The Evolution of School Nursing

The Evolution of School Nursing

Stereotypes of school nurses primarily dispensing aspirin, taking temperatures, and offering hugs are rooted in nostalgia.

These days, school nurses increasingly handle a growing number of students with chronic or serious health issues, provide emergency care, and connect with community partners to provide additional health services.

Despite the vital role that these health professionals fulfill for students, there is a lack of full-time public school nurses to help meet the well-being of students, especially in urban school districts. Only 30% of public schools have a full-time school nurse, according to a 2007 study by the National Association of School Nurses (NASN).

Additionally, only half of schools have a registered nurse 30 or more hours each week, according to a 2014 School Health Policies and Practices Study by the Centers for Disease Control and Prevention.

Informing the public about the expanded role of school nurses and the consequences of their absence benefits students, their families, and communities, nursing experts say.
“Because school nurses practice independently as the only health care provider in the education setting, they need the critical-thinking skills that bachelor-prepared nurses develop,” says Beth Mattey, MSN, RN, NCSN, president of NASN. To this end, NASN recommends a bachelor’s degree in nursing as the minimum preparation for a school nurse.

“Many states require ongoing education to maintain an RN license and/or a school nurse certification,” Mattey continues. “NASN provides ongoing education through resources, clinical guidelines, webinars, and other online education courses. We also sponsor hands-on learning and conferences to keep school nurses abreast of current practice.”

Evolving Role of Nurses

“When schools don’t have a school nurse, there is not a health professional to help students manage acute illness and chronic conditions in the school setting,” says Mattey. “Students don’t leave their health issues at the door, and many chronic conditions must be managed during the school day. This includes students with diabetes, asthma, life-threatening allergies, epilepsy, and sickle cell disease. Children who live in poverty are at greater risk of having a chronic condition and unmet health needs.”

The average adult thinks about his or her own education decades ago and assumes every school has a nurse and the health needs are the same, says Nina Fekaris, MS, BSN, RN, NCSN, president-elect of NASN.

“Unless you are a parent of a child with a chronic illness or a life-threatening disease, you just don’t think these things are in schools,” says Fekaris, the only nurse assigned to four schools serving 4,200 students in her suburban school district in Oregon. “They don’t understand what school nurses do and they don’t understand that kids are more fragile that are attending schools now. There’s a lot more care coordination that needs to happen in school buildings to keep kids safe.”

Fekaris, who has been a nurse for 40 years and has 30 years of experience as a school nurse, says the growing number of students with type 1 diabetes is a major health change. When she first started, there were none; now, there are about 150 diabetic students, including kindergarteners, in her school district.

Advances in medical treatment and technology have also altered the practice of school nursing. For example, one treatment device for children with seizure disorders is an implanted device under their skin that delivers an electrical pulse to a nerve in their neck. “At the sign of seizure, what we want to do is activate that device to fire an impulse to try and stop the seizure, and the way you activate that is by swiping a pretty powerful magnet across that device in their chest. Thirty years ago we didn’t have that technology,” explains Fekaris.

Greater Needs at Urban Schools

Students in high-poverty urban areas are especially vulnerable when schools lack an adequate number of nurses, says Maura McInerney, a senior attorney at the Education Law Center, an education advocacy group that champions the hiring of more nurses.

“The consequences can be devastating, and I don’t think that the average citizen recognizes the critical role school nurses play in the health, safety, and education of school children,” McInerney says.

Without access to full-time nurses, students may not receive urgent or accurate and timely treatment at prescribed intervals. And, children with special education needs may not be identified or receive nursing care, McInerney adds.

“Perhaps what is most striking is the number of children with qualifying disabilities such as diabetes and asthma, who fail to receive Section 504 Plans that are critical to supporting them to attend and be successful in school. Finally, school nurses are important teachers and counselors and are often the first people to identify a child’s need for health interventions and counseling services,” says McInerney.

There are 180 nurses for 332 Philadelphia public schools serving 200,000 students. In 2011, the district had 289 school nurses. By the 2013-14 school year, that number had dwindled to 179.  In March, the district announced the number of school nurses would be increased with the goal of a nurse at every school. “At that time, 123 schools had no full-time nurse and 17 schools had a nurse one day a week or less,” McInerney says. “We hope this happens, and ELC is fighting for more funding to under-resourced schools in Philadelphia and elsewhere to make this a reality.”

Unfortunately, sometimes it takes a crisis to spotlight the need for school nurses and drive changes, says Robin Cogan, who has worked 15 years as a school nurse in Camden, New Jersey. “In Flint, there was one school nurse. They now have nine school nurses. It shouldn’t take a tragedy to get a school nurse in every building,” she argues, referring to the 2015 water crisis in Flint, Michigan, that involved lead contamination.

Mattey recalled a Philadelphia student, 12, who died from an exacerbation of her asthma two years ago. “The severity of her asthma was unrecognized on that day because the school nurse was not scheduled to be in the school. The School District of Philadelphia had been having financial difficulty and school nursing services were cut,” Mattey says.

For working parents, the presence of a nurse can help them decide to enroll their child if he or she has a chronic condition, says Cherisse Howell, RN, supervisor of staff education, school health nursing, at the Montefiore Health System, one of the largest school health programs in the nation. A school nurse “gives a parent a sense of security that I can go to work and provide for my family and still feel safe that my child is OK because there is a nurse at school,” says Howell, a nurse since 2005.

Having a nurse or school clinic gets children into the building because parents share the positive experiences of the health services, Howell says. The Montefiore Health System has clinics inside elementary, middle, and high schools and provides primary, dental, mental, and community health services to over 30,000 students at 85 schools on 23 campuses.

“We transitioned from what many thought of as the school nurse… when nurses were doing ice for injuries and Band-Aids for boo boos,” says Howell. “We’ve moved to an era where, specifically in the Bronx, we have thousands of children suffering from asthma and our diabetes cases are rising. We have children with health disparities that would otherwise keep them from school. We now have these health professionals in the educational building, and children can get the treatment they need and the instruction they need simultaneously.”

Outreach and Partnerships

The volume of students treated and the complexity of their medical care require school nurses to form health care partnerships, says Lynn Meadows, RN, MS, coordinator of student health services for the Fulton County School System in Georgia.

“We can’t just do the job in a clinic. You have to partner with a local physician or a health organization in the community because it’s a team approach now of how we take care of kids,” says Meadows, a nurse for 30 years and a school nurse for 15 years. “It’s not just a school nurse trying to manage the health care needs of kids while they are in school. Yes, they are in school…but they also go home. So that collaboration and networking with health care providers outside our clinic obviously keeps that continuity of care better for kids.”

Many school nurses seek professional development to keep up with the changing care dynamic that students require, which is why partnerships are important. School districts are looking to school nurses to be caught up on health issues that can impact the community, Meadows says.

“For instance, regarding the Zika virus, my superintendent will look at me and ask, ‘Well, what should our school district’s response be to a community health issue like Zika virus?’ So I have to be up to snuff. I have to find partners that I can work with to say, ‘What is the latest, how does this impact the community, and ultimately, how might it impact the school?’ Whatever is the hottest topic or health care issue going on in the community, school nurses have to be aware of it,” says Meadows.

School nurses arrange for mobile dental clinics to visit schools and mobile vision vans to visit and provide eye exams and glasses for students who may not have those services available, says Mattey.

School nurses also work in schools and the community to promote tobacco education and cessation programs, educate students about prescription drug abuse and other substance abuse, provide immunization services for students, encourage exercise programs, and educate about healthy eating.

Measurable Results

School nurses not only play a key role for helping students learn, their presence assists educators. One study found teachers spend less than 20 minutes each day dealing with student health issues when a nurse was assigned to their school.

Data also showed students with asthma have improved attendance and better health outcomes when a school nurse managed asthma, says Mattey. Furthermore, immunization rates also improve when a school nurse is present.

“What administrators and school districts need to know is that not only do school nurses keep students in school by addressing health issues so they can stay in school, school nurses save money,” says Mattey. “A recent JAMA study demonstrated that for every $1.00 spent on school nurse service and resources, $2.20 was saved in societal costs. The study did not take into account reduced emergency room visits due to early intervention by the school nurse,” she adds.

“Consider the case of a child with a severe peanut allergy, and every day when your child goes off to school you hope that your child is not exposed to peanuts. A school nurse recognizes the potential emergency, works to make the environment safe for the child, and ensures that emergency plans are in place in the event of an exposure to peanuts. The school nurse will educate the staff on the signs and symptoms of an exposure and how to prevent the exposure in the first place,” says Mattey. “There are many health conditions children bring to school. The professional school nurse has the expertise to educate and work to prevent an emergency, but if an emergency occurs, the school nurse will recognize the emergent condition and take action.”

Raising Awareness

School nurses juggle an array of demands despite their salaries being among the lowest for RNs. However, in some areas, school nurses are paid on the teacher salary scale, which also includes benefits. For school nurses on the lower end of the salary scale, lack of understanding about all they do is a factor, nurses say.

“Traditionally, the profession of school nursing has been looked at as someone in the clinic just handling little boo boos,” explains Meadows. “There isn’t widespread public knowledge of what it takes to be a school nurse, or the volume of kids with chronic illness or medical issues. There is not enough information in the community or across the nation on how school nursing has evolved. Many people don’t get that.

“School nursing has changed. It’s a profession on its own. For many of our children, the first health provider many of them see is the school nurse. I tell many of my nurses, ‘You can be the person who finds out what is going on with that child and make a difference in that child’s life for the rest of his or her life,’” Meadows says.

Although school nurses affect educational settings, taxing working conditions can compromise their effectiveness in treating students. If the school lacks a nurse, or if the school nurse “has a workload that makes it difficult to adequately educate all staff and follow up with parents, there may not be adequate protection for students,” argues Mattey.

“The ANA has a saying, ‘Nurses are an investment in the future, not a cost center.’ I say the same about school nurses. School nurses are an investment in the future of our children, linking health and education. We are not a cost center,” Mattey adds.

Parents and guardians must address the importance of school nursing with administrators, Mattey says.

“Parents should ask, ‘Who is meeting the health needs of my child while in school?’ The answer should be a professional registered school nurse,” argues Mattey. “Parents assume that a nurse will be taking care of their children, but that is not always the case and parents need to ask the question. If not a school nurse then they need to find out, ‘Why not?’ Parents in Charlotte, North Carolina, advocated to make sure their children had access to a full-time school nurse, successfully increasing the number of school nurses in the schools.”

The Rise of Mobile Health Apps

The Rise of Mobile Health Apps

For Ashley Davis, BS, RN, using her smartphone as an ICU nurse provides quick and easy access not only to medical information, but also to a critical care physician.

“I don’t use one specific mobile app,” says Davis. “Typically, I will enter a topic or medication into Google and read from several of the results to get a well-rounded answer to my question. If I am looking for journal articles, my preferred site is Medscape. As a registered member of their site, I also receive regular e-mails from them regarding top medical news, trends, and educational opportunities.”

As helpful as the information Davis finds can be, it does have limits: “I do not rely on an app or website to dictate patient care,” says Davis, who uses a smartphone at work even though her hospital bans such use. “Rather, it is an additional tool to broaden my knowledge base. Any treatment should be administered with sound nursing judgment and under the direction of a physician.”

That Davis feels the need to use her own smartphone to access mobile health apps to improve her efficiency with patient care despite hospital policy illustrates the growing need for nurses to not only join the mHealth movement, but also become leaders in it, according to nursing experts.

Power of Nurses

“Nurses play an important role in mHealth transformation,” says Jing Wang, PhD, MPH, RN, an assistant professor of nursing systems at the University of Texas Health Science Center at Houston School of Nursing. “There are many apps that are tailor-made for nurses to better manage their patients. However, few nurses take a leading role in designing and developing apps for patients to better take care of themselves. There’s much more [that] can be done,” says Wang, a diabetes researcher.

One critical step is to integrate the apps in clinical information systems, devices, and nurse call systems, Wang says. “Nurses are at the forefront of health care. There is a huge need to connect mobile apps that nurses use to clinical information systems, so that nurses can better communicate with other health care providers. And there is also a huge need to connect patient-using apps to electronic health record systems that nurses and other providers use, so that nurses can better provide patient-centered care, in collaboration with other health care providers.”

Nurses must be taken into consideration as apps increasingly play a role in health care, says Lori O’Connor, RN, chief nursing and quality officer for Care at Hand, Inc. “Sometimes, when doctors are at the forefront, things are done a certain way, and the realistic part of nursing… doesn’t truly represent itself. I think any app that includes any type of nursing intervention, or has nurses using it, is better off for it.”

A survey done in early June 2015 by InCrowd, an on-demand market intelligence provider to the life sciences, found that despite HIPAA-/security-driven restrictions and mobile device use policies, 95% of nurses own a smartphone and 88% of them use smartphone apps at work. At 88%, nurses’ use of smartphone apps is greater than the 67% figure recorded in a February 2014 Wolters Kluwer survey, and on par or above other reports of smartphone usage by 67% of medical residents and 80% of physicians, the report found.

Most nurses, like Davis, use apps to check drug interaction or symptom and disease details. By doing so, they often find no need to consult before providing care. Apps replaced the nurse asking information of a nursing colleague (52%) or a physician (32%) to save time, according to the survey. The high smartphone app use among nurses happened even though most facilities do not provide or reimburse for smartphones or ban their use during nurses’ shifts.

Over 10,000 apps exist on IOS and Android devices, a number that has more than doubled in 30 months, according to the mHealth App Developer Economics 2014 report. Fitness, medical reference, and wellness apps make up the largest categories.

Highlighting the must-have apps is difficult since nurses work in diverse health care settings, experts say. There is no single app that every nurse would find useful, says Wang. “Nurses in clinical settings may find apps that can look up drug information helpful. Nurses working with chronically ill patients may want to invest time in learning a few popular health and fitness apps that patients use to better understand patients’ behaviors and provide individualized care.”

Apps that are popular with nurses are easy to install and use and can help with patient documentation, says Birgit Koellmer, RN, BSN, a nurse informaticist at Saint Mary’s Hospital in Waterbury, Connecticut. At Saint Mary’s, mobile apps and technologies are improving care coordination, clinical communication, patient safety, and patient engagement, says Koellmer.

To secure text messaging and other clinical communication, Saint Mary’s has adopted Imprivata Cortext, which gives its care providers a fast, secure means of communicating and coordinating right from their smartphone, iPad, or computer.  Communication is more efficient between physicians and nurses, who started using the app a year ago, although all hospital staff now uses it. The app “is good for any hospital,” says Koellmer.

Patient Engagement

Saint Mary’s has seen great improvement since implementing Imprivata Cortext, but one of the more interesting angles is how they are using it to improve patient engagement. HIPAA requirements make it difficult to have meaningful e-mail, phone, or text message communications with patients and their families because health information must be protected; native SMS texting, for example, does not meet HIPAA compliance. Imprivata Cortext allows providers to send a text to a patient, even if they don’t have Cortext, to a secure link that is encrypted. For example, after day-surgery, health care providers can send a patient’s family text messages about the status of their loved one, whether they are in a waiting room or at home unsure about what’s happening. Appointment reminders can also be sent to alert patients about appointment times or instructions.

While mobile health apps enable individuals to learn more about their own health, some of the resources they seek can be misleading, nurses say.

“I feel patients can be more informed with mobile health apps as long as they are trusted sites,” says Davis. “I have had patients in the past who have researched an illness or procedure and have been severely misinformed. Being misinformed can add undue stress to an ill patient and/or family members. This in turn can lead to mistrust of the information provided by the medical team as well as delayed treatment.”

As far as mobile apps affecting patient care directly, Davis says that won’t happen “unless they are encompassed into each facility’s EMR. I do, however, believe that they can serve as a great resource for nurses and physicians. Having additional resources will always be valuable when addressing the needs of patients.”

One app that has attracted attention for benefiting patients and health centers is the Care at Hand app, a mobile care coordination technology to help prevent hospital readmissions by using nurses as well as nonclinical support, such as home care individuals, to flag emerging issues before hospitalization is required. The app tracks a person’s health in real time on a consistent basis and has lowered hospitalizations and readmissions, says O’Connor. “The community health workers are the ones asking the questions, and all that information is transmitted to me. I can go into the app and see from my staff or the patient level, who is costing us the most money? Who is the sickest? Of the sickest patients, did we do the right intervention? Are my nurses doing what they are supposed to do to prevent those readmissions, and are the community health workers doing what they are supposed to be doing?”

The app is also popular with some homebound individuals, O’Connor says. The elderly especially like the app as it also opens up a whole new world to them. “It’s popular among people who may be alone or who don’t have family in the area. It gives them that interaction with somebody, so that’s a huge benefit,” in addition to the medical implications.

Named a 2013 Robert Wood Johnson Foundation Nurse Faculty Scholar, Wang agrees that apps can empower patients to become more informed and engaged in their health care. Her current project is evaluating the effect of mobile applications on the care of diabetic patients.

Mobile health apps for diabetes patients include one that can track blood sugar levels or automatically transmit blood sugar data from glucose meter to smartphone apps. Others set behavioral goals and track progress, such as the AADE Goal Tracker app. Popular fitness and weight-loss apps that will help diabetes patients keep track of their weight, diet, and activity levels include MyFitnessPal, Lose It!, and the Fitbit and Jawbone wristbands that can automatically track your steps and sleep.

“These self-monitoring apps can help patients with diabetes become more informed and aware of their own behaviors in relation to blood sugar control. These apps also help patients become more engaged in their own care,” says Wang.

It is important to have rigorously designed research studies to measure the efficacy of mobile health apps. Such studies are mostly lacking today, says Wang. “Nurses can take a leading role in studying the efficacy of these apps in relation to health outcomes, as we are the best patient advocates.”

Workflow Matters

As the number of mobile health apps rises, workflow integration is essential, says Ron Razmi, MD, MBA, founder and CEO of Acupera, a health care technology company that provides a population health and care coordination platform for medical centers.

“Unlocking the untapped potential of mHealth will require that all applications and data, and nurses and care teams using those apps, plug back into a population health ‘command center,’ where interoperability and workflow integration can fuel comprehensive care coordination both inside and outside the hospital’s four walls,” says Razmi.

The cardiologist and entrepreneur says that “this is an increasingly important trend with the rise of value-based care, which requires a more integrated, comprehensive, and long-term vision for patients than ever before. While nurses and remote care teams are beginning to tap into these new mHealth solutions, often through mobile devices, they will assuredly fail if the data and workflows they rely on are kept siloed, and the data being collected isn’t collected with deliberate workflow use in mind.

“While these devices can produce valuable data, that data can end up in a ‘data landfill’ without a sophisticated integration model in place, and if the insights aren’t manipulated to create real-time workflows. Doctors and care teams don’t have the time or resources to filter, process, and implement that data on their own and often are overwhelmed by the idea of unnecessary new mounds of data flooding their care delivery strategy,” says Razmi.

Mobile health apps are predicted to gain momentum and become an integral part of health care management.

Mobile health apps will give patients more autonomy and control of their own health and care, and better connect patients with providers as a way to facilitate communication between patients and providers, says Wang. “My currently funded Robert Wood Johnson Foundation Nurse Faculty Scholar Program project will provide better evidence on connecting mobile health apps with provider-facing clinical information system to bridge the gap. mHealth will definitely play a significant role in creating a culture of health.”

Koellmer predicts health providers will be able to take care of larger patient populations without compromising quality of care. Identifying outbreaks earlier will be another development, she says.

O’Connor says the future role of patients will shift. “I think you will see patients turn into consumers because mobile applications allow care to be delivered when it needs to be and where the patient is. It doesn’t require the patient to leave the house or for a patient in a rural area to drive three hours to an appointment. The technology reaches more people, and I think that it’s only going to get better from this point. I think when you have an interactive application…something like that is even more enhanced.”

Why Gender Diversity in the Workforce Matters

Why Gender Diversity in the Workforce Matters

At Charles R. Drew University of Medicine and Science, the number of male nursing students seeking a master’s degree is reason to celebrate.
“At the beginning of this semester, a faculty member said, ‘I just did an assessment of our new cohort and 15% of the incoming class are men, and it’s the most we’ve had in a cohort,’” says Sheldon D. Fields, PhD, RN, FNP-BC, AACRN, FNAP, FAANP, dean of the Mervyn M. Dymally School of Nursing.
But gender diversity is just part of the story at the historically black and Hispanic graduate institution based in South Central Los Angeles. “Not only is our male student population up, I also only have minority male students in my program,” says Fields, who previously served as an assistant dean and codirector of the Doctor of Nursing Practice Program in the Nicole Wertheim College of Nursing and Health Sciences at Florida International University. At that Miami school—a historically Hispanic institution—the male nursing enrollment is much higher at 30%.
Such historically diverse schools of nursing are key to getting more men of color into the nursing pipeline, says Fields. “Minority-serving institutions, I think, stand a better chance of attracting men because we are more flexible and we don’t have those historically traditional ways of looking at who should and who could be a nurse.”

Increasing Gender Diversity
Today, one out of 10 nurses is a male. And while more men are resisting stereotypes and increasingly pursuing a career in the most trusted health profession, many more are needed not only to achieve gender parity, but also to reflect the nation’s demographics, says William T. Lecher, RN, DNP, MBA, NE-BC, immediate past president of the American Assembly for Men in Nursing (AAMN).
AAMN has aligned its goals to improve gender diversity with the recommendations of the Institute of Medicine nursing report, which stated that to improve the quality of patient care, more efforts are needed to increase the diversity of the nursing workforce, especially in the areas of gender, race, and ethnicity.
“Our patients and families know the important role men in nursing play in meeting their nursing and health care needs. For example, The DAISY Award is provided by almost 2,000 health care facilities and celebrates and honors the extraordinary compassion and direct care nurses provide to patients and families every day,” says Lecher, senior clinical director at Cincinnati Children’s Hospital Medical Center.
“The DAISY Foundation has found that men are recognized by patients, families, and health team members two to three times the rate they are employed. Or, in other words, the patient and family experience benefits by having men in the nursing workforce. As such, our patients, families, and health care administrators should demand our nursing schools do a better job recruiting and retaining more men in nursing school. It is hard to believe that, in this day and age, men in nursing school only account for 12% of students [as of 2012] and their attrition continues about twice the rate of women in nursing programs,” says Lecher.
According to a report by the American Association of Colleges of Nursing, 2014-2015 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, men comprised 11.7% of students in baccalaureate programs, 10.8% of master’s students, 9.6% of research-focused doctoral students, and 11.7% of practice-focused doctoral students. One of AAMN’s goals is to have men make up 20% of nursing student enrollment by 2020.
To encourage schools of nursing to support its male students, AAMN has created the Excellence in Nursing Education Environments Supportive of Men program, a recognition designed to provide evidence to stakeholders that a specific program is gender-inclusive. Recognition symbolizes excellence in providing male students a positive and equitable educational environment as determined by AAMN.
The program’s goals include increasing awareness of issues that may challenge the success of male student nurses, fostering the recruitment and retention of men as nursing students, and recognizing nursing education programs that have achieved excellence in supporting male students. Recognition is valid for eight years. Schools interested in applying can do so at
Increasing the gender diversity of students to create a workforce prepared to meet the demands of diverse populations requires schools of nursing to do a better job of recruiting and retaining male students, says Marianne Baernholdt, PhD, MPH, RN, FAAN, professor and director of the Langston Center for Quality, Safety, and Innovation at Virginia Commonwealth University (VCU).
“You won’t find a school of nursing today… that wouldn’t say we do everything we can to increase minorities in nursing and that includes men. If you are not going to put money or specific actions behind [these goals] well, you will just keep doing what you are doing,” Baernholdt says. At VCU, men are 12.5% of the undergraduate nursing school enrollment, she adds.
VCU offers several entryways into nursing, including the RN-to-BSN program, and an accelerated bachelor’s degree program. “Because we have that mix, I think we have a higher proportion of male students. But VCU is known for its diversity, so that’s another reason we also have as many African Americans as we have males. Does that mean we could do better? Of course, we need to do even better,” says Baernholdt.

Growing Numbers
From 2010 to 2013, the number of male RNs increased from 8% to 10.7%. During that three-year period, an additional 70,000 male nurses entered the workforce, increasing their number to over 300,000. Since the 1970s, the percentage of male nurses has more than tripled.
The profession’s low unemployment, a desire to make a difference, and a shift in how male nurses are viewed are among the reasons men are entering nursing, experts say.
“The increased visibility of AAMN and men in other nursing organizations make it easier for men to see themselves as nurses,” says Lecher. “Furthermore, the recent recession has helped men choose nursing as a way to help others, have purpose and meaning in their work, and earn good income for their families.”
Alexandra Robbins, author of The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital, agrees. “I think they are increasingly drawn to the profession as the stigma and stereotypes wane and as more men realize just how hands-on a nursing career can be,” she says.
Fueling the growth of male nurses are innovative initiatives, including programs that train foreign-educated physicians—who cannot practice in this country—to become nurses, says Fields. The number of returning military veterans is another factor. “There are several medic-to-RN programs around the country, and the VA has put money into continuing education for vets, and a large number of them are coming into nursing,” says Fields, noting that the military is disproportionately higher in men.

Pay Disparity
While male nurses are the minority, they still earn more money than women in the same role.
A report published earlier this year in JAMA: The Journal of the American Medical Association, found that the average female nurse earns about $5,100 less than her male counterpart—even when researchers controlled for factors such as race, age, marital status, and specialty. The uneven wages also varied significantly by specialty. The highest salary gap was for nurse anesthetists, a role held by many men.
“I don’t think what we’re seeing should surprise anybody because we live in a country that has a pay disparity between men and women, with men making more money,” says Fields. “In nursing, there is a slightly larger number of men who pursue an administrative role, and they tend to work in critical care roles, which requires more credentials and pay more money,” he adds. Men seemed to be promoted quicker, too.
The bottom line? “In America, we have a patriarchal society that says men are worth more,’’ says Fields.
The salary gaps are dismaying but may not be as widespread as the study suggests, says Peter McMenamin, PhD, senior policy fellow and health economist at the American Nurses Association.
The challenge is in the data, which included information that stretched back more than 10 years, when there were fewer male nurses. Also, the wage differences are not explained but may include women who took time off to have children and, so, lost their place in the labor force and never caught up. Or, the data could include male nurses who worked two or more jobs, which meant their total compensation increased, explains McMenamin.
“So there are all these little things that suggest it’s not as simple as taking the average wage for men and women in the same category” because of other issues, including training and experience, says McMenamin. Still, he is dismayed that the differentials exist. “We’d like to live in a world where experience and education were the primary determinant of compensation…but gender alone should not.”
Gender diversity may help to resolve the uneven wages, says Lecher. “Gender occupational segregation does not promote wage advancement in nursing or any other occupation. A more gender-diverse workforce will benefit the wage potential for all nurses.”
While that remains to be seen, gender diversity improves culture competence and outcome for patients, says Elliot Brooks, senior vice president of human resources at MJHS, one of the largest health systems in the greater New York area.
“New York is one of the most diverse cities in the world. At MJHS, we believe that our employee population should reflect, understand, and respect the diversity of this great city. That doesn’t just extend to gender; it also means culture, faith, tradition, ethnicity, sexual orientation, et cetera. Our anecdotal qualitative research shows that our patients, of any background, appreciate receiving care from nurses who are culturally sensitive. This enhances care management, goal setting, and having difficult conversations. But, the benefits go beyond those important things,” Brooks says.

Amplifying Voices
Patients are more likely to open up “about their personal lives, dreams, hopes, and challenges,” Brooks continues. “By extending compassion, dignity, and respect to our patients, we are able to help provide care to the whole person—physically, socially, emotionally, psychologically, and, of course, culturally.”
The nursing community, health care stakeholders, and the public must work together to improve gender opportunity in nursing. “There’s been a huge cultural expectation and assumption shift in the past 40 to 50 years,” says Brooks. “It used to be that most people assumed all nurses were women. Today, fewer people make that assumption. I think the Millennials and future generations will help continue to push for greater gender opportunity in all professions, not just nursing.”
Lecher agrees that more vocal support is needed, particularly from fellow nurses. More men and women nurses need to demand that the profession become more gender diverse and inclusive, he says. “It would be a mistake to think that men can solve gender recruitment and retention by themselves when women dominate the profession,” he adds.
“We have many women in nursing advocates for gender diversity. There are presently five women serving in the role of AAMN chapter presidents. A lot of nurses believe our membership is limited to men, but that is not the case,” says Lecher. “The truth is our women in nursing colleagues need to take a leadership role for such change, or our progress will continue to be glacial.”
Robin Farmer covers health, business, and education as a freelance journalist. Based in Virginia, she contributes frequently to Minority Nurse magazine and website. Visit her at

The Business Case for Diverse Leadership

The Business Case for Diverse Leadership

How do you measure the impact of diverse leadership in the workplace?

Part of the answer may be in dollars and cents. A recent study found that large companies with more diverse leaders reported better financial results.

A study of 366 public companies in the U.S., U.K., Canada, Mexico, Chile and Brazil by McKinsey & Co., a major management consultancy, found “a statistically significant relationship between a more diverse leadership and better financial performance.”

Companies with gender diversity that ranked in the top quartile were 15 percent more likely to have financial results above their national industry median. The returns were even better for companies in the top quartile of racial/ethnic diversity. These businesses were 30 percent more likely to have financial returns that outpaced their industry.

On the other hand, companies that ranked in the bottom quartile for ethnicity/race and gender were less likely to achieve above average financial results.

The link between diversity at the highest levels and increased profitability should not be a head scratcher. Highly diverse companies appear to excel financially due to their recruitment efforts and talent pipelines, improved decision-making, strong customer orientation and increased employee satisfaction, the report said.

How does your workplace fare in the diversity arena? Are the decision-makers reflective of an increasingly changing nation, not just in in terms of gender and ethnicity/race, but also sexual orientation and age?

Is there a systematic approach to achieve a diverse talent pool where you work?

Investing in diversity not only increases creativity and encourages personal growth, it can improve your workplace’s competitive edge. Learn more at

Let us know what you think.

Robin writes about health, business and education. Visit her at


Tips to Make 2015 Different

Tips to Make 2015 Different

As the new year gets underway, have you thought about a new way of thinking and acting?

We all know the saying: Jan. 1 is the first blank page of a 365-page book. What will you write and how will it differ from last year? To prevent carrying over a negative attitude into 2015, consider taking these steps:

Adjust your attitude. Transforming your thoughts can shift your perspective and bring you inner peace. Try focusing on gratitude and forgiveness each day to enjoy life more. A positive mindset may not immediately change your circumstances, but it may eventually change your life,

Set up a gratitude jar. Place it in a visible spot so you are not tempted to ignore it like most of last year’s resolutions. Fill it with notes about anything you are thankful for during the year. Share it with loved ones. On New Year’s Eve, read your memorable moments aloud.

Create a vision board. Choose words and images that inspire you. When we are inspired we are more likely to take action. Your board should reflect the kind of life you want, which can include career as well as vacations and a dream home.

Keep a “done” journal. It is fine to focus on what you plan to do, but keeping a separate accounting of time actually spent on working toward your goals may help you use your time better. If writing a novel is one of your top priorities, note the number of pages or words you write each day.

A new year is the opportunity to be better than you were the year before.

Maybe Ghandi said it best: “Our greatness lies not so much in being able to remake the world as being able to remake ourselves.”

Let us know how you are doing!

Robin Farmer is a freelance writer with a focus on engaging, educating and empowering readers. Visit her at