The Regis College Haiti Project (RCHP) is an international partnership between Regis College School of Nursing, Science, and Health Professions, the University of Haiti, and Haiti’s Ministry of Health. In February 2014, with completion of a three-year program, 12 nursing faculty members were awarded Master of Science in Nursing (MSN) degrees from the University of Haiti. Through the commitment of Regis College, three cohorts over the course of seven years will obtain their master’s degree and provide sustainable nursing education advancement to all nurses in Haiti.
With this strategic plan, the RCHP enables us to build a dynamic and mutually beneficial, sustainable nursing program where faculty members in Haiti will be qualified to teach as well as produce educated nurses to serve in primary care areas and assume leadership positions with colleges, hospitals, and other health care organizations. Nurses are the key component in a health care system, and providing sustainable nursing education to a developing country is the cornerstone to the betterment of health care delivery.
Building a Relationship with Haiti
The initial stage of this international relationship began in 2007 when the president and several faculty from Regis College travelled to Haiti to meet with the ministry of health and nursing leaders to determine how they could establish a collaborative agreement to improve nursing in Haiti. A primary goal in the strategic plan of the college, among many objectives, is to establish an international footprint through interdisciplinary academic programs, the spirit of collaboration, and student-centered values. The vision statement of the college inspires all to work within its multicultural community and to be actively engaged as leaders and ambassadors of social change.
To develop a strategy, nursing leaders from both Haiti and Regis College consulted and discussed schedules, time commitment, action plans, and long-term sustainability. The mission of the RCHP is incorporated in developing an international nursing partnership. Through this vision of partnership is the goal to improve the health and well-being of the people of Haiti by elevating the level of nursing education and the sustainability of advanced nursing practice.
Project Goal
The RCHP is designed for the registered nurse in Haiti to earn both the baccalaureate and the master’s degree. Its purpose is to prepare nursing educators and nursing leaders to assume a guiding role in the effort to address Haiti’s pressing health care needs. Nurse administrators with advanced nursing education have a unique perspective in the assessment of health disparities and challenges faced in providing care to a vulnerable population. After completion of this program, they will be able to collaborate with local professionals; assist in the creation of sustainable, community-focused programs; practice collaboratively as members of interdisciplinary teams; and deliver population-focused care while reflecting on the impact of poverty and socioeconomic factors.
Specifically, this project seeks to address the acute nursing shortage in Haiti and overall advance the level of nursing education in the country. A 2003 study published in The Journal of the American Medical Association concluded that nurses prepared at the baccalaureate level or higher have significantly better patient outcomes. Partnering with our Haitian neighbors provides a new and expanded role for nurses in a developing country. Upon graduation with a MSN, this first cohort of Haitian faculty will lead the institutionalization of the master’s program for all future Haitian nursing faculty.
Currently, the public nursing schools prepare three-year diploma graduates with their focus on hospital-based care. The objective of this program is to educate Haitian nursing faculty, who can then provide baccalaureate education to all nurses in Haiti and be role models in nursing leadership.
In order to produce a new generation of nursing leaders in Haiti, capacity building is necessary. This entails a society enhancing their abilities to “perform core functions, solve problems, define and achieve objectives; and understand and deal with their development needs in a broad context and in a sustainable manner,” as described in the International Institute for Educational Planning’s Guidebook for Planning Education in Emergencies and Reconstruction. The strategies needed to accomplish this mission include the following: enhancing professional development through curriculum building; analyzing the relationship between theory, practice, and evidence-based research; synthesizing the organizational structure of nursing leadership; and promoting innovative educational methodologies.
Project Planning and Implementation
The RCHP is committed to educating three cohorts of Haitian nursing faculty over the course of seven years, with two overlapping cohorts in the summer of the third year, which would serve as transition and mentorship periods. The sidebar outlines the three years of the program and the required coursework for each cohort (see page 42).
The program began in the summer of 2011 with 12 Haitian nurse faculty from nursing schools across Haiti coming to Regis College in Weston, Massachusetts, for a six-week intensive program of study where orientation and tutorials on computer systems were provided as well as weekly graduate student dinner seminars. Each Haitian nurse faculty was paired with a Regis College nursing faculty member who remained the nurse’s mentor throughout the course of the program. The match of mentors was based on professional experiences and shared interests. The mentors served as academic and professional advisors as well as social support, and they offered guidance throughout the academic year.
When the Haitian nurses were at Regis College during summer sessions, there were opportunities for in-person interactions between mentors and mentees. In addition, the Haitian faculty had the opportunity to shadow nurses at several of the large metropolitan hospitals where they observed cutting-edge technology in both medicine and nursing. During the fall and spring semesters, the mentors and mentees maintained contact via e-mail, Facebook, Adobe Connect, and Skype, and they received technical support through Regis.
During the first year of the program, Regis College nursing faculty traveled to Haiti, where they taught in an intensive five-day format addressing trends affecting community health nursing—specifically, societal and population shifts in the different regions of Haiti following the 2010 earthquake. Morbidity and mortality concerns were also addressed in conjunction with the changes and evidence of population shifts into the cities secondary to the aftermath of the earthquake and the environmental changes. In conjunction with the Regis College philosophy of nursing—which identifies the four central concepts of the nursing discipline as person, environment, health, and nursing—each of the 12 Haitian nursing faculty identified a specific health problem endemic to their community. This was followed by identifying priorities, establishing goals, and determining interventions based on the central tenets of the philosophy. In order for the Haitian faculty to analyze a community health problem comprehensively, we introduced the epidemiologic triangle, the traditional model for infectious disease addressing the external agent or the cause of the health problem, the susceptible host identified in the community, and the environment in which the host and agent came together leading to a specific problem or outcome.
During the second year of the program, the 12 Haitian nursing faculty returned to the campus for a five-week intensive session of clinical and classroom learning over the summer of 2012. The following spring, Regis faculty traveled to Haiti for a one-week intensive training supplemented by online learning.
At the start of the third year, the 12 Haitian nursing faculty returned to the campus in the summer of 2013, where they took part in another five-week intensive session of clinical and classroom learning. Simultaneously, the 12 Haitian nursing faculty who were selected for the second cohort also arrived to the Regis campus for the first time to begin their first year of the program. With the help of Regis nursing faculty, the first cohort became the mentors for the incoming cohort and worked together to teach two out of the four courses taken by the second cohort. The first cohort continued to take two courses alongside the second one.
Conceptual Framework
In February 2014, Regis nursing faculty returned to Haiti during the mentorship period. The first cohort of Haitian nurses assumed the role of educators as they taught nursing theory, nursing leadership, and community health to the second cohort of nurses. With awareness of the shift away from traditional hospital-based care and movement toward the community, they introduced new models of care supported through collaboration in practice and education.
An example presented by the second cohort was Roy’s Adaptation Model, as it was reconceptualized and expanded in order to provide a framework for the delivery of community-based nursing. Using this theoretical framework, they encompassed population-based assessments that related to the physical, psychological, and social integrity of their community. Through this model, they identified the central concepts of the discipline of nursing with the understanding that every person has inherent dignity and worth as well as a right to receive comprehensive, compassionate health care. They viewed the person in the community as a unique biopsychosocial, cultural, and spiritual being who continuously interacts with the environment.
Using Roy’s Adaptation Model as an adjunct in the coordination of community health in Haiti offered the nurses an organized approach in the assessment of their community, incorporating the philosophic components of person, environment, health, and nursing. Through discussion of the physical integrity, their view was broadened as they identified topics incorporating nutrition, the environment, available resources, and government regulation. In discussion of the biopsychosocial characteristics, identifiers such as age distribution, gender, education, and economics were discussed.
The social integrity of the community presented another perspective in assessment of a specific community by focusing on vital statistics, such as births, deaths, prevalence of communicable and chronic disease, leading causes of mortality, and health resources. Using these guidelines in data analysis assisted with community care planning by identifying a community diagnosis, an awareness of the problem, community motivation, and realistic interventions to resolve the problem.
Challenges and Outcomes
A course challenge in our collaborative efforts of educating our Haitian colleagues was the language difference. This was addressed using a bilingual educational platform. Educational material using PowerPoint was introduced with French translation. In addition, an in-class translator was present to translate lectures, questions, and small group discussions. Through the use of Adobe Connect, Moodle, an internet connection, and e-mail, we were able to provide effective international collaboration. This also allowed rigorous evaluation that strengthened the educational models used in promoting effective community health systems for the Haitian nursing faculty. The inability to access French-translated textbooks on community health nursing and nursing theory posed another challenge, but we were able to address it by utilizing a French publishing company.
Through enhancement of scholarship and curriculum development, the new graduates will increase community awareness as well as strengthen and analyze how the environment and personal health behaviors are interrelated. Being part of the community afforded the Haitian nursing faculty the opportunity to influence and motivate others. Their understanding of Haitian lifestyle, culture, and social skills provided them practice opportunities and professional collaboration in addition to critical analysis within the community. It allowed them to be part of effective community action by contributing to the resolution of a problem.
The outcome of the first cohort came to fruition in February 2014 when the University of Haiti awarded master’s degrees to all 12 faculty members representing nursing schools across Haiti from Gonaïves, Les Cayes, Port-Au-Prince, Jérémie, Cap-Haïtien, and University of Notre Dame d’Haiti. Subsequent to achieving the master’s degree, many of the first cohorts have assumed leadership roles in their schools of nursing. One in particular was appointed dean of her nursing school, while others are taking an active role participating in professional conferences in order to enhance the international influence of nurses. Others are enhancing course content through curriculum development and are reaching out to community leaders in order to develop collaborative relationships with interdisciplinary teams. In addition, membership in professional associations has offered the Haitian nurses recognition of their expertise through certification—providing them an opportunity to make a difference and lobby to influence laws affecting nursing.
In providing new and expanded skills in nursing education, this international partnership will help ensure that nursing education in Haiti continues to progress throughout the 21st century with the use of critical thinking, problem solving, and evidence-based practice. Through collaboration, the Haitian nurses have the capacity to build sustainable nursing programs that are beneficial and dynamic for the Haitian society.
“The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.”
—William Arthur Ward
The role of the academic nurse educator is both rewarding and challenging. Furthermore, the nurse educator plays a pivotal role in the nursing profession as well as in the development and preparation of future nurses and advanced degree nurses. The nursing profession is currently experiencing a faculty shortage. According to the American Association of Colleges of Nurses, the national vacancy rate for the 2014–2015 academic year is 6.9%, which limits our ability to adequately prepare our future workforce. Consequently, this is the perfect time to consider transitioning into an academic role.
Some of the factors related to the current faculty shortage include an aging workforce, lack of a diverse cadre of educators, educational requirements, the cost associated with advancing one’s education, and lack of competitive financial compensation. Although the financial compensation is not competitive with current nursing salaries, the educator role is extremely rewarding and offers a certain degree of flexibility and autonomy.
There are several paths you can choose on your journey into the world of academia. All nurses are teachers in their own right, and nurse educators build upon these foundational skills via education and experience. Seeking out opportunities, such as the role of preceptor, patient educator, or hospital-based educator, can help you prepare for a future role in academia. Academic teaching shares many of the basic tenets of all educators; however, academic faculty must meet the triad of excellence in teaching, service to the profession and the organization, and scholarship. Completing a graduate degree in nursing education will certainly help to prepare you for the rigors of academia. There are a myriad of faculty development and scholarship programs that are offered by organizations, such as the Jonas Center for Nursing and Veterans Healthcare, Johnson and Johnson, and the Robert Wood Johnson Foundation, which help address the faculty shortage, the lack of diversity, and the related shortage of nurses.
The Institute of Medicine’s report, The Future of Nursing, also identified the need for the advanced education of all nurses and increased diversity at all levels of nursing. Academic nurse educators must possess the required clinical and educational competencies; however, there is always a need for experienced clinical nurses to fulfill the role of clinical instructor, and this is a great place to begin one’s transition.
Types of Academic Educator Roles
The role of the academic nurse educator varies based on the specific type of educational setting and program. Basic nursing programs include diploma, associate degree, and baccalaureate degree. Graduate programs include master’s degrees and doctoral degrees in a variety of specialty areas. Many programs are offered in traditional brick-and-mortar colleges and universities, but online programs have become very popular.
Academic teaching roles include adjunct, clinical instructor, lecturer, assistant professor, associate professor, and full professor. There are also a host of administrative positions for experienced educators—dean, associate dean, and director. All of these roles require related clinical experience and education.
Educational Requirements and Experience
The educational and experiential requirements for nursing faculty members are somewhat different depending on the actual role. In regards to educational level, faculty members must have a graduate degree at the master’s level to teach in an associate degree program and a doctoral degree to teach at the baccalaureate or higher level. There are exceptions to this rule, however. For example, a clinical instructor does not have to have a doctoral degree but does need the related clinical experience that is relevant to the clinical teaching role (e.g., a pediatric clinical instructor must have at least two years of experience working in a pediatric setting). Diploma and associate degree programs most often require their faculty members to have a master’s degree and related experience. Baccalaureate and graduate programs require faculty to hold a doctoral degree and related experience. Some academic institutions will hire faculty who do not hold a doctoral degree but are currently enrolled in a program. It is important to note that most academic institutions require that at least one degree be in nursing—baccalaureate or master’s.
Although it is not mandatory to have a master’s degree in nursing education, it is certainly helpful for your future role in academia. Another option is to complete a post-master’s certificate program in nursing education. This is especially helpful for nurse practitioners and clinical nurse specialists who are highly experienced clinicians but require further development in the principles of teaching, teaching and learning theories, course development, test construction, and evaluation.
A doctoral degree is required for most tenure track positions and/or when teaching in a graduate program in addition to most baccalaureate programs. Doctoral degrees include Doctor of Philosophy (PhD), Doctor of Education (EdD), Doctor of Nursing Science (DNSc), and Doctor of Nursing Practice (DNP). There are numerous other doctoral programs, but these are the most common ones for nurse educators. Academic institutions may have different requirements regarding educational and clinical experience, so be sure to do some research before deciding on which degree program to attend.
Nurse educators tend to teach in the area of their specialty, such as medical-surgical, psychiatric nursing, or pediatric nursing, but one must be versatile because you may be asked to teach new or unfamiliar content. Because health care and technology are rapidly changing, it is vital to engage in lifelong learning and development and stay abreast of the current literature.
Major Responsibilities and Key Attributes
Nurse educators have numerous responsibilities and, as such, require certain attributes and qualifications that will guide them in their transition into the world of academia. In OJIN: The Online Journal of Issues in Nursing, Penn, Wilson, and Rosseter argued that nurse educators must have the following: teaching skills; knowledge, experience, and preparation for the faculty role; curriculum and course development skills; evaluation and testing skills; and personal attributes. Additionally, nurse educators are also expected to serve as advisors and mentor students, serve on committees, and make significant scholarly contributions.
Being passionate and caring about your profession and your students is very important. As a nurse educator, you will spend a good amount of time developing various course items in addition to reading and evaluating students’ work, so writing and communication skills are vital. You will also need to clearly articulate the information you share with your students and peers, in addition to being a good listener. Time management and organization are also essential because the role of the academic nurse educator is extremely demanding.
Teaching, Service, and Scholarship
The three requirements for tenured and many non-tenured faculty members are teaching, service, and scholarship. Depending on the type of faculty appointment, there will be an expected/required percentage of each one of these. For example, in many academic settings, teaching will be the most heavily valued. However, if you are teaching at the doctoral level at a research university, then scholarship in the form of research will be equally important.
Nevertheless, the most important goal for new faculty is to become an exemplary and expert teacher. This is accomplished with experience, education, reading current literature, mentorship, evaluation (self, student, and peer), and faculty development programs. Nurse educators will eventually develop their own unique style that is influenced by personal beliefs, pedagogies, and philosophy (including the influence of their academic institution’s philosophy). Faculty development is an ongoing process and requires self-direction and motivation. It is important to develop a specific plan for how you will continue to develop your teaching skills.
Scholarship relates to learning, research, and scholarly publications. The type of required scholarly works will be dictated by your academic organization and your specific faculty appointment. Scholarship includes conducting research, peer reviewing for publications, and presenting at conferences.
Service requires one to contribute to the organization and profession without financial compensation. Typically, this includes serving on committees, serving on an editorial board, or serving as a peer reviewer. There are certainly many other ways to meet this requirement, which may also involve serving one’s community.
Rank, Tenure, and Academic Freedom
Many full-time faculty positions are tenured. Ranks include instructor, assistant professor, associate professor, and full professor. When faculty members receive an academic appointment, they are given a contract that states their rank and the number of years they have to demonstrate that they have met the required expectations of teaching, service, and scholarship to earn tenure. Tenure is one of the ways academic freedom is protected. Academic freedom pertains to a faculty member’s right to teach content, conduct research, and write or speak without censure, with the caveat that he or she demonstrates sound judgment when teaching content, especially if it is controversial. Faculty must be careful not to influence their students’ beliefs or abuse their power as educators. All faculty members should be well versed in the rights and legal, ethical, and moral responsibilities that are inherent in this role.
Ways to Transition to a Nurse Educator Role
In addition to experience and education, transitioning to the role of nurse educator requires the development of realistic goals and objectives. If you truly have the desire to teach, you should develop a specific plan with all the steps you will need to complete to meet your goal. Utilizing the nursing process will help you to develop a realistic plan. The first step is to assess your current level of knowledge, skills, education, and attributes. From there, you can begin to develop a specific individualized plan for how to accomplish each objective. Note that, if you do not have an advanced degree, you will need to enroll in a graduate program, so be sure to carefully consider which program will be best for you.
As a graduate student, you may have an opportunity to work as a teacher’s assistant, which will provide you with invaluable experience. You should seek out as many teaching experiences as you can. Consider becoming a mentor or preceptor, join the patient education committee, or develop a continuing education article. You should also consider becoming an adjunct clinical instructor in your specialty area, which is a great way to “test the waters” and eventually transition to a full-time faculty role.
Reading the current literature and attending conferences are also very helpful. You will need to network and consult with your mentor. Furthermore, developing a professional portfolio with a well-developed resume—or curriculum vitae—is crucial when applying for a faculty position.
It is also advisable to participate in mock interviews so that you will be prepared for an actual interview. It’s worth noting that the interview process at an academic setting is unique; you will most likely be interviewed by a search committee. Don’t be surprised if you are asked to demonstrate your teaching skills and share your philosophy of teaching.
Develop a Five-Year Plan
Developing a five-year plan with goals, objectives, and actions with specific dates can be very helpful when planning your transition. The goals should be realistic and achievable, and the objectives should be measurable. The actions are the steps needed to meet your objectives and accomplish your goals. Goals may be related to earning an advanced degree, obtaining a position as an adjunct, or applying for a full-time faculty role.
The plan should be evaluated on an ongoing basis and revised in accordance with your current needs. It is important to remember that plans are not set in stone and can always be revised. When you complete your first five-year plan, you will want to begin another one as you continue on your journey as a nurse educator.
Although the transition may be challenging, there are many strategies you can employ to guide you through this process. The journey from clinician to educator is filled with tremendous growth and learning.
Deborah Dolan Hunt, PhD, RN, is an associate professor of nursing at The College of New Rochelle. She is the author of The New Nurse Educator: Mastering Academe and The Nurse Professional: Leveraging Your Education for Transition into Practice.
Recently, I was taking a late-night walk with the dog and ran into my neighbor. She was just returning home from her shift as an emergency room nurse. Every time I see her she’s wearing scrubs (and I’m pretty sure they are all stained). We enjoy visiting, but her only available time is before the sun rises or after it sets. When I need to decipher the scribbles of my 5-year-old nephew, I have to ask her to read it to me. She always laughs and says it’s basically the same as translating a doctor’s notes.
As we sat down, she shared with me that she loves what she does and she adores her patients, but earlier that day someone told her she was pale and looked “sick.” She hadn’t seen the sun in weeks. When I pressed further, she shared with me that recently she had developed a desire to have more flexibility and control with the types and lengths of shifts she works. Her kids were getting older, and she hated the thought of missing even more soccer games.
She was quick to tell me she was certainly not ready to leave nursing altogether. She’d spent years in school and had spent countless hours adding continuing education credits to her resume. Truly, she was exhausted. I had been compiling research for an article on advanced career choices in the medical field, so I shared with her four finds that were directly related to nursing:
Nurse educators, especially in specific fields, are in high demand. Nurses need continuing education throughout their careers, and fresh faces are joining the ranks every year. You can combine your clinical expertise with a passion for teaching into a rewarding career. Educators are needed at colleges, universities, technical schools, and hospital-based schools. You would be required to hold a master’s or a doctoral degree in nursing. Nurse educators typically have advanced clinical training in a health care specialty. Many educators enjoy the option of flexible work scheduling.
This is an excellent choice for nurses seeking an advanced, nonclinical job in the nursing industry. Nurse researchers are employed by health policy nonprofits and private companies. Nurse researchers perform analyses and create reports based on research gathered from medical, pharmaceutical, and nursing products and/or practices. Their objective is to improve health care and medical services. Nurses with a bachelor of science in nursing (BSN) degree are eligible for these jobs, but those with a master’s or a doctoral degree may have an increased chance of acquiring a nurse researcher position.
They manage and provide health care data to patients, nurses, doctors, and other health care providers. Nursing informatics specialists ensure computer applications are easy to use and provide useful information to nurses, managers, and other health care workers. A BSN is the minimum requirement for certification for a nursing informatics job; however, several employers require a master of science in health informatics, health care management, or quality management.
The American Nurses Credentialing Center requires two years of experience as an RN and at least 2,000 hours of work in informatics within the last three years for certification. Those with certification improve their chances of obtaining a job with a higher salary. The job outlook has been steady, as many organizations hire informatics experts to solve documentation issues and decrease errors. Informatics specialists typically work for hospitals and medical-records software vendors.
A nurse attorney is exactly that: a nurse who has gone back to school to become an attorney. Few attorneys have the medical knowledge of nurses. Nurse attorneys work in many different settings, including firms that specialize in social security disability, hospital legal departments, or litigation firms.
When becoming a nurse attorney, the first step is to become a nurse by earning your BSN and passing the licensing exam. It would also be vital to acquire hands-on nursing experience. Your next step would be to apply and be accepted by a law school. This would include another three or four years of school. After completion, you will then have to take the bar exam for the state where you will practice. You could opt to open your own practice or try to get on board with a law firm or a health-care-related company.
Where Do I Begin?
If you, too, are seeking a new path, ask yourself the following questions:
•Should I focus on a non-clinical or a clinical route?
•Am I ready to move away from providing direct patient care, or would I miss the relationship with my patients?
Analyze your skill set; take a hard look at your strengths and the environment where you feel you can thrive. Remember, there are more paths in the nursing spectrum than you might think. One of the most important factors to consider is if you would need further education or credentialing and whether it’s feasible to return to school. Prioritize a list of what’s most important, the elements of nursing that you enjoy the most, salary expectations, and what kind of culture would suit your personality. Most often, I find there are several routes accessible. Find the path that makes the most sense for your journey.
Samantha Stauf is a graduate of the University of Idaho. She enjoys researching how technology has affected the health care field.
For the second year in a row, we reached out to Minority Nurse readers about what they look for in a workplace—and how their current employers stack up.
Unsurprisingly, salary and benefits once again topped the list of factors respondents considered when looking at potential employers. But for many readers, workplace satisfaction was about more than just compensation. This year’s results showed an increased focus on quality of life factors, such as corporate culture, workplace environment, and flexibility of hours. Diversity and workplace size—while still important to many respondents—were less of a factor when considering potential employers.
Overwhelmingly, this year’s results showed readers were quite satisfied with their current jobs. The majority rated their employers as “good” or “excellent” in most categories, including workplace size, job perks, and benefits. The areas most in need of improvement according to this year’s survey were opportunity for advancement and salary, though Minority Nurse’s Salary Survey from 2014 showed that readers have seen steady pay increases in that area over the last few years.
This year’s responses, which were gathered through an online questionnaire sent to Minority Nurse subscribers, came from across the country, with California, New York, Texas, and Pennsylvania as the most represented states. Companies that scored well this year were mostly very large organizations with thousands of employees, including several academic-affiliated medical centers, such as Duke University Health System and Penn State Milton S. Hershey Medical Center; government agencies, such as the US Department of Veterans Affairs and Indian Health Service; and big urban hospitals and networks, such as Children’s Hospital of Philadelphia and the Cleveland Clinic.
Our final list of top 25 companies, presented alphabetically, scored well in the categories that were most important to our readers. We’ve provided a brief introduction to each organization, as well as contact information for job seekers.
About the company: Formed in 1995 with the merger of Evangelical Health Systems Corporation and Lutheran General Health System, the Advocate Health Care network is one of the largest employers in the Chicago area. It includes 12 acute-care hospitals (six of which are Magnet-certified) and more than 200 other health care facilities, including hospices. Several Advocate hospitals have consistently ranked in the U.S. News & World Report annual best hospitals, among other accolades.
Contact: Job listings are available at jobs.advocatehealth.com
Bellin Health
Website:bellin.org
Location: Green Bay, Wisconsin
Number of nursing employees: Varies by facility (approximately 750 at Bellin Hospital)
About the company: Founded more than 100 years ago by Dr. Julius J. Bellin as General Hospital, Bellin Health is now comprised of several medical and educational entities, including the 167-bed acute-care facility Bellin Hospital, two psychiatric treatment centers, and a network of family medical offices, as well as the Bellin College of Nursing, which offers the only four-year baccalaureate-nursing program in northeast Wisconsin.
Contact: Job listings are available at bellin.org/careers
California State University
Website:calstate.edu
Location: Facilities throughout California
Number of employees: Varies by campus
About the company: California State University is the largest four-year university system in the country, with nearly 447,000 students. The CSU Nursing Program offers bachelor’s, master’s, and doctoral degrees in nursing. Nurse educators are employed at 18 of the school’s 23 campuses located throughout the state.
Contact: Job listings are available at csucareers.calstate.edu
Children’s Hospital of Philadelphia
Website:chop.edu
Location: Headquarters in Philadelphia, Pennsylvania
Number of nursing employees: Approximately 3,600
About the company: Children’s Hospital of Philadelphia is the nation’s oldest children’s hospital, and is widely regarded as one of the best. It’s topped the U.S. News & World Report list of best children’s hospitals for the last five years, and has been Magnet-certified since 2004. In addition to its main hospital in West Philadelphia, CHOP operates more than 50 smaller practices throughout Pennsylvania and New Jersey, and several large expansion projects are in the works, including a new outpatient facility set to open in 2015.
Contact: Job listings are available at chop.edu/careers
Cleveland Clinic
Website:clevelandclinic.org
Location: Headquarters in Cleveland, Ohio
Number of nursing employees: Varies by facility (approximately 6,500 at the main campus)
About the company: Known as one of the most medically innovative hospitals in the country, the Cleveland Clinic’s long list of “firsts” includes the isolation of serotonin, the first coronary bypass surgery, and the first face-transplant in the United States. It is ranked in several specialties on the U.S. News & World Report list of best hospitals. In addition to its main location in Cleveland, it operates seven more hospitals throughout Ohio, as well as affiliates in Florida and Nevada, and international outposts in Canada and Saudi Arabia.
Contact: Job listings are available at jobs.clevelandclinic.org
About the company: Established in 1956 after a massive grassroots fundraising effort by Indianapolis residents, Community Hospital (now Community Hospital East) has grown to a sprawling network of more than 200 facilities throughout central Indiana. It has been named one of the best places to work by The Indianapolis Star.
Contact: Job listings are available at employment.ecommunity.com
Duke University Health System
Website:dukemedicine.org
Location: Headquarters in Durham, North Carolina
Number of nursing employees: Varies by facility (approximately 3,000 at Duke University Hospital)
About the company: Duke University Hospital (since renamed Duke University Medical Center) was established in 1930 thanks to a bequest from James B. Duke. Today, the 7.5-million-square-foot facility is the flagship hospital in a network that includes the Duke Clinic, Duke Children’s Hospital and Health Center, Duke Regional Hospital, and Duke Raleigh Hospital, as well as the Duke University Medical School and the Duke University School of Nursing. Duke has been nationally recognized for its several specialties, including cardiology, nephrology, and ophthalmology.
Contact: Job information is available at hr.duke.edu
Gwynedd Mercy University
Website:gmercyu.edu
Location: Gwynedd Valley, Pennsylvania
Number of employees: Approximately 500
About the company: This Catholic-affiliated university offers undergraduate and graduate degrees in nursing and other medical specialties at the Frances M. Maguire School of Nursing and Health Professions division.
Contact: Job information is available at gmercyu.edu/about-gwynedd-mercy/administration/human-resources
Indian Health Service
Website:ihs.gov
Location: Headquarters in Rockville, Maryland, with facilities throughout the country
Number of nursing employees: Approximately 2,700
About the company: The Indian Health Service was established in 1955 to improve the health of American Indians and Alaska Natives. This division of the US Department of Health and Human Services has an annual operating budget of $3.8 billion and oversees more than 100 medical facilities in 12 areas, each focused on the unique needs of the native American tribes in the region.
Number of nursing employees: Varies by facility (approximately 29,400 total employees)
About the company: Indiana University Health is a network of hospitals and other facilities throughout Indiana affiliated with the Indiana University School of Medicine. Last year, IUH had more than 2.5 million outpatient visits and over 136,000 admissions. Its facilities have been nationally ranked by U.S. News & World Report in several specialties, including cancer, neurology, and orthopedics. Six of the hospitals in the network have been designated Magnet facilities.
Contact: Job listings are available at iuhealth.org/careers/nursing-careers
Kaiser Permanente
Website:healthy.kaiserpermanente.org
Location: Headquarters in Oakland, California, with facilities in California, Colorado, Georgia, Hawaii, Oregon, Washington, Virginia, Maryland, Ohio, and Washington, DC
Number of nursing employees: Varies by facility
About the company: Founded in 1945, Kaiser Permanente operates more than 600 interconnected but independently managed medical facilities in the United States, as well as a managed-care plan with more than 9 million members.
Contact: Job listings are available at kaiserpermanentejobs.org
Los Angeles County Department of Health Services
Website:dhs.lacounty.gov
Location: Los Angeles County, California
Number of nursing employees: Varies by facility
About the company: Los Angeles County Department of Health Services is the second-largest municipal health care system in the country. It operates in the most populous county in the United States, and provides medical care and services to approximately 800,000 patients annually at several hospitals and other medical centers.
Contact: Job listings are available at hr.lacounty.gov
Memorial Hermann–Texas Medical Center
Website:memorialhermann.org
Location: Houston, Texas
Number of nursing employees: Approximately 1,800
About the company: This Magnet-recognized teaching hospital (affiliated with the University of Texas Health Science Center at Houston Medical School), is the oldest institution in the massive Texas Medical Center and the flagship hospital in the vast Memorial Hermann network with facilities throughout Texas. Its Level 1 trauma center sees more than 40,000 patients annually, and its Children’s Hospital is one of the top-ranked pediatric facilities nationwide.
Contact: Job listings are available at memorialhermann.org/careers
NewYork–Presbyterian Hospital
Website:nyp.org
Location: New York, New York
Number of nursing employees: Approximately 5,000
About the company: This multi-campus institution is affiliated with two Ivy League universities, Columbia and Weill Cornell. It is the largest private employer in New York City, and one of the largest hospitals in the United States. It’s ranked sixth overall in U.S. News & World Report’s Best Hospitals survey. In addition to its two main facilities in Manhattan, the Columbia University Medical Center and the Weill Cornell Medical Center, NewYork–Presbyterian operates the Allen Hospital, Morgan Stanley Children’s Hospital, and a psychiatric facility in nearby Westchester County. In July 2013, NewYork–Presbyterian expanded its reach when it merged with New York Downtown hospital, establishing the Lower Manhattan Hospital.
Contact: Job listings are available at careers.nyp.org
About the company: A Catholic teaching hospital established 90 years ago, OLOL is one of the largest privately owned hospitals in Louisiana, as well as the largest of four hospitals in the Franciscan Missionaries of Our Lady Health System. Today, this Magnet-recognized facility serves 11 parishes, and has more than 1,000 beds.
Contact: Job listings are available at ololrmc.com/greatplacetowork
Penn State Milton S. Hershey Medical Center
Website:pennstatehershey.org
Location: Hershey, Pennsylvania
Number of nursing employees: Approximately 1,800
About the company: This 475-bed teaching hospital affiliated with Penn State College of Medicine and College of Nursing is one of the largest and most respected hospitals in south central Pennsylvania. Its Children’s Hospital is ranked among the nation’s best in U.S. News & World Report’s top hospitals list, and it features the area’s only neonatal intensive care unit. The hospital’s Cancer Institute opened in 2009, and the volunteer-run LionCare clinic has been providing free health care services since 2002.
Contact: Job listings are available at pennstatehershey.org/web/humanresources/home/searchjobs
Rutgers Biomedical and Health Sciences
Website:rbhs.rutgers.edu
Location: Facilities and institutions throughout New Jersey
Number of nursing employees: Varies by facility
About the company: Part of the vast Rutgers University system in New Jersey, RBHS was established as an umbrella organization in 2013 after the dissolution of the University of Medicine and Dentistry of New Jersey. It comprises several medical and educational institutions, including the Cancer Institute of New Jersey, University Behavioral HealthCare, the Rutgers School of Nursing, and both of the Rutgers graduate schools of medicine: New Jersey Medical School and the Robert Wood Johnson Medical School. The primary teaching hospital for Rutgers is the state-owned University Hospital in Newark.
Contact: Job information is available at uwide.rutgers.edu/about/employment-rutgers
SUNY Downstate Medical Center
Website:downstate.edu
Location: Brooklyn, New York
Number of nursing employees: Approximately 650
About the company: Founded in 1860 as Long Island College Hospital, SUNY Downstate is now one of three medical centers in the State University of New York system. Today, it includes four patient-care facilities, as well as medical, nursing, and public health schools, among other academic programs. It’s the fourth largest employer in Brooklyn—a borough of New York City with more than 2 million residents—and its alumni network is impressive: More physicians practicing in New York City graduated from the SUNY Downstate College of Medicine than any other medical school.
Contact: Job listings are available at downstate.edu/human_resources
UNC Health Care
Website:unchealthcare.org
Location: Facilities located throughout North Carolina
About the company: UNC Health Care is a state-owned network of hospitals affiliated with the prestigious University of North Carolina-Chapel Hill School of Medicine. In addition to 12 hospitals, which include several Magnet-recognized facilities, UNC Health Care provides services at family health practices, ambulatory care facilities, and urgent care units throughout the area.
Contact: Job listings are available at unchealthcare.org/site/humanresources/careers
About the company: The University of Arkansas for Medical Sciences has six academic divisions, including pharmacy, nursing, and public health schools, as well as the only medical school in Arkansas. The school’s main patient-care facility is UAMS Medical Center, though it expands it reach through smaller clinics located all over the state.
Contact: Job listings available at jobs.uams.edu
University of Maryland Medical System
Website:umms.org
Location: Facilities throughout Maryland
Number of nursing employees: Varies by facility
About the company: One of the largest hospital networks in the Mid-Atlantic region, University of Maryland Medical System is made up of nine hospitals, including one pediatric facility and several teaching hospitals affiliated with the University of Maryland.
Contact: Job listings are available at umms.org/careers
University of Michigan Health System
Website:med.umich.edu
Location: Headquarters in Ann Arbor, Michigan
Number of nursing employees: Varies by facility
About the company: This integrated health care system located in southern Michigan comprises three hospitals (University Hospital, C.S. Mott Children’s Hospital, and Von Voigtlander Women’s Hospital), 40 outpatient centers and more than 120 clinics, and a large home health care division. It also includes the University of Michigan’s Medical School and School of Nursing, and it partners with other medical centers throughout the state via the Michigan Health Corporation. The Detroit Free Press has named UMHS one of the “101 Best and Brightest Companies to Work For.”
Contact: Job listings are available at umhscareers.org
University of Texas Medical Branch
Website:utmb.edu
Location: Galveston, Texas
Number of nursing employees: Varies by facility
About the company: This division of the University of Texas is located in a 70-building, 84-acre complex, which includes several hospitals and clinics, four schools, and numerous research facilities. In 2008, many of its buildings were badly damaged by Hurricane Ike, but it’s made a strong comeback and expanded its reach since.
Contact: Job listings are available at utmb.jobs
US Department of Veterans Affairs
Website:va.gov
Location: Headquarters in Washington, DC, with facilities throughout the United States
Number of nursing employees: Varies by facility
About the company: The US Department of Veterans Affairs was established in 1930, consolidating several agencies that provided services to veterans of American conflicts. Today, the Veterans Health Administration, the wing of the VA focused on health care, operates 171 medical centers, as well as hundreds of outpatient clinics, nursing homes, and other facilities.
Contact: Job listings are available at vacareers.va.gov
Vanderbilt University Medical Center
Website: vanderbilthealth.com
Location: Nashville, Tennessee
Number of nursing employees: Approximately 3,700
About the company: This organization contains several hospitals and clinics, as well as Vanderbilt University’s School of Medicine and School of Nursing. Vanderbilt has been well ranked in the U.S. News & World Report Best Hospitals surveys, and Vanderbilt University was once named one of Forbes’s “100 Best Companies to Work For” (more than 80% of Vanderbilt’s employees work at the Medical Center).
Contact: Job listings are available at vanderbilt.edu/work-at-vanderbilt
Nursing is entering an era of great transformation that is driven by three major changes: an aging baby boomer population; the ongoing impact of the Affordable Care Act (ACA); and rising educational goals for the profession, including greater emphasis on the bachelor’s of science in nursing (BSN) and advanced practice nursing (APN) degrees.
For minority nurses, these changes bring a variety of benefits, as well as some possible drawbacks.
The aging of the baby boomers is expected to produce a plethora of new nursing jobs, which could lead to higher wages, greater job security, and greater variety in types of work. By the same token, this deluge of new patients could put new strains on the nursing workforce, possibly leading to higher patient-to-nurse ratios.
The health care law is changing the way nurses deliver care—emphasizing more outreach into the community and closer collaboration with patients. These changes could boost the need for nurses from the same cultural background as patients, at a time when African Americans and Hispanics are underrepresented in nursing. But the changes also mean less work for nurses in the traditional hospital setting.
Finally, nurses will have greater opportunities to advance their careers by going back to school for more training; APNs, and especially nurse practitioners (NPs), are already in great demand to cope with a growing physician shortage. However, having to spend more time in school may be challenging for nurses with limited finances.
Nursing is embracing these fundamental changes to keep pace with a rapidly evolving health care system, says Jo Ann Webb, RN, MHA, senior director of federal relations and policy at the American Organization of Nurse Executives. “Health care is changing, and nursing has to change with it.”
Baby Boom Changes Postponed, But Not Cancelled
For several years now, the profession has been bracing for a massive shortage of nurses, but it’s been slow to materialize.
The massive baby boomer generation, making up almost one-third of the population, began to turn age 65 in 2011. As they continue to get older, both supply and demand of nurses will be affected in a big way. On the supply side, retiring baby boomer nurses will empty the ranks of the profession. On the demand side, aging baby boomer patients will need more nursing to manage their declining health.
Yet, these massive changes were postponed by the 2008-2009 recession and the weak economy that followed, argues Marcia Faller, RN, PhD, chief clinical officer for AMN Healthcare, a health care staffing company based in San Diego.
Aging nurses, short on household funds, held off retiring and even came out of retirement to work again. Meanwhile, the aging patients have put off care, flattening the demand for health services. “Everybody is trying to figure how these changes will play out,” says Faller, who led a major AMN Healthcare survey on registered nurses in 2013.
But as a result of this delay, new nurses who had expected a strong jobs market have struggled to find openings. For example, a Denver TV station reported in 2013 that, of 752 openings for RNs in Colorado at that time, only four were for new graduates.
Lack of jobs has been especially hard on minority nurses, many of whom lack savings to fall back on. With their careers sidetracked, they’ve had to take non-RN jobs in health care or in completely unrelated fields.
In a new graduate hiring survey, the California Institute for Nursing & Health Care reported that in 2012–2013, the latest year available, a little over 40% of new RN graduates in the state hadn’t found an RN job—only a slight improvement over the previous three years. Of those who didn’t find RN jobs, 20% were working in non-RN roles in health care and 23% took jobs outside health care. The rest went back to school or volunteered in health care at no pay.
Many new graduates are angry and mistrustful. In a 2013 survey by two nursing professors at Molloy College, which was published by the National Student Nurses’ Association, many new RN grads thought the nursing shortage was just a “myth,” created by nursing schools to attract more students.
The impending nurse shortage, however, is not going away, says Mary H. Hill, PhD, RN, nursing professor and assistant provost of Howard University in Washington, DC. Aging patients can’t continue to delay treatment and aging nurses can’t continue to put off retirement. Indeed, states like Texas and many rural areas are already encountering shortages. “Nursing has experienced some challenges, but even greater challenges lie ahead as the baby boomers retire and leave the nursing workforce,” says Hill.
The need for more nurses will be overwhelming, according to the US Bureau of Labor Statistics (BLS). In a recent occupational outlook report, the BLS said there will need to be about 500,000 more nursing positions by 2022. In addition, about 500,000 baby boomer nurses are expected to retire over that same time period, meaning that over 1 million new nurses will be needed over the next decade, according to the BLS.
That means that the hospitals and other employers who are now rejecting young applicants will end up begging for them to apply, which could push up nurses’ wages. Hospitals could also simply pile more work onto existing nurses, but doing so would be unworkable in the long run.
Nursing schools have been pushing hard to expand class size so there will be enough nurses for this tsunami of demand. But they’ve had to turn applicants away, due to a lack of nurse educators. Nursing schools in New York, for example, rejected 2,900 qualified applicants in 2012, more than in any year since 2005, according to the Healthcare Association of New York State (HANYS). Many of these spurned applicants have probably moved on to other careers, which is a great loss for nursing.
Repercussions of the Affordable Care Act
Like the baby boom, the health care law represents another great sea change for nursing and is also still in its early stages. The full impact of the ACA “hasn’t shaken out yet,” according to Webb.
Beginning in January 2014, millions of Americans gained coverage under Medicaid and in subsidized policies sold on the new health insurance exchanges. But it’s still unclear how much these people will boost demand for health care and thus nurse hiring. Exchange policies tend to have very high deductibles, discouraging people from getting care. Additionally, millions of Americans still haven’t signed up, despite a federal requirement to do so. The penalties in the first year were fairly minor but will rise in succeeding years, which may boost coverage.
The elephant in the room, of course, is Republican opposition to the law. Republicans continue to promise repeal, and it could happen since they’ve gained control of the Senate and the House. In the meantime, however, this sweeping law is fundamentally changing the face of health care in this country—not just in terms of sheer numbers of patients, but also in the way it is delivered. And in another few years, it would be very hard to turn these changes back.
“I’m not saying it’s a perfect law,” says Webb, “but it has, in my view, put nursing on the map. Nurses have a bigger role now.” Accountable care organizations and patient-centered medical homes are new models of care that are encouraged by the ACA. Both models reward hospitals and other providers that coordinate care and provide more patient education—two areas where nurses excel.
“The ACA emphasizes primary and secondary prevention and education of patients,” says Shawona Daniel, MSN, CRNP, assistant professor of nursing at Tuskegee University, a historically black institution in Alabama. “Education is one of the most important nursing roles. I’d say 90% of what nurses do involves teaching patients and working on preventive issues, which helps keep patients out of the hospital.”
Webb added that working in medical homes requires computer skills in order to deal with electronic health records and telehealth services, such as e-mailing and Skyping patients, as well as using remote monitoring devices. “These patients need monitoring, and this is where nursing is really critical,” she argues.
The Shift Away From Hospitals
Daniel reported that virtually all of her students still expect to work in a hospital—at least initially. But the ACA favors new models of care outside the hospital. For example, Medicare is reducing hospital reimbursements, and hospitals are being penalized for readmissions within 30 days.
“There is an ongoing shift from inpatient to more community-based outpatient care,” says Hill.
Faller agreed with this assessment. “Only the sickest of the sick will be in the hospital, and care will flow out into the community,” she explains. As health care moves out of the hospital, home health is already a growing field, and it has become a magnet for telehealth and other high-tech services, she adds.
In addition, Hill says nurses will be able to find ample jobs at dialysis centers, community health centers, physicians’ offices, outpatient surgery centers, and pain management clinics, to name a few settings. “There are just so many opportunities,” she argues.
As part of the de-emphasis on hospital care, many patients are being discharged earlier and placed in long-term acute care (LTAC) facilities, where they spend many weeks often still on ventilators and IVs. Care in the LTACs is “complex and challenging,” says Joseph Morris, CNS, GNP, PhD, director of nursing and allied health at Victor Valley College in Victorville, California. “Nurses who work in these facilities require advanced skills, such as advanced cardiac life support and telemetry training.”
Morris, who is trained in gerontology, welcomes the influx of aging baby boomers. Many nurses seem to feel that a geriatrics career—which can mean working in a nursing home—means “lowering your sights,” he says, but he disagrees. “It’s clinically challenging because you’re more likely to see multiple health problems.”
Dealing with older patients is also personally rewarding. Morris, who is African American, has fond memories of taking care of elderly black men in Detroit. In contrast to the stereotype of geriatric patients sitting in their wheelchairs muttering to themselves, “most geriatric patients are still active,” he says.
Nurses Get More Training
The job market is beginning to favor nurses who have a BSN degree, and advanced practice nurses such as NPs are in great demand.
Both trends earned key endorsements from the Institute of Medicine (IOM) in its 2010 report, The Future of Nursing. The report set a goal that 80% of nurses should have a BSN degree by 2020 and urged states to drop barriers against NPs working “to the full extent of their education and training.”
Hospitals are quickly shifting to BSNs. In New York, 70% of hospitals in 2013 preferred hiring BSNs, compared with 46% in 2011, according to HANYS. Many younger nurses are heeding the call. Faller pointed to the 2013 AMN Healthcare survey showing that almost one-quarter of nurses ages 19–39 said they would pursue a BSN, and more than one-third said they would pursue a master’s degree in nursing.
Hill says it’s fairly easy for someone with an associate degree in nursing to transition to a BSN degree. They can enroll in a “RN-to-BSN” transition program, which lasts 12–18 months and is available in many locations across the country.
Meanwhile, NPs have been proliferating. According to a 2013 report by the Health Resources and Services Administration (HRSA), the number of NP graduates grew by 69% from 2001 to 2011, fueled by the growing shortage of physicians in primary care and easing of state restrictions on NP practice.
“Nursing students are more ambitious than they used to be,” argues Daniel. “A lot of them want to go back to graduate school and become nurse practitioners.” She says she hopes some of them will choose a career in academia so that more nurses can be trained. This was another goal of the IOM report.
Morris says the new doctor of nursing practice credential, which will be required for all NP students starting in 2015, expands the amount of study, making NPs even more desirable as primary care providers as well as specialty caregivers.
Of course, the extra time and money needed for a BSN, and especially an NP, can be a barrier for minority students. Rather than pile up loans, Morris urged students to thoroughly research available scholarships. “Nursing students have not always been proactive in seeking out the opportunities.”
Push for Diversity
The new models of care fostered by the ACA require closer relationships between providers and patients, which means hiring nurses from the same ethnic background as their patients. Hospitals and other employers “want their nurses to be compatible with the culture or their patients,” says Faller. “But this will be a challenge, particularly for the Hispanic population.”
While Hispanics make up 17.1% of the population, they account for only 4.8% of RNs, according to the HRSA. There is also a gap for African Americans, who account for 13.2% of the population but just 9.9% of RNs.
As a black male nurse, Morris says it’s easier for him than for white caregivers to connect with black patients. He says many of them are still painfully aware of the infamous Tuskegee experiment. In a project that lasted until 1972, white doctors didn’t inform black male patients that they had syphilis, so that they could follow the natural progression of the disease. As a result, older black patients in particular are still wary of “being used as guinea pigs,” he says.
Morris has worked hard to boost African American representation in nursing, visiting schools to spread the word about a nursing career. He is also interested in boosting the number of black men in nursing. While men make up almost 10% of all nurses, very few black males enter the field, he says.
Nurses Have a Central Role to Play
There are many opportunities for minority nurses in this era of great change in the health care system. According to the IOM report, nurses will take center stage in this process.
“We believe nurses have key roles to play as team members and leaders for a reformed and better-integrated, patient-centered health care system,” the report maintained. “How well nurses are trained and do their jobs is inextricably tied to every health care quality measure that has been targeted for improvement over the past few years.”
Leigh Page is a Chicago-based freelance writer specializing in health care topics.
