Pho, who worked in New York City in the beginning of the pandemic, says the nursing community and his nursing work gave him a purpose through a distinctly challenging time. “You choose a place and you choose an environment to create the most potential for relationships,” he says. “The people and nurses I met are so phenomenal.” And while the pandemic did bring a fear of an unknown threat, Pho says nurses just did their jobs. “When you sign up for nursing, this is what you sign up for,” he says.
Nursing is Pho’s second career; he was in the software industry for more than a decade. “I didn’t want to do that anymore,” he says. “It was the same plot line and a different cast of characters.” Pho was accepted into the Johns Hopkins School of Nursing accelerated BSN program with the intention of returning to the Bay Area and working as a nurse. “But I met my tribe at Hopkins,” he says, and ended up staying to complete an MSN and an MPH there as well, working as an ED nurse and even working with an emergency medical residency program in Tanzania.
After Hopkins, Pho moved to New York City and became an NP at Weill Cornell Medical while also holding a teaching role. A lifelong advocate for LGBTQ health issues, Pho had a casual conversation with a physician who needed someone to develop the LGBTQ section of a curriculum on vulnerable populations and asked if he was interested. That led to a five-year teaching role at Weill Cornell Medical where he taught the first-ever LGBTQ health curriculum for the internal medicine residency program. In 2017, he left the role to pursue his PhD studies at Columbia University which he completed in 2020.
The spring of 2020 was a pivotal time for any nursing student, but for one in New York City, it was working in chaos. But for Pho, it totally cemented his dedication to his profession. Pho worked at Callen-Lorde Community Health in New York City, one of the largest providers of LGBTQ health care in that city.
“We staffed one of the convalescent hotels in Queens, and 50 percent of the patients were COVID positive from the shelter system and the remainder symptomatic,.” he says. “During that time I lived in a third-floor walkup in New York City, and I worked from 8 pm to 8 am while working on my dissertation,” recalls Pho, who also serves as a board member for GLMA: Health Professionals Advancing LGBTQ Equality. “Nursing saved me. It was a horrible time, but my queer nurses–we were together all the time. I think about my nurses, my role, my identity, and how it all gave me a purpose. I know it saved me. We were helping save people who society didn’t want to help.”
Through it all–the uncertainty, the lack of solid information, the severe illness of patients–Pho said a guiding principle made all the difference. “I think about being a nurse,” he says, “and a sense of purpose. I knew this is what I was meant to do. It got me up every day.”
Pho says his career has been paved by taking chances and finding opportunity when he could, and making opportunities when he couldn’t. And each task he completed or each chance he took led him to be in the right place at the right time–and with the right skills–to be able to offer the help that was so needed. “You make your own luck,” he says, a lot of which he says is based on the grind of doing the hard work day in and day out. “It’s important that you show up, not because you think it’s good for your career, but because you are truly passionate about it. The rest will follow. You do it because you want to make the queer universe a better place.”
He remains enthusiastic about nursing and the students who aspire to roles like his. “New grad nurses are so inspiring to me,” he says. One new nurse was having a hard day, Pho says, and he could tell she needed the pep talk he offered. “She said to me, ‘I needed to hear that validation.'” The moment struck a chord for Pho. “I told her, “Don’t think for a minute that I don’t have those days.'” Despite his experience and education, Pho says nurses still sometimes need someone to let you know, yes, you are a nurse and look at all you are doing.
“I started to see my role a little differently,” Pho says. “Sometimes it seems like all the dots seem to connect perfectly, but I’ll tell you it doesn’t feel that way when you’re doing it.” In fact, the way a nursing career progresses is sometimes based on opportunity but, more frequently, it’s something else. “I don’t think it’s predestined,” he says. “You make choices–not right choices and not wrong choices. There’s grace in the work.”
Technology changes in the proverbial blink of an eye. Working and teaching during the COVID-19 pandemic has proven how much it will be used in the field in both practice as well as nursing education.
Julie Stegman, Vice President, Nursing Segment of Health Learning, Research & Practice at Wolters Kluwer, took time to answer our questions about their survey, Future of Technology in Nursing Education.
Why did you decide to conduct this survey? What did you hope to learn from it?
As technology advances, and more and more people have access to computers and smartphones, tech is augmenting almost every workforce. Nursing is no exception. We originated our first survey around technology usage and adoption in Nursing Education five years ago to understand how rapidly nursing programs were implementing technology as part of the education process. Technology helps nursing educators prepare students for practice so they can deliver the best care to patients everywhere, and today’s students have an expectation for a dynamic and multi-modal learning experience.
We decided to refresh our survey this year to understand the shifts in education related to the COVID-19 global pandemic and beyond. We surveyed nursing deans, program directors, and faculty to identify their plans for technology usage, adoption, and investment during the next five years and explore the barriers and opportunities related to those plans.
What are the most important results of the survey? What does this say about the future of nursing education?
Some of the results of the survey were predictable: over the last year and a half, there’s been a massive transition from in-person learning to virtual learning, with some 73% of institutions going fully online at the start of the pandemic, and another 22% adopting a hybrid model.
Though the adoption of virtual simulation and other technologies were already in play in nursing education before COVID, the pandemic greatly accelerated it out of necessity. Some 48% of respondents say they plan to invest more in virtual simulation during the next 2 years, with virtual simulation reaching full adoption by 2025.
Overall findings of the survey point to a “classroom of the future” that is hybrid, geared for digital learners with emerging and existing technologies.
How did the study work?
For our Future of Technology in Nursing Education survey, Wolters Kluwer carried out six in-depth interviews with qualified nursing respondents in August 2020, followed by a quantitative online survey sent out in December 2020. The purpose of the study was to understand technology trends. The online survey, done in collaboration with the National League for Nursing, was sent to a list of nursing administrators, faculty, and Deans provided by the National League for Nursing, yielding 450 responses.
The opinions of these respondents were critical to capture because they represent real nursing education leaders making a difference in the world of nursing education today. No one can better speak to both the day-to-day circumstances and the long-term technological trends than these respondents, and we are very pleased with our sampling.
What survey results surprised you the most?
As we showed with our previous survey, nursing education continues to be an area of early adoption of technology. This has been particularly evident in simulation learning, including research into the value and effectiveness of this learning modality. Our survey continued to reinforce this shift, with nurse educators looking ahead to fuller scale adoption of technologies as well as a continued interest in emerging technologies.
I was most surprised that the incredible shift to online learning we experienced during COVID-19 is anticipated to continue with three in ten (31%) educators saying their programs will offer the same number of online courses, and 39% indicating their program will offer more online courses.
What are the three key barriers that the survey showed are barriers to the adoption of technology? Any ideas how the nursing field can overcome them?
Various factors are hindering tech adoption in nursing education, including a lack of funding and lack of technology infrastructure. Another difficulty nursing education is facing as a side effect of increased tech adoption is faculty who may be resistant or slow to change their approach to teaching, with many faculty members opting to retire and leave the workforce. This has the potential to exacerbate an existing shortage in nursing faculty. We need to remedy this shortage to ensure that all qualified applicants can enter nursing school and become practice-ready nurses to mitigate and meet the anticipated patient demand.
COVID-19 has shown us that learning technologies need to be in place to continue to provide the best possible nursing education in the face of unpredictable learning environments, as well as address many pre-existing challenges educators faced with clinical learning. We anticipate that the pandemic and the associated shifts in learning and teaching approaches will also force a shift in funding which will help address previous hurdles as many of these solutions move from “nice to have” technologies to those that are necessary within nursing schools.
To address the gap in nursing education as a result of recent waves of retirements, we need to ensure educating future nurses is seen as critical to the nursing profession and address the challenges that create this faculty shortage. This includes compensation differences in clinical roles vs. education and ensuring that masters and doctoral programs can also increase acceptance of applicants. In addition, it’s critical to ensure that future educators are familiar with and embrace the benefits that educational technologies can bring to the learning process.
Ultimately, the #1 goal for nurses is to provide the best care to patients, everywhere and in any care setting. This begins with education and it’s essential that nursing faculty and students have the tools available to empower them to be ready to enter the workforce. The Dean’s Survey helps us understand which technologies are likely to drive this momentum, and where we can continue developing solutions to help prepare practice-ready nurses.
The coronavirus has hit minority communities harder in terms of health by amplifying social and economic factors while also revealing deep-rooted inequities. Racial disparities that were present before the pandemic have only been compounded and are evident in the rates of minorities contracting the virus compared with their percentage of the population. This has especially been seen in Latino and multiracial communities in the United States. According to the CDC, Latinos make up 18% of the population and account for nearly 29% of Covid-19 cases. Similarly, those who identify as multiracial (non-Hispanic) make up 2% of the population but 5% of Covid-19 cases.
Source: CDC Covid Data Tracker (as of 5/20/21)
As a result of the pandemic, racial and ethnic disparities in access to behavior health care have also been illuminated. Interestingly, the rates of behavioral health disorders in Blacks and Latinos do not differ from the general population. Yet, they do have markedly less access to mental health and substance-use treatment services. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), of the 4.8 million African Americans that live with mental health disorders 69.4% of them receive no treatment. Of the 6.9 million Hispanics who live with mental health disorders 67.1% receive no treatment. Both these statistics are alarmingly high when compared with the 56.7% of the overall U.S. population that do not receive treatment for mental illness. Likewise, alarming numbers can be seen in those with substance use disorder. Of the 2.3 million African Americans who have Substance Use Disorder, 88.7% do not receive treatment. Of the 3.3 million Hispanics who have Substance Use Disorder, 89.7% do not receive treatment.
There are already many barriers in place for Blacks and Latinos due to social determinants that only increase the vulnerability of those with mental illness. Black and Latinos have lower access to health care, are found to terminate care prematurely, and receive less culturally responsive care. The opioid pandemic is perhaps hitting the Black and Latinos the hardest due to their limited access to preventive treatment and recovery resources for substance use disorders. Despite Blacks having comparable rates of opioid misuse as the general U.S. population, they were found to have the greatest rate of overdose methadone synthetic opioid deaths.
Nurses must work with the health care team to prevent the interruption of substance use treatment and recovery services. Telehealth services must be expanded. Those with substance use disorders and mental illness who have Covid-19 particularly need support during this time. Recovery support groups that have been stopped, clinics that have closed, and the discontinuing of harm reduction services like syringe service programs have the potential to trigger relapses in our patients as well as increase the rates of HIV and hepatitis. According to SAMHSA, Blacks and Latinos who have substance use disorders and mental health disorders are found to be more likely to be homeless and incarcerated which further increases their risk of Covid-19.
There is much potential for managing this identified risk and problem in Black and Latino populations. Policy efforts can be made in the form of disaggregating data so that resources can be targeted based on more specific data. Policies and treatments should be more flexible. For example, SAMHSA released a guide which enabled dispensable take-home methadone treatment programs during the pandemic. There should also be a push for expanded and flexible coverage of telehealth so patients can continue to receive treatment via the telephone or video-conferencing.
Communication, health literacy, and public awareness must also be accounted for. Covid-19 education should be translated into the language of those in the communities we serve. Also, messages should be culturally tailored so that concepts presented like social distancing are culturally appropriate. Communication channels are also important so perhaps using Black and Latino radio stations, websites, and trusted media figures to deliver important messages about prevention strategies
Workforce efforts can also be had by augmenting the workforce with culturally competent healthcare professionals. The workforce is in dire need of the individuals. Perhaps fast-tracking immigrants, refugees, and bilingual health care professionals could create a much needed pool of such health care workers in the United States. Peer navigators and coaches are also valuable for creating outreach and engagement of Black and Latino communities so that they can be properly linked with mental and substance use disorder treatment. Peer navigators know the communities we serve well and know how to effectively communicate with clients. These could be made virtual to ensure Black and Latino communities receive proper behavioral health care.
Blacks’ and Latinos’ physical health have greatly been impacted by the pandemic with a disproportionate rate of Covid-19 infection. However, the pandemic is not only affecting the nation physically—but also behaviorally. As nurses we address the physical and emotional health of our clients because we see them as a whole being. Therefore, we must work hard to address these issues and advocate for our patients so that they can live healthy lives, not just in their bodies—but in their minds as well.
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