Minority Nurse 2017 Summer Issue by Springer Publishing Company

The Career and Education Resource for the Minority Nursing Professional â&#x20AC;¢ SUMMER 2017

Salary Survey Issue

Annual

Caring for Transgender Patients

WHEN NURSES GO ON STRIKE

WORKPLACE WELLNESS PROGRAMS

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Table of Contents

In This Issue

Cover Story

Editor’s Notebook

Letter to the Editor

Vital Signs

By Ciara Curtin

Making Rounds

Learn what you’re worth and help close the pay gap

The Funny Bone

Index of Advertisers

Academic Forum 33

Features 16 Caring for Transgender Patients:

How Nurses Can Be Advocates for This Marginalized Community

Coping with Incivility: Tips for New Nursing Faculty

By Cheryl Green, PhD, DNP, RN, LCSW

By Lynda Lampert, RN

Find out how to break the silence when you are a victim (or a witness) of incivility in the workplace 35 Triple-Negative Breast Cancer and the Benefits of Community Outreach: A Minority Nurse’s Perspective

2017 Annual Salary Survey

Cast your biases aside and learn how to provide respectful, competent care to the transgender community

22 How to Deal with Public Opinion When You’re on Strike

By Phyllis Morgan, PhD, FNP-BC, CNE, FAANP

By Leigh Page

Minority nurses can play an important role in raising breast cancer awareness in their communities

The public may trust nurses, but there is no guarantee that they will support your strike if it’s for the wrong reasons

Degrees of Success 37 From Nursing Student to Confident Nurse: The Importance of the Summer Externship

The Nurse’s Path to Wellness By Jebra Turner

By Denise Gasalberti, PhD, RN

Start your journey towards better health with your employer’s

Boost your confidence with an externship to ease the transition from student to working nurse

wellness program

Health Policy 38

Achieving Health Equity Through Legislative Action

By Janice M. Phillips, PhD, FAAN, RN

It’s more important than ever for nurses to have a seat at the legislative table

Minority Nurse | SUMMER 2017

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

The Power of Education

here have been a number of news stories about nurses on strike in recent years. Nurses, who are on the frontline of care, tend to spend the most time with patients and are perhaps the best equipped to come to bat for them when their safety is at stake. Last year, the grassroots group Show Me Your Stethoscope organized a rally in our nation’s capitol to advocate for safer nurse-to-patient ratios, and by the time this issue has published, they will have had another rally for the same cause. Studies have shown that when nurses are overworked and experience burnout, mistakes tend to happen. And if history has taught us anything, it’s that we should learn from our mistakes and do what we can to improve our health care and, thus, our quality of life. It sounds cliché, but knowledge is power. Are you a new faculty member worried about office politics? Learn how to cope with incivility in the workplace (page 33). Want to help with community outreach? Read about a community/faith-based education program that helped educate black women about the threat of triple-negative breast cancer (page 35).

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

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CEO & Publisher Mary Gatsch Vice President & CFO Jeffrey Meltzer

MINORITY NURSE MAGAZINE Publisher Adam Etkin Editor-in-Chief Megan Larkin

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Digital Media Manager Andrew Bennie Minority Nurse National Sales Manager Peter Fuhrman 609-890-2190 n Fax: 609-890-2108 pfuhrman@springerpub.com

Are you a current nursing student nervous about landing that first job after graduation? Consider a summer externship to gain some clinical experience and confidence (page 37).

Minority Nurse Editorial Advisory Board

Want to get more involved in health policy? Learn more about health equity initiatives (page 38).

Anabell Castro Thompson, MSN, APRN, ANP-C, FAAN President National Association of Hispanic Nurses

In the world of fake news and “alternative facts,” it’s important to take a moment to reaffirm your commitment to lifelong learning. Whether it’s doing your homework to make sure you’re being paid what you are worth (check out our 2017 Annual Salary Survey for starters on page 10), learning how to provide culturally competent care to transgender patients (page 16), figuring out how to navigate a strike (page 22), or following your own path to wellness (page 26), there’s something in this issue to help guide the way. Let’s help make America smart again. —Megan Larkin

Birthale Archie, DNP, BS, RN Faculty Davenport University Iluminada C. Jurado, MSN, RN, CNN Chair, Scholarship Committee Philippine Nurses Association of America Martha A. Dawson, DNP, RN, FACHE Assistant Professor, Family, Community & Health Systems University of Alabama at Birmingham Wallena Gould, CRNA, EdD, FAAN Founder and Chair Diversity in Nurse Anesthesia Mentorship Program Alethea Hill, PhD, ACNP-BC, ANP-BC Associate Professor University of South Alabama Romeatrius Nicole Moss, RN, MSN, APHN-BC, DNP Founder and President Black Nurses Rock

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.

Varsha Singh, RN, MSN, APN PR Chair National Association of Indian Nurses of America Eric J. Williams, DNP, RN, CNE President National Black Nurses Association

Subscription Rates: Minority Nurse is distributed free upon request. Visit www.minoritynurse.com to subscribe. Change of Address: To ensure delivery, we must receive notification of your address change at least eight weeks prior to publication. Address all subscription inquiries to Springer Publishing Company, LLC, 11 West 42nd Street, 15th Floor, New York, New York 10036-8002 or e-mail subscriptions@springerpub.com. Claims: Claims for missing issues will be serviced pending availability of issues for three months only from the cover date (six months for issues sent out of the United States). Single copy prices will be charged for replacement issues after that time. Minority Nurse ® is a registered trademark of Springer Publishing Company, LLC. © Copyright 2017 Springer Publishing Company, LLC. All rights reserved. Reproduction, distribution, or translation without express written permission is strictly prohibited.

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Letter to the Editor M

y name is Francesca Strolia, and I am a sophomore nursing major at Trinity Christian College in Palos Heights, Illinois. I am currently enrolled in our Concepts of Nursing class and we have learned the importance of joining professional nursing associations so that us future nurses can get our voices heard someday. I am choosing to write to your Minority Nurse magazine because we have recently learned about the differences in nursing education, such as diploma programs, bachelor’s degree programs, associate’s degree programs, and master’s programs. There is a “minority” of nurses that receive an education through diploma programs and bachelor’s degree programs; however, I believe that there is a sufficient need for nurses to be even more educated. The majority of RNs graduate with an associate’s degree, but not a lot of hospitals hire AD nurses anymore. Therefore, although only a minority of nurses in the United States are educated through diploma and bachelor’s degree programs, I think that the diploma and associate’s programs should be eliminated as an option in nursing education. Bachelor’s degree programs should be the minimum education that nurses today should receive. Not only does a BSN degree allow for better job placement and security, but also the nurse is better rounded because of the broad curriculum in a BSN program. There is such a broad curriculum in nursing because nurses provide care to people at the most difficult times of their lives, and therefore, nurses have to understand a whole lot about life in general. I hope that one day, even more nurses and future nurses raise their voices to the concerns that affect our lives in nursing by joining nursing organizations and associations and write to magazines like yours! —Francesca Strolia, Trinity Christian College 2019

The Magnet Recognition Program®, ANCC Magnet Recognition®, Magnet®, ANCC National Magnet Conference®, and Journey to Magnet Excellence®, names and logos are registered trademarks of the American Nurses Credentialing Center. All rights reserved.

Minority Nurse | SUMMER 2017

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Vital Signs

American Nurses Association Partners with Centers for Disease Control and Prevention to Improve Infection Prevention and Control Education for Nurses The American Nurses Association (ANA) and the Centers for Disease Control and Prevention (CDC) announced in February that they have created the Nursing Infection Control Education (NICE) Network. This is a collaboration of 20 specialty nursing organizations that hold organizational-level membership in ANA and are committed to empowering nurses to protect themselves and their patients from infection.

ICE Network members will develop infection prevention and control training materials to assist nurses responding to and containing emerging infectious disease threats, including the Ebola and Zika viruses. An emerging infectious disease is one that is either newly recognized in an area or affects a larger population or geographic area. “Nurses have played a critical role in educating the public and other health care workers about controlling and preventing the spread of the Ebola and Zika viruses,” says ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “Like the CDC, we recognize that nurses are on the front lines of delivering care and should be fully equipped to tackle emerging threats to protect themselves and the people they serve.” In addition to Ebola and Zika, recent examples of emerging infectious diseases include severe acute respiratory syndrome (SARS), H1N1 influenza, and West Nile virus. It’s extremely important to rapidly

detect and contain emerging infectious diseases and contain antibiotic resistance threats before they become global pandemics. ANA will serve as the primary contractor for the project, which runs through May 31, 2018, and will provide nurses, who have been rated by the public as the most honest and ethical profession

for 15 years straight, with realtime, tailored infection control training critical for an effective response to infectious diseases. Key tasks for the project include the following: • Identifying infection control–related training needs • Developing educational tools and outreach materials for registered nurses and nursing-related professionals, including licensed practical nurses and certified nursing assistants ANA will also work with NICE Network members to disseminate resources and implement in-person trainings at nursing organization conferences and meetings.

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ANA’s partnership with the CDC complements existing work in infection prevention and control. Last June, ANA and the Association for Professionals in Infection Control and Epidemiology (APIC) launched the ANA/APIC Resource Center, a website that consolidates resources, allowing health care professionals quick and easy access to infection prevention strategies and evidence-based best practices. For more information on CDC infection control and prevention procedures, visit www.cdc.gov/hai/index.html. Source: American Nurses Association

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Vital Signs

Study Identifies African-Specific Genomic Variant Associated with Obesity An international team of researchers has conducted the first study of its kind to look at the genomic underpinnings of obesity in continental Africans and African Americans. They discovered that approximately 1% of West Africans, African Americans, and others of African ancestry carry a genomic variant that increases their risk of obesity, a finding that provides insight into why obesity clusters in families. Researchers at the National Human Genome Research Institute (NHGRI), part of the National Institutes of Health (NIH), and their African collaborators published their findings March 13, 2017, in the journal Obesity.

eople with genomic differences in the semaphorin-4D (SEMA4D) gene were about 6 lb heavier than those without the genomic variant, according to the study. Most of the genomic studies conducted on obesity to date have been in people of European ancestry, despite an increased risk of obesity in people of African ancestry.

Obesity is a global health problem, contributing to premature death and morbidity by increasing a person’s risk of developing diabetes, hypertension, heart disease, and some cancers. Although obesity mostly results from lifestyle and cultural factors, including excess calorie intake and inadequate levels of physical activity, it has a strong genomic

Minority Nurse | SUMMER 2017

component. The burden of obesity is, however, not the same across U.S. ethnic groups, with African Americans having the highest age-adjusted rates of obesity, says Charles N. Rotimi, PhD, chief of NHGRI’s Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch and director of the Center for Research on Genomics and Global Health (CRGGH) at the NIH. CRGGH examines the sociocultural and genomic factors at work in health disparities—the negative health outcomes that impact certain groups of people—so they can be translated into policies that reduce or eliminate health care inequalities in the United States and globally. This is the first study to use a Genome-Wide Association Study (GWAS) to investigate the genomic basis of obesity in continental Africans, says Guanjie Chen, MD, study colead and a CRGGH staff scientist. A GWAS compares the genomes of people with and without a health condition— in this case, people who are obese and those who are not— to search for regions of the genome that contain genomic variants associated with the condition. Most previous studies on obesity using a GWAS have been conducted with populations of European ancestry; these studies wouldn’t have found the SEMA4D genomic variant, which is absent in both Europeans and Asians. “We wanted to close this unacceptable gap in genomics research,” says Rotimi.

“By studying people of West Africa, the ancestral home of most African Americans, and replicating our results in a large group of African Americans, we are providing new insights into biological pathways for obesity that have not been previously explored,” says Ayo P. Doumatey, PhD, study co-lead and CRGGH staff scientist. “These findings may also help inform how the African environments have shaped individual genomes in the context of obesity risk.” Rotimi and his colleagues plan to replicate these findings in more populations and conduct experiments using cell lines and model organisms, such as zebrafish, to identify the role of genomic variants in SEMA4D in obesity and obesity-related traits. (The SEMA4D gene plays a role in cell signaling, the immune response, and bone formation.) Available data show that the newly identified genomic variant overlaps a region of DNA called an “enhancer” that can be activated to increase the work of a particular gene, he says. They plan to conduct larger studies of DNA sequencing of this gene in different human populations with the hope of identifying other genomic factors that may be associated with obesity. “Eventually, we hope to learn how to better prevent or treat obesity,” says Rotimi. For more information about the NIH and its programs, visit www.nih.gov.

Vital Signs

Office of Minority Health Announces Release of Phase Two Report on Eliminating the Public Health Problem of Hepatitis B and C in the United States In March, the National Academies of Sciences, Engineering, and Medicine released the second phase of a report on eliminating viral hepatitis in the United States. The report, “Eliminating the Public Health Problem of Hepatitis B and C in the United States,” provides a U.S. strategy for eliminating hepatitis B and hepatitis C virus infection and the disease and mortality caused by these agents as public health threats by 2030. The report sets out elimination goals for the nation and a practical set of recommendations to scale up current prevention activities and focuses on five areas: (a) public health information, (b) essential interventions, (c) service delivery, (d) financing elimination, and (e) research.

esults from phase 1, released in April 2016, examined the feasibility of ending the transmission of hepatitis B and C in the United States and preventing further sickness and deaths from the diseases. The phase 1 report concluded that eliminating hepatitis B and C in the United States is feasible, but it will take considerable will and resources. In the short term, it is feasible to control hepatitis B and C by reducing their incidence and prevalence. The phase 2 report outlines some key targets for the larger goal of eliminating the public health problem of hepatitis B and C in the United States by 2030: Hepatitis B • A 50% reduction in mortality from hepatitis B (compared to 2015) is possible in the United States by 2030. • Meeting this goal will require diagnosing 90% of chronic hepatitis B cases, bringing 90% of those to care, and treating 80% of

those for whom treatment is indicated. Hepatitis C • A 90% reduction in incidence of hepatitis C is possible in the United States by 2030. • Meeting this goal will require treatment without restrictions and a consistent ability to diagnose new cases. • A 65% reduction in mortality from hepatitis C (compared to 2015) is possible by 2030. Millions of Americans are living with viral hepatitis, and more than half don’t know they have the virus. Thus, they are at risk for life-threatening liver disease and cancer and unknowingly transmitting the virus to others. It is estimated that 3.5 million people are living with hepatitis C in the United States and 850,000 people are living with hepatitis B. Viral hepatitis is especially a concern for racial and ethnic minority populations. Accord-

ing to the U.S. Department of Health and Human Services (HHS) National Viral Hepatitis Action Plan 2017–2020, • Asian Americans and Pacific Islanders (AAPI) are the racial/ethnic group that is most heavily affected by hepatitis B virus; they comprise about 5% of the U.S. population but comprise about half of all persons living with hepatitis B. • An estimated 1 in 12 AAPIs is living with hepatitis B infection. However, as many as two of three hepatitis Binfected AAPIs do not know they are infected because they have not been tested. • African Americans comprise approximately 11% of the U.S. population but comprise 25% of people in the United States with chronic hepatitis C infections. • African Americans have higher rates of infection and hepatitis C–related death compared with the overall population. • African Americans aged 60 years and older are ten times more likely to be chronically infected with

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hepatitis C compared to other races. • American Indian and Alaska Native (AI/AN) people are the racial/ethnic group with both the highest rates of acute hepatitis C infection as well as hepatitis C–related deaths. The AI/AN hepatitis C-related death rate is more than double the national rate. Hepatitis C–related hospitalizations among AI/AN people more than tripled from 1995 to 2007. The HHS Office of Minority Health thanks the National Academies for this vital report, which was sponsored by the Centers for Disease Control and Prevention’s Division of Viral Hepatitis and Division of Cancer Prevention and Control, HHS Office of Minority Health, American Association for the Study of Liver Diseases, Infectious Diseases Society of America, and National Viral Hepatitis Roundtable. To view the full report, click here: www.nationalacademies .org/hmd/reports/2017/nationalstrategy-for-the-elimination-ofhepatitis-b-and-c.aspx. Source: Office of Minority Health

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Making Rounds

May

18-21

14–16

22–25

42nd Annual Conference Arizona Biltmore Hotel Phoenix, Arizona Info: 919-573-5443 E-mail: info@thehispanicnurses.org Website: http://nahnconference.org

2017 Education Summit San Diego Marriott Marquis & Marina San Diego, California Info: 202-909-2500 E-mail: summit@nln.org Website: www.nln.org/summit

23–30

21–23

38th Annual National Convention Aboard Royal Caribbean International (Oasis of the Seas) Port Canaveral to St. Maarten, San Juan, and Labadee E-mail: infomypnaa@gmail.com Website: www.mypnaa.org

2017 Annual Conference Red Rock Casino Resort & Spa Las Vegas, Nevada Info: 859-977-7453 E-mail: info@aamn.org Website: www.aamn.org

American Association of Critical-Care Nurses 2017 National Teaching Institute & Critical Care Exposition George R. Brown Convention Center Houston, Texas Info: 800-899-2226 E-mail: info@aacn.org Website: www.aacn.org

June 5–10

American Holistic Nurses Association 37th Annual Conference The Westin Mission Hills Golf Resort & Spa Rancho Mirage, California Info: 800-278-2462 E-mail: info@ahna.org Website: www.ahna.org

20–25

American Association of Nurse Practitioners 2017 National Conference Pennsylvania Convention Center Philadelphia, Pennsylvania Info: 512-442-4262, ext. 5352 E-mail: conference@aanp.org Website: www.aanp.org

24–28

Association of Women’s Health, Obstetric and Neonatal Nurses 2017 Annual Convention Ernest N. Morial Convention Center New Orleans, Louisiana Info: 800-354-2268 E-mail: customerservice@awhonn.org Website: http://awhonnconvention.org

July 11–14

National Association for Health Care Recruitment 43rd Annual IMAGE Conference The Westin Savannah Harbor Golf Resort & Spa Savannah, Georgia Info: 407-774-7880 E-mail: bmelnick@kmgnet.com Website: www.nahcr.com

Minority Nurse | SUMMER 2017

National Association of Hispanic Nurses

Philippine Nurses Association of America

July/August July 30–August 4

National Black Nurses Association 45th Annual Conference Mandalay Bay Resort & Casino Las Vegas, Nevada Info: 301-589-3200 E-mail: info@nbna.org Website: www.nbna.org

September 13–15

Doctors of Nursing Practice, Inc. 10th National Conference InterContinental New Orleans New Orleans, Louisiana Info: 888-651-9160 E-mail: info@doctorsofnursingpractice.org Website: www.doctorsofnursingpractice.org

14–16

Academy of Neonatal Nursing 17th Neonatal Nurses Conference Westgate Las Vegas Resort & Casino Las Vegas, Nevada Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

National League for Nursing

American Association for Men in Nursing

October 5–7

American Academy of Nursing Annual Conference on Transforming Health, Driving Policy Marriott Marquis Washington, District of Columbia Info: 202-777-1170 E-mail: conferences@aannet.org Website: www.aannet.org

18–21

Transcultural Nursing Society 43rd Annual Conference Hotel Monteleone New Orleans, Louisiana Info: 888-432-5470 E-mail: staff@tcns.org Website: www.tcns.org

18–21

American Psychiatric Nurses Association 31st Annual Conference Phoenix Convention Center Phoenix, Arizona Info: 855-863-2762 E-mail: lhoop@apna.org Website: www.apna.org

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BY CIARA CURTIN

2017 Annual Salary Survey Nurses reported that they are making more in salary this year than last year, although African American and Hispanic nurses haven’t made the same gains as Asian and white nurses.

urses across the United States have reported a jump in salary this year, as compared to last year and, for some, the year prior. Last year, nurses reported a decline in pay as they said they received a median salary of $68,000 as compared to 2015’s $71,000. But this year, nurses have rebounded: They took home a median salary of $78,000. Although this boost was felt across ethnic groups, African American and Hispanic nurses Number of Respondents: only returned to their 2015 Number of Respondents: salary levels of $70,000 and $76,000, respectively. Asian and white nurses, meanwhile, Ethnicity made additional gains beyond 2.9% 2.7% 2.9% 2.7% 0.7%Ethnicity 0.7% their respective 2015 salaries 5.2% 5.2% 1.6% 1.6% 5.1% 5.1% 0.7% 2.9% 2.7% of $80,000 and $71,000. This 5.2% 1.6% 5.1% year, they received $85,000 and 13.8% 13.8% 68.0% 68.0% $79,744, respectively. 13.8% 68.0% To collect this salary and other jobs data, Minority Nurse and Springer Publish■ White/Non-Hispanic White/Non-Hispanic ■ ing Company e-mailed a link ■ African African American American ■ ■ ■ White/Non-Hispanic Asian ■ Asian to an online survey that asked ■ American ■ African Hispanic or Latino/Latina Latino/Latina ■ Hispanic or ■ Asian nurses about their career paths, ■ Native Native American American ■ ■ ■ Hispanic Prefer not notorto toLatino/Latina answer ■ Prefer answer specialties, ethnicity, and ■ ■ Native Other American ■ Other more. Some 1,631 nurses from ■ Prefer not to answer ■ Multiracial Multiracial ■ ■ Other all over the United States—and ■ Multiracial Gender even a handful from outside Gender the country—responded to the 9.1% 9.1% survey. 9.1% 90.9% 90.9% These nurses represented a 90.9% range of backgrounds and although most were involved ■ Female Female ■ in patient care, others focused ■ Male Male ■ on education or had leader■ Female ■ Male ship roles. In addition, they have earned certifications as family nurse practitioners as

1,631 1,631

Minority Nurse | SUMMER 2017

well as in education and critical care. They worked not only for a range of employers, such as public hospitals and universities, but also for home health care services and public schools. But there were differences in salaries among nurses by ethnicity. Overall, African American and Hispanic nurses reported earning less than their white counterparts. This pattern largely holds across the United States. For instance, African American nurses living out West—where the highest salaries were reported overall—made a median $84,000, whereas Hispanic nurses living there made $80,000. Meanwhile, white nurses in the West reported a median salary of $96,000. Similarly, white nurses working at private hospitals tended to have higher salaries than African American, Asian, or Hispanic nurses did. Likewise, white nurses working at public hospitals made a median $89,000, whereas African American nurses working there reported a median salary of $76,220. However, nurses working at a college or university had similar salaries, regardless of ethnicity. As in years past, nurses’ salaries tended to increase with in-

creasing education levels. This year, nurses with an associate’s degree reported a median salary of $70,000, whereas nurses with a bachelor’s degree made a median $74,813 and those with a master’s degree made $80,000. Similarly, nurses with a doctoral-level degree had a median salary of $90,000. Both African American and white nurses experienced these bumps in pay with education but still with differences by ethnicity. For instance, African American nurses with an associate’s degree took home a median $65,000, whereas white nurses with an associate’s degree received $72,000. Likewise, African American nurses with a bachelor’s degree received $70,000 and white nurses with a bachelor’s degree had a median salary of $77,000. That gap narrowed, though, as African American and white nurses with master’s degrees or with doctoral degrees reported similar salaries. Nurses also seemed to be fairly content with their jobs this year. Only about 18% of respondents—down from last year’s 23%—said they were considering leaving their current position in the near future, and 62% said they expected a raise this year.

Regions 0.2%

Employment Status

2.8%

18.7%

31.1%

■ Midwest ■ South ■ Northeast

■ West ■ Outside the United States ■ U.S. Territory

88.4%

■ I am employed full time ■ I am employed part time ■ Other

1.8%

1.2%

0.7%

3.8%

0.3% 0.5%

2.9%

10.2% 35.1%

18.0%

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

41.8%

6.0% 14.2%

20.6%

21.1%

■ College or university ■ Public hospital, including Veteran’s or Indian Affairs hospitals ■ Private hospital ■ Other (please specify) ■ Private practice or physician’s office ■ Nursing home, LTC, or rehabilitation center ■ Public school

■ Three to five years ■ Less than a year

Main Role

■ Health department/Public health agency ■ Home health care service ■ Health insurance company/HMO/MCO ■ Walk-in clinic ■ Military ■ Pharmaceutical/ Research company ■ Correctional facility

Reason for Leaving Prior Job

2.7% 2.3% 0.7%

3.7%

2.9%

1.0%

0.6%

11.9%

37.5%

9.5%

1.4%

1.5%

2.7%

16.1%

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

Employer Type

Years at Current Job

5.0%

2.2%

7.6%

22.8%

24.4%

4.0%

1.4%

0.4%

9.9%

■ Patient care ■ Education ■ Leadership/Management ■ Administrative

54.6% 15.4%

38.3%

■ Other ■ Case management ■ Research ■ Triage

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

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

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Median Salary by Region

Northeast

West

$80,000 ($70,000 five years ago)

$93,000 ($80,000 five years ago)

Midwest

$75,000 ($69,000 five years ago)

South

$75,000 ($65,000 five years ago)

Median Salary by Region and Ethnicity Northeast

White/Non-Hispanic

South Midwest West

Northeast Hispanic or Latino/Latina

South West

Asian

West

Northeast South African American Midwest West

$10,000

$20,000

■ Salary Five Years Ago ■ Current Salary

Minority Nurse | SUMMER 2017

$30,000

$40,000

■ Salary Five Years Ago ■ Current Salary

$50,000

$60,000

■ Salary Five Years Ago ■ Current Salary

$70,000

$80,000

$90,000

■ Salary Five Years Ago ■ Current Salary

Median Salary by Education Level

Median Salary by Main Role

$90,000

$100,000

$80,000

$90,000 $80,000

$70,000

$60,000

$50,000

$50,000 $40,000 $40,000 $30,000

$30,000

$20,000

$10,000

$10,000 $0

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Median Salary by Ethnicity White/Non-Hispanic

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African American

$10,000

$20,000

Salary Five Years Ago

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

Current Salary

Median Salary by Education and Ethnicity Doctorate

Master’s

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$10,000

$20,000

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$30,000

$40,000

$50,000

Hispanic or Latino/Latina

$60,000

Asian

$70,000

$80,000

$90,000

$100,000

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Minority Nurse | SUMMER 2017

$30,000

$40,000

$50,000

Hispanic or Latino/Latina

$60,000

Asian

$70,000

$80,000

$90,000

African American

$100,000

Looking to Leave Job in Coming Years

Highlights • 88.4% are employed full time

17.6%

• 41.8% work at a college or university 82.4%

• 55.7% have been at their current job for five or more years • 71.5% received a raise within the last year • 54.6% left their last job to pursue a better opportunity

■ Yes

• 38.4% do not expect a raise this year

■ No

• 17.6% say they are looking to leave their current job in the next year

Timing of Last Raise Received

• Family nurse practitioner

6.3%

8.7%

Five Most Common Specialties • Certified nurse educator

13.5% 71.5%

• Critical care (NICU, PICU, SICU, MICU) • Psychiatric/mental health • Acute care

■ Last year ■ Two years ago

■ Three to five years ago ■ More than five years ago

Most Common Certifications Being Sought in Near Future • Certified nurse educator

Percentage of Last Raise

• Administration • Family health

7.3%

3.6%

• Critical care

27.4% 61.7%

■ 1% to 2% ■ 3% to 4%

■ 5% ■ More than 5%

• Psychiatric/mental health

Highest Paid by Employer Type • Private practice • Public hospital

Raise Expected This Year 1.9%

18.5%

2.2%

38.4%

39.0%

• Private hospital • College or university

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

■ 1% to 2% ■ I do not expect a raise this year

■ 3% to 4% ■ 5% ■ More than 5%

• Dental insurance • Life insurance

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Caring for

Minority Nurse | SUMMER 2017

Transgender Patients How Nurses Can Be Advocates for This Marginalized Community BY LYNDA LAMPERT, RN

Transgender rights have always been an issue in our culture but only now are these rights being brought to light. “According to a report from the National Transgender Discrimination Survey of 6,000 respondents, 48% of transgender adults have delayed or avoided medical care compared with 17% of heterosexual adults,” states Laurel Halloran, PhD, APRN, a family nurse practitioner and professor of nursing at Western Connecticut State University. “The survey also showed that 19% reported having been refused health care because of their transgender status, 28% postponed necessary care when they were sick or injured, and 33% delayed or didn’t seek preventive care because of prior health care discrimination.”

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With statistics like this, nurses need to know how to assess, diagnose, and treat transgender patients as a community unto themselves. Of course, this starts with education. In the past, other communities, such as the AIDS community in the early 1990s, were also discriminated against. It was only through education of the health care community that these patients were able to receive better care. To ensure this frankly marginalized community gets the care it needs, some change needs to take place—and nurses are the ones to lead the charge.

“T

ransgender individuals require the same commitment to patient-centered care as do all other patients,” says Luis A. Rosario-McCabe, MS, RN, WHNP-BC, CNL, senior nurse practitioner at the University of Rochester Medical Center and senior associate at the University of Rochester School of Nursing. “The best way for nurses to sensitively care for transgender individuals is by taking cues from the patients for whom they seek to care. Get to know the health care disparities the transgender population faces and be a part of ensuring a transgender-

affirming atmosphere.” Taking care of transgender individuals is really not that different from taking care of anyone else, but nurses should be aware of how to be more sensitive to the transgender client. From honestly asking the patient to a more open assessment, caring for the transgender patient is remarkably the same with just a few differences that make the process more comfortable and respectful for patient and nurse alike.

Definitions, Pronouns, and Transitioning One primary and important distinction to make is that not

Minority Nurse | SUMMER 2017

all transgender patients are alike. In fact, transgender can often be a misnomer, as patients can identify as a wide variety of gender or agender subtypes. Rosario-McCabe gives a quick list of definitions as such: “Transgender is defined as individuals whose identity is not the same as the sex they were

female, or neither. Gender expression is how one’s outward appearance or presentation shows their gender as masculine, feminine, neither, or both. Sexual orientation refers to how individuals identify their physical and emotional attraction to others.” In addition, Jordan Rubenstein, a transgender person who has had many negative experiences with the medical establishment, states, “Nonbinary is an umbrella term that encompasses any gender identity aside from man or woman. A nonbinary person may identify as bigender, agender, genderfluid, or a number of other identities.

Another way to navigate these waters is gender inclusive language on intake forms. given at birth. Gender identity is defined as an individual’s internal sense of being male,

And a person’s gender expression can vary tremendously and doesn’t necessarily align with

their gender identity. Nonbinary people can use any pronouns (he/him, she/her, they/them, or other alternatives such as ze/zir). When it comes to pronoun usage, the best way to be inclusive is to not assume someone’s gender identity based on how they present, and to not assume a particular set of pronouns based on a person’s gender identity.” This creates a fundamental problem in determining which pronoun to use when

to female, other). It is also important to ask regarding preferred pronouns. Once these are identified, it is important to use them in the presence of the patient and when the patient is not around. Acknowledge when mistakes occur and move on. The most important factor is to maintain respect for the individual.” Nurses should also keep in mind that a person who identifies as transgender may not necessarily go through surgical

Halloran agrees, “When interacting with a patient who has identified as transgender if you don’t know what name or pronoun to use, ask. Say: ‘I’d like to interact with you respectfully. What pronoun would you like me to use? What name would you like me to use?’”

referring to a patient. In this and in many, many cases, the best course of action is to just ask. Some genderfluid patients prefer he or him or she or her. Don’t assume that their physical appearance or the presence of their anatomy means that they automatically want to be called by a certain name or pronoun. In fact, some transgender patients may prefer they/them. When in doubt, please just ask. Another way to navigate these waters is gender inclusive language on intake forms. “Allowing patients to self-identify on intake forms assists in collecting the information regarding the gender nomenclature,” states Rosario-McCabe. “Commonly, forms patients are asked to complete limit choices. Instead of asking patients to identify if they are male or female, allow for a broader range of responses: male, female, transgender (female to male, male

transition. First, the surgical transition may be far too expensive for the patient. Second, not all patients find that they need or want to transition in that way, and third, some don’t transition because of safety concerns. In the end, the situation is very fluid for each patient, and that means treating each patient on a case-by-case basis, assuming nothing.

Please, Just Ask! For all other patients, the idea of just asking about the status of their medical history is obvious, nonconfrontational, and usually not embarrassing. However, asking about gender can be difficult for nurse and patient alike because so many social mores and taboos are involved. It still comes down to the simple and obvious, though: just ask. Halloran agrees, “When interacting with a patient who

has identified as transgender if you don’t know what name or pronoun to use, ask. Say: ‘I’d like to interact with you respectfully. What pronoun would you like me to use? What name would you like me to use?’” “I think the best way to approach medical history and physical examinations is to be honest, straight-forward, and nonjudgmental with patients,” Rubenstein adds. “Like anyone else, transgender patients just want to be treated with consideration and respect. Telling the patient what to expect—for example, informing them before handling genitals—can go a long way in creating a more comfortable space.” It should be noted that judging a person based on how they present can cause a problem. For instance, if someone “looks” female, you may just assume that they are. However, if you ask, that person may not be transgender at all. For this reason, asking about transgender status needs to become standardized. Patients are asked about their religious preference, and being asked about their gender status is no different. It sets

the system. Health care needs to learn how to ask in order to include everyone to provide all people with the best care possible despite any gender or non-gender they choose to identify with.

Particular Considerations for Assessing Transgender Patients A physical assessment and history of a transgender patient is much like that for any other patient. You should be aware, though, that there are a few differences that will make both you and the patient feel more comfortable with the process. If the procedure is performed with sensitivity and respect, any other issues should be easily manageable. Halloran suggests the following: “Allow the patient to have a support person with them during the encounter. Discussing what is going to happen during each step of the exam beforehand in order to allow trust to be developed. Only the pertinent elements of the body should be examined for the complaint presented.” She adds, “The [nurse] must provide care for the anatomy

Some transgender patients—as with nontransgender patients—will be uncomfortable with their bodies, so it is important to respect any triggers that the physical exam may unearth. up a place of respect for genderfluid individuals and helps those who are too nervous to seek care for this very reason. Although it starts with the nurse simply asking the patient about transgender status, the problem really extends to

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that is present. However, remember that these patients will have some health needs that are legacies of their anatomy of birth. For example, even though a patient may have had gender-confirming surgery, she may still need to

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routine health examinations, be honest, open, sensitive, supportive, and respectful. Those are the only real assessment skills you need for any patient, but particularly for transgender and genderfluid patients.

Why Transgender and Non-Binary Care Is so Important

have PSA (prostate-specific antigen) levels checked as she ages.” Some transgender patients— as with nontransgender patients—will be uncomfortable with their bodies, so it is important to respect any triggers that the physical exam may unearth. Try to establish a rapport before a genital exam. When taking a history, understand that genderfluid patients may have sex with any other gender, so don’t assume. Also, do not assume that the patient has had surgery or hor-

tal health issues and substance abuse should be included. Transgender individuals can experience isolation, and the need for hiding and secrets. Depression and anxiety are common. They may have suffered harassment or physical trauma. Referral for psychiatric illness and substance abuse treatment should be to a mental health provider with an understanding of trans care issues.” In many cases, assessing a transgender patient is like assessing any other. Nurses would follow these steps for any other

“One of the most important things nurses can do is be aware they may have some unconscious biases towards transgender individuals,” says Rosario-McCabe. mone replacement therapy or ever will. It is important to screen for STDs based on sexual activity as with any other sexually active patient. Halloran continues, “As with all patients, screening for men-

patient. The difference is getting over the mental hurdle for both the nurse and the patient, both of whom may be feeling nervous at the thought of invasive physical contact and questioning. When performing these

Minority Nurse | SUMMER 2017

Transgender care is important because this population is not getting the care that is needs. Like homosexual men in the early 90s, mainstream medicine doesn’t know exactly how to care for this community, and people suffer because of it. Our current political climate doesn’t help matters either, as more transgender people feel marginalized and are looking for a place to feel safe. They specifically look for medical providers who are trans-friendly, and that should honestly be all of them. Rubenstein agrees, “All medical staff—from doctors to nurses to assistants—should be well-versed in how to treat transgender people respectfully. Trainings should be led by trans people, to ensure that the information portrayed is accurate. Promote your office/ practice as trans-friendly. Even the most trans-friendly doctor in the world wouldn’t help the transgender community without first informing trans people that they provide transfriendly care. Most transgender people have experienced discrimination and oppression by doctors, and some of us avoid going to medical professionals who don’t explicitly promote themselves as trans-friendly. If a doctor is proficient in providing trans-competent care, include this information prominently online so trans people can access their care.”

Bias is also present, even in the most open-minded of nurses. “One of the most important things nurses can do is be aware they may have some unconscious biases towards transgender individuals,” says RosarioMcCabe. “Unconscious biases are those stereotypes about groups of people that individuals have outside their conscious awareness. Sabin, Riskind, and Nosek (2015) found nurses have the highest unconscious bias against members of the LGBTQ community. Interventions aimed at immersing oneself in transgender culture can help break barriers that contribute to unconscious bias. Interventions include continuing education on transgender health care issues, volunteering at local LGBT centers, and webinars.” It is only through realizing that the transgender community is present, that they have a problem with obtaining health care, and that nurses can help this marginalized community that any progress can be made. Many nurses have never even encountered a transgender patient—at least, not one that they knew of—and that has to change. Transgender people have the right to dignified, open, and sensitive health care just like anyone else. It is only through education and training that nurses, doctors, and the medical community as a whole will be able to move the community from marginalized into the realm of normalized. Lynda Lampert, RN, has worked medical-surgical, telemetry, and intensive care units in her career. She has been freelancing for five years and lives in western Pennsylvania with her family and pets.

TREATING YOU BETTER…FOR LIFE. Saint Peter’s University Hospital was founded in 1907 and is a member of the Saint Peter’s Healthcare System formed in 2007. Saint Peter’s University Hospital is a Joint Commission accredited 478 bed acute care teaching hospital sponsored by the Roman Catholic Diocese of Metuchen.

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How to Deal with Public Opinion When You’re on Strike When nurses go on strike, the reaction of patients and the community can be crucial to winning concessions from hospital management. If the public won’t support the strike, it’s fairly easy for management to ignore nurses’ concerns. BY LEIGH PAGE

Minority Nurse | SUMMER 2017

he public has been exposed to a number of nurses’ strikes lately. According to news reports, nursing unions announced at least 11 strikes in 2016. They targeted institutions such as Kaiser Permanente, Stanford Health Care, and Sharp HealthCare in California; Allina Health in Minnesota; Catholic Health in New York State; and Brigham and Women’s Hospital in Boston. Four of the announced strikes were called off when management made concessions. Union leaders say this happens in large part when unions reach out to the community. “We’re always concerned about how the public would see a strike,” says Denise Duncan, RN, president of United Nurses Associations of California/ Union of Health Care Professionals (UNAC/UHCP), which

profile and explain issues from the patient’s point of view. “We work very hard to develop a relationship with the community,” says Duncan, noting that over the years, members of her union have done everything from providing health care screenings to packing meals for the homeless in San Diego. “But when negotiations for a new contract with Sharp ground to a halt last fall, the union—representing almost 5,000 nurses at Sharp—needed to develop new ways to connect with the public,” says Jeff Rogers, spokesman for UNAC/ UHCP. “Sharp is a big deal in San Diego,” says Rogers. “They advertise a lot, they are very well known, and there was a lot of media interest in the negotiations.” To make its presence felt, the

People tend to like nurses more than hospital executives, but it is not a given that the public will side with nurses in labor disputes. called off a strike against Sharp in San Diego in November. “Our communities have to trust us,” she explains. Gaining the public’s trust can be challenging because people may have a mixed view of nurses’ strikes. Americans highly respect nurses, but many of them don’t like unions and frown on striking. And when nursing care is withheld during a strike, people can get anxious about patient safety.

The Sharp Experience To win over the community, unions need to maintain a high

union decided it would crash Sharp’s 16th annual “all-staff assembly.” Each year, in what Rogers describes as a corporate pep rally, thousands of employees and volunteers gather at the San Diego Convention Center to celebrate “The Sharp Experience.” The union announced it would simultaneously hold a darker version of the rally just outside the convention center. In what they called “The Real Sharp Experience,” Sharp nurses would talk about long hours and high turnover due to low pay. Citing this planned disrup-

tion, Sharp cancelled its mega event, but the union went ahead with its event. “It turned out to be a good move,” says

tions, the strike was called off, and both sides hammered out a new contract. Details of the contract have not been

The public may be offended by strikes that focus on higher wages and benefits, so the issues of a strike need to be related to patients’ issues, says Cortez. Rogers, because the union got the full attention of local media outlets that had already planned to cover the Sharp event. But the nurses also needed to win the public debate. At a press conference, Rogers says, “Sharp management provided plenty of data purporting that its turnover rate and wage scale were not out of line.” The media began using Sharp’s numbers in its regular reporting on the negotiations. Union nurses went on air to counter Sharp’s story. Soon media reports were starting with the nurses’ version while Sharp’s version took second place, according to Rogers. Based on strong membership backing, the union planned a three-day strike and gave Sharp the required ten-day notice. In many labor disputes, management backs down after it gets the ten-day notice. At this point, the hospital has to commit to bringing in replacement nurses to work during the strike, which can cost millions of dollars. Management weighs these costs against the costs of nurses’ demands and often decides to accept the latter. This happened at Brigham and Women’s, Catholic Health, and Stanford last year, and it also happened at Sharp. Sharp reopened negotia-

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released, but the union says it won significant concessions.

It Can Be the Nurses’ Game to Lose People tend to like nurses more than hospital executives, but it is not a given that the public will side with nurses in labor disputes. The negotiations leading up to a strike are the nurses’ game to lose. “Our patients know that we care a lot for them, but you always have to pay attention to what the community is thinking,” says Zenei Cortez, RN, a Filipino American who is copresident of the California Nurses Association, which struck against Kaiser Permanente in March and June. Patients’ preference for nurses comes out strongly in interviews. When a San Diego TV station asked the son of a Sharp hospital patient what he thought about the impending strike, he said he hoped the hospital would give the nurses what they were asking for. In Gallup polls for the past 15 years in a row, nurses have been rated the most honest profession of all. In the latest Gallup poll, conducted in December 2016, 84% of Americans found nurses’ honesty and ethical standards to be “very high” or “high.”

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On the other hand, many Americans are skeptical of unions–their ability to strike, and their impact on patient safety. Although 56% of Americans approved of unions in an August 2016 Gallup poll, 36% did not.

Don’t Put Nurses’ Interests First “The public may be offended by strikes that focus on higher wages and benefits, so the issues of a strike need to be related to patients’ issues,” says Cortez. But it’s easy to link nurses’ financial concerns with patient safety. “Low nurse pay means they cannot attract experienced nurses, which affects quality,” she adds. However, Cortez doesn’t see wages and benefits as the main reason for striking. “The

always some nurses who cross the picket lines, and they are often jeered by picketers—a scene that, when captured on the evening news, can make them look like bullies. “Nurses who cross the picket perhaps unfairly reap the benefits of a successful strike without ever participating in it,” Peterson says, but “they shouldn’t be hassled and stopped at the picket line. It’s never right to be a bully.” Many union leaders, however, put solidarity first. “There’s never an excuse to cross the picket line, never,” says Ann Converso, RN, former president of United American Nurses, which became part of National Nurses United in 2009. She adds that if a friend crossed the picket line, “She would not be my friend any longer.”

Nurses who cross the picket perhaps unfairly reap the benefits of a successful strike without ever participating in it, Peterson says, but “they shouldn’t be hassled and stopped at the picket line. It’s never right to be a bully.” main issue tends to be working conditions, such as poor staffing levels,” she says. This view is echoed by Cheryl Peterson, MSN, RN, vice president for nursing programs at the American Nurses Association (ANA). “Studies show that nurses’ primary motivation is to meet patients’ needs, and wages and benefits are typically lower on the list,” she says. Like their stance on wages, nursing unions can run afoul of public opinion if they pressure wayward members to support the strike. There are

If members can’t afford to lose pay during a strike, “We have actually facilitated them getting other work,” Converso says. “They can get a job at a grocery store or an outpatient emergency clinic.” In addition, some unions have strike funds that can pay financially strapped members.

Is It Ethical to Strike? Strikes in health care are treated differently from strikes in other fields because they can endanger patients. For this reason, only strikes in the health care sector require

Minority Nurse | SUMMER 2017

a ten-day notice. Viewing this risk to patients, should nurses be striking at all? “Yes,” argues Peterson, who was a labor lobbyist at the ANA when it was more involved with unions. She says it’s a matter of balancing the risks of walking out against the risks of staying on.

Concerns About Patient Safety Of all the concerns the public may have about striking, the risk to patients is probably the most pressing. Last fall, during a 30-day strike against Allina Health in Minnesota, a patient was seriously injured when a re-

Of all the concerns the public may have about striking, the risk to patients is probably the most pressing. Peterson says the ANA Code of Ethics indicates that if nurses are exposed to poor working conditions, they are not obligated to continue working, even if it means withholding care from patients. “In fact, the ANA code says nurses are obligated to remove that harm by means that could include striking,” she adds. Nursing union leaders also argue that the risks of striking should be compared with potential improvements in patient safety from the strike. If it is successful, the union can win concessions like better more robust staffing, which has been shown to improve care, according to a 2015 ANA white paper cited by Peterson. “Patient deaths are a risk of strikes, but if you win your strike and get staffing improvements, you will have lower the mortality in the long-term,” Converso says. In fact, unions have been directly linked to better patient outcomes. Newly unionized hospitals had a better patient safety record than hospitals where unionization failed, according to a 2014 analysis by the Institute for the Study of Labor.

placement nurse administered a drug incorrectly. During the strike, patient deaths in Allina hospitals increased by 17%, according to an analysis by the Star Tribune. That’s an alarming statistic, but it’s similar to the findings of a 2010 study of nurses’ strikes at hospitals in New York State. That study, published in the American Economic Journal: Economic Policy, found that patient deaths rose by almost 20% and 30-day readmissions by 6.5%. Cortez, the union leader in California, recognizes that strikes impact patient safety, but she blames it on the hospitals. “The hospital compromises the safety of the patient because it chooses to hire replacement nurses,” she says. Hospitals can raise risks based on the number of replacement nurses they pay for, the expertise these nurses have, and how much training they get in hospital-specific protocols. Moreover, even after the strike has ended, hospitals routinely lock nurses out for several more days to satisfy contracts with replacement agencies that typically have a five-day minimum. For exam-

ple, before the strike against Brigham and Women’s was called off in June, the hospital said it would keep replacement nurses working after the strike was over. Patients can die during lockouts. A patient death after the end of a 2011 nurses’ strike at Alta Bates Summit Medical Center in Oakland, California, was attributed to a replacement nurse administering an incorrect dosage.

is another safety measure, because it limits the chances of patient injury. Unfortunately, many hospitals negate the ef-

against Catholic Health in Buffalo, New York. “We spent probably a year preparing the public and our

fect by locking out strikers for several more days to satisfy contracts with replacement companies.

members for a strike,” she says. Having retired from United American Nurses, Converso has been working for a nurses’ local of the Communications Workers of America, which called for a strike against the three-hospital Catholic system. She says nurses felt betrayed by management. “When Catholic Health fell into financial problems in 2012, the union agreed to substantial concessions, including the elimination of daily overtime, cost-of-liv-

Offering Protections During a Strike Nurses’ unions need to directly address concerns about patient safety. Rogers says that when Sharp nurses were preparing for their strike, their constant message to the public was, “We will do whatever it takes to protect our patients.” Backing up its pledge, the union offered to provide a “rapid response team” during the strike—nurses in specialties like emergency medicine and critical care who would cross the picket lines if Sharp needed them, Rogers says. Similarly, during the Kaiser strike, Cortez says the union assembled a “patient care task force” of specialized nurses whose skills might be hard to match with replacement nurses. But when the offer

Striking for just one day—an increasingly common strategy for nurses’ unions—is another safety measure, because it limits the chances of patient injury. is made, she says, “We’re often told these nurses are not needed.” Striking for just one day— an increasingly common strategy for nurses’ unions—

Prepare the Public Early On “Unions should prepare the public far in advance for the possibility of a strike,” says Converso, who was an organizer in the planned strike

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ing increases, bonus pay for nurses who came in on short notice, and seniority-based wage scales,” Converso says. By 2015, Catholic Health had recovered and had $340 million cash on hand, but she says management showed little interest in restoring the lost benefits. Meanwhile, administrators were getting bonuses for cutting wages and benefits, according to Converso. With contracts coming up for renewal in the next year, the union began to make its case against Catholic Health to the community. “Our goal was to be everywhere,” Converso recalls. “I remember handing out flyers for two hours at a Bruce Springsteen concert when it was 30 degrees and sleeting.” She thinks the union’s most effective weapon was the “Fat Cat,” a 15-foot inflatable cartoon cat holding a cigar in one hand and strangling a nurse in the other. “We put it up all over Buffalo,” she says. The “Fat Cat” was featured in a Labor Day parade that went right past Catholic Health’s flagship hospital. “Management hated the Fat Cat,” Converso recalls. Just before the strike deadline, Catholic Health offered a contract that restored wage scales. The union accepted the contract and called off the strike. Its outreach to the community had paid off. Leigh Page is a Chicago-based freelance writer specializing in health care topics.

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THE NURSEâ&#x20AC;&#x2122;S PATH TO WELLNESS BY JEBRA TURNER

Minority Nurse | SUMMER 2017

Are you participating in a workplace wellness program? Most large integrated health systems, hospitals, or clinics have one. Employers use a “carrots and sticks” approach to address conditions such as high blood pressure and diabetes, which are higher in African American and other minority communities. Minority nurse employees may be hesitant to take part in these programs for a variety of reasons, including concerns about privacy and resistance to meeting some arbitrary corporate health standard. It’s not easy to lower BMI, for instance, when you routinely work 12-hour shifts, overtime, and switch from day to night schedules. And yet, you may have to try because to opt out or to fail may cost you thousands of dollars.

ere are our top wellness program tips for health care workers— because health doesn’t always come easy.

1. Learn What Type of Wellness Programs Various Employers Offer Many organizations have some type of wellness offering, although the particulars may vary greatly. Betsey Banker, a wellness market specialist at Ergotron, Inc., says, “It’s estimated that more than two-thirds of U.S. employers are offering wellness programs as part of their benefits packages. Programs are evolving to take a more holistic approach to health—both financial and physical health, stress and mindfulness, nutrition, sleep, and so on.” According to the Society for Human Resource Management, in addition to fiscal savings, employers count on these programs to help them recruit and retain talent. Paradoxically, hospitals and other health care organizations are not trailblazers when it

comes to wellness for their employees. Some of the best wellness programs within the health care sector can be found at MD Anderson Cancer Center, Yale-New Haven Hospital, Mayo Clinic, UCLA Medical, and Kaiser Permanente. Take a look at their websites and then benchmark your own hospital’s wellness program against the best.

2. Check Out Your Own State of Health and Well-Being According to research by Truven Health Analytics, hospital employees are among the least healthy and most expensive to insure. Why? Workers have more multiple health

tend to access in the costliest manner: Emergency room visits. Hospital employees are also less likely to get health screenings or to consult a clinician in order to manage chronic conditions and avoid hospital admissions.

3. Make Sure to Move It, Move It, Move It “Exercise is especially important for minority nurses,” says Austin Nation, PhD, MSN, PHN, RN, an assistant professor at California State University, Fullerton. (It reduces the incidence of obesity, diabetes, heart disease, high BP, stress, etc.) “Nurses think that because they work

Paradoxically, hospitals and other health care organizations are not trailblazers when it comes to wellness for their employees. conditions, such as asthma, obesity, diabetes, hypertension, and depression than in other fields. Of course, that requires more health care, which they

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a 12-hour shift they will spend a lot of time walking so they don’t need to do any other exercise,” he says. Yet, they aren’t getting a cardiovascular

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Wellness Offerings at a Variety of Workplaces—How Does Your Facility Compare?  24-hour fitness centers on-site

 Library of general health books

 24-hour nursing hotline

 Lunchtime intramurals, like soccer

 Adoption and surrogacy help

 Meditation rooms

 Affordable coverage for families (sometimes parents!)

 Mindfulness classes

 Afternoon Pilates on the green roof

 Natural lighting

 Back-up childcare (when regular care arrangements fall through)

 Nutritious food in vending machines

 Nap rooms

 Basketball and golf leagues

 On-site access to chiropractor, massage therapist, or physical therapist

 Bike-to-work reimbursement

 On-site acupressure

 Breastfeeding classes

 On-site child development program

 Breast-milk shipping for nursing mothers traveling

 On-site farmers’ markets

 Bring your dog to work  Cash for newborn expenses  Club for vegetarians  Collaboration spaces  Color-coded salad bar (green = healthy choices)

 Paid sabbaticals  Personal health coaching  Plant life to suggest nature  Raw-food bar  Season passes to local ski lifts  Second-to-none health care benefits

 Daily meditation break

 Smoking cessation programs

 Drop-in nursing care for sick children

 Subsidized, prepackaged meals that are healthy and low-cost

 Egg freezing (delay pregnancy)  Flexible work arrangements  Food in cafeteria is locally sourced and sustainably produced

 Telecommuting  Terraces and other outdoor areas  Tobacco-free campus

 Four months of new parent leave

 Travel and vacation discounts

 Free flu shots

 Treadmill desks

 Free generic prescriptions

 Unlimited vacation days

 Free nutritional counseling

 Use of company-owned gliders, kayaks, and stand-up paddleboards

 Free primary medical care  Free spin classes

 Vending machines stocked 50% + with healthy food

 Fridge stocked with waters and fruit juices

 Volleyball court

 Grain bowls in the cafeteria

 Walking meetings

 Health screenings

 WELL-certified facility (ergonomic furniture, VOC-free paint, etc.)

 High-risk employees can access physiologist, dietitian, home visits

 Wellness centers

 Indoor rock wall  In-house massages  Lap pool

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 Wellness coaching  World-class tracks and trails

workout, or increasing flexibility or strength. “Maybe you ran your butt off at work, but that doesn’t mean you don’t need to go to a gym.” He was pleasantly surprised to find out about an on-site gym at a new workplace. “A gym says to me ‘This is a corporation that cares enough about employees to provide it.’” Nation remembers only one other hospital offering an on-site gym during his 30-year nursing career. “Not many hospitals invest in employees that way,” he explains.

4. Join with Coworkers on a Journey of Wellness Some hospitals do a tremendous job of promoting a culture of wellness with a wide variety of program options for nurses. “It’s no secret that nurses routinely work 10- or 12-hour shifts, rotate shifts, or work nights, which can be exhausting. I meet nurses who are burned out and they’re not fun to work with. It’s hard to be in that nurse role unless you come from a place of well-being,” says Anna Dermenchyan, RN, BSN, CCRN-K, a senior clinical quality specialist in the Department of Medicine at UCLA Health and a PhD student at UCLA School of Nursing. Inspiring coworkers to wellness is one way to ensure your own healthy, happy workplace. “In the ICU, where I worked before, the unit’s Spirit Committee would host special breakfasts for the night and day shift and staff were encouraged to give out high-five cards to nurses who’d done good work,” Dermenchyan adds. “This supported a culture of caring for one another as well as created a work environment that was collaborative.”

5. Like the Airlines Instruct: Put Your Own Oxygen Mask on First Before Assisting Others Nurses shoulder the stress and burden of taking care of patients and often their own family members, but when it comes to attending to personal well-being . . . they can be lax. “We see so much on the job, including ethical issues, that can lead to moral distress, and

Nurses have to accept that reducing personal and professional stress is a key part of taking care of themselves—and ultimately, others. Hospitals can help provide stress relief for employees by planning spaces such as quiet (e.g., cellphone-free) lounges, meditation rooms, or prayer chapels. Take advantage of any quiet and peaceful environments as

“Nurses think that because they work a 12-hour shift they will spend a lot of time walking so they don’t need to do any other exercise,” he says. Yet, they aren’t getting a cardiovascular workout, or increasing flexibility or strength. if we don’t have someone to talk to about it, it affects us deeply,” Dermenchyan says.

often as you can. “I would visit the meditation room when I was a staff nurse. I would prac-

tice deep breathing and get centered before going back on the floor to take care of patients,” says Dermenchyan.

provided Reiki and essential oils to them and what was an extremely sad experience was made less painful.”

6. Check Out Complementary or Holistic Wellness Modalities, Too

7. Protect Your Body Against Aches, Pains, and Injury from Overstress

“A few years ago, I trained in Urban Zen Integrative Therapy along with many other members of the health care team,” says Dermenchyan. “It’s a combination of yoga, Reiki, essential oils, and contemplative care. Urban Zen is meant for patients who feel pain, anxiety, nausea, insomnia, constipation, and exhaustion—that’s pretty much any patient in a hospital—and they do feel so much better after receiving the therapy. I remember one patient who was brain-dead and the family wanted to stay and say their goodbyes. We

Many of the ordinary tasks that nurses engage in can cause injury without proper body mechanics. “There is a strong correlation between hurry and injury,” says Carrie Schmitz, senior manager of human factors and ergonomics research at Ergotron, Inc. “Working at top speed without a break may seem to make your day go faster, but you also risk many stress factors.” A survey of 250 nurses shows how an ordinary activity such as electronic health record charting for three to four hours a day may lead to burnout. Nurses

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The Cost of Wellness Workplace wellness programs have been popular for decades but really took off with the Affordable Care Act, which encouraged employers to implement them. After all, who isn’t in favor of “wellness?” Turns out, many industry watchdogs, worker unions, and health advocacy organizations aren’t. The Preventive Health Partnership (the American Cancer Society, the American Diabetes Association, and the American Heart Association) has criticized wellness programs for penalizing sick and vulnerable employees. Critics see wellness programs as a sneaky way for employers to cut their own health care costs by shifting them onto employees through the use of financial disincentives and penalties. Company disincentives for employees who don’t participate or meet health standards can run up to 30% of the cost of employee insurance premiums, deductibles, and so forth. (Even higher—up to 50%— if tobacco-related.) Won’t get a biometric screening? Can’t quit smoking? Haven’t lowered your cholesterol? Beware, there may be a sizeable penalty.

reported that fatigue resulted in: (a) modifying or limiting their activity/movement on the job (22%), (b) distraction (17%), and (c) needing more

not want to disclose personal information. “One assessment asked women ‘Are you planning to get pregnant?’ My routine advice in those cases is to lie,”

Nurses have to accept that reducing personal and professional stress is a key part of taking care of themselves—and ultimately, others. assistance from other staff (14%). Take an inventory of other tasks you perform that may be stressing you out just as much and find ways to relieve that pressure.

8. Guard Your Privacy— You Never Know How That Data Will Be Used When wellness programs demand employees fill out a health risk assessment, you may

says Vik Khanna, chief operating officer of Quizzify.com and a critic of the wellness industry. “They have no business knowing if you have a martini when you get home from work. No other industry in America that accesses so much private information about Americans is so poorly regulated and policed. We know that computers and memory sticks with wellness vendors’ data have been stolen.”

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Requiring workers to answer personal questions in a health questionnaire— including if they ever feel depressed and whether they’ve

Also, workplace “weight loss challenges” and other gimmicks that encourage crash dieting are dangerous, according to a 2015 study published

“One assessment asked women ‘Are you planning to get pregnant?’ My routine advice in those cases is to lie,” says Vik Khanna, chief operating officer of Quizzify.com and a critic of the wellness industry. been diagnosed with certain illnesses—can violate federal law if it involves disabilities, says Khanna. “The work done by many wellness vendors does not meet the legal criteria necessary for HIPAA to apply. They should have a privacy provision and a firewall, but . . . do they surreptitiously share information with the employer?” he wonders. Khanna advises that nurses always consider whether an answer or action could be used against them. For example, decline when employers require you to wear an activity-tracking device or swipe a card to track gym visits. “Stay away from any tracking element. That data is going somewhere, but where?” he asks.

9. Drive Your Own Wellness Efforts, in a Group or by Yourself Once you decide on a condition you’d like to change, such as obesity, what’s the best way to do something about it? Workplace consultant Jon Robison, PhD, MD, MA, CIC, of Salveo Partners says, “If a nurse has a BMI of more than 25, she will often get referred to Weight Watchers, which, like every other weight loss program, has only about a 5% success rate” over the long term.

in The American Journal of Managed Care. Instead, Robison recommends Health at Every Size (haescommunity.com), an approach which encourages self-acceptance, sustainable physical activity, and mindful eating. “People can be healthy at a wide variety of weights. Just because a nurse has a higher BMI doesn’t mean that person is not a great nurse and a healthy one. Assuming otherwise is scientifically bereft and just so unfair,” he adds.

10. Nurses Can Lead the Charge for a Well Workplace Even if you’re not in a leadership position, you can drive a healthier work culture and environment. To become a wellness champion, first do a survey of what’s important to you and your coworkers. Then share that wish list with management. If you have a passion for something, such as sit-stand desks or healthy vending machine snacks, it’ll be easier to recruit others to your point of view. And who knows, you may have a whole department of health champions soon. Jebra Turner is a freelance writer in Portland, Oregon. Visit her at www.jebra.com.

YO U DON T H AV E T O BE SO STRONG BUT IF Iâ&#x20AC;&#x2122;M NOT, WHO WILL?

Being a caregiver takes a special kind of commitment. We know your strength is super, but youâ&#x20AC;&#x2122;re still human.

A A R P. O R G / C A R E G I V I N G 1 - 8 7 7 - 3 3 3 - 5 8 8 5

F I N D S U P P O R T F O R Y O U R S T R E N G T H.

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Academic Forum

Coping with Incivility: Tips for New Nursing Faculty BY CHERYL GREEN, PHD, DNP, RN, LCSW

In 2015, the National League of Nursing noted that the average age of full-time nurse for resigning a nurse educator educators was 46–60 years. “The average age of nursing faculty is rising, and the position. number of faculty retiring is greater than the number entering academic nursing,” What Does Incivility according to a 2013 study published in the Journal of Professional Nursing. The Look Like? Kathleen T. Heinrich, PhD, availability of nursing faculty in academia impacts nursing shortages. RN, noted behaviors associated with faculty incivility included the following: misrepresenting, shaming, splitting, blaming, joy stealing (the way someone feels after experiencing incivility), mandating, excluding, breaking boundaries, lying, setting up, devaluing, and distorting. Victims of facultyto-faculty incivility can begin to question their own abilities despite histories of personal and academic success. Sleep disturbances, appetite changes, gastrointestinal health problems, depression, and anxiety may develop, as the persistent uncivil acts experienced by the affected faculty member render them confused, frustrated, and at times, helpless and hopeless.

Breaking the Silence

ursing education is a discipline that requires collaborative teamwork, independent drive, and commitment. Faculty are required to write scholarly papers, demonstrate involvement within the institution and surrounding community, as well as teach within the classroom, laboratory, simulation, and clinical settings. However, comparatively, nursing faculty are paid significantly lower salaries than their professional

counterparts working within clinical environments.

What Is Incivility? Incivility researcher Anya Bostian Peters has defined it as a deliberate discourtesy toward another that wounds one’s self-esteem and creates doubt about his or her abilities. Lloyd J. Feldmann identified three psychological factors in which incivility presents itself in higher education: (a) a need to express power over another, (b)

a need for verbal release due to frustration over an apparently unsolvable situation, or (c) a need to obtain something of value. A 2013 study published in the Journal of

The experience of incivility within nursing education can be difficult. Emotionally affected faculty are vulnerable. Depression and physical illness can result, and the workplace itself becomes an environment of hostility and a source of stress. It is imperative that the

It is imperative that the affected faculty seek help immediately. Nursing Education noted that faculty-to-faculty incivility was the primary reason given

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affected faculty seek help immediately. However, the academic setting in itself can feel

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Academic Forum

Do not allow the incivility of a person or persons to affect your life, nor steal your joy. isolating, particularly for new (or junior) faculty. Collegial relationships have been formed among senior faculty that may be the source of the incivility and investigation followed by progressive discipline does not often occur as it does in traditional clinical settings such as hospitals. Affected faculty and peers seeking tenure may also be afraid to openly discuss the issue for fear of retribution.

The Incivility Survival Tips So, how then does a faculty experiencing incivility survive and thrive? 1. Share with a spouse or close friend what you

Minority Nurse | SUMMER 2017

are experiencing and how it makes you feel. Doing this can assist you in bringing clarity to the situation. 2. Write down dates, location, and times that the faculty-to-faculty acts of incivility events have occurred. Document who was involved and what was said. 3. If you feel emotionally and physically safe, meet with the person who is exhibiting the uncivil behavior and ask for clarity and understanding of why the behavior is occurring. If this does not resolve the behavior, discuss the issue with your chairperson. 4. If the chairperson is unable to resolve the issue, contact your faculty senate/union representative for assistance. Continue

to document uncivil faculty-to-faculty encounters. 5. Contact your Human Resources Department (and/or Diversity Department if sexual, race, sex, or age discrimination may be suspected factors) and file a formal complaint. 6. If you are having a difficult time handling the stress of the workplace incivility you have experienced, consider seeing a therapist. 7. Focus on your strengths. If you are a person of faith, pray. Spend time with people who love and support you like family, close friends, or a spiritual community. 8. Exercise daily and eat healthy. 9. Take the time to personally review your own accomplishments. You would not have obtained an academic professor position if you were not deserving of it and qualified. 10. Do not allow the incivility of a person or persons to affect your life, nor steal your joy. Celebrate each day that arise to a new day. You are worth this and more.

harm. The disease of incivility must be stopped. If you are affected by incivility or witness uncivil acts against a colleague, speak up. Silence is never the answer.

Traditionally, nursing is a profession associated with advocating for others. Yet, among our own, the disease of incivility penetrates barriers in the mind and body, causing psychological and physical harm. Each year, literature on incivility within the nursing profession itself is growing. This growth can only occur when nurses fail to support each other and advocate for themselves and their peers. The allowance of horizontal and lateral violence within the workplace should not be tolerated. If you or someone you know is experiencing incivility, do not be silent and do not resign from a job that you enjoy as a resolution to a situation that you had no part in creating. You deserve better. Seek the help you need to survive and thrive in academia. Cheryl Green, PhD, DNP, RN,

Resolution

LCSW, CNL, is a nurse, clini-

The act of incivility occurring among nurse educators does not seem plausible. Nursing is a profession of caring. Traditionally, nursing is a profession associated with advocating for others. Yet, among our own, the disease of incivility penetrates barriers in the mind and body causing psychological and physical

cal social worker, and clinical Christian counselor. She presently works as a nurse leader at Yale–New Haven Hospital, is an adjunct professor at University of Bridgeport, and an assistant professor in the Department of Nursing at Southern Connecticut State University.

Academic Forum

Triple-Negative Breast Cancer and the Benefits of Community Outreach: A Minority Nurseâ&#x20AC;&#x2122;s Perspective BY PHYLLIS MORGAN, PhD, FNP-BC, CNE, FAANP

Breast cancer is one of the most diagnosed cancers among black women and is more deadly to blacks than any other ethnic or racial group. Triple-negative breast cancer (TNBC), a rare and aggressive form of the disease more prevalent in black women, is particularly deadly because of a lack of awareness as well as limited treatment options.

lack women have higher rates of TNBC in all age groups, a less favorable diagnosis, higher recurrence within three years of diagnosis, and higher mortality rates than other racial and ethnic groups. Although other studies have analyzed disparities in various factors related to TNBC diagnosis and treatment, a community/faith-based edu-

a project conducted of this nature in the black community in Prince William County, Virginia.

Community/Faith-Based TNBC Education Program This breast health education project, for which I was a grant writer and project manager, examined whether participants had an increased awareness about key issues

Black women have higher rates of TNBC in all age groups, a less favorable diagnosis, higher recurrence within three years of diagnosis, and higher mortality rates than other racial and ethnic groups. cational program designed to educate women about this particularly deadly form of breast cancer is lacking in the literature. As an African American woman and an advanced practice nurse, I have participated in many projects and studies to identify effective approaches to increase awareness, prevention, and treatment of health issues that impact my racial and ethnic group. This was a community effort to implement a funded project aimed at educating black women about TNBC and the risks and importance of early detection and mammography screening, which are vital for survival. There had never been www.minoritynurse.com

of TNBC following a breast cancer education program. Their knowledge was assessed through pre- and posttests, which addressed these three topics: 1. Knowledgeable about potential health concerns of TNBC 2. Awareness that TNBC is more common in blacks than whites 3. U n d e r s t a n d i n g t h a t TNBC is potentially one of the more aggressive and deadly forms of breast cancer The program worked with 450 black women who resided within 1 of 11 communities in Prince William or Stafford County in Virginia. Black

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Academic Forum women were recruited primarily through black churches as well as community, civic, and social activities. Participants were African American, Caribbean, Jamaican, and African women over the age of 38 years. Programs were implemented at black churches, and prayer and scripture were included before and after each program session. It is vital to acknowledge that faith and spirituality are important components of the black community. Following the pretest to assess black women’s existing knowledge about TNBC, an educational session began with a 5- to 10-minute personal testimony by a black breast cancer survivor, followed by an engaging question-and-answer session. The women then watched a short video clip entitled African American Women Can Beat Breast Cancer. Next, various physicians, including a medical oncologist, ra-

ics, which correlates to an increased awareness about the importance of mammograms and early diagnosis. Also, the findings indicated that a large percentage of the participants had discussed health issues with their doctor and that the most common source of par-

Literature supports that African American women are more comfortable relating their experience to health care practitioners who are from their same racial and ethnic or cultural background. diologist, and breast surgeon, taught a one-hour information session that focused on breast cancer statistics, TNBC, prevention, screening, diagnosis, and treatment. Last, there was another question-and-answer session, which was followed by the posttest.

Program Results This project demonstrated that educating black women about TNBC increased knowledge on all three tested top-

ticipants’ health information was from a doctor or nurse. Although the results of this project are encouraging, it’s important to note that the black women in this community/ faith-based project were predominantly middle to upper class, and a substantial majority possessed private health insurance. Additional projects of this nature should be conducted on black women without health insurance and with lower levels of household income.

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Call to Action Literature supports that African American women are more comfortable relating their experience to health care practitioners who are from their same racial and ethnic or cultural background. Also, community projects designed

with a faith-based, spiritual component can be most effective in changing beliefs, attitudes, and health behaviors of African Americans. Personally, I have found this information to be true in my research projects focused on African Americans. As a minority nurse, I am passionate about helping improve the health and well-being of people in my racial and ethnic group and promoting commu-

access, and treatment for minorities. This project demonstrated that black women want to be informed and can benefit greatly from breast health information about TNBC that is culturally appropriate and includes black nurses and health practitioners. It is my hope

that minority nurses continue to implement breast health educational programs for black women. Education is the key to saving lives! For more information about this TNBC community and faith-based project, please view the fall issue of JOCEPS, the journal of Chi Eta Phi Sorority, Inc., (59), Pages 6–10. Phyllis Morgan, PhD, FNP-BC, CNE, FAANP, is a nurse educator, certified family nurse practitioner, and researcher focused

Education is the key to saving lives!

on African American women’s health issues. She is the academic coordinator for the family nurse practitioner specialization

nity partnerships to examine ways to overcome the disparities in health care awareness,

at Walden University and a nurse practitioner for MinuteClinic in Northern Virginia.

Degrees of Success

From Nursing Student to Confident Nurse: The Importance of the Summer Externship BY DENISE GASALBERTI, PhD, RN

Summer student nurse externships have been praised by many for easing the transition of the novice nurse from school to the realities of the workplace. Although budgetary constraints may limit the duration of traditional orientation periods as new graduates are coping with more and more orientation material to master from electronic medical records to ever expanding institutional policy, the summer externship offers nursing students a unique professional opportunity. Additionally, novice nurses are coping with learning a new workplace culture and some find the process to be a difficult one. A summer externship is one way that the student nurse can build the confidence to approach the first nursing job.

ne such student nurse externship is a longstanding partnership with Johns Hopkins in Baltimore, Maryland, and Wagner College in Staten Island, New York. This program is sponsored by a generous donor. The externs are provided

tions from two clinical faculty members. Applicants must be in good standing in all nursing courses and have a minimum of a 3.2 GPA. During the fall semester, the Hopkins externs from the previous summer meet with interested junior nursing

A summer externship is one way that the student nurse can build the confidence to approach the first nursing job. with an apartment free of cost to them and are paid for hours worked. This program provides students the opportunity to use their skills in the clinical area, transition to the hospital setting, and socialize into the culture of the workplace. Every fall semester, interested junior nursing students submit to the faculty a letter of intent with resume and recommenda-

students along with the nursing faculty liaison and the program administrator. This meeting generates a lot of positive energy and enthusiasm among potential applicants. At some point during the spring semester, after recipients have been notified of their acceptance, another meeting is held with the externs from the previous year and the new ex-

terns to prepare for the upcoming summer experience. The meeting teaches student nurses to give back to student nurses coming up behind them and to give back to the profession in general. This collegial discussion focuses specifically on the full-time, six- to eight-week paid position and life in the Baltimore area. Upon survey of these externs after graduation, all went on to be offered excellent positions upon graduation and attribute their success, in part, to having completed an externship. There are additional benefits besides gaining clinical experience. A qualitative study published in Nursing Education Perspectives found that some externs had a transformation of perceptions, values, and beliefs following their participation in an externship program. The authors point out that the externs had the experience of being part of a respected health care team while building their own skills and confidence. Additionally, some externship programs allow the student externs to receive academic credit for participating, such as Kaiser Permanente in Southern California. This could be beneficial in terms of time and money from the student perspective.

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For those interested in exploring an externship, the University of Pennsylvania Career Services Department has published an extensive list of available nurse externships online. They have identified excellent programs in nearly every state and encourage early applications. For example, the Atlantic Health System in New Jersey offers an externship opportunity as does Robert Wood Johnson University Hospital and CentraState Medical Center in South Jersey. In the New York area, NYU Langone Medical Center and New York-Presbyterian University Hospital of Columbia and Cornell offer programs as does Lenox Hill Hospital and Memorial SloanKettering Cancer Center. To see the complete list, visit www. vpul.upenn.edu/careerservices/ nursing/externships.php. Although there are various externship programs available through partnerships between schools and hospitals, student nurses should be made aware of them and encouraged to apply if they meet the application criteria. Denise Gasalberti, PhD, RN, is an associate professor with the Evelyn L. Spiro School of Nursing at Wagner College in Staten Island, New York.

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Health Policy

Achieving Health Equity Through Legislative Action BY JANICE M. PHILLIPS, PhD, FAAN, RN

Health disparities remain a serious concern for our country. Over the years, there has been increasing commitment to eliminating health disparities and, more recently, achieving health equity. Although government and nongovernmental entities as well as other stakeholders have devoted considerable effort and resources to eliminating health disparities, many populations still suffer disproportionately from poor health outcomes.

n recent years, the focus on reducing health disparities has evolved to include an emphasis on achieving health equity, eliminating health disparities, and improving the health of all popu-

to achieve health equity, determinants of health are personal, social, economic, and environmental factors known to influence health risks and health outcomes. Some even define the determinants of

Although government and nongovernmental entities as well as other stakeholders have devoted considerable effort and resources to eliminating health disparities, many populations still suffer disproportionately from poor health outcomes. lations regardless of race or ethnicity, sexual orientation, age, disability, socioeconomic status, immigration status, gender identity, English proficiency or, demographic factors associated with exclusion or discrimination. This expanded focus on health equity is articulated in Healthy People 2020 (www.healthypeople.gov) and includes an emphasis on achieving the highest level of health for everyone. Akin to the importance of achieving health for all is the need to examine and address the determinants of health. Now recognized as an integral component to any effort

health, also referred to as the sociodeterminants of health, as the conditions in the places where people live, learn, work, and play. Specifically, determinants of health are defined as access to high-quality and appropriate food, shelter, transportation, education, water, and outdoor airâ&#x20AC;&#x201D;all critical factors influencing a personâ&#x20AC;&#x2122;s overall well-being and health status.

Legislative Action Throughout history, legislation has played a key role in advancing the health disparities agenda and will continue to be of great impor-

Minority Nurse | SUMMER 2017

Throughout history, legislation has played a key role in advancing the health disparities agenda and will continue to be of great importance in years to come as we move toward achieving health equity.

tance in years to come as we move toward achieving health equity. Notably, the passage of the Affordable Care Act (ACA) of 2010 marked an historical milestone in our nationâ&#x20AC;&#x2122;s efforts to eliminate health dis-

parities by improving access to health care coverage. The ACA also included a number of other provisions specifically targeting racial and ethnic minorities. Since its passage, this landmark legislation has cov-

Health Policy ered nearly 20 million previously uninsured Americans, a large percentage of these are racial ethnic minorities. Last year, the Congressional Tri-Caucus (the Congressional

Akin to the importance of achieving health for all is the need to examine and address the determinants of health.

Black Caucus, Congressional Hispanic Caucus, and the Congressional Asian Pacific American Caucus) introduced the 2016 Health Equity and Accountability Act (HEAA). Designed to build on the improvements of the ACA, this proposed legislation serves as a road map for eliminating health disparities by providing federal resources, strengthening infrastructure, and creating specific policies focused on eliminating health disparities. The HEAA consists of the following Titles, all of which are focused on achieving health equity:

• Data collection and reporting • Culturally and linguistically appropriate health care • Health workforce diversity • Improvement of health care services • Improving health outcomes for women, children, and families • Mental health • Addressing high impact minority diseases • Health information technology • Accountability and evaluation • Addressing social determinants and improving environmental justice The HEEA has been introduced during each Congressional Session since 2007 and has informed health equity initiatives including ACA. Introduced in the House of Representatives on June 14, 2016, the HEEA was referred to the subcommittee on Health, Employment, Labor, and Pensions on September 19, 2016, for consideration. A detailed overview of the 2016 bill is located at www. govtrack.us/congress/bills/114/ hr5475/text.

Unfortunately, this legislation died in the 114th Congress because it was not enacted during the 114th congressional session. As with any legislation, identical versions of the Senate and House HEAA bill were required before sub-

mission to the President for final signature in order to become law. Just as in previous years, any new iterations of the HEEA will be of importance in our efforts to achieve health equity. Given that similar versions of the HEEA have continued to be introduced in Congress since 2007, lawmakers may propose similar legislation during the 115th congressional session. The 115th congressional session is scheduled to meet from January 3, 2017, to January 3, 2019. Janice M. Phillips, PhD, FAAN, RN, is the Director of Government and Regulatory Affairs at CGFNS International, Inc., in Philadelphia.

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The Funny Bone COMPILED BY MICHELE WOJCIECHOWSKI

At one time or another, every nurse has experienced something so funny and it becomes the tale he or she tells for the rest of their career. Enjoy the following hilarious stories sent in by your fellow nurses. Have a funny tale to tell? Email writer Michele Wojciechowski at MWojoWrites@comcast.net to share!

A Leg Up Many years ago, when patients were in multibed wards as opposed to the small rooms we have today, I had several patients in one area of the ward who were always inebriated. I kept watch on their visitors— suspicious of hidden contraband—but I didn’t find any unusual activity. One night, an elderly man with a well-healed, aboveknee amputation dragged his wooden leg prosthesis out from under his creaky old hospital bed. That’s when I saw that it was hollowed out. He reached into it and brought out a bottle of whiskey! The liquor was right there the whole time! —P.H., RN

Command-oh One day, I was in the hallway when a patient of mine with dementia—who was nonverbal 99% of the time—came out of her room wearing only her underwear and a shirt. “Hey, what are you up to?” I asked her. Stone-faced, she replied in

a monotone, “I’m waiting for you to tell me to put some clothes on.” Then she turned and walked away. —M.B., RN

Bed, Bath, and the Great Beyond When I was in nursing school 25 years ago, there was a male student nurse who was about 6’3”, 275 lb, and he was so soft-spoken—like a big teddy bear. During the first day of clinicals, he was given an elderly man as his patient, and he had to give him a bed bath. While he was giving him a bath, the patient died. The following week, he had another patient who also died. The third week, he had another patient assigned to him and that patient died as well. All of us began holding up our hands in the form of a cross, pretending to be patients, and saying, “Don’t let him be my nurse!” —J.D., RN

Minority Nurse | SUMMER 2017

Make a Call! One night in the CCU, a man lay in his bed diaphoretic, heart racing, with chest pain. He was crawling out of his skin, worried that he would die that night. The young doctors stood around his bed nervously discussing his condition and deciding what to do about it. The air in the room was thick with tension as everyone watched the cardiac monitor. The man, worried about his deteriorating condition and the youthfulness of his doctors, couldn’t take it anymore. He called out to them, “Guys! Guys! Why don’t you just call 911?!” —H.P., RN

The Worst Love Potion During my first year as a nurse, I was caring for a man in a four-bed room. He was well over 6 ft tall, and I was helping him to the commode after a dose of lactulose. Actually, he was running for it. I was trying to tell him not to sit down because there was

no bucket in the commode. He didn’t listen to me and proceeded to relieve himself, covering me in liquid stool. Then he looked me straight in the eye and said that he had feelings of love for me. Luckily, the years got better! —K.O., RN Do you have a funny story to share? It can be something that happened to you at work, while in nursing school, while teaching nursing school—practically anywhere, as long as it involves the nursing field. If so, contact Michele Wojciechowski at MWojoWrites@comcast.net. We may use your story in a future issue.

Academic Opportunities

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Academic Opportunities

Minority Nurse | SUMMER 2017

Academic Opportunities

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Academic Opportunities

Learn. Care. Lead. With one of the nationâ&#x20AC;&#x2122;s top nursing schools. Ranked #8 DNP & #11 MSN, U.S. News & World Report Best Grad Schools

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Academic Opportunities

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

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Academic Opportunities

LEADING THE WAY IN EDUCATION, RESEARCH AND PRACTICE â&#x20AC;&#x201C; LOCALLY AND GLOBALLY MASTER YOUR CAREER PATH The programs at Johns Hopkins School of Nursing open doors for you as a nurse and unlock your potential as a leader. The power of choice defines the very best of career education. No matter which path you choose, our interdisciplinary approach provides you with the tools to address changing health care needs as well as your leadership goals. Choose your path with a degree from the top-ranked Johns Hopkins School of Nursing Health Systems Management (MSN)* | Public Health Nursing (MSN) | MSN/MPH Joint Degree Advanced Practice DNP* | Executive DNP | PhD | Post-Graduate Certificates* *online options available

Learn More

nursing.jhu.edu/your_path

Minority Nurse | SUMMER 2017

Academic Opportunities

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Faculty Opportunities

Instructor/Assistant Professor (tenure track): The School of Nursing, Perimeter College, located in Clarkston, invites applications for full-time, tenure track faculty positions. The responsibilities in these 9-month and 12-month tenure track positions will include teaching in our associate degree program and participating in scholarly activities. Other responsibilities include student advisement and mentoring, as well as involvement in school, university and community service. Rank will be determined based on prior clinical experience. Minimum qualifications include: 1) Georgia RN license eligible; 2) master’s degree in nursing or related field and must be currently enrolled in 18 semester or 25 quarter hours in graduate nursing courses; and 3) a minimum of two years of nursing practice experience and teaching experience preferred.

Preferred areas clinical expertise include: • Obstetrics • Simulation • Mental Health Nursing • Pediatric Nursing

• Skills Laboratory • Medical Surgical Nursing • Childbearing Nursing

Log# 17-122

Nominations/applications are encouraged. Completed applications for these tenured track positions, including a letter of application, vitae, and contact information for three professional references, should be emailed to Kevette Woolfalk at kwoolfalk1@gsu.edu, using the subject line: Nursing Position Application. Questions regarding the position may be directed to the chair of the search committee, Veronica West, vwest@gsu.edu. Georgia State University, a unit of the University System of Georgia, is an equal opportunity educational institution and an equal opportunity/affirmative action employer and accommodates individuals with disabilities. All applicants must comply with the Immigration Reform and Control Act. Women and minorities are strongly encouraged to apply. An offer of employment will be contingent upon successful completion of a background report.

Index of Advertisers ADVERTISER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE # Civilian Corps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 AACN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2 AARP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Indian Health Service Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Aurora Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4 VCU Health System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 St. Peter’s Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Mercy Medical Center North Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 National Cancer Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 ACADEMIC OPPORTUNITIES Azusa Pacific University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Case Western Reserve University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Florida State University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Indiana Wesleyan University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Johns Hopkins School of Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Rutgers School of Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 UC Davis School of Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 FACULTY OPPORTUNITIES Georgia State University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Minority Nurse | SUMMER 2017

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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Change lives. Including your own.

At Aurora Health Care, we pride ourselves on taking care of our people. And not just our patients and community—we mean you, too. Because when you work at Aurora, you’re part of a dedicated team that’s as passionate about the work as you are. As the largest private employer in Wisconsin, we offer limitless opportunities for ongoing learning and career advancement, along with competitive compensation and a stable, secure work environment. But more than that, when you work for us, you get the chance to change lives every single day.

For more information and to apply, please visit www.aurorahealthcarecareers.org

We are an equal opportunity employer and maintain an environment that attracts, recruits, engages and retains a diverse workforce. x88612 (04/17) ©AHC