In the growing sea of nursing specialties, critical care is actually one of the oldest. It was established in the 1950s and 1960s as the specialized care provided for the first intensive and cardiac care units. Seriously ill patients with complex health issues needed qualified nurses with unique skill sets. The same remains true today.
Critically ill patients who were once mostly cared for in ICUs can now be found throughout health care facilities, in emergency departments, post-anesthesia recovery units, interventional radiology, cardiac catheter labs, pediatric and neonatal intensive care units, burn units, progressive care units such as step-down and telemetry units, and even inpatient general care areas.
The needs of the patients and their families determine whether they require a critical care nurse. It’s not based on the name of the unit or its location,” says Reynaldo Rivera, D.N.P., R.N., C.C.R.N., N.E.A.-B.C., A.N.P. Among his responsibilities as Director of Nursing in Medicine Services at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York, Rivera works with recent nursing graduates as they transition into their first professional role. “People are admitted into the hospital with more serious conditions and complex co-morbidities than patients in the past. The role of the critical care nurse continues to adapt to meet the challenges of a changing health care system,” he says.
More than half a million acute and critical care nurses comprise this specialty, which continues to grow. These nurses also teach, research, manage departments, and lead in the quest to create a health care system that is driven by the needs of patients and families.
A career in critical care has taken Cuban-born and U.S.-educated Maria Shirey, Ph.D., M.B.A., R.N., N.E.A.-B.C., F.A.C.H.E., from an internship program for new nurses at the Baptist Hospital of Miami to educator, manager, and executive positions in Florida, Texas, Louisiana, and Indiana. She is now an associate professor in the Doctor of Nursing Practice program at the University of Southern Indiana‘s College of Nursing and Health Professions in Evansville. “I have been a nurse for 33 years, and the skills gained at the bedside have been useful at every stage of my career,” she says. “Critical care nurses must make quick decisions constantly, and those decisions need to be based on evidence and data. You have someone’s life in your hands, and that’s not a responsibility to be taken lightly.”
Nurses may enter critical care immediately after licensure, or they transition into the specialty after gaining experience in other areas. Patients depend on these highly knowledgeable and skilled nurses to make accurate assessments, prioritize needs, and recognize the difference between an exception and a problem.
Linda Martinez, M.S.N., R.N., A.C.N.S.-B.C.-C.M.C., says critical care nurses begin with the basics, but soon realize textbook cases exist only in the classroom. A critical care nurse for 31 years, she works as a clinical nurse specialist for Presbyterian Heart Group at Presbyterian Hospital in Albuquerque, New Mexico. “First you learn the basics. Then, you learn the exceptions. As nurses gain experience, they start to individualize normal by putting into context what’s going on with each patient,” she says. “Assessment skills have to be very sharp in critical care. You have to be able to quickly assess a patient’s situation in case there’s a life-threatening change. You put everything you’ve learned into context.”
Rivera serves as president of the Philippine Nurses Association of America, where he advocates for diversity in the workforce, ethical recruitment practices, and professional development and standards. “Nurses in high acuity and critical care must have the competencies and requisite skills to do the job with an underlying sense of compassion and sensitivity. It’s the combination of all these attributes that inspire patients and their families to trust us,” Rivera says. “We practice as whole persons, using our hearts, the mind, and the hands. It’s also the soul of who we are.”
Shirey and Martinez have also become national leaders in nursing and critical care. Martinez serves on the national board of the American Association of Critical-Care Nurses (AACN), the world’s largest specialty nursing organization, representing the interests of more than 500,000 nurses who care for acutely and critically ill patients. Shirey chairs the AACN Certification Corporation, the association’s credentialing arm that certifies bedside and advanced practice nurses in high acuity and critical care. It also certifies nurse managers in a joint program with the American Organization of Nurse Executives.
Desire to learn
Shirey cites complex patient conditions, the fast pace, and pressure-packed environment as reasons why critical care nurses must commit to continuing professional development. “Things happen so quickly that you don’t have time to always research before acting. I either need to know it or know where to turn for help,” she says.
Shirey says she first joined AACN because of her desire to take better care of patients and their families. “I started studying the AACN core curriculum to hone my skills. I then joined AACN so I could receive the journals and earn my CCRN certification. All so I could be the best nurse for my patients.”
Armenian-born Anna Dermenchyan, B.S.N., B.S., R.N., C.C.R.N., agrees. She’s a clinical nurse in the cardiothoracic ICU at the Ronald Reagan UCLA Medical Center and an adjunct instructor at Mount St. Mary’s College, both in Los Angeles. “If we’re not learning, we’re not moving forward. Outdated skills affect patient care, especially with new medications and technology, changing policies, and procedures,” she says. “We have to be the best for our patients. We learn the most from them. Each case presents lessons for the next case.”
Ryan Cavada, R.N., a staff nurse at the UCLA Medical Center Santa Monica campus, says nurses in critical care need strong critical-thinking skills, the ability to work under pressure in a fast-paced environment, and a continual desire to learn. “Critical care is at the forefront of evidence-based nursing practice where we apply new medical research, adapt ever-changing procedures, and use the latest technology. Our patients can’t afford care that doesn’t meet this benchmark standard,” he says.
Advocate for the patient
Patient advocacy is a vital responsibility of critical care nurses, as acutely and critically ill patients often can’t express how they feel or what they need. “As a nurse, I am the main representative for my patients and their families,” Dermenchyan says. “Many times, patients can’t communicate for themselves, describe symptoms, or tell me something is wrong. I need to be on the lookout on their behalf and communicate their needs to the ICU team.”
Martinez adds, “Critical care nurses must hone their communication skills, because a lack of understanding or miscommunication can have life or death implications.” She recalls the night she realized the importance of good communication. “I was speaking with the intern on call about a patient in pain and it hit me that I am the voice of this patient. My role as a patient advocate became crystal clear. If I couldn’t communicate what was needed, that patient would suffer through the night.”
Working as a team
Critical care nurses collaborate with other nurses and health professionals with a single focus on caring for the patient. Filipino-American nurse Cavada points to critical care’s unique intimacy. “We really get to know our patients,” he said. “Nurses are more than an active part of a team. We become the team’s hub. Doctors, nutritionists, respiratory therapists, everyone involved in a patient’s care come to us for the most current information.” He says competent critical care nurses are concerned about their own patients and stand ready to assist their colleagues. “Good teamwork allows more to be done for the patient in less time. In critical care, that can make a big difference; time is of the essence.”
“When we get patients who are extremely sick, we all have to work together. It’s our patient, not my patient. We all want good outcomes,” Dermenchyan says. “Collaboration is key, or patients suffer.” Critical care nursing demands a healthy work environment and true collaboration, in which each professional’s knowledge and abilities are respected.
Collaboration in critical care also goes beyond health care professionals. “Family members are an important element to caring for the patient,” Shirey says. “Critical care nurses learn to integrate them into the care, keep them informed, and we know how to be sensitive to changes in the patient’s condition that might cause turmoil in the family.”
The willingness to work collaboratively toward a common goal has benefits beyond the bedside.
Nurses learn early on how to work well in teams,” Martinez says. “And teams are vital to improving the system of health care, not just in the delivery of care.”
Rowena Elliott, Ph.D., R.N., C.N.N., B.C., C.N.E., is one of those people who make it all seem effortless. She balances teaching and mentoring with research projects and speaking engagements. She has a handful of degress and has held the title of “Director of Nursing” at least twice—it’s hard to keep track. She also has a collection of faculty, nurse, and student of the year awards from a number of organizations, and she was named a Gates Millennium Scholar in 2000. Add to that dozens of ancillary committees.
Yet, it’s her brand-new role as president of the American Nephrology Nurses Association that has people talking. In a time when there seem to be so few “firsts,” Elliott is the first African American to hold the position. And for anyone who believes educators are, or should be, community leaders, her life is a case study of both. “She has been so determined in her professional career and volunteer leadership roles, accomplishing so much,” says Loretta Jackson Brown, Ph.D.-C., R.N., C.N.N. Brown served on the ANNA Board of Directors with Elliott from 2008–2010, where they together made history as two minorities in leadership roles within the organization. Outside the ANNA, Brown is a clinician health communicator with McKing Consulting and the Centers for Disease Control and Prevention. “She is dedicated to improving the statue of others, to including her nursing students, nephrology nurses, nurses in Mississippi, where she is an active member and leader for Mississippi Nurses Association, and many others.
“Often times people think that a leader of her rank perhaps is unapproachable and not in touch with the real members,” Brown says. “Dr. Elliott can often be found mingling with the members. She is inconspicuous and doesn’t draw attention to the fact that she is the most powerful person in the room.”
A girl from Chicago
Elliott speaks excitedly, quickly, about her life and years leading up to being elected president of the ANNA.
Born and raised in Chicago, Elliott is the second of 10 children, an even split of boys and girls. “I grew up in a household where we didn’t have a lot,” she says. “We were poor.” Elliott says she is fortunate that all of her siblings are still alive, as well as her mother, though her father passed away over a decade ago.
Elliott’s parents, who both left high school before their senior year, instilled in their children a reverence for education. They knew it would lead to a better life and exponentially more opportunities. Through education, they could achieve anything. Elliott took their advice to heart, and now holds three degrees and has been teaching since 1998. Married with two children and two grandchildren of her own, Elliott says, “I try to instill the same thing in them.”
Elliott graduated from nursing school in 1982. She wanted to become a CRNA immediately, but marriage and children postponed her plans. “Life happens,” she says. Fifteen years later, she went back to school for her master’s degree.
“I’ve done a little bit of everything,” Elliott says. As clinical nurses often do in small hospitals, “We did it all.” Juggling the responsibilities taught her to think on her feet, to move quickly, and to not be afraid.
Eventually, Elliott moved into long-term care, but she says it wasn’t her niche. She was looking for new job opportunities when she saw the hemodialysis unit in her hospital needed a director. Elliott applied, even though she couldn’t remember much about dialysis from nursing school. “I probably wouldn’t even recognize a dialysis machine!” she says with a burst of girlish laughter.
To her surprise, Elliott got the job and had a great teacher to guide her through. She says she learned how to prioritize and do things right the first time. “No shortcuts,” she says, suddenly serious. Now she shares the same advice, plus 30 years of lived experience, with her students.
For three or four years, Elliott ran the dialysis unit, and throughout that time, she heard her colleagues say she should become a nurse educator. “I never really thought about being a teacher,” Elliott says. “But I thought, ‘I have the gift to do this.'”
In 1998, she started teaching at Alcorn State University School of Nursing in Natchez, Mississippi. She moved on to her alma mater, the University of Mississippi, in 2001. The entrepreneurial bug bit her in 2005, and Elliott started her own legal nurse consultant business, but the novelty of the business side of nursing eventually wore off. “I started missing my calling,” she says. She belonged in a classroom. So she took a position at the University of Southern Mississippi in 2008, where she teaches today. Elliott is passionate about guiding and being a role model to others, particularly minority nurses and nephrology nurses. She says it plainly: “I love my students.”
The ANNA
As medical director, Elliott required her staff nurses to join the American Nephrology Nurses Association (ANNA), starting a relationship with the organization that has seen her rise through the ranks, from state to regional to national officer and now president.
Elliott, bottom left, and her family in Chicago, circa 1968
At one point, Elliott ran for ANNA national secretary, but lost. She says the election taught her a lot, and when she came back stronger and more prepared, she won the position. Six years later, she was elected president, and on March 29, 2011, she was officially sworn in. “My brother actually calls me Dr. Ro-bama,” she says, again laughing through her words.
“Rowena is very energetic, outgoing, and stylish,” says Sharon Longton, R.N., B.S.N., C.N.N., C.C.T.C., a data manager and transplant coordinator at Harper University Hospital in Detroit. The two met when Elliott joined the ANNA’s Board of Directors as National Secretary. “She works tirelessly to achieve her goals and the goals of the organization. Her personality and laughter draw others in and makes them feel like they belong,” Longton says. “She always recognizes others for what they do, no matter how small or big their contribution may be.
“I also admire Rowena’s style,” Longton says. “Ro loves shoes and Paris. It seems as though she has shoes in almost every color and style available. Her love is so significant that if you were to look closely on the cover of ANNA’s 2011 Fall Meeting program brochure, you will notice a pair of red high heels near the base of a street lamp. These were included in the picture as a subtle representation of something for Rowena. And what can I say about Paris other than it shows how classy and intelligent Rowena is.”
Being a “first”
“I get teary,” Elliott says, less than a month before the swearing-in ceremony. “When I think about it—” Her voice falters and she stops for a minute.
“I’ve come from a family where we had nothing to being the first African American president of this organization,” she continues.
“I do remember when I was a preteen that I had to sit in the ‘blacks only’ section of the local health clinic,” Elliott says. “To go from that to being the first African American to lead this organization is surreal but also warms my heart.”
Although Elliott celebrates her achievement, she does not dwell on it because it’s a part of a greater plan, she says. “I know God wants this position to be an opportunity to let other nurses and nursing students to know that no matter the obstacles and challenges that life brings, your dreams can definitely become realities.”
For Elliott, the role is more meaningful because she’s showing other minority nurses that they can do it too. “If you see something you want to change, you can change it,” she says.
Being the ANNA president was not a lifelong dream for Elliott, she says, but when she saw that Board of Directors, she felt that she just needed to be there. “[They] did not reflect the membership,” she says. Elliott remembers looking at the ANNA’s Board of Directors and asking the then president, “How do you get up there?”
For Elliott, it’s a simple matter of equal representation. “The amount of minorities does not reflect the population that we serve,” she says of the ANNA and her specialty. When you look at the patients nephrology nurses serve, they’re primarily African Americans who experience grossly disproportionate numbers of hypertension, heart disease, and diabetes, which lead to kidney problems and renal replacement. As ANNA president, Elliott wants to increase the number of all minority nephrology nurses, while boosting the number of nephrology nurses in general. “That’s been one of my goals,” she says, and she already has experience, having served on recruitment committees as a university faculty member.
Elliott, center, with two of her mentees at the Mississippi Nurses Association’s Nightingale Award ceremony
“If you want to make a change, don’t complain about it—take the steps,” Elliott says. “Make the change that you’re trying to see.”
Recruiting is about creating awareness and highlighting the benefits of this niche nursing specialty to make it an appealing path for future generations of nurses, Elliott says. Part of the effort is advocacy and speaking out. Let people know you’re there. Elliott presents at symposiums and writes about the subject at length, detailing solutions for recruitment. She recently spoke at a National Student Nurses Association event to discuss nephrology as a career path. “A lot of them didn’t even realize it was an option,” she says.
Elliott says she sees a lot of nursing students go into the ICU, women’s health, and emergency nursing—the well known specialties shown, and often idealized, on television and in movies. Nephrology needs to take a similar tact, Elliott says, but because getting it into the movies may be a challenge, it’s up to the nurses. “Our specialty is a great specialty. It’s very rewarding and exciting,” she says. “We need to make sure our name is out there.”
Elliott, or “Dr. E.” as she’s known at school, estimates two or three of her students go into nephrology nursing every year. The students tell her they chose the specialty because of the passion she expresses for it in her teaching.
“Her dynamic personality allows her to [be] interactive with individuals across all racial and ethnic groups,” Brown says. “She is infectious in her presentation and you truly are motivated to go out and accomplish more once you hear her speak…She truly epitomizes leadership excellence and encourages the hearts of others.”
Elliott hopes history will remember her for her leadership, not just as the first black ANNA president. “It’s truly an honor. I don’t have the words to express it,” she says. “But I’m ready for the work.”
Elliott credits her parents for always encouraging her to do better, to be better. “I know I’m making history,” she says. “I’m proud.”
“She is just what ANNA needs at this time,” says Donna Painter, M.S., R.N., C.N.N., the exiting ANNA President. “I know that ANNA will thrive.”
Always the teacher, Elliott hopes the next generation of nurses can learn from her nearly three decades in the profession. “Don’t settle,” she advises. “Don’t settle for anything in your personal life. Don’t settle for anything in your professional life.” If you dream about being a nurse educator, press forward until you become a nurse educator. “Stay focused on your goals and make the sacrifices,” she says. “Keep your eyes on the prize.”
It is often said, “We are a product of our environments.” In many respects this is true. In the African American culture, we tend to embrace the habits and behaviors of our surroundings. We don’t think of our childhood or adulthood lifestyles as unhealthy because we tend to repeat the behaviors we have always known.
Fast-paced and stressful workdays, a lack of physical activity, poor nutritional choices, and sedentary downtime are all factors that have led to skyrocketing levels of obesity, but are the norm in the American lifestyle. Consequently, problems like hypertension, heart disease, peripheral vascular disease, diabetes, some forms of cancer, pulmonary disease, depression, and conditions involving the musculoskeletal system plague obese populations. Additionally, the study of obesity reflects underlying economic and income inequalities, community disadvantages, and social class divisions. With the rapidly increasing pace of obesity, the weight of the matter is both individual and societal.
The term “obese” is often confused with “overweight.” We know the difference as health professionals, but the communities we serve may not. Healthy weights are determined using the Body Mass Index (BMI). People with a BMI between 25 and 29.9 are considered overweight. Those with a BMI of 30 or greater are obese.
Obesity has become one of the most serious public health problems of the 21st century, due to its prevalence, cost, and health effects. It cuts from a wide swath of people, spanning all ages and genders, making it a national priority. Obesity has reduced the lifespan of entire communities and dismantled their quality of life. African Americans are killing their bodies when they do not make the connection between lifestyle behaviors and their outcomes.
One effective strategy for solving the obesity epidemic is through educating ourselves. Taking ownership of our bodies, recognizing the problems, and changing our attitudes will help us make knowledgeable decisions about our health. Although countless excuses, from a lack of role models to fast-food conveniences, may attempt to undermine addressing the real issue, the life or death importance of seeking solutions should resonate beyond the perception that fighting obesity is futile.
For the Fort Bend County Black Nurses Association (FBCBNA), the fight against obesity is persistent. This year, FBCBNA is celebrating its 10th anniversary. We challenged our members to lose 10 pounds in honor of the occasion. The National Black Nurses Association (NBNA) awarded the FBCBNA a $1,000 seed grant to fund the initiative and develop strategies to tackle obesity. The grant will be used to introduce interventions, like personal training tips and group exercise activities, as well as community education, such as teaching people how to read food labels.
As nurses, we need to practice what we preach. Fighting obesity from within our local chapter seems like a sensible choice. Nurses do an excellent job giving advice and caring for others, but don’t always do a good job caring for themselves. Reducing one’s BMI requires changing behaviors and making lifelong healthful decisions. The FBCBNA’s obesity initiative is titled “BMI Beware: A Nursing Association’s Strategy for Changing Body Mass Index.”
The pillars of combating obesity are balanced nutritional meals and physical activity. Portion control, knowledge of ingredients, informed reading of food labels, and nutritious food choices are fundamental in changing unhealthy behaviors and developing improved lifestyles. The fight to conquer obesity must have multiple layers of intervention. Aerobic and resistance fitness programs, avoiding fast food purchases, planned healthy meals and snacks, and adequate hydration, specifically water, are all positive ways to intervene in this epidemic.
The goal in all this is to make a conscious assessment of our obesity problem. Personal lifestyle and behavior changes must be developed and then practiced daily to make a real impact. Opportunities to take on new and rewarding lifestyle changes are all around us. We just have to get moving—one day at a time, one step at a time. We owe it to ourselves, our families, and society. The obesity epidemic is serious. As we collectively transition toward healthier choices and better lifestyle routines, sharing knowledge and becoming more educated as health professionals will lead our communities to positive results.
The year 2012 marks the 50th anniversary for graduates of the Class of 1962. You’ll often hear graduates say, “We’ve made it!” to celebrate their accomplishments over the years. Yet, some graduates move through life never realizing the “it” they have made is of historical significance. The 1,700 graduates of the Freedmen’s Hospital School of Nursing indeed left their mark on the world, and each individual’s contributions should be preserved to inspire generations unborn.
A bit of history
The graduates of Freedmen’s Hospital School of Nursing (FHSN), and Howard University (HU), share an inimitable history honoring blacks in nursing, including African Americans and people of the African diaspora. This relationship was established under the direction of the United States federal government. The purpose was to train black nurses to care for freed slaves around the city of Washington, D.C.
Howard University Training School for Nurses (HUTSN) was established in 1893 and transitioned to Freedmen’s Hospital School of Nursing in 1894. Dr. Daniel Hale Williams, the first interracial U.S. surgeon, founded the Freedmen’s Hospital School of Nursing in 1894. (Incidentally, Dr. Williams also founded the first U.S. interracial hospital, Provident.) All of the esteemed faculty were master’s prepared in nursing, most graduates of Freedmen’s themselves, and with numerous achievements between them. It remained a “cooperating institution,” awarding approximately 1,587 diplomas to nurses, until its close in the early 1970s.
Freedman’s Hospital was directly linked to the post–Civil War federal Freedmen’s Bureau, established to provide emergency medical care to the many former slaves settling around the capital. Congress eventually transferred the Freedmen’s Hospital School of Nursing to Howard University in 1967. The School of Nursing was phased out not long after, admitting its last class in 1970, graduating them in 1973. From 1974 to present, Howard University has awarded the Bachelor of Science in Nursing.
Here we document the history of this relationship and the contributions of some alumnae to inspire future generations to new levels of success.
Notable alumnae
Fifty years ago, 35 graduates of Freedmen’s Hospital School of Nursing, in cooperation with Howard University, began their journey in nursing. They made, and continue to make, a profound impact on the history of black nurses and the profession of nursing. The historical significance of these 33 black women and two men is collected here to honor the graduates.
The Howard University 1962 yearbook, The Bison, has names, pictures, and documentation of those who received diplomas. It is one of the few printed works and testaments to the individuals who made and continue to help preserve the earlier history of black nurses. Some stories of the students, staff, and faculty members have been recorded and rewarded, and other contributions have yet to be immortalized.
Mary Elizabeth Carnegie
“In 1893, Howard University in Washington, D.C., established the first nursing program in a university setting—16 years before the similar and flagship program began at the University of Minnesota,” wrote Mary Elizabeth Carnegie in her 1986 publication The Path We Tread: Blacks in Nursing, 1854–1984. Dr. Carnegie cited the relationship between Howard University and Freedmen’s to exemplify how black nurses and their impact in health care had been ignored. Her contribution to that legacy was to publish a comprehensive history of black nurses. Much of Dr. Carnegie’s work features the life experiences of graduates from Freedmen’s Hospital School of Nursing and Howard University. One such experience was the Chi Eta Phi Sorority, Inc., a national sorority of registered professional nurses and nursing students. This organization was incorporated by Freedmen’s graduates and physicians of the Freedmen’s Hospital/Howard University complex. Dr. Carnegie, in her writing, acknowledges the Moorland-Spingarn Research Center, Howard University, and Joyce Elmore in helping her preserve the history of black nurses.
Joyce Ann Elmore (Archer), R.N., B.S.N., M.S.N., Ph.D.
One of Dr. Carnegie’s compatriots in nursing, Joyce Ann Elmore, R.N., B.S.N., M.S.N., Ph.D., graduated from Freedmen’s Hospital School of Nursing in 1958. In 1965, Joyce wrote an unpublished master’s dissertation, A History of Freedmen’s Hospital Training School for Nurses in Washington, D.C. 1894–1909. She published “Black Nurses: Their Service and Their Struggles” for the American Journal of Nursing in 1976. In 1990, Joyce worked to establish the M. Elizabeth Carnegie Endowed Chair at Howard University’s College of Nursing.
The Freedmen’s Hospital Nurses Alumni Club’s Triennial Reunion The Freedmen’s Hospital Nurses Alumni Club’s Triennial Reunion is scheduled for June 21–24, 2012, in Washington, D.C. The Freedmen’s Hospital School of Nursing Class of 1962, along with the Classes of 1960 and 1961, will be honored for 50 years of nursing service. The plans are to give special recognition to military service members. The reunion committee (including Salonie B. Turner, R.N.; Kathy E. Senior, R.N.; and Lawrence C. Washington, R.N., M.S.N.) hope to attract the attention of potential FHSN contributors, classmates, classmates’ family members, and other supporters to preserve the history of black nurses. To contact them with news and stories, and for more information regarding the event, e-mail [email protected].
Dr. Elmore’s contributions to medicine and the nursing profession varied greatly, but her dedication to the profession of nursing remained the same. She began her career as an administrative assistant to the director of the audio/visual aid section at Howard University’s College of Medicine. Dr. Elmore then served as the Assistant Director of Nursing Education at FHSN. In addition to those positions, the years saw her doing consulting work at Howard University; serving as the Director of the American Nurses Association Department of Nursing Education; working at the Department of Health and Human Services in Washington, D.C.; teaching as an adjunct nursing professor; and much more. Some of her many honors and awards include a 1973 Community Service Award for Outstanding Service to District of Columbia; a 1980 Commendation Medal from the United States Public Health Service Commissioned Corps for Exemplary Performance of Duty; and countless other awards commemorating her nursing practice, community service, and research. Howard University hosted a dinner gala in 2006 to further honor Dr. Elmore’s life and work.
Dr. Joyce Ann Elmore Archer, as a lifelong member of the Freedmen’s Hospital Nurse’s Alumni Club, Inc., worked with other alumni to make, write, and preserve the historical contributions of graduates from FHSN and HU, and of black nurses everywhere. She retired as an 06, having served commendably in the U.S. Air Force, U.S. Coast Guard, and U.S. Public Health Commissioned Corps. Ida C. Robinson, a mentor and coworker, says Joyce was a phenomenal person who set an example for all to emulate. Dr. Elmore’s lifeworks ended with her death on June 15, 2009.
Ida C. Robinson, R.N., M.S.N.
The life story of Ida C. Robinson, R.N., M.S.N., would be incomplete without details of her many contributions in creating and preserving history of the Freedmen’s Hospital School of Nursing. Mrs. Robinson was the Director of Nursing Education at FHSN when the nursing program transitioned to Howard University in June 1973. In this position Mrs. Robinson suggested “a directory of all graduates would be beneficial for historical reasons, as well as provide valuable information and service the alumni.” On April 19, 1971, Staff Assistant Iris L. Morton Fagan and others began a manual audit of 2,307 files, which was completed on June 12, 1972. Mrs. Robinson’s thoughts and deeds were always focused on preserving history. She continues to do so working with the Freedmen’s Hospital Nurses Alumni Club, Inc., and Howard University. She is 92 years old. In 2010, Mrs. Robinson was awarded the Doctorate of Humane Letters by The Catholic University of America.
About the Author
Lawrence C. Washington, R.N., M.S.N.
Colonel, Retired, Army Nurse Corps
It’s a unique occasion when an author’s accomplishments mirror that of his or her subjects. Here we look at the life of the man who sought to keep the memory of this historic class of nurses alive.
A native of Washington, D.C., Lawrence C. Washington earned a diploma in nursing from Freedmen’s Hospital School of Nursing, a Bachelor of Science in Nursing from The University of Maryland in Baltimore, and a Master of Science in Nursing from The Catholic University of America, also in Washington, D.C.
Colonel Washington’s health career began in 1954 as a medical aidman with the rank of private, and his active service ended the first time in 1987, as the Acting Chief Nurse of William Beaumont Army Medical Center with the rank of colonel. Highlights of his 27 years of distinguished active military service include many “firsts” of his gender, professional specialty, and ethnicity. Washington was the first male Army Nurse Corps officer to receive a commission in the Regular Army of the United States; the first black male Army Nurse Corps officer to be promoted to the rank of colonel; and the first black male nurse to be selected, attend, and receive certification for residency education at the U.S. Army Command and General Staff College.
Among his teaching credentials, Washington has served as a clinical instructor and skills supervisor in psychiatric nursing for the University Of Texas Health Science Center at San Antonio: School Of Nursing; an assistant professor and adjunct faculty member for clinical pediatric nursing at Columbia Union College (now Washington Adventist University); an assistant professor at Howard University College of Pharmacy, Nursing, and Allied Health Sciences (now two separate schools, pharmacy, and nursing and allied health); and an assistant professor at Louisiana State University in New Orleans, among other academic endeavors.
While serving as a commonwealth assistant professor at George Mason University College of Nursing and Health Science, Washington became the program coordinator of the Saudi-U.S. University Project. There he also lectured and provided clinical supervision in health assessment, leadership and management, long-term care, and community-based health promotion and disease prevention. He was also a member of the University’s Americans with Disabilities Act accommodations committee.
Washington’s awards and recognitions include the following: United States Legion of Merit, Three Meritorious Service Medals, Good Conduct Medal, National Defense Service Medal, Army of Occupation Medal, Army Service Ribbon, Overseas Service Ribbon, Order of Military Medical Merit, and an Expert Field Medical Badge.
He has held membership in The American Nurses Association, American Association of Neuroscience Nurses, American Association of Colleges of Nursing, Sigma Theta Tau International, Army Nurses Corps Association, Charter Member of Improvement Science Research Network, American Legion, Military Officers Association of America, Veterans of Foreign Wars of the United States, and The Society for Organizational Learning.
The summit of Washington’s life is to bear witness to the transformation of the lives of his wife of 53 years; their five children, 11 grandchildren, and four great grandchildren; his students; and himself, as they all move from abecedarians to professionals. “With great pride in his knowledge of God, understanding of his country, and unwavering devotion to duty,” he says. “On the wings of the spirit of service is borne the unselfish commitment to a successful life.”
Gwendylon Johnson, RNC, MA, has been a registered nurse for 30 years—and for nearly 20 of those years, she has also been a union activist within the District of Columbia Nurses’ Association.
To Johnson, the two roles are perfectly in sync. Being part of a nurses’ union, she feels, is as important to her struggle to be recognized as an African American as her activism during the civil rights movement in the 1960s, when she marched with Dr. Martin Luther King.
“Back in 1961, he delivered a speech to the AFL-CIO at its Fourth Constitutional Convention. Basically, the focus of the speech was that if black people win, labor wins,” recalls Johnson, a staff nurse in women’s health at Howard University Hospital in Washington, D.C.
Dr. King’s words resonated with Johnson. “He talked about the duality of purpose between what I as a minority was looking for and what labor was looking for,” she says. “He talked about things like decent wages, fair working conditions, health and welfare, respect and dignity.”
It’s no surprise, then, that Johnson recently assumed a key role at the negotiating table representing the United Association of Nurses (UAN), the collective bargaining arm of the American Nurses Association, during a bitter nurses’ strike at the Washington Hospital Center. The six-week walkout centered on issues such as understaffing and mandatory overtime.
“I think I’ve always had a different respect and association with the union than a lot of other nurses because I felt that [unions] have been an avenue for achieving [equity]–in the same way Dr. King felt that if the civil rights movement worked together with labor, both blacks and the unions would win,” she says.
Minority Membership Gaining Strength
At a critical time in health care history when union representation among nurses is climbing–due largely to concern over staffing shortages and the declining number of nurses entering the profession—a growing number of minority nurses are gaining a collective voice.
It Pays to Be OrganizedDid you know. . .that nurses who work at union facilities are paid on average about two to three percent more than those at non-union facilities, according to Sonia Moseley, RNP, executive vice president of the United Nurses Association of California. In fact, the first nurses’ unions were formed during World War II to demand higher wages.
Overall, about 19% of the 2.7 million registered nurses nationwide were covered by collective bargaining agreements in 2000, according to U.S. Census Department figures. That’s up from less than 17% just two years earlier.
Several unions represent RNs, including the UAN, the Service Employees International Union (SEIU), the American Federation of Teachers, the United Food and Commercial Workers Union, the American Federation of State, County and Municipal Employees (AFSCME) and the American Federation of Government Employees (AFGE), plus local and regional independents, such as the California Nurses Association.
Unionization among nurses was revved up a notch this spring as the UAN–the largest union representing exclusively registered nurses, with 100,000 members–voted to affiliate with the AFL-CIO, a move organizers hope will strengthen the voice of nurses and their patients on a national level.
While none of these unions track minority membership, union leaders say that nurses of color like Johnson appear to make up approximately the same proportion in unions as they do in the nursing workforce—i.e., about 12%.
Wearing the Union Label From Top to Bottom
Some activists say that greater diversity within nurses’ unions is needed to better reflect the U.S. population at large, particularly in urban areas where significant numbers of nurses are African-American, Hispanic, Asian or from other non-Caucasian ancestry.
“I believe very strongly that the union should reflect [diversity in its membership],” says Sonia Moseley, RNP, executive vice president of the United Nurses Association of California, which represents about 11,000 RNs and is affiliated with AFSCME.
While Moseley says her union’s membership adequately reflects the 20-30% of California RNs who are nurses of color, she feels the percentage of minority members in leadership roles is still too low, at about 1%. “[Minority union members] don’t always show an interest in moving into leadership positions, and we don’t necessarily reach out to them, so I think we’re lacking in that area,” she admits
Moseley thinks it’s important that the mix of negotiators and union leaders reflects a diversity of races and cultures. She explains, “If the nurses you are representing aren’t all lily white, you have to have people at the bargaining table who reflect the true face of your membership”–not just because some issues may affect minority members directly, but also to build credibility and trust.
Nurses’ Unions Go to School
Sylvia Barial, RN, MS, can personally attest to the impact a minority nurse can have within a union. She is the chapter chair for school nurses in the United Teachers of New Orleans, which is affiliated with the American Federation of Teachers. The AFT’s health care division represents about 60,000 RNs nationwide.
For the first 10 or 15 years of her 30-year tenure with the union, Barial was the only African American–and the only school nurse–serving on the health care committee. Over the years, she’s seen first-hand the power and professional recognition that school nurses have gained from having a stronger collective voice within the teacher’s union.
“People would say, ‘Oh, you’re only a school nurse,’” Barial remembers. But since those early years when they were paid much less than teachers, school nurses now receive the same salaries as teachers (commensurate with their level of college education and other factors).
Today, school nurses manage students with a variety of illnesses and conditions that impact their ability to learn. Says Barial, “The union has increased schools’ awareness that there are federal rules and regulations that must be followed and that it’s important for them to have school nurses who can perform these services.”
Union Ties That Bind
For the most part, leaders of nursing unions say the issues they address collectively are the same for all members, regardless of their racial or ethnic background. “The same issues that affect any nurses affect minority nurses,” says UAN chair Cheryl Johnson, RN, BSN.
Heading the list of issues are those relating to working conditions and short staffing.
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“Hospitals in particular, but nursing homes as well, do not have enough nurses and other bedside caregivers, so each nurse has too many patients and is vulnerable to unsafe care and medical errors,” says Gay Hayward, nurse alliance coordinator for the SEIU, which represents 70,000 RNs and 40,000 LPNs. “It really impacts the quality of the care that’s being given.”
Adds UAN’s Johnson, “You could be anywhere in the country right now and you’d see about the same thing. There’s not enough nursing support, and we are expected to do more work with less people. It’s scary to go to work sometimes because you don’t know the positions you’re going to be put into.”
Indeed, union membership has gathered steam in the last 10 to 15 years as cost-cutting measures at medical facilities drove many RNs into other health care jobs that offered higher pay and better working conditions–or drove them out of nursing entirely. The Bureau of Health Professions reports that 494,000 licensed nurses were not practicing in 2000.
In addition, the prospect of low pay and stressful working conditions appears to be influencing prospective nurses’ career choices. The American Association of Colleges of Nursing recently reported that enrollment of students in BSN degree programs fell 2.1% in the fall of 2000, marking the sixth straight year of declines.
Negotiating for Equality
But not all union concerns are colorblind, other union insiders say. Some labor issues, such as racial discrimination in the workplace, are particularly relevant to minorities. Most nursing unions have a system in place, through their grievance procedures, to handle allegations that arise.
“[Unions’] grievance and arbitration procedures are much more in the hands of the individual workers than, for instance, an EEOC claim or private suit would be,” according to Hayward. “The outcomes can be much more satisfying, and more timely, [when you] have the union and contract language to pursue as a venue of recourse.”
Educational opportunities for career advancement, such as tuition reimbursement, are another issue that may have special significance to nurses of color, particularly at a time when more minorities are being encouraged to enter the profession. Such issues can be addressed by unions, activists say.
“I work in a hospital that is a predominantly black institution,” says Gwendylon Johnson, “and we’ve been able to achieve strong contract language that focuses on providing the opportunity for nurses to get educational opportunities, both within and outside the workplace.”
To Join or Not to Join
While union organizers are quick to say that collective bargaining isn’t the only way to make strides in improving nurses’ working conditions, they insist that unions can be an effective tool in getting management to listen. In many cases, unions have been instrumental in boosting wages and other benefits, such as retirement compensation, innovative bonus systems and increases in differential pay.
Seven Reasons to Join a Nurses’ UnionHere are a few examples of the results that unionized nurses have achieved, according to the United American Nurses (UAN), the nation’s largest nursing union:
Nurses at several New York hospitals have won the right to determine nurse-to-patient ratios.
In their recently negotiated contract, nurses at Minneapolis hospitals now have a say in staffing issues.
RNs in Oregon can call for a review of staff patterns and utilization of on-call unit nurses to determine the need for additional positions.
Nurses at hospitals in Ohio negotiated a contract that prohibits mandatory overtime. At other hospitals nationwide, RNs have negotiated the elimination of mandatory overtime except during disasters or emergencies.
Nurses can now fine a hospital in Michigan if staffing levels fall below those outlined in their contract.
Many nurses have negotiated the ability to use “assignment despite objection” (ADO) forms when they feel assignments are inadequately staffed to provide quality patient care.
RNs at an Illinois hospital were able to stop a staff restructuring plan that would have compromised patient care by eliminating 25% of the staff nurse positions.
UAN leader Johnson tells her ANA colleagues who aren’t union sympathizers: “If you can sit with your employer and come to some kind of agreement where you have decent working conditions and you can compensate nurses so they’ll stay there, then good for you. But what we’re finding more and more, even in states that don’t have nursing unions, is that nurses are thinking about starting them.”
While nursing union organizers admit it can be difficult to get anyone–regardless of background–to get involved in unions, cultural differences can make the task of attracting minority members even harder. For instance, Philippine nurses, particularly recent immigrants, come from a culture where it is considered inappropriate to buck authority or the mainstream, and may therefore be difficult to recruit, says Hayward.
Pete-Reuben Calixto, RN, BSN, CNN, president of the Philippine Nurses Association of America, agrees with that assessment. In fact, he says, those cultural norms prevented him from joining a union when he came to the University of California at San Francisco on a work visa in the 1970s.
Although he paid the mandatory dues, Calixto didn’t officially join the California Nurses Association until a year and a half ago, when he had become more assimilated to U.S. culture and finally felt he could stand up to the changes sweeping through the health care industry.
“When you are sponsored by a certain U.S. employer, you feel that loyalty has to be paid back,” he explains, adding that other Filipino nurses may fear repercussions regarding their immigration status.
But today’s nursing unions have become more prepared to deal with these issues. They’re typically staffed with immigration lawyers and other experts to consult and defend members, if necessary. Union organizers also try to address cultural concerns one-on-one with prospective members by connecting them with current members from the same ethnic background, adds Moseley.
“It helps to tell your own story, how you became involved, how you stood up and how you didn’t get fired or have anything bad happen just because you decided you wanted to vote for a union,” she says.
Where do professional organizations for minority nurses stand on the issue of union membership? The National Black Nurses Association, for example, does not currently have a labor entity for its members but is planning to discuss union representation for the first time in the wake of UAN’s affiliation with the AFL-CIO, according to NBNA executive director Millicent Gorham.
On the other hand, Sandra Haldane, RN, BSN, president of the National Alaska Native American Indian Nurses Association, believes the decision to unionize is a local issue. “Unions have their place in some instances when staff cannot seem to work out situations with management or when they’re just taking an incredibly long time [to resolve nurses’ concerns],” she argues. “But with a very forward-thinking leadership group, you can correct situations and improve the working environment so that employees don’t feel like they have to unionize.”
A Voice for Patients, Too
Ultimately, the decision to join a union is up to each individual nurse. But many nurses of color who have taken that step feel union representation does more than just help ensure that the concerns of minority nurses are heard—it also translates to better care for their patients, which they say has always been a key concern.
“My association with the union has allowed me the ability to speak out on issues like patient advocacy without the fear of retaliation,” Gwendylon Johnson asserts, adding that the black nursing sorority to which she belongs, Chi Eta Phi, also promotes union membership.
