Minority Nurse Magazine (Spring 2014) by Springer Publishing Company

The Career and Education Resource for the Minority Nursing Professional • SPRING 2014

Salary Survey

Annual

Issue

T:10.5"

Achieving Career Satisfaction THE PATH TO WELLNESS SOCIAL MEDIA DO’S AND DON’TS

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Dedicated to Diversity

Minority Nurse magazine is committed to increasing diversity and inclusiveness in academics and nursing practice. Diversity is more than a check box on a form, more than a dry statistic hidden in a table of demographic data. It is more than the color of one’s skin, the nation of one’s heritage, or the origins of one’s social beliefs. Diversity celebrates culture. Diversity is inclusive. Diversity is the catalyst for the collaboration and discovery that is essential for an understanding and appreciation of the human spirit. Diversity allows us to engage with our differences and provides the mechanism that leads to acquiring cultural sensitivity and achieving cultural competence. We honor the individual and the community. We encourage ourselves and others to behave equitably. We promote acknowledging and respecting different beliefs, practices, and cultural norms. We uphold academic excellence, celebrate best practices, honor traditions, and embrace change that advances our objectives of caring for ourselves, advancing our educational and career opportunities, and providing quality health care for our patients. We are Minority Nurse magazine.

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Table of Contents

In Every Issue

Cover Story

Editor’s Notebook

Vital Signs

By Ciara Curtin

Making Rounds

Should you expect a raise this year? Where do the highest paid

Highlights from the Blog

nurses live? Is a master’s degree worth it? Find out how your

Index of Advertisers

Academic Forum 40

Family Scholar House: Helping Single Parents Leave Welfare Behind By Behlor Santi Equip yourself with the resources you need to overcome any financial hurdles you may be facing

salary stacks up against your colleagues with the results of our second annual salary survey

Features 9

The Fight for a Peaceful Transition: Discovering Moral Courage By Candilla Davis, RN, BSN, CCRN A critical care nurse describes her internal struggle to respect a physician’s wishes when a patient takes a turn for the worse

Are you craving a deeper connection with your patients than traditional care allows? Consider becoming a nurse coach and learn to guide your patients toward optimal wellness without suggesting a “fix”

Successes and Challenges of a Nursing Student with Dyslexia By Toni Sugg, RN Take a lesson from this inspiring nurse and don’t let a disability discourage you from pursuing your dreams

The Military Nurse: The Thrill of Leadership By James Z. Daniels The author takes a guided tour of the Womack Army Medical Center and explores such topics as health care and the state of diversity in the military

Achieving Salary and Career Satisfaction By Julia Quinn-Szcesuil

Degrees of Success 46

The Path to Wellness: The Fundamentals of Nurse Coaching By Christine Hinz

The Nurse-Family Partnership Program By Robin Farmer Feeling overwhelmed as a first-time mother? Let this program guide you through everything from a healthy pregnancy to finding a job postbaby

Second Opinion

2014 Annual Salary Survey

Think outside the box and discover the best ways to advance professionally and personally

Float Nursing on the Rise By Archana Pyati Feeling ambivalent about float pools? Learn more about the latest policies being developed to reduce nurse dissatisfaction and find out whether floating is right for you

Social Media Do’s and Don’ts for Nurses By Jebra Turner What does social media mean to you? If selfies and memes are the first things that come to mind, it’s time to rethink how you use Facebook and Twitter

Minority Nurse | SPRING 2014

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Leading Change

ast year, we conducted our first annual salary survey to gain some insight into what nurses with varying educational backgrounds and across different specialties were making across the country. We received 3,051 responses in 2013, and I’m pleased to report that nearly 5,000 nurses participated in our survey this time. Clearly, this is an important topic for nurses across the board. The results of our survey indicate that equal pay for equal experience—regardless of your ethnic background—is not yet the norm, unfortunately. But we are making some progress, and our job here at Minority Nurse is to help you be the best nurse you can be so we can close those existing wage gaps. For starters, it’s time to stop shying away from social media and start letting it work for you. Twitter is a great resource for learning about jobs before they are posted publicly, and LinkedIn allows recruiters to review your accomplishments with the click of a mouse. Jebra Turner gives you pointers on what to avoid and how to make your public profile stand out (in a good way). By now, you can probably recite key phrases verbatim from the Institute of Medicine’s 2010 report, The Future of Nursing. It should come as no surprise to learn that advancing your education is crucial if you want to climb the ladder in health care. Julia Quinn-Szcesuil gives you realistic strategies to help advance your career and maximize your salary potential without breaking the bank to get there. If you have your sights set on a leadership role, joining the military is a great option. James Daniels visited the Womack Army Medical Center in North Carolina to give you a taste of what military nursing culture is like and to prove that nurse leadership within the military is a very attainable goal. Or, perhaps a change in specialty is your next goal. If choosing which specialty seems daunting to you, consider joining a float pool. It’s gotten a bad rap lately, but hospitals are responding to nurse dissatisfaction by implementing policies that reward your efforts and give you greater autonomy to provide the best patient care. And that’s all anybody wants. — Megan Larkin

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MINORITY NURSE MAGAZINE Publisher James Costello Editor-in-Chief Megan Larkin Creative Director Mimi Flow Circulation Latoya Butterfield Production Manager Diana Osborne Digital Media Manager Joey Stern Minority Nurse National Sales Manager Peter Fuhrman 609-890-2190 n Fax: 609-890-2108 pfuhrman@springerpub.com Minority Nurse Editorial Advisory Board Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE President National Association of Hispanic Nurses Teresita Bushey, MA, APR-BC Assistant Professor, School of Nursing The College of St. Scholastica Wallena Gould, CRNA, EdD Founder and Chair Diversity in Nurse Anesthesia Mentorship Program Constance Smith Hendricks, PhD, RN, FAAN Professor Auburn University School of Nursing Ed James, MD Founder and President Heal2BFree, LLC Sandra Millon-Underwood, PhD, RN, FAAN Professor University of Wisconsin, Milwaukee, College of Nursing

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.

Tri Pham, PhD, RN, AOCNP-BC, ANP-BC Nurse Practitioner The University of Texas-MD Anderson Cancer Center Ronnie Ursin, DNP, MBA, RN, NEA-BC Parliamentarian National Black Nurses Association

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Vital Signs

NAHN’s Muevete (Move) USA™ Project Makes an Impact Nationwide There’s a movement that’s spreading across the nation, and it’s called “Muevete USA.” It’s a project that brings together nurses and nursing student volunteers, lowincome Hispanic children, and community organizations to learn about the importance of healthy eating.

uevete (Move) USA, a program designed and executed by the National Association of Hispanic Nurses (NAHN) community, is possible thanks to a $150,000 grant from The Coca-Cola Foundation. It draws inspiration from First Lady Michelle Obama’s “Let’s Move” campaign. Muevete USA seeks to equip nurses with the skills and passion to short-circuit the pervasive cycle of childhood and adolescent obesity in the Hispanic community. Since its implementation

Minority Nurse | SPRING 2014

in 2011, the five-lesson educational program—teaching the basics of healthy eating, through preparing healthy snacks and exercise activities— has gathered momentum nationwide, having doubled in both participation and enthusiasm in 2013. “The 2013 NAHN Muevete USA obesity prevention program was exceptional,” says Project Director Angie Millan, RN, MSN, NP, CNS, FAAN. “First, we doubled the number of instructors trained and the number of children who par-

ticipated. Secondly, the program was implemented in 20 NAHN chapters throughout the United States, an increase of five chapters from the previous year. “The most popular part of the program continues to be the five lessons, where the children get to interact with the instructors and participate in hands-on activities,” Millan added. In 2012, the program expanded its reach to not only children, but also to their parents, custodians, and relatives, and saw increased community partnerships, which emphasized the grassroots focus of the project. In Chicago, nursing student volunteers taught children a specialized dance routine to

the beat of Latin music at the Boys & Girls Club in the Little Village neighborhood. In Phoenix, children gathered at the Friendly House where they learned techniques in selfdefense and got their hearts pumping in relay races and obstacle courses. In Washington, DC, children and their families learned callisthenic and aerobic exercises at the Latin American Youth Center & Little Stars Camp. The NAHN chapters developed YouTube videos as part of the project. Visit www.nahnnet. org/2012MueveteUSAChaptersVi deos.html to watch the videos. “We are delighted to once again partner with NAHN and this important health lifestyle training program,” says Frank Ros, Vice President, Hispanic Strategies for Coca-Cola North America. “This program is another step towards helping to create healthy, sustainable communities.” “We are so proud of our student members, as well as the experienced NAHN nurses who came together with children and their families in low-income Hispanic communities to make this project a huge success,” remarked NAHN President Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE. “NAHN wants to thank The Coca-Cola Foundation for making this project possible.” From New York City to Rio Grande Valley to Los Angeles, NAHN chapters, Hispanic nurses and nursing students, along with children and their families, continue to move to the beat of a healthier life.

Vital Signs

Nurse Staffing and Education Linked to Reduced Patient Mortality Hospitals in Europe where nursing staff care for fewer patients and have a higher proportion of bachelor’s degree-trained nurses had significantly fewer surgical patients die while hospitalized, according to a new study. These findings underscore the potential risks to patients when nurse staffing is cut and suggest an increased emphasis on bachelor’s education for nurses could reduce hospital deaths.

he study, supported by the European Union’s Seventh Framework Programme and the National Institute of Nursing Research (NINR), part of the National Institutes of Health, is the largest and most detailed analysis to date of patient outcomes associated with nurse staffing and education in Europe. Known as Registered Nurses Forecasting (RN4CAST), the study estimated that an increase in hospital nurses’ workloads by one patient increases the likelihood of in-hospital death by 7%. Also, a better educated nurse workforce was associated with fewer deaths. For every 10% increase in nurses with bachelor’s degrees, there was an associated drop in the likelihood of death by 7%. The results of the study are published in the February 25 issue of The Lancet. “Building the scientific foundation for clinical practice has long been a crucial goal of nursing research and the work supported by NINR,” said NINR Director Patricia A. Grady. “This study emphasizes the role that nurses play in ensuring successful patient outcomes and underscores the need for a welleducated nursing workforce.” For the RN4CAST study, a consortium of scientists led by Linda Aiken of the University of Pennsylvania School

of Nursing, Philadelphia, and Walter Sermeus of the Catholic University of Leuven in Belgium, reviewed hospital discharge data of nearly 500,000 patients from nine European countries who underwent common surgeries. They also

patients had a nearly one-third lower risk of dying in the hospital after surgery than patients in hospitals where only one-third of nurses had a bachelor’s level education and cared for an average of eight patients each. “Our study is the first to ex-

surveyed over 26,500 nurses practicing in study hospitals to measure nurse staffing and education levels. The team analyzed the data and surveys to assess the effects of nursing factors on the likelihood of patients dying within 30 days of hospital admission. Based on their analysis, the researchers estimated that patients in hospitals where 60% of nurses had bachelor’s degrees and cared for an average of six

amine nursing workforce data across multiple European nations and analyze them in relation to objective clinical outcomes, rather than patient or nurse reports,” said Aiken. “Our findings complement studies in the US linking improved hospital nurse staffing and higher education levels with decreased mortality.” In the US, analysis of patient outcomes associated with nurse staffing practices has informed

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proposed or actual legislation in nearly 25 states. These types of analyses also informed the recommendation of the Institute of Medicine that 80% of nurses in the US have a bachelor’s degree by 2020. Hospitals have responded to this recommendation with preferential hiring of bachelor’s degreetrained nurses. The RN4CAST study was designed to provide scientific evidence for decision makers in Europe to guide planning

for the nurse workforce for the future. The study’s findings provide evidence to guide important decisions about improving hospital care in the context of scarce resources and health care reforms. “This study is another example of how nursing science can help inform policies that promote positive patient outcomes not only in the US, but around the world,” added Grady.

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Vital Signs

Prevalence of Allergies the Same, Regardless of Where You Live In the largest, most comprehensive, nationwide study to examine the prevalence of allergies from early childhood to old age, scientists from the National Institutes of Health (NIH) report that allergy prevalence is the same across different regions of the United States, except in children 5 years old and younger.

“B

efore this study, if you would have asked 10 allergy specialists if allergy prevalence varied depending on where people live, all 10 of them would have said yes, because allergen exposures tend to be more common in certain regions of the US,” said Darryl Zeldin, MD, scientific director of the National Institute of Environmental

Minority Nurse | SPRING 2014

Health Sciences (NIEHS), part of NIH. “This study suggests that people prone to developing allergies are going to develop an allergy to whatever is in their environment. It’s what people become allergic to that differs.” The research appeared online in February in the Journal of Allergy and Clinical Immunology and is the result of analyses performed on blood

serum data compiled from approximately 10,000 Americans in the National Health and Nutrition Examination Survey (NHANES) 2005-2006. Although the study found that the overall prevalence of allergies did not differ between regions, researchers discovered that one group of participants did exhibit a regional response to allergens. Among children aged 1 to 5 years old, those from the southern US displayed a higher prevalence of allergies than their peers living in other US regions. These southern states included Texas, Oklahoma, Louisiana, Arkansas, Tennessee, Kentucky, Mississippi, Alabama, Georgia, West Virginia, Virginia, North Carolina, South Carolina, and Florida. “The higher allergy prevalence among the youngest children in southern states seemed to be attributable to dust mites and cockroaches,” explained Paivi Salo, PhD, an epidemiologist in Zeldin’s research group and lead author on the paper. “As children get older, both indoor and outdoor allergies become more common, and the difference in the overall prevalence of allergies fades away.” The NHANES 2005-2006 not only tested a greater number of allergens across a wider age range than prior NHANES studies, but also provided quantitative information on the extent of allergic sensitization. The survey analyzed serum for nine different antibodies in children aged 1 to 5 years, and nineteen different antibodies in subjects 6 years and older. Previous NHANES studies used skin prick

tests to test for allergies. The scientists determined risk factors that made a person more likely to be allergic. The study found that in the 6 years and older group, males, nonHispanic blacks, and those who avoided pets had an increased chance of having allergen-specific IgE antibodies, the common hallmark of allergies. Socioeconomic status (SES) did not predict allergies, but people in higher SES groups were more commonly allergic to dogs and cats, whereas those in lower SES groups were more commonly allergic to shrimp and cockroaches. By generating a more complete picture of US allergen sensitivity, the team uncovered regional differences in the prevalence of specific types of allergies. Sensitization to indoor allergens was more prevalent in the South, while sensitivity to outdoor allergens was more common in the West. Food allergies among those 6 years and older were also highest in the South. The researchers anticipate using more NHANES 2005-2006 data to examine questions allergists have been asking for decades. For example, using dust samples obtained from subjects’ homes, the group plans to examine the link between allergen exposure and disease outcomes in a large representative sample of the US population. NIEHS supports research to understand the effects of the environment on human health. For more information on environmental health topics, visit www.niehs.nih.gov.

Making Rounds

April

June

July

30 – May 3

5-8

15-18

The National Conference of Neonatal Nursing Planet Hollywood Resort & Casino Las Vegas, Nevada Info: 800-377-7707 E-mail: info@cforums.com Website: www.contemporaryforums.com

34th Annual Conference: Through the Looking Glass: A Vision of Holistic Leadership Portland Marriott Downtown Waterfront Portland, Oregon Info: 800-278-2462 E-mail: conference@ahna.org Website: www.ahna.org

39th Annual Conference Hyatt Regency Miami Miami, Florida Info: 501-367-8616 E-mail: info@thehispanicnurses.org Website: http://nahnnet.org

Contemporary Forums

American Holistic Nurses Association

National Association of Hispanic Nurses

National Association for Health Care Recruitment

11-14

May 1-4

The Dermatology Nurses’ Association 32nd Annual Convention: Transforming and Evolving: Believing in Change Walt Disney World Swan and Dolphin Orlando, Florida Info: 800-454-4362 E-mail: dna@dnanurse.org Website: http://2014.dnanurse.org

8-10

American Conference for the Treatment of HIV 8th Annual Conference Sheraton Downtown Hotel Denver, Colorado Info: 540-368-1739 E-mail: ACTHIV@meetingmasters.biz Website: www.ACTHIV.org

17-22

American Association of Critical-Care Nurses The National Teaching Institute & Critical Care Exposition Colorado Convention Center Denver, Colorado Info: 800-899-2226 E-mail: info@aacn.org Website: www.aacn.org

22-25

Association of Black Nursing Faculty, Inc. 27th Annual Meeting & Scientific Conference San Juan Marriott Resort & Stellaris Casino San Juan, Puerto Rico Info: Sallie Tucker Allen, 630-969-0221 E-mail: drsallie@gmail.com Website: www.abnf.net

40th Annual IMAGE Conference Hyatt Regency Grand Cypress Orlando, Florida Info: 913-895-4627 E-mail: nahcr-info@goAMP.com Website: www.nahcr.com

August

14-18

The Association of Women’s Health, Obstetric and Neonatal Nurses

6-10

National Black Nurses Association

Annual Conference Disney Coronado Springs Resort Orlando, Florida Info: Cathy Warner, 202-261-2426 E-mail: cwarner@awhonn.org Website: www.awhonnconvention.org

42nd Annual Conference Philadelphia Marriott Downtown Philadelphia, Pennsylvania Info: 301-589-3200 E-mail: info@nbna.org Website: www.nbna.org

17-22

American Association of Nurse Practitioners Annual Conference Gaylord Opryland Resort & Convention Center Nashville, Tennessee Info: 512-442-4262 ext. 5238 E-mail: conference@aanp.org Website: www.aanp.org

24-29

Philippine Nurses Association of America 35th Annual National Convention Caesars Palace Las Vegas, Nevada E-mail: info@mypnaa.org Website: www.mypnaa.org www.minoritynurse.com

September 17-20

National League for Nursing 2014 Education Summit Hyatt Regency Phoenix and Phoenix Convention Center Phoenix, Arizona Info: 800-669-1656 E-mail: summit@nln.org Website: www.nln.org/summit

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MINORITY NURSE LETTER TO THE EDITOR

he article “The ACA and Opportunities for Nurses” featured in the Winter 2014 issue raised some key points. When the media discusses the Affordable Care Act (ACA), they tend to focus on how it will affect the uninsured and indigent populations. I like the fact that this article was balanced and specified how it would affect the delivery of care, nurses, nurse practitioners, and the primary care workforce. One of the goals the ACA seeks to accomplish is to keep people from using the emergency room for primary care services. More nurse practitioners are assuming the role as primary care providers, especially in community health centers that care for underserved populations. As mentioned in the article, only 17 states and the District of Columbia allow nurse practitioners to practice independently without a doctor’s supervision. Many nurse practitioners are advocating for more autonomy to provide primary health care services independently. However, the general consensus among most doctors is that nurse practitioners lack the extensive training that medical doctors go through to diagnose, treat, and prescribe medications to patients. Physicians argue that they attend medical school for four years. During their education, they have to take the United States Medical Licensing Exam (USMLE), which is given at various stages of their academic career. Afterwards, they initiate residences or advanced training in their specialties. Residency programs can last between three and five years. Doctors who want more specialized training or training in a subspecialty may pursue fellowships after their residences. Also, they maintain that they have a stronger foundation in biochemistry, medical genetics, and neuroscience. Nurse practitioners have a master’s degree, which requires two years of full-time study beyond the bachelor’s degree in nursing. Additionally, most nurse practitioner curricula require nurses to take advanced pathophysiology and pharmacology and countless hours of clinical rotations in hospitals and community care settings. The skill sets that advanced practice nurses possess should not be undervalued. They have a more patient-friendly approach to care. Typically, physicians use a medical model that emphasizes physical and biologic aspects of specific diseases and conditions. They focus on what’s wrong with the patient and develop a problem-solving approach. Many nurses utilize a holistic model, which focuses on a client’s mind, body, and spirit. Patient satisfaction tends to be higher with nurse practitioners than physicians. It comes from listening and being respectful, as well as spending adequate time with clients. This may be the reason patients have a better rapport with nurses and greater satisfaction than with doctors. There have been studies conducted comparing the quality of care provided by physicians and nurse practitioners, and it has been found that clinical outcomes are similar. Moreover, the Institute of Medicine recommends that Congress should make Medicare payments rendered to nurse practioners’ services the same as physicians’ services. Many Americans don’t have access to primary care. The implementation of the ACA will bridge the gap and add new, insured patients seeking primary care services. Also, we will be facing a growing aging population that will need to be treated for chronic conditions. This will present opportunities for advanced practice nurses to meet those needs, especially with the growing primary care physician shortage. More states should allow nurse practitioners to meet those needs independently without the supervision of a doctor.

—Carisa Townsend Student, SUNY Downstate

Minority Nurse | SPRING 2014

The Path to

Wellness

The Fundamentals of Nurse Coaching BY CHRISTINE HINZ As a young girl in New Dehli, India, Harpreet Gujral, MSN, FNP-BC, INC, grew up knowing medical practitioners of all stripes. Depending on the illness, her parents took her to a conventional medicine physician, a homeopathic doctor, and even an ayurvedic (ah-yur-ve-dic) practitioner. By blending those approaches, they not only exposed her to her future profession—she loved the nurse’s white cap and uniform— but also to a mix of holistic health practices.

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So when an e-mail about a nurse coaching program crossed her computer screen in 2011, Gujral took a close look. After two decades as a nurse and nurse practitioner, primarily with Inova Health System in Fairfax, Virginia, she was intrigued by the idea of returning to the holistic concepts she had set aside years ago to fit into this country’s Western health culture. As a nurse coach, she’d no longer be the “expert” voice telling individuals what to do. Instead, she’d be guiding them to their own conclusions, on their own timetables, with their unique stories front and center. In short, this would be about treating the whole person.

“I

realized that my roots were calling me,” Gujral says. “I’ve always taken pride in how I treat my patients and their families, but I also know that there’s room for improvement. There’s always a little bit more I can do in the way I practice. This holistic approach offered me that opportunity. It also took me back to my Eastern roots.” Perhaps you hear the same call. After years of dispensing care the traditional nursing way, you’re open to a practice approach that moves patients toward optimal wellness and even lifesaving self-care without suggesting a “fix.” Nurse coaching offers those opportunities. As detailed in a recently published American Nursing Association (ANA) textbook, The Art and Science of Nurse Coaching: The Provider’s Guide to Coaching Scope and Competencies, this approach puts patients (or clients, as they are often referred to) in charge of their own care by letting them direct the activity and pace. “As nurses, we’re great at telling people what to do,” says Barbara Dossey, PhD, RN, AHN-BC, FAAN, co-director of the International Nurse Coach Association

Minority Nurse | SPRING 2014

(INCA), and a coauthor of the book. “But the beauty of nurse coaching is that we’re no longer fixing things. Instead, we’re helping clients really look at their situation, tap into their own resilience, and be able to say, ‘I can try that. I can do that.’”

Patient First Is Fundamental But with a relationship-centered focus as the goal, what do nurse coaches specifically do to change the dynamic? And what constitutes the art versus the science? The short answer is

that coaching actually expands the role of nurses and nurse practitioners by integrating the scientific, scholarly based skills they learned in nursing school with a bevy of new aptitudes and theories to help them guide individuals holistically on the road to wellness. To be successful, nurse coaches accept two fundamental beliefs: First, people are unique persons in their capacity to learn, develop, and change. When invited to direct their own health, they’re very capable of positively impacting their progress. Second, nurses can play a primary role in mobilizing someone’s innate capacity for such growth

ship—one in which they’re willing to be led rather than always leading—nurses are uniquely positioned to guide any individual in realizing his or her wellness potential. That means any specialty, any setting, and any condition—acute or chronic—that might benefit from behavioral change. But how does one navigate the relationship with clients so they’re inspired to take even preliminary steps toward renewed health? For starters, rather than offering your educated opinion and advice, you should: • Encourage people to be experts in their own care. That means accepting them

As a nurse coach, she’d no longer be the “expert” voice telling individuals what to do. Instead, she’d be guiding them to their own conclusions, on their own timetables, with their unique stories front and center. and self-healing. By establishing a deep connection and true collaborative relation-

unconditionally where they are in terms of their lives and health issues while giving them

wide berth to identify their own priorities and areas for change. You may not share someone’s values or decisions, but by honoring this person’s

New Hampshire. “It was a onedimensional approach to care. But as a holistic nurse coach, I have a much broader perspective of the whole person. I’m

By establishing a deep connection and true collaborative relationship—one in which they’re willing to be led rather than always leading—nurses are uniquely positioned to guide any individual in realizing his or her wellness potential. uniqueness, you encourage a course that truly reflects his or her belief system and way of doing things. In short, you recognize that change is best achieved when it comes from within and fits someone’s readiness, desires, and goals. • Emphasize human caring in each encounter. Although this concept is a moral ideal in all of nursing, it’s particularly important when the goal is to assist someone in his or her wellness journey. Human caring requires that you’re fully present and nonjudgmental. It means creating a safe environment in which people can freely express their hopes, dreams, fears, and pain, knowing that such information will be met with empathy and respect. In short, regardless of their current vulnerabilities or choices, your clients can be confident that you’ll be supportive as they evolve toward healthier goals. “Before I was trained in holistic nursing, I approached patients as dependent persons in need of services, guidance, and resources,” says Margarita Ruiz Severinghaus, RN, MA, AHN-BC, HWNC-BC, clinical resource coordinator at the Office of Care Management for Dartmouth-Hitchcock Medical Center, based in Lebanon,

much more aware of the multiple dimensions involved in this individual’s entire experience.”

Where Art and Science Merge Eliciting your client’s health story and goals entails a level of inquiry that goes deeper than a traditional patient-provider interaction. Some of the skills you’ll weave throughout each encounter come from the counseling and psychology worlds. Others may even touch on behavioral and other principles you learned first in training. In nurse coaching, your objective isn’t to analyze a current problem, judge a previous failure, or even dig archaeologically for old issues. You’re also not there to “fix” the clinical diagnosis at hand. Since this approach is about raising a client’s health consciousness and general awareness, you’re focused on where that person is right now in generating achievable goals. That may include, for instance, helping a midnight-shift worker realize better options to quality health than hitting the all-night deli because it’s an easy stop between the subway and home. “One of the strongest principles in my approach to nurse coaching is cultivating awareness because that allows you

to make choices,” says Bonney Schaub, RN, MS, PMHCNS-BC, cofounder of the Huntington (NY) Meditation and Imagery Center, and coauthor of the ANA book. “People often don’t realize that something is a habit until you say, ‘Let’s look at the steps that go into this.’ Once they become aware, however, they can create a plan to choose differently.” Whatever you do, you want to create positive energy—or ch’i—by listening attentively, engaging skillfully, and most importantly, following your client’s lead as he or she determines the direction of each session. It’s in these exchanges that the art and science of nurse coaching converge. Of course, you’re still going to utilize the scholarly-based, critical thinking and systematic processes you learned in nursing school. The same can be said for the competencies, professional standards, and core values. They’re as fundamental to the science of nurse coaching, as are the communication skills you’ll need to break through barriers and keep people on track. The art of nurse coaching refers to how skillfully you maneuver those tasks along with additional aptitudes and tools you’ll use to address the body-mind-emotion-and-spirit connection of an integrative or holistic health experience. It also suggests the nuanced adjustments you may have to make during each encounter. In that way, the art of coaching is much like the art of dance. Both require that you know when to lead in one direction, when to follow in another direction, and when to change directions, depending on any shifts in energy. So how does that occur? As Darlene Hess,

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PhD, RN, AHN-BC, PMHNPBC, ACC, HWNC-BC, founder of Brown Mountain Visions, a coaching firm based in Los Ranchos, New Mexico, and coauthor of the ANA book, observes: “You develop an inner ability to trust yourself to be in that quiet place where you may not have a clue as to where to go next or what to do next. Yet you remain still and present, allowing that knowing to emerge. Then, as it does, you and your client dance together with it. That’s the art.” In practical terms, you’re relying not only on that intuition, but also on a bevy of other modalities—guided imagery, meditation, and art therapy on the list—to help clients discover and win their goals. But for starters, you’re just mindfully present with the person. That simply means that you’re focused entirely in the moment on what this individual is saying with no preconceived notions as to what that conversation might yield. To do so, you’re engaging in: • Deep listening plus the power of the pause and not knowing. By concentrating intently, you’re not only creating a safe space where your

In nurse coaching, your objective isn’t to analyze a current problem, judge a previous failure, or even dig archaeologically for old issues. client can deepen his or her own awareness, but you’re also allowing yourself to hear this person’s story. Perhaps it’s the woman whose spirit is broken after losing everyone she loves.

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Profession Ripe for Coaching Change As the national health consciousness shifts from disease management to prevention and wellness, nurse coaching provides a satisfying niche for experienced nurses and nurse practitioners eager to be on the cusp. Yet, it also brings the profession back to the basics first advocated by its philosophical founder, Florence Nightingale. Among her trailblazing contributions, she laid the groundwork for holistic or integrative patient care, concepts embedded in today’s profession, albeit neither taught nor practiced universally. The American Holistic Nurses Association (AHNA) has been the driving force behind this patient-centered paradigm since 1980. Yet many nursing scholars have pioneered ways to formalize Nightingale’s ideals, particularly via nurse coaching. They may differ in how they express the theories or even train professionals. Nevertheless, their models reflect similar healing goals.

So, what are the practicalities of venturing into this territory? Here are a few particulars that you should know: 1. The ANA book maps the fundamentals. In writing The Art and Science of Nurse Coaching, the authors have produced the first book to bring to the forefront the unique skills, aptitudes, and other nuanced concepts necessary for establishing a purposeful, results-oriented holistic partnership. They provide a comprehensive roadmap as to how nurse coaching preserves the principles and core values of nursing and the nursing process while pairing them with new ways to think, interact, and behave. By mastering the differences, nurse coaches create safe spaces for individuals to explore and accomplish change. The book offers the theories and tools for doing so. 2. Training is essential. Although ANA’s guide is meticulous in its detail, the only way to truly master the scope, nuances, and competencies of nurse coaching is through formal training. The six-month program usually weaves a rigorous onsite curriculum with intense at-home coursework so students can continue their current jobs. During each faculty-led seminar, participants cover the didactics they’ll need to step out of their traditional nursing mindset and into a new role as listener and follower rather than talker and driver. Once steeped in the whys and wherefores of being totally present, they’re ready to coach peers and others back home. 3. Certification is goal. As with any specialty, being board-certified in nurse coaching tells others how seriously you take your new role and how grounded you are in the nuances. The American Holistic Nurses Credentialing Corporation (AHNCC), AHNA’s certifying body, offers the only route to such designation. To qualify for AHNCC’s National Nurse Coach Certification exam, candidates must be registered nurses with at least a bachelor’s degree in nursing and two years full-time work. They must also complete at least 120 continuing education hours, 60 of which focus on content consistent with the core concepts enumerated in The Art and Science of Nurse Coaching. The additional 60 hours must involve mentored or supervised coaching experience. 4. Self-discovery is key. At the same time they’re uncovering ways to guide clients from point A to point B, nurse coaches are pursuing their own self-development, self-awareness, and selftransformation. For the same reflective modalities (e.g., meditation and guided imagery) that these professionals eventually will apply to others, they use first to understand their own shortcomings and challenges. In doing so, the goal is not just to make constructive changes for the present, but also to empower them for a lifetime of positive self-care.

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By cultivating your deep listening skills, along with additional tools such as the power of the pause and not knowing everything, you’re able to explore territories with her that might otherwise remain unknown or untouched. Deep listening also permits you to pay attention to body language, which sometimes speaks louder than words. “If somebody is ready to cry, I’m not going to interrupt where he or she is at that moment,” says Dossey. “I’m going to hold that space and just allow this person to go with it.” • Motivational interviewing and appreciative inquiry. Used in tandem, these techniques are foundational in your efforts to draw out individuals, accept what they’re saying, and encourage them to reach their own conclusions. Motivational interviewing, for instance, is about valuing change. It’s about getting a middle-aged man to understand that taking his blood pressure medication every day is important, even if it didn’t seem so in the past. You’re not trying to scare this person with the arithmetic of unchecked hypertension and silent strokes. Instead, you’re searching—through the cotechnique of appreciative inquiry—for clues as to your client’s best strategies and strengths. Perhaps in the end that means simply suggesting, “Is it possible to set the pills at your bedside with water and make them part of your morning routine?” • Open-ended questions. The tools that drive every encounter, open-ended questions allow you not only to engage people in decision-making, but also to gather important intelligence. The beauty of this technique is that you can use it no matter where your client sits

on the willingness spectrum. For instance, if he or she is just contemplating the possibility of eating healthier, sleeping better, or even getting off drugs,

strategize steps for meeting it. How long might that transition take? It’s hard to say what triggers someone from merely thinking this could be a good

Whatever the strategy, you’re always mindful of the final leg—sustainability—of your coaching efforts. you open the conversation by asking, “Is this something you might do in the future?” or “What might be some of the barriers to starting now?” Or, if your client is edging toward action, you might nudge things along with: “Can you imagine what change might look like?,” “Can you think of how you might accomplish it?,” or “Are you willing to do it in the next six months?” You know your client is finally ready for real action when he or she mentions an immediate goal, eager to

idea to saying, “I’m ready to take action.” Perhaps a wakeup call—a family member getting sick or a news story generating a scare—suggests that the time is right. It’s also difficult to assess what obstacles or new issues may emerge and intrude along the way. Daily habits, cultural practices, or even a worldview suggesting that the course of health events can’t change because that’s what God or nature intended can be overwhelming. Likewise, your client may experience a more

immediate issue that forces a course correction from the long-term plan to the problem at hand. Perhaps she’s afraid to go home, for instance, because an abusive husband is waiting. Whatever attitudes, ingrained beliefs, socio-economic circumstances, or life challenges are creating roadblocks, probing questions and deep listening allow you to guide someone in overcoming them. Whether you’re asking your abused client for permission to offer resources that might keep her safe or you just want to know what’s the “worst” and “best” case scenarios for taking off excess weight, you’re continually gauging this person’s readiness. “As nurse coaches, we sometimes feel responsible for the timing,” says Dossey. “But if we’re truly going to have a patient-centered focus, we’ve got to acknowledge that it’s someone else’s life and someone else’s choice. We can create the opportunity for change, but we can’t force people to take it. Anyone who has raised children will confirm that.”

Building Success on Strengths Whatever the timeline, when the opportunity presents itself, nurse coaches pivot to options that build on someone’s strengths rather than emphasize his or her weaknesses. Since the very premise of this approach is to praise or encour-

age people to success, you’ll likely be helping your client enlarge his or her strength vocabulary by identifying all of the traits that he or she has relied on in the past. Keep in mind, however, that people often don’t recognize the true virtues in their own story or what they’ve accomplished previously. The efforts seemed so small. The tasks were so large. Or the relapses have been too many in number to appreciate that just being open to a new attempt is evidence of progress. Whatever the challenges, the big goals for your client may be incremental at best: “I’ll walk to the mailbox.” “I’ll add vegetables to my dinner.” “I’ll reduce my salt intake.” “I’ll give up half a pack of cigarettes each day.” Even a heroin addict’s willingness to stop sharing needles can be a lifesaving behavioral change. This person may not be ready to give up drugs, but he or she is at least willing to consider the transmittal risks of infection. “It’s not necessarily going to be everything that you want for them,” says Gujral. “But just making strides in the right direction and seeing the value of those strides, even quantifying them, will keep them moving forward.” After overhearing a pre-op nurse practitioner scold one woman for having horribly high blood sugar levels for someone facing immediate car-

The art of nurse coaching refers to how skillfully you maneuver those tasks along with additional aptitudes and tools you’ll use to address the bodymind-emotion-and-spirit connection of an integrative or holistic health experience.

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diac surgery, Gujral decided to draw attention to the positive news during her subsequent diabetes consult. She parlayed her motivational interviewing techniques by focusing on how her teacher-client had accomplished a 2% decrease in her hemoglobin A1C test from results over the past two years. With a double take and a smile, the woman related that she just had made a concerted effort to eat healthier, despite the difficulty of living alone with no support system. Knowing that the levels should improve even further, Gujral followed with: “What do you think would allow you to get an even better result?” The woman offered that she’d examine her after-school schedule to see how she could incorporate more activity and a healthier eating plan. Then came the negotiation. Gujral thought her suggestion of walking 10 minutes around the house after dinner was a perfect pitch idea. But as to the TV dinners her client promised to eat each night, Gujral wondered aloud if there wasn’t another easy option with less salt. Perhaps heating mixed frozen vegetables, seasoned with olive oil, might be a doable alternative. “Would that be something that might work for you?” By securing a “Yes, I can do that,” Gujral gave her client options after surgery. “It’s really important for our clients to feel that they’re coming up with a plan that can work,” she says. “I’m available to embellish it, but not just as an expert. I’m using my coaching techniques.” Whatever the strategy, you’re always mindful of the final leg—sustainability—of your coaching efforts. You’re not

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only guiding folks in realizing what they need to do to get unstuck, but you’re also helping them break down their objectives into small tasks that can be used over time. What else must be present for this person to keep things going long-term? Besides ready responses to that inner critic and habits that can thwart their efforts, they need to recognize the tactics that have worked for them in navigating other life issues. Likewise, your client will decide how to measure success, based on the goals the two of you set up-front. Perhaps it’s to walk down the stairs without pain every morning or maybe dance at a granddaughter’s wedding next year. Whether true progress takes

geting the next one. And even if the two of you can’t celebrate winning the initial objective, you can mark any strides that might lead to fruitful results later. “Nurse coaching doesn’t necessarily guarantee that your clients will be habit-changers,” says Severinghaus. “But hopefully this process of discovery will allow them to appreciate the effect of choice on their happiness and well-being.”

Final Thoughts A nurse coaching relationship isn’t built to last forever, even if you really enjoy the interaction. Although the length of any commitment is based on someone’s needs and goals, there’s both a starting point and an ending point. Whatever

Whether true progress takes place within the context of your coaching relationship or much later, your role is to encourage the possibility and acknowledge every feat. place within the context of your coaching relationship or much later, your role is to encourage the possibility and acknowledge every feat. More importantly, you want your clients to recognize and accept what they have accomplished, too! Since momentum builds on momentum, improvement on one goal can encourage tar-

the timeline, your goal is for your client to tap into his or her innate abilities to be empowered for a lifetime. Other medical practitioners likely have explained the stakes, and may even have referred this person to you. But you’re there to right the ship so it can sail. In the meantime, you may find a deeply satisfying way to

practice that connects you to your profession and patients in an exciting new way. For instance, when she answered that e-mail in 2011, Gujral found more than just INCA’s Integrative Nurse Coach Certificate Program. She was up close and personal once again with the holistic health concepts she had first learned in her native India—only now they’re an integral part of her day. As assistant director of certifications services at the American Nurses Credentialing Center (ANCC) as well as a private hospitalist practice nurse practitioner, Gujral has found ample ways to use her nurse coaching skills. Whether she’s collaborating with ANCC staffers or guiding patients to better medical results, she delights in coaxing people to do their best. So inspired by nurse coaching as a path to wellness, she’s even pursuing a doctoral degree in nursing practice, focused on integrated health and healing. “I’ve always taken pride in being a nurse,” Gujral says. “But my satisfaction with my profession has gone up many notches since I became a nurse coach. Making the connection with people at such deep levels is amazingly fulfilling. It gives me great joy.” Christine Hinz is a freelance writer based in Milwaukee, Wisconsin.

The Military Nurse THE THRILL OF LEADERSHIP BY JAMES Z. DANIELS It’s the experience of a lifetime. After you’ve cleared security to enter Fort Bragg in North Carolina and your vehicle has been searched, you are instantaneously awed by the enormity of this army military post. I am on my way to engage two ranking officers—nurses—in conversation regarding health care in the military. The drive takes you on the four-lane All American Expressway with vehicles whizzing by between 55 and 60 miles per hour. As I slow down to take in this sprawling city, I am reminded that I am no longer in the city of Fayetteville that abuts the post. www.minoritynurse.com

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ut the pièce de résistance was the emotional tremor I felt when the Womack Army Medical Center loomed up at the end of a long entrance way to affirm that this was iconic America. This complex, 1.1-million-square-foot (this is not an error) care facility is not just impressive by its bricks and mortar, but is a care facility providing world-class health care across a compendium of general and specialized medical

is just as comfortable applying a Band-Aid to a 5-year-old with a splinter in his thumb. He leads the effort at Fort Bragg to integrate evidence-based practice (EBP) into all aspects of nursing care. Moore chose Winston-Salem State University for his undergraduate degree because of the seven-to-one ratio of women to men among the student body—a decision he candidly admits worked out for him because that was where he met

A scholar, clinician, and practitioner with a passion for attacking health care disparities, Moore knows his way around scholarly journals but is just as comfortable applying a Band-Aid to a 5-year-old with a splinter in his thumb. disciplines to our service men and women, veterans, and the families of those who serve on active military duty. To visually take it all in requires a significant swivel of my head. The purpose of my visit is to gain some measure of understanding and appreciation of this reputable institution and to tell the story to those who will not have the opportunity I had to visit and see for myself. My host is Lieutenant Colonel Angelo D. Moore, Deputy Chief, Center for Nursing Science and Clinical Inquiry, a native of Queens, New York, and graduate of Goldsboro High School in Goldsboro, North Carolina. Moore holds a PhD from UNC Chapel Hill and was the university’s first African American male awarded a doctorate from the School of Nursing. A scholar, clinician, and practitioner with a passion for attacking health care disparities, Moore knows his way around scholarly journals but

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his wife, Lee Antoinette, a civilian nurse now on the faculty at Fayetteville Technical Community College. He was posted to Fort Bragg last July from Honolulu, where he had been stationed for six months having initiated and led the EBP process. For the better part of a day, Moore allowed me to engage him in an in-depth conversation on what happens within the walls of this facility that necessitates a tour by a skilled guide to truly appreciate the delivery of military health care services. I was taken through the “miles” of passageways and corridors, to the service malls and the various departments, as well as the skilled nurses training center to witness the nurses being tested on their competencies on a variety of medical and dispensing procedures; the cafeteria to sample military fare; and, eventually, one of the deputy commanders of the medical center, Colonel Kendra

Whyatt, who on this day was in charge. Too often there is a perception that connects questionable treatment of our military service personnel to the assumption that the health care delivered is similarly questionable. Nothing could be further from the truth. In my conversation with Colonel Whyatt, she very carefully called my attention to the signature difference between a military nurse and a civilian nurse that is invaluable in understanding the dynamism of military health care. “Military nurses,” Whyatt says, “wear inseparably and simultaneously the role of the soldier and the role of the nurse, and they are expected to provide care for their fellow soldiers and protection for them if necessary, and certainly for themselves at the same level of competence.” It is this dichotomy—the syringe and the gun—that guides my desire to understand how care is delivered by our nurse soldiers to a military population of 57,000 at Fort Bragg, of which 45,000 are active duty members. What we know today as Fort Bragg came into effect in September 1922, but its history is attached to a Confederate general, Braxton Bragg, a native of

Army base; and it is the home of the Airborne—the 82nd Airborne Division, referred to as “All-American” because its members represent 48 states. It is also the home of the distinguished Special Operations Force. Among its many amenities are its schools—preschool through high school for nearly 5,000 students, the children of soldiers on active duty. Womack Army Medical Center opened its doors on March 9, 2000. The center is named for Private First Class Bryant H. Womack, a North Carolina native who was posthumously awarded the Medal of Honor for conspicuous gallantry during the Korean conflict. The center’s mission is succinctly stated: Provide the highest quality care, maximize the medical deployability of the force, ensure the readiness of Womack personnel, and sustain exceptional education and training programs. The center is 1,020,359 square feet, encompassing sixfloor towers and other buildings. It sits on a 163-acre site, has a 153-bed inpatient capacity, and serves the more than 225,000 eligible beneficiaries in the region. It is the largest beneficiary population in the Army. The building has a state-ofthe-art design: The inpatient

“Military nurses,” Whyatt says, “wear inseparably and simultaneously the role of the soldier and the role of the nurse, and they are expected to provide care for their fellow soldiers and protection for them if necessary, and certainly for themselves at the same level of competence.” North Carolina. The post occupies 127,000 acres; its population makes it the largest US

tower floors have an interstitial space between each floor that allows computers, as well as other

technical components, to be repaired without interrupting patient care. The complex is designed to transform many of the administrative areas into service areas providing care if necessary, which would double their inpatient treatment capacity. Four patient-centered medical homes are located on Fort Bragg, and two community center medical homes are located in the surrounding mili-

the medical home work for their patients rests on their enormous electronic records capacity, making it easier for them to implement the benefits from the Electronic Health Records (EHR) system that gives providers worldwide access to comprehensive and timely patient histories. The $1.2 billion medical records system began deployment that year across the entire force and

At this level, “the PhD or the DNP enables and equips a nurse to engage in visionary and strategic thinking,” explains Moore. “After ten years in the military, nurses overwhelmingly have acquired the master’s degree, and this is a distinguishing factor in military nursing culture.” tary community where their beneficiaries live and work. The Womack Army Medical Center was among the first health care providers in the

was fully operational by 2007, just as the benefits and necessity of the EHR were dawning on the civilian medical community.

coordinated, accessible, and focused on quality and safety. It has become a widely accepted model for how primary care should be organized and delivered throughout the health care system. It is a philosophy of health care delivery that encourages providers and care teams to meet patients where they are, from the simplest to the most complex medical conditions. But there is also the Soldier Centered Medical Home (SCMH). This is a care process with an exclusive and unique focus: the soldier. It includes behavioral health, physical health, and nutrition services; these are significant to soldiers who may be displaying the symptoms of Post-Traumatic Stress Disorder (PTSD). Everyone is screened using a predetermined questionnaire and an initial evaluation that determines whether the sol-

Womack Army Medical Center, Fort Bragg

country to seize on the benefits, design, and purpose of the medical home in 2004. The military’s ability to make

The medical home is best described as a model of primary care that is patient-centered, comprehensive, team-based,

dier is a prime candidate for treatment or follow-up. The Army’s official position is that “80% of all soldier complaints

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at sick-call are muscular-skeletal,” according to physician Colonel Dallas Homas, the former commander of the Madigan Army Medical Center in Tacoma, Washington, and the originator of the SCMH that became operational in November 2011. The concept grew out of an incident where an exceptional noncommissioned officer lost his knee unnecessarily, according to Homas. Diagnosis and treatment of PTSD, however, continues to be a contentious issue within the military sector and might have led to Homas’s reassignment from Madigan Army Medical Center. Colonel Ramona Fiorey, a nurse, assumed command of Madigan on August 9, 2013. The Department of Veterans Affairs (VA) has reported that for the last two years PTSD diagnoses are just shy of 30% of the 800,000-plus Iraq and Afghanistan War veterans treated at VA hospitals and clinics. It is during my conversation with Moore that a picture emerges of how the soldiernurse threads her way through the system to attain the highest heights of a nursing career. One thing they do have is the role models to motivate them to succeed. You see, the Surgeon General of the US Army is also the Commanding General of the US Army Medical Command. Currently, that person is Lieutenant General Patricia Horoho. She is a nurse. Whyatt, one of Womack’s deputy commanders, is also a nurse. Nurses provide the leadership at the highest level and at base level. This is without precedent, and the profession does take notice. Horoho has already made significant changes regarding military health care by her

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The Patient CaringTouch System

emphasis on what she calls, “life space.” She wants providers to address those periods when military personnel are away from a care facility with emphasis on ensuring they are

acronyms—PCTS. It has five components: enhanced communication, capability building, evidence-based practices, healthy work environments, and patient advocacy. The

As a male nurse in the 1990s, Moore was not an oddity because the requirements of war had always allowed the Army to attract males to the military nursing profession. engaged in healthy behavior. Horoho’s leadership centers around the Army Nurse Corps’ five-point strategy, known as the Patient CaringTouch System or—with the military’s characteristic use of

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PCTS is a patient-centered model for nursing care that was developed to reduce clinical quality variance by adopting a set of internally and externally validated best practices. Additionally, it is an enabler

of Army medicine’s culture of trust initiative and the transition from a health care system to a system of health. The plan is elaborately laid out in a campaign document intended to guide the care leadership through 2020, with emphasis on evidence-based decisions, metrics, and best practices that cannot be overemphasized. As you might expect, the Army takes the issue of leadership very seriously. Army nursing is guided by an Army Nursing Leader Capabilities Map that encompasses a thirty-year journey, and Moore is a good example of how the process has guided his own career. A nurse’s development has three

segments, and the progression is tied to seven performance criteria. The three segments are tactical skills, operational and organizational skills, and strategic thinking and execution. The nurse can move along a career path in what is called “duty positions,” beginning as a staff or charge nurse and rising in rank to a section or department chief and then deputy commander for nursing. During this progression, the Army nurse develops competency in such areas as change and people management, succession planning, and foundation thinking, where he or she is expected to demonstrate

unit-level, evidence-based decision making. At this level, “the PhD or the DNP enables and equips a nurse to engage in visionary and strategic

completion of a four-month training program. Moore tells me that this is the normal developmental pattern allowing nurses to be associated with

There is a well-known, generalized concern, however, about the low minority representation among the officer ranks in the military, which has attracted the attention of the top brass. thinking,” explains Moore. “After ten years in the military, nurses overwhelmingly have acquired the master’s degree, and this is a distinguishing factor in military nursing culture.” Lieutenant Colonel Moore (never addressed as “Dr. Moore” but exclusively by his rank, as is the pattern within the military regardless of credentials) actually wanted to be a dentist, but financing that career seemed to be out of reach. He heard about the Army College Fund, so he enlisted in 1989. He was placed in the communications section, but had a strong desire to transfer to the medical field. He was working to complete his associate’s degree at night and heard from a friend about the Army’s Green to Gold program in which, if selected, he could progress over time from an enlistee to an officer. He completed the degree and applied, was accepted, and enrolled in the nursing degree program at Winston-Salem State University, graduating with the BSN in 1995. As an active duty nurse, Moore’s assignment took him to the Eisenhower Army Medical Center in Georgia as a medical/surgical nurse; later, he chose to be certified as a critical care nurse upon

a particular specialty of their choosing. As a male nurse in the 1990s, Moore was not an oddity because the requirements of war had always allowed the Army to attract males to the military nursing profession. Medics were trained to provide treatment to fellow soldiers on the battlefield, so the transition to formal training to administer generalized or specialized care was natural for many. Today, males’ 30% representation in Army nursing is six times higher than in the civilian nursing population. “Male nurses,” Moore says, “are usually more prevalent in the areas that are ‘actionpacked,’ such as trauma, or the highly technical areas where elaborate technical components are integrated into the patient’s care and in emergency room nursing.” After several years of praying “Please, Lord, do not let any of my ICU patients die on my shift,” Moore wanted a change out of critical care and chose to work in primary care to reduce the prospect of patients needing critical care in the first place. He applied to the Army’s long-term education and training program and was accepted into the master’s program to become a nurse practitioner. His next assignment was his

appointment in 2007 as a recruiting commander stationed in Brooklyn, New York, with centers in Albany, New York, and New Jersey. Moore and his team of recruiters focused on enticing doctors, dentists, and nurses into the Army as officers by being visible at medical conferences and health forums where these professionals were present. The recruiters championed the experience, benefits, and research engagements that a recent MD graduate, for example, would never get in a hospital or private practice in his or her civilian role. They also targeted students considering careers in the medical profession. Moore responds to my question regarding minority recruitment within the Army by explaining that there is no program designed to recruit minorities into the health care ranks as a targeted group. “To the best of my knowledge, we do not look at race

the top brass. So it came as no surprise when in March 2011 the Military Leadership Diversity Commission issued a report that included the state of diversity among the leadership ranks of the military. “The disparity between the numbers of racial and ethnic minorities in the military and their leaders will become starkly obvious without the successful recruitment, promotion, and retention of racial/ethnic minorities among the enlisted force,” the report states. “Without sustained attention, this problem will only become more acute as the … makeup of the United States continues to change.” It’s similar to the state of private sector organizations. Whether the Army does or does not have a minority recruitment strategy, the fact is that officer and leader representation will not improve unless there is a deliberate pipeline strategy leading from enlistee to officer. However, as

“There is one provision, however, where we see eye-to-eye with the ACA, and that is in the aspect of prevention as opposed to curative or disease care, because a healthy lifestyle is central to mission readiness,” explains Moore. in our recruiting efforts,” says Moore. “We make appealing what the Army has to offer and allow the prospect to decide. Because of the culture of the Army, we encourage the prospective recruit to consider carefully the choice of military service.” There is a well-known, generalized concern, however, about the low minority representation among the officer ranks in the military, which has attracted the attention of

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I walked the hallways and visited the patient treatment locations at Womack, those at work and those receiving care looked very much like America. With Moore accompanying me as I toured the facility past the many labs, the enormous back-office function, work stations, administrative functions, physical therapy service areas, and clinical specialties of every description along the long and seemingly interminable walkways, he

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added to my attempt to grasp the magnitude of what takes place at Womack as a matter of routine, by citing some impressive statistics. While doing so, he emphasized that the active military and the Veterans Healthcare Services are decidedly not affected by the provisions of the Affordable Care Act (ACA). “There is one provision, however, where we see eyeto-eye with the ACA, and that is in the aspect of prevention as opposed to curative or disease care, because a healthy lifestyle is central to mission readiness,” explains Moore. “The three streams that drive mission readiness within the healthy life space triad are ac-

tivity, nutrition, and sleep— and we are confident there will be a pay-off down the road.” In fiscal year 2013, the Womack Army Medical Center had over 12,000 admissions with a 62% average daily bed occupancy rate and average length of stay of 2.6 days, over 3,000 live births, and over one million outpatient appointments. On a daily average, the associated clinics provided over 3,400 outpatient visits, approximately 6,000 outpatient prescriptions, almost 1,000 radiological exams, over 4,000 pathological tests, almost 200 Emergency Department visits, almost 40 surgeries, and at least eight live births. There

are two medical residencies (family practice and obstetrics), and 14 other physician or Allied Health educational and training programs. Moore points out that no prosthetic service is provided to the injured soldiers at this facility. He reminds me that the health care staff consists of active duty members, Department of Defense civilians, and contractors who include civilian physicians and nurses. It is easy to identify the civilian medical staff because they are listed on appointment boards by their medical credentials; whereas, the active duty medical staff are listed by their rank, often on the same appointment boards.

The author with Colonel Kendra Whyatt (left) and Lieutenant Colonel Angelo D. Moore (right)

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Moore guides me along a walkway with photographs of distinguished service members and towards the skilled nursing center where competency tests are taking place. This is a biannual event where nurses are tested and certified to perform certain medical procedures. Womack nurses are required to expose themselves to this process if they are to be allowed to perform certain procedures. It is proctored by senior nurses and other technical staff. My visit to the center as this event was taking place was purely coincidental. In a room deep inside the complex, nurses were examined on performing catheterizations on a mannequin (part of the

infusion therapy procedure) and on their ability to know the difference when it is a pediatric patient compared to an adult; reading and interpreting the ECG tape—a necessary step before referring it to a cardiologist; identifying mental health behavioral issues such as PTSD; and using newly introduced, technologically sophisticated equipment. There are charts and poster boards everywhere. The atmosphere is intensely business-like, presided over by a nurse with the rank of major and dressed in fatigues. Even the test mannequin appears to be aware of the buzz over the event’s significance. Next, Moore takes me to the pharmacy services mall, which is where the patients have their prescriptions filled. Every aspect of this procedure is very clearly understood as between 25 and 30 patients wait for either a consultation with a pharmacist or watch to see that their prescription is ready. The first served are those requiring immediate and preferential attention: the active duty soldiers. He or she registers as they all do, and the patient’s name lights up on a marquee pallet as an indication that the prescription is ready. The active duty member’s name will supersede all others. Finally, our walk heads towards the command center where Moore has arranged for me to visit with Colonel Whyatt, Deputy Commander for Nursing and Patient Services, who is acting commander today because Commander Colonel Steven J. Brewster is off the post. This is Whyatt’s first assignment to Fort Bragg. After being cleared to enter the command center, I am

seated in what is quite easily comparable to an executive suite in any corporate headquarters. The offices are bright and cheerfully wood-paneled, with each executive officer’s support staff seated within earshot of their work stations. One is dressed in fatigues, as is Colonel Whyatt. She is tall, relaxed, and with a distinctive military bearing that suggests a calm, in-control demeanor. She is a native of Greenwood, Mississippi, and was previously stationed at a military facility in Germany. With my discussion about minority recruiting still turning over in my mind, I wanted to know her opinion regarding mentoring and coaching. But first she has to be reassured by Moore that I have been cleared to have this conversation with her. I first want to know what makes for a successful and responsive military health system. “It’s the combination of the military, civilians, and contractors working together,” Whyatt responds. “What are the two top concerns that occupy your attention?” Whyatt responds succinctly: “[To stay in mission readiness], I have to recruit staff, retain and train staff, and we are facing challenges in this area; in particular, in the recruiting and retention of staff. Most everyone knows that certain funding is at a standstill.” “Do you mean the sequester?” “Yes.” But a majority of hospital executives believe there is a shortage of physicians and nurses in the US, according to a new survey from American Mobile Nurses Healthcare, a staffing company that recent-

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ly published its 2013 Clinical Workforce Survey. It found that 78% of hospital execs think there is a shortage of physicians; 66% say there is a shortage of nurses; and 50% report there is a shortage of advanced practitioners. The survey also found that the vacancy rate for physicians in hospitals is nearly 18%, compared to 10.7% in 2009, and nearly 17% for nurses, up from only 5.5% in 2009. The vacancy rate also rose for allied professions, from 4.6% in 2009 to 13.3% in 2013. But Womack is currently under a staff freeze, and the civilian workforce is expected to be reduced sometime during 2014. Colonel Whyatt owes her military career to her mother. At the end of Whyatt’s sophomore year at Prairie View A & M University, her mother strongly suggested that instead

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of coming home and looking for a summer job, she visit with the ROTC office on campus and see what they could do for her. Whyatt visited the office, enlisted, and went on to complete her undergraduate degree in nursing with a scholarship from the Army. Her career has taken her to three tours of duty to Germany and several Army posts within the US. “Are you mentoring and coaching any on active duty at this time?” I ask. “That is an expectation of this position. Yes, I am,” she responds. “And is LTC Moore one of your mentees?” “Absolutely, he is my newest.” James Z. Daniels is a consultant and writer who lives in Durham, North Carolina.

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Achieving Salary and Career Satisfaction BY JULIA QUINN-SZCESUIL Romeatrius Moss, RN, MSN, APHN-BC, DNP, doesn’t mince words when she advises other nurses about advancing their careers. “If you aren’t geared and ready and have everything in your toolbox, you are going to be left behind,” says Moss, the executive director of the Mississippi Gulf Coast Black Nurse Association. “Getting an advanced degree is extremely important. It pushes our profession forward.”

s more minority nurses advance, they are positioned to assume leadership roles and increase the diversity of nurse leaders, all of which reflects the patient population. Moss’s outlook mirrors one that is hotly debated in nursing. The Institute of Medicine (IOM) garnered attention with

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its 2010 report, The Future of Nursing: Leading Change, Advancing Health, which calls for a highly educated nursing workforce to keep pace with the changing demands of both the health care environment and the patients who are served. An 80% goal of nurses with BSN degrees and a doubling of nurses with doctorates are

imperative for the nursing community, the report stated. “It’s good for the professions, but equally good and equally more important for the people who are coming into the health care system who deserve an educated workforce,” says Jane Kirschling, PhD, RN, FAAN, president of the American Association of Colleges of

Nursing (AACN). “The bottom line is about patient safety and providing health care that is high quality, efficient, and cost effective.” In light of the study and others like it, nurses—who build careers on change—are debating the best and most reasonable ways to achieve career satisfaction and advancement. A nursing career includes different options, and one work day is never like another. To achieve maximum career success and optimize your salary potential, learn to embrace the changing atmosphere,

Barry, a senior practice and policy analyst at the American Nurses Association. And even Kirschling says that an associate’s degree is often considered a point of entry into nursing

than graduates in other fields. And while the higher salary is great, nurses are finding they need a bachelor’s to even get a job. The AACN study showed that 43.7% of hospitals and

“If you aren’t geared and ready and have everything in your toolbox, you are going to be left behind,” says Moss, the executive director of the Mississippi Gulf Coast Black Nurse Association.

says Janice Phillips, PhD, MS, RN, FAAN, director of government and regulatory affairs at Commission on Graduates of Foreign Nursing Schools International, an authenticity credentialing service of foreigneducated nurses.

Advancing Your Education The 2010 IOM report brings the issue of higher nursing degrees into sharp focus, causing some nurses to reevaluate their goals and some hospitals to implement new minimum requirements for employment. “Whether it is an associate’s, bachelor’s, or master’s-prepared nurse, the reality is that nursing requires lifelong learning,” says Kirschling. Nurses have choices about how to advance, but a degree appeals to many organizations. “A minimum of a bachelor’s in nursing will open doors when you are competing for a job, and it shows a level of commitment,” says Marie-Elena

now, not the final point. Nurses are taking notice. Results from the Health Resources and Services Administration’s (HRSA) “2008 National Sample Survey of Registered Nurses” showed that half of registered nurses hold a bachelor’s degree or higher, and just over a third hold an associate’s. The rest have a diploma in nursing. Most nurses initially receive an associate’s degree, but about a third start out with a BSN. And for those who eventually earn higher degrees, the study showed approximately half of nurses with master’s degrees work in hospitals while the rest work in academia or in an ambulatory care setting. According to a May 2012 occupational employment and wages report by the Bureau of Labor Statistics, an RN can expect to earn a mean annual wage of $67,930. Furthermore, the 2008 HRSA study revealed that RNs with graduate degrees earned an average of at least $20,000 more than RNs with other levels of education. Nurses who graduate with a degree also get into the workforce faster. Data from an August 2013 survey by the AACN revealed that nursing graduates of BSN or master’s programs are much more likely to have a job offer at graduation

other health care settings require the degree and that 78.6% of employers prefer to see the BSN on a resume even if they don’t require it. When you consider how to advance both your professional goals and your personal goals, keep in mind how each job will help you get to where you want to be. “Lots of nurses get a degree and go to work and don’t think about career development and learning how to grow your career,” says Barry. As a new nurse, you must ask yourself whether you are gaining valuable experience that you can put on a resume. And

But as the demand for nurses with a bachelor’s degree increases, schools are making it easier by offering accessible classes and accelerated degree programs. And Moss advises nurses not to be discouraged by the commitment. “This is a train,” she says. “Jump in when you can.” In the meantime, anything you can do to make yourself more valuable to an organization will help increase your salary, and often a new degree raises your pay as well. “Provide evidence of how you made a difference,” advises Phillips. Kirschling suggests talking with your employer about wanting to build on your skill set or your desire to continue your education. “Employers want to retain nurses and create career mobility within the organization,” she adds.

Keep Your Options Open “People believe the continuing mantra that nurses need to work in traditional venues like hospitals and doctors’ of-

The 2010 IOM report brings the issue of higher nursing degrees into sharp focus, causing some nurses to reevaluate their goals and some hospitals to implement new minimum requirements for employment. if you have been in nursing for years and are considering a move to academia, you should consider whether a teaching position will offer you needed benefits and retirement.

A Balancing Act Working and going to school isn’t easy, and adding other obligations, like family, often makes the task overwhelming.

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fices,” says Carmen Kosicek, RN, MSN, author of Nurses, Jobs, and Money: A Guide to Advancing Your Nursing Career and Salary. But the pay for those positions doesn’t always match the financial outlay needed to practice there, she continues. Instead, Kosicek advises nurses, especially those just graduating from nursing school, to look for other oppor-

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tunities that offer both professional experience and gainful employment. “It’s not all about the money,” says Kosicek, “but they all have bills.” According to Kosicek, many graduates are not hired for 4 to 18 months, and many of

example, you can ask for more vacation days, a higher match of your 401(k) plan, or tuition reimbursement for classes. “No one is teaching that,” says Kosicek, but it is a valuable skill because it will get you closer to your goals. Negotiat-

Just as you would negotiate the price of a house you are buying, you also must learn to negotiate salary offers, argues Kosicek. them are competing for med/ surg jobs to gain broad experience. She suggests considering other options where you will use all your skills. A position as a school nurse, for example, where you handle hundreds of varied and often complex cases is an excellent way to use your skills and learn new ones. When you apply for a new grad residency program, you are already starting above the rest of the pack, she says. If you are unsure what your next move should be, Kirschling recommends checking out www.discovernursing.com to explore opportunities.

Approach Your Career as a Business When you view your career as a business, you give yourself permission to look impersonally at your experience and your credentials. And you treat any potential job offer, salary increase, or career move with the same consideration as you would a major life change. Just as you would negotiate the price of a house you are buying, you also must learn to negotiate salary offers, argues Kosicek. “It’s not always about your base pay of dollars,” she says. “You can negotiate other ways of compensation.” For

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ing shows you are confident and know your worth. “It is a totally different language,” she adds.

Act Like a Leader Even if you haven’t reached your ultimate career goal, you can act like you have. “You can’t do a BSN [program] and expect to be a manager,” says Barry. “There are lots of little steps.” Be a leader in your nursing community and make your presence known. One way to help increase your salary potential is to get involved within your state or with national organizations, says Barry. Don’t just become a member. Begin to make a difference by giving your input, showing up at events and meeting others, or volunteering on your state board of nursing, advises Barry. “It increases your ability to network and puts your face out there.” Don’t overlook the importance of your workplace as well. Barry recommends getting involved with unit-based activities. Join a shared governance committee or work on a quality improvement project. Then give thoughtful input and work hard for the team.

Be More than Just Another Resume Your resume might be your only shot at a job you want, so make it perfect. Just as nurses need negotiating skills to get ahead, they need a resume that is detailed and exact because it could mean the difference between the slush pile and a job offer. “Nurses are not going to get in with traditional nursing resumes or traditional interviewing skills,” says Kosicek. “They have to show they are business wise.” Barry agrees. Your experience, commitment, and education all combine into one package to an employer, but they have to be able to see it. You can do your part with a detailed resume that lists your education and any current classes along with your qualifications. Become a recognizable name through your professional and appropriate exposure on social media and your networking efforts that bring you in touch with various health care professionals, suggests Barry.

Other Benefits Of course, taking on a new degree doesn’t work for every-

one. You have to consider the financial return on your investment, so you aren’t trading more education for insurmountable debt. Chart the financial impact of furthering your education. If you want a degree but can’t imagine how you will pay for it, become a sleuth for scholarships or take an alternative path. If your company doesn’t reimburse for tuition, see if your professional organization membership gives you access to scholarships or grants. Can you take one class at a time to chip away at the degree? A less tangible benefit of continuing your learning is confidence. “It gets you excited and keeps you informed and learning outside your unit,” says Barry. “Certification is important. It shows your commitment to your profession. It also shows your professional role modeling.” When you are learning and advancing by taking classes, even if it’s one at a time, you are demonstrating to your employer that you are actively engaged in your profession, she says. Phillips knows firsthand the benefits of doing the un-

Romeatrius Moss, RN, MSN, APHN-BC, DNP

Jane Kirschling, PhD, RN, FAAN

expected. She recently left a faculty job at Rush University and the comforts of family and friends for her current job in a new city. Although the prospect gave her nervous butterflies, Phillips says the job fit perfectly with her career plan, filling a gap in policy experience that Phillips wanted to have. “Sometimes you just have to do it,” she says. “I didn’t want to sit around and not take some risk. Most people who have a wellrounded professional life have taken some risk.”

ing process is going through and collecting along the way,” says Barry. “As you are getting a degree, you are exposed to all those other areas.” Even if you are not looking for a job, keep accurate records of your career successes, advises Phillips. “We don’t document our outcomes,” she says, so when the time comes to tell potential employees about them, it’s hard to remember the details. Keep a file—“call it a happy file,” suggests Phillips—where you record accurate outcomes and contribu-

Sometimes, a career move is your chance to advance professionally and personally and will lead to greater rewards, but you have to be willing to take the leap. Have a Plan Your career will stagnate if you don’t have a solid and ambitious plan to follow. Decide where you want to go and write a plan of action to get there. Put yourself in position to get where you want to be. Do you respect a nurse in a leadership position? Notice how she acts and ask about her volunteer work or about any organizations of which she is a member. “Part of the learn-

tions from your job successes. Pay particular attention to relevant numbers and dates, so you can retrieve them when necessary. “Nurses have to be prepared,” she says. “You never know when an opportunity will present itself.”

important for nurses to get a nursing degree,” says Barry. For nursing as a profession to advance with respect, getting a degree—particularly a BSN— will also bring more nurses into position to take over as future leaders. “Nursing education has a lot to do with where you go,” says Barry. Starting with a BSN is the most important goal because it keeps you competitive, argues Barry. But as Kosicek points out, you will have to find your place in the market and actively seek out nursing roles that both pay your bills and satisfy your professional goals. Sometimes, a career move is your chance to advance professionally and personally and will lead to greater rewards, but you have to be willing to take the leap.

“The risk is that we have to be open and willing to leave our comfort zone to experience all nursing has to offer,” says Phillips. “And it’s scary. But I don’t believe anyone should be burned out. You need to find a new perspective.” Just as each nurse is unique, so is each successful career path, says Phillips. “I’ve been a nurse for 37 years, and I am just as excited today as the day I graduated because I see the possibilities,” she says. “At the end of the day, how do you want to feel about what you want to do and what makes you proud of your profession?”

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

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Float Nursing on the BY ARCHANA PYATI Every hospital has stories of nurses who thrive by floating. More than likely, they have chosen to be part of the hospital’s float pool. Yet, for floor nurses who must take float assignments when their unit’s census is low or to fill staffing shortages across the hospital due to absences, vacancies, or high-acuity levels, floating can be a major source of job dissatisfaction. In the past decade, hospitals across the country have revamped their float policies to give nurses greater autonomy and agency in deciding whether or not to float.

isi Bello, RN, has been a float nurse at MedStar Washington Hospital Center in Washington, DC, for 12 years, and for the most part, loves it. The flexible schedule, the variety of clinical experiences, and the constant exposure to new patients and coworkers are what attracted Bello, 49, to floating in the first place. She’s only required to work a total of 48 hours over a six-week period, which she can work in either 8- or 12hour shifts. Although two of her shifts have to fall on major holidays each year, the schedule has given Bello, a married mom of six, a work-life balance she might not have achieved had she been a floor nurse. And watching Bello work on two different floors during separate shifts in late December, it was clear that she was comfortable wherever she went in the 926-bed hospital. She confidently cared for four patients she had met only hours before, knew where to access the floor’s medication and supplies, and updated patient records on a hand-held mobile device. “You get to meet the best people in the hospital,” says

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Bello, a native of Nigeria. “It’s socially engaging and you learn a lot because you’re not stuck with a particular set of diagnoses.”

Tools for Success In an essay published last year in MedSurg Nursing, Katie J. Bates, MSN, RN, reflects on recent research gauging nurses’ attitudes towards floating as well as her own experiences with it early in her career. Recent graduates and experienced nurses alike can feel “alone, anxious, and even incompetent when floated to other units,” if they haven’t received proper orientation, she wrote in her piece, “Floating as a Reality: Helping Nursing Staff Keep Their Heads Above Water.”

They may feel less productive as their time is spent searching for supplies or seeking help from nurses on the unit. These scenarios make the floating nurse feel “undervalued and expendable,” and patient care may suffer as a result, explains Bates, a critical care staff nurse at Good Samaritan Hospital in Puyallup, Washington. Bates recommends creating tip sheets, informational packets, or pocket guides for float nurses that contain specific information about subspecialties. For example, “an orthopedic tip sheet may describe hip precautions for postoperative patients,” she wrote. Bates also suggests having a dedicated resource nurse in each unit who doesn’t take her own patients,

“You get to meet the best people in the hospital,” says Bello, a native of Nigeria. “It’s socially engaging and you learn a lot because you’re not stuck with a particular set of diagnoses.” Nurses who float to unfamiliar units can get stuck either with less challenging patients or with the most difficult cases to give staff nurses a break.

but is there to assist nurses who float to the unit. Finally, Bates says the unit’s charge nurse should check in with the float nurse periodically to ensure she

is comfortable with her patient load and responsibilities. Bates acknowledges that budgetary constraints may preclude efforts to implement these changes. Yet additional resources and staff support are critical to turning floating into a positive experience, she argues.

Float Pools or Resource Nurse Teams In response to dissatisfaction floor nurses have expressed about mandatory floating, several hospitals have developed dedicated teams of fulltime float nurses. At MedStar Washington Hospital Center, the float pool is composed of 91 nurses who are mostly full-time floaters, says Rosemarie Paradis, RN, MS, NEA-BC, CENP, FACHE, the hospital’s vice president of nursing excellence. Additionally, the pool is also staffed by nurses from other hospitals who want to pick up shifts on their off days. Over time, the float pool has attracted new employees, with 20 nurses being added to the float pool in the past two years, according to Dennis Hoban, the hospital’s senior director

e Rise

of recruitment services. Float pool nurses, Paradis says, are expected to improve their skills and maintain their competencies just as floor nurses are. While the hospital relies on the float pool first to cover deficiencies in staffing, occasionally staff nurses are called upon to float outside their home units. “As has been our normal practice, nurses float to areas that are similar to their own…and where they have the competency to work,” says Paradis. In 2006, University of Utah Health Care’s University Hospital in Salt Lake City trans-

formed its resource nursing unit—what the hospital calls its float pool—from an underutilized tool into a highly valued asset. Until that point, the

nurses in the unit are sought after by other units because the 654-bed hospital decided to invest in training them, explains Karen Nye, BSN, RN, the

In response to dissatisfaction floor nurses have expressed about mandatory floating, several hospitals have developed dedicated teams of full-time float nurses. nurses in the unit had been perceived as fill-ins and denied opportunities to take on challenging assignments and complex patients. Now, the 45

resource nurse manager. “We have a timeline of expectations,” says Nye. “We make sure they have training opportunities within a certain

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date of their hire, and we make sure they adhere to that timeline.” Now, resource nurses can earn advanced certificates in the ER, ICU, burn, and neurology units. The hospital’s AirMed medical transport team relies heavily on resource nurses since its work requires flexibility and versatility, says Nye. Most recently, a new cardiovascular ICU opened with the assistance of Nye’s resource nurses. Since there is greater trust and utilization of resource nurses across the hospital, Nye preschedules them in units at

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risk of paying out too much overtime to staff nurses. The result has been a significant cost savings for the hospital. In five ICUs that accepted prescheduled resource nurses in 2010, there was a 62% reduction in overtime hours over a ten-month period, according to a 2011 nursing report published by the health system.

More Options for Staff Nurses who Float Other hospitals have done away with mandatory floating by floor nurses altogether to boost employee morale and reduce turnover. In 2005, Aultman Hospital in Canton, Ohio, eliminated mandatory floating in response to frustration nurses expressed at being floated from their home units on days when patient volume or acuity was low. The 808-bed hospital re-

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placed its old float policy with a “Willing to Walk” program, which gives floor nurses the right to decline an offer to float without negative consequences, according to Eileen Good, MSN, MBA, RN, Aultman’s senior vice president for clinical

Magnet recognition from the American Nurses Credentialing Center in 2006. Before Good proposed the “Willing to Walk” program, Aultman had developed specialty float pools of nurses trained to work in similar

While Mercy Hospital, a 175-bed facility in Portland, Maine, hasn’t eliminated floating, it created a tiered system of compensation directly tied to the floating nurse’s competency level in 2007. advocacy and business development. Good oversaw the development of the program when she was the hospital’s chief nursing officer. A floor nurse who declines to float to other units can either take time off without pay or use benefit time. Giving nurses choices and greater autonomy helped Aultman earn

units across the hospital. Good noticed that only a few floor nurses were being floated each day because units were taking advantage of the specialty float pools, composed of 40 to 50 nurses. The rates of floor nurses required to float had decreased significantly. “If we could improve this process with float teams, then why couldn’t we

just eliminate [mandatory floating]?” she asks. As a result of these changes, Aultman reduced its turnover rate from 8.3% in 2007 to 4.3% in 2010. The hospital is in the process of reapplying for Magnet designation, says Good. While Mercy Hospital, a 175-bed facility in Portland, Maine, hasn’t eliminated floating, it created a tiered system of compensation directly tied to the floating nurse’s competency level in 2007. The new policy was aimed at easing ill will on both sides of the float divide: nurses who floated felt unwelcomed and out of their depth when working in unfamiliar territory, while floor nurses resented the fact that float nurses were getting paid a higher daily rate regardless of their skill level. Aside from compensation issues, there were also no clear

Other hospitals have done away with mandatory floating by floor nurses altogether to boost employee morale and reduce turnover.

expectations of float nurses or the units that received them, explains Scott Edgecomb, RN, RRT, CCRN, clinical nurse lead in the hospital’s critical care unit. “The expectation was that they would function at a pretty high level when they arrived,” says Edgecomb, a member of a retention and recruitment council that developed the policy. Yet, no structure had been put in place to ensure float nurses received adequate training. The new policy created four distinct levels of competency for nurses who float, with Level One functioning as little more than “helping hands” on the receiving unit all the way to Level Four, demonstrating the highest level of competency and an ability to take complex cases on specialty floors. Now each level is compensated differently, replacing the across-the-board pay differential float nurses received before. Edgecomb says the new float policy creates greater incentives for nurses to develop their skills, and that nurses who float now are most likely functioning at a Level Three or Four. Floating is no longer looked upon with dread, but as an opportunity to earn more and develop competencies in specialized units. And the recruitment and retention council has sought to mentor nurses who are proactively seeking

floating assignments that expand their skill set. “People were stepping forward and saying they were interested in assuming those higher level roles,” he says.

Floating as New Nurse Orientation Advocate Christ Medical Center in Oak Lawn, Illinois, has developed a new program that aims to introduce new

RN, CPN, the hospital’s professional nurse educator and nurse residency coordinator. Growing out of Brown’s practicum requirements for her master’s degree, the program is starting small but could change the way the 695-bed hospital recruits its nursing staff. In 2013, the program’s pilot year, six nursing graduates were hired from over 100 applicants, and Brown plans to hire at least two

Advocate Christ Medical Center in Oak Lawn, Illinois, has developed a new program that aims to introduce new nursing graduates to their professions through floating. nursing graduates to their professions through floating. The program aims to solve two problems: the high number of seasoned float pool nurses who were leaving the pool to take positions as floor nurses and the inability of new nursing graduates in the area—south of Chicago— to find jobs, explains Kristen Brown, MSN, BA,

more rounds this year. Nurses in the new graduate float program receive a 12-week orientation and participate in a 12-month nursing residency program, where they receive training with content specialists and have a chance to interact with their peers. Once they start to float, they are sent to specific zones within the hos-

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pital—medical-surgical units, orthopedics, surgical trauma, and women’s surgery—where clinical coaches work with them one-on-one over a threemonth period. Brown says the program will enable the hospital to rebuild its float pool with clinically competent nurses. By moving away from hiring to a specific vacancy and capturing strong candidates early in their careers, the hospital can fill vacancies as they occur. It also gave new graduates a chance to learn about the health system and specialties they may want to explore in the future. “This could be the way new nurses are hired here, potentially,” Brown says. “If you have high quality candidates, you don’t have to worry about finding a spot for them. You’ve got a continuous pipeline of individuals coming in.” Archana Pyati lives in Silver Spring, Maryland, and writes frequently on health and science topics.

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Social Media Do’s and Don’ts for Nurses BY JEBRA TURNER

Most nurses are comfortable using social media to connect with family and friends, but are unsure about how to use it in a professional context. As the world of health informatics collides with the world of social media (or “new media,” as some health IT experts prefer to call it), it has wide-ranging implications for clinicians, patients, and public health policy. 30

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ere are some tips on making the most of social media, brought to you from nurses on the floor—and on the forefront of these new technologies.

1. Let social media curate health news and research studies for you. You may not be interested in the social aspects of social media (“I don’t care what my coworkers had for lunch!”), but dig deeper and you will see that there’s a world of opportunity and information, according to Lorry Schoenly, PhD, RN, CCHP-RN, owner of the blog, CorrectionalNurse.net. “Twitter is my news and information source,” she says. “I follow nurses, doctors, radiologists, and others so they curate the news for me. I can quickly stream the different content areas I’ve set up and skim through them in a couple of minutes, a few times a week.” There is so much new research to keep up with—social media can save you the time and money (for journal subscriptions, say) that you’d otherwise have to invest, Schoenly adds. In social media, “it’s all about knowing, liking, and trusting sources,” says Schoenly. If you’ve developed streams from trusted sources, you can quickly come up to speed on important health issues, public policy, and gray areas of clinical practice. With all the noise out there on the web, how can you single out reliable sources? For starters, Webicina.com has a list of free health care social media resources on 140 topics. They curate them based on recommendations from thousands of health care professionals (a

form of “crowdsourcing”) to ensure that these blogs, Facebook groups, Twitter feeds, and YouTube channels are high quality. As you tap these resources, be on the lookout for these health care social media “stamps of approval”: • Health on the Net Foundation (HONcode); • The Healthcare Blogger Code of Ethics (group is no longer active, but designation is still used); • Health Insurance Portability and Accountability Act (HIPAA).

2. Start your social media journey with training wheels. Some nurses are so intimidated by social media and fearful about making a mistake that they avoid it all to-

That type of avoidance makes some administrators and recruiters wonder about a nurse’s ability to leverage technology, or suspect that it’s a deliberate attempt to hide something unsavory. Andrea Hill, RN, MSN, FNPBC, an assistant nurse manager at University of North Carolina Hospitals in Chapel Hill, took a brief course on social media at work. She was instructed to “be careful what you put out there,” so she’s eager to avoid any activity that could be “misconstrued or misjudged,” she says. She is comfortable, however, communicating with fellow staff members on her unit’s Facebook page because of safeguards. “We have to invite staff to be members, and you can’t necessarily see their personal

There is so much new research to keep up with— social media can save you the time and money (for journal subscriptions, say) that you’d otherwise have to invest, Schoenly adds. gether, or go into “lockdown mode,” blocking their profiles and activity from public view. Example: the nurse manager who has only a Facebook profile (under a phony name) and ventures on it just to see photos of her grandchildren.

page unless they invite you. We don’t invite patients or outsiders and wouldn’t accept their request, if that ever happened,” she explains. Hill also belongs to a Doctorate of Nursing Practice online community sponsored by a

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professional group and enjoys discussing global health issues there. Locally, she participates on the North Carolina Organization for Nurse Leaders Facebook page as time allows.

3. Empower your patients through medical social media. “Social media is a whole new tool to empower patients,” says Ramona Nelson, PhD, RN-BC, ANEF, FAAN, author of Social Media for Nurses. “We should be educating patients about it. Nurses should learn about their patient population and possible resources for them. You may be surprised what’s out there and what resources patients are using. For example, where are adolescents going to get informed? I looked at the Seventeen magazine website and it has some very interesting information on various adolescent issues, such as sexual health,” she explains. According to Nelson, research shows that patients often go to the Internet first to prepare for a doctor’s visit; it helps them compile a list of clear and concise questions. Then, after the visit, they use the Internet to reinforce what the doctor told them. When clinics provide access to a computer and digital resources for patients, patients can make good use of time spent waiting for an appointment, she concludes. Nurses should also educate patients about privacy concerns and the associated risks of social media, says Nelson. “There are numerous apps you can download onto a phone. They send that information somewhere. Who’s getting that information? If it’s not a covered entity—a software company, and not a physician—that informa-

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tion is not protected by HIPAA.” Also, she adds that some of that social media user health data is collected, packaged, and sold to organizations, such as pharmaceutical companies. “That’s not a bad thing, necessarily, because it may help develop better drugs. But patients have to be aware when sharing personal information so they can do that safely.”

4. Level the playing field for minority populations. Social media can make health information more pertinent to minority patients. For example, a Spanish-language diabetes app may appeal to Hispanic patients who reportedly have a higher than average rate of cell phone ownership. Beyond the technology, minority nurses and those who care for minority populations “should push for culturally sensitive and appropriate information,” says Nelson. “It’s as simple as a parent looking up a rash in a child. They will notice there are many images of light-skinned children with various rashes. But a rash looks different on dark skin rather than light, and the number of examples of children with darker skin is more limited. We need more resources that are sensitive to the race, cul-

Lorry Schoenly, PhD, RN, CCHP-RN

ture, and health literacy of patients and their families.”

5. Start a nurse blog— or contribute to one. In 2002, an RN who goes by only “Gina” started Code Blog—Tales of a Nurse (www. codeblog.com), and has updated it ever since. “I had a personal blog with my husband and was writing nursing type stories on it,” she explains, “and a friend

“Social media is a whole new tool to empower patients,” says Ramona Nelson, PhD, RN-BC, ANEF, FAAN, author of Social Media for Nurses. suggested that I start a whole blog just for nursing stories. So I did.” She was an ER nurse at the time (and in total has 15 years of nursing experience), so the name is a play on words for “code blue.” “My experience has been extremely positive so far! I wrote more pre-children for sure, but I enjoyed writing about interesting experiences I had and getting reactions and feedback,” she adds. “I’ve met some great nurse bloggers, even in person, and that was a great experience as well. The benefits of blogging are—you get a platform for writing. Sometimes people read it and comment on it! And that’s wonderful. Sometimes it

Andrea Hill, RN, MSN, FNP-BC

Minority Nurse | SPRING 2014

starts an interesting dialogue.” Have your own compelling nurse tale to share with the whole, wide blogosphere? Gina accepts submissions, sans identifying details that may breach patient confidentiality. “In other words, use your noggin’,” say her submission guidelines. She’s especially interested in true tales, and stories that are “entertaining and thought-provoking.”

6. Tap into the power of Twitter. Not a lot of nurses utilize Twitter, but this micro-blogging platform is a favorite of savvy clinicians and recruiters. It’s easier to connect with people here—especially experts and other hard-to-reach folks— because it’s a low-risk, 140word commitment. From there you can deepen the connection on other platforms (e.g., tweet “would you mind if I connect with you on LinkedIn?”). For job-seeking nurses, sites such as TweetMyJobs.com are especially helpful for getting a jump on other applicants who wait for a job to be posted on a website. Twitter is more im-

Ramona Nelson, PhD, RNBC, ANEF, FAAN

mediate, so you get to be the first one in a recruiter’s inbox. Twitter is opening doorways in the areas of health education and policy. Nurse- entrepreneur Brian Norris, MBA, RM-BC, FHIMSS, CEO of Social Health Insights, took his dozen years in informatics and created a health-related Twitter app, in partnership with an IT developer. His inspiration? A US Department of Health and Human Services innovation challenge, called “Now Trending #Health in My Community,” sought to mine Twitter data for disease surveillance. They “requested we map 200 set terms, such as flu, influenza, and malaria,” says Norris. His team won the challenge with their app, MappyHealth.com, which has powerful applications for visualizing and researching disease trends. His company also offers other health information services and products for government and health care organizations.

7. Get LinkedIn. LinkedIn is the single best social media platform for nursing professionals and job seekers. It’s like signing up for a hyperresume and virtual networking party, and best of all, it’s free. If you haven’t completed a profile yet, do it immediately. And if you already have one, update it and connect to other members

Brian Norris, MBA, RMBC, FHIMSS

Dana Kouchel, RN, BSN

so that you fully utilize this awesome tool. Another way to network with LinkedIn’s more than 259 million members is to find several groups that resonate with you and join them. (There are many nursing groups; usually they are based on specialty.) Then you can contact any of the members at no charge. Otherwise, you have to find someone in your network that has a connection to the member you want to reach and get introduced, or pay a fee to send a direct message.

shift their mindset from “sharing with 1,000 of my closest friends” to “presenting myself as a nursing professional.”

Facebook friends with some coworkers. I like seeing their family pictures and posting ones of us together outside of

“I’m 23, so I’m on social media a lot of the time—mostly Facebook and Twitter and Tumblr,” says Dana Kouchel, RN, BSN, a nurse at University of North Carolina Hospitals in Chapel Hill. “I recently became

work. Sometimes social media is in the back of my mind, and I have to disable it, otherwise it could be a distraction.” Kouchel is careful not to share any stories about work on Facebook because “it’s a

8. Don’t overdose on social media. New nursing grads who grew up texting, Skyping, Tweeting, Facebooking, and the like are known as “social media natives” and may have a different set of challenges than older colleagues. They have to

slippery slope and I don’t want to invade anyone’s privacy. We’re patient advocates and I don’t want to jeopardize the nurse-patient relationship. They put their trust in us.” At the same time, she tries to always be “tasteful and professional,” and never include alcohol in pictures, say. Nursing students and recent graduates are the ones more likely to go back through their various social media profiles and clean them up. What looks like fun at a sorority or frat party may be construed as an example of poor judgment once you’ve entered the professional world. Jebra Turner is a freelance health and business writer based in Portland, Oregon. She frequently contributes to the Minority Nurse magazine and website. Visit her online at www.jebra.com.

The 42nd Annual Institute & Conference of the National Black Nurses Association, Inc. R

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Offering nurses, nursing students and medical professionals the very best in continuing education, career development and networking opportunities. www.minoritynurse.com

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2014 Annual Salary Survey BY CIARA CURTIN

Depending on where they work and their specialties, nurses can earn a range of salaries. Salaries continue to appear to vary by ethnic background as well, but overall, nurses reported in the second annual Minority Nurse salary survey making more this year than they did last year—and more than they did five years ago.

Number of Respondents: Number of Respondents:

4,855 4,855 4,855 Ethnicity

Number of Respondents: Ethnicity

2.2% 2.1% 2.0% 4.6% 2.2% 2.1% 2.0%1.4% 1.4% 4.6% 7.9% 2.2% 2.1% 2.0% 1.4% 4.6% 7.9% 53.6% 26.1% 53.6% 26.1% 7.9%

Ethnicity

53.6%

26.1%

n White/Non-Hispanic White/Non-Hispanic n African American African American n Hispanic or Latino/Latina n White/Non-Hispanic Hispanic or Latino/Latina n Asian n Asian American n African Other n or Latino/Latina Other American n Hispanic Native n Nativenot American n Asian Prefer to answer n Prefer not to answer n Other Multiracial n Native American Multiracial n Prefer not to answer Gender n Multiracial Gender 9.1%

Gender 9.1% 9.1%

90.9% 90.9% 90.9%

n Male Male n Female n Female n Male n Female

Minority Nurse | SPRING 2014

lthough nurses reported making higher salaries this year than they reported last year, there are wage gaps by ethnicity that remain to be closed. In 2013, nurses reported making a median salary of $67,000; this year, they reported earning a bit more, a median $68,000. Still, African American nurses earned a median $60,200 and Hispanic nurses received a median $60,000, while white nurses took home a median $72,000. To gather all this data, Minority Nurse and Springer Publishing e-mailed a link to an online survey that asked respondents about their jobs, educational backgrounds, and more to better understand their roles as nurses and to determine their current and past salaries. Some 4,850 nurses from all over the United States responded to the survey questions. The respondents also hailed from a number of specialties, including nurses working in critical care, as certified nurse educa-

tors, and in pediatrics, as well as nurses employed at public hospitals, private hospitals, and at colleges or universities. Some stark differences, though, were noticeable when survey data were broken down by ethnicity. For instance, nurses belonging to different ethnic groups working at similar institutions reported earning different amounts of money. African American nurses working at a public hospital reported earning a median $65,000, as did Asian nurses. Hispanic nurses reported making less, taking home a median $60,000. White nurses, though, said they earned $79,500. Additionally, nurses belonging to different ethnic groups with similar educational backgrounds also reported salary differences. African American nurses with a bachelor’s degree reported making a median $62,000—similar to the median $60,000 reported by Hispanic nurses—though higher than the median $50,000 received by Asian nurses, but lower than the median $70,000 that white

nurses said they made. At the master’s degree level, the picture is a little different. Asian nurses with master’s degrees commanded the highest salary, a median $80,000, followed by African American nurses, who received a median $76,000. Hispanic nurses, meanwhile, earned a median $74,940, and white nurses with a master’s degree reported making a median $73,000. Overall, respondents reported earning a higher salary this year than they took home last year and a bit more than they reported earning five years ago. For example, nurses working primarily in patient care reported earning $60,000 this year, $55,000 last year, and $47,000 five years ago, and advanced practice nurses reported making $89,000 this year, $84,000 last year, and $78,000 five years ago. Though there are still wage gaps to be bridged, nurses reported earning more now than they did just a few years ago.

Regions

Employment Status

3.8%

2.6%

2.5%

0.4%

8.4%

19% 36.4% 16%

86.1%

24.8%

n South n Midwest n West

n Northeast n Outside the US

n I am employed full time n I am employed part time n Other

n I am unemployed, but I am looking for a job n I am unemployed, and I have stopped looking for a job

Employer Type

Years at Current Job

1.9% 3.4%

2.3%

0.8% 0.8%

1.5%

0.6% 0.3%

3.8%

13.1%

31.6%

12.4%

4.5%

33.3% 8.2%

18.3%

15.8%

24.6%

n More than 10 years n Five to 10 years n One to three years

n Three to five years n Less than a year

n College or university n Public hospital, including Veteranâ&#x20AC;&#x2122;s or Indian Affairs hospitals n Private hospital n Other n Nursing home, LTC, or rehabilitation center n Public school

Main Role 3.9%

2.7%

22.7%

n Private practice or physicianâ&#x20AC;&#x2122;s office n Health department/Public health n Home health care service n Health insurance/HMO/MCO n Walk-in clinic n Correctional facility n Military n Pharmaceutical/Research company

Reason for Leaving Prior Job

1.2% 3.7%

6.7%

3.0%

1.6%

1.2%

9.8%

6.5% 38.9%

9.9%

11.6%

n Patient care n Education n Leadership/Management n Administrative

53.5% 15.6%

30.3%

n Other n Case management n Research n Triage

n To pursue a better opportunity n For personal reasons n To change careers n This is my first job

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n I was laid off n I quit n My contract ended and was not renewed n I was fired

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Median Salary by Region

Northeast

West

$75,000 ($66,000 five years ago)

$74,675 ($65,000 five years ago)

Midwest

$65,100 ($58,240 five years ago)

South

$63,360 ($57,000 five years ago)

Median Salary by Region and Ethnicity Northeast

White/Non-Hispanic

South Midwest West

Northeast Hispanic or Latino/Latina

South Midwest West

Asian

South West

Northeast South African American Midwest West $0

$10,000

$20,000

■ Salary Five Years Ago ■ Current Salary

Minority Nurse | SPRING 2014

$30,000

$40,000

■ Salary Five Years Ago ■ Current Salary

$50,000

$60,000

■ Salary Five Years Ago ■ Current Salary

$70,000

$80,000

■ Salary Five Years Ago ■ Current Salary

Median Salary by Education Level

Median Salary by Main Role $100,000

$90,000

$80,000

$80,000 $70,000

$70,000

$60,000

$60,000 $50,000

$50,000

$40,000

$30,000 $30,000

$20,000

$10,000

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Current Salary

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Salary Five Years Ago

Median Salary by Specialty

$90,000

$100,000

$80,000

$90,000

$70,000

$80,000

$60,000

$70,000

$50,000

$60,000

$40,000

$50,000 $40,000

$30,000

$20,000

$10,000

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Median Salary by Employer Type

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Median Salary by Ethnicity Median Salary by Ethnicity White/Non-Hispanic White/Non-Hispanic

Native American Native American

Multiracial Multiracial

Hispanic or Latino/Latina Hispanic or Latino/Latina

Asian Asian

African American African American $0 $0

$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000

Current Salary Salary Five Years Ago Current Salary Salary Five Years Ago

Median Salary by Education and Ethnicity Median Salary by Education and Ethnicity Doctorate Doctorate

Master’s Master’s

Bachelor’s Bachelor’s

Associate’s Associate’s $0 $0

$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000

White/Non-Hispanic Hispanic or Latino/Latina Asian African American White/Non-Hispanic Hispanic or Latino/Latina Asian African American

Median Salary by Organization and Ethnicity Median Salary by Organization and Ethnicity College or University College or University

Nursing Home, LTC, or Rehabilitation Center Nursing Home, LTC, or Rehabilitation Center Private Hospital Private Hospital

Public Hospital, including Veteran’s or Indian hospitals PublicAffairs Hospital, including Veteran’s or Indian Affairs hospitals $0 $0

$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000

White/Non-Hispanic White/Non-Hispanic

Minority Nurse | SPRING 2014

Hispanic or Latino/Latina Hispanic or Latino/Latina

Asian Asian

African American African American

Looking to Leave Job in Coming Years

48.9%

Highlights • 17.6% of respondents have a PhD or other doctoral-level degree

51.1%

• 33.3% work at a college or university • 56.2% have been at their current job for five years or longer n Yes

• 65.8% received a raise within the last year

n No

• 53.5% left their prior job to pursue a better opportunity • 41.1% do not expect a raise this year • 48.9% are looking to leave their current job in coming years

Timing of Last Raise Received 7.8%

12.5%

Top Two Degrees Held by Respondents • MSN, or other master’s-level degree

13.9%

65.8%

n Last year n Three to five years ago

n Two years ago n More than five years ago

• BSN, or other bachelor’s-level degree

Five Most Common Specialties • Critical care (NICU, PICU, SICU, MICU) • Certified Nurse Educator • Advanced practice nursing

Percentage of Last Raise

• Medical-surgical • Pediatrics

4.2% 4.8% 25.8% 65.2%

Highest Paid by Employer Type • Private practice

n 1%-2% n 3%-4%

n 5% n More than 5%

• Private hospital • Health insurance company • Public hospital • College or university

Raise Expected This Year 2.5%

2.7%

17.3% 41.1% 36.5%

Most Common Benefits Provided • Health insurance • Retirement plan (401(k), 403(b), pension, etc.) • Dental insurance • Paid time off

n I do not expect a raise this year n 1%-2%

n 3%-4% n 5% n More than 5%

• Life insurance

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Academic Forum

Family Scholar House: Helping Single Parents Leave Welfare Behind BY BEHLOR SANTI

When welfare reform, also known as Temporary Assistance for Needy Families (TANF), became law in 1996, direct funding from the federal government turned into block grants each state spent at its discretion. All states had to follow federal regulations, such as lifetime benefit limits for each welfare recipient. Some states, however, placed heavy emphasis on a concept called “self-sufficiency,” getting welfare recipients into salaried and self-employed positions as quickly as possible. With this emphasis on self-sufficiency, certain types of higher learning became preferred over others.

ccording to Joron Planter-Moore, a representative with the Virginia Department of Social Services in Richmond, Virginia, education for TANF recipients includes studying in vocational programs for up

to 12 months. Vocational programs, such as trade schools, community colleges, and fouryear institutions, should prepare the student for employment. Simply put, people on TANF who want to study liberal arts at the University of

Virginia would be out of luck. “Working towards a degree in philosophy would not be considered vocational education,” explains Planter-Moore, “because it is not directly related to employment.” Nia Gilmore, RN, of Louis-

ville, Kentucky, currently works as a registered nurse at a local hospital. She also earned a Bachelor of Science in Nursing (BSN) from the University of Louisville. She heard her mother say a common refrain: Blacks, especially black women, had to work twice as hard to succeed in America. Her mother’s emphasis on high standards extended to getting high grades. “In Kentucky,” says Gilmore, “an A is a 93. My mother would always say ‘do better.’” Medical tragedies in her family led Gilmore towards nursing. Her mother suffered from chronic illness through much of her childhood, and her nephew has sickle-cell anemia.

With this emphasis on self-sufficiency, certain types of higher learning became preferred over others. During her numerous times at the hospital, Gilmore noticed the bedside manners of the nurses. “The care they gave made a big difference,” she says. “I wanted to do the same when I became older.” Ruth Aina, a current member of Family Scholar House, looks forward to December 2014, when she’ll receive her BSN. A busy single mom and a devout Christian, Aina says that she has always been drawn to caring for others. “I’m thinking of specializ-

Minority Nurse | SPRING 2014

Academic Forum ing in pediatrics, neonatal,” she says. A typical day for Aina includes waking up at 6:30 a.m., preparing breakfast for herself and her child, dropping her child off at school, attending classes at the university, studying a lot, running back home to pick up the kid, cooking dinner, and then a little bit of solitude before sleep. Lots of prayer is included. “I ask the Lord for strength,” says Aina. Gilmore received public assistance to support herself and her daughter. She’s aware of the vicious stereotypes. “Some people think people on welfare are lazy,” she states. “That we

According to Stephanie Rowe, relationship coordinator and director of program support integration at Family Scholar House, breaking the cycle of poverty and dependency is about environment and support. have no plans for the future. That most of us are black.” She took a while to sign up for TANF, having had internalized the stereotypes. Eventually, she realized that she and her child needed the help. According to Stephanie Rowe, relationship coordinator and director of program support integration at Family Scholar House, breaking the cycle of poverty and dependency is about environment and support. “Through our comprehensive programming,” she says, “which includes, but is not limited to: academic advising; supportive housing; family support services/case management; children’s programming; childcare; counseling; mentoring; tutoring; life skills building; financial education; family nu-

trition and wellness programming; peer support; assistance with basic needs; and community referrals, our participants are empowered to break the cycles of poverty, homelessness, and dependency—not only for themselves but also for their children—by earning a college degree, achieving career-track employment, and attaining selfsufficiency.” Nursing students especially need the supportive environment Family Scholar House offers, according to Rowe. “Further, we assist with childcare, which is important for nursing students who have classes in addition to hours in the hospital for clinical experience. We connect participants with tutors, as necessary, and internship/networking opportunities through our strong network

of health care supporters and board members in the field.” Gilmore joined Family Scholar House as a high school senior. “My guidance counselor informed me about this program,” she says. “It was called ‘Project Women’ back then. Same program, but only 16 women.” Since its beginning in 1995, Project Women has

ments stating their opinions, loudly, on the nightly news. For Nia Gilmore and Ruth Aina, whether the government has a safety net or not isn’t about abstract theory in a book or slogans for taxpayers. It’s about feeding their children and eventually standing on hard ground, so they can contribute to the vital field of nursing. As Nia Gilmore points out,

For Nia Gilmore and Ruth Aina, whether the government has a safety net or not isn’t about abstract theory in a book or slogans for taxpayers. It’s about feeding their children and eventually standing on hard ground, so they can contribute to the vital field of nursing. grown into the current Family Scholar House. The originally all-female student body now includes single fathers. Gilmore praised the support system at Family Scholar House. “It’s people working for people,” she says. Welfare remains a heated topic, with activists for and against government entitle-

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single moms—in and out of the public-assistance system— should focus on why their nursing education matters. She knows why her degree matters. “I didn’t want to become a statistic.” Behlor Santi is a freelance writer based in New York City.

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Academic Forum

The Nurse-Family Partnership Program BY ROBIN FARMER

When new moms lack financial resources, caring for a baby is more challenging. A desire to empower these first-time, low-income mothers attracted Noelia Blanco to the Nurse-Family Partnership (NFP) over a dozen years ago. And there is nowhere else this registered nurse would rather be.

“I

stayed with it because NFP works,” says Blanco, a NFP nurse home visitor in Philadelphia. “I’m privileged to be a part of it.” Public health nurses like Blanco are the backbone of a national program spotlighted

turns 2 years old. They provide expectant and new mothers guidance and education on a number of topics, such as positive prenatal practices, nonviolent child-raising techniques, and life coaching. Nurses also help mothers find jobs and obtain other resources.

Nurses help parents achieve a positive life course by developing long-term relationships and serving as mentors. Inhome visits for the voluntary program are key to getting to know the mothers. “It’s a different story when you work in the community,”

for providing measurable differences in the lives of new mothers and their children. The program’s main goals include a healthy pregnancy, better child health, and improved parenting skills. Nurses conduct home visits with women from early on during their pregnancy until the child

Nearly 40 years old, NFP’s evidence-based outcomes include improved health and development of children, better school readiness, and increased maternal employment. In short, NFP, now in 43 states, has a track record for helping parents change their lives and the lives of their children.

says Blanco. “When you are in the home, you get a very com-

Minority Nurse | SPRING 2014

prehensive picture of the client. You know if they have heat, if they have electricity or food. It’s a whole different world.” Nurses visit weekly, or every other week, until the child turns 21 months, and then scale back the visits to monthly checkups. New parents are not the only people getting an education. “It has taught me to never give up on someone,” says Blanco. “I’ve always been an optimistic person, but I have seen these clients go through some real tragedies and succeed. I just love the program!” She’s not alone. Working with NFP is “one of the most validating and rewarding experiences in my nursing experience, which is why 13 years later I’m still involved with the model,” says Sara Eldridge of Philadelphia, who worked as a NFP nurse home visitor for five years, and then as a NFP nurse supervisor for five years. “As I became more culturally responsive, it was just validating to see the relationship with the client develop for two and a half years and see the powerful outcomes. It is personally and professionally rewarding. It changed me,” says Eldridge, who now works for the NFP National Service Office as a nurse consultant providing support to NFP agencies in

Public health nurses like Blanco are the backbone of a national program spotlighted for providing measurable differences in the lives of new mothers and their children.

Academic Forum Florida, Georgia, Tennessee, Alabama, Virginia, and the Virgin Islands. A commitment to the evidence-based model, as well as flexibility, autonomy,

ter nurse, and they also make you a better person because you are actually putting yourself in your client’s position. You are on their side. You are not

“It’s a different story when you work in the community,” says Blanco. “When you are in the home, you get a very comprehensive picture of the client. You know if they have heat, if they have electricity or food. It’s a whole different world.” and continuing education, attracts maternal and child health nurses to the program, she explains. A public health nurse for 18 years, Maria Solomon joined NFP in Fairfax County, Virginia, several months ago, in part because of its proven results. “You know the outcomes will be good. And I feel I am supported,” she says. “They want feedback and they always want to improve the program, and that is very appealing.” She is also thrilled to have an opportunity “to do what I love—and that is building relationships with people and helping them. . . while giving them the tools they need to become better parents. As the adage goes, ‘if you love your job, you will never work a day in your life.’ That’s how I feel about this job.” After 18 years, Solomon is still learning and growing. The home visits provide many lessons. “You go into someone’s house and it really humbles you. You learn to respect people more. I thought I did, but I think I do more now. The things that we learn and the skills that we gain, and the training we had, doing motivational interviewing—those sort of things make you a bet-

poking your finger and telling them what to do, you are guiding them,” explains Solomon. “I think a lot of women who are in this program want the best for their children, and that is such a force in itself. And if that becomes the starting point—that ‘I want this for my child’—then it’s amazing what you can do and where you can go. You go along this journey with someone. As far as changing me as a nurse, it’s very challenging, but it’s challenging in such a good way because I learn something new every day.” The NFP program in Virginia began in June 2013, says Laura Suzuki, maternal child health coordinator for the Fairfax County Health Department, who oversees the state’s program and was involved in bringing it to Virginia. Fairfax County is one of three

Noelia Blanco

locations in Virginia to start the program within the past 18 months. “The Affordable Care Act created the Maternal, Infant, and Early Childhood Home Visiting Program, and the money for many of these programs has come out of this pot of money and has enabled a lot of areas to expand their home visiting services,” says Suzuki. “So we were able to pursue that through our state.” Three other states to recently implement NFP are Idaho, Montana, and Kansas. Testing of the program in a randomized, controlled trial began in 1977 and was replicated in 1996. NFP’s strength has been its emphasis on the

states this year is a parentchild interaction tool—the Dyadic Assessment of Naturalistic Caregiver-child Experiences (DANCE)—that will enable nurses to observe areas of strength and growth. “The great things about the tool is the integration with other things we use, including educational materials,” says Eldridge. Training for NFP agencies to implement DANCE began in 2012 and will continue throughout this year. What will remain unchanged is the commitment of nurses to their clients and their ability to gain trust, says Blanco. “They know they can de-

“The nurse role has been enhanced [over the years], but it has always been a therapeutic oneon-one client relationship that contributes to the outcomes,” says Eldridge. “It’s the powerful nature of what we do.” client-nurse relationship. “The nurse role has been enhanced [over the years], but it has always been a therapeutic one-on-one client relationship that contributes to the outcomes,” says Eldridge. “It’s the powerful nature of what we do.” Among the enhancements that will be rolled out in more

pend on us and we believe in them. Some of their family members are not their biggest fans, and they don’t have the support. If you have one person’s support, it can go such a long way. I’ve seen it over and over.”

Maria Solomon

Laura Suzuki

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Robin Farmer is a freelance writer based in Virginia.

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Second Opinion

The Fight for a Peaceful Transition: Discovering Moral Courage BY CANDILLA DAVIS, RN, BSN, CCRN

As a critical care nurse, I am often confronted with difficult situations and sometimes placed in compromising ethical predicaments. It is a constant struggle to ensure the safety of the patient while respecting the wishes of the ordering physician. Over the years, I have cared for many patients and had memorable moments that have forced me to evaluate my moral reasoning and ethical standards as a nurse, but there was one particular patient who made a lasting impression on my values and ethical beliefs as a health care provider.

fter an already hectic day in the Intensive Care Unit (ICU), it was around 5:00 p.m. when we were put on

notice that a patient was being transferred to the ICU from the floor. The details of the transfer at that time were very vague. Moments later,

the phone rang and it was the transferring unit calling with the report. The patient was a 56-year-old male who was originally being treated for

complications associated with a brain tumor. Scans revealed that the patient’s cancer had metastasized to several areas throughout his body. During the course of his treatment, he underwent several surgical procedures, including a tracheotomy due to prolonged intubation. Overall, the patient’s prognosis was poor and his hospital stay was arduous. The patient experienced residual neurological deficits and was currently unresponsive to external stimuli. Despite best efforts, the primary neurology team was unable to fight the inevitable and the patient’s future appeared bleak. In an attempt to preserve the patient’s quality of life, the team discussed endof-life wishes with the family. The option of providing the patient with Comfort Measures Only (CMO) was included in the discussion. The reporting

It is a constant struggle to ensure the safety of the patient while respecting the wishes of the ordering physician. nurse confirmed that the family finally agreed to the CMO and Do Not Resuscitate (DNR) orders, and the patient was treated accordingly. The palliative care team was consulted, and the patient was transferred to the palliative care suite for family privacy and comfort.

Minority Nurse | SPRING 2014

Second Opinion At this point in the report, it had become unclear as to why the patient was now requiring an escalation in care to the ICU. As the nurse began to reveal the details of the situ-

little to no improvement in the patient’s oxygenation status, which remained 50% to 60% on the monitor. The consulting ICU team was immediately notified of the patient’s arrival.

Throughout all the commotion and the events that were occurring, I kept asking myself: “Are we doing the right thing for this patient?” ation, my confusion turned into shock and amazement. The patient, who had been placed on CMO approximately 12 hours prior, was now a full code. The patient’s family rescinded the CMO and DNR order after 12 hours. The reporting nurse described that one of the attending surgeons was not comfortable with the events that transpired. The attending physician discussed his concerns and hopefulness for the patient to recover with the family. In fact, the physician felt so strongly about his beliefs that his enthusiasm was spread to the patient’s family and they ultimately changed their minds regarding CMO/ DNR status. The orders were rescinded and the patient was made a full code. The patient emergently arrived to the ICU with full medical support at his bedside. The respiratory therapist was bagging the patient via the tracheostomy tube, while we quickly placed him on telemetry monitoring. The patient’s oxygen saturation was only 65% on the monitor, and he was quickly connected to the ventilator and placed on 100% FiO2. His skin was cool to touch and ashen grey. His body lay frail and flaccid in the hospital bed. After placing him on the ventilator, there was

The additional nurses in the room were helping to draw lab work and perform other ancillary duties. All of a sudden, the deafening alarms of the monitor started to radiate throughout the room and a once recognizable heart rhythm had transitioned to a bradyarrhythmia and then asystole. A code blue was announced overhead and chest compressions were immediately initiated. During chest compressions, every thrust of the patient’s chest felt like ribs breaking underneath my hands. Advanced Cardiovascular Life Support (ACLS) resuscitation was already in progress by the time the code blue medical team arrived at the bedside. The coronary care unit resident led the code and we went through the ACLS algorithms accordingly. The pulmonary critical care resident was at the bedside as well. After a few rounds of chest compressions and medications, the patient had a recognizable heart rhythm, but we soon noticed inflation to the patient’s chest cavity. The team suspected subcutaneous air from a pneumothorax. The pulmonary critical care resident requested setup for a chest tube placement and a right pleural chest tube was inserted and secured. Some

relief of the subcutaneous air was appreciated. Unfortunately, return of the patient’s rhythm was shortlived, because the team and I could no longer palpate a pulse and the patient was in pulseless electrical activity. Chest compressions and resuscitation were restarted. Throughout all the commotion and the events that were occurring, I kept asking myself: “Are we doing the right thing for this patient?” I noticed the chaplain in the doorway and asked him to please locate the family as soon as possible. Luckily, the family was waiting just outside the ICU doors. I asked one of the physicians in the room to discuss the patient’s condition with the family. I took a moment and looked up from the

emotions about the course of events, which ultimately determined the patient’s final transition period. The decision to make a patient a CMO/DNR is not one that is made lightly. It is one of the hardest decisions family members have to make for their loved one. In my opinion, it is a selfless act to ensure their loved one’s final hours are spent peacefully and without additional pain and suffering. The events that occurred on this memorable evening taught me a great lesson about being morally courageous. I once read a very powerful article written by author Colonel John S. Murray, who defined morally courageous individuals as being “prepared to face tough decisions and confront the uncertainties as-

The decision to make a patient a CMO/DNR is not one that is made lightly. It is one of the hardest decisions family members have to make for their loved one. patient and observed a woman with a worrisome look on her face. I already knew who she was, and by the look on her face I could tell that this was not what she wanted for her husband. Shortly after, one of the physicians returned to the room and made the announcement that after this round of ACLS, if no response, we would call it per family request. Thus, with no return of circulation and asystole on the monitor, the patient was pronounced deceased. The chaplain was called into the room with the family and they were allowed to spend private time with their loved one. Upon reflection of this patient’s case, I had many mixed

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sociated with their resolve to do the right thing despite the consequences they may face.” He further stated that moral courage “requires a steadfast commitment to fundamental ethical principles despite potential risks.” I hope to continue to build a nursing career that encompasses these principles and upholds a strong moral standard. I have made the commitment to my patients to do what is in my power to protect them and protect their wishes. Candilla Davis, RN, BSN, CCRN, has been a nurse for almost nine years and is currently employed as a critical care nurse at Tampa General Hospital.

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Degrees of Success

Successes and Challenges of a Nursing Student with Dyslexia BY TONI SUGG, RN

The International Dyslexia Association describes dyslexia as “a specific learning disability that is neurological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities.” Dyslexia is a condition that does not change in one’s lifetime.

knew I had dyslexia when I applied to nursing school in 2007. About a decade prior, I received the diagnosis of dyslexia during my unsuccessful attempt to get into graduate school. At age 43, with a daughter in middle school and a supportive husband, I was willing to try a career change again. I succeeded in my prerequisites courses, receiving A’s in Chemistry and Microbiology and a B in Anatomy and Physiology. I thought somehow maybe I “outgrew” being dyslexic. I really knew nothing about what dyslexia was. I knew learning to read was really hard and I got pulled out of reading groups in fourth grade, but I still don’t know very much about it. I knew I

Minority Nurse | SPRING 2014

did not want reading differently to stop me. I still have so much to learn. My first try at nursing school was in an accelerated nursing program. The documentation stating my dyslexia diagnosis was more than 10 years old. I attended a community college to complete my prerequisites. The community college was able to accept the documents I had and explained that a university would require updated documentation confirming the condition. To get retested and get current documents would cost approximately $600 to $1,000—an added burden to the cost of tuition and books. Accommodations for my dyslexia during the accelerated program could not be avail-

able because of the outdated status of my documents. Nevertheless, I felt elated because my grades from my prerequisites were high. Fifteen weeks into the accelerated program, I “washed out” and voluntarily withdrew. But, I had a plan. I got retested and got the updated documentation.

blocks. One test measured my reading speed. I was instructed when to start and, at different times, I was asked to point to where in the article I had read to in the given time. Once the allotted time was completed, I was asked a series of questions to test my comprehension. Soon after completion of the testing, I enrolled in CNA training. Becoming a CNA significantly contributed to my understanding of many principles I had learned in lecture on the fundamentals of patient care. As a CNA, I was able to learn at the bedside while developing relationships with patients and practicing the skills from both lab and clinicals. Nineteen days after finishing CNA training, I was employed at the location where we completed our clinicals. Having a job as a CNA provided me with the oppor-

There are many parts when I take an exam—it resembles conducting an orchestra. All of the material requires management to maximize my comprehension of the technical questions being asked. I also became a Certified Nursing Assistant (CNA). In seven months, I got the call inviting me to join the traditional Bachelor of Science in Nursing (BSN) program. I literally cried with joy. I had another chance. The tests to assess learning disabilities are not difficult. There were four one-hour sessions, including tests—some written, some verbal, and one involving making shapes with

tunity to make real the theory I had learned in class. The opportunity to work next to real nurses let me watch the lessons you cannot learn through books. My confidence grew as my dedication to complete the BSN degree cemented. Once I returned to the classroom as a student nurse, I was wholly committed to completing the program. Being back in class gave me

Degrees of Success the opportunity to fulfill my dream of being a nurse while receiving a variety of accommodations for dyslexia: Transparencies: Color transparencies over a printed page, which function like sunglasses on a sunny day. The distortion is minimized. This simple fix considerably reduces the strain from reading.

Kerzweil Text-to-Speech Reader: A computer program that changes text into audio. All the computers on campus can utilize Kerzweil, so I bring earphones in order to listen to my tests or texts. Testing Center: All of my test taking is completed in the test center. An appointment with the test center is scheduled four days prior to each exam. To limit distractions and noise, I test in a room alone. Time-and-a-Half: My test appointment time is 1.5 times the allotted time in the classroom. So, I go to the testing center early, usually 7:30 a.m. for an 8:00 a.m. test. Rarely do I need the extra time, but the benefit is not having to worry that I might run out of time near the end of the exam. This reassurance really makes a difference,

especially when I go back to recheck answers. There are many parts when I take an exam—it resembles conducting an orchestra. All of the material requires management

that I must complete and submit to the instructor for grading. The final version of the test is the audio in the Kerzweil program. Most of my classmates don’t notice that I am out of

I thought somehow maybe I “outgrew” being dyslexic. I really knew nothing about what dyslexia was. to maximize my comprehension of the technical questions being asked. There are inputs from four tests simultaneously, so I can receive the information efficiently. There is one test in front of me that I manually mark up, which is covered with a color transparency. This paper test is returned to my instructor. It is a back-up in case there is a computer malfunction. There are also two tests on the computer. One of the tests on the computer is in the Kerzweil program. This program reads the test to me so I can hear it in my earphones. Kerzweil highlights each sentence in yellow as it is being spoken and each word in that sentence is highlighted in pink. The second version of the test on the computer is the one

class during tests. Usually, when I explain I have a learning disability, the first reaction I get is disbelief since I always participate in class discussions. It is best for me to prepare for lecture prior to class time. I ask many questions as the

material comes up in lecture. To classmates, it might appear that I am really enthusiastic— which I am—but I don’t really have many other options. If I can’t understand a concept from the book, it is easiest to ask during lecture. I am always the most surprised when I get high grades on exams. During the summer of 2010 between my junior and senior years, I enjoyed participating in an externship. This consisted of fifteen 12-hour shifts, during which I followed a preceptor on the telemetry floor at a major medical center. This externship provided many opportunities for verbal

Accommodations for Students with Learning Disabilities The Americans with Disabilities Act (ADA) of 1990 extended the rights of people with disabilities. It is considered to be landmark legislation with comprehensive advocacy on behalf of persons with disabilities in the history of the US. Included in the act are issues of access to places of public accommodation, services, programs, and public transportation. In addition to preventing employers from discriminating based on disabilities, the ADA states that no public accommodation (including entities such as an elementary, secondary, undergraduate, or postgraduate private school) may discriminate “on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, [or] advantages” of said public accommodation. It further stipulates that examinations and courses must be offered “in a place and manner accessible to persons with disabilities or offer alternative accessible arrangements for such individuals.” For example, a student with a learning disability (such as dyslexia) may be legally accommodated with an oral exam or extra time.

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Degrees of Success

Additional Resources US Department of Justice, Americans with Disabilities Act (ADA) www.ada.gov

ADA National Network www.adata.org

Disability Access Information and Support www.daisweb.com

Exceptional Nurse www.exceptionalnurse.com

National Organization of Nurses with Disabilities www.nond.org

Nursing Students with Dyslexia (NSwD) http://community.nurseslounge.com/join/nswd

Minority Nurse | SPRING 2014

questions and answersâ&#x20AC;&#x201D;my preferred learning style. My preceptor was incredible. She was open to learn about my learning needs, and we discussed possible precautions to take in order to maximize my performance on the floor. According to my preceptor, there was no evidence of disability in my performance. I did use a color transparency when there was a lot of material to read and comprehend,

to practice in the United Kingdom is never questioned. Unable to locate a voice from the perspective of dyslexic student nurses, I founded Nursing Students with Dyslexia (NSwD) on www.NursesLounge.com, which is a social networking site geared specifically to nurses and student nurses. Students are able to join NSwD directly at http:// community.nurseslounge.com/ join/nswd. This page includes

There are laws that prohibit discrimination against individuals with disabilities, but application of these laws to nursing students and new nurses with dyslexia is an area that appears vacant. but that was the only accommodation I used on the floor. The transparency was also a folder that held materials that I needed, so it blended in discreetly. Despite research articles in the medical literature raising skepticism about nurses and nursing students with dyslexia, most articles call for the need for more research. There are laws that prohibit discrimination against individuals with disabilities, but application of these laws to nursing students and new nurses with dyslexia is an area that appears vacant. I have not found another group of student nurses that is directly being targeted in this way. The United Kingdom leads the way in accommodating the needs of dyslexic students. England has a complete, published protocol that details how to best maximize the learning abilities of dyslexic student nurses while ensuring the safety for all. The idea of whether dyslexic student nurses should be allowed

research available on assisting student nurses with dyslexia, along with resources and scholarship opportunities. Someday, I hope to develop a scholarship that encourages student nurses with dyslexia to network together. Maybe by sharing our stories of success we can offer greater insights into the challenges that dyslexic student nurses must overcome. Nursing education is expanding its understanding of how to provide the most successful learning experience for students, including student nurses with dyslexia. I am proud and honored to be a voice as a student nurse who is not letting a disability define or limit me. Toni Sugg, RN, graduated from Regis University in Denver, Colorado, in May 2011 and received the Nursing Excellence Award for her class. She is currently employed at El Pubeloâ&#x20AC;Śan Adolescent Treatment Community, where she cares for kids with a large range of abilities and challenges.

MINORITYNURSE.COM Highlights from the Blog

Newsletter Helping Patients Form Healthy Habits As a nurse, you’re in an excellent position to offer advice to patients about establishing healthier lifestyle habits. The question is: What’s the best way to provide guidance on habit-formation? Here are some best practices on health education.

Working with the Enemy Have you ever had to deal with a disrespectful coworker who makes your life miserable on the job? Know this: You are not alone.

Steps to Protect Your Health at Work When it comes to work-related injuries, nurses get more than their fair share. So, what are you doing to protect your health?

Sticking to a Budget So you’ve decided to take your out-of-control financial situation firmly in hand. You’ve identified your spending “hot zones,” set some motivational savings goals, and created a budget to get you where you want to go. Now the trick is: Sticking to it.

To read more, visit www.minoritynurse.com/blog.

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MINORITY NURSE SCHOLARSHIP PROGRAM Sponsored by the National Coalition of Ethnic Minority Nurse Associations (NCEMNA) and Minority Nurse Magazine Nurses will always be valuable members of any health care team, regardless of their educational backgrounds. Yet, the baccalaureate and masterâ&#x20AC;&#x2122;s degrees in nursing may offer the most professional opportunities. Thatâ&#x20AC;&#x2122;s why Minority Nurse has teamed up with NCEMNA to co-sponsor an annual scholarship to help outstanding nurses from under-represented groups complete their studies toward a Bachelor or Master of Science in Nursing. To date, we have awarded scholarships to more than 40 students, honoring their commitment to the profession, academic excellence, and community service. We are currently accepting applications for our 15th annual scholarship competition, consisting of two $1,000 awards and one $3,000 award. Scholarships will be paid in summer 2015 for the fall 2015 academic term. Questions? E-mail editor@minoritynurse.com or visit www.minoritynurse.com/scholarship/minority-nursemagazine-scholarship-program

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MINORITY NURSE 16th Annual Scholarship Program

Application Form (Please print clearly) Name ______________________________________________________________________________________________ Address ____________________________________________________________________________________________ City/State/ZIP Code _________________________________________________________________________________ Phone_______________________________ E-mail________________________________________________________ Nursing school______________________________________________________________________________________ Expected date of graduation _________________________________________________________________________ Gender: o Male

o Female

Ethnic background: o African American o Hispanic/Latino o Asian/Pacific Islander o American Indian/Alaskan Native o Filipino o Other______________ Please list any nursing associations (student, minority, or otherwise) to which you belong: __________________________________________________________________________________________________________ __________________________________________________________________________________________________________

Who Is Eligible (Please read carefully. Applications that do not meet the eligibility criteria will be disqualified.) To apply for this scholarship, students must meet all four of the following criteria: Be a minority in the nursing profession Be enrolled (as of September 2015) in either: • The third or fourth year of an accredited BSN program in the United States; or • An accelerated program leading to a BSN degree (such as RN-to-BSN or BA-to-BSN); or • An accelerated master’s entry program in nursing for students with bachelor’s degrees in fields other than nursing (such as BA-to-MSN). Note: Graduate students who already have a bachelor’s degree in nursing are not eligible.

Have a 3.0 GPA or better (on a 4.0 scale) Be a U.S. citizen or permanent resident How to Apply (Please read carefully. Applications that do not include the required documentation will be disqualified.) Complete and return this form along with all three of the following documents: Transcript or other proof of GPA Letter of recommendation from a faculty member outlining academic achievement A brief (250-word) written statement summarizing your academic and personal accomplishments, community service, and goals for your future nursing career Important: An English translation must be provided for any documentation that is not in English. Minority Nurse will award one $3,000 scholarship and two $1,000 scholarships in 2015. Selections will be made by NCEMNA. Scholarships will be paid in summer 2015. Minority Nurse reserves the right to verify community service and financial need.

Deadline for application: February 1, 2015 Return application form and documentation to: Minority Nurse Magazine Scholarship, Springer Publishing Company, 11 W. 42nd Street, 15th Floor, New York, NY 10036 www.minoritynurse.com

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Academic Opportunities

Discover Johns Hopkins doctoral nursing education The Doctor of Philosophy (PhD) for research leaders. Advance the science of nursing and healthcare. The Doctor of Nursing Practice (DNP) for clinical leaders. Advance the practice of nursing and improve health outcomes. Choose your path at the Johns Hopkins University School of Nursing—a place where exceptional people discover possibilities that forever change their lives and the world.

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Take the next step to advancing your education and your career. From Nursing Informatics to Neonatal Nurse Practitioner to Psychiatric Primary Care Nurse Practitioner—we have many programs to fit your needs.

For online and on-site program options, visit nursing.pitt.edu or call 1-888-747-0794.

School of Nursing Ranked seventh among schools of nursing in U.S. News & World Report’s 2011 America’s Best Graduate Schools

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Academic Opportunities

Applications now open! The Betty Irene Moore School of Nursing at UC Davis — a new nursing school with a vision to advance health and ignite leadership through innovative education, transformative research and bold system change.

TEMPLE UNIVERSITY A Leading Philadelphia Institution

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It is an exciting time in urban healthcare… Are you ready to play a key role?

Admission is competitive and space is limited!

Learn More About the Doctor of Nursing Practice (DNP) Program at Temple! We prepare Primary Care Nurse Practitioners to Improve Urban Health Care—we have two options:

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st DNP Program to become either an Adult or Family Nurse Practitioner **(full and part-time)

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Academic Opportunities

Make achieving your personal and professional goals a reality!

MASTER OF SCIENCE IN NURSING

Nurse Anesthesia Program OUR 28-MONTH PROGRAM FEATURES: • Classes in Asheville with clinical rotations at various sites in Western North Carolina • Small class sizes for individualized attention • Faculty committed to your success • State-of-the-art, high-fidelity simulation center • 100 overall percent pass rate on the national certification examination

s you are probably aware, the demand for nurses continues to skyrocket. What you may not know is that there’s also a critical need for nurses with advanced degrees, as hospitals turn to nurses to fill more administrative and leadership roles. Nursing schools around the country are jumping at the chance to fill this void by offering flexible Master of Science in Nursing and Doctor of Nursing Practice programs, and you’ll find many great examples in the following pages. There truly has never been a better time to pursue an advanced nursing degree. Be sure to secure your spot in the program— and your financial aid—by applying early.

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NURSING.WCU.EDU 828.654.6499

Faculty Opportunities

School of Nursing F U L L - T I M E FA C U LT Y The Milwaukee School of Engineering invites applications for a full-time faculty position in the School of Nursing beginning in the fall of 2014. The ideal candidate will have relevant clinical experience as well as experience in developing curriculum and teaching undergraduate and graduate students. MSOE is a private, non-profit, institution with approximately 2500 students. MSOE’s School of Nursing offers a pre-licensure BSN program and was granted CCNE initial accreditation in April 1999 and graduated its first class in May 1999. In keeping with the mission of MSOE, maximum enrollment in nursing class sections is 35 and the student to faculty ratio in the clinical area is 8:1. The program uses an integrated nursing model of wellness to illness across the lifespan, with balanced clinical experiences in both inpatient and community settings. Practice experience in acute adult care is required. The ideal candidate will possess a doctorate degree in nursing and have experience in classroom delivery as well as ability to supervise groups of students in acute care. Current WIRN license required. The review of candidates will begin immediately and continue until the position is filled. Please visit our website at http://www.msoe.edu/hr/ for additional information including requirements and the application process or http://www. milwaukeejobs.com/apply.asp?jid=5885432 to apply.

College of Nursing EMPLOYMENT OPPORTUNITIES • Assistant or Associate Professor of Nursing, Med-Surgical • Assistant or Associate Professor of Nursing, Pediatrics • Assistant or Associate Professor of Nursing, Psychiatric OBU requires completion of an OBU Faculty application.

You may submit your completed, signed application and materials via: Mail: Human Resource Department OBU Box 61207 500 West University Shawnee, OK 74804 Email: hr@okbu.edu | Fax: 405.585.5179 | In Person: 104 Thurmond Hall

Transform Your Career. Transform Your World! OBU complies with all federal and state non-discrimination laws and is an equal opportunity institution.

For specific questions regarding College of Nursing employment opportunities, please contact 405.585.4450 or nursing@okbu.edu.

MSOE is an Equal Employment Opportunity/Affirmative Action Employer

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he world needs more nurses. With that comes the need for experienced, dedicated nursing faculty to train them.

There is a true shortage of nursing educators—particularly minority nursing professors, who comprise a small percentage of nursing faculty overall. The American Association of Colleges of Nursing says the scarcity of professors may actually be stunting the growth of nursing programs. To counter this, nursing schools are improving the pay for nursing school faculty to increase their numbers, especially those who hold a doctorate. This section of Minority Nurse is dedicated to open faculty positions from nursing schools all over the country. Requirements vary, but all are sure to lead to exciting, rewarding careers in nursing education and research.

Faculty Searches

As a result of retirements, the College of Nursing at Villanova University invites applications for four full-time, tenure track faculty positions at the rank of Assistant, Associate or Full Professor and two non-tenure track positions. Adult Health/Acute Care Nursing—Tenure Track Positions Maternal-Infant Health Nursing—Tenure Track Position Public Health/Health Policy—Tenure Track Position Adult Health—Non-Tenure Track Positions PhD required for all tenure track positions. Master’s degree in nursing with appropriate specialty preparation. Evidence of scholarly productivity, grantsmanship and publications. Teaching philosophy commensurate with Villanova’s mission and values. Villanova University, located in beautiful suburban Philadelphia, is a Catholic university sponsored by the Augustinian order. Diversity and inclusion have been and will continue to be an integral component of Villanova University’s mission. The University is an Equal Opportunity/Affirmative Action employer and seeks candidates who understand, respect and can contribute to the University’s mission and values. Further information about the College of Nursing can be found at www.villanova.edu/nursing.

To apply, please visit https://jobs.villanova.edu and click on Faculty Positions.

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Faculty Opportunities

Index of Advertisers ADVERTISER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE # Civilian Corps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 National Black Nurses Association . . . . . . . . . . . . . . . . . 33 University of Connecticut Health Center. . . . . . . . . . . . . 25 University of Florida Health Jacksonville . . . . . . . . . . . . 21 UNCF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4

ACADEMIC OPPORTUNITIES . . . . . . . . . . . . . . . . . . . . . PAGE # Frontier Nursing University. . . . . . . . . . . . . . . . . . . . . . . 52 Johns Hopkins University . . . . . . . . . . . . . . . . . . . . . . . . 52 Penn State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Temple University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Earn a Jefferson Nursing Degree, Achieve a Jefferson Reputation BSN: full-time upper division 2-year program FACT: 12-month accelerated BSN MSN: multiple specialties; core/support courses online; clinical courses on campus; distance education via live webcasting

University of Pittsburgh . . . . . . . . . . . . . . . . . . . . . . . . . 52 Western Carolina University . . . . . . . . . . . . . . . . . . . . . . 54

FACULTY OPPORTUNITIES . . . . . . . . . . . . . . . . . . . . . . . PAGE # Milwaukee School of Engineering . . . . . . . . . . . . . . . . . 55

CRNA: full-time, 30-month, on-site program DNP: online, may complete in 2 to 5 years

Oklahoma Baptist University . . . . . . . . . . . . . . . . . . . . . 55

215-503-8055 explore.jefferson.edu/MinorityNurse

Thomas Jefferson University . . . . . . . . . . . . . . . . . . . . . 56

Philadelphia, PA THOMAS JEFFERSON UNIVERSITY

University of California, Davis. . . . . . . . . . . . . . . . . . . . . 53

Minority Nurse | SPRING 2014

Villanova University . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

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