While enrolled in the Doctor of Nursing Practice program at my PWI (predominantly white institution), I expected to be in the minority. It’s not uncommon to see less minorities in PWIs, especially in graduate level education. My hope was that the workforce would be a little different. Why? In the workforce there are many people from all over who are transplanted in Greenville, North Carolina, my small college town. I live in a place that would not be exactly be hailed as a black Mecca, but it is still somewhat diverse. The population of my county is roughly 55% White, 34% Black , and 6% Hispanic. I was mistaken. It seems the few minorities that were in my town moved away shortly after graduating from the university, or garnering a few years experience in their field.
I cannot even begin to tell you how many people actually assumed that once I graduated I would move to somewhere like Charlotte, or Atlanta. So, as I set out for employment I accepted that there may not be many colleagues that looked like me. What I did not expect was for there to be none.
I happen to work within an organization that I feel supports diversity, and I have a supervisor who is very inclusive and appreciative of all cultures. What I could not help but wonder was “Am I the ‘twofer’?”
A few years ago, I was watching a spinoff movie called ‘What Women Want’ starring the amazing Taraji P. Henson. She plays a spunky black female sports agent. In this particular scene, she was discussing her value to the team with her boss, when he hinted that she was only employed at the company because of her ethnicity and gender. I remember her proclaiming “I am not your twofer!” That struck a chord with me. ‘Twofer’ would imply that you check the box for racial inclusion and gender inclusion in a predominantly homologous role.
Fast forward to today’s newly overt recognition of what many minorities already knew, that inclusivity matters. Duh?! One can’t help to wonder whether we are being offered new roles based off merit and education or off the sudden need for companies to show that they support diversity. Am I more likely to get a job now because I am a black Nurse Practitioner or because I am the right fit? For years, the running joke in the Black community used to be name your kid something simple so that when they submit a job application, someone will not overlook them due to their ‘ethnic’ name. This may be reverse now. Are we sought after because our names indicate clues into our race when we submit applications?
Here is the kicker, being the ‘twofer’ isn’t always a bad thing. Why? Well, a seat at the table allows you to pave the way for more chairs later. This is how we change the narrative. This changes the work place from being a secondary ‘PWI’. This means we don’t all flock to the placers that are more culturally diverse, we create that space where we are so that our whole nation becomes culturally diverse.
So, if the only way to get in the door is to be let in from checking the boxes, it is our responsibility to ensure that we remain at the table because we actually have the education, experience, and expertise to stay there and make it a better place because of us. Or better yet, remember the words relayed to Tara Jaye Frank by the late Dr. Maya Angelou, “You don’t have to give up your seat to anyone. You are just as worthy of that seat as he is, and you have every right to sit proudly in it.”
Flight/Transport nurses travel throughout the country and even throughout the world. An issue in the field, though, is that not many minorities are choosing this line of work. So, how can we attract more minority nurses to flight nursing?
Bob Bacheler, MSN, CCRN, CFRN, Managing Director of Flying Angels, as well as a Board Member at Large for the Air & Surface Transport Nurses Association (ASTNA), brought this to our attention. He then took time to answer questions about why more minorities aren’t in this line of nursing world and how they can become involved if they want to pursue it.
About how many flight nurses are there in all? Do you know what percentage are minorities? Why do you think that there has been a historic underrepresentation of minority nurses in the transport nursing field? Why aren’t more BIPOC working in this field?
The shortage in minority nurses is not unique to transport/flight nursing. According to the 2017 National Nursing Workforce Survey, the nursing profession is comprised of a workforce which is predominantly female and Caucasian. Eighty-percent of all nurses identify as white, twenty percent of all nurses are BIPOC, and seven percent of the overall nursing workforce is male (2017 National Nursing Workforce Survey).
Of the overall nursing workforce, over 165,000 nurses are providing direct patient care in the transport environment (Board of Certification for Emergency Nursing (BCEN)). The flight nurse workforce trends higher in male nurses (18% in flight nursing compared to 7% overall), but lower in the percentage of BIPOC nurses (13% compared to 20% overall). Given the competitive nature getting into flight nursing, it’s beneficial for potential applicants to get their Bachelor’s or even Master’s degrees and certifications such as Critical Care Registered Nurse (CCRN), Certified Emergency Nurse (CEN), Trauma Certified Registered Nurse (TCRN), Transport Professional Advanced Trauma Course (TPATC) and/or Certified Pediatric Emergency Nurse (CPEN).
Becoming a Transport/Flight RN is only the beginning of the educational process. Obtaining certifications such as Certified Transport Registered Nurse (CRTN) or Certified Flight Registered Nurse (CFRN) requires considerable effort. Maintaining those certifications as well as usual requirements of most positions require continued education. According to BCEN, the average transport RN has 16 years of experience, with 78% holding a Bachelor’s degree or higher, which is far higher than the average RN population. Most of the applicants for Transport/Flight Nurses come from critical care nursing positions.
While the underrepresentation of BIPOC in flight nursing could possibly be attributed to a number of factors, a primary factor could be lack of access to the licensure requirements/higher education credentials necessary to obtain a flight nurse position. According to the American Association of Colleges of Nursing (AACN) report on 2018-2019 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, nursing students from minority backgrounds represented only 34.2% of students in entry-level baccalaureate programs, 34.7% of master’s students, 33.0% of students in research-focused doctoral programs, and 34.6% of Doctor of Nursing Practice (DNP).
According to the 2018 AACN Healthy Work Environment National Workforce Survey Results, minority representation in critical care nursing has only increased slightly from 14% to 20% in the past 15 years. As identified earlier, critical care nursing is one of the primary career pathways to transport/flight nursing. Public policy interventions that would increase minority access to higher education could help to increase the number of minority nurses who enter the critical care nursing field, which would eventually increase the available pool of qualified applicants for transport positions.
Why are companies looking to hire BIPOC as transport nurses? What do they bring to the field?
As the percentage of BIPOC population increases nationally, companies realize that patients are often best served when the flight RN reflects the community they are serving.
Explain what a flight nurse does. Would someone need to get additional credentials to become a transport nurse?
Flight nurses are registered nurses that have specialty training to provide medical care as they transport patients in either rotor (helicopter) or fixed-wing (plane), or either by air ambulance or commercial aircraft. Flight nurses work with other trained medical professionals like paramedics and physicians. Helicopter RNs are often called upon to help transport critically ill or injured patients to trauma centers. Air Ambulance RNs are often transporting ICU level care patients long distances.
With Commercial Medical Transport, which is Flying Angels’ specialty, RNs are tasked with accompanying patients on commercial airlines transporting patients around the country and the world. These are people who need to be transported long distances, and while they do not need the ICU level of care provided by an Air Ambulance, they do require a nurse with significant experience and skill.
What are some of the benefits of working as a flying nurse? What are the challenges?
Each specialty—Rotor Wing, Air Ambulance, Ground Ambulance, and Commercial Medical Escort—have their own rewards. All have a higher degree of autonomy than nurses who work in hospitals. Rotor Wing nurses are saving lives every day, transporting critically ill patients from trauma scenes to hospitals. Air and Ground Ambulance RNs are practicing at the peak of their skills, in cramped quarters to make sure people are where they can get the best care. Commercial Medical Escort RNs are often reuniting families around the country and the world. In many cases, they are getting people home who would otherwise have no way of getting there. All share in the reward of doing good for their patients as well as sharing a high degree of job security.
Why do you think more minorities should look into this as a career choice?
All Transport/Flight RNs practice the peak of their skills and enjoy tremendous job satisfaction. Opportunities for Transport/Flight RNs are growing each year. Transport/Flight RNs enjoy an esprit de corps and a sense of community. They are also some of the highest-paid nurses working.
What would readers be most surprised about regarding being a flying nurse?
Being a Transport/Flight RN is often hard work, in cramped quarters, for long hours. The emotional toll can be draining. Adjusting to jet lag/time zone transferring can often prove to be difficult.
Is there anything else that is important for our readers to know?
Professional associations in transport/flight nursing promote the esprit de corps. These associations give you a place where you can connect with others and share best practices. Join a professional organization such as ASTNA, which has an employment job board, and attend conferences such as the Air Medical Transport Conference (AMTC).
Black Lives Matter. These three words have been used countless times in protests and in the media. As a result of the protests, more people are talking about racism and how it affects people who are BIPOC (Black, Indigenous, and People of Color).
Many nurses have experienced it. We interviewed three Black nurses to listen to their experiences with racism, learn how to begin conversations about it, and how allies can help.
Shantay Carter, BSN, RN, founder of Women of Integrity and best-selling author of Destined for Greatness, and nurse of more than 20 years, encountered racism back in nursing school. She recalls that some instructors would “try to wean students of color out of the program.” “I had instructors accuse me of cheating on tests or tell me that I would never become a nurse,” says Carter. Early in her career, she says, “I had patients say that they didn’t want a colored nurse taking care of them…I have had patients call me the N-word or threaten to hit me….I also experienced medical providers speaking down to me because they assumed that I am dumb.” Carter also got asked, “Are you the nurse?”
Bianca Austin, RN, BSN, CCRN, has been a nurse for 19 years. She works at an inner-city Level I Trauma Center as an intensive care nurse and is also a Major in the Army Nurse Corps, U.S. Army Reserves. Austin recalls an instance in which she and three other nurses, all dressed alike in navy scrubs, were waiting for their assigned rooms. The pod leader made the assignments based on having three nurses on duty. She had to be told that Austin was a nurse, even though she was dressed like the other nurses and wore a badge with her credentials.
Glenda Hargrove, BSN, RN, owner of Pill Apparel, has been a nurse for 11 years. She says that once a patient didn’t want her as their nurse because she is Black. Another instance occurred when she was the only Black nurse working on a unit and also the only nurse who was never invited to after-work staff outings. “At first, I tried to brush it off—until even the new nurses were invited, and I was not,” she says.
We asked all three nurses to weigh in on their experiences with racism and how to start the conversation.
If nurses experience racism, what would you suggest they do? How should they react?
Carter: “In situations where the patient is being really disrespectful, I have asked another nurse to care for that patient. As a nurse, I don’t have to be subjected to or tolerate someone’s ignorance. I also make sure to know the policy when it comes to escalating a situation to management. Knowing my rights as a nurse and employee of the institution that I work in is very important. If you encounter racism, I strongly recommend that you make your manager aware and HR if necessary. Racism and any other forms of discrimination should not be tolerated at any institution.”
Austin: “Use it as a teaching moment. Always be gracious.”
Hargrove: “There is really no easy way to answer this question. Racism has different types—it can be overt or covert. As the nurse, we have to always remain professional because like Michelle Obama said, ‘When they go low, we go higher.’ In some medical spaces, there is no one else who looks like you or even believes racism is occurring. As nurses, we are taught to advocate for our patients, but when experiencing racism, you have to essentially advocate for yourself and your right to practice in a racist-free clinical setting.”
How can nurses start the conversation about racism—and this may be different with patients, coworkers, and facility management? What steps should they take to make sure that if racism occurs, it doesn’t continue.
Carter: “As nurses, we have the power to create change. In order to have a discussion about racism, the hospital, community, and country has to be willing to talk about implicit bias, and system oppression. Joining an employee resource group or (BERG) is a great way, to encourage employees and leadership to come together to address the issues that are affecting their employees and finding solutions to make the workplace a better, more diverse, and safer environment for all. There also have to be policies in place to address those issues and have training on Diversity & Inclusion as well as on Implicit Bias. The culture and tone have to be set by the hospital leadership. Racism is something that can’t be tolerated or accepted.”
Austin: “The steps to take to make sure that racism is stopped is to not let an opportunity pass by to educate someone. Kindly let the person know the offense and explain why you were offended. They would tell us if we said something to offend them.”
Hargrove: “Nurses must start the conversation about racism by acknowledging the African-American nursing pioneers. Every nursing student learns about Florence Nightingale, but the majority have no idea who Mary Mahoney is. She was the first African-American Nurse to work professionally in the United States in 1879. When I started the brand, Pill Apparel, the mission has been to educate and acknowledge Mary Mahoney and her historic contribution to our profession.
“If racism occurs the only way to make sure it doesn’t continue is to NOT ignore it. Don’t let racism be the ‘elephant in the room’ but acknowledge it in order to learn from it and prevent it in the future.”
How can the community at large be an ally or offer support to BIPOC nurses in these situations?
Carter: “The community at large can be our allies by calling people out on their racist behavior towards others and standing with them in solidarity. BIPOC nurses would appreciate their friends and colleagues to stand up for them. We have to come together as one in the face of adversity. Just because you are not a BIPOC nurse, doesn’t mean you can’t fight against what’s morally and ethically wrong.”
Austin: “The facility I work for makes annual statements that they encourage diversity. It is a major player in the community with many business alliances. I would like to see more recruitment of BIPOC nurses, starting in high school. I believe the University and the hospital could improve enrollment and employment of BIPOC nurses if they start at that level, and the community could offer resources such as money, opportunities for shadowing, and help with preparation for nursing school.”
Hargrove: “We all know the difference between right and wrong. Martin Luther King Jr. said it best, ‘The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.’”
The UConn School of Nursing is pleased to announce it has received a nationally competitive grant award from the U.S. Health Resources and Services Administration for a groundbreaking program. The innovative “PATH to PCNP” Clinical-Academic Partnership aims to increase diversity among primary care providers in medically underserved communities in Connecticut.
The nearly $3 million grant will provide scholarship support to 24 undergraduate students with disadvantaged backgrounds each year for five years. Six students from each academic year – freshman, sophomore, junior, and senior – will receive scholarships starting in the 2020-21 academic year.
“The mission of the School of Nursing is to educate nursing scholars, clinicians, and leaders, with the goal of advancing the health of individuals, communities, and systems,” says School of Nursing Dean Deborah Chyun. “The funding provided through this innovative program for underrepresented students will enhance their ability to focus on their education and graduate with minimal debt, in the hopes that they will go on to serve the areas of our state that are most in need.”
The group of faculty members leading this initiative at the School of Nursing includes: Ivy Alexander, Ph.D., APRN, ANP-BC, FAANP, FAAN; Natalie Shook, Ph.D.; Marianne Snyder, Ph.D., MSN, RN; and Thomas Van Hoof, MD, EdD, FACP.
Despite efforts to recruit registered nurses with disadvantaged backgrounds to the School of Nursing’s primary care nurse practitioner (PCNP) master’s program, numbers of such students remain low, according to Alexander. In order to increase diversity among PCNPs, the School must first increase successful completion of the bachelor’s program among disadvantaged students, and without overwhelming debt.
The objective of “PATH to PCNP” (Provide Academic Transformational Help for disadvantaged nursing students to become Primary Care Nurse Practitioners) is to help such students graduate on time through a “fast track” undergraduate program. The partnership will: increase educational support for students with disadvantaged backgrounds; foster a sense of belonging and ability for positive self-care to reduce stress, anxiety and depression; and infuse primary care curriculum and experiences in medically underserved communities.
“Students participating in the ‘PATH to PCNP’ Program will have primary care experiences during their undergraduate nursing education and graduate ready to begin graduate school to become primary care nurse practitioners,” the faculty team says.
“PATH to PCNP” is a partnership between the UConn School of Nursing and Community Health Center Inc. Senior-level students in the program will complete a capstone clinical rotation at CHCI, gaining experience providing primary nursing care to patients with complex health issues in medically underserved communities. CHCI’s Chief Nursing Officer Mary Blankson, DNP, APRN, FNP-C, will lead the initiative at CHCI, which is one of the largest federally qualified health centers in the country.
National Association of Indian Nurses of America (NAINA) is celebrating the ‘Year of the Nurse and Midwife’ with a variety of activities throughout the year. NAINA, a professional organization for nurses of Asian Indian origin and heritage, collaborates with other national and international nurses associations in its journey towards professional excellence and improving global health. In 2019, NAINA joined the ‘Nursing Now’ global campaign. For the ‘Nursing Now’ campaign, NAINA selected three focus areas: enhancing clinical practice by continuing education, empowering nurses to become leaders at the bedside and beyond, and sharing examples of best nursing practices. In January 2020, NAINA joined the American Nurses Association’s Healthy Nurse, Healthy NationTM campaign as a champion organization to positively impact the health of its members and advance the goals of ANA.
NAINA’s upcoming national event on April 18th, 2020 will advance the goals for ‘Nursing Now’ and its commitment to the Healthy Nurse, Healthy Nation challenge thereby empowering nurses to take charge of their health and the health of the nation. NAINA’s 4th Leadership conference will be held at Howard Community College, Columbia, Maryland. This conference is designed for licensed health care professionals and pre-licensure students as well. This one-day event is designed to augment the knowledge, understanding, and appreciation for self-care, workplace safety, and promote resilience in nurses. The event will promote interprofessional learning and it will highlight how nurses can lead interprofessional teams from the bedside to the boardroom and promote health for themselves and others to build a healthy nation.
Deborah J. Baker, DNP, CRNP, NEA-BC, Senior Vice President for Nursing, Johns Hopkins Health System and Vice President of Nursing & Patient Care Services, Johns Hopkins Hospital will give the keynote address. Lois Gould, MS, PMP from American Nurses Association will address the participants on the topic of ‘Healthy Nurse, Healthy Nation: The Grand Challenge’. Mary Kay DeMarco, PhD, RN, CNE, past president, Maryland Nurses Association, Georgene Butler, PhD, RN, CNE, Dean, Health Sciences, Howard Community College, Maryland, and Bobby Varghese PhD, RN, CNE, Professor of Nursing, Broward College, Florida will speak on various topics related to the theme of the event: Healthy Nurse, Healthy Nation: Leading from the Bedside to Boardroom. Viji George, MA, BSN, RN, RNC-NIC will moderate the panel discussion on the domains of ‘Healthy Nurse, Healthy Nation grand challenge’ . Teams from several state chapters of NAINA will enact how to create joy and find meaning at work amid challenges and pressure.
NAINA is an ANCC accredited provider of nursing continuing professional development and nurses may earn up to 6.5 contact hours by completing this conference activity. Registration is open to nurses for this great educational event for an affordable price of $50.00. Please visit the NAINA website for details of the conference and other monthly NAINA webinars (www.nainausa.com).
For more than a century, nursing has been thought of as the domain of women. But that has fluctuated over the last few centuries. Men actually dominated nursing through the mid-19th century. During the Industrial Revolution, men began leaving nursing for factory jobs. Florence Nightingale led the advancement of women in nursing, targeting upper and middle class women for nurse training. In fact, men were not allowed to serve in the Army Nurse Corps during World Wars I and II. Today, as workplaces evolve, more men are entering the profession again amidst a nursing shortage.
About 13% of nurses in the U.S. today are men, compared with 2% in 1960, according to the Washington Center for Equitable Growth. However, in the high-paying specialty of nurse anesthetist, there is an equal number of men and women.
The United States is leading the way in the increase in the number of male nurses. While the U.S. rate of men in nursing was not much higher than in Switzerland and Brazil in 1970, it rose rapidly over the next several decades and far surpassed these countries in addition to Portugal and Puerto Rico.
The rise of men in nursing is due in part to a shift in available jobs, especially as traditionally male-dominated jobs in manufacturing jobs like automakers have been taken over by automation or moved overseas for cheaper labor. A recent study published in the journal Social Science Research reviewed eight years of Census data. The study found that of men who had worked in male-dominated industries and then became unemployed, 14% decided to enter industries dominated by women, such as nursing. Eighty-four percent of men who didn’t lose jobs moved onto traditionally female jobs. Unemployed men who got jobs in female industries received a pay increase of 3.80% when making the move.
Where the Jobs Are
Another reason propelling more men into nursing is a shortage of nurses. According to the Bureau of Labor Statistics (BLS), employment for registered nurses will grow 12% between 2018 and 2028, much quicker than the average of other professions. There will be a need for 3.19 million nurses by 2024.
California is expected to have the highest shortage of nurses, and Alaska will have the most job vacancies. Other states that will face shortages of nurses in the next few years include Texas, New Jersey, South Carolina, Georgia, and South Dakota.
One driver of the need for more nurses is the growth of the aging population, who will require more medical care. Job growth is expected in long-term care facilities, especially for the care of stroke and Alzheimer’s patients. The need for nurses treating patients at home or in retirement communities will continue to grow. The rise in chronic conditions such as diabetes and obesity also means more nurses will be needed.
Pay and Training
The median annual wage for registered nurses was $71,730 in 2018, according to the BLS. The lowest 10% earned less than $50,800, and the highest 10% earned more than $106,530. Those working for the government and hospitals earned the most.
But like many other professions, men are outpacing women in pay. Male RNs make an average of $5,000 more per year than their female counterparts, according to a study published in the Journal of the American Medical Association. This salary gap hasn’t improved since the first year the salary survey was done in 1988. The difference in pay ranges from $7,678 per year for ambulatory care to $3,873 for work in hospitals. The largest gap, $17,290 for nurse anesthetists, may explain why so many men enter that specialty.
The researchers note that increasing transparency in how much employees are paid could help narrow the gap. In addition, part of the pay gap may be due to women taking more time out of the workforce for raising their children. FiscalTiger.com suggests that offering adequate leave to both mothers and fathers after the birth of a child could have a role in making pay more equitable.
The Washington Center for Equitable Growth’s report suggests that the amount of formal training required to become a registered nurse may bring men into nursing from other occupations later in their careers. The minimum training for registered nurses is an Associate Degree in Nursing. Increasingly, employers are demanding more education, however. That includes earning a Bachelor of Science in Nursing (BSN) degree. RNs in the U.S. military must have a BSN, and the Veteran’s Administration, which employs the most RNs in the country, requires a BSN for promotion.
While men are still a minority in nursing, various programs offer support and networking. The American Association for Men in Nursing was founded in 1971 but shuttered in a few years. In 1980 it was reformed and now has thousands of members. It encourages men of all ages to become nurses and supports their professional growth.
Some nursing schools also have groups to support male nursing students. New York University, for example, has Men Entering Nursing (MEN), open to all nursing students at the Rory Meyers College of Nursing to discuss the concerns and perceptions that affect men and what it means to be a male in the field of nursing.