An Innovative Approach to Developing Minority Nurse
Practitioners
While many nurse practitioner training programs
around the country are working hard to increase the racial and
ethnic diversity of their student populations, one innovative
program in Southern California already has an unusually high success
rate when it comes to recruitment and retention of minority students.
More than 50% of the students in the Women's Health
Care Nurse Practitioner Program (WHCNPP) at the Harbor-UCLA Medical
Center in Torrance, Calif., are students of color.
"Out of the 12 people in the class that's enrolled
now, two are African American and four are Hispanic. The previous
class had three Hispanic students, two Asian and Pacific Islander
students and one Native American student," says Susan Stemmler,
MSN, MPH, FNP, CNM, the program's acting director of education.
According to Stemmler, the program doesn't have
a magic recipe for attracting students of color, although the
diversity of its faculty could be a contributing factor. Stemmler
is Native American; the faculty also includes African American
and Filipino instructors.
Another unusual feature of the WHCNPP is that it
is a certificate program for RNs, not a degree-granting program.
The program has affiliations with several local universities that
enable the NP students to earn academic credit toward their next
degree, and many do go on to pursue a BSN or MSN after earning
their certificates. The program is accredited by the National
Association of Nurse Practitioners in Women's Health and is approved
by the California Board of Registered Nursing as a provider of
advanced practice nursing education.
WHCNPP is one of only a handful of certificate programs
still operating in the United States. When it began in 1970, it
was the first women's health care nurse practitioner training
program, with a focus on training mid-level providers to work
in rural areas, Latin American countries and other medically underserved
places where there was little or no health care available.
Five classes a year complete the intense nine-month
program, which is offered through the Los Angeles BioMedical Research
Institute at Harbor-UCLA Medical Center. Until 2006, graduates
of the program can take the state's NP licensure exam. After 2006,
however, California law will require nurse practitioners to have
a graduate degree.
But that won't mean the end of the Women's Health
Care Nurse Practitioner Program. The program has developed articulation
agreements with its university partners that will enable students
to bridge into master's degree programs. Also, says Stemmler,
some of the nurses in the WHCNPP are international students who
go back to their home countries to practice after receiving their
certificates.
"What we offer is a depth of knowledge in women's
health care," she adds. "This program is a good step
for our students, but this isn't the end for them. It's only part
of the journey. Education keeps going and it's never done."
More information about this program is available
at womenshealthnp.org
|
|
|
From Minority Nurse to Nurse Practitioner
Because nurse practitioners are able to provide primary care and
prescribe treatments, this advanced practice career can empower minority
nurses to make an even bigger difference in eliminating health disparities
By Debra Williams
Amen Eguakun, MSN, RN, FNP, considers himself blessed. Working at a
church-sponsored clinic in Nashville, he provides primary care to minority
and disadvantaged patients battling HIV and AIDS. He works independently
and can devote as much time as he needs to each of his patients. Eguakun
credits it all to three coveted initials: FNP (family nurse practitioner).
Amen Eguakun, MSN, RN,
FNP |
"If I were still a registered nurse, I could not be doing this,"
he says. "Becoming a nurse practitioner gave me [advanced] training
and expanded my knowledge of medical treatment. Now, I can combine that
with the skills I had as a nurse."
Today, many other nurses are choosing to become nurse practitioners.
According to the American Academy of Nurse Practitioners (AANP), there
are more than 106,000 NPs in the United States. This represents a threefold
increase since 1990. Even with this growth in numbers, NPs are in demand
in virtually every part of the country.
Nurse practitioners perform many functions usually associated with
physicians. They diagnose illnesses by performing physical exams and
by ordering needed lab tests or other diagnostic tools. They also prescribe
treatment. This often includes writing prescriptions for medicine as
well as ordering treatments like physical or occupational therapy. Because
NPs are able to provide basic primary care, some minority health experts
believe that increasing the number of minority nurse practitioners could
make a major difference in the war against racial and ethnic health
disparities.
What nurse practitioners do is regulated by state laws, so their responsibilities
can vary depending on their geographic location. Health care facilities
further define what nurse practitioners do within their organizations,
which means the functions NPs perform can also vary from one hospital,
physician's office or other practice setting to another. While nurse
practitioners typically hold a graduate degree, a few states allow them
to practice without one, but only after completing one or two years
of intensive training.
Why Become a Nurse Practitioner?
Many nurses who decide to continue their education and pursue a nurse
practitioner license cite such benefits as higher salaries, expanded
job opportunities and increased job security. Those are certainly very
valid reasons for becoming an NP, but many practitioners say the real
benefits are intangible.
"My job as a nurse practitioner is rewarding financially,"
says Eguakun. "But spiritually, I'm a millionaire because I have
the opportunity to make a real difference."
Eguakun, a native of Nigeria who is now a U.S. citizen, began to dream
about becoming a nurse practitioner while working in a hospital as an
RN. "Most of the ailments we were dealing with were expensive to
treat," he recalls. "I realized that I could do more if I
was involved in primary care and could prevent people from going to
the hospital. If more people were involved in preventive care, maybe
we would not have to spend so much time and money on hospital care."
He also realized that minorities, particularly those with HIV and AIDS,
often have a very difficult time getting primary care. "In the
hospital, I saw many African Americans with HIV and AIDS. They were
dying. I learned that everything has to do with prevention," he
says.
Now, as an FNP, Eguakun has the time and the authority to treat the
entire patient. Many of his patients like to refer to him as a doctor,
but he quickly corrects them. He is proud to be a nurse practitioner
and declares, "I want my profession to get the credit."
Of his work at the First Response Clinic, he says: "We take care
of patients with HIV and AIDS, but we also provide primary care. This
population is very hard to reach. We want to give them all the treatment
they need in one location. That relieves some of the patients' problems
in accessing care, like getting from one clinic to another." He
has even visited patients at home when they couldn't make it to the
clinic.
First Response Clinic, operated by the Metropolitan Interdenomi-national
Church, receives federal funding but is operated solely by the church.
Eguakun believes that gives him a better chance of reaching many patients,
providing treatment for those afflicted with HIV/AIDS and helping those
who are still healthy avoid the deadly disease.
"In the Southeast, religion and the church are big factors in
people's lives," he explains. "The religious community has
also been seen as a problem in reducing the occurrence of HIV in minorities,
because the issue is not discussed in churches. [The church that runs
our clinic] is actually in the forefront of disseminating information
about preventing the disease."
Kenneth Miller, PhD, RN,
CFNP, FAAN |
That close relationship with patients is what drives many nurse practitioners,
according to Kenneth Miller, PhD, RN, CFNP, FAAN, president-elect of
the American College of Nurse Practitioners (ACNP) and professor and
associate dean for research and clinical scholarship at the University
of New Mexico Health Sciences Center, College of Nursing.
"The biggest reward [for NPs] is having the time to do what we
were educated to do: talk to patients about disease prevention and health
maintenance," he says. "Most physicians don't have the time
to do that. [Compared to doctors], we do a lot more education and discussion
with patients."
Welcoming Diversity
Here are a few quick facts about nurse practitioners from the AANP:
The average annual salary of full-time practitioners is $73,620. Nearly
half of the country's NPs (41%) specialize in family medical care, 19.5%
specialize in adult care, 11% in women's health and another 11% in pediatrics.
Miller also expects rapid growth in two other specialty areas: acute
care and gerontology. "The hottest specialty right now is acute
care. Residents have a limited number of hours to work in the hospital
and someone has to pick up that slack. There's a demand for acute care
nurse practitioners all over the country.
"The group we really need to start focusing on for the future
is geriatric patients," he continues. "Nurse practitioners
can provide the type of care that senior citizens are going to need."
Over 95% of nurse practitioners are female, although high-profile male
NPs like Miller hope to draw more men to the field. The NP profession
is also very open to racial and ethnic minorities. According to the
most recent National Sample Survey of Registered Nurses, published by
the Health Resources and Services Administration, Bureau of Health Professions,
Division of Nursing, approximately 11% of nurse practitioners are nurses
of color-and that figure is expected to increase.
"All of the programs [that train practitioners] are trying to
recruit more minorities," Miller comments. "Here [at the University
of New Mexico], we are trying to make sure that the composition of our
class meets the cultural diversity of the state where we live. [NP]
programs want to make sure there is equity in terms of the composition
of classes that are admitted so that our practitioners can better serve
the minority populations."
Eguakun says he's never felt that his race or gender were obstacles
in becoming or practicing as a nurse practitioner. "I actually
saw it as a plus," he maintains. "I was working as the sole
nurse practitioner at a clinic in a housing development. Some people
argued that we might lose women coming in for Pap tests because I was
a man, but the number actually increased."
He has also found that being an African American male gives him the
opportunity to build relationships and trust with other black men. "The
majority of women are wonderful about seeking health care, but men do
not seek it," he says. "I can reach out to young males and
talk to them about getting medical care." He spends one day a month
walking around housing projects, passing out condoms and business cards
and connecting to young men in the community.
Choosing an NP Program
So you've decided that an advanced practice career as a nurse practitioner
is right for you. Where do you go from here? If you're already an RN,
your first step will most likely be to go back to school and earn a
graduate degree.
Some experts estimate that at least 50 new nurse practitioner training
programs have opened since 1995. They range from intensive, on-site
full-time programs to accelerated "fast-track" programs to
those offered entirely online through distance education. Before you
decide which program to apply to, first think about your passions and
then imagine what you want your life to be like after your training.
"It's always good to work as an RN for a few years," Eguakun
advises. "That will guide you to what you like and don't like and
can help you decide on a specialty. In my case, I knew I wanted to work
with disadvantaged populations and HIV/AIDS. My training, everything
I did, was geared toward that. The preceptorships that I did were designed
to reflect my needs and my goals."
Once Eguakun was in graduate school, faculty members looked at his
goals and introduced him to people who still serve as mentors, providing
advice and information on new developments in his field. "Those
relationships become very important," he emphasizes. "The
individuals you'll meet have been in the field. They'll continue to
guide you and expose you to new resources. Plus, you'll learn how to
be a mentor to the next generation of minority nurse practitioners,
and that's very important."
Miller recommends that nurses who are considering becoming practitioners
first spend a couple of days shadowing a working NP. "You have
to understand the role nurse practitioners play," he explains.
"The best way to do that is to spend two or three days with a nurse
practitioner, just to get a feel for whether this is something you want
to do."
He also reminds would-be NPs that graduate school will be very different
from their undergraduate nursing education. "The most difficult
thing in terms of becoming a family nurse practitioner is having to
think outside the box," he says. "Many nurses have been educated
in a disease mode. They learn about a disease and then they look for
signs and symptoms. Nurse practitioners look at the total picture, using
the patient's history and physical condition."
While all nurses are involved to some extent in diagnosis, NPs are
able to diagnose and prescribe treatment independently because of their
advanced education, Miller explains. "Graduate programs that train
nurse practitioners are two years in length and have 600 to 1,000 more
clinical hours beyond the bachelor's degree," he says. "Nurse
practitioners have advanced skills. They function at a level that allows
them to practice independently and they're able to make more decisions
about what is best for the patient."
Finding the Right Practice Setting
Once you've completed your educational and clinical practice requirements
and become licensed as a nurse practitioner, your next decision is choosing
where you want to practice. NPs can work in a wide variety of practice
settings, including hospitals, clinics, physician's offices, public
health departments, HMOs, home health care agencies, hospices, private
practice and more. Once again, it's important to think about what your
needs and goals are in order to choose the setting that's the right
fit for you.
"In some offices, nurse practitioners see patients every 10 minutes.
You need more time than that to do a good job of diagnosing and treating
a patient," Miller says.
On the other hand, some NPs are able to find workable solutions for
providing effective care despite these tight time constraints. Miller
says he knows a nurse practitioner who walks into a patient's room with
two assistants. As she's examining the patient, one assistant is writing
down her notes. The other follows through on her treatment plan. "When
she leaves the room, she's finished with that patient," Miller
explains.
But if spending only 10 minutes with a patient isn't your style, be
careful in selecting your first job after adding "NP" to your
signature. "When you get out of school, don't just settle for any
job," Eguakun cautions. "Find a practice group where you really
want to work."
He warns future NPs to do their homework about a practice or health
care facility before accepting a position there. "How a nurse practitioner
practices depends on the philosophy of the organization," he says.
"If you are in a private practice as an NP, your paycheck may be
based on how many patients you see. There's pressure to get patients
in and out quickly."
Organizational policies can also influence the amount of independence
an NP has, Eguakun adds. "I worked in a hospital setting after
I graduated. I was a nurse practitioner, but the physician had to see
everything [I did] and sign off on every prescription. It wasn't productive
and I knew it wouldn't work for me. I wanted to have a physician who
saw me as a collaborator. I wanted to have some independence and control
over what I did.
"Now, the physician I work with is a collaborator. We are a team
and we act as a team. He's accessible to me 24 hours a day."
Debra Williams is a free-lance writer in Morristown, Tennessee.
Back to top of page
|
