When Nick Escobedo DNP, RN, OCN, NE-BC, director of Inpatient Oncology at Houston Methodist Hospital, started his nursing career, he didn’t expect to land in oncology nursing. During May’s recognition of Oncology Nursing Month, Escobedo says the career has offered distinctive opportunities for personal and professional growth.
“I went into a basic acute care setting right out of nursing school because I wanted to get a good, solid foundation for myself in practice,” Escobedo, a former president of the Oncology Nursing Certification Corporation, says. But the learning process opened up new, and appealing possibilities. “I had an opportunity to learn the skill of chemotherapy,” he says, “and the more I got to learn about it and spend time working with patients, I quickly learned this specialty was for me, and I wanted to do that full time. It chose me.”
What sets it apart from the science and the practice part of nursing, he says, is that cancer affects every body system. Oncology nurses treat patients through a span that lasts from cancer diagnosis to remission or to end of life.
“I got to use my critical thinking skills, and I got to have knowledge of all the latest and greatest therapies available,” he says. Escobedo, a dedicated lifelong learner, says it’s imperative that he stays on top of understanding new technology and the range of cancer drugs and treatment options available to patients and the safest ways to administer them.
Thankfully, oncology nursing is very collaborative, he says, and so nurses work with physicians, frontline providers, therapists, chaplains, nutritionists, clinical pharmacists, and volunteers to understand how the different pieces help drive the care of a patient. Escobedo says a nurse might check in with a clinical pharmacist to find out more about a particular drug to learn about interactions, how a patient might respond to it, and how to use it safely.
Additional education is essential for oncology nurses, he says. “My journey toward certification was big,” he says. “That was one of my ways at looking at my competence as a clinician, to say I was an expert in the care of oncology patients. So my journey to pursue that certification and have knowledge to be successful was key. I’m a big advocate for certification.”
To balance the intensity of understanding the drugs and treatments used for cancer, Escobedo says the relationships oncology nurses develop with their patients is special. “You develop long-term connections with patients and their family members,” he says. “They give so much of themselves.”
Those strong connections can help nurses and patients through the celebrations of successfully completing cancer treatment or the more difficult prognosis or outcome. “This is very hard work,” says Escobedo. “The reward is that we get to do that work, but we need to balance that with resilience. This is tough work and we have to promote and champion a little of that balance. We try to look at the celebrations that happen.”
The success stories are uplifting and have a lasting impact on nurses. “We hear from patients who were treated years ago, and they come back to check in,” he says. Patients relay news of celebrating weddings and anniversaries and the arrival of children and grandchildren. Some have even paid it forward and after being treated for cancer, have embarked on fundraising campaigns to help others.
“Our patients push us to have that drive,” he says, “And we see lots of really good outcomes.” Patients can go through treatment that is long term and so being able to go through the process with them is something oncology nurses find so rewarding, says Escobedo.
Escobedo encourages nurses who are interested in exploring oncology nursing to find a way. “If you think you could be good at it, why don’t you try it?” he says. Find good mentors and be sure to seek out projects and opportunities that will get you out of your comfort zone. “Nurses don’t get lots of oncology nursing experience through training or nursing programs,” he says. “This is a full and rewarding specialty.”
The third week of every May (this year May 14-20) is dedicated to Neuroscience Nurses Week in recognition of and tribute to neuroscience nurses and the work they do.
Neuroscience nurses work with patients who have a range of health conditions or injuries that are related to the brain. Patients in the care of neuroscience nurses might have received a traumatic brain injury in an accident, may be recovering from a stroke, could be navigating brain cancer treatment, or may have a neurologically based condition such as multiple sclerosis or Alzheimer’s disease. The specialty treats a conditions that impact all ages of patients so they must be ready to care for issues as diverse as ALS or seizures to migraines.
The American Association of Neuroscience Nurses sponsors Neuroscience Nurses Week and is an excellent resource for nurses who work in the specialty or those who are considering this career path. Nurses in this specialty are drawn to the practice because it offers such variety of nursing challenges and opportunities. Because brain illness and injury isn’t relegated to one age group, nurses can treat across the lifespan or can focus on an age range they are particularly drawn to.
Nurses in brain-related specialties also have options for work locations. Their skills are needed in rehabilitation or long-term care centers and in physicians’ offices. Neuroscience nurses will also work in the operating room, trauma units, or the ICU.
The brain’s complexity is unsurpassed, and neuroscience nurses are fascinated by how the brain controls all the body systems. They are driven to provide the best care and find the best treatment plans for each patient. Nurses who work with these patients are highly detail oriented so they can notice the smallest changes in a patient’s condition or responses. They are also adaptable as the challenges for patients can change daily or even throughout the course of a single day. They will tolerate the frustration or fear from patients and also share the joys of their progress. The role is fast-paced and never the same.
Each patient will have a different experience with treatment and recovery and will have access to varied resources to help them heal. Nurses are there as advocates to help patients manage symptoms, which can be as overwhelming as learning how to do daily tasks or manage with reduced mobility or function. They will help families of patients navigate the complexities of home care so they have the tools to support their loved one.
Certification through the American Board of Neuroscience Nursing is an essential tool for nurses who want to remain current in the fast-changing field. Gaining this credential helps nurses gain the latest knowledge, and it also signifies to the community that they are an expert in this field of nursing. Nurses can choose to be a Certified Neuroscience Registered Nurse (CNRN®) or receive a Stroke Nursing Certification (SCRN® ). Some hospitals and workplaces offer courses to help nurses, who will already have the required work experience hours, prepare for the certification exams.
Whether you are a neuroscience nurse or thinking about moving into this specialty, the need for nurses in this field continues to grow and job prospects are good.
Good teamwork is as essential to a high-functioning nursing unit as the nurses themselves. Even the best nurses can’t operate in a silo–patient care takes a comprehensive and cohesive approach where nurses know what to do, know what everyone else does, and each nurse supports the rest of the team.
Despite being a fundamental nursing practice, teamwork can be challenging. Some teams don’t work well and don’t know what’s wrong, or they know what’s wrong and don’t implement solutions that work.
So what’s the key to good teamwork?
It’s all about communication.
“This applies to all professions–communication is key,” says Dr. Margarita David, DNP, MSN, BSN, BA, RN, PCCN, CSN, founder and CEO of Dr. Registered Nurse Success Academy, LLC. But fine-tuning communication skills sometimes gets pushed aside for the immediacy of nursing duties. “Many nurses get overwhelmed with doing what the job requires and what needs to be completed. There’s not enough time.” The dangers of an ineffective team are many; the worst outcome is when it causes patient or nurse harm. For example, patients who leave the hospital without a clear plan or a plan they need help understanding are more likely to be readmitted within 30 days. “That also affects a hospital’s numbers,” she says. “It’s a domino effect.”
Developing Skills and Practice for Effective Work
Dr. Margarita David is the founder and CEO of Dr. Registered Nurse Success Academey, LLC
Teamwork can be guided, but it can only succeed with flexibility. What works for one team may not hold for how another team operates. So constantly reassessing how a team works–its strengths and weaknesses–is necessary. “In nursing, everything changes every single day,” says David.
Building teamwork skills often starts when nurses are still in school, says Dr. Shelley Johnson, EdD, MSN, MBA, RN, NE-BC, CNE, dean and professor at Florida Agricultural and Mechanical University’s School of Nursing. “In nursing education, there’s a lot of content delivery, and we ask students to work on communicating with each other for support and to talk through difficult concepts,” she says, noting that a tried-and-true method that nurses can use throughout an entire career span is the SBAR method. Presenting problems and solutions with the SBAR method helps nurses identify issues and background, assess, and then recommend how to solve things; it’s a method that can be used in many situations. “They can use the SBAR format if they are going to a faculty member with an issue, or they can use it in a presentation to advocate for themselves, others, or as a leader.”
Dr. Shelley Johnson is the dean and professor at Florida Agricultural and Mechanical University’s School of Nursing
According to David, nurses should seek opportunities to intentionally put themselves in positions to grow confident speaking up because that’s what it takes to be an effective team member and leader. “Get involved in a research council or on practice committees,” she says. “Get involved, and then put yourself out there.” Because so much of nursing is focused on direct patient care, nurses have fewer chances to speak in front of others or to gain the confidence that comes from that experience. Nurses can also actively practice at conferences and meetings where they learn to communicate what they want.
Johnson says that when nurses grasp the skills that will strengthen their team, standardizing the language and process makes a difference. “You want it to mean the same thing when there’s an emergency,” says Johnson, “so no one is confused.”
And if tension does develop, team members need to recognize the problem, reassess the approach, and address it. Take a step back and wait for things to deescalate, says Johnson, and then come from a place of humility. Have patience, she says, and evaluate what happened, what went wrong, and how to fix it. In interdisciplinary teams or even working with patients, the chance for miscommunication is elevated, and sometimes an apology is necessary and the right thing to do. “Own your mistakes,” Johnson says. “You don’t want to break a relationship to the point where progress fails, you can’t work together, or someone doesn’t want you as a nurse.”
Recognize the cultural communication component for each team you work on, says Johnson. “Think of how others are receiving your messaging,” she says. Nurses can also look for subtle signals in their teammates to know when the teamwork isn’t optimal. Look for body language and facial expressions, and listen to the responses from team members. “We must be proactive with talking and practice active listening,” says Johnson. “That active listening is important for gathering information, managing teams, and being team members,” she says. The skill is important enough that practicing it with role-playing is valuable.
Everett Moss II, BSN, RN, EMT-P, and a nurse anesthesia DNP candidate at the Nell Hodgson Woodruff School of Nursing at Emory University, has worked as a flight medic and nurse and as a firefighter before beginning his path to his DNP. So he understands how teamwork flows from one unit to the next in the patient’s journey. “The continuum of care is only effective with communication,” he says.
Everett Moss II is a nurse anesthesia DNP candidate at the Nell Hodgson Woodruff School of Nursing at Emory University
Every person’s role is important when a patient is moved from the ER to a trauma unit or the ICU and then is moved to discharge. “We saw that especially during COVID,” he says. Healthcare industry workers who aren’t in direct contact with patients still have a significant impact on nurses’ ability to care for patients effectively, he says. And nurses routinely communicate with pharmacies, labs, other teams, and family members or caregivers, so each step extends the team working on a patient. “In nursing, you’re forced into an environment where you have to learn teamwork or suffer the consequences of not,” he says. “And in our profession, if we suffer the consequences of not, our patients do too. I don’t believe an area of nursing survives without teamwork.”
Advanced practice degrees also provide communication skills that help nurses with teamwork, whether they remain bedside nurses or expand into other roles. As nurses progress to team leaders, David says they must understand how to lead effectively. “Understanding your style is vital in making sure you lead others,” she says, noting that she found her style and works with it. “I have a democratic approach. I tell them my expectations, but then I ask about their expectations of me. I let them know if you come to me with a concern, I want to hear a potential solution.” Building rapport strengthens trust so that each nurse can work for the betterment of the whole team. “It has to be 100 percent of the people working together,” says David.
Moss likens teamwork’s effectiveness to how sports teams operate. “Until you establish who does what, everyone may not know their role,” he says. “They may think, ‘I don’t know what you’re expecting from me, and I don’t know what to expect from you.’”
Johnson agrees. “None of us can do this alone,” she says. “The moment we do, we all fail.”
With the May 10 celebration of School Nurse Day, school nurses around the country will recognize how the role of a school nurse has changed dramatically over the decades. This recognition day helps highlight the increasingly complex medical, social, and community needs and duties school nurses are responsible for.
Bales spent several years in nursing before moving into this nursing specialty. “I had no idea about school nursing when I finished nursing school,” she says. After receiving her BSN from Tuskegee University, says her heart was set on pediatric nursing and that’s where she made her first foray into nursing. She spent many years working in pediatrics and in neonatal ICU units in Florida and Georgia.
But her path changed when her family settled in one area and her children’s school district had an opening for a school nurse. She was encouraged to apply, noting that her schedule would then mirror her children’s school times. “That was 21 years ago, and I am still here,” says Bales with a laugh. “I have the opportunity to marry my love of pediatrics with the school age group and grow in my leadership skills. It’s been quite a ride.” Bales herself has assumed increasing leadership roles.
As a school nurse, Bales has taken on roles that are diverse. She has worked as an elementary school nurse, an itinerant school nurse instructor, and a consultant nurse. In her current role as a nursing supervisor, she oversees school nurses across a county school district.
Throughout her career, Bales has worked with students of elementary, middle, and high school ages and has especially enjoyed seeing them grow. And even if she might not instantly recognize a grown adult who comes up to her and says, “Mrs. Bales, it’s me!” she’s always happy to hear about their adult lives. There are many students who remember the care and comfort their school nurse gave them, and even some who are inspired to follow a nursing path because of their school nurses. Bales recalls talking with past students who have overcome health challenges and gave Bales credit for her help. “Those are very heartwarming encounters,” she says.
As with many school nurses, being able to make connections with students and their families is what keeps the profession rewarding. There are plenty of challenges school nurses face. From the increasing complexity of health conditions to the wider family and community issues that impact school children, school nurses have to be well prepared for anything.
“Some of the biggest challenges are staff shortages,” says Bales. The pandemic has compounded nursing shortages in general, and school nursing hasn’t escaped the lack of nurses to fill roles. In addition, Bales says the staffing model can look different from state to state or even within a state, and can make school nurse staffing particularly challenging. Sometimes school nurses are paid on a teacher pay scale and sometimes they are paid using a different pay scale, so it’s difficult to lure nurses, who might otherwise be offered signing bonuses and larger salaries, to the school nurse arena, says Bales.
And school nurses must continually fight for the funding they do get. Bales says it gets tiring to have to justify the need for more funding and more school nurses to lawmakers and decision makers. A healthy school community relies on the school nurses who are able to act as a liaison between students, the community, and healthcare providers. It’s frequently said that school nurses and the school health services are the hidden health system in the country, says Bales. Helping students and staff to be engaged in the learning process, she says, requires school nurses to prioritize health and safety.
For nurses thinking of moving into a school nurse role or who may already be school nurses, Bales says she encourages them to take advantage of every single opportunity that comes to them professionally. Whether it is through mentors, preceptors, or a new opportunity for a new skill, don’t turn down a challenge, she says. Join an organization like NASN to learn from others and share your own knowledge as well.
“It warms your heart to know the significant impact you are making,” says Bales. “School nursing is truly a calling.”
As National Nurses Week 2023 begins its celebration of nurses around the world, nurses everywhere will look forward to the future of nursing while also honoring nursing history and all the nurses who came before them.
Nurses in the AAHN are committed to a diverse range of topics that piece together the broad, remarkable, and often unrecognized work of nurses in history. Dr. Graham-Perel shared her nursing research experience with Minority Nurse and encourages other nurses to follow those questions they have about the nurses who paved the way.
Can you please tell me about your research and how you became interested in pursuing it?
My research focuses on the lack of racial diversity in nursing education and its direct impact on our diverse patient population. I realized there was a lack of racial diversity throughout my nursing education journey, this includes my associate’s, bachelor’s, master’s, and ultimately, doctoral degrees in nursing. I recognized that I was searching for someone who I could identify with (someone who looked like me and shared my culture) in all of those programs, it was a consistent challenge to do so. In my doctoral degree, I wanted to dig deeper into why this was a problem. Honestly, I was committed to making this research a quantitative venture, however, I realized there were more questions than answers–and that led me to historical research.
I was incredibly fortunate to meet Dr. Sandra (Sandy) Lewenson at Teachers College Columbia University, who introduced our doctoral cohort to historical research. Dr. Lewenson made me realize my love for nursing history and served as my dissertation chair. For my dissertation, I wanted to uncover why there was a lack of racial diversity in nursing education and practice. When did this start? What caused this deficiency and what can be done to correct it? The questions went on and on.
I “peeled the layers back” far enough to discover the first school of nursing established in NYC to educate Black women in nursing, that is, the Lincoln School for Nurses (LSN) of the Bronx, N.Y., 1898 to 1961. Now, out of all my years of schooling and years being an RN, I have never heard of this school. I was ashamed and frustrated at this fact. I conducted a historical investigation on the school, the graduates, and their impact on the health of Black patients.
My research continues as I conduct oral histories of living graduates of LSN. The Lincoln School for Nurses has a beautiful and enriched history that should be acknowledged and celebrated. It is my honor to share it as a nurse historian.
What is most rewarding about researching the history of nursing?
What is most rewarding about researching the history of nursing is filling in the blanks. I had so many questions (I honestly still do), but when you uncover an answer or a link to an answer, it is extremely fulfilling. I get to teach others about historical truths that were hidden from us or simply not included in nursing history.
How did the AAHN help your nursing history work?
When I joined AAHN, it was like finally finding my niche! They were helpful in guiding me with the principles of nursing history and how to efficiently conduct historical research. For example, I served as a co-investigator on the oral history of Dr. Bernardine Mays Lacey, conducted by Dr. Lewenson. We did receive AAHN funding for the oral history (which was published in AJN August 2020) and the film that was subsequently produced.
Lastly, AAHN mentorship is a definite asset of being a member. History is special; finding others who are just as passionate and excited about nursing history and are willing to mentor scholars in the arts of history is one of the greatest gifts of the AAHN.
How will your historical research efforts help broaden and enrich the nursing communities you are in?
My historical research broadens and enriches nursing academia by highlighting historical discriminatory practices that led to the deficiencies in the racial diversity of nursing. Investigating the lack of diversity in nursing education presented truths about how this impacts the recruitment, retention, and ultimate success rates of diverse nursing students.
My continued goal with historical research is to present discriminatory practices, or remnants of such practices, that are still present in our nursing profession and corrective recommendations for our future generations of nurses.
What would you want other nurses to know about this kind of work and why you might encourage them to pursue their own research projects into the history of nursing?
It is essential for all nurses to know that in order to achieve a professional identity, one must know their history. One of Marcus Garvey’s famous quotes relates to this sentiment. He stated, “A people without the knowledge of their past, history, origin and culture, is like a tree without roots.”
Nursing history is essential to understanding our profession, how we became to be, and how our past influences what lies ahead. I encourage nurses to include history in their research (no matter what type of research you are conducting), for there is not one facet of research that is not impacted by nursing history. Lastly, I encourage my peers to remember that if you have more questions than answers, history is the route to take!
