Let’s be honest, it can be hard to get a handle on the latest and greatest strategies for job market success. The economy’s changes have demanded both job seekers and current working professionals to truly exercise more flexibility and diversity than ever before. It’s as tough a market as any out there, and there’s no better time to invest in you.
Here, I mean to suggest that our personal return on investment (ROI) is substantial–provided we approach the task with sensibility, creativity, and a whole lot of perseverance when the going gets tough. No matter the capacity in which we serve (from the trauma ward nursing to non-profit volunteering), nursing is a field that has a wealth of viable options when it comes to how we brand ourselves and our services. Let’s utilize the diversity within our field to expand our professional impact and earning potential. What we offer is more than just a foundation, we’re at the forefront of health care innovation.
Take a moment to write down an overview of your personal and professional skill sets. What do you see? What’s the narrative that emerges from that list? Try to translate the story behind all of your education, training, and experience into a short, captivating statement of professional purpose. Remember that with improved precision in telling our story we can better position ourselves within the market by targeting our brand to the right audience.
What is your specialty? How do you revolutionize and advocate for your profession? What really motivates you to continue when everyone else can’t find the courage to go on?
Highlight your proficiency in the fundamentals, but also be sure to break the mold by showcasing the benefits you can offer your current team or prospective team by emphasizing why you can fulfill the requirements of modern nursing with individuality, competency, and compassion.
When the market doesn’t provide all the answers, how do you make the most of your abilities? Have you done all you can do to present yourself consistently through traditional and new media? Are you making you and your brand accessible to the growing global health market?
Just as we routinely solve complex problems by addressing their separate components, so too can we look at a thriving career as the sum of the parts rather than the whole. Think about your brand as one that goes beyond a single emphasis and encourages your network to view you as an expressive health care provider. Forget the term generalist, we’re in the age of the interdisciplinary specialist. Market yourself in advance of the next big industry shift and you’ve positioned yourself for long-term mobility.
There’s such a great deal of fantastic information and resources available that can help you craft a meaningful career, and for good reason. It’s easy to limit our scope of vision, though. How many times do we find ourselves too narrowly focused on our immediate branding in order to just get that next raise, promotion, or position? Let’s change the short-term mentality and empower sustainable, self-motivated career decisions. For all of the so-called life-changing techniques we can employ in this refinement of our professional development, let me suggest that there’s an incredibly powerful tool at your very disposal right now that can create change in your future.
To get started, get clear about your personal brand identity through the gathering of images, words, and physical objects that capture the essence of your professional vision. Create a space at home where you can display these motivating elements in a way that inspires you to begin thinking critically about your brand. This process should ideally enable you to perform three essential functions:
1. Develop one-year, three-year, and five-year professional growth goals.
2. Account for your own diversity and interests, personally and professionally.
3. Capitalize on understanding the new-market needs of changing health care economies that matter to you and future generations.
As you begin to take charge of the maintenance and evolution of your personal brand, the rewards will start to multiply. Redefining YOU makes a world of difference to us all. By promoting the importance of confident, capable and independent nurses able to navigate the demands of health care today, we do our part in establishing the trends that will shape tomorrow’s industry standards.
About 30% of Hispanic Americans and 20% of African Americans don’t have a usual source of health care, but less than 16% of white Americans lack a source.
For women who have had an abnormal screening mammogram, the length of time before a follow-up test is conducted is twice as long in Asian American, Hispanic, and black women than it is in white women.
It’s no secret that there are racial and ethnic disparities in health care. These statistics, which come from the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey, highlight a major concern in the field of medicine. Not all patients receive the same level of high quality treatment—or in some cases, receive treatment at all.
This concern is important within nursing schools, because they are tasked with making sure our country’s future nurses fully understand racial disparities and what can be done to address them, says Mary Green, PhD, MN, RN, interim chair of the Dillard University School of Nursing in New Orleans.
Schools must show the latest research and best practices to the next generation of nurses, and take them into communities so they can see firsthand the effects of health inequality, argues Green. “Nurses need to get the broadest experiences they can.”
Learning in the Community
Many nursing schools have mandatory community health courses that expose students to inequalities among groups of people. Nursing students learn about the statistical differences in health care outcomes, and along with that, many of these institutions require nursing students to meet the people behind the statistics.
For example, at the University of Alabama-Birmingham (UAB) School of Nursing, undergraduate students, along with faculty, go into communities in the greater Birmingham area that have historically had less access to health care, says Linda Moneyham, PhD, RN, FAAN, senior associate dean for academic affairs at UAB. There, nursing students learn how to master their clinical work while partnering with neighbor representatives who are interested in improving the community’s health, she adds.
“These tend to be communities that are lower income, have high minority populations, and have a lot of health needs,” she says. “In fact, Alabama is often the epicenter for some of the major health problems the country faces.”
Moneyham explains that Alabama ranks near the top for prevalence of heart disease, obesity, and HIV—and minorities are disproportionately affected. “We have to focus on these populations because they are the populations nursing students are going to be caring for,” says Moneyham.
At the University of Washington School of Nursing in Seattle, there is a similar approach. “We have for years had a required course on community health nursing that addresses health disparities and inequities,” says C. June Strickland, PhD, RN, associate professor, psychosocial and community health nursing, at the school. “It’s [often] the very first course that students take when they come into our program to study,” she says. “Essentially, it focuses on health disparities, equities, and social justice.”
“In addition, we have clinical sites in multicultural environments that include American Indian, African American, Latino, and Asian populations,” explains Strickland.
“When faculty members take students to those clinical sites, they get a cultural immersion and opportunity to understand some of the issues people are facing. For instance, with Native people, some of what we experience is the impact of colonialization that continues on in our community.”
The School of Nursing also attracts other students that plan to work in related fields, such as social work, public health, and psychology, says Strickland. “I teach a core course in assessment and that course also draws students from all over campus, because certainly these issues come up [in those disciplines].”
There are also graduate level courses that dig deeper into problems associated with inequalities. Deborah Ward, PhD, RN, FAAN, is associate dean for academics at the Betty Irene School of Nursing at the University of California-Davis in Sacramento. “We have a course in health status that all of our masters and PhD students take. That course looks at health status around the world, and it certainly looks at disparities in the US,” says Ward.
“We also have another course called Community Connection. Our masters students in the leadership program take this course where pairs of students work with community agencies,” she continues. Examples of these agencies include the Sacramento Unified School District and the local food bank’s parent-child program to provide support for parents with a variety of special needs. “Students come face to face with the issues that community agencies are working on, which includes the health effects of disparities of all kinds,” says Ward.
For example, one pair of students working with the county health department looked at soft drink vending machines in certain schools. School districts that are strapped for funds—and often in minority neighborhoods—can get money by having vending machines for soft drinks in their schools, Ward explains. “But on the other hand, if you have vending machines in schools that deliver sugary drinks, you’re contributing to the obesity epidemic that places students at all kinds of risk.”
Students who are obese are at great risk for many health problems, such as diabetes, says Ward. So the nursing students learned how school pupils in minority neighborhoods are exposed to factors that contribute to the obesity epidemic.
In this particular course, nursing students wanted to address the question of whether or not it was good for a cash-strapped school system to get immediate money from vending machines, or if it was better to ban the vending machines and have students ingest fewer sugary drinks.
“The students did a sophisticated analysis of the cost and benefits to the community in having soda machines in the school,” says Ward. “Armed with that kind of data, you can come back to your community as a nurse leader and demonstrate the long-term advantages of not having soda machines in a school.” The students learned how to work at system-level changes that are going to help communities make decisions about important health issues in their community, Ward adds.
Filling in Gaps
With upcoming changes in health care laws, there are going to be thousands of people from different communities who are going to be seeking health care services they might not have sought in the past, says Moneyham. In many areas, especially rural areas, nurse practitioners will be called on to help fill in the gap between patients requiring care and available physicians, Moneyham explains. Nursing schools are teaching their students that this is something that can directly help reduce the inequalities that have historically existed in those communities, she adds.
In addition, nursing students will be called on to share information about programs that help disadvantaged patients. For example, there are pharmaceutical companies that may supply medication for patients for minimal charge, particularly if the shelf life of the medicine is short. “Sometimes they’ll distribute those to poorer patients,” says Moneyham, and a nurse can be the link between that patient and the pharmaceutical company.
In order to give quality care to people who are from different cultures and ethnicities, all nurses, including minority nurses, need to learn to overcome misconceptions and even prejudices they may have about the patients they serve, says Moneyham. “For example, one stereotype is that if someone is overweight or they have health problems, they don’t care about themselves, and you can’t help those people because if they wanted to lose weight they could.”
But the nursing school helps students understand that there are often external affairs that affect a person’s health, and health professionals should understand what those factors are in order to effectively help a patient, she says. “We provide the experiences to nursing students to help them walk in the [patient’s] shoes, and try to understand their perspective about their weight problem and their challenges.”
The methods used when approaching people should be appropriate and respectful. If nurses don’t understand someone’s situation, any recommendation will likely not be effective, says Moneyham. She conducts focus groups with women who may be classified as obese, and she finds that many may not see themselves as overweight. Students learn that in these cases, giving lectures on losing weight likely won’t work. “What we need to focus on are things that help these women feel healthier, such as getting enough exercise or watching the types of food they eat,” she argues. “We have to work where the person is ready to work.”
Even then, minority nursing students should learn that individual actions are only a small piece of what impacts health, argues Vicki Hines-Martin, PhD, CNS, RN, FAAN, director of the office of health disparities and community engagement at the University of Louisville School of Nursing. In fact, students are often surprised to learn that social factors outside of a person’s control have a very large influence on their health. These “social determinants of health,” as outlined by the World Health Organization, identify that a person’s health status, access to care, and health outcomes are all influenced by things that are not specifically health-related, says Hines-Martin. Those determinants include economic status, education, and even access to transportation. “If you have people who have lower income, less education, and who live in communities that are less friendly to activity [and exercise], their health by definition is going to be less,” explains Hines-Martin.
“Increasingly, students at both the undergraduate and graduate levels are expected to think critically about the context from which a person comes. And as a result of that, faculty are changing where they do their work clinically, how they do their classroom teaching, and the examples they use to help a nursing student make better decisions about the populations they work with,” says Hines-Martin.
“Not only do we need to teach our nurses what they should be doing directly with the patient, we also need to put them into the context of where that patient comes from. Then we realistically adjust, adapt, or support that person’s ability to maintain whatever wellness they can,” she continues.
At Dillard, nursing students learn to address disparities and overcome their own prejudices by looking at case studies, says Green. She gives the following example of a case study:
Let’s say we have JM, who is a 47-year-old African American male who is currently homeless, jobless, and suffers from schizophrenia, uncontrolled diabetes, and hypertension. Because of the behavior attributed to his mental illness, he may be in and out of jail and perceived as a threat to the community. As nurses, what do we do?
Green explains that nursing students learn how to deal with urgent problems, such as the uncontrolled diabetes, as well as seek out other resources, such as helping to locate a case manager who could help JM access mental services that may be available.
These case studies are then followed up by actually visiting similar neighborhoods. “Going into the community gives a more accurate picture of the racial and ethnic disparities that exist,” says Green.
Understanding disparities can occur with one-on-one teaching, but diversity initiatives should also occur on an administrative, school-wide level, says Strickland. This means having a nursing school that reflects and celebrates racial and ethnic diversity in addition to teaching it. “It’s important to have systems and structures in place that support these behaviors.”
Strickland states that the University of Washington has a diversity council and an office of minority affairs that’s very active. “There is also a diversity council within our School of Nursing, and some of the activities have included working with faculty to design an evaluation so faculty can evaluate how effectively they’re addressing disparities and diversity in their course content,” she says. Strickland adds that the school recently voted to include diversity in their promotion and tenure documentation for faculty.
At UC-Davis, Ward says the first area where the school practices the goal of cultural inclusiveness is with its faculty and staff. “We like to think of what we’re doing as a multi-faceted approach,” she says. “This means cultural inclusiveness, teaching cultural approaches to care, and working with all of our communities to improve care and health.”
At the UAB School of Nursing, Moneyham says that more than 26% of students are minorities. “This is high compared to the national average,” she explains. “A lot of that has to do with where we sit in the Deep South region of the United States.” Moneyham adds that cultural diversity in nursing schools is good because nurses are able to accurately reflect the communities they serve.
When nursing schools cover minority populations and health care inequality effectively, they produce nurses who are more competent at addressing those inequalities. This in turn produces better nurses who are more likely to take a leadership role in helping eliminate disparities, says Hines-Martin. “It is a strategy of engaged scholarship, engaged teaching, and engaged research that has evolved.”
Margarette Burnette is a freelance writer based in Georgia.
Health and Human Services (HHS) recently released enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care—a blueprint to help organizations improve health care quality in serving our nation’s diverse communities.
The enhanced standards, developed by the HHS Office of Minority Health, are a comprehensive update of the 2000 National CLAS Standards and include the expertise of federal and non-federal partners nationwide to ensure an even stronger platform for health equity. The enhanced National CLAS Standards are grounded in a broad definition of culture—one in which health is recognized as being influenced by factors ranging from race and ethnicity to language, spirituality, disability status, sexual orientation, gender identity, and geography.
“We are making great strides in providing quality care and affordable coverage for every American, regardless of race or ethnicity or other cultural factors because of the Affordable Care Act,” said HHS Secretary Kathleen Sebelius. “The Enhanced National CLAS Standards will help us build on this ongoing effort to ensure that effective and equitable care is accessible to all.”
A key initiative in the department’s effort to reduce health disparities, the update marks a major milestone in the implementation of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities.
Long existing inequities in health and health care have come at a steep cost not only for minority communities, but also for our nation. As cited in a recent report from the HHS Agency for Healthcare Research and Quality, the burden of insufficient and inequitable care related to racial and ethnic health disparities has been estimated to top $1 trillion.
“Disparities have prevented improved outcomes in our health and health care system for far too long,” said Assistant Secretary for Health Howard K. Koh, MD, MPH. “The enhanced CLAS Standards provide a platform for all persons to reach their full health potential.”
Specifically, the enhanced standards provide a framework to health and health care organizations for the delivery of culturally respectful and linguistically responsive care and services. By adopting the framework, health and human services professionals will be better able to meet the needs of all individuals at all points of contact.
“Many Americans struggle to achieve good health because the health care and services that are available to them do not adequately address their needs,” said J. Nadine Gracia, MD, MSCE, Deputy Assistant Secretary for Minority Health and Director of the HHS Office of Minority Health. “As our nation becomes increasingly diverse, improving cultural and linguistic competency across public health and our health care system can be one of our most powerful levers for advancing health equity.”
For additional information, please visit www.ThinkCulturalHealth.hhs.gov and www.minorityhealth.hhs.gov.
At the beginning of 2012, the Affordable Care Act (ACA) was disliked by almost half of the public, faced formidable challenges in the courts, and seemed to be damaging Barack Obama’s prospects for reelection. By the end of the year, this historic law had made a stunning comeback, and it is well positioned for a full phase-in in 2014.
Two things happened. In a narrow 5-4 ruling in June, the Supreme Court upheld most provisions of the health reform law, including the mandate that virtually all Americans have insurance. And in the presidential elections in November, Barack Obama defeated Republican Mitt Romney, who had vowed to strike the law down on “day one” of his presidency.
Public opinion warmed up a bit. In a poll by the Kaiser Family Foundation just after the election, 43% gave the ACA a favorable rating, compared with 37% a year earlier. It will be interesting to see opinion polls in 2014, the start of the insurance mandate, which the public has never liked but may not be so bad once it happens. Also, insurers will be forced to cover preexisting conditions and state insurance exchanges will open, both of which have been widely popular.
The ACA helps minorities and minority nurses in several ways. In addition to expanding coverage for millions of uninsured minorities, it provides higher loan levels for nursing students, funds cultural diversity in nursing, and provides grants to develop specific nursing specialties. It also promotes advanced practice nursing and primary care.
But the backlash against health reform is far from over. Even though a Democratically-controlled Senate stands behind the president and his reform law, the ACA faces determined opposition from a Republican-run House of Representatives. In its last session, the House voted no less than 33 times to repeal, defund, or remove provisions from “Obamacare,” only to see them defeated in the Senate.
Deadlines forcing bipartisan agreements on the federal budget, such as the fiscal cliff and the debt ceiling, give House Republicans plenty of opportunities to push for cuts in the health care law. President Obama has already allowed one cut. To temporarily extend unemployment benefits, he signed a bill last February that removed $6.3 billion over 10 years from the ACA’s Prevention and Public Health Fund. GOP activists have targeted the fund, calling it a “slush fund” because it is not tied to specific initiatives. In 2010, the fund spent $31 million for advanced nurse education and $14.8 million for nurse-managed care centers.
Will Republicans succeed in forcing through more cuts this year? The White House said the ACA was off the table in the fiscal cliff negotiations, and the president’s election victory puts him in a stronger position to back that up. But the fiscal cliff is just the opening salvo of a year that promises endless partisan brawling over fixing the tax code and restructuring entitlements like Medicare.
Another reason Republicans could push hard in 2013 to defund the ACA is that time is running out. After the ACA launches its key reforms at the beginning of 2014, the bulk of the new law will have been implemented. It would be hard to put the genie back in the bottle.
The law’s expansion of coverage in 2014 will have a huge impact on minorities, who suffer from the lowest levels of coverage right now. According to the United States Census Bureau, 19.5% of African Americans and 30.1% of Hispanics do not have health insurance, compared with 11.1% of non-Hispanic whites.
Uninsured minorities applying for Medicaid or buying policies in new health insurance exchanges will have to educate themselves. Last summer, Aisha Hakim, a former president of the Westchester County chapter of the National Black Nurses Association in New York State, said that people of color have yet to fully understand their options, and the federal government “could do a little more in terms of educating the public.”
The law also bars an estimated 12 million undocumented immigrants from getting subsidized coverage or Medicaid coverage. Some fear lack of coverage could make these people easily identifiable to US immigration officials.
Meanwhile, some states will refuse to expand Medicaid eligibility, as the law directs. The ACA provides generous federal funding for states to open Medicaid to people with incomes as high as 133% of the poverty level, but the Supreme Court decision allowed states to opt out. As of late November, eight states––including Texas and Georgia––had done so, five more were leaning that way, and 20 had not yet decided.
As the new law is fully implemented, it will face a number of other challenges. Will the insurance exchanges be effective? To function properly, they need the right mix of healthy and sick people. Will subsidies for the exchanges be seen as too expensive? Subsidies are expected to cost the federal government $574 billion between 2012 and 2019. Will employers drop coverage rather than submit to the mandate? Employers have to pay penalties if they don’t cover their workers. And finally, will the ACA actually control health care costs? The law has launched a number of new initiatives designed to lower costs, such as accountable care organizations and patient-centered medical homes.
The midterm elections in November 2014 will be a crucial test of the fully implemented law. If the 2014 implementation is messy, Republicans could expand their seats in Congress and maybe even defund parts of the law, such as some subsidies for the exchanges. But whatever happens, this groundbreaking measure is here to stay. “Once people get the benefits,” said Democratic strategist Bob Shrum, “you can never take them away.” MN
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