Nursing is entering an era of great transformation that is driven by three major changes: an aging baby boomer population; the ongoing impact of the Affordable Care Act (ACA); and rising educational goals for the profession, including greater emphasis on the bachelor’s of science in nursing (BSN) and advanced practice nursing (APN) degrees.
For minority nurses, these changes bring a variety of benefits, as well as some possible drawbacks.
The aging of the baby boomers is expected to produce a plethora of new nursing jobs, which could lead to higher wages, greater job security, and greater variety in types of work. By the same token, this deluge of new patients could put new strains on the nursing workforce, possibly leading to higher patient-to-nurse ratios.
The health care law is changing the way nurses deliver care—emphasizing more outreach into the community and closer collaboration with patients. These changes could boost the need for nurses from the same cultural background as patients, at a time when African Americans and Hispanics are underrepresented in nursing. But the changes also mean less work for nurses in the traditional hospital setting.
Finally, nurses will have greater opportunities to advance their careers by going back to school for more training; APNs, and especially nurse practitioners (NPs), are already in great demand to cope with a growing physician shortage. However, having to spend more time in school may be challenging for nurses with limited finances.
Nursing is embracing these fundamental changes to keep pace with a rapidly evolving health care system, says Jo Ann Webb, RN, MHA, senior director of federal relations and policy at the American Organization of Nurse Executives. “Health care is changing, and nursing has to change with it.”
Baby Boom Changes Postponed, But Not Cancelled
For several years now, the profession has been bracing for a massive shortage of nurses, but it’s been slow to materialize.
The massive baby boomer generation, making up almost one-third of the population, began to turn age 65 in 2011. As they continue to get older, both supply and demand of nurses will be affected in a big way. On the supply side, retiring baby boomer nurses will empty the ranks of the profession. On the demand side, aging baby boomer patients will need more nursing to manage their declining health.
Yet, these massive changes were postponed by the 2008-2009 recession and the weak economy that followed, argues Marcia Faller, RN, PhD, chief clinical officer for AMN Healthcare, a health care staffing company based in San Diego.
Aging nurses, short on household funds, held off retiring and even came out of retirement to work again. Meanwhile, the aging patients have put off care, flattening the demand for health services. “Everybody is trying to figure how these changes will play out,” says Faller, who led a major AMN Healthcare survey on registered nurses in 2013.
But as a result of this delay, new nurses who had expected a strong jobs market have struggled to find openings. For example, a Denver TV station reported in 2013 that, of 752 openings for RNs in Colorado at that time, only four were for new graduates.
Lack of jobs has been especially hard on minority nurses, many of whom lack savings to fall back on. With their careers sidetracked, they’ve had to take non-RN jobs in health care or in completely unrelated fields.
In a new graduate hiring survey, the California Institute for Nursing & Health Care reported that in 2012–2013, the latest year available, a little over 40% of new RN graduates in the state hadn’t found an RN job—only a slight improvement over the previous three years. Of those who didn’t find RN jobs, 20% were working in non-RN roles in health care and 23% took jobs outside health care. The rest went back to school or volunteered in health care at no pay.
Many new graduates are angry and mistrustful. In a 2013 survey by two nursing professors at Molloy College, which was published by the National Student Nurses’ Association, many new RN grads thought the nursing shortage was just a “myth,” created by nursing schools to attract more students.
The impending nurse shortage, however, is not going away, says Mary H. Hill, PhD, RN, nursing professor and assistant provost of Howard University in Washington, DC. Aging patients can’t continue to delay treatment and aging nurses can’t continue to put off retirement. Indeed, states like Texas and many rural areas are already encountering shortages. “Nursing has experienced some challenges, but even greater challenges lie ahead as the baby boomers retire and leave the nursing workforce,” says Hill.
The need for more nurses will be overwhelming, according to the US Bureau of Labor Statistics (BLS). In a recent occupational outlook report, the BLS said there will need to be about 500,000 more nursing positions by 2022. In addition, about 500,000 baby boomer nurses are expected to retire over that same time period, meaning that over 1 million new nurses will be needed over the next decade, according to the BLS.
That means that the hospitals and other employers who are now rejecting young applicants will end up begging for them to apply, which could push up nurses’ wages. Hospitals could also simply pile more work onto existing nurses, but doing so would be unworkable in the long run.
Nursing schools have been pushing hard to expand class size so there will be enough nurses for this tsunami of demand. But they’ve had to turn applicants away, due to a lack of nurse educators. Nursing schools in New York, for example, rejected 2,900 qualified applicants in 2012, more than in any year since 2005, according to the Healthcare Association of New York State (HANYS). Many of these spurned applicants have probably moved on to other careers, which is a great loss for nursing.
Repercussions of the Affordable Care Act
Like the baby boom, the health care law represents another great sea change for nursing and is also still in its early stages. The full impact of the ACA “hasn’t shaken out yet,” according to Webb.
Beginning in January 2014, millions of Americans gained coverage under Medicaid and in subsidized policies sold on the new health insurance exchanges. But it’s still unclear how much these people will boost demand for health care and thus nurse hiring. Exchange policies tend to have very high deductibles, discouraging people from getting care. Additionally, millions of Americans still haven’t signed up, despite a federal requirement to do so. The penalties in the first year were fairly minor but will rise in succeeding years, which may boost coverage.
The elephant in the room, of course, is Republican opposition to the law. Republicans continue to promise repeal, and it could happen since they’ve gained control of the Senate and the House. In the meantime, however, this sweeping law is fundamentally changing the face of health care in this country—not just in terms of sheer numbers of patients, but also in the way it is delivered. And in another few years, it would be very hard to turn these changes back.
“I’m not saying it’s a perfect law,” says Webb, “but it has, in my view, put nursing on the map. Nurses have a bigger role now.” Accountable care organizations and patient-centered medical homes are new models of care that are encouraged by the ACA. Both models reward hospitals and other providers that coordinate care and provide more patient education—two areas where nurses excel.
“The ACA emphasizes primary and secondary prevention and education of patients,” says Shawona Daniel, MSN, CRNP, assistant professor of nursing at Tuskegee University, a historically black institution in Alabama. “Education is one of the most important nursing roles. I’d say 90% of what nurses do involves teaching patients and working on preventive issues, which helps keep patients out of the hospital.”
Webb added that working in medical homes requires computer skills in order to deal with electronic health records and telehealth services, such as e-mailing and Skyping patients, as well as using remote monitoring devices. “These patients need monitoring, and this is where nursing is really critical,” she argues.
The Shift Away From Hospitals
Daniel reported that virtually all of her students still expect to work in a hospital—at least initially. But the ACA favors new models of care outside the hospital. For example, Medicare is reducing hospital reimbursements, and hospitals are being penalized for readmissions within 30 days.
“There is an ongoing shift from inpatient to more community-based outpatient care,” says Hill.
Faller agreed with this assessment. “Only the sickest of the sick will be in the hospital, and care will flow out into the community,” she explains. As health care moves out of the hospital, home health is already a growing field, and it has become a magnet for telehealth and other high-tech services, she adds.
In addition, Hill says nurses will be able to find ample jobs at dialysis centers, community health centers, physicians’ offices, outpatient surgery centers, and pain management clinics, to name a few settings. “There are just so many opportunities,” she argues.
As part of the de-emphasis on hospital care, many patients are being discharged earlier and placed in long-term acute care (LTAC) facilities, where they spend many weeks often still on ventilators and IVs. Care in the LTACs is “complex and challenging,” says Joseph Morris, CNS, GNP, PhD, director of nursing and allied health at Victor Valley College in Victorville, California. “Nurses who work in these facilities require advanced skills, such as advanced cardiac life support and telemetry training.”
Morris, who is trained in gerontology, welcomes the influx of aging baby boomers. Many nurses seem to feel that a geriatrics career—which can mean working in a nursing home—means “lowering your sights,” he says, but he disagrees. “It’s clinically challenging because you’re more likely to see multiple health problems.”
Dealing with older patients is also personally rewarding. Morris, who is African American, has fond memories of taking care of elderly black men in Detroit. In contrast to the stereotype of geriatric patients sitting in their wheelchairs muttering to themselves, “most geriatric patients are still active,” he says.
Nurses Get More Training
The job market is beginning to favor nurses who have a BSN degree, and advanced practice nurses such as NPs are in great demand.
Both trends earned key endorsements from the Institute of Medicine (IOM) in its 2010 report, The Future of Nursing. The report set a goal that 80% of nurses should have a BSN degree by 2020 and urged states to drop barriers against NPs working “to the full extent of their education and training.”
Hospitals are quickly shifting to BSNs. In New York, 70% of hospitals in 2013 preferred hiring BSNs, compared with 46% in 2011, according to HANYS. Many younger nurses are heeding the call. Faller pointed to the 2013 AMN Healthcare survey showing that almost one-quarter of nurses ages 19–39 said they would pursue a BSN, and more than one-third said they would pursue a master’s degree in nursing.
Hill says it’s fairly easy for someone with an associate degree in nursing to transition to a BSN degree. They can enroll in a “RN-to-BSN” transition program, which lasts 12–18 months and is available in many locations across the country.
Meanwhile, NPs have been proliferating. According to a 2013 report by the Health Resources and Services Administration (HRSA), the number of NP graduates grew by 69% from 2001 to 2011, fueled by the growing shortage of physicians in primary care and easing of state restrictions on NP practice.
“Nursing students are more ambitious than they used to be,” argues Daniel. “A lot of them want to go back to graduate school and become nurse practitioners.” She says she hopes some of them will choose a career in academia so that more nurses can be trained. This was another goal of the IOM report.
Morris says the new doctor of nursing practice credential, which will be required for all NP students starting in 2015, expands the amount of study, making NPs even more desirable as primary care providers as well as specialty caregivers.
Of course, the extra time and money needed for a BSN, and especially an NP, can be a barrier for minority students. Rather than pile up loans, Morris urged students to thoroughly research available scholarships. “Nursing students have not always been proactive in seeking out the opportunities.”
Push for Diversity
The new models of care fostered by the ACA require closer relationships between providers and patients, which means hiring nurses from the same ethnic background as their patients. Hospitals and other employers “want their nurses to be compatible with the culture or their patients,” says Faller. “But this will be a challenge, particularly for the Hispanic population.”
While Hispanics make up 17.1% of the population, they account for only 4.8% of RNs, according to the HRSA. There is also a gap for African Americans, who account for 13.2% of the population but just 9.9% of RNs.
As a black male nurse, Morris says it’s easier for him than for white caregivers to connect with black patients. He says many of them are still painfully aware of the infamous Tuskegee experiment. In a project that lasted until 1972, white doctors didn’t inform black male patients that they had syphilis, so that they could follow the natural progression of the disease. As a result, older black patients in particular are still wary of “being used as guinea pigs,” he says.
Morris has worked hard to boost African American representation in nursing, visiting schools to spread the word about a nursing career. He is also interested in boosting the number of black men in nursing. While men make up almost 10% of all nurses, very few black males enter the field, he says.
Nurses Have a Central Role to Play
There are many opportunities for minority nurses in this era of great change in the health care system. According to the IOM report, nurses will take center stage in this process.
“We believe nurses have key roles to play as team members and leaders for a reformed and better-integrated, patient-centered health care system,” the report maintained. “How well nurses are trained and do their jobs is inextricably tied to every health care quality measure that has been targeted for improvement over the past few years.”
Leigh Page is a Chicago-based freelance writer specializing in health care topics.
Many nurses, once comfortable with the day-to-day practice of nursing, decide that the next natural step is to go the specialization route. The thinking is that nurses who select a specialty will enjoy a higher salary, greater employment demand, and career-long job security than those who don’t. The US Bureau of Labor Statistics reports that registered nurses earn a mean wage of $68,910 annually, while nurse midwives earn $92,230; nurse practitioners earn $95,070; and nurse anesthetists earn $157,690. Not all specialties guarantee increased earnings—a parish nurse, say, is typically unpaid—but the niches that demand additional training, certification, and experience that’s in short supply almost always do.
However, not everyone agrees that specialization is the best approach to navigating a nursing career. “Some nurses start out interested in pediatrics, ER, or labor and delivery, but most don’t,” says Donna Cardillo, RN, MA, a nursing career coach (www.donnacardillo.com). “Many nurses feel pressured to choose a specialty and feel deficient in some way if they don’t. That’s an old, outdated model. Most of us used to work in one specialty our whole career. It’s not like that anymore. We’re going to work in many different specialties and work settings. It’s common to weave in and out of specialties all the time.”
Cardillo believes the health care landscape has changed and so has the job market. Jobs are moving out of hospitals to alternate inpatient settings—long-term care, inpatient rehab, subacute care, and long-term subacute care.
“New nurses have to think more about the opportunity itself—the support they will get and the opportunity to grow personally and professionally, rather than ‘choosing a specialty,’” says Cardillo. “But they also have to think about opportunities outside of the hospital. For example, if interested in pediatrics, consider pedi long-term care, pedi home care, [or] pedi rehab.”
Regardless of whether you pursue a specialty or a good opportunity, as Cardillo advises, it turns out that the steps are very similar. It means thoughtful consideration, energetic career exploration, and possibly pursuing more education, certification, and on-the-job training. Here are three simple steps to specialization, plus the career stories of three nurses in some of today’s most popular specialties.
Look Inside
One of the best online resources for nurses considering a specialty is at www.discovernursing.com, which is sponsored by Johnson & Johnson. They offer a comprehensive Find Your Specialty quiz that starts with your education and skills (current or projected), then goes on to your favorite work roles and preferred work environment. Here are some representative questions and possible answers, slightly modified for brevity:
Q: What are you good at?
A: Tech savvy; good communicator; strong leader; compassionate; calm
Q: When it comes to your patients, the best way you can help them is:
A: Face-to-face; managing, training, or teaching nurses; doing research, writing, or advocating
Q: When mingling with colleagues, how do you join the conversation?
A: I lead it; I usually listen at first; I listen
Q: At work the perfect pace for you is:
A: Slower; steady; faster
Q: Your ideal day at work is:
A: Pretty much the same; slightly switched up; completely different
At the end of the test, you’ll get a top recommendation for a specialty, plus two alternatives. Each one is described in detail and includes a list of advanced training, educational degrees, or certifications required to practice. Finally, there’s a profile of a successful nurse in that specialty to give you a sense of what’s required to find satisfaction on that career path.
Look Outside
After self-exploration, it’s time to do some workplace exploration. Nurses get a great deal of first-hand knowledge of various categories of nursing as they do their rotations during nursing school. If you pay careful attention to your “gut level” reactions—to medical-surgical, pediatrics, obstetrics, or critical care—you will discover which specialties appeal to you at a deeper level. You may want to explore additional specialties through internships, externships, temporary assignments, or PRN work outside your regular work duties.
If an actual, in-the-field trial is not an option, consider going online to learn about other categories. At www.discovernursing.com, there is a database of 104 nursing specialties that you can access in a variety of ways. The specialties cover the gamut, so there’s something for everyone: 34 are outside hospital settings, 68 are research connected, 37 are managerial, and 92 are patient-facing.
One of the best parts of this database is that you can filter it by health care setting, degrees/certifications required, and job characteristics, so you don’t have to wade through all 104 specialties. The site will “curate” the ones that match your specific requirements.
One of the key factors that nurses consider when choosing a specialty is employment demand. Many associations survey their members about employment and publish results. Say that you’d like to be an OR nurse and know that the Association of periOperative Registered Nurses (AORN – online at www.aorn.org) reports that the average age of their members skews high, plus a quarter of OR nurses plan to retire or work part-time in the near future. Those demographic factors may increase job demand—or not. You have to dig a bit deeper to find out.
Now that you’ve chosen a few specialties to explore, it’s time to get out there and do some personal sleuthing. You can attend the professional association meetings near you, go to area conferences, or connect with RNs online at nursing specialty forums and at networking and social media sites.
So, when pursuing insights about being an OR nurse, for example, ask nurse leaders what prospective nurses should know about that specialty. Here’s what Deb Cooksey, RN, MBA, MS, CNOR, vice president of nursing at AORN notes: “First, they need to understand that their experience with the patient is very different; it’s very short and concise—probably the biggest difference they would experience. Also, working as part of a team is often a big change; many nurses are used to working autonomously. Another area where there is a significant difference is in how work is done; in Periop, it’s often multitasking but in a consecutive way. That can take getting used to.”
Next up, arrange one-to-one informational interviews with nurses who are successfully working in that specialty to find out more about their individual career path and what they’d suggest to a newcomer. Cardillo recommends asking experienced nurses these questions:
• How did you get started in this specialty?
• What do you like most and least about your specialty?
• What are the most important attributes of a nurse in this specialty?
• What trends do you see in this specialty?
“You’ll get your best information from those in the field, but take it with a grain of salt—that’s another reason why you should speak to four or five people,” Cardillo adds, so that nobody’s opinions weigh too heavily on your decision to pursue a specialty. Make a point to ask each person you interview for the names of one or two other nurses, and if they’re willing to make an introduction or let you say they referred you.
Assess Opportunities
Take a look at your overall career goals and areas of interest, the type of lifestyle you aspire to, your personality and work style, and the time and other resources required to pursue an avenue.
So, for instance, if you think you’d enjoy independent case management but you don’t have funds available to get a business off the ground (and wait for it to grow to support you), maybe that isn’t a good initial specialty.
Then, of course you’ll want to see what offers you get as a way of determining if your job target is actually viable. “Whether a new or experienced nurse, you don’t want to stay unemployed for any length of time,” says Cardillo. “You can continue to pursue your dream job while you’re working. Say you’re interested in pediatrics, but can’t get hired in a hospital on that unit. Maybe you get offered a job on a telemetry unit. You might consider taking that because it’s easier to get transferred into another unit than hired from outside.”
Below, three nurses weigh in on their journey to a specialty, with some advice for other nurses:
Lisa Pacheco RN, BSN, Director of Maternal Child Services, Children’s Hospital at Nevada University Medical Center, Las Vegas
My personal journey
I always knew I wanted to help moms and babies, because of a nurse who took care of me when I had my older child. I went into nursing school with the idea of maternal care but was advised not to specialize early on so I did medical-surgical nursing, then neuro subacute nursing, then I made a full circle back to my passion, a women’s care unit, and realized my love of taking care of women and children. It’s a place where I can leave my footprint and make a difference. We’re a voice for families, making sure they’re taken care of. I’ve been doing this for 23 years. There are so many aspects to this field—antepartum, NICU, women’s care unit, community nursing—it’s so broad so you can really find your niche.
Who does well in this specialty
Nurses with a passion for taking care of mothers and children do best. Follow your heart, and then even on that hardest day when you don’t think you can come back to work, you will. Find a unit that takes in new grads and trains them. Be careful not to take just anything. You want it to work for your goals.
What might surprise you about this specialty
A lot of nurses want to take care of moms and babies, but sometimes there’s disillusion. Having a baby is a dangerous thing. I always say it’s the most dangerous point of a young woman’s life. We triage patients, we have an OR for C-sections. If you work in a birthing center, it’s usually a quiet, beautiful experience. But if it’s high risk, like here at the hospital, you’ll have your fill of adrenaline. The NICU is different still, and so is postpartum.
Also, when I started, if you weren’t healthy you didn’t have babies. Now patients can have diabetes, heart problems, and asthma, and still get pregnant. Their health is compromised and their pregnancy is high risk. Patients come in by ambulance, very ill, and a lot of moms end up in the ICU later—with nothing that’s pregnancy related.
Downside of specialization
If you do specialize early, you may fear layoffs. If you’ve been a NICU nurse for 15 to 20 years, for instance, those nurses have a really hard time getting another job if we have a layoff.
For more information on this specialty, visit The Association of Women’s Health, Obstetric and Neonatal Nurses website at www.awhonn.org.
Erik Meyer, RN, BSN, Nursing Supervisor, Providence Seaside Hospital, Oregon
My personal journey
I chose ER for selfish reasons—I’m an instant gratification person. In the ER, either we fix them or we send them away. Instant results. We get a go at it, and if they stabilize they go to ICU or another department. When I was in nursing school, I saw a level 1 trauma center in inner-city Detroit. Everything you see on TV—well, that was that place. It was just a one-shift visit, but the next day I applied for a two-year internship. There were 500 applicants and they hired 30 of us. It was a free-for-all, fly-by-the-seat-of-your-pants kind of place, but a great place to learn.
I’ve been in the ER at a small, rural, critical access hospital for 18 years, now as a nursing supervisor. I work two 12-hour shifts; my wife and I are raising four kids and running a coffee business. That’s the great thing about nursing—you can work as much or as little as you want.
Who does well in this specialty
It’s so intense and we’re so busy that waiters and waitresses make the best ER nurses. You know to grab everything you need before leaving the kitchen, then check in on everyone to see how they’re doing and give them the best service possible! The ER is so like the food-service industry. That’s what I grew up doing—waiting tables.
Job search advice for new nurses
Just keep pushing. Introduce yourself to the ER manager and let them know your goal. Tell them, “If you need help, I’m available.” Keep pushing. When you pass them in the hall, ask “When can I work for you?”
ER personnel will respect people who are assertive. If you’re leaning in this direction, start getting your certifications in order and working towards becoming a Certified Emergency Nurse. Get the books and start studying for the test.
For more information on this specialty, visit the Emergency Nurses Association at www.ena.org.
Brittney Wilson, RN, BSN, also known as “The Nerdy Nurse,” Clinical Informatics Nurse, Georgia
My personal journey
After my second year of bedside nursing, I knew that I couldn’t do it forever. It’s backbreaking and emotionally draining. I began searching for MSN programs that would allow me to elevate my career and stumbled upon something called “Nursing Informatics.” When I read the job description, it was like the clouds parted, the sun broke through, the angels began to sing. Most informatics nurses are BSN-prepared. So I decided to pursue the career without the MSN in hand to see if I got any traction; three months later, I was hired. Of course, my technology savvy as conveyed through my blog (www.thenerdynurse.com) were a big help with that. In my day job, I get to do what I love every day: combine technology and health care to improve patient outcomes.
Who does well in this specialty
One of the primary parts of my job is translating the needs of nurses to IT and the needs of IT to the nurses and other clinical staff. Sometimes, when nurses and nerds get together, it can seem like they’re speaking two separate languages. That’s where informatics nurses come in.
Job search advice for this specialty
Informatics nursing has become a hot specialty, and because of this, it can be really difficult to get your foot in the door. I will say that, at minimum, you should be BSN-prepared with at least three years of bedside nursing experience. The MSN credential will certainly be a help, but many organizations also want experience, so try to find some way to get IT or technical experience.
Certifications do command a higher salary. According to the HIMSS 2014 Nursing Informatics Workforce Survey, the average salary for an informatics nurse in 2014 is $100,717, while the average salary for a nurse who is certified in nursing informatics is $121,830.
For more information on this specialty, visit the American Nursing Informatics Association at www.ania.org.
Career advice for any nurse
Read nursing blogs! There are many message boards that are filled with negativity and lots of complaining. If you want to find something more uplifting and connect with people who are really passionate about nursing, then nursing blogs are where it’s at!
Jebra Turner is a freelance health and business writer based in Portland, Oregon. She frequently contributes to the Minority Nurse magazine and website. Visit her online at www.jebra.com.
“I have a dream that one day on the red hills of Georgia, the sons of former slaves and the sons of former slave owners will be able to sit down together at the table of brotherhood.” These were the astounding words of Dr. Martin Luther King, Jr., during his famous “I Have a Dream” speech. Unfortunately, this is, in part, still a dream. Sons of former slaves and sons of former slave owners are not sitting together at the table of brotherhood. Rather, sons and daughters of former slaves and former slave owners are hiding underneath a table of institutional inequities, especially in nursing. A great deal of work must be done in order for this dream to come true. However, some of this work must be put into the hands of successful African American nurses, who ought to feel a sense of obligation to motivate and empower other African American nurses and nursing students. There are, indeed, accomplished African American nurses out there, but not enough. Nonetheless, are we holding our younger brothers’ and sisters’ hands as we should be? This can be put into practice with enlightening and enriching high school and college mentorship programs.
According to a 2013 survey conducted by the National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers, the RN population is 6% African American. Additionally, data from the American Association of Colleges of Nursing’s (AACN) annual survey revealed that 9.6% of students enrolled in baccalaureate nursing programs in 2013 were African American. At the master’s level, 14.4% were African American; only 14.2% were African American at the doctoral level.
These statistics reveal that not only is there a tremendous shortage of African American nurses in the workforce, but there are not many African Americans being enrolled into nursing programs, despite recruitment efforts that have been put forth. This is problematic when considering the population of patients; the nursing workforce is not reflective of the changing and diverse demographics of the United States population. Mentorship programs can help to increase enrollment rates, help the African American nursing shortage, and help with the deliverance of culturally competent nursing care.
There are several recruitment programs for potential African American nurses, but is this enough? For example, the Robert Wood Johnson Foundation (RWJF) joined with the AACN in 2008 to launch the RWJF New Careers in Nursing scholarship program. The program is designed to alleviate the nation’s nursing shortage by dramatically expanding the pipeline of students from minority backgrounds in accelerated nursing programs. In January 2010, the AACN published a set of expectations for nurses completing graduate programs and created faculty resources needed to develop nursing expertise in cultural competency. Several scholarships for African American nurses are also available. Additionally, the RWJF initiated the Doctoral Advancement in Nursing project in 2013 to enhance the number of minority nurses completing PhD and DNP degrees.
During my years at the University of Connecticut (UConn), I was awarded multiple scholarships, including the Yale Minority Nursing Scholarship, the Husky Nurse Scholarship, and the Chi Eta Phi Scholarship. All of these scholarships in my recollection were awarded to me because of merit and because I was from a minority background. What about mentorship programs? Why weren’t these offered to me?
As I reflect on my own undergraduate experience, I remember being very grateful for the scholarship funds. But I also remember being unprepared for the culture shock that I was about to face at the UConn campus in Storrs, Connecticut. Current literature highlights the fact that African American students in predominantly white institutions find it difficult to reach a level of comfort and acceptance within the new cultural environments. Students have reported feeling underrepresented, which results in feelings of loneliness, isolation, and frustration.
It has also been noted that the smaller the number of minority students on campus, the greater the problems because of limited social contacts. Out of my class of over 100 students, approximately 10 of these students were from minority backgrounds. Though feeling extremely proud and esteemed for becoming a graduate of the UConn School of Nursing, I would have been even more grateful to have a successful African American mentor who consistently told me, “You got this!” Self-empowerment and motivation can only go so far. What about those students and new nurses who require a pat on the back from the hand of a “brotha or sista” who truly understands and has “been there and done that”?
A few months ago, I was asked to become a mentor for an African American high school student, NiaMarie Jackson, who was inspired to become a nurse while dealing with her mother’s lifelong diagnosis of HIV. Our mentorship experience has been focused on effective nurse-patient relationships. She revealed to me that she had been included in a trial to test the efficacy of drugs that would decrease the likelihood of vertical transmission. Her childhood consisted of multiple visits to doctors and nurses who all deeply impacted her life and led her in the direction of becoming an aspiring nurse.
We developed a wonderful rapport. The very first meeting consisted of an emotional, heartfelt sharing of experiences. It felt as though I had known this ambitious young lady for more than an hour. She reminded me of myself when I was younger. Just as I had done, she participated in many programs and was doing very well academically. I found myself becoming frequently concerned as her mentor. I often questioned her about her college application process. If I had not heard from her in a few days, I became worried.
She is currently doing exceptionally well and has been accepted to Winston-Salem State University in Winston-Salem, North Carolina. Here, she will pursue a bachelor’s degree in nursing. According to NiaMarie, the mentorship experience not only “reassured me that I wanted to become a nurse, but I gained a new outlook on life and how to deal with different people in different situations.”
Every nurse from a minority background should be able to experience this. There is nothing more gratifying than knowing you have helped a member from an underrepresented group become successful while contributing to the diversity of today’s workforce. My mentee knows that I am only a phone call, e-mail, or text away as a source of support.
Mentorship should be considered as the main vehicle for African American nursing success. It allows African American nurses to connect on a level of cultural familiarity. It is easier for the student to say, “If he or she can do it, then I can do it too.” I can happily say that I am a witness to this. Dr. Martin Luther King’s wishes may still be a dream; however, it is not an impossible dream. His efforts need to continue with the African American nurses who are successful. We need to feel a sense of obligation to help others from minority backgrounds with their accomplishments. When this happens, there may be a possibility of sons and daughters of former slaves and former slave owners sitting together at a table of brotherhood and sisterhood.
Latoya Lewis, RN, MSN, is employed at the University of Connecticut Health Center in Farmington, CT as a medical surgical nurse. While obtaining her master’s degree in nursing education, she has developed a passion in reaching out educationally to underrepresented populations.
There’s nothing like that huge relief when the call from human resources says “You’ve got the job!” After the long application and interview process, you finally feel a sense of accomplishment and you’re ready to just shout, “Yes! I’ll take it!”
But don’t leap at a job just because you have it. An offer is great news, but there’s a lot to consider in a job offer package. At the top of your list is probably the hours you’ll work and how much you’ll get paid for those hours. Salary is, after all, a motivating factor in many job searches and job transitions.
But a job is a package. You’ll be paid a certain amount, but you’ll also get lots of add ons – benefits – that vary greatly from one job to the next.
Before you say yes, consider these job benefits and if they meet your needs. And if you get an offer that falls short on benefits you want, consider negotiating for what’s most important to you.
1. Health Insurance
Health insurance is huge for most employees. Find out exactly what is included in the health insurance you are offered. How much is the premium? Which doctors can you see? What is your deductible? What is the co payment for office visits, emergency room visits, and inpatient and outpatient stays? Does the coverage include any prescription plan? If so, are your medications covered?
2. Health Assistance or Savings
Does the company offer any kind of flexible spending account plan so you can set aside money to be used for healthcare?
3. Dental Insurance
How much is the premium? What kinds of care will the plan cover? If the plan covers routine preventative care like cleanings and xrays, how many is each family member entitled to? Does the plan cover any orthodontic care?
4. Vacation Days
Now frequently just lumped into a “paid days off” group, how many days does that include and will it be enough for you? Three weeks of paid time off sounds great, but if you or a family member you care for has a chronic illness that causes you to miss work more than a couple of times a year, three weeks can easily be consumed. Are you allowed to take unpaid time off?
5. Retirement Benefits
Does the package include any kind of retirement benefits like a 401k plan?
6. Volunteer Hours
If you are an avid volunteer, a company that offers paid time off to volunteer in an organization or a local school might be very attractive to you.
7. Education Plan and Career Development
If you are on track to get a higher degree or are thinking of going back to school, does the company reimburse you for partial or full tuition? Can you take classes that offer professional development or career tips?
8. Company Culture
No, the company culture isn’t listed on a benefits package form, but the company culture makes two similar organizations vastly different. If you like to socialize with your colleagues and find a sense of camaraderie essential to your professional happiness, an organization with company outings, softball teams, or volunteer groups might be worth looking into.
Don’t just take a job based on your paycheck. A good career move offers more than just money in the bank. Your benefits package is as important as your salary and can sometimes add thousands of dollars in value. And if you are close to accepting a job but really want more paid time off, for instance, see if you can negotiate. You might get what you want.
No one can ever say Lorraine Freytes backs down from a challenge.
Diagnosed with lupus when she was just 11 years old, the disease has challenged her to keep going despite debilitating symptoms and grueling therapies. Now in her junior year of nursing school at Florida International University with a 3.8 GPA, Freytes has traveled a rough road to get to this point. But, she says, taking the easy route just isn’t her way.
With lupus, Freytes became familiar with hospitals and hospital staff at an early age. A flare up of joint pain and severe fatigue so intense she was unable to get out of bed led to her diagnosis, and physicians and nurses quickly became part of her regular routine. And while they worked to make her feel better and control the lupus, they also, unknowingly, influenced her career path.
At first, Freytes and her family were unhappy with her treatment, overwhelmed by the diagnosis, and frustrated that their voices weren’t being heard by those who headed up her treatment plan. Eventually, her family found a hospital where the staff responded to her, and it changed her world.
“The staff was wonderful,” she says. “They treated me like a person, and I decided I wanted to become a nurse. I loved going to see them, and I wanted to make other kids feel the way I felt when I had to go.”
Freytes says the staff’s compassion gave her a deep sense of relief. “I can’t even describe it, like the butterflies, that someone cared,” she says. “Someone who didn’t even know me. It was heart-warming and incredible.”
As part of her treatment, Freytes received chemotherapy several times a year for several years and so became close to the staff. Her thoughts never wavered. “I wanted to be that person,” she says.
Despite the upheaval, Freytes kept her goals in sight. “I always pushed myself,” she says. “My parents said, ‘Don’t let lupus stop you from doing what you want to do.’” When she couldn’t take notes in class, she recorded the lecture. She wanted to be out in the world. “If I had to hobble out the door, I did,” she says.
As a student, Freytes takes care of herself knowing the rigors of nursing school are extra challenging for someone with lupus. She receives wonderful support from a close network that includes her family and her boyfriend. Sometimes she just has to push through symptoms like severe fatigue, she says, but she also takes care to slow down and rest. “I exercise, eat healthy, and take lots of naps,” she says, noting that her lupus is manageable right now. She hasn’t had an infusion in two years.
Freytes is thinking of a career in NICU or pediatric oncology because she received her own chemotherapy infusions there. “I like that environment,” she says. “I want to give patients hope. I can show them I was sick, too.” She also knows what it’s like to feel miserable from treatments that are helping you and that common link will help her be the kind of nurse she has always envisioned.
After Freytes finishes her bachelor’s degree, she plans to keep going until she has a PhD in hand. “I always tell people to follow their dreams,” she says. “Don’t let things stop you from what you need to do or want to do. You can’t live in a bubble.”
And even when an illness or another of life’s unexpected challenges gets thrown in your path, keep going, she says. “You have to push yourself and you have to try. You just have to do it.”
