If you’re a nurse who wants more “face time” with patients, then a career in dermatology nursing might be a good option for you.
Seriously, dermatology–the treatment of medical conditions affecting the skin, hair and nails–is a field poised for growth, especially for minority nurses. For one thing, nurses of color are greatly underrepresented in the specialty (although actual statistics are hard to come by). Additionally, the United States is currently experiencing a shortage of dermatologists. As a result, doors of opportunity are opening for nurse practitioners in dermatology, who are considered licensed independent practitioners in many states.
But above all, the specialty needs more nurses who are attuned to the unique skin health needs of Americans of color. According to the American Academy of Dermatology, some skin diseases, such as melanoma, are harder to diagnose in people with dark skin. Other dermatological conditions occur more frequently in persons of color. Furthermore, skin of color is more sensitive than Caucasian skin and may not respond well to treatment methods commonly used with white patients.
Culture Is Skin Deep, Spring 2006
In addition, there has been a growing acceptance of cosmetic skin procedures among racial and ethnic minorities in recent years. In the year 2000, people of color accounted for 14% of all such procedures performed in the U.S., according to the American Society for Aesthetic Plastic Surgery. By 2005, the percentage had soared to 20% and is expected to rise even more in the coming years.
Many of the minority dermatology nurses interviewed for this article entered the field because the opportunity presented itself, rather than as a pre-planned choice. But now that they’re there, they say they can’t imagine working in any other specialty. One of the biggest draws is the opportunity to develop relationships with patients, many of whom have weekly visits to treat their chronic skin conditions. “You really get to know the patients,” says Lisa Wesley, LPN, who works in the general dermatology clinic at the Kirklin Clinic, part of the University of Alabama at Birmingham (UAB) Health System. “You get to monitor their care and see their improvement.”
Patient education is a big part of the job. In fact, most dermatology nurses spend nearly half their time with patients educating them about caring for their skin after treatment, whether it’s removal of a mole or a chemical peel. “For every patient I treat, there is time set aside for education, depending on how often they come in,” says Jacqueline Collins, BSN, RN, a laser surgery nurse at Washington, D.C.-based Cultura Cosmetic Medical Spa. “All patients ask some questions.” A typical day for Collins, who has been trained to work with 22 different kinds of lasers, includes performing skin rejuvenation procedures, such as complexion blending to treat post-acne scarring and hyperpigmentation, and using intense pulsed light to treat melasma, rosacea, freckles and age spots, not to mention laser hair removal.
Yolanda Ephriam Patton, LPN, who works in Kirklin’s dermatologic surgery clinic, spends between two and four hours with each patient who undergoes Mohs micrographic surgery for the excision of skin cancer. Approximately half of that time she spends explaining what the patient can expect and will need to do after discharge.
Special Skin, Special Needs
The spa at which Collins works was co-founded by African American dermatologist Eliot F. Battle, MD, who specializes in treating patients of color. Although most skin diseases occur in all types of people regardless of their skin color, racial and ethnic minorities are more prone to certain skin problems.
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The biggest one is post-inflammatory hyperpigmentation, which is darkening of the skin caused by a disorder such as eczema or an injury such as a cut or burn. Others are keloids that form when a scar spreads beyond the size of the original wound; melasma, which is characterized by brown spots or patches on the face; vitiligo, a condition that results in irregular white patches; and flesh moles, usually on the cheeks. The most common hair problems affecting people of color include pseudofolliculitis barbae (caused by curved hairs growing back into the skin causing itchy, painful bumps) and alopecia or hair loss due to straightening or braiding.
The increased risk and incidence of scarring and keloid formation in people with dark skin impacts what treatments are used and how they are performed, says Battle, an assistant clinical professor of dermatology at Howard University in Washington. For example, because people of color can get dark spots from an injection and they have a different muscular structure than Caucasians in some areas of the face, there are differences in how and where they should be injected with Botox® or Restylane®.
These unique problems, plus the fact that minorities with skin conditions like psoriasis and eczema can often be misdiagnosed by doctors who may not be familiar with darker skin, underscore the need for more dermatology nurses with first-hand knowledge of what it’s like to have non-Caucasian skin and hair.
“[Minority] patients relate better when a person of color is involved in their skin care,” says Battle, who was involved in developing lasers that are safe and effective for the treatment of ethnic skin types. Many nurses of color have the same skin problems that their minority patients do, he adds, so they understand the issues at a deeper level than nurses who have never experienced them. “They also have a higher level of appreciation of the differences and nuances of lighter and darker skin types in people of color. Their knowledge extends beyond what they’ve learned in school by observing their own family members.”
Collins, who is African American, concurs. “I identify with so many of the patients’ problems because I had them,” she says. “When they look at me and say my skin looks great, I tell them that 18 months ago I was where they are. That gives them hope and makes them so much more relaxed. Their embarrassment and shyness melts away.”
Patients of color are grateful that someone understands their skin and is not turned off by hyperpigmentation, notes Mary Agnes Simmons, BSN, RN, an African American laser surgery nurse at Cultura. The patients, who often wear make-up to cover their dark spots, have to wash their face before any kind of treatment. “It’s very difficult for an ethnic-skinned woman to let us see her without any make-up,” says Simmons, “but they’re more willing to do that with a minority nurse because our skin tones and coloring are the same.”
Patton, who is also African American, says that many minority patients ask her about how she takes care of her skin and hair. “I’ve had a lot of laser procedures myself, so I can tell them what works and what doesn’t, what will hyperpigment their skin and what won’t,” she explains.
Culturally Competent Dermatology Nursing
Nurses of color also have knowledge of cultural considerations that can enhance the dermatology care of their minority patients, says Marrise M. Phillips, BSN, RN, CCRC, DNC, director of clinical trials at Mid-Charlotte Dermatology and Research in North Carolina.
“You cannot effectively treat a person you do not understand,” argues Phillips, who was the first African American president of the Dermatology Nurses’ Association (DNA). “It is extremely difficult to educate patients if you have no understanding of them as a total being, and this must include what is ‘natural’ to them.”
Understanding that some steps necessary for a successful treatment may not be acceptable to people from certain cultures enables a dermatology nurse to work around these barriers without offending the patient. Additionally, forming a trusting bond can be difficult if the patient knows the nurse doesn’t really understand her or him.
Culture Is Skin Deep, Spring 2006
This scenario plays out daily in dermatology offices across the country. Wesley, who works with Caucasian dermatologists, has found that African American patients tend to ask her questions they won’t ask the doctor.
“The number one cause of hair loss in the African American population is the use of chemicals to straighten the hair,” she says. “The first response from the doctor is: ‘Stop relaxing the hair, cut it off and start over.’” When a patient tells Wesley that this is not an option, she can suggest other choices such as wearing a natural style, braids or wigs. “They’ll take the information easier from me than from a Caucasian nurse,” she adds. Wesley can also recommend hair care products to use and those to avoid.
On Fridays–her busiest day–she works in Kirklin’s new ethnic skin clinic, which was established by a dermatology resident approximately a year ago. Patients give the clinic rave reviews and seem happy that someone has finally addressed their skin care needs, Wesley reports.
Language barriers are another cultural gap that can be bridged by minority dermatology nurses, especially those who are bilingual, says Cathleen Boeck, RN, CCRC, DNC, the current DNA president. “Inherently, minority nurses are going to be more accepted by patients who have skin of color. There’s a trust level that is more easily [achieved] with someone who looks like they do and can speak their language.”
Cecilia E. Ardila, BS, LVN, who is bilingual and able to communicate with patients who come from Central and South America, knows that to be true. “They’ll stumble through the English language,” says Ardila, who works at Dermatology Surgery Associates in Houston. “But once they know I speak Spanish, they’re so much more comfortable.”
She also shares her family history of skin cancer, a disease that many people of color mistakenly believe they are not at risk of developing because of their higher concentration of melanin. Minority dermatology nurses can play an important role in helping to dispel this myth and educating patients of color about skin cancer prevention.
Nurses Wanted. Will Train.
How can minority nurses interested in dermatology get started in the field? Although most nursing programs don’t give students much exposure to this specialty, dermatology nurses do require special training. Fortunately, most dermatologists are very willing teachers.
“The fact that the doctor was willing to train me in dermatology really inspired me to move in that direction,” says Ardila, who accepted a job offer at Dermatology Surgery Associates after 14 years in obstetrics. Today she works with general dermatology patients, assists with surgeries and performs some cosmetic procedures. She also attends, on average, one health fair a month where she educates the public about general skin care and skin cancer prevention.
Dermatology nurses can obtain specialty education through the Dermatology Nurses’ Association, which also offers certification and continuing education programs. Additionally, some American Academy of Dermatology programs are open to dermatology nurses.
As for job opportunities, the specialty offers a wide variety of practice settings. For example, dermatology nurses can works in physician’s offices, outpatient clinics, community health centers, VA hospitals and private practices that include dermatology. Nurses working in a general dermatology clinic might find themselves examining skin biopsies for melanoma, following up with patients undergoing treatment for contact dermatitis or performing phototherapy for the treatment of vitiligo. In a dermatologic surgeon’s office, nurses may perform dermabrasion to remove acne scars, inject soft tissue fillers to “plump up” and minimize wrinkles or assist during cryosurgery to remove skin growths.
Regardless of how they enter the field or where they choose to practice, minority nurses who make a career move to dermatology are likely to find it a uniquely rewarding experience. Simmons, for instance, feels that she is helping the African American community by offering cosmetic treatments, such as lasers and peels, which previously were available only to white patients.
“Some people see [cosmetic procedures] as a vanity thing, but I don’t,” she says. “These treatments help improve how you feel about yourself. And if you feel good about yourself, you can project a positive image to others.”
Calling All Nurse Practitioners
In 2005, the Dermatology Nurses’ Association (DNA) established a Nurse Practitioner Society within the association to meet the unique educational, networking and career advancement needs of nurse practitioners (NPs) in dermatology.
“We started the Society because there’s an ever-growing number of nurse practitioners in the DNA who have special needs for education,” says Barbara McKeehen, MSN, ARNP, a director of the DNA. The Society plans to develop a core body of knowledge and provide continuing education activities to maximize the competency of NPs who care for dermatologic patients. It has already developed the standards and scope of practice.
Promoting recognition of NPs as mid-level providers with an expertise in dermatology is another of the Society’s goals. “Ten years ago, most dermatologists didn’t know what NPs were,” notes McKeehen. Today that situation has changed, thanks in part to the current shortage of dermatologists, which the American Academy of Dermatology expects to worsen over the next few years.
McKeehen expects the demand for NPs practicing dermatology to grow tremendously, especially in the southern states where the shortage of dermatology MDs is more acute. “If a dermatologist goes into practice and wants to hire someone to see patients with him or her, that person can be a nurse practitioner,” she says. “And if the dermatologist has an ethnic patient population, certainly a [minority] nurse practitioner would be beneficial.”
A dermatology NP can conduct examinations, make diagnoses, order laboratory tests, perform biopsies and recommend treatments, including excision of skin cancers and prescribing of medications, if he or she has privileges to do so. Some NPs can perform cosmetic procedures such as chemical peels and microdermabrasion, as well as injecting Botox and fillers. In fact, in some states, NPs are licensed independent practitioners who can set up their own practice.
For More Information
Dermatology Nurses’ Association www.dnanurse.org
American Academy of Dermatology www.aad.org
National Institute of Arthritis and Musculoskeletal and Skin Diseases www.niams.nih.gov
What do astronauts on the International Space Station have in common with Alaska Natives on Little Diomede Island, just 2.5 miles from Russia in the Bering Strait? Not much, other than they both receive health care services via telehealth technology (also known as telemedicine).
Just as it’s impractical to send doctors and nurses out into the solar system every time an astronaut is ailing, so is the idea of patients who live on this remote, isolated island traveling many miles by air, sea or snow to see health care providers for every earache or other medical complaint. But that’s what most Diomede villagers had to do in order to receive full-scope medical care before the advent of telehealth programs.
Telemedicine, according to the Telemedicine Research Center, is the transfer of electronic medical data from one location to another. Today, a growing number of nurses and nurse practitioners are tapping into developing technology–such as computer monitoring and satellite transmission–to provide long-distance nursing to medically underserved minority populations whose geographical isolation restricts their access to medical treatment and preventive care.
Telehealth got its start as a byproduct of the Space Age. The National Aeronautics and Space Administration (NASA) needed to monitor astronauts’ physical and physiological parameters during flight. It created sensors that sent data back to Earth through microwave signals. At flight headquarters, doctors were able to track the astronauts’ pulse rates, blood pressure and other critical indicators.
Eventually, NASA recognized the potential to apply this same approach to help residents of rural communities where health care access was extremely limited. Its first endeavor was the Space Technology Applied to Rural Papago Advanced Health Care project (STARPAHC), which focused on bringing medical care to the Papago Indian Reservation in Arizona. The project, which lasted from 1972 to 1975, revealed the huge promise of this nontraditional health services delivery system.
However, STARPAHC still relied on the expensive microwave technology, which made widespread application cost-prohibitive. For the next 20 years, proponents of telemedicine pushed to advance the technology into more practical and affordable solutions. Meanwhile, the computer and telecommunications industries were also undergoing significant advancements. These innovations helped refocus attention on the possibilities of telehealth, and by 1990 four programs were underway.
Technology Catches Up
Even though the technology had made great strides, telehealth programs in the 1990s were still bound by technical limitations. Often, patients’ cases were conducted through telephone conferences and choppy videoconferencing. For example, if nurses on cruise ships needed to confer with a specialist, they made ship-to-shore calls to get step-by-step consultations.
But today, in the 21st century, improved technology is finally allowing this revolutionary concept to catch up to its full potential. The Internet, DSL, broadband and satellite transmissions have elevated telehealth to a competitive level.
“Five years ago, nurses had to be in sync with [other health care providers] on the telephone. We didn’t have the computer technology that allowed telehealth to happen in a secured fashion,” says Debbie Carr, RN, a telehealth coordinator for the Alaska Federal Health Care Access Network (AFHCAN) in Anchorage.
“Huge technical advances are driving the growth of telehealth,” agrees Gerri Lamb, PhD, RN, FAAN, associate professor and associate dean of clinical and community services at the University of Arizona School of Nursing in Tucson, and associate director of nursing for the Arizona Telemedicine Program (ATP).
“We’re doing things now that weren’t possible five years ago. We can do so much more than we even imagined.”
Indeed, tiny cameras now allow nurses to take images of a patient’s eardrum and load them onto a server from which a physician hundreds or thousands of miles away pulls them up on a computer for evaluation and instructions. Other recent developments in telehealth services include computer monitoring of blood pressures, pulses, blood sugar levels, and even long-distance wound care. The field is constantly being redefined as the equipment’s capabilities evolve.
“There are forms with pop-up templates that cue nurses for information they need to provide for an assessment,” says Penny Vasileff, RN, another telehealth coordinator for AFHCAN. “It’s new technology, but nurses already do a lot with technology.”
Reaching Out
Although the technology is impressive, the biggest impact of telehealth is its ability to help reduce minority health disparities by increasing medically underserved populations’ access to health care services. According to the Telehealth Improvement Act of 2004, 36 million people in the United States lack direct access to physicians. Alaskan Native villages are excellent examples. These small communities can’t support a full-scale hospital on their own, so community health aides (CHAs) often provide the basic treatments. For more serious conditions, patients must travel to a larger facility, but 75% of Alaska Native communities aren’t connected to a hospital by roads.
“It’s expensive to come to Anchorage, particularly if you have to accompany children or elderly patients,” says Vasileff. “It can cost thousands of dollars just to come in for an earache. The alternative used to be no care. Telehealth makes it possible to get quality care to remote villages.”
AFHCAN, which is managed by the Alaska Native Tribal Health Consortium, has developed a statewide telehealth program–utilizing sophisticated hardware and software, 42 connected servers and a satellite-based IP network–to give CHAs and regional hospitals greater access to specialists. Since 1998, the program has been implemented in 248 sites throughout Alaska.
“There was such limited access before telehealth, with 12- to 15-month backlogs to see doctors in Anchorage,” explains Stewart Ferguson, PhD, director of AFHCAN. “Now, patients stay in their villages but can be seen by specialists. There’s been a 10 to 12 percent increase in patient volume because of telehealth. Doctors have reduced backlogs so much that there are now open spots at specialty clinics.”
Such successes are not restricted to Alaska. Similar programs are popping up around the country. In underserved communities ranging from Indian reservations and inner-city neighborhoods to rural prisons, telehealth enables nurses to extend their practice and eliminate barriers that have traditionally limited these vulnerable populations’ access to quality health care services.
“A characteristic of a lot of minority communities is that the patient population is low-income, which can prohibit access,” says Carr. “In urban areas, patients may have trouble getting to providers–maybe they have to take a bus and travel a long time. But with telehealth, the case is created in the patients’ locations and then sent to remote providers, who issue orders to either stay home or come in for extended care.”
Another population benefiting from telehealth nursing is the incarcerated. Not all prisons are located near hospitals, nor do they have full medical staff. Through technology, prison nurses can treat patients more effectively without having to transport them outside the guarded walls. The Arizona Telemedicine Program estimates it has saved more than $1 million in transportation costs because more than 80% of specialty medical consultations are conducted by off-site specialists.
An Extra Set of Eyes
In most of these environments, nurses create telehealth cases by inputting patients’ vital signs and other assessment observations into the computer. Then an off-site physician or specialist obtains the data from a server for evaluation. But health care providers aren’t the only ones who are sitting down at computers to help bridge distance gaps. In some cases, patients themselves are actively involved in the telehealth process.
For more than a decade, home health care has experienced consistent growth as more people are discharged from inpatient care still requiring nursing attention. Initially, nurses were assigned a group of patients for whom they had to make routine home visits. Logistics placed limitations on how many of these patients they could see per day, as well as how much time they could devote to each patient. With telehealth technology, many of those limitations are erased.
Once patients are set up with the telehealth monitoring equipment in their homes, they input readings on a regular basis. The data are stored until nurses remotely pull up the information. Clinicians can see a more complete picture of patients’ vital signs for extended periods, enabling them to make better assessments and treatment decisions. Another benefit is that home health nurses can oversee more patients per day in addition to making traditional on-site visits.
Anecdotal research also suggests that telehealth helps increase patient compliance. The electronic charting is a visible demonstration of how treatment is progressing. “Telehealth has been tremendously useful for patient education,” notes Lamb.
Growing Pains
Even though health care providers and patients in many parts of the country are embracing telehealth, there are still a few obstacles preventing it from being fully put into practice on a national basis. A statement released by the Commerce Department in April reported that while approximately $380 million will be spent on telehealth this year, “that is a fraction of the estimated $80 billion that will be spent on all health care technology.” The report went on to quote Under Secretary of Commerce Phillip J. Bond as saying, “There is a lag in the application of [telehealth] technology in the real world.”
For More Information American Telemedicine Association
(includes a Telenursing Special Interest Group)
www.atmeda.org Telemedicine Research Center
http://telehealth.hrsa.gov Office for the Advancement of Telehealth
http://telehealth.hrsa.gov Association of Telehealth Service Providers
www.atsp.org Center for Telemedicine Law
Until recently, telehealth projects were beta-type programs usually tied to universities. When the grants ran out, the programs struggled to secure new funding. Many telehealth programs are just now trying to transition from research applications to full-scale businesses. “Telehealth is in its infancy in terms of market potential,” says AFHCAN’s Ferguson. “But there are private companies doing project development, so it’s definitely a growing industry.”
Telehealth proponents say the next step is getting insurers on board, including Medicare and Medicaid. Currently, reimbursement coverage for telehealth services is uneven. The 1997 Telemedicine Report to Congress notes that Arkansas, California, Georgia, Montana, New Mexico, North Dakota, South Dakota, Utah, Virginia and West Virginia reimburse some telemedicine services through Medicaid. According to The Washington Times,Louisiana and Texas recently passed laws prohibiting insurers from discriminating between traditional and telehealth services.
What’s preventing full-scale reimbursement is determining who should be covered. Telehealth has two distinct participants: The nurse on-site inputting patient information and the physician off-site assessing the information, making a diagnosis and creating a care plan the nurse or CHA will carry out. Insurers haven’t decided how to divvy up the reimbursement payments.
Congress got involved this year by introducing the Telehealth Improvement Act of 2004 (S. 2325) on April 21. This bill, proposed by Democratic Vice Presidential candidate Sen. John Edwards, defines the need for expanded telehealth provisions and calls for further coverage under Medicare, including reimbursement for services provided in skilled nursing and assisted-living facilities and in county or community health clinics. The legislation is currently in committee.
Supporters assert that telehealth programs will save costs in the long run by addressing medical conditions earlier, when they are more easily treatable. “I think acceptance [by insurers] and reimbursement will grow, but there needs to be research that demonstrates the cost savings,” suggests Lamb.
Initial research seems to support telehealth’s cost-effectiveness. When telemonitoring was used to track patients with chronic heart failure (CHF), researchers documented substantial savings. They estimated a potential $4.2 billion, or 52.5%, savings per year per CHF patient from reduced hospital stays and annual labor costs and benefits budgeted at two nurses per patient.
Licensure of telehealth nurses is another issue demanding attention, because there are questions as to what regulatory body retains disciplinary rights. In the acute care setting, nurses adhere to the parameters set forth by their state’s Nurse Practice Act, which is overseen by the state Board of Nursing. But in cyberspace, there aren’t distinctions noting where one state’s boundaries end and another’s begin.
According to the Center for Telemedicine Law, nearly half of the state medical boards in the U.S. currently permit out-of-state doctors to practice or consult via telemedicine technology in those states’ jurisdictions, as long as the physicians have a current license in their home state. A separate program allows RNs to earn licensing credentials to provide health care online in any of 17 states.
Some analysts recommend that states adopt a telehealth licensing system that would be similar to policies currently in place at the Department of Veterans Affairs and the Indian Health Service. These federal agencies allow RNs with a valid nursing license issued anywhere in the U.S. to come work in their facilities. For example, a licensed RN from Arizona who gets a job with a VA hospital in Maryland doesn’t need to apply for a Maryland license; his or her Arizona credential is sufficient. Proponents of this type of regulatory system say the streamlined approach would remove obstacles that are preventing the expansion of telehealth services.
Is Telenursing in Your Future?
Telehealth is an arena whose potential has yet to be fully explored, and that includes the contributions nurses can make to the field. “Involving nurses is one of the most powerful things telehealth is doing right now,” comments Ferguson. “You need to be able to communicate in order to spread health care to remote and underserved areas, and that’s where minority [telehealth] nurses would be important.”
The importance of culturally competent care is not downplayed in telehealth. In fact, some practitioners say it becomes even more critical. Some minority health consumers are distrustful of the majority health care system, so when technology and the digital divide are added into the picture, it can create even more barriers. Minority nurses can play a crucial role in explaining how telehealth technology works in culturally and linguistically appropriate terms.
What does it take to become a telehealth nurse? From the clinical point of view, telenursing utilizes the same skills and competencies as traditional bedside nursing. The biggest difference? More time on the computer. “Nurses still need strong assessment skills to evaluate clinical situations,” Lamb explains. “It’s just that technology adds another piece.”
“You have to have previous clinical experience,” adds Carr, “and it helps to have a background in computers, servers and routers. Liking technology and not being afraid of it is important.”
Telehealth nurses also have opportunities to move into administrative roles. For example, they can become telehealth coordinators, who oversee other practitioners, lead training sessions, maintain medical data and schedules, and keep communication flowing between remote sites and participating physicians. As telemedicine technology continues to evolve and become accepted as an important tool for leveling the health care playing field, “there are huge opportunities for nurses to get involved at all levels,” says Lamb.
Rosemarie Jeanpierre remembers the cruel comments as if she heard them yesterday. She was riding a crowded bus to work in Los Angeles when a perfect stranger got on and said, “move over, fatso,” as they all jostled for more standing room. Feeling ashamed, she wanted to get off the bus immediately, but kept riding, all the way to her job as a treatment nurse at Western Convalescent Hospital.
At the time, Jeanpierre weighed 220 pounds, and at 5’2″, she was considered obese. In 2003, her doctor told her she had pre-diabetes, a condition of elevated blood sugar and a harbinger for a diabetes diagnosis down the road. She had been overweight her whole life. As a girl in the Philippines, she learned the habit of overeating for emotional comfort. She had the classic symptoms: her blood sugar was “out of control,” yet she felt hungry all the time. She felt short of breath, propping up pillows at night to breathe while sleeping. And her co-workers told her she looked stressed.
“My doctor got upset with me,” Jeanpierre, L.V.N., recalls. “She said, ‘You’re only 39 and you’re a nurse!'” Being scolded by her physician was upsetting, but not nearly as traumatic as dealing with her father’s death of a massive heart attack a few years before. He had been a diabetic and suffered from high cholesterol and high blood pressure as well.,
“That gave me a big realization that I needed to do something about my health,” Jeanpierre says. “I said to myself, ‘I’m a nurse, and I want to set a good example for my patients.'”
In a dramatic reversal of fate, Jeanpierre lost half her body weight in 18 months through a disciplined regimen of exercise and dietary changes. She forced herself to reduce her daily caloric intake from 6,000 to 1,800. The trips to McDonald’s and a local bakery stopped. What began with 45-minute walks on the treadmill gradually morphed into an abiding passion for running. Jeanpierre ran her first marathon in 2005 at the urging of her nephew. Now, she routinely wins shorter distance races in her age division and plans to run the Nanny Goat 100-mile race this year.
Jeanpierre’s story is exceptional, yet could have turned out much differently if she hadn’t found the willpower to change her behavior. Diabetes, heart disease, and hypertension are chronic diseases and are among the leading causes of death in all populations, but more acutely strike minority groups: African Americans, Latinos, Native Americans, and certain Asian ethnicities. They also happen to be diseases where behavioral changes can reverse—or at least mitigate— their impact.
Nurses possess greater knowledge of these illnesses than the average person, but are no exception. In addition, researchers have recently discovered nurses may be particularly vulnerable to developing key risk factors.
Diabetes: bad for our blood vessels
If not properly managed, diabetes sets the stage for poor heart health. Grim statistics prove cardiovascular disease is the leading cause of death among people with diabetes. Two out of three people with diabetes die of heart disease or stroke; a middle-aged person with type 2 diabetes has as much of a chance of having a heart attack as someone without diabetes who has already had one heart attack, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
“Diabetes is a risk factor for cardiovascular disease, and any diabetes education program must include information about heart disease,” says Cristina Rabadán-Diehl, Ph.D., M.P.H., Deputy Director of the Office of Global Health at the National Heart, Lung, and Blood Institute.
In fact, researchers have come up with a special name for the cluster of traits that make a person prone to both diabetes and heart disease: metabolic syndrome, meaning he or she has three out of the following five conditions.
Excessive abdominal fat
High levels of triglycerides
Low amounts of HDL, or “good,” cholesterol
Hypertension
Fasting blood sugar level of 100 milligrams per deciliter
So how exactly does diabetes compromise cardiovascular health? By adding stress to our circulatory system, which carries blood and oxygen to vital organs and tissues.
In type 2 diabetes, cells become resistant to insulin, the hormone needed to extract sugar from the blood and metabolize it into energy. Having excess sugar, or glucose, in the blood contributes to the deterioration of blood vessels, but researchers have yet to pin down glucose’s specific role in this process.
“Glucose exacerbates the action of other risk factors, [and] the process of atherosclerosis gets accelerated,” says Rabadán-Diehl. Atherosclerosis is the process by which arteries become clogged and hardened by plaque, a waxy substance made of cholesterol, fat, calcium, and cellular waste, thereby narrowing the channel through which blood can flow.
According to Rabadán-Diehl, excess blood sugar could also “stimulate the production of fatty acids, and makes plaque a bit vulnerable.” By producing fatty acids, glucose potentially destabilizes pieces of plaque, moving them through our arteries to potentially form blood clots.
“Glucose likely contributes to the formation of plaque and might also contribute to the instability of plaque, causing particles to drift,” she says.
The narrowing and blockage of blood vessels is the root cause of all major cardiovascular problems, from stroke (caused by blockage of arteries leading to the brain) to coronary heart disease (blockage of arteries leading to the heart) to peripheral arterial disease (blockage of arteries leading to the legs). In addition, more pressure is felt by the arterial walls because of the constricted space through which blood can flow, giving rise to hypertension.
Why nurses are vulnerable
Nurses shoulder a unique burden among health care providers. Not only are they the primary caregivers and conveyers of health information to their patients, but they are often expected to be role models of healthy behaviors. Among nurses who care for diabetic or cardiac patients, the burden is greater since risks for both can be mitigated by behavioral changes like weight loss, dietary modifications, and exercise.
Key Statistics 18.8 million people have been diagnosed with diabetes.* A 2007–2009 survey showed among people 20 years or older, 7.1% of whites, 8.4% of Asian Americans, 11.8% of Hispanics/Latinos, and 12.6% of African Americans/blacks were diagnosed with diabetes. Compared to whites, the risk for a diabetes diagnosis was 18% higher for Asian Americans, 66% higher for Hispanics/Latinos, and 77% higher for African Americans/blacks. * Among Latinos, Mexican Americans and Puerto Ricans run the highest risk of developing diabetes. * 26.7% of African American women are overweight, and another 51% of African American women are obese; 64% of African American women are sedentary and get no leisure time for exercise. ** Latina women suffer from heart disease 10 years earlier than other ethnic groups. *** Sources * National Diabetes Fact Sheet 2011, published by the Centers for Disease Control and the U.S. Department of Health and Human Services ** The National Coalition for Women and Heart Disease *** Interview with Marleny Ramirez-Wood, communications manager, Go Red Por Tu Corazón, American Heart Association
Sally K. Miller, Ph.D., F.N.P.-B.C., and clinical professor of nursing at Drexel University, has studied obesity rates among nurses and their ability to provide weight management counseling to their patients. She links a nurse’s own health status to her credibility among those in her care: “‘Do as I say and not as I do’ is not very effective. People in general put more weight on advice from someone who is modeling that behavior and has been successful in that behavior.”
Yet how easy is it for nurses to maintain a healthy weight and avoid chronic metabolic disorders? Not terribly, according to two studies published last year.
At the University of Maryland School of Nursing, postdoctoral fellow Kihye Han, Ph.D., R.N., and professor Alison M. Trinkoff, Sc.D., M.P., B.S.N., R.N., F.A.A.N., found that nurses who worked long shifts were more likely to be obese than underweight or at a normal weight. Their results, published in the November 2011 issue of Journal of Nursing Administration, show that among the 2,103 female nurses surveyed, 55% were obese and reported less physical exertion and movement in their jobs.
“Long hours affect circadian rhythms,” Han and Trinkoff wrote in an e-mail interview. “Disrupted day/night cycles have detrimental effects on sleep quality and quantity, which are important independent risk factors for obesity, more important than even physical inactivity and high fat intake.”
Han and Trinkoff conclude that nurses who work long shifts might not have the time and energy to participate in regular exercise and that sleep deprivation also stimulates the appetite, forcing nurses to snack during shifts when healthy food choices might not be available.
Nutrition researcher An Pan, Ph.D., goes a step further by solidifying the connection between nurse’s shift work, obesity, and a dispensation towards type 2 diabetes in a study published in the December 2011 issue of PLoS (Public Library of Science) Medicine.
Pan and his colleagues at the Harvard School of Public Health analyzed responses from 177,184 nurses surveyed over a span of two decades. They discovered that a nurse’s risk of developing type 2 diabetes grew in direct proportion to the number of years she worked night shifts. A nurse working night shifts for three to nine years had a 20% chance of becoming diabetic, while that risk jumped to 58% if a nurse worked night shifts for over 20 years.
Weight gain became inevitable after years of working nights, says Pan in an interview: “Women who worked rotating night shifts gained more weight and were more likely to become obese during the follow-up.”
Nurses also say they have a tendency to turn a deaf ear to warnings about their own health, opting to take care of everyone else—patients, spouses, children—first. Eva Gómez, M.S.N., R.N., C.P.N., and a staff development specialist at Children’s Hospital in Boston, waited 13 years before following up on a diagnosis of a heart murmur she received in her 20s. In 2010, she found out she had a misshapen aortic valve, causing her aorta to bulge with backed-up blood. She scheduled valve replacement surgery for later that year and says if she had waited any longer, her aorta could have burst.
“At one point, I said, ‘That cannot be me; that’s something that happens to patients. I take care of people who have this,'” says Gómez, a national spokeswoman for the American Heart Association’s Go Red Por Tu Corazón campaign. “It never occurs to you that it could happen to me.”
Why certain races and ethnicities are at risk
Nurses face serious occupational challenges when it comes to managing their weight and stress level, and those who belong to certain racial and ethnic groups face even steeper barriers.
Latinos, African Americans, and Native Americans are at particular risk for becoming diabetic, while cardiovascular disease remains the #1 killer of all populations, despite race. While genes play a role that researchers are only beginning to understand, lifestyle, socioeconomic, and environmental factors have been the focus of most public health campaigns.
Relying on staples like rice, beans, and bread products and cooking techniques like deep frying, many Latin American cultures eat “diets that are richer in carbs and fats,” says Maria Koen, F.N.P., C.D.E., a bilingual nurse practitioner and diabetes educator at the Joslin Diabetes Latino Initiative in Boston. In addition, “they’re not necessarily having regular exercise as part of their lifestyle [or] making it a priority.”
Getting patients to eat more fruits and non-starchy vegetables remains a challenge, and fast food is perceived as a reward in certain communities. “Going to a fast food restaurant is considered to be aspirational; it’s a treat” among Latinos, says Marleny Ramirez-Wood, Communication Manager of the AHA’s Go Red Por Tu Corazón campaign. “We want to focus our message…in terms of cooking traditional meals, how they can make them healthier, [and] how they can incorporate physical activity into what they’re doing.”
For many ethnic groups, questions about access and affordability arise in conversations about eating healthier, since the corner markets in their neighborhoods may offer nothing more than liquor, cigarettes, and lottery tickets.
“Access to fresh fruits and vegetables is not available in certain communities we’re talking about,” says Lurelean B. Gaines, R.N., M.S.N., Chair of the Department of Nursing at East Los Angeles College and President-elect, Health Care & Education, of the American Diabetes Association. “If it’s not there and you don’t have the means, and with gas prices what they are, you’re not going to drive out of your community to get better food.”
A diabetes educator at the Mattapan Community Health clinic in Boston, Sharon Jackson counsels Haitian immigrants and African Americans from the neighborhood, many of whom work multiple jobs, have no time for exercise, and struggle to manage their disease.
“There isn’t a two-hour stretch where a person who is conscientious isn’t trying to take care of their diabetes,” says Jackson, M.S., R.D., C.D.E., a clinical research program manager at the Joslin Diabetes Center. “Taking care of diabetes is a full-time task…[it] becomes a luxury when you’re in a lower socioeconomic level.”
Managing the deadly three
A nurse’s hectic schedule is often beyond his or her control, especially early on in the career. Scarfing down meals on the go, never getting a decent night’s sleep, working crazy hours to make ends meet, and juggling the demands of work and family life is the norm for many.
These habits take their toll, yet are not simply a matter of individual nurses making bad choices. Institutions play their part in either discouraging or promoting a culture of health for nurses.
One hospital is taking an aggressive approach in helping nurses and other hospital staff get control over chronic diseases like diabetes, heart disease, and hypertension. For the past decade, the Cleveland Clinic has offered its staff disease management programs as part of its employee health plan. Employees are assigned case managers who help them set and reach specific goals related to their condition, says Patricia Zirm, B.S.N., R.N., M.P.H., Senior Director of Employee Health Plans at the clinic.
The clinic is known for its culture of wellness, with nine different fitness areas scattered among its 12 hospitals, reimbursement of gym memberships, a ban on regular soda in vending machines, and healthy food choices in its cafeterias.
Of more than 30,000 employees enrolled in the health plan, approximately 18,000 have one of the diagnoses for which the clinic has a disease management program, and roughly 8,000 are already enrolled in a disease management program.
In 2010, the clinic started to incentivize employee health through a program called Healthy Choice, which ties participation in one of six disease management programs to lower monthly premiums. The six programs are focused on diseases, including diabetes and hypertension, where behavioral changes in diet and exercise deliver a huge impact.
Healthy Choice is a three-tiered system of insurance premiums where the highest level of discount (gold) is awarded to employees who are complying with their disease management goals. In the case of a diabetic, one goal is to maintain a blood sugar level of less than 7%. The silver rate is for employees participating in disease management, but aren’t completely meeting their goals; the bronze rate is the standard rate, where an employee is insured but not enrolled in disease management.
Attaching health outcomes to an employee’s paycheck seems to be a smart strategy. Since 2010, Healthy Choice participation among the staff has tripled. Over the past year, 17% of clinic employees went from the standard rate to the gold rate, and employees are making fewer trips to the ER and are being admitted less frequently to inpatient care, says Zirm. These are all signs of progress, yet work remains to be done.
“Anybody who is doing shift work is more prone to stress, diabetes, and heart disease,” says Zirm. “The clinic tries to do a [favor] of addressing these issues related to shift work…we’re trying to remove barriers, but the fact remains, because of the nature of the job, we can’t fix it for everybody.”
“As nurses, we’re expected to provide quality health care to people from a variety of cultural and socioeconomic backgrounds. Without diversity among our ranks, it’s almost impossible to do that.”
That’s how May Wykle, RN, PhD, FAAN, explains her decision to make diversity the focus of her term as the 24th president of Sigma Theta Tau International (STTI), the Honor Society of Nursing.
The society, whose mission is to provide leadership and scholarship in nursing practice, education and research in order to enhance the health of all people and improve nursing care worldwide, has 120,000 active members in 90 countries. Yet, like the nursing profession itself, STTI remains predominately white and female. When Wykle, who is African American, began her two-year term as president in 2001, its membership was 96% female and 93% white.
“Since we are the international honor society of the profession, we should take the lead in defining diversity and making a commitment to achieving it,” asserts Wykle, a distinguished scholar, researcher and geriatric health specialist who is currently dean and Florence Cellar Professor of Nursing at Case Western Reserve University’s Frances Payne Bolton School of Nursing in Cleveland. “The diversity in nursing should mirror that of the general population. My definition of diversity is a broad one that includes cultural diversity, but also diversity of gender, backgrounds, resources and talents.”
To achieve these goals, the honor society has launched an ambitious initiative designed to increase and celebrate all forms of diversity within its membership ranks and in the nursing profession as a whole. The push began last year with the creation of a Diversity Task Force, whose responsibilities included drafting the organization’s official position statement on the subject, “Community Through Diversity: A Diversity Statement for Sigma Theta Tau International.”
In stating STTI’s overall motivation in pursuing diversity, the position paper notes that “diversity creates an opportunity to support a mosaic of cultural distinctiveness and nursing excellence through inclusivity, personal and professional development and the stimulation to think in different ways.”
Diversity at the Top
Sigma Theta Tau’s commitment to “the value and active engagement of diversity in achieving the society’s vision” encompasses 10 points, beginning with encouraging dialogue at the both the individual and chapter levels. The society’s more than 400 local chapters and their members are charged with finding ways to enhance diversity, such as developing educational programs that promote diversity, cultural competence and community building.
The initiative also stresses the importance of reflecting diversity in the society’s leadership by seeking officers and committee members from culturally diverse backgrounds. This “starting at the top” approach is vital to any organization’s efforts to build diversity, according to STTI Vice President Carol Picard, RN, PhD.
“You diversify an organization from the top to the bottom and horizontally,” explains Picard, associate director of the Graduate Program in Nursing at MGH Institute of Health Professions in Boston. “Having a diverse leadership makes a difference in [attracting more minority nurses and men] into the organization and in how we present Sigma Theta Tau to the world.”
This year, in addition to Wykle, the organization’s board of directors includes one other African-American woman and three men, including one European. And for the first time, the organization has elected a man, Daniel Pesut, RN, PhD, CS, FAAN, to the position of president-elect. Pesut has been involved in Sigma Theta Tau since his 1976 induction as a nursing student.
“For STTI, diversity is a means to building a community,” he says. “We want a diverse membership so that we can attract the best of the creative minds and backgrounds to build a stronger community within the organization.”
Pesut, who is professor and chair of the Department of Environments for Health at the Indiana University School of Nursing in Indianapolis, feels that attracting more minority and male nurses into the organization can best be accomplished on a one-on-one basis backed by national media coverage.
“We need more coverage of the different kinds of things that men are doing in nursing,” he adds. “The reason I am a nurse is that it gives me creativity and flexibility in career roles. You can be a consultant, you can practice, you can teach. You can do a variety of things with the same fundamental education.”
Going Local
While the honor society’s national leaders are spearheading the diversity initiative, much of the responsibility for actually changing the demographics of the organization will rest with its local chapters. At the chapter level, diversity doesn’t just mean attracting more male and minority members, but also providing education programs on cultural competence to help all local nurses better meet the needs of the diverse patient bases they serve.
Many STTI chapters have found success in attracting more nurses from underrepresented populations into their membership by jointly sponsoring educational and networking events with other local and regional nursing organizations.
“In Boston, our chapter has partnered with the New England Black Nurses Association to hold a luncheon with a guest speaker,” says Picard. “From those types of events, nurses learn about us and we can establish relationships with [minority] nurses who might be interested in joining Sigma Theta Tau. In turn, these new members take our message back to their nursing colleagues.
“I hope to see more such partnerships engaged in dialogues at the local level,” she adds. “That will give us the broadest impact across the world.”
The honor society will learn more about how well its chapters are implementing the diversity plan at the local level when chapter annual reports are submitted in July.
Encouraging Diversity Today–and Tomorrow
Attracting more men and nurses of color into its current membership is just one aspect of Sigma Theta Tau’s diversity goals. The honor society is also exploring ways to increase the racial, cultural and gender diversity of the nursing profession in the future. One local chapter, for example, is sponsoring a Girl Scout troop.
“We have to talk about the importance of nursing [careers] in the early grades,” Wykle explains. “Nursing has always been held in the highest esteem among racial and ethnic minority groups. We need to build on that.”
One barrier she hopes to challenge is the career advice many minority students interested in nursing careers receive from guidance counselors. “So many of them are counseled to go into two-year [nursing] programs,” she says. “These programs are fine, but students need to be encouraged to keep going and earn a higher degree.”
Wykle believes the low number of associate-degree and diploma students who choose to continue their nursing education at four-year universities can be blamed on the misconception that “a nurse is a nurse is a nurse.” Disproving that myth by demonstrating the career advantages a BSN degree brings would play a key role in drawing more minorities into nursing leadership roles, she adds.
“Once we have attracted a diverse group of students into nursing programs, we want to make sure they have access to faculty and practicing nurses who can provide mentorship and other types of support that help retain minority students,” the STTI president continues. “It’s one thing to bring in people [from diverse backgrounds], but we also have to ensure that they’ll stay in the profession.”
Still another key item on the Honor Society of Nursing’s diversity agenda is to address the disparities in health outcomes and quality of care between Caucasian populations and persons of color. As Wykle puts it, “We want it to be an even playing field.”
To meet this challenge, Sigma Theta Tau hopes to influence the nursing research community so that more members of underrepresented minority groups will be included in research studies.
“To change [health care] practice, you have to have the evidence,” Wykle points out. “Nursing needs research not only to discover improvements in patient care but also to contribute to the growth of the profession. STTI envisions research being conducted not just by nurse scientists with PhDs, but by nurses at all levels who value research and want to solve clinical problems. If nurses don’t do the research, who will?”
Diversity on a Global Scale
Because Sigma Theta Tau is an international society, efforts to promoting diversity within its membership must take a global approach. The organization has chapters in Canada, Brazil, The Netherlands, Hong Kong, Korea, Pakistan and several other countries. This can sometimes cause STTI’s leaders to reexamine membership policies that work well in North America but may not be effective in other parts of the world.
The society’s traditional chapter model is one such structure currently under examination. In the past, STTI chapters have always been affiliated with a university. Now, several nurses in Africa have expressed an interest in forming a Pan-Africa chapter. The nurses involved are national leaders in the profession and members of an association that meets regularly but is not affiliated with a university.
“They came forward to the eligibility committee and said, ‘this is how we connect [professionally] and we would like our association to be the way we bring Sigma Theta Tau to our nurses,’” Picard explains. “So we’re working with them to establish a new chapter model that will fit their needs.”
Being able to interact with international nurses from a diverse range of countries and cultures is a big draw for STTI members, according to Richard Smith, RN, MSN, who has held various local and national positions in Sigma Theta Tau and now serves on its national Public Relations Committee. “You have the opportunity to work very closely with people throughout the world who are working toward a common goal of promoting professional aspects of nursing, whether it’s research or another objective,” he says. “You benefit from gaining their [international] insights and perspectives.”
To Be Continued
Wykle knows that all of her goals won’t be accomplished before her term as president expires next spring. She’s hoping, however, that her two years at the helm have laid the foundation for Sigma Theta Tau International to not only increase its own racial, ethnic and gender diversity but also change the way nursing care is delivered to people of color.
“I think this initiative will eventually impact nursing significantly,” she explains. “Having an international honor organization step up and call for more diversity in nursing is going to improve the image of the profession. It’s going to attract a more diverse group of people into nursing and also attract more young people. We can’t do all of this in two years, but we can have people become more aware of the differences in care [available to white versus minority populations] and work toward a goal of erasing those disparities. We can help people understand that nursing is a wonderful, open profession.”
Becoming a Member
The opportunity to help increase the racial, cultural and gender diversity of one of nursing’s most respected professional organizations isn’t the only reason why nurses of color and male nurses should think about joining Sigma Theta Tau International. Membership in this prestigious international honor society, whose name is synonymous with excellence, leadership and scholarship in nursing, offers many benefits that can help advance your career and foster the achievement of your personal goals, whether your interest lies in clinical practice, education or research.
A 10-Point Plan for Diversity Sigma Theta Tau International’s “Community Through Diversity” initiative encompasses these 10 principles and practices, which the honor society is encouraging at both the chapter and individual member levels throughout the organization: 1. Encourage ongoing dialogue and learning in the area of the richness of diversity and its contributions to building community. 2. Develop and value the organization’s definition, policies and procedures related to diversity. 3. Support and encourage chapters to reflect the richness and diversity of their local and global communities. 4. Encourage chapters and members to find ways to enhance diversity and build community. 5. Stimulate dialogue to learn about cultural criteria for excellence, educational distinction, and ways and means to honor achievements in nursing practice, education, research and community leadership. 6. Respect the richness and diversity of traditions and heritage as the society creates and designs future plans and programs. 7. Seek diversity in nominations and appointments to committees, task forces and key policy and leadership positions. 8. Build a culturally diverse cadre of leaders, officers, board members and staff. 9. Create and use advisory groups to inform and advise the leaders of the organization regarding diversity as a means to create and support a global community of nurse leaders. 10. Develop and promote educational programs that inform and educate members on issues of diversity, cultural competence and community building.
Adding STTI membership to a resume or vita sets a nurse apart as someone who is interested in playing a leadership role in the profession, says Richard Smith, RN, MSN, who serves on the society’s national Public Relations Committee. “The organization stands behind research and supports evidence-based practices,” he explains. “STTI’s emphasis on scholarship and professionalism is its most outstanding feature.”
Smith, an assistant professor at the University of Arkansas for Medical Sciences College of Nursing in Little Rock, notes that his involvement with STTI has benefited him in every stage of his career: as a student, a clinical nurse and now as a faculty member.
“Sigma Theta Tau has opportunities for you no matter what your particular career focus is–whether you’re a clinician who works in a hospital or even a self-employed nurse entrepreneur,” he states. “There’s a heavy emphasis on research, which is necessary for good evidence-based practices. If you’re a faculty member, you want to prepare your students with the latest information for achieving better patient outcomes. Sigma Theta Tau is a good vehicle for that.”
Currently, more than 60% of the organization’s active members are clinicians, 23% are administrators or supervisors and 17% are educators or researchers. Sixty percent of STTI members hold advanced degrees.
How does the honor society recruit new members? Most of them are invited to join while still in nursing school. Undergraduate students must have completed at least half of the nursing curriculum, have a GPA of 3.0 on a 4.0 scale, rank in the upper 35 percentile of their class and meet the society’s expectation of academic integrity. Graduate students must have completed 25% of their curriculum and have a GPA of at least 3.5.
“Student members have access to the same benefits [of STTI membership] that are available to nurses who have been working in the field for many years,” says Smith. “Plus, students have the added advantage of being able to develop a mentor relationship with more experienced STTI members. For graduate students, it’s an opportunity to be involved with faculty as a peer member of the same organization, not just as a student.”
Membership in Sigma Theta Tau isn’t just open to students–practicing nurses are often invited to join as well. They must be RNs, be legally recognized to practice in their country, hold at least a baccalaureate degree in nursing and have demonstrated achievement in the profession.
For these nurses, there is less emphasis on the grade point average they may have earned years ago, emphasizes STTI Vice President Carol Picard, RN, PhD. “We’re looking for people who are community leaders. I can remember having someone come to me and say, ‘my GPA was only 2.9 but I’d like to join.’ This person happened to be running the HIV action committee for a large city,” Picard says, adding that the nurse’s professional accomplishments and contributions to health care outweighed her lack of a 3.0 average.
Even though membership in STTI is invitational, Daniel Pesut, RN, PhD, CS, FAAN, who next year will become the honor society’s first male president, encourages qualified nurses to be proactive about becoming involved in the organization, rather than waiting for an invitation to join. “Visit our Web site and find a chapter near you,” he recommends. “If someone is actively making a contribution to the nursing profession, he or she can certainly seek membership by getting connected with the local chapter.”
For more information, contact:
Sigma Theta Tau International
550 West North Street
Indianapolis, IN 46202
(888) 634-7575
Fax (317) 634-8188
www.nursingsociety.org
In our last column, “Informatics: New Opportunities in Nursing,” we discussed how the expanding role of computers and technology in our lives has pervaded health care settings, creating new opportunities for professionals interested in careers in nursing informatics.
With the approval of the HITECH Act in 2009 and funding toward adoption of electronic health records (EHR) technology, the Office of the National Coordinator of Health Information Technology anticipates that 50,000 new health information technology jobs will be created within the next five years.
There is ample job growth on the horizon. Below, you will find an exploration of the various educational and experiential pathways available to students and professionals looking to enter the dynamic field of nursing informatics.
What skills make an effective nurse informaticist?
Nurse informaticists should possess strong analytical and critical-thinking skills. Having additional education and experience with information systems and databases is also an important part of the occupation. Some prior knowledge of project management is also advantageous, as it is a similar discipline. Although all these skills can be developed during nursing school and in the field as a registered nurse, having a fundamental understanding in these areas can give you a leg up over the competition as you apply for nursing programs and open positions.
What education is required?
The most favored—and direct—route toward a career as a nurse informaticist is through higher education. Formal academic preparation in nursing informatics begins at the master’s degree level with a Master of Science in Nursing (M.S.N.). There are many graduate programs that offer specialty tracks in informatics, including on-campus, online, and hybrid programs. An informatics specialty track builds the foundational skills essential to nurse informaticists, training nurses to quickly adapt to new technology and advance patient care delivery systems.
Courses may include the practice of nursing informatics, management of data and information, health care information workflow, and project management. Students learn how to interpret, analyze, and use electronic health record technology, as well as ways to provide greater efficiency and effectiveness in health care practices.
In addition to this course work, most graduate programs require a practicum experience wherein students apply their course knowledge in a real-world setting. Upon graduation, the students are prepared in both the technological side and patient side of health care: they implement innovative EHR technology in ways that set the standards for effective patient care.
Do I need an advanced degree to become a nurse informaticist?
Not necessarily. However, it is imperative that you complete an approved Bachelor of Science in Nursing (B.S.N.) program and become a registered nurse. After completing a B.S.N. program, you must complete and pass the National Council Licensure Examination (NCLEX) in order to become registered to practice nursing in your chosen state. Upon graduation, you can find ways to become more integrated with the nursing informatics profession.
For example, try to develop experience in computerized documentation or some other technological health care focus. Nurses interested in informatics often start out as “superusers,” or unit-based support persons. They serve as managers for the main user account for their departments’ IT systems. After a certain amount of time spent with IT systems, some superusers are asked to become members of a nursing informatics team or department. However, since these nurses learn about informatics while on-the-job, not through academic training, it is advised that they read relevant texts and journals and enroll in continuing education courses to enhance their formal knowledge and skills in nursing informatics.
Do nurse informaticists need to be certified?
Whether you gained experience in informatics through formal academic training at the M.S.N. level or through on-the-job training after obtaining a B.S.N., it is advised that you become certified by a nurse credentialing organization such as the American Nurses Credentialing Center (ANCC). This distinction will make you more competitive in the job market. The minimum educational requirement to become certified is a B.S.N.; a diploma or associate degree in nursing will not serve as a sufficient academic qualification to become certified as a nurse informaticist.
Where do nurse informaticists work?
Nurse informaticists are becoming key personnel in every health care setting that employs nurses. They help IT professionals better understand the practice of nursing, just as nurses become more knowledgeable with new IT capabilities affecting their practice. Nurse informaticists can be found in hospitals, long-term care, home health care, schools of nursing, IT companies, health care consulting firms, and government organizations.
How do nurse informaticists stay involved in their industry?
There are several organizations relevant to informatics. Among the top three are the American Medical Informatics Association (AMIA), the Health Information and Management Systems Society (HIMSS), and ANIA-CARING (formerly known as the American Nursing Informatics Association and the Capital Area Roundtable on Informatics in Nursing), which provide education, networking, and information resources for professionals, strengthening the role that informatics plays in health care. Additionally, all three organizations hold annual conferences, and some even host regional events and frequent smaller meetings. At these educational events, nurses learn about new technological developments affecting the health care industry and have the opportunity to network with like-minded professionals from all over the country.
The free scholarly journal, Online Journal of Nursing Informatics (OJNI), is another great resource for nurse informaticists interested in staying informed on new technology, nursing trends, and research affecting their industry.
Is it a good time to become a nurse informaticist?
Expanding roles and technological advances in health care have increased the demand for nurses to be well versed in informatics. In fact, according to the HIMSS 2011 Nursing Informatics Workforce Survey, the number of nurses taking the nurse informaticist certification exam with the ANCC has more than doubled since 2005.
Our complex health care environment requires nurses to possess advanced knowledge and understanding of new technologies to better manage information and facilitate decision making. As a nurse informaticist, you will be trusted to adapt to new challenges and embrace the many opportunities found in the ever-evolving field of health care.
