Minority Nurse Magazine (Summer 2014) by Springer Publishing Company

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

THE AMERICAN NURSE +

The Benefits of Being Bilingual

DIVERSITY IN FAITH COMMUNITY NURSING SEXUAL ORIENTATION AND GENDER IDENTITY IN NURSING

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Table of Contents

In Every Issue

Cover Story

3 Editor’s Notebook

18 The American Nurse

4 Vital Signs

By Robin Farmer

7 Making Rounds

Filmmaker Carolyn Jones wants the world to know about the

52 Highlights from the Blog

critical roles nurses play during the most vulnerable moments

56 Index of Advertisers

Academic Forum 38 Culturally Competent Care for the South Asian Community By Divya Kulshreshtha, BSN Learn how to tailor your care to the specific needs of each patient you serve in the South Asian community 40 Ethical Considerations of Language Barriers By Elizabeth Gonzalez-Ruiz, RN As patient advocates, nurses must learn to be proactive when non-English speaking patients need help

of life in her latest documentary, The American Nurse: Healing America

Features 8 Sexual Orientation

and Gender Identity in Nursing

By Jebra Turner Many nursing programs have yet to adequately address how to treat LGBT patients, but caring for this population poses some challenges

14 The Benefits of Being Bilingual:

Breaking Down Language Barriers

Second Opinion

By Linda Childers

44 Is Magnet Certification Worth It for Nurses? By Margarette Burnette Find out whether you should consider Magnet status when searching for a new employer

As nurses see more patients with different language needs and cultural sensitivities, it’s more important than ever to consider learning another language

24 Come All Ye Faithful: Degrees of Success 46 Improving Diversity in Graduate Nurse Anesthesia Programs By Wallena Gould, CRNA, EdD, and Martina Steed, CRNA, MS The demand for culturally competent care has brought attention to the need for diverse nurses, particularly in graduate programs

Diversity in Faith Community Nursing

By Pam Chwedyk By integrating spirituality with health in all the diverse settings where people gather to pray, faith community nurses have the power to help eliminate health disparities

30 Going Lean:

The Rise of the Lean Health Care Model

By Julia Quinn-Szcesuil Discover why health care professionals are starting to embrace Toyota’s method and how being lean could help improve the quality of care at your hospital

Minority Nurse | SUMMER 2014

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Portrait of a Nurse

hen you hear the word “nurse,” what’s the first image that pops into your mind? Is it nursing pioneer Florence Nightingale, or does that image seem a bit, well, outdated? Today, the American nurse comes from a melting pot of different backgrounds and ethnicities. Filmmaker Carolyn Jones might argue that there is no correct answer here, as shown in her latest documentary, The American Nurse: Healing America. In the film, which premiered during National Nurses Week, she follows nurses from different specialties across the country and tries to capture the true spirit of nursing. In our cover story, Robin Farmer catches up with Jones as well as several of the nurses she interviewed to give you a behind-the-scenes look at the heart and soul that went into the making of this documentary. As a nurse, your goal should be to provide culturally competent care to each patient under your care. However, sometimes that’s easier said than done. Let’s say you spend more time filling out paperwork or searching for the equipment you need than spending time with your patients. A controversial model called lean (first made popular by Toyota) could help you reverse the time spent doing administrative tasks and increase the quality time you spend caring for your patients. Read Julia Quinn-Szcesuil’s article to find out if the lean method is right for your organization. Or, let’s say you need to treat a patient who doesn’t speak English and the hospital doesn’t have a translator on staff. What’s your next step? Studies have shown that language barriers can put those patients at risk if the proper steps are not taken. Elizabeth Gonzalez-Ruiz describes the ethical dilemma language barriers pose, and Linda Childers presents a convincing case as to why you should consider learning another language (if you haven’t already). Language aside, there are other potential cultural barriers to consider, such as religion or sexual orientation. How does your faith affect the care you provide? And what about your patient’s faith? You may be a devout Christian, but that doesn’t mean you can’t treat a Muslim. Pam Chwedyk gives you the know-how to assist your community in breaking down cultural barriers and lowering health disparities. Treating a patient with respect may seem like Nursing 101, but sometimes that requires stepping outside your comfort zone. Consider how you might react if a patient’s appearance didn’t match the gender checked on the hospital form they filled out. If the scenario played out in your head makes you uncomfortable, you are probably not alone. To learn more, check out Jebra Turner’s article on sexual orientation and gender identity in nursing. She chats with five LGBTQ professionals whose goal is to educate and inform so that we may pave the way to an open, accepting health care environment for all. And isn’t that what being a nurse is all about? — Megan Larkin

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Minority Nurse (ISSN: 1076-7223) is published four times per year by Springer Publishing Company, LLC, New York. Articles and columns published in Minority Nurse represent the viewpoints of the authors and not necessarily those of the editorial staff. The publisher is not responsible for unsolicited manuscripts or other materials. This publication is designed to provide accurate information in regard to its subject matter. It is distributed with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice or other expert assistance is required, the services of a competent professional person should be sought. The publisher does not control and is not responsible for the content of advertising material in this publication, nor for the recruitment or employment practices of the employers placing advertisements herein. Throughout this issue, we use trademarked names. Instead of using a trademark symbol with each occurrence, we state that we are using the names in an editorial fashion to the benefit of the trademark owner, with no intention of infringement of the trademark.

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

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Vital Signs

Longevity Gene May Boost Brain Power Scientists showed that people who have a variant of a longevity gene, called KLOTHO, have improved brain skills such as thinking, learning, and memory, regardless of their age, sex, or whether they have a genetic risk factor for Alzheimer’s disease. Increasing KLOTHO gene levels in mice made them smarter, possibly by increasing the strength of connections between nerve cells in the brain.

“T

his could be a major step toward helping millions around the world who are suffering from Alzheimer’s disease and other dementias,” said Dena Dubal, MD, PhD, an assistant professor of neurology at the University of California, San Francisco (UCSF) and the lead author of the study published in Cell Reports. “If we could boost the brain’s ability to function, we may be able to counter dementias.” As people live longer, the effects of aging on the brain will become a greater health issue. This is especially true for dementias, a collection of brain disorders that can cause memory problems, impaired language skills, and other symptoms. With the number of dementia cases worldwide estimated to double every 20 years from 35.6 million people in 2010 to 65.7 million in 2030 and 115.4 million in 2050, the need for treatments is growing. Klotho is the name of a Greek mythological goddess of fate, “who spins the thread of life.” People who have one copy of a variant, or form, of the KLOTHO gene, called KLVS, tend to live longer and have lower chances of suffering a stroke, whereas people

who have two copies may live shorter lives and have a higher risk of stroke. In this study, the investigators found that people who had one copy of the KL-VS variant performed better on a battery of cognitive tests than subjects who did not have it, regardless of age, sex, or the presence of the apolipoprotein 4 gene, the main genetic risk factor for Alzheimer’s disease. “This study shows the importance of genes that regulate the multiple aging processes involved in the maintenance of cognitive function,” said Suzana Petanceska, PhD, program director in the National Institute on Aging’s Division of Neuroscience. “Understanding the factors that control the levels and activity of KLOTHO across multiple organ systems may open new therapeutic avenues for prevention of agerelated cognitive decline and dementia.” Scientists showed that the longevity gene, KLOTHO, may improve thinking, learning, and memory. The investigators tested a variety of cognitive skills, including learning, memory, and attention. More than 700 subjects, 52 to 85 years old, were tested as part of three studies. None had any sign of dementia. Consistent with previous

Minority Nurse | SUMMER 2014

studies, 20% to 25% of the subjects had one copy of the KL-VS variant and performed better on the tests than those who had no copies. Performance on the tests decreased with age regardless of whether a subject had one or no copies of the KL-VS gene variant. The KLOTHO gene provides the blueprint for a protein made primarily by the cells of the kidney, placenta, small intestine, and prostate. A shortened version of the protein can circulate through the blood system. Blood tests showed that subjects who had one copy of the KL-VS variant also had higher levels of circulating klotho protein. The levels decreased with age, as others have observed. The researchers speculate that the age-related decrease in circulating levels of klotho protein may have caused some of the decline in performance on the cognitive tests. To test this idea, the researchers genetically engineered mice to overproduce klotho protein. The klotho-enhanced mice lived longer and had higher levels of klotho in the blood and in a brain area known as the hippocampus, which controls some types of learning

and memory. Similar to human studies, the klotho-enhanced mice performed better on a variety of learning and memory tests, regardless of age. In one test, the mice remembered the location of a hidden target in a maze better, which allowed them to find it twice as fast as control mice. Learning is thought to strengthen communication between nerve cells in the brain at structures called synapses. In the hippocampus, many synapses use a chemical called glutamate to communicate. Electrical recordings suggested that klotho makes it more likely these synapses will be strengthened during learning and memory. “Overall, our results suggest that klotho may increase cognitive reserve or the brain’s capacity to perform everyday intellectual tasks,” said senior author Lennart Mucke, MD, director of the Gladstone Institute of Neurological Disease in San Francisco and a professor of neurology at UCSF. For more information about dementia, please visit www.nia. nih.gov/health/topics/dementia or www.ninds.nih.gov/disorders/ dementias.

Vital Signs

Study Finds Premature Deaths from Five Leading Causes Due to Modifiable Risks Each year, nearly 900,000 Americans die prematurely from the five leading causes of death—yet 20% to 40% of the deaths from each cause could be prevented, according to a study from the Centers for Disease Control and Prevention (CDC).

he five leading causes of death in the United States are heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries. Together, they accounted for 63% of all US deaths in 2010, with rates for each cause varying greatly from state to state. The report, published in a May 2014 edition of the CDC’s Morbidity and Mortality Weekly Report, analyzed premature deaths (before age 80 years) from each cause for each state from 2008 to 2010. The authors then calculated the number of deaths from each cause that would have been prevented if all states had the same death rate as the states with the lowest rates. The study suggests that, if all states had the lowest death rate observed for each cause, it would be possible to prevent: • 34% of premature deaths from heart diseases, prolonging about 92,000 lives; • 21% of premature cancer deaths, prolonging about 84,500 lives; • 39% of premature deaths from chronic lower respiratory diseases, prolonging about 29,000 lives; • 33% of premature stroke deaths, prolonging about 17,000 lives; and • 39% of premature deaths from unintentional injuries, prolonging about 37,000 lives.

“As a doctor, it is heartbreaking to lose just one patient to a preventable disease or injury—and it is that much more poignant as the director of the nation’s public health agency to know that far more than a hundred thousand deaths each year are preventable,” said Tom Frieden, MD, MPH. “With programs such as the CDC’s Million Hearts initiative, we are working hard to prevent many of these premature deaths.” The numbers of preventable deaths from each cause cannot be added together to get an overall total, the authors note. That’s because prevention of some premature deaths may push people to different causes of death. For example, a person who avoids early death from heart disease still may die prematurely from another preventable cause, such as an unintentional injury. Modifiable risk factors are largely responsible for each of the leading causes of death: • Heart disease risks include tobacco use, high blood pres-

sure, high cholesterol, type 2 diabetes, poor diet, overweight, and lack of physical activity. • Cancer risks include tobacco use, poor diet, lack of physical activity, overweight, sun exposure, certain hormones, alcohol, some viruses and bacteria, ionizing radiation, and certain chemicals and other substances. • Chronic respiratory disease risks include tobacco smoke, second-hand smoke exposure, other indoor air pollutants, outdoor air pollutants, allergens, and exposure to occupational agents. • Stroke risks include high blood pressure, high cholesterol, heart disease, diabetes, overweight, previous stroke, tobacco use, alcohol use, and lack of physical activity. • Unintentional injury risks include lack of seatbelt use, lack of motorcycle helmet use, unsafe consumer products, drug and alcohol use (including prescription drug misuse), exposure to occupational hazards, and unsafe

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home and community environments. Many of these risks are avoidable by making changes in personal behaviors. Others are due to disparities due to the social, demographic, environmental, economic, and geographic attributes of the neighborhoods in which people live and work. The study authors note that if health disparities were eliminated, as called for in Healthy People 2020, all states would be closer to achieving the lowest possible death rates for the leading causes of death. ”We think that this report can help states set goals for preventing premature death from the conditions that account for the majority of deaths in the United States,” said Harold W. Jaffe, MD, the study’s senior author and CDC’s associate director for science. “Achieving these goals could prolong the lives of tens of thousands of Americans.” Southeastern states had the highest number of preventable deaths for each of the five causes. The study authors suggest that states with higher rates can look to states with similar populations, but better outcomes, to see what they are doing differently to address leading causes of death.

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Vital Signs

Vitamin D Deficiency May Be Linked to Aggressive Prostate Cancer Vitamin D deficiency was an indicator of aggressive prostate cancer and spread of the disease in European American and African American men who underwent their first prostate biopsy because of abnormal prostatespecific antigen (PSA) and/or digital rectal examination (DRE) test results, according to a study published in Clinical Cancer Research.

“V

itamin D is a steroid hormone that is known to affect the growth and differentiation of benign and malignant prostate cells in prostate cell lines and in animal models of prostate cancer,” said Adam B. Murphy, MD, MBA, assistant professor in the Department of Urology at the Northwestern University Feinberg School of Medicine in Chicago. “In our study, vitamin D deficiency seemed to be a predictor of aggressive forms of prostate cancer diagnosis in European American and African American men. “The stronger associations in African American men imply that vitamin D deficiency is a bigger contributor to prostate cancer in African American men compared with European American men,” added Murphy. “Vitamin D supplementation may be a relevant strategy for preventing prostate cancer incidence and/or tumor progression in prostate cancer patients.” The most accurate way to measure how much vitamin D we have in our body is to measure levels of 25-hydroxyvitamin D (25-OH D) in our blood. The normal range of 25-OH D is 30 to 80 nanograms per milliliter (ng/ml). In this study, European American and African American men had 3.66 times and 4.89 times increased odds of

having aggressive prostate cancer (Gleason grade of 4+4 or higher), respectively, and 2.42 times and 4.22 times increased odds of having tumor stage T2b or higher, respectively, if their 25-OH D levels were less than 12 ng/ml at the time of prostate biopsy. In addition, African American men had 2.43 times increased odds of being diagnosed with prostate cancer, if their 25-OH D levels were less than 20 ng/ml. Between 2009 and 2013, Murphy and colleagues enrolled 667 men, ages 40 to 79 years, who were undergoing their first prostate biopsy at one of five urology clinics in Chicago following an abnormal PSA or DRE. Serum 25OH D levels were measured at recruitment. Of the study participants, 273 were African American and 275 were European American, and 168 men from each group had a prostate cancer diagnosis from their biopsy. The researchers found that the mean 25-OH D levels were significantly lower among African American men (16.7 ng/ ml) compared with European American men (19.3 ng/ml). The highest 25-OH D level was 71 ng/ml in European American men, while it was only 45 ng/ml in African American men. They categorized the study group into those whose 25OH D levels were less than

Minority Nurse | SUMMER 2014

12 ng/ml, less than 16 ng/ml, less than 20 ng/ml, and less than 30 ng/ml, and found a dose-response relationship between tumor grade and vitamin D level for both European American and African American men, and the association held true even after adjusting for potential confounders including diet, smoking habits, obesity, family history, and calcium intake. The researchers also found an association between lower 25OH D levels and those at high and very high risk for prostate cancer, per National Comprehensive Cancer Network criteria, which take into account prediagnosis PSA levels, tumor stage, and Gleason grade. While no association was found between vitamin D deficiency and prostate cancer diagnosis in European American men, this association was

significant in African American men. Furthermore, the association with disease aggressiveness and cancer spread was stronger for African American men than for European American men. Skin color, which determines cumulative vitamin D levels from exposure to sun, may partly explain the discrepancies observed between European American and African American men, explained Murphy. “We will next evaluate genetic polymorphisms in the pathways of vitamin D metabolism to better understand the risk alleles underlying this association,” said Murphy. “Vitamin D deficiency seems to be important for general wellness and may be involved in the formation or progression of several human cancers. It would be wise to be screened for vitamin D deficiency and treated.”

Making Rounds

July

September

October

15-18

17-20

22-25

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

2014 Education Summit Phoenix Convention Center Phoenix, Arizona E-mail: events@nln.org Website: www.nln.org/summit

National Association of Hispanic Nurses

National League for Nursing

American Psychiatric Nurses Association 28th Annual Conference JW Marriott Indianapolis Indianapolis, Indiana Info: 855-863-2762 Website: www.apna.org

22-25

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

August 6-10

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

24-27 15-17

The American Assembly for Men in Nursing 39th Annual Conference St. Louis Union Station Hotel St. Louis, Missouri E-mail: aamn@aamn.org Website: http://aamn.org/conference.shtml

American Academy of Nursing Annual Conference on Transforming Health, Driving Policy Grand Hyatt Washington Washington, District Of Columbia Info: 202-777-1170 E-mail: conference@aannet.org Website: www.aannet.org/2014

22-25

3-6

National Neonatal Nurses Conference 14th Annual Conference Hyatt Regency New Orleans, Louisiana E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

40th Annual Conference: 40 Years of Transcultural Nursing: Living Our Mission in a Changing World Charleston Marriott Charleston, South Carolina Info: 888-432-5470 E-mail: staff@tcns.org Website: www.tcns.org

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2014 Annual Conference Westin Buckhead Atlanta, Georgia Info: 801-274-1184 E-mail: denise@aanlcp.org Website: www.aanlcp.org

November

16-18

The Transcultural Nursing Society

September

American Association of Nurse Life Care Planners

October

7-9

International Society of Nurses in Genetics 2014 Annual World Congress Doubletree by Hilton Paradise Valley Scottsdale, Arizona Info: 412-344-1414 E-mail: isongHQ@msn.com Website: www.isong.org

14-16

National Organization for Associate Degree Nursing 2014 Annual Conference Hyatt Regency St. Louis at the Arch St. Louis, Missouri Info: 877-966-6236 E-mail: noadn@dancyamc.com Website: www.noadn.org

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Sexual Orientation and Gender Identity in Nursing BY JEBRA TURNER It’s been said that lesbian, gay, bisexual, and transgender (LGBT) nurses form one of the largest minorities within the profession, and yet they are hardly recognized as a subgroup. To date, limited data are available to determine just how many nurses identify as LGBT (or some variation of those letters, such as LGBTQ, in which the “Q” stands for questioning or queer). But according to a 2013 Gallup poll, approximately 3.5% of the US general population identifies as LGBT; so whether or not you identify as LGBT, it’s likely that you will have to treat patients who do at some point during your nursing career. As patient advocates first and foremost, nurses must strive to provide culturally competent care for all, regardless of gender or sexual orientation.

Minority Nurse | SUMMER 2014

GBT nurses and patients alike face a unique set of challenges in the health care system: hostile personnel, lack of insurance, and higher rates of certain disorders, such as substance abuse. Yet both seek to make the health care system more supportive and equitable through changes in policy, education, and advocacy. Their aim: to raise cultural competence of health care professionals and lower the health disparities and barriers to care affecting LGBT individuals, families, and couples. Here are the profiles of five professionals committed to leading the charge for an open and accepting health care environment.

Austin Nation, RN, PHN, MSN PhD Student at University of California – San Francisco (UCSF) Veteran nurse Austin Nation has over 30 years of nursing experience to his credit, including stints in hospital supervision and providing AIDS services, before heading back for a PhD program. His aim is to teach nursing, which he is now undertaking as an adjunct professor at San Francisco State University. He says he’s faced a “triplewhammy” of discrimination— surprising in a city like San Francisco, where he expected more cultural competency around these issues. “I thought this was the gay mecca, with open, liberal thinkers, but that hasn’t been the case,” he says. “I’ve

PhD journey, which is already stressful enough.” Nation wonders why the UCSF system, which dominates the city and cares for a larger LGBT population than any other, is “so provincial when it comes to addressing issues closest to the heart of that community.” “We have beautiful diversity banners, photos of different kinds of people together all getting along, but it isn’t like that,” he says. “In an academic setting, change happens so slow— it’s like turning the Titanic.” Nation takes every opportunity to raise consciousness in class. “I’m trying to provide education in real time as it happens.” For example, if a nurse refers to gay patients in a distant or disrespectful way, he’ll step in: “Hey, that’s us

LGBT nurses and patients alike face a unique set of challenges in the health care system: hostile personnel, lack of insurance, and higher rates of certain disorders, such as substance abuse.

experienced racism, sexism, and homophobia. I’m a black male in nursing. I’ve been blatantly subjected to all this stress while embarking on a

you’re talking about—we’re not those people.” In addition, Nation leads a Men in Nursing group and is spearheading an LGBT Cultural Competency

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for Healthcare Providers workshop that has generated overwhelming interest. One part of the problem, Nation suggests, is that “the health care community tends to be conservative. We come from a paradigm of heterosexuality.” It wasn’t too long ago that homosexuality was considered a psychological aberration, he adds. Nurses are often uncomfortable with the subject of sexuality and reluctant to talk to patients about sexual health, Nation has observed. He suggests that discomfort first crops up during physical assessment class as undergraduates. “We learn about the human sexual reproduction system. Then, during a head-to-toe assessment of a patient, you pull the covers up and look. But what are you looking for?” What happens if a nurse pulls up the gown of a male and sees female sexual organs, say? “That’s a good opportunity to have a conversation about gender variances,” he says. “There have been many people that didn’t accept me,” explains Nation. “I’m the kid from the ghetto who made good. For me, the saving grace is that I’ve had women who’ve taken me under their

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Austin Nation, RN, PHN, MSN

Riikka Salonen, MA

wings. They watched over me and protected me in difficult or sensitive situations. I try to create that same sense of belonging for my students.”

Riikka Salonen, MA Manager, Workforce Equity and Inclusion, Oregon Health & Science University (OHSU) A bi-national native of Finland, Riikka Salonen leads diversity and inclusion strategy efforts at OHSU in Portland, Oregon. “Our intention is to provide an environment of care which is welcoming and inclusive,” she says, “as well as protective of patient and employee rights and benefits. For instance, we’ve had same-sex partner benefits since 1998, and offered transgender health-specific benefits for employees for over a year.” Family inclusion is one topic that OHSU focuses on—and for patients, that means visitation is a given for everyone, including same-sex couples or a child who has two mothers. “Family inclusion also means that if a gay employee wants to put out family photos, they feel they can without there being whispering about it.” OHSU Pride, an employee resource group for LGBTQ employees and allies, was started in 2007 to ensure an inclusive environment. “OHSU Pride has created a significant difference

Mary Bylone, RN, MSM, CNML

in our campus, which has become very LGBTQ-affirming,” says Salonen. LGBTQ education and consciousness-raising at OHSU is an ongoing effort, Salonen notes, starting with new employee orientation. From there, it proceeds on an as-needed basis, depending on a nurse’s specialty. For example, Salonen says, OHSU provides “a specific session for pediatric nurses that focuses on providing care for transgender or gender-nonconforming youth.” Parents worried about a 5-year-old boy who insists he’s a girl, for example, can be referred to TransActive Gender Center (www.TransActiveOnline. org), a national nonprofit with

Emily Pittman Newberry

HealthCare, East Region, and Director, American Association of Critical-Care Nurses National Board of Directors “I’m 58 and didn’t figure out my lesbian orientation until later in life,” says Mary Bylone. “My brother is gay and so is my son. I didn’t come out at first because of the prejudice and abuse my brother experienced. As a manager, I’m now out; [but] as a staff nurse, I wasn’t.” Bylone says her sexual orientation doesn’t totally define her: “It’s part of me, not all of me.” She has noticed that fellow employees and patients gravitate toward her to talk about gay issues. Possibly, she suspects, they do it “be-

Desiray Bailey, MD

“I remember a patient who asked to see me when I was a head nurse,” Bylone recalls. “She didn’t want to see her nurse that day. ‘Why? Is it because he’s a man?’ ‘No, that’s just the problem. He’s no man,’ is what she answered. Unfortunately, the nurse was standing outside the door and heard her cruel complaint.” Bylone adds that managers sometimes treat out nurses differently. “You may be assigned a gay patient when people know you’re gay, misunderstanding that someone’s sexual orientation does not define her or his entire person,” she explains. “I’m a nurse who happens to be lesbian, not a lesbian nurse.”

Emily Pittman Newberry

One part of the problem, Nation suggests, is that “the health care community tends to be conservative. We come from a paradigm of heterosexuality.” It wasn’t too long ago that homosexuality was considered a psychological aberration, he adds.

low-cost services for youth and families. (For those living outside Portland, Skype counseling sessions are an option.)

Mary Bylone, RN, MSM, CNML Regional Vice President, Patient Care Services, Hartford

Minority Nurse | SUMMER 2014

cause I’m an out person in a responsible position. One day, a mother started crying when she told me her son was gay. I was able to comfort her as the mother of a gay son.” Bylone has experienced situations where patients have discriminated against gay nurses.

Trans Woman and Recent Surgical Patient in Portland, Oregon Emily Pittman Newberry says she lived life for 55 years “pretending to be a man,” before embracing her gender identity as woman and transitioning over a period of five years. “People often ask me, ‘When did you decide you were a woman?’ The question should be: ‘When did you acknowledge it to yourself and choose to live openly?’” Every transgender person Newberry has met or read about says they always knew.

Newberry maintains that health care personnel have been universally professional and even kind to her during this process, though she had trouble with her insurance

as gender choices, which is limiting and potentially hazardous. Binary options are also being challenged by popular culture. Facebook now allows users to self-select from

Resources GLMA: Health Professionals Advancing LGBT Equality www.glma.org

“You may be assigned a gay patient when people know you’re gay, misunderstanding that someone’s sexual orientation does not define her or his entire person,” explains Bylone. “I’m a nurse who happens to be lesbian, not a lesbian nurse.”

company. They wouldn’t cover the cost of surgical genderconfirming surgery. She has some advice for nurses, such as not taking it for granted that you know a patient’s gender. “Ask them to self-identify and tell you what gender pronoun they prefer you use in referring to them,” says Newberry, though she understands that “asking is a tender place for a nurse and a transgender person.” “Sometimes I see someone who is clearly struggling with it—getting pronouns wrong, getting uptight [such as the time she asked a clerk to change her gender in the clinic patient record system],” says Newberry. “I want to say, ‘This is new for everybody.’ It’s my job to educate people, be kind and humane even when I feel angry. It’s a dance, and we’re all learning the steps.” Another piece of advice is to not get thrown if a transsexual patient has a health condition that doesn’t match their gender as your records show it. “If you see a prostate problem in a woman, for instance, act like it’s no big deal,” Newberry suggests. Many health care IT systems only offer “male” or “female”

56 gender options, such as “transgender” and “intersex” and “Female to Male/FTM.” There are bound to be many uncertainties and uncomfortable moments for Trans patients and their nurses as we travel this unmarked path. “Do your best to carry on in a professional way,” says Newberry. “Ask yourself: ‘Am I being tender or am I being rational?’ You can be both at all times, of course, but sometimes more on the compassionate side and other times the scientific. Both are a part of every health care professional—you can emphasize one or the other, depending on the situation.”

The world’s largest and oldest association of LGBT health care professionals

Healthy People 2020 www.healthypeople.gov Aims to achieve health equity, eliminate disparities, and improve the health of all groups

Human Rights Campaign: Healthcare Equality Index www.hrc.org/hei A survey used by inpatient and outpatient health care organizations nationwide to strengthen the care they give LGBT patients

Institute of Medicine www.iom.edu Released a report titled, “The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding”

The National LGBT Health Education Center www.lgbthealtheducation.org Provides educational programs, resources, and consultation to health care organizations with the goal of optimizing health care for the LGBT population

Desiray Bailey, MD Hospital Chief of Staff, Central Hospital, Group Health Cooperative, Seattle, WA, and immediate past president of GLMA: Health Professionals Advancing LGBT Equality (formerly known as the Gay and Lesbian Medical Association) “GLMA was a physicianoriented organization originally, but we decided to be more inclusive and include the whole health care team,” says Desiray Bailey. “We work

to provide opportunities to practice openly and more compassionately.”

Nurses are now an active part of the group, as evidenced by GLMA’s annual conference

She has some advice for nurses, such as not taking it for granted that you know a patient’s gender. “Ask them to self-identify and tell you what gender pronoun they prefer you use in referring to them,” says Newberry, though she understands that “asking is a tender place for a nurse and a transgender person.”

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and nursing summit, scheduled for September 10-13, 2014, in Baltimore, Maryland. One of the aims of GLMA is to improve education and awareness of gay and transgender issues among health care personnel. “It’s a very rare nursing program that provides LGBT education,” says Bailey. “We’d like to see it as part of the curriculum for all health professionals—physicians, nurses, physician assistants, and people in behavioral health training.” At Group Health, Bailey has been an advocate for equal treatment of LGBT staff and patients for many years, facilitat-

ton State—we’ve had domestic partnerships for a few years and now marriage equality.” According to Bailey, the Affordable Care Act has benefited the LGBT community. “Insurance plans can’t discriminate based on sexual orientation or gender identity. Legally married couples are still recognized, even if they live in a state that doesn’t recognize their union, and there aren’t lifetime limits for AIDS patients,” she adds. Among the tools available to improve LGBT equality in a health care setting is the Healthcare Equality Index of the Human Rights Cam-

One of the aims of GLMA is to improve education and awareness of gay and transgender issues among health care personnel. “It’s a very rare nursing program that provides LGBT education,” says Bailey.

ing changes in policy, employee benefits, patient and family visitation, consumer rights, and community outreach. Additionally, she advocates for equal treatment so that “any professional in a hospital or medical center who is gay, lesbian, bisexual, or transgender won’t experience discrimination as an employee because they can’t be out, or their organization doesn’t provide benefits that are equitable with straight employees.” In many states where LGBT employees aren’t a protected class, it’s possible to be discriminated against or fired for being gay. Even worse, a few states have “anti-gay laws— where certain sexual acts are illegal—or there aren’t specific protections,” Bailey says. “I’m fortunate to live in Washing-

paign, a civil rights organization. “This is a tool that really changes the atmosphere for employees and patients,” says Bailey. Once a decision has been made to participate, “there’s an organizational will to want to score well. They want to put in place the right policies and training for staff,” she adds. Seeking out legitimate information about LGBT issues is very important “if you want to take care of all your patients,” Bailey says. Jebra Turner is a freelance health and business writer based in Portland, Oregon. She frequently contributes to the Minority Nurse magazine and website. Visit her online at www.jebra.com.

Minority Nurse | SUMMER 2014

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The Benefits of Being Bilingual

Breaking Down Language Barriers

BY LINDA CHILDERS 14

Minority Nurse | SUMMER 2014

Melissa Leung, RN, BSN, still remembers the day she encountered an elderly patient who was resisting her medication. The woman, a native of China, had balked when given her pills and a glass of cold water, and it was noted on her chart that she was “medically noncompliant.” Leung, who is fluent in Mandarin, gently spoke to

“L

ike many Chinese immigrants, she had been taught to drink hot water with meals,” says Leung, who works in the cardiac catheterization lab at Einstein Medical Center in Philadelphia. “In China, some people are taught to boil water before drinking it to remove germs, and others believe that drinking cold water is bad for the stomach.” Leung noted on her patient’s chart that she preferred to take her medications with hot water. As a bilingual nurse, Leung was able not only to communicate with her patient in her native language, but also to provide culturally specific care by being sensitive and responsive to her patient’s cultural beliefs and traditions. As immigration increases, the demand for bilingual and multilingual nurses continues to grow. According to the US Census, between 1980 and 2010, the number of people speaking a language other than English climbed 158%. In addition to English and Spanish, the 2011 Census showed there were six languages spoken at home by at least 1 million people: Chinese (2.9 million); Tagalog (1.6 million); Vietnamese (1.4 million); French (1.3 million); German (1.1 million);

and Korean (1.1 million). Hospitals across the country are seeing more patients with different language needs, cultural sensitivities, and religions. While interpreters are employed by many hospitals, bilingual and multilingual nurses provide another way of bridging the cultural gap. Because factors such as language, unfamiliar customs, and misconceptions about health

the woman in her native language to determine why she was reluctant to take

of his her medicine. grandReyes m o t h e r, and his who was a comcolleagues were munity health nurse in able to take the information Santiago, Chile. gleaned in talking with Latino Five years ago, Reyes re- immigrants and to pilot sevceived a predoctoral scholar- eral programs. The information ship award to study diabetes they gathered was not only self-management in Latino translated into Spanish, but also designed to be culturally sensitive and relevant. Reyes also believes that nursAs immigration increases, the demand for bilingual es can learn about different and multilingual nurses continues to grow. cultures through medical missions and studying abroad. He care can keep foreign residents older adults. Fluent in both recently accompanied a group from seeking medical care, bi- Spanish and English, Reyes of nursing students to Costa lingual nurses can help to ease says that being bilingual al- Rica and plans to take another a patient’s fears and even re- lowed him to hold focus group to Ecuador later this year. duce barriers to clinical pre- groups in Spanish that helped “Traveling to Costa Rica ventative care. staff determine the stressors changed the world view of all There are also professional and barriers that prevented of our students, and even those benefits to learning another the patients from keeping who didn’t speak Spanish relanguage: Some bilingual em- their diabetes under control. turned to the US with a better ployees can earn more than “We learned many of these understanding of the health their single-language col- older adults would simply nod care barriers and challenges leagues. and agree with their health that many immigrants face,” care providers, even if they says Reyes. Providing Culturally didn’t understand the instrucAs a bilingual nurse educaSensitive Care tions they were being given,” tor, Reyes believes his job in Jimmy Andres Reyes, RN, explains Reyes. “For them, it providing culturally sensitive MSN, DNP, AGNP, of Cedar Rap- was simply easier to be cordial, care isn’t to change the beliefs ids, Iowa, the dean of nursing at but as a result, they weren’t of his patients, but rather to Kirkwood Community College, learning the tools and infor- provide them with all of the says he was inspired to become mation needed to manage facts they need to manage a nurse after watching the work their diabetes.” their condition.

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“We have recently started working on a cancer prevention project with Latino and Burmese immigrants,” he explains. “Most of the people we spoke with weren’t aware of the new HPV vaccine that can be given to teens to protect them against the virus that causes cervical cancer and some other forms of cancer. We’re not mandating they vaccinate their kids, but rather providing them with

and the patients just beam when they hear the nurse interacting with them in their native language,” says Reyes. “It not only shows they care; it’s also the first step in building trust.”

Addressing Patients’ Unique Cultural Beliefs and Concerns Shency Varughese, MSN, RN, an immigrant nurse from India, works in the Inpatient Surgical

“We learned many of these older adults would simply nod and agree with their health care providers, even if they didn’t understand the instructions they were being given,” explains Reyes.

the information to make an informed decision.” Reyes is a member of several professional organizations, including the National League for Nursing, the American Academy of Nurse Practitioners, the Gamma Chapter of Sigma Theta Tau International, and the National Association of Hispanic Nurses, to name a few. He encourages nurses to become involved in organizations and associations that can give them a better understanding of the diverse patients they serve, as well as to consider learning a second language to better communicate with their patient population. “We have nurses who are not Latino or Burmese who have picked up on the languages,

Unit at the Cancer Treatment Centers of America, Midwestern Regional Medical Center, in Zion, Illinois. She has found that speaking a familiar language with patients helps earn their trust and respect. “According to the nurse theorist Dr. Madeleine Leininger, nursing care must be customized to fit with the patient’s own cultural values, beliefs, traditions, practices, and lifestyle,” says Varughese. “I was able to put this into practice recently while caring for a patient who had a special request for a specific Indian tea that contained natural immunizers such as ginger and cardamom.” Varughese notes the tea needed to be prepared in a special way and was very important

Minority Nurse | SUMMER 2014

to the patient. Although she acknowledges the act of preparing tea wasn’t earth shattering and could have been performed even with a language barrier, the act allowed her the chance to connect with the patient and provide culturally sensitive care. “Our shared Hindi language allowed me to truly listen and understand his request and respect his needs,” explains Varughese. “I was able to understand how the preparation and drinking of the tea was an important part of this patient’s life.” Varughese says being multilingual has also helped in her nursing career: “My peers know that they can count on me if a patient has a need or request. We have a translation service that our patients use to help communicate anything related to their medical needs; however, I am more than happy to step in and help with all nonmedical patient requests.” Nenette Ebalo, RN, has found that her ability to speak

vice unit manager for the Head and Neck Surgery department at Kaiser Permanente’s Oakland Medical Center. In addition, Ebalo notes that in-person communication allows her to take cues from a patient’s body language that may be lost over the phone. It also allows for easier communication with elderly patients who may be hard of hearing. “As a bilingual nurse, I don’t replace our medical center’s interpreting staff, but I am able to help patients who might prefer an in-person interaction with a nurse,” says Ebalo. “This can be helpful, especially for those who have complex medical conditions and may not understand the medical terminology.” Ebalo remembers a recent case when she encountered an older couple waiting to see a speech pathologist. The wife told Ebalo she was concerned because her husband was suddenly having speech problems, and after speaking

“We have nurses who are not Latino or Burmese who have picked up on the languages, and the patients just beam when they hear the nurse interacting with them in their native language,” says Reyes. “It not only shows they care; it’s also the first step in building trust.” Tagalog provides an extra layer of comfort to the Filipino patients she sees in her job as ser-

with Ebalo in Tagalog, they asked if she could accompany them to their appointment.

After a consultation with the speech pathologist, Ebalo was able to explain to the wife that her husband’s condition was a side effect of the radiation he had been given. “They were very appreciative of my help and returned later that week with Ensaymada, a traditional Filipino sweet bread to thank me,” says Ebalo. In addition to her work at the hospital, Ebalo has worked on several medical missions and has found that her language skills prove beneficial when caring for patients abroad. “I recently accompanied some of our physicians on a medical mission to the Philippines where I worked as a bedside nurse in the recovery

tronic devices—mostly smartphones now—to communicate with the hearing world. Years ago, I was part of the committee that helped bring devices [such as TTY, the flashing door bell, and the bed alarm] to the hospital.” In addition, Moore says that although she is not a certified ASL interpreter, she has had general conversations with deaf patients and their caregivers, which allows them to feel comfortable with a culture they are familiar with. “Having the ability to speak with people in their common language is such a gift,” says Moore. “Years ago, we had a new patient who was deaf, and her interpreter was run-

“Having the ability to speak with people in their common language is such a gift,” says Moore.

room,” says Ebalo. “The doctors were repairing cleft lips and palates, and they relied on me to help them to understand both the language and the culture.”

Breaking Communication Barriers Michelle Moore, BSN, RN, HN-BC, inpatient care manager at the Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Illinois, first learned American Sign Language (ASL) to communicate with her daughter who was born deaf. Since then, Moore has found that knowing ASL has also helped her in her job. “Deaf individuals are unique in that they cannot use a language line to talk with the hearing community,” says Moore. “Deaf people use elec-

ning late. I remember sitting in the lobby waiting with the patient and just carrying on a normal conversation with her. The patient felt comfortable that someone in a strange environment was available and familiar with her language.” Moore notes that every time the patient would return to the hospital, she would ask to see her. “She often shared with me how grateful she was that I was with her on her very first visit and how it allowed her fear to decrease and put her mind at ease,” says Moore.

Becoming a Certified Medical Interpreter While many bilingual nurses help patients in an unofficial capacity, some nurses are taking their translating skills to the next level and becoming

Learning Another Language 1-2-3 Teach Me This free online course helps teach medical Spanish to nurses and other health care professionals, including sample dialogues, medical terminology, and sample interviews. There are flashcards, audio, images, and more to help guide you through scenarios such as taking a patient history, assessing the complaint, explaining procedures, and more. There is even an online self-test. To learn more, visit www.123teachme.com.

Marlee Signs Actress Marlee Matlin has designed a free smartphone app that offers a simple, visual way for people to learn American Sign Language (ASL) at his or her own pace. It starts with the alphabet, and then goes on to common expressions.

Certification If you’re a bilingual or multilingual nurse and are interested in becoming a certified medical interpreter, you should contact the International Medical Interpreters Association. Visit http://imiaweb.org for more information.

certified medical interpreters. Having credentials provides documentation that nurses have the necessary skills required to translate or interpret professionally. Yelena Tuerk, RN, BSN, MS, manager, patient care services, for the Rose D. and Joseph W. Lazinsky Neuroscience Center at Sinai Hospital in Baltimore, was born in Russia and is fluent in both Russian and English. After seeing a large influx of Russian patients at her medical center, Tuerk decided to become a certified medical interpreter in order to assist patients in a more official capacity. Tuerk enrolled in the three-

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day Qualified Bilingual Staff program offered through the Maryland Healthcare Education Institute, which covered many areas including legal requirements, cultural competency, and privacy laws. “The course taught the specific way to translate for nurses to ensure that we provide high quality care,” explains Tuerk. “The training goes beyond just speaking a second language; it also covers how to best convey medical terminology, and how to serve as the voice of the patient to ensure that all of their questions are addressed.” Linda Childers is a freelance writer based in California.

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AMERICAN

THE

A Carolyn Jones Documentary

NURSE

Naomi Cross hugs patient Becky after the joyous and successful delivery of baby Felix.

Minority Nurse | SUMMER 2014

BY ROBIN FARMER Americans possess unwavering faith in registered nurses. Year after year, nurses top the list of most trusted professionals. But ask most people just what nurses do and their answers lack clarity, conviction, and a clear-eyed understanding of nursing’s sundry roles.

he American Nurse: Healing America, a documentary film that premiered during National Nurses Week in May, teaches audiences about the diversity and scope of nursing and the critical roles these warriors of healing play during the most vulnerable moments of life, says awardwinning photojournalist and filmmaker Carolyn Jones. “These nurses will knock your socks off. They were so open and free with sharing their inner thoughts and souls, and I am very grateful, and we are lucky to have it on film,” says Jones, whose high-energy persona was palpable during a phone interview. Two years in the making, the film follows the path of nurses working in hospitals, rural homes, city streets, helicopters, and prisons. The film captures nurses on the front lines of the biggest issues facing America— poverty, aging, war, and justice. “The main thing is to raise the volume on the voices of nurses in this country,” says Jones, whose film follows the lives and work of five nurses who represent a spectrum of the country and its health care system. “They are a treasure chest of unbelievably rich information. They can make our

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hospitals run better; they can make schools run better; they can make our communities richer; and they can make the end of life so much better than it is right now. “I just want to shine that light on nurses and turn up the volume so that they are part of every conversation,” says Jones, who crisscrossed the country to interview more than 100 nurses for The American Nurse: Photographs and Interviews by Carolyn Jones, a coffee-table book published in 2012 that includes the nurses in the documentary. The nurses featured in the film include: Brian McMillion, MSN, MBA-HCM, RN, at the Veterans Health Administra-

Director Carolyn Jones Photo credit: Paul Mobley

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Brian McMillion talks to a recently-wounded soldier at the Landstuhl Regional Medical Center in Germany.

tion San Diego Medical Center; Sister Stephen Bloesl, RN, from the Villa Loretto Nursing Home

of nurses in different practice specialties, debunks common misconceptions about nurses,

“The main thing is to raise the volume on the voices of nurses in this country,” says Jones, whose film follows the lives and work of five nurses who represent a spectrum of the country and its health care system.

in Mount Calvary, Wisconsin; Tonia Faust, RN, CCN/M, from the Louisiana State Penitentiary; Naomi Cross, RN, from The Johns Hopkins Hospital, Baltimore; and Jason Short, BSN, RN, with Appalachian Hospice Care in Kentucky. The film follows the path

and raises questions for society about the challenges of healing America, say the five nurses spotlighted in the film. The featured nurses say they hope the documentary, praised by the White House, The American Journal of Nursing, and national media, educates audiences

Minority Nurse | SUMMER 2014

about their professionalism and the complexity of their roles. For McMillion, coordinator of the Caregiver Support Program and VA clinical services director, the film is an opportunity to rebrand the profession. The documentary counters the unflattering and unrealistic media portrayals such as Nurse Jackie and raises awareness about stereotypes, says the Army vet and former medic who rehabilitates wounded soldiers returning from war. “We still hear ‘male nurse’ rather than just ‘nurse,’” McMillion says, chuckling. “When I was in school, people used to ask, ‘Are you studying to be a male nurse?’ and I would say, ‘Oh, no, I don’t need to study any-

more to be a male; I have pretty much mastered that. I am studying to be a nurse.’” The film will help the public realize that nurses work outside the hospital and toil deep in the community, says McMillion. (His third title is Major McMillion, 144th Minimal Care Detachment Commander.) “We are in the most intimate places, like their homes, and sometimes we are out in tents taking care of homeless people, which is an outreach I participate in every year as the VA clinical services director. I hope we can show people this is a profession that doesn’t require gender and that it has compassion, critical thinking, and technical proficiency requirements.”

McMillion was most impressed that the film crew, which followed him to Germany and a homeless center, was able to “translate the heart and humor of our profession in a masterful way.” One message that Sister Stephen, director of nursing at

book projects with adjusting her attitude. “At one time, I was disillusioned with nursing because at times it is so nonhands-on, especially if you are in an administrative [position] or management. So many hours are devoted to paperwork,” she says. But after talking with

“We still hear ‘male nurse’ rather than just ‘nurse,’” McMillion says, chuckling. “When I was in school, people used to ask, ‘Are you studying to be a male nurse?’ and I would say, ‘Oh, no, I don’t need to study anymore to be a male; I have pretty much mastered that. I am studying to be a nurse.’” Villa Loretto Nursing Home and president of the home’s board of directors, hopes viewers walk away with is that the nursing home industry is working hard to make care residentcentered. She runs a nursing home filled with goats, sheep, llamas, and chickens. It’s a place where the entire nursing staff comes together to sing for a dying resident. “In my small, religious nursing home, we feel we can make the remaining years quality. We can be there with them and the families at the end of their life and offer them whatever comfort we can, whatever love we can, and assurance [that] there is an eternity for them, a beautiful life afterwards. If you look at it from a religious point of view, we are the hands and hearts of Jesus reaching out to these people. That’s what it’s all about for me,” says Sister Stephen, who is also president of Cristo Rey, a respite program for special needs children. Sister Stephen, who has worked at the Villa Loretto Nursing Home since 1965, credited making the film and

many of the nurses featured in the book and attending related events, “I think, ‘Wow, I am really back on board.’ I tell people to really see what a gift they can

plores the work of a nurse inside a prison. Jones says she wanted to understand how a nurse can take care of people who committed horrible crimes. Tonia Faust, hospice program coordinator, has addressed that question numerous times during the 13 years she has worked at Louisiana State Penitentiary in Angola, the country’s largest maximum security facility. Faust, who runs a prison hospice program where inmates serving life sentences care for their fellow inmates as they’re dying, says treating prisoners requires skills, not judgment. “I don’t actively look to see what their crimes are. My first year, I looked in the guys’ jackets to see what they did and sometimes I was shocked,” she recalls. “I thought, ‘I don’t

in their lives. People don’t have the same upbringing as others. “Some people may not have a choice. They have gone through the court system and been sentenced. It’s not my part to judge them or hold it against them. It could be my brother, my father, or me or my children in a prison. I look at them as patients, and my job is not to judge them, but to take care of them as best as I can with the skills I have learned through my education.” One common misconception the public has about nurses is that their role is limited with the doctor making all of the decisions about care, says Naomi Cross, a labor and delivery nurse and the perinatal bereavement coordinator at The Johns Hopkins Hospital in Baltimore, Maryland. In the film, Cross

Jason Short cares for his patient, Jeff, in his home in Appalachia.

be, what a service they can be to whatever area they decide to go in.” The documentary also ex-

need to do this for fear I may not treat them the way I am supposed to.’ Over the years, I realized people make mistakes

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coaches patient Becky, an ovarian cancer survivor, through the cesarean delivery of her son. “I had a patient two days ago who

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Tonia Faust cares for one of her patients in the hospital ward at the Louisiana State Penitentiary.

Faust, who runs a prison hospice program where inmates serving life sentences care for their fellow inmates as they’re dying, says treating prisoners requires skills, not judgment. had a complicated cancer, and we were going to deliver her baby early. I spent four hours preparing her for surgery and coordinated the doctors and other team members, about 15 people that took care of her during her surgery. “I remember I am holding her hand, and we are about to put her under, and I’m telling her everything will be OK. And she said, ‘I didn’t know you were going to come with me. I didn’t know you did all these things.’ She was surprised by the whole view of what nursing does. So many times people have said, ‘I thought the doctor

did that.’ The biggest misconception is how skilled, intelligent, and knowledgeable we are. I get that so much from my patients. They are always surprised . . . by our expertise.” The film provides the audience an honest portrayal of the men and women who spend the most time with patients, says Jason Short, who works for Appalachian Hospice Care. Short provides home care to patients in eastern Kentucky, one of the poorest areas in the nation. The film shows him driving up a creek to reach a home-bound cancer patient in Appalachia.

Minority Nurse | SUMMER 2014

“What I like about [The American Nurse], it captures the journey. It’s almost like nursing has been lost. And I think this was unique because all of us in the film, we are allowed the opportunity to do what nurses do, and that’s just care for people,” says Short, a former auto mechanic who is currently studying to become a nurse practitioner. A nurse since 2007, Short was

like to be helpless” and in need of compassionate care. For Jones, the film, book, and online videos share the inspiring stories of the women and men who have pledged their lives to the care of others. Her desire to elevate and celebrate the nation’s most trusted professionals and their calling also stemmed, in part, from a lifealtering experience with the nurse who administered her chemotherapy for breast cancer back in 2004. The memory left an indelible impression. “The book was an idea brought to me by Fresenius Kabi USA [a global health care company]. This is what I love to do, take pictures and interview people. They wanted to do something to celebrate nurses. I had a nurse who got me through chemotherapy, and she was incredible. Once it was all finished, I never really thanked her properly,” recalls Jones. Over the years, “I thought of her many times. I think you go through an illness like that and you don’t want to turn around and relive it. I thanked her at the time, but not enough, and she never knew how much it meant to me.” So when approached with the idea, Jones embraced it. The book, website, and accompa-

One common misconception the public has about nurses is that their role is limited with the doctor making all of the decisions about care, says Naomi Cross, a labor and delivery nurse and the perinatal bereavement coordinator at The Johns Hopkins Hospital in Baltimore, Maryland. drawn to the field after a terrible motorcycle accident at age 18 and he “found out what it’s

nying online videos were a hit with nurses. Accolades flowed. Yet, Jones felt her mission was

incomplete. “I learned so much doing the book about what role

what nurses do, and so that became my driving passion.

For Jones, the film, book, and online videos share the inspiring stories of the women and men who have pledged their lives to the care of others. nurses serve in society, that I felt I wanted to do something that could really broadly reach the public. Nurses have enjoyed the book greatly; it’s about nurses, and it’s very much for nurses. It was to celebrate nurses. But I didn’t feel like I was really able to cross that threshold into the realm of the public and let the public really see and know

“The other reason is I wasn’t ready to leave this world of nurses.” Robin Farmer covers health, business, and education as a freelance journalist. Based in Virginia, she contributes frequently to Minority Nurse magazine and website. Visit her at www.Robin-

FarmerWrites.com.

A Carolyn Jones Documentary

Sister Stephen helps a resident at the Villa Loretto Nursing Home.

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Come All Ye Faithful Diversity in Faith Community Nursing

BY PAM CHWEDYK

By providing health education and wellness promotion in religious communities of color, minority nurses of all faiths can make a powerful difference in eliminating health disparities.

ot that long ago, nurses who answered a calling to promote physical and spiritual health in their places of worship were known as parish nurses or congregational health nurses. But in today’s unprecedentedly multicultural America, where many of the faithful are just as likely to attend a Muslim mosque or Hindu temple as a church or synagogue, this specialty area of nursing has acquired a

new, more all-embracing name: faith community nursing. “When what we do was first recognized by the American Nurses Association [ANA] as a specialty practice in the late 1990s, it was under the title ‘parish nursing,’” says Nancy Rago Durbin, RN, MS, FCN, interim director for faith community nursing for the Health Ministries Association (HMA), a professional association for faith community nurses (FCNs). But by 2005, when Durbin was

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part of a team working with ANA to update the specialty’s Scope and Standards of Practice, the limitations of that name had become glaringly obvious. “One of the ANA leaders said: ‘Do you have to be Christian to claim this specialty?’” recalls Durbin, who is also director of Advocate Parish Nurse Ministry and the Parish Nurse Support Network for Advocate Health Care in the Chicago area. “When I said, ‘No, this is by no means an exclusive spe-

cialty, any nurse from any faith is welcome to practice,’ she said: ‘Well, your name doesn’t seem to include that.’ And she was right!” Of course, the term “parish nurse” is still alive and well. It’s widely used to denote FCNs who work to improve health in specifically Christian settings. But professional organizations like HMA and the International Parish Nurse Resource Center (IPNRC), a ministry of the Church Health Center, now rec-

ognize that church-based nursing is one thread in a much bigger tapestry that encompasses many different faith traditions. In fact, the Church Health Center, despite its name, teaches FCN training courses to nurses of all faiths all over the world. When and how did traditional parish nursing evolve into this broader, more culturally inclusive specialty? “I’ve always known it to be all-inclusive,” says Maureen Daniels, RN, MN, FCN, an IPNRC faith community nurse specialist. “I think it’s just the organic nature of it that’s helped it grow into more of these other faith settings. One of the things that’s so beneficial about this model is that it’s meant to be adapted to the community and to where the needs are.”

Different Faiths, Same Roles No matter whether the faith they practice is Baptist, Buddhist, or Baha’i, minority nurses need to be involved in addressing the health and wellness concerns of their own faith communities. Even though most FCNs do this work on a volunteer basis while also holding regular nursing jobs, they can make a tremendous difference in improving health outcomes and reducing health disparities in communities of color—especially those that are economically disadvantaged and/or medically underserved. “[Places of worship] can be a very important resource for promoting health, because they reach so many people

on a regular basis,” explains Ann Littleton, a congregational health advocate at Sacred Heart Catholic Church in Greenville,

community nursing services at her mosque, the Islamic Center of Irving, since 2009. It’s a large mosque, serving approximately

No matter whether the faith they practice is Baptist, Buddhist, or Baha’i, minority nurses need to be involved in addressing the health and wellness concerns of their own faith communities. Mississippi, which serves a predominantly African American congregation plus a smaller Hispanic congregation. “At our church, we probably have more people from the community gathered together in one place every weekend than anywhere else. We can pass out information about cancer, heart disease, stroke, and diabetes just like we pass out the Sunday bulletin.” The roles FCNs perform are remarkably similar from faith to faith. The Canadian Association for Parish Nursing Ministry organizes those functions into this easy-to-remember acronym: H – Health advisor E – Educator on health issues A – Advocate and resource person L – Liaison to faith and community resources T – Teacher of volunteers and developer of support groups H – Healer of body, mind, spirit, and community For example, Ameena Hassan, RN, a Muslim nurse who works in the ICU at Las Colinas Medical Center in Irving, Texas, has been providing faith

500 families in the Dallas area. “We do health education classes here every month,” says Hassan, coordinator of the mosque’s Health Advisory Committee. “We do blood pressure screenings and cholesterol screenings. We do mammograms every year, usually in April. During flu season, we do flu shots.” The mosque also holds an annual health fair. At last year’s

event—attended by almost 200 community members—local physicians, nurses, and dentists provided 100 cholesterol and diabetes screenings, 33 bone density screenings, 67 dental exams, and 42 vision exams. In addition, they gave 90 attendees nutrition advice and distributed 100 bicycle safety helmets to children. At New Horizon Church International in Jackson, Mississippi, “cardiovascular disease is the number one health problem among my congregation, so we do lots of CVD screenings, education, and referrals,” says Ella Garner Jackson, RN, CHN, leader of the church’s Health and Wellness Ministry. Jackson and her team also provide a full calendar of other disease prevention programs, including exercise classes, kidney disease screenings, and

Ann Littleton, congregational health advocate for Sacred Heart Catholic Church in Greenville, Mississippi.

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New Horizon Church International, Jackson, Mississippi Pastor: Bishop Ronni Crudup Health Ministry Leader: Ella G. Jackson, RN, CHN

The Health and Wellness Ministry at New Horizon Church International, led by Ella Garner Jackson, RN, CHN (lower left corner), offers many different health promotion activities for congregation members, including screenings, healthy cooking demonstrations, and cancer awareness events.

HIV/AIDS education. On the advocacy front, the ministry helps increase access to health care for low-income church members by connecting them with community resources that provide affordable prescriptions. Because Mississippi has some of the highest levels of poverty and African American health disparities in the nation—including disproportionately high morbidity and mortality rates from cancer, diabetes, and other chronic diseases—Jackson is especially focused on the FCN’s volunteer training role. In 2005, Jackson, who is also a cardiac case manager at Mississippi Baptist Medical Center, founded the Abundant Living Community Organization (ALCO), a nonprofit organization that has taught nearly 160 nurses and non-nurse volunteers to lead health ministries in African American churches throughout the state.

Same Roles, Different Needs How faith community nurses carry out these roles is driven by the unique needs of the communities in which they serve. In some faith settings, for instance, FCNs must tailor their health promotion activities to accommodate specific religious requirements. “In Islam, we don’t mix men and women together in the mosque,” says Hassan. “If we’re doing something like screenings or flu shots, we have to have it in two separate places for men and women. And the women’s space has to be covered, because they don’t want to [expose their bodies] in front of others.” But in many minority faith communities, the biggest challenges for FCNs are more likely to revolve around cultural and socioeconomic needs than belief-based ones. “Here in the Chicago metro area, Advocate’s parish nursing

Minority Nurse | SUMMER 2014

program includes two Latino congregations and two African American congregations,” says Durbin. “Our nurses who work with those communities are very focused on the needs of people who are disenfranchised, undocumented, and struggling with access to care. Some of our nurses are dealing with the problem of food deserts, and they’re trying to work with the communities to create sustainable vegetable gardens and increase access to quality foods.” Littleton, a retired English teacher who became a church health advocate after taking the ALCO training in 2010,

ask about immigration status. If anybody comes to us in need of our services or a referral, we try to make them feel as comfortable with us as possible. It’s important for them to feel that we’re not going to pry into their status; we’re just providing health services that they need.” One of the most empowering ways minority FCNs can lead their faith communities down the path to healthier living is by breaking down cultural barriers that exacerbate health inequities and impede access to care. “In some African American communities, there is still enormous distrust of the health care system,” Durbin notes. “A black faith community nurse can become the entry point for many people to develop that trusting relationship. Someone may say, ‘I went to the public health clinic down the street and they were mean to me. So I’m not going back.’ And the nurse will say, ‘Well, how about if I go with you? Because that’s where you need to be to get your meds refilled.’ Then the nurse can physically take that person back to the clinic and help them [build a better relationship with those providers].” Durbin also notes, “In our Latino communities, men’s health is a big issue. Many of the guys have traditional machismo cultural values, so they don’t take care of their health. And traditionally, it’s

How faith community nurses carry out these roles is driven by the unique needs of the communities in which they serve. emphasizes that “in our Hispanic health ministry, we don’t

the women and the older men who are the churchgoers, but

not the younger guys. Latino faith community nurses who know the culture can figure out creative ways to engage that core group of men, such as providing them with health information through the people who love these men and who do go to church.” Enlisting the aid of lay community health promoters can also help FCNs connect with hard-to-reach populations.

bers to come to health events the nurses had organized than the nurses would have gotten by themselves,” she says.

Bridging Cultural Differences

Earn Specialty Certification in Faith Community Nursing

Even if a nurse doesn’t share the same religious, ethnic, or cultural background as the faith community he or she works with, collaborating with leaders within the community can be an effective way to

It’s been more than six years in the making, but it’s finally here. In August 2014, the ANA’s American Nurses Credentialing Center will launch its first-ever certification program for the specialty of faith community nursing. Developed in partnership with the Health Ministries Association, the new portfolio-based certification is designed to formally recognize the competencies of FCNs practicing across the full spectrum of diverse faith traditions.

One of the most empowering ways minority FCNs can lead their faith communities down the path to healthier living is by breaking down cultural barriers that exacerbate health inequities and impede access to care.

FCNs who meet all of the following eligibility criteria and pass the portfolio assessment can earn the credential Registered Nurse-Board Certified (RN-BC):

Daniels cites the example of a group of parish nurses in Portland, Oregon, who are partnering with local promotores to extend their health ministry outreach deeper into the Hispanic community. “Because the promotores had such good relationships with the people, and people trusted them so much, they were able to get many more community mem-

bridge those gaps. For example, the Faith Community Health Ministry (FCHM) program at Carolinas HealthCare System in Charlotte, North Carolina, uses a model that makes it possible for the hospital system to meet the needs of virtually any belief community. “We form partnerships with faith communities through either a faith community

• Hold a current, active RN license in a state or territory of the United States or the professional, legally recognized equivalent in another country • Have a minimum of 1,000 practice hours in the specialty area of faith community nursing in the past three years • Have completed 30 hours of continuing education in faith community nursing in the past three years • Fulfill two additional professional development categories from this list: academic credits, presentations, publications or research, preceptorship, and professional service For more information, visit www.nursecredentialing.org/FaithCommunityNursing

Congregational health advocate Ann Littleton (right) and other members of her health ministry team at Sacred Heart Catholic Church conduct a diabetes self-management workshop for the local community. www.minoritynurse.com

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nurse or a faith community health promoter,” explains Sheila Robinson, BSN, RN, the program’s health ministry coordinator for Mecklenburg County. “My role is to help each one of those individual communities promote health and wellness within their own particular faith. I provide the clinical guidance and oversight to the nurses and the health promoters.” This approach enables Robinson, an African American Christian nurse, to work with such diverse faith communities as the Hindu Center of Charlotte, a temple that serves about 2,000 families. Her health promoter partner is Chidaabha Vyas, vice president of the Hindu Center’s executive committee. When they first teamed up in 2012, one of their key projects was to survey the temple’s members about their most important health concerns and then develop programs targeted to those needs. “Heart disease, allergies, and weight loss were some of the top concerns the community identified for us,” Vyas says.

Being able to work side by side with a community liaison like Vyas makes it easier for both Robinson and Carolinas HealthCare System to serve the local Hindu community in culturally sensitive ways. “When we formed the partnership, I told Chidaabha, ‘I’m of Christian faith, so you will have to help me to be able to meet the needs at the Hindu Center,’” Robinson says. One cultural lesson she learned early on is that some members of this community may be uncomfortable with the idea of placing a terminally ill family member in hospice care. “Again, this is more of an Indian cultural issue than a religious one,” Vyas stresses. “Some of us do not believe in speeding up the process of death. We believe death will come when it will come. Having a connection between our temple and the hospital system through the FCHM program is very helpful, because we can let them know that when an Indian family is resisting hospice it’s because there is a real cultural dynamic going on.”

Praying isn’t enough to make America’s health disparities crisis go away. But by educating, advocating, and integrating spirituality with health in all the diverse settings where people gather together to pray, faith community nurses have the power to bring about real change. “Diabetes is a very big concern. And it’s not specifically the Hindu community that’s so affected by this disease,” she points out. “It’s [Asian] Indian people in general. Diabetes is more of a concern for us as a race, I would say.”

A Higher Power Praying isn’t enough to make America’s health disparities crisis go away. But by educating, advocating, and integrating spirituality with health in all the diverse settings where people gather to-

Minority Nurse | SUMMER 2014

Congregational health advocate Ann Littleton (left) and other members of her health ministry team at Sacred Heart Catholic Church at work in the vegetable garden they planted to increase the community’s access to healthy foods.

gether to pray, faith community nurses have the power to bring about real change. “Because of our partnership with Sheila and the FCHM, something is happening at the Hindu Center now that was never happening before,” Vyas reports. “It has helped us develop a culture that prioritizes health. Before, health was thought of as more of an individual responsibility. But now, we’re beginning to develop a connection with our members based on the idea that ‘you are responsible for your own health, but the temple is here to help you be responsible for your health.’” Jackson adds: “My pastor

has told me, ‘I know that you’ve saved some lives in this congregation. I know that I am a healthier person myself because of all the education you’ve provided in the church.’ I can look out into the pews and show you people who were not going to the doctor, who weren’t taking their medicine, and who are now routinely seeing a physician. That’s at the heart of what a faith community nurse can do.” Pam Chwedyk is a freelance health care writer based in Chicago. She is a former editor of Minority Nurse.

Dedicated to Diversity

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

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Going

Le n

The Rise of the Lean Health Care Model

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BY JULIA QUINN-SZCESUIL When a new kind of health care model burst onto the scene more than two decades ago promising techniques that gave better patient care, created less work for nurses and physicians, and saved organizations money, the reaction was decidedly lukewarm. The promises sounded great, but the origins of what we now know as lean production principles were based on factory work with cars, not the decidedly different work of caring for human beings.

ased on Toyota Motor Corporation’s streamlined production approach (coined the Toyota Production System), hospital workers found the idea of implementing manufacturing principles into a hospital setting jarring. Building cars isn’t the same as caring for a complex human being, but the end goal is the same—a customer-driven, high-quality end result with as little waste of money and resources as possible. Lean proponents say each organization has to run efficiently and precisely because the satisfaction and safety of customers is the priority.

“One of the biggest hurdles is the recognition that lean isn’t a method for building cars, but for building a better management system and process improvement methodology,” says lean expert Mark Graban, author of The Executive Guide to Healthcare Kaizen: Leadership for a Continuously Learning and Improving Organization and author of LeanBlog.org. “It’s an improvement of quality, better workplaces, reducing wait time and cost,” says Graban. “It seems like common sense, but health care organizations are complex.” Lean is not a Band-Aid fix for a larger problem. “Lean

gets people engaged in fixing the end-to-end patient flow,” says Graban of the hospitalbased lean practices. “For an emergency department visit, that is from the time someone calls 911 to the time they are sent home.”

How Does Lean Go from Cars to People? Also known as “kaizen,” the process of lean is a customerfocused production process centered on constantly improving the start-to-finish (or end-to-end) flow of production. Whether it’s a patient or someone buying a car, consumer satisfaction with the end product is the goal.

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“There’s lots of pressure on health care to reduce costs,” says Graban. But there’s always the worry that reducing costs results in substandard patient care and lost health care jobs. Although lean has been around in health care since the Virginia Mason Medical Center in Seattle officially implemented lean programs in 2002, it is not industry-wide because, quite simply, it’s a lot of work. Charleen Tachibana, RN, is senior vice president, chief nursing officer, and hospital administrator for Virginia Mason Medical Center, the first health care facility in the country to adopt lean practices

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and now one the leaders in training professionals in the lean process. In 2001, the organization began compiling a new strategic plan and investigating other effective management systems. When they could find nothing satisfactory in a health care setting, they turned to a totally different industry, car manufacturing, which had made news for its revolutionary process, to see if any of their industry practices could be applied to hospitals, says Tachibana. After a year of investigation,

were in the middle,” Tachibana recalls. Wanting to take a waitand-see approach, the staff was willing, but hesitant. “Part of the work wasn’t the tools and production methods, it was how do you handle change,” says Tachibana.

What Is Lean? Sometimes, it’s just hard to understand something when you know nothing about it. Lean is simply an improvement method that aims to minimize waste and maximize value. Health care organiza-

they implemented a “House of Lean” model) quickly realized the methods could transfer easily to a health care setting. But lean isn’t about making everything faster with fewer people to do more work. Lean is about efficiency and quality, say proponents. For a health care consumer, that means a better health care experience in less time and with less waste. For nurses, lean means a more efficient work process, so they can get more done in less time so they have more time to spend with patients. And that’s where most nurses are happy with lean—they reconnect with patients and remember the very reason most of them got into health care in the first place.

Why Turn to Lean? Virginia Mason announced the changes to the staff’s uncertain reception. “The vast majority

tions like Virginia Mason and Beth Israel Deaconess Medical Center in Boston (where

Minority Nurse | SUMMER 2014

Alice Lee, vice president of business transformation at Beth Israel Deaconess Medical Center, first learned about lean

principles when she was approached to look at the organization’s business processes with fresh eyes. While researching practices in other industries, Lee discovered lean principles appealed to her business sense. “Back then, lean got little to no attention,” says Lee. “People in health care were not thinking in the same ways as those in industry.” After visiting manufacturing facilities, Lee says it soon became clear to her how the endto-end flow approach suited a hospital. Applying the tactics to Beth Israel would lead to an environment that was less burdensome for nurses especially and that would understand and remedy those existing burdens. “Lean is very, very, very customer-focused, “ says Graban. “But it also helps people in health care rediscover their sense of purpose. Lean as an approach is very respectful of people doing work.” Tachibana says Virginia Mason had direct goals in mind. “Our goal was to get nurses in with patients and to increase patient time,” says Tachibana. “What is adding value in what we do and what is not adding value?” At Virginia Mason, the changes were incremental, so they were both easier to adopt and easier to adjust to. “We started on one floor or with one shift until we had it where we wanted it,” explains Tachibana. “Then you can think of ‘how do you spread this.’ There was a series of changes that fed to a higher goal.”

What Is Lean Like in Real Use? What does a lean process look like? At Virginia Mason, lean means a Patient Safety

Charleen Tachibana, RN

Alert System allows any employee to “stop the line,” or make a report and cease any activity, if they ever see something that is likely to harm a patient. In another organization, IV trays were cluttered with several tools that were never used. By redesigning and streamlining the trays, staff found them easier and faster to use. At Virginia Mason, Tachiba-

na says staff-designed changes made for a better process and invested the staff in the outcomes. They were given a week at what’s called a Rapid Process Improvement Workshop, to redesign a process. Once implemented, improvements were measured at regular intervals. Moving some essential supplies to patient rooms gave nurses more time with patients. Changing a sign-off procedure to be in the patient’s room with the patient’s input not only reduced hand-off times by two-thirds, but also engaged the patient and the family in a way that was immensely more satisfying to them. When an organization adapts to lean models, innovation is encouraged, but it’s also standardized. So while another organization might welcome innovation and suggestions, staff don’t always have the resources or author-

ity to implement the suggestions or track follow-up with measurements. “The production system provides structure and methods,” says Tachibana. “It has an interesting impact in that it lib-

the opposite is true. Instead of working harder, he says, lean principles encourage working smarter. Alexandra Zaremba, RN, manager of the short-stay surgical unit at Virginia Mason,

For nurses, lean means a more efficient work process, so they can get more done in less time so they have more time to spend with patients.

erates the culture. People can get more innovative.” So while some improvement processes might focus on one problem, lean principles discover how to provide the right support and resources every step of the way. And while some might say lean only aims to treat more patients in the same amount of time and thereby creates more work and more pressure, Graban says

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and Rowena Ponischil, RN, MSN, director of the cardiac telemetry unit at Virginia Mason, have both seen the transition to lean over the past decade. “This took a lot of growing pains, and it didn’t happen overnight,” says Ponischil. But the changes made the nurses feel supported by the leadership, says Zaremba. “It gave a voice to the nursing staff,” she says. “And then

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they felt empowered and supported.” Eventually, Zaremba noticed something different when new charting procedures required her to do the chart in the patient’s room, not at the end of her shift. “I was interacting more with patients,” she says. “I was talking to them and meeting them on an emotional level.” Chikodiri Gibson, RN, MSN, MBA, DNPs, APN, CNS (Adult

Gibson recalls one change that involved rearranging the nurses’ stations. Nurses couldn’t find what they needed and patients were being delayed when they were ready to leave the hospital because it took so much time to find anything, she says. “We started one unit at a time, and everything is labeled and nice and clean and neat,” she explains. “Nurses are happier, patients are happier, and now nurses

culture where everyone in the organization makes a change. Engaging everybody, even patients, to fix the smaller problems not only highlights problems that might have been overlooked, but also makes everyone involved and invested in its outcome. “Whenever we do design work of process, space, or roles, we bring patients in to participate on the design team, and they always teach us some-

experience giving birth at the facility. Toussaint, who agreed that a poor information flow was at the root of the problem, invited the woman to a week-long improvement event to see what changes a team of staff, physicians, patients, and nurses could make to the process that encompasses the time from a baby’s birth to the time he or she visits the doctor for the first visit. “Our process involved 140

Acute Care), and senior associate director of behavioral health at HHC Kings County

have more time to spend with patients,” says Gibson. “We moved it to every unit now,

thing,” says Lee. “This has really been a wonderful way to convey to patients that we are trying to make this better.” Ponischil agrees. “We want to create a product that is good for the patient, not what we think is good for the patient,” she says. John Toussaint, CEO of ThedaCare Center for Healthcare Value and author of On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry and Potent Medicine: The Collaborative Cure for Healthcare, recalls the overhaul brought about by one patient’s letter. An obstetric patent wrote Toussaint a critical letter about her bad

steps, and we reduced it to 70 steps,” says Toussaint. “We ran experiments to see if the doctor would get all the information needed, and we were 100% reliable every time. We started at 40% reliable. It was a dramatic improvement.” The diverse group, some of whom were cynical about lean methods, were focused around one thing and that created a better experience for the patient, says Toussaint. Giving the reasons for change also helps. “You have to get that down to an individual person who asks, ‘Why should I change,’” says Tachibana. “The greatest gift of this is that people are engaged in improving

No matter how great a project is, the magic of implementing lean is creating a culture where everyone in the organization makes a change.

Hospital in New York, says even the most minor change can reap huge benefits. Having never experienced lean models before coming to Kings County Hospital, Gibson says the ideas were new to her, but the process of identifying a problem and understanding the real root causes made sense to her.

and no matter what nurses’ station you go to in the hospital, it all looks the same and you can find what you need.”

Involving More than Managers No matter how great a project is, the magic of implementing lean is creating a

Minority Nurse | SUMMER 2014

their own work. They know what works and what doesn’t.” “It’s not uncommon for a department to provide 25% more care without adding equipment or people,” Graban says. “You can take care of more patients in a shorter time without shortchanging the care. Patients are happier, but they are safer, too.” That could mean redesigned space that allows fewer steps or fewer trips to get equipment or even paperwork that is designed to reduce duplication and enhance accuracy.

Convincing People to Go Lean Is Tough Why do people resist lean? In busy hospitals and health care organizations, learning something new eats up time that no one has to give. Even nurses in the thick of the lean process say the work can seem counter-intuitive. When you have done something one way for so long, it is a struggle to change. Talk of being more efficient inevitably leads to concerns of reducing staff. “People do get nervous,” says Graban. “Sadly, the traditional way hospitals cut costs is by laying off people. Lean is one of the best alternatives to layoffs.”

How Do You Keep Lean Going? Lean doesn’t work without commitment and dedication to a long-reaching goal. Because hospital staff changes frequently, organizations are constantly acclimating new people to the lean culture. “When CEOs and managers behave in this style, it reinforces that ‘this is the way we do things here,’” says Graban. “It has to be reinforced in a lot

of ways that this is the new normal.” Beth Israel’s hiring approach begins right from the first encounter, such as an online assessment, and Lee says that is what makes lean challenging. “How do we hire people with the mindset of those who are able to work in a lean environment?” she asks. “We have 2,000 new people come in every year. That means we have 2,000 opportunities to get it right or get it wrong.”

prove the current condition. If you don’t, you resort back to chaos.” When lean practices become part of the new culture, Graban says the results are tangible and intangible. “I think the most exciting things are the moments when

A Lean Future?

you see pride on the people in the health care field,” says Graban. “To see them get reenergized about the work they are doing and why they got into health care.” Zaremba says the changes have made her unit tight. “It’s the teamwork approach,” she

What is the future of lean? Graban points out that with any manufacturing process, change happens in fits and starts over the course of decades, not months. An initial wave of interest spurs others to dabble in the process, says Graban, and of that group, some will embrace it and others will give up on it. When an organization has success, other groups will take a fresh look at the process and learn from the deeper understanding the other organizations gained from experience. Lee doesn’t pretend that lean is simplistic or quick. “We are 10 years in,” says Lee. “This work is hard, and initially there is a lot of resistance. It’s uncommon to find a hospital not doing something with lean now. Who is going to stay the course? And who will stay the course when the course gets tough? It takes daily perseverance.” Lee says keeping an eye to the future and on the end goal helps staff persevere as the health care climate evolves and changes with time. “This takes a constancy of purpose,” says Lee. “You have to believe there is no option but to im-

says. “We are responsible for each other, and we have the spirit of one team.” And Toussaint says the measurable results are inevitable if you follow lean principles correctly. “If you do it right, three things will happen,” he explains. “Staff

“Sadly, the traditional way hospitals cut costs is by laying off people. Lean is one of the best alternatives to layoffs.” morale improves, quality of care process improves, and costs go down. People recognize that this is a way to fix the system.” Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.

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The Take Pride Campaign The country is changing, with one-third of the population representing a historical “minority.” In this increasingly diverse world, you can confidently say your workplace actively fosters diversity, inclusiveness, and cooperation. For these reasons and others, you’re proud to be a part of it—and we want to hear from you. Minority Nurse is looking for nominations for health care’s diversity MVPs, from the magnet hospitals to nursing schools to local hospice care centers. Nurses can nominate their workplaces based on the facility’s efforts to improve and maintain inclusiveness and diversity. Think about what makes for a diverse institution. What does a “commitment to diversity” mean? And what does it mean to you? At Minority Nurse, it’s not just about a visible variety of skin tones seen in the halls. It’s . . . • Faculty and staff recruitment and retention efforts aimed at underrepresented populations • Collaborative hiring practices • Diversity initiatives and accessible organizations on site • Cultural competency training and resources, such as diverse foods, translators, etc. • Partnerships with other diversity organizations • And so much more When hiring groups devoted to minority recruitment and retention not only exist, but are consistently used, it shows a commitment to diversity. When hospital administrators take the time to include their nursing staff in development, they exhibit a commitment to diversity. And you, in taking the time to recognize your workplace for its commendable practices and diverse work environment, are showing a commitment to diversity as well. It’s not necessarily a numbers game—we don’t require applicants to produce statistics or quotas, though you are welcome to do so if you wish. We’re simply looking for readers who take pride in their workplaces’ commitment to diversity. A PDF of the Take Pride Campaign application is also available on our website, www.minoritynurse.com. Applications must be received before July 1, 2015. We will then reach out to our nominees to determine our winners! Questions? Let us know by e-mailing editor@minoritynurse.com.

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2015 Take Pride Campaign Application Application Form (Please print clearly. All fields required. The 250–500-word nomination can be attached separately.)

Your name __________________________________________________________________________________________ Your place of employment (must be a health care facility or institution employing nurses*) _______________________ ____________________________________________________________________________________________________ Location of facility___________________________________________________________________________________ How long have you worked at/for this facility? _________________________________________________________ Preferred e-mail _____________________________________________________________________________________ Preferred phone number _____________________________________________________________________________ In 250–500 words describe why you are nominating this facility—what makes it a model of diversity and inclusivity? __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ * All nominees must be health care–related workplaces that employ nurses, such as hospitals, nursing schools, nursing homes, hospice facilities, etc. Those work environments falling into nontraditional territories will be considered according to the discretion of the editors, staff members, and advisors of Minority Nurse. www.minoritynurse.com

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Academic Forum

Culturally Competent Care for the South Asian Community By Divya Kulshreshtha, BSN

South Asians comprise one of the fastest growing ethnic groups in the United States. While their numbers begin to climb steadily, less than 5.5% of all nurses are South Asian. In an effort to better serve the population, it is critical to have a cultural understanding of this rising demographic.

s a nurse, you may be wondering what qualifies someone as South Asian. Although most South Asians come from India, individuals from Pakistan, Bangladesh, Sri Lanka, Bhutan, Maldives, and Nepal are also categorized as South Asian. While each country has unique culturally specific practices, we will explore health matters common to all South Asian countries that influence your nursing practice.

South Asians consume more carbohydrates is because of their vegetarian diet. Although many South Asians are not vegetarian, a large portion is. They rely on white basmati

What should I look for in my nursing assessment? South Asians develop heart disease 10 to 15 years earlier than other ethnic groups. It is therefore critical to monitor their heart rate and blood pressure at an earlier stage to allow for earlier interventions. Moreover, assessing their risk factors for heart disease can be a great preventative measure. Be sure to ask about cholesterol, blood pressure, Body Mass Index (BMI), blood sugar, smoking, and stress levels. Furthermore, type 2 diabetes rates are four times higher in South Asians than other ethnic groups. South Asians tend to have a higher refined sugar intake, which contributes to the higher incidence of diabetes. Part of the reason

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rice and atta flour for bread as their staple food source. Cutting down on carbohydrates or perhaps substituting whole grains in place of refined carbohydrates can lower blood sugar levels and prevent diabetes. Body weight is also something to monitor in South Asians, specifically. South Asians may appear to have normal weight, but they have

a tendency to deposit fat in the abdominal area, leading to central obesity. In fact, the fat deposition pattern for South Asians is so different from the normal population that there is a modified BMI for them entirely. Although they may have slender arms and legs, the increased abdominal fat deposition is correlated with a higher incidence of heart disease and diabetes.

Academic Forum What cultural elements should I consider in my dietary interventions? In South Asian culture, food is the cultural glue that brings families together. Do not be surprised if South Asian families bring their own food during hospital stays. If dietary adjustments need to be made, try to adjust the diet using culturally relevant food. The American Association of Physicians of Indian Origin has culturally specific nutritional information online that can be useful in dietary assessments and interventions. For more information, visit www.aapiusa.org/ resources/nutrition.aspx. Many people emigrating from India, but not all, will have a vegetarian diet. Although in recent medical literature vegetarian diets have been shown to reduce the risk of obesity and related diseases, it is important to make sure essential nutrients are not lacking. Oftentimes, vegetarians overcompensate low protein by having high carbohydrate consumption, which can lead to diabetes. Check to see if they are receiving enough protein in the diet. If not, suggest increasing protein consumption through lentils, beans, and nuts. Vegetarians may also have lower iron and vitamin B12, which can be increased by eating cooked spinach and cheese, respectively. Use your nutritional knowledge as a nurse to provide the most balanced diet within the cultural boundaries. Diet in South Asian culture is seen as part of medicine. For example, turmeric, a yellow colored spice that has been used for thousands of years, has now been studied and shown to ameliorate Al-

zheimerâ&#x20AC;&#x2122;s disease by clearing the amyloid-beta plaque buildup in the brain. South Asians tend to hold a holistic view of medicine. After all, ayurvedic medicine originated in India. Because of their tendency to hold a holistic perspective on healing, dietary interventions may be more effective. Nurses have always (and still do) approach the body holistically, which resonates with the values of South Asians. Be sure to tap into the holistic perspective of nursing when working with the South Asian population.

What psychosocial factors should I incorporate into my nursing care? Like many Eastern cultures, South Asian culture can be described as collectivist. Collectivist cultures value the power of groups more so than an individual. The family unit becomes critical in collectivist cultures such as South Asians. In hospitals and patient visits, you may find that aunts, uncles, cousins, second cousins, and friends may be visiting or joining the patient for support. Every hospital has unique visiting policies, but as a nurse you can be culturally sensitive and accommodating to the best of your ability. Simple interventions such as providing extra chairs during visits can be beneficial for the patient. After all, studies have shown that those with social support have better immune functioning and therefore heal at a faster rate. South Asians may also have different religious beliefs depending on where they came from. Some patients may hold more traditional religious beliefs and may prefer nurses of the same gender. Be sure to ask

the patient for his or her preferences. Patients who have faith in religion have been shown to recover at faster rates. It is therefore important to provide religious support services. In hospitals, priests are often accessible. However, it is more difficult to find an Islamic imam or a Hindu pundit. As a nurse, you are the patientâ&#x20AC;&#x2122;s advocate. If these support services are not available at the hospital, perhaps you can suggest getting them at your hospital or refer patients to a nondenominational chapel where people of all faiths can pray. Across all cultures, including Western culture, there is a stigma against mental health concerns. While mental health conditions such as depression exist cross-culturally, they are often not talked about or stigmatized. If you recognize symptoms of depression or anxiety in your patients, you can provide therapeutic care as a nurse by suggesting meditation and yoga. Meditation and yoga is viewed quite positively and is practiced often in the South Asian community since it originated in India. Additionally, meditation and yoga have been shown to have a wide variety of psychologi-

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cal benefits and are widely accepted forms of treatment.

Just rememberâ&#x20AC;Ś Every patient is different. As a nurse, you may come across an 80-year-old woman who just immigrated to the United States from Pakistan, or you may come across a 17-year-old boy who has parents from India but was born and raised in the United States. The care you provide for the first patient will be quite different from the care you provide for the second patient. Although both of these patients are technically classified as South Asian, their values, belief systems, and practices will vary drastically. While there may be some overlapping values between the two patients, use your clinical judgment to tailor your care to the specific needs of each patient. Divya Kulshreshtha recently received her BSN from Columbia University. She was inspired to pursue a career in nursing after her father was hospitalized and has since done volunteer medical work in Kenya. In the future, she hopes to work with underserved populations and be involved with international health.

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Academic Forum

Ethical Considerations of Language Barriers By Elizabeth Gonzalez-Ruiz, RN

Thousands of people visit emergency rooms and are admitted to the hospital every day across the United States. These patients are given supportive education for their illness on how to cope with or prevent the ailment. However, according to the Agency for Healthcare Research and Quality (AHRQ)’s Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals, it is estimated that 25 million people—or 8.6% of the US population—speak a language other than English and are considered to be limited-English-proficient (LEP). With a high percentage of people who are classified as LEP, the AHRQ guide rationalizes that 8.6% of the patients seen in the hospital are at risk for receiving misinformation or too little information, placing them at risk for errors secondary to communication barriers.

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hough providers do not outright seek to cause harm to patients, it does inadvertently occur, especially if proper communication is not established with the patient. On many occasions, nonEnglish-speaking patients or LEP patients are placed in situations where they do not know what is going on or what is going to happen. This is where nurses play an important role in the patient’s care. Part of the responsibility of the nurse is to establish a nurse-patient rapport that will allow the nurse to

figure out what is important to the patient and become the patient’s advocate when needed. However, research has proven that this does not always occur, consequently placing the patient at risk for harm. Ethically speaking, every patient has the right to understand what is going on with his or her care and has the right to make informed decisions regarding his or her health. However, if a patient does not speak English and is not provided with a proper interpreter, these rights are stripped away and the patient is essentially placed at the

Academic Forum mercy of the health care staff and their judgments. In November 1999, the Institute of Medicine (IOM) released a startling report, To Err is Human: Building a Safer Health System. This report outlined several areas where the US hospital systems lacked, which led to medical errors

Ethical Conflicts Several case studies showcase the harm that improper communication can cause. Failure to provide proper medical interpretation services to LEP patients or non-Englishspeaking patients has been proven to be a direct link to improper patient care, result-

Part of the responsibility of the nurse is to establish a nurse-patient rapport that will allow the nurse to figure out what is important to the patient and become the patient’s advocate when needed.

that could have been prevented. One specific area that was found to be a source of many errors was the failure to communicate properly. Communication is essential to the connection between two people; therefore, if health institutions do not provide proper access to interpreter services to LEP patients, they are in essence doing those patients an outright injustice. The IOM’s follow-up report, Crossing the Quality Chasm: A Health System for the 21st Century, delves into the specifics as to how health care professionals can help close the gap, thus preventing medical errors and assuring that patient rights are protected. Continuing the work that was outlined in To Err is Human, this report outlines six aims for improvement, two of which are geared towards patient-centered and equitable care. These two recommendations support the need for the frequent and routine use of medical interpreters in order to promote patient safety and patient rights.

ing in patient harm. For example, a case study presented in the National Health Law Program’s 2010 report, The High Costs of Language Barriers in Medical Malpractice, describes the disturbing outcome of Ms. Sokolov, a 78-year-old, Russian-speaking woman who was recovering from a stroke. Upon doing his assessment, the doctor did not use an interpreter and was unable to clearly identify the quality or the severity of the pain that the patient was experiencing in her leg. The nurse caring for the patient acted as her informal interpreter but was not present during the doctor’s examination of her leg. Overnight, the condition of the affected leg changed and the doctor was not notified. Upon assessment the next day, the doctor noticed that the leg was cold below the knee. Consequently, the patient’s leg was amputated. A second case, discussed by Dr. Glenn Flores in a 2006 commentary published by the AHRQ, describes a troubling situation where a healthy

10-month-old girl was taken to her pediatrician’s office by her Spanish-speaking parents. The parents described to the physician that they noticed their daughter had some generalized weakness. Since there were no Spanish-speaking staff members or official interpreters available, one of the nurses attempted to interpret the physician’s instructions to the parents. According to the case study, the nurse spoke in broken Spanish and was able to communicate that the baby had “low blood” and needed the iron that the physician had prescribed. The parents then took the prescription to the pharmacy, where again no interpreter services were used, and they received instructions on the medication in English. Fifteen minutes after giving the baby the medication, the baby vomited. The parents took the baby to the emergency room where she was ultimately diagnosed as having an overdose of iron and was admitted to the hospital. These two case studies illustrate a bothersome truth regarding health care institutions and their commitment to the patients they serve. Al-

patient truly receives. The first case study regarding Ms. Sokolov is a perfect example of the health care system failing to protect a patient due to a language barrier. The ethical questions raised in this case study are why did the patient not receive an official medical interpreter during her hospital stay, and why was there no outright effort from any other staff members to inform her of her right to a medical interpreter? The case study mentions that during her stay the nurse on her case interpreted for the patient, but during the physical assessment the nurse was not present. This instance deprives the patient her right to advocate for herself. Due to the language barrier, she was unable to fully communicate her concerns regarding her leg to the physician. If she could have made her concerns known, then the outcome of this case study might have been different. The use of unofficial interpreters is a short-term answer to a long-term problem. This occurs more often than not in hospitals where staff members—and, unfortunately, family members—are used as

Although hospitals have come a long way in creating policies and educating their staff regarding medical interpreters, there is still a great disconnect with what the patient is entitled to and what the patient truly receives. though hospitals have come a long way in creating policies and educating their staff regarding medical interpreters, there is still a great disconnect with what the patient is entitled to and what the

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unofficial interpreters to explain important information to the patient. In the case with Ms. Sokolov, the patient was unable to properly communicate her needs to the physician, leading the physician

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Academic Forum

to overlook the seriousness of her leg condition. The nurse caring for the patient acted as her unofficial interpreter, but was not always available to speak on her behalf, which left the patient at the mercy of the physician’s objective assessment. The second case study unfortunately involves a younger, more vulnerable patient. The ethical dilemma in this case again involves the use of unofficial interpreters. Why did the parents of the 10-month-old girl not receive access to a medical interpreter? Why did the nurse attempt to interpret for the family, knowing that her Spanish was not up to par with what the family had a right to? This case study goes beyond falling short of ensuring patient safety; it is an example that proves that language barriers directly cause patient harm. Many medical clinics may not be staffed with in-person

interpreters; however, overthe-phone interpreters exist and have been created to help fill the need that LEP patients require.

Code of Ethics The American Nurses Association (ANA) created The Code of Ethics for Nurses to help encompass all that nurses do and create a profession that supports the protection of the patients they serve. According to ANA, the Code serves the following purposes: • It is a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. • It is the profession’s nonnegotiable ethical standard. • It is an expression of nursing’s own understanding of its commitment to society. By these standards, it is the nurse’s duty to ensure that every one of the patients he or she serves has the right

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to receive safe, effective, and patient-centered care. By reviewing the guidelines set forth in the Code, it is evident that the patients served in the reviewed case studies did not meet its standards. The nurses involved in the case studies should have at some point stepped up and challenged the care that the patients received.

to interpret for the patient, the nurse should have insisted on the use of a medical interpreter so that the patient could communicate her medical concerns without the language barrier. By removing the language barrier, the nurse would have been protecting the patient’s safety, advocating for her patient’s rights, and promoting a healthy outcome in the patient’s care. According to Provision 3.5 of the Code, the nurse is required to call attention to “…any factors in the health care delivery system… [that] threaten the welfare of the patient.” Had the nurse involved in the first case study called attention to the lack of proper interpreter representation that the patient was experiencing, the patient may not have lost her leg. The second case study also involves the use of Provision 3 of the Code as well as Provision 1. According to Provision 1, the nurse “practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual.” This particular provision outlines the inherent

The use of unofficial interpreters is a short-term answer to a long-term problem.

According to Provision 3 of the Code, “the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” Using Provision 3 in the first case study, the nurse should have intervened during the patient’s stay in the hospital. Knowing that she may not always be available

worth of each patient and calls to light the importance that every patient must be honored with respect and justly treated regardless of their background. Non-English-speaking or LEP patients tend to receive care that is less than just. Any time an LEP patient receives care without the use of an interpreter, that

Academic Forum patient is being robbed of his or her own voice. For example, a non-English-speaking patient who receives an explanation of a newly prescribed IV antibiotic and the side effects to watch out for in English from a nurse is receiving care that is in no way respectful of the dignity and worth of that patient.

Ethical Principles Ethical principles in medicine help to identify situations where the patient may be at risk for receiving less than adequate care. The case studies discussed highlight the need for active participation in the patient’s care with the mindset that each patient must be served with the ethical principles in mind. By following the guidelines of these ethical principles, hospital institutions and nurses can actively lower the number of medical errors, thus increasing the safety of the patients. Nonmaleficence. Nonmaleficence is described in Principles of Biomedical Ethics by Tom Beauchamp and James Childress as the obligation of the medical provider to do no harm. Although nonmaleficence is an ethical principle that can be viewed many different ways, when applied to language barriers it is simple. Language barriers have been discussed at length as a controllable problem. However, when nurses and other medical providers do nothing to remove this barrier from patient care, they are committing acts against the very idea of nonmaleficence. Nonmaleficence protects patients from unnecessary wrongdoing in the health care setting. By providing patients with the appropriate medical

interpreter while receiving medical care, nurses can ensure that patients will receive the proper information they need regarding their health and health care decisions. Justice. Justice plays a very important role for LEP and non-English-speaking patients. Justice comes in many different forms and has been extensively discussed and categorized into different theories. One particular theory of justice that fits in well with the linguistic gap is the egalitarian theory of justice. This theory is defined in Principles of Biomedical Ethics as “…the idea of equality in terms of treating persons as equals in certain respects.” If every English-speaking patient has the right to understand what is being told to him or her in a health care setting and the right to communicate freely with his or her health care provider, then non-Englishspeaking and LEP patients deserve that right as well. Veracity. Veracity, though not explicitly included as an ethical principle, is just as valuable and necessary in the health care arena. Beauchamp and Childress define veracity as the “accurate, timely, objective, and comprehensive transmission of information.” Nurses hold a distinct role in a patient’s medical team. The nurse typically helps the patient understand the plan of care and discusses with the patient what needs he or she may have regarding the plan. By employing the concept of veracity with patient care, nurses have an ethical obligation to ensure that the communication between nurse and patient is correct and understandable.

Bridging the Linguistic Gap Many solutions already exist as to how to close the linguistic gap that endures in the health care setting. Solutions such as interpreter lines and portable computers that allow face-to-face communication with an online interpreter have been rolled out in many hospitals across the US. However, these solutions are not

however, this does not make it impossible to overcome. As a nurse, I truly believe that solutions exist but require a substantial amount of work and energy from the health care systems in order to make these solutions conceivable. Patients come in to the hospital with the hopes of getting better and place their lives and the lives of their loved ones in

Patients come in to the hospital with the hopes of getting better and place their lives and the lives of their loved ones in the hands of medical providers. This trust deserves to be honored with respect.

enough to curb the medical errors that these vulnerable populations are subjected to on a daily basis. According to the AHRQ guide, in order to establish change for the better, hospital institutions and their employees must be willing to “foster a supportive culture for safety of diverse patient populations.” It also recommends that thorough followup is necessary to evaluate and correct system errors. By identifying medical errors related to language barriers, health care institutions can create reports that track medical errors, thus allowing health care educators to educate staff on areas that need improvement. By providing patients with the necessary tools to understand their care and supporting hospital staff in the use of these tools, hospitals would create a culture that is patient-focused and an environment where patients and staff are able to communicate without the barrier of language. Language barriers have long existed in the medical setting;

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the hands of medical providers. This trust deserves to be honored with respect. Each patient deserves to be treated fairly and justly, regardless of his or her language background. If a patient is unable to communicate to the nurse, it is the nurse’s responsibility to act as that patient’s advocate. To be the voice of an LEP or non-English-speaking patient means that the nurse must find ways to help that patient speak for him or herself freely and unhindered. Though not all medical errors can be prevented, medical errors related to language barriers are a category that should be and can be eliminated. Elizabeth Gonzalez-Ruiz, RN, is a recent BSN graduate from Azusa Pacific University. She is a NICU staff nurse at White Memorial Medical Center and is a mother to twins, Iker and Izel.

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Second Opinion

Is Magnet Certification Worth It for Nurses? by Margarette Burnette

Do you work at one of the more than 400 Magnet-recognized hospitals around the world? It has been said that minority nurses who work at these recognized facilities have the benefit of flourishing in a positive environment with employers who value their skills and career goals.

owever, the results of Minority Nurse’s 2014 best companies survey suggest that nurses value other qualities far more than Magnet status when it comes to selecting an ideal employer. The survey, which was conducted late last year, asked nurses how important certain qualities (such as salary, benefits, and flexibility of hours) were to them when considering an employer. The results revealed that Magnet status ranked near the bottom of the list, only ranking ahead of one category: workplace size. For some health professionals, the question of whether or not Magnet status is important can’t be fully answered

until they know more about the designation, and that includes those nurses who work at Magnet-designated facilities, says Kristin Baird, RN, a hospital consultant. “In some programs, people talk about ‘Magnet’ but people don’t understand it,” she

ready achieved the designation by the time a nurse is hired, then the nurse who didn’t go through the certification process may have a harder time understanding its importance and impact, especially when speaking with fellow nurses, Baird argues.

Patients who are seeking hospitals may also look for the Magnet designation as an objective benchmark to help them choose where they’ll do business, says Nick Angelis, CRNA, MSN, a nurse anesthetist in Pensacola, Florida. says. In turn, they may be less likely to advocate for it or share its benefits with their colleagues. If a facility has al-

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“If it’s just part of who [their hospital] is and people stop talking about it, and they don’t embrace what it means, they’re

not going to be promoting it,” she says. However, many nurses who work at Magnet hospitals and who do understand the program believe that it is a very important ideal. “Having Magnet status heightened our visibility in the community and state for being a leader for health care,” says Cabiria Lizarraga, RN, manager of telemetry at Sharp Grossmont Hospital in San Diego, California. Sharp Grossmont Hospital first received Magnet status in 2007. Other hospitals likely receive positive coverage in their communities as well, Lizarraga adds. In fact, according to the American Nurses Credentialing Center (ANCC), 15 of the 18 medical centers on the 2013 US News Best Hospitals in America Honor Roll and all 10 of the US News Best Children’s Hospital Honor Roll for the same year are recognized by the ANCC as Magnet-recognized organizations. “It’s very important to have because it shows we are committed. When people see we are a Magnet facility, they know the employer is committed to nursing excellence,” says Lizarraga. Patients who are seeking hospitals may also look for the Magnet designation as an objective benchmark to help them choose where they’ll do business, says Nick Angelis, CRNA, MSN, a nurse anesthetist in Pensacola, Florida. Angelis has worked at Magnet and non-Magnet hospitals throughout his career.

Second Opinion

Cabiria Lizarraga, RN

Nick Angelis, CRNA, MSN

Having an environment that encourages professional development among nurses is a positive, but there is a concern among some professionals, particularly those who don’t have advanced degrees, about where they fit in under a Magnet facility, says Lizarraga. Understanding the Magnet Designation According to the ANCC, which is the Magnet credentialing organization, there are three goals for the program: • Promote quality in a setting that supports professional practice; • Identify excellence in the delivery of nursing services to patients/residents; and • Disseminate best practices in nursing services. The process to achieve Magnet status is identified by the ANCC as the “Journey to Magnet Excellence.” Facilities have to show that they have strong nurse leaders who are able to guide teams, develop professionally, take the lead in research efforts, and can show good empirical outcomes and the impact of those results. The certification lasts for four years, after which time the facility can re-apply. Angelis, who has served on several committees on hospitals seeking Magnet status, says

it is an expensive and timeconsuming process, but it’s a good way for hospitals to prove that they value nurses. “A Magnet designation can be a hint that a hospital has a culture that respects the contributions its nurses make,” he explains.

Enhanced Recruiting “Nurses want to work for an organization that really strives to empower them, one that has opportunities in place for them to do research or advance their degrees,” says Lizarraga. Facilities that have Magnet status can attract some of the best nurses available, she adds. “It is used as a recruiting tool because nurses would know about Magnet nursing excellence.” Angelis says that if a hospital has low morale among nurses, achieving Magnet status can provide positive motivation. “It’s an opportunity for the hospital to change their culture,” he says. “Facilities that empower their nurses can improve mo-

rale, and that can help with job recruiting and retention.”

the peak of the profession,” she explains.

Some Nurses Left Behind?

Find the Best Match

Having an environment that encourages professional development among nurses is a positive, but there is a concern among some professionals, particularly those who don’t have advanced degrees, about where they fit in under a Magnet facility, explains Lizarraga. Will the jobs be there for LPNs and for associate degree and diploma nurses? “There is some concern about whether or not they’d be able to practice in an acute care hospital or Magnet facility,” says Lizarraga. It may be understandable why many Minority Nurse survey respondents viewed Magnet status as only “somewhat important.” But that issue is bigger than Magnet certification, Lizarraga argues. In 2011, the Institute of Medicine released a report recommending that the proportion of nurses with baccalaureate degrees be increased to 80% by 2020. This recommendation affects all nurses, not just those at Magnet hospitals, she adds. However, many nurses who have more advanced degrees obviously have an advantage,

So what’s a nurse to do? According to Baird, nurses of all education levels should first identify their career goals and factors that are personally important, such as career growth potential, flexibility options, and income. Then, identify an employer that seems to offer the best environment. “I’m a big advocate of hiring for fit and choosing a job for fit,” says Baird. “Identify your core values, then find an organization that’s in alignment with those values.” If you plan to obtain an advanced degree or would like the opportunity to go into research or academia, working at a Magnet facility may be able to provide you with more opportunities than a non-Magnet facility, she says. However, if a potential employer is not a Magnet facility, but has other benefits that may be important to you—such as more flexible scheduling or a generous tuition reimbursement program—that could be the way to go, says Baird. Whether nurses work at Magnet hospitals or not, identifying

However, if a potential employer is not a Magnet facility, but has other benefits that may be important to you—such as more flexible scheduling or a generous tuition reimbursement program—that could be the way to go, says Baird. states Baird. “It’s not to say there’s not a place for LPNs, but if you’re a Magnet hospital you’re looking at advancing nursing as a profession and making sure you’re finding nurses who want to be at

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employers aligned with their values puts them in the best position possible to benefit their patients and their careers. Margarette Burnette is a freelance writer based in Georgia.

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Degrees of Success

Improving Diversity in Graduate Nurse Anesthesia Programs By Wallena Gould, CRNA, EdD, and Martina Steed, CRNA, MS

Racially and ethnically diverse populations have grown in the US. The US Census Bureau finds that approximately 37% of the population is made up of minority groups. Nurses currently make up the largest group of health care professionals in the US, and the need for culturally diverse nurses in the workplace has been identified by many nursing leaders. The demand for culturally competent care has brought attention to the need for culturally diverse nurses. Several studies have identified that failure to provide culturally competent care can influence health outcomes. A 2009 study published in Health Affairs found that increasing minority representation in the health care workforce could have a positive effect on curbing the health care disparities found in minority populations.

he need for culturally competent health care highlights the need for a diverse nursing workforce, particularly since patients tend to migrate towards providers that share their ethnic background. Minority nurses and possibly advanced practice nurses are in a position to help these often underserved minority communities receive care that will increase their likelihood of compliance with medical treatment and increased health literacy. Additionally, implementation of the Affordable Care Act will allow for the expansion of health insurance to historically underserved populations. This expansion will require an increase in the

number of health care professionals available to care for these populations. Of the almost 3 million registered nurses in the US, approximately 133,000 are black and 55,000 are Hispanic. A 2013 study published in Journal of Transcultural Nursing reveals that minority students account for about 27% of the students in undergraduate schools of nursing. The low number of minority students represented in the undergraduate nursing school enrollment numbers highlights the difficulty noted by graduate schools when it comes to attracting and enrolling minority registered nurses. Federal initiatives like the Promoting Postbaccalaureate

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Degrees of Success Opportunities for Hispanic Americans program authorized under Title V of the Higher Education Act of 1965 are designed to expand postbaccalaureate opportunities and academic offerings for universities that are educating the majority of postsecondary Hispanic students. According to a 2010 brief published by

that in order to receive a designation as a HSI, an institution must have at least 25% Hispanic undergraduate enrollment. Emerging HSIs are those with Hispanic enrollment within the range of 12% to 24% and have the potential to become HSIs over the next few years. The HSI designation allows an institution to qualify

Prospective students tend to focus on securing a seat in a nurse anesthesia program, but it is unclear how many actually consider the rigorous nature of the program.

Excelencia in Education, there were 176 emerging HispanicServing Institutions (HSIs) in 2007. Federal law requires

for grants and other modes of funding. A 2010 study published in Journal of Latinos and Education found that, behind

funding, the most important issue facing the presidents of HSIs was the lack of academic preparedness of the students. Challenges are faced by Hispanic nurses desiring to pursue advanced nursing degrees. Like undergraduate enrollment, the number of registered nurses with baccalaureate degrees applying for advanced practice nursing tracts is low. There are four HSI institutions that offer nurse anesthesia in these fine programs: University of Miami, Kaiser Permanente / California State University, Inter-American University of Puerto Rico, and the University of Puerto Rico. A relatively large Hispanic applicant cohort of prospective students submit to these diverse nurse

Cynthia Leaks, Student Nurse Anesthetist, University of Southern California Nurse Anesthesia Program

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Diane Dy, Student Nurse Anesthetist, Villanova University Nurse Anesthesia Program

anesthesia programs along with other urban located institutions within the US. A barrier that some underrepresented students encounter is the lack of academic preparedness and/or lackluster graduate exam scores. This lack of academic preparedness equals fewer applicants who are adequately prepared for undergraduate and graduate education. In the event that a student is successful in an undergraduate program, lack of preparedness could lead to the preparation of a graduate application packet that is not representative of the candidateâ&#x20AC;&#x2122;s true potential. Optimization of the nurse anesthesia program application packet can mean the difference between acceptance and rejection. The graduate application for nurse anesthesia school normally contains many components. The application is the first glimpse of the candidate presented to the admission committee. One crucial component of the process is the essay. The essay should contain information that the candidate wants to express describing his or her participation in leadership and

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Degrees of Success How to Strengthen your Application and Secure an Interview According to the American Association of Nurse Anesthetists (AANA)â&#x20AC;&#x2122;s 2012 demographics of nurse anesthetists in the United States and Puerto Rico, as an aggregate number, there is less than 10% of underrepresented minority nurse anesthetists from the 44,000 advanced practice

The demand for culturally competent care has brought attention to the need for culturally diverse nurses. Mark Doria, Student Nurse Anesthetist, Rutgers University Nurse Anesthesia Program

extracurricular activities. Admission committee members take note of well-rounded candidates. Candidates should include evidence of involvement in professional nursing organizations and hospital committees. These types of activities highlight the candidateâ&#x20AC;&#x2122;s desire for professional development. The essay should be edited for grammar, spelling, and content before the packet is submitted to ensure that the candidate appreciates attention to detail. The construction of a comprehensive application will most likely yield an interview, but the interview process can be intimidating. Most admission committees attempt to evaluate the studentâ&#x20AC;&#x2122;s preparedness for the rigors of the program. The types of questions revolve around principles of physi-

ology, pathophysiology, and pharmacology. Candidates who recognize their deficiency in interviewing should seek out opportunities to practice these techniques. Career centers may offer opportunities to hone interviewing skills. Prospective students tend to focus on securing a seat in a nurse anesthesia program, but it is unclear how many actually consider the rigorous nature of the program. The amount of preparation that goes into the admission to a nurse anesthesia program is only minimized by the challenges of the didactic and clinical experiences for a new student. These challenges should be considered in conjunction with other stressors that can include financial obligations, reduction of income, and family responsibilities.

Minority Nurse | SUMMER 2014

nurses practicing in hospitals, surgery and endoscopy centers, and dental and pain management offices. Less than 3%, 3.2%, and 0.5% are from

Hispanic, African American, and American Indian groups, respectively. To learn more about becoming a certified registered nurse anesthetist (CRNA), visit www.aana.com/ ceandeducation/becomeacrna. Here, students will find information about the requirements of becoming a CRNA as well as a list of accredited nurse anesthesia programs, frequently asked questions, and a list of related published articles. It is imperative that prospective applicants into a nurse anesthesia program peruse not only the nurse anesthesia program of interest website, but also our national nurse anesthesia association website. It is vitally important that underrepresented minority nurses learn more about the history of nurse anesthesia and national implications of advocacy. The book Watchful Care by Marianne Bankert is a

Johnny Gayden, Student Nurse Anesthetist, University of Maryland Nurse Anesthesia Program

Degrees of Success great resource. It will expand your knowledge about nurse anesthetists and prepare you adequately for the interview, if the admission committee members ask any questions about this well-read topic. The top candidates definitely shine during the interview if they have read this material. Another way to strengthen your application is to include your shadowing experience with a CRNA in the operating room. You should contact the CRNA and ask to meet him or her in the operating room on an agreed time. Be prepared to witness the CRNA prepare the room by checking the anesthesia machine and related equipment as well as prepare medications for the planned anesthetic prior to a patientâ&#x20AC;&#x2122;s arrival in the operating room. In addition, you will witness the CRNA interview the patient extensively about his or her medical and surgical history, review and secure the anesthesia consent, and perform an oral exam to assess a Mallampati score (I â&#x20AC;&#x201C; IV) to anticipate an easy or difficult intubation prior to entering the operating room. During the shadowing experience, ask plenty of questions about what type of anesthetic

history of nurse anesthesia, as a critical care nurse with a baccalaureate degree, you should study and schedule the critical care registered nurse (CCRN) exam offered by the American Academy of Critical Care Nurses (AACN). Information regarding this exam can be found on the AACN website (www.aacn. org). This test demonstrates aptitude in critical care nursing and professional commitment towards excellence. A significant number of nurse anesthesia programs require applicants to earn critical care experience and sit for and pass the CCRN exam prior to actual submission of the essay for a nurse anesthesia program. Another viable option for underrepresented minority nurses to improve the application process, handle the stressful interview, comply with the rigor of a nurse anesthesia program, excel for clinical preparedness, and learn about doctoral programs in nurse anesthesia programs is to register and attend Diversity CRNA Information Sessions & Airway Simulation Labs scheduled in 2014. This event, sponsored by the Diversity in Nurse Anesthesia

It is vitally important that underrepresented minority nurses learn more about the history of nurse anesthesia and national implications of advocacy.

is being administered (such as general, regional, or sedation), fluid management, positioning considerations, and more. Along with learning the

Program (www.diversitycrna. org), offers an opportunity to those interested in nurse anesthesia education to fully engage oneself and learn comprehensive information

Marie Altagrace, Student Nurse Anesthetist, University of North Florida Nurse Anesthesia Program

about the process, network, and participate in a handson simulation experience in the lab. You will also have the opportunity and access to meet four nurse anesthesia program directors, AANA senior leadership, minority CRNAs, and nurse anesthesia students from across the country. As a result, you will have the ability to include details about your experience in your eventual essay and articulate it during your interview. An additional application requirement of some anesthesia programs is the Graduate Record Examination (GRE). It is incumbent of any prospective applicant to visit the GRE website (http://www.ets.org/gre) to learn about the comprehensive information about the scores and the actual make-up of the exam (verbal reasoning, quantitative reasoning, and analytical writing). So, now it is up to you. Will you peruse through

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the suggested websites to broaden your knowledge base about proper preparation for entry into nurse anesthesia? Do you want to be a competitive applicant for a nurse anesthesia program? Do you want to be academically and clinically prepared for such a program? If you answered yes to these questions, be proactive in your educational goals to advance your professional development in a nurse anesthesia program. You can do it! Wallena Gould, CRNA, EdD, is the founder and chair of the Diversity in Nurse Anesthesia Mentorship Program (www.diversitycrna.org) and chief nurse anesthetist at Mainline Endoscopy Centers. Martina Steed, CRNA, MS, is the associate program director of Webster Universityâ&#x20AC;&#x2122;s nurse anesthesia program.

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MINORITY NURSE SCHOLARSHIP PROGRAM Sponsored by the National Coalition of Ethnic Minority Nurse Associations (NCEMNA) and Minority Nurse Magazine Nurses will always be valuable members of any health care team, regardless of their educational backgrounds. Yet, the baccalaureate and masterâ&#x20AC;&#x2122;s degrees in nursing may offer the most professional opportunities. Thatâ&#x20AC;&#x2122;s why Minority Nurse has teamed up with NCEMNA to co-sponsor an annual scholarship to help outstanding nurses from under-represented groups complete their studies toward a Bachelor or Master of Science in Nursing. To date, we have awarded scholarships to more than 40 students, honoring their commitment to the profession, academic excellence, and community service. We are currently accepting applications for our 16th annual scholarship competition, consisting of two $1,000 awards and one $3,000 award. Scholarships will be paid in summer 2015 for the fall 2015 academic term. Questions? E-mail editor@minoritynurse.com or visit www.minoritynurse.com/scholarship/minority-nursemagazine-scholarship-program

Minority Nurse | SUMMER 2014

MINORITY NURSE 16th Annual Scholarship Program

Application Form (Please print clearly) Name ______________________________________________________________________________________________ Address ____________________________________________________________________________________________ City/State/ZIP Code _________________________________________________________________________________ Phone _______________________________ E-mail________________________________________________________ Nursing school ______________________________________________________________________________________ Expected date of graduation _________________________________________________________________________ Gender: ❏ Male

❏ Female

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

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

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

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

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MINORITYNURSE.COM Highlights from the Blog

Newsletter “The Nerdy Nurse” Blogs on Bullying Brittney Wilson, RN, BSN, also known as “The Nerdy Nurse,” blogs at thenerdynurse. com and authored The Nerdy Nurse’s Guide to Technology. But a love of technology wasn’t the genesis of her blogging journey.

De-stressing in a Stressful Profession Being a nurse is hard. And stressful. Depending on where you work, your daily stress level can escalate from 0 to 10 in a matter of seconds when a critical situation arises. What’s the best way for a nurse to manage daily on-the-job stressors?

5 Ways to Learn More in Less Time Keeping current with nursing industry news, health trends, or cutting-edge technology and equipment is a great way to boost your career. But, as many nurses know, finding the time to actually get that information in a class or seminar is daunting. With work schedules and family responsibilities, finding hours every week to just grocery shop sometimes seems impossible.

How to Express Your Condolences for a Loved One It can be difficult to know what to say when someone passes away. Death is often an uncomfortable topic, making it hard to express your feelings of condolence and sympathy to the survivor. Here are some effective ways you can express your condolences based on what is appropriate and what you feel the most comfortable with.

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

Minority Nurse | SUMMER 2014

6:00am GET BATH READY FOR DAD 6:30am PACK LUNCH FOR THE

KIDS 10:00am GIVE DAD HIS MEDICINE 1:00pm FOLD EVERYONE’S LAUNDRY 2:00pm SORT DAD’S BILLS 3:30pm PICK UP THE KIDS 4:20pm TAKE DAD OUT FOR FRESH AIR 5:30pm REMEMBER THE DAYS WHEN DAD TOOK CARE OF ME 6:00pm MAKE DINNER 8:00pm HELP DAD TO BED 11:00pm FINALLY GO TO SLEEP

Only those who care for others know what it’s really like to care for others. That’s why AARP created a community with experts and other caregivers to help us better care for ourselves and for the ones we love.

aarp.org/caregiving or call 1-877-333-5885

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Academic Opportunities

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

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

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

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.

Minority Nurse | SUMMER 2014

Academic Opportunities

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

Doctor of Philosophy Master of Health Services — Physician Assistant Master of Science — Leadership Master of Science — Nurse Practitioner Admission is competitive and space is limited! nursing.ucdavis.edu

BET T Y IRENE MOORE SCHOOL OF NURSIN G Scan this code to learn more

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Johns Hopkins doctoral nursing education

Doctor of Nursing Practice (DNP) Advance the practice of nursing and improve healthcare outcomes as a clinical leader. Doctor of Philosophy (PhD) Advance the science of nursing and healthcare delivery as a research leader. Choose your path at Johns Hopkins School of Nursing—a place where exceptional people discover possibilities that forever change their lives and the world. www.nursing.jhu.edu/doctoral

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Faculty Opportunities

Index of Advertisers School of Nursing Faculty Positions Available

(Tenure-Track, Non Tenure-Track, Clinical Emphasis)

In response to considerable enrollment and programmatic growth, Ohio University, a Tier 1 institution consistently ranked among the top American public universities, is now accepting applications for Nursing Faculty positions for the Athens campus beginning Fall Semester 2014. For full details on available positions and required qualifications, please visit the links below: http://www.ohiouniversityjobs.com/postings/10040 (Tenure-Track Faculty) http://www.ohiouniversityjobs.com/postings/10036 (Non Tenure-Track Faculty) http://www.ohiouniversityjobs.com/postings/10039 (Clinical Emphasis Faculty) Review of applications will begin immediately and will continue until all positions are filled. Ohio University offers competitive salaries plus excellent benefits including educational benefits for employees and eligible dependents. Ohio University is committed to creating a respectful and inclusive educational and workplace environment. Ohio University is an equal access/equal opportunity and affirmative action employer with a strong commitment to building and maintaining a diverse workforce.

Civilian Corps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Lifetime Care Home Health Care . . . . . . . . . . . . . . . . . . 13 Roper St. Francis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Thomas Edison State College . . . . . . . . . . . . . . . . . . . . . C4 UNCF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C3 University of Connecticut Health Center . . . . . . . . . . . . 35 ACADEMIC OPPORTUNITIES . . . . . . . . . . . . . . . . . . . . . . PAGE # American Association of Colleges of Nursing . . . . . . . . 55 Frontier Nursing University . . . . . . . . . . . . . . . . . . . . . . 55 Johns Hopkins University . . . . . . . . . . . . . . . . . . . . . . . . 55 University of California, Davis . . . . . . . . . . . . . . . . . . . . 55 University of Pittsburgh . . . . . . . . . . . . . . . . . . . . . . . . . 54 FACULTY OPPORTUNITIES . . . . . . . . . . . . . . . . . . . . . . . . PAGE # Ohio University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

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

There is a true shortage of nursing educatorsâ&#x20AC;&#x201D;particularly minority nursing professors, who comprise a small percentage of nursing faculty overall. The American Association of Colleges of Nursing says the scarcity of professors may actually be stunting the growth of nursing programs. To counter this, nursing schools are improving the pay for nursing school faculty to increase their numbers, especially those who hold a doctorate. This section of Minority Nurse is dedicated to open faculty positions from nursing schools all over the country. Requirements vary, but all are sure to lead to exciting, rewarding careers in nursing education and research.

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Minority Nurse | SUMMER 2014

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