Recruiting more minority nursing students is one battle that must be won to increase nursing diversity. Another important battle: ensuring these students graduate and stick with nursing through their first few years when turnover tends to be high. Mentoring is proving to be a critical type of support to help novice nurses steer successfully through early career challenges.
Marisol Montoya, BSN, RN, had one semester left at the SUNY Downstate Medical Center’s College of Nursing when she recognized she needed help navigating the next phase of her career. “I knew I would be walking into a foreign land very soon,” Montoya says. “I would have to take my NCLEX, and then I was going to have to look for a job.”
Thanks to a mentoring program offered through the National Association of Hispanic Nurses (NAHN), Montoya has spent the last year under the tutelage of a fellow Hispanic American nurse, Miriam “Mimi” Gonzalez, BS, RN. Gonzalez was able to provide Montoya with targeted support right when she needed it, drawing on her experiences and connections as one of NAHN’s founding members and a 50-year career as a labor and delivery nurse.
“I believe mentorship relationships are incredibly valuable anytime anyone is going through a transitional period,” says Montoya, who recently started a job as a postpartum nurse at Mount Sinai Health System in New York City. “It is very helpful to have someone in your life who has already done what you’re doing and knows the territory better.”
Culturally sensitive mentorships are proving critical to keeping novice minority nurses in the pipeline, helping to ensure they graduate and stay on the job after earning a degree. Research suggests that minority nursing students tend to feel lonely, isolated, and alienated on top of having financial and academic difficulties—all of which can lead them to drop out.
Student retention programs that offer mentoring and other support tend to have lower attrition rates. For instance, the SCRUBS program at Georgia Southern University increased retention rates among minority nursing students to 95% (from 69%), and NCLEX pass rates to 100% (from 84%), according to a 2013 study in the Journal of Nursing Education and Practice.
Similarly, mentoring can help reduce on-the-job vacancy rates among newly graduated nurses. In the California Nurse Mentor Project, only 8% of new hospital nurses who were assigned a mentor left within a year of being hired, compared to 23% who did not have a mentor, according to a study published in 2008 in Nursing Economics.
The first step for novice nurses looking for support and advice is not to shy away from the experience of mentoring, says Vivian Torres-Suarez, RN, MBA, BSN, director of NAHN’s Mentorship Academy. “I sometimes think people perceive that needing a mentor is like needing a tutor. They see it as a remedial type of thing. And it’s not. It’s about collegiality; it’s about learning from those who have been through a process before us. All of us should be open to it.”
Understanding What Novice Nurses Need
Three years ago, the Washington Center for Nursing (WCN), based in Tukwila, Washington, surveyed local minority nursing students and new graduates to assess their needs. In addition to finding a lack of mentoring programs, the survey identified specific topics that novice nurses were interested in: “The students really needed somebody to help them with work-life balance issues,” says Sofia Aragon, JD, BSN, RN, the executive director of WCN.
Other highly ranked topics on the survey were developing a professional sense of identity, honing leadership and communication skills, and transitioning from education to practice. The diversity committee at WCN also identified lateral violence and bullying as issues that contribute to attrition among minority nurses.
Mentors interviewed for this article stressed that many novice nurses also need help developing practical skills, such as putting together a resume, applying for a scholarship, or sorting out what paid-time-off time is all about. Nilda (Nena) P. Peragallo Montano, DrPH, RN, FAAN, would put time management and critical thinking on the top of the list. “You want them [novice nurses] to learn to think critically and make choices that are best for them,” says Montano, dean and professor at the University of Miami School of Nursing and Health Studies. “The mentor doesn’t always have the solution for the person. The student has to learn how to resolve whatever situation they come across. That’s part of learning.”
The mentees interviewed for this article emphasized how much they appreciated the empathy and encouragement they received from their mentors. “It’s good to have another person constantly telling me, ‘You can do this. I’ve gotten through this. Other nurses have gotten through it,’” says Jasmine Carter, an undergraduate in the nursing program at Arizona State University.
A 2014 study published in the Journal of Professional Nursing found that minority nursing students perceived the following traits as the most important characteristics in a mentor:
- a willingness to listen
- enthusiasm for nursing and how the mentor sparks the mentee’s interest
- clarity regarding expectations for mentees
- pushing mentees to achieve high standards
Do mentors need to be of the same race or ethnicity as the mentee? Although research suggests that minority nurses can get effective support from nonminority mentors, many nurses point to the advantages of having a mentor with a similar background and culture. “It’s important because they’ll be more likely to have the same experiences as you than someone who is from another race,” says Carter.
Carter’s mentor, Angela Allen, PhD, CRRN, RN, who teaches culture and health in her classes at Arizona State, agrees: “It’s easier for us to be able to relate when we are from the same ethnic culture, whether African American, Caucasian, or whatever. We can immediately make a connection and say, ‘I know you’ve gone through something similar to what I’ve gone through.’ There’s already a foundation for a relationship.”
Finding a Mentor
Montoya and Gonzalez met at a NAHN speed-networking event for prospective mentors and mentees, or protégés per NAHN parlance. After attending an educational session on mentoring, Montoya spelled out her goals for the mentoring experience and identified a few questions to ask potential mentors. Then she had brief one-on-one meetings with experienced nurses who had volunteered and been selected to be mentors.
“They [the protégés] ask the same questions of each mentor,” says Torres-Suarez, assistant vice president of utilization management at Healthfirst. “Then they walk away with an impression of whether that mentor is somebody they’re going to be able to work with.”
One of Montoya’s questions for the mentors asks, “What do you desire to bring to this relationship, and what do you desire for your mentee in this relationship?” As Montoya recalls, Gonzalez said something like, “I believe one of the biggest things I can bring into your life where you are right now is to connect you to everyone I know.”
This response resonated with Montoya. “In that moment, that was important to me because I felt like everyone whom she [Gonzalez] connects me to will also be a mentor to me. I felt like she was going to provide a village to raise me.”
Formal programs. Formal mentoring programs like NAHN’s is one place for novice nurses to find mentors. So far, about 20 nurses have gone through the association’s year-long Mentoring Academy. Originally piloted at the national level, the program is now being deployed at the chapter level. So far, five NAHN chapters have launched their own programs, and Torres-Suarez hopes to see every chapter create a program.
Similarly, 30 chapters of the National Black Nurses Association (NBNA) have mentoring programs. That’s how Hailey Hannon, MSN, RN, met her mentor. In 2004, when Hannon was a nursing student at Indiana University-Purdue University Indianapolis, Denise Ferrell, DNP, RN, who introduced herself to Hannon one day on campus and told her about the mentoring program offered by the NBNA Indianapolis Chapter. Ferrell, who is now president of the NBNA Indianapolis Chapter, became Hannon’s mentor during college and continued to mentor her through her first nursing job.
“I was new to the nursing program, and Denise caught me at a good time when I needed that mentoring guidance,” says Hannon. “At the undergraduate level, I looked to her for encouragement and help balancing work and being a nursing student. She would say, ‘You can do it. Let’s just talk about it.’ Then once I became a new nurse, she introduced me to the professional development side of things, like, ‘How do you find people on the unit that can help benefit you?’ or ‘Are you on any committees on your unit?’”
The NBNA is getting ready to launch a national mentoring program this year that will connect novice nurses, as well as experienced nurses in career transitions, to volunteer mentors from among the NBNA national membership. “This won’t be taking away from the mentoring programs offered by our chapters,” says Allen, who helped developed the mentoring program. “What we want to do is enhance them.”
Many nursing schools also offer various types of mentoring for minority students. For instance, American Indian and Alaska Native nursing students at the Montana State University College of Nursing are paired with a peer mentor and communicate on a biweekly basis as part of the college’s Caring for Our Own Program (CO-OP). Additionally, perspective high school students interested in pursuing a career in nursing can be paired with a CO-OP mentor who will provide them with information on scholarships, educational preparation, and career options, among other things.
Informal engagements. Not all good mentor-mentee relationships spring from formal programs like NAHN’s and NBNA’s. For instance, Carter and Allen met informally at a NBNA chapter meeting. Carter won a scholarship from the chapter, and Allen recognized her potential and decided to take her under her wing. Now, the two regularly talk, text, and e-mail each other.
Torres-Suarez encourages novice nurses to seek out various types of mentors, including informal, short-term contacts. “We have to be constantly open to opportunities to network and connect to individuals,” she says. “You can have an in-depth formal mentorship like in our [NAHN] program. And you can have an informal, five-minute mentorship with someone you just met, somebody that could be a connector for you. You can have sort of an elevator speech prepared to say, ‘I’m a new nurse. I’m not sure where to get a job, and I’m looking for some advice.’”
Torres-Suarez also thinks nurses need to seek mentors from outside of nursing, as needed. “We have to be open to mentors coming from all directions and all walks of life. While nursing mentors are important, we could also get mentoring from people who are in business because, at the end of the day, health care is a business.”
Building a Beneficial Relationship
One of the key steps novice nurses should take before seeking a mentor is to “really understand what their specific needs are,” says Aragon, who has been working to match mentees at two nursing schools with volunteer mentors at the WCN. Developing mentorship goals can help nurses identify and communicate with potential mentors—and find the best mentors for their particular needs.
Aragon shares this example: “When I was getting to know one mentor, she was talking about her journey to be more vocal with other nurses and physicians and a better communicator. She struggled with that but eventually overcame it. Then a mentee said on her application, ‘I really want to find my voice, I’d like someone to help me do that.’ This really helped me match those two up because it seemed like the mentee’s need was exactly what the mentor could give somebody.”
Yet, even the best-matched mentors and mentees need to work at building a durable, beneficial relationship. What helps? The nurses interviewed for this article provide the following lessons learned:
Create a structure that works for you. The exact structure and rules of a mentoring relationship will depend on the program and people involved. One of the requirements of the NAHN Mentorship Academy, for example, is that mentors and mentees agree to communicate with each other at least once a month for a year. Because they both preferred to connect in person, Montoya and Gonzalez agreed to meet for an hour or so before the monthly NAHN New York Chapter meeting. Then, they supplemented their monthly meetings with e-mails and phones calls, as necessary.
During the first few monthly meetings, Montoya and Gonzalez focused on getting to know each other. “We talked about our histories, and I discovered her background in nursing and the history of her life in Puerto Rico and here in the United States,” says Montoya. “When it came closer to me taking the NCLEX, our meetings became more about preparing for the NCLEX. Then we turned to preparing me for my first job interviews. When I got hired, our meetings became about accepting an employment offer. We reviewed all of the paperwork page by page.”
Walk in with intentions rather than expectations. Montoya recommends being open to what can come of a mentoring relationship. “Operate with intentions rather than expectations,” she says. “Know what your intention is. I would say that should be the first conversation that you have [with your mentor], ‘What is your intention as a mentor? What is my intention as a mentee? What is our intention for this relationship?’ Allow that to be your guiding compass throughout the relationship.”
Get personal. It’s virtually impossible for mentors and mentees who have a long-term relationship to avoid talking about personal issues, from money and child care issues to layoffs and illness, says Torres-Suarez. “This is real life. All of those things happen and all those things get addressed as part of the conversation with the mentor.”
Remember, it’s a two-way street. “It has to be a respectful relationship,” says Montano. “It’s not a one-way street where the mentees sit there and expect everything to be given to them.” Montano gives the example of a mentee not showing up for scheduled meetings. “You can’t mentor someone who doesn’t want to be mentored.”
Make use of technology. NBNA’s national mentoring program is gearing up to take advantage of live-chat, texting, e-mail, and other mobile communication technologies, says Allen. This will allow mentors and mentees from different states to communicate. NAHN also uses Skype and other technologies when needed. But Torres-Suarez recognizes the benefit of in-person meetings between mentors and mentees. “Eye contact is an important piece when you’re trying to get to know each other.”
Influencing Generations of Nurses
One argument against mentoring is that it only helps one nurse at a time. But Aragon believes the long-term effects of helping one nurse can multiply exponentially. As an example, she tells the story of the first Filipino American nurse to work in a major hospital in Yakima County, Washington. “She was someone who thought nursing was not in her universe,” yet friends, family, and community members offered her encouragement and paid her nursing school tuition, says Aragon.
“In her lifetime, she’s helped two other nurses go to school and seen the numbers of Filipino American nurses go up over time,” Aragon notes. “So, for me, even though we may only reach a few people by mentoring, just one person could be a champion and really multiply the number of minority nurses a community has.”
Often it’s not nursing knowledge that makes the difference in passing nursing boards, but having strategies for answering questions so that it’s apparent that you really “get it.” There are ways to prepare for what is often a daunting test so you can take it with complete confidence that all the time, money, and hard work that went into nursing school won’t go to waste. We interviewed experts, educators, and other nurses who aced these exams—first time around or later—and share their most helpful hints with you here.
Jake Schubert, RN, BSN
Travel nurse and executive director of Nursity.com, an online NCLEX strategies and review course
1. Carefully consider your options.
“The average candidate takes one or two prep or review course, and spends an additional 40 to 50 hours on other independent study,” according to Schubert. He recommends that students talk to their peers about their experiences and read online testimonials. In addition, check to see if your school has partnered with a test-preparation program. “Some schools provide review courses as part of the capstone curricula—ATI, Kaplan, and HESI are the big corporations with relationships with many of the schools. Most students take an additional course as well,” he adds.
2. Understand the NCLEX format and how it works.
“When you intimately know the beast, it won’t be as intimidating,” says Schubert. Because this is a computer adaptive test that uses algorithms, it’s different from every other test students have taken in their entire academic career. You must also prepare for it differently. “If you did exceptionally well or performed extremely poorly, the exam will end at 75 questions,” he explains. But if you are somewhere in the middle, it can go up to 265 questions to assess how well you know the material and whether you’ll be able to perform as a nurse in a safe manner. (See Schubert’s YouTube video—“How to Pass the NCLEX with a 58%” for more details about this type of test.)
3. Strategize how you will approach questions in which you don’t know the answer.
Most students who graduate from nursing school have sufficient content knowledge, but because the test is computer adaptive it will find an area where you are weak, says Schubert. “The NCLEX will assess your judgment as much as anything else.” What will you do when you don’t know what to do? You need strategies for these types of questions. “How do you answer a question about content you never learned? Strategy. Ask yourself, ‘Why did they write this question? Is it a medication question? A judgment question?’ As a new graduate nurse, that’s all you do all day, is try to figure out what to do in situations you don’t necessarily fully understand. This is much of what the NCLEX is assessing—will you make a safe decision?” he adds.
4. Don’t wait to study or take the exam.
The longer you wait, the more you forget, and the worst you score. “Take the exam immediately after graduating from nursing school,” Schubert advises. “Begin studying for the NCLEX before you graduate, to keep the material fresh in your mind, which will improve your score. Pass rates go down the longer a candidate waits after graduation,” he says. To find out more about pass rates, we recommend you go directly to the source: the National Council of State Boards of Nursing website at www.ncsbn.org.
5. Figure out the best way for you to study, and then stick with your plan.
“Keeping to a study schedule and certain days and times is important,” says Schubert. “But don’t cram. Instead, spread it out over a longer period.” He also recommends reducing distractions, such as television, devices, and social media as well as calls or visits from family and friends. Make sure your study area and equipment are well set up so that you’re comfortable during each study session. Then take frequent breaks so that you don’t deplete your energy, and switch among various subjects every half hour or so to maintain focus.
Launette Woolforde, EdD, DNP, RN-BC
Vice president of system nursing education at Northwell Health in New Hyde Park, New York
1. Find a role model with a similar background.
“When you don’t have minority role models that reflect who you are, it can hamper your optimism and pursuit of certain goals,” says Woolforde. “For example, I remember reading that 12% of the U.S. population is African American, but only 2% of nurses in the workforce are African American.” The lack of role models may extend to educators, staff, and mentors who can help monitor and guide students. On the other hand, those missing pieces of the career puzzle “can serve to motivate students to start a new trend and make a clean break from what’s happened before,” she adds.
2. Be aware that factors such as language, cultural norms, and your environment can influence your standardized testing experience.
Being a first-generation nurse or college student, for example, means you have to figure out your own way around in academia and career preparation, says Woolforde. “Minority nurses might not fit the norm in their family or culture. But I’m happy to see so many nurses exceeding these norms. Soon, minorities will be the majority in the U.S.”
Minority test-takers may have to “think against” their own cultural norms, cautions Woolforde. “Maybe in your culture women do not make decisions. You have a question about a patient coming into the ER—a male with a wife—and the wife is upset and vocal about it. How would you answer the question? The correct response is ‘Reassure the wife,’ but what if in your culture, wives aren’t spoken to? A wife may be dismissed in that culture.”
3. Do two or three things to “pump yourself up” each day.
“Overthinking and overprocessing while studying is a problem,” says Woolforde. “Don’t try to master everything. Do a little bit every day. Take tests over and over. Spend more time doing practice tests than in reviewing your general knowledge.” Some review services provide assessments, so take a look at your pharmacology scores, for instance, and decide if you need to allocate more time to that section of the test. Nursing students know a lot, but when they look at the questions they may not understand what the question is really asking. “It’s not ‘What is this medication for?’ but more about ‘What would you do to prepare a patient?’ For example, if a patient is taking Lasix then he needs a diet that’s rich in potassium,” she says. “Review what you’ve learned over the years. Believe in yourself. You’ve come this far, so you can pass this exam. There’s great positivity that comes from that belief. There’s power there.”
4. Don’t let fear hold you back.
Fear of failure and fear of the unknown are two major hurdles for many minority nursing students, says Woolforde. “They ask, ‘Am I smart enough?’ They’re afraid that they’ll fail the test because they don’t know the right answers. They’re afraid there’s material that they didn’t get in school or that they didn’t study it enough. I usually tell them all that might be true—you might not know the answer outright. But you can usually rule out two answers and reduce your choices. Then reread the question, think about it, and let the right answer surface,” she advises.
5. Think beyond the NCLEX.
“Even during your orientation, you can be thinking about specialty certification,” says Woolforde. “If you work in oncology and pediatrics but like peds, then you may decide, ‘This is where I want to spend my career.’” Next, consider specialty board certification as a stamp of expertise in an area of practice. In order to maintain that certification, you have to maintain a minimum number of continuing education hours and must practice for a minimum number of hours there. “Certification shows that you’re current with best practices; you’re currently practicing and staying on top of trends and issues in that specialty,” she adds.
G. Rumay Alexander, EdD, RN, FAAN
Interim chief diversity officer and director of the Office of Inclusive Excellence in the School of Nursing at the University of North Carolina at Chapel Hill
1. Keep your mind in the game.
For highly vulnerable students, every test becomes a test of language proficiency, says Alexander. Multiple choice questions are especially problematic, she adds, so practice to understand how they’re structured and how to answer them. “Outside of the U.S., most countries don’t use multiple choice questions on tests, so international students may need more help to pass. Non-English speakers typically need to translate questions into their own language and then retranslate their answer in English. Older students are another minority group that is disadvantaged; they’re out of practice with test-taking.”
2. Understand that half the battle is staying level-headed.
“Try not to let your brain get hijacked by emotions,” advises Alexander. “Avoid being hungry, angry, lonely, or tired [“H.A.L.T.” is a good memory aid]. Make sure you’re well-nourished, well-rested, and really and truly try not to get panicked because you don’t know the answer immediately. Answer the questions you are certain you know and then revisit the questions you skipped.” It’s normal for people taking the NCLEX to think that they’re failing, so try not to be overwhelmed if you need to skip questions. Usually, you are doing fine, so just stay the course.
3. Tap the various staff members and other resources that your school provides.
“We have student advisors who meet with students and take them through different tests and practice exams,” says Alexander. Practice questions come from the end of textbooks, or students go online and get questions that best address their weak spots. “Students who have test anxiety can get help at a center that helps with managing anxiety and practice with testing, too,” she adds.
4. Find your happy place.
When highly vulnerable students were not passing gatekeeper exams at her school, Alexander asked the school’s “cultural coaches” to work with them. “We told the distressed group to forget about the exam and we asked them this question: ‘If you didn’t have that coming up, what would you do?’ Their response was ‘Let’s have a party!’ so we blasted music for 40 minutes and they taught each other new dances. There was laughter, joy, and smiles. Then they went on to study for the exam.” The nursing students were advised to do visualization exercises for stress reduction, like the school’s winning basketball team did before a game. “We told them, ‘When you’re stuck on a question during the exam, go back to this time. Remember the dance or anything that makes you feel peace, joy, or sense of accomplishment.’” The visualizations worked, and students later reported that their anxiety was greatly reduced when they applied the technique.
5. Understand that not everyone will pass the exam on the first try—and that’s OK.
“If you failed, well, you’re not the first person who has,” says Alexander. “Maybe you need to practice more or review a certain part again. Students repeat exams all the time. It’s not a denial of your dream; it’s a delay. Maybe you need to work more on test anxiety or preparation. Failing should inform you, not defeat you.”
Sometimes students face difficulties right before the exam that throw them off course, such as a suddenly ill child or a minor fender bender. Everybody has a bad day, Alexander explains, and the main thing is to resist the urge to ruminate. “Instead, focus on what’s next,” she suggests. “Ask yourself, ‘What do I want? What’s my next move?’ Remember, there is a skill to test-taking and it takes intentional preparation. Prepare, don’t despair!”
There are so many ways to prepare for the nursing boards now, what with new technology as well as in real-life social support. You can pick and choose the techniques that work best for you. Take an online review course, use an app, study with a group, or set up an at-home program. Success is absolutely within your reach!
For years, business leaders have relied on the guidance and support of career coaches to help them advance in their professions and to achieve clear personal goals as well. But nurses traditionally haven’t used coaches in the same way. All that is changing as nurse coaches are becoming more common and helping nurses achieve success.
As with other types of coaching, nurse coaching appeals to and works for nurses who are looking for vastly different things. Some nurses feel stagnant in their jobs and want someone to help them get unstuck. Other nurses are unhappy with their current situation and might even be questioning an entire career change. Still, others are nearing retirement and want to stay involved in nursing, just without the demanding physical tasks and long hours—they wonder if a new career as a nurse coach might suit them.
Career coaching is nothing new in the larger world of business, but nursing lags behind, says Linda Yoder, PhD, MBA, RN, AOCN, FAAN, president of the Academy of Medical-Surgical Nurses and an associate professor at the University of Texas at Austin School of Nursing.
However, the nursing profession is gaining a better understanding of coaching, adds Yoder. In some organizations, coaching takes on a negative connotation because they view it as something to help only poor performers. Coaching is for everyone and serves to enhance personal as well as team performance.
Nurses have particular difficulty reaching out to coaches, says Phyllis Quinlan, PhD, RN-BC, who sees many nurses in her nurse coaching and consulting practice, MFW Consulting.
“Professional caregivers are very reluctant to receive help,” says Quinlan. So by the time some of them arrive at a coaching session, they feel like their backs are up against a wall and they need some stability. They might be experiencing compassion fatigue or have been on the receiving end of bullying. They think a coach can help, but they aren’t sure how.
So, how can a coach help you? Nurse coaches are especially valuable because they understand the complex industry of nursing. They get the professional side of what a nurse trains for and a nurse’s myriad responsibilities. But nurse coaches also understand how the nursing profession is also a way of life. They get that there’s no punching the clock and leaving your job behind when your shift is over.
Is It Coaching or Mentoring?
When Margaret Erickson, PhD, RN, CNS, APHN-BC, executive director of the American Holistic Nurses Credentialing Corporation (AHNCC), thinks of coaching, she thinks of the whole profession. “The role of coaching allows nurses to reconnect with each other and it has value in society,” she says.
Nurses find they have resources to help themselves, but coaching just helps reveal those resources and show nurses how to use them. Often, Quinlan says, nurses are able to reignite their initial passion for becoming a nurse in the first place. They can remember why they took this on as a career and are invigorated by the boost.
Coaches guide, but never tell someone what to do. “Part of coaching is asking powerful questions,” says nurse coach Keith Carlson, RN, BSN, NC-BC, also known as Nurse Keith. “Coaches are there to offer guidance and objectivity and to inspire people.”
Not everyone understands what coaching is, what it does, and what role each person plays in a coaching relationship. “People lump it into mentoring, and that’s a huge mistake,” argues Yoder, who presents nationally about nurse coaching. Nurse coaching helps nurses with their growth and development, which serves to increase their confidence.
How are coaching and mentoring different? Although coaching and mentoring both aim for a similar goal—to make the nurse the best nurse he or she can be—there are differences in the approach. “Managerial coaching, technically, is really a boss/employee relationship,” explains Yoder. “Mentoring is an exclusive relationship that plays a role in succession planning.”
Does that mean your boss will always be a great career coach? No. But a good boss will motivate you, show you how to do a good job, and let you know the educational, professional, and personal steps that will help you advance.
So while your boss should coach you on how to fill out a unit shift report, she might be less likely to take you under her wing and shape you into her replacement. Your coach can instruct and guide you on the subtle ways of your organization so you advance in your job, but coaches don’t share what Yoder refers to as “state secrets”—those nuggets of insider professional information that are often exchanged in the fundamentally different trust and power levels of a mentor/mentee.
And Carlson reminds nurses that coaching isn’t psychotherapy, either. There might be introspection and lots of questions to be answered, but a coach is going to rely on you to figure out some of the answers based on what your own motivations are.
Nurse Coaching Takes Hold
When Donna Cardillo, RN, CSP, known as The Inspiration Nurse, started coaching 20 years ago, hardly anyone else was in the field of coaching nurses. “Even personal coaches couldn’t effectively coach a nurse because they didn’t understand what nurses were capable of or the job market,” she says. With more nurses acting as coaches now, she says they are using a body of experience, skills, and knowledge to help other nurses with problem solving, identifying strengths and weaknesses, and following through on goal setting.
With nurses under increasing job stress and the pressure to earn higher degrees, burnout is rampant. If your job is causing you so much stress as to affect your physical and emotional well-being, start thinking of ways to make it better, says Erickson.
“Coaches know the game,” says Yoder, comparing nurse coaching to the job of a sports coach. “They know the big picture, how the game is played, every single player, and what position each player plays best in. The coach has to understand the game better than anyone else.” Coaches get to know their players and know how each works so they are able to best motivate them and make the entire nursing unit operate more effectively.
Coaches also are focused on the present. Erickson’s work is guided by the Modeling and Role Modeling holistic nursing theory, which was developed by Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain. According to Erickson, using theory rather than policies and procedures to assist others helps coaches become intentional and thoughtful in their approach to each nurse or client.
Sorting It All Out
A nurse coach helps you tweak the complex intertwined aspects of your personal and professional life to bring you more career satisfaction and help you set and reach your goals. “A coach focuses on what are your goals and what are you going to accomplish this year,” says Yoder.
For instance, coaches will get you thinking about if you want to go back to school this year or if you want to take a certification exam. Should you join a professional nursing organization, and how can you make the best out of that experience?
Kamron Keep, RN, BSN, NC-BC, says coaching helped her focus on what she really wanted. “I felt like there was a missing piece, personally and professionally,” says the Idaho-based Keep, who is now a nurse coach herself. With her coach, Keep says she uncovered her motivations and identified what was holding her back. “Working with a coach held me more accountable,” she says. “Coaching helps someone take the step forward. It helped me live the life I wanted.”
Linda Bark, PhD, RN, MCC, NC-BC, Keep’s coach and the founder of Wisdom of the Whole Coaching Academy, says she asks clients to think about their options and will even have them assess how they feel physically when thinking about each option. It’s that kind of holistic approach that shows nurses how the corners of a career, personal life, and spiritual life are all connected. “The wisdom of the whole is about taking in all that information,” says Bark.
When’s the Time to See a Coach?
Carlson says he sees several categories of nurses who come to him for coaching advice. Most of the nurses he sees want something else, but they just don’t know how to define or identify what they want or how to take the steps to get it.
Novice nurses, he says, are trying to find out what makes them tick as a nurse. Maybe they went into nursing with a specific path in mind but now want to branch out, but have no idea where to start. With so many opportunities and choices, they are bewildered.
Then, he says, mid-career nurses come with very different ideas. They have years of experience, but nursing has lost its luster. Or now they want to do something different, but stay within the nursing industry. These nurses typically want to find out about nurse entrepreneurship.
Older nurses are looking for someone who understands the profession, says Carlson, and who can help the nurse figure out the next step. They often want to stay in nursing but are looking to shed the long hours or the physically demanding tasks. “For seasoned nurses, it’s often trying to find the heart of why they became a nurse in the first place,” he says. “Sometimes they need redirection, and sometimes they need a major change.”
Is One Coach Enough?
Throughout your life, you’ll have several coaches. Some coaching relationships will be less involved—one might simply be a unit educator who coaches bedside nurses. A charge nurse might be the coach for practice kinds of issues, says Yoder, to let nurses know how they can most effectively work with different families.
If you aren’t getting the feedback you need at work or if your boss is unwilling to act in a coaching role, there are other options. A growing industry is, of course, nurse coaches you hire. These nurse coaches are certified after passing the AHNCC’s certification exam and aim to give nurses a sounding board and guide them to the best choices for their own specific lives and goals.
And although coaches won’t be holding your hand and guiding you on a specific path, says Carlson, they are listening closely to everything you say and probably seeing patterns or wishes you may not even see. You’ll likely have homework to do, something that helps you feel empowered about the choices and decisions on the horizon.
“Sometimes, it’s just about the act of being truly heard and having those experiences reflected back toward them,” says Carlson. “Being listened to is incredibly powerful.”
Many nurses find that being heard by a coach is so empowering they turn the table at work and use the same method with their patients. “Coaching enhanced my nursing practice,” says Keep. “A lot of that is a listening presence and reflecting back to the patient to validate what they say.”
Quinlan agrees. “Coaching very gently raises the ability of a client to reach out and touch their own innate knowing,” she says. Successful coaching helps clients understand their true feelings and motivations so they can peel away the layers of confusion and help remove some of the barriers for nurses to move ahead. Coaches offer a toolbox of skills nurses can use to move forward in the direction that’s best for them.
As nurses become more comfortable with coaching, Quinlan says coaches are becoming more prevalent and many older nurses are considering a career shift to become certified coaches. In particular, she says, nurses approaching retirement who have decades of experience and a wealth of knowledge are perfectly positioned to take on nurse coaching roles, either on their own or within their workplace as a designated coach on staff.
“Coaching can help you if in your head you know what you need, but in your heart you don’t know how to get there,” says Quinlan. “Coaching helps you untie the knot.”
Stereotypes of school nurses primarily dispensing aspirin, taking temperatures, and offering hugs are rooted in nostalgia.
These days, school nurses increasingly handle a growing number of students with chronic or serious health issues, provide emergency care, and connect with community partners to provide additional health services.
Despite the vital role that these health professionals fulfill for students, there is a lack of full-time public school nurses to help meet the well-being of students, especially in urban school districts. Only 30% of public schools have a full-time school nurse, according to a 2007 study by the National Association of School Nurses (NASN).
Additionally, only half of schools have a registered nurse 30 or more hours each week, according to a 2014 School Health Policies and Practices Study by the Centers for Disease Control and Prevention.
Informing the public about the expanded role of school nurses and the consequences of their absence benefits students, their families, and communities, nursing experts say.
“Because school nurses practice independently as the only health care provider in the education setting, they need the critical-thinking skills that bachelor-prepared nurses develop,” says Beth Mattey, MSN, RN, NCSN, president of NASN. To this end, NASN recommends a bachelor’s degree in nursing as the minimum preparation for a school nurse.
“Many states require ongoing education to maintain an RN license and/or a school nurse certification,” Mattey continues. “NASN provides ongoing education through resources, clinical guidelines, webinars, and other online education courses. We also sponsor hands-on learning and conferences to keep school nurses abreast of current practice.”
Evolving Role of Nurses
“When schools don’t have a school nurse, there is not a health professional to help students manage acute illness and chronic conditions in the school setting,” says Mattey. “Students don’t leave their health issues at the door, and many chronic conditions must be managed during the school day. This includes students with diabetes, asthma, life-threatening allergies, epilepsy, and sickle cell disease. Children who live in poverty are at greater risk of having a chronic condition and unmet health needs.”
The average adult thinks about his or her own education decades ago and assumes every school has a nurse and the health needs are the same, says Nina Fekaris, MS, BSN, RN, NCSN, president-elect of NASN.
“Unless you are a parent of a child with a chronic illness or a life-threatening disease, you just don’t think these things are in schools,” says Fekaris, the only nurse assigned to four schools serving 4,200 students in her suburban school district in Oregon. “They don’t understand what school nurses do and they don’t understand that kids are more fragile that are attending schools now. There’s a lot more care coordination that needs to happen in school buildings to keep kids safe.”
Fekaris, who has been a nurse for 40 years and has 30 years of experience as a school nurse, says the growing number of students with type 1 diabetes is a major health change. When she first started, there were none; now, there are about 150 diabetic students, including kindergarteners, in her school district.
Advances in medical treatment and technology have also altered the practice of school nursing. For example, one treatment device for children with seizure disorders is an implanted device under their skin that delivers an electrical pulse to a nerve in their neck. “At the sign of seizure, what we want to do is activate that device to fire an impulse to try and stop the seizure, and the way you activate that is by swiping a pretty powerful magnet across that device in their chest. Thirty years ago we didn’t have that technology,” explains Fekaris.
Greater Needs at Urban Schools
Students in high-poverty urban areas are especially vulnerable when schools lack an adequate number of nurses, says Maura McInerney, a senior attorney at the Education Law Center, an education advocacy group that champions the hiring of more nurses.
“The consequences can be devastating, and I don’t think that the average citizen recognizes the critical role school nurses play in the health, safety, and education of school children,” McInerney says.
Without access to full-time nurses, students may not receive urgent or accurate and timely treatment at prescribed intervals. And, children with special education needs may not be identified or receive nursing care, McInerney adds.
“Perhaps what is most striking is the number of children with qualifying disabilities such as diabetes and asthma, who fail to receive Section 504 Plans that are critical to supporting them to attend and be successful in school. Finally, school nurses are important teachers and counselors and are often the first people to identify a child’s need for health interventions and counseling services,” says McInerney.
There are 180 nurses for 332 Philadelphia public schools serving 200,000 students. In 2011, the district had 289 school nurses. By the 2013-14 school year, that number had dwindled to 179. In March, the district announced the number of school nurses would be increased with the goal of a nurse at every school. “At that time, 123 schools had no full-time nurse and 17 schools had a nurse one day a week or less,” McInerney says. “We hope this happens, and ELC is fighting for more funding to under-resourced schools in Philadelphia and elsewhere to make this a reality.”
Unfortunately, sometimes it takes a crisis to spotlight the need for school nurses and drive changes, says Robin Cogan, who has worked 15 years as a school nurse in Camden, New Jersey. “In Flint, there was one school nurse. They now have nine school nurses. It shouldn’t take a tragedy to get a school nurse in every building,” she argues, referring to the 2015 water crisis in Flint, Michigan, that involved lead contamination.
Mattey recalled a Philadelphia student, 12, who died from an exacerbation of her asthma two years ago. “The severity of her asthma was unrecognized on that day because the school nurse was not scheduled to be in the school. The School District of Philadelphia had been having financial difficulty and school nursing services were cut,” Mattey says.
For working parents, the presence of a nurse can help them decide to enroll their child if he or she has a chronic condition, says Cherisse Howell, RN, supervisor of staff education, school health nursing, at the Montefiore Health System, one of the largest school health programs in the nation. A school nurse “gives a parent a sense of security that I can go to work and provide for my family and still feel safe that my child is OK because there is a nurse at school,” says Howell, a nurse since 2005.
Having a nurse or school clinic gets children into the building because parents share the positive experiences of the health services, Howell says. The Montefiore Health System has clinics inside elementary, middle, and high schools and provides primary, dental, mental, and community health services to over 30,000 students at 85 schools on 23 campuses.
“We transitioned from what many thought of as the school nurse… when nurses were doing ice for injuries and Band-Aids for boo boos,” says Howell. “We’ve moved to an era where, specifically in the Bronx, we have thousands of children suffering from asthma and our diabetes cases are rising. We have children with health disparities that would otherwise keep them from school. We now have these health professionals in the educational building, and children can get the treatment they need and the instruction they need simultaneously.”
Outreach and Partnerships
The volume of students treated and the complexity of their medical care require school nurses to form health care partnerships, says Lynn Meadows, RN, MS, coordinator of student health services for the Fulton County School System in Georgia.
“We can’t just do the job in a clinic. You have to partner with a local physician or a health organization in the community because it’s a team approach now of how we take care of kids,” says Meadows, a nurse for 30 years and a school nurse for 15 years. “It’s not just a school nurse trying to manage the health care needs of kids while they are in school. Yes, they are in school…but they also go home. So that collaboration and networking with health care providers outside our clinic obviously keeps that continuity of care better for kids.”
Many school nurses seek professional development to keep up with the changing care dynamic that students require, which is why partnerships are important. School districts are looking to school nurses to be caught up on health issues that can impact the community, Meadows says.
“For instance, regarding the Zika virus, my superintendent will look at me and ask, ‘Well, what should our school district’s response be to a community health issue like Zika virus?’ So I have to be up to snuff. I have to find partners that I can work with to say, ‘What is the latest, how does this impact the community, and ultimately, how might it impact the school?’ Whatever is the hottest topic or health care issue going on in the community, school nurses have to be aware of it,” says Meadows.
School nurses arrange for mobile dental clinics to visit schools and mobile vision vans to visit and provide eye exams and glasses for students who may not have those services available, says Mattey.
School nurses also work in schools and the community to promote tobacco education and cessation programs, educate students about prescription drug abuse and other substance abuse, provide immunization services for students, encourage exercise programs, and educate about healthy eating.
School nurses not only play a key role for helping students learn, their presence assists educators. One study found teachers spend less than 20 minutes each day dealing with student health issues when a nurse was assigned to their school.
Data also showed students with asthma have improved attendance and better health outcomes when a school nurse managed asthma, says Mattey. Furthermore, immunization rates also improve when a school nurse is present.
“What administrators and school districts need to know is that not only do school nurses keep students in school by addressing health issues so they can stay in school, school nurses save money,” says Mattey. “A recent JAMA study demonstrated that for every $1.00 spent on school nurse service and resources, $2.20 was saved in societal costs. The study did not take into account reduced emergency room visits due to early intervention by the school nurse,” she adds.
“Consider the case of a child with a severe peanut allergy, and every day when your child goes off to school you hope that your child is not exposed to peanuts. A school nurse recognizes the potential emergency, works to make the environment safe for the child, and ensures that emergency plans are in place in the event of an exposure to peanuts. The school nurse will educate the staff on the signs and symptoms of an exposure and how to prevent the exposure in the first place,” says Mattey. “There are many health conditions children bring to school. The professional school nurse has the expertise to educate and work to prevent an emergency, but if an emergency occurs, the school nurse will recognize the emergent condition and take action.”
School nurses juggle an array of demands despite their salaries being among the lowest for RNs. However, in some areas, school nurses are paid on the teacher salary scale, which also includes benefits. For school nurses on the lower end of the salary scale, lack of understanding about all they do is a factor, nurses say.
“Traditionally, the profession of school nursing has been looked at as someone in the clinic just handling little boo boos,” explains Meadows. “There isn’t widespread public knowledge of what it takes to be a school nurse, or the volume of kids with chronic illness or medical issues. There is not enough information in the community or across the nation on how school nursing has evolved. Many people don’t get that.
“School nursing has changed. It’s a profession on its own. For many of our children, the first health provider many of them see is the school nurse. I tell many of my nurses, ‘You can be the person who finds out what is going on with that child and make a difference in that child’s life for the rest of his or her life,’” Meadows says.
Although school nurses affect educational settings, taxing working conditions can compromise their effectiveness in treating students. If the school lacks a nurse, or if the school nurse “has a workload that makes it difficult to adequately educate all staff and follow up with parents, there may not be adequate protection for students,” argues Mattey.
“The ANA has a saying, ‘Nurses are an investment in the future, not a cost center.’ I say the same about school nurses. School nurses are an investment in the future of our children, linking health and education. We are not a cost center,” Mattey adds.
Parents and guardians must address the importance of school nursing with administrators, Mattey says.
“Parents should ask, ‘Who is meeting the health needs of my child while in school?’ The answer should be a professional registered school nurse,” argues Mattey. “Parents assume that a nurse will be taking care of their children, but that is not always the case and parents need to ask the question. If not a school nurse then they need to find out, ‘Why not?’ Parents in Charlotte, North Carolina, advocated to make sure their children had access to a full-time school nurse, successfully increasing the number of school nurses in the schools.”
What is diversity? According to the Oxford English Dictionary, it is “the condition of being diverse, different, or varied; difference, unlikeness.” This simplistic definition of diversity does not assign any judgment or negative connotation to any of the words used to define it. However, the word “diversity” evokes multidimensional judgements, reactions, ideas, emotions, and actions, some of which could have adverse social and health consequences for generations of individuals in the United States.
Nursing, as the largest health care workforce in the United States with over 3 million nurses, is well positioned to champion diversity efforts. In 2010, the Institute of Medicine (IOM) published a landmark report, The Future of Nursing: Leading Change, Advancing Health. In this report, the IOM indicated that the nursing profession was not diverse to care for diverse populations across the lifespan. The IOM recommended that a diversity agenda be promoted, especially with increasing the diversity of nursing students. In partnership with AARP, the Robert Wood Johnson Foundation (RWJF) launched a campaign to implement the IOM recommendations from its 2010 report. Subsequently, commissioned by the RWJF, the IOM evaluated the state of affairs regarding these recommendations. In 2015, another report, Assessing Progress on the Institute of Medicine Report The Future of Nursing, was published. In this report, the IOM specified that nursing has improved on the recommendation to diverse the nursing workforce. Nonetheless, there remain gaps that must be addressed to meet the diversity goal for the nursing profession. Consequently, the new recommendation for nursing is that diversity must continue to be a priority that is paralleled with a series of actions to promote it. Before nursing can accomplish this noble goal, there should be a well-vetted strategic plan on diversity and inclusion in all nursing programs, schools, and colleges in the United States. Students, faculty, and staff must be an integral part of the dialogue to promote diversity within the nursing profession.
At the University of Florida College of Nursing (CON), we held our inaugural “Diversity and Inclusive Excellence” workshop in December 2015. This two-day workshop was designed for staff and faculty. As a member of the Diversity taskforce, I collaborated with the other taskforce members to invite G. Rumay Alexander, EdD, RN, FAAN, to lead the CON on this discussion. Alexander is director of the Office of Inclusive Excellence in the School of Nursing at the University of North Carolina at Chapel Hill, a nationally known expert with vast knowledge and expertise on diversity and inclusive excellence, and president-elect of the National League for Nursing.
During the early morning hours of December 3, 2015, my individual lesson on the topic began with Alexander as I had breakfast with her. My antenna on the topic sharpened following our conversation. After introducing her to my fellow Diversity Taskforce members, I hurried to pack my car and return to the CON to proceed with the plans of the day. I noticed the dean, Anna McDaniel, PhD, RN, FAAN, from a distance. I hurried up to keep her pace. “Good morning, Dean,” I greeted in my usual manner. McDaniel responded with a broad smile and a twinkle in her eyes that I perfectly understood. I surmised that McDaniel had finally accepted the fact that I love referring to her as the “Dean.” We conversed as we headed to the CON and into the elevator. I noticed the necklace McDaniel wore. The costume necklace had different shapes, colors, sizes, lengths, and mosaic designs. They were
- audaciously woven, yet unintimidating;
- different, yet complementary;
- individually, unassuming — yet, together, a paragon of beauty, inviting;
- all held by a perfectly thin strand, yet unbreakable.
“That’s a beautiful necklace,” I uttered. “It belonged to my mother, who died twelve years ago,” McDaniel shared. “Each bead came from a different country. I have a brochure that provides a description of each bead, including the country of origin and its material composition.” Then, McDaniel voiced the word that gladdened my heart. “I wore this necklace today because it’s appropriate to celebrate diversity, the topic of the CON workshop.”
McDaniel had appointed the Diversity Taskforce and provided us with her full support. But, the fact that she actually thought of and adorned herself with a necklace that I now coined as a “diversity necklace” to celebrate the CON inaugural diversity workshop was admirable to me.
Someone not sensitive to the current diversity concerns around the United States, and the racial unrest related to such matters, may not appreciate my exhilaration upon hearing the history of the necklace. At issue is that, in several communities around the United States, numerous individuals are thoughtless about the devastating effects of antidiversity rhetorics and actions on the lives of its victims. Many may not realize that any action, whether good or evil, begins in the mind. Conversely, any work to combat uncelebrated diversity and exclusivity must begin in the mind. When people think about and proactively perform small acts, such as expressing recognition of diversity through a piece of jewelry or other special actions to celebrate diversity, it goes a long way. It could change the thought process from exclusion to inclusion. When people are attentive to their behaviors and understand the detrimental effects their actions could have on other human beings, things might change for the better. I believe that, as a nation, we must check the poisonous thoughts that percolate in our minds and subsequently manifest in forms of antidiversity rhetorics and behaviors, unacceptance, and racism. Confronting monstrous suggestions in the mind is the first step that many of us need to take to begin to challenge the subtle and insidious systemic diversity-aversion and exclusion in the United States.
As I thought about this issue of diversity and the role that nursing can play to eliminate it, I reminisced about how the imperfections of people categorized within the social construction of race stimulate antidiversity and anti-inclusive sentiments and movements. I wondered how nursing can care for these individuals, many of whom are marred with scars of history. My poem, “The Color of Justice,” captures my perceptions of the undeniable genesis of these historical blemishes that shockingly remain, overtly or covertly, as status quo in various parts of this country.
The Color of Justice
What color is justice?
Absorbing pain, insults, and lashes
Ancestors packed shoulder-to-shoulder, hip-to-hip,
chained like fire woods
Bones of the feeble lie un-mourned in ocean deep
across the Atlantic
Their sweat built the wealth in the new world, but
crumps have become their portions
This name sound like them, we have filled the position,
they need to go away
Low-hanging pants, cove-hopping birds,
We cannot deal with the anger, we are better off
with the accent, intra-color battle ignited
Round them up, throw away the key, population control
Babes on the breast, mama and grandmamma, sitting
on the front porch pondering about the next check
Hair tightly woven, fried, or twisted, nails freshly manicured, next bun in the oven
The fortunate may triumph at the end, treacherous roads treaded, stress claims the wounded body after all
That they survive is still a mystery that ought to win
them a trophy
Who are they?
What color is justice?
Reflecting heat, demanding respect, crushing heads
Rolled into the new world in Mayflower boasting of
prostitutes, thieves, and prodigal sons
Raised arms against raised tea taxes, won freedom
but deny it to another
Melanin deficient hue suggest superiority
Blood by blood, noose on hand, destroyed a generation,
Deeds done in the name of God, He must be weeping
Damages proudly scattered in museums, we pay to
relive the tragedy
Privileges left and right on the backs of the poor
Man in bow tie, lady in heels, rear the children, your lavatory in the rear
Own your history, mend your ways, teach your babes right
Who are they?
What color is justice?
Broad face, warm hue, and welcoming gesture
Land is supreme and cares for the offspring
Infected with strange diseases, killed with gun powder, survivors kept in special places devoid of opportunities
Culture deconstructed, the sacred used as mascots
Surviving by balancing mind, body, and spirit, harmony
in the land is their mantra
Not many left but their spirit is strong
The land beckons for their touch, to purge its roots of deadened souls
What does the Unites States’ constitution say about them?
Who are they?
What color is justice?
Messiah has come, awaiting messiah, there is no messiah
We profess peace, spiritual path is the way
Whose belief is superior?
When six feet under, belief quenches, but tainted
souls still suffer
Where are their senses?
Who are they?
What color is justice?
Light? Energy? God?
Penetrates Black, White, Red hue, religious, non-religious
Building block of things created
Revitalizes without questioning, unites all things created
Shines for Black, White, and Red hue, religious and
Knows no foolishness but shines for fools
Knows no discrimination but supports the life of discriminators
Invites reconciliation until judgement day
Come unto me Black, White, and Red hue, religious,
My light is your strength, unity, and peace
One may wonder how a nurse who is an advocate for a diverse, inclusive, and just world could pen “The Color of Justice.” This poem reflects my dual perceptions as a black woman and a nurse, of how the historical racial unrest that has plagued the United States for centuries has been subtly perpetuated even today. But, they ought not have continued, had the United States paid real attention and reconciled both the apparent and undercurrent narratives of this poem after the abolition of Jim Crow laws. As a black woman, I think that the first relevant question ought to be: How do individuals from diverse backgrounds interpret their historical or lived experiences in the United States? I encourage each one of us to answer this question individually or as a family, church, academic institution, or financial organization. I assert that there must be a recognition and acceptance of the different dimensions of diversity of thoughts, ideas, and experiences. This recognition must be matched with “courageous dialogue” on diversity and inclusion. In addition, there have to be concrete and measurable action plans for allocating resources to implement iterative strategies to address identified diversity concerns. This exercise could be so powerful that diversity and inclusion become strengths and not detriments to our collective humanity.
As a nurse, I think the second pertinent question must be: What role can nursing play to mitigate the adverse generational effects of antidiversity and anti-inclusivity experiences on marginalized and excluded individuals? I contend that, in order for nursing to be professionally and culturally relevant in the future and to continue to have the public trust as a caring discipline, we must identify ways to champion the diversity and inclusive excellence agenda. There should be constant and mandated training on diversity for university staff and faculty, with measurable outcomes. Nursing as a profession should develop a curriculum with a diversity and inclusion plan threaded throughout it. One approach to operationalize this suggestion is to equip nursing students with skills necessary to be culturally competent, diversity-savvy, and inclusive-perceptive in order to encourage these values in their work settings. Patients and clients at the receiving end of compassionate, culturally competent care infused with the spirit of diversity and inclusiveness should remember the feelings associated with that care, and hopefully pay it forward. Slowly, the culture of superiority and nontolerance directed toward individuals from diverse backgrounds could dissipate and a new world facilitated by nursing and inhabited by truly compassionate and empathetic humans would emerge.
Nursing students are the future of the nursing profession. Therefore, nursing must constantly remind students that antidiversity and anti-inclusion rhetorics and behaviors, historically and contemporary, breed racism in the United States. They should also learn to celebrate how much improvement we have made as a profession. But, recognize that diversity work is lifelong. The juxtaposition of the history of racism in the United States with the improvements made toward eliminating it is useful for at least two reasons: The contrast provides the space for constructive discourses and opportunities to develop positive avenues for endorsing diversity, and it allows for future and ongoing actions to completely obliterate racism heralded by antidiversity and anti-inclusive beliefs in the United States. Consequently, bead by bead—though diverse in shapes, colors, sizes, lengths, mosaic designs, and historical origins—we can hang unbreakably strong on the perfect strand of humanity, which unites us as “one Nation under God.”
She didn’t know her words would haunt me for years to come. It was a night like any other night. I stood at the bedside of a relatively stable patient, and I was dutifully giving him his meds. The floor was quiet, patients and nurses preparing for the night shift a few hours away.
Like a fire klaxon, a voice cut through the relative peace of the hospital floor. “My husband is dying! My husband is dying!”
Instinctively, I dropped the medicines and darted out of the room. In the middle of the hall, a middle-aged woman ran toward me, screaming about her husband in the room across the hall. “He’s dying,” she yelled into my face.
Mouth dry, heart pounding, I pushed past her and entered the patient’s room. Of course, he was unconscious, blue, and not breathing. I started CPR, but the craziness was not over.
I wasn’t exactly a new nurse. I had been through a few codes, and they all went rather smoothly. I never experienced the stomach-churning nausea of having a family member witness their loved one dying.
The patient wasn’t mine, but I knew about him. He had recently had coronary artery bypass grafting surgery and was due to be transferred to the ICU any minute because his heart rate and rhythm were abnormal. His doctor was on the floor, writing the paperwork for the transfer.
Others had heard the wife call out in anguish, and everyone came running, including the doctor. He burst into the room, shouting, “I need an intubation kit! Get me an intubation kit!”
I could hear the rumble of the crash cart coming down the hall, but it hadn’t quite reached the room yet. The doctor continued to yell at me, to point, to spit. His hands shook, but I had been here before. I yelled back, “Hold on a second! It’s coming!”
I realized then that the doctor was more afraid than I was. The cart arrived, the patient continued to code, and the doctor got his intubation equipment. Although we managed to get a sustainable rhythm on the patient, he soon died in the ICU.
Of all the codes I experienced over my years as a nurse, this one sticks out as the most horrible. When codes start, nurses become the ultimate professionals. No one runs. No one yells. Everyone works as a team.
As a relatively new nurse, I never experienced the terror that “normal” people experience when someone starts to die. For me, I knew how to handle it. A patient going south deserves my close care, but the emotion is usually not high during care involving advanced cardiovascular life support. Afterward, I would cry and shake, but not when I needed my faculties about me to do everything I could to save a life.
This code was different. In fact, I can live it over and over in my mind, and I still feel as scared now as I did then. The wife and the doctor were breaking the rules. They didn’t know how to deal with death, and I don’t really blame them. I just know their actions scarred me deeply.
Trauma is a real problem in nursing, and situations like these can cause a nurse to relive moments that didn’t go well. This is especially true of new nurses. New nurses make mistakes, and they haven’t developed the ability to be the calm professional yet. This means that the trauma of extraordinary events can stay with them forever.
I never dreamed that I would face a family member who was screaming that her husband was dying. I can only imagine the torment she was going through, the heartbreak of knowing that her loved one was slipping away before her eyes. She reached out for the only help she could.
And that help was me.
Her terror has stayed with me all of these years. In that moment, I became her. I empathized with her, as any good nurse will do. I felt her sorrow, and despite our best efforts, we couldn’t save her husband. I find myself imagining how she felt when he actually passed away.
I will admit that this situation scared me, and I have dwelt on it more than I should. Nurses, especially new nurses, have to develop a sense of detachment from the patient and family. But what about the human side of the equation? Too much distance leads to too little caring.
I am happy to say that I took part in codes after this one, and I did the best job I could. In fact, I was praised for my work in situations where a life was on the line. But I never forgot the distraught woman in the hallway, or the surreal feeling of dread that her words—”He’s dying!”—caused in me.
It remains a trauma that has impacted my life forever. Nurses need to realize that they experience traumas, too, and that it is okay to talk about them. It is okay to be afraid. It is okay to reflect on the situation and examine the emotions the trauma awakens. Without this reflection, the emotions become buried. Ignored emotions manifest as substance abuse, out-of-control feelings, and hatred of the job.
My trauma is just one example. Almost every nurse has a story of when she or he was scared and traumatized. Talk about it. Don’t pretend to be so strong that you don’t need to ask for help.
I wish I could have saved that man. I wish I could have wrapped that wife up in my arms and made it easier for her. I couldn’t, but it will stay with me forever as the trauma in my career that haunts me, because I couldn’t hide behind the façade of the calm professional.
I am the calm professional, but I am human, too.