Homelessness is a global issue. It is on the rise and it impacts health physically and mentally. According to a recently published article in BMC Public Health, emergency departments are more often used by the homeless population for acute health care versus accessing preventative health care services. A 2018 study published in SAGE Open reported that the homeless population experiences health disparities with multiple chronic health conditions, mental illness, substance abuse, and depression.
The U.S. Department of Housing and Urban Development, Office of Community Planning and Development provides an Annual Homeless Assessment Report (AHAR) to Congress. On a single night in January 2018, there were 552,830 people who experienced homelessness in the United States. Most were sheltered (65%, 358,363) compared to 35% (194,467) who were in unsheltered locations. In the United States, 17 people per 10,000 experienced homelessness in 2018. Some of those who were in shelters (3,864 people) stayed in beds that were funded because the president declared natural disaster after four Hurricanes (Maria, Irma, Harvey, and Nate) and wildfires in the west. Twenty percent (111,592) of the homeless were children, 71% were over 24 years of age, and 9% ranged from ages 18-24. There were more men in unsheltered locations compared to women. Almost half (49%, 270,568) of the homeless people identified themselves as white compared to black/African Americans (40%, 219,807).
In the state of Texas on a given night in 2018 there were 25,310 homeless people. There were 9 homeless people per 10,000 in the general population of the state. Individual estimates of homelessness in Texas was 19,199; 6,111 for people in families with children; 1,379 for unaccompanied homeless youth; 1,935 for veterans; and 3,269 for the chronically homeless individuals, according to the 2018 AHAR report.
Houston is the fourth largest city in the U.S. with over 2.3 million people, according to the U. S. Census Bureau. In January of 2019, there were 3,938 homeless individuals (unsheltered and sheltered) in the cities of Houston and Pasadena and Harris, Fort Bend and Montgomery Counties.
There are various reasons that may cause an individual to experience homelessness. A 2009 study published in Psychiatric Services reported a significant association with childhood adversities and homelessness. The childhood adversities with significant findings include: having a history of running away, being ordered by a parent to leave the home, being neglected by a parent or caregiver, having a biological father incarcerated, being adopted, being in foster care, and the duration of welfare assistance before 18 years of age. Significant findings regarding socioeconomic situations included grade when respondent left school, economic difficulty in the past year, and currently employed. Mental health problems such as being diagnosed with depression and having a psychiatric hospitalization in the past five years were significant predictors of homelessness.
More recently, a 2019 study in the Community Mental Health Journal indicated the individuals with mental illness had high rates of homelessness. Addiction problems such as drugs in the past year was also a significant predictor of homelessness, according to the 2009 Psychiatric Services study. Oftentimes veterans return home after deployments to war zones suffering with invisible wounds such as post-traumatic stress disorder and traumatic brain injury. These individuals are at risk for experiencing homelessness, according to the National Alliance to End Homelessness (NAEH).
Homelessness can also be due to loss of property, family violence, or domestic violence. A 2018 study in the Journal of Community Psychology reported loss of support systems and social networks can also lead to a path of homelessness. Lower incomes often lead to an inability to pay for basics such as food, clothing, shelter, and transportation—and this places individuals at risk.
It is a common sight in Houston to see homeless people living and sleeping on the streets. Whether you walk or drive around the city, you cannot help but see individual men and women panhandling in the streets, standing at corners and intersections. They will routinely walk up to your vehicle with signs, cups, and stretched out hands for money. The homeless can be seen sleeping on the sidewalks and huddled up against buildings and fences. Although shelters for the homeless exist and initiatives have been implemented in attempt to get the homeless off the streets of Houston, the homeless population is huge. Many people who are homeless still live in tent cities under freeways.
One might say, they want to be on the streets. One might say they do not want to follow the rules of the shelters. Therefore, they chose to be out on the streets. All of those sayings might be true. All the same, someone remains homeless.
One night during November 2018, I was driving home and it was very cold outside. The temperature was in the 30s or low 40s. I was overcome with sadness and sorrow to see so many people literally sleeping on the sidewalks without any shelter. I noticed that some did not have blankets. I found myself feeling so blessed and fortunate to not be living on the streets. But then, I wanted to do something. I said they need blankets and warm clothes if they will be sleeping on the streets in this cold weather.
The “BLESSED” sign
Community Outreach Project
As a Christmas project for the Black Nurses Association of Greater Houston (BNAGH), we decided to give out blankets and socks to the homeless people in Houston. One Saturday afternoon (December 8, 2018), nurses from the BNAGH gathered the donated items to be distributed and walked the streets where a group of homeless men and women gathered. We drove to a local fast food place near Midtown, between downtown and The Texas Medical Center, and parked with permission from the manager. While still in the parking lot, a man asked me if we were getting ready to do something with the homeless. He was told we were going to pass out blankets, hats, socks, bottled water, and brown bags with snacks (peanut butter cracker, cuties, and peppermint candy canes). He stated his name and the name of his company and said he was there with his crew to do a film about the homeless in Houston. He asked if he could film us passing out the items and we told him yes. He said he would put us in the credits.
As we gathered all the items in large black plastic bags and started walking with the water, people started coming toward us to get the blankets and socks and other items. We gave away every item that we had. We even had a set of towels and a bar of soap to give out. One man said he wanted the soap. One man and lady were yelling for us to throw a blanket over the fence to them. One lady asked if we had anything girly. She asked for a pink hat. Everyone was so appreciative. Only one person did not want the items. He said he wanted dollars. He walked back into the street, running from car to car begging for money. Overall, it was an awesome experience. We provided items to approximately 60 homeless individuals.
Taking it to the streets takes courage and a compassionate heart. The needs of the homeless are many. One might feel overwhelmed if trying to take on every issue alone. It will take many people and resources. However, everyone can do something to help improve the health and lives of others. That is what the nurses of BNAGH wanted to do and that is why you might see homeless people in Houston with a sign displaying the words “BLESSED.”
Houston nurses handing out supplies
Relevance to Nursing
Homeless Individuals are a vulnerable population and are sometimes considered invisible. However, they are not invisible. They can be seen and counted. They are at risk for health disparities including mental health issues. There were so many obvious needs. One was just basic hygiene. Nurses can advocate for housing because personal hygiene is important. Hand hygiene is the most effective way to prevent and control the spread of infection. Individuals experiencing homelessness face barriers to personal hygiene. For example, personal hygiene and self-care barriers are limited access to facilities for bathing, taking a shower, doing laundry, and washing hands. Such barriers to self-care and personal hygiene can cause one to be at risk for an infectious disease.
Some things that nurses can do to bring about change:
Contact local coalitions for the homeless for information about their goals and objectives;
Advocate for jobs and housing for the homeless;
Contact and lobby local and state congressional and legislative officials regarding policies to help alleviate homelessness in America.
Such efforts will help reduce health disparities among this vulnerable population.
Stepping out of one’s comfort zone is not always easy to do. The first step seems to be the hardest. However, if nurses are to make a difference, then we must rise to the calling, step up to the plate, and do something positive to make a change. There are so many things that can be done. What I attempted to do was to provide warmth and comfort to a few people on the streets of my hometown. However, I have been inspired to do more. Hopefully you will be inspired to do something to help the homeless in your community feel encouraged and strive to be healthier.
Acknowledgements: The author wishes to thank Betty Davis Lewis, EdD, RN, FAAN and the Black Nurses Association of Greater Houston (BNAGH) and Prairie View A&M University College of Nursing faculty members for donations, and the three other nurses from BNAGH (Patricia Boone, RN, BSN; Vivian Dirden, RN, BSN, MS; and Dametria Robinson, BSN, RN-BC) who also walked in the streets of Houston to distribute the items to the homeless and provided photos. In addition, the author wishes to thank Carmen Lewis, MSN, RNC-MNN, IBCLC for providing the “BLESSED” photo.
“Nurse practitioners are not, I repeat, not physicians. They lack education, IQ, and clinical experience. There is no depth of clinical understanding. They are useful but only as minions. Not politically correct, but true. Who would you want your family member seen by—a nurse or a physician?” —Doximity.com, 10/2017
One’s initial response may be to get angry after reviewing that. Yet, instead of remaining angry, perhaps the use of emotional intelligence and research could be of more benefit with analyses of the social media post.
A Little History Lesson
In 1965, Henry Silver and Loretta Ford, a physician and a nurse, developed the first training program for NPs. The course of instruction focused on disease prevention, health promotion, and was in direct response to a national shortage of primary care physicians of that time. The deficit was especially concerning in rural, urban, and undeserved communities. This sounds eerily similar to current health care accessibility issues of today. Ford and Silver met much opposition with the development of the first formal program for NPs.
Surprisingly, the opposition was not only from physicians but also nurses. Some claim nurses believed that the title of “Nurse Practitioner” would be deceptive and somehow damage the nursing profession; meanwhile, it is believed that some physicians felt that NPs simply did not have the skills to take care of the public health needs without supervision (e.g., oversight). What is captivating, however, is how a nurse and a physician identified a need and were able to work in concert to try to address the concern.
“Nurse practitioners are not, I repeat, not physicians.”
Merriam-Webster defines a physician as: “A person skilled in the art of healing.” Thus, this could be considered offensive to a physician who has gone to school for many years and has done an average of 10,000-15,000 hours of clinical rotation. In contrast, the NP goes to school for many years too but only averages 600-1,200 clinical hours. Humbly, if one is being honest, the sheer number of clinical hours that physicians do may suggest their training is better. Does that mean that they are superior? It should stand to reason that if one’s course of study includes more hours that their training is superior, but this does not mean that a NP is not essential in their own right. Therefore, it is understood that a NP is not a physician.
“They lack education, IQ, and clinical experience. There is no depth of clinical understanding. They are useful but only as minions. Not politically correct, but true.”
It has been documented that IQ tests do not test intelligence but can simply demonstrate that one is a good “test taker.” Hence, one should understand that having a high IQ does not constitute knowledge, nor is the IQ the only predictor for one’s success. The language used in the op-ed may be viewed as crude to some and offensive to others; however, if one could look past the words and get to the root of what was being said it might be helpful. Checking egos at the door and realizing that medicine is not a power structure—it should simply be patient-centered. As such, there may be some value to the thought that NPs need oversight to practice.
What’s wrong with collaboration, anyway? This should be viewed as a valuable tool that assists with the care and safety of patients who may not otherwise have access to adequate health care. This should not degrade the NP’s worth but prove valuable for the public.
For those arguing about NPs and their worthiness—are they willing to work in rural, urban, and undeserved areas? Who does this argument really hurt? To meet the current health care demands, there would need to be a tremendous supply of willing physicians. Where are they? Additionally, some studies imply women and children suffer the most in medically underserved areas, Who will serve them? Is that physician you?
“Who would you want your family member seen by—a nurse or a physician?”
Qualifications and experiences are probably the central reasons for patients preferring a provider no matter what their title. But physicians may be more often preferred for their skills, whereas NPs may be favored for their social skill and ability.
Maybe fear, lack of confidence, and overwhelming need as a NP to validate worth could make them seem unworthy. But this should not be confused with lack of skills or professionalism of the NP. Oversight should not indicate a servant-to-leader relationship but rather a teamwork concept to support and respect one another. One cannot reasonably argue with the number of hours of study a physician puts in—it is commendable. Having said that, this does not belittle the course of study for the NP, either.
Physicians and NPs are all valuable, and working together can be nothing but good for all around. So, in the words of Rodney King, “Can’t we all get along?” Let’s work together in concert to direct a beautiful symphony called safe patient health care.
Nurses are integral in the care of patients and their health. Exploring a plant-based diet may be beneficial to patients so they can take back their health. It is time for health care disciplines to be aware of a plant-based diet and to dispel any myths that exist. In fact, a plant-based diet is not a diet—it can be viewed as a way of life. A plant-based diet are foods consumed that is devoid of animal ingredients, such as dairy and meats. A plant-based diet relies on foods that are grown from the ground such as fruits, vegetables, whole grains and nuts, and seeds.
People are living longer, but we are also living with more chronic diseases, with heart disease being at the top of the list. Heart disease, diabetes, and hypercholesterolemia are contributors to sickness where medicine is the answer. Health care providers tell patients to lose weight by restricting food intake. While patients may see results initially, they usually do not adhere to this long term as it is not sustainable for them for a variety of reasons. In addition to that, the medications with their side effects usually do not highlight many benefits. One-third of animal products in the American diet are very concentrated in calories and are deficient in antioxidants and vitamins. Needless to say, the vast majority of chronic illness is highly correlated to what we eat. There is a different biological effect of meat versus plant-based protein such as beans. The body can store these amino acids and complete them without overshooting the hormone, Insulin Growth Factor 1 (IGF 1). On the contrary, processed foods and meats produce a lot of IGF1 where insulin ends up storing a lot of fat. It is also attributable to cancer and inflammation.
People have long touted the benefits of a plant-based diet. Brooklyn Borough President Eric Adams reversed his diabetes Type 2 due to a plant-based diet. He was already suffering from nerve damage as a result of his disease with a hemoglobin A1C of 17 (anything over 6.5% is considered diabetic), so his was very high and the doctor was surprised that he was not in a coma. Adams was placed on medications, but he also sought the help of Caldwell B. Esselstyn, Jr., the same doctor who treated Bill Clinton and author of the book, Prevent and Reverse Heart Disease. He was informed by doctors that he would be on insulin for the rest of his life. He was placed on medicine for his acid reflux, medicine for his high cholesterol, and medicine for his burning and tingling of his hands and feet. His family is diabetic and was told that it runs in his family.
This past August, there was a launch of a plant-based lifestyle program at Bellevue Hospital in New York City. Doctors, nurses, dieticians, and life coaches will help at least 100 patients across all five boroughs adopt healthy eating patterns focused on legumes, whole grains, fruits, vegetables, nuts, and seeds while reducing animal products, fried foods, refined grains, and added sugars. Michelle McMacken, director of NYC Health + Hospitals/Bellevue Adult Weight Management Program, is director of the program.
At Montefiore Hospital, Dr. Robert Ostfeld spearheaded the Cardiac Wellness Program where plant-based nutrition is the prescription for management of cardiac disease. The population most affected by these diseases are non-white populations. Dr. Kim Williams, past President of the American College of Cardiology, advocates for a plant-based diet for heart disease prevention. Affronted with a high cholesterol, he decided to take measures into his own hands, and adopt a plant-based diet.
While medical doctors are beginning to advocate this lifestyle, nurses should also set an example of this lifestyle approach. Nurses are part of the health care discipline and minority nurses, especially, need to set an example. We want patients to take control of their lives. We can teach patients eating a plant-based diet instead of a standard American diet, as a form of primary prevention. Like any diet, it may take time to adjust, but this is not just a diet, it is a lifestyle. Patients would need to make an informed decision as to whether they would want to incorporate it into their lifestyle or not. There is enough supportive evidence out there that a patient can access such as documentaries, “Fork Over Knives” and “Fat, Sick, and Nearly Dead.” There are a variety of resources, including the 21-Day Vegan Kickstart program, to include in dietary prescriptions to help patients treat and prevent obesity, type 2 diabetes, and heart disease. This will require support from the patient’s primary provider, and, whether the provider is an advocate of this lifestyle or not, it should be considered. Benefits such as less medication, weight loss, and improvements in mood as well as cholesterol have been shown. Dispel the myths about a plant-based diet and protein.
This is a plea as something to consider to take better care of ourselves and take control of our lives. There have been many initiatives and programs to lose weight. Drastic measures have also occurred due to the outcomes of being overweight, such as drastic surgery and restrictions from carbohydrates. Patients are sometimes misinformed and have to get rid of the idea that medications will solve the problem—it only delays the problem. There is a possibility of reversing diabetes and cardiac disease. This is a decision that the person has to make: continue with their lifestyle with animal protein and processed carbohydrates or see a reduction in their overall weight and health by incorporating a plant-based diet.
A plant-based diet may be considered “extreme” by some people in altering their lifestyle. But given the choice between a plant-based diet or open=heart surgery, it can be posed to the patient which one they consider as extreme. Again, it is a personal choice, an evaluation of familial and cultural values would be assessed to fit the needs of the patient. Surgery can be viewed as a band-aid in that it will manage the symptoms temporarily unless the patient alters their lifestyle. Of course, it helps if the patient has a supportive network to embrace the lifestyle. It can start off as small, simple steps, as little as incorporating a plant-based meal in their day and slowly add these meals to their lifestyle. There are vegan starter kits to kick a healthier you.
Fame Conway, RN, has seen firsthand how medical cannabis can be a game changer when it comes to fighting chronic illness. Decades of suffering from chronic inflammation and autoimmune disorders made it challenging for Conway to juggle her busy life as an operating room (OR) nurse and mother of two.
Then in 2016, a devastating car accident killed Conway’s son and left her with a femur fracture and an uncertain future.
“After the accident, I suffered from intense pain and Post-Traumatic Stress Disorder (PTSD),” Conway says. “I wasn’t sure if I would ever walk again.”
During her long recovery, Conway began researching the medical uses of cannabis. She was intrigued by research showing how it could ease symptoms ranging from chronic pain to nausea and she felt the knowledge could also benefit her clients.
A member of the Cannabis Nurses Network (CNN), Conway is one of many nurses across the country who is increasing her knowledge of cannabis and its use in modern medicine. As of June 2019, eleven states and Washington, D.C.., have legalized it for recreational use for adults over 21, and 33 states have legalized medical cannabis. Yet regardless of whether a state has enacted legislation, it is estimated that several million Americans currently use cannabis and that it’s a topic that interests many patients.
Conway took online courses through the American Cannabis Nurses Association (ACNA), where she learned about the endocannabinoid system (ECS), a network of receptors that affect appetite, mood, memory, pain, and other physiological functions. Graduates of ACNA’s courses are deemed competent in cannabis nursing.
“The ECS isn’t covered in most nursing programs, but it’s important for nurses to achieve a better understanding of ECS, how it works and how, and why cannabis can be a safe and effective medication,” Conway says.
After adopting a holistic lifestyle that included a plant-based diet and cannabis products when needed to combat pain and PTSD, Conway found she was able to reverse her chronic inflammation and autoimmune diseases in a natural way.
“I learned that whole plant nutrition supplemented with cannabinoids has the ability to regenerate health and restore wellness,” Conway explains. “I’m now able to enjoy an inflammation-free life without taking medication, and I no longer suffer from pain, anxiety, psoriasis, and insomnia.”
Knowing she wanted to help others suffering from autoimmune diseases and chronic inflammation, Conway launched GraceandFame.com, and has created an online health program. She also advises clients on how to adopt a plant-based diet and find the right cannabis product to safely and effectively treat their individual health condition.
Helping Women Through Life’s Different Stages
A midwife for over 20 years, Sakina O’Uhuru, CNM, RN, co-founded Black Ash Cannabis in Fort Lee, New Jersey last year after seeing the benefits of CBD oil, which is made by extracting CBD from the cannabis plant, then diluting it with a carrier oil such as hemp seed or coconut.
“CBD oil has been shown to relieve pain, reduce anxiety and depression, and alleviate cancer-related symptoms such as nausea and pain,” O’Uhuru says. “It also helps to reduce symptoms of menopause such as hot flashes, mood swings, and insomnia.”
After seeing the positive effects of CBD oil, O’Uhuru decided to integrate it into her practice. She now sells a CBD oil, derived from hemp plants, that is legal in all 50 states.
“I had clients who were inquiring about the benefits of cannabis and I wanted to be able to answer their questions and address their health needs,” says O’Uhuru, who proceeded to take online cannabis education classes and join the CNN prior to launching Black Ash Cannabis. “I think it’s important for nurses to be able to answer questions about medical cannabis, proper dosing, and the different methods that can be used to administer cannabis that include smoking, edibles, and tincture forms (that work sublingually by applying a drop under your tongue).”
O’Uhuru has worked as a midwife for over 20 years and is the author of Journey to Birth: The Story of a Midwife’s Journey and a Reflection of the Heroic Women She Served Along the Way.
“I work with women of all ages, through childbearing age to menopause,” O’Uhuru says. “I see my training as a cannabis nurse as another part of the cornucopia of services I offer my clients.”
Resources for the Canna-Curious
The American Cannabis Nurses Association(ACNA) is currently the only professional nursing organization working towards being recognized by the American Nurses Association as a certifiable nursing sub-specialty. In conjunction with The Medical Cannabis Institute, ACNA offers an online course for nurses, as well as resources for nurses who want to learn more about medical cannabis and how it can be safely and effectively used to manage a patient’s health condition.
Patients Out of Timeis a non-profit educational charity dedicated to educating health care professionals and the general public about the therapeutic use of cannabis and the ECS system. They hold an annual conference and offer educational resources and information on their site.
The Cannabis Nurses Networkwas formed in 2015 and offers professional development courses networking, professional recognition, and legal and medical advocacy.
Cansoomoffers nurses and other medical professionals classes to become medical cannabis consultants. Founded by Lolita Korneagay, MBA, BSN, RN, Cansoom courses equip nurses with the knowledge they need to assist patients in consuming cannabis safely and effectively.
Cannabis Education Comes Full Circle
Vanessa Cruz, LPN, of Pueblo, Colorado, has always embraced traditional alternatives in health care. As a master herbalist and end-of-life doula, Cruz thought adding cannabis nurse to her extensive resume was a natural progression.
“I’ve been a nurse for over 15 years and have worked in hospice, home care, and in a hospital setting,” Cruz says. “In home care, I encountered a lot of patients who had heard about medical cannabis and had a lot of questions about whether it might benefit their health condition.”
Cruz took over 30 hours of continuing education courses through the ACNA and discovered that medical cannabis had the potential to treat a number of health conditions. She also joined the CNN to network with other nurses who had an interest in the field.
“As an end-of-life doula, I’ve found many patients who prefer medical cannabis over morphine because it can combat their pain with fewer side effects,” Cruz says. “It also helps patients who are terminally-ill and may be experiencing anxiety or nausea as a side effect of cancer treatments.”
While opioids can produce side effects such as constipation and nausea, and prolonged use can lead to addiction in some cases, Cruz says patients view cannabis as a more holistic alternative. She now offers paid consultations to clients through her business, Traditional Holistic Care.
“I meet with patients who are seeking direction on state-approved medical diagnoses for medical cannabis and have questions on how to obtain a medical cannabis card, and the right product and dosage for their medical condition,” Cruz says. “I’ve seen the potential cannabis has in treating seizure disorders [and] muscle spasms, such as those associated with multiple sclerosis.”
As it continues to grow in popularity, Cruz encourages all nurses to gain an understanding of the field and expand their knowledge of what it means to be a cannabis nurse.
“At some point, all nurses are going to encounter a patient who is using cannabis,” Cruz says. “It’s important for them to be able to determine if there are any potential cannabis-prescription drug interactions [and] how they can answer a patient’s questions and ensure the safe use of cannabis.”
Helping Patients Become Cannabis Confident
In Honolulu, Hawaii, Me Fuimaono-Poe, FNP-BC, serves as owner of the Malie Cannabis Clinic, a medical practice that provides marijuana education evaluations, education, and electronic approval for medical marijuana cards.
“We see patients with a wide variety of qualifying conditions, with the most common being pain,” Fuimaono-Poe says. “My youngest patient is about three months old and my oldest patient is 103.”
Fuimaono-Poe first became interested in cannabis after meeting Dennis Peron in 1997 at the first Cannabis Buyers Club in San Francisco. Peron, an American activist and businessman, was an early leader in the fight to legalize cannabis.
Her interest led her to take online classes through the ACNA and the CNN.
“I also attended several cannabis conferences throughout the United States so I can stay up on the latest research,” Fuimaono-Poe says. “There’s currently no certification for a cannabis nurse, but we’re working to change that. The ACNA has been actively involved in getting cannabis nursing to be seen as a nursing sub-specialty in the same way as diabetes, oncology, and critical care.”
In 2016, Fuimaono-Poe, who had previously worked in both a hospital and family medical practice, opened the Malie Cannabis Clinic, dedicated to educating patients about medical marijuana. She notes that even in states where medical cannabis isn’t yet legal, patients have questions about how cannabis might have the potential to help their specific health condition.
And since many dispensaries don’t have nurses on staff, nurses can counsel patients on potential drug interactions and how cannabis used in liquid form or through vaping, might be used as an effective replacement for opioids.
“We educate patients at every appointment on topics such as dosing information based on symptoms and side effects,” Fuimaono-Poe says. “If patients are prepared for the possibility of side effects, I feel like it decreases their fear around using cannabis.”
While acknowledging that on the whole medical cannabis is a safe and effective option, Fuimaono-Poe and her staff tell patients there’s a small risk of side effects.
“If medical marijuana patients stand up too quickly, they can get dizzy, so we let them know that that’s a possibility, and advise them to get up slowly,” she says. “Dry mouth can also be a side effect, so it’s important to stay hydrated and use an over-the-counter product dry mouth product such as Biotene if it becomes worse.”
Fuimaono-Poe believes all nurses should have a working knowledge of cannabis therapeutics.
“Nurses are educators, advocates, and caregivers, which make them a natural fit in the cannabis space,” Fuimaono-Poe says. “Some nurses work in dispensaries, some as health education consultants, and others actually cultivate cannabis.”
Looking to the future, Fuimaono-Poe says her hope is that cannabis nursing will soon become a sub-specialty and that one day in the near future there will be at least one cannabis nurse in every medical setting.
“I see cannabis nurses working in a position similar to a diabetes education nurse and helping to train both other staff members and patients on how to use cannabis safely and effectively,” she says. “Nurses are great at taking complex information and explaining it in terms that all patients can understand.”
Our health is something that we all have, and unfortunately, the condition of our health is not something that we have complete control over. We do, however, have the ability to enhance the quality of our health. We all have choices to make regarding our lifestyle and how we manage our health to make sure we ensure that our health never deteriorates and we can live a long, healthy, and fulfilling life. We can control our choices to improve the quality of our overall health, and a significant part of enhancing the quality of our overall health is making doctor’s visits a priority. Being inconvenienced with taking time off work or readjusting our schedules should become secondary to the need to seek medical attention when needed. The unfortunate aspect of health care utilization is that people often wait until it is too late before they decide to become committed to ensuring that their health is maintained and monitored.
The fragility of health became very real to me about 10 years ago when my persistence to my doctor, because I was not feeling well, finally resulted in an order for a CT of the lungs to reveal I had pneumonia. The previous x-rays of my lungs were always inconclusive. My health was in jeopardy, and I knew that I had to become intentional in my pursuit to get better. My persistence of seeking medical treatment reappeared with a vengeance in 2013 when my favorite uncle was diagnosed with stage 4 throat cancer. He was a mechanic who loved his family, and he was a very talented cook. He was one of those men who never had a lot to say, but he observed everything. It was easy to tell that he was not doing well, but I had to beg and plead with him to allow me to make him an appointment at a local clinic after we noticed that his health was declining. He was a proud man who did not like to admit when he needed some help. He was self-employed with no health insurance. His case was so difficult that most of his medical team did not want to take him as a patient. One of the wonderful physicians believed in him, and she advocated for him. He went through major surgery, and he lived another two and half years that gave me and my family more time to spend with him.
Two days before my uncle passed away, I softly spoke to him and told him that I would finish my doctoral program and make him proud of me. He nodded his head, and I was blessed to keep my promise. I believe that if my uncle would have been treated sooner, the outcome would have been different. I did not know when my uncle passed away that I would devote my research efforts to racial health disparities, or that I would have such a passion for educating the African American community on the importance of seeking health care services. Through my sorrow, I have made it a part of my mission to educate African Americans regarding the importance of seeking timely and routine medical treatment.
It is so important for African Americans to seek medical treatment because of the high incidences of health diseases and conditions that plague that population, such as high blood pressure, high cholesterol, diabetes, and heart disease. In my experience from working years as a certified pharmacy technician, too many people do not treat their health like the important commodity that it is. We sometimes feel that our health is something that we will always have, and that it will always be good. Unfortunately, I know firsthand that it simply is not true. Our bodies give us signs when things are not right, but it is up to us to pay attention. We sometimes shrug things off when we notice that variance in our health occurs in hopes that it will get better without us taking on more of an active role to ensure that it happens.
The goal of my research was to evaluate how the patient-provider relationship impacts the patient’s decision to access health services. Through my quantitative research, I wanted to delve into the rationale that African American patients have about how they make the decision about when they will visit the doctor. African American cultural norms, in addition to the historical aspects of discrimination coupled with provider biases, create a divide that can become evident during the patient’s visit. African Americans often feel as if they are not heard or a priority when they make medical visits. Chronic diseases and conditions often necessitate the need for medical visits as it pertains to African Americans, so African Americans between the ages of 40 and 65 were the target population that was studied. After reviewing the demographics within Shelby County, Tennessee, it was determined that the sample could be identified after evaluating the community right within my reach. It is apparent through observation as a former practicing certified pharmacy technician that African Americans are subjected to health disparities at an alarming rate. Those racial health disparities are prevalent because of the effects of the patient-provider relationship, limited access to health care resources, and health outcomes that are less than ideal.
A group of 56 participants were gathered through the help of alumni chapters of African American sororities and fraternities located throughout the greater Memphis area. All of the participants that were used to complete the analysis lived within Shelby County, had health insurance, had an English speaking primary care physician, and were African American. The findings evaluated the interactions that occur during the medical visits. The goal was to possibly uncover why African Americans do not go to the doctor in hopes of explaining why there is a prevalence of chronic diseases within that population. The findings did indicate that there is a significant relationship between the patient-provider relationship and the behaviors of the provider. Additionally, the behavior of the provider does contribute to the African American patient’s decision to seek health care services.
The participants that were evaluated stated that gender and assumptions that the provider makes about their education level and income did play a factor in how the provider interacted with them during the medical visit. The behavior that the staff exhibits during the medical visits of African American patients does impact the decision that is made to seek services, and the way that African American patients are made to feel during the medical visit does impact their decision to seek follow-up care and even their willingness to comply with medication compliance. It is important for the African American patient to be understood and treated with compassion, care, and concern. The historical component of the racial tension that African Americans have dealt with makes it pertinent for health care providers to treat the patient’s concerns as a priority.
In summary, there is a direct correlation between the relationship that the patient has with their provider and how the behavior of the provider is perceived during the interaction. It is important that African American patients receive ongoing education regarding the importance of seeking timely and routine health care. Providers need to be cognizant of how their mannerisms and responses affects their African American patients. African Americans do not consistently go to the doctor, which is evident by the staggering statistics of preventable and treatable conditions and diseases that plague that community. The goal for both parties within the relationship is to realize that it is impacted by both the actions and reactions of both sides.
Acknowledgment. The author would like to thank Cheryl Beers-Cullen, DHA, MPA, BSN, RN, CALA and Manoj Sharma, MBBS, PhD, MCHES for their contribution and mentorship.
Many nurses are pursuing advanced education. Expanding knowledge is always a good thing—for them, for their employers, for their patients, and for their careers. But what happens if you’re going back to school while you’re also working full-time and raising a family? Perhaps it’s challenging, but it’s definitely doable. These nurses have done it and have tips to help you do it too.
When Catherine Burger, BSN, MSOL, RN, NEA-BC, was asked by her employer to return to school to earn her bachelor’s degree in order to remain in an executive leadership position, you might say that it wasn’t the perfect time. “I was working over 60 hours per week as a nursing leader for a complicated department; we had five kids at home—all with multiple sports and commitments—ranging in age from 1 to 17 years old,” recalls Burger, a media specialist and contributor for www.registerednursing.org. “There is no perfect time to start back to college.”
But Burger and many others made it work, and you can too.
Do Your Homework Before You’re Doing Your Homework
Before you jump right into a program to earn another degree, Simendea Clark, DNP, RN, president of Chamberlain University’s Chicago campus, says that you need to do some homework. “If you’re thinking about going back to school, do your homework first. Everyone has a different set of circumstances, so it’s crucial to research programs and schools that best fit your needs. Many schools offer online modalities that allow you to take some or all of your coursework from the comfort of your home, saving you travel time to and from school,” says Clark.
Be sure that the educational program you select is something that you love—not just something that will bring in the bucks. “The key for those who want to advance their education is to make sure it is something that drives your passion for nursing,” says Adam Kless, MSN, MBA, RN, NEA-BC, vice president of clinical operations for Avant Healthcare Professionals. “Selecting an educational path for mere money will leave one hollow and disappointed in the long run.”
If it will help you, see if you can spread out your coursework. “I chose to take two classes per semester, including the summers. That helped me stay full-time in the graduate program,” says Valerie C. Sauda, PhD, MSN, RN-BC, MGSF, an assistant professor at Husson University’s School of Nursing. “Although it lengthened my study a little, it definitely helped me maintain the work/life balance. I also feel that I learned the material more thoroughly and was more engaged in the classroom and online group activities. A shorter program may not always be best for learning and life. Enjoy the journey!”
Tell Your Family and Your Boss
Now you’ve found the perfect program for you. What’s next? Your best bet is to tell the people closest to you: your family and your boss.
Your family probably already knew that you were looking into an advanced degree, but if they didn’t, be sure to tell them. You may need their support and the best way of getting this is to be honest and transparent. “Have conversations with the key stakeholders in your life—your current boss, your spouse, and your children. Creating ways for them to give you critical feedback in the moment can save a lot of heartache later. When you are under a lot of stress, it can be difficult to maintain a good communication feedback loop,” says Melissa McClung, MS, LPC, a professional career advisor and owner of LBD Careers, LLC. “Setting this up in advance can preserve your important relationships when there are inevitable conflicts.”
There are many reasons why it’s crucial to tell your boss. “Getting your boss involved will allow you to successfully incorporate your education into your work life by scheduling around class, providing you extra learning opportunities while at work, or benefit from finding a mentor at work who is already doing what you desire to do,” says Kless.
“At the outset, you may need to negotiate with your employer for some flexibility with your work schedule,” explains Divina Grossman, PhD, RN, APRN, FAAN, president and chief academic officer at the University of St. Augustine for Health Sciences. “Solicit the support of your supervisor or mentor at work so that you can have more flexibility in your schedule so you can prioritize your classes, clinicals, or to write papers and projects.”
Grossman says that when you tell your boss, you may also be able to streamline your schoolwork by having “your course requirements, such as term papers or special projects, be about topics or issues that you are dealing with at work. This way, you are not only meeting the requirements for your advanced degree, but also are resolving issues in the work setting through your research and projects. Your supervisor will be thrilled to know that you are doing research-based practical work that advances them and you.”
Plan Your Schedule, But Be Flexible
When Sauda was earning her PhD in nursing/education, she planned daily, weekly, and monthly schedules. “I prioritized time for family, time for work, and time for myself, while ensuring that I blocked out time for study and research during the school year. I had to ‘give up’ a few things, including binge-watching TV, checking my social media multiple times a day, and participating in nursing groups as a volunteer,” she says. “Creating and sticking to a daily schedule is crucial for success in an advanced degree program.”
Terri Bogue, MSN, RN, PCNS-BC, a consultant to hospitals and health care through her company, Thor Projects, LLC, planned her time as well when she returned to school. “I scheduled time to study after family dinner and on weekends. I knew that my degree would open doors and opportunities that would benefit my family as well as myself. This knowledge helped me to keep focused on my goal,” she says.
“It’s also helpful to set reminders for assignments and tests on your phone’s calendar as soon as you learn about them. Review your calendar at the beginning of each week and mark down pockets of time when you will study and do the same for spending time with your family,” says Clark.
Besides having a schedule, it’s also important to be flexible. Because, let’s face it, life happens. “The most important thing to remember about balance is that it is constantly about reevaluating and making changes,” says McClung. “I suggest developing a systematic way to check in with your priorities to ensure that you are prepared to flex when you need to. For example, this can be as simple as using a planner and scheduling out time for the important things: work and school obviously, but also family time, meal planning and preparation, exercise, and household chores.”
Have Some Space
Setting up a particular area in your home can help when it comes to doing your schoolwork. “Create a study space that helps you focus. For me, it was one corner of our dining room where I had a small bookcase for my textbooks, all the study materials I needed, and good computer access,” says Sauda. “I also set up a corner in my office at work to house my short assignment work that I could complete during breaks. Whatever you decide, do what works for you and make it a pleasant experience. You’ll accomplish more in the available time that you have.”
Bogue says that she would also set aside both time and a consistent place in her room to study. That helped her to balance it all.
“It is important to have a quiet place to study and complete coursework. A private, dedicated space will allow you to get work done, free from distractions. It is also important to get an early start on assignments, give yourself extra time to complete tasks, and seek help if needed,” says Clark.
Ask for Support
All our sources say that having a support network is crucial when you work and are going back to school. Your network can be family, friends, or even colleagues.
“Surrounding myself with people who were not in the program, but who cared and encouraged me either in person or via email, made all the difference—especially when I went through those difficult courses or when I felt like I couldn’t do it all. It’s the network that made a huge difference,” says Sauda.
Grossman takes it one step further. “You cannot be all things to all people. If you are usually the designated parent for carpool, can your spouse or a friend or neighbor help you out? I learned as a parent that if I can involve other parents in a way that we can help each other, both of us can be successful,” she says. “For example, I can do the morning pick-ups, and they can do the afternoons so that I could attend my classes and do my writing. If I am in charge of cooking meals at home, can I cook in bulk on weekends and freeze the meals or can my spouse help with the cooking?”
If you still need more help, Grossman says, think about hiring someone occasionally to clean or get your kids to help so that your work is reduced.
“Keep your lines of communication open to ask for help when needed and to keep instructors, your boss, and your family informed of any last-minute changes in schedule or areas where you need help,” recommends Clark.
Don’t limit your network to just family, friends, and coworkers. “I was scared when I took my first doctoral class. I had been out of school for over 15 years, and I was afraid that I couldn’t do the work. What I learned quickly was to ask for help, use the learning resources available online and at the campus, and develop a relationship with the faculty. As a faculty member myself, I can tell you that faculty want to help you reach your advanced education goals. They want you to be successful. Asking for help can really make a difference,” says Sauda. “One of my best experiences was in doing a literature search for a paper. I was not getting the articles that I needed to complete the paper, so I finally reached out to the university librarian. Within an hour, I had more than 20 articles that I was able to look at with her support. Not only did it save me time, but I learned the value of a librarian and library services when doing my research.”
Be Good to Yourself
To balance work, school, and life, self-care is essential. “Be patient and compassionate with yourself—this is hard work,” says Bogue.
McClung says that you have to make sure that the other areas of your life are good. To succeed, you have to make sure that you also take care of your health, relationships, and anything else that is important to you.
“Eat well, exercise by taking a walk before or after completing an assignment or after dinner with your family, and make sure to get proper rest,” advises Clark.
Grossman adds that, if you’re a parent, you keep tabs on any guilt feelings—and be easy on yourself. “Do not feel guilty about not being there when you can’t be and having your spouse or relative take over for you. This period is time-limited—not forever,” she says. “When my daughter ran track and field, they knew I could not be there for all the meets, but I could be present for some of them. I could do more on weekends than during the week because of my work and graduate school schedule.”
Totally Worth It
While this time may be difficult, it will also be memorable and fun. “The most important strategy for success is our attitude. Give yourself time to adjust to your new role as a graduate student. Like anything new, you will get the hang of it in time. Above all, make the most out of it, and enjoy the experience,” says Grossman.
Clark says to stay focused on both short- and long-term goals. “Be patient with yourself as you ease into becoming a student again.”
“The challenge and personal growth that came with pursuing an advanced degree helped me find my focus for future research and teaching,” says Sauda. “Always remember that the journey to advanced degrees is worth it!”