Minority Nurse Magazine (Winter/Spring 2016) by Springer Publishing Company

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The Career and Education Resource for the Minority Nursing Professional • WINTER/SPRING 2016

How to Weigh Job

Offers + Depression in Nurses THE NEW HEALTH CARE WORKPLACE SURVIVING YOUR FIRST YEAR AS A NURSE

P R S RT S T D U S P O S TA G E PA I D BOLINGBROOK IL PERMIT #2020

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Table of Contents

In This Issue 3

Editor’s Notebook

Vital Signs

Making Rounds

The Funny Bone

Highlights from the Blog

Index of Advertisers

Academic Forum 38

Nurses on Missions: Connecting, Serving, Caring, and Teaching

How to Weigh Job Offers By Julia Quinn-Szcesuil Getting a job offer is exciting, but how do you decide which job is right for you when more than one offer is on the table?

Features 14

Depression in Nurses: The Unspoken Epidemic

By James Z. Daniels

By Lynda Lampert, RN

Three nurses share their experiences on missions to prove that one person can make a difference

Find out why depression is arguably nursing’s best kept secret

Degrees of Success 42

Cover Story

Using Health Information Technology to Improve Minority Health Outcomes

A Day in the Life of a Nurse with Dystonia

By Pam Chwedyk

By Beka Serdans, RN, MS, ANP-BC

Discover how health IT tools can help you develop innovative

Look through the lens of a nurse with a rare movement disorder as she walks us through a typical shift

strategies for addressing racial and ethnic health disparities

The New Health Care Workplace

Health Policy

By Jebra Turner

Policy Engagement: A Call for All Nurses

Learn more about how nurses are trailblazing new roads

By Janice M. Phillips, PhD, FAAN, RN

in the profession and how you can make the most of

The need for nurses to be engaged in the policymaking process has never been greater

tomorrow’s opportunities

Surviving Your First Year as a Nurse By Nachole Johnson New nurses should follow these five tips to ease their transition from student nurse to nurse

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Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Stepping Back to Move Forward

ur nation is in need of healing. We have become numb to the horrific news stories that dominate our media. In 2016, let’s make a pledge to do better— for the sake of our families, friends, coworkers, and patients. That may seem like an impossible task, but it starts with bettering yourself. It may be something as simple as finding the right job. What qualifies as a dream job is subjective, so it’s important to consider the overall picture and not be swayed by a higher salary alone. If a happy nurse often leads to better patient care, you owe it to yourself—and your patients—to make your happiness a deciding factor. In our cover story, Julia Quinn-Szcesuil helps you weigh the pros and cons of job offers to help you find the right job. Did you know that nurses are twice as likely as the general public to experience clinical depression? While selflessly caring for others is an unofficial part of the job description, it can be detrimental to your own health. Lynda Lampert reports on why depression among nurses is considered taboo and what you can do to support one another. If you spend all day helping patients get better, why shouldn’t that extend to your colleagues as well? Technology is playing a vital role in helping nurses improve care. Not only is it making it easier for nurses to maximize their ability to address racial and ethnic health disparities, but also it is providing innovative ways to help patients with chronic diseases get better. Pam Chwedyk reports on how much progress we’ve made combatting disparities since the passage of the HITECH Act of 2009. Much like technology, nursing is constantly evolving. It can be difficult to keep up if you don’t make a lifelong commitment to advance your education. Jebra Turner analyzes five current trends to help you embrace the nontraditional roles of tomorrow. As we all know, textbook scenarios rarely translate in the real world. This means that new nurses are particularly vulnerable if they aren’t given the proper support when they are taken out of the comfort zone of nursing school. Nachole Johnson offers five tips to help newbie nurses survive that tough first year. Starting a new year is always a good opportunity to step back and look at the larger picture. Whether it’s volunteering to go on a medical mission (like the nurses in James Z. Daniels’s column), gaining perspective by stepping into someone else’s shoes temporarily (such as Beka Serdans’s, as she walks us through a typical nursing shift while dealing with her own disability, dystonia), or getting involved in the policy-making process (per Janice M. Phillips’s call to action), take a moment to do something that will lead to a better, brighter future for all of us. — Megan Larkin

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MINORITY NURSE MAGAZINE Publisher James Costello Editor-in-Chief Megan Larkin Creative Director Mimi Flow Production Manager Diana Osborne Digital Media Manager Andrew Bennie Minority Nurse National Sales Manager Peter Fuhrman 609-890-2190 n Fax: 609-890-2108 pfuhrman@springerpub.com Minority Nurse Editorial Advisory Board Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE Immediate Past President National Association of Hispanic Nurses Birthale Archie, DNP, BS, RN Faculty Davenport University Teresita Bushey, MA, APR-BC Assistant Professor, School of Nursing The College of St. Scholastica Martha A. Dawson, DNP, RN, FACHE Assistant Professor, Family, Community & Health Systems University of Alabama at Birmingham Wallena Gould, CRNA, EdD, FAAN Founder and Chair Diversity in Nurse Anesthesia Mentorship Program Alethea Hill, PhD, ACNP-BC, ANP-BC Associate Professor University of South Alabama Tri Pham, PhD, RN, AOCNP-BC, ANP-BC Nurse Practitioner The University of Texas-MD Anderson Cancer Center

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.

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Subscription Rates: Minority Nurse is distributed free upon request. Visit www.minoritynurse.com to subscribe. Change of Address: To ensure delivery, we must receive notification of your address change at least eight weeks prior to publication. Address all subscription inquiries to Springer Publishing Company, LLC, 11 West 42nd Street, 15th Floor, New York, New York 10036-8002 or e-mail subscriptions@springerpub.com. Claims: Claims for missing issues will be serviced pending availability of issues for three months only from the cover date (six months for issues sent out of the United States). Single copy prices will be charged for replacement issues after that time. Minority Nurse ® is a registered trademark of Springer Publishing Company, LLC. © Copyright 2016 Springer Publishing Company, LLC. All rights reserved. Reproduction, distribution, or translation without express written permission is strictly prohibited.

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Vital Signs

Raising Awareness of a Daily Pill that Can Prevent HIV Infection A Vital Signs report published by the Centers for Disease unaware of its promise,” says Control and Prevention (CDC) last November estimates CDC Director Tom Frieden, that 25% of sexually active gay and bisexual adult men, MD, MPH. “With about 40,000 HIV infections newly diagnearly 20% of adults who inject drugs, and less than nosed each year in the U.S., 1% of heterosexually active adults are at substantial we need to use all available risk for HIV infection and should be counseled about prevention strategies.” pre-exposure prophylaxis (PrEP), a daily pill for HIV PrEP is one essential prevention.

rEP for HIV prevention was approved by the Food and Drug Administration in 2012. When taken daily, it can reduce the risk of sexually acquired HIV by more than 90%. Daily PrEP can also reduce the risk of HIV infection among people who inject drugs by more than 70%. However, according to

recent studies, some primary health care providers have never heard of PrEP. Increasing awareness of PrEP and counseling for those at substantial risk for HIV infection is critical to realizing the full prevention potential of PrEP. “PrEP isn’t reaching many people who could benefit from it, and many providers remain

component in the nation’s high-impact prevention strategy

While PrEP can fill a critical gap in America’s prevention efforts, all available HIV prevention strategies must be used to have the greatest impact on the epidemic. These include providing treatment to suppress the virus among people living with HIV, ensuring correct and consistent use of condoms, reducing risk behaviors, and ensuring people who inject drugs have access to sterile injection equipment from a reliable source. “PrEP has the potential to dramatically reduce new HIV infections in the nation,” says Jonathan Mermin, MD, MPH, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “However, PrEP only works if patients know about it, have access to it, and take it as prescribed.” A separate analysis published in Vital Signs suggests that focused efforts can significantly expand the reach of PrEP. Researchers from the New York State Department of Health report that, in the year year following the launch of a statewide effort to increase PrEP knowledge among potential prescribers and candidates,

PrEP use among New Yorkers covered by Medicaid increased from 303 prescriptions filled from July 1, 2013, through June 30, 2014, to 1,330 prescriptions filled from July 1, 2014, through June 30, 2015. PrEP is one of four focus areas in the July 2015 update to the National HIV/AIDS Strategy. Other key elements of the Strategy and CDC’s high-impact prevention approach are • widespread HIV testing and linkage to care that enables early treatment; • broad support for people living with HIV to remain engaged in comprehensive care, including support for treatment adherence; and • universal viral suppression. “Today’s prevention landscape is complex, and with the wide range of strategies now available, no single tool addresses every prevention need. Reducing the toll of HIV in this nation will require matching the right tools to the right people,” says Eugene McCray, MD, director of CDC’s Division of HIV/AIDS Prevention. “Providers must work with patients to assess which tools best meet their needs. PrEP can benefit many who have high risk. Other risk reduction strategies, such as condoms and access to sterile injection equipment, also offer substantial protection when used consistently and correctly.” To learn more about PrEP, visit www.cdc.gov/vitalsigns/ hivprep.

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Vital Signs

Latino Youth Who Feel Discriminated Against Are More Depressed, Less Likely to Help Others Recent conversations in the United States have centered on discrimination issues; yet, little is known about how discrimination affects youths’ mental health and their willingness to help others. Now, University of Missouri researchers found Latino immigrant youth who reported feeling discriminated against had more depressive symptoms and were less likely to perform altruistic behaviors six months and a year after experiencing discrimination.

“I

t’s important to consider that experiencing discrimination starts to wear on cognitive and emotional resources that youth may have, which can lead to symptoms of depression, sadness, and withdrawal,” says Alexandra Davis, a doctoral candidate in the MU Department of Human Development and Family Science, and the lead author of the study. “Once they are experiencing these withdrawal symptoms, it becomes harder for them to engage in selfless forms of helping because they have less resources available to give to others, and it works both ways. Experiencing discrimination and becoming more withdrawn and less engaged in helping behaviors, in turn, might contribute to depressive symptoms. It can become a cycle.” For the study, 302 Latino immigrants between the ages of 13 and 17 years old completed three questionnaires over the course of a year about discrimination experiences, mental health, and prosocial behaviors, such as volunteering or helping others. The youth had lived in the United

States for five years or less. The study controlled for the teens’ previous levels of depression and involvement in helping behaviors in order to observe changes over time. “This study gives us a window into the experiences of Latino immigrant adolescents who recently arrived to the U.S.,” says study coauthor Gustavo Carlo, Millsap Professor of Diversity and Multicultural Studies in MU’s College of Human Environmental Sciences. “The reports youth provided on discrimination are not necessarily experiences that have accumulated over a long period of time. This perceived discrimination over a short period of time is already having a significant impact on their mental health and their social functioning. We can only imagine what the effects of discrimination may be like over a longer period of time.” Individuals should be aware of how youth from marginalized groups perceive discrimination because it is undermining positive social behaviors toward others, the researchers say. Additionally, adolescence is a time when peers are

important; perceiving isolation from peers and barriers in school can impact adolescents’ development. Facing these risk factors, barriers, and challenges might impact their health and long-term wellbeing, Davis says. “So many challenges and forces exist that impinge individuals’ abilities to care for others, to be compassionate and empathetic toward others,” Carlo says. “For Latino adolescents and racial and ethnic minorities, this research demonstrates that discrimination poses an uncontrollable, additional set of challenges in addition to the challenges everyone experiences, whether financial, academic, or interpersonal.” Trained mental-health professionals and accessible mental-health services could help

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buffer youth against these depressive symptoms, Davis says. The Journal of Youth and Adolescence published the study, “The Longitudinal Associations between Discrimination, Depressive Symptoms, and Prosocial Behaviors in U.S. Latino/a Recent Immigrant Adolescents,” last November. This research is part of a much larger study, Construyendo Oportunidades Para los Adolescentes Latinos, that is examining the health behaviors of recently immigrated Latino/a adolescents and their families living in Miami and Los Angeles. Source: University of Missouri News Bureau

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Vital Signs

Healthy Diet May Reduce Risk of Ovarian Cancer in African American Women A healthy diet may reduce the risk of ovarian cancer in African American women, according to data presented at the Eighth American Association for Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held last November.

“B

ecause there is currently no reliable screening available for ovarian cancer, most cases are diagnosed at advanced stages,” says the study’s author, Bo (Bonnie) Qin, PhD, a postdoctoral associate at Rutgers Cancer Institute of New Jersey. “That highlights a critical need for identifying modifiable lifestyle factors, including dietary interventions.” Ovarian cancer is the fifth leading cause of cancer death among women in the United States. African American women are less likely than white women to be diagnosed with the disease, but more likely to die from it. In order to assess whether an improved diet could reduce the risk of ovarian cancer in African American women, Qin analyzed the diets of 415 women with ovarian cancer and 629 control patients, using data from the African American Cancer Epidemiology Study, a population-based case-control study of ovarian cancer in African American women in 11 sites in the United States. Qin collaborated with her mentor Elisa V. Bandera, MD, PhD, professor of epidemiology at Rutgers Cancer Institute of New Jersey, and with fellow researchers to evaluate the impact of three index-based dietary patterns: the 2005 Healthy Eating Index, which

was based on the federal Dietary Guidelines for Americans; the 2010 Healthy Eating Index (HEI-2010), which reflects the most recent dietary guidelines and has an increased emphasis on quality; and the Alternate Healthy Eating Index-2010 (AHEI-2010), which is based on a different nutrition guide, the Healthy Eating Pyramid.

Qin said that, among all African American women in the study, those with the highest adherence to an AHEI-2010 diet were 34% less likely to be diagnosed with ovarian cancer than women with the lowest AHEI-2010 adherence. Among postmenopausal women, the women with the highest quartile of HEI-2010

Women answered questions about their diet in the year leading up to a diagnosis (for patients) or to the time of an interview (for controls). They received scores based on numerous components of the three diets.

scores were 43% less likely to be diagnosed with ovarian cancer, and the women with the highest quartile AHEI-2010 scores were 51% less likely to be diagnosed with ovarian cancer than the women in the lowest quartile.

Qin said the benefits of an HEI-2010 diet come from higher intake of total vegetables, greens, beans, seafood, and plant proteins, combined with lower intake of empty calories, such as those from solid fats, alcohol, and added sugars. Similarly, the benefits of an AHEI-2010 diet derive from higher vegetable intake and lower intake of sugar-sweetened beverages and fruit juice. The diets have many common elements, but AHEI-2010 has more specific recommendations for protein and fat sources, including nuts, legumes, and omega-3 fatty acids EPA and DHA. HEI-2010 uses an energy density approach, which recommends optimal intake of nutrients relative to a person’s daily diet. Qin said further research is necessary to determine whether all aspects of the healthier diets contributed to a reduced risk of ovarian cancer, or whether specific nutrients conferred the benefits. “As a high-quality diet is likely to have benefits for many chronic conditions, it is probably a safe bet for better health in general,” she says. Qin says the main limitation of this study is that it required women to recall their diet up to one year before the study, which introduces the possibility of recall bias and inaccurate reporting. Source: American Association for Cancer Research

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Making Rounds

February

April

24-27

6-8

30th Annual Conference Colonial Williamsburg Lodge Williamsburg, Virginia Info: 877-314-7677 E-mail: info@snrs.org Website: www.snrs.org

34th Annual Conference Hyatt Regency Miami Miami, Florida Info: 888-866-8773 E-mail: vnaa@vnaa.org Website: http://vnaa.org

Southern Nursing Research Society

28 - 30

Visiting Nurse Associations of America

American Conference for the Treatment of HIV 10th Annual Conference Renaissance Dallas Hotel Dallas, Texas Info: 540-368-1739 E-mail: ACTHIV@meetingmasters.biz Website: www.ACTHIV.org

12-16

March 3-5

National Association of Clinical Nurse Specialists 2016 Annual Conference Loews Philadelphia Hotel Philadelphia, Pennsylvania Info: 215-320-3881 E-mail: info@nacns.org Website: http://nacns.org

4-7

Asian American / Pacific Islander Nurses Association 2016 Conference at Sea 3-day Baja Mexico Cruise Carnival Inspiration (Port: Los Angeles, California, at Long Beach) E-mail: info@aapina.org Website: http://aapina.org

19-22

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

13 - April 3

The Dermatology Nursesâ&#x20AC;&#x2122; Association 34th Annual Convention JW Marriott Indianapolis Indianapolis, Indiana Info: 800-454-4362 E-mail: dna@dnanurse.org Website: www.dnanurse.org

International Society of Psychiatric-Mental Health Nurses

16-19

American Association of Critical-Care Nurses 2016 National Teaching Institute & Critical Care Exposition Ernest N. Morial Convention Center New Orleans, Louisiana Info: 800-899-2226 E-mail: info@aacn.org Website: www.aacn.org

17-20

Nurses Improving Care for Healthsystem Elders 2016 Annual Conference Chicago Marriott Downtown Chicago, Illinois Info: 212-998-5445 E-mail: conference@nicheprogram.org Website: www.nicheprogram.org

31- June 5

American Holistic Nurses Association 36th Annual Conference Hyatt Regency Coconut Point Resort & Spa Bonita Springs, Florida Info: 800-278-2462 E-mail: conference@ahna.org Website: www.ahna.org

21-23

American Nursing Informatics Association 2016 Annual Conference Hyatt Regency San Francisco San Francisco, California Info: 866-552-6404 E-mail: ania@ajj.com Website: www.ania.org

21-24 Academy of Neonatal Nursing 13th National Advanced Practice Neonatal Nurses Conference Sheraton Hotel and Marina San Diego, California Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

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May

ISPN 18th Annual Conference and 9th Psychopharmacology Institute Marriott City Center Minneapolis, Minnesota Info: 608-443-2463 E-mail: conferences@ispn-psych.org Website: www.ispn-psych.org

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How to Weigh Job Offers

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BY JULIA QUINN-SZCESUIL

Getting a job offer is thrilling, but having two offers on the table can actually heighten both excitement and anxiety. Because nurses are in demand and much needed right now, you could someday find yourself having to choose between two (or even more) job offers at once.

ow will you know what to do? What specific parts of each job will make it the right job for you? Nurses should look at each job move strategically and analyze each offer carefully. One job might offer a significantly higher salary, but the other might tempt you with flexible hours and more vacation time. The process of choosing the right job for you is stressful. You have a lot riding on this choice and the companies you are interviewing with have a big financial stake in choosing the right candidate, too, says Kathy Quan, RN, BSN, PHN, author of The Everything New Nurse Book, and founder of www.TheNursingSite.com. You don’t want to waste their time—or yours. And if you choose the wrong job, you don’t want to find yourself back at square one looking for another job. “When weighing job offers, there are financial considerations and work/life consid-

erations,” says Kerry Hannon, author of Love Your Job: The New Rules for Career Happiness and Getting the Job You Want After 50 for Dummies. “And there’s some soul searching.” Hannon says you should think hard about what makes you love your nursing work and what makes you happy in life so you know what each job can do for you. Are you leaving a position where your shift never ends on time or one where your boss is horrible? “What are your deal breakers?” asks Lisa Mauri Thomas, MS, a job search strategist and author of Landing Your Perfect Nursing Job. List those up front and rank them to give you a sense of what you absolutely won’t accept, she says. Remember, your dream job could be another nurse’s nightmare, so fi guring out what is important to your happiness makes a big difference in finding the job that will suit you. “Like most professionals, nurses can be easily swayed

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by salary,” says Nancy Brook, RN, MSN, of Stanford Health Care and author of The Nurse Practitioner’s Bag: A Guide to Creating a Meaningful Career That Makes a Difference. “But that shouldn’t be the whole decision if you are trying to establish a career path.” “Nursing is so stressful,” says Hannon. “Know what will help you balance that stress.” Is time off so you can recharge away necessary? In that case, vacation time might be worth more to you than a higher salary. Do you need a schedule where you can work three 12hour days so you can have four days off to take care of family? You need flexibility. Will a big jump in pay help relieve your worry over a mountain of bills? Then focusing on your financial goals can help you weigh what’s best for you.

Start Digging Early How can you find out all this information about a job so you know enough to make the right decision? When you

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Remember, your dream job could be another nurse’s nightmare, so figuring out what is important to your happiness makes a big difference in finding the job that will suit you.

are considering a new position, find out as much as you can during the interview process, but then dig deeper. “Interviewing is a two-way street,” says Hannon. “You are in the driver’s seat. They think you have something that can make their workplace better.” Both sides are trying to find a good fit, so the interview is when you can ask questions about culture, job duties, and management style, but save any salary, benefit, or flex time questions until you have an offer. Ask your interviewers why they enjoy working at the company, and ask if you can talk to a few people in the department where you would work. Turn to social media to find out even more. Look up any connections you might have to company employees. See if someone can make an introduction for you. Check out www.Glassdoor.com where former and current employees rate companies. And if you are hesitant about checking into a company blatantly, you have to ask yourself an important question. “If it backfires, do you really want to work there?” says Hannon. As you gather all your information, think about what might make you want the job. Some common factors include cold cash offers and culture, but there are other ways you can determine if a job choice will make you happy.

Consider Salary and Benefits Of course, salary plays a huge part in choosing a job offer that’s right for you, and

money weighs heavily in most job decisions. “If you’re not being paid what you are valuing your worth, you’ll be resentful,” argues Hannon. Have an idea of your ballpark salary and see if the organization comes close to it. But consider the value of all the other things in the job offer package. Some, like health benefits, might be worth thousands of dollars, while other items might not have a monetary value directly attributed to it (e.g., leadership opportunities), but that might have direct value on your life or lifestyle.

What’s the Work/ Life Attitude? Reflecting on what you honestly want will help you decide if the job is for you, so consider how the job fits into your life and how your life fits into your job—otherwise known as the work/life balance. “The most important thing when making a decision about the work/life balance is to look at the bigger picture,” says

Hannon. “There are things that don’t relate to money but that

though flex time discussions shouldn’t happen until the job offer is made, you can certainly get an idea of how things work by asking other nurses about their typical schedules.

Does the Company Culture Match Your Values? When you are interviewing, be extra-observant of the people and the surroundings so you can get a sense of what the atmosphere is like. “Does the vibe suit you?” asks Hannon. “Do you think you will fit in there?” Thomas recommends asking to meet with members of your potential team to ask about the leadership style or to describe the mood on the floor. “Find out who will be your most direct manager,” says Betsy Snook, MEd, BSN, RN, and chief executive officer of the Pennsylvania State Nurses Association. The fit here is crucial to your future job satisfaction. “People don’t leave work, they leave a manager,” says Snook. When you meet with the team, don’t put them on the spot by asking about the manager, but you can ask about the management style and any challenges they have with the style. Or ask them to give some adjectives that describe the style of man-

“Look at the culture,” says Snook. “Their values, their mission, their vision—does it match your core vision?”

circle around things that make us happy.” Flexibility and autonomy are often especially important for nurses. If you have a busy family life, you are probably looking for a schedule that includes flex time to some extent. Al-

agement. Brook recommends finding out how long the nurses have worked there. If many have years at the company, that’s a good sign that they are satisfied with how things are going. “Look at the culture,” says

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Snook. “Their values, their mission, their vision—does it match your core vision?” Snook says nurses might flock to the latest and greatest hospital in the area, but they should also step back and look at the new leadership as well. “What’s the management style of the leaders? Where did they work prior to here?” If you loved your previous job because you felt like you were part of the larger picture, then consider the overall corporation. “Is this a place where you believe in the ethics there or their purpose and mission?” asks Hannon. And is the organization stable, asks Snook. A quick Google search can reveal any merger talks, financial instability, strikes, layoffs, or worker dissatisfaction.

Is There Career Advancement? For a strategic career move, assess your bigger goals and figure out how each position brings you closer to meeting a specific goal. “Always think of your next step,” advises Thomas. Career mapping, as Thomas calls it, means that while you might accept a position, it doesn’t mean that is where you have to stay for 10 years. Quan agrees. “If you are looking to move up the ladder, you have to make choices that make sense,” she says. If an advanced degree is in your plans, a job package that includes some kind of tuition reimbursement for the classes you want to take will be very attractive to you. Look into other opportunities for learning. For instance, will you be able to learn new things through courses and workshops? Some companies

will pay for you to travel to conferences in your specialty. Consider what kinds of new challenges will be available and how you can take advantage of those. And as Snook mentions, make sure the timeline aligns with your own. If their nurse managers typically take a decade to achieve a certain position and you have a realistic goal of achieving that position sooner, will you want to wait? What if you aren’t looking for lots of challenges? Are you at a time in your life where your health or other personal issues are so demanding that you don’t want to be con-

stantly challenged at work? Be honest with yourself. If you are interviewing for a job that sounds ideal, but that requires lots of travel for training or that will give you a fast track to a management role that you

Finally, throw in all the other small things that can add up when you consider taking a job. “In general, pay is important, but you want

For a strategic career move, assess your bigger goals and figure out how each position brings you closer to meeting a specific goal. “Always think of your next step,” advises Thomas.

aren’t seeking and wouldn’t be comfortable with, then this isn’t the right job for you.

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Do the Nuts and Bolts Add Security?

to look at lifestyle, too,” says Brook. Does the great health plan include your fa-

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D vorite providers? How long is the commute? It is a trafficjammed mess that you’d have to navigate every day, or is it an easier ride than your current job? How much will you end up spending in gas (and consider fluctuating fuel costs)? Does the company offer smaller perks? Would on-site child care help you? What about things like dry cleaning services or a wellness program? Do you like the idea of frequent company outings and get-togethers, or does that seem like an imposition on your time away from work? What about the job expectations? Are you expected to sit on committees? Will you work holidays? Will any of these extras help you get closer to

thing in writing—including hours, vacation time, and even any job training you’ve been promised. “Anything you have negotiated should be in there,” Thomas says. “Nurses are good at caring for others, but they have to be their strongest self-advocates. If an employer is shaky on that, I would question if that’s a place I want to work for.” If you need time to consider the job offers, ask for a few days to crunch the numbers, says Thomas, but don’t mention that you are deciding between two offers. If you really can’t decide, determine what information is missing. If you need to spend time with nurses on the floor, ask to shadow someone. Say your intentions are good, but you need this

If you need time to consider the job offers, ask for a few days to crunch the numbers, says Thomas, but don’t mention that you are deciding between two offers.

information to help you make a solid decision, says Thomas. Show respect for their time as well and schedule anything right away.

As Snook says, you have to do your homework so you know the hard facts, but if you’ve taken the time to figure out your needs and you have

“When all is said and done, you just have to go with your gut,” Snook says.

Saying No Thanks to an Offer When you do choose one job over another, decline the other position with grace, says Thomas. “You don’t want to burn bridges,” she says. Instead, be very gracious and thank the company profusely for the interviewing opportunity. You can let them know it came down to certain variables—like the shorter commute time or the tuition assistance—the other company offered. As the job market changes so often, you want to keep the doors open and tell them you would like to remain in touch.

all the details on the table, you’ll probably find yourself leaning toward one company. “When all is said and done, you just have to go with your gut,” Snook says. And take pride in your accomplishments. “You are coming in with value,” says Brook. “Be confident in your ability to bring a good deal of value to the organization and make a decision that is right for you.” Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.

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What Do You Do With Offers in Hand? Now that you have a couple offers, you have some wiggle room if the offers are close. Before you make any move, it’s essential to have the job offer in writing, advises Thomas. “If they don’t offer one, you should request one,” she says. You can verbally accept a position contingent on receiving every-

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your career goals faster? For instance, will committee work, whether part of your job or as an unpaid volunteer, broaden your network or position you for leadership roles?

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Depression in Nurses: The Unspoken Epidemic

BY LYNDA LAMPERT, RN

Tears build behind your eyes. Your mind plays over and over how much you want to turn and run, but you can’t. No matter what, you have to keep going because you are strong and people are relying on you. How can you endure it, though, when one part of you wants to scream and one part of you wants to break down and sob? You can do neither, and instead, you hold yourself as taut as a wire over the Grand Canyon.

ou are in the elevator on your way up to your unit. Your shift hasn’t started yet, but these feelings are already invading your mind, spreading like tree roots into concrete. It will be worse once you are there, but nurses don’t crack. Nurses don’t break down. They get used to it. Except you can’t get used to it. It is killing you. You are a nurse with clinical depression, and no one knows— not even you.

Depression is an epidemic in nursing, but no one will talk about it. According to the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), nurses experience clinical depression at twice the rate of the general public. Depression affects 9% of everyday citizens, but 18% of nurses experience symptoms of depression. If this is such a common occurrence, why don’t nurses talk about it? They are afraid that they will not be trusted with

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patients and they will not be part of the team. Some of them cannot accept that they need care when they have always been in the caring role. Unfortunately, many nurses just don’t know they have it.

ing these men and women to feel this way? The fact that it is ignored is almost inconsequential when you consider the fact that the causes are also ignored. If the causes of this epidemic are not ad-

Depression affects 9% of everyday citizens, but 18% of nurses experience symptoms of depression.

Causes of Nurse Depression Since depression is so common in nursing, what is caus-

dressed, more nurses will become depressed, patients may be put in danger, and the

profession could wind up losing yet another nurse to the stresses of the job. “Medicine is a profession that doesn’t give much thought to mental illness,” says John M. Grohol, PsyD, the founder, CEO, and editorin-chief of PsychCentral.com. “It is not within their realm of treatment.” Since medicine is concerned with what it can see, touch, and heal, mental health concerns are often shunted to the side. Nurses not only dismiss the idea of depression in their profession,

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but they also do it to themselves. This only causes the feelings to multiply. It also doesn’t help that nursing culture is ruthless by nature. “Depression is like a cardiac disease: you don’t know you have it. You don’t realize the subtleties,” says Louise Weadock, MPH, RN, the founder and president/CEO of ACCESS Healthcare Services. “Leaders need to create a culture that lifts nurses up. It shouldn’t be a culture in which only the strong survive.

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Nurses should not be proud of eating their young. Some managers brag, ‘If you can make it on my floor, you can make it anywhere.’” The culture of survival leads nurses to feeling like they are always under tension—and this can cause anxiety, stress,

They can’t control their shift, their patient load, or even if a patient lives or dies. Helplessness is a feeling that pervades the depressed nurse. When all of these causative factors are coupled with the disruptive cycle of shift work, can depression be far behind?

by a difficult, hurtful, challenging, or disappointing event, experience, or situation. … [but] when that something changes, when our emotional hurt fades, when we’ve adjusted or gotten over the loss or disappointment, our sadness remits. … Depression is an abnormal

and depression. Some nurses seem to take great pride in the amount of horrors they have endured, but for those who struggle with depression, living up to this standard and living in the culture only makes them feel like failures. What are the evidencebased predisposing characteristics of depression, besides culture and neglect? The INQRI study found that certain factors, such as body mass index, job satisfaction, and mental well-being, can lead to clinical depression in nurses. Furthermore, family problems can exacerbate the stresses a nurse feels, and often nurses feel out of control.

Nurse-Specific Symptoms

emotional state, a mental illness that affects our thinking, emotions, perceptions, and

What does clinical depression look like in nurses? All nurses have covered mental health in their schooling and some work on mental health units. It is safe to say that most nurses know the general symptoms of depression, but it is far more subtle than what they were taught. In nurses, the symptoms are nearly buried under a continuously thwarted attempt to hide their feelings. Guy Winch, PhD, a licensed psychologist and TED speaker, describes the different nuances in sadness and depression on the Squeaky Wheel blog at PsychologyToday.com: “Sadness is usually triggered

Nurses often feel this way as well, but other factors and symptoms appear. “Nurses deal with depression by doing more, keep moving, not standing still, not putting their feelings into words,” says Michael Brustein, PsyD. “They power through it.” Blake LeVine, MSW, founder of BipolarOnline.com, also makes this point about nurse culture and the medical status quo in general: “There is more detachment in medical professionals who are depressed. It is normal to be slightly detached. When a nurse is depressed, they can also become more detached with their family. They are used to being detached, but they can’t bring it home and cry over people [who] are sick. Depressed nurses may cry more over a patient who died. They may get very emotional. Something they used to deal with in the past can get more difficult for them.” Of course, this need for detachment and getting past the pain can lead to self-medicating. Usually, that takes the form of alcohol or opiates— both downers that can make depression worse.

Some nurses seem to take great pride in the amount of horrors they have endured, but for those who struggle with depression, living up to this standard and living in the culture only makes them feel like failures. behaviors in pervasive and chronic ways. … Depression does not necessarily require a difficult event or situation, a loss, or a change of circumstance as a trigger. In fact, it often occurs in the absence of any such triggers.”

“All studies show that those with substance abuse problems have depression or anxiety,” states Nikki Martinez, PsyD, LCPC, a verified mental health counselor on BetterHelp.com. “Prescription drug problems are often present, and that be-

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comes their drug of choice. Just take a pill, and the pain is gone. When a nurse is having a bad day, they can’t wait to come home and have a glass of wine.” In addition to various negative coping mechanisms, nurses exhibit many other symptoms that are obvious to those looking in on the situation. Weadock explains them this way: “Nurses can experience difficulty concentrating, are slow to respond in a crisis, are accident-prone, and have a limited ability to perform mental tasks, such as care mapping, calculating doses, or intervals required for biometric interpretations. They are reclusive with poor interper-

it, what to do about it, or what causes it. What is behind this stigma? Grohol breaks down the problem by focusing on the two parts of stigma: prejudice and discrimination. “There is a great deal of misinformation and misunderstanding of what depression is,” he explains. “Many in the medical profession hold antiquated beliefs about mental illness, such as the condition was brought upon the self. Nurses are taught not to complain about it, and this is why they don’t talk about it.” Then, nurses must deal with discrimination when they are found out. “Discrimination comes about when people

It is safe to say that most nurses know the general symptoms of depression, but it is far more subtle than what they were taught.

with mental illness see nurses talking about those who have other medical issues, and don’t want things said about them,” Grohol continues. “Nurses would assign a person a label and boil down their personality to one word, and that is insulting and discriminatory.” A primal aspect comes into this discrimination, as well. Nurses, for lack of a better reference, are a “band of brothers.” If you suspect the nurse beside you can’t handle the pressures, then you tend not to trust them. Weadock has experienced this. “I don’t think nurse leadership or the workforce sees depressed nurses. When they perceive some sort of injury, then they throw the nurse out of the wolf pack. When you backslide into your disorder, that’s when people don’t know whether to trust you.” The stigma has become so bad that many depressed nurs-

es fear for their jobs. “Nurses know that admitting a mental health problem puts their job at risk,” says LeVine. “People are scared to admit it. That’s when mistakes happen. Get treated. Nurses feel they have to hide it to protect their jobs, but a nurse that seeks help for depression ends up a better and stronger nurse. Those who seek help have more longevity in their career.” Psychologically, the prospect of losing everything rewarding about nursing is scary, and LeVine cites that as a reason for keeping quiet. “The hard part of admitting to depression is that nursing is a good paying job and losing it is hard. You are on a big team as a nurse. When you can’t do that anymore, you lose that sense of team. It is hard to give that up. Therapy means you can work on that and possibly avoid leaving the profession.” One of the most prominent

sonal skills, struggle with time management, and have lower total productivity outcomes than nondepressed workers. They often have a ‘short-fuse,’ leading to explosive outbursts toward patient, family, or coworkers.”

Stigma against Mental Illness Nurses are usually willing to talk about the problems in the profession, such as short staffing, poor ratios, and lack of managerial support. However, what they are not willing to talk about is depression and mental illness in their ranks. It is arguably nursing’s best kept secret. Eighteen percent of nurses are suffering from some form of clinical depression—and no one will talk about their experiences with www.minoritynurse.com

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reasons for nurses to keep quiet about their mental health is the stigma associated with an

for their jobs, afraid that they are weak, and ignoring their own health in favor of oth-

Nearly all experts agree that education is the primary method to get nurses treated for depression.

“unhealthy” caregiver. Martinez describes it this way: “Nurses feel they need to be perfect and healthy at all times. It is just not possible when they are doing so much for someone else. Mental health professionals realize that this is a huge problem. Openly talking about it is the only way to break the cycle, but no one talks about it. When they do talk about it, it takes away stigma and shame.” For these reasons and more, many nurses are living with depression in silence—afraid

ers. In addition to education, treatment for nurses specifically is important for recovery and retention.

Self-Care and Treatment for Nurses Nearly all experts agree that education is the primary method to get nurses treated for depression. This means educating management on what to look for, and for nurses to know the symptoms to recognize the condition in themselves and others. Sometimes coworkers can see symptoms far better

than a manager can. If the stigma is reduced with education and support, those nurses can get the help they need from a team effort. Weadock suggests that this reform starts with the manager. “A manager should say, ‘I’m going to put you on the bench and help you get better.’ Assignments should be given out just a dose at a time, because you don’t want to ruin the reputation of a good nurse. The nurse can’t help it when they are feeling depressed. Management needs to lift the RN up by promoting them to other suitable, supportive work environments, and to make reasonable accommodations for nurses whose cyclic phase of depression is negatively affecting their work performance.” After management has identified a struggling nurse, that

nurse should be introduced to treatment and encouraged to keep attending. Many nurses terminate their therapy because they think they don’t need it, they don’t feel they should be sick, or they are afraid someone will think they are weak. “Seek medical treatment with a professional that understands depression,” LeVine suggests. “Find a therapist who understands a nurse’s career and life. Openly assess your situation. Do you need to take a break? If it is all too much, it is okay to do something else. It is better to admit that you are struggling and seek help. It’s like trying to fit a round peg into a square hole.” What can nurses do when they are in therapy and still working? According to Martinez, it all comes down to self-care. “Nurses often don’t have good self-care. It can be as simple as starting the day off right, instead of waking at the last minute and rushing around. Start off slowly: have some coffee, do meditation or yoga. Do things at the end of the day, too. Have rules with your family that the first half hour after work is for you when you come home.” Alejandro Chaoul, PhD, is an assistant professor in the integrative medicine program at the University of Texas MD Anderson Cancer Center. Working for a hospital, he often instructs nurses in how to better handle the stresses of their jobs. “The motivation for nurses is that they feel like they shouldn’t focus on self, but they can focus on how their own mental health can help patients,” Chaoul explains. “We don’t need an excuse to

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take care of ourselves. It is an important part of being, not just a nurse. We have forgotten this. Showing how busy we are is the way to go. If you tell someone you are happy, it is almost like a sin.” Nurses are practical, though. Self-care, therapy, and meditation are great ideas, but how is a depressed nurse supposed to handle the rigors of their fluctuating mood while actually work-

be done anywhere, anytime, cannot usually be seen, and can last as long as you need it. Lisa Najavits, PhD, describes grounding in her book, Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, as follows: “Grounding is a set of simple strategies to detach from emotional pain (for example, drug cravings, self-harm impulses, anger, sadness). Distraction works by focusing outward on the

If nurses hope to keep the profession vital and solve such problems as short staffing and poor ratios, they need more nurses to stay working as nurses.

ing on the floor? One helpful technique is known as grounding. Grounding can

external world—rather than inward toward the self.” Najavits breaks it down

into three categories: physical, mental, and soothing. A physical grounding exercise would comprise breathing in and out, thinking a soothing word on every exhale. A mental grounding exercise would include describing an everyday procedure, such as passing meds, in as much detail as possible. Finally, soothing grounding might be picturing your loved ones—or actually looking at a picture of them. For each type, there are many types of grounding, and these techniques can be learned through therapy. Although the reasons for nurse depression are multifactorial, part of the problem is the stigma. With education and a decrease in the antiquated notions of mental health, these nurses could get help.

Registered nurses are leaving the profession in droves. Some of those defections are due to injury, but a large part is likely due to undiagnosed or unacknowledged depression. If nurses hope to keep the profession vital and solve such problems as short staffing and poor ratios, they need more nurses to stay working as nurses. Helping, instead of ostracizing, nurses with depression is exactly what nurses need to help solve other problems that they face. Lynda Lampert, RN, has worked medical-surgical, telemetry, and intensive care units in her career. She has been freelancing for five years and lives in western Pennsylvania with her family and pets.

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Using HEALTH INFORMATION TECHNOLOGY to Improve Minority Health Outcomes BY PAM CHWEDYK

From electronic health records (EHRs) to smartphone apps, todayâ&#x20AC;&#x2122;s health IT tools can help nurses develop innovative strategies for closing the gap of racial and ethnic health disparities. 20

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“Health information technologies...are among the most impactful tools available to address health disparities among populations, communities, economic strata, rural and urban areas.” —Healthcare Information and Management Systems Society (HIMSS), 2014-2015 Public Policy Principles

ne of the top priorities of President Obama’s Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 is to reduce health disparities— such as disproportionately high rates of chronic diseases in racial and ethnic minor-

ity populations—through the “meaningful use” of EHR technology. Seven years after the passage of HITECH, how much progress have we made toward achieving that goal? In the 2013 report Understanding the Impact of Health IT in Underserved Communities and Those with Health Dispari-

ties, the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) showcases many innovative examples of how health care providers nationwide are using EHRs, as well as other types of health IT, to increase access to care

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and improve health outcomes in communities of color. From the rural Mississippi Delta to immigrant and low-income communities in large metropolitan areas, “health IT offers promising tools to address chronic diseases by facilitating the continuity of care and long-term follow-up needed

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for successful management of these conditions,” the report concludes.

cally the first person they see when they seek health care,” says Joyce Sensmeier, MS, RN-

For nurses who are working to improve minority health outcomes, one of the biggest advantages of using health IT is that these tools make it easier than ever before to capture, compare, and analyze patient data. That, of course, is where nurses come in. Take a close look at successful model programs that are deploying health IT to help close the gap of unequal health outcomes and you’ll see nurses—includ-

BC, CPHIMS, FAAN, vice president of informatics at HIMSS. “It’s really a natural extension of the nurse’s role with patients to connect the dots from the information technology side.”

use clinical decision support tools—such as computerized alerts—to respond to those changes. But increasingly, nurses are also waging war against health inequities by arming themselves with an arsenal of other high-tech tools, including the following: • patient portal websites, which give patients convenient access to their personal health information and enhance communication between clinicians and patients; • health information exchanges, which allow patient data to be securely shared between different providers—such as hospitals, ERs, and primary care providers—to improve continuity of care; • wireless and mobile health

Seeing the Bigger Picture For nurses who are working to improve minority health outcomes, one of the biggest advantages of using health IT is that these tools make it easier than ever before to capture, compare, and analyze patient data. And that translates into unprecedented opportunities for leveraging that data to better manage the needs of patients with chronic illnesses, identify gaps in care, and develop targeted interventions. “Clinicians have always been information workers,” says David Hunt, MD, FACS, medical director of patient safety and health IT adoption at the ONC. “It’s just that so often we’re focused on that one patient, that one chart. IT tools give you the ability to step back and look across

Because nearly everybody today seems to have a smartphone or cellphone, these devices can help nurses connect with hard-to-reach populations, such as young people.

David Hunt, MD, FACS

ing hospital and clinic RNs, nurse practitioners, informatics nurses, case management nurses, nurse researchers, and more—playing leadership roles. “Nurses are coordinators of care for patients. We’re typi-

For most nurses, health IT begins with the EHR. This essential platform enables them to instantly access a patient’s complete health record, document patient data in real time, monitor changes in the patient’s condition, and

(mHealth) technologies, such as smartphone apps and text messaging; • external databases, such as state and national disease registries and immunization registries, that collect clinical information about specialized populations of patients across a large geographic area; and • population management software (PMS) systems, which help nurses track health trends among specific groups of patients they care for—for example, pediatric patients, or patients with diabetes.

groups of patients to really get insight into how to make care better.” In other words, these technologies maximize nurses’ ability to address health disparities from a population health perspective. You can “slice and dice” the data stored in the EHR to classify and group patients in many different ways—for example, by race, ethnicity, age, and gender. Nurses can also zero in on patients who have particular conditions—such as heart failure, asthma, or HIV—to generate condition-specific reports and action plans, says Wanda Govan-Jenkins, DNP,

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MS, MBA, RN, lead nurse informaticist for the ONC. “You can look at the EHR and extract these groups of patients to see which patients’ blood pressure was elevated at their last visit, or which patient hasn’t been seen for a while,” she explains. Patient portals are another vehicle for communicating chronic disease management reminders to whole populations of patients, adds Lisa Oldham, PhD, RN, NE-BC, FABC, vice president of practice operations and chief nursing officer at the Institute for Family Health, which provides care to medically underserved communities at multiple facilities in New York City and state. The institute’s portal, MyChart MyHealth, is available in both English and Spanish (MiRecord MiSalud). “We can create an electronic letter for the entire organization’s patients who fall into a specific category and send it to them through the portal,” Oldham says. “The patient will get an e-mail that says, ‘Please go into your MyChart,’ and that’s where they’ll see the letter. For instance, we just sent out an e-mail blast to all our geriatric patients reminding them to come in for their annual wellness visit.” At the Cherokee Indian Hospital (CIH) in North Carolina, a tribal health system that serves more than 14,000 members of the Eastern Band of the Cherokee Indians, care management nurses develop outreach campaigns using the hospital’s PMS, which works in conjunction with the EHR. “By pulling data out of these platforms, our nurses can target in and pinpoint things like how many people need to get

A Smart Way to Teach Heart Disease Prevention From 2012 to 2015, Jo-Ann Eastwood, associate professor at UCLA School of Nursing, partnered with several local African American churches to conduct an American Heart Association–funded clinical trial that tested the effectiveness of using smartphone apps to help black women ages 25–45 reduce their risk for heart disease. Most of the study participants had multiple risk factors, such as obesity, hypertension, high cholesterol, high stress levels, and a family history of cardiovascular disease. First, Eastwood and her team taught four weekly education sessions to increase the young women’s awareness of their risks and provide tips for making risk-lowering lifestyle changes. For many participants, the classes—which covered topics such as knowing your family history, heart-healthy eating, getting more exercise, and techniques for coping with stress—were an eye-opening experience. After the last class, everyone in the intervention group was given a smartphone uploaded with apps Eastwood had developed in collaboration with UCLA’s Wireless Health Institute. “We used the apps to stay connected with the women,” she says. “They couldn’t call out on the phones, but we could call them and send them text messages.” The apps were programmed to send a rotating series of daily reminders, such as “How many servings of vegetables did you eat today?” and “Did you try to reduce your stress today?” The women entered their answers into the phone, which streamed the data to the researchers through a server at the university.

a colorectal cancer screening or a Pap test,” says Sonya Wachacha, MHS, RN, CCM, executive director of nursing at CIH. “Then the nurse generates a reminder letter to that person, such as ‘Mrs. Smith, it

Although Eastwood is still analyzing the study’s results, her initial findings are impressive. After six months, compared with a control group, the women who received the smartphone intervention had lowered their blood pressure and total cholesterol, increased their HDL (“good”) cholesterol, reduced their waist circumference, and decreased their stress. “They were changing their diets, they were becoming more physically active, and they made notable and significant lifestyle changes over time,” Eastwood reports. Even more encouraging, these changes empowered the women to improve not just their own cardiovascular health but their families’ as well. One woman, for instance, had been serving her husband and children meals that were high in sodium, fat, and cholesterol. As a result, her husband’s blood pressure was 210/120—dangerously out of control. But when she switched to more heart-healthy cooking habits, his hypertension began to drop dramatically. And at the end of the study, says Eastwood, “he came in and thanked us for saving his life, because his blood pressure was now 120/80 for the first time since sixth grade.”

looks like you’re due for your mammogram. Can you please come in and get that done?’” On an even larger scale, says Hunt, “disease registries are wonderful resources, because you can identify char-

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In addition, the phones automatically tracked the women’s physical activity throughout the day and took their blood pressure once a week. “We gave them wireless talking blood pressure machines,” Eastwood explains. “The women would push a button on the phone, their blood pressure would be taken, and the phone would tell them what their numbers were. Then they would push a button that would stream it to our server.”

acteristics and trends that you don’t have insight into when you’re just looking at a group of patients within your own practice. Having the benefit of looking at large amounts of data from many, many provid-

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ers gives you tremendous insight in terms of being able to infer more information about your patient population.”

their own health. Patients can log into their care provider’s portal and access disease management educational materials, which

Ultimately, Wachacha believes, being able to interact with their own health data and personally follow their progress toward meeting their health improvement goals can make a big difference in engaging patients to take a more active part in their care.

Educate, Engage, Empower Nurses are also finding that consumer-driven health IT tools, like patient portals and mHealth technology, can offer exciting new ways to help patients who are living with chronic diseases become bet-

health systems can tailor to meet the needs of limited-English-speaking and low-literacy patients. For example, the Institute for Family Health’s portal has links to patient education resources in more than 40 languages.

est poverty levels in the state, “the most prevalent disease processes in our patient population are diabetes and cardiovascular problems,” says staff nurse Santiago Diaz, RN. “The portal has information specifically for these patients. We walk them through the basics of where to find the information, and we show them the shortcuts so that they don’t get lost in all the information that’s up there.” Because nearly everybody today seems to have a smartphone or cellphone, these devices can help nurses connect with hard-to-reach populations, such as young people. Jo-Ann Eastwood, PhD, RN, CCNS, CCRN, associate professor and advanced practice program director at UCLA School of Nursing, recently conducted a research study that used custom-designed smartphone apps to teach young African American women who were at high risk for heart disease how to make heart-healthy lifestyle changes (see sidebar). “When we look at chronic disease prevention in minority populations,” she says, “we have to look at the population that’s between 25 and 45 years old, or even younger. If we’re

it’s salient.” Govan-Jenkins, who is also a professor of informatics in the graduate program at Walden University School of Nursing, recommends teaching patients how to download and use the many free or low-cost mobile apps that are available in the consumer health marketplace. For instance, there are diabetes management apps that let patients monitor their blood glucose levels and upload that data to their patient portal for nurses to track. “Patients who have smartphones or mobile devices can download continuous selfmonitoring apps that let them see things like how many steps they took that day and how many calories they burned,” Govan-Jenkins continues. “The nurse can also send weekly or monthly text messages to condition-specific groups of patients, such as reminding them to take their medication.” Ultimately, Wachacha believes, being able to interact with their own health data and personally follow their progress toward meeting their health improvement goals can make a big difference in engaging patients to take a more active part in their care.

t b t A a m t w c d t

As members of the nation’s most trusted profession, nurses are ideally suited to educate patients who are unfamiliar or uncomfortable with technology about how to use health IT tools and become more computer-literate. LaVerne Perlie, MSN, RN

ter educated about their conditions, more engaged with their treatment, and more empowered to self-manage

At the Institute’s Ellenville Family Health Center in Ellenville, New York, a rural community with one of the high-

going to develop prevention strategies that are relevant to this population that is very technologically astute, that is fast-moving, that is busy, we have to hit them where

“With our EHR, we can create graphs that let patients see how their blood sugar or blood pressure readings are going up or down over time,” she says. “When our

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r e o b I c o l v i a d t t

Wanda Govan-Jenkins, DNP, MS, MBA, RN

tribal members who have diabetes, for example, can look at that graph and see that their A1C levels are going down after they start exercising, it’s meaningful for them. It gets them motivated to do more with their care, because they can see that the things they’ve done are having an impact on their results.”

Reaching Across Barriers According to the ONC report, health care providers must find solutions for overcoming “challenges and barriers to the use of health IT” in medically underserved communities of color. Some of those challenges include limited access to Internet service and cellphone connectivity in underdeveloped rural areas, cultural and linguistic differences, and low rates of technology literacy among these patients.

Telehealth remote monitoring systems (software-based IT tools that let nurses collect data via a device they install in the patient’s home) are an effective strategy for reaching patients in rural communities who don’t have access to computers, says LaVerne Perlie, MSN, RN, senior nurse consultant at the ONC. At the initial home visit, telehealth nurses show patients how to record their health information, such as blood pressure readings, and enter those numbers into the system. “That data is sent directly to the nurse in the provider’s office so that he or she knows when to come out and visit the patient and make recommendations for ongoing care, such as scheduling an office visit or even a hospital admission,” Perlie explains. As members of the nation’s most trusted profession, nurs-

es are ideally suited to educate patients who are unfamiliar or uncomfortable with technology about how to use health IT tools and become more computer-literate. At Institute for Family Health facilities, patients receive information about MyChart MyHealth as soon as they walk in the door. In the examination room, says Oldham, nurses explain how the portal works and the benefits of using it. They answer any questions the patient has. Then they help patients register for the portal right there, guiding them through the process of how to log in, create a correctly formatted password, and navigate the website. For patients who don’t have a computer at home, “we encourage them to use the computers at the public library [or to download the MyChart MyHealth mobile app to their smartphone if they have one],” adds Diaz. Still, another challenge cit-

Many health IT projects fail, Govan-Jenkins cautions, because the implementation team didn’t seek input from frontline nursing staff.

ed in the Understanding the Impact of Health IT report is that “customization of offthe-shelf health IT products [is] often necessary to ensure that they [meet] the needs of underserved populations.” For example, the Cherokee Indian Hospital serves a patient population that has a high risk for suicide, substance abuse, and tobacco use. Because its EHR and PMS didn’t include functions for monitoring these risks, the hospital had to add

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them. Hunt and Perlie emphasize that the best way hospitals can make sure their investment in technology will provide information that’s the right fit for their population health management needs is to get nurses involved in the design of health IT systems right from the start—before the technology is implemented. Many health IT projects fail, Govan-Jenkins cautions, because the implementation team didn’t seek input from frontline nursing staff. “And then they had to rebuild and re-implement the system, because it was just not capturing the data they needed to capture for their specific type of patients.” That, says Sensmeier, is what reducing health disparities through the meaningful use of health IT is really all about. “It’s not just about adopting the technology. It’s about using it in such a way that we can capture the data

that’s been entered and learn from it—learn what makes an impact in different patient populations, what care models and treatments work, what outcomes are being realized, and how we can change our practice.” Pam Chwedyk is a freelance health care writer based in Chicago. She is a former editor of Minority Nurse.

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The New Health C A photo from the Johnson & Johnson Campaign for Nursingâ&#x20AC;&#x2122;s Future

Courtesy of Johnson & Johnson

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BY JEBRA TURNER As you know, health care is opening to a world of opportunities, as we’ve seen sweeping changes unlike any other in the last five decades. Social, political, economic, and technological trends form a “perfect storm.” Today’s nurses are trailblazing new roads in the profession, as they adopt different roles and operate in nontraditional workplace settings.

urses today still care for patients, but they must also provide it in the right manner, at the right time, and in the right place. Health care organizations still seek to provide the best patient experience, but they also must cut costs, boost outcomes, and ensure safety. There is growing demand for registered nurses, both in and outside hospital doors, that demands caretakers develop a new skillset and a new mindset. Below are five ways that demonstrate how nursing has morphed and shape-shifted recently, and how nurses can make the most of tomorrow’s opportunities.

Trend #1: Jobs are moving outside of hospitals. Inpatient units—and sometimes whole hospitals—are being closed and patients are being moved into alternative settings, such as long-term care, rehab, and subacute care facilities. Case in point: Experts estimate that today 65% of health care services are delivered in ambulatory settings, rather than hospitals. That transition from inpatient to ambulatory care settings occurred slowly over the past decade. Why the switch? The Patient Protection and Affordable Care Act of 2010 was a major factor that hastened

what hospitals were already doing: offering services outside their doors. Health care organizations want to cut down on admissions (and readmissions), and they seek to do that by pumping up preventive care and caring for patients at home, or on an outpatient and community basis. Andrea Higham leads Johnson & Johnson’s Campaign for Nursing’s Future, launched in 2002 to recruit and retain more nurses and nursing faculty, including minority, male, and other underrepresented groups. “Nursing is

ery of care across the board,” says Higham. “So many people are entering health care because of a confl uence of so many forces, such as the Affordable Care Act and an aging population. Nurses are working not just in hospitals, but also in home health care, at clinics, as advanced practice nurses, and managing the entire health care journey. There’s a strong need for nurses in many places outside of the traditional health care setting.” Think about opportunities outside of the hospital. For example, if you’re interested

Nurses today still care for patients, but they must also provide it in the right manner, at the right time, and in the right place.

at a very exciting time, and nurses are on the frontline of health care, providing deliv-

in pediatrics or working with adolescents, consider openings in pediatric long-term care,

h Care Workplace Future

ohnson

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nonprofit sectors also need qualified registered nurse candidates to fi ll the high demand for traditional and alternative roles.

Trend #2: New or returning nurses must develop job-search savvy and resolve to land coveted hospital positions.

Andrea Higham

pediatric home care, pediatric rehab, or at group homes for children or teens. According to Phyllis Quinlan, PhD, RN-BC, president of MFW Consultants to Professionals and a nursing coach, nontraditional settings, such as subacute care, are fine places to practice if applicants can overcome their preconceptions. “Long ago and far away, it was considered grandma’s nursing home, but now it’s a combination of residential care and shortterm rehabilitation. It could even include pediatric or nongeriatric care,” she explains. “Hospitals are shutting down med-surg floors, and shifting patients to other, lower-cost venues for treatment. Say someone falls and breaks a hip—now they have to learn how to walk with that new

hip. That’s when they need bridge care—skilled care, rehabilitation, nursing care—until they can go back home. It’s not about disease care anymore, but about preventative

“For those new graduates hoping for good med-surg experience after nursing school but can’t get a job in a hospital, don’t despair,” says Quinlan, even though hospitals have adopted stringent nurse recruiting requirements and sought to cut costs in every way without compromising care. “Most urban area hospitals aren’t hiring, but in other areas, that’s not the case,” she explains, suggesting that new grads and nurses with some experience apply for residency or internship programs to “fast track” their careers with intensive preparation for 12 to 18 months. “Some health care systems are rich with nursing training

Nurses who are open to filling short-term temp assignments also have a leg up on other candidates; hospitals are offering six-month contracts rather than making long-term commitments they may not be able to honor. care and home care for managing diseases today. Hospitals soon will be only for emergency care, cardiac care, burns, traumatic injury, [and] cancer centers.” In addition, health care organizations within the private, government, and

resources, others do it but in a more conventional way,” she adds. Another way to get your foot in the door at a hospital: “Move to [an] area where they are hiring. The State of Texas is hiring new nurses, and other states are recruiting nurses to serve a special need or a grow-

ing population.” Nurses who are open to fi lling short-term temp assignments also have a leg up on other candidates; hospitals are offering six-month contracts rather than making long-term commitments they may not be able to honor.

Trend #3: Nurses must further education, clinical skills, and knowledge to keep up with complexities. Once, a two-year associate’s program could prepare a nurse for a secure and fulfilling career. Not anymore. “Most places now will hire a nurse with an associate’s degree but ask that she sign a hiring agreement to get a baccalaureate within five years or so,” says Quinlan. “Across the 50 states, the culture varies, but independent facilities and major health systems tell me ‘we’ll only hire baccalaureatetrained nurses,’ so you need to make your peace with the fact that the minimum preparation for practice is now a bachelor’s in nursing.” The other source of tidal change is digital technology and big data, which make it possible for nurses to do more with their expertise and deliver care from practically any corner of the world, while enjoying the advantages of telecommuting, like other professions. “Technology allows nurses to practice off the beaten path in more ways than ever before,” says Brittney Wilson, RN, BSN, also known as “The Nerdy Nurse” (www.thenerdynurse.com). “With jobs like remote case management, telephone triage, and even informatics consulting, nurses can use the clinical knowl-

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edge and technical skills to help patients from the comfort of their home. “Opportunities to work from home and attend to patient care needs virtually do come with a price,” adds Wilson, who is a nurse expert with experience as a clinical informatics nurse. “You have to have above-average computer skills and must be able to learn new software quickly.” There’s a big need for nurses who have a business background. Traditional nursing programs do not address business aspects of health care. Nurses who go on for a master’s degree in business administration or health administration will understand policies and procedures that are governing health care now.

Trend #4: Nurses must focus on their own personal and career development to progress in the profession. Clinical and other technical skills are important for any nurse to develop, but so are “soft skills”— for example, effective communication and problem-solving know-how. “New to nursing? Maybe you have great ideas, but maybe you’re missing skills in how to talk to a patient or family members or how to collaborate with others,” says Higham. “You can always access our avatar-based online program, Your Future in Nursing, on the Campaign’s website.” The cutting-edge format, a game-like simulation environment for practicing key on-the-job concepts and skills, helps a student nurse prepare

Looking for Alternatives to Traditional Nursing Roles? At www.discovernursing.com, sponsored by Johnson & Johnson, there is a database of 104 nursing roles—34 of which are outside of a hospital setting. Each one is described in detail and includes a list of advanced training, educational degrees, or certifications required to practice. Here are 10 examples of nontraditional nursing roles that do not require an advanced nursing degree: •

Ambulatory Care Nurse

•

Case Management Nurse

•

Certified Nurse-Midwife

•

Developmental Disability Nurse

•

Nurse Entrepreneur

•

Occupational Health Nurse

•

Rehabilitation Nurse

•

School Nurse

•

Telemetry Nurse

to make the often tough transition to practicing nurse. Accelerating change in the health care workplace may require that new and seasoned nurses adjust their attitude and become more flexible about new ways of doing things. According to Quinlan, author of the recently pub-

lamenting the good old days. “Nurses are some of the most creative people on the planet; they’ll make something out of nothing on a daily basis,” she says. “Some feel that they’re expected to adjust instantly to changing conditions and expectations, and they resent it. Those nurses must make peace

“Most places now will hire a nurse with an associate’s degree but ask that she sign a hiring agreement to get a baccalaureate within five years or so,” says Quinlan.

Phyllis Quinlan, PhD, RN-BC

lished Rediscover the Joy of Being A Nurse: A Holistic Approach to Recovery from Compassion Fatigue, there’s no point in www.minoritynurse.com

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with the new health care environment, themselves, and their profession.” Until then, “they’re at a

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M crossroads, and risk starting to swing to the dark side, having lost connection with the joy of practicing,” Quinlan adds.

Trend #5: Nurses will take on expanded and pivotal roles as part of tomorrow’s health care team. How will we prepare nurses to transition to these advanced practice roles? That

novation at North Shore-LIJ Huntington Hospital in New York. “Nurses are going into master’s programs early on in their careers—after getting a baccalaureate, they’re going straight into a master’s or even doctoral degrees,” she says. “They have less clinical experience prior to getting an advanced degree, so we have an obligation as a profes-

Tanzi recommends nurse residency programs or fellowship programs for an extensive, tiered approach as students make the transition into their complex new roles. “Nurses were tending to leave a job in the first year, or to leave nursing totally, because they weren’t prepared for the demands of the role,” she explains. “The bottom line and the message that I want to get out there is go

education. Entrepreneurship, consulting, and research and development are also growth areas for advanced practice nurses. Everywhere we look, nurses are being called on to surf the tidal waves of a changing health care environment and the emerging opportunities that come forth from it. Tomorrow’s nurses, with the right technical skills and personal qualities, can look

Accelerating change in the health care workplace may require that new and seasoned nurses adjust their attitude and become more flexible about new ways of doing things.

Donna Tanzi, MPS, RN-BC, NE-BC

question has long been central for Donna Tanzi, MPS, RN-BC, NE-BC, director of nursing education and in-

sion to support them. Entry to DNP takes seven years from entry to graduation, similar to the medical model.”

“Technology allows nurses to practice off the beaten path in more ways than ever before,” says Brittney Wilson, RN, BSN, also known as “The Nerdy Nurse” (www.thenerdynurse.com).

into nursing for the right reasons. Recognize it’s an art and a science and we have the ability to impact people’s lives every day. Continue learning—there [are] always new directions and avenues to explore. There’s no reason to ever become stagnate or get bored in nursing; there are too many opportunities.” There are many areas where advanced practice nurses apply their expertise gained through a master’s (or increasingly, a doctorate) in nursing or a related field. Clinical nurse practitioners are opening independent practices, or working with an academic affiliation in hospitals, or affiliated with physicians in their practices. Administrative leadership roles usually call for an MBA or MHA. Demand for nurses continues, so we need nurses to teach in nursing schools. At a minimum, instructors must have a master’s in nursing or in nursing

W a $ w in

To m

forward to a rewarding career where they can deliver even greater value to their patients and communities. Jebra Turner is a freelance health care writer living in Portland, Oregon. She frequently contributes to the Minority Nurse magazine and website. Visit her at www.

C ap

jebra.com.

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MINORITY NURSE SCHOLARSHIP PROGRAM Sponsored by the National Coalition of Ethnic Minority Nurse Associations (NCEMNA) and Minority Nurse Magazine We are currently accepting applications for our 17th annual scholarship competition, consisting of two $1,000 awards and one $3,000 award. Selections will be made by NCEMNA. Scholarships will be paid in summer 2016 for the fall 2016 academic term.

Who Is Eligible To apply for this scholarship, students must meet all four of the following criteria: Be a minority in the nursing profession Be enrolled in the United States (as of September 2016) in either: • The third or fourth year of an accredited BSN program; 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 Complete the form at minoritynurse.com/minority-nurse-scholarshipapplication and attach 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

Deadline for application: May 1, 2016 Questions? E-mail editor@minoritynurse.com

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BY NACHOLE JOHNSON Nursing school is difficult, no doubt, but it pales in comparison to the first year working as a nurse. New nurses face many obstacles they may not have even fathomed while in school. Whether you landed a position in your dream unit or had difficulty securing the first job, the first year out for any nurse is challenging.

nce out of school, many wonder if their first job will be anything like their professors taught. Unfortunately, it’s not, but there are ways to cope with learning the ropes of nursing. A nurse of just over one year, Kelsea Bice, BSN, RN, an emergency room staff nurse at MD Anderson Cancer Center in Houston, Texas, realized her first-year nurse training was much different than school. “Most came from preceptor roles. I found it extremely difficult to rationalize my book training with the experience of my preceptors and my own thoughts,” she recalls. “It was very overwhelming at times.” Although it can be overwhelming, here are some key points for newbie nurses to remember when transitioning from student nurse to nurse.

1. Remember that School and NCLEX Do Not Reflect the Real World Many new graduates struggle with the sheltered environment of school and the hypothetical world of NCLEX when they are in their first job working with real patients. The ultimate goal of nursing school is to teach one how to pass NCLEX. A nurse’s first year on the job teaches the individual

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how to become a nurse. The two realms massively collide with the first job after school. “The most difficult part of the first year is taking critical thinking from a theoretical/ hypothetical situation to a real person in a real bed in front of you,” states Bice. As a student, the first-year nurse is not exposed to all of the internal policies and systems of a clinical facility. In

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a new environment, reports may be conducted differently from the ways one was previously exposed to, some common procedures may be completed in an unfamiliar

Once out of school, new nurses soon realize that patient ratios will often be higher than they were while in school. Nurses, especially new nurses, have to really

New nurses face many obstacles they may not have even fathomed while in school.

manner, and, when a patient is crashing in a real-life setting, it isn’t always “textbook” like NCLEX. These nuances can be hard for new graduates to grasp without their own experiences to pull from.

work on honing their timemanagement skills. When asked how nursing schools can better prepare students, Arthandreale Nicholas, BSN, RN, a nurse at Harris Health Outpatient Medicine Clinic

in Houston, Texas, says, “[M] ore clinical hours with realistic nurse-to-patient ratio staffing [are needed] so new nurses can be prepared to have more patients and develop timemanagement skills.” As any experienced nurse knows, time-management skills will improve with time. Prioritization also serves a vital role in a nurse’s first year on the job. Prioritization and time management go hand-inhand; once one is mastered, the other will become easier and vice versa. Nicholas, a nurse of five years, recalls her most valuable lesson in her first year was prioritization of duties. “Make sure to see sickest patients first and get meds passed ASAP,” she suggests. New nurses may not realize how long 12-hour shifts really are—or that they may not get the desired shift they want to work directly out of school. Typical 12-hour shifts turn out to be longer when you factor in commute times, codes at shift change, or a lengthy

between night and day shifts. “I only stayed at my first job for four months. The schedule with the commute made me very discouraged, so I actually went months without working until a local hospital gave me a chance,” says Nicholas. New nurses are ill-prepared for these realities since the average nursing school does not typically have students complete a full 12-hour clinical day. In addition, the clinical sites are typically in close proximity to the school.

2. Respect Your Elders We’ve all heard the phrase “Nurses Eat Their Young” (or “N.E.T.Y.”) when referring to the way some seasoned nurses communicate with newer nurses. Sometimes, there are personality conflicts between people, but most of the time seasoned nurses are just frustrated with the newer generation thinking they know more than they actually do directly out of school. As the saying goes, “You don’t know

“The most difficult part of the first year is taking critical thinking from a theoretical/hypothetical situation to a real person in a real bed in front of you,” states Bice.

report. In addition, nursing schools don’t prepare students for difficulty finding their first job in an oversaturated market. Nicholas experienced long days and an undesirable shift firsthand; her commute to her first job, a neuro step-down unit, was 60 miles each way and she worked a “swingshift,” meaning she alternated

what you don’t know.” Seasoned nurses on the unit have a wealth of information to share with you—just be willing to listen. Bice has her own take on the relationship between newer and more experienced nurses: “Older or ‘more experienced’ nurses say new nurses are coming out of school really

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cocky or with bad attitudes, but I truly think that’s just the generation gap in the workforce showing through.” Bice believes new nurses can thrive in their first year with more encouragement from seasoned nurses. “I think if new nurses are nurtured through their orientation and supported and offered a safe environment to ask questions, make mistakes, and figure it out, they could be successful on any unit,” she adds. Newer nurses should also understand that there are multiple ways to carry out nursing

duties. Their preceptors may have a different way of doing certain tasks. Not all nursing tasks are textbook like they were in school, and this may be a hard concept to grasp when just starting out. Be willing to understand why particular individuals carry out their nursing responsibilities the way they do. And if you don’t like it, put your own spin on it later. Be open to others’ opinions when you first start out—you may realize you have learned something you may not have known otherwise. Take it all as a learning experience.

3. Don’t Cause Waves One of the quickest ways to become the unpopular nurse on the unit is to act like a know-it-all. No one cares that you had a 3.9 GPA in school

Be willing to understand why particular individuals carry out their nursing responsibilities the way they do. And if you don’t like it, put your own spin on it later. or that you passed the NCLEX with 75 questions. All anyone—including colleagues, pa-

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tients, and family members— really cares about is how you can safely and effectively deliver care to patients. Remember, the first job is to learn how to become a real nurse.

Another way to cause waves during the first year of nursing is to actively complain

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about your chosen profession. The story plays out time and time again—a new grad comes into the unit and continuously vocalizes how much he or she hates bedside nursing

ence, but it’s imperative to ask for help from others when needed. Nursing involves teamwork. In addition, starting a new job and attempting to be a martyr by making fel-

One of the quickest ways to become the unpopular nurse on the unit is to act like a know-it-all. No one cares that you had a 3.9 GPA in school or that you passed the NCLEX with 75 questions.

and declares plans to be out of there in one year—on to NP or CRNA school. Doing this usually causes a deep divide between you and other seasoned nurses on the unit.

This may be where some of the N.E.T.Y. comes into play. Newer nurses may feel isolated due to their inexperi-

low coworkers look bad only actually makes you look bad in the long run. One day, you will be on the other end and won’t appreciate the lack of compassion. Everybody makes

mistakes, and you don’t want to be thrown under the bus because of one. Learn to speak to your colleagues when a prob-

lem arises; it could uncover a learning experience for both of you.

4. Continue Your Education Just because you have finished nursing school and passed your boards doesn’t mean your education should cease. The real education has actually just begun. Continuing education doesn’t mean you immediately go back to school for an advanced degree; it means continuing to learn in your new role. Jonanna Bryant, MSN, MS, RN, a veteran nurse of 24 years, who is currently working on her doctorate, wholeheartedly agrees. “Learning doesn’t stop after one leaves school,

and you don’t have to return to school in order to learn,” she says. As a new nurse, you should be constantly looking

up medications, medical terms, and diagnoses that you don’t know. It’s uncomfortable being asked a question for which you don’t know the answer. Not knowing the answers should bother you to the point that you want to seek additional knowledge. It’s imperative that you continue to educate yourself in your chosen specialty—meaning that if you work in the ER, brush up on triage or work towards your trauma certification. Get your Basic Life Support and Advanced Cardiac Life Support certifi cations. Read nursing journals, re-read your nursing textbooks, and become involved in professional nursing organizations— anything that will enhance your knowledge base. The education of a nurse never stops. In addition to learning jobspecific skills, learn more about the roles of other health care professionals. Learn the role of a respiratory therapist, physical therapist, and radiation tech— these are all professionals you will work with on a daily basis. Education provides opportunities for you to grow not only as a nurse, but also as a person. Enhancing yourself through education makes you a better nurse and allows you to educate your patients, their family members, and your colleagues. If you do eventually decide to go back to school for an advanced degree, make sure you master your role in your current position before doing so. Regardless of what some may say, an experienced nurse has an advantage when heading into graduate school. Concepts covered in grad school can be easily grasped with the experience one gains from working as a nurse.

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T fi o

5. Find a Mentor Many nurses, if not all, may feel they were not adequately prepared for the real world even after finishing school and passing the NCLEX. The type of treatment new nurses receive in their first year can negatively or positively affect their overall career trajectory. This leaves a new nurse either loving the profession and wanting to stay in for the long haul or loathing the profession and trying to leave altogether. “The first year was hard,” says Nicholas. “I honestly almost broke and thought about other career paths. I’m thankful for the good shifts and grateful patients who encouraged me to keep going.” Potential challenges one may face in nursing should be discussed and support should be given to newer nurses, both in school before they graduate and on the job. Bice believes having more open, honest discussions with preceptors and other experienced nurses on the job would be beneficial. “Debriefing after incidents, like ‘what could I have done better?’ [and] ‘what will I do differently next time?’ This way, gaps in learning are realized and bridged,” she says.

a part of orientation for all nurses new to the profession. Bryant, a nurse consultant for the Centers for Medicare and

The type of treatment new nurses receive in their first year can negatively or positively affect their overall career trajectory. New nurses should not only be oriented to their new career, but also mentored by seasoned nurses. A mentor serves as an experienced and trusted adviser. Mentorship should be

Medicaid Services in Philadelphia, Pennsylvania, also believes in new nurses having a preceptor or mentor for the first year, “…someone who they will follow and be able

to ask questions and talk to regarding concerns with their new job,” she says. The first year of nursing is tough, but manageable with the right mindset. Bice advises the newer generation of nurses starting out to “chill out and listen,” which is in line with Bryant’s recommendations for the first year: “Pace yourself, be thorough, and communicate.” Nicholas wishes she could have told her first-year self to be “more confident” and to not be afraid to question orders she was unsure about. Use their advice to suc-

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cessfully integrate into your new role. Soon enough, you’ll be a seasoned nurse and will be able to give tips to the newbies on your unit. In addition to working as a FNP, Nachole Johnson is a freelance copywriter and an author. Her first book, You’re a Nurse and Want to Start Your Own Business? The Complete Guide, is available on Amazon. Visit her ReNursing blog at www.renursing.com for more ideas on how to reinvent your career.

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Academic Forum

Nurses on Missions: Connecting, Serving, Caring, and Teaching BY JAMES Z. DANIELS

It is an enviable opportunity to provide healing services to a country in need by combining a fairly large, diverse, multidisciplined medical team. Three nurses on missions did just that, and in the process, they saw that one person can make a difference. They share their experiences in the Dominican Republic (DR), Haiti, Kenya, and Uganda here in the hopes of inspiring others to do the same. Dominican Republic The Haitian and Dominican cane cutters and their families in the Dominican Republic are spread over some 350 bateyes (cane-cutting communities). They were in dire need of access to health care—and Marie Etienne, PhD, MSN, a professor of nursing at Miami Dade College, responded. Etienne, who was born in Haiti, came to the United States at the age of 14. From her youth, she has seen herself as a servant leader and believed a

career in nursing would provide opportunities to fulfill her aspirations. She has been a member of the Haitian American Nurses Association of Florida (HANA) and served as president from 2005 to 2007. Today, she serves as the chairperson of the International Nursing Committee of the Red Cross. In 2005, an attorney and member of the Miami Haitian community visited the bateyes in the DR, and when he returned, he told her that he had seen living conditions of the

migrant workers and they were être traités comme des esclaves (being treated as slaves), with no access to health care. He suggested that HANA do something to shine a light on the conditions in the bateyes and devise ways to help the workers and their families. Etienne took the findings of the attorney to the Haitian American Professionals Coalition (HAPC) and obtained support to conduct a needs assessment of the situation. One of the objectives of the HAPC is to examine and

address issues affecting Haitians in the United States and abroad. “We went on the first mission trip to the DR in 2005 to assess the need and take care of the people in the bateyes,” recalls Etienne. The team saw over 1,000 patients in the week they were there and realized the level of need was so great that they decided to do two medical missions each year. Haitian cane cutters in the DR are not recognized as citizens, and children born in the country do not receive birth certificates. The sugar cane farming sector of the DR depends fundamentally on Haitian migrants, who represent 90% of the labor force in sugar cane cutting and are paid $1 per day. The team, once assembled, included a diverse blend of medical and health care competencies and others who offered their availability in a supporting role. “But in 2006, I decided that we needed to get nursing students involved because there are certain things you can teach students in the classroom and certain things you can’t,” explains Etienne. She received the support and participation of the college’s administration and trustees, who quickly approved and funded the project. “As a professor, I inaugurated this project as part of the students’ learning activity to get them engaged and to give back to the community so they may become global citizens and in the process enhance their cultural competence,” she says.

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Academic Forum conditions of these communities are extremely poor, and immigrants generally live in impoverished barracks that have

“God puts us here to serve other people, and if we can put a smile on someone else’s face—if we can change someone’s life—we should not think twice about it,” she says emphatically.

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them by themselves, keeping them hydrated so they can see the primary. “Some have asked us if

Marie Etienne, PhD, MSN, with Haitian children

Twelve nursing students from the associate’s degree program were added to the team. The team travelled to the DR to do a one-week mission trip twice each year from 2006 to 2009—each time serving some 1,200 patients ranging from children to the elderly with a wide spread of medical and health conditions.

went to Haiti about five times that year going back and forth. I also went to one of the universities to teach the nursing students basic skills and show how they can be empowered to take care of their own country.” In 2012, the team was asked back to the DR because the health care needs persisted and the living conditions were deplorable. The people in the

“But in 2006, I decided that we needed to get nursing students involved because there are certain things you can teach students in the classroom and certain things you can’t,” explains Etienne. Haiti In 2010, an earthquake struck Haiti, killing over 200,000 people, and the mission’s focus shifted to Haiti. “Our attention turned to the needs in Haiti as relief efforts, and other nurses who were members of the [National Black Nurses Association] came together to share in the relief response treating wounds, stabilizing the injured, triaging patients according to symptoms, and whatever else was necessary,” says Etienne. “I

bateyes were doing their level best by any means necessary to survive, but the team decided not to go back in 2013 because the DR Supreme Court had ruled that the government could proceed to deport all persons who are in the country illegally, and that put a lot of fear into the workers needing health care. Many Haitians arrive in the DR through open borders without legal documents and stay in the country this way. The living

no electricity, no basic sewage services, and no potable water. There are no health services, recreational spaces, or schools. The workers work 12 hours per day on average and face the threat of deportation when they attempt to organize to obtain basic rights. “As the impact of the Supreme Court’s decision began to be felt, violence subsequently broke out and, for the sake of the students, I could not take them there that year,” Etienne explains. On their visits, the U.S. team partnered with the Universidad Central del Este, which assigned 50 medical students for a week. They gave one rotation in the morning and one in the evening to work with Miami Dade College students. “We were assigned a primary school in one of the towns outside Santo Domingo, the capital, where we set up the clinic,” says Etienne. “We had registration in one area, a room for triage, and vital signs in another area. Then we sent the patients to see the primary care doctor, or the PA, and then they went to pharmacy, where all the medications were donated by U.S. Catholic charities and others. We designed a pediatric area, and it had balloons, coloring books, toys, and games just to make the children comfortable where we did play therapy. And for the elderly, we would triage

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we feel like we are putting a Band-Aid on the conditions of people’s lives in the bateyes. I would explain that our purpose of going there was so we could save lives. One of the patients had a seizure, and if we were not there he would have died. Another had an asthma attack, and because of the ventilator machine we brought along with the administration of some albuterol and follow-up care, that patient recovered. We feel we are saving lives and making an impact. The people know that someone cares about them and that they are not forgotten,” says Etienne. “God puts us here to serve other people, and if we can put a smile on someone else’s face— if we can change someone’s life—we should not think twice about it,” she says emphatically.

Kenya At the tender age of eight, Sharon Smith, PhD, believed that one day she would be a missionary. She knew she would go to Africa and serve in some capacity, but she never really knew how that would happen. “I just figured it would somehow come through my interest in health care,” she explains. As a young person, her aspiration was to be an oral surgeon, but she knew she would not like some of the situ-

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Academic Forum ations she would see, so she chose nursing. She is currently a nurse practitioner at the Family Health Centers of San Diego. “Nursing offered me more career flexibility. My roles as a nurse just fit my personality, so I am glad I chose nursing instead,” says Smith. “I didn’t know I would go to Kenya, but that is where I landed, and I have really enjoyed the connections and my experience work-

Tumutumu and spent time doing crafts with the children in a home for the deaf and hearing impaired. This was possible because the group from California included a young woman who could sign. The home for the deaf was adjacent to the Tumutumu Hospital, which provides care to approximately 3,000 inpatients and more than 16,000 outpatients each year. Tumutumu Hospital is

tices in Kenya and the United States. They saw how much was lacking by way of resources and training. In a ward, there would be a patient with pneumonia next to a surgical patient with an open wound, who may be next to a patient with HIV. There was no segregation based on medical condition. In the pediatric ward, however, three or four rooms were set aside for preemies or

Sharon Smith, PhD, with a Maasai tribesman

ing with the people there. That is what kept me going back.” Smith’s first trip to Kenya was in 2006 with 12 members of a Pentecostal church group out of Carlsbad, California. A physician friend was unable to go and suggested that she go instead. Since then, she has been back twice on her own. Nairobi served as the primary hub on each visit, but on her first visit she went to the town of North Kinangop, about a two-hour drive from Nairobi, the capital. She also visited the town of

one of the three mission hospitals in Kenya sponsored by the Presbyterian Church of East Africa (PCEA). Smith and her team came with hospital supplies that they delivered to the staff. The hospital had a large HIV clinic, and while the children waited on their parents, they were provided with school supplies and toys as gifts from Smith and her team. As the visitors toured the hospital wards (floors), they were exposed to the differences between nursing prac-

small children who were intubated or on ventilators. Smith

the PCEA Tumutumu Nursing School. “They ran the hospital with the number of beds at about almost 200, inclusive of the maternity ward. There was no ICU, however,” she explains. On her third trip to Kenya in 2010, Smith, who was at that time one of two nurse practitioners in the U.S. team of eight, visited an orphanage of 250 children and did physicals on over 100 of them, from newborns up through teenagers. This provided the orphanage with the children’s first medical records. While on this trip, Smith also had an opportunity to work with some of the nurses of Kenya on a very large, day-long health expo in the Maasai village. They performed health screenings, vaccinations, physicals, oral examinations and extractions, working alongside physicians and dentists from Kenya. Smith did have an opportunity to see up close the delivery of care inside a hospital in Nairobi after a dog bit a member of the U.S. team and required medical attention. Her assessment is that the hospital provided care comparable to that found in most U.S. hospitals. “My focus and concern was, however, the care delivered by the rural hospitals,” she says.

As the visitors toured the hospital wards (floors), they were exposed to the differences between nursing practices in Kenya and the United States. They saw how much was lacking by way of resources and training. says that at this hospital there were one or two experienced nurses, but all the work was done by student nurses from

For Kenyans, Smith is the sister returning home, so they go through the villages and alert the community that “our sister

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Angela Allen, PhD, with the head nurse at a Uganda hospital

is coming home.” “They plan for my arrival ahead of time,” she says, “and I am planning my return in 2016.”

Uganda Raised by her communityminded grandmother, Angela Allen, PhD, took her mission trips to Uganda with concern for both the physical and spiritual well-being of the people of Uganda. The Detroit native received her doctorate from Arizona State University with a focus on geriatric and dementia patients, and now she is the clinical research program director with the Banner Alzheimer’s Institute in Phoenix, Arizona. Allen visited Uganda in 2010 and 2012 for periods up to three weeks each visit. Her visits allowed her to interact with the elderly who might have some form of cognitive impairment. What she uncovered was that

cognitive impairment was less of a concern than physical impairment, which prevented the people in the community from caring for themselves. Even though she had gone with a religious purpose sponsored by

themselves with the Ugandans they sought to reach by sleeping in their huts and immersing themselves into the life and rhythm of the communities. “The people were hungry for knowledge more so than food,

“The people were hungry for knowledge more so than food, so I taught them, spending time with the women to help them develop a sense of community and even preached to them,” Allen says.

the Church of God in Christ, Allen did have an opportunity to do research in an area of interest to her. Virtually all of the team’s time was spent in towns like Jinja, a town of approximately 70,000 people and a two and half hour’s drive from the capital, Kampala. The team fully identified

so I taught them, spending time with the women to help them develop a sense of community and even preached to them,” Allen says. “I was well received because, after my first visit to the hospital in Hoima, I was invited back by the hospital. So, I took what I had learned from the qualitative observations I

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had conducted and returned in 2012 as part of a team of 25 people and a fully developed plan, including a full curriculum for the nursing students.” Allen’s plan included addressing the needs of adolescents, especially girls, who needed to hear that they were appreciated and acknowledged as persons of value. With the help of town officials, she recruited young girls and, using an interpreter, exposed exposed them to two days of instruction on self-esteem and self-pride. She also worked on securing hospital supplies through Project C.U.R.E. (Commission on Urgent Relief and Equipment) in Phoenix, as well as surplus supplies from hospitals where she had worked in the past. These filled several crates that were presented to the hospital in Hoima. Lastly, Allen sought to teach a two-day class to the nurses, but in the process she realized that the level of training the nurses had received was comparable to the training provided to nursing assistants in the United States. Her observations of the accommodations provided to the patients was comparable to those Smith observed in Kenya (e.g., patients were not segregated by medical condition in the wards). “This was a life-changing experience for me,” says Allen. “I never imagined that this visit to the continent of Africa would affect me so much. It was a very emotional experience because the need is so great. I reaffirmed that my purpose in life is to help others.” James Z. Daniels is a consultant and writer who lives in Durham, North Carolina, and frequently contributes to Minority Nurse.

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A Day in the Life of a Nurse with Dystonia BY BEKA SERDANS, RN, MS, ANP-BC

You might ask how a wannabe artist/photographer ended up working nights surrounded by medical equipment and really sick people. I blame it on my father. Of course, he’s not here to defend himself anymore, but take my word for it, there was no way that he was going to let any of his three daughters become starving artists.

o, now I’m a semistarving nurse. When I started (not all that long ago…in dog years), my salary was $8.65 an hour. I do earn a bit more these days, but Bernie Madoff never solicited me for investment opportunities. What’s rather interesting

is that we seem to pay more for interior decorators than we do for the people we depend on to save our lives. I put aside artistic dreams for the reality of mastering the science and art of critical care nursing. There was this side of me that was fascinated

by some of the “big” questions in medical care, such as: “What do you do when all the body’s organs start failing?” and “How do you help those people who are truly suffering without resorting to Jack Kevorkian measures?” Solving analytical problems humane-

ly seemed far more rewarding than photographing magnificent images (although I still find tremendous pleasure stealing away and capturing the world through a viewfinder). Oddly enough, my professional journey through medicine intersected with a personal medical condition— one that would remain undiagnosed and untreated for five years. Some doctors said that my facial tics (e.g., hemifacial spasms) and strange pains were

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Degrees of Success due to stress or some hysterical “woman’s disease.” Yes, we’re talking this century. Eventually, I picked the right door—it happened to be at Mount Sinai in New York City—and walked out with a few names and treatments for a disease that affected my head

could wake up and discover this has only been a long, bad dream? You bet. However, until a magic wand appears, you can find me at an intensive care unit doing what I love despite my physical limitations. How do I manage? I’ve got the system semifigured out. No

What’s rather interesting is that we seem to pay more for interior decorators than we do for the people we depend on to save our lives.

but was not “in my head.” I started my nursing career with dysphonia, cervical dystonia, and even generalized dystonia. Early treatments might have been much more fun if they were given for cosmetic reasons, but the Botox, Myobloc, and eventually Deep Brain Stimulation (DBS) were prescribed to ease some of the less than glamorous symptoms. Now, how much trust would you put in a nurse who twitched and twisted? Not much. So, at first, I worked in a soft cervical collar that allowed me to perform sensory tricks that convinced me that my body was aligned and not twitching and twisting. Well, that didn’t last too long. I thought I was doing a terrific acting job, but as patients began asking me, “What’s wrong with you? Are you in pain? Should I call a doctor, a nurse?” I knew the gig was up. Since retirement at 30 was not exactly an option, I figured out a way to continue doing what I loved despite the pain and the drugs and the brain surgery. Has it been worth it? Yes. Am I an effective nurse? Ask my patients. Do I wish I

one wants to work nights and weekends. I do. It’s not easier or quieter or better paying; it just makes me that much more valuable. What’s it like to work from 7:00 at night to at least 7:30 in the morning? First, you should know that when you start at 7:00 p.m., you have to be at the hospital way before then. And, if you live in New York City (NYC) and happen to have dystonia, like I do, you should probably start out the day before. Find me a day without gridlock in NYC, and I’ll bet it’s either a national disaster or a holiday weekend. Within the first half hour, we have the changing of the guard. The night team leader makes assignments and reports are exchanged. Let me take you with me as my shift begins.

A Typical Shift 7:30 pm: I have two patients, one who is on a ventilator and will probably be bleeding all night since a drug she has been taking for migraines, Methotrexate, has eliminated more than her headaches—it has eliminated the ability of her blood to clot. Oh, and her mouth is filled with packing

material. My other patient weighs about 300 pounds, has pneumonia, and is in the second stage of lung cancer. How in the world am I going to turn her over? I should tell you that despite my height, I weigh slightly more than 100 pounds. I also have wires in my neck (no, you can’t see them) that connect a pacemaker to my brain. These wires are not industrial grade— they can snap. This would not be a good thing for me or my patient. I will deal with this issue later. I have work to do. 7:45 pm: I review the computerized order checklists to make sure what medications are due at 10:00 p.m. 7:50 pm: A family member asks for coffee. This is not a big deal except that walking with a steady, even gait is not my strong suit. With a rather interesting weave, I deliver hot coffee. No spills, no burns, no thanks. 8:30 pm: I stop in to see patient #1. The oral packing is bloody. The bed is bloody. It’s time to call the Ear, Nose, and Throat (ENT) residents. Her platelet count is only seven. Luckily, she is sedated, and her

I run into the drug room, and if you’ve ever seen someone with dystonia run, it is not going to rate an Olympic-scored 10 for style points.

vital signs are holding steady. 8:50 pm: I see patient #2 and hear gurgling sounds. She is not gargling. You do not have to be a medical whiz to know that this is not a good noise. Should you have a medical background, you might recognize the sound as a signal that there’s water in the lungs. I call it a “wet” sound, and since

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this patient has also refrained from urinating for most of the day, I’m betting that she will be much, much happier if I suction her. I do. She is—and I even hear a faint, “Thank you.” I like this lady (but please, don’t fall on the floor). 9:00 pm: The ENT residents have ordered platelets for patient #1. Does that mean that I get them ASAP? No. That means I now have to call the blood bank and grovel. “I need them in a hurry.” Translation to their reply of “Yeah, yeah” (and in a Jamaican accent it sounds like “Ya-di-dah”): “You’ll get them when I get to you on my list of things-to-do, people-to-see, and dinner-toorder.” Am I happy? No. Is this stressful? Yes. Does this make my straight hair curl and my dystonia symptoms go away? Take a guess. 9:30 pm: I have got to work on my begging and pleading skills. They do not teach this in nursing school. The platelets have yet to be delivered, and no one has even called from the blood bank to say, “Come and get them,” or even more unlikely, “We’re on our way.”

So, I call them again. Were they (a) delayed or (b) forgotten? My hunch is that the order was still sitting on the “to-do” pile. 10:00 pm: My 300-pound patient needs to be turned over for a skin assessment. This is not good. Before getting a chance to figure out this physics problem, I add two bags of antibiotics to her IV. As I’m

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Degrees of Success

Resources National Institute of Neurological Disorders and Stroke www.ninds.nih.gov/disorders/dystonias Includes a detailed fact sheet on everything you need to know about dystonia

Dystonia Medical Research Foundation www.dystonia-foundation.org Provides information on current research efforts, treatment and support options, and how to get involved

Dystonia Health Global Monitor www.facebook.com/DystoniaHGM An open forum consolidating the latest news, research information, and education resources for a wide range of movement disorder issues

Deep Brain Stimulation www.medtronic.com/innovation/smarter-dbs.html Explains how DBS therapy works and the risks involved

doing this, it occurs to me that I’ve been on duty for a while, but I haven’t had a chance to enter anything about my patients into the computer. I’ll do it now. No, I won’t. Alarm bells go off. My other patient’s blood pressure is dropping. This is when all the years of training and experience pay off. I react automatically. 10:10 pm: I run into the drug room, and if you’ve ever seen someone with dystonia run, it is not going to rate an Olympic-scored 10 for style points. I grab a bag of premixed intravenous Levophed, a medication that’s administered to

raise blood pressure—something I surely do not need. My heart is pumping away like I might actually have to break the sound barrier. I dash back to my patient’s room, hook it up, and remain by the bedside for the next half-hour. 10:45 pm: The bells are ringing, and they are all for me. Has anyone done a study on how many things a single person can do at the same time? I need to clone myself (and this time without dystonia, please). Okay, who gets priority: the bedpan seeker or the hungry patient? No contest. 11:00 pm: A knight in shin-

ing scrubs appears: Stu. He helps me turn my 300-pound patient. That’s the good news. Why is there always bad news? Suddenly, her oxygen level is doing that downward slide. Please, don’t make her need to be intubated or put on a ventilator. I call the resident on duty and ask for a C X-ray order. I hope she is not retaining fluid. I am retaining stress. This does not bode well for my next activity: writing status reports. 11:20 pm: I start off with a bang, but my hands have a mind of their own. I think “write.” They think “I’m cramping up, honey.” They win. Writing will come later. 11:42 pm: Half a miracle: C X-ray done. Patient’s blood pressure has stabilized. The

nurses, this would be slightly more relaxing than the dramas taking place at the bedside, but with dystonia it’s not quite so easy. In fact, it’s more than just a “pain in the neck,” it causes hand cramping and pain. So, I’ve learned to master the art of two-fingered typing. No speed records will be broken tonight. 12:15 am: The formerly illusive platelets are now finding a new home in patient #1’s bloodstream. However, patient #2 doesn’t look good and her breathing is labored. I think she needs more than suctioning, so an order goes out for a diuretic to get rid of some that water. This time we go for something a bit more formidable: 40 mgs of IV Lasix. 1:10 am: Some of my chart-

With dystonia, you learn to make accommodations and work around the physical limitations. A secret: I usually rearrange the patient’s room so that everything is in my line of sight. blood bank remains a “no show,” and I really have to eat something and/or go to the bathroom. Can you get scrubs from NASA? Those spacesuits could work. 11:55 pm: I make an executive decision: I’m going to the blood bank for my patient’s platelets. If we needed them before, we really need them now. This isn’t an order for pizza. 12:10 am: Speaking of pizza, I’m still hungry, but if I don’t sit down for five minutes I may fall over. ICU nurse hits the floor. Patients and coworkers not impressed. Okay, now that I’m sitting, I look up at the clock and realize now would be a good time to start all the chart work. For most

ing is completed, the platelets have infused, the Lasix seems to be working, but it’s time to turn both patients over. I still haven’t eaten. In the background, I hear a nurse arguing with the resident on-call about an emergency room admission. What’s new? There are not enough nurses on duty tonight. We are so short-staffed that I already know that coming off duty in the early morning is not going to be on my chart. Why? If you’re not in nursing, you might not know the mantra: “NOT documented, NOT done.” Remember my typing skills? This is an obstacle to nurses with dystonia. 1:30 am: I notice bloody urine coming from patient #1.

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Degrees of Success Wondering if her liver is failing, I decide to draw her blood and send her lab work off early. She will need more platelets—she is not clotting well. 1:40 am: A patient is dying at the other end of the unit. He’s only 20 years old. The family is living by the bedside. No matter how many times I’ve seen this drama unfold, it never gets any easier. 2:10 am: Now that all the “labs” (as we call them) and diagnostic tests are completed, patient #2 raises my blood pressure to a nightly high. Her heart has gone into a lethal arrhythmia. Running into the room, I pound her on the chest, hoping beyond hope to get a normal rhythm to return. My neck is killing me. The pre-

order more platelets and some liver function tests. Her blood pressure has been stable. I finish my computerized charting entries. However, due to the dystonia, my arms hurt from hanging bags of platelets on a barely unreachable ceiling pole. What do shorter nurses do? 3:00 am: The few of us on the unit tonight have been running, for what seems like forever. I do not want to come back as a hamster. Forget ordering take-out dinners, forget about even eating the healthy snacks that some of us have packed. In between ringing bells and critical care nursing, we gulp down chips, soft drinks, and the unhealthiest snacks imaginable. What if a dietitian happened to decide to spend the night here?

third world country, but you’d never know that. The pharmacist, right here in this very large, very busy, NYC hospital decides to let us know in no uncertain

cordial thump works. An EKG and complete labs are ordered. Uh oh, her oxygen level has dropped again. Does she need even more Lasix? 2:40 am: As I’ve now become to feel quite possessive of patient #1’s platelet activity, I feel like celebrating as her number goes up from seven to 24! Just for good measure, the ENT guys

We’d have to find her a bed. 3:10 am: The 20-year-old patient dies. I feel sad. His parents were at the bedside. Morgue care is ordered. 3:30 am: “My” platelets are ready. I ask the unit clerk to pick them up as well as stop by the pharmacy for some newly ordered antibiotics. This is not a medical mercy mission to a

the bed and its surroundings are soaked with diarrhea? This is a job for the true angels of nursing: housekeeping. I clean the patient, giving her a back rub as well as a respiratory treatment. Before leaving the room, I do a platelet check. 4:30 am: Platelets are done. Will this shift ever end? Whatever could go wrong has already

Have you ever had to estimate the amount of diarrhea produced? I must have missed this lecture in nursing school.

terms (read: venting) that the pharmacy doesn’t have the variety that was ordered. Am I in a new Twilight Zone? What kind of pharmacy is this? 4:00 am: Meanwhile, back on the floor, patient-turning is the next activity. What could be worse than trying to perform this task alone, especially when

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happened, I think. My feet hurt. Note to self and other wouldbe nurses with dystonia: Clogs might as well be three-inch heels. My feet turn inwards,

but my clogs do not. A new ER admission arrives on the unit. The few of us left standing all help the patient settle in. Do you think that any of us are contemplating Nurses’ Week every May? No. We just want to sit down and go home. 4:45 am: Some of the routine things that nurses do are no longer easy for me to accomplish without help. Night nurses are responsible for changing IV tubes for new ones. This used to be a nonevent, but now I can’t open the packaging without using scissors or a clamp or a helping hand. It’s frustrating. 5:10 am: A minor miracle: My paperwork is up-to-date, and there are only two more hours left to this awful night. 5:22 am: A colleague is having trouble inserting an IV. I offer to help. Even though I am unable to turn my head the “right way” anymore, I can do IVs by instinct. With dystonia, you learn to make accommodations and work around the physical limitations. A secret: I usually rearrange the patient’s room so that everything is in my line of sight. There’s another thing that I have to constantly be aware of since I had DBS: electromagnetic interference. All those security devices may be great, but they can cause havoc with my pacemaker, which goes to my

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Degrees of Success brain rather than to my heart. This, among other things, is anxiety-producing, so my neurosurgeon has me taking a mild dose of Klonopin to reduce stress. Did I remember to take it this evening/morning? No. I will pay for it on the bumpy bus ride home. 5:47 am: An alcoholic in withdrawal wanders out of his room. His IVs are in disarray, he has a bloody gown, his EKG monitor is off, and he announces to all of us that he is ready to leave. Perhaps we should call the bellboy for his luggage and have the front desk prepare his bill. He resists our cajoling him back to bed and then hits one of the nurses. We call security and the docs. He isn’t listening to anyone. 6:00 am: Perfect timing. The head nurse is now walking down the hallway as the alcoholic is making his way to the nurse’s station. He is using four-letter words and making comments that will not be printed in The New York Times. Where is security? Are they in cahoots with the blood lab people? I really don’t want to be a punching bag, even if I’m beginning to feel like one. If my muscles get any tighter, I may explode. 6:10 am: Security arrives. Using less than spectacular intervention skills, they tackle the patient. Now what? We decide to ship him to the psych ward…stat! 6:24 am: Check patient #2 and discover more diarrhea. She is producing the type of diarrhea that is irritating to the skin and induced by antibiotics. To make matters worse, this 300-pound lady can’t breathe when she is in a prone position. Getting her out of bed would be impossible. I only

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The author with her service dog, Lia Boo Boo

weigh 115 lbs. Can it get better than this? Sure. There’s no protective cream available. I call my knight in scrubs, Stu, and we clean her up once again. Now I do the “uh-oh” check. Are my neck wires still intact? Yes. I can exhale. 6:45 am: Go back to the charts and enter final vital signs. Also need to compute things like intake and outtake of fluids. Have you ever had to estimate the amount of diarrhea produced? I must have missed this lecture in nursing school.

7:10 am: Patient #1 needs extra IV potassium. I grab a bag from the drug room and hang it on the IV pole. The day-shift staff begins arriving. I actually have a minute to swallow my dose of my medication, which helps relieve spasms related to dystonia. 7:26 am: Before giving a verbal report to the day shift, I review any last-minute orders to make sure nothing was missed. Nothing missed. It’s going to be a good day! 7:45 am: Shift over. Scalp pain erupts. Neck twisting and

turning begins. I just want to sleep. Intensive care nursing with dystonia is not for the faint of heart, but it is possible—and rewarding! Beka Serdans, RN, MS, ANP-BC, currently works as a private duty nurse with Access Nursing at Mount Sinai Medical Center in New York City. When not providing care to patients, she can be found hiking with her service dog, Lia Boo Boo. She is a recipient of the 2008 New York Times Tribute to Nurses Award.

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Health Policy

Policy Engagement: A Call for All Nurses BY JANICE M. PHILLIPS, PhD, FAAN, RN

The need for nurses to become familiar with and engaged til I started conducting breast sured women in gaining access in the policy-making process has never been greater. cancer disparities research to breast and cervical cancer While nurse leaders throughout time have emphasized the with underserved women that screening and diagnostic serit occurred to me that someone vices. Expanding on the need need for nurses to become more involved in advocating (e.g., survivors or cancer orga- for follow-up care, the Breast for patients and the profession, the passage of the Affordable Care Act (ACA) and the release of the Institute of Medicineâ&#x20AC;&#x2122;s The Future of Nursing report both call for The renewed interest in policy engagement for the transformation of health care delivery and underscore nurses is further evidenced by the proliferation of opportunities for policy engagement. health policy books and resources for the nursing

he renewed interest in policy engagement for nurses is further evidenced by the proliferation of health policy books and resources for the nursing profession and the increased emphasis on including health policy content in nursing education programs. In fact, the American Association of Colleges of Nursing developed a set of core competencies for integration into nursing edu-

cation programs, all of which emphasize the need for nurses to develop competencies in this area.

Practice, Research, Policy: Connecting the Dots I recall the aha moment when I realized the importance of identifying the policy implications of my practice and research. While I had worked in underserved communities for many years, it was not un-

profession and the increased emphasis on including health policy content in nursing education programs. nizations) was advocating for legislation to improve access to cancer screening services. Concurrently, the Breast and Cervical Cancer Mortality Prevention Act of 1990 directed the Centers for Disease Control and Prevention to establish the National Breast and Cervical Cancer Early Detection Program to assist low-income and unin-

and Cervical Cancer Prevention and Treatment Act was signed into law in 2000, helping to ensure access to breast cancer treatment services for low-income and uninsured women diagnosed with breast cancer. As a volunteer for the American Cancer Society and the chair of public policy for the Chicagoland Affiliate of Susan G. Komen for the Cure, I started participating in lobby days advocating for more affordable and accessible cancer prevention and treatment services. Building on my desire for more engagement, I began lobbying with my professional nursing organizations to advocate for funding to support nursing education and research. Thankfully, I realized the strong connection between practice, research, and policyâ&#x20AC;&#x201D;and now encourage nurses to do the same.

To Get You Started, Suggested Activities Include the Following: â&#x20AC;˘ Complete a health policy course during your nursing education and your nursing career. www.minoritynurse.com

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Health Policy

Health Policy Resources American Association of Colleges of Nursing www.aacn.nche.edu/government-affairs

American Nurses Association www.nursingworld.org/MainMenuCategories/Policy-Advocacy

Center on Budget and Policy Priorities www.cbpp.org

GovTrack (site for tracking legislative bills) www.govtrack.us

Kaiser Family Foundation http://kff.org

National Conference of State Legislatures www.ncsl.org

National League for Nursing www.nln.org/advocacy-public-policy

Office of Legislative Policy and Analysis https://olpa.od.nih.gov

Office of Minority Health www.minorityhealth.hhs.gov

Health Policy Books Cancer and Health Policy: Advancements and Opportunities, edited by Janice M. Phillips and Barbara Holmes Damron Health Care Finance, Economics, and Policy for Nurses: A Foundational Guide, by Betty Rambur Health Policy and Advanced Practice Nursing: Impact and Implications, edited by Kelly A. Goudreau and Mary C. Smolenski Nurses Making Policy: From Bedside to Boardroom, edited by Rebecca Patton, Margarete Zalon, and Ruth Ludwick Policy and Politics for Nurses and Other Health Professionals: Advocacy and Action, by Donna M. Nickitas, Donna J. Middaugh, and Nancy Aries Policy and Politics in Nursing and Health Care, by Diana J. Mason, Deborah B. Gardner, Freida Hopkins Outlaw, and Eileen T. O’Grady

• Become more involved through your professional and specialty organizations. • Attend state lobby days sponsored by your nursing organizations or home institutions. • Participate in virtual lobby days. • Invite congressional leaders to tour your nursing program, professional meetings, or community activities. • Look for policy implications in presentations, publications, and textbooks. • Seize the opportunity to identify public policy implications in your everyday practice. • Incorporate a policy component into your clinical experience (e.g., student interviews with state lawmakers and city council members, and student attendance at public hearings). • Tap into your institution’s Office of Government Relations. • Read policy-related journals (e.g., Nursing Outlook or Policy, Politics, and Nursing Practice). • Become familiar with websites that offer health policy resources (e.g., National League for Nursing, American Nurses Association, and the American Public Health Association). • Tap into your professional organization’s resources for policy development. • Share your personal experiences in the policy arena. Regardless of practice setting, there are public policies and legislative initiatives that influence the scope of nursing practice or the amount of available resources to provide patient care or support nursing

education. For example, the recent push toward full scope of nursing practice has already influenced the way advanced practice nurses practice in each state. Members of the nursing community, along with a number of stakeholders, are working with state and federal legislative officials to see what legislative and regulatory actions are needed to ensure that nurses are practicing to the full extent of their preparation. The outcomes of these efforts will have huge implications for the nursing profession and the patients we serve. Akin to this are the provisions outlined in the ACA, many of which have direct implications for nurses. Key provisions focused on primary workforce, patientcentered care, nurse-managed health centers, school-based clinics, quality improvement, and patient safety, to name a few. These provisions present opportunities for nurses to pursue leadership roles that will enable them to help implement aspects of the ACA legislation. What a great time for nurses to contribute to the policy discourse that is taking place on the local, state, and federal level. From the new grad to the more seasoned professional, nurses are encouraged to become familiar with the policymaking process and identify ways in which they can make a meaningful contribution to improving the quality of patient care and advancing the profession through advocacy and political activism. Janice M. Phillips, PhD, FAAN, RN, is Director of Government and Regulatory Affairs at CGFNS International, Inc. in Philadelphia.

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THE FUNNY BONE

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COMPILED BY MICHELE WOJCIECHOWSKI

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Dear Readers,

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Welcome to our new humor column! Here we’ll share real-life stories about some of the funny things that happen in the nursing field. Have a funny story of your own? Contact writer Michele Wojciechowski at MWojoWrites@comcast.net to share!

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Expecting the Unexpected I once had a young adult patient. I saw in the report that he was said to be “difficult.” For example, he would refuse care, etc. We began talking, and I started to get to know more about him. I learned that music and tattoos were both very important to him. As we talked, he asked me if I had any kids. I told him I was expecting and that I was 28 weeks pregnant. He grinned and exclaimed, “I knew it! I knew it!” “I knew you weren’t fat!” We both laughed. Turns out that he really wasn’t a difficult patient after all. He just needed a good laugh. So did I… —J.G., BSN, RN

Cadence Clarity I am a graduate from a nursing school in Puerto Rico, and English is my second language. When I moved to Houston, Texas, my pronunciation of medications was in a Spanglish way. As a result, my encounters with the pharmacy were a

learning experience. I would call the pharmacy to request a drug: with a drug called Lasix, for example, I would pronounce it “LASEESK.” You can see that there was a communication problem. I quickly learned that spelling out the name of the drugs was a win-win for both the pharmacist and me. Today, every time I see the drug Lasix, as a joke, I still pronounce it in Spanish. —E.C., MSN, RN, ANP-C

From the Mouths of Babes About 20 years ago, I was working with a patient who only spoke Spanish. I didn’t speak it at all, and I was frustrated because I couldn’t communicate with the patient. One day, my son, who was then in middle school, came by the hospital. He was studying Spanish in school, and he was struggling with it. In fact, it seemed like there was nothing you could do, at the time, to get him to study it more. Since he wasn’t doing great with his Spanish studies, I

wasn’t going to ask him to try to speak with my patient. My son found out that I couldn’t speak with her, and he asked if he could go with me to see her. To my shock, he began speaking with her—asking if she was hungry, had to go to the bathroom, etc. His visit was perfect for all of us: I got to “speak” with my patient; she got to tell me what she needed; and my son learned that Spanish could be useful in real life. After that, his grades went up! —L.R., RN, MPC

Tag in the Nurse I worked my first nursing job at a rehabilitation center/ nursing home. I worked on the rehab side. I learned quickly that the older ladies liked the

Do you have a funny story to share? It can be something that happened to you at work, while in nursing school, while teaching nursing school— practically anywhere, as long as it involves the nursing field. If so, contact Michele Wojciechowski at MWojoWrites@comcast.net. If we use your story, we’ll only use your initials to protect the innocent—and to be HIPAA compliant.

www.minoritynurse.com

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guys who worked there…but not for the reason you might think. As a former Marine, I’m a big, solid guy. I’m 5’8” with the build of, well, a former Marine! I was working the night shift, 11:00 p.m. to 7:00 a.m., when a nurse’s aide went to help a woman transfer onto the bedside commode. “I don’t want you,” the woman yelled. “I want the nurse!” So they got me. When I walked in and said I was the nurse, she said, “You ain’t no nurse! You’re a wrestler!” I lifted her up easily and put her right down on the commode. For the remainder of her stay, anytime I was working and she needed to use the bedside commode, she would say, “Get that wrestler in here!” —F.E., RN

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MINORITYNURSE.COM Highlights from the Blog

Newsletter Six Tips to Help with Final Exam Stress If the thought of your nursing school final exam schedule has you harried and anxious, it’s time to take a step back and figure out some tricks to help you get through this very stressful time.

Is Your Nursing Clinical Making You Nervous? Nursing students anticipate going into a nursing clinical where they can finally begin to take all their book knowledge and apply it in real situations. Sounds exciting and empowering, right? Sure, but the thought of starting a first nursing clinical also terrifies a lot of nursing students. So, what spikes anxiety about clinicals?

When Faced with Discrimination, Practice Mindfulness A patient calls you a racial slur. A coworker makes a racially charged statement. A family member makes a racial joke and anticipates you will laugh with them. How would you respond to such hurtful comments? Do you respond by confronting them verbally? Do you scold them? Or do you contemplate responding to them in a physical manner? What is the best course of action of the nurse?

How to Squeeze in Some “Me” Time Where can you steal some me time when you have a schedule that barely lets you breathe? This isn’t the “me” time we all crave—the hours-long lunches with friends or days at the spa. That is important but takes some real planning. This list holds ideas for a few ways to capture the true stolen moments that you can manage to sneak into your day every now and then.

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

Minority Nurse | WINTER/SPRING 2016

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Academic Opportunities

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Academic Opportunities

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

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

www.minoritynurse.com

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Academic Opportunities

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

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Ranked fifth among schools of nursing in U.S. News & World Report’s 2016 America’s Best Graduate Schools

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

Minority Nurse | WINTER/SPRING 2016

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Faculty Opportunities

FACULTY POSITIONS AT WASHINGTON STATE UNIVERSITY SPOKANE COLLEGE OF NURSING SEEKING DOCTORALLY PREPARED PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER Washington State University College of Nursing, Spokane, Washington is seeking exceptional faculty applicants to: 1) contribute to our established research strengths in health disparities, behavioral health, chronic conditions, community and environmental health, and patient care quality and safety 2) provide high quality teaching for undergraduate and graduate programs 3) engage in meaningful College, University, and public service. Tenure-track/tenured position openings are at the rank of Assistant Professor, Associate Professor or Full Professor. Salary, rank and tenure status are dependent upon experience and qualifications. To apply, visit www.wsujobs.com Position is open until filled. Review of applications will begin September 4, 2015 and continue until suitable candidates are identified or until March 31, 2016. Position start dates are January 1, 2016 or August 16, 2016. This posting may be used to fill multiple positions. WASHINGTON STATE UNIVERISTY IS AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EDUCATOR AND EMPLOYER. Members of ethnic minorities, women, special needs/disabled veterans, veterans of the Vietnam-era, recently separated veterans, and other protected veterans, persons of disability and/or persons age 40 and over are encouraged to apply.

nursing.wsu.edu

FACULTY POSITIONS AT WASHINGTON STATE UNIVERSITY SPOKANE COLLEGE OF NURSING CLINICAL ASSISTANT, CLINICAL ASSOCIATE or CLINICAL PROFESSOR Washington State University College of Nursing is seeking applications from exceptional nurses who hold a DNP or PhD in nursing or related field to fill a Clinical Assistant, Clinical Associate or Clinical Professor position within our College. We are particularly interested in • Individuals prepared as Family Nurse Practitioners (#086821) • Individuals prepared as Psychiatric Mental Health Nurse Practitioners (#104103) The College has a reputation for delivering high quality undergraduate and graduate programs. Our faculty, along with graduates of our programs, are recognized throughout the region for their sound research, clinical skills and ability to practice evidence-based nursing. To view position qualifications and to apply, visit www.wsujobs.com The online application requires: 1) A cover letter describing education and experience as related to the 2) curriculum vitae 3) names and contact information for four professional references Positions are open until filled. Review of applications will begin September 8, 2015 and continue until suitable candidates are identified or until March 15, 2016. Position start dates are January 1, 2016 or August 16, 2016. This posting may be used to fill multiple positions. WSU Spokane is a tobacco-free campus. WASHINGTON STATE UNIVERSITY IS AN EO/AA EDUCATOR AND EMPLOYER.

nursing.wsu.edu www.minoritynurse.com

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Faculty Opportunities

CLINICAL TRACK FACULTY POSITIONS AT WASHINGTON STATE UNIVERSITY TRI-CITIES COLLEGE OF NURSING

Washington State University Tri-Cities is seeking exceptional faculty applicants to join the College of Nursing and contribute to our pre-licensure baccalaureate program, RN to BSN program, master of nursing (MN) and post-master’s certificate programs, and doctoral of nursing practice (DNP) program. Clinical faculty members will be responsible for teaching undergraduate and/or graduate students, serving on master’s thesis/clinical project committees, advising undergraduate and/or graduate students, participating in clinical scholarship, and providing service to the university, community and profession of nursing. Faculty rank is based on qualifications. Positions will remain open until suitable candidates are identified. Review of applications will begin October 19, 2015 and continue until suitable candidates are identified. This posting may be used to fill multiple positions. For more information and to apply, visit www.wsujobs.com and search for position number 122194. WASHINGTON STATE UNIVERSITY IS AN EEO/AA/ADA EDUCATOR AND EMPLOYER.

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Dedicated to Diversity

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

Join Our Community. Get your Free Subscription! Visit www.MinorityNurse.com and subscribe today!

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