When I went to nursing school, I never imagined there would come a time when I would be so privileged to give a “keynote” address. My expertise is more on narcotic keys and nurse’s notes. But it happened. I was honored to address the graduating class at the College of Nursing at New York University during their pinning ceremonies. I asked my co-faculties for some suggestions for my speech. They told me to talk about what I know best, stories from my own life. So I looked inwards and shared with them this personal lived experience.
In late November of 2009, I took care of a 75-year-old Asian woman. She had a longstanding history of diabetes, CAD, HTN. Her health had started to decline earlier that year. She broke her wrist in a mechanical fall, and a wound failed to heal on the sole of her right foot after a debridement. Another fall led to a sub-dural hematoma, requiring surgical evacuation, after her foot amputation. The nearest hospital was two and half hours from her home, through rugged mountain roads. She did not have health insurance, and her immediate caregivers were only vaguely aware of the basics of infection control. She also had no advance directives, and she admitted to being incompliant with her diabetic meds, as she was trying to economize her meager resources. Later that year, she passed away due to complications of sepsis after a failed CPR. This grandmother of 10, who spoke little English, endured it all calmly and without complaint, even as she watched her life savings vanish in the last three months of her life to pay for health care. This woman was my mother.
I share this story not for sentimental reasons, but to reflect on the challenges that all nurses face today. The headlines constantly remind us of the ever-increasing uninsured population, the health care disparities, the lack of access to health care resources, gaps in practice and research, deficiencies in culturally competent care, the global graying of the population, geriatric syndromes, the astronomical cost of health care, and so much more. These issues make nurses, now more than ever, vital collaborators in health care delivery and reform, because in our jobs we become intimately aware of these things.
Of course, I didn’t know I would have to deal with these challenges when I went to nursing school. I was barely 16-years old when I was accepted into the program. All I wanted was a college degree, and it didn’t matter which one. Looking back after almost 25 years of nursing, I can say with great confidence and pride that sticking with nursing was the best decision I have ever made.
Men and women join the nursing profession for a variety of reasons. As a faculty member, I have the privilege of hearing students articulate the reasons why they choose to become a nurse. What is the underlying theme in their testimonies? They are committed to healing the sick and bringing compassion to the bedside and beyond. Generally speaking, nurses are not in it for the money.
When President Obama rallied the legislature to reform United States health care, he sought the advice of nurses. In his remarks on July 15, 2009, he said, “I know how important nurses are, and the nation does too. Nurses aren’t in health care to get rich. Last I checked, they’re in it to care for all of us, from the time they bring a new life into this world to the moment they ease the pain of those who pass from it. If it weren’t for nurses, many Americans in underserved and rural areas would have no access to health care at all.”1 In many ways, nurses are patients first and last line of defense.
As a nursing faculty member, I have the unique honor and obligation of ushering young and still malleable minds to become professional healers and agents of change in their profession. I explain to them that meeting the challenges of nursing is similar to peeling an onion. As graduates assume whatever life-saving careers they choose, they will assume responsibilities and meet challenges, peeling that onion until they are down where the tears are. But I don’t mean tears of despair and helplessness, even if their first job is not exactly how they imagined it to be. I am thinking of tears of satisfaction firmly rooted in compassion. These are the quiet, deeply felt tears that I sometimes shed because I am glad I have nursed someone.
So, nurse, what are you in it for?
President Barack Obama. “Remarks by the President on Health Care Reform.” Rose Garden. Office of the Press Secretary. 15 July, 2009.
Editor’s Note: This article is adapted from a presentation given by Dr. Robertson at the Oncology Nursing Society’s Cancer Prevention and Early Detection Program for HBCU/MSI Nurses: Dissemination Colloquium, May 3-4, 2002 in Miami.
Recent studies have shown that racial and ethnic minority patients are more likely to choose a minority physician for their health care.1 Consequently, physicians of color must be educated to assume a prominent position on the front lines of the war against minority health disparities by providing the best possible preventive education, early detection and treatment options for diseases that disproportionately affect minority populations. One such target disease is breast cancer. According to the Centers for Disease Control and Prevention, white women have the highest incidence rate of breast cancer, yet black women have the highest death rates from the disease.
Meharry Medical College in Nashville, Tenn., the nation’s largest private, historically black institution exclusively dedicated to educating health care professionals, is answering this call by updating its curriculum to include information on breast cancer morbidity and mortality in African Americans and by strengthening its course in physical diagnosis for African-American medical students. What is particularly noteworthy about these initiatives is that they were developed and implemented by nurse practitioners.
The role of nurse practitioner faculty in Meharry Medical College is a very important one. Nursing practice is based on nursing theory, which encompasses scientific research, intellectual judgment, tested hypotheses and human understanding. It is creative, imaginative, practical and flexible. Nurses employed in medical schools have a unique opportunity to bring nursing theories, as well as a strong emphasis on patient advocacy, into the teaching environment.
In the case of breast cancer screening, teaching medical students to conduct clinical breast examinations properly and to interview their patients to obtain the necessary diagnostic information is extremely crucial. In addition, our goal was to teach the students how to communicate effectively and sensitively with their patients about breast cancer risks and the importance of early detection, and how to teach the women to perform breast self-exams.
Nurses are in an ideal position to accomplish this task because we base our actions upon the work of nursing theorists such as Dorothea Orem and Martha Rogers. Orem’s idea of empowering patients can be established by an agreement between the patient and the provider as they work together to outline health care goals.2 Rogers held that equipping patients with information could be powerful because knowledge is power.3 Based on this theoretical foundation, nurses at Meharry Medical College are able to help minority medical students learn to teach women of color to take control of their own breast health.
Learning to Talk
The targeted community our institution serves is Davidson County in Nashville, a racially and ethnically diverse area that is home to 68,685 African-American men and 79,038 African-American women. According to the Tennessee Department of Health, the second leading cause of death among black Americans in Davidson County is cancer.
The health care disparities identified in the federal Healthy People 2010 report–i.e., unequal access to providers, screening and diagnostic tests because of financial, personal, physical and structural barriers–hold true for many underserved African-American women in the North Nashville area. In addition, lack of knowledge and education concerning breast cancer risk reduction, screening, early detection and treatment options is a formidable barrier that can render these women powerless.
Today’s medical schools are extremely concerned about their students mastering large amounts of information, utilizing technological interventions and passing comprehensive examinations to prove that they are competent. However, far less attention is paid to the students’ development of communications skills and effective physician-patient relationships. To ensure that minority doctors are able to form partnerships of empowerment with female patients, their medical school education must include training in therapeutic communication skills, patient education and compassionate attitudes and behaviors.
Simulated Patients, Real Learning
The breast cancer education program we designed for the Meharry students encompasses several different instructional formats. As part of the curriculum update, nurse practitioner faculty developed new breast and lymphatic student learning objectives and incorporated them into the 2001-2002 Freshman II syllabus. Lecturers–who have included the chief medical officer from a major local hospital–are given a copy of the new objectives to ensure that the prescribed information is covered in the classroom. We also supplemented the standard Physical Diagnosis History and Examination textbook by Swartz with additional materials that are required reading.
In addition, the Bates Breast Physical Examination Video is available for all students to review. They can take notes while watching the video and faculty members are present to answer students’ questions. Thirdly, each student must participate in a breast exam practice session, using standardized patients, in which the instructor demonstrates techniques in both breast assessment and patient communication.
Educator H.S. Barrows pioneered the use of standardized patients, who are trained by medical experts and used in practice sessions to facilitate teaching and evaluation of medical students’ clinical skills. They can be professional actors, educated patients or simply normal everyday people, and they are carefully coached to accurately portray an actual patient during the practice encounter. Often they are so well trained that skilled clinicians cannot detect their simulation. Standardized patients are also taught to evaluate medical students’ performance, based on predetermined criteria, and provide a written or verbal assessment.
After the practice session, the students are encouraged to continue to practice these techniques on their own. If they need additional help, medical education faculty is available to provide one-on-one instruction.
Finally, the students must perform a skills session to demonstrate what they’ve learned. Each student takes on the role of the physician and conducts a complete breast exam on a standardized patient in an actual examination room. A faculty member is present during the exam to assess the student’s work. The exam room is also equipped with a video camera to record the session, in case there is later any discrepancy, concern or question about a student’s performance.
A Teaching Style for Every Student
The reason why we gave our program this multifaceted structure was to accommodate the different learning styles of individual students. A 1993 study on learning styles revealed that most faculty members believe students learn important content most effectively through the traditional lecture system.4 Clearly, this method works best for some students but not necessarily for the majority. Because students need to become lifelong learners, teaching methods must encourage self-directed learning.
In our program, each student is responsible for the reading material. In addition, breast exam videos are available to meet the needs of visual learners. Tactile/sensing students who prefer direct, concrete learning experiences have the opportunity to learn from hands-on instruction and role-playing. Intuitive learners have the option of receiving open-ended instruction and having some autonomy with the standardized patient during the practice session.
Independent learning experiences outside the classroom are still another key component. We encourage the students to utilize the information they’ve learned by teaching peers, friends and family members. After the students see the breast examination performed in the practice session, they do the exam themselves. They are then able to teach others–and eventually, their patients–to perform the exam with competence and confidence.
Results and Recommendations
Although the impact of the breast cancer education project at Meharry Medical College is still being evaluated, our initial results have been very positive. Students have reported that they enjoyed the sessions and that the combination of lectures, reading materials, the video and the practice session has been extremely helpful.
Based on our experience with this program, we believe that nursing schools as well as medical schools can benefit from this approach, which focuses on developing students’ ability to internalize knowledge and to become both clinically competent and patient-focused. These skills are essential in helping students make a smooth transition from academic theory into practice.
If we are to train a new generation of minority health care providers to play leading roles in the fight against racial and ethnic health disparities, updating curricula to reflect the breast cancer morbidity and mortality faced by African-American women is essential. Arming our students with knowledge of real health care barriers, preventive measures, updated treatment options and the importance of patient education and empowerment will equip them to truly make a difference in eradicating unequal health outcomes in underserved minority communities.
We also believe that the use of standardized patients in clinical training to make the learning experience more “real” to students and provide assessments of students’ performance from the patient’s viewpoint may prove to be as beneficial for student nurses as it is for medical students. According to McGraw and O’Conner, the fact that students are spread throughout the hospital seeing patients may limit the opportunity for faculty to observe the students’ clinical skills.5
Our final recommendation is that medical colleges and nursing schools take full advantage of opportunities to use minority nurse practitioners as an important resource for both teaching and curriculum updating. With their unique grounding in the worlds of both medicine and nursing, they can play a crucial role in helping to create health care professionals who will treat minority women patients with dignity and respect, who are competent and compassionate, and who are skilled not only in diagnosing and treating breast cancer in women of color but also in empowering them to save their own lives through early detection.
References
1. Freeman, J., Loewe, R., & Bensin, J. (1998). “Training Family Medicine Faculty to Teach in Underserved Settings.” Family Medicine, 30(3). 2. Orem, D.E. (1991). Nursing: Concepts of Practice (4th ed). St. Louis: C.V. Mosby Books, Inc. 3. Rogers, M.E. (1970). Introduction to Theoretical Basis of Nursing. Philadelphia: F.A. Davis Co. 4. Schroeder, C. (1993). “New Students–New Learning Styles.” Change, 25(5). 5. McGraw, R. & O’Conner, H. (1999). “Standardized Patients in the Early Acquisition of Clinical Skills.” Medical Education, 33.
What’s an African American neonatal intensive care nurse doing in the middle of Kandahar City, Afghanistan? Teaching neonatal resuscitation protocols (NRP), what else!
During my deployment to Afghanistan in 2005 in support of Operation Enduring Freedom VI, I had the opportunity to teach NRP to local nurse-midwives in Kandahar. I had been assigned to the 249th General Hospital Alpha Detachment as an adult intensive care nurse. After months of caring for a variety of sick patients, I jumped at the chance to teach a class. I was excited about getting the opportunity to meet Afghan nurses and learn about their practice.
I had been invited to teach the class by Dr. Holland, a pediatrician assigned to the 173rd Army Battalion out of Italy. He had taught a previous NRP course in Kandahar and felt that having a female nurse assist with the teaching would be beneficial to the students.
The class I taught was coordinated by a Canadian physician who worked with both the coalition forces and local nationals. The goal of the course was to familiarize Afghan nurses and doctors with basic NRP in an effort to address the high rate of infant mortality in the region. There was also hope that after Dr. Holland and I taught the course to local nurse-midwives and pediatricians, they in turn would be able to teach NRP basics in their hospital and at the local midwifery school.
Dr. Holland and I donned our protective military equipment and traveled about 30 minutes from our base in Kandahar Airfield to an enclosed Canadian military base in the heart of Kandahar City. The base was surrounded by an eight-foot-high concrete fence topped with threatening barbed wire. Soldiers with weapons guarded the gates and kept watch from towers high above the ground.
While we felt safe inside the base, our students did not. The class was some two hours late getting started because of an early morning suicide bombing in the city. Because of the nurses’ security concerns, we were forced to condense two days of eight-hour-long classes into two blocks of instruction two hours each in length.
The Afghan nurses were concerned about being seen working with coalition forces. They felt unsafe traveling to the Canadian facility because the route was dangerously laden with improvised explosive devices. Due to an increase in suicide bombings and Taliban activities around the country, many husbands had restricted the movement of their wives and children. The nurses’ frustrations were compounded by several other factors, such as the refusal of a local male pediatrician to attend the course. He had been scheduled to take the class but refused to attend because he did not want to be seen traveling with a group of women.
But in spite of their fears and concerns, the eight nurses and one female pediatrician were full of energy. They arrived huddled together dressed in sky blue burkas that concealed their faces and bodies. Once the women were inside the classroom, the burkas came off and the course began like any other NRP class. We used an interpreter to translate each slide and followed up the instruction with lots of hands-on practice. The students were excited and eager to learn. They were desperate to improve their clinical knowledge and skills.
Most Afghan midwives are trained by experienced nurses. They have very little classroom education. They also continue to do a fair number of deliveries in patients’ homes rather than in mater-nity wards. This is because their local hospitals lack many vital newborn supplies, such as bulb suctions and ambu bags. The typical Women and Pediatrics Ward has minimal oxygen and a small foot-pump suction machine. The local city hospital had two donated newborn warmers but they were kept in storage because no one knew how to use them and the hospital lacked the proper power supply.
Cultural Exchange
Teaching this class in a country where medical technology was primitive, women lacked freedom and potential danger was everywhere made me feel as though I was teaching NRP to black nurse-midwives in rural America at the turn of the 20th century. I found myself wondering about the lives and working conditions of these African American nurse-midwives from an earlier era. Like the Afghan nurses, did they worry about their safety as they traveled around the countryside? Did they cluck their tongues at the dangers of 14-year-old girls giving birth in dusty village houses? Did they shake their heads at doctors who refused to be seen in the company of a nurse-midwife?
Perhaps they too trained younger nurses in back kitchens with little equipment in the hope that some young woman wouldn’t have to travel miles on unsafe roads just to give birth. I also wondered if black midwives from the past century were as vocal as the Afghan nurses of today about the lack of basic prenatal care available to women.
The students in our NRP course were excited to have a female nurse teaching the class. They were fascinated by my skin color and hair texture. “Is she from Africa?” they whispered amongst each other.
They were shocked that I would leave my children at home in America in the care of my husband to go work in a foreign country—something that would be unthinkable in their culture. “Why would any mother do this?” they wondered. They were disappointed that I had traveled to their country without my husband or brother but they were pleased that I was a married woman, a nurse with children who was educated and able to earn her own money.
At the end of the course, each nurse-midwife was provided with a copy of the NRP book, in English. They hoped that perhaps a doctor or local interpreters would translate the important pages we earmarked for them. As the women donned their burkas, they voiced excitement at the thought of practicing and sharing their new clinical skills. (And yes, they now know that there are black female nurses in America!)
I learned a great deal about bravery from the Afghan nurses. Today, as I travel back and forth across the world to do my job, I am grateful that I don’t have to be overly concerned about my personal safety. Above all, I am gratified that the classes Dr. Holland and I taught added a small amount of useful knowledge to midwifery clinical practice in Kandahar, Afghanistan. I believe this knowledge will help make a difference in improving the lives of women and children in this war-torn city.
CAPT Colleen Reid, BSN, RN, is a military nurse who currently works at the Landstuhl Army Regional Medical Center in Germany.
Harvey “Skip” Davis, RN, PhD, switched from full-time student to full-time nursing educator this year after completing his doctorate last summer. Then, he says, his education began in earnest.
“The transition has been daunting at times,” the San Francisco State University assistant professor admits. “The amount of actual work required between teaching, serving on committees and my research has been the biggest surprise. Teaching a class is actually the easiest thing I do.”
In addition, Davis is the only person of color on the nursing faculty and one of only two men.
That situation is all too common at many of the nation’s nursing schools, but it’s slowly beginning to change. Today, more and more academic institutions are aggressively seeking out racial, ethnic and gender minority nursing faculty, just as they’re trying equally hard to diversify their student populations.
For minority nurses who are just starting out as faculty members, getting on the right career path in academia requires navigational skills that Magellan would have envied. Should you choose a tenure- or non-tenure-track position? Would you be happier at a historically minority-serving institution? Will your college support your research efforts?
Completing a graduate degree is, of course, the first step toward getting on the faculty career track. After that, many different doors are open to you. Entering the right one is critical, not only for your professional advancement but also for your personal fulfillment. Just be sure to keep your expectations realistic.
Alone in a Crowd
Because nurses of color and male nurses are still extremely underrepresented in the ranks of nursing school faculty, many minority junior faculty starting out their careers at majority schools are likely to find themselves in a position similar to Davis’. While you would think that the enlightened, intellectual halls of academe would be free from prejudice and discrimination, the unfortunate reality is that this isn’t always the case. Davis knew this and he set out to find a university that would welcome him not only as a nurse educator but also as an African-American man. His first priority, however, was to become part of a high-quality educational institution, and SFSU’s reputation among area health care providers for graduating well-prepared nurses was the initial attraction. He looked at several schools, though, to make sure his gender wouldn’t hamper his career progress.
“Male faculty members need to ask questions to make sure you avoid [schools that aren’t welcoming to men],” he explains. “I’m pretty straight to the point. I ask if there’s a feminist philosophy. Do that and listen to the various responses you receive from members of a search committee. You’ll be able to figure out quickly if men are welcome.”
While it’s advice heard often, nursing education leaders recommend that minority faculty members who are victims of bias speak up and work within the institutional framework to address the issue. Begin with your supervisor or, if that’s not feasible, with the equal opportunity officer of the division or the college.
Minority professors looking for a completely prejudice-free campus, though, are unlikely to find it. “Sometimes you may feel that no matter how much you do, it’s never going to be enough to achieve the status of your non-minority colleagues. Just do the best you can do, give it 100% and then let it go,” advises Barbara Broome, RN, PhD, CNS, assistant dean and chair of community/mental health nursing at the University of South Alabama College of Nursing in Mobile. She is also president of the Association of Black Nursing Faculty.
The faculty lounge is not the only place on campus where minority professors may encounter insensitivity based on race or gender. Roxanne Struthers, RN, PhD, has the luxury of being one of three American Indian nursing faculty members at the University of Minnesota at Minneapolis. Still, she often faces an entirely Caucasian classroom.
“The student body is often very monocultural and that’s hard sometimes for faculty,” she says. “It’s important to know how to teach about [other cultures] and how to be proactive to help students understand. They’re not going to get it from their classmates.”
Struthers, an assistant professor in nursing and an adjunct professor in the university’s American Indian Studies department, encourages other minority faculty to take advantage of their captive audience and view it as an opportunity to educate majority students about minority cultures. One way to do that, she adds, is simply by making yourself available and listening to questions with a nonjudgmental attitude. “Encourage questions even though they may not be politically correct or may even seem uncomfortable or out of the ordinary.”
Struthers also refuses to let student attitudes influence her own. “One of the things I notice about students,” she says, “is that because I am a member of a minority group and they are not, they have a tendency to act as if I’m invisible. They go on and on talking about everything under the sun as though I’m not even there. It’s as though they think I’m not on their level. I just delve into class when that happens. I don’t say anything and I don’t let myself get frustrated.”
Historically Minority Schools: A Haven for Minority Faculty?
Teaching in a Historically Black College or University (HBCU), a Hispanic-Serving Institution (HSI) or a Tribal College or University (TCU) may seem like the perfect alternative for professors of color who want to avoid the potential for prejudice they might find at a majority school. But while choosing this option may increase your comfort level on campus, it doesn’t completely banish the specter of discrimination. Majority nurses are often unaware of the rich academic and social traditions of historically minority institutions and may incorrectly perceive those schools–and their faculty–as second-rate.
“There’s a misconception that because a school is historically black, there’s always an open admission policy or that students come here because they can’t make it in a majority institution,” says Alma Dixon, RN, EdD, MPH, dean of nursing at Bethune-Cookman College, a historically black college in Daytona Beach, Florida. “That’s simply not true.”
Most students, she argues, are drawn to HBCUs because of their academic excellence, the nurturing environment and the strong traditions. In fact, many students choose to attend them because of the positive experiences their parents had as students at historically black colleges.
“Certain sororities and fraternities are well-recognized within the black community and are only present on black campuses,” Dixon emphasizes. “People come here to share in that experience and tradition. That’s why I want my son to go to a historically black college.”
Teaching at a traditionally minority nursing school offers many rewards, but also presents its own unique challenges. Because these institutions are typically smaller schools, one of the biggest challenges, says Dixon, is staying financially sound. While no one becomes a nursing professor to get rich, faculty members and administrators at financially strapped universities often must stretch to make sure the budget can cover the entire semester.
“At a historically black college, you’re always mindful of money, “ Dixon explains. “You are always aware of what things cost. My colleagues at several state institutions are facing this now for the first time. You have to carefully weigh which conferences you’re going to attend. Traveling needs to be very cost effective, so that may mean two faculty members sharing a room or driving instead of flying.”
An indirect benefit of tight budget constraints is a constant focus on student retention. Dixon says that’s common to all private institutions, not just historically minority schools.
“In private institutions, you are always aware of how tuition translates into revenue,” she adds. “There’s a greater focus on retaining students and that creates a challenge in and of itself: keeping students while still maintaining your commitment to academic excellence.”
Getting the Right Fit
Teaching at a university that’s not a good fit for your interests and your style can be far more uncomfortable than wearing shoes that are a size too small. Dixon believes the most important thing to do when shopping around for a teaching position is to first do a thorough self-analysis.
“You have to know what you’re looking for and what your interests are,” she says. “Then, if you’re comparing different faculty positions, you need to know what the mission of the school is and how that plays out. Research may be stressed at one college, service at another.”
Most schools value a combination of teaching, research and service, but not necessarily in that order. You need to look at how your working hours will be allotted to determine which of those three will be most important.
“At our school, teaching is more important than service and research,” Dixon continues. “Here, you’re expected to have so many teaching hours and so many office hours. If you have a research project that’s going to take up three days every week, it would never work at this school because of the teaching and nurturing demands.”
Antonia Villarruel, RN, PhD, FAAN, associate professor and director of the Center for Health Promotion at the University of Michigan School of Nursing in Ann Arbor, says it’s important to make sure you know all the details about the school’s faculty evaluation system before walking into the classroom.
“I am fortunate to be at a place where being a director is not just an added responsibility. It’s considered part of my workload,” she comments. “That’s an indication of the school’s commitment to my research.”
Indeed, one of the reasons why Villarruel, a past president of the National Association of Hispanic Nurses, accepted the position at the University of Michigan is because the school allows her to grow in her specialty areas, which are preventing HIV infection in Latino youth and health promotion. “If a university tells you they value research and then gives you a very heavy teaching load, it’s going to be tough for you if you want to do research,” she says.
Dixon also advises beginning faculty to watch out for red flags that may signal hidden problems at the school. One example would be a low passing rate on the NCLEX-RNâ exam.
“This is a hard thing for us to talk about,” she says, “but you need to find out what the student success rate is. If the school is struggling with constant program reports to the board of nursing, that’s going to be an intense cloud hanging over the institution. I would want to know about problems like that before I signed on. At least going in I would know where the focus is. I would expect a lot of my energy to be consumed in making sure students pass that exam.”
Tenure: The Brass Ring?
Davis has just completed his first year in a track that will eventually lead him to tenure, that magical milestone sought and treasured by most faculty members.
“It’s a big rite of passage,” says Villarruel. “Every faculty member has a ‘tenure story’ to tell. The destination is the same but the journey is different. Everyone has encountered different roadblocks and figured out different paths.” She encourages minority faculty to share their stories as a way of learning from each other.
Most tenure tracks are seven years long. To reach tenure, professors are usually required to show excellence in the areas of teaching, scholarship and service to the university.
Teaching excellence can be measured in several different ways, the most common being the dreaded student evaluations. Some schools also evaluate faculty on the basis of student performance on standardized tests and use peer evaluations.
Scholarship means a track record in research and it is usually measured in two ways. First, faculty members are encouraged to bring grant money for research projects into the university. Second, they’re expected to publish their research results.
“Some people say that the research project isn’t finished until the articles are published,” says Villarruel. “You can have a wonderful project but if the world doesn’t know about it, it’s a moot exercise.”
Service can be measured in many ways and can mean different things at different institutions. “At some schools, it can be service to a professional organization,” Villarruel explains. “At others, it has to be service at the university. So it’s very important to know how you will be evaluated.”
While tenure is still highly valued, it has lost some of its glitter in recent years. Today, tenured professors no longer have reason to relax and stop worrying about having to prove themselves.
“In the past, tenure did bring a certain sense of job security and a certain amount of prestige,” says Villarruel. “Now, universities do post-tenure reviews and evaluations. You still have to do research and publish and continuing performing at the expected level.”
If the pressures associated with becoming tenured seem too stressful for you, or if you’d rather skip the research and service aspects of faculty positions, Broome suggests you consider a non-tenure track.
“Be aware of all the different roles and options that are available to you in academia,” she counsels. “Going into a non-tenured track allows you to focus only on teaching and clinicals.”
Broome does, however, caution new instructors to realize what they are giving up by not pursuing a tenure track. Non-tenure teaching tracks offer very limited, if any, research or publishing opportunities. Teaching loads will be very heavy, reducing time available to participate in other aspects of university life. Non-tenured faculty may also be paid less and be the last to be considered for professional development opportunities.
Aiming Higher
While many nurse educators thrive on daily classroom interaction with students, for others the classroom is just the beginning. A career in academia can offer minority nursing faculty many opportunities to advance into administrative and leadership roles, including department chair, dean, curriculum developer and education policy-maker.
“I love teaching, but I wanted to do more,” says Broome. While she has only been an assistant dean for a little over a year, she’s very pleased to have moved up to a position that allows her to have some influence on the future of nursing education.
“It’s good to be involved in helping to make changes that will benefit students,” she continues. “I also have the opportunity to be supportive of faculty and I am in a position to be an advocate for them.”
Broome advises junior faculty hoping to climb the academic career ladder to do so in small steps. One the most important breaks in her career came when she relocated to the University of South Alabama to assume a chair position.
Both Broome and Dixon credit previous clinical managerial positions with helping them develop the leadership skills needed to succeed in academia’s higher levels.
“Having a leadership position in a hospital gave me a clear view of the practicing environment of nursing, and I’ve never lost sight of it,” Dixon explains. “You do need a strong clinical experience [even in an academic setting].”
She also advises nursing faculty members to leave the security of the nursing department and venture out into other areas of the campus. For example, she says, get involved with university-wide faculty senates, seek out committee assignments that match your interests, and network with non-nursing faculty.
However, just as administrative experience and leadership skills can help you rise to a new role, making a few critical mistakes will block your path. One of the biggest “don’ts,” says Broome, is burning your bridges behind you.
“Nursing is a very small world,” she cautions, “especially when that world is narrowed down to minority faculty members. There are still so few of us that you will practically get to meet most of them during your career. Never forget where you came from. It’s been said that you meet the same people on the way down that you passed on the way up, and I think that’s true.”
Getting Along
In the business world, the process of fitting in with your employer’s company philosophy, goals and style is known as “navigating the corporate culture.” Similarly, every academic institution has its own personality and it’s the wise faculty member that learns its rules early. Perhaps even more important is learning how you function inside those rules, which are often unwritten.
Playing politics, though, can derail your career and your enjoyment of training future nurses.
“Don’t get caught up in things that may not pertain to you or in things you cannot control,” says Villarruel. “As a faculty member, you have enough on your mind.”
Broome advises junior faculty members to find other instructors with whom they can build networks of support. Alliances, after all, aren’t just limited to reality TV shows.
“Faculty circles do have cliques,” she says. “There are certain people you will be able to work well with regardless of color and you should seek those people out and form alliances to further your work.”
Still, if you are a racial or gender minority faculty member teaching at a majority school, it’s empowering to be able to network with colleagues who look like you. But since this is not always possible, all of the educators interviewed for this article stress the importance of becoming involved in minority nursing associations.
Davis encourages young faculty members not to overlook the opportunity to learn from nurses who are different from you. He says he’s grown and benefited from the support of many female nurses. “The reality is that this is a woman-dominated field,” he adds. “You will find many willing mentors who are women and have different things to offer. Just listen and take what you think will work for you.”
Fact #1: Registered nurses comprise the largest portion of the health care work force in the United States.1 Fact #2: Of the nearly 2.7 million licensed RNs in this country, only 13% come from racial or ethnic minority backgrounds.2 Fact #3: Twenty-five percent of the total U.S. population—i.e., one out of four Americans—is non-Caucasian.3 Fact #4: Within the next 25 years, the ethnic and racial minority population of the U.S. is projected to increase at a faster rate than the nation’s Caucasian population.1,4
These statistics dramatically illustrate America’s urgent need to develop a more diverse nursing work force that is able to provide culturally and linguistically competent care to our increasingly multicultural population. This means not only increasing the number of minority nurses but also ensuring that nurses of all races and ethnicities are thoroughly prepared to care for patients from widely diverse backgrounds and cultures.
One place to start is by making sure that our nursing schools’ curricula truly reflect the cultural differences of our country’s wide spectrum of racial and ethnic populations. Although curricula may contain accurate cultural terminology, they often lack the qualities that enable students to understand different cultures and their health care needs. When revising curricula to incorporate a multicultural perspective, it is crucial to include in-depth information on cultural factors,6, 7 such as:
• environmental control (e.g., the practice of folk medicine or use of traditional healers) 8
• biological (physical and genetic) differences among cultural groups, which can include not only body build, skin color and hair texture, but also healing responses, susceptibility to disease and nutritional variations8
• social organizations, such as families, that shape an individual’s cultural development, beliefs and responses to major life events
• space and time orientation (e.g., some cultures are future-oriented and concerned with long-range planning while others focus on the present).
In addition, communication is an integral part of nursing practice. To communicate effectively with patients from diverse cultures, nurses must have knowledge of different languages, verbal and nonverbal behaviors, use of silence and attitudes about eye contact. They must understand not only what is communicated but also how it is communicated.
Evening Up the Score
While much has been written about incorporating cultural competency into nursing school curricula, one area that has received little attention is faculty-generated classroom testing. Because test scores play a significant role in student evaluations, it is important to utilize test questions that are as culturally unbiased as possible.
Educators must keep in mind that nursing students come from a diverse range of cultural backgrounds and may lack the necessary experience to perform well on tests if these cultural differences are not taken into account. In fact, a faculty’s failure to recognize the potential for bias in classroom testing can adversely affect minority students’ ability to succeed in the nursing program.
This inability to do well on tests is not due to lack of intelligence, but instead may result from a lack of necessary learned behaviors, or from differences in thinking patterns between cultures.9 For example, the Native American student has learned by stories, legends and role modeling.9 This nonlinear way of learning allows for more than one right answer,9 as opposed to the multiple-choice testing format customarily used in nursing schools. As a result, Indian students may have difficulty not only in learning but also in expressing their knowledge and understanding test questions.
Fortunately, most students are capable of learning test-taking skills if they are given the opportunity. It is the faculty’s responsibility to provide this opportunity—for example, by making tutoring available, within or outside of the nursing department, to help students identify and strengthen areas that need further development, such as writing, studying and time management. Providing these options for minority students does not mean lowering standards; rather, it means that mechanisms should be in place to enable faculty to refer students for additional help if it is needed.
A Culturally Sensitive Approach to Testing
What can nursing schools do to ensure that faculty-generated tests are not inadvertently biased against minority students? One solution is to use culturally sensitive standardized test questions. While these may be hard to find, one helpful resource is the National League for Nursing (www.nln.org), which is striving to make standardized tests culturally sensitive by reviewing them for potential bias. Another recommendation is to have culturally diverse groups of students and faculty evaluate potential test questions.
Within the larger context of providing a culturally sensitive learning experience for all nursing students, it is important to use clinically focused scenarios and class exercises that relate to multicultural issues, and to select textbooks, journal articles and reference materials that reflect cultural diversity. The following texts are recommended for their culturally diverse content:
• Spector, R.E. (1996). Cultural Diversity in Health and Illness (4th edition). Stamford, Conn.: Appleton & Lange.
• Kelly, M.L. & Fitzsimons, V.M. (2000). Understanding Cultural Diversity: Culture, Curriculum, and Community in Nursing. Sudbury, Mass.: Jones & Bartlett.
• Bennett, C.I. (1999). Multicultural Education: Theory and Practice (4th edition). Boston: Allyn & Bacon.
Finally, inviting culturally diverse guest speakers to discuss culture-specific behaviors and customs can be excellent way to help both students and faculty broaden their understanding of cultural differences.
References
1. Moses, E.B. (1992, March). Nursing Facts: From the American Nurses Association.
2. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing (2000, March). Preliminary Findings, National Sample Survey of Registered Nurses.
3. U.S. Census Bureau (2001, March). Census 2000 Brief: Overview of Race and Hispanic Origin.
4. U.S. Census Bureau (1995, August). Selected Social and Economic Characteristics for the 25 Largest American Indian Tribes: 1990.
5. U.S. Census Bureau (1997, October 31). Facts for Native American Month (November 1-30).
6. McCarthy, M. (1996). “Travelers From Many Lands: The Impact of Culture.” In Carson, V.B. & Arnold, E.N. (Eds.), Mental Health Nursing: The Nurse-Patient Journey (1st edition). Philadelphia: W.B. Saunders.
7. Strasser, J., Maurer, F.A., & Kavanagh, K.H. (1995). “The Relevance of Culture and Values for Community Health Nursing” (ibid.)
8. Spector, R.E. (1996). Cultural Diversity in Health and Illness (4th edition). Stamford, CT: Appleton & Lang.
9. Crow, K. (1993). “Multiculturalism and Pluralistic Thought in Nursing Education: Native American Worldview and the Nursing Academic Worldviews.” Journal of Nursing Education.
Last summer, I was approached on campus by an African-American nursing student who said to me: “I have been waiting to meet you. I didn’t know your name or what you looked like. But I was looking for someone [on the faculty] who looks like me. And if I didn’t find you, the university administration would have to answer to why.”
This incident dramatically illustrates the frustration many minority students feel concerning the shortage of minority faculty in the nation’s schools of nursing. While minority student enrollment in college and university nursing programs continues to increase, this growth has not been matched by minority faculty hiring.
Students and teachers alike recognize the importance of providing role models for both minority and majority students in an academic environment of diverse cultures and ethnicities. In particular, the lack of professional role models for students of color within an increasingly diverse U.S. population threatens to result in educational deficits for our minority youth—deficits that could damage America’s future prosperity and our ability to compete in the educational arena with other industrial countries around the world.
Several factors have been identified as contributors to the minority teacher shortage. One of the most troubling and significant of these is a general decline of interest in the teaching profession, partly as a result of non-competitive faculty salaries and slower rates of academic promotion. Furthermore, because the median age of full-time nursing faculty in 1998-99 was 50 years, early retirement programs are taking their toll on the faculty supply.1, 2
Clearly, greater efforts to recruit and retain minority nursing faculty are urgently needed.3 However, a solution to the crippling shortage of minority faculty is unlikely to be achieved without some major adjustments in thinking and methodology on the parts of both nursing school faculty search committees and nurses of color who hope to pursue teaching careers.
The Four Cs
Based on my own experience as a black faculty member teaching at a predominantly white institution, I believe the keys to success in recruiting and retaining minority nursing faculty can be summed up by “the four Cs”—commitment, concern, collaboration and creativity.
Nursing schools must demonstrate commitment and concern about tackling the shortage of minority faculty by providing leadership and sufficient revenues to launch a successful recruitment campaign. Current minority faculty can also provide this commitment from a personal standpoint. A few years ago, when I was the only black faculty member at my institution, I resolved that instead of just complaining about the situation or being passive, I would actively commit myself to improving minority faculty recruitment efforts: I volunteered to chair the university’s faculty search subcommittee.
The third C, collaboration, means there must be active involvement, networking and joint efforts between all concerned parties—not just the search committee but also faculty members, administrators and student representation.
Creativity is perhaps the most overlooked factor in the entire process. Successfully recruiting minority nursing faculty requires both a clearly defined, targeted plan for search efforts and the use of innovative strategies to locate and advertise for minority candidates. This means using not just the traditional sources, such as the Chronicle of Higher Education and AACN journals, but specifically targeting places where minority faculty are likely to be looking for positions—such as local minority media, minority professional organizations and minority colleges.
Creativity also plays a key role in the retention of minority faculty once they are hired. Minority faculty should be offered more opportunities to serve as chairs of committees instead of just committee members. They should also be incorporated into decision-making processes affecting all facets of college life. This can be achieved through a thorough orientation process that promotes collegiality, support and commitment.
Finally, schools of nursing must provide mentoring and growth opportunities for minority faculty members. This can be done by empowering them to assume leadership roles within the institution, by providing opportunities for research and publications through research support programs within the nursing department, by providing clinical or field placements at ethnically diverse institutions and by encouraging seminars that foster cultural sensitivity.3
Bringing the Right Tools to the Table
The other crucial lesson I learned from becoming personally involved in the minority faculty search process was that many of the candidates who apply for faculty positions —and especially the minority candidates—are simply not prepared for careers in academia. This is largely because many would-be nurse educators possess substantial experience as clinical nurse specialists or clinical educators but lack the specific criteria that nursing schools typically use to determine qualified faculty.
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Nurses of color who hope to successfully make the transition from the clinical setting to academia must be acutely aware of how faculty search committees will be evaluating their background—and must be fully prepared to meet these criteria. Here is what you will need to bring to the table:
• Education in the area in which you want to teach. Search committees look for education in the form of a terminal degree (PhD, EdD, DNSc, MSN, etc.). The more closely your degree is related to nursing and the specialty area required for the position, the more highly you will be evaluated. If you want to be a professor of nursing, do your doctorate in nursing. If you want to teach a certain nursing specialty, make sure your master’s degree is in that specialty.
• Teaching experience. Don’t expect to land a job as a university professor unless you have some type of experience teaching college-level students. I often recommend starting out as an adjunct, or even teaching in a diploma or associate degree nursing program, to get your feet wet in this crucial area.
• Solid clinical experience. Faculty search committees look for extensive, full-time clinical experience—rather than part-time or short-term experience—that is concentrated in the candidate’s nursing specialty.
• Published scholarship and research. Many minority faculty candidates are especially lacking in this type of experience. Look for opportunities to build a track record by writing and publishing articles in peer-reviewed nursing journals, presenting poster or podium sessions in peer-reviewed forums and conducting independent research.
• Professional and community involvement. This component is critically important. It is not enough to simply belong to your state nursing association or a professional group such as the National Black Nurses Association. Faculty search committees evaluate candidates on the number of professional organizations they belong to, as well as the leadership positions they have held in those organizations. Similarly, active involvement in community service is seen as another key indicator that the candidate is a well-rounded, committed individual.
References
1. American Association of Colleges for Teacher Education, 1989. 2. American Council on Education, 1997. 3. Washington, L. Joyce (1999). “Expanding Opportunities in Graduate Education for Minority Nurses,” Journal of the National Black Nurses Association, 10(1), 68-80.
