Incivility in nursing education has become an increasingly bothersome problem; however, it has especially become a nuisance in online education. Suplee, Lachman, Siebert, and Anselmi (2008) indicated that a faculty witnesses daily encounters in classes and clinical settings. Incivility is defined as behavior that is unprofessional, rude, and disrespectful. It can result in burnout and psychological and physiological distress for the parties on the receiving end, especially if left unaddressed (Butler & Strouse, 2022).
Another term that has especially been seen in the online realm is bullying, which can occur student-to-faculty and faculty-to-student. Unfortunately, it can also occur in faculty-to-faculty (Butler & Strouse, 2022). There has been an increase seen in student-to-faculty students’ displeasure with their achieved grades.
We must evaluate the reasons that the behavior is happening.
Stress from many walks of life can be the culprit, including working too many hours, mismanagement of work-life balance, stressful work assignments, financial strains, relationship strains, biases, and so on. Butler and Strouse (2022) also indicated that burnout and demanding workloads contribute to the greatest stressors. Personally, I have observed these behaviors displayed when providing constructive criticism. How can we, the faculty, help to ease the burden and create the traditional professional environment that many of us were able to participate in our educational journey?
As a part of a nursing faculty for ten years, I feel it is my calling. I enjoy helping deploy educated and competent novice nurses and advanced practice nurses into the workforce. However, the stress and incivility sometimes make one feel burned out. Many of us ponder going back into the clinical setting, feeling unappreciated and undeserved.
Caputi (2015) reported that the faculty can assist students in engaging in constructive evaluation of themselves and others. One factor is professional maturity, which can allow the students to analyze their own performance. As a faculty, providing feedback that is useful in the workplace and not hurtful can be helpful for growth and development. Self-reflection and guided introspection can be useful (Caputi, 2015). Discussing values, morals, attitudes, and the AACN essentials, pertaining to professionalism and leadership can be useful in developing students with incivility and assisting students in understanding (Caputi, 2015). However, the most important element is support from the administration and the appropriate follow-up and disciplinary actions.
In today’s climate, nursing is everywhere. It’s in the news and social media, but the coverage is rarely positive. Nursing has been America’s most trusted profession for years, but COVID-19 changed the perception of nursing.
No longer are nurses viewed as the safe harbor for patients who were battered by the winds and wrath of an industrial health care complex. Instead, nurses are publicly placed on trial for system errors and named in lawsuits for medical malpractice. What does the future of nursing look like in America? No one knows for certain, but I do know
who can reframe the perception of nursing, and that is the nurse educator.
Soul of Nursing
The nurse educator is truly the master of the soul of nursing. Still, they are rarely esteemed for the critical work accomplished. The nurse educator takes the raw material of an eager student and pours endless knowledge and skills to form the building blocks of a nurse. There is not a single nurse in existence who has not passed through the skilled hands of a nurse educator. The educator can genuinely alter the perception of a new nurse before the nurse even realizes they have been altered. The nurse educator can transfer tolerance and understanding through their formative teachings, prejudice, and judgment. The responsibility to develop the future of the entire profession rests on a select few, rarely acknowledged, who guard our profession with love and passion.
It is passion that drives the nurse educator. It surely is not the ability to earn a high income. According to the Bureau of Labor Statistics, the average nurse educator earns an annual income of $78,000. For a job that requires an advanced degree, any nurse educator could be better served with more lucrative uses of their degree, such as a nurse practitioner or joining an organization’s nursing leadership. It’s not the hours that drive the nurse educator. Is getting Christmas off a perk? Absolutely! Is waking up to 13 texts from a student who could not upload an assignment a benefit! Absolutely not. As a nurse educator, the breaks from classes are spent reworking material, developing new experiences, and continuing to grow professionally. It is truly a passion and a calling that drives the nurse educator.
Need for Nursing Faculty
Why should every nurse be aware of the need for nursing faculty? According to the American Association of Colleges of Nursing, a faculty vacancy rate of 8.8% nationwide has remained. This has resulted in a horrendous outcome of over 91,000 qualified applicants being turned away from nursing programs. Turning away applicants continues to exacerbate the nursing shortage. With the current projection from NCSBN of close to one-fifth of the nursing workforce looking to exit in the next five years, every applicant to a nursing school is a building block to the solution.
Know Your Influence
So why consider nursing education? The nurse educator is an artist. They take a piece of unformed clay and place pressure to mold and change the clay into a beautiful vase. With every student, educators leave a tiny part of themselves to transform a corner of the world. As a bedside nurse, I touch a few lives every shift. But if, as an educator, I have taught the floor of nurses, my reach is far greater than I will ever know. Knowing that your influence can affect the health care of a region, state, or nation is a pride and privilege few know. Nursing education is a beautiful profession that is far too often overlooked but should be dutifully considered.
That advice about timing resonated last month as she prepared to donate a kidney to her mentor, professor and faculty colleague. Professor and biostatistician Vicki Stover Hertzberg, PhD, who directs the school’s Center for Data Science, had been waiting nine months for a transplant after being diagnosed with kidney failure.
The two professors’ personal relationship is only one aspect of their remarkable story.
Both long ago had personal experiences that made them aware of the high need for living kidney transplants and the safety of donation. At the nationally No. 2-ranked School of Nursing, both women work on a research team that studies renal issues and other health problems related to heat exposure in farmworkers and published their findings in March. Both say their life-giving partnership reflects their school’s caring connections.
Chicas was only one of several Emory employees who answered Hertzberg’s call for potential donors in mid-2021. While others matched enough to donate, Chicas was the closest match.
“So much science has gone into it for such a long time, and to be able to use that science to help Dr. Hertzberg be healthier and live longer, it’s awesome. And I get to be a part of it.”
—Roxana Chicas, PhD, RN
“I have no words to express my gratitude for the individuals who came forward including those who ultimately, for one reason or another, could not be a donor,” Hertzberg said before the March 15 transplant surgery. “And for Roxana to do this is just phenomenal. I find it very overwhelming and very humbling.”
Most of us only need one kidney
Chicas’ first job at a pediatric office in Atlanta, when she was 18, exposed her to kidney issues and solutions. She translated for pediatric nephrologist Stephanie M. Jernigan, an associate professor of pediatrics at Emory School of Medicine.
“Children who were born with just one kidney often lived perfectly normal lives,” she says. “Other children who had kidney transplants did very well, even though it’s a very invasive surgery.”
She also learned to see her own intellectual potential.
Having come from El Salvador at age four and undocumented, Chicas had received temporary protective status that allowed her to work for the pediatricians. She helped them communicate with families who only spoke Spanish, and thought she might be smart enough to become a medical assistant so she could help them more. Pediatrician A. Gerald Reisman, MD, urged her to try nursing instead, and at age 28, Chicas enrolled in what is now Perimeter College at Georgia State University.
That educational decision led to Bridges to the Baccalaureate, an Emory program that nurtures minority students in research. With School of Nursing Dean Linda A. McCauley, PhD, RN, FAAN, as her advisor, Chicas got a BSN and went directly into the doctoral program. She joined McCauley’s team working on farmworker health, which felt personal because her mother, Maria Chicas, farmed in El Salvador. Farmworkers are 35 times more likely to die from heat-related illnesses than any other profession, she says.
“My goal is to do great science that will really improve the working conditions of agricultural workers,” Chicas says. “They are the backbone of this country and the globe. They feed us, and I think we need to value them more and recognize their worth, and they should be treated with dignity and given the same benefits that sometimes we take for granted. Many of them are undocumented and live in poverty, and I hope that I can be a part of a movement to better their lives.”
Heat-related illnesses affect kidney function, and Chicas did a postdoctoral stint in renal (kidney-related) medicine at the Emory School of Medicine. The research team measures indicators of health like core body temperature and kidney function.
“I got lucky, because I could have been working out in the field,” Chicas says. “I’m not there because of sacrifices that my mom made, and many other Latino parents have made and by having a mentor who told me that I can be a professional.”
A mentor in need
Hertzberg became Chicas’ professor and research teammate. From Florida to Mexico to Brazil, Chicas was in direct contact with farmworkers while Hertzberg worked to tell the story of the collected data.
“A wonderful mentor,” Chicas, 39, calls Hertzberg, 67. “She taught me that you can be smart and be strong in your career, and yet still be very kind.”
As the director for the nursing school’s Center for Data Science, Hertzberg is an internationally-recognized expert on “big data” and its impact on health care. She is widely known for her work measuring the social contacts in emergency departments and disease transmission on airplanes.
“Mentoring is what graduate education is all about,” Hertzberg says. “You learn a lot from each other. Part of it is just kind of a natural process because we’re engaged through research activities and part of that is just kind of understanding how the world works and what makes people tick. Roxana is incredibly driven and intrinsically kind, and always keeps me and our team focused on issues that our partner community experiences in ways that we don’t.”
On the farmworker longitudinal study, newer data relates to 25 markers of kidney function disease because of a relatively recent phenomenon called chronic kidney disease of undetermined etiology (CKDu). “Young farmworkers who had been feeling fine or really healthy all of a sudden wake up sick,” Hertzberg says. “Lo and behold, they have kidney failure and need dialysis.”
In late 2020, Hertzberg’s own bloodwork showed acute kidney injury, and when restrictive diet didn’t improve function enough, she was referred for a kidney transplant in mid-2021.
Like Chicas, Hertzberg had learned about the disease long before through a family friend and others. She reached out to her network by email and social media.
“Ideally a living donor is best,” she wrote. “A kidney from a living donor lasts on average 25 years, while a kidney for somebody who is about to have life support turned off is on average 12 years. Obviously, the 25 years is my preference…. the wait for a kidney from the person on life support will take three to seven years.”
“I knew it’s a pretty big surgery, but I was just like, ‘I have an extra kidney. I’m pretty healthy,’” she says. “And I called my mom and asked her what she thought and she was like, well, if that’s what you feel that you’re called to do, then go for it. And I was like, Okay.”
When she found out that there was competition to give a kidney to Hertzberg, Chicas told herself, “If God wants me to be the donor, then I’m going to match. So much science has gone into it for such a long time, and to be able to use that science to help Dr. Hertzberg be healthier and live longer, it’s awesome. And I get to be a part of it.”
Hertzberg even had colleagues clamoring to organize her meal train. This loyalty is partly from working at Emory since 1995, and supporting so many people and projects with her expertise. She served on dissertation committees for Chicas in 2020 and (at the University of Cincinnati) for McCauley in 1988.
Christian Larsen, MD, DPhil, professor of surgery in the Division of Transplantation at Emory and former dean of the Emory School of Medicine, transplanted Hertzberg’s new kidney last month. Larsen and Hertzberg knew each other through their collaborative research. From 2005 to 2010, they teamed-up on a protective immunity project studying aspects of the immune system in kidney transplant patients.
“This is not a road I would have chosen for myself,” Hertzberg says. “So I’m trying my hardest to learn the lessons along the way and to keep being positive. I want to dance at my grandchildren’s weddings, and the oldest one is soon to be five years old.”
Chicas believes that her success, her mentors and her organ donation have proved her favorite quote.
“Mother Teresa said, ‘If you can’t feed 100 people, then feed just one,’” she says. “I’m not a philanthropy. I’m not a billionaire. But I feel like there are certain things that I can do.”
“We’ve come a long way,” remarks Dr. Yvonne Commodore Mensah, Ph.D, MHS, RN. Now an assistant professor at the Johns Hopkins School of Nursing—where she started her PhD study in 2010—she is guiding the next generation of emerging scientists.
With a special interest in mentees of color.
That’s because sheer numbers are not the whole story of diversity, equity, and inclusion. In 2018-2019, about 15,000 Black Americans earned PhDs, about 14,000 Hispanic or Latino Americans, and just 720 American Indians — compared to over 100,000 white Americans.
Mentors guide junior researchers through opportunities with world-renowned nursing faculty, cutting-edge facilities, and opportunities for interdisciplinary collaboration throughout Johns Hopkins University and health care system. Among researchers of color and women, mentors are also critical for sponsorship and in building the fortitude to navigate underrepresented and unfamiliar spaces.
Meet Dr. Commodore-Mensah and her mentees: Dr. Ruth-Alma Turkson-Ocran and Dr. Oluwabunmi (Bunmi) Ogungbe
“Yvonne was always asking me ‘when are you going to come to Hopkins and get your PhD?’” laughs Dr. Ruth-Alma Turkson-Ocran, Ph.D., MPH, FNP-BC, RN.
They’re the same age – they are also both from Ghana, went to the same high school, and came (unknowingly) to the U.S. in the same year to become nurses. Dr. Commodore-Mensah traveled a more direct research path however, while Dr. Turkson-Ocran became a nurse practitioner first. She earned her PhD at the Johns Hopkins School of Nursing in 2019 and was a post-doc at Johns Hopkins School of Medicine until summer 2021, when she became an instructor of medicine at the Beth Israel Deaconess Medical Center and Harvard Medical School.
On the other hand… “I found and reached out to Yvonne when I began to explore doctoral programs,” Bunmi Ogungbe, MPH, RN/BSN says. Bunmi is from Nigeria. “She was one of the first people investigating cardiovascular disease among African immigrant populations.”
The COVID-19 curveball
Heart disease and African immigrant health are interests all three women share. In fact, Bunmi began the PhD program at Johns Hopkins in 2019 intending to investigate cardiovascular disease medication adherence in Ghana, working through an existing study by Dr. Commodore-Mensah. But then COVID-19 threw her work a curveball.
Grounded, with travel unsafe, Bunmi conferred with Dr. Commodore-Mensah and additional mentors, including former dean Patricia Davidson and other faculty internationally recognized for their cardiovascular and chronic care research, to take her research in a new direction: examining biomarkers that indicate an injury to the heart, to determine the long-term cardiovascular effects of COVID-19 among Baltimore City residents.
“Dean Davidson advised me that part of the journey is knowing when to pivot and take advantage of emerging opportunities,” Bunmi says. “Yvonne helped me work through such a big change. She has connected me with so many mentors and sponsors, and brought me into the spaces that matter.”
“It’s really interesting when the mentee takes a slightly different path. There is mutual learning that enhances our skills and knowledge,” says Dr. Commodore-Mensah. “After working with Bunmi I was asked to give a presentation on cardiovascular disease and COVID. And Ruth-Alma is my tech person.”
As faculty at the Beth Israel Deaconess Medical Center and Harvard Medical School, Dr. Turkson-Ocran gets to explore her interest in technology with projects investigating blood pressure at home, ambulatory blood pressure (meaning tracking blood pressure over a 24-hour period), and exploring how to use machine learning to examine blood pressure. Incredibly, information on blood pressure from wearable devices could be actionable in as little as five years.
With the interview process for her faculty position fresh in mind, Dr. Turkson-Ocran reflects on Dr. Commodore-Mensah’s generosity.
“It’s empowering to work on a multicultural team, yet, as underrepresented women in health and academia, there is something to be said for having someone who looks like me there to help raise me up.”
– Ruth-Alma Turkson-Ocran, PhD, MSN, MPH, RN
“Yvonne has constantly sponsored me, encouraged me to take on responsibilities I didn’t realize I was ready for.” She continues, “It’s empowering to work on a multicultural team, yet, as underrepresented women in health and academia, there is something to be said for having someone who looks like me there to help raise me up. It tamps down imposter syndrome and reinforces that this path is truly meant for me.”
“There is this façade of scarcity in academia,” Bunmi says. “People feel the need to hoard resources, opportunities, networks. Yvonne doesn’t do that.”
“You don’t lose anything by being kind.’ Former Dean Davidson used to say that, and I’ve been so fortunate with all my mentors that I can’t help but pass it on,” says Dr. Commodore Mensah.
Read more about graduate and post graduate degrees at the Johns Hopkins School of Nursing:
Maria Rodriguez Shirey, Ph.D., associate dean for Clinical and Global Partnerships and inaugural holder of University of Alabama Birmingham‘s (UAB) Jane H. Brock – Florence Nightingale Endowed Professorship in Nursing, became dean of the UAB School of Nursing on June 1 following a national search. Shirey is succeeding Doreen Harper, Ph.D., holder of the Fay B. Ireland Endowed Deanship in the School of Nursing, who announced her intent to retire in 2021.
“Dr. Shirey’s work within the university, the community and the world at large is a testament to her abilities to lead this ever-growing school. We are confident that she will continue to propel the world-class academic, research and clinical enterprises in the School of Nursing,” said Provost Pam Benoit.
“As a Health Promoting University, it is essential that our leadership embraces the challenges of advocacy for local and global well-being, and we are fortunate to have a demonstrated champion in Dr. Shirey,” said President Ray Watts.
Shirey, a tenured professor of nursing at UAB since 2013 who is board certified in advanced nursing executive practice and health care management, is eager to assume her new role as the fifth dean in the school’s 70-plus year history. Provost Benoit thanked outgoing Dean Doreen Harper for her service, calling her a driving force of positive change who elevated the success and reputation of the school in her 17 years as its leader. “Dr. Harper’s vision for the School of Nursing has brought international acclaim to UAB and its community and has produced countless nurse leaders who continue to transform health care,” she said.
Shirey, who previously chaired the SON Department of Acute, Chronic and Continuing Care, has strategic, financial, human resources and operational responsibility for the school’s multiple community partnerships, the faculty practice enterprise and the Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Center for International Nursing.
Shirey’s areas of scientific focus on leadership science and health services outcomes research across the health care continuum. Since joining the UAB School of Nursing in 2013, she has extended her leadership and health services outcomes research focus and funding to test the efficacy and comparative effectiveness of interprofessional collaborative practice care delivery models advancing access to care, population health, care transitions and health equity addressing disparities in vulnerable populations with chronic diseases in urban and rural community settings. For her career contributions to advancing leadership and health systems science, Shirey was recognized in 2019 by the American Organization for Nursing Leadership Nurse Researcher Award.
She also has held several other administrative leadership positions in the school, including as the leader of its diversity, equity, and inclusion initiatives. Most notably in the clinical realm, Shirey was the founding director for the nurse-led Heart Failure Transitional Care Services for Adults Clinic in UAB Hospital in 2014 and continues to consult with its executive leadership.
Her current roles include co-leadership of philanthropic grant processes for community-based projects in the school and interim co-director of the PAHO/WHO Collaborating Center for International Nursing.
Shirey is a senior scientist in two universitywide centers — Minority Health & Health Disparities Research Center and the Center for Outcomes and Effectiveness Research. She also serves on the leadership committee of Live HealthSmart Alabama, winner of UAB’s first Grand Challenge competition, which is a key component of UAB’s strategic plan, Forging the Future.
Shirey’s service extends beyond the school to the university and its health system. She has had an integral role as leader in the UAB Nursing Partnership and is a member of the new universitywide Community Engagement Council and the UAB/St. Vincent’s Urgent Care Alliance Taskforce. Her work in the community currently includes an advisory role with the National Family Partnership of Central Alabama.
She is a fellow of the National Academies of Practice, Academy of Nursing Education, American Academy of Nursing and American College of Healthcare Executives.
Shirey earned a bachelor of science degree in nursing from Florida State University plus a master of science in nursing from Texas Woman’s University and a master of business administration from Tulane University before completing her doctorate in nursing science at Indiana University.
To be a nurse, one must possess many different skills, with clinical judgment –the ability to think critically and make quick decisions that impact patient outcomes – being one of the most important. Another increasingly important skill is technology literacy, or the ability to use, understand and manage technology. Elsevier’s recent Clinician of the Future report found that 53% of U.S. nurses believe that technology literacy will become their most valuable capability over the next ten years, ranking higher than clinical knowledge.
The report also found that 54% of U.S. nurses predict they will draw on tools utilizing artificial intelligence to inform most of their clinical decisions. However, 69% of U.S.-based nurses report being overwhelmed with the current volume of data available and 84% of nurses in the U.S. predict the widespread use of digital health technologies will represent an even more challenging burden in the future. Despite these concerns, 59% of nurses in the U.S. still agree that the widespread use of digital health technology will enable a positive transformation of healthcare.
While use of technology in the healthcare setting is not without challenges, I believe it has a net positive benefit, particularly providing nurses with tools and information to enable rapid critical thinking and sound clinical judgment in patient care. I propose three ways higher-education institutions and health systems can maximize technology throughout a nurse’s career.
Utilize Education Technology (EdTech) Solutions
A nurse’s career journey begins in the classroom, and it’s during this time they develop the foundation for clinical judgment and critical thinking they will use throughout their careers. New and emerging forms of educational technology solutions, such as simulation-based and virtual-reality (VR) scenarios are providing students with an immersive way to learn skills in a safe and standardized environment. In these realistic patient scenarios that integrate the latest evidence-based research and education content, nurses can build confidence through practice on digital patients in a virtual environment that encourages exploration, adaptation and the development of critical reasoning skills.
Shadow Health, a suite of simulation learning products, features a diverse patient set representing various backgrounds with different health concerns. This conversation-based solution allows students to respond to many patient scenarios, while developing clinical judgment skills and practicing therapeutic communication. These innovative forms of education technology are already having a profound impact on how students absorb information. A recent study on the efficiency of patient care skills for nursing students in programs that use Shadow Health found that 82% of learners showed an increase in overall efficiency and 68% were better equipped to identify the number of correct care plan components.
Make the Transition to Practice Easier
As nurses make the transition from nursing school to practice, they are entering an increasingly demanding and complex environment. In addition to patient care responsibilities and keeping up with evolving care guidelines, nurses must also update electronic health records (EHRs) and handle time-consuming administrative work. These stressors can result in high turnover rates, with some hospitals seeing novice nurse turnover as high as 35%.
Learning how to balance these responsibilities can be overwhelming and may be contributing to more patient-related errors for new nurses. According to research from the National Library of Medicine and The Online Journal of Issues in Nursing, 40% of new graduate nurses reported making medication errors, and 50% reported missing signs of life-threatening conditions. The industry can better support nurses and ensure they are always practice-ready by providing technology solutions.
Providing novice nurses in a hospital setting with simple-to-use tech-based reference and communication tools enables safe, practice-based development of their patient care competency. Nurses can rely on these resources when they have questions or are unsure of procedures, supporting the ongoing development of their critical thinking skills and reducing patient care errors.
Provide Continued Professional Development on Digital Health Technology
While a nurse’s journey begins in the classroom, ongoing education remains critical throughout their career. The Clinician of the Future report found that 79% of U.S. nurses believe that training and ongoing education needs to be overhauled so they can keep pace with technological advancements. While resident nurses may have been exposed to emerging forms of technology during nursing school and are more comfortable with digital solutions, nurses who have been in-practice for decades may not be as comfortable using unfamiliar technologies.
Healthcare leaders must identify where nurses need the most support and provide continued professional development to ensure nurses at all levels are comfortable using digital health technologies. Hospitals, health systems and nursing organizations can provide solutions for nurses throughout their careers to enable technological proficiency and support critical thinking during patient care. These resources ensure nurses have access to the latest guidelines and evidence-based treatment pathways, empowering them to make more informed, confident decisions and driving better patient results.
At the same time, it is crucial for leaders to be thoughtful about the technologies they are considering deploying and to take the time to understand the benefits of any solution under consideration. A study published in the Western Journal of Nursing Research found that the use of telehealth to manage certain diseases, such as Type 2 diabetes and hypertension actually worsened nurses’ workloads and led to twice as many activities completed by nurses. To gauge the impact new technologies will have on nurses, administrators may want to consider issuing employee surveys or informally gathering feedback, which is also a great way to show nurses that their voices matter in choices being made by the organization.
The last few years have shown us that nurses are invaluable to the healthcare industry, and it’s imperative that we provide them with tools for success throughout their entire career. Technology is going to continue to play a major role in healthcare. Healthcare leaders and educational institutions can use technology to their advantage, but they must provide current and future nurses with development opportunities to enhance their technology skills.