Minority Nurse Magazine (Summer 2016) by Springer Publishing Company

The Career and Education Resource for the Minority Nursing Professional â&#x20AC;˘ SUMMER 2016

Salary Survey Issue

Annual

Guiding Cancer Survivorship

THE OVERWEIGHT NURSE DERAILED BY A HEALTH CRISIS

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Table of Contents

In This Issue 3

Editor’s Notebook

Vital Signs

Making Rounds

The Funny Bone

In the Spotlight

Highlights from the Blog

In Memoriam

Index of Advertisers

Cover Story 30

2016 Annual Salary Survey By Ciara Curtin Looking to make more money? Check out the results of our annual salary survey and find out where other nurses are thriving

Features 8 How Nurses Can Improve Communication Skills

Academic Forum

By Jebra Turner

36 Latest Developments in the Fight against HIV/AIDS

Follow these 10 tips to avoid conflicts and misunderstandings in

the workplace and improve patient safety

By Terah Shelton Harris

Learn about the new drug that could revolutionize HIV treatment compliance

Guiding the Cancer Survivorship Journey By Pam Chwedyk

Second Opinion 40 Culturally Responsive Women’s Health Care: What It Is and Why It Matters

By Denise M. Tate, EdD, APRN-BC

To be cared for is a basic human need, and not every woman’s needs are the same

Discover how you can help your patients navigate the difficult journey from patient to survivor

20 Are You a Hypocrite? The Stigma Against the Overweight Nurse

By Lynda Lampert, RN Find out why weight issues often lead to mistrust in health care

Degrees of Success 42 Rhode Island Nurses Institute Middle College: Prepping Students for Success

By Jennifer L. W. Fink

Discover how the nation’s first nursing-focused public school is breaking new ground

Health Policy 45

Federal Regulations: The Essentials

By Janice M. Phillips, PhD, FAAN, RN

Brush up on your knowledge of the basics of policymaking at the federal level

Minority Nurse | SUMMER 2016

and how we can shift the focus from BMI to overall health

24 When a Health Crisis Derails Your Plans:

How to Get Your Health and Your Career Back on Track

By Julia Quinn-Szcesuil Expect the unexpected and learn how to ease your transition back to work after a health crisis

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Through the Looking Glass

lection seasons tend to bring out the worst in people. We’re quick to judge others who don’t see things eye to eye with us—and that often extends to every facet of our lives. So, what can we do about it? Take a moment to put yourself in another’s shoes. If you’re feeling unappreciated at work, for instance, ask yourself whether you’ve become complacent, or whether maybe your manager isn’t acknowledging your hard work due to a personal health crisis. If the former, it may be time to check in with other nurses. Our annual salary survey results can help you decide whether it’s time to get that advanced degree, change specialties, or consider relocating. Are your communication skills up to par? Good communication is not only crucial in providing culturally competent care, but also improves coworker relations so you avoid conflicts. Follow Jebra Turner’s 10 tips to sidestep misunderstandings in the workplace and learn how to work more efficiently as a team with your fellow nurses, doctors, and health care professionals. All patients can benefit from an open line of communication, but teamwork is critical when treating cancer patients. A cancer diagnosis alone is tough. Every cancer patient deserves to be educated on possible side effects, the challenges they will face physiologically and emotionally, and the support networks available to them. Nurses can play a critical role in educating survivors—many of whom are minorities—and increasing their quality of care. Pam Chwedyk teaches you how to help survivors cope with the “new normal” and live longer, healthier lives. If nursing is consistently ranked as one of the trusted professions, why do patients often mistrust an overweight nurse? Lynda Lampert investigates why the stigma exists and what we can do to shift the focus. The next time you or a loved one is in the hospital and is being taken care of by an overweight nurse or doctor, take a moment to appreciate how selfless they are being, placing your well-being above their own health. Nurses are still human beings, after all. But they don’t have time to get sick, right? Many can’t fathom being on the receiving end of patient care, but it happens—and you don’t want to be blindsided when it does. Julia Quinn-Szcesuil helps you prepare for the worst so that when a health crisis affects your work, you can focus on getting better instead of worrying that you’re now unemployed. Going forward, let’s make an effort to restore the Golden Rule. Education is an important first step in developing empathy for others, whether it’s being educated on the latest HIV/AIDS research to better understand a patient’s needs, asking a woman about her cultural beliefs in order to provide culturally sensitive care, teaching students at a nursing-focused public school, or learning about health policy to advocate for safer nurse-patient ratios. — Megan Larkin

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

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Vital Signs

CVS Health Partners with NBNA and NAHN As part of an ongoing commitment to develop a diverse workforce that reflects the patients and communities it serves, CVS Health announced strategic partnerships with two leading national organizations whose mission is to advance the multicultural nursing populations in the United States: the National Black Nurses Association (NBNA) and the National Association of Hispanic Nurses (NAHN).

hrough these newly formed alliances, CVS Health, the nation’s largest pharmacy innovation company, will establish workforce development programs and strategies that facilitate multicultural talent acquisition to further develop the company’s own diverse nursing populations through education, training, and colleague engagement. With a unique continuum of health care products and services, CVS Health supports a broad nursing workforce that includes nurse practitioners who see patients through the company’s MinuteClinic network, nurse patient care specialists who serve the company’s specialty patients, pulmonary arterial hypertension nurses who provide in-home education and infused medication therapies, and patient education nurses who deliver disease education and case management to patients over the phone. Additionally, these partnerships will enable CVS Health to increase the number of internships and scholarships that the company extends to multicultural candidates. “At CVS Health, we recognize the strong connection between a culturally diverse nursing workforce and the ability to

provide quality, culturally competent patient care,” says David Casey, vice president of workforce strategies and chief diversity officer at CVS Health. “We value the multicultural communities, customers, and patients we serve and we look forward to working closely with NBNA and NAHN, as we continue to help bridge the current nursing shortage in the United States and enhance access to quality care to underserved populations.” According to the U.S. Bureau of Labor Statistics, there will be more than one million

Minority Nurse | SUMMER 2016

open positions for registered nurses across the country by 2022. Moreover, while U.S. Census Bureau statistics show that ethnic minority groups account for 37% of the U.S. population, industry research shows that nurses from minority backgrounds represent only 19% of the RN workforce, with African American and Hispanic nurses representing 6% and 3%, respectively. “CVS Health and NBNA share the common goal of supporting the development of African American nurses which is reflective of our nation’s diversity,” says Eric J. Williams, DNP, RN, CNE, president of the NBNA. “This new partnership will allow our two organizations to work collaboratively to increase access to care and improve the health of the communities we serve.” “We’re grateful to CVS Health for partnering with NAHN to help achieve our

mission of improving the quality of health care for Hispanic consumers,” says Celia Besore, executive director of NAHN. “We look forward to working together to provide equal access to educational, professional, and economic opportunities for Hispanic nurses in our country.” As one of the largest employers of pharmacists and nurse practitioners, CVS Health is committed to helping advance the education of talented students pursuing careers in the field. The CVS Health Foundation has provided scholarships to pharmacy students for many years and, in 2016, the Foundation will begin awarding funding to nursing and physician assistants schools to support the pipeline of much-needed nurse practitioners in local communities across the country.

Vital Signs

High Glycemic Index Associated With Increased Risk of Lung Cancer Glycemic index, a measure of carbohydrate intake and glucose levels, was associated with increased risk of lung cancer in non-Hispanic whites, with a significantly higher risk in those who had never smoked, according to a study published in Cancer Epidemiology, Biomarkers & Prevention.

“A

lthough smoking is a major, well-characterized risk factor for lung cancer, it does not account for all the variations in lung cancer risk,” says the study’s senior author, Xifeng Wu, MD, PhD, professor and chair of Betty Marcus Cancer Prevention in the Department of Epidemiology at The University of Texas MD Anderson Cancer Center. Glycemic index (GI) assigns foods an indexed value to show how quickly and how much carbohydrates in the food cause blood glucose levels to rise after eating. Glycemic load (GL) is a related measure that is calculated by multiplying GI by the amount of carbohydrates in grams, then dividing by 100. Previous studies have investigated the association of GI and GL with certain types of cancer, including colorectal, stomach, and pancreatic cancers, but there has been limited research into the association with lung cancer. Wu and colleagues selected patients and control subjects from an ongoing case-control study of lung cancer conducted at MD Anderson. The patients

were newly diagnosed and had not received treatment other than surgery. The healthy control subjects were selected from patient lists at Kelsey-Seybold Clinics, a large physician group in the Houston area. The study results encompass 1,905 cases and 2,413 controls. Researchers conducted in-person interviews to determine the subjects’ health histories and dietary behavior, including food frequency and portion size. Foods were assigned GI values according to previously published research, and the study subjects were categorized into quintiles, based on GI and GL as determined by Wu and her colleagues. The researchers stratified the data by age, gender, education, smoking status, and body mass index to adjust for confounding factors. Overall, those in the highest quintile of GI had a 49% greater risk for developing lung cancer than those in the lowest quintile. Compared with those in the lowest quintile of GI, those in the highest quintile had a 92% higher risk of developing squamous cell carcinoma, but less significant association was seen with developing adenocarcinoma.

Among subjects who had never smoked, those in the highest quintile of GI were more than twice as likely to develop lung cancer as those in the lowest quintile. Wu explained that because smoking is the strongest risk factor for lung cancer, the absence of smoking allowed for detection of other risk factors, such as GI. According to Stephanie Melkonian, PhD, a lead author of the paper, GL was not associated with increased lung cancer risk for most patients, with the exceptions of the never-smokers, where those in the highest quintile, compared with those in the lowest quintile, had an 81% higher risk. Among participants with less than 12 years of education, those in the highest quintile had a 55% higher risk of developing lung cancer than those in the lowest quintile. Melkonian says one possible explanation for the connection between GI and lung cancer is

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that diets high in GI result in higher levels of blood glucose and insulin, which promote glucose intolerance and insulin resistance. In turn, insulin resistance has been associated with changes in the body’s insulin-like growth factors, which play a role in cell proliferation and differentiation in cancer, according to previous research. Wu says further research could examine whether dietary changes have an effect on cancer-related biomarkers, and whether the association between GI and lung cancer carries over to other racial and ethnic groups. “The results from this study suggest that, besides maintaining healthy lifestyles, reducing the consumption of foods and beverages with high glycemic index may serve as a means to lower the risk of lung cancer,” Wu says.

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Vital Signs

Superbugs Threaten Hospital Patients America is doing a better job of preventing health careassociated infections (HAIs), but more work is needed— especially in fighting antibiotic-resistant bacteria. The Centers for Disease Control and Prevention’s (CDC) latest Vital Signs report urges health care workers to use a combination of infection control recommendations to better protect patients from these infections.

or serious antibioticresistant bacteria; • A 17% decrease in surgical site infections (SSIs) between 2008 and 2014 related to 10 procedures tracked in previous HAI progress reports; • 1 in 7 remaining SSIs are caused by urgent or serious antibioticresistant bacteria; • No change in the overall catheter-associated urinary

“N

ew data show that far too many patients are getting infected with dangerous, drugresistant bacteria in health care settings,” says CDC Director Tom Frieden, MD, MPH. “Doctors and health care facilities have the power to protect patients—no one should get sick while trying to get well.” Many of the most urgent and serious antibiotic-resistant bacteria threaten patients while they are being treated in health care facilities for other conditions, and may lead to sepsis or death. In acute care hospitals, 1 in 7 catheterand surgery-related HAIs can be caused by any of the six antibiotic-resistant bacteria listed below. That number increases to 1 in 4 infections in long-term acute care hospitals, which treat patients who are generally very sick and stay, on average, more than 25 days.

The six antibiotic-resistant threats examined are: • Carbapenem-resistant Enterobacteriaceae • Methicillin-resistant Staphylococcus aureus • ESBL-producing Enterobacteriaceae (extended-

shows that progress has been made in decreasing hospitalonset C. difficile infections by 8% between 2011 and 2014. Along with the updated annual progress report, the CDC released the Antibiotic Resistance Patient Safety Atlas, a new web app with interactive data on HAIs caused by antibioticresistant bacteria. The tool provides national, regional, and state map views of superbug/ drug combinations showing percent resistance over time. The Atlas uses data reported to CDC’s National Healthcare Safety Network from 2011 to 2014 from more than 4,000 health care facilities.

CDC Message to Health Care Providers

spectrum β-lactamases) • Vancomycin-resistant Enterococcus • Multidrug-resistant Pseudomonas aeruginosa • Multidrug-resistant Acinetobacter

U.S. Hospitals Doing Better at Preventing Most HAIs The national data in this Vital Signs report, along with data from CDC’s latest annual progress report on HAI prevention, show that acute care hospitals have achieved: • A 50% decrease in central line-associated bloodstream infections (CLABSIs) between 2008 and 2014; • 1 in 6 remaining CLABSIs are caused by urgent

Minority Nurse | SUMMER 2016

tract infections (CAUTIs) between 2009 and 2014. During this time, however, there was progress in non-ICU settings, progress in all settings between 2013 and 2014, and most notably, even more progress in all settings towards the end of 2014. • 1 in 10 CAUTIs are caused by urgent or serious antibiotic-resistant bacteria. The report also examines the role of Clostridium difficile (C. difficile), the most common type of bacteria responsible for infections in hospitals. C. difficile caused almost half a million infections in the United States in 2011 alone. The CDC’s annual progress report

The CDC is calling on doctors, nurses, health care facility administrators, and state and local health departments to continue to do their part to prevent HAIs. The report recommends doctors and nurses combine three critical efforts to accomplish this: • Prevent the spread of bacteria between patients; • Prevent infections related to surgery and/or placement of a catheter; and • Improve antibiotic use through stewardship. “For clinicians, prevention means isolating patients when necessary,” says Clifford McDonald, MD, associate director for science at CDC’s Division of Healthcare Quality Promotion. “It also means being aware of antibiotic resistance patterns in your facilities, following recommendations for preventing infections that can occur after surgery or from central lines and catheters placed in the body, and prescribing antibiotics correctly.”

Making Rounds

May 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

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

June 11-15

Association of Womenâ&#x20AC;&#x2122;s Health, Obstetric and Neonatal Nurses 2016 Annual Convention Gaylord Texan Resort Grapevine, Texas Info: 202-261-2426 E-mail: cwarner@awhonn.org Website: http://awhonnconvention.org

21-26

American Association of Nurse Practitioners 2016 National Conference Henry B. Gonzalez Convention Center San Antonio, Texas Info: 512-442-4262, ext. 5238 E-mail: conference@aanp.org Website: www.aanp.org

July 12-15

National Association of Hispanic Nurses 41st Annual Conference Hyatt Regency Chicago Chicago, Illinois Info: 501-367-8616 E-mail: info@thehispanicnurses.org Website: http://nahnconference.org

12-15

22-24

42nd Annual IMAGE Conference The Cosmopolitan Las Vegas, Nevada Info: 913-895-4627 E-mail: nahcr@goAMP.com Website: www.nahcr.com

41st Annual Conference Hyatt Regency Miami Miami, Florida E-mail: kmota@aamn.org Website: http://aamn.org/conference

20-24

October

National Association for Health Care Recruitment

The American Assembly for Men in Nursing

Philippine Nurses Association of America

5-7

37th Annual National Convention Grand Hyatt Washington Washington, DC E-mail: info@mypnaa.org Website: www.mypnaa.org

Doctors of Nursing Practice Conference 9th National Conference Baltimore Marriott Inner Harbor at Camden Yards Baltimore, Maryland Info: 888-651-9160 E-mail: info@doctorsofnursingpractice.org Website: www.doctorsofnursingpractice.org

August 2-7

12-15

National Black Nurses Association

The Transcultural Nursing Society

44th Annual Conference Sheraton Memphis Downtown Memphis, Tennessee Info: 301-589-3200 E-mail: elazenby@nbna.org Website: www.nbna.org

42nd Annual Conference Hilton Cincinnati Netherland Plaza Cincinnati, Ohio Info: 888-432-5470 E-mail: staff@tcns.org Website: www.tcns.org

19-22

September

American Psychiatric Nurses Association

8-10

National Neonatal Nurses Conference 16th Annual Conference Gaylord Opryland Hotel Nashville, Tennessee E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

21-23

National League for Nursing 2016 Education Summit Orlando World Center Marriott Orlando, Florida E-mail: summit@nln.org Website: www.nln.org/summit

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30th Annual Conference Connecticut Convention Center Hartford, Connecticut Info: 855-863-2762 E-mail: lhoop@apna.org Website: www.apna.org

20-22

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

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How Nurses Can Improve Communication Skills BY JEBRA TURNER

Health care has changed dramatically for nurses, physicians, and others on the health care team. The whole environment is a more complex, fast-paced, and continually shifting culture. Most facilities aim to emphasize efficiency, reduce costs, and improve patient outcomes. That goal requires that nurses and other team members work together closely, with good communication as the linchpin of that collegiality and collaboration.

ccording to Phyllis Quinlan, PhD, RNBC, president of MFW Consultants and a nursing coach, agencies such as The Joint Commission and the Institute for Healthcare Improvement stress the absolute necessity of improving the sticky aspects of communication as a way to prevent errors and improve safety and quality of care. “All the reports show that communication breakdowns are the number

one thing contributing to a substantial number of preventable errors and deaths,” she says. “The health care industry has taken huge steps to acknowledge that we’re a global community. We all work to ensure the best possible outcome for our patients, so we have to find ways to make sure that our communication is optimal. We looked to the other industries, like the nuclear energy field and the

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military, where clear and distinct communication was vital to ensure the safety of troops and limitation of collateral damage,” she explains. In addition, nurses who display clear and effective communication with coworkers enjoy trust, respect, and the power of true partnership— which translates into better patient relationships, greater patient engagement, and better health outcomes.

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Here are 10 of the best strategies to sidestep misunderstandings, errors, and conflicts. 1. Learn more effective ways to communicate with physicians. Physicians report being frustrated with the communication style of some nurses who are unprepared or unspecific in their communications, especially when on the phone. When calling a patient’s physician, it is good to be direct and precise, rather than descriptively telling a story when the doctor is waiting to hear the problem in order to supply a solution. One of the most popular communication frameworks for communicating patient information, says Quinlan, goes by the acronym SBAR, which stands for situation, background, assessment, and recommendation. “That’s so when nurses call they don’t have to go over the river and

can repeat it back for clarification and validation. ‘You know, Doctor, this would be the third hypertensive medication that your patient is on. Do you want that?’” she explains. It may be difficult for a newly graduated nurse to be assertive and direct, even when using SBAR as a tool, but usually with more clinical experience, a clear and persistent approach will become second-nature when talking to physicians.

2. Be mindful of cultural differences in communication style.

Phyllis Quinlan, PhD, RN-BC

formation. It depends on the institution. If it’s in a private hospital, where the doctor is king, then you have to watch your P’s and Q’s. There’s an unwritten rule among African Americans: you have to work

“African Americans tend to be fairly direct, but that can be perceived in a different way,” says Gregory Woods, RN, BSN, clinical

When calling a patient’s physician, it is good to be direct and precise, rather than descriptively telling a story when the doctor is waiting to hear the problem in order to supply a solution.

through the woods but can get directly to the point. I can’t tell you how much it has helped communication. Say you’re speaking to a physician on the phone, and that doctor gives you an order, so you

nurse at UC Davis Medical Center and president of the Bay Area Black Nurses Association. “Others may feel personally challenged—when you’re not challenging them but only trying to convey in-

Minority Nurse | SUMMER 2016

Gregory Woods, RN, BSN

twice as hard, and your communication has to be twice as good. You really have to watch the words that you utilize, watch how you express that directness or passion. In the end, we’re both here for the patient’s safety.” Other minority groups face their own sets of difficulties with communication, which are different but no less vexing. For instance, a nurse of Japanese ancestry may be perceived as quiet, shy, or reticent and be told to be more assertive. Alternatively, in some situations, minority status may work in a nurse’s favor, as it sometimes does for Woods. “As a male in nursing, I may have an advantage over females because males are traditionally seen as more authoritative,” he says.

A superb way to strengthen relationships between nurses, physicians, and others is through interdisciplinary collaborative patient rounds.

In addition, Woods spent 15 years in pharmaceutical sales, where he developed a high comfort level with making presentations to physicians.

addition, leadership must also protect nurses against abuse by developing and enforcing code-of-conduct and zero-tolerance policies that are applied equally to all parties. Every facility is different, so check to see who is responsible for counseling disruptive personnel about their behavior and/or administering disciplinary action in extreme or recurrent cases. In many cases, it may be the medical director who handles these difficult situations, and in others a professional mediator may be present.

4. Advocate for patients, especially when caring for minority populations. Stéphane Pady, MSN, APRN, RN-C

3. Know who to go to in case of conflict. Health care professionals can be rude, bullying, dismissive, or downright intimidating—and so can staff members with little authority, such as aides and clerks, but with plenty of power to make your work life unpleasant. If you do have a problem with a coworker, then you may want to go directly to that person first to discuss the situation. In

Nurses are educated to see patients holistically and to focus on the more human aspects of care, such as helping patients and their families deal with disease and treatment in the present and after discharge. They often serve as medical “interpreters” between physicians and patients and families, even when they are all fluent in English. “There have been plenty of moments when I might have to increase my advocacy of patients and education of patients about standard of care,” says Stéphane Pady, MSN, APRN,

RN-C, pediatric nurse at Stamford Hospital in Stamford, Connecticut. “Standards of care are different with minority patients; many studies have shown that there’s a quality chasm. I encourage families to be strong advocates. Sometimes mothers and fathers don’t know what’s common and what to ask for, the way that someone from a higher socio-economic group would insist ‘I want an MRI’—they might not know to even ask for that.”

5. Increase communication between all members of the health care team. A superb way to strengthen relationships between nurses, physicians, and others is through interdisciplinary collaborative patient rounds. “My department is a bit unique because nurses and the health care team round together instead of separately,” says Pady about her pediatrics unit. “I can’t believe that other departments don’t function that way. Nurses

on what’s best for the patient. That’s why we’re there—patient care.”

Andrea Higham

6. Use the shift change as another opportunity to improve communication and patient safety. “Each and every shift there’s a patient hand-off, so it’s a good strategy to have a brief huddle, to debrief and get a report on patient assignments at the end of a shift,” says Quinlan. “This is

“Each and every shift there’s a patient hand-off, so it’s a good strategy to have a brief huddle, to debrief and get a report on patient assignments at the end of a shift,” says Quinlan. may not know the plan of care otherwise because they don’t round with the physicians. Communication between all members is focused

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a 90-second stand-up huddle where everyone groups. Say the shift coming on is told they’re getting three admissions, and they get their shift

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responsibilities. Then 45 minutes later, the charge nurse says that instead of three, they’re getting five admissions. She’d revise the assignment on paper, but then call another huddle and explain, ‘I’ve written it down, let’s go over it again.’”

7. Boost your communication skills online. Clinical and other technical skills are important for any nurse, but so are effective communication and the

Brittney Wilson, RN, BSN

ability to develop collegial relationships with everyone on the health care team. New nurses especially may need to practice communicating with physicians, patients, and patients’ families. Yet, they may feel too vulnerable to fill in the gaps of their experience while working on the floor.

“You can always access our avatar-based online program, Your Future in Nursing, on our website [www.discovernursing.com/yourfutureinnursing],”

forums, or video conferencing tools. We’re on the precipice of the next big thing in health care communication technology, says Brittney Wil-

Before physicians treat nurses more respectfully and collaboratively, nurses need to respect themselves and each other.

says Andrea Higham, the leader of Johnson & Johnson’s Campaign for Nursing’s Future. “The game-like simulation can help newly graduated nurses practice teamwork, communication, and collaboration so they acclimate more quickly to health care and the nursing role. In this evolving environment, it’s crucial for nurses to be assertive, to stand up for their patients, and to truly become the voice of the patient.” Studies tend to show that people learn better when training is done in a fun, engaging way, so take advantage of this and other online tools. Even experienced nurses can benefit from downloading online games like this one, or podcasts and webinars about the “soft skills” of nursing.

8. Practice good electronic communication skills, too. Much nursing communication is now carried out electronically via e-mail, voicemail, text, chat, online

Minority Nurse | SUMMER 2016

son, RN, BSN, also known as “The Nerdy Nurse,” whose background is in clinical informatics nursing. “There’s an incredible opportunity now to get information instantaneously, but it’s not secure so we can’t use it to discuss patients because of HIPAA. There are some secure communication mechanisms like the apps TigerText [a fully encrypted, HIPAA-compliant messaging platform for health care workers], but the problem is there’s no standardization yet.” One roadblock is leadership lacking in innovative ideologies. They don’t believe in technology or don’t want to allocate money to institute integrated programs, Wilson explains. Some EMRs have integrated communications functionality, but then it becomes part of a patient’s record and subject to more scrutiny. “Now patients have access to their own records, so we have to be careful and objective,” says Wilson.

Beth Boynton, RN, MS

“Social media is excellent for communicating with each other. ‘Show Me Your Stethoscope’ is a Facebook group where health care professionals gather for the common good. Whenever you identify yourself as a nurse online, be sure to represent yourself and your profession well,” she adds.

9. Address the underlying dynamics of collegial relationships. Communication is only the tip of the iceberg, says Beth Boynton, RN, MS, author of Successful Nurse Communication: Safe Care, Healthy Workplaces, and Rewarding Careers. Before physicians treat nurses more respectfully and collaboratively, nurses need to respect themselves and each other. “Emotional intelligence, human behavior, power dy-

namics, and organizational culture are all influencing our communication and relationships,” says Boynton. “It takes self-awareness and self-esteem to be assertive. I use medical improvisation as an experiential method for training nurses in communication skills. It gets at the core areas of self-esteem and selfrespect. It’s about the underlying emotional intelligence. Improv activities help nurses with truly listening and communicating in a respectful and concise way.” Boynton uses fundamental improvisation exercises, but then frames them in terms of nursing. One such activity is

are one person. For example: The. Sky. Is. Blue. Because… That way, participants have to share responsibility for creating the answer, which may be a different experience for everyone. After the activity, the participants stop and talk about what they learned. “The golden rule of improv is [to respond with an attitude of] ‘yes and …’ The ‘yes’ part is about listening. The ‘and’ part is about assertiveness,” she explains. Listening and guiding are both necessary for effective team communication.

10. Empower yourself with more education and expertise. Physicians say they have more collegial relationships with nurses with up-to-date knowledge and expertise in their specialty. Most nurses also feel more confident and assertive when they know

a master’s or a doctorate degree in order to qualify as advanced practice nurses. Scharmaine Baker, DNP, FNP-BC, FAANP, CEO of DrBakerNP (www.DrBakerNP.com), has a private practice as a nurse practitioner and also works with two collaborating doctors. “I communicate daily or every other day with my collaborating doctors. It’s nice to run things by them. I use them as a backup and sounding board. They respect my practice and expertise, and

Physicians say they have more collegial relationships with nurses with up-to-date knowledge and expertise in their specialty.

them either; the buck stops here.’ Nurses don’t have an issue calling me Dr. Baker and respecting me. I’ve heard through the grapevine that there may be grumbling, but I choose not to notice.” Excellent hospitals are alike in aiming to promote a more communicative and collaborative workplace. It is a goal that nurses, physicians, administrators, and all other members of the health care team share. Outstanding relationships improve nurse satisfaction, patient safety, and outcomes, in addition to giving organizations a competitive advantage as high-quality environments. Jebra Turner is a freelance health writer living in Portland, Oregon. Visit her online at www.jebra.

Scharmaine Baker, DNP, FNP-BC, FAANP

called Dr. Know-it-all. Three people sit side by side and answer an open-ended question one word at a time as if they

that they’re on top of their clinical game. Some ways to further your training: earning continuing education credits, gaining certification in a specialty, or attending workshops and conferences. Many nurses have pursued

have no problem calling me Dr. Baker, even though I’m not an MD,” she says. “I’ve had encounters with doctors who say, ‘I don’t want to talk to an NP, have a doctor call me back.’ My collaborators say, ‘No, we won’t talk to

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Guiding the Cancer Survivorship Journey BY PAM CHWEDYK “Nurses need to be aware of what resources are available in the patient’s community, including experts in the field who are available to answer patients’ questions and refer them to services.” —Sandra Millon-Underwood, PhD, RN, FAAN By providing culturally sensitive care plans, advocacy, and support, nurses can play a leadership role in reducing cancer survivorship disparities and helping minority cancer patients regain their physical and emotional health.

here’s a good reason why the American Cancer Society calls itself “the official sponsor of birthdays.” Thanks to decades of advances in screening, early detection, and treatment, more Americans are surviving cancer than ever before. A disease that only a few generations ago was feared as an unstoppable killer is now considered a chronic illness that,

in many cases, can be managed and controlled. According to the most recent (2014) statistics from the National Cancer Institute (NCI), there are almost 14.5 million cancer survivors living in the United States. Even more encouraging, the number of people who have fought cancer and won is increasing: NCI estimates that the survivor population will soar to nearly

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19 million by 2024. And even though some racial and ethnic minority groups continue to have disproportionally high cancer mortality rates compared with whites, the ranks of minority survivors are growing, too. However, cancer patients’ health care needs don’t end when their initial treatment does. All too often, survivors return home from the hospital

loaded down with health challenges that require short- and long-term monitoring and follow-up. That’s why it’s important for nurses who are working to end cancer disparities in communities of color to start focusing more attention on multicultural survivorship care. “There are hundreds of thousands of men, women, and children who are surviving the disease but who still need to be managed within the health care system,” says oncology nurse researcher Sandra Millon-Underwood, PhD, RN, FAAN, professor at Univer-

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Survivorship Care Plan Guidelines American Society of Clinical Oncology Survivorship Care Plan templates www.asco.org/practice-research/cancer-survivorship

LIVESTRONG Care Plan

these patients from falling through the cracks. “Cancer is a tough disease, so patients need continued survivorship support to help them live with the physical and psychological effects,” says Sandra San Miguel de Ma-

ing everyday activities, sexual dysfunction, and—over the longer term—heart damage and loss of bone density. And for many survivors, the psychological battle scars—depression, anxiety, and fear of cancer recurrence—are

Increasing cancer survivors’ quality of life starts with having a thorough understanding of their needs.

www.livestrongcareplan.org

Journey Forward Survivorship Care Plan Builder for Health Professionals www.journeyforward.org

Memorial Sloan Kettering Cancer Center Survivorship Care Plan www.mskcc.org/referring-physicians/survivorship/ survivorship-care-plan

sity of Wisconsin-Milwaukee College of Nursing. “Their treatment is complete, their condition is stable. But to get on with their lives and their overall well-being, they need support from nurses.” There is also an urgent need for nurse-led interventions that can help improve survivorship outcomes for people from diverse racial and ethnic backgrounds, especially in medically underserved populations. Although some of the inequity gaps are beginning to close, many cancer patients of color still don’t live as long after treatment as Caucasian survivors do. NCI’s SEER Cancer Statistics Review 1975–2012 reports that the 2005–2011 five-year cause-specific survival rate for all cancers combined was 67.6% for whites but only 62.3% for blacks and 59.7% for

American Indians and Alaska Natives. In addition, minority cancer survivors are more likely to have poorer health and quality of life after treatment, lower compliance with follow-up treatment, and a heavier financial burden of cancer-related costs. A variety of factors are to blame, including late diagnosis, inadequate access to state-of-the-art cancer care, lack of health insurance, and cultural and linguistic barriers.

Meeting Unmet Needs Increasing cancer survivors’ quality of life starts with having a thorough understanding of their needs. Because many survivorship experts believe the health care system isn’t doing enough to address those needs, nurses must become survivor advocates to keep

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jors, MS, senior public health program director at the National Cancer Institute and formerly a research instructor at the Institute for Health Promotion Research (IHPR) at the University of Texas Health Science Center at San Antonio. “Many survivors, once they’re done with treatment, feel like they’ve been abandoned by the medical team: ‘OK, you’re fine, you can go back to your regular life.’ But very often, they really struggle with going back to being who they were.” “With cancer, we talk about ‘the new normal,’” adds Emily Haozous, PhD, RN, FAAN, an assistant professor at the University of New Mexico College of Nursing in Albuquerque whose research focuses on reducing cancer disparities in American Indian populations. “After cancer, your body is completely different, because cancer treatment takes you through the wringer.” The lingering aftereffects of powerful treatments like chemotherapy, radiation, and surgery can be formidable. They may include pain, fatigue, sleep disturbances, side effects (e.g., “chemo brain”), complications (e.g., lymphedema), difficulty in perform-

equally devastating. In San Miguel de Majors’ research at the IHPR, “we found that a lot of survivors are suffering from post-traumatic stress disorder,” she says. “They have feelings of diminished self-esteem and lost control. They have body image issues, and relationship and intimacy issues. There’s a lot of anger and a lot of fear of what the future may hold.” One reason why so many survivors from vulnerable populations are unprepared to cope with the challenges of life after cancer is that they’re not being provided with enough education about what to expect. “They need to learn how to manage their overall wellness,” Millon-Underwood explains. “Often, survivors don’t have an understanding of the things they must be mindful of as they go forward, such as how the effects of the disease and treatment affect mobility, nutrition, their ability to work. That’s where being engaged with nurses who are knowledgeable about survivorship issues is really key.”

Creating the Survivorship Road Map “Every cancer patient

FPO should have an individualized survivorship care plan,” says Karen Meneses, PhD, RN, FAAN, professor and associate dean for research at University of Alabama at Birmingham School of Nursing and co-leader of the Cancer Control and Population Sciences Program at the UAB Comprehensive Cancer Center. In 2012, Meneses notes, the American College of Surgeons’ Commission on Cancer (CoC), which accredits hospital can-

written survivorship care plans (SCPs) for their patients. The CoC is phasing in this mandate over the next few years: Accredited hospitals must give SCPs to 25% of eligible patients by 2016, increasing incrementally to full compliance (providing SCPs to 100% of eligible patients) by 2019. What should oncology nurses include when developing an SCP? “First, patients should be given a summary of all their treatments,” says

One reason why so many survivors from vulnerable populations are unprepared to cope with the challenges of life after cancer is that they’re not being provided with enough education about what to expect.

cer programs, issued a new accreditation standard that requires programs to provide

Marjorie Kagawa Singer, PhD, MA, MN, RN, FAAN, research professor and director of eq-

uity, diversity, and inclusion at UCLA’s Fielding School of Public Health. “More often than not, patients I’ve talked to had no idea what the names of their drugs were, how many doses they received, over what period of time. Second, the document should tell patients what post-treatment symptoms they should monitor— like heart symptoms, which is a big risk with many of the cancer drugs. “These reports should be sent to the primary care physician, too, because that’s where much of the follow-up will occur,” Kagawa Singer continues. “But often that record of treatment doesn’t get transferred back to the PCP. It’s important for nurses to help patients understand that they have a right to this information, that their primary care physician should have a copy of it, and that they should have a discussion with their PCP about followup care.” Survivorship care plans should also contain an assessment of the patient’s emotional health needs, such as screening the patient for depression, San Miguel de Majors recommends. “It’s a good idea for nurses to evaluate whether patients are having difficulty moving on with their lives and whether they need a referral to individual therapy or group support.” Meneses, who has worked extensively with African American breast cancer survivors in rural Southern communities, emphasizes that SCPs should encourage patients to adopt wellness behaviors, such as healthy eating, weight management, exercise, and smoking cessation. For instance, she says,

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“Breast cancer patients of all races tend to gain weight after treatment. Unfortunately, this increases their risk for recurrence.” If you’re new to survivorship care planning, you don’t have to reinvent the wheel. “Nurses need to know that there are evidence-based, proven guidelines available for creating SCPs,” Meneses advises (see our resources sidebar). “Some of them are targeted to specific minority populations. Others you will have to customize to fit the needs of the population you’re working with.” For limited-English-speaking patients, SCPs should be provided in the language the patient prefers, says San Miguel de Majors. And minority nurses who share the same cultural background as their patients often have an advantage in tailoring standard SCP templates to make them more sensitive to cultural differences. But all the experts interviewed for this article caution against relying on cultural generalizations and stereotypes. Above all, survivorship care plans must recognize that every patient is a unique individual. “You must be able to ask any patient, of any background, some fundamental questions that will help you indentify individual needs,” says Kagawa Singer, who is also co-leader of the Training Program Core for the Asian American Network for Cancer Awareness and Training. “The first thing is to ask, ‘How has this experience [of having cancer] affected you and your family?’ Then, you can use the cultural knowledge about a particular population

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as guideposts and determine whether or not they apply to that patient.”

Replacing Silence with Support Another crucial component of survivorship care planning is connecting patients with resources that can provide medical, emotional, social, and financial support. “Nurses need to be aware of what resources are available in the patient’s community, including experts in the field who are available to answer patients’ questions and refer them to services,” Millon-Underwood says. Because many cancer patients in disadvantaged communities of color are uninsured or underinsured, they may need assistance paying for things like inpatient and outpatient treatment, prescriptions, and nonmedical expenses, such as wigs for chemotherapy patients and breast prostheses for women who have had a mastectomy. Nurses must also ask whether the patient faces any barriers to accessing follow-up care—

such as lack of transportation, or having a job that makes it hard to take time off to come in for chemotherapy or radiation sessions—and make sure the SCP contains strategies for eliminating them. Meneses, Haozous, Kagawa Singer, and San Miguel de Majors all note that in some minority populations there is

cial or ethnic background in a safe, empathetic environment. Before recommending a group, be sure it’s a good fit for the survivor’s needs, MillonUnderwood stresses. “There are many support groups available, but a lot of them don’t seem to provide sufficient breadth and depth of care and resources for many of the minority cancer patients I’ve worked with,” she says. “Another thing I see is that often the established groups don’t seem to be open to asking the survivors, ‘What do you need?’ rather than coming in with a prescribed program of activities.” An obvious solution is that culturally knowledgeable minority nurses are ideally suited to create and lead survivor support groups themselves. For example, says Haozous, who is a member of the Chiricahua Fort Sill Apache Tribe, “There aren’t enough Native American cancer support

And minority nurses who share the same cultural background as their patients often have an advantage in tailoring standard SCP templates to make them more sensitive to cultural differences.

a traditional “code of silence” in which talking about cancer, or even one’s own body, is a cultural taboo. This stigma can make survivors reluctant to seek support services; as a result, they feel alone and emotionally isolated. Nurses can help break down these walls by referring patients to culturally competent support groups where they can share their experiences with other survivors from their own ra-

Minority Nurse | SUMMER 2016

groups out there, so there’s a huge need for tribal nurses to become involved in this. The nurse who can speak the Western medical language but also speak the cultural language of his or her community can be the safe person to help provide that support.”

Helping Patients Navigate Perhaps the most empowering role nurses can play in providing cancer survivor-

ship care for people from vulnerable populations is to help them navigate the difficult journey from patient to survivor. From translating oncologists’ medicalese into language patients can understand to guiding them through the unfamiliar, confusing world of specialized cancer hospitals, a growing body of evidence suggests that patient navigation interventions can make a significant impact in leveling the survivorship playing field. In fact, another new CoC accreditation standard requires cancer programs to provide patients with navigators in addition to survivorship care plans. As a result, many hospitals now employ oncology nurse navigators, which the Oncology Nursing Society defines as “professional RNs with oncology-specific clinical knowledge who offer individualized assistance to patients, families, and caregivers to help overcome health care system barriers … throughout all phases of the cancer continuum.” Some of the most effective patient navigation models for maximizing positive survivorship outcomes in underserved minority communities involve partnerships between nurses and local lay health workers, such as promotoras. “Using community health workers as navigators is very beneficial, because they know the community inside and out,” says San Miguel de Majors, who has trained promotoras to introduce a culturally customized version of the LIVESTRONG Foundation’s survivorship support program in cities with large Latino populations. “They are

trusted leaders within their community, so they serve as a bridge between the community and the health care system. They can be your best patient advocates.” In one of Millon-Underwood’s current projects, called Partners in Pursuit of the

But can culturally competent patient navigation really make a measurable difference in helping minority cancer survivors live longer, healthier lives? Amelie Ramirez, DrPH, director of the Institute for Health Promotion Research at UTHSCSA, thinks so. She has led several

Above all, survivorship care plans must recognize that every patient is a unique individual.

Resources for Nurses and Survivors Survivor Education Materials The National Cancer Survivorship Resource Center www.cancer.org/survivorshipcenter Provides information for survivors in Spanish and six Asian languages, along with English-language tips on healthy eating, tobacco cessation, financial and transportation assistance, finding support groups, and more

The National Cancer Institute Office of Cancer Survivorship Promise: B’CAUSSSE (Breast Cancer Awareness, Understanding, Screening, Survivor Support and Empowerment), nurse practitioners are collaborating with community health workers to reduce breast cancer survivorship disparities among economically challenged African American women in Milwaukee. First, the team educates program participants about the importance of screening and early detection. The NPs conduct clinical breast exams, and they refer and case-manage women who need mammography screening or other follow-up. If the screening reveals that the woman has cancer, says Millon-Underwood, “we ensure that she has a network of community health workers and clinicians who can navigate and support her through the care trajectory, from diagnosis all the way to the end of treatment, and beyond.” For instance, part of the community health workers’ role is to help newly diagnosed women who don’t have health insurance and/or a medical home find resources that will enable them to get the treatment they need without incurring a major financial burden.

randomized controlled studies designed to test how well navigator programs work. Her latest study is investigating whether a group of mostly low-income Latino breast, colon, and prostate cancer survivors in San Antonio and Chicago who receive a navigation intervention will have better treatment adherence and quality of life compared with a control group. “The intervention includes weekly phone calls from a bilingual, bicultural patient navigator and access to LIVESTRONG navigation services,” she explains. Although the data analysis is still in progress, the study’s initial findings are exciting. “At baseline, these survivors reported significantly lower general health-related quality of life, physical well-being, and emotional well-being,” Ramirez says. “Our preliminary results appear to indicate that this intervention reduces survivors’ psychological needs and improves multiple domains of quality of life and well-being.” Pam Chwedyk is a freelance health care writer based in Chicago. She is a former editor of

http://cancercontrol.cancer.gov/ocs Offers many free, downloadable patient education booklets for survivors, family members, and caregivers

The University of Texas MD Anderson Cancer Center www.mdanderson.org/patients-family/ diagnosis-treatment.html Provides information on cancer diagnoses and treatment options as well as helpful tips on how to manage the many different physical and emotional effects of cancer treatment

Culturally Competent Survivor Support Programs Sisters Network Inc. www.sistersnetworkinc.org A national support organization for African American breast cancer survivors

Native American Cancer Education for Survivors http://natamcancer.org/naces An innovative online program that uses storytelling to help Native survivors cope with quality of life issues

The Asian and Pacific Islander National Cancer Survivors Network www.apiahf.org/programs/chronic-diseases/ api-national-cancer-survivors-network Offers education, advocacy, networking, and multilingual resources for Asian American, Filipino American, Native Hawaiian, and Pacific Islander survivors Note: There are also many local, state, and regional groups throughout the United States. For example, local support networks for Hispanic/Latina breast cancer survivors include Comadre a Comadre in Albuquerque and ALAS-WINGS in Chicago.

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ARE YOU A HYPOCRITE? The Stigma against the Overweight Nurse BY LYNDA LAMPERT, RN

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Sara Goodspeed, LPN, would not describe herself as significantly overweight. “According to BMI, I am morbidly obese. I’m a thick girl, but in no way am I morbidly obese, at least in my book,” she says.

t didn’t seem to matter to the one patient she took care of in a long-term care facility. No matter how kind and understanding she was, he would not stop insulting her about her weight. “He’s alert and oriented times three. I try not to let it get to me. One time, though, he just wouldn’t quit so I left the room and may have slammed the door on the way out on accident/ purpose. Honestly, his comments infuriated me. I know I have weight issues, but this man himself is 300-something pounds and unhealthy,” she adds. Unfortunately, Goodspeed’s experience with this patient is not an isolated incident. In fact, it is more common than many health care providers may know. It isn’t just nurses, either. Doctors and support staff are often con-

fronted with patients who judge them because of their weight. Patients tend to not trust these providers, view them as hypocrites, and judge them without all of the information about their lives. Weight issues in health care providers can lead to mistrust among patients. “Patients

for Food Policy and Obesity at the University of Connecticut. Nicholas “Dr. Nick” Yphantides, MD, MPH, the chief medical officer of San Diego County, used to weigh over 600 pounds, but he didn’t let that stop him from being a physician or giving advice

Trust is important in the provider-patient relationship, and many patients just don’t think that someone overweight will be able to tell them how to be healthy.

have differing views of the body weight of providers. When they have a practitioner who is obese, they are less likely to follow given advice, more likely to change providers, and less trusting of the provider in general,” says Rebecca Puhl, PhD, deputy director of the Rudd Center

on weight. He recalls one patient’s reaction to him that ended up cutting him deeply. “One of my regular patients cancelled, and we slipped in a new patient with an urgent problem. She was an attractive young woman, and when she saw me, she asked for a moment alone. When I went

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back into the exam room, she was gone. I asked at the desk where she went, and they told me that when she saw me, she didn’t think she could trust me. However, I had a trust factor with many patients that was powerful and made me very popular,” he says. Trust is important in the provider-patient relationship, and many patients just don’t think that someone overweight will be able to tell them how to be healthy. They feel that the provider is unhealthy and either not able to tell them how to be healthy or clearly not following their own advice. This leads to the feelings in the patient of the hypocrite provider. “You cannot infer a person’s credibility based on body fat,” says Puhl. “The Surgeon General was overweight and got flack because of her size. It didn’t mean

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she was not more qualified for the job. She was the best person for the job. Somehow, being overweight disqualifies

“You cannot infer a person’s credibility based on body fat,” says Puhl.

her from the post. Weight has nothing to do with credibility. Weight has nothing to do with job performance.” Unfortunately, health care providers fall into the trap of “do as I say, not as I do,” and this can cause some of the mistrust among patients who are confronted with an overweight nurse or doctor. Yphantides has also faced this issue. “I was liked by some, but not by all. The prevailing attitude by those who did not know me was that I was a hypocrite. That was the biggest thing I struggled with,” he says. “Patients saw

me as board certified in medical hypocrisy. Some people judged me just because of my size and not by knowing me.” And that is part of the problem. Overweight practitioners are often judged on their size without patients knowing the struggles that they may have faced or are still facing. “We don’t know what people are

Most people with obesity— patient and provider—have trouble dieting because diets don’t work.” If overweight health care providers are not trusted and seen as hypocrites, then what can be done to flip the scales? How can providers have important nutritional conversations with patients when so

doing about their weight,” says Puhl. “Why is it reasonable to expect only thin people to be health care providers? Two thirds of the population is overweight. Patients

much stigma exists between the two? Puhl has some ideas on how to address this issue. “Shift the focus from the scale and the idea of thinness to thinking about other factors that contribute to health,” she suggests. “Nurses can do a better job by talking to patients about weight as important but not the only thing. Clinical interaction is about having a positive conversation about the health of the patient and shouldn’t be impaired by size of the nurse.” In his practice, Yphantides

“Patients saw me as board certified in medical hypocrisy. Some people judged me just because of my size and not by knowing me.” are not always going to have a non-overweight provider…

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has found that he is often admired by his patients. They are overweight themselves, and they appreciate that he understands their struggles. “Instead of being jaded, it made me humble and gracious and accepting,” he says. “Because of that, I was a much more human physician than people were accustomed to

You aren’t being a hypocrite if you understand their position and assist them with strategies to overcome their health problems.

experiencing. Patients saw vulnerability and authenticity, and these endeared me to people, made for trusting relationships. In some ways, I was the antithesis to the sharply dressed physician. I had a trust factor with pa-

tients that was powerful. It helped me because it made me so humble in disposition.” Perhaps this is the best way to combat the stigma that surrounds overweight health care providers. Nurses should have conversations with patients that focus on healthy habits rather than on what the BMI chart states,

“We don’t know what people are doing about their weight,” says Puhl. “Why is it reasonable to expect only thin people to be health care providers? Two thirds of the population is overweight.”

and the most important part is to have a sense of acceptance. Approaching a patient and expecting them to do as you say isn’t helpful. Instead, an open, caring conversation about health and how it will impact their lives is more helpful. You aren’t being a hypocrite if you understand their position and assist them with strategies to overcome their health problems. Goodspeed, for instance, confronted the patient who harassed her because of her weight: “I said something along the lines of ‘I know I have some extra weight as well, and I’m working on that. But let’s discuss your eating habits so we can both get healthy.’” In some ways, this is the perfect response to this unfortunately all-

too-common scenario—and one in which experts would agree. Goodspeed sums it up this way: “It’s just not appropriate to have a stigma against anyone who is overweight. Someone who is overweight knows they’re overweight.

They don’t need to be called on it.” 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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When a Health Crisis Derails Your Plans How to Get Your Health and Your Career Back on Track BY JULIA QUINN-SZCESUIL

Nurses will be the first ones to tell you they don’t have time to get sick. With so many patients to care for, units or hospitals to run, or classes to teach, the thought of a health crisis sidelining their essential work is almost unimaginable.

ut it happens. What would you do if a health crisis interrupted your work or your education plans? How would you cope? Where would you even start? Of course, you can hope it never happens, but if an illness or a family member’s crisis re-

quires you to take some time off, you want to be as prepared as possible. “Whether you are in the nursing field or not, we all have to prepare,” says Perla Estrada, LMSW, MBA, WorkHealthy Oregon program manager of the Oregon Nurses Foundation. “Nurses under-

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stand that from a provider role, but not always from ‘What if I am a patient?’ role.” And any health crisis that causes you to miss work will naturally cause some anxiety about your job. In today’s atmosphere, employees are always being urged to be indispensable, but what if everything moves along just fine when you are out? Most of the time, that is a misconception and one based on anxiety about the unknown while you are away from work. “In many cases, employers are willing to work with someone through a health crisis,” says Estrada. But you should make sure your bases are covered, and

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you should have an idea of what existing policies cover illness and leave.

your company’s current sick policy and leave policy and know where you stand.

“Understand your rights,” Estrada urges. Because each company is different and has varying policies, take a look at your company’s current sick policy and leave policy and know where you stand.

There are two kinds of health crises that can happen: the one you anticipate and the one that is sudden. If you know you are facing surgery that could keep you out of work for a few days or a few weeks, you should talk to your employer as soon as possible. Whatever crisis comes your way, you can be as prepared as possible with just a couple of steps. “Understand your rights,” Estrada urges. Because each company is different and has varying policies, take a look at

“One way to relieve the anxiety is to familiarize yourself with the Family and Medical Leave Act [FMLA],” says Estrada. “If you are an employee, you have a right to FMLA. And familiarize yourself with your employer’s benefits.” Eileen Watkins, MSN, RN, CCRN, commissioner on workforce issues for the Virginia Nurses Association, says you might also have to come up with your own questions. “There may be policies available, but you have to ask,” she says. “Your manager will be

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key for you to learn the policies. FMLA doesn’t compensate you for your illness. It protects your job and protects your absences to be covered as absences.” Ask about short-term and long-term disability to provide income while you are out and find out what documentation, phone calls, or communication you are responsible for to make

sure everything is covered. “Some facilities are different from others, so it’s not just a leave policy, but they might have an attendance policy,”

potentially avoid any mistakes.

What Do You Say? Experts agree that you need to tell your employer if you require time off from work for a health issue, but how much you say after that is at your discretion. “If it’s personal health care information, you are protected and don’t have to share that,” says Estrada. “You can just say you are having a personal health crisis and need to be out.” But not everyone wants to do that, Estrada says. Some nurses want to share because they are close to their coworkers, and it gives them a chance to justify their absence. Other nurses might feel guilty for leaving already understaffed units. “It is up to you,” says Estrada, “but keep these things in mind. Any kind of medical information is protected, so you are not required to share that with anyone.” It’s worth noting that if you delay saying anything, you might put your career at risk if your condition impacts your work, says Joan Friedlander, a career coach and author of Business from Bed: The 6-Step Comeback Plan to Get Yourself Working Again After a Health Crisis. Many of us, when faced with a health crisis, will re-

Experts agree that you need to tell your employer if you require time off from work for a health issue, but how much you say after that is at your discretion.

explains Watkins. Knowing ahead of time rather than trying to catch up after the fact will save everyone time and

spond with a bit of denial. Whether you think nothing can slow you down or you don’t want to face the reality of

a health problem, not recognizing how your work is changing is a problem, she says. Friedlander speaks from experience. When her diagnosis of a chronic illness impacted her work, her supervisors noticed it first and relieved her of some of her duties. Had they known ahead of time of her health problems, Friedlander wonders if her experience might have been different. If you know you are going to be out and you have some advance warning, then that gives you the luxury of preparing for your time away from work. If you are in a clinic role with very specific duties, you will probably plan as if you are going on vacation and will cover

dents taking a leave of absence and have many resources to help students. But that willingness to be flexible doesn’t mean they don’t have a lot of standards to abide by. Many nursing schools have strict attendance policies to consider, and you’ll need to find out about any financial ramifications of withdrawing. You might be able to take one or two semesters off or you might opt for part-time status, says Ambrose Appiah Ozieh, MPH, LMSW, assistant director of advising and academic services at New York University School of Nursing. “A lot of students don’t know the options available to them,” says Ozieh. If you

Being absent from work causes a lot of anxiety for employees, and for students that unease is often multiplied.

your responsibilities with colleagues who can do your work, says Estrada. If you are an ER nurse, your boss is going to be more concerned about who is going to fill in your shifts because your duties are more likely to be covered by other nurses.

What If You Are a Student? Being absent from work causes a lot of anxiety for employees, and for students that unease is often multiplied. No matter how understanding professors are, classes aren’t put on hold because you are absent. And you hope you will have good access to lecture notes and expectations, but you can’t always count on it. The good news is that schools are familiar with stu-

know you will have to miss a lot of class time, talk first to your professor and then work directly with your advisor or the advising office to find out the next best step. Depending on the school and the program, some students might find more flexibility than they thought, but they need to learn about their options as early as possible and assess their own situation. “Sometimes, the students don’t come in until it’s too late,” Ozieh says. For example, if you are going to be put on bed rest halfway through the semester, you might need to take the semester off. Remember, however, that even if you have to interrupt your educational plan, it doesn’t mean you can’t pick it up again. “It is

better to withdraw than to try to attend and fail,” says Ozieh. “Withdrawing or leaving isn’t failure. It shows the strength of a student. Maybe you can’t continue this semester, but you can come back.”

Planning For Your Return Understanding your workplace policies can also help when you return to work. But before you approach your employer, you need to have some information in hand, advises Estrada. Speak with your health care provider about when you are cleared to return to work from a physical and a mental health perspective. Is it okay for you to continue with the same level of work? In what capacity can you return to work? Assess where you are physical-

talk to your manager about your anticipated return date and provide updates if that date changes. Talk about any restrictions or accommodations you need and how to best go about meeting those changes. “You don’t have to share specifics of your illness to your manager,” says Watkins. “Communicate what you need as a staff member.” By talking about what you can and cannot do, your manager can focus on what needs to be done to keep everything running smoothly and how they can plan ahead for scheduling purposes. For instance, will they need to cover your hours with overtime from other nurses or will they need to look to contract staffing? If your leave of absence came

“It’s difficult, disheartening, and challenging,” says Friedlander of reassessing a career when you didn’t expect to do so. But, she says, it can also be a gift and lead you into other avenues as well.

ly, mentally, and emotionally, because a health crisis can take a toll on all three of these areas. With that information ready,

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at an important time in your career — say, during a training period or when you were new to your duties—make sure

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Your return is not the time to try to power through. If you were out long enough to miss

Ozieh says nursing students who have to take a leave of absence are learning important skills early on, such as the importance of self-care.

work, you will need a proper amount of recovery time. If your employer can make accommodations, that will be your key to a successful recovery, so be honest about what you need. If you are limited on how many pounds you can lift, how long you can remain on your feet, or even if you need to elevate a foot or an arm during the day, say so. And, says Friedlander, consider other options if your condition will be chronic or will

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How It Impacts You

leave lasting limitations. “You think, ‘Now what?’” she says. If you can’t work in the physically demanding role you are used to, where else might you be able to work? “It’s difficult, disheartening, and challenging,” says Friedlander of reassessing a career when you didn’t expect to do so. But, she says, it can also be a gift and lead you into other avenues as well. “Whenever it’s

When you start at the top, there’s no limit to how far you can go. EOE M/F/Vets/Disabled. VCUHS appreciates diversity and encourages women, minorities, veterans and persons with disabilities to apply.

you communicate that when you return, says Watkins. They won’t know you are struggling unless you tell them. “As a manager, I appreciate it more when employees communicate,” says Watkins. “It helps me plan with the team.”

You want to work with the best team—with no limits on how far you can take your career. Simply put, we’re the best because our people are. Plus we offer more than 400 work/life benefits, including flexible work options and schedules, competitive pay, generous benefits, on-site child and elder care and prepaid tuition assistance that will help your career—and your life—soar.

possible, be gentle with yourDiscover how you can start at the top at vcuhealth.org/careers. self,” she says. It can be hard for nurses, who are so used to providing care, to accept they are suddenly in the reverse role. “This is especially tough for providers because they are used to will keep your focus in spite important thing,” she says. But VCU3013_HR_MinorityNurseAd_3_4x4_5.indd 1 4/4/16 3:07 PM being in that role and not the of the challenges or barriers.” if you can’t care for yourself, patient,” says Estrada. The Ozieh says nursing students how will you tell your patients emotional toll is tough. who have to take a leave of to do the same thing? “Nurses get discouraged absence are learning impor“I tell the students, ‘It’s not when something like this hap- tant skills early on, such as the about how fast you get there, pens,” says Watkins. “If you importance of self-care. “As as long as you get there,’” have the passion for it, you nurses, self-care is not the most Ozieh says. “You’re not giving up on your dream; you are just taking time off to care for yourself.” And remember the nursing path is not always straight. “Keep focused on your goals as a nurse,” says Watkins. “For many, their journey to nursing is fairly short, and for some, it takes years and years. Life happened to them and they have a winding path because of necessity, but eventually they got to where they wanted to go.” Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.

Minority Nurse | SUMMER 2016

Body language can tell you all sorts of things. Like someone is having a stroke.

SPEECH DIFFICULTY

FACE DROOPING

ARM WEAKNESS

strokeassociation.org www.minoritynurse.com

TIME TO CALL 911

Know the sudden signs.

Spot a stroke F.A.S.T.

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BY CIARA CURTIN

2016 Annual Salary Survey Nurses—particularly African American, Asian, and Hispanic nurses—reported in the annual Minority Nurse salary survey making less in salary this year than they reported last year.

verall, nurses reported earning a bit less in salary this year than they previously did, and minority nurses in particular reported earning less. Nurses reported earning a median salary of $68,000, as compared to last year’s reported $71,000. However, African American nurses reported earning a median $62,500 this year, similar to the $62,000 and $62,400 salaries that Asian and Hispanic nurses reported earning, respectively. Meanwhile, white nurses reported earning a median salary of $73,000 — a slight increase this year as compared to last year’s median salary of $73,000.

Numberof ofRespondents: Respondents: Number Number of Respondents:

2,869 2,869 2,869

Ethnicity Ethnicity Ethnicity

3.2% 2.2% 3.2% 1.4%2.2% 1.4% 1.6% 1.6% 8.9% 8.9% 3.2% 1.4% 2.2% 1.6% 8.9% 7.1% 7.1% 25% 25% 7.1%

50.6% 50.6%

25%

50.6%

White/Non-Hispanic ■■White/Non-Hispanic AfricanAmerican American ■■African ■ White/Non-Hispanic Asian ■■Asian ■ African American Hispanicor orLatino/Latina Latino/Latina ■■Hispanic ■ Asian NativeAmerican American ■■Native ■ Hispanic Prefernot notor toLatino/Latina answer ■■Prefer to answer ■ Native Other American ■■Other ■ Prefer not to answer Multiracial ■■Multiracial ■ Other ■ Multiracial

Gender Gender Gender 12.9% 12.9% 12.9%

87.1% 87.1% 87.1%

Female ■■Female Male ■■Male ■ Female ■ Male

To collect this data, Minority Nurse and Springer Publishing Company e-mailed a link to an online survey that asked respondents about their jobs, ethnicity, educational background, and more. More than 2,800 nurses from all over the United States responded to the survey to provide a peek into their jobs, future plans, and benefits as well as their salaries. These nurses hailed from a variety of backgrounds, and their day-to-day responsibilities run the gamut from patient care to administration and research. In addition, they have earned certifications in critical care, advanced practice nursing, and family health, among others. They work for a range of employers, including public hospitals and universities, and for large organizations with more than 10,000 employees as well as for ones with 100 or fewer employees.

Minority Nurse | SUMMER 2016

After diving into the data, differences in salaries among nurses by ethnicity begin to stand out. For instance, white nurses working at public hospitals reported that they earned a median $77,200, while African American nurses earned a median $63,000. Similarly, at private hospitals, white nurses earned a median $76,000, while African American nurses earned a median $60,000. However, nurses employed by universities reported fairly similar salaries falling in a tight range of between $71,000 and $73,000. A bit of a gap, though, could be found among nurses working at private practices: white nurses there reported earning a median $86,000, though African American nurses reported earning $60,000. The U.S. regions where nurses work also affected their salaries. Overall, nurses in the Northeast reported earning the most, followed by nurses living in the West. However, there also appeared to be slight differences by ethnicity within those regions. For example, white nurses living in the Northeast earned a median $79,289, while African American nurses in the Northeast earned a median $70,000. Similarly, white nurses living in the West earned $79,500, while African Ameri-

can and Hispanic nurses in the West earned $60,000 and $65,000, respectively. Education level also influenced nurses’ salaries. Nurses with associate’s-level degrees reported earning $59,000, while nurses with bachelor’slevel degrees said they earned $65,000. Salaries increased further with advanced degrees, as those with master’s degrees reported earning a median $76,000. Within the category of education level and its association with salary, though, there were also variations by ethnicity. For instance, African American nurses with associate’s degrees reported a median salary of $50,000, while white nurses reported a median salary of $64,000. At the bachelor’s level, that gap persisted, though it closed slightly as African American nurses reported earning $66,000, while white nurses reported earning $70,287. Even with these apparently flat or slightly falling salaries, most respondents said they had received a raise with in the past three years, though those raises were typically a slight 1% to 2% increase. Still, most respondents were hopeful that they would receive a similar increase in pay later this year.

Regions

Employment Status 4.5%

3.2%

1.1%

17.1%

3.6%

10.9% 38.1%

16.8%

79.9%

24.8%

■ South ■ Midwest ■ Northeast

■ West ■ Outside the United States

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

Employer Type

Years at Current Job

2.0% 0.3%

0.3% 17.4%

26.8%

1.3%

21.5%

2.0%

0.8%

8.8%

29.8%

23.7%

20%

14.3%

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

16.5% 4.3% 3.2%

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

■ College or university ■ Nursing home, LTC, or rehabilitation center ■ Private practice or physician’s office ■ Public school ■ Private hospital ■ Public hospital, including Veteran’s or Indian Affairs hospitals ■ Walk-in clinic

■ Three to five years ■ Less than a year

Main Role 1%

2.2%

3.3%

7.2%

1.7%

1.2%

12.3%

52.3% 14.8%

8.3%

■ Education ■ Patient care ■ Leadership/Management ■ Administrative

2.9%

11.5%

45.3% 27.6%

■ Other (please specify) ■ Pharmaceutical/ Research company ■ Correctional facility ■ Health department/ Public health agency ■ Health insurance company/HMO/MCO ■ Home health care service ■ Military

Reason for Leaving Prior Job

5.4% 3%

5.0%

■ Other ■ Research ■ Case management ■ Triage

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

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

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Median Salary by Region

Northeast

West

$77,000 ($66,000 five years ago)

$70,000 ($58,000 five years ago)

Midwest

$68,750 ($60,000 five years ago)

South

$65,000 ($57,000 five years ago)

Median Salary by Region and Ethnicity Northeast

White/Non-Hispanic

South Midwest West

South Hispanic or Latino/Latina

West

South Asian

West

Northeast South African American Midwest West

$10,000

$20,000

■ Salary Five Years Ago ■ Current Salary

Minority Nurse | SUMMER 2016

$30,000

$40,000

■ Salary Five Years Ago ■ Current Salary

$50,000

$60,000

■ Salary Five Years Ago ■ Current Salary

$70,000

$80,000

$90,000

■ Salary Five Years Ago ■ Current Salary

Median Salary by Education Level

Median Salary by Main Role

$90,000

$100,000

$80,000

$90,000 $80,000

$70,000

$60,000

$50,000

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

$30,000

$20,000

$10,000

$10,000 $0

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Median Salary by Specialty

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$70,000

$80,000 $60,000 $70,000 $50,000

$60,000

$40,000

$50,000 $40,000

$30,000

$30,000 $20,000 $20,000 $10,000

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Salary Five Years Ago

Current Salary

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Salary Five Years Ago

Minority Nurse Magazine

Current Salary

@MinorityNurse

Median Salary by Ethnicity White/Non-Hispanic

Multiracial

Hispanic or Latino/Latina

Asian

African American

$10,000

$20,000

Salary Five Years Ago

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

Current Salary

Median Salary by Education and Ethnicity Doctorate

Master’s

Bachelor’s

Associate’s

$10,000

$20,000

White/Non-Hispanic

$30,000

$40,000

$50,000

Hispanic or Latino/Latina

$60,000

Asian

$70,000

$80,000

$90,000

African American

Median Salary by Organization and Ethnicity Private Hospital

Public Hospital

College or University

$10,000

$20,000

African American

Minority Nurse | SUMMER 2016

$30,000

Asian

$40,000

$50,000

$60,000

Hispanic or Latino/Latina

$70,000

$80,000

White/Non-Hispanic

$90,000

Looking to Leave Job in Coming Years

Highlights • 79.9% are employed full time

23.3%

• 29.8% work at a college or university

76.7%

• 46.7% have been at their current job for five or more years • 68.8% received a raise within the last year • 52.3% left their last job to pursue a better opportunity

■ Yes

• 42.2% do not expect a raise this year

■ No

• 23.3% say they are looking to leave their current job in the next year

Timing of Last Raise Received 7.3%

9.9% 13.9%

Five Most Common Specialties • Critical care (NICU, PICU, SICU, MICU)

68.9%

• Advanced practice nursing • Family health • Certified nurse educator • Medical-surgical

■ Last year ■ Two years ago

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

Percentage of Last Raise

Highest Paid by Employer Type • Private practice • Health insurance company/HMO/MCO

4.3%

5.7%

• College or university

24.8% 65.2%

■ 1% to 2% ■ 3% to 4%

■ 5% ■ More than 5%

• Private hospital • Public hospital

Most Common Benefits Provided • Health insurance

Raise Expected This Year 3.2%

2.4%

• Retirement plan (401(k), 403(b), pension, etc.) • Dental insurance • Paid time off

16.6% 42.2% 35.6%

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

■ 3% to 4% ■ 5% ■ More than 5%

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Academic Forum

Latest Developments in the Fight against HIV/AIDS BY TERAH SHELTON HARRIS

The Centers for Disease Control estimates that there are more than 1.2 million people in the United States who are infected with HIV. However, since the first identification of AIDS in 1981, and the eventual discovery of HIV two years later, we have gone from a disease with a life expectancy that was barely a few years to a chronic disease with a long life expectancy.

n HIV/AIDS diagnosis is no longer the automatic death sentence it was once considered to be, thanks to advanced research, new medications, and cutting-edge treatments. And one of the new drugs making waves is PRO 140.

Development and Action The PRO 140 injection is a medication for those infected with HIV that has the advantage of being long-acting and requiring only weekly dosages.

An HIV/AIDS diagnosis is no longer the automatic death sentence it was once considered to be, thanks to advanced research, new medications, and cuttingedge treatments.

If successful, such an approach would revolutionize HIV treatment compliance and make adherence much easier, replacing daily pills. PRO 140 is being developed by CytoDyn, Inc., and is associated with a group of HIV drugs called entry and fusion inhibitors. These inhibitors block HIV from getting into and infecting certain cells of the immune system. PRO 140 is an engineered monoclonal antibody that works by attaching to a protein, called the CCR5 co-receptor, on the surface of immune cells. The antibody blocks the receptor, preventing viral entry into target cells. According to CytoDyn, Inc., PRO 140 has certain unique attributes that distinguish it from other therapies designed to block HIV entry: • PRO 140 is an antibody, not a synthetic drug, and has no apparent issues with toxicity.

Minority Nurse | SUMMER 2016

• Laboratory studies have shown that PRO 140 does not induce the development of resistant viruses in previous short-term trials. • PRO 140 only blocks the precise site on CCR5 that HIV needs to enter the cell without affecting the normal function of CCR5. “If the virus can’t enter the cell, the infection of that cell can’t take place,” says Amesh

Center. “The other aspect is that it blocks the receptor for an extended period of time, allowing the drug to be dosed weekly—a major advantage.”

Clinical Trials PRO 140 has been identified as a fast-track candidate by the U.S. Food and Drug Administration (FDA). Clinical trials are conducted in three phases. So far, PRO 140 has been the subject of seven clinical trials. In May 2007, results from the Phase I clinical trial demonstrated “potent, rapid, prolonged, dose-dependent, highly significant antiviral activity” for PRO 140, according to a study published in The Journal of Infectious Diseases. “These studies involved assessing the ability of the antibody to block HIV infection of cells in a laboratory setting,” Adalja says. “The positive results of these studies showed that the antibody had a biological effect that then prompted the larger clinical studies.”

The PRO 140 injection is a medication for those infected with HIV that has the advantage of being long-acting and requiring only weekly dosages. If successful, such an approach would revolutionize HIV treatment compliance and make adherence much easier, replacing daily pills.

Adalja, MD, an infectious disease physician at the University of Pittsburgh Medical

In 2008, PRO 140 entered into Phase II of clinical trials. According to the National

Academic Forum Institute of Allergy and Infectious Diseases, PRO 140 is currently being studied in Phase IIb/III clinical trial and has been used in more than 140 HIV-infected subjects in placebo-controlled and open label FDA-approved clinical trials. An investigational drug, such as PRO 140, must prove to be effective and safe in a Phase III clinical trial in order to be considered for approval by the FDA. In Phase IIa, HIV-infected adults with R5-tropic HIV were given PRO 140 by subcutaneous infusion without any other HIV medicines. The purpose of the study was to monitor antiviral activity and the safety of PRO 140 and compare it to a placebo. In Phase IIa, it was reported

that the most common side effects were headaches, swollen glands, diarrhea, and high blood pressure. Mild and temporary hardening of the tissue was also reported around the injection site. Additionally, in a separate Phase IIa study, pa-

adults with R5-tropic HIV were placed on antiretroviral therapy (ART) for a year. This study evaluated whether these participants with undetectable viral loads could take a temporary break from their daily ART by using PRO 140 as a

“If the virus can’t enter the cell, the infection of that cell can’t take place,” says Amesh Adalja, MD, an infectious disease physician at the University of Pittsburgh Medical Center.

regimen in HIV-infection drug users who have viral rebound and who had poor adherence to HIV medicine treatment. Adalja says that further testing will reveal that PRO 140’s approach is effective and safe for treating people with R5-tropic virus. “There is the real prospect that with PRO 140 injections a long-acting injectable, single-agent therapy for HIV might become a viable treatment option,” he says. Terah Shelton Harris is a freelance writer based in Alabama.

tients given an IV infusion of PRO 140 reported headaches and nasal congestion. In Phase IIb, HIV-infected, treatment-experienced

treatment substitution. In the current Phase IIb study, researchers are looking at subcutaneous PRO 140 plus an optimized antiretroviral

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The TAKE PRIDE Campaign The country is changing, with one-third of the population representing a historical “minority.” In this increasingly diverse world, you can confidently say your workplace actively fosters diversity, inclusiveness, and cooperation. For these reasons and others, you’re proud to be a part of it—and we want to hear from you. Minority Nurse is looking for nominations for health care’s diversity MVPs, from the magnet hospitals to nursing schools to local hospice care centers. Nurses can nominate their workplaces based on the facility’s efforts to improve and maintain inclusiveness and diversity. Think about what makes for a diverse institution. What does a “commitment to diversity” mean? And what does it mean to you? At Minority Nurse, it’s not just about a visible variety of skin tones seen in the halls. It’s . . . • Faculty and staff recruitment and retention efforts aimed at underrepresented populations • Collaborative hiring practices • Diversity initiatives and accessible organizations on-site • Cultural competency training and resources, such as diverse foods, translators, etc. • Partnerships with other diversity organizations • And so much more When hiring groups devoted to minority recruitment and retention not only exist but are consistently used, it shows a commitment to diversity. When hospital administrators take the time to include their nursing staff in development, they exhibit a commitment to diversity. And you, in taking the time to recognize your workplace for its commendable practices and diverse work environment, are showing a commitment to diversity as well. It’s not necessarily a numbers game—we don’t require applicants to produce statistics or quotas, though you are welcome to do so if you wish. We’re simply looking for readers who take pride in their workplaces’ commitment to diversity. A PDF of the Take Pride Campaign application is also available on our website, www.minoritynurse.com. Applications must be received before July 1, 2016. We will then reach out to our nominees to determine our winners! Questions? Let us know by e-mailing editor@minoritynurse.com.

MINORITY NURSE

2016 Take Pride Campaign Application Application Form (Please print clearly. All fields required. The 250- to 500-word nomination can be attached separately.)

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

Second Opinion

Culturally Responsive Women’s Health Care: What It Is and Why It Matters DENISE M. TATE, EdD, APRN-BC

As the population becomes more diverse, so do the ingness to comply with treatneeds of the female patients who enter the health care ment and follow-up care. system. To be cared for is a basic human need. The extent The Importance of Culturally to which basic needs are met is an important factor in Responsive Care a person’s level of health. However, values, beliefs, and Culturally responsive care is practices of caring may vary among women and their important because it reduces cultures. Health care providers must be aware of these health disparities and increases specific behaviors and words particular to each cultural early identification of culturespecific diseases and techniques. group that they care for. It addresses inequitable access What is Culture? Nursing theorist Madeleine Leininger describes culture as “the values, beliefs, norms, and practices of a particular group that are learned and shared and that guide thinking, decisions, and actions in a patterned way.” Children are born tabula rasa (“blank slate”). Culture is individual, learned, and shared. It is passed down from genera-

In many countries, a physician is viewed as an authority, not to be questioned, so the idea of bringing or asking questions may need to be empathically encouraged many times. On the other hand, your patient may think you are lacking in some regards if you aren’t familiar with their treatment modality, though they probably will not say so. When you hold very differ-

In many countries, a physician is viewed as an authority, not to be questioned, so the idea of bringing or asking questions may need to be empathically encouraged many times. tion to generation but varies across groups. Culture determines who is healthy or sick. The reason(s) why a sickness occurred, where to seek treatment, and what types of treatments will be used. Many of these patients behave in preconceived ways, based on their prior experiences in the United States or in their countries of origin.

ent health beliefs than your patients, it can impact the patients’ trust in you, and their perception of your abilities as a health care provider could interfere in their understanding of assessment and treatment options offered to them. It may make obtaining consent for procedures very difficult and may even reduce patients’ will-

Minority Nurse | SUMMER 2016

to primary health care. It positively impacts the health status of culturally diverse women as well as their families. A 2015 report from the U.S. Census Bureau projects that non-Hispanic whites will no longer make up the majority of the population by 2044. This is a revision of earlier projections, which projected this demographic change to take place in 2050. Today, non-Hispanic whites make up about 62% of the population. This is expected to fall to 44% in 2060. The report foresees the Hispanic population rising from 17% today to 29% by 2060. Today, African Americans make up 13% of the population; in 2050, they are projected to comprise 14% of the population. Asian Americans make up 5% of the population today, and they are expected to make up 9% in 2060. Between 2014 and 2060, the total population is projected to increase by 31%. These growing numbers reflect not only a diverse patient population, but also diversity in our health care workforce.

Cultural Assessment Information on culture is essential for holistic assessment of a woman, family, and community. The assessment process must be comprehensive, accurate, and systematic. The individual’s, the families’, and the community’s perspective of their culture is needed for an accurate cultural assessment. Health care providers should approach a woman, individual, or family, with the intent to gain understanding of the expressions, patterns of beliefs, and practices related to health care. Health care providers should conduct a cultural interview with their patients to discern the dynamic cultural and social structural dimensions that influence their patients’ health. Have patients describe their own experiences about health and caring. Then, document the description of

Second Opinion

the individual’s, the families’, and the community’s cultural and social structure that influences health patterns and concern. Learning about cultures can be helpful in the health care setting; however, health care providers must be cautious not to create a set of stereotypes or generalize patient characteristics within ethnic groups. Rather, knowledge of a culture’s shared experiences should be used by providers as a foundation on which to

culture follow all of the beliefs and values that are unique to that culture. Your patient is a woman, not a culture—and in each culture is an individual. Here are a few ways you can be culturally responsive: • Practice ways to build rapport. Ask tactful, nonjudgmental questions about your patient’s preferences and practices. • Know something about the cultural beliefs of your patients, but don’t stereotype. Be sure to ask your patient

Culturally responsive care is important because it reduces health disparities and increases early identification of culture-specific diseases and techniques. build a personal care relationship with each particular patient. One should never assume that all women of a certain

about “her” beliefs since they may or may not be consistent with those of her culture.

One should never assume that all women of a certain culture follow all of the beliefs and values that are unique to that culture. Your patient is a woman, not a culture—and in each culture is an individual. • Use trained interpreters and use them effectively; don’t “wing it.” Don’t make the assumption that all women will want the same thing, or do things for the same reasons. Keep in mind that your patient is an individual and may not fit into the cultural patterns of her ethnic group. • Understand family roles in health care, such as appropriate labor partners. How will you find out such information? Again, by asking. You will be surprised how receptive your patient will be to the questions asked. Most will

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be flattered that you have taken the time to listen to them and to learn about their culture and beliefs. Doing so, you will gain cultural knowledge and strategies in order to appropriately provide culturally responsive care. Denise M. Tate, EdD, APRN-BC, is the associate dean of undergraduate nursing programs at the W. Cary Edwards School of Nursing at Thomas Edison State University in Trenton, New Jersey.

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Degrees of Success

Rhode Island Nurses Institute Middle College: Prepping Students for Success BY JENNIFER L. W. FINK

Efforts to increase diversity within nursing schools are nothing new. Colleges and universities throughout the country are working hard to recruit and retain minority nursing students in an attempt to increase the diversity of the nursing workforce and address persistent racerelated health disparities.

hode Island Nurses Institute Middle College (RINIMC) is taking a slightly different approach. As the nation’s first (and currently only) public school focused exclusively on nursing, RINIMC aims to increase diversity within nursing and improve opportunity for students by addressing the nursing pipeline. “There are a lot of colleges and nursing programs doing

wonderful things, but we believe that the real problem with the pipeline has to do with secondary education,” says Pamela McCue, RN, MS, chief executive officer of RINIMC. “There’s some hardcore research saying that the secondary school experiences of some kids, particularly lowincome, urban students, is not leading to a college pathway.” To succeed in nursing, students need a strong back-

Minority Nurse | SUMMER 2016

ground in math and science, and that’s a foundation that too many minority students lack. “Clearly, there’s an equity gap for black students, and there’s an equity gap for Hispanic students and American Indian students. Those equity gaps are profound. They’re found in every district across the board,” says Colleen Hitchings, BS, MEd, RINIMC’s chief academic officer. “We’re working to ad-

dress those issues and close the equity gaps so students have equal opportunities for college and beyond.”

Individualized Support Key to Student Success When RINIMC opened in 2011, it was a grades 10-through12+ school. Students entered in grade 10 and stayed for four years. During that time, they earned both a high school diploma and dozens of college

As the nation’s first (and currently only) public school focused exclusively on nursing, RINIMC aims to increase diversity within nursing and improve opportunity for students by addressing the nursing pipeline.

Degrees of Success credits. Beginning next school year, RINIMC will be a grades 9-through-12 school. “We’ve collected the data and done the research, and found that the earlier you start this

cation Technology Standards, and the Common Core State Standards. Nursing and health care concepts are woven into nearly every single course. For instance, instead of simply of-

To succeed in nursing, students need a strong background in math and science, and that’s a foundation that too many minority students lack.

RINIMC Statistics Student Capacity 272

Current Enrollment 266

Sex 243 (92%) Female 23 (8%) Male

preparation for students, the better,” McCue says. “Too often, 9th grade is a lost year. We decided, why do remediation? Ninth grade is too important a year to lose.” To help each student succeed, RINIMC uses an individualized, comprehensive approach. “We really work on differentiating our instruction so it meets all the individual needs,” Hitchings says, noting that some students are well below average academically when they begin, while other students are at or above grade level. McCue adds, “We don’t have ‘10th grade classes’ — we have classes that meet individual needs. So, someone may be in a math that requires some fundamental support but in a college-level psychology or history course.” The school also supports the whole student. “It’s not just about getting in the classroom and doing your homework,” McCue says. “We also provide social services, family supports, and basic study skills. We provide internship and apprenticeship opportunities too, so our kids can actually connect what is learned in the classroom with their future career goals.” The innovative curriculum at RINIMC was created from scratch and is aligned with the Next Generation Science Standards, the National Edu-

fering American Literature, RINIMC offers American Literature: Exploring Topics in Healthcare. Other unique courses include Sociology: Global Health Issues and Art in Medicine.

Race & Ethnicity

Real-World Experience Builds Skill and Motivation

% of RINIMC students working toward a baccalaureate degree

All RINIMC students participate in internship and apprenticeship experiences. “On Wednesdays, we have kids going off to hospitals, nursing homes, community clinics, and long-term care,” McCue says. “The younger kids, they’re following nurses in hospitals and learning different specialties.” These immersive experiences are designed to expose students to the breadth of opportunities available in nursing, particular-

Latino – 45% Black – 36% White – 16% Asian – 3%

100%

% of students meeting federal income guidelines for free or reduced lunch 87% Source: www.rinimc.org

high school achievement, college, and a professional career, and shows students how to obtain their goals.

These immersive experiences are designed to expose students to the breadth of opportunities available in nursing, particularly within community environments.

ly within community environments. They also allow students to build confidence and clinical skills—students can earn their CNA certification while at RINIMC, for instance—and provide much needed motivation for students to continue their studies. A RINIMC education makes clear the link between

Hope for the Future The mission of RINIMC is to prepare a diverse group of students to become the highly educated and professional nursing workforce of the future, and all indications are that the school is on track to meet its goals. The school has graduated three classes of students already,

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and while none of them are far enough along in their studies to have earned a BSN or other college degree, all RINIMC students know that that’s the ultimate goal. “Our expectation here is not about the high school diploma,” says McCue. “A lot of schools focus on the diploma, but we know that, especially in nursing, you need much more than that. So we give our students the opportunity to see and experience a career path that will lead to a successful life.” Jennifer L. W. Fink is a registered nurse-turned-freelance writer. Visit her at www.jenniferlwfink.com.

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Don’t Miss Another Issue of

America’s most respected magazine for diversity and employment is now free. Minority Nurse is a must-read! Each issue comes to you packed with in-depth articles that cover hot topics in nursing care, minority health, and nursing education and career development. Only in Minority Nurse will you find these original columns: • Academic Forum—research on issues with a direct impact on nurses as well as minority communities • Degrees of Success—written by nursing school representatives who address a variety of issues related to classroom diversity • Second Opinion—an outlet for members of the minority nursing community to voice their opinions on important topics in today’s health care environment • Vital Signs—the latest news in minority health, diversity in nursing, and the achievements of minority nurses

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

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Health Policy

Federal Regulations: The Essentials BY JANICE M. PHILLIPS, PhD, FAAN, RN

The policymaking process would be incomplete without a regulatory component or specific guidance for implementing passed legislation. Regulations, also referred to as rulemaking, aid in operationalizing the actual law and provide a framework for implementation and evaluation. While most nurses may be familiar with the legislative process, some nurses may be less familiar with what happens during the regulatory process at the federal level.

t the federal level, laws are created and passed by the legislative branch of government (Congress) and implemented by the executive branch (administrative agencies). Regulations, used interchangeably with rules, are administered by the executive branch or heads of the administrative agencies in the government. These agencies in turn develop the

regulations to help implement the law. These specific guidelines are just as important as the actual law because rules are central to implementing public policy. Regulations may be written any time during the year by an administrative agency. Enacted in 1946, The Administrative Procedure Act defines the manner in which an administrative agency may propose

or create rules or regulations. After the rulemaking process is complete, an agency evaluates potential alternative

solutions to the rules or regulations to determine whether the benefits of the rule warrant the cost. Agencies may use a benefit-cost analysis or other types of evaluations, when appropriate, to determine the best alternative solutions. In some cases, agencies may publish an â&#x20AC;&#x153;Advanced Notice of Proposed Rulemakingâ&#x20AC;? to secure public comments to determine if they should initiate

While most nurses may be familiar with the legislative process, some nurses may be less familiar with what happens during the regulatory process at the federal level.

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Health Policy a rulemaking. These actions occur prior to the proposed rule stage and are published in the Federal Register, which is

lations along with related timelines for public comment and other related information. It also includes a listing of activi-

Nursing regulation, as carried out by the various nursing boards, is designed to protect the public by ensuring that nurses who must adhere to their Nurse Practice Act (NPA) are appropriately trained and licensed.

a federal government journal that is available to the public in print and online at www. federalregister.gov. Itâ&#x20AC;&#x2122;s important to note that there may be some variations to the process. For example, an agency may issue a final rule without any notice of the proposed rulemaking while some agencies may have more than one call for public comment.

The Federal Register The Federal Register provides a description of rules and regu-

ties for the various governmental agencies, including meeting schedules and calls for nominations to serve on committees and advisory boards at the federal level. For example, in the Federal Register Vol. 80, No. 221, dated November 17, 2015, the Department of Health Resources and Services Administration (HRSA) posted a call for nominations to fill vacancies on the National Advisory Council on Nurse Education and Practice (NACNAP). The NACNAP is

responsible for advising the Secretary of Health and Human Services and Congress on issues germane to administering Title VII Nursing Programs at HRSA. These issues include nursing workforce, nursing education, and practice improvement. The rules, outlining the specifics related to federal committees, advisory boards, and the like, flow directly from guidance outlined in the Federal Advisory Committee Act, which provides specific guidance for establishing, maintaining, or terminating federal advisory committees. Committee membership, functions, reporting responsibilities, and other related activities are outlined in this legislation as well.

Regardless of practice setting, specialty, level of education, or years of experience, it is critical that nurses remain up-to-date with their NPA.

The calls for nominations to fill vacancies for the NACNAP appear periodically in the Federal Register. To stay abreast of whatâ&#x20AC;&#x2122;s posted each day, individuals can sign up for daily alerts. Regulations may be changed or amended by the administrative agency after public comment and typically go into effect 30 to 90 days after the final posting of the public comment.

State Boards of Nursing: An Exemplar of Regulations Nurses are most familiar with the State Boards of Nursing, the legal authority approved to regulate the profession of nursing. Nursing

Minority Nurse | SUMMER 2016

regulation, as carried out by the various nursing boards, is designed to protect the public by ensuring that nurses who must adhere to their Nurse Practice Act (NPA) are appropriately trained and licensed. Each state NPA includes a set of rules that: 1) outline the scope of and standards for nursing practice (RN and APRN) and education; 2) stipulate criteria for issuing and disciplining a nursing license; and 3) provide guidance for handling issues of professional misconduct and establishing potential remedies. All NPAs are updated and amended, as appropriate, to reflect changes in scope of practice. Regardless of practice setting, specialty, level of educa-

tion, or years of experience, it is critical that nurses remain up-to-date with their NPA. For additional information on State Boards of Nursing and related roles, responsibilities, and activities, please visit www.ncsbn.org. Nurses are encouraged to familiarize themselves with the regulatory process. Engagement during this segment of the policymaking process is an important yet somewhat untapped opportunity for nurses. Janice M. Phillips, PhD, FAAN, RN, is director of government and regulatory affairs at CGFNS International, Inc. in Philadelphia.

The Funny Bone COMPILED BY MICHELE WOJCIECHOWSKI

Dear Readers, Ready for some laughs? Welcome to the second installment of our new humor column, The Funny Bone. Enjoy these hilarious stories that happened to other nurses. Have a funny story of your own? Contact writer Michele Wojciechowski at MWojoWrites@comcast.net to share!

Say What? I was counseling a patient who was being discharged after a heart attack. He asked me, “What about nookie?” I said, “You can have it with red sauce.” He repeated, “No! What about NOOKIE?” Again, I said it was fine, but not with a cream sauce. He then had to explain to me that he wasn’t talking about “gnocchi,” but instead about sex. Oops… —F.D., RN

Christmas in July I was working in a nursing home as a CNA early in my career when I met a patient we’ll call Sally. She wasn’t even close to being oriented, but, boy was she alert. It was the middle of July, and I was in the hall, feeding a patient a snack. Sally walked her wheelchair by me singing, “Jingle Bells, jingle bells, jingle all the way!” Of course, as was her style, Sally made a left turn and headed directly into another patient’s room, still caroling

at the top of her lungs. Unfortunately, the resident had visitors, and they were, um, a bit shocked to be serenaded with Christmas carols in the middle of the summer. I jumped up and pulled Sally out of the room. She craned her neck to look up at me and said, “Well, I guess they didn’t like it!” —L.L., RN

Toilet Humor I live in Hawaii, and I was a manager of an outpatient dialysis unit in the early 1990s. I would usually go around and talk with people getting dialysis. One day, we were talking about how expensive it is to live in Hawaii. Somehow, we ended up talking about expensive funeral services. Out of the blue, a patient who had covered herself with a blanket—and whom we thought was sleeping—piped up and said, “Oh, just have yourself cremated and have someone flush your ashes. They’ll go into the ocean!” Um, maybe not. —T.S., RN, BSN

A Hairy Situation When I was a nursing student, I broke one of the cardinal rules of nursing: secure your hair. Not only is it professional, but also a means of infection control. I had a fresh blowout, so I left it down. One shift, during the handoff report, the off-going nurse informed me that the patient was post-op day 2 of a right fem-pop bypass and said that this was her favorite patient. Since she was post-op, I wanted to complete the patient’s physical assessment immediately. Throughout the assessment, I noticed that she was staring intently at my hair. At the time, I thought nothing of it. As a relatively new nurse, I wasn’t keen on chatter because I was so focused on taking care of my patients and avoiding mistakes.

Since I was so engrossed in examining the patient’s wound, my head was locked in the downward position, and my eyes were fixed on her incision. So I wasn’t paying attention to what was going on around me. When I lifted my head, I realized that my patient was lightly touching my hair with her left hand. Then she grabbed some and gave a little tug. I immediately stood up straight and tried to regain my composure. After I finished my assessment, I walked out of the room. When about five minutes had passed, I walked back in to ask why she touched my hair. “I’m a hairstylist,” she said. “I saw that your hair was out of place.” After thanking her, I went to the breakroom—still a bit freaked out—and rifled through my locker. Luckily, I found a twister and pulled my hair up—away from my face. Ever since, I’ve always worn my hair up around patients. Because you never know if a hairstylist taking pain meds may just attempt to try to style it! —A.W., MSN, FNP-BC

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.

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MINORITYNURSE.COM In the Spotlight

Newsletter

Dasrine Gordon Dasrine Gordon grew up in Jamaica and dreamed of going to college, but right after graduating from high school she was not able to afford it.

he moved to the United States and worked as an LPN for nine years before completing her RN program. As she concluded her RN program, Gordon determined she wouldn’t stop there. While researching BSN opportunities, she discovered the RN-to-MSN degree at Western Governors University (WGU), and decided it was the right opportunity for her. Around the same time she enrolled, she started a new job as a staff nurse and learned she was pregnant with her third child. Gordon and her husband were concerned that she was taking on too much at once. She consulted with her faculty mentor at WGU and, together, they created a plan to help her balance work, school, and family responsibilities so that she could be successful in all areas of her life. She was able to take advantage of the flexibility at WGU, learning at her own pace and on her own schedule. The journey was definitely not an easy one for Gordon, and she and her family were required to make a lot of sacrifices. But three years after she started at WGU, Gordon completed her MSN degree and, in February 2016, celebrated at commencement festivities in

Orlando, Florida. The moment was surreal for her, especially considering at one point she questioned how she would even be able to afford to go to college. And now she’s well on her way and living her dream. With a busy and often hectic schedule, one would think that Gordon would take a bit of a break, but think again. She is pursuing her nurse practitioner license from South University, in her ongoing quest to be the best nurse that she can be. During the process, Gordon has set an example for those who follow in her footsteps, including her colleagues and her children, now ages 22, 12, and 2 years old. Looking back on her experience, Gordon has some advice for nurses, young and old, who are starting in the health care field: “Take things one step at a time. Don’t get discouraged by how long it will take to earn your degree, or how old you are, or how long you’ve been out of school. Simply do it while you have the chance, and you’ll create many new opportunities for yourself that you’ll be glad you did.”

Minority Nurse | SUMMER 2016

MINORITYNURSE.COM Highlights from the Blog

Newsletter Nurses and Mental Health Care In the medical community, the subject of mental health care services in the United States is one that appears to be receiving more and more attention with questions surrounding the appropriateness and level of care that is being provided to patients.

Interesting Facts about the Health of Minority Women Health is defined as the state of being free from illness or injury. Health is what keeps all individuals in a state of harmony and balanceâ&#x20AC;&#x201D;when our health is good, we are good. However, the state of being free from illness or injury is not equal across all spectrums of the human species.

Taming Student-nurse Stress While all nurses face high levels of stress on the job, student nurses shoulder a particularly challenging load. Student-nurse stress contributes to substanial upset and career questioning. Student nurses must cope with an incredibly rigorous course load of school work, often while juggling time-consuming clinicals as well.

Should Nurses Consider Medical Malpractice Insurance, Too? If you are a nurse, chances are this question has crossed your mind all too often. Although many nurses in the United States are covered under a medical malpractice insurance carrier, a significant number of nurses are not. But the truth is that a nurse can be sued for medical malpractice at any time.

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

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MINORITYNURSE.COM In Memoriam

Newsletter

Ida Latisha Johnson Spruill, PhD, RN, LISW, FAAN It is with great sadness that we inform you that Ida Latisha Johnson Spruill, PhD, RN, LISW, FAAN, a former board member of the National Black Nurses Association (NBNA) and the founding president of the Tri-County Black Nurses Association in Charleston, South Carolina, passed away on March 16, 2016. Dr. Spruill was an Associate Professor Emerita in the College of Nursing at The Medical University of South Carolina (MUSC). She had over 20 years of nursing and social work experience, including faculty positions at Hampton University, the University of South Carolina, and Limestone College. She was most noted for her work in diabetes with the Sea Islanders (Gullahs) population in South Carolina. From 1995-2004, she was the nurse manager for a communitybased genetic research project at MUSC known as Project SuGar. The scientific aims of the project were to isolate and identify genes responsible for the expression of Type 2 Diabetes and obesity among the Gullahs. The project was successful in creating a database and DNA Repository of 650 Gullah families.

Minority Nurse | SUMMER 2016

Dr. Spruill was also primarily responsible for creating the Diabetes Institute at the NBNA Conference. She conducted research with her colleagues around genetics and was solely responsible for conducting surveys within the NBNA membership around their knowledge of genetics and genomics. She received many awards for her work, including the MUSC Developing Scholar Award, the NBNAâ&#x20AC;&#x2122;s Trailblazer Award, and the College of Nursingâ&#x20AC;&#x2122;s Outstanding Alumnus Award. Most recently, she received the Presidential Early Career Award for Scientists and Engineers. Dr. Spruill is survived by her son: Jabari Saeed Fitzpatrick Spruill (Denise), grandson: Jabari Saeed Fitzpatrick Spruill, Jr., Siblings, Ethel V. Cochran, Mona C. Harris, Cartez B. Johnson (Betty), Carver L. Johnson (Janie), Hazel W. Johnson (Josephine), Jacquelyn J. Johnson, Stewart Johnson and Wilma J. Johnson, sister-in-law, Dorothy F. Johnson, several nieces, nephews, cousins, other relatives, and friends. In lieu of flowers, please send donations to the Ida J. Spruill scholarship fund. For more information, contact the Tri-County BNA at tricountyblacknurses@gmail.com or (843) 256-3342.

Academic Opportunities

Dedicated to Diversity

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

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Academic Opportunities

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

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