Frank Baez poses with family and friends after his graduation ceremony. (Credit: Kate Lord/New York University)
Twelve years ago, when Frank Baez was spending his weekends cleaning patient rooms, bathrooms, and hallways at NYU Langone’s Hospital, he couldn’t have imagined that one day he would go from taking care of patient rooms to taking care of patients.
But that’s exactly what’s on the horizon for this recent graduate of NYU Rory Meyers College of Nursing.
When Baez was a recent immigrant from the Dominican Republic, he was finishing high school in Brooklyn and learning English, while working part-time in housekeeping to help support his family. So how did he go from working as a janitor to becoming a nurse?
“I worked as a housekeeper for almost 3 years. While cleaning the rooms and hallways, I observed the interactions between health care professionals and patients and felt that a career in health care suits my values and aspirations,” says Baez, now 29.
He began working in health care by being a patient transporter, taking patients for imaging and other testing. During that time, Baez earned a Bachelor’s degree in Spanish literature with a minor in biological sciences at Hunter College.
After graduating from Hunter, Baez got a job as a unit clerk at NYU Langone Orthopedic Hospital’s special care unit. In this position, he developed a system that improved the process of how patients received their prescriptions after their discharge. While Baez was obviously doing well in his job, he wanted to do even more.
Baez wanted to be a nurse. His colleagues encouraged him to apply to nursing school, and the senior director of nursing even suggested writing his letter of recommendation.
“I became inspired to become a nurse by working with other nurses at NYU Langone Health. Seeing their work on a day-to-day basis and learning how they care for their patients and how they advocate for them inspired me to become one of them,” says Baez.
Frank Baez at NYU Langone Orthopedic Hospital
Because Baez already had a degree, he was accepted into the accelerated program at the NYU Rory Meyers College of Nursing. During an intense 15-months, Baez earned a degree in nursing with a 3.5+ GPA. He was inducted into the Sigma Theta Tau International Honor Society of Nursing as well.
During his final semester, Baez took the Critical Care Nursing elective, which gave him the opportunity to spend time in the Cardiac ICU. Now, he’s working on a Master’s degree to become an acute care nurse practitioner. “When I took care of my first heart transplant patient, I was impressed by the efficiency and skills of the nurse I worked with,” says Baez. “I also saw the power of medicine and nursing to tide over the patient in critical illness. I want to be a part of that.”
Baez has advice for anyone thinking of becoming a nurse: “I would advise any aspiring nurses to not let any barriers stand in your way. Most importantly, find mentors and coaches. Emulate their attributes and add grit and determination to achieve your goals,” says Baez. “Being in the right place at the right time is just the beginning—one must seize the possibilities. I did.”
This month, many nursing students will be graduating and, soon after, looking for employment. While some may know exactly where they want to work, others might just be ready for a change and want to move across the country.
As a result, it’s good to have information about what states are the best and worst for nurses.
WalletHub came up with their results by comparing all 50 states as well as the District of Columbia “across 21 key metrics that collectively speak to the nursing-job opportunities in each market.”
The top ten best states for nurses are:
The ten worst states for nurses are:
42. Virginia 43. Vermont 44. Ohio 45. Mississippi 46. Alabama 47. Oklahoma 48. Louisiana 49. Hawaii 50. New York 51. District of Columbia
As for some highlights of best versus worst, WalletHub discovered the following:
“Oregon has the highest annual mean wage for registered nurses (adjusted for cost of living), $83,867, which is about 1.4 times higher than in Vermont, the lowest at $58,810.
Utah has the lowest current competition (number of nurses per 1,000 residents), 8.46, which is 2.4 times lower than in the District of Columbia, the highest at 20.49.
Nevada has the lowest future competition (projected number of nurses per 1,000 residents by 2026), 7.47, which is 4.2 times lower than in the District of Columbia, the highest at 31.49.
Minnesota has the highest ratio of nurses to hospital beds, 5.03, which is 2.3 times higher than in District of Columbia, the lowest at 2.22.”
The states expected to have the lowest competition in the field by 2026 are: Nevada, Alaska, Arizona, California, and Washington. Those expected to have the highest amount of competition by 2026 are: West Virginia, Nebraska, South Dakota, North Dakota, and the District of Columbia.
WalletHub also asked some experts about the nursing field. When asked for tips for recent nursing grads about where to live and work, William “Bill” J. Duffy, RN, MJ, CNOR, FAAN, Instructor, Director of Health System Management Program, Loyola University, Marcella Niehoff School of Nursing, said, “All nurses need to find a work life balance. The amount of care needs in our society right now can burn a caring nurse out if he/she doesn’t find that balance. So to answer the ‘where to live’ question I would say go somewhere that will make you happy (as you should be able to find a health employer looking for nurses in that area). If you want to move to the big city, there will be jobs. If you want to travel and do assignments in different parts of the country? There will be opportunities. The key is don’t just work anywhere.
Right now, there are options so you should work and live where you have a desire to be. For work, I would look for a place that is willing to invest in developing you and your career. So many organizations are looking to fill staff vacancies, that they are not looking at why nurses are leaving their organization. Nurses are loyal, caring people, but the organization has to respect and care about them as well. Make sure your prospective employer is interested in helping you and [your] career grow.”
Duffy says that recent grads should ask the following questions of their prospective employers:
Do they have a tuition forgiveness program?
Do they have a tuition reimbursement program for advanced degrees?
Does the organization support flexible work schedules to support school requirements?
How many nurses have been promoted from within?
Does the organization support the use of advanced practice nurses?
When WalletHub asked Janet Rico, MBA, NP-BC, PhD, Assistant Dean, Nursing Graduate Programs School of Nursing – Bouvé College of Health Sciences, Northeastern University, the same question, she responded with, “Seek adventure and challenge. Wherever you practice, you will be challenged, humbled, and incredibly rewarded. Consider less-traditional practice settings such as home care, day programs, and long-term care. You will be able to practice to the top of your license and will grow in your ability to think and act independently and collaboratively.”
During a recent Washington State Senate floor debate, Senator Maureen Walsh said, “By putting these types of mandates on a critical access hospital that literally serves a handful of individuals, I would submit to you those nurses probably do get breaks. They probably play cards for a considerable amount of the day.”
To say that nurses were upset is the understatement of the year. We asked some nurses for their reactions to the Senator’s quote. Here’s what they had to say.
“Walsh’s comment infuriates nurses because it reflects dangerous ignorance, at best. The very reason for the kind of legislation she is opposing here is that, contrary to the implication of her comment, nurses today struggle with rampant understaffing that pushes them to burnout. Research shows that puts their patients at higher risk of suffering, complications, and death. It’s one thing to claim that more regulation will harm a particular industry. But for a comfortable state legislator to tell an exhausted health professional that she has lots of time to play cards highlights a huge failure of understanding. No surprise: The entertainment media presents nurses as low-skilled servants who sit or stand around waiting for orders (or maybe thinking about their bridge club!), while physician characters do the work that nurses do in real life.
We think Walsh’s comment shows the need to establish a “Nursing Awareness Certificate” for decision-makers. Anyone who wants to make health-related policy or media should have to complete a “Follow a Nurse” program that we are initiating at The Truth About Nursing. That would involve following a hospital nurse with an average workload for a typical 12-hour day of clinical practice: arriving and leaving when the nurse does; staying side-by-side with the nurse for every step of the nurse’s day; eating, drinking, resting, and getting a rest room break only when the nurse does; no special meetings with administrators. We will help find the nurses for them to follow.”
—Sandy Summers, RN, MSN, MPH, executive director of The Truth About Nursing, and coauthor of Saving Lives: Why the Media’s Portrayal of Nursing Puts Us All at Risk
“I have been a Registered Nurse for the past 19 years. I found it to be very insulting that Senator Walsh would suggest that all we do is play cards all day. Clearly, she has no idea what our profession is about or even has walked in our shoes. I am a very hard-working, dedicated, and caring nurse, who doesn’t have time to play cards, because I am too busy saving lives.
Patient care is a nurse’s top priority. This type of ignorant statement feeds into the stereotype that nurses don’t do anything or that our job is so easy. I would love for Senator Walsh to have an area with 6-8 patients, who may be confused, or on a tube feeding, or have wound dressing changes, or getting a post op or ER admission. Let’s see how she would feel about being a nurse then.
Her statement also showed her lack of respect for the profession. If you do not work in a profession, then you should not be able to pass judgment on a profession.”
“I’ve been a nurse for over 10 years and have worked in various different roles from the emergency room to orthopedics. During all of this time, I’ve never had a break other than a lunch break (some days, not even that). Some days at the end of my shift (12 hours or more), as I was getting ready to leave, I would realize that I hadn’t even gone to the bathroom because I hadn’t had time.
From the reactions I’ve seen on social media and heard from my current colleagues, there’s no question that the Senator’s remarks have sparked an outrage among the nursing community. I personally feel that they show ignorance on her part in regards to what we actually do. They also show a lack of respect for people who go to work every day where our job is to take care of other human beings during which, for many of them, is the most unpleasant moments of their lives.
I think I can speak for most in the profession that each one of us cares enormously about our patients and feel what we do is important to helping others feel better. This is what drives us to go to work each day even though we know we probably won’t have a break and are lucky if we get to go to the bathroom. Granted there are some areas of the profession that aren’t this way and even if the nurses who work in these areas are able to have breaks, I highly doubt they are playing cards.”
“The unfortunate comments by Senator Walsh were uninformed and reflect a profound disrespect for nurses. Despite her mother being a nurse, it seems she is not aware of how hard nurses work at helping their patients. While her stated goal of keeping small rural hospitals is laudable and a goal shared by nursing, her attack is not the way to do so.
Nursing is the largest health care occupational group and, as such, are privileged to be there when babes are born and at the end of life. That Senator Walsh believes we spend our time playing cards shows how little she is aware of what nurses actually do.”
—Bob Smithing, MSN, FNP, FAANP, clinical director at FamilyCare of Kent and executive director of ARNPs United of Washington State
“Senator Maureen Walsh’s comment that nurses ‘probably play cards for a considerable amount of the day’ was insulting to say the least. Nurses who work in direct patient care are among the hardest working members of the health care team. We often forgo breaks and stay extra hours because of short staffing. My labor and delivery colleagues and I spend our time charting, monitoring fetal heart strips, coaching patients as they push for hours, helping new moms breastfeed, assessing newly delivered patients for signs of postpartum hemorrhage, among many other responsibilities.
Although the comments were made in regards to the necessity of mandatory overtime among hospital staff nurses, Senator Walsh’s statement overlooks the many nursing roles beyond the bedside such as nurse educators and nurse researchers. My days as an Assistant Professor of Nursing at Widener University are filled with preparing the next generation of nurses and advancing the field through lecturing, creating exams, holding office hours, grading papers, prepping for future lectures, designing research studies, submitting research grants, and writing manuscripts for publication.
There is no time for a game of spades, Uno, or even solitaire. It is clear that Senator Walsh does not understand the vast role nurses play, none of which include dealing cards.”
—Tiffany Montgomery, PhD, RNC-OB, C-EFM, a labor and delivery nurse at Einstein Medical Center and assistant professor at Widener University
Kim Dupree Jones
“Nurses are too busy caring for patients to even sit down, no less play cards.”
—Kim Dupree Jones, PhD, FNP-BC, RN, FAAN, dean of the Linfield College School of Nursing
“What is important for nurses is to go to the source of the information directly in order to put the comments into context. While her flippant comment was unnecessary and insulting, I understand Sen. Walsh’s frustration with a bill that will significantly impact the staffing model of critical access hospitals. As she was referring only to those nurses who may work an entire shift with only one or two patients in the facility, I am sure many of those nurses are aware of how they spend their hours of down time.”
Especially since the #MeToo Movement began, sexual harassment has been in the spotlight. We spoke with nurses who have been harassed, legal experts, and nursing professionals to determine what you should and can do if this happens to you.
Celia,* RN, a longtime hospice nurse, remembers it like it was yesterday. A younger man, at least younger for hospice, had been admitted with terminal cancer. While Celia says she recalls other nurses talking about the patient having made “inappropriate comments,” she had never experienced it herself.
Until she did.
The patient had been angry and struggling with what he deemed the unfairness of dying young and leaving his wife and child—and knowing that he wouldn’t be able to take fun trips or do things with his daughter. Because he had a trach, which requires frequent suctioning and medication, he felt like the staff was treating him like a leper—when actually, they were simply following all safety precautions.
“Once trach care was completed, I sat down, took my gloves off, and offered him a hand to hold—this is standard practice between hospice staff and patients, and it’s not frowned upon,” says Celia. At the time, the patient held her hand, cried, and expressed gratitude for the time to talk. “I felt we had a nice, professional, and therapeutic rapport.”
A few weeks later, a couple of days after Christmas, Celia was caring for the patient, and he asked if she was married. When she responded that she was in a long-distance relationship, he asked how she took care of her sexual needs—and asked using inappropriate, graphic sexual language.
Celia replied, “One—that is none of your business. And two—It’s not appropriate conversation between a patient and a nurse!” Then, Celia calmly informed him that this was harassment and abuse. With one word to her managers, she told him, she would never have to be his nurse again. She says that the patient was contrite and apologized. Celia passed it off as a one-time thing and let it go.
Unfortunately, that wasn’t the end of the harassment. After a couple of weeks, Celia was the patient’s nurse again. While taking care of his trach, she talked with him. When he could speak, they discussed their favorite kinds of music. She recalls, “It was a nice interaction, as I grew up in a musical home, and discussing this was special to me.”
Near the end of the treatment, though, everything changed. The patient told her lots of things that he would like to do with her sexually, in graphic detail.
Celia recalls, “I was horrified. I was angry. I felt nauseated. I felt ashamed about my body, and I wanted to cry. I was shaking, inside and out.”
She told the patient that he was so far out of line. He was shocked that she was so rattled and tried to justify it by saying that it was a compliment. Celia left his room immediately.
The first thing she did was post on the staff’s white board that she would no longer care for this patient. When she calmed down, she emailed her managers and then communicated with them in person the next day.
Celia’s managers were supportive. She never saw the patient again, and he left the facility a few days later.
Harassment is Prevalent
A Medscape.com survey published last year revealed that the majority of nurses—71%—say that they had been sexually harassed by a patient. Of those responding, 90% were female nurses, 10% male.
But male nurses get harassed as well. They may, however, be even less inclined to report it. In the same survey results, it states, “By gender, female nurses…were much more likely to say they had been sexually harassed than their male counterparts (73% for female nurses vs 46% for male nurses).”
No matter the gender of the nurse who experiences it, sexual harassment is wrong. That said, how do you decide if what a patient is doing or saying is sexual harassment?
If it Looks Like a Duck and Quacks Like a Duck
According to Trista Long, RN, DNP, MBA, ON-C, a nurse manager for an inpatient med/surg unit with Blessing Health System, it is easy, most times, for nurses to differentiate between behavior that is appropriate or inappropriate. “The first sign of inappropriate behavior is when patient’s actions or conversation makes the nurse uncomfortable. Patients who are making inappropriate comments will first ‘test the waters’ by making inappropriate jokes or mild comments to gauge the nurse’s response. If the nurse dismisses the comment, the patient will likely continue with the inappropriate conversation or actions.”
If a patient exhibits inappropriate verbal behavior, it’s often easy to recognize, says Long. “Nurses know what crosses a line and what doesn’t,” she says. Because of the physical nature of nursing, however, Long says that inappropriate physical behavior can sometimes be more difficult to recognize.
“I often tell my staff that—again—inappropriate touch is anything that makes them uncomfortable…it’s no different than being in public and having someone touch you inappropriately. Just because you are in a hospital does not give another person the right to touch you,” explains Long. “Most patients will want to hold your hand or touch your arm, but they will not go any further than that. An action or remark could be considered harassment if the nurse directs the patients to stop, but that direction is ignored.”
“A ‘reasonable person standard’ is generally used to determine if conduct is motivated by prurient interests or for a person’s sexual gratification,” says Debra W. Levin, counsel in the health law group at Brach Eichler. She previously served as counsel to the New Jersey State Board of Medical Examiners and was the Assistant Section Chief responsible for legal services provided to more than 50 licensure boards, including the New Jersey Board of Nursing. “If a reasonable person would be offended, then it can be determined to be sexual harassment. Because the standard is subjective, it is often hard to determine.”
“Sexual harassment is generally any unwanted sexual direct or indirect physical contact or comments. Of course, some physical contact may be more overtly ‘sexual’ than other contact, but much of the time, the intent will be evident,” says Jessica T. Ornsby, LL.M., Esq, managing attorney with A+O Law Group. “A good rule of thumb is whether the contact is objectively appropriate under the circumstances. For example, if a nurse is taking a patient’s blood pressure, is it necessary for the patient to place his or her hand on the nurse’s thigh? Probably not. But if a nurse is helping a patient into bed, that patient may need assistance stabilizing himself/herself and may rest his or her hand on the nurse in a way that would otherwise not be necessary.”
She adds, “Sexual harassment is basically a step down from sexual assault. If the action/contact involves force or any kind of penetration, that is most likely assault and should be addressed accordingly.”
What to Do if It Happens to You
Suppose a patient sexually harasses you. What do you do?
“Experts believe that sexual harassment is significantly underreported in health care. For that reason, I believe the best defense for nurses starts with reporting these types of incidents,” says Jennifer Flynn, CPHRM, risk manager at Nurses Service Organization. “No matter who the harasser—whether it be a supervisor, coworker, or a patient—nurses can take steps to address harassment in their workplace.”
“While working in a hospital, the first step is for the nurse to address the behavior. The nurse should tell—not ask—the patient to refrain from the inappropriate comments or actions and to stop immediately. The nurse should then report the behavior to his/her manager so that the leader can be aware. If the behavior stops, it typically will not need to go further,” says Long. “It is imperative that the nurse set boundaries with the patient immediately once s/he recognizes the behavior. If the action is severe or violent, the nurse should report it immediately, and the leader should address it. If the nurse is uncomfortable caring for the patient, the patient can be reassigned to another nurse. There have been times when I have assigned only male nurses to a patient who was harassing the female nurses.”
There may be times in which a patient won’t stop. In this case, Long says that the leader should talk with the patient and stress that the behavior won’t be tolerated and must cease. “If the behavior continues or if the nurse is uncomfortable caring for the patient, the patient should be reassigned to another nurse, and the leader should engage the Risk Management Department and/or the Security Department to assist. Many times, a Security Officer will be asked to speak with the patient and direct them to stop the behavior. Since they are often in uniform, it can be a show of added authority and the behavior will stop. If it does not, the Risk Management Department can speak to the patient and explain any legal consequences to their continued inappropriate behavior,” says Long.
Ornsby says that each work environment, ideally, should have some kind of policy with regard to sexual harassment. “Nurses should make note of these policies and earmark them for future reference,” she says. “If the policy does not specify to whom to report the incidents—ask. If a patient’s behavior…is making you uncomfortable or causing you to feel unsafe, leave the situation immediately. Your personal safety and well-being are the most important. Federal laws on sexual harassment apply regardless of whether the harassment is taking place at a hospital or a doctor’s office.”
Levin agrees that health care organizations should have policies in place. “Larger or licensed facilities may have staff to counsel the patient regarding harassing behavior. Additionally, in regard to patients, the patient can be transferred to another’s care, a chaperone can be provided, and the patient can be counseled. In dramatic situations, the patient can be discharged/terminated from the practice or facility. State-specific laws apply that govern termination of the doctor/patient relationship/discharge so that the patient is not abandoned, and there is a transition of care,” she says.
The American Nurses Association has challenged nursing professionals to end sexual harassment in the workplace by adopting a zero-tolerance policy. “Much has been written lately about the importance of nurses engaging in self-care. Not tolerating sexual harassment is an integral component not only for self-care, but also for self-respect, vital for professional effectiveness. Speak up when sexual harassment occurs and facilitate a civil work environment,” Flynn says.
The Bottom Line
“If the organization is not responsive to the nurse’s claims, s/he should consult legal counsel or their union. No one should be subjected to sexual harassment in the work place,” says Levin.
Long says that harassment, whether physical or verbal, has been perceived in health care as “part of the job.” But it’s not and never should be seen as such. “It is never acceptable to be harassed by anyone at any time. Nurses are an integral part of the health care team and should command the same respect as every other profession,” says Long. “Unfortunately, nurses have been depicted in a sexual manner for ages and that has demeaned the profession. Being a nurse does not negate my rights as a human being to not be verbally or physically assaulted.”
“I took an oath to care for others, but that does not mean that I have to sacrifice my physical or mental well-being,” Long adds.
Barbara Stilwell, PhD, RN, FRCN, is the Executive Director of Nursing Now, a three-year global campaign seeking to raise the profile of nurses.
Dr. Stilwell recently talked with Minority Nurse about what she hopes Nursing Now will accomplish before the campaign ends next year.
What follows is
an edited version of our interview.
What do you hope to accomplish?
The campaign ends in 2020 and by then we aim to achieve the following:
1. On investment: There is greater investment in the nursing workforce—in education and professional development, standards and regulation, and employment conditions as well as in numbers in training and employment.
Measurement: that there are increases globally in investment in nursing and in the numbers of nurses in training and employment, and that a trajectory has been established and progress is being made towards eliminating the shortfall of nine million nurses and midwives by 2030, tracked through the State of the World’s Nursing report.
2. On policy: The health workforce generally—and nursing and midwifery specifically—are more central to global and national health policies.
Measurement: that all global and national policies on health and health care acknowledge the role of nursing in achieving their goals and include plans for the development of nursing. That national plans for delivering UHC make specific proposals for enhancing and developing the role of nurses as the health professionals most able to deliver patient centred UHC to individuals, families, and communities.
3. On leadership and influence: There are more nurses in leadership positions where they are able to influence policy and decision making and more opportunities for leadership and development for nurses at all levels.
Measurement: at least 75% of countries have a CNO or Chief Government Nurse as part of their most senior management team with the longer term aim of all countries having such posts; there is an increase in the availability of senior leadership programs for nurses; and a global nursing leadership network is established. More young nurses have access to leadership development programs.
4. On evidence: There is more evidence available to policy and decision makers in forms that are understandable about: i) the impact of nursing and where it can have most effect, ii) the barriers that currently prevent nurses from practicing to their full potential, iii) practical methods for addressing these barriers, iv) and that there is more research underway.
Measurement: There are increasing numbers of articles on aspects of nursing in peer reviewed journals that reach an audience broader than nurses; there is a coordinated global network on research on nursing; and there are innovative methods tested of bridging the evidence to policy gap in nursing.
5. On effective practice: There is more dissemination and sharing of effective and innovative practice in nursing and improved methods for doing so.
Measurement: that there is a
coordinated global portal allowing access to examples of effective practice and
innovation that is supported by nursing organizations and available to nurses and
policy makers globally.
What has the campaign accomplished so far?
We now have 170 Nursing Now groups in 77 countries and growth continues. We are a social movement that works through its groups and networks to change the culture of nursing, and feedback so far suggests that the campaign has come at a moment when nurses are ready for change.
What do you hope to have happen in the next year?
WHO has declared 2020 will be the Year of the Nurse and Midwife and is preparing a State of the World’s Nursing Report—the first one ever. While there is support at WHO for nursing and midwifery, the presence of a global campaign has highlighted the significant issues in nursing development if Universal Health Coverage is to be achieved.
Our Nursing Now groups are spearheading initiatives to tackle today’s health issues—for example, how to achieve universal health coverage, the health of homeless people, gender-based violence, men in nursing, the image of nursing and midwifery, and many more.
How can nurses and/or health care providers become involved in it?
We have a great web site which
invites comments and case studies. Please explore it and contact us if you have
ideas. This is a movement that belongs to all nurses.
Dr. Barbara Stilwell, Global Campaign Executive Director for Nursing Now, an initiative to empower nurses worldwide by building grassroots support to demand better investment in nursing and midwifery to tackle 21st-century health challenges, is the author of “#Nursing Now," an article about this campaign, in the most recent issue of Creative Nursing: A Journal of Values, Issues, Experience, and Collaboration.
This issue is currently free to read for a limited time.