Two years ago, Evelyn Javier was working in a research lab in Maryland and was unhappy with her career. “I liked the job, but it did not fulfill my purpose,” she says. “I felt like there was more I could do.”
What she really wanted to do, she decided, was to help people. In 2011, she quit her lab job and entered nursing school in New Jersey. Javier, now age 29, just received her RN degree and is about to launch her new career.
Many young minorities, after making false starts in other fields, discover that a career in nursing is actually the best fit for them. These career-changers—usually in their mid-20s—are attracted by the opportunity to help others, get out of an office setting, and interact with many different people. They also like the wide variety of nursing jobs they can choose from.
Nurse educators say these more seasoned students are generally more intense, get higher grades, and have a clearer idea of their career goals than their younger counterparts. After trying out something else, “they know what they want,” says Deborah A. Raines, PhD, RN, ANEF, a professor of nursing at the University at Buffalo School of Nursing. Though Javier had good grades, Raines says some latecomers to nursing were initially poor students who worked for a few years in low-paying jobs and then became more serious about their careers.
Raines, who authored the 2011 study “What Attracts Second Degree Students to a Career in Nursing?” in OJIN: The Online Journal of Issues in Nursing, says nursing tends to be something these second-careerists always wanted to do, but they were sidetracked into careers like teaching, business, or marketing for a few years. These students often bring skills from the previous jobs. Javier, for instance, says she brought a knowledge of aseptic techniques and teamwork skills from her lab job.
A Career Change From the Heart
While traditional nursing students often cite salary and job security as key reasons for going into nursing, Raines says career-changers tend to have “intrinsic” motivations—reasons that come from the heart. “They really want to help other people,” she adds.
Javier switched to nursing after she took a career aptitude test, showing the field was her real calling. “I realized I wanted to go back into the community,” she says. “I wanted to be the person providing the extra care for those in need.”
As with many second-career nurses, Javier already had a college degree and could shorten her nursing education. Since she had already taken all the science courses she’d need for a bachelor’s in nursing degree, she was able to jump right into clinical training at the Muhlenberg School of Nursing in Plainfield, New Jersey. To help support herself as well as decide whether she wanted to be in clinical care, she took a job as a patient care technician at the same hospital where she was training. “I wanted to see if the hospital environment was right for me,” Javier says. It turned out to be a good fit.
Having just earned her degree, Javier now plans to work for about a year and start a bridge program for a master’s in nursing degree next spring. Ultimately, she wants to be a nurse practitioner specializing in family health with an emphasis on women’s health. And as a member of the New Jersey Chapter of the National Association of Hispanic Nurses (NAHN), she wants to focus on helping Hispanic patients. “I’m concerned about the cultural and language barriers that Hispanics face,” she explains.
Overcoming Family Expectations
Raines says second-career nurses often have to overcome family expectations about another line of work. “They were directed a certain way by their parents, and then they found out that nursing was what they really wanted to do,” she says.
She recalls a second-career student from Haiti whose parents insisted that she should work at a law firm. The student did so for a while, but “she always wanted to be a nurse,” says Raines. She earned her nursing degree, worked for a year as an emergency medical technician, and then went back to graduate school. She is now in a doctoral program.
Jade Curry, an African American nurse, also had to overcome the expectations of some family members who thought she should be a doctor. To see if she’d like it, she even worked in a dermatology office for a year and attended a mini-medical school at the University of Michigan, where she majored in biology. But she didn’t like it and instead considered a career as a science teacher or in public health.
Her career path took another turn when, as an undergraduate, she began working for a program to help boost minority participation in certain health care professions, including nursing.
She became a strong proponent of the profession. “There are so many things you can do with a nursing degree,” says Curry. “You can go into teaching or practicing. You can work in multiple settings, like the ER or the ICU. You can get into a specialty like pediatrics or oncology. Or you can do research. Every discipline needs a nurse because we are the gatekeepers.”
After graduating college in 2003, Curry briefly considered taking another minority recruitment job at the University of California in Los Angeles, but instead she enrolled in the University of Michigan’s School of Nursing. “Basically, I recruited myself,” she says.
After earning a nursing degree in 2006, Curry received a master’s of science in nursing degree from the University of Pennsylvania in 2009. Now married with a one-year-old son, she is a nursing PhD candidate and is working at a teen health center. Her research interest revolves around how parents with teenagers communicate about sex.
Raines says many second careerists are “very focused about where they want to go.” She recalls a nursing student who came from a human resources job. “She wanted a nursing job in a certain unit, with a certain number of beds,” she recalls.
Helping Others
Vaneta Condon, PhD, RN, served as director of the Pipeline to Registered Nursing program at Loma Linda University in California, which recruits underrepresented minorities into nursing. She says about 30% of the students already had a college degree in areas such as science, business, and teaching, and some already held jobs before they switched to nursing.
“The biggest reason they give for going into nursing is wanting to spend more time helping people,” she says. Since they already had some life experiences, “they start off as better nurses. They can adapt more readily to a nursing program and working with other people.”
Helping people has been the life work of Suleima Rosario-Diaz, RN, who has been a minister in the American Baptist Church in New Jersey for many years. A few years ago, she decided to get a nursing degree with the goal of performing health care missionary work in other countries.
Rosario-Diaz entered an accelerated nursing program at the University of Medicine and Dentistry of New Jersey. Now age 30 and married, she works as an admissions and discharge nurse at Palisades Hospital in Edgewater, New Jersey, and is working on a master’s degree.
She is still a minister as well as vice president of the New Jersey Chapter of NAHN. “Being a minister helps me to be a better nurse, to show love to people,” she says. “I want to be a calming presence.”
Rosario-Diaz wants to combine her therapeutic education with pastoral counseling. “A lot of religious folks do chaplaincy work in the hospital, but that does not interest me,” she explains. “I want to be hands-on, to be a presence when you are in pain. I am task-oriented, so it’s a great fit.”
Other Experiences
Minorities have entered nursing from all kinds of walks of life. From the loss of a loved one to an unfulfilling job, inspiration can strike just about anywhere—and the smallest trigger can ignite that spark to become a nurse. Here are four examples to encourage you to make the leap:
Losing a Loved One. Chrispina Chitemerere was a schoolteacher in Zimbabwe before immigrating to the United States.1 She got a teaching job but didn’t like the work, she said in the May 2013 issue of the Elms News. Chitemerere said she found a new calling while taking care of her mother, who was dying of cancer. She became a licensed practical nurse and then enrolled in the Accelerated Second Degree in Nursing Program at the Elms College School of Nursing.
Combining Passions. For nine years, Randi Simpkins taught fifth and sixth grades in elementary school.2 “While I absolutely love the field of education, I knew that there was more for me to learn,” she wrote in an essay that won a Robert Wood Johnson Foundation New Careers in Nursing scholarship last year. “Daily I encouraged my students to pursue excellence and reach beyond their limits. Upon reflection, I was forced to acknowledge that I, myself, had not attained my own goals of academic accomplishment.” She “stumbled upon the opportunities in nursing” and enrolled in the Duke University School of Nursing in January 2012.
Encouraged by Others. When Christine Hernandez’s mother was dying of cancer, a hospice nurse came into their home to care for her and sparked Hernandez’s interest in nursing.3 “She was amazing,” Hernandez told RN Builder.com. “It wasn’t just my mother she was helping but all of us. She was a strength that we just couldn’t have done without.” A few years later, Hernandez worked as a nanny for a dual-physician couple. They encouraged her to get an RN degree, so she enrolled in an RN program at Salt Lake Community College in Utah. Her goal is to work in pediatrics, oncology, or hospice.
Divine Intervention. In India, Binny Varghese earned a bachelor’s degree in human genetics and worked as a researcher in the biosciences.4 But as a child, “I gained a passion to serve others,” he told the Kansas City Nursing News in 2012. After immigrating to the United States for an arranged marriage with an Indian American woman, he decided that nursing was his real calling and entered an accelerated nursing program at MidAmerica Nazarene University in Olathe, Kansas. “When God wants you to do something better, he shows you the way,” he told the paper.
References
1. Elms College. From Africa to Chicopee, Two Students Earn Second Degree in Nursing. Elms News. May 15, 2013. www.elms.edu/elms-news/from-africa-to-chicopee-two-students-earn-second-….
2. Randi Simpkins. “I believe this about nursing…” essay. Robert Wood Johnson Foundation New Careers in Nursing. August 2012. www.newcareersinnursing.org/scholars/essay-contest/winners/randi-simpkin…
3. G. Jones. Nursing Student Interview with Christine Hernandez. RN Builder. April 11, 2013. www.rnbuilder.com/blog/education/nursing-student-interview-with-christin…
4. Nursing is second career for MNU student. Kansas City Nursing News. 2012. prewww.kccommunitynews.com/kc-nursing-news/30992401/detail.html.
Advanced education and specialty certifications can help minority nurses take their careers—and their ability to improve health outcomes—to a whole new level.
Carmen Paniagua has so many educational and professional credentials after her name that she practically needs an oversized business card to fit them all. In addition to being an RN, she is an ANP (Adult Nurse Practitioner), a board-certified ACNP (Acute Care Nurse Practitioner) and AGACNP (Adult-Gerontology Acute Care Nurse Practitioner), an APNG-BC (Advanced Practice Nurse in Genetics), and a FAANP (Fellow of the American Academy of Nurse Practitioners). She’s also a CPC (Certified Procedural Coder) and a CMI (Certified Medical Interpreter), and she holds MSN and EdD (Doctor of Education) degrees.
“Some people probably look at my CV and think this is just a lot of ‘alphabet soup,’” says Paniagua, a faculty member at the University of Arkansas for Medical Sciences College of Medicine in Little Rock. “But advanced degrees and certifications are more than just a collection of letters. They’re the evidence and recognition of your competence and clinical expertise. They enable nurses to take pride in the accomplishment of advanced practice knowledge and to demonstrate their specialty expertise to both employers and patients.”
Jose Alejandro, president of the National Association of Hispanic Nurses and corporate director of case management at Cornerstone Healthcare Group in Dallas, agrees that it’s what those abbreviations really stand for that counts.
“You can have all the degrees and certifications you want, but it’s the tools you learn from having them that’s the biggest benefit,” says Alejandro, an RN-BC (Registered Nurse-Board Certified), CCM (Certified Case Manager), FACHE (Fellow of the American College of Healthcare Executives), and a MBA who recently earned his PhD. “They give you additional skills and what I call your ‘chops.’ That’s primarily what has enabled me to move up in my career, because I can accomplish things based on more than just having experience.”
Opening Doors
There are many compelling reasons for minority nurses to pursue graduate education and specialty nursing certifications. Acquiring these credentials opens the door to a wide new horizon of rewarding advanced practice careers and leadership roles—from nursing professor and nurse scientist to nurse practitioner, nurse anesthetist, nurse executive, and more. Furthermore, the Institute of Medicine’s (IOM’s) landmark 2010 report The Future of Nursing: Leading Change, Advancing Health calls for all nurses to “achieve higher levels of education and training” and “attain competency in specific content areas” in order to respond more effectively in today’s rapidly evolving health care environment.
But the IOM report also underscores an even more persuasive reason. Advanced degrees and certifications—or more precisely, the specialized knowledge and skills nurses gain from them—are linked to improved patient outcomes and better nurse-led interventions for eliminating minority health disparities.
“This is a wonderful time for all nurses, and particularly nurses of color, to seriously look at graduate education, because of the millions of uninsured and underinsured people who will now be coming into the health care system as a result of the Affordable Care Act,” says Kem Louie, PhD, RN, PMHCNS-BC, APN, CNE, FAAN, professor and director of the graduate nursing program at William Paterson University in Wayne, New Jersey. “Many of these new patients will be members of medically underserved minority populations. The other issue is that there’s a shortage of primary care physicians. So there’s a tremendous need to increase the number of culturally competent advanced practice nurses who can meet these patients’ primary health care needs.”
Of course, it’s also hard to ignore the “what’s in it for me?” benefits. Becoming certified in an in-demand specialty—for example, emergency nursing, perioperative nursing, critical care, or pediatrics—increases your value to employers. Plus, it’s no secret that many advanced practice (APRN) specialties that require a master’s degree and board certification—such as Certified Registered Nurse Anesthetist (CRNA) and Certified Nurse-Midwife (CNM)—pay substantially higher salaries than the typical staff RN position (see sidebar). In fact, according to the most recent (2008) Health Resources and Services Administration (HRSA) National Sample Survey of Registered Nurses, RNs with graduate degrees earn an average of at least $20,000 more per year than nurses with lower education levels.
But it’s not just about the money, argues Henry Talley V, PhD, CRNA, MSN, MS, director of the nurse anesthesia program at Michigan State University College of Nursing in East Lansing and treasurer of the American Association of Nurse Anesthetists. “Advanced degrees and specialty certifications do increase your earning powers,” he says. “But they also increase your ability to make change happen in health care. They make you an expert in your particular field, and they put nurses on an equal footing with other health professionals.”
Breaking Down Barriers
Minority enrollments in graduate nursing programs have nearly doubled over the past decade, according to the American Association of Colleges of Nursing (AACN). Yet racial, ethnic, and gender minority nurses continue to be underrepresented among the ranks of APRNs and certified RNs—primarily because they’re still underrepresented in the nursing population as a whole. Fortunately, numerous nursing organizations, from AACN to the American Board of Nursing Specialties, are recognizing the need to identify and remove barriers that may prevent nurses from diverse backgrounds from earning the advanced credentials they need to succeed.
Traditionally, one of the biggest challenges in going back to school—for majority and minority nurses alike—is finding the funds to pay for it. And thanks to the current economy, with its skyrocketing tuition rates and burgeoning student loan debt, figuring out how to afford graduate school can be a trickier task than ever. Then there’s the cost of certification examinations, which in some cases can range from about $300–$400 to as high as $725 for the CRNA exam. But even though finances can be a formidable obstacle, they’re not an insurmountable one.
“What I have personally observed is that our potential minority nursing students are much more hesitant to take out loans and incur debt than majority students,” says Courtney Lyder, ND, ScD(Hon), GNP, FAAN, dean and professor at UCLA School of Nursing. “And what I tell them is: Nurses make good salaries. Compared with other academic disciplines, the compensation in nursing makes it one of the few professions in which you can actually pay off student debt in a timely manner.”
“One of the benefits of coming to graduate school now is that there are still scholarships and federal financial assistance programs available,” adds Louie, who is also the founding president of the Asian American/Pacific Islander Nurses Association. She cites HRSA programs like the National Health Service Corps, which provides scholarships for nurse practitioner and nurse-midwife students in return for a commitment to practice in a medically underserved area for at least two years after graduation, and the Nurse Faculty Loan Program, which forgives 85% of student loan debt for RNs who complete a graduate degree at a participating school and agree to serve as full-time nursing faculty.
Talley and his wife, a Clinical Nurse Specialist (CNS), recently conducted research examining some of the other factors that impede minority nurses from pursuing advanced degrees in general and nurse anesthesia degrees in particular. Lack of knowledge about APRN and specialty nursing career paths is another big barrier, he says.
“There are still people of color out there who have just not had the exposure to these career options,” Talley explains. “Nursing specialties have to get the message out to them about these opportunities and what the requirements are. Nurses need to know early on that they will want an advanced degree, because the key to opening that door will be how well they do in their undergraduate studies. Otherwise, they’ll find out about advanced practice specialties later in their BSN programs and decide ‘I want to do that’ when their GPAs will not support it.”
But Alejandro believes that perhaps the hardest hurdle for minority nurses to clear is the surprisingly common “fear factor.”
“It’s the fear of failure, fear of the unknown, fear of whatever,” he says. “I tell all the students I mentor: ‘The very first barrier you have to overcome in pursuing any advanced education or any certification is removing that fear.’ In my case, once I was over that fear, I was able to ask questions. If I didn’t understand something in a particular class, I went ahead and asked classmates who understood it a little better.”
Starting the Journey
So you’ve decided it’s the right time to return to school, earn an advanced degree, and chart your course toward a fulfilling specialty nursing career. Congratulations! But where do you start? How do you choose which graduate program to apply to? And what type of degree should you go after? Is a terminal master’s enough or will you need a doctorate?
Lyder, who made history by becoming the first male minority dean of a school of nursing in the United States, as well as the first African American dean at UCLA, says it all boils down to answering one basic question: What do you want to do?
“Find your bliss,” he advises. “Is it pediatrics, geriatrics, psych/mental health, administration, nurse-midwifery, nurse anesthesia? Once you’ve figured that out, the next step is to identify schools in your community that may have those programs. Then, contact those schools and schedule a time to talk with the admissions counselors—and I don’t mean an e-mail—to see if this is something you really want to pursue. Also, try to find an opportunity to shadow someone who’s in that role. Identify that CRNA or that psychiatric nurse practitioner and say, ‘Can I shadow you for a day to get a sense of whether this is what I want to do?’”
Getting over the fear of speaking directly with admissions officers or the graduate program director to get the facts you need to make well-informed decisions about a school is key, Louie emphasizes.
“You have to tell yourself, ‘Just pick up the phone,’” she says. “Graduate programs in nursing are competitive and some of them can be very daunting. But I find that I have to invite students to talk to me, to ask me, ‘What support services are available? Tell me about the admission requirements. Help me through the application process.’”
As for what kind of advanced degree to get, once again it all depends on your goals.
“Some nurses are confused about advancing their education. They think they all have to be PhDs,” says Paniagua. “Well, if you’d like to be a nurse researcher, then a PhD is fine, because it’s primarily a research-focused doctorate. But then there are other avenues. You can get a doctorate in nursing practice (DNP), which is a professional practice degree, or you can get an EdD, which is an education-focused doctorate. So if you’re planning to have a career in academia, you should pursue either an EdD or a PhD. If you’re planning to practice or to work in the clinical setting, you should get your DNP. Or you can just get a master’s degree [in your specialty area of interest, such as an MBA or an MSN in nursing informatics].”
Above all, the most important thing to consider when shopping around for a graduate program is finding one that’s the right fit for your specific needs—both academic and personal.
“You need to make sure that your value system is in sync with the mission and vision of the institution,” Lyder says. “For example, here at UCLA we are a research-intensive school of nursing. Our professors infuse research and evidence-based practice into every course, every lecture, everything they do. If that’s not the type of learning environment you want, then this isn’t going to be a good match for you.”
Louie recommends investigating different program formats to find options that will accommodate what she calls “your life needs.” For instance, if you have to keep working at your job while going to school, or you have young children or other family obligations, the traditional full-time, brick-and-mortar campus model may not work for you. “You need to know that there are online programs, there are blended online/on-campus programs, there are part-time and weekend programs,” she says.
Another alternative worth exploring is the accelerated (fast track) format. These programs include RN-to-MSN—also known as a Master’s Entry Program in Nursing (MEPN)—which bypasses the traditional BSN degree, and BSN-to-PhD, which bypasses the master’s. Their greatest advantage is that they enable nurses to earn graduate degrees more quickly and earlier in their careers. However, because the accelerated time frame makes the academic workload extremely intensive, these programs aren’t for everybody.
Taking the Plunge
Achieving the advanced degrees and certifications that will boost your career to a higher level can be an arduous process. But all the nurse leaders interviewed for this article agree that the rewards are worth it. In fact, with the right preparation, the right program, and strong support networks (family, friends, faith, colleagues, mentors, and minority nursing associations), it might just be easier than you think.
Talley offers this advice: “Don’t be afraid to take the plunge. I think sometimes we [minority nurses] doubt ourselves, and there’s no reason to. Believe in yourself, have faith in yourself, and don’t let anyone interfere with your dreams.”
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