The Take Pride Campaign: Introducing Our Winners!

In our winter 2012 issue, we called for submissions to our first ever Take Pride Campaign, an effort to recognize those places of employment that went above and beyond regarding encouraging diversity; recruiting and retaining minorities; and creating a cooperative, inclusive work environment. We were so pleased with the response! Nurses, and even teams of nurses, recommended their places of employment to acknowledge such efforts. And the funny thing is, there is no prize. Not for our nominees nor for our nominators. Furthermore, there is no real winner. The only reward, per se, is their inclusion here. Then again, perhaps the reward is inherent—we’re just bringing it to light. We’re so glad these nurses found such inclusive places to call “home” (during their shifts, at least!). We hope the facilities continue to lead by example, and we are proud to recognize them here.

Alacare Home Health and Hospice, Muscle Shoals, Alabama

Nominated by LaConda Davenport, R.N., B.S.N., M.S.N., M.H.A.

In the five and a half years LaConda Davenport has been with Alacare Home Health and Hospice, she has traveled and worked in several of the company’s 23 offices. As she’s moved within the company, she has “witnessed cultural diversity as a top priority,” she says. “Everyone, regardless of race, age, gender, or whatever makes us unique given equal footing to achieve equal status within the company.”

The company makes its position on diversity clear not just in writing (in its diversity statement), but through diversity training, targeted staff education, and recruitment efforts aimed at minorities. Moreover, the company requires its employees to “renew their commitment to diversity” each year, Davenport says. “Alacare fosters an environment of cultural awareness amongst its employees, and everyone has equal opportunity to strive and rise to the top.”

Davenport started as an RN and went on to earn two master’s degrees and eventually became a Hospice Clinical Manager. “I couldn’t have done this without the support of the company I work for,” she says. “Diversity means that I am afforded every opportunity to grow and mature in my profession within an environment that believes in me and wants to see me strive in a positive manner that is beneficial to me and my organization. Alacare has this attitude and that’s why I believe Alacare is diversified and inclusive—they stand not behind but beside their employees.”

Bayhealth Medical Center, Dover and Milford, Delaware

Nominated by Ludmila Santiago-Rotchford, M.S.N., R.N., P.C.C.N., A.C.N.S.-B.C.

Arriving in Dover, Delaware, back in 2000 felt like going back in time to Ludmila Santiago-Rotchford. “It seemed that most people I met had rarely ventured out of the First State and many people had been here for generations,” she says. “Who knew that this state . . . just a few hours away from metropolises of Philadelphia and New York City was where the infamous Mason Dixon line that separated the North from the South was found.”

Along with a colleague, Kimberly Holmes, M.S.N., R.N., P.C.C.N., A.C.N.S.-B.C., Santiago-Rotchford hoped to promote diversity in her health care system. A simple suggestion grew into the Bayhealth Diversity Committee, a multidisciplinary group that meets bimonthly. “For the past several years we have offered Scoop on Diversity sessions where staff can learn about topics of diversity while enjoying a sundae bar,” she says. “Our annual Diversity Cruise attracts many attendees where we employees display information and samplings of food representative of cultures from around the world.”

A busy committee, they disseminate a “tip sheet” each month called Insights on Diversity and recently partnered with Delaware State University for a Celebration of Culture event. Their website includes further resources regarding diversity, as well as a way for staff to leave feedback.

“Our dream has come to fruition in large part due to the support we have received from our committee members,” Santiago-Rotchford says, citing facilitator Marianne Foard, M.S., R.N., and Chief Nurse Executive Bonnie Perratto, M.S.N., R.N., M.B.A.,N.E.A.-B.C.,F.A.C.H.E., specifically.

Frontier Nursing University, Hyden, Kentucky Nominated by Nena Harris, Ph.D., F.N.P.-B.C., C.N.M.

Nena Harris started her journey at Frontier Nursing University

10 years ago as a student, one of three minority women in her orientation session. “The nature of our program, which is distance learning, creates challenges in that there are few face-to-face interactions,” she says. “As a student, I did not engage in attempting to understand the school’s commitment to diversity, but I also did not witness any active display of this commitment in a way that students could recognize.”

Then, when Harris became a Frontier faculty member six years ago, she was the only professor of color. “Since that time, several faculty of color have been hired,” she says. “Also, I have more face-to-face interactions with students on campus and the composition of those sessions has become more colorful over the years.” In that time, Harris says she’s seen the school “develop a passion for diversity.”

A school founded to address the health care needs of the underserved, FNU is well suited to train nurses to go into those communities that continue to be marginalized—often minority communities. “The administration and faculty realize that providing care to diverse populations requires educating nurse-midwives and nurse practitioners who are committed to returning to the diverse communities in which they live and have roots,” Harris says. To that end, the school is working to recruit more diverse students and faculty, in part through its recently launched, multifaceted PRIDE (Promoting Recruitment and Retention to Increase Diversity in Nurse-Midwifery and Nurse Practitioner Education) initiative.

“FNU is a leader because it demonstrates the importance of educating a diverse workforce to meet the health care needs of an increasingly diverse population,” Harris says. “I am very proud to be associated with this institution.”

Grady Health System, Atlanta, Georgia

Nominated by Dennis Flores, B.S.N., A.C.R.N., et al.*

“Inherent in Grady Health System’s tradition of care is over a century’s worth of diverse personnel who advocate for everyone and discriminate against no one,” says Dennis Flores. “As nurses in our white scrubs, we represent a kaleidoscope of ethnic and racial backgrounds that fulfill the promise of nursing in our everyday practice.”

Many of Grady Health System’s clients come from underserved communities, and Flores says they can relate quickly to their providers, as the staff mirrors the diverse population of the Metro Atlanta region. “Nurses and patients speak the common language of a shared history and world-view, one that translates to better patient care,” he says.

Flores commends a number of things illustrating the facility’s commitment to diversity, including minorities in various leadership positions, cooperative decision making at all levels, an endorsement from the Human Rights Campaign as a Leader in LGBT Healthcare Equality, and even a multicultural Nurses Week ad campaign. “Not only is [the ad] a tacit endorsement of the variety that makes up the staff, but it wisely capitalizes on our strength: Grady’s diversity,” he says.

“The culture here allows for us to thrive and newer staff members soon become acculturated to what fierce advocacy is all about,” Flores says. “We are blessed to be working here and we take exceptional pride in representing Grady Health System.”

Dennis Flores is joined by the following in nominating Grady Health System: Lillian Bryant, L.P.N.; Patrice Henry, L.P.N.; Luis Lopez, B.S.N., R.N.; Marie Lotin, R.N.; Andrea Mayo, R.N.; Njorge Ngaruiya, B.S.N., R.N.; Faith Works, R.N.

HCR Homecare, Rochester, New York

Nominated by Yvette Conyers, M.S.N., R.N., C.T.N.-B.

“Since I first walked through the doors of HCR Homecare, almost five years ago, I felt the culture of inclusion and diversity,” Yvette Conyers says. By meeting the need for more nurses, particularly Spanish-speaking nurses, to serve the many Hispanic patients in the area, the institution has demonstrated an ongoing commitment to diversity.

“The mission and vision of HCR Homecare supports diversity and values its employees considerably,” Conyers says. “The name HCR rings loud in a small community where everyone talks, and comments are always positive.” She cites the facility’s research into the needs of Hispanic patients, such as 2008’s Exito, which tackled reducing health care disparities through improved access and culturally competent care. HCR Homecare has also extended its efforts to improving care for African American, Russian/Ukranian, and various refugee populations. They do so, in part, through partnerships with many local agencies, such as the Rochester Housing Authority.

“Training in cultural competence, specifically transcultural care, has been implemented and is constantly being upgraded to provide better patient care and decrease hospitalizations rates, creating trustful relationships and addressing the overall disparities our nation faces,” Conyers says. Certified nurses lead training sessions and help ensure continued efforts to improve cultural competence. “The constant changes and increased number of minorities both on a national and local level support the need to have an agency that is caring, diverse, and is inclusive of the clients they serve,” Conyers says. “I take pride in my organization!”

Seton Healthcare Family, Austin, Texas

Nominated by Cindy Ford, R.N., B.S.N.

Cindy Ford can name a litany of programs that make Seton Healthcare Family an admirable force in the promotion of diversity. And with 35 years of service to the organization, she would know. “During three decades, I have witnessed Seton lead medical, nursing, and technology advancements; become nationally respected for evidence-based practices; and progress as a leader in diversity.”

The faith-based collection of facilities includes 11 hospitals and 80 other various offices, and Ford says Seton is committed to “improving the diversity and inclusion of staff…by reflecting the communities we serve.”

That started with Seton’s Diversity Leadership Initiative, which “identified the challenges in reflecting the demographic makeup of the community,” Ford says. From those efforts came the hospital system’s Office of Diversity and Inclusion, established in 2006 to meet the needs of the growing populations of African Americans, Latinos, and Asian Americans in Texas. “Programs were developed to meet leadership initiatives,” she says, including diversity/cultural competence workshops, awareness events and cultural celebrations, an interpreter program, and a recruitment team committed to diverse hiring. Seton has also adopted Cincinnati Children’s Hospital’s Project SEARCH, a hiring initiative aimed at young people with developmental disabilities.

University of Wisconsin Hospital and Clinics, Madison, Wisconsin

Nominated by Tracey L. Abitz, M.S., R.N., C.T.N.-B.

From Tracey Abitz’s description of the University of Wisconsin health care employee benefits and resources, it seems like a great place to work, regardless of whether you’re a minority or not! But those employee benefits and resources also reveal a determination to recruit and retain minorities, as well as provide culturally congruent care for diverse patients.

“There is a commitment to diversity and cultural competence to community groups and partners by reaching out to the community with the assistance of the director of community partnerships,” Abitz says. For example, the University of Wisconsin system offers a wide array of language and interpretation services, including those for the deaf or hard of hearing, as well as 32 languages through face-to-face interpreters and over 250 by phone.

Abitz describes the hospital system’s many employee resources, from child and elder care to tuition reimbursement, and the facility has also partnered with a credit union to offer free tax services to employees in a lower income bracket. “There is ongoing review of recruitment and retention data of minority groups with increased efforts to try to diversify the recruitment pool for positions at the hospital, especially leadership positions,” she says.

The nursing staff in particular has served as advocates of diversity, including their use of the Purnell Model for Cultural Competence to assess patients and family needs, Abitz says. The nurses even designed an internal diversity website with resources for clinicians.

“A new interdisciplinary resource group led by nursing has been designed to have a group of champions interested in learning more about culture and diversity with the goal of raising awareness and knowledge, allowing them to be a resource to their colleagues,” Abitz says. “There is continual reflection and commitment to always strive for improvement.”

A Military Victory

There are many memories from my military career that will last a lifetime, such as scrubbing a toilet (or head, as it’s referred to in the Navy) with a toothbrush, and standing at attention for countless hours in the rain. I will carry some of those memories to my deathbed.

But believe it or not, those subservient and meaningless tasks have paved my way to success–both as a nurse and on a more personal level. I would never have known what it is to be a leader if I had not experienced the role of being a follower. The military philosophy is that these types of tasks help recruits build character and develop a disciplined life. In actuality, my superiors were instilling in me the values of pride in one’s work, respect for authority and time management.

Of course, it would be easier to perform a task with the proper tools, such as cleaning toilets with a toilet brush. However, completing the job as ordered, under less than optimal conditions, instills humility as well as a greater appreciation for cleanliness. It is also far better to learn how to follow orders on the floor of a barracks toilet than when soldiers’ lives are at stake.

I have been very fortunate to have had great role models and mentors in the military. I became who I am today–a proud Hispanic American nurse patriot and leader–because of the time, energy and devotion that these people have invested in me. With their help, I was able to break free from the social and economic stereotypes of my Hispanic ethnicity and achieve my dreams of success.
One of my most life-changing experiences with mentorship in the military occurred during my first duty station as an enlisted Navy seaman at Camp Smith, Hawaii, where I served from 1975 to 1979. My first supervisor in the Navy recommended that I go to college. He also offered me the opportunity to explore the field of health care by learning about the Camp Smith clinic.

I followed through with both suggestions. I learned about sick call, pharmacy, lab and supply, and on my off-duty days, I attended Leeward Community College. Little did this mentor know that he would be the first person to start opening doors of opportunity for a young Hispanic woman from an impoverished background–doors that would lead to a 27-year career in the health care profession.

Much later, when my career as a young lieutenant was starting to take off, I was asked to report to the chief nurse’s office. This encounter, too, helped shape my life as a future leader. He told me that as an officer, people would have to respect the bars on my shoulders, but respect as a person was something I would have to earn. Another valuable lesson he taught me was that any respect I hoped to receive would be the result of my respecting those under my guidance and command.

One of the most significant awards I have received during my military career was a Meritorious Service Award for my role in an Army Reserve active duty training mission called “Golden Medic 2001.” I am especially proud of this award because I was nominated not by my superior officers but by a junior officer serving under me, Amanda Parham-Roshell, 1LT, AN. I had personally trained and mentored this young lieutenant, just as others had once done for me.

In nominating me for the award, she wrote: “LTC Hazlett went above and beyond the call of duty because she single-handedly taught each junior officer the ins and outs of operating a field hospital. Without her knowledge, experience and great leadership skills, our mission would have failed. Because our mission was a success, LTC Hazlett earned respect from all those under her command.”
In other words, the chief nurse had been absolutely right. A good leader will value every opportunity to influence a young person to aspire to greater heights. As a leader, one of the most important parts of my mission is to develop our future leaders.

Poverty and Pride

Today I am a wife, mother, nurse, PhD candidate and a lieutenant colonel in the United States Army Reserves. But if it hadn’t been for the military, I would have proceeded down quite a different road. I have come a long way from my roots in South Texas.

I grew up without knowing my parents. My brother and I were reared by our maternal grandparents after our mother’s death when I was three years old. My father killed her in a jealous rage and was imprisoned. My grandparents were illiterate and not fluent in the English language, but my grandfather gave us loving care. Our household was run on pride, responsibility and the love of a man who accepted a parenting role at the time when most men his age were poised to live out the remainder of their days in leisure.

I became a teenage wife and mother in a small town where prejudice was quite active, and I lived literally on the wrong side of the tracks. It would have been easy for me to have become a statistic. The military provided the means for me to pursue an alternate path and take control of my life. Serving in the military has supplied me with the characteristics needed to succeed as a dependable worker and as a leader. I have had to work very hard, but the result is a life founded on loyalty, duty, respect, service, honor, integrity and personal courage.

My military career started as a Navy seaman recruit in 1975. I transferred to the Army in 1983 after completing a BSN degree from the University of Texas at Austin. I received my master’s in nursing from Texas Woman’s University in 1988 and I’m currently working on my doctorate. In addition, I have completed all the military schools in a career progression: Officer Basic School, Officer Advance School, Combined Arms and Services Staff School, and Command and General Staff College.

I have gained much from the educational benefits the military has to offer. By covering the cost of my tuition, the military has enabled me to continually advance my education in a way that would have been impossible on my own. Even now, after all my educational benefits have been exhausted, the state of Texas is paying for my doctoral studies under the Hazelwood Act, which was established to assist Texas veterans.

Today I am proud to say that I have been mobilized as an Army nurse for the second time in my career. In 1991 I answered Operation Desert Storm’s call, and I am now responding to our present situation in the Persian Gulf: Operation Enduring Freedom and Operation Iraqi Freedom. I am stationed at a medical facility in Landstuhl, Germany. During the war in Iraq, we were the primary medical center for treating soldiers coming from the front lines. We were very busy. It has been a very different experience for me. These soldiers are outstanding, very dedicated to our country. They are real heroes!

Helping Those Who Come After

As a Hispanic, I want to be a leader and role model for the next generation of my people. I have read all the dreadful statistics about the problems affecting our Hispanic youth: teenage pregnancy, high rate of school dropouts, high unemployment, etc. Hispanic Magazine recently published a series of articles about our “crisis in education.”1 We desperately need to make strides with this generation. We must be active and diligent in voicing our concerns.

Hispanics are the most rapidly growing segment of the U.S. population. In my state of Texas, we are the largest minority ethnic group.2, 3 Unfortunately, we are also number one in health disparities. We have very high rates of illnesses such as diabetes and heart disease. We have pronounced problems with obesity, linked to our high consumption of dietary fat and fewer daily servings of fruits and vegetables.4, 5, 6 There has also been a rapid increase in the number of HIV infections.7 Our Hispanic families are more likely to live in poverty than the majority population.8, 9

As a Hispanic nurse, I’m an advocate for recruiting more Hispanic students into the profession. Spanish-speaking nurses can provide linguistically and culturally competent care and also serve as role models and mentors for our young people. However, I encourage Hispanic youth to seek success in other careers as well. I do think nursing is a great profession that enables you to really make a difference, but my focus is on promoting success.

While the military lifestyle is not for everyone, I am living proof that serving in the armed forces can help minority nurses open doors to education, career advancement and personal fulfillment that might otherwise have remained closed to them. My own success story could have easily gone in the other direction without the mentors and leadership opportunities afforded to me by the military. I could have contributed to the disparaging statistics that are being quoted about our Hispanic population. Consequently, I am a strong advocate for educating our people, because I know firsthand the difference it can make.


1.  Rodriguez Valladares, M. 2003. “From the Beginning. . .There Needs to Be Light!” Hispanic Magazine: 20-25.
2. U.S. Census Bureau. “Texas QuickFacts,”
3.  Scharrer, Gary. 2001. “Hispanics Account for 60% of State’s Growth.”  El Paso Times, electronic version.
4.  Elder, John, Woodruff, Susan I., Candelaria, J., Golbeck, A., Alvarez, J.L., Criqui, Michael H., Norquist, Craig D., Rupp, Joan W. 1998.  “Socioeconomic Indicators Related to Cardiovascular Disease Risk Factors in Hispanics.” American Journal of Health Behavior, May/June 1998, Vol. 22, No. 3, 172-185.
5.  Mays, Vickie M., Yancey, Antronette K., Cochran, Susan D., Weber, Mark, Fielding, Jonathan E. 2002. “Heterogeneity of Health Disparities Among African-American, Hispanic and Asian-American Women: Unrecognized Influences of Sexual Orientation.” American Journal of Public Health, April 2002, Vol. 92, No. 4, 632-639.
6.  Apodaca, J., Woodruff, Susan I., Candelaria, J., Elder, John, Zlot, Amy. 1997. “Hispanic Health Program Participant and Nonparticipant Characteristics.” American Journal of Health Behavior, Sept./Oct. 1997, Vol. 21, No. 21, 356-364.
7.  Greeley, Alexandra. 1995. “Concern About AIDS in Minority Communities.” FDA Consumer, Vol. 29, Nos. 10, 11.
8.  U.S. Census Bureau. “U.S. Hispanic Population: 2000,”
9.  U.S. Department of Health and Human Services.

Wounded by Words

Entering the patient’s room, I immediately took note of the look on the elderly woman’s face. There was no way I could look past her grimacing. As an African-American male nurse, I had seen this look before and knew it was in response to my gender, my race or both. Pulling away from the side of the bed where I was standing, she demanded: “Where are all the white people?”

Busy and rushed for time as most nurses are, I was not sure how to handle this situation and still get my medication pass done in a timely manner. I did not think therapeutic communication or touch would work in this particular case. She would not let me get that close to her, either physically or emotionally. Acting as if I could not comprehend her, I offered her the medications that were ordered. She looked at the medicine cup and abruptly said, “I’m not going to take that!” Now the dilemma had evolved into how to distribute medication to this patient.

Who knows what was going through this woman’s mind? Maybe she thought that my being alone with her in her room was a perfect opportunity for racial retaliation: Here was this black man who was finally going to pay her back for centuries of racial injustices. More than likely, she felt I was not intelligent enough to follow the physician’s orders and that the meds I was offering her were incorrect. At this point, it was all irrelevant. My intention was to help her, but in her mind I only represented someone from a race she considered inferior and had spent a lifetime hating.

This patient may not have known the date, or what the name of the health care facility was, or even her own name, but she could and did hold on to racial intolerance. Years of other life training may have abandoned her, but the training she had received about race remained intact. I saw in her face what could only be described as a mixture of hate, fear and anxiety. The year was 2004, but in my mind this incident transported me back to our nation’s past and gave me a taste of how ugly and complicated life must have been for past generations of black and white Americans.

Frustrated with my inability to administer medications to this patient, I exited her room and searched for the other nurse on duty. She was also African American, but I thought there was a chance she would fare better because she was female. This nurse was not new to the ward and she was not surprised by the patient’s reaction to me. When I asked her how I should handle this matter, she replied, “She won’t take medications from me either.”

Needless to say, this patient did not receive her medication that particular shift. I documented the incident and continued to care for the patients who would allow me to.

Unfortunately, it seems the only repercussions that resulted from this incident of racism were the painful feelings that have continued to stay with me. Nothing was ever addressed on any other level that I was made aware of. My employer’s apparent reluctance to acknowledge the problem disappointed me. It seems that even the most liberal and up-to-date facilities fall short when it comes to addressing this issue.


“Get Over It”

Another of my notable experiences involving racism in a patient care situation was an encounter I had with a veteran. This incident affected me deeply for two reasons. First, I am a veteran myself, having served eight years in the U.S. Air Force. Veterans usually feel a kinship toward other vets, regardless of their background, branch of service or duration of service. Secondly, I had taken care of this particular patient for some time and thought that our relationship had somehow transcended race. Until this incident occurred, our interactions had always been very cordial and respectful.

This was a patient who needed total care. He was paralyzed on his left side from a stroke and needed another’s help for even his most basic needs. The incident occurred on evening shift. Because of our limited staffing, once the total care patients were put to bed for the night it was our practice to leave them in the bed until morning. But on evenings when bingo was being played, I would help this patient get dressed again, put him in a wheelchair and push him to wherever the game was located.

He was prone to fits of yelling and anger, but in the past I had always been able to calm him down. Entering the room this particular night, I could tell that he was not in the best of moods, but I was not expecting the encounter that ensued. All of my attempts to calm him failed. In fact, they seemed to just heighten his anger. And at the apex of his anger, he yelled, “N- – – – -, get out of my room!”

Many emotions ran through me at that moment-certainly too many to count. What I did next escapes me. I assume I must have straightened his blankets and did what I thought would make him comfortable. I do know that I exited his room angry and told the charge nurse about the encounter.

The nurse in charge was totally sympathetic but at a total loss as to how she should handle the situation. I was sitting in the staff break room obviously angry and frustrated, with my arms crossed on top of my chest. She under- stood that she could not just let this incident go without some intervention on her part. Her decision was to call the house supervisor.

I had what I thought was a decent working relationship with the house supervisor, so I was not against discussing this incident with her. When the evening supervisor arrived on the ward, I was still in the break room fuming from the incident. She came in and asked me to explain what had happened; I gave her my interpretation of the incident. Her reply did nothing to soothe my anger. She basically said, “Get over it.”

She then began to relate some incidents of disrespect she had encountered in her own journey through nursing. Being called out of her name, having her level of intelligence questioned and being touched inappropriately were all situations she described. She seemed to indicate that this was part of our job and we had to take it.

I sat there listening, refusing to believe what I was hearing. I also refused to accept her personal doctrine that this type of treatment was “normal” and that nurses should accept it. I sat there respectfully, but her words did nothing to redeem my dignity or help repair my relationship with this patient.

The incident did send some minor ripples toward the higher-ups at the facility. They never spoke to me directly, but their messages found a way to me somehow. The messages consisted of blaming the occurrence on the patient’s condition, saying that stroke patients sometimes react that way. The patient’s medication was also increased, especially his psychiatric medications.


A Gesture of Healing

The one person who truly seemed to understand how much this incident had hurt me was the patient’s wife. His wife, who was a volunteer at the facility, was tireless in her efforts to continue caring for him and many other veterans. She seemed to be his exact opposite in terms of temperament. She volunteered mainly on the day shift, but our paths crossed as the day shift ended and the evening shift began. She too had always been very cordial and respectful to me. The day she confronted me about this incident was no different. I did not intentionally avoid her, but I was not looking forward to encountering her either.

Our discussion took place in the doorway of the patient dayroom. She had always been very direct and that part of her personality was very much in evidence now. She looked me straight in the eyes and said, “I heard about what happened between you and my husband, and I would like to apologize for the awful word he called you.”

I immediately dropped my head and was silent, not because I was ashamed but because I was so full of anger. She continued, “My husband was not a man who used that type of language when he younger, and we did not raise our children to use that type of language either.”

I was still silent, but now we were staring into each other’s eyes. We could both see how deeply this incident had touched me. “I have offered an apology and I can not force you to take it,” she said, “but I hope that you will and that you will continue to care for my husband in the same manner as you have always done.” That was her last statement to me as she gently patted my hand and walked away.

We did speak again after that, but the subject of what happened that day was never touched on. Our conversations were genuine and honest, but I believe we both felt that enough had been said on the subject. Even though I never said anything to her about the incident, she comprehended the depth of the damage her husband had caused by uttering that offensive word.


Emotional Scars

As much as I would like to say that my treatment of that patient did not change, the truth is that it did. I was still very professional and considerate to him. But all of the things one would describe as “extras” ceased. I never got him up for bingo again and my conversations with him held brevity in my tone.

Time passed and I was transferred to another unit at the facility. But I never forgot that patient or that painful incident. Any time I visited that unit to see past co-workers, I would always peek into his room just to see how he was managing.

I began to hear that his health was declining. By the time I had gathered enough courage to actually step into his room, he had deteriorated to the point where he was alert only to himself and being fed by a nasogastric feeding tube. I stood at his bedside and asked him how he was doing, but all he could do was gaze up at the ceiling and mumble incoherent words. He continued to steadily decline until a co-worker notified me of his death.

Later that week I read his obituary. I was surprised at the sterility of the announcement. There he was in an old picture from his military days, hat cocked to the side, smiling. The obituary mentioned a lifetime of loved ones and military service. It was brief and to the point. He existed, but now he was gone.

I was not sure of my feelings then and I am still not sure of them now. All I knew was that he was dead and our joint legacy of pain had died with him. But it still lives in me.

The point of this personal reminiscence is that we in the nursing profession must ask ourselves how to handle the issue of racism in the nursing workplace, and more specifically, how to handle racism when it is expressed by patients. I guess the first step is to admit that the problem exists. Even when they are in a hospital receiving care for the effects of diseases, aging or traumatic physical injuries, there will always be some individuals who will put their racial ideology above anything they are confronted with. That is their right.

But we professional caregivers of color also have the right and the obligation to stand against such behavior and demand to be treated with respect and dignity.

Teaching Neonatal Resuscitation in Afghanistan

What’s an African American neonatal intensive care nurse doing in the middle of Kandahar City, Afghanistan? Teaching neonatal resuscitation protocols (NRP), what else!

During my deployment to Afghanistan in 2005 in support of Operation Enduring Freedom VI, I had the opportunity to teach NRP to local nurse-midwives in Kandahar. I had been assigned to the 249th General Hospital Alpha Detachment as an adult intensive care nurse. After months of caring for a variety of sick patients, I jumped at the chance to teach a class. I was excited about getting the opportunity to meet Afghan nurses and learn about their practice.

I had been invited to teach the class by Dr. Holland, a pediatrician assigned to the 173rd Army Battalion out of Italy. He had taught a previous NRP course in Kandahar and felt that having a female nurse assist with the teaching would be beneficial to the students.

The class I taught was coordinated by a Canadian physician who worked with both the coalition forces and local nationals. The goal of the course was to familiarize Afghan nurses and doctors with basic NRP in an effort to address the high rate of infant mortality in the region. There was also hope that after Dr. Holland and I taught the course to local nurse-midwives and pediatricians, they in turn would be able to teach NRP basics in their hospital and at the local midwifery school.

Dr. Holland and I donned our protective military equipment and traveled about 30 minutes from our base in Kandahar Airfield to an enclosed Canadian military base in the heart of Kandahar City. The base was surrounded by an eight-foot-high concrete fence topped with threatening barbed wire. Soldiers with weapons guarded the gates and kept watch from towers high above the ground.

While we felt safe inside the base, our students did not. The class was some two hours late getting started because of an early morning suicide bombing in the city. Because of the nurses’ security concerns, we were forced to condense two days of eight-hour-long classes into two blocks of instruction two hours each in length.

The Afghan nurses were concerned about being seen working with coalition forces. They felt unsafe traveling to the Canadian facility because the route was dangerously laden with improvised explosive devices. Due to an increase in suicide bombings and Taliban activities around the country, many husbands had restricted the movement of their wives and children. The nurses’ frustrations were compounded by several other factors, such as the refusal of a local male pediatrician to attend the course. He had been scheduled to take the class but refused to attend because he did not want to be seen traveling with a group of women.

But in spite of their fears and concerns, the eight nurses and one female pediatrician were full of energy. They arrived huddled together dressed in sky blue burkas that concealed their faces and bodies. Once the women were inside the classroom, the burkas came off and the course began like any other NRP class. We used an interpreter to translate each slide and followed up the instruction with lots of hands-on practice. The students were excited and eager to learn. They were desperate to improve their clinical knowledge and skills.

Most Afghan midwives are trained by experienced nurses. They have very little classroom education. They also continue to do a fair number of deliveries in patients’ homes rather than in mater-nity wards. This is because their local hospitals lack many vital newborn supplies, such as bulb suctions and ambu bags. The typical Women and Pediatrics Ward has minimal oxygen and a small foot-pump suction machine. The local city hospital had two donated newborn warmers but they were kept in storage because no one knew how to use them and the hospital lacked the proper power supply.

Cultural Exchange

Teaching this class in a country where medical technology was primitive, women lacked freedom and potential danger was everywhere made me feel as though I was teaching NRP to black nurse-midwives in rural America at the turn of the 20th century. I found myself wondering about the lives and working conditions of these African American nurse-midwives from an earlier era. Like the Afghan nurses, did they worry about their safety as they traveled around the countryside? Did they cluck their tongues at the dangers of 14-year-old girls giving birth in dusty village houses? Did they shake their heads at doctors who refused to be seen in the company of a nurse-midwife?

Perhaps they too trained younger nurses in back kitchens with little equipment in the hope that some young woman wouldn’t have to travel miles on unsafe roads just to give birth. I also wondered if black midwives from the past century were as vocal as the Afghan nurses of today about the lack of basic prenatal care available to women.

The students in our NRP course were excited to have a female nurse teaching the class. They were fascinated by my skin color and hair texture. “Is she from Africa?” they whispered amongst each other.

They were shocked that I would leave my children at home in America in the care of my husband to go work in a foreign country—something that would be unthinkable in their culture. “Why would any mother do this?” they wondered. They were disappointed that I had traveled to their country without my husband or brother but they were pleased that I was a married woman, a nurse with children who was educated and able to earn her own money.

At the end of the course, each nurse-midwife was provided with a copy of the NRP book, in English. They hoped that perhaps a doctor or local interpreters would translate the important pages we earmarked for them. As the women donned their burkas, they voiced excitement at the thought of practicing and sharing their new clinical skills. (And yes, they now know that there are black female nurses in America!)

I learned a great deal about bravery from the Afghan nurses. Today, as I travel back and forth across the world to do my job, I am grateful that I don’t have to be overly concerned about my personal safety. Above all, I am gratified that the classes Dr. Holland and I taught added a small amount of useful knowledge to midwifery clinical practice in Kandahar, Afghanistan. I believe this knowledge will help make a difference in improving the lives of women and children in this war-torn city.

CAPT Colleen Reid, BSN, RN, is a military nurse who currently works at the Landstuhl Army Regional Medical Center in Germany.

Recommendations for Patients with Sickle Cell Disease

Nurses are the largest health care workforce in the United States, but in our patients’ eyes, we may not have much force at all. In 2010, the Institute of Medicine (IOM) published a report on the Future of Nursingand made recommendations that just as easily could have come from patients with sickle cell disease (SCD), had we listened.

During the 2011 faculty retreat at the University of Illinois at Chicago College of Nursing, we deliberated on the IOM recommendations. Recently, as I read anecdotes of patients with SCD from my research on perceived injustice—a context-bound unfairness of treatment that a person receives from important others, such as health care providers—I noticed striking similarities with the IOM recommendations.1,2

SCD is an inherited blood disorder affecting approximately 80,000–100,000 people in the United States, mostly of African descent; it’s among the most common fatal inherited diseases. Pain crisis, its hallmark and most disabling complication, is severe and recurrent. Patients with SCD often interact with nurses within the health care system asking for help to control their pain.

As I read the research anecdotes from patients with SCD about their interactions with nurses, the patients’ message was clear: nurses lack enough training about SCD to provide competent pain care. They echoed the IOM’s recommendations:

  • Implement nurse residency programs

Some nurses recognize inadequacies in their education but blame their incompetency in caring for patients with SCD on nursing education programs. One patient wrote about a nurses’ comment to her, “When you attend school to become an RN, the [nursing] school [doesn’t] go into a lot of details on SCD.” Nurse residency programs could provide nurses with opportunities for exposure to diverse patient populations and engender necessary confidence for clinical practice. One may contend that lack of funding is a barrier for residency programs to implement this education. But it is costlier to the U.S. health care system not to do so. In 2006 alone, the cost of acute health care visits for patients with SCD was $2.4 billion.3 If nurse residencies could help reduce the 33.4% and 22.4% of patients with SCD re-admitted within 30 days and 14 days, respectively, for pain crisis, there would be possible substantial cost savings.4

  • Ensure that nurses engage in lifelong learning

Patients with SCD say that nurses need lifelong learning to champion their care. One patient asserted that “there needs to be more training on [SCD] and more understanding of why it is necessary to treat [SCD] pain crisis with narcotics ASAP to help patients get control of the pain and move toward ending the painful crisis.” Another said most of her problems come “from ignorant nurses.” Lack of time could factor as a deterrent for continuous learning. But with advancement in technology and Internet access, nurses can search and learn about a disease in no time and with little cost.

  • Prepare and enable nurses to lead change to advance health

Patients with SCD, particularly those who are knowledgeable about their conditions, want a partnership with nurses for better control of their pain. Nurses are well positioned to be their champions, but need personal and professional growth. A patient with SCD applauded a nurse who embodied this recommendation when she wrote, “Few nurses took training from Dr. X, and my nurse came to me and said that she now understood more on our pain and that she [learned] a lot about SCD that she didn’t know.” This statement gives me hope for our profession. We need more efforts to sustain it and advance health for those with SCD.

It is in nurses’ best interests to engage in personal and professional development. The consequence of inaction could be detrimental. We may be the largest health care workforce, but without much force we lose patients’ trust in our competency, profession, and ability to ease their suffering. The IOM report is a “dawn of a new day” for nurses, and we are in an excellent position to advance health care. We should take advantage of its recommendations and this opportunity to improve the nursing profession so that all patients maintain the trust they have bestowed upon us.


The work cited in this publication was made possible by funding from the NIH Basic and Translational Research Program (1 U54 HL090513) and the Computerized PAINRelieveIt for Adult Sickle Cell Disease (R01 HL078536). The author thanks the patients with sickle cell disease for their study participation; the staff at the Comprehensive Sickle Cell Center for their support of the work; her colleagues (Diana Wilkie, Ph.D., R.N., F.A.A.N.; Robert Molokie, M.D.; and Crystal Patil, Ph.D.); and the other members of the research team for their assistance with study implementation (Marie Suarez, Ph.D.), data management (Young Ok Kim, Dr.P.H., R.N., C.H.E.), and data collection (Harriett Wittert, B.S.N.; Jesus Carrasco, B.A.; and Veronica Angulo, B.A.).


  1. J.A. Colquitt, “On the Dimensionality of Organizational Justice: A Construct Validation of a Measure,” Journal of Applied Psychology, 86 (2001), 386–400.
  2. M. Elovainio, J.E. Ferrie, D. Gimeno, R. De Vogli, M. Shipley, E.J. Brunner, and M. Kivimaki, “Organizational justice ans sleeping problems: The Whitehall II study,” Psychosomatic Medicine, 71 (2009), 334–340.
  3. S. Lanzkron, C.P. Carroll, and C. Haywood, Jr., “The burden of emergency departments use for sickle-cell disease: an analysis of the national emergency department sample database,” American Journal of Hematology, 85 (2010), 797–799.
  4. D.C. Brousseau, P.L. Owens, A.L. Mosso, J.A. Panepinto, and C.A. Steiner, “Acute care utilization and rehospitalizations for sickle cell disease,” Journal of American Medical Association, 303 (2010), 1288–1294.