The Path to Wellness: The Fundamentals of Nurse Coaching

The Path to Wellness: The Fundamentals of Nurse Coaching

As a young girl in New Dehli, India, Harpreet Gujral, MSN, FNP-BC, INC, grew up knowing medical practitioners of all stripes. Depending on the illness, her parents took her to a conventional medicine physician, a homeopathic doctor, and even an ayurvedic (ah-yur-ve-dic) practitioner. By blending those approaches, they not only exposed her to her future profession—she loved the nurse’s white cap and uniform—but also to a mix of holistic health practices.

So when an e-mail about a nurse coaching program crossed her computer screen in 2011, Gujral took a close look. After two decades as a nurse and nurse practitioner, primarily with Inova Health System in Fairfax, Virginia, she was intrigued by the idea of returning to the holistic concepts she had set aside years ago to fit into this country’s Western health culture. As a nurse coach, she’d no longer be the “expert” voice telling individuals what to do. Instead, she’d be guiding them to their own conclusions, on their own timetables, with their unique stories front and center. In short, this would be about treating the whole person.

“I realized that my roots were calling me,” Gujral says. “I’ve always taken pride in how I treat my patients and their families, but I also know that there’s room for improvement. There’s always a little bit more I can do in the way I practice. This holistic approach offered me that opportunity. It also took me back to my Eastern roots.”

Perhaps you hear the same call. After years of dispensing care the traditional nursing way, you’re open to a practice approach that moves patients toward optimal wellness and even lifesaving self-care without suggesting a “fix.” Nurse coaching offers those opportunities. As detailed in a recently published American Nursing Association (ANA) textbook, The Art and Science of Nurse Coaching: The Provider’s Guide to Coaching Scope and Competencies, this approach puts patients (or clients, as they are often referred to) in charge of their own care by letting them direct the activity and pace.

“As nurses, we’re great at telling people what to do,” says Barbara Dossey, PhD, RN, AHN-BC, FAAN, co-director of the International Nurse Coach Association (INCA), and a coauthor of the book. “But the beauty of nurse coaching is that we’re no longer fixing things. Instead, we’re helping clients really look at their situation, tap into their own resilience, and be able to say, ‘I can try that. I can do that.’”

Patient First Is Fundamental

But with a relationship-centered focus as the goal, what do nurse coaches specifically do to change the dynamic? And what constitutes the art versus the science? The short answer is that coaching actually expands the role of nurses and nurse practitioners by integrating the scientific, scholarly based skills they learned in nursing school with a bevy of new aptitudes and theories to help them guide individuals holistically on the road to wellness.

To be successful, nurse coaches accept two fundamental beliefs: First, people are unique persons in their capacity to learn, develop, and change. When invited to direct their own health, they’re very capable of positively impacting their progress. Second, nurses can play a primary role in mobilizing someone’s innate capacity for such growth and self-healing. By establishing a deep connection and true collaborative relationship—one in which they’re willing to be led rather than always leading—nurses are uniquely positioned to guide any individual in realizing his or her wellness potential. That means any specialty, any setting, and any condition—acute or chronic—that might benefit from behavioral change.

But how does one navigate the relationship with clients so they’re inspired to take even preliminary steps toward renewed health? For starters, rather than offering your educated opinion and advice, you should:

Encourage people to be experts in their own care. That means accepting them unconditionally where they are in terms of their lives and health issues while giving them wide berth to identify their own priorities and areas for change. You may not share someone’s values or decisions, but by honoring this person’s uniqueness, you encourage a course that truly reflects his or her belief system and way of doing things. In short, you recognize that change is best achieved when it comes from within and fits someone’s readiness, desires, and goals.

Emphasize human caring in each encounter. Although this concept is a moral ideal in all of nursing, it’s particularly important when the goal is to assist someone in his or her wellness journey. Human caring requires that you’re fully present and nonjudgmental. It means creating a safe environment in which people can freely express their hopes, dreams, fears, and pain, knowing that such information will be met with empathy and respect. In short, regardless of their current vulnerabilities or choices, your clients can be confident that you’ll be supportive as they evolve toward healthier goals.

“Before I was trained in holistic nursing, I approached patients as dependent persons in need of services, guidance, and resources,” says Margarita Ruiz Severinghaus, RN, MA, AHN-BC, HWNC-BC, clinical resource coordinator at the Office of Care Management for Dartmouth-Hitchcock Medical Center, based in Lebanon, New Hampshire. “It was a one-dimensional approach to care. But as a holistic nurse coach, I have a much broader perspective of the whole person. I’m much more aware of the multiple dimensions involved in this individual’s entire experience.”

Where Art and Science Merge

Eliciting your client’s health story and goals entails a level of inquiry that goes deeper than a traditional patient-provider interaction. Some of the skills you’ll weave throughout each encounter come from the counseling and psychology worlds. Others may even touch on behavioral and other principles you learned first in training.

In nurse coaching, your objective isn’t to analyze a current problem, judge a previous failure, or even dig archaeologically for old issues. You’re also not there to “fix” the clinical diagnosis at hand. Since this approach is about raising a client’s health consciousness and general awareness, you’re focused on where that person is right now in generating achievable goals. That may include, for instance, helping a midnight-shift worker realize better options to quality health than hitting the all-night deli because it’s an easy stop between the subway and home.

“One of the strongest principles in my approach to nurse coaching is cultivating awareness because that allows you to make choices,” says Bonney Schaub, RN, MS, PMHCNS-BC, cofounder of the Huntington (NY) Meditation and Imagery Center, and coauthor of the ANA book. “People often don’t realize that something is a habit until you say, ‘Let’s look at the steps that go into this.’ Once they become aware, however, they can create a plan to choose differently.”

Whatever you do, you want to create positive energy—or ch’i—by listening attentively, engaging skillfully, and most importantly, following your client’s lead as he or she determines the direction of each session. It’s in these exchanges that the art and science of nurse coaching converge. Of course, you’re still going to utilize the scholarly-based, critical thinking and systematic processes you learned in nursing school. The same can be said for the competencies, professional standards, and core values. They’re as fundamental to the science of nurse coaching, as are the communication skills you’ll need to break through barriers and keep people on track.

The art of nurse coaching refers to how skillfully you maneuver those tasks along with additional aptitudes and tools you’ll use to address the body-mind-emotion-and-spirit connection of an integrative or holistic health experience. It also suggests the nuanced adjustments you may have to make during each encounter. In that way, the art of coaching is much like the art of dance. Both require that you know when to lead in one direction, when to follow in another direction, and when to change directions, depending on any shifts in energy. So how does that occur? As Darlene Hess, PhD, RN, AHN-BC, PMHNP-BC, ACC, HWNC-BC, founder of Brown Mountain Visions, a coaching firm based in Los Ranchos, New Mexico, and coauthor of the ANA book, observes: “You develop an inner ability to trust yourself to be in that quiet place where you may not have a clue as to where to go next or what to do next. Yet you remain still and present, allowing that knowing to emerge. Then, as it does, you and your client dance together with it. That’s the art.”

In practical terms, you’re relying not only on that intuition, but also on a bevy of other modalities—guided imagery, meditation, and art therapy on the list—to help clients discover and win their goals. But for starters, you’re just mindfully present with the person. That simply means that you’re focused entirely in the moment on what this individual is saying with no preconceived notions as to what that conversation might yield. To do so, you’re engaging in:

Deep listening plus the power of the pause and not knowing. By concentrating intently, you’re not only creating a safe space where your client can deepen his or her own awareness, but you’re also allowing yourself to hear this person’s story. Perhaps it’s the woman whose spirit is broken after losing everyone she loves. By cultivating your deep listening skills, along with additional tools such as the power of the pause and not knowing everything, you’re able to explore territories with her that might otherwise remain unknown or untouched. Deep listening also permits you to pay attention to body language, which sometimes speaks louder than words. “If somebody is ready to cry, I’m not going to interrupt where he or she is at that moment,” says Dossey. “I’m going to hold that space and just allow this person to go with it.”

Motivational interviewing and appreciative inquiry. Used in tandem, these techniques are foundational in your efforts to draw out individuals, accept what they’re saying, and encourage them to reach their own conclusions. Motivational interviewing, for instance, is about valuing change. It’s about getting a middle-aged man to understand that taking his blood pressure medication every day is important, even if it didn’t seem so in the past. You’re not trying to scare this person with the arithmetic of unchecked hypertension and silent strokes. Instead, you’re searching—through the co-technique of appreciative inquiry—for clues as to your client’s best strategies and strengths. Perhaps in the end that means simply suggesting, “Is it possible to set the pills at your bedside with water and make them part of your morning routine?”

Open-ended questions. The tools that drive every encounter, open-ended questions allow you not only to engage people in decision-making, but also to gather important intelligence. The beauty of this technique is that you can use it no matter where your client sits on the willingness spectrum. For instance, if he or she is just contemplating the possibility of eating healthier, sleeping better, or even getting off drugs, you open the conversation by asking, “Is this something you might do in the future?” or “What might be some of the barriers to starting now?” Or, if your client is edging toward action, you might nudge things along with: “Can you imagine what change might look like?,” “Can you think of how you might accomplish it?,” or “Are you willing to do it in the next six months?” You know your client is finally ready for real action when he or she mentions an immediate goal, eager to strategize steps for meeting it.

How long might that transition take? It’s hard to say what triggers someone from merely thinking this could be a good idea to saying, “I’m ready to take action.” Perhaps a wake-up call—a family member getting sick or a news story generating a scare—suggests that the time is right. It’s also difficult to assess what obstacles or new issues may emerge and intrude along the way. Daily habits, cultural practices, or even a worldview suggesting that the course of health events can’t change because that’s what God or nature intended can be overwhelming. Likewise, your client may experience a more immediate issue that forces a course correction from the long-term plan to the problem at hand. Perhaps she’s afraid to go home, for instance, because an abusive husband is waiting.

Whatever attitudes, ingrained beliefs, socio-economic circumstances, or life challenges are creating roadblocks, probing questions and deep listening allow you to guide someone in overcoming them. Whether you’re asking your abused client for permission to offer resources that might keep her safe or you just want to know what’s the “worst” and “best” case scenarios for taking off excess weight, you’re continually gauging this person’s readiness.

“As nurse coaches, we sometimes feel responsible for the timing,” says Dossey. “But if we’re truly going to have a patient-centered focus, we’ve got to acknowledge that it’s someone else’s life and someone else’s choice. We can create the opportunity for change, but we can’t force people to take it. Anyone who has raised children will confirm that.”

Building Success on Strengths

Whatever the timeline, when the opportunity presents itself, nurse coaches pivot to options that build on someone’s strengths rather than emphasize his or her weaknesses. Since the very premise of this approach is to praise or encourage people to success, you’ll likely be helping your client enlarge his or her strength vocabulary by identifying all of the traits that he or she has relied on in the past. Keep in mind, however, that people often don’t recognize the true virtues in their own story or what they’ve accomplished previously. The efforts seemed so small. The tasks were so large. Or the relapses have been too many in number to appreciate that just being open to a new attempt is evidence of progress.

Whatever the challenges, the big goals for your client may be incremental at best:

“I’ll walk to the mailbox.”

“I’ll add vegetables to my dinner.”

“I’ll reduce my salt intake.”

“I’ll give up half a pack of cigarettes each day.”

Even a heroin addict’s willingness to stop sharing needles can be a lifesaving behavioral change. This person may not be ready to give up drugs, but he or she is at least willing to consider the transmittal risks of infection. “It’s not necessarily going to be everything that you want for them,” says Gujral. “But just making strides in the right direction and seeing the value of those strides, even quantifying them, will keep them moving forward.”

After overhearing a pre-op nurse practitioner scold one woman for having horribly high blood sugar levels for someone facing immediate cardiac surgery, Gujral decided to draw attention to the positive news during her subsequent diabetes consult. She parlayed her motivational interviewing techniques by focusing on how her teacher-client had accomplished a 2% decrease in her hemoglobin A1C test from results over the past two years. With a double take and a smile, the woman related that she just had made a concerted effort to eat healthier, despite the difficulty of living alone with no support system.

Knowing that the levels should improve even further, Gujral followed with: “What do you think would allow you to get an even better result?” The woman offered that she’d examine her after-school schedule to see how she could incorporate more activity and a healthier eating plan. Then came the negotiation. Gujral thought her suggestion of walking 10 minutes around the house after dinner was a perfect pitch idea.  But as to the TV dinners her client promised to eat each night, Gujral wondered aloud if there wasn’t another easy option with less salt. Perhaps heating mixed frozen vegetables, seasoned with olive oil, might be a doable alternative. “Would that be something that might work for you?” By securing a “Yes, I can do that,” Gujral gave her client options after surgery. “It’s really important for our clients to feel that they’re coming up with a plan that can work,” she says. “I’m available to embellish it, but not just as an expert. I’m using my coaching techniques.”

Whatever the strategy, you’re always mindful of the final leg—sustainability—of your coaching efforts. You’re not only guiding folks in realizing what they need to do to get unstuck, but you’re also helping them break down their objectives into small tasks that can be used over time. What else must be present for this person to keep things going long-term? Besides ready responses to that inner critic and habits that can thwart their efforts, they need to recognize the tactics that have worked for them in navigating other life issues.

Likewise, your client will decide how to measure success, based on the goals the two of you set up-front. Perhaps it’s to walk down the stairs without pain every morning or maybe dance at a granddaughter’s wedding next year. Whether true progress takes place within the context of your coaching relationship or much later, your role is to encourage the possibility and acknowledge every feat. More importantly, you want your clients to recognize and accept what they have accomplished, too! Since momentum builds on momentum, improvement on one goal can encourage targeting the next one. And even if the two of you can’t celebrate winning the initial objective, you can mark any strides that might lead to fruitful results later. “Nurse coaching doesn’t necessarily guarantee that your clients will be habit-changers,” says Severinghaus. “But hopefully this process of discovery will allow them to appreciate the effect of choice on their happiness and well-being.”

Final Thoughts

A nurse coaching relationship isn’t built to last forever, even if you really enjoy the interaction. Although the length of any commitment is based on someone’s needs and goals, there’s both a starting point and an ending point. Whatever the timeline, your goal is for your client to tap into his or her innate abilities to be empowered for a lifetime. Other medical practitioners likely have explained the stakes, and may even have referred this person to you. But you’re there to right the ship so it can sail.

In the meantime, you may find a deeply satisfying way to practice that connects you to your profession and patients in an exciting new way.  For instance, when she answered that e-mail in 2011, Gujral found more than just INCA’s Integrative Nurse Coach Certificate Program. She was up close and personal once again with the holistic health concepts she had first learned in her native India—only now they’re an integral part of her day. As assistant director of certifications services at the American Nurses Credentialing Center (ANCC) as well as a private hospitalist practice nurse practitioner, Gujral has found ample ways to use her nurse coaching skills. Whether she’s collaborating with ANCC staffers or guiding patients to better medical results, she delights in coaxing people to do their best. So inspired by nurse coaching as a path to wellness, she’s even pursuing a doctoral degree in nursing practice, focused on integrated health and healing.

“I’ve always taken pride in being a nurse,” Gujral says. “But my satisfaction with my profession has gone up many notches since I became a nurse coach. Making the connection with people at such deep levels is amazingly fulfilling. It gives me great joy.”


How Mentoring Programs Influence Workforce Diversity

How Mentoring Programs Influence Workforce Diversity

Karen Bankston, PhD, MSN, FACHE, didn’t have management in her career sights when she started as a fledgling emergency room nurse in 1976 at then-Southside Hospital in Youngtown, Ohio. She wasn’t thinking much beyond giving the best care possible to patients with traumatic injuries and acute health issues.

Yet Bankston’s chief nursing officer, Ruth Eldridge, MSN, RN, had a different idea. She saw enough leadership potential in her young nurse to offer herself as a mentor. Bankston admits that she didn’t even know what the term meant back then. But with Eldridge’s counseling persistence, her career took a rewarding trajectory, eventually leading to her present position as associate dean for clinical practice, partnership, and community engagement at the University of Cincinnati’s College of Nursing.

It’s from that perch that Bankston now offers similar counsel to nurses-in-training. As faculty advisor for AMBITION—Advising Minorities By Inspiring and Transforming Them Into Outstanding Nurses—she wants to impart the same wisdom that her now retired mentor did to her years ago. “I’ve always been grateful to Ruth. If she hadn’t taken that step and said to me, ‘I’m going to help guide you because I see that you can do some great things,’ I might have had a totally different career than the one I’m enjoying today.”

A Place at the Table

Perhaps you’ve had a similar experience. Someone spotted you as a diamond in the rough, a professional gem ready to be mined and polished. Or maybe you were the one searching for a seasoned colleague to help you buff your skills, build your portfolio, or strategize your next move. In either case, you’ve likely reaped the benefits in forging relationships with people who have your back and your best interests at heart.

But in the bigger universe, how does mentoring actually help diversify the nursing workforce? What role does it play in answering the calls of the National Academies’ Institute of Medicine (IOM) and other nursing organizations for increasing diversity and giving an ever-changing patient population culturally competent care?

Mentoring can have widespread implications beyond boosting individual careers. By giving minority nurses and nurse practitioners a necessary leg-up in broadening their options and fine-tuning their skills, mentoring changes the face of one organization and the makeup of the entire field. By encouraging persons of color to join, grow, succeed, and stay in the profession, it expands diversity, one person at a time.

More specifically, developing a mentoring relationship exposes you to jobs you’ve never heard of—and to people who’ve never heard of you. It shows you that others have done what you’ve only thought of doing in passing. Now that you know their path, however, you can accomplish those goals too! Finally, by tapping people you respect for their wisdom, you ready yourself as an effective participant at any leadership table. In doing so, you’ll bring diversity to the highest decision-making levels of the profession’s ladder, not just those lower rungs.

As Commander James Dickens, DNP, NP, FAANP, US Public Health Services, Office of Minority Health, Dallas-based Region VI, observes: “Nurses always talk about having a place at the table, but I think it’s more important than just that. You also need to have a fundamental understanding of what occurs…of what roles you and your colleagues bring to the team. Sometimes you may be the only nurse or nurse practitioner sitting there, so it’s important to understand the expectations.”

An Invitation into the Fold

Yet you can’t diversify the leadership table if you’re not in the profession in the first place. Although mentoring is an essential technique for helping nurses and nurse practitioners of color enter the job market and capitalize on their skills, it’s also an effective tool in attracting promising young men and women into the field initially.

By encouraging ethnically and racially diverse students to take the academic plunge, mentors play a critical role in expanding the nursing universe at the earliest possible juncture. They’re key for steering mentees as they navigate the rigors of training programs that are both new and challenging. They’re a sounding board when the educational waters get murky or rough. But their primary role, beyond helping fledgling nurses graduate with flying colors, is to make sure persons of diversity understand that they have a place in the profession and are capable of the work.

“People sometimes have the perception that they can’t succeed at nursing, especially if they’re part of a racial minority or from a different culture or lower socio-economic background,” says Willa Hill Fuller, RN, executive director of the Orlando-based Florida Nurses Association and a veteran mentor and mentee. “They didn’t have a mom like my mother who just never let me think that I couldn’t do something. Mentors can help eliminate those kinds of attitudes, so their mentees can realize their potential.”

Growing up disadvantaged, Gordon Gillespie, PhD, RN, a Robert Wood Johnson Foundation Nurse Faculty Scholar and assistant professor at the University of Cincinnati’s College of Nursing, had no aspirations to be a nurse. Like many men, he initially bought into the gender biases surrounding the profession, stereotypes that can stifle that initial interest and prevent retention. But Gillespie had a major supporter in his mother-in-law, herself an RN. She not only saw his potential, but eventually, with the help of other nurses, convinced him that nursing fit him to a “T.”

“As I look back, it’s almost a miracle that I graduated from college, let alone became a PhD,” he says. “But someone looked at me and said, ‘I have faith in you. I believe in you. I will challenge you.’ That’s where mentorship is really essential. It can keep students in a program until graduation so we have that diverse workforce.”

Today, Gillespie is both a mentor and mentee. As part of a scholarship program designed to single out the next generation of academic leaders, he’s put together a team of role models to facilitate his own growth beyond the doctorate and the experience he’s already amassed. For Gillespie, that includes two campus colleagues—one a nurse and the other from a different discipline—to help him deal specifically with being a good researcher, teacher, and fellow professional within his program. A third mentor, separate from both nursing and Cincinnati, serves as his external “safeguard.” She offers a broader perspective on a given situation from her spot in Baltimore. “I used to believe that having a one-on-one relationship with a single mentor was the perfect situation,” he says. “But now I realize that a package of mentors is excellent. It’s going from good to great.”

The model has worked so well for Gillespie that he uses it as a guide in mentoring his own students, particularly the young men he meets as the faculty advisor for the College of Nursing’s MENtorship program. With the ultimate goals of enrollment and retention to graduation and beyond, MENtorship was initiated to help male nursing students not only recognize the possibilities of a career in a caring profession, but also to deal with the real-life issues of choosing one dominated by women. In doing so, the discussion between mentors and mentees—upper classmen for lower classmen, and licensed nurses for seniors—often centers on dispelling gender myths and dealing with the challenges of caring for the opposite sex.

Gillespie’s mission is to turn out male nurses who are not only potential leaders, but also content enough in their own skin to stick with the profession. “Our goal is to give these young men the support they need so they’re very comfortable with who they are as men in nursing,” Gillespie says. “We want them to be able to go out and broadcast to the world, ‘Here I am. I’m proud of what I do.’”

Formalizing Tasks

To be effective, should mentoring occur vis-à-vis a formal structure or can you connect successfully in other “organic” ways? Truth is, whether you come together in the framework of a program or by linking with people whose substance and style you admire, you can have a very successful relationship. That is, as long as you’re on the same page in terms of goals, expectations, and even practicalities. There are times, however, when a formal construct not only cements mentoring as an important part of a nurse’s professional life and training, but also serves as a significant tool for bringing and keeping more persons of color into the fold.

For instance, in 2008, the Robert Wood Johnson Foundation (RWJF) joined with the American Association of Colleges of Nursing (AACN) to launch the RWJF Careers in Nursing Scholarship Program, an effort to alleviate the nation’s nursing shortage by dramatically expanding the pipeline of students from minority backgrounds via accelerated nursing programs. Since its inception, RWJF has awarded some 2,700 $10,000 scholarships, through grantee schools of nursing, to entry-level nursing students coming into the field from other careers. Preference is given to awardees from underrepresented groups or disadvantaged backgrounds.

To achieve that success, however, program officials knew early on that they had to establish consistency in how their grantees—nursing programs throughout the country—not only defined mentoring, but how they would be implementing it. Out of the concerns that people don’t confuse mentoring with academic counseling came a toolkit ( to guide grantees in setting up a program.

“If organizations can formalize their mentoring efforts, I think the odds are much better that they’ll see success,” says Vernell P. DeWitty, PhD, RN, program deputy director. “But even if they don’t have the resources we provide our grantees, as long as they have a good understanding of what mentoring should look like and how it should be approached, I think it can work.”

Likewise, for the past six years Marquette University’s College of Nursing has used Project BEYOND (Building Ethnic Youth Opportunities for Nursing Diversity), an effort funded by the Federal Health Resources and Services Administration, to increase the number of minority BSN students admitted to and graduating from its nursing program. Mentoring is one aspect of an agenda that also includes tutoring, structured leadership programming, and peer-to-peer support.

In terms of connecting, both mentors and mentees come together in what’s called the “World Café,” a meet-and-greet event conducted much like speed dating. Mentees spend five minutes with each licensed RN to share information and measure the chemistry. Before formalizing any relationship, however, they spell out their three top choices from which program directors make the final match. From there, it’s a matter of meeting initially to firm up the details, which must include at least two face-to-face meetings per semester. Most mentoring pairs, however, are regularly in touch throughout their collaboration.

Since the goal is academic success, Project BEYOND features a separate specialist who also oversees a small cadre of upper grads or graduate assistants who peer tutor younger students. “We find that peer mentoring can be very effective because the relationship with another student is often easier to establish than with a faculty member or nurse,” says Juanita Terrie Garcia, MEd, RN, Project BEYOND coordinator. “Mentees have a level of confidence that they’ll benefit from their mentors because they’ve just gone through something similar. It’s fresh.”

Since the inception of Project BEYOND, Marquette nursing officials have witnessed an increase in minority enrollment from 12% to 18% with retention rates of 96% to 100%. That’s translated into more than 30 underrepresented minority students successfully graduating, with seven enrolling in graduate programs. Project staff members believe they’re making progress because they’ve taken a “holistic” approach to raise not only academic skills, but self-confidence as well.

“One of the most significant factors affecting the success of minority students is their level of confidence,” says Gloria Rhone, MSN, RN, Project BEYOND’s academic support coordinator. “They have to deal with all sorts of stereotypes about their ability to perform whether they’re applicable or not. So having somebody there to motivate them, encourage them, and just be a good listener can help build that self-esteem.”

Opening Doors, Expanding Opportunities

By connecting with supportive and insightful individuals, minority students can indeed bolster their initial skills so they’re ready to be successful, working members of the profession. Yet establishing mentoring relationships after you’ve finally entered the workplace as a licensed practitioner can be just as fruitful as connecting with role models in training. Mentoring throughout your working years not only secures your personal long-term success, but also introduces your talent, perspective, and vision to the organization.

By assisting new (or seasoned) nurses in plotting their career paths and fine-tuning their skills, mentors help mentees take their ambitions to the next fulfilling level. Whether you connect formally or informally, working with a mentor is a way to network with colleagues, demonstrate your abilities, and grow into jobs that fit your ambitions and long-term plans. From promotions to PhDs, mentoring brings a bevy of people into the job force, priming them for the next move. But for starters, it bridges the inevitable gap between education and practice so there can be no doubt that a new face on the block will be a valuable asset.

Once they come on board at Minneapolis-based Fairview Health Services, for instance, new graduates, along with nurses new to an acute care setting, undergo a variety of steps to ensure their initial success and long-term tenure. Beyond orientation and a preceptor to help them navigate the hospital and their unit, they’re also part of a year-long nursing residency program, an added layer of training and support. It’s then that they buddy with a mentor—usually a nurse manager or other nurse leader—to master the nuances of Fairview’s unique workplace.

They may also join the system’s diversity circle, a separate mentoring effort that brings minority professionals together to broaden their networking reach in meeting leaders of color. Although diversity is part and parcel of every endeavor, the circle puts real faces to the concept that you can grow within the organization.

Indeed, later on when they’re ready to take on more responsibilities, they’ll have access to developmental programs available to every promising nurse. But initially, the focus is on grappling with the challenges of picking up the pace and seeing greater numbers of patients than they did in training. It’s about learning how to be in command of their new environment—and comfortable enough to commit for the long haul.

“It’s important to connect people with people,” says Laura D. Beeth, Fairview’s systems director, talent acquisition. “It shows that you care about them…that you’re not just throwing them out there. Instead, you’re giving them a safe place to ask questions, especially when they’re overwhelmed and need to reach out.”

In terms of diversity, Fairview’s residency program is far from the organization’s only attempt to broaden its nursing corps. Officials have established a veritable roadmap of pipeline programs to lure minority persons into the medical field, whatever their ultimate career choice. From support for two Minneapolis health career-focused high schools to individual scholarships and summer internships, Fairview has instituted opportunities at every step of the training continuum to find, attract, and fund potential nurses of color.

Much of the activity begins with the hospital’s award-winning SCRUBS Camps, an annual opportunity for minority teens, among other high schoolers, to live and breathe what it’s like to work in medical careers. So named for the attire of the attendees, SCRUBS is an intense three- to five-day college campus tutorial involving a largely hands-on agenda. Participants network with faculty members who, if only for a short time, mentor them on their choices.

Although her introduction to Fairview didn’t involve summer camp, Marion Lee, RN, BA, MSN, has benefited in other ways from her relationship with the health system and her colleagues. Besides a $10,000 sponsorship to finish her nursing education (via an accelerated master’s degree), Lee has reaped many rewards from the preceptors and mentors she’s encountered as both a student and newly minted professional. The people surrounding her have been instrumental, for instance, in helping her sharpen her skill sets, especially in approaching patients, interacting with their families, and managing her time doing both.

But the biggest advice she’s received may involve just being sensitive to other cultures. Even though Lee is Mexican by birth, she has to keep in mind that patients from other areas of the world don’t always appreciate her Latino warmth. “We’re very touchy, feely people,” Lee says. “We love to hug and touch. Sometimes patients look so lonely that I just want to hold their hands. But I have to step back and realize that I can’t do that. I have to remember that there are boundaries.”

Testing New Waters

Like Lee, you may have discovered your niche at the bedside. But not every nurse will find caring for patients his or her forte. Fortunately, in today’s market there are other ways to use your skills and unique background. Whether filling a for-profit or not-for-profit position, nurses and nurse practitioners are sought-after commodities in all sorts of places that need their clinical expertise and patient perspectives.

So how can mentoring ensure that minority nursing professionals have options beyond traditional health care jobs? By helping mentees fine-tune their business savvy and sharpen their political senses, mentors are critical assets in broadening choices beyond direct patient care. They facilitate diversity not only by helping nurses boost their competencies in areas never addressed in nursing school, but also by steering them to new options for their expertise.

As Elizabeth Allee, BSN, clinical trial project manager for Indianapolis-based Eli Lilly and Company, observes: “Mentoring in a corporate environment is extremely, extremely important. In a hospital, a nurse is a nurse, even though every area is different. But when you come into a company, your knowledge and training can be used across multiple departments. You need a mentor to help you leverage your expertise so someone will look at you and say, ‘This person would be a great fit for our team!’”

Allee credits the right people for giving her the right advice at the right time as she’s transitioned from her first Lilly job in global patient safety to her current role overseeing global clinical trials for various therapeutic teams. Ten mentors along the way have helped her navigate the politics of the organization and readied her for the next step. Today, she’s returning the favor by marshaling advice for 12 fellow employees, many of whom are nurses of color.

She’s also a founding leader of the Lilly Nursing Forum, a ground zero effort for promoting both patient-centered community initiatives and nursing professionals. Even though there’s no formalized mentoring structure within the forum, the networking that occurs exposes nurses to opportunities not always obvious in a behemoth corporation. Allee, for instance, just returned from a six-month assignment in China, a stint that wasn’t on her career radar until she learned of it through her forum contacts.

Among their activities this year, forum participants are keying into Lilly’s corporate initiative, “Fit for Life,” by focusing on career as one of several wellness areas. As part of that agenda, Allee predicts an increased emphasis on mentoring, not only as a strategy to help individual nurses realize their potential within the company, but also to help the company retain its nursing talent.

When Dorothy Jackson, RN, MS, came to Lilly in 2006, she brought along 20 years of diverse experience in surgical, coronary care, ICU, and community health nursing. As a former clinical research coordinator for an outside cardiology group, her past experience fit nicely into her first job, a contract employee on Lilly’s cardiovascular research team. Today, Jackson serves as a global lead for case management, meaning she provides safety collection oversight for Lilly’s endocrine clinical drug trials.

She’s also a Lilly Nursing Forum leader, a position suggested initially by her friend and current mentor, Liz Allee. Jackson had worked with two previous mentoring colleagues before tapping her former department co-worker to help her identify her next professional steps. Together, the two are focused on fine-tuning her career development plan so the path she chooses fits her strengths and skills.

Besides offering advice and networking contacts, Allee has encouraged her mentee at every turn to chase new pursuits in broadening herself and upping her profile. When the nursing forum started, for instance, she urged Jackson to join, even though her mentee was hesitant of the time commitment. Allee persevered, however. Today, they’re collaborating not just on Jackson’s future, but also in creating educational outreach projects using a variety of forum nurses. It’s a natural fit for Jackson, who does health training and diabetes education in her community.

“Liz made me take a second look at something I probably would have passed on,” says Jackson. “She kept saying, ‘You’d be good at this. You do community service all the time. You have a good outlook on nursing. Let’s do this together.’ I think an important part of being a good mentor is simply looking at a person and saying, ‘You’d be a great fit.’”

Good Mentors Worth Gold

What makes for good mentoring? There’s no one-size-fits-all formula in selecting people to emulate or tap for their advice. But here are some factors that you may want to think about as you make your choices.

Numbers and variety count. Mentoring doesn’t have to be one-stop shopping. Putting together a team of people who can work with you on a variety of fronts can help you address issues beyond even nursing. One of the best mentors DeWitty had as a young unit head nurse, for instance, was her hospital director. He gave her the opportunity to sit in on meetings and afterwards ask any questions about the deliberations. By delving into the details of such conversations, she had a better understanding of how things worked. To broaden her perspective, DeWitty has tapped people from fields other than nursing throughout her career. The variety, she says, “not only gives you a different perspective but also helps you become a much more rounded professional.”

Think culture and beyond. Don’t limit yourself to nurses who share your race or ethnicity. Even though it’s important to find examples of people within your own community who’ve excelled at what you want to do, it’s just as important to match your needs with the best resources available. The first mentor who made such a difference in Bankston’s life, for instance, was Caucasian. Likewise, it was expected that DeWitty would pair with African American nurse mentors during her PhD program. But she had lived and worked most of her life in a culturally diverse environment, so she looked for a role model mix. “Similarities in ethnicities are important,” she says. “But you should go deeper to see if two people are operating on the same wavelength and are really the best match.”

Reach beyond your environment. Nowhere is it written that you have to limit your choices to those directly surrounding you. A good mentor can be as close as the next office or as far away as a distant land. Just as long as you have a structure in place for connecting with someone efficiently, you can make those long distance collaborations work nicely. For instance, Dickens, who usually confines his advice as a mentor to masters-degree hospital administration nurses stateside, also mentors a chief nursing officer at an American hospital in Saipan. He’s helping her traverse the concerns of being isolated geographically in a hospital that needs help with its CMS (Centers for Medicare and Medicaid Services) status when she’s not necessarily being prepared for the job.

Be flexible. If you’re the mentee, don’t be afraid to ask for a referral or to end the relationship when you’ve gone beyond what this person can offer you. If you’re the mentor, be ready to suggest another nurse or professional who has the right contacts and advice if that’s not you. Dickens, for instance, doesn’t hesitate to push people along or connect them with new sources. “It’s extremely fluid,” he says. “Some of my mentees have outgrown me because their career trajectory has set them in another direction. I understand that. I say, ‘Look, I want to keep you in my back pocket. I’ll never go away. I’ll always be available to you.’”

A Final Note

Whether you’re starting your career or just moving into the next phase, seeking the counsel of wise and diverse colleagues can make the difference between success and failure. Mentoring is critical at every step in a minority nurse’s professional journey—to soar academically as a student, to transition into the workplace as a novice, and to plot the best career path as an experienced pro. It can provide nurses of color the kind of insight and edge that helps them succeed personally as they bring needed diversity to their patients, colleagues, and the profession at large.

Bankston, for instance, has benefited immensely from her mentor’s early and frequent message: To be taken seriously, especially in a world fraught with biases, she’d need to be at the top of her game. Whether that meant polishing her skills, dusting off her professional demeanor, or adding another credential to a growing resume, Bankston responded by listening, learning, and doing. When Eldridge pointed out, for instance, that Bankston’s hand movements were a distraction when she presented, she practiced diligently in front of the mirror to employ them effectively. Likewise, when her mentor suggested that an advanced degree would be paramount in the roles she envisioned for her young charge, she started thinking PhD.

Today, Bankston counts stints as both a hospital chief nursing officer and chief executive officer among the titles she’s earned since her mentor first spotted those leadership qualities. As the faculty advisor for AMBITION, a peer-to-peer tutoring group, she wants young minority nursing students not just to have the right skills to behave admirably in the workplace, but to master the rigors of nursing school so they can get their foot in the door. By pairing upper classmen with freshmen who need to overcome any hurdles, AMBITION alleviates the isolation that Bankston herself felt in nursing school 40 years ago. It also keeps a new generation of minority nurses committed to a profession they, in turn, will diversify.

“As minority nurses, we need people in our lives who’ve already navigated the waters,” says Bankston. “Finding mentors who are both trustworthy and honest can help us recognize the potential missteps and even push us when we think that we just can’t do anymore. They’re very important in our career journey.”


Nursing Pharmaceutics: Educating Toward Safer Pharmaceutical Care

Nursing Pharmaceutics: Educating Toward Safer Pharmaceutical Care

When Felicia Menefee, RN, NP, ACNS, recruited patients for the landmark African-American Heart Failure Trial (A-HeFT), little did she know that the study would yield such positive results for them—or future patients.

Since African Americans with advanced left ventricular heart failure do worse than Caucasians in all phases of this condition, scientists wanted to see if adding a potent nitrate-vasodilator-duo to their standard therapy would make a positive difference in their symptoms, hospitalizations, and daily activities. What was the target of this National Institutes of Health study? A fixed-dose combination of isosorbide dinitrate (ISDN) plus hydralazine (HYD).

When researchers discovered that patients on the drugs indeed functioned better clinically than previously (some even energized enough to exercise), they halted the blind study prematurely. In doing so, they also handed the US Food and Drug Administration (FDA) enough data to demonstrate that survival and quality of life indeed increased, while hospitalizations decreased, on the medications. The FDA approved ISDN/HYD in June 2005 for heart failure therapy in blacks.

A-HeFT is just one of a myriad of NIH- and industry-sponsored drug and device trials Menefee has participated in during her 17 years as a nurse practitioner with Kansas City-based St. Luke’s Cardiovascular Consultants. Staffed by 48 cardiologists, many of whom are tied to academia, the practice provides ample opportunity for her to participate in clinical studies.

“Research is extremely important in advancing medicine,” she says. “Without it, health care stagnates. But with drug and other studies we can improve care. Sometimes a trial’s results are negative; sometimes they’re positive. But we won’t know unless we do it.”


Primed for Drug Studies

Perhaps you have the same curiosity as Menefee in advancing new pharmaceuticals or expanding indications for existing ones. What role can you play to help develop the next cutting-edge prescription or the newest use for an over-the-counter standard?

Truth is that unless you’ve piggy backed your nursing experience onto another degree—perhaps pharmacy, biochemistry, or medicine—your contribution likely won’t be in a drug company (or academic center) laboratory. Pharmaceutical scientists involved in the discovery or refinement of new medications typically bring masters and PhDs in the hard sciences to a company’s research and development function.

But that doesn’t mean your experience isn’t valuable. Clinical knowledge, critical thinking skills, and caregiver intuition can be a perfect match for other positions directly impacting medications. In fact, by parlaying and building on your background, you can ensure that what scientists produce in the laboratory is both safe and efficacious in real people. Whether you’re coordinating clinical drug trials in a patient setting, fielding adverse events for a pharmaceutical company, or playing another role, you can find a rewarding frontline niche.

As Sherry Banez-Muth, RN, manager of coordinating services, Center for Clinical Studies, Washington University School of Medicine, St. Louis, observes: “It’s definitely satisfying when you see people taking a new treatment that may be life-changing. It’s a good feeling to say, ‘Wow, I contributed to this.’”


Coordinating for Results

            The good news for nurses and nurse practitioners is that you don’t have to stray far from a patient setting to be part of the drug development process. Once scientists have tested their hypothesis to determine that a preparation developed in the lab may indeed help with a specific indication, the scene shifts to the FDA for a human study protocol approval. When the regulatory agency is on board, sponsors can enlist multiple clinical trial sites—health systems and large medical practices—for the Phase I to IV (and post-marketing) human studies.

Much of the work at those locales rests with nursing professionals, point people in the day-to-day operations of a drug trial. As clinical research or study coordinators, they juggle multiple tasks in making the protocol work. They not only train supporting cast members to find, screen, enroll, monitor, and collect data on participants, but they’re often on board from the onset, helping principal investigators prove that a health provider has what it takes—in experienced staff, adequate space, and access to the right patient demographics—to move a protocol forward.

As a director of clinical research for the Dallas-based Baylor Health Care System, Jennifer Thomas, RN, BSN, MS, CCRC, works side-by-side with investigators, first reviewing potential drug or device trials to ensure that they’re a good fit both financially and clinically for the institution. Thomas had her nursing skills tucked neatly under her belt when she earned a clinical research administration masters to even the negotiating playing field with sponsors over start-up costs and other numbers. “It helped me look at the bigger picture,” she says. “I’m better able to account for everything we need to do to go into a trial.”

Although Thomas no longer conducts individual studies, her imprint is widespread since she provides education and other resources to 40 professionals who manage from 70 to 100 investigational drug, device, and prevention studies, covering a multitude of conditions from diabetes to transplant research. She makes sure others are knowledgeable about a particular study and ready to conduct it according to regulations and good clinical practice.

That means becoming familiar with all aspects of the protocol, a regulatory document that can range from a mere 20 pages to a 500-page tome. It covers every possible nuance, from the hypothesis and research behind the drug to the goals, criteria, and requirements for participation. Whether the information is gleaned from principal investigator meetings, in-service tutorials, or other sources, mastering the fundamentals and logistics of a protocol is critical in running it correctly and consistently with other centers so results are valid.

“If there are too many variations, the sponsor can’t tell what’s causing a problem,” says Lynn Fukushima, RN, MSN, FNP, MBA, CCRC, nurse coordinator for the Keck Medical Center of the University of Southern California. “Is it the proposed medication itself or something else? We have to be very meticulous in our record-keeping so there’s no doubt.”

Fukushima wears many research hats in navigating drug studies related to cystic fibrosis and other pulmonary or lung diseases. For starters, she also helps her physician-colleagues determine if a clinical drug trial is appropriate by submitting information to the institutional review board for an up-or-down decision. Because her job includes budgetary tasks, she earned a health care administration MBA to better grasp the financial implications of a study.

In terms of each protocol, Fukushima sometimes works alone, organizing all aspects of a study, while other times, she’s coordinating with staffers. Whatever the case, her patient involvement changes with each trial stage. Phases I and II, for instance, can be intense since researchers are looking closely at efficacy and safety. She may see subjects weekly, daily, or even several times a day for blood draws and other procedures. During phases III, IV, and post-marketing, the individual interaction diminishes since sponsors are no longer tracking efficacy, but safety in an expanded universe of patients.

Whatever the stage, the paper chase with a clinical drug trial demands the kind of attention to detail and familiarity with medical jargon and charts that usually fit nursing professionals to a T. The skills you’ve likely established in training and honed in practice can provide an important cornerstone for managing the administrative and patient-contact components of any given study. But it’s also the ability to stay up-to-speed, think outside the box, and respond with on-the-spot analysis or critical thinking that’s important. Each protocol is replete with guidelines, but you still need to accommodate new information and unexpected turns-of-events.

In managing a support service unit for principal investigators throughout Washington University School of Medicine, St. Louis, Banez-Muth is used to the structured training and continuing education necessary to get a trial up, running, and producing valid results.

Of the 35 to 40 active NIH- and industry-sponsored studies she and her seven coordinators target at any given time, the phase II to IV drug trials represent a spectrum of urological and gastrointestinal targets. Whether Banez-Muth is personally managing a trial for a principal investigator or overseeing the work of others, she not only has to be organized but nimble on her feet. “As black-and-white as you would like things to run, it’s never that way. There’s always one patient who falls outside the box,” she says. “When that happens you want to make sure that you’re doing what you can to keep this person safe during the protocol.”


From Tuskegee to Transparency

Indeed, beyond data integrity, the primary task of nursing professionals involved in a clinical drug trial is to protect the subjects they seek, find, vet, enroll, and follow. From the moment coordinators scan medical records, tap health care providers, or reach into the community to find subjects, their focus has to be on complete honesty and concern about someone’s health and well-being.

That wasn’t always the case, given this country’s sometimes chilling research history, especially in regards to minorities. The infamous Tuskegee syphilis experiment, for instance, may have started in 1932 to chart the progression of an untreated sexually transmitted disease in black sharecroppers. Yet, by the time it ended in 1972, it had put hundreds of them at medical risk because US public health scientists and their local physician-partners withheld what had become standard-of-care treatment: penicillin. Even decades after whistleblowers shut it down, Tuskegee has left an indelible mark, particularly among African Americans.

Thankfully, clinical trials today are light years from Tuskegee, not just in terms of bioethical standards but also in practical safeguards. Study coordinators can point to a drug process so rigorous and regulated by the sponsor, the FDA, institutional review boards, and other agencies that safety rules at every turn. Patients are monitored so closely with high-tech imaging and other services that care often exceeds what they receive nominally from their personal physicians. “The wonderful thing about research is that you get excellent follow-up care,” says Menefee. “It can be a very special opportunity for participants.”

But nurses must be both transparent and on their toes in engaging candidates with a medical history that matches a given protocol. Informed consent is the primary tool they hold in their quiver to ensure that every enrollee understands every relevant specific—possible risks, benefits, and commitments—of a given study. But in outlining the parameters, they also target their rights. Distilling the caveats is important for every clinical trial, especially those that demand much of a participant, perhaps even an invasive procedure, with no guarantee of positive results.

In fact, making promises that someone will receive an active ingredient or that it will work with no side effects, is a trial taboo. The only guarantees nursing professionals should be sharing with their enrollees are that they’ll be good patient advocates, pursuing everything possible to ensure a safe experience. That includes collecting vital signs and good data with each office visit, addressing any side effects or adverse events, and keeping everyone, including a patient’s personal physician, apprised of important changes. As one coordinator notes: “You’re asking people to participate in a clinical trial from which they may or may not derive any benefit. So establishing trust and rapport is important.”

Whatever the specifics, vetting presents a great opportunity for minority nursing professionals to convince fellow patients of color that their participation in a study is critical. Given your own sensitivity to the cultural mores and concerns of a community, you can be a key link in dispelling any myths about drug research while bringing volunteers into the fold.

In engaging her enrollees, Thomas, for instance, makes sure they know that they’ll never be asked to sign on to a Baylor study without someone reviewing every paragraph of the consent form with them. More importantly, if it’s not a good fit, they can leave at any time. “I understand the sensitivity among African Americans enrolling in research studies,” she says. “Hopefully I can educate them so they have a good understanding and they’re willing to say, ‘OK, I will participate in this.’”

Similarly, when Judith A. Rivera, MSN, recruits subjects for both NIH- and pharma-sponsored memory trials, her goal is to find an ethnically diverse pool of people when the study merits it. As a Latino nurse practitioner and principal study coordinator for the University of California-San Diego’s Comprehensive Alzheimer’s Program, Rivera is well aware that dementia is a serious health issue among minority, as well as majority, Americans. Unfortunately, in some ethnic communities memory loss is often dismissed as simple aging rather than a potentially serious disease.

But by targeting culturally and racially diverse subjects for a slew of drug and other studies related to memory, researchers at her institution are giving vital information to pharmaceutical companies about all of the people, not just Caucasians, who might need their products. More importantly, they’re also raising awareness among enrollees about the potential pharmaceuticals—albeit under study—that might help them remain active and functioning. “We want them to be as independent as possible for as long as possible.”


Monitoring for Safe Outcomes

Making sure that a participant isn’t compromised during a drug trial is an important part of realizing any positive results. From phase I to post-marketing, nursing professionals are not only helping patients navigate the terrain of a protocol, but they’re also gathering information about a drug’s safety and effectiveness.

Detecting and forwarding potential problems to a sponsor is a natural for nursing coordinators since their training and frequent interactions often give them a pulse on what people are experiencing. “Some nurses have a sixth sense about how a patient is doing,” Fukushima says. “If they see a frown on a face or hear unusually short answers, they may be a little more aggressive in investigating the cause.”

But overseeing a clinical trial isn’t the only way to determine if a drug is working well or not so well in a patient. In fact, many nurses are finding satisfying ways to use their critical thinking and detail skills in other research-related venues. From pharmaceutical companies to clinical research organizations (CROs) and other patient service firms, prospects abound for managing and monitoring trials as well as educating and tracking subjects. Besides sales and marketing functions to promote approved products further down the line, the activity usually centers on making sure medications aren’t hurting users.

As a clinical safety specialist for GlaxoSmithKline’s (GSK) Global Clinical Safety and Pharmacovigilance Division, Shannon Hart Anderson, BSN, RN, JD, also manages adverse event reports—unexpected and potentially harmful reactions—for a bevy of pharmaceuticals bearing the GSK imprimatur. From over-the-counter remedies to prescriptive medications, her potential targets include therapies for a wide spectrum of benign and serious diseases. “We’re like the safety police,” she says, “We have to make sure that our products aren’t harming the public.”

From her berth in GSK’s US headquarters located in Research Triangle Park, North Carolina, Anderson processes initial complaints from consumers, health professionals, sales reps, and even the FDA. She then collects follow-up information, which is entered into a safety database that serves as grist for further investigation as well as the regulatory agency reports she also must prepare. To capture the most accurate information possible, Anderson routinely relies on the logical reasoning, problem-solving, and even communication and advocacy skills she’s honed as both a nurse and an attorney.

But the most important roadmap may be the positions she’s held previously with CROs, outside firms hired by a pharmaceutical company to provide a wide range of support services. That may include managing the day-to-day operations of a drug study or even serving as an outside monitor, making sure that each site follows a protocol correctly and meets FDA standards. In honing the pharmacovigilance skills she now uses at GSK, Anderson mastered the nuances of adverse event reporting and the importance of being detail-oriented as a drug safety scientist. “We need to know the ins and outs of what happens,” she says, “so that we can look for trends that may prompt us to change our label or even our product.”

Likewise, as a diabetes-musculoskeletal medical professional for Indianapolis-based Eli Lilly and Company, Marla Neal, RN, BSN, MHCA, educates health professionals about drugs and devices that may help their patients. When physicians and other practitioners pose questions of the sales force, she’s tapped to provide the definitive answer. Neal accesses every possible database and medical professional to respond to each request. She also updates sales members about current clinical trials while helping them understand how each Lilly product impacts a disease process.

But it’s her other priorities—capturing accurate information about unexpected side effects and product complaints—that really tap her nursing skills. “Oftentimes patients don’t even realize that they’re having an adverse event,” she says. “So I’m very diligent about asking the direct questions and picking through the subtle conversation for clues. It’s critical for making sure that our drugs are really improving the lives of our customers.”

Adds Shannon Bradley, RN, a telehealth nurse educator and team lead for The Lash Group, a Charlotte, North Carolina-based patient services support company: “When you’re speaking to someone on the phone, you need to ask the right questions because people don’t always come forth with information on their own. You have to help them identify what’s important.”

Bradley is the nursing voice on the other end of the line when patients, pharmacists, and other health care professionals make contact with her company’s Dallas office, usually by dialing the “800” reporting number on a medication’s packaging. Using her clinical intuition, honed as a hospital neonatal intensive care unit and trauma nurse, she collects and reports adverse events linked to medications manufactured by one of her firm’s pharmaceutical company clients. It’s a varied list, from digestive and fertility drugs to oncology and neurology medications.

But her primary role is often to educate and support patients in staying the course with their medication. For no matter how many drugs move from clinical trial to market, they aren’t effective if they’re not taken according to directions. “We want them to understand,” she says, “the significant impact medication compliance has on their therapy outcome.”


Reaping Rewards: Better Health and Other Benefits

Besides bedside nursing, there may not be a better way to use your skills and intuition than in drug development. You might not be the academic researcher or laboratory scientist behind a preparation, but you can help bring a drug the final distance via other roles. Truth is, by participating in the process once it involves ordinary people, you’re witnessing cutting-edge medications making dramatic differences in the quality of real lives. A grandmother who couldn’t comb her hair or walk without a cane before an arthritis drug trial, for instance, performs both tasks eight months into it. A grandfather who couldn’t play with his grandchildren now travels across country to romp with them.

As to Menefee, the landmark A-HeFT trial left her with many good feelings about being a co-investigator in the drug improvement process. Even though she didn’t place many African Americans in the trial, the protocol has worked so well since that now whenever a black heart failure patient in her practice meets the medical criteria, she prescribes ISDN/HYD to optimize their other meds. She hasn’t been disappointed yet.

The medication duo not only gives her more options in extending quality of life, but also serves as proof that research works. Every trial success, as well as every study failure, just reinforces her belief in the benefits of being part of the process. “Before a drug is even approved, I already know something about it,” she says. “So when it’s brought to market, I don’t need a sales rep to tell me how great it is. I know because I’ve already been involved with it. I’ve seen it work!” MN


Running the Gauntlet

The lengthy and complicated process of moving a drug to market is broken down into various phases. After a pre-clinical development stage during which animal and other laboratory tests have proven that a product is initially safe, the emphasis shifts to human or clinical trials. Although most drugs never reach that stage, the ones that do undergo a rigorous process in winning FDA-approval.

           Phase I: A drug is tested on 20 to 80 healthy volunteers not only to see if it’s initially safe but also to determine the most frequent side effects.

•           Phase II: If the drug hasn’t produced unacceptable levels of toxicity during the first phase, it’s tested in a few dozen to 300 subjects with the condition or disease to obtain preliminary data on how well it’s working.

•           Phase III: If a drug demonstrates a good level of effectiveness, it’s tested in an expanded pool of subjects, from several hundred to about 3,000, to see how it works with different dosages, populations, and in combination with other drugs.

•           Phase IV and other post-marketing studies: Conducted after the FDA has approved a given drug, these trials are used to gather additional information about safety, efficacy, and even other uses.