Minority Nurse Summer 2018 Issue

The Career and Education Resource for the Minority Nursing Professional • SUMMER 2018

Salary Survey Issue Annual

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The Art of Negotiation BILINGUAL NURSES STAYING AT THE BEDSIDE

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Table of Contents

In This Issue 3

Editor’s Notebook

4

Vital Signs

7

Making Rounds

43

The Funny Bone

Academic Forum 29 Microaggressions in the Nursing Classroom Environment

By Andrea Doctor, MSN, RN, CCRN, CCRC

Cover Story 12 2018 Annual Salary Survey

By Ciara Curtin Find out which types of nurses fared best (and worst) in our latest survey

Features 8 Getting to Yes: The Art of Negotiation for Nurses

By Jebra Turner

Learn how to promote safe learning in a multicultural setting

Feeling underpaid? Learn how to negotiate effectively and finally get that raise

Second Opinion 31 Standing Up for the Right to Be Ourselves, Part Two

18 The True Nursing Epidemic: Getting Nurses to Stay at the Bedside

By Spencer Miller, RN

By Lynda Lampert, RN

A gay male nurse shares his views on what’s changed over the last decade

Degrees of Success 33

Single Motherhood in Academia

By Miriam O. Ezenwa, PhD, RN

This single mom proves that a work/life balance is possible

Health Policy 37 From Public Health Advisor to Congressional Candidate: An Interview with Lauren Underwood

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By Janice M. Phillips, PhD, FAAN, RN

A n interview with an inspiring nurse looking to challenge the status quo in Congress

Minority Nurse | SUMMER 2018

Find out the four common reasons nurses leave the bedside and some possible counter strategies to help retain them

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The Growing Need for Bilingual Nurses

By Michele Wojciechowski With one in five U.S. households speaking a language other than English at home, it’s more important than ever to be bilingual

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Time to Stand Up

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ith gender inequality still being an issue and nursing being predominantly female, it’s no surprise that we have our work cut out for us. With that in mind, we run our salary survey each year to help you level the playing field just a bit more. Check out the latest results on page 14 and see where you stand.

Once you know your worth, how can you make it a reality? Research shows that women are more apprehensive about negotiating salaries than men, but it’s important for all nurses to learn this essential life skill. Jebra Turner interviews negotiation experts to help you get that “yes” (page 9).

Because nurses are often underpaid and overworked, they are left feeling overwhelmed and undervalued. Unfortunately, this leads to many leaving the bedside.

Lynda Lampert investigates the reasons nurses decide to leave and offers solutions for retaining them going forward (page 20).

Imagine what it’s like to be hospitalized in a country where you know little of the language, and you’ll understand why it’s more important than ever for U.S. nurses to be bilingual. Michele Wojciechowski explores how learning another language can help you better serve your community—and make you more marketable (page 24).

It can be a challenge for nurse educators to promote safe learning in a diverse classroom, especially in our current political climate. Andrea Doctor describes some of the common occurrences and what educators can do to help create an inclusive environment (page 31).

Nearly a decade ago, Spencer Miller wrote an article in Minority Nurse regarding whether it was okay to be “out” at work. In this issue, he reflects on the progress we’ve made on LGBTQ issues since then and stresses the importance of being yourself no matter how you identify (page 33).

Are you interested in the academic career track but having doubts about whether you can have a proper work/life balance? Miriam Ezenwa is living proof that it’s possible to have your cake and eat it too—with the right kind of support. She shares her doubts and successes about her choice to become a single mother while working in academia (page 35).

Like most of us, Lauren Underwood is fed up with politicians lying to their constituents. Unlike most, she is turning her frustration into an opportunity to make a difference and is running for Congress. Janice Phillips interviews Underwood about her decision to run and what she hopes to achieve if she wins (page 39).

It can be tough to remain hopeful in a sea of negativity, but nurses have a unique opportunity to be a shining beacon of light—and I have faith that they will continue to advocate for what’s right for all of us.

—Megan Larkin

SPRINGER PUBLISHING COMPANY

CEO & Publisher Mary Gatsch Vice President & CFO Jeffrey Meltzer

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Digital Media Manager Andrew Bennie Minority Nurse National Sales Manager Andrew Bennie 212-845-9933 abennie@springerpub.com Minority Nurse Editorial Advisory Board Anabell Castro Thompson, MSN, APRN, ANP-C, FAAN President National Association of Hispanic Nurses Birthale Archie, DNP, BS, RN Faculty Davenport University Iluminada C. Jurado, MSN, RN, CNN Chair, Scholarship Committee Philippine Nurses Association of America Martha A. Dawson, DNP, RN, FACHE Assistant Professor, Family, Community & Health Systems University of Alabama at Birmingham Wallena Gould, CRNA, EdD, FAAN Founder and Chair Diversity in Nurse Anesthesia Mentorship Program Romeatrius Nicole Moss, RN, MSN, APHN-BC, DNP Founder and President Black Nurses Rock Varsha Singh, RN, MSN, APN PR Chair National Association of Indian Nurses of America Debra A. Toney, PhD, RN, FAAN Director of Quality Management Nevada Health Centers

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

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

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Vital Signs

Germs with Unusual Antibiotic Resistance Widespread in United States

Health departments working with CDC’s Antibiotic Resistance Lab Network found more than 220 instances of germs with “unusual” antibiotic resistance genes in the United States last year, according to a CDC Vital Signs report.

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erms with unusual resistance include those that ­cannot be killed by all or most antibiotics, are uncommon in a geographic area or the United States, or have specific genes that allow them to spread their resistance to other germs.

Rapid identification of the new or rare threats is the critical first step in CDC’s containment strategy to stop the spread of antibiotic resistance (AR). When a germ with unusual resistance is detected, facilities can quickly isolate patients and begin aggressive infection control and screening actions to discover, reduce, and

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stop transmission to others.

“CDC’s study found several dangerous pathogens, hiding in plain sight, that can cause infections that are difficult or impossible to treat,” says CDC Principal Deputy Director Anne Schuchat, MD. “It’s reassuring to see that state and local experts, using our containment strategy, identified and stopped these resistant bacteria before they had the opportunity to spread.”

New strategy stops resistant bugs before they spread widely The CDC containment strategy calls for rapid

Minority Nurse | SUMMER 2018

i­dentification of resistance, infection control assessments, testing patients without symptoms who may carry and spread the germ, and continued infection control assessments until spread is stopped.

The strategy requires a coordinated response among health care facilities, labs, health departments, and CDC through the AR Lab ­Network. Health departments using the approach have conducted infection control a ­ ssessments and colonization screenings within 48 hours of finding unusual resistance and have reported no further transmission during follow-up over several weeks.

The strategy complements foundational CDC efforts, including improving antibiotic use and preventing new infections, and builds on existing detection and response infrastructure. New data suggest

that the containment strategy can prevent ­thousands of difficult-to-treat or potentially untreatable infections, ­including high-priority threats such as Candida auris and ­carbapenem-resistant ­Enterobacteriaceae (CRE).

Germs will continuously find ways to resist new and existing antibiotics; stopping new resistance from developing is not currently possible.

Recent, nationwide infrastructure investments in laboratories, infection control, and r­esponse are enabling tailored, rapid, and aggressive investigations to keep resistance from spreading in health care settings.

Other study findings showed: • One in four germ samples sent to the AR Lab Network for testing had a special gene that allow them to spread their resistance to other germs.

• Further investigation in facilities with unusual resistance revealed that about one in 10 screening tests, from patients without symptoms, identified a hard-to-treat germ that spreads easily.

This means the germ could have spread undetected in that health care facility.

• For CRE alone, estimates show that the containment strategy would prevent as many as 1,600 new infections in three years in a single state—a 76% reduction.

To read more about the ­containment strategy and the entire Vital Signs report, visit www.cdc.gov/vitalsigns/containing-unusual-resistance.

Vital Signs

The Joint Commission Issues New Sentinel Event Alert on Violence against Health Care Workers Workplace violence includes not only events involving active shooters or physical violence that make the news, but also everyday occurrences, such as verbal abuse, which are often overlooked. In health care, violence is especially prevalent—health care workers are four times more likely to be victimized than workers in private industry.

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n response, The Joint Commission issued a new Sentinel Event Alert during Workplace Violence Awareness Month to help health care workers in hospitals and other health care settings recognize violence from patients and visitors, become prepared to handle it, and more effectively address the aftermath.

Contributing factors associated with perpetrators of ­violence in health care include an altered mental status or mental illness, patients in police custody, long wait times or crowding, being given “bad news” about a diagnosis, gang activity, domestic disputes among patients or visitors, and the presence of firearms or other weapons. To help address these contributing factors, the alert provides seven actions suggested by The Joint Commission: • Clearly define workplace violence and put systems in place across the organization that enable staff to report workplace violence instances, including verbal abuse.

• Recognizing that data come from several sources,

capture, track, and trend all reports of workplace ­violence—including verbal abuse and attempted assaults when no harm occurred, but in which the health care worker feels unsafe.

• Provide appropriate followup and support to victims, witnesses, and others affected by workplace violence, ­i ncluding psychological counseling and trauma-

informed care if necessary.

• Review each case of workplace violence to determine contributing factors. Analyze data related to workplace violence, and worksite conditions, to determine priority situations for interventions.

• Develop quality improvement initiatives to reduce incidents of workplace violence.

• Train all staff, including security, in de-escalation, self-defense, and response to emergency codes.

• Evaluate workplace violence reduction initiatives.

“Leadership needs to make the safety of health care workers a top priority and encourage candor in reporting. Health care workers are often hesitant to report violence because they think that it is part of the job or believe that patients are not responsible for their actions,” says Ana Pujols McKee, MD, executive vice president and chief medical officer, The Joint Commission.

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“When violence occurs, it should be immediately reported to leadership, internal security and, as needed, to law enforcement. Such reporting can help health care organizations analyze what happened and inform actions that need to be taken to minimize risk in the future.”

The alert provides The Joint Commission’s related standards, references, and resources—including those from the Occupational Safety and Health Administration, Crisis Prevention Institute, Centers for Disease Control and Prevention, and Centers for Medicare & Medicaid Services. An accompanying downloadable infographic also is available for health care organizations to print and share at their facilities.

The Sentinel Event Alert and infographic are available on The Joint Commission website.

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Vital Signs

Study Finds Blacks and Whites Differ in Their Willingness to Participate in Health Research Studies Racial and ethnic minorities, especially African Americans, are significantly less likely to participate in health-related research than whites, says a new study from Ball State University.

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his impedes the testing, development, implementation, and evaluation of various clinical and community-based disease prevention and health promotion interventions, says Jagdish Khubchandani, a community health education professor at Ball State University and the author of the study, “Black–White Differences in Willingness to Participate and Perceptions about Health Research.”

The research, which was recently published in Journal of Immigrant and Minority Health, examines health research participation history and willingness to participate.

“According to the findings, lesser-educated, older, and male African Americans are less likely to participate in health research studies,” ­Khubchandani says. “It could be possible that this generation of older African American males still experiences prejudice or is highly aware of the past exploitation of racial and ethnic m ­ inorities in health care research and health care systems.”

Researchers found that about 15% of African American respondents have participated in a health research study and 48% would participate in a health research study if invited. While more than a fifth of whites (23%) have partici-

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pated in a study, the majority would like to participate if invited (57%).

“Trust building should be a key component of healthcare professional training and practice,” says Khubchandani.

“If individuals do not want to participate in health research studies, it becomes difficult to find better care or disease prevention methods.”

Community members ages 18 years or older enrolled in Health Street, an innova-

Minority Nurse | SUMMER 2018

tive community engagement ­research program, comprised the source of the study population. A total of 7,809 community members (58.6% females) participated in the study with 65.8% African Americans and 34.2% whites.

The study also found: • Older African American males with lower education are the least likely to participate in health research studies.

• The amount of fair compensation desired by ­African Americans to participate in health research studies was two times higher than whites.

• Individuals who are unem-

ployed, food insecure, and chronically ill are more likely to volunteer for health research studies.

• Those who have participated in health research studies in the past are more likely to be willing to participate again, if invited to participate.

“Health care practitioners need to ensure beneficence, justice, and respect for all.

While billions of dollars are spent every year due to existing health disparities, these disparities can be reduced by better research and including racial and ethnic minorities as a key component of all health care initiatives from governance to consumer preference.”

Making Rounds

June

September

November

23–27

5–8

1–3

18th National Neonatal Nurses ­Conference Hyatt Regency New Orleans, Louisiana Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

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

Association of Women’s Health, Obstetric and Neonatal Nurses 2018 Annual Convention Tampa Convention Center Tampa, Florida Info: 800-354-2268 E-mail: customerservice@awhonn.org Website: www.awhonn.org

June/July June 26–July 1

American Association of Nurse Practitioners 2018 National Conference Colorado Convention Center Denver, Colorado Info: 512-442-4262 E-mail: conference@aanp.org Website: www.aanp.org

July 25–29

Philippine Nurses Association of America 2018 Annual Convention Hyatt Regency Jersey City on the Hudson Jersey City, New Jersey E-mail: infomypnaa@gmail.com Website: www.mypnaa.org

July/August July 31–August 3

National Association of Hispanic Nurses 43rd Annual Conference Hilton Cleveland Downtown Cleveland, Ohio Info: 919-573-5443 E-mail: info@thehispanicnurses.org Website: http://nahnnet.org

July 31–August 5

National Black Nurses Association 46th Annual Institute and Conference St. Louis Union Station Hotel St. Louis, Missouri Info: 301-589-3200 E-mail: info@nbna.org Website: www.nbna.org

Academy of Neonatal Nursing

American Academy of Nursing

12–14

9–11

National League for Nursing

Organization for Associate Degree Nursing

2018 Education Summit Hyatt Regency Chicago Chicago, Illinois Info: 202-909-2500 E-mail: summit@nln.org Website: www.nln.org/summit

2018 National Convention Loews Philadelphia Hotel Philadelphia, Pennsylvania Info: 877-966-6236 E-mail: oadn@oadn.org Website: www.oadn.org

27–29

Doctors of Nursing Practice, Inc. 11th Annual Conference Westin Mission Hills Golf Resort and Spa Palm Springs, California Info: 888-651-9160 E-mail: info@doctorsofnursingpractice.org Website: www.doctorsofnursingpractice.org

October 4–6

The American Assembly for Men in Nursing

February/March February 27–March 2

Dermatology Nurses’ Association 37th Annual Convention Marriott Wardman Park Washington, District of Columbia Info: 800-454-4362 E-mail: dna@dnanurse.org Website: www.dnanurse.org

2018 Annual Conference Hyatt Regency Milwaukee Milwaukee, Wisconsin Info: 859-977-7453 E-mail: info@aamn.org Website: www.aamn.org

17–20

Transcultural Nursing Society 44th Annual Conference Embassy Suites on the Riverwalk San Antonio, Texas Info: 888-432-5470 E-mail: staff@tcns.org Website: www.tcns.org

24–27

American Psychiatric Nurses Association 32nd Annual Conference Greater Columbus Convention Center Columbus, Ohio Info: 855-863-2762 E-mail: inform@apna.org Website: www.apna.org

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Getting to YES

The Art of Negotiation for Nurses

BY JEBRA TURNER One of the American Nurses Association’s seven Bill of Rights for Registered Nurses is to “freely and openly advocate for themselves and their patients.”

Yet, women and minorities may not be as effective advocating because they’re less likely to negotiate. There is a “win-win” negotiating style, developed at Harvard’s famed Negotiation Project, which may be more appealing. Practice them in small ways until they become second nature. Then when it’s necessary to advocate about safety, staffing, workplace violence, etc., you will be ready with a collaborative, problem-solving approach.

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ut if you don’t negotiate? Nurses who accept poor ­compensation or working conditions can end up feeling victimized, devalued, and unmotivated.

With that attitude, they are less likely to provide excellent patient care and to get promotions. Don’t let that happen to you. Elevating your negotiation skills will lead to better communication, collaboration, and results for you and every other party.

Reframe the Concept of Negotiations Given the overwhelming percentage of female nurses, it’s important to consider how

The word can have a negative connotation but only because most people don’t understand what it really is,” explains Cardillo. In health care, there is an additional connotation, and that’s terms of negotiation and union contracts, she adds.

According to Webster’s Dictionary, “negotiation” is defined as “to meet and discuss with another in order to reach an agreement.” But many of us suspect that in order to do that, one party must dominate, trick, or pressure the other into submission.

Sometimes, we have to reframe an uncomfortable concept, like negotiation, and

Elevating your negotiation skills will lead to better communication, ­collaboration, and r­esults for you and every other party. gender plays into negotiation.

Research shows that women are two and a half times more apprehensive about negotiating, while men are four times more likely to initiate a negotiation. In fact, 20% of women say they don’t ever negotiate, even when the situation necessitates it, according to Linda Babcock and Sara Laschever, authors of Women Don’t Ask: Negotiation and the Gender D ­ ivide.

That apprehension keeps many nurses from learning and practicing this important communication competency.

“Negotiation is in the top five life skills that everyone should have,” insists Donna C ­ ardillo, RN, author of The Ultimate ­Career Guide for Nurses.

“We negotiate all the time—with our kids, p ­ artners, ­patients, and coworkers, often without even realizing it.

perceive it in a new way, to make it more palatable, notes Cardillo.

“For example, say a nurse wants to attend a national nursing conference, and get paid time off, and expenses covered and so on. I’ll advise explaining the benefit to the hospital and the nurse manager. ‘By going, I’ll be able to bring back information from national speakers and experts to share. I will do an in-service session, or write a paper on it, and I’ll bring back printed materials,’” she explains. Nurses needn’t let a “No” response discourage them, either, adds Cardillo, because it may take repeated requests to get what you want. But if you don’t ask, the answer is always “No.” Another way to reframe it, Cardillo says, is that by asking you’re planting seeds of change

for the future, so you’re advocating for yourself and for your profession.

“Many of us were raised not to ask for what we want and to feel satisfied with whatever we got. I just saw a tweet from a nurse: ‘People say I need this job. I say this job needs me.’

That’s so true. Everyone is entitled to feel valued in the workplace,” she says.

Steven P. Cohen, author of The Practical ­Negotiator, has trained health care ­professionals in negotiation skills globally and agrees that nurses must self-advocate.

“Your number one job is to look out for your own interests.

Self-interest means maximizing circumstances to help you get what you need: good pay and benefits, rewards, and resources that let you serve the patient.

You must be well served.” He notes that if a nurse is treated badly, then he or she can’t function well, and patients suffer.

There are three kinds of interests to consider and prioritize in a negotiation—in conflict, complementary, or in common, according to Co-

there are complementary interests and no conflict, and to build step-by-step to a win-win solution. “Most anyone in a hospital, from aide to CEO, has similar objectives,” he adds “and is asking the same questions: How can I make the most of my job? How can I take care of the people I need to take care of?”

Negotiate in Your Off-Hours One of the best ways for nurses to become empowered is for them to learn and ­practice good negotiation skills, asserts Michelle Podlesni, RN, president of the National Nurses in Business Association. “Why are we having nurses that don’t last two years in a hospital setting?

Because they aren’t empowered and negotiation starts with assuming your power. I help nurses to understand their power,” she explains.

Podlesni believes that negotiation skills can be learned, like other important nursing skills.

Earlier in her career she read The Power of Nice by Ronald Shapiro and Mark Jankowski, and it made a big impression on her. The book defines nego-

Sometimes, we have to reframe an uncomfortable concept, like ­negotiation, and ­perceive it in a new way, to make it more palatable, notes Cardillo.

hen. “If you’re going on vacation with a multigenerational family, how likely is it that you have common interests and all want to do the same things?

Not likely. But you may have complementary interests. Your goal could be that everyone in the family will have a good time on the vacation.” He advises nurses to look for where

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tiation as using knowledge to get what you want, using the “three P’s” of preparing, probing, and proposing.

“Say a new nurse is getting scheduled in a certain way. How do they know it’s fair? You ask: ‘How is the schedule made?’

Nurses don’t always assess their own situation and propose what works better for them.

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We need to make a paradigm shift—your license is a license to start practicing in your business as a nurse,” Podlesni says.

discount, clerks may have the power to sweeten the deal in some other way. “Another time at Macy’s I bought furniture

One of the best ways for nurses to become ­empowered is for them to learn and practice good ­negotiation skills, asserts Michelle Podlesni, RN, president of the National Nurses in Business ­Association.

Think of your negotiation skills as a muscle and flex it often in everyday situations.

“Practice everywhere you go, even at the Macy’s makeup counter,” she says. “When you go to put lipstick on the counter, say ‘By the way, is this

and had to wait for an extended period during my workday, so I said to the clerk, ‘I know it’s not your fault but what can you do to help me out?’ She took away the delivery fee and saved me $150,” she adds.

For examples of opportuni-

end of the day discount?” She would often get it, or a free sample, or a bonus bag of produce.

Over the course of one year, she asked for a discount 411 times.

Analyzing her success rate, she discovered that she did better when she was nice (80%) versus when she was meek (58%).

Perhaps unsurprisingly, she enjoyed the greatest success (85%) when she was very nice, or even flirtatious.

Negotiate with Coworkers Whether delivering direct patient care as a manager, researcher, or as an entrepreneur, nurses need effective negotiation skills. Not every nurse is in a role that requires negotiating with patients, students,

Suggested Phrases for Negotiations How you phrase a request is never as important as your manner during the delivery.

As long as you’re pleasant, you can make any reasonable request—and have a shot at getting a “Yes.” (People can sense confidence and power.) Being willing to walk away is equally important to phrasing.

Soft but assertive: “Can you do any better?”

Be specific: “How about ten percent off?”

Delay if dissatisfied: “That’s less than what I was expecting. Let me think about it.”

Strongly block an unfair assessment: “That may be your opinion; however, it’s an inaccurate one.” (Michelle Podlesni suggests this phrase.)

Softly deflect: “Wow, we really see this situation differently. Can you explain your point of view?”

Probe further: “I’m surprised by your response. Let’s talk about this some more.”

Compromise: “Well, if you can’t meet my requests, how close can you come?” on-verbal responses are effective, too. Pause for a full beat—regardless of the offer—then repeat it back slowly.

N That hesitation may prompt the other party to sweeten the deal, without another word from you.

the best you can do?’ And then wait. And talk through a smile,” she advises. As long as you’re pleasant, salespeople will try to accommodate bargain-hunters, often pulling a percentage-off coupon from under the counter.

Even if they can’t give you a

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ties in which to practice your negotiation skills and ideas about effective strategies, check out the blog The Daily Asker.

A graduate student, Roxana Popescu, set herself the goal of negotiating a request everyday. So, at the farmer’s market, she might ask, “How about an

Minority Nurse | SUMMER 2018

vendors, clients, or external agencies. But almost universally, nurses must negotiate with colleagues and coworkers.

“I’m a double minority, a male nurse and an ethnic minority,” says Usama Saleh, RN, BSN, MSN, PhD, a nurse educator. “Nurses are about 90%

f­ emale today, but when I started it was only 3 to 5% male. I always felt like a minority in terms of gender, so I had to learn to negotiate with female nurses. Naturally there are differences in terms of negotiation styles. But I need to be able to work effectively within a female dominate profession.”

Saleh was working as an RN in oncology and often negotiated with colleagues about the assignment of patients, for instance, and to resolve conflict so all parties are satisfied. In addition to ensuring an equitable workload, “it’s important to negotiate with your nurse mates on the team in order to deliver effective care. I always look at it in terms of quality of care,” he explains.

Saleh came to the U.S. from the Gaza Strip and also had to become accustomed to the negotiation style of Americans who were born and raised here.

“Culture and religion influence the etiquette of negotiation,” he says. “I wasn’t able to be aggressive; I was a soft negotiator. I admired it when negotiators were more assertive, but because of cultural factors I couldn’t do it.”

Saleh also taught in China for a short while and saw how negotiation is different there, as it is throughout the Middle East. Though he can adjust his individual style to the culture, overall, he’s happy with it. “I believe using a softer negotiating style has given me good results. It’s softer than usual in the U.S., but it is still effective and I’m very satisfied with the outcomes,” he adds.

Now You’re Ready for Salary Negotiations “When I speak to groups of nurses I have a joke: ­Everything

in life is negotiable except for the salary of a staff nurse,” says Cardillo. Most hospitals have set salary ranges for nurses, sometimes negotiated by unions, until you go on to be a case ­manager, supervisor, or manager.

If you’re not sure if salary negotiation is appropriate in your role or organization, Cardillo suggests you probe with these phrases: • Is there any way to … ?

(Boost salary, add benefits, etc.)

• Are any adjustments available?

• Is there any room for negotiation?

Where to get salary survey info: professional associations, National Association of Colleges and Employers (NACE), Salary.com, jobstar.org, bls.gov, medzilla.com, career fairs, career development centers, and coworkers.

Even if you can’t negotiate your initial salary, you may be able to negotiate during a wage and performance review or an improvement plan meeting. “Most of the time, nurses are nervous going in to that type of meeting,” says Podlesni. “Take ownership of the discussion and go in prepared with information and knowing your desired outcome.”

For example, in a performance evaluation where a nurse is judged poorly, he or she doesn’t have to accept an unfair assessment. In one such situation, “an emergency room nurse was told she did not have timely emergency room skills such as inserting NG tubes,” Podlesni recounts. “I advised her that evaluations need to be conducted fairly and use consistent criteria across that board…I recommended that

she request a video or documentation of someone doing the skill in the timeframe suggested. They were unable to provide this, and as a result, she received her $10,000 annual salary increase.”

During a wage evaluation, you can always negotiate for a higher salary or better benefits package. “Say your salary is $60,000 a year,” Podlesni says. “What stops you from saying ‘I love my job and want to keep working here, but I need to get to $65,000 a year to spend that much time out of my home and to pay childcare expenses’?” You may not get that raise but at least it starts a

sistant professor of nursing at the University of Pennsylvania School of Nursing. “We’re taught that you have to be modest, don’t call attention to yourself. It’s about building relationships and taking care of others. We have to balance humility with self-confidence.”

At the National Hartford Centers of Gerontological Nursing Excellence leadership development program, Perez learned the essentials of career success, including salary negotiation.

“AACN publishes mid-toaverage salaries for professors that might not factor in additional skills or expertise,”

Minority nurses bring an extra dimension to their work that they may not recognize and value highly enough.

conversation and then you can decide if you want to stay in the job or if it’s time to find a better paying employer.

Believe in Your Value Minority nurses bring an extra dimension to their work that they may not recognize and value highly enough. “Being Latina and bilingual, bicultural, we’re typically in a culture that doesn’t boast,” says Adriana Perez, PhD, ANP-BC, FAAN, as-

she explains. “I’m a bilingual, board-certified adult nurse practitioner, and researcher addressing health equity issues that are national research priorities. There aren’t that many Latina nurse scientists so it puts me in a great bargaining position. I can help the school meet its inclusion and diversity mission. But that’s not enough. I have to produce results and demonstrate a measurable impact.”

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Polish Your Negotiating Skills Many organizations offer professional development workshops that focus on cultural diversity, communication skills, negotiation, and conflict resolution. The leadership program that Perez benefited from included a career-enhancing mentorship relationship.

“We grew from mentor and mentee to now colleagues and friends. I attribute a lot of my growth to that program,” she says. “I recommend finding mentors. Study the leaders in your organization whose style you like and who are well-respected. Ask them for coffee: ‘Can we schedule some time?’

Nurses are giving and want to help. They’ll share lessons learned and will tell you about programs, scholarships, training, and other resources out there.”

It’s true that some nurses will never enjoy advocating for themselves. But it doesn’t have to be that way, with a little practice they can increase their confidence and ability. The end result: Better outcomes for everyone.

Jebra Turner is a freelance health care writer in Portland, Oregon.

Visit her at jebra.com.

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BY CIARA CURTIN

2018 Annual Salary Survey Nurses this year reported a slight dip in their salaries overall, as compared to last year, but African American and Asian nurses reported making slightly more this year than they did last year.

T

his year, nurses broadly reported earning a median $75,000, down from the $78,000 they reported last year. However, this year’s salary numbers are still higher than the median $65,000 nurses said they were paid five years ago and higher still than what nurses reported making in 2016 and 2015.

Not all nurses, though, experienced­a decline in pay. African American nurses reported earning a median $80,100 this year, as compared to last year’s $70,000 and $62,500 in 2016, while Asian nurses reported earning a median $91,000 this year, as compared to $85,000 last year and $62,000 in 2016.

Hispanic nurses, meanwhile, reported nearly the same salary this year—$75,000—as last year, but white nurses noted the largest drop, from $79,744 last year to $72,750 this year.

To collect this salary and job data, Minority Nurse and Springer Publishing e-mailed a link to an online survey that asked nurses not only about their pay, but also about their ethnicity, benefits, training, and more. More than 1,400 nurses from across the United States—from Alaska to Alabama—and a few from outside the country responded.

The nurses who answered the survey came from a range of backgrounds. While the vast majority were women, more than 7% of respondents were men. Most nurses reported holding a Number Number of of Respondents: Respondents: bachelor’s degree, but others had an associate’s or master’s degree. The majority of respondents said they spend most of their day on patient care, but others were involved in administration or Number of Respondents: research. Some worked for large employers with more than 10,000 employees, and others worked for smaller ones with less than 100 employees.

Ethnicity Nearly 83% of respondents were employed full-time.

Ethnicity 1.7% 1.3% The best-paying employers, according to respondents, are walk-in clinics, followed by col2.7% 1.7% 1.3% 2.7% Ethnicity 1.0% 8.6% 1.0% 8.6% leges or universities, private hospitals, and private practices. African American nurses working 2.7% 1.7% 1.3% for a private hospital reported earning a median $80,000, while Asian, white, and Hispanic 5.6% 1.0% 5.6% 8.6% 5.9% nurses working for the same employer type made $90,000, $75,000, and $73,000, respectively.

73.1% 5.9% 73.1% 5.6% Salaries, though, varied by where nurses lived. Nurses who lived out West reported earning more 5.9% 73.1% than nurses elsewhere in the United States, and in particular more than those living in the M ­ idwest.

When broken down by e­ thnicity, additional variations in pay by region arose. Asian nurses ■ ■ White/Non-Hispanic White/Non-Hispanic working out West reported taking home a median $100,000, while Hispanic nurses there re■ ■ Hispanic Hispanic or or Latino/Latina Latino/Latina ported receiving $77,000 and white nurses $83,000. At the same time, African American nurses ■ Asian ■ White/Non-Hispanic Asian ■ ■ African American ■ African American in the South reported earning a median $80,050 and Hispanic nurses in the region reported ■ Hispanic or Latino/Latina ■ Prefer ■ Asian Prefer not not to to answer answer ■ receiving $79,000 and white nurses $70,000.

■ Other ■ African Other American ■ ■ Multiracial As in years past, nurses’ salaries also correlated with their level of education, and nurses with ■ Prefer Multiracial ■ not to answer ■ Native ■ Other Native American American ■ more advanced degrees largely reported earning higher pay. For instance, nurses with bachelor’s ■ Multiracial degrees took home a median $71,000 and those with master’s degrees made $90,000.

Gender ■ Native American Gender Additionally, African American and Asian nurses with bachelor’s degrees made $80,000, while 7.6% 7.6% Gender Hispanic and white nurses with bachelor’s degrees earned slightly less, a respective $75,000 and $70,000. At the master’s degree level, African American nurses earned a median $85,000 to Asian 7.6% 92.4% 92.4% nurses’ $115,000 and white nurses’ $90,000.

92.4% A number of respondents reported that they would soon be seeking new certifications, most commonly in oncology, education, or medical-surgical nursing.

■ ■ Female Female ■ Male Still, most respondents said they’d be sticking around in their job for a while. Only about ■ Male 18% said they were thinking about changing jobs in the next year. And when nurses did leave ■ Female ■ Male their jobs in the past, the majority said it was to pursue a better opportunity.

1,441 1,441

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Regions

Employment Status

1.6%

3.1%

1.3%

0.3%

12.5%

19.2% 32.1% 23.3%

82.8%

23.8%

■ South ■ Midwest ■ West

■ Northeast ■ Outside the United States

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

Employer Type

Years at Current Job

1.2% 2.3%

0.3% 1.0%

7.9%

35.5%

32.8%

8.8%

19.8%

13.4%

20.8%

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

■ Three to five years ■ Less than a year

4.4%

4.1%

2.9%

■ Patient care ■ Education ■ Leadership/Management ■ Administrative

■ Walk-In Clinic ■ Health Department/ Public Health Agency ■ Health Insurance Company/HMO/MCO ■ Pharmaceutical/ Research Company ■ Military ■ Correctional Facility ■ Public School

Reason for Leaving Prior Job

1.4% 1.7%

12.4%

25.1%

■ Public Hospital, including Veteran’s or Indian Affairs Hospitals ■ Private Hospital ■ College or University ■ Other ■ Private Practice or Physician’s Office ■ Nursing Home, LTC, or Rehabilitation Center ■ Home Health Care Service

Main Role

9.0%

1.8%

0.4% 0.3% 1.0%

3.7%

9.2% 14.7%

4.4%

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

2.3% 1.3% 1.1%

8.0% 13.0%

63.8%

52.0% 18.2%

■ Case management ■ Other ■ Triage ■ Research

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

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

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Median Salary by Region

Northeast

West

$78,000 ($70,000 five years ago)

$85,000 ($75,000 five years ago)

Midwest

$67,000 ($57,000 five years ago)

South

$72,000 ($62,000 five years ago)

Median Salary by Region and Ethnicity

Northeast White/ Non-Hispanic

South Midwest West

Hispanic or Latino/Latina

Asian

South West

West

Northeast African American

South

$0

$10,000

$20,000

■ Salary Five Years Ago ■ Current Salary

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Minority Nurse | SUMMER 2018

$30,000

$40,000

■ Salary Five Years Ago ■ Current Salary

$50,000

$60,000

■ Salary Five Years Ago ■ Current Salary

$70,000

$80,000

$90,000

■ Salary Five Years Ago ■ Current Salary

Median Salary by Education Level

Median Salary by Main Role

$100,000

$100,000

$90,000

$90,000

$80,000

$80,000

$70,000

$70,000

$60,000

$60,000

$50,000

$50,000

$40,000

$40,000

$30,000

$30,000

$20,000

$20,000

$10,000

$10,000

$0

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Median Salary by Specialty

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Median Salary by Ethnicity White/Non-Hispanic

Hispanic or Latino/Latina

Asian

African American

$0

$10,000

$20,000

Current Salary

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

Salary Five Years Ago

Median Salary by Education and Ethnicity

Master’s

Bachelor’s

Associate’s

$0

$10,000

$20,000

White/Non-Hispanic

$30,000

$40,000

$50,000

Hispanic or Latino/Latina

$60,000

$70,000

Asian

$80,000

$90,000

$100,000

$110,000

African American

Median Salary by Organization and Ethnicity

Public Hospital

Private Hospital

$0

$10,000

$20,000

White/Non-Hispanic

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Minority Nurse | SUMMER 2018

$30,000

$40,000

$50,000

Hispanic or Latino/Latina

$60,000

Asian

$70,000

$80,000

$90,000

African American

$100,000

$120,000

Looking to Leave Job in Coming Years

Highlights • 82.8% are employed full time

17.9%

• 32.8% work at a public hospital 82.1%

• 56.2% have been at their current job for five or more years • 77.8% received a raise within the last year • 52.0% left their last job to pursue a better opportunity

■ Yes

• 33.4% do not expect a raise this year

■ No

• 17.9% say they might leave their current job in the next year

Timing of Last Raise Received 7.1%

10.5%

Five Most Common Specialties • Oncology

4.6%

• Family health 77.8%

• Critical care • Medical-surgical • Pediatrics

■ Last year ■ Two years ago

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

Best Pay by Employer Type • Walk-in clinic • College or university • Private hospital

Percentage of Last Raise 4.0% 4.3% 29.5% 62.2%

• Private practice or physician’s office

Most Common Benefits Provided • Health insurance • Retirement plan (401(k), 403(b), pension, etc.)

■ 1% to 2% ■ 3% to 4%

■ 5% ■ More than 5%

• Dental insurance • Paid time off

Raise Expected This Year 2.9%

1.9%

19.6% 42.2%

Most Common Certifications Being Sought in Near Future • Oncology

33.4%

• Certified nurse educator • Medical-surgical • Administration/Management (tie) ■ I do not expect a raise this year ■ 1% to 2%

■ 3% to 4% ■ 5% ■ More than 5%

• Critical care (tie)

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Minority Nurse | SUMMER 2018

THE TRUE NURSING EPIDEMIC GETTING NURSES TO STAY AT THE BEDSIDE

BY LYNDA LAMPERT, RN

K

yana Brathwaite, founder and CEO of KB CALS- Caring Advocacy & Liaison Services, worked as a critical care nurse when she hurt her shoulder during a patient transfer.

“Our patient population is getting heavier [and] it is not always realistic to pull colleagues from different areas/departments to help. My true issue was not with the injury—although unfortunate, they do happen—my issue was with how my particular situation was handled after the injury by both management and the entity I worked for,” she explains.

For these reasons, the pain of her injury and the lack of support by management, Brathwaite chose not to stay at the bedside. Would she have

stayed had circumstances been different? “Prior to the injury, I was considering staying at the bedside for at least five more years to give me time to plan the direction in which I wanted to take my nursing career.”Although she did plan to continue her career eventually, she would have given

deplorable. They look for jobs in advanced practice, teaching, and other non-bedside related areas of nursing, while the number of nurses taking care of the most critical patients continues to dwindle.

Here are four reasons nurses leave the bedside and some ideas as to how to make them stay.

In nursing school, clinicals usually don’t go beyond two to three patients per student so they are not exactly exposed to the real-life rigors and stresses that come with the life of a bedside life—and cultural shock is a very real phenomenon. solid years to suffering bedside nursing specialties.

In fact, many nurses run from the bedside as soon as possible because conditions are so

1. New Grad Education New grads can go into a bedside job and not know exactly what they are in for.

In nursing school, clinicals

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usually don’t go beyond two to three patients per student so they are not exactly exposed to the real-life rigors and stresses that come with the life of a bedside life—and cultural shock is a very real phenomenon.

“Nursing students are constantly told by faculty, peers, mentors, and experienced nurses what bedside nursing is ‘really like,’” says Greg E ­ agerton, DNP, RN, an associate professor at the University of Alabama at Birmingham School of Nursing.

“However, it is like the first time we ride the bike by ourselves…

The same is true for new nurses; their hands are held throughout their training and then the day comes when they are ‘alone’ and it’s a little frightening. They now have the sole responsibility for their patient’s care, their

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patient’s life—and that can be daunting. It’s also the reason we always encourage team support from their mentors, their

nurses would rather find a new job than to put their licenses and their mental health on the line like that. For this reason,

Getting the floors better staffed is only one part of the puzzle, but addressing pressing issues such as horizontal violence is needed, too.

more experienced peers, and from all members of the health care team, including physicians, therapists, support staff, etc.”

Although this is true, new grads often express intense dislike of their new role as a bedside nurse, and they immediately want to move to another branch of the profession. Is it that the nurse is not prepared or that the job is simply too difficult? It certainly sounds like management is trying to accommodate new nurses, but a quick search of internet nurse boards will reveal new nurses in despair. Perhaps more intensive job shadowing will allow new grads to see what bedside nurses do. Perhaps more realistic teaching would also go a long way toward helping them.

Whatever the answer, new grads are a special population that needs attention—though it already gets quite a bit—to keep them safe and happy at the bedside.

2. Staffing Ratios Another issue that chases nurses from the bedside is poor staffing ratios. It can be overwhelming for one nurse to have eight to ten patients to themselves. Not only is it unsafe, it is also stressful, and many

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Minority Nurse | SUMMER 2018

staffing ratios are important to consider when examining the loss of bedside nurses.

“I do not feel staffing ratios is the main driving factor,” argues Ken Shanahan, MSN, RN, CCRN-K, clinical nursing director at Tufts Medical Center.“ One of the main reasons I feel this way is because the only state with staffing ratios is California and yet they have the most nurse strikes. These strikes are actually increasing dramatically and are something we will need to address as a profession. The work environment is the most important factor and number of nurses or ratios is only a component of the working environment.

There are many other components that we are not hitting the mark on that would help create a healthy work environment.”

Although a large portion of nurses would disagree with Shanahan’s opinion on the importance of staffing ratios, he does have a point: they are not all that is involved here. Getting the floors better staffed is only one part of the puzzle, but addressing pressing issues such as horizontal violence is needed, too. Everyone knows about staffing ratios, but few realize

they are only one prop to hold up a very large house meant to keep nurses at the bedside.

3. Compassion Fatigue and Burnout Compassion fatigue and burnout are the psychological components that keep nurses from staying at the bedside.

The two are closely related but are not the same. Burnout, in short, is frustration with the situation and is typified by anger. Compassion fatigue is an exhaustion of the ability to extend oneself emotionally anymore and is typified by depression. Please note, these are very simple definitions and they are not exhaustive.

Both of these conditions can occur together, and neither is pleasant. Nurses have had their lives broken over these issues, and no one wants to go through that. How, then, do we solve this problem?

“Burnout and compassion fatigue are concerns for direct care providers in all professions,” explains Eagerton. He suggests the following mea-

time.

• Schedule time for staff to have discussions about what stressors they are experiencing that may lead to burnout and fatigue.

• Create opportunities for staff to be involved in activities that allow them to do things that are not direct patient care but have meaning to them, such as committee membership, attending professional conferences, and so on.

• Have resources available for nursing staff in addition to their managers to discuss their stressors, such as chaplains, mental health professionals, and counselors.

• Have dedicated space(s) on or near the units where they work where they can have some quiet time or time to eat their meal or have their break without interruption.

With these ideas in place, nurses can have a better shot at overcoming compassion fatigue and burnout. When these are not a factor or are a mitigated factor, the more a nurse can feel

Providing mechanical lifts, better security, and education about safety could go a long way towards protecting nurses and keeping them at the bedside.

sures to help support staff: • Leaders should be visible and approachable.

• Work schedules should allow adequate time off between shifts.

• Adequate breaks should be provided during the work shift so that staff have down

happier staying at the bedside.

4. Injuries Nursing is definitely a contact sport, as stories like Brathwaite’s prove. Transferring ­patients is getting more and more difficult with increased body weights. In addition,

various specialties are more susceptible to transfer related injury. For instance, operating room nurses are at great risk because they must move patients who are unconscious and essentially dead weight.

However, that doesn’t make your typical bedside nurse any less at risk. Moving and lifting are just as much a part of the job, and mechanical equipment is usually not available to help.

“There is only one of you,

you can’t lift that 300-pound patient, then don’t even try, no matter how much it needs to be done. Similarly, hospitals need to make allowances for nurse injuries. P ­ roviding mechanical lifts, better security, and education about safety could go a long way towards protecting nurses and keeping them at the ­bedside.

In the end, the question of keeping nurses at the bedside is definitely multifactorial— and controversial. Patients

The reason to change is that the nursing shortage is real, and it isn’t what you think. It isn’t a lack of trained nurses. It is a lack of trained nurses willing to work. [and] there will always be more patients,” says Nick ­Angelis, CRNA, MSN, author of How to Succeed in ­Anesthesia School (And RN, PA, or Med School) and cofounder of BEHAVE Wellness. “If no one is available to perform a task safely with you, don’t do it.

Hospitals always push putting the patients first, but you’re a danger to patients if you give and give until your weekly schedule must also include time for massage and chiropractor appointments. Flu vaccines, unsafe equipment, dangerous staff ratios, risk of physical harm from unruly patients because hospital security resembles nursing home patients—these all require putting yourself first.”

It really does come down to this: Nurses need to learn how to put themselves first. If

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have been cared for all this time with the methods we’ve been using, so why change?

The reason to change is that the nursing shortage is real, and it isn’t what you think. It isn’t a lack of trained nurses.

It is a lack of trained nurses willing to work. If we can make the bedside more appealing to these nurses who have run for cover, perhaps the nursing shortage wouldn’t really exist at all.

Lynda Lampert, RN, has worked medical-surgical, telemetry, and intensive care units in her career. She has been freelancing for five years and lives in western ­Pennsylvania with her family and pets.

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THE GROWING NEED

BILINGUAL NURS

BY MICHELE WOJCIECHOWSKI

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Minority Nurse | SUMMER 2018

FOR

ES As increasing numbers of patients don’t speak English as their first language—or at all—the health care field is taking action. Here’s what’s happening and how you can become involved.

I

magine if you were in a hospital in a country where no one spoke English. ­Being in a strange hospital or other health care facility can be scary enough, but if you had no idea what was going on, it would make you more stressed—possibly making your health worse. You would feel incredibly vulnerable, as not knowing what was happening to you or if the workers could help you would be terrifying.

There was a time in the United States when that could happen. Although it shouldn’t happen, legally, anymore, as Allison Squires, PhD, RN, FAAN, explains, there is still a need for more bilingual

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nurses. “All health care facilities are required by law—including the Civil Rights Act and updated regulations in the Affordable Care Act—to provide patients who do not speak English with an interpreter,” says Squires, an associate professor at the New York University Rory Meyers College of Nursing. “The interpreter can be an in-person interpreter or a telephone or video interpreter to meet the requirements of the law.”

According to Squires, the increase in patients who haven’t developed English skills comes from two situations: the postWWII legacy in which U.S. citizens came here as immigrants, and the most recent

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Although particular languages may be needed to serve certain populations, there are also instances in which unexpected languages may also be required.

wave of immigration, which has matched or surpassed the immigration numbers of the early 20th century. “According to the Pew Research Center, one in five households in the U.S. speaks a language other than English at home. More communities are also becoming refugee resettlement cities across the U.S., which means increasing linguistic diversity in places that have historically only had English speakers,” says Squires. “The demand for nurses who speak another language is at an all-time high.”

Location, Location, Location While all the sources whom we interviewed agree that Spanish is the most prevalent second language needed for

24

­ atients, they also say that p other languages are vital as well, depending on your region of the country. “Spanish is the priority language nationally. Other languages depend on where you live and who is ­migrating there,” says Squires. “For example, in the New York City and New England regions, there are now large numbers of Russian speakers. These individuals often come from former Soviet Union states where Russian was the official language.

Other parts of the country, like Texas and Louisiana, have large numbers of Vietnamese speakers who came to the U.S. as refugees or ­immigrants.

Other than Spanish, language demand is often specific to a

Minority Nurse | SUMMER 2018

local health care service area.”

“Spanish is the language in highest demand, particularly in Texas, California, Florida, and Illinois. In California, bilingual skills are needed for Spanish, Chinese, Vietnamese, and Russian,” says Terry Mort, who is manager of talent acquisition for VITAS Healthcare, the nation’s leading pro-

communities we serve and pay ­attention to how they’re changing over time,” explains Mort. “Take California as an example. At one time, South Central Los Angeles was primarily an African American community, whereas today it’s predominately Hispanic.

And as our services move into outlying areas of Los Ange-

Squires says that if you work in a hospital, home care, long-term care, or rehabilitation, there are four key times when ­interpreters are ­needed—admission, ­patient education, consent, and discharge. vider of end-of-life care. In the 14 states and the District of Columbia in which they provide care, VITAS Healthcare has also found the need for Mandarin, Cantonese, Tagalog, Hmong, Korean, and Creole.

“We constantly have to look at demographics of the

les County, our needs change again because we encounter more families that are Filipino, Asian American, or Hispanic American.”

Currently, in South Florida, several VITAS hospice teams are solely Spanish speaking to appropriately serve their patients’ and community’s

needs. “In California, a trilingual nurse—someone who speaks English, Spanish, and another language—would be in high demand,” says Mort.

Although particular languages may be needed to serve certain populations, there are also instances in which unexpected languages may also be required. For example, when

Speaking to patients in their native language isn’t only about the words; it’s also about their culture. there was a recent influx of patients from Puerto Rico at the University of Maryland ­Baltimore Washington Medical Center who needed health care after Hurricane Maria, there were more Spanishspeaking patients, says Edith Lopez Dobbins, RN. Dobbins is a JET Nurse, which stands for Just Excellent Timing and means that she is a full-time nurse who serves as supplemental staff for different nursing units throughout the hospital. As a result, she has noticed an overall increase in patients who speak Hindi and Korean as their first language.

“In the hospice profession particularly, we also have the challenge of end-stage dementia patients, who may revert to their language of origin as their disease progresses. We had a Russian patient who reverted to speaking Russian, but the family indicated he had not conversed in that language for more than 20 years.

If that happens, it requires us to update our care plan so that our nurses and staff members

can communicate effectively with these patients in a language they understand,” explains Karen Peterson, senior vice president and chief nursing officer for VITAS Healthcare. “The more languages our staff members can speak, the easier our job is.”

ing with psychosocial issues says that while they use “lanassociated with end of life.” guage phone-lines” to keep at Another advantage to staff- patients’ bedsides so that they, ing or being a bilingual nurse their families, and the health is that when you are speaking care workers can communithe same language as a pa- cate—which is certainly helptient, the work you are doing ful—the phones can also make will take the same amount of talking more impersonal. “It time that it does as when you makes patients and their famiare talking with an English- lies uncomfortable—­possibly Benefits to Being Bilingual speaking patient, says Squires. because it’s not just about Bilingual nurses on staff help There’s no need to be con- language, it’s about culture. open everyone up to another cerned about waiting for an Most of the time, we use peers world as well as another set of interpreter to arrive or to have in the health care team who patients to care for, says V ­ ivian to deal with any issues that speak the same language as Carta Sanchez, DNP, ARNP, can occur when using an inter- the patient for better commufrom Tenet Florida Physician preter by phone. In addition, nication and overall quality of Services. “Nurses who are bi- communicating with family care,” says Dobbins. lingual can also serve as trans- members may also be easier.

“Bilingualism is even more lators to communicate very “That being said, as a bilin- imperative in the hospice proimportant information from gual nurse, if you are the first fession because there’s a lot of physicians who do not speak language nurse to work with emotion and psychosocial asthe language,” says S­ anchez. the patient when they access pects of language surrounding Squires says that if you work health services—be they in the the dying process. Each person in a hospital, home care, long- hospital, home care, or prima- might have a different opinterm care, or rehabilitation, ry care—sometimes you spend ion or thought process around there are four key times when more time with them initial- the issues related to dying. It’s interpreters are needed—­ ly because the patient is so unique in that people may admission, patient educa- happy to have someone who have difficulty conveying their tion, consent, and discharge. speaks their own language,” thoughts and feelings, even “­Using an interpreter during states Squires. “You find out in the same language, simthese times can help reduce all this other stuff that the ply because it’s about death,” your patient’s risk for read- patient held back because of explains P ­ eterson. “Some mission and ­complications,” the language barrier or issues ­patients or family members explains Squires. with interpreter services. An- can’t even say the word ‘hosHaving a nurse who is other advantage of being a pice,’ so they find a way not ­bilingual, rather than using a bilingual nurse is that you can to say it. But when our nurses, family member to translate, can be crucial. “Let’s say that I take five minutes to explain Nursing schools need to recognize local demand something in detail to a pafor bilingual services and restructure curricula to tient, and the family member help ensure the success of English as a Foreign who translates what I said to the patient takes about 30 sec- Language (EFL) students, says Squires. onds. I can tell that my patient isn’t hearing the same thing that I said—and that’s a risk quality check video or phone families and patients underto the patient, because they’re interpretation.” stand each other’s language not getting complete informaand cultural nuances, we’re tion,” says Peterson. “It’s one Culture Comfort more confident that patients of the reasons we prefer not to Speaking to patients in are making the right decisions use family members as transla- their native language isn’t and receiving the best possible tors because they are part of only about the words; it’s also care because everyone underthe unit of care and also deal- about their culture. Dobbins stands each other.”

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At the end of the day, being bilingual or having bilingual nurses on staff is all about patients’ safety and comfort.

Knowing about patients’ culture has become so important that the Chamberlain University College of Nursing began offering a Hispanic concentration on its Phoenix, AZ campus in May 2016.

Pam Fuller, EdD, MN, RN, the Phoenix campus president, states that this concentration doesn’t aim to attract Hispanic nurses, but rather to appeal to nurses who want to care specifically for this culturally diverse group. This concentration is offered to anyone who is enrolled in the university’s pre-licensure BSN program. Because of its ability to logistically provide clinical experiences for students who are enrolled in the Hispanic concentration, the Phoenix campus volunteered to pilot it. “The local hospitals and health care centers currently serve Hispanic patients and families every day, and Chamberlain helps provide nurses and care to these local communities,” says Fuller.

“Providing nursing care requires not just an appropriate educational degree and a license, but also crosses

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boundaries of human dignity and respect. Many, if not all, hospitals and care centers are challenged to communicate more effectively with their ­p atients, regardless of cultural background. Chamberlain specifically launched the ­Hispanic concentration based on information from hospitals in our local markets,” explains Fuller. “When a patient is in pain or in need of health care, they tend to revert to what is comfortable to them, culturally. If you are culturally more comfortable with your own language and traditions, if there is someone who can speak—at least a little bit—the language you speak, it makes the care that much more effective and personal.”

“Chamberlain’s Hispanic concentration is not a ­language program. This concentration exposes students to the Hispanic language and culture and allows for 25% of their clinical experience to be placed with a Hispanic patient. This gives them realtime experience in serving the Hispanic population,” says Fuller. “Any student—­

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regardless of their personal cultural background—may enter this ­c oncentration…

The goal of the Hispanic concentration is to educate students and expose them to the culture and language of the H ­ ispanic community to provide an improved level of care to this p ­ opulation.”

Attracting Appropriate Personnel How can facilities go about recruiting bilingual nurses?

Squires believes that a combination of actions could help. Nursing schools need to ­recognize local demand for bilingual services and restructure curricula to help ensure the success of English as a ­Foreign Language (EFL) students, says Squires. “Even now, EFL students have lower pass rates on the NCLEX-RN exam, and that’s not helping to meet our need for more bilingual nurses. Schools need to change how they teach and support EFL students so they have the same success rates as English speakers,” Squires says.

“Organizations should give bonuses to people who are bilingual to encourage better communication,” says ­Sanchez.

As for becoming bilingual, Squires says that to achieve the level of fluency to be able

to effectively and safely communicate with patients about health issues, nurses would be required to undergo years of study or at least a six-month immersion in a country where the language that they want to learn is spoken. “Having just a few words or phrases can be helpful for recognizing when a patient is in pain or [has] toileting needs, but when it comes to the complex communication needs that go with admission for services, patient education, consent, and discharge, you really need to have what’s called sociolinguistic competence in a language. That’s something that your employer should help you certify or do it on your own to make yourself more marketable,” says Squires.

At the end of the day, being bilingual or having bilingual nurses on staff is all about patients’ safety and comfort. “As a nurse, many of my most rewarding moments have to do with going the extra mile to help a Spanish-speaking family during their hospital stay,” says Dobbins.

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

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Academic Forum

Microaggressions in the Nursing Classroom Environment

BY ANDREA DOCTOR, MSN, RN, CCRN, CCRC

One of hottest topics amongst nurse educators today is finding strategies to promote safe learning in the classroom environment. According to the American Association of Colleges of Nursing (AACN), it is estimated that over 73% of “nontraditional” students are studying in undergraduate nursing programs. The term “nontraditional” refers to all students who meet the following criteria: over the age of 25, ethnic minority groups, speaks English as a second language, a male, has dependent children, has a general equivalency diploma (GED), required to take remedial courses, and students who commute to the college campus. Nurse educators have a responsibility to ensure that all of their nursing students are learning in a safe environment.

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or instance, microaggression is something that nurse educators must address in order to promote a safe classroom environment.

Microaggressions are subtle, verbal and nonverbal snubs, insults, putdowns, and condescending messages directed towards people of color, women, the LGBTQ population, people with disabilities, and any other marginalized group. These insults are often automatic and unconscious in nature, according to Derald Wing Sue, PhD, author of Microaggression in Everyday Life: Race, Gender, and Sexual Orientation. Microaggression can cause a person to question themselves regardless of whether the microaggression occurred or not because they were unsure if they were just being oversensitive to the offense or if the perpetrator really intended to harm them with what they said. Microaggres-

sions are usually committed by “well-intentioned folks” who are unaware of the hidden message that is being transferred.

Types of Microaggression Microaggressions are similar to carbon monoxide— “invisible, but potentially lethal”—­continuous exposure

Nurse educators have a responsibility to ensure that all of their nursing students are learning in a safe environment. to these types of interactions “can be a sort of death by a thousand cuts to the victim,” says Sue. He further outlines three themes in three ­microaggression ­categories. The three themes are: racial, gender, and sexual orientation. The

themes appear to occur in three different forms of microaggression: microassaults, microinsults, and microinvalidations.

Microassaults. Also known as “old-fashioned racism,” microassaults are conscious verbal or nonverbal attacks meant to hurt, oppress, or discriminate against the marginalized groups. This can range from telling racial jokes, name-calling, or isolating a student base on their racial, sexual, or gender identity. For instance, a student may deliberately refer to an Asian classmate as an Oriental. (Hidden message: You are not a true American. You are a perpetual foreigner in your own country.) Another example of a microassault is a teacher asking an African American male student, “Are you a first-time generation ­college student?”

(Hidden message: African Ameri-

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can males usually do not go to college.) Microassaults leave the students feeling unwanted, uncomfortable, and invisible.

Microinsults. A microinsult is an unconscious and unintentional discriminatory action against one’s identity. For instance, a teacher not asking a transgender student what pronoun to use when addressing the student (Hidden message: You are not acknowledging my identity.) Another example of a microinsult is a teacher calling on an Asian student to come to the blackboard to work out a drug calculation problem.

(Hidden message: All Asians are supposed to be good at math.)

Or a student jokingly making the comment “that’s so gay.”

(Hidden message: Being gay is associated with negative and undesirable characteristics.) A microinsult can also be non-

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Academic Forum verbal. For instance, when a white professor fails to call on the African American students in the classroom. (Hidden message: People of color contributions are unimportant.) Microinsults can have a far-fetching negative impact on a student, and they can affect a student’s ­motivation and commitment as well as mental health.

Microinvalidations. Microinvalidations are unconscious ­communications or environmental cues that faintly exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person’s identity. One example of microinvalidation is a student asking an Asian student, “Where are you from? You speak perfect English.” The Asian student replying, “I was born and raised in Florida.” (Hidden message: You are not American.) Or when a teacher continues to mispronounce the name of a student even after the student has repeatedly corrected the teacher. (Hidden message: I am not willing to learn how to pro-

quently delivered microinvalidations. Another example of microinvalidation is a student who unconsciously opens the door for a classmate who is in a wheelchair. (Hidden message: You are not able to independently take care of yourself.)

The student should wait for the student in the wheelchair to ask for help if she or he needs it. Microinvalidation is one of the most harmful forms of microaggression because it leaves the victim feeling ashamed and asking themselves “Am I being oversensitive or paranoid?”

How to Address Microaggressions in the Classroom Professors and students are the most common perpetrators of microaggressions in the nursing classroom environment.

In the course of interaction, the professor or student may say something that offends a student intentionally or unintentionally. Since microaggressions are usually invisible to the p ­ erpetrator and may seem

These insults are often automatic and unconscious in nature, according to Derald Wing Sue, PhD, author of Microaggression in Everyday Life: Race, Gender, and Sexual Orientation. nounce a non-English based name.) Or a white science professor asking the male nursing students, “Why are you going into a nursing? It’s a female profession.” (Hidden message: ­Nursing is not “a real man’s job.”) Or the classic case of a white student telling her black roommate, “I don’t see color.

There is only one race: the human race.” The color blindness offense is one of the most fre-

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to have reasonable alternative explanations, the student may be left feeling uneasy and questioning themselves about what the implied message was.

Microaggression is processed in five different phases, Sue says. Phase one is the incident (verbal, nonverbal, or environmental). The perpetrator intentionally or unintentionally commits the offense. Phase two is the receiver’s perception of

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the offense. For instance, the receiver may ask themselves,

ed” incidents. You should work with your students to create a

Nurse educators need to be aware of what programs (e.g., student counseling center, disability services) are available on their campus so they can refer students who may need help d ­ ealing with the psychological consequences of microaggressions.

“Was I just discriminated against?” or “Did she say what I think she said?” Phase three is the receiver’s immediate response to the offense. The receiver may respond by taking a defensive stand. Phase four is the receiver’s interpretation of the meaning of the offense.

They may even ask themselves, “Should I say something?” or “If I say something it may make it worse.” Phase five is the consequence that may happen to the receiver of the offense. For instance, students may lose confidence in their ability to ­complete the course. Microaggressions can cause psychological consequences on the students over time, such as anxiety, depression, helplessness, and loss of drive, which can impede the student’s academic performance.

Therefore, the first step to addressing microaggression in the classroom environment is to acknowledge that it exists, says Jared Edwards, PhD, a psychology professor at Southwestern Oklahoma State University.

Nurse educators need to get to know their students. You should be aware of their campus cultural environment and the specific challenges that your students from different backgrounds may face. Do not dismiss the classroom experience of microaggressions as “isolat-

safe classroom atmosphere by establishing solid ground rules and classroom expectations.

You can incorporate open classroom discussions about microaggressions into your courses.

For instance, have students conduct a group presentation on the impact of microaggressions in a classroom environment.

This will promote teambuilding skills and communication and writing skills as well as help create awareness surrounding the common occurrences of microaggressions. Nurse educators need to be aware of what programs (e.g., student counseling center, ­disability services) are available on their campus so they can refer students who may need help dealing with the psychological consequences of microaggressions.

Nurse educators must be prepared to teach and advocate for culturally diverse students in a multicultural classroom setting. Additionally, they can show they value their students in many ways. For instance, taking the time to learn how to properly pronounce every student’s name can show the students that you value the student’s identity.

Andrea Doctor, MSN, RN, CCRN, CCRC, is an associate professor at the University of the District of Columbia Community College.

Second Opinion

Standing Up for the Right to Be Ourselves, Part Two

BY SPENCER MILLER, RN

Nine years ago, I was so happy to have my first article published in Minority Nurse. The article was a discussion on whether or not it’s OK to be out at work as a gay person. Looking back at the changes I’ve seen over this time period, I decided to put together a few thoughts.

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he county hospital where I work is rolling out some new ­intake questions for our electronic health record system. The impetus is to better serve our LGBTQ patients.

A transgender person with residual breast tissue did not know he could still get breast cancer. An MTF person devel-

Just asking these questions can be a litmus test of our own feelings.

oped prostate cancer. These patients slipped through the cracks because they lived their true self but had body parts susceptible to illness that the caregiver was not aware of. By next month, we hope to have 10% of our patients properly classified using our new Sexual Orientation and Gender Identity (SOGI) questions. As the program rolls out, we will capture more and more of our population so caregivers can better serve them.

As a gay man in my 50s, I

have seen great changes in my lifetime on LGBTQ issues. There was a time when just being out was a danger.

But we bring some unique perspectives to our job that shouldn’t be overlooked. We know what it’s like to be the underdog. We cherish family because we worked so hard to have our families recognized.

Respect for minorities come easily to us because we have suffered discrimination. Fairness in ­treatment under the law was not free for us or other minorities so we always strive to protect our patients’ rights.

We know that being gay does not give you AIDS, but we also know what those risk factors are and we are able to educate our patients on the facts without judgement.

Now that we are rolling out a campaign to identify our patients’ unique needs regarding sexual health, reproductive issues, and mental health, we are working to destigmatize these issues in our community. Just asking these questions can be a litmus test of our own feelings. When the program was being explained

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Second Opinion in an employee meeting, there was pushback. “Our patients will be insulted.” Or, “Our patients won’t understand the terms.”

It occurred to me that we might be projecting our own

We are charged with the care of all our patients, not just the ones that fit into neat boxes. feelings and, in some cases ignorance, onto our patients.

Of course, there are what seem like valid issues when trying to tease this information out of patients in the geriatric clinic. My feeling is that you just throw the questions out there and you get what you get. The elderly are just as much part of the world as the young (and in between). I can’t wait to get some real world experience in asking these questions: • What is the sex on your original birth certificate?

• What is your gender identity?

• What is your sexual orientation?

Some explanation might be needed with some patients.

Sexual identity is not your sexual orientation. Sexual identity cannot be inferred from your birth certificate.

We are looking forward to the rollout but with a bit of trepidation b ­ ecause we are not used to asking such personal questions. But, if you want to better serve this population, you have to identify them.

The FTM person who never got a breast cancer screening because his caregivers never informed him of the risk— that can be preventable with

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better understanding of our patients. More information is better than less.

I take away two points from the SOGI questions that excite me. The first is that caregivers

by normalizing this conversation, both patients and caregivers can talk openly about a subject that was once taboo.

It’s OK to be gay or lesbian, FTM, MTF, something in be-

Now that we are rolling out a campaign to identify our patients’ unique needs regarding sexual health, reproductive issues, and mental health, we are working to destigmatize these issues in our community. are going to be more aware of the disparities in health care that can occur with our LGBTQ patients. We are charged with the care of all our patients, not just the ones that fit into neat boxes. Just being aware of the differences makes us stop to weigh implications that might have been missed in the past. The second is that

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tween, or nothing at all. We all have health care needs.

Annette Smith, a nurse and coworker with 35 years of experience, has insight into changes in practice like the new SOGI questions: “At the beginning, there is a lot of pushback. The sky is falling, the sky is falling. But after a while, the process becomes

normalized and it’s not a big deal anymore. We end up wondering what all the fuss was about!”

There was a time when just talking about sexual orientation was not even ­considered.

Now we are required to ask!

This destigmatizes the whole subject. To revisit my first question: It should never be a question of whether it’s right or wrong to be out at work. It’s just a question of you being comfortable enough in your own skin to let other people know.

Spencer Miller, RN, is an emergency room nurse who has worked at v ­ arious hospitals in Florida, ­Georgia, and California as a traveler. He currently lives in Sunnyvale, California.

Degrees of Success

Single Motherhood in Academia

BY MIRIAM O. EZENWA, PHD, RN

In May 2015, I joined the faculty at the University of Florida College of Nursing (UF CON) as an associate professor. Fourteen months later, I became a single adoptive mother to a newborn. My successful journey through single motherhood while balancing my academic responsibilities was due, in large part, to the overwhelming support I received from the entire body of the CON including the dean, department chair, faculty, staff, and students.

Working From Home When I think about the reaction of my senior colleagues when I shared the news that I adopted a newborn, I am in awe. My department chair was elated, and after congratulating me, the first words she uttered were, “Miriam, you have my support. I am here to provide

you with whatever resources you need to succeed at motherhood and your academic career. You can take maternity leave, work from home to direct your research, teach online, and teleconference as needed.”

Before I could respond, my department chair excitedly went next door to inform the dean,

who glowed with joy about my news, grabbed my hands, and stated emphatically, “You are taking maternity leave.” I was stunned.

I was surprised about the reactions I received from the administrators because I was not sure what to expect. I was a newly hired associate professor

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trying to build my research program following relocation from another institution. Because I was a relatively new hire, I was afraid they would express misgivings about my status as a single mother with no family support, which might affect my productivity as an employee; however, these fears were not realized. Although the administrators strongly encouraged me to take maternity leave, I opted to work primarily from home and hire a babysitter to assist me, who cared for my son when I travelled to campus to teach and to attend research team

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Degrees of Success meetings. Incredibly, s­enior colleagues encouraged me to bring my son to our hourlong meetings and to classes after students requested it. As a result of their kind support, I brought my son to research team meetings, where my colleagues enjoyed meeting him, and to class, where my students happily posed for photos with my son and me.

Was it Unprofessional to Bring a Baby to Work?

Despite the tremendous support I received to bring my son to the CON, at times, I felt that it was unprofessional. Realizing that I was projecting upon myself the negative stereotypes about motherhood and childrearing, I asked myself several key questions: What is unprofessional about being a mother?

What is ­unprofessional about role modeling to my son the importance of strong work ethics? What is unprofessional about exposing a baby to intellectuals who are positive role models? I surmised that expos-

Because I was a relatively new hire, I was afraid they would express misgivings about my status as a single mother with no family support, which might affect my productivity as an employee; however, these fears were not realized. ing my son to an environment replete with kind, smart, and diligent professionals could only help him learn the behaviors he needs to become successful in life.

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His Majesty, Kasi, Among Nurses

By Miriam O. Ezenwa, PhD, RN Nurses, my Angels They gather to do what they do best Fix the ills around the world Care for those needing their healing presence Enters, His Majesty, Kasi, drawing attention Heads turn left and back, eyes twinkle starry-like Smiles everywhere, hearts blooming light Love! Love in the air for His Majesty Calm nurses, my Angels, research retreat in progress Work in teams, way of the future Stand strong, hands locked in place Embrace people from far and wide Including those who don’t look alike We are stronger in the spirit of the rainbow Need to rest from the trip to here Nurse Karen holding tight, heart pumping peace The future is smart for His Majesty, nurses’ wisdom grows in strength His Majesty needs a diaper change Nurse Jeanne-Marie and nurse mommy to the rescue Now, where were we?

Back to fixing the world How about fixing how we secure our existence?

Many ways of teaching, the more the merrier, the merrier the better Sleepy-sleepy, growth in rapid measure Uncle Yingwei got this one, his manly touch is much needed Once! Twice! Hunger and starvation Hurry Mommy! Tummy thunders, feels like no end in sight Mommy doting, needs now met Sorry for my interruptions, I am just a baby To resume business, let’s take stock Goals are important, set now, assess in time We are nurses, born to fix ills, from birth to death Yes, nurses fix ills all the time

His Majesty needs a break, nap is golden Nurse Versie won the prize, His Majesty is a treasure Mommy close by inspecting every touch New mommy, but instincts never fail Back to research retreat, His Majesty is listening Teams assembled, lead authors identified. Here! Here!

Oh no! Nature calls again, can’t ignore Nurse Cindi in charge this time Mommy always in tow, my bag in hand Back again to wrap up, day went well We must tell our story, stir the soul His Majesty must depart now The throne at home beckons, Queen Mommy in charge Car must be readied, His Majesty commands comfort Uncle Yingwei again to help, he has been there from day one Goodbye, nurses. His Majesty must retreat Till we meet again, a year from now Assess your outcomes, inform His Majesty Did I say that nurses are great?

Lest I forget, nurses are magnificent You are my tribe, away from home His Majesty, Kasi, enjoyed your company Spread the word, it takes a tribe A tribe of nurses, best any time.

Degrees of Success

At that moment, I knew that I had found my tribe at the UF CON even though I was 6,000 miles away from my home country, Nigeria.

It has been nineteen months since I started my motherhood journey, and I am still breathless about the kindness and support I received and continue to receive from my colleagues. Knowing that I had

myself of how blessed I am for the inherent flexibility of my academic position. This feeling of gratitude propels me to work harder so that I do not disappoint myself or the trust the administrators bestowed

I surmised that exposing my son to an environment replete with kind, smart, and diligent professionals could only help him learn the ­behaviors he needs to become successful in life.

the option of taking maternity leave as well as the full support of the administrators who were not concerned about my productivity was reassuring. It helped me focus on enjoying motherhood and have the peace of mind related to a secure livelihood. I remind

upon me, to find an appropriate work-life balance required for success in academia.

My Tribe Away From Home When my son was six weeks old, the CON had a faculty research retreat, and although I did not have a babysitter, I did

not want to miss the retreat. I talked to my department chair about this problem, and she suggested that I bring my son to the retreat. The entire faculty in attendance surprised me with their support. At that moment, I knew that I had found my tribe at the UF CON even though I was 6,000 miles away from my home country, Nigeria. I captured the interactions between my son and my newly found tribe in the poem, His Majesty, Kasi, Among Nurses.

Take Home Message Current knowledge s­ uggests that many mothers in academia struggle to succeed as they balance motherhood and academic responsibilities.

These challenges could be quadrupled for single mothers in academia who are immigrants

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and who may not have family support. I experienced many challenges being a single adoptive mother, particularly on the days that my son was sick; however, I always had the help of my colleagues, who personally assisted me in caring for him. Their support enabled me to excel at motherhood and my faculty role, and I am immensely grateful for this support. Based on my positive experiences, I encourage other universities around the United States to emulate the actions of the UF CON administrators and support mothers in academia as they balance two important aspects of their lives: motherhood and an academic career.

Miriam O. Ezenwa, PhD, RN, is the author of the book, THEY Live in My Tainted Soul (penname: Miriam O. Everest), and is currently finishing two books of poetry, To Love and to Heal and Tomorrow is Pregnant.

Ezenwa is working on her memoir, The Courage of a Dancing Lioness, which is about achieving success despite childhood poverty, sexual abuse, and homelessness. She is also the founder and CEO of The Strongest Me, a motivational speaking company. Ezenwa is an associate professor of nursing at the University of Florida College of Nursing. You can connect with her and read her blog at www. thestrongestme.com.

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Health Policy

From Public Health Advisor to Congressional Candidate: An Interview with Lauren Underwood

BY JANICE M. PHILLIPS, PhD, FAAN, RN

Q

Tell us about Last issue’s health policy column highlighted nursing’s increased engagement in the working for the public policy arena. To continue this conversation, this column highlights a registered Obama administration. nurse running for Congress to help champion access to affordable health care. Yes, Got a call the week that Mr. Lauren Underwood, MSN/MPH, RN, of Naperville, Illinois is running for Congress to [Thomas Eric] Duncan was represent the 14th Congressional District of Illinois. in the hospital in Dallas with Her Journey to Pursuing an Elected Position Underwood is steadfast and fiercely committed to helping shape policies and programs focused on ensuring that everyone has access to affordable health care. She is a registered nurse who received her BSN from the University of Michigan and her MSN/MPH from Johns Hopkins University. Her nursing experiences include

service as a health policy advisor, research fellow, senior director, and research nurse at the National Institutes of Health Clinical Center. Her passion for public policy was heightened while serving as a health policy advisor in the Office of the Secretary at the Health and Human Services in Washington, DC initially under the leadership of Secretary Kathleen Sebelius followed

by the leadership of Secretary Sylvia Burwell. In this capacity, Underwood worked on private insurance reform, summary of insurance benefits, health care quality in the Medicare program, the Agency for Healthcare Research and Quality, and preventive services (free screenings, immunizations, and contraceptive coverage) for four and a half years from 2010-2014

Lauren Underwood, MSN/MPH, RN Democratic Candidate for Congress, 14th Congressional District of Illinois www.minoritynurse.com

­ bola asking if I would be E willing to join the President’s team to help with disaster response, so I transferred over to ASPR, the Assistant Secretary for Preparedness and Response, at HHS. We worked on emerging infectious diseases (e.g., Ebola, Zika Virus, Middle East Respiratory Syndrome virus, or MERS), we also did national disasters (e.g., wildfires, hurricanes, floods) and then bioterror (small pox, anthrax) and worked with drug companies to develop vaccines, treatments, and diagnostics. I stayed in the administration until the very end, the last day.

And so, when the election happened in 2016 we were working on the water crisis in Flint.

I was surprised, and I thought that Hillary Clinton’s team was going to win and that we were going to hand off our work on health reform and on Flint to people who cared and wanted to continue the process. And then we got the Trump team who made it very clear they wanted to do away with health care coverage. And that’s not why I went into nursing or why I did this work. So, I knew I could stay in government and help them do that. I wanted to continue the work and so I came back home to Illinois because Illinois is a state that expanded Medicaid. I got a job working for a Medicaid man-

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Health Policy aged care company in Chicago as the Senior Director for Strategy and Regulatory Affairs for a company called Next Level Health.

Q

Are you still there?

I left my job about six weeks ago. The primary campaign was about eight months. I worked full time six and a half months; you know you have to do that. I am a young person, not someone of particular means or whatever, so it was necessary. And then it was like “Lauren, you could really win if you put your time and energy into the campaign.” And so that was an easy choice to transfer to full time.

Q

So, you are now devoting full time to the campaign?

Yes.

Q

This reflects your journey. Describe in a few words what really made you run for an elected position.

I am going to tell you a story.

Last spring when I returned home, I went to Congressman Randy Hultgren’s one and only public event. It was a moderated event hosted by the League of Women Voters. And during that evening, he made a promise and said that he was only going to support a version of Obamacare repeal that allowed people with preexisting conditions to keep their coverage. That’s important to me as a nurse. I also know how critical it is for people with chronic illness to have access to medications and procedures that they need. Obviously, I worked to implement the Af-

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fordable Care Act so I read the law and I know that it works. I know that we can fix what does not work. We do not have to throw the whole thing away.

Like so many Americans, I have a preexisting condition myself.

I have a heart condition, SVT (supraventricular tachycardia), and it is well controlled. As you know, it is a preexisting condition, so I would not be able to get coverage under these repeal scenarios. And so, when the congressman made that promise I believed him.

And then a week to ten days later he went and voted for the American Health Care Act, which is a version of repeal that did the opposite. It made it cost prohibitive for people like me to get coverage. And so, I was upset not at the vote itself, but because he did not have the integrity to be honest the one time he stood before our community. That’s not what a representative is supposed to do. A representative is supposed to be transparent, accessible, and honest. And we deserve better. I said, “you know what, it’s on! I’m running” and launched my campaign in August and just won the primary on March 20th. I was in a field of seven—the only woman running against six men—and I won 57% of the vote.

Q

Were you the only African American?

Yes.

Q

I know you are concerned about overall access to care and have a deep commitment to utilizing your expertise and experience while working in the Obama administration.

Minority Nurse | SUMMER 2018

I believe that health care is the number one issue in this election across the country and in our district, and we need a solution to make health care more affordable for American families. It is not enough for families to rake together money for their premiums and have an insurance card in their pockets and cannot afford the coverage.

I believe that a lot of the conversation in the last sev-

as a result, we see extraordinarily high premiums that are unaffordable for most families.

That is not how the program was designed to work and so I think there are technical fixes we can do to make the program more affordable. We can do things like negotiate drug prices, it can be done, we need to take a strong position on this opioid drug addiction crisis. We need to implement reforms like how we pay for re-

I believe that health care is the number one issue in this election across the country and in our district, and we need a solution to make health care more affordable for American families. eral years has been political in nature and undoing President Obama’s legacy and not at all focused on trying to lower costs and make health care accessible for American families. That’s my objective!

I want to work on drug prices.

I want to work on this opioid drug crisis so that loved ones can get the treatment that they so desperately need.

And so, I believe there is a lot of value in having a nurse at the negotiation tables when we are making these decisions and passing policies that will transform our health care system. I am excited about the opportunity to be a leading voice on Capitol Hill on these important issues.

Q

What do you think are the most pressing issues impacting nursing and health care?

Affordability. Any program that is starved of resources will fail. The ACA has been intentionally sabotaged and

hab and how we award funds to municipalities in order to create a pathway for lasting change. And then there are opportunities to expand coverage so we will have fewer uninsured Americans. What we are seeing now in order to resuscitate it takes 2-3 doses of Narcan because the drugs are so strong. Municipalities who have received Narcan grants are running out of Narcan. A Narcan only solution is not a solution. Law enforcement only solution is not a solution.

Addiction is an illness and we need to treat it as such. We need to send people to treatment so they can have a shot at recovery. We could have an evidence-based policy solution. We know treatment can be effective.

Q

What do you think is the most pressing issue affecting nursing today?

I think there are a few things.

The high cost of our education. We have not really seen

Health Policy increases in funding. What we have seen are marginal increases or flat funding. I think that this is unacceptable, in particular in the context of what we are seeing in higher education more broadly. And not just at the federal level. In higher education, many states have reduced putting money into public education, shifting the responsibility to families and individuals and with that coupled with flat funding for nursing education we are seeing a generation of nursing students with significant debt.

And that is going to be a barrier, I believe, to our profession being able to grow. Right now, we have an economic situation where we are not seeing the shortage that we saw ten years ago. But it’s very easy to get back to that point if the economics of going into nursing shifts when you graduate from a BSN program with $100,000 in debt and are limited in your initial salary. Loan repayment programs are not that plentiful as they used to be. The economics of it makes it tough.

Because we are talking about middle class folks who are not able to take on that debt. And

Q

What are your thoughts about safe staffing?

Q

When elected, what would you do to go about helping to ensure equitable access to health care?

That’s like the question! For me, equitable access to health care allows everyone to get health care. Health care is a human right. Human rights have been fundamental to

And so, I believe there is a lot of value in having a nurse at the negotiation tables when we are making these decisions and passing policies that will transform our health care system. when it is becoming increasingly attractive to become an APRN, that is all debt to be able to get the master’s to become a nurse practitioner or a nurse midwife. We are going to need some serious advocacy and a plan to deal with the cost of our education.

Nurses Serving in Congress

It is so interesting. Safe staffing has been a legislative priority for decades. We have not been able to pass these bills.

I think the approach needs to be more balanced with safe staffing committees in these hospitals. Moving away from these ratios and having hospitals have safe staffing committees that would take into consideration the circumstances that facilities and the region when staffing levels.

On these committees, nurses would serve so a legislative body is not dictating it. I think that this is an appropriate approach coupled with compelling Medicare participating facilities to set staffing levels and monitor outcomes.

my nursing practice. It is written in our Code of Ethics—this idea that everyone should have health care—and I think our policies should reflect that. For me, that includes fixing the Affordable Care Act to ensure affordable coverage; and making sure we

Currently, there are three nurses serving in Congress: Representatives Karen Bass, APRN (D-CA), Diane Black, BSN (D-TX), and longtime Congressional Representative Eddie Bernice Johnson, BSN (D-TX). To learn more about nurses serving in Congress, please visit www.nursingworld. org/practice-policy/advocacy/federal/nurses-serving-in-congress.

The House and Senate Nursing Caucus The House Nursing Caucus was created in the U.S. House of Representatives in 2003 by former Congresswoman Lois Capps (D-CA) and is a bipartisan group of congressional members who create a forum to address a number of issues affecting in nursing. To learn more about the House Congressional Nursing Caucus, please visit www.aacnnursing. org/Portals/42/Policy/PDF/House-Nursing-Caucus-Members.pdf.

Similarly, the Senate Nursing Caucus was created in 2010 by Senators Jeff Merkley (D-OR), Mike Johanns (R-NE), Olympia Snowe (R-ME), and Barbara Mikulski (D-MD). To learn more about the Senate Congressional Nursing Caucus, please visit www.aacnnursing.org/Portals/42/Policy/ PDF/Senate-Nursing-Caucus-Members.pdf.

have clinics, hospitals, and facilities in communities so that the burden is not on lowincome people or people with transportation challenges or resource limitations so that people are able to get the care and services they need. We have so much innovation, technology, and so many improvements now in a way we are able to provide care whether it’s telemedicine or individualized health care. It is a shame if all of that innovation and all of those improvements are seen in resource communities. We need to be focused in these conversations about reform and transforming our system to ensure that it is serving everyone—rural, urban, low income, and elderly.

Your country needs you! There are too few nurses in policy positions. Seek a County Board position. The County Board supervises the local Department of Health. Run for state legislator, they address scope of practice issues.

Run for Congress! There are many opportunities to serve and lead. Step forward!

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

Q

What advice would you give to aspiring policy advocates who may be considering a run for public office?

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The Funny Bone COMPILED BY MICHELE WOJCIECHOWSKI

Nursing can be a tough job, but sometimes you just need a good laugh to keep you going. Enjoy the following hilarious stories sent in by your fellow nurses. Have a funny tale to tell? E-mail writer Michele Wojciechowski at MWojoWrites@comcast.net to share!

Watch What You Eat One time, for my class, I was making all these vomit and urine moulage items for my simulations. I needed to request a shelf in the faculty refrigerator for them so that they could stay fresh. The President and Dean of the nursing school were very weirded out by my assortment of items and types, but I got the shelf anyway.

Surprisingly, some faculty members thought the stuff was edible and actually tried to take some. Luckily, I stopped them before they could eat any.

I then placed signs on my items.

The simulations looked like vomit and urine—made me wonder what those folks normally brought for lunch!

—M.D., RN

This Takes the Cake!

When I teach about bowel elimination, I’ve learned that students respond more when I have fun with it. I convey the importance of nursing assessment and decision making to promote health and healing through lighthearted

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jokes and sharing my comical ­awkwardness with this topic.

On this particular day, I started off the lecture the same way I always do, making jokes and playing up my discomfort discussing and teaching about bowel movements and d-e-f-ec-a-t-i-o-n (even now, I can’t say it). I displayed the Bristol Stool Chart and told a story of my experience documenting and having the chart visible in our electronic medical record.

The students were sitting silent though feverishly taking notes.

Suddenly I heard one of them ask, “What does fluffy pieces with ragged edges mean?” “Is type 4 normal?”

The questions had begun. With this, the class came alive with more and more questions. I had never had the Bristol Stool Chart inspire inquiry in a group like that before. It was by far the most surprising and uncomfortable conversation I have ever had teaching nursing.

Two days later at the next class, a cake was waiting at the front of the room decorated impeccably with the infamous stool chart! I was glad that my class had learned how to have a sense of humor in this field.

We all ate it, and it was delicious!

—K.R., RN

Minority Nurse | SUMMER 2018

Kids Say the Darndest Things I’m a school nurse, and I went to check on a student recently. I had sent her home a couple days before and wanted to see how she was doing and how her day was going. Here’s how our conversation unfolded: Me: “How are you feeling today? You look better. Your dad told me you got some medicine from your doctor? So, I am just checking on you to see how your day is going.”

Student: “The doctor told me I had arthritis!”

Me: “Sweetie, you are so young to have arthritis! Oh my!”

I’m sure that she meant she had bronchitis!

—C.R., RN

Going to the Dogs While doing a med review, I asked a patient about an antibiotic for peritonitis prophylaxis.

His wife told me that it was in her purse.

My patient explained that one day, he took an antibiotic pill for the dog. He went up to his wife who was busy preparing dinner and said, “Hon, I think I took the dog’s

a­ ntibiotic!” So, his wife stopped and asked for the bottle. After examining it, she replied, “Yup, you did take the pills for the dog.”

The patient was all concerned and asked her, “Is something bad going to happen to me?” She responded, “Well, it is an antibiotic, and our dog weighs about 16 pounds, so I think you’ll be fine. But let me know how you feel later.”

The patient sat down and was still bothered about it.

His wife turned around and asked, “But if you start getting sick, who do we call? The vet or your doctor?” Both broke down into tears laughing.

After telling me this story, his wife looked at me and said, “So can you see why I keep the antibiotic for the peritonitis prophylaxis in my purse? To keep it away from him!”

And this is why we do med reviews every month…

—S.H., RN Do you have a funny story to share? It can be something that happened to you at work, while in nursing school, while teaching nursing school—practically anywhere, as long as it involves the nursing field. If so, contact Michele Wojciechowski at

MWojoWrites@comcast.net.

We may use your story in a future issue.

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.

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