Minority Nurse Summer 2020 Annual Salary Survey Issue by Springer Publishing Company

® The Career and Education Resource for the Minority Nursing Professional • SUMMER 2020

Salary Survey

Annual

Issue

Nurse-Led Innovation FINANCE 101 FOR NURSE MANAGERS SURVIVING COVID-19

www.minoritynurse.com

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New COVID-19 Clinical Trial Announced To Treat Over 90% of Patients With Underlying Medical Conditions A new clinical trial has been announced that could significantly increase the rate of recovery for COVID-19 patients with underlying health conditions and save lives! Circularity Healthcare’s trial will help some of the most at-risk patients suffering from complications due to diabetes, poor circulation, hypertension, cardiovascular disease and high blood pressure. The trial will involve the use of Circularity’s already FDA-approved drug and IDE device D’OXYVA® (deoxyhemoglobin vasodilator) – a non-toxic, non-invasive microcirculation transdermal device. It is the first biotech solution of its kind to improve overall oxygen-rich flo The device has been shown to significantly heal diabetic wounds, reduce the risks of amputations, blood flow. prevent sepsis and septic shock, improve blood pressure and general vital organ function of the pancreas, liver, brain and kidneys, while increasing overall health for some of the most vulnerable patients.

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Table of Contents

In This Issue 3

Editorâ&#x20AC;&#x2122;s Notebook

Vital Signs

Making Rounds

Academic Forum 30

The Fear of Caring: Novice Versus The Experienced Nurse

Cover Story 12

By Ciara Curtin

Features 18

Trailblazer in Nursing: A Major Career Accomplishment By Michael L. Jones, PhD, MBA, RN

Health Policy 33

Surviving COVID-19: When Nurses Need Advocates By Janice M. Phillips, PhD, RN, CENP, FAAN

Minority Nurse | SUMMER 2020

Discover Nurse-Led Innovation By Jebra Turner

By Marie Murray, MSN, BSN, RN

Degrees of Success

2020 Annual Salary Survey

Finance 101: What New Nurse Managers Need to Know By Michele Wojciechowski

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Our Essential Workers Deserve Better

11 West 42nd Street, 15th Floor New York, NY 10036 212-431-4370 ■ Fax: 212-941-7842

he onslaught of bad news over the last few months is enough to make anyone

SPRINGER PUBLISHING COMPANY

despair: the death toll from COVID-19; the murder of Ahmaud Arbery, Breonna Taylor, George Floyd, and countless other African Americans by racist cops;

the closing of neighborhood businesses and the high unemployment rate; the forced

isolation from everyone we hold dear; and the cancellation of basically anything we were looking forward to this year.

CEO & Publisher Mary Gatsch Vice President & CFO Jeffrey Meltzer

MINORITY NURSE MAGAZINE Editor-in-Chief Megan Larkin

On top of everything else, we’re seeing what seems like daily news stories of Americans assaulting essential workers of all kinds because of their refusal to wear a mask. Understandably, tensions are high with the uncertainty of our economy and our health amidst the pandemic, but why are we not doing more to protect these essential workers—who are quite literally risking their own health and their families’ health to help keep us all safe? For starters, we need to acknowledge their value and pay them accordingly. In our annual salary survey, nurses reported earning slightly less than last year. This should come to no surprise in the middle of a pandemic where everyone is forced to do more with less, and unfortunately, nurses have been negatively impacted as well. Instead of hiring every qualified nurse in the country to help us fight COVID-19, we’ve seen

Creative Director Mimi Flow

Production Manager Diana Osborne

Digital Media Manager Andrew Bennie Minority Nurse National Sales Manager Andrew Bennie 212-845-9933 abennie@springerpub.com Minority Nurse Editorial Advisory Board Anabell Castro Thompson, MSN, APRN, ANP-C, FAAN President National Association of Hispanic Nurses Birthale Archie, DNP, BS, RN Faculty Davenport University Iluminada C. Jurado, MSN, RN, CNN Chair, Scholarship Committee Philippine Nurses Association of America

our fair share of stories of layoffs and furloughs. There may be a lot of things happening that are out of our control these days, but we can make an effort to restore our humanity. And that begins with a little empathy and simple acts of kindness. The next time you see an essential worker—whether it’s a nurse, grocery clerk, or delivery driver—be sure to thank them. You may be lucky enough to not know anyone personally who has been afflicted with this virus, but that doesn’t mean that others aren’t struggling. We have to let go of this “us” versus “them” mentality. We can—and we must—do better if we ever want a return to normalcy.

Martha A. Dawson, DNP, RN, FACHE Assistant Professor, Family, Community & Health Systems University of Alabama at Birmingham Wallena Gould, CRNA, EdD, FAAN Founder and Chair Diversity in Nurse Anesthesia Mentorship Program Varsha Singh, RN, MSN, APN PR Chair National Association of Indian Nurses of America Debra A. Toney, PhD, RN, FAAN Director of Quality Management Nevada Health Centers

—Megan Larkin

Eric J. Williams, DNP, RN, CNE, FAAN President National Black Nurses Association

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. Subscription Rates: Minority Nurse is distributed free upon request. Visit www.minoritynurse.com to subscribe.

For editorial inquiries and submissions: editor@minoritynurse.com For subscription inquiries and address changes: admin@minoritynurse.com

Minority Nurse ® is a registered trademark of Springer Publishing Company, LLC. © Copyright 2020 Springer Publishing Company, LLC. All rights reserved. Reproduction, distribution, or translation without express written permission is strictly prohibited.

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@MinorityNurse

Vital Signs

NIH-Supported Research Survey to Examine Impact of COVID-19 on Rare Diseases Community

or the millions of people living with a rare disease, the novel coronavirus disease COVID19 presents challenges, from potential reduced access to needed medical care to possible heightened anxiety and stress. A new online survey launched by the National Institutes of Healthsupported Rare Diseases Clinical Research Network (RDCRN) aims to find out how the COVID-19 pandemic is impacting individuals with rare diseases, their families, and their caregivers. Results will help the rare disease research community shed light on the needs of people with rare diseases during the COVID-19 pandemic and other potential health crises, in addition to informing future research efforts. The RDCRN, led by NIH’s National Center for Advancing Translational Sciences (NCATS), in collaboration with nine other NIH Institutes and Centers, currently is made up of 20 recently funded clinical research consortia focused on better understanding how rare diseases progress and developing improved approaches for diagnosis and treatment. Scientists from different disciplines at hundreds of clinical sites around the world work together with about 140 patient advocacy groups to study more than 200 rare diseases, including immune system disorders,

heart, lung, and kidney disorders, brain development diseases, and more. “As a leader in fostering innovative, collaborative clinical research to improve

Minority Nurse | SUMMER 2020

the lives of individuals with rare diseases, the RDCRN is uniquely positioned to carry out a survey like this,” says Anne Pariser, MD, director of the NCATS Office of Rare

Diseases Research, which oversees the RDCRN. “The network has the necessary infrastructure, disease expertise, and access to patients through patient organizations

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Participants will be eligible for 14 Contact hours upon completion of the course. Contact hours are valid until June1, 2022. This CNE activity has been provided by Ohio Nurses Association. Learners must attend the entire session (live presentation or 11 webinars) and receive a passing post-test with a score of at least 80% in order to receive a certificate of contact hours. There is no conflict of interest for anyone with the ability to control content of this activity. This nursing continuing professional development activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91)

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Vital Signs to find answers to important questions.” Though individually rare, affecting only a few hundred to several thousand people, rare diseases collectively affect an estimated 30 million people in the United States. Many rare diseases are life- threatening, and about half of those affected are children. T h e r e s e a rc h s u r v e y, developed and led by the RDCRN Data Management and Coordinating Center at Cincinnati Children’s Hospital Medical Center, is one of the first efforts nationwide to quantify the impact of a health crisis on the rare disease community. It is seeking responses from at least 5,000 people with a rare disease or caring for someone who has a rare disease. The survey will be distributed online to participants. In addition, some RDCRN-funded scientists plan to incorporate survey results into natural history studies, which follow patients to chart the progression and course of a disease. The survey is open to anyone with a rare disease, along with family and caregivers, and is not limited to the diseases studied within the RDCRN. The impetus for the survey began through conversations among network researchers and patient advocacy organizations. Patients, families, and caregivers were worried about how COVID-19 might affect them. “People affected by a rare disease, and families and caregivers, initially asked how to avoid the virus,” says RDCRN Program Director Tiina Urv, PhD. “Then they became concerned about access to medicines and maintaining

medical care during the pandemic, and the status of clinical trials. They were concerned about meeting the medical challenges that they face every day. We were hearing enough anecdotally that we wanted to get a clearer picture of the problem.” As consortia scientists and clinicians engaged with patient groups and patients, sharing information and advice, a plan came together over several weeks to conduct a scientific research study to gauge the impact of COVID-19 on those in the rare disease community. Questions in the research survey focus on a range of topics, from a patient’s ability to get proper care for a rare disease or condition to mental and emotional health. The survey asks what their concerns are as a person with a rare disease, or as family members and caregivers. Groups of people with different rare diseases and the

Minority Nurse | SUMMER 2020

community will have different needs and concerns, whether it is how to get needed medications or physical therapy to navigating an emergency room in a medical crisis. “We hope the study questionnaire will help us better estimate the proportion of rare disease patients who have been diagnosed with COVID19, and find out how they are affected whether or not they had COVID-19,” says project principal investigator Maurizio Macaluso, MD, DrPH, at Cincinnati Children’s. “This survey provides an opportunity for the rare disease community to get timely data on the challenges they face.” The researchers also think the survey data may help them tease out answers to many other questions. For example, do some subgroups of people with rare disease fare better or worse with the virus? Are certain individuals

more prone to infection because of their underlying rare condition or disease? Ultimately, the researchers hope the survey will help determine how the RDCRN can respond to the rare disease community’s concerns by providing information and advice through its network of medical experts and patient advocacy groups. “This survey is a great example of how the consortia and patient groups are working together as a network to make a difference for the entire rare disease community,” Urv says. For more information on the RDCRN COVID-19 survey, including how to participate, go to https:// www.rarediseasesnetwork. org/COVIDsurvey. To learn more about the RDCRN, see https://ncats.nih.gov/rdcrn.

Vital Signs

Rates of Testicular Cancer are Rising Among Racial/Ethnic Minorities

etween 2001 and 2016 in the United States, Asian/Pacific Islander men experienced the greatest increase in the incidence of testicular germ cell tumors (TGCT), followed by Hispanics and American Indians/Alaska Natives, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research. TGCT is the predominant form of testicular cancer, which is the most frequently occurring cancer among men between the ages of 15 and 44 years in the U.S. The incidence of TGCT has been increasing since the mid-20th century, but the underlying reasons for the increase remain unclear. “While risk factors are not well understood, TGCT is known to be associated with other male reproductive disorders. As such, increases in incidence can be indicative of problems in male reproductive health,” explains Armen Ghazarian, PhD, MPH, first author on the study and a program director in the Division of Cancer Control and Population Sciences at the National Cancer Institute (NCI) at the National Institutes of Health. TGCT is most common among men of Northern European ancestry; however, a previous study from Ghazarian and colleagues revealed that rates increased among Hispanic men between 1998 and 2011. “We have long known of the risk among men of Northern European ancestry, but the results of our previous study

highlighted that rates were increasing among other racial/ ethnic groups as well,” says Ghazarian. The latest study builds on this work. “We expanded our analysis to include data from across the U.S.,” notes Katherine McGlynn, PhD, MPH, senior author on the study and a senior investigator in the Division of Cancer Epidemiology and Genetics at NCI. “The goal was to determine if similar trends persisted in the more recent data. Monitoring trends is critical to building a better understanding of potential risk factors.” In this study, Ghazarian and McGlynn examined TGCT incidence data from the United States Cancer Statistics public use databases. The analysis included data on TGCT cases reported between 2001 and 2016 from registries in all 50 states and the District of Columbia. The authors found that the incidence of TGCT was highest among non-Hispanic white men, followed by Hispanics, American Indians/ Alaska Natives, Asians/Pacific Islanders, and non-Hispanic Black men. While the incidence of TGCT increased across all racial/ethnic groups during this period, the authors found that Asian/ Pacific Islander men experienced the greatest increase, with an annual percent change (APC) of 2.47, meaning that the incidence increased by 2.47% each year. All other racial/ethnic groups experienced annual rate increases as well: Hispanics APC = 2.10, American Indians/

Alaska Natives APC = 1.71, non-Hispanic blacks APC = 1.28, and non-Hispanic whites APC = 0.41. The authors also examined differences in TGCT incidence by geographic region as defined by the U.S. Census Bureau. They found that Asian/ Pacific Islander, Hispanic, and American Indian/American Native men had the highest incidence of TGCT in the West, while non-Hispanic Black and non-Hispanic white men had the highest incidence in the Northeast. While significant increases in incidence among Hispanic men were observed in all geographic regions, significant increases in incidence were observed for Asian/Pacific Islander men in the West, non-Hispanic Black men in the South, and non-Hispanic white men in the Northeast and Midwest. However, Ghazarian cautioned that these results may partially reflect the distribution of different racial/ethnic groups across the country. A previous study examining global trends did not find similar increases in TGCT incidence in Asian countries. “Given the differences in trends, it would be interesting to examine U.S. trends using data on the birthplace of Asian/Pacific Islander men, as there could be an interplay between genetic and environmental risk factors,” notes McGlynn. In her ongoing work, she aims to understand the contribution of environmental exposures, such as endocrine-disrupting chemicals, on TGCT risk.

“I hope the results from this study will increase awareness of TGCT among men of all racial/ ethnic groups,” says McGlynn. “While incidence remains highest among non-Hispanic white men, it is becoming increasingly clear that this disease does not just affect men of European ancestry.” A limitation of the study was that all Asian/Pacific Islanders were examined as a single group rather than by individual ancestry. This was also the case for Hispanic men. These groupings prevented the examination of whether risk was specific to men of certain ancestries. Another limitation was the lack of data regarding birthplace; incidence trends could be different for men who emigrated to the U.S. compared to men of the same racial/ethnic group who were born in the U.S.

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Vital Signs

CDC Launches National Viral Genomics Consortium to Better Map SARS-CoV-2 Transmission

DC has kicked off t h e S A R S - C o V- 2 Sequencing for Public Health Emergency Response, Epidemiology and Surveillance (SPHERES) consortium, which will greatly expand the use of whole genome sequencing (WGS) of the COVID-19 virus. This national network of sequencing laboratories will speed the release of SARSCoV-2 sequence data into the public domain. SPHERES will provide consistent, real-time sequence data to the public health response teams investigating cases and clusters of COVID19 across the country. It will help them better understand how the virus is spreading, both nationally and in their local communities. Better data, in turn, will help public health officials interrupt chains of transmission, prevent new cases of illness, and protect and save lives. “The U.S. is the world’s leader in advanced rapid genome sequencing. This coordinated effort across our public, private, clinical, and academic public health laboratories will play a vital role in understanding the transmission, evolution, and treatment of SARS-CoV-2. I am confident that our finest, most skilled minds are working together to help us save lives today and tomorrow,” said CDC Director Robert Redfield, MD.

into the biology of SARSCoV-2, the virus that causes COVID-19, and help define the changing landscape of the pandemic. By sequencing viruses from across the United States, CDC and other public health authorities can monitor important changes in the virus and use this information to guide contact tracing, public health mitigation efforts, and infection control strategies. The SPHERES consortium is an ambitious effort to coordinate SARS-CoV-2 genome sequencing nationally, organizing dozens of smaller, individual efforts into a single,

Tracking the COVID-19 Virus as it Evolves Genomic sequence data can give unprecedented insight

Minority Nurse | SUMMER 2020

distributed network of laboratories, institutions, and corporations. The consortium combines the expertise, technology, and resources of 40 state and local public health departments, several large clinical laboratories, and over two dozen collaborating institutions across the federal government, academia, and the private sector. SPHERES will establish best practices and consensus data standards, accelerate open data sharing, and establish a pool of resources and expertise to help bring cutting-edge technology to the national COVID-19 response.

SPHERES Data Open, Shared Consortium members share a commitment to rapid open sequence sharing. They plan to submit all useful sequence data into public repositories at the National Library of Medicine’s National Center for Biotechnology Information (NLM/NCBI), the Global Initiative on Sharing Avian Influenza Data (GISAID), and other public sequence repositories. This will help ensure that that viral sequence data from across the United States is rapidly available for public health decision making and freely accessible to researchers everywhere.

Vital Signs Consortium include:

members

Federal Agencies and Laboratories • Centers for Disease Control and Prevention, Office of Advanced Molecular Detections • Argonne National Laboratory • National Institute of Allergy and Infectious Diseases, Office of Genomics and Advanced Technology • National Institute of Standards and Technology • N a t i o n a l L i b r a r y o f M e d i c i n e ’s N a t i o n a l Center for Biotechnology Information • Walter Reed Army Institute of Research

State/Local Public Health Laboratories • Arizona • California • Delaware • District of Columbia • Florida • Hawaii • Massachusetts • Maine • Maryland • Michigan • Minnesota

• North Carolina • New Mexico • North Dakota • Nevada • New York • Utah • Virginia • Washington • Wisconsin • Wyoming

Academic Institutions • Baylor University • Cornell University • Fred Hutchinson Cancer Research Center • Mount Sinai School of Medicine • New York University • Northern Arizona University • University of Buffalo • University of California, Berkeley • University of California, Davis • University of California, Irvine • University of California, Los Angeles • University of California, San Francisco • University of California, Santa Cruz • University of Chicago • University of Maryland • University of Minnesota

• University of Nebraska • University of New Mexico • University of Washington • Yale University

Corporations* • Abbott Diagnostics • bioMérieux • Color Genomics • Gingko Bioworks • IDbyDNA • Illumina • In-Q-Tel • LabCorp • One Codex Nanopore • O x f o r d Technologies • Pacific Biosciences • Qiagen • Quest Diagnostics • Verily Life Sciences *Names of corporations are provided for information purposes only, and their inclusion here does not constitute an endorsement of the corporations or any of their commercial products or services by the U.S. Centers for Disease Control and Prevention.

• Broad Institute • Chan Zuckerberg BioHub • J. Craig Venter Institute • Public Health Alliance for Genomic Epidemiology • Scripps Research • The Jackson Laboratory • Translational Genomics Research Institute – North • Walder Foundation For the past six years, CDC’s Office of Advanced Molecular Detection program has invested in federal and state public health laboratories to expand the use of pathogen genomics and other advanced laboratory technologies for infectious disease surveillance and outbreak response. The current consortium investment aims to save lives in the SARS-CoV-2 pandemic and prepare the United States and the world for future pandemic response. To learn more about genomic sequencing or CDC’s work in advanced molecular detection, visit https://www.cdc.gov/amd.

Non-Profit Public Health or Research Institutes • Association of Public Health Laboratories • Bill and Melinda Gates Foundation

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Making Rounds

August 20-22

American Nursing Informatics Association 2020 Annual Conference Virtual Info: 866-552-6404 E-mail: ania@ajj.com Website: www.ania.org

September 9-12

Academy of Neonatal Nursing 2020 Fall National Advanced Practice Neonatal Nurses Conference Virtual Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

23-25

National League for Nursing 2020 Education Summit Virtual Info: 800-669-1656 E-mail: summit@nln.org Website: https://summit.nln.org

October 15-17

The American Assembly for Men in Nursing 2020 Annual Conference Virtual Info: 929-515-4945 E-mail: info@aamn.org Website: www.aamn.org

Minority Nurse | SUMMER 2020

21-24

Transcultural Nursing Society 46th Annual Conference Galt House Hotel Louisville, Kentucky Info: 888-432-5470 E-mail: staff@tcns.org Website: www.tcns.org

November 1-4

Association of Women’s Health, Obstetric and Neonatal Nurses 2020 Annual Convention Mirage Hotel and Convention Center Las Vegas, Nevada Info: 800-673-8499 E-mail: customerservice@awhonn.org Website: www.awhonn.org

April 2021 21-24

Academy of Neonatal Nursing 2021 Spring National Advanced Practice Neonatal Nurses Conference Hilton Hawaiian Village Oahu, Hawaii Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

June 2021 15-20

American Association of Nurse Practitioners 2021 National Conference Anaheim Convention Center Anaheim, California Info: 512-442-4262 E-mail: conference@aanp.org Website: www.aanp.org

August 2021 3-8

National Black Nurses Association 2021 Annual Institute Conference The Diplomat Beach Resort Dallas, Texas Info: 301-589-3200 E-mail: info@nbna.org Website: www.nbna.org

and

11-13

Doctors of Nursing Practice 2021 National Conference Swissotel Chicago Chicago, Illinois Info: 888-651-9160 E-mail: info@doctorsofnursingpractice.org Website: www.doctorsofnursingpractice.org

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BY CIARA CURTIN

2020 Annual Salary Survey In this year’s salary survey, nurses report earning lower salaries than last year, but factors such as experience, education, and specialty affect pay levels.

urses reported making slightly lower salaries this year than they did last year. Overall, respondents to this year’s Minority Nurse salary survey earned a median $65,469, down from the median $76,000 respondents to last year’s salary survey said they made.

Both African American and Hispanic nurses reported lower salaries this year than last. African American nurses said they made a median $74,000 this year, while last year they reported earning a little more, a median $76,000. It’s still more than African American nurses reported earning five years ago, a median $70,000. Hispanic nurses noted more of a decline, reporting a median $56,100 in salary this year, as compared to $72,000 in 2019. In 2015, Hispanic nurses reported making a median $76,000. To collect this data, Minority Nurse and Springer Publishing e-mailed a link to an online survey that asked nurses what their salaries were. The survey also asked nurses about their educational background, where they worked, any specialization they might have, and more. Nearly 200 nurses from across the U.S., from Alabama to New York to California, responded.

Number of Respondents:

193 Ethnicity 1.6%

7.3%

5.7% 3.1%

4.1%

56.0%

15.5% 6.7%

■ African American ■ Multiracial ■ Other ■ Asian ■ Native American ■ Prefer not to answer ■ Hispanic or Latino/Latina ■ White/Non-Hispanic

Gender 10.5% 89.5%

The respondents work in various roles, from triage to administration to research, but nearly 60%, are involved in patient care. They also work in a range of settings encompassing not only public and private hospitals, but also correctional facilities and the military. The respondents also hail from a range of career stages: while about a third of respondents have been working as nurses for five years or less, more than 28% have been in the field for more than 21 years. That experience is reflected in their salaries. Nurses just starting out—those who have been working in the field for a year or less—reported earning a median $42,000. However, salaries then rose. Nurses with six to 10 years of experience said they earned $71,500, while nurses who have been in the field for 21 or more years reported a median salary of $82,000. Education also affected how much nurses take home in pay, with increasing education associated with boosts in overall salary. Nurses with associate’s-level degrees reported a median salary of $58,491 and those with bachelor’s degrees reported a median $63,000. Nurses with master’s degrees and doctoral-level degrees, meanwhile, reported higher salaries of $94,021 and $99,000, respectively. The same pattern held true among African American nurses. African American nurses with associate’s-level degrees made a median $60,000 and African American nurses with bachelor’s degrees made $67,600, while African American nurses with master’s degrees earned a median $91,500. Some specialties also had higher salaries than others. Family nurse practitioners reported earning the most, taking home a median $86,000, though medical-surgical nurses were not far behind, earning a median $82,000. Acute care and critical care nurses, meanwhile, said they earned $71,000 and $68,000, respectively.

■ Female ■ Male

Minority Nurse | SUMMER 2020

Regions

Years as a Nurse

4.2% 8.8%

14.1%

17.3% 19.9%

28.2%

44.5%

■ South ■ Northeast ■ Midwest

20.4%

■ West ■ Outside the United States

■ 21 or more years ■ 11 to 20 years ■ 6 to 10 years

Main Role 3.3%

■ 1 to 5 years ■ Less than a year

0.5% 3.8%

1.6%

0.6% 6.6%

18.2%

Employer Type

3.3% 7.7%

24.3%

6.6%

3.8%

1.6% 3.8%

1.1%

11.5%

0.5%

9.3%

13.3% 39.9%

58.6%

2.7%

16.9%

2.7%

■ Patient care ■ Leadership/Management ■ Education ■ Administrative

■ Other ■ Case Management ■ Triage ■ Research

■ Public Hospital, including ■ Health Department/ Veteran’s or Indian Affairs Public Health Agency Hospitals ■ Home Health Care Service ■ Private Hospital ■ Public School ■ College or University ■ Walk-In Clinic ■ Other ■ Correctional Facility ■ Nursing Home, LTC, or ■ Military Rehabilitation Center ■ Pharmaceutical/ ■ Health Insurance Research Company Company/HMO/MCO ■ Private Practice or Physician’s Office

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Median Salary by Region

Northeast

West

$78,000

$87,500

Midwest $60,000

South $65,000

Median Salary by Region and Ethnicity

$70,825

Northeast

$84,500

$55,000

South

$67,800

Midwest

$72,500

$68,000

West $92,500

$10,000

$20,000

Hispanic or Latino/Latina

Minority Nurse | SUMMER 2020

$30,000

$40,000

$50,000

African American

$60,000

$70,000

$80,000

$90,000

$100,000

Median Median Salary Salary byby Education Education Level Level $120,000 $120,000

Median Median Salary Salary byby Main Main Role Role $90,000 $90,000 $83,000 $83,000

$94,021 $94,021 $70,000 $70,000

$80,000 $80,000

$65,000 $65,000

$60,000 $60,000 $63,000 $63,000

$60,000 $60,000

$85,000 $85,000

$80,000 $80,000

$99,000 $99,000 $100,000 $100,000

$85,000 $85,000

$56,550 $56,550

$50,000 $50,000

$58,491 $58,491

$40,000 $40,000 $40,000 $40,000

$30,000 $30,000

$20,000 $20,000 $20,000 $20,000 $10,000 $10,000 $0 $0

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$100,000 $100,000

$90,000 $90,000

$86,000 $86,000 $82,000 $82,000

$80,000 $80,000 $70,000 $70,000

$80,000 $80,000 $67,600 $67,600

$71,000 $71,000

$64,800 $64,800

$60,000 $60,000

$70,000 $70,000 $54,000 $54,000

$68,000 $68,000

$60,000 $60,000

$50,000 $50,000 $50,000 $50,000 $40,000 $40,000 $40,000 $40,000 $30,000 $30,000 $30,000 $30,000 $20,000 $20,000 $20,000 $20,000 $10,000 $10,000 $0 $0

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Median Salary by Ethnicity

Hispanic or Latino/Latina

$56,100

African American

$74,000

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

Median Salary by Education and Ethnicity

$55,000

Hispanic or Latino/Latina $64,050

$91,500

African American

$67,600

$60,000

$10,000

$20,000

Master’s

$30,000

$40,000

Bachelor’s

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

Associate’s

Median Salary by Organization and Ethnicity

$50,000

Nursing home

$72,000

Public hospital

$66,990

Private hospital

$75,000

$10,000

$20,000

Hispanic or Latino/Latina

Minority Nurse | SUMMER 2020

$30,000

African American

$40,000

$50,000

$60,000

$70,000

$80,000

Timing of Last Raise Received 8.4%

Highlights • 39.9% work at a public hospital • 58.6% work in patient care

4.8%

• 28.2% have been working as a nurse for 21 years or more

12.0%

• 74.9% received a raise within the last year • 62.4% said their last raise was a 1-2% boost 74.9%

■ Last year ■ 2 years ago

■ 3 to 5 years ago ■ More than 5 years ago

Top Two Degrees Held by Respondents • BSN, or other bachelor’s-level degree • ADN, or other associate’s-level degree

Most Common Specialties • Critical care (NICU, PICU, SICU, MICU) • Medical-surgical

Percentage of Last Raise 10.0%

• Community health/Public health • Psychiatric/Mental health

3.5%

24.1%

• Acute care

Best Pay by Employer 62.4%

• Private hospital • Public hospital, including Veteran’s or Indian Affairs hospitals

■ 1% to 2% ■ 3% to 4%

■ 5% ■ More than 5%

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Discover Nurse-Led Innovation

Minority Nurse | SUMMER 2020

BY JEBRA TURNER

urses have always applied their expertise and ingenuity to improve the workplace and patient care. Nurse innovation is now its own specialty, as well as a soughtafter skill that every nurse must develop. As we face global health threats, such as COVID-19, it is time to empower front-line nurses and innovation specialists to solve our most pressing problems. After all, nurses bring a unique perspective that physicians, researchers, and administrators can’t offer. In these profiles, innovation nurse leaders describe their work, and show how nurses—in and out of hospital settings—can transform health care in this brave new world.

HIGH-TECH, LOWTECH, NO-TECH “Even as a nursing student I was inventing workarounds

for my patients,” says Hiyam Nadel, MBA, CGC, RN, director of the Center for Innovations in Care Delivery at Massachusetts General Hospital. “Most nurses are natural innovators—innovation is a sexy term right now, but it's really about solving problems.” For example, while ambulating patients with foley catheters during an internship, Nadel devised a taping solution to keep the catheter from pulling and causing pain. When several years later the solution was commercially available, other nurses thought it was her invention. But it wasn’t—someone else beat her to market. Disappointed by that missed opportunity, she wondered, ‘What am I missing?’ and decided to pursue an MBA in innovation to find out. She later became a founding member of the Society of

Nurse Scientists, Innovators, Entrepreneurs, and Leaders (SONSIEL). Why are nurses poised to be such an influential force in health care innovation? “Nurses are on the frontline, they understand human needs and dignity at a very deep level, they touch the equipment and can recognize when it’s not working well,” says Nadel. “We have to get them around the table, contributing to problem solving and identifying solutions.” By providing training on entrepreneurship and the legal implications of innovation, some nurses are taking their workarounds and turning them into products and devices. “Innovation shouldn’t be intimidating. It doesn’t have to include technology. In fact, we encourage solutions that are high-tech, low-tech, and no-tech,” she says.

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Nadel leads “mini-hackathons” at the hospital to problem solve in a new way on important issues. “I teach them the ideation process. As we break things down, people can generate ideas, then innovations spread from

“People think innovation is a buzzword or a fad but across history, the nursing profession was founded on innovation,” Love says. unit to unit, so we’re not so siloed,” she adds. One example of an innovation in development is an adaptive feeding kit for ALS patients so that they can feed themselves. Otherwise, these patients would have to prematurely go into a long-term care setting, or wait to eat until caregivers employed outside the home are present, explains Nadel. Recently, outside organizations have requested innovation consultation from nurses at the hospital, recognizing their unique perspectives. “Startup companies are coming to us for nurse pilot programs. They’re aware that nurses are the end users so they should be the ones to test new products before commercialization,” she says. The center is also involved in product prototyping.

REBEL NURSE Rebecca Love, MSN, RN, president and cofounder of SONSIEL, has been on the vanguard of pushing the boundaries of the nursing profession to include a pivotal role in health care innovation. The Boston-based

innovator is also one of the authors of The Rebel Nurse Handbook: Inspirational Stories by Shift Disruptors, which covers over 40 stories of innovation and entrepreneurship. “People think innovation is a buzzword or a fad but across history, the nursing profession was founded on innovation,” Love says. When Florence Nightingale led the charge for sanitation in military hospitals during the Crimean War, she challenged conventional thinking. The doctors of that time didn’t accept the new germ theory and her insistence on sanitation in patient care. “They believed that ‘if you could not see it, it does not exist.’ So nursing was always the ability to think differently.” Love points out that the current state of health care asks nurses to do more with less but doesn’t provide a way to venture into other arenas. “There are no opportunities to not live a Groundhog’s Day life,” she explains. “The traditional path for nurses is to pursue their degrees, up to a PhD, then join academia, and publish research. Innovation and entrepreneurship are not highlighted as viable options. When we deny nurses the right to innovate, they leave the bedside.” Years ago, when Love was a struggling entrepreneur, someone suggested she attend a hackathon, a multi-day event where people work together to innovate. “There were administrators and physicians and PTs there, but no nurses,” she recalls. “I thought I was in the wrong room—that these were the decision makers, and I didn’t belong there.” Later, Love learned that though few

Minority Nurse | SUMMER 2020

nurses participated in Bostonarea hackathons, a high percentage of the winning teams included a nurse member. Love then sought to organize the first nurse hackathon, but “got shot down at university after university” until Northeastern University hosted the summit in June of 2016. “Two weeks before the event, it sold out and it was a big success. The weekend of the hackathon changed my life. There’s a sense of empowerment, and for many nurses, when they leave the event they feel they can change the world.”

NURSE PERFORMANCE IMPROVEMENT Innovation is the new

Innovation is the new required nurse skillset, according to Uniqua Smith, PhD, RN, NE-BC, associate director of innovation and performance improvement at MD Anderson Cancer Center in Houston, Texas. required nurse skillset, according to Uniqua Smith, PhD, RN, NE-BC, associate director of innovation and performance improvement at MD Anderson Cancer Center in Houston, Texas. Nurses have always been innovative but “they don’t toot their own horns,” she says. “Many do not call it innovation; this is just what we do. But nurses don’t realize just how spectacular their innovation skills are.” It is Smith’s mission to help hospital staff to come up with

better ideas, improve their practice, and then to share those innovations with other units and hospital systems. An example of a nurse-led innovation at MD Anderson involves hospital compression stockings, which for years have been required for surgery. But some nurses noticed that they caused skin integrity issues. “Those stockings had been part of traditional practice, to reduce the risk of DVT, but if a device is causing harm to our patients, we need to assess it,” explains Smith. “The literature says the results are just the same using sequential compression devices, without the stockings. So the nurses launched a pilot program on their unit, and the results basically changed the policy for the entire institution.” The nurses are also in the final stages of publishing their findings in an academic journal. “Nurses are trained in the clinical aspects of nursing, but not so much in sharing the great things that they’re doing,” says Smith, which is something that she assists them with in her abstract writing class and other interventions. Another crucial innovation focus is nurse well-being and resilience. “We’re looking at nurse wellness, to make sure our staff members do not burn out, especially in oncology.” The nurses in one of the units decided to create an “escape room,” and received a grant from the wellness department to outfit the room with a massage chair, aromatherapy scents, and healthy snacks. Their next innovation opportunity is ensuring that nurses make use of the

room—without apology or guilt. “When I was a bedside nurse I didn’t even want to take a restroom break or a full lunch break,” says Smith. “My manager decided to allocate an extra nurse who could serve as ‘lunch relief’ and relieve people to go to lunch,” a system that’s still in use a decade later, she adds. Smith notes that younger nurses are comfortable asking, “Why do we do it this way?”— and not just going along with generally accepted practices. “They open the door for all of us to do the same,” she says. “Do the research, read the literature, and see for yourself why we do it like that. We encourage evidence-based practice, but if there is no evidence then you need to put on your thinking cap and figure out a way to improve it.”

INNOVATE FOR NURSE RESILIENCY Some hospitals have innovation labs while others take a unit-based approach, says

Montalvo recommends that nurses approach innovation in an organic manner. Start reading and listening to podcasts about business and innovation, but know that “nursing sets you up for innovation,” she says. Nicole Lincoln, MS, RN, CCNS-BC, FNP-BC, CCRN, senior manager of nursing innovation at Boston Medical Center and a SONSIEL founding member. All are committed to innovation as part of the

magnet model, which emphasizes shared governance and giving voice to nurses at the bedside. “I was a nurse educator so it was natural for me to go to the nurses in the units,” she explains. “Some hospitals are more involved with innovating products but my nurses in unit-based councils are more about workflow.” Why are bedside nurses benefited by nurse-led innovation initiatives? “Innovation builds resiliency in nurses. Otherwise you can feel like it’s a hopeless situation—but if they can see that they have power to address inefficient workflows, that can be very motivating because it makes it a better workplace for them,” she says. “If something is broken nurses don’t feel they can fix

it, but can just come up with workarounds, that only causes burnout.” One of the broken areas in need of improvement is electronic recordkeeping, which has been a boon in some ways, “but for nurses, it’s also terrible,” Lincoln says. Where before nurses could quickly flip through a chart, now they have to navigate through an endless labyrinth of information. “The people who created the electronic records technology are not nurses. So, we’ve formed a nurse informatics council that comes together for one whole day every month to make changes. Our group is all nurses working at the bedside because they’re closest to the work. That’s part of the shared governance piece,” she says. Information technology is one of the keys to closing the

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communication gap between nurses and doctors, who often work in separate areas of the hospital. “Nursing is at risk of losing the core of our p rofession—caring and compassion,” she warns. “Everybody is just staring at the screen.” Oftentimes talk of nurse resiliency is focused on wellness, mindfulness, and selfcare. But another aspect of resiliency is vital for nurses: “Power to make the changes we need in our workplace— whether that’s technology, product, or innovation, but most of the time it is workflow,” Lincoln explains. “It also helps connect them with their patients, giving them purpose, as it is rewarding knowing they had a positive impact on their patients’ lives.”

INNOVATING FOR COMMUNITY HEALTH Antonette Montalvo, MSN, PNP-BC, BSN, RN, pediatric nurse practitioner and community health consultant in South Carolina, is cofounder of Montalvo International Community Health Initiative. Montalvo’s parents are pastors in a small town there, focused on the care of the whole person, including the

Beaudet believes the “incredible spike in the cost of delivering care” could be reduced if nurses were empowered to bring their knowledge, ideas, and insights to the table.

Minority Nurse | SUMMER 2020

health problems of their congregants. “I heard about illness and people having complications because of diabetes,” Montalvo recalled, and relocated in order to help. She intended to open a medical clinic but ran into resistance, as South Carolina is one of the most restrictive states for nurse practitioner full practice authority. She also found it harder to break into town silos. Montalvo had education and experience in global, community, and population health so she applied the same perspectives to this southern town. “I was seeing community factors influencing the health of the person. So if a patient had high blood pressure or diabetes, I’d ask myself all these questions,” she explains. “Do they have access to medicine? Do they

have transportation or the money to get it? Are people in the church congregation aware this person has diabetes? Does everyone in the family have diabetes so that it seems normal to them?” Patients and families often didn’t understand all the factors involved in their illness— and sometimes neither did clinicians. She was able to act as a liaison between the two groups, says Montalvo. “In this rural area you have to be able to drive 20 minutes to get to a clinic. If you don’t have a car, you can’t get there,” she explains. With other community members, she would like to pilot creative solutions, such as a mobile clinic parked where people already gather, perhaps at the library or Walmart.

Tradition of Supporting Nurses– With a New Twist When Lynda Benton, senior director of corporate equity at Johnson & Johnson, took on the role of leading the J&J Nursing Campaign in 2017, she was tasked with evaluating the focus of the company’s 120-year commitment to advocating for the nursing profession. “Many people know J&J from when we stepped in to help address the U.S. nursing shortage in 2001, when a severe U.S. nursing shortage of 500,000 nurses was forecasted to occur by 2020,” she explains. “By 2017, when we saw that 1.1 million people had indeed joined the profession, J&J leadership asked me to take a fresh look at the focus of our strategy.” After conducting extensive research, Benton led a strategy shift as a way to do more to empower nurses and elevate their profile as innovative leaders on the global health care stage. “Championing Nurses as innovative leaders launched in 2018 with a TV commercial, which was very well-received,” she says. “But I knew we had a responsibility to do more. We needed to find a way to directly empower and support nurse-led innovation in health care so that nurses would be more visible, and more involved in shaping our complex, evolving health care system. The J&J Nurse Innovation platform includes multiple initiatives, some with partner organizations, including J&J Nurses Innovate QuickFire Challenge Series; J&J Nurse Innovation Fellowship; SEE YOU NOW podcast; and SONSIEL Nurse Hackathon 2.0. “The hackathon was a phenomenal experience for the nurses who attended, and for me personally. There were over 200 attendees there, from student nurses to people in their early 70’s with decades of experience,” Benton explains. “I kept hearing them say: ‘I didn’t know what to expect, but I feel like I found my tribe.’ It was a high-energy, warm, supportive weekend.” A second SONSIEL Hackathon is scheduled for September 2020.

Montalvo recommends that nurses approach innovation in an organic manner. Start reading and listening to podcasts about business and innovation, but know that “nursing sets you up for innovation,” she says. “Understand your vision, your North Star, and see our nursing skillset as the basis for innovation.” Surprisingly, Montalvo’s main business has become life coaching and mentorship for nurses. “When I began sharing on LinkedIn about starting my initiative, nurses started reaching out to me,” she says. Now she coaches other nurses on how to innovate in their personal lives, careers, and in the wider community.

QUEST FOR DIVERSITY AND ETHICS “Innovation is one of our priority initiatives and for organizational strategies, but it’s also core to who we are as a profession,” says Oriana Beaudet, DNP, RN, PHN, the vice president of nursing innovation at American Nurses Association (ANA). “Nurses have always been innovators. They think like engineers—they’re always working to find the best solution for patients, families, and communities. And if it doesn’t work, they go back to the drawing board.” Beaudet believes the “incredible spike in the cost of delivering care” could be reduced if nurses were empowered to bring their knowledge, ideas, and insights to the table. ANA is one of the lead organizations driving nurse innovation today. Because it is a strategic priority, they are creating opportunities for funding of research around

nurse-led innovation, the ANA Innovation Award powered by BD, a partnership with HIMSS around innovation and NursePitch™, they also have the podcast SEE YOU NOW with Johnson & Johnson. Beaudet says diverse representation matters in innovation because it leads to more creativity. “Innovation requires radical inclusivity. When looking at the science of teams, the broader an individual’s background, it increases the likelihood of the group’s ability to come up with innovative solutions,” she explains. Liz Stokes, JD, MA, RN, director of ANA’s Center for Ethics and Human Rights, believes it’s also critical for nurses to understand that innovation, and especially artificial intelligence (AI), carries an ethical dimension for nurses. “Nursing is already involved in the use, implementation, and design of AI, and we continue to see technology in health care,” she says. “AI or any type of program or design that approximates the human mind, that searches data from algorithms and then predicts something—patients discharge, for instance—is an important justice issue for nurses and people of color.” How is technology an ethical issue? Stokes explains that devices “may be marvelous gadgets, but deficient because they haven’t been designed for a minority population or people of color may not have access to them.” Jebra Turner is a freelance writer located in Portland, Oregon. Visit her at www.jebra.com.

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FINANCE

101

What New Nurse Managers Need to Know 24

Minority Nurse | SUMMER 2020

By Michele WOJCIECHOWSKI

When you become a nurse manager, your duties will include dealing with financial responsibilities. Here’s what you need to know to be a success.

ou are good at your job, and you know it. You can supervise staff, keep up on supplies, and are a good leader. But the only finances you’ve worked with in the past have been your own. How can you transition to taking care of budgets, payroll, and other financial needs of your job? Don’t worry. If you don’t have the skills, you can get them. Karen Albright, RN, BSN, nurse administrator at Riva Road Surgical Center, LLC, says that she trains nurses in administration as part of her job. “The nurses seem to have a much clearer understanding of the whole picture and a much longer tenure with the company. They don’t give up easily. Nurses are tenacious and refuse to fail,” says Albright. In addition, know that your superior skills are what brought you to this position in the first place. “New nurse managers tend to be good clinicians with solid clinical, organizational, and personal management skills. It’s these traits and skills that got you noticed and qualified you for a management position,” says Al Kauffman, PhD, an associate professor of nursing and dean of the School of Nursing and Health Sciences at Spring Arbor University. “As a new nurse manager, you will be

using all of these skills in addition to developing new ones. One of the most important skillsets you will learn is financial management. The success of your unit will be measured in part by its financial outcomes. Consequently, your success will be measured, in part, by your management of the financial aspects of your new position. By applying the same techniques you used to become a great clinician, you can become a great financial manager.”

Look to Others for Help Whether you are learning on the job about finances or you are studying (see educational opportunities later in the article), it’s a good idea when you first start your position to meet with the budget analyst for your unit or clinic. “This will help you understand how the budget is developed,” suggests Jamesha Ross, MBA, BSN, RN, an occupational health manager for the City of Tulsa. This person can also help you understand what you are responsible for exactly. “You will need to set a routine for monitoring your budget. This should be done monthly at a minimum. It is important to know what spending decisions you can make without approval and what the dollar threshold is. Usually organizations will

implement a spending freeze if budget projections are not on target. Are you responsible for inventory control? If you are, make sure you understand the process of ordering and the

“Transitioning from a direct care nurse to nurse manager is a dynamic experience,” says Ross. approved levels of supplies on hand. Some organizations have a department that controls inventory and supplies, and it is not a direct responsibility of the nurse manager.” Marisha G. Grimley, DNP, MSN, PHN, director of nursing education services at Nightingale College, agrees. “One piece of crucial information I was given that has served me really well is to befriend the organization’s Chief Financial Officer (CFO) or accounting director,” she says. “A good partnership with these key leaders can really help move an organization forward. Having a CFO or accounting director as an ally can be beneficial to the entire organization.”

The Basics As a new manager, you will need to know and understand some basic financial

terminology. Kauffman suggests that these terms are a must: • Full-time Equivalent (FTE): Units equivalent to an employee working fulltime, usually 30-40 hours per week. • Cost Center: A unit in an organization which costs are charged for. • Revenue Center: A unit in an organization responsible for producing revenue. • Budget: A summary of planned expenses and revenue for a period of time. Types of budgets include operating, supplies and equipment, personnel, capital, and revenue. • P a t i e n t C l a s s i f i c a t i o n System: A system developed to determine workload requirements for a nursing unit including staffing needs and work hours. • Cost Accounting: The recording of costs incurred in a business unit. • Unit of Service: The unit of measurement uses for billing of therapy. • Expenses/Costs: The money required for something. Types of costs include direct, indirect, fixed, variable, and sunk. “Transitioning from a direct care nurse to nurse manager is a dynamic experience,” says Ross.

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some organizations have a fiscal budget year of July 1 through June 30. • ROI: Return on investment. This is usually used to measure effectives of programs that are offered by your unit or clinic. Understand the metrics being used. • Compensation: Employee compensation is more than salary or wages. Understand how much each position is being compensated (e.g., benefits, paid time off, retirement). • Cost Savings: The amount of money saved as the result of changes or planning. Your organization may have a policy that includes annual bids for services that are over a certain dollar amount.

Additional Foundational Concepts

In addition to managing staff members, you need to recognize the part they play in your budget. “Understand the process of staffing is a subset of managing personnel,” says Kauffman.

“The responsibility of managing a unit or clinic is totally different than managing a team of patients. Finance will become your second language. In most hospital settings, the nurses are considered an expense. This makes the nurse manager focus more on controlling expenses to stay within budget.”

She suggests that nurse managers learn the following terms (some have already been suggested above, however, her reasons/definitions for including are somewhat different): • Budget: Money that is allotted for your unit or clinic operations. You need to find out which budgets support your unit or clinic. How many budgets do you have? Understand how much it takes to operate your unit. Do you have input on budget development? • Revenue: The amount of money that is charged for the unit’s services. • Costs: The amount of money spent on operating the unit. You will need to

Minority Nurse | SUMMER 2020

know what it costs to provide your services. • Market Share: The amount of services or admissions that are provided by your organization compared to other organizations in a certain area or for a certain diagnosis. • Payor Mix: How the payors breakdown for your organization. • Staffing: How many nurses are needed for the patient census. Are staffing decisions made on patient census or acuity? • FTE: Full-time employee equivalent. What is the threshold for full-time employment for the positions that report to you? • Fiscal: The financial budget year. For example,

“It’s important for all clinical leaders to understand the organization’s mission statement, as well as its strategic plan, which always includes the organization’s financial goals,” says Stephen “Jan” Grigsby, MHA, FHFMA, vice president and chief financial officer at Springhill Medical Center in Mobile, Alabama. He explains that clinical leaders should also learn about: • The overall financial and productivity goals set by management on an annual basis (Operating Margin, Department of Labor Productivity Standards, Clinical Quality measures from the Federal Government that carry financial implications). • Their own department/unit’s statistical measures and the relation to their budgeted financial expectations for the particular fiscal year.

• Their own department/ unit’s measure of Labor Productivity standards, set annually with the vice president. Grigsby also advises nurse managers to know the following so that they can create and stick to their annual budgets. He says that this is crucial for measuring operational as well as managerial performance: • Salary expense controls— Labor productivity targets • Supply expense controls— Maintain sufficient levels to meet budgeted statistical volumes and control costs to avoid excess expense. • C o n t r a c t s e r v i c e s — Maintain working knowledge of any outside services contracted for your department (e.g. Dialysis, Laundry, Agency Nursing). • Service contract—You may be asked to lead a department with several sophisticated pieces of equipment. You must work with biomedical leadership to monitor maintenance and replacement needs for equipment. Peter B. Longley, DNP, RN, a service line finance manager, explains that nurse managers need to understand that patient care centers are “cost centers,” which means that “the organization is focused on how the expenses are being managed for that area as compared with the published budget and the previous year for comparison,” he says. “There are two major categories within the cost center— salary and non-salary. Salary expenses pertain to staff working to care for the patients as well as their premiums, such as shift and weekend

differentials and overtime. Non-salary expense items are medical and surgical supplies, linen, telephone, utilities, allocation, travel, conferences, and the like. Every institution will define them differently.”

Staffing In addition to managing staff members, you need to recognize the part they play in your budget. “Understand

the process of staffing is a subset of managing personnel,” says Kauffman. “The personnel budget is usually a major expense in a nurse manager’s budget. New nurse managers will need to become familiar with the legal aspects and organizational policies related to all facets of managing personnel. Personnel management includes hiring, onboarding, employee compensation, mentoring, discipline, employee termination, and staff mix.” In case of emergencies, like staff shortages or changes in patient volume, Grigsby says, “You will need to be aware of your annual staffing budget and full-time equivalent calculations. You will need to be trained on how to flex staff for changes in patient volume, sometimes at a moment’s notice. Finally, you will need to be aware of the organization’s PRN pool, if available. This resource can prove extremely valuable in times of volume increase, or staff shortages.”

Longley explains that nurse managers must understand their staffing resources in order to be able to manage their salary budget. He says they need to know the following: • Staffing grids: This is how you anticipate care being delivered and by whom. (Example follows.) How many staff members you need during different shifts will affect the salary part of your budget. » Day Shift—5 RNs, 2 patient care technicians » Evening Shift—4 RNs, 2 patient care technicians » Night Shift—3 RNs, 1 patient care technician • Payroll: The department responsible for compiling all of the timecards and paying staff correctly. • Timecards: You will need to verify and sign-off on every staff member’s timecard, so that Payroll releases the correct amount of money to the staff.

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While some nurse managers do learn on the job, others choose to find ways to build their financial skillset. Getting the Education Needed While some nurse managers do learn on the job, others choose to find ways to build their financial skillset. Ross worked in her first managerial position before she had any business training. So she learned on the job. “I learned from the other unit nurse managers, and I set up meetings with the CFO, controller, and human resources director to get a more in-depth look at how my unit was performing so that I could optimize performance,”

she says. “Mentors and coaching are also an option.” “There are conferences for new managers on understanding budgeting and other financial aspects of managing nursing units. Many health care organizations provide training sessions for new managers. One effective way to learn financial management skills is to ask your manager. Allow your manager to mentor you in this area,” says Kauffman. “New nurse managers should be encouraged to meet the people in their organization working in accounting and the business office. Often, these employees are happy to communicate with and teach new managers. Of course, new managers can take formal classes in accounting and finance for managers in a

university setting either as part of a degree-seeking program or individual classes.” Grigsby says that classes or degree programs in Health Administration or Business Administration may include the financial information that nurse managers need. “Any Master’s of Science in Nursing Administration will have a health care finance course that will dive deeper,” says Longley. “There are also certifications you may earn, such as the Certified Nurse Manager and Leader (CNML) credential.

Top-ranked nursing programs Distance learning options Multiple entry options for nurses and non-nurses

nursing.vanderbilt.edu Vanderbilt is an equal opportunity affirmative action university.

Minority Nurse | SUMMER 2020

Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about

Believe in Yourself

the nursing field but comes close

Whether you know a lot or a little about financial terminology and foundations when you start your nurse management position, any

to fainting when she actually sees

ADVANCE TO THE NEXT LEVEL MSN . DNP . POST-MASTER’S . PhD

answers or knowledge you need is out there. You just need to look for it. “Just know that the collaboration between nursing and finance has improved considerably over the past decade in health care,” says Grigsby. “The more communication that takes place between the two areas, the better tools we all have to best take care of our patients, and therefore, our community.”

blood. She’s also author of the humor book, Next Time I Move, They’ll Carry Me Out in a Box.

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Academic Forum

The Fear of Caring: Novice Versus The Experienced Nurse By Marie MURRAY, MSN, BSN, RN

Fear is a word that all of us try to ignore, and most of the time, we deny it. Being afraid is a natural emotion or reaction to some situations. According to the King James Version Dictionary, fear is defined as a painful emotion or passion excited by an expectation of evil, or the apprehension of impending danger, and expresses less apprehension than dread, and dread less than terror and fright.

s a child, the introduction to fear can be simple or complex, passing or sustained throughout a lifetime. For example, childhood fear of the roller coaster can fade over time; however, remains recessed in the corners of one’s mind. Fear, when introduced as an adult, can trigger lifelong changes and can redirect one’s goals, ambitions, and self-image. Recently, the word was explored in conversation with a group of nursing professionals of varied ages. Novice nurses expressed the common fear of achievement and the apprehension of what’s to come. As a novice, nurses carry great responsibility as they too hold the lives of many in the palm of their hands. And whether good or bad the outcomes, the novice nurse feels the same responsibility as does the nurse who has practiced for decades. According to a 2016 study published in Journal of Caring Sciences, transition to practice can be a very difficult period. Fear for the novice can be examined and described as a period of questioning their own nursing knowledge and ability to do their jobs well. While older, more seasoned nurses are said to be the most skilled and productive employees, the ability to retain the

wealth of knowledge and skill has become difficult for many organizations. Older nurses have been viewed as more dedicated and loyal, and take less time off. Still, with new technologies, older nurses express a fear of being unable to keep the technological pace now being required, such as those skills required to preserve the integrity of PHI. The older nurse holds or possesses the skills and expertise to support the organization while

Fear, when introduced as an adult, can trigger lifelong changes and can redirect one’s goals, ambitions, and self-image.

Minority Nurse | SUMMER 2020

maintaining patient safety, support, and care. Older nurses also express the fear of being replaced before they have made the decision to leave the profession, or sometimes feeling pressured by anxiety-provoking tasks or assignments that are often seen as attempts to intimidate. Often, this can cause the older or more experienced nurse to self-doubt. Presenting a new world to the older nurse can be threatening and cause the nurse, despite her wealth of experiential knowledge and academic achievements, to feel inadequate. The ability to climb the academic ladder is challenging and requires self-discipline, focus, and determination that only a few possess early in their career. For the older nurse, many times the academic growth and

movement occurs after years of being in the clinical setting versus the novice nurse possessing a doctorate degree but no bank of experiential knowledge. So, in the perfect and supportive nursing world, the two groups would collide and form one united force to give those in their care their very best. Older nurses have the ability to build the profession by embracing and supporting the novice nurses, providing opportunities for growth and confidence. In turn, the novice nurse has the opportunity to share their vast, new knowledge, and technological skills to add to the restructuring or rebuilding of their organization’s nursing model. Together, the novice plus the experienced nurses can reduce the fears and apprehensions while celebrating the new. Marie Murray, MSN, BSN, RN, is a registered nurse with a 32-year background in psychiatric nursing.

Degrees of Success

Trailblazer in Nursing: A Major Career Accomplishment By Michael L. JONES, PHD, MBA, RN

On Wednesday, March 25, 2020, I successfully defended my dissertation titled “Perceptions of Rural CommunityBased Nurses and Perceived Family Stigma Related to HIV/ AIDS: A Mixed-Methods Study” at Hampton University, a historically black college and university (HBCU). In doing so, I became the first African American male—and only the third male—to successfully defend a dissertation in the school’s PhD nursing program. Additionally, there is only one other HBCU in the nation with such a program. It has not yet had an African American male graduate.

his was a major accomplishment for me as it was a first in many regards. Having grown up in very humble beginnings in rural Mississippi, I was the first in my family to become a registered nurse and ultimately earn a doctorate in nursing.

Since I graduated from high school, my grandmother always wanted me to become a “doctor.” While I was unable to give her a medical doctor, I was able to give her a different type of doctor. I’m proud just to know that I’ve made her proud. I’m extremely blessed in that she

is alive to see this accomplishment. In September of this year, she will celebrate her 86th birthday. My career in nursing began in 2000, when I earned an associate’s degree in nursing. I always wanted to serve in a profession where I could help individuals. It was either nursing school or become an English teacher. I decided to pursue nursing. This was one of the best decisions of my life. My very first job as a RN was as an orthopedic nurse. I later transitioned to a spinal cord injury rehabilitation unit where I practiced both full time and part time for approximately seven years. During that time, I continuously furthered my education, earning a bachelor’s

degree in 2003 and then a master of science in nursing degree in 2005. At the end of 2005, I felt myself getting burned out with bedside nursing. In 2006, I left the bedside full time, but continued to work part time on the weekend. During that time, I became employed in an insurance company as a provider educator. This was my first position outside of bedside nursing, while I continued to utilize my nursing skills. Over the years, I have worked in various capacities outside of nursing. In 2008, I earned a master of business administration with an emphasis in health care administration. It was also during this time that I found

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Degrees of Success my calling to serve underserved populations. As such, my career took a turn to focus on ensuring vulnerable populations had adequate access to care. Since then, I have been heavily involved in public and population health, primarily to ensure the social determinants of health and health literacy are addressed in populations dealing with various health issues. This includes my eightyear tenure (2008-2016) as Chief Community Health Officer for the University of Mississippi Medical Center (UMMC), where I had the duty of directing strategic relationships between the sole academic medical center (UMMC) in the state of Mississippi, the Mississippi State Department of Health, and the 21 Federally Qualified Health Centers in the state of Mississippi. These three organizations collectively provided the majority of care to the poor and underserved in Mississippi. I have written several articles,

including the Mississippi Nurses Association, Mississippi Public Health Association, Sigma Theta Tau, Eliza Pillars Registered Nurses of Mississippi, and the Association of Health Care Executives, just to name a few. For approximately 11 years, I have served as an adjunct instructor for various schools of nursing and schools of public health. Having received yet another calling to educate future nurses and public health professionals, I decided to pursue a PhD in nursing. As I researched various schools who offered this program, I found that Hampton University offered its program online. This would also assist in providing some flexibility given my busy work schedule. I also found that Hampton University had only graduated two males from its program, but not yet an African American male. I saw

Having grown up in very humble beginnings in rural Mississippi, I was the first in my family to become a registered nurse and ultimately earn a doctorate in nursing. spoken at various conferences (nationally and locally), and served on various committees (nationally and locally), related to public and population health. I have also been recognized for my work, including in 2013, when I received the Mississippi State Medical Association Award for Excellence in Wellness Promotion. I am active in various health-related organizations

Minority Nurse | SUMMER 2020

this as a challenge and took the plunge. I entered the program in the Fall of 2011 and worked at it over the next eight years. Having to juggle family life, a full-time job, several part time

Having to juggle family life, a full-time job, several part time activities, and other life issues, my progression took a little longer, but all of my hard work paid off on MarchÂ 25, 2020. activities, and other life issues, my progression took a little longer, but all of my hard work paid off on March 25, 2020. Currently, I serve as a project manager on a PatientCentered Outcomes Research Institute (PCORI) grant with

a local university. This grant is designed to address menâ&#x20AC;&#x2122;s health issues in the Mississippi Delta, which is one of the poorest and sickest areas of the nation. I also continue to serve as adjunct faculty in a School of Nursing and local School of Public Health. I plan to seek out full-time positions in academia where I can further advance the profession of nursing through education and research, particularly community-based participatory research. My goal is to establish programs to assist in increasing the number of minority males in nursing as well as increasing the number of minority males with doctoral degrees in nursing. Michael L. Jones, PhD, MBA, RN, is the founder of Jones Healthcare Solutions, LLC and serves as the senior consultant and trainer.

Health Policy

Surviving COVID-19: When Nurses Need Advocates By Janice M.PHILLIPS, PHD, RN, CENP, FAAN

The Coronavirus (COVID-19) has taken the world by storm leaving no nation untouched. For the first time in over 100 years, nurses in the United States are experiencing in real time what it is like to be on the front lines serving during a pandemic. Not since 1917-1918 has the United States’ health care system been tasked to meet the health care needs of its residents during such a widespread and deadly infectious disease outbreak.

imilar to nurses across the globe, nurses in the United States are providing direct care to some of the nation’s sickest patients affected by the virus. Each day nurses report to duty, placing themselves in harm’s way by increasing their personal risk for becoming infected by the COVID-19. The ability to apply personal protective equipment (PPE), whenever needed, is absolutely imperative in helping to mitigate the risk of exposure to any infectious disease. With COVID-19 cases surpassing one million in the United States and over 72,000 deaths nationwide, the ability to have access to life protecting equipment and supplies cannot be overemphasized. However, of concern are the recent reports that nurses in some settings across the country do not have appropriate access to PPE as recommended by leading public health authorities. Building on their strong history of advocating on behalf

of patients and the profession, nurses are now expanding their efforts to advocate for themselves and other nurses on the front lines during the current

Legislation

pandemic. Nurses across the country have started mobilizing and protesting to shed light on the criticality of the lack of PPE in their respective workplaces.

Provisions

Status

The American Nurses Association and other professional nursing organizations such as the National Black Nurses Association have

Comments

The Coronavirus Aid, Relief, And Economic Security (The CARES ACT)

$16 B to the Strategic National Stockpile

Passed

To be immediately used to purchase PPE and other life saving supplies

H.R. 6406 American-Made Protection for Health Care Workers and First Responders Act

Requires federal government to include PPE into the national stockpile as well as procure such equipment from U.S. sources.

Proposed

https://www.govtrack.us/congress/ bills/116/hr6406

One of the first pieces of legislation to be introduced this Congressional session on 3/24/2020.Similar pieces of legislation may be forthcoming.

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Health Policy

RESOURCES

History of the Strategic National Stockpile https://www.ncbi.nlm.nih.gov/books/NBK396378/

The CARES ACT and Key Health Care Priorities https://thehill.com/blogs/congress-blog/ healthcare/489878-cares-act-delivers-on-our-healthcare-needs-in-a-big-way

The American Nurses Association and Related Resources https://anacapitolbeat.org/2020/03/27/congresspasses-and-the-president-signs-into-law-third-covid19-package/

reached out to the nation’s highest-ranking elected officials demanding an immediate resolution to the shortage of PPE. The AARP, the nation’s largest nonprofit, nonpartisan

organization dedicated to empowering Americans age 50 and older, has been steadfast in advocating for better working conditions and protections for nurses during the

current COVID-19 pandemic. A growing number of groups, professional societies, nongovernmental agencies, and others are advocating on behalf of all of the health professions. This is a priority for protecting all members of America’s health care workforce. Although Congressional responses are unfolding, advocacy on behalf of nurses continues to grow and is much appreciated. The table provides a brief snapshot of recently passed and proposed legislation that will aid in addressing the current PPE shortage. To date, the Coronavirus Aid, Relief, And Economic Security (CARES Act) constitutes the greatest piece of recent legislation that will help address the shortage. Other pieces of legislation may be forthcoming. Some states and hospitals

are also instituting their own plan of action to ensure that frontline workers are protected. Prompt federal, state, and local responses are all needed during this time of crisis. All nurses are encouraged to stay abreast of the latest developments in this area. Please see the additional resources that provide information about the shortage and suggested solutions. In the meantime, be well, be safe and know that you are appreciated no matter where you are serving during this unprecedented time in our nursing history. Janice M. Phillips, PhD, RN, CENP, FAAN, is an associate professor at Rush University College of Nursing and the director of nursing research and health equity at Rush University Medical Center.

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Minority Nurse | SUMMER 2020

WE SALUTE OUR

NURSE HEROES

At Lewis, we share your passion for excellence and commitment to compassionate patient care. You will work closely with faculty in our state-of-the-art nursing facilities and online to become an expert practitioner and innovative leader, prepared to transform practice in a rapidly evolving healthcare system. Faculty promote Catholic and Lasallian values by creating an environment that fosters critical thinking, enlightenment, compassion, and community. We place an emphasis on respect for the human dignity of each person, and the pursuit of the common good in a community setting. Ethics, social justice, moral leadership and diversity are important priorities. The baccalaureate degree program in nursing/master’s degree program in nursing/ Doctor of Nursing Practice program and post-graduate APRN certificate program at Lewis University is accredited by the Commission on Collegiate Nursing Education (CCNE). ccneaccreditation.org

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Personal attention throughout the program Affordable and flexible face-to-face and online format Passionate, highly educated faculty with clinical experience Financial aid is available for those who qualify. Discounts for Graceland alumni. The program you need: Bachelor of Science in Nursing, Master of Science in Nursing, Doctor of Nursing Practice

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