Did you ever look back upon your career and reflect on those humble beginnings? As educators, we sometimes forget that it was not easy to aspire to the higher academic goals we have been so fortunate to have attained. When we counsel our students, we must not disregard that they too have many barriers to overcome in their journey to be successful. In retrospect, we can embrace the challenges we must face in the effort to ensure our students’ academic success.
One morning during break, I overheard one of my student’s discussion with her colleague regarding how lucky she was that her children would be cared for over the weekend. This would allow her time needed to study for the final exam. Knowing this student, I was aware that she was a single parent and working mom, and more importantly, my student was pursuing a future career in nursing no less. It was a revelation that this fortunate incident for her was not expected, but was a gift. I began to ponder how this student would have prepared for the final if the childcare issues had not been resolved. Upon review, I realized that this student’s grades were not always consistent. During counsel, her excuses for poor grades or incomplete homework assignments were due to illness (whether be it her own or one of her children’s) or because of a busy work schedule, which entailed all shifts conceivable. So, when did she have time to study?
Lack of study time was also noticeable in the part-time evening students. I recall the blank stares on their faces during a Q&A session in preparation for the day’s lesson. Upon inquiry, the group confessed that
they had not prepared for the evening’s lecture in their attempt to balance work, family, homework, and study hours. The weekends had been relegated to study time in preparation for the upcoming week’s assignments, albeit incomplete. Add this to childcare, spousal duties, and familial responsibilities and you have one overworked, fatigued, and ill-prepared nursing student.
Many times, as educators we focus on the negative aspects of our students: the fatigue, lack of engagement during lecture or clinical, and the behavioral issues (tardiness, absenteeism, and disputes with colleagues). This can hinder our ability to focus on putting interventions into place to enhance our students’ learning abilities. We might complain about time consumed due to providing an inordinate amount of time with a student that was not responding to intense tutelage. Perhaps we should invest in discussions about the ever-changing policies affecting our curriculum or work hours. Somehow, the drudgery of this negative outlook overshadows a focus on the academic pursuits of those struggling to attain a portion of our accomplishments. We must be sensitive to the vulnerability of this population during their journey. Whether it be in the case of the traditional, the returning, or the recycled adult learner, financial constraints are taxing. Adhering to professional and attendance policies takes effort. Striving to maintain a precarious balancing act to function commendably in multiple roles are all central themes of the adult learner. In acknowledging this, it is incumbent upon us to assist our students in getting past these barriers.
I have contemplated methods to assist nursing students, which have resulted in better outcomes. Some interventions I have put into place have made the difference in my students’ success as evidenced in their test scores. The following interventions are worth noting:
Games: the Millennials love them. Who said learning should be boring? The younger generation thrives off the technological support, which surreptitiously enhances learning. The games can be competitive, informal, and applied individually or after breaking the class into groups. Games are used best when they can be accessed as a resource after classroom sessions as a study tool before testing.
Provide a quick recap at the end of class. Some students may be so attentive during lecture that they do not take notes that were imperative to have as a review for the next test. This is easy to rectify by providing a short review of pertinent facts at the end of the day, paying special attention to the material that will be included on the test. This quick review gives the learner another chance to process and make note of what the instructor was attempting to stress in the previous lecture(s). This may seem redundant, but we cannot forget that this is all new information for the learner.
Remind the student of your availability. I state my office hours on a weekly basis most emphatically after testing. This publicly reinforces my commitment to their learning needs and hopefully abates their reluctance to seek my instruction.
Review one-on-one over the previous tests taken with students who have scored poorly. Allow the student to reflect, write, and question the material covered in the test(s). Educators have gained insight about their students during these sessions (e.g., what type of learner they are, if there are linguistic barriers, and/or if there is a lack of effective study habits). This session also establishes a rapport between you and the learner, which can be motivational.
Allocate extra time to be available for hours before testing. You would be surprised to see how many students will attend for review after a long, clinical day in anticipation of a test pending the next day. Is it more time consuming? Not nearly as much as counseling them one-on-one would be.
These are a few tips I have used to incorporate in teaching my students before I notice a decline in test scores. As I look back on my humble beginnings, I realize that the barriers I encountered are not so different. I am fortunate enough to have had support and encouragement throughout my career as a student and as a practitioner. It is as challenging for both the educator and the learner; diligence is required from all parties. But we are in the trenches together. We all had to start somewhere.
Few nurses have a solid grounding in personal finance about making decisions about their own financial future. Money management can be overwhelming. But you don’t need to learn the fine points of microeconomics – just the fiscal facts that pack a wallop on your wallet.
The good news is that the economic outlook for most nurses is rosy. Employment prospects are strong, says Donna Cardillo, RN, nurse entrepreneur and inspirational/motivational speaker. “The job market for nurses is much better. The market is cyclical and always has been. The last slump lasted about seven years, but that has all changed and many employers are now offering sign-up bonuses,” she explains.
The bad news? Many nurses still struggle to lead financially empowered lives, rather than being slaves to debt or just getting by paycheck to paycheck. Here are nine ways to make powerful personal and career decisions.
Evaluate an Employer’s Salary and Benefits Package
Often nurses decide to accept a job offer based only on the hourly wage, without being aware of the entire salary structure and how it can drastically pump up your pay.
Jon Haws, RN, CCRN, nurse educator and founder of NRSNG, wrote a popular article about how he doubled his first-year earnings as a new nurse. In “How I Made Over $70,000 My First Year as a Nurse (how I learned to game the system),” he recounts his experience as a newly graduated critical care nurse at a Level I Trauma center in Dallas, Texas.
According to Haws, that article “is a bit dated and I realize the $70,000 is nothing to a California nurse, but I outline some step-by-step ways to really maximize what you can make right out of school.”
Some of his steps included grabbing the pay differential for nights and weekends, getting an automatic raise after 6 months and a year, and working overtime and bonus shifts. That strategy requires that you make yourself an expert on your HR department or union contract rules, of course, which may be difficult before you’re hired. Not every employer is transparent about its pay policies. It’s easy enough to check Payscale.com or Salary.com for comparisons. Also, be sure to consult with a tax professional about the ramifications of higher compensation—you want to be ready when the tax bill arrives.
“The benefits package is something that employees don’t always take into consideration, but it can be significant,” says Launette Woolforde, EdD, DNP, RN-BC, vice president for nursing education and professional development at Northwell Health in New Hyde Park, New York.
She encourages nurses to plan for the next step of their education and especially note those related benefits. “Some organizations offer employees some sort of tuition reimbursement plan. When you get a job and get through adapting to your new role as nurse, that’s the time to take advantage of those benefits.”
According to Woolforde, some organizations provide employees with a discounted rate or deferred payment options for a number of nursing schools. “So a $500 a credit may be reduced to $400 a credit and the student isn’t invoiced until after the class is over. By then the tuition reimbursement will have kicked in so students don’t suffer out of pocket expenses that disrupt their cashflow,” she says.
In addition, many organizations pay a stipend or differential based on a nurse’s educational achievements. “For example, let’s say the salary is $50,000 a year to start, but if a nurse has a bachelor’s degree, they may add $5,000 a year. If you’re certified they may add even more,” she explains.
Decide on Your Financial Priorities and Make Every Step a Learning Point
There may be a sunny employment outlook for nurses, but you still have to earn and save to fund your priorities. Not every nurse will have the same financial needs and not every nurse will experience life transitions in the same order. Yet, there are some goals, such as starting a family, buying a house, or early retirement, which many nurses aim to achieve and can—with some work on their inner and outer game.
“I made $35,000 or $45,000 my first years in nursing and had to figure out a way to increase income or reduce spending,” says Brittney Wilson, RN, BSN, nurse influencer at TheNerdyNurse.com. “I opened the door to those possibilities.” Wilson carried $40,000 in student debt that she now believes was avoidable, if she’d lived at home, attended a community college, worked a part-time job, etc.
As a young wife and mother, she tried many methods to economize, as she wasn’t emotionally able to work more hours at the bedside. “One example, I tried extreme couponing and was able to take our $600 grocery bill down to $100. I had to figure out a way to get diapers and formula for my baby,” she explains. Wilson started her blog a couple of years later, mainly for personal expression, but she also started getting free products and fees from brands. “People kept offering me money but initially I felt some guilt about it,” she says. “When I came to terms with it and actively decided to monetize my blog, I hung the ‘I’m available to be paid’ shingle directly, and even more offers came in.”
As Wilson felt more and more confident that she was providing a valuable service, she increased her ad and consulting rates, and focused her blog on her nursing specialty. “Earning extra income is like walking down a hospital hallway. It’s a journey. You can open each door and look around or keep going down the path. Just keep opening doors until you find the one that is right for you,” she advises other nurses.
Wilson got so good at earning and saving that she and her husband are on-track to pay off their house mortgage in a little over five years.
If you’d like to get better at the nuts and bolts of budgeting, bill paying, and tracking various financial accounts, you may want to try apps and programs like Mint.com. By corralling everything into one place, you get a better handle on your spending and saving, and can see in charts and graphs how well you’re doing with your finances.
There are also minority personal finance experts you can follow for advice from someone who figuratively speaks your language. For example, African American pros include Michelle Singletary, who writes “The Color of Money,” for The Washington Post and syndicates. Or, if you prefer podcasts, Rich Jones and Marcus Garrett host Paychecks & Balances for Millennials aiming to pay down debt
Decide When to Make Major Purchases
Even if a purchase is appropriate for your life stage, try to minimize your total household overhead. Even well-paid nurses risk fatigue from worry or overwork to manage bills and payments for one-time splurges or ongoing financial commitments.
Woolforde encourages nurses to carefully consider whether a major purchase is a sound money investment. “I see this often—the first thing a nurse graduate buys is a flashy, brand new car, as a reward for all that hard work in school. A flashy new car is nice but it’s a rapidly depreciating item as opposed maybe holding out for a down payment on a new home that appreciates for a good long-term return,” she explains.
You might decide that your next major investment will be in your own higher education or specialized training. If so, be sure to take advantage of employer-provided assistance programs before taking out large student loans. Maybe your current workplace has a tuition reimbursement plan if you’ll commit to working there after graduation, but you hesitate to limit your options. Find out how often graduates using that program decide to stay with that employer; usually the figure is high. If your circumstances and goals match theirs, you’re likely safe in taking the same route.
So many students lament how little they knew about educational loans that a free interactive game called Payback was created by a financial literacy non-profit. The makers warn: “College can help you realize your dreams, unless it leaves you with a student loan nightmare.” Students navigate an online maze of decisions: What school to attend, what major to declare, whether to focus on studies for a higher GPA or social life for more connections, etc. At the end, if a player does decide to borrow educational funds, it’s with eyes wide open.
Choose a Specialty That’s Fulfilling—And Remunerative
Whether you’re a new nurse graduate or you’ve been in the field for years, now might be a good time to switch to a specialty or workplace with better long-term prospects for pay and benefits.
Cardillo encourages nurses to explore non-traditional career options and to take risks. “Your next job may not pay as much, but may have many other advantages. When it comes to being a bedside clinical nurse in a hospital, there’s only so much you can make, even with overtime. Some other health care related industries have greater earning potential over the long run even if you have to take a pay cut in the short term,” she says.
Cardillo points to a variety of popular nurse settings and roles that pay well, such as: Nurse informatics, quality management nurse, corporate wellness nurse, insurance nurse, or nurse consultant.
You may also want to check out DiscoverNursing.com for interactive features that guide you through the process of choosing from scores of specialties. Some under-the-radar titles have surprising rewards, including high demand or ease of entry. You’ll get information on the education, training, and certification required to fill a role, as well as its average salary and employment outlook.
Decide to Cut Hours or Leave the Bedside Altogether
Reducing your hours to, say, care for a family can be a difficult choice that depends on many conditions, but it can be the right choice, if done right.
“If you opt to get out of the job market for a while, stay in touch with nursing colleagues through professional associations [and] keep up with credentials and licenses,” advises Cardillo. “Keep yourself current, marketable, and connected.” She warns that nurses who let their licenses lapse—accidentally or not—won’t be ready to jump back in when they need to or want to.
“Some nurses drop out of the workforce to take care of elderly parents, but then the parents die and they’re left with literally nothing and can’t find a job,” she warns.
Cardillo recommends that you first explore opportunities to work at home, which are more common today for nurses. If that’s not possible, check to see if your state allows for an inactive status license, rather than outright letting it lapse.
Another life stage when nurses may be tempted to let their license lapse is at retirement, but Cardillo sees downsides to that. “Nurses retire, but after so many years they get bored or financially need to work again because they don’t want a lower standard of living.”
Care for Yourself and Your Career Longevity
“Nurses are leaders—they advocate for their patients, but they struggle with advocating for themselves,” says Diane Neustadt, director of operations at New York-based Forest Hills Financial Group.
Her firm supports the National Association of Hispanic Nurses New York chapter, of which Neustadt is an active member. Because of her involvement with the chapter, she’s able to explain the importance of managing one’s own financial life in terms that nurses relate to. “I tell them it’s like being proactive about your own health. Nurses work long, unpredictable hours so self-care is so important: physically, emotionally, and spiritually. I’m a spiritual person and also know the importance of financial well-being—live one day at a time but not just for today.”
Neustadt believes in “protection first,” which means having enough insurance and the right kind. “Employer-sponsored benefits are a good thing,” she explains, “but not only may company benefits not be portable and go with you, generally those employer-provided benefits are minimum benefits and should be viewed as the base of benefits to build upon. Three areas that normally need attention are disability, additional retirement income, and long-term care.”
Make the Most of Expertise from Family, Friends, and Coworkers
Woolforde received informal money mentorship from two unexpected sources who guided her to become financially savvy. The first was her older brother, who went to college when she was in her senior year in high school and was surprised at the expenses beyond tuition that he hadn’t anticipated. “When he came home at his first break he told me frankly, ‘You’re going to have to get scholarship money if you plan on going to college.’ So, we spent countless hours in the library combing through books and catalogs looking for scholarships. That was before everything was available online.”
She was doubtful about her ability to garner scholarship funds—others will have a higher GPA, more financial need, better applications. “At first, I said, ‘there’s no way I’m going to get it’ and he said, ‘you don’t know until you try,’” she explains. After piecing together several small scholarships—$600 here and $2,000 there from various sources—Woolforde was able to fund her freshman year at a commuter college. Good grades allowed her to garner full scholarship funding for the rest of her bachelor’s degree in nursing.
Woolforde next got valuable advice from a nurse preceptor who insisted they visit the hospital credit union after one shift. “She helped me open a retirement account and set up direct deposit of part of my paycheck into that account. I was just starting my career, so retirement was the farthest thing from my mind as a 21-year-old,” she says.
Try to find a money mentor who understands your situation and connects or relates to you in that way, advises Woolforde. “My brother understood the home situation and my preceptor maybe recognized me as her younger self—she was an African American female, too. Everyone who has walked this path, grown in professionalism, grown in a nursing career, it’s our responsibility to share what we’ve learned,” she says.
Make the Most of Your Employer’s Financial Programs
Your organization may offer employee benefit education, such as having an HR representative provide short updates at staff meetings, or making a vendor available for one-on-one consultations. Take advantage of these resources if they can help you fill in the financial puzzle pieces of your life.
“My family emigrated from Armenia when I was nine years old,” says Anna Dermenchyan, RN, MSN, CCRN-K, senior clinical quality specialist in the Department of Medicine at UCLA Health and a PhD student at UCLA School of Nursing. “At the time, my parents didn’t know the language or the culture, and thus we struggled financially as a family.” When she worked at a bank as a senior in high school, she learned about financial concepts and became more proactive about managing money.
Dermenchyan now actively engages with the University of California system’s excellent financial program for employees and students, which include onsite classes as well as live webinars on financial wellness and retirement.
“I’m an early Millennial and we think about work-life balance and living in the moment, and this necessarily doesn’t help us save enough money for the future. We want to earn, spend, travel, and just enjoy life,” she explains. “However, financial health is part of achieving wellness and maximizing potential benefits for the future. Just like with Maslow’s hierarchy of needs—personal finance is at the basic level, and everything rests on it.”
Most nursing schools don’t include a financial component in the curriculum, so many workplaces fill in the gaps with seminars, consultations, and program “nudges” to encourage fiscal health. “At first, I just put in $100 a month towards retirement; that’s what I could afford after paying loans and family expenses,” says Dermenchyan. “The automatic deduction from each paycheck makes it easier, and some institutions make a matching contribution. In addition, I was advised by a financial consultant that with every salary increase, I should increase my contribution to retirement,” and she has continued to ramp up her rate of saving and investing.
Prepare for Retirement
Some nurse leaders point to numbers of disengaged older nurses who are forced to continue working because of under-funded retirement plans. They didn’t put aside enough money for the future, and early social security payouts at 64 are too small to support even modest lifestyles.
“Nurses are unlike other caring professions—police, firefighters, and teachers—because they don’t earn pensions from municipal government employers,” says Ric Edelman, a #1 New York Times bestselling author of personal finance books such as The Truth About Money and The Truth About Retirement Plans and IRAs. “That puts their financial future in jeopardy.”
Edelman is also the founder of Edelman Financial, one of the nation’s largest independent financial planning firms. His firm offers a free financial plan to nurses, waiving its customary fee for the two-meeting process—either in person or via teleconferencing—which results in recommendations for investments, insurance, estate planning, and more.
By starting the process toward financial stability and independence, you can empower yourself as an earner, saver, and investor. It is possible to experience the feeling of security that comes from having your financial life firmly in hand. This moment is the best time to take that first step.
February 5 through 11 is a national observance of National PeriAnesthesia Nurse Awareness Week, sponsored by the American Society of PeriAnesthesia Nurses (ASPAN). Nurses who help transition patients pre- and post-procedure are there to offer intensive medical care and equally essential caregiving. They especially want patients to know they are there for them. They are their advocates throughout the process.
If you are interested in a career as a perianesthesia nurse, you’ll find the challenges of the position range from using your advanced nursing skills in urgent situations to incorporating the most basic hands-on comfort skills. Charged with caring for patients at critical pre- and post-procedure points, perianesthesia nurses must be able to multitask, to identify and respond to patient conditions immediately, and to do this all with a calm demeanor to help keep patient stress at bay.
Perianesthesia nurses especially enjoy their work caring for patients before and after procedures that require any anesthesia. Before a procedure, they are the nurses who are there to find out any information that could have an impact on the anesthesia care. With more and more patients appearing with several health conditions, they have to factor in variables like medications, physical condition and limitations, and emotional stability in their patient assessment. While they are assessing and gathering information, they are also providing a calm and unwavering support to help nervous patients know they are in trusted hands.
Perianesthesia nurses are also there when patients come out of anesthesia and are sometimes confused, uncomfortable, or even nauseated or vomiting. Post-procedure, nurses are once again continually monitoring a patient, assessing vital signs, reassessing existing health conditions, and at the same time, offering that hands-on caregiving that helps patients feel safe. Perianesthesia nurses then help determine how a patient can safely move to their next place whether that is to home, another hospital, or another care facility.
Many perianesthesia nurses say they have perfected a way to develop a rapport with patients that can build the trust necessary for completing such a long task list in a short time and under pressure. Once a nurse has identified a topic that helps the patient relax, they can begin conversations about family, pets, schooling, movies, or books that are both informative for nurses and distracting for patients. Many nurses also say they use those nuggets in the conversation to help bring a patient out of a drowsy and sometimes confused anesthesia.
For those considering this branch of nursing, ASPAN offers many resources and is an excellent reference to find out information about certification (through the American Board of Perianesthesia Nursing Certification, Inc.) that must be renewed every three years, scholarships for education, career resources, mentoring opportunities, conferences, and up-to-date anesthesia information.
This week, recognize and appreciate the perianesthesia nurses on your team. Their skills often help the entire procedure proceed smoothly and safely.
Nursing education is done a little differently at Linfield College. We pride ourselves on creating innovative methods in which aspiring nurses can learn and grow into strong and competent professionals. One of the many ways in which that is done is through our simulation program. Our simulation program is run out of our experiential learning center (or ELC); it includes low, mid, and high-fidelity simulations. With these simulations, our students go in one by one to care for the patients individually for ten to fifteen minutes at a time with each student picking up where the other one left off. They plan the care together using what’s called a mega brain and prioritize the patient’s needs within the plan prior to the start of care for the patient. We have not witnessed this method being used at many facilities.
The students have the option of continuing care as the previous student or changing the plan; they are all the same nurse so if they are in the middle of a task then they are able to continue with that task without starting the steps over again, which saves time and enables them to carry out the task. In the past, we had found that having each student start over took away from the simulation experience and that the students were more focused on the task instead of the patient. This brought about the solution of one mind nursing. The students have found this to be extremely helpful and have verbalized how this increases the realism of the clinical simulation by having them think like a nurse, especially with the situation of end of shift or hand-off. In this situation the students have to consider what is the best option if they receive hand-off in the middle of a nursing task. This is one of the aspects that increases realism.
Another method of increasing realism comes from the use of alumni. We use alumni as family members during the simulation (we have a manikin or a standardized patient as an actor). During the simulation, the alumni act as though they are the family members dealing with that situation. After the simulation is complete, they help with debriefing after we walk through the case and ask high-level critical thinking questions to stimulate reflection, retention, and transference. They tie in clinical examples of how it relates to their clinical practice and emphasize why the clinical reasoning and actions based on clinical judgement are so important. The students enjoy having the alumni because they have shared their experience and have gone through what they have experienced and have become successful after it. The alumni serve as additional mentors and role models in this way, offering advice and further insight into the role of nurses. With this addition to our clinical simulation program, we have created a more realistic and enjoyable experience for our students.
Planting the health policy seed has become increasingly important to professional nursing organizations, nurse educators, and even nursing students who applaud the call for integrating health policy and advocacy content in today’s nursing curricula. As nursing students become acquainted with the policymaking process, they are also encouraged to familiarize themselves with the various professional and specialty nursing organizations who advocate on behalf of the nursing profession and the patients/consumers they serve.
Numerous nursing organizations including the American Nurses Association (ANA), National Council State Boards of Nursing (NCSBN), and National League for Nursing (NLN), to name a few, work to ensure that nursing’s voice is represented during policy discussions on issues that impact health care delivery, patient outcomes, nursing workforce development, and other issues of concern to the profession. These and other organizations advocate to ensure that students have financial support to attend nursing school, have access to loan repayment programs, and support to advance their nursing education and training. These organizations work diligently to help ensure that today’s nursing workforce is well prepared to meet the demands of providing high-quality health care services in an ever-changing complex and challenging health care environment.
Suzanne Miyamoto
In this article, we present information about the American Association of Colleges of Nursing (AACN) and share insights from AACN Chief Policy Officer Suzanne Miyamoto, PhD, FAAN, RN.
The American Association of Colleges of Nursing
Since 1969, AACN has been a leader in advancing nursing education, research, and faculty practice. Moreover, AACN serves as a national voice for baccalaureate and graduate nursing education. In addition to creating standards for designing and delivering quality nursing education programs, AACN represents over 810-member schools and colleges of nursing nationwide. The AACN has a Government Affairs Committee and a Health Policy Advisory Council that coordinate and spearhead several public policy initiatives and activities focused on advancing nursing education, research, and faculty practice. Currently, the association’s federal policy agenda focuses on four key areas: workforce, higher education, research, and models of care—all ongoing public policy imperatives.
Here, Miyamoto shares some insights about her organization and health policy advocacy.
Describe Your Role and the Role of the AACN in Preparing Today’s Nursing Students in Becoming Influential Advocates in the Health Policy Arena.
As Chief Policy Officer, I oversee AACN’s policy and advocacy work at the federal level working with all three branches of government. My role and that of our team can be described as strategist, lobbyist, and analyst. To ensure we meet the needs of our member organizations, the association has a Government Affairs Committee and Health Policy Advisory Council that provides guidance when we are reviewing legislative proposals or federal regulations. We want to ensure that what we support, oppose, or remain neutral on is in line with the experiences or challenges of our member institutions. AACN is in a unique position that we represent the schools of nursing, which includes the deans, faculty, and students. This requires our advocacy work to be nimble and abreast of the key issues Congress and the Administration are discussing. It is our role to not only develop the strategy but to educate and inform our membership on our position and why we take it. Information is the best offense and the best defense. That is why AACN fully supports all members of a nursing school to be engaged in our advocacy efforts. We have a grassroots network with other 11,000 students, faculty, and deans. This network has great potential to grow and offers real-time, advocacy opportunities.
What Are Some Top Priority Policy Issues Impacting the Profession and Health Care Today?
Some key issues impacting the profession today include
• Securing funding for Nursing Workforce Development Programs, Title VIII of the Public Health Service Act, National Institute of Nursing Research, National Health Service Corps, among others
• The Title VIII Nursing Workforce Reauthorization Act (H.R. 959, S. 1109)
• Health reform
• Deferred Action for Childhood Arrivals (DACA)
• Public Service Loan Forgiveness
• Opioid epidemic
What Can Students Do Within Their Area of Influence to Advocate for the Profession?
It is important that students stay informed of the issues. Students need to be active participants in their own learning. To understand what is happening at the federal level, a student must embrace the policy from multiple lens. It is not enough to read one source or one disciple. To truly garner the depth and breadth of the issue, the more voices, for and against, the better one’s understanding becomes. Securing a basic level of knowledge on an issue that may impact one’s education, research, or future practice is an excellent starting point.
Grassroots campaigns are central to any of our efforts. We can be more effective if we know how our national organizations are weighing in on issues. It’s also important to listen to all perspectives. Again, policy think tanks like the Center for American Progress or the Heritage Foundation may have different political viewpoints, but on some issues, they may see eye to eye. Their rationale for getting there may be different, but it is that difference that can help further an argument depending on the audience. Students can also join forces with faculty and others to reach out to legislators at the federal, state, and local level on issues important to nursing. Discussing issues with nursing faculty, who can serve as tremendous mentors for those interested in policy, can ignite a passion for this work in the future. That is how I came to seek a career in health policy and advocacy. It was the foresight of my faculty mentors who gave me the opportunities to succeed.
What Resources Are Available for Nursing Faculty Who Are Preparing the Next Generation of Health Policy Activists?
AACN established a Faculty Policy Think Tank that worked to prepare a set of recommendations for AACN’s Board of Directors on this exact question. The charge of the group was to inform and improve the state of health policy education in undergraduate and graduate education. The ultimate goal was to consider ways that will help create a generation of future nurses who understand the micro and macro drivers that impact policy—most importantly, how nurses in the future can continue to skillfully insert nursing expertise into policy discussions. The report was released in October 2017.
Turning to the continued need for policy advocacy at the student level, AACN also offers a three-day student policy summit open to undergraduate and graduate nursing students enrolled at AACN member institutions. The program helps to prepare students to engage in policy advocacy and the federal policymaking process. For more information, visit http://www.aacnnursing.org/Policy-Advocacy/Get-Involved/Student-Policy-Summit.
As mentioned earlier, AACN’s 2017–2018 Federal Policy Agenda is well suited to serve as a foundation for shaping policy discussions during online and classroom discussions as well as during virtual and/or actual lobby days. Students are encouraged to speak with their deans and faculty at their nursing programs to learn more about what’s happening within their institutions regarding public policy advocacy efforts that impact nursing education and nursing practice.
Seeking Federal Support for Nursing Workforce Development Programs: A Clarion Call for Continued Advocacy
Very central to this discussion is the need for ongoing advocacy to secure funding to support Title VIII programs. Title VIII programs are administered under the U.S. Department of Health and Human Services, Health Resources and Services Administration. The Nursing Workforce Development Program (Title VIII of the Public Health Service Act) continues to benefit countless numbers of nursing programs, practicing nurses, faculty, students, patients, and communities. In fact, numerous minority nurses continue to benefit from diversity grants because of Title VIII funding. During 2015–2016, the Nursing Workforce Diversity grants supported 7,337 students. Numerous other minority nurses, including minority nurse faculty, have received funding through this program to support their advanced nursing education or pay back student loans. To learn more about how Title VIII programs are making a difference for nursing students, practicing nurses, academic institutions, and communities at large, visit http://www.aacnnursing.org/Policy-Advocacy/Title-VIII-Community-Impact.
As a nursing student, speak with your faculty and professional organizations about how you can play a role in policy advocacy. Throughout nursing’s history, nurses have made a tremendous impact in advancing the profession and the delivery of health care by advocating for issues of importance to them. Developing your knowledge base about these and other issues impacting the profession is a great first step to becoming an influential advocate on behalf of the profession and the patients and communities you serve.
There have always been challenges facing nursing students. What are the biggest ones today, and how can students deal with and overcome them? Some experts weigh in.
Frederick Richardson, a BSN student and the Breakthrough to Nursing director for the National Student Nurses’ Association, had no doubt about how much of his time would be taken up when he began attending nursing school. Yet, he says, this seems to be one of the toughest aspects of attending nursing school that students struggle with.
“One of the biggest issues that nursing students face is time—making time for everything,” explains Richardson. “Nursing school is very demanding, and when you add in the coursework, reading for homework, and the clinical work, there usually isn’t time for anything else.”
Richardson says that he was fortunate enough to learn about this before choosing to attend nursing school. His older brother had attended nursing school, and Richardson saw firsthand how often he didn’t see his brother during that time. “He would be at the library studying, at class, or at clinicals,” recalls Richardson. “When I’d see him, it would be late at night. And he would be out of the door first thing in the morning. At the time, I recognized that when I would get to nursing school, I would probably have a similar schedule, and sure enough, it’s been exactly the same way.”
To overcome this, Richardson says that students need to have perspective and be realistic regarding what they can accomplish in their lives while attending such vigorous programs. “Our schedules can get really hectic. But I think that when you get into nursing school, you have to recognize that you’re going to devote the majority of your time to your nursing program. A lot of students don’t realize that,” he says.
Students need to set their priorities straight and decide how they are going to organize their time. Richardson, for example, says that he had to learn how to plan his time, organize his life and tasks on a calendar, and then follow that calendar every single day. From his perspective, quite a lot of students expect to attend nursing school and still have an active social life and do everything they did before, like watch all their favorite television shows.
“I think that the trouble students run into is they believe they can have everything—do well in nursing school, have an active social life, et cetera. If they go in with that kind of view, I don’t think they’re going to survive nursing school,” says Richardson. “They’re going to have to sacrifice a lot of that time, but once you get into it, it gets a bit easier.”
Martha A. Dawson, DNP, MSN, FACHE, assistant professor and coordinator of Nursing and Health Systems Administration at the University of Alabama at Birmingham School of Nursing, as well as the current historian for the National Black Nurses Association, agrees that having enough time can be an issue for nursing students. Traditional nursing students still face challenges that relate to study time, finances, and part-time work. In addition to the challenges of traditional students, however, second degree nursing students, such as those in a BSN to MSN bridge or other accelerated degree program, may also have immediate family obligations, explains Dawson. For instance, some may be primary caregivers for older parents. “Many students in these new and emerging programs are older, and these added life demands can lead to both high stress and exhaustion,” she adds.
Money, Money, Money
Richardson and Dawson agree that financial issues can also be a big challenge for nursing students. Dawson says that with the varying nursing programs and the older student population in them, these students may have greater financial obligations besides school, like a mortgage. “The current economic climate is making it more difficult for students to gain access to scholarships, trainee grants, and other forms of funding without going further into debt,” says Dawson.
In addition to taking out loans to attend nursing school, Richardson says that there are a number of scholarships available for students. Believe it or not, though, not a lot of students are applying for them. “There are a good number of scholarships available,” says Richardson. “After speaking with some people who have scholarships or who fund scholarships for students, I’ve discovered that they’re not getting a lot of applications. One reason is because of the time. A lot of students don’t know that the scholarships exist, and a lot who know they exist feel like they don’t have the time to fill out the applications because of the high demand of nursing school.”
The reality, Richardson says, is that studying takes up so much of the students’ days that many don’t think they could take the time to do what some scholarships may require in their applications—like get a letter of recommendation, write three essays, get transcripts, and the like.
Recently, Richardson had a heart-to-heart talk with a student who was frustrated because of going to school, clinicals, and a part-time job. “I said, ‘If you took about three hours applying for a scholarship, you would get more money to help you out with your school fees,’” says Richardson. He continued to explain to the student that he was working twice as hard and putting in twice as many hours at his part-time job to make the same amount of money that he could get if he applied for a scholarship—which would ultimately free up more of his time. “It would help the student more in the long run,” says Richardson.
Family Support
Along with not getting enough financial support, some nursing students don’t have as much family support, says Rebecca Harris-Smith, EdD, MSN, BA, dean of Nursing and Allied Health at South Louisiana Community College. “Nursing classrooms across the nation are filled with an intergenerational, multicultural group of students that range from millennials to baby boomers,” explains Harris-Smith. “This nontraditional classroom of students has many that are parents who frequently do not have siblings, parents, or other relatives to assist them with child care. The expense of child care, transportation, and after-hours coverage often impacts the nursing student’s classroom, clinical, and study time.”
Richardson says that family support and encouragement is often needed, but not every student has it. “I noticed immediately that I needed a lot of support,” says Richardson.
Communication
“In my personal experience, soft skills as they relate to interpersonal people skills have become an issue for nursing students. The ability to communicate both verbally and in writing appears to be a challenge,” says Harris-Smith. She says that because Gen Xers and millennials have grown up with a lot of technology, they have spent a lot of their early years communicating that way.
“Basic socialization has changed in that the younger generations would prefer to text over having a verbal conversation. The lack of appropriate communication skills has an impact on the students’ ability to work collaboratively with physicians, fellow nurses, and other members of the health care team,” explains Harris-Smith.
“Effective communication is essential due to the intra- and interprofessional team collaboration essential in the health care arena,” Harris-Smith explains. “Additionally, nursing students must learn flexibility, professionalism, and a strong work ethic—which are essential to the development of the new nurse graduate. Being able to adapt to an ever-changing environment is important as health care facilities have staffing issues often requiring nurses to work beyond their shifts.”
Challenges for Minority Students
Although the challenges for nursing students are often the same for students of color and those who aren’t, “students from underrepresented groups in the nursing profession and in society . . . have them on a much larger scale,” says Dawson. “There are barriers and biases that these students experience such as academic skills, perceived perceptions about their abilities, lack of faculty role models, limited peer support, and major financial issues that ‘majority’ students do not have to deal with on a daily basis. Many minority students also struggle with the very basics of housing and food.”
An additional burden that minority students face, says Harris-Smith, is that of access and equity in education. “A selective admission process is used by schools of nursing across the nation, and this very process can serve as a barrier for students of color. Academic profiling of students ensures admission of the most academically prepared students that rank highest among their peers, but students from underrepresented populations are often the first-generation college students that struggle with the issues of being the first in the family to attend college. This situation places a heavy burden on the student because s/he may be dealing with the pressure of being the ‘savior’ for the family. These students are generally not savvy enough to apply for multiple college programs, have difficulty completing financial aid forms, and generally come to college with limited resources,” says Harris-Smith.
“Nursing programs tend to address diversity in their mission statements but fail to explain how this is accomplished. Merely placing the statement in the mission statement does not explain how the school of nursing addresses the issue. To ensure transparency, each school of nursing could better address this issue by providing information on the way in which this mission is accomplished,” says Harris-Smith. For example, she says, schools could use a statement that’s more explanatory: This school of nursing addresses diversity via academic profiling of students but is careful to admit a diverse student body that resembles the demographics of the community in which we live.
“There is a need for schools of nursing to restructure their admission process to address the lack of the underrepresented students in attendance at their colleges and universities,” Harris-Smith adds.
Richardson says that’s why he is a part of the Breakthrough to Nursing committee because its goal is to increase diversity in the nursing profession. Another challenge he’s seen is that some minority students don’t last in nursing school because they have different ways of learning. “Culturally, students from different backgrounds learn differently. I’m a kinesthetic learner. If you show me how to start an IV, I will know how to start an IV more efficiently than reading three chapters about how to start an IV,” Richardson explains. “A lot of nursing school is geared toward your textbook. But a lot of students are visual, auditory, and kinesthetic learners.”
He says that there are also students from various cultural backgrounds who don’t know how to study. “For students who come from the other side of the world to America to learn, their views are different from yours, and when you have a different perspective, you’re able to become more aware. You’re able to see a different view. It actually makes us stronger and allows us to become smarter to look at the way that other people do things,” suggests Richardson.
“With diversity, we need to recognize and communicate to understand what the other person’s thinking is and allow them to realize that though their culture is different, it’s not a bad thing,” says Richardson. “It’s just a different view and perspective for them.”
