Advancing your education isn’t a prescription for debt. Here’s how to earn that degree without interest.
One out of 10 Americans has student loan debt. That debt is steadily on the rise, with projections putting the total at $1 trillion this year, according to numbers compiled by Consolidated Credit. That number may seem unfathomable to many, but how big is your slice of that debt pie? Do you view student loans as the only way to fund your nursing education?
If you answered yes, it’s understandable why you may feel that loans just come with the territory of higher education. After all, tuition is at an all-time high—with no signs of slowing down. According to The College Board’s Annual Survey of Colleges, average in-state tuition and fees are $8,893 for public four-year and $3,264 for public two-year institutions. To put those numbers into perspective, the average yearly tuition at a four-year school in the 1980s was $3,449.
If you dream of becoming a nurse or if you are already a nurse and wish to earn an advanced degree (or two), know that you don’t have to contribute to those startling national student debt totals. Take the time to become financially savvy and seek out the right opportunities, and you could come out with substantially less student loan debt than your fellow classmates.
One of the first steps before making decisions about funding your education is to step back and thoroughly research your options. Look at the type of degree you are considering and make sure there is a high enough demand in the job market and job growth projections for that specialty. Also, look at salary averages for your chosen degree/career plan.
“Very few people can afford to pay for college out-of-pocket,” says Tiffany “The Budgetnista” Aliche, author of The One Week Budget: Learn to Create Your Money Management System in 7 Days or Less! “But student loans are avoidable if you plan carefully. Student loan debt in itself is not bad. The problem is that most people chose student loan debt as their first option and it really should be their last.”
Aliche stresses that getting an education is an investment. “What you put in should give you more money back in return, and if it doesn’t then you have made a gross error,” she warns. “If you invest $150,000 and only make $40,000 coming out, that’s a mistake. It doesn’t make sense. For example, if a doctor invests $100,000— that’s OK because they’re probably going to make over $100,000.”
Shannon McNay, community outreach and customer support manager at ReadyForZero, an online debt elimination tool, agrees. “Crunching the numbers is the absolute best way a nurse can decide if he or she should pursue an advanced degree,” she says. “What are the projected earnings for the position a higher degree will get you? Compare the price of the schools you’d go to and see which one you’d pick. If the tuition is equal to one year of the pay, it could be a worthwhile opportunity.”
The college or university you select can instantly drive up or reduce the cost of your education. “People will say ‘go to the best college you can.’ I disagree. I say go to the college that offers you the most money,” argues Aliche. “If you go to this amazing college and they offer you no money [scholarships], and you come out owing hundreds of thousands of dollars, no one cares that you went to Princeton and you don’t have a job. If you work really hard and do internships, you can compensate for not going to a school with a big name. But you can’t compensate for owing $100,000 in debt. And then you’re going to be stuck with a job that you hate because you have to pay off the student loan debt.”
The Importance of a Nursing Education
The Institute of Medicine’s 2010 report The Future of Nursing reported that the Bachelor of Science in Nursing (BSN) degree is the new starting point to get hired as a registered nurse. In fact, according to the findings, nurses with a BSN will increase from 50% to 80% by 2020.
There’s no denying that the higher you go in your nursing education, the higher you can go in your nursing career and earning potential. With our ever-changing health care landscape that is a result of the Affordable Care Act, advanced practice nurses (e.g., nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives) are often primary care providers. Those roles require a master’s or doctorate degree. They also require a large investment of time and money.
Paying for Your Education
Before you sign on the dotted line for that student loan, it’s wise to explore other options for paying for your degree. For starters, look into scholarship opportunities—you may find easy money waiting for someone like you to claim it.
Aliche says that most students never apply for any scholarships. “It’s smart to explore scholarships as many programs offer them but have no applicants, making the competition low,” she explains. “There are a lot of people who say ‘I don’t want to apply’ or ‘I won’t get it.’ Apply, since you may be the only one. There may be three scholarships and three people applied; so by default, you win.”
Another alternative to student loans is to work while you’re in school and pay as you go. Many students can’t go to college full-time and literally work their way through evening and weekend programs. Accelerated master’s programs can be good options for parents who need to maintain employment while working on their degree.
“I think employment during your college/advanced degree experience is a good way to pay for—or at least offset—the cost of tuition, fees, books, and living expenses,” says John Heath, an attorney with Lexington Law, a credit repair firm. “Further, there are employers that will pay for college/advanced degree courses as long as the course fits their respective business model and you meet the criteria expected by the employer.”
If you have exhausted all other options for paying for your education, it’s time to look into student loans to help fill the gaps. But it’s vital that students fully understand the various types of loans and the terms and conditions.
As a general rule of thumb, Aliche advises students to steer clear of private loans because of interest fluctuation. She says federal loans are the best choice because they offer a fixed interest rate and less risk overall.
“With private loans, if you get sick or even if you pass away, you may still owe because, usually with a private loan, you have to get a co-signer—making that person equally responsible for the loan,” explains Aliche. “If you pass away, that person may still have to pay. But with a federal loan, if you pass away or become disabled, your student loan is forgiven. If you can no longer perform those tasks or face financial hardship, you can apply for forbearance, which means they allow you not to pay [on the loan] for six months to a year until you get back on your feet. Private loans do not offer that option. That’s why I tell people, if you’re going to get a loan, try not to get private loans because, when it comes to repaying it, there are very strict guidelines that are not there for federal loans.”
Loan Repayment Programs
Because skilled nurses are in high demand, especially in urban and rural areas, there are programs through the government, nonprofits, and employers offering loan forgiveness to nurses who are willing to work in underserved areas for a specified amount of time.
The US Department of Health and Human Services Health Resources and Services Administration offers the NURSE Corps Loan Repayment Program (http://nhsc.hrsa.gov) for professional registered nurses working in a critical shortage facility. Those accepted receive 60% of their total qualifying nursing education loan balance for two years of service.
National Health Service Corps alumna Tamara Bumpus, MSN, NP-C, a nurse based in Toledo, Ohio, took advantage of the loan repayment program and has already completed her two-year commitment.
“I work for the Neighborhood Health Association, which serves the homeless, and the other office I work at serves the underserved— people with low-to-no insurance,” says Bumpus. “I always heard that there’s money out there. I researched and found that the National Health Service Corps was available, and I applied for it. It seemed like a difficult process at first, but it was more of a waiting game—waiting to see if you were going to be approved or not for the loan reimbursement—and I was approved the first time I applied. There’s nothing better than getting money back after you’ve taken out student loans. I wanted to be a nurse practitioner, and it was so helpful to have that burden removed. If I had known about the scholarships, I would have done that also.”
Smart Budgeting for Repayment
If you already have existing student loans or plan to get one in the future, it’s smart to plan early for how you will repay the debt. Aliche says an old-fashioned budget is the best place to start.
“Include everything from your rent to getting your hair done,” Aliche says. “Before you can pay a loan back, you need to know how much you can afford. So if you add up your money list and your life costs you $2,500 per month and you make $4,000, you will know how much you can afford to make in payments.”
Aliche says that only you can know how much you can truly afford to pay each month— not your lender.
“No one should tell you how much your payment should be, you should tell them,” she argues. “You can say, ‘Honestly, I did my budget and, with my bills, I don’t have $300 per month . I have $150 that I can guarantee.’ It’s a different conversation when you say that. ‘I have a budget and you want me to promise you $300, but you’re not going to get that.’ That’s the kind of conversation that you want to have. You can definitely try to negotiate your monthly payment. It may take you talking to five people on the phone or a week of calling. I know someone whose monthly payment was $900 and she got it down to $400 per month. You can e-mail them a copy of your budget so they can see that you don’t have things like cable. Most people are not having that conversation with their lender, so that’s why it’s easier for someone to say yes to you.”
Another good strategy for those still in school is to make payments now, not after graduation.
“Calculate a small amount of money to pay each month so you can get a head start,” McNay suggests. “You may also want to dedicate some monthly savings to building an emergency fund. If you end up finding a higher-paying job out of state, you’ll want some startup money to get you there. Don’t lose out on opportunities just because you’re not financially ready for them. School is a great time to save.”
McNay says nursing students should stay mindful of what’s available to them after graduation. “If you’re really struggling, the [federal government’s] Income-Based Repayment Program [https://studentaid.ed.gov] can be an absolute lifesaver— yet so few people know about it,” she says. “Stay up-to-date on changes in legislation that can benefit your finances—these changes aren’t just for current students.”
By educating yourself on the various options for funding your education, you can avoid the many pitfalls that land so many students in mountains of debt. Careful planning will allow you to begin to build the life you dream of after you graduate, whether that’s traveling the world or buying a home. The less student loan debt you have, the faster you can finance your other dreams.
Student Loan Do’s and Don’ts
There is so much information out there about student loans. Keep these expert tips in mind to keep your loans in check.
Do Face Your Debt
“If you don’t already know who you owe or how much you owe, drop everything and find out right now. Ignoring the student loans will not make them go away. This website will help you figure it out: www.nslds.ed.gov.” —Shannon McNay, community outreach and customer support manager, ReadyForZero
Do Be Careful When Consolidating
“Do not refinance a federal loan to a private company. All of the protection you get with a federal loan, you will not get it if you refinance with a private company. With a federal loan you can consolidate. So if you have 10 federal loans, they will take the average interest and give you one payment.” —Tiffany “The Budgetnista” Aliche
Do Shop Around
“Pick your top five schools and talk to each of them about the real cost of your degree. Financial aid packages vary greatly, so let the schools make you an offer.” —Matt Kelly, founder, Momentum: Personal Finance Coaching
Don’t Waste Refund Checks
“If you get back $2,000, some people think that’s free money. No, that’s money that you owe. If you don’t need that money, send it back. That will lower how much you owe when you get out of school.” —Tiffany “The Budgetnista” Aliche
Don’t Overborrow
“It’s a mistake to take a large amount (more than needed) of student loans to maintain the lifestyle you were accustomed to at your parents’ house. It is better to live like a student while you are a student than to live like a student after you have graduated because of your large student loan payment.” —John Heath, attorney at Lexington Law
Denene Brox is a freelance writer based in Kansas City, Kansas.
Sharon Tissell, RN, dreamed of one day helping those around the world without the fortune of growing up in a loving, middle-class family like hers. Tim Harrison, RN, MPH, flew for 10 years with a medical helicopter service and knew he had the right skill set to make a difference. Martina Ford found that she thrived in multicultural settings.
All three of these nurses have found their professional sweet spot, which, at most, pays them a modest stipend and requires them to endure Spartan—and often dangerous—living conditions for months at a time. They are humanitarian medical relief nurses who make multiple trips each year to the very places we see in the news that we are told to avoid.
Places like the Syrian-Lebanese border, which is experiencing the largest exodus of refugees in recent history as Syrians flee their country after a brutal government crackdown and civil war began in 2011. Or South Sudan, Africa’s newest nation where ethnic rivalries have destabilized a fragile government and led to violence, bloodshed, and the internal displacement of tens of thousands. Or the Philippines, where Typhoon Haiyan flattened towns and villages, crippling a country’s capacity to deliver basic services and medical care to its people.
What motivates Tissell, Harrison, and Ford to return to these situations time and again is the opportunity to offer unconditional care, comfort, and compassion to the world’s most vulnerable populations. Across vast geographic, cultural, and ethnic boundaries, their work goes to the heart of what nursing is.
They don’t let politics and war keep them away, although these are often the factors fueling the crises at hand. While fearless, humanitarian relief nurses are hardly reckless, receiving intensive security training from their sponsoring organizations and working on highly coordinated teams where personal safety is valued above all else. Moreover, these nurses hardly see what they do as a personal sacrifice.
“It’s not about you,” says Harrison, a nurse with Médicins Sans Frontières (MSF), or Doctors Without Borders, who lives in Maine when he is not traveling for MSF. “It’s really about the direct connection between donors [of humanitarian aid] and beneficiaries. You’re simply the conduit.”
Wearing Multiple Hats
While nursing can be a satisfying career, it also runs the risk of being repetitious; working internationally can be a “way to break out of the doldrums going into your shift every day,” says Sue Averill, RN, cofounder and president of One Nurse At a Time, an organization that provides information and scholarships to nurses who want to work in humanitarian relief. Averill herself has gone on eight missions with MSF and several others with Medical Teams International (MTI), based in Tigard, Oregon, and with Smile Train, based in New York City.
Averill says experiences in the ER, ICU, surgical, and critical care floors are great preparation, as are courses in public health and tropical diseases such as Dengue fever, malaria, and others rarely seen in the West.
Also invaluable are critical thinking skills that empower you to be resourceful and in situations where supplies, medicines, and equipment are limited. Reorienting yourself to medicines that may be similar to those in American hospitals but with different branding, dosage levels, and packaging is also key.
Being able to communicate crossculturally and understanding cultural biases are as important as having strong medical training, Averill says. For example, a small white pill may be perceived to be inferior to a large white pill or a colored capsule in certain cultures. Local people and medical staff may “imbue [Western nurses] with qualities [they] may or may not have,” she adds. “People believe that simply because you came across the world to help them that you come with something better than they have,” even when that may not be the case.
That’s why it’s critical to have frequent conversations with patients to understand cultural biases and figure out how to work around them. One major strategy is to make sure you and your translator are “on the same page,” suggests Averill.
Relief work also requires nurses to wear multiple hats, she adds: “You’re a human resources person. You’re diagnosing and treating. You’re hiring and firing.” But perhaps most importantly, you’re teaching local people to think critically.
Averill was once tasked with setting up a hospital for Darfurian refugees in an isolated village on the border between Western Sudan and Chad. The endeavor required training local workers, including a woman who said she was a traditional birth attendant. After asking the attendant how many weeks pregnant a local woman was, the attendant said “36,” when the woman was nowhere near full-term. It was then that Averill realized that the attendant was unable to count.
In a similar vein, other workers claimed to know how to take pulses and blood pressures, but in fact didn’t understand how to do either. Another worker wore the same pair of gloves as she screened patients for malaria.
“They were doing these tasks rotely and not understanding what they mean,” Averill says. “That critical thinking piece wasn’t there.”
So, Averill went over the basics, teaching the staff how to take vital signs, the importance of glove disposal and frequent hand washing, and how to do A/B/O typing for blood transfusions. “It was really fun to see the light bulb go on,” Averill says, similar to the one going off in her own head as she stretched her own skill set.
Similarly, Ford had little experience in obstetrics before traveling with MTI to the Nakivale Refugee Settlement in Uganda last year. The local midwives were eager to see a “muzungu,” or white person, to deliver a refugee woman’s baby. So with “no IV, no monitors, no electricity,” Ford says she stepped up to the plate and did it. “It was mind-blowing.”
“When you’re talking to people about going on these trips, many people like the idea of it,” she adds. “But nothing is what you think it’s going to be.”
Street Smarts
Having a successful experience as a humanitarian relief nurse also requires emotional fortitude, flexibility, and the ability to think on your feet, says Harrison. Being a medical transport nurse for Boston MedFlight not only gave him a broad skill set in obstetrics, pediatrics, and trauma care, but also taught him the importance of teamwork and maintaining equilibrium in situations that are fluid and unpredictable.
Harrison first encountered MSF in 2004 working on a volunteer assignment in Chad with another medical assistance organization. What impressed him about MSF was its long-term investment in communities lacking the medical infrastructure to contend with disease outbreaks and public health emergencies. He also observed that MSF didn’t do “drop-in medicine” like other relief organizations did, allowing it to have a larger impact; he also admired MSF’s independence from government funding and its neutral stance towards political debates and conflicts. With several international assistance trips under his belt, he decided to apply for a full-time nursing position with MSF.
After a lengthy interview process with MSF, Harrison was accepted in 2008 and left Boston MedFlight with the blessings of his boss. That year, Zimbabwe was being devastated by a cholera epidemic caused by the breakdown of water sanitation and sewage systems in urban areas; the disease spread quickly to the countryside after city-dwellers visited relatives in rural areas.
Harrison’s first assignment was to manage a database that tracked the epidemic as it moved from cities to towns and villages. Later on, he joined a team responding to malnutrition and cholera in prisons around Harare, the country’s capital. Rather than focusing on the prison’s water delivery system, the MSF team focused on chlorinating the water supply, boosting the immune systems of prisoners through antibiotics and nutritional therapy, and getting infected prisoners into treatment.
After six years with MSF and multiple trips to conflict zones throughout Africa, Harrison says the work brings out his street smarts. “I seem to have the mentality that [MSF] can put me some place in the world and I can work out what’s going on,” he says.
At no other time was Harrison’s even-keeled temperament tested more than a harrowing trip to South Sudan late last year. His experience also underscores how rapidly the situation on the ground can change and the importance of staying alert and in contact with team members.
Since 2009, Harrison has made trips to South Sudan, which achieved independence from Sudan in 2011 after a protracted civil war between rival ethnic groups. MSF has had a strong presence in the region since 1983, delivering primary and secondary health care in clinics and hospitals in several major cities including Juba, the capital, as well as Lankien, Bor, Bentiu, and Malakal.
On his first trip in 2009, Harrison went to Lankien to oversee a feeding center for malnourished residents. He spent time training local hospital staff who had little or no medical training. After a brief trip to the region in 2010, he returned to Malakal in October 2013 to see the fruits of MSF’s investment in the local workforce. “You could really see the change,” he remembers. “I had skilled people working for me.”
As with his previous trips, Harrison was assigned to one of MSF’s kala azar treatment centers within the Malakal Teaching Hospital. Kala azar, a tropical disease that attacks the immune system and is fatal if untreated, is transmitted to humans through sand flies, carriers of the leishmania parasite. The disease persists in Sudan despite MSF’s long-established kala azar clinics.
On December 15, 2013, a coup was attempted on President Salva Kiir’s postindependence administration after long-simmering tensions between rival ethnic groups, the Dinka and Nuer, exploded. A Dinka, President Kirr accused Vice President and Nuer politician Riek Machar of instigating the coup. The military began splintering along ethnic lines, and armed conflict began spreading from Juba to other regions.
By the week of Christmas, the fighting had reached Malakal. Harrison and an Amsterdam-based MSF team were hunkered down in their rented house in the middle of Malakal’s downtown marketplace, gunfire and mortars exploding around them. Harrison and others had been staying in touch with MSF outposts in Juba and other cities to get the latest news. “By the time it became obvious something was going to happen, we couldn’t get out,” he recalls.
The group managed to move down the street to a house rented by an MSF team from Spain. Altogether, there were nine MSF team members who had remained in Malakal, holed up in a 12 x 12 room for 36 hours until Christmas Day, when the shooting began to dissipate. By Thursday, the day after Christmas, the teams decided to make their way back to the Malakal Teaching Hospital to assist an International Committee of the Red Cross (ICRC) surgical team with a brand new set of patients: soldiers and civilians wounded in the crossfire.
When he returned to the hospital, Harrison noticed that many of the healthier kala azar patients had simply fled. He quickly switched gears and helped set up a 60-bed triage unit to deal with the sheer numbers of wounded streaming into the hospital. With his experience as a trauma nurse, Harrison jumped in to assist the ICRC surgeons with anesthesia, wound debridement, IVs, and “whatever was needed.”
Harrison’s work continued on like this until mid-January, but what was becoming painfully obvious was the deterioration of the security situation inside the hospital. Initially, the soldiers agreed not to bring their guns inside, but soon, guns and “cases of whisky” could be found on the hospital grounds. Family members of the wounded and refugees from Malakal soon began overrunning the hospital to escape the violence.
“At one point, there were 1,000 people in the hospital,” Harrison says. “It had become an IDP [Internally Displaced Persons] camp.”
What finally convinced Harrison and his fellow MSF team members who had remained in Malakal that staying was no longer an option was when teams in both MSF residences took a hit. The Spanish team was robbed of their mobile phones and laptops at gun-point by an armed group; a drunken soldier burst into the compound where Harrison and the rest of the Amsterdam team were staying and started shooting in the air. The house’s security staff talked the soldier down and got him to leave. The next day, Harrison and the entire MSF team headed to a United Nations compound outside of Malakal and were on a flight out of the county soon after.
Harrison says the decision to leave was wrenching, but one that ultimately made sense given the escalating conflict. The hardest part was wondering whether the work could be continued by the hospital’s local staff, many of whom said that it probably wouldn’t. (By February, MSF had to suspend its activities at Malakal Teaching Hospital, according to a recent MSF report.) Still, the team’s departure weighs on his mind: “How does this look that you’re having to flee? You can always leave. You can always go home. What about the people left behind?”
A Higher Purpose
Tissell remembers clearly what inspired her to work internationally: the National
Geographic magazines her parents subscribed to at the family’s home in Kerkhoven, Minnesota. As she perused stories about hardship and traditional cultures from all over the world, she began to realize that “not everyone had the same upbringing as me.”
Her parents, now in their 80s and extremely supportive of her work with MTI, gave Tissell both a great childhood and self-awareness. “I had a strong sense as a young person that I had a whole lot and [some] people had nothing,” she says.
Ford, too, was deeply affected by the unequal distribution of medical care throughout the world. As a childhood survivor of uterine cancer, Ford pursued nursing because of wonderful care she received at a children’s hospital in Portland. “I have a lot of guilt related to inequalities in medicine and education,” she says. She channels her guilt into providing medical assistance and communicating across cultures through trips with MTI.
With her propensity to help those in need, nursing was a natural fit for Tissell. When her eldest of four children turned 17 in 1999, she decided to join an MTI month-long trip to Honduras to set up mobile medical clinics in remote villages destroyed by Hurricane Mitch. The last two weeks, Tissell’s team packed their medicine and supplies and rode mules into the dense jungles of the Mosquito Coast. “We saw a lot of Dengue fever, malaria, a lot of infections from injuries, upper respiratory infections…and childhood disease that hadn’t be treated with vaccines,” she recalls.
Over the next 15 years, Tissell went on more than a dozen medical trips with MTI. She now works shifts at two different hospitals to accommodate and subsidize her travel.
Through her work, Tissell has provided medical care to refugee communities around the world uprooted by high-profile natural disasters and wars. She has treated famine-stricken Somali families seeking refuge in Ethiopia. She served in an IDP camp in northern Uganda to receive malnourished women and children who had fled the terror of Joseph Kony and his Lord’s Resistance Army. On a trip with Los Angeles-based International Medical Corps, she was treating civilians at hospitals in Libya just days before Colonel Quaddafi was captured and killed. And she was in a tented settlement in Lebanon’s Bekaa Valley in May 2013 providing medical care to the thousands of middle-class families from Damascus and other Syrian cities streaming across the border after President Bashar al-Assad began shelling his own people.
The families, who had left homes and careers behind, weren’t suffering from exotic diseases, but rather chronic illnesses such as lymphoma, diabetes, and heart disease that they were unable to treat without access to medicines and regular medical care. “One woman said, ‘We lived in a nice house, we had three bedrooms,’” Tissell says. “This was a total disruption of what their life had been like.”
Each time she returns to her home in Happy Valley, Oregon, Tissell arrives with photos and memories of the families she has helped. Motivated by a strong sense of divine purpose, Tissell says she is perennially awe-struck by the gratitude expressed by people who have just lost everything—and in many cases, everyone. She says she’ll never forget a Congolese woman she met in Uganda whose husband had just been shot during an outbreak of violence in their native country. When she asked the woman if she thought God had abandoned her, the woman turned to her and said, “Of course He hasn’t. Otherwise you wouldn’t have made it here.”
Archana Pyati lives in Silver Spring, Maryland, and writes frequently on health and science topics.
“Keeping an open mind” is probably one of the most clichéd expressions within the English lexicon. Yet, when I placed that phrase into action, it sparked my nursing career. I hope that my message will allow others, especially new graduate, millennial registered nurses like myself, to consider a growing yet still relatively small aspect of nursing: home care/visiting nursing.
Like countless other children and teenagers, I had many different career aspirations. However, in retrospect, my becoming a RN is not an extreme surprise. Being the son of Afro-Trinidadian immigrants and growing up in the predominately African American/Caribbean neighborhoods of Central Brooklyn in New York City, I had decent exposure to the health care industry. While it is a generalization, it is common to see many Afro-Caribbeans (e.g., Haitians, Jamaicans, and Trinidadians) in New York City working within health care, ranging from nursing assistants to LPNs, RNs, and so forth. With that assertion, I indeed have family members and friends of my parents who are active in these occupations.
After I finished high school, I did more research on health careers, specifically nursing. Of course, I was not ignorant of the fact that nursing is a profession dominated by women and that, unfortunately, there are myths and stereotypes about men who enter into the profession. Being a man, especially a young African American man, I knew that I was not the image that most people would think of in regards to being a nurse. Nevertheless, I kept an open mind. I enrolled at New York City College of Technology in Brooklyn, and I was eventually accepted into the nursing program.
Without a doubt, nursing school was the hardest academic endeavor that I have experienced thus far in my life. It took me time to adjust from a standard memorization model of learning to the analytical and critical-thinking process that is the essence of nursing school. There were times when I wondered if I could ever get that cognitive skill. Of course, despite the fact that I was in school, the process of life still went on. From my anxieties about my future to dealing with illness and death in my family (two of my relatives passed away in roughly a three-month span), nursing school was not easy for me. However, with perseverance, I graduated with my associate’s degree in nursing in January 2011 and passed the NCLEX later that year. I returned to New York City College of Technology to complete the RN-to-BSN program and received my BSN in 2013.
Despite holding my BSN degree, I still found it challenging to find employment with the hospitals in New York City. While I obviously had the degree requirement, I lacked the RN experience that was specified for a majority of the jobs. Also, by speaking with some of my colleagues who were also having issues with nursing employment, I knew that I was not suffering from random bad luck. There were indeed structural issues—things beyond my control—that were affecting the nursing job market. While I was never depressed during this time, it did hurt to some extent to have a viable degree yet no tangible evidence (e.g., a nursing job) to show for it.
To quote the late R&B singer Marvin Gaye, I “heard it through the grapevine” from some of my colleagues about visiting nursing with home health agencies. While it is true that some home health organizations want an experienced nurse (hospital or otherwise), I heard that some organizations were willing to take new graduates and train them as needed for their nursing duties. Even though the thought of going into clients’ homes did not seem overly appealing, given my limited employment options, I once again kept an open mind and did my research. I found organizations within my district of New York City that were willing to take recent graduates.
Currently, I work with three different Licensed Home Care Services Agencies (LHCSA): ValuCare, PellaCare, and The Royal Care, all of which are based in Brooklyn. The crux of my duties as a LHCSA RN includes making a full physical assessment of the client, inspecting their home environment, and viewing their active medications for compliance and side effects. In addition to those tasks, I contact their respective physicians to get pertinent data and give current information. Then, I craft a care plan for the home health aide to follow to assist clients with their needs, from helping them with activities of daily living to calling the EMT/paramedics for emergencies.
Like any subdivision of nursing, there are pros and cons with being a LHCSA RN. For cons, you never know what you might encounter in a client’s home, and being a New Yorker, I do go to some districts that suffer from urban decay. However, the benefits definitely outweigh the negatives. I am able to create my own schedule. If you live in a city with a decent mass transit system like my hometown, you can use the bus, subway, or tram instead of a car. And due to New York’s diversity, I get to see clients of all backgrounds. As minority nurses, being in this role allows us to give back to our respective communities by being agents of preventive care and health advocacy that will hopefully alleviate some of the ailments that afflict minority populations. Finally, with national health care reform, this area of nursing is growing.
Obviously, being a LHCSA RN is not for everybody. If you love the hospital, nursing home, or another clinical setting, then do what is right for you. Nevertheless, given the somewhat tough job market for new nurses, let life be a lesson as it unfolds and keep an open mind.
Brandon Archer, RN, BSN, graduated from New York City College of Technology in 2013 and currently works as a LHCSA RN. He lives in the New York City borough of Brooklyn.
Nursing can be physically taxing on the body, putting your health, and ultimately your finances in jeopardy. This can all be avoided by taking steps to being healthy, wealthy, and wise.
Every nurse needs to be healthy, wealthy, and wise to sustain a long, productive, and financially rewarding career.
How is this achieved?
Taking care of yourself: This means losing the extra 20 lbs you’re carrying by making healthier food choices and exercising. Taking care of yourself also includes cutting out bad habits such as smoking and binge drinking on the weekends. Getting enough sleep is also important and everyone should strive for at least 7 hours per night. Nurses are also notoriously known to not drink enough water when working. Drink up and aim for at least half your weight in ounces daily. Water helps aid in weight loss, flushes out toxins, and keeps you from getting UTI’s during those long shifts.
Saving for the future: Everyone, nurse or not, needs to have a savings account. There are many types of savings accounts, but for the sake of simplicity nurses need to have at least two. The first major account you need a retirement fund. Take full advantage of your employers company match if they have one…it’s free money! The second account you need is an emergency fund. Experts suggest having at least 3-6 months worth of living expenses in this account, but you can start with saving $1,000. If something unexpectedly comes up; ie: loss of employment, sickness, vehicle breakdown, ect, you will have the money and won’t be near as stressed due to finances if you didn’t have an emergency fund.
Education: Education is the key to getting ahead in life and in your career. I’m not necessarily talking formal education here, although formal education has its place. The type of education I’m talking about is the life-long learning that a nurse must do to keep up with advances in healthcare. Be proactive with your education and seek out new learning experiences that will make you a valuable asset to the healthcare team. If you’re in an environment and someone is offering to train you on a new skill…do it! More education may lead to more money for you in the long run, helping you meet your wealthy goal more quickly.
In addition to working as a FNP, Nachole Johnson is a freelance copywriter and an author with her first book, You’re a Nurse and Want to Start Your Own Business? The Complete Guide, available on Amazon. Visit her ReNursing blog at www.renursing.com for more ideas on how to reinvent your career.
Racially and ethnically diverse populations have grown in the US. The US Census Bureau finds that approximately 37% of the population is made up of minority groups. Nurses currently make up the largest group of health care professionals in the US, and the need for culturally diverse nurses in the workplace has been identified by many nursing leaders. The demand for culturally competent care has brought attention to the need for culturally diverse nurses. Several studies have identified that failure to provide culturally competent care can influence health outcomes. A 2009 study published in Health Affairs found that increasing minority representation in the health care workforce could have a positive effect on curbing the health care disparities found in minority populations.
The need for culturally competent health care highlights the need for a diverse nursing workforce, particularly since patients tend to migrate towards providers that share their ethnic background. Minority nurses and possibly advanced practice nurses are in a position to help these often underserved minority communities receive care that will increase their likelihood of compliance with medical treatment and increased health literacy.
Additionally, implementation of the Affordable Care Act will allow for the expansion of health insurance to historically underserved populations. This expansion will require an increase in the number of health care professionals available to care for these populations.
Of the almost 3 million registered nurses in the US, approximately 133,000 are black and 55,000 are Hispanic. A 2013 study published in Journal of Transcultural Nursing reveals that minority students account for about 27% of the students in undergraduate schools of nursing. The low number of minority students represented in the undergraduate nursing school enrollment numbers highlights the difficulty noted by graduate schools when it comes to attracting and enrolling minority registered nurses.
Federal initiatives like the Promoting Postbaccalaureate Opportunities for Hispanic Americans program authorized under Title V of the Higher Education Act of 1965 are designed to expand postbaccalaureate opportunities and academic offerings for universities that are educating the majority of postsecondary Hispanic students. According to a 2010 brief published by Excelencia in Education, there were 176 emerging Hispanic-Serving Institutions (HSIs) in 2007. Federal law requires that in order to receive a designation as a HSI, an institution must have at least 25% Hispanic undergraduate enrollment. Emerging HSIs are those with Hispanic enrollment within the range of 12% to 24% and have the potential to become HSIs over the next few years. The HSI designation allows an institution to qualify for grants and other modes of funding. A 2010 study published in Journal of Latinos and Education found that, behind funding, the most important issue facing the presidents of HSIs was the lack of academic preparedness of the students.
Challenges are faced by Hispanic nurses desiring to pursue advanced nursing degrees. Like undergraduate enrollment, the number of registered nurses with baccalaureate degrees applying for advanced practice nursing tracts is low. There are four HSI institutions that offer nurse anesthesia in these fine programs: University of Miami, Kaiser Permanente / California State University, Inter-American University of Puerto Rico, and the University of Puerto Rico. A relatively large Hispanic applicant cohort of prospective students submit to these diverse nurse anesthesia programs along with other urban located institutions within the US. A barrier that some underrepresented students encounter is the lack of academic preparedness and/or lackluster graduate exam scores. This lack of academic preparedness equals fewer applicants who are adequately prepared for undergraduate and graduate education. In the event that a student is successful in an undergraduate program, lack of preparedness could lead to the preparation of a graduate application packet that is not representative of the candidate’s true potential.
Optimization of the nurse anesthesia program application packet can mean the difference between acceptance and rejection. The graduate application for nurse anesthesia school normally contains many components. The application is the first glimpse of the candidate presented to the admission committee. One crucial component of the process is the essay. The essay should contain information that the candidate wants to express describing his or her participation in leadership and extracurricular activities. Admission committee members take note of well-rounded candidates. Candidates should include evidence of involvement in professional nursing organizations and hospital committees. These types of activities highlight the candidate’s desire for professional development. The essay should be edited for grammar, spelling, and content before the packet is submitted to ensure that the candidate appreciates attention to detail.
The construction of a comprehensive application will most likely yield an interview, but the interview process can be intimidating. Most admission committees attempt to evaluate the student’s preparedness for the rigors of the program. The types of questions revolve around principles of physiology, pathophysiology, and pharmacology. Candidates who recognize their deficiency in interviewing should seek out opportunities to practice these techniques. Career centers may offer opportunities to hone interviewing skills.
Prospective students tend to focus on securing a seat in a nurse anesthesia program, but it is unclear how many actually consider the rigorous nature of the program. The amount of preparation that goes into the admission to a nurse anesthesia program is only minimized by the challenges of the didactic and clinical experiences for a new student. These challenges should be considered in conjunction with other stressors that can include financial obligations, reduction of income, and family responsibilities.
How to Strengthen your Application and Secure an Interview
According to the American Association of Nurse Anesthetists (AANA)’s 2012 demographics of nurse anesthetists in the United States and Puerto Rico, as an aggregate number, there is less than 10% of underrepresented minority nurse anesthetists from the 44,000 advanced practice nurses practicing in hospitals, surgery and endoscopy centers, and dental and pain management offices. Less than 3%, 3.2%, and 0.5% are from Hispanic, African American, and American Indian groups, respectively. To learn more about becoming a certified registered nurse anesthetist (CRNA), visit www.aana.com/ceandeducation/becomeacrna. Here, students will find information about the requirements of becoming a CRNA as well as a list of accredited nurse anesthesia programs, frequently asked questions, and a list of related published articles. It is imperative that prospective applicants into a nurse anesthesia program peruse not only the nurse anesthesia program of interest website, but also our national nurse anesthesia association website.
It is vitally important that underrepresented minority nurses learn more about the history of nurse anesthesia and national implications of advocacy. The book Watchful Care by Marianne Bankert is a great resource. It will expand your knowledge about nurse anesthetists and prepare you adequately for the interview, if the admission committee members ask any questions about this well-read topic. The top candidates definitely shine during the interview if they have read this material.
Another way to strengthen your application is to include your shadowing experience with a CRNA in the operating room. You should contact the CRNA and ask to meet him or her in the operating room on an agreed time. Be prepared to witness the CRNA prepare the room by checking the anesthesia machine and related equipment as well as prepare medications for the planned anesthetic prior to a patient’s arrival in the operating room. In addition, you will witness the CRNA interview the patient extensively about his or her medical and surgical history, review and secure the anesthesia consent, and perform an oral exam to assess a Mallampati score (I – IV) to anticipate an easy or difficult intubation prior to entering the operating room. During the shadowing experience, ask plenty of questions about what type of anesthetic is being administered (such as general, regional, or sedation), fluid management, positioning considerations, and more.
Along with learning the history of nurse anesthesia, as a critical care nurse with a baccalaureate degree, you should study and schedule the critical care registered nurse (CCRN) exam offered by the American Academy of Critical Care Nurses (AACN). Information regarding this exam can be found on the AACN website (www.aacn.org). This test demonstrates aptitude in critical care nursing and professional commitment towards excellence. A significant number of nurse anesthesia programs require applicants to earn critical care experience and sit for and pass the CCRN exam prior to actual submission of the essay for a nurse anesthesia program.
Another viable option for underrepresented minority nurses to improve the application process, handle the stressful interview, comply with the rigor of a nurse anesthesia program, excel for clinical preparedness, and learn about doctoral programs in nurse anesthesia programs is to register and attend Diversity CRNA Information Sessions & Airway Simulation Labs scheduled in 2014. This event, sponsored by the Diversity in Nurse Anesthesia Program (www.diversitycrna.org), offers an opportunity to those interested in nurse anesthesia education to fully engage oneself and learn comprehensive information about the process, network, and participate in a hands-on simulation experience in the lab. You will also have the opportunity and access to meet four nurse anesthesia program directors, AANA senior leadership, minority CRNAs, and nurse anesthesia students from across the country. As a result, you will have the ability to include details about your experience in your eventual essay and articulate it during your interview.
An additional application requirement of some anesthesia programs is the Graduate Record Examination (GRE). It is incumbent of any prospective applicant to visit the GRE website (http://www.ets.org/gre) to learn about the comprehensive information about the scores and the actual make-up of the exam (verbal reasoning, quantitative reasoning, and analytical writing).
So, now it is up to you. Will you peruse through the suggested websites to broaden your knowledge base about proper preparation for entry into nurse anesthesia? Do you want to be a competitive applicant for a nurse anesthesia program? Do you want to be academically and clinically prepared for such a program? If you answered yes to these questions, be proactive in your educational goals to advance your professional development in a nurse anesthesia program. You can do it!
Wallena Gould, CRNA, EdD, is the founder and chair of the Diversity in Nurse Anesthesia Mentorship Program (www.diversitycrna.org) and chief nurse anesthetist at Mainline Endoscopy Centers.
Martina Steed is a CRNA and Associate professor and Assistant director in the Department of Nurse Anesthesia at Webster University in St Louis, Missouri. She is also a small business owner and PhD candidate in the College of Health Sciences at Walden University.
