The health care crisis resulting from the current nursing shortage continues to worsen across the country. Some experts have estimated that more than 1.7 million new nurses will be needed by the year 2020. In some parts of the country, such as California, hospitals and other health care facilities have been forced to turn patients away because of a lack of trained RN staff. As the U.S. population continues to grow and to age, there are just not enough nurses to meet the increasing demand.
This is especially true in America’s more ethnically diverse communities, where there are many recent immigrants who do not speak English. Because of the burgeoning growth of the nation’s Latino and Hispanic population, demand for Registered Nurses who are fluent in Spanish far exceeds the supply, especially in specialty areas such as critical care, obstetrics and operating rooms. According to the most recent census, Hispanics now account for 13% of the U.S. population, yet only 2% of the current RN population is Hispanic.
In the Los Angeles area, TELACU (The East Los Angeles Community Union), a non-profit community development corporation, is working to change this situation. Through its TELACU Education Foundation, the organization established a Health Careers Program three years ago to help ensure that there are enough bilingual, culturally sensitive nurses and other health care workers to serve the area’s growing Latino communities.
Jimmy Benavides, co-founder of Future Leaders of America, speaks to Health Careers Program students.
At a time when many hospitals are importing nurses from other countries to fill their staffing gaps, it’s important to recognize that there are many people from underrepresented populations here in the United States who could become nurses. The TELACU Health Careers Program was created to encourage Latino students to pursue careers in the health professions, and particularly, to meet the growing need for bilingual doctors, nurses, technicians and other medical professionals. The program provides support for these students in a variety of ways, including scholarships, tutoring, counseling and more.
“We need bilingual/bicultural men and women working in our hospitals to serve our population,” says David C. Lizárraga, TELACU president and CEO. “There are young Latino men and women [in our communities] who have an interest in working as nurses or other health care professionals. Our program provides more than just financial assistance to help them achieve their goal. It benefits not just the students but the entire community.”
Maribel Lara, RN, a nurse at Downey Regional Medical Center (DRMC) in Downey, Calif., is one young woman who has benefited from the TELACU program. She received a scholarship that enabled her to complete her ADN degree from East Los Angeles College in May 2002. “I enjoy being a nurse,” she says. “When I decided to choose a career, I wanted to work in a field where I could help people and touch their lives.” As a nurse who is bilingual, Lara says she is “always being pulled aside to translate for others. With such a large Hispanic population, we need more people who can speak Spanish working in hospitals.”
The TELACU scholarship, she adds, made it easier to achieve her goal. “It let me focus more on school, my grades improved and I was not as stressed. It took the pressure off and really made a difference,” Lara explains. “Now, I urge others to consider nursing as a profession and I tell them about TELACU’s program.”
Karen Ochoa, RN, had considered nursing as a career while growing up in East Los Angeles, but when she became a single mom at age 17, her goal seemed impossible to achieve. She persevered, however, and enrolled in the nursing program at East Los Angeles College, where she heard about the newly established TELACU scholarship. She was one of the very first students to apply for it and one of the first scholarship recipients. “It made going to school much easier,” she recalls. “I was able to buy my supplies, the extra books I needed, gas for my car and other things I needed. It also paid for childcare for my daughter.”
Ochoa is now a nurse at DRMC, working in critical care. “Even though it’s hard work,” she reports, “I like helping people, talking to the patients, and I try to always keep a positive attitude.”
Financial Support Is Just the Beginning
Initially, the Health Careers Program began with a partnership between TELACU Education Foundation, Downey Regional Medical Center and East Los Angeles College. The plan was for TELACU to provide scholarships and other assistance to academically excellent, financially needy Latino nursing students at the college. When the students completed their education and passed their licensing exams, they would be offered the opportunity to work at DRMC, a 199-bed hospital and medical campus.
Program graduate Joaquin Nunez
Since then, the program has expanded to help more students realize their dreams of a nursing career. Today the TELACU Health Careers Program serves students at three area colleges, in partnership with three local hospitals. In addition to the TELACU/DRMC partnership with East Los Angeles College, there is now a TELACU program at White Memorial Medical Center (WMMC) in Los Angeles, in partnership with Rio Hondo College, as well as one at Pasadena City College, working with Tenet Healthcare.
Currently, the Health Careers Program awards approximately 30 scholarships and stipends annually, totaling approximately $300,000, to qualifying second-year nursing students at the participating schools. Individual awards range from $1,500 to $10,000. All of the funding comes from the DRMC Foundation, WMMC Foundation and Tenet Healthcare Foundation, which contribute $100,000 each.
Program graduate Martha Medina
But financial assistance is only one aspect of this multifaceted program. The scholarships are enhanced by academic and emotional support to ensure that the students succeed. For example, the program has purchased laptops that are available to the students on loan. Health Careers Program coordinators and local health care professionals provide tutoring, workshops and one-on-one counseling. The program also covers the cost of the test prep courses that help the students prepare for the NCLEX-RN exam.
In the three years since its inception, the TELACU Health Careers Program has already begun to make a difference and has provided the community with approximately 50 new bilingual Latino nurses. Thirty newly graduated nurses from the program are now working at Downey Regional Medical Center. “Our partnership with TELACU has brought us some excellent new nurses,” says Allen R. Korneff, DRMC’s president and CEO. Although the newer programs with Tenet Healthcare and White Memorial Medical Center were just launched in 2003, between them they have already had about 20 students finish the program and begin work at their facilities.
Through these alliances, TELACU’s program is opening doors to new career opportunities for local Latino young people interested in the health care profession, who will in turn improve the community through the delivery of better, more culturally and linguistically competent health care services. While each of the partnerships is unique in some ways, they all share the goal of bringing more bilingual nurses into our hospitals.
Looking to the future, the TELACU Health Careers Program is also working to encourage younger students to consider careers in the health care field. Many of today’s teenagers may not have considered working in health care as an attractive career option and they may be unaware that nursing is a well-paying profession for both women and men.
Each year, the program gives presentations on health careers at local middle and high schools, participates in community career fairs and takes middle and high school boys and girls on hospital tours. These tours enable the students to experience for themselves what working in health care would be like and gives them the opportunity to hear from the hospital CEO as well as some of the nurses and other health care workers. If they are interested, they can begin to plan their future early, learning which classes are most important to take in high school to prepare them for their college coursework.
To learn more about TELACU Education Foundation’s Health Careers Program, visit the Web site www.telacu.com or call (323) 721-1655.
I was born in Guyana, South America, in 1952. As a child I dreamt of being a nurse and caring for the sick. But faced with numerous obstacles, including financial difficulties and lack of opportunity, I was forced to postpone that dream for many years.
Today I am a successful nurse who recently earned her master’s degree in nursing at the age of 50. Reflecting on my past, I am so happy that I made the decision to change my career and pursue a nursing education, which allowed me to finally fulfill the dreams I had so long ago. My words of advice to other people of color who may encounter obstacles to following their dreams are, “Don’t give up.”
After graduating from high school in Guyana, I applied to a nursing school but I was not accepted. So I gave up on my dream of becoming a nurse and pursued other career paths. I joined the military, where I worked in communications as a switchboard operator for many years. After that, I held various civilian jobs, such as working at a glass factory.
In 1987, at age 35, I immigrated to the United States with my family. I worked in the insurance industry as a file clerk, but subsequently resigned because there was no opportunity for professional growth or development. I started a new career in banking and requested numerous transfers for financial and professional growth. As a new immigrant my motto was to “get rich quick,” so I was encouraged by my peers to seek a second, part-time job to earn additional money. I had never worked two jobs in Guyana, but I was willing to do anything honest to survive in America.
I opted for a housekeeper position at a long-term care facility, where I worked every other weekend, leaving my family and my church activity. Because this position paid more money than my file clerk job at the bank, I decided to resign from banking and work full time as a housekeeper. My family was very upset with the decision I had made to leave the prestigious banking profession for a housekeeper position, and there were many embarrassing questions I had to answer. Honestly, I was looking for a better-paying job in order to survive.
While working at the long-term care facility, I was surprised by the number of elderly people living there and their inability to care for themselves. I felt deep empathy for them, and whenever they would call upon me to tie their shoelaces or hand them a glass of water to drink, I willingly dropped my broom and gave them the assistance they needed.
One day I was reprimanded for assisting one of the residents. I was told that this was not in my job description and that only nursing personnel were allowed to help the residents. This statement caught me by surprise. I asked why I could not help them, because in my culture I was taught to be respectful to the elderly. The response was: “That’s the policy. If you’re not a nurse’s assistant, you can’t have patient contact.”
The Turning Point
That incident reawakened my desire to become a nurse and gave me the impetus to try again to follow my dream. I retained my position as a housekeeper at this facility because of the tuition reimbursement I was able to receive through my union’s 1199 Training and Upgrading Fund. I registered for a nursing assistant course at Capital Community College in Hartford.
After successfully completing this course, I gladly accepted a nursing assistant position at the Hebrew Home and Hospital, a long-term care facility in West Hartford. This opportunity increased my passion to become a nurse. During the time I was employed as a housekeeper and then a nursing assistant, I attended Capital Community College and graduated in 1995 with an associate’s degree in nursing. I remained employed at the Hebrew Home and Hospital in the capacity of a charge nurse.
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Since then, I have worked in various long-term care facilities, sharing the joy of caring for the elderly population. I have taken an extra step along the path of professional success and obtained my certification as a gerontological nurse from the American Nurses Credentialing Center in 1998. Wanting to do still more with my career, I attended the University of Hartford and obtained my BSN degree in 1999.
On May 18th, 2003, I graduated from the University of Hartford with a master’s degree in nursing. My daughter and her two children came all the way from Japan to attend my graduation ceremony. My childhood dream has truly become a reality.
I am thankful to my supportive husband who stood by me throughout the years. I also thank my two children for their patience, as well as my sisters, sisters-in-law, brothers, brothers-in- law and friends who nurtured me all the way. Most of all, I want to thank my nursing instructors who gave me all their support and put their faith in my becoming a nurse.
It was not an easy journey to achieve my lifelong dream. But my experience proves that if you follow your dreams and never give up, you will be rewarded with the career of your choice. I have not regretted for a moment the choices I have made, and as a result I continue to have a fascinating, enriching and exciting life as a nurse.
Sandra Sanchez-Zutic, RNC, a child/adolescent psychiatric nurse, gained the confidence to get more involved in her local nursing association and run for office. She’s now vice president of the New Jersey chapter of the National Association of Hispanic Nurses.
Teresa Sewall Philogene, RN, a clinical research associate for a major pharmaceutical company, renewed her commitment to continue her professional education and pursue a master’s degree.
School nurse Cynthia Samuel, RN, MS, sharpened her focus on what she wants to study on the doctoral level and made contacts that will enable her to advocate for school health issues statewide.
These three minority nurses come from diverse backgrounds and specialties, but they all share one thing in common: They have leadership potential. And now, thanks to a unique program at Rutgers, The State University of New Jersey, they are better equipped to develop their natural leadership abilities and pursue their goals. They are among 17 nurses to participate this year in the Minority Nurse Leadership Institute (MNLI), an annual nine-month program (October to June) developed through the Educational Opportunity Fund Program at the Rutgers College of Nursing in Newark.
Established in 1999, the institute’s mission is to help minority RNs continue their education, advance into leadership roles and use their influence to improve minority and community health. MNLI Project Director Deborah Walker McCall, RN, MBA, says the program is the only one of its kind in the country, as far as Rutgers officials know. As the institute becomes more established, she would like to see it become a national model and replicated at other universities.
The institute recruits nurses of color from New Jersey, New York and neighboring Northeastern states who have completed or are working toward a BSN or MSN degree and have demonstrated leadership ability in nursing, such as involvement in civic activities or professional organizations, holding offices, etc. MNLI Fellows must also demonstrate a commitment to working with minority populations in urban communities and serving as mentors to other nurses.
The size of the group is kept relatively small–no more than 25 nurses per year–so that participants can get to know one another and receive individual attention. The nurses attend monthly, daylong Saturday workshops at Rutgers on leadership topics like public speaking and networking. They ¬then get a chance to apply what they’ve learned by creating a community health project. The project must coincide with the goals of Healthy People 2010, the national campaign to eliminate minority health disparities and increase life expectancy and quality of life for all Americans. Each MNLI Fellow is also partnered with a mentor who is a leader in the nursing or health care profession.
A U.S. Department of Health and Human Services grant provided seed money to start the institute, and grants from the Kellogg Foundation and Johnson & Johnson have funded the program in subsequent years. While the MNLI is currently dependent on annual grants to continue, McCall hopes an endowment will be established to provide ongoing funding. The program, she says, has benefited from the strong support of College of Nursing Dean Hurdis Griffith, RN, PhD.
The institute’s long-term goal is for its graduates to serve as role models and agents of change who can make a far-reaching impact in providing culturally appropriate care to minority communities, championing health care reform, encouraging young people to enter the nursing profession and persuading other nurses of color to become leaders as well.
Noting that minority nurses are severely underrepresented in health care management, academia, policy making and other leadership roles, McCall, who is African American, envisions MNLI graduates advancing to positions where they can advocate for minority patients and help end race-based health care disparities. “The biggest things I’d like to see happen as a result of this institute are the improved health of minority populations and an actual elimination of the health gap,” she says.
Take Me to Your Leaders
Through the monthly workshop seminars, MNLI Fellows gain exposure to the wide spectrum of nursing disciplines and leadership positions to which they can aspire.
“It really begins to let them see that the nursing profession offers many more options than just working at the bedside,” comments Yvonne Wesley, RN, PhD, an African-American nurse and MNLI mentor who is vice president of research and development for the Northern New Jersey Maternal Child Health Consortium. “To become minority nurse leaders, they need to have that big-picture perspective.”
The institute does more than emphasize that nurses of color can rise to the top and become hospital CEOs, heads of government agencies, nursing school deans and more—it proves it by bringing participants face to face with role models who have done just that.
“The MNLI brings together a hard-core cadre of accomplished minority faculty and professionals,” says Rutgers University College of Nursing Assistant Professor Gloria McNeal, RN, PhD, CS, another mentor for the institute. “You can see in [the students’] faces that they didn’t even know people like us existed.”
Institute Fellows not only get to learn from top-ranked minority scholars and health officials in a lecture format, they also get to chat informally with them.
“Unless you’re lucky enough to be able to go to national conferences, you really wouldn’t have access to that level of professionals,” Sanchez-Zutic explains. The opportunity to get acquainted with such high-caliber nurse leaders, she adds, is akin to “physicists getting to talk to Einstein.”
Besides offering instruction, workshop leaders also share their personal stories of frustration and triumph. “It was really such an incredible opportunity to see nurses of color in these positions of power and listen to how they did it and get the feeling that yes, you can do it, too,” says Sanchez-Zutic.
Cynthia Samuel agrees that participants can’t help but be inspired by what these minority nurse leaders have accomplished. “You get consumed by their passion. You just want to be like them,” she relates. “I love to surround myself with people who are goal-oriented, who are driven and enthusiastic and willing to share information. I look forward to each session because of the caliber of people who will be there and the information that’s being presented.”
Building Leadership Skills
Behind every great leader there are great leadership skills. The MNLI program introduces minority nurses to leadership concepts that they otherwise might have to spend years learning on the job. The workshops focus on how to network, negotiate, work through the political process, give effective public presentations and form partnerships with other health care professionals.
Participants also take the Myers-Briggs personality assessment test to learn the characteristics of their leadership styles and an accompanying test that reveals the types of people with whom they work best. They also receive guidance in how to capitalize on their strong points and strengthen their weaknesses so they can shape an effective management style.
Bernice Dillard, RN, MSN, APNC, a student health services nurse at Rutgers University who attended the institute in its first year, says this skill-building approach helped her gain a greater awareness of the leadership contributions she can make, particularly in the area of influencing young people to enter the field of nursing.
That type of leadership role comes naturally to Dillard, who is currently president of the South New Jersey chapter of the National Black Nurses Association. “But I just don’t think I ever realized how significant that role was,” she recalls. “I wish I would have been able to attend this institute about 20 years ago!”
Testing Their Wings
Through the minority health projects they complete while they attend the institute, MNLI Fellows get a unique opportunity to not only translate theory into practice but also make an immediate impact on their communities. The purpose of the projects is to increase participants’ understanding and involvement in minority health care issues while enabling them to become involved in real-world leadership activities.
For example, two nurses in the program worked together to develop a prostate cancer screening initiative in partnership with the community service group 100 Black Men of New Jersey. According to the federal Office of Minority Health, the prostate cancer death rate for African-American men is more than twice that of white men.
Another MNLI participant designed a project to improve access to prenatal care for homeless women. Other nurses’ projects have run the gamut from teaching senior citizens how to manage chronic illnesses, such as diabetes, to raising Asian-American college students’ awareness about dating violence and sexual assault.
For her project, Samuel decided she wanted to increase public awareness about hepatitis C, a disease on the rise in her community. She held a workshop for students and parents at Grove Street Elementary School in Irvington, N.J. About 30 people attended and learned about hepatitis risk factors, prevention and testing. The event was so successful that the local newspaper wrote about it, giving the topic even wider community exposure.
Teresa Sewall Philogene focused on diabetes and hypertension, diseases that are disturbingly prevalent in her Caribbean culture and have touched her personally. “High blood pressure and diabetes unfortunately run in my family, so these problems are in the forefront of my mind,” she explains.
In collaboration with three African-American congregations in her community, Philogene created a program to educate people about the risk factors and how to prevent these illnesses through diet and exercise. “This gives me a chance to get back to my roots,” she emphasizes.
The Fellows’ mentors help guide them as they plan and carry out their community
projects. Samuel feels that the support she received from her mentor, Yvonne Wesley, was priceless. “She was immediately excited [about my topic]. She gave me tips on preparing information packets, who to talk to, how to advertise. She even came to the hepatitis workshop and brought colleagues with her.”
Samuel adds that she found more than a mentor in Wesley–she found a friend. “We’ve bonded significantly,” she says. “We just clicked.”
Wesley, in turn, enjoys the role of supporting future leader like Samuel, who already have the drive and vision for where they want to go. “I wouldn’t have gotten to where I am in my own career without the support of mentors who showed me the way,” she remembers. “Now, as a mentor myself, I get a sense of giving back.”
For More Information
Although many of the participants in the Rutgers University College of Nursing’s Minority Nurse Leadership Institute (MNLI) are recruited by the program, nurses of color who have demonstrated strong potential for leadership ability can also apply for MNLI Fellowships. Applicants must be racial or ethnic minority RNs and should live within easy traveling distance of the Rutgers campus in New Jersey so they can attend monthly workshops and meet with their assigned mentors.
Tuition for the nine-month program is currently $500, with discounts available to members of minority nursing associations and other nursing professional organizations. Scholarships and other forms of financial aid are available. Keep in mind, though, that admission to the program is highly competitive—the MNLI is limited to a maximum of 25 nurses per year.
For more information, visit the Web site http://nursing.rutgers.edu or contact:
Deborah Walker McCall, RN, MBA
Director, Educational Opportunity Fund
Project Director, MNLI
Rutgers College of Nursing, EOF
Conklin Hall, Suite 226
175 University Avenue
Newark, NJ 07102
(973) 353-5326, ext. 523
Fax (973) 353-1495 [email protected]
During his three-and-half-year journey toward becoming a nurse, Jorge Juarez experienced a series of personal tragedies that would have caused most other people to give up. His parents died, his brother had a stroke, and he lost his house to a fire caused by lightning
But Juarez didn’t give up. In December 2005, at age 41, he and 16 of his fellow students became the first graduating class of the University of Nebraska Medical Center (UNMC) College of Nursing’s newly launched accelerated BSN degree program.
This remarkable story begins in 2002. Juarez had just retired from a 20-year career in the Air Force and was trying to decide what he wanted to do next in life. But shortly after his return to civilian life, his father had a stroke and his mother was diagnosed with cancer. The stroke left his father partially paralyzed and his mother ultimately went into a nursing home. Juarez traveled to Texas with his wife Lynelle and their two children to be with his parents.
It was this crisis that helped plant the idea of a possible career change into nursing. “This was one of the things that introduced me to the health professions,” Juarez explains. “I saw all the nurses who interacted with my mom and dad. It really had an impact on me.”
Then more crises came. In September 2002, his 50-year-old brother, who lived in North Carolina, had a stroke.
“Our family really had a rough time,” says Juarez. “It kind of made me look at myself. I have high blood pressure, too. It got me closer to the medical profession.”
While Juarez was visiting his brother, his house in Bellevue, Neb., near Omaha, was struck by lightning and burned down. Fortunately, his family, including the dog and cat, got out of the house unharmed.
Juarez says this string of unhappy events gave him a lot to think about. “It gives you a new perspective on what you value. It brings you closer to your family and God.”
A Son’s Promise
While the family was having their house rebuilt, Juarez made the decision to pursue a nursing degree. “It’s a total 180 from what I was doing before,” he says, explaining that his job in the Air Force involved working primarily with computers and electronics in aircraft and satellites. “It was a total change in careers.”
He started applying to nursing schools. In January 2004 he was accepted into the accelerated BSN degree program at Creighton University Medical Center in Omaha.
That spring, his mother’s health deteriorated. “The chemo wasn’t working, the radiation wasn’t working. The tumor got worse,” Juarez says.
Sometime in April or May, she was admitted to hospice. She died on May 22.
The loss took a profound toll on Juarez. “My grades suffered,” he recalls. “So I pulled out [of the nursing program]. I tried to stay in the program. But looking back, I should have pulled out even sooner than I did.”
When he was visiting his mother in hospice, she would always tell the nurses that her son was in nursing school. “She was proud,” Juarez says. He made a promise to his mother that he would continue to pursue his nursing degree.
When he came back to Bellevue after her death, he found he had to reapply to get back into Creighton’s program. He considered doing that, but he also looked into UNMC’s newly created accelerated BSN program, which had not existed back when he originally made his decision to pursue a nursing degree. The UNMC program, which was scheduled to hold its first classes in January 2005, was made possible by a $1.17 million grant from the federal Health Resources and Services Administration (HRSA). The grant provides three years of funding to establish the program.
“Deciding between the two schools was a tough decision, because they both have stellar reputations,” Juarez remembers. He eventually found himself leaning toward the UNMC program for several reasons. For one thing, he says, “it was an exciting opportunity to be part of the first class at a college with such an outstanding reputation.”
Juarez spoke with Larry Hewitt, director of student services at the UNMC College of Nursing, and learned that he needed two more prerequisite courses before he could be admitted to the program. Though the classes he needed had begun a week earlier at Metropolitan Community College, he convinced officials to let him enroll. He took the courses, passed, and applied to the UNMC nursing program just in time to begin classes in January.
A Race to the Finish
Once Juarez began the accelerated program, he found his life moving at a frantic pace. In this particular program, students earn their BSN degree in just one year, taking classes for two semesters and in the summer, without the usual breaks. Clinical rotations and academics are also held on evenings and weekends. In contrast, the traditional accelerated BSN program typically takes five semesters over two-and-a-half years.
Both Juarez and his wife describe the pace of the program as “insanity.” He was taking 27 or 28 credit hours at once, versus a typical undergraduate student load of 15 hours. “It was really hard,” he says.
In May of 2005, just as his first semester was about to end, tragedy struck again. Juarez’s father had a massive heart attack and died on May 23–exactly one year and a day from the date his mother had died.
But this time, Juarez kept going. He stayed in school and completed the first semester. “The [college] really worked with me,” he explains. “I finished the semester, then was able to [go to Texas] to be with my family.” He returned to Omaha to start the summer semester, then completed the home stretch of the program, culminating in his graduation at the end of the year.
According to Juarez, both he and his classmates were glad the accelerated program ended when it did. “I think when we got to a point towards the end, we were thinking that if it wasn’t going to end soon [we wouldn’t be able to keep up the pace much longer],” he says. “We were really burned out.”
For Juarez, the hardest part of the experience wasn’t the challenging academics, the clinical rotations or even the punishing pace–it was not being able to be there for his family.
“I barely saw my wife and kids,” he says. “My daughter is in a soccer club, my son is in band. I missed out on a lot of that. It was rough for all of us. Sometimes my kids would be doing their homework and I’d be sitting there doing mine, too. I’d come home to do my homework till the wee hours of the morning.”
He admits his age made studying a challenge. “I fell back on my Air Force experience,” he says. Part of his military job involved teaching, which in turn required him to study a lot.
Setting a Good Example
Through tragedy and triumph, Jorge Juarez’s dream of becoming a nurse was always in the back of his mind. Today he is finally living that dream, working as a nurse on the Liver Special Care Unit at the Nebraska Medical Center.
“Nurses really make the difference,” he believes. “The way you interact with a patient really makes a difference. You can see it. In nursing school I had a preceptor, Kim Janssen, a nurse at [the Nebraska Medical Center’s] Clarkson Tower, who emphasized the importance of being a patient advocate. Helping people is a big draw for me.”
As for being a man in a female-dominated profession, Juarez acknowledges that some people still harbor prejudices about men in nursing. But for him, it’s not an issue.
“I don’t see it as any difference,” he maintains. “I don’t see genders. I see a nurse, a professional. I think more men should go into the nursing profession. I’m really glad I went into it.”
In addition to fulfilling the promise he made to his mother, Juarez says he also wanted to prove something to his children.
“I [didn’t do this] just for myself,” he emphasizes. “I really wanted to give a good example to my kids that you can do anything you set your mind to. If you really feel strongly about [accomplishing] something, you can do it.”
Capt. Evangelina Montoya, RN, MSN, is reading aloud from a report on migrant farm workers. “‘We work from sunrise to sunset,’” she recites, “‘and my body gets so tired it’s hard to walk. My uncle has to park the truck so far away, and I get so cold and tired when I walk back to the truck.’”
This experience is all too familiar to Montoya, who grew up as the daughter of migrant farm workers in Visalia, Calif. “I can put my face on this story,” she says. “For me it isn’t just statistics—it was a fact of life.”
When Montoya started attending community college, she realized that she wanted to go into the health care field. “I chose nursing because it reflected my values,” she explains. Her interest in providing health care to an underserved population in a rural community, along with her desire to travel, drew Montoya to public health nursing. Now a commissioned officer in the U.S. Public Health Service, she is a public health analyst for the federal Division of Community and Migrant Health, where she helps develop health care policies affecting migrant workers.
Another former migrant worker who is dedicating herself to improving health conditions in migrant communities is Aurora Hernandez. Growing up in Texas, Minnesota and Wisconsin, Hernandez worked the fields while other kids rode their bikes and went to Disneyland. Every year, her mother took her to a migrant health clinic for a checkup. When she was 12, Hernandez was examined by a nurse—an experience that made a lasting impression on her young mind.
“The nurse could probably tell that I was unhappy,” Hernandez recalls. “I wasn’t looking up and I didn’t talk much. She was concerned about me, and I noticed how nice she was. She was very sincere and kind.”
When the young girl asked the woman what she did, she replied that she was a nurse. “That was my first experience meeting a nurse and seeing how their work involves helping people,” says Hernandez. “I realized that [as a nurse] I could have a good job, be able to talk with kids and families and spend my day inside a building! From that day on, I wanted to be a nurse and work with migrant kids.” Hernandez is now a nursing student at Georgetown University in Washington, D.C., and the first Hispanic president of the National Student Nurses’ Association.
At a Greater Risk
Migrant farm workers are the people who pick the fruits and vegetables that you and your family eat every day. There are three to five million of them in the United States and their average income is less than $7,500 a year. Eighty percent of these migrant farm workers are Hispanic, and two thirds of them are under 35 years of age. Sixty-six percent of migrant worker parents have their children with them as they work.
The migrant worker community is divided into three “streams.” The West Coast stream stretches from California to the Pacific Northwest; the Midwest stream starts in Texas and extends north, while the East Coast stream reaches from Florida to Vermont and New Hampshire.
A migratory lifestyle and harsh working conditions create a myriad of health problems for these workers. “They have more complex health problems than those of the general population,” Montoya notes. “They suffer more frequently from infectious disease and they have more clinic visits for diabetes. Contact dermatitis is also common because of the exposure to pesticides.” Other common ailments affecting migrant workers include cancer, hypertension and asthma.
Many of these health problems stem from poor nutrition. “Migrant farm workers have extremely low incomes, and they work six days a week, 10 to 12 hours a day,” explains Hernandez. “When things are really terrible—when the weather’s bad and the crops aren’t growing well—the result is malnutrition. People working 10 to 12 hours every day in 95-degree weather have tremendous nutrition needs.”
The health of migrant workers’ children is another area of concern. These children often suffer from Vitamin A deficiencies or ear infections that can lead to deafness if left untreated. Pesticide exposure is another serious health issue. One recent study revealed that 48% of migrant children had worked in fields when the plants were wet with pesticides and 36% had been sprayed either directly or indirectly by pesticide drifts. Thirty-four percent of children’s homes had been sprayed in the process of crop-dusting the fields.
“As the planes sprayed the fields, you could feel the drifts,” remembers Montoya. Hernandez has similar memories. “Every morning, the crops were sprayed,” she relates. “[It mixed with the dew] and when it dried, the pesticide residue would be on your clothes and your skin. It looked like a white film.”
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Such exposure is particularly dangerous for children because their higher metabolic rates and lower body weights make them more susceptible to the toxic effects of pesticides than adults.
Some migrant worker health disparities have a devastating effect on both parents and their children. “There is a very high rate of depression in both mothers and fathers in migrant families for a variety of reasons,” says Mary Lou de Leon Siantz, RN, PhD, FAAN, who teaches at Georgetown University and is the current president of the National Association of Hispanic Nurses. “Depressed parents are less able to interact and communicate with their babies, and that places a child who’s already at a substantial risk for health problems at an even greater risk.”
Siantz has received funding from the National Institute for Nursing Research to study the prevention of developmental delays in Mexican migrant infants. She is also actively involved in getting migrant babies prepared for school in the Migrant Head Start program and is working with the University of Washington to develop a culturally and linguistically sensitive intervention program for Spanish-speaking migrant workers.
Still another factor that contributes to increased health risks for migrant workers is substandard housing. “Whatever the farmer [whose fields you are working in] provides is where you live,” says Hernandez. “Our family lived in houses that had been condemned.”
Nurses who work in migrant communities can attest to the health problems poor housing can cause. “We see increases in infectious diseases, gastrointestinal disorders and emotional distress in people exposed to those living conditions,” Hernandez explains. There are increased risks of accidental injury as well, she adds. “People can fall through holes in the floor. At one home I lived in, I fell into a well that was covered up by grass and dirt.”
Working Without a Net
Even though they face disproportionate health risks, most migrant farm workers don’t have the peace of mind of health insurance. Because they are always on the move, they rarely reside in one place long enough to qualify for insurance. As a result, routine medical exams account for only 1.4% of all visits to the Division of Community and Migrant Health’s clinics—39% below the national average.
“By the time they show up in the ER or at the clinic, their health problems have become very severe, because [nurses] don’t see these patients until they’re too sick to work,” says Montoya.
Then there’s the issue of lack of access to health care. Migrant families tend to work in regions that are even more remote than typical rural communities, and these areas often lack clinics and medical professionals.
The Division of Community and Migrant Health is attempting to address these problems through a national nursing voucher program that is instituted in regions where migrants work for only a few months and then move on. Under this program, migrant workers can receive vouchers to bring to participating clinics to “buy” health care services. The program also allows nurse practitioners to provide primary health care, and RNs can refer workers to a physician or another nurse for advanced medical care. Currently, there are 21 such voucher programs providing health care to migrant workers in the United States, serving some 56,000 patients per year.
“Nursing voucher programs are an area where nurses can really take the lead in filling gaps in migrant workers’ access to medical care,” says Gloria Torres, RN, MS, assistant clinical director of Community Health Partnership (CHP) in Aurora, Ill., an organization that serves migrant farm workers exclusively. Another nurse who grew up in a migrant worker family, Torres administers a nursing voucher model that is used at six CHP sites in Illinois.
Imagine trying to comprehend health care information from a doctor who speaks only Swahili and you’ll understand why language differences are another major barrier to providing effective health care to migrant farm workers. “My parents spoke Spanish at home, so I didn’t learn English until I started school,” says Montoya. Hernandez also has experience with the language barrier: “When I was a young child of 11 or 12, I went with my parents to the doctor to translate for them.”
Cultural barriers may have an even stronger effect on health care providers’ ability to treat migrant workers. “My father had hypertension and diabetes,” Hernandez recalls. “He would say ‘yes, yes’ at the clinic, but at home he would not do what they told him to. I came to realize that he didn’t trust them, because they didn’t understand his culture. When you’re discussing food with a migrant worker who is diabetic, you need to understand that they eat tortillas, beans and rice because they work 10 to 12 hours a day, and they need food that will help them do all that work.”
How Nurses Can Help
These cultural and linguistic competency issues help explain why the field of migrant worker health care urgently needs more Hispanic nurses. Sara Erlach, a retired nurse who received a Lifetime Achievement Award from the National Association of Hispanic Nurses last year for her pioneering work in migrant worker health care, emphasizes that “[minority nurses] are in demand everywhere. Only 2% of the RN population is Hispanic.”
The demand for nurses who speak the language and who are familiar with (or are willing to learn about) the needs of migrant farm worker communities is especially great. Nurses need these qualifications to earn the trust of Hispanic patients, Hernandez explains. “When my father finally met a nurse who spoke his language and came from his background, that’s when [the health care advice] really clicked,” she says. “Everything that nurse said was like the Bible to him. He felt that she understood his life and he believed everything she told him.”
There are many opportunities available for nurses who want to enter the field of migrant worker health care. “If you’re working at a migrant health clinic, you can work as an LVN as well and do some of the technical aspects that are done in traditional clinics,” says Siantz. Other opportunities include making home visits in migrant communities, teaching health awareness, developing public programs and creating public health announcements for Spanish-language radio.
Research on migrant health issues is another important career path. “If we had more [nurses] interested in research, we could develop better policies and have more advocates and clinicians,” says Hernandez.
Some of the most rewarding career opportunities for nurses in migrant health care are with the federal government or other nonprofit national organizations, such as the National Center for Farmworker Health, the Migrant Clinicians Network, the Pan American Health Organization and the U.S. Department of Health and Human Services’ Office of Minority Health (OMH). To find migrant worker clinics that may be looking for nurses, contact the OMH and ask for information about clinics in your region of interest (see “Resources”).
When asked what qualities a nurse needs to become involved in migrant worker health care, Siantz lists only three things: “Good communication skills, an understanding of the culture and a good heart.”
