From the National Association of Indian Nurses of America’s second biannual national conference, held October 22 and 23, 2010, in Houston Texas. Pictured (from left) are the Executive Advisory Board: Vice President Ann Verghese, Secretary Lydia Albuquerque, Treasurer Ammal Bernnard, Past President and Advisory Board Chair Sara Gabriel, and President Omana Simon. The conference’s theme was “Transforming Health Care through a New Lens: Opportunities and Challenges.” Keynote speaker Jean Watson, Ph.D., R.N., endowed Chair in Caring Science at the University of Colorado, shared her vision of holistic caring in nursing practice.
The NAINA is a professional resource for Indian nurses, established in 2006 to address their unique professional, social, cultural, and political needs. It hopes to serve as the official voice of Indian nurses practicing in America and is currently working to “achieve acceptance and recognition among other associations like American Nurses Association (ANA), National Coalition of Ethnic Minority Nurses Associations (NCEMNA), Trained Nurses Association of India (TNAI), [and] International Council of Nurses (ICN),” says the organization’s mission statement. The NAINA is calling for Indian nurses to unite under the umbrella of the organization, particularly the state-level Indian nurses association found throughout the country, including California, Illinois, Massachusetts, Michigan, Florida, New Jersey, New York, Pennsylvania, and Texas.
The NAINA plans to promote political and professional awareness through its website, www.nainausa.com, and through newsletters and other publications.
In 1909, Lillian Wald, founder of the Visiting Nurse Service of New York (VNSNY) and the “mother of public health nursing,” hosted the NAACP’s inaugural meeting at her agency’s early headquarters, at a time when integrated meetings were forbidden by local ordinance. Last year, the NAACP remembered Wald’s courage and work during its centennial anniversary celebration in New York City. On their website, they refer to Wald as one of the organization’s “first and oldest friends.”
Wald truly set a tone for the agency she established. From its founding in the late 19th century, the VNSNY has served a broad range of diverse communities, played pioneering roles in the civil and women’s rights movements, and blazed a trail for diversity in the workforce.
In the late 1800s, Manhattan’s Lower East Side neighborhood was deemed the world’s most densely populated slum. At that time, Wald was a young graduate of New York Hospital’s nursing program, studying medicine and teaching immigrant women about home health and hygiene. Galvanized by the public health needs she saw among immigrant communities in the area, she and a fellow volunteer launched VNSNY in 1893. Wald and her colleague became the first public health nurses in the country.
Wald championed women’s rights by hiring and promoting women. In fact, the National Women’s History Project included her among its 2009 honorees. She played a prominent role in the women’s suffrage movement and is enshrined with Susan B. Anthony, Elizabeth Cady Stanton, and others in the National Women’s Hall of Fame. From Wald’s 1933 retirement to present day, women have led the VNSNY, culminating in 1989 with the arrival of current President and CEO, Carol Raphael. Ten years ago, the VNSNY staff was composed of over 90% women. Today, that figure stands at about 80%. Because of the agency’s highly diverse clientele, VNSNY has been at the forefront of promoting cultural awareness, developing and retaining a diverse workforce, and creating an inclusive environment—all elements that are crucial to effective service delivery. According to U.S. Census data, nearly 37% of New York City’s population is foreign-born, and 48% of the city’s residents speak a language other than English at home. More than a quarter of VNSNY patients are non- English speaking, and its staff members speak more than 50 languages.
Following their founder’s example, the agency has a proud legacy in the hiring of minorities. In the 1920s, when mortality rates in the black community were 200% higher than elsewhere in New York City, African Americans comprised 15% of VNSNY’s patients. Wald and other agency leaders responded by increasing its African American nursing staff from one supervisor and four nurses to two supervisors and 18 nurses, a number commensurate with their patient load. In her 1933 book Windows on Henry Street, Wald noted that VNSNY was the first organization to hire black nurses on equal terms. Today, roughly a quarter of its patients and more than half of its employees are descendants of the African diaspora, including African Americans, Afro-Caribbeans, and colleagues from Nigeria, Sierra Leone, Togo, and other African nations. VNSNY has also been caring for Asian and Hispanic immigrant patients and hiring staff of the same descents.
For most of its history, VNSNY also has been caring for patients in a number of other ethnic communities, while employing clinicians who share their cultures and heritages. In recent years, VNSNY developed multicultural home care programs dedicated to serving New York’s Hispanic, Asian, and Russian communities. Patients often feel more comfortable and, in some cases, recover more quickly, when they receive care from nurses and other caregivers who speak their language and have in-depth knowledge of their culture.
Currently, VNSNY employs the largest pools of Asian and Hispanic caregivers in the New York area, offering home health care teams trained in providing culturally sensitive care to patients in their native languages, incorporating their customs and values. Staff tailor comprehensive home health care and community-based services to the more than two million Spanish-speaking residents of New York City, who trace their heritage to 35 nations worldwide. Patients from these communities make up approximately 20% of active cases, a fi gure that mirrors the 20% of VNSNY colleagues who self-identify as Hispanic/ Latino.
Features offered include a Spanish-language telephone hotline for referral and information; nutritional diet plans specifically designed for Hispanics; patient forms and educational materials in Spanish; partnership programs with key Hispanic community organizations and referrals to community resources; and a close alliance with Hispanic community agencies, doctors, hospitals, and managed-care organizations. In late 2008, VNSNY was honored with a special institutional award from the New York chapter of the National Association of Hispanic Nurses for extraordinary outreach in that community.
The composition of VNSNY’s workforce and patient populations also reflect a spike in Asian immigration to New York City over the past decade. The staff now includes more than 700 colleagues of Asian descent, including Chinese, Filipino, Indian, Korean, Pakistani, and other nationalities. These colleagues speak several dialects of Chinese, Tagalog (Philippines), Korean, Hindi, and other Asian languages. They provide home health care familiar with the cultures, values, and customs of many different Asian groups. VNSNY also administers the Chinatown Community Center, which has served more than 65,000 community residents since it opened in 1999. The facility administered hundreds of free fl u shots last year, and it regularly provides free cholesterol, diabetes, and blood pressure screenings; health classes; community outreach; and other services to residents, particularly seniors, of New York’s Chinatown. VNSNY also runs the Chinatown Neighborhood Naturally Occurring Retirement Community (NNORC) program, launched in 2006. In addition to the public health services offered at its Chinatown Community Center, the Chinatown NNORC nurses and social workers visit homebound seniors to assess their individual needs and provide culturally sensitive care.
To serve the more than one million émigrés from the former Soviet Union now residing in the New York area, VNSNY has hired more than 200 colleagues who immigrated from Russia and former Soviet republics, including Ukraine, Azerbaijan, and more. The agency also employs escort translators who speak other languages, ranging from Korean and Japanese to Haitian Creole. In addition to the VNSNY Multicultural Home Care Programs, the agency makes a number of smaller, less formal arrangements to coordinate caregivers and patients in New York’s many other diverse communities. VNSNY also regularly sponsors events tailored to recruit nurses and other staff members from various multicultural NYC communities.
In 2009, CATALYST, a global organization dedicated to promoting diversity in the workplace, added VNSNY to its roster of “case studies”—models of inclusive practices in the workplace.
Comfortable with their knowledge of other cultures, VNSNY staff often act as the organization’s ambassadors to various New York communities and teach coworkers about their cultural heritages. VNSNY has carried its 117-year-old inclusive, multicultural approach well into the 21st century, a philosophy suited to a highly diverse workforce and its patients.
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?
We often say nurses are on the “front lines” of health care, meaning they work closely with patients and become intimately acquainted with the issues those patients face. And while hospitals can seem a lot like trenches sometimes, they are a far cry from the military operations taking place worlds away.
Here, two military nurses share their stories, from the stress of coordinating care in a combat zone to dealing with prejudice and personal growth, all while caring for the men and women serving in the U.S. armed forces.
Joseph D. Hacinas, R.N., M.S.N., C.N.S., P.H.N.
Lieutenant Commander, United States Navy Nurse Corps Last year, 2011, marked my 10th year as a nurse. Those years have been marked by personal and professional accomplishments. However, this was not always the case. In fact, my nursing career was almost never a career to begin with.
After graduating with honors, I had a great sense of pride and confidence. Perhaps I had too much self-confidence. As a result, I failed miserably with my nursing board exam. Worse, I blamed everything and anything but myself. Having failed this exam almost cost me my job and the opportunity to become a commissioned officer in the U.S. Navy. My mentality relied heavily on the fact that I was going to be a nurse. I intended to be an outstanding nurse, just like the hundreds of outstanding nurses of Asian/Filipino descent who came before me.
Yet, I assumed I could pass the nursing board exam without really studying or working for it. Well, lesson learned. An expensive lesson, I should add. Had I not eventually passed my nursing board exam, I would have been looking at an employer recoupment of about $20,000. Ouch! The good news is that I was able to overcome this barrier just in time.
I began my career in a military nursing at the Naval Medical Center in San Diego, and my goals were simple: learn as much as possible and don’t make mistakes with potentially dire consequences (e.g., a medication error). Not so different from civilian nursing, really!
I remember that rookie year vividly. Looking back, I am still not sure how I was able to succeed in such a demanding work environment. I was assigned as a staff nurse at a 28-bed medical-surgical unit. By far, we were the busiest nursing unit in our 250-bed facility. Every day was non-stop action. It felt like my heart rate increased by at least 10 beats per minute every time I set foot in the unit. It seemed like we never slowed down—and the tempo was dizzying. I would typically have six patients with an assistant. For any given shift, my duties would consist of AM care, vitals, assessment, medications, and procedures. I also had to coordinate MRI visits, CT consults, and X-ray availability while calling for discharge medications in pharmacy. No matter how physically and mentally prepared I tried to be, it was hard to maintain a sense of control. There were times that I was so stressed I literally made myself sick. Basic nursing skills such as prioritization of patients and critical-thinking skills were learned on the go. I wouldn’t exactly call it chaos. But it was close.
Yet, as crazy as it may sound, I actually did not mind it one bit. It’s the truth. One of the reasons was that I had great mentors around me. I used to look around our nursing unit and realized my nursing colleagues were more than willing to help, no matter what. Perhaps it was our sense of teamwork. Or it could have been our dedication to military nursing and our patients. Whatever it was, it didn’t take me long to realize that I had made the right career move. Unlike my civilian nursing colleagues, I have had the unique opportunity to care for patients who have served and are serving this great nation. It is a feeling like no other. To come in on a daily basis and know that I am part of something meaningful is incredible. This couldn’t have been more evident than after the events of September 11, 2001.
I was actually on my way to work when I heard of the terrorist attacks. Not knowing much at the time, I just remember thinking that my nursing skills were about to become a commodity, whether I was ready or not. It was a fearful and uncertain time for everyone, almost surreal to think that such an attack was even humanly possible. I just remember hearing from my supervisors, “Be ready.” There was a good chance most of us were bound for deployment overseas. Soldiers, marines, sailors, and airmen were counting on us to provide the best patient care possible under all circumstances. As it turns out, I was actually one of the nurses that ended up staying behind during the early stages of the war. Nevertheless, it was professionally fulfilling. It provided a great way for me to contribute. For the next few years, I found myself in various nursing assignments, from California to Japan. I have been blessed to grow professionally and gain a better perspective of my overall purpose as a military nurse.
Like some people find their niche in a nursing specialty like pediatrics or oncology, I have found that being a military nurse has its own advantages. I work with an outstanding team. From physicians to social workers, it is a rewarding experience to collaborate and gain a sense of unity. This is especially important as nurses and the rest of the health care team are tasked to care for patients with complex disease processes. More importantly, my service to active-duty patients and beneficiaries truly defines who I am as a nurse. Whether I am teaching a dependent spouse about healthier eating habits or holding a patient’s hand and praying with him before a major surgery, I am there to give it my all. Because, chances are, they would do the same for me. And that alone is what matters most. In a sense, we are more than just a family. We are united as one.
Of course, to say my military nursing career has been nothing but great experiences wouldn’t be entirely accurate. I can recall one incident when caring for a retired military member. He rang his call bell for assistance. When I walked in to his room, he said, “I’m sorry, but I had asked for a nurse.” I politely answered that I would be the one taking care of him for the night. He quickly replied, “No, no, no. I asked for a nurse—the one who has blonde hair, blue eyes, and wears a nice skirt.” Obviously, I could have reacted in a negative manner. Rather, I chose to remain calm and respectfully informed him that not all nurses are females with blonde hair. Somewhat perplexed, the patient quickly changed the topic and turned his attention to the television. I did not feel anger towards that particular patient; all I could think of was trying to find ways to help him understand the evolving nature of nursing, which now consists of men as well as Asian/Filipino nurses like me.
As troubling as that patient’s reaction seemed at first, I truly felt he came to realize that male nurses were more than able and capable of caring for patients like him. Though he never said so directly, I just had a feeling. And if nothing else, I know my serving as his nurse was a concrete example that contradicted his former world-view.
The common thread
Nursing is an ever-evolving profession. And changes in our health care delivery system will happen, regardless. The past 10 years of nursing have taught me valuable lessons. For one, I have learned to remain humble. I have also learned to not take things personally when it comes to patient comments. Granted, some comments are downright ignorant and hurtful. But, I believe there is a common thread and human decency in everyone. As a military nurse, I am proud to be a part of their lives. In particular, I am proud to know that I have been given ample opportunities to touch lives and care for my patients. I never imagined I would be in the position to make an impact on someone’s life. Personally, those few minutes of comforting patients during the worst of times have turned to a lifetime of personal and professional satisfaction.
Yet, as with any profession, nursing is not for everybody. I have friends and colleagues who left nursing. I think some of the more common reasons for doing so were the stress of the patient workload and the lack of support from nursing leaders. Being a minority nurse, my advice is to truly and honestly evaluate one’s dedication and intention before committing to nursing. Nursing is a great and well-respected profession, but it does come with its challenges. For example, there have been times when I feared for my safety when caring for patients with developmental delays and mental instability. In addition, minority nurses may still encounter racial and ethnic stereotypes.
Once, a patient bluntly asked if all Filipino nurses speak Tagalog among one another in front of non-Filipino patients. Taken aback, I informed her that no, that is not the case. They only speak their native language during their off-duty time. In another instance, when reporting to my new supervisor (who happened to be a minority), she said, “I can already see two things that are against you. You’re an Asian and a male.” In the U.S. Navy Nurse Corps, we value diversity and strongly feel that concept results in a better work environment for all of our valued staff members, regardless of their race or color. Yet, we, as a health care organization, also understand that we are at risk for discrimination. The good news is that we have a solid support structure that enhances equal opportunity for all.
I learned there remains a small group of people in the nursing world who are who they are and believe what they believe, and there’s no changing them. More importantly, I learned the value of self-discipline while serving my patients at the most honorable level. Ignorance and immaturity exist in this world, but we, as minority nurses, have more than the power and ability to achieve the highest levels in long, fulfilling careers. We should not and cannot allow minor setbacks to dictate who we can become as professionals—we are simply too valuable to the profession. I have always seen nursing as a rewarding career, personally and professionally. Joining the nursing ranks seemed like a no-brainer. And, in general, my expectations of camaraderie, mentorship, and professional development have been met.
Who knows what the next 10 years will bring? I may pursue other interests such as golfing and traveling across the globe. I may even find myself teaching at a local university. I am okay with the unknown that lies ahead when it comes to my career as a military nurse. The one thing that I am certain about is that I will continue to strive in providing the best patient care. The ability to make a difference in patients’ lives means a lot to me. And sometimes, that is all you need. Here’s to another 10 years!
Artemus Armas, R.N., M.S.H.S, B.S.N, C.E.N.
Major, United States Air Force, North Carolina
I have been an Air Force nurse since January 2002. Before that I was in the National Guard and Army Reserve for 17 years before I went on active duty. In the Guard I was an Army Infantry officer.
During my fourth deployment, I was at the Camp Bastion Joint Operating Base in the Helmand Province of Afghanistan, the fiercest combat zone in Afghanistan at the time I was there. I was in charge of the Aeromedical Evacuation Liaison Team (AELT) at Camp Bastion Joint Operating Base Hospital. The team consisted of a flight nurse (myself), a medical service corps officer, and two radio technicians. We were primarily responsible for providing fixed-wing aeromedical evacuation for NATO forces and sometimes civilians. The team also helped anyone, including civilians, who may need to be seen by a specialist not stationed at Camp Bastion.
The AELT’s key function is transferring patients, such as those with traumatic amputations or other combat injuries, who need more specialized treatment to a different facility. The hospital relies on the AELT to coordinate the patient’s transfer with a medical aircrew (Aeromedical Evacuation Crew, or AEC), which flies the patient from point A to point B. Once the patient is picked up by the AEC and en route to a higher level of medical care, the AELT advises the staff and hospital awaiting the patient’s arrival.
A secondary mission for AELT is providing emergency medical assistance to local nationals and Afghan National Security Theater hospitals. Camp Bastion is a joint hospital, meaning whichever nation’s military is in charge of the hospital collaborates with the other countries working there. When I was there we had the Danish, British, and U.S. military.
Camp Bastion is a Role 3 hospital. Role hospitals break down as follows: Role 1 hospitals are assigned to areas providing basic or initial care; Role 2 are facilities with some surgical capabilities; Role 3 facilities can support trauma care, surgical procedures, and burn care; and Role 4 is advanced medical center care. As the lead medical person on the AELT, I made sure patients were properly prepared for flight. I also trained coalition force physicians, nurses, and medical technicians regarding approved devices, brands, and materials, including pumps, chest tube drainage systems, and traction devices.
I also taught hospital leadership on how our system works, the process of getting a patient to a higher echelon of care; this education included Army, Navy, and Marines. While at Camp Bastion I authored and implemented new policies on moving patients through the theater hospital systems, called the Patient Movement Requirement (PMR). Fortunately, implementing these procedures cut down patient movements errors by 60%.
The AELT took the lead in teaching hospital personnel how to sanitize patients before entering the hospital. We sanitized over 500 ally and enemy casualties (patients), meaning we removed any guns, ammo, or explosives before injured personnel entered the hospital. This was for security, assuring nothing happened to hospital staff and patients.
Through these initiatives and two published articles, my goal was to educate AE crews as much as possible so they would not stress when they saw unfamiliar medications or procedures, while giving a report for patients being moved by the AECs. I also included a quick reference sheet of drugs used by the coalition facility and its U.S. equivalent. By the end of this deployment, my four-person team had moved 313 patients, including 102 battle injuries.
ICU in the sky
On my second deployment that year, I had a five-day notice to get my bags and go, due to an injured person who was deployed. I went to Southeast Asia, where I was in charge of the Aeromedical Evacuation Operations Team. I managed up to eight Aeromedical Evacuation Crews and two Critical Care Air Transport Teams (CCATT).
CCATT is basically an airborne intensive care unit. The team consists of a physician, nurse, and respiratory technician; they transport the most critical patients with the assistance of the AEC. I needed to make sure the crews were ready to fly 24 hours a day, seven days a week, so we could pick up patients in the Area of Responsibility, which covered seven countries. I planned and coordinated training as needed for the crews, from medical guidelines to how to use specialized communication equipment. Mentoring was also a big part of the job, including how to deal with crewmembers and patients, career planning, and writing military reports.
Another big aspect was scheduling AECs, by following regulations regarding when crews could and could not fly. Crews need enough time to recoup and rest to be able to perform their duties on the plane and provide high-quality patient care. Scheduling can sometimes be hectic, because you have crews both on call and on missions.
I also coordinated over two tons of Patient Movement Items to the AOR, while my team also maintained and managed 73 Portable Therapeutic Liquid Oxygen units (patient oxygen). This optimized five AE units and kept them fully mission capable. While there I functioned as a crewmember when personnel were unable to fly due to injury or illness. I flew three missions as part of an AEC and pulled 120 hours of alert status, resulting in the transfer of 18 coalition casualties to advanced care. During increased operations we relocated 12 Aeromedical Evacuation Crew members and two CCATTs to Bagram, Afghanistan, increasing Operation Enduring Freedom capabilities by 20%. The efforts during that time lead our team to win the Expeditionary Aeromedical Evacuation Squadron “Team of the Month.” While deployed, the team safely evacuated over 400 wounded personnel on 180 sorties.
The most important result of all that I do is making sure patients, whether military or civilian, receive the best, most comprehensive care possible throughout the AE system. You need everything: great patient care, equipment, leadership, management, and more. If you just focus on one, the system will not be optimal. It is crucial to be well-rounded on all aspects of the AE system. I am honored that my commanders have seen qualities in me to give me the opportunity to succeed in the positions where I have been placed. My philosophy is to do what is best for the patient and those who take care of them; everything else will fall in place.
While deployed as an AELT, I lead our team with a program called “Soldiers’ Angels” (www.soldiersangels.org). We would collect items such as books, food, soap, clothes, music, and blankets from people throughout the United States to give to personnel living in austere conditions and patients who needed supplies in the hospital. We ended up distributing over $50,000 in products to over 500 patients, 24 units, and 12 Forward Operating Bases.
Recently, I was honored with two awards: The Air Force Flight Nurse of the Year and Nurse of the Year. When my commander informed me I won, I was shocked. It is an honor just to win one. I had learned my commander had put a Flight Nurse of the Year package in for me when I was deployed to Southeast Asia, but I never expected to win. I gave her my information and didn’t think of it again until I won. It was a shock to both of us when I also won the Nurse of the Year. However, though I say “I” in describing all these events, I truly could not have done it alone. The team makes it happen—I just tried to lead them in the right direction.
Getting the opportunity to be a flight nurse has been the most satisfying job I have had thus far in my nursing career. Being a flight nurse in the Air Force has given me opportunities to be an effective leader and make an immediate difference for those I have taken care of that I would not have had as a nurse in a clinic or hospital. Like the rest of the nation, the Air Force needs more nurses and the AF Flight Nurse community needs even more, as a specialty. I would recommend this life to anyone who likes adventure, leadership opportunities, and enjoys taking care of our wounded warriors.
“A year ago, we never thought we would have had this meeting. This is truly an opportunity to learn from each other.” With these words, SeonAe Yeo, PhD, RNC, president of the Asian American Pacific Islander Nurses Association (AAPINA), officially opened AAPINA’s 2004 Annual Conference–the first such national gathering in the association’s 12-year history.
The inaugural conference, held last August 7 at the Hyatt Regency Embarcadero in San Francisco, drew a small but enthusiastic audience of AAPINA members and Asian American/Pacific Islander nursing students from around the country. Together they spent a very full day listening to speakers, viewing poster sessions on Asian American health topics, attending business meetings, networking, and brainstorming ideas in breakout discussion groups.
AAPINA was founded in 1992 by a group of 14 nurses who wanted to create a unified voice to advocate for equity and justice in nursing and health care for Asian American and Pacific Islander people in the U.S. and its territories. The association’s first president was nursing educator Kem Louie, PhD, RN, FAAN, who is a member of Minority Nurse’s editorial advisory board.
The First Annual AAPINA Conference was held in conjunction with the National Black Nurses Association (NBNA)’s 32nd Annual Institute and Conference, also at the Hyatt Embarcadero. In her opening remarks, AAPINA vice president and conference chair Jillian Inouye, PhD, APRN-BC, thanked the NBNA for its collaborative support. “We’re fortunate to have you as our ‘big sister’ to help sponsor our first conference,” she said. NBNA President Bettye Davis Lewis, EdD, RN, FAAN, responded in kind: “We are so happy to be here as your ‘big sister.’ This is an historic occasion.”
Added Yeo, who is an associate professor at the University of Michigan School of Nursing in Ann Arbor, “Each minority group has different health disparities. Each of [our minority nursing organizations] must articulate our own issues–but at the end of the day, we have to work together. AAPINA can’t match the NBNA’s 32-year history, but we hope we will grow and thrive as they have.”
In keeping with the AAPINA conference’s theme of “Developing and Networking with Other Ethnic Minority Nurses,” the Asian American nurses enjoyed many opportunities to interact and share ideas, not just among themselves but also with prominent minority nurses from a variety of cultural backgrounds. In addition to several NBNA leaders, attendees included leaders from the National Association of Hispanic Nurses, the Philippine Nurses Association of American, the National Alaska Native American Indian Nurses Association and even an NBNA member who registered for the AAPINA event because she was taking a transcultural nursing class.
Nurse executive Marilyn Chow, DNSc, RN, FAAN, a founding member of AAPINA who is vice president, patient care services, at Kaiser Permanente in San Francisco, was the conference’s keynote speaker. Discussing the role of cultural and linguistic competency in health care, she noted that many U.S. hospitals “are now experiencing a collision of cultures–the patients are more and more multicultural and so are the health care staff.”
But because of the emphasis on networking and learning from each other, Chow spent most of her allotted time facilitating open dialog between the audience members instead of merely giving a speech. The result was a lively, far-ranging discussion touching on everything from unmet Asian health needs and the nursing faculty shortage to the isolation felt by a Taiwanese graduate student in Chicago who said she receives little support from her nursing school “because the Asian population is not considered a priority in Chicago, compared to African Americans and Hispanics.”
Dr. Yeo spoke passionately about the challenges of breaking down cultural and linguistic barriers that contribute to Asian American health disparities. “Unlike Hispanic subgroups, who all speak Spanish, Asians have more than 60 different languages,” she said. “And just knowing the language is not enough ; you must also have knowledge of the patient’s culture.
“We also need to fight stereotypes about Asian patients–for example, that they are stoic about pain,” the AAPINA president continued. “Just because they don’t express [their pain] doesn’t mean they don’t feel it.”
Another unaddressed Asian health care challenge in the U.S. is providing care to Japanese businesspeople who come over to America to work for a few years, bringing their spouses and families with them. “This group has very unique health care needs,” Yeo explained. “They are not interested in learning English, because they are only here short-term.”
For more information about the Asian American Pacific Islander Nurses Association, contact Dr. SeonAe Yeo at [email protected].