From Minority Nurse to Nurse Practitioner

From Minority Nurse to Nurse Practitioner

Amen Eguakun, MSN, RN, FNP, considers himself blessed. Working at a church-sponsored clinic in Nashville, he provides primary care to minority and disadvantaged patients battling HIV and AIDS. He works independently and can devote as much time as he needs to each of his patients.

Eguakun credits it all to three coveted initials: FNP (family nurse practitioner). “If I were still a registered nurse, I could not be doing this,” he says. “Becoming a nurse practitioner gave me [advanced] training and expanded my knowledge of medical treatment. Now, I can combine that with the skills I had as a nurse.”

Today, many other nurses are choosing to become nurse practitioners. According to the American Academy of Nurse Practitioners (AANP), there are more than 106,000 NPs in the United States. This represents a threefold increase since 1990. Even with this growth in numbers, NPs are in demand in virtually every part of the country.

Nurse practitioners perform many functions usually associated with physicians. They diagnose illnesses by performing physical exams and by ordering needed lab tests or other diagnostic tools. They also prescribe treatment. This often includes writing prescriptions for medicine as well as ordering treatments like physical or occupational therapy. Because NPs are able to provide basic primary care, some minority health experts believe that increasing the number of minority nurse practitioners could make a major difference in the war against racial and ethnic health disparities.

What nurse practitioners do is regulated by state laws, so their responsibilities can vary depending on their geographic location. Health care facilities further define what nurse practitioners do within their organizations, which means the functions NPs perform can also vary from one hospital, physician’s office or other practice setting to another. While nurse practitioners typically hold a graduate degree, a few states allow them to practice without one, but only after completing one or two years of intensive training.

Why Become a Nurse Practitioner?

Many nurses who decide to continue their education and pursue a nurse practitioner license cite such benefits as higher salaries, expanded job opportunities and increased job security. Those are certainly very valid reasons for becoming an NP, but many practitioners say the real benefits are intangible.

“My job as a nurse practitioner is rewarding financially,” says Eguakun. “But spiritually, I’m a millionaire because I have the opportunity to make a real difference.”

Eguakun, a native of Nigeria who is now a U.S. citizen, began to dream about becoming a nurse practitioner while working in a hospital as an RN. “Most of the ailments we were dealing with were expensive to treat,” he recalls. “I realized that I could do more if I was involved in primary care and could prevent people from going to the hospital. If more people were involved in preventive care, maybe we would not have to spend so much time and money on hospital care.”

He also realized that minorities, particularly those with HIV and AIDS, often have a very difficult time getting primary care. “In the hospital, I saw many African Americans with HIV and AIDS. They were dying. I learned that everything has to do with prevention,” he says.

Now, as an FNP, Eguakun has the time and the authority to treat the entire patient. Many of his patients like to refer to him as a doctor, but he quickly corrects them. He is proud to be a nurse practitioner and declares, “I want my profession to get the credit.”

Of his work at the First Response Clinic, he says: “We take care of patients with HIV and AIDS, but we also provide primary care. This population is very hard to reach. We want to give them all the treatment they need in one location. That relieves some of the patients’ problems in accessing care, like getting from one clinic to another.” He has even visited patients at home when they couldn’t make it to the clinic.

First Response Clinic, operated by the Metropolitan Interdenominational Church, receives federal funding but is operated solely by the church. Eguakun believes that gives him a better chance of reaching many patients, providing treatment for those afflicted with HIV/AIDS and helping those who are still healthy avoid the deadly disease.

“In the Southeast, religion and the church are big factors in people’s lives,” he explains. “The religious community has also been seen as a problem in reducing the occurrence of HIV in minorities, because the issue is not discussed in churches. [The church that runs our clinic] is actually in the forefront of disseminating information about preventing the disease.”

That close relationship with patients is what drives many nurse practitioners, according to Kenneth Miller, PhD, RN, CFNP, FAAN, president-elect of the American College of Nurse Practitioners (ACNP) and professor and associate dean for research and clinical scholarship at the University of New Mexico Health Sciences Center, College of Nursing.

“The biggest reward is having the time to do what we were educated to do: talk to patients about disease prevention and health maintenance,” he says. “Most physicians don’t have the time to do that. [Compared to doctors], we do a lot more education and discussion with patients.”

Welcoming Diversity

Here are a few quick facts about nurse practitioners from the AANP: The average annual salary of full-time practitioners is $73,620. Nearly half of the country’s NPs (41%) specialize in family medical care, 19.5% specialize in adult care, 11% in women’s health and another 11% in pediatrics.

Miller also expects rapid growth in two other specialty areas: acute care and gerontology. “The hottest specialty right now is acute care. Residents have a limited number of hours to work in the hospital and someone has to pick up that slack. There’s a demand for acute care nurse practitioners all over the country.

“The group we really need to start focusing on for the future is geriatric patients,” he continues. “Nurse practitioners can provide the type of care that senior citizens are going to need.”

Over 95% of nurse practitioners are female, although high-profile male NPs like Miller hope to draw more men to the field. The NP profession is also very open to racial and ethnic minorities. According to the most recent National Sample Survey of Registered Nurses, published by the Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing, approximately 11% of nurse practitioners are nurses of color–and that figure is expected to increase.

“All of the programs [that train practitioners] are trying to recruit more minorities,” Miller comments. “Here [at the University of New Mexico], we are trying to make sure that the composition of our class meets the cultural diversity of the state where we live. [NP] programs want to make sure there is equity in terms of the composition of classes that are admitted so that our practitioners can better serve the minority populations.”

Eguakun says he’s never felt that his race or gender were obstacles in becoming or practicing as a nurse practitioner. “I actually saw it as a plus,” he maintains. “I was working as the sole nurse practitioner at a clinic in a housing development. Some people argued that we might lose women coming in for Pap tests because I was a man, but the number actually increased.”

 

An Innovative Approach to Developing Minority Nurse Practitioners

While many nurse practitioner training programs around the country are working hard to increase the racial and ethnic diversity of their student populations, one innovative program in Southern California already has an unusually high success rate when it comes to recruitment and retention of minority students. More than 50% of the students in the Women’s Health Care Nurse Practitioner Program (WHCNPP) at the Harbor-UCLA Medical Center in Torrance, Calif., are students of color.

“Out of the 12 people in the class that’s enrolled now, two are African American and four are Hispanic. The previous class had three Hispanic students, two Asian and Pacific Islander students and one Native American student,” says Susan Stemmler, MSN, MPH, FNP, CNM, the program’s acting director of education. According to Stemmler, the program doesn’t have a magic recipe for attracting students of color, although the diversity of its faculty could be a contributing factor. Stemmler is Native American; the faculty also includes African American and Filipino instructors.

Another unusual feature of the WHCNPP is that it is a certificate program for RNs, not a degree-granting program. The program has affiliations with several local universities that enable the NP students to earn academic credit toward their next degree, and many do go on to pursue a BSN or MSN after earning their certificates. The program is accredited by the National Association of Nurse Practitioners in Women’s Health and is approved by the California Board of Registered Nursing as a provider of advanced practice nursing education.

WHCNPP is one of only a handful of certificate programs still operating in the United States. When it began in 1970, it was the first women’s health care nurse practitioner training program, with a focus on training mid-level providers to work in rural areas, Latin American countries and other medically underserved places where there was little or no health care available.

Five classes a year complete the intense nine-month program, which is offered through the Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center. Until 2006, graduates of the program can take the state’s NP licensure exam. After 2006, however, California law will require nurse practitioners to have a graduate degree.

But that won’t mean the end of the Women’s Health Care Nurse Practitioner Program. The program has developed articulation agreements with its university partners that will enable students to bridge into master’s degree programs. Also, says Stemmler, some of the nurses in the WHCNPP are international students who go back to their home countries to practice after receiving their certificates.

“What we offer is a depth of knowledge in women’s health care,” she adds. “This program is a good step for our students, but this isn’t the end for them. It’s only part of the journey. Education keeps going and it’s never done.” More information about this program is available at www.womenshealthnp.org.

 

 

For More Information
  • The American Academy of Nurse Practitioners
    www.aanp.org
  • The American College of Nurse Practitioners
    www.nurse.org/acnp
  • The National Association of Pediatric Nurse Practitioners
    www.napnap.org
  • The National Conference of Gerontological Nurse Practitioners
    www.ncgnp.org
  • The National Association of Nurse Practitioners in Women’s Health
    www.npwh.org

He has also found that being an African American male gives him the opportunity to build relationships and trust with other black men. “The majority of women are wonderful about seeking health care, but men do not seek it,” he says. “I can reach out to young males and talk to them about getting medical care.” He spends one day a month walking around housing projects, passing out condoms and business cards and connecting to young men in the community.

Choosing an NP Program

So you’ve decided that an advanced practice career as a nurse practitioner is right for you. Where do you go from here? If you’re already an RN, your first step will most likely be to go back to school and earn a graduate degree.

Some experts estimate that at least 50 new nurse practitioner training programs have opened since 1995. They range from intensive, on-site full-time programs to accelerated “fast-track” programs to those offered entirely online through distance education. Before you decide which program to apply to, first think about your passions and then imagine what you want your life to be like after your training.

“It’s always good to work as an RN for a few years,” Eguakun advises. “That will guide you to what you like and don’t like and can help you decide on a specialty. In my case, I knew I wanted to work with disadvantaged populations and HIV/AIDS. My training, everything I did, was geared toward that. The preceptorships that I did were designed to reflect my needs and my goals.”

Once Eguakun was in graduate school, faculty members looked at his goals and introduced him to people who still serve as mentors, providing advice and information on new developments in his field. “Those relationships become very important,” he emphasizes. “The individuals you’ll meet have been in the field. They’ll continue to guide you and expose you to new resources. Plus, you’ll learn how to be a mentor to the next generation of minority nurse practitioners, and that’s very important.”

Miller recommends that nurses who are considering becoming practitioners first spend a couple of days shadowing a working NP. “You have to understand the role nurse practitioners play,” he explains. “The best way to do that is to spend two or three days with a nurse practitioner, just to get a feel for whether this is something you want to do.”

He also reminds would-be NPs that graduate school will be very different from their undergraduate nursing education. “The most difficult thing in terms of becoming a family nurse practitioner is having to think outside the box,” he says. “Many nurses have been educated in a disease mode. They learn about a disease and then they look for signs and symptoms. Nurse practitioners look at the total picture, using the patient’s history and physical condition.”

While all nurses are involved to some extent in diagnosis, NPs are able to diagnose and prescribe treatment independently because of their advanced education, Miller explains. “Graduate programs that train nurse practitioners are two years in length and have 600 to 1,000 more clinical hours beyond the bachelor’s degree,” he says. “Nurse practitioners have advanced skills. They function at a level that allows them to practice independently and they’re able to make more decisions about what is best for the patient.”

Finding the Right Practice Setting

Once you’ve completed your educational and clinical practice requirements and become licensed as a nurse practitioner, your next decision is choosing where you want to practice. NPs can work in a wide variety of practice settings, including hospitals, clinics, physician’s offices, public health departments, HMOs, home health care agencies, hospices, private practice and more. Once again, it’s important to think about what your needs and goals are in order to choose the setting that’s the right fit for you.

“In some offices, nurse practitioners see patients every 10 minutes. You need more time than that to do a good job of diagnosing and treating a patient,” Miller says.

On the other hand, some NPs are able to find workable solutions for providing effective care despite these tight time constraints. Miller says he knows a nurse practitioner who walks into a patient’s room with two assistants. As she’s examining the patient, one assistant is writing down her notes. The other follows through on her treatment plan. “When she leaves the room, she’s finished with that patient,” Miller explains.

But if spending only 10 minutes with a patient isn’t your style, be careful in selecting your first job after adding “NP” to your signature. “When you get out of school, don’t just settle for any job,” Eguakun cautions. “Find a practice group where you really want to work.”

He warns future NPs to do their homework about a practice or health care facility before accepting a position there. “How a nurse practitioner practices depends on the philosophy of the organization,” he says. “If you are in a private practice as an NP, your paycheck may be based on how many patients you see. There’s pressure to get patients in and out quickly.”

Organizational policies can also influence the amount of independence an NP has, Eguakun adds. “I worked in a hospital setting after I graduated. I was a nurse practitioner, but the physician had to see everything [I did] and sign off on every prescription. It wasn’t productive and I knew it wouldn’t work for me. I wanted to have a physician who saw me as a collaborator. I wanted to have some independence and control over what I did.

“Now, the physician I work with is a collaborator. We are a team and we act as a team. He’s accessible to me 24 hours a day.”

Recruiting and Retaining Minority Nursing Faculty

Recruiting and Retaining Minority Nursing Faculty

When Dr. Margaret Moss, RN, earned her doctorate in nursing science from the University of Texas Health Science Center at Houston, she became part of a very small and select group: minority nurses who hold terminal degrees.

Moss is one of only 14 American Indian nurses in the entire country who hold doctoral degrees and the numbers for other minority groups aren’t much better. These statistics mean that nursing programs looking to increase the diversity of their faculty face keen competition for professors like Moss. With such a small pool of qualified candidates to draw from, nursing schools that hope to recruit minority and male faculty–and even more importantly, to retain them–must be active, committed and, above all, sincere.

According to the minority nursing professors interviewed for this article, the number one rule faculty search committees should keep in mind is: Hire for ability, not color or gender. In fact, they caution, focusing your search activities on ethnicity or gender alone will drive away minority applicants instead of attracting them.

“Show an interest in the person’s knowledge rather than just the color of their skin,” advises Moss, an assistant professor at the University of Minnesota School of Nursing in Minneapolis. She stresses the importance of being familiar with the candidate’s accomplishments, experience and expertise and being able to discuss them intelligently. If a candidate gets the impression that you only want him or her because of race or gender, don’t expect a “yes” to your offer.

“People can see right through that and they won’t accept it,” Moss says.

Kevin Mallinson, RN, PhD, AACRN, an assistant professor at Georgetown University in Washington, D.C., agrees. “If a school wants to attract male faculty members, for me that would mean they wouldn’t make an issue out of the fact that I’m male,” he argues. “I don’t want a search committee saying, ‘we really want a man here.’”

Mallinson joined the faculty at Georgetown in August 2003. The fact that he was a man was not an issue in the recruiting process, he says. But that hasn’t always been the case. He recalls sitting in on a meeting at another nursing school where the program’s recruiting success was measured solely on the number of men and people of color who were hired as faculty members.

Instead of demonstrating that the institution values diversity, comments like that undervalue the contributions of the minority faculty recruited, Mallinson believes. “It made us feel as though we weren’t recruited because we were great researchers or because of our teaching background,” he says. “We were only recruited for our color or gender.”

The Comfort Factor

While you don’t want to make candidates feel that having X number of minority or male professors is of paramount importance to your program, you do want them to feel comfortable about joining your faculty. For many minority professors, that means not being one-of-a-kind.

“In all the nursing programs I had been in as a professor or a student, I had never encountered an American Indian faculty member,” Moss recalls. The fact that the University of Minnesota had two other Native nurses on the faculty drew her to the campus.

Even though she herself is Caucasian, Sandra Edwardson, RN, PhD, dean of the University of Minnesota School of Nursing, realizes the importance of helping new minority faculty members establish cultural connections so that they don’t feel like they’re alone in a crowd. “I know it’s a pretty lonely existence to be the only person of your race at a school,” she explains.

 

Suggestions from the NLN

The National League for Nursing’s Task Group on Recruitment and Retention of Students has been charged with developing guidelines for recruiting and maintaining a diverse student population in nursing. While the Task Group is not yet ready to release formal guidelines, Chief Program Officer Theresa M. Valiga, RN, EdD, FAAN, notes that one key factor in attracting more minority and male students to nursing schools is the presence of a diverse faculty population. She offers these suggestions for recruiting and retaining minority nursing faculty:

1. Make sure there is a commitment on the part of the university to provide adequate support (time, money, staff) for the recruitment process.

2. Develop a recruitment communications package containing information about the university’s minority community, including statistics on the number of minority students and information about area housing, churches and schools.

3. Develop and include information on employment opportunities for spouses.

4. Share information and schedules for local minority cultural events and festivals that would be of interest to the targeted minority population(s).

5. Form an advisory board composed of members of the minority groups being recruited.

6. Establish an environment of open communication among administrators and other faculty. A forum in which minority faculty can interact with each other can also provide an avenue of acceptance.

7. Provide mentors, both internal and external, for recruited minority faculty members.

8. Help faculty and staff recognize and embrace cultural differences.

At her program, Edwardson encourages faculty search committees to be creative in linking minority candidates to the community off-campus. “Here in Minnesota, we have an uphill battle in trying to recruit faculty of color, particularly if they’re coming from warm southern climates,” she says. “In addition to linking them with individuals on campus, we try to make sure they have some social time during the recruiting process to spend with representatives of the local minority community of which they may become a part. That way, they understand what it’s like to live in this northern, homogeneous city. That’s a strategy that has worked fairly well for us.”

Edwardson also encourages other deans at the university to make plans that will help new minority faculty members connect easily with other people of their race, ethnicity or gender on campus, regardless of what academic department they’re affiliated with.

“Another strategy to deal with the potential isolation is to bring together minority students and faculty with other people of color here in the academic health center and even the university at large,” she notes. “They may not be in the same discipline, but they can still share their problems and successes. It’s a good way for mentoring to happen.”

Target Your Marketing Plan

Diane Oates, president of Academic Diversity Search, Inc., a Webster, N.Y.-based firm that specializes in connecting minority candidates with academic institutions, has one word of advice for majority nursing schools that hope to attract minority faculty members: talk. Talk to minority nursing associations often. Talk about your program, your current faculty and their accomplishments, and your plans for the future.

“The most important thing that universities can do is make sure they are talking to the audiences they want to reach,” she advises. “You’ve got to work to get the word out to the right audience.”

That means advertising in journals and publications that are read by minority nursing faculty and graduate students, Oates says. It also means getting out of your office and seizing opportunities to meet potential candidates face-to-face at nursing conferences and meetings.

The search for qualified minority faculty members should go on even when you don’t have an open position, she adds. “You’ve got to be looking constantly. Talk to everybody you can about your program.”

Be honest if you’re not currently looking for faculty, but be open to planting seeds of interest that could pay off in the future. The young minority or male master’s candidate you meet at next weekend’s conference could be the country’s leading pediatric nursing researcher 10 years from now.

Fill your Rolodex with the names of potential candidates and keep in contact with those you meet. It may be just passing along an article of interest or sharing news about a grant opportunity. When the time comes for you to fill a position, tap into that network and let your contacts of all races know about an opening.

As a founder of the Association of Black Nursing Faculty, Sallie Tucker-Allen, RN, PhD, FAAN, has seen this networking approach work many times in that organization. “If positions are open, we spread the word [to our members],” she says. That’s advertising you can’t buy.

Improving Your Image

Nursing is a small world, and news–both good and bad–travels quickly. If your attempts to attract a more diverse faculty through networking and advertising aren’t working, perhaps your institution has a bad reputation for not being welcoming to minority faculty in the past. Recruiting minority and male faculty will be particularly difficult if the school has had an all-white or all-female teaching force for years, or if it’s perceived as being too large and impersonal.

Tucker-Allen, who is director of the Methodist School of Nursing in Peoria, Ill., and former assistant dean of Chicago State University’s nursing program, says minority professors will avoid any college or university perceived as operating with a “revolving door,” an unwritten but still enforced policy at some schools.

“They bring you in, but they make no effort to support you and have no intention of tenuring you,” she explains. “In six years, you’re gone and someone else comes on board. On the books, the program has always had a minority faculty member.”

Once a program has gained such a reputation, attracting minority faculty can be difficult, even if the school is now making an effort to correct the situation by shedding its old policies and embracing diversity. But that doesn’t mean it can’t be done.

“There has to be a visible commitment starting at the top,” Tucker-Allen emphasizes. “It must start with a commitment from the dean and the president of the university because they control the funds and have to be willing to invest the money needed.”

Oates adds that this commitment to faculty diversity must not only run up the school’s chain of command but also run down it. Faculty members at all levels must buy into the diversity initiative and be willing to welcome, support, mentor and learn from new faculty members that happen to be of a different race or gender.

“People that report to the dean must understand how important diversity is,” she says. “They need to know why diversity is what’s best for the university and the students. You have to show them how it will make the program stronger.”

One way to do that, says Tucker-Allen, is to keep the diversity recruiting process open to everyone. Get both majority and minority faculty members and administrators actively involved in your efforts.

Once you’ve sold your diversity initiative inside your institution, go to great lengths to spread the word off-campus to the national nursing community. “Be prepared to tell minority nurses in academia what your program has to offer them and what sets you apart from their perspective,” Oates says.

If you’re not sure what that perspective is, ask. If necessary, bring in a consultant, preferably someone who is a member of the targeted minority group. According to Tucker-Allen, one mistake too many nursing schools make is bringing in outside consultants that do not represent minority populations.

“White faculty members and white consultants will not give you the solution,” she believes. “They are not going to say the same things that a black or Hispanic consultant would say.”

Put Your Money Where Your Mouth Is

Some minority nursing educators who have been on both sides of the academic hiring process think nursing schools might do better to abandon all the talk in favor of some high-profile action.

“If you’re serious [about attracting minority faculty], look at salaries, especially if you want to lure faculty members from other schools,” says Tucker-Allen. “Most black nursing faculty have traditionally taught at historically black colleges and they are probably tenured. They’re not going to leave that unless there’s a really good carrot at the end of your stick.”

Money may be the carrot of choice for many candidates, but it’s not the only one. Tucker-Allen suggests that nursing programs offer incentives such as the opportunity to do post-doctoral work and receive funding for research projects. “You have to look at the [candidate] pool and see what people really want,” she stresses. “Even though someone may have tenure in their current position, the person may be amenable to change if the right conditions are there.”

Established minority faculty members can also be lured away by nursing schools that have demonstrated a strong and sincere interest in minority health issues.

“In general, [minority] faculty researchers are interested in health disparity issues,” Moss explains. “Programs that target those issues are attractive.” One of the deciding factors in her decision to join the University of Minnesota, which has a Center for Nursing Research on Elders, was knowing that her own area of research interest–health care for American Indian elders–would be able to expand and be supported there.

Since such research projects are long-term and require financial support, a school’s encouragement of this type of faculty research conveys that the program is serious about eliminating health disparities and serving minority communities. It also helps assure newly hired minority faculty members that their expertise will be highly valued. Universities that fail to fully utilize the specialized knowledge and interests of minority faculty risk losing them.

But at more and more schools, the quest for a diverse nursing faculty that reflects the increased racial, cultural and gender diversity of the student population is creating unprecedented opportunities for minority educators interested in shaping the future of the next generation of nurses. As Mallinson says, “When it comes to being a faculty member and being a male, I could go anywhere. The world is open to me and that’s a wonderful feeling.”