Tony Omlor, RN, BSN, CCRN, knows the 13 years he spent caring for critically ill patients was a good investment of his time. But like many nurses, he grew frustrated watching people suffer and he eventually began to look for ways to use his nursing skills to help people avoid serious illnesses. “Darn it,” he thought, “there’s got to be something I can do to keep people from getting to this point.” Today, as clinical manager for heart and vascular services at Grant Medical Center’s health and fitness center in Columbus, Ohio, Omlor is doing just that.
Helping Americans stay healthy and prevent disease is one of the main thrusts behind an emerging trend that combines nursing with some aspect of fitness or sports. Although the nursing profession has yet to officially develop a specialty in “fitness nursing” or “sports nursing” on either the professional or academic level, a growing number of nurses are becoming involved in these areas.
The connection between physical fitness, wellness and disease prevention is well documented. As a result, hospitals and HMOs around the country have begun opening fitness centers and offering wellness programs with information on nutrition, stress management and exercise. Many corporate employers, meanwhile, have begun offering on-site fitness programs and wellness centers for their employees.
In addition to these practice settings, nurses can also find job opportunities working for professional sports teams, college and university athletic departments, and hospitals, clinics and orthopedic practices that have sports medicine or sports injury programs. Some nurses are involved in sports medicine on a full-time basis while others work on a part-time, contract basis for sports teams.
For example, some nurses work for professional football teams each summer, evaluating the health and fitness of players who are either preparing for another season or trying to make the team for the first time. Other nurses work professional baseball games, either sitting in the dugout to help injured players or treating injured fans at the first-aid stations.
Taking Fitness to Heart
Perhaps the most direct transition from traditional nursing to fitness or sports nursing takes place in cardiac rehab units at hospitals. Patients who have suffered a heart attack or other cardiac event recover by improving their conditioning. Thanks to cardiac rehab nurses, they also learn the proper way to exercise, get encouragement to continue exercising and receive nutritional information designed to improve their diets.
“It’s a refreshing atmosphere with healthy patients coming and going,” Omlor says. “When all you see are people who are very ill, it wears on you after a while.”
Although people who live and work in the neighborhood also use the Grant Fitness Center to work out, the nurses work exclusively with hospital patients recovering from illness. Patients work out in classes that typically number between eight and 10 people, although some classes have as many as 22.
The nurse–or two nurses for large classes–doesn’t work with patients the way a personal trainer would, Omlor explains. Instead, they move from patient to patient as they exercise, watching for signs of exertion such as an elevated heart rate or blood pressure. They also monitor the patient’s EKG to make sure they’re tolerating the exercise. Sometimes a nurse will stop and interview a patient to see how they’re feeling and how they’re progressing in the program, which typically runs about 12 weeks.
Nurses are also responsible for taking action when a patient shows signs that are outside the normal guidelines, such as a patient who comes in with elevated blood pressure. “The nurse is the one who has to intervene, call a physician, find out what to do and implement treatment,” says Omlor.
Along with exercise, most cardiac rehab programs include information on diet and stress management. Nurses work with physical therapists and nutritionists to develop a plan to help each patient recover in the best possible manner.
According to Omlor, the atmosphere in the health and fitness center is so enjoyable that he has no problem filling open positions. Nurses are clamoring to escape the more stressful atmosphere found in other practice settings. It isn’t all fun and games, though. Omlor has had to call on his prior experience as a critical care nurse to help patients who have suffered heart problems while working out.
“The first time I defibrillated a patient here, I had done it so many times that it seemed routine,” he recalls. “You have to know how to do things like that and you have to be comfortable dealing with that situation.” Nurses who work in a cardiac rehab program must have ACLS certification and be able to do the basics, such as starting an IV. Omlor believes a background in critical care nursing is also important, whether it be in an ICU, catheterization lab, open heart step-down unit or on an open heart floor.
Setting an Example
Another important quality nurses working in cardiac rehab programs must have is an appreciation for exercise. And not just in the intellectual sense–they must value it so much that they incorporate it into their own lives.
It’s a matter of walking what you talk, Omlor explains. “Patients respect it when the person who is taking care of them actually does the exercises. They’re much more willing to listen if they see it’s important to you.”
One of the first things a patient will ask a nurse in a cardiac rehab program is what sort of exercise he or she does to stay in shape and stave off illness. Telling the patient to “do as I say, not as I do” won’t cut it, Omlor warns. “To that patient, you’ve lost all credibility if you’re not doing something [to keep yourself fit].”
Some patients get the chance to see nurses and other health care professionals practice what they preach. Omlor says he has never been to a cardiac rehab unit that didn’t encourage the employees to use the exercise equipment. Seeing nurses squeezing a few reps into their schedule on their lunch hour or coffee break goes a long way with patients and adds an element of fun to the job.
Although some patients need to be prodded to exercise, others need to be reined in. “Younger males will come in with an idea of how they used to work out and try to resume that form right after having a heart attack,” says Omlor. “They’ll be huffing and puffing, sweating profusely and straining for that last rep. That’s when a nurse has to step in and remind them: ‘This is a gym but you’re in a cardiac rehab program.’ If they feel like you’re taking something away from them, you have to be careful because that can deteriorate quickly into an ugly situation.”
Although the hours are great for a nurse–7 a.m. to 7 p.m. weekdays–there are other rewards that make working in a cardiac rehab program worthwhile. Some patients enter the program angry and sullen, but somewhere along the way they make the transition into happy, even jovial people. “When you go home from work after experiencing something like that, you’re walking 10 feet off the ground,” Omlor declares. “There’s no paycheck that can compare to that.”
Fitness for the Medically Underserved
Because fitness nursing is still an emerging field, it can offer nurses entrepreneurial opportunities to design their own careers. Lori Radcliffe, RN, BS, CPT/CFC, has turned her interest in fitness, nursing and humor into a business called “Jest” for Fitness & Food. The Eatontown, N.J. resident is an African-American nurse who is also trying to introduce fitness to low-income communities that are underserved or ignored by other health care workers.
Radcliffe teaches classes in Pilates and dance and movement therapy at a nearby nursing school, a hospital and the Rutgers University athletic center. However, she says, fitness nursing as a specialty has not yet progressed to the point where nurses will find job listings under that title.
“You have to be careful not to jump right into the fitness area,” Radcliffe cautions. “It’s something that you have to balance between what you’re currently doing [as a nurse] and the skills you’re trying to develop.”
Radcliffe’s own evolution from RN to fitness nurse came quite naturally. A longtime athlete who received an athletic trainer’s scholarship in college, she first earned a degree in kinesiology before continuing her education by earning a nursing degree. She later became a certified kickboxing instructor and has used her nursing credentials to help her secure work in the fitness field.
“I have contracts with these places [where she works] and I know they hired me because I was a nurse first,” she explains. “I’m not saying someone with [just] a fitness background couldn’t have done it, but the way I got in there was through my contacts in nursing.”
For instance, Radcliffe was recently trained in The Lebed Method of dance and movement therapy for breast cancer survivors. She received the training because the hospital for which she teaches the class wanted a nurse to teach the course to its breast cancer patients.
“They wanted somebody [with medical background] so the doctors would be more comfortable with it,” she says. “Over the years, the connections I’ve made being a nurse have helped me.”
According to Radcliffe, a nurse doesn’t need a degree in kinesiology to become a fitness nurse, but a national certification as a personal trainer would be a big help. She says fitness nurses can’t demand the fees that personal trainers get ($50 to $150 an hour), but it’s not unreasonable for a nurse to charge a rate of $50 to $60 an hour.
Fitness and nursing are a natural combination, she adds. “Nurses generally like to help people anyway, and I think it’s a natural avenue for someone who likes health and wants to help others.”
Healing Injured Athletes
Frederick Brown, RN, MS, ONC, APN, a sports medicine nurse at Midwest Orthopaedics in Chicago, finds rewards in his job as well. He works as a nurse for an orthopedic surgeon who specializes in shoulder and elbow surgeries. Midwest Orthopaedics has 35 to 40 physicians who specialize in various orthopedic injuries, many of which are sports- related. Brown estimates that the physician he works for has performed more than 300 shoulder surgeries in 2004.
The doctors perform surgery on athletes as young as 12 (usually gymnasts) as well as college-age athletes. The physician for whom Brown works has patients who are baseball players, basketball players, swimmers and wrestlers. Midwest Orthopaedics provides orthopedic services for the Chicago White Sox professional baseball team and the Chicago Bulls basketball team. The facility also treats people who have been injured on the job as well as elderly people who have to have an entire joint replaced.
“I think the biggest challenge for me is that not only are you taking care of the patient but there’s usually a parent involved and sometimes a coach, depending on the player’s level of expertise,” Brown says. “If you have enough of those types of people in your practice, that’s a lot of people you’re taking care of.” He often finds himself dealing with parents, coaches and athletes who are anxious about whether the patient will be able to return to his or her sport.
These days, Brown mostly works in the areas of administration and education. The latter role usually involves breaking information down into simple terms so the patient and others can understand their injury and their expectations for recovery. “You have to describe to patients and parents and coaches–and even physical therapists–exactly what the injury means and what the treatment plan is,” he explains. “With most people, you have to tell them a few times before it actually sinks in.”
He goes over the surgical procedure, recovery and the rehabilitation protocol. Sports nurses don’t actually work with the patient on rehabilitative exercises. That’s the domain of physical therapists. But the nurses work with the PTs and physician’s assistants to move patients through the various phases of recovery.
Another challenge Brown has learned to overcome is his lack of sports experience. He has never played many of the sports played by his athlete patients. “It’s important to know some of the mechanisms that go along with the sport,” he says. “For me it was somewhat of a steep learning curve.”
Perhaps the hardest part of a sports nurse’s job is dealing with an injured patient who will never be able to return to his or her sport. Sometimes the athlete has dedicated his or her life to that sport and suddenly is unable to continue. The question for the athlete then becomes: What do I do with my life?
There are, however, many other instances when all goes well and the athlete is able to return to competition. Brown says the physician for whom he works often receives letters from athletes thanking the doctor and nurse for helping them return to competitive sports. One female weightlifter sent them a photo of herself with the trophy she won at a power-lifting tournament.
Take Me Out to the Ball Game
Some opportunities in sports medicine let nurses get even closer to the action. Ruth Allen, RN, an administrative nurse in the psychiatric unit at Alameda County Medical Center in California, turned her love of baseball into a part-time job. This 69-year-old African-American mother of three grown sons is a nurse for the Oakland A’s professional baseball team, working in the first-aid station at home games. She became a team nurse when a colleague spotted Allen at a game and asked her to fill in for her while she was on vacation. The colleague never came back to work.
Allen says she took the job because, as a season ticket holder, she would have been at the games anyway. She and her sons are avid baseball fans and the job provided her with free entry to the game plus tickets for friends and relatives.
She has worked A’s games for 25 years, sharing duties with another nurse. Allen works roughly half the A’s home games, fitting them into her schedule when not working at the hospital.
According to Allen, the most common injuries suffered at baseball games are burns (from the steam or burners in concession stands), ankle injuries (people trip and stumble a lot at games) and injuries incurred when someone gets hit by a foul ball–which, she says, typically happens three times during an average game.
Fans have also suffered heart attacks and strokes at games. Plus, team nurses often provide monitoring and education for ballpark employees, many of whom are retirees with health problems such as diabetes and hypertension.
Nurses won’t get rich working at baseball games, Allen says. The pay rate is between $19 and $21 an hour. She arrives about two-and-a-half hours before the game and leaves about an hour-and-a-half after. But still, the perks are nice. She can get six to eight tickets a game, if needed, and does so whenever her sons visit from out of town. She also has quite a collection of souvenir shirts and jackets and the much-coveted bobble-head dolls.
Nurses believe medical errors could be reduced if the medical devices hospitals rely on for testing, monitoring, and treating patients could seamlessly share information, according to the results of a national survey of more than 500 nurses conducted online by Harris Poll on behalf of the Gary and Mary West Health Institute.
Each year, it is estimated that more than 400,000 Americans die from preventable medical errors. This not only takes an enormous emotional toll on families and friends, but also places a heavy economic burden on the nation—an estimated trillion dollars or higher. As hospitals wage a war on error, there is growing appreciation that medical devices, while individually safe and effective at improving care and saving lives, can create risks for patients and challenges for clinicians when not seamlessly connected.
According to the survey, half of these nurses said they witnessed a medical error resulting from a lack of coordination among medical devices in a hospital setting. Devices include everything from infusion pumps, ventilators, pulse oximeters, and blood pressure cuffs to electronic health records. The weighted survey was conducted online from January 7–16, 2015, and included 526 nurses (credentialed at RN or higher and with an education of BSN or higher) who work full–time in a non–school setting.
Among these nurses, three in five (60%) said medical errors could be significantly reduced if medical devices were connected and shared data with each other automatically. This problem could be addressed by the widespread adoption of open communications standards that allow for the safe and secure exchange of data.
“Nurses are the front line of patient care and have an unrivaled ability to identify and address problems at the intersection of patients and technology,” says Dr. Joseph Smith, West Health Institute’s chief medical and science officer. “The survey helps show how much of a nurse’s time could be better spent in direct care of patients and families, and how errors could be potentially avoided if medical devices, which have been so successful at improving patient care, were able to take the next step and seamlessly share critical information around the patient’s bedside.”
Medical device interoperability, the ability to safely share health information across various technologies and systems, could provide important benefits such as enhanced patient safety and better clinical outcomes at a lower cost. The West Health Institute has estimated that a system of connected devices could potentially save more than $30 billion each year by reducing redundant testing, manual data entry, and transcription errors.
According to the survey, nearly half of these nurses (46%) said an error is extremely or very likely to occur when information must be manually transcribed from one device to another.
“I have seen many instances where numbers were incorrectly transcribed or put in reverse or put in the wrong column when typed manually, which can cause errors,” said one nurse who participated in the anonymous poll.
But perhaps even more important, transcribing data “takes way too much time for the nurses to adequately care for the patient,” one nurse responded. Many of these nurses agreed, with more than two out of three (69%) saying manually transcribing data is very likely to take time away from patients who need attention.
“Nurses enter the profession because they want to care for patients, not because they are interested in programming machines,” says Patricia H. Folcarelli, RN, senior director of Patient Safety at the Silverman Institute for Health Care Quality and Safety at Beth Israel Deaconess Medical Center. “As many as 10 devices may monitor or treat a single patient in an intensive care unit. The nurse not only has to program and monitor the machines, he or she often spends a significant amount of time transcribing data by hand because the devices are not designed to share information.”
“It’s time that we free our health care workers to do what they do best and what they are most needed for, which is caring for patients,” says Smith. “Let’s not ask busy clinicians to do those things that technology can automate easily and effectively. Medical device interoperability can save lives, time, and money, and at the same time allow nurses to focus on caring for patients.”
ABOUT THE WEST HEALTH INSTITUTE
The Gary and Mary West Health Institute is an independent, nonprofit medical research organization that works with health care providers and research institutions to create new, more cost–effective ways of delivering high–quality care. For more information, visit www.westhealth.org.
With more than 86 million Americans living with prediabetes and nearly 90% of them unaware of it, the American Medical Association (AMA) and the Centers for Disease Control and Prevention (CDC) announced in March that they have joined forces to take urgent action to prevent diabetes and are urging others to join in this critical effort.
Prevent Diabetes STAT: Screen, Test, Act – Today™, is a multi-year initiative that expands on the robust work each organization has already begun to reach more Americans with prediabetes and stop the progression to type 2 diabetes, one of the nation’s most debilitating chronic diseases. Through this initiative, the AMA and CDC are sounding an alarm and shining a light on prediabetes as a critical and serious medical condition.
“It’s time that the nation comes together to take immediate action to help prevent diabetes before it starts,” says AMA President Robert M. Wah, MD. “Type 2 diabetes is one of our nation’s leading causes of suffering and death—with one out of three people at risk of developing the disease in their lifetime. To address and reverse this alarming national trend, America needs frontline physicians and other health care professionals as well as key stakeholders such as employers, insurers, and community organizations to mobilize and create stronger linkages between the care delivery system, our communities, and the patients we serve.”
People with prediabetes have higher-than-normal blood glucose levels but not high enough yet to be considered type 2 diabetes. Research shows that 15% to 30% of overweight people with prediabetes will develop type 2 diabetes within five years unless they lose weight through healthy eating and increased physical activity.
As an immediate result of this partnership, the AMA and CDC have co-developed a toolkit to serve as a guide for physicians and other health care providers on the best methods to screen and refer high-risk patients to diabetes prevention programs in their communities. The toolkit along with additional information on how physicians and other key stakeholders can Prevent Diabetes STAT is available online at www.preventdiabetesstat.org.
Over the past two years, both the CDC and the AMA have been laying the groundwork for this national effort. In 2012, the CDC launched its National Diabetes Prevention Program based on research led by the National Institutes of Health, which showed that high-risk individuals who participated in lifestyle change programs, like those recognized by the CDC, saw a significant reduction in the incidence of type 2 diabetes. Today, there are more than 500 of these programs across the country, including online options.
The AMA launched its Improving Health Outcomes initiative in 2013 aimed at preventing both type 2 diabetes and heart disease. That work includes a partnership with the YMCA of the USA to increase the number of physicians who screen patients for prediabetes and refer them to diabetes prevention programs offered by local YMCAs that are part of the CDC’s recognition program. This joint effort included 11 physician practice pilot sites in four states, where care teams helped to inform the development of the AMA and CDC’s toolkit. In the coming months, the AMA will be identifying states in which to strengthen the linkages between the clinical care setting and communities to reduce the incidence of diabetes.
“Long-term, we are confident that this important and necessary work will improve health outcomes and reduce the staggering burden associated with the public health epidemic of type 2 diabetes,” says Wah.
Erma Willis-Alford, BSN, RN, is quick to say that her experience as the first African American nurse at Memorial Hospital of Southern Oklahoma is “no Rosa Parks story.”
Unlike the late Parks, who became a symbol of courage in the civil rights era for refusing to give up her seat on a Montgomery, Ala., bus to a white man, the 61-year-old nurse says she experienced little prejudice from colleagues and patients when she joined the Ardmore, Okla., hospital in 1966.
Her story, instead, could more aptly be described as the heart-warming tale of an African American woman embraced by a hospital and city seeking to bring about peaceful integration. Anyone who remembers or has studied the 1960s civil rights struggle will remember that integration often occurred only after overcoming violent resistance.
Willis-Alford says her story is quite the opposite. She wasn’t trying to make a statement or become a civil rights pioneer when she applied for a position at the hospital that now goes by the name of Mercy Memorial Health Center. She just wanted a job. She had become impressed with the hospital after visiting a sick cousin who was a patient there. To a small-town girl from Pauls Valley, Okla., the four-story building looked like a gleaming tower dedicated to modern medicine.
Compared with the one-story hospital in Pauls Valley, a city that to this day has a population of only 9,152 people, the Ardmore facility looked like a skyscraper, Willis-Alford remembers. The well-dressed staff appeared so efficient and professional that she yearned to be a part of it all. So she decided to apply for a job there, “not knowing that they did not have a black nurse and had never had a black nurse on the staff.”
“A Beautiful Experience”
Willis-Alford’s interest in nursing started at a young age and seemed quite natural for someone in her family. Her great-great grandmothers and their sisters had all been midwives and her father worked as a scrub tech in a hospital operating room. She began her formal training as a teenager in 1964, when she enrolled in a first aid class. A year later she took a class to become a nurse’s aide and that same year began work at the Pauls Valley State School, a facility for children born with deformities.
Willis-Alford, who says she has worked in every type of nursing except the operating room, isn’t sure what the administration at Memorial Hospital of Southern Oklahoma had on its mind when they hired her. If there was some plan to integrate the hospital and use her as the guinea pig, they never told her. And they didn’t parade her through the facility as some sort of symbol of brotherly love.
They just put her to work, placing her with two other nurse’s aides who taught her the ropes. Later, when she became a nurse, the floor nurses took her under their wings and trained her so she could work on any floor.
“It was a beautiful experience,” she recalls. “I’m sure there must have been some racism, but it wasn’t blatant. I didn’t see it. I was so eager to work and make a good salary.” She had three children at the time (and would eventually give birth to another) and didn’t have time to worry about what people were saying. “I was more concerned about doing my job, doing what the head nurse asked me to do and doing exactly what the physicians wanted,” she explains.
The hospital staff went out of its way to make her feel included, she adds, and she, in turn, went out of her way to get to know people. Although she didn’t drink coffee or smoke, she willingly joined her colleagues on coffee or smoking breaks because it gave her a chance to get to know them on a personal level. “I would stand there and inhale their second-hand smoke and enjoyed every bit of it,” she laughs.
Willis-Alford, who eventually became supervisor of the hospital’s emergency department, says she never received “the dirty end of the stick.” She was expected to do the same work as any other nurse and never felt she was given more work than others.
Memorial Hospital deserves much of the credit for Willis-Alford’s career progression from nurse’s aide to licensed vocational nurse and, eventually, to registered nurse. The hospital paid for her to attend a 12-month LVN program at Southern Oklahoma Technology Center in Ardmore. When she graduated in 1968, she became the second African American to complete that particular program, which had been established two years earlier. She received her LVN license in 1968.
Three years later, the hospital again provided financial support that enabled her to continue her professional education. They paid for her to attend a two-year RN program at nearby Murray State College. She became the first African-American to graduate from that program, which was also in its second year. But she would not have achieved that milestone if the Ardmore community hadn’t stepped up to help her during a time of family crisis.
In 1973, an accident left her young daughter severely burned and facing months of recuperation and reconstructive surgery. Willis-Alford’s instinct was to quit school and care for her, and she would have done that had it not been for the wives of Ardmore’s Shriners, who offered to tend to her daughter while she attended school each day.
“[They] told me, ‘Go on to school, you get your lessons and learn to be a nurse,’” she says. Later, when she and her daughter traveled to Galveston, Texas, for reconstructive surgeries, two Ardmore physicians offered to let her son stay with them until she returned.
The Shriners’ wives and the physicians were all white. “They’re just that way,” she says, explaining why people went out of their way to help. “They wanted to do the right thing.”
Oil discovered more than a century ago had brought wealth to Ardmore residents, and that wealth bought more than just the stately mansions that still stand along the city’s Sunset Boulevard. It also helped fund five major foundations and endowments that have brought high standards of excellence in medicine, academics and the arts to Ardmore.
Perhaps the fact that the city operated, at least to some degree, on a “higher plane” led Memorial Hospital to integrate so easily and to support Willis-Alford’s aspirations to become a nurse. Or maybe the hospital simply valued her work. “I was told that I gave excellent care,” she says. “I pride myself on doing the right thing for my patients.”
At first, some of the older patients had trouble adjusting to having an African American nurse care for them. Willis-Alford says some used what she calls “the ‘N’ word” to refer to her. She didn’t like the word then any more than she does now.
“But I did not take it out on them, because that’s how they were raised,” she says. “They didn’t know any better. Why would I fight with someone who was ill? You don’t do that. But eventually they would say, ‘Have the black girl come in’ [because I provided such good care].”
Another major step forward took place a short time after Willis-Alford’s arrival at the hospital. Until then, the patients had always been segregated, and minority patients were sometimes placed in hallways and treatment rooms. Suddenly, the hospital staff started placing patients in rooms without regard to race. In a subtle way, her presence was again making a difference.
Erma Willis-Alford paved the path for other nurses of color in Oklahoma to follow. Although she was the only black RN in Ardmore for 15 years, other African Americans were hired by Memorial Hospital to work as nurse’s aides and LVNs.
“I think my presence and the road I took stimulated others to want to do the same things,” she says.
Eventually, more African American RNs began working in Ardmore. Willis-Alford estimates that approximately 15 black RNs work in the city today. More are needed, she says, adding that she hopes more African American men and women will enter the profession.
“We do need more and more and more [minority nurses], because sometimes [minority patients are able to relate better to caregivers who share their race or ethnicity],” she says. “Sometimes another person of their race may be able to get them to speak up and explain the problems that they have.”
Why are African Americans and other people of color still so underrepresented in nursing? Willis-Alford believes that sometimes the barriers to progress come from inside rather than from others.
“I think a lot of it has to do with self-determination and controlling your own environment,” she explains. For example, some minority students look at the rigorous coursework needed to become a nurse and red flags of self-doubt pop up. She feels it is crucial for parents and educators to work together to encourage and prepare young people of color to pursue health care careers–for example, by making sure they take science and math classes from an early age. “By the time they are ready to graduate from high school, it is too late to begin to take those classes,” she asserts. “[For students who don’t have that preparation,] college will be an uphill struggle.”
She speaks highly of a national training initiative called the Area Health Education Center (AHEC) program, designed for underrepresented and disadvantaged students from under-served urban and rural areas who are in the seventh grade and higher. The federally funded program, established in 1971, enables students to shadow someone who works in the health care field. AHEC also hosts a summer camp that allows students to gain hands-on experience in health care-related activities.
Still Spreading the Message
Willis-Alford eventually left Memorial Hospital in the 1980s for a better-paying job at Presbyterian Hospital in Oklahoma City, where she worked on the cancer floor. She became certified in chemotherapy and worked with bone marrow transplant patients.
She is now semi-retired, although it’s hard to tell. She lectures once a month at the Ardmore Senior Citizens Center, serves on various boards, reviews grants for the federal government, helps organize health fairs and works in youth camps each summer. In November 2003, she was part of a U.S. medical delegation that traveled to Cuba through the People to People Ambassador Program, an international exchange program established by President Dwight D. Eisenhower in 1956.
Willis-Alford is also involved in many preventive education activities aimed at fighting health disparities in the African American community. She provides information on diabetes, chronic kidney disease, cardiovascular disease, cancer, obesity and HIV/AIDS. Some of this information isn’t readily available at community health clinics, she says.
“Certain chronic diseases may not be prevented, but they can certainly be delayed,” she emphasizes. “That is the message I try to get out. People should not wait for signs and symptoms to appear before they seek medical help. We are now in the era of prevention.”
Not surprisingly, three of Willis-Alford’s four children work in the health care field–her youngest daughter became an RN exactly 20 years after she did–and one of her 12 grandchildren is studying to become a physician. These days, she says she can’t maintain the pace she did years ago and has no interest in working the “long hauls” that one has to endure as a floor nurse. But that doesn’t mean she plans on retiring to her rocking chair any time soon.
Her next major goal is to earn a graduate degree, preferably a doctorate in health education and leadership. She’s considering schools in Oklahoma City and Denton, Texas, that offer doctorates with classes structured in such a way that she won’t have to attend school five days a week.
This remarkable nurse may not be the Oklahoma equivalent of Rosa Parks, who died in October 2005 at the age of 92. But when the history of Ardmore, Okla., is written, there will no doubt be a page devoted to Erma Willis-Alford.
Photo by leoncillo sabino
The current health care crisis is multifaceted, ongoing, and incredibly significant to those within the profession. The reform the country is currently experiencing came as a result of several factors: high cost of treatment, ineffective payment methods, and millions of uninsured Americans in need. Though these problems have begun to enter the national conversation, there are still many issues that need to be addressed and fixed.
Nurses are often referred to as the front line of the health care system—meaning that the changes occurring on a national level will affect them directly, perhaps even first. With the coming reform, health care facilities and their nursing staff must account for slashed budgets, reduced personnel, and political pressure. Moreover, President Obama recently set aside more than $36 billion to create a nationwide network of electronic health records—a massive undertaking that will require a combination of proven communication skills and strategic management to implement, use, and manage.
In addition to these changes, the population is aging, Medicare funding is in jeopardy, and the nursing shortage is projected to grow to one million by 2020. As the public gains access to health care, the lack of nurses will be felt even more acutely.
Nurses must equip themselves with the skills necessary to manage and help solve these crises.
The next generation of nursing leaders will be charged with placing an emphasis on interpersonal and interdepartmental communication—translating and acting as a diplomat between the clinical and business sides of health care institutions. Nursing leaders must have a strong working knowledge of clinical practice and the business of health care, all within an everchanging political arena. Nurses holding both a Master of Science in Nursing (M.S.N.) and a Master of Business Administration (M.B.A.) will be better equipped to understand both sides of the equation.
This may be unfamiliar territory for the nursing profession. Executives must be able to identify key health care trends, watch regulatory rules and legislation—and be able to implement changes within their own organization based on these findings.
Dual degrees in nursing and business help nurses manage these responsibilities in more ways than one could count. Registered nurses are not generally educated in the business side of health care, and while a Bachelor of Science in Nursing is excellent preparation for nursing clinical practice, patient care is far removed from the fiscal responsibility of bringing consumption and cost to sustainable levels. A business-trained leader, such as an M.B.A.-prepared executive, may be able to provide financial analysis of factors associated with treatment, providing the cost in real dollars and highlighting areas of strength or problematic gaps. Yet, while that training may prove invaluable in discovering economic stopgaps, understanding financial problems is not effective in providing a cost benefit unless a clinical solution can be found as well. Therein lies the primary benefits of obtaining dual M.S.N./M.B.A. degrees—understanding and linking both sides of health care.
M.S.N./M.B.A. programs aim to prepare students for mid- to upper-level management roles in health care organizations, including chief nursing executives, nursing managers, nursing supervisors, nursing educators, nursing informaticists, nurse practitioners, clinical nurse specialists, and more. According to the Centers for Medicare and Medicaid Services, by 2015 health care costs will hit $4 trillion and account for 20% of the U.S. economy. By 2012, the number of nursing executives is expected to increase faster than most health care professions. Still, in today’s diffi cult economic environment, being as educationally competitive as possible is key to securing a position as a nursing executive.
Employers will be looking for nursing executive candidates skilled in communication and conflict resolution, leaders who have the ability to cultivate an ongoing conversation between patients, staff, and administration. M.S.N./ M.B.A. degree programs also generally provide more targeted business preparation, training students in areas such as relationship management, organizational leadership, business relations, and change management—skills which are more crucial now than ever.
Class work, prerequisites, clinical requirements, and other details of these dual degree programs vary widely. Students may obtain their dual degree at one school or through articulation agreements between two distinct schools of nursing and business. Accelerated programs often combine these studies even further, saving students both time and money. At Chamberlain College of Nursing, courses such as Leadership Role Development, Health Policy, and Informatics prepare graduates to serve as effective nursing leaders, able to understand the politics and decisions inherent in health care leadership. Business studies, including Managerial Accounting, Marketing Management, and Business Economics help students develop strong analytical abilities, understand health care economics, learn to resolve organization and business issues, execute health care strategies, and foster communication and interpersonal skills.
In order for the health care field to flourish in the face of a continuing recession and monumental policy changes, the profession must seek out and support individuals prepared for both the monetary and clinical challenges. The time for aspiring health care leaders to gather the knowledge and credentials they need is now. The industry’s success depends just as much on cost savings as on the finite resources vital to maintaining crucial care—namely, the people and practices that allow health care to function. Future nursing leaders must further prepare themselves to manage every facet of the coming changes to the industry, including attaining knowledge of both the business and the science of health care.