Minority Nurse Summer 2019

The Career and Education Resource for the Minority Nursing Professional • SUMMER 2019

Salary Survey

Annual

Issue

+

The Entrepreneurial Nurse RETIREMENT PLANNING THE IMPOSTER PHENOMENON www.minoritynurse.com

Creating possibilities through inspired care Elizabeth Seton Children’s Center, a nationally recognized leader in health care and the largest provider of pediatric post-acute care in the U.S., offers a professionally challenging environment and personally rewarding opportunities in caring for our technology-dependent and medically complex children. The Center provides vital medical, nursing, therapeutic and educational services to ensure that each child can reach his or her greatest potential. We provide short-term interventions, as well as long-term care where the Center becomes a “home.”

Nurse Manager (Full-Time)

Registered Nurse

Requirements: • Minimum five (5) years RN experience with at least two (2) years in a supervisory role • Bachelor of Science degree in nursing or a related field • Current NYS RN license • At least two (2) years pediatric experience and five (5) years of nursing experience • Three (3) years of management/supervisory experience

Full-Time (Days & Nights) 12-Hour Shifts

Wound Care Prevention/ Treatment Coordinator (Full-Time) Requirements: • Current NYS RN license • BSN or MSN preferred • Certification in wound care as a Certified Wound Care Nurse (CWCN), Certified Wound Ostomy Continence Nurse (CWOCN) or Wound Care Certified (WCC) is preferred • Medical-surgical or pediatric nurse with a minimum of five (5) years clinical experience. Experience in pediatric and/or adolescent chronic/rehabilitative care preferred • Three (3) years of experience required in wound care • Must be able to prepare a lesson plan, write behavioral objectives and teach a program using valid teaching strategies • Must be able to design self-instructional programs • Must be able to coordinate and oversee a wound care program Center-wide • Must be able to design a performance checklist • Must be able to monitor quality assurance activities • Must possess computer-based competencies • Must be able to evaluate, track and monitor clinical performance and outcome measures

Requirements: • Graduate of an accredited RN program • Current NYS RN license • Bachelor’s degree in nursing preferred • Current BLS certification • One (1) year clinical experience in a pediatric and/or adolescent chronic/rehabilitative care facility preferred

For a complete description and to apply, please visit our website at

www.setonchildrens.org We are an equal opportunity employer, committed to diversity.

Table of Contents

In This Issue 3

Editor’s Notebook

4

Vital Signs

8

Making Rounds

Cover Story 10 2019 Annual Salary Survey

By Ciara Curtin

Features Academic Forum 31 Confronting the Imposter Phenomenon as a Minority Nurse

By Miriam O. Ezenwa, PhD, RN, FAAN

16 Navigating the Road to Nursing Leadership

By Michele Wojciechowski

20

Retirement Planning for Nurses

By Denene Brox

Degrees of Success 34 The Characteristics of a Professional Nursing Student

By Michelle Tanner, MSN, RN

Second Opinion 37

How to Retain Nurses in a Shortage Epidemic

By Kayla Carleton

Health Policy 39 The Indian Nurses Association of Illinois: Taking Matters to Heart

2

By Janice M. Phillips, PhD, FAAN, RN

Minority Nurse | SUMMER 2019

24 The Entrepreneurial Nurse: Unusual Side Hustles and Career Transitions

By Jebra Turner

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Do You Know Your True Worth?

E

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

very year we run our salary survey to help inform our community, but this year we decided to take a slightly different approach. We made the conscious

SPRINGER PUBLISHING COMPANY

decision to focus solely on you—our dedicated Minority Nurse readers—for your feedback rather than reaching out to our broader nurse network. The

result? A more accurate representation of what minority nurses actually make.

If you are feeling stifled by a less than ideal salary after seeing our results, then it may be time to think outside the box and consider the entrepreneurial route. Jebra Turner interviews nine nurse entrepreneurs who have unusual side businesses to help you discover the secrets of their success.

CEO & Publisher Mary Gatsch Vice President & CFO Jeffrey Meltzer

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

Creative Director Mimi Flow

Or maybe you are feeling trapped at a job with no room for growth. Want to take

Production Manager Diana Osborne

the leap towards leadership? Michele Wojciechowski investigates what it takes to be

Digital Media Manager Andrew Bennie

a nurse leader so you can decide whether this career path is right for you.

Whether you are at the bottom rung of the career ladder or all the way at the top, it’s important for every nurse to think about securing their financial future—and preferably sooner than later. Denene Brox speaks with financial experts to help you realize your retirement dreams.

It’s easy for nurses to feel undervalued, but it’s time we lift each other up as a community—and that starts with you. In her column, Miriam Ezenwa helps accomplished nurses confront the imposter phenomenon to realize their own self-worth. Meanwhile, Michelle Tanner advises nursing students on how to be professional to help them transition into the workforce.

Furthermore, HR recruiter Kayla Carleton argues for more on-the-job support for stressed-out nurses to help with retention, and Janice Phillips interviews the president of the Indian Nurses Association of Illinois about what nurses can do collectively to be influential advocates in health care, which benefits us all.

We hope that this issue will help you realize what your combined experience, skill set, and values are truly worth. Go forth and empower your fellow nurse!

—Megan Larkin

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.

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 Eric J. Williams, DNP, RN, CNE, FAAN President National Black Nurses Association

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

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

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

Vital Signs

Pregnancy-Related Deaths Happen Before, During, and Up to a Year After Delivery Pregnancy-related deaths can occur up to a year after a woman gives birth—but whenever they occur, most of these deaths are preventable, according to a new CDC Vital Signs report.

O

f the 700 pregnancyrelated deaths that happen each year in the United States, nearly 31% happen during pregnancy, 36 % happen during delivery or the week after, and 33% happen one week to one year after delivery.

Overall, heart disease and stroke caused more than 1 in 3 (34%) pregnancy-related deaths. Other leading causes included infections and severe bleeding. The leading causes of death varied by timing of the pregnancyrelated death.

The findings are the result of a CDC analysis of 2011-2015 national data on pregnancy mortality and of 2013-2017 detailed data from 13 state maternal mortality review committees. CDC defines pregnancy-related death as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication; a chain of events initiated by pregnancy; or the aggravation of an unrelated condition by the physiologic effects of pregnancy.

The data confirm persistent racial disparities: Black and American Indian/Alaska Native women were about

4

three times as likely to die from a pregnancy-related cause as white women.

However, the new analysis also found that most deaths were preventable, regardless of race or ethnicity.

Every Pregnancy-Related Death Reflects a Web of Missed Opportunities The CDC Vital Signs report provides the most current data available from CDC’s Pregnancy Mortality Surveillance System. It also summarizes potential prevention strategies from 13 state maternal mortality review committees (MMRCs).

MMRCs are multidisciplinary groups of experts that review maternal deaths to better understand how to prevent future deaths.

The committees determined that each pregnancyrelated death was associated with several contributing factors, including access to appropriate and high-quality care, missed or delayed diagnoses, and lack of knowledge among patients and providers around warning signs. MMRC data suggest that the majority of deaths—regardless of when they occurred—could have

Minority Nurse | SUMMER 2019

been prevented by addressing these factors at multiple levels.

Key Findings •• From 2011-2015, of pregnancy-related deaths: »»Nearly 1/3 (31%) happened during pregnancy. »»Just over 1/3 (36%) happened at delivery or in the week after. »»Exactly 1/3 (33%) happened 1 week to 1 year postpartum.

•• Leading causes of death differed throughout pregnancy and after delivery.

»»Heart disease and stroke caused more than 1 in 3 deaths overall. »»Obstetric emergencies, like severe bleeding and amniotic fluid embolism (when amniotic fluid enters a mother’s bloodstream), caused most deaths at delivery. »»In the week after delivery, severe bleeding, high blood pressure, and infection were most common. »»Cardiomyopathy (weakened heart muscle) caused

Vital Signs most deaths 1 week to 1 year after delivery.

Working Together to Prevent Maternal Deaths MMRC data demonstrate the need to address multiple contributing factors to prevent deaths during pregnancy, at labor and delivery, and in the postpartum period: •• Providers can help patients manage chronic conditions and have ongoing conversations about the warning signs of complications.

•• Hospitals and health systems can play an important coordination role, encouraging cross-communication and collaboration among health care providers. They can also work to improve delivery of quality care

before, during, and after pregnancy and standardize approaches for responding to obstetric emergencies.

•• States and communities can address social determinants of health, including providing access to housing and transportation. They can develop policies to ensure high-risk women are delivered at hospitals with specialized health care providers and equipment—a concept called “riskappropriate care.” And they can support MMRCs to review the causes behind every maternal death and identify actions to prevent future deaths.

•• Women and their families can know and communicate about the warning symptoms of complications and note their recent

pregnancy history any time they receive medical care in the year after delivery.

CDC is Prioritizing the Lives of America’s Mothers to Prevent PregnancyRelated Death •• CDC tracks pregnancyrelated mortality and severe pregnancy complications.

The agency provides technical assistance and resources to MMRCs to review maternal deaths and make prevention recommendations.

•• CDC will provide support to as many as 25 MMRCs across the country through the Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees funding opportunity, beginning in Fall 2019.

•• CDC also funds 13 state perinatal quality collaboratives to improve the quality of care for mothers and their babies.

•• To help states standardize their assessment of levels of maternal and newborn care for their delivery hospitals, CDC offers the CDC Levels of Care Assessment Tool and provides technical assistance to those who want to use it.

•• CDC is working to educate the public about pregnancyrelated death and how to prevent it.

To read the entire Vital Signs report, visit: www.cdc.gov/ vitalsigns/maternal-deaths. For more information about CDC’s work on maternal m ­ ortality, please visit: www.cdc.gov/ reproductivehealth.

Elderly Survivors of Three Common Cancers Face Persistent Risk of Brain Metastasis Elderly survivors of breast cancer, lung cancer, and melanoma face risk of brain metastasis later in life and may require extra surveillance in the years following initial cancer treatment, according to results of a study published in Cancer Epidemiology, Biomarkers, & Prevention, a journal of the American Association for Cancer Research.

“A

s cancer treatments have gotten better and more people are surviving a primary cancer diagnosis, it’s important to study secondary cancers, including metastasis to the brain,” says the study’s senior author, Jill S. BarnholtzSloan, PhD, Sally S. Morley Designated Professor in Brain

Tumor Research, Cleveland Institute for Computational Biology and Department of Population and Quantitative Health Sciences at Case Western Reserve University School of Medicine in Cleveland. “With an aging U.S. population, the number of people with brain metastasis is increasing, although sometimes that metastasis does not

occur until many years after the initial cancer diagnosis.”

“As people are living longer after an initial cancer diagnosis, their ‘time at risk’ for metastasis is going up. In addition, the majority of primary cancer diagnoses have no standard of care for brain metastasis screening,” says the study’s first author, Mustafa S. Ascha, MS, a PhD candidate in the Center for Clinical Investigation, Department of Population and Quantitative Health Sciences at Case Western.

In this study, researchers analyzed rates of synchronous brain metastases (SBM), those diagnosed during the staging

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workup for the primary cancer, and lifetime brain metastases (LBM), those diagnosed later in life. Primary cancers in this study were lung cancer, breast cancer, and melanoma, which are more likely to metastasize to the brain than many other cancer types.

The researchers linked data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database to Medicare claims data on brain metastases to investigate rates of brain metastasis in elderly patients.

Because Medicare is the primary insurer for most patients age 65 or older, the results of SEER-Medicare studies are

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Vital Signs generalizable to the elderly population, Barnholtz-Sloan explains. Final data included patients diagnosed in 2010 through 2012, with 70,974 lung cancer cases, 67,362 breast cancer cases, and 21,860 melanoma cases.

The researchers calculated incidence proportion, the ratio of brain metastases counts to the total number of cases, for each primary cancer.

For primary lung cancer, the incidence proportion of SBM was 9.6% and for LBM, 13.5%. The highest rates of metastasis were in small-cell and non-small-cell lung carcinoma, compared with adenocarcinoma, a more common type of lung cancer.

For primary breast cancer, the incidence proportion of

6

SBM was 0.3% and for LBM, 1.8%. The rates of brain metastasis were lowest among patients who had localized breast tumors and highest among those whose cancer had already spread to another part of the body. The rates also varied by molecular subtype, with the highest rates for triple-negative breast cancer.

For melanoma, the incidence proportion of SBM was 1.1% and for LBM, 3.6%. Rates rose dramatically for patients whose melanoma had already spread at the time of diagnosis; 30.4% of those who had distant disease at diagnosis would later develop brain metastasis, compared with 15.2% of those who had regional and lymph node involvement, 13.2% who had lymph node involvement

Minority Nurse | SUMMER 2019

only, 7.8% who had regional tissue involvement, and 2.5% among those who had localized disease.

Barnholtz-Sloan and Ascha say that the results of the study could help clinicians better understand patients’ risk for brain metastasis and could potentially influence screening and surveillance practices.

“Brain metastases are detected with MRI, which is very expensive,” BarnholtzSloan says. “An improved understanding of who is likely to develop a brain metastasis could help determine who should get an MRI.” Ascha adds that more targeted surveillance could potentially help physicians detect metastases at early stages.

“If we can identify brain

metastases earlier in their progression, that could allow for earlier treatment and improved outcomes for these patients,” he says.

The authors said the study’s primary limitation is that Medicare data, while providing a comprehensive view of the elderly population, cannot always be generalized to younger patients. Also, the study encompassed four to five years of follow-up, whereas in some cancers, such as breast cancer, brain metastasis can occur decades after the initial cancer, Barnholtz-Sloan says.

For more information about this study, visit www.aacr.org.

Vital Signs

Emergency Treatment Guidelines Improve Survival of People with Severe Head Injury A large study of more than 21,000 people finds that training emergency medical services (EMS) agencies to implement prehospital guidelines for traumatic brain injury (TBI) may help improve survival in patients with severe head trauma. The findings were published in JAMA Surgery, and the study was supported by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.

“T

his demonstrates the significance of conducting studies in realworld settings and brings a strong evidence base to the guidelines,” says Patrick Bellgowan, PhD, program director at NINDS. “It suggests we can systematically increase the chances of saving lives of thousands of people who suffer severe traumatic brain injuries.”

Based on scores of observational studies, guidelines for prehospital management of TBI that were developed in 2000, and updated in 2007, focused on preventing low oxygen, low blood pressure, and hyperventilation in people with head injury.

Collectively, the studies suggested that controlling those factors before patients arrived at the hospital could improve survival, but actual adherence to the guidelines had not been examined.

The Excellence in Prehospital Injury Care (EPIC) Study, led

by Daniel Spaite, MD, professor of emergency medicine at the University of Arizona in Tucson, trained EMS agencies across Arizona in the TBI guidelines and compared patient outcomes before and after the

guideline implementation. All patients in the study experienced head injury with loss of consciousness. This public health initiative was a collaboration between the university and the Arizona Department of Health Services. The EPIC study is the first time that the guidelines were assessed in real-world conditions.

The results showed that implementing the guidelines did not affect overall survival of the entire group, which included patients who had

moderate, severe, and critical injuries. However, further analysis revealed that the guidelines helped double the survival rate of people with severe TBI and triple the survival rate in severe TBI patients who had to have a breathing tube inserted by EMS personnel. The guidelines were also associated with an overall increase in survival to hospital admission.

“We found a therapeutic sweet spot and showed that the guidelines had an enormous impact on people with severe TBI. The guidelines did not make a difference in the moderate TBI group because those individuals would most likely have survived anyway and, unfortunately, the extent of injuries sustained in many critical patients was too extreme to overcome,” says Spaite.

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Bentley Bobrow, MD, professor of emergency medicine at the University of Arizona and coprincipal investigator for the study says, “It was exciting to see such dramatic outcomes resulting from a simple twohour training session with EMS personnel.”

Although the guidelines provide specific recommendations for oxygen levels and blood pressure, researchers will examine whether those ranges should be revised.

More research is needed to determine the best strategies for airway management and breathing support to optimize ventilation. Additional studies will investigate the best methods for national and global adoption of the TBI guidelines.

For more information about NIH and its programs, visit www.nih.gov.

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Making Rounds

July 16-19

26-28

National League for Nursing

44th Annual Conference Peppermill Resort Hotel Reno, Nevada Info: 919-573-5443 E-mail: info@thehispanicnurses.org Website: http://nahnnet.org

2019 Education Summit Gaylord National Resort & Convention Center National Harbor, Maryland Info: 202-909-2500 E-mail: summit@nln.org Website: www.nln.org/conferences/ summit-2019

23-28

27-29

47th Annual Institute and Conference Hilton New Orleans Riverside New Orleans, Louisiana Info: 301-589-3200 E-mail: info@nbna.org Website: www.nbna.org

National Educational Conference Flamingo Hotel and Casino Las Vegas, Nevada Info: 877-353-8888 We b s i t e : h t t p s : / / n n b a n o w. c o m / nnba-conference-2019

National Association of Hispanic Nurses

National Black Nurses Association

24-28

Philippine Nurses Association of America 2019 National Convention Atlanta Marriott Marquis Atlanta, Georgia E-mail: infomypnaa@gmail.com Website: www.mypnaa.org

August

National Nurses in Business Association

October 16-19

Transcultural Nursing Society 45th Annual Conference Omni Hotel Richmond, Virginia Info: 888-432-5470 E-mail: staff@tcns.org Website: www.tcns.org

7-9

24-26

Doctors of Nursing Practice

American Academy of Nursing

2019 National Conference Fairmont Washington, D.C., Georgetown Washington, District of Columbia Info: 888-651-9160 E-mail: info@doctorsofnursingpractice.org Website: www.doctorsofnursingpractice.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

September 11-14

Academy of Neonatal Nursing Fall National Advanced Practice Neonatal Nurses Conference Caribe Royale Hotel Orlando, Florida Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

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Minority Nurse | SUMMER 2019

October/ November October 31 – November 2 The American Assembly for Men in Nursing

2019 Annual Conference Wyndham Lake Buena Vista Orlando, Florida

Info: 859-977-7453 E-mail: info@aamn.org Website: www.aamn.org

November 8-10

Organization for Associate Degree Nursing 2019 National Convention Omni Louisville Hotel Louisville, Kentucky Info: 800-809-6260 E-mail: oadn@oadn.org Website: www.oadn.org

March 18-20

Southern Nursing Research Society 34th Annual Convention Sheraton New Orleans New Orleans, Louisiana Info: 877-314-7677 E-mail: info@snrs.org Website: www.snrs.org

18-21

Dermatology Nurses’ Association 38th Annual Convention Crowne Plaza Denver Denver, Colorado Info: 800-454-4362 E-mail: dna@dnanurse.org Website: www.dnanurse.org

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BY CIARA CURTIN

2019 Annual Salary Survey Overall, salaries among respondents to this year’s Minority Nurse salary survey largely held steady but are influenced by where nurses work as well as their education and experience levels.

N

urses reported making approximately the same salary this year as they did last year.

Overall, respondents to this year’s Minority Nurse salary survey earned a median $76,000, a slight uptick from the median $75,000 respondents to last year’s survey said they made.

Hispanic and African American nurses, however, reported making slightly less this year than they did last year. This year, Hispanic nurses earned a median salary of $72,000, as compared to $75,000 in 2018, and African American nurses earned a median $76,000 in salary this year, but $80,100 last year.

White nurses, meanwhile, made approximately the same salary this year as last year—$72,325 versus $72,750—but Asian nurses this year said they made a median salary of $116,000, a jump from last year’s $91,000.

Number of Respondents:

310 Ethnicity 7.5%

2.9%

3.3% 2.0% 1.6%

5.8% 10.7%

66.2%

■ African American ■ Hispanic or Latino/Latina ■ White/Non-Hispanic ■ Asian ■ Prefer not to answer ■ Other ■ Multiracial ■ Native American

Gender 10.5%

89.5%

■ Female ■ Male

10

To collect this data, Minority Nurse and Springer Publishing e-mailed a link to an online survey that asked nurses about their salaries, as well as about their education, employers, specialties, and more. More than 300 nurses, largely from the United States, but also from outside the country, responded.

The nurses who responded to the survey work in everything from patient care to research and fill administrative and leadership roles, as well as roles in education and case management.

Some have been a nurse only for a little while (5.5%,), but about 40% of those who took the survey have been in nursing for 21 or more years. Some of the nurses who responded have sought certification in specialties, including in family health, acute care, and mental health.

Most of the respondents—nearly 90%—are women.

According to the survey results, some employers pay better than others. For instance, nurses working at private hospitals reported taking home the highest median salary, $89,000. Nurses working at public hospitals, meanwhile, made less, a median $70,000.

Colleges and universities were also among the top-paying employers, with nurses working there earning a median $82,000 in salary, according to respondents.

Similarly, nurses in some specialties are paid more than nurses in other specialties. Topping the high-paying specialty list are family nurse practitioners, who said they earn a median salary of $110,000, followed by nurses who specialized in administration at $102,500, and by nurses specializing in mental health nursing, who reported a median salary of $90,000.

Educational background also influenced respondents’ salaries. Nurses with doctoral-level degrees reported the highest salary, a median $104,500, followed by nurses with master’s degrees who said they took home $89,293, and nurses with bachelor’s or associate’s degrees earned $74,500 and $65,250, respectively.

At the bachelor’s-level, nurses of different ethnic backgrounds made broadly similar salaries.

African American nurses with a bachelor’s degree made a median $75,000, though white nurses and Hispanic nurses received slightly less, a respective $68,500 and $72,500 in salary.

Similarly, nurses with more years of experience in the field received higher salaries. While freshly trained nurses reported making a median $60,969, nurses with 21 years or more of experience said they took home a median $90,000.

Minority Nurse | SUMMER 2019

Regions

Years as a Nurse

3.0% 5.5%

15.8%

17.4%

40.9%

39.8% 15.8%

19.1%

22.0%

20.7%

■ South ■ Northeast ■ Midwest

■ West ■ Outside the United States

■ 21 or more years ■ 11 to 20 years ■ 6 to 10 years

Main Role 10.7%

2.8%

Employer Type 2.8%

1.1%

3.4%

3.1%

1.4%

0.7%

0.7%

2.4%

3.4%

10.0%

40.5%

6.2% 10.4%

■ 1 to 5 years ■ Less than a year

8.2%

18.3%

■ Patient care ■ Leadership/Management ■ Education ■ Administrative

33.0%

5.8% 7.6%

■ Other ■ Case Management ■ Triage ■ Research

11.7%

15.8%

■ Public Hospital, including ■ Health Department/ Veteran’s or Indian Affairs Public Health Agency Hospitals ■ Home Health Care Service ■ Private Hospital ■ Public School ■ College or University ■ Walk-In Clinic ■ Other ■ Correctional Facility ■ Nursing Home, LTC, or ■ Military Rehabilitation Center ■ Pharmaceutical/ ■ Health Insurance Research Company Company/HMO/MCO ■ Private Practice or Physician’s Office

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Median Salary by Region

Northeast

West

$85,500

$82,398

Midwest $80,000

South $71,162

Median Salary by Region and Ethnicity

Northeast

South

Midwest

West

$0

$10,000

$20,000

■ Hispanic or Latino/Latina

12

Minority Nurse | SUMMER 2019

$30,000

$40,000

■ African American

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

Median Median Salary Salary byby Education Education Level Level

Median Median Salary Salary byby Main Main Role Role

$110,000 $110,000

$100,000 $100,000

$100,000 $100,000

$90,000 $90,000

$90,000 $90,000

$80,000 $80,000

$80,000 $80,000

$70,000 $70,000

$70,000 $70,000 $60,000 $60,000 $60,000 $60,000 $50,000 $50,000 $50,000 $50,000 $40,000 $40,000

$40,000 $40,000

$30,000 $30,000

$30,000 $30,000 $20,000 $20,000

$20,000 $20,000

$10,000 $10,000

$10,000 $10,000

$0 $0

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Median Median Salary Salary byby Specialty Specialty

$100,000 $100,000

$110,000 $110,000

$90,000 $90,000

$100,000 $100,000

$80,000 $80,000

$90,000 $90,000

$70,000 $70,000

$80,000 $80,000

$60,000 $60,000

$70,000 $70,000

$50,000 $50,000

$60,000 $60,000

$40,000 $40,000

$50,000 $50,000

$30,000 $30,000 $20,000 $20,000 $10,000 $10,000 $0 $0

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$40,000 $40,000 $30,000 $30,000 $20,000 $20,000 $10,000 $10,000 $0 $0

t t r r r r e e n n lth lth to to ar ar en en ne ne tio tio C C ca uca ea ea io itio t ra tra em gem e te u i t t g t ct d Ed s is l H al H a a u cu i c E a c a a t t in in an an A A se se Pr Pr en en m m M M ur ur se se se se N N Ad Ad /M c/M c ur ur i i d d Ca Ca r r N N ie ie at at tif tif ily ily hi hi er er m m yc syc C C s Fa Fa P P

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Median Salary by Ethnicity White/Non-Hispanic

Hispanic or Latino/Latina

Asian

African American

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

$110,000

$120,000

Median Salary by Education and Ethnicity

Master’s

Bachelor’s

$0

$10,000

$20,000

$30,000

White/Non-Hispanic

$40,000

$50,000

Hispanic or Latino/Latina

$60,000

$70,000

$80,000

$90,000

$100,000

$110,000

$120,000

African American

Median Salary by Organization and Ethnicity

Public Hospital

Private Hospital

$0

$10,000

$20,000

Hispanic or Latino/Latina

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$30,000

$40,000

Asian

$50,000

$60,000

African American

$70,000

$80,000

$90,000

$100,000

$110,000

Timing of Last Raise Received 11.1%

Highlights • 33.0% work at a public hospital • 40.5% work in patient care

4.3%

• 40.9% have been working as a nurse for 21 years or more

12.8%

• 71.8% received a raise within the last year • 59.8% said their last raise was a 1-2% boost 71.8%

■ Last year ■ 2 years ago

■ 3 to 5 years ago ■ More than 5 years ago

Top Two Degrees Held

by Respondents • BSN, or other bachelor’s-level degree • MSN, or other master’s-level degree

Most Common Specialties • Administration/Management • Family Nurse Practitioner

Percentage of Last Raise

• Case management • Acute care (tie) • Critical care (tie)

5.4%

4.7%

• Psychiatric/Mental health (tie)

30.1% 59.8%

Highest Paid by Employer Type • Private hospital • College or university

■ 1% to 2% ■ 3% to 4%

■ 5% ■ More than 5%

• Public school • Health insurance company/HMO/MCO • Private practice or physician’s office

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Navigating the Road to Nursing Leadership Leadership—it’s the Holy Grail that’s stressed in business and health care administration. But how can you get there? And how do you know if nursing leadership is even right for you?

By Michele WOJCIECHOWSKI

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“N

ot everyone has the skills, desire, or disposition to be an administrative leader,” says Laura S. Scott, PCC, CPC, ELI-MP, CPDFA, president and founder of 180 Coaching, an executive coaching and leadership training provider based in Tampa, Florida. “I recommend that my clients go to a trusted supervisor and ask, ‘Where do you see me going as a professional and leader?’ and then just listen. You might be surprised at what you hear.

If you have a role in mind, ask that trusted supervisor if they think you would be a good fit for that role and ask, ‘Why or why not?’”

Use caution when thinking about getting into leadership. “Don’t rush into what isn’t easily seen as an opportunity,” says Alisha Cornell, DNP, MSN, RN, a clinical consultant with Relias, a health care talent and performance solutions company. To decide whether a leadership role is right for them and what they want get out of it, Cornell says that self-exploration is necessary. “How did the nurses identify that they even wanted to be nurses? My recommendations are to stick to the original design. Whatever got you to nursing school and whatever helped to push you out of there, that’s your personalized equation.”

If you’re not sure if you want to be a leader, Romeatrius Nicole Moss, DNP, RN, APHN-BC, founder and CEO of Black Nurses Rock, says, “First, it is determined by the specialty you enjoy, followed by what you can contribute.

Leadership starts now, as a staff nurse.” She suggests you ask yourself these questions:

•• Do people often come to you for help, advice?

•• Do you offer suggestions at meetings?

•• Are you the go-to person for issues on the unit before elevation to leadership?

•• Are you available, outgoing, approachable?

“If you are the unit leader, charge nurse, etc., these positions are set up to move you to the [higher] levels when opportunities arise,” explains Moss.

“So be ready.”

If you know that you aspire to a leadership position, then move ahead. If you don’t or you try a leadership role and don’t like it, that’s okay. “If you don’t like nursing leadership, you can always go back to patient care,” says Thomas Uzuegbunem, BSN, RN, an RN administrative supervisor as well as the editor of the nursing leadership blog, NurseMoneyTalk.com. “Some nurses can get enough leadership fulfillment by being on a board. Others find that it’s not enough, and they want to move into nursing leadership as a career.”

Make sure that after selfreflection, you are the one making the decision to move into a leadership position.

“Nurses who are seen as good caregivers are often promoted.

While patient care is extremely important, being able to care for a patient does not mean that a nurse can care for a team of peers,” explains Bill Prasad, LPC, LCDC, CTC, a licensed professional counselor who has also worked as a hospital director and a leadership coach. “A nurse must understand that moving to a leadership role means you are moving from a focus on health care to a focus on organizational health.”

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If that doesn’t fit in your life goals, there’s no shame in not pursuing leadership or moving into management. Yanick D. Joseph, RN, MPA, MSN, EdD, an assistant professor of nursing at Montclair State University in New Jersey sums it up: “Not everyone is destined to lead or to be an administrator,” she says.

Skills and Characteristics Needed for Nursing Leadership “Leaders are born, but there are no born leaders,” says Prasad. “Becoming an effective leader takes training and education. Without this, you don’t know what you don’t know.”

Communication, flexibility, and organizational skills are the most important skills that Moss believes nurses wanting to move to leadership need to have. “Leaders should have the skills that allow them to be calm in stressful situations such as in crisis, emergencies, schedule management, and more,” she says. Nurses also need the “ability to work with different personalities and change leadership styles based on the staff member. Nurses should understand this even while working with their teams: you cannot use the same leadership style on everyone. Some people do better with taskers and checklists, while others need a little supervision to flourish.”

Moss says that leaders must be relatable and personable.

“Allow your staff to see you get your hands dirty. Be the expert on the unit/department and show the team your skills and that you can handle the unit if need be. Start IVs, jump in on a code, participate while letting your team lead.”

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One other characteristic Moss believes is imperative for nurses who want to lead is to be calm when challenged or with disagreements. “It is

“These characteristics are important because the normal job responsibilities of the nurse require quick thinking and paying attention to details.

“A nurse must understand that moving to a leadership role means you are moving from a focus on health care to a focus on organizational health.” important to understand differences of opinion and to negotiate the best options. It’s even more important when dealing with difficult staff, family, etc. to not get emotional and to always be open-minded.” She admits that this was tough for her when she began to lead. “I had to understand the different personalities, politics, and overall strategic plan, and how they all come into play with decision making. Once you get this, your life will become less stressful,” she explains.

Scott agrees that good communication skills are crucial.

“Effective communication and opening the channels for two-way feedback is very important. Also important is knowing what keeps these staff and providers on board and engaged so that you can give them what they need to stay motivated and fulfilled,” says Scott.

When communicating with others, Cornell says to keep this in mind: “Nurses are wellversed in the scientific methods of providing care from an academic perspective, but relating to ourselves, learning to listen for the conversation instead of solving a problem, and not reacting spontaneously are all critical skills of a strong leader.”

Nurses also need to be patient and have courage.

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However, being a great leader requires the brain to slow down and digest the information in order to resolve a problem or at least know where to look to resolve it,” says Cornell.

Educational Necessities While our sources have different opinions on how much education leaders need, one thing is certain: if you want to hold a leadership position, you must keep learning all the time.

“Nurses need to obtain additional education, certifications, and always continue to have a thirst for knowledge,” says Cornell. “A nurse leader should have, at minimum, a master’s degree in a focused area of nursing.” While she says other advanced degrees are helpful,

“Leaders are born, but there are no born leaders,” says Prasad.

“Becoming an effective leader takes training and education. Without this, you don’t know what you don’t know.” one focused specifically on nursing “drives the objectives of nurse leadership and the shared experiences of nurse leaders. At the advanced leadership level— which includes directors and CNOs, they should have a docNurse leaders, Uzuegbunem says, must have an ability to accept diversity and understand technology. “Nurse leaders must be able to embrace diversity and adapt to those cultural differences of the nurses they lead as well as the patients the nurses take care of,” says Uzuegbunem.

“Technology is having more of an influence in health care. From electronic medical records to the equipment nurses use. [Leaders] need to be able to adapt to these technological changes.”

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“A nurse aspiring a position in leadership should attain the highest level above what the unit or department requires,” suggests Moss. “Managing nurses who have higher credentials could lead to resentment or turnover as the staff nurse doesn’t see progression at the top. A unit should be led by the expert, in my opinion, the go-to person. This person should obtain the needed certification, education, and training to support this.”

Scott reminds nurses to check to see if the facility you work for provides funding for earning advanced education.

“Many hospital groups will offer tuition reimbursement to qualified candidates, so you don’t have to go into deep debt to get this education,” she says.

Uzuegbunem believes that there’s no set educational path to leadership. “Depending on who you talk to, you’ll get different answers. Some will say that nurses should have at least a BSN before being able to get into leadership. I don’t. I also don’t think a certification is needed. All that’s required is a desire to lead others and a willingness to serve those you lead,” he argues.

Moss says that leaders must be relatable and personable. “Allow your staff to see you get your hands dirty. Be the expert on the unit/department and show the team your skills and that you can handle the unit if need be.” torate. The terminal degree is a collaborative journey of nursing experience and leadership needed to facilitate a structured systems approach to patient care and organization of nursing teams.”

Money, Money, Money Besides the other skills, characteristics, and education that prospective leaders need, there’s another that many don’t consider—financial knowledge. Jane C. Kaye,

MBA, president of HealthCare Finance Advisors, states that nurses in supervisory positions in all types of health care facilities need to have some financial skills. “The financial health of health care organizations depends on how well nurse leaders manage staff and supply costs. For example, salaries are the single largest expense line in any health care facility, and nurses represent the largest share of salaries. Similarly, nurses lead large departments such as surgical services, where supply costs are very high. If salary and supply costs are not managed, the sheer size of these spending areas can jeopardize the financial health of the health care entity,” explains Kaye.

According to Kaye, the types of financial skills nurse leaders need include: management of full-time equivalent staff, management of supplies, expense variance analysis techniques, knowledge of budgets, an understanding

“A nurse aspiring a position in leadership should attain the highest level above what the unit or department requires,” suggests Moss. of operating statistics, and an understanding of charge capture techniques so that all services performed are included on the patients’ bills.

For nurses who don’t have good math and finance skills, Kaye suggests that they find a trusted colleague in finance to help them understand financial concepts. “They should never be afraid to ask questions,” she says.

Attending webinars, seminars, and workshops on finance may also help.

leadership roles outside of work. For those who want to become more confident speakers and grow in leadership presence, she recommends looking into Toastmasters, a national organization with chapters across the U.S. that help members learn to give great speeches.

Cornell says that networking is a must but can begin way before nurses are even considering leadership

Prep Work A good way to prepare for a nursing leadership role, says Scott, is by taking on

A good way to prepare for a nursing leadership role, says Scott, is by taking on leadership roles outside of work. roles. “Knowing colleagues in the industry is always a plus, and it helps to learn what other nurses are doing.

Volunteering for committees and sitting on boards are all great experiences, and nurse leaders should participate in these activities,” says Cornell.

She cautions that doing this should be fine. If it’s not what the nurse is aligned with liking or doing then s/he will lose interest fast.

“Becoming part of committees and boards allows you to gain the experience and confidence you need to speak out

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on your opinions, work with different personalities, and see your strengths and weaknesses,” says Moss. “It can really show you what type of leader you naturally are.”

To prepare for taking a leadership role, Joseph suggests the following: reading professional journals, attending seminars, networking, joining LinkedIn, researching the role you want, reaching out to professional organizations for best practices, speaking to a mentor or someone who has made the transition, being proactive and enthusiastic about learning the intricacies of the new role, and being visible.

No matter what, being true to yourself is most important.

“Being a leader is challenging, arduous, demanding, trying, and hard,” says Joseph. “But the joy of doing what you are born to do and have a passion to accomplish is indescribable.”

Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about the nursing field but comes close to fainting when she actually sees blood. She’s also author of the humor book, Next Time I Move, They’ll Carry Me Out in a Box.

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Retirement Planning for Nurses Are you saving for retirement? Here’s your guide to getting on track with securing your financial future.

BY DENENE BROX

S

aving for retirement can often feel so daunting that you push it to the back of your mind.

When trying to manage your career and other personal finance goals such as buying a house and paying down debt, retirement planning and investing often takes a back seat. You know you should ask your HR department about the 401(k) plan your company offers, but you never get around to it. But it’s worth the effort now so that you are wellprepared for the future.

The truth is many Americans are not saving for their golden years.

According to a 2018 survey

by Northwestern Mutual, one in five Americans has nothing saved for retirement. And 78% of Americans are “extremely” or “somewhat” concerned about affording a comfortable retirement. One in three Baby Boomers (33%), the generation closest to retirement age, have between $0-$25,000 in retirement savings.

Generations X and Y are often saddled with student loan debt and stagnant wages, making it a struggle to save.

While these are scary facts, the good news is that once you take the time to educate yourself on the basics of retirement

planning and you take a few smart steps to invest, you can largely put retirement investing in the back of your mind and not feel guilty that you

about retirement planning.

She also says that making projections and calculating retirement budgets can be a pain but is important to do.

You know you should ask your HR department about the 401(k) plan your company offers, but you never get around to it. But it’s worth the effort now so that you are well-prepared for the future. aren’t taking necessary action.

Jane Bryant Quinn, author of How to Make Your Money Last: The Indispensable Retirement Guide, says many people don’t want to think

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“You have to add up your savings, estimate what you’ll get from Social Security, make an investment plan, estimate how much income your investments will provide,

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and estimate your retirement expenses,” says Bryant Quinn.

To help figure all of this out, Bryant Quinn says to create budgets. “If you’re married, make three estimated budgets—one for you as a couple, one for you if your mate dies first, one for your mate if you die first. For example, married couples get two Social Security checks (one for each). When one of you dies, the survivor will get the larger check but lose the other one. So, you have to plan for all circumstances,” she says.

Daniel Burke, CFP, ChFC, president of Burke Financial Group, LLC, says nurses spend their entire working careers caring for the needs of others, but often by doing this, they tend to neglect important planning components for themselves.

Are you ready to take action? Below are answers to the most common questions about retirement planning and investing to get you started on the road to a secure future.

What Are My Retirement Dreams?

Start with finding your why.

What motivates you when you dream about your retirement?

Do you want to spend a year traveling around the country in an RV? Do you want to move to a new city? Do you want to spend more time on hobbies such as gardening, crafts, or learning to speak Spanish? Or perhaps you want more time to devote to friends and family or a cause close to your heart.

Identifying the life you’d like to retire to can serve as a strong motivator as you start down the path of savings.

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It’s much easier to devote 15% of your income to your retirement account versus

Identifying the life you’d like to retire to can serve as a strong motivator as you start down the path of savings.

spending that money on something fleeting when you can e ­ nvision the life you’re saving for.

How Do I Get Started?

“Benefits through the employer are a great place to start as nurses begin planning for themselves and their families,” says Burke.

Educate yourself on the retirement benefits offered by your employer. If your employer offers a 401(k) or 403(b) option with a matching benefit, sign up for the match immediately. If you are not taking advantage of your employer’s match, you are literally leaving free money on the table.

If your employer doesn’t offer a 401(k) option, then open a Roth IRA through a brokerage such as Fidelity or Vanguard. Contributions made to a Roth are after-tax contributions, but your money and earnings grow tax-free (meaning you will not pay taxes on any returns you earn from your investments).

and change the past, but you can commit to saving going forward.

Bryant Quinn offers the following advice, depending on your age.

New Grads: “Start a savings account, to have a little cash on hand. Put a little into your employer’s retirement plan, despite your student loan. If you change jobs, don’t cash out the amount you saved, take it with you to a new job,” says Bryant Quinn.

Mid-Career: Higher earning years means higher savings. “In your retirement plan, chose funds that lean heavily to stock market investments.

It doesn’t matter if stocks go down. Throughout history, they have always come back,” says Bryant Quinn. “You have the time to wait. It’s your best shot at a nest egg. Keep con-

If you haven’t been saving anything for retirement, it’s important not to beat yourself up. You can’t go back and change the past, but you can commit to saving going forward.

tributing to your plan, even if your kids are in college (or at least try to).”

Near Retirement: Time to plan. “Keep investing in stockowning mutual funds,” says Bryant Quinn. “You will probably live another 30 years (or more—my mom made it to 103). Over such a long period of time, stocks always go up.”

How Much Should I Save?

What If I Haven’t Been Saving?

If you haven’t been saving anything for retirement, it’s important not to beat yourself up. You can’t go back

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everyone should take advantage of it. For instance, if your company offers a 5% 401(k) match, you should invest no less than 5%. But that’s just a starting point.

Another strategy that Bryant Quinn suggests is to simply start by taking at least 5% out of every paycheck and putting it into your 401(k) or 403(b). “If you’re already contributing, increase the amount. What will happen when you get a slightly smaller net paycheck?

Nothing will happen. We all tend to spend whatever money we have in our checking accounts. If there’s less in your account, you’ll spend less—even without a budget,” she says. “You’ll make small adjustments without realizing it. It’s the only magic I know in personal finance.”

If you’re starting from scratch, a good starting point is to invest enough to get any company match offered by your employer. This is essentially free money and

If your company does not offer a 401(k) program or a match, you can open a Roth IRA through a brokerage service on your own.

“If you have no plan [at work], Individual Retirement Accounts (IRAs) can be purchased at low-cost no-load mutual fund groups such as Vanguard. They’re available at banks, too, but usually with higher fees. Always choose low-cost investments,” says Bryant Quinn.

Once you start gaining some confidence in your knowledge and are eager to save more Bryant Quinn suggests

utilizing financial resources, such as online retirement calculators and budgeting tools to estimate retirement living expenses.

automatically investing any annual or performance raises you receive. If you were living on what you made before you got a raise, just keep living off

If all of this sounds complicated and you would like a helping hand, consider working with a financial advisor. But choose wisely as many financial advisors get paid by selling you on specific mutual funds, often with high fees.

Overall, determine a percentage goal that works for you and challenge yourself to increase it incrementally (e.g., every six months or annually). You can also boost your savings effortlessly by

of that amount and invest the extra income.

Do I Need A Financial Planner?

helping hand, consider working with a financial advisor.

But choose wisely as many financial advisors get paid by selling you on specific mutual funds, often with high fees.

These fees will eat away at your nest egg.

Your best bet is to hire an independent advisor who is fee-only or paid directly by you by the hour. Your company may provide consultations with an advisor from the administrator of your 401(k)/403(b) plan, but it’s important to remember that their loyalty is first and foremost with their employer, not you.

What Is the Biggest Mistake I Could Make?

“Not saving enough,” says Bryant Quinn. “You can save money, even if you’re living paycheck to paycheck.”

Denene Brox is a freelance writer based in Kansas City, Kansas.

If all of this sounds complicated and you would like a

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The Entrepreneurial Nurse Unusual Side Hustles and Career Transitions

BY JEBRA TURNER

Many nurses have answered the call to entrepreneurship, starting successful part-time endeavors or profitable full-time enterprises.

The nurses profiled here started interesting businesses that are unusual, creative, or outright quirky.

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L

earn from these nurses as they describe their start-up experiences, and from some business development experts who advise nurses. They will likely spark ideas for your own entrepreneurial adventure.

To make anything a business you need to make sure you have three things: Somebody who wants, needs, and desires it—and who is willing to pay for it. You have to be able to produce your widget, content, or product. You also have to administer money effectively and profitably. I always advise nurses to identify the fastest path to cash. Bigger than your money investment, even, is your time commitment.

If a nurse doesn’t have a strong interest or passion, then what?

Michelle Podlesni, RN President of the National Nurses in Business Association (NNBA)

What do you advise nurses who want to start a business?

I always ask them: What makes you happy? What makes your heart sing? Nurses are creative, and there are always ways to express more of who they are. You can design a workstyle around your lifestyle. We’re more than one thing—we may be moms, sis-

Some nurses don’t want to do their own thing, they want a business in a box. Franchises are well-suited to nurses. And there are all kinds of opportunities out there. I do have one big caveat—always test your assumptions before investing.

Nurses don’t do enough due diligence. Do proper investigation before putting money in anything, whether an MLM, franchise, or a website design service.

What does the NNBA offer someone new to that path?

About 50% of our members are nurses who are aspiring entrepreneurs. We have many resources and tools on our website and Facebook page. Nurses inter-

If you don’t have a passion for a certain business, you won’t be able to keep going. We need nurses to be patient advocates and to dispel myths.

will be held September 27-29, 2019, in Las Vegas, Nevada.

What’s your advice for a nurse who wants to become a medical cannabis consultant?

Lolita Korneagay, RN, BSN, MBA, LNC Nurse Medical Cannabis Consultant and Founder of Cansoom

Tell us about your unusual new venture.

I started Cansoom in 2017, and my business is all about teaching people to use cannabis in a healthier way. There are two types of people that I teach: Regular people and medical professionals—that’s the train-the-trainer portion of my business.

Cannabis is important because there are 40 million people in the U.S. who use it.

(It’s legal in over 30 states for medicinal use, and for recreational use in 10 or 11 states right now.) Year by year, the users are increasing, and medical professionals need to be prepared. But there are not a lot of opportunities for them to learn.

What was the genesis of your business? ters, executives, fundraisers.

Don’t limit yourself, and your potential. There’s no secret to business—it’s simple but, it’s not easy.

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ested in more freedom, flexibility and financial rewards can also attend our Nurse Entrepreneurship & Career Alternatives Conference. It

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medical marijuana can help cancer patients, maybe it can help me. It took 22 months to come up with a treatment plan. There were no authoritative books, so I tested everything on myself. Then I put it in a handbook, and later I put together classes.

It grew out of a personal need. I was diagnosed with a condition and was in a lot of pain. I had surgery, but the pain continued. I thought: If

If you don’t have a passion for a certain business, you won’t be able to keep going. We need nurses to be patient advocates and to dispel myths. Within the African American community, for instance, marijuana has negatively affected it because people were imprisoned for just possession. But that’s not the case anymore.

Gwen Jewell, RN, BSN, CWS Founder of Jewell Nursing Solutions

How did you come up with the idea for your wound care pillows?

I worked on a med-surg unit and started asking: Isn’t there anything better for bed sores?

Most professionals say to turn

patients and reposition them every two hours. But there is so much more to it than that.

It’s not easy. No wonder we get more and more pressure ulcers.

I know a nurse who has been a nurse for her whole life and she’s in her 80s. The whole time she never saw a pressure ulcer.

At least 50% of what I see now as a wound care nurse is preventable. A nurse’s day is getting more and more crowded with technology. There is less time to do the simple, basic stuff like turning a patient.

My side hustle has been trying to figure out how to make a support cushion that honestly works, as comfortable as possible, without touching the bedsore.

woman with chronic Crohn’s who fell into a depression after surgery. She struggled for 10 years to get anyone to listen.

If you have a good idea, then lean into it. Don’t quit your day job. Test it out first. Fear is the biggest deterrent. We’re in a nursing shortage, so we are always needed and can always get work. So, don’t be afraid.

What’s your advice to nurses with a product idea?

Just do it! We have a whole industry around nursing innovation. Like the woman who developed the colostomy bag, way back near WWI time. She did it for her sister, a young

going to share it with others and eat it.

What’s next for you as The Nurse Farmer?

I’m not making money yet, but I plan to kick it up a notch.

After both our sons graduated, we moved back to Alabama last year, onto a 10-acre farm.

The climate is different, and I made some poor choices, but

If you have a good idea, then lean into it. Don’t quit your day job. Test it out first. Fear is the biggest deterrent.

vegetables if they raise them and those habits go with them into adulthood. It’s like a piece of art: if you raise it, you’re

How did you design and develop your invention?

I called up a foam manufacturer and they gave me chunks of foam. I bought a knife to cut the foam and sew the cover. I tested it on myself and others like my brother who is paralyzed from a spinal cord injury.

It’s hard to get this information to the people who need it.

There’s a long learning curve. I finally bought Google ads and sell them, mostly to patients at home. I work on it whenever I can before going to work. (I work swing.) It’s become a passion to put it out in the world. I want to leave a legacy and make a real impact toward creating a world where pressure wounds are a thing of the past.

Alabama—when I took a job as a travel nurse, we went to Vallejo where we had a large—

by California standards—farm and grew citrus, vegetables, and kept hens. That’s where our two sons were raised. We adopted them when they were 4 and 6—and they’re now 18 and 20. For them, gardening was more of a chore. But children will eat more fruits and

I’m getting back into Alabama mode. We’ve already got some vegetables; next is herbs and flowers to attract pollinators.

Clifton Joullian, RN, BSN The Nurse Farmer

How did you come to start this venture?

In studying for my bachelor’s and gathering data, I found some research related to the health benefits of gardening. I was a backyard farmer, so I asked myself: What if I could teach people how to grow their own food organically and how that could help promote health? I had a conversation with Michelle [Podlesni] at the NNBA and she told me it was a great concept, to go to Facebook, create a page, and see where it goes.

How do you fit it in with your nursing job and family life?

My husband and I both grew up in Mobile,

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I’m working on a collaboration with The Nature Nurse, Susan Allison, that we hope to launch next year. I’m working with a new local farmers market doing free BP checks.

I’m hoping to do cooking demonstrations, like showing people how to process tomatoes, turn them to Creole sauce, but without the salt.

everything in nursing—from NICU to hospice—but my specialty is palliative care.

When I incorporated Mya as a therapy dog in my practice, she brought so much comfort and joy. I’m retirement age and was having physical and other medical issues so I wanted to try something less demanding.

scene of an accident or she can be around during an assisted activity. A therapy dog has to be invited, and there can only be one dog at a time. Mya is a favorite with patients with dementia: They can be mute, and then all of a sudden, with her, they will talk.

What was helpful to you in launching your book?

Nancy Joyner, RN, MS, APRNCNS, ACHPN Owner of Mya & Me therapy dog team and author of Through Mya’s Eyes

How did you start your entrepreneurial journey?

I’ve worked for 40 years as a nurse—I tell people I’m seasoned, not old! I also work as a nurse mentor for a group of diverse nurses. I’ve done

I found the [NNBA] and started a five-year plan there.

A booklet was the easiest thing to publish, so I wrote What If the Doctor Asks Me About CPR? My second book was a “real book,” Through Mya’s Eyes, which is told from her point of view. The unique thing about my book is that includes color artwork, drawings, and paintings from students ages 14 to 18. The book is for a younger, family-oriented audience.

You have a multidimensional enterprise—what else do you do?

I own Njoy Publishing, Nancy Joyner Consulting [palliative care consulting service], and a pet sitting business, too.

Mya, my therapy dog, is part of my practice. A therapy dog has to go through a lot of training so she can go to the

How do you get so much done, with a corporate job, a blog, and now the Academy?

Brittney Wilson, RN, BSN The Nerdy Nurse and Cofounder of The Health Media Academy

What’s the best way for a nurse to explore entrepreneurship?

I always recommend nurses start a business as a side hustle, because it’s too stressful otherwise. If you start off fulltime, it’s too hard, especially if you’re the primary breadwinner, which many nurses are.

Idea Sparks “The possibilities are endless from the bedside to case management, telephone triage, legal nurse consulting and writing, teaching online, and becoming an entrepreneur. Consider using your nursing background to start a health related consulting business, or become a clown or humorist, certified yoga instructor, Reiki master, massage therapist, personal chef, inventor, blogger, fitness coach, holistic nutritionist, cosmetic tattoo artist, tutor for nursing students, host a radio show, or design apparel for people with disabilities.”

—Donna C. Maheady, founder and president of Exceptional Nurse

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Figure out something you can do part-time on the side and do that. As a nurse, you can work three days a week on the floor and one on your business, and the rest can be for your family. You have to make time for your family—if not, your family will resent it and you really need their support to succeed.

You have to be focused. A lot of people aren’t strategic; they fly by the seat of their pants. That little bit of time that you’ve devoted to your business, you have to be 100% focused to write that blog post. Ask: Is it a task that will produce revenue?

However, sometimes a business just finds you. I didn’t start blogging with the intent to produce revenue. I started my blog because it was fun, it was my hobby, like other people crochet. At first, my blog didn’t make money. If it’s not fun, you might as well work more hours at your job.

With so many business options, how does a nurse decide what to pursue?

Don’t begin with deciding if you’ll be selling essential oils or CBD oils. I started my business by focusing on making connections. It’s better to build a personal brand first and cast a net that’s a little wider before niching down.

Focus on general wellness, healthy eating, and healthy living; get known for that, then after you’re trusted, later you can sell oils. Build your brand first and your revenue later. Know that it’s a long game, and you may not

earn income for six to nine months. It’s been said that “there are riches in niches,” but you don’t want to start out so hyper- focused that you have no ability to pivot if you see a business model isn’t right for you.

What part of the entrepreneurial journey is hardest for nurses?

Nurses are used to hard work, but business is marketing and sales and they’re not comfortable with that. But think about it: everything you do in nursing is a sales pitch—time to ambulate after surgery—that’s a sales pitch.

Nurses are masters of persuasion and educating patients on the benefits of completing a task. They just don’t realize that’s what sales is and that they already know how to make a sales pitch; they just call it education.

Jon Haws, RN, BSN Founder and CEO of NRSNG

NRSNG. To me, it means you have to be able to take on greater and greater challenges as you grow your business.

So, to answer the question, I believe that one of the most important skills a business owner can possess would be the ability to manage chaos and roll with the problems and punches. Just like in nursing, there are 1,000,000 things you can focus on, but only a few matter. Being able to identify those few problems that matter and solve them will help you and your business grow.

Do you find that any particular skill set or mindset is crucial for entrepreneurs?

What tips do you have for nurses employed fulltime who want to make a total transition?

One of my favorite quotes is “you are only as successful as the level of problem you are able to solve.” I have no idea who said that, but it has had a profound impact on growing

Patience. Many people think they have to “win” today. This mindset will lead them into doing things that simply make money versus doing things that benefit their customers.

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It’s all about building something that brings real value to the world … not about just

You have to make time for your family—if not, your family will resent it and you really need their support to succeed. quitting your job. I think when the customer really becomes your focus versus just trying to make enough to quit a job, this will reflect in your business.

Customers will notice that you really do care and you are fighting to solve their problem.

Any other advice for our minority nurse readers about entrepreneurial life?

At NRSNG our mission is to end the nursing shortage. This is a global problem with a huge

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scale. We respect the enormity of what we are trying to do and that drives our decisions. If we had small goals, we would make small decisions. Instead, we adopt a world-changing goal and make all of our decisions from that vantage point.

There really isn’t anything “easy” about the entrepreneur life, but it truly is the most fulfilling journey in the world.

Watching users find success with your product, watching employees buy into the mission, watching your kids find love for the company. It’s incredible. Find a big mission and chase it like hell!

I quickly became an advocate for her, and overtime expanded my advocacy efforts to include nurses and nursing students with disabilities.

Is it a business, or a nonprofit, or a passion project?

Exceptional Nurse is a nonprofit resource network for nurses and nursing students with disabilities. The nonprofit provides information, support, mentors, employment opportunities, social media, and related articles. It also awards scholarships to nursing students with disabilities.

knowledge, experience, and skills to share. They have walked the walk and gained insight into patient care. Their experiences inform and benefit their practice. Many have a passionate desire to care for others. Nurses with disabilities can be the best role models for patients.

What entrepreneurial lessons have you learned?

Donna Maheady, EdD, ARNP Founder and President of Exceptional Nurse

How did you come to start Exceptional Nurse?

Lauren, my daughter, was born in 1986 and later diagnosed with autism, OCD, epilepsy, and a host of other autism-related challenges.

Do what you love! Being a risk taker is important along with being resilient… moving past setbacks and criticism. A strong work ethic is also important—being an entrepreneur isn’t a 9-5 job! It takes hard work and perseverance to succeed. Continue to learn new skills, network with others, and ask for help when needed. Give as much as you take. Surround yourself with positive, like-minded people.

Manage money wisely.

What advice do you have for our readers?

To my fellow nurses and nursing educators, I would stress the importance of recognizing that disability is part of life…for everyone!

Nurses with disabilities have

It’s been said that “there are riches in niches,” but you don’t want to start out so hyper- focused that you have no ability to pivot if you see a business model isn’t right for you.

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Paul Scrivens Founder of Dare to Conquer

What productivity tips do you have for nurses who are employed full-time but want to launch a side hustle?

It’s tough. Mentally, the idea of making it all work is easy, but the execution is really hard.

Usually it isn’t because of time.

You can always make time. The biggest problem is willpower. At the end of the day, after working your tail off, you usually don’t [have] the willpower to get more things done.

The best thing you can do is come up with a long-term gameplan and lay out the tasks that you need to get done.

Then break those tasks down as much as possible into smaller chunks. Now that you have these small chunks, take a look at your schedule.

For about a week, keep a journal with you at all times

and every hour that you’re up, write down what you did for that hour. What you’ll usually notice is that the times you aren’t working or sleeping, there are lots of gaps where you’re not really doing anything.

Being a risk taker is important along with being resilient… moving past setbacks and criticism. A strong work ethic is also important—being an entrepreneur isn’t a 9-5 job!

Fill those gaps with bursts of effort where you get your tasks done. If you find that at the end of the day you mentally can’t do more things, then wake up earlier and get them done. Diet and exercise also go a long way.

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

Academic Forum

Confronting the Imposter Phenomenon as a Minority Nurse

By Miriam O. EZENWA, PHD, RN, FAAN

As an academic nurse researcher from an underrepresented minority background, for years, I was plagued by a certain phenomenon: specifically, the imposter phenomenon. In 1978, psychologists Pauline Rose Clance and Suzanne Imes coined this term to describe the internal experience of “intellectual phoniness” that is prevalent in high-achieving women who, despite their academic and professional triumph, feel that they aren’t smart enough, that they have somehow deceived others to view them as successful, and that they will soon be exposed as frauds.

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f course, this phenomenon isn’t limited to women: a 2011 review article published by Jaruwan Sakulku and James Alexander suggests that 70% of all individuals experience imposter phenomenon at some points in their lives.

However, in my article, I focus on how I myself experienced the imposter phenomenon as a woman with African roots within Western academia.

More importantly, I share my experience to express how

detrimental the imposter phenomenon is to educators in academia. Today, I feel obligated to share my story with my students through my teaching and mentoring.

What are the attributes of the imposter phenomenon?

From the definition of the term, I identified at least three destructive factors that contributed to my personal experience of it: namely, selfdoubt, negative self-statements, and socialization as an African female.

An individual who sports self-doubt lacks confidence in her own capabilities and thus relies upon others to assess her accomplishments, failures, and reality. Naturally, self-doubt fuels negative selfstatements that this individual utters about herself and eventually comes to believe about herself. And her negative self-statements will ultimately reinforce what her society and culture demands of women. If this individual is African like me, she will be haunted by her society’s belief that women are a weaker sex, that they should not be heard but only seen, that they are given things and will never truly earn them,

and that they are meant to be taken care of by men and other authority figures in their lives.

So, how did this series of negative reasoning come to plague me? It was several weeks after starting my new position as a Sickle Cell Scholar through a grant funded by the National Institutes of Health. A staff colleague was trying to get my attention as I walked through a hallway to my office and she whispered, “Dr. Ezenwa.”

I cringed and quickly turned my head around to figure out who she was addressing. Of course, it was me. We were the only two people in that space.

I thought, “Wow. Dr. Ezenwa, my foot!”

Of course, this phenomenon isn’t limited to women: a 2011 review article published by Jaruwan Sakulku and James Alexander suggests that 70% of all individuals experience imposter phenomenon at some points in their lives.

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Academic Forum As soon as this astonishment faded, I went into my office and was arrested by a severe panic at the thought of my “lies” being discovered.

My body felt hot, my heart clapped with a chaotic cho-

I, as an immigrant, broke through the culture shock of living and working in America and always sought peaceful resolutions to clashes in culture. rus of groans, and my stomach fluttered like a butterfly rain forest. Pearls of cold sweat dripped from my palms. I felt like a deceiver, a trickster. An imposter.

Slowly, my self-doubt magnified and my anxiety about achieving success intensified.

I began to question myself: Did I learn enough in my PhD program to be an independent researcher? Do I know enough to teach at the undergraduate, graduate, and PhD levels? What was I going to tell my students? What if I ruin their lives and academic careers because I teach them the wrong things and extinguish their drive for continuous learning and growth? Will they even understand a word I say to them through my African accent?

These self-doubts naturally morphed into destructive self-statements: I am not good enough. I am not smart enough. I am not worthy.

Then, perhaps most devastatingly, these destructive selfstatements made me feel boxed in and limited by multiple historical and social orientations

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forced upon women, even though I had escaped them long ago.

As an African immigrant in Western academia, I worked hard to break through multiple levels of convention. I broke through many societies’ beliefs that the proper place for a woman is at home and her role is to bear children, cook meals, and clean up messes.

I broke through the pressure of growing up poor and earning the opportunity to reach greater heights without any real road map or directions. I broke through to success as a black woman who American society believes is lesser than her white counterparts thus deserves less in life. I, as an immigrant, broke through the culture shock of living and working in America and always sought peaceful resolutions to clashes in culture.

But under the spell of selfdoubt and negative self-talk, I began to think that even the actuality that I’d broken out of these social constructions was all a big lie. These feelings only magnified and manifested as psychological and cognitive obstacles that cornered me into mental blocks. I soon lacked the confidence I needed to effectively teach and conduct research, as well as to see myself as successful and accomplished.

Now, I first learned about the concept of the imposter phenomenon many years ago during my graduate program.

Back then, I brushed the idea aside as silly. How could individuals who paid with blood and sweat to accomplish their goals diminish their accomplishments? But after spiraling into such depths upon simply being called by my appropriate

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doctorate title, I realized that I was not above this sort of destructive thinking. I had to take control of this phenomenon if I was going to effectively and full-heartedly serve my students, my institutions, and, most importantly, myself.

So, how did I cope with the imposter phenomenon? There are three major strategies that I endorse and have taught my students: self-accountability, accountability with a trusted partner, and continuous self-love.

First, self-accountability: I began by recognizing that I am accountable to myself to be the best I can be in all my life’s endeavors. I am accountable for the outcomes of my actions and inactions, as well as my failures and successes. Once I accepted this fact, I engaged in bone-deep self-reflection about the imposter phenomenon that I had allowed to take up residence in me. I asked myself, “Why do you think you’re not bright enough?

Why do you think you’ve fooled anyone who believes otherwise? Why do you think you’re not good enough, that you’re unworthy?”

I wrote down my thoughts on a piece of paper and waited a few days to return to it.

phenomenon had been creeping up on me my entire life.

Growing up, everyone had told me that I was “so smart” and openly assumed that I would become a medical doctor. I had always been afraid that I might not live up to this idea of intellectual perfection that my family and friends held about me, and, even after I became an academic doctor, I felt that I was not the genius everyone believed that I was.

When I had excavated my mind of these recognitions and purged any negative ideas that imprisoned my capabilities, I reached out to my accountability partner for a meeting.

I shared with her the result of my self-reflection honestly and openly and, in turn, she worked with me on enhancing my confidence. My accountability partner assisted me in three important areas: changing my mindset, developing a strategic plan of action to combat the imposter phenomenon, and constantly checking in to see if the plan was on track.

To shift my mindset, my accountability partner coached me to see the opposite side of my negative thoughts. For example, if I doubted that I was not smart enough to have accomplished the current goals

So, how did I cope with the imposter phenomenon?

There are three major strategies that I endorse and have taught my students: self-accountability, accountability with a trusted partner, and continuous self-love.

When I saw all the questions and my initial answers written out, other realizations came to mind. I, for instance, suddenly understood that the imposter

in my life, she empowered me to believe that my current achievements were not handed to me for free like Halloween candy. Instead, I had to earn

Academic Forum them through a combination of my intelligence, efforts, and wise leveraging of available resources. She assured me that I already had a long record of accomplishments, and there was no reason for that trend to stop so long as I was willing to challenge myself and do the work required.

Once this mindset shift was underway, my accountability partner helped me develop specific, time-bound goals and strategies to succeed in my

current endeavors. Finally, we set a timeline with consistent, scheduled follow-up meetings to assess my progress. During these follow-ups, we reevaluated my goals and strategies, as well as adjusted my timeline as necessary.

The third and final strategy I used to combat the imposter phenomenon was practicing continuous self-love.

As a woman, both in African and American society, I was

socialized to care for everyone else before thinking of myself. Consequently, I was petrified to upend the status quo and focus on myself for once in my entire life; after all, I had equated self-love with selfishness.

The question is, are we willing to confront the imposter monster in ourselves?

So, to successfully exercise self-love, I had to be intentional. I worked tirelessly to reprimand myself every time I felt guilty for focusing on my needs over other obligations.

I reminded myself that, when I am overflowing with love for myself, I will have enough energy to achieve my goals and dreams and also healthily give to my family, career, academics, and finances. I made sure I celebrated my successes, both

big and small. Every night in front of the mirror, I stood and told myself how deserving I was of all the accomplishments I worked so hard to earn.

So, with all three strategies combined, did I beat the imposter phenomenon? That I am still a professor and a researcher in one of America’s top ten public universities is a testament to how I conquered self-doubt and negative selfstatements and how I refused to allow my ancestral background and cultural identity to confine me from living in my highest potential. That I was recently inducted as a Fellow in the American Academy of Nursing is evidence that my research on health disparities in pain management in patients with sickle cell disease or cancer made a difference in peoples’ lives locally, regionally, nationally, and internationally. That I am now an entrepreneur is a manifestation of my mindset that now asserts, “You are good enough.

You are smart enough. You are worthy.” So, yes, these strategies worked!

The imposter phenomenon is a monster, and the struggle to overcome it is real. Successful women have systematically been robbed of important opportunities because of our own self-doubts, negative self-statements, and our giving into social orientations that seek to confine us.

But there is hope and there is help. The strategies I mentioned here, as well as with professional help from psychotherapists, can move us toward controlling the phenomenon and casting it out of our lives.

The question is, are we willing to confront the imposter monster in ourselves? Are we

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willing to tear down limiting beliefs about academic success, professional success, business success, financial success, and whatever else we desire? Are we willing to free ourselves from the bondage of history, cultural codes, and oppressive gender roles? Are we willing to look in the mirror and say “I am good enough, I am smart enough, I am worthy?” Are we willing to do the hard work to love and respect ourselves?

And, finally, are we willing to do the work now? Not next year, next month, next week, or tomorrow. Now. Are you willing to take the challenge?

You may write me down in history With your ­bitter, twisted lies, You may trod me in the very dirt But still, like dust, I’ll rise.

—Maya Angelo, “And Still I Rise” Miriam O. Ezenwa, PhD, RN, FAAN, is the author of the book, THEY Live in My Tainted Soul (pen name: Miriam O. Everest), and two books of poetry, To Love and to Heal and Tomorrow is Pregnant.

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

www.TheStrongestMe.com.

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Degrees of Success

The Characteristics of a Professional Nursing Student

By Michelle TANNER, MSN, RN

If you are a nursing student, I would like to welcome you to the fabulous field of nursing! There is nothing more rewarding than serving in this meaningful profession.

I anticipate you plan to practice in this arena upon graduating and passing the state board exam. However, be cognizant that one of the most challenging transformations your nurse educator will be responsible for will be in assisting you to become a professional in the medical field.

I

know that you think that your instructors are always nagging you about your appearance, but at the end of this process, you will understand how important this transition is in order to socialize you. You have certainly heard educators discussing first impressions and how important

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they are in establishing credibility and rapport with your patients and with the health care team. As health care professionals, our demeanor affects everyone around us while we are on duty. Since I am a nurse educator, I would like to disclose some of the dos and don’ts of your daily conduct

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that you should be aware of as a student entering the nursing profession.

Let us start with the basics: punctuality. Have you ever heard the statement that when you are on time, you are late and when you are early you are on time? This applies to both the classroom and clinical setting. It is disturbing and disruptive as latecomers arrive to the classroom once lecture or testing has begun. As you enter the room tardy, open and close the door, remove extraneous clothing (coats, scarves, etc.), retrieve necessary items from your book bag… Well, you get the idea. While you catch up with the rest of the class, your

colleagues have preceded you in doing so. Consequently, the energy in the room shifts as you now settle in for a long day of studies. Have you considered how your lack of punctuality affects those around you?

Maybe it is time you do so.

You may ask, “How about makeup? How much is too much?” My answer for this is that if you are putting false eyelashes on before attending class and clinical, you clearly have too much time on your hands.

Why not spend those extra 10 minutes reviewing notes taken during lecture or take a quick peek at those index cards? Why not work on those intravenous drip calculations you have been struggling with? It only takes a few minutes out of your day to commit to tackling the less desirable tasks. Facial makeup now takes second place once you realize that the extra minutes you use to embellish your outward appearance would be better spent on nurturing critical thinking skills.

Do you ever have downtime?

By this I mean the time you have during breaks and lunch.

How do you spend this time?

Watching kitten videos, catching up with the celebrities, or perhaps finishing a movie or television show? I tire of over-

As health care professionals, our demeanor affects everyone around us while we are on duty. hearing the ­latest on the pop stars—the Kardashians, etc. You must know that your instructors

Degrees of Success are observing you and that we are very much aware of what occupies your time. No, we are not telepathic. We know by the incomplete homework you turn in (or not) and by the multitude of excuses you have for late assignment submissions. We know by the test scores that

in uniform. Having these body images in view is unprofessional and if you want to be taken seriously, save this look for socializing (e.g., dating, clubbing, or spending weekends with friends). Your patient nor your instructor desires to be distracted.

Think about your appearance this way: when you are practicing in the clinical setting, you are interviewing for potential employment.

you feel are acceptable, even when we, as instructors, know you can perform academically better. I implore you to spend all the time that you have honing your skills for nursing.

There is plenty of curriculum to embrace, so do so every moment you have. I promise you will not be disappointed.

It is not cool to have your shoelaces or velcro straps untied. This look appears anything less than professional. It is hard to take anyone seriously who has not taken the time to attend to such details before entering the clinical arena.

Another detail worth addressing is gum chewing. Along with the former offenses, it is difficult to accept that the person who is chewing gum is focused on anything other than smacking idly while passively listening or speaking to their audience.

In my profession, potential candidates for employment were simply dismissed during an interview because of gum chewing. Do not let this be your fate while seeking employment.

Confine all cracks, cleavage, tummies, and tattoos for activities aside from nursing.

Let me be clear: cover all external crevices at all times while

While we are noting external appearances, there is a reason for us to request that you not wear jewelry larger than stud earrings and a wedding band.

The focus on you should not be about your taste in jewelry.

Jewelry is a vehicle for the transmission of germs, and while I am addressing the chain of infection, allow me to broach the topic of nails. Remember

your lecture on infection control: hand washing in between patients, before and after meals, after smoking and toileting?

You discovered how microbes harbor under long nails and in cuticles. The studies have been done, and the results are in. Nails are to be no longer than one-quarter of an inch.

You cannot effectively palpate or percuss body contours and abnormalities with long nails.

Uniforms: the glorious look of a uniform, but only if it is clean and ironed. No wrinkles are allowed on uniforms or lab coats. Your first impression from your mentors and patients should exude professionalism as noted in unsullied and tidy apparel. Your patients want to know that they are safe with you—that you will protect them, not infect them. Not only does appearance count but so do scents. I will take the fresh aroma of antiseptic soap from thoroughly washed

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hands any day over the stench of cigarettes. While you are observing your patients, let it be known that they are observing you, too. Leave them with an impression you can be proud of. Think about your appearance this way: when you are practicing in the clinical setting, you are interviewing for potential employment.

When you are in class or clinical, you are in a work zone.

No cell phones allowed! Please

Good communication skills entail proper dialogue with your instructor, among colleagues, patients, and health care providers. stop checking them. Instead, check the cell phones at the door and place them on silent, in your pocket, or in your car.

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Degrees of Success I am looking forward to the day when administrators will mandate that cell phones be left with the instructor or outside of class and clinical altogether.

I am aware of the potential family emergencies, children, health-related issues, etc. There must be arrangements for emergency calls. If a protocol does exist and despite this, we find our students clinging to these electronic devices making it difficult for instructors to maintain our students’ attention.

For example, during clinical orientation (I am ashamed to say) students and educators are now being in-serviced regarding prohibiting cell phone use.

Cell phones are not to be used in the facilities while practicing. It should be common sense that when you are at work, you should not have time for

texting, checking emails, or Instagram. You should be working, which means meeting the needs of your patients.

In meeting patient needs, how do you communicate with

Nursing is a taxing profession. Take care of yourselves so that you can take care of others. them? Do you use “honey,” “sweetie pie,” or other affectionate terms with your patients? This is unacceptable as it is highly probable that your patients are older than you and as such, deserve your utmost respect. Along with respect for your patients, I would also like to add appropriate

communication to use with your instructor: never use obscenities. You will develop a plethora of new words in this profession, none of which is profanity. Good communication skills entail proper dialogue with your instructor, among colleagues, patients, and health care providers.

Using the last name with the prefixes Miss, Mrs., or Mr. is acceptable unless your patient has given you permission to call him or her otherwise. And how will you know how you should address your patients?

If the patient does not inform you that they would like to be called by another name, simply ask them after having addressed them formally. You will always gain the respect of your patients by being respectful.

Did you know that your posture and gait say so much about you? Walk like you have purpose. Strut up that hallway and answer those call lights as if it were necessary, because it is.

Exhibit energy and enthusiasm as opposed to being lethargic.

You may be tired, but keep it moving! Your patients want to know that you have the vigor required to take care of them.

For this emotionally and physically exhausting profession, I would advise you to follow the Beatitudes: be well rested, be fit, and be well nourished. Nursing is a taxing profession. Take care of yourselves so that you can take care of others.

Michelle Tanner, MSN, RN, is a PN instructor at Porter and Chester Institute.

Believe. Begin. Become.

Answer the Call.

Specialty tracks for nurses who want to advance their careers.

SPECIALTIES OFFERED Nurse-Midwife | Family Nurse Practitioner Women’s Health NP2019 | Psychiatric-Mental Health NP 36 Minority Nurse | Care SUMMER

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Second Opinion

How to Retain Nurses in a Shortage Epidemic

By Kayla CARLETON

Employment projections are estimating that Registered Nurse (RN) needs will continue to grow rapidly—at the same time a shortage in nurses is expected. Due to this shortage, it is critical for health care organizations to implement a firm training program, have direct leadership relationships, and target minority populations.

Doing this will assist in filling RN openings and help create an organization that truly invests and cares for their nurses, which will positively impact retention.

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ursing school enrollment is not advancing fast enough to meet the RN demand, and with nurse baby boomers aging there will be fewer nurses available as the health care sector continues to grow.

For example, in the Orlando, Florida region specifically, there are over 1,600 current RN job openings available, with 191 direct employers competing to fill those open positions. Simply put, there are not enough nurses to

fill all those critical needs in the market. This shortage is impacting the current nurses’ job satisfaction, increasing their stress, and even driving some nurses to leave the profession.

Without nurses we cannot run our health care organizations, which is why having a process in place to train and support them is essential.

To invest, you must have a proper training program to support the nurse and ensure they are demonstrating safe

quality care to patients.

Certain organizations, such as AdventHealth, implement this in their Graduate

training. During that time the new nurse goes through a three-day simulation lab to provide hands-on learning before they even enter the department. The following months are focused on individual preceptor training.

The nurse is partnered with an experienced nurse for a certain amount of duration (8-16 weeks depending on the acuity

Without nurses we cannot run our health care organizations, which is why having a process in place to train and support them is essential.

Nurse Residency Program in the Orlando region. The first two weeks of the program are focused strictly on modules, simulations, and computer

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of the unit) to train the new nurse and will be with them every single shift side by side so they have the resources and training to be successful. After

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Second Opinion

Nurse leaders need to uphold regular one-onone meetings and gain a professional relationship with their employees to understand their struggles. the focused preceptor training, the new nurse continues to be provided educational courses and simulations as needed.

This shows the nurse that the company is investing in their future.

Proper training programs and support for nurse staff is essential for the nurse to feel like they have more opportunity, and desire to stay and grow as part of the organization. With the shortage of nurses, you need to ensure the nurses that you do have feel supported and uplifted to reach their full potential.

Providing this training will provide a higher percentage of nurses to feel valued enough to want to stay in that organization and to have the desire to give back full circle to the organization that invested in their learning and education.

Leadership involvement is also a direct way for organizations to increase retention.

If a nurse is feeling overworked, they need to at least feel appreciated for all they do. Open communication is critical for retention—and to really understand where your employees are coming from.

Nurse leaders need to uphold regular one-on-one meetings and gain a professional relationship with their employees to understand their struggles.

During this meeting it is also important for the leader to ask

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intuitive questions, so they are aware of the things that motivates their nurse employees to continue being a nurse every day to help others. Remind them why they started this career, so even through the

well. Health care organizations also need to focus on out of the box recruitment efforts targeting different populations—specifically, minority nurses. Health care in the United States is seeing a high

Health care organizations also need to focus on out of the box recruitment efforts targeting different populations—specifically, minority nurses.

negative days they resort back to the positive reasons why they started their nursing career.

In today’s recruitment efforts, the candidate pool of nursing talent is getting smaller since nursing schools can’t accommodate the applicants. Even though the schools can’t accommodate the volume of applicants, the nursing programs still need to ensure their selection process is fair in diversity selection as

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influx of minority patients.

When the number of minority patients increase, so does the demand for minority nurses to care for those patients. It is very important for the team of nurses at an organization to be well-rounded and diversified to care for patients from a variety of cultural backgrounds.

Implementing training programs, leadership engagement, and targeting minority nurse nurses will not only help with recruitment and retention, but

also project longevity amongst nurse employees. Nurses need to feel wanted and valued.

Nursing is one of the toughest jobs, but when an employer makes them feel respected, appreciated, and gives them the proper tools to be successful, they will be more likely to continue to stay within an organization that supports them wholeheartedly. Every organization needs to focus on these areas to be able to retain their nursing staff and provide the utmost care to their patients every day.

Kayla Carleton is a human resources nurse recruiter at a Florida hospital and is currently working on obtaining her Master’s in Human Resources (MHR) at Rollins College.

Health Policy

The Indian Nurses Association of Illinois: Taking Matters to Heart

By Janice M. PHILLIPS, PHD, FAAN, RN

Quite often a nurse will ask me how to become engaged in the health policy arena. I frequently advise nurses to get involved with their professional organizations as a start. Many nursing organizations have an advocacy and legislative agenda and are oftentimes engaged in advocating on behalf of patients and the profession.

Here, we share a conversation with Aney Abraham, DNP, RN, NE-BC, who is a founding member and current president of the Indian Nurses Association of Illinois (INAI). Abraham discusses the origins of her organization and current issues they are addressing.

W

ith regard to legislative issues, Abraham highlights a piece of legislation that was introduced during the 115th Congressional Session. The proposed legislation “H.R. 3592 South Asian Heart Health Awareness and Research Act of 2017� aims to address the high rate of cardiovascular disease in the South Asian community.

And while the proposed legislation did not gain much traction during the 115 th Congressional Session, the INAI is hopeful that the original sponsors of the proposed legislation will reintroduce it and continue to seek funding to support research focused on finding solutions to the high rate of cardiovascular disease in this population.

This targeted approach to improving the health and well-being of this population takes into consideration cultural factors that may influence health status and calls for early intervention and treatment through education and awareness.

As president of the Indian Nurses Association of Illinois (INAI), can you share with me a bit about the INAI, its origins, its mission, and membership?

The Indian Nurses Association of Illinois was established in 2002. I was a nurse with about 18 years of experience at this time and among one of the few nurses that thought of this idea of forming a professional organization for nurses of Indian origin. There were many reasons for starting this organization. The first and foremost was that Indian nurses who immigrated to the U.S. faced many challenges as they transitioned in the United States.

Foreign nurses become minorities overnight having little or no orientation to the country or health care facility that they worked for. We realized that many nurses were eagerly anticipating the birth of this organization and thus successfully established the organization in 2002.

The mission of INAI is to identify and meet the

professional, cultural, and social needs of nurses of Indian origin. In addition

As nurse leaders and professional organizations, we need to work on finding ways to address awareness and ways to mitigate these issues that are facing our profession. to our mission, our purpose is to ensure that we provide representation and interact with other professional

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organizations as well as promote cultural awareness by communicating the uniqueness and diversity of the Indian culture.

What do you believe are the top nursing issues impacting our profession today?

Job safety is important to all professions; nurses are not exempt from working in unsafe environments. One of the top nursing issues impacting our profession is workplace violence. Every day, our nurses are impacted by violence perpetrated by patients, their family members, and visitors. Incidents that may start

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Health Policy small can spiral out of control within minutes. Even though nurses are very familiar with incidents of violence, research seems to suggest that workplace violence is increasing. We certainly hear about these incidents through TV, print media, and reports from nurses.

The second issue that is impacting our nurses is stress and burnout. Nurses are on

age discrimination, equal pay, and family/medical leave.

Another issue impacting Indian nurses (majority of which are of South Asian descent) is that they suffer from heart disease, high blood pressure, and diabetes too frequently and too early in life. Compared to other ethnic groups, South Asians are four times more likely to have

We can be more impactful when we combine our voices with other nursing organizations to enhance our policy advocacy on behalf of patients and the profession. the front lines providing direct nursing care, advocating for patients’ medical needs, comforting patients/ families, and working with a multidisciplinary team to ensure that patients receive safe high-quality patient care.

Stress and busyness can easily escalate with the demands that are placed on nurses daily.

As nurse leaders and professional organizations, we need to work on finding ways to address awareness and ways to mitigate these issues that are facing our profession.

heart disease, experience heart attacks 10 years earlier in average, and have a 50% higher mortality rate from heart disease. To address this, in 2017 Rep. Pramila Jayapal (D-WA7) proposed H.R. 3592 “South Asian Heart Health Awareness and Research Act of 2017.� This is a very specific piece of legislation targeting Asian Americans.

What are some of the top policy or regulatory issues impacting the Indian nursing community?

Representatives Pramila Jaypal and Joe Wilson co-sponsored this bill to raise awareness of the alarming rate at which the South Asian community is developing heart disease.

The overall purposes of this legislation are to:1) promote heart healthy eating among Asians; 2) conduct research to understand why South Asians are at an increased risk for developing heart disease and; 3) develop educational tools

One of the issues impacting nurses of Indian origin is abusive employment practices. To address this, in 2008 the ANA released the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States. The code addresses minimum fair labor standards, civil rights,

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What is the overall purpose of this legislation, and why is it important to you as a nursing organization and to the Asian community at large?

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about heart disease for South Asians.

This legislation is important to us as a nursing organization and to the Asian community at large. The members of the Indian Nurses Association spend a tremendous amount of time offering free community services in the Indian community. Our advanced practice nurses spend time on the weekends visiting the various churches conducting health fairs, offering lectures, and educating the community on the dangers of heart disease and diabetes. Legislation that supports research will enhance our ability to learn more about the root causes of the high risk for the Asian community and prepare us to share lifesaving information with the community at large.

Are there any updates on this given this did not pass out of committee?

We will continue to monitor where this is going as the original sponsors are committed to raising awareness and supporting research in this area.

What are some of the ways that your

organization has engaged in community education regarding Asian American cardiovascular disease?

Every year we host a minimum of three community health fairs and lectures in the Indian community. Our members, many of which are advanced practice nurses, have the skills, expertise, and knowledge to effectively lead these health fairs. In addition to the health fairs, we offer free BLS and ACLS certification.

How does INAI prepare its members to be influential advocates in the policymaking arena?

INAI invites public officials and elected officials to speak at our meetings and conferences. For example, some of our guests in the past have included, at that time, Senator Barak Obama before he went on to become President of the United States and Dr. Ann Kalayil, Bureau Chief, Cook County Bureau of Asset Management. Dr. Kalyil was the former President of the South Asian American Policy and Research Institute.

Additionally, members stay informed through educational

Health Policy seminars and educational offerings posted on social media outlets such as Twitter and Facebook. We also stay abreast of issues by following the legislative agenda of the American Nurses Association.

Are there other policy issues that are a part of your health policy agenda?

Many of our members are advanced practice nurses.

Thus, we support the policy agenda of the National Association of Clinical Nurse Specialists (NACNS). Their priorities—including nursing workforce issues, health care reform, and health information technology—resonate with our legislative priorities.

The Indian Nurses Association is an organization of about 200 members. We can be more impactful when we combine our voices with other nursing organizations to enhance our policy advocacy on behalf of patients and the profession.

If you had to offer advice on why nurses should be engaged in advocacy and policy advocacy on behalf of

At a Glance: South Asians and Heart Disease • • • • •

South Asians are one of the fastest growing ethnic groups in the United States.

Family origins mostly from: Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka.

High cardiovascular prevalence not readily known due to lack of data.

Research examining heart disease in Asians in general lacks subgroup analyses.

Possible contributing factors include early onset of diabetes, cholesterol abnormalities, westernized diets, and lifestyle.

Source: American Heart Association For a more detailed discussion of heart disease in South Asian populations, please see the American Heart Association’s Scientific Statement.

patients and the profession, what would you say?

Nurses instinctively advocate for their patients. Equally important is for nurses to engage in legislative and polit-

Nurses instinctively advocate for their patients. Equally important is for nurses to engage in legislative and political advocacy. ical advocacy. This is needed to advance the profession and patient care. It is important for the voice of the nurse to

be heard when any new legislation or bill is being introduced. An example of a recent bill is SB2151, a bill sponsored

by Senator Hastings. This bill is about the Nurse Practice Act language surrounding delegation. Specifically, nurse delegation in communitybased settings is of concern.

Nursing has to provide the definition of what nursing practice entails, how nursing interventions and tasks can be delegated, and in what care settings the delegation can occur.

Nurses can stay informed on legislation that impacts their practice and profession

by following nursing forums like @ANAnurses [and] @RN Action.

To stay engaged or not engaged in policy advocacy is a decision each nursing professional has to make, and he or she must always err on the side of staying actively engaged on behalf of the patients and those they serve.

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.

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