Like many minority nurses, Jackie F. Webb, DNP, FNP-BC, RN, associate professor at Linfield College School of Nursing in Portland, Oregon, had to overcome many challenges on her career path to becoming a family nurse practitioner.
Webb is the daughter of immigrants to the United States and is a first-generation college graduate. Her parents worked hard to provide for their family and instilled the importance of going to college. It wasn’t until Webb got a job in a nursing home that she set her sights on becoming a nurse.
“I did not start out college knowing I wanted to be a nurse,” says Webb. “It was the experience of working in a nursing home and meeting an incredible nurse who exposed me to the challenges of nursing that convinced me to major in nursing. Looking back, I realize the time this nurse took to help me see the power and art of nursing, and her support is what gave me the belief I, too, could be a nurse.”
Webb initially thought she wanted to work as a critical care nurse, but soon realized she was most interested in preventing patients from ever needing a critical care unit.
“Working as a public health nurse opened my eyes to the challenges of seeing patients in their own homes, without fancy equipment but my stethoscope and a BP cuff, and my ability to really listen and take a thorough health history.”
This experience motivated Webb to go to graduate school and become a nurse practitioner where she learned how to manage chronic illnesses and how to incorporate cultural beliefs into the patient’s management plans. She has been a family nurse practitioner for more than 30 years.
Like many minority nurses, along the way Webb had several challenges to overcome.
“Not having role models, not having parents who knew how to navigate the world of college applications, finances, scholarships, etc. Additional challenges for me included not having good writing skills, not having a rich vocabulary, and not having experiences like so many of my friends. My parents didn’t take vacations, they didn’t belong to book clubs, they didn’t have dinner parties nor did they have their brothers and sisters or any family member close by. They both had to work long hours to afford a roof over our head. The isolation of being a first-generation immigrant was at times difficult.”
Webb believes that there are ways for colleges and universities to help immigrant and first-generation college students overcome the unique challenges they face.
“Colleges and universities who work with immigrant students and/or first-generation college students need to know that these students are for the most part willing to work harder than any other student population,” says Webb. “For some they see how hard their parents work to just keep food on the table, they don’t take anything for granted. These students are grateful for any type of assistance and will overcome amazing barriers to obtain their college degrees. Many of these students end up inspiring other students and take on challenges many students are fearful to take. Many students value their college community and will take on various leadership roles.”
So what advice would Webb offer to minority nursing students today? “I would tell them to value their personal stories,” says Webb. “Value your history and that of your family. Be proud of the hard work your family has gone through to get to where you are now. The passion, the self-reliance, and support students have will get them very far.
Webb also encourages minority students to reach out for support. “For many students of color they are the first to attend college. This is an incredible journey they are undertaking and they cannot do it alone,” says Webb. “It is so important that they find a mentor or advisor so they can feel comfortable asking how to navigate this new journey. Use every available resource so you are able to be successful. Don’t be afraid, embarrassed, or feel that asking for help is a sign of weakness. I believe it is absolutely the reverse: asking for help is a definite sign of strength as it shows you are ready to do the work.”
Last Saturday, as part of a program called “Minority Nurse Leadership in the 21st Century,” about 100 minority nurses from all around California met at Saint Agnes Medical Center in Fresno to discuss the role of nurses in patient advocacy and leadership. According to statistics, 40 percent of the California population are Latino while only 7 percent of the nurses statewide are Latino, proving the need for more minority nurses in California.
A 2014 Board of Nursing report from the California State Board of Registered Nursing reported that Latinos will continue to be underrepresented and become even more underrepresented in the nursing workforce in the future. African American nurses are also expected to be underrepresented until 2030, while all other racial groups continue to be overrepresented compared to the general population.
The number of white nurses in the workforce has declined from 77.2 percent in 1990 to 51.6 percent in 2014. This decline leaves the most highly represented nonwhite group of nurses as Filipinos at 20.3 percent of the workforce, with non-Filipino Asian nurses at 8.5 percent, and black nurses at about 5 percent.
Pilar De La Cruz-Reyes, a member of the California State Board of Registered Nursing and director of the Central California Center for Excellence in Nursing at Fresno State, says the purpose of the minority nurse meeting in Fresno was to get more minority nurses into leadership positions so they can serve as role models and mentors to minority students who want to go into nursing but don’t see a realistic way to get there.
Kimberly Horton, chief executive officer at Vibra Hospital of Sacramento, says that nursing is an opportunity that many Latinos have never thought about so nursing programs need to be marketed to that population, and using minority nurses to educate their peers about the nursing profession is a great way to get started. Horton is an African American registered nurse and she was one of five speakers at the Fresno meeting.
Minority nurses can be wonderful advocates for patients, bringing a special understanding of health beliefs that are ethically, culturally, and religiously based and that can have a real effect on patient health. By including nurses who represent ethnic groups in the development of patient health care plans, health care teams can better develop logical plans for treatment that won’t negatively impact the health of minority patients due to common misunderstandings or misperceptions that patients have about their health and treatment.
Top 5 Tips for Graduate school
So, you are thinking about completing your Master’s degree. You may be just graduating with your bachelor’s, established in your career, seeking career advancement, or an overall career change. You should commend yourself wherever you currently are in your professional journey. Graduate school is essential for career progression and as daunting as the challenge may be it is feasible and worthwhile. However, there are certain things that I wish I had known previously to enrolling in my first graduate courses that would have saved me a ton of grief on this grad school journey.
Learn the APA Manual
Do you briefly remember being introduced to this in your undergraduate English and Research classes? You know, the blue book that you couldn’t wait to toss as soon as you completed those courses! Well, don’t get too excited and toss that manual out just yet. The APA manual will be your bible at the graduate level. It is best to not only familiarize yourself with it but read it cover to cover. In all seriousness, there will be no mercy for APA formatting issues at the graduate level, and failure to comply will hinder your ability to graduate. Let’s be honest; graduate school is very expensive so do not lose points over APA errors and get your bang for your bucks when it’s time to cash in on that top G.P.A.
Grad school will push your writing capabilities to the maximum. When I first started, I went in under the false pretenses that I was a decent writer. After all, my highest scores were always in English and Language Arts. However, never underestimate the power of proofreading your document, or having someone else review it. It is important to remember that you are not supposed to be writing as if you are talking in scholarly writing. Read every single thing you submit out loud at least two times before turning it in. You will be surprised at some errors you will find in your documents once you hear it out loud. I swear by Owlet Purdue, Grammarly, and PERRLA to assist with the completion of my papers.
One of the biggest mistakes that I made during my Grad school journey was “taking a break”. Apparently, life happens to everybody, but if you can help it, you should stay on the course to graduate on time. While taking a leave of absence is certainly an option, there are some universities have a time limit on the amount of time you can spend on the completion of your master’s degree. Taking a leave of absence sounds a nice break until you return and you are under even more pressure to complete your degree. Stay on track and graduate on time. Put yourself out of grad school misery. Try not to prolong it.
My zodiac sign of a Libra makes finding balance very high on my priority list. Regardless of your sign, it is essential to find a way to balance everything you have going on in life. Many of us are career focused, have spouses or partners, children, and community obligations. There are going to be some times that you will simply have to say no to others as well as avoid taking on too many additional duties. You have to be able to take care of yourself before you can take care of others. Do not feel guilty about taking a step back or going on a much need hiatus to keep everything together. Remember that this is temporary, and there will always be opportunities to restock your plate once you have graduated.
Cost vs. Reputation
This has been an ongoing debate for such a long time. I will give you my honest opinion and say that it is best to go for value in regards to selecting a school to attend. There is absolutely nothing wrong with investing yourself, but please do not break the bank along the way. Try your very best to avoid debt, save up, and develop a reasonable budget that you can use to finance your educational goals. If you are shelling out a ton of money, ensure that the institution has a reputation that fits your tuition bill. Student loan debt is a serious problem. Remember that you will need to pay that money back, and if this degree does not make a high paying job seem promising to you it may be necessary to scale back. Remember, grad school isn’t cheap!
Wrapping it All Up
I hope that you avoid the pitfalls that I incurred during my grad school journey and that these tips will help ease you in your transition and prepare you for entry into grad school. A graduate degree is totally obtainable; it’s just a different academic dynamic. I’ll see you on the other side!
“ Once you know yourself, in this living stillness, there is nothing in this world that is greater than you”
One of the elements of discovery is “stillness”… I am sure you are thinking, ” What does that really mean? As healthcare professional, how can I incorporate STILLNESS into my life when I have been trained to move and move fast because it is the difference between life and death?”
Guess what, IT IS POSSIBLE! Let’s break this down a little bit more.
Many people see the word “stillness” and automatically think it means to have no movement which is true to a certain point, but from the perspective of discovery, “stillness” is the state of being or being one with yourself. Not thinking about the kids, what you have to cook for dinner, the bills you need to pay, but can’t… the job you dread, the co-worker or friend that gets on your nerves, etc. I mean you DO NOT think about any of that, just simply BE!! In the state of being is where we really and truly get to “know thyself” and not what everyone else tells us about ourselves. In stillness we allow the voice of the holy spirit, which is our GPS navigation system, to guide us through the streets called life. In stillness we learn to quiet the mind and not allow anything that is going on around us affect us. So when you are in a state of stillness, it doesn’t mean that things are not going on around you, it means that they are not going on within you. Let me make it a little clearer for you, you can be at work on a 35 bed med-surg unit with 10 physicians and 3 respiratory therapist on the unit, family all over the place, a supervisor who is screaming at staff, and a co-worker who scrolling through her social media timelines chilling while you have 10 outstanding task and not let ANY, I mean ANY of it affect you internally. The key is to create an intention of stillness which can be achieved by having some intentionality about how you are carrying yourself in a given moment and focus on what is within your control.
Now that we have what stillness means from the perspective of discovery out of the way, I can hear you saying “ Nicole I don’t have time for that”, I have to take care of my family, walk the dogs, manage all the household chores, manage the financial accounts, and I am sure that the list could go on and on but guess what you CAN practice stillness through all of this (I am not telling you what anyone told me but what I know)!! And to be honest if you want to live a life purposefully as a healthcare professional according to Gods’ will then it is a non-negotiable.
So let me share 4 tips that helped me to begin my practice of stillness and make the practice of stillness a ritual in my life.
1. Deep Breath- Yep simply deep breath! I hear you saying “and what is that going to help”? When we take deep breaths it induces the parasympathetic system and slows down your heart rate, which leads to a state of relaxation (use this one when you have trouble going on all around you so that it is not going on in you).
2. Schedule Time to Be- Look lets keep it real we all live busy life’s that pull us in 50 directions and many us live by a Google calendar which tells where to be and when. Well guess what place your “Be Time” on there too. It has been proven that anything we do for 21 days becomes a habit.
3. Get off Social Media- Yep I said it!! Get off Facebook, Instagram, Snapchat, etc. stalking pages and looking at fairytale lives that often don’t exist and practice just “ Being” (I was once guilty of this one, LOL). With the hours we spend on these sites weekly, we can really get to “know thyself” and find our purpose as a healthcare professional.
4. Find a Location that brings you Serenity- Know I know I said the state of being can happen when trouble is all around you which means we can have stillness anywhere but to get to a place where we can do this, we can get practice by doing it in areas where we find peace. So that may be by the water, outdoors with the birds chirping, a certain room in your home, etc. Practicing stillness in a location that brings you peace prepares you to be able to do it anywhere.
These tips are the very tip of the iceberg for practicing stillness because stillness goes much deeper but I wanted to start with building a foundation for you to build upon.
Remember in Psalms 46:10 we were told to “ Be still and know that I am god”.
A law is defined as a system of rules that are enforced through social institutions to govern behaviors. As citizens of our respective countries we all try our best to abide by the laws that have been set forth by our government so we can avoid any havoc in our lives and remain in a state of freedom. But what about laws for success and or to navigate this thing called life…do we have a system of rules in these capacities? According to Deepak Chopra there is a system of rules that have been set-forth to govern our path to success and life. In the book titled “ The Seven Spiritual Laws of Success” we are presented with a set of laws that serve as a practical guide to the fulfillment of our dreams.
My first thought when reading the title of the book was “ok so now I have another set of laws that I must adhere to if I want to be successful and have a fulfilling life, here we go with more rules and regulations”. However, after reading the statement “ Success is a journey, not a destination” and that “the law of success and life is the process by which the unmanifest becomes the manifest; it’s the process by which the observer becomes the observed; it’s the process by which the seer becomes the scenery; it’s the process through which the dreamer manifest the dream” in the introduction alone, I knew there was something different about these laws. I had a sense that these laws were getting ready to go into a deep spiritual space in which I honestly knew needed to be rattled up within me, so I dived in head first.
After being intrigued by the introduction, there laid the seven spiritual laws to success which were The Law of Pure Potentiality; The Law of Giving; The Law of “Karma” or Cause & Effect; The Law of Least Effort; The Law of Intention and Desire; The Law of Detachment; & The Law of “Dharma” or Purpose in Life. Each of these laws made me have a “ That’s Right ”moment as they went deeper and deeper into my spiritual space.
The law of Pure Potentiality let me know that I need to be still! Often times with the daily hustle and bustle of life and all the different moving pieces of our lives we don’t have to time to just sit in stillness. God has an assignment for each one of us and wants to give us special spiritual instructions to carry out our divine assignments, to go in the direction he wants us to go, or operate in the capacity in which he wants us to operate in but we are not in a state of stillness to hear from him.
The law of giving impressed upon me that I am not given money, joy, peace, etc. to hoard it, but rather I am given these things to share with others and every time I encounter someone I must GIVE! I must give a prayer, a compliment, a word of encouragement, or a flower. My giving can be material or nonmaterial but the bottom line is I must give something.
The law of “Karma” or cause and effect made me realize that before I perform any action, I need to ask myself two important questions, which are “what are the consequences of this choice that I am getting ready to make? and will this choice bring fulfillment and happiness to me and those involved?” and if the answer to these questions are not favorable then I need to stop in my tracks and consciously rethink my actions.
The law of least effort made me aware that I am not obligated to defend my point of view to anyone, but rather take that energy and put it toward something more purposeful.
The law of intention and desire provided me with a sense of ease as it let me know that my attention needs to be in the present, then my intent for the future will manifest because my future state is being created in my present state, as I must accept the present as it is.
The law of detachment forced me to come out of my comfort zone and to go into the area of uncertainty which is where all possibilities are located. When we detach from the norm then we are no longer attached to the things in which we are truly fearful of because in attachment lies our fears and insecurities.
The law of dharma or purpose in life encouraged me find my divinity. I was created for a purpose that me on only me can fulfill. It doesn’t matter how many other people do what I do, only I can do it my way with the talents and gifts that I express only the way that I can express them. Once I had the courage to truly get to know thy self then I was able to serve humanity by living on purpose.
To sum up what these laws have done for me is simple, they are ensuring that I am a law-abiding citizen who lives on purpose!
Medical Malpractice is defined as the improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional. Let me help make this a little bit clearer for you and share a few interesting facts and figures about medical malpractice:
- The belief that malpractice suits are filed with the intention of making a lot of money is false. A study done between 51 New York hospitals showed that poor, Medicaid, or uninsured patients are significantly less likely to sue for malpractice.
- The ratio of the number of people that die due to preventable mistakes and the number of people who file a lawsuit is low. According to the Institute of Medicine, about 98,000 die each year due to preventable mistakes, and hundreds of thousands more are injured because of them. However, only one in eight people actually file a lawsuit.
- The states with the highest per capita malpractice payouts are New York, Pennsylvania, New Jersey, Massachusetts, and Connecticut. While the lowest states are North Dakota, Texas, Wisconsin, Mississippi, and Indiana.
- It seems like a no-brainer that medical malpractice is preventable, but it’s the third leading cause of death in America. According to the Journal of the American Medical Association, 80% of events in the healthcare system are the result of human error.
- Malpractice suits usually deal with serious injury, and most people don’t bother suing over small accidents that don’t leave any lasting harm. In 75 different countries, 90% of malpractice suits involved permanent injury or death.
- Although nurses are usually in charge of nursing homes patients, many states have adopted special procedures for nursing home issues that don’t fall under malpractice.
- While the number of doctors has increased, some doctors still feel they’re handling too many patients. According to the Maryland Practice Team, 40% of doctors feel their patient volume can lead to errors.
- America spends $2.2 trillion a year on healthcare, and only $7.1 billion on defending claims and compensating victims. While that seems like a lot, it only accounts for 0.3 percent of healthcare costs.
- There are two common reasons for a malpractice suit. For inpatient errors, 34% of malpractice suits were because of surgical errors. For outpatient errors, 46% of malpractice suits were the result of errors in diagnoses.
- Only 7.6 percent of doctors found guilty in two or more malpractice suits were punished, and only 13 percent of doctors who were guilty in five or more malpractice suits were punished.
Wow, so that was a lot right? Yes it was! These interesting facts and figures may have you wondering how can I avoid being apart of a medical malpractice suit where I am defending my actions as a clinician. Well I am glad you asked! I would like to share 5 tips to help you remain free and clear of being a defendant of a medical malpractice case:
- Document, Document, Document– As a legal nurse consultant, I can’t tell you how many nurse are not documenting properly. Remember the things we were all taught in nursing school ” if it was documented, it wasn’t done!! It is very hard to go before a court and say “Oh I did it, but I forgot to document it”. I can tell you this is a automatic strike against you. Also make sure your documentation is clear and concise. It should paint a very clear picture of exactly what happened while that patient was in your care and not leave anything to the imagination.
- Check Physician Orders a Minimum of 3 Times Before Carrying Them Out- Listen I know how it is to be on a floor with 6 patients, all of them needing IV pushes, 3 of them are on the call light, and the physician is giving you 10 orders; can you say frustrating!! But we have to slow down and verify physician orders and if they do not seem right, don’t be afraid to question the physician on the orders. I have witnessed countless medical malpractice cases where the nurse carried out incorrect orders or orders that should have made a light bulb go off in their head and say ” I don’t think this is right “, and they didn’t verify the order and carried it out which caused serious damages to the patient.
- Write Your Notes Legibly– For some of us we are not yet at a stage where we have the privilege to document on our patients in a computerized charting system through our respective employer. So we are still hand writing our documentation. The barrier with that is that notes can become extremely hard to read at times thus leaving a lot of room for questions should a patient that you ever took care of decides to file a medical malpractice suit. Now while you can definitely explain to a court what the notes says while in the middle of a medical malpractice litigation suit, why send yourself through that headache of having to do that when you can just write legibly.
- Communicate– Communication is key! We know this to be true in every area of our life and this is no different within the healthcare profession. To prevent from making any type of error on a patient that you are caring for, you must communicate with all parties involved in their care and that includes but is not limited to the physician, certified nursing assistant, charge nurse, radiology, social worker etc. Everyone has to be on the same page with what is going on with the patient and notify each other of any critical information that is going on with the patient. I have seen numerous cases where the clinican indicates ” Well I didn’t do xyz because no one communicated this information to me. NOPE, that is not going to fly!! We are licensed professionals that have taken an oath and we must act as so, so we must COMMUNICATE.
- Always be a Student– Like everything around us, healthcare is changing. Which means we must change with it, we must stay updated on the latest and greatest, on the practices that were once in practice that has now been eliminated, etc. Attend conferences, take that class you employer is offering, really pay attention in those continuing education courses. We are ultimately responsible as licensed clinical professionals to provide care that is current, up to date, and the standard for our profession.
Nicole Thomas, RN, MSN, CCM, LNC