Family nurse practitioners (FNPs) are needed now more than ever, especially in our fast-growing-but-underserved Latinx communities.
Latinx patients disproportionately report not having a usual source of healthcare and face challenges when trying to find a provider. They are also more likely to live in a community that is experiencing a provider shortage, so they often seek out care in community health centers.
FNPs are more likely to work in these health centers and can ensure Latinx families have access to the care they need.
Dedicated to Diversity and Inclusion
In Arlington County, home of Marymount University’s physical campus, Latinx residents comprise 20-25 percent of the population, the largest concentration in the state. Marymount University’s student population reflects the local demographic, with 25 percent of its undergraduate students identifying as Latinx or Hispanic.
Marymount is dedicated to the idea that diversity is a shared value lived by students, faculty, and staff. Those efforts were recognized when they were named the first Hispanic-Serving Institution (HSI) in Virginia.
Marymount also supports its Latinx students through a recent initiative called ¡Avanzamos! (“Moving Forward Together”), which ensures campus-wide programs and student-success efforts include issues that impact their Latinx student population. ¡Avanzamos! is part of a larger effort to promote diversity and inclusion entitled, “You Belong Here,” which brings together students, faculty, and staff who understand the challenges and needs associated with discrimination and inclusion.
The time has never been better for nurses who want to complete a Family Nurse Practitioner program. Marymount’s online nursing programs prepare nurses for a career as an FNP, allowing them to help underserved populations across the country, including Latinx communities.
Marymount offers several FNP programs for nurses with various levels of education.
For BSN-prepared nurses, Marymount’s online DNP-FNP program teaches skills needed to be a nurse leader who not only offers compassionate care but improves patient outcomes by providing the best patient care across multiple populations in a complex, ever-changing environment.
Marymount’s CCNE-accredited online MSN-FNP program, also designed for nurses with a BSN, utilizes a curriculum strongly focused on ethics and evidence-informed care. Learn from practicing FNPs who are experts in their field and translate theoretical knowledge from the sciences and humanities into the delivery of advanced nursing care to diverse populations.
Marymount’s FNP post-master’s online certification prepares nurses who already have an MSN degree to build on existing knowledge to optimize patient care and be at the forefront of the ever-changing healthcare landscape.
Marymount’s online FNP programs offer a unique opportunity to balance work and school, achieve career goals, and obtain the knowledge and skills needed to sit for the AANP or ANCC family nurse practitioner certification exam after graduation.
To ensure all students can concentrate fully on working and studying, Marymount’s Clinical Placement Team coordinates all aspects of the clinical placement process to ensure the successful completion of clinicals at a placement site within a reasonable distance to the student’s home.
In Oklahoma, the minority population is increasing faster than the majority, but its nursing workforce does not reflect this trend.
In hopes to better mirror the state’s growing Hispanic population, Oral Roberts University places a special emphasis on recruiting Hispanic students.
Dr. Kenda Jezek, Dean of the Anna Vaughn College of Nursing, says the rapidly increasing Hispanic population has made recruitment in this community a priority.
In order to more effectively do so, the University recently opened the ORU Hispanic Center, the first of its kind not just in Oklahoma but at any Christian university in the nation. The center will be a place for Hispanic students, and prospective students in general, to access resources to help them achieve academically at ORU.
In 2009, 31% of the nursing majors were of an ethnic minority. That same year, the School of Nursing celebrated 100% of its 2009 graduating class passing the National Council Licensure Examination for Registered Nurses.
In order to encourage more students to study nursing, ORU is also developing a partnership with local high schools that have high Hispanic and African American representation in their student bodies. As a part of the program, ORU nursing students will teach health services and assist students with lab projects.
Oral Roberts University, as the Senior Educational Partner of the Hispanic Evangelical community, is committed to reflecting the multiethnic culture around them, said Reverend Samuel Rodriguez, President of the National Hispanic Christian Leadership Conference.
ORU believes that increasing diversity and culture on campuses across the country will enrich and empower communities around the world.
The Constitution State now has its own chapter of the National Association of Hispanic Nurses, new as of spring 2010! They’re eager to welcome new nurses interested in working toward improving the health care and quality of life of the Hispanic community. The organization promotes furthering nursing education, promoting and providing culturally competent care, and eliminating health disparities.
“As President of the Connecticut Chapter of NAHN, I am committed to providing an environment where we are all able to work together towards the same common goals of our National Association, and that is to increase the number of Hispanic/Latinos seeking nursing as a career,” says chapter President Maria D. Krol, M.S.N., R.N.C.-N.I.C. “We want our nursing students to find mentorship within an association that will help them enter the nursing profession and encourage them to further their education.”
“The time has come for Hispanic/Latinos to get involved to increase our numbers and to help improve the health of our communities,” Krol says. And you could be the next one to join. For more information, e-mail us at [email protected].
Texas is a big state with a big population. To be singled out as one of the most powerful and influential people in the Lone Star state is quite an achievement, and it’s one that Norma Martinez Rogers, Ph.D., R.N., F.A.A.N., can now celebrate.
Rogers, a clinical nursing faculty member at the University of Texas Health Science Center in San Antonio, was named one of the “Most Powerful and Influential Women in Texas” by the National Diversity Council in April 2011. She was one of 20 women given the title at the seventh annual Texas Diversity and Leadership Conference.
The National Diversity Council had ample accomplishments to review when considering Rogers as one of their honorees, particularly with regard to her mentoring initiatives. She founded the Juntos Podemos (Together We Can) mentoring program in 2000, with just 20 students. Since then the program has served about 2,400 students, around 200 each semester.
In 2010, both the Health Resources and Services Administration and Congressional Hispanic Caucus gave Rogers $900,000 and $500,000 grants, respectively, to support her mentoring programs. In her current role in the Department of Family and Community Health Systems, Rogers has developed even more mentoring programs specifically for diverse nursing students.
In addition to a slew of organizational roles, including a member of the U.S. Department of Health and Human Services’ Office of Minority Health’s Movilizandonos per Nuestro Futuro (as a part of the steering committee), the commissioner of the Medicaid and CHIP Payment and Access Commission, and a member of the Congressional Hispanic Caucus, Rogers also led the National Association of Hispanic Nurses from 2008–2010.
Find out more about the award and next year’s 2012 Texas Diversity and Leadership Conference at www.texasdiversityconference.com.
A recent Institute of Medicine report documented evidence that minorities in the United States received lower levels of mental health care, even when variables such as insurance status and income were controlled, says Debbie Stevens, P.M.H.C.N.S.-B.C., a doctoral student at Emory University’s School of Nursing in Atlanta, Georgia. That’s because nurses play a major role in helping reduce these disparities by educating patients, families, and their communities, Stevens says.
Overcoming cultural barriers
Finding treatment for an illness, such as depression, can be difficult for members of minority groups because they may face stumbling blocks to care, says Vicki Hines-Martin, Ph.D., R.N., F.A.A.N., a professor in the University of Louisville School of Nursing in Louisville, Kentucky.
A major barrier is a perceived cultural stigma of mental health issues. Hines-Martin says some minority populations don’t talk about suicide or depression because it’s seen as shameful. “You may have people who say, ‘I know about suicide, but it has nothing to do with my family or my group,'” she says.
Another problem is that many people may not understand the seriousness of their needs, says Harriett Knight, R.N., a nurse at Sinai Hospital in Baltimore, Maryland. Some people may initially seek an appointment with a specialist, but if treatment involves ongoing medication for an illness, such as depression or schizophrenia, the patient may be resistant to taking the drug as prescribed, or they don’t fully accept that they should continue to take it, says Knight.
Sylvia Hayes R.N., M.S.N., is a nurse in the mental health unit of Peninsula Regional Medical Center in Salisbury, Maryland. She says many patients she sees also don’t accept that mental health is a specific medical science. “They tend to believe their issues are caused by a physical problem,” she says. So they may seek help for a persistent headache, when the real issue may be anxiety related, she says.
In many cases, if a patient realizes that his or her medical issue does involve mental health, they may face another barrier—the fear of being stigmatized. Hayes says she’s seen many African American patients who are afraid that they’ll be “labeled” if they admit to having mental health issues.
“They don’t want to be considered ‘crazy,’ and their family doesn’t want them to be considered ‘crazy,'” says Hayes. “They may be afraid their family will isolate them if they seek help, because then they’ll become an embarrassment.”
Of course, many families support their loved ones suffering from mental illness, regardless of any perceived social stigma. In fact, when relatives are accepting of their loved ones and are willing to help them find care, they can be a vital part of the recovery plan. Many patients will even turn to family members for help before they turn to the medical system, says Hayes. This is good, as long as well-meaning relatives encourage patients to seek professional help when necessary. “It can be a negative if the family delays the patient from receiving the treatment they need,” she says.
Many families actually hold the key to helping patients understand their medical histories, Hayes says. “I’ve seen people with family secrets. They had an uncle or aunt who may have dealt with the same mental health issue,” she says. But if the family shunned that aunt or uncle, the patient may not be as open to finding help.
Family cooperation is also important in treating children and teens. Hayes says many mental illnesses are present at a young age. “I’ve worked with kids as young as two years old,” she says.
However, it may be difficult for well-meaning families to receive satisfactory care. A recent press release from the National Alliance on Mental Illness (NAMI) reports “63% of families reported their child first exhibited behavioral or emotional problems at seven years or younger,” but at the same time, “only 34% of families said their primary care doctors were knowledgeable about mental illness.”
Language and cultural obstacles present another challenge for mental health patients. If a person can’t find a medical professional they can simply talk to, they are less likely to seek medical care, says Patricia Lazalde, Ph.D., Director of Behavioral Health at San Ysidro Health Center in San Diego, California.
San Ysidro serves many Spanish-speaking Latino clients, so it’s important for minority nurses to be able to speak Spanish too, she says. “Minority clients may come in with a variety of stressors, but due to language issues they often don’t seek help until it reaches a crisis,” says Lazalde.
Immigrants of various backgrounds encounter similar stressors. In Louisville, Kentucky, there are increasing numbers of members in immigrant and refugee communities, particularly form Somalia and Myanmar, says Hines-Martin. “They’re newcomers, and they’re dealing with the stressors of changing from one environment to another,” she says. “How they deal with these stressors and whether they want to talk about them is important.”
Members of minority populations may also postpone or avoid seeking care for mental health issues, Hines-Martin says. It’s not so much related to an ethnicity or racial group, but it’s associated with people who hold more traditional values related to their culture, and are less likely to follow mainstream care, she says. “People who are less acculturated into the general population may be less likely to seek help if their culture says it’s not something they should do.”
Financial stress and mental health
The slow economy is also creating a barrier to care for some people, even as it’s identified as a stressor for many. Patients are dealing with the stress of lost jobs, eviction, and foreclosure, says Hines-Martin. She recently completed a study of 127 people in a low-income area and found that poorer residents had almost double the rate of depression as the general public.
“When you look at the economic factors they have to deal with, it makes perfect sense,” Hines-Martin says. The stress of constantly figuring out how to survive can wear down a person, and those factors are associated with depressive systems, she says. “If you have problems in several areas of your life, it can affect your mental health.”
Obviously, financial setbacks don’t always cause mental illness, but they can exacerbate problems in people who are vulnerable, says Knight. “A lot of patients don’t know they’re getting sick until there’s a trigger,” she says. For example, a person may get a call from their mortgage company informing them that they’re being foreclosed on, and they can’t handle their emotions, she says.
Lazalde agrees that whenever there is a loss of financial status within the family, nurses tend to see people with increased levels of depression and anxiety, particularly with wage earners.
“Traditionally, Latino males are the primary breadwinners for families, so the loss of a job and the inability to properly care for the family can really create an additional sense of anxiety, depression, and worry. It’s because they can’t live up to the more traditional roles that they would typically fulfill for the Latino family,” Lazalde says. As a result, there’s an increase of male Latinos coming to seek help for depression and anxiety, she says. The issues affect the entire family. “It creates marital problems. Parents are fighting, and we see the kids coming in with levels of anxiety as well,” Lazalde says.
Residents often have to move out of their homes and move in with relatives and extended family because of financial problems, she says. “Family members have to change schools and meet new friends, and there are not a lot of places they know to go to in terms of seeking resources and finding a shoulder to cry on,” Lazalde says.
Financial problems can also limit access to health care, including treatment for mental health needs. “Many clients are losing medical or health insurance coverage,” says Lazalde. This means fewer people can afford their doctor visits, and they have a more difficult time paying for their prescriptions.
Immigration issues are another stressor in many minority communities. There’s a lot of anxiety and depression when people hear about immigration reform on the news, and they’re worrying about what the outcomes and changes will be, says Lazalde.
“Many of our families are being impacted. A number are split up, with half the family living in the United States and the other half in the native country,” Lazalde says. As a result, wage earners have to support two homes, while they’re responsible for the cost of attorneys and other fees. “They have the stress of keeping the family together.”
One way nurses can help patients deal with their stresses, and improve mental health care overall, is to become active in the communities they serve. This helps build trust between residents and medical professionals, says Hines-Martin.
She says that’s a goal of the Office of Disparities within the University of Louisville’s School of Nursing, where she serves as the center’s Director. The office was started because the school of nursing identified a need to focus on how nursing education, practice, and research could help populations that experience disparities in health, Hines-Martin says.
The Office of Disparities sponsors a variety of programs, including faculty and student activities. Hines-Martin’s most recent project involves working with an entire low-income public housing community. “There are about 700 people in a one-block area,” she says. “It’s a way for us for us to see how economics, food, and trans-generational housing affect how people cope.”
Hines-Martin and her nursing students have found they don’t necessarily see people who are actively engaged in behaviors that are detrimental, such as self-inflicted violence or substance abuse. “But I do see people taking risky behaviors because they don’t care anymore,” Hines-Martin says. These people put themselves in dangerous situations, such as drinking excessively, and the drinking is actually related to depression or a depressed state of mind, she says.
There are many challenges, but the program is yielding results for patients who receive care, says Hines-Martin. She says she’s seen people who received help for psychological conditions and didn’t need to be readmitted to a medical facility after receiving treatment.
There’s also been a decrease in the number of people who have been evicted from their homes because of problems that could be tied to mental illness, such as drug use, says Hines-Martin.
“The community is in partnership with us,” Hines-Martin says. “We’ve learned that people are really invested in having a better understanding of their lives and mental health. It makes it easy to partner with them and invest in them.”
Another way to help build trust is to work with other professionals and community leaders to help educate the population about mental health topics. “Many Latino families aren’t likely to go to a behavioral health specialist initially. Instead, they’re more likely to seek help from clergy or a medical doctor,” Lazalde says. With regards to minority nurses, if they are connected to these influencers, they can help patients find needed behavioral care more quickly, she says.
Identifying red flags
Finding good mental health care is not simply a task reserved for nurses who specialize in behavioral health. Minority nurses in all specialties can help identify red flags that a patient may need a referral for a behavioral health specialist, Lazalde says.
When a nurse in any practice area sees a patient, he or she should look for issues such as a high frequency of usage, she says. The primary care doctor is usually the first person a potential mental health patient will visit, Lazalde says. If a patient has historically only visited the doctor’s office once or twice a year, but now they’re visiting two or three times a month, that’s a red flag, she says. These patients tend to have physical complaints with no apparent cause, so the real issue could be stress or anxiety related, she says.
Minority nurses also need to pay attention to comments patients make during their visits. “They may see a doctor and complain about a headache, or pain in the chest or back, but at the end of the session they bring up family problems,” Lazalde says.
Another red flag could be visits from multiple family members. “If you’re seeing a mom, dad, and siblings for physical problems, all within the space of a month, it could be a sign that there’s some sort of turmoil in the family,” Lazalde says.
And nurses shouldn’t wait until the visit is nearly over before addressing mental health issues. “I think it’s really important for nurses to ask questions early on,” says Lazalde. “Ask how things are going in the family and at home. If the questions are addressed by the medical provider or nurse, it normalizes the situation and allows the family to speak more freely,” she says.
When nurses are rushed for time, sometimes really important pieces of information fall through the cracks. This can be prevented by having a patient fill out a survey at the start of their visit, Lazalde says. She encourages the use of a questionnaire, such as the Generalized Anxiety Disorder 7-item scale (GAD7), to help assess a patient’s mental health needs. “It only takes a few minutes and can be completed in the waiting room, and it doesn’t take away the nurse’s time,” she says.
If it’s determined that a patient should receive specialized care, Lazalde recommends that referrals be “normalized.” For example, when nurses make a referral to a provider who’s an oncologist, it’s normal because the oncologist is simply a member of the health care team, she says.
“So we have to find a way to make the behavioral health provider a member of a team. Instead of making the client feel as if there’s something wrong with them when they receive a referral, they’ll know that they’re just meeting another member of the team,” she says.
Lazalde also has another important piece of advice for minority nurses: don’t give up on your patients. “It often takes more than one referral to be successful. Sometimes we have to refer the patient three, four, and five times,” she says. If nurses approach their roles knowing that it takes multiple referrals before they reach a successful linkage to the other provider, then nurses may be less likely to get discouraged, she says. “We’ll know that the family hears the referral more times and there’s a higher likelihood the patient will go and complete the referral and receive the services they actually need.”
Perhaps the most disappointing barrier minorities face are the ones caused by the attitudes of medical professionals. Minority nurses can exhibit the same biases about their patients as anyone else, and if they’re not careful, they may start to form negative opinions that could affect their levels of care, says Stevens. “Just because a nurse is a minority doesn’t mean they’re immune to stereotyping,” she says.
Some nurses, particularly those who serve low-income communities, fall into the trap of assuming that some poorer patients check into medical facilities to access prescription drugs, three square meals, or a warm bed, she says. “I’ve heard people say ‘the patients are looking for three hots and a cot,'” Stevens says.
These biases are often reinforced when patients have high rates of repeat visits, she says. But despite the challenges, many minority patients who do receive appropriate care become better and are able to function in society, she says. Minority nurses must provide the best service possible by making a sincere effort to view each patient as deserving of quality medical attention, Stevens says. “Nurses have to fight to eliminate negative stereotypes they see, even if they may have had those same stereotypes themselves,” Stevens says.
Translating policy into practice can be difficult because of how pervasive some biases are, but it can be fought the way any ethnic or cultural stereotype is fought, says Stevens. “It starts with education and awareness.”
Some patients will be difficult, Stevens concedes. But if mental health care is your specialty, you should remain confident that you are helping your patients. Standards of care have to be the same, regardless of who the patient is or where he or she comes from, Stevens says.
Minority nurses are specially suited to help break down barriers and stigmas, build trust among their communities, and help their patients live the best lives possible.