Minority Nurse Magazine (Winter 2014)

®

The Career and Education Resource for the Minority Nursing Professional • WINTER 2014

25

Top Nursing Employers • Crash Course in Hospital Disaster Planning • Evaluating SANE Programs • The Generational Shift

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Table of Contents

In Every Issue

Cover Story

3

Editor’s Notebook

12

4

Vital Signs

By Ethan LaCroix

8

Making Rounds

Is it time to move on to greener pastures? Check out the results

50

Highlights from the Blog

of our first annual best companies survey and see whether your

56

Index of Advertisers

employer made the cut

Academic Forum 35

The ACA and Opportunities for Nurses

By Archana Pyati Nurse practitioners are eager to fill the need of primary care providers but face unique battles when it comes to being uniformly embraced

Top 25 Nursing Employers

Features 9

Are Health Centers the Future?

By Leigh Page Experts predict that the influx of newly insured will go to community health centers due to limited capacity at physician practices,

39

Child Abuse and Autism: How Nurses Can Help

By Behlor Santi Discover how fighting domestic violence could help decrease the rate of children with autism

so why are so many of them holding off on hiring?

19

By Jebra Turner

Second Opinion 41

No Older Adult Left Behind

By Staja “Star” Booker, RN, MS Children may be the future, but their parents and grandparents deserve competent care too

Expect the unexpected and follow these steps to ensure your hospital is prepared in case of an emergency

23

Degrees of Success 44

Mentoring and the Use of Innovative Curriculum Design to Develop a Global Nurse Leader

By Sandra Davis, PhD, DPM, ACNP-BC Learn how to transform your students into global leaders despite budgetary restraints

Crash Course in Hospital Disaster Planning and Response for Nurses

The Generational Shift: How to Manage Different Generations in the Workforce

By Robin Farmer Cast aside your prejudices and promote intergenerational harmony for a happier, more efficient workplace

26

Honoring Religious Practices

By Julia Quinn-Szcesuil

47

Lessons for the Teacher

By Leona Konieczny, DNP, MPH, RN-BC One professor’s experience in the classroom proves that a nurse’s education is never truly finished

Find out how to walk the fine line between spirituality and science with your patients

29

Evaluating SANE Programs

By Kimberly Bonvissuto While SANE programs—and the forensic nurses behind them— are making an impact, only a handful of programs have been evaluated rigorously

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Minority Nurse | WINTER 2014

®

Editor’s Notebook:

A Lifelong Commitment to Learning

W

hether you are a new graduate fresh out of college or have decades of experience under your belt, there is always an opportunity for you to learn something new and grow personally and professionally. Career development should mean more to you than simply padding your resume with a new skill or job title. It’s not just an end result to get you a raise or another rung up the ladder, either. Sure, those are respectable goals to have. But what are you really looking for in an employer besides a bigger salary? We asked our readers to share what qualities matter most to them in the workplace and whether their employers stand out from the pack. Check out the results in our cover story and decide whether yours is up to par.

Remember, there is more to life than a paycheck—and happier nurses often translate to better health for everyone.

It’s a chain reaction, after all. Career development means bettering yourself, and while that may seem like a selfish exploit, those around you benefit as well. It could start with something as simple as reading a news story about Superstorm Sandy and wanting to work with your employer to ensure that the staff can react quickly the next time Mother Nature strikes. If the fear of natural disasters keeps you up at night, check out Jebra Turner’s article for a crash course in tackling the unexpected.

Or, let’s say you are obsessed with TV shows like Law & Order: SVU and want to pursue forensic nursing, so you decide to sign up for a Sexual Assault Nurse Examiner (SANE) program. Not only will you learn how to provide comprehensive care to survivors, but you’ll also help address the under-prosecution of adult sexual assaults in this country.

In her article, Kimberly Bonvissuto examines the value of SANE programs and the future of this evolving specialty. Look at the bigger picture and realize that each step you take can make a real difference in the lives of others.

Would you treat each patient the same regardless of religion? Of course you want to provide competent health care to all, but you would need to apply the knowledge you have to each individual and their unique situation. For instance, what would you do if your patient asked you to pray with them? You don’t have to practice a particular faith to provide quality care, but a little self-awareness goes a long way. Read Julia Quinn-Szcesuil’s article on honoring religious practices and discover the power of communication.

Whether you work with the young or the elderly, you know that each generation might respond differently, depending on how instructions are communicated. Nurse managers are learning quickly that a one-size-fits-all approach does not exist when working with four different generations of nurses. Robin Farmer teaches you how to adapt so you can communicate effectively with each age group.

As a nurse, you made the commitment to be a lifelong learner. Take a lesson from Leona Konieczny and let those around you inspire you to grow. No matter how insignificant or inexperienced we may seem, there is always something we can teach one another.

— Megan Larkin

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3

Vital Signs

Colorectal Cancer Screening Rates Remain Low About one in three adults aged 50 to 75 years have not been tested for colorectal cancer as recommended by the United States Preventive Services Task Force (USPSTF), according to a new Vital Signs report from the Centers for Disease Control and Prevention (CDC). Despite research that shows colorectal cancer screening tests save lives, screening rates remain too low.

“T

here are more than 20 million adults in this country who haven’t had any recommended screening for colorectal cancer and who may therefore get cancer and die from a preventable tragedy,” said CDC Director Tom Frieden, MD, MPH. “Screening for colorectal cancer is effective and can save your life.”

Colorectal cancer is the second leading cancer killer among men and women in the United States, after lung cancer. Screening tests can prevent cancer or detect it at an early stage, when treatment can be highly effective. Adults aged 50 years and older should get tested with one or a combi-

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Minority Nurse | WINTER 2014

nation of these screening tests: • Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) done at home every year; • Flexible sigmoidoscopy, done every five years, with FOBT/FIT done every three years; • Colonoscopy done every 10 years.

A colonoscopy can detect cancer early, and it can find precancerous polyps so they can be removed before they turn into cancer. An FOBT/ FIT is a simple at-home test that can detect cancer early by identifying blood in the stool, a possible sign of cancer. People are not always offered a choice of colorectal cancer tests, but studies have

shown that people who are able to choose the test they prefer are more likely to get the test done.

CDC researchers reviewed colorectal cancer screening data from CDC’s 2012 Behavioral Risk Factor Surveillance System to estimate the percentage of people aged 50 to 75 years who reported getting screened as recommended by type of test.

Major Findings • Among adults who were screened as recommended, colonoscopy was by far the most common screening test (62%). Use of the other USPSTF-recommended tests was much lower: FOBT (10%), and flexible sigmoid-

oscopy in combination with FOBT/FIT (less than 1%).

• The highest percentage of adults who were up-todate with colorectal cancer screening was in Massachusetts (76%).

• The percentage of people screened for colorectal cancer using the FOBT within one year was more than twice as high in California (20%) when compared with most states.

• Blacks and whites had similar screening rates, but a higher percentage of blacks across all income and education levels used FOBT. The authors noted that increasing use of all tests may increase screening rates. Furthermore, research shows that more people may get tested if health care providers used an organized approach to identify people who need to be screened: contact them at their home or community setting; advise them of each test; and carefully monitor to make sure they complete their test.

CDC provides funding to 25 states and four tribal organizations across the United States to help increase colorectal cancer screening rates among men and women aged 50 years and older through organized screening methods. Through the Affordable Care Act, more Americans will have access to health coverage and preventive services like colorectal cancer screening tests. The tests will be available at no additional cost. Visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more.

Vital Signs

One Dose of HPV Vaccine May Be Enough to Prevent Cervical Cancer Women vaccinated with one dose of a human papillomavirus (HPV) vaccine had antibodies against the viruses that remained stable in their blood for four years, suggesting that a single dose of vaccine may be sufficient to generate long-term immune responses and protection against new HPV infections, and ultimately cervical cancer, according to a study published in Cancer Prevention Research.

“T

he latest Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention on vaccination coverage indicates that in 2012, only 53.8% of girls between 13 and 17 years old initiated HPV vaccination, and only 33.4% of them received all three doses,” said Mahboobeh Safaeian, PhD, an investigator in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute (NCI) in Bethesda, Maryland.

“We wanted to evaluate whether two doses, or even one dose, of the HPV 16/18 L1 VLP vaccine [Cervarix] could induce a robust and sustainable response by the immune system,” she added. “We found that both HPV 16 and HPV 18 antibody levels in women who received one dose remained stable four years after vaccination. Our findings challenge previous dogma that protein subunit vaccines require multiple doses to generate longlived responses.”

Data for this study are from the NCI-funded phase III clinical trial to test the efficacy of Cervarix in women from Costa Rica. About 20% of the women in the study received

fewer than three doses of the vaccine, not by design.

The researchers looked for the presence of an immune response to the vaccine (measured by antibody levels) in blood samples drawn from 78, 192, and 120 women who received one, two, and three doses of the vaccine, respectively, and compared the results with data from 113 women who did not receive vaccination but had antibodies against the viruses in their blood because they were infected with HPV in the past.

They found that 100% of the women in all three groups had antibodies against HPV 16 and 18 in their blood for up to four years. Antibody levels were comparable for women receiving two doses six months apart and those receiving the full three doses.

The researchers also found that while antibody levels among women who received one dose were lower than among those who received the full three doses, the levels appeared stable, suggesting that these are lasting responses. In addition, the levels of antibodies in women from the one- and two-dose groups were five to 24 times higher than the levels of antibodies

in women who did not receive vaccination, but had prior HPV infection.

“Our findings suggest promise for simplified vaccine administration schedules that might be cheaper, simpler, and more likely to be implemented around the world,” said Safaeian. “Vaccination with two doses, or even one dose, could simplify the logistics and reduce the cost of vaccination, which could be especially important in the developing world, where more than 85% of cervical cancers occur, and where cervical cancer is one of the most common causes of cancer-related deaths.”

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In some parts of the world, including Chile and British Columbia, two doses of HPV vaccine is now the recommended vaccination program, according to Safaeian. But for a single HPV dose, “while our findings are quite intriguing and show promise, additional data are needed before policy guidelines can be changed,” she clarified.

“For instance, it is important to note that persistence of antibody responses after a single dose has not been evaluated for Gardasil, the quadrivalent HPV vaccine that is more widely used in the United States and many other countries.”

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5

Vital Signs

Black Women Develop Lupus at Younger Age with More Life-Threatening Complications There are substantial racial disparities in the burden of lupus, according to initial data from the largest and most far-reaching epidemiology study ever conducted on the disease lupus and published recently in the journal Arthritis and Rheumatism.

New data from two registries, part of the National Lupus Patient Registry (NLPR), also reveal that black females disproportionately are burdened by lupus, a devastating and complicated autoimmune disease.

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Minority Nurse | WINTER 2014

A

n extensive review of records from hospitals, specialists’ offices, and clinical laboratories in Georgia and Michigan showed blacks had an increased proportion of lupus-related renal (kidney) disease and progression to end-stage renal disease than whites, and that black females developed lupus at a younger age than white females. To learn more, visit www.lupus. org/news.

The NLPR is the first comprehensive population-based epidemiology study in lupus, with five registry sites located in Georgia, Michigan, California, New York, and the Indian Health Service. The sites are collaborating to use similar case definitions and data collection procedures to capture diagnosed lupus in these areas and allow more accurate data comparison, critical in assessing this complicated disease.

The Georgia and Michigan sites are the first to report their findings.

With a grant and under direction of the Centers for Disease Control and Prevention (CDC) and in partnership with the Georgia and Michigan state health departments, investigators from Emory University and the University of Michigan led this landmark epidemiology study to include blacks and whites of all ages. “Black women had very high rates of lupus, with an incidence rate in Georgia nearly three times higher than that for white women, with signifi-

Vital Signs cantly high rates in the 30-39 age group,” said Georgia principal investigator, S. Sam Lim, MD, MPH, Emory University, Department of Medicine, Division of Rheumatology.

“These are young women in the prime of their careers, family, and fertility. This means a severely compromised future, with a disease that waxes and wanes, affecting every aspect of daily living for the rest of their lives.”

“We found a striking difference in patterns of lupus between the black and white populations, which may help us better assess risk for developing this disease,” explained Michigan principal investigator, Emily C. Somers, PhD, ScM, University of Michigan, Departments of Internal Medicine, Environmental Health Sciences, and Obstetrics & Gynecology. “Not only was the peak risk of lupus earlier among black females, but a higher proportion also developed severe or life-threatening complications of lupus, such as neurologic or kidney disease, including end-stage renal disease. Health care providers caring for this population should be aware of the importance of screening for early signs of lupus, in particular kidney disease.”

“The results just from these two registries illuminate the enormous burden of lupus among young women in the prime of their life,” said Sandra C. Raymond, President & CEO, the Lupus Foundation of America. “But data from these sites represent only the tip of the iceberg. Lupus is a complex and diverse disease that can take many forms. We need a more complete understanding of the impact of all forms

of lupus among all populations at risk for developing the disease. The data from the next three sites will help to fill in gaps and document the urgent need to elevate lupus to a national health priority.”

The Georgia and Michigan investigators noted the challenges with diagnosing lupus, stating that likely there remain undiagnosed cases in the community and that applying more up-to-date diagnostic criteria might result in even higher incidence and prevalence rates. The investigators also said they plan to use the lupus patient registries to recruit cohorts for ongoing studies to document the progression of the disease and determine the economic burden of lupus over time, which, according to data already available, is substantial.

“The purpose of the National Lupus Patient Registry is to develop more complete population-based incidence and prevalence estimates and to assess the impact of lupus,” said Charles Helmick, MD, medical epidemiologist, CDC. “The results of previous lupus epidemiology studies have varied widely for a number of reasons, including lack of representation of populations at high risk, different case definitions, and limited or small source populations.

The Georgia and Michigan studies include four counties with a combined population of nearly four million people.

The large surveillance population, along with the extensive review of records from many sources, has resulted in the most reliable and up-todate statistics for lupus,” said Helmick.

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7

Making Rounds

February 12-15

Southern Nursing Research Society 28th Annual Conference: Enhancing Value-based Care: Generating New Knowledge San Antonio Marriott Rivercenter San Antonio, Texas Info: 877-314-SNRS E-mail: info@snrs.org Website: www.snrs.org

March 22-25

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

25-29

International Society of PsychiatricMental Health Nurses 7th Annual Psychopharmacology Institute Conference, 16th Annual ISPN Conference The Hyatt Regency Greenville, South Carolina Info: 866-330-7227 E-mail: conferences@ispn-psych.org Website: www.ispn-psych.org

27-29

American Nursing Informatics Association Paris Las Vegas Hotel and Casino Las Vegas, Nevada Tel: 866-552-6404 E-mail: ania@ajj.com Website: www.ania.org

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Minority Nurse | WINTER 2014

March

May

28-29

1-4

Asian American Pacific Islander Nurses Association 11th Annual Conference Holiday Inn San Diego North Miramar San Diego, California E-mail: info@aapina.org Website: www.aapina.org

April 2-4

Visiting Nurse Associations of America 32nd Annual Conference Westin Lake Las Vegas Resort and Spa Lake Las Vegas, Nevada Info: 202-384-1420 E-mail: vnaa@vnaa.org Website: http://vnaa.org

6-8

Nurses Improving Care for Healthsystem Elders 17th Annual Conference Sheraton San Diego Hotel and Marina, Harbor Island San Diego, California Info: 212-992-9422 E-mail: conference@nicheprogram.org Website: www.nicheprogram.org

23-26

Academy of Neonatal Nursing 11th National Advanced Practice Neonatal Nurses Conference Sheraton Waikiki Honolulu, Hawaii Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

The Dermatology Nurses’ Association 32nd Annual Convention: Transforming and Evolving: Believing in Change Walt Disney World Swan and Dolphin Orlando, Florida Info: 800-454-4362 E-mail: dna@dnanurse.org Website: http://2014.dnanurse.org

8-10

American Conference for the Treatment of HIV 8th Annual Conference Sheraton Downtown Hotel Denver, Colorado Info: 540-368-1739 E-mail: ACTHIV@meetingmasters.biz Website: www.ACTHIV.org

17-22

American Association of Critical-Care Nurses The National Teaching Institute & Critical Care Exposition Colorado Convention Center Denver, Colorado Info: 800-899-2226 E-mail: info@aacn.org Website: www.aacn.org

June 5-8

American Holistic Nurses Association 34th Annual Conference: Through the Looking Glass: A Vision of Holistic Leadership Portland Marriott Downtown Waterfront Portland, Oregon Info: 800-278-2462 E-mail: conference@ahna.org Website: www.ahna.org

Are Health Centers the Future?

BY LEIGH PAGE

As millions of uninsured people get coverage under the Affordable Care Act (ACA), job opportunities for registered nurses could open up in the nation’s community health centers because many of the newly insured are expected to go there for care. These facilities, also known as federally qualified health centers (FQHCs), provide primary care in medically underserved areas, regardless of patients’ ability to pay. Teams of physicians, nurse practitioners, registered nurses, and other health care workers treat mostly Medicaid patients and the uninsured.

F

QHCs, the mainstay of the nation’s health care safety net, have been growing by leaps and bounds in the past decade, posting an 80% increase in new jobs. Now a new wave of patients is expected, fueled by the Medicaid expansion and the new health insurance exchanges, where premiums for low-income people are subsidized.

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Planners of the expansion predicted that since many physician practices have limited capacity for new patients, many of these patients would go to FQHCs. Therefore, the ACA set aside billions of dollars in construction funding to help FQHCs expand their facilities so they could handle an onrush of patients.

No one knows, however, how many new patients will

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9

come, and the centers, operating under tight budgets, have been holding off on hiring until they get a better idea.

Also, while FQHCs employ a significant number of RNs, these facilities may not appeal to everyone. Salary levels vary widely, with some facilities paying less than hospitals, and many FQHCs are more interested in health care workers with less training, like licensed practical nurses.

What FQHCs Want Community health centers are looking for nurses who are committed to serving low-

FQHCs, the mainstay of the nation’s health care safety net, have been growing by leaps and bounds in the past decade, posting an 80% increase in new jobs. income people, usually minorities, says Gary Wiltz, MD, chair of the National Association of Community Health Centers.

“The work should be viewed as a calling,” he says. When

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Minority Nurse | WINTER 2014

Wiltz interviews job applicants for his own FQHC, the Teche Action Clinic in southern Louisiana, he says he wants to see compassion. “The patients are disenfranchised, but many of them have jobs and are working very hard,” he notes. “As a provider, you have to be aware of what they are going through.”

Jennifer Fabre, RN, a nurse practitioner at Teche Action, says nurses are paid less than those who work in hospitals or nursing homes. But Community Health Services, an FQHC in Hartford, Connecticut, pays them comparable rates, according to Valerie Tyson, RN, a nurse at the Connecticut facility.

Tyson says working in a FQHC is very different from the hospital med-surg unit where she used to work. “The hospital has people who are very sick, but here the patients have an acute illness or need follow-up care for a chronic illness,” she says. “This is their primary care stop.”

A big part of the job, she explains, is teaching patients to manage chronic conditions.

The RNs also take patients’ calls, routing some of them to doctors or nurse practitio-

ners but taking care of most of them, she adds.

The Connecticut FQHC serves inner-city patients who

ment in America.

This little village is in the heart of the Mississippi Delta, a land of cotton fields that gave birth to the blues. The health center sits on land once owned by the brother of Confederate president Jefferson Davis, Joseph E. Davis, who encouraged “self-leadership” among his slaves, letting them build a “model community.”

After emancipation, Joseph E. Davis’ former slaves spent two decades earning enough money to purchase the land, founding the village in 1887.

Today, Mound Bayou has 687 households and is still almost entirely black. The town came

No one knows, however, how many new patients will come, and the centers, operating under tight budgets, have been holding off on hiring until they get a better idea. are mostly Hispanic and black, some sharing Tyson’s roots in Jamaica. Unlike in the hospital, “you get to know these patients over time,” she says.

“You develop a relationship with them.”

Fabre added that nurses have to understand their patients’ needs. “You do whatever you need to do to help the patient,” she says. “It doesn’t do patients any good if you prescribe a medication for them and they can’t pay for it.”

Roots in the Civil Rights Era FQHCs have a rich history of community service, going back to the Civil Rights era. The oldest rural FQHC, the Delta Health Center, was founded in 1967 in Mound Bayou, Mississippi—the oldest predominantly black settle-

into prominence again in the Civil Rights era of the 1960s, when it caught the eye of H. Jack Geiger, MD, an idealistic Massachusetts physician who wanted to create a new type of health care facility for the poor.

In the 1964 Economic Opportunity Act, the cornerstone of President Lyndon Johnson’s

lion for the centers, mostly for construction, to help them build capacity to meet

Community health centers are looking for nurses who are committed to serving low-income people, usually minorities, says Gary Wiltz, MD, chair of the National Association of Community Health Centers.

“War on Poverty,” Geiger persuaded President Johnson to include $1.2 million for test sites at Mound Bayou and Boston. Envisioning a self-sustaining community, Geiger and his followers not only built a clinic in Mound Bayou but also dug wells and helped residents improve farming methods.

FQHCs have enjoyed a renaissance in the new century, starting with a wave of new federal funding under President George W. Bush. Patient volume grew by 50%, reaching the 15 million mark in 2006.

Under President Obama, the Recovery Act set aside $2 billion in extra funding for FQHCs in 2009, and patient volume then reached 20 million.

The ACA set aside $11 bil-

the coverage expansion. The Delta Health Center received $5 million of this funding, allowing for its first significant expansion since it opened 47 years ago.

The new building will open in February. “We’re going to have brand-new rooms and new equipment,” says Neuaviska Stidhum, RN, the chief operating officer at Delta. “It means we’ll be able to see more patients.”

Centers Holding off on Hiring But even as Delta and many other FQHCs expand, they are holding off on hiring more staff and even, in some cases, opening some of their new projects. Facilities have to be

careful about hiring because the new federal funding does not cover operational expenses. Teche Action Clinic, Wiltz’s FQHC in Louisiana, renovated two new sites using federal money, but it doesn’t have the funds to open them.

Moreover, there are signs that the anticipated onrush of new patients may not be as large as expected. Half of the states, including Mississippi and Louisiana, aren’t participating in the Medicaid expansion. Technical problems with

pacity, so there would be less reason for the newly insured patients to use her FQHC. “We don’t know what we’ll do yet, “said Stidhum when asked about hiring. “Maybe we’ll need more staff, or maybe we’ll just need to shift their duties around.”

The story is different in Connecticut, which has joined the Medicaid expansion and has a very active insurance exchange. Tyson says her Hartford FQHC has put off hiring, but she is optimistic about

Fabre added that nurses have to understand their patients’ needs. “You do whatever you need to do to help the patient,” she says. “It doesn’t do patients any good if you prescribe a medication for them and they can’t pay for it.”

exchange websites are dissuading some people from signing up, and the fine for not obtaining coverage may initially be too low to force some people to buy insurance.

Stidhum adds that many doctors’ offices in the Delta region still have a lot of ca-

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hiring in the future. “The center is really busy,” she says.

“If there are more patients, we would have to hire more nurses.”

Leigh Page is a Chicago-based freelance writer specializing in health care topics.

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11

TOP

25 NURSING

EMPLOYERS

BY ETHAN LACROIX 12

Minority Nurse | WINTER 2014

What makes a company one of the “best” places to work is, of course, highly subjective. For some, a top-notch workplace is all about friendly coworkers and flexible hours; for others, salary and benefits are all that matter.

F

or Minority Nurse’s Best Companies survey, we asked readers to tell us what was most important to them as nursing professionals. Benefits, salary, and opportunity for advancement were among the top factors for our survey respondents, while workplace size was much less important. Magnet recognition wasn’t a primary concern for most readers, but many said they did consider it when looking at potential employers. The majority of the respondents said that their current workplace is not Magnet certified.

In their current jobs, readers were most satisfied with their

workplace environment, workplace size (in terms of the number of employees), and benefits (including retirement funds and health insurance). They were least satisfied with opportunities for advancement, job perks (such as education reimbursement and on-site childcare), and salary. As far as the latter, it’s worth noting that Minority Nurse’s Salary Survey, published in the Spring 2013 issue, found that our readers’ average salaries had increased at a higher rate than inflation in the last five years. Still, many who answered our survey clearly see a need for improvement.

We created our top-25 list by

sending an online questionnaire to Minority Nurse subscribers. We received more than 1,000 responses from across the country. California, New York, Texas, and Florida were the most heavily represented states among survey takers. Rated workplaces were split fairly evenly between large, medium, and small organizations.

Companies that scored well comprise a variety of nursing workplaces, with large metropolitan hospitals and networks—including New York’s North Shore–LIJ Health System, Cedars-Sinai Medical Center in Los Angeles, and Our Lady of the Lake Regional Medical Cen-

ter in Baton Rouge—being the most well-represented. Government agencies (both federal and local) also appear on the list, as well as wide-ranging networks such as Kaiser Permanente and Mayo Clinic. Nonprofit and government entities outweigh for-profit companies on our final list.

The 25 companies listed alphabetically below scored best in terms of correlation between what nurses are looking for and what their employers are offering. Most of these organizations are actively recruiting, and we’ve provided links to job listings for anyone looking to make a change.

Number of Respondents:

1,064 Regions (%)

Organization Type (%)

Organization Size (%)

1% 19% 42%

17%

21%

1% 1%

23%

17% 15%

21%

5%

13%

19%

6%

2%

■ South ■ Northeast ■ Midwest ■ West ■ Other

14%

27%

13% 20%

3%

■ Public hospital, including Veteran’s or Indian Affairs hospitals ■ Private hospital ■ School or university ■ Nursing home or rehabilitation center

■ Home health care service ■ Private practice or physician’s office ■ Military ■ Walk-in clinic ■ Correctional facility ■ Other

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■ 1–100 employees ■ 101–500 employees ■ 501–1,000 employees ■ 1,001–5000 employees ■ 5,001–10,000 employees ■ 10,001 or more employees

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Blue Cross Blue Shield of North Carolina Website: bcbsnc.com Location: Headquarters in Chapel Hill, NC Number of nursing employees: Varies by division (approximately 4,000 total employees) About the company: Part of the Blue Cross Blue Shield Association, BCBS North Carolina provides insurance and medical care for 3.7 million people in North Carolina. Nursing jobs here do not generally involve medical care; nurses are involved with medical review, training, claim resolution, and case management.

Contact: Job listings are available at bcbsnc.com/careers

Carolinas HealthCare System Website: carolinashealthcare.org Location: Headquarters in Charlotte, NC Number of nursing employees: Varies by location (approximately 60,000 total employees) About the company: This sprawling network of facilities throughout North Carolina and South Carolina includes a wide range of medical workplaces, including hospitals, rehabilitation centers, nursing homes, and hospice care. Its Levine Children’s Hospital is ranked as one of the nation’s best pediatric hospitals by U.S. News & World Report Report, and Charlotte Parent Magazine named it one of the area’s “Top 40 Family-Friendly Employers.”

Contact: Job listings are available at careers.carolinashealthcare.org

Cedars-Sinai Website: cedars-sinai.edu Location: Los Angeles, CA Number of nursing employees: Approximately 2,700 About the company: Cedars-Sinai has been a presence in Los Angeles since 1902. The company’s hospital, research facility, and educational center has a patient base of more than 16,000, and it’s nationally ranked in several specialties, including cardiology, gastroenterology, and orthopedics. More heart transplants are performed here annually than at any other facility in the world.

Contact: Job listings are available at cedars-sinai.edu/careers

DaVita Website: davita.com Location: Headquarters in Denver, CO Number of nursing employees: Varies by location (approximately 53,000 total employees) About the company: In 1999, this kidney-care company was known as Total Renal Care; it was rechristened DaVita—”giving life” in Italian—by its employees. Today, DaVita operates more than 2,000 outpatient dialysis centers in the US, offering medical services as well as counseling, education, and prescription management. It’s ranked No. 311 on the Fortune 500, and has racked up a number of accolades for its community outreach efforts, environmental sustainability programs, and workplace benefits.

Contact: Job listings are available at careers.davita.com

Fresenius Medical Care North America Website: fmcna.com Location: Headquarters in Waltham, MA Number of nursing employees: Varies by division (55,000 total employees in the US) About the company: The North American branch of the German medical company Fresenius focuses on renal care, with operations devoted to pharmaceuticals, manufacturing, research, and patient care. It operates more than 2,100 dialysis centers throughout the continent, and it was named one of Forbes’ 100 Most Innovative Companies in 2013. Nursing staff is employed primarily in its medical Forbes’ services, vascular care, and traveling nurse divisions.

Contact: Job listings are available at jobs.fmcna.com

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Howard University Hospital Website: huhealthcare.com Location: Washington, DC Number of nursing employees: Approximately 500 About the company: This comprehensive medical care facility was founded in 1862 as Freedman’s Hospital, which provided medical care for freed slaves who had been denied elsewhere. Today, it’s housed in a former army barracks on the campus of the historically black Howard University, and offers a wide variety of services and specialties, and includes a Level 1 trauma center.

Contact: Job listings are available at huh.ugbk.com/hr/careers

Indiana University Health Website: iuhealth.org Location: Facilities throughout Indiana Number of nursing employees: Varies by facility (36,000 total employees) About the company: Indiana University Health is a network of hospitals and other facilities throughout Indiana affiliated with the Indiana University School of Medicine. Last year, IUH had more than 2.5 million outpatient visits and over 144,000 admissions. Its facilities have been nationally ranked

by U.S. News & World Report in several specialties, including cancer, neurology, and orthopedics.

Contact: Job listings are available at iuhealth.org/careers/nursing-careers

Kaiser Permanente Website: healthy.kaiserpermanente.org Location: Headquarters in Oakland, CA, with facilities in California, Colorado, Georgia, Hawaii, Oregon, Washington, Virginia, Maryland, Ohio, and Washington, DC Number of nursing employees: Varies by facility (approximately 180,000 total employees) About the company: Founded in 1945, Kaiser Permanente operates more than 600 interconnected but independently managed medical facilities in the US. One respondent to our survey praised Kaiser Permanente’s “strong promotion of diversity, [including] gender, sexuality, race, and religion.”

Contact: Job listings are available at kaiserpermanentejobs.org

Los Angeles County Department of Health Services Website: dhs.lacounty.gov Location: Los Angeles County, CA Number of nursing employees: Varies by facility About the company: Los Angeles County Department of Health Services is the second-largest municipal health care system in the country. It operates in the most populous county in the US, and provides medical care and services to approximately 800,000 patients annually at several hospitals and other medical centers.

Contact: Job listings are available at hr.lacounty.gov

Maimonides Medical Center Website: maimonidesmed.org Location: Brooklyn, NY Number of nursing employees: Approximately 1,400 About the company: More than half of the people living in the communities served by this New York City hospital are foreign-born, and the hospital prides itself on its cultural diversity—more than 70 languages are spoken by the staff. In 2011, Maimonides opened a facility devoted entirely to breast cancer treatment, and its Heart & Vascular Center underwent a recent major renovation and expansion.

Contact: Job listings are available at maimonidesmed.org/main/CareerOpportunities.aspx

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Mayo Clinic Website: mayoclinic.org Location: Headquarters in Rochester, MN, with additional facilities throughout the US, including large centers in Jacksonville, FL, and Phoenix, AZ Number of nursing employees: Varies by facility (approximately 42,000 employees at its main facilities) About the company: Founded in 1889, the Mayo Clinic medical practice and research organization is widely regarded as one of the best hospital systems in the country. Its Rochester campus came in at No. 3 out of 4,793 institutions considered in the 2013 U.S. News & World Report Best Hospitals rankings, and it has remained near the top of that list for more than 20 years.

Contact: Job listings are available at mayoclinic.org/jobs

Memorial Hermann–Texas Medical Center Website: memorialhermann.org Location: Houston, TX Number of nursing employees: Approximately 1,500 About the company: This renowned teaching hospital (affiliated with the University of Texas Health Science Center at Houston Medical School) is the oldest institution in the massive Texas Medical Center, and the flagship hospital in the vast Memorial Hermann network throughout Texas. Its Level 1 trauma center sees more than 40,000 patients annually, and its Children’s Hospital is one of the top-ranked pediatric facilities nationwide.

Contact: Job listings are available at memorialhermann.org/careers

Montefiore Medical Center Website: montefiore.org Location: Bronx, NY Number of nursing employees: Approximately 3,000 About the company: This teaching hospital, associated with the Albert Einstein College of Medicine, is one of the largest employers in New York City and has won several local and national awards, including being nationally ranked for three specialties in U.S. News & World Report’s Best Hospitals guide.

Contact: Job listings are available at montefiore.org/careers

Mount Sinai Health System Website: mountsinai.org Location: New York, NY Number of nursing employees: Varies by facility (36,000 total employees) About the company: In 2013, two major NYC medical institutions—Continuum

Health Partners and Mount Sinai Medical Center—merged to form this massive network, which is now the largest nongovernment employer in New York. It includes seven major hospitals (Beth Israel Medical Center, Beth Israel Brooklyn, the Mount Sinai Hospital, Mount Sinai Queens, New York Eye and Ear Infirmary, Roosevelt Hospital, and St. Luke’s Hospital) as well as more than 400 ambulatory care units and other medical facilities spread across New York City. Mount Sinai also includes the Center for Nursing Research and Education, one of the nation’s few nursing centers established within a medical school.

Contact: Job listings are available at mountsinai.org/careers

NewYork–Presbyterian Hospital Website: nyp.org Location: New York, NY Number of nursing employees: Approximately 5,000 About the company: This New York City institution is affiliated with two Ivy League universities, Columbia and Weill Cornell. It’s one of the largest hospitals in the US, and is widely regarded as one of the best—it’s ranked seventh overall in U.S. News & World Report’s Best Hospitals survey. In addition to its two main campuses in Manhattan, the Columbia University Medical Center and the Weill Cornell Medical Center, NewYork–Presbyterian also operates the Allen Hospital, Morgan Stanley Children’s Hospital, and a Westchester County division. In July 2013, NewYork–Presbyterian expanded its reach when it merged with New York Downtown hospital, establishing the Lower Manhattan Hospital.

Contact: Job listings are available at careers.nyp.org

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North Shore–LIJ Health System Website: northshorelij.com Location: Headquarters in Great Neck, NY Number of nursing employees: Varies by facility (approximately 46,000 total employees) About the company: The North Shore–LIJ Health System was established in 1997 with the integration of the North Shore Health System and Long Island Jewish Medical Center. Today, it’s the largest health care system in New York in terms of patient revenue. It includes 16 hospitals throughout Long Island and New York City, as well as three skilled nursing facilities and nearly 400 ambulatory and physician practices. The network has nursing school affiliations with 15 colleges and universities.

Contact: Job listings are available at nslijcareers.com

Orlando Health Website: orlandohealth.com Location: Orlando, FL Number of nursing employees: Varies by facility (approximately 14,000 total employees) About the company: This private, not-for-profit hospital network provides health care and medical services for 1.6 million central Florida residents and thousands of visitors annually. Its main campus consists of the Orlando Regional Medical Center, Arnold Palmer Hospital for Children, Winnie Palmer Hospital for Women and Babies, and MD Anderson Cancer Center Orlando.

Contact: Job listings are available at jobsatorlandohealth.com

Our Lady of the Lake Regional Medical Center Website: ololrmc.com Location: Baton Rouge, LA Number of nursing employees: Approximately 1,000 About the company: A Catholic teaching hospital established 90 years ago, OLOL is one of the largest privately owned hospitals in Louisiana, as well as the largest of four hospitals in the Franciscan Missionaries of Our Lady Health System. Today, it serves 11 parishes and has 700 licensed beds.

Contact: Job listings are available at ololrmc.com/greatplacetowork

University of Michigan Health System Website: med.umich.edu Location: Headquarters in Ann Arbor, MI Number of nursing employees: Approximately 4,700 About the company: This integrated health care system located in southern Michigan comprises three hospitals (University Hospital, C.S. Mott Children’s Hospital, and Von Voigtlander Women’s Hospital), 40 outpatient centers and more than 120 clinics, and a large home health care division. It also includes the University of Michigan’s Medical School and School of Nursing, and it partners with other medical centers throughout the state via the Michigan Health Corporation. The Detroit Free Press has named UMHS one of the “101 Best and Brightest Companies to Work For.” Contact: Job listings are available at umhscareers.org

University of Pittsburgh Medical Center Website: upmc.com Location: Headquarters in Pittsburgh, PA Number of nursing employees: Varies by facility (approximately 54,000 total employees) About the company: UPMC is a network of more than 20 hospitals and 400 outpatient facilities affiliated with the University of Pittsburgh Schools of the Health Sciences. With more than 50,000 total employees and $10 billion in operating revenue, it’s one of the largest employers in Pennsylvania. In addition to offering medical care, UPMC covers 2.2 million members through its Insurance Services Division.

Contact: Job listings are available at upmc.com/careers

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US Department of Veterans Affairs Website: va.gov Location: Headquarters in Washington, DC, with facilities throughout the United States Number of nursing employees: Varies by facility (approximately 278,000 total employees) About the company: The US Department of Veterans Affairs was established in 1930, consolidating several agencies that provided services to veterans of American conflicts. Today, the Veterans Health Administration, the wing of the VA focused on health care, operates 171 medical centers as well as dozens of outpatient clinics, nursing homes, and other facilities.

Contact: Job listings are available at vacareers.va.gov

Vanderbilt University Medical Center Website: vanderbilthealth.com Location: Nashville, TN Number of nursing employees: Varies by facility (approximately 14,000 total employees) About the company: This organization contains several hospitals and clinics, as well as Vanderbilt University’s School of Medicine and School of Nursing. Vanderbilt has been well-ranked in the U.S. News & World Report Best Hospitals surveys, and Vanderbilt University was once named one of Forbes’ “100 Best Companies to Work For” (more than 80% of Vanderbilt’s employees work at the Medical Center). In 2013, VUMC sought to offset losses in government and insurance reimbursements with a hiring freeze, which resulted in the loss of 700 positions, as well as an additional 1,000 layoffs—affecting all areas of operations—by the end of the year. Still, at press time, there were several full- and part-time open nursing positions advertised on the hospital’s website.

Contact: Job listings are available at vanderbilt.edu/work-at-vanderbilt

Vidant Health Website: vidanthealth.com Location: Headquarters in Greenville, NC Number of nursing employees: Varies by facility (approximately 9,300 total employees) About the company: Vidant Health (formerly University Health Systems of Eastern Carolina)

is a nonprofit system of nine hospitals and other facilities located throughout eastern North Carolina. It’s one of the state’s largest employers, and it serves more than 1.4 million people.

Contact: Job listings are available at vidanthealth.com/jobs

Visiting Nurse Service of New York Website: vnsny.org Location: New York Metropolitan Area Number of nursing employees: Approximately 2,500 About the company: Lillian Wald started the Visiting Nurse Service of New York in 1893 in Manhattan’s impoverished Lower East Side neighborhood. Today, the organization she founded is the largest not-for-profit home health care agency in the country. The VSNY operates and has offices in all five boroughs of New York City, as well as nearby Westchester, Suffolk, and Nassau counties.

Contact: Job listings are available at vnsny.org/careers

Walgreens Healthcare Clinic Website: walgreens.com Location: Locations throughout the country Number of nursing employees: Varies by location About the company: Walgreens Healthcare Clinic (formerly Take Care Health Services) is a convenient care clinic—a rapidly expanding job market—which operates inside Walgreens stores around the country. Clinics provide preventative care, including physical exams, vaccines, and health screenings.

Contact: Job listings are available at takecarejobs.com

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Minority Nurse | WINTER 2014

Crash Course in Hospital

Disaster Planning and Response for Nurses

BY JEBRA TURNER

A spate of disasters this past decade, including Hurricane Katrina and the Boston Marathon bombing, have shown us as a nation just how vulnerable our health care facilities can be. We’re not as naïve as we were in the pre-September 11th days—and we are learning from each and every disaster. Make sure your hospital, clinic, or other care facility is prepared in case of an emergency so that you can protect patients, staff, and the physical building itself.

T

he majority of a hospital’s staff is nurses, so hospital disaster planning necessarily involves nurses. Minority populations tend to be hardest hit by disasters—we saw that with Katrina. They were the ones less likely to be able to evacuate.

Hospitals must plan for people who speak a different language or persons with different cultural backgrounds and religious beliefs. Follow these steps so you’ll be prepared for expected emergencies (e.g., power out-

ages), the horribly unexpected (e.g., bioterrorist attacks), and everything in between. Best of all, in planning for disasters at your clinical workplace, you also take steps to safeguard yourself, your family, and your wider community.

Step 1: Your hospital has devised an emergency operations/management plan.

Learn it. In order to meet hospital certification/accreditation requirements and myriad federal, state, and local regulations, management has to have emer-

gency plans and procedures on file. In addition, they must keep evacuation equipment on hand and enough generators, portable ventilators, and food and water to last for three days without access to outside resources.

For example, natural disasters (severe weather patterns, such as a storm system) and human-made disasters (such as an accidental or deliberate airplane crash) may be deemed top risks by a certain health care facility. But that organization also has to be prepared for

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common and ordinary events, such as a building fire, which is the number one reason for a hospital evacuation.

Nurses need to learn all they can about their hospital’s response plan, advises Jacquelyn Nally, RN, BSN, an emergency preparedness HAZMAT program coordinator at Massachusetts General Hospital and an emergency department staff nurse at Newton Wellesley Hospital.

Most hospitals put their emergency plan on an Intranet for staff members, but you can

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Influenza Common but Deadly Epidemics and Pandemics Biohazards may present a dramatic threat, but ordinary and recurring threats, like a particularly nasty flu season, also knock us for a loop. Resources wear out (including medical personnel) when a state of emergency drags on long enough.

Paul Biddinger, MD, attending physician at Paul Biddinger, MD the Massachusetts General Hospital Department of Emergency Medicine, experienced just that when Boston declared a public health emergency in January 2013 after 700 flu diagnoses and four deaths.

“Flu does happen every year, and its distribution seems to be inherently unfair to a lot of at-risk communities,” he says, noting that in the H1N1 epidemic there were more cases among Hispanic and African American patients. “Whether it’s communities with economic disparities, or more limited access to health care or health communication, there’s a chance minorities will suffer disproportionately from these threats.”

Plus, influenza is unpredictable and frequently changing so there’s no way to know how any one flu season will play out. “If the virus changes in a major way, that’s what causes a pandemic,” says Biddinger, citing H7N9 as possibly the greatest current influenza emerging threat. “We haven’t seen sustained in human-to-human transmission of H7N9 influenza right now, but if it ever became possible, the consequences could be deadly, especially to the elderly, those with a compromised immune system, and pregnant women.”

Infectious disease may be transmitted via different mechanisms, whether contact, droplet, or airborne, says Biddinger.

Since there are a variety of potential threats with different modes of transmission, institutions must stress good prevention and control practices at all times. In case of a full-blown epidemic, personal protective gear is a must. “When SARS was active in China, some clinical staff put masks and other appropriate personal protective equipment on, but some didn’t put them on or take them off correctly, and they became exposed to the disease,” recalls Biddinger. “You have to take it seriously.”

Another significant potential threat is MERS, which stands for Middle East Respiratory Syndrome, he adds. “It’s similar to the virus that causes SARS, but it developed in the Middle East. Because of global travel, it is possible that there could be a case here at any time. In our hospital, nurses are trained to get a travel history of anyone who comes in with fever or symptoms to start the right kinds of precautions, to protect our patients and themselves.”

For more information, visit www.flu.gov.

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also get more details at a new employee orientation or at a regular staff meeting. “Nurses should ask many questions about the plan, such as: ‘Who will be in charge during an incident?,’ ‘What’s my role if we have an evacuation?,’ ‘What’s my role if there’s a mass casualty?,’ ‘What equipment will be used in these various scenarios?,’ [and] ‘What other resources might be available to me then?,’” explains Nally.

Examples of logistical matters that nurses need to be aware of—and which aren’t usually covered in school—are how to protect patients during a disaster. Your hospital plan may have a designated safe location for tornado or other severe weather conditions on the lowest floor in a windowless interior space. Nurses should also know how to operate equipment in case the power goes out. (For instance, certain outlets are connected to the hospital’s emergency power supply.)

ments is to continue learning more and to take every opportunity to practice your disaster response. The Department of Homeland Security (www.dhs. gov) offers free online courses for clinicians. The Institute of Medicine (http://iom.edu) also has a helpful toolkit for hospital disaster planning.

As part of your continuing education, you can go to FEMA’s website (www.fema.gov) and take the Introduction to the Incident Command System for Healthcare/Hospitals online course (IS-100.HC). It will help you understand how your hospital uses the incident command system. Most large hospitals have coalitions of local (hospital), state, and federal agencies.

“Request unit-based training from your educator or clinical specialist or nurse manager,” says Nally. “The Joint Commission [on Accreditation of Healthcare Organizations] requires hospitals to have drills,

The key for nurses in all settings and departments is to continue learning more and to take every opportunity to practice your disaster response.

Of course, you’ll need to avoid elevators during a power outage or in the event of a fire.

Once familiar with the hospital’s existing plan and procedures, you have an opportunity to influence it by participating on a hospital planning committee. Nurses are a critical part of a hospital’s emergency response team so their involvement in the process is vital.

Step 2: Pump up your knowledge and skills for handling hazards. The key for nurses in all settings and depart-

so participate when you’re able to in drills and other exercises, like tabletop discussions with fire, police, and health care workers. Volunteer to act as a victim or clinical participant in a training exercise. Your goal is to protect your patients, yourself, other staff members, or the facility.”

One thing that may change during an emergency is the chain of command. “Know who to take direction from. Don’t just go off and do your own thing. Take direction from your

“We’ve made leaps and bounds over the past few years.

It’s been thrilling in my position to see that, but we can’t say we’re there yet—we don’t know where there is.”

—Cheri Hummel, VP, Disaster Preparedness, California Hospital Association

Cheri Hummel, VP, Disaster Preparedness, California Hospital Association

nurse manager or the unit leader in charge,” says Nally. “That individual gets direction and information pushed down to the unit, and they feed information and needs back up that chain of command. So there aren’t 10 nurses from one unit calling the president of the hospital.”

Repeated drills and exercises allow nurses to perform their jobs during a disaster without missing a step. You may want to get more training and experience (while helping victims of disasters around the world) by signing up for the Nurse Volunteer Corps and volunteering through the Medical Reserve Corps Network.

Step 3: Make sure your personal and family disaster plan is in place. “When Hurricane Katrina hit, I was called in the middle of the night and had to be ready to go—but I had a nine- and an eleven-year-old at home,” remembers Mary Massey, BSN, MA, PHN, hospital preparedness coordinator at the California Hospital Association’s Hospital Preparedness Program. “My family is my life, so I wasn’t leaving until my family was taken care of.”

Thankfully, Massey had already arranged for childcare

and household back-up so she could deploy to Biloxi, Mississippi, quickly. “At home, I always have my ‘go bag’ packed with two weeks of stuff, including food that I regularly replace as it expires,” she explains.

Nurses will have different plans depending on their dependents, which may go beyond family and pets, “to the lady down the street who you get medicine for,” she adds.

The American Red Cross has incredible programs for individuals and families that nurses can access (www.redcross.org/pre-

pare). “You can register ahead of time so that your family or other loved ones (and only those people) can call them to see if you’re okay during a disaster,” says Massey. “The Centers for Disease Control and Prevention’s website [emergency.cdc. gov] also has resources for clinicians, and the general public and even one for kids.” The Ready.gov website, by the US Department of Homeland Security, is another good resource.

Step 4: Acknowledge that we’ve come a long way as a nation in our response to haz-

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ards and incidents. Probably the toughest decision hospital management has to make is when to evacuate. “Hospitals must treat patients, protect staff and visitors, and they can’t evacuate in an emergency like a school can,” says Cheri Hummel, vice president of disaster preparedness at the California Hospital Association.

Possibly no city knows that better than New Orleans, which suffered the devastation of Hurricane Katrina, necessitating the evacuation of hospitals in addition to the area’s populace.

Knox Andress, RN, BA, ADN, FAEN, designated regional coordinator for Louisiana’s Region 7 Hospital Preparedness Coalition, served as Incident Commander during both Hurricanes Katrina and Rita.

“We’ve made plans for evacuating the coast of Louisiana,”

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trina and Rita did three years before, but our response was as different as night and day,”

Hummel about the medical center’s successful evacuation of some 300 patients from its 700-

Repeated drills and exercises allow nurses to perform their jobs during a disaster without missing a step.

Jacquelyn Nally, RN, BSN, in a medical field hospital in Haiti one week after the earthquake in 2010

says Andress. “To exercise those plans, we enact simulated patient evacuation—putting mannequins in planes, then tracking them, and triaging those ‘patients,’ moving them from hospitals in New Orleans and

at-risk locations to safer areas.”

All that planning and drilling paid off in 2008 when Hurricanes Gustav and Ike hit the Louisiana Gulf, only three weeks apart. “They came at us just like Hurricanes Ka-

says Andress. “In Katrina, 13 hospitals evacuated pre-storm landfall and 26 evacuated poststorm. During Gustav, a full 63 hospitals evacuated pre-storm landfall and only 10 evacuated post-storm.”

With each and every disaster, we become better prepared to evacuate patients safely. In 2012, when Superstorm Sandy hit the coast of New York and New Jersey, medical personnel performed heroically as hospitals activated their emergency preparedness plans. “We commend NYU Langone,” says

bed facility. “They didn’t lose any patients or have any significant injuries. They were able to get critical patients distributed to other hospitals. We’ve made leaps and bounds over the past few years. It’s been thrilling in my position to see that, but we can’t say we’re there yet—we don’t know where there is.”

Jebra Turner is a freelance health and business writer based in Portland, Oregon. She frequently contributes to the Minority Nurse magazine and website. Visit her online at www.jebra.com.

Disaster Planning Tips NURSING OPPORTUNITIES The University of Connecticut Health Center is a leading healthcare, educational and research facility offering challenging nursing positions in all specialty patient care areas as well as Case Management, Nursing Informatics, and Outpatient Services. We are an equal opportunity employer with a strong commitment to diversity and provide: • Competitive Benefits

• Competitive Salaries

• Upward Mobility

• Excellent Training

Department of Human Resources 16 Munson Road Farmington, CT 06034-4035

860.679.2426 phone 860.679.1051 fax

For a complete listing of all open jobs visit our website:

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Minority Nurse | WINTER 2014

1. During an earthquake, it’s easier to call out of state than in-state. “In my family, we all know to call our relatives in Iowa,” she says.

2. Plan to improvise essentials, such as food and shelter. “We’ll put up our tents outside and cook on Bar-B-Ques,” seniors told Massey when she spoke at a retirement center about preparedness.

3. Keep a big box of diaper wipes on hand. “They’re useful for so many things when you don’t have water, like cleaning hands and washing dishes,” she explains.

4. Stow a pair of old tennis shoes in your car. “They’re handy if a road is washed out or you have to wait for AAA,” she says.

www.uchc.edu Affirmative Action /Equal Opportunity Employer

Here are a few personal and family tips from Mary Massey, based on her extensive experience:

KNOW BETTER CARE

The Generational Shift How to Manage Different Generations in the Workforce

BY ROBIN FARMER

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With four generations of nurses working side by side in hospitals—each with different strengths and approaches—how can nurse leaders promote intergenerational harmony? By understanding the values of each group, connecting a diverse staff to a common vision, and customizing leadership style, nursing experts say.

T

he four generations populating the workforce include the traditionalists or veterans, who were born before or during World War II (1925-1945); the baby boomers (1946-1964); the Gen Xers (1965-1980); and, Generation Y, also known as the Millennials (1981-2000).

One of the biggest differences between each group revolves around communication styles, says Rose O. Sherman, RN, NEA-BC, FAAN, professor and director of the Nursing Leadership Institute at Christine E. Lynn College of Nursing at Florida Atlantic University.

“I do a lot of research with nurse leaders, and it is communication that is presenting them with problems. The average nurse manager has 60plus people to supervise, and there will be a cross-generational workforce” and leaders must make adjustments, says Sherman. “That same type of communication will not work

for every generation.”

For example, veterans and boomers enjoy getting information through memos,

The generations differ with their attitudes about job expectations and life-work balance, experts say. phone calls, and staff meetings. These nurses prefer face-to-face communication and may appear too talkative to younger co-workers. Vets and boomers “have long preambles. When they want to tell you something they want to give you background. . . they want to make sure you understand the background story,” says Kelley Arllen, RN, MSN, CCCE, staff development/childbirth education, Department of Education and Research at the Virginia Hos-

pital Center. “It’s important to listen to that and not just pooh-pooh it and say, ‘What’s your point?’”

Tension occurs since “Gen X and Y, to an extent, speak bluntly and quickly. They want to be very to the point, so that makes it hard for them sometimes to listen to the preamble. The vets and boomers think they are blunt and rude people, so there can be a disconnect there,” Arllen continues.

Millennials, who have grown up “attached to their smartphone devices” want communication short, to the point, and they want the communication loop closed, says

Sherman. “They don’t want to sit at endless meetings where processes are being discussed and there doesn’t appear to be any outcomes.”

They like texting and social media as their primary form of communication versus email and face-to-face discussions. Savvy nurse managers are learning no one-size-fitsall approach exists and they will have to communicate differently and in a way that is meaningful to each age group.

“I read somewhere. . . about a communication timeline,” says Arllen. “If a veteran asks you a question, they need an answer within a week. If a boomer asks you a question, they need an answer within a few days. If Gen X asks, they will wait for a response for about 24 hours. For Gen Y, they need a response immediately. I think part of that is we used to write letters, then we did more with telephone calls, and then e-mail, and now it’s texting.”

The first building block to successfully managing a multigenerational workforce requires leadership to respect the differences between the generations and embrace a belief that diversity in the workplace is good.

The Millennials’ preference for informal communication may come at a price, argues Beth A. Smith, MSN, RN, director of the Nurse Residency Program at Penn Medicine, who works with many new nurses.

“I think there’s a need for development with interpersonal skill development. I sense in the Millennial generation a general unease about how to communicate with physicians,

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patients, and family members,” says Smith, who is also a nursing professional development specialist at the Hospital of the University of Pennsylvania.

The generations differ with their attitudes about job expectations and life-work balance, experts say. Some of that

that diversity in the workplace is good. Other major components include a willingness to change one’s leadership style and a drive to bring people together by looking for common ground.

“In a health care setting, everyone on the team can agree

Another strategy for managing a four-generation staff is to customize rewards, incentives, and career development to appeal to each different generation.

may reflect different generations being at different stages in their careers. For example, the vets and boomers are more interested in career stability compared to Gen X and Y. The youngest nurses are more interested in being coached and mentored and having a healthy personal life.

Life-work balance wasn’t important to boomers who were so grounded in their jobs that they sometimes were extreme with their allegiance, says Sherman. But Gen X and Y “are really interested in having work-life balance and that will impact their decisions about different jobs they take.”

The concept of loyalty to an organization is also changing for every generational group after massive corporate layoffs.

Nurses of all ages “don’t feel like organizations have been loyal to them. Gen Y tends to be more loyal to the teams and managers they work for than the organization they work for,” explains Sherman.

The first building block to successfully managing a multigenerational workforce requires leadership to respect the differences between the generations and embrace a belief

the reason they are there is to support the patient and family,” says Sherman. “We might have differences on how that is best managed, but we all want to see the same outcomes.”

Creating an inclusive governance structure also matters.

Invite nurses from each generation to the table for decisionmaking, says Smith. Another strategy for managing a fourgeneration staff is to customize rewards, incentives, and career development to appeal to each different generation.

Leaders must find a way to define and create a common language and culture. All generations have a defined work ethic and a desire for respect and recognition, but it looks different for each generation, says Arllen, who recommends two books on the topic: The Nurse Manager’s Guide to an Intergenerational Workforce and Managing the Generation Mix. Arllen suggests that teams come up with representatives from each generation to answer a series of questions that will reflect differences, such as: “What does coming to work on time mean?,” “Does it mean starting at 7 a.m., or does it mean you are ready to

work at 7?,” “What does business- causal mean?,” and “Are flip flops and sleeveless tops okay because that’s what Generation X is going to wear, or did you have slacks and sweat-

but you are realizing that your team can be more than the generational things and work together,” Arllen says.

Smith agrees. “If you can create a dialogue and al-

A Snapshot of Each Generation Veterans have a historical perspective and value organizational loyalty and authority.

Boomers are great mentors with a strong work ethic and are steadfast.

Generation X members are independent and focused on outcomes.

Generation Y members are technologically savvy, civic-minded, and less loyal to corporate culture.

ers in mind?” Other possible topics could include cursing at work or bringing food into a meeting. Build on common values and make sure the team figures out how the group is going to communicate.

Once these things are in place, focus on the mission and review it regularly. Then “you will have a better cohesion because you are including the generational things,

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low their strengths to come through, you will clearly impact workplace satisfaction,” she says. “You will impact retention, which has a financial component to any organization, and you will impact productivity.”

Robin Farmer is a freelance writer based in Virginia.

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Honoring Religious

Practices

BY JULIA QUINN-SZCESUIL

When Maria Krol, DNP(c), MSN, RNC-NIC, a professor in Southern Connecticut State University’s nursing program, talks to her students about religious traditions, she gives them this concise advice: “I tell them check ‘I wouldn’t do that!’ at the door.”

K

rol’s point echoes what many experts say when thinking of the delicate and critically important intersection of religious beliefs and medical practices. No matter your own beliefs or your own understanding of what will make a patient’s health better, each patient has to be able to live with their choices, says Krol.

And while nurses need to have an understanding of the impact religion can have on a patient’s approach to medical instructions, they do not necessarily have to become experts in world religions to be effective.

“How they interpret practices is in some sense irrelevant to

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nursing,” says Marsha Fowler, co-author of Religion, Religious Ethics and Nursing, and professor of spirituality and ethics for the Haggard School of Theology at Azusa Pacific University in Azusa, California. Patients, even those within very specific traditions of one faith, can still have varying practices and beliefs. “What they share is how traditions define their health care and influence their choices,” says Fowler. “Interpretation of one’s own traditions is widely divergent.”

If you are unsure of a patient’s preferences and wishes, just ask, says Fowler. “At the heart of nursing is relationships,” she says. “At the heart of religion is relationships.”

“In this day and age, it is not politically correct to talk about religious beliefs,” says Barbara Head, president of the Hospice and Palliative Nurses Association, and assistant professor in the interdisciplinary program for palliative care and chronic illness at the University of Louisville School of Medicine.

“But as a nurse, you have to ask about those beliefs.” And realize that even those who don’t align with a particular faith may still hold significant beliefs. “Think of spirituality before you drill down to religion,” she says.

“Everyone is spiritual. There

showed that 83% of respondents were open to discussing their religious beliefs and spirituality with medical staff at least in some circumstances. Patients reported wanting physicians to understand their beliefs and use that knowledge to help guide their approach and interactions. Some said they thought if caregivers understood their religious beliefs, they would gain a better understanding of the patient and how he or she makes decisions.

Most experts say nurses should have a general understanding of the major faiths of

And while nurses need to have an understanding of the impact religion can have on a patient’s approach to medical instructions, they do not necessarily have to become experts in world religions to be effective. are very spiritual people who don’t go to church.”

A 2004 study published in the Annals of Family Medicine

the population they treat, but should not be as concerned with understanding the practices as they are with under-

Of course, be mindful of any information that could cause discomfort. For instance, some faiths strongly believe in same-sex caregivers. Muslim

who wants to feel more comfortable dealing with religious topics. “Encourage people to talk, ask open-ended questions, and be a good listener,” she

Most experts say nurses should have a general understanding of the major faiths of the population they treat, but should not be as concerned with understanding the practices as they are with understanding how the patient interprets those practices.

standing how the patient interprets those practices. “You need to know how religion functions and how religious traditions define health, care for the self, and care for the stranger,” says Fowler. “It is how their religious faith informs the ways they do or do not care for themselves during times of illness.”

And in many cases, nurses may find that most religions set aside many guidelines and regulations in instances of illness, says Fowler. In Judaism, she says, 610 of 613 religious laws can be set aside in case of illness—only idolatry, murder, and adultery cannot. But patients may want to adhere to certain traditions because those practices give them comfort.

“If a patient has eaten a particular way all his or her life, the need to adhere to it may not be a matter of religious faith but a not wanting to change the diet when ill,” she says.

Nickie Burney, NP, a recent graduate of the Simmons

School of Nursing and a nurse practitioner on the inpatient general medicine ward at Brigham and Women’s Faulkner Hospital in Boston, says sometimes patients are looking for reassurance before they open up to you. “Patients want to talk about themselves and how they treat a problem, and how their families react,” she says.

“If you don’t give them space to understand their practices, you are shutting them down.

Let them tell you that.”

One of the best ways to help patients who rely on faith and spiritual practices is to ensure a continuity of care throughout all the nursing staff and shifts. Nancy Beck, a nurse in a progressive care unit at a Columbia, Missouri, hospital, says reporting details from nurse to nurse keeps information from getting lost. If you can do this in front of the patients and the family, the result is that much better. “It relieves a lot of stress on the family when it is shared openly,” says Beck.

patients who may need time to pray five times a day will appreciate it if procedures are not scheduled during those times. Some religious holidays require fasting, sometimes for hours at a time.

“Communication is the key,” says Krol. “You can’t assume they know something is important.” A diabetic cannot go a whole day without food, so Krol says finding a modification of the practice that will work and be acceptable to the patient is crucial. You can give all the instructions you want, she says, but if the plan is something that the patient is not willing to live with, followthrough will be poor.

advises. Questions like “How does your spirituality impact your coping?,” “How important is spirituality and religion to you?,” and “What do you rely on in times of need?” can help you understand your patient’s needs.

Burney also advises listening carefully to other clues that may be faith-based. Discussions about foods or medicines they have used might give you more insight to their practices if you just ask about them. “I just tell them I have never heard of that and ask them what is that and what does that do,” she says. “You have to ask people what is going on.”

Advice for New Nurses

Finding Your Own Comfort Level

Even if a nursing school offers a general overview course in world religions, the nuances of religious practice and belief are something you can only get by interacting with each patient. Hopefully, a nursing student learns a little amid the science-packed nursing curriculum, says Head. But it really takes time with patients and the guidance of a mentor for a nurse to gain comfortable footing on such an oftenintangible subject.

Head’s advice for new nurses is also helpful for any nurse

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Nurses know their jobs bring them in contact with people in crisis who may be asking themselves and their caretakers tough questions. Patients might even ask you to pray with them or might inquire about your own religious beliefs. How comfortable are you with that?

“Nurses help people and tend to think they have to fix a problem and do something,” says Head. “There is no fix for spiritual questions.” And even when patients ask difficult questions

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like “What will happen after I die?,” Head says they are not looking for an answer. “They are asking to be heard. Even if you give an answer, it might not work for them.”

Nurses don’t have to solve everyone’s problems, and for issues they find uncomfortable or unable to answer appropriately, they should always remember to call on the leaders of the patient’s faith, whether that is a chaplain, rabbi, shaman, or whomever the patient prefers.

Sometimes, especially if a nurse is going through a personal crisis, spiritual discussions with patients can be uncomfortable. While many experiences in a nurse’s life can help others and be meaningful to them, assumptions about religion have to be set aside.

That can be challenging for a nurse, but it is important for the patient.

you are not comfortable participating but that you will call the chaplain for them.

“It is about taking a deep breath and being centered and confident in who I am,” says Beck. “My recommendation is to get clear on your beliefs and to know what is your truth.”

Nurses certainly don’t come to this realization without some reflection and some thought, but if they can take the time to do so, they will end up in a much more comfortable place.

Beck says she knows when most patients ask her about her beliefs, it comes from a place of caring.

Paths A nurse’s responsibility is to make sure patients have enough information to make an informed choice about their own health care. “Once they are given that information,

One of the best ways to help patients who rely on faith and spiritual practices is to ensure a continuity of care throughout all the nursing staff and shifts.

“If a nurse is uncomfortable with that, he or she probably needs to do a little work in that area,” says Head. “There needs to be a self-awareness that there is that discomfort. They can read books or speak with a counselor or spiritual mentor.”

If you are comfortable with other religions and participating in some way, you can say to the patient, “You pray and I will pray with you,” advises Head. You can ask them for their words of prayer if you want. Some nurses prefer not to pray in another faith. That is fine, says Head, just let the patients know that while you respect and honor their beliefs,

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then we support their choice, even if it may not be our choice,” says Head. Especially in palliative care, choices about treatment are very personal.

If the choices stir up feelings in the nurse, it risks shifting

the focus of the conversation from the patient to the nurse.

“Without even realizing it, I

other groups?); and Address in care (What can be done to help you get your religious and

Even if a nursing school offers a general overview course in world religions, the nuances of religious practice and belief are something you can only get by interacting with each patient. can walk into a room with an agenda,” says Burney, who is cautious about evaluating her own assumptions.

Carol M. Davis, DPT, EdD, MS, FAPTA, a professor emeritus in the University of Miami Miller School of Medicine’s department of physical therapy, recommends the FICA method of evaluating how to get a sense of what is happening with your patient.

The FICA evaluation method, developed by Christina Puchalski, MD, allows a nurse to assess how religion and spirituality play a role in a patient’s understanding and motivation to get better and what he or she relies on for support and comfort. The evaluation includes questions about the patient’s: Faith (Do you consider yourself religious?); Importance and influence of religion (How important is religion to you?); Community (Besides attending church, are you a member of

spiritual needs resolved here?).

Studies have shown that patients are comfortable with discussing religion with caregivers who are willing to walk the line of spirituality and science.

“The bottom line,” says Davis, “is that active listening and compassion is enough, along with questions of ‘how can I help’ and ‘who can I get to come talk with you?’”

Despite the often-charged atmosphere around religion and diverse beliefs, nurses’ questions are often received with relief and welcome. “Human beings all want the same love and respect for the individuals we are and want to be listened to,” says Davis. “The ill have resources to cope, and for most people that will include some spiritual help. Our job is to help.”

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

Evaluating

SANE Programs Sexual Assault Nurse Examiner (SANE) programs were created by nursing professionals to address the under-reporting and underprosecution of adult sexual assaults by providing comprehensive medical care to survivors and expert forensic evidence to the legal community.

BY KIMBERLY BONVISSUTO

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T

o date, there are more than 600 SANE programs in every state in the country, addressing the unique and often complex needs of sexual assault victims, according to the International Association of Forensic Nurses (IAFN). And while SANE programs are held up as the model for best practice in the case of sexual assault victims, only a handful of programs have been evaluated rigorously.

Rebecca Campbell, PhD, professor of community psychology and program evaluation at Michigan State University, says SANE programs caught on and spread quickly throughout the United States and internationally, but they did so with little evaluative data to guide implementation.

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Studying SANE Campbell’s research focuses on sexual assault and how the legal, medical, and mental systems respond to the needs of rape survivors. She and her team conducted a series of research studies on how SANE programs impact adult sexual assault prosecution, including the following: • By analyzing criminal case outcomes five years prior to the launch of a SANE program and during the first seven years of SANE programs, one study found that more sexual assault cases moved through the legal system and raised guilty pleas or trial convictions from 24% to 29% after the implementation of a SANE program.

• An examination of SANE program goals and philoso-

phies and how they influenced patient care practices for sexual assault victims found that programs with a primary goal of case prosecutions lacked comprehensive victim services, including education that impacts a victim’s long-term well-being.

• A national random sampling of 110 SANE programs found consistency in forensic evidence collection, sexually transmitted infection prophylaxis, information on HIV and pregnancy risk, and referrals to community resources.

Several SANE studies have confirmed that the criminal justice system benefits from SANE programs through quality evidence collection, expert testimony, and improved communication with law enforcement.

The common thread in these studies is that SANE programs lead to increased arrest rates, charges, convictions, and sentences in sexual assault cases.

These studies also noted the impact of SANE nurses is felt on many levels: • SANE nurses attend to the medical, forensic, and psychological needs of sexual assault victims; • SANE nurses have extensive training and experience in forensic evidence collection; • SANE programs may increase prosecution rates in their communities by collecting forensic evidence that increases the likelihood of case referral by police; • SANE programs contribute to the recovery gains made by victims.

But a number of studies, including a 2007 study from the University of Kentucky, pointed out that only a small number of programs had a formal reporting system in place that communicates case outcomes, including arrests, prosecutions, and convictions. Knowledge of case outcomes, study authors noted, provides a learning experience by identifying strengths and weaknesses at both the law enforcement and medical community levels.

At the first national SANE Coordinator Symposium in 2009, the group called for additional research in several areas, including developing best practice for SANE programs and compiling SANE models used nationally.

SANE Toolkit Campbell and her team used

Diane Daiber, RN, SANE-A

Rebecca Campbell, PhD

Susan M. Schmidt, PhD, BSN, MSN, CNS, COHN-S, CNL

a competitive grant from the National Institute of Justice to develop a practitioner toolkit for evaluating the work of SANE programs. The toolkit offers three evaluation designs: • Pre-SANE/post-SANE evaluation—compares how far cases progress through the criminal justice system before and after the implementation of the SANE program; • Post-SANE-only evaluation— compares how far cases progress through the system after launching a SANE program; • Ongoing evaluation—charts prosecution outcomes from this point forward.

the three types of evaluations a program can use, and an illustration of how to create community action by determining what works and what needs to be improved in a particular SANE program.

The pilot program evaluated six SANE sites—two rural, two mid-sized, and two urban programs. The pilot found that most sexual assaults reported to law enforcement (80% to 89%) were never referred by police to prosecutors, or there were no charges filed by the prosecutor’s office. None of

reported with forensic exam do not end up in successful prosecution. That’s what the six programs in this study highlights.

“This continues to be an issue, a problem.”

Campbell says the toolkit did what her team hoped it would do—it got people talking and looking at data to see what’s really happening in their communities, in regard to sexual assault cases. She says the toolkit resulted in communities applying for new grants to form new programs or to

The toolkit walks users through a six-step evaluative process and offers ideas for using those findings to improve best practices, as well as reporting, investigation, and prosecution of sexual assault cases. The goal of the toolkit is to assist SANE program staff in evaluating how their program affects the progression of sexual assault cases through the criminal justice system.

The four main sections of the toolkit include a basic overview for conducting a program evaluation, an introduction of how SANE programs create change in communities, a step-by-step explanation of

“Nursing programs focused on patient care and forensic work should continue to focus on good patient health outcomes, because it’s a crapshoot on what happens in the legal system.”

the programs had a statistically significant increase in prosecution rates pre-SANE to post-SANE, but cases processed post-SANE were 80% more likely to achieve convictions or guilty pleas.

Campbell said the evaluative results of the six programs are representative of SANE programs nationwide. “Nationally, this is very typical,” she says. “We’ve seen a lot of studies where most sexual assaults

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revitalize existing sexual assault response teams.

The toolkit and materials are available for public distribution through the National Criminal Justice Reference Service, and other SANE programs are starting to use it, according to Campbell. She says she hopes to secure additional grant funding to create a more interactive, web-based version of the toolkit.

“There is only so much one

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organization—one discipline— can do in terms of trying to address the problem of underprosecution of sexual assault,” Campbell says. “Nursing programs focused on patient care and forensic work should continue to focus on good patient

Creating a SANE Program Diane Daiber, RN, SANEA, a forensic nursing services coordinator at the Cleveland Clinic in Ohio, was working as a staff RN and case manager in the emergency department setting for 19 years when she

“Many nurses will describe taking care of a patient who has experienced sexual assault and not having the understanding or knowledge about sexual violence to provide optimal care,” says Daiber, adding that most nurses have no training in assessment of sexual assault or in the collection of evidence.

health outcomes, because it’s a crapshoot on what happens in the legal system.”

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realized there was a disconnect between health care and patients touched by violence.

“Many nurses will describe taking care of a patient who has experienced sexual assault and not having the understanding or knowledge about sexual violence to provide optimal care,” says Daiber, adding that most nurses have no training in assessment of sexual assault or in the collection of evidence. “I cannot think of any other diagnosis that is handled that way. I knew there must be a better way of caring for patients who have experienced violence, and took the SANE training.”

She took her initial SANE class in 2001 with two other nurses and was granted the opportunity by her employer to develop a SANE program at Hillcrest Hospital in the Cleve-

land Clinic system. Today, the SANE program employs four SANE-A (adolescent/adult), two of whom have dual certification in SANE-P (pediatric).

Daiber says once the program was developed, the benefits became clear. The Cleveland Clinic SANE practice evolved to forensic nursing, with SANEs responding to domestic violence and other forms of maltreatment and trauma, as well as sexual assaults.

“As nurses, our priority is the health and welfare of our patient. We provide one-onone, holistic, patient-centered care,” says Daiber. “Sexual assault has short- and long-term health consequences. We understand the neurobiological effects of trauma.

“Our goal is to decrease the effects of that trauma and begin the healing process from the moment we meet this patient and their family or significant others.”

The Cleveland Clinic’s SANE practice is hospital-based, with most patients seen in the emergency department. But SANEs will travel to other nursing floors for consultation, and forensic teams travel to other hospitals in the Cleveland Clinic system if the patient’s medical condition prohibits her or his transport to a SANE. Daiber says there is great interest in the field, but the on-call structure of most departments makes it challenging for nurses to maintain a commitment. She explains that expanding the patient population to include domes-

trauma patients will ensure the most comprehensive use of the clinical skills of the forensic nurse.

“The key is that forensic nurses have trauma-informed care skills to provide care to patients that have experienced all forms of trauma and abuse,” says Daiber.

Preparing Tomorrow’s Forensic Nurses More and more schools of nursing are adding forensic nursing certificate and degree programs to address the increased interest.

“There is no specific path to getting into the field,” says IAFN President Polly Campbell, RN, BS, BA. “Some nurses seek out the forensic nursing role through their workplace; others discover the

While SANE programs—and the forensic nurses behind them—are making an impact and interest in the field is growing among nursing professionals, finding a job in this relatively new and still evolving field can be a challenge. tic and teen dating violence, child and elder maltreatment, liability-related issues, and

role through reading, webinars/educational sessions, or colleagues; others pursue it

through higher education.”

Educational opportunities in forensic nursing have increased significantly in the last 10 years, says Jennifer R. Campbell, program coordinator and assistant director of the University of California, Riverside Extension, which offers a Forensic Nursing Certificate through an online degree program that focuses on victim advocacy and investigative sciences.

Mary Kozub, PhD, RN, assistant professor and forensics advisor at Xavier University School of Nursing in Cincinnati, Ohio, says television and media are driving a societal and cultural fascination with forensic sciences. She jokes about writing a letter to the crime drama CSI to suggest adding a forensic nurse to the team to educate the public about their work.

Xavier offers an MSN forensic nursing concentration, in addition to a dual degree option with the Criminal Justice Department. As a nurse at Cincinnati Children’s Hospital Medical Center for six years, Holly Shively saw everything from trauma to gunshot wounds in the operating room. When she was look-

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ing for advanced educational opportunities, she found the forensic nursing program at Xavier University and refocused her career goal on working in homicide and, potentially, a coroner’s office.

“I would like to do evidence collection and expert witness testimony in the court system,” says Shively, adding that she worked with the local police homicide unit and the coroner’s office through the Xavier program. “I was able to do anything they were doing at any of the crime scenes, including collecting evidence, taking pictures, interviewing suspects and witnesses. I actually went into the crime lab and learned to do fingerprinting.

They taught me their skills.”

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Sexual Assault Statistics • Every t o minutes someone in the United States is sexually assaulted.

• Each year there are about victims of sexual assault.

•

of se ual assaults are not reported to police.

•

of rapists ill never spend a day in jail.

• Nearly in or million women in the United States have been raped in their lifetime.

•

of surveyed atinas reported being sexually assaulted at some point during their lifetime.

• About in blac and hite non Hispanic women, and 1 in 7 Hispanic women, have experienced rape at some point in their lives.

• ore than one uarter of omen who identified as Native American/ Alaska Native reported rape victimization in their lifetime.

Sources: The Rape, Abuse & Incest National Network (RAINN) and The National Center for Victims of Crime (NCVC)

Susan M. Schmidt, PhD, BSN, MSN, CNS, COHN-S, CNL, director and professor/ epidemiologist in the Xavier University School of Nursing, says she worked with the Criminal Justice Department at the university on the dual

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degree option because health care workers do not understand crime scenes and the importance of protecting evidence, as well as how to treat a criminal and a victim with respect and dignity.

“A nurse could bring a lot

to that crime scene,” says Schmidt. “We’re moving as a nation into a whole new area of the Affordable Care Act. With that, we’re moving into population health and away from taking care of sick people, trying to take care of well people and keep them from getting sick.

“Forensic nursing will help one of the leading causes of ill health in our nation turn around.”

Job Outlook While SANE programs— and the forensic nurses behind them—are making an impact and interest in the field is growing among nursing professionals, finding a job in this relatively new and still evolving field can be a challenge.

In the United States, most forensic nurses practice in hospitals, but they can also work in child advocacy centers, universities, community anti-violence programs, coroners’ and medical examiners’ offices, corrections institutions, and psychiatric hospitals. They also may be called in on mass disasters or to help out during community crisis situations.

According to the US Bureau of Labor Statistics, there were 2.7 million registered nurses in

the United States in 2010. Job growth for RNs is expected to grow by 26% through 2020.

The IAFN’s goal is to have a forensic nurse in every hospital and venue where her or his skills are needed. But because it is a relatively new specialty in nursing, there aren’t many jobs out there. Typically, a forensic nurse creates a job that is then recognized in the work setting. But Polly Campbell says there is a growing value and recognition of the skills forensic nurses bring to the table, and she is confident opportunities will grow with time.

“As is often the case, a forensic nurse must often pioneer her first position in a hospital or community since there is so little awareness of the role and what the specialty has to offer,” says Polly Campbell. “Changes in attitudes and beliefs, federal and state laws, and caring health care providers have all contributed to an improved standard of care for victims and perpetrators of violence.

Forensic nurses are change agents, leading the way for all practitioners.”

Kimberly Bonvissuto is a freelance writer based in Cleveland, Ohio.

Academic Forum

The ACA and Opportunities for Nurses

BY ARCHANA PYATI

It’s just after lunchtime at Community Clinic Inc. (CCI), a federally qualified health center in Takoma Park, Maryland, a Washington, DC, suburb with a large immigrant and refugee population. Team Nurse Jose Aguiluz, RN, leads the afternoon huddle, a daily ritual where primary care providers—physicians and nurse practitioners—discuss their most complex cases with other members of the clinical team, including community health workers, medical assistants, and Aguiluz himself.

T

he huddle’s purpose is to spotlight patients with multiple conditions that need to be carefully monitored. The team identifies those who may benefit from “care management,” an approach that combines intensive patient education, follow-up calls and visits, and coordination with specialists.

Most of CCI’s patients are lowincome and face significant barriers to care, including a lack of transportation, lack of health insurance for those not covered by Medicaid or Medicare, lack of family support like child or elder care, poor nutrition, and mental health complications.

Today’s discussion, for example, includes a woman with bipolar disorder, schizophrenia, and breast cancer who is leery about undergoing a mastectomy and an encephalopathic patient who is convinced he has been followed for the past 20 years.

Care management at CCI has been in the works for two years, ever since the organization decided to become a “patient-centered medical home,” where patients follow a treatment plan and are cared for

by a multidisciplinary team of professionals, led by a doctor or nurse practitioner.

Care management, or care coordination as it is also called, is intended to keep patients healthy and is one of the guiding principles of the Affordable Care Act (ACA), President Obama’s signature health care law passed in 2010. In addition to requiring everyone to carry health insurance starting this year, the ACA attempts to lower costs by discouraging episodic care and incentivizing care that anticipates acute illness before it occurs.

“The focus now is on preventative care,” says Aguiluz, who fields daily inquiries about the ACA from patients. “The questions we’re asking our-

Nurses will play an instrumental role in an evolving health care system brought forth by the ACA. The law pres-

Nurse practitioners are eager to fill the need—particularly in underserved communities—but face unique battles when it comes to being uniformly embraced in primary care roles. selves is: How are we treating chronic conditions? How do we prevent people from seeking care in the hospital?”

ents both opportunities and challenges to both registered nurses and advanced practice nurses since both groups will

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be called upon to meet the needs of newly insured patients seeking care on a more regular basis.

Nurses will be integral not only on care coordination teams as both managers and clinicians, but also in a more robust primary care sector the ACA mandates. Health policy experts question whether there will be an adequate supply of primary care providers with fewer medical students pursuing careers in primary care.

Nurse practitioners are eager to fill the need—particularly

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Academic Forum in underserved communities— but face unique battles when it comes to being uniformly embraced in primary care roles.

The Role of RNs in Care Coordination According to the Department of Health and Human Services, health centers like CCI are expected to be a testing ground for how well the ACA works since they serve as a magnet for uninsured patients.

Some of CCI’s uninsured will now be eligible for Medicaid while others will qualify for subsidies to purchase individual policies. The ACA set aside $11 billion for health centers nationwide, although no funds are specifically designated for care management. Navigators have been hired or contracted by many health centers to assist patients shopping for insurance on the online health care exchanges.

“If you look at the law, it talks about shifting care into the community away from hospitals,” says Susan Hassmiller, PhD, RN, FAAN, senior advisor on nursing at the Robert Wood Johnson Foundation.

“In my mind, nurses are the ideal people to deliver care in this changing model. We need people who can take care of patients holistically, over their lifetime. ” Health centers have hired more nurses in recent years not in direct anticipation of the ACA, but as a result of structural changes to the way they serve clients. Since CCI began its transformation into a medical home nearly two years ago, its nursing staff has grown from two to 10, says Shobhna Shukla, RN, MSN, FNP, clinical programs director at CCI. The “linchpin” of each

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clinical team at each of CCI’s seven locations, nurses could be a determining factor when newly insured consumers select a primary care provider, explains Shukla.

“Health centers are often measured by the quality of their nursing staff,” she adds.

“What we do with nurses here…is going to be very important in terms of when people make choices about where to go.”

For years, Andrew Swiderski, MD, MPH, a pediatrician at CCI, felt frustrated by his inability to keep up with the “big pile of chronic issues” presented by certain patients—asthma, obesity, allergies, and diabetes among them. Now that care management is part of CCI’s culture, a dedicated RN and community health worker help Swiderski’s patients navigate the maze of specialist referrals, prescriptions, and other pre-

ventative services they need. It frees Swiderski to focus on the patient’s immediate medical issue in the short window of time he has with them.

“I feel so much better about what I do,” says Swiderski. “I don’t have to feel guilty about patients who need constant follow-up.” After Swiderski’s visit with a patient, the team nurse spends time educating the patient and his or her family about the next steps

Academic Forum in their treatment plan.

“It’s amazing the depth [the team nurse] covers,” he says.

Empowering the Uninsured The medical home model being implemented at health centers around the country and guidelines set forth by the ACA are, in many ways, complementary, says Margarita Sol, RN, the nursing care coordinator who oversees care management efforts at each of CCI’s seven clinics. Both initiatives prioritize access to health care, care coordination, prevention, health outcomes, and choice. “Choice means it’s patient-centered,” she adds.

[that] has been on hold or at a sluggish pace,” says Sol. Now, adds Shukla, “they won’t have to delay if they don’t have the cash.”

Ruth Jackson of Brandywine, Maryland, knows firsthand the anxiety that comes with delaying care. Jackson, 41, is an uninsured single adult and a full-time student who pays for her own medical expenses.

Before she became uninsured, her primary care doctor noticed her thyroid was enlarged. By the time Jackson got around to scheduling an MRI, she had quit her job so she no longer had health insurance. She paid $200 for the MRI, which re-

gree in public administration, Jackson’s goal was to keep working while pursuing her studies.

Then her parents became bedridden and wheelchair-bound, and Jackson became their fulltime caregiver. Faced with a choice of having employersponsored health insurance or caring for her parents, she chose the latter.

For her master’s thesis, Jackson is writing about the experience of uninsured consumers—herself included—using the online health exchange.

Her research focuses on clients of Greater Baden Medical Services, a Brandywine-based community health center where

vealed nodules on her thyroid.

Jackson has since postponed a biopsy of the nodules because she can’t afford one.

“It’s worrisome,” she says. “I don’t know if my condition has gotten worse.”

Before starting a master’s de-

44% of patients are uninsured, according to Colenthia Malloy, chief executive officer. Jackson also serves as a client representative on Greater Baden’s Board of Directors.

To Jackson, the ACA’s longterm promise is that “every

person including myself will have access to care,” which means she’ll have better control over her asthma and will be able to visit a dentist, whom she hasn’t seen in two years. In the short term, she says, having insurance means “being able to determine whether I have cancer.”

Nurses, Jackson says, can play an influential role in educating consumers about how the ACA benefits them. One nurse-managed health center in Baltimore is doing just that.

The East Baltimore Community Nursing Centers are in the process of becoming training sites for navigators who will assist clients sign up for health insurance, says Patty Wilson, RN, MSN, director of the centers.

Some of the centers’ clients are having difficulty enrolling, particularly with technical glitches in the Maryland health exchange website.

Also, clients don’t prioritize purchasing insurance as work and family obligations take up most of their time. While they “have other things on their plate,” says Wilson, each center’s goal is to assist clients “become advocates for their own health care.”

Shobhna Shukla, RN, MSN, FNP

Jose Aguiluz, RN

Margarita Sol, RN

“If you look at the law, it talks about shifting care into the community away from hospitals,” says Susan Hassmiller, PhD, RN, FAAN, senior advisor on nursing at the Robert Wood Johnson Foundation. “In my mind, nurses are the ideal people to deliver care in this changing model. We need people who can take care of patients holistically, over their lifetime. ” In Maryland, like other states who opted to expand Medicaid, patients who previously didn’t qualify for the program will be eligible now. Meanwhile patients who earn too much for Medicaid could receive subsidies to purchase insurance on the exchange.

While they can’t predict how many new patients they’ll see as a result of the law, CCI clinicians say current patients who are self-paying are likely to benefit from expanded insurance options. They won’t have to shoulder the cost of necessities like labs, visits to specialists, and medical supplies or equipment entirely on their own.

“There is a pool of patients who have been waiting for more care outside of our clinic

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Academic Forum

Nurses, Jackson says, can play an influential role in educating consumers about how the ACA benefits them.

Nurse Practitioners and the Primary Care Workforce At Unity Health Care, a federally qualified health center in Washington, DC, the number of nurse practitioners occupying slots as primary care providers has grown from a “handful” to about 50 across Unity’s clinics in DC, says Sarah Price, RN, MSN, director of nursing development. While MDs make up the majority of providers at Unity, nurse practitioners have their own patient panels and are “very independent and focused on primary care,” she says.

“We weren’t able to be where we are in terms of thinking outside the box without hiring nurse practitioners,” says Malloy of Greater Baden Health Services, which will extend hours at all their clinics this year to keep up with demand. Nurse practitioners make up 30% of Greater Baden’s providers.

According to the American Association of Nurse Practitioners (AANP), 89% of nurse practitioners receive training in a primary care specialty, including family medicine, pediatrics, and women’s health. And while the AANP reports growth in enrollment and graduation rates for nurse practitioners, other experts say the shortage of faculty and the lack of clinical training opportunities and dedicated mentorship cripple the ability of nursing schools to contribute meaningfully to the primary care workforce.

Unlike family physicians, nurse practitioners in primary

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care don’t undergo a residency program before taking on their own patients. Nurse practitioners from earlier generations usually earned their advanced degrees after years working in a clinic or hospital as a registered nurse. Newer graduates, however, are heading straight to graduate programs with fewer clinical experiences under their belt. Swiderski, the CCI pediatrician, says he has seen inexperienced nurse practitioners “get thrown into the fire” only to deliver “suboptimal care.”

“There has not been equivalent support for undergraduate or graduate nursing education until now,” writes Jackie Tillett, ND, CNM, FACNM, in a 2011 paper published in the Journal of Perinatal and Neonatal Nursing.

The ACA somewhat rectifies this situation by setting aside money to bolster the clinical experiences of registered nurses and nurse practitioners. The law lifts the cap on grants given to nurses to repay loans if they pursue doctoral degrees, and it also gives financial support to nurses who want to teach at the university level. The National Health Service Corps has also expanded under the ACA, with nurses receiving $50,000 for every two years of service with an at-risk population.

Additionally, the ACA funds demonstration projects at five hospitals throughout the country to train advanced practice nurses. The Centers for Medicare & Medicaid Services (CMS)

will reimburse the hospitals to place advanced practice nurses with clinical preceptors in their communities, says Matthew McHugh, PhD, JD, MPH, RN, FAAN, associate director for health outcomes and policy research at the University of Pennsylvania, one of the five sites chosen by CMS. “It’s important to focus on the substance and quality of the training so that nurses can

same services also vary greatly, with nurse practitioners usually receiving less money. In 2010, the Institute of Medicine with the Robert Wood Johnson Foundation issued a policy statement urging states to allow nurse practitioners to practice to the full extent of their training, regardless of where they work.

Yet until laws are liberalized across all 50 states, nurse prac-

Yet until laws are liberalized across all 50 states, nurse practitioners will have to continue to advocate for their rightful place as primary care providers, even with the ACA as the law of the land.

work in a new and more complex health care system,” says McHugh.

Legislative and political barriers preventing nurse practitioners from fully occupying primary care roles need to be removed, say McHugh and other experts. Only 17 states and the District of Columbia allow nurse practitioners to practice independently without a doctor’s supervision. Reimbursement rates of private insurance and government programs to nurse practitioners and physicians performing the

titioners will have to continue to advocate for their rightful place as primary care providers, even with the ACA as the law of the land.

“There is lot of care that needs to be provided,” says McHugh. “And we need everyone practicing to the top of their abilities to make the most of the workforce that we can.”

Archana Pyati lives in Silver Spring, Maryland, and writes frequently on health and science topics.

Academic Forum

Child Abuse and Autism: How Nurses Can Help

BY BEHLOR SANTI

According to statistics from the Centers for Disease Control and Prevention, 1 in 88 American children have autism spectrum disorder (ASD). The National Institute of Mental Health defines ASD as “a group of developmental brain disorders,” with a “wide range of symptoms, skills, and levels of impairment, or disability.” Children living with ASD can show minor or severe impairment.

E

ver since Bruno Bettelheim came out with pioneering Freudian theories concerning ASD, researchers have tried to uncover this ailment’s mysterious origins. In the 21st century, Bettelheim’s theories blaming maternal alienation are considered dated. Researchers now

look to genetic, environmental, and behavioral factors.

In the May 2013 issue of JAMA Psychiatry, two researchers from the Harvard School of Public Health (HSPH) in Cambridge, Massachusetts— Andrea Roberts, PhD, and Marc Weisskopf, PhD—presented a new, intriguing the-

ory. The HSPH researchers found that women who experienced physical, sexual, or emotional abuse as children had a higher chance of bearing children with ASD than women not abused as girls.

The most severely abused women had three-and-a-half times the risk, and even women who endured more moderate abuse as children had a higher risk of bearing children with ASD—a 60% higher risk.

The authors of the study had gathered data from more than 50,000 women in the Nurses’ Health Study II. The findings suggest that childhood trauma not only affects the victim but

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her offspring as well.

“Our study identifies a completely new risk factor for autism,” said Roberts in the school’s press release. She then called for further research to understand the connection between a woman’s experience with abuse and her child’s autism. Such research will be used to treat preventable risk factors.

Traditionally, the “face” of ASD has been white, middleclass children. Organizations like New York City-based Autism Speaks work with clinicians around the country to make care available to children and families of all backgrounds. Even with the numerous stories of minorities breaking through the “concrete ceiling” to middle-class success, a third of black American children remain in poverty— and poverty is one factor that leads to child abuse, according to a 2011 Washington University study on race and childabuse statistics. As the HSPH study implies, child abuse is partly responsible for America’s high ASD rate.

Alycia Halladay, PhD, is senior director for clinical and environmental sciences at Autism Speaks. On the job for nearly nine years, she entered the field back when few services existed for any autistic child.

“The average age of diagnosis was eight,” says Halladay.

“We thought it could only be diagnosed by age seven. Now, we know it is much lower.”

Halladay’s focus is on helping minority children become diagnosed as early as possible.

Despite the changes in treatment in the last 10 years, mi-

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Academic Forum nority children living with ASD still get diagnosed less often and later in life. “Seeing families receive help they deserve . . . is incredibly gratifying, but challenging,” says Halladay. “For every one person we help today, there are hundreds of thousands that need the same help.”

In Autism Speaks’ Early Access to Care Program, families receive scientific information and tools, health care providers are trained to refer families with a concern, and culturally competent material is created to reach underserved groups.

“We can’t expect people in the community to find us,” says Halladay, urging health care providers, including nurses, to reach out. “Please contact us, and we’ll work together to help your families get the help they deserve.”

Kathryn Smith, BSN, MN, DPH, works as a registered nurse and nurse care manager at the Boone Fetter Clinic at Children’s Hospital Los Angeles in California. What drew her to pediatric nursing? “I like working with children and their families,” says Smith. “Plus, the kids are so cute.”

For Smith, working with cute kids brings a bit of levity to a condition as perplexing as ASD. “Parents come to the

ents describe their concerns, and the clinicians at Boone Fetter provide a comprehensive, interdisciplinary assessment.

Smith hasn’t seen a direct link between child abuse and ASD, as theorized by the HSPH study. However, she talks about young patients coming from families with additional stressors, like poverty or drug abuse. She believes that nurses can help women of all backgrounds. They can help women optimize pregnancy health, take time from busy schedules to take care of their own health, prepare and eat healthy food, and exercise. “[This] may be particularly important,” says Smith, “for those women experiencing other life stressors.”

Dorothea C. Lerman, PhD, currently directs the University of Houston-Clear Lake’s Center for Autism and Developmental Disabilities (CADD) in Texas.

After volunteering and working at facilities with mentally disabled people, Lerman decided to make the field of psychology her life’s work.

Lerman teaches graduate and undergraduate students in practicum activities, conducts research, administers the behavior analysis graduate program, and directs CADD. Most of CADD’s services are offered

Despite the changes in treatment in the last 10 years, minority children living with ASD still get diagnosed less often and later in life.

Boone Fetter Clinic with concerns about their child’s behavior or development, and they are afraid,” she says. Smith and her colleagues take parents through a process where par-

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at no cost, a godsend for Houston’s low-income families. The waiting list for the early-intervention program runs about two years.

While Lerman is not a cli-

nician, the graduate students at CADD provide clinical services, all while learning on the

tant,” says Lerman.

Since the days of Bettelheim, academics have advanced re-

As the HSPH study suggests, maybe the first step in reducing the autism pandemic is respecting our daughters before they become mothers. job. With a grant from Autism Speaks, CADD has started a program for Spanish-speaking families. In the program, the families learn how to communicate with their autistic child, and they also receive Englishenhancement classes.

“Making services more accessible to non-English-speaking families, minorities, and those with low-income is very impor-

search into autism, advocates continue to educate, and nurses show families ways to live with their child’s disability.

As the HSPH study suggests, maybe the first step in reducing the autism pandemic is respecting our daughters before they become mothers.

Behlor Santi is a freelance writer based in New York City.

Second Opinion

No Older Adult Left Behind

BY STAJA “STAR” BOOKER, RN, MS

Older adults are one of the fastest growing populations in the nited States. According to the S census there are approximately 40 million adults 65 years and older an increase of over million since . This burgeoning growth in the US and worldwide necessitates that emerging entry-level nurse generalists be competent in caring for older adults. The American Association of Colleges of Nursing (AACN) has recommended that nursing curricula include a stand-alone gerontological nursing course with a didactic and clinical component.

H

owever, many Historically Black Colleges and Universities (HBCUs) have been slow to adopt the AACN’s recommendation. As of 2005, only a third of US baccalaureate nursing programs required a geriatric nursing course, according to a study published in The Journal of Professional Nursing.

After an online search of nurs-

ing curriculum plans at HBCUs (as posted on websites), I discovered that currently over 65% of traditional four-year BSN programs did not have a stand-alone gerontological nursing course. Accordingly, about 35% of HBCUs did.

Comparing this observation to the 2005 national survey, this suggests that HBCUs are doing slightly better than the

general US programs. But it must be remembered that there are considerably fewer HBCUs compared to the number of predominantly white institutions.

Afua Arhin, PhD, RN, department chair and professor at Fayetteville State University School of Nursing argues, “Because there is a 1 in 4 chance of encountering a patient who is 50 years or older, it is imperative that gerontology as a specialty is integrated into nursing education curriculum at all universities, especially HBCUs, to ensure that student

nurses are competent in caring for this important crosssection of the population.”

Thus, current and future nurses will most likely care for an older adult at some point in their career. In fact, many of today’s medical-surgical patients are 65 years or older. Unfortunately, many medical-surgical nursing textbooks present minimal, if any, information on best practices for older adults, according to a recent study conducted by the National League for Nursing (NLN). It is clear that there is dire need for greater num-

As far back as 1993, Verna Holtzen and colleagues reported that gerontological nursing education was no longer a “curricular luxury” but a necessity for a baccalaureate degree.

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Second Opinion bers of health care professionals prepared to care for older adults. The results of the 2013 America’s Health Rankings® Senior Report showed that many states’ older adult populations are very unhealthy.

It is interesting to note that many of the HBCUs without a gerontological course are located in the lowest ranking states for senior health: Louisiana, Arkansas, Mississippi, Alabama, Georgia, Tennessee, and Oklahoma.

In order to improve care of older adults, all nursing programs must implement gerontological didactic courses and

clinical practicums into their curricula. As far back as 1993, Verna Holtzen and colleagues reported that gerontological nursing education was no longer a “curricular luxury” but a necessity for a baccalaureate degree. Nursing students and nurses without adequate knowledge of the aging lifecourse will continue to provide care that doesn’t reflect best practices; consequently, the health of older adults will remain suboptimal.

Reasons for Lack of Course Interestingly, in 1993, Terri H. Brower and Ruth E. Yur-

Professional Gerontological Organizations The American Geriatrics Society www.americangeriatrics.org

American Society on Aging http://asaging.org

Association for Gerontology in Higher Education http://aghe.org

Gerontological Advanced Practice Nurses Association www.gapna.org

The Gerontological Society of America www.geron.org

International Association of Gerontology and Geriatrics www.iagg.info

National Gerontological Nursing Association http://ngna.org

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chuck examined the state of gerontological nursing education in Southern states. According to their study published in

“Retooling for an Aging America: Building the Health Care Workforce,” emphasizing geriatric competency of the entire

If implementing a stand-alone course in geriatrics is not feasible, incorporating gerontological content into existing specialty courses—such as community health, medical-surgical, and psychiatric-mental health nursing courses—should be considered.

Nursing and Health Care, much variation was found in the amount of content, topic areas, and reasons for lack of gerontological content. Though it remains unclear why many schools today have yet to require a gerontological nursing course, several general reasons may explain this absence. For one, there persists a perceived lack of priority in implementing gerontological content, most likely due to insufficient knowledge of older adults’ unique needs.

Additionally, many nursing programs’ curricula are already overloaded with nursing courses, making it difficult to incorporate any additional courses. Insufficient financial resources and infrastructure further hinder the infusion of gerontological content, including a shortage of qualified faculty to develop and teach gerontological nursing courses.

While no state board of nursing mandates the inclusion of gerontological content, minimal gerontological content on the NCLEX promotes the perception of older adult care as lower priority.

Current Recommendations and Alternatives In 2008, the Institute of Medicine released its report,

health care workforce and the need for improved delivery of care in older adults. Then in 2010, the AACN released Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults, which highly recommended that nursing programs implement a standalone gerontological nursing course.

Subsequently, the National Gerontological Nursing Association further recommended that all undergraduate RN programs establish a three-hour didactic gerontological standalone nursing course and a three-hour clinical practicum by 2013. Yet, as we see, these recommendations have not been implemented nationally. Several other organizations—including the NLN, National Hartford Centers of Gerontological Nursing Excellence, and The Reynolds Center for Geriatric Nursing Excellence—have committed to increasing and improving gerontological nursing education and research.

“Current statistics illustrate there will not be enough providers with specialization in geriatrics to meet the needs of the aging population—thus, one important response is to assure that all pre-licensure health

Second Opinion professional students, including nurses, are prepared to address the health care needs of older people,” states Keela Herr, PhD, RN, FAAN, AGSF, co-director of the Hartford/ Csomay Center for Geriatric Nursing Excellence at The University of Iowa.

If implementing a standalone course in geriatrics is not feasible, incorporating gerontological content into existing specialty courses—such as community health, medical-surgical, and psychiatricmental health nursing courses—should be considered.

Older patients are present in almost every health care setting, and nurses in these specialty areas must be equipped to care for older adults. Being that more and more grandparents are caring for young children, a life-span approach can be taken, in which geron-

older adult care before they transition into professional practice, and this approach fosters inter-professional learning.

The future of nursing education is driven by two powerful forces—the aging population and a transforming nursing education system. Although some programs have integrated some gerontological content in various courses, courses dedicated solely to nursing care of older adults are missing in many HBCUs. We must prepare our students to be able to care for older patients in their practice, as well as their grandparents, aging parents, and elderly family members and neighbors. Nursing education must attend to and reflect current nursing practice populations.

Our generation’s and future generations’ success is based

Gerontological Education Resources To assist schools of nursing in infusing gerontological content into their curricula, various nursing organizations provide free evidence-based resources on care of older adults. The following resources consist of guidelines, PowerPoint presentations, webinars, podcasts, videos, assessment tools, exam questions, white papers, position statements, and sample teaching strategies:

Advancing Care Excellence for Seniors www.nln.org/facultyprograms/facultyresources/aces

Caring for an Aging America: A Guide for Nursing Faculty, by The American Association of Colleges of Nursing www.aacn.nche.edu/geriatric-nursing/monograph.pdf

Facilitated Learning to Advance Geriatrics http://flagprograms.org

Gerontological Nursing: Scope and Standards of Practice, by the American Nurses Association Gero Nurse Online www.geronurseonline.org

Geropsychiatric Nursing Collaborative

The future of nursing education is driven by two powerful forces—the aging population and a transforming nursing education system.

www.aannet.org/geropsychiatric-nursing-collaborative

Geropsychiatric Nursing Competency Enhancements,

by Cornelia Beck, Kathleen Buckwalter, and Lois Evans Hartford Institute for Geriatric Nursing http://hartfordign.org

tological content is integrated into pediatric and maternal health nursing courses as well.

Perhaps, HBCUs can partner with schools that offer a gerontological course and allow their students to enroll for course credit. Offering course credit to participate in a summer geriatric externship is an additional strategy.

Other strategies include offering a gerontological nursing course as an elective, or allowing nursing students to take gerontology-related or aging-specific courses in other departments. This can at least provide some knowledge of

on the sacrifice of past generations. It is our responsibility to assure quality health care for seniors in all of America.

We can’t afford to leave older adults behind!

Staja “Star” Booker, RN, MS, is a geriatric nurse and an alumna of Grambling State University.

Currently a PhD student (Aging/ Gerontological Nursing) at The University of Iowa, she is also a 2013-2015 National Hartford Centers of Gerontological Nursing Excellence Patricia G. Archbold Scholar.

National Hartford Centers of Gerontological Nursing Excellence www.geriatricnursing.org

Portal of Geriatrics Online Education www.pogoe.org

Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults, by The American Association of Colleges of Nursing www.aacn.nche.edu/geriatric-nursing/ AACN_Gerocompetencies.pdf

Reynolds Center for Geriatric Nursing Excellence http://nursing.ouhsc.edu/Research/Reynolds-Center

Stanford Geriatric Education Center http://sgec.stanford.edu

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Degrees of Success

Mentoring and the Use of Innovative Curriculum Design to Develop a Global Nurse Leader

BY SANDRA DAVIS, PhD, DPM, ACNP-BC that it can serve as an exemplar in creating global opportunities in schools of nursing.

The journey began with a 52-year-old certified palliative care and hospice nurse who entered an Adult Nurse Practitioner Program with the secret desire to deliver hospice and palliative care to the terminally ill suffering from HIV/AIDS and cancer in the remote villages of Kenya. Her unrelenting vision enabled me, as a faculty member, to recognize the personal, social, and career attributes of a global leader and to create an innovative NP curriculum to support the student’s development.

Recognizing the Personal Attributes of a Global Nurse Leader

Globalization is changing the way we live and work, and by extension, it is transforming the experiences and aspirations of students entering Nurse Practitioner (NP) programs. Many of today’s students enter NP programs with a desire to acquire the advanced knowledge and skills needed to make a difference in faraway and remote places across the globe. Given budgetary and logistical constraints in nursing programs nationwide, existing curricular and institutional resources must be used in innovative and creative ways to develop, support, and mentor students with the potential for global leadership.

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ith more college students studying abroad, more students are entering NP programs with experience

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in global health care activities or services. Students with international experience may have participated in a high school foreign student exchange pro-

gram, studied abroad in college, or travelled with a volunteer- or faith-based mission, or may have had a personal background in international travel. Many of these students have an expanded worldview and want to become NPs so that they can make a difference globally. In response, schools of nursing are establishing departments of international and global health, creating systematic course work and certificate programs in global health and leadership, and offering experiential global opportunities as part of their curriculum. I share one student-faculty mentoring experience I had in the hopes

I first met the student at my university’s master’s-degree orientation for new students in the summer of 2011. I was her academic advisor, and she had come to my office to map out her course work and plan of study. Equipped with her notepad and ready to take notes, she was startled by my first question. I told her to dream big and asked: “If you could do anything at all, what would you do with your NP degree?”

Without hesitation, her response was: “My dream is to travel to the remote villages in Kenya to deliver hospice and palliative care to those who are terminally ill and suffering from HIV/AIDS and cancer.” Her tone was an alarming blend of authenticity, sincerity,

Degrees of Success and optimism. Fascinated by this student’s passion and enthusiasm and intrigued by her conviction of purpose, I asked her to tell me what she knew about Kenya.

Having traveled to Kenya myself, I was thrilled to have a frame of reference. I could easily recall highlights of Kenya’s topographic and demographic

well as their triumphs and struggles. The student learned about the palliative care social worker’s beliefs and values and how they influenced her views about life and about death and dying. The student was very much aware of her own values and belief system and willingly shared them with the palliative care social worker.

But as her story unfolded, I discovered that she knew something far more valuable than all of the facts, figures, and statistics that I was expecting to hear. data. I even retained a working knowledge of Kenya’s Ministries of Health, its governmental structure, and its key economic drivers. Admittedly, the student really did not know much about the country and had never traveled there. But as her story unfolded, I discovered that she knew something far more valuable than all of the facts, figures, and statistics that I was expecting to hear.

Several years ago, the student was approached by a colleague who asked a favor.

Knowing the student was a hospice and palliative care nurse, her colleague asked if she would write to her friend, a palliative care social worker in Kenya who was struggling with the enormity of suffering in her country. Without hesitation, the student agreed and thus began their ongoing virtual relationship.

For three years, the student and the palliative care social worker in Kenya shared their lives and their experiences with death and dying. Across continents, cultures, languages, and barriers, they developed an appreciation and an understanding of each other, as

Without judgment, but with curiosity, openness, and sensitivity, the student compared and contrasted their cultures, traditions, perceptions, misperceptions, and views. She reflected upon the similarities and differences along with the challenges and potential conflicts.

Teaching is a two-way street, and that day this student taught me how to recognize the attributes of a global nurse leader. Through telling her story, this student demonstrated self-confidence, self-awareness, cross-cultural communication, flexibility, adaptability, and the passion to take on new challenges. She possessed the core attributes of a global leader but did not recognize this in herself. I was compelled to assist this student with realizing her potential.

unfortunate. Worse yet, imagine extinguishing the flames of passion for global health by ignoring the vision when we need more global nurse leaders. I needed to engage this student in her graduate course work in such a way that it strengthened and supported the commitment to her dream. Moreover, I wanted to assist the student with realizing that she had the ability and skills to make her dream a reality.

I asked the student if she would be willing to make a commitment to the ongoing development of her knowledge, abilities, and skills as a

global leader by working with me to develop a structure and foundation for her dream. She agreed, and from that moment on, her dream began to crystallize. Graduate school was no longer classes and coursework; it became her passion, her life’s work, and the pursuit of her dream.

For the next year, the student and I worked together, using the existing curriculum, to develop a rich and engaging plan of study that provided the opportunity for balancing ideas, perceptions, and critical perspectives from her partnership with the palliative care social worker against

Mentoring This student came to graduate school with a global mindset, a passion for global health, and the vision of a leader. To place such energy and passion on hold—for two years—while working through a master’s degree in nursing would be www.minoritynurse.com

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Degrees of Success evidence-based knowledge and theoretical frameworks.

The student’s literature review led her to the work of Dr. Anne Merriman and Hospice Uganda Africa. The student used her research courses to examine Merriman’s model for affordable oral morphine in

to educate, advocate, spread, and advance their mission.

Building Relationships Relationship building is an essential component of becoming a global leader. The student’s relationship with the palliative care social worker

Teaching is a two-way street, and that day this student taught me how to recognize the attributes of a global nurse leader.

Uganda to relieve end-of-life suffering. In addition, she investigated Merriman’s model as a possible model of care for the palliative care social worker’s community. The student’s partnership with the social worker had given her a global advantage. She had developed the adaptability, flexibility, and stability to deeply engage in the assessment and evaluation of the challenges and barriers related to one specific issue in one area of the world not only from a Western perspective, but from a broader perspective.

Merriman’s accomplishments as a leader resonated with the student. In her Nursing Leadership and Nursing Theory courses, the student focused on transformational leadership and change theory to better understand Merriman’s accomplishments in advancing palliative care in Africa. Eventually, the student interviewed Merriman for a Nursing Leadership class assignment. The Skype conversation with Merriman was a defining moment in the student’s career. Merriman’s respect, interest, and sincerity reflected the heart of most passionate leaders. They spend time investing in and sharing with others who share their vision in order

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in Kenya was invaluable to her development and success as a global leader. Her vision was born out of their partnership.

However, how was this student going to make her dream happen? In order to actualize her dream, she needed to identify support or opportunities for collaboration, partnership, research, or even funding. She needed experience in navigating organizations. In addition, she needed to join international professional nursing organizations to network and to create and maintain relationships.

I arranged for the student to meet with senior administrators from both the School

extraordinary outcome of our relationship at the Sigma Theta Tau International Research Congress in Sydney, Australia.

Through this experience, the student had the opportunity to work with me one-on-one to prepare for her podium presentation. This type of guidance and support can facilitate highquality results, and many leaders report this type of coaching as vital to their success. In addition, the student had the unique opportunity to network

Relationship building is an essential component of becoming a global leader. of Nursing and the School of Medicine at my university to build support for her work. As a result of those meetings and making those connections, she was introduced to major global leaders doing work in her area of interest.

Furthermore, the student was inducted into Sigma Theta Tau International in 2012 and, together, we presented the

with global nurse leaders from all over the world.

Lessons Learned • Do not allow perceived time constraints or fears of failure deter your desire to become an educational innovator.

The impact of this successful innovation on student learning and faculty development far outweighs time and risk.

• Tying innovative teaching strategies into existing curricular structure provides a means for measurement and evaluation of student outcomes.

• This innovative approach for developing global nurse leaders will not work for all students. Recognizing the attributes of a global leader in someone with the passion for global service will optimize successful results.

• Never underestimate the power of virtual collaboration when developing global relationships.

As transformational coaches, educators can make learning come alive for students by becoming aware of a student’s vision, strengthening that vision by connecting it to the learning, and then empowering the student to make his or her dreams happen.

Sandra Davis, PhD, DPM, ACNPBC, is an assistant professor at the George Washington University School of Nursing.

Degrees of Success

Lessons for the Teacher

BY LEONA KONIECZNY, DNP, MPH, RN-BC

My career in pre-licensure nursing education started in 1986. As a professor at Capital around the conference table as Community College in Hartford, Connecticut, I have taught and learned much in the students from Columbia, Puerto Rico, Poland, and the United last plus years. have had the privilege to teach students from the immediate States supported and enriched Hartford and greater Hartford areas, Mexico, the Caribbean, and several countries in the clinical experience for each South America, Europe, Asia, and sub-Saharan Africa. During a recent data-gathering other. Having students give verproject as part of a teaching innovation, students at my college were asked to self- bal reports to other health care givers or give mock reports over disclose on race ethnicity gender and age. The Class of in nursing as the phone to each other helps African American . Hispanic and . Asian. The students predominant boost their fluency and conage range as to years old and . of the students ere male. e ections on fidence. this rich student sample resulted in my personal list of the following top 10 teaching 3. Recognize the lessons that I have learned. cultural background that each student brings with him or her.

Leona Konieczny, DNP, MPH, RN-BC, with some of her students at Capital Community College

1. Examine your words carefully, both verbally and in writing.

I re-examine the words that I use in class or the college laboratory for double meanings. Common words such as “stoop” or “duck” are examples.

If words can have more than one meaning, then I need to check in with the students to ensure that my message is clear.

This is important when writing test questions. Some years ago, a student challenged the use of the words “granola bar.” This

student was from Africa and did not know the type of food termed “granola.” My assumption was invalid, and now it is described as a cereal bar in a subsequent nutrition question.

. Students may come from cultures where English is not their first language.

Also, students’ pre-collegiate educational preparation may not have been in English. However, students still need literacy skills to meet current health care expectations. Written as-

signments can strengthen skills and identify the few students who might need assistance from the Academic Success Center related to literacy. Having students lead a post-conference is another educational technique that can strengthen verbal fluency. An excellent student from Columbia who had the ability to lead was reticent to contribute verbally. Exposing students to group speaking validates their knowledge and boosts confidence. During last year’s spring semester, I looked

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A student from Chile shared that when someone in her community was hospitalized the expectation was all family, friends, and neighbors would visit. It helped me to acknowledge and share that multiple visitors in a hospitalized patient’s room may be viewed as respect—not an assault on privacy or expediency.

A student from China offered up her cultural upbringing concerning the use of hot or cold foods related to a specific condition. There are two things that I have taken from this. Firstly, the reinforcement of alternative therapies such as heat and cold may be used before the prevalent dash to a pharmacological intervention.

Secondly, it is an opportunity to encourage nursing students to assess the patient’s use of cultural therapies to ameliorate or cure a condition.

4. Appreciating the cultural background influences the teacher and student interaction.

A student from the Philippines would not look me in the

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Degrees of Success language line, the immediacy of material provides culturally competent care. The diversity at the clinical site provides a lived learning experience.

7. Increase the use of pictures and videos in your teaching to reflect the diversity in the community and the student population.

eye as I was giving her feedback on a nursing procedure on campus. What could be interpreted as lack of engagement and assertiveness was a demonstration of her respect for someone who was in an authority position.

Her comments to me opened the door for more substantial communication and a discussion of communication expectations in her role in the US.

5. Because of the college’s diversity, a number of students are the first in their family to pursue a college education.

Last year, a student from Vietnam shared that she was the only one in her group of friends who started the prerequisite courses and who subsequently earned an Associate Degree in Nursing.

As her advisor, I congratulated her on this significant accomplishment. I reviewed her resume at her request and went over sample questions for a hiring interview. This student’s paper was presented as an exemplar work in the

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nursing pharmacology course.

It is important, however, not to make this generalization. I taught a student from Albania whose parents were both educators. She was fluent in Albanian, French, and Italian prior to coming to this country. She worked in a bakery and lived above it until she mastered English. It was important to this student that I was aware of her personal history. She completed the Associate Degree, has since earned a Baccalaureate of Science in Nursing, and has been a homeowner for the last few years.

Another student from Bosnia privately shared her experiences during the war and the compelling reasons for her relocation to America. I often forget to acknowledge how nursing education is an important part in the process of achieving a student’s dream. I have learned to appreciate this important part in the student’s journey.

6.The student population that mirrors the cultural diversity in the community is an asset.

The health care setting is enriched when there is less difference among the caregivers and the care recipients.

The selection of clinical sites

My colleagues and I review textbooks and media that include cultural considerations.

The nursing laboratory on campus has mannequins that represent virtual patients of diverse race/ethnicity and across the lifespan. Audio in any language can be uploaded to the human patient simulator to support cultural competency. Some cultural topics are anticipated, such as teaching about the cultural differences related to the epidemiology of

Having students give verbal reports to other health care givers or give mock reports over the phone to each other helps boost their fluency and confidence. that reflect the diversity in the community is important.

It reinforces the concepts of physical assessment findings consistent with ethnicity. It reinforces the embracing of humanity that will serve the students well in their careers.

My clinical site at the Hospital of Central Connecticut at New Britain General Hospital has three predominant languages: English, Spanish, and Polish. Patient-teaching material is available in all three languages, and staff is often bilingual. Patient compliance with the treatment plan is promoted with these approaches. While the hospital subscribes to a telephone

tuberculosis. Other cultural topics are not as obvious, such as examining evidence-based literature to look for diversity in the study sample. For example, when I teach about nursing care of a person with a burn injury, I include pictures of burn survivors with lighter and darker complexions. In completing an online module on medication reconciliation, I was mindful to include pictures of persons from many ethnicities.

8. Students are taught to be lifelong learners.

There is benefit in my position as a role model for students related to continuing

Degrees of Success education. I started as an AD graduate in the 1970s. Progressing from a BSN in the 1980s to a Master’s in the 1990s, I completed a Doctorate in Nursing Practice in 2013. I can empathize with students about the joys and challenges of working while continuing along the educational path. Since faculty members do not usually graduate with advanced degrees, students may benefit from hearing about our personal journey in the education process. However, I challenge students to shorten the timeline for meeting advanced educational goals. Providing dual enrollment in the AD and RNto-BSN programs is one way to promote advanced education. A local university has invited students to sit in on Bachelor’s degree level classes.

With support from my colleagues, I have learned to introduce advancing education early and often.

9. Faculty’s improvement in teaching results from formal education and outside experience.

10. Appreciate the teaching and learning experience with a diverse student population.

Formal education classes address strategies for teaching with diversity in learning styles, age, and culture. Education conferences or seminars are another mechanism for self-improvement. However, I have learned differently from travel experiences. On a nursing delegation to South Africa, I observed care at a rural HIV/ AIDS clinic at Groote Schuur Hospital, which was the site of the first heart transplant, and visited a sangoma, the local healer. On a stay at a cattle station in the Australian outback, I learned about rural primary health care. On a trip to Costa Rica, I learned that some Americans receive care there for lower cost and comparable quality. Certification as a Reiki Master Teacher has provided me with another option to offer comfort to patients.

I have taught students with a wide range of educational preparation. The spectrum has ranged from students with a GED in lieu of a high school diploma to a professor of economics who pursued nursing to give back to the Latino community. All nursing educators who teach a diverse student body deserve to be celebrated. Various and multiple teaching strategies are utilized by educators who teach students between the ages of 19 to over 50 years; students who balance the demands of school, work, and family; and students who bring different backgrounds to their nursing education. I admit to times of frustration, but the multiple teaching strategies can produce significant learning for students and teachers. This last lesson occurs over time after the other lessons have

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been internalized.

These 10 items are not meant only as a summary of lessons learned but rather a vehicle to amplify the concepts and expand the list in the future.

There are many opportunities for more lessons to be learned.

Embracing new technologies such as virtual, online health settings is an area for growth.

The use of creative assignments such as video production, Wiki sites, or social media are areas for further learning by educators. Systematic review of the curriculum for content, learning activities, and assessment methods will continue to ensure optimal outcomes are met for all students. As a teacher, I look forward to the new lessons I will learn from the students.

Leona Konieczny, DNP, MPH, RN-BC, is a professor at Capital Community College in Hartford, Connecticut.

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MINORITYNURSE.COM Highlights from the Blog

Newsletter Top 5 Reasons Why Good Nurses Leave the Profession Some nurses are becoming frustrated with the profession and leaving altogether to pursue other careers. I’ve known a few well-seasoned nurses who have left after 10, 20, or 30 years in the profession. Some nurses leave after only a short time in the field. Why?

MTV’s Scrubbing In Rattles Critics They flirt. Fight. Curse. Party. And that’s some of the behavior in the trailer of MTV’s Scrubbing In, a new reality show about a group of 20-something-year-old traveling nurses in Orange County, California. By now, you’ve probably heard about the controversy. Even before the show’s premiere, critics were angered by the trailer and its less than flattering portrayal of nurses.

Nurses Face Greater Risk for Depression Nurses deal with a spectrum of emotions on any given day. As caregivers, you see your share of gut-wrenching moments. Stressful occurrences are constant. With time, you learn coping skills to protect your heart, your sanity, your life. But what if the “blues” or a “bad day” lingers too long?

Communication is Key: Importance of Effective Hand-off Reporting Communication breakdown is the leading cause of medical errors such as gaps in health care, incomplete or missing information, and medication errors. Most importantly, communication supports the foundation of patient care. So, hand-off reporting during shift change is a critical process that is key in protecting a patient’s safety.

To read more, visit www.minoritynurse.com/blog.

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Minority Nurse | WINTER 2014

Academic Opportunities

Applications now open!

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Academic Opportunities

Discover Johns Hopkins doctoral nursing education

E NURSING PROGRAM N I L Nurse Executive and Advanced ON DOCTOR OF

Practice tracks are offered.

Applicant Must: *Hold a MS degree with a concentration in nursing (related degrees may be eligible). *Hold an RN license. *Submit a 500-word letter of intention describing career goals. *Have national certification or eligibility for certification in advanced practice or nursing leadership.

The Doctor of Philosophy (PhD) for research leaders. Advance the science of nursing and healthcare.

The Doctor of Nursing Practice (DNP) for clinical leaders. Advance the practice of nursing and improve health outcomes.

All courses are online. Three one-to-two-day on-campus visits for orientation and project defense purposes are required. Two year full-time or three year part-time options are available.

Choose your path at the Johns Hopkins University School of Nursing—a place where exceptional people discover possibilities that

For your home campus, apply to either:

forever change their lives and the world.

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Minority Nurse | WINTER 2014

Academic Opportunities

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RN-BSN/M MSN/Certificate Option Welcome to y W your future! e! At Jacksonville nville State Univ n iversity, y our y, focus is getting you y rea eady d for dy where y you are going! oing! Our nursing students are prepared ed to care ca for patients in many ny y settings and to n achiev e e positiv ev i e patient outcomes. iv outcomes Nursing today requires es a workforce armed with adv d anced education dv and skills to provide o ovide ex xemplary care to any nyon ny yone, anytim nytime, any nytim n where! ny

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Academic Opportunities

TENURED/TENURE- TRACK FACULTY POSITIONS Washington State University College of Nursing provides high quality and accessible education to baccalaureate, MN, DNP, and PhD students. The college is seeking applications for: Tenured & Tenure-Track Faculty. Health science researchers and educators with an earned PhD (at time of hire) in Nursing, Psychology, Public Health, Medicine or Research in Health Sciences, particularly individuals prepared as APNs with specialization as a Family Nurse Practitioner, Psychiatric Mental Health Nurse Practitioner or in Community/Population Health. Job duties include teaching, research and service. Position is located in Spokane, Washington, at the rank of Assistant Professor, Associate Professor, or Full Professor. Salary, rank, and tenure status are dependent upon experience and qualifications.

Apply Now! 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.

Screening begins immediately and will remain open until suitable candidates are identified. This posting may be used to fill multiple positions. Position is available January 1, 2014 or August 16, 2014.

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

nursing.wsu.edu

PENN STATE | ONLINE

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Penn State’s College of Nursing Online Programs  RN to B.S. in Nursing  Master of Science in Nursing  Certificates in: —Nursing Management —Nursing Informatics —Nursing Forensics

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Achieve your goals—apply today!

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.

www.worldcampus.psu.edu/minority-nurse U.Ed.OUT 14-291/14-WC-0434ajw/smb

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Minority Nurse | WINTER 2014

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.

Faculty Opportunities

The College of Nursing and Health Sciences is seeking a dynamic individual for the Academic Chair of the Nursing Department A full-time Academic Department Chair position is available in the College of Nursing and Health Sciences at UW - Eau Claire beginning June 1, 2014. This is a full-time academic year appointment as well as an additional summer appointment. Primary responsibilities include leadership and management of the nursing department, faculty teaching and class scheduling, management of personnel, budget oversight, fostering faculty growth, and supporting a healthy work environment. Requirements include a doctoral degree, Master’s degree in nursing and current RN license.

For a complete position description and to apply, go to http://www.uwec.edu/Employment/uweccareers.htm.

Review of applications will begin September 5, 2013.

Screening will continue until the position is filled. A criminal background check will be required prior to employment. For questions contact Dr. Mary Canales, Chair of the Search & Screen Committee canalemk@uwec.edu or 715-836-5737.

UWEC is an EOE/AA employer http://www.uwec.edu

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.

Oakland University | School of Nursing Take your career to the highest level

DOCTOR OF NURSING PRACTICE PROGRAM Health policy, community health, evidence-based research, organization leadership

Be welcomed at the table as a valued advanced practice nurse leader Alumni from Oakland’s graduate programs have become presidents of nationally ranked hospitals, chief operating officers, chief nurse executives, vice presidents of patient services of large health systems, and much more.

Oakland’s 38-credit DNP program fits the busy lifestyles of today’s nurses who are seeking to advance their careers.

DNP nursing curriculum emphasizes: = Health care policy advocacy = Interprofessional collaboration = Evidence-based advanced nurse practice = Translational research = Prevention and improvement of population health outcomes = Information systems and use of patient care technologies = Clinical professorships in academic institutions = Policy reform in government = Preparation in becoming clinical leaders in health care systems

Program highlights: First school in Michigan to offer the DNP program Flexible: Full-time working nurses can complete the program by following a part-time plan of study.

Diverse: Students throughout the U.S. are enrolled online.

Leadership experiences: Curriculum includes trip to Capitol Hill in Washington D.C. and courses emphasizing leadership.

3001 Human Health Building 2200 North Squirrel Road Rochester, MI 48309-4401 (248) 370-4253

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oakland.edu/nursing/dnp

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SCHOOL OF NURSING

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Faculty Opportunities

Index of Advertisers ADVERTISER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE # AACN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2

Faculty Position Assistant Professor Nursing

Abington Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 DaVita . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Montefiore Medical Center . . . . . . . . . . . . . . . . . . . . . . . C4 University of Connecticut Health Center. . . . . . . . . . . . . 22

ACADEMIC OPPORTUNITIES . . . . . . . . . . . . . . . . . . . . . PAGE # Frontier Nursing University. . . . . . . . . . . . . . . . . . . . . . . 51

(2 positions) UMass Amherst, the flagship campus of the University of Massachusetts system, sits on nearly 1,450 acres in the scenic Pioneer Valley of western Massachusetts, 90 miles from Boston and 175 miles from New York City. The campus provides a rich cultural environment in a rural setting close to major urban centers.

The College of Nursing at the University of Massachusetts is committed to building a more diverse faculty, staff and student body in a research-based environment as it responds to the diverse population and educational needs of the Commonwealth of Massachusetts and the nation. The College of Nursing has a large on-campus enrollment and a welldeveloped distance education component. The University of Massachusetts is a member of the Five College Consortium including Amherst, Smith, Mount Holyoke and Hampshire Colleges.

Johns Hopkins University . . . . . . . . . . . . . . . . . . . . . . . . 52

The College of Nursing invites applications for two full-time tenure-track Assistant Professor faculty positions (nine-month appointment). The earliest appointment date is September 1, 2014.

Responsibilities include teaching, academic advising of students, scholarship and research activities, community and academic service activities and participation in national, college and University committees.

Penn State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Minimum Requirements: Earned PhD in nursing or a health-related field and a proven track record of research and publications.

Jacksonville State University . . . . . . . . . . . . . . . . . . . . . 53

University of California, Davis. . . . . . . . . . . . . . . . . . . . . 51 University of Nevada. . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 University of Pittsburgh . . . . . . . . . . . . . . . . . . . . . . . . . 51 University of Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . 52 Washington State University. . . . . . . . . . . . . . . . . . . . . . 54

FACULTY OPPORTUNITIES . . . . . . . . . . . . . . . . . . . . . . . PAGE # Oakland University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 University of Massachusetts . . . . . . . . . . . . . . . . . . . . . 56 University of Wisconsin. . . . . . . . . . . . . . . . . . . . . . . . . . 55

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Preferred Requirements: Postdoctoral education. Preference will be given to applicants with a clinical specialty in Public Health Nursing, Primary Care, or Acute Care Nursing, teaching and online education experience, specialized advanced practice skills, and/or national certification.

Applicants should apply online http://umass.interviewexchange. com/jobofferdetails.jsp?JOBID=43794. Include a cover letter (in Word or PDF format), statement of research interests, curriculum vitae, sample publications and three letters of recommendation. We will begin to review applications on November 15, 2013, and will continue to accept applications until the positions are filled.

The University provides an intellectual environment committed to providing academic excellence and diversity, including mentoring programs for faculty. The University seeks to increase the diversity of its professoriate, workforce and undergraduate and graduate student populations because broad diversity is critical to achieving the University’s mission of excellence in education, research, educational access and service in an increasingly diverse globalized society. Therefore, in holistically assessing many qualifications of each applicant of any race or gender we would factor favorably an individual’s record of conduct that includes students and colleagues with broadly diverse perspectives, experiences and backgrounds in educational, research or other work activities. Among other qualifications, we would also factor favorably experience overcoming or helping others overcome barriers to an academic career or degree.

The University of Massachusetts Amherst is an Affirmative Action/Equal Opportunity Employer committed to equality in education and employment. Women and members of minority groups are encouraged to apply.

Minority Nurse | WINTER 2014

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Dedicated to Diversity

Minority Nurse magazine is committed to increasing diversity and inclusiveness in academics and nursing practice.

Diversity is more than a check box on a form, more than a dry statistic hidden in a table of demographic data. It is more than the color of one’s skin, the nation of one’s heritage, or the origins of one’s social beliefs.

Diversity celebrates culture.

Diversity is inclusive.

Diversity is the catalyst for the collaboration and discovery that is essential for an understanding and appreciation of the human spirit. Diversity allows us to engage with our differences and provides the mechanism that leads to acquiring cultural sensitivity and achieving cultural competence.

We honor the individual and the community.

We encourage ourselves and others to behave equitably.

We promote acknowledging and respecting different beliefs, practices, and cultural norms.

We uphold academic excellence, celebrate best practices, honor traditions, and embrace change that advances our objectives of caring for ourselves, advancing our educational and career opportunities, and providing quality health care for our patients.

We are Minority Nurse magazine.

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Montefiore Medical Center is honored to be named a “Top 25 Nursing Employer” WE ARE PROUD TO OFFER OUR MORE THAN 3,000 NURSES a rewarding work environment combining a compassionate culture of care with an emphasis on shared governance and lifetime learning to enhance the professional experiences of our nurses and ensure the very best for our patients.

For more information, go to www.montefiore.org/nursing.

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