and you will gradually become more independent. Ease into first-time assessments and interviews by
seeing patients with a clinician shadowing you. Invite constructive criticism and feedback. It can only benefit
ferences in perspective. My background includes five years in a medical-stepdown unit and the emergen-
Avoid the trap of drawing baseless conclusions. One graduate is not better than the other; however, experience shapes perspective. You will notice differences in perspective. you. Invest in an updated prescriber’s guide, and search online for local and national organizations relative to your specialty. If you do not want to go bankrupt joining organizations, look at their event calendar. From there, you can attend meetings that would be most beneficial to you for a nominal fee.
Be Self-Aware As the mental health supervisor mentioned, your training and experience may differ from that of your mentor. You will find a surprising number of nurse practitioners are oriented to their role by physicians. In addition, consider the variation of training and clinical experience within our own profession. There are nurse practitioner programs that require years of experience working as a registered nurse. Conversely, there are other programs that require little to no experience at all. You will see these variations in your workplace. Research suggests that RN experience neither promotes nor inhibits transitioning to the nurse practitioner role. Avoid the trap of drawing baseless conclusions. One graduate is not better than the other; however, experience shapes perspective. You will notice dif-
cy department as a registered nurse, so, naturally, not getting a set of vital signs because “they need to do that” is strange and disconcerting. I remember hearing a nurse practitioner say, “You are doing well. Do you see the difference? You are a nurse practitioner now. Nurses do not critically think. Nurses just take orders. Real thinking is not involved in that. Now, you have to think critically.” Now, I have to be honest with you. You may hear similar comments in the office, the breakroom, or a meeting. Remember, some nurse practitioner programs are a fast-track to terminal degrees with little to no experience working as a registered nurse. Furthermore, physicians orient nurse practitioners to their role, not the other way around. These comments are not personal affronts. They are knowledge deficits. People do not know what they do not know, so know yourself. You critically think in your sleep. Be self-aware.
Know Your Place Find your job description and read it thoroughly. Inquire about your role in your area. By role, I am not talking about the mechanics of advanced practice. I am talking about your position on
your team. Nurse practitioners are utilized so many different ways. For instance, psychiatric mental-health nurse practitioners in my facility can admit and discharge patients, round on inpatient units, treat patients in the psych holding area of the emergency department, and see patients in an ambulatory care setting. It is important to know what role you play in your area. Discuss performance measures and standards of care with your supervisor. “What are your expectations? How are you evaluating my performance? What is the standard of care?” Add their expectations to the list of expectation you should have for yourself. Use them to set your short- and
thing. I have seen three nurse practitioners share one office. I could not fathom the “No Talk While Typing” rule going over so well. Again, I did not consider it a personal affront. It was another opportunity for me to learn. Office culture is not at all like bedside culture. Read about office etiquette in shared spaces and be prepared. I most certainly was not. I do not embarrass easily, so I am comfortable sharing my experiences. I hope my sharing will help make your transition smoother and less intimidating. The nurse practitioner role is indebted to the art of caring and compassion that is nursing. You are a member of the most ethical profession in the world, and nursing is at the heart of
Knowing your place also has to do with knowing the culture. Every work environment has a culture. For me, transitioning from bedside nursing to an office setting was like waking up in the twilight zone. long-term professional goals. Knowing your place also has to do with knowing the culture. Every work environment has a culture. For me, transitioning from bedside nursing to an office setting was like waking up in the twilight zone. I went from sharing everything (i.e., computers, lunch, dreams, scrubs, pens) to boundaries and territories. Once, I was politely and abruptly escorted out of my office, a shared space, for taking a call while the other provider was charting on one patient. The first and only patient seen all day. This was yet another ride on the emotional rollercoaster. Again, I am accustomed to sharing every-
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everything you accomplished. It is what distinguishes nurse practitioners from other clinicians. Remember, role change does not imply change of character or professional identity. You are a nurse, so this is not your first role transition. You have done this before, and you can do it again. Jhaurel R.F. Johnson White, MSN, PMHNP-BC, PCCN, is a board certified psychiatric-mental health nurse practitioner at VA Loma Linda Healthcare System. She is an ad hoc member on the Mental Health Field Advisory Committee in Washington, DC and a doctoral candidate attending the University of South Alabama.
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Academic Forum
Formal Mentoring for Novice Academic Nurse Administrators BY CAROL DELILLY, PhD, MSN, RN
While experienced ANAs are retiring or resigning, formal mentoring for incoming Novice Academic Nurse Administrators (NANAs) remains relatively absent.
According to the American Association of Colleges of Nursing, only 2.1% of deans and directors are 45 years of age or younger. Further, according to the Robert Wood Johnson Foundation, a large percentage of senior nursing faculty members and Academic Nurse Administrators (ANAs) will retire over the next decade, and half are likely to retire by 2020. While experienced ANAs are retiring or resigning, formal mentoring for incoming Novice Academic Nurse Administrators (NANAs) remains relatively absent. Few nurses or nursing faculty fully grasp the complex responsibilities of this position. Typically, ANAs preside over the perpetual cycle of nursing student admission, academic progression, student attrition, and graduations. The specific roles and legal responsibilities of ANAs are outlined by each state in their state nurse practice act. Most programs are offered in community colleges or universities.
R
egardless of the location or type of nursing educational program, ANAs are responsible for the majority of decisions made regarding the legal operations of these programs. Ultimately, ANAs are critical to the delivery, operations, and sustainability of nursing education and ultimately to the perseverance of the nurs-
ing profession. Unfortunately, formal nursing educational programs seldom address the daunting operational challenges that ANAs—and particularly NANAs—face when attempting to meet the expectations of this role transition. Consequently, vacancies loom across the nation, creating an urgent need for retention through formal mentoring.
Significant Challenges for ANAs Experienced and novice ANAs are responsible for their nursing program’s state approval through accreditation. This lengthy endeavor requires at least one year of advanced preparation. State accreditation for pre-licensure nursing programs includes a program self-study and program evaluation, gen-
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erally under severe time constraints. Accreditation topics under review include a total program evaluation plan, sufficiency of resources, appropriate administration, nursing faculty, nursing content experts, curriculum assessment, adequate clinical facilities, demonstration of student engagement, and a self-study summary. Additional responsibilities include monitoring the program’s National Council of Licensure Examination for Registered Nursing (NCLEX-RN) pass rates, sustaining student enrollment, maintaining nursing faculty stability, retaining program accreditation, and remaining fiscally sound despite varying degrees of institutional rigidity. Seasoned ANAs recognize that the terminal goal for each nurse graduate is to successfully pass the NCLEX-RN exam and thus earn state registered nursing licensure. For ANAs, policymaking occurs continuously. Issues are brought to administration and faculty for exploration of the necessity to make or change policies to ensure that educational and nursing practice standards are current, and to
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Academic Forum
Seasoned ANAs recognize that the terminal goal for each nurse graduate is to successfully pass the NCLEX-RN exam and thus earn state registered nursing licensure. change policies when they are not. Changes are also generated by requirements of affiliating health care agencies, university, college, and statewide policy recommendations that require extensive institutional buy-in and support. Many ANAs exert great efforts to receive institutional and faculty support in the operations of their nursing programs. A 2014 study in Nursing Education Perspectives found that among 242 ANAs, factors associated with job dissatisfaction included a lack of institutional support,
ly indicating the need for formal mentoring.
Formal Mentoring Praxis In Integrated Theory & Knowledge Development in Nursing, authors Peggy Chinn and Maeona Kramer define praxis as the integration of knowing: empirical, ethical, aesthetic, personal, and emancipatory concepts. In formal mentoring, experienced ANA mentors will apply their integration of knowing through mentorship of NANAs with the following conceptual guidelines:
Overall, studies have revealed that the most helpful role transition experiences came from mentoring (53.5%), while (30.2%) came from work experiences, strongly indicating the need for formal mentoring.
mentorship, recognition, and respect. Furthermore, over a decade ago, it was reported that aging, bullying, and stress correlated with increased vacancies among all ANAs. In a current online survey of nursing faculty from 12 of the 15 highest-ranked universities, 22.5% reported not having a mentor, most (61.2%) found mentors on their own, and only 16.3% had formally assigned mentors. Overall, studies have revealed that the most helpful role transition experiences came from mentoring (53.5%), while (30.2%) came from work experiences, strong-
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• Empirical: Use of a practical and pragmatic approach to mentoring • Ethical: Addresses the legal issues affecting nursing education • Aesthetic: Sharing of creative artistic diagrams, charts, and visual aids • Personal: Storytelling of lessons learned as an experienced ANA • Emancipatory: Supporting the independence and growth of the mentee
Critical Social Theory (CST) and NANA Mentoring Critical social theorists aim to
aid in the process of progressive social change by identifying not only what is, but also identifying the existing (explicit and implicit) ideals of any given situation and analyzing the gap between what is and what might and ought to be. In Advances in Nursing Science, P.E. Stevens identified six tenets of CST. Three of the six tenets of CST have important underpinnings to the praxis of leadership mentoring for NANAs. The first tenet examines the academic institutions’ social, political, and economic influence on the development of a formal NANAs mentoring program. The second seeks to reduce invisible oppressive institutional rigidity found in an academic environment while the third seeks to provide formal mentoring that emancipates and liberates the NANAs leadership potential.
Strategy and Implementation Following the attendance of a formal mentoring workshop, ANAs would be assigned to mentor NANAs for one year. The three tenets of CST would serve as guides for the ANAs mentoring endeavors. Informed by CST and the praxis (integration of knowing), ANAs will share knowledge beyond empirics to more aesthetic, ethical, personal, and emancipatory patterns. The ANA mentor and NANA mentee would agree upon a formal mentoring schedule of two-hour weekly meetings to address specific nursing program director related topics, such as: • Faculty to Director Role Transition • Compliance with the State Nurse Practice Act • Program Directors Manuals/ Handbooks
• Maintaining State Program Accreditation • Writing of Policies and Procedures • Seeking Institutional Support • Handbooks (Student & Faculty) • Ethical and Legal Issues • Essential Documentation • Hiring and Orientation of New Staff and Faculty • Collegiality Among Stakeholders • New Student Orientations • New Student Admissions • Academic Progression • Student Advisement • Student Attrition/Retention • Student Essential Behaviors • NANAs Scholarly Expectations • Grant Writing • Promotions, Tenure • Director & Faculty Professional Development This formal mentoring program design aims to report positive post survey responses in job satisfaction and retention among NANAs. It is intended to create scholarly academic dialogue to explore the implementation of this mentoring model for NANAs. Future research and discussion will focus on the qualitative experiences of the ANAs mentors’ roles and NANAs mentees as participants. The provision of the CST as a framework for the praxis of formal mentoring guides ANAs in their mentoring endeavors. The success of a praxis leadership mentoring model can facilitate enhanced role transition and increased retention among NANAs. Carol DeLilly, PhD, MSN, RN, is an associate professor and nursing program director at Mount Saint Mary’s University in Los Angeles, California.
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Degrees of Success
Becoming a Mentee: Tips on How to Establish a Mentee-Mentor Relationship BY KELLY BRITTAIN, PhD, RN
Experts agree that mentoring is vital to your professional and personal development as a nurse. Good mentoring can lead to getting into—and through—nursing school, getting a great job, and getting into graduate school. However, as a minority nursing student or nurse, you may have little experience being a mentee and have many questions. Questions like: How do you approach a person you would like to have as a mentor? Do you only need one mentor? How do you know if you have a good mentor? Some minority nursing students and nurses have had mentors of the same culture or ethnicity as you and you may feel uncomfortable asking a nurse, instructor, or professor from an ethnicity or culture different from yours to be your mentor. The following tips may help you find a mentor and set the foundation for a rewarding mentee-mentor experience. Q: How do I know if I need a mentor? All of us need a mentor. A mentor is an experienced per-
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son that advises you as you work to accomplish a goal or guides you through your education or career. As a nurse, there are many benefits to
having a mentor. One benefit of having a nurse mentor is having someone who is impartial and can listen to you and give you direction. When your
mentor shares their knowledge and experiences with you, you gain knowledge and insight. Thus, you can make choices, decide to gather more information, or even seek the advice of another mentor. Another benefit of having a mentor is often they will extend their network to you to help you. Many nurse mentors are willing to introduce you to other nurses that may be of assistance to you. For example, your mentor is a cardiology nurse and you are interested in going back to school to become an AdultGerontology Nurse Practitioner
Degrees of Success (AGNP). If your mentor knows one, they may often put you in touch with the AGNP because they cannot answer the types of questions you have about becoming one.
Q: How do I approach someone I would like to have as a mentor? Before you approach your prospective mentor, think about or write down why you
Keep in mind that you are deciding if this nurse will be a good mentor for you so ask what you need to know so you can make an informed decision.
Many nursing students and nurses have more than one nurse mentor. You can have an all-round mentor, an education mentor, and one that is career specific, one that is research specific, and one that is a mentor in your practice specialty. You can have as many mentors as you need. It is better to find a mentor early in your nursing education or soon after you graduate because mentors are excellent recommendation writers for jobs or school because your mentor has listened to you talk about your aspirations and goals and can write about what they know about you.
Q: The person I would like as my mentor is of an ethnicity or culture different from mine. Can that work? Absolutely! In nursing, it can be very hard to find a mentor that is of your ethnicity or culture. It is perfectly fine to ask what has been their experience mentoring a person from a background different from theirs, what they learned, and what the challenges were. Keep in mind that you are deciding if this nurse will be a good mentor for you so ask what you need to know so you can make an informed decision.
would like to have them as your mentor. It does not have to be elaborate. It could be that you aspire to be like them and you want to get their advice. It could be that you are interested in the type of nursing practice or research they do, and you want to shadow or work with them. Whatever your reason is, make sure you can concretely express it. Your potential mentor wants to know how they can help you. Remember, mentors are agreeing to share their time with you and they do not want to waste your time either. Next, you should contact them by sending an email or calling them. When you contact them, you should let them know what you want and why. After an email response or call, you should ask to meet with them to begin the mentor-mentee relationship. This meeting can be over the phone if meeting face-to-face is not possible. This meeting is important for the two of you to get to know each other.
Q: They have agreed to be my mentor! How do I prepare for our first meeting? There are three goals for your first meeting. One is to have your mentor get to know you; the second is for you to get to know your mentor; and the
third is to define your menteementor relationship. In some cases, where a deadline or project is involved, a timeline may be necessary—and that is your fourth goal. There is no way for you to know everything about your mentor and for them to know you in one meeting. The important topics should include: where you are from, why you chose nursing, your goals and aspirations, and why you believe your mentor can help you. You should ask those same questions and add a question about why they choose their nursing career path, and their current goals and aspirations. Having this conversation is an excellent way for you and your mentor to connect and begin to build the foundation of a good mentee-mentor relationship. Defining the mentee-mentor relationship should be the fo-
mentor relationship. A formal mentorship is usually in writing because it usually entails a project or deadline. Mentee-mentor relationships can go from being informal to formal and from formal to informal. Communication between the two of you is essential to navigating that part of the relationship. Second, you need to decide how often you are going to meet. In informal relationships, this could be as needed or once a month. In a formal relationship, the frequency of meetings is often defined by what the project or deadline is. Third, you must decide what type of meetings you are going to have and how long will they be. Again, in an informal relationship that may not be necessary as you will not be meeting frequently, and you can set the length of
Before you approach your prospective mentor, think about or write down why you would like to have them as your mentor.
cal point of the first meeting because it establishes the foundation of your interactions. It defines what you want from the relationship and leads to the discussion on how to make your mentee-mentor relationship work for you both. There are three areas to cover in defining the relationship; the first is deciding whether the mentee-mentor relationship is formal or informal. An informal relationship does not require much work. Usually a verbal agreement to stay in touch with some regularity and the person agreeing to be your mentor is enough for an informal mentee-
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the meeting as it fits you and your mentor’s schedule. In the case of a formal relationship where regular meetings are necessary, the length of the meetings are important so that the appropriate amount of time can be set aside. In a formal mentoring relationship, an agenda or key discussion items are sent to your mentor in advance of the meeting. The agenda helps keeps you both on target. In the case of most formal relationships, a documented timeline (i.e., a beginning and end) of the relationship or project is established. In establish-
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Degrees of Success ing a timeline, you incorporate meeting dates, dates when you will send something to your mentor, and the timeframe when you should expect their feedback. When you do this step early in the relationship, it tends to keep everyone on task and on target. Of course, things happen, but it is important that each of you honor your formal agreement and renegotiate timelines as needed.
Q: What do I do if my mentor is not a good fit for me? Do not worry. Sometimes, the mentee-mentor match up does not work out as planned due to timing, different approaches, communication, and personality, among other things. Being an expert nurse, professor, or nurse researcher may not always mean that they will be a good mentor for you. If after your initial meeting or even after multiple meetings you find that you and your mentor are not a good fit, then the professional way to handle it is to end it. In the case of informal relationships, it is easier since there is no agreement for regular contact. However, it is best to thank your mentor for their time when you end the mentee-mentor relationship. In the case of a formal mentee-mentor relationship, a call, email, or letter is the most professional method to end it. Again, if you have spent time with your mentor, you should thank them for their time and what you state after that should be very professional, honest, and give at least one reason you no longer want to have a menteementor relationship with that person. Keep in mind that if
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this is a person working in your career field that you do not want to “burn bridges,” so a scathing email or letter is not professional. When in doubt about what you have written, ask another trusted mentor or colleague.
Q: How do I know I have found a good mentor? Inc.com give us seven key qualities of an effective or good mentor. The seven key qualities are: • Ability and willingness to communicate what they know. A good mentor is able to make complex concepts and issues easy (or easier) to understand. A good mentor is open to sharing all the “secrets” of success with you in an effort to help you succeed. You just have to be open to listening and learning. • Preparedness. As a mentee, you should have an agenda or at least tell your mentor what you would like to discuss before you meet so that your mentor can be prepared. A prepared mentor has given thought to your questions or topic and is ready to have an efficient and directed conversation with you. • Approachability, availability, and the ability to listen. As part of the first meeting, you as the mentee have set up dates and times with your mentor and your mentor should keep those commitments and be ready to listen. • Honesty with diplomacy. A good mentor is going to be honest about whatever you are discussing. Being honest with you should be done in a professional and tactful manner, especially if your
mentor is giving you feedback or critique. • Inquisitiveness. Your mentor may know a lot, but that does not mean they know everything. A good mentor is willing to learn new things about you and new topics. In essence, a good mentor is a lifelong learner. • Objectivity and fairness. A good mentor is looking forward to helping you succeed and that is it. There are no favors involved. Most often, your mentor may give you networking suggestions or offer to give you the name of a person who may be able to give additional support or a “foot in the door.” However, an expectation of a job or anything else because of the mentee-mentor relationship is not part of a mentee-mentor relationship. In the case where you and your mentor are working on a project, publication, or other work related items, the way your mentor will be acknowl-
Being honest, fair, and objective does not equal mean and cold. A good mentor listens when you are having difficulties and is happy when you succeed. A mentee-mentor relationship is not a friendship; you may not be Facebook friends or follow each other on Instagram. However, a good mentee-mentorship relationship comes awful close to a good friendship and over time, who knows? Taking the first step to establish a mentee-mentor relationship is usually on the mentee. Like any relationship, a good mentee-mentor relationship takes planning and having clear expectations and goals for the relationship. For minority nursing students and nurses, finding the right mentor and having a productive mentee-mentor relationship can be a daunting task when you have not had previous mentee experience and there are very few minority nurses
Being an expert nurse, professor, or nurse researcher may not always mean that they will be a good mentor for you.
edged should be finalized before the project begins. For example, if you are a nursing student working on a research project you should know if you would be listed on a conference abstract or publication. If you are leading the project, you should ask your mentor how they would like to be recognized on the project. • Compassion and genuineness. Essentially, your mentor should be a good person.
to select as mentors. However, understanding how to establish the mentee-mentor relationship may make it less daunting and even more fruitful to enhancing your nursing career. Kelly Brittain, PhD, RN, is an associate professor at Michigan State University College of Nursing.
Degrees of Success
Nursing Students Reaching Out Globally and Making a Difference BY DENISE GASALBERTI, PhD, RN, and EDNA AURELUS, DNP, FNP-BC, RN-BC, APRN
During Spring Break 2018, graduate nursing students from Wagner College travelled to Cap-Haïtien airport where they would begin a six-day mission to provide health care to the men, women, and children of Haiti. Our NP students acquire 50 community hours toward the required practicum hours for their service.
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aiti, a beautiful country with white beaches and clear blue water, is approximately one-third of this tropical island, which it shares with the Dominican Republic. The name actually means “high land,” as much of the island is covered with mountains. The official language is French with most people speaking a dialect known as Creole. “For Haiti With Love” is located in the northern area of Haiti called Cap-Haïtien. Our team of volunteers brought a large amount of medicine and supplies, as our NP students would be treating as many as 50 people per day during the first days in the clinic. Although exhausted, there were no complaints, as this was a gift to the Haitian people given from the heart. Interactions with the local people gave the student nurses a great sense of satisfaction and exposure to a new and interesting culture. The group was well received with genuine acceptance and welcoming love. Riding on the back of a pick-up truck and eating fried goat were some of the unique aspects of the culture that contributed to this bonding experience.
Upon arrival, poverty and issues with waste management were noted with trash being seen along the road and in the water. Another major issue was widespread unemployment. It was also noted that there was no access to running water or electricity inside their homes. Although the nursing students were anxious initially, the people made the volunteers feel comfortable and safe. The group was warmly embraced and received three home cooked meals per day and were treated like family. Children were well dressed and smiling. Although underprivileged on many levels, education was extremely valued among the Haitian people. The volunteer work at the clinic involved a lot of wound care, such as venous stasis ulcer care. Although volunteers were working in the burn clinic, no one was turned away if they had other health issues that needed to be addressed. Many children received burn injuries from spilling hot water upon themselves. Education related to prevention of burn injuries was badly needed. Most of these children went directly to school after having a debridement and
dressing change with little pain management. Privacy was another concern since many patients were treated in one room at the same time. The volunteers used their clinical skills in a place outside of their comfort zone. Knowing that most of their patients would return to very poor living conditions was difficult for the volunteers. Many reported that this changed their perceptions and their lives. It helped them appreciate their own good fortune, the value of good health, and accessibility to health care. Similarly, the people of Haiti were filled with love, trust, and appreciation for everything the volunteers were able to provide. Upon the return of the volunteers to campus, they were given the opportunity to present their experiences to other graduate nursing students in
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their Health Policy, Organization, and Finance class. A lively discussion and exchange recapped the entire experience for our volunteers and left our other students in awe. Making a difference in the lives of those who may not have the means necessary to help themselves was a good feeling. Most volunteers said they would do it all again if given the opportunity because it was an experience of a lifetime. Denise Gasalberti, PhD, RN, is an associate professor with the Evelyn L. Spiro School of Nursing at Wagner College in Staten Island, New York. Edna Aurelus, DNP, FNP-BC, RNBC, APRN, PMHNP, is an assistant professor with the Evelyn L. Spiro School of Nursing at Wagner College in Staten Island, New York.
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Health Policy
Reversing the Rise in Maternal Death Rates: Implications for Nursing Awareness and Advocacy BY JANICE M. PHILLIPS, PhD, FAAN, RN
Nurses are encouraged to stay abreast of this issue by identifying the state of maternal health in their respective communities.
While maternal outcomes have improved over the years, a considerable number of women in the United States die from or continue to experience a number of pregnancy-related complications. According to the National Center for Chronic Disease Prevention and Health Promotion [NCCDPHP], each year approximately 700 women die of pregnancy related causes while 50,000 women experience severe pregnancy complications. Women living with chronic conditions such as hypertension, diabetes, heart disease, and obesity are at a higher risk for complications during pregnancy, childbirth, and the postpartum period. In particular, African American women are more likely to die from pregnancy-related complications when compared to their white counterparts. Notably, maternal mortality is higher in the United States than in any other developed nation.
S
evere maternal mortality is due to severe pregnancy complications. According to the NCCDPHP, these rates have doubled from 2000–2010 and have affected more than 50,000 women in the United States. Some contributing factors in-
clude: maternal age, persisting chronic conditions, complications during delivery, and prepregnancy obesity. Researchers note that approximately half of pregnancy-related deaths are preventable and point to implications for reducing maternal mortality.
Notably, maternal mortality is higher in the United States than in any other developed nation.
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Efforts to reverse these disturbing statistics will require a multifaceted and comprehensive approach. Interventions must include a focus on better data collection, quality improvement measures, provider and patient education, earlier identification and intervention targeting high-risk women, proactive preconception health approaches, and improved obstetrical and maternal care services. Many
hospitals and health systems across the country are addressing the mortality death rates and have designed programs, which include some of the aforementioned strategies. The rise in maternal morbidity and mortality has stimulated discussion and action among nongovernmental and governmental agencies, advocacy, and professional groups and the United States Congress. Groups such as the American College of Obstetricians and Gynecologists, Black Women’s Health Imperative, and the Alliance for Innovation on Maternal Health (AIM), to name a few, are speaking out for legislative action. The table on the following page provides a brief snapshot of legislative proposals introduced at the federal level during 2018, the second half of the 115th Congressional Session. These and other initiatives are a critical first step to reversing the poor maternal health outcomes for women. Nurses are encouraged to stay abreast of this issue by identifying the state of maternal health in their respective communities. Nurses wishing to improve maternal outcomes can do so by helping to iden-
Health Policy
Efforts to reverse these disturbing statistics will require a multifaceted and comprehensive approach. tify high-risk populations and working with their respective institutions to develop educational programs, outreach initiatives, and quality standards for maternal care. As health care providers, nurses are well-suited to work with multidisciplinary teams to disseminate best practices as well as advocate for sound public policies focused on alleviating poor maternal outcomes. Additionally, nurses can look to professional/specialty organizations to identify what
organizations are doing to address maternal mortality. For example, the Association of Women’s Health, Obstetric and Neonatal Nurses, one of nursing’s leading organizations devoted to women’s health and newborns, has a number of resources on this issue and advocates for work that expands the work of state-based Maternal Mortality Review Committees. Maternal Mortality Review Committees are critical to collecting, reviewing, and monitoring data on pregnancy-related deaths. Janice M. Phillips, PhD, FAAN, RN, is an associate professor at Rush University College of Nursing and the director of nursing research
RESOURCES American Colleges of Obstetricians and Gynecologists www.acog.org/Advocacy/ACOG-Legislative-Priorities
Association of Women’s Health, Obstetric and Neonatal Nurses www.awhonn.org
Maternal Health Task Force www.mhtf.org/topics/maternal-health-in-the-united-states
Severe Maternal Morbidity in the United States www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html
and health equity at Rush University Medical Center.
Source: https://www.govtrack.us
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The Funny Bone COMPILED BY MICHELE WOJCIECHOWSKI
Nursing can be a tough job, but sometimes you just need a good laugh to keep you going. Enjoy the following hilarious stories sent in by your fellow nurses. Have a funny tale to tell? E-mail writer Michele Wojciechowski at MWojoWrites@comcast.net to share!
Put on Your Dancing Shoes
Sometimes Nurses Can’t Even Take It
Worried About the Family Jewels
When mothers were in early labor and not very far dilated, they would sometimes ask for pain medicine to take the edge off. One mother was uncomfortable, but the doctor was not ready for her to have an epidural. We offered her an IV pain medication that would help her feel better, but, at the same time, wouldn’t do anything to slow down her labor. Some moms would compare the feeling to being drunk or high. They sometimes saw things, smelled things, basically hallucinated. So this woman was given the meds, and she started singing and dancing in her bed—while she was in labor. About two hours later, her doctor finally gave in and said she could get the epidural. The anesthesiologist came in the room and asked her to sit on the side of the bed. She sat up. He then asked her to swing her legs around to the side of the bed and hold on to the nurse. She replied, “I’ll do as you ask, but first, let’s dance!” We didn’t dance with her, but we did help her get ready to have her baby. —J.W., RN
Back when I was in nursing school, I was doing my operating room rotation, and I was told to come to observe a 7:30 a.m. surgery. I arrived when I was required to and entered the OR. The patient was on the table, and there was a table full of tools. As I was looking at the various tools, I noticed that one of them was a chainsaw. I turned to the nurse in charge and asked her what surgery I was going to be observing. She said, “Oh, it’s an above-theknee amputation.” I quickly backed up away from everyone and ended up against the wall. Before I could pass out, I began to slide down the wall onto the floor. The nurse came over and opened the OR door so that I could crawl out the door and into the hallway. I thought I could handle anything as a nursing student—nope! Luckily, it taught me that surgery wasn’t the way for me to go… —W.D., RN
I was a young and really naïve twenty-something nurse when I was working at a neurotrauma ICU. I was working the night shift with some really difficult head-injured patients. On the night shift, I was caring for my primary patient, who had a frontal lobe brain injury. But he also had a broken leg with pins and traction. His leg was suspended in the air with traction applied via weights hanging from the rope attached to his leg. He had a Foley catheter in his bladder because he never knew when he needed to go to the bathroom. The urine bag was draped over the railing and attached to the bar underneath the bed. On this particular night, he was agitated, so he began swinging the leg in the traction. The brakes on the bed had never worked right, and he swung the leg so hard that the bed, literally, bounced out the door into the hallway. He rocked and rolled so hard that he rolled out of the bed with his leg still suspended in traction, and his catheter hanging on the other side of the bed.
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I spent several hours after this with him in CT scan that night, and all he could worry about was his genitals. “My d*ck! My d*ck is falling off! Fix it!” he repeatedly yelled. Luckily, had hadn’t injured anything, including his penis. —N.G., RN Do you have a funny story to share? It can be something that happened to you at work, while in nursing school, while teaching nursing school—practically anywhere, as long as it involves the nursing field. If so, contact Michele Wojciechowski at MWojoWrites@ comcast.net. We may use your story in a future issue.
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Academic Opportunities
T
he world needs more nurses. With that comes the need for experienced, dedicated nursing faculty to train them.
There is a true shortage of nursing educators—particularly minority nursing professors, who comprise a small percentage of nursing faculty overall. The American Association of Colleges of Nursing says the scarcity of professors may actually be stunting the growth of nursing programs. To counter this, nursing schools are improving the pay for nursing school faculty to increase their numbers, especially those who hold a doctorate. This section of Minority Nurse is dedicated to open faculty positions from nursing schools all over the country. Requirements vary, but all are sure to lead to exciting, rewarding careers in nursing education and research.
Index of Advertisers ADVERTISER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE # AACN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Frontier Nursing University . . . . . . . . . . . . . . . . . . . . 8 The University of Tennessee Knoxville, College of Nursing Invites applications for the following positions: Assistant, Associate, or Full Professor Faculty Position in Health, Innovation, Technology & Simulation Assistant, Associate or Full Professor Faculty Positions
Please visit http://nursing.utk.edu for position details. The University of Tennessee is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA institution in the provision of its education and employment programs and services. All qualified applicants will receive equal consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, marital status, sexual orientation, gender identity, age, physical or mental disability, or covered veteran status.
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Frostburg State University . . . . . . . . . . . . . . . . . . . . C2 Indiana Wesleyan University . . . . . . . . . . . . . . . . . . 17 RWJ Barnabas Health . . . . . . . . . . . . . . . . . . . . . . . . 28 Springer Publishing Company . . . . . . . . . . . . . . . . . 42 UC Davis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C3 University of Tennessee . . . . . . . . . . . . . . . . . . . . . . 44 University of Maryland . . . . . . . . . . . . . . . . . . . . . . . 32 Vanderbilt University . . . . . . . . . . . . . . . . . . . . . . . . C4
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