A member of the Academy of Medical-Surgical Nurses (AMSN), LaToya Freeman DNP, APRN, ACCNS-AG, CPPS, HNB-BC, PCCN is also a clinical nurse specialist at Michigan Medicine. In honor of Med-Surg Nurses Week, Dr. Freeman shared her thoughts about this nursing specialty with Minority Nurse. Above all else, she sees a positive future ahead.
“The best days for nursing are in front of us,” says Freeman.
Tell me a little about your current role and how you got into the field of med-surg nursing. My nursing journey began over 14 years ago, following a “no” from a college advisor and a passion for medicine. Nursing has given me a purpose outside of myself and an amazing opportunity to connect with others compassionately during vulnerable moments.
My current role is one of the roles I have enjoyed the most during my journey. As a clinical nurse specialist, I am seen as the clinical expert and a change agent. I am able to influence patient care and outcomes through three spheres of practice: patients, nurses, and the system/organization. I have had the pleasure of working with multidisciplinary teams to provide quality care to patients through a multitude of venues. My background is mostly comprised of critical care as a staff nurse, but I would teach med-surg nursing clinicals as adjunct faculty. This is where I had the opportunity to connect with bedside staff on med-surg units, and I was able to understand that med-surg nursing is truly a specialty. It takes skill, a strong foundation, grit, and a passion as they are building their practice and developing their critical thinking skills. It is quite an honor to observe a new nurse with the complexities of med-surg patients grow from novice to expert.
What are some of your typical responsibilities over a week? My responsibilities over a week range in a variety of functions, which is another reason why I enjoy my role. The CNS optimizes patient care by working with care teams and nursing staff, educating nurses, educating patients and the families supporting and managing their conditions, analyzing data and patient care outcomes, assisting in research, bringing evidence-based practice to the bedside, creating policy that drives patient care, and implementing patient care programs.
What aspects of your education and training are most valuable to you in your career? My most valuable training was completing my doctoral studies. As I am a lifelong learner, I have completed my BNS, MSN/Ed, post-masters, and DNP. All of my educational experiences provided a different level of thinking to support patients and nursing staff. With my most recent degree, the DNP, I was able to obtain skills to influence organizations with system thinking and application of advancing nursing practice and improving patient care outcomes. This training has been beneficial in supporting the med-surg nursing units.
Are there particular skills that serve med-surg nurses best and how do they help? When you think about the needs of patients on med-surg units, one of many skills includes critical thinking such as critically thinking through treatment plans, orders, lab interpretation, and the nursing impact on the care being provided. Adaptability is another skill that serves well within med-surg. There are constant changes from the patient, the provider, and often the organization so being flexible is imperative. Flexibility is one of the keys to nursing. The other skill that is role modeled often is compassion. Patients are coming to the hospital during vulnerable times and may be provided an unfavorable diagnosis. Being able to connect with patients and families and support them during a challenging time is what nursing is all about.
What do you like about working in med-surg? Med-surg nursing is a quiet secret in the nursing profession. Unless you work in med-surg, you may not understand the complexities of patients that are treated within the walls of med-surg. Med-surg is a specialty of its own, providing a variety of skills, problem-solving, and understanding of multiple diagnoses within the same admission. Med-surg nurses wear several hats and juggle a variety of tasks within a typical assignment. Watching nurses thrive in this setting while providing exceptional care to the patients and taking care of each other is a sight that warms the heart.
How does a professional organization like AMSN help your career? Creating opportunity for professional development by a variety of means such as conferences, continuing education, and publications has been helpful. Committees within AMSN have assisted with networking with other professionals outside of my local circle. The publication journals supported by AMSN provided a venue to disseminate best practices.
Acknowledgement of the specialty by honoring the med-surg nurses with the PRISM award has assisted in leveraging the careers of many nurses by highlighting the amazing work that is completed daily.
As the nation continues to grapple with the wide-ranging effects of racism, the nursing industry continues to take steps to address disparities, inequalities, and racism. Last summer, the Academy of Medical-Surgical Nurses (AMSN) ramped up the AMSN DEI Campaign, motivated by the killing of George Floyd.
Terri Hinkley, EdD, MBA, BSN, RN, and chief executive officer of the Academy of Medical-Surgical Nurses (AMSN) and Medical-Surgical Nursing Certification Board (MSNCB), says Floyd’s killing troubled her deeply, leading her to question if she had done everything she could to make the world as safe and inclusive as possible. Hinkley spoke with the presidents of AMSN and MSNCB and with her family and then wrote, My Reckoning, an op-ed expressing her commitment to actively working to combat racism.
While the program helps nurses learn about DEI, it’s also a way for them to build competence, says Hinkley, especially in areas they may not be familiar with or have a deeper understanding of. “We do not understand the norms, practices, and requirements of cultures we did not grow up with or in,” she says. “By focusing on building competency, we are striving to take away the ‘blame and shame’ that often surrounds these issues and discussions. Let us start with the basic principle that everyone wants to be respectful of others and build on that to help them understand and be able to take action to make that happen.”
75% of the nurses that completed the survey reported that they wished to have a better understanding of topics related to diversity, equity, and inclusion.
92% reported that it is important for their national professional association to take action regarding diversity, equity, and inclusion and lead efforts for its members.
46% reported experiencing harassment or discrimination because of issues of race, class, gender, age, religion, culture, sexuality, or ability.
63% witnessed harassment or discrimination.
DEI work is sometimes uncomfortable, as Hinkley noted, and that’s why it’s important to give nurses the tools to have discussions around difficult topics. “We genuinely believe that we, as nurses, start from a position of caring and compassion,” she says. “We believe that every nurse wants the best possible outcome for their patient, and for their teammates to be respected and supported as an integral part of the team.”
As nurses learn more and become more intentional with their DEI work, they can more effectively advocate for those around them—whether teammates or patients. “DEI isn’t a one and done initiative,” says Hinkley. “It is a journey that will only have its beginning in the first 18 to 24 months. This is a lifelong learning initiative, one that AMSN is embracing and committing to.”
Hinkley says AMSN is committed to making this process inclusive and developed several different activities intended to help nurses be able to identify their own biases, or those within their institutions, and develop solutions to combat them.
Members can participate in a six-module educational certificate program in which the first module (the first module is offered at no cost to members) will focus on why the program is important. The remaining modules will allow deep dives into the areas of greatest discrimination, such as race, sexual orientation and gender identity, disabilities, age, and culture and religion, says Hinkley.
As nurses begin to move through the process and gain a new understanding, Hinkley says stepping back for the big picture is essential. “AMSN wants to build a culture of inquiry, where our nurses can start to question why we do things the way we do, or why I believe the things I believe,” she says. “Is there a different perspective that might shape how I approach a situation, or patient, or problem? Am I intentional in my actions, or am I just doing what I was taught and the way it has always been done? It is all about opening conversations, with yourself and others.”
Gaining competence and new perspectives will transfer into better nursing practice, higher nursing standards, and patient care in very specific ways, she says, including
as individual employees who remain competitive and effective in a changing workforce
as employees of organizations who will be DEI ambassadors to their organizations after completing the certificate program
as members of the largest segment of the healthcare workforce who will increase DEI competence across the healthcare sector
as primary providers of patient care in the nation whocan address the inequities in patient care
Hinkley noted that even with a DEI focus, real-life experiences can be uncomfortable. “I would like to share an example I experienced recently,” she says. “Someone I know came out as non-binary, changed their name (I will call them Storm), and their pronouns. Another friend (I will call Alice) was so distressed she would not be able to remember Storm’s pronouns because we have spent a lifetime of only having binary choices: he/him or she/her. ‘They’ sounds odd and feels odd, and we have a lifetime of using ‘they’ for more than one person. That results in dissonance and is incredibly challenging from a cognitive perspective. Alice is doing her best to be supportive and respectful and was so worried that she was going to forget and say the wrong pronoun. I tried to help Alice understand that if it were an honest mistake, Storm would understand, and they would not be offended. I tried to stress that Storm understands that we are all doing our best to be supportive and, in turn, have new things to learn as a result.”
As Hinkley notes, overnight change isn’t expected, but there are things nurses can do to help themselves move forward. “I think it is important to understand that no one expects perfection, they just expect the same respect and value that everyone else is given. What helped me was practicing. I practice using inclusive pronouns at every opportunity. I also challenge myself not to use binary pronouns, but rather to collectively refer to individuals I do not know as ‘they’ until I learn their preferred pronouns. I am not always successful, and just the other day I said ‘he or she’ when referring to a nurse in an example to a point I was making. I was gently corrected to ‘they’ and the conversation continued. Life-long learning is a hallmark of the nursing profession, and we embrace that in every other area of our lives, so why not this one?”
As nurses’ DEI work grows stronger, Hinkley says it will have a pervasive effect on nurses’ work, patient care, and the workplace in general. “Having the opportunity to improve health for all individuals would be the best possible outcome of this initiative and would bring me personal and professional joy,” says Hinkley. “I also feel very strongly about doing my part to contribute to the work environment for all nurses. I am keenly interested in issues regarding the work environment, and the human cost of caring to nurses and healthcare providers. There are so many wonderful aspects to nursing and being in the caring profession, but we do not all have the same experience at work, and I am excited to be able to improve the work experience for all nurses.”
When you’re thinking of a career move, you know your success depends on more than an impressive resume. Standing out from a crowd of highly qualified nurses takes a combination of professional skills, personality match, networking contacts, and knowing how to promote your best qualifications and qualities.
Minority Nurse recently caught up with Marisa Streelman DNP, RN, CMSRN, and director of the Academy of Medical Surgical Nurses (AMSN) to find out how nurses can emerge as front runners when they’re applying for a new role and seeking the best career move.
Q: When a nurse is thinking about starting a job search, what are the top three areas of a job history to really focus on?
A: When nurses are thinking about a job search there would be a different approach to job history depending on where they are in their career.
New graduate nurses would need to focus on their clinical experiences and highlight the skills they improved upon, location of their clinical, number of hours spent with direct patient care, and if they took a full patient assignment, specifically during their final clinical experiences.
For experienced nurses, the job history they would want to highlight would be dependent on the job they are seeking. I would recommend including areas that match the job they are seeking, as well as leadership roles, clinical or patient awards, quality improvement projects, and committees they have been a part of in their most recent roles.
For both the new graduate and the experienced nurse, highlighting any volunteer nursing work is also valuable, as it could resonate with the hiring manager and make the individual stand out from the other candidates.
Q: What are some of the qualities and skills recruiters or hiring managers notice and want to see in a job candidate?
A: Hiring managers today are looking for job candidates who can discuss—and have participated in—quality improvement projects either in school or in their most recent positions. A nurse candidate who understands nursing quality indicators, such as Central Line Associated Blood Stream Infections (CLABSI), Fall Prevention, or Catheter Associated Urinary Tract Infections (CAUTI), and the evidence-based practice which is needed to improve patient outcomes, would be valuable to a hiring manager.
Leadership skills, precepting other nurses, teamwork, and being on a unit or hospital-wide committee are also valuable for a hiring manager. Many hands-on skills in nursing can be taught, some of the softer skills in nursing such as having a positive attitude, a good bedside manner, and working well within a team, are what hiring managers would be looking for during the interview process.
Q: How can nurses translate those good qualities and skills in a job search so they can stand out?
A: It can be hard to stand out in a job search, especially for new graduate positions. Adding bullet points or a cover letter to describe their nursing skills and attributes in a narrative form can help the hiring manager get a better sense if they would be a good fit for the position. It is important to always list the place they worked or completed clinical, their role, and time they were there—either years or clinical hours.
Many times new graduate candidates stood out to me with listing their non-nursing experience as well as their clinical information. For example, if someone managed in a restaurant, that tells me she is a leader, can multi-task, and probably has good customer service skills.
As I mentioned earlier, adding volunteer experiences can also make a candidate stand out to a hiring manager, even if it is not all nursing-related. This lets the hiring manager know a little more about the candidates and their skills for the position.
Q: What are the best ways nurses can leverage all the job hunting tools at their disposal—LinkedIn, Indeed, job boards, networking, etc.—and how can they do that to get the best results for a good career move?
A: There are so many different sites and job hunting tools out there to use it can be very daunting to nurses starting their job search. Being a part of a professional nursing organization, like the Academy of Medical Surgical Nurses (AMSN), is one way to narrow the search to areas which you are familiar, or you are looking to go into, and can network with other nurses within the organization.
Many professional organizations have career centers and resources that provide current openings from around the country, as well as networking areas on their websites so nurses can ask questions of other members. AMSN has an entire web section devoted to med-surg specific career development.
I have found the best way to apply for nursing positions is to apply directly to positions on companies’ websites, and follow up with the nurse recruiter via phone. Also, referrals from friends, co-workers, or classmates are helpful to hiring managers. As a manager, nurses would refer someone they used to work with or a friend, and I would always complete an interview with them. Sometimes they worked out, and sometimes they didn’t, but referrals are one way to get your resume looked at by a hiring manager.
Another way to check out an organization is to attend a career fair, which many organizations have. These are a great way to talk directly to nursing recruiters and hiring managers. At times they complete an interview on the spot.
Q: How is the job search process for a career move changing right now and what do job seekers need to know to help them?
A: The major way the job search process is changing would be the number of positions in nursing may be lower than usual due to the coronavirus and the financial impact healthcare systems are experiencing currently and throughout the last five to six months. Some areas of the country are working on recovery while others are now dealing with a new surge of cases.
Candidates may need to widen their view of what they are looking for as the “perfect” job might not be available in this current environment. Certain units within organizations are so consumed by caring for COVID-19 positive patients they do not have time to respond to inquiries or interview requests, while others are actively hiring to fill vacancies, and still others are on a hiring freeze.
As a candidate, research is needed to understand how the pandemic is impacting their local area or the place they are looking for a new position. Another item to consider would be that many career fairs are now virtual. Candidates will need to have access to technology to attend and if selected for an interview, it might be virtual as well.
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