Lauren Underwood, former Public Health Advisor for President Obama and current Congresswoman from Illinois’s 14th congressional district, is featured on Springer Publishing’s new health care podcast series, Conversations About Health Care Delivery in the United States. Underwood has gone from congressional candidate to congresswoman. To get you all caught up and ready for her guest appearance, this story is a repost of her interview with Minority Nurse from 2018.
Last issue’s health policy column highlighted nursing’s increased engagement in the public policy arena. To continue this conversation, this column highlights a registered nurse running for Congress to help champion access to affordable health care. Yes, Lauren Underwood, MSN/MPH, RN, of Naperville, Illinois is running for Congress to represent the 14th Congressional District of Illinois.
Underwood’s Journey to Pursuing an Elected Position
Underwood is steadfast and fiercely committed to helping shape policies and programs focused on ensuring that everyone has access to affordable health care. She is a registered nurse who received her BSN from the University of Michigan and her MSN/MPH from Johns Hopkins University. Her nursing experiences include service as a health policy advisor, research fellow, senior director, and research nurse at the National Institutes of Health Clinical Center. Her passion for public policy was heightened while serving as a health policy advisor in the Office of the Secretary at the Health and Human Services in Washington, DC initially under the leadership of Secretary Kathleen Sebelius followed by the leadership of Secretary Sylvia Burwell. In this capacity, Underwood worked on private insurance reform, summary of insurance benefits, health care quality in the Medicare program, the Agency for Health care Research and Quality, and preventive services (free screenings, immunizations, and contraceptive coverage) for four and a half years from 2010-2014.
Lauren Underwood, MSN/MPH, RN
Democratic Candidate for Congress, 14th Congressional District of Illinois
Tell us about working for the Obama administration.
Got a call the week that Mr. [Thomas Eric] Duncan was in the hospital in Dallas with Ebola asking if I would be willing to join the President’s team to help with disaster response, so I transferred over to ASPR, the Assistant Secretary for Preparedness and Response, at HHS. We worked on emerging infectious diseases (e.g., Ebola, Zika Virus, Middle East Respiratory Syndrome virus, or MERS), we also did national disasters (e.g., wildfires, hurricanes, floods) and then bioterror (small pox, anthrax) and worked with drug companies to develop vaccines, treatments, and diagnostics. I stayed in the administration until the very end, the last day. And so, when the election happened in 2016 we were working on the water crisis in Flint. I was surprised, and I thought that Hillary Clinton’s team was going to win and that we were going to hand off our work on health reform and on Flint to people who cared and wanted to continue the process. And then we got the Trump team who made it very clear they wanted to do away with health care coverage. And that’s not why I went into nursing or why I did this work. So, I knew I could stay in government and help them do that. I wanted to continue the work and so I came back home to Illinois because Illinois is a state that expanded Medicaid. I got a job working for a Medicaid managed care company in Chicago as the Senior Director for Strategy and Regulatory Affairs for a company called Next Level Health.
Are you still there?
I left my job about six weeks ago. The primary campaign was about eight months. I worked full time six and a half months; you know you have to do that. I am a young person, not someone of particular means or whatever, so it was necessary. And then it was like “Lauren, you could really win if you put your time and energy into the campaign.” And so that was an easy choice to transfer to full time.
So, you are now devoting full time to the campaign?
Yes.
This reflects your journey. Describe in a few words what really made you run for an elected position.
I am going to tell you a story. Last spring when I returned home, I went to congressman Randy Hultgren’s one and only public event. It was a moderated event hosted by the League of Women Voters. And during that evening, he made a promise and said that he was only going to support a version of Obamacare repeal that allowed people with preexisting conditions to keep their coverage. That’s important to me as a nurse. I also know how critical it is for people with chronic illness to have access to medications and procedures that they need. Obviously, I worked to implement the Affordable Care Act so I read the law and I know that it works. I know that we can fix what does not work. We do not have to throw the whole thing away. Like so many Americans, I have a preexisting condition myself. I have a heart condition, SVT (supraventricular tachycardia), and it is well controlled. As you know, it is a preexisting condition, so I would not be able to get coverage under these repeal scenarios. And so, when the congressman made that promise I believed him.
And then a week to ten days later he went and voted for the American Health Care Act, which is a version of repeal that did the opposite. It made it cost prohibitive for people like me to get coverage. And so, I was upset not at the vote itself, but because he did not have the integrity to be honest the one time he stood before our community. That’s not what a representative is supposed to do. A representative is supposed to be transparent, accessible, and honest. And we deserve better. I said, “you know what, it’s on! I’m running” and launched my campaign in August and just won the primary on March 20th. I was in a field of seven—the only woman running against six men—and I won 57% of the vote.
Were you the only African American?
Yes.
I know you are concerned about overall access to care and have a deep commitment to utilizing your expertise and experience while working in the Obama administration.
I believe that health care is the number one issue in this election across the country and in our district, and we need a solution to make health care more affordable for American families. It is not enough for families to rake together money for their premiums and have an insurance card in their pockets and cannot afford the coverage.
I believe that a lot of the conversation in the last several years has been political in nature and undoing President Obama’s legacy and not on at all focused on trying to lower costs and make health care accessible for American families. That’s my objective! I want to work on drug prices. I want to work on this opioid drug crisis so that loved ones can get the treatment that they so desperately need. And so, I believe there is a lot of value in having a nurse at the negotiation tables when we are making these decisions and passing policies that will transform our health care system. I am excited about the opportunity to be a leading voice on Capitol Hill on these important issues.
What do you think are the most pressing issues impacting nursing and health care?
Affordability. Any program that is starved of resources will fail. The ACA has been intentionally sabotaged and as a result, we see extraordinary high premiums that are unaffordable for most families. That is not how the program was designed to work and so I think there are technical fixes we can do to make the program more affordable. We can do things like negotiate drug prices, it can be done, we need to take a strong position on this opioid drug addiction crisis. We need to implement reforms like how we pay for rehab and how we award funds to municipalities in order to create a pathway for lasting change. And then there are opportunities to expand coverage so we will have fewer uninsured Americans. What we are seeing now in order to resuscitate it takes 2-3 doses of Narcan because the drugs are so strong. Municipalities who have received Narcan grants are running out of Narcan. A Narcan only solution is not a solution. Law enforcement only solution is not a solution. Addiction is an illness and we need to treat it as such. We need to send people to treatment so they can have a shot at recovery. We could have an evidence-based policy solution. We know treatment can be effective.
What do you think is the most pressing issue affecting nursing today?
I think there are a few things. The high cost of our education. We have not really seen increases in funding. What we have seen are marginal increases or flat funding. I think that this is unacceptable, in particular in the context of what we are seeing in higher education more broadly. And not just at the federal level. In higher education, many states have reduced putting money into public education, shifting the responsibility to families and individuals and with that coupled with flat funding for nursing education we are seeing a generation of nursing students with significant debt. And that is going to be a barrier, I believe, to our profession being able to grow. Right now, we have an economic situation where we are not seeing the shortage that we saw ten years ago. But it’s very easy to get back to that point if the economics of going into nursing shifts when you graduate from a BSN program with $100,000 in debt and are limited in your initial salary. Loan repayment programs are not that plentiful as they used to be. The economics of it makes it tough. Because we are talking about middle class folks who are not able to take on that debt. And when it is becoming increasingly attractive to become an APRN, that is all debt to be able to get the master’s to become a nurse practitioner or a nurse midwife. We are going to need some serious advocacy and a plan to deal with the cost of our education.
What are your thoughts about safe staffing?
It is so interesting. Safe staffing has been a legislative priority for decades. We have not been able to pass these bills. I think the approach needs to be more balanced with safe staffing committees in these hospitals. Moving away from these ratios and having hospitals have safe staffing committees that would take into consideration the circumstances that facilities and the region when staffing levels. On these committees, nurses would serve so a legislative body is not dictating it. I think that this is an appropriate approach coupled with compelling Medicare participating facilities to set staffing levels and monitor outcomes.
When elected, what would you do to go about helping to ensure equitable access to health care?
That’s like the question! For me, equitable access to health care allows everyone to get health care. Health care is a human right. Human rights have been fundamental to my nursing practice. It is written in our Code of Ethics—this idea that everyone should have health care—and I think our policies should reflect that. For me, that includes fixing the Affordable Care Act to ensure affordable coverage; and making sure we have clinics, hospitals, and facilities in communities so that the burden is not on low-income people or people with transportation challenges or resource limitations so that people are able to get the care and services they need. We have so much innovation, technology, and so many improvements now in a way we are able to provide care whether it’s telemedicine or individualized health care. It is a shame if all of that innovation and all of those improvements are seen in resource communities. We need to be focused in these conversations about reform and transforming our system to ensure that it is serving everyone—rural, urban, low income, and elderly.
What advice would you give to aspiring policy advocates who may be considering a run for public office?
Your country needs you! There are too few nurses in policy positions. Seek a County Board position. The County Board supervises the local Department of Health. Run for state legislator, they address scope of practice issues. Run for Congress! There are many opportunities to serve and lead. Step forward!
Tune into Springer Publishing’s new monthly health care podcast series, Conversations About Health Care Delivery in the United States, featuring discussions with prominent experts, innovators, and leaders in the health sector available on Spotify, Apple Podcasts, and Amazon Music.
Given the diversity in our world today, take a moment and ask yourself: Are you a culturally competent nurse or nursing student? Do you demonstrate cultural humility?
You may have explored the concepts of cultural competence and humility in nursing school, but let’s take it a step further and consider how to apply these concepts in everyday interactions with members of diverse groups and communities.
Whether working in a hospital, walking into a local store, or interacting with neighbors, cultural competence and humility are cornerstones of building strong relationships. Practically speaking, this isn’t a skill you check off your to-do list once. Instead, developing cultural competence and humility is a lifelong process and journey involving continuous reflection, learning, and unlearning. It makes the individuals and groups we interact with feel seen, heard, and valued.
What is Cultural Competence vs Cultural Humility?
Cultural competence is about equipping yourself with knowledge of diverse cultural practices and beliefs, which enables you to provide respectful and appropriate care to patients from varied backgrounds. According to the American Academy of Nursing, cultural competence includes integrating knowledge, attitudes, and skills to facilitate intercultural communication and interactions between people from different racial, ethnic, socio-economic, and religious backgrounds. It’s understanding different cultural customs, traditions, beliefs, and behaviors and utilizing this knowledge to communicate effectively with others.
Here’s what cultural competency as a nurse might look like:
Using appropriate words and phrases that are familiar to the individual
Respecting an individual’s choices and preferences (e.g., diet, treatment)
Refraining from labeling an individual who comes from a particular group
Advocating for an interpreter to translate to facilitate informed decision-making
Acknowledging what is acceptable and not acceptable to say or do with an individual from another culture/background
Cultural humility, a new concept introduced more than thirty years ago, embraces the idea that we must all critically explore and critique ourselves as the first step to learning from and about others. It’s more than being knowledgeable about other cultures and practices. Cultural humility is being ‘others-oriented’ instead of “me-oriented” and recognizing that our understanding of different cultures constantly evolves. It’s a lifelong process of critical self-reflection and an openness to learning from the experiences of others. Humility acknowledges the power imbalances, emphasizing the importance of being receptive to learning from those who may not look, act, or believe in the same things we do.
Demonstrating cultural humility can include:
Participating in cultural competency training
Actively listening to an individual’s beliefs and practices without judgment
Respecting individual autonomy and cultural values when making decisions
Asking open-ended questions to understand an individual’s cultural preferences
Customizing healthcare delivery to align with the individual’s cultural, religious, or linguistic needs
These examples above, rooted in an attitude of openness and self-reflection, can lead to strengthening and maintaining effective relationships built on trust, respect, and collaboration.
How Do I Become More Culturally Competent and Demonstrate Cultural Humility?
Being culturally competent and demonstrating cultural humility takes time to happen. It is also not about choosing cultural humility over cultural competence or vice versa. Instead, it’s about cultivating and enabling both to work in unison.
Here’s how you can begin your journey towards cultural competence and humility.
1. Examine your ‘Blind Spots’
Start by examining and reflecting on your biases, assumptions, attitudes, and values and how they may influence your interactions with others. Identify any implicit bias that might be at play. Implicit biases are those unconscious stereotypes and attitudes you’ve learned and carried toward specific groups of people. These biases are like “blind spots”—you aren’t aware they exist unless you intentionally look!
Identifying your blind spots may involve asking yourself:
Am I tolerant enough to learn from others?
Are there privileges that I have that others don’t?
What do I think about other cultures that are different from my own?
Do I actively seek out perspectives or experiences that differ from my own?
Do I recognize and challenge my assumptions about people different from me?
Do I refrain from having deep conversations about social issues? If I do engage in dialogue, am I listening with intent or just talking?
Once we can identify our blind spots, the work can begin to address those stereotypes and attitudes. We can start unraveling, challenging, and correcting our learned biases.
2. Consider Others’ Point of View
Putting ourselves in another person’s shoes, or “shoe-shifting,” helps us begin to consider the experiences and perspectives of others. Cultural humility and competence require us to avoid being distracted by what we think we know. It’s asking ourselves whether there is anything we ought to know and framing our interactions with others as a partnership. So next time you’re interacting with someone who may appear different than you or may hold different beliefs and values, ask yourself, “What else should I know?” instead of “What do I know?” Be intentional about incorporating humility into your interactions – listening more than speaking, feeling comfortable with not knowing or understanding everything, and demonstrating genuine curiosity. Although we know empathy and compassion are the right things to do, it can be challenging to put these into practice when faced with our stereotypes and implicit biases. Why, though? Perhaps because to truly put ourselves in another person’s shoes, we must be willing and able to remove our shoes first!
3. Get to Know People Different From You
It’s easy to get along with people who are similar to us. Seriously, think about those people who are closest to you, and more than likely, many of them will resemble….well, you! But if you want to develop cultural competence and humility, you’ve got to stretch a little and step outside your backyard. This involves active and intentional efforts to experience others.
Reading books (e.g., autobiographies) to gain new perspective/appreciation
Volunteering or participating in organizations that serve diverse communities
Attending community/multicultural events to promote direct dialogue and interaction
Listening to podcasts with hosts/guests who have different lived experiences or beliefs
When we stretch ourselves this way, we can challenge our stereotypes and attitudes toward others and begin to value their unique experiences. We can create meaningful connections built on respect, appreciation, and a deeper understanding beyond superficial interactions. These proactive strategies allow you to enhance cultural competence and humility and contribute to more inclusive and united communities.
Conclusion
As you strengthen your cultural competency and humility skills, consider yourself and the individuals you live, learn, and work with. Every interaction with an individual is an opportunity to practice, demonstrate, and enhance these skills.
Gradellini, C., Gómez-Cantarino, S., Dominguez-Isabel, P., Mecugni, D., & Ugarte-Gurrutxaga, M. I. (2021). Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review. Front Psychol, 12(1).
Hughes, V., Delva, S., Nkimbeng, M., Spaulding, E., Turkson-Ocran, R.-A., Rushton, C., . . . Han, H.-R. (2020). Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty. Journal of Professional Nursing, 36(1), 28-33.
McDaniel, V. P. (2021). Cultural Humility in Nursing Building the Bridge to. Virginia Nurses Today, 29(2), 12-14.
Stubbe, D. E. (2020). Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients. Focus (Am Psychiatr Publ), 18(1), 49–51.
Laughter is the best medicine for Kelli Dunham, RN, BSN, a NYC-based nurse, comedian, and writer who has been performing comedy as a nursing side gig for 25 years to help nurses deal with the profession’s stress.
Dunham’s latest show she wrote and is performing in is called Second Helping: Two Dead Lovers, Dead Funny. Dunham will be performing in NYC, on the Lower East Side’s Caveat on May 18th at 4 pm (with a virtual option May 18th).
The show is part stand-up comedy, part sit-down tragedy, with love and body fluids in the cracks in between. A hilarious queer tragicomedy about death, grief, nuns behaving badly, exploding knee replacements, and the limitations of bootstraps.
“Second Helping is…a love letter to the power of community. This show is a must-see for anyone who’s ever hesitated before asking for help” -Bechdel Theatre.” Second Helping is drop-dead funny” –Go Magazine.
Get Your Tickets
Caveat is at 21A Clinton Street, New York, NY.
Tickets are $15 (early bird, one week before the event), $18, or $23 at the door.
Livestream is $8 and is available for ten days after the event.
Get tickets here.
Admission includes a zine and a special commemorative coloring sheet.
Running time for the opening act and Second Helping is 80 minutes.
Dunham’s sister, who is also a nurse, is opening for her, making it a two-nurse comedy show! She plans to perform the show in Philadelphia and is doing a Midwest tour this summer.
On the surface, the show is about losing partners to cancer, but the actual theme is about learning how to ask for and accept help. “We’re excellent at helping other people but not very good at accepting help,” says Dunham. She says all the clinical instructors she’s talked with have agreed that helping nursing students figure out how and when to ask for help is one of their biggest and most challenging tasks on the hospital floor.
Dunham says she just returned from Hiram College in Ohio, where she performed Second Helping for a group of nursing students. Afterward, they had a two-hour discussion. “They really identified with the theme,” she says.
Busy nurses don’t always seek out professional organizations or groups dedicated to nursing, and for valid reasons. They need more time or energy to devote to a group, the meetings are inconvenient, or they see it as an extension of work. However, joining a nursing community is one of the most powerful personal and career moves a nurse can make.
“The importance of community is relevant to nurses at all levels of their careers,” says Gloria E. Barrera, MSN, RN, PEL-CSN, a public health nurse who practices as a school nurse at a high school outside of Chicago. “The sense of community is a unifying force that fosters professional growth and enhances the overall impact of nursing practice.”
For nurses identifying with a particular group, such as a minority nurse or a nursing specialty, being part of a community of nurses is validating. “The best advice that I was given was to join a professional nursing organization and then to join my specialty nursing organization,” says Barrera, who holds longtime membership in the American Nurses Association (where she is now the Executive Member of the Board) and the National Association of School Nurses.
Having a community that shares your experience, whether personal or professional, is vital to a sense of belonging in a group. “As a Latina nurse, it was important for me to join a professional organization that authentically represents the diversity of my community,” says Barrera. “We can’t be what we can’t see! Once we see others who look like us succeeding in their respective roles, it gives us a blueprint to continue on our journeys.”
Joining a group is excellent, but what happens if nothing fits what you’re looking for? For Danielle McCamey, DNP, CRNP, ACNP-BC, FCCP, starting a group was the answer. McCamey, founder, president, and CEO of DNPs of Color, started the organization several years ago. “I was trying to find that community when I was going through my doctoral program,” she says. Finding nothing that could offer support with a similar lived experience that McCamey had, she decided to create it. There is a shared language and a shared understanding that’s essential when you gather with other nurses. “A community helps offer you that validation you need,” says McCamey. “There is always someone who can say, ‘Here are some strategies to help you navigate that.’”
Joining a community offers opportunities and benefits that aren’t always obvious.” When looking at nurses from underprivileged backgrounds, the connections within a nursing community, especially through local chapters of professional organizations, can be most impactful,” says Barrera. “It gives these nurses access to financial resources, for example, scholarships, mentorship programs, and networking opportunities that wouldn’t otherwise be afforded them.”
Nurses also say the support they find in a community of nurses extends both ways. McCamey notices that even as more senior nurses help lead, they also need guidance as they move through leadership roles and situations. An organization that supports all levels of nurses will have members who share their experiences, both good and bad, to help other nurses take steps that produce results or avoid any potential pitfalls.
Nurses interested in personal and professional connections will find that most groups offer both organically. “Communities provide nurses with opportunities for ongoing education and professional development, for example, workshops and seminars,” says Barrera.
Nurses can also have more impact as a group. For advocacy purposes, a larger group of nurses can accomplish more, and that satisfaction is motivating. A network or group that is workplace-based can work for change in policies and processes for your immediate needs, just as a group that isn’t isolated to one location or workplace can take on broader issues in the industry.
If you can’t find the community that best supports your goals and needs, you can start one. “Nurses are the epitome of innovators and creators,” says McCamey. “We identify gaps and create solutions.” If a nurse feels there is a community lacking in a certain space, there are likely others who feel the same.
“As you build that community, people will come,” says McCamey. “The key to success is networking.” That doesn’t mean showing up at social events and conferences, although those are tried-and-true networking methods. McCamey says the pandemic removed barriers and that lets nurses form connections more easily. “You can reach out to people and ask for a conversation, and it’s socially acceptable,” she says. Before the pandemic, the rules around outreach were more rigid, but now nurses have new opportunities. Use texting, group chat, social media groups, or even academic institutions to help make the desired connections.
McCamey feels the need for connection deeply, saying that if a community like DNPs of Color can help make one nurse’s journey easier, that’s essential. “Life is better in a community,” she says. “It is always inspiring to see people get nursing fires relit.”
Finding the right nursing community can make a difference between staying in the field and leaving it for nurses who feel especially burned out or isolated. “It reduces feelings of isolation,” says Jarrin. “It feels good to share accomplishments and successes. Sometimes, it’s hard to draw attention to your achievements, but in a supportive community, it’s viewed as celebrating success. There’s a sense of, ‘We’re doing this together.’”
As a nurse, you’re empathetic and compassionate and go out of your way to ensure you provide your patients with the best possible care. But when it comes to looking after yourself, self-care may get prioritized far down the list – or not at all.
Such a mindset may be harmful to you and, ultimately, your patients. Nurses are great patient advocates, but “we do need to start advocating for ourselves because you can’t keep helping everyone. Then you don’t have anything left in your reserves,” said Linda Roney, EdD, RN-BC, FAAN, associate professor, Egan School of Nursing and Health Studies, Fairfield University.
“I think you have to be selfish, which is hard in a selfless profession to balance, but I think that is one of the ways that we can keep ourselves healthy. You have to prioritize yourself,” said Crystal Smith, DNP, RN, NE-BC, director of the medical-surgical unit at Children’s Nebraska.
As healthcare professionals and organizations celebrate Nurses Week with its theme of “Nurses Make the Difference,” now is a perfect time to assess your attention to self-care. In this article, we’ll offer practical strategies to help you care for yourself.
No Perfect Time
When it comes to self-care, “one of the biggest lessons for me is that self-care is not a one-size-fits-all,” said Roney. Nurses need to be aware of their unique needs.
Another awareness is not to wait for the perfect time for self-care. Roney said you can work on “small, incremental changes” for five or ten minutes that can accumulate over a day. You might try “habit stacking”: combining a potentially burdensome task with something enjoyable, notes Roney.
Days Off and “Zen Dens”
Smith meets with her new nurses at Children’s Nebraska in Omaha to discuss a self-care plan. If a nurse is struggling, Smith can consult the nurse’s plan and see the measures that might help that person.
One self-care policy at Children’s Nebraska allows nurses to take a day off if they need to recharge—if “your tank isn’t full enough to come in and give all of yourself that day,” said Smith. There are no negative repercussions should a nurse choose to do so.
Nurses are also encouraged to disconnect completely when they need a break. “It’s very hard to get away from the work when you’re at work,” Smith explained. Nurses are encouraged not to take their work phones on break but to trust that the staff can handle the patients while away.
Another self-care tactic involves “Zen dens.” When the hospital opened a new tower two years ago, these rooms were built into each unit. Zen dens have a lock, a massage chair, essential oil diffusers, books, and low lighting. A nurse can connect a phone to a speaker to play quiet music. “You can go in there and decompress how you need,” said Smith.
Smith noted that accessibility of these Zen dens is key. “We as organizations have always had places for people to do that, but never right on the unit. It’s tough to get a nurse or even a doctor to leave the unit where their patients are without any way to communicate with them.”
Added to these measures is a “Thrive” team, a department dedicated to employee wellness, noted Smith. Two members of Thrive are Howie, a golden retriever, and his handler, David. They may, for instance, join the staff for a debriefing after a difficult patient or family situation. Besides Howie and David, Thrive has a team of trained peer supporters and group facilitators available 24/7 for clinical and non-clinical team members.
Howie, the golden retriever, and his handler, David, make their rounds
What’s more, staff are encouraged to go home after a death in the facility. Death in general is very hard, noted Smith, “but I would say especially in pediatrics, it’s usually very traumatic. To expect the nurse who just went through that with a family and a patient to turn around then and take an entirely new patient, the mental load of that is really heavy. And so, to the best of our ability, we try to give them the option to go home.” At the same time, the facility understands that a nurse may want to stay at work instead of going home as a way of coping.
Back to Basics
As a nurse, you also need to take to heart the common-sense advice you probably give to patients about self-care, such as the following:
Sleep and downtime. You may want to spend some downtime on your phone, but be wary of it, noted Roney. “You feel as if you are relaxing and having a positive experience. But all this time is going on, cutting into your sleep/wake cycle.”
Nutrition and hydration. “If you talk to any nurse, most of us would agree we would put our needs after our patient, so there are many times we might miss a lunch break, or we may eat several hours later than we usually do because there might be something going on with our patient and we need to put their needs first,” said Roney. As a solution, “really be intentional and plan on bringing your meals and snacks to work.” Stay hydrated throughout your shift, noted Roney.
Simple measures such as making sure to take your breaks, eat your meals, and use the bathroom regularly while on shift are a start for self-care, according to Sarah K. Wells, MSN, RN, CEN, CNL, clinical practice specialist, practice excellence team, American Association of Critical-Care Nurses (AACN). Next, prioritize quiet times and activities that bring you joy each day.
Moments of Gratitude
Practicing gratitude can also help with self-care. In talking to an experienced nurse who was struggling, Smith told her, “You guys have to remember that the tiniest things you do make the biggest difference.”
Smith says, “Sometimes we must find and center ourselves around those tiny moments of gratitude. It’s easy to leave work and feel like your entire day was terrible. But really, you probably did many good things throughout the day.”
Along with their trauma and flight nursing colleagues, burn nurses are now privileged to demonstrate their expertise in burn care with the new Certified Burn Registered Nurse (CBRN) exam from the Board of Certification for Emergency Nursing (BCEN). Introduced in the fall of 2023, CBRN certification spans the entire burn care continuum including prehospital care and initial management, acute and critical care, post-acute rehabilitation, outpatient and community care, and aftercare and reintegration, as well as injury prevention, education, and psychosocial patient and family support.
With this new certification, burn nurses are uniquely positioned to highlight the important role burn nurses play in the care of traditionally underserved communities. As burn injuries are often associated with several social determinants of health, including poverty (Patel, 2018), food insecurity (Elsey, 2016), and living in under-resourced neighborhoods (Alnabantah, 2016), burn nurses play a crucial role in caring for some of the patients most in need of care.
Burn nurses’ work is similar to that of critical care specialties like trauma and emergency nursing. However, burn nurses are also responsible for complex wound care, often requiring hours-long procedures in patient rooms. This affords burn nurses one-on-one time with their patients, allowing them prolonged individual time to assess individual socio-demographic risk factors better. This individual time also provides an expanded role for the burn nurse, often taking on the caretaker and trusted confidant role. In this role, burn nurses can better assess the needs of their patients post-discharge, anticipating potential problems like lack of transportation, living conditions without heat or electricity, or unstable food resources.
The ability of burn nurses to anticipate these needs post-discharge is such a crucial aspect of their role that it is a component of the CBRN exam. The CBRN exam tests burn nurses for diversity, equity, inclusion, community outreach, and interprofessional collaboration knowledge. In addition to acknowledging the unique role these nurses play in recognizing and intervening when necessary, the CBRN exam also acknowledges the difference in the presentation of both burn injuries and skin disorders like Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN). Given the recent acknowledgment of the lack of diversity in medical education training (Louie & Wilkes, 2018), it is vital for all nurses. However, burn nurses should know the differences in presentation for full-thickness burns and skin injuries in light versus dark-complected patients. In addition to including DEI as a testable item, CBRN item writers and exam construction review committee (ECRC) members made a concerted effort to include depictions of all skin tones to test this knowledge.
As a burn nurse of almost 13 years, I have seen the profound difference providing culturally sensitive care has made to patients in our burn center. When I started caring for patients with burns, for example, we used one type of shampoo and one type of lotion for all of our patients. While it seems like a small piece of care, providing products designed to work with the patient’s hair and skin demonstrates a commitment to culturally competent care. I profoundly hope that as we continue to make strides in educating burn nurses, we find new ways to provide the best care possible to all our patients.
REFERENCES
Louie P, Wilkes R. Representations of race and skin tone in medical textbook imagery. Soc Sci Med. 2018 Apr;202:38-42. doi: 10.1016/j.socscimed.2018.02.023. Epub 2018 Feb 23. PMID: 29501717.
Elsey H, Manandah S, Sah D, Khanal S, MacGuire F, King R, et al. (2016). Public Health Risks in Urban Slums: Findings of the Qualitative’‘Healthy Kitchens Healthy Cities’ Study in Kathmandu, Nepal. PLoS ONE 11(9): e0163798 Doi: 10.1371/journal.pone.0163798
Alnababtah K, Khan S, Ashford R. Socio-demographic Factors and the Prevalence of Burns in Children: An Overview of the Literature. Paediatrics and International Child Health (2016). 10.1179/2046905514Y.0000000157 [PubMed] [CrossRef] [Google Scholar]
Patel DD, Rosenberg M, Rosenberg L, Foncerrada G, Andersen CR, Capek KD, Leal J, Lee JO, Jimenez C, Branski L, Meyer WJ 3rd, Herndon DN. Poverty, population density, and the epidemiology of burns in young children from Mexico treated at a U.S. pediatric burn facility. Burns. 2018 Aug;44(5):1269-1278. doi: 10.1016/j.burns.2018.02.003. Epub 2018 Mar 7. PMID: 29551448; PMCID: PMC6453533.
This National Nurses Week, learn more about Mary Eliza Mahoney, America’s first professionally-trained Black nurse whose birthday lies on May 7, the second day of National Nurses Week.
Mahoney’s journey to becoming a nurse in the 1800s was full of setbacks she couldn’t control, yet she persevered to create a decades-long career as a nurse known for compassion and bringing comfort to others.
However, her story doesn’t end there—she later became a well-known leader in the nursing field, co-founding the National Association of Colored Graduate Nurses (NACGN) in 1908 and supporting the women’s suffrage movement before it became popular. She was inducted into the National Women’s Hall of Fame in 1993 for her contributions to breaking racial barriers in nursing.
Today, Mahoney inspires Black nurses and other nurses of color who relate to her struggles in a world where breaking the mold is never easy.
From Nurse Aide to Nursing Graduate
Born in Dorchester, Massachusetts, on May 7, 1845, Mary Eliza Mahoney knew at a young age that she wanted to be a nurse. She started her career at the New England Hospital for Women and Children at the age of 20. The hospital was progressive in its time, including an all-women staff of physicians, and provided healthcare to only women and their children. Mahoney first worked as a nurse aide among licensed nurses, but her wages were too low, so she worked in various roles, including washerwoman, janitor, and cook.
After 15 years of domestic service duties, Mahoney was offered a spot at the hospital’s prestigious graduate school in 1878, assisted by a doctor who believed in her potential.
The graduate school’s program was intensive, consisting of 16-hour days learning how to prep and complete ward duty, overseeing up to six patients. The program was so intensive that out of the 42 accepted students, only four remained, including Mahoney. However, Mahoney’s hard work ethic and experience in nursing paid off. After 16 months in the program, she graduated with her nursing diploma, making her the first professionally trained Black nurse at the time.
Mahoney’s Legacy to Nurses
For the next four decades, Mahoney worked as a private nurse to wealthy white families in the Boston area due to discrimination against Black women in hospitals and other professional settings. Mothers and families who worked with her admired her professionalism and work ethic, and she received requests across the Northeast to work with other wealthy families. Over time, Mahoney grew fond of her work, referring to her clients as family.
Mahoney knew that her work would set an example for minority nurses who could work in fields outside of domestic service. As a result, she raised the bar for more Black women to find careers in nursing and similar professions.
In her later years, Mahoney was a vocal advocate for all nurses, including nurses of color. From 1911 to 1912, she was the director of the Howard Colored Orphan Asylum for Black children in Long Island, New York. As a leader in the NACGN, she was already known as a pioneer in nursing. She gave the welcoming address at the NACGN Convention in 1908 and was made an honorary lifetime member and elected chaplain in 1909.
In 1923, Mahoney was diagnosed with breast cancer and died on January 4, 1926, at the age of 80. To remember her legacy, the NACGN created the Mary Mahoney Award in 1936 for any nurse who made a lasting contribution to social justice within their field. This award is still being given today by the American Nurses Association (ANA) after the NACGN merged with the organization.
Mahoney’s legacy shows the values many minority nurses bring to the field. Her efforts to build organizations that highlight the accomplishments of minority women teach what every nurse of color can offer to patients today.
Learn more about Mary Eliza Mahoney
If you want to learn more about this nursing pioneer, here are some resources for a deeper look at her past and significance to nursing:
BlackPast is an online encyclopedia providing information on Black history internationally, especially in North America. Read Mary Eliza Mahoney’s biography and learn more about the history of Black nurses in the U.S.
The American Association of Nurse Practitioners (AANP) wrote an article on the impact of Mahoney’s work on diversity, equity, and inclusion in nursing.
As part of the ANA’s Journey of Racial Reconciliation series, the organization will host a webinar on Mahoney’s birthday with diverse nursing leaders on how nurses can draw inspiration from her impact on the field.
At a point in my career, a devastating event deeply affected me. One of my former nursing students, a vibrant young Black woman, tragically lost her life and the life of her newborn during childbirth. Despite access to healthcare, she fell victim to maternal complications that ended in her untimely death. This loss was not an isolated incident but rather indicative of a more significant crisis facing Black mothers in the United States – one that is not just a healthcare issue but rather a matter of social justice and equity.
In recognition of National Nurses Week, it’s crucial to reflect on nurses’ profound impact on healthcare, particularly in addressing health disparities. This year’s theme, “Nurses Make the Difference,” resonates deeply with me, as I have dedicated my career to advocating for improved maternal health outcomes for Black women and preparing nurses for careers in healthcare aimed at advancing health equity.
Every maternal death is a devastating tragedy that leaves a hole in families – representing a forever-altered dynamic. Perhaps even worse, statistics from the Centers for Disease Control and Prevention show that most maternal deaths are preventable.
This staggering data also demonstrates that Black women are nearly three times more likely to die from pregnancy-related complications than white women. Morbid racial disparities such as these do not have a place in the 21st century. Still, they are exacerbated by socioeconomic factors, a shortage of providers, and a lack of access to quality healthcare.
Central to this work is the recognition of the lived experiences of Black women. Factors such as poverty, barriers to healthcare access, and lifestyle choices are frequently used to explain the disparity in Black maternal health; however, these factors alone are inadequate to explain the problem. Healthcare providers often fail to see their patients as individuals with unique needs and concerns. Implicit bias and cultural incompetence compound these disparities, leading to substandard care and poor outcomes.
To effect meaningful change, we must address these root causes head-on. This includes increasing access to quality healthcare, fostering diversity and inclusivity in healthcare practices, and educating healthcare workers to be culturally competent and understand the social determinants of health.
Increasing access to quality healthcare is essential, and addressing the nursing shortage is a top priority when it comes to Black maternal health. By creating new programs and expanding existing ones that reach future healthcare workers, we can help prepare the next generation of diverse nurses who can reduce the burden on the current population of healthcare workers and meet the evolving needs of society – especially Black women.
As a nurse educator with over 18 years of experience in higher education, I believe education is integral to creating positive, sustainable change. At Walden University, where I serve as the associate dean for the BSN program, our online curriculum emphasizes the social determinants of health and the role of nurses in addressing health disparities. I am particularly excited about a new course we launched this spring, “Advocating for Diversity, Equity, and Inclusion in Healthcare.” This course, among others at institutions like Columbia and Frontier Universities, challenges students to confront their biases and privilege while equipping them with the tools to advocate for inclusive and equitable care. Our focus areas include implicit bias, systemic racism, microaggressions, health disparities, the healthcare ecosystem, and advocacy strategies to improve healthcare outcomes. These programs, which establish a better understanding of the unique experiences of our diverse population, are just a part of the solution. Patient outcomes can also be significantly improved by changing the face of those who deliver it. With minority populations experiencing disproportionate rates of disease and death, it is clear we need to create pathways to the nursing profession for all, regardless of ethnic, religious, or financial factors.
One way to do this is by providing educational access to those who may not yet have had the opportunity, which can mean emphasizing online education programs. This approach enables students to earn their degrees from where they live and encourages the development of nurses who practice within their communities, reflecting the communities they serve. This is a proven way to improve the healthcare outcomes of minorities, and it has the additional benefit of combatting the nursing shortage, particularly in rural areas.
Nurses, educators, policymakers, and advocates must join forces to dismantle the systemic barriers perpetuating healthcare inequality. Our industry has a unique opportunity to drive change and promote health equity by elevating the voices of marginalized communities, challenging implicit biases, and advocating for policies that prioritize equity and justice.
As we celebrate National Nurses Week, let us recommit ourselves to compassion, advocacy, and equity principles. Together, we can make a difference in the lives of Black mothers and ensure that every woman receives the quality care she deserves with the understanding she needs.
Nurses Week occurs every year during the second week of May, and much fanfare is made of the pizza parties, tote bags, water bottles, and signs proclaiming “heroes work here.”
If we want to be more thoughtful and reflective about the phenomenon of National Nurses Week, there’s much more to this annual moment of recognition than these familiar superficial trappings.
And since Nurses Week is built around the celebration of Florence Nightingale’s birthday (May 12, 1820), it’s appropriate to wonder what the veritable godmother of modern nursing would think of how we do (or don’t) celebrate our profession.
What Would Florence Think?
The American Nurses Association (ANA) has chosen the theme “Nurses Make the Difference” for the 2024 celebration. While not altogether original or overly inspiring, we can all agree that nurses make a difference in patient care, research, entrepreneurship, academia, technology, and other areas of endeavor.
Would Ms. Nightingale agree that nurses make a difference? She certainly would, and I would venture that she would have much to say about how that statement rings true. In her time, nurses were purveyors of comfort, cleanliness in the form of improved sanitation and hygiene, and the carrying out of physicians’’ orders in caring for the infirm, the injured, and the dying.
In Nightingale’s theory, nurses aimed to ensure that patients were cared for in a manner that allowed nature to intervene in the interest of their health (e.g., the healing of wounds, the resolution of infection, etc.). If she saw nursing as “the activities that promote health which occurs in any caregiving situation,” nurses make a difference by assuring patients are cared for in a way that maximizes their healing potential. And if, as can be asserted, Nightingale’s theory sees illness as “the absence of comfort,” nurses’ ability to provide comfort can make all the difference in the world.
There’s no doubt that Ms. Nightingale would agree that nurses’ ability to provide positive interventions in the interest of patients’ healing is a central mission of the profession. However, what would she think of how we recognize nurses for their efforts during the annual celebration of her birthday?
In Nightingale’s day, there were no tote bags or water bottles bearing the hospital logo, nor were there pizza parties, greeting cards, and banners hung over hospital entrances. While it’s all conjecture on our part, one might hope she would look down upon such superficial acknowledgments of nurses’ worth.
Even though Nightingale was a revolutionary, out-of-the-box thinker as a Victorian woman, she might still be significantly shocked at the wages nurses command in the 21st century. She would also likely be shocked by the salaries earned by hospital CEOs, let alone the power of the insurance industry.
As a brilliant and forward-thinking woman, Nightingale would be likely quick to understand that women’s place in 21st-century post-industrial society has dramatically evolved since her time, and one could imagine that she would be wholly supportive of nurses receiving increases in salary, benefits, and other forms of recognition that demonstrate acknowledgment of their value as healthcare professionals. Plainly stated, Nightingale might be heard to remark, “Give those nurses a substantial raise — they deserve it.”
Reflecting on Nurses Week
Some hard-working nurses will likely appreciate an employer’s gestures during Nurses Week through food, gifts, and banners expressing gratitude for their contributions.
That said, salary increases, improved benefits, tuition and certification reimbursement, and other support for nurse professional development would likely be much more well-received. Improvements in staffing, protections against workplace violence, and updated technologies that truly make our work easier would also likely be much more well-received.
Nurses make a difference, and the satisfaction of a job well done can go far in creating one’s personal sense of self-worth, especially when coupled with patients’ and colleagues’ respect.
Nurses Week is a moment to pause for the cause and reflect on our value in the scheme of things. Tote bags and pizza aside, our work’s true value provides meaning, and Nightingale knew this too well.
What would Nightingale think? She would think that 21st-century nurses have greatly advanced the profession. She might also remind us that what we feel in our hearts—and the thoughts we have about who we are and what we do—always matter most in the larger scheme of things.
Dorma Liz Davila (Lizzy) RN, BSN, CPN, EMT never expected a quick volunteer weekend as a camp nurse to provide a transformative experience, but it did. And now she wants other nurses to know how helping kids at Paul Newman’s The Hole in the Wall Gang Camp can breathe new life into their nursing careers.
The Hole in the Wall Gang Camp is an organization that provides what the organization calls “a different kind of healing” to thousands of seriously ill children and family members every year. The campers attend completely free of charge and are cared for by the skilled nurses who volunteer in the infirmary for a weekend, a week, or more.
Davila, who works as a pediatric critical care transport nurse, first volunteered last year when a colleague who works as a camp nurse there told her they needed nurses for the Spanish-speaking family weekend. Her colleague had talked about how much she enjoyed being a camp nurse there, so Davila decided to give it a try. But she didn’t really know what to expect.
The first day, Davila got a crash course in the facility, the campers and their conditions, the equipment she’d need, and that was before even meeting all the new campers. But it didn’t take long for her to feel something she didn’t expect. “The first time I went I just fell in love,” she says. “It is like no other job. It’s just completely different.” Davila’s feeling from that one weekend spurred a commitment to future work, and she will also participate as a camp nurse this summer. “I got hooked,” she says. “I said ‘I am your Spanish weekend nurse.'”
The biggest surprise for Davila was how joyful the camp experience is and how much fun she had personally. As a transport nurse, Davila sees patients at their worst, she says. So coming to the camp, she was able to see the kids just having fun, building relationships, and having some freedom, despite their illnesses. And she says it’s also different from working as a bedside nurse with the associated stress of potentially having too many patients or caring for patients in a rushed environment.
While Davila provides support and is there for medical emergencies, during the Spanish weekend, families come with their children and provide the usual medical care they provide at home. “I am there as a nurse, but I am also with them doing arts and crafts or meeting them at the tower for the zip line,” she says. “It’s almost like I am a camper. It’s not like I am on the sidelines.” And while she’s working with the children, she’s also working with the families who appreciate the support and camaraderie of the medical staff and the other families.
Davila didn’t attend camp as a child and was curious about what it would be like. What she found as an adult was an experience that struck a sensitive chord. The campers’ families and caregivers often talk about how the children are teased in school by other kids who don’t understand their medical needs or equipment they must use. At the camp, the feeling of pure acceptance is something Davila felt personally–and it affected her profoundly.
“To go to the camp and see these kids laughing and smiling and there are no kids picking on them,” she says. “At camp, no one puts anyone else down.” As a Latina nurse born and raised in Puerto Rico, Davila says feeling different or other, something that happens in the real world, was entirely absent at the Hole in the Wall Gang Camp. “I came home and said this was a fairy tale world within the real world,” she says. “It’s like a bubble.”
Davila encourages other nurses with pediatric backgrounds and training (particularly training in emergency medicine or urgent care (pediatric or adult), pediatric intensive care, pediatric hematology/oncology, pediatric metabolic/mitochondrial disease, and pediatric immunology) to consider working at the Hole in the Wall Gang Camp or one like it. As overwhelmingly positive as it is to see the campers truly bloom during the weekend, Davila says the staff are impacted as well.
“I wish I could have people experience this,” she says. “It was therapeutic for me too. I recommend this to all nurses.”
