The Career and Education Resource for the Minority Nursing Professional • SPRING 2018
Inventors on the Frontline
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Table of Contents
In This Issue
Cover Story
3
Editor’s Notebook
4
Vital Signs
7
Making Rounds
By Linda Childers
47
The Funny Bone
Discover why the best ideas for patient care are often developed
8 Minority Nurse Inventors: Improving Patient Care Through Unique Clinical Solutions
by those on the frontline
Academic Forum 37 Implementing a Nutrition and Wellness Education Program to Promote Better Dietary Habits By Kougang Anne Mbe, Kalea Vo, BSN, RN, and Constance Hill, PhD, RN Education plays a crucial role in helping disadvantaged communities make better lifestyle choices
Features 14 How Nurses Can Make Better Financial Decisions
By Jebra Turner Learn how to make smart personal and career decisions to lead a
Degrees of Success 41
We All Had to Start Somewhere
By Michelle Tanner, MSN, RN
An educator reflects on humble beginnings and reminds us that we’re all in this together
financially empowered life
20 The Link Between Cultural Communication, Hospital Safety, and Desired Outcomes
By James Z. Daniels, MPA, MSc, and Janice Bonham West, MEd
Health Policy 43 Pursuing a Career in Public Policy: No Longer the Road Less Traveled in Nursing
By Janice M. Phillips, PhD, FAAN, RN
More nurses are getting involved in the policy-making process—and so should you
Providing culturally competent care is more important than ever
26 Emotional Rescue: How to Protect Yourself from Stressful Work Experiences
By Michele Wojciechowski Find out how to set healthy boundaries and combat compassion fatigue without sacrificing your humanity
32 Adapting to Different Work Cultures By Nuananong Seal, PhD, RN, and Mary Wiske, RN A non-toxic work culture is critical to job satisfaction
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Editor’s Notebook:
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E
very year, nurses are ranked the most trusted profession in health care—and for good reason. Nurses are often patients’ #1 advocate for better health, whether it’s through the invention of a product that improves lives, the understanding of a patient’s culture and how it interplays with health decisions, or creating healthy boundaries so they can provide patients with high-quality care without the threat of compassion fatigue. In our cover story, we highlight four nurse inventors who turned their ideas into reality and have successfully improved the quality of life for those around them. Got a great idea of your own? Flip to page 8 to find out how they achieved success and how you can, too. Nurses may be the most trusted, but sadly, that trust doesn’t necessarily translate into wealth. Feeling burdened by student loan debt or just wishing you had a little more saved in the bank? Jebra Turner interviewed financial experts and savvy nurses to equip you with the life hacks you need to feel financially empowered (page 14). Effective communication skills are important in every facet of your life, especially when it comes to helping your patients make smart decisions about their health. James Daniels and Janice Bonham West explore the importance of providing culturally competent care in improving patient outcomes (page 20). Helping patients might be in your DNA, but don’t neglect your own health. Nurses are often exposed to distressing situations and may be susceptible to compassion fatigue and burnout if they don’t take the proper precautions before they reach a tipping point. Learn how to recognize these warning signs so you know when additional help is necessary (page 26). Communicating effectively with your coworkers is equally important to your (mental) health. Nuananong Seal and Mary Wiske offer guidance on how to adapt to your work culture, so you can have a fulfilling career in an inclusive environment (page 32). There are many paths to fulfillment. Perhaps you wish to help your community combat obesity by implementing a wellness education program (learn more on page 37) or you want to dip your toes in public policy (learn more on page 43). No matter where you are in your career, Michelle Tanner reminds us that we all had to start somewhere (page 41). The next time you find yourself struggling, remember that it’s perfectly okay to ask for help once in a while—and to reciprocate when others are in need. After all, we’re all in this together.
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Debra A. Toney, PhD, RN, FAAN Director of Quality Management Nevada Health Centers Minority Nurse (ISSN: 1076-7223) is published four times per year by Springer Publishing Company, LLC, New York. Articles and columns published in Minority Nurse represent the viewpoints of the authors and not necessarily those of the editorial staff. The publisher is not responsible for unsolicited manuscripts or other materials. This publication is designed to provide accurate information in regard to its subject matter. It is distributed with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice or other expert assistance is required, the services of a competent professional person should be sought. The publisher does not control and is not responsible for the content of advertising material in this publication, nor for the recruitment or employment practices of the employers placing advertisements herein. Throughout this issue we use trademarked names. Instead of using a trademark symbol with each occurrence, we state that we are using the names in an editorial fashion to the benefit of the trademark owner, with no intention of infringement of the trademark. Subscription Rates: Minority Nurse is distributed free upon request. Visit www.minoritynurse.com to subscribe.
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Vital Signs
Female Night Shift Workers May Have Increased Risk of Common Cancers Night shift work was associated with women having an increased risk of breast, skin, and gastrointestinal cancer, according to a meta-analysis published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.
“B
y systematically integrating a multitude of previous data, we found that night shift work was positively associated with several common cancers in women,” says Xuelei Ma, PhD, oncologist at State Key Laboratory of Biotherapy and Cancer Center, West China Medical Center of Sichuan U niversity,
on understanding the association between female night shift workers and breast cancer risk, but the conclusions have been inconsistent. To build upon previous studies, Ma and colleagues analyzed whether longterm night shift work in women was associated with risk of nearly a dozen types of cancer. Ma and colleagues performed a meta-analysis using data from
Chengdu, China. “The results of this research suggest the need for health protection programs for long-term female night shift workers.” Ma explained that because breast cancer is the most d iagnosed cancer among women worldwide, most previous meta-analyses have f ocused
61 articles comprising 114,628 cancer c ases and 3,909,152 participants from North America, Europe, A ustralia, and Asia. The articles consisted of 26 cohort studies, 24 case–control studies, and 11 nested case–control studies. These studies were analyzed for an association between long-term night shift
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work and risk of 11 types of cancer. A further analysis was conducted, which looked specifically at long-term night shift work and risk of six types of cancer among female nurses. Overall, long-term night shift work among women increased the risk of cancer by 19%. When analyzing specific cancers, the researchers found that this population had an increased risk of skin (41%), breast (32%), and gastrointestinal cancer (18%) compared with women who did not perform long-term night shift work. After stratifying the participants by location, Ma found that an increased risk of breast cancer was only found among female night shift workers in North America and Europe. “We were surprised to see the association between night shift work and breast cancer risk only among women in North America and Europe,” says Ma. “It is possible that women in these locations have higher sex hormone levels, which have been positively associated with hormone-related cancers such as breast cancer.” Among female nurses alone, those who worked the night shift had an increased risk of breast (58%), gastrointestinal (35%), and lung cancer (28%) compared with those that did not work night shifts. Of all the occupations analyzed, nurses had the highest risk of developing breast cancer if they worked the night shift. “Nurses that worked the night shift were of a medical background and may have been more likely to u ndergo screening examinations,” noted Ma.
“Another possible explanation for the increased cancer risk in this population may relate to the job requirements of night shift nursing, such as more intensive shifts.” The researchers also performed a dose–response meta-analysis among breast cancer studies that involved three or more levels of exposure. They found that the risk of breast cancer increased by 3.3% for every five years of night shift work. “Our study indicates that night shift work serves as a risk factor for common cancers in women,” says Ma. “These results might help establish and implement effective measures to protect female night shifters. Long-term night shift workers should have regular physical examinations and cancer screenings.” “Given the expanding prevalence of shift work worldwide and the heavy public burden of cancers, we initiated this study to draw public attention to this issue so that more large cohort studies will be conducted to confirm these associations,” he added. A limitation of this work is a lack of consistency between studies regarding the definition of “long-term” night shift work, with definitions including “working during the night” and “working at least three nights per month.” A dditional limitations include significant between-study heterogeneity and publication bias.
Vital Signs
Smoking is Down, but Almost 38 Million American Adults Still Smoke Overall, cigarette smoking among U.S. adults (aged ≥18 years) declined from 20.9% in 2005 to 15.5% in 2016. Yet, nearly 38 million American adults smoked cigarettes (“every day” or “some days”) in 2016, according to data released by the Centers for Disease Control and Prevention (CDC).
T
he new data, from the National Health Inter view Sur vey (NHIS), show that among adults who have ever used cigarettes, the percentage who have quit increased from 50.8% in 2005 to 59.0% in 2016. During 2005–2016, the largest increase in quitting was among adults ages 25–44 years. “The good news is that these data are consistent with the declines in adult cigarette smoking that we’ve seen for several decades,” says Corinne Graffunder, DrPH, director of the CDC’s Office on Smoking and Health. “These findings also show that more people are quitting, and those who continue to smoke are smoking less.” Since 1965, the NHIS has tracked cigarette smoking, the most common form of tobacco product use among U.S. adults. The U.S. Surgeon General has concluded that the burden of death and disease from tobacco use in the U nited States is overwhelmingly caused by cigarettes and other combusted tobacco products. Among daily smokers, the average number of cigarettes smoked per day declined from about 17 cigarettes in 2005 to 14 cigarettes in 2016. The proportion of daily smokers who smoked 20 to 29 cigarettes per day dropped from 34.9% in
2005 to 28.4% in 2016, whereas the proportion who smoked fewer than ten cigarettes per day rose from 16.4% in 2005 to 25% in 2016.
Persistent Disparities in Cigarette Smoking Despite this progress, disparities in smoking persist across population groups. Cigarette smoking was especially high among males, those aged 25–64 years, people who had less education, American Indians/ Alaska N atives, A mericans of multiple races, those who had serious psychological distress, those who were uninsured or
insured through Medicaid, those living below the poverty level, those who had a disability, those who were lesbian, gay, or bisexual, and those who lived in the Midwest or South. “The bad news is that c igarette smoking is not declining at the same rate among all population groups,” says Brian King, PhD, deputy director for research translation in CDC’s Office on S moking and Health. “Addressing these disparities with evidence-based interventions is critical to continue the progress we’ve made in reducing the overall smoking rate.”
Reducing SmokingRelated Disease: What More Can Be Done? Proven population-based interventions—including tobacco price increases, comprehensive smoke-free laws, anti-tobacco
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mass media campaigns, and barrier-free access to tobacco cessation counseling and medications—are critical to reduce cigarette smoking and smoking-related disease and death among U.S. adults, particularly among populations with the highest rates of use. Cigarette smoking among U.S. adults has been reduced by more than half since 1964, yet remains the leading preventable cause of disease and death in the United States. It kills more than 480,000 Americans each year. For every person who dies this year from smoking, there are over 30 Americans who continue to live with a smoking-related disease. For more information or for free help quitting, call 1-800-QUIT-NOW or go to www.smokefree.gov.
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Vital Signs
New Study Offers Insights on Genetic Indicators of COPD Risk Researchers have discovered that genetic variations in the anatomy of the lungs could serve as indicators to help identify people who have low, but stable, lung function early in life, and those who are particularly at risk of chronic obstructive pulmonary disease (COPD) because of a smoke-induced decline in lung function. The results of the study, which was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, appear in the journal Proceedings of the National Academy of Sciences of the United States of America.
C
igarette smoking has long been the most common cause of COPD, but not all smokers develop the condition, and many non-smokers do. Why that is so has never been fully understood, but a team of researchers now have a clue after discovering that genetically programmed airway tree variation is linked to a higher prevalence of COPD among older adults. “This work raises many interesting questions for researchers. Understanding precisely why these genes influence the development of COPD may lead to entirely new and more effective ways of preventing or treating this disease,” says James Kiley, MD, director of the NHLBI D ivision of Lung Diseases. “This novel study suggests that a CT scan, which is widely available, can be used to measure airway structure and predict who is at higher risk for smoke-induced lung injury.” COPD, a progressive disease that makes it hard to breathe, is the fourth leading cause of death in the United States. An estimated 16 million p eople
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are currently diagnosed with COPD, and millions more are believed to have the condition. Until recently, researchers believed that COPD developed later in life as a result of prolonged exposure to cigarette smoke or air pollution, which accelerated the decline in lung function. However, recent studies have shown that many older adults with COPD had low lung function early in life and experienced the normal lung function decline associated with aging, not an accelerated decline. “In the current study, we found that central airway branches of the lungs, which are believed to form early in life, do not follow the textbook pattern in one quarter of the adult population and these non-textbook variations in airway branches are associated with higher COPD prevalence among older adults,” says the study’s first author, Benjamin M. Smith, MD, MS, assistant professor at Columbia University Medical Center. “Interestingly, one of the airway branch variants was associated with COPD among smokers
and non-smokers. The other was associated with COPD, but only among smokers.” These airway tree variations are identifiable on low-dose screening lung CT scans, which are currently indicated clinically for lung cancer screening in older p atients with a history of heavy smoking in the prior 15 years. B efore CT scans are used outside of this group for the identification of airway variants in clinical practice, the study authors say more research will be needed to c onfirm that preventive or therapeutic interventions based on the presence of airway tree variations can improve patients’ outcomes. In the meantime, the researchers say they will be investigating another impor-
tant finding—this one around family history. Their study identified a common airway branch variation that occurs within families and is associated with COPD among non-smokers. Smith says while other developmental events that occur within families may be involved, his research team is looking into whether there is a genetic basis for this variant. “If proven,” he says, “this would represent a novel mechanism of COPD among non-smokers.” The researcher emphasized that for all the new findings, quitting smoking remains the best antidote to COPD, and smokers trying to quit should seek professional help, if necessary, to succeed. To learn more about the NHLBI, visit www.nhlbi.nih.gov.
Making Rounds
March
May
June/July
11–16
4–6
June 26–July 1
2018 Cruise Conference Princess Cruises Fort Lauderdale, Florida to Dominican Republic to Turks and Caicos Info: 844-267-7665 Website: https://bnrcruise.com
2018 Spring National Advanced Practice Neonatal Nurses Conference Marriott Downtown Waterfront Portland, Oregon Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org
2018 National Conference Colorado Convention Center Denver, Colorado Info: 512-442-4262 E-mail: conference@aanp.org Website: www.aanp.org
21–24
10–12
Black Nurses Rock
Southern Nursing Research Society 32nd Annual Conference Sheraton Atlanta Atlanta, Georgia Info: 877-314-7677 E-mail: info@snrs.org Website: www.snrs.org
24–27
American Association of Colleges of Nursing Deans Annual Meeting The Fairmont Washington Washington, District of Columbia Info: 202-463-6930 E-mail:conferences@aacn.nche.edu Website: www.aacn.nche.edu
April
Academy of Neonatal Nursing
American Nursing Informatics Association
ISPN 20th Annual Conference and 11th Psychopharmacology Institute Tempe Mission Palms Hotel and Conference Center Tempe, Arizona Info: 608-443-2463 E-mail: info@ispn-psych.org Website: www.ispn-psych.org
2018 Annual Convention Hyatt Regency Jersey City on the Hudson Jersey City, New Jersey E-mail: infomypnaa@gmail.com Website: www.mypnaa.org
2018 National Teaching Institute & Critical Care Exposition Boston Convention and Exhibition Center Boston, Massachusetts Tel: 800-899-2226 E-mail: info@aacn.org Website: www.aacn.org
5–10
International Society of PsychiatricMental Health Nurses
Philippine Nurses Association of America
American Association of Critical-Care Nurses
66th Annual Convention Gaylord Opryland Hotel Nashville, Tennessee Info: 718-210-0705 E-mail: nsna@nsna.org Website: http://nsnaconvention.weebly.com
10–14
25–29
21–24
June
National Student Nurses’ Association
July
2018 Annual Conference Hilton Buena Vista Palace Orlando, Florida Tel: 866-552-6404 E-mail: ania@ajj.com Website: www.ania.org
4–8
American Holistic Nurses Association 2018 Annual Conference The Sheraton at the Falls Niagara Falls, New York Info: 800-278-2462 E-mail: info@ahna.org Website: www.ahna.org
23–27
Association of Women’s Health, Obstetric and Neonatal Nurses 2018 Annual Convention Tampa Convention Center Tampa, Florida Info: 800-354-2268 E-mail: customerservice@awhonn.org Website: www.awhonn.org
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American Association of Nurse Practitioners
July/August July 31–August 3
National Association of Hispanic Nurses 43rd Annual Conference Hilton Cleveland Downtown Cleveland, Ohio Info: 919-573-5443 E-mail: info@thehispanicnurses.org Website: http://nahnnet.org
July 31–August 5
National Black Nurses Association 46th Annual Institute and Conference St. Louis Union Station Hotel St. Louis, Missouri Info: 301-589-3200 E-mail: info@nbna.org Website: www.nbna.org
September 27–29
Doctors of Nursing Practice, Inc. 11th Annual Conference Westin Mission Hills Golf Resort and Spa Palm Springs, California Info: 888-651-9160 E-mail: info@doctorsofnursingpractice.org Website: www.doctorsofnursingpractice.org Minority Nurse Magazine
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Minority Nurse Inventors Improving Patient Care Through Unique Clinical Solutions
BY LINDA CHILDERS 8
Minority Nurse | SPRING 2018
Ernesto Holguin, RN, BSN, CNN, dialysis clinical coordinator at Las Palmas Medical Center in El Paso, Texas, was saddened to see his elderly patient arrive for her dialysis appointment in 2003 with a foot infection caused by a diabetic ulcer.
“D
iabetes had affected her eyesight and caused her to lose feeling in her feet,” says Holguin. “It was only when she smelled a foul odor emanating from her foot that she realized something was wrong.” Wishing there was a tool that could assist diabetic patients in preventing foot u lcers from developing, Holguin decided to invent a device. Holguin is one of many nurses across the country who have envisioned inventions they believe will help improve patient care. One of the earliest nurse inventors, Bessie Blount Griffin, an African American nurse, invented a feeding tube during World War II to help feed paralyzed veterans. Since then, many more nurses
have tapped into their natural problem-solving skills to invent devices to i mprove the patient experience. For Holguin, that meant finding a way for patients to avoid diabetic foot ulcers or in the event they did develop a foot ulcer, to prevent it from becoming infected. The American Podiatric Medical Association (APMA) says that foot ulcers are one of the most common complications in patients with diabetes and if not treated properly, can lead to infections and in some cases, diabetes-related amputation. According to the APMA, foot ulcers occur in approximately 15% of diabetic patients and are commonly located on the bottom of the foot. Among patients who develop a foot ulcer, 6% will be hospitalized due to infection or
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Lisa Vallino, RN, BSN
ulcer-related complications, and 14–24% of patients with diabetes who develop a foot ulcer will require an amputation. “The current protocol for prevention of diabetic foot ulcers involves patients checking their feet on a daily basis for cuts, cracks, blisters, and signs of an open wound,” Holguin says. “Patients who have trouble viewing the bottom of their feet are often told to stand over a mirror at home, but this can
consults became a distinct possibility. In 2015, Holguin was invited to a workshop that the MakerNurse program was holding in Texas. Founded in 2013, MakerNurse works with nurses to bring their ideas for inventions to fruition, believing the best ideas for patient care are often developed by those on the front lines who work directly with patients. “I told Anna Young and Jose Gomez-Marquez, the cofounders of MakerNurse, about my invention and they were very enthusiastic and encouraged me to build a prototype,” Holguin recalls. “Even though I’ve always liked to tinker, I never imagined I would one day design and build a device that could help my patients.” Gomez-Marquez says MakerNurse launched in 2013 with support from the R obert Wood Johnson Foundation. MakerNurse provides the tools, platform, and training to help nurs-
with their idea.” Working out of his garage in El Paso, Holguin recently finished the fourth prototype for his device. The first three he says were too large and cumbersome for patients to use. The U.S. Patent and T rademark Office recently certified Holguin’s patent, and is now working with a local medical incubator to turn his idea into a medical grade device. “The next step is to have the device tested in clinical trials, and if successful, to submit it to the Food and Drug Administration (FDA) for approval,” Holguin explains. “I’ve talked with several doctors who believe my invention could be part of an important part of
a diabetic patient’s treatment plan.” In addition to making it easier for diabetic patients to monitor their feet for foot ulcers, Holguin believes his invention would reduce hospital readmissions. And more importantly, it could also help patients maintain a better quality of life. “Some diabetics are only in their forties or fifties when an infected foot ulcer leads to amputation and disability,” says Holguin. “I’m confident this device can help diabetic patients to remain employed and live fulfilling lives.”
Nurses as Makers Roxanna Reyna, BSN, RNCNIC, WCC, a wound care coor-
“Founded in 2013, MakerNurse works with nurses to bring their ideas for inventions to fruition, believing the best ideas for patient care are often developed by those on the front lines who work directly with patients.” be difficult for patients who are overweight, arthritic, or elderly and don’t have good balance.” Holguin envisioned a d evice that patients would use at home to prevent and effectively monitor their diabetic foot ulcers. The apparatus would inspect, dry, and take pictures of a patient’s feet and then send that information to their clinician. His idea began to gain traction in 2007 when the first iPhone was released, and the idea of doing remote patient
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es like Holguin make the next generation of health technology. Two years ago, MakerNurse partnered with the University of Texas Medical Branch at Galveston to open their first MakerHealth Space in John Healy Hospital. “Too often nurses have a great idea on how to but aren’t sure how to make it a reality,” says Gomez-Marquez. “We encourage nurses who have an idea for an invention to build a prototype and run
Roxanna Reyna, BSN, RNC-NIC, WCC
Ernesto Holguin, RN, BSN, CNN
“Too often nurses have a great idea on how to but aren’t sure how to make it a reality,” says GomezMarquez. “We encourage nurses who have an idea for an invention to build a prototype and run with their idea.”
dinator at Driscoll Children’s Hospital in Corpus Christi, Texas, calls herself “MacGyver Nurse.” True to her moniker, she invented a unique skin and wound dressing for infants with abdominal wall defects. Reyna’s workplace, Driscoll Children’s Hospital, was one of five “expedition sites” initially launched at hospitals in California, New York, and Texas, by MakerNurse. Reyna got the idea to make a dressing for children born with
omphalocele, a type of birth defect that leaves intestines protruding from the body and covered only by a thin layer of tissue. Surgery repairs the defect, but in the interim, the infant is at risk of infection. “There weren’t any d ressings or bandages made for kids that provided the same level of healing,” says Reyna. “So, I started experimenting with bandages, sponges, and tape.” Reyna’s invention not only helped her colleague and young patients, but she was also invited to the White House in 2014 to meet President Obama and to take part in an event honoring “makers.” Since Reyna’s product is tailored to a specific group of patients and there’s not enough demand for it to be manufactured on a large-scale basis, she did make directions on how to construct her dressing through MakerNurse.
A Path of Beauty Monique Rodriguez was working as a labor and delivery nurse in Indiana when she decided to launch her own beauty company, Mielle Organics. “While looking for natural solutions for my own hair challenges, I began creating products in my kitchen and blog about my hair journey on social media,” says Rodriguez. “I gained an audience and people began to ask if they could purchase my concoctions. A light bulb went off and Mielle Organics was born.” Rodriquez initially stayed in her nursing job to save money to fund the company. “I strongly believe in speaking things into existence. I wrote my resignation letter in May and dated for November and was actually able to quit my job sooner,” she says. Although she had little entrepreneurial experience when she
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started her company, R odriguez did have drive and determination. In an effort to learn as much as she could, Rodriguez read books, listened to podcasts, and scoured the Internet to obtain as much information as possible. “When I launched my business in 2014, natural hair products for black hair was an emerging market and I was attempting to stay on the cutting edge,” she says. “Today, the market is much more competitive, and although there’s room for all brands to succeed, we strive to be number one.” Rodriguez, who worked as a nurse for nine years, says one of the biggest barriers she faced in launching her own business was not letting fear overcome her. “It was very scary leaving my career as a RN, because of the fear of the unknown,” says Rodriguez. “I also wish that I had a business mentor or someone to talk with in the beginning.” Rodriguez says her background in nursing also proved helpful in developing the Mielle Organics line. “I understood the importance of using high quality ingredients that are effective for hair growth,” she says. “When we formulate our products, we don’t just focus on hair care, but also how healthy are the ingredients.” Today, Rodriquez leads a corporate staff of 13 and her business is thriving. Mielle Organics are now sold at Sally Beauty, Target, and CVS locations.
An Invention Leads to a New Business Lisa Vallino, RN, BSN, still remembers when she and her nurse colleagues would turn plastic cups into makeshift in-
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Making Your Idea a Reality Do you have an invention you think would improve patient care? Here are some tips on how to get started. Conduct Due Diligence. It’s important to research whether there are any similar products in development, and also to decide whether you want to sell your idea to a company or to start your own business. Organizations such as the Small Business Administration can help you with these decisions. Design a Prototype. Ideas are great, but you need to have something tangible to demonstrate how your invention works. MakerNurse can help nurses learn how to sketch and design a prototype and test out their ideas. Seek out Support. MakerNurse has MakerHealth Spaces across the country that provides nurses with direct access to tools, materials, and expertise to build prototypes and test their ideas. Interested hospitals can host a MakerNurse workshop or invest in a MakerHealth program for their hospital. Visit MakerNurse.com to learn more. Additionally, companies like Edison National Medical lend their expertise to help inventors to make their ideas a reality. The company says inventors will never pay more than $25 so it’s low-risk. Consider a Patent. After you’ve developed a prototype for your idea, consider getting a patent to protect your invention. Visit the U.S. Patent and Trademark Office to see patents on ideas similar to yours, and also learn how to patent your idea.
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Monique Rodriguez
travenous (IV) covers for their pediatric patients. Although it worked to prevent patients from accidentally dislodging their IVs, Vallino thought there had to be a b etter way. “Nurses are inventors by nature,” says Vallino. “I looked at
“It was very scary leaving my career as a RN, because of the fear of the unknown,” says Rodriguez. “I also wish that I had a business mentor or someone to talk with in the beginning.” these IV cups we were using to keep our young patients from snagging and pulling out their IV tubing, and it occurred to me that someone should invent a pre-cut IV insertion site cover.” Vallino mentioned the idea to her mother Betty Rozier, and the two worked to design
their own version of an IV site protector. They started with a specimen cup and tweaked the dimensions into a prototype they called “IV House.” “The first feedback we received from nurses was that the device was too big,” says Vallino. “We went back to the drawing board and made a smaller size, as well as providing ventilation so we weren’t providing a warm, dark, and moist environment under the IV House.” She and her mom then worked with a plastics manufacturer to produce the product in bulk. “The first attempt was a disaster,” explains Vallino. “The manufacturer delivered the IV House shipment to the hospital without labels and we also discovered the finished product was full of flaws.” The experience taught Vallino to fully vet and test a prototype with a manufacturer before committing to the
process. While continuing to work as a nurse, Vallino spent her off hours developing her invention. “We started with the UltraDome for pediatric patients, a clear, plastic IV site protector designed to shield, secure, and stabilize the catheter hub and loop of tubing at an IV insertion site,” says Vallino. “Since then, we’ve invented a new and improved UltraDome that is used in hospitals around the world.” Since her first invention, Vallino has gone on to develop 19 other products under the IV House name and to also work with other nurses to develop their inventions. “Several years ago, a nurse friend had an idea for an invention that I bought,” says Vallino. “That idea resulted in the new TLC UltraSplint, featuring an ergonomic design and seethrough openings. We found that with traditional arm boards there were injuries occurring that could be avoided.” Vallino says she still hears from a lot of nurses who have ideas for inventions. Many just want to know if their idea is viable. After signing a nondisclosure agreement, Vallino offers feedback on the ideas, and for those that show promise, she encourages those nurses to find the right buyer. “Our business is concentrating on working to create the most effective and highest quality products available to IV therapy patients,” says Vallino. “In addition to maintaining our current products, I have ideas for an additional five to six inventions I’d like to roll out in the near future.” Linda Childers is a freelance writer based in California.
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How Nurses Can Make Better Financial Decisions BY JEBRA TURNER Few nurses have a solid grounding in personal finance about making decisions about their own financial future. Money management can be overwhelming. But you don’t need to learn the fine points of microeconomics—just the fiscal facts that pack a wallop on your wallet.
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T
he good news is that the economic outlook for most nurses is rosy. Employment prospects are strong, says Donna Cardillo, RN, nurse entrepreneur and inspirational/ motivational speaker. “The job market for nurses is much better. The market is cyclical and always has been. The
last slump lasted about seven years, but that has all changed and many e mployers are now offering sign-up bonuses,” she explains. The bad news? Many nurses still struggle to lead financially empowered lives rather than being slaves to debt or just getting by paycheck to paycheck. Here are nine ways to
make powerful personal and career decisions.
Evaluate an Employer’s Salary and Benefits Package Often nurses decide to a ccept a job offer based only on the hourly wage, without being aware of the entire salary structure and how it can drastically pump up your pay.
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Jon Haws, RN, CCRN, nurse educator and founder of NRSNG, wrote a popular article about how he doubled his first-year earnings as a new nurse. In “How I Made Over $70,000 My First Year as a Nurse (how I learned to game the system),” he recounts his experience as a newly graduated critical care nurse at
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a L evel I Trauma center in Dallas, Texas. According to Haws, that article “is a bit dated and I realize the $70,000 is nothing to a California nurse, but I outline some step-by-step ways to really maximize what you can make right out of school.” Some of his steps included grabbing the pay differential for nights and weekends, getting an automatic raise after six months and a year, and working overtime and bonus shifts. That strategy requires
that you make yourself an expert on your HR department or union contract rules, of course, which may be difficult before you’re hired. Not every employer is transparent
about its pay policies. It’s easy enough to check Payscale.com or Salary.com for comparisons. Also, be sure to consult with a tax professional about the ramifications of higher com-
“The benefits package is something that employees don’t always take into consideration, but it can be significant,” says Launette Woolforde, EdD, DNP, RN-BC, vice president for nursing education and professional development at N orthwell Health in New Hyde Park, New York.
pensation—you want to be ready when the tax bill arrives. “The benefits package is something that employees don’t always take into consideration, but it can be significant,” says Launette Woolforde, EdD, DNP, RN-BC, vice p resident for nursing education and professional development at Northwell Health in New Hyde Park, New York. She encourages nurses to plan for the next step of their education and especially note those related benefits. “Some organizations offer employees some sort of tuition reimbursement plan. When you get a job and get through adapting to your new role as nurse, that’s the time to take advantage of those benefits.” According to Woolforde, some organizations provide employees with a discounted rate or deferred payment options for a number of n ursing schools. “So $500 a credit may be reduced to $400 a credit and the student isn’t invoiced until after the class is over. By then the tuition reimbursement will have kicked in so students don’t suffer out of pocket expenses that disrupt their cashflow,” she says. In addition, many organizations pay a stipend or differential based on a nurse’s educational achievements. “For example, let’s say the s alary is $50,000 a year to start, but if a nurse has a bachelor’s degree, they may add $5,000 a year. If you’re certified they may add even more,” she explains.
Decide on Your Financial Priorities and Make Every Step a Learning Point There may be a sunny employment outlook for nurses, but you still have to earn and
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save to fund your priorities. Not every nurse will have the same financial needs and not every nurse will experience life transitions in the same order. Yet, there are some goals, such as starting a family, buying a house, or early retirement, which many nurses aim to achieve and can—with some work on their inner and outer game. “I made $35,000 or $45,000 my first years in nursing and had to figure out a way to increase income or reduce s pending,” says Brittney Wilson, RN, BSN, nurse influencer at TheNerdyNurse.com. “I opened the door to those possibilities.” Wilson carried
says. “When I came to terms with it and actively decided to monetize my blog, I hung the ‘I’m available to be paid’ shingle directly, and even more offers came in.” As Wilson felt more and more confident that she was providing a valuable service, she increased her ad and consulting rates, and focused her blog on her nursing specialty. “Earning extra income is like walking down a hospital hallway. It’s a journey. You can open each door and look around or keep going down the path. Just keep opening doors until you find the one that is right for you,” she a dvises other nurses. Wilson got so good at earn-
“Earning extra income is like walking down a hospital hallway. It’s a journey. You can open each door and look around or keep going down the path. Just keep opening doors until you find the one that is right for you,” she advises other nurses. $40,000 in student debt that she now believes was avoidable, if she’d lived at home, attended a community college, worked a part-time job, etc. As a young wife and mother, she tried many methods to economize, as she wasn’t emotionally able to work more hours at the bedside. “One example, I tried extreme couponing and was able to take our $600 grocery bill down to $100. I had to figure out a way to get diapers and formula for my baby,” she explains. Wilson started her blog a couple of years later, mainly for personal expression, but she also started getting free products and fees from brands. “People kept offering me money but initially I felt some guilt about it,” she
ing and saving that she and her husband are on-track to pay off their house mortgage in a little over five years. If you’d like to get better at the nuts and bolts of budgeting, bill paying, and tracking various financial accounts, you may want to try apps and p rograms like Mint.com. By corralling everything into one place, you get a better handle on your spending and saving, and can see in charts and graphs how well you’re doing with your finances. There are also minority personal finance experts you can follow for advice from someone who figuratively speaks your language. For example, African American pros include Michelle Singletary, who writes
“The Color of Money,” for The Washington Post and syndicates. Or, if you prefer podcasts, Rich Jones and Marcus Garrett host Paychecks & Balances for Millennials aiming to pay down debt.
Decide When to Make Major Purchases Even if a purchase is appropriate for your life stage, try to minimize your total household overhead. Even well-paid nurses risk fatigue from worry or overwork to manage bills and payments for one-time splurges or ongoing financial commitments. Woolforde encourages nurses to carefully consider whether a major purchase is a sound money investment. “I see this often—the first thing a nurse graduate buys is a flashy, brand new car, as a reward for all that hard work in school. A flashy new car is nice but it’s a rapidly depreciating item as opposed to maybe holding out for a down payment on a new home that appreciates for a good longterm return,” she explains. You might decide that your next major investment will be in your own higher education or specialized training. If so, be sure to take advantage of employer-provided assistance programs before taking out
graduation, but you hesitate to limit your options. Find out how often graduates using that program decide to stay with that employer; usually the figure is high. If your circumstances and goals match theirs, you’re likely safe in taking the same route. So many students lament how little they knew about educational loans that a free interactive game called Payback was created by a financial literacy nonprofit. The makers warn: “College can help you realize your dreams, unless it leaves you with a student loan nightmare.” S tudents navigate an online maze of decisions: What school to a ttend, what major to declare, whether to focus on studies for a higher grade point average (GPA) or social life for more connections, etc. At the end, if a player does decide to borrow educational funds, it’s with eyes wide open.
Choose a Specialty That’s Fulfilling—And Remunerative Whether you’re a new nurse graduate or you’ve been in the field for years, now might be a good time to switch to a specialty or workplace with better long-term prospects for pay and benefits. Cardillo encourages nurses to explore non-traditional
You might decide that your next major investment will be in your own higher education or specialized training. If so, be sure to take advantage of employer-provided assistance programs before taking out large student loans. large student loans. Maybe your current workplace has a tuition reimbursement plan if you’ll commit to working there after
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c areer options and to take risks. “Your next job may not pay as much, but may have many other advantages. When
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Jon Haws, RN, CCRN
Anna Dermenchyan, RN, MSN, CCRN-K
Brittney Wilson, RN, BSN
Launette Woolforde, EdD, DNP, RN-BC
it comes to being a bedside clinical nurse in a hospital, there’s only so much you can make, even with overtime. Some other health care related industries have greater earning potential over the long run even if you have to take a pay cut in the short term,” she says.
Decide to Cut Hours or Leave the Bedside Altogether
see if your state allows for an inactive status license rather than outright letting it lapse. Another life stage when nurses may be tempted to let their license lapse is at retirement, but Cardillo sees downsides to that. “Nurses retire, but after so many years they get bored or financially need to work again because they don’t want a lower standard of living.”
a time but not just for today.” Neustadt believes in “protection first,” which means having enough insurance and the right kind. “Employer-sponsored benefits are a good thing,” she explains, “but not only may company benefits not be portable and go with you, generally those employer-provided benefits are minimum benefits and should be viewed as the base of benefits to build upon. Three areas that normally need attention are disability, additional retirement income, and long-term care.”
Reducing your hours to, say, care for a family can be a difficult choice that depends on many conditions, but it can be the right choice, if done right. “If you opt to get out of the job market for a while, stay in touch with nursing col-
“If you opt to get out of the job market for a while, stay in touch with nursing colleagues through professional associations [and] keep up with credentials and licenses,” advises Cardillo. Cardillo points to a variety of popular nurse settings and roles that pay well, such as, nurse informatics, quality management nurse, c orporate wellness nurse, insurance nurse, or nurse consultant. You may also want to check out DiscoverNursing.com for interactive features that guide you through the process of choosing from scores of specialties. Some under-the-radar titles have surprising rewards, including high demand or ease of entry. You’ll get information on the education, training, and certification required to fill a role, as well as its average salary and employment outlook.
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leagues through professional associations [and] keep up with c redentials and l icenses,” advises Cardillo. “Keep y ourself current, marketable, and connected.” She warns that nurses who let their licenses lapse— accidentally or not—won’t be ready to jump back in when they need to or want to. “Some nurses drop out of the workforce to take care of elderly parents, but then the parents die and they’re left with literally nothing and can’t find a job,” she warns. Cardillo recommends that you first explore opportunities to work at home, which are more common today for nurses. If that’s not possible, check to
Care for Yourself and Your Career Longevity “Nurses are leaders—they advocate for their patients, but they struggle with advocating for themselves,” says Diane Neustadt, director of operations at New York-based Forest Hills Financial Group. Her firm supports the N ational Association of Hispanic Nurses New York chapter, of which Neustadt is an active member. Because of her involvement with the chapter, she’s able to explain the importance of managing one’s own financial life in terms that nurses relate to. “I tell them it’s like being proactive about your own health. Nurses work long, unpredictable hours so self-care is so important: physically, emotionally, and spiritually. I’m a spiritual person and also know the importance of financial well-being—live one day at
Make the Most of Expertise from Family, Friends, and Coworkers Woolforde received informal money mentorship from two unexpected sources who guided her to become financially savvy. The first was her older brother, who went to college when she was in her senior year in high school and was surprised at the expenses beyond tuition that he hadn’t anticipated. “When he came home at his first break he told me frankly, ‘You’re going to have to get scholarship money if you plan on going to college.’ So, we spent countless hours in the library combing through books and catalogs looking for scholarships. That was before everything was avail-
Diane Neustadt
Donna Cardillo, RN
able online.” She was doubtful about her ability to garner scholarship funds—others will have a higher GPA, more financial need, better applications. “At first, I said, ‘there’s no way I’m going to get it’ and he said, ‘you don’t know until you try,’” she explains. After piecing together several small scholarships—$600 here and $2,000 there from various sources— Woolforde was able to fund her freshman year at a commuter college. Good grades allowed her to garner full scholarship funding for the rest of her bachelor’s degree in nursing. Woolforde next got valuable advice from a nurse preceptor who insisted they visit the hospital credit union after one shift. “She helped me open a retirement account and set up direct deposit of part of my paycheck into that account. I was just starting my career, so retirement was the farthest thing from my mind as a 21-yearold,” she says. Try to find a money mentor who understands your situation and connects or r elates to you in that way, advises Woolforde. “My brother understood the home situation and my preceptor maybe recognized me as her younger self—she was an African American female, too.
Everyone who has walked this path, grown in professionalism, grown in a nursing career, it’s our responsibility to share what we’ve learned,” she says.
Make the Most of Your Employer’s Financial Programs Your organization may offer employee benefit education, such as having an HR representative provide short updates at staff meetings, or making a vendor available for one-on-one consultations. Take advantage of these resources if they can help you fill in the financial puzzle pieces of your life. “My family emigrated from Armenia when I was nine years old,” says Anna Dermenchyan, RN, MSN, CCRN-K, s enior clinical quality specialist in the D epartment of Medicine
nior in high school, she learned about financial concepts and became more proactive about managing money. Dermenchyan now actively engages with the University of California system’s excellent financial program for employees and students, which include onsite classes as well as live webinars on financial wellness and retirement. “I’m an early Millennial and we think about work-life balance and living in the moment, and this necessarily doesn’t help us save enough money for the future. We want to earn, spend, travel, and just enjoy life,” she explains. “However, fi nancial health is part of achieving wellness and maximizing potential benefits for the f uture. Just like with Maslow’s hierarchy of needs—personal finance is at the basic level, and everything rests on it.” Most nursing schools don’t include a financial component in the curriculum, so many workplaces fill in the gaps with seminars, consultations, and program “nudges” to encourage fiscal health. “At first, I just put in $100 a month towards retirement; that’s what I could afford after paying loans and family expenses,” says Dermenchyan. “The automatic deduction from
Try to find a money mentor who understands your situation and connects or relates to you in that way, advises Woolforde. at UCLA Health and a PhD student at UCLA School of Nursing. “At the time, my parents didn’t know the language or the culture, and thus we struggled financially as a family.” When she worked at a bank as a se-
each paycheck makes it easier, and some institutions make a matching contribution. In addition, I was advised by a financial consultant that with every salary increase, I should increase my contribution to
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retirement,” and she has continued to ramp up her rate of saving and investing.
Prepare for Retirement Some nurse leaders point to numbers of disengaged older nurses who are forced to continue working because of under-funded retirement plans. They didn’t put aside enough money for the future, and early social security payouts at 64 are too small to support even modest lifestyles. “Nurses are unlike other caring professions—police, firefighters, and teachers—because they don’t earn pensions from municipal government employers,” says Ric Edelman, a #1 New York Times bestselling author of personal finance books such as The Truth About Money and The Truth About Retirement Plans and IRAs. “That puts their financial future in jeopardy.” Edelman is also the founder of Edelman Financial, one of the nation’s largest independent financial planning firms. His firm offers a free financial plan to nurses, waiving its customary fee for the two-meeting process—either in person or via teleconferencing—which results in recommendations for investments, insurance, estate planning, and more. By starting the process t oward financial stability and independence, you can empower yourself as an earner, saver, and investor. It is possible to experience the feeling of security that comes from having your financial life firmly in hand. This moment is the best time to take that first step. Jebra Turner is a freelance health care writer in Portland, Oregon. Visit her at jebra.com.
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The Link Between Cultural Communication, Hospital Safety, and Desired Outcomes BY JAMES Z. DANIELS, MPA, MSc, AND JANICE BONHAM WEST, MEd A clinician sees a Somali patient with a primary complaint of back pain and, following an exam, prescribes a traditional course of western medical action. The patient, however, is reluctant to act on the medical advice because he thinks his back pain is caused by a bad relationship with his parents or guilt over something he did. “It is always good (for clinicians) to have some knowledge about their patient’s culture, to know who they are dealing with,” says Fozia Abrar, MD, of Minneapolis. “It might cost time and money, but you save more money by not getting a misdiagnosis, by improving quality of care.” www.minoritynurse.com
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S
uffering from bacterial gastritis, a Somali woman in Minnesota visits several providers but does not take the medication they prescribe. When met with a smile and a greeting in her native language by Dr. Abrar, the patient complies with the same treatment recommended by the previous providers—Dr. Abrar successfully p ersuaded the patient to fill a prescription
safety, and whether employees take advantage of opportunities as they arise. Organizations that dedicate additional employee resources to patient safety signal to employees that both employee effectiveness and patient safety are high priority. In other words, organizational values and beliefs guide employee commitment to patient and worker satisfaction. According to the Agency
Every cultural group has traditional health beliefs that shape members’ perspectives about wellness. and take the medication because of her k nowledge of the patient’s culture. This situation is not new or unique—medical anthropologist and psychiatrist Arthur K leinman, MD, has spent 30 years championing cultural issues in medicine. He says a great body of evidence shows culture does matter in clinical care. Every cultural group has traditional health beliefs that shape members’ perspectives about wellness. The increasingly diverse, twenty-firstcentury patient population requires clear communication and practitioner awareness of patient health perspectives in order to significantly impact patient satisfaction, safety, compliance, and outcomes.
Organizational Culture, Patient Satisfaction, and Safety Organizational culture informs every worker whether patient satisfaction is a key value. By influencing employee behavior and how employees are treated, culture drives employee effectiveness,
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for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture: 2016 User Comparative Database Report, patient safety improved more at hospitals where they increased employment of staff who reported incidents, compared to hospitals that did not expand the number of employees who reported incidents. At Atrius Health, a Massachusetts ambulatory care provider with 36 locations, staff can report safety events while updating existing electronic health records (EHRs). This
In other words, e mployee accountability shapes workplace and organizational culture. reporting mechanism has increased the number of reported events, and as many as 30% of events reported monthly come in through the EHR tool, according to Ailish Wilkie, patient safety and risk management
director for Atrius Health. In other words, employee a ccountability shapes workplace and organizational culture.
Patient Culture, Provider Culture In addition to the effect workplace culture has on patient satisfaction and employee competency, two additional areas of culture impact health care effectiveness. Both a patient’s cultural background and the provider’s scientific/medical culture inform patient and provider wellness perspectives. If patient compliance with the treatment plan is the goal, providers need to understand the patient’s cultural identity. By the same token, patients need to know that their perspectives are respected. Few health care o bservational studies have reported s ufficient information to support the claim of provider bias, but a 2006 study published in the Journal of General Internal Medicine reported that most internal medicine residents gain cross-cultural skills through informal training, and most stated that delivery of highquality, cross-cultural care was important but were skeptical about the expectation of learning every little detail about all cultures. Barriers to cross-cultural care included lack of time, not knowing enough about the religion or ethnic group of the patient they were caring for, and/or dealing with belief systems which are different than their own. A 2000 study in Social Science and Medicine found that physicians rated m inority patients more negatively than White patients; the study also report-
ed that physicians viewed minorities as non-compliant and more likely to engage in risky health behaviors. Clearly, providers need reliable resources to add to their understanding of the patient’s perspective. A 2017 survey of 111 health care providers revealed where providers currently turn to access cultural training and information, and what types of information providers need when they are unsure/unaware of the patient’s cultural profile and its implications for treatment decisions, patient compliance, and safety outcomes. The survey found that providers want more data on their patients’ use of nontra-
If patient compliance with the treatment plan is the goal, providers need to understand the patient’s cultural identity.
ditional medicine; their faith beliefs; and who the health care decision-makers are.
Diversity and Disparities An increase in racial and ethnic minority health professionals provides greater opportunity for minority patients to see a practitioner who speaks their primary language or is from their own racial or ethnic background. This can improve the quality of communication, patient safety, satisfaction, compliance, and outcomes. In addition to increasing the diversity of practitioners, hospitals are working to improve hiring diversity, employee cultural awareness, and organizational culture.
A serious flaw in the HRET survey was zero data collected on hospital patient national
In 2015, The Health Research & Educational Trust (HRET) commissioned a national survey of hospitals and health systems to quantify the actions they are taking to promote diversity in leadership and governance, and reduce health care d isparities. Data for this project were collected through a national survey mailed to the CEOs of 6,338 U.S. registered hospitals. The response rate was 17.1%, with the sample generally representative of all hospitals. Minorities represent a
show that minorities represent only 14% of hospital board membership, 14% of executive leadership positions, and 15% of first- and mid-level positions. As a sign of progress, though, nearly half of hospitals surveyed had a plan to recruit and retain a diverse workforce matching their patient population. Further, 42% said they implemented a program to find diverse employees in the organization worthy of promotion.
(95%) and first language (94%). But, the percentage of hospitals that correlated the impact
these factors have to the delivery of care was a mere 18%. Remarkably, in 2011 only 20%
origin. The report listed myriad reasons why hospitals might be failing to meaningfully use the
reported 32% of patients in hospitals that responded to the survey, and 37% of the U.S. population, according to other national surveys. In contrast, the HRET survey data
Cultural Data Collection
of hospitals analyzed clinical quality indicators by race and ethnicity to identify patterns, whereas 14% looked at hospital readmissions, and 8% analyzed medical errors.
data, such as fearing potential liability issues after publicly acknowledging disparities in care, concerns about the public relations backlash, and a lack of knowledge in developing
The HRET data show that 98% of hospitals are collecting patient data on race. Additionally, other areas of data collection included ethnicity
An increase in racial and ethnic minority health professionals provides greater opportunity for minority patients to see a practitioner who speaks their primary language or is from their own racial or ethnic background.
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Results of Health Care Provider Cultural Preferences Survey, 2017 80%
73%
70%
71%
69% 63%
61% 60%
48%
50% 40% 30% 20% 10% 0% Institutions Collect Practitioners Want More Prefer Computer-Based Want Data on Patient Cultural Data Cultural Data Training, Resources Use Non-Traditional Medicine
clinical programs that would reduce or eliminate inequalities. Plus, some hospitals noted the lack of a “diversity champion” on their staff to help lead the effort. Hospitals seem to be making
iversity initiatives such as: d allocating adequate resources to ensure cultural competency/diversity initiatives are sustainable; incorporating diversity management into budget planning and implementation
As a sign of progress, though, nearly half of hospitals surveyed had a plan to recruit and retain a diverse workforce matching their patient population. progress in educating staff on diversity, with 80% providing cultural competence training during orientation and 79% offering continuing education opportunities on cultural competency, according to the survey.
What’s Next? Hospitals have begun to include leadership goals designed to reduce care disparities by implementing
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process; increasing hospital board diversity to reflect that of its patient population; board members demonstrating completion of diversity training; developing plans specifically to increase ethnic, racial, and cultural diversity of executive and mid-level management teams; and executive compensation tied to diversity goals. Beyond the C-suite, hospitals are developing diversity
Want Data on Patient Faith Beliefs
plans with initiatives that include diversity goals in hiring manager performance expectations; implementation of programs to identify diverse, talented employees within the organization for promotion; documented plans to recruit and retain a diverse workforce that reflects the organization’s patient population; required employee attendance at diversity training; hospital collaboration with other health care organizations to improve health care workforce training and educational programs in the communities served; and education of all clinical staff during orientation about how to address unique cultural and linguistic factors affecting the care of diverse patients and communities. This increased implementation of appropriate health care and adherence to effective diversity and cultural education programs at every level
Want Data on Who Makes Patient Health Care Decisions
of health care will ultimately result in improved patient satisfaction, compliance, hospital safety, and patient health outcomes. James Z. Daniels, MPA, MSc, is a consultant and writer who lives in Durham, North Carolina, and frequently contributes to Minority Nurse. Janice Bonham West, MEd, is a writer and consultant who lives in Raleigh, North Carolina.
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Emotional Rescue How to Protect Yourself from Stressful Work Experiences
BY MICHELE WOJCIECHOWSKI
The stress of nursing can take quite a toll on nurses emotionally and psychologically. Learn to recognize the signs, what to do, and when to seek help.
A
bbegail Eason, RN, remembers some of the most devastating moments she’s witnessed as a nurse: a teenage girl learning she would never walk again after being shot by a gang member, a mom who
gave birth but then died from a cerebral aneurysm just days later, and a baby who was left in a store’s parking lot and ended up dying. “In these types of situations, it’s almost impossible not to be affected after your shift is
over,” says Eason, a holistic coach at Abbegail Eason, LLC. “Every nurse is susceptible to suffering from emotional distress,” explains Lucia M. Thornton, RN, MSN, AHN-BC, a consultant, educator, and author of Whole Person Caring:
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An Interprofessional Model for Healing and Wellness. Thornton and other sources we interviewed say that while all nurses can be affected emotionally, those in particular specialties may be more apt to experience this kind of is-
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sue. Some of the areas where nurses are especially at risk: emergency departments and trauma, intensive care unit (ICU), hospice, o ncology, pediatrics, HIV clinics, homeless medicine, high-risk pregnancy clinics, palliative care, and neonatal intensive care unit (NICU), among many others. “Anyone who is empathetic and works in a caregiving role—including nurses and certified nursing assistants— are at risk for developing compassion fatigue and increased caregiver stress, which affects emotional health,” explains Karen Whitehead, MS, LMSW, DCC, CCFP, who provides counseling in the greater Atlanta area and at TurningPoint Breast Cancer Rehabilitation. “Nurses who overidentify with patients and blur boundaries, as well as nurses with personal trauma histories, poor social support, isolated working conditions, or a previous history of unmanaged anxiety are at greater risk. Feeling a lack of control about your work environment— including schedule, lack of
triggers the sympathetic nervous system and keeps the body in fight or flight mode. This heightened stress reaction can, over time, lead to compassion fatigue and ongoing emotional distress,” she adds. It can also be especially difficult for nurses because they are on the frontline of patient care, says Carl J. Sheperis, PhD, NCC, CCMHC, MAC, ACS, LPC. “Aside from the o ngoing stressors of variable schedules, budget cuts, and constant technology changes, nurses are faced with a broad range of emotions experienced by patients,” explains Sheperis, a licensed professional counselor as well as the program dean for the College of Social Sciences at the University of Phoenix. “According to the American Nurses Association 2011 Health and Safety Survey, over 56% of participating nurses had experienced some type of threat or verbal abuse from patients. All of these stressors compound and result in high incidences of compassion fatigue and burnout for nurses.”
“Experiencing emotional reactions is human and appropriate,” says Sheperis. “The key is recognizing when the emotional reactions are out of proportion to a situation or when they have a negative impact on you or others around you. Nurses are often good at compartmentalizing emotional reactions, but sometimes the compartments become full, and the emotions spill out.”
recognition, or sense of community—can also contribute to caregiver stress.” “Working in these areas with these types of patients
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Compassion Fatigue, Moral Resilience, and Burnout Mary Bylone, RN, MSM, CNML, president of Leaders Within, LLC, and a for-
mer board member of the American Association of Critical-Care Nurses (AACN) often lectures and writes about the AACN’s healthy work environment standards. Bylone says that while compassion fatigue, m oral resilience, and burnout are terms often used interchangeably because they do have a lot of overlap, they also have some differences. “Burnout is best used to describe a situation in which an individual feels overwhelmed and exhausted. It can be seen when people sacrifice themselves for work or become overwhelmed with the feeling that the work is never done. Compassion fatigue refers to the weariness that develops from caring for individuals when the caregiver feels saddened that they cannot change the situation and give of themselves in the hope of relieving pain or suffering in the patient,” explains Bylone. “Moral resilience refers to the aspect of an individual’s character to rise above situations creating moral distress, such as being asked to provide futile care or care against a patient’s wishes. R esilience comes when the nurse is able to restore and maintain their integrity by challenging or pushing back when asked to do things they do not feel are right. It involves using one’s bold voice to speak up when others would remain silent— to ensure that the morally right thing is done.” For the past decade, the AACN has addressed all these issues. Its National Teaching Institute recently held a special interactive session during which more than 300 nurses spent an afternoon sharing the types of experiences that
would cause these feelings and sharing their solutions with their colleagues as well. “The AACN puts a lot of energy into hope and resilience rather than dwelling on the negative,” says Bylone.
Recognizing the Signs “Experiencing emotional reactions is human and appropriate,” says Sheperis. “The key is recognizing when the emotional reactions are out of proportion to a situation or when they have a negative impact on you or others around you. Nurses are
The first action that nurses can take to keep their emotional health intact is to set boundaries, says Gail Trauco, RN, BSNOCN, a grief mediator, owner of Front Porch Therapy, and author of Conquering Grief from Your Own Front Porch.
often good at compartmentalizing emotional reactions, but sometimes the compartments become full, and the emotions spill out.” Some of the signs that a nurse is experiencing negative effects from emotional overload are: using a greater number of sick days and/ or dreading going to work; feeling exhausted; problems sleeping; using drugs or alcohol to sleep; having workrelated dreams, nightmares, or intrusive thoughts; being angry a lot either at work or home; yelling at patients or families; changes in mood or
behavior at work; crying all the time; feeling angry at supervisors or coworkers; developing fears about the safety of friends or family; feeling less engaged in their personal and/ or professional life; the inability to think clearly; headaches; gastrointestinal problems; irregular breathing patterns, feeling devalued, and losing the capacity to care about themselves, their patients, their family members, or really anyone. This doesn’t even touch on the signs of clinical d epression, which nurses may also e xperience. The point is that if nurses notice vast changes in themselves or
in their coworkers, they may need to seek or suggest help.
Taking Action The first action that nurses can take to keep their emotional health intact is to set boundaries, says Gail Trauco, RN, BSN-OCN, a grief mediator, owner of Front Porch Therapy, and author of Conquering Grief from Your Own Front Porch. Nurses can do small things to make themselves happy. “Be sure you have things that you visually see which create an immediate ‘happy sensation,’” suggests Trauco. “This can be a favorite coffee mug, brightcolored scrubs, flowers on
your desk, or even a funny stethoscope cover.” One of the biggest problems nurses have is that they tend to put everyone else’s care above their own, says Jill Howell, MA, ATR-C, LPC, a
Draw, Collage: Create Your Way to a Less Stressful Life. While she works at Pocono Psychiatric Associates, Howell worked with many nurses at the Pocono Medical Center. “It’s all about self-care—
“It’s all about self-care—nurses will, of course, react by saying that they don’t have time,” says Howell. “Please remember what they say on the airplane—put your oxygen mask on first before you try to help others.”
board-certified registered art therapist, professional counselor, and author of Color,
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nurses will, of course, react by saying that they don’t have time,” says Howell. “Please remember what they say on the airplane—put your oxygen mask on first before you try to help others.” When working with nurses, Howell would check in with them to see how they were dealing with work, give them an opportunity to vent, and make small self-care suggestions. She would also do quick guided meditations with them, teach a relaxation technique, or set up large sheets of mural paper and have them draw out their frustrations. “I have found that most nurses, while they can care for others continuously, have a very difficult time in caring for themselves,” says Thornton. “Self-compassion is an important and useful practice for nurses to develop.” “Nurses are givers. We go into the field because we are caretakers,” says Eason. “Many of us feel we are at our best when taking care of others.” She says that it’s important, though, for nurses to understand that they have to take care of themselves first. “Ensure you are getting
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dequate, quality sleep. You are a eating a well-balanced meal. You are getting adequate exercise. You are spending time cultivating a life that is mean-
the “bad” that occurs in their jobs, the “good” is the most rewarding part of what they do. “Nurses should work together to ensure that they are okay
“Ensure you are getting adequate, quality sleep. You are eating a well-balanced meal. You are getting adequate exercise. You are spending time cultivating a life that is meaningful, rich, and deep outside of work,” says Eason. ingful, rich, and deep outside of work,” says Eason. After a particularly stressful experience at work, Lisa R adesi, DNP, CNS, RN, a cademic dean at the School of N ursing, College of Health Professions, University of Phoenix, says that nurses and other staff should have a d ebriefing session and remember that, despite all of
after an incident. If a nurse notices a coworker is not doing well, they should talk with the coworker and bring it to the attention of the supervisor or manager,” says Radesi. “Above all, nurses should feel comfortable s eeking treatment and communicating about emotional issues they may experience. Keeping this infor-
mation bottled up can lead to issues and stress that have longlasting effects. Know that it is not weakness, but strength, to acknowledge emotional disturbances and respond to them accordingly.” If you see a coworker in distress, you can do something as simple as strike up a conversation with her or him, advises Bylone. “Use open-ended questions to find out how they are doing. Sometimes hearing the other person’s story really puts things into perspective. Let them know you care, and you are there to help, if only to listen. Please do not watch them suffer alone. Left unattended, these feelings only deepen and create lasting impact, often causing them to leave the profession,” she says.
Seeking Professional Help Let’s face it: there are times when a spa day, time out with friends, or a bubble bath just won’t cut it in alleviating
fects of your chosen population at work.” If you need professional help, first see if your workplace has a program for staff members. If not, Sheperis says that the National Board for Certified Counselors has a directory of board-certified counselors across the U nited States (visit nbcc.org for more info). Psychology Today.com also has a therapist d irectory that includes profiles of providers who can help. There’s no shame in s eeking help to get better. Sheperis says, though, that all nurses should do whatever they can to prevent their emotional stress from getting to this level. “Most people only seek p rofessional help after something in their life had caused significant distress. While it is important to seek help if you are reaching a level of burnout or compassion fatigue, it is much better to take proactive steps and to work with a counselor to build
If you see a coworker in distress, you can do something as simple as strike up a conversation with her or him, advises Bylone.
emotional problems. That’s when nurses need to seek professional help. “If you are experiencing distressing symptoms over an extended period of time, it’s a good idea to check in with a professional therapist or counselor,” says Whitehead. “Whether it is distress from work or something related to your life outside of work, connecting with a professional can help you be a more effective caregiver and build your own resilience to mitigate the ef-
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resilience prior to hitting an emotional wall,” he says. Sheperis also suggests that nurses focus on wellness practices at the onset of their careers. “It is easy to become engrained in a high-pressure system and to become emotionally overwhelmed if you don’t have a set of wellness practices in place.”
Michele Wojciechowski is an award-winning writer and author of the humor book Next Time I Move, They’ll Carry Me Out in a Box.
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Adapting to Different Work Cultures BY NUANANONG SEAL, PhD, RN, AND MARY WISKE, RN
Our health care system today has made tremendous progress in providing care to individuals and families. Change is good, but as the health care industry rapidly responds to emerging trends, markets, and opportunities, how staff nurses respond to different kinds of work culture is important, particularly when work culture highly impacts a nurse’s job function.
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W
ork culture is made up of the norms, values, and beliefs that characterize an organization. Several factors, including management, workplace practices, policies and philosophies, e mployees and their interactions, leadership, expectations, rewards or recognitions, communications, transparency, and s upport within an organization, can
Your Work Culture
Work culture, which can make or break a workplace, is powerful. It can inspire health care employees to be more productive and positive at work, or it can make them feel undervalued and frustrated. influence work c ulture. Work culture,which can make or break a workplace, is powerful. It can inspire health care employees to be more produc-
tive and positive at work, or it can make them feel undervalued and frustrated. Thus, it plays a crucial role in shaping behaviors in organizations.
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Ask yourself the following: • What is the culture like in your workplace? • Do staff naturally unite and collaborate? • Are the leadership and executive teams available and transparent? • What values and principles does your organization express? Sometimes, you might say
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“it’s challenging.” Defining work culture can be difficult; nevertheless, it is fundamental to good (or poor) practice. Work culture is not often discussed, but clearly, nurses can be n egatively or positively i nfluenced by their work culture. Work culture in nursing is critical to job satisfaction, nurse retention, and patient outcomes. A toxic work culture
vide quality nursing care. Work culture can impact everything from the safety of patients to job satisfaction. If yours is negative and discouraging, you cannot just wait for it to change. The first thing you must realize is that it might not change at all without you taking some kind of action. Understanding your work culture is key to developing practice that aims to improve
Defining work culture can be difficult; nevertheless, it is fundamental to good (or poor) practice.
can lead to increased sick days, stress-related symptoms, and nurse turnover. It also plays a large role in the ability to pro-
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care. Although a positive work culture is mostly created from the top down, it often happens from the bottom up. Nurses
should not undervalue the power of their work culture. Understanding work culture as a learning environment is related to how nurses choose to engage in their workplace and how the workplace normalizes their involvement in activities and interpersonal relations. Nurses can take inspired action, engage in networks, and initiate work culture change. This is not a simple task, but nurses can utilize their own personal power and create cultural transformation in their workplace. Keep in mind that work culture can—and will— change and evolve over time. The first approach is to define and evaluate your work culture—both what it is now and what it should be in the future. Every workplace has its
own work culture. Most of this is unspoken, but a lot can be learned from an employee handbook or company policy. Observation, assessment, and communication
A toxic work culture can lead to increased sick days, stress-related symptoms, and nurse turnover. It also plays a large role in the ability to provide quality nursing care.
are key a pproaches to help you uncover your work culture. These key approaches can also be utilized by some-
one who has unique developmental and s ocialization needs, such as new graduate nurses, international nurses, student nurses, and nurses who are undergoing role status changes or transitioning to a new area. No matter what your status is, here are five ways to help you thrive in your work culture. • Watch and learn. Give yourself some time to understand the reasons behind workplace behavior and you will be much more successful in understanding the causes. Observe how things are done. Take notes. Keep track. Building relationships with people in your workplace and connecting with someone on your team who has a good understanding of how the workplace culture works can help you better understand and avoid making a mistake.
• Don’t be afraid to ask questions. You don’t need to know everything. Questions are a great way to clear up differences and get to know people. Also, be sure to ask for help whenever you need
background and your career goals. Don’t hesitate to share your ideas and let your team and supervisor know what other skills you have to offer. • Acknowledge your mistakes. Apologize and laugh
Nurses can take inspired action, engage in networks, and initiate work culture change.
these skills. Adapting to a new work culture is an ongoing process. Once you have the skills, you can work more effectively with different groups of people and adjust easily to working in different cultures throughout your career. Nuananong Seal, PhD, RN, is an experienced researcher in health promotion and is the project director of a nonprofit health and wellness program.
it. Asking for assistance or an explanation should not be considered a sign of weakness. • Remain motivated at work. Nurse burnout is real, so it is important to recognize the impacts you make on your patients and workplace every day. Focus on yourself and how you can be a positive influence. • Be transparent. Let your coworkers know about your
it off. Keep your sense of humor and learn from every mistake you make. Developing the skills and ability to understand and communicate effectively with all your coworkers (including your supervisor) is critical to your success in your own career, as well as the success of your organization. These skills are not innate; they require practice, but anyone can develop
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Mary Wiske, RN, is a retired community health nurse.
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LEADING THE WAY IN EDUCATION, RESEARCH AND PRACTICE – LOCALLY AND GLOBALLY MASTER YOUR CAREER PATH The programs at Johns Hopkins School of Nursing open doors for you as a nurse and unlock your potential as a leader. The power of choice defines the very best of career education. No matter which path you choose, our interdisciplinary approach provides you with the tools to address changing health care needs as well as your leadership goals. Choose your path with a degree from the top-ranked Johns Hopkins School of Nursing § Public Health Nursing (MSN and MSN/MPH) § Health Systems Management (MSN and MSN/MBA) § Advanced Practice DNP* § Advanced Practice DNP/PHD § Executive DNP* § Executive DNP/MBA* § PHD § Post-Degree Certificates* *online options available Learn More
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Academic Forum
Implementing a Nutrition and Wellness Education Program to Promote Better Dietary Habits BY KOUGANG ANNE MBE, KALEA VO, BSN, RN, AND CONSTANCE HILL, PhD, RN
Obesity rates are alarmingly high in the United States. Altogether, overweight and obesity rates exceed 70% of the U.S. adult population according to the Centers for Disease Control and Prevention. This figure comes with staggering health care costs, as obesity is known to heighten the risk of several chronic diseases including hypertension, type 2 diabetes, and certain forms of cancer. Obese individuals also experience a decreased quality of life and a higher mortality rate. These negative health consequences are pronounced among minority populations who often have less access to health care along with a higher rate of obesity-related comorbidities.
A
frican Americans are disproportionately affected by obesity. According to the American Heart Association, 77% of African American women and 63% of African American men are overweight or obese. Within African American faith-based communities, health education programs remain limited despite substantial evidence from the literature indicating its advantages. Significant barriers contribute to a low utilization of health promotion programs in African A merican faith-based communities. According to a systematic review in Obesity Reviews, some of these barriers include scheduling conflicts with church activities and keeping the interest of participants. Nonetheless, the same study concludes that health p rograms focused on weight management and weight-related behavior in African American churches can effectively help a ddress the obesity issue.
The NWEP Project The Nutrition and Wellness Education Program (NWEP) was a pilot study led by a team of two student nurses and one faculty to provide health education in the All Nations Church of God in Christ, which is a predominately African American congregation located in North Richmond, California. The program was conducted during the fall of 2016 and consisted of a series of six workshops of about two hours each facilitated by the team of student nurses. The www.minoritynurse.com
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Academic Forum workshops consisted of teaching using PowerPoints and handouts; group activities, such as modifying recipes and building shopping planners; and recipes/ cooking demonstrations. The NWEP aimed to provide the par-
abits among the program’s h participants. The NEWP was an eye-opening experience for the women who participated in the program. They lacked b asic nutrition literacy, such as the five food groups, or the infor-
Within African American faith-based communities, health education programs remain limited despite substantial evidence from the literature indicating its advantages. ticipants with the knowledge, resources, and tools to access and select healthier food options in order to sustain positive nutritional outcomes. This program provided nutrition education regarding the basic food groups, the properties of food items, the benefits of eating certain foods, and hands-on demonstrations of healthier meal preparations. Furthermore, participants learned how to select healthier foods in groceries and restaurants within a limited budget.
The Significance of Nutrition Education Education plays a crucial role in providing disadvantaged communities with the essential resources needed to make better lifestyle choices. Although obesity originates from a complex interplay of genetic, environmental, and behavioral factors, poor dietary habits remain an important contributor to this health issue. Nutrition education is an integral part of reducing excessive body weight since it can increase knowledge about food and cost-effective approaches to eating healthy. In this regard, NWEP aimed to bridge the knowledge gap and stimulate the adoption of healthier dietary
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mation contained on nutrition facts labels. They expressed reactions that ranged from surprise and disbelief to apprehension as they grasped the notion of added salt and sugar in food items. For example, when the workshop facilitators showed the amount of sugar in an eightounce soft drink, one participant exclaimed: “Oh, that is a lot of sugar! I would have never imagined this is the amount of sugar I get from one can of Coke.” Similarly, when the facilitators demonstrated that in certain brands of chips, a single bag could contain more than the recommended daily intake of sodium, their reactions were indicative of the fact that they lacked the basic knowledge to make informed dietary choices. Other fundamental nutrition concepts covered in the program were calories and nutrients in foods. This allowed the participants to differentiate between high-calorie, nutrient-poor foods versus low-calorie, nutrient-rich foods and the benefits of incorporating more of the latter into one’s diet. Moreover, participants had to practice the lessons learned during the workshops. Each participant was invited to ex-
plore strategies that fit their individual needs and circumstances. Most of them agreed that cooking at home allowed for a better control over their food’s quality because fast food contains a higher amount of salt, sugar, and fat. Throughout the workshops, the facilitators presented ideas for improving the nutritional qualities of their foods. These included swapping ingredients, lightening the seasoning, and improving the flavors with alternatives such as herbs and spices instead of butter or cheese. Other suggestions included using weekly meal planning, consuming in-season, fresh fruits and vegetables instead of canned foods, and baking in place of deep frying. Nonetheless, one cannot
They could relate to the content of the lessons since it provided relevant information to improve their diets. These women acknowledged the importance of eating a healthy diet and the potential of this pilot program to help them make a positive impact on their health and that of their families since they were generally the primary grocery shoppers and cooks in the household. During the workshop sessions, they actively engaged in the activities, participated in the discussions, asked questions, and shared their challenges in adopting a healthier diet. This enthusiasm was indicative of the need and importance of health p romotion program in this faith-based community.
Although obesity originates from a complex interplay of genetic, environmental, and behavioral factors, poor dietary habits remain an important contributor to this health issue. ignore that increased knowledge alone is insufficient in achieving behavior and dietary change. In the Annals of Global Health, Himmelfarb and colleagues argued that knowledge is not everything as far as behavior modification is concerned. It is necessary to reinforce the skills of these participants and to provide them with support resources (e.g.,regular dietary counseling) to reach the goal of adopting and sustaining healthier dietary habits.
Observations and Feedback The participants of the NWEP demonstrated a strong interest in the topics covered during the workshops.
The women gave positive feedback overall and reported that they would be interested in staying in the program if it was extended. It was also a good opportunity to address some of their misconceptions about food properties, such as the characteristics of w hole-grain foods. Beyond the learning experience of the NWEP, the participants developed a fellowship and camaraderie. They often stayed on the premises of the church and engaged in long, lively conversations at the end of the sessions. This act of bonding could be used as a support system to sustain the desired lifestyles change.
Academic Forum Lessons Learned and Recommendations for Future Projects The NWEP underscores the challenges and opportunities for implementing health education programs in a faithbased environment. This study highlights the importance of nutrition education because a limited understanding of nutrition and diet also accounts for poor food choices and dietary habits. Improving nutritional literacy is a critical component of health education because it can initiate a behavior modification. The interest the participants displayed during the workshops is a clear indication of the need for health literacy and health promotion programs. Such programs should be implemented over a longer period and should be expanded to provide substantial support and sustain healthy lifestyles such as physical activity, dietary counseling, or health monitoring. Training lay-health educators among church members offers an efficient and inexpensive means to reach a wider audience within the community for a longer duration of time. Despite its success, there were several challenges encountered while running this pilot program. Ongoing com-
grocery gift certificates, may increase participants’ attendance. Using innovative technology such as text message reminders could also boost the attendance rate. Substantial financial
The interest the participants displayed during the workshops is a clear indication of the need for health literacy and health promotion programs.
munication between facilitators and faith-based organizations will help ensure efficient workshop sessions. Also, providing the participants with monetary incentives, such as paying for their transportation or offering
support is equally critical for the success of such programs because the host community may lack basic equipment including a kitchen, a projector, and internet access, to facilitate the program.
The NWEP helped identify strategies to improve health outcomes in underserved communities. Health education in African American faith-based communities holds the potential to improve access to preventive care services. Despite its promise to reach a large number of individuals in underserved populations, health education programs in faith-based communities are limited. The NWEP attempts to address this gap by focusing on nutrition, which is a crucial component of health. Nutrition is a major part of health care and dietary modification is an essential, primary intervention in improving the
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overall health of disadvantaged populations. Kougang Anne Mbe is a student at the Valley Foundation School of Nursing at San José State University. Kalea Vo, BSN, RN, is a new graduate from the Valley Foundation School of Nursing and currently works as a staff nurse in a major hospital in San José. Constance Hill, PhD, RN, is an assistant professor at the Valley Foundation School of Nursing at San José State University.
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NATIONAL & GLOBAL
Degrees of Success
We All Had to Start Somewhere BY MICHELLE TANNER, MSN, RN
Did you ever look back upon your career and reflect on those humble beginnings? As educators, we sometimes forget that it was not easy to aspire to the higher academic goals we have been so fortunate to have attained. When we counsel our students, we must not disregard that they too have many barriers to overcome in their journey to be successful. In retrospect, we can embrace the challenges we must face in the effort to ensure our students’ academic success.
O
ne morning during break, I overheard one of my student’s discussion with her colleague regarding how lucky she was that her children would be cared for over the weekend. This would allow her time needed to study for the final exam. Knowing this student, I
was aware that she was a single parent and working mom, and more importantly, my student was pursuing a future career in nursing no less. It was a revelation that this fortunate incident for her was not expected, but was a gift. I began to ponder how this student would have prepared for the
final if the childcare issues had not been resolved. Upon review, I realized that this student’s grades were not always consistent. During counsel, her excuses for poor grades or incomplete homework assignments were due to illness (whether be it her own or one of her children’s) or because of a busy work schedule, which entailed all shifts conceivable. So, when did she have time to study? Lack of study time was also noticeable in the part-time evening students. I r ecall the blank stares on their faces during a Q&A session in preparation for the day’s lesson. Upon inquiry, the group confessed that they had not prepared for the eve-
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ning’s lecture in their attempt to balance work, family, homework, and study hours. The weekends had been relegated to study time in preparation for the upcoming week’s assignments, albeit incomplete. Add this to childcare, spousal duties, and familial responsibilities and you have one overworked, fatigued, and illprepared nursing student. Many times, as educators we focus on the negative aspects of our students: the fatigue, lack of engagement during lecture or clinical, and the behavioral issues (tardiness, absenteeism, and disputes with colleagues). This can hinder our ability to focus on putting interventions into place to enhance our stu-
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Degrees of Success
As educators, we sometimes forget that it was not easy to aspire to the higher academic goals we have been so fortunate to have attained.
dents’ learning abilities. We might complain about time consumed due to providing an inordinate amount of time with a student that was not responding to intense tutelage. Perhaps we should invest in discussions about the ever-changing policies affecting our curriculum or work hours. Somehow, the drudgery of this negative outlook overshadows a focus on the academic pursuits of those struggling to attain a portion of our accomplishments. We must be sensitive to the vulnerability of this population during their journey. Whether it be in the case of the traditional, the returning, or the recycled adult learner, financial constraints are taxing. Adhering to professional and attendance policies takes effort. Striving to maintain a precarious balancing act to function commendably in multiple roles are all central themes of the adult learner. In acknowledging this, it is incumbent upon us to assist our students in getting past these barriers. I have contemplated methods to assist nursing students, which have resulted in b etter
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outcomes. Some interventions I have put into place have made the difference in my students’ success as evidenced in their test scores. The following interventions are worth noting: • Games: the Millennials love them. Who said learning should be boring? The younger generation thrives off the technological support, which surreptitiously enhances learning. The games can be competitive, informal, and applied individually or after breaking the class into groups. Games are used best when they can be accessed as a resource after classroom sessions as a study tool before testing. • Provide a quick recap at the end of class. Some students may be so attentive during lecture that they do not take notes that were imperative to have as a review for the next test. This is easy to rectify by providing a short review of pertinent facts at the end of the day, paying special attention to the material that will be included on
the test. This quick review gives the learner another chance to process and make note of what the instructor was attempting to stress in the previous lecture(s). This may seem redundant, but we cannot forget that this is all new information for the learner. • Remind the student of your availability. I state
and/or if there is a lack of effective study habits). This session also establishes a rapport between you and the learner, which can be motivational. • Allocate extra time to be available for hours before testing. You would be surprised to see how many students will attend for review after a long, clinical day in anticipation of a test pending the next day. Is it more time consuming? Not nearly as much as counseling them oneon-one would be. These are a few tips I have used to incorporate in teaching my students before I notice a decline in test scores. As I look back on my humble beginnings, I realize that the
Striving to maintain a precarious balancing act to function commendably in multiple roles are all central themes of the adult learner. In acknowledging this, it is incumbent upon us to assist our students in getting past these barriers. my office hours on a weekly basis most emphatically after testing. This publicly reinforces my commitment to their learning needs and hopefully abates their reluctance to seek my instruction. • Review one-on-one over the previous tests taken with students who have scored poorly. Allow the student to reflect, write, and question the material covered in the test(s). Educators have gained insight about their students during these sessions (e.g., what type of learner they are, if there are linguistic barriers,
barriers I encountered are not so different. I am fortunate enough to have had support and encouragement throughout my career as a student and as a practitioner. It is as challenging for both the educator and the learner; diligence is required from all parties. But we are in the trenches together. We all had to start somewhere. Michelle Tanner, MSN, RN, has 40 years of nursing experience, which has been derived from a diverse background. Over the course of her career, she has practiced in the acute care setting, long-term care, and management and presently teaches in New England.
Health Policy
Pursuing a Career in Public Policy: No Longer the Road Less Traveled in Nursing BY JANICE M. PHILLIPS, PhD, FAAN, RN
A nursing career in public policy was considered unique decades ago. However, increasingly nurses have developed the skill and expertise needed to inform the policy-making process through their professional and voluntary endeavors. Nurses now serve in numerous leadership roles where they use their health policy expertise to shape the policy discourse, monitor the impact of legislation, and oversee regulatory processes.
I
n addition to the increased numbers of nurses working in governmental and nongovernmental agencies, nurses serve as elected officials and work as health policy consultants or health
care lobbyists. Regardless of role or setting, nurses working in the policy arena are required to use their public policy acumen to inform legislation, oversee regulations, or advocate for policies that
are of benefit to consumers, patients, and the profession. Nurses serving as elected/ appointed officials or health care lobbyists are immersed in the policy-making process and have a front row seat in
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influencing the public p olicy a genda. Both opportuni ties require a comprehensive knowledge of the complexities associated with lawmaking and a willingness to listen and assess varying perspectives. The ability to communicate well and build partnerships while working with diverse stakeholders cannot be overemphasized. Noteworthy, three nurses are serving as elected officials during the 115th Con-
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Health Policy
gress. Representative Karen Bass, APRN, represents California’s 37th congressional district and is in her fourth term. C ongresswoman Bass serves as a ranking member of the Subcommittee on A frica, Global Health, Global Human Rights, and International Organizations.
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The ability to communicate well and build partnerships while working with diverse stakeholders cannot be overemphasized.
Representative Diane Black, BSN, has represented Tennessee’s sixth congressional
istrict since 2010. She serves d on the House Ways and Means Committee.
Representative Eddie Bernice Johnson, BSN, is the first nurse elected to the U.S. Congress and is now in her thirteenth term representing the 30th congressional district of Texas. Representative Johnson serves on the House Committee on Science, Space and Technology; House Transportation and Infrastructure Committee; the Aviation Subcommittee; the Highways and Transit S ubcommittee; and Water Resources and Environment Subcommittee. Many nurses are familiar with former representative, Lois Capps. Capps represented California’s 24th congressional district after winning the seat in 1998 after her husband died in office. She championed numerous nursing and health care issues and started the Congressional Nursing Caucus. No doubt, other nurses are well poised to follow suit bringing their expertise to an elected office. For example, Lauren Underwood launched her campaign last fall to represent the fourteenth congressional district in Illinois. Underwood brings a wealth of nursing and government expertise and is passionate about ensuring access to high-quality health care for all. Nurses are also well suited to serve as health care lobbyists because of their vast knowledge of nursing, health, and health care. An extensive knowledge of these and other areas is critical to advocating for legislation aimed at improving access to health care, enhancing health outcomes, and transforming our health care delivery system. Additional competencies needed for such a role include strong interpersonal communica-
Health Policy tion skills, research/analytical skills, detail orientation, knowledge of political, legislative, and regulatory processes, and the ability to create and deliver messages to a wide array of diverse stake-
spokesperson providing testimony before my state legislature regarding the “Reducing Breast Cancer Disparities bill.” This bill includes significant provisions designed to reduce breast cancer disparities among
The current push to increase the number of nurses serving on boards provides yet another opportunity for nurses to become more engaged in aspects of the policy-making process. holders including legislative officials. Health lobbyists are responsible for conducting policy analyses and summarizing information that is suitable for a variety of audiences. Nurse lobbyists may work as a consultant employed by a professional/specialty nursing or non-nursing organization, health care facility, insurance company, or p harmaceutical company, to name a few. The current push to increase the number of nurses serving on boards provides yet another opportunity for nurses to become more engaged in aspects of the policy-making process. Depending on the mission of the organization, board members may be responsible for shaping a legislative or advocacy agenda on behalf of the constituents they serve. To illustrate, I acquired some of my health policy skills while serving as the Chair of P ublic Policy for my local Susan G. Komen Affiliate. In this capacity, I along with board members advocated for breast cancer funding for underserved women and helped to s hape and monitor the organization’s legislative agenda. This experience provided a unique opportunity for me to serve as a lead
underserved and underinsured women across the entire state. In addition to some of the previously mentioned career opportunities in the health policy arena, nurses in the following roles utilize their policy knowledge and expertise to advance the nursing profession and transform today’s health care delivery system: • Dean/Associate Dean of a School or College of Nursing • Director of Government and/or Regulatory Affairs • Office of Government Relations • Director/CEO of a Government Agency • CEO or Executive Director of a Nonprofit Health Care Organization • CEO of a Professional Nursing Organization • Chief Nursing Officer • Surgeon General/Assistant Surgeon General • Chair of Health Policy Committee for a Professional or Specialty Organization • Health Commissioner • Board Member for a Health Department, Hospital, or Community-Based Health Care Organization • Chair of a Health Policy Committee for a Voluntary Organization
• Nurse Attorney • Hospital Administrator • Executive Director of a State Board of Nursing • Health Policy Analyst • Nurse Regulator Nurses wishing to pursue a career in health policy can begin by first identifying what is most important to them. Nurses who do not have a background in political science or law may need to invest in professional development through formal/informal education. Taking health policy courses is a good step as such course work provides an overview of the policy-making process and may provide some exposure to in-person or virtual lobbying. Getting involved with the advocacy/legislative arm of
icy fellowships, internships, or other structured immersion activities can go a long way in laying the foundation for future engagement in the policy arena. I cannot overestimate the value of talking with those already in the field. Elected officials, nurse/health care lobbyists, and individuals currently running for office as well as other nurse leaders can provide valuable insights regarding the expectations for this type of role. Attending a state board of nursing m eeting is a nother excellent way to become a cquainted with the regulatory aspects of the policy-making process. Finally, staying abreast of current and emerging issues in health care and nursing provides a critical foundation for future advocacy
Participating in health policy fellowships, internships, or other structured immersion activities can go a long way in laying the foundation for future engagement in the policy arena.
one’s professional or specialty organization is yet another great way to gain exposure and experience related to the policy-making process. Many nursing organizations have a policy agenda and work to ensure that their voices are heard on things of importance to the profession and those they serve. Serving as an intern in a legislative office for an elected official may also provide some beginning exposure to the policy and legislative process. These types of experiences can enhance one’s credibility when launching a career in public policy. Participating in health pol-
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and political activism in the health policy arena. Janice M. Phillips, PhD, FAAN, RN, is an independent consultant residing in the Chicagoland area.
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The Funny Bone COMPILED BY MICHELE WOJCIECHOWSKI
Nursing can be a tough job, but sometimes you just need a good laugh to keep you going. Enjoy the following hilarious stories sent in by your fellow nurses. Have a funny tale to tell? E-mail writer Michele Wojciechowski at MWojoWrites@comcast.net to share!
What a Boob
Oh Sheet!
For many decades, I worked as a surgical nurse. One day I was really hot and decided not to wear my surgical scrub top underneath my warm-up jacket. I snapped up my jacket with only my bra on under it. My first patient of the day was a person with colon cancer. As I prepared to prep the patient’s abdomen for the operation, the surgeon kept complaining. “Hurry up! Hurry up! Come on! Let’s go!” he yelled. After several minutes of ranting from the doctor, I became steaming mad and had enough of his crap. In total frustration, I ripped off my warm-up jacket, forgetting that I had no scrub top underneath. Yep. I exposed myself to the entire surgical team… The surgeon’s mouth dropped open, and his wide eyes fixated on my chest. As my face flushed with embarrassment, I quickly snapped up my surgical jacket—and the whole surgical team screamed with laughter. I worked with this surgeon for many years after this incident. He never once harassed me again. —J.D., RN, BSN, CNOR
One semester, we had a Greek patient who had dementia. She must have decided it would be fun to go around to all the linen carts. She began taking the clean towels off the carts, and throwing them on the floor, each time yelling, “Opa!” We should have seen it coming. She began by throwing the pillows off her bed. Then she went for the linens. —T.N., nursing student
Say What? Years ago, a patient taught me the importance of not just hearing, but listening. I was trying to get a Family History, when I heard the patient state that her mother had died at a “bus stop.” I immediately told her how sorry I was that her mother had been run over by a bus and how tragic this must have been for the family. The patient looked at me with incredulous eyes and confusion and said, “What are you going on about? My mother
drowned in a bathtub after having a stroke!” From then on, I always made sure to listen and not just hear. —J.W., DNP, RN
Oh Poo… When I was teaching a class, we were talking about the side effects of certain gastrointestinal disorders. As expected, we came upon the subject of diarrhea. I speak with my hands a lot, and when I teach, I motion with my hands to act things out. I am also a fan of active learning strategies. While I was teaching about this, I didn’t realize that the door to the classroom had glass around it so that anyone could see you from the hallway. I began acting out what a patient with diarrhea would look like, and I was being quite animated. What I didn’t know was that, at that moment, the president of the college happened to walk by. I didn’t n otice, but he apparently watched me for quite some time, as the students saw him and were laughing.
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He stopped it to see what I was doing, and I explained it. He laughed and commented on my unique teaching style. The president must have found me entertaining, as he later sat in sometimes on a few of the courses I taught. —K.R., RN, PhD Do you have a funny story to share? It can be something that happened to you at work, while in nursing school, while teaching nursing school— practically anywhere, as long as it involves the nursing field. If so, contact Michele Wojciechowski at MWojoWrites@comcast.net. We may use your story in a future issue.
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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.
Index of Advertisers ADVERTISER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE # Azusa Pacific University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Case Western Reserve University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Duquesne University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Indian Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Indiana Wesleyan University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Johns Hopkins University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Springer Publishing Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2 University of California, Davis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 University of Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4 Vanderbilt University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C3
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