When welfare reform, also known as Temporary Assistance for Needy Families (TANF), became law in 1996, direct funding from the federal government turned into block grants each state spent at its discretion. All states had to follow federal regulations, such as lifetime benefit limits for each welfare recipient. Some states, however, placed heavy emphasis on a concept called “self-sufficiency,” getting welfare recipients into salaried and self-employed positions as quickly as possible. With this emphasis on self-sufficiency, certain types of higher learning became preferred over others.
According to Joron Planter-Moore, a representative with the Virginia Department of Social Services in Richmond, Virginia, education for TANF recipients includes studying in vocational programs for up to 12 months. Vocational programs, such as trade schools, community colleges, and four-year institutions, should prepare the student for employment. Simply put, people on TANF who want to study liberal arts at the University of Virginia would be out of luck.
“Working towards a degree in philosophy would not be considered vocational education,” explains Planter-Moore, “because it is not directly related to employment.”
Nia Gilmore, RN, of Louisville, Kentucky, currently works as a registered nurse at a local hospital. She also earned a Bachelor of Science in Nursing (BSN) from the University of Louisville. She heard her mother say a common refrain: Blacks, especially black women, had to work twice as hard to succeed in America. Her mother’s emphasis on high standards extended to getting high grades.
“In Kentucky,” says Gilmore, “an A is a 93. My mother would always say ‘do better.’” Medical tragedies in her family led Gilmore towards nursing. Her mother suffered from chronic illness through much of her childhood, and her nephew has sickle-cell anemia. During her numerous times at the hospital, Gilmore noticed the bedside manners of the nurses.
“The care they gave made a big difference,” she says. “I wanted to do the same when I became older.”
Ruth Aina, a current member of Family Scholar House, looks forward to December 2014, when she’ll receive her BSN. A busy single mom and a devout Christian, Aina says that she has always been drawn to caring for others.
“I’m thinking of specializing in pediatrics, neonatal,” she says. A typical day for Aina includes waking up at 6:30 a.m., preparing breakfast for herself and her child, dropping her child off at school, attending classes at the university, studying a lot, running back home to pick up the kid, cooking dinner, and then a little bit of solitude before sleep.
Lots of prayer is included. “I ask the Lord for strength,” says Aina.
Gilmore received public assistance to support herself and her daughter. She’s aware of the vicious stereotypes. “Some people think people on welfare are lazy,” she states. “That we have no plans for the future. That most of us are black.”
She took a while to sign up for TANF, having had internalized the stereotypes. Eventually, she realized that she and her child needed the help.
According to Stephanie Rowe, relationship coordinator and director of program support integration at Family Scholar House, breaking the cycle of poverty and dependency is about environment and support.
“Through our comprehensive programming,” she says, “which includes, but is not limited to: academic advising; supportive housing; family support services/case management; children’s programming; childcare; counseling; mentoring; tutoring; life skills building; financial education; family nutrition and wellness programming; peer support; assistance with basic needs; and community referrals, our participants are empowered to break the cycles of poverty, homelessness, and dependency—not only for themselves but also for their children—by earning a college degree, achieving career-track employment, and attaining self-sufficiency.”
Nursing students especially need the supportive environment Family Scholar House offers, according to Rowe. “Further, we assist with childcare, which is important for nursing students who have classes in addition to hours in the hospital for clinical experience. We connect participants with tutors, as necessary, and internship/networking opportunities through our strong network of health care supporters and board members in the field.”
Gilmore joined Family Scholar House as a high school senior. “My guidance counselor informed me about this program,” she says. “It was called ‘Project Women’ back then. Same program, but only 16 women.”
Since its beginning in 1995, Project Women has grown into the current Family Scholar House. The originally all-female student body now includes single fathers.
Gilmore praised the support system at Family Scholar House. “It’s people working for people,” she says.
Welfare remains a heated topic, with activists for and against government entitlements stating their opinions, loudly, on the nightly news. For Nia Gilmore and Ruth Aina, whether the government has a safety net or not isn’t about abstract theory in a book or slogans for taxpayers. It’s about feeding their children and eventually standing on hard ground, so they can contribute to the vital field of nursing.
As Nia Gilmore points out, single moms—in and out of the public-assistance system—should focus on why their nursing education matters. She knows why her degree matters.
“I didn’t want to become a statistic.”
Behlor Santi is a freelance writer based in New York City.
When new moms lack financial resources, caring for a baby is more challenging. A desire to empower these first-time, low-income mothers attracted Noelia Blanco to the Nurse-Family Partnership (NFP) over a dozen years ago. And there is nowhere else this registered nurse would rather be.
“I stayed with it because NFP works,” says Blanco, a NFP nurse home visitor in Philadelphia. “I’m privileged to be a part of it.”
Public health nurses like Blanco are the backbone of a national program spotlighted for providing measurable differences in the lives of new mothers and their children. The program’s main goals include a healthy pregnancy, better child health, and improved parenting skills. Nurses conduct home visits with women from early on during their pregnancy until the child turns 2 years old. They provide expectant and new mothers guidance and education on a number of topics, such as positive prenatal practices, nonviolent child-raising techniques, and life coaching. Nurses also help mothers find jobs and obtain other resources.
Nearly 40 years old, NFP’s evidence-based outcomes include improved health and development of children, better school readiness, and increased maternal employment. In short, NFP, now in 43 states, has a track record for helping parents change their lives and the lives of their children.
Nurses help parents achieve a positive life course by developing long-term relationships and serving as mentors. In-home visits for the voluntary program are key to getting to know the mothers.
“It’s a different story when you work in the community,” says Blanco. “When you are in the home, you get a very comprehensive picture of the client. You know if they have heat, if they have electricity or food. It’s a whole different world.”
Nurses visit weekly, or every other week, until the child turns 21 months, and then scale back the visits to monthly checkups.
New parents are not the only people getting an education. “It has taught me to never give up on someone,” says Blanco. “I’ve always been an optimistic person, but I have seen these clients go through some real tragedies and succeed. I just love the program!”
She’s not alone.
Working with NFP is “one of the most validating and rewarding experiences in my nursing experience, which is why 13 years later I’m still involved with the model,” says Sara Eldridge of Philadelphia, who worked as a NFP nurse home visitor for five years, and then as a NFP nurse supervisor for five years.
“As I became more culturally responsive, it was just validating to see the relationship with the client develop for two and a half years and see the powerful outcomes. It is personally and professionally rewarding. It changed me,” says Eldridge, who now works for the NFP National Service Office as a nurse consultant providing support to NFP agencies in Florida, Georgia, Tennessee, Alabama, Virginia, and the Virgin Islands. A commitment to the evidence-based model, as well as flexibility, autonomy, and continuing education, attracts maternal and child health nurses to the program, she explains.
A public health nurse for 18 years, Maria Solomon joined NFP in Fairfax County, Virginia, several months ago, in part because of its proven results. “You know the outcomes will be good. And I feel I am supported,” she says. “They want feedback and they always want to improve the program, and that is very appealing.”
She is also thrilled to have an opportunity “to do what I love—and that is building relationships with people and helping them. . . while giving them the tools they need to become better parents. As the adage goes, ‘if you love your job, you will never work a day in your life.’ That’s how I feel about this job.”
After 18 years, Solomon is still learning and growing. The home visits provide many lessons.
“You go into someone’s house and it really humbles you. You learn to respect people more. I thought I did, but I think I do more now. The things that we learn and the skills that we gain, and the training we had, doing motivational interviewing—those sort of things make you a better nurse, and they also make you a better person because you are actually putting yourself in your client’s position. You are on their side. You are not poking your finger and telling them what to do, you are guiding them,” explains Solomon.
“I think a lot of women who are in this program want the best for their children, and that is such a force in itself. And if that becomes the starting point—that ‘I want this for my child’—then it’s amazing what you can do and where you can go. You go along this journey with someone. As far as changing me as a nurse, it’s very challenging, but it’s challenging in such a good way because I learn something new every day.”
The NFP program in Virginia began in June 2013, says Laura Suzuki, maternal child health coordinator for the Fairfax County Health Department, who oversees the state’s program and was involved in bringing it to Virginia.
Fairfax County is one of three locations in Virginia to start the program within the past 18 months. “The Affordable Care Act created the Maternal, Infant, and Early Childhood Home Visiting Program, and the money for many of these programs has come out of this pot of money and has enabled a lot of areas to expand their home visiting services,” says Suzuki. “So we were able to pursue that through our state.”
Three other states to recently implement NFP are Idaho, Montana, and Kansas.
Testing of the program in a randomized, controlled trial began in 1977 and was replicated in 1996. NFP’s strength has been its emphasis on the client-nurse relationship.
“The nurse role has been enhanced [over the years], but it has always been a therapeutic one-on-one client relationship that contributes to the outcomes,” says Eldridge. “It’s the powerful nature of what we do.”
Among the enhancements that will be rolled out in more states this year is a parent-child interaction tool—the Dyadic Assessment of Naturalistic Caregiver-child Experiences (DANCE)—that will enable nurses to observe areas of strength and growth. “The great things about the tool is the integration with other things we use, including educational materials,” says Eldridge. Training for NFP agencies to implement DANCE began in 2012 and will continue throughout this year.
What will remain unchanged is the commitment of nurses to their clients and their ability to gain trust, says Blanco.
“They know they can depend on us and we believe in them. Some of their family members are not their biggest fans, and they don’t have the support. If you have one person’s support, it can go such a long way. I’ve seen it over and over.”
Robin Farmer is a freelance writer based in Virginia.
As a critical care nurse, I am often confronted with difficult situations and sometimes placed in compromising ethical predicaments. It is a constant struggle to ensure the safety of the patient while respecting the wishes of the ordering physician. Over the years, I have cared for many patients and had memorable moments that have forced me to evaluate my moral reasoning and ethical standards as a nurse, but there was one particular patient who made a lasting impression on my values and ethical beliefs as a health care provider.
After an already hectic day in the Intensive Care Unit (ICU), it was around 5:00 p.m. when we were put on notice that a patient was being transferred to the ICU from the floor. The details of the transfer at that time were very vague. Moments later, the phone rang and it was the transferring unit calling with the report. The patient was a 56-year-old male who was originally being treated for complications associated with a brain tumor. Scans revealed that the patient’s cancer had metastasized to several areas throughout his body. During the course of his treatment, he underwent several surgical procedures, including a tracheotomy due to prolonged intubation. Overall, the patient’s prognosis was poor and his hospital stay was arduous. The patient experienced residual neurological deficits and was currently unresponsive to external stimuli.
Despite best efforts, the primary neurology team was unable to fight the inevitable and the patient’s future appeared bleak. In an attempt to preserve the patient’s quality of life, the team discussed end-of-life wishes with the family. The option of providing the patient with Comfort Measures Only (CMO) was included in the discussion. The reporting nurse confirmed that the family finally agreed to the CMO and Do Not Resuscitate (DNR) orders, and the patient was treated accordingly. The palliative care team was consulted, and the patient was transferred to the palliative care suite for family privacy and comfort.
At this point in the report, it had become unclear as to why the patient was now requiring an escalation in care to the ICU. As the nurse began to reveal the details of the situation, my confusion turned into shock and amazement. The patient, who had been placed on CMO approximately 12 hours prior, was now a full code. The patient’s family rescinded the CMO and DNR order after 12 hours. The reporting nurse described that one of the attending surgeons was not comfortable with the events that transpired. The attending physician discussed his concerns and hopefulness for the patient to recover with the family. In fact, the physician felt so strongly about his beliefs that his enthusiasm was spread to the patient’s family and they ultimately changed their minds regarding CMO/DNR status. The orders were rescinded and the patient was made a full code.
The patient emergently arrived to the ICU with full medical support at his bedside. The respiratory therapist was bagging the patient via the tracheostomy tube, while we quickly placed him on telemetry monitoring. The patient’s oxygen saturation was only 65% on the monitor, and he was quickly connected to the ventilator and placed on 100% FiO2. His skin was cool to touch and ashen grey. His body lay frail and flaccid in the hospital bed. After placing him on the ventilator, there was little to no improvement in the patient’s oxygenation status, which remained 50% to 60% on the monitor. The consulting ICU team was immediately notified of the patient’s arrival.
The additional nurses in the room were helping to draw lab work and perform other ancillary duties. All of a sudden, the deafening alarms of the monitor started to radiate throughout the room and a once recognizable heart rhythm had transitioned to a bradyarrhythmia and then asystole. A code blue was announced overhead and chest compressions were immediately initiated. During chest compressions, every thrust of the patient’s chest felt like ribs breaking underneath my hands. Advanced Cardiovascular Life Support (ACLS) resuscitation was already in progress by the time the code blue medical team arrived at the bedside. The coronary care unit resident led the code and we went through the ACLS algorithms accordingly. The pulmonary critical care resident was at the bedside as well. After a few rounds of chest compressions and medications, the patient had a recognizable heart rhythm, but we soon noticed inflation to the patient’s chest cavity. The team suspected subcutaneous air from a pneumothorax. The pulmonary critical care resident requested setup for a chest tube placement and a right pleural chest tube was inserted and secured. Some relief of the subcutaneous air was appreciated.
Unfortunately, return of the patient’s rhythm was short-lived, because the team and I could no longer palpate a pulse and the patient was in pulseless electrical activity. Chest compressions and resuscitation were restarted. Throughout all the commotion and the events that were occurring, I kept asking myself: “Are we doing the right thing for this patient?” I noticed the chaplain in the doorway and asked him to please locate the family as soon as possible. Luckily, the family was waiting just outside the ICU doors. I asked one of the physicians in the room to discuss the patient’s condition with the family. I took a moment and looked up from the patient and observed a woman with a worrisome look on her face. I already knew who she was, and by the look on her face I could tell that this was not what she wanted for her husband. Shortly after, one of the physicians returned to the room and made the announcement that after this round of ACLS, if no response, we would call it per family request. Thus, with no return of circulation and asystole on the monitor, the patient was pronounced deceased. The chaplain was called into the room with the family and they were allowed to spend private time with their loved one.
Upon reflection of this patient’s case, I had many mixed emotions about the course of events, which ultimately determined the patient’s final transition period. The decision to make a patient a CMO/DNR is not one that is made lightly. It is one of the hardest decisions family members have to make for their loved one. In my opinion, it is a selfless act to ensure their loved one’s final hours are spent peacefully and without additional pain and suffering. The events that occurred on this memorable evening taught me a great lesson about being morally courageous.
I once read a very powerful article written by author Colonel John S. Murray, who defined morally courageous individuals as being “prepared to face tough decisions and confront the uncertainties associated with their resolve to do the right thing despite the consequences they may face.” He further stated that moral courage “requires a steadfast commitment to fundamental ethical principles despite potential risks.” I hope to continue to build a nursing career that encompasses these principles and upholds a strong moral standard. I have made the commitment to my patients to do what is in my power to protect them and protect their wishes.
Candilla Davis, RN, BSN, CCRN, has been a nurse for almost nine years and is currently employed as a critical care nurse at Tampa General Hospital.
Depending on where they work and their specialties, nurses can earn a range of salaries. Salaries continue to appear to vary by ethnic background as well, but overall, nurses reported in the second annual Minority Nurse salary survey making more this year than they did last year—and more than they did five years ago.
Although nurses reported making higher salaries this year than they reported last year, there are wage gaps by ethnicity that remain to be closed.
In 2013, nurses reported making a median salary of $67,000; this year, they reported earning a bit more, a median $68,000. Still, African American nurses earned a median $60,200 and Hispanic nurses received a median $60,000, while white nurses took home a median $72,000.
To gather all this data, Minority Nurse and Springer Publishing e-mailed a link to an online survey that asked respondents about their jobs, educational backgrounds, and more to better understand their roles as nurses and to determine their current and past salaries.
Some 4,850 nurses from all over the United States responded to the survey questions. The respondents also hailed from a number of specialties, including nurses working in critical care, as certified nurse educators, and in pediatrics, as well as nurses employed at public hospitals, private hospitals, and at colleges or universities.
Some stark differences, though, were noticeable when survey data were broken down by ethnicity. For instance, nurses belonging to different ethnic groups working at similar institutions reported earning different amounts of money. African American nurses working at a public hospital reported earning a median $65,000, as did Asian nurses. Hispanic nurses reported making less, taking home a median $60,000. White nurses, though, said they earned $79,500.
Additionally, nurses belonging to different ethnic groups with similar educational backgrounds also reported salary differences. African American nurses with a bachelor’s degree reported making a median $62,000—similar to the median $60,000 reported by Hispanic nurses—though higher than the median $50,000 received by Asian nurses, but lower than the median $70,000 that white nurses said they made.
At the master’s degree level, the picture is a little different. Asian nurses with master’s degrees commanded the highest salary, a median $80,000, followed by African American nurses, who received a median $76,000. Hispanic nurses, meanwhile, earned a median $74,940, and white nurses with a master’s degree reported making a median $73,000.
Overall, respondents reported earning a higher salary this year than they took home last year and a bit more than they reported earning five years ago. For example, nurses working primarily in patient care reported earning $60,000 this year, $55,000 last year, and $47,000 five years ago, and advanced practice nurses reported making $89,000 this year, $84,000 last year, and $78,000 five years ago.
Though there are still wage gaps to be bridged, nurses reported earning more now than they did just a few years ago.
Highlights
17.6% of respondents have a PhD or other doctoral-level degree
33.3% work at a college or university
56.2% have been at their current job for five years or longer
65.8% received a raise within the last year
53.5% left their prior job to pursue a better opportunity
41.1% do not expect a raise this year
48.9% are looking to leave their current job in coming years
The International Dyslexia Association describes dyslexia as “a specific learning disability that is neurological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities.” Dyslexia is a condition that does not change in one’s lifetime.
I knew I had dyslexia when I applied to nursing school in 2007. About a decade prior, I received the diagnosis of dyslexia during my unsuccessful attempt to get into graduate school. At age 43, with a daughter in middle school and a supportive husband, I was willing to try a career change again. I succeeded in my prerequisites courses, receiving A’s in Chemistry and Microbiology and a B in Anatomy and Physiology. I thought somehow maybe I “outgrew” being dyslexic. I really knew nothing about what dyslexia was. I knew learning to read was really hard and I got pulled out of reading groups in fourth grade, but I still don’t know very much about it. I knew I did not want reading differently to stop me. I still have so much to learn.
My first try at nursing school was in an accelerated nursing program. The documentation stating my dyslexia diagnosis was more than 10 years old. I attended a community college to complete my prerequisites. The community college was able to accept the documents I had and explained that a university would require updated documentation confirming the condition. To get retested and get current documents would cost approximately $600 to $1,000—an added burden to the cost of tuition and books.
Accommodations for my dyslexia during the accelerated program could not be available because of the outdated status of my documents. Nevertheless, I felt elated because my grades from my prerequisites were high. Fifteen weeks into the accelerated program, I “washed out” and voluntarily withdrew. But, I had a plan. I got retested and got the updated documentation. I also became a Certified Nursing Assistant (CNA). In seven months, I got the call inviting me to join the traditional Bachelor of Science in Nursing (BSN) program. I literally cried with joy. I had another chance.
The tests to assess learning disabilities are not difficult. There were four one-hour sessions, including tests—some written, some verbal, and one involving making shapes with blocks. One test measured my reading speed. I was instructed when to start and, at different times, I was asked to point to where in the article I had read to in the given time. Once the allotted time was completed, I was asked a series of questions to test my comprehension.
Soon after completion of the testing, I enrolled in CNA training. Becoming a CNA significantly contributed to my understanding of many principles I had learned in lecture on the fundamentals of patient care. As a CNA, I was able to learn at the bedside while developing relationships with patients and practicing the skills from both lab and clinicals. Nineteen days after finishing CNA training, I was employed at the location where we completed our clinicals. Having a job as a CNA provided me with the opportunity to make real the theory I had learned in class. The opportunity to work next to real nurses let me watch the lessons you cannot learn through books. My confidence grew as my dedication to complete the BSN degree cemented. Once I returned to the classroom as a student nurse, I was wholly committed to completing the program.
Being back in class gave me the opportunity to fulfill my dream of being a nurse while receiving a variety of accommodations for dyslexia:
Transparencies: Color transparencies over a printed page, which function like sunglasses on a sunny day. The distortion is minimized. This simple fix considerably reduces the strain from reading.
Kerzweil Text-to-Speech Reader: A computer program that changes text into audio. All the computers on campus can utilize Kerzweil, so I bring earphones in order to listen to my tests or texts.
Testing Center: All of my test taking is completed in the test center. An appointment with the test center is scheduled four days prior to each exam. To limit distractions and noise, I test in a room alone.
Time-and-a-Half: My test appointment time is 1.5 times the allotted time in the classroom. So, I go to the testing center early, usually 7:30 a.m. for an 8:00 a.m. test. Rarely do I need the extra time, but the benefit is not having to worry that I might run out of time near the end of the exam. This reassurance really makes a difference, especially when I go back to recheck answers.
There are many parts when I take an exam—it resembles conducting an orchestra. All of the material requires management to maximize my comprehension of the technical questions being asked. There are inputs from four tests simultaneously, so I can receive the information efficiently. There is one test in front of me that I manually mark up, which is covered with a color transparency. This paper test is returned to my instructor. It is a back-up in case there is a computer malfunction.
There are also two tests on the computer. One of the tests on the computer is in the Kerzweil program. This program reads the test to me so I can hear it in my earphones. Kerzweil highlights each sentence in yellow as it is being spoken and each word in that sentence is highlighted in pink.
The second version of the test on the computer is the one that I must complete and submit to the instructor for grading. The final version of the test is the audio in the Kerzweil program. Most of my classmates don’t notice that I am out of class during tests. Usually, when I explain I have a learning disability, the first reaction I get is disbelief since I always participate in class discussions.
It is best for me to prepare for lecture prior to class time. I ask many questions as the material comes up in lecture. To classmates, it might appear that I am really enthusiastic—which I am—but I don’t really have many other options. If I can’t understand a concept from the book, it is easiest to ask during lecture. I am always the most surprised when I get high grades on exams.
During the summer of 2010 between my junior and senior years, I enjoyed participating in an externship. This consisted of fifteen 12-hour shifts, during which I followed a preceptor on the telemetry floor at a major medical center. This externship provided many opportunities for verbal questions and answers—my preferred learning style. My preceptor was incredible. She was open to learn about my learning needs, and we discussed possible precautions to take in order to maximize my performance on the floor.
According to my preceptor, there was no evidence of disability in my performance. I did use a color transparency when there was a lot of material to read and comprehend, but that was the only accommodation I used on the floor. The transparency was also a folder that held materials that I needed, so it blended in discreetly.
Despite research articles in the medical literature raising skepticism about nurses and nursing students with dyslexia, most articles call for the need for more research. There are laws that prohibit discrimination against individuals with disabilities, but application of these laws to nursing students and new nurses with dyslexia is an area that appears vacant. I have not found another group of student nurses that is directly being targeted in this way.
The United Kingdom leads the way in accommodating the needs of dyslexic students. England has a complete, published protocol that details how to best maximize the learning abilities of dyslexic student nurses while ensuring the safety for all. The idea of whether dyslexic student nurses should be allowed to practice in the United Kingdom is never questioned.
Unable to locate a voice from the perspective of dyslexic student nurses, I founded Nursing Students with Dyslexia (NSwD) on www.NursesLounge.com, which is a social networking site geared specifically to nurses and student nurses. Students are able to join NSwD directly at http://community.nurseslounge.com/join/nswd. This page includes research available on assisting student nurses with dyslexia, along with resources and scholarship opportunities.
Someday, I hope to develop a scholarship that encourages student nurses with dyslexia to network together. Maybe by sharing our stories of success we can offer greater insights into the challenges that dyslexic student nurses must overcome. Nursing education is expanding its understanding of how to provide the most successful learning experience for students, including student nurses with dyslexia. I am proud and honored to be a voice as a student nurse who is not letting a disability define or limit me.
