Clinical research is one of the most important — and least openly discussed — cornerstones of medicine. This type of research enables scientists to develop new medications, cures, and preventative measures for some of the most difficult diseases facing the human race today. Likewise, clinical trials give scientists an avenue to test new treatments and determine their safety and effectiveness before they go to market and are distributed to the masses.
As great and important as clinical research is, it certainly isn’t free from its fair share of sticky problems. Perhaps one of the most pressing issues in clinical research today is a significant lack of equal representation in clinical trials. The vast majority of clinical research is tested on middle-aged white men, meaning that the side effects of certain treatments on minorities and occasionally even women are pretty unknown. There are a plethora of reasons for this lack of representation. For instance, research studies typically focus on those who volunteer to participate. Historically, many clinical trials involving minorities crossed clear ethical boundaries, which has led to continued widespread distrust of the system.
Lack of Inclusion in Clinical Trials
Unfortunately, minorities have typically been left out of clinical studies altogether. Outside of a few notorious — and disturbing — examples of minority-focused clinical research, most studies have long been predominantly white — upwards of 80-90% white.
Part of this is because rigorous scientific experimentation has long required limiting the number of variables or demographic differences amongst test subjects. Doing so makes it easier to clearly prove that the medication is what is making the difference in outcomes. The obvious negative to this type of research is that once a medication hits the market, it will be recommended to thousands of patients of different ethnicities — many of which the medication was never rigorously tested on in the trial phase.
Congress took a step in the right direction in 1993 with the passage of the National Institutes of Health Revitalization Act. This required the agency to include more women and people of color in their medical research studies. Fast forward to the era of COVID-19 and most ethnicities were represented in medical trials in a proportionately appropriate way. That is, except African Americans.
Lack of Trust
There is no mistaking that a lack of trust in the health care system and in medical research is a significant part of why these disparities exist. In reality, this distrust is completely fair. There are plenty of examples of unethical medical testing throughout history. Some of the most notable ones include the Tuskegee Syphilis Study, where black men were deliberately left untreated for syphilis, or the Plutonium Trials, where participants were given injections of plutonium without an adequate explanation of the risks.
Today, many people argue over the ethics of cutting-edge research studies into things like nootropics or stem cell research. However, even some of the most common research studies lack willing minority participants. For instance, in many cancer studies, medical researchers struggle to garner interest in many minority patients.
The most heartbreaking aspect of this phenomenon is that participating in this type of research may be what saves the lives of many other minority patients in the future. Oftentimes racially and ethnically diverse patients suffer from health issues disproportionately to their populations. Recruiting for studies can be difficult because many do not have access — due to finances or other resource availability — to treatment facilities where the studies are taking place.
Breaking Down Barriers in Clinical Trials
The need to break down these barriers is immense. Not only can including more minorities in medical research studies produce better results for the entire population, but it can save lives in the long run. So the question then becomes — how do we start to break down these barriers and build more trust?
For many medical experts, the answer lies in building a relationship with patients. Earning the trust and respect of a patient through conversations and getting to know them as an individual is important. Even on a very basic level, they have to trust that a medical professional truly has their best interests at heart and cares about them as a real person.
Emphasizing the importance of personalized medical trials to increasing knowledge of how certain diseases and treatments impact minorities.
Improving access to medical information and trial opportunities at the local hospital level.
Expanding upon minority representation in healthcare career paths.
Providing educational materials that can help patients better understand the goals of medical research.
The value of medical research cannot be understated. However, there is a chronic lack of minority representation in the majority of clinical trials. Breaking down barriers that lead to a lack of inclusion and distrust in the system are important to improving the health of all patients. As a minority nurse, it is possible to play a pivotal role in starting to break these barriers down.
During this year’s International Infection Prevention Week (IIPW), it helps to shed light on how every small effort can make a big difference. During a continuing pandemic and an impending flu season, infection control is critically important to protect patients, healthcare workers, and the community at large.
Nurses’ days are guided by infection control processes and the last year and a half has seen more controls and preventive measure implemented. Not only wearing PPE, but putting it on and removing it correctly are essential to proper infection control.
International Infection Prevention Week began 35 years ago and this year’s theme is “Make Your Intention Infection Prevention.” According to IIPW, the organization intends to highlight the science of infection prevention during this year’s awareness week to help the general community understand how infections happen and how they can be prevented.
As nurses, interactions with patients are excellent times to remind them of infection control practices, and infection control in your workplace is critically important.
Talk with your patients
More people are aware of vaccination, mask wearing, hand washing, keeping a social distance, and other infection prevention measures that have become so common and essential in helping to control COVID-19. Reminding patients how these things are important to future infection prevention is helpful. Bring up antibiotic resistance and explain the caution around taking antibiotics for conditions where they aren’t helpful and can actually contribute to antibiotic resistance.
Remind them to get help
Let patients know they should seek medical care when things just don’t seem right. Former President Bill Clinton’s recent infection landed him in the hospital, and it’s reported that he felt off–just especially extra tired. Patients don’t always realize that something like a urinary tract infection can lead to a much larger and potentially life-threatening infection. Educating them that infection comes in many forms will help them recognize trouble. As a nurse, it’s also a good tips to remember. You’re around so many people and it’s worth being aware of when something seems off.
Spread awareness at work
Healthcare workplaces have seen a surge in infection prevention measures since COVID emerged. Although it might seem like second nature, it is always a good idea to keep infection prevention at the center of workplace issues. Depending on the patient population you work with, infection prevention could also include needle safety for everything from injections to blood draws to IV insertion. Anything involving bodily fluids, wound care for example are also potential infection spreading tasks. Find out how your workplace is focused on keeping workers safe.
October 10 kicks of a celebration of the work emergency nurses do with Emergency Nurses Week. In the past year and a half, emergency nurses have faced a pandemic and the overwhelming care needs of a staggering patient load. Frequently, emergency nurses are the initial care provider for people who have COVID-19 symptoms, and they have taken on a care caseload filled with some of the sickest patients these nurses have ever encountered.
Emergency nurses are needed more than ever. As pandemic cases continue to rise and fall and as patients who put off needed care are presenting with even more advanced needs, emergency nurses are in perpetual demand.
As the need for their skills rises, emergency nurses are especially prone to exhaustion and burnout. Taking care of themselves becomes a low priority when the demands of the job are so high, so continual, and so overwhelming. If running to the bathroom is considered a break, how can emergency nurses be expected to keep up the pace?
And while there’s no magic potion to improve the work balance (let alone a work-life balance), nurses can be aware of doing whatever they can to make life any easier right now. And remembering that eventually, this impossible time will pass.
With an unrelenting job, nurses need to let themselves take shortcuts when they can. Buying premade meals or getting groceries delivered saves time and effort that are in short supply. The shortcut doesn’t have to lead to unhealthy choices. Focus on foods that give you the biggest nutritional bang for the buck. Prepared salads, cooked veggies, chopped fruit, and grilled meats are great choices. And when you’re too tired to even think about eating, a comforting soup–pureed or hearty–with bread and cheese will fill you up and nourish you.
Asking for help is often a nurse’s Achilles heel. After giving so much care, nurses are reluctant to admit they need some help. Whether it’s childcare, elder care, transportation, or mental health care, a little assistance can make your life easier–and that can make the world of difference. Even connecting with other nurses through an organization like the Emergency Nurses Association can give you the support you’re seeking.
Find the Joy
For many nurses, there’s been less joy this year. As waves of patients remain high, the emotional toll on nurses and healthcare workers is evident. Keep yourself going by finding the small joys in your day. A great playlist, a funny podcast, a movie that lets you escape (even if it takes five sessions to watch because you keep falling asleep), or even the softest socks that soothe your aching feet at the end of the day are good choices. Bonus points if it requires no extra effort and double bonus points if it’s something you can look forward to.
During Emergency Nurses Week, honor those who work in this demanding specialty. And if you are an emergency nurse, thank you for all you are doing!
This week’s celebration of Pediatric Nurses Week (October 4-8) is a reminder of the specialized work these dedicated nurses offer to their young patients.
For anyone interested in a career as a pediatric nurse, it’s helpful to know the responsibilities of this job. Nurses who work with children are the biggest advocates for their young patients. From toddlers to teenagers, pediatric nurses will become familiar with, and fluent in, the issues facing these ages.
Nurses who work with children will have an understanding of everything from toilet training and toddler play habits to social media and adolescent decision making habits. Pediatric nurses will see children for well visits, minor illness like a stomach flu, and life-threatening diseases including cancer.
Because of the range of ages, potential conditions, and situations, pediatric nurses have to know myriad relevant medical information and also how any issues or concerns will impact the family. Working with so many different families while focusing on a young patient can be challenging for pediatric nurses. Families are also the best advocates for the child and so creating a good working relationship with families is especially helpful. Compassion and understanding go a long way, but calling attention to concerns is also a pediatric nurse’s responsibility.
The Society of Pediatric Nurses is an excellent resource for nurses who work with children and their families. It offers guidance on education, advocacy, and clinical information to cover the needs of just about any pediatric nurse.
Nurses in this specialty are in high demand and can find a satisfying career in one office or by changing the focus of their career. They can find work in a family practice, a specialty practice, a hospital, an outpatient or surgical clinic, schools, or even rehabilitation centers.
By taking the exam, nurses are proving they have the most updated knowledge on evidence-based practices and on treating their young patients. This helps them give the best care possible as this specialty changes rapidly. Nurses who become certified are also demonstrating a specific commitment to being the best nurses they can and to gaining the tools necessary to make that happen. For a career move, this extra level is frequently noticed by your peers, supervisors, and organization. Nurses who are certified and keep their certification current are the nurse leaders organizations look for and depend on.
When Danielle McCamey DNP, CRNP, ACNP-BC, FCCP, was searching for other nurses of color who were on the same path to a doctorate degree in nursing, she had a tough time. Knowing she couldn’t be the only one seeking a similar camaraderie, McCamey founded DNPs of Color, a nonprofit focused on building the community she was hoping to find.
“When I got my DNP, I was the only Black woman, and I had a different lived experience from my cohort mates,” says McCamey, now DNPs of Color’s president and CEO. “I craved a community.”
In 2016, McCamey approached several professional nursing organizations. She pitched the idea of an organization focused on building a community of nurses of color who were on the path to earn the DNP, had earned it, or were just beginning to think about getting this advanced degree. No one followed up on the idea, so McCamey took it on as a personal project and started up a DNPs of Color Facebook page hoping to connect with others on her own. “That blew up,” she says. “It was beyond my expectations, and there were so many similar stories.”
As a first-generation student, McCamey’s academic track was new to her family. “There was lots of pressure to succeed and to represent myself for my community, my family, my ancestors,” she says. And she also wanted a sense of validation on her journey, one in which she experienced microaggressions, implicit bias, and racism.
A Lived Experience
McCamey is so passionate about DNPs of Color because of her own history. If not for the encouragement and guidance of Bimbola Akintade PHD, MBA, MHA, CCRN, ACNP-BC, NEA-BC, FAANP, she never would have considered earning a DNP. The two were colleagues (Akintade is a DNPs of Color board member), and McCamey was in her second year as an NP when he suggested she earn a higher degree.
“I had a small voice in my head that I was not capable,” she says, recalling a high school guidance counselor who told her that because she was Black and from a single-parent family, she’d never make it to college. An encouraging track coach changed her mind, and she was accepted to all 20 colleges she applied to (and, yes, she has since informed her old guidance counselor of her successes). Based on her own lived experiences, McCamey says DNPs of Color is dedicated to giving voice to those who have been silent or silenced for so long.
Establishing an Organization
In 2018, McCamey moved DNPs of Color to a nonprofit status because there was nothing else like her organization, and she knew how much it could help other nurses. The first virtual program DNPs of Color held was a virtual commencement and the immediate and enthusiastic feedback was encouraging. “It was about elevating stories of students of color earning their degrees,” she says. “There are so many stories. I never get tired of people saying this organization serves a purpose and ultimately impacts patients and health equity.”
The new focus of the Future of Nursing 2020-2030 report puts DNPs of Color in a direct position to support DNP students, diversity, and those in the BIPOC community, says McCamey. Right now, DNPs of Color is a social media-based platform with plans to move into a membership-based format next year. For now, she encourages anyone interested to join DNPs of Color’s private Facebook or LinkedIn groups so they will be alerted to the new strategies in the new year.
With three guiding pillars, McCamey says DNPs of Color focuses on networking, mentoring, and advocacy. Within those pillars, nurses are able to connect and learn essential guidance for moving forward in their careers, gaining fellowships, professional development tips, or navigating speaking and teaching engagements. “Many people do not understand the value of networking,” says McCamey because they may have never had mentors who can demonstrate it. “It opens up so many opportunities.”
Mentors, she says, are needed in all aspects of life–personal and professional. When McCamey finally had her DNP in hand, she says she wasn’t quite sure what was expected and what she could do to contribute to her community and give back. It was almost a feeling of “I did this, but now what?”
The advocacy piece of the organization is devoted to serving people of color and those who are historically marginalized or excluded, says McCamey. It’s about nurses doing what they can to make nursing and healthcare more equitable. Nurses with a DNP have a special skill set, she says, as they are well versed in academia and in clinical practice. They know how to create policies that are possible, effective, and nursing- or patient-focused. “For people of color, healthcare outcomes increase when implicit bias decreases,” she says. “Patients want to see people who look like them. If we are there, it promotes diversity.
The DNPs of Color community continues to grow daily, says McCamey. “As an organization, I am expecting that we are going to grow exponentially. And as the push for DEI increases, we will be instrumental in moving that needle forward.”
Whether you are an experienced nurse practitioner with years of clinical practice already under your belt, or you’re a student preparing for a fulfilling career devoted to helping people, you’re likely to face some unexpected challenges and some exciting opportunities in the work you have chosen. The role of the nurse practitioner is rapidly evolving, responding both to changes in the health care industry and to the evolving needs of the communities you serve. This article explores some of the most significant trends nurse practitioners are facing today.
An Expanding Role
The global health care shortage is not news, but what is news, perhaps, is how significant and widespread it is. In fact, in the United States alone, it is estimated that the shortfall in the number of physicians needed by 2033 will approach 140,000.
And that reality is rapidly and dramatically expanding the role of and the demand for skilled nurse practitioners. Where nurse practitioners might have once worked primarily in collaboration with a physician, increasingly, nurse practitioners are taking the lead in patient care. In many states, this includes overseeing and implementing treatment plans and even coordinating end-of-life care.
In addition to operating more independently than ever before, nurse practitioners are also finding themselves drawing on an array of skills, resources, and knowledge to provide more comprehensive care.
For example, as demand and cost pressures on the system mount, health care providers and patients alike are seeking more holistic strategies to promote wellness and prevent disease. This often includes, for instance, an emphasis on fitness and nutrition, constituting a significant shift in standard medical practices.
Historically, health care providers have been dissuaded or even prohibited from offering nutritional advice, as it may have been considered outside of the clinician’s scope of practice.
In addition to cultivating specialized knowledge to provide higher quality and more comprehensive care, nurse practitioners are also increasingly being looked to as multigenerational health care providers. In such cases, nurse practitioners may provide many of the services of a primary care physician, general practitioner, or family physician.
For this reason, a large number of nursing schools are offering students the opportunity to train as family nurse practitioners (FNP), enabling them to offer optimal patient care across all stages of the lifespan, from birth to death. Licensure as an FNP can be a particularly attractive option for those who seek to develop long-term, trusting relationships not only with individual patients but with an entire family.
Serving At-Risk Communities
Disparities in access to consistent, affordable, and high-quality health care have long been known and lamented. However, health care systems are increasingly turning to nurse practitioners to stand in the breach, filling a desperate need for health care providers in underserved communities.
That means that nurse practitioners may routinely find themselves asked to serve in remote, rural communities or impoverished urban areas where the need for qualified health care providers is greatest. In fact, nurse practitioners who have pursued specializations in community or public health can find themselves in particularly great demand and may build rewarding careers as traveling nurse practitioners, serving communities in need for weeks or even months at a time before moving on to the next post.
When it comes to both training and practice, nurse practitioners have more options and opportunities than ever before. In addition to choosing specific areas of specialization, such as adult or pediatric care, nurse practitioners can also select from an array of subspecialties which will increase their marketability.
However, the degree of clinical autonomy nurse practitioners enjoy will vary from state to state. In some U.S. states, licensed nurse practitioners enjoy what is known as full-practice authority (FPA), meaning that they can prescribe medication, order tests, and define and implement patient care strategies without requiring a physician to sign off on the plan. In other states, though, nurse practitioners still need a physician’s authorization before a treatment plan can be implemented.
Nevertheless, the opportunities for nurse practitioners to earn FPA are growing. For instance, attaining an Advanced Practice Registered Nurse designation can give you full practice authority in many states, including some states where a physician’s sign-off would otherwise be required. Most exciting of all, organizations such as the American Association of Nurse Practitioners are working to establish a nationwide certification protocol to enable qualified nurse practitioners to enjoy full practice authority in all U.S. states and territories.
It is an exciting time to be a nurse practitioner, a time of high demand, increasing independence, and tremendous opportunity. Nevertheless, the challenges are significant, principally due to an ongoing labor shortage and continuing disparities in health care access. In a time when both the need and the reward are great, nurse practitioners are perfectly positioned to fill the gap.