Minority Nurse Magazine (Winter 2015) by Springer Publishing Company

The Career and Education Resource for the Minority Nursing Professional • WINTER 2015

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Table of Contents

In Every Issue

Cover Story

Editorâ&#x20AC;&#x2122;s Notebook

Vital Signs

Making Rounds

Highlights from the Blog

find out what they look for in a workplace and how their current

Index of Advertisers

employers stack up. Find out whether yours made the list!

Academic Forum 39

Bridging to Higher Education in Haiti By Susan S. Sawyer, PhD, RN, CPNP, and Allison Bernard, DNP, MSN

Top 25 Nursing Employers of 2014 By Ethan LaCroix For the second year in a row, we reached out to our readers to

Features 10

Providing sustainable nursing education to a developing country is the cornerstone to the betterment of health care delivery.

Baby Boomers and Beyond: The Evolution of Nursing By Leigh Page As more baby boomers prepare to retire and more Americans gain health coverage, how will the nursing profession keep pace with a rapidly evolving health care system?

Second Opinion 44

Discovering the Possibilities: Where Can I Go From Here? By Samantha Stauf

Best Practices in Hospice Care By Sonya Stinson

If you are struggling to make a change, take a look at your strengths and the environment where you feel you could thrive.

Sometimes the most compassionate care a nurse can give to a dying patient is to quiet the room. Learn why communication is key to providing quality end-of-life care.

Degrees of Success 46

Transitioning from Clinical Nurse to Educator

Bullying in a Least Expected Place

By Deborah Dolan Hunt, PhD, RN

By James Z. Daniels

Looking to join the world of academia? There are several paths you can follow to get there.

Hostility in the workplace is increasingly common in the health care sector and diverse studies identify nursing as a risk group. What can we do about it?

Minority Nurse | WINTER 2015

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

The Pursuit of Career Satisfaction

n our second annual best companies survey, we asked Minority Nurse readers to tell us about their current employers. What qualities matter most to you when it comes to career satisfaction? It should come to no surprise that salary and benefits topped the list. However, our readers also considered the bigger picture. Quality of life factored heavily into their decisions as well, such as a friendly work environment and flexible hours. Nurses may work longer hours than the 9-to-5 crowd, but they still want a proper work/life balance. Is your employer on our top 25 list? If not, ask yourself whether they deserve to be—and if not—consider applying to one of these standout organizations. As a nurse, helping people likely tops the list of reasons you got into the profession. Are you ready for a change and looking for a deeper connection with your patients? Consider a career in hospice nursing. Helping dying patients is not for the faint of heart, but easing them in their transition can be extremely rewarding. Read Sonya Stinson’s article on what it takes to provide quality end-of-life care and decide whether this is right for you. Alternatively, consider joining the world of academia, which comes with its own set of challenges and rewards. Not sure how to make the transition from clinical practice? Deborah Dolan Hunt, author of The New Nurse Educator: Mastering Academe, acts as your guide and gives you practical advice for taking the steps necessary to make this transition. As the baby boomer population comes closer to retiring, we’ll start to see a surge of new nurses in the workplace. For many, the nursing shortage has seemed like a myth, but as Leigh Page indicates in his article, it’s still on the horizon. It’s only been delayed due to a weak economy and uncertainty over our new health care law. But as baby boomer nurses retire and a new wave of patients seeks health care services, there will be sweeping changes to the profession. Read Leigh’s article to find out more. We’ve all heard the expression that nurses eat their young. But if you’ve ever been on the receiving end, you know it doesn’t get any easier the older you are. Workplace bullying in health care is alarmingly common, and nurses in particular are at risk. James Daniels investigates why this is and what we can do to make the work environment safer—and happier—for all. The next time you find yourself wanting to point the finger at someone who made a mistake, take a moment to consider what’s going on in your colleague’s life first. Maybe she’s going through a divorce, getting over the loss of a loved one, or dealing with a health issue of her own. If anger has a domino effect, why can’t kindness too? Apply the Golden Rule to your workplace, and everyone—including your patients— will benefit.

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

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

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Vital Signs

Even With Equal Health Care Access, Cancer Survival Rates Are Worse in American Indians and Alaskan Natives Five- and 10-year cancer survival rates were lower among American Indians and Alaskan Natives (AIANs) compared with non-Hispanic whites even when they had approximately equal access to health care, according to data presented at the American Association for Cancer Research conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.

“O

ur preliminary analysis suggests that with presumed equal access to health care, five- and 10-year cancer survival among mostly urban-dwelling AIANs was lower than among nonHispanic whites,” says Marc Emerson, MPH, a cancer research training award fellow in the Division of Cancer Control and Population Sciences at the National Cancer Institute in Bethesda, Maryland. “Our

Minority Nurse | WINTER 2015

study focused on AIANs who live largely in urban areas, a population often hidden to researchers. “The AIAN population experiences some of the greatest disparities in health and health outcomes, yet this remains an understudied area of research,” adds Emerson. “Future research should focus on factors other than health care access that may be driving disparity in the cancer outcomes observed.”

Emerson and colleagues found that the top four cancer diagnoses among AIANs and non-Hispanic whites were the same: prostate, breast, lung, and colorectal cancers. The fifth most common cancer type among AIANs was nonHodgkin lymphoma, while it was melanoma for non-Hispanic whites. The researchers also found that the five-year survival rates for AIANs and non-Hispanic whites were 52% and 58%, respectively, and the 10-year survival rates were 37% and 44%, respectively. The most common comorbidities were the same for both races—chronic pulmonary disease, diabetes, and congestive heart disease—but the rates of these comorbidities were higher among AIANs compared with non-Hispanic whites.

“In future analyses, we will examine the extent to which prevalence of comorbidities and other factors may account for the survival differences observed,” says Emerson. The researchers collected data from Kaiser Permanente Northern California electronic health records for 1,022 AIANs and 139,725 non-Hispanic whites diagnosed with primary invasive cancer between 1997 and 2012. They used sociodemographic and health data of the study participants, including age at diagnosis, race, cancer site, type of treatment, comorbidities, and treatment follow-up time, for their study. This study was funded by the National Cancer Institute.

Vital Signs

Millions of US Women Are Not Getting Screened for Cervical Cancer Despite evidence that cervical cancer screening saves lives, about 8 million women ages 21 to 65 years have not been screened for cervical cancer in the past five years, according to a new Vital Signs report from the Centers for Disease Control and Prevention (CDC). More than half of new cervical cancer cases occur among women who have never or rarely been screened.

“E

very visit to a provider can be an opportunity to prevent cervical cancer by making sure women are referred for screening appropriately,” says CDC Principal Deputy Director Ileana Arias, PhD. “We must increase our efforts to make sure that all women understand the importance of getting screened for cervical cancer. No woman should die from cervical cancer.” Researchers reviewed data from the 2012 Behavioral Risk Factor Surveillance System to determine women who had not been screened for cervical cancer in the past five years. They analyzed the number of cervical cancer cases that occurred during 2007 to 2011 from CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Cervical cancer deaths were based on death certificates submitted to the National Vital Statistics System.

Key findings include: • In 2012, 11.4% of women reported they had not been screened for cervical cancer in the past five years; the percentage was larger for women without health insurance (23.1%) and for those without a regular health care provider (25.5%).

• The percentage of women not screened as recommended was higher among older women (12.6%), Asians/Pacific Islanders (19.7%), and American Indians/Alaska Natives (16.5%). • From 2007 to 2011, the cervical cancer incidence rate decreased by 1.9% per year while the death rate remained stable. • The Southern region had the highest rate of cervical cancer (8.5 per 100,000), the highest death rate (2.7 per 100,000), and the largest percentage of women who had not been screened in the past five years (12.3%). Using the human papillomavirus (HPV) vaccine as a primary prevention measure

could also help reduce cervical cancer and deaths from cervical cancer. Another recent CDC study showed that the vaccine is underused; only 1 in 3 girls and 1 in 7 boys had received the 3-dose series in 2013. The HPV vaccine is recommended as a routine vaccine for children 11–12 years old. Modeling studies have shown that HPV vaccination and cervical cancer screening combined can prevent as many as 93% of new cervical cancer cases. Even with improvements in prevention and early detection methods, most cervical cancers occur in women who are not up-to-date with screening. Addressing financial and non-financial barriers can help

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increase screening rates and, in turn, reduce new cases of and deaths from this disease.

Efforts to Prevent Cervical Cancer CDC’s National Breast and Cervical Cancer Early Detection Program provides lowincome, uninsured, and underinsured women access to breast and cervical cancer screening and diagnostic services in all 50 states, the District of Columbia, five US territories, and 11 American Indian/Alaska Native tribes or tribal organizations. To learn more about recommended ages and tests for cervical cancer screening, visit www. cdc.gov/cancer/cervical.

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Vital Signs

Stronger Collaboration between RNs, Employers Encouraged to Reduce Risks from Nurse Fatigue The American Nurses Association (ANA) calls for stronger collaboration between registered nurses (RNs) and their employers to reduce the risks of nurse fatigue for patients and nurses associated with shift work and long hours, and emphasizes strengthening a culture of safety in the work environment in a new position statement.

NA contends that evidence-based strategies must be implemented to proactively address nurse fatigue and sleepiness. Such strategies are needed to promote the health, safety, and wellness of RNs and ensure optimal patient outcomes. “Research shows that prolonged work hours can hinder a nurse’s performance and have negative impacts on patients’ safety and outcomes,” says ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “We’re concerned not only with greater likelihood for errors, diminished problem solving, slower reaction time, and other performance deficits related to fatigue, but also with dangers posed to nurses’ own health.” Research links shift work and long working hours to sleep disturbances, injuries, musculoskeletal disorders, gastrointestinal problems, mood disorders, obesity, diabetes mellitus, metabolic syndrome, cardiovascular disease, cancer, and adverse reproductive outcomes. ANA offers numerous evidence-based recommendations for RNs and employers to enhance performance, safety, and patient outcomes, such as the following suggestions:

Minority Nurse | WINTER 2015

• Involve nurses in the design of work schedules and use a regular and predictable schedule so nurses can plan for work and personal responsibilities. • Limit work weeks to 40 hours within seven days and work shifts to 12 hours. • Eliminate the use of mandatory overtime as a “staffing solution.” • Promote frequent, uninterrupted rest breaks during work shifts. • Enact official policy that confers RNs the right to accept or reject a work assignment based on preventing risks from fatigue. The policy should include conditions that a rejected assignment does not constitute patient abandonment, and that RNs should not suffer adverse consequences in retaliation for such a decision. • Encourage nurses to manage their health and rest, including sleeping seven to nine hours per day; developing effective stress management, nutrition, and exercise habits; and using naps in accordance with policy. The position statement was developed by a Professional Issues Panel, established by the ANA Board of Directors.

The panel was comprised of 15 ANA member nurses with expertise on the issue, with additional input from an advisory committee of about 350 members who expressed interest in participating. The statement was distributed broadly for public comment to nursing organizations, federal agencies, employers, individual RNs, safety and risk assessment experts, and others, whose suggestions were

evaluated by the panel for incorporation in the statement. The new position statement replaces two 2006 position statements—one for employers and one for nurses. The statement clearly articulates that health care employers and nurses are jointly responsible for addressing the risks of nurse fatigue. Source: American Nurses Association

Making Rounds

February

April

May

25-28

14-17

18-21

29th Annual Conference: Conducting Research in Difficult Times: Come Revitalize your Research Spirit Saddlebrook Resort Tampa, Florida Info: 303-327-7548 E-mail: info@snrs.org Website: www.snrs.org

Annual Conference Walt Disney World Swan and Dolphin Orlando, Florida Info: 212-998-5445 E-mail: info@nicheprogram.org Website: www.nicheprogram.org

The National Teaching Institute & Critical Care Exposition San Diego Convention Center San Diego, California Info: 800-899-2226 E-mail: info@aacn.org Website: www.aacn.org

Southern Nursing Research Society

March 11-14

Advanced Practice Neonatal Nurses 12th Annual Conference Sheraton Chicago Hotel & Towers Chicago, Illinois Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

21-24

American Association of Colleges of Nursing The Fairmont Washington Washington, DC Info: 202-463-6930 E-mail: info@aacn.nche.edu Website: www.aacn.nche.edu

24-28

International Society of PsychiatricMental Health Nurses ISPN 17th Annual Conference and 8th Psychopharmacology Institute The Grand Hyatt Seattle, Washington Info: 608-443-2463 E-mail: conferences@ispn-psych.org Website: www.ispn-psych.org

27-28

Asian American Pacific Islander Nurses Association

Nurses Improving Care for Healthsystem Elders

20-22

American Association of Critical-Care Nurses

Visiting Nurse Associations of America 33rd Annual Conference The Roosevelt Hotel New Orleans, Louisiana Info: 888-866-8773 E-mail: vnaa@vnaa.org Website: http://vnaa.org

23-25

American Nursing Informatics Association Loews Philadelphia Hotel Philadelphia, Pennsylvania Tel: 866-552-6404 E-mail: ania@ajj.com Website: www.ania.org

June 12-17

American Holistic Nurses Association 35th Annual Conference Chateau on the Lake Resort and Spa Branson, Missouri Info: 800-278-2462 E-mail: conference@ahna.org Website: www.ahna.org

July

23-26

7-10

33rd Annual Convention Rio All-Suites Hotel & Casino Las Vegas, Nevada Info: 800-454-4362 E-mail: dna@dnanurse.org Website: www.dnanurse.org

Annual Conference Hyatt Regency Anaheim, California Info: 501-673-1131 E-mail: info@thehispanicnurses.org Website: http://nahnnet.org

The Dermatology Nursesâ&#x20AC;&#x2122; Association

National Association of Hispanic Nurses

29 - May 2

American Conference for the Treatment of HIV 9th Annual Conference Renaissance Dallas Hotel Dallas, Texas Info: 540-368-1739 E-mail: ACTHIV@meetingmasters.biz Website: www.ACTHIV.org

12th Annual Conference DoubleTree Las Vegas Airport Las Vegas, Nevada E-mail: info@aapina.org Website: www.aapina.org www.minoritynurse.com

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MINORITY NURSE LETTERS TO THE EDITOR

he changing demographic of the United States population requires a response from nursing professionals. I currently—and in the future—commit to helping others help themselves by becoming a champion of cultural sensitivity and diversity. In the world of political correctness and the changing face of America, I often listen for thoughts and attitudes on diversity and cultural competence in the workplace. The health care arena is my workplace, located in a hospital at a micropolitan area on the border of Virginia and North Carolina. Being in the southern USA with its past history of slavery, civil war, and Jim Crow, one can expect some residual attitudes on diversity. Nevertheless, in this quantum age, especially amongst medical professionals, one would believe and expect that health care professionals would possess knowledge and sensitivity when it comes to cultural competency and diversity. One event in particular stands out in my mind, about a health care professional’s lack of knowledge and sensitivity regarding cultural competency and diversity. The hospital that I work at embarked upon a medical residency program. The program ushered in medical doctors of diverse backgrounds and cultures. One particular doctor wore a turban, a Middle Eastern male headdress. In passing amongst some employees I would hear comments such as “towel head.” To my surprise, I heard a member of administration having the following exchange with a patient’s family member: Family member: “So many foreign doctors around here, and you can’t tell them apart. I can’t understand them, and did you see the one with the head wrap?” Administrative employee: “Yes, I did.” [laughing and smiling] Family member: “You don’t know if he is a terrorist and will blow up the place.” Administrative employee: [nodding head in agreement with family and smiling] The irony? The resident physician was born in America and raised in Los Angeles.

Minority Nurse | WINTER 2015

The changing face of America dictates that nursing must respond to the changing demographics of diversity within the nation. This demographic trend has significance to nursing, and influences the way nurses must deliver care to a diverse society. This trend also dictates inclusion of diversity into all facets of the health care workplace. Nursing must address diversity with cultural-competency programs that assist workers in the development of cultural awareness and sensitivity. Diversity must be infused into nursing practice, addressing the cultural perspectives of health care workers, health care organizations and settings, as well as the diverse clients they serve. With the globalization of health care, increased diversity in the workplace, and multicultural emphasis in society, cultural awareness has become one of the most important facets in almost every health care industry. Understanding cultures of those around you will enhance communication, productivity, and unity in the workplace. You can prepare yourself to be a culturally competent nurse by avoiding ethnocentric behavior (e.g., being totally unaware of other cultural beliefs and values—or assuming your beliefs and values are the only correct perception). Additionally, avoid behaviors of cultural imposition or imposing your cultural beliefs on others. An intervention to promote cultural competency in the workplace involves the development and implementation of a pilot presentation on diversity, cultural competency, and cultural sensitivity. This was presented to a group of nurses in the Post Anesthesia Care Unit (PACU). Post presentation, the PACU staff was given the option to assess their awareness of personal culture, values, beliefs, attitudes, and behaviors. Nurses could view the National Center for Cultural Competence website (www.nccccurricula.info) and complete module 1. This activity will allow them to assess their awareness of cultural competence. —Leslie M. Waller, MSN/Ed, RN PACU

NURSING OPPORTUNITIES

was reading an article in the Fall edition titled “Nursing and the Table of Brotherhood and Sisterhood.” I noted how the writer mentioned how difficult it was being an African American student on a predominately white campus, which is something I can relate to when I was at University of Rhode Island for my undergraduate, now as a graduate student at UCONN, and even in my workplace as the only African American nurse on my floor. However, I will say that there are some efforts being made to help increase the diversity of nursing at UCONN through a grant that I am currently working on with one of the professors. With this grant, we work with students in underserved populations/inner city (i.e., Hartford, CT) trying to show them that there is a way and that support is available. I think the tough part is actually getting the students to work hard in high school, unless it is something they truly want, like the mentee mentioned in the article. Another thing I help out with is working with the undergraduate students in regard to classes, study tips, clinical concerns, and transitioning to working as a nurse. I agree that there needs to be an increase in diversity and programs that support this cause because when the students see a familiar or similar face to their own, it only reinforces that they are capable of achieving this goal as well. Recently, I met with a state representative to advocate for the need for increased diversity in nursing, which is something that is important, especially with the enrollment of the Affordable Care Act. At the meeting, it was stated that although there are funds allocated for this purpose, organizations have not created an effective way of utilizing and implementing this change. Overall, I enjoyed the article and agree there is a big need for mentorship in nursing because this could help so many students in the long run and create a positive cycle!

The University of Connecticut Health Center is a leading healthcare, educational and research facility offering challenging nursing positions in all specialty patient care areas as well as Case Management, Nursing Informatics, and Outpatient Services. We are an equal opportunity employer with a strong commitment to diversity and provide: • Competitive Benefits

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BEST PRACTICES IN HOSPICE CARE BY SONYA STINSON

Minority Nurse | WINTER 2015

Sometimes the most compassionate care a nurse can give to a dying patient is to quiet the room. Cheryl Thaxton, RN, MN, CPNP, FNP-BC, CH-PPN, a nurse practitioner on the supportive and palliative care team at the Baylor Regional Medical Center at Grapevine, says when a patient is near death, care providers need to be attentive to personal desires and family traditions regarding those final moments.

S “S

ometimes death is such a new experience to families that they don’t know what to expect or what to ask for, so we have to dig deeper into what their beliefs are,” Thaxton explains. “Some people want privacy in the moment of death. They don’t want someone coming into the room to change the garbage can or bring a lunch tray. They see this moment as sacred, and they want to have prayer or peace without interruptions.” Among Asian Pacific Islanders (APIs), choices about endof-life care often are made by the family as a whole, or by a designated decision maker within the family, says Merle Kataoka-Yahiro, DrPH, MS, APRN, an associate professor of nursing at the University of Hawaii at Manoa. “There needs to be improved crosscultural intervention—using culturally appropriate and sensitive communication and behavioral change approaches—for health professionals

as they interact and engage with API patients and families on topics related to palliative, hospice, and end-of-life care,” says Kataoka-Yahiro. The Institute of Medicine (IOM) counts attention to patients’ cultural, social, religious, and spiritual needs as core components of quality end-of-life care, along with management of pain and

The number had steadily increased since 2008, when it stood at 1.2 million. About 66% of hospice patients received care where they lived, whether that was a private residence, nursing home, or residential facility. Roughly 27% were in a hospice inpatient facility, and nearly 7% were in an acute care hospital. The median length of hospice service

Sometimes the most compassionate care a nurse can give to a dying patient is to quiet the room. symptoms and support for family members. This holistic view of hospice care lends itself to a collaborative, team approach that’s guided by respect for each patient’s identity and autonomy.

The State of Hospice Care In 2012, 1.5 million to 1.6 million patients received hospice services, according to the most recent report from the National Hospice and Palliative Care Organization (NHPCO).

in 2012 was 18.7 days, while the average was 71.8 days. In 2012, 57.4% of hospices were freestanding, independent agencies; 20.5% were part of a hospital system; 16.9% were part of a home health agency; and 5.5% were part of a nursing home, according to NHPCO. The NHPCO report found that 56.4% of hospice patients were female, 43.6% were male. More than 6% were of Hispanic or Latino origin (with Hispanic

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origin reported separately from race). Eighty-one and a half percent were White/Caucasian; 8.6% Black/African American; 2.8% Asian, Hawaiian, or Other Pacific Islander; 0.3% American Indian or Alaskan Native. While cancer patients made up the largest percentage of US admissions when hospice care began in the 1970s, today cancer diagnoses make up only about 37% of hospice admissions. Unspecified disabilities accounted for 14% of admissions in the NHPCO survey. Dementia was 12.8%; heart disease, 11.2%; and lung disease, 8.2%. These changes are having an impact on access to hospice care, says Brian Guthrie, MD, associate medical director at Burke Hospice & Palliative Care in Burke County, North Carolina. The standard of eligibility for hospice care benefits from Medicare is that the patient must have consulted two doctors who agree that life expectancy is six months or less if the illness progresses normally.

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“That’s easier to do with cancer than it is with heart or lung disease, and it’s especially difficult to do with people with advancing dementia,” says

sion guidelines with as many numbers and algorithms as we can figure out as to who might die in six months, but it’s a bigger challenge all the time.”

“Sometimes death is such a new experience to families that they don’t know what to expect or what to ask for, so we have to dig deeper into what their beliefs are,” Thaxton explains. Guthrie, who is board certified in hospice and palliative medicine. “There are admis-

Guthrie’s wife, Birgit Lisanti, RN, MSN, MBA, is CEO of Burke Hospice. With an aver-

age daily census of about 120, the facility employs another physician who works full-time, while Guthrie fills in when needed. Guthrie was formerly a hospice physician at Tidewell Hospice in Sarasota, Florida, which had an average daily census of 1,200. “The tremendous growth of hospice nationally has been a challenge for [the Centers for Medicare and Medicaid Services] because they had not planned that it would be this big an industry—and that they would be financially responsible for so much care,” Guthrie says. “They’ve had to be vigilant—or you could say heavy-handed if you want—in trying to ensure that we don’t treat people for years and years on hospice when they are continuing to survive.” Jennifer Gentry, RN, MSN, ANP-BC, ACHPN, FPCN, president of the Hospice and Pallia-

says Gentry, who is a clinical associate at the Duke University School of Nursing. “They don’t get the full benefit of what hospice has to offer, not only for the patient but for their family unit.”

Holistic, Patient-Centered Both palliative and hospice care are most effective when they take into consideration the patient’s physical, emotional, social, and spiritual needs, says Maureen Leahy, RN, BSN, MHA, CHPN, clinical nurse manager in the Wiener Family Palliative Care Unit at The Mount Sinai Hospital in New York City. Staff for the 13-bed unit includes nurses, physicians, geriatric and palliative care fellows, a nurse practitioner, and art, music, and pet therapists. There are even doulas that Leahy calls “midwives to the soul.” Rather than help-

Both palliative and hospice care are most effective when they take into consideration the patient’s physical, emotional, social, and spiritual needs, says Maureen Leahy, RN, BSN, MHA, CHPN, clinical nurse manager in the Wiener Family Palliative Care Unit at The Mount Sinai Hospital in New York City. tive Nurses Association, says one of the biggest changes in hospice care is that it is now viewed as part of a continuum that begins with earlier stages of palliative care. She notes that a number of hospice agencies have added nonhospice palliative care to their services. “The unfortunate thing is that sometimes we don’t recognize the benefits of hospice soon enough, and patients are not referred for hospice care until days before they die,”

Minority Nurse | WINTER 2015

ing women give birth, these volunteer doulas are trained to help patients and their families transition to the end of life. “They may serve coffee,” Leahy says. “They may sit a vigil with a dying patient. They may spend time with grandchildren of the patient doing painting and drawing.” Guthrie notes that Medicare-approved, independent hospice agencies are required to have a multidisciplinary staff that meets at least ev-

ery two weeks to discuss each patient. “The social workers, chaplains, aides, nurses, and physician all meet together and talk about the plan of care, challenges, what we expect to see next, and they try and work together to ensure that all of the patient’s needs—medical, emotional, spiritual, and social—are met,” Guthrie says. “The focus is on the family as well.” Listening is one of the most important services end-of-life caregivers provide, in Leahy’s view, but time-pressured health care professionals don’t always do it well. “We sometimes dictate to them what they need in terms of their health care, their medical treatment,” says Leahy. “Patients lose their autonomy very quickly when they become sick. . . . They often lose the sense of their ability to decide for themselves what is right or good.” As professionals who “lay hands on people,” as Leahy says, nurses are in a unique position to hear the needs and wants of dying patients. “The ethical constructs that drive our care are things like autonomy and justice and beneficence, our duty to do good and . . . to do no harm,” says Leahy. “Nurses often can identify early on when our well-intended treatment and care . . . become harmful, when people stop living and begin dying.” Thaxton says nurses and other care providers at Baylor Regional Medical Center help patients and their families with advance care planning. They discuss choices, such as whether the patient wishes to have intertracheal or long-term feeding tubes.

“We can offer a lot of things, because we know a lot of things and we have the technology,” says Thaxton. “But are those really beneficial, and are those things what the patient and family really want?” Pam Malloy, project direc-

MSN, AOCN, CHPN, director of clinical practice and chief nurse at HCI Care Services, an independent hospice agency in West Des Moines, Iowa. “Hospice is probably the last frontier for the cost-quality revolution of health care,”

Training End-ofLife Caregivers

tor and co-investigator for the End-of-Life Nursing Education Consortium (ELNEC), says patients have become more knowledgeable about the options they have. “They’ve heard lots of horror stories about people not dying well,” Malloy says. “It gets them thinking: I don’t want to die in the ICU with tubes in me. . . . They realize that if they don’t make their own decisions about their end-oflife care, someone else will.” Regulatory change—especially the requirement to provide measurable evidence of quality—is one of the biggest issues in hospice care today, says Danielle Pierotti, RN,

Pierotti says, noting that hospitals, nursing homes, home health agencies, and physicians’ offices faced the issue years earlier. She says hospice agencies are taking “baby steps” to learn how to collect data that will help them demonstrate their value in ways that can be measured. They are learning a lot from the experience of quality experts in hospital settings. “There are a lot of great conversations happening at the national level to help decide what those indicators are and help to put our arms around what it means to provide good end-of-life care,” Pierotti says.

end-of-life care. Unfortunately, the IOM committee also found that “recent knowledge gains have not necessarily translated to improved patient care,” and that the small number of hospice and palliative care specialists in the field means patients are often treated by clinicians who lack sufficient training and expertise. “The committee recommends that educational institutions, professional societies, accrediting organizations, certifying bodies, health care delivery organizations, and medical centers take measures to both increase the number of palliative care specialists and expand the knowledge

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“Dying in America,” a new study from the IOM released in September 2014, lauds the improvements over the last few decades in the education of health professionals providing

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HCI’s continuing education program, the Hospice of Central Iowa Institute, presents educational conferences to nurses,

guy comfortable. I thought, ‘If I ever get a chance, I’m going to do this full-time. This is the best medicine I’ve ever seen.’”

“As a frontline nurse, what impressed me over and over again was how much impact I could have for people at the end of their life,” says Pierotti.

base for all clinicians,” the report states. Since 2000, ELNEC has been developing curricula for nursing students, nursing faculty, practicing nurses, and nursing researchers, says Malloy. With a

Jersey. The two-hour class focuses on a different topic each week—for example, holistic health care; religion, culture, and ritual; grief theory; comforting the dying; pain and symptom management; and

“In caring for the dying, communication is our tool,” Ropis says. “People often don’t realize when they take care of the dying that the support we give to other people is a nursing intervention. You need to be very skilled in communication to take care of this population.” reach that extends to 84 countries, the consortium has taught more than 19,000 professionals over the last 14 years in its train-the-trainer courses. “Our goal is to promote this education,” Malloy says. “We will never change practices until people are educated.” Patricia Ropis, MSN, RN, teaches the “Dying with Dignity” course at the College of Nursing at Seton Hall University in South Orange, New

Minority Nurse | WINTER 2015

communication. That last topic is one Ropis believes is especially important for hospice nurses. “In caring for the dying, communication is our tool,” Ropis says. “People often don’t realize when they take care of the dying that the support we give to other people is a nursing intervention. You need to be very skilled in communication to take care of this population.”

home health and hospice aides, and other health care professionals. “Educating the community—meaning everybody, including health care providers . . . lay people, patients, families, and neighbors—about what end of life is and what it means and how hospice can be supportive in that period of time has always been a central tenet of what we do,” explains Pierotti. Hospice and palliative care providers have entered the specialty via many different paths, but they seem to share the view that what they do is not just a career but a calling. Years ago, when Guthrie was a physician in an emergency department in his native Saskatchewan, Canada, he became involved in treating the husband of the ER director for kidney cancer. Guthrie began working with the hospital pharmacist to try to control the patient’s tremendous pain. “Very quickly, I realized the pharmacist had a set of knowledge I didn’t even know about,” Guthrie recalls. “He started telling me that he was from Montreal and that he’d studied under Cicely Saunders, the very famous British nurse/doctor/ social worker who started hospice and palliative care in Britain. We worked together and did what we could to make this

Pierotti began her career as an oncology nurse, a specialty she notes is often intertwined with hospice care. “As a frontline nurse, what impressed me over and over again was how much impact I could have for people at the end of their life,” says Pierotti. “I think that was a surprise to me at the beginning, and it’s continuously a surprise to patients and families.” Thaxton became a palliative care nurse about five years ago, after 23 years in ICU nursing. She notes that nurses who are new to the death experience need special attention to ensure they are emotionally prepared. “Some people think: Am I still a good nurse if this patient is going to die on my watch?” Thaxton says. “The first death experience for a nurse can be really life-changing. We get into medicine and nursing because we want to save people. But helping them to die peacefully and free of pain, respecting their dignity, and making sure their wishes are honored, is a noble thing to do.” Sonya Stinson is a freelance writer

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Bullying in a Least Expected Place BY JAMES Z. DANIELS 16

Minority Nurse | WINTER 2015

It was an intentionally simple question the clinical nurse in the examining room heard. “Lynn,” I said, “Have you ever been bullied?” There came a pause. Then, she responded with a torrent of emotions reflecting anger and disappointment that took her back to the start of her career 23 years ago. I posed the question as she prepped me for the ECG my doctor ordered.

fter completing her nursing degree, Lynn went to work as a registered nurse in the emergency department at a suburban hospital in North Carolina. For the next two years, she was abused, intimidated, openly berated, and humiliated by staff nurses with more seniority and the nurse manager. “What was that like?” She said it was just how you were treated. “You were made to feel stupid when you sought clarification of a physician’s charted instructions, for example, or asked for input to correctly respond to a patient’s request. Eventually, I left.” What happened to Lynn is not a rare occurrence among nurses, unfortunately. On July 9, 2008, The Joint Commission, which provides oversight to over 20,000 hospitals and other care facilities, issued a policy directive to its membership called a Sentinel Event Alert. Its instruction was to have procedures in place to deal with “behaviors that undermine a culture of safety” by January 1, 2009. It described “intimidating and disruptive behaviors” in great detail, which is the most widely accepted definition of bullying. Its rationale was clearly embedded within the body of the policy: “There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care.” With mounting evidence that bullying was surprisingly prevalent within the health care sector, the intended purpose of the Sentinel Event Alert was to amend its leadership standards. Accredited health care organizations would be required to create

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codes of conduct that define disruptive and inappropriate workplace behaviors as well as establish and implement procedures for managing such behaviors. Additionally, the institutions The Joint Commission accredits were expected to make their data available for review, according to Gerard M. Castro, PhD, The Joint Commission’s project director for patient safety initiatives.

Nursing’s Dirty Little Secret “Nurses eat their young,” wrote Theresa Brown, a registered nurse, in an article in The New York Times in February 2010. “The expression is standard lore among nurses, and it means bullying, harassment, whatever you want to call it. It’s that harsh, sometimes abusive treatment of new nurses that is entrenched on some hospital floors and schools of nursing. It’s the dirty little secret of nursing.” Her story is not exceptional, and it prompted me to contact Gina, a clinical nurse in Worcester, Massachusetts, with a master of science degree in nursing education and 35 years of experience—15 of which were on a nursing school’s faculty. “There are nurses that I do not assign a new-to-nursing nurse to because of what I know would be their experience,” Gina tells me. Then, she describes her very recent experience where she accepted a per diem assignment in the operating room (OR) of a local hospital with which she is very familiar: “I almost never survived a month because of the bullying that went on. I had never seen anything like it and never experienced anything like it in my years in nursing.”

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It seems that there had not been an assignment of someone new to the OR in 10 years, so Gina was treated as an outsider and not part of the clique. So targeted was the hostility that after three

sion to issue a specific directive regarding workplace bullying, or lateral violence, as it is technically referenced. Diverse studies identify nursing as a risk group for workplace bullying; further, they confirm

workplace behavior. Duke shies away from describing intimidating and disruptive behaviors as bullying per se— and perhaps may have tacitly not reinforced the implications that bullying is specific

months of enduring the treatment, she says, “I began to feel myself spiraling down, losing my self-confidence. I endured badgering criticism; I couldn’t do anything right; there was an absence of kindness.” Fortunately, there was a change of supervisor who observed the climate in the OR and stepped in to end the intimidation by referring the preceptor for retraining.

that the problem of hostility in the workplace is very common in the health care sector. Indeed, health systems are aware of this hostility and re-

and disruptive conduct that impacts the delivery of care. Carole Akerly, BSN, director of accreditation and regulatory affairs at Duke Univer-

An Occupational Hazard

sponding to the Commission’s directive. Duke University and the University of North Carolina, for instance, have policies and procedures to deal with

Scenarios similar to the one Gina describes must have been alarmingly common to have prompted The Joint Commis-

Minority Nurse | WINTER 2015

Diverse studies identify nursing as a risk group for workplace bullying; further, they confirm that the problem of hostility in the workplace is very common in the health care sector. sity Hospital, responded to my inquiry. “Duke,” she says, “has identified behaviors that are appropriate and has not specifically described intimi-

dating and disruptive behaviors, and I don’t know whether we have identified it as that close.” But if bullying is as prevalent as the research and reports indicate—and there are many—it is unlikely that Duke and other health care providers have an incident pattern less than the norm. The University of North Carolina Health Care System, on the other hand, provides a detailed description of intimidating and disruptive behavior and a very specific description of what constitutes appropriate behavior, so the employee has no room to allege ambiguity. The rationale for its disruptive and inappropriate behavior policy admits that disruptive behavior “intimidates others and affects morale or staff turnover [and] can be harmful to patient care and satisfaction as well as employee satisfaction and safety.” Further, the policy acknowledges the possible presence of such behavior: “While this kind of conduct is not pervasive in our facilities, no hospital or clinic is immune.” Carol F. Rocker, PhD, RN, the lead investigator of a study of nurse-to-nurse bullying and its impact on retention in Canada, reported in OJIN: The Online Journal of Issues in Nursing in September 2008 that Canadian nurses are not alone when it comes to workplace bullying and emphasized that workplace bullying among nurses is now recognized as a major occupational health problem in the United Kingdom, Europe, and Australia. Why did The Joint Commission go to the trouble of defining bullying if it was not to delineate behaviors that threatened patient

safety and care quality? The answer is embedded in what led the Commission to do this in the first place. It’s found in

go unreported, such as fear of retaliation, the stigma associated with “blowing the whistle” on a colleague, and

In addressing the need to create a climate of safety related to wrong site, wrong patient, and wrong procedure within a health care facility, the Commission became aware that one of the contributing factors was the failure to speak up.

the promulgation of the Universal Protocol (UP). In addressing the need to create a climate of safety related to wrong site, wrong patient, and wrong procedure within a health care facility, the Commission became aware that one of the contributing factors was the failure to speak up. What stops a clinician from speaking up? Oftentimes, it’s the deference to the physician and other clinicians. “We have heard of abusive behavior by physicians when clinicians in the operating room, for example, have corrected the physician. Not speaking up is the result of deference to the physician,” says Castro. The UP team became aware at that time that this harmful behavior within care facilities was a safety issue. A 2003 survey on workplace intimidation conducted by the Institute for Safe Medication Practices found that 40% of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator. Elaborating on this issue, the Commission’s Sentinel Event Alert cites several reasons why disruptive behaviors

leniency towards physicians who generate high amounts of revenue. But, so serious is the epidemic of workplace bullying— with particular emphasis on the nursing sector—that 26 state legislatures have proposed legislation to address this concern, beginning with California in 2003. The model, the Healthy Workplace Bill, provides very specific employee and employer remedies, protections, and sanctions. There is clearly a movement to expand safety in the workplace from the purely physical aspect to the equally important emotional and psychological aspects.

who was previously a scrub technician is shunned by both camps. These episodes, Bartholomew says, pose the question whether this is what life is like in the OR. When the administration at Indiana University Ball Memorial Hospital studied the issue of bullying, it was clear that the problem existed beyond nursing units. “It starts with physician to physician and then trickles down the chain of command,” says Renee Twibell, PhD, the lead investigator and an associate professor of nurs-

The consequences of adult bullying have led investigators to name it as a significant occupational stressor in the workplace. Moreover, the Center for American Nurses labels workplace bullying a serious issue affecting the nursing profession in particular, and defines it as any type of repetitive abuse in which the victim suffers verbal abuse, threats, humiliating or intimidating behaviors, or behaviors that interfere with the victim’s job performance and are meant to place the health and safety of the victim at risk.

When Nurses Hurt Nurses Kathleen Bartholomew, RN, MN, renowned for nursing consulting and training, cites episodes of nurse bullying that astonishes: a nurse hides a surgeon’s favorite instrument when a substitute fills in as the scrub; a circulator, a nurse who makes preparations for an operation and continually monitors the patient and staff during the surgery, doesn’t tell a new nurse who is scrubbed that she knows the shunt the surgeon selected has fallen on the floor; a newly hired RN

But, so serious is the epidemic of workplace bullying—with particular emphasis on the nursing sector—that 26 state legislatures have proposed legislation to address this concern, beginning with California in 2003.

ing at Ball State University. “If the doctor kicks the nurse, that nurse turns around and kicks the new nurse or the CNA.”

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Are all nursing sectors equally at risk? Specifically, I was curious to know whether military nurses have a simi-

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lar experience. Having spoken with Lieutenant Colonel Angelo D. Moore, PhD, the deputy chief for the Center for Nursing Science and Clinical Inquiry at Fort Bragg Womack Army Medical Center for a previous story, I remembered what he

Cheryl Dellasega, PhD, faculty member at the Penn State University College of Medicine and author of When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of Bullying, provides significant research that led her to state that there

Nurse leaders must establish clear guidelines about what behaviors will not be tolerated and what is unacceptable, Dellasega believes.

had said. Moore turned my inquiry around and wondered whether gender issues might be at work in some bullying episodes. The ratio of male to female nurses in the military is thrice that of the nonmilitary nursing sector and, according to Moore, the combination of having been to war and the culture of the military contributes to very few incidents where bullying was alleged. Still, bullying is a complex phenomenon. Although bullies are responsible for their behaviors, investigators have analyzed several potential factors that prime the workplace for bully behaviors, which include organizational leadership and culture, the social system, character traits of the victim, and character traits of the bully. Bullying clearly qualifies as hostile workplace behavior, and if the target can claim protected class status, it becomes a major legal issue for hospitals and care centers. A 2011 study of student nurses by the American Nursing Association reported that 53% of study participants had been “put down” by a staff nurse, and 52% had been threatened or experienced verbal violence at work.

Minority Nurse | WINTER 2015

are cases where the nurse manager or charge nurse—often a highly competent, valuable nurse that the administration does not want to lose—may act as a bully, playing favorites when it comes to assignments or time off. “If they are role modeling this stuff, it will be worse among the staff,” Dellasega told NurseZone.com. “If they get the message that it’s OK to treat people like this, everybody will.”

Moving Forward So, what’s the remedy? Bullying in the workplace is both an awareness and a leadership issue. Moreover, as is so often the case in workplace practices, the leadership should be careful not to be caught being party to making case law by a complainant seeking to link hostile workplace to bullying as a protected class member. Hospital management might address the presence or prevalence of bullying behavior by examining how it is factored into their training in root-cause analysis, as well as what their whistleblowing protection policy provides. Nurse leaders must establish clear guidelines about what behaviors will not be toler-

ated and what is unacceptable, Dellasega believes. She also recommends creating a suggestion system so nurses can anonymously report things

avoid praising or rewarding nurses for their work performance if they are bullies. Instead, respectful treatment of patients and positive interac-

Ultimately, it’s all about modeling positive behaviors and holding employees accountable.

that happen on the unit, and asking for feedback about what would make the work environment better. Gabriela Cora, MD, takes a harder stand, saying hospital administrators should have zero tolerance for bullying behavior. “Lay a plan for improvement,” Cora adds. “Reward them when they improve their behavior and be ready to fire them if they continue the bullying behavior. Second,

tions with colleagues should be rewarded.” Ultimately, it’s all about modeling positive behaviors and holding employees accountable. If the policy is zero tolerance for bullying, it should mean just that—zero tolerance. James Z. Daniels is a consultant and writer who lives in Durham, North Carolina, and frequently contributes to Minority Nurse.

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Baby Boomers and Beyond The Evolution of Nursing

BY LEIGH PAGE

Nursing is entering an era of great transformation that is driven by three major changes: an aging baby boomer population; the ongoing impact of the Affordable Care Act (ACA); and rising educational goals for the profession, including greater emphasis on the bachelorâ&#x20AC;&#x2122;s of science in nursing (BSN) and advanced practice nursing (APN) degrees.

Minority Nurse | WINTER 2015

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or minority nurses, these changes bring a variety of benefits, as well as some possible drawbacks. The aging of the baby boomers is expected to produce a plethora of new nursing jobs, which could lead to higher wages, greater job security, and greater variety in types of work. By the same token, this deluge of new patients could put new strains on the nursing workforce, possibly leading to higher patient-to-nurse ratios. The health care law is changing the way nurses deliver care—emphasizing more outreach into the community and closer collaboration with patients. These changes could boost the need for nurses from

Nursing is embracing these fundamental changes to keep pace with a rapidly evolving health care system, says Jo Ann Webb, RN, MHA, senior director of federal relations and policy at the American Organization of Nurse Executives. “Health care is changing, and nursing has to change with it.”

Baby Boom Changes Postponed, But Not Cancelled For several years now, the profession has been bracing for a massive shortage of nurses, but it’s been slow to materialize. The massive baby boomer generation, making up almost one-third of the population,

the same cultural background as patients, at a time when African Americans and Hispanics are underrepresented in nursing. But the changes also mean less work for nurses in the traditional hospital setting. Finally, nurses will have greater opportunities to advance their careers by going back to school for more training; APNs, and especially nurse practitioners (NPs), are already in great demand to cope with a growing physician shortage. However, having to spend more time in school may be challenging for nurses with limited finances.

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began to turn age 65 in 2011. As they continue to get older, both supply and demand of nurses will be affected in a big way. On the supply side, retiring baby boomer nurses will empty the ranks of the profession. On the demand side, aging baby boomer patients will need more nursing to manage their declining health. Yet, these massive changes were postponed by the 20082009 recession and the weak economy that followed, argues Marcia Faller, RN, PhD, chief clinical officer for AMN Healthcare, a health care staffing company based in San Diego.

Aging nurses, short on household funds, held off retiring and even came out of retirement to work again. Meanwhile, the aging patients have put off care, flattening the demand for health services. “Everybody is trying to figure how these changes will play out,” says Faller, who led a major AMN Healthcare survey on registered nurses in 2013. But as a result of this delay, new nurses who had expected a strong jobs market have struggled to find openings. For example, a Denver TV station reported in 2013 that, of 752 openings for RNs in Colorado at that time, only four were for new graduates. Lack of jobs has been especially hard on minority nurses, many of whom lack savings to fall back on. With their careers sidetracked, they’ve had to take non-RN jobs in health care or in completely unrelated fields. In a new graduate hiring survey, the California Institute for Nursing & Health Care reported that in 2012–2013, the latest year available, a little over 40% of new RN graduates in the state hadn’t found an RN job—only a slight improvement over the previous three years. Of those who didn’t find RN jobs, 20% were working in non-RN roles in health care and 23% took jobs outside health care. The rest went back to school or volunteered in health care at no pay. Many new graduates are angry and mistrustful. In a 2013 survey by two nursing professors at Molloy College, which was

published by the National Student Nurses’ Association, many new RN grads thought the nursing shortage was just a “myth,” created by nursing schools to attract more students. The impending nurse shortage, however, is not going away, says Mary H. Hill, PhD, RN, nursing professor and assistant provost of Howard University in Washington, DC. Aging patients can’t continue to delay treatment and aging nurses can’t continue to put off retirement. Indeed, states like Texas and many rural areas are already encountering shortages. “Nursing has experienced some challenges, but even greater challenges lie ahead as the baby boomers retire and leave the nursing workforce,” says Hill.

The need for more nurses will be overwhelming, according to the US Bureau of Labor Statistics (BLS). In a recent occupational outlook report, the BLS said there will need to be about 500,000 more nursing positions by 2022. In addition, about 500,000 baby boomer nurses are expected to retire over that same time period, meaning that over 1 million new nurses will be needed over the next decade, according to the BLS. That means that the hospitals and other employers who are now rejecting young applicants will end up begging for them to apply, which could push up nurses’ wages.

Hospitals could also simply pile more work onto existing nurses, but doing so would be unworkable in the long run. Nursing schools have been pushing hard to expand class size so there will be enough nurses for this tsunami of demand. But they’ve had to turn applicants away, due to a lack of nurse educators. Nursing schools in New York, for example, rejected 2,900 qualified applicants in 2012, more than in any year since 2005, according to the Healthcare Association of New York State (HANYS). Many of these spurned applicants have probably moved on to other careers, which is a great loss for nursing.

Repercussions of the Affordable Care Act Like the baby boom, the health care law represents another great sea change for nursing and is also still in its early stages. The full impact

the new health insurance exchanges. But it’s still unclear how much these people will boost demand for health care and thus nurse hiring. Exchange policies tend to have very high deductibles, dis-

For several years now, the profession has been bracing for a massive shortage of nurses, but it’s been slow to materialize.

of the ACA “hasn’t shaken out yet,” according to Webb. Beginning in January 2014, millions of Americans gained coverage under Medicaid and in subsidized policies sold on

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couraging people from getting care. Additionally, millions of Americans still haven’t signed up, despite a federal requirement to do so. The penalties in the first year were fairly mi-

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nor but will rise in succeeding years, which may boost coverage. The elephant in the room, of course, is Republican opposition to the law. Republicans continue to promise repeal, and it could happen since they’ve gained control of the Senate and the House. In the meantime, however, this sweeping law is fundamentally changing the face of health care in this country—not just in terms of sheer numbers of patients, but also in the way it is delivered. And in another few years, it would be very hard to turn these changes back. “I’m not saying it’s a perfect law,” says Webb, “but it has, in my view, put nursing on the map. Nurses have a bigger role now.” Accountable care organizations and patientcentered medical homes are new models of care that are encouraged by the ACA. Both models reward hospitals and other providers that coordinate care and provide more patient education—two areas where nurses excel. “The ACA emphasizes primary and secondary prevention and education of patients,” says Shawona Daniel, MSN, CRNP, assistant professor of nursing at Tuskegee University, a historically black institution in Alabama. “Education is one of the most important nursing roles. I’d say 90% of what nurses do involves teaching patients and working on preventive issues, which helps keep patients out of the hospital.” Webb added that working in medical homes requires computer skills in order to deal with electronic health records and telehealth services, such

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as e-mailing and Skyping patients, as well as using remote monitoring devices. “These patients need monitoring, and this is where nursing is really critical,” she argues.

The Shift Away From Hospitals Daniel reported that virtually all of her students still expect to work in a hospital— at least initially. But the ACA favors new models of care outside the hospital. For example, Medicare is reducing hospital reimbursements, and hospitals are being penalized for readmissions within 30 days. “There is an ongoing shift from inpatient to more community-based outpatient care,” says Hill. Faller agreed with this assessment. “Only the sickest of the sick will be in the hospital, and care will flow out into the community,” she explains. As health care moves out of the hospital, home health is already a growing field, and it has become a magnet for telehealth and other high-tech services, she adds. In addition, Hill says nurses will be able to find ample jobs at dialysis centers, community health centers, physicians’ offices, outpatient surgery centers, and pain management clinics, to name a few settings. “There are just so many opportunities,” she argues. As part of the de-emphasis on hospital care, many patients are being discharged earlier and placed in longterm acute care (LTAC) facilities, where they spend many weeks often still on ventilators and IVs. Care in the LTACs is “complex and challenging,” says Joseph Morris, CNS, GNP, PhD, director of

nursing and allied health at Victor Valley College in Victorville, California. “Nurses who work in these facilities require advanced skills, such as advanced cardiac life support and telemetry training.” Morris, who is trained in gerontology, welcomes the influx of aging baby boomers. Many nurses seem to feel that a geriatrics career—which can mean working in a nursing home—means “lowering your sights,” he says, but he disagrees. “It’s clinically challenging because you’re more likely to see multiple health problems.” Dealing with older patients is also personally rewarding. Morris, who is African American, has fond memories of taking care of elderly black men in Detroit. In contrast to the stereotype of geriatric patients sitting in their wheelchairs muttering to themselves, “most geriatric patients are still active,” he says.

Nurses Get More Training The job market is beginning to favor nurses who have a BSN degree, and advanced practice nurses such as NPs are in great demand. Both trends earned key endorsements from the Institute of Medicine (IOM) in its 2010 report, The Future of Nursing. The report set a goal that 80% of nurses should have a BSN degree by 2020 and urged states to drop barriers against NPs working “to the full extent of their education and training.” Hospitals are quickly shifting to BSNs. In New York, 70% of hospitals in 2013 preferred hiring BSNs, compared with 46% in 2011, according to HANYS. Many younger nurses are

heeding the call. Faller pointed to the 2013 AMN Healthcare survey showing that almost one-quarter of nurses ages 19–39 said they would pursue a BSN, and more than one-third said they would pursue a master’s degree in nursing. Hill says it’s fairly easy for someone with an associate degree in nursing to transition to a BSN degree. They can enroll in a “RN-to-BSN” transition program, which lasts 12–18 months and is available in many locations across the country. Meanwhile, NPs have been proliferating. According to a 2013 report by the Health Resources and Services Administration (HRSA), the number of NP graduates grew by 69% from 2001 to 2011, fueled by the growing shortage of physicians in primary care and easing of state restrictions on NP practice. “Nursing students are more ambitious than they used to be,” argues Daniel. “A lot

expands the amount of study, making NPs even more desirable as primary care providers as well as specialty caregivers. Of course, the extra time and money needed for a BSN, and especially an NP, can be a barrier for minority students. Rather than pile up loans, Morris urged students to thoroughly research available scholarships. “Nursing students have not always been proactive in seeking out the opportunities.”

Push for Diversity The new models of care fostered by the ACA require closer relationships between providers and patients, which means hiring nurses from the same ethnic background as their patients. Hospitals and other employers “want their nurses to be compatible with the culture or their patients,” says Faller. “But this will be a challenge, particularly for the Hispanic population.” While Hispanics make up 17.1% of the population, they

The new models of care fostered by the ACA require closer relationships between providers and patients, which means hiring nurses from the same ethnic background as their patients.

of them want to go back to graduate school and become nurse practitioners.” She says she hopes some of them will choose a career in academia so that more nurses can be trained. This was another goal of the IOM report. Morris says the new doctor of nursing practice credential, which will be required for all NP students starting in 2015,

account for only 4.8% of RNs, according to the HRSA. There is also a gap for African Americans, who account for 13.2% of the population but just 9.9% of RNs. As a black male nurse, Morris says it’s easier for him than for white caregivers to connect with black patients. He says many of them are still painfully aware of the infa-

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mous Tuskegee experiment. In a project that lasted until 1972, white doctors didn’t inform black male patients that they had syphilis, so that they could follow the natural progression of the disease. As a result, older black patients in particular are still wary of “being used as guinea pigs,” he says. Morris has worked hard to boost African American representation in nursing, visiting schools to spread the word about a nursing career. He is also interested in boosting the number of black men in nursing. While men make up almost 10% of all nurses, very few black males enter the field, he says.

Nurses Have a Central Role to Play There are many opportunities for minority nurses in this era of great change in the health care system. According to the IOM report, nurses will take center stage in this process. “We believe nurses have key roles to play as team members and leaders for a reformed and better-integrated, patientcentered health care system,” the report maintained. “How well nurses are trained and do their jobs is inextricably tied to every health care quality measure that has been targeted for improvement over the past few years.” Leigh Page is a Chicago-based freelance writer specializing in health care topics.

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TOP

NURSING EMPLOYERS

OF 2014

Minority Nurse | WINTER 2015

For the second year in a row, we reached out to Minority Nurse readers about what they look for in a workplace—and how their current employers stack up. BY ETHAN LACROIX

nsurprisingly, salary and benefits once again topped the list of factors respondents considered when looking at potential employers. But for many readers, workplace satisfaction was about more than just compensation. This year’s results showed an increased focus on quality of life factors, such as corporate culture, workplace environment, and flexibility of hours. Diversity and workplace size—while still important to many respondents—were less of a factor

when considering potential employers. Overwhelmingly, this year’s results showed readers were quite satisfied with their current jobs. The majority rated their employers as “good” or “excellent” in most categories, including workplace size, job perks, and benefits. The areas most in need of improvement according to this year’s survey were opportunity for advancement and salary, though Minority Nurse’s Salary Survey from 2014 showed that readers have seen steady pay in-

creases in that area over the last few years. This year’s responses, which were gathered through an online questionnaire sent to Minority Nurse subscribers, came from across the country, with California, New York, Texas, and Pennsylvania as the most represented states. Companies that scored well this year were mostly very large organizations with thousands of employees, including several academicaffiliated medical centers, such as Duke University Health System and Penn State Milton S.

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Hershey Medical Center; government agencies, such as the US Department of Veterans Affairs and Indian Health Service; and big urban hospitals and networks, such as Children’s Hospital of Philadelphia and the Cleveland Clinic. Our final list of top 25 companies, presented alphabetically, scored well in the categories that were most important to our readers. We’ve provided a brief introduction to each organization, as well as contact information for job seekers.

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Number of Respondents:

Number of Respondents: Number of Respondents: 1,064

1,064 1,064 Organization Type (%)

Regions (%) .3%

s (%)

34%

14%

Organization Type (%) Organization Type (%) 14%

22%

34%

2% 3%

Organization Size (%)Size 9% Organization (%)29% 11%

62%

17%

15%

30%

14%

34%

17%

Organization Size (%)

14% 17%

■ South ■ Northeast ■ Midwest ■ West ■ Other

9% 11%

11% 62%

62%

15%

■ School or university ■ Public hospital, including Veteran’s or Indian Affairs hospitals ■ Private hospital

9% 29%

20%

16%

29%

15%

■ Private practice or physician’s office ■ Nursing home or rehabilitation center ■ Other

16%

20% 16%

20%

■ 1–100 employees ■ 101–500 employees ■ 501–1,000 employees ■ 1,001–5,000 employees ■ 5,001–10,000 employees ■ 10,001 or more employees

Number of Respond

■ School or university or practice or ■ School or university ■ Private practice ■ Private ■ Public hospital, including physician’s office ■ Public hospital, including physician’s office Veteran’s or Indian Affairs ■ Nursing home or Veteran’s or Indian Affairs ■ Nursing home or hospitals rehabilitation center hospitals rehabilitation center ■ Private hospital ■ Other ■ Private hospital ■ Other

■ 1–100 employees ■ 1–100 employees ■ 101–500 employees ■ 101–500 employees ■ 501–1,000■employees 501–1,000 employees ■ 1,001–5,000 employees employees ■ 1,001–5,000 ■ 5,001–10,000 employees employees ■ 5,001–10,000 ■ 10,001 or more employees ■ 10,001 or more employees

Regions (%)

Organization Type (%

.3%

14% 34%

22%

1,064 2%

14% 17%

62%

30%

■ South ■ Northeast ■ Midwest ■ West ■ Other

■ School or university ■ Public hospital, including Veteran’s or Indian Affairs hospitals ■ Private hospital

Advocate Health Care Website: advocatehealth.com Location: Facilities throughout Illinois Number of nursing employees: Approximately 10,000 About the company: Formed in 1995 with the merger of Evangelical Health Systems Corporation and Lutheran General Health System, the Advocate Health Care network is one of the largest employers in the Chicago area. It includes 12 acute-care hospitals (six of which are Magnet-certified) and more than 200 other health care facilities, including hospices. Several Advocate hospitals have consistently ranked in the U.S. News & World Report annual best hospitals, among other accolades.

Contact: Job listings are available at jobs.advocatehealth.com

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■ Private pra physician’s ■ Nursing ho rehabilitat ■ Other

Bellin Health Website: bellin.org Location: Green Bay, Wisconsin Number of nursing employees: Varies by facility (approximately 750 at Bellin Hospital) About the company: Founded more than 100 years ago by Dr. Julius J. Bellin as General Hospital, Bellin Health is now comprised of several medical and educational entities, including the 167-bed acute-care facility Bellin Hospital, two psychiatric treatment centers, and a network of family medical offices, as well as the Bellin College of Nursing, which offers the only four-year baccalaureate-nursing program in northeast Wisconsin.

Contact: Job listings are available at bellin.org/careers

California State University Website: calstate.edu Location: Facilities throughout California Number of employees: Varies by campus About the company: California State University

is the largest four-year university system in the country, with nearly 447,000 students. The CSU Nursing Program offers bachelor’s, master’s, and doctoral degrees in nursing. Nurse educators are employed at 18 of the school’s 23 campuses located throughout the state.

Contact: Job listings are available at csucareers.calstate.edu

Children’s Hospital of Philadelphia Website: chop.edu Location: Headquarters in Philadelphia, Pennsylvania Number of nursing employees: Approximately 3,600 About the company: Children’s Hospital of Philadelphia is the nation’s oldest children’s hospital, and is widely regarded as one of the best. It’s topped the U.S. News & World Report list of best children’s hospitals for the last five years, and has been Magnet-certified since 2004. In addition to its main hospital in West Philadelphia, CHOP operates more than 50 smaller practices throughout Pennsylvania and New Jersey, and several large expansion projects are in the works, including a new outpatient facility set to open in 2015.

Contact: Job listings are available at chop.edu/careers

Cleveland Clinic Website: clevelandclinic.org Location: Headquarters in Cleveland, Ohio Number of nursing employees: Varies by facility (approximately 6,500 at the main campus) About the company: Known as one of the most medically innovative hospitals in the country, the Cleveland Clinic’s long list of “firsts” includes the isolation of serotonin, the first coronary bypass surgery, and the first face-transplant in the United States. It is ranked in several specialties on the U.S. News & World Report list of best hospitals. In addition to its main location in Cleveland, it operates seven more hospitals throughout Ohio, as well as affiliates in Florida and Nevada, and international outposts in Canada and Saudi Arabia.

Contact: Job listings are available at jobs.clevelandclinic.org

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Community Health Network Website: ecommunity.com Location: Facilities throughout Indiana Number of nursing employees: Varies by facility About the company: Established in 1956 after a massive grassroots fundraising effort by Indianapolis residents, Community Hospital (now Community Hospital East) has grown to a sprawling network of more than 200 facilities throughout central Indiana. It has been named one of the best places to work by The Indianapolis Star.

Contact: Job listings are available at employment.ecommunity.com

Duke University Health System Website: dukemedicine.org Location: Headquarters in Durham, North Carolina Number of nursing employees: Varies by facility (approximately 3,000 at Duke University Hospital) About the company: Duke University Hospital (since renamed Duke University Medical Center) was established in 1930 thanks to a bequest from James B. Duke. Today, the 7.5-million-square-foot facility is the flagship hospital in a network that includes the Duke Clinic, Duke Childrenâ&#x20AC;&#x2122;s Hospital and Health Center, Duke Regional Hospital, and Duke Raleigh Hospital, as well as the Duke University Medical School and the Duke University School of Nursing. Duke has been nationally recognized for its several specialties, including cardiology, nephrology, and ophthalmology.

Contact: Job information is available at hr.duke.edu

Gwynedd Mercy University Website: gmercyu.edu Location: Gwynedd Valley, Pennsylvania Number of employees: Approximately 500 About the company: This Catholic-affiliated university offers undergraduate and graduate degrees in nursing and other medical specialties at the Frances M. Maguire School of Nursing and Health Professions division.

Contact:

Job information is available at gmercyu.edu/about-gwynedd-mercy/administration/human-

resources

Indian Health Service Website: ihs.gov Location: Headquarters in Rockville, Maryland, with facilities throughout the country Number of nursing employees: Approximately 2,700 About the company: The Indian Health Service was established in 1955 to improve the

health of American Indians and Alaska Natives. This division of the US Department of Health and Human Services has an annual operating budget of $3.8 billion and oversees more than 100 medical facilities in 12 areas, each focused on the unique needs of the native American tribes in the region.

Contact: Job listings available at ihs.gov/dhr

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Indiana University Health Website: iuhealth.org Location: Facilities throughout Indiana Number of nursing employees: Varies by facility (approximately 29,400 total employees) About the company: Indiana University Health is a network of hospitals and other facilities throughout Indiana affiliated with the Indiana University School of Medicine. Last year, IUH had more than 2.5 million outpatient visits and over 136,000 admissions. Its facilities have been nationally ranked by U.S. News & World Report in several specialties, including cancer, neurology, and orthopedics. Six of the hospitals in the network have been designated Magnet facilities.

Contact: Job listings are available at iuhealth.org/careers/nursing-careers

Kaiser Permanente Website: healthy.kaiserpermanente.org Location: Headquarters in Oakland, California, with facilities in California, Colorado, Georgia, Hawaii, Oregon, Washington, Virginia, Maryland, Ohio, and Washington, DC

Number of nursing employees: Varies by facility About the company: Founded in 1945, Kaiser Permanente operates more than 600 interconnected but independently managed medical facilities in the United States, as well as a managed-care plan with more than 9 million members.

Contact: Job listings are available at kaiserpermanentejobs.org

Los Angeles County Department of Health Services Website: dhs.lacounty.gov Location: Los Angeles County, California Number of nursing employees: Varies by facility About the company: Los Angeles County Department of Health Services is the second-largest municipal health care system in the country. It operates in the most populous county in the United States, and provides medical care and services to approximately 800,000 patients annually at several hospitals and other medical centers.

Contact: Job listings are available at hr.lacounty.gov

Memorial Hermannâ&#x20AC;&#x201C;Texas Medical Center Website: memorialhermann.org Location: Houston, Texas Number of nursing employees: Approximately 1,800 About the company: This Magnet-recognized teaching hospital (affiliated with the University of Texas Health Science Center at Houston Medical School), is the oldest institution in the massive Texas Medical Center and the flagship hospital in the vast Memorial Hermann network with facilities throughout Texas. Its Level 1 trauma center sees more than 40,000 patients annually, and its Childrenâ&#x20AC;&#x2122;s Hospital is one of the top-ranked pediatric facilities nationwide.

Contact: Job listings are available at memorialhermann.org/careers

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NewYork–Presbyterian Hospital Website: nyp.org Location: New York, New York Number of nursing employees: Approximately 5,000 About the company: This multi-campus institution is

affiliated with two Ivy League universities, Columbia and Weill Cornell. It is the largest private employer in New York City, and one of the largest hospitals in the United States. It’s ranked sixth overall in U.S. News & World Report’s Best Hospitals survey. In addition to its two main facilities in Manhattan, the Columbia University Medical Center and the Weill Cornell Medical Center, NewYork–Presbyterian operates the Allen Hospital, Morgan Stanley Children’s Hospital, and a psychiatric facility in nearby Westchester County. In July 2013, NewYork–Presbyterian expanded its reach when it merged with New York Downtown hospital, establishing the Lower Manhattan Hospital.

Contact: Job listings are available at careers.nyp.org

Our Lady of the Lake Regional Medical Center Website: ololrmc.com Location: Baton Rouge, Louisiana Number of nursing employees: Approximately 1,300 About the company: A Catholic teaching hospital established 90 years ago, OLOL is one of the largest privately owned hospitals in Louisiana, as well as the largest of four hospitals in the Franciscan Missionaries of Our Lady Health System. Today, this Magnet-recognized facility serves 11 parishes, and has more than 1,000 beds.

Contact: Job listings are available at ololrmc.com/greatplacetowork

Penn State Milton S. Hershey Medical Center Website: pennstatehershey.org Location: Hershey, Pennsylvania Number of nursing employees: Approximately 1,800 About the company: This 475-bed teaching hospital affiliated with Penn State College of Medicine and College of Nursing is one of the largest and most respected hospitals in south central Pennsylvania. Its Children’s Hospital is ranked among the nation’s best in U.S. News & World Report’s top hospitals list, and it features the area’s only neonatal intensive care unit. The hospital’s Cancer Institute opened in 2009, and the volunteer-run LionCare clinic has been providing free health care services since 2002.

Contact: Job listings are available at pennstatehershey.org/web/humanresources/home/searchjobs

Rutgers Biomedical and Health Sciences Website: rbhs.rutgers.edu Location: Facilities and institutions throughout New Jersey Number of nursing employees: Varies by facility About the company: Part of the vast Rutgers University system in New Jersey, RBHS was established as an umbrella organization in 2013 after the dissolution of the University of Medicine and Dentistry of New Jersey. It comprises several medical and educational institutions, including the Cancer Institute of New Jersey, University Behavioral HealthCare, the Rutgers School of Nursing, and both of the Rutgers graduate schools of medicine: New Jersey Medical School and the Robert Wood Johnson Medical School. The primary teaching hospital for Rutgers is the state-owned University Hospital in Newark.

Contact: Job information is available at uwide.rutgers.edu/about/employment-rutgers

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SUNY Downstate Medical Center Website: downstate.edu Location: Brooklyn, New York Number of nursing employees: Approximately 650 About the company: Founded in 1860 as Long Island College Hospital, SUNY Downstate is now one of three medical centers in the State University of New York system. Today, it includes four patientcare facilities, as well as medical, nursing, and public health schools, among other academic programs. It’s the fourth largest employer in Brooklyn—a borough of New York City with more than 2 million residents—and its alumni network is impressive: More physicians practicing in New York City graduated from the SUNY Downstate College of Medicine than any other medical school.

Contact: Job listings are available at downstate.edu/human_resources

UNC Health Care Website: unchealthcare.org Location: Facilities located throughout North Carolina About the company: UNC Health Care is a state-owned

network of hospitals affiliated with the prestigious University of North Carolina-Chapel Hill School of Medicine. In addition to 12 hospitals, which include several Magnet-recognized facilities, UNC Health Care provides services at family health practices, ambulatory care facilities, and urgent care units throughout the area.

Contact: Job listings are available at unchealthcare.org/site/humanresources/careers

University of Arkansas for Medical Sciences Website: uamshealth.com Location: Little Rock, Arkansas Number of nursing employees: Approximately 1,400 About the company: The University of Arkansas for Medical Sciences has six academic divisions, including pharmacy, nursing, and public health schools, as well as the only medical school in Arkansas. The school’s main patient-care facility is UAMS Medical Center, though it expands it reach through smaller clinics located all over the state.

Contact: Job listings available at jobs.uams.edu

University of Maryland Medical System Website: umms.org Location: Facilities throughout Maryland Number of nursing employees: Varies by facility About the company: One of the largest hospital networks in the Mid-Atlantic region, University of Maryland Medical System is made up of nine hospitals, including one pediatric facility and several teaching hospitals affiliated with the University of Maryland.

Contact: Job listings are available at umms.org/careers

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University of Michigan Health System Website: med.umich.edu Location: Headquarters in Ann Arbor, Michigan Number of nursing employees: Varies by facility About the company: This integrated health care

system located in southern Michigan comprises three hospitals (University Hospital, C.S. Mott Children’s Hospital, and Von Voigtlander Women’s Hospital), 40 outpatient centers and more than 120 clinics, and a large home health care division. It also includes the University of Michigan’s Medical School and School of Nursing, and it partners with other medical centers throughout the state via the Michigan Health Corporation. The Detroit Free Press has named UMHS one of the “101 Best and Brightest Companies to Work For.”

Contact: Job listings are available at umhscareers.org

University of Texas Medical Branch Website: utmb.edu Location: Galveston, Texas Number of nursing employees: Varies by facility About the company: This division of the University of Texas is located in a 70-building, 84-acre complex, which includes several hospitals and clinics, four schools, and numerous research facilities. In 2008, many of its buildings were badly damaged by Hurricane Ike, but it’s made a strong comeback and expanded its reach since.

Contact: Job listings are available at utmb.jobs

US Department of Veterans Affairs Website: va.gov Location: Headquarters in Washington, DC, with facilities throughout the United States Number of nursing employees: Varies by facility About the company: The US Department of Veterans Affairs was established in 1930, consolidating several agencies that provided services to veterans of American conflicts. Today, the Veterans Health Administration, the wing of the VA focused on health care, operates 171 medical centers, as well as hundreds of outpatient clinics, nursing homes, and other facilities.

Contact: Job listings are available at vacareers.va.gov

Vanderbilt University Medical Center Website: vanderbilthealth.com Location: Nashville, Tennessee Number of nursing employees: Approximately 3,700 About the company: This organization contains several hospitals and clinics, as well as Vanderbilt University’s School of Medicine and School of Nursing. Vanderbilt has been well ranked in the U.S. News & World Report Best Hospitals surveys, and Vanderbilt University was once named one of Forbes’s “100 Best Companies to Work For” (more than 80% of Vanderbilt’s employees work at the Medical Center).

Contact: Job listings are available at vanderbilt.edu/work-at-vanderbilt

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

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MINORITY NURSE 16th Annual Scholarship Program

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

❏ Female

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

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

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

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

Academic Forum

Bridging to Higher Education in Haiti BY SUSAN S. SAWYER, PHD, RN, CPNP, AND ALLISON BERNARD, DNP, MSN

The Regis College Haiti Project (RCHP) is an international partnership between Regis College School of Nursing, Science, and Health Professions, the University of Haiti, and Haitiâ&#x20AC;&#x2122;s Ministry of Health. In February 2014, with completion of a three-year program, 12 nursing faculty members were awarded Master of Science in Nursing (MSN) degrees from the University of Haiti. Through the commitment of Regis College, three cohorts over the course of seven years will obtain their masterâ&#x20AC;&#x2122;s degree and provide sustainable nursing education advancement to all nurses in Haiti.

ith this strategic plan, the RCHP enables us to build a dynamic and mutually beneficial, sustainable nursing program where faculty members in Haiti will be qualified to teach as well as produce educated nurses to serve in primary care areas

and assume leadership positions with colleges, hospitals, and other health care organizations. Nurses are the key component in a health care system, and providing sustainable nursing education to a developing country is the cornerstone to the betterment of health care delivery.

Building a Relationship with Haiti The initial stage of this international relationship began in 2007 when the president and several faculty from Regis College travelled to Haiti to meet with the ministry of health and nursing leaders to determine how they could es-

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tablish a collaborative agreement to improve nursing in Haiti. A primary goal in the strategic plan of the college, among many objectives, is to establish an international footprint through interdisciplinary academic programs, the spirit of collaboration, and studentcentered values. The vision statement of the college inspires all to work within its multicultural community and to be actively engaged as leaders and ambassadors of social change. To develop a strategy, nursing leaders from both Haiti and Regis College consulted and discussed schedules, time

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Academic Forum commitment, action plans, and long-term sustainability. The mission of the RCHP is incorporated in developing

and overall advance the level of nursing education in the country. A 2003 study published in The Journal of the

Nurses are the key component in a health care system, and providing sustainable nursing education to a developing country is the cornerstone to the betterment of health care delivery. an international nursing partnership. Through this vision of partnership is the goal to improve the health and wellbeing of the people of Haiti by elevating the level of nursing education and the sustainability of advanced nursing practice.

Project Goal The RCHP is designed for the registered nurse in Haiti to earn both the baccalaureate and the master’s degree. Its purpose is to prepare nursing educators and nursing leaders to assume a guiding role in the effort to address Haiti’s pressing health care needs. Nurse administrators with advanced nursing education have a unique perspective in the assessment of health disparities and challenges faced in providing care to a vulnerable population. After completion of this program, they will be able to collaborate with local professionals; assist in the creation of sustainable, community-focused programs; practice collaboratively as members of interdisciplinary teams; and deliver populationfocused care while reflecting on the impact of poverty and socioeconomic factors. Specifically, this project seeks to address the acute nursing shortage in Haiti

Minority Nurse | WINTER 2015

American Medical Association concluded that nurses prepared at the baccalaureate level or higher have significantly better patient outcomes. Partnering with our Haitian neighbors provides a new and expanded role for nurses in a developing country. Upon graduation with a MSN, this first cohort of Haitian faculty will lead the institutionalization of the master’s program for all future Haitian nursing faculty. Currently, the public nursing schools prepare three-year diploma graduates with their focus on hospital-based care. The objective of this program is to educate Haitian nursing faculty, who can then provide baccalaureate education to all nurses in Haiti and be role models in nursing leadership. In order to produce a new generation of nursing leaders in Haiti, capacity building is necessary. This entails a society enhancing their abilities to “perform core functions, solve problems, define and achieve objectives; and understand and deal with their development needs in a broad context and in a sustainable manner,” as described in the International Institute for Educational Planning’s Guidebook for Planning Education in Emergencies and Reconstruction. The strate-

gies needed to accomplish this mission include the following: enhancing professional development through curriculum building; analyzing the relationship between theory, practice, and evidence-based research; synthesizing the organizational structure of nursing leadership; and promoting innovative educational methodologies.

Project Planning and Implementation The RCHP is committed to educating three cohorts of Haitian nursing faculty over the course of seven years, with two overlapping cohorts in the summer of the third year, which would serve as transition and mentorship periods. The sidebar outlines the three years of the program and the required coursework for each cohort (see page 42). The program began in the summer of 2011 with 12 Haitian nurse faculty from nursing schools across Haiti coming to Regis College in Weston, Massachusetts, for a six-week intensive program of study where orientation and tutorials on computer sys-

on professional experiences and shared interests. The mentors served as academic and professional advisors as well as social support, and they offered guidance throughout the academic year. When the Haitian nurses were at Regis College during summer sessions, there were opportunities for in-person interactions between mentors and mentees. In addition, the Haitian faculty had the opportunity to shadow nurses at several of the large metropolitan hospitals where they observed cutting-edge technology in both medicine and nursing. During the fall and spring semesters, the mentors and mentees maintained contact via e-mail, Facebook, Adobe Connect, and Skype, and they received technical support through Regis. During the first year of the program, Regis College nursing faculty traveled to Haiti, where they taught in an intensive five-day format addressing trends affecting community health nursing—specifically, societal and population shifts in the different regions of Haiti following the 2010

A 2003 study published in The Journal of the American Medical Association concluded that nurses prepared at the baccalaureate level or higher have significantly better patient outcomes. tems were provided as well as weekly graduate student dinner seminars. Each Haitian nurse faculty was paired with a Regis College nursing faculty member who remained the nurse’s mentor throughout the course of the program. The match of mentors was based

earthquake. Morbidity and mortality concerns were also addressed in conjunction with the changes and evidence of population shifts into the cities secondary to the aftermath of the earthquake and the environmental changes. In conjunction with the Regis

Academic Forum College philosophy of nursing—which identifies the four central concepts of the nursing discipline as person, environment, health, and nursing—each of the 12 Haitian nursing faculty identified a specific health problem endemic to their community. This was followed by identifying priorities, establishing goals, and determining interventions based on the central tenets of the philosophy. In order for the Haitian faculty to analyze a community health problem comprehensively, we introduced the epidemiologic triangle, the traditional model for infectious disease addressing the external agent or the cause of the health problem, the susceptible host identified in the community, and the environment in which the host and agent came together leading to a specific problem or outcome. During the second year of the program, the 12 Haitian nursing faculty returned to the campus for a five-week intensive session of clinical and classroom learning over the summer of 2012. The following spring, Regis faculty traveled to Haiti for a oneweek intensive training supplemented by online learning. At the start of the third year, the 12 Haitian nursing faculty returned to the campus in the summer of 2013, where they took part in another five-week intensive session of clinical and classroom learning. Simultaneously, the 12 Haitian nursing faculty who were selected for the second cohort also arrived to the Regis campus for the first time to begin their first year of the program. With the help of Regis nursing faculty, the first cohort

Photo credit: Alexis Lawton Przybylski

became the mentors for the incoming cohort and worked together to teach two out of the four courses taken by the second cohort. The first cohort continued to take two courses alongside the second one.

Conceptual Framework In February 2014, Regis nursing faculty returned to Haiti during the mentorship period. The first cohort of Hai-

introduced new models of care supported through collaboration in practice and education. An example presented by the second cohort was Roy’s Adaptation Model, as it was reconceptualized and expanded in order to provide a framework for the delivery of community-based nursing. Using this theoretical framework, they encompassed populationbased assessments that related

In order to produce a new generation of nursing leaders in Haiti, capacity building is necessary.

tian nurses assumed the role of educators as they taught nursing theory, nursing leadership, and community health to the second cohort of nurses. With awareness of the shift away from traditional hospital-based care and movement toward the community, they

to the physical, psychological, and social integrity of their community. Through this model, they identified the central concepts of the discipline of nursing with the understanding that every person has inherent dignity and worth as well as a right to receive

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comprehensive, compassionate health care. They viewed the person in the community as a unique biopsychosocial, cultural, and spiritual being who continuously interacts with the environment. Using Roy’s Adaptation Model as an adjunct in the coordination of community health in Haiti offered the nurses an organized approach in the assessment of their community, incorporating the philosophic components of person, environment, health, and nursing. Through discussion of the physical integrity, their view was broadened as they identified topics incorporating nutrition, the environment, available resources, and government regulation. In discussion of the biopsychosocial characteristics, identifiers such as age distribution, gender, education, and economics were discussed. The social integrity of the

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Academic Forum community presented another perspective in assessment of a specific community by focusing on vital statistics, such as births, deaths, prevalence of communicable and chronic disease, leading causes of mortality, and health resources. Using these guidelines in data analysis assisted with community care planning by identifying a community diagnosis, an awareness of the problem, community motivation, and realistic interventions to resolve the problem.

Challenges and Outcomes A course challenge in our collaborative efforts of educating our Haitian colleagues was the language difference. This was addressed using a bilingual educational platform. Educational material using PowerPoint was introduced with French translation. In addition, an in-class translator was present to translate lectures, questions, and small group discussions. Through the use of Adobe Connect, Moodle, an internet connection, and email, we were able to provide

effective international collaboration. This also allowed rigorous evaluation that strengthened the educational models used in promoting effective

ulty. The inability to access French-translated textbooks on community health nursing and nursing theory posed another challenge, but we were able to

Through this model, they identified the central concepts of the discipline of nursing with the understanding that every person has inherent dignity and worth as well as a right to receive comprehensive, compassionate health care. community health systems for the Haitian nursing fac-

address it by utilizing a French publishing company.

International Nurse Faculty Partnership Initiative Year 1 Summer Six-week intensive at Regis College

Fall Four-month semester in Haiti

• Professional Concepts and Challenges in Nursing Practice taught during a six-week residency at Regis

• Concepts of Nursing Leadership online coursework supplemented by mid-semester, on-site lectures in Haiti

• Health Assessment and Simulation Modules

• Statistics taken in Haiti at state university

• Seminar in Teaching and Learning with Classroom Practicum

Spring Five-month semester in Haiti • Nursing theory online course with Regis faculty • Community-Based Nursing online supplemented by mid-semester, online lectures in Haiti

• Evidence-Based Nursing

Year 2 Summer

Fall

Five-week residency at Regis College

Four-month semester in Haiti online or Haitian university-based courses

• Organizational Structure on Nursing Leadership

• Economics of Health Care

• Advanced Nursing Research

• Health Ethics and the Law

Spring Five-month semester in Haiti • Health Informatics online coursework supplemented by mid-semester, on-site lectures in Haiti • Health Policy Seminar: Focus on policy initiatives in Haiti, online coursework supplemented by mid-semester on-site lectures in Haiti

Year 3 Summer Five-week residency at Regis College • Regulatory Issues in Nursing Leadership • Assessment and Evaluation in Nursing Education

Fall Four-month semester in Haiti • Leadership Mentorship with Health Care/ Nursing Leaders in Haiti, weekly online seminar with Regis faculty via Adobe Connect • Financial Analysis in Health Care Administration, taken in Haiti at state university

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Spring Graduation • Receive master’s degree in nursing

Academic Forum

Photo credit: Alexis Lawton Przybylski

Through enhancement of scholarship and curriculum development, the new graduates will increase community awareness as well as strengthen and analyze how the environment and personal health behaviors are interrelated. Being part of the community afforded the Haitian nursing faculty the opportunity to influence and motivate others. Their understanding of Haitian lifestyle, culture, and social skills provided them practice opportunities and professional collaboration in addition to critical analysis within the community. It allowed them to be part of effective community action by contributing to the resolution of a problem. The outcome of the first cohort came to fruition in February 2014 when the University

of Haiti awarded master’s degrees to all 12 faculty members representing nursing schools across Haiti from Gonaïves, Les Cayes, Port-Au-Prince, Jérémie, Cap-Haïtien, and University of Notre Dame d’Haiti. Subsequent to achieving the master’s degree, many of the first cohorts have assumed leadership roles in their schools of nursing. One in particular was appointed dean of her nursing school, while others are taking an active role participating in professional conferences in order to enhance the international influence of nurses. Others are enhancing course content through curriculum development and are reaching out to community leaders in order to develop collaborative relationships with interdisciplinary teams. In addition,

membership in professional associations has offered the Haitian nurses recognition of their expertise through certification—providing them an

of critical thinking, problem solving, and evidence-based practice. Through collaboration, the Haitian nurses have the capacity to build sustain-

Through enhancement of scholarship and curriculum development, the new graduates will increase community awareness as well as strengthen and analyze how the environment and personal health behaviors are interrelated. opportunity to make a difference and lobby to influence laws affecting nursing. In providing new and expanded skills in nursing education, this international partnership will help ensure that nursing education in Haiti continues to progress throughout the 21st century with the use

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able nursing programs that are beneficial and dynamic for the Haitian society. Susan S. Sawyer, PhD, RN, CPNP, and Allison Bernard, DNP, MSN, are associate professors at Regis College.

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Second Opinion

Discovering the Possibilities: Where Can I Go From Here? BY SAMANTHA STAUF

Recently, I was taking a late-night walk with the dog and ran into my neighbor. She was just returning home from her shift as an emergency room nurse. Every time I see her she’s wearing scrubs (and I’m pretty sure they are all stained). We enjoy visiting, but her only available time is before the sun rises or after it sets. When I need to decipher the scribbles of my 5-year-old nephew, I have to ask her to read it to me. She always laughs and says it’s basically the same as translating a doctor’s notes.

s we sat down, she shared with me that she loves what she does and she adores her patients, but earlier that day someone told her she was pale and looked “sick.” She hadn’t seen the sun in weeks. When I pressed further, she shared with me that recently she had developed a desire to have more flexibility and control with the types and lengths of shifts she works. Her kids were getting older, and she hated the thought of missing even more soccer games. She was quick to tell me she was certainly not ready to

Minority Nurse | WINTER 2015

leave nursing altogether. She’d spent years in school and had spent countless hours adding continuing education credits to her resume. Truly, she was exhausted. I had been compiling research for an article on advanced career choices in the medical field, so I shared with her four finds that were directly related to nursing:

Nurse Educator Median salary: $65,000 Nurse educators, especially in specific fields, are in high demand. Nurses need continuing education throughout their careers, and fresh faces are

joining the ranks every year. You can combine your clinical expertise with a passion for teaching into a rewarding career. Educators are needed at colleges, universities, technical schools, and hospitalbased schools. You would be required to hold a master’s or a doctoral degree in nursing. Nurse educators typically have advanced clinical training in a health care specialty. Many educators enjoy the option of flexible work scheduling.

Nurse Researcher Median salary: $90,000 This is an excellent choice for

nurses seeking an advanced, nonclinical job in the nursing industry. Nurse researchers are employed by health policy nonprofits and private companies. Nurse researchers perform analyses and create reports based on research gathered from medical, pharmaceutical, and nursing products and/ or practices. Their objective is to improve health care and medical services. Nurses with a bachelor of science in nursing (BSN) degree are eligible for these jobs, but those with a master’s or a doctoral degree may have an increased chance of acquiring a nurse researcher position.

Nursing Informatics Specialist Median salary: $62,115 They manage and provide health care data to patients, nurses, doctors, and other health care providers. Nurs-

Second Opinion ing informatics specialists ensure computer applications are easy to use and provide useful information to nurses, managers, and other health care workers. A BSN is the minimum requirement for certification for a nursing informatics job; however, several employers require a master of science in health informatics, health care management, or quality management. The American Nurses Credentialing Center requires two years of experience as an RN and at least 2,000 hours of work in informatics within the last three years for certification. Those with certification improve their chances of obtaining a job with a higher salary. The job outlook has been steady, as many organizations hire informatics experts to solve documentation issues and decrease errors. Informatics specialists typically work for hospitals and medical-records software vendors.

Nurse Attorney Median salary: $49,000 A nurse attorney is exactly that: a nurse who has gone back to school to become an attorney. Few attorneys have the medical knowledge of nurses. Nurse attorneys work in many different settings, including firms that specialize in social security disability, hospital legal departments, or litigation firms. When becoming a nurse attorney, the first step is to become a nurse by earning your BSN and passing the licensing exam. It would also be vital to acquire hands-on nursing experience. Your next step would be to apply and be accepted by a law school. This would include another three or four

years of school. After completion, you will then have to take the bar exam for the state where you will practice. You could opt to open your own practice or try to get on board with a law firm or a healthcare-related company.

Where Do I Begin? If you, too, are seeking a new path, ask yourself the following questions: • Should I focus on a nonclinical or a clinical route? • Am I ready to move away from providing direct patient care, or would I miss the relationship with my patients? Analyze your skill set; take a hard look at your strengths and the environment where you feel you can thrive. Remember, there are more paths in the nursing spectrum than you might think. One of the most important factors to consider is if you would need further education or credentialing and whether it’s feasible to return to school. Prioritize a list of what’s most important, the elements of nursing that you enjoy the most, salary expectations, and what kind of culture would suit your personality. Most often, I find there are several routes accessible. Find the path that makes the most sense for your journey. Samantha Stauf is a graduate of the University of Idaho. She enjoys researching how technology has affected the health care field.

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Degrees of Success

Transitioning from Clinical Nurse to Educator BY DEBORAH DOLAN HUNT, PHD, RN

“The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.” —William Arthur Ward

he role of the academic nurse educator is both rewarding and challenging. Furthermore, the nurse educator plays

a pivotal role in the nursing profession as well as in the development and preparation of future nurses and advanced degree nurses. The nursing

All nurses are teachers in their own right, and nurse educators build upon these foundational skills via education and experience.

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profession is currently experiencing a faculty shortage. According to the American Association of Colleges of Nurses, the national vacancy rate for the 2014–2015 academic year is 6.9%, which limits our ability to adequately prepare our future workforce. Consequently, this is the perfect time to consider transitioning into an academic role.

Some of the factors related to the current faculty shortage include an aging workforce, lack of a diverse cadre of educators, educational requirements, the cost associated with advancing one’s education, and lack of competitive financial compensation. Although the financial compensation is not competitive with current nursing salaries, the

Degrees of Success educator role is extremely rewarding and offers a certain degree of flexibility and autonomy. There are several paths you can choose on your journey into the world of academia. All nurses are teachers in their own right, and nurse educators build upon these foundational skills via education and experience. Seeking out opportunities, such as the role of preceptor, patient educator, or hospital-based educator, can help you prepare for a future role in academia. Academic teaching shares many of the basic tenets of all educators; however, academic faculty must meet the triad of excellence in teaching, service to the profession and the organization, and scholarship. Completing a graduate degree in nursing education will certainly help to prepare you for the rigors of academia. There are a myriad of faculty development and scholarship programs that are offered by organizations, such as the Jonas Center for Nursing and Veterans Healthcare, Johnson and Johnson, and the Robert Wood Johnson Foundation, which help address the faculty shortage, the lack of diversity, and the related shortage of nurses. The Institute of Medicine’s report, The Future of Nursing, also identified the need for the advanced education of all nurses and increased diversity at all levels of nursing. Academic nurse educators must possess the required clinical and educational competencies; however, there is always a need for experienced clinical nurses to fulfill the role of clinical instructor, and this is a great place to begin one’s transition.

Types of Academic Educator Roles The role of the academic nurse educator varies based on the specific type of educational setting and program. Basic nursing programs include diploma, associate degree, and baccalaureate degree. Graduate programs include master’s degrees and doctoral degrees in a variety of specialty areas. Many programs are offered in traditional brick-and-mortar colleges and universities, but online programs have become very popular. Academic teaching roles include adjunct, clinical instructor, lecturer, assistant professor, associate professor, and full professor. There are also a host of administrative positions for experienced educators—dean, associate dean, and director. All of these roles require related clinical experience and education.

Educational Requirements and Experience The educational and experiential requirements for nursing faculty members are

somewhat different depending on the actual role. In regards to educational level, faculty members must have a graduate degree at the master’s level to teach in an associate degree program and a doctoral degree to teach at the baccalaureate or higher level. There are exceptions to this rule, however. For example, a clinical instructor does not have to have a doctoral degree but does need the related clinical experience that is relevant to the clinical teaching role (e.g., a pediatric clinical instructor must have at least two years of experience working in a pediatric setting). Diploma and associate degree

ulty to hold a doctoral degree and related experience. Some academic institutions will hire faculty who do not hold a doctoral degree but are currently enrolled in a program. It is important to note that most academic institutions require that at least one degree be in nursing—baccalaureate or master’s. Although it is not mandatory to have a master’s degree in nursing education, it is certainly helpful for your future role in academia. Another option is to complete a postmaster’s certificate program in nursing education. This is especially helpful for nurse prac-

Academic teaching shares many of the basic tenets of all educators; however, academic faculty must meet the triad of excellence in teaching, service to the profession and the organization, and scholarship.

programs most often require their faculty members to have a master’s degree and related experience. Baccalaureate and graduate programs require fac-

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titioners and clinical nurse specialists who are highly experienced clinicians but require further development in the principles of teaching,

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Degrees of Success teaching and learning theories, course development, test construction, and evaluation. A doctoral degree is required for most tenure track positions and/or when teaching in a graduate program in addition to most baccalaureate programs. Doctoral degrees include Doctor of Philosophy (PhD), Doctor of Education (EdD), Doctor of Nursing Science (DNSc), and Doctor of Nursing Practice (DNP). There

into the world of academia. In OJIN: The Online Journal of Issues in Nursing, Penn, Wilson, and Rosseter argued that nurse educators must have the following: teaching skills; knowledge, experience, and preparation for the faculty role; curriculum and course development skills; evaluation and testing skills; and personal attributes. Additionally, nurse educators are also expected to serve as advisors and mentor

Because health care and technology are rapidly changing, it is vital to engage in lifelong learning and development and stay abreast of the current literature.

are numerous other doctoral programs, but these are the most common ones for nurse educators. Academic institutions may have different requirements regarding educational and clinical experience, so be sure to do some research before deciding on which degree program to attend. Nurse educators tend to teach in the area of their specialty, such as medical-surgical, psychiatric nursing, or pediatric nursing, but one must be versatile because you may be asked to teach new or unfamiliar content. Because health care and technology are rapidly changing, it is vital to engage in lifelong learning and development and stay abreast of the current literature.

Major Responsibilities and Key Attributes Nurse educators have numerous responsibilities and, as such, require certain attributes and qualifications that will guide them in their transition

Minority Nurse | WINTER 2015

students, serve on committees, and make significant scholarly contributions. Being passionate and caring about your profession and your students is very important. As a nurse educator, you will spend a good amount of time developing various course items in addition to reading and evaluating students’ work, so writing and communication skills are vital. You will also need to clearly articulate the information you share with your students and peers, in addition to being a good listener. Time management and organization are also essential because the role of the academic nurse educator is extremely demanding.

Teaching, Service, and Scholarship The three requirements for tenured and many nontenured faculty members are teaching, service, and scholarship. Depending on the type of faculty appointment, there will

be an expected/required percentage of each one of these. For example, in many academic settings, teaching will be the most heavily valued. However, if you are teaching at the doctoral level at a research university, then scholarship in the form of research will be equally important. Nevertheless, the most important goal for new faculty is to become an exemplary and expert teacher. This is accomplished with experience, education, reading current literature, mentorship, evaluation (self, student, and peer), and faculty development programs. Nurse educators will eventually develop their own unique style that is influenced by personal beliefs, pedagogies, and philosophy (including the influence of their academic institution’s philosophy). Faculty development is an ongoing process and requires self-direction and motivation. It is important to develop a specific plan for how you will continue to develop your teaching skills. Scholarship relates to learning, research, and scholarly publications. The type of required scholarly works will

tribute to the organization and profession without financial compensation. Typically, this includes serving on committees, serving on an editorial board, or serving as a peer reviewer. There are certainly many other ways to meet this requirement, which may also involve serving one’s community.

Rank, Tenure, and Academic Freedom Many full-time faculty positions are tenured. Ranks include instructor, assistant professor, associate professor, and full professor. When faculty members receive an academic appointment, they are given a contract that states their rank and the number of years they have to demonstrate that they have met the required expectations of teaching, service, and scholarship to earn tenure. Tenure is one of the ways academic freedom is protected. Academic freedom pertains to a faculty member’s right to teach content, conduct research, and write or speak without censure, with the caveat that he or she demonstrates sound judgment when teaching content, especially if it is controversial.

You should seek out as many teaching experiences as you can. Consider becoming a mentor or preceptor, join the patient education committee, or develop a continuing education article.

be dictated by your academic organization and your specific faculty appointment. Scholarship includes conducting research, peer reviewing for publications, and presenting at conferences. Service requires one to con-

Faculty must be careful not to influence their students’ beliefs or abuse their power as educators. All faculty members should be well versed in the rights and legal, ethical, and moral responsibilities that are inherent in this role.

Degrees of Success Ways to Transition to a Nurse Educator Role In addition to experience and education, transitioning to the role of nurse educator requires the development of realistic goals and objectives. If you truly have the desire to teach, you should develop a specific plan with all the steps you will need to complete to meet your goal. Utilizing the nursing process will help you to develop a realistic plan. The first step is to assess your current level of knowledge, skills, education, and attributes. From there, you can begin to develop a specific individualized plan for how to accomplish each objective. Note that, if you do not have an advanced degree, you will need to enroll in a graduate program, so be sure to carefully consider which program will be best for you. As a graduate student, you may have an opportunity to work as a teacher’s assistant, which will provide you with invaluable experience. You should seek out as many teaching experiences as you can. Consider becoming a mentor or preceptor, join the patient education committee, or develop a continuing education article. You should also consider becoming an adjunct clinical instructor in your specialty area, which is a great way to “test the waters” and eventually transition to a fulltime faculty role. Reading the current literature and attending conferences are also very helpful. You will need to network and consult with your mentor. Furthermore, developing a professional portfolio with a well-developed resume—or curriculum vitae—is crucial

when applying for a faculty position. It is also advisable to participate in mock interviews so that you will be prepared for an actual interview. It’s worth noting that the interview process at an academic setting is unique; you will most likely be interviewed by a search committee. Don’t be surprised if you are asked to demonstrate your teaching skills and share your philosophy of teaching.

Develop a Five-Year Plan Developing a five-year plan with goals, objectives, and actions with specific dates can be very helpful when planning your transition. The

goals should be realistic and achievable, and the objectives should be measurable. The actions are the steps needed to meet your objectives and accomplish your goals. Goals may be related to earning an advanced degree, obtaining a position as an adjunct, or applying for a full-time faculty role. The plan should be evaluated on an ongoing basis and revised in accordance with your current needs. It is important to remember that plans are not set in stone and can always be revised. When you complete your first five-year plan, you will want to begin another one as you continue on your journey as a nurse educator.

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Although the transition may be challenging, there are many strategies you can employ to guide you through this process. The journey from clinician to educator is filled with tremendous growth and learning. Deborah Dolan Hunt, PhD, RN, is an associate professor of nursing at The College of New Rochelle. She is the author of The New Nurse Educator: Mastering Academe and The Nurse Professional: Leveraging Your Education for Transition into Practice.

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

Minority Nurse | WINTER 2015

MINORITY NURSE

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

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

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MINORITYNURSE.COM Highlights from the Blog

Newsletter Ready for Winter Storms? As a nurse, you’re always ready to deal with the unexpected. Nurses think quick on their feet, no question about it. They also know how to plan and coordinate their actions with others.

4 Ways to Ace the Exit Interview You thought the interview to get your job was stressful enough, but now they want another interview when you’re leaving. What’s up with that?

Quit Your Job and Keep Your Professionalism Did you ever leave a job you loved because you knew it was a good career move? What about the opposite—you couldn’t wait to walk out the door and never look back?

Allaying Your Ebola Fears As a health care professional, news about the progression of Ebola may cause you to feel stress, fear, and a general anxiety about your personal health. That’s to be expected—who wouldn’t be apprehensive when there’s a medical emergency and your vocation puts right in the middle of it?

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

Minority Nurse | WINTER 2015

Academic Opportunities

Discover

Johns Hopkins doctoral nursing education

Doctor of Nursing Practice (DNP) As a clinical leader, advance the practice of nursing and improve healthcare outcomes.

TEMPLE UNIVERSITY A Leading Philadelphia Institution

Doctor of Philosophy (PhD) As a research leader, develop new knowledge for the science and practice of nursing and health.

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

Choose your path at Johns Hopkins School of Nursing—a place where exceptional people discover possibilities that forever change their lives and the world.

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

nursing.jhu.edu/doctoral15

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

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.

Post-Master’s DNP Program for Advanced Practice Registered Nurses—certified nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists **(full and part-time) To apply online visit: www.temple.edu/nursing

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.

For more information, please contact: Ms. Audrey Scriven TUnurse@temple.edu or 215-707-4618

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Academic Opportunities

Care for the Community Find your purpose with a College of Nursing and Health Care Professions degree from Grand Canyon University. • Earn your degree 100% online • Learn from academically prepared faculty in our vibrant online learning community • Christian perspective integrates spiritual principles into practice

Our degree programs include: • Registered Nurse to Bachelor of Science in Nursing (RN to BSN) • Master of Science in Nursing with an Emphasis in Nursing Leadership in Health Care Systems • Master of Science in Nursing with an Emphasis in Nursing Education • Doctor of Nursing Practice (DNP)

For more information contact your local representative at 855-428-1263 Grand Canyon University is regionally accredited by the Higher Learning Commission. (800-621-7440; http://hlcommission.org/)For more information about our graduation rates, the median debt of students who completed the program, and other important information, please visit our website at www.gcu.edu/disclosures. Please note, not all GCU programs are available in all states and in all learning modalities. Program availability is contingent on student enrollment. 14INTL0026

Master your nursing career. Pick your pathway with our nationally ranked master’s program. You’re a full-time nurse, wearing scrubs by day — or night — and you’re ready to take your career to the next level. Now you need a master’s program to make that happen. Our program offers advanced clinical experiences backed by our standing in the nation’s top 10 percent, as ranked by U.S. News & World Report. And with concentrations ranging from primary or acute care to administration and leadership, you can tailor your degree to the path you want. Ready to learn more? Visit nursing.vcu.edu/education/masters.

Creating collaboration. Advancing science. Impacting lives.

School of Nursing an equal opportunity/affirmative action university

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Faculty Opportunities WOULD YOU LIKE TO WORK WITH A UNIQUE NEW PROGRAM NEAR TWO AWE-INSPIRING MOUNTAIN RANGES AND A BEAUTIFUL LAKE? The Nursing and Nutrition Department of the State University of New York, College at Plattsburgh invites applications for the positions below. The Nursing Program educates nurses to provide care for multicultural clients in community-based and high-tech acute care settings. The Nursing Program offers both traditional 4-year and Registered Nurse Baccalaureate Programs. These are unique opportunities to join a faculty who encourage educational motivation and support a mission that emphasizes excellence in teaching and scholarship.

ADULT-GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER PROGRAM These are unique opportunities to contribute to be part of a new program as it enters its initial year. This program joins a pre-licensure BS program and an RN-to-BS program that are fully accredited by the Commission on Collegiate Nursing Education and well established at the College. The Nursing Department currently serves approximately 400 undergraduate students. The successful candidates will be committed to excellence in teaching, scholarship and service. He or she will be expected to demonstrate an understanding of and sensitivity to diversity and gender issues, as SUNY Plattsburgh is committed to ensuring that its graduates are educated to succeed in a increasingly complex, multicultural, and interdependent world. ASSOCIATE PROFESSOR & PROGRAM DIRECTOR FOR THE MASTER’S DEGREE IN NURSING

ASSISTANT PROFESSOR OF NURSING

This position will advance the mission of the department by contributing to the development of new and innovative programs in Nursing, as well as perform teaching and administrative duties.

Responsibilities will include teaching in primarily an online environment, ongoing curriculum development, student advisement, participation in on-campus graduate seminars, and clinical management.

Required Qualifications: A doctoral degree in Nursing or related field with a master’s degree in Nursing in an area focusing on Adult Health is required, along with national certification as an Adult or Adult-Gerontology Nurse Practitioner. Qualifications for licensure as a Nurse Practitioner in New York State must be met. The successful candidate will have demonstrated an ability to work effectively and collegially with faculty, staff, and administrators. Preferred Qualifications: The ideal candidate will have significant clinical experience as a Nurse Practitioner in an adult primary care setting, demonstrated experience teaching nursing at the graduate and undergraduate levels, and experience with curriculum development and design commensurate with the rank of Associate Professor. Salary: $85,000 minimum, plus excellent benefits.

Required Qualifications: A Master’s Degree in Nursing with a focus in Adult Health is required, along with national certification as an Adult or Adult-Gerontology Nurse Practitioner. Qualifications for licensure as a Nurse Practitioner in New York State must be met. The successful candidate will have demonstrated an ability to work effectively and collegially with faculty, staff, and administrators. Preferred Qualifications: Doctoral level preparation is preferred. The ideal candidate will have significant clinical experience as a Nurse Practitioner in a primary care setting, and demonstrated teaching ability in nursing education, commensurate with the rank of Assistant Professor. Salary: $70,000 minimum, plus excellent benefits.

SUNY Plattsburgh is an equal opportunity employer, committed to excellence through diversity. As an equal opportunity employer and a government contractor subject to VEVRAA, SUNY Plattsburgh complies with hiring regulations regarding sex, color, religion, national origin, disability, age and veteran status. For further position details and to apply, please visit http://jobs.plattsburgh.edu and select “View Current Openings”

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

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

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Faculty Opportunities

COLLEGE OF NURSING NURSING FACULTY NEEDED

College of Health Sciences School of Nursing Faculty Positions Located in the historic industrial city of Lowell, 25 miles northwest of Boston, the University of Massachusetts Lowell would like to invite applications for the following open faculty positions in the School of Nursing within the College of Health Sciences:

• Assistant/Associate Professor • Clinical Assistant Professor • Lecturer • Visiting Faculty (Multiple Positions)

Oklahoma Baptist University invites applications for tenure track positions as Assistant and Associate Professors of Nursing. The OBU College of Nursing is a baccalaureate program for the preparation of a professional nurse and views nursing as a Christian ministry and as a professional practice. During nursing courses, students learn to provide quality nursing care through competent practice. Upon completion of the program, the graduate is qualified to take the national examination for licensure as a registered nurse. Salary and rank will be commensurate with qualifications and experience. Applicants must submit a letter of application, the OBU faculty application form available online at okbu.edu/hrforms, vita, three current letters of recommendation, and graduate transcripts. Review will begin immediately. All materials may be submitted to hr@okbu.edu.

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For complete job descriptions, required materials, application deadlines and to apply, please visit https://jobs.uml.edu.

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The School of Nursing at UMass Lowell is poised for growth in its new home, the new Health and Social Sciences Building. Located near the Merrimack River where the Industrial Revolution began, the School of Nursing strives toward excellence in nursing education, research and community service. With state-of-the art simulation laboratories, the new hospital-like facility offers faculty and students a collaborative and realistic place to teach and learn. Our unique location in the diverse City of Lowell offers healthcare opportunities for our students and faculty to provide culturally competent care. With over 600 students in a wide range of programs – a bachelor’s degree; a master’s degree that prepares nurse practitioners; a Ph.D. in nursing with a health promotion focus; and a Doctorate of Nursing Practice – the school anticipates hiring tenure-track nursing faculty.

AACN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C4 UNCF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 University of Connecticut Health Center. . . . . . . . . . .9 ACADEMIC OPPORTUNITIES Grand Canyon University. . . . . . . . . . . . . . . . . . . . . .54 Johns Hopkins University . . . . . . . . . . . . . . . . . . . . .53

Find out more about the University near the river, just 25 miles north of Boston. Visit www.uml.edu/nursing.

Monmouth University . . . . . . . . . . . . . . . . . . . . . . . .C2

Underrepresented minorities are strongly encouraged to apply. We believe that diversity that reflects the community we serve enhances the academic experience for our students and is essential to the University of Massachusetts Lowell’s success.

Temple University . . . . . . . . . . . . . . . . . . . . . . . . . . .53

The University of Massachusetts Lowell is an Equal Opportunity/Affirmative Action, Title IX employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, ancestry, age over 40, protected veteran status, disability, sexual orientation, gender identity/expression, marital status, or other protected class.

Virginia Commonwealth University. . . . . . . . . . . . . .54 FACULTY OPPORTUNITIES Oklahoma Baptist University. . . . . . . . . . . . . . . . . . .56 SUNY Plattsburgh . . . . . . . . . . . . . . . . . . . . . . . . . . .55 University of Massachusetts, Lowell . . . . . . . . . . . .56

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Minority Nurse | WINTER 2015

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