Congratulations, Minority Nurse Scholarship Winners!

Another year, another record-breaking number of applicants, and another group of nurses and soon-to-be nurses that overwhelmed us with their determination, dedication, compassion, and intelligence. Choosing our scholarship winners has always been a difficult task, and this year was no exception. But after much deliberation, we are so proud and thrilled to introduce our winners to you! We hope their stories resonate with you just as they did with us.

And just as we reveal this year’s winners, we invite you to send in your applications for next year’s scholarship. To apply for the Minority Nursescholarship, you must:

  • Be a racial or ethnic minority.
  • Be enrolled (as of September 2013) in either the third or fourth year of an accredited B.S.N. program in the United States or an accelerated program leading to a B.S.N. degree (such as R.N.-to-B.S.N. or B.A.-to-B.S.N.) or an accelerated master’s entry program in nursing for students with bachelor’s degrees in fields other than nursing (such as B.A.-to-M.S.N.). Graduate students who already have a bachelor’s degree in nursing are not eligible.
  • Have a 3.0 GPA or higher (on a 4.0 scale).
  • Be a U.S. citizen or permanent resident.

We encourage you to apply for the 2013 scholarship and look forward to reading your application!

First-Prize Winner, Shylisa Hicks

Born in San Diego, Shylisa Hicks now lives in Bastrop, Louisiana, and attends Grambling State University. She belongs to a litany of nursing associations, volunteers her time, and has bright plans for the future.

But it is Shylisa’s life story, one of overcoming seemingly crushing adversity, that truly inspires. Her father was killed when she was five years old. Child Protective Services removed Shylisa from her mother’s home at 10 years old. She went to live with her grandmother, then aunt and uncle, where she stayed.

Originally two grades behind her peers, Shylisa persevered and eventually graduated high school early as an honors student. She continued her honors course work at Grambling State.

Bubbly and laughing, Shylisa says she calls her aunt and uncle mom and dad. “I wouldn’t be anywhere with out my parents,” she says. “I appreciate it all.” She also credits her success to her supportive husband—also her high school sweetheart. She hopes to one day have two children of her own.

“I really wanted a big family,” Shylisa says, and she grew up with three siblings. “I love kids . . . especially to make them feel better when they’re sick.” She currently treats children and families in their homes. “I just fell in love with it,” Shylisa says.

Shylisa plans to obtain a doctoral degree and become a certified Sexual Assault Nurse Examiner (SANE). “Somebody has to do it,” she says. “I want it to be me….I’ve had a rough life myself.”

“It’s been a bumpy road, but I love it,” Shylisa says of her nursing education. She is excited for the future, and she intends to go back to school to become a Nurse Practitioner, eventually going on to establish a pediatric clinic.

Runner-up, Sandrine Nankap

Now living in Winchester, Virginia, where she attends Shenandoah University, Sandrine Nankap grew up in Cameroon, on the West coast of Africa. Hundreds of people in her country live in poverty and die of AIDS due to lack of knowledge and resources, she says. Though she volunteered with children and teens to teach them about HIV/AIDS prevention, Sandrine wanted to do more.

The fourth of seven children, Sandrine says her parents could only afford to send one of them to school. “They put all their money on me,” she says. “They did their best to encourage me in everything I wanted to do.” In her culture only men are thought to deserve schooling, to lead a family, Sandrine says. “I had a lot of pressure to be a successful woman.”

Ranked high in her secondary school class, Sandrine wanted to educate others and make a difference in their lives, so she went to nursing school, graduating in 2004. In 2008 she was “blessed with the opportunity to come to America,” hoping to become a nurse educator, combining two professions in which she believed strongly.

But upon arriving in America, Sandrine found she did not have enough money to support the continuing education needed and her two young children. “As a single mom, I started to work as a coffee maker at Dunkin Donuts for almost one year.” She was promoted to assistant manager. “Working with that company, I kept some money that allowed me to go for my nursing assistant training.”

Within two months, Sandrine took a job as a nurse assistant. It was one of her lucky breaks, she says. The other nurses counseled her, taught her. “They helped me achieve my dreams,” she says. “I passed [the NCLEX] on the first try and today, after all this struggle and tears, I am proud to be a registered nurse.” She still wants to become a nurse educator, teaching both in the United States and Cameroon.

In five years, she’ll be pursuing her doctorate, Sandrine says, and she’s starting her master’s course work next year. “I like to learn. I love knowledge,” she says in a soft yet steady voice. “I worked so hard for everything that I have….I have a lot of ambition.”

Sandrine says she wants to send her younger siblings to schools as well. She sends them whatever money she can so they can come to America too. Sandrine also wants to return to Cameroon to help other young women become nurses. “I’m really grateful for this opportunity to be what I want to be in life,” she says.

Runner-up, Cerilene Small

“Every morning I wake up and begin my daily rituals of feeling the left region of my face,” says Cerilene Small. She keeps her eyes shut, afraid she will open them and be unable to see. It’s happened in the past, and because she has multiple sclerosis, it could happen again. Cerilene was diagnosed in 2009.

A competitive African dancer, Cerilene first knew something was wrong when she lost feeling in her body—but her mother thought it was due to her dancing all night. Then, after months of inconclusive tests, she learned she had MS.

“It was really hard” going into senior year, Cerilene says. She was scared of going anywhere, hopeful but cautious of what her future might hold. Originally from Brooklyn, Cerilene applied to New York University undecided, but after spending a month in the hospital, she says she realized she wanted to become a nurse. “My nurses really had a strong impact on my recovery,” Cerilenesays—so much so that she redid her college applications.

Now enrolled at NYU, Cerilene started classes in February 2011, and she had her first MS “flare up” not long after. She says she has about one flare-up each semester, but she’s trying and adjusting to the effects of a new treatment.

Being an honors student, a high school valedictorian, and a first-generation student, they all pale in comparison, Cerilene says, to being able to take advantage of every day “as a leader.” She mentors other first-generation students and one day hopes to open a youth health center offering free clinical services. She aspires to pursue a five-year dual degree (B.S.N./M.S.N.) in pediatric nursing.

Become familiar with the population you want to serve, Cerilene advises soon-to-be nurses. “Try to get involved before clinicals.” Know that the work is hard, but learn to “be a leader on your own.” After that, just “have faith,” she says. “You’ll do fine.”

Double Minority: Mental Health Attitudes and Discrimination in Nursing

Double Minority: Mental Health Attitudes and Discrimination in Nursing

The end of the year was dreamlike. Not only was I accepted into an accelerated nursing program, the school also selected me as a recipient for a prestigious scholarship award. The honor of being among an elite group chosen to represent the ideal future “face” of nursing leadership was an incredible sensation. But those exciting days quickly spiraled into a nightmare.

Many of us belonging to ethnic and racial groups experience disturbingly disparate health, educational, and economic outcomes, and we have committed ourselves passionately to improving the well-being and quality of life of individuals from populations from which we ourselves are drawn.

My faculty advisor for the scholarship program was so impressed with my curriculum vitae and scholarship application essay that she strongly encouraged me to pursue scheduling a meeting with the director of the Ph.D. program to discuss a seamless progression from a B.S. to an M.S.N. to a Ph.D. One week later, I met with my faculty advisor again to discuss some initial temporary feelings of anxiety I had about the program. I sought to proactively inquire about accessing resources and strategies to succeed in the program, with my diagnosis of depression and anxiety disorder. The next day, in a meeting with my advisor and one of the school’s deans, I was urged to voluntarily withdraw my admission and cancel my acceptance.

The experience was unfathomable; literally within a week, I went from being encouraged to complete all levels of nursing education at the school to being told “this is a very intense program,” “we want you to be well,” “there are other seconddegree programs,” and “when one opportunity closes another opens.” A week after the scholarship orientation and on the fourth day of classes, they concluded that I lacked the emotional fortitude to handle the rigors of the intense, accelerated program. Additionally, when I called several weeks later to honor my end of the scholarship contract with the organization, I was informed that the school had already contacted the organization the day after my withdrawal and requested that the scholarship funds be given to another fi nalist. Along with the frustration inherent in the situation, I was very disappointed with the enduring stigma of mental illness, so pervasive that my health condition superseded the accomplishments that resulted in my selection as a prestigious scholar.

About a month after the experience, I traveled overseas for a service mission trip. An uncanny experience served to maintain my resolute desire to be a nurse, in spite of the indignant and vilifying event.

As the service team of approximately 60 volunteers waited to begin our five-day service mission, the warm community residents greeted us individually. One young girl caught my attention, as she was wearing a bright pink shirt, decorated with the word “princess” (printed in English) and a rhinestone-studded tiara. It reminded me of something I would have worn at her age. Speaking in Spanish, I said, “I really like your shirt.” She tilted her head, her eyes downcast. Her facial expression indicated that she heard me, but she didn’t respond to my compliment. I then proceeded to tell her how pretty it was and called her Princess. Again, I received no response and little eye contact. I finally asked her if she understood me, as I didn’t rule out the possibility that my Spanish was rustier than I realized, but she answered “yes.”

When I walked off I watched the young girl and noticed she was aloof from the other girls and women who were waiting to enter the clinic area. I had two initial thoughts: first, this young girl needs to see a provider and feels shame or embarrassment, or she is extremely shy. Several hours into the afternoon, I saw her again and asked her age. She clearly responded with her head lifted, making eye contact: “16.” Then she became reticent to speak again, and I watched her from a distance and noticed that she remained aloof.

I asked one of the missionaries of a partnering organization about the average age of parity and the familial structure. He said couples are usually partnered anywhere from 12 years to adulthood. I asked our pharmacy manager if we had pregnancy tests. We didn’t.

I saw the Princess again for the third time in the late afternoon but didn’t find an appropriate opportunity to speak with her in an inconspicuous manner. The next day, I spoke with the pediatrician about my assumption, and when I spotted the young lady, I discreetly pointed her out. My hope was that she could be examined and referred to the permanent clinic, about a 30–40 minute walk, to receive the care I believed she needed. A few minutes prior to leaving for my service project worksite, I greeted her with a wave and a smile and it was reciprocated with a partial wave and smile. The next day, I discovered that a teenage girl was seen by one of our providers and that she indeed thought she might be pregnant but was afraid her mother was unaware of her potential pregnancy.

I shared my experience with my student mentor assigned to me at the time of my admission offer to the scholarship program. She expressed her concern about the information I revealed and reasoned that as a black female ostensibly entering a predominately white women’s profession, disclosing my mental health condition might not have been the action of my better judgment. I respectfully, wholeheartedly disagree.

Not only does concealment fuel stigma, but carrying this unnecessary burden hinders one’s ability to achieve a complete and whole state of wellness. Additionally, I candidly shared with her that my father was a physician, trained in the ’70s, who labored under the stigma and shame of his depression for 30 years, unbeknownst to most of his colleagues. Out of fear of losing his medical license and the respect of his colleagues, he concealed his illness and failed to receive the appropriate level of treatment he needed during a crisis episode. As a result, his lifelong battle with depression ended in suicide. His family, friends, colleagues, fellow community members, and former patients were absolutely devastated and angry that he never reached out for adequate help.

My very considerate and compassionate student mentor addressed a relevant and poignant concern, one I also believe has been inadequately examined in society: in a country that professes a desire for diversity, but where racial prejudice still exists and opportunities to render a racial/ ethnic minority as incompetent can be exploited, how does one handle a having a mental illness?

While this question should by no means be ignored, I’ve debated my decision to disclose my mental health history and the physical manifestations that I experienced. My conclusion? I unequivocally have no regrets. One of the main roles of a nurse is to be a patient advocate. I believe that if I can effectively advocate for myself, I’m well qualifi ed to be a uniquely effective advocate for a patient.

Finally, to my father, I’m so very proud of you for dedicating your life, service, and passions to helping others, even as you did your best to address your own struggles and challenges. Thank you for giving me the resiliency and courage to pursue my passions and dreams amidst obstacles and adversity. I love you.

If you are struggling with depression and/or anxiety, we encourage you visit the National Alliance on Mental Illness website at www.nami.org or the National Institute of Mental Health at www.nimh.nih.gov.

The Greatest Gift

Editor’s Note: This article is adapted from an essay submitted with an application to the 2005 ExceptionalNurse.com Scholarship Awards. Because of the sensitive nature of the topic, the author has requested that only his initials be used.

I know I have more than the average nurse to contribute to the nursing profession. As a nurse with HIV who knows what it is like to live with a chronic disease and to go through the maze and humiliation of the welfare system, I have much wisdom to offer my patients and fellow nurses.

I have lost friends, family and coworkers to HIV. No, I didn’t lose them by their untimely death; I lost them because of the ignorance and fear that surrounds HIV/AIDS. There is a stigma of living with HIV that is perpetuated through the media. The stereotyped image of a person with HIV is someone who uses intravenous drugs, has unsafe sex with multiple partners and lives life on the edge. While this may be true for some, we cannot all be placed in the same box. Some people with HIV, like myself, simply acquired it through love and trust–a big price to pay for a meaningful relationship.

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When I was diagnosed, my CD4 count or T-cells were 30 (normal should be above 600). I was working as an LPN and was enrolled in an RN program. When told I only had six months to live, I decided to go on a leave of absence from my job to travel and rest. I started the HIV meds, put school on hold, cashed in all my life insurance policies and started my journey as a “person with AIDS.” I went on Social Security Disability, Supplemental Security Income (SSI) and Medicare/MediPass.

During that time, I felt like a leper. I had few outlets for social interaction except for my HIV/AIDS support group. I lived on $1,000 per month. This had to cover my rent, utilities, car payments, co-pay for medications and doctor visits. I had little left for food or other needs.

For almost two years, I was on welfare. The Community AIDS Network helped with groceries and my personal needs. I lost weight, had many reactions to medications and stayed in bed most of the time.

Finally, I realized that I was not going to die as the doctors had predicted. I decided to go back to work. This turned out to be no easy task. A nurse diagnosed with AIDS is not something a health care institution wants on its payroll.

After much persuasion and networking I came off my leave of absence and started back to work part time. A year later, I was doing fine and my T-cells slowly, very slowly, started to climb. So I went back to work full time. In 2003 I found an online, self-paced RN program that worked well for me. The journey to become an RN will have taken me 15 years.

Walking In Their Shoes

I am a nurse, but I am not just any nurse. I am a special nurse with a unique gift that allows me to make a special contribution to my profession.

I have taken care of patients who were newly diagnosed with HIV and I have felt their shock, disbelief and anxious feelings of “what now?” When the doctor or nurse practitioner gives such news to a patient, the professional can only think and explain it in technical medical terms. Most health care professionals cannot feel what it is like to be told you have a chronic disease, one that cannot be cured even with today’s advanced medical care.

As the doctor leaves the room and the patient is left to ponder what happens now, I can step in and fill the void. I have walked in their shoes, remembering when I was told the devastating news, “You have HIV.” Back then, I had no one to turn to.

Now, I have the greatest gift of all to share. I’ve been there, experienced it, know the different treatment plans, and I’m a survivor. I have referred many of my patients to the appropriate agencies to help them obtain education about HIV, care options and support groups. I listen to their expressions of disbelief, their questions of “how did this happen to me?” And I can respond with the understanding and empathy they need.

When I disclose my status to patients, I always hear the same thing: “You don’t look sick.” My response is, “I didn’t know I was supposed to look sick!” Then we both laugh. Again, I hear the stigma. People with HIV are supposed to look sick. What better education for patients than seeing and talking to a real person who has experienced what they are going through? This is the gift I give.

When you live with a chronic disease day in and day out, you become familiar with what is changing in your body and in your life. You can educate and inspire your patients and coworkers just by showing up for work and setting a positive example. Over time, people learn to see you in a different light–not as a person with a chronic illness, but a person who takes what life dishes out and runs with it into their dreams.

I am that person. I go to work every day, and by doing so I’m contributing to the nursing profession and setting an example for all people with disabilities, whether chronic or acute. I’m a daily reminder that if you decide to take charge of your life and health you can do anything, no matter what type of disability you may have.

As I continue my career in nursing and my journey of HIV, I know I will continue to gain even more wisdom to share with my patients and colleagues. I now have diabetes, hypertension and lipoatrophy, all caused by HIV. Each one of these conditions is a disability in its own right. My example of living life to the fullest and not giving up, no matter how difficult or challenging it may become, will only help erase the stigma associated with disability. I believe that to have a disability is to receive a gift.

When you are given this gift, you can either choose to keep it wrapped up or you can open it up and learn to use it to help others. By choosing to open your gift and share your experiences with others, you begin the process of educating, becoming a role model and ending discrimination against persons with disabilities. It’s easy to sit on the sidelines, do nothing and watch the world go by. It’s hard to get on the court with a disability and play. But with the right tools, education and support, everyone with a disability can play in the game.

I used to question, “Why am I here, God?” But now I know the answer. I am here to share my positive gift with the world. I just didn’t know that I’m more positive than most people. . .until now.
 

Forgotten Heroes

As the nation and the world witnessed in the wake of the September 11 terrorist attacks, police officers and firefighters who get hurt in the line of duty are treated like heroes—and deservedly so. When one of their own is injured or becomes disabled, these professionals rally together to help their fallen comrade, providing both emotional and financial support.

Unfortunately, this is often not the case in the nursing profession. Based on my own experience as well as those of other RNs in the same situation, nurses who become disabled due to on-the-job injuries are far more likely to be cast aside by their employers and colleagues than to receive their solidarity and support.

With the nation’s nursing shortage now at crisis levels, more RNs are becoming injured and permanently disabled because of unsafe working conditions. Today’s understaffed health care workplace, where severely overworked nurses are staggering under the burden of unprecedentedly long hours and increased patient-to-nurse ratios, is an injury time bomb waiting to explode. Consider this scenario:

You arrive at work just like you have done for years. Your patient assignment is already a heavy one when three more admissions come your way. You go into Mr. Jones’s room to help him change position. Even though this patient is a large man, asking one of the other floor nurses to help you lift him is not an option, because their workloads are just as frantic as yours.

So you do it yourself—and then you feel an incredible pain in your back. The pain shoots up your neck, causing an unbearable headache. Just as quickly, you experience numbness in your arms and legs, and you fall to the floor. Obviously, you need immediate medical attention. But if you leave the unit, who will take care of your patients?

Because you are not an indestructible Supernurse, however, you have no choice but to go to employee health. Meanwhile, your colleagues are feeling resentment at having to take on your patients and responsibilities in addition to their own. They project their frustrations onto you–and now your coworkers and friends are upset with you because of an unforeseeable accident that was not your fault.

Employee health tells you that you can go back to work if it is light duty–is there any such animal as “light duty” in nursing?–or else you will have to take the next 10 days off. So you stay home for the next week and try to recover. But after a few days, your condition worsens. Now the nightmare begins.

Your medical insurance will not cover you for the accident because it was work-related. The workers’ compensation insurance company insists that you be seen by one of their doctors. After three hours of sitting in a waiting room, the doctor finally enters, pushes you in a couple of places and tells you, “You’re fine, go back to work”—even though your pain is so severe you can barely walk or stand.

Your coworkers can’t understand why you are not coming back to work if the doctor said you are fine. You must be malingering, they conclude. And what if you are unable to return to work for weeks or months? What will you and your family do after the paychecks and disability-leave benefits run out—while your medical expenses continue to mount?

Money Talks

While what I’ve described may sound unbelievable, several employment-law attorneys I consulted after my accident, including the lawyer who is currently handling my case, report that my experience is not unique. And, they add, the reason why this situation keeps occurring can be summed up in one word: money.

Employers pay the premiums for workers’ compensation insurance with the understanding that they want their employees back to work as soon as possible. The insurance company, in turn, wants to keep its costs down by paying out as few claims as possible. Since money talks, the party that is paying the premiums is the one whose interests are honored. As the injured nurse, you quickly learn that you are not a priority with the insurance company.

As for the question of how workers’ comp doctors can get away with telling severely injured nurses they are well enough to return to work despite obvious evidence to the contrary, who is going to go after them? Disabled nurses who have no money to take them to court because they now have no income, medical coverage or workers’ comp benefits?

In New Jersey and some other states, an injured employee is denied by law the right to sue their employer for negligence or even force them to have the worker’s compensation insurer pay for their lost wages or medical care. To make matters worse, another reality I learned the hard way is that work-injured nurses must endure the humiliation of having people from the insurance company follow you and photograph your movements in the attempt to prove that you are a fraud. As a result, you must obtain a lawyer to protect your rights, incurring even more expense.
Depending on the severity of your injuries, this nightmare can drag on for years, leaving many disabled nurses unable to pay their bills or receive appropriate medical care. Some may even lose their homes and their marriages. Many of the work-injured nurses who have shared their stories me have had their cases in litigation for anywhere from eight to 15 years before they were settled. And even though these nurses’ experiences seem to indicate that such cases are usually settled in favor of the disabled worker, why are we forced to wait so long to receive justice?

Some workers compensation companies have tried to argue in court that the nurses are faking their injuries by using their medical knowledge. This is simply absurd. Are police officers who are wounded in the line of duty accused of shooting themselves because they carry guns? Are firefighters who suffer from smoke inhalation accused of starting the fire because they have knowledge of fires? Why does this seem to happen only in the nursing profession—a field whose very reason for existence is to help the sick and injured?

An Unequal Commitment

In England, a government agency, NHS Direct, has been looking into solutions for assisting nurses who have become disabled due to workplace injuries. As reported in the September 2000 issue of Nursing Times, a “work-based assessment is done and ergonomically designed equipment is provided to meet their needs.” Here in the U.S., the federal Department of Vocational Rehabilitation provides resources—such as assessments, educational funding, hearing aids and computers—to help work-injured persons resume their careers or transition into new ones.

But the nursing profession, whether in the clinical setting or in academia, has yet to demonstrate this same level of commitment to helping nurses who have fallen in the line of duty regain their professional lives.

Some work-injured nurses do manage to continue their careers by returning to school and earning advanced degrees. But this, too, is a long process with its own challenges, barriers and prejudice caused by preconceived images of people with disabilities. According to a recently published Minority Nurse article on nurses with disabilities, “because of a long-standing myth that health care providers must be physically perfect…many [disabled nurses] are told that they have no business pursuing or continuing a career in health care altogether.”

The passing of the Americans with Disabilities Act (ADA) more than a decade ago has done much to help level the playing field for disabled nurses. But still, change is slow. A February 2001 Nursing Spectrum article noted that “career transitioning is hard work for disabled nurses…new grads and experienced [nondisabled] nurses are also in competition for the same positions. It’s a buyer’s job market.”

As nurses, we devote our lives to caring for our patients—but when we are the ones who are hurt and need help, we don’t receive the same level of care. When injured nurses are in danger of losing their livelihood, the nursing profession should be part of the solution, not part of the problem. Disabled nurses have a right to expect their employers, educators and colleagues to step up to the plate for them and show the same professional support that police and firefighters do. We deserve more than to be cast aside like forgotten heroes.

Author’s Note: Thanks to Carolyn Zagury, RN, PhD, for her sincere help and support.

Turning a Knee Injury into a Step Forward

A labor and delivery nurse in Springfield, Missouri, Rosario Kowalski, M.S.N., R.N., was working towards her master’s degree in nursing when she experienced an unexpected trauma of her own: she tore a ligament in her knee while walking up the stairs. “It was completely out of the blue,” she says, a nurse for nearly 30 years.

Knee surgery and a difficult, lengthy recovery followed the accident. “When you’re in pain, all you can think about is getting out of pain,” Kowalski says. “I couldn’t work at the job I loved. I couldn’t even walk. I felt like I’d lost everything.”

Despite having to take a break from her job, she was able to continue working toward her M.S.N. because she was enrolled in a distance-learning program with Regis University in Denver, Colorado. “During my difficult recovery, it was wonderful to have education. I looked at my curriculum and felt better. I realized that I was probably only two semesters from graduating,” she says. Kowalski opted for an online approach to her master’s degree because it fit with her lifestyle. Like many nurses, her work schedule varied, and she juggled working full time with family life. Distance-learning offered her the flexibility she needed to pursue her degree.

“I loved working alone and at my own pace within given time frames and guidelines, so independent studying worked well for me,” she says. “The convenience was important to me since I live in a rural area and didn’t want to drive. For years, I drove 55 miles each way to work and I didn’t want more drive time.”

Making the most of a difficult situation, she threw herself into her studies, completing four courses in seven months. “I was able to study, and it really saved me. I had a schedule, something to do, and a sense of the future,” Kowalski says. “I learned so much and had a lot of insights into things that I wouldn’t have had the time to learn otherwise. The courses provided a distraction from my tumultuous circumstances.”

In addition to the convenience, she discovered that Regis was a good fit for her personally. “I really felt in harmony with their approach. Their leadership style is a servant-leader style, and that matches my goals. It opened up a brand-new world for me,” Kowalski says. “In my work setting, I see things differently and I’m a better nurse now.”

The married mother of three grown children, Kowalski had to overcome another major obstacle before she started studying for her M.S.N. and the injury to her knee. “I was acutely aware of being an older student. I hadn’t been in school for 25 years, and I was intimidated by the technology,” she says. “I was a nurse and loved what I did, but I hadn’t fully integrated technology into my practice, and every job now requires computer skills.” Kowalski took several basic computer courses before starting her nursing course work and found that she greatly enjoyed the challenge. “I was really, really excited!” she says. “By the time I took my first online exam, I was back into studying and felt comfortable with computers and the online aspect.

“For me, there is something about wanting more knowledge,” Kowalski says. “I always loved school. I saw that no GRE was required by Regis University for an M.S.N. if you took a statistics course in college. I had statistics in college, so that got my interest. I didn’t want to take the GRE after being out of college for so many years. I signed up—and thought I was crazy for signing up for an online program when I was not efficient with technology!”
Though she had initial reservations, Kowalski graduated in May of 2007 with her M.S.N. from Regis.

Achievement as a family tradition

Born and raised in Belize City, Belize, Kowalski came to the United States in 1972 to go to college. She first attended the University of New Orleans for her prerequisites for the nursing program at Louisiana State University Medical Center. LSU’s nursing program was the only B.S.N. program in the state at that time, and admission was very competitive. “At that point, the school was very progressive in their thinking and very much trying to push nursing into the academic arena. They encouraged research and nursing theory and were offering a B.S.N. when most schools in the area were only offered diploma certificates in nursing,” she says. “It was very visionary at the time. Now, almost all schools have shifted to some type of B.S.N. program.”

Kowalski earned her bachelor’s in nursing from LSU and started working as a nurse in med-surg. “My husband’s role as a minister required us to relocate about every three years. I had always wanted to be a labor and delivery nurse but the frequent relocations would have made it difficult. Relocating did remind me, though, of the variety and job security you have in nursing. I was able to work wherever we went.”

After they moved to rural Missouri in the 1980s, Kowalski was finally able to pursue cross-training as a labor and delivery nurse. “Labor and delivery was my passion,” Kowalski says. “Every day was a wonderful experience. I couldn’t believe they were paying me to do this. When you love what you do, nothing is hard. I had found something I just loved.”

Education is an important part of Kowalski’s family. Both of her daughters graduated from college, her son is currently earning his degree, and her husband is an adjunct professor at a local bible college. She also comes from a big family, with five sisters and two brothers, all of whom attended pursued higher education.

She is, however, the only one of her siblings to earn a master’s degree. “When I got my master’s degree, no one was more delighted than my mother,” she says. She credits her mother for always being very supportive of education. “We all understood that we would be going to college.”

Her entire family has since immigrated to the United States. She credits their Mayan ancestry for their passion for education. “The Yucatan people are of Mayan descent, and the Mayans were a brilliant people,” Kowalski says. “My mother’s family is from that area, and that genetic pool helped us.”

Growing acceptance of online education

While distance education has existed for centuries, the development of the home computer and the Internet has made it possible for working nurses like Kowalski to take whatever classes they like, whenever they like, and complete them as fast as they like.

Of course, the convenience of an online course does not mean it’s simple to complete successfully. “I think people used to think that an online course is easy, like a correspondence course. But you really have to earn your grades. You have to be disciplined, but I loved the freedom and the online culture. And there’s plenty of individual attention and more online support,” Kowalski says. “You do have to be able to sacrifice time to accomplish the work because it is no cake walk.”

With changing and unconventional work schedules, nurses often find attending a traditional classroom-based program impossible. Distance learning offers flexible class schedules and immediate start dates often with no waiting lists like traditional nursing programs.

In addition to saving money compared to traditional two- or four-year colleges, the ability to continue earning a steady paycheck and supporting their families while taking courses is typically a key factor for nurses like Kowalski who decide to pursue online education.

She even hopes to teach nursing after she fully recovers from two knee replacement surgeries.

Kowalski credits her family, education, and opportunity for her success in nursing. “The United States really is a land of opportunity,” she says. “You can accomplish anything if you are willing to work hard. People will give you opportunities, and if you hold onto them, you can become anything you want to be.”

Minority Mental Health: Shining a Light on Unique Needs and Situations

A recent Institute of Medicine report documented evidence that minorities in the United States received lower levels of mental health care, even when variables such as insurance status and income were controlled, says Debbie Stevens, P.M.H.C.N.S.-B.C., a doctoral student at Emory University’s School of Nursing in Atlanta, Georgia. That’s because nurses play a major role in helping reduce these disparities by educating patients, families, and their communities, Stevens says.

Overcoming cultural barriers

Finding treatment for an illness, such as depression, can be difficult for members of minority groups because they may face stumbling blocks to care, says Vicki Hines-Martin, Ph.D., R.N., F.A.A.N., a professor in the University of Louisville School of Nursing in Louisville, Kentucky.

A major barrier is a perceived cultural stigma of mental health issues. Hines-Martin says some minority populations don’t talk about suicide or depression because it’s seen as shameful. “You may have people who say, ‘I know about suicide, but it has nothing to do with my family or my group,'” she says.

Another problem is that many people may not understand the seriousness of their needs, says Harriett Knight, R.N., a nurse at Sinai Hospital in Baltimore, Maryland. Some people may initially seek an appointment with a specialist, but if treatment involves ongoing medication for an illness, such as depression or schizophrenia, the patient may be resistant to taking the drug as prescribed, or they don’t fully accept that they should continue to take it, says Knight.

Sylvia Hayes R.N., M.S.N., is a nurse in the mental health unit of Peninsula Regional Medical Center in Salisbury, Maryland. She says many patients she sees also don’t accept that mental health is a specific medical science. “They tend to believe their issues are caused by a physical problem,” she says. So they may seek help for a persistent headache, when the real issue may be anxiety related, she says.

In many cases, if a patient realizes that his or her medical issue does involve mental health, they may face another barrier—the fear of being stigmatized. Hayes says she’s seen many African American patients who are afraid that they’ll be “labeled” if they admit to having mental health issues.

“They don’t want to be considered ‘crazy,’ and their family doesn’t want them to be considered ‘crazy,'” says Hayes. “They may be afraid their family will isolate them if they seek help, because then they’ll become an embarrassment.”

Of course, many families support their loved ones suffering from mental illness, regardless of any perceived social stigma. In fact, when relatives are accepting of their loved ones and are willing to help them find care, they can be a vital part of the recovery plan. Many patients will even turn to family members for help before they turn to the medical system, says Hayes. This is good, as long as well-meaning relatives encourage patients to seek professional help when necessary. “It can be a negative if the family delays the patient from receiving the treatment they need,” she says.

Many families actually hold the key to helping patients understand their medical histories, Hayes says. “I’ve seen people with family secrets. They had an uncle or aunt who may have dealt with the same mental health issue,” she says. But if the family shunned that aunt or uncle, the patient may not be as open to finding help.

Family cooperation is also important in treating children and teens. Hayes says many mental illnesses are present at a young age. “I’ve worked with kids as young as two years old,” she says.

However, it may be difficult for well-meaning families to receive satisfactory care. A recent press release from the National Alliance on Mental Illness (NAMI) reports “63% of families reported their child first exhibited behavioral or emotional problems at seven years or younger,” but at the same time, “only 34% of families said their primary care doctors were knowledgeable about mental illness.”

Language and cultural obstacles present another challenge for mental health patients. If a person can’t find a medical professional they can simply talk to, they are less likely to seek medical care, says Patricia Lazalde, Ph.D., Director of Behavioral Health at San Ysidro Health Center in San Diego, California.

San Ysidro serves many Spanish-speaking Latino clients, so it’s important for minority nurses to be able to speak Spanish too, she says. “Minority clients may come in with a variety of stressors, but due to language issues they often don’t seek help until it reaches a crisis,” says Lazalde.

Immigrants of various backgrounds encounter similar stressors. In Louisville, Kentucky, there are increasing numbers of members in immigrant and refugee communities, particularly form Somalia and Myanmar, says Hines-Martin. “They’re newcomers, and they’re dealing with the stressors of changing from one environment to another,” she says. “How they deal with these stressors and whether they want to talk about them is important.”

Members of minority populations may also postpone or avoid seeking care for mental health issues, Hines-Martin says. It’s not so much related to an ethnicity or racial group, but it’s associated with people who hold more traditional values related to their culture, and are less likely to follow mainstream care, she says. “People who are less acculturated into the general population may be less likely to seek help if their culture says it’s not something they should do.”

Financial stress and mental health

The slow economy is also creating a barrier to care for some people, even as it’s identified as a stressor for many. Patients are dealing with the stress of lost jobs, eviction, and foreclosure, says Hines-Martin. She recently completed a study of 127 people in a low-income area and found that poorer residents had almost double the rate of depression as the general public.

“When you look at the economic factors they have to deal with, it makes perfect sense,” Hines-Martin says. The stress of constantly figuring out how to survive can wear down a person, and those factors are associated with depressive systems, she says. “If you have problems in several areas of your life, it can affect your mental health.”

Obviously, financial setbacks don’t always cause mental illness, but they can exacerbate problems in people who are vulnerable, says Knight. “A lot of patients don’t know they’re getting sick until there’s a trigger,” she says. For example, a person may get a call from their mortgage company informing them that they’re being foreclosed on, and they can’t handle their emotions, she says.

Lazalde agrees that whenever there is a loss of financial status within the family, nurses tend to see people with increased levels of depression and anxiety, particularly with wage earners.

“Traditionally, Latino males are the primary breadwinners for families, so the loss of a job and the inability to properly care for the family can really create an additional sense of anxiety, depression, and worry. It’s because they can’t live up to the more traditional roles that they would typically fulfill for the Latino family,” Lazalde says. As a result, there’s an increase of male Latinos coming to seek help for depression and anxiety, she says. The issues affect the entire family. “It creates marital problems. Parents are fighting, and we see the kids coming in with levels of anxiety as well,” Lazalde says.

Residents often have to move out of their homes and move in with relatives and extended family because of financial problems, she says. “Family members have to change schools and meet new friends, and there are not a lot of places they know to go to in terms of seeking resources and finding a shoulder to cry on,” Lazalde says.

Financial problems can also limit access to health care, including treatment for mental health needs. “Many clients are losing medical or health insurance coverage,” says Lazalde. This means fewer people can afford their doctor visits, and they have a more difficult time paying for their prescriptions.

Immigration issues are another stressor in many minority communities. There’s a lot of anxiety and depression when people hear about immigration reform on the news, and they’re worrying about what the outcomes and changes will be, says Lazalde.

“Many of our families are being impacted. A number are split up, with half the family living in the United States and the other half in the native country,” Lazalde says. As a result, wage earners have to support two homes, while they’re responsible for the cost of attorneys and other fees. “They have the stress of keeping the family together.”

Getting involved

One way nurses can help patients deal with their stresses, and improve mental health care overall, is to become active in the communities they serve. This helps build trust between residents and medical professionals, says Hines-Martin.

She says that’s a goal of the Office of Disparities within the University of Louisville’s School of Nursing, where she serves as the center’s Director. The office was started because the school of nursing identified a need to focus on how nursing education, practice, and research could help populations that experience disparities in health, Hines-Martin says.

The Office of Disparities sponsors a variety of programs, including faculty and student activities. Hines-Martin’s most recent project involves working with an entire low-income public housing community. “There are about 700 people in a one-block area,” she says. “It’s a way for us for us to see how economics, food, and trans-generational housing affect how people cope.”

Hines-Martin and her nursing students have found they don’t necessarily see people who are actively engaged in behaviors that are detrimental, such as self-inflicted violence or substance abuse. “But I do see people taking risky behaviors because they don’t care anymore,” Hines-Martin says. These people put themselves in dangerous situations, such as drinking excessively, and the drinking is actually related to depression or a depressed state of mind, she says.

There are many challenges, but the program is yielding results for patients who receive care, says Hines-Martin. She says she’s seen people who received help for psychological conditions and didn’t need to be readmitted to a medical facility after receiving treatment.

There’s also been a decrease in the number of people who have been evicted from their homes because of problems that could be tied to mental illness, such as drug use, says Hines-Martin.

“The community is in partnership with us,” Hines-Martin says. “We’ve learned that people are really invested in having a better understanding of their lives and mental health. It makes it easy to partner with them and invest in them.”

Another way to help build trust is to work with other professionals and community leaders to help educate the population about mental health topics. “Many Latino families aren’t likely to go to a behavioral health specialist initially. Instead, they’re more likely to seek help from clergy or a medical doctor,” Lazalde says. With regards to minority nurses, if they are connected to these influencers, they can help patients find needed behavioral care more quickly, she says.

Identifying red flags

Finding good mental health care is not simply a task reserved for nurses who specialize in behavioral health. Minority nurses in all specialties can help identify red flags that a patient may need a referral for a behavioral health specialist, Lazalde says.

When a nurse in any practice area sees a patient, he or she should look for issues such as a high frequency of usage, she says. The primary care doctor is usually the first person a potential mental health patient will visit, Lazalde says. If a patient has historically only visited the doctor’s office once or twice a year, but now they’re visiting two or three times a month, that’s a red flag, she says. These patients tend to have physical complaints with no apparent cause, so the real issue could be stress or anxiety related, she says.

Minority nurses also need to pay attention to comments patients make during their visits. “They may see a doctor and complain about a headache, or pain in the chest or back, but at the end of the session they bring up family problems,” Lazalde says.

Another red flag could be visits from multiple family members. “If you’re seeing a mom, dad, and siblings for physical problems, all within the space of a month, it could be a sign that there’s some sort of turmoil in the family,” Lazalde says.

And nurses shouldn’t wait until the visit is nearly over before addressing mental health issues. “I think it’s really important for nurses to ask questions early on,” says Lazalde. “Ask how things are going in the family and at home. If the questions are addressed by the medical provider or nurse, it normalizes the situation and allows the family to speak more freely,” she says.

When nurses are rushed for time, sometimes really important pieces of information fall through the cracks. This can be prevented by having a patient fill out a survey at the start of their visit, Lazalde says. She encourages the use of a questionnaire, such as the Generalized Anxiety Disorder 7-item scale (GAD7), to help assess a patient’s mental health needs. “It only takes a few minutes and can be completed in the waiting room, and it doesn’t take away the nurse’s time,” she says.

If it’s determined that a patient should receive specialized care, Lazalde recommends that referrals be “normalized.” For example, when nurses make a referral to a provider who’s an oncologist, it’s normal because the oncologist is simply a member of the health care team, she says.

“So we have to find a way to make the behavioral health provider a member of a team. Instead of making the client feel as if there’s something wrong with them when they receive a referral, they’ll know that they’re just meeting another member of the team,” she says.

Lazalde also has another important piece of advice for minority nurses: don’t give up on your patients. “It often takes more than one referral to be successful. Sometimes we have to refer the patient three, four, and five times,” she says. If nurses approach their roles knowing that it takes multiple referrals before they reach a successful linkage to the other provider, then nurses may be less likely to get discouraged, she says. “We’ll know that the family hears the referral more times and there’s a higher likelihood the patient will go and complete the referral and receive the services they actually need.”

Erasing stereotypes

Perhaps the most disappointing barrier minorities face are the ones caused by the attitudes of medical professionals. Minority nurses can exhibit the same biases about their patients as anyone else, and if they’re not careful, they may start to form negative opinions that could affect their levels of care, says Stevens. “Just because a nurse is a minority doesn’t mean they’re immune to stereotyping,” she says.

Some nurses, particularly those who serve low-income communities, fall into the trap of assuming that some poorer patients check into medical facilities to access prescription drugs, three square meals, or a warm bed, she says. “I’ve heard people say ‘the patients are looking for three hots and a cot,'” Stevens says.

These biases are often reinforced when patients have high rates of repeat visits, she says. But despite the challenges, many minority patients who do receive appropriate care become better and are able to function in society, she says. Minority nurses must provide the best service possible by making a sincere effort to view each patient as deserving of quality medical attention, Stevens says. “Nurses have to fight to eliminate negative stereotypes they see, even if they may have had those same stereotypes themselves,” Stevens says.

Translating policy into practice can be difficult because of how pervasive some biases are, but it can be fought the way any ethnic or cultural stereotype is fought, says Stevens. “It starts with education and awareness.”

Some patients will be difficult, Stevens concedes. But if mental health care is your specialty, you should remain confident that you are helping your patients. Standards of care have to be the same, regardless of who the patient is or where he or she comes from, Stevens says.

Minority nurses are specially suited to help break down barriers and stigmas, build trust among their communities, and help their patients live the best lives possible.

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