Men are more likely to put off routine health care appointments for screenings which often leads to a less healthy lifestyle. Men are also more likely to delay seeing a health care provider for symptoms of a health problem that could lead to conditions affecting men such as heart disease, prostate, testicular, and colon cancer along with osteoporosis and nutrition issues.
With the glaring issues of Men’s health, Mr. Graham has recently started his clinic that focuses on primary care and men’s health. NP-VIP Concierge Medical clinic provides comprehensive health care in your home, over your phone or home computer with the use of a HIPAA-approved telemedicine app. Telemedicine is the use of telecommunication and information technology to provide clinical health care from a distance. It has been used to overcome distance barriers and to improve access to medical services that would often not be consistently available in distant rural communities or busy lifestyles.
Mr. Graham started his medical career of as a medical assistant 26 years ago when he joined the United States Army and served a total of 22 years of active duty service. During his tenure in the Army, he became a Registered Nurse, graduating from Alcorn State University in 2006 with his BSN and Walden University in 2015 with an MSN as a Nurse Practitioner and is currently pursuing his DNP. Mr. Graham is also a Duke-Johnson & Johnson Nurse Leadership Fellow at Duke University. As an Advanced Practice Nurse, Mr. Graham has worked in areas such as Primary Care, Urgent Care, and Critical Care. With the variety of experience, Mr. Graham has focused on Primary Care with a focus on Men’s health. Research has shown that men, their health has for the most, has taken a back seat to women’s health. Mr. Graham’s focus is on prevention and early detection.
I seriously never thought being an educator was part of my career path, but I remember when the opportunity presented itself, like it was yesterday. At the time I was working as a resource nurse within a big hospital. I was caring for a patient whose mother happened to be the director of nursing. She approached me and said how impressed she was with my bedside manner and nursing skills. She asked if I ever thought about teaching nursing students. I had a blank stare because I never really thought about it. She handed me her business card and informed me to call her when I graduated from grad school. She said “you have a job”.
I learned a valuable lesson that day…..you NEVER know who is in your presence. You must remain professional at ALL times. Well…fast forward 8 years and I am still doing what I love…. teaching as adjunct faculty.
So, how do you know if teaching is right for you? Just like nursing, teaching isn’t for everyone. It requires a lot of compassion and patience, but so does nursing. You need a minimum of a master’s degree. Next, you have to be committed. You must be devoted to working with each student, and trust me when I say that you will often times encounter students that are downright CHALLENING. Flexibility is a must, particularly in the clinical setting. While, I’m thankful to have worked on great units and with great nursing staff, not all floors are conducive to the learning needs of the students.
There are multiple educator roles that range from adjunct or part-time faculty to full time educators. Working as adjunct faculty is a great way to get a small dose of where most of us started, at the bedside. It’s particularly great for me since I practice as Nurse Practitioner in an outpatient setting.
As mentioned, there are challenges. You are working with numerous students that often times have various learning needs. I’m open to constructive feedback just as much as I give it. My goal is to help individualize, if needed, the learning needs of my students….within reason of course.
Our job isn’t to discourage future nurses but to encourage and guide them along the right path. You will meet a lot of different personalities, but hey is that really that different from what we are used to day to day? I take my job very seriously. I’m there to help mold a good nurse, an excellent nurse. I support and encourage each and every one of my students.
When it comes to my students, I keep the motto “yes you can”. Yes you can get through this program, yes you can become an excellent nurse and yes you can advance your career in whatever ever direction you may choose. Believe me, it’s rewarding!
Can’t you just hear Aretha’s background singers singing “Doo Woop! The House that Jack Built!” Our Queen of Soul, may she rest in peace and love. Certainly, we all have so much respect for Aretha and the legacy she’s left behind; with an estate including property, fancy furs, cars and music royalties valued in the millions. However, frankly speaking (no pun intended) her family won’t have JACK for many years with an estate left to argue over publicly in probate as there was no will despite battling a fatal illness for many years. See Aretha is different from us in that we don’t have millions of dollars to pass on, but the same as most of us in that little forethought is given to end of life/advanced care planning (EOL/ACP) or estate planning. This occurs despite the reality there is increased communication between the patient-caregiver unit and clinicians, particularly nurses during illness and “at the heels “of an individual’s quietus.
So if there’s increased contact with clinicians, particularly nurses what are the forces/influences that play a part in the aversion to discussing EOL/ACP. Nurses Sullivan & Dickerson’s (2016) article appraised the current state of affairs of ACP in the US using theoretical analysis from a critical social theory perspective to “…understand society’s taken-for-granted beliefs that tend to empower certain groups and restrict the decision-making power of others. In their article they explore this problem from a political, economic, social and historical context. Sullivan & Dickerson (2016) note, historically we live in continuous medically advancing times which supports societal views towards life promoting treatments and laws supporting an individual’s right of self-determination. From a political context, bipartisan politicians have played on the public’s fears of doctors billing for EOL counseling during visits under the Affordable Care Act as “life-devaluing”. This misinformed argument against Obamacare tied into the “death panel” hysteria created by some Republicans. The economical context points to CMS payment models with limited EOL care coverage, federal research dollars focused on cures versus support of EOL care and disease focused payment models which primarily reimburse for life maintaining care even if futile. The societal context notes our society’s romanticism with staying young and older adults’ fear of ageism that might prevent them from sharing critical medical information. Significantly, the AMA’s physician dominance (paternalism) asserts a physician led team approach despite the fact facilitating family meetings to promote EOL discussions is within the RN and NPs scope of practice; yet it remains within the physician domain. Nurses should feel like an empowered member of the medical team and begin to spark meaningful EOL/ACP conversations.
How do you start a meaningful conversation about EOL/ACP? For starters, one has to acknowledge that talking about death is a conversation that involves coming to grips with life’s finality. If you the informant aren’t comfortable with the realities of your own mortality, you won’t be with someone else’s. Reflect on your own personal, cultural and spiritual beliefs about death. Next, ensure you have some cultural awareness of the patient you plan to have the discussion with. And if you don’t, respectfully ask. Transparency is very humbling and healing; it shows our shared humanity. Seize milestone life events to initiate the conversation such as births, marriages, divorce or surgery as suggested by the National Hospice and Palliative Care Organization. Present the information in such a way that you assure the patient you’d like to honor their preferences or their family’s/spiritual leader’s preferences in the event they would not be able to speak for themselves with regards to life saving measures and/or treatment. Take into consideration the patient may feel entrusting someone with their preferences surrounding EOL as burdensome. Allay their fears by informing them it’s more burdensome if a caregiver felt guilty not knowing if they decided as the patient would. In the case of older adults, they might also have feelings that such a discussion is a gesture of forfeiture of their autonomy. There might also be patient fears of their caregiver/family dealing with anticipatory grief in illnesses with poor prognosis. Also keep in mind, as a clinician about to initiate an EOL dialogue, first you must hash out any feelings of defeat within yourself as the treatment plan moves away from a cure and more towards maintenance and comfort.
EOL/ACP discussions are also likely to be avoided due to fear of bringing up assets, property and funeral arrangements. Like anything in life and naturally in death, it boils down to the bottom line. For minorities, particularly Blacks EOL/ACP is avoided because we are less likely to own property or leave an inheritance for family. It’s difficult to directly inform loved ones that there isn’t much to contribute to personal burial expenses and the family’s financial outlook. But with minorities slowly making socioeconomic gains, we are acquiring assets and property to contribute to generational wealth. Nurses should not give estate planning advice but should encourage patients/caregivers to seek out estate planning services as to not cause psychological stress and untoward health affects in their loved ones fighting amongst each other and with the government for what they believe you would want them to have.
Essentially, the primary factor why we don’t discuss EOL/ACP/estate planning is fear and misconceptions. Nurses need to address these fears and provide clarity to misconceptions. Be empowered to start these difficult conversations as well as serve as examples by having EOL/ACP/estate planning talks with your friends and families. Begin with checking off your driver’s license/state ID organ donor status and discussing it with family members. Choose a healthcare proxy, create a living will that specifies what medical decisions/preferences you have if you’re incapable of making them, reach out to an estate planning professional to draft a will and if you have a special needs child create a trust. Through our actions we will be prepared to assist patients or loved ones in starting an EOL conversation which is the best way of honoring a person and showing R-E-S-P-E-C-T!!!
Laura L. Gayle is a RN and Notary Public with 15 years experience in Pediatric Intensive Care units and an outpatient adult transplant clinic, coordinating care for medically complex transplant recipients. Laura enjoys writing, reading, the outdoors and trying to live life out of the comfort zone.
Can’t you just hear Aretha’s background singers singing “Doo Woop! The House that Jack Built!” Our Queen of Soul, may she rest in peace and love. Certainly, we all have so much respect for Aretha and the legacy she’s left behind; with an estate including property, fancy furs, cars and music royalties valued in the millions. However, frankly speaking (no pun intended) her family won’t have JACK for many years with an estate left to argue over publicly in probate as there was no will despite battling a fatal illness for many years. See Aretha is different from us in that we don’t have millions of dollars to pass on, but the same as most of us in that little forethought is given to end of life/advanced care planning (EOL/ACP) or estate planning. This occurs despite the reality there is increased communication between the patient-caregiver unit and clinicians, particularly nurses during illness and “at the heels “of an individual’s quietus.
So if there’s increased contact with clinicians, particularly nurses what are the forces/influences that play a part in the aversion to discussing EOL/ACP. Nurses Sullivan & Dickerson’s (2016) article appraised the current state of affairs of ACP in the US using theoretical analysis from a critical social theory perspective to “…understand society’s taken-for-granted beliefs that tend to empower certain groups and restrict the decision-making power of others. In their article they explore this problem from a political, economic, social and historical context. Sullivan & Dickerson (2016) note, historically we live in continuous medically advancing times which supports societal views towards life promoting treatments and laws supporting an individual’s right of self-determination. From a political context, bipartisan politicians have played on the public’s fears of doctors billing for EOL counseling during visits under the Affordable Care Act as “life-devaluing”. This misinformed argument against Obamacare tied into the “death panel” hysteria created by some Republicans. The economical context points to CMS payment models with limited EOL care coverage, federal research dollars focused on cures versus support of EOL care and disease focused payment models which primarily reimburse for life maintaining care even if futile. The societal context notes our society’s romanticism with staying young and older adults’ fear of ageism that might prevent them from sharing critical medical information. Significantly, the AMA’s physician dominance (paternalism) asserts a physician led team approach despite the fact facilitating family meetings to promote EOL discussions is within the RN and NPs scope of practice; yet it remains within the physician domain. Nurses should feel like an empowered member of the medical team and begin to spark meaningful EOL/ACP conversations.
How do you start a meaningful conversation about EOL/ACP? For starters, one has to acknowledge that talking about death is a conversation that involves coming to grips with life’s finality. If you the informant aren’t comfortable with the realities of your own mortality, you won’t be with someone else’s. Reflect on your own personal, cultural and spiritual beliefs about death. Next, ensure you have some cultural awareness of the patient you plan to have the discussion with. And if you don’t, respectfully ask. Transparency is very humbling and healing; it shows our shared humanity. Seize milestone life events to initiate the conversation such as births, marriages, divorce or surgery as suggested by the National Hospice and Palliative Care Organization. Present the information in such a way that you assure the patient you’d like to honor their preferences or their family’s/spiritual leader’s preferences in the event they would not be able to speak for themselves with regards to life saving measures and/or treatment. Take into consideration the patient may feel entrusting someone with their preferences surrounding EOL as burdensome. Allay their fears by informing them it’s more burdensome if a caregiver felt guilty not knowing if they decided as the patient would. In the case of older adults, they might also have feelings that such a discussion is a gesture of forfeiture of their autonomy. There might also be patient fears of their caregiver/family dealing with anticipatory grief in illnesses with poor prognosis. Also keep in mind, as a clinician about to initiate an EOL dialogue, first you must hash out any feelings of defeat within yourself as the treatment plan moves away from a cure and more towards maintenance and comfort.
EOL/ACP discussions are also likely to be avoided due to fear of bringing up assets, property and funeral arrangements. Like anything in life and naturally in death, it boils down to the bottom line. For minorities, particularly Blacks EOL/ACP is avoided because we are less likely to own property or leave an inheritance for family. It’s difficult to directly inform loved ones that there isn’t much to contribute to personal burial expenses and the family’s financial outlook. But with minorities slowly making socioeconomic gains, we are acquiring assets and property to contribute to generational wealth. Nurses should not give estate planning advice but should encourage patients/caregivers to seek out estate planning services as to not cause psychological stress and untoward health affects in their loved ones fighting amongst each other and with the government for what they believe you would want them to have.
Essentially, the primary factor why we don’t discuss EOL/ACP/estate planning is fear and misconceptions. Nurses need to address these fears and provide clarity to misconceptions. Be empowered to start these difficult conversations as well as serve as examples by having EOL/ACP/estate planning talks with your friends and families. Begin with checking off your driver’s license/state ID organ donor status and discussing it with family members. Choose a healthcare proxy, create a living will that specifies what medical decisions/preferences you have if you’re incapable of making them, reach out to an estate planning professional to draft a will and if you have a special needs child create a trust. Through our actions we will be prepared to assist patients or loved ones in starting an EOL conversation which is the best way of honoring a person and showing R-E-S-P-E-C-T!!!
Laura L. Gayle is a RN and Notary Public with 15 years experience in Pediatric Intensive Care units and an outpatient adult transplant clinic, coordinating care for medically complex transplant recipients. Laura enjoys writing, reading, the outdoors and trying to live life out of the comfort zone.
Medical Billing services can be quite a handful for a medical office to carry-out. In some cases, a medical office might decide to engage the services of qualified medical billers who are willing to work full time in the office, while others might decide to outsource their medical billing and management practice services.Some might decide to combine both methods, but outsourcing medical billing services seems to be the more preferred option. In this article, we would be looking at the benefits of outsourcing medical billing services for a medical office. Let’s check out some of them below;
Reduction In Cost Of Labor
Reduction in the cost of labor has always been an important factor for most small businesses, and we all know how expensive maintaining a medical billing department can be. The standard practice entails that an office should have 1.5 workers for every two doctors in practice. This is in line with the average salary package for a qualified and experienced medical billing expert which is placed at $35,000 annually, including benefits such as; Dental Insurance, Life Insurance, Health Insurance, Unemployment Insurance and many more. So, engaging the services of 1.5 workers will cost over $50,000 per year.In addition to these costs, there are other miscellaneous expenses associated with adequately providing those medical billers with the right set of equipment and supplies to enable them to carry out their job effectively. Now, we can all see how expensive it is to operate an in-house medical billing department. This is where outsourcing comes in; it helps your business save some extra cash and reduce your total overhead cost.
Reduces Billing Errors
Outsourcing your medical billing services to professional medical billers ensures that your claims are submitted accurately and quickly. The primary purpose of a medical billing company is to provide quality medical billing services, and they are solely responsible for making sure that their staffs are well trained and equipped with the know-how needed to submit medical claims properly. This helps to ensure that the number of rejected and denied medical claims due to billing errors is reduced.
Billing Compliance
The healthcare sector changes constantly, and insurance companies are partly responsible for this. One thing which makes medical billing very tasking is having to stay updated with the changes in Medicare, Medicaid, and third-party payers. Medical billing services are best seen as a full-time job, to ensure that the medical office is kept in line with the appropriate formalities required by each payer. Medical billing firms are required to stay up to date with the recent changes in protocol to enable them to maintain billing compliance.Its now very clear why outsourcing medical billing services can be of tremendous benefits to a physician, this is because medical billing services are one of the most important functions of a medical office, and a huge percentage of your income can be derived as a direct benefit of having a functional medical billing services firm to work with.
Dr. Scharmaine Lawson, NP, FAANP, FAAN
As seen on CBS Evening News with Katie Couric, Dr. Scharmaine Lawson is a nationally recognized and award-winning nurse practitioner in New Orleans, Louisiana. She is a Fellow of the American Academy of Nursing (FAAN), Fellow of the American Association of Nurse Practitioners (FAANP), winner of the 2013 Healthcare Hero award (New Orleans City Business magazine), and 2008 Entrepreneur of the Year award (ADVANCE for Nurse Practitioner magazine) where she was featured on the magazine cover.A highly sought after keynote speaker and media personality, Dr. Lawson is available for speaking engagements related to Advanced Practice Nursing, Business Concepts, and Entrepreneurship.
It only takes minutes, turn on your TV or radio and you will hear we are in the midst of an opioid crisis. It seems every professional healthcare groups in America are weighing in. Guidelines, recommendations, ideas and sometimes sensationalism is flooding the arena of healthcare. Everyone feels they have an answer to the opioid crisis.
What is always important to ask is… Is the information being reported correct? Are you really seeing the entire picture of the crisis? I really don’t think we are. The media reports that opioid overdoses have overzealous, greedy pharmaceutical companies, and overprescribing healthcare providers to blame.
Hold on.
It’s just not that easy.
Here is what we know-The current statistics about drug deaths say:
o All drug deaths (including ANY drug/medication a patient takes) account for 60,000 to 70,000 annual deaths.
o All opioid deaths (including heroin/fentanyl and prescription opioids) account for 30,000 to 40,000
Now, let’s compare to:
o Hospital-acquired infections deaths: 99,000 annually
o Tobacco, Alcohol, Guns and Traffic Accidents: >700,000 annually
It’s just important to put things into perspective.
Now let’s look at the opioid death statistics.
The number of actual prescription opioid overdose deaths are only a small percentage of the overall opioid overdose statistics.
o For instance, Fentanyl is responsible for 79% of all opioid overdose deaths. So, your first reaction might be “no one should ever prescribe fentanyl.”
o YET, only 5% of all fentanyl overdose deaths are due to pharmaceutical grade fentanyl.
For instance, in Illinois, opioid overdoses increased from 589 in 2015 to 1233 in 2016, despite significant decrease in opioid prescribing in that state. The increase appears to be almost completely driven by illicit fentanyl analogs, not legitimate fentanyl prescribed for the chronic pain patient. Schatman, Zieglar (2017) Pain Management, Prescription Opioid Mortality and the CDC.
To quote Dr Stefan Friedrichsdorf, “We do not have an “prescription opioid crisis” but really we have a polypharmacy crisis.” He cited that in New Hampshire, 72% of deaths involving oxycodone, also included alcohol, and/or benzodiazepines, cocaine, kratom, methamphetamine, and other opioids (which may not have been prescribed concurrently).
One accidental death from a prescribed opioid, illicit opioid or any other medication is one too many. But the answers are not simple. The present problem is more about illicit drugs than prescription drugs, as well as, combinations of both prescription and illicit drugs. Multiple sedating prescribed medications is also an issue. To add, more deaths are associated with illicit use of prescription opioids, than the intended prescribed reason. So many in our society, are looking for an escape and dangerously finding it through polypharmacy.
We have an epidemic of substance use disorder.
Substance Use Disorder.
THIS is what’s being ignored. That’s because there are so many factors associated: unemployment, poor education, depression, limited mental health access, mental health stigmas, availability of illicit drugs, diverted prescription opioids, genetic predisposition to substance use disorder, and psychiatric co-morbities.
Where do we go from here? More providers need to be screening for Substance Use Disorder. States need to allow more NPs and PAs to have the ability to treat Substance Use Disorder. There needs to be more education on how and when to prescribe opioids. Also, an increase in national education on appropriate disposal of medications when they are no longer needed. This act alone will help reduce the likelihood of diversion. It’s just the beginning, but it’s a start!
Reference:
Schatman, Zieglar (2017) Pain Management, Presctiption Opioid Mortality and the CDC.
LGBTQIA? Sounds a bit like alphabet soup right? The acronym LGBT has evolved over the past several years to include other populations but the individual needs of each population within this acronym vary and are not “one-size-fits-all. “ These gender and sexual minorities still encounter issues concerning sexuality, identity, gender and freedom of expression with their healthcare providers. It is a well-documented fact that the majority of healthcare providers today have not been properly educated on how to care for this population therefore, the specific needs pertaining to each individual group represented in this acronym go largely ignored.
The truth is more and more persons are identifying as something other than what is considered gender binary-the classification of two fixed genders: male or female, masculine or feminine. Persons who identify as non-gender binary may present to your office as lesbian, gay, bisexual, transgender, intersex, queer or questioning, asexual or ally. As providers of healthcare, we already know how to take care of the human body in whatever manner is necessary to optimize patients’ health however; it is equally important to be able to speak their language. Understanding some common terminology will relay the message to your patients that you are providing inclusive and affirming care. Below are some of the most common and acceptable terms that are used by the LGBTQIA community.
Lesbian: A woman who is attracted to other women romantically, physically and psychologically.
Gay: A sexual attraction towards people of the same gender.
Bisexual: A person who is attracted both physically and romantically towards people regardless of their gender.
Transgender: A person whose identity and/or gender expression differs from the sex they were assigned at birth. A transgender person may choose to transition with the help of hormones, surgery, and name change to the gender to which they best identify. The term “tranny” is considered derogatory and should never be used.
Queer: Traditionally, the term “queer” has been as a type of gender slur but in the correct context, people who identify as queer are those whose gender, gender expression and/or sexuality do not conform to the societal norm. It is an umbrella term for someone who does not identify as cis-gender or heterosexual.
Questioning: This term describes a person who is exploring their gender, gender expression and sexual orientation.
Intersex: An individual who has been born with ambiguous genitalia or a combination of both male and female chromosomes and genitalia.
Asexual: The absence of sexual attraction or desire for any type of a partnered relationship.
Ally: An advocate or someone who supports the LGBTQIA community.
Cisgender: A person whose gender identity aligns with their biological sex.
Cross-dressers: Individuals who wear clothing of the opposite sex for erotic arousal, emotional or psychological reasons. This is a form of gender expression. The term “transvestite” is no longer used and is considered a derogatory term.
FTM: (Female-to-male): A biological female who identifies as male. This is also referred to as a transgender male.
Gender fluid: A person whose gender expression and identity that crosses between the typical male and female outside of the societal norm.
Gender Queer: A person whose gender identity and gender expression may be a combination of either male and female genders or neither.
MTF (Male-to-female): A biological male who identifies as female. This is also referred to as a transgender female.
While there are a great deal of other populations and terms, this short list will provide you with a little bit of insight as to the differences among individuals who identify as such. Keeping an open mind as well as acknowledging if you mis-gender someone will go a long way in establishing a healthy patient/provider relationship built on mutual respect and trust. After all, this community of people is just that-people and they deserve the same treatment given to everyone else.
Vanessa Pomarico-Denino, Ed.D, FNP-BC, FAANP
Northeast Medical Group, Hamden, CT: APRN, Lead trainer for transgender education
Fitzgerald Health Education Associations (FHEA), North Andover, MA: Senior consultant
Southern Connecticut State University, Adjunct faculty
Origin, as defined by Merriam-Webster’s: 1: ancestry, parentage2 a:rise, beginning, or derivation from a source b: the point at which something begins or rises or from which it derives; also: something that creates, causes, or gives rise to another 3: the more fixed, central, or larger attachment of a muscle. 4: the intersection of coordinate axes. (Merriam-Webster, 2004, p. 875).
Origins.
What is our history? What is our beginning? Are we “the muscle?” What role does a nurse play in healthcare today? There are many books and essays regarding the origins of nursing as a profession. My aim is not to bore you or review an entire history of nursing, but rather to briefly overview some relevant and often overlooked history. We are all familiar with and respect Florence Nightingale. But she is not included in this overview because she is an overused person in the conversation.
1. Ancestry, parentage
My own family includes many nurses. My mother graduated from a diploma program in 1969 and a Bachelor’s of Science in Nursing (BSN) program in 1981. She worked medical-surgical (med-surg), on a pediatric burn unit, an adolescent psych ward (unfortunately this experience did not help her much during my adolescence), home health, public health for the Tom Dooley Foundation in Nepal, rural health in Montana, and finally Hospice. She worked for Hospice starting in 1992 and recently retired from nursing in 2017.
My maternal grandmother was a flight nurse in WWII. She flew wounded troops from war zones back to England and the US. During this time there was a roster of nurses, listing which would be assigned to the next flight. After flying, the name would drop to the bottom of the list. Grandma (Helen) was up for her turn. Another nurse wanted to switch with her and go on that flight. So, Helen stayed behind. That plane crashed and everyone on the flight was killed. She was fortunate to survive. Unfortunately, Grandma Helen died when I was very young. I have so many questions to ask her. My mother still has her letters, signed “Angel in Flight.” We all have our own histories as nurses, even if we are first-generation or multiple-generation nurses. Nursing as a whole has a more utilitarian origin. In a nutshell from our nursing textbooks: Nursing has always existed in some form in all cultures. Nursing was traditionally a “lower-class” woman’s job in early Europe (Egnes, 2009). Religious organizations took over and many hospitals in the US today have roots in various Christian churches. The Civil War and other societal changes within the US demanded the need for nurses in the US and soon after training facilities were initiated (Egnes, 2009). Like I said, “in a nutshell.”
2. A rise, a beginning.
Nursing school is not easy. Characters in movies who are “going to nursing school” are cute, empty, and generally “extra” types usually played by a young, pretty white woman. Folks do not realize that nursing school is incredibly competitive, stressful, time-consuming, expensive, and challenging. Nursing school is the beginning to actually becoming a licensed professional. Many of us start in other healthcare jobs, such as Certified Nurse’s Assistants (CNAs), Emergency Medical Technicians (EMTs) or paramedics, phlebotomists, etc. but nursing school is a solid start on the path to becoming a Registered Nurse or Licensed Practical Nurse. Many nurses continue their education to become Advanced Practice Providers such as Family Nurse Practitioners (my current role in 2018), Nurse Midwives, Certified Registered Nurse Anesthetists, and others. These roles are much different from an RN or LPN role and in many states advanced nurses can practice autonomously. Your primary care provider (PCP) might be a nurse practitioner which is why “medical provider” is preferred to physician or “doctor” even though some nurse practitioners have their doctorate degree. See the American Association of Nurse Practitioners (AANP) campaign to increase awareness of these roles in healthcare. Nursing programs have dramatically changed over the years in the United States, however, incredible barriers still exist to access nursing education. This is especially true for marginalized populations, namely people of color. Mary Mahoney was the first Black woman to be admitted into a nursing school in the 1900s. She was a member of the American Nurses’ Association (ANA) and fought for equality for nurses of color. She was also very involved in women’s right to vote and various sources report she was one of the first women registered to vote in the United States in 1920. (“African-American Medical Pioneers, 2003). As a side note, we know that not all women of color (specifically Black women) were able to exercise their right to vote until The Voting Rights Act of 1965. But I digress, as racism, sexism, and homophobia/transphobia in current day still impacts who is working in healthcare roles. According to Minority Nurse, about 75.4% of RNs categorize as “white.” Only 9.1% of RNs identify as men (“Nursing Statistics”, 2014). There is limited information on the number of LGBTQ+ nurses, and many reasons why some people in this subgroup would not identify gender identity or sexual orientation publicly due to potential employer & patient discrimination. Demographic information for NPs is somewhat limited, but AANP reports their membership (which does not encompass all NPs) is as follows based on most recent data in 2010: “92% of members are female. 97% are not Hispanic or Latino. The racial distribution of membership is: American Indian/Native Alaskan 0.9%, Asian 3.7%, Black/African American 5.7%, Native Hawaiian/Pacific Islander 0.4%, White 90.3%” (AANP, 2010). The educational & healthcare systems have much work to do to decrease barriers & discrimination for those working in & receiving care within healthcare system. This is just scratching the surface of this topic. But nursing has also made huge strides since the beginning. Nursing has evolved from a “lowly” job to a profession that is largely respected although arguably misunderstood.
3. The more central, fixed attachment of a muscle.
Well. We can appreciate this “origins” definition! Think of Anatomy and Physiology nightmares. This can be an analogous to many situations.
Think about the origin of a muscle. How about the deltoid? The origin is the clavicle and scapula. Those bones are not going to move when you move the muscle. Nurse Practitioners, Physicians, and Physician Assistants have their various roles within healthcare. Nurses also have a “scope of practice” and must legally function within that scope too. If you just had the deltoid without the clavicles, you would be in serious trouble. The body simply would not work without its origins, just like a hospital simply would not work without its nurses. Sometimes nurses are referred to as doctor’s “helpers.” Nurses are not “helpers.” When non-advanced practice nurses (RNs, LPNs) follow medical provider orders, there is consideration regarding why the provider has ordered a particular medication, therapy, diagnostic test, or lab. Sometimes nurses do not know the answer, and there needs to be clarification with the provider. Much of the job needs to be done autonomously, while following orders and staying within scope of practice. In the hospital setting, a nurse is not “managed” by a physician or other APP. Nurse managers do that job. We’ve heard the cliché that “nurses are the heart of healthcare!” The heart is a muscle. But, the majority of healthcare is a business within our capitalist system, whether we like that aspect or not and that is another topic entirely with multiple layers of complexity. Sometimes the humanity of healthcare is lost in the economics and politics of that system. Of course, everyone from janitors and housekeepers to therapists and front office staff are the “human” aspect of healthcare for patients. We all have power to advocate for our patients. Nurses, especially, have incredible power as patient advocates and the same is true in the provider role. That is, of course, our job. So, the big question is: Are nurses the clavicles of healthcare or the heart?
4. Intersection of axes
Popular media has misconstrued the role of nurses. Simply blaming “the media” alone, however, is simplistic as even educational systems reinforce some of these misconceptions. This misunderstanding impacts the way regular people (er–not nurses) understand and treat nurses. Folks sometimes think a nurse’s job is to simply give bed baths, follow provider’s orders without critical thinking, and hold hands. That may be in the history of nursing, but these basic nursing care roles are no longer the role of a nurse. The advanced practice provider roles are even more often misunderstood, or assumed that the “next step” is becoming a physician when in fact that is not the end goal. Nurses (RNs specifically in this paragraph) have many roles. RNs multitask patient needs, prioritize cares, recognize signs and symptoms of declining patients, consider pathophysiology of disease, learn about new medications and procedures, change wound dressings, listen to complaints and praise, communicate with medical providers, ask questions, read nursing journals on the latest evidence-based practice, hold their bladders for far too long, walk on their feet for twelve hours, tell off-colored jokes, and drink coffee (at least, most nurses). Nurses are not angels or saints. Nurses get mad sometimes. Nurses make mistakes, just like everybody else. Sometimes nurses feel downright incompetent, so they also ask a lot of questions. Nurses are just human. There are “good” nurses and “bad” nurses, and a lot of funny ones but none are one-dimensional. One patient can take a lot of coordination. The nurse working on a hospital floor needs to communicate with therapies, the nurse’s aid, the medical provider, the housekeeper, and the family. Sometimes this role can be incredibly frustrating, especially when there are five different people and five different plans of care. But, this role is vital to the patient’s outcome. Nurses help to facilitate overall care for a patient. If any of the pieces are disjointed or missing, the patient’s care might suffer. Nurses are right in the thick of a patient’s care. Nurses really want all the pieces to fit together and for patients to receive the best care (most nurses, that is). Nurses don’t always “agree” with the patient’s choices, because we all come from different backgrounds and experiences.
Our individual origins as nurses are many. The origins of nursing are complex and ever-evolving.
So, why did I become an RN in the first place?
I started doing nurse’s aide work in high school and had various jobs as a nurse’s aide for about seven years. I always bonded with and enjoyed the geriatric population (I’ve been schooled that the correct word is “mature”). I love working with folks who have dementia, except when they are trying to punch me.
I loved anatomy and physiology (except the memorizing origins and insertions part) and chemistry, and just “how things work” overall. The body is kind of fabulous. I had the privilege of interning at a hospital in Ghana for six months (which is a separate conversation & one that I have mixed feelings about regarding international aid work). I did random housekeeping and paperwork and wrote down verbal orders from the medical provider on rounds. I ran to the pharmacy for medications. I helped with what I could when there was only one nurse in a full ward of adults and kids. Those nurses were badass. They knew how to improvise. I remember thinking, “I want to do that.” “I want to be that good.” Of course, because of my origins, I was “never” going to be a nurse because my mom was a nurse. But, my mom is a great nurse.
*This “Origins” essay was originally written in 2014 and updated in 2018. Some of the statistics, unfortunately, do not have recent updates, so older article credits remain. Since the original article was written, I have worked as an RN in many other environments outside of the hospital including assisted living, crisis mental health, and a county jail. I learned over time that I preferred some of these other healthcare settings as opposed to working on a hospital floor. I worked six years in total as an RN and while still working part-time at the jail, continued my education with a Master’s program to become a Family Nurse Practitioner (FNP). I have since graduated, obtained my licenses, and have been working as an NP in a rural clinic for nine months at the time of this writing.
Egenes, K. (2009). History of Nursing. In G. Roux (Ed.), Issues and Trends in Nursing: Essential Knowledge for Today and Tomorrow (pp. 2-8). Sudbary, MA: Jones and Bartlett.
Long before I had the inkling to become a nurse entrepreneur myself, I was helping other nurses cultivate their entrepreneurial ideas. I was good at coming up with business ideas for others who wanted to start a business using their nursing education. For as long as I can remember colleagues always seemed to ask me about doing something outside of the bedside.
After awhile, I decided to write a book about being a nurse entrepreneur without actually being an entrepreneur. In 2013, I published my first book, So You’re a Nurse and Want to Start Your Own Business? The Complete Guide for nurses who wanted to move from the bedside. My business, ReNursing Edu (Formally known as ReNursing Career Consulting), was modeled after this book. Unbeknownst to me, my book was just the beginning.
Not long after publishing my book, I was contacted by an editor for Minority Nurse magazine to write blog posts and articles for their magazine. I was thrilled! I wrote regularly for Minority Nurse about nursing topics I had experience in—starting a business and being a nurse practitioner.
Fast-forward to today and I am the published author of more than 20 titles that mostly focus on business and nurse practitioner education. My focus is on nurse practitioners because while in school I noticed a gap in our education that left us at a disadvantage after graduating. This gap encompasses not only clinical education, but also business education and personal finance when dealing with the cost of going to school and the aftermath of student loan debt.
My books have branched out into other educational products for nurse practitioners that will assist them in clinical practice. My most recent product is the NP H&P ™ clinical journal that helps students log their clinical encounters while in school for easy access when it comes time to enter them in their schools clinical tracking system. The journal also contains prompts on what to ask when taking a patient history so as not to forget the important points.
Other products in the ReNursing Edu line include NP Clinical Cheatsheets™ that provide a quick reference guide for everyday clinical practice. The cheatsheets have a lot of information in a single page such as charting tips, common measurements, fracture types and more. They are available in both laminated and digital versions depending on preference. A second cheatsheet will be coming out later this year that focuses on issues seen more in an urgent or emergent type setting.
When I wrote my first book I never imagined where it would take me, especially since I didn’t plan on writing another. Since starting ReNursing Edu, I’ve come to realize that as an entrepreneur your business may not look like you imagined it would be when you first started. It’s important to go with the flow and change direction if your business ends up taking you elsewhere.
Nachole Johnson, MSN, FNP-BC
https://www.renursing.com
For more information on ReNursing Edu or ReNursing Edu products please visit www.renursingedu.com
There has been no better time in history than the present for black nurses to live out our full potential. So many of us have gone to college and obtained our nursing degrees. We proudly display our credentials behind our names using almost every letter in the alphabet. But I will ask you at what cost? Many nurses are broken down financially, physically, mentally and emotionally. In some ways, the harsh reality is that healthcare has a way of expecting nurses to give their all while receiving little in return. Long shifts, inappropriate ratios and unsafe conditions take their toll. Not to mention, the underlying racism and inequality that still persists.
The corporate mentality will have you believing that you have made it once you have a fancy degree and are making a decent salary with great benefits. Unfortunately, this mentality can be stagnating. It sets you up for complacency and a mediocre mindset of which I want to encourage you to avoid. This doesn’t mean that I support or am encouraging you to perform your work duties at a subpar level. I am simply suggesting that you work twice as hard building and maturing your potential to the full extent.
You are likely a first-generation nurse or you come from a long-line of nurses. Either way, you have more opportunities than ever before to be great. The duty and responsibility of the black nurse comes with a little extra. We should be creating new businesses and opportunities that focus on empowering and uplifting our people. If the example you are looking for is not there, create it. Be the example that you want to see in a world that needs to hear your voice. I am a firm believer that God has instilled within us exactly what we need to be great. This greatness gives us the ability to do things that have never been done before.
We represent generations of people who did not trust the healthcare system because of the mistreatment, the lies and the unethical practices. Our responsibility is more than just passing meds and taking vital signs. It is our duty to live up to our full potential. We are simply too brilliant and too smart not to take advantage of being at the forefront of an evolving healthcare system. This call to duty extends past the four walls of a hospital building, but into the minds, hearts and communities of each citizen.
Living out your full potential doesn’t have to be hard. It may include:
· advocating for sufficient healthcare for everyone in this country.
· ensuring that our children have safe places to play, learn and grow.
· ensuring that our elderly are cared for with dignity and respect.
· ensuring that we are making smart and savvy financial decisions.
· making sure we are taking care of our mind, body and spirit.
· making sure that we are leaving the next generation with something to build on.
· AND, using our nursing and leadership skills to build lasting legacies.
As you start focusing on your potential, please remember that what God has given to our people cannot be suffocated nor muted. It is up to you to take advantage of the amazing opportunity, we as health professionals and leaders, have to stand up for what is right, just and necessary. The potential is there, but you will have to develop and nurture it. The seed has already been planted within the depths of your soul. If you never tap into your potential, then you never discover what God has instilled into you and our very livelihood depends upon it.
Now tap into your potential and go be great!!!
Alvionna J. Brewster, BSN, RN
Alvionna Brewster has been a registered nurse since 2005, primarily specializing in cardiovascular care and preventative medicine. In 2015, Alvionna started Black Nurse Entrepreneurs in order to network, empower, and encourage entrepreneurship amongst black nurses. Currently, Alvionna is pursuing a Master’s Degree in Nursing Education with hopes of opening a nursing education center with a focus on community and clinical educational resources. She is passionate about the success of new nurses, helping patients successfully understand and manage disease processes and the advancement of African-Americans. In her free time, you will catch her creating crafts for her first business, The Creative Brewtique.
Recently, Alvionna completed her first book called Transparency: Claiming Victory in Life and in Nursing.
