At a point in my career, a devastating event deeply affected me. One of my former nursing students, a vibrant young Black woman, tragically lost her life and the life of her newborn during childbirth. Despite access to healthcare, she fell victim to maternal complications that ended in her untimely death. This loss was not an isolated incident but rather indicative of a more significant crisis facing Black mothers in the United States – one that is not just a healthcare issue but rather a matter of social justice and equity.
In recognition of National Nurses Week, it’s crucial to reflect on nurses’ profound impact on healthcare, particularly in addressing health disparities. This year’s theme, “Nurses Make the Difference,” resonates deeply with me, as I have dedicated my career to advocating for improved maternal health outcomes for Black women and preparing nurses for careers in healthcare aimed at advancing health equity.
Every maternal death is a devastating tragedy that leaves a hole in families – representing a forever-altered dynamic. Perhaps even worse, statistics from the Centers for Disease Control and Prevention show that most maternal deaths are preventable.
This staggering data also demonstrates that Black women are nearly three times more likely to die from pregnancy-related complications than white women. Morbid racial disparities such as these do not have a place in the 21st century. Still, they are exacerbated by socioeconomic factors, a shortage of providers, and a lack of access to quality healthcare.
Central to this work is the recognition of the lived experiences of Black women. Factors such as poverty, barriers to healthcare access, and lifestyle choices are frequently used to explain the disparity in Black maternal health; however, these factors alone are inadequate to explain the problem. Healthcare providers often fail to see their patients as individuals with unique needs and concerns. Implicit bias and cultural incompetence compound these disparities, leading to substandard care and poor outcomes.
To effect meaningful change, we must address these root causes head-on. This includes increasing access to quality healthcare, fostering diversity and inclusivity in healthcare practices, and educating healthcare workers to be culturally competent and understand the social determinants of health.
Increasing access to quality healthcare is essential, and addressing the nursing shortage is a top priority when it comes to Black maternal health. By creating new programs and expanding existing ones that reach future healthcare workers, we can help prepare the next generation of diverse nurses who can reduce the burden on the current population of healthcare workers and meet the evolving needs of society – especially Black women.
As a nurse educator with over 18 years of experience in higher education, I believe education is integral to creating positive, sustainable change. At Walden University, where I serve as the associate dean for the BSN program, our online curriculum emphasizes the social determinants of health and the role of nurses in addressing health disparities. I am particularly excited about a new course we launched this spring, “Advocating for Diversity, Equity, and Inclusion in Healthcare.” This course, among others at institutions like Columbia and Frontier Universities, challenges students to confront their biases and privilege while equipping them with the tools to advocate for inclusive and equitable care. Our focus areas include implicit bias, systemic racism, microaggressions, health disparities, the healthcare ecosystem, and advocacy strategies to improve healthcare outcomes. These programs, which establish a better understanding of the unique experiences of our diverse population, are just a part of the solution. Patient outcomes can also be significantly improved by changing the face of those who deliver it. With minority populations experiencing disproportionate rates of disease and death, it is clear we need to create pathways to the nursing profession for all, regardless of ethnic, religious, or financial factors.
One way to do this is by providing educational access to those who may not yet have had the opportunity, which can mean emphasizing online education programs. This approach enables students to earn their degrees from where they live and encourages the development of nurses who practice within their communities, reflecting the communities they serve. This is a proven way to improve the healthcare outcomes of minorities, and it has the additional benefit of combatting the nursing shortage, particularly in rural areas.
Nurses, educators, policymakers, and advocates must join forces to dismantle the systemic barriers perpetuating healthcare inequality. Our industry has a unique opportunity to drive change and promote health equity by elevating the voices of marginalized communities, challenging implicit biases, and advocating for policies that prioritize equity and justice.
As we celebrate National Nurses Week, let us recommit ourselves to compassion, advocacy, and equity principles. Together, we can make a difference in the lives of Black mothers and ensure that every woman receives the quality care she deserves with the understanding she needs.
This National Nurses Week, learn more about Mary Eliza Mahoney, America’s first professionally-trained Black nurse whose birthday lies on May 7, the second day of National Nurses Week.
Mahoney’s journey to becoming a nurse in the 1800s was full of setbacks she couldn’t control, yet she persevered to create a decades-long career as a nurse known for compassion and bringing comfort to others.
However, her story doesn’t end there—she later became a well-known leader in the nursing field, co-founding the National Association of Colored Graduate Nurses (NACGN) in 1908 and supporting the women’s suffrage movement before it became popular. She was inducted into the National Women’s Hall of Fame in 1993 for her contributions to breaking racial barriers in nursing.
Today, Mahoney inspires Black nurses and other nurses of color who relate to her struggles in a world where breaking the mold is never easy.
From Nurse Aide to Nursing Graduate
Born in Dorchester, Massachusetts, on May 7, 1845, Mary Eliza Mahoney knew at a young age that she wanted to be a nurse. She started her career at the New England Hospital for Women and Children at the age of 20. The hospital was progressive in its time, including an all-women staff of physicians, and provided healthcare to only women and their children. Mahoney first worked as a nurse aide among licensed nurses, but her wages were too low, so she worked in various roles, including washerwoman, janitor, and cook.
After 15 years of domestic service duties, Mahoney was offered a spot at the hospital’s prestigious graduate school in 1878, assisted by a doctor who believed in her potential.
The graduate school’s program was intensive, consisting of 16-hour days learning how to prep and complete ward duty, overseeing up to six patients. The program was so intensive that out of the 42 accepted students, only four remained, including Mahoney. However, Mahoney’s hard work ethic and experience in nursing paid off. After 16 months in the program, she graduated with her nursing diploma, making her the first professionally trained Black nurse at the time.
Mahoney’s Legacy to Nurses
For the next four decades, Mahoney worked as a private nurse to wealthy white families in the Boston area due to discrimination against Black women in hospitals and other professional settings. Mothers and families who worked with her admired her professionalism and work ethic, and she received requests across the Northeast to work with other wealthy families. Over time, Mahoney grew fond of her work, referring to her clients as family.
Mahoney knew that her work would set an example for minority nurses who could work in fields outside of domestic service. As a result, she raised the bar for more Black women to find careers in nursing and similar professions.
In her later years, Mahoney was a vocal advocate for all nurses, including nurses of color. From 1911 to 1912, she was the director of the Howard Colored Orphan Asylum for Black children in Long Island, New York. As a leader in the NACGN, she was already known as a pioneer in nursing. She gave the welcoming address at the NACGN Convention in 1908 and was made an honorary lifetime member and elected chaplain in 1909.
In 1923, Mahoney was diagnosed with breast cancer and died on January 4, 1926, at the age of 80. To remember her legacy, the NACGN created the Mary Mahoney Award in 1936 for any nurse who made a lasting contribution to social justice within their field. This award is still being given today by the American Nurses Association (ANA) after the NACGN merged with the organization.
Mahoney’s legacy shows the values many minority nurses bring to the field. Her efforts to build organizations that highlight the accomplishments of minority women teach what every nurse of color can offer to patients today.
Learn more about Mary Eliza Mahoney
If you want to learn more about this nursing pioneer, here are some resources for a deeper look at her past and significance to nursing:
BlackPast is an online encyclopedia providing information on Black history internationally, especially in North America. Read Mary Eliza Mahoney’s biography and learn more about the history of Black nurses in the U.S.
The American Association of Nurse Practitioners (AANP) wrote an article on the impact of Mahoney’s work on diversity, equity, and inclusion in nursing.
As part of the ANA’s Journey of Racial Reconciliation series, the organization will host a webinar on Mahoney’s birthday with diverse nursing leaders on how nurses can draw inspiration from her impact on the field.
Nurses Week occurs every year during the second week of May, and much fanfare is made of the pizza parties, tote bags, water bottles, and signs proclaiming “heroes work here.”
If we want to be more thoughtful and reflective about the phenomenon of National Nurses Week, there’s much more to this annual moment of recognition than these familiar superficial trappings.
And since Nurses Week is built around the celebration of Florence Nightingale’s birthday (May 12, 1820), it’s appropriate to wonder what the veritable godmother of modern nursing would think of how we do (or don’t) celebrate our profession.
What Would Florence Think?
The American Nurses Association (ANA) has chosen the theme “Nurses Make the Difference” for the 2024 celebration. While not altogether original or overly inspiring, we can all agree that nurses make a difference in patient care, research, entrepreneurship, academia, technology, and other areas of endeavor.
Would Ms. Nightingale agree that nurses make a difference? She certainly would, and I would venture that she would have much to say about how that statement rings true. In her time, nurses were purveyors of comfort, cleanliness in the form of improved sanitation and hygiene, and the carrying out of physicians’’ orders in caring for the infirm, the injured, and the dying.
In Nightingale’s theory, nurses aimed to ensure that patients were cared for in a manner that allowed nature to intervene in the interest of their health (e.g., the healing of wounds, the resolution of infection, etc.). If she saw nursing as “the activities that promote health which occurs in any caregiving situation,” nurses make a difference by assuring patients are cared for in a way that maximizes their healing potential. And if, as can be asserted, Nightingale’s theory sees illness as “the absence of comfort,” nurses’ ability to provide comfort can make all the difference in the world.
There’s no doubt that Ms. Nightingale would agree that nurses’ ability to provide positive interventions in the interest of patients’ healing is a central mission of the profession. However, what would she think of how we recognize nurses for their efforts during the annual celebration of her birthday?
In Nightingale’s day, there were no tote bags or water bottles bearing the hospital logo, nor were there pizza parties, greeting cards, and banners hung over hospital entrances. While it’s all conjecture on our part, one might hope she would look down upon such superficial acknowledgments of nurses’ worth.
Even though Nightingale was a revolutionary, out-of-the-box thinker as a Victorian woman, she might still be significantly shocked at the wages nurses command in the 21st century. She would also likely be shocked by the salaries earned by hospital CEOs, let alone the power of the insurance industry.
As a brilliant and forward-thinking woman, Nightingale would be likely quick to understand that women’s place in 21st-century post-industrial society has dramatically evolved since her time, and one could imagine that she would be wholly supportive of nurses receiving increases in salary, benefits, and other forms of recognition that demonstrate acknowledgment of their value as healthcare professionals. Plainly stated, Nightingale might be heard to remark, “Give those nurses a substantial raise — they deserve it.”
Reflecting on Nurses Week
Some hard-working nurses will likely appreciate an employer’s gestures during Nurses Week through food, gifts, and banners expressing gratitude for their contributions.
That said, salary increases, improved benefits, tuition and certification reimbursement, and other support for nurse professional development would likely be much more well-received. Improvements in staffing, protections against workplace violence, and updated technologies that truly make our work easier would also likely be much more well-received.
Nurses make a difference, and the satisfaction of a job well done can go far in creating one’s personal sense of self-worth, especially when coupled with patients’ and colleagues’ respect.
Nurses Week is a moment to pause for the cause and reflect on our value in the scheme of things. Tote bags and pizza aside, our work’s true value provides meaning, and Nightingale knew this too well.
What would Nightingale think? She would think that 21st-century nurses have greatly advanced the profession. She might also remind us that what we feel in our hearts—and the thoughts we have about who we are and what we do—always matter most in the larger scheme of things.
Dorma Liz Davila (Lizzy) RN, BSN, CPN, EMT never expected a quick volunteer weekend as a camp nurse to provide a transformative experience, but it did. And now she wants other nurses to know how helping kids at Paul Newman’s The Hole in the Wall Gang Camp can breathe new life into their nursing careers.
The Hole in the Wall Gang Camp is an organization that provides what the organization calls “a different kind of healing” to thousands of seriously ill children and family members every year. The campers attend completely free of charge and are cared for by the skilled nurses who volunteer in the infirmary for a weekend, a week, or more.
Davila, who works as a pediatric critical care transport nurse, first volunteered last year when a colleague who works as a camp nurse there told her they needed nurses for the Spanish-speaking family weekend. Her colleague had talked about how much she enjoyed being a camp nurse there, so Davila decided to give it a try. But she didn’t really know what to expect.
The first day, Davila got a crash course in the facility, the campers and their conditions, the equipment she’d need, and that was before even meeting all the new campers. But it didn’t take long for her to feel something she didn’t expect. “The first time I went I just fell in love,” she says. “It is like no other job. It’s just completely different.” Davila’s feeling from that one weekend spurred a commitment to future work, and she will also participate as a camp nurse this summer. “I got hooked,” she says. “I said ‘I am your Spanish weekend nurse.'”
The biggest surprise for Davila was how joyful the camp experience is and how much fun she had personally. As a transport nurse, Davila sees patients at their worst, she says. So coming to the camp, she was able to see the kids just having fun, building relationships, and having some freedom, despite their illnesses. And she says it’s also different from working as a bedside nurse with the associated stress of potentially having too many patients or caring for patients in a rushed environment.
While Davila provides support and is there for medical emergencies, during the Spanish weekend, families come with their children and provide the usual medical care they provide at home. “I am there as a nurse, but I am also with them doing arts and crafts or meeting them at the tower for the zip line,” she says. “It’s almost like I am a camper. It’s not like I am on the sidelines.” And while she’s working with the children, she’s also working with the families who appreciate the support and camaraderie of the medical staff and the other families.
Davila didn’t attend camp as a child and was curious about what it would be like. What she found as an adult was an experience that struck a sensitive chord. The campers’ families and caregivers often talk about how the children are teased in school by other kids who don’t understand their medical needs or equipment they must use. At the camp, the feeling of pure acceptance is something Davila felt personally–and it affected her profoundly.
“To go to the camp and see these kids laughing and smiling and there are no kids picking on them,” she says. “At camp, no one puts anyone else down.” As a Latina nurse born and raised in Puerto Rico, Davila says feeling different or other, something that happens in the real world, was entirely absent at the Hole in the Wall Gang Camp. “I came home and said this was a fairy tale world within the real world,” she says. “It’s like a bubble.”
Davila encourages other nurses with pediatric backgrounds and training (particularly training in emergency medicine or urgent care (pediatric or adult), pediatric intensive care, pediatric hematology/oncology, pediatric metabolic/mitochondrial disease, and pediatric immunology) to consider working at the Hole in the Wall Gang Camp or one like it. As overwhelmingly positive as it is to see the campers truly bloom during the weekend, Davila says the staff are impacted as well.
“I wish I could have people experience this,” she says. “It was therapeutic for me too. I recommend this to all nurses.”
We nurses know lots of things. Our heads are filled with innumerable ideas, thoughts, concepts, theories, observations, and facts. We know so much about pathophysiology, anatomy, chemistry, pharmacology, communication, informatics, psychology, sociology, and countless other topics that we’re almost bursting at the proverbial seams.
But have you ever wondered if we sometimes know so much that our knowing can get in the way? What if our certainty and knowledge keep us from seeing something in an entirely new light or thinking outside of a box that we’ve more or less locked ourselves into based on our area(s) of expertise?
What would happen if we could break the mental calcification that our knowing can lead to and open our minds to new ways of thinking about a problem or challenge? Is this one of the places where inspiration and creativity are born?
The Inertia of Our Knowing
In some obscure corner of the internet, I recently heard someone say that we can “break the inertia of our knowing” by opening our minds to novel ways of looking at things. We can say plenty of positive things about the concept and experience of certainty. Still, we can also say that it can sometimes lock us into a frame of reference that prevents us from wearing a different lens at a moment when it could be helpful — or even revolutionary.
Did Einstein come up with his Theory of Relativity by only thinking thoughts he’d had before? Were Nightingale’s theories and concepts the products of a closed mind? Did Leonardo DaVinci devise sketches for flying devices and other fantastical machines by accepting commonly held beliefs about what was possible for 16th-century humans?
These groundbreaking innovators from different historical periods allowed themselves to break the inertia of their knowledge by opening their minds to what others in their time might have considered impossible or even crazy.
If your nursing career, your way of practicing, or any other aspect of who you are and what you do is stuck in the mud of stale thinking and close-mindedness, maybe it’s an excellent time to see how you might lift yourself into a new state of mind that transcends the boundaries of what you think you understand about the world around you.
“Maybe” and “Yes, And”
Every parent knows that the dreaded word “no” is dangerous when it comes from a two-year-old’s mouth, but it’s equally dangerous when it comes from a 22-year-old medical intern or a 52-year-old charge nurse.
The word no is like the castle gates crashing down to keep anything new from entering the kingdom. No, it isn’t about creativity or critical thinking — it’s about staying stuck in the inertia of your knowing.
When a problem or challenge is apparent, and someone offers a potential solution, saying “no” turns off the faucet of creativity. However, if you instead say “maybe,” the possibilities are now open for discussion. And if you want to take it even further, saying “Yes, and…” as described by medical improv expert Beth Boynton, RN, MSN, opens the door even more.
For example:
Nurse A: “This family and patient are so difficult — there’s just no way of getting through to them.”
Nurse B: “Yes, and there might be a way to get their clergy involved to help them feel safer and less ganged up on by the team.”
Nurse C: “Maybe if we bring the deacon or pastor in for the next meeting, they’ll feel like they have allies in the room.”
Nurse B: “Yes, and if they feel safer, they’ll be more likely to hear what we say and be open to our proposed solutions.”
If Nurse B or C had said “no, but” instead of “yes” or “maybe,” the conversation may not have been productive. However, more possibilities emerge when building upon one another with positivity and openness. This breaks the inertia of knowing and opens the door to creative solutions.
Sailing to New Horizons
The inertia of our knowing creates closed doors, whether in our careers, clinical practice, or even our personal lives. If Leonardo DaVinci had said to himself, “These are the things that I know, and nothing beyond that is possible,” so much of what he could have accomplished would have remained unrealized and unimagined.
If Florence Nightingale hadn’t allowed herself the luxury of thinking in new ways about hygiene, sanitation, and the emerging science of biostatistics, her breakthroughs would never have flourished in her mind and created new methods and strategies for improving the health of injured soldiers in the Crimea, not to mention patients around the world for hundreds of years to come.
If the inertia of your knowing is holding you back and keeping you from growing, then it’s up to you to short-circuit that inertia and think differently. Whether it’s your health and wellness, career growth, marriage, parenting, or any other aspect of your life, your certainty of how things “should” could stand in the way of a personal revolution.
So, the next time you feel stuck or somehow held back in life, ask yourself if the inertia of your knowing is the anchor that must be pulled up from the murky depths to allow your ship to sail to new horizons.
With unforeseen vistas and possibilities opening up in your mind’s eye, there’s no telling where you’ll go. This might seem like a scary proposition, but staying stuck in the inertia of your knowing might be even more terrifying.
Try this approach next time something new is called for, and see how breaking the inertia of your knowing can be the best decision you’ve ever made.
In the press of caring for patients, family nurse practitioners (FNPs) must tend to a patient’s physical well-being and mental health. Caring for a patient’s mental status can be vital to meeting healthcare needs.
As primary care providers, FNPS play a significant role in tending to mental health concerns. The American Association of Nurse Practitioners (AANP) reflected that 88% of the nation’s NP workforce are certified in an area of primary care, with over 70% delivering primary care services, notes LaMicha M. Hogan, PhD, APRN, FNP-BC, associate dean/department chair for APRN Programs for the Texas Tech University Health Sciences Center School of Nursing-Graduate Program.
In this article, we’ll offer ways to ensure you’re attending to your patient’s mental health needs and touch on how FNP programs should educate students about mental health.
Great Impact
Though stigmatizing societal attitudes regarding mental healthcare have improved, a patient’s initial encounter with a healthcare provider will likely have the most significant impact on self-perception of a mental health complaint as well as willingness to seek continued treatment, notesHogan.
Early detection and intervention lead to the best outcomes, in conjunction with a trusting, collaborative rapport between the patient and FNP to reduce stigma present with having a mental health condition, according to Hogan. FNPs must be aware that a patient’s mental health status has a greater impact on chronic physical health conditions if undiagnosed or left untreated, she notes.
It’s imperative for FNPs, especially those in primary care settings, to prioritize the screening of conditions such as depression and anxiety, notes Amanda Ringold, DNP, FNP-BC, CRNP, SANE-A, assistant professor at the University of Pittsburgh School of Nursing. “To ensure effective mental health assessments, FNPs must address and overcome organizational barriers, including time constraints, a lack of a universal screening policy, and providers’ feelings of inadequacy in conducting mental health screenings. FNPs are poised to take on leadership roles within clinical settings to address and mitigate these challenges,” she explains.
Screening Strategies
Various strategies exist for dealing with mental health during patient care visits. For instance,
Ringold notes that not every screening needs to be done face-to-face with the FNP. Instead, screenings can be conducted with pen and paper in the waiting room or via an app before the appointment. She notes that other team members, including nurses or medical assistants, can be trained in administering the screenings.
Lisa Johnson, DrNP, CRNP, ACNP-BC, associate professor and DNP/NP Program Coordinator at Gwynedd Mercy University, agrees that patients can complete questionnaires in the waiting room or before the visit. However, “we have to be cautious not to fatigue patients with questionnaires and to ascertain their reading level and primary language prior to requesting a mental health assessment be completed by the patient,” she warns.
In an interview, Irene W. Bean, DNP, FNP/PMHNP-BC, FAAN, FAANP, FNAP, CEO of Serenity Health Care, P.C., and Tennessee State Rep for AANP, says to pay attention to a patient’s body language once in a patient encounter. Watch for poor eye contact or note whether a patient has been crying.
She says to pay attention to slurred speech and be aware of signs such as a patient who typically speaks loudly suddenly speaking in a whisper or a normally talkative patient now being reserved.
FNP Programs
Johnson says NP educational standards emphasize assessing mental health in varied patient populations. Healthcare providers and institutions of higher education need to focus on the cultural considerations of mental health disorders and further emphasize collaborative communication between primary care and mental health providers, she notes.
Hogan says clinical competencies are best attained via a competency-based educational model throughout the FNP curricula. Specialized courses on mental health, simulation training, interprofessional education, and clinical rotations in primary care settings can develop competence. She says that after graduation, FNPs should maintain continuing education specific to FNP’s scope of practice and evidence-based care for mental health concerns.
Ringold notes a growing trend of students at the University of Pittsburgh School of Nursing opting for dual FNP-PMHNP degrees.
Scope of Practice
While FNPs can treat mental health conditions such as basic anxiety and depression, they need to be mindful of their state’s scope of practice, says Bean. For patients with conditions such as bipolar disorder or schizophrenia, you may be stepping outside your practice scope and may need to refer the patient to a specialist, Bean says
“One thing that I would stress, and I stress to my students, is that you want to protect your license. You want to ensure the patient is safe while protecting your license,” Bean says.
Calling on Compassion
When you realize your patient is anxious, depressed, or dealing with a mental health issue, “What you don’t want to do is rush that patient from that conversation,” says Bean. “You’re going to miss a lot of things when you rush patients who have a mental health crisis through your clinic,” Bean says.
“You have to have compassion for patients dealing with a crisis. Their crisis may not be something you feel is a crisis, but to them, it’s everything. You can’t discount their feelings, and you can’t discount what you’re seeing in that patient.”
