National Nurses Week | Special Issue May 2023

FOCUS: NATIONAL NURSES WEEK

PRESENTED BY:

® ®

“A Nurse Making a Difference: Nurse Alice Benjamin”

6

A Nurse Making a Difference: Nurse

Alice

Benjamin

By Reneé Hewitt

14 Saving Sight Around the World

By Michele Wojciechowski

18 Taking a Seat at the Table: Why Nurse Unions Are Necessary Today

By Karie Pinnix

22 Teamwork Makes Every Nursing Team Better

By Julia Quinn-Szcesuil

26

Last-Minute Advice - Preparing Your Students for the NCLEX®

By Maria Flores-Harris

Editor’s Notebook

Happy National Nurses Week!

The impact nurses make on health care is unparalleled. For that reason alone, nurses deserve a month-long celebration to acknowledge, appreciate, thank, and celebrate your invaluable contributions to making a difference in the world.

Nurses are care providers, decision-makers, policy-shapers, health advocates, volunteers, educators, medical correspondents, bloggers, entrepreneurs, innovators, and the bedrock of their families and our communities.

We honor you and your varying roles for your positive impact on everyone’s lives.

This month for National Nurses Week, Minority Nurse focuses on nurses making a difference.

• Meet Alice Benjamin, a nurse making a difference in her patient’s lives, the surrounding community, and the nursing profession. She shares her secret sauce for being a happy nurse and loving your nursing career.

• Meet Angela Purcell, a nurse making a difference by saving patients’ sight and teaching others how as part of the Flying Eye Hospital.

• Hear two nursing union leaders discuss why nurse unions are necessary today.

• Teamwork is essential, and three nursing leaders discuss how it improves every nursing team.

• Some last-minute advice for preparing your students for the NCLEX.®

Kind hearts are the gardens, Kind thoughts are the roots, Kind words are the flowers, Kind deeds are the fruits, Take care of your garden, And keep out the weeds, Fill it with sunshine, Kind words and kind deeds.

~Henry Wadsworth Longfellow

You Make a Difference!

—Reneé

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Focus: National Nurses Week “You Make a Difference”

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A Nurse Making a Difference: Nurse Alice Benjamin

Learn Nurse Alice’s Secret Sauce for Being a Happy Nurse and Loving Your Nursing Career

By Reneé Hewitt

You Make a Difference: such simple words to write but a challenge to put into practice. So I’m thrilled to introduce you to a nurse living up to the mantra. Meet Alice Benjamin, or Nurse Alice, as she’s known to many and how she’s making a difference in her patient’s lives, the surrounding community, and the nursing profession every day.

Nurse Alice’s personal experience of her father dying in the ER from cardiac arrest while awaiting care inspired her to become the best cardiac nurse in the world and a community health leader to help create programs and empower and educate communities of color to take control of their health and get the most out of their health care.

But that is only part of her incredible journey.

After starting as a volunteer with the American Heart Association educating people about basic heart health, she advanced her nursing education. She learned more about research, health policy, and public health and advanced her clinical expertise within cardiology as a CNS and NP. Nurse Alice’s education and personal experiences helped her become a well-respected and credible community health leader.

She eventually landed opportunities on national platforms and in the news media to become a TV medical correspondent. Each stop of her nursing journey provided her with unique, colorful, resourceful, well-rounded, and practical, real-life experiences that have molded Nurse Alice into the nurse leader she is today.

Minority Nurse  chatted with Alice Benjamin, APRN, MSN, ACNS-BC, FNP-B, CCRN, CEN, CV-BC, Chief Nursing Officer and correspondent for  Nurse. org, clinical nurse specialist and family nurse practitioner, and critical-care and emergency medicine nurse at the Community Hospital of Huntington Park, California, with over 23 years of experience about the need for community education, how to make a difference in nursing, being a health advocate, her poignant story about her connection to the ER, the endless possibilities for creating a job in nursing, why nursing needs all of the brightest minds and kind-hearted people, and more.

The ANA’s theme for National Nurses Week this year is “You Make a Difference.”

You’re a nurse making a difference in nursing as the chief nursing officer and correspondent for Nurse. org and host of the podcast

“Ask Nurse Alice,” a medical correspondent for NBC LA, a family nurse practitioner, clinical nurse, and a mom, author, and health advocate. What is your secret for juggling it all?

The secret sauce is I love what I do in different ways. They’re the same. But there’s

a common thread of education and community service, which is something that fills my bucket. I enjoy community education and talking to other people. And my mantra is that I love to talk to people before they become my patients, just because I’ve seen so much of the devastation as a daughter and mother. It’s different when I’m on one side of the bed rails taking care of a patient, but when I’m on the other side, and it’s my loved one in the bed, it’s a vulnerable place to be in. So I like to talk to people to prevent their issues as much as possible so they can have a quality of life. So I love doing what I do as an extension. It’s patient education, using different platforms, like on television with NBC, on a podcast, through Nurse.org, or blogs. I feel so lucky, so blessed to love what I do. Now, some parts of nursing are challenging, but overall, I love what I get to do. I’m like, wow, this is so cool.

Your work makes a difference in the lives of so many every day. What are some ways that nurses can make a difference?

There are numerous ways in which nurses can make a difference. There are nearly 4.4 million of us now, and if we could all divide and conquer. And I would like to empower nurses to think about their passion. What are you good at? What’s your lane? There are so many different ways that we can approach this. But one of the things I think nurses need to do is take care of the patient inside of those hospital walls or those clinics. We must cover so much groundwork, strategizing, and working with other groups and disciplines

outside hospital walls. Yes, people come to the hospital for care, but that’s already after something happened. We don’t want to work ourselves out of a job, but we want to care for people so well that they don’t need to come here. And to do that, we need to swing the pendulum and focus on preventative care, health promotion, disease identification, and early intervention because we want to keep people outside the hospital. Nurses need to get out in the communities to educate and become patient advocates in whatever area they wish. Advocate for their patient’s best interests—advocating for what will be better for their care, a more efficient and effective work system, and better work conditions. Because when you have happy nurses, you have happy patients.

You talk about happy nurses. However, nurses must cultivate and maintain optimal mental and physical health to affect change in their patients. What are some things that nurses should be doing to ensure they’re healthy to provide the best patient care possible?

Nurses and health care providers know exactly what to do because we tell our patients what to do. But yet, we don’t always do those things for ourselves. We’re so focused on caring for others that we don’t fill our cups. So nurses need to allow themselves to embrace and recognize we are consumers of health care too. So when we’re talking about our patients, we’re taking care of our patients too.

And I think somewhere along the line, nurses and doctors over here, their patients over

there. Nurses and doctors are patients, too, right? So we must ensure we’re doing our annual physical and getting our mental health checks. That’s something that even the whole general public misses altogether. The pandemic highlighted many things, but nurses were going through the mud. It’s such a place of being happy to help people but simultaneously feeling devastated because we are asked to do more with less in a situation where we were fighting the Invisible Man before we understood what COVID is. It’s a profession that’s predominantly women. Many of us are mothers, so we’re also taking care of children and always heard stories about the woman being the rock of the home and making sure everyone else is cared for. So we must allow ourselves some grace and recognize that we are also patients. We need just as much physical wellness, mental wellness, respite care, relaxation, and de-stressing as the next person, and if we don’t do that, we will find ourselves being someone’s patient.

Nurses were the heroes throughout COVID. So what can nursing do to honor nurses who are leading, excelling, and innovating our health care systems and the communities they’re practicing in?

Something that we as nurses can do is celebrate each other to support one another. The American Nurses Association is so powerful. They’re able to move legislation and lobby and get things done. There are fewer physicians than nurses, yet nurses have been so fragmented. We have the AMA, but not everyone’s a member.

But if we were more unified and took our collective voice to support different initiatives, we could be more powerful in moving important legislation and changing practices for the better, not just for the nursing profession, but for the patient.

To lead and excel in nursing, we have to support one another. That’s one part of it. The other part is that we must also learn to play well in different sandboxes. Because a lot of what we do as nurses are inward driven, nursing school and nursing education, you have this whole larger health care conversation happening adjacent to us. And we can’t just be side to side. We must jump into that sandbox, join the conversation, and collaborate. Historically, nurses haven’t been invited. So it’s essential that as we move forward, and we move our profession forward, we need to be more politically savvy and more strategic in how we work with other agencies and groups. Because overall, many groups outside of nursing all have the same goal of improving patient outcomes, improving health care, and decreasing chronic illnesses. So working nurses need to unify our voices and learn how to strategize and work with other groups to move the needle on important health initiatives.

To move the needle on important health care initiatives, nurses must leverage every opportunity for professional development. So what are the best ways for nurses to access resources and insights to guide their professional development?

This starts in nursing school, but I know nursing school is

jam-packed. But early on, as soon as we enter nursing, we need to learn the importance and significance of finance, budgeting, and strategy working with other groups. Because when I went to nursing school, we were taught to care for the patient. It doesn’t matter how much this costs, or don’t worry about anyone else. You focus on the patient. This practice has blinded many of us, not realizing that we can work smarter instead of harder if we collaborate and network with other groups, agencies, and disciplines to share some of our resources. There’s no point in nursing establishing a committee to do all this work independently while another group is doing it. And we’re both doing work but not making as much progress. If we worked together, we could move that needle further. But in nursing school, that’s not necessarily one of the priorities and teachings. But as we grow in our career ladder, we need to foster experiences and learning opportunities that teach us how to do that networking and the collaboration that happens in an interdisciplinary setting. And also in the back of our mind being business and finance savvy to understand that. This is in the patient’s best interest, and B and C might be good considerations considering finances and resources.

What do you recommend nurses do to excel and lead in their nursing careers or inspire others in their nursing journey?

I’m joining a professional organization, and there’s AMA, but then there’s also your specialty nurse organization. I’ve always

been a part of my professional organizations and participated in events remotely and in person. I’ve always been a part of my professional organizations, and I’ve participated in events remotely and in person. The synergy happening in that room when you have a nurse or an ER nurse from California, an ER nurse in New York, and you’re discussing situations and can hear like, oh, wow, that’s how you handled that situation. Now that’s the process. Oh, let me bring that practice back to my facility. And it’s an opportunity to share evidence-based practice and talk about the latest research. Iron sharpens iron to build our community and engage with one another.

I did something beneficial for me, and I hope it’ll help someone else. As someone who was very cardiovascular health-focused, my love, my number one love and passion, I was a volunteer for the American Heart Association first and still am for several years. I take my expertise as a nurse and my knowledge about cardiovascular health and work with the American Heart Association to help identify programs and processes that specific communities need to improve patient outcomes to get people to check their blood pressure, eat better diets, and things like that. I was often the only nurse in the room, but work with people of different interests. These are all community folks convening together for the sake of wanting to improve cardiovascular health. But it opened my eyes to what happens in our communities. I know hospital stuff, and I know some clinical things, and I know those

health care organizations. Still, when a grocery store owner is so interested in cardiovascular health and wants to put on events at their store and do a cooking demo, it opened my eyes to creative ways to do patient education and empower the community to take charge of their health. We have many opportunities to expand and grow our skills and knowledge outside our nursing organizations.

You mention engaging with the community. What are some ways for nurses to better engage with the community besides joining nursing organizations? For example, I did community service with the American Heart Association. I also served as the health chair for my local NAACP and Urban League. I also volunteered at my son’s schools. Wherever there are people, there will be some health issues. Someone might fall and break their knee, and as nurses, even if you’re a NICU nurse, or labor and delivery nurse, if someone slips and hurts their knee, you will know some basic fundamental things to stabilize that patient. When COVID hit, all know how to stop the transmission of infection. Every nurse was a great resource during the COVID pandemic, teaching different communities about preventing transmission and things you should do to protect yourself. So it’s essential for nurses first to identify their passion. What places are you going to, and what groups are you already part of? Maybe it’s something that’s happening at your church, perhaps it’s your daughter’s Girl Scout troop,

and you can participate there. So there are just so many different opportunities. That’s one of the great things about nurses too. We’re so creative and innovative. I’m sure once you identify my passion and what groups I am a part of, you can probably list 100 ways you could help communities.

Talk about the importance of what nurses do beyond the bedside: advocacy, shaping public policy, serving on an organization’s board, and having a seat at the table. It’s critical that nurses, while we are at the bedside, do as much as possible to share with the public, the community, and our politicians what we do and how we can contribute. Yes, I can start an IV, but then I can also help you strategize an effective plan or bill to improve the quality of school lunches so our children aren’t becoming obese with the foods they’re eating at school. So beyond the bedside, we can advocate.

During the President Obama administration, I had the pleasure of volunteering with AARP. I went through this extensive AARP Volunteer Leadership Program and learned the Affordable Care Act inside and out. So when I came back from training in Washington, DC, I participated in different congresswoman’s town halls, talking about the ACA and seeing changes opening up. Here I am talking about health’s significance and its importance. Health is universal, and it impacts everyone, regardless of what side you sit on politically. But advocacy, I was able to do that, working with state politicians. That’s something that you can do

to shape public policy. I live in Los Angeles. I would go to Sacramento, be there to talk to the general public as well, and go knocking on doors to talk about the significance of a particular bill, like the tobacco tax, to decrease the number of people smoking. So I participated in shaping public policy. You do that because the public makes up the voters. They’re the constituents that the politician needs to listen to, but also knocking on those doors and speaking directly to those politicians, and serving on executive boards. This is something I don’t necessarily like, but again, this is where you lean on what your passion is. And it might not be now, but many years from now. It’s so important that we have nurses sit on hospital boards and boards of insurance companies.

There’s a nursing process called ADPIE. And that’s short for assessment, diagnosis, planning, implementation, and evaluation. It’s like a Six Sigma. We go through a thought process whenever we provide patient care, and the ADPIE strategy can be applied anywhere. And if we can get nurses on these boards, especially decision-making boards, that will be key in helping to guide and shift and change policy, procedure, and practice not just in the hospital but outside in the community and how things are done. We know what patients need because we care for them 24/7 and listen to stories that physicians don’t hear because patients trust us. So that experience and thought process will be instrumental in helping to move and make changes outside of hospital walls.

You are a health advocate for your patients. How do you empower them to take control of their health, wellness, and lifestyle?

Whenever I get in front of people, to take their guard down so they don’t think I’m talking at them, I’ll start the conversation by reminding them I’m a patient too. I’ve been in the hospital too. This has happened to me. I’m a nurse, but I’m also a regular person just like you, so I’m not immune to sickness or illness or any of these things, just like I’m telling you about the significance of getting mental health checks and talking to a therapist, I need that too. We’re equal. We are all human beings. We are all subject to the same things. So I do that first to establish trust. Then, I take the time to understand the audience I’m speaking to because, in nursing, we’re taught to talk to the 80%. But there’s also going to be a 20%. Maybe this doesn’t apply or needs to be individualized to the patient. So I constantly individualize the information I’m presenting or talking about.

For example, suppose I’m at an event and speaking to a roomful of Asian people. When it comes to talking about diet, I’m making sure that while I’m talking about traditional foods, I’m also going to speak to those cultural and ethnic foods that are common. Doing that helps the people who are listening to me to feel seen. Many times, especially small, minority, and vulnerable groups feel like they’re talking over my head. They’re not talking to me because that doesn’t apply. My culture doesn’t do that. But when I can individualize it, they feel heard and seen,

fostering trust. And when we can foster trust, people are more inclined to follow up with the care plan. So when you have that distrust or mistrust, patients will say, they said that, but I’m not doing that because there’s no trust.

So I try my best to continue to support them. Sometimes there’s that one-time interaction with someone. And it’s like, here today, gone tomorrow. But we can still help one another through social media and other ways. And I think that’s why Facebook groups are so big. You can have a community of supporters even long past the initial interaction.

What do you like best about being a family nurse practitioner?

I didn’t plan to be a nurse practitioner, especially not in the emergency room. I wanted to be an accountant. When I was going to school, my dad fell sick. When he was in the military, he began smoking cigarettes because they would say to smoke them if you got him. So he picked up smoking, which led to high blood pressure, a heart attack, a stroke, and congestive heart failure. And ultimately, my dad died in the emergency room from a massive heart attack and went into sudden cardiac arrest. Now being the eldest, I would help my mom care for my dad and things like that. I’d always question why this didn’t make sense. And it was because, at the time, providers weren’t communicating effectively or in a way that my dad understood or that my family understood because we weren’t health care professionals. We didn’t know that particular hospital had

many patients and was underresourced. And unfortunately, it’s one thing we don’t necessarily like about health care, but we’ve all heard the stories about ERs being so busy, and then someone dies in the hallway while waiting to be seen because they’re so understaffed. And so that was my situation with my dad.

I said I would be the best cardiac nurse in the world. And that’s when I set out to work with American Heart Association, anything and everything cardiovascular. I’m doing it as volunteer work. I don’t care. I want to learn it all. So I can teach and empower the community so this doesn’t happen to them. I worked in ICU critical care, telemetry, and all these places, and I’ve worked in home health everywhere. I never wanted to work in the emergency room because it was too painful. So fast forward. I got frustrated with not having prescriptive authority, and in my journey, I ultimately went back to become a nurse practitioner and landed in the ER. And it was a place I never wanted to work because it was too painful. But now I can redeem things for my father because I’m now that provider and will be so attentive. I’m not going to let you die in the hallway. We know that sometimes people come in the ER and feel their symptoms are dismissed –medical gaslighting–and we’re not doing any of that. So I get to be the provider and care for someone like my dad. Hopefully, in my attentiveness, and because I care so much because of being a patient advocate, I can do as much as possible not to have those outcomes. I can’t control

it all the time, but I can do my best to prevent those things from happening.

Do you think education level and specialties play a role in a nurse’s job satisfaction and navigating your career? More education puts you in a position for opportunities you may not have as an associate degree nurse versus a doctoralprepared nurse. And then also along the lines, it’s not just the letters behind your name but the quality of education. That’s what you’re learning in the program. As someone who’s gone back for more, I started with the LPN certificate and then ADN, and I initially thought a nurse was a nurse. So along that journey, I learned more about evidence-based practice research leadership, performance improvements, how to be more politically savvy, strategize, negotiate, work with and have crucial conversations with stakeholders, and learn more about budgeting, finance, and cost avoidance. So those are important elements of nursing education that you learn along the way. You’ll still get frustrated with some things, but you’re better equipped with tools and how to navigate those rough waters. So I think education and specialty training, like getting your certification if you work in critical care, having your CCRN or if you’re an emergency room nurse and having your CEN because, in that certification, you’re tested on a series of clinical situations, medication scenarios with how you would manage certain conditions. And when you work in one hospital, you might not have exposure to something. If you go back for

your certification, you will have been exposed to multiple relevant things within your specialty. So if a high-risk, lowvolume case comes into your hospital, you’ll know how to manage it. So education certification plays a role in job satisfaction and career navigation.

Nursing is an admired and honorable profession, and nurses have been ranked as the most honest profession 21 times, yet nurses need help to persist in their field. So what can nursing do to save itself and progress forward?

We must maintain the integrity of our nursing education. There have been many discussions about compact states and nursing schools, some not so good, some great as of late, but we mustn’t have a nursing shortage. Yes, we need more bodies, but how will we get there? We won’t get there by lowering the entry standards to nursing programs because it’s still critical and life dependent. We’re taking care of people’s lives, so we don’t want to water down the requirements for nursing school. That’s not how we’re going to solve the nursing shortage. While you may get more people to care for patients, how does that affect the quality of patient care?

In the end, if you’re pushing nurses through just trying to get them through, we need to focus on investing in our nurse educators and getting more of them. Then attract the best of the best and the brightest because if you want students to learn about critical care, you need the practicing critical care nurse, not the retired 20-year retired critical-care nurse teaching it. But you’re only going to

attract them with competitive salaries. Working at the bedside, for the most part, does pay more than working as an educator. So we must look at how we will improve nursing in that sense. And see what else as far as saving itself. That will be a key and foundational thing we must take care of. And then the other pieces. As nurses, we need to move beyond the bedside. And I don’t mean abandoning patient care. We need people in patient care, but there may be creative opportunities. For example, some larger academic organizations allow their nurses to work at the bedside. Then for their community service for a certain amount of hours, they are compensated or given other points or a reward system to do things in the community. So to move the needle forward, we need one foot at the bedside and one foot beyond the bedside. So we’re straddling the fence. But I know it sounds like a daunting task, but we can do it. We have to look at our resources. And it’s not a game of checkers. This is the game of chess we’re playing. But if there’s anyone that can pull this off, nurses can. We’re the largest segment of health care workers; when we talk, people should listen.

What are your words of wisdom for nurses currently in the profession and others considering becoming a nurse?

First, I want to say we need you. We need anyone and everyone passionate about

taking care of patients. That is the primary charge. I know it’s a reliable profession. But, most importantly, you have to want to care for patients. And that caring is going to look a little bit different for everyone. Some people say I can’t stand the sight of blood or I can’t do this. I want people to understand that, yes, there are some fundamental things that you will have to learn. But we have nurses in government. We have nurses in politics. We have nurses in education. We have them in public health. We have them in schools. Take your pick. There are so many options. Nursing is one of the few professions you can enter where everyone has a standard education, and we all pass a standardized test, the NCLEX. But once you do, that sky’s the limit. And I had a mentor tell me, Alice, wherever there is pain and wherever there are people, there will be problems, so you can create your job. During the pandemic, we’ve seen many nurses leave the bedside, some are still at the bedside, but they’ve created their jobs. Some are still in patient care, but it looks slightly different. There are so many problems and plenty of work to go around. We need all the best and the brightest minds and kind-hearted people. We need you.

Reneé Hewitt is the editor and content strategist for Minority Nurse . When enjoying life unplugged from the digital world, you’ll find her on a trail taking wildlife photos or birdwatching.

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Saving Sight Around the World

By Michele Wojciechowski

Angela Purcell, a nurse making a difference, has helped save patients’ sight and taught others how as part of the Flying Eye Hospital.

Angela Purcell didn’t start her career expecting to help save people’s eyesight around the globe. In fact, she didn’t even start working as a nurse until an amazing experience changed her life permanently.

Purcell, now an RN with an Ophthalmic Nurse diploma and the Associate Director of Nursing for  Orbis International’s Flying Eye Hospital, began her career as a legal secretary.

“When I was unexpectedly hospitalized, my life and career path changed forever. During that brief experience as a patient, I was inspired by the nurses around me. Good nursing depends on discipline, keen observation, and sound clinical skills. Those attributes attracted me to the profession,” recalls Purcell. “It was then I decided to start my training to become a nurse. I knew it was the right decision as I thought about the lives I could change by helping to improve the well-being of others.”

Purcell attended nursing school at Cambridge University Hospital in England, earning her RN degree in 1985. Her first job out of nursing school was working as part of intensive care teams at a cardiovascular heart and lung specialty hospital. “After a few years in this high-intensity specialty, I moved to specialize in eyes and earned my diploma in ophthalmic nursing,” she says.

During her ophthalmic studies, Purcell attended a conference where she heard an Orbis representative talk about their work. “I was captivated. I promised myself that I would join their Voluntary Faculty, a global force of more than 400 medical experts who share their skills with local eye care teams around the world,” says Purcell.

And beginning in 2012, she did just that. She began working as a volunteer faculty scrub nurse, and a few months later, she was offered a permanent position as Orbis’s Head Nurse with the Flying Eye Hospital Team.

care teams–ophthalmologists, nurses, anesthesiologists, and biomedical engineers–on how to deliver the same care in their community.

“Training is at the heart of everything Orbis does and everything I do in my daily role. I provide in-person, hands-on training to local nurse teams in infection control and emergency preparedness during training programs. I work with them on the plane and in the partner hospital,” explains Purcell. “During training programs, we care for children and adults with a wide variety of eye diseases, including cataracts, glaucoma, strabismus, and other conditions that can cause vision loss or blindness.”

Globally, she says, 1.1 billion people live with vision loss–90% of which is avoidable.

“The work I do is fighting to decrease this statistic,” says Purcell.

During the pandemic, when she couldn’t teach people in person, Purcell began teaching on  Cybersight, the Orbis telemedicine and e-learning platform. Even when in-person programming returned, Purcell continued to teach online. “I found that virtual training is a great way to reach everyone,” she says. “It’s a fabulous complementary tool to every nurse’s training.”

Eyes in the Skies

According to Purcell, the Flying Eye Hospital is a fully accredited ophthalmic teaching hospital on board a plane. It travels to locations that don’t have access to quality eye care, and the staff trains eye

Another crucial part of Purcell’s job is that she plays an important role in ensuring that the standards to obtain accreditation for the Flying Eye Hospital from the American Association of Accreditation for Ambulatory Surgery, are met and adhered to.

“In my role, I also ensure [that] Orbis employees are benefiting and growing, which, in turn, benefits my occupational development,” says Purcell.

Miracles Happen

One of Purcell’s greatest rewards in her job is hearing some of the patients’ stories. She shared this one:

“One of my favorite stories in my nursing career happened in April 2018 when I went to Trujillo, Peru, with the Flying Eye Hospital for a three-week training program. I worked with a volunteer nurse to care for patients before and after their surgeries. While she was preparing a patient for surgery–a young man of about 25 years old–I spoke to his mother. To my surprise, this was the second time her son had been a patient at the Flying Eye Hospital.

Twenty years ago, her son had surgery on his eye on the plane as a small child. She said she was so grateful and surprised the plane was back in Peru when her son needed urgent surgery. He had just had an accident and injured the same eye that had been operated on as a child. His mother proudly showed me pictures from the day of her son’s first surgery on the plane.

“As I looked at the pictures of the little boy and the nurse caring for him, I realized this was the same nurse preparing him for surgery again, so many years later. The nurse remembered him as a child, and the nurse, the patient, and the mother had a sweet, sentimental reunion. For me, as a witness to this fascinating

Angela Purcell is the associate director of Nursing for Orbis International’s Flying Eye Hospital.

Photo credit: Geoff Oliver Bugbee/ Orbis International

story, I will always remember how it made me realize that miracles do happen in our ‘hospital with wings.’”

Purcell says she’s realized how well her job fits her skill sets. “I am great at networking and communicating with people from different cultures. Working with a global organization allowed me to collaborate, innovate, meet targets,

help others, and challenge myself. Some of the highlights of my current role working at the Flying Eye Hospital have enabled me to meet quite famous individuals, including Cindy Crawford, HRH Duchess of Wessex, many heads of state, and the list goes on,” she says.

But there are many other reasons why she loves the work

she does. “I love my Flying Eye Hospital team. We are like a family. We are a small, multi-cultural, close-knit team that supports one another and encourages progression and collaboration. We all share the same vision and are dedicated to fighting avoidable vision loss together,” says Purcell.

“I am inspired by the people around me and how rewarding

it is to see the results of our work.”

Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about nursing but comes close to fainting when she sees blood. She’s also the author of the humor book, Next Time I Move, They’ll Carry Me Out in a Box. •

Celebrating 100 Years of Excellence in Nursing Education

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Taking a Seat at the Table: Why Nurse Unions are Necessary Today

By Karie Pinnix

Nurses have been front and center of every medical crisis, and after the COVID-19 pandemic, nurses were recognized as frontline heroes. However, more nurses are stepping up and admitting that although they were able to save lives, the pandemic exacerbated unequal workplace conditions, which made their job harder, longer, and more stressful.

As a result, a safe space nurses joined to advocate for their needs was nurse unions.

Nurse unions have existed since the 20th century, but it wasn’t until 2005 that union membership among nurses started to increase, according to a 2010 article in the Journal of Clinical Nursing

Since then, more nurses have become advocates to eliminate workplace violence, uneven nurse-to-patient ratios, and unfair hiring practices within the health care system. This is certainly true with the recent strikes in New York, California, Minnesota, and the U.K.

Strikes for Safe Staffing and Fair Contracts

Although hospital executives and management have set standards such as how many nurses can be hired and what benefits they get, nurse associations like National Nurses United (NNU) have fought to protect nurses’ safety when these contracts don’t reflect nurses’ needs in the workplace.

One issue that has been a significant cause of nursing strikes across the United States is safe staffing.

Many hospitals are faced with uneven nurse-to-patient ratios, which diminishes the quality of care among patients. This leaves nurses to make up for the lack of staff in hospital units through increased hours and fewer mandated breaks–and in turn, that can lead to more medical errors.

California is the only state to have mandated minimum nurse-to-patient staffing ratios in all hospitals. Therefore, many would think that having a law to prevent understaffing already existed. Still, according to the president of National Nurses United, Zenei Triunfo-Cortez, RN, this was not the case.

are looking to change that. In other affiliate states with NNU, nurses who are part of the organization also hold rallies to build awareness of the need for safe staffing and legislative laws protecting nurses’ right to organize.

“We will not stop until working conditions are a lot better for all of our nurses, no matter which state you are in, and it doesn’t matter which area of practice you are in. We’ll make sure that our nurses are well provided for in all areas,” says Triunfo-Cortez.

Ethnic Minorities and Nurse Unions

Nurses from minority backgrounds make up almost 20% of registered nurses, according to the American Association of Colleges of Nursing. Sadly, their representation among the nursing community compared to the population of BIPOC Americans remains small.

“They went to college together, got their nursing degrees, and all wanted to serve their communities. They stuck it through the pandemic,” says Barcott. “Then, when things didn’t get better after the pandemic slowed, they realized that the hospital wouldn’t address the staffing issues. They were continuing to go on as if the pandemic was still here.”

Zenei Triunfo-Cortez, RN, is the president of National Nurses United

“Since beginning my nursing career, we have always fought for safe nurse-to-patient ratios. It was a lot of work, persuasion, and real-life stories about what happens to us every day in our work life that helped us show legislators that we need this because this is what’s happening in our lives day in, day out.” However, there is no nationwide federal law for safe staffing. Triunfo-Cortez and other union nurses at NNU

Many nurses of color feel discouraged in their workplace if their fellow nurses don’t look like them, so it’s no surprise that they can leave their jobs faster if they don’t receive support when they’re overworked.

Julia Barcott, the chair of economic and general welfare at the Washington State Nursing Association (WSNA), has seen this happen in her workplace. Barcott is an ICU nurse at the Astria Toppenish Hospital in Toppinish, Washington, an area with a large population of Hispanic, Filipino, and Indigenous tribes. She adds how she mentored four Hispanic and Indigenous bilingual nurses who experienced understaffing during the COVID-19 pandemic.

Barcott explained that these nurses eventually left their jobs, despite receiving signon bonuses.

“You want to have racial equity and have people that look like yourself if you’re a patient that understands your customs and beliefs,” says Barcott. “These four young women were like that. They were a huge asset.”

Chronic workplace conditions such as these are some of the reasons why nurses of color join unions. However, systemic racism has also factored into why BIPOC nurses can be disillusioned with the profession.

Dealing with discrimination as a nurse in the early 90s is why Triunfo-Cortez, a Filipina, decided to become involved with unionizing.

“I was applying for a transfer and was bypassed because the

Julia Barcott is the chair of economic and general welfare at the Washington State Nursing Association

manager told me she could not hire more Filipinos. And so, at that moment, I thought, why should you look at the person’s ethnicity? You have to be looking at the qualifications, right?” says TriunfoCortez. “And so I became involved thinking that nurses need to speak up because this is modern history, and there’s still apparent discrimination happening.”

When nurses of color get involved with unionizing, they provide unique views on chronic health care challenges that others may not have. BIPOC nurses can also gain more accurate representation in a health care system where white-dominated opinions can be at the center.

Nursing Shortages

Don’t Exist

While nursing unions can help bring awareness to unfair nurse-to-patient ratios and workplace violence, they also bring light to long-held beliefs about the health care system–like nursing shortages don’t exist.

“What we have is not a staffing shortage, but a shortage

of nurses who do not want to work under unsafe working conditions because we do not want to be blamed for bad outcomes of our nursing care,” says Triunfo-Cortez.

Barcott mentions that some people with nurse licenses aren’t practicing as a nurse at all because of understaffing.

“There’s like 150,000 nurses in Washington. Less than half of those are working right now, but many of them are the ones that have active licenses. They are not willing to work in the conditions that are occurring now,” Barcott says. “They would rather not work as a nurse or take time off because they’re burned out, or they go do something different.”

Hospital executives and management often think of profits and business expenses more than the harmful conditions nurses experience daily. Some employers believe that to solve this retention problem. Then they need to direct more funds toward hiring new nurses.

For example, Barcott explains that it costs around $100,000 to orient a new nurse over six months. However,

when hospital management and financial officers don’t address chronic workplace issues, these nurses leave faster, causing this cycle to repeat.

Nursing unions see this issue, which is why many lobby for legislation for fair staffing and safe workplace practices.

In Washington, the WSNA pushes for state laws to be passed supporting safe staffing standards, enforced rest breaks, and functional staff committees. Like the WSNA and the NNU, the New York State Nurses Association (NYSNA) educates union nurses on worker rights. It helps them bargain for health benefits, higher wages, and paid holidays.

Using Unions to Make a Difference

When nurses of all demographics sit at the table to discuss fair workplace conditions, everyone, including patients, benefits from a better quality of care.

“It’s uplifting to know that most of our nurses are real and true patient advocates, not just

by word, but in action as well,” says Triunfo-Cortez. “When you think alike and know that your goal and your mission are the same, then you will do everything in your power to achieve those goals because we know that if we all work together towards a common goal, it would be for the betterment of everyone.”

After the pandemic, more people now see that nurse unions exist and are here to stay. People not working in health care are picking up protest signs, while hospital management sees that there’s strength in numbers.

“I think that’s why membership is starting to go up in a lot of areas where essential workers were put in that position because that was the only that’s the only way we can collectively band together and express the needs of our patients. And it was only a matter of time,” says Barcott.

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We understand and appreciate now more than ever the tireless dedication you show others every day— Nurses Week is the perfect time for us to recognize you.

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Discover Drexel’s 40+ online nursing programs designed for the leader in you and learn more about how we will help you prepare for your personal nursing journey.

Teamwork Makes Every Nursing Team Better Developing Skills and Practice for Effective Work

By Julia Quinn-Szcesuil

Good teamwork is as essential to a highfunctioning nursing unit as the nurses themselves. Even the best nurses can’t operate in a silo–patient care takes a comprehensive and cohesive approach where nurses know what to do, know what everyone else does, and each nurse supports the rest of the team.

Despite being a fundamental nursing practice, teamwork can be challenging. Some teams don’t work well and don’t know what’s wrong, or they know what’s wrong and don’t implement solutions that work.

So what’s the key to good teamwork?

It’s all about communication.

“This applies to all professions–communication is key,” says  Dr. Margarita David, DNP, MSN, BSN, BA, RN, PCCN, CSN, founder and CEO of  Dr. Registered Nurse Success Academy, LLC . But fine-tuning communication skills sometimes gets pushed aside for the immediacy of nursing duties. “Many nurses get overwhelmed with doing what the job requires and what needs to be completed. There’s not enough time.” The dangers of an ineffective team are many; the worst outcome is when it causes patient or nurse harm. For example, patients who leave the hospital without a clear plan or a plan they need help understanding are more likely to be readmitted within 30 days.

“That also affects a hospital’s numbers,” she says. “It’s a domino effect.”

can be used in many situations.

“They can use the SBAR format if they are going to a faculty member with an issue, or they can use it in a presentation to advocate for themselves, others, or as a leader.”

Teamwork can be guided, but it can only succeed with flexibility. What works for one team may not hold for how another team operates. So constantly reassessing how a team works–its strengths and weaknesses–is necessary. “In nursing, everything changes every single day,” says David.

Building teamwork skills often starts when nurses are still in school, says  Dr. Shelley Johnson, EdD, MSN, MBA, RN, NE-BC, CNE, dean and professor at  Florida Agricultural and Mechanical University’s School of Nursing. “In nursing education, there’s a lot of content delivery, and we ask students to work on communicating with each other for support and to talk through difficult concepts,” she says, noting that a tried-and-true method that nurses can use throughout an entire career span is the SBAR method. Presenting problems and solutions with the SBAR method helps nurses identify issues and background, assess, and then recommend how to solve things; it’s a method that

According to David, nurses should seek opportunities to intentionally put themselves in positions to grow confident speaking up because that’s what it takes to be an effective team member and leader. “Get involved in a research council or on practice committees,” she says. “Get involved, and then put yourself out there.” Because so much of nursing is focused on direct patient care, nurses have fewer chances to speak in front of others or to gain the confidence that comes from that experience. Nurses can also actively practice at conferences and meetings where they learn to communicate what they want.

Johnson says that when nurses grasp the skills that

will strengthen their team, standardizing the language and process makes a difference. “You want it to mean the same thing when there’s an emergency,” says Johnson, “so no one is confused.”  And if tension does develop, team members need to recognize the problem, reassess the approach, and address it. Take a step back and wait for things to deescalate, says Johnson, and then come from a place of humility. Have patience, she says, and evaluate what happened, what went wrong, and how to fix it. In interdisciplinary teams or even working with patients, the chance for miscommunication is elevated, and sometimes an apology is necessary and the right thing to do. “Own your mistakes,” Johnson says. “You don’t want to break a relationship to the point where progress fails, you can’t work together, or someone doesn’t want you as a nurse.”

Recognize the cultural communication component for each team you work on, says Johnson. “Think of how others are receiving your messaging,” she says. Nurses can also look for subtle signals in their teammates to know when the teamwork isn’t optimal. Look for body language and facial expressions, and listen to the responses from team members. “We must be proactive with talking and practice active listening,” says Johnson. “That active listening is important for gathering information, managing teams, and being team members,” she says. The skill is important enough that practicing it with role-playing is valuable.

Dr. Margarita David is the founder and CEO of Dr. Registered Nurse Success Academey, LLC

Dr. Shelley Johnson is the dean and professor at Florida Agricultural and Mechanical University’s School of Nursing

Everett Moss II is a nurse anesthesia DNP candidate at the Nell Hodgson Woodruff School of Nursing at Emory University

Everett Moss II, BSN, RN, EMT-P, and a nurse anesthesia DNP candidate at the  Nell Hodgson Woodruff School of Nursing at Emory University , has worked as a flight medic and nurse and as a firefighter before beginning his path to his DNP. So he understands

how teamwork flows from one unit to the next in the patient’s journey. “The continuum of care is only effective with communication,” he says.

Every person’s role is important when a patient is moved from the ER to a trauma unit or the ICU and then is moved to discharge. “We saw that especially during COVID,” he says. Health care industry workers who aren’t in direct contact with patients still have a significant impact on nurses’ ability to care for patients effectively, he says. And nurses routinely communicate with pharmacies, labs, other teams, and family members or caregivers, so each step extends the team working on a patient. “In nursing, you’re forced into an environment where you have to learn teamwork or suffer

the consequences of not,” he says. “And in our profession, if we suffer the consequences of not, our patients do too. I don’t believe an area of nursing survives without teamwork.”

Advanced practice degrees also provide communication skills that help nurses with teamwork, whether they remain bedside nurses or expand into other roles. As nurses progress to team leaders, David says they must understand how to lead effectively.

“Understanding your style is vital in making sure you lead others,” she says, noting that she found her style and works with it. “I have a democratic approach. I tell them my expectations, but then I ask about their expectations of me. I let them know if you come to me with a concern, I want

to hear a potential solution.”

Building rapport strengthens trust so that each nurse can work for the betterment of the whole team. “It has to be 100 percent of the people working together,” says David. Moss likens teamwork’s effectiveness to how sports teams operate. “Until you establish who does what, everyone may not know their role,” he says. “They may think, ‘I don’t know what you’re expecting from me, and I don’t know what to expect from you.’”

Johnson agrees. “None of us can do this alone,” she says. “The moment we do, we all fail.”

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Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.

Last-Minute AdvicePreparing Your Students for the NCLEX®

By Maria Flores-Harris, DNP, RN, CNE

May signifies everything we look forward to–time for graduations, pinning ceremonies, vacations, and anticipation for warmer weather. However, for the recent nursing graduate, May also signifies a time for preparation for one of the most important exams they may ever take, NCLEX. Graduates can look forward to taking the NCLEX if they remember PUPS. (More on PUPS below.)

As nurse educators, we know that prepping for NCLEX differs from preparing for a classroom exam. For one, the NCLEX is a cumulative exam that focuses on one thing, clinical judgment. Can the student make the best decision for their patient at the bedside?

Secondly, the NCLEX tests integrate processes like safety, infection control, and physiological integrity throughout the test. It’s not divided into pharmacology, pediatrics, and management like nursing school courses and tests. It is a comprehensive evaluation of the nursing graduate’s ability to holistically care for a patient, from basic care and comfort to management of other health care staff.

Because of this comprehensive and integrated approach, questions may look different and be perceived as more difficult. Medications and disease processes the student did not learn in class may be tested. For most students, the unknown is a scary concept. However, there are things we can do, even last minute, to prepare our students.

Remember PUPS. If you’re like most nurses, we care for humans and animals.

Hopefully, PUPS is an easy to remember mnemonic and one with a positive connotation.

Practice NCLEX-style questions

Understand the NCLEX P ractice anti-anxiety techniques Show up prepared

Practice NCLEXstyle Questions

There are studies and literature that state a student must answer 5000 to 10,000 questions to be deemed ready for NCLEX. There are hundreds of websites that students frequent that provide many different numbers. I have seen very specific numbers, from 2800 questions to as low as 500. Quantity matters, but quality matters more.

We must inform our students that practicing NCLEXlike questions is critical to success and where they can find those questions. Please provide them with the names of credible resources and encourage them to practice as many questions as possible.

Practice means answering the questions and remediating them to understand what they do and don’t know. Practice does not mean answering question after question but never reviewing the answers and

rationales. The question banks students use for preparation should include an opportunity for testing in an NCLEX-like environment and provide a review of answers with rationales. The practice question banks should also have alternate-type questions on NCLEX and be written at the cognitive levels of application and analysis.

Practice means simulating the real testing environment by sitting in a quiet room and answering the questions on the computer while you time yourself. The NCLEX today is 75-145 questions with a five-hour allotment. Encourage your students to take a 75-question minimum test and to take several 145-question tests as well. Practicing a few questions at a time is okay but should be only some of the practice.

Endurance is important. Most students graduate from nursing school and have never taken more than 100 questions at one time. However, they must practice a 145-question test and note when they get tired or lose concentration to take a break in the “real” test. Therefore, a student should never sit for NCLEX without having the benefit of practicing 145-question tests.

Understand the NCLEX

All students taking the NCLEX should have visited the website ncsbn.org many times. They should know the NCLEX blueprint–the definitions of the client need categories tested and at what percentage they are tested. Students want to know what is on the test to feel more comfortable and confident. The NCSBN gives them that information. Maybe not to the specificity the student

wants, but it provides much beneficial information, and knowledge is power. For example, a student must know that physiological adaptation, management of care, and pharmacological and parenteral therapies make up almost 50% of the NCLEX-RN. Therefore, these three areas command more attention than the other five areas of the test plan.

Students should also watch the videos on the ncsbn.org website that explain the testing procedures for check-in and while taking the test. These videos include what you can and cannot bring with you, allowable breaks, accommodation requests, and much more. Knowing what to expect lessens anxiety.

Practice Anti-anxiety Techniques

As mentioned above, one of the reasons students practice questions is to understand their mental and physical endurance. Students should note when they get tired or lose focus while taking a long exam. For some students, that’s around 50 questions. For others, it’s about ten questions. Students need to know this before sitting for NCLEX. When they reach their limit, instruct them to take a mental break. That could mean taking fingers off the keyboard and eyes off the screen, completing a few stretches of the shoulders and neck, or taking a few deep breaths.

A quick note about deep breathing: it’s not just something to do. Deep breathing better oxygenates your brain, stimulating the parasympathetic nervous system, which aids in calmness. Deep

Maria-Flores-Harris, DNP, RN, CNE

breathing is an important antianxiety strategy for us all. Other techniques to combat anxiety include getting adequate sleep (which is especially important the night before the test); eating a good meal before the test so that you are not hungry (do not overdo it on carbs or sugar, which can cause sleepiness); proper hydration preferably with water and a bathroom break before the exam; positive talk before and during the exam (You got this!); eating peppermint candy or chewing peppermint gum

which can decrease anxiety and possibly increase mental alertness (I’ve had several students who swear by peppermint); and the most crucial technique to combat anxiety, is tip #4–show up prepared.

Show Up Prepared

There is no better technique for success than attending an exam and feeling wellprepared. Know where the testing center is and leave early to give yourself plenty of time for unexpected traffic. Students should double-check

with ncsbn.org that they have the correct documents to get into the test.

At this point in their preparation, they know the content, the process, and what to expect. There are no surprises because they have used PUPS - practiced thousands of questions, understand how the test works and what is being tested, know how to calm anxiety because they have practiced calming techniques, and are showing up prepared and confident.

References

https://nursejournal.org/resources/ nclex/tips-on-passing-the-nclexfrom-nurses/

https://www.ncsbn.org/2019_RN_ TestPlan-English.pdf

https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC6814313/

Hanson-Zalot, M, Gerolamo, A & Ward, J. The voices of graduates: Informing faculty practices to establish best practices for readying NCLEX-RN applicants. Open J Nurs. 2019;9: 125-136. doi: 10.4236/ojn.2019.92012

Maria Flores-Harris DNP, RN, CNE