Crooks has published a paper, titled “The Impact of COVID-19 Among Black Girls: A Social-Ecological Perspective,” in the Journal of Pediatric Psychology, reporting on the findings of a qualitative study that featured interviews with 25 Black girls—ages 9 to 18—from December 2020 to April 2021. Most participants reported significant psychological and physical consequences, including depression and anxiety, disrupted eating, distorted body image, and changes in self-esteem.
“Black girls are a very vulnerable and unprotected population, especially within the context of COVID,” Crooks says. “I thought it was a really critical question to be asking youth: How has this impacted their perceptions of self?”
Black girls are particularly vulnerable because they enter puberty and develop secondary sex characteristics earlier than their non-Black peers, according to the paper, causing them to suffer from “adultification” and “sexualization by society.” This can lead to elevated sexual and mental health risks.
Crooks found that only two of the girls in the study received any formal sexual education during the pandemic, as schools opted to delay teaching sex education during online learning due to the sensitive nature of the topic.
“Missing such a critical component of education was alarming to me,” she says. “This is a critical period in their life. Just because the world stops, doesn’t mean their bodies stop growing and evolving.”
Social media also played an outsized role in the girls’ lives as they found themselves isolated from peers during quarantine. Some girls struggled with body image issues and eating disorders, Crooks says.
“They were sitting in their houses watching TV, or they were on social media sites like Instagram or Tik Tok, so they were constantly exposed to overly-sexualized, unrealistic expectations for what their bodies are supposed to look like,” Crooks says.
Conversely, a majority of the participants said the isolation and reduction in peer interactions allowed them to engage in emotional healing and self-discovery, independent from peer pressure.
The pandemic also intersected with the Black Lives Matters movement. As the participants increasingly turned to media in lieu of social interactions, they saw mistreatment of Black people by police, including the murders of Breonna Taylor and George Floyd, nationally broadcasted. These messages led to mixed feelings among the participants.
“A lot of what the girls talked about was feeling empowered to be Black and having a sense of pride within their identities,” Crooks says. “On the other hand, there was fear that came with color of their skin – fear of being harmed themselves, or their fathers, brothers or other family members being hurt. There was this constant fear and threat to Black families.”
Crooks says her research shows the need for more school-based programming to bridge the gap in sexual health education in schools, as well as the need for family interventions to instill protective strategies in Black girls to help them be prepared to handle threatening situations.
In many people’s minds, the “typical” nursing student is an 18- to 22-year-old enrolled in a bachelor of science in nursing (BSN) degree program at a college or university. However, there are many degree options available for aspiring nurses at all stages of life—even if you’re a nontraditional student—and you’ll be graduated and putting on your scrubs before you know it.
According to the National Center for Education Statistics, a nontraditional student meets one of seven criteria: delayed enrollment into postsecondary education, attending college part-time, working full time, financially independent for financial aid purposes, dependents other than a spouse, single parents, or those without a high school diploma. If any of these describe you and you’d like to go back to school to get your nursing degree, here are seven online programs that anyone from around the country can take.
1. St. Xavier University
St. Xavier has numerous online options for those looking to earn nursing degrees. It offers an RN-to-BSN program for currently licensed registered nurses who have completed an associate degree in nursing (ADN) from an accredited school of nursing and are looking to take the next step in their education. St. Xavier was also named the best online master’s nursing program by U.S. News and World Report, and it offers three master of science in nursing (MSN) tracks online: clinical leadership, executive leadership, and nurse educator. If you’re not looking for the full degree, St. Xavier also offers certificates in clinical leadership and nurse educators.
2. Medical University of South Carolina
The Medical University of South Carolina (MUSC) offers an online RN-to-BSN program, which is a 12-month program that covers three consecutive semesters, allowing registered nurses to earn their bachelor’s degrees in just a year. The online program is designed specifically for working adults. MUSC also offers several online advanced degrees in nursing, including a doctor of nursing practice (DNP) and a PhD in nursing science, though some of the courses may require a visit to campus.
3. Johns Hopkins
Johns Hopkins is an incredibly well-respected name in the medical community—and you can earn a graduate nursing degree from the university online. Johns Hopkins provides an MSN in health systems management both by itself and in combination with an MBA. It also offers a DNP in three specialties: adult-gerontological health clinical nurse specialist, adult-gerontological critical care clinical nurse specialist, and pediatric critical care clinical nurse specialist. You can also earn a DNP Executive Track, either on its own or in combination with an MBA. Finally, Johns Hopkins offers a couple post-master’s certificates for nurses looking for even more education.
4. George Washington University
George Washington offers a wide range of online programs for nurses of all experience levels. It has both RN-to-BSN and RN-to-MSN programs, as well as four other master’s programs for adult-gerontology primary care nurse practitioners, family nurse practitioners, nurse-midwifery, and nursing leadership and management. Other options include three post-MSN certificate opportunities, two post-BSN doctoral degrees, and two post-MSN doctoral degrees, including a DNP degree.
5. The University of Texas at Tyler
The great state of Texas has equally great online programs for nursing students through the University of Texas at Tyler. Its RN-to-BSN track has a flexible schedule and graduation date, so you can proceed through the coursework at your own pace as your current job allows. Their graduate options include four MSN programs (administration, dual MSN administration/MBA, education, and family nurse practitioner), four certificate programs (post-master’s administration, post-master’s education, post-master’s family nurse practitioner, and post-baccalaureate health care informatics), two PhD programs (MS-to-PhD and BSN-to-PhD) and one doctor of nursing practice (DNP). As an added bonus, the University of Texas at Tyler was named the #1 most affordable online master’s in nursing program.
6. Duke University
Duke’s School of Nursing has been using distance-learning education strategies for more than two decades, and the school has honed its creative approach to distance teaching and learning over the years. Some programs do include a few short on-campus intensive sessions, usually two to three days in length, but the commitments are minimal. Duke offers a doctor of nursing practice as well as eight different nurse practitioner tracks for their master of science in nursing: adult-gerontology (primary and acute), family, neonatal, pediatric (primary and acute), psychiatric mental health, and women’s health. It also offers three systems MSN degrees in nursing and health care leadership, nursing education, and nursing informatics.
7. University of Cincinnati
Cincinnati’s reputation as a great online nursing school has spread: The school’s number of distance learners has been increasing, and the website boasts that more than 62% of the student body is now enrolled in online classes. Most of its graduate nursing degrees are offered completely online, though a few courses do have minimal on-campus requirements for clinical or lab work hours, so don’t forget to pack your nursing bag. The school offers four MSN specialty programs (adult-gerontological primary care nurse practitioner, family nurse practitioner, nurse midwifery, and women’s health nurse practitioner) as well as two post-master’s certificates (psychiatric mental health nurse practitioner and family nurse practitioner).
If online classes don’t appeal to you, see if any schools in your area offer a nursing degree for working adults who usually rely on night and weekend classes in order to accommodate work schedules. And no matter how your get your degree, you’ll have to study for and pass the National Council Licensure Examination for RNs (NCLEX-RN) exam if you haven’t already and perhaps pass additional licensure requirements depending on your state.
Whether you’re a working nurse looking to take the next step or a young professional looking to switch careers, there’s a nontraditional degree program out there for you. Thanks to the recent breakthroughs in education technology, students can now attend nursing degree programs online anywhere, anytime, and these seven well-respected programs are a great place to start.
A decade ago, a smattering of nursing schools first began offering degree and certificate programs that focus specifically on minority health, eliminating health disparities and serving the needs of vulnerable patient populations. More recently, however, both the number and quality of these programs has begun to increase significantly.
“In the last five years, there has been a more serious attempt at understanding what we should be doing in these types of programs,” says Shirley Moore, PhD, RN, FAAN, director of a new pre- and post-doctoral training program at Case Western Reserve University’s Frances Payne Bolton School of Nursing in Cleveland that prepares nurses for research careers focused on vulnerable populations with multiple morbidities. “These programs are moving to more substantive issues in minority health and a greater understanding of culture as a context for care.”
A primary reason for this shift is the increased national awareness of the crisis of minority health disparities. Studies such as Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, the landmark report issued by the Institute of Medicine (IOM) in 2003, have documented extensively that Americans of color do not receive the same quality of care as the white majority. The IOM report also suggested that bias, prejudice and stereotyping on the part of health care providers may contribute to these differences in care.
The underlying principle of social responsibility runs deep in the nursing profession. As nurses become increasingly concerned about health care inequities in communities of color, they are spurred to gain a better understanding of these issues and to build the skills needed to address them. “Nurses have always had the underlying value of tailoring care and incorporating patient preferences,” says Moore. “But how do we tailor care for patients when we don’t know much about their [cultural] background?”
Another reason for the proliferation of these programs is that federal agencies, such as the Health Resources and Services Administration (HRSA), have earmarked millions of dollars in funding specifically for nursing schools. In fiscal year 2006, the agency awarded 151 Advanced Education Nursing grants, 53 Nursing Workforce Diversity grants and 138 Nurse Education Practice and Retention grants, says Annette Debisette, PhD, ANP, RN, director of HRSA’s Division of Nursing. Last year, HRSA appropriated almost $150 million to nursing schools that offer programs focusing on underserved populations.
“The availability of [federal] dollars has permitted us to act on our good will to create these centers and programs that train people with new views on how to approach [cultural issues in nursing care],” Moore says.
Changing the Student Profile
Many of these minority-health-focused nursing programs are attracting a highly diverse mix of students from a wide spectrum of racial and ethnic backgrounds. While they are not targeted specifically to students of color, there’s no denying that these types of programs have helped boost minority enrollments in nursing schools across the board.
“Every training program we’ve had that was working toward understanding diversity, access to care and other minority health issues has been a big attraction for minority students,” says Moore. She adds that the new pre- and post-doctoral training program “is changing the profile of the doctoral student here at Case.”
The Catholic University of America (CUA) School of Nursing in Washington, D.C., offers three HRSA-funded master’s degree tracks in community/public health that focus on decreasing health disparities and increasing the number of nurses from minority populations. Of this year’s graduates, 58% are students of color, says Eileen Sarsfield, PhD(c), MSN, APRN, BC, project manager of the Immigrant, Refugee and Global Health Clinical Nurses Specialist (CNS) Program track.
Three quarters of the students enrolled in this track for the fall semester are racial and ethnic minorities. “This program appeals to nurses who are immigrants themselves or minorities interested in giving back to their community,” Sarsfield notes.
Most of these types of programs are offered at the graduate level, and the nurses who are enrolling in them are as diversified in their career tracks as they are in their ethnic and cultural backgrounds.
Of the 33 students currently enrolled in the University of Texas at Arlington School of Nursing’s PhD program, which focuses on preparing nurse scientists to meet the health needs of diverse and vulnerable populations, some are nurses who work in an administrative capacity at large health care organizations, says Jennifer Gray, PhD, RN, associate dean of the program. Others are nurses with years of clinical experience at the bedside or advanced practice nurses who want to move into a leadership or management role. Some are faculty members at other educational institutions. Some of the full-time students work as graduate research assistants.
Similarly, the 60 students enrolled in the University of Illinois at Chicago (UIC) College of Nursing’s Adult/Geriatric Nurse Practitioner programs, which focus on caring for diverse patient populations, range from master’s-entry students making a career change into nursing to RNs with a few years of experience, says Jean Berry, PhD, RN, CNP, director of the nearly three-year-old programs.
There are even some students coming directly from the undergraduate nursing program, Berry reports. However, they are encouraged to work part time to gain clinical experience, because that will help when they start their clinical courses.
Common Goals, Different Options
While these types of programs all share a common focus on improving the health of underserved populations, each one has its own unique twist. Some are research-oriented, others have a clinical focus and still others address the need for more nursing educators who are specialists in minority health issues.
The goal of Case Western Reserve’s program is to prepare a cadre of nurse researchers committed to the elimination of health disparities. The nursing school received a grant from the National Institute of Nursing Research (NINR) to create the program, which was launched in Fall 2006.
“We’re looking for nurses who understand that [these] patients come with multiple morbidities,” says Moore. “They have diabetes, hypertension, cardiovascular disease and arthritis. Studying only one of these conditions in isolation doesn’t provide a good picture of how to manage the patient’s health.”
Students learn new study design methods and statistics based on complexity science that take into account that it’s difficult to disentangle the factors associated with health disparities in vulnerable populations, she adds.
Moore is hoping to collaborate more closely with other academic departments, such as sociology and anthropology, as well as the Case School of Medicine’s Center for Reducing Health Disparities and Center for Health Promotion. “Working with the different disciplines and centers will help our students get a bigger picture,” she explains.
The new pre-/post-doctoral training program’s minority health focus is also helping the school’s entire nursing faculty expand its parameters. “It has galvanized us around understanding the complexity of health care issues [affecting] people who are economically disadvantaged, and what that means in terms of the impact on the mental, physical and psychosocial health of this population,” says Moore. “The program is challenging us about the methods we’re using, the knowledge we’re producing and how we’re moving into social policy and practice.”
The University of Texas at Arlington’s PhD program offers two areas of study: clinical research and academic role development. The clinical research track is designed to prepare nurse scientists for original research and theory development that will improve health care for diverse and/or vulnerable populations. The academic role development track focuses on developing nursing faculty who will create learning environments that attract students from culturally diverse backgrounds and prepare them to provide care to diverse populations.
Students in the Catholic University of America’s community/public health MSN program who are interested in working with underserved populations can choose from three different options. In addition to the Immigrant, Refugee and Global Health Clinical Nurse Specialist track, there is also a Promoting Healthy Families in Vulnerable Communities track and a Community/Public Health Nurse Specialist Educator track.
The Promoting Healthy Families program prepares students for the blended role of family nurse practitioner and community/public health CNS. The Nurse Specialist Educator program is designed to prepare community/public health nurses to teach in associate and baccalaureate degree programs, staff development programs and patient/family education programs. This track addresses the critical shortage of nursing faculty and strives to improve community-based care for vulnerable populations.
Serving the Global Community
Last July, CUA’s School of Nursing was awarded a three-year, $778,077 HRSA grant to create the Immigrant, Refugee and Global Health CNS program, the newest of the three tracks. As the name implies, the program’s goal is to prepare community and public health nurses to improve access to health care and reduce health disparities in medically underserved immigrant and refugee populations. The program also seeks to attract immigrant and international students as a means of diversifying the nursing workforce and giving immigrant and refugee patients access to caregivers who share a similar cultural and linguistic background.
Students gain exposure to theoretical content and clinical experiences that focus on health policy, global health issues, finance and information systems, and emergency preparedness.
“Nurses involved in immigrant and public health need to know about policy structures, such as Medicare, Medicaid and the State Children’s Health Insurance Program,” says Sister Rosemary Donley, PhD, APRN, BC, ANP, FAAN, project director for both the Immigrant, Refugee and Global Health CNS program and the Community/Public Health Nurse Specialist Educator program. “They also need to know about immigration issues and about diseases that are endemic to different parts of the world, such as tuberculosis and malaria.”
Despite their differences in focus, the three tracks have one thing in common: Most of the students in the programs have a strong sense of social responsibility and many are mission focused. “We don’t get a call from someone asking, ‘How much money will I get when I graduate?’” says Sarsfield. “That’s not usually the kind of students we attract.”
Adds Donley, “They come here because they want to work with underserved populations with health disparities. When they graduate, most do just that.” In fact, 62% of the programs’ graduates work in underserved areas. Many work for public health departments and community clinics, and some have long-term goals of opening clinics in developing countries. CUA has agreements with several entities, such as the U.S. Congress and the World Bank, to provide students with health policy practicum opportunities.
Increasing Students’ Access
Social responsibility is also at the core of the Fuld Fellowship program at Emory University’s Nell Hodgson Woodruff School of Nursing in Atlanta. The program, made possible through a grant from the Helene Fuld Health Trust, targets career-changing students with degrees in fields other than nursing who are strongly committed to improving care for vulnerable populations.
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The full-tuition fellowship provides much-needed assistance for these students, who typically don’t have as much access to financial aid resources as first-degree nursing students, says Ann Connor, MSN, RN-C, FNP, assistant professor of nursing. Since 2001, eight students have graduated from the program, and there are 14 Fuld Fellows currently enrolled.
Fuld Fellows attend core courses leading to a BSN degree, followed by a master’s degree in specializations such as nurse-midwifery, public health and family nurse practitioner. They also participate in the school’s social responsibility programs, such as the Farm Worker Family Health Program (http://www.whsc.emory.edu/_pubs/en/2003spring/feature_lessons.html), Alternative Spring Break Trips (http://www.whsc.emory.edu/_pubs/en/2005winter/newsbriefs.html) to work with HIV/AIDS patients in Jamaica and the Bahamas, and the Korean Exchange Program (http://whsc.emory.edu/_pubs/en/2003spring/feature_root.html).
These second-degree nursing students enrich the pool of nurses because of their diverse professional and educational backgrounds, says Connor. They have the advantage of maturity and a variety of life experiences and skills that allow them to assess issues from a different perspective than traditional nursing students. “They help change health care delivery models because they come with fresh ideas,” she explains.
Some nursing schools are using distance learning to make their minority-health-focused programs more accessible to students. The Oregon Health & Science University (OHSU) School of Nursing in Portland has an online Master of Public Health (MPH) degree program focusing on primary health care and health disparities. It is offered in conjunction with the Oregon Master of Public Health (OMPH) program (http://www.oregonmph.org/), a collaborative statewide degree program offered through OHSU, Oregon State University and Portland State University.
Launched in 2005, the Primary Health Care & Health Disparities MPH program emphasizes improvement in primary health care accessibility and quality for underserved populations. The curriculum evolved over a year of increasing collaboration between the MPH program and OHSU’s Center for Health Disparities Research, explains associate professor of nursing Deborah Messecar, PhD, RN, MPH, CNS.
The program currently has approximately 40 students, roughly half of whom are nurses. The Center for Health Disparities Research has relationships with community-based agencies, creating opportunities for student field experiences. The program is also linked to the international initiatives of the OHSU School of Nursing’s External Programs, giving students opportunities to work with vulnerable populations in Thailand and Ecuador.
Students with a Mission
Why are students responding so enthusiastically to these new nursing programs that focus on minority health and cultural diversity issues? It’s because many of the students pursuing these degrees have a deep commitment to serving vulnerable populations and eliminating health disparities—a commitment that has been fueled by work-related experience, personal experience or both.
Carmen Alvarez, who graduated in May from the Fuld Fellowship program at Emory University’s Nell Hodgson Woodruff School of Nursing, believes that nurses are obligated to help the underserved and that they become empowered when they learn how to address the issues that affect these patients. “When we don’t address their health care issues as early as possible, [those problems] are going to become more challenging, and then we’re going to see the effects in the hospital or at the tertiary level, which is more costly and taxing for us as health care providers,” she says.
For Alvarez, who is of Belizean descent, the motivating factor that led her to return to school and pursue a nursing degree after four years of conducting research in nutritional science was her exposure to marginalized groups in the developing countries in which she lived up until the age of 13. Her father was a plant geneticist who traveled to countries such as Nigeria and Rwanda to help farmers improve their crops.
Tarsha Jones, a full-time student in the Catholic University of America’s community/public health MSN program, points out that the growth of immigrant and refugee population in America means that even more people from disenfranchised groups will require health care in the future. “We need to reach out to them to provide knowledge and resources to improve their health outcomes,” she emphasizes. “If we can focus more on health promotion and disease prevention within specific minority populations, eventually we will improve the overall health of our country.”
Jones, a former pediatric nurse, was born in Jamaica and emigrated to the U.S. when she was 10 years old, so she knows firsthand what it’s like to be a part of a disenfranchised group. “I have a working understanding of being an immigrant and of not having one’s health care needs represented,” she says.
At least once every two years Jones returns to Jamaica, where some impoverished areas don’t even have running water. “Being in a Third World country has opened my eyes to realize what a great opportunity I have living in America and being able to attend a graduate school like CUA where they encourage us to be aware of what’s going on nationally and also internationally,” she says. “[This program] is empowering us to help people here in the United States and also giving us a better understanding of global health nursing.”
When she graduates in 2008, Jones plans to obtain a leadership position in program development where she can work on health promotion and disease prevention to benefit vulnerable minority populations.
Similarly, Alvarez would eventually like to work for an entity such as the World Health Organization (WHO) that uses clinical research to affect public policy. It may take her a little longer to get there, though. This summer, she began pursuing her PhD in nursing with a focus on health promotion and risk reduction at the University of Michigan in Ann Arbor.
Karen Johnson-Guy returned to school after five years of working as a nurse in high-risk obstetrics. With a master’s in nursing and certification as a nurse-midwife and childbirth educator, she plans to start pursuing a PhD in nursing with a focus on vulnerable populations from Case Western Reserve University’s Frances Payne Bolton School of Nursing this fall. After conducting research in Uganda on midwives’ attitudes toward patients with HIV, she knew that she wanted to prepare herself for a career as a nurse scientist. Her research interests include breastfeeding and preventable pathologies of newborns related to the intrauterine environment in mothers who are addicted to crack cocaine and/or methamphetamines.
Johnson-Guy feels that her personal experience of having grown up in public housing projects in inner-city Minneapolis enables her to relate to medically underserved people with health disparities. And where does she see herself five years from now? “I see myself with a PhD—teaching, practicing and researching.”
“I always wanted a BSN,” says Pilar De La Cruz. “But being married and having two small children, I felt that I could not manage work, family life and four years of school at the same time.”
Faced with a difficult choice, De La Cruz opted for a diploma in nursing, so that she could start working as an RN as soon as possible. But looking back, she feels that in the long run she paid a big price for that decision. “I was fortunate enough to be promoted to supervisory positions,” she explains, “but I always felt inferior to non-minority nurses who had their [BSN] degree.
“I worked for a vice president of nursing who had a master’s,” De La Cruz continues, “and because I did not have a degree, she felt I was not worth much as a manager. As a Latina, I felt I had to work even harder to be recognized for my efforts because I lacked a bachelor’s degree.”
She found her solution by returning to school at California State University, Dominguez Hills in 1989, taking classes part time and traveling to different CSU campuses to accommodate her work schedule. In 1996, she received her baccalaureate and cried throughout the ceremony. “Finally, I could feel that I was equal to other nurses who were in management positions and were not minority,” she recalls.
De La Cruz went on to earn her MSN in 2001. As a result, she has attained the executive-level position of vice president of Education Development, Volunteers and Community University at Community Medical Centers in Fresno. “I like to mentor other Latinas [to go back to school],” she says. “I tell them, ‘if I could do it, so can you.”
She’s not alone. Many minority nursing leaders and educators feel there is an urgent need to encourage more nurses of color to think of their diplomas or associate’s degrees as a stepping-stone, not a stopping point. According to the 2000 National Sample Survey of Registered Nurses, published by HRSA’s Division of Nursing, nearly 60% of the total RN population, regardless of race/ethnicity, reports their highest level of educational preparation as either a diploma or associate’s degree. The one notable exception is Asian, Native Hawaiian and Pacific Islander RNs, who have the highest percentage of baccalaureate degrees than any other racial group.
Experts agree that while a terminal two- or three-year degree may be adequate for some nurses, the four-year BSN is the degree that truly opens the doors of opportunity for minority nurses. Those doors can lead not only to advanced degrees but also advanced careers–as managers, educators, researchers, nurse practitioners, clinical nurse specialists and more.
Recognizing the need to create more opportunities for minority nurses to earn degrees that will help them move up the ladder, America’s nursing schools, health care employers, government agencies and nursing associations are rising to the occasion. By developing innovative solutions–such as more flexible BSN and MSN programs, bridge programs, scholarships and an expanded loan repayment program–they are teaming up to make those doors easier to open than ever before.
Bridging the Gaps
“Going beyond the two-year degree is necessary for minority nurses’ careers and futures,” says Dr. May Wykle, RN, FAAN, dean of the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland. “When the nursing shortage eases, employers will want to hire nurses who have BSN degrees. We have to raise the image of nursing and create more awareness that it is collaborative work with doctors–and that this level of professionalism requires a baccalaureate.”
One reason why many minority nurses choose to attend associate’s or diploma programs is because of the lower costs, Wykle explains. Then, when they graduate, the demands of their jobs and family responsibilities make it difficult to continue their education.
“It’s hard to work and finish a degree at the same time,” she points out. “Many nurses do it, but sometimes they can’t study as much as they wish. I often recommend they begin by taking one course. Working full time and trying to study full time lessens their chances of completing their degree.”
The Bolton School is one of many nursing schools that are taking steps to make baccalaureate education more accessible to RNs who are graduates of diploma or associate’s degree programs. Wykle is considering a number of strategies, including the work-study option. “In some professions, such as engineering, students work a semester and go to school a semester,” she says. “This is a new idea to nursing but it makes sense.”
In addition, many schools are establishing bridge programs that make it easier for students in associate’s degree and diploma programs to transition into BSN programs, says Dr. Sheldon Fields, assistant professor at the University of Rochester Medical Center School of Nursing in Rochester, N.Y. “Some schools have formed partnerships and articulation models with junior colleges. At the University of Rochester, we are looking into making it seamless for a student at Monroe Community College to come into our program.”
Fields also believes that increasing the number of minority faculty would help encourage more RNs of color to earn bachelor’s and graduate degrees. “It is not unusual for large nursing schools to have a dearth of minority faculty–the numbers are not there,” he explains. “You cannot bring [minority] students in and not give them mentors. Those of us in faculty positions are a minority within a minority. For me–an African American and a Latin and a man–that has worked both to my advantage and against me.”
However, Wykle, who is also the current president of Sigma Theta Tau International (STTI), the Honor Society of Nursing, emphasizes that nursing schools will not be able to do the entire job alone. “We need to have both associations and schools promote BSN degree-earning,” she says. “And we need the support of health care organizations and the government, in the form of tuition assistance, loan forgiveness and making loan repayment easier.
“At STTI, we are collaborating with a coalition of other nursing organizations to raise the image of nursing through a program called Nurses for a Healthier Tomorrow. At the same time, as a nursing school dean, I’m very involved in trying to get sources of scholarship funding, and partnering with health care agencies. It’s slow going but we have to do it.”
C. Alicia Georges, RN, EdD, FAAN, a lecturer in nursing at Lehman College in Bronx, N.Y., and president of the National Black Nurses Foundation, says she is encouraged by Department of Health and Human Services Secretary Tommy G. Thompson’s January 2002 announcement that “the President’s [2003] budget will include a total of $15 million, a 50% increase above last year’s funding, to expand the Nursing Education Loan Repayment program.” But still, she believes, “The federal government’s role in nursing education needs to be amplified.”
Minority nursing associations, meanwhile, are also focusing increased attention on promoting the benefits of baccalaureate education to current and potential members. For example, the National Association of Hispanic Nurses (NAHN) is concentrating on strategies such as offering scholarships, says Viola Benavente, RN, MSN, CNS, an instructor in the Department of Acute Nursing Care at the University of Texas Health Science Center in San Antonio and chairperson of NAHN’s Public Relations Committee.
“We are not telling people to go for the bachelor’s as opposed to the associate’s degree,” she stresses. “The BSN may not fit the needs of all nurses. We do say, though, that it is the baccalaureate-level nurse who is in high demand.”
Partnering With Employers
Nursing schools aren’t the only ones who are recognizing that RNs need more flexible educational options that mesh with their work/life needs. Health care employers, too, are reaching out to help their nurses earn the bachelor’s degrees that will enhance their job performance and career potential.
For LaShawn Williams, RN, the cooperative effort between Detroit’s Wayne State University (WSU) and Henry Ford Health Systems was an exciting option. “I knew from the beginning that I’d come back to school,” she says. “It’s important for my long-term goals to have an advanced degree. There’s not much room for growth in the profession without it.”
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After earning her associate’s degree, Williams took a job in the critical care unit at Henry Ford Hospital. There she learned the hospital partnered with WSU to offer a bachelor’s degree completion program. “It’s convenient, because classes and labs are held here at the hospital,” she explains. “Still, working and going to school is tough. I had to cut my hours to make it work.” Williams balances her job, studying and taking care of elderly grandparents by working the midnight shift so she can get tasks done during the day.
“The cohort program with Henry Ford Health Systems started in January 2002,” says Dr. Barbara K. Redman, dean of Wayne State’s School of Nursing. “Most of the classes are taught at the hospital by our faculty, but some of it is online.”
In addition to convenience, centering learning at the worksite provides “a support system,” according to Redman. “There is a major move for nurses to go back to school,” she notes. “We are reaching them at work because the employers have an interest in a more highly educated nursing workforce. The hospital provides access for us to counsel nurses, evaluate their diploma credits and talk to them about our program.” Students with all the prerequisites generally finish the BSN program in about two years.
Our Place or Yours
Online colleges–such as National University in San Diego and Excelsior College in Albany, N.Y.–and distance learning programs offered by traditional nursing schools are still another non-traditional solution that is making it easier than ever before for minority nurses to earn bachelor’s degrees even if they are working full time.
Through the magic of the Internet, these ultra-flexible programs let students take classes at the place and time that’s most convenient for them, complete the program at their own pace and even receive credit for the nursing knowledge they already have.
“Our bachelor’s degree program is all independent study with some online support services,” says Dr. Marianne Lettus, associate dean of the Excelsior College School of Nursing. “Students complete the degree by successfully completing exams.”
Excelsior offers both BSN and RN-to-MSN programs. “The bachelor’s degree tends to attract more minority nurses,” Lettus adds. “The RN-to-MSN program is relatively new and takes longer to complete.”
For Fernando C. Pimentel, an Infection Control Practitioner and ICU nurse at Guam Memorial Hospital in Oka, Guam, distance learning was the ideal option for making his dream of earning a BSN degree a reality.
“In my [Filipino] culture, education is valued very highly,” says Pimentel, who is working toward a BSN through Excelsior College. “I currently hold a bachelor’s degree in Business Administration and am concurrently pursuing a master’s in health sciences at the California College of Health Sciences. I look at education as a journey rather than a destination.”
Support Systems
Encouraging diploma- and associate’s-prepared minority nurses to enter BSN programs is one thing; making sure they successfully complete their degree is another. Both students and faculty agree that even with today’s advantages of extra flexibility and convenience, the challenge of juggling college, work and family can often be overwhelming. That’s why many nursing schools are going the extra mile to provide increased support services to help these students not only go back to school but also go the distance.
The key to preventing students from giving up and dropping out “is to have our faculty keep in close contact with them so we can sense if they seem to pull away,” says Dr. Donna Demarest, dean of the School of Nursing at the College of New Rochelle (N.Y.). Like many retention programs for returning students, she adds, the emphasis is on both tutorial and personal support.
“Most of our RNs who come back to school are women and minorities,” Demarest comments. “They tend to work in inner city hospitals where the stress is heavy.
So our program has a learning and caring center for nursing, as well as a holistic nursing track. When you tell adult female students they need stress reduction, they say they don’t have time. So we built it into the degree curriculum. They learn therapeutic touch, relaxation, yoga and other approaches.”
Georges believes scheduling is also critical. “Time management is the biggest challenge for nurses coming back to school,” she explains. “Most of them work and have families. If they haven’t been in school for a while, they have trouble scheduling their time. Peer support helps, including sharing ideas about what works best. Working in study groups adds structure.
“I think the key is setting up the kind of program that fits the schedules of real people. We have clinicals on weekends and classes in the morning or evening. We’re looking at how we can be more flexible to meet the needs of the working RN.”
For Gloria Spires, CRNA, BS, one of the most rewarding aspects of her work as a nurse anesthetist is when a patient wakes up after surgery and says with surprise, “Is it done?”
To the patient, it seems like it was only a few seconds ago when Spires offered comfort and confident reassurance before putting him under. He is grateful and relieved: The surgery was a breeze. Little does he realize, though, that while he slept and the surgeon worked, Spires watched over him like a guardian angel, monitoring every heartbeat and every breath, making sure he would come through just fine.
Nurse anesthetists like Spires, who is African American and works at the Surgery Center at Southwoods in Youngstown, Ohio, have been providing anesthesia care for more than 100 years. Today they administer 65% of the 26 million anesthetics given each year to patients in the United States, according to the American Association of Nurse Anesthetists (AANA). They are the sole anesthesia providers in about half of all U.S. hospitals, almost 70% of the nation’s rural hospitals and in many inner city health care facilities.
This advanced practice nursing specialty involves significant challenges and responsibilities-and provides significant rewards to match. Rather than having to juggle many patients at once, nurse anesthetists care for one patient at a time. They also enjoy a greater sense of autonomy than many other nurses. Last but definitely not least, they earn great money, with starting salaries averaging about $118,000, according to a recent survey by Allied Consulting, a Dallas-based health care staffing firm.
In fact, Certified Registered Nurse Anesthetists can even earn more than what some physicians make. According to Allied, salary offers for CRNAs can go as high as $180,000-more than 20% above the average salary offered to pediatricians and family doctors. Because skilled, experienced nurse anesthetists are currently in extremely short supply, their field is one of the top 10 recruited health care specialties. And like most other specialty areas of nursing, racial and ethnic minority nurses are seriously underrepresented in the field.
To become a CRNA, a nurse must earn a master’s degree in nurse anesthesia and pass a certification exam after graduation. Nurse anesthesia academic programs are full-time, range from two to three years in length and include clinical training. The prerequisites needed for acceptance into a program are a BSN or other appropriate bachelor’s degree, a current license as a registered nurse and at least one year of practice in an acute care setting.
Independence Days
Nurse anesthetists practice in any setting where anesthesia is administered: hospital operating rooms, obstetrical delivery rooms, critical access hospitals and outpatient surgery centers. They also work in the offices of dentists, podiatrists, ophthalmologists and plastic surgeons as well as in the military, the U.S. Public Health Service, and Veterans Administration health care facilities. They collaborate with other health care professionals, such as surgeons, dentists and anesthesiologists, but they don’t necessarily have to work under the supervision of an anesthesiologist.
This high degree of independence was one of the factors that attracted Juan Quintana, CRNA, MHS, to the field. “This career allows nurses to do what we got into the profession to do,” he says. “The patients’ lives are in our hands and we are there to care for them.”
Quintana had been a registered nurse for 10 years, working with pulmonary patients in operating rooms and intensive care units, when he decided he wanted to have a greater say in patient care. Working as a CRNA allows him to combine his critical thinking and decision-making skills with advanced knowledge and sensitivity toward patients.
Today Quintana runs an independent nurse anesthesia practice in rural Texas that includes himself, two other full-time and two part-time nurse anesthetists. The practice, called Sleepy Anesthesia Associates, works on contract with five hospitals.
Moving up to this more advanced, autonomous role after working as a staff nurse requires a shift in thinking, agrees Ronny Ancog, RN, a nurse anesthesia student at Samuel Merritt College in Oakland, California. “As a nurse, you’re often reliant on a physician to give orders,” explains Ancog, who is of Filipino descent. “As a nurse anesthetist, I can actually write orders for other people to implement. I can decide that an intervention is necessary and have that decision carried out.”
Risk Management
Nurse anesthesia is a demanding, intense career that is ideal for nurses who thrive on challenge. “The time in which we’re taking care of patients is a very dynamic time for them physiologically,” says Julie Pearson, CRNA, MSN, assistant director of the Nurse Anesthesia Program at Georgetown University in Washington, D.C. “When something goes wrong, it’s a matter of life or death.”
Constant vigilance is critical even when things are going well. A nurse anesthetist must always maintain the perspective that a patient’s status can change dramatically at any time.
There is no one-type-fits-all, “cookbook recipe” for anesthesia, notes Prudentia Worth, CRNA, PhD, director of the anesthesia department and post-anesthesia care unit at Detroit Receiving Hospital and director of Wayne State University’s Department of Anesthesia. Therefore, nurse anesthetists must gather a complete patient history and use it to develop a custom anesthesia plan.
But in emergency situations, there may be no opportunity to get full information about the patient. In these cases, says Worth, “you’re working with individuals you know nothing about. You’re faced with physiological changes in the OR that you don’t have a history to relate to, but you still have to manage. The response has to be quick and correct.”
Another challenge CRNAs must master is informing patients of the risks of anesthesia without frightening them. Fortunately, today’s improved anesthetic drugs and procedures have substantially reduced patient mortality rates in anesthesia care. According to a 1999 Institute of Medicine report, the practice is almost 50 times safer today than it was 20 years ago. Yet there are still some lingering risks, which nurse anesthetists must be able to communicate to patients while still putting them at ease.
Spires reports that patients often ask her, “I’m going to wake up, aren’t I?”
Bringing Diversity to Nurse Anesthesia
Because patient education and communication is such a critical component of the nurse anesthetist’s work, there is an urgent need within this specialty for racial and ethnic minority CRNAs who can provide culturally and linguistically competent care to an increasingly diverse range of patients.
Fast Facts About Careers in Nurse Anesthesia
Nurse anesthesia is an attractive career for both men and women–approximately 45% of the nation’s 28,000 Certified Registered Nurse Anesthetists (CRNAs) are men.
Nurse anesthetists take care of patients before, during and after surgical or obstetrical procedures. They stay with the patient for the entire procedure, constantly monitoring every important body function and individually modifying the anesthetic to ensure maximum safety and comfort.
With a projected need for over 35,000 CRNAs by the year 2010, and with 33% of current CRNAs expected to retire by 2007, the nurse anesthetist shortage is one of the most severe in the nursing profession.
CRNAs are qualified and permitted by state law or regulations to practice in every state in the nation.
Managed care plans recognize CRNAs for providing high-quality anesthesia care with reduced expense to patients and insurance companies. Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program.
There are currently 85 accredited nurse anesthesia education programs in the U.S.
CRNAs must be recertified every two years.
Sources: American Association of Nurse Anesthetists, Nurses for a Healthier Tomorrow, Florida International University School of Nursing
As a Hispanic nurse anesthetist, for instance, Quintana’s first-hand understanding of Hispanic culture and his ability to communicate in both Spanish and English help him establish rapport with patients and their families. “We’ve found that it really does make a difference,” he says.
Yet nurses of color are vastly underrepresented in the field. According to the AANA, only 2.1% of CRNAs are black, 2.1% are Asian, 1.4% are Hispanic and less than 1% are Native American.
This situation is slowly beginning to change, however, thanks to the efforts of a growing number of university nurse anesthesia programs to attract more minority students. For example, last fall Florida International University (FIU) School of Nursing in Miami, in an effort to address South Florida’s severe CRNA shortage, received a grant from the Health Resources and Services Administration to expand its nurse anesthesia program from 15 to 40 students. Forty percent of the program’s students and a third of the faculty are nurses of color.
John McDonough, CRNA, EdD, ARNP, director of the FIU nurse anesthesia program, attributes much of this diversity recruiting success to the school’s reputation for cultural sensitivity. As part of its P.R.I.D.E. Project, for instance, FIU is partnering with two local high schools to recruit and mentor minority students who are interested in nursing careers. The program includes a summer camp where the teens can meet nurses from various specialties, get hands-on lab experience and shadow nurses at work.
The expansion of FIU’s nurse anesthesia program was also made possible by the school’s collaboration with Miami Beach Anesthesia Associates, which runs the anesthesia department at nearby Mount Sinai Hospital. The anesthesia group is paying half the salaries of the nurse anesthesia professors, and the hospital is serving as a clinical site for the program. Through this partnership, the anesthesia associates will gain opportunities to recruit the program’s students when they graduate.
FIU has also started a distance learning program for nurse anesthesia students in central and north Florida. This flexible, convenient program enables students to do their clinical work close to home and take most of their classes locally or through two-way videoconferencing. The new distance learning option is expected to make nurse anesthesia education even more accessible to minority students, who are more likely to be working full-time than their Caucasian counterparts.
In 2001, Georgetown University School of Nursing launched a diversity initiative to recruit more minority students to its nurse anesthesia program. As a result, says Pearson, the 2003 nurse anesthesia class has more students of color than any other class in the program’s history. At open houses for the nurse anesthesia program last year, 38% of those who attended were nurses of color.
The program is reaching out to minority candidates through state and regional nursing associations, local critical care units and minority nursing professional organizations, such as the National Association of Hispanic Nurses. It is also priming the pipeline by establishing partnerships with local associate degree nursing programs-e.g., helping the students find financing for school and providing support and mentoring to help them complete their studies and make plans to continue their education to the next level.
Exploring the Opportunities
What qualities and skills does it take to be successful in a nurse anesthesia career? “We look for individuals who are self-motivated, self-directed and can think outside the box,” Worth says.
Prospective CRNAs should also be prepared for a vigorous program of study and a lifetime of learning. Worth, who is one of the nation’s most prominent and respected minority nurse anesthetists and CRNA educators, was raised in the West Indies, then worked as a nurse in England before moving to New Jersey with her family in the 1960s. She was working as a private duty nurse at Henry Ford Hospital in Detroit when a surgeon said he thought she would make a good nurse anesthetist and referred her to a university program.
“I worked extremely hard, and the field was more than I bargained for,” Worth recalls. Support from instructors and a strong drive to succeed helped her finish the program, but she didn’t stop there. After becoming certified in nurse anesthesia, Worth went on to earn a master’s and then a PhD in education. “This was a profession that was constantly moving and growing,” she explains, “and I felt like I needed to grow with it.”
Ancog says one of the challenges for RNs enrolled in a nurse anesthesia master’s program is adjusting to being a student again, rather than an expert on the job. “Every day you get critiqued,” he points out. “You have to adapt to that and be open to suggestions.”
Spires believes nurse anesthetists need to be confident and assertive, able to make quick judgments and able to work well in conjunction with other health care professionals, such as anesthesiologists and surgeons.
How can you find out more about whether this demanding but highly rewarding advanced practice career is right for you? To get a feel for the specialty’s expectations, Sandra Morris-Harris, clinical director of the Georgetown Nurse Anesthesia Program, suggests reviewing the national practice standards for nurse anesthetists. Here are some additional ways to explore what the field of nurse anesthesia is all about:
Visit the American Association of Nurse Anesthetists Web site at www.aana.com. The site contains a wealth of information about the profession, a list of accredited nurse anesthesia education programs, national practice standards, news, links to other helpful sites and more.
Get in touch with a local AANA chapter and ask to shadow a nurse anesthetist at work.
Contact an accredited nurse anesthetist program and ask to visit different clinical settings. Worth says talking to nurse anesthesia students will provide insight into the academic requirements of the program, and visiting a variety of clinical sites will give a feel for what kind of work setting might be the best fit for you.
Strengthen your science background and get familiar with the anesthetics used in hospital ORs and intensive care units.
