Thriving as a Nurse in Underserved Communities

Thriving as a Nurse in Underserved Communities

Many rural and urban communities face a shortage of qualified health professionals to meet the population’s needs. These underserved communities face unique challenges and nurses working in these areas need unique skills to meet those challenges.

What’s it like working as a nurse in an underserved community? What skills and qualities should nurses have in order to succeed in this area?

Amanda Buccina, BSN, is an RN for the Street Outreach Nurse Program for WellSpace Health in partnership with Sutter Health. She says that nurses should have a passion for working with underserved communities, possess strong coping skills, and understand the importance of self-care. She also notes that nurses working with underserved populations should be interested in and willing to make deep connections with people from all walks of life.

If you are thinking about pursuing a career as a nurse in an underserved area, these tips will help you succeed.

Understand the Culture

Erin G. Cruise, PhD, RN, NCSN, associate professor, Radford University School of Nursing, who has worked in public health and school nursing in rural areas and small hospitals for more than 10 years, says that nurses wishing to work in rural, underserved areas, and/or with vulnerable populations need to have a good foundation in clinical skills, organization, and communication. Cruise also emphasizes the importance of understanding the cultural dynamics of the community.

“Small hospitals and community agencies generally found in rural areas are often part of a close-knit community,” says Cruise. “People know each other and they want to know the nurse caring for them on a more personal level.”

Cruise says that new rural nurses can be taken aback by the expectation of openness. “Some nurses are not comfortable with having their personal lives become an open book,” she says. “It can be a thin line between patients just being friendly and curious and the nurse feeling that he/she lacks the privacy and anonymity found when working in larger agencies and big cities.”

People in rural or small town communities are also more likely to ask questions about private health information regarding their neighbors. “While neighborly concern and curiosity are usually quite innocent, nurses in these settings must be very careful and familiar with HIPAA and their own hospital or agency policies on confidentiality to avoid sharing that information inappropriately,” warns Cruise.

Build Strong Patient Relationships

A typical day for Buccina includes walking and driving around Sacramento, CA, meeting with patients on the streets, without the convenience of a full clinical facility. She works hard at building trust with her patients.

“A lot of my job is relationship building,” says Bucinna. “I work to build trust and rapport with my clients so even if they don’t need me in that exact moment, we have a relationship and familiarity with one another. I’m there when clients do want and need support, like medical advice, an advocate at a doctor’s appointment, help getting into an alcohol or drug rehab program, or just general wound care.”

Provide Judgment-Free Care

Cruise notes that many vulnerable people lack the resources that allow them to manage their health effectively, and nurses should be prepared to meet these patients right where they are, without judgment.

“They may have low literacy, live in poverty, live in environments that are polluted, run down, or crime-ridden; and work in jobs with low pay and dangerous conditions,” says Cruise. “People in these situations will pick up on a disapproving attitude by the nurse and shut down, shut the nurse out, and be less likely to follow his or her health care directions. Nurses should adopt a caring approach. While not condoning negative or criminal behaviors, accepting clients as they are and demonstrating concern for their health and well-being are more likely to motivate them to listen to the nurse’s advice and make positive changes.”

Jan Jones-Schenk, national director of Western Governors University’s (WGU) College of Health Professions and chief nursing officer for WGU, encourages nurses working with underserved populations to avoid making assumptions about their patients.

“Don’t label or assume individuals who don’t follow prescribed advice are non-compliant,” says Jones-Schenk. “There may be financial, social, physical, or cultural reasons why individuals do not follow the advice given. In such cases, the problem can easily be that it’s the wrong advice for that patient. Taking a patient-centered approach means the advice given has to be something the patient thinks makes sense too.”

Jones-Schenk advises nurses to remain open to listening carefully to understand the barriers and limitations individuals may be facing.

Gain Mental Health Experience

Buccina says that her best advice for nurses considering working in underserved communities is to gain some experience in mental health in order to understand human growth and development from a psychological perspective, and to become well-versed in social issues in order to avoid judgment and approach the population from a place of knowledge and compassion.

Practice Self-Care

Finally, Cruise advises nurses working with vulnerable populations and/or in rural areas to find the time and space to take care of themselves.

“Because these communities are close-knit and vulnerable populations, they may mistake the nurse’s caring approach for a desire to have a more personal relationship. The nurse will have to set boundaries in a way that is kind and not perceived as rejecting of the client, yet allows the nurse to be seen as a professional and not just a friend,” says Cruise.

Jose Sala Shares His Passion for Critical Care Nursing

Jose Sala Shares His Passion for Critical Care Nursing

The American Association of Critical-Care Nurses held its annual National Teaching Institute and Critical Care Exposition this week in Houston, TX. During the four-day event, 25 acute and critical care nurses were presented with the Circle of Excellence Award, recognizing their efforts to achieve optimal patient outcomes.

Jose Sala, night nurse manager, surgical and liver ICU at Houston Methodist Hospital, was among this year’s honorees.

“I feel so honored and privileged to be a recipient of this prestigious award,” says Sala. “I consider it one of my most rewarding accomplishments. I dedicate it to my family, my former professors, and preceptors, and most importantly, the patients whom I’ve cared for at the bedside during the past nine years. They have been my best teachers.”

Sala earned his BSN in 2012 from the University of Texas Health Science Center at the Houston School of Nursing and feel in love with critical care nursing during his capstone preceptorship in a general medical/surgical trauma ICU in South Texas.

“I was awed and impressed by how knowledgeable my preceptor was about pharmacology, pathophysiology, and patient management,” says Sala. “I saw how she was such an integral part of the critical care team, and how she had finesse, confidence, and a strong rapport with the surgeons and intensivists and all the other professionals in the unit. That two-month period played a seminal role in my journey in critical care.”

In his current role as the night nurse manager in the surgical and liver ICU, Sala has had the opportunity to work on initiatives that have improved not only patient care, but the overall work environment for his team. These initiatives led to his Circle of Excellence award.

He is most proud of his work to develop “flash rounds” in his unit – an initiative that directly impacts patient outcomes.

“Together with Dr. Atiya Dhala, one of our intensivists, and with the support of my director, Michele Ramirez, I implemented what we called “flash rounds” in our unit that focused on the ABCDEF bundle,” explains Sala. “This bundle aims to prevent the unintended consequences of critical illness, including delirium, prolonged ventilation, and excessive muscular deterioration. Every morning, at 8 a.m., each and every bedside staff nurse presented their patient to the team – the intensivists, nurse practitioners, residents, physical therapists, and respiratory therapists – as they rounded on the whole unit. Strictly focusing on these components and separate from teaching rounds, the flash rounds set the tone for the day for the team. This was not only met with much enthusiasm and support by most of our staff, but it also helped increase the mobilization rate, decreased our self-extubations, and reduced our ventilator days.”

Sala has also worked hard to improve his unit’s work environment.  

“One of our key challenges in our unit was the rocky transition of our new graduate nurses (GNs) into clinical practice,” he says. “I mentored a group of GNs whose project for their nurse residency program was to create a buddy program that paired upcoming GNs with a buddy (who is a different person from their preceptor). This allowed them to integrate more easily into the culture and fellowship in the unit.”

Sala offers this advice to aspiring critical care nurses: “Work hard and study hard, and don’t lose sight of your goals. When you do rotations in nursing school, or work in any unit, find key mentors who can either directly guide you in the process of becoming a critical care nurse, or introduce you to people who can. Be inquisitive, read widely, and always ask questions.”

Nursing Careers Beyond the Bedside

Nursing Careers Beyond the Bedside

When many people think of a nurse, they most likely picture someone wearing scrubs and working directly with patients in settings such as hospitals, clinics, and doctor’s offices. But there are nursing careers that don’t focus on providing direct patient care, but still greatly impact the health outcomes of communities.

If you’re a brand new nurse, a few years of clinical experience can be great training ground in gaining valuable first-hand knowledge of the issues, challenges, and best practices that nurses can only learn in the field. But keep in mind that there are many rewarding careers outside of clinical settings.

Here are a few careers to consider to take your nursing career beyond the bedside.

Leadership Roles

Nurses in leadership roles perform a wide variety of duties and need many skills beyond providing patient care. Positions in nursing leadership include nurse manager, health care administrator, or care manager. These roles are more administrative and require strong leadership, financial and strategic planning skills.

Nurses working in leadership positions manage nurses, create budgets for their departments, and develop, plan, and implement programs and procedures for improved patient outcomes.

If working in a leadership role interests you, be sure to develop your leadership skills early. Get involved with nursing associations and seek out leadership roles whenever you can. And be sure to look for opportunities to mentor other nurses. If you’re still in school, look for leadership opportunities within your student nursing association.

If you’re serious about a career in nurse leadership, consider earning an MS in Nursing Leadership degree.

Nurse Educator

If you are interested in one day teaching the next generation of nurses, consider a career as a nurse educator.

Nurse educators teach nursing to college students and practicing nurses in academic and/or health care facilities.

Nurse educators develop curriculum and must have a high level of nursing experience and expertise. You will be required to hold a bachelor’s degree in nursing, be an RN, and complete a graduate-level nurse educator program to succeed in this specialty.

Health Policy

If you have a passion for advocating for legislative change, a career in health policy may be for you. Health policy nurses work on a variety of public health issues such as tobacco control or care for the aging.

According to, health policy nurses work to create an overall healthier society through advocacy, research, and analysis. They work in health service research firms, legislative offices, health care provider associations, or hold elective office.

In order to succeed in health policy, you’ll first need to obtain a master’s degree in nursing and complete a 10-week health policy program. You’ll also need strong leadership, communication, and analytical skills.

Gain experience by getting involved in nurse advocacy as a volunteer. The American Nurses Association is a great resource to get started in advocacy work.

Nurse Recruiter

Transitioning from direct patient care to nurse recruiting can be a fast-paced and exciting career for nurses who are interested in the human resources side of health care.

In a nutshell, nurse recruiters screen, interview, and recommend candidates for open positions in the health care industry. Recruiters also provide career guidance to candidates, negotiate job offers and stay up-to-date on the latest job search trends.

Nurse recruiters possess strong communication and sales skills. You’ll need a bachelor’s degree in nursing, as well as a strong clinical background to gain entry into this field.

Thinking about career options beyond patient care can open up many opportunities for nurses and may just be the perfect fit for you.

Should You Participate in a Student Loan Forgiveness Program?

Should You Participate in a Student Loan Forgiveness Program?

Many nurses consider entering into a public service or government position after graduation in hopes of qualifying for a student loan forgiveness program.

It sounds great, right? Work for 10 years in the public sector and your student loan balance will disappear. It does sound great, but recent news that the Department of Education (DOE) is calling the approval letters of the Public Service Loan Forgivness (PSLF) program “invalid” have many borrowers concerned.

Launched in 2007, the PSLF program agreed to forgive student loan debt for borrowers who worked for 10 years in qualifying public-sector jobs, made 120 timely loan payments, and submitted an annual employment certification form. Many professionals, including nurses, entered the program with hopes that their years of public service would result in their student loan debt being wiped out.

This fall, borrowers who entered the PSLF program in 2007 are scheduled to have their loans forgiven. But the DOE sent notices last year that many workers were no longer eligible and that previous letters of acceptance were no longer binding. The American Bar Association responded with a lawsuit against the DOE, and many of the nearly half a million borrowers in the program are left in confusion over the status of their loans.

PSLF isn’t the only student loan forgiveness program out there for nurses. If you are thinking about entering a loan forgiveness program, here are some important factors to consider.

Make Sure You Know the Rules

Many borrowers in the PSLF program are facing challenges with ensuring they are following the program’s guidelines over 10 years. For example, borrowers who received letters that their promise letters may be invalid thought they were in good standing with the program, were working for qualifying organizations, and were making income-based repayments based on the program’s guidelines.

It’s important to keep on top of any repayment programs you may enter and watch for changes in the requirements. However, this isn’t a sure-fire guarantee of repayment as the borrowers in the PSLF program are currently experiencing uncertainty.

Limited Earning Potential

Many of the borrowers currently in the PSLF program have worked for lower incomes in public service jobs for nearly 10 years, greatly limiting their earning potential. Before you enter a public service nursing position for the sole purpose of loan forgiveness, do the math to make sure it will actually pay off in the long run. For instance, if you could make a much higher salary and increase your repayments over 10 years, is it worth it to limit your salary/career prospects for a decade?

Be sure to evaluate the time commitment required in the program to ensure it’s not keeping you in debt longer than necessary.

It Could Slow Down Debt Reduction

Many nurses are able to repay student loans on their own by cutting expenses and avoiding lifestyle inflation. If you could get yourself out of student debt in a few years, why wait 10 years?

Research the Program’s Track Record

Despite the controversy surrounding the PSLF program, there are programs out there with good track records. It’s a good idea to look for programs with strong histories and examples of nurses who have had their loans paid off.

For example, programs like NURSE Corps, which awards scholarships and loan repayment to nurses, nursing students and nurse faculty, have long track records of student loan forgiveness.

NURSE Corps pays for 60% of unpaid nursing education debt over two years, with an option to extend to a third year for an additional 25% of the original balance. Program participants are required to “work for a minimum of two years in one of the thousands of Critical Shortage Facilities across the country, including hospitals, clinics, and other facilities experiencing a critical shortage of nurses.”

Since 2007, 8,321 nurses have successfully completed the NURSE Corps Loan Repayment Program.

In addition to the NURSE Corps program, the National Health Service Corps offers a loan repayment program that funds nursing awards to primary care nurses. Since its inception, 4,655 nurses have successfully completed the NHSC Loan Repayment Program.

Evaluate Your Career Goals and Passion

In conclusion, many nurses are passionate about working in the public sector and would happily choose to work for clinics and non-profits with strong missions to help underserved communities – whether it came with the promise of loan forgiveness or not.

But for others, it wouldn’t be a first choice and they should use caution when making career and financial decisions within a loan forgiveness program.

Student loan forgiveness programs can be complicated to understand and something that nurses should thoroughly research before committing to them.

If you decide to participate in a loan forgiveness program, be sure you are complying with the rules by evaluating your status on a regular basis and keeping up with the latest news about the program to make certain it’s still a viable repayment option.

Is that Job a Good Fit? How to Research Potential Employers

Is that Job a Good Fit? How to Research Potential Employers

So you’ve decided to search for a new job. Maybe you’re looking for higher pay, more advancement opportunities or a better work environment. There are many reasons why nurses desire to make a job switch.

The job search can often feel like a daunting task. You need to prepare your resume and cover letter, network in the field, and prep for interviews with potential employers.

While it’s important to spend time polishing your resume and practicing your interview skills, don’t skimp on an important part of any job search – company research.

Researching a potential employer means more than just reading their job post and employee benefits summary. Many jobs sound great on paper. But it’s wise to make sure the company is a good fit for your career goals and work style. The job post may sound like your dream job; however, it’s important to make sure the organization you’ll be working for is also your dream employer and an organization where you can grow your nursing career.

Another key benefit for researching a company is that it helps you prepare for job interviews. Many HR managers will ask candidates directly what they know about the organization and why they want to work there. Answering these questions with “I want to impact patient health outcomes” isn’t enough to impress a recruiter. You want to be armed with good company research so you aren’t thrown off by these questions.

Here are a few key areas to consider when researching potential employers.

Culture Fit

The culture of an organization includes size, policies, atmosphere, brand, and goals. Start by exploring the company website and social media profiles. Does the company’s online presence feel conservative? Or does it feel innovative and fun? Some organizations have an HR section on their website where they post employee policy handbooks and benefits information. Read through these to get an idea of their attendance policy, time-off allowances, and fringe benefits. It can be difficult to assess the culture online, but it’s a great starting point.

Management Style

You’ll want to ask questions about the organization’s management style during your interview. Find out who you will report to and ask them how they describe their management style. Does the manager talk in terms of helping nurses succeed and advance? Listen carefully to the manager’s answers, because this person may be your manager if you get the job.

Employee Reviews

You can find more than product reviews online these days. Employees are reviewing their employers on websites like

Another great resource is LinkedIn. Use it to search for current and past employees and connect with them to get their feedback on what it’s like to work for the company you’re considering. It’s worth it to do some digging and get insight from actual employees. This is inside information you aren’t likely to get from the HR manager during your interview.

Advancement Opportunities

Avoid stalling your career growth by using LinkedIn to find out if the company likes to promote employees from within. Ask your contacts about advancement opportunities. Read profiles of current employees to see if they have held a series of advancing positions while working there. If you land an interview, ask for examples of employees who have been promoted from the position you’re interviewing for.

If you’re a new nurse with dreams of advancing your career and education, you’ll want to be in a culture that promotes its talent from within.

Also be sure to research the health of the company. If it’s a hospital, is it growing? Are they keeping up with cutting-edge technology and offering the best patient care in the area? These are signs that you can grow your career right along with the organization’s growth.

By making company research a key part of your job search strategy, you are more likely to land in a job that will be a great fit for years to come.