Nursing education after COVID will rely more on technology and digital tools than ever. Simulation and online learning will be part and parcel of the curriculum for nursing students. It will also be more competency-based as the new AACNEssentials further integrate into nursing curriculums.
But what about the content of the curriculum?
Nursing education, according to Mary Dolansky, Ph.D., RN, FAAN, Sarah C. Hirsh Professor, Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school, may include instruction on telehealth, an emphasis on systems thinking, stress on leadership, and a focus on innovation and design thinking.
Mary Dolansky, Ph.D., RN, FAAN, is a Sarah C. Hirsh Professor at the Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school
A Look at Nursing Education After COVID
Understanding how to use telehealth in nursing is key, according to Dolansky. The Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, developed a series of four modules on telehealth so that all students received a basic foundation in telehealth nursing, including telehealth presence. It included teaching on using Zoom or the phone to assess and evaluate patients. She notes that interactive products that give students a feel for how such interactions occur and practice them can provide an excellent education.
Another aspect of post-COVID nursing education involves systems thinking, says Dolansky. This involves “really getting students to think beyond one-to-one patient care delivery and about populations. We need to create more curricula for nurses out in primary care sites and nurses out in the community, and that has not been a strong emphasis in schools of nursing. Instead, we focus mainly on acute care.”
More specifically, students should learn, for instance, how to use data registries to look at areas of patient need. One COVID example, notes Dolansky, would be to use registries to identify long-term COVID patients. Another could be to use a registry or database to discover what patients have followed up on their chronic disease since, during COVID, many patients stopped visiting healthcare providers.
In the post-COVID curriculum, developing leadership skills may become more critical. “What we observed in the COVID crisis,” says Dolansky, “was an opportunity for nurses to stand up and speak out more. We were the ones at the frontline and had the potential to be more innovative and responsive. Many great nurses did step up and speak up, but we need to ensure that every nurse can speak up for patients in future crises or even advocate for our patients now. Nurses can be the biggest advocates for patients.”
Every school of nursing probably has a leadership course, Dolansky notes. But ensuring that there are case studies from COVID as to how nurses did stand up and speak out and how that made a difference would be a fundamental curriculum change.
“We want to prepare our students that you will be a leader and you will be on TV talking about how you are innovating and adapting to the changing needs of the health of our population. And COVID was a great example for that.”
Post-COVID, nursing education needs to help students with innovation and design thinking, notes Dolansky. Over the past 10 years with QSEN, “what we’re trying to advocate is shifting the lens of a nurse from direct patient care delivery, which has been the focus of nursing, to shifting a little bit to systems thinking.”
Critical thinking, notes Dolansky, focuses on making decisions for an individual patient. Design thinking and innovation are more about “looking at the system in which we work and empowering the nurses to fix the systems. This is key to quality and safety, but it’s also key to the need for our nurses to contribute strongly to the health of the future population. They have to be at the table to respond to these crises. We need them to have the skill set of being a leader, standing up, being at the table and when they’re at the table, having ideas, being creative, and knowing how to test them. And having the technical skills to use the technology is probably where most of the solutions will be for the future.”
While revising the Essentials began before the pandemic, the experiences and learnings from the pandemic greatly impacted the work, notes a recent article in Academic Medicine. As a result, the Essentials includes population health competencies that specifically address disaster and pandemic response and will better prepare the next generation of nurses to respond safely in future events, the article says.
Now, a crosswalk has developed between QSEN competency statements and the 2021 AACN Essential Statements, notes Dolansky. However, she notes that the AACN is taking the QSEN foundation and moving it forward, stating to the public that “the nursing profession has these competencies that are providing safe quality care to the public.”Since 2012, the QSEN effort has been based on the Frances Payne Bolton School of Nursing.
“Own Their Competency”
In the culture of nursing education, students now need to be educated to “own their competency,” says Dolansky. “Students will see that competency development is part of their lifelong professional development.
Prior to finding out about Mercy Ships, Christel A. Echu, RN, admits that if you asked her if she wanted to volunteer for any organization and not get paid, she would have said, “No.”
But when a friend who was an authority in the church she attended in Cameroon, Africa, she changed her mind. “I decided to volunteer with Mercy Ships because I was interested in being a part of the great work they were doing for the people of my country, and I wanted to help in any way that I could,” Echu says.
Mercy Ships Bring Hope and Healing
Mercy Ships is a non-profit Christian organization, she says, that sails across West and Central Africa with the mission and vision to provide hope and healing to patients who are poor and/or forgotten in countries there.
When Echu began volunteering with Mercy Ships, she had just graduated from nursing school. First, she worked as a volunteer translator when the ship, the Africa Mercy, was docked in the port of Cameron. She volunteered as a translator for 10 months.
Mercy Ships bring hope and healing
By then, Echo says, she was hooked. She ended up continuing to volunteer for another two years. “I transitioned from that [working as a translator] to working as a volunteer screening nurse until the end of my commitment,” she says. “Screening nurses, we see all the patients before they are seen by the rest of the hospital. We screen, assess, and ensure patients are healthy enough for surgery.”
She says that they pre-screened more than 6,000 patients in a day when they were in Guinea Conakry. “That was the longest shift I have ever had,” she says.
One of the aspects that Echu loved about Mercy Ships is that she got to work with nurses from all over the world: including the Netherlands, Canada, Australia, the United States, and others.
“I loved working with patients and with my team. We also worked alongside our wonderful translators, which was a blessing because they helped to facilitate communication between the patients and nurses,” she recalls. “I think I enjoyed the fact that we could learn from each other to provide the best care to the patients we served. I enjoyed seeing the joy the patients felt whenever we announced to them that they were getting surgery. “The dance of joy” was a thing in the screening tent and I enjoyed seeing the patients come back to show us their “new self” without the tumor or the deformity. Moments like that, reminded me why I decided to volunteer in the first place and kept me going on difficult days.”
There were tough days. Echu says that one of her biggest challenges while working with Mercy Ships was being away from her family, home, and community. But another difficult part was when she had to say “No” to people they couldn’t help.
“This is a part of my job that we don`t talk much about. The ship has specific surgeries they do when they sail in a nation. However, there are patients who present with conditions that are not within Mercy Ships scope of practice and that`s when we get to do ‘no’ conversations. Screening nurses initiate that conversation before the chaplaincy team on the ship takes over,” she says. “That was the most challenging thing about my job—having those ‘no’ conversations was never an easy thing to do. Most of the patients we see come with the hope of being helped, but when we have to say no to them, it almost feels like that hope crumbles before their very eyes.”
She also, though, had many rewards—the greatest of which was forming relationships with the ship’s community. “The relationships I built during that time, [ones] that become an integral part of my life. The community is really special. Now, I have friends all over the world,” says Echu, who now lives in Minnesota. “I do not have family here in the United States, but I know friends with whom I worked with on the ship, [and they] are my family while I am here.”
Echu says she will never forget “the amazing patients I got to work with and their families and the joy they always had on their faces even without having much.”
If you’re a nurse thinking about volunteering with Mercy Ships, she says, “Do it! Go and see for yourself. Have an open mind and be ready to learn and receive as well,” she says. “Most volunteers go on the ship with the mindset of giving and serving which is good, but also go with the mindset of receiving. Receiving could be anything—like being welcome in the house of a local, or being encouraged by a patient who doesn`t have much, but they still have a big smile on their faces. It’s an experience that would change your life completely for good.”
Please tell me a little about your background and how you decided to become a nurse.
When I was in high school, it seemed everyone (including myself) had me destined to become a doctor, so I was lucky enough to participate in a program that let students complete hours shadowing someone in a profession for a partial class credit. When I began my hours at the local hospital, and started learning more about each healthcare role, I really connected with the nurses and knew that was what I wanted to do.
What is your current role and how did your career path lead you to this position?
Currently, I work at the NIH/NIDDK as a research nurse. I help to coordinate clinical trials, which includes recruiting and screening potential research participants, and helping coordinate their care. In my program, we see patients with a variety of endocrine conditions. Prior to this position, I was a nurse at the NIH Clinical Center on the medical-surgical inpatient unit, and that’s where I became familiar with this patient population with rare endocrine conditions.
What kind of academic preparation helped you the most?
After receiving my BSN from Hampton University, I completed the medical-surgical nurse internship at the NIH Clinical Center. This program was a phenomenal opportunity to help me transition into a role as a med-surg nurse, and the patient population at the NIH was so very interesting. I learned so much, but of course what I enjoyed learning the most about was the endocrine system.
How did you learn about endocrine nursing and what about this specialty appeals to you?
While completing my internship program, we were able to attend many in-depth courses to help us learn more about populations often seen on our medical-surgical units, and one of them was a course on the endocrine system. I also really enjoyed working with this population on a daily basis.
I think what appeals to me the most is that the endocrine system is so complex, and related to every other system as well from the immune system to cardiovascular and more. We were also encouraged to come up with our own research projects and posters for presentation, and that’s when I was first able to present a poster at a meeting of the Endocrine Nurses Society (ENS). I also love the amount of roles present in endocrine nursing, from floor nurses, to diabetes educators, nurse practitioners, university professors, and clinical researchers.
How has your ENS association helped your professional life?
Being a member of the Endocrine Nurses Society has really helped me connect and network with other nurses in this field, and I’ve found great mentors who have helped continue my career development. ENS has also helped me continue to further my knowledge with the many continuing education opportunities. Being able to connect with, work with, and collaborate professionally with endocrine nurses across the world has solidified my confidence in my career path.
What would you like anyone considering an endocrine nursing specialty to know about your job?
Endocrine nursing is an opportunity to work with such a wide variety of patients, in a wide variety of settings. Endocrine nurses work in primary care, hospitals, research, academia, and more. Endocrine nurses can be clinical, scientists, primary care providers, educators, the list is endless. If nurses are looking for a specialty with flexibility, opportunities for growth, and a field with constant learning, I highly recommend endocrine nursing!
Vanderbilt University School of Nursing created a new leadership development program for nurses new in health care leadership and academic positions who are from groups historically underrepresented in nursing and/or those who support them. The Academy for Diverse Emerging Nurse Leaders will be held in Nashville from November 14-18. Applications for the inaugural class of fellows are now being accepted.
“The need for nursing faculty and nurse leaders from groups historically underrepresented in nursing is well established, but research shows a need for career development resources that address the specific needs and challenges of diverse nurse leaders,” says Pamela Jeffries, PhD., FAAN, ANEF, FSSH, dean of Vanderbilt School of Nursing. “We believe that the knowledge, mentorship, strategy, and skills that new leaders will attain via the Academy for Diverse Emerging Nurse Leaders will empower them to continue to advance and lead.”
VUSN Associate Dean for Diversity, Equity and Inclusion Rolanda Johnson and Vanderbilt University Medical Center Senior Director for Nurse Diversity and Inclusion Mamie Williams will co-direct the academy, designed for nurses who have been in academic or health care leadership roles for less than three years.
“What makes this fellows program different from other professional development opportunities is that it incorporates and builds on the lived experiences of diverse faculty and health care leaders who have navigated a similar leadership path,” says Johnson. “It explores the challenges of being a leader from an underrepresented group as well as the challenges of supporting and expanding diversity in nursing leadership.”
Academy for Diverse Emerging Nurse Leaders
Academy for Diverse Emerging Nurse Leaders
The academy is taught by experienced faculty and health care leaders from diverse backgrounds and is specifically designed to serve the needs of new and emerging nurse leaders and faculty. In addition to the initial five-day, in-person meeting, fellows will also participate in virtual sessions, receive mentorship from an executive coach and institutional mentor and develop a leadership project.
Williams said that the idea for the academy resonated with her as she thought about her own nurse leadership journey of more than 25 years. “This leadership academy, based on specialized education, discussions, and interactions with peers and diverse nurse leaders, affords the emerging leader an opportunity to thoughtfully design their leadership journey,” she says.
She and Johnson said the academy was developed to help new nursing faculty and new nurse leaders build skills, gain knowledge, and build a network of colleagues and mentors to help them advance their careers and mentor other emerging nurse leaders.
If the coming fall season makes you think about someday returning to school or even getting a new certification, then it’s time to start planning how you can turn your thoughts into actions. There’s a lot to consider as you compare programs and courses that will boost your knowledge, move your career forward, and appeal to your interests.
Going to school takes a lot of time and is considered a financial investment in your future, so assess the resources and any available benefits you have to devote and plan accordingly. “I would recommend they find a program that aligns with their career goals and meets their personal needs,” says Lopez. “Oftentimes, graduate students are still working in their nursing careers and balancing a family. A program with full- or part-time options as well as online would provide flexibility and convenience.” In addition, online programs may also be more affordable. For example, UCF’s online programs offer reduced tuition through fee waivers for some campus-based amenities.
Map your route
No matter what your level of education, you’ll find several options to reach your goal in your return to school. In some accelerated degree programs, RNs can pursue a graduate degree without a BSN. The same goes for some nurses who want to pursue a doctorate degree–there are accelerated programs that help them combine some MSN and DNP or PhD requirements so it takes less time to complete the degree. Even some prerequisite courses that nurses will need to complete for a degree program can be flexible. Those courses can often be taken before or during the course of studies. All those details will help you plan how long different programs will take and how much each will cost.
Know your expectations
Most nurses with advanced degrees will encourage others to strive for a higher level of education, but they also advise giving it careful thought. Nurses should do the work to understand their real motivation for wanting that additional degree. Is it for a promotion opportunity or to meet a personal goal? Are they looking for a salary increase and how would they view their efforts without a salary bump? “I would advise applicants to review the policies within their organization first to determine the best path for advancement,” says Lopez, “as some employers have policies about degrees required for promotion and salary increases.”
There’s a lot of information to consider when thinking of returning to school. With careful thought and planning, you can find the right program for you.
Pho, who worked in New York City in the beginning of the pandemic, says the nursing community and his nursing work gave him a purpose through a distinctly challenging time. “You choose a place and you choose an environment to create the most potential for relationships,” he says. “The people and nurses I met are so phenomenal.” And while the pandemic did bring a fear of an unknown threat, Pho says nurses just did their jobs. “When you sign up for nursing, this is what you sign up for,” he says.
Nursing is Pho’s second career; he was in the software industry for more than a decade. “I didn’t want to do that anymore,” he says. “It was the same plot line and a different cast of characters.” Pho was accepted into the Johns Hopkins School of Nursing accelerated BSN program with the intention of returning to the Bay Area and working as a nurse. “But I met my tribe at Hopkins,” he says, and ended up staying to complete an MSN and an MPH there as well, working as an ED nurse and even working with an emergency medical residency program in Tanzania.
After Hopkins, Pho moved to New York City and became an NP at Weill Cornell Medical while also holding a teaching role. A lifelong advocate for LGBTQ health issues, Pho had a casual conversation with a physician who needed someone to develop the LGBTQ section of a curriculum on vulnerable populations and asked if he was interested. That led to a five-year teaching role at Weill Cornell Medical where he taught the first-ever LGBTQ health curriculum for the internal medicine residency program. In 2017, he left the role to pursue his PhD studies at Columbia University which he completed in 2020.
The spring of 2020 was a pivotal time for any nursing student, but for one in New York City, it was working in chaos. But for Pho, it totally cemented his dedication to his profession. Pho worked at Callen-Lorde Community Health in New York City, one of the largest providers of LGBTQ health care in that city.
“We staffed one of the convalescent hotels in Queens, and 50 percent of the patients were COVID positive from the shelter system and the remainder symptomatic,.” he says. “During that time I lived in a third-floor walkup in New York City, and I worked from 8 pm to 8 am while working on my dissertation,” recalls Pho, who also serves as a board member for GLMA: Health Professionals Advancing LGBTQ Equality. “Nursing saved me. It was a horrible time, but my queer nurses–we were together all the time. I think about my nurses, my role, my identity, and how it all gave me a purpose. I know it saved me. We were helping save people who society didn’t want to help.”
Through it all–the uncertainty, the lack of solid information, the severe illness of patients–Pho said a guiding principle made all the difference. “I think about being a nurse,” he says, “and a sense of purpose. I knew this is what I was meant to do. It got me up every day.”
Pho says his career has been paved by taking chances and finding opportunity when he could, and making opportunities when he couldn’t. And each task he completed or each chance he took led him to be in the right place at the right time–and with the right skills–to be able to offer the help that was so needed. “You make your own luck,” he says, a lot of which he says is based on the grind of doing the hard work day in and day out. “It’s important that you show up, not because you think it’s good for your career, but because you are truly passionate about it. The rest will follow. You do it because you want to make the queer universe a better place.”
He remains enthusiastic about nursing and the students who aspire to roles like his. “New grad nurses are so inspiring to me,” he says. One new nurse was having a hard day, Pho says, and he could tell she needed the pep talk he offered. “She said to me, ‘I needed to hear that validation.'” The moment struck a chord for Pho. “I told her, “Don’t think for a minute that I don’t have those days.'” Despite his experience and education, Pho says nurses still sometimes need someone to let you know, yes, you are a nurse and look at all you are doing.
“I started to see my role a little differently,” Pho says. “Sometimes it seems like all the dots seem to connect perfectly, but I’ll tell you it doesn’t feel that way when you’re doing it.” In fact, the way a nursing career progresses is sometimes based on opportunity but, more frequently, it’s something else. “I don’t think it’s predestined,” he says. “You make choices–not right choices and not wrong choices. There’s grace in the work.”
Nursing for me is about making a difference — and every day I’m making a difference in the lives of the people I care for. Take a Monday earlier this month. A patient of mine living with cerebral palsy was struggling to complete her therapeutic exercises. Her mother, clearly frustrated, feared her daughter wasn’t making sufficient progress. Dedicated and caring, the mother also worried that she wasn’t doing enough to help her daughter improve and succeed.
But this young woman was improving — slowly, surely, in ways imperceptible to the untrained eye. “Your daughter can now open both of her hands; all of our hard work is clearly paying off,” I explained, as the mother’s face transformed from hopeless to full of hope. “Your daughter just wants to be independent,” I continued, “and she obviously gets this spirit from you.”
Independence – as much as making a difference – is becoming a bigger focus for me in my career. The freedom to control my schedule. The freedom to control my income. The freedom to care for my three children. The freedom to care for me.
Until recently, I didn’t really have that choice.
For too long nurses have been treated like afterthoughts. We’re burned out and stressed out – from Covid, from our home lives, from feeling like our needs are always considered last. And this not only impacts our ability to perform, it threatens the effectiveness of the entire healthcare systems we’re so passionately committed to supporting. Yet, the working conditions and rigid schedules have not changed with the world around us.
Over my six-year career in nursing, I’ve witnessed both the indifference and abuse that has become too common in our industry. As a result, our community is suffering. Less than half of the 12,000 nurses recently polled by the American Nurses Association (ANA), for instance, believe that their employers care about them – a mere 19 percent for nurses 35 and under. More than 50 percent of all nurses are also thinking about leaving nursing; a figure that rises to 63 percent for nurses under 35. The latter numbers particularly worry me; with so many of my younger brothers and sisters ready to give up on nursing – and a national nursing shortage only expected to get worse – the future of the profession I love has never felt grimmer.
I know what it’s like to be undervalued in the workplace. I’ve been told by nursing agencies to wait in the cold if my patients are running late. Then when they finally do arrive, I’ve been expected to wash their clothes – even though I’m a nurse, not a housekeeper. I’ve been berated by patients for “moving too slowly” and battled with administrators for adequate PPE safety gear during the height of the pandemic. I’ve been made to feel like a number – a body – by nursing agencies just focused on profits and disrespected by patients and family members aggressively insistent I could just “do more.”
But more must be done to consider our needs, too – both by the nursing industry and the community of nurses to whom we all belong. What we seek is to be seen, valued, and supported in ways that matter. To be listened to if we are struggling during a hard shift. To hear “thank you” instead of being ignored. To give us tools and resources to take care of our mental health because after the past two years, we need it.
I experienced this kind of support unexpectedly when I found connectRN, a new platform that matches nurses with health care facilities that need our services. The ability to work when I want, where I want has given me the independence I was seeking, and an opportunity to step away if I need to recharge. As a mother, this flexibility is more important than ever. I can take on shifts that work with my child-care needs, eliminating the stress that usually occurs when making money and being a Mom collide. This should become an industry standard, rather than a perk from a digital start-up.
One of the things I value most about connectRN is that they are nurse-first and care as much about our community as the shifts they post. When I joined the platform, I was given access to The Beat, a private community of nurses who also work with connectRN. It is a safe space to chat with your peers about the things only nurses can truly understand – without the fear of reprisal or retribution. We share stories about hard shifts, give each other support to keep going, and often find “work buddies” in the places we work often. As debates rage around the role of nursing unions, hospitals and agencies must understand that a united nursing community is a better nursing community – better equipped, better prepared, and far better focused on the needs of our patients. With my life far more than just nursing – kids (both teens and a toddler), my extended family, a bit of me time – I feel lucky to be part of this community
For me, personally, The Beat proved particularly helpful when dealing with mental health concerns. At the height of Covid, the community offered telehealth therapy sessions through a partnership to use at our discretion. To be honest, I never considered I might need this kind of help — no one had ever asked me. But the death of a colleague — a young mother who passed away shortly after giving birth — hit me harder than I’d initially expected. I needed help to process how I was feeling and I took advantage of the offer. To have that support – for free – made me feel worthy and valued.
Over the past two years, I’ve been struck by a newfound respect for nurses as the Covid crisis continues unabated. Patients and families recognize our role at the frontlines of the pandemic and understand the risks taken daily to help their loved ones survive. What’s needed now is a parallel boost in understanding and appreciation from the hospitals and nursing agencies that power our profession. Because fairer pay, added flexibility, stress reduction, and self-care won’t just improve the lives of nurses, they’ll help ensure the positive patient outcomes we all desire. As nurses, we intuitively understand the necessity of these demands; it’s time for staffing agencies and health facilities to embrace this mindset with equally open hearts and minds.
Nursing jobs offer the kind of high salary and job demand that make them especially noteworthy. In the Indeed list, a registered nurse (RN) earned the top spot for its strong salary potential (listing an average base salary at $84,074) and the 34 percent increase in job postings from 2019-22. For every one million job postings in the survey’s timeframe, 619 of those were for RNs. U.S. News & World Report gave an RN role the number 12 spot of best jobs for its low unemployment, longevity of the career, and meaningful work.
A nurse practitioner role, which requires more education, landed in the number eight spot with an average base salary of $128,105 and an impressive 100 percent job posting growth rate over the past three years. U.S. News & World Report gave the second top spot to a NP role (it earned the number one spot in the organization’s Top 100 Healthcare Jobs), mentioning the high salary and the low unemployment rate of 1.2 percent.
The Covid pandemic sharpened an already growing need for nurses, so the growth rate for these kinds of jobs isn’t surprising. It does speak to the job security of a nursing career; nurses often don’t have to go far to find an open position in the field. And if they aren’t able to find the exact job they want, they have many other options to keep them gainfully employed while they continue their job search.
Hidden within the statistics is the potential for nurses to find the jobs that work for their professional goals and personal needs. They may want a job that allows them to move between roles or specialties and to have a career that is relevant on a global level. Nurses are able to move into different units in their local area or find jobs at healthcare organizations in rural areas and densely populated urban centers alike. They can work as a travel nurse to gain experience while also living in varied locations or they can acquire experience to pursue advocacy roles. Nurses have flexibility if they are seeking jobs with scheduling options or if they want to work in particular areas or with specific populations of interest to them.
With a high demand for skilled nurses–in patient-facing roles and in administrative roles–the trend of nursing job growth means nurses are in an excellent position to find the job that suits them best.
Melanoma is a potentially deadly form of skin cancer that effects people of every racial and ethnic group. The risk factor most closely linked to developing melanoma is exposure to ultraviolet, or UV, rays from the sun. In fact, sunburns have been associated with doubling one’s risk of melanoma.
Sunscreen can block UV rays and therefore reduce the risk of sunburns, which ultimately may reduce the risk of developing melanoma. Thus, the promotion of sunscreen as an effective melanoma prevention strategy is a reasonable public health message.
But while this may be true for light-skinned people, such as individuals of European descent, this is not the case for darker-skinned people, such as individuals of African or Asian descent.
In Black people, melanoma usually develops in parts of the body that are not exposed to the sun, such as the palms of the hands and soles of the feet. These cancers are called “acral melanomas,” and sunscreen will do nothing to reduce the risk of these cancers.
Last year my research group conducted a systematic review in which we analyzed all of the published medical literature related to UV exposure and melanoma in people of color. This includes those of African, Asian, Pacific Islander, Indigenous and Hispanic descent. Of the 13 studies that met our criteria for inclusion, 11 showed no association between UV exposure and melanoma.
Among the two studies that showed an association, one study showed a positive association between melanoma and UV exposure in Black men. But that same study also examined UV exposure and melanoma in other groups, including Black women, white men and women and Hispanic men and women. In these other groups the researchers found no association between UV exposure and melanoma. This is a surprising result, given that white people are the group in which the association between UV exposure and melanoma has been consistently demonstrated, calling into question the validity of the study results.
The other study showing an association between UV and melanoma was among Hispanic men in Chile based on latitude within the country. A major caveat to this study is that the city with the highest number of melanomas is also home to a large population of Chileans of Croatian descent, who would not be considered people of color.
Unfortunately, none of these studies measured melanin concentrations of individuals, so it is not possible to know whether theoretically lighter-skinned people of color may be at risk for UV-associated melanoma. However, even in light-skinned East Asian individuals, there is no evidence that UV exposure is linked to melanoma.
The bottom line is that the link between UV exposure and melanoma in people of color has been studied many times over and has yielded little to no evidence of a connection.
Racial disparities in melanoma outcomes are not related to UV exposure
Many dermatologists often point out that Black patients tend to show up to the doctor with later-stage melanoma, which is true. However, this is an issue of access and awareness and has nothing to do with sunscreen application or protection from the sun. Black people should be aware of growths on their skin and seek medical attention if they have any changing, bleeding, painful or otherwise concerning spots, particularly on the hands and feet.
However, the notion that regular application of daily sunscreen will reduce an already extremely rare occurrence is nonsensical.
UV radiation does affect dark skin and can cause DNA damage; however, the damage is seven to eight times lower than the damage done to white skin, given the natural sun-protective effect of increased melanin in darker skin.
To be clear, using regular sunscreen may help with reducing other effects of the sun’s rays such as sunburns, wrinkling, photoaging and freckling, which are all positive. But for the average Black person, sunscreen is unlikely to reduce their low risk of melanoma any further.
If sunscreen were important in the prevention of melanoma in dark-skinned patients, then why have we never heard of an epidemic of melanoma in sub-Saharan Africa, a region with intense sun, a lot of Black people and little sunscreen?
In certain subpopulations of Black people, such as those with disorders causing sun sensitivity, or patients with albinism – a condition in which people produce little or no melanin – or those with suppressed immune systems, sunscreen use may reduce risk of melanoma. But if you don’t fall into one of these categories, any meaningful risk reduction from the application of sunscreen is unlikely.
One-size-fits-all public health messaging misses the mark
Many dermatology and skin cancer-focused organizations – a few of which I belong to – promote the public health message of sunscreen use to reduce melanoma risk among Black patients. However, this message is not supported by evidence. There exists no study that demonstrates sunscreen reduces skin cancer risk in Black people. Period.
To me, the most shocking part of the studies were that most of the participants were Black, the group least likely to derive any meaningful associated health benefits from sunscreen, while being exposed to potentially harmful levels of chemicals.
As dermatologists and public health advocates, we can improve how we educate patients and the public about melanoma prevention without promoting public health messages that are grounded in fear and lack evidence. Black people should be informed that they are at risk of developing melanoma, but that risk is low.
Any dark-skinned person who develops a new, changing or symptomatic mole should see a doctor, particularly if the mole is on the palms or soles. We don’t know what the risk factors are for melanoma in Black or dark-skinned people, but they certainly are not UV rays.
Do you have friends at work? Do work friendships matter?
In a time of the “Great Resignation,” a phenomenon that is having a particular impact on healthcare industry, having friends at work can make your work life easier. Work friends see you more than almost anyone else–sometimes even more than your family. And while those familiar faces are often a comfort, work friendships can sometimes turn into a problem.
Research suggests that having at least one friend at work–someone you can rely on and talk to about somewhat personal matters–can help make you more satisfied with your employment, reduce stress, and can sometimes act as motivation. And while things like small talk at work can irritate some people (and even cause real distractions), even those small connections can be enough of a mood boost to make it worthwhile. Having people you consider friends on your team can also help your team perform better and accomplish more.
The theory makes sense. When you are happy to see the people you work with and feel connected to them and to their lives, you come to work with a more positivity. Teams that have a foundation in friendship will work hard to lift the work of the entire team. They are also more attuned to each other–whether that is a work style or knowing when someone isn’t in a good mood–and can help each other.
But are work friendships the same as your non-work friendships? Sort of. Work friendships often build into lifelong friendships and continue long after job and career changes. But like any friendship, there are always challenges–and having that friction or emotional stress at work can become a problem.
Go for Shared Interests
Does a work friend like to exercise at lunch or run fun 5Ks? Do you have a coworker who is a home pasta-making pro or who takes in weekend concerts? Bonding over shared interests is an excellent way to connect with work friends. You’ll have plenty to talk about, can meet up for fun get togethers, and you still have a common work interest.
What kind of image does your work friend project outside of work? Are they sometimes in trouble with higher ups? Your parents were right–you’ll be seen in the same light as the people you hang out with. So if they have values or morals that don’t match your own, you’ll want to know that.
Recognize that when you’re first getting to know someone, you need to remain friendly, but professional. Your career is based on your place of work–and the people in it. The last thing you want to do is divulge the latest family drama or your recent health crisis to someone at work and find out they shared your story with others. It’s okay to hold back even if others are sharing things with you. Protect yourself and your story.
Know Your Boundaries
It helps to know what you want to share with your work friends so having boundaries in place, and sticking to them, is good practice. And just because you choose to share your frustration with losing weight but not your frustration with your partner, doesn’t mean you aren’t coming to work as your whole self. It just means you are keeping some of your story private.
Protect Your Team
No matter how close you are to someone at work, skip the gossip mill. Talking about others, even with someone you trust, can land you in hot water professionally. Gossiping about your colleagues can also cast a shadow on how others see you; remember today’s peer could be your boss next year. Your goal is to build your team up and gossip is a barrier to that goal.
Work friendships are important and can make your daily job more enjoyable and more productive. But being careful about how you treat work friendships is important because, like it or not, they can have a lasting impact on your career.