Minority Nurse Magazine (Summer 2013)

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

Nurses in

the

Media • Cancer Treatments and Lingering Disparities • Nurses in Hospital Planning • Nursing Pharmaceutics • Profiles of Nurse Leaders

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NEW EDITION! FOURTH EDITION

RURAL NURSING

Designated a Doody’s Core Title!

CONCEPTS, THEORY, AND PRACTICE EDITED BY

CHARLENE A. WINTERS, PhD, APRN, ACNS-BC

A New Edition of the Only Text to Focus on Nursing Concepts, Theory, & Practice in Rural Settings THE 4TH EDITION PRESENTS NEW CHAPTERS ON: • Border health issues

• Use of rural hospitals in nursing education

• Health disparities

• Public health accreditation in rural and frontier counties

• Social disparities in health

KEY FEATURES: • Provides a single-source reference on rural nursing concepts, theory, and practice • Covers critical issues regarding nursing practice in sparsely populated regions

• Presents a national and international focus • Updates content and includes a wealth of new information

Pub. Date: 03/13/2013 · 520 pp · Softcover · ISBN-13: 978-0-8261-7085-9

Y M m fo

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Table of Contents

In Every Issue 3

Editor’s Notebook

4

Vital Signs

7

Making Rounds

56

Index of Advertisers

Cover Story 28

By Erica Patino An investigation of how nurses have been portrayed in the media historically and what we can do to change the public’s current

Academic Forum 33

35

37

Dissecting the Origins of Sickle Cell Anemia

By Kathryn Norcutt Learn more about this neglected genetic condition that affects one in 12 African Americans Breast Cancer Prevention Beyond Mammograms: Addressing Root Cause

By Ed James, MD Be proactive with your patients and make prevention— not treatment—a priority Putting Culturally Competent Communication into Hospital Accreditation

By Pam Chwedyk An examination of the Joint Commission’s culturally competent standards one year later

perception

Features 8

Nursing: What It Was, What It Is, and Where It’s Going

By Denise Gasalberti, PhD, RN From Nightingale to Newman, we must look at our past to move forward

Consider a career in hospital planning and learn how to improve the quality of patient care

12

47

2

Minority CRNAs and Student Registered Nurse Anesthetists: Soaring to New Heights with Doctoral Degrees

By Wallena Gould, CRNA, EdD These six interviews explore the steps necessary to obtain CRNA certification and the opportunities that exist once you do More Men in Nursing: Strategies for Support and Success

By June R. Soto, MA.Ed, APRN While more men are becoming nurses than ever before, there are still barriers to break to secure their future in the profession

Minority Nurse | SUMMER 2013

The Forefront of Cancer Treatments and Lingering Disparities

By Linda Childers Despite recent advancements in prevention and treatment, cancer continues to be the number one cause of death for many minorities in the United States

19

Nursing Pharmaceutics: Educating Toward Safer Pharmaceutical Care

By Christine Hinz Whether you are coordinating clinical drug trials in a patient setting or fielding adverse events for a pharmaceutical company,

Degrees of Success 41

Nurses in Hospital Planning, Working with Administration

By Margarette Burnette

Second Opinion 39

Lights, Camera, Accuracy: Nurses in the Media

you can find a rewarding niche in this specialty

24

Movers and Shakers: Profiles of Nurse Leaders

By Susan Wessling Let these five amazing individuals and their achievements inspire you to not be satisfied with the status quo

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Shifting the Focus

E

ach year, we celebrate the work of nurses (as well as the birthday of Florence Nightingale) from May 6-12. But we don’t need National Nurses Week to remind us of the amazing work nurses do on a daily basis. Since the stereotype of the nurse as the doctor’s handmaiden is still prevalent today, we decided

to investigate the media’s portrayal of nursing and what can be done to reflect more accurately what nurses do and the lives they touch. In our cover story, Erica Patino examines the history of nurses in mainstream media and the steps we can take to level the medical playing field.

For starters, Susan Wessling highlights the lifetime achievements of five extraordinary nurses who are not satisfied with the status quo. Let them inspire you to be

more actively involved in your profession. Whether you are interested in getting involved in the decision-making process at your hospital or the development of new drugs, there is a niche for you. Margarette Burnette and Christine Hinz explore jobs

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

SPRINGER PUBLISHING COMPANY President & CEO Theodore Nardin Vice President & CFO Jeffrey Meltzer

MINORITY NURSE MAGAZINE Publisher James Costello Editor-in-Chief Megan Hughes Creative Director Mimi Flow Circulation Latoya Butterfield Production Manager Diana Osborne Digital Media Manager Joey Stern

in hospital planning and pharmaceutics to help you reach new heights in your career.

Or perhaps your dream is to become a certified registered nurse anesthetist (CRNA).

Wallena Gould interviews six minority CRNAs and student registered nurse anesthetists to help you figure out what it takes to join the specialty that most appeals to

Minority Nurse National Sales Manager Peter Fuhrman 609-689-1033 n Fax: 609-689-1034 pfuhrman@springerpub.com

male nurses. Although men now comprise nearly 10% of the nursing population—an all-time high—we still have a long way to go before we close the gender gap. June Soto offers strategies for recruiting and retaining male students in nursing programs.

No matter your gender or ethnicity, as a nurse you undoubtedly want to help others. There are still racial disparities across the board when it comes to cancer, and cancer remains a leading cause of death for many minorities. Don’t wait until it’s too late—talk to your patients now about making healthier choices so there isn’t a need to discuss treatment options later. Linda Childers and Ed James discuss the benefits of screenings and adopting a healthy, active lifestyle to decrease your risk for most types of cancers.

From Florence Nightingale to Margaret Newman, Denise Gasalberti re-examines the past to contemplate the future of nursing. The 21st century nurse is by no means limited to the bedside. Learn to be proactive rather than reactive, and the future is yours for the taking.

— Megan Hughes

Minority Nurse Editorial Advisory Board Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE President National Association of Hispanic Nurses Teresita Bushey, MA, APR-BC Assistant Professor, School of Nursing The College of St. Scholastica Wallena Gould, CRNA, EdD Founder and Chair Diversity in Nurse Anesthesia Mentorship Program Constance Smith Hendricks, PhD, RN, FAAN Professor Auburn University School of Nursing Ed James, MD Founder and President Heal2BFree, LLC Sandra Millon-Underwood, PhD, RN, FAAN Professor University of Wisconsin, Milwaukee, College of Nursing

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

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

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

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Vital Signs

New Standards Will Help Organizations Improve Quality of Care and Reduce Health Disparities Health and Human Services (HHS) recently released enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care—a blueprint to help organizations improve health care quality in serving our nation’s diverse communities.

T

he enhanced standards, developed by the HHS Office of Minority Health, are a comprehensive update of the 2000 National CLAS Standards and include the expertise of federal and non-federal partners nationwide to ensure an even stronger platform for health equity. The enhanced National CLAS Standards are grounded in a broad definition of culture—one in which health is recognized as being influenced by factors ranging from race and ethnicity to language, spirituality, disability status, sexual orientation, gender identity, and geography.

4

“We are making great strides in providing quality care and affordable coverage for every American, regardless of race or ethnicity or other cultural factors because of the Affordable Care Act,” said HHS Secretary Kathleen Sebelius. “The Enhanced National CLAS Standards will help us build on this ongoing effort to ensure that effective and equitable care is accessible to all.”

A key initiative in the department’s effort to reduce health disparities, the update marks a major milestone in the implementation of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities.

Minority Nurse | SUMMER 2013

Long existing inequities in health and health care have come at a steep cost not only for minority communities, but also for our nation. As cited in a recent report from the HHS Agency for Healthcare Research and Quality, the burden of insufficient and inequitable care related to racial and ethnic health disparities has been estimated to top $1 trillion.

“Disparities have prevented improved outcomes in our health and health care system for far too long,” said Assistant Secretary for Health Howard K. Koh, MD, MPH. “The enhanced CLAS Standards provide a platform for all persons to reach their full health potential.”

Specifically, the enhanced standards provide a framework to health and health care organizations for the delivery of culturally respectful and linguistically responsive care

and services. By adopting the framework, health and human services professionals will be better able to meet the needs of all individuals at all points of contact.

“Many Americans struggle to achieve good health because the health care and services that are available to them do not adequately address their needs,” said J. Nadine Gracia, MD, MSCE, Deputy Assistant Secretary for Minority Health and Director of the HHS Office of Minority Health. “As our nation becomes increasingly diverse, improving cultural and linguistic competency across public health and our health care system can be one of our most powerful levers for advancing health equity.”

For additional information, please visit www.ThinkCulturalHealth.hhs.gov and www.minorityhealth.hhs.gov.

Vital Signs

Study Suggests Only Half of Americans with Hepatitis C Receive Complete Testing for the Virus Only half of Americans identified as ever having had hepatitis C received follow-up testing showing that they were still infected, according to a recent report issued by the Centers for Disease Control and Prevention (CDC).

“M

any people who test positive on an initial hepatitis C test are not receiving the necessary follow-up test to know if their body has cleared the virus or if they are still infected,” said CDC Director Tom Frieden, MD, MPH. “Complete testing is critical to ensure that those who are infected receive the care and treatment for hepatitis C that they need in order to prevent liver cancer and other serious and potentially deadly health consequences.”

Testing for hepatitis C includes a blood test, called an antibody test, to determine if an individual has ever been infected with the virus. For people with a positive antibody test result, a follow-up test— called an RNA test—should be given to determine whether they are still infected so they can get needed care and treatment.

A small number of people with antibody-positive tests will have cleared the infection on their own, but most people with hepatitis C (about 80%) remain infected and can go on to develop significant health problems.

Researchers looked at data from eight areas across the nation funded by the CDC to conduct enhanced surveillance for hepatitis C virus infection.

Of the hepatitis C cases report-

ed in these areas (i.e., those cases with antibody-positive results), only 51% of the cases also included a follow-up (RNA) test result that identified current infection. Without follow-up testing, the other half are likely unaware if they are currently infected and therefore cannot get appropriate medical care.

Data included in this analysis also underscore the severe impact of hepatitis C among baby boomers. In the eight areas studied, 67% of all reported cases of current infection were among those born from 1945 through 1965. Deaths among people with hepatitis C also were more common among those born during these years (accounting for 72% of all reported deaths).

“Hepatitis C has few noticeable symptoms, and left undiagnosed it threatens the health of far too many Americans— especially baby boomers,” said John Ward, MD, director of CDC’s Division of Viral Hepatitis. “Identifying those who are currently infected is important because new effective treatments can cure the infection better than ever before, as well as eliminate the risk of transmission to others.”

Overall, approximately 3 million Americans are infected with hepatitis C and up to 3 out of 4 do not know they are infected. The vast majority of

those affected are baby boomers, or those born from 1945 through 1965. Left untreated, hepatitis C can cause serious liver damage, including liver cancer. Hepatitis C is a leading cause of liver cancer and the most common indication for liver transplants. In fact, liver cancer is the fastest-rising cause of cancer-related death in the United States. Deaths from hepatitis C have nearly doubled over the past decade, now accounting for more than 15,000 deaths each year.

In light of increasing evidence that many patients are not receiving the follow-up test, as well as recent changes in testing technologies and the availability of new effective treatments for hepatitis C, the CDC is issuing updated guidance for health care providers

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on hepatitis C testing. These guidelines reinforce the recommended process for hepatitis C testing and underscore the importance of providers conducting follow-up RNA testing for all patients with a positive antibody test result in order to help ensure people infected with hepatitis C are properly tested and identified.

The CDC recommends that everyone in the United States born from 1945 through 1965 be tested for hepatitis C. The CDC also recommends that other populations at increased risk for hepatitis C get tested, including those who received blood transfusions or organ transplants before widespread screening of the blood supply began in 1992, or those who have ever injected drugs.

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Vital Signs

Women Smokers May Have Greater Risk for Colon Cancer Smoking increased the risk for developing colon cancer, and female smokers may have a greater risk than male smokers, according to data published in Cancer Epidemiology, Biomarkers & Prevention.

“G

lobally, during the last 50 years, the number of new colon cancer cases per year has exploded for both men and women,” said Inger Torhild Gram, MD, PhD, professor in the Department of Community Medicine at the University of Tromsø in Norway. “Our study is the first that shows women who smoke less than men still get more colon cancer.”

Gram and her colleagues examined the association between cigarette smoking and colon cancer, by tumor location, in a large Norwegian cohort of more than 600,000 men and women. The participants from four surveys initiated by the National Health Screening Service of the Norwegian Institute of Public Health had a short health exam and completed questionnaires about smok-

6

ing habits, physical activity, and other lifestyle factors. The participants were followed by linkage to the Cancer Registry of Norway and the Central Population Register. During an average 14 years of followup, close to 4,000 new colon cancer cases were diagnosed.

Gram and colleagues found that female smokers had a 19% increased risk compared with never-smokers, while male smokers had an 8% increased risk compared with never-smokers. In addition, women who started smoking when they were 16 or younger and women who had smoked for 40 years or more had a substantially increased risk, by about 50%.

“The finding that women who smoke even a moderate number of cigarettes daily have an increased risk for colon cancer will account for a substantial number of new

Minority Nurse | SUMMER 2013

cases because colon cancer is such a common disease,” said Gram. “A causal relationship between smoking and colorectal cancer has recently been established by the International

Agency for Research on Cancer of the World Health Organization, but unfortunately, this is not yet common knowledge, neither among health personnel nor the public.”

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Making Rounds

July

September

16-19

8-11

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

13th Annual Conference Caesars Palace Las Vegas, Nevada E-mail: conferenceinfo@academyofneonatalnursing.org Website: www.academyonline.org

24-28

18-21

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

2013 Education Summit Marriott Wardman Park Hotel Washington, District Of Columbia Info: 800-321-6338 E-mail: summit@nln.org Website: www.nln.org/summit

National Association for Health Care Recruitment

Philippine Nurses Association of America

23-26

National Neonatal Nurses Conference

The Transcultural Nursing Society

National League for Nursing

November 8-10

National Organization for Associate Degree Nursing 2013 Annual Conference Peppermill Resort Spa & Casino Reno, Nevada Info: 877-966-6236 E-mail: noadn@dancyamc.com Website: www.noadn.org

July/August

October

31 - August 4

17-19

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

40th Anniversary of the Academy’s Transforming Health Care: Driving Policy Conference Hyatt Regency on Capitol Hill Washington, District Of Columbia Info: 202-777-1170 E-mail: info@AANnet.org Website: www.aannet.org/2013conference

National Black Nurses Association

August 6-9

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

39th Annual Conference: Transcultural Nursing: Relationships for Health Locally, Nationally and Internationally Hotel Albuquerque at Old Town Albuquerque, New Mexico Info: 888-432-5470 E-mail: staff@tcns.org Website: www.tcns.org

American Academy of Nursing

23-25

American Association of Nurse Life Care Planners 13th Annual Conference Loews Philadelphia Hotel Philadelphia, Pennsylvania Info: 801-274-1184 Website: www.aanlcp.org/conference

16-20

The American Assembly for Men in Nursing 38th Annual Conference: Men in Nursing: Guided by the Past, Based in the Present, and Unfolding Our Future Hilton Newark Airport Elizabeth, New Jersey Info: 205-956-0146 E-mail: aamn@aamn.org Website: http://aamn.org/conference.shtml

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8-11

Sigma Theta Tau International Honor Society of Nursing 42nd Biennial Convention JW Marriott Indianapolis Indianapolis, Indiana Info: 888-634-7575 E-mail: convention@stti.org Website: www.nursingsociety.org

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Nurses in Hospital Planning, Working with Administration

BY MARGARETTE BURNETTE 8

Minority Nurse | SUMMER 2013

Good nurses are professionals who strive to make a positive impact in their organizations.

Some are able to make this impact by working in planning with hospital administrators.

T

he minority nurse who works in planning is in a pivotal role for making sure patients are safe, says Evelina Echols-Sutton, BSN, RN, nursing director of Women and Children’s Services at Methodist Charlton Medical Center in Dallas, Texas.

These professionals often have leadership titles, such as nurse manager or nurse director. Or they may be in specialty roles, such as nurse statistician and nursing informatics, she says. But one common theme is that they are called on to share ideas with their organization’s leadership.

“They are in those key meetings where decisions are made on the policies that we adopt, the equipment that we eventually bring in to our facility, and the streamlined workflows that will make sure our patients and family are safe,” says Glenda Totten, RN, MSN, CNS, director of nursing service, nursing administration, at Kaiser Permanente Los Angeles Medical Center in California.

On an average workday, a nurse who works in planning may interact with the director of pharmacy, information technology, environmental services, human resources, risk management, and legal departments, says Echols-Sutton. “My typical day is probably about four hours of meetings, four hours of office work, and then four hours of follow-up on all these activities.”

“Meetings are also a constant variable in my day,” says Sylvia Williams, RN, MSN, director of education and inpatient nursing services at La Rabida Children’s Hospital in

Chicago, Illinois. “They range from brainstorming meetings on quality initiatives to troubleshooting staffing concerns.

On average, I would say I am in meetings a good five to six hours per day. They are important to keep morale high and ensure everyone works together harmoniously.”

Kanoe Allen, RN, MSN-CNS, PHN, ONC, is chief nursing officer at Hoag Orthopedic Institute in Irvine, California. She says that nurses who work in planning have to juggle meetings with idea generation.

“One of the challenges is carving out time to sit quietly and

relationships within nursing, and with managers, supervisors, staff nurses, and executive leaders, says Totten. “It takes all that to make it work and have a world-class facility.”

In addition to working with leadership, minority nurses in hospital planning also have to help manage their organizations’ external pressures, says Totten. There are numerous outside factors to consider, such as working to meet the standards established by the Joint Commission. As an example, Totten regularly conferences

Kanoe Allen, RN, MSN-CNS, PHN, ONC, chief nursing officer at Hoag Orthopedic Institute in Irvine, California

Sylvia Williams, RN, MSN, director of education and inpatient nursing services at La Rabida Children’s Hospital in Chicago, Illinois

think through the issues and to have time to develop solutions,” says Allen.

Unsurprisingly, nurse leaders are better compensated for their efforts. The median pay for a nurse manager is $77,988, while it’s only $55,447 for a registered nurse, according to Payscale.com.

Hospitals in turn get someone who engages in positive

with a stroke performance improvement committee to help her facility earn a comprehensive designation from the Joint Commission.

“It’s ensuring that for any [stroke] patient that goes to our emergency room, or any that are inpatients, we react immediately. We get the neurology resident in there and get the team in there within

Managing Inside and Out

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seconds,” she says.

Totten also works on a nursing quality improvement committee to assess nurse-sensitive measures, such as interventions that help prevent falls in the hospital. Her teams are responsible for coming up with tools to communicate with nurses so that they are quickly informed about any relevant changes within the medical facility.

“We plan for our 1,200 or so nurses to make sure that everyone, including the per diem nurses, know what’s coming, what’s changing, how they can get more education, and the kinds of tools they need so that they’re up-to-date with the changes,” explains Totten.

Another planning team is responsible for providing constructive criticism to nurses on meeting patients. This involves communicating the best ways to exhibit caring behaviors, such as pulling up a chair and sitting eyeball to eyeball with those they serve, says Totten.

“It’s evidence-based and proven that you don’t want to stand over [patients]. You want to be as close to them as possible,” she notes. “We’re trying to standardize how we greet our patients when they come in on admission and also while they’re here.”

These issues are important because of the new valuebased purchasing environment, says Shawana Burnette, OB-RNC, MSN, CLNC, a nurse manager in High Risk Postpartum and High Risk OB at Carolinas Medical Center in Charlotte, North Carolina.

A portion of reimbursements received from the Centers for

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9

Medicare and Medicaid Services will be based on the patient’s value perception of the care they receive, she explains.

This means nurses in planning have to encourage their teams to not only help the patient heal, but to also have a good bedside manner.

Another area where nurses who work in planning are called on to help is to find ways to improve infection rates. The Centers for Disease Control and Prevention as well as the Institute for Healthcare Improvement review these rates, and of course, the goal is to have them as low as possible, says Totten. “You have to plan how you can show that you have a stellar place.”

Medical centers also compete with other health care centers in the community. “The consumer is more astute nowadays, and they are open to shop for the best medical facility, best health care facility, and the best insurance,” she notes.

This means nurses who work in planning often need

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to represent their medical centers at events. “We have a foundation that does fundraising. In order to help them, I have to go out and speak,” says Echols-Sutton. “You want to talk to those that you serve, and find out what’s important to them.”

Improving Soft Skills, Leveraging Clinical Skills First, health care is a highly regulated industry. Second, reimbursements are based upon

ple and solutions to the front,” says Allen. “It is a team spirit, not an individual-only spirit.

That is key to the success of multidisciplinary patient care.”

People come to nursing with a big heart and a desire to help others, and it serves them well in collaborative environments where they have to work together to find the solutions, she adds.

Allen notes that being successful in nurse planning requires emotional intelligence,

and working in a collaborative manner to solve regulatory and other issues, she says.

Minority nurses who work in planning can also help bridge multicultural gaps. Multicultural environments are a challenge to blend and the goal is to bring out the best attributes, says Allen.

“We serve patients from many backgrounds, and having a diverse staff allows us to better anticipate and understand their cultural needs,” notes Williams.

Soft skills are necessary in higher levels of planning, but practical experience is also important, explains Totten. “One thing you can never take away from a nurse is her clinical skills. It’s handy when you’re working in a clinical setting.

The more you move up in your career, [the more] those clinical skills are key.”

It all comes down to ensuring that staff members have the correct resources to care for patients, says Allen. Providing the right resources allows the staff to provide strong patient care.

“Staff who do not have to worry about resources and administration support provide great customer service,” she adds.

The Career Path

The minority nurse who works in planning is in a pivotal role for making sure patients are safe, says Evelina Echols-Sutton, BSN, RN, nursing director of Women and Children’s Services at Methodist Charlton Medical Center in Dallas, Texas. the customers’ perceptions of “soft” skills, explains Allen.

“Putting the two together is a change for this industry.”

Fortunately, nurses are usually well-prepared. “Nurses, by their calling, have a set of innate behaviors of putting peo-

Minority Nurse | SUMMER 2013

meaning the ability to understand and have a sense of another person’s views. To achieve success in planning means being a team player, using that emotional intelligence to understand the interplay between various personalities and departments,

Minority nurses who want to work with hospital administrators, or who want to be in administration themselves, have multiple options.

“The best thing about the profession of nursing is you can pretty much take any path. You can be in a clinical track and still move up to administration. There is also the education track, nurse practitioner track, and advanced practice nursing,” says Totten. “All these elements can secure you a good position in administration.”

Totten’s own background is as a clinical nurse specialist, but she emphasizes there are many ways to advance.

As a first step, Burnette suggests becoming a bachelor’sprepared nurse. “They have the four-year preparation that includes handling more professional issues and critical think-

career in nursing,” argues Williams. A good mentor can instill these lessons to their mentees and help them find their way, she adds.

Mentoring is intended to help nurses develop their skills and grow within the nursing profession. “The mentor accomplishes this by sharing their years of

Unsurprisingly, nurse leaders are better compensated for their efforts. The median pay for a nurse manager is $77,988, while it’s only $55,447 for a registered nurse, according to Payscale.com. ing,” she explains. “The classes prepare you to be in a leadership role.”

But you should also have your sights set on earning a master’s degree. “Years of experience on the nursing unit are critical, but I would strongly recommend to anyone that is interested in this path to pursue an advanced degree in nursing,” says Williams.

“Nurses who work in planning need knowledge-based skills like budgeting and financials, experience you don’t necessarily receive on the floor,” she continues. The more educated you are regarding the area you’re going in, the more prepared you will be.

Mentoring Another important means for having a successful career in hospital planning is to find a mentor who can show you the ropes in a real life environment, notes Williams.

“There are many ups and downs in nursing. There are plenty of wonderful days, and there are days in which nothing seems to go right. Being able to balance the good with the bad is essential to having a long

experiences—warts and all—to help them see nursing in its true light,” explains Williams.

Mentoring also helps a person explore who they are and how they can achieve more in their career, says Allen. In some cases, it opens doors for opportunity as well. “I have had a mentor who challenges my thoughts and plans, refocuses me when I am at a loss and then cheers me on,” she continues.

Having a mentor can also help nurses develop critical work skills, such as priority setting, stress management, people management, and good communication, says Echols-Sutton. She hasn’t had an “official” mentor, but she has had role models she patterned herself after. Other nurses who aren’t in employee-sponsored mentor programs can do the same, she notes.

“I didn’t have just one person. I tried to learn from everybody, including coworkers, bosses, and even people out in the community,” says EcholsSutton. “They were available for me to pick their brains.”

Burnette advises nurses to find mentors who are not nec-

essarily in their departments. If you talk to someone who works in another area of the hospital, they can give you a more global view of your organization. It’s important to surround yourself with people who have different perspectives but who are committed to achieving the same goal of providing patients with the best possible health care, she adds.

Whether a nurse joins a formal preceptor program or starts an informal mentoring friendship, anyone who wants to work in planning should reach out to a health care professional with more experience to help them along, argues Totten. “It’s not just enough to sit in your position.”

to budgeting, and it is impossible to have a “go alone” mindset, says Williams. That’s why nurses who are in planning are a vital part of the team. Nurses who work with hospital administration report that their careers are fulfilling, and they have a large say in improving their hospitals.

“When you’re working in planning, you’re able to communicate with all the various staff as well as patients. It gives you a love for the ways you can improve the care that’s delivered to patients,” says Williams.

“That’s where you can make the biggest impact.”

Margarette Burnette is a freelance writer based in Georgia.

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The Forefront of Cancer Treatments and Lingering Disparities

BY LINDA CHILDERS

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Minority Nurse | SUMMER 2013

Despite advances in recent years relating to cancer prevention, detection, and treatment, many minority groups in the United States continue to bear a greater cancer burden than whites.

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ccording to the National Cancer Institute’s Center to Reduce Cancer Health Disparities, while one in three Americans will develop some form of cancer, it continues to be the number one cause of death for many minorities in the United States. Nationwide, African Americans have a higher rate of death from cancer than Caucasians, and cancer has surpassed heart disease to become the leading cause of death among Hispanics and Asian Americans in the United States.

While the statistics are sobering, researchers say minority nurses can play an important role in working to reduce cancer disparities in their communities.

“Nurses are at the forefront of care and can have a major impact in eradicating cancer disparities by educating patients about the importance of cancer screenings, early detection, and access to care,” says Kimlin Ashing-Giwa, PhD, professor and director of the City of Hope’s Center of Community Alliance for Research and Education in Duarte, California. Ashing-Giwa’s work focuses on addressing the disparities in treatment and outcomes between patients with different access and cultural approaches to medicine.

white women to be diagnosed with breast cancer, they are more likely to be diagnosed at a later stage and to die of their disease,” says Ashing-Giwa.

“Despite the decline in overall breast cancer death rates in the past 20 years, black women continue to have higher death rates.”

A 2012 report from the Centers for Disease Control and Prevention (CDC) says that mammography may be used

less frequently among black women than white women.

It’s also more common for a longer amount of time to pass between mammograms for black women. Additionally, Ashing-Giwa notes that African American women commonly have subtypes of tumors that are harder to treat, especially an inflammatory form called triple negative breast cancer.

The CDC report also stresses

the importance of educating women about the preventive benefits and coverage provided by the Affordable Care Act, including coverage of mammograms without co-pays in many health plans and, beginning in 2014, expanded access to health insurance coverage for 30 million previously uninsured Americans.

“Additionally, a woman’s best overall preventative health strategy is to reduce her known

“Nurses are at the forefront of care and can have a major impact in eradicating cancer disparities by educating patients about the importance of cancer screenings, early detection, and access to care,” says Kimlin Ashing-Giwa, PhD, professor and director of the City of Hope’s Center of Community Alliance for Research and Education in Duarte, California.

How Breast Cancer Affects African American and Latina Women “Although African American women are less likely than www.minoritynurse.com

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Cancer Education Resources Learn more about how breast cancer affects the African American community by attending the National African American Breast Cancer Conference Tour, a 10city event presented by The Sisters Network, which runs through October 2013. More information can be found at http://sistersnetworkinc.org.

The CDC’s National Breast and Cervical Cancer Early Detection Program provides lowincome, uninsured, and underinsured women access to breast and cervical cancer screening and diagnostic services in all 50 states. Visit www.cdc.gov/ cancer/nbccedp.

The American Cancer Society offers a variety of patient education materials on colorectal cancer and early detection in English, Spanish, and Chinese.

Other cancer materials are also available. Call 800-227-2345 or visit www.cancer.org.

risk factors for breast cancer as much as possible by avoiding weight gain and obesity, engaging in regular physical

“Cervical cancer should have been eradicated 30 years ago with the invention of the Pap test,” argues Ashing-Giwa. “Most women who are diagnosed with cervical cancer today are those who have never been screened for it.” activity, and minimizing alcohol intake,” says Ashing-Giwa, who encourages nurses to talk to patients about their risk of breast cancer and the importance of getting mammograms and doing breast self-exams.

If women can’t afford a mammogram, there are many free resources available that nurses can recommend to patients (see sidebar). In addition, black women are less likely to get prompt followup care when their mammogram shows that something is abnormal. Waiting longer for follow-up care can lead to cancerous tumors that are

The National Center for Reducing Asian American Cancer Health Disparities offers cancer educational materials that can be printed from their website as well as links to other cancer organizations that serve Asian Americans. Visit http://aancart.org/

cancer-research/publications/ aancart-educational-materials.

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larger and harder to treat.

Follow-up care after mammograms is also a problem for Latinas. “While Latinas have

Minority Nurse | SUMMER 2013

lower incidences of breast cancer than white or African American women, breast cancer is the leading cause of cancer death for Latinas,” AshingGiwa says.

A March 2013 study conducted at the Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio and published in SpringerPlus found that it took Latinas 33 days longer to reach definitive diagnosis of breast cancer than non-Hispanic white women.

Researchers found that Latinas with abnormal mammograms benefitted significantly from

the help of trained professionals called “patient navigators,” who were trained in providing culturally sensitive support. Patient navigators were also helpful in providing transportation, language, and childcare solutions.

“We need to move toward more prevention, screening, treatment, and follow-up that speaks to people in a language they understand,” says Ashing-Giwa.

Despite Being Preventable, Disparities Still Exist With Cervical Cancer Also of concern are the large differences in rates of new cases and deaths from cervical cancer among African American and Latina women.

“Latina women have the highest rates of cervical cancer, followed by African American women,” says Ashing-Giwa.

“This is troubling because most cases of cervical cancer are largely preventable and treatable with regular Pap tests and follow-up.”

Mortality Rates are Also Higher for Women over 50 “Many women believe that since they are single and not sexually active, they don’t need a Pap test,” Ashing-Giwa says. While stressing the need for older women to get regular Pap tests, she notes it’s also important for nurses to encourage younger women to get the human papillomavirus (HPV) vaccine and to use condoms. HPV infection is the leading cause of most cervical cancers.

“Cervical cancer should have been eradicated 30 years ago with the invention of the Pap test,” argues Ashing-Giwa.

“Most women who are diagnosed with cervical cancer today are those who have never been screened for it.”

Minorities Less Likely to Get Screened for Colon Cancer A 2012 study conducted at the Center for Health Policy at the University of Nebraska Medical Center College of Public Health and published in the public health journal, Health Affairs, found that minorities are less likely to be screened for colon cancer. The data revealed that 42% of Caucasians were screened for colorectal cancer, compared with 36% of African Americans, 31% of Asian and Native Americans, and 28% of Hispanics.

“The death rate for colon cancer has increased among African Americans and Hispanic people despite it being one of the most preventable forms of cancer, and if caught early, one of the most curable,” says Durado Brooks, MD, MPH, director of prostate and colorectal cancers for the American Cancer Society.

“Although many people

of color are aware of colon cancer, they don’t always see how it applies to them,” says Brooks. “If they don’t have a family history of the disease or have symptoms, such as blood in their stools, they often don’t see the need to be screened.”

Only 10% of colon cancer cases are tied to family history, and by the time warning signs are apparent, the cancer has often progressed to an advanced stage where it’s harder to treat. And while it is currently recommended that regular colon screenings begin at the age of 50, it’s recommended that screenings for minorities begin at 45 since many colorectal cancers have been caught in African Americans and Hispanics at younger ages.

“Many people are unaware of the benefits of colorectal screenings,” says Brooks.

“There’s the perception that cancer is a death sentence, yet up to 90% of colon cancer cases are preventable with screening.”

Brooks praises Kaiser Permanente for being proactive about screening its health plan members for colorectal cancer. “Rather than waiting for people to ask to be tested, Kaiser Permanente sends out fecal immunochemical testing kits, a type of fecal occult blood test, in the mail to their members who are 50 and older,” Brooks says. “Not all health care providers are as proactive with their approach.”

And while colonoscopies are still considered the gold standard for detecting colorectal cancer, they also require rigorous preparation—a point that prevents many people from getting tested. In an ef-

© Walter Urie Photography

Kimlin Ashing-Giwa, PhD

fort to increase testing for colon cancer, Brooks notes that it’s important to let patients know they have choices and that there are other screening options available.

A study published in the April 9, 2012, issue of Archives of Internal Medicine confirmed this by noting that patients were less compliant with screening for colorectal cancer when colonoscopy was the only option offered. Yet when patients were given a choice between a colonoscopy and fecal occult blood testing, 69% completed one of the two exams.

Latino Men at High Risk of Prostate Cancer According to the American Cancer Society, prostate cancer is the most commonly diagnosed form of cancer among Latino men, and they are also the most likely to be diagnosed with later-stages of the disease.

A new study conducted by researchers at the University of California–Los Angeles (UCLA) and published in the March 2013 issue of Qualitative Health Research concluded that a combination of financial, cultural, and communication barriers

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plays a role in preventing Latino men from accessing the care and treatment they need.

“These obstacles require a new focus on not only adequate health care coverage, but also on the array of hurdles that limit patient access,” says Sally L. Maliski, PhD, RN, FAAN, associate dean for academic affairs at the UCLA School of Nursing and senior author of the study.

Maliski cites inability to afford medical insurance, difficulty understanding insurance policies, a lack of health literacy among the men, and their limited proficiency in English as barriers throughout the entire prostate cancer-care process.

“Our findings made it clear that we need a system where not only is care affordable, but where we use a multi-faceted approach to improve access, increase health literacy, and greatly improve care coordination,” says Maliski.

Focusing on Cancer Disparities in the Asian Community “The cancer burden in the Asian American community is unique because cancer has been the leading cause of death

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Since prevention and early detection are key components of cancer control, Chen recommends that nurses who work with different Asian American

date differences in language fluency, dietary practices, and cultural beliefs can help to remove some of the barriers that exist in screening and treating

Since prevention and early detection are key components of cancer control, Chen recommends that nurses who work with different Asian American populations either learn the specific language of their demographics, or have cancer education materials readily available in different languages such as Vietnamese, Korean, Mandarin, and Tagalog.

Moon Chen, Jr., PhD, MPH

among Asian Americans for the past 13 years,” says Moon Chen, Jr., PhD, MPH, principal investigator for the National Center for Reducing Asian American Cancer Health Disparities headquartered at the University of California-Davis Cancer Center. Chen adds that hepatitis B induced-liver cancer is the greatest cancer health disparity for Asian Americans.

“All Asian American immigrants and their children should be screened for hepatitis B to lead to earlier detection,” Chen says. “And Asian Americans who do not have hepatitis B immunity should also get the hepatitis B vaccine, [which is] the best way to stop the spread of hepatitis B.” Chen and his colleagues have received a federal grant to increase screening for hepatitis B. Since December of last year, screening events have been held in Northern California at Asian health clinics, local churches, temples, health fairs, and community organizations.

Many Asian Americans don’t get regular cancer screenings, which also adds to poor cancer outcomes. “Un-

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til they have symptoms, many Asian Americans aren’t really concerned about cancer and don’t think screening is necessary,” Chen says. “Vietnamese women have the highest rates of cervical cancer, which can be detected and treated early through Pap smears.”

Chen says cigarette smoking is also a big problem among Asian American immigrants and that they are the racial group least likely to be counseled on smoking cessation.

“Smoking is the leading cause of death worldwide and it’s a preventable risk factor,” Chen says. “It’s a complicated message and often language can be a barrier. There’s a great need for smoking-cessation programs that are culturally tailored to Asian populations, both in language and intent.”

Stomach cancer is also prevalent in Asian Americans, and Chen attributes this to chronic infection with Helicobacter pylori bacteria, which is common in developing countries. In Koreans, diet is also to blame, specifically foods that are preserved with nitrates and nitrites, such as kimchi.

Minority Nurse | SUMMER 2013

populations either learn the specific language of their demographics, or have cancer education materials readily available in different languages such as Vietnamese, Korean, Mandarin, and Tagalog.

“Nurses who can accommo-

minority patients,” Chen says.

“Nurses who have this expertise are often the bridge between health care systems and minority communities.”

Linda Childers is a freelance writer based in California.

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Yet, the baccalaureate and master’s degrees in nursing may offer the most professional opportunities.

That’s why Minority Nurse has teamed up with NCEMNA to co-sponsor an annual scholarship to help outstanding nurses from under-represented groups complete their studies toward a Bachelor or Master of Science in Nursing.

To date, we have awarded scholarships to more than 40 students, honoring their commitment to the profession, academic excellence, and community service.

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

Questions? E-mail editor@minoritynurse.com or visit www.minoritynurse.com/scholarship/minority-nursemagazine-scholarship-program

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MINORITY NURSE 15th Annual Scholarship Program

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

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

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

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

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

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

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

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

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Minority Nurse | SUMMER 2013

Nursing Pharmaceutics Educating Toward Safer Pharmaceutical Care

BY CHRISTINE HINZ When Felicia Menefee, RN, NP, ACNS, recruited patients for the landmark African-American Heart Failure Trial (A-HeFT), little did she know that the study would yield such positive results for them—or future patients.

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ince African Americans with advanced left ventricular heart failure do worse than Caucasians in all phases of this condition, scientists wanted to see if adding a potent nitrate-vasodilator-duo to their standard therapy would make a positive difference in their symptoms, hospitalizations, and daily activities. What was the target of this National Institutes of Health (NIH) study? A fixed-dose combination of isosorbide dinitrate (ISDN) plus hydralazine (HYD).

When researchers discovered that patients on the drugs indeed functioned better clinically than previously (some even energized enough to exercise), they halted the blind study prematurely. In doing so, they also handed the US Food and Drug Administration (FDA) enough data to demonstrate that survival and quality of life indeed increased, while hospitalizations decreased, on the medications. The FDA approved ISDN/HYD in June 2005 for heart-failure therapy in African Americans.

A-HeFT is just one of a myriad of NIH- and industry-sponsored drug and device trials Menefee has participated in during her 17 years as a nurse practitioner with Kansas City-based St. Luke’s Cardiovascular Consultants. Staffed by 48 cardiologists, many of whom are tied to academia, the practice provides ample opportunity for her to participate in clinical studies.

“Research is extremely important in advancing medicine,” she says. “Without it, health care stagnates. But with drug and other studies we can improve care. Sometimes a trial’s results are negative; sometimes they’re positive. But we won’t know unless we do it.”

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Running the Gauntlet The lengthy and complicated process of moving a drug to market is broken down into various phases. After a pre-clinical development stage during which animal and other laboratory tests have proven that a product is initially safe, the emphasis shifts to human or clinical trials. Although most drugs never reach that stage, the ones that do undergo a rigorous process in winning FDA-approval.

• Phase I: A drug is tested on 20 to 80 healthy volunteers not only to see if it’s initially safe but also to determine the most frequent side effects.

• Phase II: If the drug hasn’t produced unacceptable levels of toxicity during the first phase, it’s tested in a few dozen to 300 subjects with the condition or disease to obtain preliminary data on how well it’s working.

• Phase III: If a drug demonstrates a good level of effectiveness, it’s tested in an expanded pool of subjects, from several hundred to about 3,000, to see how it works with different dosages, populations, and in combination with other drugs.

• Phase IV and other postmarketing studies: Conducted after the FDA has approved a given drug, these trials are used to gather additional information about safety, efficacy, and even other uses.

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Primed for Drug Studies

Coordinating for Results

Perhaps you have the same curiosity as Menefee in advancing new pharmaceuticals or expanding indications for existing ones. What role can you play to help develop the next cutting-edge prescription or the newest use for an overthe-counter standard?

Truth is that unless you’ve piggy backed your nursing experience onto another degree—perhaps pharmacy, biochemistry, or medicine—your contribution likely won’t be in a drug company (or academic center) laboratory. Pharmaceutical scientists involved in the discovery or refinement of new medications typically bring masters and PhDs in the hard sciences to a company’s research and development function.

But that doesn’t mean your experience isn’t valuable. Clinical knowledge, critical thinking skills, and caregiver intuition can be a perfect match for other positions directly impacting medications. In fact, by parlaying and building on your background, you can ensure that what scientists produce in the laboratory is both safe and efficacious in real people.

Whether you’re coordinating clinical drug trials in a patient setting, fielding adverse events for a pharmaceutical company, or playing another role, you can find a rewarding frontline niche.

As Sherry Banez-Muth, RN, manager of coordinating services, Center for Clinical Studies, Washington University School of Medicine, St. Louis, observes: “It’s definitely satisfying when you see people taking a new treatment that may be life-changing. It’s a good feeling to say, ‘Wow, I contributed to this.’”

The good news for nurses and nurse practitioners is that you don’t have to stray far from a patient setting to be part of the drug development process.

Once scientists have tested their hypothesis to determine that a preparation developed in the lab may indeed help with a specific indication, the scene shifts to the FDA for a human study protocol approval. When the regulatory agency is on board, sponsors can enlist multiple clinical trial sites—health systems and large medical practices—for the Phase I to IV (and post-marketing) human studies.

Much of the work at those locales rests with nursing professionals, point people in the day-to-day operations of a drug trial. As clinical research or study coordinators, they juggle multiple tasks in making the protocol work. They not only train supporting cast members to find, screen, enroll, monitor, and collect data on participants, but they’re often on board from the onset, helping principal investigators prove that a health provider has what it takes—in experienced staff, adequate space, and access to the right patient demographics—to move a protocol forward.

Minority Nurse | SUMMER 2013

drug or device trials to ensure that they’re a good fit both financially and clinically for the institution. Thomas had her nursing skills tucked neatly under her belt when she earned a clinical research administration masters to even the negotiating playing field with sponsors over start-up costs and other numbers. “It helped me look at the bigger picture,” she says.

“I’m better able to account for everything we need to do to go into a trial.”

Although Thomas no longer conducts individual studies, her imprint is widespread since she provides education and other resources to 40 professionals who manage from 70 to 100 investigational drug, device, and prevention studies, covering a multitude of conditions from diabetes to transplant research. She makes sure others are knowledgeable about a particular study and ready to conduct it according to regulations and good clinical practice.

That means becoming familiar with all aspects of the protocol, a regulatory document that can range from a mere 20 pages to a 500-page tome. It covers every possible nuance, from the hypothesis and research behind the drug to the goals, criteria, and requirements for participa-

“Research is extremely important in advancing medicine,” she says. “Without it, health care stagnates.

But with drug and other studies we can improve care.

Sometimes a trial’s results are negative; sometimes they’re positive. But we won’t know unless we do it.”

As a director of clinical research for the Dallas-based Baylor Health Care System, Jennifer Thomas, RN, BSN, MS, CCRC, works side-by-side with investigators, first reviewing potential

tion. Whether the information is gleaned from principal investigator meetings, in-service tutorials, or other sources, mastering the fundamentals and logistics of a protocol is critical

in running it correctly and consistently with other centers so results are valid.

“If there are too many variations, the sponsor can’t tell what’s causing a problem,” says Lynn Fukushima, RN, MSN, FNP, MBA, CCRC, nurse coordinator for the Keck Medical Center of the University of Southern California. “Is it the proposed medication itself or something else? We have to be very meticulous in our recordkeeping so there’s no doubt.”

Fukushima wears many research hats in navigating drug studies related to cystic fibrosis and other pulmonary or lung diseases. For starters, she also helps her physician-colleagues determine if a clinical drug trial is appropriate by submitting information to the institutional review board for an up-or-down decision. Because her job includes budgetary tasks, she earned a health care administration MBA to better grasp the financial implications of a study.

In terms of each protocol, Fukushima sometimes works alone, organizing all aspects of a study, while other times, she’s coordinating with staffers.

Whatever the case, her patient involvement changes with each trial stage. Phases I and II, for instance, can be intense since researchers are looking closely at efficacy and safety. She may see subjects weekly, daily, or even several times a day for blood draws and other procedures. During phases III, IV, and post-marketing, the individual interaction diminishes since sponsors are no longer tracking efficacy, but safety in an expanded universe of patients.

Whatever the stage, the paper chase with a clinical drug trial demands the kind of at-

tention to detail and familiarity with medical jargon and charts that usually fit nursing professionals to a T. The skills you’ve likely established in training and honed in practice can provide an important cornerstone for managing the administrative and patient-contact components of any given study.

But it’s also the ability to stay up-to-speed, think outside the box, and respond with on-thespot analysis or critical thinking that’s important. Each protocol is replete with guidelines, but you still need to accommodate new information and unexpected turns-of-events.

In managing a support service unit for principal investigators throughout Washington University School of Medicine, St. Louis, Banez-Muth is used to the structured training and continuing education necessary to get a trial up, running, and producing valid results.

Of the 35 to 40 active NIHand industry-sponsored studies she and her seven coordinators target at any given time, the phase II to IV drug trials represent a spectrum of urological and gastrointestinal targets. Whether Banez-Muth is personally managing a trial for a principal investigator or overseeing the work of others, she not only has to be organized but nimble on her feet.

“As black-and-white as you would like things to run, it’s never that way. There’s always one patient who falls outside the box,” she says. “When that happens you want to make sure that you’re doing what you can to keep this person safe during the protocol.”

From Tuskegee to Transparency Indeed, beyond data integ-

rity, the primary task of nursing professionals involved in a clinical drug trial is to protect the subjects they seek, find, vet, enroll, and follow. From the moment coordinators scan medical

decades after whistleblowers shut it down, Tuskegee has left an indelible mark, particularly among African Americans.

Thankfully, clinical trials today are light years from Tuske-

records, tap health care providers, or reach into the community to find subjects, their focus has to be on complete honesty and concern about someone’s health and well-being.

That wasn’t always the case, given this country’s sometimes chilling research history, especially in regards to minorities.

The infamous Tuskegee syphilis experiment, for instance, may

gee, not just in terms of bioethical standards but also in practical safeguards. Study coordinators can point to a drug process so rigorous and regulated by the sponsor, the FDA, institutional review boards, and other agencies that safety rules at every turn. Patients are monitored so closely with high-tech imaging and other services that care often exceeds what they

From the moment coordinators scan medical records, tap health care providers, or reach into the community to find subjects, their focus has to be on complete honesty and concern about someone’s health and well-being. have started in 1932 to chart the progression of an untreated sexually transmitted disease in black sharecroppers. Yet, by the time it ended in 1972, it had put hundreds of them at medical risk because US public health scientists and their local physician-partners withheld what had become standard-ofcare treatment: penicillin. Even

receive nominally from their personal physicians. “The wonderful thing about research is that you get excellent follow-up care,” says Menefee. “It can be a very special opportunity for participants.”

But nurses must be both transparent and on their toes in engaging candidates with a medical history that matches a

given protocol. Informed consent is the primary tool they hold in their quiver to ensure that every enrollee understands every relevant specific—possible risks, benefits, and commitments—of a given study.

But in outlining the parameters, they also target their rights. Distilling the caveats is important for every clinical trial, especially those that demand much of a participant, perhaps even an invasive procedure, with no guarantee of positive results.

In fact, making promises that someone will receive an active ingredient or that it will work with no side effects, is a trial taboo. The only guarantees nursing professionals should be sharing with their enrollees are that they’ll be good patient advocates, pursuing everything possible to ensure a safe experience. That includes collecting vital signs and good data with each office visit, addressing any side effects or adverse events, and keeping everyone, includ-

ing a patient’s personal physician, apprised of important changes. As one coordinator notes: “You’re asking people to participate in a clinical trial from which they may or may not derive any benefit. So establishing trust and rapport is important.”

Whatever the specifics, vetting presents a great opportunity for minority nursing professionals to convince fellow patients of color that their participation in a study is critical. Given your own sensitivity to the cultural mores and concerns of a community, you can be a key link in dispelling any myths about drug research while bringing volunteers into the fold.

In engaging her enrollees, Thomas, for instance, makes sure they know that they’ll never be asked to sign on to a Baylor study without someone reviewing every paragraph of the consent form with them.

More importantly, if it’s not a good fit, they can leave at any

time. “I understand the sensitivity among African Americans enrolling in research studies,” she says. “Hopefully I can educate them so they have a good understanding and they’re willing to say, ‘OK, I will participate in this.’”

Similarly, when Judith A. Rivera, MSN, recruits subjects for both NIH- and pharma-sponsored memory trials, her goal is to find an ethnically diverse pool of people when the study merits it. As a Latino nurse practitioner and principal study coordinator for the University of California-San Diego’s Comprehensive Alzheimer’s Program, Rivera is well aware that dementia is a serious health issue among minority, as well as majority, Americans. Unfortunately, in some ethnic communities memory loss is often dismissed as simple aging rather than a potentially serious disease.

But by targeting culturally and racially diverse subjects for a slew of drug and other studies related to memory, researchers at her institution are giving vital information to pharmaceutical companies about all of the people, not just Caucasians, who might need their products. More importantly, they’re also raising awareness among enrollees about the potential pharmaceuticals—albeit under study—that might help them remain active and functioning. “We want them to be as independent as possible for as long as possible.”

Monitoring for Safe Outcomes Making sure that a participant isn’t compromised during a drug trial is an important part of realizing any positive results.

From Phase I to post-marketing, nursing professionals are not only helping patients navigate

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Minority Nurse | SUMMER 2013

the terrain of a protocol, but also gathering information about a drug’s safety and effectiveness.

Detecting and forwarding potential problems to a sponsor is a natural for nursing coordinators since their training and frequent interactions often give them a pulse on what people are experiencing. “Some nurses have a sixth sense about how a patient is doing,” Fukushima says. “If they see a frown on a face or hear unusually short answers, they may be a little more aggressive in investigating the cause.”

But overseeing a clinical trial isn’t the only way to determine whether a drug is working well or not so well in a patient. In fact, many nurses are finding satisfying ways to use their critical thinking and detail skills in other research-related venues.

From pharmaceutical companies to clinical research organizations (CROs) and other patient service firms, prospects abound for managing and monitoring trials as well as educating and tracking subjects. Besides sales and marketing functions to promote approved products further down the line, the activity usually centers on making sure medications aren’t hurting users.

As a clinical safety specialist for GlaxoSmithKline’s (GSK) Global Clinical Safety and Pharmacovigilance Division, Shannon Hart Anderson, BSN, RN, JD, also manages adverse event reports—unexpected and potentially harmful reactions—for a bevy of pharmaceuticals bearing the GSK imprimatur. From over-the-counter remedies to prescriptive medications, her potential targets include therapies for a wide spectrum of benign and serious diseases.

“We’re like the safety police,”

she says, “We have to make sure that our products aren’t harming the public.”

From her berth in GSK’s US headquarters located in Research Triangle Park, North Carolina, Anderson processes initial complaints from consumers, health professionals, sales reps, and even the FDA. She then collects follow-up information, which is entered into a safety database that serves as grist for further investigation as well as the regulatory agency reports she also must prepare. To capture the most accurate information possible, Anderson routinely relies on the logical reasoning, problem-solving, and even communication and advocacy skills she’s honed as both a nurse and an attorney.

But the most important roadmap may be the positions she’s held previously with CROs, outside firms hired by a pharmaceutical company to provide a wide range of support services.

That may include managing the day-to-day operations of a drug study or even serving as an outside monitor, making sure that each site follows a protocol correctly and meets FDA standards. In honing the pharmacovigilance skills she now uses at GSK, Anderson mastered the nuances of adverse event reporting and the importance of being detail-oriented as a drug safety scientist. “We need to know the ins and outs of what happens,” she says, “so that we can look for trends that may prompt us to change our label or even our product.”

Likewise, as a diabetes-musculoskeletal medical professional for Indianapolis-based Eli Lilly and Company, Marla Neal, RN, BSN, MHCA, educates health professionals about drugs and devices that

may help their patients. When physicians and other practitioners pose questions of the sales force, she’s tapped to provide the definitive answer. Neal accesses every possible database and medical professional to respond to each request. She also updates sales members about current clinical trials while helping them understand how each Lilly product impacts a disease process.

But it’s her other priorities—capturing accurate information about unexpected side effects and product complaints—that really tap her nursing skills. “Oftentimes patients don’t even realize that they’re having an adverse event,” she says. “So

what’s important.”

Bradley is the nursing voice on the other end of the line when patients, pharmacists, and other health care professionals make contact with her company’s Dallas office, usually by dialing the “800” reporting number on a medication’s packaging. Using her clinical intuition, honed as a hospital neonatal intensive care unit and trauma nurse, she collects and reports adverse events linked to medications manufactured by one of her firm’s pharmaceutical company clients. It’s a varied list, from digestive and fertility drugs to oncology and neurology medi-

Given your own sensitivity to the cultural mores and concerns of a community, you can be a key link in dispelling any myths about drug research while bringing volunteers into the fold.

I’m very diligent about asking the direct questions and picking through the subtle conversation for clues. It’s critical for making sure that our drugs are really improving the lives of our customers.”

Adds Shannon Bradley, RN, a telehealth nurse educator and team lead for The Lash Group, a Charlotte, North Carolina-based patient services support company: “When you’re speaking to someone on the phone, you need to ask the right questions because people don’t always come forth with information on their own. You have to help them identify

cations.

But her primary role is often to educate and support patients in staying the course with their medication. For no matter how many drugs move from clinical trial to market, they aren’t effective if they’re not taken according to directions. “We want them to understand,” she says, “the significant impact medication compliance has on their therapy outcome.”

Reaping Rewards: Better Health and Other Benefits Besides bedside nursing, there may not be a better way to use your skills and intuition than in

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drug development. You might not be the academic researcher or laboratory scientist behind a preparation, but you can help bring a drug the final distance via other roles. Truth is, by participating in the process once it involves ordinary people, you’re witnessing cutting-edge medications making dramatic differences in the quality of real lives.

A grandmother who couldn’t comb her hair or walk without a cane before an arthritis drug trial, for instance, performs both tasks eight months into it. A grandfather who couldn’t play with his grandchildren now travels across country to romp with them.

As to Menefee, the landmark A-HeFT trial left her with many good feelings about being a co-investigator in the drug improvement process.

Even though she didn’t place many African Americans in the trial, the protocol has worked so well that now whenever a black heart failure patient in her practice meets the medical criteria, she prescribes ISDN/ HYD to optimize the patient’s other meds. She hasn’t been disappointed yet.

The medication duo not only gives her more options in extending quality of life, but also serves as proof that research works. Every trial success, as well as every study failure, just reinforces her belief in the benefits of being part of the process. “Before a drug is even approved, I already know something about it,” she says. “So when it’s brought to market, I don’t need a sales rep to tell me how great it is. I know because I’ve already been involved with it. I’ve seen it work!”

Christine Hinz is a freelance writer based in Milwaukee, Wisconsin.

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MOVERS AND SHAKERS

PROFILES OF NURSE LEADERS

BY SUSAN WESSLING

There are people who are not satisfied with the status quo in their careers and instead help shape their vocations. They are the leaders in their professions.

Nurses are no different. There are many movers and shakers within the nursing ranks, and Minority Nurse selected five such individuals to highlight.

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Maria Gomez, RN, MPH Maria Gomez, the founder, president, and CEO of Mary’s Center, is no stranger to the spotlight. She has won a plethora of awards, perhaps none bigger than the nation’s second-highest civilian honor. Gomez was selected by the White House as one of 18 recipients of the 2012 Presidential Citizens Medal. “It was a great honor coming from a president like Barack Obama because I think it is very clear that his priorities are very much aligned with our priorities at the health center,” says Gomez.

Gomez was also quick to point out the role the center’s staff had in her receiving the award. “I received the medal for the collective and extraordinary work of my colleagues and our partners in the community,” she explains. “My role is to make sure that all the administrative pieces are in place and that there are sufficient funds to meet our goals.

The issues that the president is diligently working on, such as health reform, early childhood education, economic equity, and immigration reform, are issues that we are dealing with

day in and day out with the community that we serve.”

Gomez, along with a group of nurses and social workers, founded Mary’s Center in 1988 on an initial budget of $250,000. It served 200 participants a year at its inception.

“There were so many community needs around the indigent population that were not being met,” she says. The vast majority of patients served was Hispanic women, and at that time, a small cohort of African women, according to Gomez.

Today, the center has an annual budget of $40 million and is projected to serve over 70,000 participants at six sites throughout the District of Columbia and Maryland in 2013.

The Hispanic population still makes up about 75% of whom the center serves with an ever increasing number of African Americans. “But depending on the areas we are in, we serve individuals from over 110 countries throughout the world who have become uninsured, either because they lost their jobs or because they just cannot make ends meet,” says Gomez.

The center provides comprehensive primary care, intensive social services, and—in partnership with Briya Public Charter School—it provides family literacy classes and job skills with the goal of keeping families healthy, supported in their communities, and moving up the economic ladder.

“My education at Georgetown School of Nursing made me very conscious of the interconnectedness of health and the environment in which people live,” explains Gomez. “In order to keep people healthy, individuals need to be supported in the basic necessities of life, such as housing, food,

and employment, before they can tackle their diabetes. This

Halloran. “It is not so much that I had any personal interest

“It was a great honor coming from a president like Barack Obama because I think it is very clear that his priorities are very much aligned with our priorities at the health center,” says Gomez. model of comprehensive care is very hard to establish within a health department where I was working, so that was our motivational factor to start Mary’s Center.”

Edward Halloran, RN, FAAN, PhD Although he didn’t start out to be a trailblazer, Edward Halloran has traveled the road less taken. In a predominately women’s field, his career spans back almost 50 years and has seen him take on many leadership roles—a result he says goes back to a book he read at the beginning of his career.

“At that time, it was much more common for every other nurse to just want to be a nurse and just do your thing. But this book said if you are not visible no one will ever know that there is such a thing, so that is what started my interest in being more visible,” says

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in it as much as if there were ever going to be more men in the field, it had to be because the ones that were there were more visible. That prompted my involvement over the years in the American Assembly for Men in Nursing [AAMN].”

The 2012 recipient of the AAMN’s Lee Cohen award, Halloran was selected to receive the award by the Board of Directors of AAMN to recognize his significant contributions to the organization. “I was kind of surprised by that,” says Halloran. “I was very pleased [and] delighted that the people that I have been working with for the last three or four years acknowledged that.”

Halloran is a long-time member of the American Nurses Association and the American Academy of Nursing as well as the former vice president of the National League for Nursing and past president of the AAMN. He is currently finishing his second term as vice president of the latter organization.

Halloran spent a significant amount of time in hospital management. Among his management positions, he was the coordinator of special studies and projects at the Veterans Administration Hospital in Hines, Illinois; the director of nursing at the Gottlieb Memorial Hospital in Melrose Park, Illinois; and the senior vice president, director of nursing

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and corporate nurse executive at the University Hospitals in Cleveland, Ohio.

“I thought there might be better opportunities to do

many ways I had … the opportunity to do these things over the years, which has been an honor, and then the second piece is to shape [nursing],” he

“I thought there might be better opportunities to do more in a public way by writing about things or researching them then on a day-to-day basis performing them,” he says about his decision to move into academia. more in a public way by writing about things or researching them then on a day-today basis performing them,” he says about his decision to move into academia. “I had been there and done that, so the academic world offered opportunities to do something different.”

Since 1989, Halloran has been an associate professor of nursing at the University of North Carolina and UNC Hospitals at Chapel Hill. During this time, he taught two years in Hong Kong. From 19911992, he was a senior clinical nurse on the research unit at UNC Hospitals. He practiced involved care of patients who volunteered for experimental treatment for chronic illnesses, including cancer, HIV, end-stage renal disease, heart disease, sickle cell anemia, diabetes, and other diseases.

Halloran says the highlights of his career include changing the patient care environment.

“That gave me the biggest satisfaction,” he adds. “We improved care, and this is very difficult to do from the insideout of a major teaching hospital or even a suburban hospital or even a rural hospital.”

Halloran says he feels privileged to be considered a leader in the field of nursing. “In

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says. “I have done that through practice and through the teaching I have done.”

Mi Ja Kim, PhD, RN, FRCN, FAAN Mi Ja Kim is one of four nursing educators in the United States named a 2012 Living Legend by the American Academy of Nursing. Since 1994, the Academy has named just 86 Living Legends in the United States. The award honors the distinguished careers of those who have made notable contributions to nursing practice, research, and education.

Kim is a professor, dean emerita, and the executive director of the Global Health Leadership Office at the University of Illinois at Chicago (UIC), College of Nursing

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(CON). She is known internationally for her leadership in research, scholar training, administration, and policy development. She has published 116 scientific papers and made over 260 research and scholarly presentations at national and international conferences. She has also secured over $6 million in training and research funding from the National Institutes of Health (NIH) and other sources.

Kim served as the dean of the UIC CON, which prides itself as a top 10 college in the country, and was the first nurse to be appointed as the vice chancellor for research and dean of the graduate college at UIC. She earned her PhD in physiology at UIC and—with the exception of one year as a Senior Fulbright Scholar at her alma mater, Yonsei University, in Korea—has spent her whole career at the university. “UIC really has been an incredible place for me,” Kim notes. “It is open to anyone who is accomplished in her/his field, regardless of race or ethnicity.”

Kim’s extensive list of accomplishments only reaffirms her status as a leader in her field.

She is an Honorary Fellow of the Royal College of Nursing in the United Kingdom and has received the Lifetime Achievement Award from the Asian

the NIH’s National Advisory Council. Kim has been named one of the 100 Most Influential Women in Chicago by the Chicago Tribune; has received the Recognition of Outstanding Contributions to Nursing (The Public Women’s Award), American Nurses Association Minority Fellowship Programs and the Cabinet on Human Rights; two awards for “Meritorious Service in the Fight Against Heart Diseases–Public Policy and Government Relations” from the Chicago Heart Association; and two American Journal of Nursing Book of the Year awards for the Pocket Guide to Nursing Diagnosis and Classification of Nursing Diagnoses: Proceedings of the Fifth National Conference.

Her research interests include pulmonary physiology/ nursing, cardiovascular health disparities in Korean Americans, and the quality of nursing doctoral education involving seven countries. Her career documentary has been filmed by the Korean Broadcasting System, which is the largest TV network in Korea—an accolade she finds a high honor.

The students appreciate Kim. She lists two “Golden Apple” awards she received from the junior and senior undergraduate students as highlights of her career. Since 2013, she has

“I never thought when I went into nursing I would be on the forefront providing care to the patients using telehealth technology,” says Simon.

American Pacific Islanders Nurses Association. She was one of 18 charter members of the National Institute of Nursing Research’s (NINR) study section as well as a member of

been the program director of the Bridges to the Doctorate for Minority Nursing Students, which is funded by the NIH. Eleven PhD students have graduated under this grant

and 23 are in the Bridges program currently. This program is one of the largest ones in the country that have educated and trained underrepresented minority nursing students pursuing a doctoral degree.

Omana Simon, DNP, RN, FNP-BC Omana Simon is an advanced practice nurse who serves as the facility telehealth coordinator at Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston, Texas. A native of India, Simon came to the United States in 1983 and began her health care career with a BSN before diligently working her way up the ladder.

Today, she works on the cutting edge of technology.

Simon provides primary, secondary, and tertiary prevention strategies to the veteran population. For her efforts, she was the Gold Award winner in 2012 of the Good Samaritan Foundation’s Excellence in Nursing Awards in the Clinical Practice in the Large Hospital category and a recipient of the 2012 Nursing Excellence award in the Advancing and Leading the Profession category for the Texas region.

As the facility telehealth coordinator at MEDVAMC, Simon is responsible for a program that allows vets to receive home telehealth, store and forward, and clinical video telehealth (different modalities of telehealth). “Telehealth in Veterans Affairs is a huge project,” says Simon. “We can provide health care through the use of telehealth devices, video conferencing equipment, or Jabber/MOVI.” Simon is a true leader in her field, implementing a number of clinical video telehealth programs at her facility, including telepreop, telerehab, and teleepilepsy, to name a few. These programs connect the veterans in the rural areas where health care is not easily available to a provider at a distant site.

She also oversees telehealth equipment and telehealth programs. “I never thought when I went into nursing I would be on the forefront providing care to the patients using telehealth technology,” says Simon.

Under her direction, the home telehealth program at MEDVAMC received three hospital-wide recognitions. “She is very hard working, very intelligent, and very insightful,” says Nicholas Masozera, MD, the primary care director at MEDVAMC. For her part, Simon says she gets her inspiration from the veterans she serves. “It is truly an honor to serve the nation’s heroes by providing exceptional 21st century health care that improves their health and well-being,” she notes. Simon exemplifies excellence in her role as a family nurse practitioner as well as a mentor and teacher of future caregivers.

Simon upholds the tradition of nursing by being a caring,

compassionate nurse who settles for nothing but health care excellence for veterans and the community she serves.

Ora Strickland, PhD, RN, FAAN Ora Strickland is a nationally recognized leader in women’s health, minority health, and nursing measurement. Not only has Strickland won nine American Journal of Nursing Book of the Year awards, but she was also the first person to hold an endowed professorship in the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, Georgia.

Formerly a professor at Emory, Strickland is now the dean and a professor at the College of Nursing and Health Sciences at Florida International University in Miami.

Strickland began her writing career early. “Writing is storytelling but on paper. If you are excellent at writing, your work will last a long time; its imprint will be longer,” notes Strickland. “You can build and extend on knowledge and present problems and their solutions in new and unique ways.”

Strickland says she recognized that she could write text-

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books when she was a student herself. “You can blaze trails [writing],” she adds. “You can really make a difference if you are good at writing textbooks.

You can have an impact on how people are taken care of.”

Strickland is the founding editor and served as senior editor of the Journal of Nursing Measurement for 20 years.

She has been on a plethora of prestigious editorial boards and panels, including Advances in Nursing Science, Research in Nursing and Health, Nursing Outlook, Journal of Professional Nursing, Scholarly Inquiry for Nursing Practice: An International Journal, Encyclopedia of Nursing Research, Health Care for Women International, Nursing Leadership Forum, and the American Journal of Public Health.

Strickland has been recognized by many groups and organizations. She was the youngest person inducted into the American Academy of Nursing at age 29 and has won the “Trailblazer Award” from the National Black Nurses Association (NBNA). She also earned the Mary Elizabeth Carnegie Award from the Southern Council on Collegiate Nursing for her contributions to health and nursing. Additionally, she was inducted into the NBNA Institute of Excellence.

“I don’t think about the awards I won. It isn’t important,” says Strickland. “I get joy in what my students have produced, the research and work they are doing. That is where I find my joy and that is where my rewards come from.”

Susan Wessling is an awardwinning columnist, editor, and writer. She lives in Worcester, Massachusetts.

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LIGHTS, CAMERA, ACCURACY

NURSES IN THE MEDIA

H

istorically, nurses have played a secondary role in health care-focused TV shows, perhaps showing up as the attractive “naughty nurse” or not featured at all. There were few prominent portrayals of nurses until the 1970s TV show M*A*S*H, which introduced Major Margaret “Hot Lips” Houlihan, played by Loretta Swit, to the popular culture.

In addition to being the only main female character in the ensemble cast, Houlihan was an army nurse who served as

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romantic fodder for a few of the male characters over the course of the show.

But the majority of the media focus has traditionally been on physicians, with nurses serving as their handmaidens.

“The media portrays nursing as a career for yesterday’s women living in the dustbin of history—women who just never got the memo that if you want to do anything of meaning in the field of health care, then become a physician,” says Sandy Summers, RN, MSN, MPH, who is the founder and

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executive director of the nonprofit organization The Truth About Nursing, which seeks to increase public understanding of the central role nurses play in modern health care. “If the media knew that nurses actually perform intensely interesting and dramatic work and portrayed nurses doing it, the public would come to better understand—and respect— nursing.”

Recent Portrayals of Nursing In the past decade, nurses have started to appear more

DeNiro: Courtesy of Universal Studios Licensing LLC

Your favorite movie or TV show may feature a spunky heroine who’s smart, capable, and great at her job, but chances are she’s not a nurse. Although TV shows and movies are known to take artistic liberties with many professions—such as homicide detectives, lawyers, and politicians—the importance of what nurses do has been consistently downplayed and marginalized in mainstream media.

DeNiro: Courtesy of Universal Studios Licensing LLC

BY ERICA PATINO www.minoritynurse.com

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frequently in entertainment, but the portrayals aren’t often reflective of reality. Summers says that, unfortunately, the most popular shows that reach the largest audiences, such as Grey’s Anatomy, Private Practice, and House, tend to show physicians doing all the work—including tasks that are in reality performed by nurses—with nurse characters simply fetching things for the physicians.

In real life, of course, the work nurses do is far more involved.

Manisha Ati, RN, BSN, is an operating room nurse at New York University Langone Medical Center in Manhattan.

“During nursing interventions, nurses are making critical decisions without involving a doctor—decisions such as giving pain meds or escalating a patient’s situation if they’ve taken a turn for the worse,” says Ati. “I don’t think people realize what a complex and dynamic job nursing really is, just from watching media.”

The long-running TV hit ER (1994-2009) featured a large cast, but the emphasis was still on physicians. “Among the non-nurse shows, ER had good diversity of the nurse characters. There were Asians, African Americans, and men. Sadly, all were minor characters existing at the edges of the plot,” says Summers.

In recent years, more nurse-focused TV shows have cropped up, including Nurse

Jackie, Mercy, and HawthoRNe, although Nurse Jackie is the only one that’s still on the air.

“All three shows had good ethnic and gender diversity of nurse characters,” says Summers. HawthorRNe featured Jada Pinkett Smith in the title role of Christina Hawthorne, and Mercy featured Jaime Lee Kirchner as Sonia Jimenez, both African American nurses.

Nurse Jackie, which Summers says does show some depictions of strong, astute nurses, includes South Asian and Middle Eastern nurse characters.

The hospital-set comedy Scrubs (2001-2010) also featured a Latina nurse, Carla Espinosa, played by Judy Reyes.

Similar to entertainment, news reporters tend to highlight physicians instead of nurses when covering medical stories.

One notable exception was during the October 2012 coverage of Hurricane Sandy at NYU’s Langone Medical Center, where Ati works. When the hospital basement flooded and back-up power generators failed, nurses evacuated 260 patients, including babies from the neonatal intensive care unit, and the national news outlets picked up the story, citing the heroics of nurses who worked through the night to carry patients to safety.

“Nurses are generally portrayed as being in the background.

That’s what was unique about the news coverage of Hurricane Sandy—the media actually rec-

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“The media portrays nursing as a career for yesterday’s women living in the dustbin of history—women who just never got the memo that if you want to do anything of meaning in the field of health care, then become a physician.”

—Sandy Summers, RN, MSN, MPH

ognized nurses for doing the work of moving patients. Even President Obama acknowledged the nurses for what they did— and that’s the kind of work nurses really do,” says Ati.

Are Minority Nurses Stereotyped?

As a field, nursing is extremely diverse. “Different cultures and backgrounds are embraced in the nursing profession, and I think that’s good; it makes you a better nurse,” says Ati. Diversity in the nursing field also helps nurses deal with the myriad backgrounds and cultural differences of the patients they serve.

Sources say that while nurses aren’t shown enough in the media, minority nurses are being portrayed fairly, when they do appear. “It’s not so much that minorities are being stereotyped—nurses as a whole are being stereotyped,” notes Summers. Ati agrees: “It’s not that minority nurses are portrayed differently—it’s that nurses in the media are the minority!”

Male nurses in entertainment tend to fall into two

categories, says Summers: the “boy toy” that promotes female power when women boss them around, or the medical school drop-out, as evidenced with male nurse Gaylord Focker in the Meet the Parents movies—who won the professional approval of his father-in-law only after his fiancée revealed that he had scored in the 97th percentile on the MCAT—and staff nurse Ray Stein on HawthoRNe, who failed the MCAT the first time and dreamed of going to medical school.

Taking the Reins of Media Perceptions The landmark Woodhull Study on Nursing and the Media analyzed articles published in 16 US newspapers, magazines, and health trade publications from September 1997. Researchers found that less than 1% of magazine articles and less than 4% of newspaper articles referenced nurses—and such references were made mostly in passing, not mentioning a nurse more than once. The study concluded that it was up to nurses to

1972

1994

2000

2001

M*A*S*H introduces Major Margaret “Hot Lips” Houlihan

ER focuses on physicians, but depicts nurses as competent

Gaylord Focker is ridiculed for being a male nurse in Meet the Parents

Nurse Carla Espinosa of Scrubs is often undermined by the doctors

Ho of th ma

nosa ten by

take a more assertive role in the media, such as speaking at public events and writing more letters to the editor to correct misrepresentations of the nursing field in the media.

Diana Mason, PhD, RN, FAAN, Rudin Professor of Nursing at Hunter College, City University of New York, heartily agrees. Dr. Mason is the co-director of the Center for Health, Media & Policy (CHMP) at Hunter, along with her col-

Ati agrees: “It’s not that minority nurses are portrayed differently—it’s that nurses in the media are the minority!” league Barbara Glickstein, MPH, MS, RN, a health journalist.

They also host a long-running radio show called Healthstyles on WBAI in New York. Through

CHMP, Glickstein is the lead on media training, running workshops that prepare nurses to speak to the media—or start media on their own, such as through a blog, Twitter, or Facebook. “As nurses, it’s our responsibility to show the media what nurses do. We focus on what patients need and want, and that’s an important perspective,” says Mason.

Mason cites the CHMP blog, HealthCetera, as a good nursing media source to follow. In addition, Mason is proud of the ongoing work from nurses who have been through the media training workshop of CHMP, such as Chelsea Savage, RN, and Nancy Rudner, DrPH, RN. Rudner, a nurse practitioner, writes a regular health column for the Winter Park/Maitland Observer in Florida. Savage, a nurse who is interested in health care reform, is active on Twitter and Facebook.

Among minority nurses who have been through the CHMP media training, Mason cites Angie Millan, MSN, RNP, CNS, FAAN, who is the immediate past president of the National Association of Hispanic Nurses, and Patricia Lane, RN, BSN, an African American nurse in Virginia, as star students. Lane, whose passions include health policy and continuing education, wrote an op-ed piece entitled “More patients now assured of help” for the Richmond Times-Dispatch in June 2012 to

comment on the passing of the Affordable Care Act. “Since nurses are the most trusted health care providers, we can relay important health information to patients in a way they can really understand,” says Lane in a phone interview.

Furthering her media outreach, Lane was selected by the American Heart Association to be part

nurse researchers to speak to journalists,” she says. “Nurses need to be prepared to describe what we do.”

In addition, nurses may be reluctant to talk to the media.

“Nurses don’t respond to journalists. Nurses may be afraid that they don’t have the right expertise or aren’t comfortable speaking to the media. The me-

“As nurses, it’s our responsibility to show the media what nurses do. We focus on what patients need and want, and that’s an important perspective,” says Mason. of the Spotlight Speaker Series on Racial and Ethnic Disparities in Hypertension: Beginning the Conversation 2012-2014. “It’s a volunteer engagement and community outreach program that will run in 18 US cities from January to June 2013,” Lane says. “We’ll assign mentors to coach participants to decrease their high blood pressure numbers and work with them to achieve a healthy lifestyle.”

dia need to recognize and value that expertise, but they need nurses to speak to, as well,” says Mason.

Mason notes that nursing journals and organizations also need to become more media-friendly. She served for over 10 years as editor-inchief of the American Journal of Nursing (AJN), where Mason continues in an emeritus position. Under her leadership, AJN became the journal most frequently cited in the public media. It’s also important to frame nursing conferences to make them easy for journalists to cover, which hasn’t been done in the past, she says.

“What we can do is more outreach with public journalists,” says Mason. “The change will have to come from nurses and those who are educating

How Nurses Can Gain More Exposure When it comes to the lack of nurses portrayed in the media, Mason says that the problem goes both ways. Although the media should feature more nurses, there are also some barriers from the nursing community. “We have to do a better job of preparing nurses and

2004

2005

2009

House paints the role of the physician as the master of health care

Nurses are cast to the sidelines in Grey’s Anatomy

Three nursing-centric TV shows launch (Nurse Jackie, HawthoRNe, and Mercy)

2012 Nurses are portrayed as heroic during news coverage of Hurricane Sandy

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Nurses: If Florence Could See Us Now premieres

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nurses, not from the media.”

Summers points to the “Take Action” page on The Truth About Nursing website where nurses, the media, and members of the public can seek to improve the media’s understanding of nursing. She says it’s important for entertainment writers to start with an accurate idea of what nurses do before they begin creating TV shows and movies that feature them. “We encourage the media to consult nurses as experts on health care shows and news articles instead of assuming that physicians are masters of all health care,”

Douglas wants the public and policymakers to better understand who nurses are and what they really do. “The media is lacking true representations of nursing. The power of the role isn’t represented at all. You only hear about nurses when there’s a shortage or a strike,” she says. Douglas conceived and directed the documentary Nurses: If Florence Could See Us Now, which took about a year from its inception to its premiere in Los Angeles on October 11, 2012. The documentary seeks to paint a real picture of nurses today.

Douglas and her team spent

we need them, such as when we’re sick,” she says. Second, the documentary is for nurses themselves, to inspire and recognize them.

“I’m happy to share my story with others, to let people take from it what they will, which is hopefully a piece of hope or inspiration,” says Jonathan Van Nuys, RN, a nurse at Mission Neighborhood Health Center in San Francisco, who was featured in the film. Van Nuys was so moved by the support he got from a nurse named Laurie Mathers (also featured in the film) while he was a cancer

Douglas was struck by how humble her interview subjects were: “I’m not sure they even know how amazing they are. It’s important for nurses to pause and recognize what they do.”

Summers says. “So much relies upon the media to just stop buying into stereotypical assumptions and start asking nurses about nursing.”

What It Really Means to Be a Nurse If media perceptions of nurses aren’t what they should be, there are different opinions on how to address the issue. “Although there aren’t many representations of nurses in the media, I just accept that that’s the way it is. I know what I do and the impact I have on my patients,” says Ati. One nurse working to fill the media void is Kathy Douglas, RN, MHA, who is chief nursing officer for API Healthcare and the president of the non-profit organization On Nursing Excellence, which works to improve the efficiency, well-being, and recognition of the health care workforce.

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about four months filming.

They interviewed 120 nurses in nine different states, and of those, 73 nurses made it into the film. Douglas says there was no script she followed. “I would show up with a camera and interview nurses based on their specialty,” she says. “It was spontaneous, authentic, from-the-heart speaking.”

The Nurses documentary focuses on a wide variety within the field, including pediatric nurses, nurse educators, nurse practitioners, geriatric nurses, military nurses, critical care and trauma nurses, and nurse researchers, all sharing their stories of triumph and heartbreak. The goal of the documentary, says Douglas, is twofold: First, to educate the public, including the voting population and policymakers, to understand the role of nursing better. “People need to think of nurses not just when

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patient undergoing chemotherapy that he was inspired to become a nurse himself.

As an RN now, he works and volunteers to support people with HIV and is continuing his education to become a nurse practitioner.

During the filming, Douglas says her appreciation of nurses only increased. “I already had a deep respect for what nurses do, but it went to a whole other level.” Douglas was struck by how humble her interview

subjects were: “I’m not sure they even know how amazing they are. It’s important for nurses to pause and recognize what they do.”

Douglas says that the reaction the filmmakers often got from nurses they interviewed was, “Who, me? I was just doing my job.”

“But that’s not the reality for those they touch,” she notes. Douglas adds that it shouldn’t take a crisis, such as Hurricane Sandy, to celebrate the work of nurses. “All the bad stuff in the news sells, but let’s talk about all the good nurses are doing.”

Nurses touch many lives, and this informs a unique perspective. “One of the deepest privileges of being a nurse provider is to sit as witness to people’s stories, their struggles, their vulnerability, their hopes and dreams,” says Van Nuys.

Hopefully with more media created by nurses themselves and more media that seeks to have a true understanding of the profession, nurses will be able to do something they haven’t in the past— share their own stories with a larger audience.

Erica Patino is a freelance writer based in Monterey, California.

Academic Forum

Dissecting the Origins of Sickle Cell Anemia

BY KATHRYN NORCUTT

It was never fully explained during the movie Beasts of the Southern Wild, but we can surmise that Hushpuppy’s father may have suffered from sickle cell anemia. Her father, Wink, after being missing for days, finally strolls back to “The Bathtub” still donned in his hospital gown, and it is obvious something is seriously wrong with him.

What, exactly, remains a mystery, but when Hushpuppy presents her father’s hospital identification bracelet to her schoolteacher, her teacher quickly gathers a type of folk-remedy to give to Hushpuppy that is supposed to help her father.

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f course, her father refuses his daughter’s ministrations, which only confounds Hushpuppy. Even after she faces the brutal aurochs, Hushpuppy still cannot prevent her father’s eventual demise. And as illustrated in real life, sickle cell is a very ruthless and painful genetic condition, most commonly found among the African American community.

According to the Centers for Disease Control and Prevention, it is estimated that 1 out of 12 African Americans have

as well as enduring days in a diminished capacity and longsuffering state. Tests are available that a pregnant mother can have performed during an amniocentesis to screen for sickle

cell. Of course, if it comes back positive, she will still be faced with more questions than answers, among them treatment options, quality of life, and severity of the disease.

By investigating the origins of sickle cell anemia, we can understand how it went from one of the most shamefully neglected conditions to one promising scientific breakthrough, where perhaps one day, we will have something close to a cure for those future generations who are afflicted.

Genetic Components Interestingly enough, the sickle cell gene originated along

the equatorial belt as a natural selective means to thwart the devastating effects of malaria.

However, though it protects the carrier from mosquito-borne illness, sickle cell disease is a highly debilitating illness and its effects can diminish the stricken with a lifetime of painful joint, organ, and bone complications. In the human body, normal red blood cells are smooth-surfaced and round, hence the simplicity in which they slide through veins. When someone has full-blown sickle cell anemia, their hemoglobin is deficient, creating cells that are inherently sticky-surfaced and like a farming tool, sickle

And as illustrated in real life, sickle cell is a very ruthless and painful genetic condition, most commonly found among the African American community. some form of the disease, either carrying the sickle cell trait, which generally has no symptoms but can be passed along to their subsequent offspring, or the full-blown case of it, which can entail a shortened lifespan www.minoritynurse.com

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Academic Forum in shape. The problems caused by the damaged cells come in the form of chronic pain or “attacks” where the cells have lodged together, either in certain organs, bones, or blood of the infirmed. The patient’s

promising results with the use of Hydroxyurea, a drug commonly used in the treatment of cancer. It can help prevent the sickle cell buildup, reducing the amount and occurrence of painful attacks, but it has its

On May 16, 1972, President Richard Nixon took sickle cell anemia to center stage with the signing of the National Sickle Cell Anemia Control Act. blood vessels are blocked by clumps of sticky, sickle cells, which is the source of the patient’s chronic pain.

Treatment Options This can range due to the severity of the disease and can consist of treating the pain with anti-inflammatories, or if needed, a bone marrow transplant. There have been some

side effects as well. Symptoms can include nausea, constipation, hair loss, fever, weight gain, leg ulcers, and bleeding.

With children, some experts are cautioning the use without knowing the long-term effects; some studies have demonstrated genetic changes and an increased risk for cancer.

For those extreme cases there is bone marrow transplantation,

but of course, this requires finding a compatible donor as well as extensive treatments.

Care Unfortunately, due to factors such as medical discrimination, a lack of awareness, care, and treatment options, sickle cell anemia has historically not received the recognition among our scientific and medical community. On May 16, 1972, President Richard Nixon took sickle cell anemia to center stage with the signing of the National Sickle Cell Anemia Control Act. But at the end of the day, it rests upon those in the medical community who can be that critical segue for pain management and controlling symptoms, especially young children who are suffering from the effects of this genetic disease. Treatment op-

tions, education, and cultural respect should be clearly understood for those caring for the afflicted.

Certainly, we have come a long way in recognizing the needs of a long-suffering community. And by implementing quality care, facilities, and adherence to treatment for those in the throes of this disease, we can undoubtedly help improve the overall quality of someone’s life.

Kathryn Norcutt has been an active member of the health care community for over 20 years. During her time as a nurse, she has helped people from all walks of life and ages. Now, Kathryn leads a much less hectic life and devotes most of her free time to writing for RNnetwork (www.rnnetwork.com), a site specializing in RN jobs.

CHOP Nursing: Leaders and Partners at All Levels At The Children’s Hospital of Philadelphia, hiladelphia, we respect, value and honor the difference that our employees bring to CHOP. We believe that these very differences help us to remain innovators at the forefront of pediatric care. Every person that we employ plays an essential part in ensuring our continued excellence.

CHOP nurses contribute to a renowned nursing team that delivers pediatric care centered on evidence-based research, so they can achieve the best possible outcomes for our patients and their families. Re-designated as a Magnet® institution in November 2008, the CHOP Department of Nursing gives our professionals the independence to participate in individual research programs at the bedside, along with the tools and environment to ensure an unmatched career.

Our organization offers total compensation packages befitting a world class institution.

To learn more and apply, please visit us at www.chop.edu/careers.

One Career. Endless Opportunities.

WWW.CHOP.EDU/CAREERS

EOE

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Minority Nurse | SUMMER 2013

The Children’s Hospital of Philadelphia is ranked as one of America’s best hospitals for children by U.S. News & World Report and Parents

Academic Forum

Breast Cancer Prevention Beyond Mammograms: Addressing Root Cause

BY ED JAMES, MD

When Americans think of breast cancer, most consider it to be like a game of craps. If a woman is lucky she will avoid breast cancer during her lifetime; but if she is unlucky, then she may be diagnosed with this dreadful disease. This philosophy on breast cancer is unfortunately perpetuated in the United States health care system.

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e doctors, nurses, and other health professionals learn early in our educations that breast cancer is virtually inevitable for many women. Currently, the lifetime risk of breast cancer in an American woman is about 12%. In other words, a female born in the United States has about a 1 in 8 chance of developing breast cancer during her lifetime.1 This is one of the highest breast cancer rates in the entire world. It is well known that rates of breast cancer are substantially lower in many developing countries

In the United States, our approach to breast cancer is tailored around its inevitability. where diets consist of more plant-based whole foods (and less animal-based foods) and where lifestyles are generally less sedentary. For example, compared with a 12% lifetime breast cancer risk in the US, there is only a 3% lifetime risk in East Asia, Central and subSaharan Africa, and Western sub-Saharan Africa.

In the United States, our ap-

proach to breast cancer is tailored around its inevitability.

As a result, instead of investing substantial research into dietary and lifestyle prevention of this disease, we prefer to focus upon early diagnosis and treatment. Techniques used for diagnosis most often include physical examination, mammography, ultrasound, and biopsy procedures. Such screening simply identifies cancers that have been around long enough that they have grown to where they can be detected.

Breast cancer treatments often include surgery (e.g., mastectomy or lumpectomy), radiation, and chemotherapeutic agents. These approaches to breast cancer are unfortunately reactive, similar to how we typically approach many other diseases in our country, including heart disease, stroke, and hypertension. “Wait until the disease is diagnosed. Then prescribe drugs and perform surgery.�

This approach ignores the root causes of these diseases, which is principally our diet and lifestyle.

Key risk factors for breast cancer include early age of menarche, late age of menopause, high levels of female hormones in blood, and high

blood cholesterol. These were confirmed in the China Study and have been documented in many other research studies.2 With the exception of the blood cholesterol, these risk factors are all related to exposure to excess female hormones, such as estrogen and progesterone, which increases breast cancer risk. Women who consume diets rich in animalbased foods and relatively low in plant-based whole foods have menarche earlier and menopause later, resulting in greater lifetime exposures to

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estrogen. This explains why research has shown that lifetime exposure to estrogen is 2.5 to 3 times higher among Western women when compared with rural Chinese women.2 Estrogen is a direct participant in the breast cancer process.3 Its levels are a key determinant of breast cancer risk. High levels of estrogen and other female hormones result from consuming typical Western diets, high in fat and animal protein, but low in dietary fiber.4 This research strongly suggests that the risk of breast cancer can

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Academic Forum be markedly reduced simply by eating foods that keep estrogen levels at lower levels than is typical with the Standard American Diet (SAD).

Instead of addressing preventable dietary causes of breast cancer, we prefer to discuss other risk factors, including genes, hormone replacement, and environmental toxins. While it is true that genes play a role in breast cancer, it is wrong for women to feel that if they have a family history of breast cancer, there is nothing they can do to decrease their risk. This is simply untrue and it removes personal responsibility from the equation. In truth, most breast cancer is much more strongly tied to diet and lifestyle than to genes. Even in women who have so-called “breast cancer genes,” those genes would need to be expressed in order for breast cancer to manifest.

Whether such genes are expressed is closely related to one’s diet and lifestyle.5 Hormone replacement therapy is considered a risk factor for breast cancer. As discussed previously, exposure to female reproductive hormones during the course of a woman’s life increases her breast cancer risk.

Therefore, it is no surprise that administering these hormones as therapy in postmenopausal

based diet) reduces the abrupt hormone changes that typically cause menopausal symptoms and may make such hormonal therapy unnecessary in many women.5 Environmental chemicals such as dioxins, Polychlorinated Biphenyls (PCBs), and Polycyclic Aromatic Hydrocarbons (PAHs) have also been discussed as increasing a woman’s breast cancer risk. While such chemical exposures may contribute to carcinogenesis, it is important to realize that with similar chemical exposures, a plant-based diet has been shown to be protective against cancers, while an animal-based diet is more conducive to cancer cell growth.5 A review of more than 60 research studies suggests that premenopausal and postmenopausal women who exercise regularly may reduce their incidence of breast cancer by 20% to 40%.6 Also, a study of nearly 3,000 nurses with stages 1, 2, or 3 breast cancer published in The Journal of the American Medical Association indicated that simply walking three to five hours per week reduced the risk of breast cancer by 26% to 40%.7 Stress also seems to play a role in breast cancer. A study following nearly 60,000 African American women for six

In summary, based on much research to date, there is reason to believe that the following may significantly reduce your risk of breast cancer … and that of your patients: • Depart from the SAD, which is high in animal-based and processed foods, and instead adopt a plant-based, wholefood diet that is high in nutrients and fiber.

• Engage in regular exercise.

• Reduce your stress levels through prayer, yoga, meditation, and mutually supportive relationships.

Don’t sit back and let breast cancer find you. Be proactive and reduce your risk of this terrible disease in the first place.

As health care providers, we can do more than merely suggest mammograms for our patients. We must educate them on dietary and lifestyle changes to prevent this terrible disease from happening in the first place.

Dr. Ed James is an editorial advisory board member of Minority Nurse and the founder and presi-

While it is true that genes play a role in breast cancer, it is wrong for women to feel that if they have a family history of breast cancer, there is nothing they can do to decrease their risk. women would also increase breast cancer risk. The good news is that consuming a plant-based diet (as opposed to the typical American animal-

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years found that women who reported feelings of racial discrimination were more likely to develop breast cancer than their peers.8

Minority Nurse | SUMMER 2013

dent of Heal2BFree, LLC (http://

heal2bfree.com).

References 1. Forouzanfar MH, Foreman KJ, Delossantos AM, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: A systematic analysis. Lancet. 2011 Oct 22;378(9801):1461-84.

2. Junshi C, Campbell TC, Junyao L, Peto R, eds. Diet, Life-style and Mortality in China: A Study of

the Characteristics of 65 Chinese Counties. Oxford, UK; Ithaca, NY; Beijing, PRC: Oxford University Press; Cornell University Press; People’s Medical Publishing House; 1990.

3. Bocchinfuso WP, Lindzey JK, Hewitt SC, et al. Induction of mammary gland development in estrogen receptor-alpha knockout mice. Endocrinology. 2000 Aug;141(8):2982-94.

4. Adlecreutz H. Western diet and Western diseases: some hormonal and biochemical mechanisms and associations. Scand J Clin Lab Invest Suppl. 1990;201:3-23.

5. Campbell TC, Campbell TM II. The China Study. BenBella Books; 2006.

6. Exercise and malignancy: Can you walk away from cancer?

Harv Mens Health Watch. 2006 Nov;11(4):4-6.

7. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005 May 25;293(20):2479-86.

8. Taylor TR, Williams CD, Makambi KH, et al. Racial discrimination and breast cancer incidence in U. S. black women: The Black Women’s Health Study. Am J Epidemiol. 2007;166(1):46-54.

Academic Forum

Putting Culturally Competent Communication into Hospital Accreditation

BY PAM CHWEDYK

Last summer, The Joint Commission’s culturally and linguistically competent patient-centered communication standards became part of the hospital accreditation process. One year later, what difference are they making?

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n 2009, Minority Nurse published a Vital Signs story that asked: “Have you ever wished that hospitals had more of an incentive to provide culturally and linguistically competent patient care?”

What prompted that question was The Joint Commission’s announcement that it was developing a set of standards that would incorporate the provision of culturally competent patient-centered care into the national requirements for hospital accreditation.

They’ve been a long time coming, but on July 1, 2012, these new and revised standards for patient-centered communication officially became part of the overall accreditation decision. The standards—which are published in a free downloadable implementation guide, Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals— require health care organizations to, among other things: • Identify and effectively meet the oral and written communication needs of all patients, including those with limited English proficiency, hearing or visual impairments, and low health literacy; • Use highly qualified interpreters and translators, rather than untrained individuals, family members, or bilingual staff;

• Document patients’ language and communication needs in their medical records.

Plus, the standards include two provisions designed to create a more equitable environment for lesbian, gay, bisexual, and transgender (LGBT) patients and their loved ones. One requires hospitals to prohibit discrimination based on sexual orientation and expression of gender identity. The other provides equal hospital visitation rights for same-sex domestic partners by allowing “a family member, friend, or other individual to be present with the patient for emotional support during the course of stay.”

As all nurses know, Joint Commission accreditation reviews are something hospitals take seriously. One year later (or two years in the case of the LGBT standards, which took effect in July 2011 to align with the Centers for Medicare & Medicaid Services’ 2011 visitation rights regulations1), what effect have the patient-centered communication standards had?

Are they helping hospitals do a better job of serving culturally diverse patients’ needs? And more importantly, are they starting to make any difference in improving minority health outcomes?

Too Soon to Know The answer is: It’s still too early to tell.

“We’ve been trying to do some analysis of the scoring data and the requirements for improvement that we’ve seen

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since last July,” says Christina Cordero, PhD, MPH, associate project director, Department of Standards and Survey Methods, at The Joint Commission.

“These data have been somewhat limited because of the time frame. But we’re planning to [look at] that information to see how frequently these issues are being scored, what kinds of situations and comments are coming up on survey, and what our surveyors are seeing on-site.”

In the meantime, anecdotal evidence suggests that most hospitals are at least trying to make sure they’re implementing the standards correctly. For instance, says Cordero, who helped develop the patient-centered communication standards and the Roadmap for Hospitals, The Joint Commission has been fielding many questions about how to implement standard

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Academic Forum RC. 02.01.01, EP 28, which requires hospitals to include patients’ race and ethnicity in their medical records.

“Most of these inquiries have focused on what categories and question formats hospitals should use to collect that information from patients,” she explains. “For example, should they ask about race and ethnicity together in one question or in two separate questions? We responded by publishing FAQ documents on our website to help hospitals implement a data collection system that works for them.”

As for identifying areas where improvement may be needed, The Joint Commission’s initial analysis of data from surveyor site visits seems to indicate that hospitals are finding some of the standards harder to comply with than others.

“The one standard that has been coming up most frequently on-site over the last few months is PC.02.01.21, identification of patients’ language and communication needs during the provision of care, treatment, and services,” Cordero reports.

“This may mean that hospitals are struggling more with that issue. Our surveyors are looking at not just the documentation of communication needs but what hospitals are doing to identify and address those needs.”

Is It Enough?

Minority health advocates are also keeping an eye on what The Joint Commission’s evaluation of the standards’ early years will reveal.

“I hope there will be a systematic examination of the outcomes and the impact on the quality of patient care,” says

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Cora Muñoz, PhD, RN, co-author of the book Transcultural Communication in Nursing. “But the fact that there are now two external bodies that require this—the Office of Minority Health [which developed the Culturally and Linguistically Appropriate Services (CLAS) standards in 20002] and now The Joint Commission—is a step in the right direction.”

Hector Vargas, JD, executive director of GLMA: Health Professionals Advancing LGBT Equality (formerly the Gay & Lesbian Medical Association) feels that the patient-centered communication standards are “just one piece of a larger picture of progress we’ve seen over the last few years. These stan-

dates—in place is not enough.

Unless these requirements are vigorously enforced, she believes, there’s no guarantee that hospitals will act on them.

Vargas agrees. “The policies are there at the macro level,” he says, “but we really have to rely on the professionals in the hospitals—nurses in particular, but all members of the health care team—to make sure those policies are enforced.”

Nurses as Communication Champions What can nurses do to help ensure that their institutions are complying with the standards on an ongoing basis—not just when Joint Commission surveyors show up? Muñoz,

“When nurses have a patient who needs language assistance, they must demand that the patient gets those [interpretation] services,” Muñoz adds. “As patient advocates, they should not settle for just getting by, or using family members [as interpreters] when it is convenient. That is not acceptable.”

sity of South Carolina College of Nursing and a member of GLMA’s board of directors, gives two reasons why it’s important for nurses to be involved in championing the standards’ LGBT-inclusive provisions.

“One is patient protection and advocacy. The other is to protect the rights of their [LGBT] colleagues, whether they themselves are LGBT-identified or not.” However, she cautions, “If they’re working in a state, or a hospital, that is not accepting of LGBT people, it’s a little trickier for them to be an advocate without endangering their own employment.”

Even though the impact of the patient-centered communication standards is still a work in progress, Muñoz emphasizes that progress is the key word.

“At least we have the standards now; we didn’t have them before,” she says. “We’re moving forward. I wish we could move faster. But we’re moving.”

Pam Chwedyk is a freelance health

dards, the CMS hospital visitation rules, the [2011] Institute of Medicine report [The Health of LGBT People: Building a Foundation for Better Understanding], Healthy People 2020—which for the first time includes specific LGBT health goals—and the Affordable Care Act have all made a difference in how hospitals are addressing the needs of LGBT patients.”

But some transcultural nursing leaders, such as Josepha Campinha-Bacote, PhD, MAR, PMHCNS-BC, CNS, CTN-A, FAAN, president and founder of Transcultural C.A.R.E. Associates in Cincinnati, argue that simply having culturally sensitive accreditation standards—or even federal government man-

Minority Nurse | SUMMER 2013

who is professor emeritus and an adjunct professor at Capital University School of Nursing, asserts that nurses must be leaders in a constant dialogue about the crucial role culturally competent communication plays in planning and delivering the best possible care for every patient.

“When nurses have a patient who needs language assistance, they must demand that the patient gets those [interpretation] services,” Muñoz adds. “As patient advocates, they should not settle for just getting by, or using family members [as interpreters] when it is convenient.

That is not acceptable.”

Laura Hein, PhD, RN, an assistant professor at the Univer-

care writer based in Chicago. She is a former editor of Minority Nurse.

References 1. U.S. Department of Health and Human Services, “Medicare Finalizes New Rules to Require Equal Visitation Rights for All Hospital Patients,” November 17, 2010, www.hhs.gov/news/ press/2010pres/11/20101117a. html, accessed March 26, 2013.

2. U.S. Department of Health and Human Services, Office of Minority Health, “National Standards on Culturally and Linguistically Appropriate Services (CLAS),” http:// minorityhealth.hhs.gov/templates/ browse.aspx?lvl=2&lvlID=15, accessed March 25, 2013.

Second Opinion

Nursing: What It Was, What It Is, and Where It’s Going

BY DENISE GASALBERTI, PhD, RN

When Florence Nightingale wrote her book Notes on Nursing: What It Is and What It Is Not, the purpose was to assist any woman in the practice of nursing in the home and elsewhere. Although it was not specifically a manual for nurses, it provided a vivid description of the enormous weight and responsibility for nurses during the Victorian period. In the Victorian era, medicine and nursing were described as distinctly different in their functions. A strong emphasis on providing a healthy environment for the ill person was central to the profession of nursing. Adequate ventilation, clean water, warmth, noise control, adequate light, and control of waste and odor needed to be attended to so that patient healing would be possible.1 The practice of medicine during this time period involved focusing on the cure of disease and repair of the injured. It is said that Nightingale supported genderization in health care roles: men in medicine and women in nursing.2

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n the 1950s, the work of Hildegard Peplau highlighted the importance of nurse–patient communication and the significance of a therapeutic nurse–patient relationship. She believed that this relationship was central to all nursing activity with a patient.

Establishing an environment conducive to developing trust, and working on a health issue then moving toward independence are important steps in providing nursing care.3 Fast forward to the professional life of Martha Rogers (1914–1994), and note that by this time understanding and treating the “irreducible whole” person had become

of nursing focuses on people and the manifestations that emerge from a continuous mutual human and environmental process. The human being and the environment are “energy fields” and each field can be identified by pattern and

observed by manifestations.4 Fine-tuning the observation skills of the professional nurse were of the utmost importance in this system.

Strongly influenced by Martha Rogers was Margaret Newman. Margaret New-

man believed that the focus of nursing is not to correct what is wrong with the patient, but to attend to the process of health as expanding consciousness. This is a philosophy of “being with” as opposed to solely “doing for” the patient. Newman knew that people could be healthy in the midst of an illness because health and illness are manifestations of a greater whole. According to Newman, the nurse tends to the patient’s definition of health.5 This model is especially helpful when providing care to the dying patient and the patient with a progressive illness.

In the 21st century, today’s nurse is expected to know and incorporate all of what is known about nursing with

In the Victorian era, medicine and nursing were described as distinctly different in their functions. the realm of nursing. Every human being was viewed as a Unitary Being. According to Martha Rogers, the profession www.minoritynurse.com

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Second Opinion the addition of some responsibilities that have been traditionally viewed as the practice of medicine. Nurses with ad-

but it leaves young nurses to wonder about whether something larger is at work.

In the name of cost-effec-

In the 21st century, today’s nurse is expected to know and incorporate all of what is known about nursing with the addition of some responsibilities that have been traditionally viewed as the practice of medicine. vanced degrees are performing physical exams and writing prescriptions in numbers like never before. In the new health care environment, we can be sure that there will be greater numbers of people needing and requesting nursing services. Yet for the first time in years, new graduates are reporting difficulty finding their first job. The economy may have prevented the expected number of retirements in nursing,

tiveness, nurses wonder if we will be delegating much of what nursing has traditionally been to technicians and nurse-extenders because these workers are less expensive than the professional nurse. Should we be moving further from the bedside into supervisory roles for technicians and nurse-extenders as many nurses move into roles that fill the void in the system for primary health providers?

Nurses have always been a good value for the dollar. With a broad level of knowledge and expertise, nurses have been prepared to step up to additional responsibilities in the provision of health care while retaining the valuable skills necessary in meeting the needs of the whole human being. We must be able to spend time with our patients, interacting directly and observing firsthand. A patient should never feel rushed or as if imposing on the nurse’s time. Nurses must practice fully with reasonable workloads and adequate staffing. There is no substitute for the nurse.

The future of nursing is bright as we continue our mission as patient advocates and health care activists and providers. We must never tire of making our voices heard and continue to provide feedback as a new system is shaped and

refined. We must be active contributors every step of the way.

We have an important contribution to make!

Denise Gasalberti, PhD, RN, is an assistant professor at the Evelyn L. Spiro School of Nursing at Wagner College.

References 1. Nightingale F. Notes on nursing: what it is and what it is not. New York: Dover Publications; 1969.

2. Parker ME, Smith MC. Nursing theories and nursing practice.

3rd Ed. Philadelphia: F.A. Davis Company; 2010.

3. Peplau HF. Interpersonal relations: a theoretical framework for application in nursing practice.

Nurs Sci Q. 1992 Spring;5(1):13-8.

4. Malinski VM, Barrett, EA. Martha E. Rogers: her life and her work.

Philadelphia: F.A. Davis Company; 1994.

5. Newman MA. Transforming presence: the difference that nursing makes. Philadelphia: F.A. Davis Company; 2008.

For more than 160 years, nurses have enjoyed a rewarding career at Columbia St. Mary’s. That includes all the benefits of a strong, stable organization. But our nurses are also part of a team of healthcare providers who receive our full support in delivering the highest quality and most personal care to their patients. And that means we’re not the only ones showing our appreciation for a job well done.

How rewarding can it be to practice nursing at Columbia St. Mary’s? To begin to find out, visit p a s s i o n f o r p a t i e n t c a r e . o r g

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Minority Nurse | SUMMER 2013

Degrees of Success

Minority CRNAs and Student Registered Nurse Anesthetists: Soaring to New Heights with Doctoral Degrees

BY WALLENA GOULD, CRNA, EdD

So many are called, but only a few are chosen! You have finally made the decision to apply to a nurse anesthesia program. Before you start navigating any of the 113 accredited nurse anesthesia programs’ websites and firing up the search engines, you must be proactive in being well acquainted with the most updated Practice Doctorate Standards for Accreditation of Nurse Anesthesia Programs. These proposed changes will determine what doctorate degree will be awarded upon successful completion of a nurse anesthesia program.

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ow do you become a Certified Registered Nurse Anesthetist (CRNA)? In order to be a CRNA, you must graduate from a nurse anesthesia program accredited by the Council of Accreditation of Nurse Anesthesia Educational Programs (COA) and successfully pass the national certification examination administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).

Today, CRNAs are masters’ or doctorate-level advance practice registered nurses (APRNs).

Although there are many accredited nurse anesthesia programs offering master’s degrees—including Master of Science (MS), Master of Science in Nurse Anesthesia (MSNA), and Master of Science in Nursing (MSN)—you may consider applying to a nurse anesthesia program that offers a Doctor of Nursing Practice (DNP) or Doc-

tor of Nurse Anesthesia Practice (DNAP). Many nurse anesthesia programs are currently in transition into doctoral degree programs in nurse anesthesia.

It has been determined by the COA that, by 2025, all accredited nurse anesthesia programs will be mandated to offer a doctoral degree including DNP or DNAP. In addition, in June 2007, the American Association of Nurse Anesthetists (AANA) Board of Directors adopted a position statement on a proposed change for all nurse anesthesia programs to transition from master’s degree programs into doctorate degree programs by 2025. Nursing schools and allied health programs will award DNP and DNAP degrees upon completion of a capstone project and fulfilling the requirements of the nurse anesthesia curriculum.

AANA Chief Executive Officer, Wanda Wilson, CRNA, PhD,

stated, “to best position CRNAs to meet this challenge and remain leaders in anesthesia care, the AANA strongly supports doctoral education that encompasses technological and pharmaceutical advances, informatics, evidence-based practice, systems approaches to quality improvement, and other subjects that will shape the future for anesthesia providers and their patients.” Presently, many nurse anesthesia programs are hiring doctoral-prepared faculty and transitioning to the practice doctorate while others are still conferring master’s degrees.

Requirements for admission into a doctoral degree nurse anesthesia program include a bachelor’s degree in nursing or other appropriate baccalaureate degree; active RN licensure; a minimum of one to two years critical care experience; acceptable GRE and/or TOEFL; CCRN (preferred) scores (if applicable); a calculated GPA of 3.0 or higher; letters of references from nursing supervisors and/or colleagues; and a formal one-to-

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one panel intensive interview.

Most, if not all, doctoral nurse anesthesia programs require candidates to complete and implement a capstone project.

It is an evidence-based practice intensive written document that is subject to peer scrutiny and guidance approval by committee. In the DNP programs, your capstone project will be related to nurse anesthesia practice, leadership, or an education focus.

In the past five years, CRNAs with master’s degrees have been able to work and enroll in doctorate programs. Some of the CRNAs have completed a Doctor of Philosophy (PhD) and Doctor of Education (EdD) program that culminates in a dissertation and successful defense, while many have enrolled or been awarded a doctorate of nursing practice degree (DNP or DNAP). This article presents six distinct interviews of minority CRNAs with DNP degrees and student registered nurse anesthetists who are in pursuit of their doctorate in nursing practice.

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Degrees of Success The following interview was conducted with Wallena Gould, CRNA, EdD, and Dan Lovinaria, CRNA, MBA, DNP, the associate director of the University of Minnesota’s BSN-DNP nurse anesthesia program.

was your capstone project on as your research focus?

anesthesia program and for mentoring opportunities?

Lovinaria: “While practicing as a full-time CRNA at Fairview Southdale Hospital, I had decided to pursue my doctorate in nurse practice (DNP) at the University of Minnesota in Minneapolis and successfully obtained the DNAP in December 2008. My clinical capstone project was on the “Implementation of Perioperative Blood Glucose Protocol in Diabetic Patients Undergoing Cardiac Surgery.”

Lovinaria: “The BSN-DNP program is a 36-month program (9 semesters) full-time study. The Post-MS DNP can be earned in one academic year (3 semesters) as a full-time student, or in two academic years (6 semesters) as a part-time student.

It is important that registered nurses of color be proactive in exploring and searching the specific nurse anesthesia programs of interest, understanding its requirements, and being strategic by taking the opportunities to visit nurse anesthesia programs to meet program directors. As an associate program director of the BSNDNP nurse anesthesia program at University of Minnesota, I highly recommend prospective students participate in shadowing different clinical CRNAs to understand the profession and attending nurse anesthesia information sessions, including the well-organized and established Diversity in Nurse Anesthesia Mentorship Program held all over the country.”

Q

Dan Lovinaria, CRNA, MBA, DNP (Minnesota)

Q

Where did you obtain your MSNA?

Lovinaria: “I have been a registered nurse in Honolulu, Hawaii, since 1991 where I obtained my bachelor of science in nursing (BSN) at the University of Hawaii at Manoa.

While in Honolulu, Hawaii, I have worked in nurse specialties including rehabilitation, psychiatric, nursing home, risk management, telemetry, infection control, nursing staff education, and lastly, critical care nursing. After intensive exploration and understanding of the noble nurse anesthesia profession, I had decided to pursue my master in nurse anesthesia at St. Mary’s University of Minnesota and earned a certificate in nurse anesthesia at the Minneapolis School of Anesthesia in September 2000 and successfully obtained my master and certificate in December 2002.”

Q

Where did you obtain your DNP and what

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What is the DNP degree? What are the criteria for the nurse anesthesia program for the DNP at the University of Minnesota?

Lovinaria: “A DNP is one of the highest terminal professional degrees in nursing that primarily emphasizes on translating evidence rather than generating new evidence or research. The DNP curriculum generally includes advance practice, leadership, informatics, teaching, health policy, program evaluation, ethics, and more importantly, application of clinical research.

The DNP degree is to prepare registered nurses to become advance practice registered nurses, including: certified registered nurse anesthetist (CRNA), nurse practitioner (NP), certified nurse midwife (CNM), and clinical nurse specialist (CNS).”

Q

What is the length of the program for a DNP at the University of Minnesota nurse anesthesia program? Would you suggest nurses search online well in advance before applying to a nurse

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Q

How does a student find a research focus on their capstone project?

How is it different from a PhD dissertation?

Lovinaria: “DNP students learn about the components of the DNP scholarly leadership project by completing a series of three seminar didactic courses. Students complete the project-related clinical work and write their final DNP project paper under the direction of a faculty project director/ advisor during a series of three project direction practicum.

Students are expected to submit capstone project proposals as part of their application

packets. However, students also find generated evidence to translate into practice during their clinical rotation at various perioperative care settings.

A PhD dissertation is embodying results of original research and especially substantiating a specific view, whereas a DNP capstone project is translating evidence into clinical practice in ways that improve the quality and safety of patient care and outcomes, improve organizational systems, and processes.”

Q

What type of support is provided for a nurse anesthesia student enrolled in the DNP program at the University of Minnesota?

Lovinaria: “Upon start of the DNP program at the University of Minnesota, students are immediately assigned to a faculty advisor to help facilitate, guide, coach, and direct them to successful completion of the program. Students are required to meet with faculty advisor on an ongoing basis for guidance and support.”

Q

What opportunities exist for CRNAs with a DNP? Lovinaria: “CRNAs with DNP degrees will have opportunities to advance in various positions. DNP leads to degree parity with other health care professions and assist graduates to assume leadership roles in clinical practice including chief CRNAs, directors of nurse anesthesia, anesthesia program directors, clinical professors, and health care policymakers.”

Degrees of Success The following interview was conducted with Wallena Gould, CRNA, EdD, and Wonedwesson Goshu, CRNA, DNP, of Texas.

Wonedwesson Goshu, CRNA, DNP (Texas)

Q

Where did you obtain your MSNA?

Goshu: “I earned the Master of Science in Nursing Anesthesia at Saint Mary’s University of Minnesota, Minneapolis, in 2004. It was there that I was able to start building a network of fellow students, mentors, and professionals from the nursing industry to build upon both my education and experience as well as branch out into other areas of opportunity such as speaking engagements on a variety of topics related to obtaining a nursing degree, the anesthesia field, and DNP.”

Q

Where did you obtain your DNP and what was your capstone project on as your research focus?

Goshu: “I graduated from the DNP program at Rocky Mountain University of Health Professions in 2011. My capstone project described the level of Advanced Practice Nurse (APN) knowledge, awareness, and attitudes toward non-operating room (non-OR) timeout procedures before and after participation in an online educational

intervention. In this process, the researcher seeks to answer the following questions: (a) According to the literature, what is the current level of health care knowledge regarding non-OR timeout procedures? (b) What is the level of Advanced Practice Nurse (APN) knowledge, awareness, and attitudes toward non-operating room (non-OR) timeout procedures before and after participation in an online educational intervention and at a six-week follow-up?

Post-DNP, I have used my research in teaching and sharing my experiences with students and peers and it often proves very effective and invaluable to those seeking more information on what it is really like to pursue a DNP. By telling my personal story, I hope that men and women alike will realize that they too can reach these same goals.”

Q

What is the DNP degree?

Did you work while you were enrolled in the program?

Goshu: “A lot of organizations define what DNP is and I think my school website describes it well. In a nutshell, the Doctor of Nursing Practice (DNP) degree utilizes system redesign and evidence-based decisionmaking to implement their program, which effectively prepares advanced practice leaders to affect change in the health care industry, whether it be influencing health policies, social change and procedures, and more.

The setting provides its education through coursework, directed independent study, and capstone project implementation.

The DNP graduate is trained

to adapt to a variety of venues amongst diverse demographics.

Point of care is a major focus as is research, the pace of the industry and its demands, and the DNP program pinpoints the need for highly degreed individuals with a skillset and approach of leadership.

Social responsibility, consumer savvy, financial/clinical/political factor expertise, care model transformation—these are all study areas that the graduate becomes immersed in. There are so many more facets to it; I encourage anyone considering their DNP to research it further by looking online. I would also be happy to assist in any way I can to provide good information in a positive way because I believe in it wholeheartedly!

Yes, I worked full-time while attending school, which was hard at times, but well worth the effort. In hindsight, time management is the key to juggle family, work, and school under the pressure and I greatly benefitted from the experience and its challenges in many ways. It made me the person I am today and I am happy to share my story with those that are facing obstacles, searching for tools, and wanting to also share information.”

Q

Did you have any speaking engagements on your capstone topic at state and national nurse anesthesia association meetings?

Goshu: “In August 2012, I was fortunate to be one of the AANA Annual Meeting speakers in San Francisco to share my findings from my research and how to improve and implement timeout to improve patient safety. My title was ‘Time Out for Patient Time.’

I found the experience very

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positive in so many ways. It was invigorating to be able to share my story, experience, and my knowledge with so many industry professionals. I was blown away to find that my passion for the subject matter and the industry as a whole could be even more inspirational—to me and hopefully others—when I was able to interact with a large audience. Having enjoyed comedy my whole life, I felt as though I had discovered a way to educate and entertain while speaking on a topic I love and that total experience has led me to follow this journey through speaking engagements, and it has been awesome!”

Q

What opportunities exist for CRNAs with a DNP?

Goshu: “While attending the AANA meeting I was approached to apply for teaching positions. This is another example of the scope of opportunity available to CRNAs with a DNP. Remember, a DNP will implement evidence-based practice and policy strategies that optimize access to care and clinical outcomes. It prepares you for leadership roles in the nursing discipline itself, which reflects such rapid growth that this type of higher education is a benefit to nurses, doctors, and patients alike.

It has been my experience that the profession offers such diversity (Nurse Practitioner/ NP, Certified Registered Nurse Anesthetist/CRNA, Certified Nurse Midwife/CNM) and is employment-rich—job opportunities are abundant and equally diverse—that I am continually striving to learn more, set goals, teach, mentor, and better my knowledge base every chance I get. That included obtaining my DNP and I have

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Degrees of Success never regretted it.

Again, my passion for the industry has led me to speak out on the topic, especially to high school and college students, and I make myself available to do so at events, tradeshows, job fairs—even just corresponding to emails through my website.

CRNA is a career worth pursuing and a DNP can only enhance the experience.”

The following interview was conducted with Wallena Gould, CRNA, EdD, and Angella Jones, CRNA, DNP, of Michigan.

Q

What is the DNP degree?

Did you work while you were enrolled in the program?

Jones: “This degree is a practice doctorate. It is geared toward nursing clinicians performing as experts in their discipline.

Many other professions have made the practice doctorate entry level. These professions include: dentistry, medicine, podiatry, pharmacy, and physical therapy. This degree is the next step in the evolution of advanced practice nursing. I worked full-time during my DNP education. The programs are usually flexible, and they are geared toward the working student.”

nursing the opportunity to be in a more decision-making position and to have more control over our profession.”

The following interview was conducted with Wallena Gould, CRNA, EdD, and Kim Kimble, a student registered nurse anesthetist at Case Western Reserve University in Ohio.

What is your capstone interest in a DNP program?

Do you teach as a faculty member in a nurse anesthesia program?

Angella Jones, CRNA, DNP (Michigan)

Q

Where did you obtain your DNP?

Jones: “I received the DNP from Oakland University in 2011.

My capstone project was ‘Angiotensin Converting Enzyme Inhibitor Induced Angioedema in a Midwestern Hospital.’ I observed what appeared to be an unusual number of African American patients admitted with this life-threatening condition, although when researching, I found that much of the literature used the term ‘rare condition’ when describing it.

This piqued my interest and was the motivation for my capstone project.”

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Q

What opportunities exist for CRNAs with a DNP? And, why is it important to get a DNP? Jones: “The opportunities available for those obtaining the DNP are both personal and professional. Personally, there is immense satisfaction in furthering your nursing education and being viewed as an expert in the profession. Professionally, the DNP will allow nursing to be viewed as an expert discipline by other professions that require a clinical doctorate as entry level. This degree will allow nursing to play a bigger role in this dynamic health care environment. It will also allow

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Kimble: “Yes, prior to my acceptance into anesthesia school, I had the distinct pleasure of being mentored by two wonderful nurse anesthetists who are highly active within their state, national nurse anesthesia associations, and the Diversity in Nurse Anesthesia Mentorship Program. Dr. Wallena Gould, CRNA, EdD, and John Bing, CRNA, were instrumental in my admission into my first choice, Case Western Reserve University’s nurse anesthesia program.”

Q

Q

Jones: “I am a guest lecturer at University of Detroit Mercy in the anesthesia program and I am a full-time professor at South University. I teach advanced practice nursing students pharmacology, advanced pathophysiology, and advanced nursing practice.”

in the nurse anesthesia program at Case Western Reserve University?

Kim Kimble, SRNA (Case Western Reserve University Nurse Anesthesia Program) pictured with American Association Nurse Anesthetist (AANA) PresidentElect, Dennis Bless, CRNA, MS

Q

Where did you learn about nurse anesthesia?

Kimble: “I’ve wanted to go into health care since I can remember. I fell in love with nursing while in grade school after having surgery. Once I graduated from nursing school, I was drawn to the ICU because of the vigilance and critical thinking skills that were required to take care of the patients. Nurse anesthesia allowed for continuity of the passion I have for critical care.

But as an APRN, I will now have more autonomy in the care that I provide to my patients.”

Q

Were you mentored by any CRNAs prior to being accepted and enrolled

Kimble: “My capstone interest is how to successfully implement education on hypertension self-management in Medicaid patients.”

Q

Would you want to present your findings from your capstone project at a state and national nurse anesthesia association meeting?

Kimble: “Absolutely. Any research that may contribute to improvements in the patient care provided by nurse anesthetists should be shared. Also, I am the student representative for the Ohio State Association of Nurse Anesthetists and would like to prepare a formal presentation at the fall or spring meeting.”

Q

Why do you want to pursue the DNP degree upon graduating from the nurse anesthesia program?

Kimble: “Because our patient population is aging and disease processes are becoming more complex, there is an increas-

Degrees of Success ing educational expectation of health care professionals. I believe that doctoral preparation will ensure that I am well prepared to tackle our complex health care system. With a doctorate in nursing practice, I feel that I will be educationally equipped to implement scientific developments that will improve the safety, efficiency, and quality of patient care.”

The following interview was conducted with Wallena Gould, CRNA, EdD, and Daniel Vera, a student registered nurse anesthetist at the Inter-American University Puerto Rico.

Daniel Vera, SRNA (Inter-American University Puerto Rico Nurse Anesthesia Program)

Q

Where did you learn about nurse anesthesia?

Vera: “In 2001 I was given the opportunity to train as an Anesthesia Technician at a Hospital in Southern California.

At the time, I was not sure of what I wanted to study. It was then that I was introduced to the wonderful specialty of anesthesia. The hospital employed Certified Registered Nurse Anesthetists (CRNAs) in the operating room. The continuous care, compassion, knowledge, and enthusiasm of

the CRNAs were of great influence in my decision to obtain my Bachelor’s Degree in Nursing and pursue a Master’s in Anesthesia.”

national nurse anesthesia association meeting?

Q

Q

Were you mentored by any CRNAs prior to being accepted and enrolled in the nurse anesthesia program at Inter-American University of Puerto Rico?

Vera: “During the process of fulfilling the prerequisites of getting accepted into a nurse anesthesia program, I was introduced to you as the founder of the Diversity of Nurse Anesthesia Mentorship Program; you then became my mentor.

Thanks to your guidance, I completed a series of steps in order to make my resume more competitive upon applying to anesthesia programs. As my mentor, you were also a big part of my support system, intellectually and emotionally. I met minority CRNAs with DNPs and those who were enrolled, very motivating. You, Dr. Gould, helped me every step of the way to navigate through the process as a student nurse anesthetist at Inter-American University of Puerto Rico.”

Vera: “Yes, it would be my honor to present my findings to colleagues and peers.”

Why do you want to pursue the DNP degree upon graduating from the nurse anesthesia program?

Vera: “There are several reasons why anesthesia practitioners should obtain a Doctorate in Nursing Practice. In a few years from now, all the new graduates from nurse anesthesia programs will graduate with a Doctorate in Nursing Practice. I personally would like to become an instructor, educator, and mentor. I would like to transmit the passionate interest that I possess towards my profession to future students of different ethnicities.”

The following interview was conducted with Wallena Gould, CRNA, EdD, and Byron Anderson, a student registered nurse anesthetist at Arkansas State University.

Q

What is your capstone interest in a DNP program?

Vera: “While many issues have heightened my interest in nurse anesthesia practice, I would like to research the clinical significance of cricoid pressure during rapid sequence induction in patients at risk for aspiration.”

Q

Would you want to present your findings from your capstone project at a state and

Byron Anderson, SRNA (Arkansas State University Nurse Anesthesia Program)

Q

Where did you learn about nurse anesthesia?

Anderson: “I learned about

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nurse anesthesia from my Godmother Fay-Theresa Smith, who works at Our Lady of the Lake Regional Medical Center (OLOLRMC) in Baton Rouge, Louisiana. When I attended Southern University A&M College in Baton Rouge, Louisiana, I wasn’t sure what I wanted to major in. At first I decided to major in biology pre-medicine because it was something that I was familiar with. It was Momma Fay that had a long conversation with me and encouraged me to choose nursing as a career option. I immediately questioned her by asking, “What does a nurse do that would make me interested in selecting that as a major?” She responded by saying, “Nurse anesthetist, the most respected nurses in the hospital.” It was then that I began to research the career of advanced practice nurses that specialized in delivering safe anesthesia to millions of patients nationwide. I was so fascinated with CRNAs that I made a binder about all there was to know about this amazing profession. I unknowingly met my first CRNA when I was completing my OB rotation while pursing my BSN degree.

He attended Texas Christian University and assured me that nurse anesthesia provided both professional reward and personal satisfaction. After his confirmation, I set a goal of doing whatever was required of me to become a CRNA.”

Q

Were you mentored by any CRNAs prior to being accepted and enrolled in the nurse anesthesia program at Arkansas State University?

Anderson: “I was fortunate enough to be introduced to

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Degrees of Success the Diversity in Nursing Anesthesia Mentorship Program (DNAMP) by my colleague and friend Kim Andrews, CRNA, APRN, where we worked together in a level-one trauma center in downtown Atlanta, Georgia. I attended my first DNAMP meeting and simulation workshop in Baltimore at the University of Maryland where I met the founder, Dr. Lena Gould, CRNA, EdD, and John Bing Jr., CRNA. It was there that I was able to gain more insight about the admission process and true rigors of CRNA programs. I was so inspired that the following year I attended the DNAMP airway workshop at Thomas Jefferson University and the University of Pittsburgh. Afterwards, I shadowed Mr. Alan Williams, CRNA, at the VA Medical Center in Atlanta.”

Q

Q

What is your capstone interest in a DNP program?

Anderson: “My capstone interest in a DNP program will focus on CRNAs and pain management with advanced interventional techniques. In November 2012, The Centers of Medicare & Medicaid Services (CMS) approved a ruling to allow millions of Americans to have access to CRNAs and allow CRNAs to bill Medicare directly for performing chronic pain management services. This was a huge victory for CRNAs and the American Association of Nurse Anesthetists (AANA).

I am extremely interested in seeing an accredited and board-certified pain management fellowship program created specifically for CRNAs in the future. “

Who are the CRNA experts in that field and do you have access to them on your future capstone project for the DNP?

Anderson: “The experts in the field of pain management who I would want to learn more from are Arthur Zwerling, CRNA, DNP, DAAMP, and past-president of AANA Jackie Rowles, CRNA, MBA, FAAPM. I will seek their advice and hopefully they can serve on my doctoral committee.”

Q

Why do you want to pursue the DNP degree upon graduating from the nurse anesthesia program?

Anderson: “I want to pursue my DNP to become an expert in the field of anesthesia as an African American male. My goal is to one day have an in-

dependent pain management practice in an urban area. Furthermore, I plan on teaching students nationwide about advanced pain management techniques. I believe that the future is bright for advanced practice nurses. I look forward to the day when all of my colleagues will graduate with a terminal degree.”

Wallena Gould, CRNA, EdD, is an editorial advisory board member of Minority Nurse. She is the founder and chief executive officer of the Diversity in Nurse Anesthesia Mentorship Program

(www.diversitycrna.org) and the chief nurse anesthetist of Mainline Endoscopy Centers in Pennsylvania.

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What makes YNHH a destination for patients also attracts the most capable practitioners. If you’re ready to bring your best, join us at Yale-New Haven Hospital. EOE

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Minority Nurse | SUMMER 2013

Our growth has generated the following opportunities: • Education • Management/Leadership • Staff Nurses • Advanced Practice Full and part-time positions available. To learn more, call us toll free at 866-811-7797, or visit our career site at: ynhhcareers.org

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Degrees of Success

More Men in Nursing: Strategies for Support and Success

BY JUNE R. SOTO, MA.Ed, APRN

Community colleges are experiencing an increase in the number of men pursuing nursing as a career choice. The National League for Nursing’s Annual Survey of Schools of Nursing for the 2010-2011 academic year indicated that 15% of associate degree students were males.

At 15%, men enrolled in basic RN programs remained at the historic high reached at the beginning of the current economic recession. Across all levels of nursing education, approximately one in seven nursing students was male in 2011. This represents a 2% increase in the male student population since 2010.1 These statistics are encouraging and provide a possible solution to the worldwide nursing shortage.

F

rom Fall 2001 until Fall 2012, the Borough of Manhattan Community College (BMCC) enrolled 504 male nurses in their associate degree program.

This increase in the number of male students has provided impetus for further examination of the reasons why more men are pursuing nursing as a career in the 21st century, and what faculty can do to support and facilitate the integration, progression, and success of male students in nursing programs.

A structured survey consisting of 10 key questions was sent to 68 male students currently enrolled in the associate degree nursing program at BMCC. The survey questions were framed from general to specific in order to draw conclusions. A total of 52% responded and provided answers to questions such as: • The motivating factors for deciding on a career in nursing;

• Influencing factors, such as type of work in the military and their decision to enter the health care field; • Personal reasons for choosing nursing, such as: job stability, better pay, career flexibility, and opportunity for advancement; • Work placement preference after graduation; • Resources that would be most beneficial to their success in nursing programs.

than nursing; and 25% had a bachelor’s degree from a field other than nursing. Seventy percent (70%) had no previous health care experience. And 87% had no military medic background.

The second half of the survey focused on male students’ view of their place in nursing.

Categories ranged from strongly disagree to strongly agree.

Findings indicated that 70% of respondents expressed a desire to help others; 66% of male

specialized areas. These findings confirm the literature’s viewpoint that most male nurses tend to gravitate toward specialty areas.

Results of the last area of the study addressed the importance of having adequate resources to facilitate progression and positive outcome for male students.

Most respondents felt that career counseling/internships (80%), academic tutoring in nursing content (74%), faculty mentoring (65%), personal counseling

It’s a Man’s Opinion Results of the first half of the survey have shed light on male student nurses’ view of their place and future in the profession. Demographic data related to male students indicated that 54% of respondents were in an age group of 35 to 44. Seventy-five percent (75%) of male students entered nursing after another career; 33% of male students had an associate degree in a field other

This increase in the number of male students has provided impetus for further examination of the reasons why more men are pursuing nursing as a career in the 21st century, and what faculty can do to support and facilitate the integration, progression, and success of male students in nursing programs. students had no knowledge about the history of men in nursing; and 45% believed that male nurses choose to work in

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(60%), and financial aid (60%) would be beneficial to students’ progression and success in the nursing program.

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Degrees of Success Career Counseling/ Internships Career counseling is abundant in most colleges and universities, primarily for retail industries. Counseling for nursing students, however, focuses on how students can best prepare for graduating, passing the NCLEX exams, and achieving licensure.

With a drastic change in today’s economy, health care institutions have felt compelled to focus on creative ways of meeting staffing needs and cutting costs for orientating new graduates once hired. Due to the economic recession, nursing jobs are more difficult to secure. In addition, most hospitals require at least one year of bedside nursing experience before hiring a new graduate.

How will a new graduate acquire the experience necessary to land a job? The American Association of Colleges of Nursing reported that 88% of graduates from baccalaureate programs had jobs within six month of graduation.2 However, associate degree program graduates are not as fortunate.

In order to adequately prepare for the workforce, associate degree graduates are counseled on the need to continue their education and to participate in an internship program during their final year of school or an externship program after graduation.

Colleges often apply for and receive grants in collaboration with hospitals to provide externship programs that will facilitate training and mentorship for new graduates. Most programs are limited to 10–15 students, depending on the cost for six weeks of training and mentorship. In this program, students are often given

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additional training in EKG, venipunctures, and physical assessment skills. Students must successfully complete the training program, at which time they receive job placement either at the institution of training or a sister institution within the same conglomerate.

Most faculty in nursing programs serve as counselors to nursing students and have an ongoing relationship with health care institutions to pro-

who are relaxed and adequately prepare perform better on exams. At BMCC, tutoring is offered each semester for all nursing students. A schedule is usually posted outside the tutoring room so students can plan to receive extra help with course content. At times, students who lag behind are placed with the more outstanding students in study groups, which form a basis of support for struggling students.

With a drastic change in today’s economy, health care institutions have felt compelled to focus on creative ways of meeting staffing needs and cutting costs for orientating new graduates once hired. vide internships, externships, or volunteer residency programs. In these programs, students acquire more hands-on experience, which tend to be limited during the school year.

All students, regardless of gender, receive career counseling and the opportunity to apply for internships or externships during the summer months.

Students are also counseled to continue their nursing education, whether from an ADN-to-BSN or a BSN-to-MSN program. Most colleges and universities offer a free NCLEX review course to prepare students for the licensure exam.

This serves as a win-win situation for students since most public colleges, including the City University of New York, pay for the cost for the threeday review session.

Tutoring in Nursing Content Tutoring, mentorship, meditation, and relaxation have been categorized as stress-reducing resources that can be offered to students.3 Students

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Additionally, course faculty is available during office hours to clarify content and to discuss any issue students may have.

Male students are informed of the availability of a male faculty mentor, if they so desire to meet with him instead. Tutoring is also available through the etutor website. Students follow specific guidelines for submitting electronic questions and are required to be specific as to what help they need. Communication via e-tutor requires students to convey information such as assignment, textbook, edition, page number, and any other relevant materials that will help facilitate the process.

Students provide a valid email address for ongoing communication and feedback.

Mentoring Opportunities Addressing the need for faculty mentoring of male students focuses on the benefit of having professional role models. Ideally, male faculty can fulfill this role. However, only about 5% of full-time teachers

in nursing school today are men.4 One strategy that could provide mentorship for male students is to pair male students with male graduates of the program. For example, the American Assembly for Men in Nursing (AAMN) has initiated a chapter within the greater New York area aimed at providing networking and collaboration among the 17 colleges within the City University system. In other colleges and universities, developing bonds with nontraditional older male student mentors via establishment of mentorship programs is another means to foster a supportive environment for male nursing students.

Personal Counseling Schools of nursing should readily refer male students to counselors to discuss problems that may impinge upon their educational experience.

It’s preferable to assign a male counselor who can relate to the student’s issues. Faculty should look for red flags that may indicate a student’s need for counseling referral or a need for help with problemsolving issues. Implementation of counseling should be done early in the semester when problems first surface to avoid a point-of-no-return situation.

The lead faculty could meet individually with the student after the first exam if the student does not pass, and the student can be given a choice to discuss the issue at hand with the faculty or see a counselor. The student should also be asked if they would prefer a male or female counselor.

Financial Aid Obtaining a nursing education is expensive. The average

Degrees of Success annual cost for tuition, room, and board for the 2010-2011 academic year ranged from $8,085 at public two-year colleges to $32,617 at private fouryear universities.5 This does not include the cost of books, lab fees, equipment, and supplies.

Additional expenses may include uniform, transportation to and from school, testing,

to learn. One such example is the maternal–child clinical rotation. Research suggests that male students are uncomfortable and have feelings of not knowing what to expect in the postpartum area. A beneficial strategy by faculty that could mitigate the situation is first being cognizant of students’ feelings and identifying male

Implementation of counseling should be done early in the semester when problems first surface to avoid a point-of-no-return situation. and malpractice insurance fees.

Financial concerns are some of the main reasons students struggle in or leave school. Students often are able to qualify for work-study, which provides extra cash for personal expenses. It is also possible to apply for grants and scholarships to offset the cost of tuition. Overall, some means of financing a nursing education is always available whether through state or federal funding. From time to time, small nursing incentive scholarships become available as well, which serves as additive means for helping students through a financial crunch.

Where Do We Go From Here?

A review of the literature has pointed to other areas in which faculty can have significant input in changing the culture of indifference towards male students in nursing programs. One such area is in the planning of clinical rotation experiences.

Male students often begin their clinical rotation eager to apply theoretical concepts to clinical learning experiences. Sometimes, however, their emotions may overshadow their ability

students’ concerns before starting the clinical rotation in any setting.

Male students may also have difficulty with the concept of caring and expressing emotion. Use of vernacular, which is broad and encompassing, would challenge misconceptions of male nurses as non-caring providers. Encouraging the use of gender-neutral language during discussions of concepts around caring would be beneficial to male students.6 Faculty can recognize that male students are able to demonstrate caring in a different way, such as touching a patient’s shoulder and providing words of encouragement—and they could show the same act of caring as holding a patient’s hand, which is so often done by female nurses.

A 2005 study published in the National Student Nurses’ Association’s magazine, Imprint, indicated that men considered nursing a “calling” and that they enjoyed “making a difference.” BMCC’s recent survey reveals similar findings. Clearly, there is a need for a change in faculty perspective of male students in nursing programs.

Addressing the needs of male

students calls for implementation of strategies that promote diversity and integration within the profession. There also must be a challenge to the public’s perceptions of males in nursing that create barriers for male students. Nursing leaders and administrators need to implement recruitment strategies that emphasize gender and racial diversity in brochures, nursing magazines, billboards, as well as in the media.7 Just as historically traditional male professions— such as medicine and law—have been altered over time by the entry of women and minorities, integrating more men into nursing programs allows the profession to proactively address the problem of gender imbalance within nursing.

4. National League for Nursing.

(2011). Re health affairs and the nurse educator shortage. Retrieved from http://www.nln.org/aboutnln/ blast/blast_health_affairs_response.htm 5. U.S. Department of Education, National Center for Education Statistics. (2012). Digest of Education Statistics, 2011 (NCES 2012-001), Chapter 3. Retrieved from http:// nces.ed.gov/fastfacts/display. asp?id=76.

6. Patterson J, Morin KH (2002) Perceptions of the maternal-child clinical rotation: The male student nurse experience. Journal Nursing Education 41, 266-272.

7. Roth, JE, Roth, Coleman CL. (2008) Perceived and real barriers for men entering nursing: Implications for gender diversity, Journal of Cultural Diversity 15, 148-152.

June R. Soto, MA.Ed, APRN, is an assistant professor and lead faculty of medical-surgical nursing at the Borough of Manhattan Community College.

References 1. Kaufman, KA. Findings from the Annual Survey of Schools of Nursing Academic Year 2010-2011.

National League for Nursing. June 2012. www.nln.org/researchgrants/ slides/exec_summary_1011.pdf.

2. American Association of Colleges of Nursing. Employment of New Nurse Graduates and Employer Preferences for BaccalaureatePrepared Nurses. Research Brief. October 2011. http:// www.aacn.nche.edu/ leading_initiatives_news/ news/2011/employment11 3. Moscaritolo LM. (2009) Interventional Strategies to decrease nursing student anxiety in the clinical learning environment. Journal of Nursing Education 48, 17-23.

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Academic Opportunities

UC Davis offers new degrees The Betty Irene Moore School of Nursing at UC Davis — a new nursing school with a vision to advance health and ignite leadership through innovative education, transformative research and bold system change.

Distance Education from the Birthplace of Nurse-Midwifery and Family Nursing in America

Become a...

• Nurse-Midwife • Family Nurse Practitioner • Women’s Health Care Nurse Practitioner

for Master of Science for nurse practitioners and Master of Health Services physician assistants.

APPLICATIONS NOW OPEN FOR 2014

Complete your coursework and clinical work in your own community

M.S. — LEADERSHIP AND PH.D. interprofessional Nursing Science and Health-Care Leadership Degree program applications open October 2013 for fall 2014.

Admission is competitive and space is limited!

nursing.ucdavis.edu

Distance education options: • Doctor of Nursing Practice (DNP) - new in • Post-Master’s Doctor of Nursing Practice (DNP) • Master of Science in Nursing (MSN) • Bridge Option for ADNs • Post-Master’s Certificates

BET T Y IRENE MOORE SCHOOL OF NURSIN G Scan this code to learn more

www.frontier.edu/mn

Explore the possibilities...Online at the Johns Hopkins University School of Nursing Applied Health Informatics Forensic Nursing Clinical Nurse Specialist Health Systems Management Nurse Educator

www.nursing.jhu.edu/online

525 N.Wolfe St.

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Minority Nurse | SUMMER 2013

The Johns Hopkins University School of Nursing—A place where exceptional people discover possibilities that forever change their lives and the world.

Baltimore, MD 21205

410.955.7548

Academic Opportunities

Ranked 9th in U.S. News & World Reports 2013 Best Online Programs and 7th in their 2011 America’s Best Graduate Schools, the most recent issue ranking schools of nursing.

Earn a Jefferson Nursing Degree, Achieve a Jefferson Reputation RN-BSN: online or online/on campus MSN: multiple specialties; core/support courses online; clinical courses on campus; distance education via live webcasting DNP: online, may complete in 2 to 5 years

MSN, DNP, or PhD

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

1-877-533-3247 explore.jefferson.edu/MinorityNurse

School of Nursing

Philadelphia, PA

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

1-888-747-0794 THOMAS JEFFERSON UNIVERSITY www.minoritynurse.com

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Academic Opportunities

UNIVERSITY OF SOUTH ALABAMA COLLEGE OF NURSING

Master of Science in Nursing NURSING INFORMATICS ONLINE PROGRAM Earn a Master of Science in Nursing by completing this web-based Nursing Informatics program. The Nursing Informatics program is designed to provide nurses with the necessary knowledge and skills to enhance the quality of patient care and outcomes through the development, implementation, and evaluation of health information management tools and systems.

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

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

For further information on the Nursing Informatics Track, contact Dr. Todd Harlan, Nursing Informatics Track Coordinator by email at tharlan@usouthal.edu.

DESIGN YOUR EDUCATION

ADVANCE YOUR CAREER Our flexible, self-paced nursing programs are designed to advance clinical expertise, technological competence, and professional leadership. Our offerings include: • MSN

• RN-BSN

• Graduate Nursing Certificate Programs

• RN-BSN/MSN

Design Your Education Accelerate degree completion; ask about generous credit transfer and demonstration of college-level knowledge earned outside the classroom. Choose from convenient, state-of-the-art learning opportunities.

Thomas Edison State College is one of the 12 senior public colleges and universities in New Jersey, and is accredited by the Middle States Commission on Higher Education, 3624 Market Street, Philadelphia, PA 19104 (267-284-5000).

All nursing programs are accredited. For specific accreditation information, please visit the nursing webpage at www.tesc.edu/nursing.

Apply Now! Learn more at www.tesc.edu/nursing, or call 866.540.9378.

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Minority Nurse | SUMMER 2013

Academic Opportunities

A

s you are probably aware, the demand for nurses continues to skyrocket. What you may not know is that there’s also a critical need for nurses with advanced degrees, as hospitals turn to nurses to fill more administrative and leadership roles.

Nursing schools around the country are jumping at the chance to fill this void by offering flexible Master of Science in Nursing and Doctor of Nursing Practice programs, and you’ll find many great examples in the following pages.

There truly has never been a better time to pursue an advanced nursing degree. Be sure to secure your spot in the program— and your financial aid—by applying early.

Global Disaster Nursing MSN, DNP, & PhD Post-Master’s Certificate

Preparing nurse leaders for practice, policy, and scholarship Competency-based curriculum combines classroom learning, simulation exercises, and fieldwork for exceptional hands-on training opportunities and global perspective.

Coursework in: * Natural & Man-Made Disasters * Public Health Emergencies * Humanitarian Relief * Domestic & International Response * Crisis Management & Leadership

Now Accepting Applications Distance Learning Available

Speraw

For more information: CONgrad@utk.edu (865) 974-7586 http://nursing.utk.edu

Speraw

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Academic Opportunities

Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico

Do you know how to research and advocate for policies that can help address the nation’s health and health care challenges?

Our nursing and health policy fellows do.

The Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico College of Nursing is preparing a new generation of PhD nurse leaders to help reshape the nation’s health policies and practices. The nurses who complete the fellowship are highly educated and well prepared to conduct groundbreaking research and analysis, develop innovative new policies,

RWJF NHPC Ad 7x4.5 121121.indd 3

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Minority Nurse | SUMMER 2013

and become powerful advocates to improve care, especially for those in underserved communities.

The program is open to candidates with either BSN degrees or MSN degrees who are interested in pursuing a PhD.

In partnership with the University of New Mexico College of Nursing and its PhD in Nursing program, fellows complete a course of study that includes a health policy concentration as part of their PhD in Nursing studies. We offer a generous package of financial support, including full tuition, stipends, and fee coverage.

The deadline for applications is November 15, 2013. To apply, visit http://nursinghealthpolicy.org/#apply.

Learn more about the RWJF Nursing and Health Policy Collaborative at UNM at www.nursinghealthpolicy.org or email con-rwjf@salud.unm.edu.

11/29/12 1:19 PM

Faculty Opportunities

Effecting healthcare through education is at the core of Concorde Career Colleges. As a premier education system, focusing on healthcare, we provide students of diverse backgrounds an opportunity to contribute and excel in a growing industry. Our student’s success can be attributed to our educators, who provide knowledge, experience, and support through their educational journey.

We have numerous nursing opportunities for dedicated and compassionate teachers at campuses across the country.

California Colorado Florida

Missouri (Kansas City) Texas Tennessee

Our employees enjoy a comprehensive benefits package that includes Medical/ Dental/Vision, 401K plan, paid holidays, vacation time, and educational reimbursements.

To view all openings at Concorde and to apply, visit: jobs.concorde.edu

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Faculty Opportunities

LOOKING FOR THE BEST LOOK NO NURSES? FURTHER.

Index of Advertisers ADVERTISER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE # Bridgeport Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Children’s Hospital of Philadelphia . . . . . . . . . . . . . . . . . 34 Columbia St. Mary’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Roper St. Francis Healthcare . . . . . . . . . . . . . . . . . . . . . 16

ACADEMIC AND FACULTY OPPORTUNITIES Faculty Postings Academic Profiles

Banners and Print/Web Combos E-Newsletter Sponsorships

For rates and discount information, contact Peter Fuhrman Address: 49 Foy Drive Hamilton Square, NJ 08690 E-mail: PFuhrman@SpringerPub.com Phone: 609-689-1033 Fax: 609-689-1034

University of Connecticut Health Center. . . . . . . . . . . . . 11 U.S. Navy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4 Yale-New Haven Hospital . . . . . . . . . . . . . . . . . . . . . . . . 46

ACADEMIC OPPORTUNITIES . . . . . . . . . . . . . . . . . . . . . PAGE # Frontier Nursing University. . . . . . . . . . . . . . . . . . . . . . . 50 Johns Hopkins University . . . . . . . . . . . . . . . . . . . . . . . . 50 Oakland University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Thomas Edison State College . . . . . . . . . . . . . . . . . . . . . 52

Invites Applications for the Tenet HealthSystem/Jo Ellen Smith, BSN

Endowed Chair of Nursing

​The LSU Health Sciences Center, School of Nursing, Tenet

HealthSystem/Jo Ellen Smith, BSN Chair of Nursing focuses on research and scholarly endeavors. This noted researcher and scholar will have the opportunity to engage in collaborative research within LSUHSC and the hospitals comprising the LSU Health Care Services Division to conduct clinical nursing and interprofessional research.

These research findings are expected to support state-of-the-science clinical nursing practice and mission of the School of Nursing. ​Become part of the dynamic efforts to re-envision nursing and health care in Louisiana. This Endowed Chair of Nursing will provide research leadership to improve healthcare in a post-Katrina environment still recovering from damage. The Endowed Chair, working closely with nursing faculty and partnering with area and system hospitals, will establish programs of study that are inclusive of the vulnerable groups represented in this underserved and medically needy area. We invite you to be a force of change and growth, contributing to

Return, Rebuild, Renew New Orleans

Forward letter of interest and CV to: Dr. Demetrius Porche, Dean, electronically to: NSapply@lsuhsc.edu.

Thomas Jefferson University . . . . . . . . . . . . . . . . . . . . . 51 University at Buffalo . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 University of California, Davis. . . . . . . . . . . . . . . . . . . . . 50 University of New Mexico . . . . . . . . . . . . . . . . . . . . . . . . 54 University of Pittsburgh . . . . . . . . . . . . . . . . . . . . . . . . . 51 University of South Alabama. . . . . . . . . . . . . . . . . . . . . . 52 University of Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . 53

FACULTY OPPORTUNITIES . . . . . . . . . . . . . . . . . . . . . . . PAGE # Concorde Career College . . . . . . . . . . . . . . . . . . . . . . . . 55 LSU Health Sciences Center . . . . . . . . . . . . . . . . . . . . . . 56

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Minority Nurse | SUMMER 2013

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