Minority Nurse 2017 Fall Issue

The Career and Education Resource for the Minority Nursing Professional • FALL 2017

Alternative

Career

+

Paths

Medication Errors ADVOCATING FOR YOUR PATIENTS

BRIDGING THE NURSE–FACULTY GAP

www.minoritynurse.com

THE MAGAZINE IS JUST THE BEGINNING...

Minoritynurse .coM YOUR GO-TO SOURCE FOR NURSING NEWS ON THE WEB. WHAT ELSE WILL YOU FIND ON MINORITYNURSE.COM? JOB POSTINGS ACADEMIC AND EMPLOYER PROFILES SCHOLARSHIPS

Hundreds of national listings, updated regularly.

Explore schools of nursing, hospitals, and other health care facilities.

Almost 15,000 scholarship opportunities, worth $52 million.

Table of Contents

In This Issue 3

Editor’s Notebook

4

Vital Signs

7

Making Rounds

39

The Funny Bone

Cover Story 8 Time to Leave the Floor? Other Careers for Nurses

By Jebra Turner Are you experiencing burnout and ready for a change? Four nurses share their success stories to help you successfully navigate

Degrees of Success 30 From Student Leaders to Registered Nurses: How On-Campus Leadership Impacts the Next Generation of Nurses

By Christian Catiis, RN, BSN

Recent graduates share how their extracurricular involvement has influenced their nursing experience

alternative career paths

Features 14 Medication Errors: What Every Nurse Should Know

By Michele Wojciechowski

Second Opinion 33 What You Should Know Before Becoming Nurse Faculty

By Poy Sakjirapapong, MSN, RN, CCRN

Learn why errors occur, what the most common mistakes are, and how to bounce back from making one.

20 Why Advocacy Matters and How to Get Involved

An educator shares her wisdom to help novice instructors succeed

By Julia Quinn-Szcesuil

35

Drinking from the River of Success

Discover the most effective ways to advocate for your patients

By Latoya Lewis, MSN, RN

It’s best to understand the expectations of nursing students before taking the plunge

(and your profession)

24

Strategies to Recruit and Retain Faculty

By Robin Farmer

Health Policy 37 The Congressional Budget Office: Forecasting the Cost of Legislation

By Janice M. Phillips, PhD, FAAN, RN

Strengthen your advocacy efforts by learning more about the CBO and how it helps inform the legislative process

2

Minority Nurse | FALL 2017

Interested in academia? Learn more about what universities are doing to help bridge the faculty gap

®

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Let the River Flow

B

urnout. It’s something we all experience at one point or another, but it doesn’t have to mean leaving your nursing career—and the years of education that came with it—behind. To rekindle your flame, take a moment to remind yourself why you became a nurse in the first place. Are you truly ready to hang up your scrubs for good, or are you just feeling burned out from working in a fast-paced environment? If the latter, maybe it’s time to pursue a career beyond the bedside. In our cover story, four nurses share their success stories with alternative career paths to inspire you to find your own.

Regardless of where your path takes you, patient safety should always be your #1 concern. Unfortunately, medication errors are one of the leading causes of death, and if you’re experiencing burnout on the job you may be putting your patients at risk. Flip to page 14 to learn the most common types of medication errors, the best course of action to take after making one, and how you can prevent it from happening again.

Learning to speak up is an important part of advocating for the safety of your patients (and for your fellow nurses). The best way to advocate for positive change is to get involved, whether that’s by joining a grassroots organization or learning more about government agencies and the role they play with proposed legislation (page 37). Learn more about how you can get involved on page 20. Still a nursing student? Christian Catiis shares testimonies from his peers on how getting involved on campus has helped them grow (page 30). It’s never too early to start!

Do you enjoy educating others? Consider a career in academia because there’s a desperate need for more nurse faculty. Learn more about what universities are doing to help recruit and retain faculty and address the nursing shortage (page 24).

On page 33, an educator shares her lessons learned to help ease your own transition into academia.

Retention is an issue for students and faculty alike. Latoya Lewis argues that to drink from the “river of success,” students should be well-informed of the rigors of nursing school and want to be there for intrinsic reasons (page 35). In other words, look before you leap.

Follow your passion and you, too, can drink from that river.

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

SPRINGER PUBLISHING COMPANY

CEO & Publisher Mary Gatsch Vice President & CFO Jeffrey Meltzer

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

Creative Director Mimi Flow

Production Manager Diana Osborne

Digital Media Manager Andrew Bennie Minority Nurse National Sales Manager Peter Fuhrman 609-890-2190 n Fax: 609-890-2108 pfuhrman@springerpub.com Minority Nurse Editorial Advisory Board Anabell Castro Thompson, MSN, APRN, ANP-C, FAAN President National Association of Hispanic Nurses Birthale Archie, DNP, BS, RN Faculty Davenport University Iluminada C. Jurado, MSN, RN, CNN Chair, Scholarship Committee Philippine Nurses Association of America Martha A. Dawson, DNP, RN, FACHE Assistant Professor, Family, Community & Health Systems University of Alabama at Birmingham Wallena Gould, CRNA, EdD, FAAN Founder and Chair Diversity in Nurse Anesthesia Mentorship Program Alethea Hill, PhD, ACNP-BC, ANP-BC Associate Professor University of South Alabama

—Megan Larkin

Romeatrius Nicole Moss, RN, MSN, APHN-BC, DNP Founder and President Black Nurses Rock

Minority Nurse (ISSN: 1076-7223) is published four times per year by Springer Publishing Company, LLC, New York.

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

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

Subscription Rates: Minority Nurse is distributed free upon request. Visit www.minoritynurse.com to subscribe.

Change of Address: To ensure delivery, we must receive notification of your address change at least eight weeks prior to publication. Address all subscription inquiries to Springer Publishing Company, LLC, 11 West 42nd Street, 15th Floor, New York, New York 10036-8002 or e-mail subscriptions@springerpub.com.

Claims: Claims for missing issues will be serviced pending availability of issues for three months only from the cover date (six months for issues sent out of the United States). Single copy prices will be charged for replacement issues after that time.

Minority Nurse ® is a registered trademark of Springer Publishing Company, LLC. © Copyright 2017 Springer Publishing Company, LLC. All rights reserved. Reproduction, distribution, or translation without express written permission is strictly prohibited.

www.minoritynurse.com

For editorial inquiries and submissions: editor@minoritynurse.com For subscription inquiries and address changes: admin@minoritynurse.com

Minority Nurse Magazine

3

@MinorityNurse

Vital Signs

Patients in Health Care Facilities at Risk for Legionnaires’ Disease

A new CDC analysis finds that among the 21 U.S. jurisdictions studied, 76% reported health care– associated cases of Legionnaires’ disease, a concerning finding because Legionnaires’ disease acquired from health care facilities can be particularly severe. The findings highlight a possibly deadly risk to patients from exposure to Legionella in health care facilities, according to a CDC Vital Signs report.

L

egionnaires’ disease is a serious lung infection (pneumonia) that people can get by breathing in small droplets of water containing Legionella bacteria. Although most cases of Legionnaires’ disease are not associated with health care facilities, one in four people who get the infection from a health care facility will die.

This death rate is higher than for people who get the infection elsewhere.

All 50 states and two large cities report basic data to CDC on Legionnaires’ disease cases, but not all report information on where those people might have been exposed to Legionella, including in health care facilities, hotels, and the community.

4

Minority Nurse | FALL 2017

During 2015, approximately 6,000 cases of Legionnaires’ disease were reported to CDC; only about half included exposure data.

The Vital Signs findings are based on exposure data from 20 states and New York City.

The analysis was limited to these 21 jurisdictions because they reported exposure information for most of their cases.

These details were used to see how often Legionnaires’ disease was associated with health care facilities. Findings indicate that 3% of Legionnaires’ disease cases are definitely associated with a health care facility (inpatient stays of 10 days or more before symptoms begin) and an additional 17% are possibly associated with a

health care facility (exposure to a health care facility for less than 10 days before symptoms begin).

“Legionnaires’ disease in hospitals is widespread, deadly, and preventable. These data are especially important for health care facility leaders, doctors, and facility managers because it reminds them to think about the risks of Legionella in their facility and to take action,” says CDC Acting Director Anne Schuchat, MD. “Controlling these bacteria in water systems can be challenging, but it is essential to protect patients.”

Among the Legionnaires’ disease cases definitely associated with health care facilities: • 80% were associated with long-term care facilities, 18% with hospitals, and 2% with both.

• Cases were reported from 72 unique facilities, with the number of cases ranging from one to six per facility.

• 88% were in people 60 years of age or older.

“Safe water at a health care facility might not be on a physician’s mind, but it’s an essential element of health care quality,” says Nancy Messonnier, MD, director of CDC’s National Center for Immunization and Respiratory Diseases. “Having a water management program that focuses on keeping facility water safe can help prevent Legionnaires’ disease.”

A new measure was just put in place on June 2, 2017, to encourage implementation of water management programs.

The Centers for Medicare & Medicaid Services released a survey and certification memo stating that health care facilities are expected to develop and adhere to policies and procedures to reduce the risk of Legionella and other waterborne pathogens.

Legionella growth occurs in building water systems that are not managed adequately and where disinfectant levels are low, water is stagnant, or water temperatures are ideal for growth of bacteria.

Last year, the CDC released a toolkit for building owners and managers: Developing a Water Management Program to Reduce Legionella Growth & Spread in Buildings: A Practical Guide to Implementing Industry Standards. Based on ASHRAE Standard 188, a document for building engineers, the toolkit provides a checklist to help identify when a water management program is needed, examples to help identify where Legionella could grow and spread in a building, and ways to reduce the risk of Legionella contamination. The toolkit also includes examples relevant for health care facilities.

Most healthy people do not get Legionnaires’ disease after being exposed to Legionella.

People at increased risk for Legionnaires’ disease are 50 years of age or older or have certain risk factors, such as being a current or former smoker, having a chronic disease, or having a weakened immune system.

For more information, visit www.cdc.gov/VitalSigns.

Vital Signs

Study Finds Nurses so Stressed They Might Get Sick Most of America’s nurses admit they are stressed out, consuming too much junk food, and getting too little sleep, says a Ball State University study.

“T

he Impact of Perceived Stress and Coping Adequacy on the Health of Nurses: A Pilot Investigation,” published in the online journal Nursing Research and Practice, found that nurses with high stress and poor coping had difficulty with patients, working in teams, communicating with coworkers, and performing their jobs efficiently.

“This study reveals stress takes a toll on nurses’ health and they need better ways to handle it,” says Jagdish Khubchandani, a Ball State University health science professor who was part of a multi-university team that examined how nurses cope with stress. “Nurses need to improve their lifestyles and health behaviors, take advantage of all health benefits available to them, and learn to manage stress and conflicts at the workplace.”

The study of 120 nurses working in the Midwest found that most nurses had poor health habits: • 92% had moderate-to-very high stress levels.

• 78% slept less than eight hours per night.

• 69% did not exercise regularly.

• 63% consumed fewer than five servings of fruits and vegetables per day.

• 22% were classified as binge drinkers.

The study also found that

when confronted with workplace stress, 70% of nurses reported that they consumed more junk food and 63% said that they used food as a coping mechanism.

Nurses in the “high stress/ poor coping” group had the

poorest health outcomes and highest health risk behaviors compared to those in other groups, researchers also found.

“Management has a big role to play in providing health promotion services and employee assistance programs to help deal with stress-related poor health behaviors, such as addiction,” Khubchandani said. What I find severely lacking is the understanding of

www.minoritynurse.com

burnout in nurses, its prevalence and its long-term impact on the nursing workforce of any facility.

“Management needs to invest in assessing and addressing these issues. In the long term, employers can save costs if their nurses remain fit and perform to the best of their abilities.”

Minority Nurse Magazine

5

@MinorityNurse

Vital Signs

Secondhand Smoke Exposure Among Nonsmoking Adult Cancer Survivors Has Declined From 1999/2000 to 2011/2012, exposure to secondhand smoke among nonsmoking adult cancer survivors declined from 39.6% to 15.7%, but rates of exposure were higher among those with a history of a smoking-related cancer and those living below the federal poverty level compared with those with other types of cancer and those with the highest incomes, respectively, according to results published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

“W

e were surprised to discover that rates of secondhand tobacco exposure among nonsmoking adult cancer survivors were similar to those reported for the general population of U.S. adults,” says Oladimeji Akinboro, MD, MPH, chief medical resident in the Department of Medicine at Montefiore New Rochelle Hospital in New Rochelle, New York. This is concerning because those who have had or have cancer represent a group of people whose health outcomes are adversely influenced by any form of tobacco exposure, whether direct smoking or secondhand exposure.

“Cancer patients and survivors must be encouraged to be their own advocates regarding secondhand smoke exposure, in adopting voluntary smoke-free home and vehicle rules, and avoiding settings outside the home where they are more likely than not to be involuntarily exposed to tobacco smoke,” adds Akinboro. “Smoking households and social contacts of cancer patients and survivors also need to be engaged, and as a society, we can reduce secondhand smoke exposure by intensifying local, state, and federal measures and

6

Minority Nurse | FALL 2017

policies that prohibit smoking in the workplace, in public places, and multiunit housing.”

Akinboro and colleagues set out to estimate the percentage of nonsmoking adult cancer survivors in the United States who had evidence of secondhand smoke exposure.

He explained that this research is important because secondhand smoke exposure in cancer patients has been shown to lead to worse clinical outcomes, such as higher death rates, and to a decreased likelihood that smokers who have, or have had cancer, will quit smoking. It also leads to higher rates of strokes and heart attacks in cancer survivors, similar to those who have not had cancer, he says.

The researchers used interview and serum cotinine data for 686 nonsmoking adults with a history of cancer from seven consecutive cycles of the National Health and Nutrition Examination Survey. They used data from 82 participants in the 1999/2000 survey, 106 in the 2001/2002 survey, 118 in the 2003/2004 survey, 79 in the 2005/2006 survey, 145 in the 2007/2008 survey, 87 in the 2009/2010 survey, and 69 in the 2011/2012 survey.

A serum cotinine level of between 0.05 and 10 ng/ml was defined as exposure to secondhand smoke.

Among all the adults studied, 28.26% had been exposed to secondhand smoke. Certain segments of the population had higher rates of exposure compared with others. For example: • 55.64% of non-Hispanic blacks had been exposed to secondhand smoke compared with 26.14% of nonHispanic whites.

• 35.54% of those with a history of a smoking-related cancer had been exposed to secondhand smoke compared with 26.33% of those with a type of cancer not linked to smoking.

• 53.25% of those with an income below the federal poverty level had been exposed to secondhand smoke compared with 22.8% of those with an income three or more times greater than the federal poverty level.

The proportion of those exposed to secondhand smoke decreased by an average of 6.31% between consecutive cycles.

Among all the adults studied, 4.53% reported living in a household where someone smoked.

“The difference in the rates of secondhand smoke exposure, as measured by blood levels of cotinine, and self-reported rates of indoor household secondhand smoke exposure were striking,” says Akinboro. “It is very plausible that this difference may be related to inhalation of tobacco smoke from other households in multiunit apartments, clubs, bars, and public spaces, which would have numerous policy implications, including encouraging widespread adoption of nonsmoking policies in multiunit housings by housing managements and public housing authorities.”

According to Akinboro, the main limitation of the study was that the researchers analyzed data that had been collected at a single point in time from a random selection of U.S. adults, some of whom were cancer survivors. Because the individuals were not followed over time, no factor—such as race/ethnicity or income level or cancer type—can be attributed as being a cause of secondhand smoke exposure; they can only be associated, says Akinboro.

For more information, visit www.aacr.org.

Making Rounds

September

18–21

March

13–15

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

21–24

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

14–16

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

14–16

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

21–23

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

October 5–7

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

Transcultural Nursing Society

18–21

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

November 17–19

Organization for Associate Degree Nursing 2017 National Convention Fairmont Scottsdale Princess Scottsdale, Arizona Info: 877-966-6236 E-mail: oadn@oadn.org Website: www.oadn.org

February 14–17

Dermatology Nurses’ Association 36th Annual Convention Sheraton San Diego Hotel & Marina San Diego, California Info: 800-454-4362 E-mail: dna@dnanurse.org Website: www.dnanurse.org

February/March February 28–March 3 National Association of Clinical Nurse Specialists

2018 Annual Conference Renaissance Austin Hotel Austin, Texas Info: 215-320-3881 E-mail: info@nacns.org Website: http://nacns.org

www.minoritynurse.com

Southern Nursing Research Society 32nd Annual Conference Sheraton Atlanta Hotel Atlanta, Georgia Info: 877-314-7677 E-mail: info@snrs.org Website: www.snrs.org

24–27

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

April 10–14

International Society of PsychiatricMental Health Nurses 11th Annual Psychopharmacology Institute and 20th Annual Conference Tempe Mission Palms Hotel and Conference Center Tempe, Arizona Info: 608-443-2463 E-mail: info@ispn-psych.org Website: www.ispn-psych.org

May 4–6

Academy of Neonatal Nursing 2018 Spring Advanced Practice Neonatal Nurses Conference Marriott Downtown Waterfront Portland, Oregon Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

10–12

American Nursing Informatics Association 2018 Annual Conference Hilton Buena Vista Palace Orlando, Florida Info: 866-552-6404 E-mail: ania@ajj.com Website: www.ania.org

Minority Nurse Magazine

7

@MinorityNurse

Time to Leave the Floor?

Other Careers for Nurses

BY JEBRA TURNER 8

Minority Nurse | FALL 2017

You’ve burned out as a nurse—now what? By some estimates, a third of hospital nurses leave the bedside within the first two years. Although some nurses transition to other specialties, many leave the profession altogether. But there are a number of options for departing nurses that make good use of their education and experience. That way, personal reinvention can equal career progression. Jobs with health care–allied organizations, such as insurance or pharmaceutical companies, provide a corporate route. Forays into business as a consultant, trainer, or product developer provide an entrepreneurial path.

The following four nurses show it’s possible to successfully navigate either type of alternative career.

Here’s how...

Scharmaine Baker, RN, DNP, FNP-BC, FAANP Currently CEO of Advanced Clinical Consultants (www.

DrBakerNP.com), Scharmaine Baker owns a nurse practitioner private practice in New Orleans, Louisiana, and simultaneously created a popular series of children’s books, entitled Nola The Nurse ® , which features seven-yearold Nola, who longs to be a

nurse like her mother.

“I was an unlikely entrepreneur,” says Baker. “A physician approached me with a need and I said yes” to providing home health calls in 2004.

“Patients told people, who told people, and soon I had a whole community of folks,” she says. By the time Hurricane Katrina hit her hometown,

www.minoritynurse.com

Minority Nurse Magazine

9

@MinorityNurse

Love What You Do Consider your hobbies and see if you can combine one with health care to come up with your own unique career path. For instance, would you love a java-related job? Erik Meyer, RN, BSN, a nursing supervisor at Providence Seaside Hospital in Oregon, has served in the ER of a small, rural, critical access hospital for over two decades now. His part-time hours fit in nicely with a busy family life; he and his wife operate a coffee business and care for four young children.

Baker’s phenomenal patient load landed her a CBS Evening News interview with Katie Couric about providing health care to underrepresented populations.

When Baker launched her company, though, there were few resources to guide her so she created The Housecall Course in 2008. “You literally can go into the home health care business with no money down. Today, we have trained 400 people, including RNs, physicians, home health agency folk, and others. I wanted to make miniclones of me all across America; there is such a need out there for these services.”

What Baker did with her home health service business, she’d like to repeat with her product-based business. “Now I’m trying to see how to do a full-court press with Nola The Nurse®,” she says. “As a nurse, we’re used to doing everything by the book. Is there a right way to do it? Is there a theory to support it?

10

Minority Nurse | FALL 2017

But with entrepreneurship, there’s only the unknown.”

In addition to multiple Nola The Nurse® books and dolls, Baker has produced six activity books and is working on the seventh, focused on STEM careers. “That usually means mathematicians or engineers to people,” she says. “But how about health care careers?

We’re part of the alphabet and the conversation, too. We’re the ‘S’ for science. There’s a lot of science in our nursing education and training.”

Baker also brings Nola The Nurse ® programs to local and out-of-state elementary schools. “I share with them what I do and introduce them to the role of the advanced practice nurse. The kids are so excited, they bring me energy.

In programs, we use New Orleans things, like beads, and they love Nola,” she explains. “I’ve spent almost a lifetime as a nurse. Now I’m using it in a different way, as an educational and entertainment platform.”

Joe Flores, RN, JD, APRN, MSN, BSN The legal field provides many exciting opportunities for nurses as consultants, advocates, and expert witnesses, says attorney Joe Flores, RN, JD, APRN, MSN, BSN, principal at Flores Law Firm in Corpus Christi, Texas. As a teenager, he worked as a nurse’s aide and then quickly progressed to critical care nurse, nurse practitioner, nurse legal consultant, and trial attorney.

He still maintains his creden-

Legal nurse consultants help lawyers gather and study evidence or detect fraud in medical malpractice, product liability, and other health care issues. They may be hired as consultants or employed by law firms, government agencies, hospitals, and insurance companies.

Although working as a family nurse practitioner, Flores “met a lawyer who asked me to review some medical records, I wrote a two-page report and got a $2,000 check in the mail. That was more than two weeks’ pay! I called to tell him it must have been a mistake.” The attorney assured Flores there was no mistake; he’d helped him win a complex case with a big payout. He reviewed more cases, earning more in a month doing that than as a nurse.

He decided to pursue a law degree and supported himself through law school by freelancing as a legal nurse consultant.

Although there is no re-

By some estimates, a third of hospital nurses leave the bedside within the first two years.

tials as a nurse practitioner.

“Nurses are the biggest workforce in the U.S., we’re the most trusted profession, but we’re low-paid because nurses are mostly women and minorities,” says Flores.

“By getting into legal nurse consulting, nurses can learn about the law, and earn $40 to $150 an hour to review medical cases, and $150 to $200 or more an hour as an expert witness,” although these fees aren’t guaranteed.

quirement for a legal degree or certification, Flores has authored a course on legal nurse consulting to help nurses to get started. “Nurses can learn the basics of the law, how to review records, and set up a consulting business. They can also get continuing ed credit, and get certified, too. The course is geared towards minorities and especially women.” Minority nurses may be able to translate legal documents and otherwise aid at-

torneys in representing clients from other cultures.

The legal field is a natural fit for nurses who often act as advocates for their patients and watchdogs regarding medical and financial abuses. “Nurses have experience in dealing with extremely stressful environments and also coping with traumatic atmospheres. We only have our brains, hearts, minds, and communication skills to protect ourselves in this tough environment.” Legal knowledge adds to a nurse’s ability to navigate a personal career and an employer’s workplace, even without putting it to use as a consultant.

Brittney Wilson, RN, BSN, also known as “The Nerdy Nurse,” started blogging. Bedside nursing was physically and emo-

and nursing. Her popular blog, TheNerdyNurse.com, was instrumental in helping her make the jump without an advanced de-

Wilson advises nurses to do something that they enjoy and would do for free. Then whatever you choose, keep your job while trying it out.

Brittney Wilson, RN, BSN Soon after entering the demanding nursing profession,

tionally draining, and to make matters worse, she was being bullied by fellow nurses. “Blogging was cathartic and therapeutic,” she says.

Two years later, Wilson found her way into the field of clinical informatics, which combines her love of technology

www.minoritynurse.com

gree; it made a compelling case for her tech savvy with health care recruiters.

The next step in her career was joining the business world as a health care product community manager, and now, she is a product manager for HealthStream in Nashville, Tennessee. “I get to make things that nurses use every day,” Wilson says.

She is so enthusiastic about nurse blogging that she created HealthMediaAcademy.com, a training resource on using media to influence the health care conversation and make a positive impact on the world.

Nurses are natural educators, so they easily teach, inspire, and make supportive connections.

Blogging is also a great way to build a professional reputation, to promote a sideline such as a health coaching practice, or to earn extra income through eBooks and ecourses.

“Once a nurse, always a nurse,” is a common expression, according to Wilson, and “nurse culture at large has a tough time seeing nursing as nursing if they aren’t doing bedside care. But you can do lots of things that use your nursing education and experience. You can still call yourself a nurse without putting on scrubs.”

She enjoys her current leadership position because she can be innovative and visionary on

Minority Nurse Magazine

11

@MinorityNurse

Explore the Possibilities If your aim is a research, managerial, or entrepreneurial niche, check out DiscoverNursing.com, sponsored by Johnson & Johnson. Start with a five-minute quiz about your education, experience, and preferences. You’ll get niche recommendations based on your answers. From there, look over their database of 104 ways to put your nursing skills to work, many outside of a hospital setting.

a large scale. “Working in business, I get to impact so many nurses—this company is in 70% of health care organizations,” she explains. “When you’re a nurse on the floor—you make the donuts. There was a bit

of culture shock. Now I have more responsibilities and more stress. The attitude in business is: You’re the expert. You solve the problems.”

Wilson advises nurses to do something that they en-

joy and would do for free.

Then whatever you choose, keep your job while trying it out. “Quitting creates undue stress, so don’t jump in feet first, when you don’t know if there’s an audience—build your side hustle slowly,” she adds.

Michelle Podlesni, RN After leaving the bedside, Michelle Podlesni, RN, made a surprising discovery: She loved data analysis and trending. “I’m a nerd! I never knew that before,” she says. “Nursing skills are transferrable to so many areas. I went to a large insurance company and while there as a case manager, I did quite a bit of analysis and review. After that, I was recruited to help with a software program and this evolved to my becoming a corporate executive in the health care information technology field.

After 20 years as a speaker and business adviser, Podlesni is now president of National Nurses in Business Association.

“The majority of nurses show innovation, creativity, and problem-solving abilities. Nurses inherently look to improve outcomes—it’s in their DNA,” she says. Additionally, as entrepreneurs, they can control their

12

Minority Nurse | FALL 2017

own time, be their own boss, and do things in a bigger, better way. Some popular options for nurses, according to Podlesni: health care consultant, patient advocate, community educator, blogger or social media influencer, or product creator. She advises targeting the insurance and pharmaceutical industries, or any corporation with an employee wellness program.

“A million and a half nurses are over 45 and nursing is mentally and physically challenging. Many want to reduce their hours, but not their wages,” she says. At the conference her association sponsors, “Nurses can meet entrepreneurial nurses and learn how to take their knowledge and monetize it. They look at other ways to use nursing knowledge to their benefit.

Nurses tend to discount what they do. At the conference, they fall in love with nursing again.”

Podlesni recommends that nurses consider creating a side business, even if they don’t want to leave floor nursing. “There are so many mergers and acquisitions now that nurses need to think about protecting their career longevity and financial health,” she says. “My advice to all nurses: Try some new things. You never know what your passion is.”

Nursing is a catalyst to a wide variety of vocations, whether part-time, on the side, or full steam ahead. That way, nurses have options for getting unstuck when they’re bored, worn-out, overworked, underpaid, or abused by patients or staff. You can always build on your education and experience for a brighter future.

Jebra Turner is a freelance health care writer in Portland, Oregon. Visit her at jebra.com.

www.minoritynurse.com

Minority Nurse Magazine

13

@MinorityNurse

14

Minority Nurse | FALL 2017

Medication Errors

What Every Nurse Should Know

BY MICHELE WOJCIECHOWSKI

Medication errors can be a nurse’s worst nightmare.

What are the most common, and how can you prevent them? The experts explain.

M

istakes—all of us make them in our lives. But in most circumstances, the results are benign. In the health care field, however, mistakes can literally cause life-or-death situations.

With medications, errors can cause illness, death, and even lawsuits.

Take for example, an instance that Cole Sloan, PharmD, BCPS, a clinical pharmacist in Emergency Medicine at the University of Utah Hospital and Clinics, remembers from a previous job when he worked in Arizona: “We had a phenomenal Emergency Department nurse give a patient hydralazine—for blood

pressure—instead of hydroxyzine—uses include itching and anxiety.” He explains that the nurse had pulled multiple medications for multiple patients at shift change. “They had scanned the medication, so the computer thought everything was fine. But then they were pulled out of the room for an urgent case—only

www.minoritynurse.com

to come back in the room and administer a different medication from their pocket. We notified the physician and patient of the mix-up once the error was caught a few minutes later in the next patient’s room. No harm resulted, but it is very unnerving for both the patient and the health care team,” he says.

Minority Nurse Magazine

15

@MinorityNurse

Although Sloan says that barcode scanning and other technologies have helped avoid medication errors by ensuring that the correct medicines are administered to the correct patients, as the previous example indicates, there are other factors that can also cause errors.

Why Medication Errors Occur “Simply put, humans lead to medication errors,” says

Sloan. As a result, sometimes mistakes are made.

“Medication errors in nursing often occur due to distractions—a nurse not having enough time to complete a given task—or work environments—nurses who are chronically overworked and exhausted,” says Jalil A. Johnson, BSN, MS, ANP-BC, national director of Show Me Your Stethoscope. “They can also occur for other reasons as well,” says Sally Rafie,

PharmD, BCPS, a pharmacist specialist at the University of California, San Diego Health. “[Errors occur because of]

who had a child the same age at the time, noticed that the amount was too high for a three-year-old, but it was the

“Simply put, humans lead to medication errors,” says Sloan.

health care provider confirmation bias, fatigue, look-alike/ sound alike medication, and many more. Most errors occur at the point of prescribing or administration,” Rafie explains.

Diane C. Fernald, RN, JD, vice president of education and consulting at MRM Group, says that in her opinion, based on anecdotal data from her years in administration and in defending nurses in lawsuits as well as board investigations, wrong dose and wrong medication are still the most common types of medication errors. “They occur for

correct amount ordered from the doctor. What happened was the EMT had measured the child’s weight in pounds, but entered it in kilograms.

The pharmacist had verified the order in the computer, but didn’t have a lot of pediatric experience, so he didn’t think to question that a three-yearold was said to weigh 40 kg, which is 88 pounds. “It was 3 a.m., and the parents were not excited to be in the ED, but when I explained it, they were thankful to spend an extra 30 minutes in the ED to avoid a large antibiotic overdose.

Took extra time, but if that

“Medication errors in nursing often occur due to distractions—a nurse not having enough time to complete a given task—or work environments— nurses who are chronically overworked and exhausted,” says Jalil A. Johnson, BSN, MS, ANP-BC, national director of Show Me Your Stethoscope. many reasons: Nurses do not know or understand the medications they are giving; they over-rely on the physician’s knowledge, or are afraid to question his or her orders.”

In addition, Sloan says that inexperienced personnel can also lead to medication errors.

He recalls a time when a new EMT was working in triage, and a three-year-old child was ordered an antibiotic. Sloan,

16

Minority Nurse | FALL 2017

was my kid, I would hope they would take all the time that is necessary to safely administer the correct dose,” he says.

The Most Common Types of Medication Errors Johnson says that the following are the most common medication errors related to nursing: Omission Errors: Failure to give a medication dose before

the next one is scheduled.

Wrong Time Errors: A medication is given outside the predetermined interval from its scheduled time.

Improper Dosing Errors: A greater or lesser amount of a medication is delivered than is required to manage the patient’s condition.

Wrong Dose Errors: The correct dosage was prescribed, but the wrong dose was administered.

Improper Administration Technique Errors: Administering a medication intravenously instead of orally.

Wrong Drug Preparation Errors: A medication is incorrectly formulated (i.e., too much or too little diluting solution added when a medication is reconstituted).

Robert L. Alesiani, PharmD, GCP, chief pharmacotherapy officer at CareKinesis says that, in their case, “The vast majority of our patients are high-risk older adults who are on multiple medications.” As a result, the most common problems regarding medication errors that they see are missed doses; accidental overdose (i.e., forgetful patients taking repetitive doses) or via drug interactions (one drug blocks another’s ability to leave the body); polypharmacy (the result of prescribing a cascade whereby multiple medications are added to a regimen to treat the side effects of other medications); and drug/drug interactions, drug/food interactions, drug/ disease interactions, or drug/

“After making a medication error, the nurse should immediately ensure that their patient is safe and take steps—like notifying the patient’s physician, etc.—to ensure their patient’s safety if they are at risk of injury or death,” explains Johnson.

gene interactions.

Sloan says that it’s sometimes hard to quantify the most common medication errors because not all errors are noticed and not all errors are reported.

What to Do if an Error Occurs Although every health care facility should have its own procedure for when a medication error occurs, here is what

www.minoritynurse.com

nurses should do in general.

“After making a medication error, the nurse should immediately ensure that their patient is safe and take steps—like notifying the patient’s physician, etc.—to ensure their patient’s safety if they are at risk of injury or death,” explains Johnson. “The nurse should then report this incident to his or her supervisor.

While this may seem risky, it is very important for manag-

Minority Nurse Magazine

17

@MinorityNurse

ers and quality improvement teams to track medication errors and try to fix or prevent

up a medication error,” says Sloan. “Oftentimes, patients or visitors will sense something

Clear communication between health care workers, especially when dealing with medications, is extremely important. them. It is important for the nurse to report all of the factors he or she believes led to the error. If the medication error was related to a systemic or environmental problem, the nursing leadership must be aware of the problem in order to address it.”

Fernald adds that if it’s relevant, the nurse should contact the facility’s pharmacy as well. In addition, “Clear, concise, and accurate documentation, completed as soon as possible after the event, is also necessary to record all the facts of how the error occurred, who was involved, and what steps were taken immediately afterwards. Once that is completed, the facility’s policy and procedure should outline the steps for remediation of the nurse’s action, creation of incident reports, and the conduct of a root cause analysis. Finally, there should be a means by which the nurse will meet with management and/ or physicians to learn from the error and participate in ways that might improve the care given, and/or the system involved.”

Besides contacting the patient’s physician to make sure that no harm comes to the patient, one of the most important actions is not to conceal that an error has happened—ever. “You should never attempt to hide or cover

18

Minority Nurse | FALL 2017

is wrong and being secretive or misleading will only make the situation worse. Patients trust medical professionals with their lives; don’t violate that trust trying to cover up medication errors.”

Preventing Errors No matter how many safeguards are in place, as we’ve seen, medication mistakes may still occur. There are, however, many things that nurses can do to prevent them—for example, be willing to speak up, and listen to your gut; if you think something may be wrong, say something.

Alesiani says that for all clinicians, medication safety begins by listening with an empathetic ear. “Listen to and be supportive of what you’re being told,” he says. How many times have we prescribed/ dispensed to/counseled a patient and cavalierly recommended, ‘Avoid grapefruit juice, limit green, leafy vegetables, avoid the sun, make sure you’re drinking plenty of fluids, etc.,’ without asking them how these restrictions might affect their daily living?

“In my opinion, there are two critical things a nurse can do to reduce medication errors: Become knowledgeable about medications that they give, and not to assume the physician is infallible when it comes to prescribing medica-

tions,” says Fernald. “Be sure about the actions of medications and why they are prescribed, what the benefits and side effects are, and the common interactions and risks of interactions are also important. Second, never hesitate to speak up and question the physician if the medication order appears wrong—it often is.”

Clear communication between health care workers, especially when dealing with medications, is extremely

important. “It is often one of the key issues involved: miscommunication between physician and nurse,” says Fernald. “Mistakes can also occur when nurses aren’t clear about handoffs of care from one shift to another or when information gets ‘dropped’ during transfer from one facility or unit to another. Communication issues between pharmacies and nurses in the hospital or between pharmacies-physicians-patients in the outpatient setting also

account for a fair number of medication errors.”

Fernald once defended a medication error in a longterm care facility. Nurses gave the wrong dose of the medication methotrexate to an elderly woman for eight days straight before the error was caught. (Although methotrexate is given to patients on a weekly basis for rheumatoid arthritis, it can be given daily as a form of chemotherapy.

This patient was supposed to receive the drug for rheumatoid arthritis, but was given the wrong dosage.)

“The nurses wanted to change the time of the medication administration from afternoon to morning because the patient was often off the floor in the afternoon at activities or at therapy. A software glitch in the computer system that sent the order to the pharmacy and created the medication administration record, inadvertently changed the dosing frequency from weekly to daily,” explains Fernald. “No one picked up on the error for eight days due to changes in staffing and a variety of ‘perfect storm’ circumstances. The error was discovered when the patient started showing signs of toxicity, and a new nurse decided to investigate the patient’s symptoms. In spite of immediate hospitalization and treatment, [the patient] passed away two weeks later due to kidney failure caused by the large amount of methotrexate in her system.”

This leads directly into another suggestion from Sloan on preventing medication errors: trust, but verify. He explains: “Trust that the doctor who placed the order [and] the

pharmacist who verified and prepared the medication know what they are doing, but verify it by using your judgment.”

“All nurses are trained in using the five rights of medication administration: right medication, right dose, right patient, right time, right route,” says Rafie. “This cannot be replaced by technology such as barcode scanning, which should serve as a second check rather than replace the nurse’s first check.”

Sloan suggests that nurses should ask themselves questions such as, “What is the prescriber trying to accomplish? Based on what I know about this medication, does it make sense?”

“If any of those make you uneasy, take the time to look in the chart, call the pharmacy, page or talk to the doctor, etc.,” says Sloan.

“Spending a minute or two looking into a situation can

“Nurses have to do a lot of charting already, but I love it when I see a note in the chart that says ‘medication X ordered for patient, clarified intent with pharmacist and administered per medication record.’ Not only does it show you looked into this, but if something unexpected does happen, anyone reviewing the chart can see you did more than your due diligence.”

delay your seemingly endless workflow—but a serious medication error can harm your patient. If a serious medication error happens, your task list will fall by the wayside anyway. Nurses have to do a lot of charting already, but I love it when I see a note in the chart that says ‘medication X ordered for patient, clarified intent with pharmacist and administered per medication record.’ Not only does it show you looked into this, but if something unexpected does

www.minoritynurse.com

happen, anyone reviewing the chart can see you did more than your due diligence.”

Michele Wojciechowski is an award-winning writer and author of the humor book Next Time I Move, They’ll Carry Me Out in a Box.

Minority Nurse Magazine

19

@MinorityNurse

WHY ADVOCACY MATTERS AND HOW TO GET INVOLVED

20

Minority Nurse | FALL 2017

BY JULIA QUINN-SZCESUIL Nurses spend their days and nights with one goal in mind—providing the best care for their patients. And if their jobs don’t have them in daily contact with patients, they are likely focused on providing the best legislation, policies, and environment for both nurses and patients.

B

ut the process isn’t always easy. Working environments or policies often present barriers.

Nurses sometimes find themselves in the difficult position of advocating for a patient’s best interests when it conflicts directly with a physician’s orders.

Nurses might also need to speak up for their own rights when staffing cuts or state or federal legislation proposes changes that will have a direct, negative impact on the quality of patient care or the ability of nurses to provide the best care they possibly can.

“Nurses are the ones who are with the patients the most,” says Pam Chally, PhD, RN, dean emeritus at the Brooks College of Health and now interim provost and vice president of academic affairs for the University of North Florida. “They notice subtle changes in clinical status,

and they are aware of what the patient is thinking or feeling.”

Although a nurse’s job is to care for patients, a nurse also has to watch out for broader influences on patient care and that can mean everything from alarm fatigue to too much overtime. Whether you are a

because they are the ones on the front lines. As a group, they have a powerful voice, says Jalil Johnson, MS, BSN, ANP-BC, national director of Show Me Your Stethoscope. “Nurses are the largest population within the health care system as employees,” he says. “Having a

Indeed, many nurses consider advocacy woven in with nursing ethics. But nurses advocating for themselves is just as important to the health and safety of both nurse and patient.

nursing student or a nursing veteran, your job requires you to make tough calls every day.

Why is it so important that nurses are comfortable speaking up?

Nurses have to speak up for themselves and their patients

voice is really important. People become empowered by seeing other people empowered.”

Nurses know advocacy is part of their job. Indeed, many nurses consider advocacy woven in with nursing ethics. But nurses advocating for themselves is

www.minoritynurse.com

just as important to the health and safety of both nurse and patient.

“Nurses are natural advocates for their patients,” says Lorina Marshall-Blake, president of the Independence Blue Cross Foundation and a member of the National Advisory Council on Nurse Education and Practice. “They are the first point of contact for patients in the health care system, often coordinating and managing patient care across the spectrum. Selfadvocacy may come less naturally for nurses whose natural instinct may be to make the patient his or her priority. However, self-advocacy is important and can make nurses a better caregiver and patient advocate.”

Johnson agrees. He says it’s difficult for nurses to switch between nurse advocacy and patient advocacy because they are so compelled to make sure

Minority Nurse Magazine

21

@MinorityNurse

patients have the care they need and the organization has the hours covered for that to happen.

When a staff shortage calls on nurses to work longer hours

profession of all (according to a Gallup poll),” says Heath.

With so much force, what makes some nurses uneasy when they have to speak up and are reluctant to do so?

Sometimes, younger nurses are at more of an advantage than veteran nurses. Nursing students generally learn from the first day of nursing school that they are the profession that advocates for the patient, says Linda Norman, DSN, RN, FAAN, dean of the Vanderbilt School of Nursing. or to take on more patients, the balance nurses need to give the best care possible becomes off-kilter. Because nurses know their patients depend on them, they are often reluctant to push back fearing that their patients won’t get care. “Patients depend on us for safety,” says Chally, so if nurses aren’t able to say when they are overburdened, patient care still might decline.

“We need to make sure we don’t just take on more and more and more because in the end, our patients suffer, and we do too. There’s only so much you can do.”

The more nurses are able to vocalize those issues, the bigger the chance of having it corrected. “From local to state to national legislators and the White House, nurses are in the most valuable position of all to lend their expertise in influencing health and public policy at all levels,” says Janie Heath, PhD, APRN-BC, FAAN, dean and Warwick professor of nursing at the University of Kentucky College of Nursing.

The sheer numbers of nurses is a factor in how powerful nurses are as a group. “We are 4.2 million strong and we continue to be the most trusted

22

Minority Nurse | FALL 2017

According to Heath, some nurses want to make sure that if they have to speak up and advocate for a patient, they do it the right way. They want to say the right thing to get an effective result, and they want to do it without putting their jobs in jeopardy. Sometimes, they just don’t know how to do that and when to do it, Heath says.

Sometimes, younger nurses are at more of an advantage than veteran nurses. Nursing students generally learn from the first day of nursing school that they are the profession that advocates for the patient, says Linda Norman, DSN, RN, FAAN, dean of the Vanderbilt School of Nursing. “That is so much now a requirement in health care delivery—it’s not just something good to do,”

she says. “The fabric of what we teach in nursing has to be about advocacy and not only the role but the responsibility.” Nursing schools are setting the example for why and how to effectively communicate. “Nursing leaders and educators have a responsibility to ensure nursing curricula builds that skill set and knowledge base in,” says Heath.

When a nurse sees something that isn’t in a patient’s best interests or that a patient has a need that isn’t being met, is there a specific approach they should take?

“You have to voice it in the right way,” says Norman. Consider what needs to be said and decide the best person in the chain of command to go to.

And also consider what you can do if your issue remains unresolved.

Luckily, Norman says, the atmosphere is changing to be

quality and safety are priorities and expectations. Some places are instituting varying methods to address the issue.

At Vanderbilt, says Norman, nurses can make an anonymous comment if they see something that isn’t right.

But it’s not a nationwide trend yet, and there are still places where nurses don’t feel like they can speak up.

“Advocating for patients can feel like you are taking a risk,” says Chally.

Few nurses would deny the fear of retaliation when they advocate for themselves and even the patients in their care.

They could be labeled as troublemakers, not a team player, difficult, complaining, and can become ostracized. And nurses have good reason to feel a little insecure when it comes to staff reductions. Nursing staff are often the largest employee section

The best way to advocate for change is to get involved. Start by becoming an active member of a local community hospital or nursing board to begin a conversation about what nurses need to help care for patients. more accepting of those who are advocating and being vocal when things are amiss. The environment is shifting so that

of a health care organization’s budget, so when there’s a need to cut the budget, nursing staff is often a prime target.

How can nurses learn effective ways to advocate?

As nurses settle into roles, they will find effective ways where they can work advocacy into an environment, says Marshall-Blake. “Through education and practical experience, nurses understand the necessity of their role as a patient advocate in every interaction and continuously work to promote the health, safety, and rights of their patients,” she says.

But she also notes that sometimes advocacy does take a back seat in a given moment. During a shift, a nurse might find that other issues or clinical procedures are taking immediate priority, she says. In those cases, nurses can use their nursing rounds to work patient advocacy into the care plan. They can also use the grand rounds as an opportunity for continued nursing education as well.

And Chally says nurses can help protect themselves and their patients by becoming diligent at documenting patient care. Because a patient record is a document, it’s a valuable tool for nurses. Include things like relevant comments a patient made to you. Continue to speak up with your immediate supervisor, but be deliberate when you bring up any sensitive issues. Chally suggests being aware of your verbal and nonverbal cues, so that both are calm and not emotionally charged. Begin with statements like, “It’s in this patient’s best interests if we . . .,” or “Mrs. Smith told me she didn’t get her medications correctly yesterday. . . .”

Advocacy starts from the top down, so nursing leaders can present advocacy as something that is part of the job and build structures into the nursing en-

vironment so nurses can see decision making related to all aspects of patient care and who can either offer their support or clarify their stand, says Heath.

“You have to create a culture where you can bring up issues that are a problem,” says Norman, noting that many magnet settings work with that goal in mind and many other organizations are adopting similar policies. By doing that, nurses will gain on-the-job advocacy skills and get comfortable with their role as a patient advocate and as a nurse advocate.

The payoffs for advocacy are huge. In an environment where nurses are seen as key components of a health care team, they feel more comfortable speaking up, have greater job satisfaction, enjoy better communication, and have greater retention.

The best way to advocate for change is to get involved. Start by becoming an active member of a local community hospital or nursing board to begin a conversation about what nurses need to help care for patients.

“Be willing to jump in and to follow through,” says Chally.

“If you say you are going to participate, show up.” Your state board of nursing or your employer’s governing council are also good places to make an impact as are national profes-

mater is an excellent source of connections, networks, and advocacy resources. Student nurses can join a student nursing organization, nursing honor societies, and a student society on campus.

And as nurse leadership positions expand, nurses will wield greater legislative power.

“Adding more nurses in the boardroom and in executive portions within health systems will ensure a more comprehensive knowledge of the organizational needs, from top to bottom,” says Marshall-Blake.

Johnson recommends that nurses find the advocacy approach that works for them and then put their efforts into that approach. Whether it’s showing up to events, joining organiza-

Whether it’s showing up to events, joining organizations, writing or just signing letters, or engaging online by writing a blog or sharing your own story, it’s just critical to do something.

something.

“Join thousands of nurses from across the country by becoming a grassroots nurseadvocate,” says Heath. “Simply contacting our legislative and local representatives provides the opportunity to speak as one collective voice. No one can tell the story better than nurses.”

Heath also mentions the importance of nursing as a profession. “When we have a ‘professional identity optimized,’ that will help foster the strategy to be more comfortable advocating for ourselves and others,” she says.

Johnson agrees, saying when nurses present a united front, their voices become that much more powerful.

“Never lose sight that we already have that skill set and competency,” says Heath. “We do this every day for our patients and their families, our communities, and our health care systems and settings.”

Julia Quinn-Szcesuil is a freelance writer based in Bolton,

sional nursing organizations.

And don’t forget to be an active member of your school’s alumni association. Your alma

tions, writing or just signing letters, or engaging online by writing a blog or sharing your own story, it’s just critical to do

www.minoritynurse.com

Massachusetts.

Minority Nurse Magazine

23

@MinorityNurse

Strategies to Recruit and Retain Faculty 24

Minority Nurse | FALL 2017

BY ROBIN FARMER Mentors with open-door access and a focus on growth opportunities are integral to the successful recruitment and retention of faculty at the Johns Hopkins School of Nursing.

F

ormal and informal mentors continue to make a profound difference for Janiece L. Walker, PhD, MSN, RN, who arrived on a two-year postdoctoral assignment and joined the faculty as an assistant professor in the Department of Community and Public Health last July.

“From the moment I walked in they were like, ‘Okay, you are here to succeed and what can I do to help you succeed?’ And then they followed that up with action. If I was weak in an area, like if I did not understand the statistics or the research comment, they were quick to put me in contact with someone who did.”

www.minoritynurse.com

“The mentors I’ve had are really invested in me succeeding,” says Walker, who grew up in New Mexico. “We texted on the weekends. I’m not saying all mentors need to do that, but I needed that support being so far away from family and everyone I knew. And going from a public to a private institution, mentorship was key.”

Other strategies colleges and schools of nursing nationwide pursue to address the faculty shortage include innovative fast-track BSNto-doctoral programs, “grow your own faculty” initiatives, faculty development, and loan forgiveness programs.

In response to projections that Wisconsin could face a shortage of 20,000 nurses

Minority Nurse Magazine

25

@MinorityNurse

by 2035, the University of Wisconsin announced the $3.2 million Nurses for Wisconsin Initiative to provide fellowships and loan forgiveness for future nurse faculty who commit to teach in the state after graduation, according to the American Association of Colleges of Nursing (AACN). Funding is provided through a University of Wisconsin System Economic Development Incentive Grant.

Since 2005, an aging faculty, higher salaries in clinical and private sector settings, and budget constraints have fueled the declining numbers of nurse faculty. In 2016, insufficient faculty, clinical sites, classroom space, clinical preceptors, and budget constraints led schools across the nation to turn away 64,067 qualified applicants from baccalaureate and graduate nursing programs, according to the AACN. Most survey participants cited faculty shortages as a reason for not accepting all qualified ap-

from doctoral programs because of a lack of faculty and clinical education sites.

The role of salary can be an issue in attracting and retaining faculty, nurse leaders say.

plicants into baccalaureate programs.

AACN found 9,757 applicants were turned away last year from master’s programs and 2,102 were turned away

26

Minority Nurse | FALL 2017

Money Issues The role of salary can be an issue in attracting and retaining faculty, nurse leaders say. The salaries available within academics are always

lower than salaries available to those who chose to stay in practice in the clinical area, says Sheldon D. Fields, PhD, RN, FNP-BC, AACRN, FAANP, FNAP, FAAN, dean and professor, School of Health Professions, New York Institute of Technology.

“But everyone knows that.

You have to agree to take a slightly lower salary to come and be a full-time academic.

The tradeoff oftentimes is the lifestyle,” he says.

Fields recalled after he finished his master’s as a

family nurse practitioner he commanded a certain salary. He returned to school and earned a PhD in nursing. When he sought an academic appointment as a new assistant professor, “For the most part the salaries offered were less than what I could make as master’s-prepared family nurse practitioner,” says Sheldon.

Compensation can depend on geographic location and experience, but “I think it’s a bit of a myth that faculty salaries are much lower than

practice salaries,” says Marie T. Nolan, PhD, MPH, RN, FAAN, professor and executive vice dean at the Johns Hopkins School of Nursing.

In Baltimore, a new nurse

come an issue when juggling mortgages, tuition and other bills, she says.

The average salary of a nurse practitioner is $97,083, according to the American

“By allowing more release time for faculty to practice, schools are ensuring that faculty are well-versed in contemporary nursing practice, which is important to preparing the next generation of registered nurses,” says Deborah Trautman, president and CEO of the AACN.

might earn a starting salary of $62,000, whereas the national starting average is $68,000. A starting salary for a doctorally prepared nurse in the faculty position at Johns Hopkins would be close to about $110,000– $115,000. A new nurse practitioner would earn about $100,000–$110,000. Salaries rise with rank.

“In hospital and community settings you make higher salaries with more responsibilities and the same is true in the academic setting,” says Nolan.

Earlier Planning Salaries are less of an issue if nurses are younger when they earn their doctorates so having that conversation with students earlier is another strategy, says Lisa M. Lewis, PhD, RN, FAAN, associate professor of nursing and dean for Diversity and Inclusivity at the University of Pennsylvania School of Nursing.

In nursing, people tend to look at doctoral programs fairly late, in their 40s and 50s, a time when salaries be-

Association of Nurse Practitioners. By contrast, AACN reported last year that the average salary for a master’sprepared assistant professor in schools of nursing was $77,022.

“We don’t have this conversation early enough with students at the undergraduate level, that you can think about a career in academic nursing. What we do in nursing education when we are training nurses at the baccualerate and associate levels is direct care, and that’s important. But we don’t talk about how you can make a bigger impact by teaching or doing research,” Lewis says.

“Those who do become nurse faculty, it’s not for the money. It’s for the love of training the next generation of students. It’s for the love of research that has implications for patient health and patient care. But we don’t typically have those conversations when we are training them at the undergraduate level.

If we did, we might have a better pipeline for nursing faculty,” explains Lewis.

The University of Pennsylvania School of Nursing is one of three schools nationwide offering the Hillman Scholars Program in Nursing Innovation, which is a BSN-PhD program. It awards students with a loan up to $75,000 to support the last two years of undergraduate work plus one full year of full-time doctoral studies. The loan is forgiven after successful completion of the PhD. “The goal is to increase the number of doctorally prepared nurses, which would increase the nurse faculty pipeline,” says Lewis.

The Robert Wood Johnson Future of Nursing Scholars Program, headquartered at Penn Nursing, fast tracks the next generation of PhD students “so that they can go into faculty positions earlier,” says Lewis. PhD students complete their doctoral degrees in three years. To support them, the program awards $75,000 per scholar, which is matched by $50,000 from the school.

New Directions Other creative strategies to bridge the faculty gap include nursing schools partnering with clinical agencies and hospitals to share graduateprepared nurses who are interested in teaching, nurse leaders say.

“By allowing more release time for faculty to practice, schools are ensuring that faculty are well-versed in contemporary nursing practice, which is important to preparing the next generation of registered nurses,” says Deborah Trautman, president and CEO of the AACN. To address the faculty shortage, AACN is advocat-

www.minoritynurse.com

Sheldon D. Fields, PhD, RN, FNP-BC, AACRN, FAANP, FNAP, FAAN

ing for new federal legislation and increased funding for graduate level nursing education; coordinating faculty scholarship programs; hosting faculty development conferences and professional developments opportunities for new nurse educators and publishing data to quantify the scope of the shortage and its impact on student enrollment; and, disseminating long- and short-term strategies.

The AACN supports such strategies as “grow your own faculty” initiatives and innovations in nursing programs that increase the pipeline of graduate nursing students, including fast track BSN-todoctoral programs, entry-level MSN programs, and online programs.

Sheldon envisions another strategy that may help alleviate the nurse faculty shortage if adopted by colleges and schools of nursing.

“We’re producing more DNPs than we are PhDs and that’s not going to change.

We have to figure out in academics what I see as a long-

Minority Nurse Magazine

27

@MinorityNurse

term solution, which is another type of faculty member called a professor of practice,” he explains. The position would require a partnership with clinical institutions to share employees.

Professors of practice would work at the university for three days a week, but also work in clinical practices somewhere “and we split the difference of their salaries.

They are generating their income in the practice arena and then we can give them a

28

Minority Nurse | FALL 2017

certain amount. We should be able to keep people at comfortable salaries” with this approach, Sheldon says.

“But we don’t call them clinical faculty. We don’t call them tenure-earning faculty. We call them professor of practice. It’s a long-term solution I wish people would listen to,” he says.

At Johns Hopkins, faculty mentoring underrepresented minority doctoral students addresses one pipeline issue.

Mentors include the dean,

Nolan, and other faculty who periodically meet with students to discuss, among other issues, any support needed.

“We are serving not only future faculty at Johns Hopkins, we believe we are creating faculty leaders for the other research-intensive universities as well. That’s why we pay attention to our activities to promote diversity at both the doctoral and faculty level,” said Nolan.

Another measure to increase diversity involved the

creation of nine full-time clinical instructor positions last year. Nurses with a master’s degree who worked parttime were allowed to apply.

Underrepresented minorities were encouraged to pursue the positions.

“Once we get them in the door we talk to them about advancing their career. We said to potential applicants, ‘You’ve been teaching parttime. We think you are impressive and you have great potential. Have you thought

about getting a doctoral degree?’” Several said they would love that opportunity.

“Out of the nine who took the job, three in the first year have already enrolled and

nursing organizations, including male nurses. “We can’t seem to break the barrier of about 10% of nurses are men.

If we could really encourage more men to be nursing fac-

“In nursing, people tend to look at doctoral programs fairly late, in their 40s and 50s, a time when salaries become an issue when juggling mortgages, tuition and other bills,” she says.

been accepted in doctoral programs . . . and we are still working on the others,” Nolan says.

To assist with recruitment of minority postdoctoral fellows, faculty members, or applicants, the Office of the Provost began providing funding two years ago to hire a faculty member “who maybe we don’t have a current need for, but will in the next three years,” she says. So they provide the funding for up to three years for 75% of the faculty member’s effort.

“It’s very effective. Given the aging of the population, and everyone is in this category right now across the U.S., if you start looking three to five years down the road all of us have significant numbers of faculty retiring. If we can just support that faculty salary for up to three years we will have a need in that area.”

Recruitment efforts include posting ads for faculty openings in a variety of journals as well as the AACN’s website. More than a third of the $38,000 spent in the past year on advertisements was targeted toward minority

ulty and nurses we would do a great deal to decrease the faculty shortage,” Nolan says.

Another strategy provides minority postdoctoral fellows with teaching experience to make them more competitive when applying for faculty positions. “They are very commercial because they can say I cotaught a course at Johns Hopkins School of Nursing.

I try to have PhD and postdoctoral fellows teach a prelicensure course as well as a graduate or doctoral course because when they apply for a position, most schools of nursing have large prelicensure programs, and then of course a smaller DNP and PhD program. So if they can demonstrate that they have taught a very large class where there is a great teaching need then they are just that more competitive,” says Walker.

Building Faculty The role of mentoring in recruiting and retaining faculty must not be underestimated, nurse leaders say.

Based on feedback, Nolan says Johns Hopkins’ mentoring program, which pairs

seasoned faculty with assistant professors and associate professors, will likely become more structured with recommendations that include a minimum number of meetings and more templates for goal setting and evaluating career advancement.

Mentoring is critical as it helps faculty members weigh the strengths and limitations of various choices they have in their careers, Nolan says.

“It’s having someone as a sounding board and to provide advice on how you spend your time. At Hopkins, there is no end to opportunities to get involved in research or practice activities or testify before Congress.”

Walker, who was encouraged to apply for a faculty position after her first year as a postdoctoral fellow, credits her mentors for helping her

Mentoring is critical as it helps faculty members weigh the strengths and limitations of various choices they have in their careers, Nolan says.

Marie T. Nolan, PhD, MPH, RN, FAAN

students, but for nurses in general. To be able to contribute to upcoming nurses and help them learn what they need to do to improve the health outcomes, helps me find purpose and worth,” says Walker.

“Research is a big part of it as well and being able to hopefully affect communities and address health inequities. If I could do that with my career then I would be content.”

Robin Farmer covers health, business, and education as a freelance journalist. Based in Virginia, she contributes frequently to Minority Nurse magazine and website. Visit her at www.RobinFarmerWrites

realize her goal to teach a new generation of nurses while serving as a role model.

“I started with my LPN in high school and then I went on to my bachelor’s. I went from a CNA program to a PhD program and I had very few African American faculty. So it was important for me to be able to be that example and not just for other minority

www.minoritynurse.com

.com.

Minority Nurse Magazine

29

@MinorityNurse

Degrees of Success

From Student Leaders to Registered Nurses: How On-Campus Leadership Impacts the Next Generation of Nurses

BY CHRISTIAN CATIIS, RN, BSN found that student engagement is congruent or linked to stronger skills in collaborative task management, critical thinking, and interpersonal communication. Although the study does conclude in favor of students joining clubs or organizations, one must not devalue the importance of education as well because student leadership should be seen as a supplement, not a replacement, in terms of academic work.

Health care is well known for being a dynamic and everchanging field; with advancements in medicine and technology, how we take care of patients today provides only a small indication of what it could be in years

When a candidate is considered for employment, certain factors are looked into such as qualifications, educational background, past employment experience, and so forth.

However, for many newly graduated students, entering the workforce can be seen as challenging when applying for full-time positions. Because nursing school only gives students minimal clinical exposure, sometimes only for two years, how can newly graduated nurses make themselves more marketable to employers? Both research and personal testimonies agree that student engagement and extracurricular activities improve not only a newly graduated nurse chance of obtaining employment but aid in his or her clinical performance as well.

W

hen recruiters were surveyed about what characteristics they valued most in terms of newly graduated students, certain charac-

30

Minority Nurse | FALL 2017

teristics such as interpersonal skills and leadership qualities were deemed highly sought for.

Career counselors and student advisors alike concur that being well-rounded with experience

Both research and personal testimonies agree that student engagement and extracurricular activities improve not only a newly graduated nurse chance of obtaining employment but aid in his or her clinical performance as well. from a multitude of fields is much more favorable in comparison to being solely strong in academics. Furthermore, gaining leadership roles/experiences can be a valuable predictor in terms of job performance. And when a study was conducted regarding the true impact of extracurricular involvement, overall, the research supported the authors’ hypotheses. The results, published in the journal Human Resource Management,

to come. As newly graduated nurses prepare to enter the workforce, what they bring to this profession, albeit not clinical expertise, is a rich background of multiple disciplines such as community service, civic activism, and cultural awareness. But how does this translate within the clinical environment?

Nursing is both an art and science. From the medicinal perspective, nurses have to be

Degrees of Success knowledgeable of various disease processes, pharmacology, and the significances of various laboratory results. But taking care of a patient is significantly

As newly graduated nurses prepare to enter the workforce, what they bring to this profession, albeit not clinical expertise, is a rich background of multiple disciplines such as community service, civic activism, and cultural awareness.

much more than medication administration; it involves therapeutic communication, empathy, and above all, compassion.

This is where leadership and campus engagement is placed at the forefront, and how student leaders can effectively demonstrate skills not taught within the classroom. Here are just three personal testimonies from minority student leaders and how their extracurricular involvement influenced their nursing experience.

Alyssa Dumatol, RN, BSN Previous Leadership Positions at Ramapo College of New Jersey: Resident Assistant, Peer Facilitator, Orientation Leader, Student Success Peer Advisor, President of Alpha Phi Omega—Alpha Delta Mu Chapter “The primary goal for clinical is to give students the opportunity to apply nursing knowledge and to become

comfortable caring for patients.

Otherwise, you get limited opportunities to refine skills that I believe are so critical to becoming not just a nurse, but a great nurse. As a student leader, I’ve gained confidence and strengthened skills such as time management, planning, and essential communication skills that could help me, hypothetically, manage a patient who becomes angry or frustrated.

I now understand how to not be overwhelmed because I’ve learned how to critically analyze the situation, implement solutions, and how to efficiently de-escalate the situation.”

Michele Tanigaki, RN, BSN Previous Leadership Positions at Ramapo College of New Jersey: Co-President of United Asian Association “What co-presidency has taught me is that collaborating with a team of supportive people can truly make a difference. If you have people you can rely on, such as how a nurse supports his or her patient, you are more likely to have a positive outcome. And as a nurse, I hope to develop a trusting relationship with each and every one of my patients so they themselves are encouraged to become better and healthier.”

Alexandra Ebol, RN, BSN Previous Leadership Positions at Seton Hall University: Co-President of the Red Cross Club, Treasurer of the Holistic Health, and Yoga Club “Taking the position as co-

president for the Red Cross Club, I’ve come to learn that teamwork is a crucial component to keeping any organization active. Through collaboration, we are able to accomplish projects in a timely manner. From efficient communication there can be a stronger and cohesive bond with my fellow executive board members.

And from working towards a common goal, we trust one another to inform the fellow team regarding any status updates about a planned event or program. This is similar to the clinical setting where if we noticed anything unusual regarding the patient’s status, we advocate for him or her to tackle any potential problems effectively.

As future registered nurses, we prioritize patient safety; and in

a team environment. Because of these newly found traits, I know I am ready to tackle any challenges as I begin to make the transition from nursing student to registered nurse.

With each graduating year, we enter an era of progression where nurses are becoming more diverse and with much to offer. The nursing profession itself has gone through multiple advancements in which we are better equipped to take care of our patients now than ever before. Student nurses have a heavy course load as it is; however, one cannot forget that learning about yourself and the people around you cannot be taught in a textbook. The making of a great nurse is the ability to see the patient past their disease(s) and see them as

Student nurses have a heavy course load as it is; however, one cannot forget that learning about yourself and the people around you cannot be taught in a textbook.

order to do so, we must eradicate all possible medical errors by effectively communicating with everyone who is a part of the patient care team.”

I myself can attest the value of student involvement. Being shy for considerably a majority of my life, when I began my freshman year in my BSN program, I questioned whether or not I was cut out to be a nurse.

However, through nearly four years of personal development through various roles in organizations and leadership positions, I am now confident in my abilities regarding advocacy, social/cultural awareness, and how to effectively work within

www.minoritynurse.com

the people they are. By placing the person first and the patient second can newly graduated nurses demonstrate what it truly means to be a leader in the clinical world.

Christian Catiis, RN, BSN, is a graduate of Ramapo College of New Jersey. His previous leadership positions at Ramapo have included: Resident Assistant, Ramapo Admissions Student Ambassador, New Interest Member Educator of Alpha Phi Omega - Alpha Delta Mu Chapter, and Cultural Chair for the Filipino American Student Association, among others.

Minority Nurse Magazine

31

@MinorityNurse

U.S. DEPARTMENT OF JUSTICE Federal Bureau of Prisons and the U.S. Public Health Service Commissioned Corps Are you an RN or NP student graduating in 2019? Would you like to be paid a salary and receive full benefits while in your last year of school without having to work?

You are GUARANTEED a career in your field after graduation…

Pursue the Senior Commissioned Officer Student Training & Externship Program (SRCOSTEP) through the US Public Health Service (USPHS) Commissioned Corps with Federal Bureau of Prisons (BOP) sponsorship.

Benefits include: ➢ Become a Commissioned Corps Officer ➢ Full salary, is based on current year US Military Pay Chart averaging between $3400 - $8000 /mo. to start - includes nontaxable Basic Allowances for Housing (BAH) depending on school zip code. ➢ No Cost Health Care - Tricare ➢ 30 days paid leave per year ➢ Malpractice coverage ➢ Mobility – maintain a valid license in one state or territory, and work at any of our facilities ➢ Continuing Education allowances

➢ Have the satisfaction of serving your country while providing treatment to an under-served population with challenging health care needs using a Team Medicine approach For more information on the USPHS Commissioned Corps, Qualifications, and how to apply, please visit www.usphs.gov. For more information on the BOP, please visit www.bop.gov.

Or contact: Commander Sonjia Howard SRCOSTEP Coordinator Federal Bureau of Prisons BOP-HSD/Recruitment@bop.gov

Application window: 1 September 2017 – 15 November 2017. Apply at http://www.usphs.gov/apply/srcostep.aspx

The Federal Bureau of Prisons is an equal opportunity employer

32

Minority Nurse | FALL 2017

Second Opinion

What You Should Know Before Becoming Nurse Faculty

BY POY SAKJIRAPAPONG, MSN, RN, CCRN

You may be an experienced bedside registered nurse (RN) who has passionately served as a preceptor for newly graduated nurses in your unit. Now, you are seriously considering teaching nursing students in a formal educational setting. If you have decided to answer your new calling and are seeking more experience as an educator, exploring the role of nurse faculty, or desiring a career change, a smooth transition into the role of nurse faculty is crucial to your success.

break into this field?” First and foremost, the initial step is to check your eligibility as an instructor with the Board of Nursing (BON). For instance, in California, nursing faculty must be clinically competent in the areas to which they are assigned. Clinically competent means that a nursing program faculty member must possess

have direct patient care experience within the last five years in the designated nursing specialty, which can be fulfilled by one year of continuous, full-time patient care in a clinical setting or one academic year of RN-level clinical teaching experience in the designated nursing area or its equivalent. Unfortunately, working as a manager, supervisor, or an educator without direct patient care may not qualify you as clinically competent.

A nurse can only teach in the approved clinical area.

For instance, if you have only worked in the pediatric unit

I have often been asked this question: “I want to teach in nursing school.

How do I break into this field?” First and foremost, the initial step is to check your eligibility as an instructor with the Board of Nursing (BON).

I

have experienced many challenges in my transition from an experienced bedside nurse to a novice nurse faculty. Although I truly enjoy the role of nurse faculty, there are essentials I wish I had known prior to teaching

my very first group of nursing students.

Know the State Board of Nursing Faculty Eligibility I have often been asked this question: “I want to teach in nursing school. How do I

and exercise the degree of learning, skill, care, and experience ordinarily possessed and expected by staff-level registered nurses of the clinical unit in which the faculty member will be educating.

Additionally, the RN must

www.minoritynurse.com

for the duration of your career, then you can only teach pediatric nursing. The BON has established five categories of nursing as follows: medicalsurgical, obstetrics, children, psychiatric/mental health, and geriatrics. For example, I cannot teach psychiatric/mental health nursing because I do not have the BON approval because of lack of working ex-

Minority Nurse Magazine

33

@MinorityNurse

Second Opinion perience in that field. If you have worked in multiple units, then you may be approved for more than one category. I have

I began as an assistant instructor with a bachelor’s degree in nursing. As an assistant instructor, I was limited to teaching in

I had to remind myself to be as “fearless” as I was when I entered the nursing profession. You will soon learn as I did that your experience as an expert clinician helps and informs your role as an educator. working experience as a bedside RN in a medical-surgical unit, postpartum couplet care, adult intensive care unit, and pediatric intensive care unit.

Therefore, I am approved to teach in medical-surgical, obstetrics, children, and geriatrics.

the clinical setting and I could not be a lead instructor for any theory course. You can become an instructor after one full year of teaching experience, and you must possess a master’s degree.

Know Your Area of Interest Know the Required Education Similar to the BON faculty eligibility, you must know your state educational requirements.

The California Board of Registered Nursing has defined three levels of nursing faculty—an instructor, an assistant instructor, and a clinical teaching assistant. The instructor must possess a master’s degree or higher from an accredited college or university that includes coursework in nursing, education, or administration.

If your degree is in another field other than nursing, you must submit documentation verifying coursework in nursing education. Next, the assistant instructor must possess a bachelor’s degree from an accredited college, which must include courses in nursing or in a natural, behavioral, or social science relevant to nursing practice. Lastly, the clinical teaching assistant must have at least one year of experience within the previous five years as a registered nurse providing direct patient care.

In the role of nurse educator,

34

Minority Nurse | FALL 2017

Do you like teaching in a clinical setting, laboratory, or classroom? I exclusively taught in the skills laboratory and in an acute care hospital when I first started teaching. I did not venture into teaching theory in the classroom until my fifth year as a nurse faculty.

As an experienced RN, I was very comfortable with clinical teaching. However, I hesitated to teach theory because of a lack of previous classroom teaching experience. I overcame my lack of experience by spending many hours observing other faculty’s lectures. I

with clinical education. I enjoy teaching theory as much as educating students in a hospital setting.

Know (and Be Confident) that You Can Teach!

You are considering the role of the nurse faculty because you love teaching. The joy of teaching and passion to transfer knowledge is an excellent foundation for any nurse faculty. Do not be afraid to teach and venture into the role of nurse faculty. I was afraid of being a novice educator. I was uncertain about my classroom teaching skills and doubted my clinical teaching abilities.

I had to remind myself to be as “fearless” as I was when I entered the nursing profession.

You will soon learn as I did that your experience as an expert clinician helps and informs your role as an educator. After all, nurses teach patients and their families on a daily basis.

Advice for Minority Nurses Let’s face it . . . there are challenges in becoming a nurse faculty. As an immigrant who grew up in the United States, I still face discriminatory questions from patients, staff RN, fellow nurse faculty, and even students—“Did you

Above all, being a minority nurse faculty gives you the opportunity to serve as a mentor for other minority students.

I also found that many students have a lack of exposure to different racial and ethnic backgrounds. I recently encountered a student who described a patient as “brown in color, which is appropriate for the Hispanic race.” I had to explain to the student that skin color should not be documented as “brown in color.”

The same student questioned if my skin color should then be described as “yellow” because I am Asian.

The beauty of being a minority nurse faculty is that I can relate to students with diverse and different backgrounds. Students may seek out a faculty advisor for their club or simply want you to serve as their role model. I was asked to be a faculty advisor for the Asian Pacific American Health Care Club, which got students to participate in a health fair and community outreach. Above all, being a minority nurse faculty gives you the opportunity to serve as a mentor for other minority students.

The transition from bedside nurse to nurse faculty requires BON approval and entails certain educational standards that must be met. Knowing your state BON faculty eligibility, area of interest, education requirements, and ability to teach will help in a smooth transition into the role of nurse faculty.

Poy Sakjirapapong, MSN, RN, CCRN, is a lecturer at University

then “guest lectured” in several classes until I was no longer fearful of lecturing and realized that teaching in the classroom is not so terrifying. Currently, I teach in both the classroom and clinical setting and I enjoy bridging classroom material

graduate from school in the United States?” or “What country is your nursing school in?” I have learned not to take those questions personally and even jokingly respond, “I graduated from the country of California.”

of California, Los Angeles School of Nursing and is a staff registered nurse at Northridge Hospital. She has been a working nurse faculty for over six years, and she has been a licensed RN since 2004.

Second Opinion

Drinking from the River of Success

BY LATOYA LEWIS, MSN, RN

How many times have we heard the metaphorical saying, “You can lead a horse to water, but you can’t make it drink?� When it comes to nursing schools and retention, the saying ought to be considered further; how deep is the water? How did the student get to that body of water?

What would make them want to drink from it? This body of water will be referred to as the river of success.

B

efore drinking from the river of success, a prospective nursing student must consider the alarming statistics. It is estimated that on average, approximately 20% of students entering college will not graduate. According to a study published in the ABNF Journal, over the last ten years, nursing programs have seen a decline in students who are completing

their nursing degrees from 70% to about 50%. There are multiple reasons for such a decline, such as: disparities affecting ethnic groups whose members may be ill prepared for a higher education; first-generation students who may be disadvantaged; families/friends who may not understand expectations of students in higher education; and a lack of sustaining intrinsic motivational factors.

This means that stronger efforts must be put in place to familiarize prospective students and their families about the rigor of nursing schools. Such knowledge and awareness can help the prospective nursing student make better decisions about entry. Informed decisions about entry may then help to ensure the success of students who do enter them.

Too much time and money is being invested and wasted.

Enlightenment efforts must begin with the metaphorical analysis of drinking from the river of success.

The first part of the analysis begins with determining the depth of the river. In nursing school, the river is very deep (i.e., intense) and winds

www.minoritynurse.com

through several foothills and valleys. Accelerated nursing programs are even deeper.

Most of the nursing programs require a passing grade in each course of 75 or greater.

Failure in one course usually means that the student cannot continue the program as they have not met the linear requirements. Studying and completing homework assignments should take several hours per night. While studying and completing assignments that take several hours per night, the adult student must also juggle other roles. Students have multifaceted roles including but not limited to parent, spouse/significant other, and child caring for aging parents, not to mention financial responsibilities and the need to work to sustain income.

The prospective nursing student must also come to this realization: Unsatisfactory attendance is not acceptable.

A student is actually dismissed if they cannot fulfill these requirements. Chronic ailments of a student or family member will interfere with the ability to meet these requirements. If the student cannot keep up with the intensity and the demands of nursing school, they will simply choke and may even drown (i.e., fail). Drinking from the river of success involves not only being aware of the depth of the water but also having a willingness, ability, and determination to clear the throat to prevent choking.

The nursing student must have the ability to fight (i.e., swim) to remain above the surface

Minority Nurse Magazine

35

@MinorityNurse

Second Opinion or with the head above water.

The next part of the metaphorical analysis involves figuring out how the prospective student was led to the river of

year are not influenced by the right kind of motivation and are not likely to succeed. But when students come to nursing school because of a personal de-

This means that stronger efforts must be put in place to familiarize prospective students and their families about the rigor of nursing schools. success. They could have been led by one of two things: intrinsic or extrinsic motivational factors. Intrinsic motivation is defined as performing an action or behavior because you enjoy the activity itself. It also refers to an action performed because of personal desires of acceptance, curiosity, honor, independence, order, power, social contact, or social status.

Extrinsic motivation refers to performing an action or behavior in order to receive an external reward or outcome or to avoid punishment/negative outcomes. Studies show that the tasks that are performed as a result of intrinsic motivational factors are more successful. Therefore, the prospective

sire to care for others or because of a thirst for learning about the discipline of nursing, they are influenced by the right kind of motivation and are more likely to succeed. So in a sense, we can lead a horse to water, but we shouldn’t. The horse (i.e., nursing student) should be led to the river of success by intrinsic motivational factors.

The last part of the metaphorical analysis involves looking at what gives the student the desire to drink from the river of success. We already explored the right route; the highway of intrinsic motivational factors. But how do we keep them at the river of success while hoping that the nursing student actually takes

But when students come to nursing school because of a personal desire to care for others or because of a thirst for learning about the discipline of nursing, they are influenced by the right kind of motivation and are more likely to succeed. nursing student should be led to drink from the river of success because of intrinsic motivational factors. The students that come to school because their parents strongly encouraged them to pursue a career or because of an advertisement that talked about a certain salary per

36

Minority Nurse | FALL 2017

a sip? The nursing student usually decides to take a sip when their life is somewhat stable or when the needs on the bottom of Maslow’s hierarchy (e.g., food, shelter, and water) are taken care of. They may decide to take a sip even when being in chaotic situations (which is

the case of most adult learners).

However, this depends on whether or not strong support systems are in place. In the case of the student with multiple societal roles, they will continue drinking when there is someone available to help with the laundry and a spouse/significant other to pick up more hours as the students’ work hours lessen. The student will continue drinking when someone is there to help put the children to bed and/or to ensure that their aging parents have taken their medication . . . and so on. These are support systems that actually have a true understanding of what the

The student needs to understand that instructors are not responsible for successful learning or failure to learn. Rather, instructors help students learn how to learn.

When a horse gets to the river of success via the right route, realizes the depth of the water, and has herds of families, friends’ faculty, and staff rooting for them, they are ready to reap the benefits of drinking from it; they become fully hydrated with the vitamins and minerals that success has to offer. With that being said, the decline of students completing their nursing degrees does not have to remain a prob-

Students need to understand all of the responsibilities that they have as a student, including seeking out experiences, resources, and the instructor for assistance. nursing student is experiencing. We might as well tell the student not to drink when unrealistic expectations are placed upon them. During the consultation phase of the admission process, students are usually discouraged to enter if there is no possibility of delegating domestic obligations and cutting down work hours.

Faculty and staff may serve as support systems as well. It is important for students to understand this while taking advantage of the resources that are offered to them. Oftentimes, students wait until it is too late to get the help that is needed from faculty or staff. Students need to understand all of the responsibilities that they have as a student, including seeking out experiences, resources, and the instructor for assistance.

lem. Nurses, nursing educators, faculty, and staff must take a deeper look into the metaphorical statement while fully and properly enlightening the prospective nursing student about this river.

Latoya Lewis, MSN, RN, is an education supervisor at Porter and Chester Institute, where she is responsible for overseeing the practical nursing curriculum and optimizing the academic/clinical experience of practical nursing students as well as managing and coaching the faculty to help improve student achievement.

Health Policy

The Congressional Budget Office: Forecasting the Cost of Legislation

BY JANICE M. PHILLIPS, PhD, FAAN, RN

As we continue our dialogue on health policy and the policymaking process, nurses need to have a working knowledge of the various government agencies and the role they play during the legislative process. To illustrate, the Congressional Budget Office (CBO) is one of many agencies that helps to inform this process and is central to any discussions and decisions regarding the federal budget, revenues, and federal spending. The CBO is an agency within the legislative branch of the federal government and was established as a nonpartisan agency

by Title II of the Congressional Budget and Impoundment Control Act of 1974 (Pub. L. 93-944). Since 1975, the CBO has performed economic projections and formal cost estimates of proposed legislation. This agency informs Congress about the economic implications of legislative proposals (e.g., bills, amendments) in the president’s budget and a broad array of policy issues. The CBO and staff at the Joint Committee on Taxation collaborate to provide estimates that are based on current tax laws and other pertinent statues. Discussions and decisions made during the legislative process are informed by detailed cost estimates and budget analyses performed by the CBO.

T

he CBO also provides data analyses and other key information to members of Congress.

The chairman or ranking members of any Congressional committee or subcommittee as well as leadership in the House and Senate may call on the CBO for written reports, assistance in reaching budget consensus, and vital information to support the budget process. In contrast, the CBO does not provide estimates for appropriation bills, legislative bills that grant the government permission

to spend money. Formal cost estimates and other findings may be presented in the form of reports, working papers, Congressional hearings, or informal communique. Reports may include details about federal spending, program allocations, federal policies or budget, and economic concerns, to name a few. The CBO provides independent analyses of budgetary and economic implications for approximately 500–700 bills annually and produces an annual Budget and Economic Outlook as designated by statute .

To ensure objectivity of its estimates and analyses, the CBO conducts reviews of governmental data and reports, consults with outside experts, strict-

ly enforces conflict of interest policies, performs a rigorous review process of all its analyses, and does not make any policy recommendations based on its

The federal budget and related processes are extremely complex and requires the participation of a broad range of stakeholders including the president, members of Congress, advisors, and others.

www.minoritynurse.com

Minority Nurse Magazine

37

@MinorityNurse

Health Policy reviews or analyses. Because of its nonpartisan status, the CBO does not hire employees based

Affordable Care Act, was passed by the House of Representatives on May 4, 2017, and is pend-

Because of its nonpartisan status, the CBO does not hire employees based on their political affiliation but based on one’s expertise or level of competency in performing the required duties.

on their political affiliation but based on one’s expertise or level of competency in performing the required duties.

The CBO and the staff at the Joint Committee on Taxation released their estimates regarding the financial impact of the American Health Care Act (AHCA) on health insurance, federal spending, health care coverage, and the federal deficit. The AHCA, a bill devoted to repealing and replacing the

ing Senate approval. Here are two examples of recent CBO projections: 1. In March 2017, the CBO provided estimates on the impact of the Republican bill on the number of uninsured and changes in the Medicaid program among other things.

By 2026, an estimated 23 million will be uninsured. This represents an 82% increase when com-

pared to the number of uninsured under the Affordable Care Act. 2. According to CBO projections, Medicaid would decrease direct spending by $880 billion during the period 2017–2026.

The reductions in Medicaid spending are due, in part, to the anticipated decreasing enrollment into Medicaid; an estimated 14 million fewer people will be enrolled in Medicaid if the AHCA passes. CBO anticipates that the total number of uninsured could reach 52 million in 2026; 24 million more than what is projected under current provisions in the Affordable Care Act. The federal budget and related processes are extremely complex and requires the participation of a broad range of stakeholders including the president, members of Congress, advisors, and others. Likewise, forecasting the cost of pro-

posed legislation by the CBO is complex and is often debated on many fronts. Nonetheless, CBO estimates are an integral part of the legislative process.

Readers are encouraged to visit the following websites for a detailed discussion on the federal budget and related processes: *Center of Budget and Policy Priorities’ Introduction to the Federal Budget Process (www.cbpp.org/research/policybasics-introduction-to-the-federal-budget-process) *American Nephrology Nurses Association’s Federal Budget & Appropriations Primer (www.annanurse.org/federalbudget-appropriations-primer) Such awareness will help complement our discussion on the CBO and may also help to strengthen our advocacy efforts on behalf of patients and the profession.

Janice M. Phillips, PhD, FAAN, RN, is an independent consultant residing in the Chicagoland area.

Such awareness will help complement our discussion on the CBO and may also help to strengthen our advocacy efforts on behalf of patients and the profession.

38

Minority Nurse | FALL 2017

The Funny Bone COMPILED BY MICHELE WOJCIECHOWSKI

Nursing can be a tough job, but it has a ton of fun sides as well. Enjoy the following hilarious stories sent in by your fellow nurses. Have a funny tale to tell? E-mail writer Michele Wojciechowski at MWojoWrites@comcast.net to share!

Oh Baby!

While on a traveling nurse assignment in the Washington, DC area, I was taking care of a couple. The wife was in labor with their second baby. She really wanted to deliver with no epidural, so my job was intense—talking her through every contraction.

I almost always tell the husbands that they have to make sure to eat and drink plenty of fluids because “I don’t take care of adult men.” Most men argue with me and say, “I don’t pass out” or “I don’t get queasy.”

Like those things are insulting.

This particular husband just seemed like he was on a roller coaster. His wife had gotten an epidural with their first child, so he hadn’t experienced the noises and emotions to the extent that she was exhibiting them this time.

After the delivery, mom was beaming and fell madly in love with her baby. She paid very little attention to dad at first.

At some point, dad went to the restroom.

I was busy tending to mom and baby when I heard a loud thud in the bathroom. My reflex was to run to the bathroom, and I was shocked! Dad had his pants around his ankles,

dinky out, was bleeding from a small cut on his forehead, and completely passed out.

Because we carry ammonia smelling salts on us, as it’s not uncommon for new moms to faint the first time getting out of bed, I grabbed one, snapped it, and held it under his nose.

He came to right away, really embarrassed!

After he pulled up his pants, I helped him into a wheelchair and took him to the ER to be seen. Luckily for him, he mostly sustained only a bruised ego!

—M.A.B., RN

Beauty Is in the Eye of the Beholder I was working on a 52-bed medsurg unit. One wing had four beds. In the middle of the night, I was walking this confused woman to the bathroom and woke up the other three patients.

The puzzled patient wanted to know why she was in a room with all men. I said, “They’re not men. They’re women.”

She responded, “Well, they are the three ugliest women I’ve ever seen!”

—S.G., RN

Modesty Is the Best Policy Most moms say that after having a baby, they no longer have any modesty. One time, I was working in obstetrics and caring for a mom and her new baby. The dad wasn’t around . . . or so I thought.

After I changed the baby’s diaper, I walked into the bathroom to wash my hands, and the father was right there, sitting on the toilet. I apologized quickly and closed the door.

When I returned to the room, I apologized to the mom for walking in on him. Her reply? “Now he knows how I feel!”

—J.D., RN

Not-so-Private Privates When I had my first baby, my water broke at home.

When I got to the hospital, they said they wouldn’t be checking my cervix very often to see how far I was dilated in order to prevent infection.

This was at a teaching hospital, and I was the only one in labor that day. As a result, tons of students and other people

www.minoritynurse.com

were coming in. My husband said, “If they weren’t going to check you often, I’d hate to see how many times you’d be checked if your water hadn’t broken.”

When yet another person came in to check on me, my husband got annoyed and blurted out forcefully, “Would you like to send the janitor in now? He’s the only one who hasn’t seen my wife’s crotch today!”

The nurse tactfully said, “Don’t worry. I’ll take care of it.”

She probably had to leave the room to keep from cracking up!

—J.D., RN Do you have a funny story to share? It can be something that happened to you at work, while in nursing school, while teaching nursing school—practically anywhere, as long as it involves the nursing field. If so, contact Michele Wojciechowski at MWojoWrites@comcast.net. We may use your story in a future issue.

Minority Nurse Magazine

39

@MinorityNurse

Academic Opportunities

SCHOOL OF NURSING

ADVANCE YOUR NURSING CAREER ONLINE

Access a rigorous, Christ-centered education in a convenient online format and gain advanced skills and knowledge for a deeper level of patient care. Choose from the following programs, available online or on campus: • RN to BSN • MSN in Healthcare Administration and Leadership • MSN in Nursing Education • Doctor of Nursing Practice (DNP)

Apply today! apu.edu/nursing Scholarships and financial aid available.

20249

40

Minority Nurse | FALL 2017

Academic Opportunities

LEADING THE WAY IN EDUCATION, RESEARCH AND PRACTICE – LOCALLY AND GLOBALLY MASTER YOUR CAREER PATH The programs at Johns Hopkins School of Nursing open doors for you as a nurse and unlock your potential as a leader. The power of choice defines the very best of career education. No matter which path you choose, our interdisciplinary approach provides you with the tools to address changing health care needs as well as your leadership goals.

Choose your path with a degree from the top-ranked Johns Hopkins School of Nursing Health Systems Management (MSN)* | Public Health Nursing (MSN) | MSN/MPH Joint Degree Advanced Practice DNP* | Executive DNP | PhD | Post-Graduate Certificates* *online options available

Learn More

nursing.jhu.edu/your_path

www.minoritynurse.com

Minority Nurse Magazine

41

@MinorityNurse

Academic Opportunities

42

Minority Nurse | FALL 2017

Academic Opportunities

Define Yourself

with a degree from IWU

SCHOOL OF NURSING BACHELOR’S DEGREES

BSN- Traditional 4-Year Program RN to BSN Transition to Nursing MASTER’S DEGREES

ASN- MSN • MSN- MBA MSN Post MBA MSN- Nursing Administration MSN- Nursing Education MSN- Primary Care (FNP) MSN- Psychiatric Mental Health Nursing DOCTORAL PROGRAM

Doctor of Nursing Practice (DNP) CERTIFICATE PROGRAM

Post Master’s Certificates

Online Nursing Programs SOME PROGRAMS ARE ALSO OFFERED

Onsite EDUCATION CENTERS IN

INDIANA OHIO KENTUCKY Not all programs are offered at onsite locations.

indwes.edu/nursing | 866.498.4968 www.minoritynurse.com

Minority Nurse Magazine

43

@MinorityNurse

Academic Opportunities

Are you ready to be a Pitt Nurse?

From Clinical Nurse Leader to Nursing Informatics, Pitt Nursing has many graduate programs to fit your needs, many now available fully online.

Visit nursing.pitt.edu/degree-programs or call 1-888-747-0794 for more information.

University of Pittsburgh School of Nursing 44

Minority Nurse | FALL 2017

Academic Opportunities

Learn. Care. Lead.

With one of the nation’s top nursing schools.

Ranked #8 DNP & #11 MSN, U.S. News & World Report Best Grad Schools

BSN • MN • MSN • DNP • PhD • DNP/PhD

Apply today at nursing.case.edu.

Waive your application fee with code 4080.

www.minoritynurse.com 171042_CWRU_Nursing_LCL_Ad_MinorityNurse_Fall2017.indd 1

Minority Nurse Magazine

45

@MinorityNurse 8/1/17 4:05 PM

Academic Opportunities

Take your next step at a school that embraces diversity and inclusion Diversity and inclusion are not just buzzwords at Vanderbilt University School of Nursing.

As part of Vanderbilt University, we’re deeply committed to a pursuit of excellence that recognizes, welcomes and values people with diverse backgrounds, views and abilities.

MSN Practice specialties for all interests Post-master’s certificates in all specialties for current MSNs

DNP

PhD Learn more. Apply today: http://vanderbi.lt/fubw7

Community of scholars with broad faculty expertise Distance learning Seamless MSN to DNP option Dedicated services for underrepresented students

46

Minority Nurse | FALL 2017

T E ACH IN G | P R AC T ICE | R E SE A R CH | IN F O R M AT IC S Vanderbilt is an equal opportunity affirmative action university.

Academic Opportunities

T

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

There is a true shortage of nursing educators—particularly minority nursing professors, who comprise a small percentage of nursing faculty overall. The American Association of Colleges of Nursing says the scarcity of professors may actually be stunting the growth of nursing programs. To counter this, nursing schools are improving the pay for nursing school faculty to increase their numbers, especially those who hold a doctorate.

This section of Minority Nurse is dedicated to open faculty positions from nursing schools all over the country. Requirements vary, but all are sure to lead to exciting, rewarding careers in nursing education and research.

www.minoritynurse.com

Minority Nurse Magazine

47

@MinorityNurse

Academic Opportunities

A

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.

Index of Advertisers ADVERTISER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE # Civilian Corps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2 Indian Health Service Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Elliot Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C3 Mercy Medical Center North Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 ACADEMIC OPPORTUNITIES Azusa Pacific University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Case Western Reserve University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Frontier Nursing University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4 Indiana Wesleyan University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Johns Hopkins School of Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Northeastern University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 U.S. Department of Justice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 UC Davis School of Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 University of Pittsburgh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Nursing Programs 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Vanderbilt University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

48

Minority Nurse | FALL 2017

MN_Fall17_R7.indd 48

8/29/17 2:25 PM

Nursing Opportunities Full-time, part-time and per diem Qualified applicants must be a graduate of an accredited school of Nursing, Bachelor’s of Nursing is preferred, and have clinical experience in an acute healthcare institution. A current license in the State of NH as a Registered Nurse is required.

Elliot Hospital is a 296-bed, acute care facility and Level II Regional Trauma Center distinguished by an extensive Primary Care Physician Network, Women’s Health Program, Geriatric Programs, and Regional Cancer Center.

Yo u r c a r e e r ’s b e s t c h o i c e .

www.elliotcareers.org

Become a Nurse-Midwife or Nurse Practitioner

Earn an MSN or DNP through our Innovative Encouraging diversity in nursing…

Distance Education Programs Distance Education Programs: Master of aScience in Nursing Become Nurse-Midwife or Nurse Practitioner Doctor of Nursing Practice

Earn an MSN or DNP ADN Bridge Entry Option through our Innovative Distance Education Programs Post-Graduate Certificate Distance Education Programs: Master of Science in Nursing Doctor of Nursing Practice “FNU values diversity and no ADN Bridge Entry Option matter what your background Post-Graduate Certificate

they find a fit for you and “FNU values diversity and no accommodate you very well.” matter what your background

frontier.edu/mn frontier.edu/mn

they find a fit for you and -Alesia Traeye, Family accommodate youNurse veryPractitioner well.”

Student -Alesia Traeye, Family Nurse Practitioner Student