Minority Nurse Spring 2020

The Career and Education Resource for the Minority Nursing Professional • SPRING 2020

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Table of Contents

In This Issue 3

Editor's Notebook

4

Vital Signs

7

Making Rounds

Academic Forum 25 Enough is Enough: Ending Nurses’ Toleration of Workplace Violence and Bullying

By Cheryl Green, PhD, DNP, RN, LCSW, CNL, MAC, FAPA, ACUE, CNE 27

The 2020 Census: Since It Impacts Us, Complete It!

By Brenda Robinson, DNP, MSN, BSN, RN

Cover Story 8 Resumes, LinkedIn, and HR Portal Profiles, Oh My!

By Jebra Turner

Features 14 Nurse Practitioners: Opening Your Own Practice

By Michele Wojciechowski

20 The School Nurse—Fully Engaged in Community Health

Degrees of Success 30 Learning Good Bedside Manner Through Trial and Error

By Kevin M. Chu, MFA, MSN, RN

Health Policy 32 Local Legislation Impacts Nursing and Those We Serve

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By Janice M. Phillips, PhD, RN, CENP, FAAN

Minority Nurse | SPRING 2020

By James Z. Daniels, MPA, MSc

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Overcoming a Public Health Crisis

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

A

s we wrap up this Spring issue, states across the nation (including my own New SPRINGER PUBLISHING COMPANY

York) are going on lock down to help prevent the spread of COVID-19, a coronavirus that has shocked the world and brought us all to our knees, quite literally.

As the world economy grinds to a halt, millions of people are now finding themselves unemployed and being asked to stay at home for an indeterminate amount of time while worrying about how they will pay their bills and put food on the table in the months to come.

We can overcome this public health crisis together, but we must all do our part to

CEO & Publisher Mary Gatsch Vice President & CFO Jeffrey Meltzer

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

Creative Director Mimi Flow

Production Manager Diana Osborne

Digital Media Manager Andrew Bennie

help “flatten the curve”—and this will require great sacrifice. Remember, you may be

Minority Nurse National Sales Manager

able to bounce back quickly if you get infected, but others around you—such as your

Andrew Bennie 212-845-9933 abennie@springerpub.com

grandmother, your childhood friend battling cancer, or your neighbor with asthma— might not be so lucky. To that end, I ask that each of you practices social distancing as recommended by medical experts (and not our president), practice good hygiene and wash your hands frequently, and stay in touch with your loved ones via social media so that we can return to “normal” sooner than later. (And don’t forget to thank all of the “essential” workers risking their own health to help us overcome this pandemic!)

During this time of solitude and reflection, please take a moment to be grateful for whatever you do have—whether it’s a loving family, a steady paycheck, or just your health. I, for one, am thankful for all the wonderful nurses and health journalists who make each issue of Minority Nurse possible.

Minority Nurse Editorial Advisory Board Anabell Castro Thompson, MSN, APRN, ANP-C, FAAN President National Association of Hispanic Nurses Birthale Archie, DNP, BS, RN Faculty Davenport University Iluminada C. Jurado, MSN, RN, CNN Chair, Scholarship Committee Philippine Nurses Association of America Martha A. Dawson, DNP, RN, FACHE Assistant Professor, Family, Community & Health Systems University of Alabama at Birmingham Wallena Gould, CRNA, EdD, FAAN Founder and Chair Diversity in Nurse Anesthesia Mentorship Program

Stay safe and be well!

Varsha Singh, RN, MSN, APN PR Chair National Association of Indian Nurses of America

—Megan Larkin

Debra A. Toney, PhD, RN, FAAN Director of Quality Management Nevada Health Centers Eric J. Williams, DNP, RN, CNE, FAAN President National Black Nurses Association 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.

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

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Minority Nurse ® is a registered trademark of Springer Publishing Company, LLC. © Copyright 2019 Springer Publishing Company, LLC. All rights reserved. Reproduction, distribution, or translation without express written permission is strictly prohibited.

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Vital Signs

CDC Confirms Person-to-Person Spread of New Coronavirus in the United States

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he Centers for Disease Control and Prevention ( C D C ) ­c o n f i r m e d that the 2019 Novel Coronavirus ­( 2019-nCoV) has spread between two people in the United States, representing the first instance of ­person-to-person spread with this new virus here.

Previously, all confirmed U.S. cases had been associated with travel to Wuhan, China, where an outbreak of respiratory illness caused by this novel coronavirus has been ongoing since December 2019.

However, this latest 2019nCoV patient has no history of travel to Wuhan, but shared a household with the patient diagnosed with 2019-nCoV infection on January 21, 2020.

Recognizing early on that the 2019-nCoV could potentially spread between people, CDC has been working closely with state and local partners

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to identify close contacts of confirmed 2019-nCoV cases.

Public health officials identified this Illinois resident through contact tracing.

Both patients are in stable condition.

“Given what we’ve seen in China and other countries with the novel coronavirus, CDC experts have expected some person-to-person spread in the US,” says CDC Director Robert R. Redfield, MD. “We understand that this may be concerning, but based on what we know now, we still believe the immediate risk to the American public is low.”

Limited person-to-­person spread with 2019-nCoV has been seen among close contacts of infected travelers in other countries where imported cases from China have been detected. The full picture of how easily and sustainably the 2019-nCoV

spreads is still unclear. Personto-person spread can happen on a continuum, with some viruses being highly contagious (like measles) and other viruses being less so.

MERS and SARS, the other two coronaviruses that have emerged to cause serious ­illness in people, have been known to cause some person-to-person spread. With both those viruses, personto-person spread most often occurred between close contacts, such as health care workers and those caring for or living with an infected person. CDC has been proactively preparing for the introduction of 2019-nCoV in the U.S. for weeks, including: • First alerting clinicians on January 8 to be on the lookout for patients with respiratory symptoms and a history of travel to Wuhan, China.

• Developing guidance for preventing 2019 novel coronavirus (2019-nCoV) from spreading to others in homes and communities.

• Developing guidance for clinicians for testing and management of 2019-nCoV, as well as guidance for infection control of patients hospitalized or being evaluated by a health care provider.

CDC is working closely with Illinois health officials and other local partners.

A CDC team has been on the ground since the first 2019-nCoV-positive case was identified and is supporting an ongoing investigation to determine whether further spread with this virus has occurred.

It is likely there will be more cases of 2019-nCoV reported in the U.S. in the coming days and weeks, including more person-to-person spread. CDC will continue to update the public as we learn more about this coronavirus. The best way to prevent infection is to avoid being exposed to this virus.

Right now, 2019-nCoV has not been found to be spreading widely in the United States, so CDC deems the immediate risk from this virus to the general public to be low. However, risk is dependent on exposure, and people who are in contact with people with 2019-nCoV are likely to be at greater risk of infection and should take the precautions outlined in CDC’s guidance for preventing spread in homes and communities.

For the general public, no additional precautions are recommended at this time beyond the simple daily precautions that everyone should always take. It is currently flu and respiratory disease season, and CDC recommends getting vaccinated, taking everyday preventive actions to stop the spread of germs, and taking flu antivirals if prescribed. Right now, CDC recommends travelers avoid all nonessential travel to China.

For more information about the current outbreak in China, visit https://www.cdc.gov/ coronavirus/2019-ncov/index. html. For travel health information, visit https://wwwnc. cdc.gov/travel/notices/watch/ pneumonia-china.

Vital Signs

Adolescent and Young Adult Cancer Survivors May Have an Elevated Risk of Hospitalizations

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dolescent and young adults who survived at least two years after a cancer diagnosis had nearly double the risk of being hospitalized compared with their siblings and unrelated, age-matched people without cancer, according to results published in Cancer Epidemiology, Biomarkers, & Prevention, a journal of the American Association for Cancer Research.

“Few studies have investigated health risk in adolescents and young adults after cancer treatment,” says Chelsea Anderson, PhD, MPH, a postdoctoral fellow at the American Cancer Society. “Our results underscore the importance of long-term, risk-based follow-up care to prevent and treat severe late effects and other health conditions in this patient population.”

Approximately 70,000 American adolescents and young adults, defined as those between the age of 15 and 39 years, are diagnosed with cancer each year. As five-year survival rates have steadily climbed higher over the past few decades to more than 80% for all cancer types combined, more cancer survivors have an increased risk of adverse health outcomes later in life as a result of their cancer treatment.

Previous studies on the impact of cancer treatment on late morbidities and hospitalizations among survivors of childhood cancer, such as the Childhood Cancer Survivor

Study, have included survivors from birth to 20 years and focused on selected cancers common among children, such as leukemia and central nervous system tumors. As a result, hospitalization patterns have not been well-characterized for adolescents and young adults, especially those with breast, colorectal, and other cancer types that are more common at the older end of the age group.

Anderson and colleagues at the University of Utah and the University of North Carolina examined the risk of first hospitalization and rate of total hospitalizations among adolescents and young adult cancer survivors using data from the Utah Population Database. The resource links statewide population records to cancer diagnosis information in the Utah Cancer Registry, which is part of the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program, as well as hospital discharge information from the Utah Department of Health.

The researchers analyzed data for 6,330 cancer survivors, 12,924 siblings, and 18,171 agematched people without cancer.

The risk of a first hospitalization among adolescent and young adult cancer survivors was 1.78 times higher compared with their siblings and 1.93 times higher than unrelated, age-matched people without cancer.

Compared with controls, the risk of a first hospitalization

increased 4.76-fold for survivors of leukemia, 3.45-fold for survivors of central nervous system tumors, 2.83-fold for survivors of colorectal cancers, 2.76-fold for survivors of non-Hodgkin lymphoma, and 2.37-fold for survivors of breast cancer. The lowest risks of a first hospitalization were for cervical/uterine cancers and melanoma.

The rate of total hospitalizations increased by 56% for adolescent and young adult cancer survivors compared with controls.

Cancer survivors also had more than double the risk for several other conditions, including infectious and parasitic diseases, nervous system diseases, circulatory diseases, skin diseases, respiratory conditions, injury, and poisoning. They also had a somewhat elevated risk for digestive, mental, musculoskeletal, and genitourinary diseases.

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“A better understanding of the burden of hospitalizations among AYA cancer survivors may help to anticipate future health care utilization in more recently diagnosed patients,” Anderson says. “These findings may also inform the development of guidelines for ­follow-up care for adolescent and young adult cancer survivors.”

The main limitation of the study was that the number of hospitalizations was too small to perform analyses on specific cancer types or diagnostic codes within groups. The research was limited to hospitalizations that occurred in Utah. The study authors were not able to identify patients who were undergoing active cancer treatment during the follow-up period; therefore, some hospitalizations could reflect toxicities associated with some cancer therapies.

To learn more, visit www. aacr.org.

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Vital Signs

Pregnancy, Breastfeeding May Lower Risk of Early Menopause, NIH-Funded Study Suggests

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omen who breastfed their infants exclusively for seven to 12 months may have a significantly lower risk of early menopause than their peers who breastfed their infants for less than a month, according to an analysis funded by the National Institutes of Health.

The study also suggests that pregnancy can reduce the risk of early menopause.

The study was conducted

by Christine Langton, MSW, MPH, of the University of Massachusetts at Amherst, and colleagues. It appears in JAMA Network Open. Funding was provided by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Cancer Institute.

“The study results provide the strongest evidence to date that exclusive breastfeeding may reduce the risk of early menopause,” says Lisa Halvorson, MD, chief of the NICHD Gynecological Health and Disease Branch, which oversaw the research.

Previous studies have suggested that menopause before age 45 (early menopause) increases the risk of early death, cognitive decline, osteoporosis, and cardiovascular disease. Smaller studies have found evidence linking pregnancy and breastfeeding with later menopause, but because of their size and other limitations, the results are inconclusive. Moreover, the earlier studies focused on timing of

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menopause and not on the risk of early menopause.

In the current study, researchers analyzed data from more than 100,000 women ages 25 to 42 years in the Nurses’ Health Study II. Every two years, from 1989 to 2015, the participants responded to detailed questionnaires, providing health information and medical history, including pregnancy history. Compared to women who had never been pregnant or who had been pregnant for less than six months, women who had one full-term pregnancy had an 8% lower risk of early menopause. Those who had two pregnancies had a 16% lower risk, and those who had three pregnancies had a 22% lower risk.

Women who breastfed had an even smaller risk for early menopause. Those who breastfed for a total of 25 months or more during their premenopausal years had a 26% lower risk than women who breastfed for less than a month.

Similarly, women who breastfed exclusively seven to 12 months had a 28% lower risk of early menopause, compared to those who breastfed for less than a month.

The study did not determine why pregnancy and breastfeeding might lower the risk of early menopause.

However, researchers theorize that because pregnancy and breastfeeding halt ovulation, the slowing of the egg loss may delay menopause.

To learn more, visit www. nih.gov.

Making Rounds

May

July

September

7-9

1-5

23-25

2020 Annual Conference Hyatt Regency Chicago Chicago, Illinois Info: 866-552-6404 E-mail: ania@ajj.com Website: www.ania.org

2020 Annual Convention Manchester Grand Hyatt San Diego San Diego, California E-mail: infomypnaa@gmail.com Website: www.mypnaa.org

2020 Education Summit Orange County Convention Center Orlando, Florida Info: 800-669-1656 E-mail: summit@nln.org Website: https://summit.nln.org

American Nursing Informatics Association

June 13-17

Association of Women’s Health, Obstetric and Neonatal Nurses 2020 Annual Convention Phoenix Convention Center Phoenix, Arizona Info: 800-673-8499 E-mail: customerservice@awhonn.org Website: www.awhonn.org

23-28

American Association of Nurse Practitioners 2020 National Conference New Orleans Ernest N. Morial Convention Center New Orleans, Louisiana Info: 512-442-4262 E-mail: conference@aanp.org Website: www.aanp.org

Philippine Nurses Association of America

National League for Nursing

14-17

National Association of Hispanic Nurses 45th Annual Conference Hyatt Regency Miami Miami, Florida Info: 919-573-5443 E-mail: info@thehispanicnurses.org Website: http://nahnnet.org

October 15 – 17

The American Assembly for Men in Nursing 2020 Annual Conference The Handlery Hotel San Diego, California Info: 929-515-4945 E-mail: info@aamn.org Website: www.aamn.org

July/August July 28 – August 2

21-24

National Black Nurses Association 48th Annual Institute and Conference The Diplomat Beach Resort Hollywood, Florida Info: 301-589-3200 E-mail: info@nbna.org Website: www.nbna.org

Transcultural Nursing Society 46th Annual Conference Galt House Hotel Louisville, Kentucky Info: 888-432-5470 E-mail: staff@tcns.org Website: www.tcns.org

August 5-7

Doctors of Nursing Practice 2020 National Conference Hilton Tampa Downtown Tampa, Florida Info: 888-651-9160 E-mail: info@doctorsofnursingpractice.org Website: www.doctorsofnursingpractice.org

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Resumes, LinkedIn, and HR Portal Profiles, Oh My! 8

Minority Nurse | SPRING 2020

BY JEBRA TURNER Most nurses at one time or another in their career will want to get hired, get promoted, or get noticed. Besides what everyone has to keep in mind (like how to look for another job without alerting a present employer), nurses have unique considerations when it comes to resumes, online professional profiles, and social media usage.

Y

et most nurses receive little career development assistance during their nursing school education. Often, the how-tos of resumes and interviewing are covered quickly in a twohour seminar at the end of their coursework. If they’re lucky, new nurse graduates may get more guidance and training through professional associations or on-the-job

mentor relationships. Most likely they won’t. That’s why we asked savvy nurses and career experts for their answers to your resume and profile questions.

Ok, Why Do I Need a Stellar Resume?

Creating a resume can be a major stumbling block for anyone, so it’s easy to give that task short shrift. Some

nurses can get away with that, but not when they’re at certain points in their careers.

For instance, inexperienced nurses, nurses who are targeting a new specialty, or relocating to a certain geographic area need to bring their “A” game.

When you’re a new nurse graduate…

Kati Kleber, MSN, RN, CCRN-K, a nurse educator and founder of FreshRN, developed an online course on how to get your first nursing job in order to address a pressing need.

Kleber sat in on many employment interviews for

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new graduates and realized that a lot of them “seriously want to do well but shoot themselves in the foot.” She observed that their resumes tend to be generic-looking, with the same coursework, clinicals, and rotations listed.

To get around that, she recommends that new nurses highlight what they can uniquely offer, for instance, a willingness to be coached and an eagerness to belong to a strong health care team.

“Clinical experience is important, but you don’t want that to be the only thing you list on your resume, which is a common misconception,” Kleber says. “Nursing students

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think employers would rather hear all of their clinical experience, but what’s more impactful to a hiring manager is

an employer’s HR portal or email it, using their preferred method and document format. If applicants don’t follow instructions precisely, it can cause the hiring team “to wonder if they can follow directions or if they can handle the technology that goes along with nursing. If you have to call and ask how to upload a resume, that’s a problem,” warns Kleber.

When you’re transitioning to a competitive specialty…

Kati Kleber

learning about all of the other experiences a potential candidate has—like other employment history, even if it’s not related to health care.”

But what if you don’t have any work experience, even in a somewhat-related field, like food service? “Be proactive; there are a lot of opportunities for nurses to volunteer,” she suggests. “Even if it’s only one five-hour shift a

“Clinical experience is important, but you don’t want that to be the only thing you list on your resume, which is a common misconception,” Kleber says. week, that speaks volumes. It says: I can commit and I will show up.”

Polished resume in hand, you can then upload it to

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Not every new nurse comes to the workplace with a blank slate. Some have experience in other fields or nursing specialties and must translate that skill set for a new role. “If you have a background as a teacher, you can be a nurse educator. Business background? Go into a nursing leadership role,” explains Thomas Uzuegbunem, BSN, RN, nurse blogger at NurseMoneyTalk.com and GI nurse in the Oklahoma City area. “The beauty of nursing is that there’s a lot of choice.

You can really leverage your nursing degree because of how big the field is.”

Going into a new field or specialty can be personally and financially rewarding, but it takes some strategy to first choose the right specialty, and then to slice and dice previous experience and present it well to a new employment situation.

“You have to show ‘here are the things about me that make me perfect for the job’ and tailor your resume to the job,” says Brittney Wilson, BSN, RN,

an informatics expert based in Nashville, Tennessee who owns a popular blog called The Nerdy Nurse.

When Wilson wanted to leave the bedside for a nurse informatics role, she got help from a savvy fellow nurse already employed in that specialty. “I said ‘I’m applying, but I’m not getting any bites.’ He asked to see my resume and critiqued it for free,” she explains. His advice? Use buzzwords, not just general terms, and focus on your skills and qualifica-

Thomas Uzuegbunem

tions. In Wilson’s case, her qualifications included serving as a technology superuser on her unit, she’d been published, and she had built up an impressive blog which also served as a portfolio.

In addition to getting a resume critique from someone expert in the field, Wilson recommends taking other steps to set yourself apart. Especially if you’re making a transition into a competitive specialty.

“If you’re going from med-surge to cardiac, you have to get more training

and education, like through Kati’s [FreshRN] cardiac nurse crash course. Or go to a conference in that specialty,” she says. “You’ve got to prove you’re not just status quo, that you’re willing to go above and beyond for the job. Show the employer ‘I’m putting my money where my mouth is, putting boots on the ground.’”

When you’re moving to a new geographic area…

There are some areas where it’s easy to find a nursing position and others, such as California, that are much more competitive markets.

Nurses may want to relocate for Cali’s sunny surfing beaches, or they may need to relocate in order to follow a coder spouse to Silicon Valley,

Another reason to focus on only a handful of employers is the power of referrals. Candidates are in a much stronger position if they can cite even a weak connection when applying, says Prichard.

the technology mecca.

Mac Prichard, founder of Mac’s List, an online career hub for the Pacific Northwest, has helped many new arrivals to a region that’s highly desirable for its creative, laidback lifestyle.

He recommends that nurses be strategic about how they

conduct their job search in an unfamiliar city. “First, identify the top five employers

Brittney Wilson

and be really specific about where you want to work,” he explains. “Look in business specialty magazines, business directories, and ask your contacts to find the places you want to be. Then, create a list and rank it. You can’t apply everywhere—you’ll exhaust yourself. Don’t be the person doing a ‘spray and pray’ job search.”

Another reason to focus on only a handful of employers is the power of referrals.

Candidates are in a much stronger position if they can cite even a weak connection when applying, says Prichard.

“People are more likely to hire people they know, like, and trust—or applicants who are referred by people they know who know, like, and trust the applicant,” he says.

It’s not easy to find connec­ tions in a town where you don’t know anyone, but it can be done. Search LinkedIn or your alumni directory to see if anyone you know has

relocated to that city, or they’re connected to someone who has. Using a six degrees of separation methodology, you can inch your way closer to connections in your target ­mar­ket. Or, be brave and reach out directly to employees at your target employers.

Online networking isn’t the only option, either. Pick up the phone and call a friend of a friend or attend a professional conference and arrange to have coffee with nurses in your target city or at your favorite hospitals.

As a long-distance applicant, you may face some hurdles that someone already in the area would not. For instance, employers may prefer local candidates. One way to handle that is to be very direct, advises Prichard. “Be upfront and say, ‘I plan to move on November 1 and this will be my new home, because I have family there or another connection to the area.’ Otherwise they may think ‘this person is just fishing,’ but if you address it directly, then it becomes a non-issue.”

But what if your resume gets spit out by an applicant tracking system or recruiter that gives preference to locals? “That’s another reason to build connections inside of an organization,” says Prichard. “There are two ways to get a job: through the front door, using the website, the ATS, and a formal hiring process. Or through the back door,” where you rely on personal connections to bypass digital or human screeners.

When you’re a minority nurse…

There’s an acute shortage of nurses, especially minority nurses, and the unemployment rate overall in health care is extremely low. Yet some candidates experience conscious or unconscious bias based on race, ethnicity, gender, or age. Some research suggests that the name of an applicant is one such signifier.

A recent two-year study showed that companies are more than twice as likely to call applicants who display no racial clues on their job resumes; that applies even to “pro-diversity” employers.

An Asian American applicant named “Lei,” for instance, may substitute the nickname “Luke,” include non-stereotypical hobbies (motorcross and camping), and tweak the names of minority associations, scholarships, and awards.

Online networking isn’t the only option, either.

Pick up the phone and call a friend of a friend or attend a professional conference and arrange to have coffee with nurses in your target city or at your favorite hospitals.

Whether this type of subterfuge will serve you well once in the interview or result in a job offer is unclear. But the one-third of minority

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candidates who admit to whitening their resumes rationalize that you can’t get a job offer if you can’t even get your foot in the door for an interview.

Most minority candidates did not scrub their resumes of bias markers, for a variety of reasons, including ethical ones. “Nurses should seek employers that are aligned with their personal and professional values,” says Liz Stokes,

Mac Prichard

JD, MA, RN, director of the American Nurses Association Center for Ethics and Human Rights. Additionally, “Nurses should inquire about diversity initiatives within an organization. These initiatives should promote inclusiveness, civility, and mutual respect, contain methods for reporting violations, and require interventions to avoid recurrence.”

Do I Really Need a LinkedIn Profile?

Keith Carlson, BSN, RN, NC-BC, nurse career coach at NurseKeith.com says he’s often asked why LinkedIn is necessary. His answer? “Your

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LinkedIn profile is like a resume on steroids.”

According to Carlson, here are a few of the powerful ways LinkedIn can boost your career: • You can reach out to people in other places or specialties.

“Say you want to work at Johns Hopkins. You could look up the recruiter or nurse manager or a nurse in the unit where you want to work,” advises Carlson.

“Contact the nurse and say ‘Hi, I’d like to meet with you to learn more about your unit and to find out what you’re looking for in an ideal candidate.’”

• You can be seen by recruiters so you can get job offers.

“LinkedIn is actually a really robust search engine. If you want to be found or you want to find others, be sure your profile is peppered with keywords related to your skills, experience, and expertise,” he says.

Additionally, he notes that recruiters may hold back some openings and search LinkedIn for candidates that they then contact directly.

• LinkedIn has an “Easy Apply” button.

“There are thousands of jobs out there that you can apply for with a click of a button,” Carlson says.

Applicants and recruiters both like this option. Strong nurse candidates may be already employed but will still click one button when they wouldn’t otherwise fill out lengthy, tedious online applications.

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How About Social Media?

Do I Need to Do That, Too? LinkedIn doesn’t appeal to every nurse and some experts believe it reflects the needs

Liz Stokes

• Recommendations are “social proof.”

On LinkedIn, a contact can write you a detailed testimonial, or simply click a button to endorse one or more skills. “To ask for one, say ‘I’m in the job market—would you write me a recommendation?’

Easy endorsement also works as social proof,” says Carlson. “For example, if I’m endorsed 200 times for nursing, someone looking at my profile will think ‘maybe Keith actually does know something about nursing.’

It’s like that saying, ‘100 million Elvis fans can’t be wrong.’”

• LinkedIn Pulse is an easy way to publish—and get read.

“If you want to be known as a leader, or thought leader, you can publish on LinkedIn’s native publishing platform,” says Carlson. “Say you’re an oncology nurse, write an article about your experiences in that specialty and an employer may read it and say ‘Wow, I want to see this person!’”

“Nurses should seek employers that are aligned with their personal and professional values,” says Liz Stokes, JD, MA, RN, director of the American Nurses Association Center for Ethics and Human Rights. of employers, not employees, and doesn’t help nurses connect with each other, either.

Additionally, many recruiters say they find nurses on Facebook, Instagram, and Snapchat.

If nurses gather on social media and recruiters follow, then it may make sense for a job seeker to do the same. But nurses are also professionals who must use social media appropriately.

What is “appropriate” usage remains a question. “There’s a 60/40 controversy in the nursing community on social media,” says Wilson. “I argue that media has represented us as dumb, ditzy, sexy nurses.

So, when you put a bikini shot of yourself with a #nurselife hashtag online, you’re not doing us any favors.”

If you’re not as concerned about the profession’s image, you might consider your own personal brand. “I make

a comparison to big companies and how they protect their brands so much,” says Uzuegbunem. “There’s value in that name, that brand.

We need to put that same emphasis on our own brands.

Corporations invest heavily in creating a brand name and logo and will go to great lengths to prevent that brand from being tarnished.”

And finally, nurses need to use social media appropriately in order to protect their ability to practice. “Nurses must be cognizant of sensitive or potentially damaging information that might be publicly accessible to others,” says Stokes. “Nurses are held to the Code of Ethics and unprofessional conduct, even online, can be subject to negative consequences such as termination or reprimand.”

Protect Your Safety With a Defensive Online Footprint One of the things that

Keith Carlson

makes nurses nervous about being online, whether it’s social media or an online profile, is personal safety.

Transparency may be valued more highly by younger nurses who grew up expecting that anything they shared

to maintain digital safety, according to social media savvy nurses. “While our entire existence as nurses is to alleviate pain and suffering, there are times when a patient might put our own personal safety at risk,” says Jon Haws, BSN, BS, RN, founder and CEO of

The concern for safety needs to begin at the bedside and extend to your online security measures.

Jon Haws

would be public. Not so for others, such as nurses who want to maintain boundaries between personal and work life, or advanced practice nurses who fear becoming targets for drug-seeking patients.

There are a lot of things nurses can and should do

NURSING.com, an educational hub for nurses.

The concern for safety needs to begin at the bedside and extend to your online security measures. “As such, I think a couple of very simple measures can keep you generally safe,” says Haws. “Don’t tell patients your last name,

don’t mention kids/family/ hometown. Keep social profiles private and only accept friendships from known individuals.”

In addition to setting digital profiles to private, you can set up a separate email and phone number for professional use only. There are free options for doing that, such as Gmail and Google Voice.

Taking this kind of approach means you’ll be easy to find for recruiters, but you can ignore unwanted contacts by recruiters, patients, or anyone else you meet up with online.

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

Resume and Social Media Resources • FreshRN offers a free downloadable resume template for entry-level nurses.

• Thomas Uzuegbunem’s nurse finance blog provides resume tips for new grads.

• Brittney Wilson’s e-book, The Nerdy Nurse’s Guide to Technology, covers using social media to advance your career.

• “ Whitened Résumés: Race and Self-Presentation in the Labor Market,” included 1,600 online applications to entry-level jobs in various industries.

• ANA’s position statement on bias and the nurse’s role in addressing discrimination.

• ANA’s article on social media missteps that could put your license at risk.

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NURSE PRACTITIONERS

O P E N I N G Y O U R O W N P R A C T I C E

BY MICHELE WOJCIECHOWSKI

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In many states, Nurse Practitioners (NPs) can open their own practices. But just because you can doesn’t mean you should. Here’s how to decide and, if you choose to, the types of actions you’ll need to take.

W

hen Scharmaine Lawson, FNP-BC, FAANP, FAAN, had been a nurse for 15 years, she had worked in many different specialties. One of her favorites was home care. In fact, it was her passion.

“I wanted to help my community, and a physician approached me about starting my own clinic/housecall service. It was a ‘right time/right place’ moment,” she recalls.

Lawson ended up founding a VIP housecall practice, Advanced Clinical Consultants in Louisiana, which has been successful for the last 15 years. She also penned Amazon’s number one house call book, Housecalls 101: The Only Book You’ll Need to Start Your Housecall Practice. Finally, she’s designed a course called Housecalls 101, in which she teaches other clinicians how to start and maintain a successful home visit program. Since 2008, Lawson says she has trained more than 600 nurses on how to do this themselves.

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“When the opportunity presented itself, it was a natural fit in an environment I felt comfortable operating in,” says Lawson. “Plus, I saw the community need and felt I could best be a servant leader. At the end of the day, the ability to serve is my superpower. It’s an honor that I don’t take lightly.”

Should You Open a Practice?

As Lawson says—and as do our other sources—first, you need to find your passion.

You also need to decide if this is something you really can do. “Opening your own practice takes guts, time, and dedication. If you’re missing any of those, it’s not worth it,” says Graig Straus, DNP(c), APRN, CEN, FF-NREMT, founder and owner of Rockland Urgent Care Family Health NP in New York. “I always knew that I wanted to be my own boss, make my own rules, and care for my patients on my own terms. Having that desire really drove me to the point of wanting to open my own business.”

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While fulfilling, opening and running your own business isn’t easy. “Nurse practitioners should only open their own practices if they want all the things that go along with owning any business: bookkeeping, marketing, networking, hiring/firing, social media, etc.,” says Bradley A. Bigford, MSN, APRN, NP-C, CCHP, founder and owner of Table Rock Mobile Medicine, PLLC in Idaho. “If they like working 9-5 jobs, owning their own businesses likely isn’t for them. They have to put in long days and nights, weekends, and holidays.”

If you’re up to the task, the next step is to determine what kind of impact you want to have on your community and profession, while making sure that what you want to do matches up with a need in the area you want to serve. “It was a simple decision for me,” says Maurice D. Graham, DNP(c), MSN, APRN, FNP-BC, CEO of Graham Medical Group,

a concierge medical practice in Maryland. “As an African American male, [I know that] we are often undertreated for health care issues, accompanied with the fact that African American men do not seek routine screenings and prevention.”

Ask yourself tough, but important, questions. Melanie Balestra, JD, NP, MN, of the Law Offices of Melanie Balestra, is a lawyer and an NP and has been working with other NPs in a legal capacity to help them set up their own practices for more than 25 years. She says you should

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ask yourself some of the following questions: • What are the goals of opening your own practice?

• Where will it be located?

• What will be the focus of it?

• Will you take insurances or be cash based?

“Opening your own practice takes guts, time, and dedication.

If you’re missing any of those, it’s not worth it,” says Graig Straus, DNP(c), APRN, CEN, FF-NREMT, founder and owner of Rockland Urgent Care Family Health NP in New York.

• Will you need support help?

• Will you be taking out a loan? If so, where will you apply for one?

• Will you be able to function in the red for at least a year?

“The biggest challenge is that it does not happen overnight,” says Balestra. “The NP needs patience and be able to evaluate what might not be going right in the practice. This is why location is important. Collections can be a nightmare, so it’s important to have a good billing and collection service. The biggest mistake is expecting overnight success, and then when it does not happen, giving up.”

What to Do First The first thing you need to do if you plan to open your

own practice is to develop a business plan, says Balestra.

“If you are in a state that requires a supervising physician, make sure you have him/ her on board. When this is done, hire an attorney who has experience with setting up NP businesses and understands the laws of your state.

Hire an accountant to work with the lawyer on setting up the best entity for you legally and tax wise,” she explains.

Have several office spaces in mind and make sure they are zoned for medical practices. If you need a loan to start business, it may be a personal loan but a note can be written so that the business pays back the loan.”

Do your research. “Nobody should just open a practice for

the sake of opening one without any research into their idea or doing market analysis,” says Lawson. “This is a disaster waiting to happen.”

Bigford stresses that you also need to talk with your family.

“It takes a buy-in from everyone because of the sig­nificant work it takes from everyone involved and their loved ones

If you’re up to the task, the next step is to determine what kind of impact you want to have on your community and profession, while making sure that what you want to do matches up with a need in the area you want to serve.

to pick up their slack,” he says.

As for how long it will take—for our sources, it took anywhere from four months to two years before they opened their practices.

Straus says that after you incorporate, you should also get a group NPI number—this is different from the personal one you would have gotten when you initially began practicing. “This establishes your company as an organization capable of being recognized by CMS,” he says. He then went and spoke with his local Industrial Development Agency to determine what tax breaks and industry connections he could get. “This will help to reduce costs and potentially hasten any permits needed to build a practice.

These are quasi-governmental agencies who have the ability to lessen the tax burden

placed on you in the initial stages of opening a business.

The goal of these agencies is to promote sustainable businesses and help support local communities.”

You’ll also need insurance— for yourself and your business.

“Insurance is a necessity prior to your business opening,” says Emily Keller Rockwell, RN, MSN, CRNP, owner and founder of The Montchanin Center for Facial Aesthetics in Delaware. “Without question, have a detailed meeting with your insurance agent, discussing your business in detail— making sure they understand all aspects of your business and will provide the adequate coverage and limits to protect you and your business.” A few kinds of insurance to discuss, she says, are property, liability, errors and omissions coverage, umbrella, and disability, among others.

Hiring Staff Some of our sources didn’t hire staff—at least for the first year. “Staffing depends on the volume of business being generated,” says Graham. “My first year, I didn’t hire anyone. I did all my administration duties and cared for my patients. My goal was to keep my overhead as low as possible without lowering the level of care given to my patients.

This worked out well for me.”

Rockwell also waited a year to hire an assistant. Now she has three and a full-time publicist. “I am able to do ­speaking engagements, conduct trainings, and attend training events to further my professional knowledge,” she says.

If your type of practice requires that you have staff

from the beginning, Balestra says to know what you’re looking for in attitude, skill level, and personality.

Bigford says that “Hiring non-revenue generating staff should be kept at a minimum.” When you hire anyone, he suggests that you find people who have a good work ethic. “Someone personable, easy going, and friendly is important,” says Straus.

A Location Once you’ve determined your business, you may need to find a place. (Obviously, if you choose to have a house call business, you don’t need a brick-and-mortar office.)

“Think about the services you want to offer and the space you need to do it in,” says Straus. His urgent care facility needed a lot more resources than a primary care office. “I specifically met with architects who specialize in medical offices to help determine the size and capabilities of the space, based on my needs.”

Graham had one large room that included his own personal desk as well as all the equipment he needed to conduct assessments and provide routine care to his patients.

Rockwell says that when designing your space, keep your clients’ need in mind.

“Design a warm, comfortable waiting area to keep patients relaxed,” she says.

Attracting Patients All our sources say that you must have a website. Even if it doesn’t bring clients in directly, they will want to look at it to get information about you and the kinds of services you offer.

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Don’t discount word of mouth. This can be one of your best marketing tools.

Social media is your friend.

Learn how to use it. If you don’t know how, hire someone who does.

When using social media, decide which is best for you.

For Rockwell, Instagram has brought her the most clients.

Bigford says to go where your core consumers are. His are on Facebook and Instagram.

“Post every single day. Go to Facebook groups. Facebook and Instagram ads work really well for me to build trust,” he says.

Straus suggests having “coming soon” ads before you actually open to build up curiosity. “Ads in local papers that cater to your community could be beneficial,” he says.

He adds that advertising in church newsletters, school calendars, and through the police athletic leagues—any organization that involves your community—can be beneficial to your business.

If your type of practice requires that you have staff from the beginning, Balestra says to know what you’re looking for in attitude, skill level, and personality.

Our sources also stress getting patients/clients to give you reviews on Yelp, Google, and Facebook. High ratings attract new consumers.

Additional Info Before you start your own business, there’s still more to know. “Get experience

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elsewhere first,” says Bigford.

“If you’re trying to learn to be an NP and start your own business, you’re going to struggle at both.” He also suggests that you get traction with patients.

It took Bigford about a year to

my work time and personal time equally. As with anything in life, you need to reboot or you will burn out. Schedule yourself into your schedule!”

Look for a mentor. “NPs should look for a mentor or

get a steady stream of patients and referrals. “If you have a high overhead in the beginning, you can go out of business before you even see your first patient,” he cautions.

Be sure that you know how to properly manage your time. That was Rockwell’s ­biggest challenge.

“I wanted to see and help every patient who inquired,” she recalls. “I quickly found out that I needed to manage

Before you start your own business, there’s still more to know. “Get experience elsewhere first,” says Bigford. “If you’re trying to learn to be an NP and start your own business, you’re going to struggle at both.”

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someone who has already established a clinic, and pick their brain. That’s what I did,” says Graham.

Have enough money to get you through. “In jobs that rely on insurance, payments are delayed. You do not simply offer a service and get paid the exact moment of exchange.

A claim has to be made, filed, and processed. Then payment is issued per contracts,” says Straus. “A solid 4-6 months of cash on hand to cover expenses is needed while you establish your practice, build clientele, and await the beginning of insurance reimbursements.”

Despite all the hard work and sacrifice needed to run your own practice, our sources wouldn’t have it any other way.

Lawson’s biggest reward in having her own practice?

“Complete autonomy,” she says. “It is the biggest entrepreneurial superpower.”

Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about the nursing field but comes close to fainting when she actually sees blood. She’s also author of the humor book, Next Time I Move, They'll Carry Me Out in a Box. Disclaimer: This story is meant to give general advice. For specific individual advice on starting your own business, be sure to consult a lawyer, an accountant, and other professionals.

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The School Nurse Fully Engaged in Community Health

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Minority Nurse | SPRING 2020

BY JAMES Z. DANIELS, MPA, MSC The Centers for Disease Control and Prevention (CDC) continues to issue the rise in the number of youths who have been diagnosed with measles. This national outbreak of the highly contagious measles virus has been recorded as 1,282 individual cases in 31 states as of December 2019 and growing. This is the greatest number of cases reported in the U.S. since 1992. More than 73% of the cases this year are linked to outbreaks in New York. Now the necessity of the school nurse has come into focus.

A

ccording to the National Association of School Nurses (NASN), about 40% of our nation’s schools only have a part-time nurse, and 25%

don’t have a nurse at all. Not surprisingly, the school systems that are largely affected or at greater risk are rural and urban schools. But with the potential of measles affecting

a large number of children and adolescents, school nurse practitioners in several states hurried to refresh themselves on the measles symptoms and to reach the parents of students at risk of infection while working to keep all students safe. They have become the first line of defense in ­protecting school communities.

The origin of the school nurse has been traced to a Canadian trained woman named Lina Rogers Struthers who is credited as the first school nurse in America. She was assigned to work as a school nurse in four different

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lower Manhattan schools just as a month-long experiment in October 1902. Officials wanted to see whether having a school nurse would improve students’ health and attendance. Despite the fact that there were 10,000 students, her presence made a huge impact on improving the health of students. In fact, in just one month the absentee rate of students in all four schools dropped dramatically. And after the sixmonth mark, absenteeism fell by 90%. The surprise at the numbers spoke for themselves.

The officials next secured funding to employ another

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27 school nurses. By the end of 1914, there were as many as 400 school nurses in New York City alone. Noticing what the impact school nurses were having, other cities quickly followed suit. Los Angeles was one of the first cities to jump on the bandwagon; it hired its first school nurse in 1904.

Today, everything that has to do with school nurses and vaccines—from unequivocal conversations with parents about the science of immunization to the firsthand monitoring of student populations

is a current and forecasted national shortage of nurses because of talent pipeline conditions. While 25% of the country’s public schools do not employ a nurse, and in many school systems there are only part-time nurses, the issue is not merely the unavailability of talent. The overarching issue here is funding.

There are no federal laws regulating school nurses.

Today, there are no federal laws regarding school nurse staffing, hours of work, compensation, or caseload. But the American

According to the National Association of School Nurses (NASN), about 40% of our nation’s schools only have a part-time nurse, and 25% don’t have a nurse at all.

for diseases, have been made difficult by the underfunding of nursing services. In school systems without full-time nurses, it is not unusual for nurses to travel between three or four schools a day or week.

Burdened with caseloads of up to 1,500, they try to distribute medications and treatments on time, attempting to triage the most critical cases, while also keeping on top of a mountain of paperwork, according to the National Education Association, which shares with the NASN concern for the need to ramp up the number of fulltime nurses.

At a time when the nation’s health care debate is receiving fixed attention, it is indisputable that the delivery of effective and responsive health care is dependent on adequate staffing resources and much success is dependent on adequate nurse staffing levels. But there

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Academy of Pediatrics (AAP) recommends at least one fulltime registered nurse in every school—a standard many districts have failed to meet or are unable to meet.

The NASN defines school nursing as a specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, selfmanagement, self-advocacy, and learning.

A recently published research article in the NASN School Nurse journal focused on one of the most difficult

problems for school nurses and families: the issue of suicide.

The article concluded that a knowledge gap exists in school communities regarding suicide prevention education. It highlights two interrelated topics: school nurse engagement in dialogue with students’ families, and the implementation of a community-based suicide prevention educational program at a suburban public school district. Diane Cody Roberts, MPH, BSN, RN, and her coauthors provide an overview of the public health problem of suicide for students, current student challenges, the role of the school nurse in suicide prevention, and a key gap in current school nursing practice. The two overarching goals for this community-based project were to have school nurses engage in productive conversations with students’ parents and families about suicidality concerns and to increase the school community’s knowledge about suicide prevention.

Today, everything that has to do with school nurses and vaccines— from unequivocal conversations with parents about the science of immunization to the firsthand monitoring of student populations for diseases, have been made difficult by the underfunding of nursing services.

But as Laurie Combe, MN, RN, NCSN, president of NASN pointed out recently, when the nurse is not in the

school—because they are covering multiple schools—then the nurse misses lots of opportunities to build trust with parents and with families. If they don’t see the nurse and if the nurse is simply the person telling them to comply with immunization directives, then there is the likelihood of resistance.

In May 2017, the Joint Legislative Program Evaluation Oversight Committee of the North Carolina General Assembly directed the Program Evaluation Division (PED) to analyze the need for school nurses and determine how these nurses are funded. Need is growing due to increased attendance by exceptional children and students with chronic conditions as well as laws and policies expanding the health care responsibilities of schools. The PED found that only 46 of 115 Local Education Agencies (LEAs) currently meet the school nurse-to-student ratio of 1:750 recommended by the State Board of Education in 2004. Achieving either the 1:750 ratio or providing one nurse in every school (the current recommended standard of the NASN) would cost between $45 million and $79 million annually.

The report continued that approximately 60% of all medical procedures conducted in schools are performed by school employees who are not nurses. As a result, students are vulnerable to errors and gaps in emergency medical care, and funding intended for education is being used to subsidize health care. Furthermore, unlike other school-based services such as speech therapy, few LEAs file for Medicaid reimbursement for nursing

services because, under the current Medicaid State Plan, a Registered Nurse must provide the care as ordered by a physician as part of an Individual Education Plan for the student.

Lee Antoinette Moore, MSN, on the faculty of the Durham, North Carolina Technical Community College School of Nursing, is a former school nurse with experience in New York City from 2004-2006, in North Carolina 2008-2010, and in Hawaii 2012 as a cover nurse who is called when there is an unplanned nurse’s absence.

Her prior experience includes that of a military nurse in Germany. Both North Carolina and New York are comparable

in many ways. As a whole, with the exception of a few districts, the nursing staff are each assigned to cover more than one school. All of North Carolina’s metropolitan areas have nurses covering more than one school. At the start of the school year, nurses are assigned to engage the schools’ support staff—the administrative support on such things as insulin injection, distribution of medication, some symptom identification, temperature taking and reading, as well as when to invite emergency assistance.

In 2016, the AAP issued a policy statement recognizing the important role school

nurses play in promoting the health and well-being of children in the school setting. By understanding the benefits and responsibilities of school nurses working in collaboration with the school physician, pediatricians can support and promote school nurses in their own communities, thus improving the health, wellness, and safety of children and adolescents.

Because the nurse plays such an integral role in the school, school nurses must be able to work with a variety of people.

School nursing training focuses on improving communication skills, developing organizational skills, performing

clinical work, making presentations, and learning the correct methods for teaching healthrelated lessons to students.

At a time when the nation’s health care debate is receiving fixed attention, it is indisputable that the delivery of effective and responsive health care is dependent on adequate staffing resources and much success is dependent on adequate nurse staffing levels.

Staff at Durham Technical Community College Nursing School www.minoritynurse.com

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Lee Antoinette Moore teaching

Nurses must be self-motivated and dedicated. In addition, they must be able to commit to continuing their education throughout the course of their careers.

Moore’s experience because of her assignment as a dedi-

But as Laurie Combe, MN, RN, NCSN, president of NASN pointed out recently, when the nurse is not in the school—because they are covering multiple schools—then the nurse misses lots of opportunities to build trust with parents and with families. cated nurse to one school on Staten Island, New York is able to compare that experience to her North Carolina experience

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where she rotated up to three schools each schoolyear over the course of her tenure as a school nurse.

A 1995 graduate of Winston Salem University School of Nursing, Moore chose school nursing to accommodate the school schedule of her young children after many years working in a variety of hospital and clinical nursing assignments. This is often the reason nurses choose school nursing as a career.

School nurses have a grounded understanding of the significance of the role they play in school systems where the primary emphasis is providing medical skills across a variety of health conditions and in a setting where they are not regarded as just adjunct staff. Penny Rosser, RN, BSN, NCSN, the lead school nurse in Orange County, North Carolina with its upper income

Far too often it is the students that are on their own. The death of a student in a school because of the absence of a nurse is rare, but it does occur. city of Chapel Hill, has a nurse in almost every school.

There are 13 schools served by 12 nurses. “In this job,” Rosser says, “you are truly on your own, except for your team. Continuing education and how to keep skill sets up to date are always a concern.

Working in the field, alone, is quite different from working in a hospital or clinic, as you are unable to attend many educational sessions or learn the latest techniques. We are truly generalists.”

Far too often it is the ­students that are on their

own. The death of a student in a school because of the absence of a nurse is rare, but it does occur. California and Pennsylvania have had such occurrences in the not too distant past. Are students getting sicker—i.e., are there more cases of asthma, ­diabetes, and chronic and com­ municable diseases? Rosser responds, “I think it is inevitable that school sizes will increase and along with the increased population will come increased illness. I don't think students are sicker than ever; I believe there is more ­diagnosed illness and more ­responsibility placed on school staff. I do believe that there has been an increase in mental health needs, however.”

As public awareness and public support for services to tackle mental health concerns grow, the school nurse will be thrust into the point position in our nationwide school systems.

With increased responsibility will come greater appreciation of their contribution to the health status of our communities. Possibly, one school nurse for each school will take root.

From Los Angeles to New York and places in between such as Chicago and Raleigh, there is a ground-swell of support. The overarching principle is simply: Healthy students improve the potential to learn.

James Z. Daniels, MPA, MSc, is a consultant and writer who lives in Durham, North Carolina, and frequently contributes to Minority Nurse.

Academic Forum

Enough is Enough: Ending Nurses’ Toleration of Workplace Violence and Bullying

By Cheryl GREEN, PHD, DNP, RN, LCSW, CNL, MAC, FAPA, ACUE, CNE

N

ursing is a profession of service to others.

Daily, nurses meet the physiological, psychosocial, and spiritual needs of the patients and patients’ significant others to whom health care is provided. The provision of quality, safe, evidenced-based practice nursing care is delivered by nurses in both inpatient and outpatient health care settings. However, the provision of nursing care can be significantly impacted when nurses are not provided

safe environments to work within.

In 2018, I had the opportunity to work with my fellow nursing colleagues on the American Nurses Association (ANA) Professional Issues Panel #endnurseabuse. The panel was an advisory committee consisting of nurses throughout the United States. Our mandate, to critically and honestly discuss workplace violence perpetrated against nurses. I commend the ANA on their stance on violence against nurses in the

workplace perpetrated by such entities as visitors, patients, intimate partners, nurses-to-nurses, and others, as well as their 2015 position statement on bullying, incivility and violence within the workplace. In 2019, Ambrose H. Wong, M.D., MSEd, Jessica M. Ray, PhD, and Joanne D. Iennaco, PhD, PMHNP-BC, APRN, noted in an article written within The Joint Commission Journal on Quality and Patient Safety, that “Health care workplace violence is a growing, pervasive, and underreported

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problem.” Of concern is that despite the identification of the problem of workplace bullying and violence, it remains an ongoing issue.

Enough is Enough Workplace violence can consist of both physical and psychological threats against others. While bullying can become physical, perpetrators tend to use negative words (i.e., humiliation, backstabbing, verbal abuse) to gain psychological intimidation over their

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Academic Forum victims. In February 2019, as I sat within a Sigma Theta Tau International conference on healthy workplaces breakout session, a normally quiet per-

If I would have known that violence and bullying was tolerated within the nursing profession as a normal ritualistic patterned behavior, I may have rethought my entry into health care. son, I found myself verbalizing the words, “Enough is Enough,” as stories were shared of working with disrespectful nurse colleagues in clinical and academic settings. I have been a nurse for over 29 years and became a nurse to administer care to the physically and mentally ill. It is a privilege to help in the healing process of others. If I would have known that violence and bullying was tolerated within the nursing profession as a normal ritualistic patterned behavior, I may have rethought my entry into health care.

Alas, I am a nurse for life.

And although I have

contemplated leaving the profession I never will. The truth is, I love being a nurse and I love caring for patients. And, I enjoy the collaboration that occurs with my colleagues that leads to positive health outcomes with patients we jointly care for in clinical settings.

And so, I am challenging my nursing colleagues in clinical and academic settings, nursing leadership, and nursing health care organizations, to take back our profession by deeming violence and bullying in nursing as not being acceptable. By ignoring violence and bullying in the workplace, nurses perpetuate the cycle of anger and violence.

The co-existence of anger and violence in health care environments will continue if nurses do not deem these behaviors as harmful to our profession.

As a profes­sion of caritas that places the safety and health of others as a priority, we must take this professional ideal and transfer it not only to the care of our patients, but our care for one another.

Ways Nurses Can End Violence and Bullying Nurses are wonderful advocates for patients. Let’s become

advocates for one another. If you observe bullying or violence within the health care environment, report it (i.e., notify your immediate supervisor, nursing leadership, and human resources). Calmly acknowledge that you have observed the behavior of the perpetrator and affected nurse and ask, “Can I assist the two of you in anyway? There appears to be a disagreement of some kind.” This places the bully or potentially ­violent person on notice that others have witnessed their behavior.

Nurses can educate themselves on how bullying and violence presents itself in the workplace by becoming familiar with the ANA Code of Ethics with Interpretative Statements, the United States Department of Labor Occupational Safety

The co-existence of anger and violence in health care environments will continue if nurses do not deem these behaviors as harmful to our profession.

and Health Administration (OSHA) workplace guidelines, and The Joint Commission’s stance on workplace bullying

Nurses are wonderful advocates for patients.

Let’s become advocates for one another. and violence. Additionally, there are now several nursing articles that can provide further insight on behaviors that can negatively impact health care environments, health care workers, and patients. A list of current websites is provided in the sidebar for your reference and support.

Together, nurses united can create healthy and supportive workplace environments for all!

Cheryl Green, PhD, DNP, RN, LCSW, CNL, MAC, FAPA, ACUE, CNE, is an off shift nurse leader at Yale-New Haven Hospital and an associate professor of nursing at Southern Connecticut State University.

Resources • ANA’s Practice & Advocacy: Workplace Violence www.nursingworld.org/practice-policy/advocacy/state/workplace-violence2 • ANA’s 2015 Position Statement on Incivility, Bullying, and Workplace Violence www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/incivility-bullying-and-workplace-violence • The Joint Commission’s Quick Safety 24: Bullying Has No Place in Health Care www.jointcommission.org/resources/news-and-

multimedia/newsletters/newsletters/quick-safety/#first=20 • The Joint Commission’s Workplace Violence Prevention Resources www.jointcommission.org/workplace_violence.aspx • OSHA: Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers www.osha.gov/Publications/osha3148.

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Minority Nurse | SPRING 2020

Academic Forum

The 2020 Census: Since It Impacts Us, Complete It!

By Brenda ROBINSON, DNP, MSN, BSN, RN

S

ince it impacts us, ever y household is encouraged to complete the 2020 Census. The U.S. Congress started taking the U.S. Census in 1790, as noted in the U.S. Constitution. The Constitution also required that the federal government do the census every 10 years.

Political power and funding are greatly impacted by the census, which also impacts all the elements that contribute to the social determinants of health. The census is used to allocate congressional seats,

electoral votes, funding for government programs, as well as the database of a lot of research.

More than $675 billion federal funding is distributed yearly based on the U.S. Census. Accuracy in the “count,” counting the correct category, clear descriptive verbiage, and engagement are imperative. Relating the importance of completing the census to all stakeholders, and creating an environment where people feel safe in completing the census, especially marginalized populations, is

essential. Minorities, children, immigrants, and low-income areas are noted to be difficult to count.

The Count Accuracy of the count has always been a concern from day one. President Washington and his Secretary of State, Thomas Jefferson, shared concern that the Census of 1790 undercounted the population greatly—and we still have this issue today.

According to the U.S. Census Bureau, the first Census consisted of six questions: the

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name of the head of the family, free white males at least 16 years old, free white males under 16 years old, free white females, “other free persons,” and slaves. Slaves were counted as three-fifths of a person and Indians were not counted until almost 100 year later.

The 2020 Census has had a hot debate over including a citizenship question and the negative impact it would have. Although the suppressive citizenship question will not be included, citizenship numbers could be extracted

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Academic Forum from the yearly American Community Survey (ACS), which falls under the U.S. Census Bureau. We still deal with inaccuracies of the census, concerns of undercounting the population, as well as debates over the questions included on the census. The census has a huge impact on the allocation of funding, research, and political representation.

African Americans and Latinos have been historically undercounted. These groups are even ranked by states in census tracks called HTC (Hard to Count) with New York, Texas, Florida,

Relating the importance of completing the census to all stakeholders, and creating an environment where people feel safe in completing the census, especially marginalized populations, is essential.

California, and Georgia in the top five states respectively for African Americans and for Latinos, it is California, Texas, New York, Arizona, and Florida, respectively, according to CensusCounts.org.

Children also have a ranking in HTC states. Many elements play a role in why the census does not reflect an accurate count or low survey participation with minorities, low-income, children, and immigrant population.

Fear, distrust, inequity, lack of information, privacy, and intent contribute to poor participation.

The 2020 Census adds a new element that for some

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may be a barrier and/or learning curve, which is technology. For the first time in history, the census will be available online. The addition of media brings about many issues, such as computer literacy and internet access issues. The HTC marginalized population should be targeted for support and resources to get optimal participation in completing the 2020 Census.

improvements, and more.

As noted above, more than $675 billion federal funding is distributed yearly based on the U.S. Census. According to the College Board’s annual

Many sources that track the social determinants of health, such as income and poverty level, use census-derived data.

Political Representation The U.S. Census data determines our political representation. Congressional seats for each state are determined by census data. As a result, a state could lose a member in Congress or your city could lose state representation.

For example, the House of Representatives divides its 435 memberships or seats among the 50 states based on the total resident population (citizen as non-citizens) using a 1941 calculation methodology; a complex process. Let’s not forget two important political terms: redistricting and gerrymandering.

Redistricting is the period where legislative boundaries are redrawn. The data is used to define legislative districts, school district areas, as well as other areas in government.

Gerrymandering is a method that officials may use to draw district lines to influence election results, manipulating boundaries and changing voting districts to favor a political group.

Funding Census data is used to make decisions on road repair, schools, services, jobs, education, neighborhood

Trends in Student Aid report, in 2017-2018, there were 7 million Pell grant recipients equaling $28.2 billion.

In 2016-2017, 49% of Pell grant recipients were dependent students; 37% of these students came from families with incomes of $20,000 or less, and another 36% came from families with incomes between $20,000 and $40,000. Funding is allocated in one of three ways: selection and/or restriction of recipients, award allocation, and monitoring and assessment of program performance.

Medicaid, for example, is the largest source of health insurance for low-income and disabled persons. It’s a federal and state program where funding and reimbursement level calculations include the state’s population and income levels, which are derived from the U.S. Census.

The Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) serves low-income women, infants, and children at nutritional risk by providing nutritious foods and health care referrals. WIC provides vouchers for crucial foods like baby formula, eggs, milk, and fresh

fruits. According to the Food and Nutrition Service, in 2018, WIC served approximately 6.87 million (5.5 million being children and infants served).

For the first five months of FY 2019, 6.4 million had been served. WIC uses the Health and Human Services (HHS) guidelines for WIC eligibility. WIC uses the Consumer Price Index, which is derived from the U.S. Census, to see monthly food voucher prices and the ACS (which is also part of the Census Bureau) to allocate funds to each state. By the way, the U.S. Department of Agriculture reported that in 2016, 58.6% of WIC participants were white, 20.8% Black or African American, 10.3% American Indian or Alaskan Native, and 4.4% Asian or Pacific Islander.

Research We often look to the Centers for Disease Control and Prevention (CDC) for data collection and research; from tracking diseases and prevention to program evaluations for effectiveness. It is

This research has impacted health care delivery and highlighted the realization that care is not equal, and inequities exist which we must address.

accepted as vetted, accurate information; as well as the guardians of public health while utilizing this data. The National Health Interview Survey (NHIS) is the methodology used for this data

Academic Forum and it is based on the decennial census information and updated with every census.

Many sources that track the social determinants of health, such as income and poverty level, use census-derived data.

The Current Population Survey (CPS) is one of these sources, collecting data since 1940. CPS,

This study confirmed what people of color have always known through personal experience, but valida­tion by a scholarly entity through research was ­priceless. This research has impacted health care delivery and highlighted the realization that care is not equal, and inequities exist which we must address.

Our elected officials, our representation, advocate for funding and represent us in all issues that impact life, liberty, health, and even our pursuit of happiness

Summary

sponsored by the U.S. Census Bureau and U.S. Bureau of Labor Statistics, provides information about our jobs, earning, education, and other studies that note the population’s social well-being, such as volunteerism, child support, and health insurance coverage. A huge impact of CPS is obtaining the number of unemployed population and the demographics. Unemployment data and economic data are used by policymakers to address unemployment and the repercussion of it.

One of the largest, wellknown research projects commissioned by the Institute of Medicine was published in Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The Institute of Medicine used data from the U.S. Census throughout this research. This study concluded, “Evidence of racial and ­ethnic disparities in healthcare is, with few exceptions, remarkably consistent across a range of illnesses and healthcare services.”

A complete and accurate count of our population by the U.S. Census is imperative.

The U.S. Census data impacts many elements of life, especially funding, representation, and research. Federal funding allocation dictated by the U.S. Census affects our classrooms, jobs, senior services, health care in our communities, and numerous other programs

and services. This includes health insurance programs like Medicaid; as well as WIC and Head Start. Hence, the U.S. Census impacts health care disparities and the social determinants of health as well.

Minorities and low-income people are undercounted and noted to be difficult to count for many reasons, yet census data impacts this ­population greatly. Our political represen­ tation and redistricting is based on the census data and being counted dictates the number of representatives. Our elected officials, our representation, advocate for funding and represent us in all issues that impact life, liberty, health, and even our pursuit of happiness.

Research drives the allocation of funds, health care delivery and changes, social issues

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and justice, just to name a few areas in which the US Census Data is used as a resource.

Funding ­dictated by the census impacts our classrooms, jobs, grants, and health care in our communi­ties—especially vulnerable, underserved populations. Since the U.S. Census impacts us all, we must encourage everyone to complete it.

Brenda Robinson, DNP, MSN, BSN, RN, is a health and community advocate from Albany, New York. She wears many hats including: CEO and founder of the Black Nurses Coalition, City of Albany Human Rights Commissioner, City-wide re-elected Albany Public Library Board Trustee, President of the Arbor Hill Neighborhood Association, and a 27 year employee of the Veteran Health Administration.

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Degrees of Success

Learning Good Bedside Manner Through Trial and Error

By Kevin M. CHU, MFA, MSN, RN

M

y two greatest fears before starting my pediatric rotation were finding common ground with a critically ill child and looking incompetent. The second fear seemed easy enough to conquer if I

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studied the material prior to my clinical days. The first one, however, would be more difficult and out of my control.

How would I care for a child that might not have long to live? What topics do I bring up in conversation? What if I slip

up and make an inappropriate joke? These questions would prove to be a hinderance to my care of a patient who just wanted to be treated like everyone else.

My clinical partner Diana and I were tasked with taking

the vitals of our patient, J.R., first thing in the morning.

The 18-year-old, schedule 1A cardiac transplant patient we were assigned meant that this was not going to be an easy day. My approach was very professional as

Degrees of Success I used my penlight to find the patient’s blood pressure cuff and inspect the safety measures of the dimly

The second fear seemed easy enough to conquer if I studied the material prior to my clinical days.

The first one, however, would be more difficult and out of my control. lit room at 7:15 a.m. With my free hand h ­ iding the beam of light from my s­leeping patient’s eyes, I searched around the bed for a mere second before I heard a voice from above saying, “Are you looking for this?” As J.R. handed me the blood pressure cuff that was wrapped around the left side rail of his bed it was clear to me that my second fear had just become realized.

Unfortunately, my initial visits with J.R. did not help alleviate my second fear at all. This was a patient who had been in and out of the hospital for heart issues since the day he was born, rattling off medical terminology as if they were names of his favorite pop stars: pacemaker; hypoplastic left heart syndrome; and open-heart surgery. Clearly, I wasn’t going to outsmart J.R. using fancy textbook words and techniques. This became abundantly clear on the second day of my clinicals when I tried to show him my fancy nursing tool kit including reflex hammer, tuning forks, and scissors, only to be met with a bewildered look from J.R. and a question, “Where’s

your gown?” J.R. had acquired C. Diff in between our meetings, and I cannot think of another way that I could have looked more incompetent than not donning my isolation precautions before entering the room.

What I was left with was my first fear, finding common ground with my patient.

I asked J.R. about his hobbies and learned how cooking was one of his passions.

He told me how he planned on attending culinary school once he was out of the hospital, returning to his hometown in Long Island, and

This was a patient who had been in and out of the hospital for heart issues since the day he was born, rattling off medical terminology as if they were names of his favorite pop stars: pacemaker; hypoplastic left heart syndrome; and open-heart surgery. opening a casual dining style Mexican restaurant. This felt like progress. Still, there was a sense of detachment in our conversation. Even though J.R. was divulging all this information about himself, he constantly looked towards the entrance of his room, watching everyone walk by as if he longed to be outside with them. It was then that I began thinking about the social aspect of J.R.’s day.

I decided to approach this teenager as I approached my own teenaged social interactions, with a group of

friends joking around, teasing each other, and even mildly insulting our favorite television shows. I reasoned this because I imagined being in and out of the hospital ever since the day I was born, not being able to have a steady group of friends because I had a heart condition that had to be constantly monitored.

The group of friends in this case would be my classmates, a handful of pop culture movie and food enthusiasts who would spark an engaging conversation. It was obvious from the start that I was the least knowledgeable about the latest Netflix series, and once again my ignorance was the focus of the experience as I was teased for seeming uncool. I may have even uttered the phrase, “They don’t make movies like they used to,” more than once.

Although, being the butt of their jokes was the last thing on my mind when I noticed that J.R. was enjoying himself as part of the group and having a laugh at my expense.

If my ignorance bonded my patient with my classmates, then it was to my benefit.

The group could tease me all they wanted for sounding out of touch, but I could smile through it all because through my failures I had pulled from my resources to improve

patient care. My team had done the job of finding common ground.

Maybe I don’t need to worry about playing it safe.

Maybe this was part of patient care. The obstacle of overintellectualizing my approach had been removed and I gained a confidence in my ability to speak with this pediatric patient that I felt I could carry to future patients.

Moreover, I look forward to the day I can visit J.R.’s casual dining Mexican restaurant, walk into the kitchen to see him cooking, give him a bewildered look and ask him, “Where’s your hairnet?”

Kevin M. Chu, MFA, MSN, RN, received his MFA from the University of Florida and MSN from Columbia University. His previous publications include writing for Imprint, the National Student Nurses’ Association’s professional magazine for student nurses, as well as several stories for the Recanati/Miller Transplantation Institute website at the Mount Sinai Hospital.

The group could tease me all they wanted for sounding out of touch, but I could smile through it all because through my failures I had pulled from my resources to improve patient care.

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Health Policy

Local Legislation Impacts Nursing and Those We Serve

By Janice M. PHILLIPS, PHD, RN, CENP, FAAN

E

ach year states and municipalities usher in a new set of laws and regulations that will affect the lives and wellbeing of everyday people. And while new federal laws are also introduced each year, local laws, rules, and regulations can have a very far reaching impact as well. In some instances, even more so. As nurses we may be challenged to stay abreast of the many new state laws that may impact the health of those that reside in our immediate communities.

As nurses we may be challenged to stay abreast of the many new state laws that may impact the health of those that reside in our immediate communities.

For example, beginning January 1, 2020, two hundred and fifty-five (255) new laws will take effect in Illinois. These new laws focus on a number of things such as license plates fees, trade in vehicle tax, sexual harassment, and expanded immigrant rights, to name a few.

However, some of the new laws will impact the health and well-being of those residing in the state of Illinois.

Of the 255 new laws, 35 are categorized as being health related. (See the sidebar for

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a brief snapshot of select Illinois legislation that will have implications for the health of residents as well as for the nursing profession.)

Nurses may need to familiarize themselves with the new laws and regulations in their respective states as some may have reporting or continuing education requirements for nurses. For example, beginning January 2020, all nurses (LPNS, RNs, APNS) in Illinois seeking to renew their nursing license will need to complete one hour of continuing ­education on sexual harassment. Professional nursing organizations, health care employers, and the Illinois State Board of Nursing as well as the Illinois Department of Professional

Regulation and others provided information on this new requirement through their various communication platforms.

With the tsunami of information that confronts us each day, where can nurses go to get information about new state legislative initiatives? There a number of avenues to pursue when looking for such information. As each year is winding down and states prepare for the upcoming new year, many news media outlets (e.g., television, radio, and written press) provide a brief snapshot on new legislation. These outlets traditionally do a recap of the year’s activities/milestones and may include this informa­ tion during various news briefings. Nurses employed in

health care settings may wish to ask their Office of Government Affairs to do a brief overview on new legisla­ tion with an emphasis on health-related aspects. In fact, health care institutions may have some reporting require-

With the tsunami of information that confronts us each day, where can nurses go to get information about new state legislative initiatives? ments when new legislation goes into effect, so an update may be helpful.

Departments of Nursing within our various health

Health Policy care settings share nursing related information so that staff can be in compliance of any new regulatory or legislative requirement. Noteworthy, in 2018 the Illinois General Assembly passed the Health Care Workplace Violence Prevention Act. This legislation focuses on protecting health care workers from violent encounters. An overview of this legislation has been disseminated by a number of professional and specialty nursing organizations, the Illinois Health Association, and many governmental offices. Many health care institutions presented an overview of this new legislation so that health care workers would be aware and that individuals visiting these facilities would know about consequences associated with harming a health care worker.

Locating this type of information need not be laborious.

In addition to paying attention to the various news media outlets and working with our institutions to stay abreast of new legislation that

Staying active in one’s professional or specialty organization is yet another way to stay apprised of new pieces of legislation that will impact those you serve or the nursing profession. may impact heath and the nursing profession, a number of resources are available to assist us in our pursuit of information.

For instance, each state legislature has a website and may post a listing of new

legislation to be enacted at the start of a new year. For laws impacting nursing specifically, the National Council of State Boards of Nursing provides a link to the various state boards of nursing who provide information on new regulatory requirements that affect nursing practice, education, or nursing licensure.

State nursing organizations or affiliates of the American Nurses Association also provide information through their various publications, town hall meetings, or periodic legislative updates. If you are not familiar with these offerings, reach out to see if your state nursing association can come to your facility to provide a legislative update.

Staying active in one’s professional or specialty organization is yet another way to stay apprised of new pieces of legislation that will impact

those you serve or the nursing profession. Each year, The Nurse Practitioner journal produces an annual legislative and regulatory update noting a number of legislative and regulatory implications for advanced nursing practice. In 2020, information for the 32nd Annual APRN Legislative Update is available here.

So, as the saying goes, all politics is local—and all politics on the local level are vitally important!

Janice M. Phillips, PhD, RN, CENP, FAAN, is an associate professor at Rush University College of Nursing and the director of nursing research and health equity at Rush University Medical Center.

Select 2020 New Legislation in Illinois (effective ­January 1, 2020) Focus

Provision

HB 2895 - Reduce Maternal Mortality

Hospitals providing care to pregnant and postpartum women must train for related issues and implicit bias training and support statewide quality improvement initiatives to reduce racial ethnic disparities.

SB 1702 - APRN Practice

Allows APRNs (Advanced Psychiatric Nurses) to complete certificates for commitment and authorize restraints and seclusion for patients.

HB 3435/HB 3113/HB 3509 - Expanded Insurance CoverageHB 3435HB 3113HB 3509

Plans must cover medically necessary epinephrine pens for people under age 18.Plans must include an annual office visit for a whole body skin examination without out of pocket cost.Coverage for donated breast milk if prescribed by medical professional.

HB 3550 - Sex Education and Consent

For students in grades 6–12, sex education is required to have ageappropriate materials and discussion on the meaning of consent.

HB 2045 - Eliminates Co-Pays for Committed Individuals

Prohibits the Department of Corrections and the Department of Juvenile from charging co-payments for medical or dental services.

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