She didn’t know her words would haunt me for years to come. It was a night like any other night. I stood at the bedside of a relatively stable patient, and I was dutifully giving him his meds. The floor was quiet, patients and nurses preparing for the night shift a few hours away.
Like a fire klaxon, a voice cut through the relative peace of the hospital floor. “My husband is dying! My husband is dying!”
Instinctively, I dropped the medicines and darted out of the room. In the middle of the hall, a middle-aged woman ran toward me, screaming about her husband in the room across the hall. “He’s dying,” she yelled into my face.
Mouth dry, heart pounding, I pushed past her and entered the patient’s room. Of course, he was unconscious, blue, and not breathing. I started CPR, but the craziness was not over.
I wasn’t exactly a new nurse. I had been through a few codes, and they all went rather smoothly. I never experienced the stomach-churning nausea of having a family member witness their loved one dying.
The patient wasn’t mine, but I knew about him. He had recently had coronary artery bypass grafting surgery and was due to be transferred to the ICU any minute because his heart rate and rhythm were abnormal. His doctor was on the floor, writing the paperwork for the transfer.
Others had heard the wife call out in anguish, and everyone came running, including the doctor. He burst into the room, shouting, “I need an intubation kit! Get me an intubation kit!”
I could hear the rumble of the crash cart coming down the hall, but it hadn’t quite reached the room yet. The doctor continued to yell at me, to point, to spit. His hands shook, but I had been here before. I yelled back, “Hold on a second! It’s coming!”
I realized then that the doctor was more afraid than I was. The cart arrived, the patient continued to code, and the doctor got his intubation equipment. Although we managed to get a sustainable rhythm on the patient, he soon died in the ICU.
Of all the codes I experienced over my years as a nurse, this one sticks out as the most horrible. When codes start, nurses become the ultimate professionals. No one runs. No one yells. Everyone works as a team.
As a relatively new nurse, I never experienced the terror that “normal” people experience when someone starts to die. For me, I knew how to handle it. A patient going south deserves my close care, but the emotion is usually not high during care involving advanced cardiovascular life support. Afterward, I would cry and shake, but not when I needed my faculties about me to do everything I could to save a life.
This code was different. In fact, I can live it over and over in my mind, and I still feel as scared now as I did then. The wife and the doctor were breaking the rules. They didn’t know how to deal with death, and I don’t really blame them. I just know their actions scarred me deeply.
Trauma is a real problem in nursing, and situations like these can cause a nurse to relive moments that didn’t go well. This is especially true of new nurses. New nurses make mistakes, and they haven’t developed the ability to be the calm professional yet. This means that the trauma of extraordinary events can stay with them forever.
I never dreamed that I would face a family member who was screaming that her husband was dying. I can only imagine the torment she was going through, the heartbreak of knowing that her loved one was slipping away before her eyes. She reached out for the only help she could.
And that help was me.
Her terror has stayed with me all of these years. In that moment, I became her. I empathized with her, as any good nurse will do. I felt her sorrow, and despite our best efforts, we couldn’t save her husband. I find myself imagining how she felt when he actually passed away.
I will admit that this situation scared me, and I have dwelt on it more than I should. Nurses, especially new nurses, have to develop a sense of detachment from the patient and family. But what about the human side of the equation? Too much distance leads to too little caring.
I am happy to say that I took part in codes after this one, and I did the best job I could. In fact, I was praised for my work in situations where a life was on the line. But I never forgot the distraught woman in the hallway, or the surreal feeling of dread that her words—”He’s dying!”—caused in me.
It remains a trauma that has impacted my life forever. Nurses need to realize that they experience traumas, too, and that it is okay to talk about them. It is okay to be afraid. It is okay to reflect on the situation and examine the emotions the trauma awakens. Without this reflection, the emotions become buried. Ignored emotions manifest as substance abuse, out-of-control feelings, and hatred of the job.
My trauma is just one example. Almost every nurse has a story of when she or he was scared and traumatized. Talk about it. Don’t pretend to be so strong that you don’t need to ask for help.
I wish I could have saved that man. I wish I could have wrapped that wife up in my arms and made it easier for her. I couldn’t, but it will stay with me forever as the trauma in my career that haunts me, because I couldn’t hide behind the façade of the calm professional.
Hilda Ortiz-Morales, ACNP, MSN, PhD, has a history with HIV prevention and treatment—a history that nearly traces back to the origin of the HIV/AIDS epidemic in the United States. With degrees from Lehman College and the College of New Rochelle, Ortiz-Morales has spent 34 years as a nurse practitioner, many of those years at Montefiore Medical Center, one of the busiest hospitals in the Bronx, New York.
Like many registered nurses, Ortiz-Morales had wanted to work in the field since childhood. Her mother was chronically ill, requiring visiting nurses. “The care and caring they provided my mother left a lasting impression on me,” she says. “I knew then that I was going to become a RN when I grew up.”
With immigrants from the Dominican Republic, Jamaica, Ghana, Bangladesh, and many other nations, the Bronx is an extraordinary example of America’s increasing diversity. With a population of 53% Latinos, 30% African Americans, 11% whites, and 3% Asians, the Bronx differs from the average American county in several ways. Almost one-third of its residents were born outside the United States, half of its children are born to foreign-born mothers, and the borough stands as the first borough in New York City to have the majority be people of color.
While the Bronx benefits from its diverse population, historic problems of poverty and poor health continue to plague its residents. The Bronx is one of only five American counties to have more than 30% single-parent households. In New York City, neighborhoods as varied as mostly black Harlem, and mostly white Chelsea, are familiar with the devastation brought by the HIV/AIDS pandemic.
The Bronx is no exception. African Americans represent 12% of the U.S. population and are the second-biggest minority in the Bronx. Yet according to 2010 statistics from the Centers for Disease Control and Prevention (CDC), blacks accounted for about 41% of people living with HIV. Things are especially dire for young black men who have sex with other men (MSM). In 2010, 4,800 new HIV infections occurred in this group. Young black MSM represented 45% of black MSM who newly became infected and 55% among all young MSM newly infected.
Nurses, working at places as varied as hospitals, private clinics, and community centers, are using their scientific knowledge, as well as their helping, healing “soft” knowledge, to educate vulnerable populations about HIV and STDs. Cultural competency is key to reaching people who feel marginalized by mainstream medicine.
“My experiences include infectious diseases, HIV/AIDS, critical care, utilization management/quality assurance, medicine, and surgery,” Ortiz-Morales continues. She currently works at the Montefiore Infectious Diseases (ID) Clinic, where she serves as coordinator and primary clinician of the HIV/Hepatitis C virus (HCV) specialty service. While HCV doesn’t get the constant attention of HIV/AIDS, it’s a serious sexually transmitted infection that many people with HIV have concurrently. The HIV/HCV specialty program evaluates and treats all co-infected and mono-infected patients treated in the ID clinic.
Ortiz-Morales works to educate patients—and the community in general—about HIV and STD misconceptions, such as the “lack of understanding about the acquisition of STDs among adolescents and adults in the Bronx.” Young people bare the brunt of sexually transmitted infections, HIV, and unintended pregnancies. Case in point: Young people aged 15 to 24 years acquired half of all new STDs in 2013, according to the CDC’s Sexually Transmitted Diseases Surveillance statistics. The Bronx, in particular, has several zip codes with some of New York City’s highest rates of STDs and HIV.
Recognizing the importance of HIV/STD testing as prevention and treatment strategy, Montefiore’s Emergency Department launched an initiative to offer HIV testing to all patients coming in for treatment.
“This mandatory offer is the latest example of Montefiore’s commitment to drive AIDS awareness and deliver seamless care to patients with HIV/AIDS,” says Ortiz-Morales. Montefiore also offers the Adolescent AIDS Program (AAP). AAP provides comprehensive care to HIV-positive youth, as well as risk reduction and HIV counseling and testing services for such high-risk groups as young men who have sex with men, intravenous drug users, and young people involved in sex work.
The increasing attention to hepatitis C influences Montefiore’s newest initiative, Project INSPIRE NYC. According to Ortiz-Morales, Project INSPIRE NYC “is an integrated, innovative, and evidence-based comprehensive service model that … demonstrates a model of service delivery and payment that can reduce morbidity and death from chronic hepatitis C … [and] reduce costs associated with its complications.”
Of the estimated 146,500 New Yorkers with chronic hepatitis C, about half do not know that they are infected, according to the New York City Department of Health. Over the next three years, clinicians at Montefiore plan to use an integrated model of care for Medicare and Medicaid patients at risk for hepatitis C. Primary care clinicians work closely with care coordinators and specialists to increase access to effective hepatitis C care for patients. HCV care coordinators provide care coordination, navigation, health promotion, and medication adherence to each patient; they also work with a peer educator. The peer educator is a person formerly with hepatitis C, who shares his or her experiences and helps patients navigate through the process.
The Bronx represents both the best and worst developments in 21st-century America. The future of this borough’s young people, as well as people of all ages and backgrounds, is dependent on nurses comfortable with sexual intelligence, reaching people without judgment.
Behlor Santi is a freelance writer based in New York.
The issue of embittered race relationships in the United States has been on my mind since August 9, 2014, when a white police officer named Darren Wilson shot and killed Michael Brown, an unarmed black teenager, in Ferguson, Missouri. The violent protests that erupted after the shooting culminated in even more pronounced violent protests in the early morning hours of November 25, 2014, following the grand jury decision not to indict Officer Wilson for the fatal shooting of Brown.
Not being close to the case, or having examined the evidence upon which the decision not to indict was based, I wondered whether that decision was purely based on evidence, or whether historical and institutionalized racism, discrimination, and injustice against blacks in the United States played a role. While I have no answers to my question, I struggled to think about what we, as a nation, can learn from Michael Brown’s death that will help this nation heal.
I believe that each one of us in the United States needs to think long and hard about race relations in this country. I allowed my mind to wander as I took this journey myself. I thought about the Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. In this report, the committee—charged by Congress with identifying and recommending strategies to eliminate racial disparities in health care in the United States—chronicled the pervasiveness of poor health outcomes for minorities.
As a minority and an academic nurse researcher with a focus on health disparities in pain management, I thought about historical and institutionalized racism, discrimination, and injustice that contribute to poor pain management for patients with sickle cell disease—an inherited blood disorder suffered by an estimated 100,000 Americans, mostly of African descent—and for patients with other pain conditions. I thought about an article I had written for Minority Nurse back in 2003 titled “Mentorship in Black and White,” where I narrated my experience of being mentored by a white senior professor when I was a nursing student. This mentorship experience affirmed my belief that humanity is inherently good, but social constructions such as race taint our good nature. I thought about my current experience as an assistant professor of nursing in higher education and how I have reacted when I encountered interactions I felt were unjust. I wondered about how I have interacted with students in my capacity as a nursing faculty where I have the opportunity to teach and mentor both black and white students. I wonder if I have done everything humanly possible and within my power to pay forward the inherent human goodness to improve race relations with my students, colleagues, and friends.
I thought about the slave ship captain and later an abolitionist, John Newton, who, after his repentance, wrote the hymn “Amazing Grace.” This hymn is sung in Christian churches around the world by many Christians to confess and repent of sins and enlighten the spirit. The song has also become the mainstay of funeral services around the globe— a way to send the dead home believing they had the chance to repent of their sins at the time of death.
Now, in the United States, we must sing “Amazing Grace” in unison. Why is amazing grace important in this moment of pain and hurt, loss of faith in humanity, and lack of trust in race relations in the United States? The nurse in me feels that this nation needs healing. We must repent for whatever we might have done consciously or unconsciously, overtly or covertly, to contribute to racial unrest and the suffering of blacks and other minorities in the United States,. We will not stand and just sing the lyrics of the hymn paying lip service. We must be on our knees and feel the words break through our hearts, minds, and spirits. The words must purge us of the biases, injustices, discriminations, racism, sexism, ageism, and other “isms” that have deadened our spirits in this country. We have to let the spirit that connects us as humans and make us one with the universe—the trees, the oceans, the winds, and the animals—emerge to help us heal. We must let the light of our spirit unite us, and together we can outshine the darkness in our hearts and minds that we use to oppress others who look different than us.
We must heal our nation by checking our individual biases that encourage us to treat others unfairly. Like Newton, we must repent so that God and the universe will shower our spirits with the everlasting peace that comes with positive race relationships in the world full of turmoil and unrest. We must heal our nation, the United States of America.
Miriam O. Ezenwa, PhD, RN, is an assistant professor in the Department of Biobehavioral Health Science at the University of Illinois at Chicago, College of Nursing.
Recently, I was taking a late-night walk with the dog and ran into my neighbor. She was just returning home from her shift as an emergency room nurse. Every time I see her she’s wearing scrubs (and I’m pretty sure they are all stained). We enjoy visiting, but her only available time is before the sun rises or after it sets. When I need to decipher the scribbles of my 5-year-old nephew, I have to ask her to read it to me. She always laughs and says it’s basically the same as translating a doctor’s notes.
As we sat down, she shared with me that she loves what she does and she adores her patients, but earlier that day someone told her she was pale and looked “sick.” She hadn’t seen the sun in weeks. When I pressed further, she shared with me that recently she had developed a desire to have more flexibility and control with the types and lengths of shifts she works. Her kids were getting older, and she hated the thought of missing even more soccer games.
She was quick to tell me she was certainly not ready to leave nursing altogether. She’d spent years in school and had spent countless hours adding continuing education credits to her resume. Truly, she was exhausted. I had been compiling research for an article on advanced career choices in the medical field, so I shared with her four finds that were directly related to nursing:
Nurse educators, especially in specific fields, are in high demand. Nurses need continuing education throughout their careers, and fresh faces are joining the ranks every year. You can combine your clinical expertise with a passion for teaching into a rewarding career. Educators are needed at colleges, universities, technical schools, and hospital-based schools. You would be required to hold a master’s or a doctoral degree in nursing. Nurse educators typically have advanced clinical training in a health care specialty. Many educators enjoy the option of flexible work scheduling.
This is an excellent choice for nurses seeking an advanced, nonclinical job in the nursing industry. Nurse researchers are employed by health policy nonprofits and private companies. Nurse researchers perform analyses and create reports based on research gathered from medical, pharmaceutical, and nursing products and/or practices. Their objective is to improve health care and medical services. Nurses with a bachelor of science in nursing (BSN) degree are eligible for these jobs, but those with a master’s or a doctoral degree may have an increased chance of acquiring a nurse researcher position.
They manage and provide health care data to patients, nurses, doctors, and other health care providers. Nursing informatics specialists ensure computer applications are easy to use and provide useful information to nurses, managers, and other health care workers. A BSN is the minimum requirement for certification for a nursing informatics job; however, several employers require a master of science in health informatics, health care management, or quality management.
The American Nurses Credentialing Center requires two years of experience as an RN and at least 2,000 hours of work in informatics within the last three years for certification. Those with certification improve their chances of obtaining a job with a higher salary. The job outlook has been steady, as many organizations hire informatics experts to solve documentation issues and decrease errors. Informatics specialists typically work for hospitals and medical-records software vendors.
A nurse attorney is exactly that: a nurse who has gone back to school to become an attorney. Few attorneys have the medical knowledge of nurses. Nurse attorneys work in many different settings, including firms that specialize in social security disability, hospital legal departments, or litigation firms.
When becoming a nurse attorney, the first step is to become a nurse by earning your BSN and passing the licensing exam. It would also be vital to acquire hands-on nursing experience. Your next step would be to apply and be accepted by a law school. This would include another three or four years of school. After completion, you will then have to take the bar exam for the state where you will practice. You could opt to open your own practice or try to get on board with a law firm or a health-care-related company.
Where Do I Begin?
If you, too, are seeking a new path, ask yourself the following questions:
•Should I focus on a non-clinical or a clinical route?
•Am I ready to move away from providing direct patient care, or would I miss the relationship with my patients?
Analyze your skill set; take a hard look at your strengths and the environment where you feel you can thrive. Remember, there are more paths in the nursing spectrum than you might think. One of the most important factors to consider is if you would need further education or credentialing and whether it’s feasible to return to school. Prioritize a list of what’s most important, the elements of nursing that you enjoy the most, salary expectations, and what kind of culture would suit your personality. Most often, I find there are several routes accessible. Find the path that makes the most sense for your journey.
Samantha Stauf is a graduate of the University of Idaho. She enjoys researching how technology has affected the health care field.
“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.
