Clara Bridges, Atlanta Housing’s oldest living resident and nursing veteran of 33 years, celebrated her 102nd birthday with friends, family, and song at the Peachtree Senior Tower, where she has been a resident since 1975.
The spry centenarian, known for her sharp memory, recalls birthdays and phone numbers of nieces and nephews. At 102, she still has a quick wit, a zest for life, and the energy to exercise and enjoy healthy foods.
She answered with hushed passion when asked for the secret to her longevity. “People don’t know. God rained down on us. Days like this, people don’t realize what senior citizens go through,” she explains. “How did you get there, Ms. Bridges?” she says, she is often asked. “I said, just a closer walk with God.”
Her wisdom continues. “I look back over my life and often ask myself, ‘Have I lived the life that was given to me to live? ’Cause a lot of us would take someone else’s life and live,” she explains. “But I wanted mine.”
The day’s treat was having one of her birthday wishes come true: to meet Dr. Bernice King. Dr. King reached a milestone birthday herself. “Whenever somebody this age calls, God’s speaking,” says King. “I hope we don’t take this moment for granted or lightly.”
An Atlanta native who grew up in what is now known as the West End, Bridges knew she wanted to be a nurse by the time she was seven. After graduating from Booker T. Washington High School and completing nursing programs at Clark College and Grady Hospital, she enlisted in the U.S. Army and served honorably at four military installations. After 33 years of service in nursing, Mama Bridges, as she is affectionately known, retired to the senior high-rise in 1976, becoming its first Black resident.
“Mama Bridges represents the best of Atlanta, our state, and our region,” says Eugene E. Jones, Jr., president and CEO of Atlanta Housing. We are privileged and honored to still have her in our lives, and the love and compassion she shares is a living example for us all.”
Esther Conteh has enjoyed an extraordinary and varied healthcare and nursing career for over 25 years. She emigrated to New York City from Sierra Leone as a teenager and was inspired by her mother’s work as a midwife back home and decided to pursue a career in healthcare.
After working as a home health aide at VNS Health, she became an RN with the organization and moved quickly through the ranks, leading to her current leadership role, where she oversees a large and diverse team.
In everything she does, Esther works towards building a culture of inclusivity and family for her team. She is committed to providing top-notch care to the communities served by VNS Health Choice MAP and MLTC, many of whom come from vulnerable backgrounds.
I’m an Advanced Practice Nurse (APRN) and Associate Vice President at VNS Health, one of the nation’s largest nonprofit home and community-based healthcare organizations. I manage care for members of our Medicare Advantage and Medicaid Long Term Care health plans, which were developed specially for people with complex, chronic health conditions.
Please discuss your career path and how you ascended to that role.
I have been at VNS Health for 25 years—I started here as a home health aide working in Manhattan. I knew from the beginning that caring for people in their homes was what I wanted to do, so I got in on the ground floor, and it was a great beginning. As a home health aide, I absorbed the experience of what it was like for people to recover. I got a chance to see what people needed and their concerns. I learned how to reassure and help people as they regained strength or coped with changing health conditions. The empathy I found in those days still guides me today.
After working as an aide, I went on to train and become a nurse and graduated as an Advanced Practice Nurse (APRN) from NYU. I was eager to build my skills in home health nursing. As I expanded my education, I focused on home health–a specialty I’ve always been drawn to because you can interact with people, and education is a big component. There is always the potential to help people understand what they need to stay healthy.
Throughout it all, I am grateful for the support of my mentors and those I work alongside. For example, when I was just about to enter the field as a nurse, I was also in the middle of my first pregnancy. As you might imagine, balancing so many life changes at once can be challenging! Thankfully, I had a lot of flexibility in home care, but the job could still be intense when I first started. I’m immensely grateful for the support I received from the team I worked with and my managers. Those early relationships helped me get where I am now.
After several years working in the field and many changes in the healthcare system, I’ve moved into a new role that’s been exciting. The work I do today as an AVP of Care Management for our VNS Health Health Plans is very much informed by my field experience. When talking with a client on the phone, I can visualize their home and ask questions about their environment, lifestyle, companions, or caregivers at home. Every day is different, but each structure is similar in many ways. That’s one thing I love about this work. Working with our MLTC (Managed Long Term Care) and Medicare members requires skill, empathy, and patience. Our plans serve some of the most vulnerable communities in the city. Disabilities, diabetes, heart disease, cancer, dementia, arthritis, and other chronic illnesses all come with fears and potential complications for our members. We try to simplify things and help them navigate complex systems, so they feel more in control of their health and well-being. Working in a management role, I still feel like I am a nurse first, but I’m also part of a care team that needs to be agile and deliver care quickly. My experience helps me support others on the team, too—especially younger clinicians.
Why did you become a nurse?
Growing up in Sierra Leone, my parents were healthcare workers and educators, helping all the locals. It sparked my desire to work in health care and to help others as my parents did. The care they provided others shaped my thinking, and I have never swayed from my passion for working in health and helping others. I moved to New York when I was sixteen, and as I finished school, I started moving into a career in health care, starting first as a home health aide. That experience still informs my work today and has given me a valuable perspective on best serving different patients.
What are the most important attributes of today’s nursing leaders, and why?
The first word that comes to mind for me is integrity. As a nurse, you’re often with people at their most vulnerable and truly depend on you, so integrity is critically important. Another core value that makes a good leader is empathy. Next, you have to understand where people are in their life journey. And lastly, you need to be agile and flexible and be able to pivot when needed. Especially working in people’s homes, our nurses are always mindful of where our patients come from. Every day has the potential to bring something entirely unexpected or new.
What does being a nursing leader mean to you, and how are you making a difference?
Experience is so important. Leading others, whether that is guiding someone who needs care or a team member that supports them, as is the case with our health plan care managers, that both the members and my colleagues know they can trust me. Leading requires clarity and honesty. I use those skills every day. There’s a lot of urgency in the work we do. Precision is essential, and you must make decisions quickly sometimes—it can be stressful. Everyone experiences that, both members and our experts on the phone. We lead by example and communicate one step at a time so we can hear what our members are saying—we try to “meet them where they are.”
Those we serve are often facing multiple comorbidities and life challenges. So you must ask yourself, what can I do right now to ease some of the issues this person has to deal with? It’s about considering all their needs, not just nursing care, but do they have access to food? Are they safe? If not, we must prioritize those crucial basics for our members.
What is the most significant challenge facing nursing today?
As the aging adult population grows, so will the need for skilled home care nurses and caregivers. It’s an exciting time to be in this specialty, but it also means more nurses with skills in home health care will be needed.
I don’t think the solution is simply hiring more people. Instead, we must think carefully about where nursing is going and how to improve. It is about what we learn from those we care for and how that can transform nursing. It is about working smarter, not harder. Because we can all agree burnout is a prevalent issue across the industry, and it’s important to support both veteran and novice nurses that put their all into the work.
As a nursing leader, how are you working to overcome this challenge?
Technology has become a valuable tool and resource for our team. Throughout the pandemic, it’s been amazing to see how telemedicine has transformed how we communicate and deliver care. The pandemic brought people together through technology and made it easier to trust and feel a face-to-face connection, even if that was on a phone or computer screen. For many of us in nursing, I think it opened our eyes to new possibilities.
For example, with remote patient monitoring, you can recognize a problem before you are even there in person, enabling us to respond faster. From afar, we can manage our patient’s heart rates, blood pressure, blood sugar levels, and much more. With this data, we can spot emergencies and react immediately. At VNS Health, we created a sort of dashboard where we could track and monitor incidents with patients. This lets us monitor risk and work with different teams to determine which services or interventions are likely needed.
Technology encourages even the most seasoned nurses to think out of the box. Our world is changing, and that’s not necessarily a bad thing! Especially if it can help nurses excel, feel supported, and better serve their patients.
What nursing leader inspires you the most and why?
That’s a tricky question because there are so many who have been an inspiration to me! Someone who comes to my mind first is Susan Underwood, Director of Compliance Operations with VNS Health. I first met her in an entirely different capacity from the one I am now, as I had just graduated from another part of the organization, so it felt like I was starting somewhere new. However, she was incredibly supportive and recognized my potential, encouraging me to grow.
She approached me one day and said, “I think you are ready to take the next step. So let’s work together to find a role where you can grow your skillset and mature.” And she was right. Moving into a leadership/managerial role was daunting, but I’m glad I did it.
Looking back even further, I think the founder of our organization, America’s first public health nurse, Lillian Wald, was such a visionary figure. Her work 130 years ago still holds so much in common with what we do today. She looked around at the communities she worked in and saw significant issues that needed to be addressed. So, she took action. And that way of seeing the world, of instilling change, is very much a part of the culture here at VNS Health today.
In home health, as a nurse, you have the privilege and the challenge of being aware of so much. We watch family dynamics firsthand; we see the ins and outs of a patient’s life and understand the many unspoken things behind the scenes. Home health nurses must ask ourselves, “What help do I need to bring? Do they trust me in this relationship?” Home health nurses must consider all the factors that impact a patient when planning care.
What message would you like to share with the next generation of nurses?
It is so important to have a passion for this field, knowing that it can be tough sometimes. But nurses will find that sticking with this career is worth it if it is their passion. In nursing, as in every other career, there will always be challenges, and many of us face added hurdles because of race or ethnicity. However, one advantage I’ve seen is a better understanding of some health disparities because of my lived experience. That alone can play a powerful part in healing.
I would tell future nurses you have a significant role, especially when serving people who look like you and might share the same experience. Remind yourself that it’s important to implement a certain amount of selflessness, be there for them, and show up for them because you can make a real difference in their lives.
As you advance in your career, don’t let your fears hinder your growth. You are never truly alone in the journey; don’t be afraid to reach out to others for support. You will have so many people–to inspire you, encourage you, help you grow, and share their experiences with you. I have been so blessed to have people, all my leaders, all my bosses, and all the people I’ve encountered in this job, and I learn from them. So have a toolkit in place, be ready to be a sponge, and soak up new experiences. Education never ends when you’re a clinician; there’s always something new to learn.
As a Black woman, I want to tell other nurses that your contribution will speak for itself. Sometimes, you may feel like people don’t always tell you they appreciate you. But trust me; you will be rewarded. You may not see it immediately, and it may not be tangible, but there is a reward for all you do.
Is there anything else you’d like to share with our readers?
Nursing has always felt so natural to me. It could be because it brings me joy every day, and I chose a career that keeps me happy and smiling. As nurses, we may not have all the answers all the time, but if we do what we can at the moment to change somebody’s life and positively impact them, then we’ve done our job.
The real beauty of nursing is that there are so many ways to be a part of it, and you can find an outlet for your strengths. You could work in different environments or specialties like home health, hospice, or behavioral health. You can lead teams as a care manager or become an expert in analytics and data …you have so many options and choices. The sky’s the limit when you have a nursing career!
Diabetes Alert Day was introduced in 1988 and for decades has helped raise awareness about diabetes this significant medical condition.
During her early years as a nurse, Kim Ellis MSN, FNP-C, CDCES and founder of Ellis Diabetes Education & Consulting, LLC, discovered there was a big need for diabetes information in the communities she served, so she focused her specialty in helping folks with the condition and sharing education. She’s now known as the Diabetes NP (check out the Diabetes NP YouTube videos) and helps patients and nurses learn as much as possible about diabetes.
As nurses know, successful diabetes management is complex and looks different for every patient. Understanding your patient populations, their culture, and their traditions around food and activity can help nurses and patients create a successful plan, says Ellis. Nurses who are mindful and have cultural competence around the specific patient populations will be able to connect with patients and understand their motivations and any sources of resistance to better health.
“I always tell people it’s not always about the 1 to 10 steps,” she says. “Always be curious about your patient. Always keep yourself as a student, because learning doesn’t stop when you graduate.”
To help understand patients, Ellis recommends asking questions so that you can really learn about their culture. You’re less likely to offend someone when you are authentically interested in what they have to say and you are being open about trying to learn, she says. “Always ask permission when you want to ask questions. People appreciate that.”
Nurses don’t need to know every cultural tradition, but they do need to understand the ones they might encounter. “You typically have two or three cultures to come into your practice,” she says. “Make it your business to know those.” Getting out into the community where you work so you meet people where they are and begin to understand some lifestyle specifics will make a difference in how you and your patients relate to each other.
What are some things nurses might want to ask about? Ellis says ask about food, festivals, and the meanings of any food traditions. “I need to know that to come up with goals and plans,” she says. “And one that’s not coming from a place of restriction.” Ellis might be able to help people identify the best food choices and show them how to balance out something that a diabetes plan wouldn’t typically include, like a special event, but where people are going to eat.
Maybe the patient will want to be particularly mindful of food choices and check their blood sugar before they go to a family party and have a special indulgence. Then maybe they can go for a walk or incorporate some kind of movement after eating and check their blood sugar again. “We can adjust,” says Ellis, so the patient doesn’t feel like they are making a bad choice or one that they need to hide from her.
She advocates for being equipped with knowledge to help manage diabetes successfully. People can learn to load up on protein and drink lots of water to help make them feel full and keep their blood sugar more stable before they have lots of carbs. Carbs raise blood sugar and don’t create lasting fullness, so she tells patients how just making adjustments can help them eat foods they want to eat while also keeping their health front and center.
Knowing that your patients need flexibility will go a long way to building their trust. “I like it when the light bulb goes off and people realize we don’t need to do some elaborate plan,” says Ellis. “A little can go a long way. Nurses can think outside the box to sculpt what will work for them.”
And whether you are trying to educate patients about prevention or about managing their diabetes successfully, Ellis recommends giving them the facts without being confusing. “Remind them of why their health is important to them,” she says. “Everyone has a why–whether that’s children, grandchildren, travel.”
Nurses have been called many things over the years, and saint, hero, angel, and savior are just several ways they’ve been described. In a misguided sense, nurses have even been unceremoniously sexualized in the form of the tired cliché of the sexy nurse Halloween costume.
Throughout the COVID-19 pandemic, it became increasingly common to see signs outside hospitals saying something akin to, “Heroes work here.” Is the hero moniker truly helpful to the cause of nursing? Does calling nurses saints, heroes, angels, and saviors help them in any way? I posit that it’s the opposite: using such terms is a dehumanizing misinterpretation of what nurses do and who they truly are.
Heroes Work Here?
Much praise was heaped upon nurses and other healthcare professionals during the worst months of the pandemic. On many a day throughout those most challenging times, people stood outside of their homes banging pots and pans at the 7 pm change of shift to express gratitude for nurses’ hard work (never mind that it’s the rare nurse who can get out of work at 7 pm to hear such a concert, but it’s the thought that counts).
Meanwhile, the “heroes work here” banners outside hospitals reiterated the claim of heroism, putting nurses and their colleagues on pedestals that might have felt just a tad uncomfortable and precarious.
So, what’s wrong with the proclamation that heroes work in a given facility? What harm does it do when we tell a nurse they’re a saint in scrubs? What does it say when we place a mantle of superhumanity on those who serve as frontline healthcare professionals, risking their lives in the process? There’s nothing inherently wrong with a sincere expression of gratitude, yet it can sometimes not sit well with those on the receiving end.
Superhumans ‘r’ Us
Angels, saints, and heroes are individuals with superhuman traits. They are people whose qualities place them above the powers of mere mortals. They leap tall buildings in a single bound, fly weightless on gossamer wings, and perform miracles and wonders before amazed groups of onlookers.
While the work of nurses may appear superhuman and saintly to the average layperson, the day-to-day slog of hanging chemo, transferring patients, changing catheters, cleaning up feces, drawing blood, and dressing wounds may not feel so heroic or superhuman to those who perform such duties.
Nurses work on the front lines amidst the muck, mire, and bodily fluids of human life and suffering. And during their work, they can be slapped, punched, kicked, spat on, cursed at, and verbally abused.
Nurses’ work can cause them to suffer compassion fatigue, burnout, addiction, depression, anxiety, post-traumatic stress, and suicidal ideation. Are these superhuman traits and reactions? I would say they’re altogether human.
While it is simply a game of semantics, the difference between hero, angel, saint, and warrior could not be starker. When we consider angels, saints, and heroes, we might be more prone to think of creatures who have fewer needs than us mortals — these creatures with special powers have more endurance and are more impervious to the slings and arrows of life. By seeing nurses as superhuman, we can dehumanize them.
Call Us Warriors
Many nurses I’ve spoken with are much more comfortable with the word warrior than the descriptors hero, angel, or saint. They feel that warrior is a more accurate description of what they do and who they are as nurses. Healthcare delivery can feel like a battle – especially during situations like the coronavirus pandemic — and pushing through the worst times in the medical trenches makes the term warrior extremely apt.
Heroes of folklore, mythology, and fantasy are mythic, larger-than-life figures who demonstrate superhuman faculties that set them apart. I would venture that few nurses feel larger than life; in fact, most nurses are arguably more fully in touch with the realities of life (and death) in ways that many members of the general public are not.
Nurses are warriors fighting for the good of the whole against disease, illness, injury, and, at times, death itself. They engage in the battle by leveraging their human knowledge, expertise, skill, and compassion acquired through years of study, hard work, suffering, and learning. See them as heroic if you must, but also see them as the righteous warriors they truly are.
Minority Nurse is thrilled to feature Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
For 15 years, Latanya Weston was in operating rooms in her home state of Georgia, amputating the limbs of patients who suffered from kidney disease. The feeling of the scalpel pushing down on flesh and the sound of the bone cracking haunts her.
A Georgia native, Weston knew that the mortality rate of kidney disease is 30 to 40 percent higher in her state than the national average. But, while the numbers show that the percentage of black and white adults treated for kidney disease are roughly the same, Weston knows a different reality.
The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Latanya Weston, a nurse practitioner at Somatus, the nation’s leading and largest value-based kidney care company.
Talk about your career path and how you ascended to that role.
I was constantly stricken with various illnesses when I was growing up. As a high school student, I spent most of my senior year being operated on or hospitalized. Although I could maintain my overall academic achievements through these health issues, I was told I would need to repeat my first semester as I had been in the hospital too much. It was unfair to the other students. This news was incredibly disheartening. I had already mapped out a career plan and did not want to delay graduating. I made a tough decision and begged my parents to let me sit for the “General Education Development” exam. I excelled and went on to sit for the SATs. I became a college student while my friends were still in high school.
Once graduating from the surgical technology program, my career path began at Mitchell County Hospital, where I was a surgical technologist. Together our surgical team operated on many patients suffering from advanced kidney disease and renal failure. In many cases, these patients had developed peripheral arterial disease. They were on the table to have a limb amputated or were crashing into dialysis and needed to get a venous catheter implanted. Although I loved being a surgical technologist, my heart’s desire was always to become a nurse. So, in 2006, while working as a surgical technologist, I returned to school and became an operating room nurse. This allowed me to work at a bigger hospital in my hometown to gain more experience. However, the unsettling patient trends I had noticed in the county hospital were now amplified—more amputations and dialysis catheters, and again always in patients of color. So, in 2007, I again shifted my career and decided to leave my hometown for a hospital away from home.
After more than a decade along this career path and seeing patients in severe distress day after day, I grew to feel I needed to make a change. Then, one day while I was on call for the operating room, I fell down a flight of stairs and hurt my foot. The pain was constant, and I could no longer stand on my feet in the operating room as long as I had. I had to make a change, and a part of me felt like this was a sign that I should go back to school to educate and prevent the disease processes that were landing so many patients on the operating room table. For quite a while, I had been thinking about what impact I could make if I met patients earlier in their healthcare journey before surgery was the only option. I then decided that I would become a nurse practitioner.
What inspired you to become a nurse?
I knew I wanted to be a nurse from a very young age. My aunt was a nurse who would conduct home health visits at her patients’ houses, and from the time I was in second grade, I would beg to go with her. I enjoyed visiting patients and watching my aunt care for them. I always felt I had this same gift of caring as she did. Nursing takes a special heart and mind; everyone does not possess this attribute.
Furthermore, I grew up in a community with significant health challenges, yet people didn’t prioritize their health. Most people don’t have primary care physicians, schedule annual check-ups, or think about preventive care. Members of my community were often struggling with obesity, diabetes, and kidney disease, and there were several dialysis centers in my neighborhood. Kidney disease impacted my family as well. My sister passed away at 33 because she could not get a kidney transplant.
I’ve lived my whole life in Georgia, where the mortality rate from chronic kidney disease is over 40% more than the national average.
As a nurse practitioner, I finally feel I am where I was meant to be. Now I reach patients early on in their healthcare journey when their primary care physician first diagnoses them with kidney disease. Through education and support, I can change the direction of a person’s life and stop them from ending up on someone’s operating room table.
What are the most important attributes of today’s nursing leaders?
Given the changes in the healthcare industry, building trusting relationships between clinicians and consumers can often be taxing. Nursing leaders must be of great character and moral values. This includes the ability to show respect to another and communicate appropriately. One of the major complaints in the patient population is that providers do not listen. As nursing leaders, we can’t overstate the importance of being a good listener and communicating relevant information to providers. This will strengthen the patient-provider relationship and encourage more communication, improving overall patient outcomes. Nurse leaders must maintain integrity, respect, grace, and professionalism and always take the time to listen and communicate, making their relationships the building blocks to success.
What does it mean to you to be a nursing leader, and how are you making a difference?
The leader I am today is the ultimate assignment. I wanted to uncover the world of medicine and was given the great opportunity to travel as a Locum Tenens Nurse Practitioner from 2016 to 2018. That experience blessed my entire being and made me realize that my mission is not only to save lives but to change them. I worked in the Pacific Northwest to combat mental illness and addiction and changed many lives. In every home or exam room I enter, the person on the other side of the door becomes my family. No matter the situation, I take their hands, and together we weather the storm one diagnosis at a time. I ensure they do not feel alone in the battle, which makes a difference in patient outcomes.
What is the most significant challenge facing nursing today?
The healthcare industry has come a long way in recognizing the impact of social determinants of health on patient health, but this is still the most significant challenge facing us today. As nurses, we see first-hand, time and again, that providing “equal” care to patients is not enough. Care plans must consider the whole person, where they live, their resources, and everything else that affects them when they leave their doctor’s office.
In many cases, patients don’t realize they have kidney disease until the day their doctor gives them the diagnosis. Without understanding the disease process and how each element of the care plan works together to slow and control their chronic kidney disease progression, it’s very difficult for a patient to commit to making significant lifestyle changes.
We also know that socioeconomic issues are tied to kidney disease. Even if a patient has health insurance, they may still have financial concerns, making it difficult to afford medications and treatments. They may be worried about paying their rent or utility bills, which makes it difficult to focus on their physical health. In addition, they may not have a wheelchair or a ramp to get in and out of their house or transportation to their next doctor’s visit.
Shopping for kidney-friendly foods may also be a challenge, both in terms of affordability and availability. Patients may also need help adopting new meal preparation methods with no one to guide them, and they find it much easier to fall back on frozen meals.
There are countless other barriers to care that we see in our patients every day, and as nurses, we are often the best equipped to inform the rest of the care team about what our patients need.
As a nursing leader, how are you working to overcome this challenge?
I’m now a nurse practitioner at Somatus, the country’s first value-based kidney care company. Our goal is to give whole-person, 360-degree support to kidney disease patients, providing preventive care and breaking down the barriers and challenges patients face every day. For example, when a patient is first diagnosed with kidney disease, we go to the patient’s home to do a complete evaluation, look through their cupboards, figure out where they can source nutritious food, demonstrate how to prepare meals, and even help them with administrative tasks and paperwork.
Together with my fellow Somatus care team colleagues, we work with a nephrologist and other health care providers to give patients the whole-person support they need to follow their care plan and make lifestyle changes.
Every day I see the impact of individualized, patient-centered care. Sometimes there are significant actions like teaching a patient to monitor their blood pressure every day, but other times it’s something small, like praying with one of my patients, that makes a huge difference. This is what I love.
What nursing leader inspires you the most and why?
Mary Eliza Mahoney is the first African American licensed nurse in the U.S., and when I think of her perseverance and tenacity, I also see myself. She worked tirelessly as a private home nurse, doing what she loved while advocating to be treated as a professional and equal. Her example shows that we can not only prolong and save lives but can also change them.
What inspirational message would you like to share with the next generation of nurses?
When you become a nurse, whenever you walk through the door, someone on the other side waits for you to enter the room and be their guiding light. So I like to take a moment to ask myself, “I wonder who my next blessing is in that room?” every time I meet a new patient. This road is not for the weak, but the journey is incredibly rewarding as you touch and change lives day after day. I always tell people, “Nursing is not a money thing… it is a heart thing.”
The annual celebration of GI Nurses and Associates Week (this year from March 19-25) marks a special milestone this year. The 2023 GI Nurses & Associates Week is the 10th anniversary of honoring nurses in this specialty and all the work they do.
Gastroenterology (GI) nurses specialize in the gastrointestinal tract. Patients who have disorders or symptoms related to the digestive tract will seek out GI specialist teams to help them navigate what can be elusive and sometimes debilitating symptoms.
Nurses interested in this specialty will help patients in many ways. They can assist with upper and lower GI diagnostic procedures and surgeries including endoscopy and colonoscopy, stomach emptying studies, cancer surgery, and more. GI nurses frequently work with patients who have liver and pancreas problems and also with patients who have hernias.
Gastroenterology nurses are an important resource for patients who are managing GI symptoms. As a GI nurse, you’ll be well informed of how varied factors impact a person’s digestive tract.
Food and Diet
You’ll want to help patients with diet to see what might trigger or ease symptoms, what needs to be avoided, and what they might need to add to their diet to help alleviate symptoms. As a GI nurse, you’ll want to be aware of potential food sensitivities or allergies that could be causing problems as well as conditions like celiac disease in which patients can’t tolerate any gluten at all.
Exercise and Motion
Exercise helps GI symptoms in many ways by reducing inflammation, keeping the digestive tract moving, and reducing stress. Nurses in the specialty will have an idea of what to recommend to patients who might need to increase their exercise or moderate an intense exercise routine. Some GI conditions have such severe symptoms that a regular exercise routine might be impossible, so nurses will want to understand how that problem can be balanced in a way that will work for each individual.
Sleep and Rest
Regular, high-quality sleep is good for everyone, but gastroenterology patients are particularly prone to symptom flare ups when they are short on sleep. Nurses are great motivators to help people focus on getting the proper rest to see if it helps any of their symptoms. And GI nurses offer something else that’s just as important for patients to hear–permission to slow down and get rest to help themselves heal. That message alone can be a powerful motivator for some.
Stress and Mental Health
Stress wreaks havoc on a GI system in the best circumstances, but when there’s any kind of disruption or illness, stress or mental health issues can have lasting gastroenterology effects. Having a digestive tract condition is hard enough to manage and that alone can cause stress to raise its head for many patients. Nurses are aware of this and are an important resource to help patients lower their stress levels through various methods like yoga, meditation, or through professional help that might include therapy or medication.
Education and Knowledge
Patients need to be educated and informed about their condition or about procedures that are necessary. GI nurses can listen to a patient’s fears, about nagging symptoms, and about the problems dealing with GI symptoms that can crop up at any time. With more information at their disposal, patients can work out a careful and educated approach to living life with a GI condition.
Gastroenterology nurses work with patients on so many levels and the complexity of the work is both emotional and professional. If you are a GI nurse, take this week to celebrate all you do for your patients!
The fundamental mission of every healthcare provider is to first do no harm. Unfortunately, however, for far too long systemic inequities in the healthcare system have perpetrated and perpetuated harm.
Both implicit and explicit biases have strongly determined healthcare processes, including informing how patient pain is understood, diagnosed, and treated. Stereotypes relating to gender, race, and ethnicity have contributed to a pattern of delayed and erroneous diagnosis and inappropriate or insufficient palliative care. And as a result, untold numbers of female and minority patients have been consigned to suffer needlessly.
But there is hope, and nurses are helping to provide it. By prioritizing workforce diversity, qualified healthcare professionals enjoy greater career opportunities, and diverse patients increasingly receive the pain control they need. This article examines the importance of diversity in the healthcare industry and its implications for improving palliative care for diverse patients.
Biases and the Treatment of Pain
Generally, healthcare providers enter the field because they genuinely want to help people. Of course, financial security and social prestige are a perk, but no matter your particular role, the work is incredibly emotionally, cognitively, and physically demanding. Nevertheless, it is a profession you enter or remain in with a sense of a higher calling and a deeper purpose.
But, no matter how well-intentioned, healthcare providers are still very much human, and as such, they are shaped, both consciously and unconsciously, by the society in which they live. And that means that systemic biases have almost inevitably seeped into the care provider’s consciousness, contributing to the formation of false and dangerous stereotypes.
Research has shown, for example, that racial stereotypes concerning African-Americans have contributed strongly to the mismanagement of Black patients’ pain. These stereotypes are generally rooted in misperceptions of biological differences between African-American and Caucasian patients. This includes the false belief that Black patients have a higher pain tolerance than whites and the false presumption that Black patients are more likely to abuse drugs.
Implicit and explicit gender biases are also ubiquitous in modern medical practice. For example, female patients complaining of pain are more likely to experience treatment delays than male patients reporting the same or similar symptoms. Women’s pain symptoms, for instance, are significantly more likely to be attributed to emotional or psychological etiologies than men’s. This increases the likelihood that their pain will go untreated or under-treated, and severe disease symptoms will go unrecognized, thus delaying treatment.
Diversity and Cultural Competence in Healthcare
Nurses are at the front lines of patient care. They provide the majority of hands-on patient care, and, in general, their interactions with patients are more frequent and substantive than those of physicians.
For this reason, diversity in the nursing sector is particularly critical in redressing inequities in treating patients’ pain. Culturally competent patient care almost inevitably ensures that nurses derive from various ethnic, racial, socioeconomic, and gender backgrounds.
More specifically, this means that nurses with high cultural competence will better understand, recognize, and respond to culturally-specific manifestations of patient pain.
For instance, women or patients from specific cultural or religious backgrounds may feel reluctant or unable to express their symptoms, especially if these pertain to “taboo” areas. Nurses from similar backgrounds are more likely to have the cultural competence to identify and overcome these cultural taboos.
This enables them to formulate strategies that help patients express their concerns in more comfortable and culturally acceptable ways. In addition, by enhancing the dialogue with patients, nurses can provide physicians with more comprehensive and accurate case notes, increasing treatment efficacy.
Addressing Medical Anxiety
Promoting diversity in nursing doesn’t just equip healthcare teams to understand and address cultural differences among patient populations effectively. Diversity also enables healthcare teams to recognize and remediate systemic healthcare disparities’ profound and long-enduring impacts.
There is mounting evidence, for example, that minority patients are far less likely than Caucasians to be satisfied with their quality of medical care. Deficiencies in minority patient care can be linked to various factors, from the lack of healthcare access to a shortage of interpreters for patients who do not speak English.
These care deficiencies can instigate severe medical anxiety in patients, particularly for those who have experienced significant physical or emotional trauma in past medical encounters. Nurses from similar backgrounds may have also experienced such challenges in the healthcare system, whether for themselves or someone they love. And as such, they are more likely to be able to accurately anticipate or ascertain signs of medical anxiety in female and minority patients.
Equipped with such insight, diverse nurses can lend a measure of patient support and empathy that comes from understanding and experience. And, importantly, they can more effectively advocate for patients and their unique needs, particularly in treating pain.
Disparities in the healthcare system have for too long led to deficiencies in palliative care for minority and female patients. By promoting diversity in the nursing profession, however, the needless suffering to which diverse patients have been subjected can finally end.
The annual recognition of Certified Nurses Day on March 19 honors the nurses who go the extra step to achieve certification in their specialties. But the day also helps raise awareness in the nursing community about the importance of certification and the benefits it brings to a nursing career.
Certification is an excellent career advancing move; after all gaining more knowledge and skills in your nursing specialty is only going to help you be a better nurse. But many nurses overlook another important result of gaining certification–the confidence boost it gives you and the new peer recognition of your advanced knowledge.
Clara Beaver, MSN, RN, ACNS-BC, AOCNS, and president of the Oncology Nursing Certification Corporation (ONCC) says certification brings better patient care, but also changes a nurses relationship with patients. “The best part [of nursing] is the buildup of trust with patients,” she says, “and having certification shows you have that commitment to oncology and that you have that knowledge. You both care about it and you know about it.”
Each certification is different, so look into one that that matches your specialty area. For example, ONCC offers five certifications: Oncology Certified Nurse, Certified Pediatric Hematology/Oncology Nurse, Certified Breast Care Nurse, Blood and Marrow Transplant Certified Nurse, and Advanced Oncology Certified Nurse Practitioner. Beaver says the bone marrow and breast care certifications are newer and were industry driven as a result of many nurses specializing in oncology subspecialties.
Some nursing specialties are starting to require certification as the advanced and most current skills are required for patient care. Many Magnet hospitals require certification for some nurses as do many cancer centers.
“We’re always trying to find the value in increasing knowledge and commitment,” says Beaver. “Certification says to the community that those nurses are staying up-to-date on what’s going on and their skills may be higher.” Beaver says when she became certified it made her think about patient care differently. “I looked at my patient differently because I had increased knowledge,” she says. :I looked at the entire background and not just at the task in front of me.” With certification, Beaver says she understood more of how things worked and could explain what was going on to the patient a little more.
Nurses who are certified are proud to show their certification, says Beaver, because it is instant recognition that you’ve gone above and beyond what’s required. “I feel like certification takes you up a little higher and they become like the informal leaders. They have raised confidence.” And their success with becoming certified shows other nurses that they can also achieve the same thing.
Nurses do find one of the biggest roadblocks to certification is test anxiety. “Nothing is as bad as the NCLEX,” says Beaver with a laugh. Before each of her three certification exams, Beaver says she had to overcome major test anxiety, so she understands why it can be a deterrent. “I just had to remember this is what I do every day,” she says. “Test taking is scary.”
Before each exam, she studied the test blueprints. She also pulled all the resources that were referenced to study those as well. That’s what the questions are based on, she says, so review all that information carefully. “Pull the statistics and the references,” she says and find out your weakest areas so you can focus on those places intensely. Reading information out loud helped Beaver retain the information, and she encourages nurses to find a method that works best for them.
When you sit for the test, Beaver suggests that you read the entire question, then read all the answers, and then go back and read the question over again. This will help you slow down and comprehend exactly what is being asked.
If paying for the exam is a barrier, see if your organization will help pay for it or if a professional organization will help.
“Certification is an important part of our job as nurses,” Beaver says. “And it’s attainable. It expands your knowledge base and your skill set. And it shows a commitment to what you are doing.”
Please tell me about your role now and how your career brought you to this place.
My current role is as the Clinical Nurse Specialist and ARNP for Renal, Dialysis, and Transplant at the University of Washington Medical Center. Although I am involved in several committees and projects, my primary focus is on the inpatient kidney replacement therapy program. We have an in-house team that consists of over 100 unit-based RNs trained in HD, SLED, PD & CRRT who perform approximately 6,000 procedures a year on one campus with support from the dialysis technician team. My role includes staff training, patient education, regulatory compliance, evidence-based practice, quality improvement, and research. I also am consulted regarding evidence-based practice and care planning.
Following my passion and having the support of mentors in finding my way was invaluable. I started working as a nurse technician on the dialysis and transplant unit while I was in nursing school. When I graduated from nursing school, I was hired as a staff nurse. I had mentors who believed in me as I gained knowledge and confidence. I was able to become a charge nurse, dialysis nurse, and eventually assistant nurse manager. After being an assistant manager for several years, I realized that the parts of my role I enjoyed most were providing education, mentoring, clinical care, and improving systems. At the time I was applying for Master of Nursing programs, I was encouraged by one of the nursing professors to apply for the dual acute care nurse practitioner and advanced practice specialist tracks so that I could have the most flexibility in my future career path. I have been fortunate to find a role where I can still provide patient care directly and impact care at the system level.
Like many nursing students, I was fascinated with labor and delivery and pediatrics. There were no openings there so my first job as a nurse technician was on a dialysis and liver/kidney transplant unit. I had little exposure to nephrology in nursing school but once I started working with this population, I found a new passion. Instead of individuals bringing home a newborn, I was helping individuals bring home a new organ that they were learning to care for and helping them create a new life after transplant. It was inspiring, fast paced, and still a growing field. As I learned more about kidney disease, I also realized that the diseases that contribute to kidney disease, like diabetes and hypertension, run in my family and are prevalent in the community. This added another level of connection to kidney care as a way to advocate and provide the best care possible to other individuals who have these diseases in their families.
What do you especially enjoy about your specialty?
I enjoy that there are several nephrology subspecialties such as chronic kidney disease, vascular access, outpatient dialysis, home dialysis, acute dialysis, and transplant. I have been able to continue working with the kidney community throughout my career and do different kinds of nursing – bedside, clinic, administrative, research. I have the privilege of working with individuals living with kidney disease over time and can support them through different stages of their health. Kidney care is very interdisciplinary, and I enjoy collaborating with colleagues in nutrition, pharmacy, social work, and nephrology. I have also worked on committees with patient advisors which has been so fulfilling professionally and personally. Professionally, I believe the systems that we create with patient advisors are more individualized and patient centered. Personally, I have learned so much about the strength of community, the power of hope, and how essential support systems are.
Please describe some of the activities you do within a week, i.e., patient care, medical records, family interactions, working with your team.
Every day and week vary some. I provide dialysis education to ICU and medical surgical nurses, meet with patients who are having issues with their vascular access or need dialysis modality education, am consulted on potential safety issues and perform chart audits, work with interdisciplinary committees on preventing catheter-associated bloodstream infections and urinary tract infections, consult on research or quality improvement projects, plan for continuing education, cover breaks for dialysis nurses performing intraoperative hemodialysis, and guest lecture at the school of nursing. Some days I am in meetings about developing care pathways with transplant surgery, updating the electronic medical record, discussing supply chain new equipment, or in a patient plan of care conference. With any system or product that impacts kidney care, the medical director, dialysis operations manager, and I are involved.
How do you keep up with all the industry changes around patient care and technology?
I attend ANNA’s National Symposium and Fall Meeting whenever I can. The quality of the presenters is excellent, and the content is evidence-based, relevant, and up to date. I also attend local nephrology conferences, attend online seminars, read the Nephrology Nursing Journal, attend Nephrology Grand Rounds, and subscribe to online nephrology list serves including the regional ESRD Network. The list serves provide highlights on a daily or weekly basis, and have different focus such as quality, new medications, treatments innovation, guidelines, and health policy. I also follow professional organizations on social media to get a sense of what are topics of discussion in the nephrology community.
If you are certified, how did you decide to pursue that additional credential and how has it helped your performance as a nurse and your overall career?
My first certification was the Certification in Nephrology Nursing (CNN) which I earned in 2001 because I knew I wanted to be a nephrology nurse long term. It also helped that I work in a Magnet institution which supports certification with professional development time and certification pay. I was starting to feel more comfortable with my nursing knowledge and skills and saw this as an opportunity to challenge myself and build confidence. I remember feeling so proud when I earned my CNN, and have continued to maintain it. My certification motivates me to stay current and engaged in my specialty. It also lets people know I am committed to nephrology care. I recently received my 20-year CNN pin and it is very special to me.
Can you talk a bit about how joining a professional organization like ANNA has helped your nursing career?
As a newer RN, I looked to ANNA to provide me with education and learning more about caring for people with kidney disease. As my career continued, I became involved in the chapter education planning committee and eventually chapter leadership. ANNA provided complimentary volunteer leadership education and tools to support me as a new leader. These skills carried over into my work as well as I became an assistant manager. When I was in graduate school and my husband was laid off, ANNA awarded me a career mobility scholarship that allowed me to finish my Master of Nursing. I have been able to present abstract posters at ANNA National Meetings and was published in the Nephrology Nursing Journal. I began volunteering on ANNA national committees and eventually became a director with the ANNA Board of Directors. Through ANNA, I met mentors and friends who have encouraged and mentored me over the years. There are so many potential benefits of engaging with a professional nursing organization, and I hope other nurses take advantage of all the benefits that membership offers. ANNA has made my nursing career and life fuller.
What else do you enjoy outside of your work?
Outside of work, I like to spend time with my husband of 26 years, our 24-year-old son, 21-year-old daughter, and our dog. We like to try foods from all over the world, visit national parks, take walks, visit museums, go to musicals, and play board games. My husband and I both have large extended families so we like to visit them when we can. At the end of the day, my introverted side takes over. I like to read, cook, work on puzzles and do crafts like knitting, making photo books, painting, and sewing. I also like to plant things and watch them grow.
Healthcare workers know that hand washing helps keep them safe and helps prevent the spread of germs in the patient population. “Every episode of hand hygiene can interrupt the spread of germs between patients, between patients and healthcare personnel, and between the contaminated environment and patients,” says Sickbert-Bennett. “Healthcare personnel need to wash their hands dozens of times throughout their workday as they have complex interactions with very sick patients.”
Despite knowing how effective simple soap and water (or alcohol-based hand sanitizer) is at preventing the spread of germs, the study found that complete hand washing guidance isn’t always followed. In an intense and rushed environment, it’s not simply forgetfulness or a lack of intent that sometimes prevents proper hand hygiene. “The biggest factor is likely time – which impacts our ability to do hand hygiene often enough and thoroughly enough,” says Sickbert-Bennett. “An important way to mitigate this is to make sure that hand hygiene supplies are easily accessible in areas where patient care is occurring.”
And education about the proper techniques for keeping hands clean is essential, particularly considering that the report cites research that shows only 7% of healthcare personnel effectively clean the entire surface of their hands with thumbs and fingertips being the most frequently missed. The report also notes the potential for bacteria being difficult to remove if providers have certain fingernail polish or applications such as acrylic nails. Guidance around the need for proper cleaning practices, even if gloves are also worn, is also noted.
“Hand hygiene programs that use reminders to reinforce the habit of hand washing at the right times have been shown to be effective,” she says. “Nurses can play an important role in hand hygiene and patient safety by reminding their colleagues to clean their hands throughout the day as they take care of patients.”
Commitment from the top levels of organizations will also move the needle in the right direction. The report notes that nurses and healthcare personnel need easy access to hand-cleaning supplies and also moisturizing lotions that are in compliance with hygiene safety standards. All that hand washing takes a toll on the skin and cracks can also lead to infection. That means plenty of access to soap and water and also wall mounted pumps containing alcohol-based hand sanitizer instead of nurses carrying hand sanitizer in bottles in their pockets.
As healthcare providers, nurses can care for themselves and their patients with increased attention to an essential tool–their hands.