Minority Nurse Magazine (Winter 2013)

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

Financial Planning for

Nurses

+ The Career Issue • Know Your Worth: Nurses and Financial Planning • CenteringPregnancy and Resources for Low-Income Mothers • An Introduction to Surgical Nursing • New Nurses and the Fight to Find Work

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Table of Contents

In Every Issue 3

Editor’s Notebook

4

Vital Signs

9

Making Rounds

56

Index of Advertisers

Cover Story 10

By Julia Quinn-Szcesuil Whether you are just starting your career or are nearing retirement, this crash course in financial planning will equip you with

Academic Forum 33

Uncovering the Secret Silver Bullet: How to Replenish the Nursing Shortage

By Kathryn Norcutt The solution to our nation’s nursing shortage may be right in front of us

the knowledge you need to secure your financial future

Features 17

An Introduction to Medical-Surgical Nursing

By Sandra Fights, MS, RN, CMSRN, CNE, and

Degrees of Success 35

Financial Planning 101: Know Your Worth

Kathy Lattavo, MSN, RN, CMSRN, ACNS-BC, RN-BC

Men in Nursing

A glimpse at a typical day in the life of a medical-surgical nurse,

By Tri Pham, PhD, RN, AOCNP-BC, ANP-BC

what the specialty entails, and what the future holds

An examination of the barriers male student nurses face and ways to overcome them 37

The Lived Experience of a Visiting Professor

20

New Nurses Fight to Find Work

By Leigh Page

By Charlotte Stoudmire, PhD, MN, RN

An examination of the nursing shortage and strategies

One nurse shares her experience teaching abroad

for new nurses looking for work

Second Opinion 40

CenteringPregnancy: Better Birth Outcomes, Happy Caregivers, Satisfied Patients

24

By Jebra Turner

By Archana Pyati

Learn to recognize the warning signs of workplace fatigue

Explore the benefits of this nontraditional form of prenatal care 44

Health Promotion and the African American Community

Avoiding Workplace Fatigue

and find out how to prevent job-related burnout

31

Careers Stemming from an Education in Health Care Policy

By Kerri Henderson, BSN, RN

By Carole Eldridge, DNP, RN, CNE, NEA-BC

Health fairs may play an important role in reducing racial disparities

Interested in health care reform, but not sure how to get involved?

Find out if you have what it takes to be a part of this exciting new nursing specialty

46

Prevent “The Big One”—Ischemic Heart Disease

By Ed James, MD Guarding against a family history of heart disease may be as simple as changing your diet

2

Minority Nurse | WINTER 2013

Table of Contents

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Conquering the Nursing Shortage—and Beyond

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

J

anuary is a time for reflection and change. Whether change comes in the form of a new job or an addition to the family—in our case, this publication—it is an opportunity to wipe the slate clean and start a new chapter. Like many young nurses, you may be wondering just what the future holds for your profession. Scholars and news pundits alike have been warning us about a nursing shortage for what seems like an eternity. But don’t fret. There are steps you can take to help secure your future, both financially and mentally. Leigh Page and Kathryn Norcutt investigate the nursing shortage and explore the best solutions for surviving in an unstable economy. In our cover story, Julia Quinn-Szcesuil discusses the importance of financial planning. With a few tweaks to your budget, you can help secure your future as well as your family’s.

As you flip through our annual Career Issue, take a moment to reflect on what’s most important to you. Have you recently decided to start a family, but aren’t sure whether traditional care is right for you? More women are opting for an innovative form of prenatal care called CenteringPregnancy. Or perhaps you are a recent graduate looking to jumpstart your career? Consider pursuing a career in medical-surgical nursing or health care policy nursing. Chances are you have witnessed a heated discussion about health care reform over the last few years. And with the re-election of President Obama, reform will continue to be a hot topic. The public spoke loud and clear last November: health care is a right, not a privilege. But what is the best path for ensuring universal health care? More nurses are joining the discussion than ever before—and you should too. Carole Eldridge describes what it takes to be involved in health care policy and the career opportunities available to those seeking to make a difference for their patients and their profession.

Nurses may be universally known as caregivers, but they do not always practice what they preach. Life gets complicated as you grow older and juggle more responsibilities.

And it can make matters worse if your hospital is understaffed and you are carrying the workload of more than one nurse. Do yourself a favor, and read Jebra Turner’s tips for avoiding workplace fatigue. Knowing your body’s limitations is crucial to maintaining optimal health for yourself and those around you. In Dr. Ed James’ article, he stresses the importance of a healthy diet and exercise in preventing “the big one.” A family history of heart disease doesn’t mean your health is out of your control.

Wherever your path may take you, be sure to make your health a priority. Your patients will thank you, and so will we.

— Megan Hughes

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

MINORITY NURSE MAGAZINE Publisher James Costello Editor-in-Chief Megan Hughes Creative Director Mimi Flow Circulation Latoya Butterfield Production Manager Diana Osborne Digital Media Manager Joey Stern Minority Nurse National Sales Manager Peter Fuhrman 609-689-1033 n Fax: 609-689-1034 pfuhrman@springerpub.com Minority Nurse Editorial Advisory Board Jose Alejandro, PhD(c), RN-BC, MBA, CCM, FACHE President National Association of Hispanic Nurses Teresita Bushey, MA, APR-BC Assistant Professor, School of Nursing The College of St. Scholastica Wallena Gould, CRNA, MSN Founder and Chair Diversity in Nurse Anesthesia Mentorship Program Constance Smith Hendricks, PhD, RN, FAAN Professor Auburn University School of Nursing Ed James, MD Founder and President Heal2BFree, LLC

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.

Sandra Millon-Underwood, PhD, RN, FAAN Professor University of Wisconsin, Milwaukee, College of Nursing Tri Pham, PhD, RN, AOCNP-BC, ANP-BC Nurse Practitioner The University of Texas-MD Anderson Cancer Center

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3

Vital Signs

Racial/Ethnic Disparities in Survival after Breast Cancer Remain Despite Similarities in Education, Neighborhood Socioeconomic Status

Disparities in survival after the socioeconomic status of breast cancer persisted across the neighborhood in which racial/ethnic groups even af- they lived, according to data ter researchers adjusted for presented at the Fifth AACR multiple demographics, such Conference on The Science eoejad_2012_Layout 1 11/30/12 4:49 PM Page 1 as patients’ education and of Cancer Health Disparities,

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Inspiring better health.

4

Minority Nurse | WINTER 2013

held on October 27-30, 2012.

“We learned that the effects of neighborhood socioeconomic status differed by racial/ethnic group. When simultaneously accounting for race/ethnicity and socioeconomic status, we found persistent differences in survival within and across racial/ethnic groups,” said Salma ShariffMarco, PhD, MPH, a researcher at the Cancer Prevention Institute of California in Fremont.

Shariff-Marco and colleagues studied data from 4,405 patients with breast cancer who had participated in one of two populationbased studies undertaken in the San Francisco Bay Area.

Participants included 1,068 non-Latina whites, 1,670 Latinas, 993 African Americans, and 674 Asian Americans.

All-cause survival was worse for African Americans and better for Latinas and Asian Americans compared with non-Latina whites after adjusting for age, study, and tumor characteristics. When the researchers additionally adjusted for treatment and

reproductive and lifestyle factors, they found that African Americans had similar survival rates to non-Latina whites, but the survival rates of Latinas and Asian Americans remained better.

Researchers also evaluated disparities in survival while considering racial/ethnic and socioeconomic status interactions. Compared with nonLatina whites with high education and high neighborhood socioeconomic status, worse survival was seen for African Americans with low neighborhood socioeconomic status (regardless of education) and better survival was seen among Latinas with high neighborhood socioeconomic status (regardless of education) and Asian Americans with high education and high neighborhood socioeconomic status.

The researchers noted that certain groups who were identified as having better or worse survival would benefit from further study to understand their risk profiles and target specific interventions.

Vital Signs

Minorities Most Likely to Have Aggressive Tumors, Less Likely to Get Radiation Women with aggressive breast cancer were more likely to receive adjuvant chemotherapy, but at the expense of completing locoregional radiation therapy, according to recently presented data. This was especially true in minorities, who were the most likely to present with moderate- to high-grade and symptomatically detected tumors.

“Radiation treatment decreases the risk for breast cancer recurring and improves survival from the disease,” said Abigail Silva, MPH, Susan G. Komen Cancer Disparities Research trainee at the University of Illinois in Chicago, who presented the results at the Fifth AACR Conference on The Science of Cancer Health Disparities, held on October 27-30, 2012.

Prior studies have shown that black and Hispanic women are less likely than white women to obtain radiation treatment when eligible, and this may partly explain racial/ ethnic disparities in breast

cancer outcomes, according to Silva.

To further examine factors in disparities in guideline-concordant radiation treatment, Silva and colleagues gathered interview and medical record data from a population-based study of patients with single invasive primary tumors, including 397 non-Hispanic whites, 411 non-Hispanic blacks, and 181 Hispanics.

Of the patients who consented to medical record abstraction and were eligible for radiation treatment, 88% received a recommendation for radiation treatment and 93% of those patients accepted treatment. However, only 97% of patients who accepted treatment actually received radiation. Therefore, initiation occurred in only 79% of the initial population of women who were eligible for radiation treatment.

Data indicated that minority women were less likely to initiate radiation treatment com-

pared with non-Hispanic white women. In addition, minority women were more likely to have moderate- to high-grade tumors and symptomatically detected tumors.

“We also found that patients who got chemotherapy were less likely to get radiation when they needed it,” Silva said. “Because minorities tended to have more aggressive breast cancer that more often required chemotherapy, this disproportionately affected them.”

Given these results, Silva and colleagues said clinicians may not be recommending guideline-concordant radiation treatment to all eligible patients.

“Indeed, we found that once a treatment recommendation was made, the vast majority of patients received treatment,” Silva said. “In addition, greater diffusion of gene expression profiling may improve cancer care, not only by reducing overuse of chemotherapy but

by eliminating chemotherapy as a potential barrier to receipt of radiation.”

In the next phase of their research, Silva and colleagues plan to examine the role of mutable patient factors such as social support, cultural beliefs, and provider mistrust, which may help explain the disparity in initiation of radiation treatment.

New Study Finds Racial Disparity in Kidney Cancer Patients A study published in the journal Cancer finds that black patients diagnosed with renal cell carcinoma (RCC)—the most common type of kidney cancer in adults—have a lower survival rate than white patients. Using data from the National Cancer Institute Surveillance, Epidemiology, and End Results program, Wong-Ho Chow of the University of Texas MD Anderson Cancer Center and her

colleagues identified nearly 40,000 patients diagnosed with RCC from 1992-2007.

Approximately 89% of those identified patients were white.

However, Chow discovered that there were proportionally more blacks diagnosed with RCC with localized cancer and under the age of 50.

Whites were more likely to have clear cell RCC, the most common subtype of renal cell cancer. Meanwhile, pap-

illary or chromophobe RCC was more common among blacks. Despite the fact that patients with clear cell RCC were found to have a poorer prognosis than those with papillary or chromophobe RCC, the researchers discovered that white patients still fared better: whites had a 5-year survival rate of 72.6%, whereas blacks had a 5-year survival rate of 68%. However, black patients who did not receive surgical

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treatment had a higher survival rate than whites (14.5% versus 10.5%).

Overall, whites had a consistently higher rate of survival than blacks regardless of age, sex, or tumor size. Women had higher survival rates than men, and so did younger patients compared with older ones. However, further study is needed to determine the factors contributing to this racial disparity.

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5

Vital Signs

Soaring Diabetes Rates Across the US Rates of diabetes in the United States have skyrocketed over the last two decades, according to a report from the Centers for Disease Control and Prevention (CDC). In 1995, just

three states—California, Louisiana, and Mississippi—had a diabetes prevalence rate of 6% or higher. But in the November 16, 2012, release of the Morbidity and Mortality Weekly

Report (MMWR), the CDC revealed that every single state now has a diabetes prevalence rate of 6% or higher. Additionally, the prevalence rate peaked at 10% for six states.

The MMWR report, which analyzed self-reported data collected by the Behavioral Risk Factor Surveillance System from 1995-2010, determined that the diabetes prevalence rate increased by 50% or higher in 42 of the states. The South fared the worst, with

Oklahoma (226.7%), Kentucky (158.3%), Georgia (145.0%), and Alabama (140.4%) seeing the highest increases over the 15-year period.

Obesity, which is often linked with type 2 diabetes, may be the culprit, as Americans’ waistlines have expanded in recent years due to an increasingly sedentary lifestyle.

Going forward, obesity prevention measures will be key in lowering these alarming prevalence rates across the country.

NAINA Celebrates Third Biennial Educational Convention

BY LORRAINE STEEFEL, DNP, RN, CTN-A More than 300 members of the National Association of Indian Nurses of America (NAINA) gathered on October 5-6, 2012, at the Westchester Marriott in Tarrytown, NY, for the third biennial national convention, “Nurses at the Forefront of Healthcare Revolution: Challenges and Opportunities.” Motivational speaker, Stuart Robertshaw, EdD, JD (Dr. Humor), President and CEO of the National Association for the Humor Impaired, began the keynote speeches on the healing power of humor by demonstrating strategies to enhance humor and laughter for positive effects on wellbeing.

Suzanne Bakken, DNSc, RN, FAAN, FACMI, Professor of Biomedical Informatics and Director of the Center for Evidence-based Practice in the Underserved at Columbia University School of Nursing, reminded participants that “just as all nurses influence the health of their

6

Minority Nurse | WINTER 2013

patients, Indian nurses can do so through NAINA’s leadership while keeping their unique identity.”

Guest speaker Susan B. Hassmiller, PhD, RN, FAAN, Senior Advisor for Nursing at the Robert Wood Johnson Foundation and Director of the RWJF initiative Future of Nursing: Campaign for Action, reviewed key issues of the IOM’s report on The Future of Nursing: Leading Change, Advancing Health, which, when implemented, will advance the nursing profession’s success in providing better health care for all Americans in a transformed health care system. “Nursing is about doing; it’s a role essentially the same as Florence Nightingale’s, as we look back to go forward,” said Hassmiller.

At the conference, nurses had the opportunity through a variety of breakout sessions, presentations, and networking to share and gain knowledge that will enhance them personally and professionally and

New NAINA Officers were installed for 2013-2014 at the third biennial convention.

enable them to better provide high quality patient care.

The Hon. Kevin Plunkett, Deputy County Executive of Westchester County, NY, inaugurated the Gala Night, which was marked by festivities including native dance presentations, awards to nurses and scholarships to nursing students, and the installation of new NAINA officers for the 2013-2014 term. NAINA President Solymole Kuruvilla,

PhD, RN, ACNP-BC, NYSAFE, offered full support to them and to President-elect Vimala George, MSN, RN, ANP-C. In 2006, NAINA was established with the primary goal of identifying the unique professional, social, and cultural needs of all nurses of Indian origin/heritage and to optimize their contribution to the health and well-being of our citizens.

To learn more about NAINA, visit www.nainausa.com.

Vital Signs

Dr. Adelita Cantu Selected as 2012 NAHN Nurse of the Year

BY CELIA TRIGO BESORE, MBA, CAE The National Association of Hispanic Nurses (NAHN) has selected Adelita Cantu, PhD, RN, as the recipient of the 2012 NAHN Nurse of the Year Award.

“I have worked with Adelita on many projects at NAHN and as members of the NAHN Board of Directors,” said NAHN President Jose Alejandro, PhD(c), RN-BC, MBA, CCM, FACHE. “As a fellow Texan, I am especially proud of her work as a leader, researcher, and nurse educator at the University of Texas Health Science Center San Antonio and her commitment to the health of her community.

Adelita’s tremendous efforts with the Healthy Choices for Kids since its inception in 2008 is a prime example of the spectacular work our NAHN members do. The program is in the same vein as NAHN’s Muevete USA program, in which she has also been involved for the last two years. Both programs work to improve the overall good health of children by promoting healthy food choices, portion control, and physical activity.”

“It was an honor to be part of the 2012 Nomination Committee for Nurse of the Year,” said Mario Alfredo M. Chavez, BSN, RN, NAHN Board of Directors member and Awards and Scholarship Committee Chair.

“There were so many wonderful candidates that exemplified what NAHN represents. Unfortunately, we could only pick one in this wonderful group of nominees.”

“Dr. Adelita Cantu’s work

with Healthy Choices for Kids, Healthy Choices for Seniors, and her work with NAHN at a national and local level exemplifies NAHN’s mission to advance the health in Hispanic communities and to lead, promote, and advocate the educational, professional, and leadership opportunities for Hispanic nurses. For her hard work and dedication to NAHN and the Hispanic community, I want to congratulate Dr. Adelita Cantu, the 2012 NAHN Nurse of the Year,” added Mr. Chavez.

“What a phenomenal pleasure it was to read all the candidates for this year’s NAHN Nurse of the Year,” said Susana Gonzalez, MSN, MHA, RN, CNML, one of the 2012 judges.

“All the nominees were impressive beyond words! However, Dr. Adelita Cantu demonstrates the qualities necessary to be the ideal nurse of the year. Her life-long journey of making a difference, not only in the Hispanic community, but for all the lives she touches, made her stand out.”

Dr. Cantu for her part said, “I am humbled for this recognition and sincerely thank NAHN for its continued support and their consistent work to improve the health care of the Hispanic community. I am very proud to be a member of NAHN and look forward to our future together.”

Dr. Cantu was honored at a Congressional reception and briefing in Washington, DC, on October 10, 2012.

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Vital Signs

New Nursing Documentary Premieres at ANCC National Magnet Conference NURSES: If Florence Could See Us Now made its debut at the American Nurses Credentialing Center (ANCC) National Magnet Conference in Los Angeles on October 11, 2012.

The film, which was funded by several sponsors including the American Nurses Association, the ANCC, and API Healthcare, is a feature-length documentary that showcases the complex and challenging world of nursing.

Over 100 nurses across nine states were interviewed, representing the many different roles that nurses have. “There was no scripting or prepping.

We showed up with a camera crew and had candid conversa-

Filmmaker and API Healthcare Director of Nursing Kathy Douglas, RN, MHA, interviews Karen Hill, RN, ANP-C, MSN, PhD, of the University of California San Francisco, School of Nursing, for the film

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

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

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

Open your doors at bayviewjobs.org

EOE/AA, M/F/D/V

8

Minority Nurse | WINTER 2013

tions. It’s authentic and real,” says documentary filmmaker Kathy Douglas, RN, MHA. Douglas’ inspiration for the film was driven by her belief that a deeper understanding of the role and value of nursing among the public and policymakers will help form a successful future for health care in this country.

“The film’s title acknowledges the role Florence Nightingale played in the development of the field of nursing.”

The film was well received at the conference. “Thank you again and again for the comprehensive picture of who nurses are today,” says Kathleen Lambert, RN, BSN, JD, an attorney at law in Tucson, Arizona. “Florence would be proud of the diversity, intelligence, innovation, dedication, and tenderness that was so evident in each frame of this production.”

“One of the deepest privileges of being a nurse provider is to sit as witness to people’s stories, their struggles, their vulnerability, their hopes and dreams,” says Jonathan Van Nuys, RN, who is featured in the film. “I see stories that break your heart, stories that touch my core; I fall in love with each patient in a different way and just want to mentally hold and embrace them. I’m happy to share my story with others, to just let it go and let people take from it what they will, which is hopefully a piece of hope or inspiration.”

NURSES: If Florence Could See Us Now is dedicated to nurses everywhere for the extraordinary work they do every day and in memory of Joyce C. Clifford, PhD, RN, FAAN, for her numerous contributions to the profession. To learn more about the film, visit www.nursesthemovie.com.

Making Rounds

February 21-23

Cleveland Clinic Center for Continuing Education New Directions: The Future of Palliative Medicine and Supportive Oncology Key Largo Marriott Resort Key Largo, Florida Info: 216-448-0770 E-mail: clevelandclinicmeded@ccf.org Website: www.clevelandclinicmeded.com

27-2

Southern Nursing Research Society 27th Annual Conference: Expanding Networks of Knowledge for Healthcare Innovations The Peabody Hotel Little Rock, Arkansas Info: 877-314-SNRS E-mail: info@snrs.org Website: www.snrs.org

March 16-19

American Association of Colleges of Nursing The Fairmont Washington Washington, DC Info: 202-463-6930 E-mail: info@aacn.nche.edu Website: www.aacn.nche.edu

19-20

Asian American Pacific Islander Nurses Association

21-23

10-12

American Conference for the Treatment of HIV

Visiting Nurse Associations of America 31st Annual Conference Bonaventure Resort and Spa Weston, Florida Info: 202-384-1420 E-mail: regevent@vnaa.org Website: http://vnaa.org

7th Annual Conference Sheraton Downtown Hotel Denver, Colorado Info: 540-368-1739 E-mail: ACTHIV@meetingmasters.biz Website: www.ACTHIV.org

16-20

International Society of Psychiatric-Mental Health Nurses

April 3-6

Advanced Practice Neonatal Nurses 10th Annual Conference Hyatt Regency San Francisco San Francisco, California Info: 707-795-1421 E-mail: Conferenceinfo@academyofneonatalnursing.org Website: www.academyonline.org

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

4-7

21-24

31st Annual Convention: A Portal to Knowledge, Care Excellence, and Networks Sheraton New Orleans Hotel New Orleans, Louisiana Info: 800-454-4362 E-mail: dna@dnanurse.org Website: www.dnanurse.org

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

The Dermatology Nurses’ Association

10-12

Contemporary Forums

Nurses Improving Care for Healthsystem Elders (NICHE) 16th Annual Conference: Forging New Paths and Partnerships Loews Philadelphia Hotel Philadelphia, Pennsylvania E-mail: info@nicheprogram.org Website: http://nicheprogram.org

10th Annual Conference Hale Koa Hotel Honolulu, Hawaii E-mail: info@aapina.org Website: www.aapina.org

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June 5-8

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

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9

FINANCIAL PLANNING 101:

KNOW YOUR WORTH

BY JULIA QUINN-SZCESUIL 10

Minority Nurse | WINTER 2013

: Cindy Hounsell, JD

Lee Baker, CFP(R)

Jose Alejandro, PhD(c), RN-BC, MBA, CCM, FACHE

For all the miraculous work nurses do as caretakers, they are notorious for neglecting the very things in their own lives they know are important, such as physical or financial health. But ignoring either one can have serious consequences.

W

ith careers full of complicated calculations and splitsecond decisions, nurses often don’t want to tackle the complexities of financial planning in their spare time. But like physical health, financial health is essential to a secure and comfortable future. A 2011 Fidelity Investments Nurses Study revealed that although 79% of nurses interviewed feel secure in their jobs and their financial futures, 71% do not think they are saving enough to fund their retirements.1 Like any skill, financial planning takes time and effort. “In health care, we speak healthcare and others don’t understand it,” says Cassandra Chandler, the RN Money Coach and author of The Retirement Game for Nurses. “Finance is a whole other language, too.”

For many nurses, tackling financial issues is one more thing on a long to-do list. “It can be so complicated,” says Jorge Prada, RN, an obstetrics

nurse in New York City. “The jobs are so draining and so tiring and you don’t have time for that. But financial health is very important.”

And for some minority populations, simply talking about financial matters can be a challenge. If money and investing were not topics of conversation growing up, it

thing except their finances, he says, especially if they are unfamiliar with the terms and concepts.

But just like health issues, it only helps to overcome the hesitation and look at the big picture. You can make some big mistakes without a solid financial plan, and doing nothing at all is one of the

A 2011 Fidelity Investments Nurses Study revealed that although 79% of nurses interviewed feel secure in their jobs and their financial futures, 71% do not think they are saving enough to fund their retirements.

can be difficult to overcome the barriers to discussing something many see as very personal, says Lee Baker, a certified financial planner and founder of Apex Financial Services, Inc., in Tucker, Georgia. “When talking to clients who are minorities, the issue you have a lot of times is the comfort level,” he says. People are often more comfortable discussing just about any-

biggest. “You have to know what you have, and you have to know what you need,” says Chandler, who recommends envisioning what you want from your retirement. “It takes a little work.”

Baker notes that one person’s idea of retirement may not be the same as what is often portrayed as ideal. “There are things that are seen as ‘normal’ in the US that don’t

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resonate culturally with everyone,” says Baker. For many cultures, the typical image of a carefree retirement is not something that matches their desires. “For some, that imagery comes across as being selfish,” he says, because they prefer to help family members.

“Don’t assume what you see applies to you.”

So it is essential to differentiate what you want to do from what society expects you to do when you retire. Think about what you want to accomplish in the near future and in later years. Now answer the following questions: • What does retirement mean to you?

• Are you planning to return to school?

• Will you be helping children pay for college?

• Do you want to travel?

• Do you want to move somewhere else?

• Do you want to be mortgage-free?

Once you identify personal goals, you need to accurately estimate how much you will

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need and decide how to fund those plans. “It is worth it to make sure you are saving enough,” says retirement expert Robert Brokamp, Editor of The Motley Fool’s Rule Your Retirement newsletter and author of several books on financial health. “Seventy-five percent of people approaching retirement have less than $30,000 saved.” And there is no backup plan for retirement. “If you do not have enough when you reach retirement, you cannot get a loan,” says Brokamp.

What makes financial planning so daunting? For starters, your financial needs fluctuate constantly and different cultures have varied priorities. A 2012 Retirement Report commissioned by the ING Retirement Research Institute showed differences in the ways minorities approach financial planning and retirement goals. Of the 4,050 respondents (including 500 African Americans, 500 Hispanics, and 350 Asian Americans), only 29% said they have a formal investment plan, but African Americans reported

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being most likely to have one at 32%. And respondents reported that life’s roadblocks such as debt (for African Americans) or lack of information (for Hispanics) stood in their way of saving enough.

and day-to-day expenses can eat up a big chunk of your salary. But as life progresses, a mortgage, children, additional schooling, or even caring for aging parents will change your financial outlook.

For nurses who appreciate the flexibility of moving in and out of the workplace in many capacities, job benefits can make a big difference in retirement savings.

Minority Nurse | WINTER 2013

That lack of planning shows in the end. While the Retirement Report showed only one in four Asian Americans have one month or less of savings for an emergency fund, 47% of Hispanics and 50% of African Americans reported having no emergency fund at all. But African American respondents have larger life insurance policies, and 70% of them indicated they are likely to leave the proceeds to their heirs (versus 53% of the total respondents).

It helps to realize that each life stage requires a flexible approach. For recent graduates, student loan payments

So where do you start? Decide if you want to do everything yourself or hire someone to help you. Either choice requires familiarity with some financial planning basics. “You have to know enough to know whether you are getting good advice,” says Brokamp. “Money is boring [and] complicated, but we spend the majority of our waking hours making money, so it is worth it.”

Familiarizing yourself with the lingo will make you more comfortable talking about finances, advises Cindy Hounsell, JD, President of the Women’s Institute for a Secure Retirement (WISER). Her

organization pairs with the American Nurses Association to offer classes in which nurse educators teach nurses about financial planning and investing. The classes offer sound advice from trusted leaders, says Hounsell.

A 2008 WISER survey revealed that only about 6% of nurses thought they had a strong grasp of financial planning issues, but nearly all thought understanding the information was important.2 These classes offer a place to begin. “[Nurses] need to know to start and to not give up,” says Hounsell. “If you don’t start, that puts you in trouble.”

If you choose to do everything yourself, you should plan to devote at least one weekend annually to financial matters. Examine all your accounts, benefits, and insurance to make sure everything is up to date including beneficiaries. Use Quicken or Excel to track details such as goals, account numbers, amounts, and relevant dates. Creating an organized and effective plan requires only basic methods, says Brokamp.

If you choose to hire help, a fee-based planner is a great place to start. Fee-based planners do not work on commission so they stand nothing to gain by recommending anything. By paying the adviser for time instead of products, any conflict of interest is removed.

Nurses, who are used to doing everything themselves, can find it tough to hire a financial planner, and they want someone they trust. But if you are not making progress on your own, hiring someone will help. “Nurses are very

good at taking care of people,” says Prada, who hires financial help. “And there are people who are good at taking care of money. You have to give them credit for that. They can give you advice you have never heard before.”

While there are many ways to save money, through individual accounts such as an Individual Retirement Account (IRA), an employer-sponsored 401(k) or 403(b), or a personal savings account, it all requires the money getting there. Everyone would like to deposit large amounts, but don’t be discouraged if you can only save $10 a week. It will add up.

Have it automatically deposited each week or each month so you do not even see it.

No matter which type of account you have, all experts agree that it’s necessary to have an emergency fund so you can pay your bills during financially tight times. Plan to tuck away 3 to 6 months’ worth of your income into an easily accessible fund like a CD for this purpose. However, if your income fluctuates or if there is a chance you could have difficulty securing a job if you are laid off, you need to have a larger emergency fund.

Save for Retirement Before All Else Nurses have to change the way they view retirement savings. While you might think that funding a child’s education should come before saving for retirement, it should never come first—and that is for the benefit of your children as well. Your retirement affects your quality of life. You can always receive a loan or have your child apply for scholarships and grants

to help fund higher education, but banks won’t help you stretch your retirement funds when you fall short. And if you do not save enough, you might become a financial burden to the very children you were helping out financially years ago. Making retirement savings a priority will protect your children from having to support you later.

For retirement, many nurses use a company 403(b) plan (not-for-profit institutions) or a 401(k) plan (for-profit institutions) to save. With 2012 maximum contributions set at $17,000 annually for 401(k) or 403(b) accounts and $5,000 for an IRA, the amounts are significant. But if you work as a contractor, you can still investigate individual 401(k) plans.

These will let you put away more money than a traditional plan to make up for the lack of employer-matched funds.

Target retirement funds, which are based on your estimated retirement year, are gaining in popularity as well, says Brokamp. Fund companies like Vanguard, for instance, allocate your funds into a mix of options that change in risk as your retirement nears. “It is easy,” says Brokamp of target funds, but not fool proof. The funds are not a magic potion for savings. You still have to calculate how much you are saving and make sure you will have enough when you retire. But for the person looking for a one-stop option, he says, this concept is worth considering.

How do you know if you will have enough to retire when you want? There are many retirement calculators on the Internet that are easy to use, and you can also pay a fee-only

Financial Resources Consult the RN Money Coach: • www.RNmoneycoach.com

Find a Certified Financial Planner: • www.CFP.net

Read about the Nurses’ Investor Education Project: • www.wiserwomen.org/index. php?id=37&page=Nurses`_Investor_Education_ Project

Take an Online Course on Investing: • www.investingforsuccess.org

Use a Retirement Calculator: • http://apps.finra.org/Investor_Information/Calculators/1/RetirementCalc.aspx

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consultant to help you. Expect to pay somewhere around $200 for the service, but consider it money well spent.

Benefits Are More Than Just Perks Salary is often a big motivator for changing jobs, but take the time to weigh the benefits package as well. Consider the options in dollar amounts, not as perks. For nurses who appreciate the flexibility of moving in and out of the workplace in many capacities, job benefits can make a big difference in retirement savings. Many young nurses change jobs to find the right career fit. “It can be good for a career, but bad for financial planning,” says Mary Aleksiewicz, recently retired Vice President of Nursing at Fair-

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lawn Rehabilitation Hospital in Worcester, Massachusetts.

Employer-sponsored matching programs could potentially add thousands of dollars to the total benefits package. “If you don’t add to that, you are throwing money away,” says Aleksiewicz.

If you work on a contract basis that offers a higher hourly rate but no benefits, you have to put extra money aside for retirement because you have no employer-matching options.

“Benefits include retirement,” says Teresa Haller, RN, MSN, MBA, NEA-BC, of patient care services at the University of Virginia Health System. “So [contract work] comes at a cost.”

At the very least, a job should have a retirement plan and decent health insurance.

Many companies offer sever-

al kinds of insurance as well.

Short-term or long-term disability and life insurance will help keep your family financially secure if anything happens to you. Some employers will even provide opportunities to speak with financial planners or with lawyers who can draft a simple will, a service that can be worth hundreds of dollars and is invaluable to your family’s financial health.

Haller says nurses must know what benefits are left behind at each job as well.

“When nurses leave, they lose track of what might be coming to them,” she says. “They may be eligible for benefits from their employers if they worked there long enough.”

If you are a recent graduate, begin tracking retirement benefits from each employer. Or if

you are several years into your career and do not have this information, call any previous employers’ benefits office and ask them to look it up. Then remember to call them when you retire, says Haller, because they are not going to call you.

How Can You Save?

You know the basics, but just how can you put enough money away? The younger you are, the easier it is to save, say many experts. But for young nurses, just paying off loans and possibly gaining a mortgage or paying rent makes it tough to save anything. But the sooner you start, even with a small amount, the more likely you are to reach a comfortable retirement goal. And for women especially, the importance of

saving enough cannot be overstated. “Minority women tend to fall into that spot of women living in poverty later in life,” says Haller, noting that single minority women are most at risk in older age.

“Budget based on your salary, and not on overtime and your total salary,” recommends Jose Alejandro, PhD(c), RN-BC, MBA, CCM, FACHE, President of the National Association of Hispanic Nurses.

Nurses can run into financial trouble when overtime stops and they have become dependent on that income to live.

And Alejandro knows what happens when nurses neglect retirement plans. “I have seen nurses who would love to retire but cannot,” says Alejandro. In fact, the 2011 Fidelity study revealed that 42% of nurses believe they will never fully retire, primarily because they think they will need the money for living expenses. “One thing I always tell students who are graduating is that your first meeting should be with a financial planner,” says Alejandro. “And then start putting something away.”

Experienced nurses who know the value of retirement savings or even those who have learned the hard way are often great resources for colleagues. Monica Garcia, MSN, RN, FNP, who works in student health services at the University of California at San Diego, says the sage advice she received as a young nurse made a huge impact. “When I first started nursing, I didn’t even think about [saving],” she says. “Luckily, I worked with a nurse who asked me if I was contributing to my 401(k).” Her colleague encouraged her to save anything at

all, even if it amounted to just 2% of her income.

When Garcia went back to grad school, she continued to contribute to her retirement, but the amount was minimal.

Now she is playing catch up, she says, adding more to the funds to make up for the lean years. And Garcia, who has always worked as a full-time nurse, takes on per diem jobs to help fund extras such as travel. The extra money is not part of her normal budget but helps her keep a lifestyle she wants. And it might just be a good option for you if you want a similar lifestyle.

Financial health is not just socking away money and paying off debt. It really is about your life plan.

Prada agrees: “Financial freedom is about what is important to you.”

Cultural Differences in Retirement Planning • 54% of Hispanics, 50% of African Americans, 48% of whites, and 44% of Asians reported feeling “not very” or “not at all” prepared for retirement.

• Most (73%) reported barriers to saving, with African Americans reporting debt as a big barrier and Hispanics reporting a lack of information as a problem.

• African Americans (54%), Asians (53%), and Hispanics (50%) are more likely to get their financial information from the Internet and media compared with only 45% of whites.

• Asians are the least likely to have a last will and testament (26%), compared with 31% of Hispanics and 37% of whites.

• 47% of Hispanics, 50% of African Americans, and 25% of Asians reported having virtually no emergency savings (one month or less).

Source: Retirement Revealed, ING U.S. Study commissioned by the ING Retirement Research Institute, 2012

Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.

LOOKING FOR THE BEST NURSES?

References 1. Fidelity Investments, “Fidelity® Survey Finds Nurses Feeling Secure About Their Jobs, But Many Reveal Economy Has Impacted Their Retirement Plans,” (2011).

Accessed 2012. www.fidelity. com/inside-fidelity/individualinvesting/TEM-nurses-survey.

2. J. Osborne, “Final Report: Nurse Investor Education Survey, A Joint Project of the Center for American Nurses and WISER, the Women’s Institute for a Secure Re-

MINORITY NURSE

ACADEMIC AND FACULTY OPPORTUNITIES Faculty Postings Academic Profiles

Banners and Print/Web Combos E-Newslette Sponshorships

tirement,” (2009). Accessed 2012. www.wiserwomen.org/images/ imagefiles/wiserNurseSurvey. single%20page%20layout.pdf.

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Who would have thought? Garrett Morgan did in 1923. The Traffic Signal, developed by Garrett Morgan,

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

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

Š2008 UNCF

AN INTRODUCTION TO MEDICAL-SURGICAL NURSING

BY SANDRA FIGHTS, MS, RN, CMSRN, CNE, AND KATHY LATTAVO, MSN, RN, CMSRN, ACNS-BC, RN-BC

You start your shift with the following assignments:* 1 Ms. Smith, a 68-year-old who was admitted with a diagnosis of fluid overload. She has a history of chronic renal failure, hypertension, and type 2 diabetes. She will be receiving hemodialysis today in her room and is also scheduled for a 2-D echocardiogram. 2 37-year-old John White, who was admitted with a diagnosis of appendicitis.

He is scheduled for a laparoscopic appendectomy at 1300 hours. 3 Mr. Jackson, a 72-year-old patient with exacerbation of chronic obstructive pulmonary disease. He is oxygen dependent and has scheduled respiratory treatments throughout the shift. 4 Anne Brown, 48 years old, who was admitted with a cat scratch. Her left lower extremity is swollen, red, and painful. She is receiving three different antibiotics to combat the infection and cellulitis. 5 David Martin, 58 years old, who is one-day postoperative after a pancreatectomy for a pancreatic tumor. He has a nasogastric tube, Foley catheter, patient-controlled analgesia, peripherally inserted central catheter, and sequential compression devices. And you were just notified that you would be receiving Joseph Garcia, an 84-year-old with a diagnosis of altered mental status, from the Emergency Department. *All scenarios, although seemingly real, are created; all patients described are fictitious.

W

ho are you? Well, you are a medical-surgical (medsurg) nurse, of course. You are a member of a very talented and competent nursing specialty. Let’s delve into this in more detail.

Have you ever tried to define nursing to anyone? Chances are you’ve heard different descriptions from different nurses. Florence Nightingale (1859) stated that nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient.”1 The American Nurses Association defines nursing as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.”2 As you can see, the scope of nursing

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has really expanded from the time of Florence Nightingale.

How do you define med-surg nursing? Now, that becomes even trickier. Med-surg nursing is defined as “the diagnosis and treatment of human responses of individuals and groups to actual or potential health problems.”3 The goal of med-surg nursing is to assist the individual or group in promoting, restoring, or maintaining his/her optimal health.

Some describe the practice of med-surg nurses as foundational to all nursing practice.

Med-surg nurses can work in a variety of settings ranging from the hospital to the home to outpatient clinics. It can be argued that the med-surg unit is the most important department in an acute care hospital

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since the unit houses the most number of patients that can determine patient satisfaction scores.4 Is med-surg nursing really a nursing specialty or it is just basic nursing? The American Board of Nursing Specialties (ABNS) Accreditation Standards outlines several criteria for a nursing specialty5: 1. There is a unique and distinct body of scientific knowledge.

2. There is an identified need for the specialty.

3. The specialty must be defined, its core knowledge explicated, a scope of practice written, with the nursing component delineated, and standards for the specialty specified.

the med-surg patient, evolving technology, and the advancement of health care reform, a commitment to lifelong learning is essential. Whether continuing education is obtained by attendance at conventions and workshops or through reading journal articles, AMSN has worked to provide those needed materials for the medsurg nurse.

Another step was to establish a certification exam that was developed based on the practice of the med-surg nurse.

This has been accomplished by AMSN’s partnership with the Medical-Surgical Nursing Certification Board (MSNCB). Nurses can demonstrate expertise in their practice by completing the certification process.

Because of the complexity of the med-surg patient, evolving technology, and the advancement of health care reform, a commitment to lifelong learning is essential.

Med-surg nursing certainly meets the above criteria. These criteria are further refined and defined throughout the ABNS Accreditation Standards with med-surg nursing fulfilling the requirements. One of the criteria deserving particular notice states there should be the presence of a national or international organization with registered nurse members endorsing or supporting the specialty. The Academy of Medical-Surgical Nurses (AMSN) was established for the purpose of supporting and promoting the work of the med-surg nurse.

One of the ways AMSN has worked to support the role of the med-surg nurse is in the area of continuing education.

Because of the complexity of

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In the 2012 Practice Analysis/ Role Delineation conducted

by MSNCB, there were several interesting results. The sample size was 1,272 certified medsurg nurses (CMSRNs). The following results were from the respondents that did not have a master’s (or higher) degree: • 52.5% had a baccalaureate in nursing.

• The average number of years in nursing was 17.2 years while the average number of years in medsurg nursing was 14.7 years.

• 76% stated that “staff nurse” best described their work.

• 81% have worked on an inpatient med-surg unit.

• 60% stated they spent their time in direct patient care.

These facts provide insight into the dedication, experience level, and educational background of the med-surg nurse. Other components of the analysis are used in refining the practice-based CMSRN certification exam.

Benner, Kyriakidis, and Stannard identified nine different domains of practice in acute and critical care nursing practice.6 Some of the domains that med-surg nurses participate in include: diagnosing and managing life-sustaining physiologic functions; assuring patient safety; making a case; and providing comfort measures. In 2012, MSNCB further expanded these domains for the med-surg nurse. Some of the additional domains include the teaching/coaching function, the helping role, and administering and monitoring therapeutic interventions.7 How do med-surg nurses practice these domains? Let’s look at a typical day.

What does a med-surg nurse do on a shift-to-shift basis?

Nurses begin their shift by receiving a report or handoff from the off-going nurse. After report, the nurse will discuss the tentative plan of care with other health care providers.

Time is next spent conducting thorough head-to-toe assessments and administering ordered medications. Med-surg nurses discuss care with physicians as well as admit, discharge, and transfer patients throughout their shift. An experienced med-surg nurse is able to identify subtle changes in a patient’s condition and alert the physician before rapid deterioration occurs. They also assist with activities of daily living, teach patients and families, and continually

work with other departments to ensure safety and care. Typically, med-surg nurses will be assigned four to six patients at the beginning of their shift.

However, it is not unusual that they discharge two to three patients and receive two to three new patients during their shift.

And, don’t forget documentation of all these treatments and activities. As you can see, it is a busy shift.

The complexity of the patients, increasing care demands, and increasing regulatory demands push the med-surg nurse into new ways of thinking. In the future, the med-surg nurse’s role will continue to expand. The practice of the med-surg nurse demands skill and expertise in a wide variety of disease states, medications, and communication techniques, as well as the ability to work with numerous members of the health care team. The Institute of Medicine’s Future of Nursing report recommends that nurses should practice to the full extent of their practice.8 While some have interpreted this recommendation as addressing the advanced practice nurse, the intent of the

An experienced medsurg nurse is able to identify subtle changes in a patient’s condition and alert the physician before rapid deterioration occurs. recommendation was broader, including the practice of the registered nurse.

When considering the practice of the med-surg nurse,

there is much that can be done in considering the full extent of practice. Often the clinical decision-making and

as they recover from their acute state to a time of rehabilitation, whether in a facility or as they return to home.

The practice of the med-surg nurse demands skill and expertise in a wide variety of disease states, medications, and communication techniques, as well as the ability to work with numerous members of the health care team. work in care coordination by the med-surg nurse is not fully recognized. Med-surg nurses have long been involved in seeing the whole picture for the patient, looking beyond the patient’s immediate state to the steps post-hospitalization.

The med-surg nurse has the opportunity to connect with the patient, the family, physicians, nursing staff, and the rest of the health care team.

This provides an opportunity to make connections and carefully plan for the patients’ care

In the accountable care environment, the role of the med-surg nurse will be key in providing quality care and preventing readmissions. The practice of the med-surg nurse is considered to be primarily in the acute care setting. The increasing complexity of patients in the home stretches the boundaries of the medsurg nurse’s practice. Nurses in long-term acute care describe their practice as that of a med-surg nurse. Other changes within health care may con-

tinue to stretch the practice settings and opportunities for the med-surg nurse.

The future will bring continued efforts to provide evidence that supports the work and the functions of the med-surg nurse. Nurses at the bedside are interested in discovering why the care they provide improves patient outcomes. Med-surg nurses seek to learn the most effective techniques that will lead to higher quality patient care. The care med-surg nurses provide is a rich source for future research.

As nurses at the bedside gain new skills and abilities, they become the expert and leader in their work setting. The medsurg nurse in the future will be the clinical leader at the bedside. This is an expanding role for the nurse. The clinical leader will be skilled in delegation, communication, conflict management and resolution, coordination of care among the interdisciplinary health care team, and working with multiple groups across the health care organization. The nurse will not leave the bedside to be a clinical leader. Rather, nurses will expand their scope of practice to include these important skills.

Med-surg nursing is for you if you: 1) like a challenge; 2) want to make a difference in the life of a patient; 3) want to expand your knowledge base, 4) are not afraid of hard work; and 5) want to work in a dynamic work environment. Med-surg nurses are critical thinkers, clinical leaders, and integral members of the interdisciplinary team. They show commitment by being connected and compassionate with others. Give this nursing specialty a try. The rewards are amazing!

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Sandra Fights, MS, RN, CMSRN, CNE, is the Immediate Past President of the Academy of MedicalSurgical Nurses (AMSN). Kathy Lattavo, MSN, RN, CMSRN, ACNS-BC, RN-BC, is the President of the Academy of MedicalSurgical Nurses (AMSN) and Medical-Surgical CNS at St. David’s Medical Center in Austin, Texas. © 2013 The Academy of MedicalSurgical Nurses (AMSN). All rights reserved.

References 1. F. Nightingale, Notes on Nursing: What It Is and What It Is Not, 1st ed. (London: Harrison, 1859), 6.

2. American Nurses Association, “What is nursing?,” retrieved August 27, 2012, from www.nursingworld.org/EspeciallyForYou/ What-is-Nursing.

3. H. Cravens, Core Curriculum for Medical-Surgical Nursing, 4th ed.

(Pitman, NJ: Anthony J. Jannetti, Inc., 2009).

4. R. Parsons, “Spotlight on Med/ Surg,” retrieved July 6, 2012, from www.hfsconsultants.com/blog/ spotlight-on-medsurg.

5. Accreditation Board for Specialty Nursing Certification, ”Accreditation Standards,” retrieved August 17, 2012, from www.nursingcertification.org/accreditation-standards. html.

6. P. Benner, P.H. Kyriakidis, and D. Stannard, Clinical Wisdom and Interventions in Acute and Critical Care: A Thinking-in-Action Approach, 2nd ed. (New York: Springer Publishing, 2011), 1-26.

7. Medical-Surgical Nursing Certification Board (MSNCB), Practice analysis and role delineation of medical-surgical nursing (Pitman, NJ: Anthony J. Jannetti, Inc., 2012).

8. Institute of Medicine (IOM), The future of nursing: Leading change, advancing health (Washington, DC: The National Academies Press, 2010).

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NEW NURSES FIGHT TO FIND WORK

BY LEIGH PAGE

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When Rhys Gibson, RN, received his nursing degree from the University of Illinois at Chicago in 2009, the recession had started and it took him eight months to land a job.

“I thought I was the cat’s meow and everything because I’m an African American guy coming out of here,” he told National Public Radio. “I had the grades, had the experience, to an extent but not the practical experience as a nurse working on the floor.”1

M

inority graduates from nursing schools are swept up in a nationwide decline in job opportunities that still continues today, forcing job applicants like Gibson to fight to find work. A 2011 survey by the National Student Nurses’ Association (NSNA) found that 36% of RN graduates had no job four months after leaving school.2 The survey further indicated that graduates with associate degrees, who make up most of RN graduates, were having markedly more problems finding jobs than their BSN counterparts. In a follow-up survey six months later, half of those without a job still hadn’t found work.3 Mary Chatman, PhD(c), RN, Chief Operating Officer and Chief Nursing Officer at Memorial University Medical Center in Savannah, Georgia, says sharp downturns in the nursing job market are not a

Mary Chatman, PhD(c), RN

new phenomenon. “I lived it,” she says, recalling that when she received her RN degree in North Carolina many years ago, “the nursing schools in the area were graduating far more students than the hospitals needed.” She had to work hard to find a job.

found that more than 250,000 nurses entered the workforce in 2007-2008––a 30-year record––then schools continued to expand enrollment even as demand for health care services plummeted with the recession.5 There were plenty of enthusiastic applicants. In 2011, nursing schools had to turn away more than 70,000 qualified applicants.6 But as record levels of new nurses graduated, they plunged into a highly competitive job market. “I pursued a career in nursing because I was told there was a high demand and I would always have a job,”

A large segment of older nurses is slated to retire soon, while demand for health care is expected to explode due to an aging population and expansion of coverage under health reform.

The same lopsidedness between supply and demand confronts nurses today––only on a nationwide scale with no end in sight yet. The new glut of nurses came as a surprise, because for many years, nursing supply experts have been predicting the exact opposite— a huge shortage of nurses was on the horizon.

A large segment of older nurses is slated to retire soon, while demand for health care is expected to explode due to an aging population and expansion of coverage under health reform.4 The reform law is poised to add more than 30 million more people to Medicaid or private insurance in 2014.

To head off this shortage, nursing schools have been pushing up their output of new nurses for many years now. A 2009 study in Health Affairs

a BSN graduate wrote in the NSNA survey. “The large number of applicants makes every position very competitive.”

In addition to competition from other graduates, these new nurses also faced inactive nurses who began returning to work when the recession hit, says LeAnn Thieman, CSP, CPAE-Nurse, a nurse recruitment and retention consultant in Fort Collins, Colorado. She adds that hospitals often prefer hiring these seasoned nurses over new nurses who would have to be trained.

The situation is further complicated by hospitals’ reluctance to hire permanent nurses due to the unstable economy, says Marco Colosi, President of NSI Nursing Solutions, Inc., a nurse-staffing firm in East Petersburg, Pennsylvania. He reports that demand for tem-

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porary nurses has risen and hospitals have put existing staff on longer hours.

Colosi adds that hiring has also been stymied by the uncertain future of health reform. The Supreme Court’s decision on the law last June lets states opt out of the Medicaid expansion, and demand for services could be reduced yet further if health reform is repealed.

How to survive a hostile job market Under these harsh circumstances, new minority nurses trying to find work have to be resourceful, Thieman says.

“Keep in mind that 160,000 US nursing positions went unfilled last year,” she says.

Here are some steps new nurses should take to keep their careers on track: • Get job experience. Since employers prefer applicants with previous work, Thieman advises taking any job you can get whether it involves a midnight shift, work in a nursing home, or even volunteering part-time.

• Get yourself noticed. “Getting a job is all about visibility,” Chatman says. “Get yourself in front of the people who will make the hiring decisions.” Rather than just sending in resumes, unemployed nurses should visit the units where they would like to work and firmly but politely ask for an interview, she says.

• Highlight your minority status. Chatman says hospitals with a high proportion of Medicaid patients may desire minority nurses who can relate to those patients. “Don’t lay it on too thick, but let them know that in addition to your nursing skills, you come

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from the same background as their patients,” she says.

• Attend nursing conferences.

“This is a great way to make connections,” says Geneviève M. Clavreul, RN, PhD, a health care management consultant in Pasadena, California. She advises to always wear proper attire and maintain a neat appearance.

• Look beyond hospital jobs.

Hospitals employ almost twothirds of all nurses and are the preferred destination for new nurses, but health services are moving away from the hospital, says Diane Mancino, EdD, RN, CAE, Executive Director of the NSNA. • Be willing to move. Nurses rarely relocate for work, but those who do can take advantage of pockets of strong demand, such as rural areas and certain parts of Florida, Texas, and the Southwest, Colosi says.

• Go back to school. Associate degree nurses can enter RN-toBSN programs, offered at more than 600 schools.7 Study lasts one to two years, and tuition can be as low as $106 per credit hour.8

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• Take advantage of expanded student loan programs. The health reform law increases borrowing limits for the Nursing Student Loan program as well as the number of programs that can be funded by the Nursing Workforce Diversity program, which helps underrepresented minorities. Diversity grants totaling $3.6 million are now available for students in RN-to-BSN and accelerated nursing degree programs.9

Careers to consider New nurses mapping out their careers have a variety of viable options to choose from.

Here is a small sampling: • Long-term care. People over age 84 are the fastest growing segment of the US population, but only 3% of graduates are interested in this field, according to the NSNA survey. Certification requires at least two years in a nursing home and passing an examination. Certified long-term care can earn about $67,000.10 • Community health. The NSNA survey shows that only 8% of graduates are interested

in community or home health, even though there are a variety of opportunities here, including domestic violence, forensics, HIV/AIDS, hospice, public health, and telemetry. Home health nurses help patients regain physical independence and manage their medication, and their basic pay is about $57,000 a year.11 • Dialysis nurse. This position is one of the nation’s fastest growing nursing specialties, according to www.thebestschools.org, which pegs the

form 60% to 80% of a PCP’s work, and they make an average of $78,000 a year working in hospital clinics, physicians’ offices, or independent practice.12 They must get a master’s degree, which normally takes two to three years to complete, and obtain state licensure.

Hang in there The NSNA survey shows that while unemployed graduates are still committed to finding a job, dissatisfaction is sinking in for many. More

Despite current job woes, Thieman says nursing is still a better option than most other careers. In 2011, 56% of new BSNs had a job offer at the time of graduation, compared with 24% of all new college graduates. salary at $63,500. You’ll need at least 2,000 hours of experience to sit for the certification exam.12 • Nurse practitioner. This career shows promise due to a growing shortage of primary care physicians. NPs can per-

than 90% said they remain “passionate about nursing and will continue to seek employment as an RN until [they] succeed,” but 38% said they were not getting support and were disillusioned with the profession.

Thieman advises unemployed graduates to hang in there. “I’d say to them, ‘stay in nursing,’” she says. “We are at the brink of a tremendous nursing shortage of crisis proportions.” Clavreul predicts jobs will become more plentiful within two years, as older nurses retire and the expansion in coverage is slated to start under health reform.

Despite current job woes, Thieman says nursing is still a better option than most other careers. In 2011, 56% of new BSNs had a job offer at the time of graduation, compared with 24% of all new college graduates.13 And the Bureau

of Labor Statistics predicts a 26% increase in nursing jobs from 2010 to 2020, while jobs in other occupations will rise just 14% on average.14

3. Griswold A. Has Nursing Been

http://www.aacn.nche.edu/news/

ry.html. Accessed October 2012.

Overhyped As A Career Choice?

articles/2012/enrollment-data. Ac-

11. Aspiring Nurse. Home Health

Forbes. June 18, 2012. http://

cessed October 2012.

Nurse Salary. January 13, 2012.

www.forbes.com/sites/alisongris-

7. Perez-Pena R. More Stringent

http://www.aspiringnurse.com/

wold/2012/06/18/has-nursing-

Requirements Send Nurses Back

home-health-nurse/home-health-

been-overhyped-as-a-career-

to School. The New York Times.

nurse-salary/. Accessed October

choice/. Accessed October 2012.

June 23, 2012: A13. http://www.

2012.

Leigh Page is a Chicago-based

4. Recession may temporarily re-

nytimes.com/2012/06/24/edu-

12. The Best Schools. 10 Best

freelance writer specializing in

solve nursing shortage. Strategies

cation/changing-requirements-

Nursing Careers. November 23,

health care topics.

for Nurse Managers. http://www.

send-nurses-back-to-school.

2011. http://www.thebestschools.

strategiesfornursemanagers.com/

html?pagewanted=all

org/blog/2011/11/23/10-nursing-

ce_detail/234741.cfm. Accessed

8. Best Colleges Online. Top 10

careers. Accessed October 2012.

References

October 2012.

Most Affordable Online RN to BSN

13. American Association of

1. Gross A. Sick Economy

5. Buerhaus P, Auerbach D,

Programs. http://www.bestcol-

Colleges of Nursing. New AACN

Means Nursing Jobs Harder

Staiger D. The Recent Surge In

legesonline.org/most-affordable/

Data on Nursing Enrollments and

To Find. National Public Radio.

Nurse Employment: Causes And

online-rn-to-bsn-programs/ Ac-

Employment of BSN Gradu-

May 9, 2011. http://www.npr.

Implications. Health Aff. 2009 Jul-

cessed October 2012.

ates. December 6, 2011. http://

org/2011/05/09/136138374/sick-

Aug;28(4):w657-68. http://content.

9. Teitelbaum J. Nursing Work-

www.aacn.nche.edu/news/

economy-means-nursing-jobs-

healthaffairs.org/content/28/4/

force. HealthReformGPS. June

articles/2011/11enrolldata. Ac-

harder-to-find. Accessed October

w657.full. Accessed October

15, 2011. http://healthreformgps.

cessed October 2012.

2012.

2012.

org/resources/nursing-workforce/.

14. Bureau of Labor Statistics,

2. Mancino D. Inaction is Not

6. American Association of Col-

Accessed October 2012.

U.S. Department of Labor.

an Option. Dean’s Notes.

leges of Nursing. New AACN Data

10. Salary Wizard. Staff Nurse

Registered Nurses. Occupational

2011;33(2):1-4. http://www.ajj.

Show an Enrollment Surge in

– RN – Long-Term Care – U.S.

Outlook Handbook: 2012-13

com/services/publishing/deans-

Baccalaureate and Graduate Pro-

National Averages. Salary.com.

Edition. http://www.bls.gov/ooh/

notes/nov11.pdf. Accessed

grams Amid Calls for More Highly

http://www1.salary.com/Staff-

Healthcare/Registered-nurses.

October 2012.

Educated Nurses. March 22, 2012.

Nurse-RN-Long-Term-Care-Sala-

htm. Accessed October 2012.

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

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

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Avoiding Workplace Fatigue

BY JEBRA TURNER Feeling overwhelmed? Heavy patient load, blazing speed, 24/7 shifts, and an ever-evolving field have long been complaints among nursing professionals.

Add the stress of a slumping economy, budget cuts, and staff re-jiggering, and job fatigue can hit critical mass in the workplace.

Here are some ways to sidestep the most common pitfalls, so that stress doesn’t torpedo your efforts to serve patients, their families, and your co-workers.

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How nurses are affected by workplace fatigue What are the classic warning signs of fatigue? “Nurses exhibit frequent tardiness, calling in sick a lot, demonstrating a lack of empathy, or a ‘flat affect’ when taking care of patients—being more focused on tasks than the whole person,” says Michelle Bragazzi, RN, BS, Community Editor of TheONC. org. Job dissatisfaction is high.

Departmental morale is low.

Chronic fatigue is also associ-

ated with rising medical errors, and even patient deaths.

Anecdotal accounts of burnout point to the stress of a demanding profession, often with extended or rotating shifts, and little time for rest breaks. Besides plummeting job performance, there are harmful health-related outcomes.

These include disturbed sleep patterns, elevated stress hormones, expanding waistlines, and mental health issues, such as depression.

Workplace stress affects every aspect of a nurse’s being: physical, mental, and spiritual.

And it can overflow into every area of a nurse’s life, upsetting relations at home or out in the community.

The organization itself suffers when its nurses suffer chronic fatigue. Spiraling absenteeism, high staff turnover, and rising Workers’ Compensation costs take a heavy financial toll. Conflict between staff members as

A popular topic in the press, HR departments, and staff lunchrooms, burnout is a still a fuzzy medical concept.

A popular topic in the press, HR departments, and staff lunchrooms, burnout is a still a fuzzy medical concept. It is not a recognized disorder in the DSM-IV, for instance. The Maslach Burnout Inventory (MBI), developed by Christina Maslach, one of the leading researchers of burnout, is the most rigorously validated measure. A recent study using the MBI showed that more than one-third of nurses report levels of job-related burnout.1 When nurses are chronically stressed and feel unsupported by the work environment, it can lead to lapses in infection control practices. The research shows that the busy schedules and heavy workloads of nurses are contributing factors to the rise in infections.

well as friction between management and workers can create additional workplace dysfunction and stress.

Which specialties are most or least at risk?

“School nurses have the highest satisfaction of all specialties,” says Linda Davis-Alldritt, RN, MA, PHN, FNASN, FASHA, President of the National Association of School Nurses (NASN). That’s even more noteworthy, considering “their average salary is $20,000 less than what nurses earn in hospitals.”

Typically, school nurses work a schedule like other school district employees: Monday to Friday, an average of 39 hours a week, and capped at about 180 days a year.

A stress-free specialty? Hardly.

Running an autonomous practice can be tough, especially for inexperienced nurses. Mainly, though, school nurses shoulder a heavy case load. “Nationwide, it averages one nurse for every 4,000 students,” says DavisAlldritt. “The numbers are the biggest stressor.”

Nurses in certain specialties, where they continually witness trauma or death, may believe they likely experience worse job-related fatigue, or that they experience it in a unique way.

“Oncology nurses love what they do but they face chronic stress and compassion fatigue,” says Bragazzi, after 16 years in the field. “There’s a difference between compassion fatigue and nurse burnout. Symptoms tend to appear over a longer period of time. They witness trauma—not like in an ER—our patients are very ill for a long time, and then there’s often death.”

Experienced nurses in similar “high stress” specialties disagree. “No specialty has cornered the market on compassion,” says Ramón Lavandero, RN, MA, MSN, FAAN, Senior Director of the American Association of Critical-Care Nurses (AACN). “All nurses are compassionate. That’s in the DNA

of nursing. But then sometimes when they burn out, they find they’ve run out of compassion.” Lavandero doubts that any specialty is intrinsically stressful, just in and of itself.

“It’s not the situation that’s stressful; it’s how we respond to it. So if you’re experiencing burnout or fatigue, look at it deeply—don’t say ‘oh, it’s a trauma unit, of course I’m stressed.’”

He advises fatigued nurses to reflect about the source of their work strain. Ask yourself: “Is this the right place?

Right time? Right tasks? Right now?” According to Lavandero, when nurses are willing to reflect honestly, they can identify the root cause of stress. Often it’s about keeping a balance between work and non-work, and the relationship between the two. “They may realize that ‘you know, I’m in a healthy work environment, communication is excellent, leadership is authentic, but I’m stressed because my spouse just left, or my parents passed away, or my child developed an illness,’” he says. We are multifaceted beings, so often when one part of our lives is off-kilter, the whole of it overturns and we aren’t entirely sure why it has happened.

1. Michelle Bragazzi, RN, BS 2. Linda Davis-Alldritt, RN, MA, PHN, FNASN, FASHA 3. Ramón Lavandero, RN, MA, MSN, FAAN 4. Anna Dermenchyan, RN, BSN, CCRN-CSC 1.

2.

3.

4.

5. Arilma St. Clair, RN, MSN 6. Steve Wooden, DNP, CRNA 7. Riza V. Mauricio, RN, PhD, CCRN, CPNP-AC 8. Deborah Eldredge, PhD, RN 5.

6.

7.

8.

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Burnout is perplexing; it can mimic psychological diseases, such as depression.

Here is a checklist of classic symptoms: 1 Feelings of sadness, anxiety, or not enjoying usual activities/ people.

2 Spats, blaming, and complaints regarding co-workers or supervisors.

3 Incidents with patients that make you feel ashamed, or less than your best.

4 Waking up and dreading going to work. Tardiness. Calling in sick.

5 Wondering: What’s the use?

Nothing I do makes any difference.

6 Gaping distance between reality and your expectations.

7 Changes in health, sleep, or eating patterns; use of alcohol, drugs, or tobacco.

8 Working faster and faster, like a hamster in a cage, and getting nowhere.

9 Feeling lonely, isolated, or misunderstood.

10 Being in a high-risk category: young, in job under five years, single, or married with no children.

If you experience any of the above symptoms occasionally, no problem. But if your distress is continual, seek immediate help.

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“You won’t be happy in the profession if you don’t go into it for the right reasons,” says Anna Dermenchyan, RN, BSN, CCRN-CSC, staff nurse in the cardiothoracic ICU at Ronald Reagan UCLA Medical Center.

A nice paycheck or job security isn’t enough to keep the passion alive when reality kicks in.

“I do see a lot of nurses who just show up for work. It’s just sad to see.”

Dermenchyan says that burnout can happen right away. “Energized new grads enter the field, but then it’s just so stressful, they kind of lose interest in the profession.”

She advises getting involved in something outside of work to get re-energized. “Some people love their family, so that’s what they should do. It’s whatever gives your life meaning, happiness, and balance.”

Lavandero encourages stressed nurses to lean on constructive peers and mentors, as “positive people who point out possibilities are one of your biggest supports.” He also suggests expanding your social circle to include folks in other professions. “It’s common to hang out with fellow nurses outside of work. While that can be reassuring, work conversations tend to continue, so they shouldn’t be the only people you talk to.”

Over and over, nurses credit involvement with a professional organization—related to their specialty or ethnicity—as a personal lifesaver. “At our organizational meetings, we listen to one another and guide each other when that is asked for,” says Arilma St. Clair, RN, MSN, President of the National Association of Hispanic Nurses

District of Columbia Chapter and occupational health nurse.

“Sometimes we just need to listen and allow ourselves to vent without action or recommendations.”

Other times, St. Clair nudges nurses to take direct action—in addition to letting off steam.

“If they complain ‘the nurse in charge always gives me the heaviest duty,’ then I suggest ‘if you see a trend, bring it to the supervisor. If it’s not taken care of, go to the next level,’” she says. The association endeavors to be the voice of its members, and St. Clair offers to write a letter or help file a complaint on behalf of aggrieved nurses.

After a while, nurses learn they must take a continual stress “temperature” to check how they’re holding up. “I’ve

without rest or sleep for long periods. If I’m on-call, there’s nobody to back me up.”

Awareness isn’t enough, says Riza V. Mauricio, RN, PhD, CCRN, CPNP-AC, Director of the AACN National Board of Directors and pediatric ICU nurse practitioner at The Children’s Hospital of the University of Texas, MD Anderson Cancer Center in Houston. “As health care professionals, we know all about fatigue but often don’t apply that knowledge to ourselves. We underestimate our degree of fatigue, we just keep going, keep going—like the Energizer Bunny—taking care of patients without thinking of our own well-being.”

The solution can be on an individual basis, and as simple as taking care of ourselves in the

“

As health care professionals, we know all about fatigue but often don’t apply that knowledge to ourselves. We underestimate our degree of fatigue, we just keep going, keep going—like the Energizer Bunny—taking care of patients without thinking of our own well-being.

“

Fatigue/ Burnout Indicators

What can nurses do to avoid burnout?

—Riza V. Mauricio, RN, PhD, CCRN, CPNP-AC

been in practice over 30 years, so now I understand when I’ve reached the point when I don’t function well,” says Steve Wooden, DNP, CRNA, President of Wooden Anesthesia PC in Albion, Nebraska. “Then I remind myself to slow down and double-check, because a major focus under stress should be to avoid harming patients.”

Wooden is one of only two anesthesia practitioners in a rural community 100 miles west of Omaha. “Obstetrics is unscheduled, takes a long time, and a lot of care, so we will go

most basic ways. “We hardly even go to the bathroom. Or we’ll take a meal break late— instead of at noon, at 2:00 p.m., or not at all. Take a deep breath, do a physical activity, stretch or walk. Take time for yourself. Nurses don’t take care of ourselves, we take care of others,” she explains.

Mauricio says we can use that altruism to our advantage, by helping fellow nurses practice self-care. “We have a shared responsibility to take care of one another and take care of our patients.”

Wooden concurs. “We all need to be aware of when individuals are tired, and step in so they don’t harm patients. It’s not just nurses, but also doctors who may be fatigued.”

ter can help if stress threatens to overwhelm, such as when there is a series of deaths in a unit. “That can take a toll on a person,” says Mauricio.

Off-site retreats in a restful

Nurses who learn to handle job and life pressures can avert chronic fatigue and enjoy the flip side of burnout: engagement.

Preventive measures already in place Most organizations offer employee assistance, wellness, or stress management programs.

Don’t hesitate to access these offerings, which are often free or low-cost. Talk to your peers, supervisors, or allied staff members. “The pastoral care team is trained to provide support in stressful situations, especially ones that test someone’s faith,” says Lavandero. “Social workers in the hospital may also be very helpful.”

Some workplaces have instituted extraordinary programs to deal with employee stress.

“Our facility—MD Anderson, a huge institution—is big on fatigue prevention,” says Mauricio. “They promote health in body, mind, and spirit. They know prevention is much better than aftercare.”

In addition to a fitness center, the hospital has what are called Be Well Stations throughout the building for employees to use. “In my ICU, there’s equipment close to me, like ellipticals, treadmills, scales, a stretch trainer, strengthening chair.” Plus the stress management program offers massage therapy sessions at a reduced rate of $20 for 20 minutes.

If that isn’t enough to combat fatigue, the counseling cen-

shifts, and lack of fatigue countermeasures, such as rest breaks.

Deborah Eldredge, PhD, RN, Director of Nursing Quality, Research, and Magnet Recognition at Oregon Health & Science University School of Nursing in Portland, believes that proper scheduling is key to maintaining their healthy

setting may be best for reflection and renewal. “While many institutions offer wellness programs, my hospital offers Circle of Caring,” says Dermenchyan. “The Ethics Department sponsors it for health care professionals—it’s open to all—for three and a half days. It’s a wonderful community of people who discover again why you went into health care and to find meaning in their roles. It’s wonderful when holistic programs like this exist.”

Steps hospitals can take to improve safety Ann Rogers, RN, PhD, FAAN, has conducted seminal research at the Pennsylvania School of Nursing. It overwhelmingly shows that wonky work schedules put the health of nurses— and their patients—at risk.

Nearly 400 hospitals in the United States have achieved so-called “magnet” status, and these are the ones most likely to institute evidence-based scheduling. They discourage sleep deprivation (chronic or one-night), extended work www.minoritynurse.com

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work culture.

“Nurses work 12 hours, six out of 14, four or five days in a row, but the fourth or fifth day are error prone. Some management has dictated that there be no fifth day. That requires being adequately staffed so nurses don’t need to work additional shifts,” she explains. “And talking with folks about their schedule, maintaining vigilance, and monitoring when they’re tired.”

She points to one unit that has instituted a rest break ritual of tea every afternoon. “At 4:00 p.m., snacks come out, and they sit down together while doing their charting. They’re eating, and also getting a chance to unload. They can stay close to patients, maintain their hydration, and have companionship, too,” she says.

Some states have gone as

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far as mandating certain safe scheduling practices. California, for instance, has a one to five nurse-to-patient ratio in surgical units. Does that small ratio help to reduce patient deaths?

Apparently so. A 2010 study predicted that patient deaths in New Jersey and Pennsylvania would drop 14% each if they followed California’s lead.2

Issues unique to minority nurses St. Clair explains that minority nurses must wear many hats—as all nurses do—but in addition, “we also wear the interpreter and translator hats.

We get pulled out of our assignments to interpret for any and all providers in the care of Spanish-speaking patients.

Thus, time management is a bigger challenge for us because we are still expected to complete

our assignment on time.”

On the other hand, nurses who speak only English may be at a disadvantage working with immigrant patient populations. Their need to rely heavily on translators throws a monkey wrench into already tight schedules and adds to mounting stress. “It’s harder to do our work, as well as patient education, because it all has to be interpreted,” Eldredge says.

“For that reason, I had a nurse who thought it might be easier for her to learn Spanish so she could communicate with her diabetes-care patients.”

St. Clair says that nurses from certain cultural backgrounds face additional hurdles because their citizenship and training are suspect. “I am Latina, thus I must be a foreign nurse and thus, have less than standard preparation.” That’s one bias that Caucasian and African American nurses, who are assumed to be American, usually don’t face, she adds.

Regardless of language and citizenship, do minority nurses experience discrimination based on their status, generally? St. Clair says about half her memberships reports that they do. When a nurse does run up against bias, St. Clair advises: “We need to reorient individuals who exhibit intolerance.

They need to be taught [that] none of us can treat people differently based on our personal values.”

Other types of bias are more difficult to pin down. For instance, Wooden says it’s sometimes assumed that a male nurse will do the heavy lifting, risking strain and injury. “Now, some women would disagree and say they certainly can pull their own weight,” he says. A more worrying problem, though, is

that minority nurses may miss out on the social support that other nurses enjoy. “They may not fit into a social niche,” says Wooden. “They won’t have a support system from a work group, where they understand you, you understand them. People who can help you identify when you’re having a bad day.”

Nurses who learn to handle job and life pressures can avert chronic fatigue and enjoy the flip side of burnout: engagement. That’s the opposite of exhaustion, cynicism, and inefficacy, according to stress researcher Maslach. Engagement is a state characterized by energy, involvement, and efficacy.

Good news for nurses. Good news for their patients.

Dermenchyan explains how the patient-nurse satisfaction loop works: “Patients will say ‘I know when a nurse is engaged and cares about me as a person.

I know when they don’t care.’

That’s when patients complain about everything. But when they feel cared for, they won’t even complain about the hospital food.”

Jebra Turner is a freelance writer in Portland, Oregon.

References 1. Aleccia J. Burned-out nurses linked to more infections in patients. NBCNews.com. July 30, 2012. http://vitals.nbcnews. com/_news/2012/07/30/12994989burned-out-nurses-linked-tomore-infections-in-patients?lite.

Accessed November 2012.

2. Carlson J. Nurse staffing study predicts Calif. mandate would save lives elsewhere. ModernHealthcare.com. April 20, 2010. http:// www.modernhealthcare.com/article/20100420/NEWS/304199955#.

Accessed November 2012.

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

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

We are currently accepting applications for our 14th annual scholarship competition, consisting of two $1,000 awards and one $3,000 award. Scholarships will be paid in summer 2013 for the fall 2013 academic term.

Questions? E-mail editor@minoritynurse.com or visit www.minoritynurse.com/2013scholarship.

MINORITY NURSE 14th Annual Scholarship Program

Application Form (Please print clearly) Name ______________________________________________________________________________________________ Address ____________________________________________________________________________________________ City/State/ZIP Code _________________________________________________________________________________ Phone _______________________________ E-mail________________________________________________________ Nursing school ______________________________________________________________________________________ Expected date of graduation _________________________________________________________________________ Ethnic background: African American Hispanic/Latino Asian/Pacific Islander American Indian/Alaska Native Filipino Other______________ Please list any nursing associations (student, minority, or otherwise) to which you belong: __________________________________________________________________________________________________________ __________________________________________________________________________________________________________

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

To apply for this scholarship, students must meet all four of the following criteria: Be a racial or ethnic minority Be enrolled (as of September 2013) in either the third or fourth year of an accredited B.S.N. program in the United States OR an accelerated program leading to a B.S.N. degree (such as R.N.-to-B.S.N. or B.A.-to-B.S.N.) OR a graduate program.

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

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

Minority Nurse will award one $3,000 scholarship and two $1,000 scholarships in 2013. Selections will be made by the editors of the magazine. Scholarships will be paid in summer 2013. Minority Nurse reserves the right to verify community service and financial need.

Deadline for application: February 1, 2013 Return application form and documentation to: Minority Nurse Magazine Scholarship, Springer Publishing Company, 11 W. 42nd Street, 15th Floor, New York, NY 10036

Careers Stemming from an Education in Health Care Policy

BY CAROLE ELDRIDGE, DNP, RN, CNE, NEA-BC

In 1996, two game-changing pieces of health care legislation had the attention of the industry.

T

he Health Insurance Portability and Accountability Act (HIPAA) was being enacted, and the Balanced Budget Act (BBA) was being debated. Nurse leaders crowded into public hearing rooms to try to understand the potential ramifications of HIPAA and to protest the challenges they foresaw if the BBA’s provisions were enacted. Many nurses watched in dismay, feeling like victims of federal policymaking engines. Some tried to learn more about political action in an effort to save their businesses and help their patients. Out of that experience, and others that followed, political activism started growing among nurses. Nurse professionals learned that if they weren’t more involved in influencing health care policy decisions, then they would have to live with the results.

We are in the midst of another dramatic upheaval in health care regulation, with most of the provisions required by the Affordable Care Act going into effect between now and 2014.

Instead of being victims of the process, nurses are at the table more than ever before, and our involvement is making a difference. By fighting in the political arena for safe, high-quality health care, we give our patients a voice and function as true patient advocates at and beyond the bedside.

In addition, a growing number of nurses are finding that involvement in health care policy leads to new and exciting careers that didn’t seem possible just a few years ago. A new nursing specialty in health care policy is evolving and expanding. If the thought of making a real difference in the world gets your heart racing, health care policy nursing might be the career path for you. www.minoritynurse.com

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What Does It Take to Be a Successful Health Care Policy Nurse?

The most important trait of a nurse in the health care policy arena is a desire to make a real difference. If you believe that health care around the world can be improved, and you want to help make that happen, then you can learn the rest of what you need to know. Other favorable characteristics include: • Willingness to engage in negotiation and the give-and-take of debate • Persistence in researching the facts of a situation and maintaining a long-term commitment to policy developments • Listening skills to help you understand the agendas of various stakeholders • Communication ability to help you educate others on the issues • Organizational skills to help you stay on top of multiple initiatives

What Paths Can I Take to Become a Health Care Policy Nurse?

six specialty classes. The specialty courses address health care systems, economics, global health, and leadership, all from a politics and policy perspective. A 100-hour practicum under the mentorship of experienced health care policy nurses leads to a capstone project that puts concepts into practice and gives students valuable experience in the work of this specialty.

After completing an educational program in health care policy, a nurse can be wellequipped and well-connected to launch this exciting career.

Nurses who care about making a difference, who are passionate about health care issues, and who are willing to persevere through the challenges and triumphs of change can fashion a career that can have a broad impact on the world.

Very few nurses start their careers with an in-depth understanding of how health care policy work is done. Some graduate nursing schools have recognized this need and offer educational programs in this growing specialty to registered nurses who have a Bachelor of Science in Nursing degree. Chamberlain College of Nursing, for example, offers a Healthcare Policy specialty track in its Master of Science in Nursing (MSN) degree program. Students in this track complete a core of six MSN courses in theory, informatics, leadership, research, advanced nursing roles, and health care policy before progressing to

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It is possible to embark on a health care policy nursing career without an advanced degree, but many employers prefer it. Prior experience is often preferred; however, nurses who have completed a graduate program with a strong practicum have often gained significant experience in the field through rigorous academic work. Practicum projects such as researching a health care policy initiative and writing a summary for a political officeholder, or working with a community organization to secure political support for a new program, provide the experiential base employers seek.

Where Do Health Care Policy Nurses Work?

Health care policy nurses are sought after to evaluate the impact of health care policy changes, to advocate for patients and organizations as educators, writers, speakers, or researchers, and to help nurses mobilize around political action. These specialty nurses can work with lobbyists, politicians, consulting firms, health departments, education foundations, nonprofit groups, and government organizations in a wide range of roles. Some health care policy nurses enter academics, while others become community leaders or political officeholders themselves.

The range of tasks they perform can include analyzing health care policies, laws, and regulations; advising policymakers, leaders, and the public; administering grants; researching public health care issues; or planning and proposing new health care policies. Health care and education systems hire health care policy nurses as spokespeople, analysts, and regulatory officials. Wherever health care policy and health care organizations intersect is

a place where these specialized nurses may be needed.

Why Should Nurses Enter the Policy Arena?

Health care policy nurses are the experts, the people that others turn to for advice on how governments should structure their health care systems to best meet the needs of their populations. Nurses who care about making a difference, who are passionate about health care issues, and who are willing to persevere through the challenges and triumphs of change can fashion a career that can have a broad impact on the world.

There are currently seven nurses in the US Congress, and their presence at the federal table means that our profession is being heard. Nurses know patients better than anyone, and it is our job to protect the safety, quality, and efficacy of global health care in every way we can.

Carole Eldridge, DNP, RN, CNE, NEA-BC, is the Director of Graduate Programs at Chamberlain College of Nursing. © 2013 Chamberlain College of Nursing, LLC. All rights reserved.

Academic Forum

Uncovering the Secret Silver Bullet: How to Replenish the Nursing Shortage

BY KATHRYN NORCUTT

B

y now, most of us within the health care sector have already become well-acquainted with the impending and grim statistics facing the United States, mainly in regards to the staggering dearth in our nursing profession purportedly by the year 2014. There are a number of factors attributing to this predicament, namely an aging elderly population (baby boomers), consistently low enrollments at nursing schools across the country, and job burnout and dissatisfaction, which ironically raises the average nurse age to 45.2 years. And though these facts paint a dreary picture of our nation’s future, there may be a silver lining. Perhaps, the answer has been sitting right in front of us all along. By looking at the future of health care with a different lens, we can not only fill the gap but create higher quality in a system that has been steadily declining.

Veterans. President Obama has already challenged our nation to hire Iraq War vets by inviting community health centers to employ 8,000 veterans—approximately one veteran per health center site—over the next few years. In addition to this proclamation, the Health Resources and Services Administration (HRSA) has offered to create careers for servicemen that will even rise above nursing and into the realm of physician assistants. Of course, although these numbers are encouraging, they will fall short to fill in the expected tens of thousands of jobs needed, but at least it is a start.

Minorities. Of the 3,063,162 registered nurses in the United States, approximately 83% are Caucasian.1 This means of course that within the remaining 17% the numbers consist of

those who are African American, Asian Pacific-Islander, Hispanic, and/or of mixed race.

Based upon the recent 2010 US Census, Caucasians are at 72.4%, African Americans 12.6%, Asians 4.8%, Native Americans 0.2%, and 2.9% who claim multiple ethnicities.2 So when looking at the numbers based on ethnicity across the United States, the results speak loud and clear: minorities need to be a stronger presence in health care as a way not only to gain numbers in the field, but also to reach out to communities that are currently woefully underserved. According to the HRSA, a Division of the US Department of Health and Human Services, of the patients who use health centers, 62% are described as ethnic or non-white and, of those, 23% do not speak English.3 This is where minority nursing gradu-

ates, especially those who are bilingual, could become that all-necessary segue to ensuring patient needs at every level.

At the end of the day, health care needs will continue to rise. In order to combat the low numbers, there are additional programs that private health organizations have implemented to reach out to prospective nursing students.

For example, Aurora Health Care, an integrated not-forprofit health care provider serving communities throughout eastern Wisconsin and northern Illinois, offers a Minority Nursing Scholarship Program by allowing up to $15,000 in loan forgiveness ($5,000 per year for a three-year commitment after graduation) and offers potential candidates a mentoring relationship with a staff RN. They are also given opportunities for leadership development and part-time employment while earning their degree. There are a few qualifications any potential candidate should consider. Among them are completion of either a qualified clinical rotation or certified nursing assistant program and maintaining a 3.0 or better GPA. After graduation, you must also be willing to be employed by Aurora Health Care as a graduate nurse. The good news? How many other employers can make that kind

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of guarantee to someone wading through mid-term papers, all-nighter study sessions, and cramming for finals? When you graduate—you have a job waiting for you.

Now, that is something worth thinking about.

Kathryn Norcutt has been an active member of the health care community for over 20 years.

During her time as a nurse, she has helped people from all walks of life and ages. Now, Kathryn leads a much less hectic life and devotes most of her free time to writing for RNnetwork (www.rn-

network.com), a site specializing in RN jobs.

References 1. US Department of Health and Human Services, Health Resources and Services Administration.

The Registered Nurse Population: Findings from the 2008 National Sample Survey of Registered Nurses. September 2010. http:// bhpr.hrsa.gov/healthworkforce/ rnsurveys/rnsurveyfinal.pdf. Accessed November 2012.

2. US Census Bureau. 2010 Census Data: United States National Population. http://2010.census. gov/2010census/data. Accessed November 2012.

3. US Department of Health and Human Services, Health Resources and Services Administration.

Health Center Data: 2011 National Data. http://bphc.hrsa.gov/uds/ view.aspx?year=2011. Accessed November 2012.

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Minority Nurse | WINTER 2013

Degrees of Success

Men in Nursing

BY TRI PHAM, PhD, RN, AOCNP-BC, ANP-BC

In 2008, there were 3,063,162 licensed registered nurses in the United States. Only 6.6% of those were men and 16.8% were non-Caucasian.1 Despite efforts from nursing schools across the nation to recruit and retain more men and minorities, the results have been fairly modest.

I

n 2010, approximately 11% of the students in baccalaureate programs were men and 26.8% were a racial/ethnic minority.2 We know that student nurses, in general, face many obstacles such as academic pressure.

However, studies have shown

biases, hostile interpersonal climates, and feelings of social isolation.11-13 To recruit and retain more men in the nursing profession, we must investigate these barriers and work on strategies to minimize stress for this important group of future nurses.

nurses tend to be very “visible” to their classmates and faculty. As a result, they face extra scrutiny in and outside of the classroom. Sitting silent in the back of a classroom is often not an option when you are the only male in your class.

Even still, professors may ne-

cifically for female students in a predominantly-female school or they may encounter female patients who are uncomfortable having a male nurse, particularly in obstetrics/gynecology.

Ridiculed for Being a Male.

One of the primary reasons more men do not pursue a career in nursing is because of the assumption that becoming a male nurse will trigger ridicule from others. For many, nursing is not viewed as a respectable profession for men.

Many male nursing students will experience anxiety and stress when dealing with a patient and his/her family— and sometimes even their own family—because of this stigma.

Breaking the Barriers

that male student nurses experience additional barriers and discrimination, such as: lack of information and support from guidance counselors; lack of sufficient role models; unequal clinical opportunities and requirements; isolation; poor instruction on the appropriate use of touch; and a lack of teaching strategies appropriate to male learning needs.3-10 And student nurses from minority groups encounter unique obstacles as well. They must often contend with classroom

Why Men Do Not Pursue Nursing Higher Perceived Expectations. Any nursing student may struggle to live up to others’ expectations, whether those expectations come from a relative or a professor. But being a male student comes with the additional challenge of facing society’s expectations.

Because nursing is predominantly female, males must work harder just to prove that they can be as competent as their female counterparts.

Outnumbered. Male student

glect to tailor their curriculum to address concerns unique to male nurses.

Treated Differently. Male student nurses are expected to be physically stronger than their female peers and are often asked to assist with lifting heavy patients. They are more likely to be mistaken for a doctor or medical student in a clinical setting. And they do not always have the same opportunities as women in this field. They may miss out on scholarships created spe-

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Male students make a very conscious decision to become a nurse, and no one should be criticized for wanting to help others. To conquer gender and racial biases in the nursing profession, nursing faculty, students, and other health care professionals are encouraged to take the following steps: • Nursing school faculty and nurses who are given the opportunity to precept male student nurses should make efforts to provide them with the same opportunities given to other student nurses in the program.

• Female student nurses should treat male student

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Degrees of Success nurses with the same respect, especially in the clinical setting.

• Other health care professionals should make efforts to respect the decision male students make to become nurses. They should acknowledge their contributions to nursing and health care and encourage them to grow professionally.

• Friends and families of male student nurses should avoid being judgmental and ridiculing the decision made by these men to become nurses.

Instead, friends and families should support their decision and provide all the necessary assistance and encouragement possible to help these men grow personally and professionally.

Sitting silent in the back of a classroom is often not an option when you are the only male in your class.

• A patient and his/her family should make efforts to recognize and address male student nurses by their proper title, to treat them with the same respect and dignity given to other professionals, and to provide them with the same opportunities to learn and develop professionally.

• Nursing school faculty, male student nurses, and male nurses should make efforts to educate the public about the invaluable contributions made by men in the nursing profession by appearing and presenting at public events such as college and career days, health fairs, and/or talk shows.

It is time for an intervention

36

study with nursing education.

Just as female medical students had to break the gender barriers in medicine, male nursing students want to break the gender barriers in nursing.

Tri Pham, PhD, RN, AOCNP-BC, ANP-BC, is an editorial advisory board member of Minority Nurse and full-time nurse practitioner with The Department of Stem Cell Transplantation and Cellular Therapy at The University of Texas-MD Anderson Cancer Center.

He is also on the faculty at Texas Woman’s University-Houston Center-College of Nursing.

References 1. US Department of Health and Human Services, Health Resources and Services Administration.

The Registered Nurse Population: Findings from the 2008 National Sample Survey of Registered Nurses. September 2010. http:// bhpr.hrsa.gov/healthworkforce/ rnsurveys/rnsurveyfinal.pdf. Accessed November 2012.

2. American Association of Colleges of Nursing, “2011 Annual Report: Shaping the Future of Nursing Education,” http://www. aacn.nche.edu/aacn-publications/ annual-reports/AR2011.pdf.

3. T.W. Barkley and P.A. Kohler, “Is nursing’s image a deterrent to recruiting men into the profession? Male high school students respond,” Nursing Forum, 27 (1992), 9-13.

4. N.R. Kelly, M. Shoemaker, and T. Steele, “The experience of being a male nurse,” Journal of Nursing Education, 35 (1996), 170-174.

5. T. Kippenbrock, “School of nursing variables related to male student college choice,” Journal of Nursing Education, 29 (1990), 118-121.

6. G.D. Okrainec, “Perceptions of nursing education held by male nursing students,” Western Journal of Nursing Research, 16 (1994), 94-107.

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7. B.L. Paterson, S. Tschikota, M. Crawford, M. Saydak, P. Venkatesh, and T. Aronowitz, “Learning to care: Gender issues for male nursing students,” Canadian Journal of Nursing Research, 28 (1996), 25-39.

8. H.J. Streubert, “Male nursing students: Perceptions of clinical experience,” Nurse Educator, 19 (1994), 29-32.

9. I. Trachtenberg, “Hear our voices: A phenomenological perspective of male nursing students’ experiences in obstetrics,” retrieved September 24, 2009, from Texas Woman’s University Library Web site: http://ezproxy. twu.edu:2119/pqdweb?index=39& did=731869041&SrchMode=1&sid =1&Fmt=6&VInst=PROD&VType=P QD&RQT=309&VName=PQD&TS= 1253826671&clientId=48335.

10. M.J. Villeneuve, “Recruiting and retaining men in nursing: A review of the literature,” Journal of Professional Nursing, 10 (1994), 217-228.

11. B.B. Gunnings, “Stress and the minority student on a predominately White campus,” Journal of NonWhite Concerns, 11 (1982), 11-16.

12. L.N. June, B.P. Curry, and C.L. Gear, “An-11-year analysis of Black students’ experience of problems and use of services: Implications for counseling professionals,” Journal of Counseling Psychology, 37 (1990), 178-184.

13. G. Walker-Burt, “Relationship between person-environment fit, psychological strain and coping behaviors among student nurses,” Dissertation Abstracts International, 39 (1979), 6041.

Degrees of Success

The Lived Experience of a Visiting Professor

BY CHARLOTTE STOUDMIRE, PhD, MN, RN

What an exciting opportunity to be invited to teach Why I Accepted the Invitation I have always wanted to in the Bachelor of Science in Nursing program at St. teach abroad, especially in George’s University in Grenada, West Indies. St. George’s the Caribbean. So, when I reUniversity brings professors and lecturers from other ceived the invitation to teach nations and cultures to the college for a semester or a at St. George’s, I jumped at the year to embolden a global perspective to the nursing chance. The visiting professorprofession for the school’s international student body. ship opened a door to be a part of the international nursing The college’s tropical location, population of friendly education experience, which people, and lively culture provide a perfect backdrop other visiting professors have written about in the past and to St. George’s global educational focus.

G

lobal nursing education partnerships are rapidly developing.

These partnerships open gateways to exchanging best practices and enhancing nursing education programs around the world. The question is: How do those involved with improving global nursing practices accomplish this task?

The nursing profession, as a

whole, needs new strategies to provide global benchmarks in education for nursing students and practicing nurses. Nurses simply cannot practice in a vacuum in the 21st century.

Faculty exchanges are a great way for nurses to experience a different culture and understand global health issues, as the problems of one country may affect another.1

I have only read about. Now, I get to write about my experience.

Additionally, this opportunity to serve as a visiting professor helped me widen my career network and build valuable relationships. I have forged many lasting professional relationships with outstanding practitioners in their field, and I have even made some friends that I will continue to cherish.

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Global nursing education partnerships are rapidly developing. These partnerships open gateways to exchanging best practices and enhancing nursing education programs around the world.

Juggling the demands of my businesses while teaching made traveling to Grenada a little tricky. Even though I was actualizing a dream, I still had several active contracts that I needed to fulfill. I found I had to plan ahead to ensure that I had Internet access and access to a phone line to stay in touch with clients and students. This would prove to be no small task.

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Degrees of Success

Interested in being a visiting professor?

Contact the International

Professor Exchange www. professorexchange.com to learn more. But before you accept an invitation, you should research the following: • Information about the university • The type of nursing program you would be teaching (e.g., practical nursing and bachelor’s or master’s level level) • Contract deliverables and compensation • Country visa • International health insurance options • Living arrangements • Food accommodations • Transportation both to and from the university • Internet and e-mail access options • Orientation: expectations, courses, supplies, computer access

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Minority Nurse | WINTER 2013

Beverly Bonaparte, PhD, ANP, RN, FAAN, Dean of Nursing and Allied Health Sciences, provided me with an overview of the university and its policies as well as information on housing, transportation, and food accommodations. St. George’s University hosted everything, which was provided to me in a detailed contract.

The contract laid out the courses I would teach, the timeframe, travel arrangements, and compensation.

An Unforeseen Event While en route to Grenada to begin my assignment, I fractured my left thumb. At the time, I was unaware that my thumb had sustained such an injury, so when I settled in I treated my injury as a strain. It quickly became clear that my injury was not a simple strain.

I relented and sought medical attention. This gave me the opportunity to experience the Grenadian health care system firsthand.

St. George’s University has a health care clinic, which serves students, faculty, and staff. The college provides health insurance, at a cost of $200 per semester, that a visiting professor can purchase. I had opted not to purchase the insurance.

I was examined by one of the clinic’s doctors. Then I was sent to an offsite medical facility to have an x-ray of my thumb and receive an orthopedic consultation. My US health insurance was not accepted, so I had to pay out-of- pocket for the services. However, I was provided with claim forms to send to my health insurance company for reimbursement as well as a copy of my x-ray and the physician’s recommendations.

The costs for the health services were low compared to what it would have cost in the United States. I followed up with St. George’s University health clinic for any additional services needed. When I returned to the United States, I followed up with a specialist who validated that the treatment and recommendations I had received in Grenada were excellent.

Types of Visiting Professors There are typically five types of visiting professors at universities in the United States and across the globe: • A medical doctor of a specific specialty who teaches for a period of one to four weeks. Some assist in testing and evaluations then return to their practice.

• A professor on sabbatical from another university. These professors want to share their expertise and experience a different educational culture.

• A professor with certain areas of expertise who is offered to teach a variety of courses or one special course. These PhD prepared professors are seasoned in their field of expertise with at least three to five years of experience in teaching. Their areas of expertise may range from research to technology in their concentrated field.

• A virtual visiting professor who shares his/her expertise via information technology and does not necessarily go to the campus. This professor may be a practitioner, professional, or faculty member from another institution. The information technologies connecting this professor with the students provide immediacy and open the path for an engaged discussion.2

• A PhD graduate who has done a reasonable amount of research but has little teaching experience. This new graduate will take a visiting professorship to enhance his/her career options by gaining teaching experience.

University Benefits The host university may need specialized courses taught and its current faculty may not possess adequate knowledge of the subject. Also, budget constraints may not allow the school to hire additional fulltime faculty. This combination necessitates the hiring of visiting professors.

The contracts are usually a minimum of two months to a maximum of two years.

The timeframe depends on the course delivery and method.

For example, I was contracted for a 16-week semester but taught a course in a hybrid model, meaning I taught part of the course on campus and the other part online.

The university particularly benefits when the visiting professors are on sabbatical since half of their salary is often paid by their home universities.3 And when a school is looking to hire a professor permanently, some will try out the visiting professor first. The university saves money using short-term teaching assignments while it builds an internal pipeline of candidates for future full-time faculty openings.

Further, the schools encourage visiting professors to work with the administrative teams and faculty on research projects and other programming.

Personally, I worked with the dean and other faculty on several projects, such as service

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Faculty and Student Benefits Typically, there are other visiting professors with whom to work at the university. This provides immediate value to each practitioner as best practices for classroom management and teaching approaches are shared and opportunities for networking are provided.

Additionally, the visiting professor team-teaches with a fulltime faculty—a beneficial arrangement for both students and faculty. I enjoyed this arrangement because it made it easier for the students to transition from one style of instruction to another. This exposure has strengthened my ability to teach multinational students. I also learned that even though the Grenadian culture is different from my own, our standards of nursing practice and provision of quality patient care are the same.

Not all professors want to be committed to teaching at one university. Many appreciate variety in their teaching experiences. The opportunity to serve as a visiting professor fits that need. The immersion in new cultures and exposure to different professional perspectives are invaluable. Visiting professors have tremendous knowledge in relevant and contemporary topics and can share their experiences with the students to provide opportunities for learning and critical thinking. They can also build a sense of community in the learning environment between classroom work and what happens globally.

The visiting professor expe-

rience allowed me to teach for several semesters at St. George’s and online at other colleges while maintaining my businesses. My time in Grenada was both educational and delightful as I learned much about the culture of the Grenadians and had the opportunity to understand more about nursing practice in another country. I also met and learned from other professors who are from Europe, Asia, and other parts of the United States.

What I loved the most was that the university’s campus is located near the ocean. Every day at lunchtime I would sit on a bench, daydream, and watch the waves of the ocean.

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DENNIS MANARCHY © 2004 UNCF ALL RIGHTS RESERVED

learning projects and new program development. It has proven to be a rewarding experience.

DENNIS MANARCHY © 2004 UNCF ALL RIGHTS RESERVED

Degrees of Success

®

Charlotte Stoudmire, PhD, MN, RN, is currently an adjunct professor of nursing at Indiana Wesleyan University for the Online Graduate program and is the Founder/CEO of JAMAA Health Consultants, Inc., a not-for-profit consulting firm specializing in program development and delivery of community-based health programs that serve the homeless and at-risk youth. In addition, she is President of Stoudmire Consulting, a boutique firm that assists colleges with program development in nursing education and distance learning.

®

References 1. Lange I, Ailinger RL. International nursing faculty exchange model: a Chile-USA case. Int Nurs Rev. 2001 Jun;48(2):109-16.

2. Russo TC, Chadwick SA. Making Connections: Enhancing Classroom Learning with a Virtual Visiting Professor. Communication Teacher 2001;15(3):7-9.

We are born with limitless potential. Help us make sure that we all have the chance to achieve. Please visit uncf.org or call 1-800-332-8623.

Give to the United Negro College Fund.

3. Shingler D. Visiting professors elevate learning experience.

We are born with limitless potential. Help us make sure that we all Crain’s Cleveland Business. have the chance to achieve. Please visit uncf.org or call 1-800-332-8623.

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Second Opinion

CenteringPregnancy: Better Birth Outcomes, Happy Caregivers, Satisfied Patients

BY ARCHANA PYATI

The women trickle in, one by one, into a brightly lit ground floor conference room at Providence Hospital, a large urban hospital in Washington, DC. A vibrant social worker greets each one as “honey” as they take their seats in a circle of chairs. Each is pregnant and in her third trimester; some are alone, a few with male partners by their side. A teenager has brought her mother. Refreshments and gifts sit waiting for them on a table at one corner of the room.

T

he warm atmosphere couldn’t resemble a waiting or examination room any less, yet this space functions as both.

All of the women are here for their prenatal checkups, one of many they will experience together leading up to their deliveries a month from now. They are participating in a “centering” pregnancy group, an innovative form of prenatal care that Providence— and other hospitals around the country—are offering to pregnant women. By moving them out of the clinic and into a group space, centering seeks

to revolutionize prenatal care by reducing racial disparities in birth outcomes, boosting caregiver morale, and controlling costs.

Centering is the brainchild of Sharon Schindler Rising, CNM, MSN, FACNM, President/CEO of the Centering Healthcare Institute based in Silver Spring, Maryland, and Boston, Massachusetts. She dreamed up the word “centering” to describe the model of care she wanted to provide while driving her daughter to school one morning and formally introduced it to her colleagues at a national con-

ference for nursemidwives in 1995.

In her own words, Rising says centering brings together three components of prenatal care: the medical assessment or checkup, patient education, and community building. The last feature is at the A single parent, Lawanne Johnson found emoheart of what cen- tional support and parental advice through the tering is about as it group. erases the hierarchy between clinicians and patients freewheeling conversation in and encourages women to seek the conference room ranges out expertise in one another. from the serious to the lightCentering empowers wom- hearted, covering everything en, says Rising, allowing them from cervical mucus to coping

By moving them out of the clinic and into a group space, centering seeks to revolutionize prenatal care by reducing racial disparities in birth outcomes, boosting caregiver morale, and controlling costs. “to make friends and to sort out problems with each other and get solutions that are more appropriate than what a provider would be able to give in this very short touchpoint of a traditional visit.”

Sharon Schindler Rising, President and CEO of the Centering Healthcare Institute, created the centering model for women to build community with each other during prenatal visits.

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Minority Nurse | WINTER 2013

A Circle of Support Over a two-hour period, the

with sibling jealously after the baby comes home to having a game plan for when contractions start. How will first-time mom Luwanne Johnson remain calm in the final stretch towards delivery? “Keeping people who annoy me away from me,” she says, eliciting smiles and nods of agreement

Second Opinion from her peers.

Indeed, this last phase of pregnancy is making everyone—moms and dads alike—a bit high-strung. Group facilitator Alexandra Ebken, MSW, encourages the group to let loose. “I have this terrible attitude,” admits DeWayne Felder, 25, adding, “I don’t know where it’s coming from.

I just be spazzing. I’m just snapping at everyone.” His partner, Taekia Hungerford, 24, admits to running hotand-cold, making it difficult for Felder to guess her mood.

“Sometimes I’m like, ‘leave me alone, I don’t want to be bothered,’” says Hungerford.

“And then some days, I just want to be cuddled with or paid attention to.”

The centering group has offered some desperately needed continuity for 19-year-old Johnson, who has recently experienced more than her fair share of upheaval. Her pregnancy was unplanned and she is no longer in a relationship with her baby’s father. In the spring, she and her family were evicted from a home they were renting in DC’s Brightwood neighborhood that was foreclosed upon.

Johnson came home to find their belongings strewn on the sidewalk stretching across an entire city block. The family’s church paid for the family to stay in a hotel while they found new housing.

Not only does the centering group feel like a refuge from the stresses of her personal life, but it has given her more courage to ask questions she might have been too intimidated to ask during a oneon-one doctor’s visit. Plus, women in the group who are already parents share their tips

on childbirth and parenting.

“Coming in that first time, it felt warm,” she recalls. “Everyone was interacting. They welcomed me in. Everyone was so helpful to each other.

I felt like I was better off with the group.”

Every centering group gets a workbook covering pregnancy basics, yet they are not opened even once during the

pause, the corrective message is never preachy, but always delivered using the Socratic method where facilitators ask more questions instead of providing ready-made answers.

Rising recalls a centering group she attended in Atlanta where women discussed the virtues of eating clay for nutritional purposes during pregnancy — a practice known as

stop doing this,’” she says.

Ebken maintains a light touch by broaching necessary topics with open-ended questions, drawing in quieter participants by directly asking their opinion. She tries to get the group to anticipate the long road of parenting ahead of them by asking, “have you thought about how you are going to raise your babies?”

Takeia Hungerford and DeWayne Felder participated in Providence Hospital’s CenteringPregnancy group as a couple.

group. In fact, Rising insists that centering group should never be called “class,” as it was created to stand in sharp contrast to the didactic model of clinician-knows-best. Centering’s emphasis is on sharing lessons gained from day-today experiences, and receiving wisdom from family members, friends, and folk traditions that may not be sanctioned by the medical establishment.

Even when a practice is mentioned that gives a clinician

geophagy. She insisted they take her to a market where varieties of clays were sold because she was more interested in understanding their worldview than correcting them.

Centering’s way of challenging certain deeply held beliefs or practices during pregnancy— particularly if they are harmful—is to discuss their origins and to provide another perspective. “It’s not going to win us any friends if we just say, ‘this is bad and you need to

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What follows is a spirited discussion on how not to spoil your child, how to keep kids away from sexual predators, and what to do when kids become sexually active.

“At the end of the day, their agenda is more important than mine,” says Ebken.

“As a facilitator, my job is to make sure everyone feels like they have a voice. Giving the group power is way more important. So often their voices go unheard a lot of the time.”

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Second Opinion Greater Personalization of Care through the Group It’s clear that everyone is enjoying the camaraderie and commiseration. Yet mixed in is the serious business of making sure each woman’s pregnancy is on track. As the morning progresses, nurse-midwife Suz Brown, CNM, MSN, calls each woman to an examination bed set up at one end of the room where she checks fetal heart beats and chats with mothers about how they are feeling.

to the sheer volume of appointments each day brings. Centering groups tend to consist of 10 to 12 participants, but can sometimes be as large as 20.

In her position at Providence, Brown sees patients one-on-one in the clinic and co-facilitates a number of groups. “It becomes really focused on what do I have to get done [in the clinic],” she says, such as administering tests or reading charts rather than building a relationship with the patient. “When I

The paradox of centering is that caregivers seem to feel a deeper connection to patients who participate in groups over those whom they see individually.

The paradox of centering is that caregivers seem to feel a deeper connection to patients who participate in groups over those whom they see individually. Nurses and nurse-midwives have more time to get to know patients’ individual histories since centering is spread out over ten two-hour sessions and usually facilitated by the same two individuals. It’s easier for Brown to notice changes or milestones when she gets consistent exposure to the same cohort of patients. Trust and rapport develop not only among women but between them and the group’s facilitators.

“There’s a bond that gets established,” says Brown. “You worry about them when you wake up in the morning. It’s more intimate in a way; you have that time with the group.”

She also feels more invested in making sure a centering member has a positive experience with delivery.

By contrast, Brown says that it can be difficult to remember patients’ names in a clinic due

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first started at Providence, I was notorious for running behind. I just didn’t feel right doing the ten-minute visit.”

Centering, Brown says, makes explicit the mind-body connection that traditional care often does not. “We medicalize [obstetric care] so much, but there’s such an emotional and spiritual component that you can bring out in the whole group.” There is also an emotional payoff. “The interaction for people never gets old,” she says. “It gives me new energy because it’s always different.”

One of the main reasons Rising began centering is that she’d grown weary of repeating the same answers to the same questions day in, day out with her patients. “One woman’s question is another woman’s question, and so you don’t just continue with the repetitive question-answering that is so much a driver in traditional care,” she says.

The other critical piece of centering is that patients take a more active role in their own

care. At the beginning of each session, each woman weighs herself and takes her own blood pressure. They keep track of their own data and often read their own lab results. They understand what’s happening to their bodies better and can use the proper terminology to behave and speak with confidence when they deliver.

“We hear anecdotally time again and again that…when a woman who has been in centering arrives, [the hospital staff] know it without looking at the chart because she just behaves differently,” says Rising. And because centering groups always meet at the same time for a two-hour period, it makes it less likely that a patient will miss her checkups, improving her chances of having a full-term delivery. This consistent scheduling makes centering an attractive choice for women who rely on public

transportation, have inflexible work schedules, or depend on child care. “Traditional care runs around the needs of the agency and the clinicians,” says Rising. “It really doesn’t revolve around the needs of patients.

With centering, groups start and end on time. It’s honoring a woman’s time.”

Centering: Does it Actually Work?

While centering doesn’t target a specific demographic, practitioners and researchers have found it works particularly well with high-risk groups: women who are low-income, Latinas and African American women, and teen mothers.

“It works particularly well with vulnerable populations,” says Debra Keith, CNM, MSN, the Director of Providence Hospital’s Center for Life. “Groups that we have have…a lot of issues at home, they may be

Through its cozy and inviting atmosphere, CenteringPregnancy groups offer an alternative to the sometimes sterile environment of waiting and examination rooms at a doctor’s office.

Second Opinion African American women was more dramatic with the centering participants having a 10% chance of a preterm birth compared to 15.8% for those in conventional care.

More recently, a 2012 study published in the American Jour-

“

women receiving traditional care.2 Other studies show higher rates of breastfeeding among centering participants, lower rates of sexually transmitted diseases, and greater spacing between pregnancies, particu-

Traditional care runs around the needs of the agency and the clinicians,” says Sharon Schindler Rising, CNM, MSN, FACNM. “It really doesn’t revolve around the needs of patients. With centering, groups start and end on time. It’s honoring a woman’s time.

“

struggling in school and not have a lot of support. Group just does wonders for them. It gives them an opportunity to feel like they’ve been heard.”

Providence, like other hospitals in major cities, offers centering groups conducted entirely in Spanish. Other hospitals around the country offer groups conducted in Vietnamese and Arabic.

A 2007 study in Obstetrics & Gynecology co-authored by Rising found that among 1,047 women participating in centering groups at hospitals at Yale and Emory Universities, the risk of preterm birth lowered to 9.8% from the 13.8% risk women receiving conventional prenatal care face.1 The average age of the study’s participants was 20.4 years, and 80% of the women were African American. The risk reduction among

nal of Obstetrics & Gynecology that followed 316 low-income women in a CenteringPregnancy group at the Greenville Hospital System Obstetrics Center in Greenville, South Carolina, found a 47% reduction in preterm delivery among centering participants compared with

larly among teens. At the end of the day, all the preterm births and complications from STDs that are averted translate into cost-savings for hospitals, says Rising, who estimates that centering saves hospitals $2,000 per pregnant woman.

Most telling, moms and dads

who participate in centering report consistently higher levels of satisfaction with their prenatal care. As Felder, the young father who participated in Providence Hospital’s centering group, put it: “It’s almost like a therapy session. You rarely come out of here upset. You were mad out there, but not in here.”

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

References 1. Ickovics JR, Kershaw TS, Westdahl C, et al. Group Prenatal Care and Perinatal Outcomes. Obstet Gynecol. 2007 August; 110(2 Pt 1): 330–339.

2. Picklesimer AH, Billings D, Hale N, et al. The effect of CenteringPregnancy group prenatal care on preterm birth in a low-income population. Am J Obstet Gynecol.

2012;206:415.e1-7.

My child is going to college at

.

Their tomorrow depends on your words today.

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

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43

Second Opinion

Health Promotion and the African American Community

BY KERRI HENDERSON, BSN, RN from a stroke than Caucasian men.6 Additionally, African American stroke survivors are more likely to become disabled and have difficulty with activities of daily living.7

Challenges

The nursing profession has always been an advocate for providing community assessment, education, and health screenings to the public to promote healthier communities. Never has health promotion been more important than now. Healthy People 2020 (www.healthypeople.gov) is leading the charge by providing goals and objectives to improve the health for all Americans. One of its goals is to “achieve health equity, eliminate disparities, and improve the health of all groups.�1 This is a very important goal for the African American population in particular. Two-thirds of all deaths in the United States are caused by five major chronic diseases: cancer, cardiovascular disease, chronic lower respiratory disease, diabetes, and stroke.2 And African Americans have the highest mortality rates for three of them.

R

esearch has found that African Americans have higher rates of mortality and morbidity from cardiovascular disease (CVD) than their Caucasian counterparts. In 2008, the National Heart, Lung, and Blood Institute found CVD accounted for 25% of all deaths in the United States, and CVD was the number one cause of mortality for African Americans.3 Within the African American group,

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women have a higher mortality rate for CVD than males as well as Caucasian females.

African American women have a 35% higher mortality rate for CVD compared to Caucasian women, whereas African American males have only a 7% higher mortality rate compared to Caucasian men.4 Diabetes also affects the African American population at a higher rate. African Americans are twice as likely to be diag-

nosed with diabetes as their Caucasian counterparts. The effects of diabetes make this population twice as likely to have end-stage renal disease and lower extremity amputations.5 Stroke is another chronic disease that leads to a higher rate of death for African Americans. They are 60% more likely to have a stroke than Caucasians, and African American men are 60% more likely to die

Chronic illnesses are a vicious cycle where one illness often leads to another. There are several behaviors and lifestyle choices that can influence the development of these chronic conditions, such as uncontrolled high blood pressure, poor diet (which can lead to high cholesterol and obesity), and smoking. Education and mentoring about health promotion and screening unhealthy behaviors are important measures in preventing CVD, diabetes, and stroke.

While there are many educational programs available to African Americans about chronic illnesses and unhealthy behaviors, they are less likely to seek out preventive care.8 Cheatham, Barksdale, and Rodgers have identified numerous barriers that prevent African Americans from seeking health care and wellness promotion: socioeconomic

While there are many educational programs available to African Americans about chronic illnesses and unhealthy behaviors, they are less likely to seek out preventive care.

Second Opinion status, masculinity, prejudice, not knowing or understanding the need for a physician, peer influences, and religious beliefs.9 Additionally, slavery and the Tuskegee Syphilis Experiment have made the African American population wary of seeking medical treatment.10 Finding an effective way to address these barriers is crucial in order to decrease the morbidities and mortality rates from chronic illnesses in the African American population.

Are Health Fairs the Answer?

Lack of education, unhealthy behaviors, and barriers to seeking health promotion play a large part in these high mortality rates among African Americans. One way to provide

port more effective health promotion activities, education, and assessments.

There are several important issues to address when planning a wellness promotion fair.

Qualified individuals need to be enlisted to provide accurate screenings and reliable information. It is important that individuals organizing these events properly train the screeners and educators regarding the services they are providing to build trust between the workers and the population. It is particularly important to establish a trusting relationship between the health care provider and African Americans. A 2006 study in the Archives of Internal Medicine found that African Ameri-

Health fairs allow you to work within a specific community to identify unique needs for health promotion as well as provide basic education and preventive information.

ple 2020’s goals is to “attain a higher quality of life that is free from preventable disease, disability, injury, and premature death.”1 The goal is not to teach but rather to mentor those who do not have the tools to make better choices about their health.

Kathleen Thimsen, RN, CWON, MSN, FNS, an instructor at the Southern Illinois University Edwardsville School of Nursing and Clinic Director of its Community Nursing Services, states it best: “Vulnerable populations are rich with people who want the same as everyone else, yet have tremendous obstacles. Mentoring goes farther to create change than ‘teaching at people.’”11

ties issue. J Natl Med Assoc.

2009;101(6):536-40.

5. The Office of Minority Health.

Diabetes and African Americans. http://minorityhealth.hhs.gov/ templates/content.aspx?ID=3017.

Accessed October 2012.

6. The Office of Minority Health.

Stroke and African Americans. http://minorityhealth.hhs.gov/ templates/content.aspx?ID=3022.

Accessed October 2012.

7. Centers for Disease Control and Prevention. Differences in Disability Among Black and White Stroke Survivors – United States, 2000-2001. MMWR. 2005;54(1):36. www.cdc.gov/mmwr/preview/ mmwrhtml/mm5401a2.htm.

8. Halbert CH, Armstrong K, Gandy Jr. OH, and Shaker L. Racial differences in trust in health care providers. Arch Intern Med.

Kerri Henderson, BSN, RN, has worked for eleven years in the field of nursing. Her experience has always been in the critical care area but now she is working in the area of hospice. She is currently working on her MSN.

2006;166(8):896-901. http:// archinte.jamanetwork.com/article. aspx?articleid=410195.

9. Cheatham CT, Barksdale DJ, Rodgers SG. Barriers to health care and health-seeking behaviors faced by black men. J Am Acad

health promotion information to a variety of communities is through a wellness promotion fair. Health fairs allow you to work within a specific community to identify unique needs for health promotion as well as provide basic education and preventive information.

Screenings and presentations are great ways to deliver basic health information to a large population—and they can inspire a community to make better health choices. Wanting to improve health is simply not enough. A person needs the education and support to make smarter decisions, and health fairs can provide important information that can ultimately save lives. A well prepared health fair can sup-

cans are less likely to report a trusting relationship with their health care provider.8 It is also important to remind those attending the health fair that the information and screenings provided do not replace the need to seek further follow-up from a physician.

Simple screenings on blood pressure or cholesterol and basic information on health changes are great ways to identify health concerns. However, they should never replace a primary care physician. It should be a goal of the health fair to direct the African American population to health care providers practicing in their area because continuity care with patients can improve trust among African Americans.8 Another one of Healthy Peo-

References

Nurse Pract. 2008;20(11):555-62.

1. Healthy People 2020. Overarching goals. www.healthypeople. gov/2020/about/default.aspx.

Accessed October 2012.

10. Osher T, Garay L, Jennings B,

2. Fierro MP. Costs of Chronic Diseases: What are States Facing?

The Council of State Governments Trends Alert. Spring 2006. www. healthystates.csg.org/NR/rdonlyres/E42141D1-4D47-4119-BFF4A2E7FE81C698/0/Trends_Alert. pdf.

3. National Heart, Lung, and Blood Institute. Morbidity & Mortality: 2012 Chart Book on Cardiovascular, Lung, and Blood Disease. Chart Book. www.nhlbi.nih.gov/resources/docs/2012_ChartBook_508.pdf.

Accessed October 2012.

4. Williams RA. Cardiovascular disease in African American

Jimerson D, Markus S, Martinez K. Closing the gap: Cultural perspectives on family-driven care.

Technical Assistance Partnership for Child and Family Mental Health. September 2011. www. tapartnership.org/docs/ClosingTheGap_FamilyDrivenCare.pdf.

Accessed October 2012.

11. Thimsen K. Creating healthy nutrition and access in the inner city with community gardening. Southern Illinois University School of Nursing with the Community Nursing Center. http://www.aptrweb.org/resource/resmgr/sp_nursing/ southernillinoisevansville_t.pdf.

Accessed October 2012.

women: A healthcare dispari-

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45

Second Opinion

Prevent “The Big One”—Ischemic Heart Disease

BY ED JAMES, MD

Heart disease is the leading cause of death in the United States both for men and women, killing 25% of Americans, and heart disease deaths are most often due to ischemic heart disease (e.g., heart attack).1 These facts are well known among doctors, nurses, and other health professionals. However, did you know that virtually all “heart attacks” are preventable by diet and lifestyle?

I

f you have never heard this, you are not alone. In my opinion, our education as health professionals tends to focus on the treatment of disease, using drugs, surgery, and other technological advances, and unfortunately, generally underemphasizes relatively inexpensive preventive techniques, including healthy dietary and lifestyle changes. Furthermore, doctors and nurses are trained to pay close attention to disease trends within families and to remind patients of their family histories. As a result, patients often leave doc-

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Minority Nurse | WINTER 2013

tors’ offices and hospitals with a misconception that if certain diseases, such as heart attacks, are common in their family, they will also likely die from the same disease. I have encountered many people who feel that their fate with regard to disease is sealed in their genes.

In actuality, I strongly believe that heart attacks (and most other common chronic diseases that impact Americans) have more to do with families eating the same fatty, salty, sugary, high calorie, processed, animalbased, low-nutrient foods and sharing the same couch than

having similar DNA. As deliverers of health care, we have the opportunity to empower ourselves and our patients as we become more familiar with the current research on preventive health, and as we personally embrace healthier diets and lifestyles.

Let’s consider heart attacks in more detail. Plaques develop as a consequence of damage to the endothelial cells that line our coronary arteries. Only about 12% of heart attacks are actually related to coronary arteries closing off due to large old plaques. The remaining 88% of heart attacks are due to rupture of relatively young, fatty coronary artery plaques.2 Subsequently, clot forms in an attempt to heal this injury, but often occludes the vessel, so that not enough oxygen-rich blood reaches the heart muscle. This death of heart muscle (myocardial infarction) is often referred to as a heart attack. There is credible and comprehensive research that this cascade of events, which is often fatal, is directly related to a typically Western diet.3 Nearly all heart attacks are preventable based upon my review of the current research.

For example, beginning in 1985, Dr. Caldwell Esselstyn studied a group of patients who had severe coronary artery disease.4,5 The 18 patients that remained in the study (five patients dropped out) had suffered 49 coronary events in the eight years leading up to the study, including angina, bypass surgery, heart attacks, strokes, and angioplasty. During the study, they were to eat

a plant-based, whole-foods diet, avoiding oils, meat, fish, fowl, and dairy products, except for skim milk and non-fat yogurt.

Only a very low dose of a cholesterol lowering statin drug was used. During the course of the study, the average cholesterol dropped from 246 mg/ dL to 132 mg/dL. LDL levels also dropped dramatically. In the following 11 years, there was only one coronary event, which occurred in a patient who strayed from the diet. Seventy percent of Dr. Esselstyn’s patients experienced opening of their clogged arteries. Furthermore, it is compelling that Dr. Esselstyn and two other prominent heart researchers, Dr. Bill Castelli (longtime director of the Framington Heart Study) and Dr. Bill Roberts (longtime editor of the prestigious medical journal, Cardiology), each indicated that they had never seen a heart disease fatality among their patients who had blood cholesterol levels below 150 mg/dL.6 It is also noteworthy that the rate of heart attack deaths in the United States is among the highest in the world, with rates over the years typically 10 to 15 times greater than some other countries.7 In fact, there are some countries where heart disease is rare.8 Please note that Japanese men who live in Hawaii or California have a much higher total cholesterol and incidence of coronary artery disease than Japanese men living in Japan.9,10 These data are not explainable by genes, but rather by diet and lifestyle.

We know that 35% of heart attacks strike Americans with

Second Opinion

I strongly believe that heart attacks (and most other common chronic diseases that impact Americans) have more to do with families eating the same fatty, salty, sugary, high calorie, processed, animalbased, low-nutrient foods and sharing the same couch than having similar DNA. cholesterol levels between 150 and 200 mg/dL.11 Why then do we set our goals for a total cholesterol of under 200, when, actually, a truly safe cholesterol has been shown to be under 150 mg/dL? I believe that cultural bias plays a role here, impacting governmental legislation and medical education.

After learning this valuable information about heart attack prevention, several years ago, I decided to personally strive for a total cholesterol level of below 150 mg/dL. By adopting a whole-foods, plant-based diet, I was able to achieve a sub150 cholesterol within a few months and have maintained it. In the words of Dr. Esselstyn, I have now been “heart attack proof” for four years. I have no intention of returning to the Standard American Diet, because since adopting this healthy diet and lifestyle, I have also “cured” my pre-diabetes without meds and lost more than 50 pounds, which is a typical response to a plantbased, whole-foods diet and regular exercise. My dietary caloric intake is about 95% plant food and 5% animal-based food (generally fish). I virtually never eat red meat and only occasionally eat skinless grilled chicken (typically on a salad).

It is most important that we seek the truth. The truth is that heart attacks are preventable in nearly all cases, and once informed, we all have the option of protecting ourselves (through

our diet and lifestyle) from coronary artery disease. In my opinion, we also have an obligation to pass this information along to our families, patients, and friends. It is my experience that many people will make healthy dietary and lifestyle changes, when they fully understand the benefits of doing so, as well as the potential consequences of not making such changes. As doctors and nurses, let’s take the lead by personally embracing healthier diets and lifestyles to prevent and reverse chronic disease, becoming role models whose behavior our patients can emulate. In doing so, we can also rest assured that we will not succumb to “the big one“!

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

References 1. Kochanek K, Xu J, Murphy SL, Minino AM, Kung HC. Deaths: Final Data for 2009. National Vital Statistics Reports. Centers for Disease Control and Prevention.

2011; 60(3):5,8,37,70. http://www. cdc.gov/nchs/data/nvsr/nvsr60/ nvsr60_03.pdf.

2. Esselstyn CB Jr. Prevent and Reverse Heart Disease. 2007;16.

3. Campbell TC, Parpia B, Chen J. Diet, lifestyle, and the etiology of coronary artery disease: The Cornell China Study. Am. J. Cardiol.

1998 Nov 26;82(10B):18T-21T. 4. Esselstyn CB Jr, Ellis SG,

Medendorp SV, Crowe TD. A strategy to arrest and reverse coronary artery disease: a 5 year longitudinal study of a single physician’s practice. J Fam Pract. 1995 Dec;41(6):560-8.

HB. Epidemiologic Studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: serum lipids and diet. Am. J. Epidemiol.

1973;97(6):372-385.

5. Esselstyn CB Jr. Introduction: more than coronary artery disease. Am J. Cardiol. 1998 Nov 26;82(10B):5T-9T.

11. Castelli W. Take this letter to your doctor. Prevention.

1966;48:61-64.

6. Campbell TC, Campbell TM II. The China Study. 2006;79.

7. Jolliffe N, Archer M. Statistical associations between international coronary heart disease death rates and certain environmental factors. J. Chronic Dis. 1959 Jun;9(6):636-52.

8. Scrimgeour EM, McCall MG, Smith DE, Masarei JR. Levels of serum cholesterol, triglyceride, HDL, cholesterol, apolipoproteins, A-1 and B, and plasma glucose, and prevalence of diastolic hypertension and cigarette smoking in Papua New Guinea Highlanders.

Pathology. 1989 Jan;21(1):46-50.

9. Kagan A, Harris BR, Winkelstein W Jr, et al. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: demographic, physical, dietary and biochemical characteristics. J. Chronic Dis. 1974 Sep;27(7-8):345-64.

10. Kato H, Tillotson J, Nichaman MZ, Rhoads GG, Hamilton

www.minoritynurse.com

Suggested Media Books • The China Study, by T. Colin Campbell, PhD, and Thomas M. Campbell II • Prevent and Reverse Heart Disease, by Caldwell Esselstyn, Jr., MD

Film • Forks over Knives (2011)

Podcast • Funerals and Fried Chicken® Topic: Heart Disease www.blogtalkradio.com/learnforlife/2012/04/15/funeralsand-fried-chicken

Minority Nurse Magazine

@MinorityNurse

47

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

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

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

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

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

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

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

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

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

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Minority Nurse | WINTER 2012

MINORITY NURSE

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

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

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Minority Nurse | WINTER 2012

Academic Opportunities

A

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

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

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

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Minority Nurse | WINTER 2013

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

Academic Opportunities

ADVANCE YOUR NURSING CAREER Get ahead of the curve.

At West Coast University we have over 100 years of experience educating motivated individuals for rewarding careers in a wide variety of settings. With our reputation, WASC* and ACICS** accreditations, curriculum and technologically advanced Simulation Centers, West Coast University has produced graduates that are highly sought after by employers.

Our nursing programs include: • Bachelor of Science in Nursing (BSN) • Licensed Vocational Nurse (LVN) to BSN • Registered Nurse (RN) to BSN† ª Master of Science in Nursing (MSN) • Master of Science in Health Care Mgmt. (MSHCM)

877-470-6510 • chooseWCU.com Los Angeles | Orange County | Ontario | Dallas 8435 N. Stemmons Freeway, Dallas, TX 75247 | Programs vary by campus. *Accrediting Commission for Senior Colleges and Universities of the Western Association of Schools and Colleges (WASC), 985 Atlantic Ave #100. Alameda, CA 94501, 501-748-9001, wascsenior.org. **Accrediting Council for Independent Colleges and Schools (ACICS), 750 www.minoritynurse.com Minoritymust Nurse Magazine @MinorityNurse have graduated with an associate First Street, NE, Suite 980, Washington, DC 20002-4223, 202-336-6780, www.acics.org. †Applicants degree in nursing and hold a current license as an RN in the US. For graduation rates, median debt of graduates completing these programs and other important information, visit www.westcoastuniveristy.edu/disclosures.

51

Academic Opportunities

Explore the Possibilities

and the unique opportunities offered through our PhD program.

At the Johns Hopkins University School of Nursing, most full-time PhD students are 100% funded with a stipend for the first two years of study. Full funding is also available for students in following years.

For full eligibility of scholarship opportunities, apply by January 15.

Johns Hopkins University School of Nursing—a place where exceptional people discover possibilities that forever change their lives and the world. www.nursing.jhu.edu/phd

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

Our nursing and health policy fellows do.

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

NHPC Ad 7x4.5 121121.indd 52RWJF Minority Nurse | WINTER32013

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

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

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

To apply, visit http://nursinghealthpolicy.org/#apply.

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

12/3/12 2:49 PM

Academic Opportunities

Master of Science in Nursing Nursing Informatics Online Program Earn a Master of Science in Nursing by completing this web-based Nursing Informatics program. The

Nursing Informatics program is designed to provide nurses with the necessary knowledge and skills to enhance the quality of patient care and outcomes through the development, implementation, and evaluation of health information management tools and systems.

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

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

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53

Academic Opportunities

Join the Frontier community without leaving yours!

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

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

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

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

Let us help you pay for your graduate education PICTURE YOURSELF at the Betty Irene Moore School of Nursing at UC Davis—a new nursing school with a vision to advance health and ignite leadership through innovative education, transformative research and bold system change.

SPACE IS LIMITED! APPLICATIONS ARE NOW OPEN FOR FALL 2013 classes in the M.S. and Ph.D. interprofessional Nursing Science and Health-Care Leadership Degree Programs.

MSN, DNP, or PhD

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

UNLEASHING THE

POWER

PA S S I O N

AND OF NURSING

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

BET T Y IRENE MOORE SCHOOL OF NURSIN G nursing.ucdavis.edu

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1-888-747-0794 Scan this code to learn more

Minority Nurse | WINTER 2013

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Faculty Opportunities

T

he world needs more nurses. With that comes the need for experienced, dedicated nursing faculty to train them.

There is a true shortage of nursing educators—particularly minority nursing professors, who comprise a small percentage of nursing faculty overall. The American Association of Colleges of Nursing says the scarcity of professors may actually be stunting the growth of nursing programs. To counter this, nursing schools are improving the pay for nursing school faculty to increase their numbers, especially those who hold a doctorate.

This section of Minority Nurse is dedicated to open faculty positions from nursing schools all over the country. Requirements vary, but all are sure to lead to exciting, rewarding careers in nursing education and research.

Eastern Michigan University Assistant Professor - Nursing The School of Nursing invites applications for a tenure-track position; the appointment will be at the rank of Assistant Professor with a start in Fall 2013.

The School of Nursing is one of four schools in the College of Health and Human Services. The School offers both undergraduate program options and a graduate program in adult health nursing. A PhD in Educational Studies with a concentration in Nursing Education in collaboration with the College of Education is also offered. Eastern Michigan University is located in southeast Michigan and has more than 23,000 students. For more information contact the Nursing Search and Screen Committee at: (734) 487-2310 or visit www.emich.edu/nursing.

Qualifications include: Master’s degree in nursing or an appropriate allied health field; Completed 18 credit hours toward doctorate in addition to Masters (Applicants without 18 credit hours of doctoral study may be considered at Instructor level rank); Current or eligible for Registered Nurse license in the State of Michigan; At least 4 years of combined teaching and clinical experience; Evidence of scholarly activities commensurate with rank.

Preference is given for applications that demonstrate: Master’s specialization in any of the following clinical specialty practice areas; Medical/Surgical, Pediatrics, Psychiatric/Mental Health, or Community/Public Health; Doctoral degree attainment in Nursing or a related field; Evidence of professional and/or community service.

All applications must be made online at https://www.emujobs.com.

Applications must include letter of application and CV/resume. Review of applications will begin immediately and continue until the position is filled. For more information, contact the Search Committee Chair: Marty Raymond, RN, PhD, Associate Professor, School of Nursing, (734) 487-2054.

EMU is an equal opportunity employer, and the institution is regularly recognized by U.S. News & World Reporter for its diversity.

Minority Nursing Magazine Size: 1/4 Page (3.4” x 4.5”) Cost: $1,650.00

St. Paul’s School of Nursing in Queens is seeking qualified candidates for Director of the Associate

Degree in Medical Assistant Program and Master Teachers for the Associate Degree in Nursing Program. The Medical Assistant program is expand-

ing rapidly and requires strong management and curriculum expertise. The Nursing program is adding new faculty positions to enhance the student experience in that program. Candidates with strong positive experience in the classroom are encouraged to apply. Competitive salaries and flexible schedules.

Apply at stpaulsschoolofnursing.edu or call 718.357.0500.

www.minoritynurse.com

Minority Nurse Magazine

@MinorityNurse

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Faculty Opportunities

TENURED/TENURE-TRACK FACULTY POSITIONS AT WASHINGTON STATE UNIVERSITY COLLEGE OF NURSING Washington State University College of Nursing provides high quality and accessible education to baccalaureate, master’s, and doctoral nursing students. The college is seeking applications from: • Individuals who are nurse scholars with an active program of clinical research and an interest in teaching and mentoring both health professional students and practicing clinicians, for a shared position with Washington State University College of Nursing and Providence Health Care at the rank of Assistant Professor, Associate Professor, or Full Professor.

• Individuals with an earned doctoral degree, particularly with specialization in biostatistical methodologies that support clinical trials research. Special consideration will be given to candidates who have proficiency in missing data and adaptive design strategies for a tenure-track position at the rank of Assistant Professor.

• Individuals with an earned doctoral degree, particularly individuals prepared as Advanced Practice Nurses (APNs) with specialization as a Family Nurse Practitioner or Psychiatric Mental Health Nurse Practitioner. Tenure-track/ tenured positions are offered at the rank of Assistant Professor, Associate Professor, or Full Professor.

All three positions are located in Spokane, Washington. Salary, rank, and tenure status are dependent upon experience and qualifications. >> To apply, visit www.wsujobs.com The online application requires: 1) a cover letter discussing education and experience as related to the required and desired qualifications, 2) curriculum vitae, 3) names and contact information for four professional references.

Position will remain open until suitable candidates are identified. Screening begins immediately and will remain open until suitable candidates are identified.

WASHINGTON STATE UNIVERSITY IS AN EEO/AA/ADA EDUCATOR AND EMPLOYER.

nursing.wsu.edu

Index of Advertisers ADVERTISER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE #

University of Pittsburgh School of Nursing. . . . . . . . . . . 54

American Association of Critical Care Nurses . . . . . . . . C2

University of New Mexico . . . . . . . . . . . . . . . . . . . . . . . . 52

Carilion Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

University of South Alabama. . . . . . . . . . . . . . . . . . . . . . 53

Columbia St. Mary’s Recruitment. . . . . . . . . . . . . . . . . . 23

University of Buffalo . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Froedert Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

University of Tennessee School of Nursing. . . . . . . . . . . 50

Johns Hopkins Bayview Medical Center. . . . . . . . . . . . . . 8

West Coast University. . . . . . . . . . . . . . . . . . . . . . . . . . . 51

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

FACULTY OPPORTUNITES. . . . . . . . . . . . . . . . . . . . . . . . PAGE #

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

Eastern Michigan University. . . . . . . . . . . . . . . . . . . . . . 55

Betty Irene Moore School of Nursing . . . . . . . . . . . . . . . 54

St. Paul’s School of Nursing . . . . . . . . . . . . . . . . . . . . . . 55

Frontier Nursing University. . . . . . . . . . . . . . . . . . . . . . . 54

Washington State University. . . . . . . . . . . . . . . . . . . . . . 56

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

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Minority Nurse | WINTER 2013

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