Nursing is a second career for Derek J. Flores, RN, CHPN, BS, a hospice nurse in Colorado since 2012.
In 2020 Flores was a featured guest on the TV Show, The Doctors, sharing his expertise on end-of-life hospice care. He’s also written two books to increase knowledge of end-of-life care. Flores’ first book, Seven Keys to a Peaceful Passing, walks patients and families through common challenges and decisions they must make during their hospice journey. His second book, Letter to a Hospice Nurse, celebrates the lives of hospice patients and gives a format for surviving family and friends to process grief.
Flores has a Spanish mother and Mexican father and credits his background, education, and experiences for helping him connect with his patients to provide good outcomes.
The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Derek Flores, RN, CHPN, BS, and hospice nurse in Colorado.
Talk about your role in nursing.
I’m a hospice nurse case manager in the Denver Metro area. I work with a varying census of patients facing a terminal diagnosis. Besides regularly visiting my patients, I coordinate care between other disciplines, including CNAs, social workers, chaplains, and volunteers. Our team serves a widely diverse community of beautiful people from various backgrounds. Many of my patient visits can be considered ‘routine,’ others unexpectedly are filled with urgency to treat symptoms at the end of life. I work in the world of the ‘dying.’ It is a place and space where the dignity of each person is cherished and celebrated.
How long have you worked in the nursing field?
I earned my LPN in 2011, then passed the NCLEX-RN in 2012 after graduating from Laramie County Community College in Cheyenne, Wyoming. Nursing is a second career for me. I graduated from Colorado State University in 1991 with a BS in business administration. I spent a dozen years working in various industries in marketing and sales departments. I even had my own business for a few years.
Why did you become a nurse?
The seeds for me becoming a hospice nurse were sewn while observing both of my parents care for their aging, then dying parents. The love and compassion I saw from them was an inspiration. My mother, whose name is Crisela, has family roots in Spain. The Archuleta family arrived in Mexico in the 17th Century, then migrated to northern New Mexico, where they were farmers and ranchers. My mother’s first language was Spanish. She worked as an elementary school teacher in Pueblo, Colorado for many years before retiring. My earliest memories are of my mom and grandma speaking Spanish in the kitchen while the smells of a delicious dinner were in the air. The love, devotion, and endurance she showed in the care of her parents moved my heart. My mother and her siblings cared for Grandma Rita and Grandpa Ambrosio for fifteen years before Grandma passed peacefully at the age of 103.
My dad’s family was from southern Texas and Mexico. My late father, Jim, worked as a teacher specializing in special education. He was also a former Green Beret, champion runner, and weight lifter. He showed compassion for his students and the tenderness he had in the care of his parents at the end of their life. My parents were the first generation to earn bachelor’s and master’s degrees, breaking down societal barriers during my formative years in the 1970s and 80s. Their example set a standard for pursuing higher education and service to others.
I began the journey to become a nurse during a difficult period of my life as I turned 40 years old. During this time, I began to work as a CNA. My experience as a CNA helped form me into a well-rounded nurse. I learned how to provide basic care to my patients, who often lived in difficult conditions. After watching some of my supervising nurses do their work, I realized, ‘I can do that’! The next thing I knew, I was in nursing school. My family’s example of hard work and never giving up helped me make a career change.
What are the most important attributes of today’s nursing leaders?
In the hospice environment of today, a nursing leader has many hats to wear. In nursing school, we are taught to become multitaskers. As a hospice nurse case manager, I lead my interdisciplinary team by being responsive and communicative. If someone asks me a question, I respond as quickly as possible. I like surprising people with very quick responses. This level of communication sets a ‘Nursing Leader’ apart.
A hospice organization is multi-faceted with clinical, administrative, and management pieces. The clinical part of my work is also just as important because our patients depend on us to manage symptoms in often very stressful situations. When this happens, everyone looks to us for good nursing judgment, a cool head, and a soft heart.
What does being a nursing leader mean to you, and what are you most proud of?
I have been and will probably always be a bedside hospice nurse because my personality makeup doesn’t do well behind a desk or in the same location all day. I work out of my car, driving to each patient’s location. I lead my hospice team as a case manager by being attentive to my patients and team. My hope is they are inspired and motivated by my actions.
I’m most grateful for recognizing that nursing is a vocation I have been called to do. It’s rare that I don’t feel I have contributed to someone going through the most difficult time in their life. I’m most proud that I live out the legacy of my parents, Jim and Cris. Their example of serving others drives me each day. I’ve always wanted them to be proud of me.
Tell us about your career path and how you ascended to that role.
I’ve alternated throughout my career in hospice between case management and on-call roles with both for-profit and not-for-profit companies. The caseloads in some hospices can exceed twenty patients, so my career path has been marked by individual experiences with patients in difficult situations and measured by how I assisted them to be free of the symptom or symptoms they were struggling with.
Hospice nursing can be very emotionally trying, so I have taken sabbaticals by working in pediatric home health. I found that medically challenged children bring joy to everyone around them. They have helped heal my heart when I needed it most, preparing me to return to hospice nursing to do the work I’m called to do.
What is the most significant challenge facing nursing today?
My nursing work must be completed within a limited amount of time. There isn’t any wiggle room for this, so I can’t even list this as a challenge. It simply has to get done, no matter what. I never have a day like the previous one, so planning every moment of my week is almost impossible. I always have to try and stay ahead of the next patient emergency or death by pushing to get tasks done in the moment. I know if I don’t get something done now, it might not get done at all.
My family is most important to me. I am recently married at 54 to a wonderful woman, Kirsten. After many years alone, I now have a wonderful and kind companion. We enjoy our life together, including time with three adult daughters, one lovely granddaughter, and another who is making her debut in a few months. Our hearts are full.
I share my professional challenge of having enough time to meet all my work and personal responsibilities because it is common for hospice nurses to quit after their job takes over their lives. It’s not uncommon to work a full day, kiss your loved one as you arrive home, then head to your home office to work another few hours before you go to bed. It’s super easy to have hospice take over your life. Quite often, hospice nurses are paid on salary, so at some point, you may decide you’re working for a much-reduced rate than you thought you were. Then you choose to leave. The result is that patients get shortchanged by nurses who are rushed to get everything in their day completed. I encourage hospice nurses struggling with situations like this to ask their manager for adjustments. Caseloads can be lightened, geographic work areas can be shrunk to decrease time driving each day, and changes can be made if a manager wants to keep a nurse. Don’t be afraid to speak up if you have difficulty getting everything done.
In the end, if nurses and their managers don’t find solutions, the result can often be rushed nursing visits or nurses who aren’t fully present to their patients because they multitask. Our patients aren’t aware of all of the demands of our positions. They want to share what is happening with themselves on that particular day – needing us to meet their needs.
As a nursing leader, how are you working to overcome this challenge?
I try to put my patients first by being present to them. If I were to fail them by supporting them with my full attention, then not much else matters. I think my efficiency and proficiency in this role have improved over time. I also get up very early in the morning when I have work to do so I don’t take time away from my family.
I also have a mission outside of my bedside nursing practice. I write and publish books to increase knowledge of end-of-life care. My first book is Seven Keys to a Peaceful Passing and my second is Letter to a Hospice Nurse. I’ve also created journals that nurses and families can use to communicate with each other and keep track of important tasks like medication administration.
What nursing leader inspires you the most and why?
I had a colleague named Ted in the first years of my nursing career. I identified with him in several ways. He looked a lot like my dad with his black wavy hair and chocolate brown skin and had a similar background. Seeing another person like me, with Spanish and Indigenous roots, gave me the strength to look outward to solve our patients’ challenges. Ted is one of the most knowledgeable hospice nurses I’ve known. I still use his recommendation to help patients suffering from chronic nausea.
What inspirational message would you like to share with the next generation of nurses?
I’d encourage anyone considering a career in nursing to look deep and find the one thing that fills their heart. If it is helping those in need, you’ll never have a day in nursing where you don’t take away a feeling of satisfaction for your hard work. If you are a young nurse struggling to get traction in your career, please reach out to an experienced nurse to find a solution to your challenges. I’d also suggest that once you have a few years of successful experience, you realize you are a hot commodity. Don’t be afraid to ask for a competitive wage or salary. Negotiate the time off from work you need for your family and yourself. You are in high demand!
Is there anything else you’d like to share with our readers?
Nursing should be a vocation for everyone who chooses to do this work. By finding the intersection of your heart and mind, you’ll never work a day. Instead, you will have a life filled with purpose, struggle, and satisfaction for the benefit of others. You’ll have a life that matters.
Community colleges are experiencing an increase in the number of men pursuing nursing as a career choice. The National League for Nursing’s Annual Survey of Schools of Nursing for the 2010-2011 academic year indicated that 15% of associate degree students were males. At 15%, men enrolled in basic RN programs remained at the historic high reached at the beginning of the current economic recession. Across all levels of nursing education, approximately one in seven nursing students was male in 2011. This represents a 2% increase in the male student population since 2010.1These statistics are encouraging and provide a possible solution to the worldwide nursing shortage.
From Fall 2001 until Fall 2012, the Borough of Manhattan Community College (BMCC) enrolled 504 male nurses in their associate degree program. This increase in the number of male students has provided impetus for further examination of the reasons why more men are pursuing nursing as a career in the 21st century, and what faculty can do to support and facilitate the integration, progression, and success of male students in nursing programs.
A structured survey consisting of ten key questions was sent to 68 male students currently enrolled in the associate degree nursing program at BMCC. The survey questions were framed from general to specific in order to draw conclusions. A total of 52% responded and provided answers to questions such as:
The motivating factors for deciding on a career in nursing;
Influencing factors, such as type of work in the military and their decision to enter the health care field;
Personal reasons for choosing nursing, such as: job stability, better pay, career flexibility, and opportunity for advancement;
Work placement preference after graduation;
Resources that would be most beneficial to their success in nursing programs.
It’s a Man’s Opinion
Results of the first half of the survey have shed light on male student nurses’ view of their place and future in the profession. Demographic data related to male students indicated that 54% of respondents were in an age group of 35 to 44. Seventy-five percent (75%) of male students entered nursing after another career; 33% of male students had an associate degree in a field other than nursing; and 25% had a bachelor’s degree from a field other than nursing. Seventy percent (70%) had no previous health care experience. And 87% had no military medic background.
The second half of the survey focused on male students’ view of their place in nursing. Categories ranged from strongly disagree to strongly agree. Findings indicated that 70% of respondents expressed a desire to help others; 66% of male students had no knowledge about the history of men in nursing; and 45% believed that male nurses choose to work in specialized areas. These findings confirm the literature’s viewpoint that most male nurses tend to gravitate toward specialty areas.
Results of the last area of the study addressed the importance of having adequate resources to facilitate progression and positive outcome for male students. Most respondents felt that career counseling/internships (80%), academic tutoring in nursing content (74%), faculty mentoring (65%), personal counseling (60%), and financial aid (60%) would be beneficial to students’ progression and success in the nursing program.
Career Counseling/Internships. Career counseling is abundant in most colleges and universities, primarily for retail industries. Counseling for nursing students, however, focuses on how students can best prepare for graduating, passing the NCLEX exams, and achieving licensure.
With a drastic change in today’s economy, health care institutions have felt compelled to focus on creative ways of meeting staffing needs and cutting costs for orientating new graduates once hired. Due to the economic recession, nursing jobs are more difficult to secure. In addition, most hospitals require at least one-year of bedside nursing experience before hiring a new graduate. How will a new graduate acquire the experience necessary to land a job? The American Association of Colleges of Nursing reported that 88% of graduates from baccalaureate programs had jobs within six month of graduation.2 However, associate degree program graduates are not as fortunate. In order to adequately prepare for the workforce, associate degree graduates are counseled on the need to continue their education and to participate in an internship program during their final year of school or an externship program after graduation.
Colleges often apply for and receive grants in collaboration with hospitals to provide externship programs that will facilitate training and mentorship for new graduates. Most programs are limited to 10-15 students, depending on the cost for six weeks of training and mentorship. In this program, students are often given additional training in EKG, venipunctures, and physical assessment skills. Students must successfully complete the training program, at which time they receive job placement either at the institution of training or a sister institution within the same conglomerate.
Most faculty in nursing programs serve as counselors to nursing students and have an ongoing relationship with health care institutions to provide internships, externships, or volunteer residency programs. In these programs, students acquire more hands-on experience, which tend to be limited during the school year. All students, regardless of gender, receive career counseling and the opportunity to apply for internships or externships during the summer months. Students are also counseled to continue their nursing education, whether from an ADN-to-BSN or a BSN-to-MSN program. Most colleges and universities offer a free NCLEX review course to prepare students for the licensure exam. This serves as a win-win situation for students since most public colleges, including the City University of New York, pay for the cost for the three-day review session.
Tutoring in Nursing Content. Tutoring, mentorship, meditation, and relaxation have been categorized as stress-reducing resources that can be offered to students.3Students who are relaxed and adequately prepare perform better on exams. At BMCC, tutoring is offered each semester for all nursing students. A schedule is usually posted outside the tutoring room so students can plan to receive extra help with course content. At times, students who lag behind are placed with the more outstanding students in study groups, which form a basis of support for struggling students.
Additionally, course faculty is available during office hours to clarify content and to discuss any issue students may have. Male students are informed of the availability of our male faculty mentor, if they so desire to meet with him instead. Tutoring is also available through the e-tutor website. Students follow specific guidelines for submitting electronic questions and are required to be specific as to what help they need. Communication via e-tutor requires students to convey information such as assignment, textbook, edition, page number, and any other relevant materials that will help facilitate the process. Students provide a valid email address for ongoing communication and feedback.
Mentoring Opportunities. Addressing the need for faculty mentoring of male students focuses on the benefit of having professional role models. Ideally, male faculty can fulfill this role. However, only about 5% of full-time teachers in nursing school today are men.4One strategy that could provide mentorship for male students is to pair male students with male graduates of the program. For example, the American Assembly for Men in Nursing (AAMN) has initiated a chapter within the greater New York area aimed at providing networking and collaboration among the 17 colleges within the City University system. In other colleges and universities, developing bonds with non-traditional older male student mentors via establishment of mentorship programs is another means to foster a supportive environment for male nursing students.
Personal Counseling. Schools of nursing should readily refer male students to counselors to discuss problems that may impinge upon their educational experience. It’s preferable to assign a male counselor who can relate to the student’s issues. Faculty should look for red flags that may indicate a student’s need for counseling referral or a need for help with problem-solving issues. Implementation of counseling should be done early in the semester when problems first surface to avoid a point-of-no-return situation. The lead faculty could meet individually with the student after the first exam if the student does not pass, and the student can be given a choice to discuss the issue at hand with the faculty or see a counselor. The student should also be asked if they would prefer a male or female counselor.
Financial Aid. Obtaining a nursing education is expensive. The average annual cost for tuition, room, and board for the 2010-2011 academic year ranged from $8,085 at public two-year colleges to $32,617 at private four-year universities.5This does not include the cost of books, lab fees, equipment, and supplies. Additional expenses may include uniform, transportation to and from school, testing, and malpractice insurance fees. Financial concerns are some of the main reasons students struggle in or leave school.Students often are able to qualify for work-study, which provides extra cash for personal expenses. It is also possible to apply for grants and scholarships to offset the cost of tuition. Overall, some means of financing a nursing education is always available whether through state or federal funding. From time to time, small nursing incentive scholarships become available as well, which serves as additive means for helping students through a financial crunch.
Where Do We Go From Here?
A review of the literature has pointed to other areas in which faculty can have significant input in changing the culture of indifference towards male students in nursing programs. One such area is in the planning of clinical rotation experiences. Male students often begin their clinical rotation eager to apply theoretical concepts to clinical learning experiences. Sometimes, however, their emotions may overshadow their ability to learn. One such example is the maternal-child clinical rotation. Research suggests that male students are uncomfortable and have feelings of not knowing what to expect in the post-partum area. A beneficial strategy by faculty that could mitigate the situation is first being cognizant of students’ feelings and identifying male students’ concerns before starting the clinical rotation in any setting.
Male students may also have difficulty with the concept of caring and expressing emotion. Use of vernacular, which is broad and encompassing, would challenge misconceptions of male nurses as non-caring providers. Encouraging the use of gender-neutral language during discussions of concepts around caring would be beneficial to male students.6 Faculty can recognize that male students are able to demonstrate caring in a different way, such as touching a patient’s shoulder and providing words of encouragement—and they could show the same act of caring as holding a patient’s hand, which is so often done by female nurses.
A 2005 study published in the National Student Nurses’ Association’s magazine, Imprint, indicated that men considered nursing a “calling” and that they enjoyed “making a difference.” BMCC’s recent survey reveals similar findings. Clearly, there is a need for a change in faculty perspective of malestudents in nursing programs. Addressing the needs of male students calls for implementation of strategies that promote diversity and integration within the profession. There also must be a challenge to the public’s perceptions of males in nursing that create barriers for male students. Nursing leaders and administrators need to implement recruitment strategies that emphasize gender and racial diversity in brochures, nursing magazines, billboards, as well as in the media.7 Just as historically traditional male professions—such as medicine and law—have been altered over time by the entry of women and minorities, integrating more men into nursing programs allows the profession to proactively address the problem of gender imbalance within nursing.
References
1. Kaufman, KA. Findings from the Annual Survey of Schools of Nursing Academic Year 2010-2011. National League for Nursing. June 2012. www.nln.org/researchgrants/slides/exec_summary_1011.pdf.
2. American Association of Colleges of Nursing. Employment of New Nurse Graduates and Employer Preferences for Baccalaureate-Prepared Nurses. Research Brief. October 2011. http://www.aacn.nche.edu/leading_initiatives_news/news/2011/employment11
3. Moscaritolo LM. (2009) Interventional Strategies to decrease nursing student anxiety in the
clinical learning environment. Journal of Nursing Education 48, 17-23.
4. National League for Nursing. (2011). Re health affairs and the nurse educator shortage.
Retrieved from http://www.nln.org/aboutnln/blast/blast_health_affairs_response.htm
5. U.S. Department of Education, National Center for Education Statistics. (2012). Digest of Education Statistics, 2011 (NCES 2012-001), Chapter 3. Retrieved from http://nces.ed.gov/fastfacts/display.asp?id=76.
6. Patterson J, Morin KH (2002) Perceptions of the maternal-child clinical rotation:
The male student nurse experience. Journal Nursing Education 41, 266-272.
7. Roth, JE, Roth, Coleman CL. (2008) Perceived and real barriers for men entering nursing:
Implications for gender diversity, Journal of Cultural Diversity 15, 148-152.
The nursing profession remains overwhelmingly female, but the representation of men has increased as the demand for nurses has grown over the last several decades, according to a recent US Census Bureau study.
The new study shows the proportion of male registered nurses has more than tripled since 1970, from 2.7% to 9.6%, and the proportion of male licensed practical and licensed vocational nurses has more than doubled from 3.9% to 8.1%.
The Men in Nursing Occupations study presents data from the 2011 American Community Survey to analyze the percentage of men in each of the detailed nursing occupations: registered nurse, nurse anesthetist, nurse practitioner, and licensed practical and licensed vocational nurse. The study also provides estimates on a wide range of characteristics of men and women in nursing occupations. These include employment status, age, race, citizenship, educational attainment, work hours, time of departure to work, median earnings, industry and class of worker.
“The aging of our population has fueled an increasing demand for long-term care and end-of-life services,” says the report’s author, Liana Christin Landivar, a sociologist in the Census Bureau’s Industry and Occupation Statistics Branch. “A predicted shortage has led to recruiting and retraining efforts to increase the pool of nurses. These efforts have included recruiting men into nursing.”
Men typically outearn women in nursing fields but not by as much as they do across all occupations. For example, women working as nurses full time, year-round earned 91 cents for every dollar male nurses earned; in contrast, women earned 77 cents to the dollar men earned across all occupations.
Because the demand for skilled nursing care is so high, nurses have very low unemployment rates. Unemployment was lowest among nurse practitioners and nurse anesthetists (about 0.8% for both). For registered nurses and licensed practical and licensed vocational nurses, these rates were a bit higher, but still very low, at 1.8% and 4.3%, respectively.
Other highlights:
There were 3.5 million employed nurses in 2011, about 3.2 million of whom were female and 330,000 male.
Of the employed nurses (both sexes), 78% were registered nurses, 19% were licensed practical and licensed vocational nurses, 3% were nurse practitioners, and 1% were nurse anesthetists.
While most registered nurses (both sexes) left home for work between 5 a.m. and 11:59 a.m. (72%), a sizable minority (19%) worked the evening or night shifts.
The majority of registered nurses (both sexes) worked in hospitals (64%). The majority of licensed practical and licensed vocational nurses worked in nursing care facilities or hospitals (about 30% each). The percentages for hospitals and nursing care facilities are not significantly different from each other.
In 2011, 9% of all nurses were men while 91% were women. Men earned, on average, $60,700 per year, while women earned $51,100 per year.
Men’s representation was highest among nurse anesthetists at 41%.
Male nurse anesthetists earned more than twice as much as the male average for all nursing occupations: $162,900 versus $60,700.
The American Community Survey provides a wide range of important statistics about people and housing for every community across the nation. The results are used by everyone from town and city planners to retailers and homebuilders. The survey is the only source of local estimates for most of the 40 topics it covers, such as education, occupation, language, ancestry, and housing costs for even the smallest communities. For more information, visit www.census.gov/acs/www.
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