by | Mar 30, 2013 | Magazine
Nursing programs at Tribal Colleges and Universities (TCUs)–such as the Nursing Departments of Oglala Lakota College in Pine Ridge, S.D., Sisseton Wahpeton Community College in Sisseton, S.D., and Salish Kootenai College in Pablo, Mont.–play a tremendously key role in helping American Indian students in underserved areas increase their access to nursing careers. Yet many of the nation’s 32 TCUs are underbudgeted, receive no state funding and are struggling to meet their operating costs.
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Recognizing, as U.S. Secretary of Education Rod Paige puts it, that “the nation’s TCUs have an historic and unique role in American higher education and serve many Americans who might otherwise be left behind,” the federal government has expanded and strengthened its commitment to supporting these important institutions. As part of the ongoing White House Initiative on Tribal Colleges and Universities (WHITCU), President Bush issued an executive order on July 3 creating a President’s Board of Advisors on TCUs within the Department of Education.
Chaired by Ron McNeil, president of Sitting Bull College in Fort Yates, N.D., and a member of the Standing Rock Sioux tribe, the advisory board is charged with ensuring that TCUs have full access to federal and private programs and funds that benefit other higher education institutions. Specifically, the group will make recommendations about ways the federal government and the private sector can help tribal colleges expand their resources, programs, facilities and use of technologies. The board’s 14 members, most of whom are American Indians, include several other TCU presidents as well as Indian leaders from the business, cultural and political arenas.
In addition, President Bush’s 2003 budget calls for more than $18 million for programs to strengthen Tribal Colleges and Universities–a 3.6% increase over current funding levels.
For more information, contact the WHITCU office in Washington at (202) 260-7485 or [email protected]. The WHITCU Web site is located at www.ed.gov/offices/OPE/TribalColleges.
by | Mar 30, 2013 | Magazine, Minority and Community Health, Native American Nurses, Veterans in Nursing
For Native American nurses, many of their stories have been lost to the past. Scholars have generally paid scant attention to the lives and deeds of rural minority women, and few articles have been written about the early education of Native American nurses and their contributions to health care. The people of the Catawba Indian Nation use storytelling to keep their culture and the memory of their heroes alive. Consider this one such story, one such hero.
The Sage Memorial Hospital School of Nursing, known simply as “Sage Memorial,” operated from 1930–1953. It was the only nursing school ever opened for the sole purpose of educating Native American women as nurses.1 One of these nurses was Viola Elizabeth Garcia, a graduate of the Class of 1943.2 Viola’s life illuminates the struggles for education common among the women who attended Sage Memorial. Her contributions and experiences as a World War II nurse demonstrate the hardships encountered and outstanding contributions made by many of her fellow alumna.
Ganado
By law and custom, most nursing schools were segregated by race before the passing of the Civil Rights laws of the 1960s. From the 1880s through the 1960s, most schools of nursing were comprised of either all white or all African American student bodies, leaving few opportunities for Native Americans, Asian Americans, or Hispanic Americans to obtain a nursing education.
The Board of National Missions of the Presbyterian Church was unique in its efforts to address this inequality. In 1901, the National Presbyterian Church opened the Ganado Mission on Navajo Nation land, in the northeast quadrant of Arizona, near the New Mexico, Colorado, and Utah borders, in the community of Ganado.
After a church and school were successfully operating at the Mission, the home missionaries turned their attention to health care.3 In 1929, Dr. Clarence Salsbury and his wife, Nurse Cora Salsbury, took over the mission work at Ganado. One of their first priorities was expanding the antiquated 12-bed hospital into a modern facility of 150 beds, an operating suite, a delivery suite, and a laboratory. This new hospital was named Sage Memorial Hospital after one of its largest benefactors and was accredited by the American College of Surgeons.
In order to staff the hospital with nurses, as well as to provide skilled employment opportunities for Native American women, the Salsburys opened Sage Memorial Hospital School of Nursing in 1930.4
The school opened while naysayers proclaimed no Native American woman would ever be up to the academic task of completing a Nightingale-based nursing education program. They also claimed these women, given their culture, would not be willing to interact with the sick or dying. Sage Memorial graduates proved these assumptions wrong.
Dr. Salsbury felt training Native American nurses was crucial. “They would be able to understand the patients as no white personnel ever could,” he said.1 Sage Memorial started small, with an entering class of two Navajo women: Adele Slivers and Ruth Henderson. They both graduated three years later and passed the Arizona State Board of Nursing Examinations. Their graduation exercises in 1933 were a festive event with scripture readings, vocal duets, a piano solo, and a pinning ceremony. Dignitaries including the Arizona governor, an Arizona State Board of Nursing member, and one of the chief Navajo medicine men praised the graduates and the school during the proceedings.3
As word and reputation of the school expanded among minority communities, the student body increased in number and diversity. By 1943, students from 28 tribes, including the Navajo, Kiowa, and Catawba; students who identified as Eskimo, Hawaiian, Spanish American, Cuban, and Mexican; and one Japanese student from a relocation camp were either enrolled or graduates of Sage Memorial.6 By all accounts, this unique experiment in multicultural education was a success.
In the 1930s and 1940s, such training and cultural exchange among Native Americans and other minority women was not found anywhere else in the United States. The nurses developed a camaraderie and commitment to their work that consistently earned them the highest marks on state licensing exams. The students lived in interracial cooperation while learning the nursing arts and sciences. The school’s stellar reputation drew the attention of white applicants—who were denied consideration because they had access to many other schools of nursing.1
Viola Elizabeth Garcia
Viola Elizabeth Garcia was born on April 12, 1919, in Sanford, Colorado, a poor, rural Mormon community home to approximately half the members of the Catawba Nation. Viola’s family was financially impoverished, but rich in family and culture. The older brothers, George and Labon, left school after completing the fourth and fifth grade to help their ailing father support the large family. Viola’s father was ill for much of her young life and died when Viola was only 11 years old, leaving behind 10 children for his wife to support.
Viola completed the ninth grade in Sanford, but due to the Great Depression, the public high school was closed. For the next three years, Viola tried desperately to complete her high school education by repeatedly applying for admission to the Bureau of Indian Affairs Haskell Boarding School in Lawrence, Kansas. Finally, she was admitted at 18 years old and completed her high school diploma in 1940 at the age of 21. Viola’s classes focused on cooking skills, sewing, home care, and arts. As graduation neared, she was offered full-time employment as a cook’s assistant on the Apache reservation in New Mexico, but Viola was determined to continue her education.2
With the guidance of the staff at Haskell Boarding School, Viola applied to several nursing programs but was only admitted to Sage Memorial. One such rejection stated that she was too old at 21 years of age to begin the nursing program. There was also a concern, as World War II loomed and U.S.-Japan relations became strained, that her Native American features would appear Japanese and frighten patients.6
The head mistress of Haskell wrote in a reference letter about Viola, “Whatever Viola decides to do, she does.” Several months after Viola enrolled at Sage Memorial, Dr. Salsbury personally wrote the Haskell headmistress asking if she had any other students like Viola, and if so, to please send them to his school.6
Studying at Sage Memorial
Applicants to Sage Memorial had to be unmarried high school graduates between 18–30 years of age. Their applications had to be accompanied by a health certificate, as well as four character references, with one being their pastor. Tuition was $100 for the first year with additional fees of $1 for laboratory courses, $0.50 for library use, and $3.50 for health fees. The hospital provided room, board, and laundry services. In addition to their course work, students tended the hospital floors eight hours a day, six days a week. However, students had time to relax outside of their rigorous classroom and clinical schedules, enjoying picnics, parties, movies, and glee club, as well as mandatory gym class and chapel.4
Although Viola was accepted to Sage Memorial, she was not sure that she could afford the tuition, fees, and living expenses. As the months progressed, Dr. Salsbury procured the funds to pay for all her education expenses except for personal items she needed to bring with her.6 According the 1940 catalog, all students had to supply for themselves the following: a bag for soiled clothing, rubbers or galoshes, toiletries, two fountain pens (one for red ink and one for blue), a watch with a second hand, an alarm clock, two standard-size loose-leaf notebooks, a napkin ring, and coat hangers.4 Viola’s eldest brother, George, gave her an entire month’s wages so she could buy the required watch with the second hand sweep. With her determination and supplies in tow, Viola began her three-year long education at Sage Memorial.6
Over the next three years, Viola and her fellow students not only studied the nursing curriculum but also spent many clinical hours on the hospital floors. They made and rolled their own patient bandages and folded disposable patient trash bags and slippers out of newspapers. Third-year students were expected to help teach the lower-level nursing students. Viola not only learned the nursing skills that she would use throughout her life, but she developed a deep devotion and admiration for the Navajo people. She even taught herself to speak Dine, the Navajo language.6
A nurse in practice
Though Viola grew up in the rural, remote, and poor town of Sanford, she was surprised to learn that her new community at Ganado was even more so. Patients were brought to the hospital on horseback and buckboard wagons, and sometimes by rattling old vehicles over rutted and narrow dirt roads. Many roads were so rough and rocky that they were impassable in wet and winter weather. The nursing students were expected to go on home visits with the nursing staff to the homes of the Navajo people, traditional dwellings known as hogans.7 They made these visits in buckboard wagons. Viola would write back to her mentor at Haskell Board School that these hogans were “loving and cozy homes.”6
Viola viewed success as the ability to provide for herself, and she felt her education was essential to achieving that level of self-reliance. Viola studied hard and was the 1943 class valedictorian. She was awarded a set of surgical instruments for her academic success.
In 1943 Viola took her Arizona nursing boards and returned home to Colorado to await the results. She had been worried because she did not have an additional $75 to retake the nursing board examination if she failed. One day a letter arrived addressed to Viola Garcia, R.N., and she knew she had passed. In fact, Viola received the highest test score in the entire state of Arizona. Viola’s academic and nursing success, however, was common among the students who graduated from Sage Memorial.
World War II
Not long after graduating from nursing school, Viola found herself working in Denver, Colorado, when President Roosevelt delivered an ominous speech. While the war efforts in Europe were drawing to a close, battles were still raging in the Pacific, and there might be a need to draft nurses into the military. Viola was told that if she volunteered for military service, she could select her location of duties. In January 1944, she enlisted in the United States Army Nurse Corps, requesting no surgical duties or overseas assignments. Within weeks of her enlistment, she was assigned to Camp Carson (now, Fort Carson, Colorado Springs, Colorado) in the surgical suite where she assisted with amputations from the war-wounded returning from the bitter winter campaign in Europe under General Patton. There were endless mounds of amputated ears, fingers, toes, hands, feet, arms, and legs that filled the air with putrid smells. Viola approached her supervisor and informed her of what she had requested: “No surgery and no overseas duties.” She was promptly informed, “Honey, you are in the Army now.”6
Within a few months, First Lt. Viola Garcia shipped out from Camp Carson to Los Angeles, where she, along with 600 other nurses, embarked on the largest U.S. Army Hospital Ship at the time, the USAHS Marigold, with an unknown destination. After two weeks, the ship arrived in Hawaii, and 300 of the 600 nurses disembarked, but Viola’s group remained on board. After leaving Hawaii, ship’s public address system announced their destination: Tokyo, still a heavy battle area as the war in the Pacific raged on. “My heart just dropped, I was so frightened,” Viola recalled. The U.S. military was fighting Japanese troops on many Pacific Islands and an invasion of the Japanese mainland was thought to be imminent. The costs in human life for both sides would be high.6
The ship was under the command of General Douglas McArthur, who over saw the military operations in the Pacific. The 300 nurses in Viola’s grouping were to be part of the U.S. invasion actions in Japan. Military leaders expected heavy casualties among those nurses during the invasion operations; the 300 nurses left behind in Hawaii would be their replacements.
Under international rules of combat, hospital ships were not to be attacked at sea, and thus were to be lit up at night and clearly marked with a red cross. Not long out at sea, the Japanese attacked one such marked ship, and the Marigold was immediately ordered to go into complete darkness. As the lights were put out, those in surgery raced to cover the windows of surgeries in progress. A frightening silence fell upon the crew as the Marigold steamed along in darkness on its way across the Pacific.
The Marigold stopped in the Philippines, and the nurses were allowed to disembark for a few days before the ship went to Japan. While docked there, however, the United States dropped the atomic bombs on Japan, and World War II was brought to a close. Yet, the Marigold continued on to Tokyo, but this time with a different mission. The USAHS Marigold was the first U.S. ship to enter Yokahoma Bay after the Japanese ended the war, and it was in Tokyo Bay where General McArthur accepted the formal surrender of the Japanese on the USS Missouri. That day the sea was filled with ships and the air was filled with flyover planes celebrating the end of the Second World War.
Rebuilding in Tokyo
Over the next eight months, Viola was stationed in Tokyo at the 42nd General Hospital. She treated survivors of the Bataan Death Camp and Corregidor Island (a military stronghold in the Philippines). The hospital had five surgical rooms that had been stripped of all equipment by the Japanese at the end of the war. They were filled with soot and rubble. Several Army nurses ranking higher than Viola were assigned the task of restoring these rooms to their full function. According to Viola, none of the higher-ranking nurses could deal with such an overwhelming task; each time, Viola was asked to “fill in.” After a third nurse was left in tears at the monumental task, Viola was asked to take on the responsibilities as acting head surgical nurse.6
Viola walked into surgical suites devoid of the equipment necessary for performing operations—no surgical tables, no IV stands, no surgical tools. She remembered entering the rooms: “I just wanted to cry too and said to myself, ‘Oh Lordy, what am I going to do?'” But Viola went on to do what she had always done—she rolled up her sleeves and got to work. Viola called in her military crew and ordered them to wash and scrub all the rooms from top to bottom. When that was done, she began looking for equipment for her surgical rooms, including salvaging items from the hospital ship.6 She even taught herself to speak Japanese, just as she learned to speak Dine as a nursing student.
First Lt. Garcia’s work in Tokyo was supported by her own ethic of care, as well as the training she received at Sage Memorial Hospital School of Nursing. From those days following the war until her death in 2004, Viola continued caring for others, marrying Herbert Schneider, another member of the U.S. Army, and raising three daughters. Her legacy, one of determination and pride, compassion and grace, lives on.
References
- Salsbury, C.G., & Hughes, P. (1969) The Salsbury Story. Tucson: The University of Arizona Press. 152–153.
- People of Catawba official website, “Life of Viola Schneider.” Cynthia Walsh. http://www.catawba-people.com/viola_schneider_eulogy.htm. (Accessed 2011).
- Trennart, R. (2003). “Sage Memorial Hospital and the Nation’s First All-Indian School of Nursing.” The Journal of Arizona History, vol. 44, 353.
- Prospectus of School of Nursing, (Ganado, Arizona: Sage Memorial Hospital, n.d), 1-11; Presbyterian Historical Society, Philadelphia, Pennsylvania: Ganado Mission Records.
- “Excerpts from Statement re: School of Nursing, Sage Memorial Hospital, Ganado, Arizona sent in on January 3, 1939.” Document from Ganado Mission Records, Presbyterian Historical Society; Philadelphia, Pennsylvania.
- Viola Garcia, personal comm. with author.
- Salsbury, C.G. (1932). “Medical Work in Navajoland.” The American Journal of Nursing, 32(4), 415.
by | Mar 30, 2013 | Asian-American and Pacific-Island Nurses, Black and African-American Nurses, Hispanic and Latino Nurses, Magazine, Native American Nurses, Nursing Careers, Nursing Students
There’s no sugarcoating it: pursuing a doctoral degree is tough. Balancing a clinical job with classes and homework—not to mention family time and your social life—takes determination and sacrifice. But if you’re prepared for the challenge, that hard-won degree may be the best investment of your life.
That intimidating introduction aside, keep in mind that hundreds of nurses proudly graduate with a Doctor of Nursing Practice (D.N.P.) or another doctoral degree every year. So what does a D.N.P. program really entail? We asked two experts some common questions surrounding doctoral study, from the admission process to program requirements. Both doctoral-prepared nurses, they can speak to their personal experiences as they now guide other nurses as university administrators.
Q. D.N.P. or Ph.D.: How should nurses choose between them?
TORRES: Ph.D. and D.N.P. programs differ both in their goals and in the competencies of their graduates. The decision to pursue a D.N.P. or Ph.D. depends on your career goals. While a Ph.D. student generates and develops new knowledge, a D.N.P. student translates research already done, evaluates it to see if it works for a specific problem or project, and then puts it into practice.
Ph.D. programs focus heavily on scientific content and research methodology, so if you want to be a nurse scientist/scholar with a research-centric career, you should pursue a Ph.D. The D.N.P. is designed for nurses seeking a terminal degree in nursing practice and offers an alternative to research-focused doctoral programs.
Generally, a D.N.P. is the choice for Advanced Practice Registered Nurses (Certified Registered Nurse Anesthetists, Nurse Practitioners, Clinical Nurse Specialists, or Nurse Midwives) or nurses in other areas of specialized nursing practice (nursing administration, informatics, public health) who want to continue practicing in their area of expertise and are interested in gaining advanced knowledge and skills.
In recent years, there has been a growing demand for D.N.P. programs and degrees. According to the American Association of Colleges of Nursing (AACN), currently there are 153 D.N.P. programs, and between 2009 and 2010, the number of students enrolled in these programs increased from 5,165 to 7,034. In the same period, the number of nurses graduating with a D.N.P. doubled.
RODRIGUES FISHER: The increasing need for practitioners with D.N.P.s stems, in part, from hospitals and health systems looking for skilled nurses who can provide primary care to many people and, in particular, to those in low-income communities. There is also a move to increase the number of Latino and African American nurses who have advanced practice degrees because patients want primary care providers who have the same understanding of cultural beliefs and health care issues.
In order to determine which advanced degree is best for you, it’s important to decide if you want to continue practicing or if you wish to pursue research and teaching.
TORRES: Rather than concentrating on dissertations or research, D.N.P. programs help nurses build upon their current practice, learn new skills, and conduct applied research. Many doctoral students also find great value in completing a project that they can readily apply in practice.
Q. How should nurses prepare for the doctoral program application process?
RODRIGUES FISHER: Start by brushing up on your writing, language, and math skills. They will serve you well. In my personal experience, because English is not my first language, it was important for me to study and brush up on my writing and math skills. I struggled until a professor in my master’s program recommended I take an English course; it was truly the best decision I could have made. After bolstering my language and writing abilities, I felt prepared to take the GRE for my doctoral program.
You should also generate a list of organizations you support, either as a member or otherwise. For example, if you participated in a fundraiser for the American Heart Association or did something to engage members of your community to encourage minority students to continue their education, be certain to list those activities in your application. If you are out in your community doing good deeds, institutions will recognize you as someone who would represent them well.
Make sure someone else reviews your application before you send it in! It’s important to submit a polished application. It should shine a light on you and your achievements, but any mistakes will be blinding.
TORRES: Some schools require Ph.D. and D.N.P. applicants to write an essay about why they want to earn a doctoral degree, what their career goals are, and what they hope to accomplish with the degree. The essay needs to be well-written, with no spelling errors and good grammatical structure.
Many doctoral programs also request written references. Be especially careful who you ask to provide a reference—preferably it should be someone in your area of practice or a faculty member who teaches in that area—and make sure they know you well. Check with the institution if you have any questions about the application or the process.
Q. What are admission counselors looking for in nurses’ applications?
TORRES: Counselors evaluate applications based on a variety of factors, including academic record, essays, and prior experience. Requirements may include a master’s degree or its equivalent, a 3.0 minimum GPA in that master’s program, an active R.N. license, two or more professional references, and official transcripts of highest course work completed, plus the completed application and fee.
RODRIGUES FISHER: Yet, it’s not just about the applicant’s individual grades. Admission counselors look at the whole person, and they want people with broad, varied experiences.
Some questions admission counselors will be asking themselves as they review applications are “What have they done?” “What committees have they served on either in their community or in their health care facility?” and “Have they demonstrated they will be successful in the program?” It’s important to list all activities and committees you are involved in and specifically what your role was on those committees.
TORRES: Doctoral programs may also prefer (or require) a number of years of professional nursing experience. International students may need to demonstrate equivalency via an additional evaluation from the Commission on Graduates of Foreign Nursing Schools (CGFNS).
The D.N.P. requires 1,000 post-bachelor’s clinical hours, of which 500 must be at the D.N.P. level. Admission counselors will obtain information on how many clinical hours the entering students had in their master’s program.
Q. What does the typical doctoral program entail?
TORRES: A typical D.N.P. program is developed based on AACN’s The Essentials of Doctoral Education for Advanced Nursing Practice and covers both course work and clinical hours. The publication outlines the curricular elements and competencies that must be present in programs conferring the Doctor of Nursing Practice.
Doctoral course work is very rigorous. Time management is important, and you will need to closely examine how you are going to complete the course work and use your time to your advantage.
An integral part of the D.N.P. program is the final D.N.P. project, which is usually based on an issue or problem at the student’s institution or facility. It’s important for students to work closely with their schools to ensure the institution supports the project’s implementation. During this project, the student will typically accrue the practicum hours needed. In some ways, the D.N.P. project is similar to a dissertation since it requires approval of the Institutional Review Board (IRB) and includes a committee to guide the project.
RODRIGUES FISHER: All doctoral programs require a lot of reading and library research. Once you get through your core course work, it will be important to identify your research area and possible mentors. One additional piece of advice: focus your course work in the direction of your research.
Q. How might doctoral course work impact a working nurse’s personal life?
RODRIGUES FISHER: Going back to school to pursue your doctorate will definitely impact your personal life. I worked full time, went to school, and had a family to take care of, but the great support from my family made it all possible. My husband made sure the children were taken care of and the housework was done. The house wasn’t always as clean as it could be, and I missed some of my children’s games, but because of the partnership with my husband, we made it work.
TORRES: Before you start a doctoral program, talk with your family so they understand what’s involved, how it may impact them, and how they can help you succeed. You will soon discover how many courses you can manage at a time and whether you can handle a full- or part-time commitment, based on your family, work, and other commitments.
Online programs typically offer nurses more flexibility to work their classes around individual schedules. But even if the delivery method is online, course work still takes time, and doctoral students quickly realize they won’t be able to continue to do all they were doing before deciding to pursue a doctorate. On average, each course is a minimum of 15 hours of work per week.
RODRIGUES FISHER: They say if you educate a woman, you educate a family, and I believe this to be true. Yes, going back to pursue my doctorate took away from some of the other things in my life, but my children benefited as they saw me working hard to achieve what I wanted, both for myself and our family. I was proud to be that kind of role model for them. Work hard and you will be rewarded.
Q. How will a nurse’s duties change after obtaining his or her D.N.P.?
TORRES: Most nurses pursue their D.N.P. because they want to advance in their careers and increase their income. According to the 2009 salary survey conducted by ADVANCE for Nurse Practitioners magazine, D.N.P.-prepared NPs earned $7,688 more than master’s-prepared NPs.
Many graduates move into a new job or position where they can use the skills they learned while acquiring their D.N.P. Others decide to take on additional responsibilities in their current jobs or go into teaching.
RODRIGUES FISHER: The biggest change is more responsibility. As a nurse with a D.N.P., you will be put into leadership positions supervising other nurses. You will also have a more familiar relationship with physicians at your facility. In short, a D.N.P. means increased opportunity.
Q. What do you think about the AACN’s push to have nurses earn a D.N.P.?
TORRES: I support the movement toward the D.N.P. In the transition to the D.N.P., nursing is moving in the direction of other health professions such as medicine (M.D.), dentistry (D.D.S.), pharmacy (Pharm.D.), psychology (Psy.D.), physical therapy (D.P.T.), and audiology (Aud.D.) to provide their professionals with a practice-oriented degree. Nursing is advocating having more nurses obtain their D.N.P., so we are headed in the right direction. In fact, the AACN membership approved a target goal for transition of Advanced Practice Registered Nurse programs to the D.N.P. by 2015.
RODRIGUES FISHER: It’s not just a push from the AACN, but also from the Institute of Medicine to have more educated nurses out there to deliver needed health care to the nation. We are an aging population that is living longer and needs more care. However, with a shortage of health care providers, we need to have nurses who are prepared to practice, are well educated, and can work in a colloquial role with physicians.
Many nurses who choose Walden University do so to advance their careers and become better practitioners. Colleges and universities are looking to develop lifelong learning programs, such as associate to master’s programs and B.S.N. to D.N.P. programs, in order to quickly meet the increased and growing demand for more educated nurses.
Q. What advice do you have for nurses debating whether or not they should pursue a doctorate?
RODRIGUES FISHER: My number one piece of advice is to think about what you are willing to give up for a short period of time in order to pursue your doctorate. I had to give up some of my personal and family time to advance my education and career. For me, the end results—making contributions in the quality and delivery of care and giving patients the best health services they can receive—are truly worth it.
TORRES: Know your career goals, assess your personal life, and identify your passion. Where are you in your career, and what do you want to do? Do you want to concentrate on research and academia, or do you wish to advance your practice?
Timing is everything, so ask yourself: Is this the right time in my life to do this? If not now, when?
by | Mar 30, 2013 | Magazine
On January 12, 2011, little seven pound, 10 ounce, 20.5 inches long Carson joined the Samantis family after a fairly easy pregnancy and uncomplicated delivery. Until Carson was born, both his mother, Kristen, an interventional cardiology nurse at Massachusetts General Hospital in Boston, and father, C.J., worked full time. Until four days before Carson was born, Samantis, now 31 years old, was working.
In the 1980s and 1990s, over 80% of women ages 25–34 years old were working, according to the U.S. Bureau of Labor Statistics. Before the Family and Medical Leave Act (FMLA) passed in 1990, around one-third of women never worked while they were pregnant, one-third quit their jobs, and only one-third took a maternity leave that often lasted under a week.1 For employers and employees, today’s culture of working mothers elevates work-family relationships to a high priority. The FMLA allows employees who have worked at least 1,250 hours to leave their jobs for 12 work weeks in a 12-month period, without pay, to give birth and care for a newborn child.
But nurses face particular stressors when they return from maternity or paternity leave, and the Massachusetts Nurses Association and other unions say these benefits could be better. While all working mothers (and fathers) have a difficult time reacclimating to work, nurses generally face grueling 12-hour shifts, so they are away from home for longer periods of time and may feel especially drained by the nature of the work they do caring for patients.
Samantis decided to start a family only after carefully considering the economy and her job. She waited to have Carson until she had earned enough time off to take the full 12 weeks of paid maternity leave. While she has worked at MGH as a nurse for over two years, she has worked at MGH for a total of nine years, with a previous position in health education.
Welcome back
The days when every mom was a stay-at-home mom are a distant memory. New mothers are returning to work in large numbers, and nurses are actually more likely than other moms to return to work full time. According to the U.S. Department of Labor, 20% of nurses work part time, and most of those women are married with young children. At Massachusetts General Hospital, where Samantis works, nurses represent 15% of the hospital’s overall maternity and paternity leave, but most of the new parents return to the full-time 36- to 40-hour workweek, according to the hospital’s human resources department.
“This is where the recent economy has had a larger impact on nurses and this trend [of working mothers],” says Steve Taranto, Director of Human Resources at the Knight Nursing Center for Clinical & Professional Development and the Yvonne L. Munn Center for Nursing Research at Massachusetts General Hospital. “Especially in today’s economy where fewer people have jobs and more nurses are supporting unemployed spouses, this is the career that the marriage or family will turn to as the reliable source of benefits,” he said.
After Carson was born, the Samantis family decided they didn’t want to put the baby in daycare, so they agreed that Kristen would work part-time. How that reduction in income from her career would affect their new family’s lifestyle troubled her.
“I was a nervous wreck when I had to go back to work,” says Samantis. “I kept thinking about it as each week of maternity leave passed by.”
While hospital administrations have streamlined adjusting schedules when nurses take paternity or maternity leave and return, nurses find returning to work particularly stressful because of their own schedules. Nurses often work nights on already minimal sleep as new parents, and they are balancing a baby’s sleeping patterns with long hours and/or night shifts at the hospital.
“Since I was going back to work mostly nights, I was sad that I wouldn’t be the one putting him to bed each night,” Samantis says. C.J., her husband, was handling nightshifts with the baby on his own, and little Carson wasn’t sleeping through the night. C.J. would stay up all night with the baby, then return to work in the morning, and Kristen would work nights, then stay awake most of the day taking care of Carson.
According to research published in Health Affairs in 2011 by Project Hope: The People to People Health Foundation, job burnout or dissatisfaction among nurses is a big problem in hospitals because of risks to patients, work disputes, and turnover.1 The research found much higher levels of burnout with nurses working in hospitals and nursing homes, where lower patient satisfaction levels correlated with more dissatisfied or overworked nurses.
What’s best for you and your family
“There are fewer jobs out there, so the nurses, even if they have just had a baby, have more of an incentive to pick up more hours as they adjust back into work, where their career is often a large source of income for their family,” says Taranto.
While Samantis originally thought she would sleep when the baby took naps during the day, she discovered that Carson napped less as he got older, which didn’t allow her to sleep like she planned. “That makes for a cranky baby and mom!” she says. Immediately after returning from maternity leave, Samantis worked 36 hours a week, but she has since dropped that number to 28. “We are not superheroes!” she says.
Communicate with your supervisor
The nature of nurses’ schedules when taking maternity leave, versus other roles in a hospital, may actually be advantageous. Nurse managers have more freedom and flexibility to adjust schedules to meet a new parent’s needs by offering more hours to part-time workers and per diem nurses.
Before and during her leave, Samantis closely communicated with her supervisor and still does. When she needed to cut back her hours after Carson was born, her supervisor was supportive and checked in periodically to see how things were going. Her manager recently gave Samantis the option to cut back to 24 hours a week, which the new mom is considering now that Carson is five months old and sleeping less while she is at home with him during the day.
Although cutting back working hours is a big decision, as fewer hours means less income, Samantis would only need to be at work two days a week instead of three, a schedule worth considering for a family not using daycare.
According to the Human Resources department where Samantis works, most nurses return from maternity leave at the 36- to 40-hour workweek level, while only a few come back at the 20- to 24-hour workweek level. They attribute this trend to the economic stresses of the past three years. Like Samantis, nurses who are new parents are working on limited sleep and would prefer to be home more often with their babies, but taking cuts in their hours means cuts in their paychecks.
“Mass General’s flexibility with nursing schedules is what leads to the greatest success with regards to retaining nurses post-maternity leave,” Taranto says. The hospital was named a “Working Mom Institution” in 2005 by Working Mother, scoring particularly high in child care options, parenting and child care workshops, and benefit policies that allow mothers flexibility around part- or full-time employment. MGH has a job vacancy rate of 1% and a turnover rate of 3.1%, which represents return for education, nurses becoming stay-at-home moms, or family situation changes. Communication between supervisors and nurses about schedules is key to keeping MGH working mothers happy, Taranto says.
Mark your calendar
According to the Mayo Foundation for Medical Education and Research, returning to work at the end of the week or on a weekend eases new parents back into the work routine. Nurses have the flexibility as well to not schedule themselves two days in a row at first, so they only need to get through one day of work before they can return to their babies.
Of course, returning to work also presents an emotional challenge for new parents. For moms in particular, postpartum hormones are still fluctuating 12 weeks after giving birth, so being back at work may be that much more stressful.
“You haven’t had a chance to wrap your head around taking care of a baby yet,” says Samantis, who says she felt “out of sorts” when she returned to work after her maternity leave. According to the Mayo Foundation, for all new parents, nurses or otherwise, calling to check in with your baby and whoever is taking care of him or her is important for your peace of mind and to stay connected with a shift in your life that is still so new.
Recruit reinforcements for baby and you
Leaving your baby in someone else’s care is one of the most important decision new parents can make. Finding reliable childcare is also one of the most challenging aspects of being a working parent. While MGH provides childcare for their workers 10 minutes away from the hospital, as well as onsite daycare centers for emergencies, the Samantis family decided they didn’t want their baby in daycare but had no one to call to stay at home with him. Working their careers around alternating days and nights at home was the best decision for her family, Samantis says. In this way, her schedule options allowed her family to work through this.
Breastfeeding
Breastfeeding can also complicate the return to work. Some babies have trouble latching, and it takes time to develop a routine. Once moms are back at work, sticking with this schedule becomes even harder.
According to the World Alliance for Breastfeeding Action, for the first six months back at work, employed women should receive support from their workplace to provide private breastfeeding options. Hospitals today have lactation rooms set aside for their working moms, but the commitment presents daily challenges. Finding time during your shift to sit in a lactation room is one thing; you then need coworkers to care for your patients while you’re pumping. But many still make it work.
At MGH, Human Resources and the Employee Assistance Program have been monitoring and keeping track of numbers in the hospital’s lactation rooms, which have been adjusted and their numbers increased based on their volume of use.
“Pumping while back at work is a huge commitment,” says Samantis, who shifted to baby formula for Carson when they returned from the hospital, even though she originally planned to breastfeed until she went back to work. “With that being said, many of the moms I work with do it and are successful!”
Baby yourself and stay positive
Maintaining regular bed times, cleaning out unnecessary commitments, and maintaining a positive attitude are all keys to balancing your work and home life.
The Samantis family has found good routine now, and Kristen says Carson “is sleeping like a champ through the night.” She still doesn’t work two days in a row unless it’s the weekend, so she says her lack of sleep at home doesn’t affect her work too much. She is thankful she can be home with Carson to watch him play and grow while still maintaining her career.
“I’m just now feeling like I can balance everything—home, life, relationships, work. It’s still hard being a working mom, but everyday I feel like it’s getting a little easier!”
by | Mar 30, 2013 | Magazine
After spending 33 years caring for the health needs of her fellow Native Americans as a nurse with the Indian Health Service, Frances Stout, R.N., had earned a well-deserved rest. She could have taken some time for herself, started a hobby, or perhaps traveled a bit. Instead, in her 70s, Stout now serves as Chair of the Board of the Tohono O’odham Nursing Care Authority (TONCA), which under her leadership governs the groundbreaking and innovative Archie Hendricks, Sr. Skilled Nursing Facility on the Tohono O’odham Reservation in Arizona.
Reflecting on her years of dedication to others, Stout says, “My grandmother said, ‘We are here to serve…that is why we are put on this earth.’ As long as I am physically and mentally able, I will do so. I am very grateful for this privilege.” In 2009, the Robert Wood Johnson Foundation honored Stout with the prestigious Community Health Leader Award for her work on behalf of the senior citizens in her region.
The Navajo in Arizona
Stout was born at the Ganado Mission on the Navaho Reservation in Ganado, Arizona. Founded in 1910 by the Presbyterian Church, the Mission became the largest Native American mission in the United States. A school for Navajo children opened in 1911 shortly after the Mission’s founding, and Stout’s family history is rooted in the institution. The Ganado Mission became a driving force behind educational and medical advancements for the Navajo people.
Part of its advancements included the twelve-bed Sage Memorial Hospital, the first non-governmentally funded hospital on a Native American reservation in the United States. Sage Memorial opened a School of Nursing in 1930, the first and only accredited nursing training school for Native American women in the United States. At the time of its founding, attitudes persisted among many Anglo-Americans that Native American people were not mentally capable of succeeding in an academic environment.
The Sage Memorial School of Nursing’s founder, Dr. Clarence Salsbury, was a personal acquaintance of Stout’s. “I was told a thousand times that Indians were just not temperamentally suited to be nurses,” writes Dr. Salsbury in his memoirs. “Lots of people said that girls with red skin would never be able to handle the academic subjects, could not master the surgical techniques, and most emphatically [because of their cultural attitudes towards death] would never touch a dead body.” Stout is evidence to the contrary; her cultural beliefs and customs did not impede her nursing practice—rather, she incorporates them into her work.
The school was very successful, graduating many Native American students from all over the United States as well as foreign students from as far away as China and Japan. The school closed in 1951 due to a combination of factors, including changes in administration, difficulties meeting increasingly rigorous accreditation standards, and a change in emphasis towards educating nurses in colleges or universities rather than hospital diploma programs. However, the significance of the Sage Memorial Hospital School of Nursing cannot be underestimated. With the pioneering success of the school and its graduates, it challenged the negative attitudes towards the capabilities of Native American people. In addition, the school’s Native American nurse graduates were at least partially responsible for an increased acceptance among Native people of the benefits of modern, “white” medicine and technology.
Finding her calling
“There is a lot of information out there, you can never know it all,” Stout’s grandmother would say. She encouraged her granddaughter to pursue wider dreams than those readily available on the reservation. After graduating from Ganado Mission High School in 1953, Stout decided to pursue a career in nursing. “When I chose to be a nurse, way back when, there were only three careers available for women—nurse, teacher, and secretary, so I decided nurse. It has been extremely rewarding,” Stout says. “There isn’t another career that allows a woman to use her ability to comfort or care for another person the way that nursing does.” By the time she was ready to enroll in nursing school, the Sage Memorial Hospital School of Nursing was closed, so Stout headed to Dallas, Texas, where she attended and graduated from the Methodist Hospital School of Nursing. Stout continued her education, earning a public health certificate at Western Reserve University (now known as Case Western Reserve University) in Cleveland, Ohio. From there, Stout found her calling in the Indian Health Service. She worked all over Arizona, from Flagstaff to Sells, where she finally retired—at least, she “officially” retired. Her busy schedule says otherwise. “My whole family was involved with public service,” Stout told the Navajo Times in 2009. “I was raised that you serve as long as you are able.”
After retiring, Stout saw how older members of the Tohono O’odham Nation had to leave the reservation to find skilled nursing care. Some elders found it difficult to spend their last years in a facility without traditional foods, language, or ceremonies. TONCA identified a number of gaps and fragmentations in the services provided to the elders of the Tohono O’odham Nation, and the group, under Stout’s leadership, created an elder care consortium to address these issues, including transportation, housing, and safety matters affecting elderly Native Americans.
To address this need, Stout worked with others to create a unique institution, the Archie Hendricks, Sr. Skilled Nursing Facility, which now also includes the Tohono O’odham Hospice. This 60-bed, five-star facility provides culturally sensitive long-term care, respite care, and hospice services for the Tohono O’odham people. The facility offers a combination of the most current evidenced-based care with Tohono O’odham values, traditions, and culturally appropriate care using traditional healers. “Because we are a sovereign nation, we want to preserve our beliefs, traditions, and culture,” Stout explains. “[For example] the Activity Director at the Center wanted to use aromatherapy. The Board asked her what she had in mind, what she planned to use. She told me and then I asked her, ‘Can’t you use mesquite?’ In the morning, the women of the village are making bread and the smell of mesquite is very strong—it is a comforting smell. The elders would love to smell this at the facility along with the sage.”
One of the facility’s initiatives is The Starlight Program, which monitors residents suffering dementia and encourages their involvement in activities. Other offerings include music and aroma therapy, intergenerational activities, and Alzheimer’s outreach.
Since its opening, the Archie Hendricks, Sr. Skilled Nursing Facility has received numerous accolades, including a 2008 award from the Harvard Project on American Indian Development, a 2008 local impact award from the National Indian Health Board, a 2009 award from the Indian Health Service, a 2009 Top Small Workplaces award from The Wall Street Journal, and a five-star rating from the Centers for Medicare and Medicaid Services (CMS) federal agency.
Stout and the TONCA Board were the driving force behind the creation of the Elder Care Consortium (ECC) that coordinates four tribal entities to address the needs of the Tohono Nation’s senior citizens. ECC members include TONCA, the Indian Health Service, the tribe’s Health and Human Services Department, and the Tohono O’odham Community College. All work together to address the varied challenges that face the nation’s elders.
“Healthy aging is an important issue. Many of our people have diseases that could be prevented. We must invest more in preventative health and education, including the incorporation of traditional Native American medicine. Western medicine does not have all of the answers,” Stout explained to the Robert Wood Johnson Foundation. “Our elders suffer from a number of chronic diseases, such as diabetes and hypertension. In addition, transportation, housing, and safety are also major issues for the aging Native American population. We live very far apart, and many of the elderly live alone. How are they supposed to get to the grocery store or to the clinic when there is no transportation? It is very difficult. We have to literally create all of our own services.”
After decades of hard work, Stout continues to address such services and her people’s unique needs. In addition, she serves on another nonprofit board and is also a member of the San Xavier Health Committee. Currently, a typical day may find Nurse Stout doing a lot of reading and responding to these committees. Some days are spent driving to the nursing care facility two and a half hours away from her home. (“The scenery is beautiful and very calming, so I don’t mind the drive,” she says.) As committed to her family as she is to her profession, Stout can also be found driving her grandson to the university he attends.
While Stout has dedicated her career to caring for Native Americans, she notes, “I don’t want people to think we are so different. A nurse can respond to any culture she’s working with. Nursing gave me the ability to care for and work with anyone, no matter where they come from or who they are.”
When Nurse Stout approaches recruiting young people to the field of nursing, she emphasizes fostering dedication and commitment. For Nurse Stout, when it comes to recruiting and reaching out to young people on behalf of nursing, it’s all about fostering dedication and commitment. They should also know up front that the classes, clinicals, and careers are not easy. She believes it is critical that future nurses commit themselves to the work wholeheartedly. Then again, all they need to do is follow her example.
