Minority Nurse Magazine (Spring 2013)

The Career and Education Resource for the Minority Nursing Professional • SPRING 2013

Annual •C losing the Food Allergy Gap •G enetics and Genomics •D evelopments in the Fight Against HIV/AIDS • Automated Hospital Systems

www.minoritynurse.com

Salary Survey

Issue

Who would have thought? Dr. Charles Drew did in 1938. The Blood Bank, developed by Dr. Charles Drew,

is just one of the many life-changing innovations that came from the mind of an African American.

We must do all we can to support minority education today, so we don’t miss out on the next big idea tomorrow. To find out more about African American innovators and to support the United Negro College Fund, visit us at uncf.org or call 1-800-332-UNCF. A mind is a terrible thing to waste.

Š2007 UNCF

Don’t Miss Another Issue of

Minority Nurse!

America’s most respected publication for practicing minority nurses and nursing students is now available by individual subscription!

Minority Nurse is a must-read! Each issue comes to you packed with in-depth articles on hot topics in nursing, minority health issues, and profiles of outstanding minority nurse role models. Plus, advance your career with pages full of professional resources.

YES! I want a personal subscription to Minority Nurse magazine! Please send my one-year (4 issues) subscription for $19.95 to:

Payment Information (please check one payment option)

Name __________________________________

Credit Card #_________________________________ Expiration Date _____________

Address_________________________________

Verification # ________________ (last three digits on back of card)

_______________________________________

Name as it Appears on Card ________________________________________________

City ____________________________________

Cardholder Billing Address (only if different than subscription destination address)

State ______________ ZIP ________________

Name ________________________________________________________________

Phone __________________________________

Address_______________________________________________________________

Fax ____________________________________

City______________________________ State _______ ZIP ____________________

E-mail __________________________________

Signature of Cardholder___________________________ Date ____________________

q My check for $19.95 is enclosed (please make check payable to Springer Publishing Company) q Please charge $19.95 to my credit card (appears as a charge from Springer Publishing Company) Credit Card Type (please check one):

q MasterCard

q VISA

(required)

e Sav Off SuE r IS 70Th% E PEr PrICE E

CoV

Order personal or institutional subscriptions at

www.minoritynurse.com/subscriptions Fax or mail this completed form to: Circulation Dept., c/o Springer Publishing, 11 West 42nd Street, 15th Floor, New York, NY 10036 www.minoritynurse.com Minority Nurse Magazine @MinorityNurse Phone: 212-431-4370 · Fax: 212-941-7842

1

Table of Contents

In Every Issue

Cover Story

3

Editor’s Notebook

5

Vital Signs

9

Making Rounds

By Ciara Curtin

56

Index of Advertisers

Curious to find out if you are being paid what you’re worth? Check

10

2013 Annual Salary Survey

out the results of our first annual salary survey to determine

In the Spotlight 38 Lifting Up the Homeless

By Jebra Turner

In our new column, we highlight the accomplishments of three nurses seeking to make a difference in their communities

whether it’s time for a change in scenery (or specialty)

Features 16

Closing the Food Allergy Gap

By Pam Chwedyk Learn how to recognize and respond to food allergies and teach

Academic Forum 40 Administering Medications Safely and Effectively

By Rev. Steven K. Wheeler, MSN, RN Administering meds to a patient may seem like Nursing 101, but you don’t want to make this mistake

your community to do the same

22

The Future of Nursing: Genetics and Genomics

By Kimberly Bonvissuto With the advent of personalized medicine and the increased avail-

41 The Challenges of Caring for Older HIV/AIDS Patients

By Archana Pyati With the advancement of HIV/AIDS treatments, nurses must learn to go beyond providing palliative and endof-life care to the elderly population

ability of genetic tests, it will become crucial for you to learn how to deliver competent genetic- and genomic-focused care

27

Learn more about the latest drug treatments that bring us one step closer to eradicating this disease

Second Opinion 44 What’s on the Horizon for Health Care Reform?

By Leigh Page An examination of the hotly contested Affordable Care Act and its impact on minority communities

Developments in the Fight Against HIV/AIDS

By Terah Shelton Harris

32

The Benefits of Automated Hospital Systems

By Sonya Stinson Find out how the latest technology can improve the efficiency and outcomes of patient care at your workplace

46 Rehabilitation and Care of Immunosuppressed Elderly Patients

By Jeanette Centeno, RN With the incidence of immunosuppressed elderly patients on the rise, find out how to safeguard this vulnerable population 47 “Sugar” – A Preventable Disease with Devastating Consequences

By Ed James, MD Discover the benefits of adopting a plant-based, whole-food diet

2

Minority Nurse | SPRING 2013

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Closing the Gap

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

H

ave you ever wondered how your salary compares to someone of a different ethnicity who has the same level of education and experience as you? How do salaries of nurses living in the West compare to those in the Northeast? Is the increase in salary really worth the time and money involved in earning a PhD? Discussing salaries in the workplace is often considered taboo, and a Google search can only provide you with a general idea of how your salary stacks up in your field. That’s why Minority Nurse reached out to over 3,000 nurses across the country to get the inside scoop for you in our first annual salary survey. In honor of April being National Minority Health Month, our spring issue is also chock-full of the latest health news to equip you with the resources you need to help close existing disparity gaps.

Do you work with children? Would you know how to administer epinephrine to a child suffering from a severe allergic reaction? Because children from underserved groups are particularly vulnerable to food allergies, it’s crucial that nurses working with these young kids learn how to recognize and respond to severe allergic reactions. Pam Chwedyk gives you the know-how to take control in an emergency situation.

Since the completion of the Human Genome Project, we have made a lot of progress in the fields of genetics and genomics. But genetics may not have been part of your curriculum unless you are a recent graduate. All nurses owe it to themselves—and to their patients—to have a basic understanding of genetics so that they can easily identify highrisk patients. Consider becoming a genetic nurse specialist and you can learn firsthand how to help prevent a disease rather than just care for an existing one. Kimberly Bonvissuto highlights the important role genetics will play in patient care going forward.

As this issue went to press, news had just broken out that a baby had been cured of HIV. Read Terah Shelton Harris’ article to learn more about the latest developments in treating HIV/AIDS and help your afflicted patients live longer, fuller lives. Because an AIDS diagnosis is no longer an automatic death sentence, it should come as no surprise that the disease is increasingly common among the elderly. Archana Pyati and Jeanette Centeno investigate the challenges that come along with caring for an aging population.

Administering medications may seem second nature to you, but it often goes hand in hand with a patient’s good (or bad) prognosis. Reverend Steven Wheeler cautions you to switch off the autopilot and worry about more than just the proper dosage. Consider the bigger picture—including the patient’s diet, the patient’s other prescribed medications, and how they might interact—to avoid the types of errors Wheeler describes.

Are you burdened with piles of paperwork, but skeptical of technology? Check out Sonya Stinson’s article on the latest developments in health information technology and find out how these tools can help streamline your hospital’s workflow. Not only will they improve the quality of patient care, but they’ll also allow you to spend less time deciphering doctors’ scribblings and more time at the bedside. Now that’s what we call a win-win.

— Megan Hughes

SPRINGER PUBLISHING COMPANY President & CEO Theodore Nardin

Vice President & CFO Jeffrey Meltzer

MINORITY NURSE MAGAZINE Publisher James Costello Editor-in-Chief Megan Hughes

Creative Director Mimi Flow

Circulation Latoya Butterfield

Production Manager Diana Osborne Digital Media Manager Joey Stern Minority Nurse National Sales Manager Peter Fuhrman 609-689-1033 n Fax: 609-689-1034 pfuhrman@springerpub.com Minority Nurse Editorial Advisory Board Jose Alejandro, PhD(c), RN-BC, MBA, CCM, FACHE President National Association of Hispanic Nurses Teresita Bushey, MA, APR-BC Assistant Professor, School of Nursing The College of St. Scholastica Wallena Gould, CRNA, MSN Founder and Chair Diversity in Nurse Anesthesia Mentorship Program Constance Smith Hendricks, PhD, RN, FAAN Professor Auburn University School of Nursing Ed James, MD Founder and President Heal2BFree, LLC Sandra Millon-Underwood, PhD, RN, FAAN Professor University of Wisconsin, Milwaukee, College of Nursing

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

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

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

Subscription Rates: One year print subscription USA and Canada: Individuals, $19.95/year; Institutions, $35/year. 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.

For editorial inquiries and submissions:

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 U.S.). Single copy prices will be charged for replacement issues after that time.

For subscription inquiries and address changes:

Minority Nurse ® is a registered trademark of Springer Publishing Company, LLC.

editor@minoritynurse.com admin@minoritynurse.com

© Copyright 2013 Springer Publishing Company, LLC. All rights reserved. Reproduction, distribution, or translation without express written permission is strictly prohibited.

www.minoritynurse.com

Minority Nurse Magazine

@MinorityNurse

3

My child is going to college at Their tomorrow depends on your words today.

Help complete your child’s future by encouraging them to get a college degree. Call the Hispanic Scholarship Fund today at 1-877-HSF-INFO or visit YourWordsToday.org to learn more.

4

Minority Nurse | SPRING 2013

.

Vital Signs

Male Nurses Becoming More Commonplace The nursing profession remains overwhelmingly female, but the representation of men has increased as the demand for nurses has grown over the last several decades, according to a recent US Census Bureau report.

T

he new report indicates the proportion of male registered nurses has more than tripled since 1970, from 2.7% to 9.6%, and the proportion of male licensed practical and licensed vocational nurses has more than doubled from 3.9% to 8.1%.

The Men in Nursing Occupations report presents data from the 2011 American Community Survey to analyze the percentage of men in each of the detailed nursing occupations: registered nurse, nurse anesthetist, nurse practitioner, and licensed practical and licensed vocational nurse. The report also provides estimates on a wide range of characteristics of men and women in nursing occupations. These include employment status, age, race, citizenship, educational attainment, work hours, time of departure to work, median earnings, industry, and class of worker.

“The aging of our population has fueled an increasing demand for long-term care and end-of-life services,” says the report’s author, Liana Christin Landivar, a sociologist in the Census Bureau’s Industry and Occupation Statistics Branch. “A predicted shortage has led to recruiting and retraining efforts to increase the pool of nurses.

These efforts have included recruiting men into nursing.”

Men typically outearn women in nursing fields but not by as much as they do across all occupations. For example,

women working as nurses full time, year-round earned 91 cents for every dollar male nurses earned; in contrast, women earned 77 cents to the dollar men earned across all occupations.

Because the demand for skilled nursing care is so high, nurses have very low unemployment rates. Unemployment was lowest among nurse practitioners and nurse anesthetists (about 0.8% for both). For registered nurses and licensed practical and licensed vocational nurses, these rates were a bit higher, but still very low, at 1.8% and 4.3%, respectively.

Other Highlights: • There were 3.5 million employed nurses in 2011, about 3.2 million of whom were female and 330,000 male.

• Of the employed nurses

(both sexes), 78% were registered nurses, 19% were licensed practical and licensed vocational nurses, 3% were nurse practitioners, and 1% were nurse anesthetists.

• While most registered nurses (both sexes) left home for work between 5 a.m. and 11:59 a.m.

(72%), a sizable minority (19%) worked the evening or night shifts.

• The majority of registered nurses (both sexes) worked in hospitals (64%). The majority of licensed practical and licensed vocational nurses worked in nursing care facilities or hospitals (about 30% each). The percentages for hospitals and nursing care facilities are not significantly different from each other.

• In 2011, 9% of all nurses were men while 91% were women. Men earned, on average, $60,700 per year, while

www.minoritynurse.com

women earned $51,100 per year.

• Men’s representation was highest among nurse anesthetists at 41%.

• Male nurse anesthetists earned more than twice as much as the male average for all nursing occupations: $162,900 versus $60,700.

The American Community Survey provides a wide range of important statistics about people and housing for every community across the nation. The results are used by everyone from town and city planners to retailers and homebuilders.

The survey is the only source of local estimates for most of the 40 topics it covers, such as education, occupation, language, ancestry, and housing costs for even the smallest communities. For more information, visit www.census.gov/acs/www.

Minority Nurse Magazine

@MinorityNurse

5

Vital Signs

National Survey Shows Hispanic Mothers Want Support for their Infant Feeding Choices Hispanic mothers want to continue making their own Key Findings infant feeding decisions and they want unrestricted • 62% of Hispanic mothers access to infant feeding information, according to a have already decided how to feed their babies before enterrecent national survey. The new survey also shows that ing the hospital.

Hispanic mothers in the United States do not agree with • 79% of Hispanic mothers hospital or government policy that limits their access to get infant feeding information educational information on infant formula and samples from their doctors and nurses.

• Hispanic moms reported during their hospital stay.

T

he nationally representative survey of mothers with children under 12 months was conducted by the bipartisan team of Greenberg Quinlan Rosner Research (GQRR) and Public Opinion Strategies and sampled opinions of more than 1,000 moms (210 of whom identified as Hispanic).

“Hispanic mothers are tell-

ing us that they want to feel supported by hospitals and health care providers whether they choose to breastfeed or formula feed,” says Anna Greenberg, Senior Vice President at GQRR. “Being fully informed is important to moms, and they trust hospitals to not restrict their access to infant feeding information and formula samples.”

Create your own legacy.

not being able to produce enough breast milk, having to go back to work or school, and the cost of a breast pump as the three biggest barriers to feeding their baby breast milk.

• 93% of Hispanic mothers said restricting the use of formula in the hospital would not have changed their decision on whether or not to breastfeed or how long they breastfed.

• 91% of Hispanic mothers approve of hospitals giving out hospital discharge bags with infant formula samples, and 83% said they used the samples they were given.

• 72% of Hispanic mothers opposed hospital policies that restrict hospital discharge bags with infant feeding information and infant formula samples, and 82% opposed government restrictions on hospital discharge bags.

“The National Association of Hispanic Nurses (NAHN) believes that breastfeeding is the ideal infant feeding choice.

However, we also believe it’s important that moms receive information on both breastfeeding and infant formula,”

Portland, Oregon

Whether we realize it, our legacy is something we create every time we interact with our patients, their families or our colleagues.

It is the way we live the values of medicine. It is what we do, and why we do it.

At Legacy Health, our legacy is doing what’s best for our patients, our people, our community, and our world. Our fundamental responsibility is to improve the health of everyone and everything we touch - to create a legacy that truly lives on.

Legacy Health places a high priority on building a culture that values diversity in how we work with each other, how we deliver care and how we partner with our community and how we do business.

We believe we have an opportunity to differentiate ourselves in the market we serve. We are coming from a position of strength.

We have demonstrated our commitment to diversity by our partnerships in the communities we serve, in the way we do business with vendors, in the way we build our workforce, and in the way we treat our patients and their families.

Portland, Oregon is one of the top cities in the United States for quality lifestyle with choices for trendy urban or family friendly suburban living. Located along the Columbia River and Cascade Mountains and 90 minutes from the Pacific Ocean to the west and Mt. Hood to the east, Portland is pet-friendly, bike-friendly, and one of the top cities for sustainability in the country.

As we consider qualified candidates, we are committed to building a culture that values diversity and is reflective of those we care for.

For current openings please visit our website, www.legacyhealth.org/jobs, or contact a Legacy Recruiter at 503-415-5405. www.legacyhealth.org/jobs

6

Minority Nurse | SPRING 2013

AA/EOE

Vital Signs

says Jose Alejandro, President of NAHN. “According to the new survey, only 55% of Hispanic moms polled reported receiving educational material on infant formula. Hispanic mothers that do not receive information on safe preparation and use of formula may be at a disadvantage.”

When asked what actions could help increase breast-

feeding in the United States, 24% of Hispanic mothers said, “guaranteeing paid maternity leave or longer maternity leave” and 28% of Hispanic mothers who received health and nutrition assistance through Women, Infants, and Children said, “providing more support from health care professionals after mothers leave the hospital, including

home visits following birth.”

Hispanic moms also said they would like more breastfeeding support in the workplace.

“These are areas where health care providers, the government, and employers could do more to support Hispanic mothers to increase breastfeeding initiation and duration rates,” Alejandro adds.

Hispanic mothers identi-

fied a number of other barriers that either prevented them from initiating or continuing breastfeeding—the most common of which include the inability to produce enough milk and problems associated with breastfeeding (e.g., sore or cracked nipples, engorged or leaking breasts, breasts infected or abscessed).

“Many Hispanic mothers want to breastfeed,” states Greenberg, “but oftentimes they realize that when it’s time to go back to work, continuing to exclusively breastfeed and maintain their milk supply can be difficult without adequate support.”

For more information, contact Celia Trigo Besore, MBA, CAE, Executive Director & CEO, National Association of Hispanic Nurses, director@thehispanicnurses.org.

JOIN A COMMUNITY THAT CARES

R

WE ARE HIRING

GEO employs top-notch talent, offers amazing benefits, promotes safety, and prepares inmates for re-entry into society.

NURSES NATIONWIDE

SCAN TO APPLY ONLINE

The GEO Group, Inc. (GEO) is the world’s leading provider of correctional, detention, and community re-entry services.

866.301.4436, EXT 5863 | www.geogroup.com | www.jobs.geogroup.com Equal Opportunity Employer

www.minoritynurse.com

Minority Nurse Magazine

@MinorityNurse

7

Vital Signs

Hospitals Report Reductions in Some Types of Health Care-Associated Infections Hospitals in the United States continue to make progress in the fight against central line-associated bloodstream infections and some surgical site infections, according to a recent report issued by the Centers for Disease Control and Prevention (CDC). Catheter-associated urinary tract infections remained unchanged between 2010 and 2011.

“Reductions in some of the deadliest health care-associated infections are encouraging, especially when you consider the costs to both patients and the health care system,” says CDC Director Tom Frieden, MD, MPH. “This report also suggests that hospitals need to increase their efforts to track these infections and implement control strategies that we know work.”

The report examined data submitted to the National Healthcare Safety Network, CDC’s premiere infection tracking system, which receives data from more than 11,500 health care facilities across all 50 states, Washington, DC, and Puerto Rico. The number of infections reported was compared with data from 2010, as well as with a national baseline.

Patrick Conway, Chief Medical Officer of the Center for Medicare & Medicaid Services (CMS) says, “The significant decrease in central line and surgical site infections means that thousands of patients avoid prolonged hospitalizations and the risk of dying in the hospital. Providers, working with CDC and CMS, are fulfilling Medicare’s

8

Minority Nurse | SPRING 2013

quality measurement reporting requirements for hospital infections and demonstrating that, together, we can dramatically improve the safety and quality of care for patients.”

• A 41% reduction in central line-associated bloodstream infections since 2008, up from the 32% reduction reported in

was not evident for all procedure types, and there is still substantial opportunity for improvement across a range of operative procedures.

• A 7% reduction in catheter-associated urinary tract infections since 2009, which is the same percentage of reduction that was reported in 2010. While there were modest reductions in infections

2010. Progress in preventing these infections was seen in intensive care units (ICUs), wards, and neonatal ICUs in all reporting facilities. A central line is a tube that is placed in a large vein of a patient’s neck or chest to give important medical treatment.

When not put in correctly or kept clean, central lines can become a route for germs to enter the body and cause serious bloodstream infections.

• A 17% reduction in surgical site infections since 2008, up from the 7% reduction reported in 2010.This improvement

among patients in general wards, there was essentially no reduction in infections reported in critical care locations.

Catheter-associated urinary tract infections among ICU patients are an area of significant concern because patients who get these infections are more likely to need antibiotics. While antibiotics are critical for treating bacterial infections, they can also put patients at risk for other complications, including a deadly diarrhea caused by the bacteria Clostridium difficile.

The CDC reported for 2011:

As part of the National Action Plan to Prevent Healthcare-Associated Infections that was established in 2008, the Department of Health and Human Services has set goals for reducing central line-associated bloodstream infections, catheter-associated urinary tract infections, and surgical site infections by December 2013. The data included in this report indicate that steady progress is occurring towards the goal of a 50% reduction in central line-associated bloodstream infections and a 25% reduction goal for surgical site infections over the course of five years. Although progress towards the 25% reduction goal for catheter-associated urinary tract infections is moving more slowly, with sustained prevention efforts, the 2013 goal remains attainable.

The federal government has a number of ongoing efforts to protect patients and improve health care quality. The Partnership for Patients initiative focuses on protecting patients in America’s health care facilities through the prevention of hospital-acquired conditions.

Federal initiatives, including Partnership for Patients, the National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination, CMS Quality Improvement Organizations, and the Comprehensive Unitbased Safety Program funded by the Agency for Healthcare Research and Quality, aim to accelerate the prevention progress happening throughout the country.

Making Rounds

April

June

July

16-20

5-8

16-19

33rd Annual Conference: Oceans of Possibilities Norfolk Waterside Marriott Norfolk, Virginia Info: 800-278-2462 E-mail: info@ahna.org Website: www.ahna.org

39th Annual IMAGE Conference Hyatt Regency Minneapolis Minneapolis, Minnesota Info: 913-895-4627 E-mail: nahcr@goAMP.com Website: www.nahcr.com

International Society of Psychiatric-Mental Health Nurses 6th Annual Psychopharmacology Institute Conference, 15th Annual ISPN Conference Hyatt Regency Hill Country Resort and Spa San Antonio, Texas Info: 866-330-7227 E-mail: conferences@ispn-psych.org Website: www.ispn-psych.org

21-24

Contemporary Forums Obstetric Nursing Conference New Orleans Marriott Hotel New Orleans, Louisiana Info: 800-377-7707 E-mail: info@cforums.com Website: www.contemporaryforums.com

May 2-4

American Nursing Informatics Association Navigating the River of Data to Wisdom San Antonio Marriott Rivercenter San Antonio, Texas Info: 866-552-6404 E-mail: ania@ajj.com Website: www.ania.org

20-23

American Association of Critical-Care Nurses The National Teaching Institute & Critical Care Exposition Boston Convention Center Boston, Massachusetts Info: 800-899-2226 E-mail: info@aacn.org Website: www.aacn.org

American Holistic Nurses Association

National Association for Health Care Recruitment

12-16

24-28

26th Annual Meeting & Scientific Conference Los Angeles Airport Marriott Los Angeles, California Info: Dr. Sallie Tucker Allen, 630-969-0221 E-mail: drsallie@gmail.com Website: www.abnf.net

34th Annual National Convention Renaissance Hotel Cleveland, Ohio E-mail: info@mypnaa.org Website: www.mypnaa.org

15-19

July 31 - August 4

Annual Conference Gaylord Opryland Resort and Convention Center Nashville, Tennessee Info: 800-673-8499 E-mail: customerservice@awhonn.org Website: www.awhonnconvention.org

41st Annual Conference: Advancing the Profession of Nursing Through Education, Practice, Research and Leadership Hyatt Regency New Orleans New Orleans, Louisiana Info: 800-575-6298 E-mail: contact@nbna.org Website: www.nbna.org

Association of Black Nursing Faculty, Inc.

The Association of Women’s Health, Obstetric and Neonatal Nurses

19-22

International Family Nursing Association 11th Annual Conference: Honoring the Past, Celebrating the Future Hyatt Regency Minneapolis Minneapolis, Minnesota Info: 412-344-1414 E-mail: debbie@internationalfamilynursing.org Website: www.internationalfamilynursing.org

www.minoritynurse.com

Philippine Nurses Association of America

July / August National Black Nurses Association

August 6-9

National Association of Hispanic Nurses 38th Annual Conference Crowne Plaza Hotel New Orleans, Louisiana Info: 202-387-2477 E-mail: info@thehispanicnurses.org Website: http://nahnnet.org

Minority Nurse Magazine

@MinorityNurse

9

2013 Annual Salary Survey

BY CIARA CURTIN While there is a range in how much nurses earn, nurses reported making more money this year than they earned five years ago. Respondents to the first annual Minority Nurse salary survey reported an overall current median salary of $67,000 and said they had a median salary of $60,000 five years ago. Furthermore, many, though not all, employers also offer benefits, most commonly health insurance and a retirement plan.

Number of Respondents:

3,051 Ethnicity 3%

4%

2%

H

1%

8% 55%

27%

■ White/Non-Hispanic ■ African American ■ Hispanic or Latino/Latina ■ Asian ■ Other ■ Multiracial ■ Native American

Gender 10% 90%

■ Female ■ Male

10

Minority Nurse | SPRING 2013

owever, those values encompass all regions of the United States as well as a variety of specialties and other factors, including ethnicity and education.

For example, respondents living in the West reported the highest median salary, $74,250, while respondents living in the Midwest reported the lowest median salary at $63,000.

To gather all this data, Minority Nurse and Springer Publishing e-mailed a link to an online survey that asked respondents some 18 questions to characterize their educational backgrounds, main roles as nurses, and employer type, as well as to ascertain their current and past salaries. More than 3,000 nurses responded to this sur-

vey, representing every US state and the District of Columbia.

The respondents also correspond to a broad swath of the profession, with nurses working in administrative roles or performing research as well as nurses tending to patients at their bedside in the NICU or in a psychiatric clinic.

Breaking the data down reveals some key differences in salary levels.

Median salary also varied by ethnic background. People of white/non-Hispanic backgrounds earned a median $71,119, followed by people of Asian descent making a median $64,000 and African Americans reporting a median $60,500. Hispanic or Latino/ Latina nurses reported a median salary of $58,000 and Native American nurses earned

a median salary of $60,000.

Additionally, people who identified as multiracial reported earning $50,000 as the median.

Education also affected salaries as respondents with higher levels of education reported earning more in income. For instance, nurses with a bachelor’s level degree commanded a median salary of $65,000, while nurses with a master’s level degree said they earned a median salary of $70,000.

In addition, nurses with an advanced practice nursing specialization reported a median salary of $84,000. However, nurses with a medical-surgical specialization said they made a median salary of $55,000.

The good news: Nearly all respondents reported earning more than they did just five years ago.

Regions (%)

Employment Status (%)

4.6%

2.4%

2.4%

0.3%

8.5%

16.6% 38% 17%

86.4%

23.8%

■ South ■ Midwest ■ Northeast

■ West ■ Outside the US

■ I am employed full time ■ Other ■ I am employed part time ■ I am unemployed, and I have ■ I am unemployed, but I am stopped looking for a job looking for a job

Employer Type (%)

Years at Current Job (%)

0.8%

1.3% 2.4% 1.3% 13.2%

25.7%

0.5%

4.3% 7.8%

20.5%

■ Three to five years ■ Less than a year

Main Role (%) 3.2%

2.7%

43.7%

12.9%

24.3%

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

19.7%

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

■ Home healthcare service ■ Walk-in clinic ■ Public school ■ Health insurance/HMO/MCO ■ Health dept/public health ■ Correctional facility ■ Military ■ Pharmaceutical/Research company

Reason for Leaving Prior Job (%)

1.1% 3.4%

3.2%

1.6%

1.2%

8.4%

7.6% 40.3%

10.3%

12.9%

29.4%

■ Education ■ Patient care ■ Leadership/Management ■ Administrative

0.7%

2.8%

16.3%

5.3%

0.7%

1.2%

54.3% 15%

■ Other ■ Case management ■ Research ■ Triage

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

www.minoritynurse.com

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

Minority Nurse Magazine

@MinorityNurse

11

Median Salary by Region

Northeast

West

$70,000 ($64,000 five years ago)

$74,250 ($65,000 five years ago)

Midwest

$63,000 ($58,000 five years ago)

South

$65,000 ($56,925 five years ago)

Median Salary by Region and Ethnicity West

African American

Midwest South Northeast

Asian

West South

West Hispanic or Latino/Latina

Midwest South Northeast

West Midwest White/Non-Hispanic South Northeast $0

$10,000

$20,000

■ Salary Five Years Ago ■ Current Salary

12

Minority Nurse | SPRING 2013

$30,000

$40,000

■ Salary Five Years Ago ■ Current Salary

$50,000

$60,000

■ Salary Five Years Ago ■ Current Salary

$70,000

$80,000

■ Salary Five Years Ago ■ Current Salary

Median Salary by Education Level

Median Salary by Main Role

$100,000

$100,000

$80,000

$80,000

$60,000

$60,000

$40,000

$40,000

$20,000

$20,000

$0

e

at

r to

’s

er

t as

oc

$0

’s

te

a ci

ge

As

n

tio

ia Tr

so

c Ba

M

D

’s

or

l he

■ Salary Five Years Ago ■ Current Salary

h rc

ea

a uc

s Re

Ed

t en

ti

Pa

Median Salary by Employer Type

en

m ge

na

a

C

t

en

M

e

as

■ Salary Five Years Ago ■ Current Salary

t

e

ar

C

na

a

M

p/

i sh

m ge

i

m

Ad

n

io

at

tr

s ni

er

ad

Le

Median Salary by Specialty $100,000

$80,000

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

$50,000

$60,000

$40,000 $40,000

$30,000

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

$0

l

oo

lic

h Sc

b

Pu

ty

si

r ve

ni

o

rC

ic

ge

le

ol

-in

k

al W

e

U

H

om

H

■ Salary Five Years Ago ■ Current Salary

re

ca

th

l ea

es

e

ic

lin

C

v er

S

si

ng

ur

N

om

e

at

iv

Pr

e

ic

ct

H

a Pr

e

at

iv

Pr

l

ta

pi

os

H

ic

bl

Pu

$0

l

ta

pi

os

lth

H al

t

en

at

hi

c sy

P

ed

Pr

e

tic

ac

M

/ ric

ng

si

ea

H

ur

nc

a dv

se

M

d

ie

tif

er

ur

u Ed

)

U

IC

U

IC

,P

,S

,M

U

IC

N

U

IC

e

ar

■ Salary Five Years Ago ■ Current Salary

r

to

ca

a

ic

ed

u l-S

C

A

www.minoritynurse.com

al

ic

rg

N

(N

a

ic

rit

lC

C

Minority Nurse Magazine

@MinorityNurse

13

Median Salary by Ethnicity African American

Asian

Hispanic or Latino/Latina

Multiracial

Native American

White/Non-Hispanic

$0

$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000

■ Salary Five Years Ago

■ Current Salary

Median Salary by Education and Ethnicity Associate’s

Bachelor’s

Master’s

Doctorate

$0

$10,000

$20,000

■ White/Non-Hispanic

$30,000

$40,000

$50,000

■ Hispanic or Latino/Latina

$60,000

■ Asian

$70,000

$80,000

$90,000

$100,000

■ African American

Median Salary by Organization and Ethnicity College or University

Nursing Home, LTC, or Rehabilitation Center

Private Hospital

Public Hospital, Including Veteran’s or Indian Affairs Hospitals

$0

$10,000

$20,000

■ White/Non-Hispanic

14

Minority Nurse | SPRING 2013

$30,000

$40,000

$50,000

■ Hispanic or Latino/Latina

$60,000

■ Asian

$70,000

$80,000

$90,000

■ African American

$100,000

Looking to Leave Job in Coming Years (%)

49.1%

Highlights • 23.2% of respondents have a PhD or other doctoral-level degree

50.9%

• 43.7% work at a college or university • 50.0% have been at their current job for five years or longer ■ Yes

• 63.2% received a raise within the last year

■ No

• 54.3% left prior job to pursue a better opportunity • 45.2% do not expect a raise this year • 49.1% are looking to leave their current job in coming years

Timing of Last Raise Received (%) 7.8%

14.3%

63.2%

14.7%

Five Most Common Specialties • Critical care (NICU, PICU, SICU, MICU) • Certified Nurse Educator • Medical-surgical

■ Last year ■ Three to five years ago

■ Two years ago ■ More than five years ago

Percentage of Last Raise (%) 6%

• Advanced practice nursing • Psychiatric/mental health

Highest Paid by Employer Type • Private hospital

4%

• Private practice

28%

62%

• University or college • Public hospital • Walk-in clinic

■ 1-2% ■ 3-4%

■ More than 5% ■ 5%

Raise Expected This Year (%) 2%

2%

• Health insurance • Retirement plan (401(k), 403(b), pension, etc.)

• Dental insurance

18% 45% 33%

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

Most Common Benefits Provided • Paid time off • Sick leave

■ 3-4% ■ 5% ■ More than 5%

www.minoritynurse.com

Minority Nurse Magazine

@MinorityNurse

15

Closing Foo losing thetheFoo

BY PAM CHWEDYK Minority children have higher rates of food allergy than their white counterparts, yet they’re less likely to receive the treatment they need to manage their condition and avoid potentially life-threatening allergic reactions. Nurses can play a key role in serving up interventions that will help take food allergy disparities off the menu.

“F

ood allergy doesn’t discriminate,” proclaims a poster from the national nonprofit organization FARE (Food Allergy Research and Education). But even though allergies to foods such as peanuts, milk, fish, eggs, wheat, soy, shellfish, and tree nuts affect some 15 million Americans of all ages, races, and ethnicities, a growing body of scientific evidence shows that food allergy does affect some populations disproportionately— and children of color are at

16

Minority Nurse | SPRING 2013

particularly high risk.

According to a recent study published in the Journal of Allergy and Clinical Immunology, minority children and children from low-income families are more likely to have undiagnosed and untreated food allergies than their majority and/ or more affluent peers.1 “What’s interesting about food allergy is that we tend to see it more in mid- to highincome Caucasian kids,” says the study’s lead author, Ruchi Gupta, MD, MPH, an associate professor of pediatrics

at Northwestern University’s Feinberg School of Medicine in Chicago. “So one big question I had was: Is food allergy really less prevalent in minority and low-income kids or are we just not diagnosing it in them?”

Other recent studies reveal similarly troubling findings: • Black and Asian children have significantly higher odds of having a food allergy than Caucasian youngsters.2 • Between 1997 and 2007, Hispanic children had the greatest increase in parent-reported food allergies, compared with

kids from other ethnic groups.3 • Black children are twice as likely as white children to have peanut and milk allergies and four times as likely to be allergic to shellfish. Unlike some other food allergies, which children tend to outgrow, shellfish and peanut allergies are more likely to continue into adulthood, creating a lifelong risk.3,4 FARE calls food allergy “a growing public health concern” that currently affects one in 13 children and adolescents in the United States. Symptoms

od Allergy Gap Ga od Allergy of an allergic reaction to food may include itching, coughing, sneezing, swelling of the mouth and throat, vomiting, stomach cramps, skin rash, diarrhea, trouble breathing, and loss of consciousness. The severity of reactions can range from mild to life-threatening.

In its most dangerous form, a food allergy attack can result in anaphylaxis, a rapid-onset whole-body reaction that can be fatal if the child is not immediately treated with the drug epinephrine.

because there’s a need for more awareness about these allergies in communities of color? Or are the usual socioeconomic suspects that so often contribute to health disparities—such as cultural and linguistic barriers, limited financial resources, and unequal access to quality medical care—also a factor?

have access to a primary care provider, they may take it into their own hands and just try to make sure their child avoids the food. But there are also many parents who just don’t discuss their child’s food allergy with their clinician, because they’re unaware that there is any kind of treatment or plan

FARE calls food allergy “a growing public health concern” that currently affects one in 13 children and adolescents in the United States.

Why the Disparities?

If food allergies are more common in racial and ethnic minority children, why do these kids have a lower chance of being diagnosed? Is it simply

“It could be a little of both,” says Gupta, who is also a pediatrician at Ann & Robert H. Lurie Children’s Hospital of Chicago. “If the family doesn’t

that would help the child.”

Cynthia Samuel, RN, MS, PhD(c), a school nurse at Grove Street Elementary School in Irvington, New Jersey, believes

www.minoritynurse.com

one of the biggest culprits is “just not being educated about food allergies—not knowing what signs to look for and what to do should symptoms occur.

In some instances, the family may think the child will outgrow the allergy, so they don’t do anything until it becomes more complex to treat or so severe that they have no other option but to take the child to the emergency room.”

Still, another reason for the underdiagnosis is that health care professionals don’t always know what to look for either, says Karen Rance, DNP, RN, CPNP, AE-C, a pediatric nurse practitioner at Allergy, Asthma, & Clinical Immunology Associates in Indianapolis. “Overall, there’s room for improvement

Minority Nurse Magazine

@MinorityNurse

17

in helping health care providers recognize the symptoms of food allergy,” she explains.

“There are so many moving parts with that diagnosis that often the symptoms can be very subtle.”

What Nurses Can Do Nurses—including pediatric nurses, allergy nurses, school nurses, camp nurses, public health nurses, and nurse practitioners—can make a tremendous difference in helping to level the playing field for minority children with food allergies. Because nurses are the professionals who are most often responsible for health teaching, says Gupta, they can play a crucial part in educating patients, families, caregivers, and even entire communities about everything from understanding the risks to handling anaphylaxis emergencies.

“It’s critical that parents and kids get educated about things like how to choose safe foods and how to read food [ingredient] labels in stores,” she em-

high risk for food allergies, to seek [those] educational opportunities,” says Rance. Fortunately, there’s no shortage of information available to bring you up to speed, from NIH clinical guidelines and professional association websites (see “Resources” sidebar) to books like The Health Professional’s Guide to Food Allergies and Intolerances, published by the Academy of Nutrition and Dietetics.

Kids and families must also learn how to administer the epinephrine that could potentially save the child’s life if he or she were to have a severe reaction, Gupta continues.

“Nurses should all know how to use an epinephrine autoinjector, and they should have a practice device available to teach with,” she says. “You can show [parents] a video demonstration, but that’s not going to help in an emergency situation. Unless they have practiced holding the auto-injector, popping the top off, and sticking [the needle] in, they’re not

Nurses—including pediatric nurses, allergy nurses, school nurses, camp nurses, public health nurses, and nurse practitioners—can make a tremendous difference in helping to level the playing field for minority children with food allergies. phasizes. “Nurses also need to make sure families know that food allergy is serious and that it will have a major impact on their lives.”

But before they can teach others, nurses must become knowledgeable about this health issue themselves. “We need to encourage nurses and nurse practitioners, especially those who care for children at

18

Minority Nurse | SPRING 2013

going to feel comfortable trying to inject their child.”

For community education, nurses can tap into national outreach programs such as Food Allergy Awareness Week (sponsored by FARE) and Anaphylaxis Community Experts (ACEs). The award-winning ACEs program, developed by Allergy & Asthma Network Mothers of Asthmatics in

trained 20 teachers to use epinephrine auto-injectors.

The School Nurse’s Role In its most recent position statement on allergy and anaphylaxis management in the school setting, the National Association of School Nurses states that “the registered professional school nurse [must be] the leader in a comprehensive approach [that] includes planning and coordination of care, educating staff, providing a safe environment, and ensuring prompt emergency response should exposure to a lifethreatening allergen occur.”

Gupta couldn’t agree more.

“School nurses are going to become more and more critical in caring for children with

“

“School nurses are going to become more and more critical in caring for children with food allergies,” Gupta says. “The students are in school all day, and food is a part of everything they do. Between breakfast, lunch, snacks, holiday treats, et cetera, there’s a ton of exposure to foods at school.”

“

partnership with the American College of Allergy, Asthma & Immunology, sends teams of health professionals into communities to increase awareness of anaphylaxis and conduct free seminars on treating and preventing anaphylactic episodes.

At South Bay Allergy & Asthma Associates in Torrance, California, staff nurses Ruena Mantes, BSN, RN, PHN, Lisa Lin, BSN, RN, and Anna Chocholek, BSN, RN, PHN, are actively involved in their local ACE team. They host workshops for parents, schools, employees of area businesses, and other community groups about how to recognize and respond to food allergy emergencies.

Last summer, the nurses visited a nearby preschool where they

—Ruchi Gupta, MD, MPH

food allergies,” she says. “The students are in school all day, and food is a part of everything they do. Between breakfast, lunch, snacks, holiday treats, et cetera, there’s a ton of exposure to foods at school.”

Samuel points out that in economically disadvantaged communities of color, school nurses can play a unique role in closing the gap of food allergy disparities by serving as

www.minoritynurse.com

an entry point into the health care system. “Many of these families don’t have the time, money, or transportation resources to easily reach doctors,” she explains. “By having the school nurse there, at least the student and the family have someone they can turn to who understands them and is familiar with their cultural background.”

If a student with an undi-

Minority Nurse Magazine

@MinorityNurse

19

Food Allergy Resources for Nurses, Patients, Families, and Communities • The National Institute of Allergy and Infectious Diseases

(www.niaid.nih.gov), one of the National Institutes of Health, provides free clinical guidelines for health care professionals on the diagnosis and management of food allergies.

• FARE (www.foodallergy.org) offers patient handouts, posters, videos, allergen-free recipes, and more, plus research grants and information on clinical trials.

• The American Academy of Allergy, Asthma, & Immunology

(www.aaaai.org), American College of Allergy, Asthma & Immunology (www.acaai.org), and Asthma and Allergy Foundation of America (www.aafa.org) all provide a wealth of food allergy information, much of it also available in Spanish.

• Allergy & Asthma Network Mothers of Asthmatics (www.

aanma.org) has two national community awareness programs that nurses can implement locally: Anaphylaxis Community Experts (ACEs) and Epi Everywhere! Every Day!TM School-Based Anaphylaxis Preparedness: Policies in Practice.

• The National Association of School Nurses (www.nasn.

org) has developed an extensive online tool kit to help nurses manage food allergy in the school setting, including checklists, forms, anaphylaxis action plans, and staff training materials.

• AllergyHome (www.allergyhome.org) provides food allergy teaching tools for schools, camps, and families. Linguistically competent resources include a food allergy action plan available in Spanish, Chinese, Somali, Hmong, Korean, and Vietnamese.

• Allergy Ready (allergyready.com) offers How to C.A.R.E.TM for Students with Food Allergies: What Educators Should Know, an interactive online course for school personnel.

20

Minority Nurse | SPRING 2013

agnosed food allergy suddenly has an allergic reaction at school, “the school nurse can bring the family in and use that as a teachable moment for initiating a health care plan for that child,” Samuel says. “And in the case of a severe reaction, the school nurse may be able to administer emergency epinephrine or at least call an ambulance to get the child to an emergency room.”

Providing referrals for allergy testing is another way school nurses can make it easier for minority students to get the diagnosis and treatment they need. “I had a case involving a student who would eat lunch at school and get a stomachache every day,” says Beverly Horne, RN, BSN, MPH, a lead school nurse for Chicago Public Schools’ South Cluster magnet schools. “I was able to contact the girl’s mother to find out if this was also happening at home. I referred the student to a pediatrician who did the workup on her and found that she was having [allergy] problems with some of the foods that were being served at school.”

In addition, school nurses can take the lead in helping their institutions develop food allergy policies and action plans.

“One of the things I did at my school was that I colorcoded the lunch cards for all of the kids with food allergies,” says Samuel. “A green smiley face indicates an allergy to milk and dairy products; a yellow smiley face means ‘allergic to peanuts,’ and so on. When the student gives his or her card to the lunch aides, they know right away that this is what this child is allergic to. I also faxed this

information to the food service company that supplies our school. We implemented this safety measure in 2011 and it’s had an extremely high success rate.”

Food Allergy Advocacy One of the most empowering contributions nurses and nurse practitioners can make to the fight against food allergy disparities is helping minority and low-income families find resources and support systems. For instance, families who live in impoverished, food desert communities may have difficulty locating and affording allergen-free or lowallergen foods, which are often expensive.

“We just did a study on the economics of food allergy,” reports Gupta, who is the author of the book The Food Allergy Experience (www.foodallergyexperience.com), a guide for families, caregivers, and teachers of food-allergic kids.

“It found that ‘special foods for your child’ was one of the biggest out-of-pocket costs for these families.”

Nurses can bridge this gap by letting families know that financial assistance options are available. “For those parents who are on a limited income and yet their child presents with a challenging and complex food allergy diagnosis, [I] will refer them to the children’s hospital in our area, which has a nutrition department,” says Rance.

“The parents’ Medicaid insurance will pay for a nutrition consult.”

She also informs her patients who have access to the federally funded Special Supplemental Nutrition Program for Women, Infants,

Lunch Card Allergy Color Codes Green Smiley Face: Milk/Dairy/Cheese Yellow Smiley Face: Peanut Butter/Nuts

Ruchi Gupta, MD, MPH

Pink Smiley Face: Citrus/Fruits Blue Smiley Face: Catsup/Tomatoes Cynthia Samuel, RN, MS, PhD(c)

Samuel’s color-coded school lunch cards.

and Children (WIC)—which serves low-income mothers and children up to age five who are at nutritional risk— that WIC will cover the cost of certain specialty foods, such as soy-based milk and amino acid-based infant formulas for children who are allergic to milk products.

Nurses can also be advocates by urging their federal, state, and local lawmakers to support legislation that could provide greater protection for all children with food allergies. One example is the federal School Access to Emergency Epinephrine Act (S. 1884/H.R. 3627), which was introduced into Congress in late 2011. If passed, this legislation would give states incentives to adopt laws allowing schools to maintain a supply of stock epinephrine

auto-injectors that could be administered to any student in the event of an anaphylaxis emergency. For more information, visit www.foodallergy. org/advocacy/school-access-toepinephrine.

In underfunded school districts that have cut back on staff to reduce costs, nurses must work together to make the case that hiring a full-time nurse at every school is not a luxury but a lifesaving necessity, says Samuel.

“If a district has only one or two school nurses, those nurses need to come together and get on the same page,” she stresses. “They have to pool their documentation so they can say, ‘On a given day, I see this many kids with food allergy problems,’ or ‘I had four occurrences this month in which students had an allergic reac-

tion or went into anaphylactic shock.’ [Then they can] pull all this data together and come up with a report [that summarizes the need]. You really have to present the evidence, because that’s what’s going to support the potential hiring of another school nurse. If people don’t recognize food allergy as a problem or a challenge, it’s not going to be treated as such.”

Jan;131(1):150-6.

2. Gupta RS, Springston EE, Warrier MR, et al. The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States. Pediatrics.

2011;128(1):e9-e17.

3. Liu AH, Jaramillo R, Sicherer SH, et al. National Prevalence and Risk Factors for Food Allergy and Relationship to Asthma: Results from the National Health and Nu-

Pam Chwedyk is a freelance

trition Examination Survey 2005-

health care writer based in Chi-

2006. J Allergy Clin Immunol. 2010

cago. She is a former editor of

Oct;126(4):798-806.e14.

Minority Nurse.

4. Food Allergy & Anaphylaxis References

Network. Food Allergy Facts and Statistics for the U.S. http://www.

1. Gupta RS, Springston EE, Smith

foodallergy.org/page/facts-and-

B, Pongracic J, Holl JL, Warrier

stats. Accessed October 29, 2012.

MR. Parent report of physician diagnosis in pediatric food allergy.

J Allergy Clin Immunol. 2013

www.minoritynurse.com

Minority Nurse Magazine

@MinorityNurse

21

The Future of Nursing: Genetics and Genomics

BY KIMBERLY BONVISSUTO The completion of the Human Genome Project in 2003 gave scientists access to the complete genetic blueprint for human beings. A decade later, genetic and genomic scientific advances are coming at warp speed, placing nurses on the frontlines in educating, counseling, and supporting patients through the informed decision-making and consent process.

22

Minority Nurse | SPRING 2013

G

enetics—the study of single genes and their effects—and genomics—the study of the functions and interactions of all genetic material in the genome—are integrated into every aspect of health care, from screening and diagnosis to management and treatment of illness. And the increased availability of direct-to-consumer marketing of genetic tests is making the primary care office ground zero for demand for information.

This increased access to genetic information carries baggage, including navigating ethical challenges associated with maintaining privacy and facilitating decision-making concerning undergoing genetic testing. Add to that the advent of personalized medicine, and the demand for nurses with a background in genetics and genomics will only increase, according to experts in the field.

What is a Genetic Nurse Specialist?

A genetic nurse specialist is a licensed professional nurse with specialized education and training in genetics. Genetic nurses perform risk assessments, analyze the genetic aspects of disease risk, and work with individuals and families on managing their health.

A Genetic Clinical Nurse (GCN) is a licensed registered nurse with specialty credentialing from the Genetic Nursing Credentialing Commission. GCNs work with patients and families affected by genetic conditions. According to the National Human Genome Research Institute (NHGRI), a GCN’s job duties include taking detailed medical histories, assessing for the presence of

genetic and non-genetic disease risk factors, and managing patients’ genetic health care needs.

An Advanced Practice Nurse in Genetics (APNG) is a licensed registered nurse with a master’s degree with specialty credentialing who provides care to patients afflicted with genetic conditions. Patients are generally referred to APNGs, who perform detailed assessments, build family histories, develop care plans, diagnose medical conditions, prescribe treatments, and offer genetic counseling. They often also conduct research, write informational articles, and coordinate community health resources.

Both GCNs and APNGs work in outpatient clinics, hospital settings, university/academic health care centers, and public and private research facilities.

They also can be found in specialty genetic clinics, prenatal and reproductive technology centers, cancer centers, and primary care practices. And they can serve as resources for others trying to achieve basic genomic competencies.

petent genetic- and genomicfocused nursing care.

Kathleen Calzone, PhD, RN, APNG, FAAN, a senior nurse specialist/researcher in the Genetics Branch of the National Cancer Institute (NCI)’s Center for Cancer Research, is a cochair of the Genetic/Genomic Nursing Competency Initiative, a national initiative that established nursing workforce competencies in genetics and genomics. She is among those pushing to educate all nurses about the importance of genetics and genomics in health care.

Calzone worked with Jean F. Jenkins, PhD, RN, FAAN, a senior clinical advisor in the Genomic Healthcare Branch of the NHGRI, to develop the Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators, which establishes nursing competencies that apply to all nurses who are not genetic specialists. The competencies define the basic information and understanding of genetics and genomics that all nurses need to operate in the real world.

As the influx of genetic and genomic information redefines the health care landscape, professional nursing organizations and higher education institutions are making the push to prepare the roughly 3.1 million licensed nurses to deliver competent genetic- and genomic-focused nursing care.

Educating the Masses As the influx of genetic and genomic information redefines the health care landscape, professional nursing organizations and higher education institutions are making the push to prepare the roughly 3.1 million licensed nurses to deliver com-

“We can’t do everything, but if we can provide foundational knowledge and understanding, the generalist nurse can identify high-risk persons and refer them to a genetic counselor or genetics nurse specialist,” says Jenkins.

Sandra Daack-Hirsch, PhD,

www.minoritynurse.com

RN, an assistant professor at the University of Iowa’s College of Nursing, says nursing programs are all over the spectrum in their offerings in the field of genetics, but more and more are building programs with genetics and genomics in mind.

“We are recognizing that genetics is becoming a tool for all care providers,” says DaackHirsch, adding that genetics is integrated into the curriculum at all levels in Iowa’s College of Nursing.

Jenkins and Calzone worked with the American Association of Colleges of Nursing (AACN), which accredits baccalaureate and graduate nursing education programs, and the National League for Nursing, which grants Certified Nurse Educator certification through the Academic Nurse Educator Certification Program, to update educational goals. Calzone says the effort has been successful in having genetics and genomics integrated into the AACN baccalaureate and, more recently, master’s degrees in nursing for schools accredited by the Commission on Collegiate Nursing Education, AACN’s accrediting arm.

According to Calzone, there are huge opportunities in the field to become both a faculty member and a practitioner with a focus on genetics. Right now, there is a very small cadre of providers with a specialty in genetics.

“I think we’re at the stage of relevancy,” says Jenkins of the nursing profession. “There are some pockets of resources, such as champions of knowledge in our discipline leading the way in what goes into the curriculum.

“I think it’s beginning to make a difference to patient

Minority Nurse Magazine

@MinorityNurse

23

• The typical salary range is $43,410 to $92,240, with median income at about $62,450.

• Credentialing for both Genetic Clinical Nurses (GCNs) and Advanced Practice Nurses in Genetics (APNGs) is offered by the Genetic Nursing Credentialing Commission.

• GCNs must be RNs with a bachelor’s degree from an accredited nursing program. They must have completed a minimum of 50 genetic cases in the preceding five years and have 45 contact hours of genetic content within three years of application.

• APNGs must be RNs in good standing with a master’s degree from an accredited graduate nursing program. They must have a letter of recommendation verifying skills, extensive clinical practice experience, proof of continued education in genetics, written genetic case studies, and evidence of professional achievement.

• Both credentials are valid for five years.

Source: Genetic Nursing Credentialing Commission

24

Minority Nurse | SPRING 2013

care, but it’s going to take a few years. Identifying what’s of value in a practice is just the beginning.”

Calzone recently worked with the National Institute of Nursing Research to identify a blueprint for what research needs to be conducted looking at nursing outcomes.

“There are a lot of gaps in genomic understanding,” says Jenkins, adding that it has taken awhile for nursing, as a profession, to recognize the importance of genomics and genet-

“

ics. “Scientific discoveries will make huge differences in the next three to five years.”

The Journal of Nursing Scholarship, the official journal of The Honor Society of Nursing, Sigma Theta Tau International, is helping to address the education deficits in the nursing community. In March 2013, the journal devoted an entire issue to genetics and genomics in nursing.

Genetics in Practice Calzone says the reality is that genetics and genomics

“

Genetic Nursing At a Glance

There are a lot of gaps in genomic understanding, says Jenkins, adding that it has taken awhile for nursing, as a profession, to recognize the importance of genomics and genetics.

are moving into practice at a remarkably rapid pace. The difference is that the majority of health providers did not have genetics as a basic science unless they graduated recently, so their capacity to understand the literature and integrate those findings into practice is more compromised.

“In these settings, this is really hard for people to learn because they haven’t had it and don’t have a foundation. They have to learn a whole new science sufficient enough to understand and absorb what you need to know and teach in a way people will understand,” says Calzone.

According to a recent study published in the Journal of Nursing Scholarship, more than 70% of nurses felt it was important to pursue genetic education; however, over 80% rated their current knowledge of genetics as poor or fair.

Calzone and Jenkins are now working with a $300,000 grant from the National Council of State Boards of Nursing in collaboration with Laurie Badzek, JD, RN, a professor at the West Virginia University School of Nursing and the director of ANA’s Center for Ethics & Human Rights, to train educators and administrators at Magnet-designated hospitals to boost nurses’ awareness of genetics’ role in patient care.

The two-year grant, awarded in 2011, is being used to establish a program for improving genetics literacy. Calzone says they chose Magnet hospitals because of the infrastructure already in place for education and research, and benchmarks of being cutting-edge.

“The addition of administrators is critical. If you have people taking something as

simple as family history and teach people how to do it and what to do with that information, but the electronic health records doesn’t allow for documentation of that and offers no support for that, you haven’t accomplished anything,” says Calzone. “The ability to sustain practice change dissipates because there is no way to document or do anything with the information collected.

“You have to have administrators have a sufficient understanding to know the decisions they are involved in play a role in the practicing community,” Calzone continues. “You can’t just focus solely on the active practitioner. You have to focus on the whole player in the health care setting.”

The yearlong initiative will end this fall, at which time the group will determine if they were able to effect change in the practice environment.

Jenkins says she is committed to preparing others to become aware of, plan for, and integrate genetic concepts into clinical practice. She and Calzone were instrumental in the Genetics/ Genomics Competency Center, which is a resource repository mapped to the competencies.

That work led to the creation of the Global Genetics/Genomics Community, which provides unfolding case scenarios used by faculty and in the practice setting for continuing education efforts.

Susan Tinley, PhD, RN, CGC, former President of the International Society of Nurses in Genetics, and an associate professor emeritus at Creighton University, recently worked on the Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees, a competency resource for advanced

Genetics and Genomics Nursing Resources • Cincinnati Children’s Hospital Medical Center (www.cincinnatichildrens.org) offers a Genetics Education Program for Nurses, which provides access to continuing education as well as instructional resources to help nursing faculty add genetics and genomics content to their curricula. Cincinnati Children’s also hosts the Web-Based Genetics Institute, an 18-week teacher-facilitated online offering.

• Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators, which was developed by an independent panel of nurse leaders, guides nurses in the application of their professional skills and responsibilities.

• GeneTests (www.genetests.org) lists the availability of genetic/ DNA testing, searchable by disease, and promotes the appropriate use of genetic services in patient care and personal decision-making. A Genetic Testing Registry is now available at

www.ncbi.nlm.nih.gov/gtr.

• The Genetic Nursing Credentialing Commission (www.geneticnurse.org) is the credentialing agency for APNGs and GCNs. • The International Society of Nurses in Genetics (www.isong. org) is a global nursing specialty organization dedicated to promoting the scientific and professional growth of nurses in human genetics and genomics worldwide.

• The National Coalition for Health Professional Education in Genetics (www.nchpeg.org) is an organization dedicated to promoting health professional education and access to information about advances in human genetics.

• The National Human Genome Research Institute (www.genome.gov) offers a variety of genetics educational materials and information.

• The National Institute of Nursing Research (www.ninr.nih. gov) sponsors the Summer Genetics Institute, a tuition-free, one-month, intensive research training program at the National Institutes of Health in Bethesda, Maryland.

• The New England Research Institutes (www.nursingethicsce. com) offer web-based nursing ethics continuing education programs for practicing RNs.

www.minoritynurse.com

Minority Nurse Magazine

@MinorityNurse

25

Everyone in the business of genetics is sensitized to protecting patients, says Coleman. practice nurses. Tinley says it’s been fascinating to watch the developments and progress of genetics over the years.

It’s become imperative for nurses to understand the genetic components of diseases, according to Tinley. She adds that genomics impacts all levels of nursing practice, and it is every nurse’s responsibility to understand the basics of genetics and genomics and to stay informed.

She says the Internet is full of resources, including webpages from every institute within the National Institutes of Health, Oncology Nursing Society, the NCI, and the American Cancer Society.

Cynthia A. Prows, MSN, CNS, a genetics clinical nurse specialist in the Division of Human Genetics at Cincinnati Children’s Hospital Medical Center, realized there was a need for nursing education in genetics and genomics after talking to families—and the nurses caring for them.

Prows began offering a Genetics Resource Nurses Program at Cincinnati Children’s Hospital in 1992 with two-day workshops and preceptorships.

When she saw how the Human Genome Project was expanding and the basic level at which nurses were coming into her program, she wrote a grant application to the Ethical, Legal, and Social Implications Research Program of the NHGRI. She was funded to create a Genetics Education Program for Nurses to target nursing faculty across the country. While the 12-day summer institute was popular, attendance began to

26

Minority Nurse | SPRING 2013

wane as faculty shortages and workloads increased.

Prows received additional funding from NHGRI and cofunding from US Department of Health and Human Services’ Health Resources and Services Administration, Nursing Division, to create the online version of the summer institute in 2002. The Web-Based Genetics Institute was expanded to include both nursing faculty and nurses in practice. While the programs were primarily designed to help practicing nurses and faculty function in or expand on their current roles, some have continued on to careers in nursing genetics.

“I really see that the nursing expansion will be in that direction, where APNs who are already specialists in their field will then expand their role to focus on the genetic aspects— not just use genetics, but to focus on that,” Prows says. “I think that will be the area of growth.”

Ethical Challenges Ethics is always at the forefront of genetics, according to Bernice Coleman, PhD, ACNP, a research scientist in the Division of Nursing, Department of Nursing Research and Development, and a nurse practitioner in the Ventricular Assist Device Program at Cedars-Sinai Heart Institute in Los Angeles, California. The specialty of genetics, she says, is actually growing faster than the ethical underpinnings that need to support it.

Everyone in the business of genetics is sensitized to pro-

tecting patients, says Coleman.

While the Genetic Information Nondiscrimination Act of 2008 provides clear protections, it’s difficult to see what’s around the corner.

“Right now, things are covered, but it’s clear the science is moving rather rapidly,” Coleman says, adding that nursing will be involved in the genetic revolution. “It’s not a stagnant environment, as it relates to ethics. Always to be ready for the implications for the next piece of genetic information that comes through and how that’s applied, that’s what the specialty is focusing on.”

For example, Jenkins says a lot of work is being done in pharmacogenetic testing and identifying genetic variation to determine how different individuals metabolize the same drug. She says whole genome sequencing and technology is moving at such a quick pace there will soon be the ability to look at a person’s whole genome. The question, she says, becomes who interprets that information and at what point in a person’s life—at birth? At age 21?

“Policy issues on privacy and workforce development need to happen quickly because this is projected to be available any day,” says Jenkins. “Nurses need to be at the policy table to make decisions about who has access, when it happens, and what do you tell individuals and families experiencing this health care transformation.”

The Future As science moves at lightning pace to provide earlier disease detection, increase opportunities for prevention, and develop more targeted personalized medicine, all areas of nursing will be impacted. The nursing profession, as a whole, needs to continue to move forward by pursuing continuing education, demanding curriculum that prepares future nurses, and claiming a seat at the policy table with other health care professionals to ensure equal access to genetic information and genomic health care services.

Kimberly Bonvissuto is a freelance writer based in Cleveland, Ohio.

Developments in the Fight Against HIV/AIDS

BY TERAH SHELTON HARRIS

Since the first identification of AIDS in 1981, and the eventual discovery of HIV two years later, HIV/AIDS has become a dominant global public health priority with a wide range of humanitarian and economic implications.

A

ccording to the World Health Organization, nearly 70 million people have been infected with the HIV virus since the beginning of the epidemic, and approximately 35 million people have died of AIDS since the 1980s. The Centers for Disease Control and Prevention (CDC) estimates that there

are approximately 1.3 million people in the United States who are infected with HIV. While those statistics are alarming, it is important to acknowledge how far we have come in the fight against HIV/ AIDS in the last three decades.

“For those of us that have worked in HIV/AIDS over the past 20 years it’s almost im-

possible to imagine where we are now,” says Liza Solomon, MHS, DrPH, an HIV/AIDS public policy leader and a principal associate at Abt Associates.

“Treatments were rudimentary and there seemed to be very little that medicine could offer.”

Since that time, new drugs have become available, medications have improved, side

www.minoritynurse.com

effects have lessened, and death rates have declined. Even more, AVERT, an international HIV and AIDS charity, estimates that in 2008 alone, over $15 billion was spent on HIV and AIDS compared to $300 million spent in 1996. This money from donor governments, low-income and middle-income country governments, the private

Minority Nurse Magazine

@MinorityNurse

27

sector, and individuals has helped fund research and treatments as well as fuel scientific advances in the fight against HIV/AIDS. Scott Kim, MD, Medical Director for HIV Medicine at AltaMed Health Services, believes that new developments not only attest to the tremendous importance of governmentfunded basic science research, visionary pharmaceutical leaders, strong public advocates, and a federal government committed to extending care to all HIV-infected patients, but confirms that we have gone from a disease with a life expectancy that was barely a few years to a chronic disease with a long life expectancy.

28

Minority Nurse | SPRING 2013

Simply put, an HIV/AIDS diagnosis is no longer the automatic death sentence it was once considered.

“We can now speak of HIV/ AIDS as a chronic disease, and for the first time, researchers and public health practitioners talk about an AIDS-free world,” Solomon says. “It is clearly not here now, but there is the sense that perhaps we can hope to achieve that within the foreseeable future.”

Research and Medications Medications have changed significantly since combination antiretroviral drugs (ARVs) were first available in 1996.

The development of ARVs— medications for the treatment

of infection by retroviruses like HIV—has resulted in greater control of the disease and a prolonged, better quality of life for those infected.

Recent clinical studies have proved conclusively that individuals who are on effective antiretroviral treatments are significantly less likely to transmit HIV to an uninfected partner. The clinical trial called HPTN 052 (HIV Prevention Trials Network) showed a 96% reduction in transmission from individuals infected with HIV to their uninfected partner.

JoAnn D. Kuruc, MSN, RN, a program manager in the AIDS Clinical Trials Unit at the University of North Carolina (UNC) at Chapel Hill, believes research related to HIV and treatments for the disease is responsible for the great strides achieved in the development of medications over the last 30 years.

In the past, HIV drug treatments consisted of a large number of pills taken at multiple points throughout a day.

Today, treatments have improved greatly, resulting in minimal side effects and requiring fewer pills—and in some cases—just one pill per day.

“Research in the drug development has led to more options, allowing individuals with severe side effects or drug resistance to switch to different medication regimens,” Kuruc says. “Years ago, there was only one class of drug available to treat a person with HIV infection, but now this has increased to five different mechanisms or classes of drugs.”

Pre-Exposure Prophylaxis Kali Lindsey, Director of Legislative and Public Affairs at National Minority AIDS Council, reports a swarm of new biomedical interventions resulting from investment in research—including scientific advances such as treatment as prevention and pre-exposure prophylaxis—that have provided exciting new tools to combat the spread of HIV.

Simply put, an HIV/AIDS diagnosis is no longer the automatic death sentence it was once considered.

“Not only was it challenging to remember to take the pills, but the sheer volume that you had to swallow was an obstacle to overcome,” says Kuruc.

Additionally, side effects (nausea, vomiting, and diarrhea) associated with early medications were themselves a barrier to adherence and compliance. Kim says toxicities associated with frequent dosing included lipodystrophy, kidney stones, hepatic inflammation, diarrhea, and nausea.

The CDC defines pre-exposure prophylaxis, or PrEP, as a new HIV prevention method in which people who do not have HIV infection take a pill daily to reduce their risk of becoming infected.

“Pre-exposure prophylaxis is the use of an antiretroviral drug in HIV-negative individuals who engage in behaviors that place them at heightened risk for acquiring HIV,” says Amesh Adalja, MD, FACP, an infectious diseases physician

at the University of Pittsburgh Medical Center. “By taking anti-HIV medications prior to exposure, they substantially decrease the risk of acquiring HIV if they are exposed.”

The pill contains medicines that prevent HIV from making a new virus as it enters the body and helps keep the virus

infection by roughly 62% overall in the study population of uninfected, heterosexual men and women. The Partners PrEP study also found that daily doses of TDF/FTC or daily doses of tenofovir alone reduced HIV transmission among heterosexual serodiscordant couples (in which one partner is infected

“Few scientific and medical challenges are as daunting and complex as the attempts to develop a cure for HIV infection,” says Kuruc. from establishing a permanent infection. If used effectively and by persons at high risk, PrEP has been shown to reduce the risk of HIV infection.

According to the CDC, in July 2011, researchers announced the results of the TDF2 study that found a oncedaily tablet containing tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) reduced the risk of acquiring HIV

with HIV and the other is not) by 73% and 62%, respectively.

The CDC is also evaluating PrEP’s effectiveness in preventing HIV infection among individuals exposed to HIV through injecting drugs, but those results are not yet available.

Eradicating HIV Reservoirs While drug treatment has not provided an actual cure,

research is now honing in on ways to eradicate the remaining reservoirs of HIV from infected individuals whose HIV is fully suppressed by therapy.

Research focused on eradication is still in the early phases, and much of the analysis and data to date has been obtained from ex vivo studies, as well as a few Phase I clinical trials, Kuruc explains.

Highly active antiretroviral therapy (HAART) is capable of suppressing HIV viral replication in the body; however, it is incapable of eradicating the virus. When HAART is stopped, viral replication reemerges. The viral rebound stems from virus that exists in latent reservoirs.

There may be distinct sites throughout the body that function as “latent cell reservoirs,” perhaps in the lymphoid tissue, the gastrointestinal tract, or the central nervous system.

Virus is also known to persist in CD4 cells (T cells) that are in the resting, or quiescent state,

www.minoritynurse.com

found either in the blood or in tissue.

“One of the first steps in developing a cure involves the identification, activation, and elimination of the resting CD4 cells from the reservoir and getting the virus released,” Kuruc says. “Once expressed from the cells, the patient’s current HAART would inhibit new infection from occurring.”

Kuruc adds that scientists are looking at various ways to express the virus from the latently infected cells. Stimulating key areas of the cell that are known to play integral parts in HIV storage (chromatin) or transcription (P-TEFb, or the NF-kB proteins) have been the focus of much of this research.

One approach proposed to stimulate HIV-1 expression is the use of a histone deacetylase (HDAC) inhibitor. Suberoylanilide hydroxamic acid (SAHA), or Vorinostat, is one HDAC inhibitor that is getting much attention in this field. In 2006,

Minority Nurse Magazine

@MinorityNurse

29

Vorinostat was approved by the Food and Drug Administration for the treatment of cutaneous T-cell lymphoma. A recent ex vivo study confirmed the ability of the drug to disrupt latently infected cells. David Margolis at UNC, in a proof of concept study, demonstrated a significant increase in the expression of viral RNA when SAHA was given in a clinical trial.

“Although this was an enormous breakthrough, research still needs to determine: if the reservoirs are depleted; if the cells die after releasing the virus; and if the drug is safe to take for an extended period of time without any adverse effects,” Kuruc says.

Kuruc explains that once the virus is released by the latent cell, eradication of the virus and obliteration of the cells remain a concern. Recent ex vivo research illustrated that viral expression from the latent cell may not lead to cell death.

Thus, it may be necessary to combine the activation and expression of the virus from the latent cell (SAHA) with other therapies.

“Few scientific and medical challenges are as daunting and complex as the attempts to develop a cure for HIV infection,” says Kuruc. “The progress made so far in understanding the complex biology of HIV infection and the stunning achievements of HAART should give us hope that we can overcome the recognized and the yet-to-bediscovered challenges of persistent, latent HIV infection.”

Vaccines Vaccines will lead the upcoming fight against HIV, says Robert McNally, PhD, President and CEO of GeoVax, a biotechnology company developing

30

Minority Nurse | SPRING 2013

human vaccines for diseases caused by HIV and AIDS. So far, the results have been encouraging. In 2009, Sanofi Pasteur, the vaccines division of Sanofi-Aventis, participated in a preventive vaccine trial that lowered the rate of HIV infection by 31.2%. The trial, involving more than 16,000 adult volunteers in Thailand, demonstrated that an investigational HIV vaccine regimen was safe and modestly effective in preventing HIV infection.

“Albeit modest, the reduction of risk of HIV infection is statistically significant. This is

with a substantial scientific lead for an effective preventive vaccine, thanks to the door opened by the Sanofi Pasteur trial. “This glimmer of hope for an effective vaccine has paved the way for biotech companies like GeoVax to gain traction with the next generation of products.”

Currently, McNally reports that human clinical trials for the preventive use of the GeoVax HIV/AIDS vaccine found that their vaccines were well tolerated with no or mild, local and systemic reactions in the majority of trial participants

“The single largest barrier to HIV/AIDS services in this country, whether prevention or care, is lack of access to quality, affordable health care,” says Lindsey.

the first concrete evidence, since the discovery of the virus in 1983, that a vaccine against HIV is eventually feasible,” says Michel DeWilde, R&D Senior Vice President for Sanofi Pasteur, in a 2009 press release.

McNally says GeoVax is also at the forefront of this effort,

and that 80% of both low and full dose trial participants responded to the vaccine, which stimulated antiHIV T cells (white blood cells) and antibody responses.

“The goal is to produce a vaccine like the one for polio where large portions of the atrisk population could be vac-

cinated; thus, over time, the incidence of HIV will decline to the point where the vaccine will hopefully become unnecessary,” he says.

HIV Testing Decades ago, HIV testing initially consisted of a series of blood tests that took several weeks for the results. Now HIV testing has become easier and more accessible with rapid testing where the test results are available within 45 minutes.

“Newer blood testing techniques currently being marketed not only allows for quicker turnaround of test results but is sensitive enough to detect HIV prior to the body developing antibodies to the virus, thus having persons diagnosed in the earliest stages of the disease (known as the acute phase); [and] therefore, allowing individuals to be diagnosed and treated prior to the virus doing severe damage to the immune system,” says Kuruc.

Solomon says that researchers at Abt Associates are working on two different projects with the goal of educating individuals about HIV, making HIV testing available, and linking individuals into care. The first project involves working with minority serving institutions (colleges or universities that serve predominantly minority students) to develop HIV prevention programs for their students.

“The nursing school at Florida International University’s program is designed to train nursing students to be peer educators and provide HIV prevention education while at school,” Solomon says. “The students are a resource to their

peers while they are students, and will develop skills regarding HIV testing and prevention that they will utilize in their future role as practicing nurses.”

Abt Associates’ other HIV project involves a large effort to provide HIV testing to minority men who have sex with men and do not know their HIV serostatus. The goal is to identify 3,000 previously undiagnosed HIV positive men and link them into care.

“We are working with community-based organizations and academic institutions throughout the country to implement this three-year testing and linkage program.

A critical component of this program is to bring HIV testing to non-traditional settings so that individuals who may

not routinely interact with the medical care system have access to testing,” says Solomon.

Patient Protection and Affordable Care Act While the developments in biomedical research over the last few years has been exciting to witness, nothing is as critical to the fight against the HIV/AIDS epidemic than the passage and now implementation of the Patient Protection and Affordable Care Act (ACA), according to Lindsey.

“The single largest barrier to HIV/AIDS services in this country, whether prevention or care, is lack of access to quality, affordable health care,” says Lindsey. “While not perfect, the ACA will go far to providing such access, both through its insurance

A Man’s Guide to a Nursing Career Chad O’Lynn, RN, PhD

$30.00 | October, 2012 232 pp | Softcover ISBN: 9780826106858

11 West 42nd Street, 15th Floor, New York 10036 | P: 212 431 4370

exchanges and its Medicaid expansion. Its patient’s bill of rights will also help ensure that people living with HIV or AIDS cannot be discriminated against by insurance companies through rescission or denial of coverage based on preexisting conditions.”

Currently, only about 13% of people living with HIV/ AIDS have access to private insurance. What’s more, less than 30% have achieved viral suppression through adherence to a treatment regimen.

Another 20% of people living with HIV are not even aware that they carry the virus. Minorities not only have higher rates of infection, but also suffer significantly poorer health outcomes, including increased mortality.

With more than 56,000 new HIV infections in the United States each year, the AIDS epidemic is far from over. And www.minoritynurse.com

despite better treatments, there is still no cure. Lindsey believes that expanding access to health care is the single most important thing our nation can do to both improve health outcomes for those living with HIV/AIDS while also working to bring an end to the epidemic itself.

“For the first time in over thirty years,” says Lindsey, “it is possible to realistically envision an end to HIV/AIDS. But ending this epidemic will not be easy. It will require bold, visionary leadership and the commitment of all of us to successfully translate the promise of this moment into a world without HIV/AIDS. Science and research have given us powerful tools; now we must decide to act.”

Terah Shelton Harris is a freelance writer based in Alabama.

Minority Nurse Magazine

@MinorityNurse

31

The Benefits of Automated Hospital Systems

BY SONYA STINSON 32

Minority Nurse | SPRING 2013

The pace is picking up in the movement of hospitals toward automated tracking of health records, medications, and patient care. Who better than nurses—with their intimate, on-the-ground expertise—to lead the way?

H

ospitals are tapping into a variety of computer and telecommunications technologies to help improve the efficiency and outcomes of patient care.

The success of these high-tech systems depends greatly on how readily the staffs adapt to them and how easily they fit into the existing workflow.

Nurses with training in informatics are playing a vital role in tailoring health information technology (HIT) to meet the needs and goals of their workplaces, as well as educating fellow clinicians in how to use it.

Speedier Information Access The Affordable Care Act is giving many hospitals the nudge to trade the traditional hand-scribbled chart notations for electronic records.

“It’s going to be mandated by the federal government, so the hospitals cannot be sustained without medical information systems,” notes EunShim Nahm, PhD, RN, FAAN, who is an associate professor and Program Director of Nursing Informatics at the University of Maryland School of Nursing.

Hospital nurses who have been leaders in the early adoption of electronic health records (EHR) say the new systems save time and make it easier for health care providers to share information with each other and their patients.

As Chief Nursing Officer for NorthShore University HealthSystem in Illinois, Nancy T. Semerdjian, MBA, RN, CNABC, FACHE, was in charge of implementing the hospital’s

electronic medical records system. One of the most welcome improvements to come from the system, which she and her team began installing 10 years ago, was the automatic reporting of data from doctor visits, laboratory tests, and other patient encounters throughout the hospital.

“You didn’t have to wait for a paper to print somewhere or get a fax sent to the unit,” says Semerdjian, who adds that authorized clinicians can access patient records remotely using a key fob.

At Ann and Robert H. Lurie Children’s Hospital of Chicago, families of patients can apply for access to an online portal that lets them view their records online, including their latest test results and upcoming appointments, says Karen Carroll, PhD, RN, NEA-BC, Director of Nursing Informatics and Innovations.

The EHR system at Fletcher Allen Health Care in Burlington, Vermont, has enabled the oncology department to create a seamless patient care record that includes visits to doctors’ offices, ambulatory centers, and the hospital, says Anne Ireland, MSN, RN, AOCN, CENP, Director of Clinical Practice and Innovation.

“What we had before were disparate systems in all of those locations,” says Ireland, who previously led the EHR implementation across all departments at the hospital. “One place didn’t know what the other knew, because they all kept their own records.”

Medical device integration (MDI) is a technology help-

ing to speed up and enhance the safety of data sharing. MDI systems capture information from the medical instrumentation hooked up to patients and automatically send updates to the patients’ electronic records.

“We’re automating that clinical documentation piece, so the nurse no longer has to manually transcribe the device data—therefore eliminating the risk of transcription error,” says Mary Carr, RN, Chief Nursing Officer for iSirona, a MDI software company headquartered in Panama City, Florida. “As a clinician, you gain more time for direct care and ultimately improve patient outcomes.”

The US Department of Veterans Affairs (VA) has become a world leader in the application of telehealth technology to improve patient care and education, and the VA aims to

ers in remote locations.

Patients participating in home telehealth take home a device called a Health Buddy that enables them to record and send information about their vital signs and symptoms.

At the hospital, several nurses and a nurse practitioner regularly review the data, and the patient’s medication can be adjusted accordingly.

The program currently focuses on the treatment of uncontrolled diabetes, uncontrolled hypertension, depression, heart failure, and COPD, and the hospital plans to add telehealth programs for smoking cessation and palliative care, according to Simon.

With clinical video telehealth, patients go to the nearest VA clinic and sit in front of a video monitor. A clinician at the Houston medical center provides long-distance consultation, while a clinical technician at the local site is on hand to assist the patient.

Data from the video encounter

The Affordable Care Act is giving many hospitals the nudge to trade the traditional hand-scribbled chart notations for electronic records.

double its program’s reach to 825,000 veterans by the end of 2013. At the Michael E. DeBakey VA Medical Center in Houston, telehealth is part of a two-pronged HIT system that also includes secure messaging for patient e-mails, says Omana Simon, DNP, RN, FNP-BC, the facility telehealth coordinator. Components of the program include home telehealth, clinical video telehealth, and a store-and-forward process for relaying information to provid-

www.minoritynurse.com

is automatically added to the patient’s medical record.

Improving Patient Care “Many studies have shown that [the telehealth programs] have improved the patients’ quality of life, patient satisfaction, and clinical outcomes,” says Simon, who notes, for example, that blood sugar and blood pressure results have improved, while the number of ER visits and unscheduled clinic visits has decreased.

Minority Nurse Magazine

@MinorityNurse

33

NorthShore University HealthSystem puts its electronic records system to use in managing chronic illnesses,

upon this message—go out and see the patient and work with the nurses on the floor to come up with the best treatment pro-

“Many studies have shown that [the telehealth programs] have improved the patients’ quality of life, patient satisfaction, and clinical outcomes,” says Simon, who notes, for example, that blood sugar and blood pressure results have improved, while the number of ER visits and unscheduled clinic visits has decreased. for example, by generating automatic checklists for patients admitted with congestive heart failure, Semerdjian says.

“When the patient is discharged, we make sure the patient has a follow-up visit with their physician, that they receive instructions in medications, and that they know to weigh themselves every day,” she says. “Those are the kinds of things that, in the paper world, you just didn’t have.”

The Mayo Clinic in Rochester, Minnesota, uses Fair Isaac Corporation’s Blaze Advisor® business rules management system to create pop-up warnings for the prevention of pressure ulcers.

“If certain pressure ulcer conditions are met, the Blaze rule will pick up on it and send a message to a clinical nurse specialist, who will then act

34

Minority Nurse | SPRING 2013

cess,” says Bob Kirchner, RN, MSN, MBA, an informatics nurse specialist at the Mayo Clinic.

Medication delivery is another target area for enhancement through HIT. The Mayo Clinic has been using barcode medicine administration for the past two years, and Kirchner says the evidence shows the system has prevented medication errors.

Nikita Cowan, RN, a charge nurse and the interim manager in the Acute Med Surgical Unit at Texas Health Presbyterian Hospital in Dallas, says barcoding is the most significant automation tool the hospital has implemented in the last few months. Like Kirchner, she touts the system for reducing errors.

“It just builds that extra barrier of protection and safety for

the patient and for the nurse,” Cowan says.

Fletcher Allen Health Care employs programmable electronic IV pumps that are connected to the EHR system so records are updated instantly whenever medication is administered. “If I change the infusion rate on a patient’s pump, the computer knows what I’ve done,” Ireland says.

HIT is also improving the efficiency of prescription orders.

Semerdjian notes that NorthShore physicians’ medication orders show up simultaneously in the pharmacy department and on the chief nursing officer’s medical administration record, speeding up the time that the medicine gets transported to the hospital unit.

Texas Health Presbyterian recently implemented an early warning score system for monitoring patients’ vital signs. The system features color-coded electronic charts that help clinicians keep track of significant changes in a patient’s condition.

“I think it has a direct impact on the number of RRTs— rapid response team calls or code blues—because the system is picking up on some subtle things that the nurse or staff may not be aware of,” Cowan says.

Nurses at the Design Table Not only are nurses often in charge of implementing and managing hospital HIT projects, they also are tapped for their expertise in the planning stages.

Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN, Vice President of Informatics at the Healthcare Information and Management Systems Society (HIMSS), says nurses need to

get involved in the process as early as possible.

“It’s really critical to have nursing represented at the table for the decisions that are made about electronic health records and the technology systems around them, because nurses understand what patients need,” says Sensmeier, who is a co-founder and ExOfficio Chair of the Alliance for Nursing Informatics, an organization co-sponsored by HIMSS and the American Medical Informatics Association (AMIA).

“They understand the importance of accuracy, consistency, and documentation.”

Semerdjian notes that when nurses partnered with HIT experts in planning the EHR project at NorthShore University HealthSystem, the working group was divided into teams with specific expertise. For example, one team dealt with an application for scheduling appointments and medical procedures, another with a system for outpatients.

Nurses at Lurie Children’s offered guidance on how to integrate the EHR system into the various hospital units, says Carroll.

“There is no such thing as an isolated system, entity, or department when you’re talking about computer records,” she says. “Everything hinges on another and has to communicate with another system.”

At Texas Health Presbyterian, Cowan has been a designated superuser of the HIT system since 2009. During monthly meetings, she and other superusers get updates on new pilot programs and planned upgrades to existing ones; then they relay the news to the rest of the staff.

Graduate-level nursing informatics studies programs are

providing nurses with academic credentials for these leadership roles. For instance, Middle Tennessee State University’s (MTSU) School of Nursing in Murfreesboro offers an MSN with nursing informatics concentration and an MSPS with informatics concentration for other health professionals such as physical and respiratory therapists. A required four-hour practicum gives students handson experience in the field. Take,

Symposium in Chicago last November was titled “Why is Interoperability Taking So Darn Long?” Sensmeier is a longtime advocate for interoperability in health care IT, which would involve, among other things, standardizing terminology and programming language so that different hospital systems could communicate with one another.

“Every hospital has been pretty much doing its own

“I had a physician say to me [that] he spent his first few days swearing at it,” Carroll says. “Now he swears by it.” for example, the MTSU nursing student assigned to the VA hospital in Kingston, Tennessee.

“She is working on a really cool project . . . to actually integrate a medical surgical floor into the electronic medical record environment,” says Richard Meeks, MSN, RN, CPHRM, an assistant professor at MTSU. The project includes creating concept maps and floor diagrams to help guide unit nursing leaders in adapting their workflows to an automated documentation system, Meeks adds.

Nahm, at the University of Maryland, says vendors need nurses trained in informatics to help them build better HIT systems that fit the way hospital staffers work.

“The system should correctly and accurately reflect the clinician’s workflow,” Nahm says. “If the system doesn’t work for them, it can create medical errors.”

HIT: A Work in Progress One of Sensmeier’s favorite sessions at the AMIA’s Annual

thing for a long time,” Sensmeier says. “To require them to standardize and begin to integrate is a huge challenge.”

As with any technology, another challenge for HIT users is coping with the glitches that crop up from time to time: sluggish or errant data flow, interpretation flaws, and equipment failures.

“When I first got into nursing informatics, I respected computers and thought that whatever comes out of a computer is probably correct,” Sensmeier recalls. “Well, during my first testing experience with a computer, I could see how easy it was for a system to misinterpret something, or for data to not get to the right place, or for printers to break.”

Nurses at Lurie Children’s continually monitor the EHR system for its efficacy in improving patient outcomes.

“We have a nursing-driven clinical informatics committee that reviews, with the staff on our front lines, what they are seeing in documenting and providing care,” Carroll says.

“That is nursing’s opportunity to have input and to bring up issues and their suggestions for improvement.”

Sometimes the toughest job for the nurse informaticist is educating other clinicians about computers and getting them to embrace the technology. NorthShore University HealthSystem provided every physician with 16 hours of computer training, which helped convert a lot of skeptics among them.

“I had a physician say to me [that] he spent his first few days swearing at it,” Carroll says. “Now he swears by it.”

Fletcher Allen Health Care even offered its clinicians free typing classes, though not many signed up, according to Ireland. She notes that some found it easier to make the transition from pad and paper when they viewed the com-

www.minoritynurse.com

puter as a tool for interacting with patients.

Meeks says the best results come from taking an analytical approach to implementing new technology, thoroughly assessing how it will fit into the way nurses and other health care providers do their jobs.

“When we bring on this type of technology—medical records, electronic scanning of meds—we traditionally dump that stuff into an environment that hasn’t been updated since the ’70s,” Meeks says. “That causes an imbalance in that environment, and it causes frustration and anxiety in the staff—not only nurses but other clinicians and physicians— because we’ve not done a good job integrating all of that technology into their practice.”

Sonya Stinson is a freelance writer based in New Orleans.

Minority Nurse Magazine

@MinorityNurse

35

MINORITY NURSE ScholarShip program Nurses will always be valuable members of any health care team, regardless of their educational backgrounds. Yet, the baccalaureate and master’s degrees in nursing may offer the most professional opportunities.

That’s why Minority Nurse offers an annual scholarship to help outstanding nurses from underrepresented groups complete their studies toward a Bachelor or Master of Science in Nursing. To date, we have awarded scholarships to more than 40 students, honoring their commitment to the profession, academic excellence, and community service.

We are currently accepting applications for our 15th annual scholarship competition, consisting of two $1,000 awards and one $3,000 award. Scholarships will be paid in summer 2014 for the fall 2014 academic term.

Questions? E-mail editor@minoritynurse.com or visit www.minoritynurse.com/2014scholarship.

36

Minority Nurse | SPRING 2013

MINORITY NURSE 15th Annual Scholarship Program

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

❏ Female

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

Who Is Eligible (Please read carefully. Applications that do not meet the eligibility criteria will be disqualified.)

To apply for this scholarship, students must meet all four of the following criteria: Be a minority in the nursing profession Be enrolled (as of September 2014) in either the third or fourth year of an accredited BSN program in the United States or an accelerated program leading to a BSN degree (such as RN-to-BSN or BA-to-BSN) or an accelerated master’s entry program in nursing for students with bachelor’s degrees in fields other than nursing (such as BA-to-MSN). Graduate students who already have a bachelor’s degree in nursing are not eligible.

Have a 3.0 GPA or better (on a 4.0 scale) Be a U.S. citizen or permanent resident How to Apply (Please read carefully. Applications that do not include the required documentation will be disqualified.)

Complete and return this form along with all three of the following documents: Transcript or other proof of GPA Letter of recommendation from a faculty member outlining academic achievement A brief (250-word) written statement summarizing your academic and personal accomplishments, community service, and goals for your future nursing career important: an English translation must be provided for any documentation that is not in English.

Minority Nurse will award one $3,000 scholarship and two $1,000 scholarships in 2014. Selections will be made by the editors of the magazine. Scholarships will be paid in summer 2014. Minority Nurse reserves the right to verify community service and financial need.

Deadline for application: February 1, 2014 return application form and documentation to: Minority Nurse Magazine Scholarship, Springer Publishing Company, 11 W. 42nd Street, 15th Floor, New York, NY 10036

www.minoritynurse.com

Minority Nurse Magazine

@MinorityNurse

37

In the Spotlight

Lifting Up the Homeless

BY JEBRA TURNER

Although we may not have personal experience with homelessness, as nurses we can easily imagine the way in which life might unravel—a collapsing economy, long-term unemployment, a series of missed mortgage payments—leading to a life on the street, in a car, or at a shelter. Nurses are privileged to be in a position to help people get back on their feet and take the necessary steps toward a more secure future. As we enter our fifth year since the start of the Great Recession, here are what three exemplary nurses have to say about caring for one of our most vulnerable populations.

© Anna M. Campbell

Dorothy L. Powell, RN, EdD, FAAN

Amy Hardy, RN, BSN

“

Cindy Underwood, RN

As nurses, we have the power to do a lot for underserved populations. Keep yourself from making judgments, because these clients have had really challenging lives. It’s an opportunity to provide good quality care for people who haven’t received it in the past.

Like you and me, they’re just trying to get through the day.

—Amy Hardy, RN, BSN

“

Young Nurse Focuses on Caring for Homeless Amy Hardy, RN, BSN, nurse manager at Old Town Clinic Amy Hardy is a nurse manager at Old Town Clinic in Portland, Oregon, a site serving 3,000 primary care patients a year as part of Central City Concern (CCC).

“Our agency’s mission is to end homelessness and support clients to self-sufficiency,” Hardy explains.

The population the clinic serves is diverse, and there is a

38

Minority Nurse | SPRING 2013

significant minority segment.

“We have Spanish-speaking support staff, and CCC offers special programs, like Puentes, to meet the behavioral health needs of Latinos,” she says.

There’s been an increase in homeless women and family households. “It’s hard to find shelters for women,” says Hardy. “CCC has a program that allows women to keep their children and not give them up during substance abuse treatment. It also operates housing for families in recovery but

still, more is needed.”

A wider definition of homelessness includes the “precariously housed,” explains Hardy.

“These are folks who suffer from generational poverty, and don’t have their own place for a long period of time. They may be doubling up, and staying with family and friends—that’s especially common in the Latino community—as well as on the streets or in shelters.”

“So many of our clients are high emergency department

utilizers,” says Hardy. “We work with area hospitals to coordinate care for clients.”

Programs serve to provide respite or short-term residential care for patients after hospital discharge.

“As nurses, we have the power to do a lot for underserved populations,” Hardy says. “Keep yourself from making judgments, because these clients have had really challenging lives. It’s an opportunity to provide good quality care for people who haven’t

In the Spotlight

received it in the past. Like you and me, they’re just trying to get through the day.”

Nurse Pioneers Homeless Care Programs Dorothy L. Powell, RN, EdD, FAAN, Associate Dean of the Office of Global and Community Health Initiatives in the School of Nursing at Duke University Dorothy Powell first became involved with caring for the homeless in Washington, DC, in the early 1980s at leading advocate Mitch Snyder’s shelter, which was then the largest in the United States. Soon after, she led the development of a health care unit at the 2nd & D Street Shelter, another large facility. “Nurses provided respite care 24/7, and we collaborated with persons in the homeless community,” she says.

Powell empowered homeless individuals through a nationally lauded program, Nursing Careers for Homeless People, in the early 1990s.

“We identified homeless people who would benefit from being nursing assistants, and we prepared them to work along with other staff people,” she says.

Participants set an ambitious goal: Prepare for a better job so as to move from a shelter to transitional housing.

Nearly 90 individuals achieved that target.

“We had many success stories. Over 75% finished the

three-month Pre-Admissions Readiness Program, passed the nursing assistant exam, and got jobs. A third went on to more education at the collegiate level, usually in nursing.

Some became RNs, some finished at the top of their nursing class—one even went into a master’s program,” she adds.

At Duke University, Powell developed a community service program called Raising Health, Raising Hope. “The message is that despite your vulnerability and homelessness, if the status of one’s health can be improved, it can give hope to move forward with other aspects of their lives,” she explains.

Powell has also gone beyond her community of Durham, North Carolina, and is now working globally to address health disparities.

Nurse’s Mission Changes Lives in Birmingham Cindy Underwood, RN, operating room nurse at St. Vincent’s East and founder of Changed Lives Medical Clinic Cindy Underwood, along with a few colleagues from St. Vincent’s East, has provided medical care to the homeless people of Birmingham, Alabama, for a dozen years at a monthly outdoor clinic.

“I realized that I can’t care for the homeless or indigent in the same way as the insured,” she says. “I have to think and work outside the normal box.”

“

Many patients are regulars with chronic or complex conditions. “We take the pressure off hospital emergency rooms,” she says. Common health conditions are high blood pressure, high blood sugar, athlete’s foot, and respiratory conditions, which are exacerbated by living on the streets or in abandoned buildings.

Sometimes, a trip to the ER can’t be avoided. “One homeless lady came to the clinic at night during a bad winter.

She had frostbite on her toes, and we saw her to the hospital. The doctor said she would have lost toes if she had not come in for treatment,” she recalls.

Don’t be afraid to step outside of the doctor’s office or hospital to where people des-

It started with bringing Band-Aids in the back of my station wagon. Then it grew into a clinic. Even if it is just Tylenol or multivitamins, they’re so excited, it makes it worth it.

—Cindy Underwood, RN

“

“The message is that despite your vulnerability and homelessness, if the status of one’s health can be improved, it can give hope to move forward with other aspects of their lives,” explains Powell.

Health care resources that are usually taken for granted— equipment, lab work, and sanitation—are absent. “You may want to get a urinalysis, but you’re in an area where they can’t go to the bathroom,” she adds.

Underwood also learns about each patient’s living situation. “You can’t assume they’re going home to a house with electricity—maybe they don’t have running water. If a homeless patient is suffering from pneumonia and it’s winter, you may have to find a shelter,” she adds.

The clinic runs every fourth Tuesday night from 6-8 p.m. under a viaduct downtown.

“We see 100 to 125 people each month, and for 85%, we’re their primary care providers. We are their doctors

and their pharmacists.” The clinic also provides free overthe-counter medications, or a month’s supply of prescription drugs, with refills available at return visits.

Underwood works a fulltime job and cares for a family, in addition to running the monthly clinic. Why does she do it? “It’s a faith thing. I’m a Christian and God truly told me ‘you could do so much more for them,’” she explains.

“It started with bringing BandAids in the back of my station wagon. Then it grew into a clinic. Even if it is just Tylenol or multivitamins, they’re so excited, it makes it worth it.”

www.minoritynurse.com

perately need help, advises Underwood. “Don’t worry about losing your license; it’s a charitable act,” she says. “If you do it with a pure heart, there’s not any case where a judge has ruled against it.”

If you would like to start a similar clinic in your community, e-mail Cindy Underwood at cindynunderwood@ yahoo.com.

Jebra Turner is a freelance writer living in Portland, Oregon, and reporting on jobs, careers, and the workplace.

Minority Nurse Magazine

@MinorityNurse

39

Academic Forum

Administering Medications Safely and Effectively

BY REV. STEVEN K. WHEELER, MSN, RN

Many nurses are under the impression that once they pass their medications to their Case Study #2: patients, their job is done. But this is the farthest thing from the truth. For example, A nurse is admitting a patient to her unit with a diagnosis of a nurse administering Celexa to a patient who has a diagnosis of depression must depression.

The patient is curcontinue to monitor that patient for a very serious side effect of that medication rently on Celexa for her depresknown as the serotonin syndrome. Serotonin syndrome is an idiosyncratic medication sion. The nurse asks the patient, reaction with a fairly rapid onset that occurs with the excessive accumulation of “What medications are you serotonin. The patient needs to be monitored for mental status changes, muscle currently taking?� The patient spasms (myoclonus), overactive reflexes (hyperreflexia), uncoordinated movements identifies all of her medications (ataxia), fever, and diarrhea. Early identification and monitoring is important. If that are currently prescribed, inserotonin syndrome is suspected, the physician should be notified immediately and cluding over-the-counter medications. Has the nurse effectivethe medication discontinued. ly done her job? Not quite. It is

H

ere are a couple of other possible scenarios that could go fatally wrong if you switch to autopilot after administering medication to a patient:

Case Study #1: The nurse is administering aspirin (81 mg), Lisinopril (10 mg), and Nardil (20 mg) daily to an elderly patient. The patient refuses her medication unless it is mixed in with her favorite yogurt instead of applesauce.

The nurse administers the medication and ensures that all of

the medication is taken before moving on to her next patient.

Has the nurse effectively done her job? If you answered yes,

tors. Patients who are taking monoamine oxidase inhibitors must avoid foods that contain tyramine. Yogurt, which this

Nurses need to follow the six rights of medication administration, but they also need to monitor their patients for adverse side effects.

you have answered incorrectly.

Nardil, which is also known as Phenelzine, belongs to a class of antidepressants known as monoamine oxidase inhibi-

patient loves dearly, is a food that should be avoided while taking this class of antidepressant to prevent what is known as a hypertensive crisis.

important that nurses know all of the prescribed medications, but they should also be familiar with herbal, alternative, and complimentary remedies because these can influence the efficacy and safety of antidepressants. Incidentally, the patient was also taking St.John’s wort, which is an herbal supplement used to treat depression. Some researchers have shown that this herb taken with certain antidepressants can lead to serotonin syndrome.

Nurses need to follow the six rights of medication administration, but they also need to monitor their patients for adverse side effects. They must be aware of potentially harmful food and drug interactions.

Lastly, they need to assess their patients holistically, looking for alternative and complimentary remedies that the patient might be taking in an attempt to promote their healing.

Rev. Steven K. Wheeler, MSN, RN, is the Pastor of Impact Christian Ministry in Cincinnati and a professor of clinical nursing at Fortis College in Centerville, Ohio.

40

Minority Nurse | SPRING 2013

Academic Forum

The Challenges of Caring for Older HIV/AIDS Patients

BY ARCHANA PYATI

Leopold Linton faulted the omelet he ate during a flight five years ago to Jamaica, his country of origin. He was sick to his stomach by the time he arrived at the airport in Black River on a Tuesday. By Friday, he was admitted to the hospital, where a doctor informed him he had full-blown AIDS.

W

hile shocking, the news actually solved the mystery of why Linton’s health had deteriorated so rapidly during the previous year. He’d felt weak, lost weight, and soaked his bed sheets at night with sweat.

He rarely saw his doctor, so he surmised his diabetes was out of control. His trip back

citizen. He joins the growing ranks of people over 50 grappling with HIV/AIDS— a population that includes long-term survivors, the newly diagnosed, and the newly infected. Thanks to groundbreaking antiretroviral drugs developed in the mid-1990s, HIV has gone from being a death sentence to a lifelong, chronic illness like diabetes,

The Centers for Disease Control and Prevention estimates that by 2015, 50% of people with HIV in the United States will be in this age group, presenting unique challenges and opportunities for nurses.

home, in fact, was prompted by a gut feeling he was dying, although he didn’t know why.

“I might as well spend my last days where it’s warm,” he remembers thinking.

Linton started antiretroviral therapy in Jamaica, allowing him to return in 2010 to the Washington, DC, region, his home for the past 40 years. He is now happily receiving care at Whitman-Walker Health, DC’s preeminent health care provider for low-income people with HIV/AIDS. At 68, Linton received his AIDS diagnosis as a senior

where treatment adherence can prolong life expectancy.

The Centers for Disease Control and Prevention estimates that by 2015, 50% of people with HIV in the United States will be in this age group, presenting unique challenges and opportunities for nurses.

Nurses: Front and Center As HIV shifts from being a fatal illness to a manageable one, experts say HIV care will become a routine element of primary health care. Nurses will be on the front lines in the expanded effort to test se-

niors, educate them about risk factors, and motivate them to stay in treatment if they test positive.

“When it comes to retention and keeping people in care, nurses are so important,” says Wayne E. Dicks, MPH, a training coordinator with the Pennsylvania/MidAtlantic AIDS Education Training Center based at Howard University. “They need to be understanding and compassionate.”

Nurses, in fact, were at the

www.minoritynurse.com

heart of Whitman-Walker’s restructuring of its health care delivery system five years ago. The goal was to be more medically—rather than social service—oriented, says Justin Goforth, RN, BSN, Director of the Medical Adherence Unit at Whitman-Walker Health.

During the epidemic’s early days, HIV/AIDS care was palliative, focusing on getting patients basic necessities such as food, shelter, and end-of-life pain medication since they

Minority Nurse Magazine

@MinorityNurse

41

Academic Forum

Justin Goforth, RN, BSN, is the Director of the Medical Adherence Unit at Whitman-Walker Health, a leading health care provider for people with HIV in Washington, DC.

would do this except a nurse.”

In 2008, Whitman-Walker replaced its social work staff with nurse case managers, each of whom oversees a caseload of 250 to 300 patients.

Support staff handles referrals to benefits, food, and housing assistance. And while each Whitman-Walker client is assigned a physician, doctors only have 15-minute timeslots to see patients—enough time to prescribe medications or order labs, but not enough to talk in detail about their HIV care regimen.

“We needed nurses as case managers because we’re going to need to be teaching people throughout their lifetime about what’s going on in their bodies and why is this treatment something they need to commit to,” says Goforth.

“And why they need to integrate it into their lives.”

Accelerated Aging with HIV weren’t expected to survive.

A case management system was established at WhitmanWalker, but staffed with social workers and activists who had passion for the cause but little medical training, according to

Comorbidities include heart and kidney disease, high blood pressure, cognitive impairments, depression, and nonAIDS-related cancers affecting the anus, prostate, and colon.

“Every time a new comor-

Diagnosed in 1989, Kermit Turner is an immaculately groomed retired IT professional who hasn’t let HIV slow him down. It’s hard to imagine the 59-year-old has had four near-

death experiences from HIVrelated infections between stretches of good health.

“I’m not the rocking chair type,” he says. “Yes, HIV is going on [in] your life, but HIV is not your entire life.”

Another Whitman-Walker client, Turner has battled pneumocystis pneumonia— the strain associated with early AIDS sufferers—in addition to a locked bowel and non-Hodgkin’s lymphoma. In 2011, his left lung was removed because of aspergillosis, a pulmonary disease caused by a fungus affecting people with weakened immune systems.

Turner experiences problems with vision and shortterm memory. A sense of humor, he says, is an essential weapon against forgetfulness—and HIV. “I’m the one with the Post-its about the Post-its,” Turner says.

Researchers are beginning to understand how HIV accelerates aging, and it has much to do with “immune senescence,” or aging of the immune system itself. A recent Israeli study published in the Rambam Maimonides Medical

Stigma and lack of HIV knowledge among medical staff remain powerful obstacles to HIV testing and care for people over 50.

Goforth, who has been HIV positive since 1992.

With the antiretroviral revolution came the need for medical expertise—especially from those who could speak in plain language to patients about comorbidities and noninfectious, age-related illnesses exacerbated by HIV and, in some cases, HIV medications.

42

Minority Nurse | SPRING 2013

bidity is added on and a new treatment is added on, the complexity of [a patient’s] whole regimen is affected,” Goforth says. “We have to sit down with them, and say, ‘Okay, where are we going to fit this in? Does this have any contraindications with taking it at the same time as this other med?’ I’m not sure who

Kermit Turner, 59, attends a support group at Whitman-Walker Health for long-term survivors of HIV.

Academic Forum Journal attributed rapid aging among people with HIV to chronic inflammation of the immune system and the loss of CD4 cells, activated by the immune system to fight infections, rather than the amount of HIV virus—known as “viral load”—in a person’s blood.

Additionally, a research review published in the Journal of NeuroVirology found that the immune systems of HIVinfected individuals resemble those of non-infected people decades older, triggering heart disease, kidney disease, and diabetes much earlier.

In 2009, Jay Jones had a double-bypass after his chest pains and shortness of breath were misdiagnosed as asthma by an emergency room doctor. He was 48 at the time and experienced heart problems much earlier than members of his extended family with its history of heart disease. Living with HIV for 21 years, Jones, 52, tried several drug regimens, which his doctor told him were partially responsible for his coronary blockages.

“I was angry because they didn’t tell me this could be a result of taking medications,” the US Army veteran says. “I wondered if I should continue taking them.”

He continued his HIV therapy, but added blood cholesterol medication and started a more active lifestyle. His ability to surmount challenges posed by HIV, heart disease, and depression motivated him to start a second career as a minister at his son’s church in Washington, DC.

Sex and Stigma Jones says once he’d overcome his internal stigma—for being HIV positive and same

gender loving—he was able to accept himself and the unconditional love of his former wife and their children. Stigma and lack of HIV knowledge among medical staff remain powerful obstacles to HIV testing and care for people over 50.

“We’ve done an abysmal job doing sexual histories on the elderly,” says Frances Jackson, RN, BSN, MA, MSN, PhD, a professor emeritus at the Oakland University School of Nursing in Rochester, Michigan. “There’s still a level of discomfort in discussing sex lives with elderly people.”

Among the elderly, specific cultural and sexual identities must be considered. Mental health should be part of the conversation as seniors are prone to depression and feelings of isolation from their peers—especially if they test positive for HIV, experts say.

Jackson says older heterosexual men and women may not use condoms because fertility is no longer a factor. Older gay men may feel rejected by younger gay men as sexual partners, leading them to recreational drug use to overcome their inhibitions, says Dicks.

“We need to do a better job with some of our questions,” he says.

Jackson suggests framing discussions about risk behaviors around what a patient’s personal goals are. “You can’t scare people into healthy behaviors,” says Jackson. “We have to meet people where they are. We have to tie it [to] what the individual wants out of their life.”

Jackson, who has practiced HIV/AIDS care for 30 years, remembers when medical staff hosed down hospital rooms where an AIDS patient had

stayed. While such stories are less frequent today, the knowledge level of nurses in non-AIDS specialties feels “almost like we’re in the 1980s again,” says Marion Smith, RN, BSN, a nurse case manager at Whitman-Walker Health.

In an oncology unit at a major urban hospital where she worked before her current position, Smith often heard nurses caution each other: “Be careful when you’re in that room because that person is positive.”

Smith says what’s needed is to normalize HIV for nurses and other medical staff, no matter the context. Since HIV care is “continually evolving and changing,” health care managers need to “figure out

www.minoritynurse.com

how to keep people abreast about what’s happening,” she says.

Assumptions that seniors aren’t sexually interested or active, that they’re monogamous, that they’re heterosexual, and that they understand HIV risk factors are all barriers to testing and care, says Goforth.

“We have all this trauma instilled in us about what is HIV and we keep perpetuating that,” he says. “That keeps people… from thinking ‘I have good options about having a healthy life in case I am HIV positive.’”

Archana Pyati is a freelance writer based in Silver Spring, Maryland.

Minority Nurse Magazine

@MinorityNurse

43

Second Opinion

What’s on the Horizon for Health Care Reform?

BY LEIGH PAGE

At the beginning of 2012, the Affordable Care Act (ACA) was disliked by almost half of the public, faced formidable challenges in the courts, and seemed to be damaging Barack Obama’s prospects for reelection. By the end of the year, this historic law had made a stunning comeback, and it is well positioned for a full phase-in in 2014.

T

wo things happened.

In a narrow 5-4 ruling in June, the Supreme Court upheld most provisions of the health reform law, including the mandate that virtually all Americans have insurance. And in the presidential elections in November, Barack Obama defeated Republican Mitt Romney, who had vowed to strike the law down on “day one” of his presidency.

Public opinion warmed up a bit. In a poll by the Kaiser Family Foundation just after the election, 43% gave the ACA a favorable rating,

44

Minority Nurse | SPRING 2013

compared with 37% a year earlier. It will be interesting to see opinion polls in 2014, the start of the insurance mandate, which the public has never liked but may not

will open, both of which have been widely popular.

The ACA helps minorities and minority nurses in several ways. In addition to expanding coverage for millions of unin-

According to the US Census Bureau, 19.5% of African Americans and 30.1% of Hispanics do not have health insurance, compared with 11.1% of non-Hispanic whites. be so bad once it happens.

Also, insurers will be forced to cover preexisting conditions and state insurance exchanges

sured minorities, it provides higher loan levels for nursing students, funds cultural diversity in nursing, and provides

grants to develop specific nursing specialties. It also promotes advanced practice nursing and primary care.

But the backlash against health reform is far from over. Even though a Democratically-controlled Senate stands behind the president and his reform law, the ACA faces determined opposition from a Republican-run House of Representatives. In its last session, the House voted no less than 33 times to repeal, defund, or remove provisions from “Obamacare,” only to see them defeated in the Senate.

Deadlines forcing bipartisan

Second Opinion agreements on the federal budget, such as the fiscal cliff and the debt ceiling, give House Republicans plenty of opportunities to push for cuts in the health care law. President Obama has already allowed one cut. To temporarily extend unemployment benefits, he signed a bill last February that removed $6.3 billion over 10 years from the ACA’s Prevention and Public Health Fund.

GOP activists have targeted the fund, calling it a “slush fund” because it is not tied to specific initiatives. In 2010, the fund spent $31 million for advanced nurse education and $14.8 million for nursemanaged care centers.

Will Republicans succeed in forcing through more cuts this year? The White House said the ACA was off the table in the fiscal cliff negotiations, and the president’s election victory puts him in a stronger position to back that up. But the fiscal cliff is just the opening salvo of a year that promises endless partisan brawling over fixing the tax code and restructuring entitlements like Medicare.

Another reason Republicans could push hard in 2013 to defund the ACA is that time is running out. After the ACA launches its key reforms at the beginning of 2014, the bulk of the new law will have been implemented. It would be hard to put the genie back in the bottle.

The law’s expansion of coverage in 2014 will have a huge impact on minorities, who suffer from the lowest levels of coverage right now. According to the US Census Bureau, 19.5% of African Americans and 30.1% of Hispanics do not have health insurance,

compared with 11.1% of nonHispanic whites.

Uninsured minorities applying for Medicaid or buying policies in new health insurance exchanges will have to educate themselves. Last summer, Aisha Hakim, a former

effective? To function properly, they need the right mix of healthy and sick people. Will subsidies for the exchanges be seen as too expensive? Subsidies are expected to cost the federal government $574 billion between 2012 and 2019.

In addition to expanding coverage for millions of uninsured minorities, the Affordable Care Act provides higher loan levels for nursing students, funds cultural diversity in nursing, and provides grants to develop specific nursing specialties. president of the Westchester County chapter of the National Black Nurses Association in New York State, said that people of color have yet to fully understand their options, and the federal government “could do a little more in terms of educating the public.”

The law also bars an estimated 12 million undocumented immigrants from getting subsidized coverage or Medicaid coverage. Some fear lack of coverage could make these people easily identifiable to US immigration officials.

Meanwhile, some states will refuse to expand Medicaid eligibility, as the law directs.

The ACA provides generous federal funding for states to open Medicaid to people with incomes as high as 133% of the poverty level, but the Supreme Court decision allowed states to opt out. As of late November, eight states––including Texas and Georgia–– had done so, five more were leaning that way, and 20 had not yet decided.

As the new law is fully implemented, it will face a number of other challenges. Will the insurance exchanges be

Will employers drop coverage rather than submit to the mandate? Employers have to pay penalties if they don’t cover their workers. And finally, will the ACA actually control health care costs? The law has

launched a number of new initiatives designed to lower costs, such as accountable care organizations and patient-centered medical homes.

The midterm elections in November 2014 will be a crucial test of the fully implemented law. If the 2014 implementation is messy, Republicans could expand their seats in Congress and maybe even defund parts of the law, such as some subsidies for the exchanges. But whatever happens, this groundbreaking measure is here to stay. “Once people get the benefits,” said Democratic strategist Bob Shrum, “you can never take them away.”

Leigh Page is a Chicago-based freelance writer specializing in health care topics.

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

• Competitive Salaries

• Upward Mobility

• Excellent Training

Department of Human Resources 16 Munson Road Farmington, CT 06034-4035

860.679.2426 phone 860.679.1051 fax

For a complete listing of all open jobs visit our website:

www.uchc.edu Affirmative Action /Equal Opportunity Employer

www.minoritynurse.com

Minority Nurse Magazine

KNOW BETTER CARE

@MinorityNurse

45

Second Opinion

Rehabilitation and Care of Immunosuppressed Elderly Patients

BY JEANETTE CENTENO, RN

The incidence of immunosuppressed elderly patients has increased over the past few years. Hospitals and rehabilitation centers are seeing patients with greater complications, which poses many risks. Patients face the dangers of mass infection, greater length of stay, isolation from friends and family, limited resources, and poor patient follow-up. These potential threats combined with Medicare cuts in an ever-changing health care system are putting our elderly in jeopardy.

I

mproving patient care is essential to this community by increasing education and providing better preventive programs and follow-up. Many elderly patients are discharged into a rehabilitation setting after spending some time in the hospital due to illness or trauma. Complications can be seen very early and vary from weakness and dehydration to cognitive and physical problems. In order for a patient to receive optimal care, problems need to be addressed accordingly.

Patients’ physiological changes can cause a simple illness to present differently and can make treatment difficult. In rehabilitation, patients require detailed assessments from the rehabilitation team, easy-tofollow instructions, a well-lit environment, minimal noise level, and a keen eye from caregivers to notice changes in the patient. Evidence-based practice must include continuous education for staff on topics such as interventions for current disease processes, assessments of current medications and side

46

Minority Nurse | SPRING 2013

effects, and an evaluation of support systems and community needs.

Nurses can also provide a positive rehabilitation experience for elderly patients who suffer from dementia by simply minimizing triggers that may cause anxiety. Patients need to feel comfortable in their new surrounding. Reorient the patient often and repeat instructions accordingly. Encourage safety and maintain an open dialogue with the patient and his/her family to enhance opportunities for teaching and learning.

Nurses need to be aware of changes that could cause a patient to become increasingly confused: fever, infection, dehydration, a change in room, poor eyesight, poor sleeping habits, or medications such as antidepressants. Confusion can also lead to falls, which can lead to increase in length of stay and/or lawsuits. Within the past few years, the cost of falls has risen to $30 billion.

The statistics for fall-related incidences are shocking: • 1 in 3 adults over the age of

65 will be treated for a hospital fall-related injury.

• 30% suffer complications such as infection and/or death.

• By the year 2020, falls will cost health insurance companies more than $50 billion.

Immunocompromised patients may require longer hospitalization and rehabilitation.

Premorbid conditions may present differently and can be difficult to treat. Family and caregivers must be taught to watch for signs and symptoms of infection and dehydration.

Education is extremely important, particularly current medications and their side effects as well as proper follow-up. Patients can become lost for many different reasons: lack of support, decrease in income, lack of understanding of current disease process, or no means of getting to the doctor. Families must be encouraged to participate in the care of the elderly patient in order to have a positive outcome.

Patients who have better access to community services fare better and are more likely to follow-up with doctor visits. They tend to keep a better dialogue with visiting nurses, require less hospitalization, and comply with medications and procedures. These patients gain an understanding of their disease process, identify possible risks, and seek medical help sooner.

Helping seniors remain inde-

pendent for as long as possible is extremely important to their psyche. Community services vary from town to town and in availability and cost. Coordinating care can be tricky, but a case manager is an essential source of information. Caregivers can arrange transportation, meals, social and physical programs, and group events. Some programs are even specifically geared to gender, needs, race, or religious affiliation.

Staying active and being part of the community plays an important role in health. Daily fears of isolation, poor health, decrease in income, and loss of friends can contribute to an ailing health. In reality, caring for the elderly requires a community—nurses, doctors, family, friends—in order to maximize independence and decrease current challenges.

Rehabilitation can allow patients to regain communication skills, increase mobility and strength training, and gain emotional support. Rehabilitation programs offer patients and families the chance to learn, intervene, and reduce complications. These interventions are proactive in nature to prevent further accidents, injury, and acute hospital care.

Jeanette Centeno, RN, works at the Kessler Institute for Rehabilitation in the Center for Spinal Cord Injury Rehabilitation.

Second Opinion

“Sugar”—A Preventable Disease with Devastating Consequences

BY ED JAMES, MD

As a child, more than four decades ago, I once heard older relatives talking about their health troubles related to diabetes, which they often simply called “sugar.” This sounded more to me like a tasty treat than a disease. I soon learned that diabetes could have dreadful health consequences, often resulting in much suffering and early death. Sadly, more than 20 million Americans have diabetes, which is a nutritionally related disease that is preventable, reversible, and often curable (in cases of Type 2) by dietary changes.1 Type 1 vs. Type 2 Diabetes mellitus is a group of metabolic diseases that result in a person having abnormally high blood sugar, either because the pancreas does not produce enough insulin or cells do not respond to the insulin produced. Nearly all cases of diabetes mellitus are either Type 1 or Type 2. Type 1, which accounts for about 5% to 10% of diabetes cases, typically develops in early

childhood and adolescence and is sometimes called “juvenile diabetes.” Type 2 accounts for about 90% to 95% of diabetes cases and used to be referred to as “adult-onset diabetes,” but now up to 45% of new cases are actually in children.2,3

A Physiological System Gone Haywire After we eat, the carbohydrates in food are broken

down into simple sugars that enter the bloodstream. In response, the pancreas normally produces insulin, which helps the glucose enter cells for both short- and long-term energy.

However, in diabetes, this process breaks down. Type 1 diabetics cannot make enough insulin since certain cells in the pancreas have been destroyed, whereas Type 2 diabetics do produce insulin, but it is not effective. Both types

www.minoritynurse.com

lead to dangerously high levels of blood sugar, which has detrimental health consequences, both short- and long-term.

Complications of diabetes include increased risk of heart disease, stroke, high blood pressure, blindness, kidney disease, Alzheimer’s disease, and limb amputations. More than 80% of adults who have diabetes die from heart attacks or strokes.1

Genes and Destiny Doctors and nurses recognize the importance of recording detailed family histories from patients, and diabetes in a family is always considered noteworthy. Unfortunately, in my experience, too many patients leave their doctors’ offices believing that a strong

Minority Nurse Magazine

@MinorityNurse

47

Second Opinion family history of a certain disease, such as diabetes, is essentially a crystal ball sealing their fates.

As mentioned in my last column, I strongly believe that Type 2 diabetes (and most other common chronic diseases that impact Americans) has more to do with families eating the same fatty, salty, sugary, high-calorie, processed, animal-based, low-nutrient foods and sharing the same couch than having the same DNA.

that were low in fat. Diabetesrelated death rates dropped from 20.4 to 2.9 per 100,000 people, as plant-based carbohydrate (low-fat) intake increased and animal-based (high-fat) intake decreased.5

dietary and lifestyle changes to me as a cure rather than a lifetime reliance on prescription medications, which may delay the onset of diabetesrelated complications and death, but will not prevent, reverse, or cure diabetes. As

Research Support for Plant-Based Diet The results of many research studies strongly suggest that the clinical course of both Type 1 and Type 2 diabetes can be dramatically improved simply by making dietary changes. For example, Dr. James Anderson studied the effects of 25 Type 1 diabetics and 25 Type 2 diabetics in a hospital setting, all of whom were taking insulin. His experimental “veggie” diet consisted of mostly whole-plant foods. After only three weeks, the Type 1 diabetic patients were able to lower their insulin medication by an average of 40%. Their blood sugars improved greatly, and their cholesterol levels decreased by 30%. For the Type 2 diabetics in his study, all but one were able to discontinue their insulin medication after only a few weeks.4 It is also worth noting that in the early 20th century, H.P. Himsworth compiled research comparing diets and diabetes rates in six countries. He found that people in some countries were eating diets high in fat and animal-based foods while people in other countries had diets high in plant-based foods

48

Minority Nurse | SPRING 2013

for beating diabetes. Losing weight by adopting a plantbased, whole-food, healthful diet and lifestyle, including regular exercise, is the best diabetes “medicine” and offers many other health benefits, as well. As we health professionals personally begin to embrace healthier lifestyles, we can often cure ourselves and will be in a much better position to advise our patients, families, and friends, so we can all be…healed and free at last!

Dr. Ed James is an editorial advisory board member of Minority Nurse and the founder and president of Heal2BFree, LLC

(dredjames.com).

References 1. American Diabetes Association: Diabetes Statistics. http://www. diabetes.org/diabetes-basics/ diabetes-statistics. Accessed January 14, 2013.

Suggested Media Books • Eat to Live, by Joel Fuhrman, MD • The China Study, by T. Colin Campbell, PhD, and Thomas M. Campbell, II

Films • Forks Over Knives (www.forksoverknives.com) • Hungry for Change (www.hungryforchange.tv)

On a Personal Note I was obese and pre-diabetic until only a few years ago.

Now, I am cured of prediabetes and no longer obese, simply because of significant dietary and lifestyle changes. Fortunately, my doctor suggested

health professionals, we are most effective when we are able to address root-cause in order to prevent, reverse, or cure any disease for our patients—and for ourselves.

Also, remember that overcoming obesity is essential

2. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007.

Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.

3. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care.

2000;23(3):381-389.

4. Anderson JW. Dietary fiber in nutrition management of diabetes. In: Vahouny GV, Kritchevsky D, eds. Dietary Fiber: Basic and Clinical Aspects. New York, NY: Plenum Press; 1986:343-360.

5. Himsworth HP. Diet and the incidence of diabetes mellitus.

Clin. Sci. 1935;2:117-148.

The Take Pride Campaign The country is changing, with one-third of the population representing a historical “minority.” In this increasingly diverse world, you can confidently say your workplace actively fosters diversity, inclusiveness, and cooperation. For these reasons and others, you’re proud to be a part of it—and we want to hear from you.

Minority Nurse is looking for nominations for health care’s diversity MVPs, from the magnet hospitals to nursing schools to local hospice care centers. Nurses can nominate their workplaces based on the facility’s efforts to improve and maintain inclusiveness and diversity.

Think about what makes for a diverse institution. What does a “commitment to diversity” mean? And what does it mean to you? At Minority Nurse, it’s not just about a visible variety of skin tones seen in the halls. It’s . . .

• Faculty and staff recruitment and retention efforts aimed at underrepresented populations • Collaborative hiring practices • Diversity initiatives and accessible organizations on site • Cultural competency training and resources, such as diverse foods, translators, etc.

• Partnerships with other diversity organizations • And so much more When hiring groups devoted to minority recruitment and retention not only exist, but are consistently used, it shows a commitment to diversity. When hospital administrators take the time to include their nursing staff in development, they exhibit a commitment to diversity.

And you, in taking the time to recognize your workplace for its commendable practices and diverse work environment, are showing a commitment to diversity as well.

It’s not necessarily a numbers game—we don’t require applicants to produce statistics or quotas, though you are welcome to do so if you wish. We’re simply looking for readers who take pride in their workplaces’ commitment to diversity.

A PDF of the Take Pride Campaign application is also available on our website, www.minoritynurse.com. Applications must be received before July 1, 2013. We will then reach out to our nominees to determine our winners!

Questions? Let us know by e-mailing editor@minoritynurse.com.

46

Minority Nurse | WINTER 2012

www.minoritynurse.com

Minority Nurse Magazine

@MinorityNurse

49

MINORITY NURSE

2013 Take Pride Campaign Application Application Form (Please print clearly. All fields required. The 250–500-word nomination can be attached separately.)

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

47

Minority Nurse | WINTER 2012

Academic Opportunities

Join the Frontier community without leaving yours!

Complete your degree online and become a Nurse-Midwife or Nurse Practitioner

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.

Distance Education Programs: Post-Master’s Doctor of Nursing Practice Master of Science in Nursing • Nurse-Midwifery • Family Nurse Practitioner • Women’s Health Care Nurse Practitioner • ADN-MSN Bridge Post-Master’s Certificates

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.

www.frontier.edu/MN Distance Education from the Birthplace of Nurse-Midwifer y and Family Nursing in America

Use the past, in the present, to change the future by

teaching!

Kaplan College Las Vegas – School of Nursing is accepting applications for F/T INSTRUCTORS. Must have MSN and clinical experience. OB, Peds +/or Psych Specialty Preferred.

Please email resume to Dr. Katherine Cylke, DON, at kcylke@kaplan.edu or mail to: Kaplan College, 3535 W. Sahara, Las Vegas 89102

www.minoritynurse.com

Minority Nurse Magazine

@MinorityNurse

51

Academic Opportunities

O P E N Idoors NG Everyone has a purpose and a personality – the traits that make each of us unique. At Johns Hopkins Bayview Medical Center, it’s our mission to provide compassionate health care that is focused on the uniqueness and dignity of each person we serve.

We offer this care in an environment that promotes, embraces and honors the diversity of our community.

Johns Hopkins Bayview opens doors for talented people who would like to be part of one of the strongest, most trusted reputations in health care. As a leading academic medical center, we provide an enriching environment for our employees and an exceptional health care experience for our patients and their families. We offer great pay and benefits, including tuition reimbursement for you and your dependents. Johns Hopkins Bayview is conveniently located off I-95 and I-895 in Baltimore, MD.

Open your doors at bayviewjobs.org

EOE/AA, M/F/D/V

Master of Science in Nursing Nurse Anesthesia Program Our 28-month program features: • Classes in Asheville with clinical rotations at various sites in Western North Carolina • Small class sizes for individualized attention

Ranked 7th among schools of nursing in U.S. News & World Report’s 2011 America’s Best Graduate Schools

MSN, DNP, or PhD

Earn a graduate degree online or onsite at one of America’s top schools of nursing.

• Faculty committed to your success • State-of-the-art, high-fidelity simulation center • 100 overall percent pass rate on the national certification examination

Make achieving your personal and professional goals a reality!

NURSING.WCU.EDU | 828.654.6499 52

Minority Nurse | SPRING 2013

School of Nursing Advancing Nursing Science, Education, and Practice www.nursing.pitt.edu/programs

1-888-747-0794

Academic Opportunities

We set an example to follow by the way we lead.

UT Southwestern.

• Award-winning nursing staff • Generous salaries and state of Texas benefits that begin your first day • A supportive, culturally diverse environment • World-class medical and scientific faculty, including 5 Nobel Laureates • One of the nation’s leading academic medical centers, with 12 specialties earning national recognition from U.S. News & World Report for 2012-13 • Ask about our sign-on bonus and relocation

Earn a Jefferson Nursing Degree, Achieve a Jefferson Reputation

Date: Media Order: Size: Publication: Section:

Apply online at:

March 2013 332332 3.4” x 9.2” (1/2 Pg. Vertical) Minority Nurse Far Forward

It’s exciting to be a part of one of the world’s leading academic medical centers. Here you’ll find team-oriented units with supportive leadership that provides collaborative learning environments for nurses.

For questions, contact Denise.Allen@UTSouthwestern.edu (No agencies please)

Follow the progress of our new William P. Clements Jr. University Hospital online at newhospital.utsouthwestern.edu

We are the future of medicine, today.

BSN: full-time upper division 2-year program FACT: 12-month accelerated BSN RN-BSN: online or online/on campus MSN: multiple specialties; core/support courses online; clinical courses on campus; distance education via live webcasting DNP: online, may complete in 2 to 5 years 512.328.9000

utsouthwestern.edu/careers

1-877-533-3247 explore.jefferson.edu/MinorityNurse Philadelphia, PA Dallas, Texas The University of Texas Southwestern Medical Center is an Equal Opportunity Institution.

THOMAS JEFFERSON UNIVERSITY

www.minoritynurse.com

Minority Nurse Magazine

@MinorityNurse

53

Academic Opportunities

Master of Science in Nursing Nursing Informatics Online Program Earn a Master of Science in Nursing by completing this web-based Nursing Informatics program. The Nursing Informatics program is designed to provide nurses with the necessary knowledge and skills to

enhance the quality of patient care and outcomes through the development, implementation, and evaluation of health information management tools and systems.

Escalating demands for health services and growing complexities of managing health information are increasing the need to prepare nurses with expertise in Nursing Informatics. Students are prepared, through collaboration with the College of Nursing and the School of Computer Information Sciences, to work with the latest health information management systems and tools in the health care environment. All course work is completed online. Most students can complete practicum requirements in their own community using student-identified preceptors approved by faculty.

For more information on application to the program, visit http://www.southalabama.edu/nursing/informatics.html or contact the MSN Graduate Advisor by email at congrad@usouthal.edu or by phone at 251-445-9400. For further information on the Nursing Informatics Track, contact Dr. Todd Harlan, Nursing Informatics Track Coordinator by email at tharlan@usouthal.edu.

Faculty Opportunities

Nursing Instructors

T

The college is diverse, creative, engaging and is recognized nationally as Achieving the Dream “leader college.” We are

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.

54

Minority Nurse | SPRING 2013

Cascade and Olympic mountain ranges. The college is currently constructing a new $39M Harned Center for Health Careers (opening 2014). We invite you to join our team during this time of innovation and implementation of ground breaking technology.

Our Nursing Instructors design, implement, prepare and teach a variety of nursing concepts across the health care continuum and hold expertise in one of the following areas; medical-surgical, maternal-child, pediatrics, or mental health nursing. Participate in the selection of clinical facilities and provide clinical instruction for students. Participate in academic advising and periodic program evaluations. Master’s Degree in Nursing, 2 years of nursing experience, current WA RN license or eligibility and requirements. www.tacomacc.edu/abouttcc/careersattcc Equal Opportunity Employer & Educator

Faculty Opportunities As an integral part of a research-intensive private university, “in the public service,” NYU College of Nursing’s mission is to generate new knowledge and educate future nursing professionals who, in turn, demonstrate the standards of excellence in research, education and practice for a global society.

Seeking Applicants for Faculty Positions Announcing several exciting faculty opportunities central to a futuristic strategic plan which will enlarge the College’s full-time faculty and build a state-of-the-art nursing facility.

Active searches include:

Ranked #5 in Research Funding

Clinical-Track Faculty who are leaders in undergraduate and/or graduate nursing education.

Those who are prepared to teach in more than one clinical area, including clinical sciences, will receive special consideration. Applicants must have an earned doctorate in nursing or a related field.

Ranked #1 NP Graduate Program in Geriatrics

A demonstrated record of effectiveness in teaching and scholarly productivity, as well as skills for collaborative team work, are required. Positions are 12-month, with appointment and salary commensurate with experience at the assistant, associate, or full professor level.

Clinical or Tenure Track Faculty with expertise in education research (simulation, on-line, design, innovation), program evaluation, and individuals with high-level informatics skills.

Director of Doctor of Nursing Practice (DNP) Program with accomplishments appropriate for the academic leader of a clinical doctoral program. Expertise in DNP education, evaluation, evidencebased practice, innovation, and clinical scholarship is required.

Tenure Track Faculty to contribute to the College’s research and educational strengths in Gerontology, Health Systems/Workforce, Prevention and Management of Chronic Disease/NonCommunicable Diseases (NCDs), and HIV/AIDS/Infectious Disease, with the vision and experience to contribute to our Global mission.

Applicants should submit a letter of interest and curriculum vitae to: nursing.facultyopenings@nyu.edu NYU College of Nursing envisions continuous progress in the excellent of scholarship and innovation to advance humane and quality healthcare for all people.

NYU is an Equal Opportunity/Affirmative Action Employer and actively seeks to enhance its diversity.

www.minoritynurse.com

Minority Nurse Magazine

@MinorityNurse

55

Faculty Opportunities

college of nursing

Index of Advertisers

Leveraging Technology. Transforming Health Care.

Join Our Team!

ADVERTISER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE # The Geo Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Hispanic Scholarship Fund . . . . . . . . . . . . . . . . . . . . . . . . 4

Thrive

Thrive

Legacy Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Springer Publishing Company . . . . . . . . . . . . . . . . . . . . . 31

UC has received national recognition including ranking by U.S. News and World Report and the Chronicle of Higher Education , which calls UC a “research heavyweight�. The University has the highest Carnegie classification (RU/VH) for research.

UNCF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2

Connect

University of Connecticut Health Center . . . . . . . . . . . . . 45

Connect

The College offers a collaborative network of researchers and is part of the UC Health system that includes four colleges; Hoxworth Blood Center, UC Barrett Cancer Institute and other institutes. We also partner with the Cincinnati VA Medical Center and Cincinnati Children's Hospital Medical Center.

Excel

Excel

U.S. Navy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4

ACADEMIC OPPORTUNIES . . . . . . . . . . . . . . . . . . . . . . . PAGE #

Our BSN and MSN programs are accredited by the Commission on Collegiate Nursing Education. The MSN and Doctor of Nursing Practice programs focus on a variety of advanced nursing areas.

The MSN online program is ranked #6 by TheBestColleges.org.

Frontier Nursing University . . . . . . . . . . . . . . . . . . . . . . . 51

Currently Open Positions

Johns Hopkins University School of Nursing . . . . . . . . . . 52

Clinical Track Faculty Positions Individuals who have expertise in community health, adult health, pediatrics, family medicine, neonatal or mental health

Tenure-Track Faculty Positions Researchers with pre-doctoral or post-doctoral funding or an established program of research

Jane E. Procter Endowed Chair Individuals with an established program of research in public health and evidence of sustained, substantial external funding

Director, Occupational Health Nursing, UC Education & Research Center (Currently funded through NIOSH) Individuals with an established program of research in or with application to occupational health and evidence of sustained, substantial external funding

Kaplan Higher Education Campus . . . . . . . . . . . . . . . . . . 51 Thomas Jefferson University . . . . . . . . . . . . . . . . . . . . . . 53 University of Pittsburgh School of Nursing . . . . . . . . . . . 52 University of South Alabama . . . . . . . . . . . . . . . . . . . . . . 54 University of Texas Southwestern . . . . . . . . . . . . . . . . . . 53 Western Carolina University . . . . . . . . . . . . . . . . . . . . . . 52

FACULTY OPPORTUNITES . . . . . . . . . . . . . . . . . . . . . . . . PAGE # NYU College of Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Oakland University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Please send a letter of interest and curriculum vitae via email to: Dean Greer Glazer, RN, CNP, PhD, FAAN at Greer.Glazer@uc.edu www.nursing.uc.edu/joinourteam The University of Cincinnati is an affirmative action/equal opportunity employer.

Women, people of color, persons with disabilities and veterans are encouraged to apply.

56

Minority Nurse | SPRING 2013

Tacoma Community College . . . . . . . . . . . . . . . . . . . . . . 54 University of Cincinnati . . . . . . . . . . . . . . . . . . . . . . . . . . 56

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.

•

•

•

•