Do you work at one of the more than 400 Magnet-recognized hospitals around the world? It has been said that minority nurses who work at these recognized facilities have the benefit of flourishing in a positive environment with employers who value their skills and career goals.
However, the results of Minority Nurse’s 2014 best companies survey suggest that nurses value other qualities far more than Magnet status when it comes to selecting an ideal employer. The survey, which was conducted late last year, asked nurses how important certain qualities (such as salary, benefits, and flexibility of hours) were to them when considering an employer. The results revealed that Magnet status ranked near the bottom of the list, only ranking ahead of one category: workplace size.
For some health professionals, the question of whether or not Magnet status is important can’t be fully answered until they know more about the designation, and that includes those nurses who work at Magnet-designated facilities, says Kristin Baird, RN, a hospital consultant.
“In some programs, people talk about ‘Magnet’ but people don’t understand it,” she says. In turn, they may be less likely to advocate for it or share its benefits with their colleagues. If a facility has already achieved the designation by the time a nurse is hired, then the nurse who didn’t go through the certification process may have a harder time understanding its importance and impact, especially when speaking with fellow nurses, Baird argues.
“If it’s just part of who [their hospital] is and people stop talking about it, and they don’t embrace what it means, they’re not going to be promoting it,” she says.
However, many nurses who work at Magnet hospitals and who do understand the program believe that it is a very important ideal. “Having Magnet status heightened our visibility in the community and state for being a leader for health care,” says Cabiria Lizarraga, RN, manager of telemetry at Sharp Grossmont Hospital in San Diego, California. Sharp Grossmont Hospital first received Magnet status in 2007.
Other hospitals likely receive positive coverage in their communities as well, Lizarraga adds. In fact, according to the American Nurses Credentialing Center (ANCC), 15 of the 18 medical centers on the 2013 US News Best Hospitals in America Honor Roll and all 10 of the US News Best Children’s Hospital Honor Roll for the same year are recognized by the ANCC as Magnet-recognized organizations.
“It’s very important to have because it shows we are committed. When people see we are a Magnet facility, they know the employer is committed to nursing excellence,” says Lizarraga.
Patients who are seeking hospitals may also look for the Magnet designation as an objective benchmark to help them choose where they’ll do business, says Nick Angelis, CRNA, MSN, a nurse anesthetist in Pensacola, Florida. Angelis has worked at Magnet and non-Magnet hospitals throughout his career.
Understanding the Magnet Designation
According to the ANCC, which is the Magnet credentialing organization, there are three goals for the program:
• Promote quality in a setting that supports professional practice;
• Identify excellence in the delivery of nursing services to patients/residents; and
• Disseminate best practices in nursing services.
The process to achieve Magnet status is identified by the ANCC as the “Journey to Magnet Excellence.” Facilities have to show that they have strong nurse leaders who are able to guide teams, develop professionally, take the lead in research efforts, and can show good empirical outcomes and the impact of those results. The certification lasts for four years, after which time the facility can re-apply.
Angelis, who has served on several committees on hospitals seeking Magnet status, says it is an expensive and time-consuming process, but it’s a good way for hospitals to prove that they value nurses. “A Magnet designation can be a hint that a hospital has a culture that respects the contributions its nurses make,” he explains.
Enhanced Recruiting
“Nurses want to work for an organization that really strives to empower them, one that has opportunities in place for them to do research or advance their degrees,” says Lizarraga. Facilities that have Magnet status can attract some of the best nurses available, she adds. “It is used as a recruiting tool because nurses would know about Magnet nursing excellence.”
Angelis says that if a hospital has low morale among nurses, achieving Magnet status can provide positive motivation. “It’s an opportunity for the hospital to change their culture,” he says. “Facilities that empower their nurses can improve morale, and that can help with job recruiting and retention.”
Some Nurses Left Behind?
Having an environment that encourages professional development among nurses is a positive, but there is a concern among some professionals, particularly those who don’t have advanced degrees, about where they fit in under a Magnet facility, explains Lizarraga.
Will the jobs be there for LPNs and for associate degree and diploma nurses? “There is some concern about whether or not they’d be able to practice in an acute care hospital or Magnet facility,” says Lizarraga. It may be understandable why many Minority Nurse survey respondents viewed Magnet status as only “somewhat important.”
But that issue is bigger than Magnet certification, Lizarraga argues. In 2011, the Institute of Medicine released a report recommending that the proportion of nurses with baccalaureate degrees be increased to 80% by 2020. This recommendation affects all nurses, not just those at Magnet hospitals, she adds.
However, many nurses who have more advanced degrees obviously have an advantage, states Baird. “It’s not to say there’s not a place for LPNs, but if you’re a Magnet hospital you’re looking at advancing nursing as a profession and making sure you’re finding nurses who want to be at the peak of the profession,” she explains.
Find the Best Match
So what’s a nurse to do? According to Baird, nurses of all education levels should first identify their career goals and factors that are personally important, such as career growth potential, flexibility options, and income. Then, identify an employer that seems to offer the best environment.
“I’m a big advocate of hiring for fit and choosing a job for fit,” says Baird. “Identify your core values, then find an organization that’s in alignment with those values.”
If you plan to obtain an advanced degree or would like the opportunity to go into research or academia, working at a Magnet facility may be able to provide you with more opportunities than a non-Magnet facility, she says.
However, if a potential employer is not a Magnet facility, but has other benefits that may be important to you—such as more flexible scheduling or a generous tuition reimbursement program—that could be the way to go, says Baird. Whether nurses work at Magnet hospitals or not, identifying employers aligned with their values puts them in the best position possible to benefit their patients and their careers.
Margarette Burnette is a freelance writer based in Georgia.
Americans possess unwavering faith in registered nurses. Year after year, nurses top the list of most trusted professionals. But ask most people just what nurses do and their answers lack clarity, conviction, and a clear-eyed understanding of nursing’s sundry roles.
The American Nurse: Healing America, a documentary film that premiered during National Nurses Week in May, teaches audiences about the diversity and scope of nursing and the critical roles these warriors of healing play during the most vulnerable moments of life, says award-winning photojournalist and filmmaker Carolyn Jones.
“These nurses will knock your socks off. They were so open and free with sharing their inner thoughts and souls, and I am very grateful, and we are lucky to have it on film,” says Jones, whose high-energy persona was palpable during a phone interview.
Two years in the making, the film follows the path of nurses working in hospitals, rural homes, city streets, helicopters, and prisons. The film captures nurses on the front lines of the biggest issues facing America—poverty, aging, war, and justice.
“The main thing is to raise the volume on the voices of nurses in this country,” says Jones, whose film follows the lives and work of five nurses who represent a spectrum of the country and its health care system. “They are a treasure chest of unbelievably rich information. They can make our hospitals run better; they can make schools run better; they can make our communities richer; and they can make the end of life so much better than it is right now.
“I just want to shine that light on nurses and turn up the volume so that they are part of every conversation,” says Jones, who crisscrossed the country to interview more than 100 nurses for The American Nurse: Photographs and Interviews by Carolyn Jones, a coffee-table book published in 2012 that includes the nurses in the documentary.
The nurses featured in the film include: Brian McMillion, MSN, MBA-HCM, RN, at the Veterans Health Administration San Diego Medical Center; Sister Stephen Bloesl, RN, from the Villa Loretto Nursing Home in Mount Calvary, Wisconsin; Tonia Faust, RN, CCN/M, from the Louisiana State Penitentiary; Naomi Cross, RN, from The Johns Hopkins Hospital, Baltimore; and Jason Short, BSN, RN, with Appalachian Hospice Care in Kentucky.
The film follows the path of nurses in different practice specialties, debunks common misconceptions about nurses, and raises questions for society about the challenges of healing America, say the five nurses spotlighted in the film. The featured nurses say they hope the documentary, praised by the White House, The American Journal of Nursing, and national media, educates audiences about their professionalism and the complexity of their roles.
For McMillion, coordinator of the Caregiver Support Program and VA clinical services director, the film is an opportunity to rebrand the profession. The documentary counters the unflattering and unrealistic media portrayals such as Nurse Jackie and raises awareness about stereotypes, says the Army vet and former medic who rehabilitates wounded soldiers returning from war. “We still hear ‘male nurse’ rather than just ‘nurse,’” McMillion says, chuckling. “When I was in school, people used to ask, ‘Are you studying to be a male nurse?’ and I would say, ‘Oh, no, I don’t need to study anymore to be a male; I have pretty much mastered that. I am studying to be a nurse.’”
The film will help the public realize that nurses work outside the hospital and toil deep in the community, says McMillion. (His third title is Major McMillion, 144th Minimal Care Detachment Commander.) “We are in the most intimate places, like their homes, and sometimes we are out in tents taking care of homeless people, which is an outreach I participate in every year as the VA clinical services director. I hope we can show people this is a profession that doesn’t require gender and that it has compassion, critical thinking, and technical proficiency requirements.”
McMillion was most impressed that the film crew, which followed him to Germany and a homeless center, was able to “translate the heart and humor of our profession in a masterful way.”
One message that Sister Stephen, director of nursing at Villa Loretto Nursing Home and president of the home’s board of directors, hopes viewers walk away with is that the nursing home industry is working hard to make care resident-centered. She runs a nursing home filled with goats, sheep, llamas, and chickens. It’s a place where the entire nursing staff comes together to sing for a dying resident.
“In my small, religious nursing home, we feel we can make the remaining years quality. We can be there with them and the families at the end of their life and offer them whatever comfort we can, whatever love we can, and assurance [that] there is an eternity for them, a beautiful life afterwards. If you look at it from a religious point of view, we are the hands and hearts of Jesus reaching out to these people. That’s what it’s all about for me,” says Sister Stephen, who is also president of Cristo Rey, a respite program for special needs children.
Sister Stephen, who has worked at the Villa Loretto Nursing Home since 1965, credited making the film and book projects with adjusting her attitude. “At one time, I was disillusioned with nursing because at times it is so non-hands-on, especially if you are in an administrative [position] or management. So many hours are devoted to paperwork,” she says. But after talking with many of the nurses featured in the book and attending related events, “I think, ‘Wow, I am really back on board.’ I tell people to really see what a gift they can be, what a service they can be to whatever area they decide to go in.”
The documentary also explores the work of a nurse inside a prison. Jones says she wanted to understand how a nurse can take care of people who committed horrible crimes. Tonia Faust, hospice program coordinator, has addressed that question numerous times during the 13 years she has worked at Louisiana State Penitentiary in Angola, the country’s largest maximum security facility. Faust, who runs a prison hospice program where inmates serving life sentences care for their fellow inmates as they’re dying, says treating prisoners requires skills, not judgment.
“I don’t actively look to see what their crimes are. My first year, I looked in the guys’ jackets to see what they did and sometimes I was shocked,” she recalls. “I thought, ‘I don’t need to do this for fear I may not treat them the way I am supposed to.’ Over the years, I realized people make mistakes in their lives. People don’t have the same upbringing as others.
“Some people may not have a choice. They have gone through the court system and been sentenced. It’s not my part to judge them or hold it against them. It could be my brother, my father, or me or my children in a prison. I look at them as patients, and my job is not to judge them, but to take care of them as best as I can with the skills I have learned through my education.”
One common misconception the public has about nurses is that their role is limited with the doctor making all of the decisions about care, says Naomi Cross, a labor and delivery nurse and the perinatal bereavement coordinator at The Johns Hopkins Hospital in Baltimore, Maryland. In the film, Cross coaches patient Becky, an ovarian cancer survivor, through the cesarean delivery of her son. “I had a patient two days ago who had a complicated cancer, and we were going to deliver her baby early. I spent four hours preparing her for surgery and coordinated the doctors and other team members, about 15 people that took care of her during her surgery.
“I remember I am holding her hand, and we are about to put her under, and I’m telling her everything will be OK. And she said, ‘I didn’t know you were going to come with me. I didn’t know you did all these things.’ She was surprised by the whole view of what nursing does. So many times people have said, ‘I thought the doctor did that.’ The biggest misconception is how skilled, intelligent, and knowledgeable we are. I get that so much from my patients. They are always surprised . . . by our expertise.”
The film provides the audience an honest portrayal of the men and women who spend the most time with patients, says Jason Short, who works for Appalachian Hospice Care. Short provides home care to patients in eastern Kentucky, one of the poorest areas in the nation. The film shows him driving up a creek to reach a home-bound cancer patient in Appalachia.
“What I like about [The American Nurse], it captures the journey. It’s almost like nursing has been lost. And I think this was unique because all of us in the film, we are allowed the opportunity to do what nurses do, and that’s just care for people,” says Short, a former auto mechanic who is currently studying to become a nurse practitioner.
A nurse since 2007, Short was drawn to the field after a terrible motorcycle accident at age 18 and he “found out what it’s like to be helpless” and in need of compassionate care.
For Jones, the film, book, and online videos share the inspiring stories of the women and men who have pledged their lives to the care of others. Her desire to elevate and celebrate the nation’s most trusted professionals and their calling also stemmed, in part, from a life-altering experience with the nurse who administered her chemotherapy for breast cancer back in 2004. The memory left an indelible impression.
“The book was an idea brought to me by Fresenius Kabi USA [a global health care company]. This is what I love to do, take pictures and interview people. They wanted to do something to celebrate nurses. I had a nurse who got me through chemotherapy, and she was incredible. Once it was all finished, I never really thanked her properly,” recalls Jones. Over the years, “I thought of her many times. I think you go through an illness like that and you don’t want to turn around and relive it. I thanked her at the time, but not enough, and she never knew how much it meant to me.”
So when approached with the idea, Jones embraced it. The book, website, and accompanying online videos were a hit with nurses. Accolades flowed. Yet, Jones felt her mission was incomplete. “I learned so much doing the book about what role nurses serve in society, that I felt I wanted to do something that could really broadly reach the public. Nurses have enjoyed the book greatly; it’s about nurses, and it’s very much for nurses. It was to celebrate nurses. But I didn’t feel like I was really able to cross that threshold into the realm of the public and let the public really see and know what nurses do, and so that became my driving passion.
“The other reason is I wasn’t ready to leave this world of nurses.”
It’s been said that lesbian, gay, bisexual, and transgender (LGBT) nurses form one of the largest minorities within the profession, and yet they are hardly recognized as a subgroup. To date, limited data are available to determine just how many nurses identify as LGBT (or some variation of those letters, such as LGBTQ, in which the “Q” stands for questioning or queer). But according to a 2013 Gallup poll, approximately 3.5% of the US general population identifies as LGBT; so whether or not you identify as LGBT, it’s likely that you will have to treat patients who do at some point during your nursing career. As patient advocates first and foremost, nurses must strive to provide culturally competent care for all, regardless of gender or sexual orientation.
LGBT nurses and patients alike face a unique set of challenges in the health care system: hostile personnel, lack of insurance, and higher rates of certain disorders, such as substance abuse. Yet both seek to make the health care system more supportive and equitable through changes in policy, education, and advocacy. Their aim: to raise cultural competence of health care professionals and lower the health disparities and barriers to care affecting LGBT individuals, families, and couples. Here are the profiles of five professionals committed to leading the charge for an open and accepting health care environment.
Austin Nation, RN, PHN, MSN
PhD Student at University of California – San Francisco (UCSF)
Veteran nurse Austin Nation has over 30 years of nursing experience to his credit, including stints in hospital supervision and providing AIDS services, before heading back for a PhD program. His aim is to teach nursing, which he is now undertaking as an adjunct professor at San Francisco State University.
He says he’s faced a “triple-whammy” of discrimination—surprising in a city like San Francisco, where he expected more cultural competency around these issues.
“I thought this was the gay mecca, with open, liberal thinkers, but that hasn’t been the case,” he says. “I’ve experienced racism, sexism, and homophobia. I’m a black male in nursing. I’ve been blatantly subjected to all this stress while embarking on a PhD journey, which is already stressful enough.”
Nation wonders why the UCSF system, which dominates the city and cares for a larger LGBT population than any other, is “so provincial when it comes to addressing issues closest to the heart of that community.”
“We have beautiful diversity banners, photos of different kinds of people together all getting along, but it isn’t like that,” he says. “In an academic setting, change happens so slow—it’s like turning the Titanic.”
Nation takes every opportunity to raise consciousness in class. “I’m trying to provide education in real time as it happens.” For example, if a nurse refers to gay patients in a distant or disrespectful way, he’ll step in: “Hey, that’s us you’re talking about—we’re not those people.” In addition, Nation leads a Men in Nursing group and is spearheading an LGBT Cultural Competency for Healthcare Providers workshop that has generated overwhelming interest.
One part of the problem, Nation suggests, is that “the health care community tends to be conservative. We come from a paradigm of heterosexuality.” It wasn’t too long ago that homosexuality was considered a psychological aberration, he adds.
Nurses are often uncomfortable with the subject of sexuality and reluctant to talk to patients about sexual health, Nation has observed. He suggests that discomfort first crops up during physical assessment class as undergraduates.
“We learn about the human sexual reproduction system. Then, during a head-to-toe assessment of a patient, you pull the covers up and look. But what are you looking for?” What happens if a nurse pulls up the gown of a male and sees female sexual organs, say? “That’s a good opportunity to have a conversation about gender variances,” he says.
“There have been many people that didn’t accept me,” explains Nation. “I’m the kid from the ghetto who made good. For me, the saving grace is that I’ve had women who’ve taken me under their wings. They watched over me and protected me in difficult or sensitive situations. I try to create that same sense of belonging for my students.”
Riikka Salonen, MA
Manager, Workforce Equity and Inclusion, Oregon Health & Science University (OHSU)
A bi-national native of Finland, Riikka Salonen leads diversity and inclusion strategy efforts at OHSU in Portland, Oregon. “Our intention is to provide an environment of care which is welcoming and inclusive,” she says, “as well as protective of patient and employee rights and benefits. For instance, we’ve had same-sex partner benefits since 1998, and offered transgender health-specific benefits for employees for over a year.”
Family inclusion is one topic that OHSU focuses on—and for patients, that means visitation is a given for everyone, including same-sex couples or a child who has two mothers. “Family inclusion also means that if a gay employee wants to put out family photos, they feel they can without there being whispering about it.”
OHSU Pride, an employee resource group for LGBTQ employees and allies, was started in 2007 to ensure an inclusive environment. “OHSU Pride has created a significant difference in our campus, which has become very LGBTQ-affirming,” says Salonen.
LGBTQ education and consciousness-raising at OHSU is an ongoing effort, Salonen notes, starting with new employee orientation. From there, it proceeds on an as-needed basis, depending on a nurse’s specialty. For example, Salonen says, OHSU provides “a specific session for pediatric nurses that focuses on providing care for transgender or gender-nonconforming youth.”
Parents worried about a 5-year-old boy who insists he’s a girl, for example, can be referred to TransActive Gender Center (www.TransActiveOnline.org), a national nonprofit with low-cost services for youth and families. (For those living outside Portland, Skype counseling sessions are an option.)
Mary Bylone, RN, MSM, CNML
Regional Vice President, Patient Care Services, Hartford HealthCare, East Region, and Director, American Association of Critical-Care Nurses National Board of Directors
“I’m 58 and didn’t figure out my lesbian orientation until later in life,” says Mary Bylone. “My brother is gay and so is my son. I didn’t come out at first because of the prejudice and abuse my brother experienced. As a manager, I’m now out; [but] as a staff nurse, I wasn’t.”
Bylone says her sexual orientation doesn’t totally define her: “It’s part of me, not all of me.” She has noticed that fellow employees and patients gravitate toward her to talk about gay issues. Possibly, she suspects, they do it “because I’m an out person in a responsible position. One day, a mother started crying when she told me her son was gay. I was able to comfort her as the mother of a gay son.”
Bylone has experienced situations where patients have discriminated against gay nurses. “I remember a patient who asked to see me when I was a head nurse,” Bylone recalls. “She didn’t want to see her nurse that day. ‘Why? Is it because he’s a man?’ ‘No, that’s just the problem. He’s no man,’ is what she answered. Unfortunately, the nurse was standing outside the door and heard her cruel complaint.”
Bylone adds that managers sometimes treat out nurses differently. “You may be assigned a gay patient when people know you’re gay, misunderstanding that someone’s sexual orientation does not define her or his entire person,” she explains. “I’m a nurse who happens to be lesbian, not a lesbian nurse.”
Emily Pittman Newberry
Trans Woman and Recent Surgical Patient in Portland, Oregon
Emily Pittman Newberry says she lived life for 55 years “pretending to be a man,” before embracing her gender identity as woman and transitioning over a period of five years. “People often ask me, ‘When did you decide you were a woman?’ The question should be: ‘When did you acknowledge it to yourself and choose to live openly?’” Every transgender person Newberry has met or read about says they always knew.
Newberry maintains that health care personnel have been universally professional and even kind to her during this process, though she had trouble with her insurance company. They wouldn’t cover the cost of surgical gender-confirming surgery.
She has some advice for nurses, such as not taking it for granted that you know a patient’s gender. “Ask them to self-identify and tell you what gender pronoun they prefer you use in referring to them,” says Newberry, though she understands that “asking is a tender place for a nurse and a transgender person.”
“Sometimes I see someone who is clearly struggling with it—getting pronouns wrong, getting uptight [such as the time she asked a clerk to change her gender in the clinic patient record system],” says Newberry. “I want to say, ‘This is new for everybody.’ It’s my job to educate people, be kind and humane even when I feel angry. It’s a dance, and we’re all learning the steps.”
Another piece of advice is to not get thrown if a transsexual patient has a health condition that doesn’t match their gender as your records show it. “If you see a prostate problem in a woman, for instance, act like it’s no big deal,” Newberry suggests.
Many health care IT systems only offer “male” or “female” as gender choices, which is limiting and potentially hazardous. Binary options are also being challenged by popular culture. Facebook now allows users to self-select from 56 gender options, such as “transgender” and “intersex” and “Female to Male/FTM.”
There are bound to be many uncertainties and uncomfortable moments for Trans patients and their nurses as we travel this unmarked path. “Do your best to carry on in a professional way,” says Newberry. “Ask yourself: ‘Am I being tender or am I being rational?’ You can be both at all times, of course, but sometimes more on the compassionate side and other times the scientific. Both are a part of every health care professional—you can emphasize one or the other, depending on the situation.”
Desiray Bailey, MD
Hospital Chief of Staff, Central Hospital, Group Health Cooperative, Seattle, WA, and immediate past president of GLMA: Health Professionals Advancing LGBT Equality (formerly known as the Gay and Lesbian Medical Association)
“GLMA was a physician-oriented organization originally, but we decided to be more inclusive and include the whole health care team,” says Desiray Bailey. “We work to provide opportunities to practice openly and more compassionately.”
Nurses are now an active part of the group, as evidenced by GLMA’s annual conference and nursing summit, scheduled for September 10-13, 2014, in Baltimore, Maryland.
One of the aims of GLMA is to improve education and awareness of gay and transgender issues among health care personnel. “It’s a very rare nursing program that provides LGBT education,” says Bailey. “We’d like to see it as part of the curriculum for all health professionals—physicians, nurses, physician assistants, and people in behavioral health training.”
At Group Health, Bailey has been an advocate for equal treatment of LGBT staff and patients for many years, facilitating changes in policy, employee benefits, patient and family visitation, consumer rights, and community outreach.
Additionally, she advocates for equal treatment so that “any professional in a hospital or medical center who is gay, lesbian, bisexual, or transgender won’t experience discrimination as an employee because they can’t be out, or their organization doesn’t provide benefits that are equitable with straight employees.”
In many states where LGBT employees aren’t a protected class, it’s possible to be discriminated against or fired for being gay. Even worse, a few states have “anti-gay laws—where certain sexual acts are illegal—or there aren’t specific protections,” Bailey says. “I’m fortunate to live in Washington State—we’ve had domestic partnerships for a few years and now marriage equality.”
According to Bailey, the Affordable Care Act has benefited the LGBT community. “Insurance plans can’t discriminate based on sexual orientation or gender identity. Legally married couples are still recognized, even if they live in a state that doesn’t recognize their union, and there aren’t lifetime limits for AIDS patients,” she adds.
Among the tools available to improve LGBT equality in a health care setting is the Healthcare Equality Index of the Human Rights Campaign, a civil rights organization. “This is a tool that really changes the atmosphere for employees and patients,” says Bailey. Once a decision has been made to participate, “there’s an organizational will to want to score well. They want to put in place the right policies and training for staff,” she adds.
Seeking out legitimate information about LGBT issues is very important “if you want to take care of all your patients,” Bailey says.
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.
By providing health education and wellness promotion in religious communities of color, minority nurses of all faiths can make a powerful difference in eliminating health disparities.
Not that long ago, nurses who answered a calling to promote physical and spiritual health in their places of worship were known as parish nurses or congregational health nurses. But in today’s unprecedentedly multicultural America, where many of the faithful are just as likely to attend a Muslim mosque or Hindu temple as a church or synagogue, this specialty area of nursing has acquired a new, more all-embracing name: faith community nursing.
“When what we do was first recognized by the American Nurses Association [ANA] as a specialty practice in the late 1990s, it was under the title ‘parish nursing,’” says Nancy Rago Durbin, RN, MS, FCN, interim director for faith community nursing for the Health Ministries Association (HMA), a professional association for faith community nurses (FCNs). But by 2005, when Durbin was part of a team working with ANA to update the specialty’s Scope and Standards of Practice, the limitations of that name had become glaringly obvious.
“One of the ANA leaders said: ‘Do you have to be Christian to claim this specialty?’” recalls Durbin, who is also director of Advocate Parish Nurse Ministry and the Parish Nurse Support Network for Advocate Health Care in the Chicago area. “When I said, ‘No, this is by no means an exclusive specialty, any nurse from any faith is welcome to practice,’ she said: ‘Well, your name doesn’t seem to include that.’ And she was right!”
Of course, the term “parish nurse” is still alive and well. It’s widely used to denote FCNs who work to improve health in specifically Christian settings. But professional organizations like HMA and the International Parish Nurse Resource Center (IPNRC), a ministry of the Church Health Center, now recognize that church-based nursing is one thread in a much bigger tapestry that encompasses many different faith traditions. In fact, the Church Health Center, despite its name, teaches FCN training courses to nurses of all faiths all over the world.
When and how did traditional parish nursing evolve into this broader, more culturally inclusive specialty? “I’ve always known it to be all-inclusive,” says Maureen Daniels, RN, MN, FCN, an IPNRC faith community nurse specialist. “I think it’s just the organic nature of it that’s helped it grow into more of these other faith settings. One of the things that’s so beneficial about this model is that it’s meant to be adapted to the community and to where the needs are.”
Different Faiths, Same Roles
No matter whether the faith they practice is Baptist, Buddhist, or Baha’i, minority nurses need to be involved in addressing the health and wellness concerns of their own faith communities. Even though most FCNs do this work on a volunteer basis while also holding regular nursing jobs, they can make a tremendous difference in improving health outcomes and reducing health disparities in communities of color—especially those that are economically disadvantaged and/or medically underserved.
“[Places of worship] can be a very important resource for promoting health, because they reach so many people on a regular basis,” explains Ann Littleton, a congregational health advocate at Sacred Heart Catholic Church in Greenville, Mississippi, which serves a predominantly African American congregation plus a smaller Hispanic congregation. “At our church, we probably have more people from the community gathered together in one place every weekend than anywhere else. We can pass out information about cancer, heart disease, stroke, and diabetes just like we pass out the Sunday bulletin.”
The roles FCNs perform are remarkably similar from faith to faith. The Canadian Association for Parish Nursing Ministry organizes those functions into this easy-to-remember acronym:
H – Health advisor
E – Educator on health issues
A – Advocate and resource person
L – Liaison to faith and community resources
T – Teacher of volunteers and developer of support groups
H – Healer of body, mind, spirit, and community
For example, Ameena Hassan, RN, a Muslim nurse who works in the ICU at Las Colinas Medical Center in Irving, Texas, has been providing faith community nursing services at her mosque, the Islamic Center of Irving, since 2009. It’s a large mosque, serving approximately 500 families in the Dallas area.
“We do health education classes here every month,” says Hassan, coordinator of the mosque’s Health Advisory Committee. “We do blood pressure screenings and cholesterol screenings. We do mammograms every year, usually in April. During flu season, we do flu shots.”
The mosque also holds an annual health fair. At last year’s event—attended by almost 200 community members—local physicians, nurses, and dentists provided 100 cholesterol and diabetes screenings, 33 bone density screenings, 67 dental exams, and 42 vision exams. In addition, they gave 90 attendees nutrition advice and distributed 100 bicycle safety helmets to children.
At New Horizon Church International in Jackson, Mississippi, “cardiovascular disease is the number one health problem among my congregation, so we do lots of CVD screenings, education, and referrals,” says Ella Garner Jackson, RN, CHN, leader of the church’s Health and Wellness Ministry. Jackson and her team also provide a full calendar of other disease prevention programs, including exercise classes, kidney disease screenings, and HIV/AIDS education. On the advocacy front, the ministry helps increase access to health care for low-income church members by connecting them with community resources that provide affordable prescriptions.
Because Mississippi has some of the highest levels of poverty and African American health disparities in the nation—including disproportionately high morbidity and mortality rates from cancer, diabetes, and other chronic diseases—Jackson is especially focused on the FCN’s volunteer training role. In 2005, Jackson, who is also a cardiac case manager at Mississippi Baptist Medical Center, founded the Abundant Living Community Organization (ALCO), a nonprofit organization that has taught nearly 160 nurses and non-nurse volunteers to lead health ministries in African American churches throughout the state.
Same Roles, Different Needs
How faith community nurses carry out these roles is driven by the unique needs of the communities in which they serve. In some faith settings, for instance, FCNs must tailor their health promotion activities to accommodate specific religious requirements.
“In Islam, we don’t mix men and women together in the mosque,” says Hassan. “If we’re doing something like screenings or flu shots, we have to have it in two separate places for men and women. And the women’s space has to be covered, because they don’t want to [expose their bodies] in front of others.”
But in many minority faith communities, the biggest challenges for FCNs are more likely to revolve around cultural and socioeconomic needs than belief-based ones.
“Here in the Chicago metro area, Advocate’s parish nursing program includes two Latino congregations and two African American congregations,” says Durbin. “Our nurses who work with those communities are very focused on the needs of people who are disenfranchised, undocumented, and struggling with access to care. Some of our nurses are dealing with the problem of food deserts, and they’re trying to work with the communities to create sustainable vegetable gardens and increase access to quality foods.”
Littleton, a retired English teacher who became a church health advocate after taking the ALCO training in 2010, emphasizes that “in our Hispanic health ministry, we don’t ask about immigration status. If anybody comes to us in need of our services or a referral, we try to make them feel as comfortable with us as possible. It’s important for them to feel that we’re not going to pry into their status; we’re just providing health services that they need.”
One of the most empowering ways minority FCNs can lead their faith communities down the path to healthier living is by breaking down cultural barriers that exacerbate health inequities and impede access to care.
“In some African American communities, there is still enormous distrust of the health care system,” Durbin notes. “A black faith community nurse can become the entry point for many people to develop that trusting relationship. Someone may say, ‘I went to the public health clinic down the street and they were mean to me. So I’m not going back.’ And the nurse will say, ‘Well, how about if I go with you? Because that’s where you need to be to get your meds refilled.’ Then the nurse can physically take that person back to the clinic and help them [build a better relationship with those providers].”
Durbin also notes, “In our Latino communities, men’s health is a big issue. Many of the guys have traditional machismo cultural values, so they don’t take care of their health. And traditionally, it’s the women and the older men who are the churchgoers, but not the younger guys. Latino faith community nurses who know the culture can figure out creative ways to engage that core group of men, such as providing them with health information through the people who love these men and who do go to church.”
Enlisting the aid of lay community health promoters can also help FCNs connect with hard-to-reach populations. Daniels cites the example of a group of parish nurses in Portland, Oregon, who are partnering with local promotores to extend their health ministry outreach deeper into the Hispanic community. “Because the promotores had such good relationships with the people, and people trusted them so much, they were able to get many more community members to come to health events the nurses had organized than the nurses would have gotten by themselves,” she says.
Bridging Cultural Differences
Even if a nurse doesn’t share the same religious, ethnic, or cultural background as the faith community he or she works with, collaborating with leaders within the community can be an effective way to bridge those gaps. For example, the Faith Community Health Ministry (FCHM) program at Carolinas HealthCare System in Charlotte, North Carolina, uses a model that makes it possible for the hospital system to meet the needs of virtually any belief community.
“We form partnerships with faith communities through either a faith community nurse or a faith community health promoter,” explains Sheila Robinson, BSN, RN, the program’s health ministry coordinator for Mecklenburg County. “My role is to help each one of those individual communities promote health and wellness within their own particular faith. I provide the clinical guidance and oversight to the nurses and the health promoters.”
This approach enables Robinson, an African American Christian nurse, to work with such diverse faith communities as the Hindu Center of Charlotte, a temple that serves about 2,000 families. Her health promoter partner is Chidaabha Vyas, vice president of the Hindu Center’s executive committee. When they first teamed up in 2012, one of their key projects was to survey the temple’s members about their most important health concerns and then develop programs targeted to those needs.
“Heart disease, allergies, and weight loss were some of the top concerns the community identified for us,” Vyas says. “Diabetes is a very big concern. And it’s not specifically the Hindu community that’s so affected by this disease,” she points out. “It’s [Asian] Indian people in general. Diabetes is more of a concern for us as a race, I would say.”
Being able to work side by side with a community liaison like Vyas makes it easier for both Robinson and Carolinas HealthCare System to serve the local Hindu community in culturally sensitive ways. “When we formed the partnership, I told Chidaabha, ‘I’m of Christian faith, so you will have to help me to be able to meet the needs at the Hindu Center,’” Robinson says. One cultural lesson she learned early on is that some members of this community may be uncomfortable with the idea of placing a terminally ill family member in hospice care.
“Again, this is more of an Indian cultural issue than a religious one,” Vyas stresses. “Some of us do not believe in speeding up the process of death. We believe death will come when it will come. Having a connection between our temple and the hospital system through the FCHM program is very helpful, because we can let them know that when an Indian family is resisting hospice it’s because there is a real cultural dynamic going on.”
A Higher Power
Praying isn’t enough to make America’s health disparities crisis go away. But by educating, advocating, and integrating spirituality with health in all the diverse settings where people gather together to pray, faith community nurses have the power to bring about real change.
“Because of our partnership with Sheila and the FCHM, something is happening at the Hindu Center now that was never happening before,” Vyas reports. “It has helped us develop a culture that prioritizes health. Before, health was thought of as more of an individual responsibility. But now, we’re beginning to develop a connection with our members based on the idea that ‘you are responsible for your own health, but the temple is here to help you be responsible for your health.’”
Jackson adds: “My pastor has told me, ‘I know that you’ve saved some lives in this congregation. I know that I am a healthier person myself because of all the education you’ve provided in the church.’ I can look out into the pews and show you people who were not going to the doctor, who weren’t taking their medicine, and who are now routinely seeing a physician. That’s at the heart of what a faith community nurse can do.”
Melissa Leung, RN, BSN, still remembers the day she encountered an elderly patient who was resisting her medication. The woman, a native of China, had balked when given her pills and a glass of cold water, and it was noted on her chart that she was “medically noncompliant.” Leung, who is fluent in Mandarin, gently spoke to the woman in her native language to determine why she was reluctant to take her medicine.
“Like many Chinese immigrants, she had been taught to drink hot water with meals,” says Leung, who works in the cardiac catheterization lab at Einstein Medical Center in Philadelphia. “In China, some people are taught to boil water before drinking it to remove germs, and others believe that drinking cold water is bad for the stomach.”
Leung noted on her patient’s chart that she preferred to take her medications with hot water. As a bilingual nurse, Leung was able not only to communicate with her patient in her native language, but also to provide culturally specific care by being sensitive and responsive to her patient’s cultural beliefs and traditions.
As immigration increases, the demand for bilingual and multilingual nurses continues to grow. According to the US Census, between 1980 and 2010, the number of people speaking a language other than English climbed 158%. In addition to English and Spanish, the 2011 Census showed there were six languages spoken at home by at least 1 million people: Chinese (2.9 million); Tagalog (1.6 million); Vietnamese (1.4 million); French (1.3 million); German (1.1 million); and Korean (1.1 million).
Hospitals across the country are seeing more patients with different language needs, cultural sensitivities, and religions. While interpreters are employed by many hospitals, bilingual and multilingual nurses provide another way of bridging the cultural gap.
Because factors such as language, unfamiliar customs, and misconceptions about health care can keep foreign residents from seeking medical care, bilingual nurses can help to ease a patient’s fears and even reduce barriers to clinical preventative care.
There are also professional benefits to learning another language: Some bilingual employees can earn more than their single-language colleagues.
Providing Culturally Sensitive Care
Jimmy Andres Reyes, RN, MSN, DNP, AGNP, of Cedar Rapids, Iowa, an instructor in advanced practice nursing with Kaplan University School of Nursing and the dean of nursing at Kirkwood Community College, says he was inspired to become a nurse after watching the work of his grandmother, who was a community health nurse in Santiago, Chile.
Five years ago, Reyes received a predoctoral scholarship award to study diabetes self-management in Latino older adults. Fluent in both Spanish and English, Reyes says that being bilingual allowed him to hold focus groups in Spanish that helped staff determine the stressors and barriers that prevented the patients from keeping their diabetes under control.
“We learned many of these older adults would simply nod and agree with their health care providers, even if they didn’t understand the instructions they were being given,” explains Reyes. “For them, it was simply easier to be cordial, but as a result, they weren’t learning the tools and information needed to manage their diabetes.”
Reyes and his colleagues were able to take the information gleaned in talking with Latino immigrants and to pilot several programs. The information they gathered was not only translated into Spanish, but also designed to be culturally sensitive and relevant.
Reyes also believes that nurses can learn about different cultures through medical missions and studying abroad. He recently accompanied a group of nursing students to Costa Rica and plans to take another group to Ecuador later this year.
“Traveling to Costa Rica changed the world view of all of our students, and even those who didn’t speak Spanish returned to the US with a better understanding of the health care barriers and challenges that many immigrants face,” says Reyes.
As a bilingual nurse educator, Reyes believes his job in providing culturally sensitive care isn’t to change the beliefs of his patients, but rather to provide them with all of the facts they need to manage their condition.
“We have recently started working on a cancer prevention project with Latino and Burmese immigrants,” he explains. “Most of the people we spoke with weren’t aware of the new HPV vaccine that can be given to teens to protect them against the virus that causes cervical cancer and some other forms of cancer. We’re not mandating they vaccinate their kids, but rather providing them with the information to make an informed decision.”
Reyes is a member of several professional organizations, including the National League for Nursing, the American Academy of Nurse Practitioners, the Gamma Chapter of Sigma Theta Tau International, and the National Association of Hispanic Nurses, to name a few. He encourages nurses to become involved in organizations and associations that can give them a better understanding of the diverse patients they serve, as well as to consider learning a second language to better communicate with their patient population.
“We have nurses who are not Latino or Burmese who have picked up on the languages, and the patients just beam when they hear the nurse interacting with them in their native language,” says Reyes. “It not only shows they care; it’s also the first step in building trust.”
Addressing Patients’ Unique Cultural Beliefs and Concerns
Shency Varughese, MSN, RN, an immigrant nurse from India, works in the Inpatient Surgical Unit at the Cancer Treatment Centers of America, Midwestern Regional Medical Center, in Zion, Illinois. She has found that speaking a familiar language with patients helps earn their trust and respect.
“According to the nurse theorist Dr. Madeleine Leininger, nursing care must be customized to fit with the patient’s own cultural values, beliefs, traditions, practices, and lifestyle,” says Varughese. “I was able to put this into practice recently while caring for a patient who had a special request for a specific Indian tea that contained natural immunizers such as ginger and cardamom.”
Varughese notes the tea needed to be prepared in a special way and was very important to the patient. Although she acknowledges the act of preparing tea wasn’t earth shattering and could have been performed even with a language barrier, the act allowed her the chance to connect with the patient and provide culturally sensitive care.
“Our shared Hindi language allowed me to truly listen and understand his request and respect his needs,” explains Varughese. “I was able to understand how the preparation and drinking of the tea was an important part of this patient’s life.”
Varughese says being multilingual has also helped in her nursing career: “My peers know that they can count on me if a patient has a need or request. We have a translation service that our patients use to help communicate anything related to their medical needs; however, I am more than happy to step in and help with all non-medical patient requests.”
Nenette Ebalo, RN, has found that her ability to speak Tagalog provides an extra layer of comfort to the Filipino patients she sees in her job as service unit manager for the Head and Neck Surgery department at Kaiser Permanente’s Oakland Medical Center. In addition, Ebalo notes that in-person communication allows her to take cues from a patient’s body language that may be lost over the phone. It also allows for easier communication with elderly patients who may be hard of hearing.
“As a bilingual nurse, I don’t replace our medical center’s interpreting staff, but I am able to help patients who might prefer an in-person interaction with a nurse,” says Ebalo. “This can be helpful, especially for those who have complex medical conditions and may not understand the medical terminology.”
Ebalo remembers a recent case when she encountered an older couple waiting to see a speech pathologist. The wife told Ebalo she was concerned because her husband was suddenly having speech problems, and after speaking with Ebalo in Tagalog, they asked if she could accompany them to their appointment. After a consultation with the speech pathologist, Ebalo was able to explain to the wife that her husband’s condition was a side effect of the radiation he had been given.
“They were very appreciative of my help and returned later that week with Ensaymada, a traditional Filipino sweet bread to thank me,” says Ebalo.
In addition to her work at the hospital, Ebalo has worked on several medical missions and has found that her language skills prove beneficial when caring for patients abroad.
“I recently accompanied some of our physicians on a medical mission to the Philippines where I worked as a bedside nurse in the recovery room,” says Ebalo. “The doctors were repairing cleft lips and palates, and they relied on me to help them to understand both the language and the culture.”
Breaking Communication Barriers
Michelle Moore, BSN, RN, HN-BC, inpatient care manager at the Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Illinois, first learned American Sign Language (ASL) to communicate with her daughter who was born deaf. Since then, Moore has found that knowing ASL has also helped her in her job.
“Deaf individuals are unique in that they cannot use a language line to talk with the hearing community,” says Moore. “Deaf people use electronic devices—mostly smartphones now—to communicate with the hearing world. Years ago, I was part of the committee that helped bring devices [such as TTY, the flashing door bell, and the bed alarm] to the hospital.”
In addition, Moore says that although she is not a certified ASL interpreter, she has had general conversations with deaf patients and their caregivers, which allows them to feel comfortable with a culture they are familiar with.
“Having the ability to speak with people in their common language is such a gift,” says Moore. “Years ago, we had a new patient who was deaf, and her interpreter was running late. I remember sitting in the lobby waiting with the patient and just carrying on a normal conversation with her. The patient felt comfortable that someone in a strange environment was available and familiar with her language.”
Moore notes that every time the patient would return to the hospital, she would ask to see her. “She often shared with me how grateful she was that I was with her on her very first visit and how it allowed her fear to decrease and put her mind at ease,” says Moore.
Becoming a Certified Medical Interpreter
While many bilingual nurses help patients in an unofficial capacity, some nurses are taking their translating skills to the next level and becoming certified medical interpreters. Having credentials provides documentation that nurses have the necessary skills required to translate or interpret professionally.
Yelena Tuerk, RN, BSN, MS, manager, patient care services, for the Rose D. and Joseph W. Lazinsky Neuroscience Center at Sinai Hospital in Baltimore, was born in Russia and is fluent in both Russian and English. After seeing a large influx of Russian patients at her medical center, Tuerk decided to become a certified medical interpreter in order to assist patients in a more official capacity.
Tuerk enrolled in the three-day Qualified Bilingual Staff program offered through the Maryland Healthcare Education Institute, which covered many areas including legal requirements, cultural competency, and privacy laws.
“The course taught the specific way to translate for nurses to ensure that we provide high quality care,” explains Tuerk. “The training goes beyond just speaking a second language; it also covers how to best convey medical terminology, and how to serve as the voice of the patient to ensure that all of their questions are addressed.”
