by | Mar 30, 2013 | Faculty Nurses, Magazine
Perhaps you are a newly graduated nurse. Maybe you’re an experienced nurse assuming a new position. Or perhaps you’re looking for a little guidance as you investigate new nursing roles. What all of these situations have in common is a need to learn the ropes of a new position. One effective avenue is mentoring.
Jill is a new RN who had been seeking a nurse position in her home state. With today’s wilting economy, she was unable to find a suitable position, so she ventured into a new territory and accepted a position in her chosen specialty, medical-surgical nursing. She felt fortunate to have found a position at a medical center about 200 miles from her family.
Jill is encountering many new things at once: a new home, new city, new hospital, and new job. Sounds overwhelming, doesn’t it?
One of the reasons Jill selected the medical-surgical unit at her new hospital is because her interview with the nurse manager and the unit staff went so well. She found them to be welcoming, caring, friendly, professional, and patient-centered. Also high on her list of positives about the job was the unit’s mentoring program. Jill had the opportunity to interview with a mentor and mentee in the program, and it was this interview that sealed the deal for her decision to accept the position.
So what exactly is mentoring?
Mentoring is a reciprocal and collaborative learning relationship between two individuals with mutual goals and shared accountability for the success of the relationship. The mentor is the guide, expert, and role model who helps develop a new or less experienced mentee.
In many instances, mentoring is a spontaneous relationship that develops between two people. However, mentoring can also be successful when the mentor and mentee are paired or matched intentionally. This is often the case in health care facilities when a mentee transitions into a new role. The mentee is paired with an experienced nurse to learn a new position and develop in the role.
Mentoring is more than orientation or preceptorship, which may last a few weeks or through a three-month probationary period. The duration isn’t cast in stone; it is an ongoing relationship that will last as long as the mentor and mentee find meaning and value in it.
A mentoring relationship can occur at any phase of an individual’s career, whether a new graduate, an experienced nurse assuming a nurse manager or clinical nurse specialist position, or an established clinician taking on a leadership position as the chairperson of a shared governance council. Some nurses may also become a mentor themselves one day, using their knowledge, wisdom, and experience to provide meaningful learning experiences for a mentee.
Mentoring is a partnership between the mentor as a teacher and the mentee as a learner. As adult learners, mentees are responsible for their own learning and behaviors. As teachers, mentors act as guides or facilitators of learning.
Each of us has numerous opportunities throughout our lives to be new at something, and it isn’t always a pleasant experience. There is fear of the unknown, uncertain confidence, fear of making a mistake, and just the uncomfortable feeling of not being in control. We’ve all been there and will be there again at some point. In the role of a mentor, it is very helpful to remember what it was like being new to a position or task. It helps to get in the frame of reference of the mentee.
Novice to expert continuum
Patricia Benner, Ph.D., R.N., in her book From Novice to Expert: Excellence and Power in Clinical Nursing Practice, says learning new skills requires a progression through stages or levels. These levels are novice, advanced beginner, competent, proficient, and expert.
When nurses take on new and unfamiliar roles, they often begin at the novice stage. Novices use rules and facts to guide their actions. They adhere to these rules without consideration for the context of the situation. It is difficult for a novice to put all of the parts together and see the whole picture. They are concerned with the tasks at hand and often cannot do more than one thing at a time.
Most novices want to feel and be seen as competent immediately upon taking on a new role. It is uncomfortable knowing one does not have a firm grasp of the position. Mentors and mentees must remember that learning new skills is a process that takes time. Both individuals must be patient during this formative time and realize what’s occurring is normal.
With time and experience, novice nurses continue to experience the real world and progress to the advanced beginner and higher levels of the continuum. Mentors can continue to play a significant role in the mentees’ progression.
Mentees
Mentees will become successful in their roles more quickly when they listen actively to what is going on and are willing to soak up as much learning as possible. Mentors are a rich source of knowledge—they’ve been there, done that, and learned the critical pieces to perform successfully. Thus, mentees can gain a tremendous amount from an effective mentoring relationship.
Successful mentoring relationships are built upon trust, openness to self-disclosure, affirmation, and willingness and skill in giving and receiving feedback. Mentoring involves a significant expenditure of time and energy on the part of the mentor and especially the mentee. Living up to promises and commitments to each other is extremely important to the relationship.
Mentees learn to achieve a balance between their own independence and reliance on the mentor. Over time, the independence will most likely dominate and the relationship will change.
After experiencing an effective mentoring relationship, mentees often feel refueled and inspired to make a difference in their practice. Other benefits of mentoring for the mentee include:
- Increased self-confidence
- Enhanced leadership skills
- Accelerated acclimation to the culture of the unit/facility
- Advancement opportunities
- Enhanced communication skills, especially with the interdisciplinary team
- Reduced stress
- Improved networking ability
- Political savvy
- Legal and ethical insight
Mentors
Time seems to be the most precious commodity these days. Potential mentors may feel they don’t have the time to spend on a mentoring relationship, especially when they have a full workload themselves. However, the time invested in mentoring a nurse transitioning to a new role is time well spent for the mentor and mentee, as well as the unit and facility. It is a huge contribution to advancing the future of nursing.
Mentors help mentees learn the ropes, their role, the political environment, and the culture of the unit or organization in a formal—yet unstructured—way. They create a warm and accepting environment that allows mentees to control the relationship, while at the same time allowing mentees to be themselves and voice relevant needs and concerns. Mentors are personable, approachable, reasonable, and competent individuals committed to helping mentees achieve the success of which they are capable.
Effective mentors are confident enough in their own knowledge, skills, and successes that they do not perceive mentees or their accomplishments as threatening. They are committed to seeking situations that will benefit the mentees’ development.
Mentors provide their mentees with insights that would otherwise have been gained only through trial and error. They ask a lot of questions—especially “Why?”—which encourages mentees to stop and reflect on situations and potential alternatives. Mentors are good at linking different bits and pieces of their mentees’ lives, such as work and home, thoughts and feelings, successes and failures. They try to look at the bigger picture and the future. Mentors help their mentees grow in their critical-thinking skills and progress along the novice to expert continuum.
Potential problems with mentoring
Not every relationship is successful. This can be true of a mentoring relationship as well. Sometimes the interpersonal dynamics or the match between mentor and mentee just doesn’t work. One partner might grow faster than the other or in a different direction, and a strain on the relationship may occur.
One common problem is the lack of follow-up and commitment to sustain the relationship. Mentors might overburden the mentee with work and responsibilities and vice versa. Mentees may become a clone of the mentor and lose their individuality. They may also become too dependent on their mentors. An unfavorable incident may occur in which the mentor or mentee feels let down or betrayed. Jealousy and personal or ethical disagreements can also strain the relationship.
There is also the case of toxic mentors who are detrimental to the success of their mentees. Toxic mentors may be unavailable or inaccessible to mentees or may throw the mentees to the wolves to either sink or swim. Toxic mentors may also block the mentees’ progress or criticize them in various non-constructive ways.
Both mentors and mentees can learn from the problems others have encountered in the mentoring relationship. If signs of these problems begin to develop, both individuals have a responsibility to confront the situation and actively plan a resolution or dissolution.
Prior to entering into a mentoring relationship, both parties should agree to a no-fault separation if one or both individuals realize the relationship is not working.
Mentoring facilitates professional growth
Mentoring has proven to be a successful way of facilitating the professional growth and development of recently graduated nurses and other nurses transitioning to a new role.
The Academy of Medical-Surgical Nurses (AMSN) has long recognized the value of mentoring for nurses in the acute care setting. AMSN has recently evolved its long-standing Nurses Nurturing Nurses (N3) mentoring program into a self-directed format that provides the tools for designing a successful mentoring program of your own, whether you are a mentor, mentee, or a mentoring program coordinator.
The AMSN Mentoring Program is provided on a complimentary basis. The program contains a Mentor Guide, Mentee Guide, Site Coordinator Guide, and an Introduction to Mentoring” article. You may use and customize the information and tools provided in any manner you deem appropriate for your facility or yourself.
by Sonya Stinson | Mar 30, 2013 | Asian-American and Pacific-Island Nurses, Black and African-American Nurses, Faculty Nurses, Hispanic and Latino Nurses, LGBT Nurses, Magazine, Men in Nursing, Nurse Recruitment, Nursing Careers, Nursing Mentorship, Nursing Students
Diversity directors appear to be a small but dedicated niche among nursing schools that are making an effort to better include and serve people of varying racial, ethnic and cultural backgrounds. While campus-wide diversity and multicultural affairs offices are fairly common at major U.S. universities, it’s rarer for nursing schools—or other individual colleges and professional schools, for that matter—to have a diversity department of their own.
“There have been pockets, but it hasn’t been done consistently, and there hasn’t been a big vision ,” says Mary Lou de Leon Siantz, PhD, RN, FAAN, assistant dean for diversity and cultural affairs at the University of Pennsylvania School of Nursing in Philadelphia.
There’s at least one reason, however, why the idea of establishing an office dedicated to enhancing the recruitment, retention and teaching of a diverse population may soon catch on at more nursing schools. “Now more than ever, because of the changing demographics of the United States, [a greater focus on multiculturalism in nursing education and practice] is very badly needed,” notes Siantz, who is a past president of the National Association of Hispanic Nurses.
By having their own formalized diversity departments and appointing diversity directors, nursing schools are in a position not only to create a more inclusive profession but also to prepare future nurses to meet the health care needs of an increasingly multicultural patient population. But what exactly do diversity directors do? And is this an emerging career opportunity that more minority nurses should consider pursuing?
The Mission and the Vision
One of the first tasks that Lillian Stokes, PhD, RN, FAAN, took on when she took the helm of the Office of Diversity and Enrichment at Indiana University School of Nursing in Indianapolis was to help fashion a diversity mission statement. Today, she sees that message displayed on a bronze plaque each time she walks through the front entrance of the school.
“Our overall vision is to try to promote an environment that values respect and reflects a global view of diversity,” says Stokes, who is also an associate professor at Indiana and the national president of Chi Eta Phi, a sorority for minority nurses.
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Clarifying the vision of a diversity department usually starts with determining what diversity means. “We define diversity here as ‘holding multiple perspectives without judgment,’” says G. Rumay Alexander, EdD, RN, director of the Office of Multicultural Affairs and associate clinical professor at the University of North Carolina-Chapel Hill School of Nursing.
Nursing school diversity directors say they want to expand the definition of diversity beyond the familiar parameters of race, ethnicity and gender. “One of the things I always talk to our first-year students about is the need to think about diversity in broader terms, not just [in terms of] ethnicity,” says Jana Lauderdale, PhD, RN, assistant dean for cultural diversity at Vanderbilt University School of Nursing in Nashville. “That’s something I kind of preach all the way through the program.”
The term can apply to any subculture or underrepresented group, she explains–for example, homeless persons, people with disabilities or people with chronic illnesses.
In Alexander’s view, achieving diversity means more than simply admitting more students from diverse backgrounds. These students need to find a supportive environment that will help them succeed.
“If you’re inviting people into an environment that for whatever reasons does not feel welcoming to them, or treats some [members] of its community in an inequitable way, then you may be bringing in many people through the door, and your numbers may be going up in terms of admissions,” she says. “But if these students are not successful in matriculating through the program and graduating, then it’s kind of like coming in the front door of a house and going out the back door.”
At Penn, Siantz says a key element of the school’s vision is that the commitment to diversity must be top-down. “That means that at the top there is recognition of the need to diversify the administration and the faculty, as well as the student body, to better promote the mission of the school,” she explains. “Diversity is the number one strategic goal of the School of Nursing. Globalization is the second.”
The Scope of the Job
A common thread in the job descriptions of nursing school diversity directors is a major focus on assisting students. Some are also involved in faculty programs and curriculum development.
At Indiana University School of Nursing, Stokes’ Office of Diversity and Enrichment is part of the Center for Academic Affairs. The enrichment part of her job title is broad in scope.
“This position calls for working with all students, not just minority students or underrepresented students,” she says. “Although the faculty and my office are committed to supporting underrepresented students as much as possible, I probably see just as many or more majority students.”
Diversity-related programs at Indiana’s nursing school include “empowerment sessions” to aid students with test taking, stress management, time management, organization and other skills; peer-led tutorial reviews of specific classroom subjects; a Diversity Forum series featuring presentations by faculty members and local and national leaders; and workshops for faculty on teaching students from diverse cultures.
Recruitment of minority and international students is another aspect of Stokes’ job, although she says it’s not her primary role. “We have a marketing and recruitment person [who is in charge of that],” she explains. “I work very closely with that office, and also with our graduate offices.”
Stokes and some of the senior nurse researchers on the faculty have established a program called Connections that targets students who might be good candidates for the PhD program in nursing. “We meet with students—it may be one student or ten—who express an interest or who I see have potential,” she says. “We take them through the admissions process [and] get them to start thinking about their research area, so we can think about a faculty member who might work with them.”
Two students–one African American and one Nigerian–who participated in Connections have since begun their doctoral studies in the School of Nursing. “They are doing very well,” Stokes reports.
She is also a founding member of the nursing school’s Minority Advisory Council, now called the Diversity and Enrichment Council. The group includes faculty, students, staff and community partners, such as practicing nurses, politicians and leaders of local organizations.
Lauderdale, who is president-elect of the Transcultural Nursing Society, says the range of her job at Vanderbilt “seems to be a moving target. Almost every day, there seems to be another layer added to it, which tells you something about the scope of the need for a position of this type.”
Lauderdale’s initial focus was on ensuring a “cultural diversity content thread” throughout the curriculum, “so that by the time students graduate, they feel comfortable working with patients from different cultures and are able to provide culturally competent care.”
Today, in its expanded role, the cultural diversity office at the School of Nursing offers an Academic Enrichment Program in which a group of students meet about once a month for brown bag lunch discussions on a wide range of topics–from critical thinking skills and time management to working with culturally diverse patients. Lauderdale also coordinates a Pre-Nursing Society for freshmen and sophomores who are considering nursing as a career.
For faculty, the nursing school’s summer institute on teaching strategies includes discussions of how to celebrate cultural diversity in the classroom. In addition, Lauderdale works closely with the faculty member who directs the cultural diversity program in the School of Medicine.
Diversity Is a Full-Time Job
When Alexander came aboard at UNC, she turned what had previously been a part-time role into a full-time focus. “Prior to my [being hired], the issues relating to diversity and inclusion were part of an assignment [given to] someone else on the faculty,” she explains. For her predecessors, this function took up a relatively small percentage of their responsibilities.
“I came into the interview with a clear understanding, because of [my] past work experience in diversity, that if it wasn’t getting the full attention of someone and it was kind of the job of ‘everybody,’ it was not going to get the traction that it needed to get,” Alexander says.
Specific diversity enhancement strategies at her school include a continuing education requirement for faculty and staff that is linked to their performance evaluations and compensation; the Kindred Spirits Award for Excellence in Multicultural Scholarship, given each year at commencement to a student who exemplifies respect for diversity; and an Ethnic Minority Visiting Scholars Program.
All of these elements, Alexander says, make her days on the job “unpredictable and lots of fun.”
At Penn, Siantz works closely with the nursing school’s Master’s Curriculum Committee and Diversity Committee. She also partners with other groups within the school and throughout the campus that are interested in promoting diversity.
For example, Siantz has partnered with the university’s medical school to develop a Leadership Education and Policy Development program to promote leadership skills among nurses and physicians of color. Supported by the university vice provost’s Office for Diversity, this program also teaches them how to use their research and clinical practice to help shape public health policies to eliminate disparities.
Another key strategy for Siantz has been to become a faculty member of minority nursing student organizations on campus, holding leadership retreats with the groups’ outgoing and incoming boards.
Challenges and Rewards
All of the nursing school diversity directors interviewed for this article admit that the work they do has its share of challenges. Yet they also find it extremely rewarding, especially when they see that their efforts to promote diversity and inclusiveness are producing measurable results and making a real difference at their institutions.
Siantz says one of the biggest challenges in diversifying the nursing profession is that nursing schools need to extend their outreach beyond the college campus.
“We need to partner with the [elementary and secondary] school systems, because despite the fact that the numbers [of people of color] are growing, they’re not going to college,” she emphasizes. “That’s something that the schools in individual communities need to wrestle with in terms of how they’re going to change that picture over time.”
Stokes sums up the main barrier multicultural students face in advancing their nursing studies with one word: “Money.” For example, she says, “I’ve been in communication [recently] with a young lady who graduated from another university here in [Indianapolis]. She has attended several of [our] Connections programs, but right now it’s [the lack of] money that’s keeping her away [from pursuing doctoral studies here].”
On the plus side, the school has been successful in obtaining a National Institutes of Health grant that provides some scholarships and stipends for qualified nursing students. About 36 nursing students at Indiana have participated in the university-wide Summer Research Opportunities Program, and several have gone on to pursue graduate studies. “I think we have had more students in the program than any other unit [of the university],” Stokes comments.
Another success story for Stokes has been seeing the nursing school’s learning environment change for the better when it comes to faculty interaction with students from diverse backgrounds. “They just have a better understanding of students who are different from them,” she says.
At UNC, one of Alexander’s proudest accomplishments has been to have the School of Nursing become a national role model for promoting and achieving diversity.
“We are called on frequently to consult with other schools about how to walk the talk of inclusion,” she says.
Is This a Career for You?
Because nursing school diversity directors represent a newly emerging specialty, there is little data available about their current employment statistics, salary levels or the career outlook for the field. However, the U.S. Bureau of Labor Statistics reports that the mean annual wage for all education administrators in colleges, universities and professional schools was $86,480 in 2006.
What kind of background and experience would be prerequisites for this career? The BLS notes that top student affairs positions usually require an EdD or PhD, along with good interpersonal, leadership and decision-making skills.
The directors interviewed for this article all have credentials that fit that profile. Alexander has an MSN from Vanderbilt University, training as a family nurse practitioner and an EdD in educational administration and supervision from Tennessee State University. She also has work experience in both hospital and corporate settings. Just prior to arriving at UNC, she was the head of her own diversity consulting business in Nashville.
Lauderdale has an MSN with a major in maternal-child health from Texas Women’s University and a PhD in transcultural nursing from the University of Utah.
Stokes has an MSN from Indiana University School of Nursing and a PhD in instructional psychology with a minor in gerontology from Indiana University-Bloomington. She says her instructional psychology background, with its focus on teaching behaviors, is an asset in her current job.
Siantz has a master’s in child psychiatric nursing and community mental health from UCLA and a PhD in human development from the University of Maryland. Before accepting her position at the University of Pennsylvania, she was an associate dean and director of the Center for Excellence in Hispanic Health at Georgetown University.
Siantz believes the successful nursing school diversity director will be someone who is a visionary leader with excellent communication skills and strong relationship-building skills. “The person who is recruited to this position must be a senior-level person who not only walks the talk but also understands, and has a vision for, how to pull it forward,” she says.
by | Mar 30, 2013 | Faculty Nurses, Magazine, Nursing Students
For any student pursuing a nursing degree, the clinical rotations are where you really earn your pin.
“In clinical studies you put into practice what you learn in theory,” says José Blanco, MSN, MEd, RN, instructor in clinical nursing and director of the RN-to-BSN program at the University of Texas at El Paso School of Nursing. “The most important outcome is that you demonstrate that you know nursing—[which means] not only knowing the disease processes but also identifying signs, symptoms and treatments.”
There’s no denying that performing well in clinicals is a major challenge for just about any nursing student. But for minority students—including male students, as well as students of color—success in the clinical rotation often is linked to faculty members’ sensitivity to issues these students face that may differ from what non-minority students experience. It also can depend on adapting teaching strategies to diverse learning styles, advocating for students who encounter bias in the clinical setting, and creating effective interventions for students who run into obstacles or need to improve their performance.
The process begins with making sure students fully understand what they are expected to accomplish. While the overall objective of clinical studies is for the student to demonstrate competency in providing safe nursing care to patients, each clinical rotation has a different set of objectives, determined by the related course and the academic level of the student, says Emilia Frederick, MSN, RN, clinical instructor in the Department of Nursing at North Carolina Central University, a historically black university in Durham, N.C.
“The objectives students need to accomplish in a clinical rotation in their first semester as a nursing student are very different than the objectives students have to accomplish in their senior year,” she emphasizes.
Blanco notes that clinical students must learn to master a wide range of subject areas: pharmacology, I.V. therapy, transfer and discharge procedures, error and injury prevention, emergency response plans, safe use of equipment, infection control and patient rights. They also need to understand how to manage care and be an advocate for the patient, he says.
In addition, Frederick says, students must also become familiar with the particular standards and practices of the health care facility and unit where they are training—from the method of dispensing medication to the policies for interacting with patients’ family members.
Recognize Cultural Differences
One way instructors can help eliminate barriers to success in clinicals is to recognize different learning styles among students from diverse backgrounds.
“Many minority students, when we actually assess their learning styles, come across typically as sensory learners, as opposed to being analytical learners,” Frederick says.
Sensory learners need to have their senses engaged in the learning process, she explains. “If they don’t see it, hear it or touch it, it takes a long time for them to assimilate the information and be able to analyze it and apply it to the patient. If someone is an analytical learner, you can give them the information right out of the book and they are able to process it.”
While some studies suggest that sensory learners are especially prevalent among African Americans and other ethnic minority populations, Frederick argues that this learning style is not exclusive to those groups.
“We also have a generation of students who are from the computer age,” says Frederick, whose school has incorporated everything from simulation to YouTube videos and MP3 players to capture the attention of such students. “Sensory input is all that you get in the high-tech environment we’re living in today, so learning is really [becoming] more geared to sensory stimulation.”
Instructors also need to be aware that for some Hispanic students, cultural and language differences make the clinical rotation especially challenging, says Blanco, whose nursing school serves a large number of ESL (English as a second language) students. An even bigger obstacle for many of these students is time management. In addition to their nursing studies, many Hispanic students also have demanding family obligations, and they are also more likely to be working while going to school. At the University of Texas at El Paso School of Nursing, which has an 80% Hispanic student population, 75% of the students work, Blanco says.
Make Sure They’re Prepared
Perhaps no other success strategy is as important as making sure minority students are thoroughly prepared before they receive their clinical assignments. At North Carolina Central University, a pre-clinicals skills lab introduces students to the basic skill sets in which they will have to demonstrate competence. They also must pass a medication documentation exam before being allowed to mix and dispense medications to patients. Before each patient assignment, which comes with a 24-hour notice, the student must review the patient’s medical history and prepare a care management plan.
Global clinical training: As part of an elective course taught by clinical instructor José Blanco, MSN, MEd, RN (right), students from the University of Texas at El Paso School of Nursing traveled to a rural clinic in the mountains of Mexico, where they participated in reconstructive surgery.
“It’s important to clearly communicate the goals and expectations for students, and to be consistent with those expectations,” Frederick says. “It gets crazy when there’s inconsistency, or it’s constantly evolving. That creates a recipe for disaster.”
Ensuring that students get off to a good start can even involve something as simple as addressing transportation issues, according to Norma Martinez-Rogers, PhD, RN, FAAN, president of the National Association of Hispanic Nurses (NAHN) and associate professor/clinical instructor at the University of Texas Health Science Center at San Antonio (UTHSCSA) School of Nursing. “We have programs [at our school] that help students find ways to get to clinical sites,” she says. “We highly encourage carpooling.”
Advance preparation is especially critical for male nursing students entering the OB/GYN and pediatrics rotations. At the University of Portland (Ore.) School of Nursing, all students complete a skills lab before entering these rotations. But clinical instructor Kathleen Bell, MSN, RN, CSN, says, “The people who get the most out of it tend to be the male students. They like having an opportunity to role play. They like being able to practice on a doll how to diaper a baby, how to wrap the baby appropriately and how to hand the baby to the parents, because they may not have had real-life experience doing that. We also have patient simulation equipment available so that male students can practice performing a breast examination on the models. They can be shown how to use the peri-packs before they are in a situation where they have to do this with real people.”
The skills lab also devotes significant time to teaching labor support—“the old-fashioned things like rubbing backs, warm showers, foot massages [and generally] being able to help women cope with labor in ways that don’t involve the use of pharmacology,” Bell says.
To help allay male students’ fears that female patients might accuse them of sexually inappropriate touching, two other faculty members at the University of Portland School of Nursing have developed a video called “Intimate Touch for Males.” It explains the need for male nurses to approach sensitive OB examinations differently than female nurses—for example, “being aware of other females in the room and always doing a neutral touch before engaging in a very sensitive touch,” Bell says.
“We give [male students going into OB/GYN rotations] extra attention and time, because this is a particularly sensitive area and it may be difficult for them,” adds Bell, who asks for male students to be assigned to her courses because of her experience in helping them overcome gender-based barriers. “That being said, I find that the male students love OB, and they are always surprised. They expect that it’s going to be terrible, that they’re going to want to run screaming down the hall in the other direction—and they don’t.”
Another key practice at the University of Portland is to have instructors on the hospital site during students’ OB and pediatric rotations. “This is not our model in every other clinical setting,” Bell explains. “But because this is delicate information and just a big crisis time for families, we believe it’s very important to have the instructor there on site. It makes a big difference for students who come from a different culture or whose primary language is not English, and it’s certainly helpful for the male students.”
Stand Up for Their Rights
Unfortunately, there may be times when minority students encounter racial, cultural or gender bias in their clinical assignments, such as racist remarks from a patient or disparaging comments about male nurses from female RN staff on the unit. In the workshops Frederick conducts with nursing faculty from various schools, she tells them that part of their job is “to protect your students.”
“You have to know when you need to step in front of the firing line, so to speak, because there are certain things a student should not be exposed to as an entry-level student in nursing,” she maintains. “They haven’t learned the socialization completely yet. They are still getting their feet wet. If you don’t protect them, it can be quite a problem.”
Playing that protector role might mean talking with the unit staff about avoiding assigning problematic patients to students who are too inexperienced to handle them, Frederick says. She admits that it’s a delicate balancing act. “You have to be able to select the right patients to match the academic standing of the student but still give him or her a very realistic patient population to work with.”
Blanco stresses that nursing students must be trained to render competent care no matter what the patient’s attitude might be. “The student has to understand: You are not there to value-judge,” he says. “You are not there to stereotype. You are not there to share your values with the patient or give advice to the patient. You need to be an advocate of the patient.”
Martinez-Rogers concurs. “Unfortunately, students are not there to change the opinion of whoever they’re dealing with. They have to remain focused and stick with their goal. If [the problem] gets really bad, we advise students to go to [the faculty member] who is in charge of their course.” If a student does bring a legitimate grievance to the faculty, she adds, “we’ll support them.”
In Bell’s view, “skill and caring [transcend] cultures and genders.” Still, she concedes, even though male nurses have become a familiar sight in many hospital units, gender does make a difference for some patients, especially in the OB/GYN setting. Bell’s practice is to give OB patients the option to reject any nurse they don’t feel comfortable with, for whatever reason.
Intervene Early
What can instructors do to help minority students who are not doing well in their clinicals improve their performance? When and how should you intervene?
When faculty members see that a student is not performing well, says Frederick, “they need to intervene as quickly and as early as possible.” She tells her workshop groups to follow their gut feelings. When they sense that students are in trouble, it’s time to start observing them more closely and discussing their concerns.
Objectivity is paramount when evaluating student performance. “It cannot be based on personalities or on whether or not you like them,” Frederick says.
She recommends documenting the student’s deficiencies in writing, as well as each conversation with the student about how to resolve the issues.
“Students can be emotionally charged during these discussions, and they don’t always hear everything that you are telling them,” she explains. “You need to document [what was said] and have a witness.” She suggests bringing the student’s advisor in on the discussion.
Martinez-Rogers adds: “I think the faculty has a moral obligation the minute they suspect that a student is having a problem to work with that student one-to-one and refer the student to [sources for] help.”
That intervention might take the form of a tutoring or mentoring program, like the one at UTHSCSA School of Nursing that pairs undergraduates with graduate nursing students. Nursing schools typically offer a variety of resources to help students succeed. The challenge, according to Martinez-Rogers, “is trying to get [students] to learn that it’s OK to ask for help.”
In the Spring 2009 semester, Bell began teaching what she says is a unique course at the University of Portland, in which nursing students develop their own study plans in preparation for professional licensure. Students in the class review their performances on standardized tests, such as those administered by the Assessment Technology Institute.
“They get a report of the areas in which they are deficient,” Bell says. “It can be critical thinking. It can be leadership. It can be patient safety.” By observing patterns in their test results, the students are able to design a “care plan” for improving their own performance.
Having nursing instructors on site during clinical rotations is a major advantage, Bell adds, because they can assist in identifying ways to address a problem immediately. “It’s not one of those things [that should be] left to the nurse on the unit.”
To be effective, intervention must be both constructive and timely, Martinez-Rogers advises. “It doesn’t work to tell students they did [something] wrong if you don’t help them to find a solution,” she says. “[You shouldn’t be] telling students at mid term, ‘you are failing clinicals.’ It’s a little late.”
For any student, a nursing education requires a major investment of time, effort and, in many cases, money—and for minority nursing students, the sacrifices are sometimes even more significant. That’s why Martinez-Rogers believes that preparing minority students for success in clinicals—and other steps toward receiving their diplomas—is so important.
“These students work hard,” she says. “They spend a lot of money on their [tuition and] books. And none of them come to nursing school to fail.”
by | Mar 30, 2013 | Black and African-American Nurses, Faculty Nurses, Magazine, Nursing Mentorship
Dear Deans of Nursing:
A sense of urgency is upon us. Now, certainly not later, is the time to seriously consider starting a nurse anesthesia education program at your institution. Consider this fact: Of the 106 nurse anesthesia master’s degree programs in the U.S. and Puerto Rico that are currently accredited by the American Association of Nurse Anesthetists (AANA) Council on Accreditation (COA), not one is located at a historically black college or university (HBCU). This means that any BSN graduates from your fine institutions who are seriously interested in pursuing a rewarding advanced practice career in nurse anesthesia will have to apply elsewhere.
Why now rather than later? The COA has drafted a position stating that it will not consider accrediting any new master’s degree nurse anesthesia programs after 2015. This is because all accredited nurse anesthesia programs will be converted into doctoral programs by 2025.
Here’s another fact to consider: There are currently 37,000 certified registered nurse anesthetists (CRNAs) in the United States—yet there is less than 6% minority representation in the nurse anesthesia profession. How are we going to properly introduce and prepare racially and culturally diverse nursing students to enter the nurse anesthesia field? When will the minority nurse leaders who serve as administrators and educators in HBCU nursing schools sit down to have a serious dialogue about how adding a nurse anesthesia program can benefit both their students and their institutions?
Today’s historically black schools of nursing have moved proudly into the new millennium, adding state-of-the-art buildings, “smart rooms,” simulation labs and other educational innovations. Many of you are currently in the process of adding graduate degree programs, or expanding existing graduate-level offerings. What better time to embark on adding a nurse anesthesia program as a viable option for your BSN graduates, as well as other talented students from across the country who are interested in this growing specialty? Which HBCU school of nursing will one day be recognized as one of the nation’s premier nurse anesthesia programs, widely respected as a leading source of scholars, practitioners and innovators in the CRNA profession?
The time is now and the decision is yours.
by | Mar 30, 2013 | Faculty Nurses, Magazine
Nursing schools looking to increase the diversity of their faculty have a great new tool at their disposal. They can find certified minority nurse educators in a flash using the Minority Nurse Educator database, a free service provided by the School of Nursing at Thomas Edison State College in Trenton, New Jersey.
“Many nursing schools throughout the country have worked successfully to increase the diversity of their student populations, but there remains a shortage of minority nursing faculty to serve as role models for students,” says Dr. Susan M. O’Brien, the dean of the nursing school. The 52 men and women listed in the database all completed an online minority nurse educator program, which consists of 20 weeks of distance learning and a 12-week online teaching mentorship.
Database users can pick and choose according to their needs. They can narrow their search by gender, areas of expertise, ethnicity, and highest degree earned, among other criteria. The candidate then appears as an anonymous listing until the interview and hiring process goes into full swing.
by | Mar 30, 2013 | Faculty Nurses, Hispanic and Latino Nurses, Magazine
The numbers tell the story.
Hispanics are the fastest-growing segment of the United States’ population—they currently comprise 16% and are expected to grow to 30% by the year 2050, according to the U.S. Census Bureau. However, Hispanic nurses make up only 3.6% of all registered nurses in this country, as reported by the 2008 National Sample Survey of Registered Nurses (NSSRN).
While other minority populations experience problematic underrepresentation in nursing, it is especially apparent in the Hispanic community, and the gap widens every day. In 2008, only 5.1% of all RNs spoke Spanish, according to the NSSRN. There are not enough Hispanic nurses to deal with the health care issues facing this growing population, and the language barriers and lack of cultural understanding created by the void lead to substandard health care for the entire community. In fact, a July 2006 article published by USA Today pointed out that the lack of English language proficiency in patients directly contributed to diminished health care for those individuals.
A 2008 workforce survey showed that Hispanics were 28 years old on average when obtaining their initial licensure compared to an average age of 25 for whites. The most common type of initial R.N. education among Hispanics was the associate degree in nursing (55.1%) followed by the bachelor’s (39.4%), and then a hospital diploma (5.5%). Why does the associate degree come out ahead? The reason may be financial. The A.S.N. provides earning power earlier than a four-year bachelor’s program in nursing. Hispanics were also more likely to pursue a bachelor’s degree after obtaining the initial R.N. (41%), but were less likely to pursue graduate degrees (11%) than white, non-Hispanic RNs (39% and 14.5%, respectively). Hispanic nurses comprise only 3.5% of all nurses in advanced practice fields.
The vast majority of Hispanic nurses (68.8%) work in hospitals and then in ambulatory care (6.9%). Hispanic nurses also hold only 10.9% of all nursing management jobs, possibly due to the low number of Hispanic nurses with graduate degrees. Finally, there are fewer Hispanic mentors in higher education and nursing leadership positions who can guide other Hispanics. Attracting and retaining nursing students from racial and ethnic minority groups can’t be accomplished without strong faculty role models. According to 2009 data from American Association of Colleges of Nursing member schools, only 11.6% of full-time nursing school faculties come from minority backgrounds, and only 5.1% are male.
As the U.S. population becomes more diverse, leaders in multicultural segments, including Hispanic communities, must encourage minorities—and minority nurses—to become leaders themselves, so when they continue to build upon their skills and advance their careers, they will help themselves and their communities. Health care for this underserved population should ultimately improve if it helps members of the Hispanic nursing community become leaders in health care, experts in the growing field of nursing informatics, and trained nurse educators.
Taking advantage of the online learning environment
Many factors promote successful career development and mobility among Hispanic nurses, and one of the most important is the opportunity for educational advancement. Online higher education programs in the field of nursing help students develop critical leadership skills that, in turn, lead to improvements in their overall community. The online format provides flexibility, providing students the opportunity to take courses while meeting their professional and personal obligations, contributing to multiple other benefits of studying nursing online.
Minority students at all educational levels can see graduates from these programs as role models and examples of how they, too, can achieve success. In cases where students may be struggling, it’s especially important when they can point to a nurse in a leadership position—someone who looks and sounds like they do—as an inspiration to keep going, whether it’s toward getting a Bachelor of Science in Nursing (B.S.N.), a Master of Science in Nursing (M.S.N.), getting a promotion, or taking on an important social change initiative to help a group in need.
Many of these minority students seek out mentors in school, possibly other minority nurses, and often go on to become mentors for the next generation of nurse leaders. For example, many of Walden University’s graduates work and teach in associate degree nursing programs, which have a large representation of Hispanic nursing students, and they help in retain these students through mentoring.
In some ways, online education “levels the playing field” for minority students, fostering increased participation and confidence that may lead to their greater success in the classroom and workplace. Many Hispanic students speak English as a second language and may write better than they speak. Since writing is integral to online learning, it adds a level of confidence that Hispanic students may not feel when sitting in a traditional, bricks-and-mortar classroom. There is no sitting in the back of the room or far from the action and dialogue up front. Consequently, minority students who may struggle in a traditional setting often thrive in online classes, which provide a unique venue for students to have a new voice, speak up, and become leaders in the classroom and beyond.
Increased participation in the online classroom has additional benefits for Hispanic and other minority nursing students. These students not only have the opportunity to hone their personal and professional skills and talents, but they can also develop relationships and network with other nurses across the country. A nurse working in the Cuban American community in South Florida may share best practices with a nurse working with the Mexican American population in Southern California. Or perhaps non-Hispanic nurses working with Hispanic patients may consult with their Latino classmates online for advice regarding how to provide the best care for these patients. Online higher education gives students a special way to connect so they can enhance their education and make a difference in the lives of many.
Making strides toward improving access
As a minority fellow of the American Nurses Association and a current board member of Ethnic Minority Programs for the organization, I work with my colleagues to develop proactive strategies to train, recruit, and retain more minority nurses, especially Hispanics. As Associate Dean of Walden University’s School of Nursing, I lead an experienced, dedicated, and talented team of faculty and staff focused on creating the next generation of leaders in the minority nursing community. Through programs like our Master of Science in Nursing and Bachelor of Science in Nursing Completion Programs, we can make great strides toward increasing the number of Hispanic nurses who serve as role models for the larger minority community.
For many M.S.N. and B.S.N. students, the training they receive in their online courses is put to work directly in their own communities. During their practicum or capstone course, M.S.N. students can choose projects that are inclusive of the needs of their workplace or neighborhoods. Often, these projects involve working with underserved populations to solve problems in community health care. B.S.N. students undertake similar projects in their community health practicum. They can all tap into their nationwide network of fellow students to come up with the best solutions for problems they encounter.
I especially recognize the importance of recruiting faculty members at the doctorate level from minority groups. Since there already is a shortage in the number of Hispanic nurses, you can only imagine how few in this population have earned their doctorates. Yet, they do exist, and when they teach, they make a difference.
One example is Patti Urso, Ph.D., A.P.R.N., C.N.E., Specialization Coordinator of Nursing Education, who currently teaches nursing education courses at Walden. Dr. Urso, a Cuban American originally from Miami, is a nurse practitioner who now lives in Hawaii and works with other underserved populations from Polynesian and Micronesian communities. In Hawaii, she engages with Hispanic patients through community churches and is involved in forming a new chapter for the National Hispanic Nurses Association. She hopes to inspire her students to reach out to underserved communities, and she mentors Hispanic students in the capstone course of the nursing education program.
One of the ways Dr. Urso works to connect with Hispanic nurses is through contact with alumni such as Lydia Lopez, one of the first graduates from Walden’s M.S.N. program in 2007. As a nurse and mentor, Ms. Lopez is committed to being a role model who recruits and retains minority nurses, keeping them interested in their course work and giving them the necessary tools and strategies to facilitate academic success. “True role models are those who possess the qualities that we would like to have and those who have affected us in a way that makes us want to be better people,” she says.
The nursing profession needs both men and women from all ethnicities to meet the needs of society. Minority nurses—especially Hispanics—with bachelor’s degrees and, eventually, master’s and doctoral degrees—who are prepared to educate and lead a new generation of minority nurses—will help improve this critical situation and provide essential health care for all.
