Going to school while working full-time as a nurse and raising a four-year-old with her husband isn’t easy, so Ashley Willie knew she wanted an online nursing program with supportive instructors and a flexible schedule.
“I wanted instructors who were interested in their students’ personal and career goals as well as their educational goals,” she said.
In addition, she said, “I was looking for a program that didn’t require me to be online at a certain time. I wanted more freedom and autonomy.”
Willie said prospective nursing students should look at what kind of financial support and resources are available for minority students, as well as what past and current students and instructors have to say about the program. And of course, they should check the matriculation rate and accreditation of a school, she said.
Financial support: putting your money where your mouth is
Sheldon Fields, the inaugural associate dean for equity and inclusion at the Penn State Ross and Carol Nese College of Nursing, agreed that prospective students should look at what kind of financial resources an institution commits to multicultural students.
Sheldon Fields, PhD, RN, CRNP, FNP-BC, AACRN, FNAP, FAANP, FAAN. Associate Dean for Equity and Inclusion, Ross and Carol Nese College of Nursing.
“To put their money where their mouths are, schools need to be committing resources — sponsoring lecture series, offering scholarships, resources specifically focused on supporting multicultural students,” he said.
Fields, who has been a nurse for 30 years, said schools should have a clear stance on diversity, equity and inclusion that is reflected in their mission statement and their strategic plan, which should be available online, and should also teach diversity, equity and inclusion issues as part of their undergraduate and graduate curricula.
If there are no multicultural nursing student groups and the topic appears to be ignored, “It’s a big red flag,” Fields said. “A multicultural student is not going to find support for who they are, for the unique perspectives and talents that they bring, and the needs they have.”
Fields urged prospective students to look carefully at a school’s nursing faculty.
“It’s one thing to say you want a diverse faculty; it’s another to actually make it happen,” he said.
Denita Wright Watson, associate director of equity, inclusion, and advocacy for the Penn State World Campus Student Affairs office, urged students to seek out institutions that focus on addressing health care disparities, inequities, and bias in health care and that are focused not only on attracting diverse talent, but also retaining it. Schools should go beyond lip service to invest in students’ academic and professional success, she said, by providing professional development opportunities and other career services, as well as supporting students’ personal well-being through mental health support, student identity groups and DEI–related programs.
Denita Wright Watson, MLD, Assoc. Director of Equity, Inclusion, & Advocacy for Student Affairs. Penn State World Campus.
Students should ask, “What support is out there for me, beyond academic support?” Wright Watson said. “What support is there to aid in my growth as a person?”
Prospective students should “scour and scour” a school’s website not only for their mission and values statements, but also to see what service projects the institution is involved in and what kind of speakers and events are offered, Wright Watson said.
“Google should be their best friends,” she said. “Just ask questions: Why should I pick this university? Why should I pick this program? What are they doing to meet the needs of underserved students and communities?”
Fields added: “Ask them, ‘What did you learn in a program about diversity, equity and inclusion?’ If they tell you nothing — run the other way.”
Willie agreed that it’s important to look for an institution that recognizes health care inequities and equips students with tools to help reduce health care disparities, seeking to improve health care outcomes at both the individual and the population levels. An example of that is teaching students methods of recognizing vulnerable populations and using evidence-based tactics to improve health care literacy and health and wellness, she said.
All her professors at Penn State have valued both her cultural and professional background and make time to meet with individual students to discuss their goals and aspirations, Willie said.
“For me this is very important because not only do I feel valued individually, I feel like the instructors are invested in my success as a woman of color.”
In this essay, I present my firsthand account of my experience as an African American nursing student in a predominantly nonminority nursing program as well as my perceptions and interactions with fellow students. As an autoethnographer, I sought to answer the following question: What is the African American student nurse’s experience of education in a predominantly nonminority school of nursing and university, and how does that experience affect her as an individual?
Pre-Nursing School: Being “White”
In high school, I was called “white” by the majority of the few African American students in a high school of nearly 500 students in the Northeast. Initially, when they said this to me I was shocked. I had been on the receiving end of racially charged comments by white peers, and now I had to deal with this from my own race and ethnicity, too? I wondered why I could not catch a break. I remained confused but focused on my schoolwork. Since being a freshman, I was in honors classes, those with the maximum rigor in the entire school. It was viewed as if only the elite were in these classes, but I surely did not feel like the elite. My white peers in those classes assumed I came from the ghetto and asked me to teach them Ebonics and about rap music (which I did not listen to). I was isolated in those classes because of such stereotypical comments and the competition to be number one of the entire graduating class, but mainly because I was the only African American student in such classes. The comments from my African American peers only intensified as I was enrolled in both cosmetology in vocational school and Advanced Placement courses (which could alleviate me from taking college courses, once enrolled).
One of my African American acquaintances, who I thought seemed amicable, approached me purposefully one day in the hall. She looked like she was on a mission to find me as I put my things in my locker. I met her with a kind hello—I did not have many friends in school. I blamed myself for that, being so quiet. She stated loudly with a greeting, “Do you think you are better than us?” I said, totally confused, “Us? Better than who?” She quipped, “You know exactly who I mean, the few blacks in this school.” My face must have looked blank. I just stared at her with curiosity due to the fact that, besides the “white” comments, there was never an extended conversation or association besides my distant friendship with several other minorities. She continued to badger me, “You know you think you are better than us since you are in those special classes. Who do you think you are?” I simply responded, “Nothing.” At the time, my self-esteem was low; I had become tired of my lack of association. She was not buying it. “You know what? It must be true that you are white because you even talk like them,” she said. “Don’t ever think you are better than us. We are just as smart, although we may not be in the AP classes.” Taken aback, I explained, “I never said you weren’t. You should talk to your advisor about enrolling in one of the classes.” Without acknowledging my reply, she stormed away, saying, “Wow, you are white.” As she walked away, I blinked at her and said to the dust trailing behind her, “It is funny because my skin is black like yours.” I went on to finish my day; however, the episode never stopped playing in my head, even after I became a nursing student.
Katie Love, PhD, APRN, BC, AHN-C, wrote about the lived experience of African American nursing students in a predominantly white university in a 2010 article published in the Journal of Transcultural Nursing. One of the themes of her phenomenological study was that of fitting in and “talking white.” She reports about a study participant who had grown up in a predominantly white secondary school and had become accustomed to experiences with white students. African American nursing students who did not have such an experience described some African American students as being “Oreos…Black on the outside and white on the inside.” Such “Oreos” are described as African American students who are black but “act White, socialize, and talk like White people.” One of the participants of the study shared the following observation: “To me it’s kinda a funny thing that it’s such a problem in the Black community that you could not talk in a certain way…but if you start talking slang, then to them you’re trying.”
I could identify with Love’s study as my isolation from peers—from within my own race and from without—began in high school. In high school, I was excluded by white students because of the color of my skin and, at the same time, excluded by my African American peers because of the way I carried myself and spoke. In nursing school, my isolation continued. It would eventually lead to my depression.
Nursing School: Feeling Isolated and Excluded
Fast forward to nursing school. The faculty and advisors began our edification with a talk about the rigor of the courses. I remember a gentleman announcing, “Look around the room. See everyone here? Not all of you will be here in four years. The truth is, nearly half of you may not make it to graduation.” I remember sitting in the warm amphitheater and feeling intimidated by his words. When I looked around, as instructed, I noticed the class was made up of only three African Americans. The largest minority group were of Hispanic background.
The first few semesters were full of straight science courses, which translated into nonstop studying. I spent my days in the library enjoying my books and learning. The days went so fast, when all I did was read and study the day away. In the blink of an eye, the end of the first year arrived. All of the Hispanic students were eliminated either by not meeting academic requirements or by choosing to leave the program. I was afraid that I would be next. My classmates were mostly white students. At times, I felt I did not belong. None of my professors looked like me. The nonminority students studied together and did not invite me, much less speak to me.
I remember our professor addressing the class during our sophomore year. She advised everyone in our small section to avoid driving alone to a distant clinical site and to carpool instead. I looked around the room attempting to make eye contact but did not receive any response. My nonminority peers turned around in their seats and, within minutes, had arranged themselves into two car groups, which left me out. I told myself, “You really thought it would be different, huh?” I laughed to myself and stopped looking for a group. That experience solidified the divide for me.
In 2004, Nancey France, PhD, RN, and her colleagues at Murray State University published a pilot study in Visions: The Journal of Rogerian Nursing Science that examined the lived experiences of black nursing students and found many reported feeling isolated and discounted. One of the themes of the data was “You’re just shoved to the corner.” One African American student nurse clarified, “You may get one or two that wants to include you…You may go up to them, you’ll risk to say ‘are you going to study?’ If you think that you know them and everything’s o.k., you’ll say, ‘are you all going to have a study group this weekend?’ And they’ll say ‘yeh’. But, when the time comes…you can’t get in.” Another student reported, “I’m the only black, in all my classes I’ve been the only black. It’s hard because…you got to prove yourself. If you don’t do as well as the other students they just single you out. That’s why I have to strive to do the best I can.”
Black students also reported feeling they were only admitted to schools of nursing to meet a quota. They described the increased pressure exerted on them when minority attrition rates were high in their class. As a result, they experienced emotions such as self-doubt, fear, lack of confidence, and diminished self-esteem before attending class. Many students reported these feelings pushed them “even harder to prove they could be successful.” There seemed to be a consensus that there was an unspoken expectation of African American students to fail, which propelled these students to greater levels of determination to prove that “they were as smart as anyone else.”
Moving Up: The Benefits of Exclusion
During my third semester in nursing school, I became tired of sitting in the back of the classroom. What had once seemed comfortable became an annoyance to me. The students who supposedly knew all the answers sat in the front, always the first ones to raise their hands. However, their answers were the same as mine—always. They weren’t any better than I was. I decided to beat the caste system within my own classroom. I felt my sitting in the back row was perhaps contributing to my isolation and depression that had begun to develop. Humans are not meant to be excluded—we need contact. As a result, I started moving forward, slowly but purposefully, to avoid and overcome my feelings of exclusion.
I remember deciding I would not allow myself to sit in the back anymore. I felt like Rosa Parks as I migrated up to the middle rows of the classroom. I began to raise my hand more. I found that studying alone was beneficial to me, as I knew the full answers to questions that other students merely answered in a general way. As a result, I started raising my hand and answered insightfully each time.
I wasn’t sure of myself until my anatomy and physiology professor approached me and asked if I wanted to become a physician. He tried to convince me to enter the premedical program. I was flattered and taken aback, but I knew it was not what I wanted. I had fallen in love with the few nursing courses we were allowed to take. I could not betray my passion for nursing and really “being” with the people. However, he had not approached anyone else in the class with this offer.
It was after that discussion that I moved up and became the snob who raised her hand to answer every question, at every opportunity. It was not until then that I had my first contact with nonminority students, other than a glance. They soon began asking how well I did on my exams. When interrogated, I replied without emotion, saying I did “okay” when I knew I got an A. They soon lost interest in me again. They did not know that their exclusion of me in their study groups was paying off greatly for me. I had become an independent and successful learner.
As the years progressed, I think they began to suspect I was doing better than just “okay” as I began to earn scholarships and recognition from my professors in class. It was unwanted attention for me because I wanted to keep my head low. What began as a business venture to simply gain a skill that would sustain me as an adult turned into a love for the profession of nursing. I had not expected that—it just happened. As my love grew, I began to excel. As I excelled, I felt the isolation increase. I had become used to it; it didn’t really bother me on the surface. It seemed other students were in school to make lifelong friends and to have a good time. I was in nursing school solely to earn my degree, focusing intently and singularly on my studies; so, most nursing students tended to avoid most nursing students avoided me.
I soon began to wonder if I had isolated myself, but then I noticed in my junior year that professors began to assign more group assignments. In those voluntary group assignments, I observed minority students chose to work together in the same groups, while nonminority students chose to work together in their own groups. I wondered if the professors noticed the same thing I did. It went on like this until the end of the nursing program.
A 2015 integrative review published in Nursing Education Perspectives reaffirmed that there are several studies where African American nursing students reported feeling “voiceless, not part of the important conversations, left outside of the cliques, alienated and insignificant.” Many minority students coped with these conditions by forming their own network among other minorities and “sticking together.” Additionally, Love noted in her study that African American students familiar with “being left out” from high school experience were better able to accept exclusion and move beyond the experience.
All that studying and exclusion seemed to work better for me. It worked out because I graduated. During graduation, I knew a select few would earn special acknowledgement for their achievements. I was sure it would not be me. I was so focused on getting out of there. I had the chance to extern on a unit in a teaching hospital where nonminority staff embraced me as if I was family. I just wanted out of nursing school. At the end of four years, it felt like prison only being able to talk to and connect with six minorities who made it to the end of the program. Now, I was free to explore the world as an adult with a real job—not just a student building up debt.
These were my thoughts as I was called up to shake hands with all of my professors. I was so focused on receiving my degree that the moment when they called my name seemed only a second. When they began to announce the special recognition awards for academic and clinical excellence, I kept looking back at my family and realized I was one of the few students wearing a purple tassel, which meant we were part of a special group: the Honor Society of Nursing, Sigma Theta Tau. We had high GPAs.
Then I heard one of my professors say my name. I looked around and those around me whispered, “That’s you! Get up! They called you!” I had earned the award for clinical excellence. I was speechless and nearly stumbled up to the stage. I thought my professors were not interested in me, but they had nominated me for this award (and I assume they voted that I receive it). I was flabbergasted but filled with pride because I—the quiet African American student nurse—had earned this great honor. I thought I had not deserved it, because there were so many things I did not yet know, and I knew I was not the perfect student. I critiqued myself for those few senseless Bs I had earned. It was not until I returned to my seat the second time that I realized maybe I did deserve this award. Just maybe, I had worked hard enough in that I enjoyed putting the entire patient picture together—staying in their rooms, discussing how they felt about their illnesses while taking it all in, and figuring out how I could use my knowledge to prevent one less complication. I was more than a student nurse in those moments with my patients; I assumed the role of nurse and took such opportunities with the utmost seriousness. I remember a great exhalation as everyone threw their caps to the roof of the auditorium. I was deserving.
Soon after graduation, I passed my licensing exam on the first try and began working on a medical-surgical floor at a teaching hospital. My work was challenging and kept my attention, but I soon began to crave schooling. I decided to enroll in an online program. The main reason for doing so was so no one could see my face and perhaps I could fit in for once. And I did. I felt since no one could see the color of my skin or the youth of my face there would be no divisions. It proved true. I enjoyed my online schooling and soon pursued a doctorate program online after completing my master’s in nursing education.
In a 1998 study published in the Journal of Nursing Education, author Mary Lee Kirkland, EdD, RN, concluded that the most successful coping strategies of female African American nursing students are active coping and social support. She explains that “although they may have faced times of discouragement or despair, they did not waver in their pursuit of their goals. They relied on their inner strength to take the action needed to conquer their stressors and move on successfully.” I had a support system of my spirituality, my family at home, and my friends of the same faith that kept me strong. They probably were unaware how they were the one thread that held me together through emotional turmoil and numbness.
Enlightenment Upon a Return to the University: Six Years Postgraduation
Aside from the anatomy and physiology professor, who was from the biology school, I was never sure how the true nursing faculty viewed me. It was not until I returned six years later as a clinical nurse specialist to become a mentor for nursing students like I had been—of the minority. I was also pursuing a scholarship for my doctoral education with a focus on nursing education.
When I met with one of the professors, I was sure she had forgotten me by the e-mail she had sent back when I asked for a letter of reference and to meet to discuss a mentorship program for minority nursing students. However, when I walked in the door in my professional attire, she told me, “Wow, I remember you. I wasn’t completely sure in your e-mail, but now I know who you are exactly…You were always so bright. I knew it then, and look at you now and all you have accomplished. You have your master’s and are a clinical nurse specialist….[Another professor] and I are rooting for you to get this scholarship.” Our conversation ran long before a student showed up for her advisement. The professor told me warmly, “Keep in touch. We are so proud of what you will become and have become already!” She had written my letter of recommendation. However, the recognition she provided in those moments proved to me I did not know myself those years as well as I did right then.
I had not been invisible, after all, and the award I received upon graduation was not for show, but because my professors saw such great potential in me. I had become visible to myself and the world. My confidence soared as I left the campus. I had driven in, but I seemed to fly home, alongside the clouds.
If there’s one question that I frequently get asked by nursing students, it is how to properly study to pass nursing tests and exams and make it out of nursing school alive. During nursing school I tried different ways to study and it took trial and error for me to finally find what worked best for me. Here are my top study habits to help you get those A’s and tackle nursing school exams.
Best Study Habits:
1. What type of learner are you?
First and foremost, determine what your learning style is. It’s imperative that you’re honest with yourself about the type of learner you are to get the best results from studying. Learning styles typically fall into 3 categories: visual, auditory or tactile/kinesthetic learning. Each learning style retains and processes information differently. So before signing up to be a part of that study group session find out if it works for you. Some students are able to study in only quiet places while others can concentrate around loud noise. Here are two educational websites that offer free learning assessments to help you determine which learning style fits you the best: https://www.how-to-study.com/learning-style-assessment/ and http://www.educationplanner.org/students/self-assessments/learning-styles-quiz.shtml
2. Be organized.
Before you begin studying collect all of your essential tools such as notecards, pens, highlighters, coffee, and wine (just kidding). There’s nothing worse than being in your groove when studying and you realize that you’ve forgotten your favorite pen or highlighter. Have a plan of what you want to study for each session and a realistic expectation of how long it will take to go over the material. Give yourself adequate time to review each subject and include break times for each study session. According to a study recently done by Microsoft the average adult has a concentration span of only 8 seconds. That is less than that of a goldfish! So studying straight for hours without any breaks will not help you retain the information more.
3. Set goals.
You had a goal to get into nursing school and you have a goal to graduate, so why not set goals when studying? If there is a particular topic that is a weak area for you take out your planner and set a goal for when you want to fully master that material. Create a study outline with exact dates, time and even the location for when you will study each material. This will help you avoid having to cram for exams. Your class syllabus should have dates for when exams and texts will take place so don’t wait until you’re two weeks into the class to begin setting your study goals.
4. Less is more.
One of the biggest mistakes you can make when studying in nursing school is using too many books or resources at once. Determine which resources are necessary for each exam and study that content. Professors typically outline which books or resources are appropriate to use for each course so use that as a guide on what to use when studying. If not you may run the risk of studying information that contradicts what you were taught in the classroom. Seek guidance from your professor when choosing to use other resources aside from what is required.
Nursing school is probably one of the most stressful and rewarding things you’ll ever go through in life. Help make things easier for yourself with the four study tactics I listed above to help you prepare for every test and ace those exams. Always remain positive and remember to relax before an exam. You’ve got this!
Stay connected with other nurses just like you! Facebook: Fierce Expression and Instagram: @fierceexpression.
Over the last decade, there has been talk of an impending shortage of nurses. Even in light of the economic downturn, the soaring demand for more educated nurses is expected to continue as baby boomers age and health care coverage expands. For nurses who are entering or are in the field already, this demand presents an excellent opportunity to advance their careers and expand their knowledge.
So what is the logical next step? Often, it is to obtain an advanced degree. Once the decision to pursue higher education has been made, the next question is where to enroll. As online degree programs have increased in popularity over the last few years, many prospective students may wonder about the similarities and differences between online and traditional nursing programs. Before making your decision, consider what type of institution and program will best suit your needs and situation.
Benefits of an online education
Many nurses say the primary reason they chose an online program is because of the convenience and flexibility. Online learning offers students who are trying to balance a family, career, and other commitments the opportunity to earn a degree without sacrificing their other interests and obligations. An online nursing program may also offer a wider variety of degrees than a local university—if a local university is even an option. Especially in rural areas, the distance and time to travel to a brick-and-mortar institution may make this option impractical.
Another benefit of online learning is the asynchronous environment. In an asynchronous learning environment, students can participate at their convenience instead of being limited to participating at the designated location and the time when a class is offered. In the online format, students can generally post their homework and contribute to discussions when it works best for them. This is an especially important benefit to nurses who work shifts that potentially preclude them from attending traditional classes.
Some nurses believe that enrolling in an online program means losing out on the networking and interaction opportunities that occur in a traditional classroom. While it is true that actual face-to-face interaction is limited, nurses still have the opportunity to connect and network with other professionals online. The online setting also allows students to network with classmates and faculty from across the country and potentially around the world. As a result, nurses have the opportunity to hear about what’s happening beyond their local area, as well as benefit from the practical experience and knowledge shared by colleagues in other locations. The ability to connect with professionals from different practice settings and to share experiences and challenges is also cited as a unique feature of online learning. And other student resources, such as career advisement and even tech support, are typically as accessible and readily available via online universities as traditional.
While it may be the solution for some, online learning isn’t for everyone. There are students who want or need a traditional learning environment. For instance, an online classroom lacks the nonverbal cues that visual learners prefer. Some students simply need the face-to-face interaction. Many feel most comfortable having conversations in person and not over the phone or via an online discussion.
In addition, online and traditional nursing programs have different communication styles. On the job, nurses are taught to be succinct in their writing style because of the volume of required documentation in electronic records and because much of their work is done via checklists. Nurses who choose online education participate in a more intensive writing program than traditional education offers, since nearly all of the communication online occurs in written form. Prospective students should keep their personal communication style and preferred learning format in mind when selecting a program.
For both traditional and online nursing programs, practicum or clinical experience is required. However, practicum arrangements vary by degree program as well as by institution. Undergraduate practicums in face-to-face programs are usually arranged by the institution, while undergraduates in online programs typically propose the facility and preceptor. For graduate practicums, the trend for both online and face-to-face programs is for the student to propose their facility and preceptor.
No back row
Class participation is a very different dynamic in an online program versus a traditional program. In a traditional classroom, faculty members typically lecture, and grades are often based on exams and papers rather than on classroom participation. On the other hand, an online program places greater emphasis on participation: everyone participates in discussions by posting their thoughts—there is no back row.
The asynchronous online environment is an unexpected benefit for many students, because it allows students to think about what they want to say before they actually say it. Online students have time to reflect on the discussion, and they are actually more engaged. Traditional students who fear public speaking tend to stay silent in class, whereas an online setting can help build confidence in shy individuals or help those for whom English is a second language compose their thoughts before speaking.
Above all else, quality
Regardless of the delivery method, it is important that students find a quality nursing program. When researching which program or type of institution is best, one of the first things prospective students should check is the accreditation. The program should be accredited by either the National League for Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE). Additionally, the school should also have a Higher Learning Commission (HLC) accreditation if it offers doctoral programs, as Ph.D. programs are not NLNAC- or CCNE-accredited.
Let’s Get Quizzical You’ve already given careful thought to that mother-of-all continuing education questions, “Should I go back to school?” Now that you’ve decided to venture down that path, you’re faced with another pressing question: “Online or traditional nursing education?” As with so many important decisions, answering that question comes with a little self-reflection and consideration. Here’s a short quiz to help you figure out which learning environment is best for you.
How much face-to-face interaction with my professor and classmates do I want or need?
What kind of flexibility does my work and family schedule allow for my educational pursuits?
How do I feel about writing-intensive assignments and interactions?
How do I feel about class participation?
Is my home environment conducive to study?
How comfortable am I using the Internet, e-mail, instant messengers, etc.?
How accessible are the closest brick-and-mortar nursing schools?
Another consideration when choosing a nursing program is to look at the level of faculty preparation and experience. Faculty credentials are important, and faculty members should be teaching in their areas of expertise—as established through both academic preparation and experience. Faculty members should be experts, and they should be certified in their areas of practice.
For an online nursing program in particular, it is important to see how long the institution has been in the business of teaching and offering classes online. Many schools are now offering classes online, but that doesn’t mean that their classes are designed for a truly online experience. To provide a high-quality online nursing program, it is necessary for the school to have expert instructional-design knowledge as well as the technology support that online students need.
Above all, prospective nursing students need to be diligent and research the institution. Talk to an enrollment advisor about the program and the various resources available. Also, reach out to faculty members and current students, as well as alumni who have gone through the program. Ask them questions about their experience, course content, and how the degree has helped them succeed. Prospective students can also check out benchmarks with the American Distance Education Consortium (ADEC), the American Federation of Teachers (AFT), and the National Education Association (NEA) to see if the institution they are interested in enrolling in is meeting those benchmarks.
At the end of the day, there is no significant difference between student outcomes for traditional and online nursing programs. Both can provide a rewarding learning experience, but, ultimately, it is up to the student to determine which program and delivery method are best suited to his or her current situation and needs.
Without a doubt, the nursing profession is rooted in scientific knowledge. We diagnose and treat patients based on presenting symptoms, resulting labs, and diagnostic procedures. As nurses and nursing students, we are taught to remain unbiased while caring for patients. However, some nurses and healthcare professionals do not practice this vital quality. Nonetheless, it is crucial to relinquish our personal opinions or preconceived notions about “certain” patients like drug users/seekers because it may prove to be the difference between a misdiagnosis or an epic save. As health care professionals, we see patients at their worst. These individuals are relinquishing a hidden past that may be unknown to their spouse or dearest friend. They may be sharing their darkest secret in hopes of us diagnosing and treating their complaint. So, we must do our due diligence by setting aside our pride and opinions to provide care that is based solely on the case at hand and not by public opinion.
As a nurse practitioner student, I was fortunate to learn from excellent clinicians like Deborah Mitchell, MSN, FNP-BC, and Edgar Brown Jr., MD. They taught me to listen keenly and elicit the patient’s “backstory” (or social history), which can be helpful in formulating potential differential diagnoses. However, they also stressed to me that I must never allow my personal judgment about the patient’s actions sway how I treat him or her. For instance, an African-American gentleman with a history of drug and alcohol abuse presented to the clinic with left upper abdominal pain and chest pain. He reported that he had been experiencing excruciating pain for two weeks. Moreover, he stated that he went to the local emergency department two days earlier because his pain became unbearable. Unfortunately, the clinician on duty was aware of the patient’s social history and diagnosed a muscle spasm and discharged the patient home. The clinician did not order labs, diagnostic exams, or perform any test to support their diagnosis. So, the gentleman sought treatment from Deborah Mitchell, MSN, FNP-BC. As a nurse practitioner student, watching her work was mesmerizing and inspiring. She actively listened to the patient’s story and concern. She shared with the patient that she was sorry about his experience at the ED and that he was not experiencing a muscle spasm, but something much more concerning.
So, she ran a battery of tests and labs. Unfortunately, the EKG results had shown a possible cardiac infarction, which warranted immediate medical intervention. As a result, Edgar Brown Jr., MD, was consulted. Dr. Brown sent the patient to the closest ED for serial troponin labs to rule out a possible cardiac infarction or cardiac ischemia. Moreover, Deborah Mitchell and Dr. Brown agreed that the patient required a stat CT scan of the chest and abdomen. Unfortunately, the CT scan had shown large masses in the patient’s lungs that needed immediate attention. All in all, if Deborah Mitchell and Dr. Brown’s personal judgment influenced their patient’s medical treatment, he may have fallen victim to an unfortunate outcome. As health care professionals, it is not our role to pass judgment upon those who seek our care. Our job is to do no harm. Sadly, sometimes, personal opinions hinder how we provide care to “certain” patients. It is imperative that we provide equal care to all individuals. As a new nurse practitioner, I utilize their teachings and practice methods when providing care to my patients. Health care professionals are not the judge and the jury. Rather, we are the detectives that collect the evidence and build the case.