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Nursing’s secret ingredient: Diversity

Monday June 25, 2012
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Through the years, the nursing profession has morphed into its current form — a well-oiled transformable machine with interchangeable pieces that can serve different purposes depending on the patient population or community. The versatility of the profession is part of what makes it an appealing career, as nurses and prospective nurses discover there are more ways than one to help patients heal and live healthier lives. The demographics of the profession also have changed into a workforce as diverse as the “melting pot” nation it serves, with nurses from both genders representing a kaleidoscope of nationalities, ethnicities and belief systems. In the cover story, we profile just a few of the different faces of nursing and highlight their most notable accomplishments to date.


Rita K. Adeniran, RN
A global perspective - Rita K. Adeniran, RN, DrNP, CMAC, NEA-BC, Chairwoman, Nursing Cultural Competence Committee Hospital of the University of Pennsylvania, Philadelphia

By Debra Anscombe Wood, RN

Having experienced firsthand the challenges foreign-born individuals face assimilating in America’s healthcare system, Rita K. Adeniran, RN, DrNP, CMAC, NEA-BC, global nurse ambassador and chairwoman of the Nursing Cultural Competence Committee at the Hospital of the University of Pennsylvania in Philadelphia, has dedicated her career to elevating colleagues’ cultural competence.

“I went into nursing to help people, and I am reaching a larger audience than as a one-on-one nurse at the bedside,” said Adeniran, who came to the U.S. from Nigeria in 1990 and appreciates how her career has evolved. “Coming from another culture and seeing the freedom I have in this country, I love it.”

Adeniran now trains and supervises cultural competency education nurse champions on each unit, introduces new hires to the program during orientation and consults on patient cases. She credits Victoria L. Rich, RN, PhD, FAAN, CNE, associate executive director at HUP, with identifying her as a leader and challenging her to bridge cultural gaps at the hospital.

“Nurses’ over-arching goal is to provide safe, quality care for their patients, and I’ve been able to demonstrate the value of understanding patients’ culture and its affect on the medical regimen,” Adeniran said. She offers as an example a patient who believes disease comes from an imbalance of hot and cold — a belief held by some Hispanic and Asian cultures — so he will not take a red or “hot” pill. But rather than challenge the nurse, who he views as an authority figure, he pretends to swallow it and then tosses it in the trash when the nurse is not looking. Without the medicine, the patient fails to return to good health.

However, that need not be the case. “When providers let the patient know they are willing to listen to and honor the patient’s perception, the patient will share a lot of information,” Adeniran said.

With that knowledge, the nurse can plan alternative interventions or adjust the approach to care, perhaps, finding a way of combining the patient’s alternative-medicine beliefs with allopathic care. But not everyone from a certain culture adheres to the same tenets. Adeniran cautions nurses not to blindly accept generalizations or stereotypes about different groups of people but rather ask about their beliefs. She also suggests nurses stay aware that when people are sick or distressed, they often will revert back to old customs. Once nurses understand the drive behind patients’ actions, care can improve.

HUP nurses frequently tell Adeniran they never thought about cultural differences in the ways she explains them. She also helps nurses new to the U.S. adjust to providing care at HUP. “We have to teach them the different aspects of healthcare in the United States, which is very different from other countries,” she said. “We have so many resources we take for granted, and here nurses are supposed to think and not do whatever the doctor says. We have to empower them.”

Foreign-born nurses often tell Adeniran colleagues are rude, because they quickly say, “Hello,” but don’t stop to talk. She helps them understand that in today’s fast-paced hospital environment, people often don’t have 10 minutes to spare for chatting and to accept the brief greeting as welcoming. “They use culture to judge, and a lot of that is going on in the world,” she said. “If we could stand back and look at things, we would see that it’s not about us.”

Adeniran encourages people to look for the things we have in common and to celebrate those things every day. “Penn nurses are leading best practices for clinical competency,” Adeniran said. “What started as a little department program is leading the way in a global environment.” •

Debra Anscombe Wood, RN, is a freelance writer.


Angie Millan, RN
On the move for children - Angie Millan, RNP, MSN, CNS, 2010-2012 President, National Association of Hispanic Nurses; Director, Children’s Medical Services, County of Los Angeles Department of Public Health

By Debra Anscombe Wood, RN

For as long as she can remember, Angie Millan, RNP, MSN, CNS, president of the National Association of Hispanic Nurses and director of Children’s Medical Services in the County of Los Angeles Department of Public Health, has set personal and professional goals, upping the ante every time she achieved one. “That’s how I got ahead, staying focused on those goals until I met them,” Millan said.

Years ago, as a clerk and translator in a hospital, Millan observed the care nurses gave patients in the East Los Angeles community where she lived. She became convinced of the need for more bilingual nurses who understood the culture. Millan became the first in her family to graduate from college, earning an associate degree in nursing in 1986, while continuing to work at the hospital.

“It took so much longer to do — many, many years to complete,” Millan said. “That was the biggest, greatest accomplishment.”

Millan returned to school and earned a BSN in 1990, an MSN in 1993 and a women’s health nurse practitioner degree in 1996. She plans to pursue a PhD.

She began her career as a labor-delivery nurse, later became a maternal-child clinical nurse specialist and has held various positions at LAC-USC Women’s and Children’s Hospital and Olive View-UCLA Medical Center, both in Los Angeles. In 1999, she joined Children’s Medical Services, where she moved up the ranks and now oversees 346 nurses in the county program serving special-needs children.

Millan joined the Los Angeles chapter of NAHN early in her career and has served four terms as chapter president, from 1996-1999 and from 2005-2008. Last year, she assumed the leadership reins of the national organization and set some serious goals for her presidency.

With Hispanics accounting for merely 3.6% of the 3 million nurses in America but comprising 15.4% of the American population, Millan hopes to attract more young people from the Hispanic community to nursing. She and other Los Angeles chapter members go to schools to talk with youngsters and mentor them. “We tell them they have to set goals and see themselves where they will be in the future to get there,” she said.

Millan also has led the association in its efforts to combat childhood obesity through the expansion of the Muevete (MOVE) USA program, a Coca-Cola Foundation grant-supported project to educate Hispanics about the importance of healthy eating, food labels and physical activity. “I feel I am doing something for the community,” Millan said.

Millan enjoys traveling around the country as NAHN president, conducting workshops about healthcare reform and listening to various communities’ needs. She has worked with local NAHN chapters to create health guides with information about free and low-cost services for uninsured Americans.

“They are a big hit, because there is such a need out there,” Millan said. “People don’t have the information and don’t have the resources.”

Volunteering with NAHN also offers Millan a vehicle for giving back to the mentors and supervisors, Hispanic and non-Hispanic, who helped her along her professional path and to make new friends — people she would never have encountered without her involvement in the association. “I really enjoy meeting people who want to make a difference and truly care about our communities,” she said. “I believe that NAHN has given us a voice that we would not have in any other organization.”

In addition to her full-time job and volunteer work with the association, Millan teaches the next generation of nurses as a clinical nursing instructor at East Los Angeles College. “It keeps my skills updated,” Millan said. “And I find it very rewarding to be educating our future.” •

Debra Anscombe Wood, RN, is a freelance writer.


Pete-Reuben Calixto, RN
Advocating for men, minorities - Pete-Reuben Calixto, RN, BSN, CNN, Transplant coordinator, San Francisco VA Medical Center, Clinical nurse, University of California-San Francisco

By Teresa McUsic

Pete-Reuben Calixto, RN, BSN, CNN, knows there is power in numbers.

Under his leadership as the “millennial” president of the Philippine Nurses Association of America in 2000, he helped increase membership and establish five new chapters in locations from New England to Hawaii.

“That was very satisfying,” he reflects now as an advisory council member of PNAA. “As president of just one chapter (PNAA-California), I felt the need to be involved in the bigger picture.”

But Calixto, a nephrology nurse for more than 30 years, saw an even bigger opportunity for minority nurses than moving PNAA into a nationwide organization. While president, he helped oversee the development of the National Coalition of Ethnic Minority Nurses, a group of five minority nurse organizations formed to provide a unified voice for advancing the interests of minority nurses.

The coalition is made up of key leaders from the National Black Nurses Association, the National Association of Hispanic Nurses, the Asian American/Pacific Islander Nurses Association, the National Alaska Native American Indian Nurses Association and PNAA. “We realized that among certain aspects of our population healthcare disparities existed,” Calixto said. “Each organization wrote a white paper to serve as a benchmark for research.”

Calixto was one of five co-authors of the PNAA white paper for the coalition.
By joining forces, the coalition was able to obtain funding to sponsor a nursing science conference. The coalition also received a grant from the National Institutes of Health “for developing our own nurse scientists, ” he said.

Minority nurses — who collectively represent only 16.8% of the RN workforce, according to the U.S. Census Bureau — are an important but untapped resource, Calixto said. But the growth of minority nurses is not keeping pace with the growth of the general minority population, which now is one-third of all Americans.

Calixto has the added challenge of being male in a female-dominated profession. But his ambition and empathy toward patients has led him to be the transplant coordinator at the San Francisco VA Medical Center and a clinical nurse in the Kidney-Pancreas/Liver Transplant unit at the University of California-San Francisco. “My guiding principle is always that I will make a difference today on the care that my patient is going to receive while I am there,” he said. “It is always encouraging to hear a patient’s gratitude when you are leaving your shift or when they express the quality of care that they received from you. On the other hand, it is always nice to tell them that it was a pleasure working with them that day.”

Being male did not dissuade Calixto from seeking the PNAA presidency, he said. He held numerous offices with the local PNAA chapter and the nation organization, first. “I had the goal of being the leader of the organization knowing it would not come overnight,” he said. “I had to bring in a few ideas that were not in existence at that time.”
He organized the first international conference of the PNAA in the Philippines in 2001.
In the past, Calixto also has served as a chapter president, secretary and legislative representative for the American Nephrology Nurses’ Association.

As he moves forward, Calixto will focus on the importance of diversity in the healthcare market. “Diversity at this time and age not only covers racial but also gender and generational boundaries,” he said. “Cultural competency increases the effectiveness of the nurse as a provider.” •

Teresa McUsic is a freelance writer.


Janice Phillips, RN
To whom much is given - Janice Phillips, RN, PhD, FAAN, Rush University College of Nursing, Chicago

By Teresa McUsic

As a nurse researcher, Janice Phillips, RN, PhD, FAAN, conducted one of the first phenomenology research studies targeting young African-American women at risk for breast cancer. She served as a lead spokeswoman assuring the successful passage of Illinois’ first breast cancer disparity bill — work that earned her a standing ovation from the Illinois legislature. In 2010, she analyzed and synthesized sensitive and complex data in support of implementing the Affordable Care Act as a Robert Wood Johnson Foundation health policy fellow.

But Phillips will tell you her biggest accomplishment was getting her BSN at North Park College in Chicago after seven “horrific” years in foster care. “College was not something we sat around the kitchen table and talked about when I was growing up,” she said. “But you can’t get to the next level unless you build a foundation.”

Phillips went on to earn her master’s degree in community health and PhD in public health nursing. African Americans make up less than 12% of the total enrollment in nursing doctoral programs, according to the 2011 annual enrollment study by the American Association of Colleges of Nursing.

“I had done a lot of work in clinical practice, but the doctorate expanded me into so many different things,” she said. “It opened doors to expand my expertise and influence. There’s a saying: ‘The more you know, the more you grow.’”

After her education, Phillips went on to become program director at the National Institute of Nursing Research. While at NINR, she encouraged and oversaw health disparities research at 20 academic partnership centers, as well as the implementation of more than 100 research and career development awards in women’s health, adolescent health, health promotion, oncology and health disparities.

“I helped develop a body of evidence around disparities in healthcare and sound evidence-based interventions to make a difference,” she said. “We are well on our way to linking that to policy changes.”

In 2008, her research and policy influence combined when Phillips and other breast cancer advocates presented evidence to the Illinois General Assembly that Chicago’s African-American women are more than twice as likely to die from breast cancer than their white counterparts. That led the assembly to unanimously pass the Reducing Breast Cancer Disparities Act in 2009, which eliminated copays for mammograms and required insurers to cover additional treatments, among other new benefits.

For her work, she was named the 2011 National Black Nurses Association’s Researcher of the Year. She also has received service awards from the National Institutes of Health and was inducted into the American Academy of Nursing in 2000.
Phillips said she has had numerous life-altering experiences as a nurse. “I am finding myself in places where I never imagined I would be,” she said. “I remember my first international trip was to Sao Paolo, Brazil, for breast cancer research. I was amazed to find myself there. You don’t know those opportunities exist unless you are open to them.”

Phillips said she is guided by biblical scripture, specifically Luke 12:48, which says, in part, “To whom much is given, much is required.”

“Being a nurse is a privilege and an honor,” she said. “It’s not something I take lightly. We get to look at people close up and personal and take our knowledge and skills and literally change people’s lives.”

Phillips is an associate professor at Rush University College of Nursing in Chicago, looking for the next opportunity to link policy with research. “The task is never over,” she said. “We have to remain vigilant and get policies implemented to go along with our research and clinical practice.” •

Teresa McUsic is a freelance writer.


Sam and Akouete Kouevi-Gou, RNs
Sibling unity - Akouete and Sam Kouevi-Gou, RNs, Advocate Trinity Hospital, Chicago

By Joe Stevenson

Akouete Kouevi-Gou, RN, came to the U.S. 11 years ago pursuing a profession in which he could help others. As a nurse at Chicago’s Advocate Trinity Hospital, Kouevi-Gou does that every day. But his goodwill is much more far-reaching. Kouevi-Gou, his brother Sam, who also works as an RN at Trinity, and several other family members now living in the U.S., set out with a plan in 2008 to build a medical clinic in their native country of Togo, located between Ghana and Benin in western Africa.

Healthcare is scarce around Sivame, their home village. Akouete and Sam estimate about 5,000 people live in Sivame and another 5,000 live in areas around the village. Thus, the clinic could serve nearly 10,000 people and greatly improve their chances of living healthier lives, even by providing some of the most basic healthcare services. “It means a lot to me,” Akouete said. “My passion is to make a difference. It will be a pleasure for this to become a reality.”

The project was scheduled to be completed in March.

“It will mean a lot to them,” Akouete said. “This village has been there for 350 years. The day they put down the first brick, I was rejoicing. A lot of people are dying every day from small things. Farmers will incur injuries and have nothing to help them, so they die from those injuries.”

The brothers receive photos from people in Togo updating the clinic’s construction progress and were proud when the latest picture showed the building was ready for a roof. “We are pleased to do the project,” Sam said. “They need the healthcare attention. We can‘t just let people die. Some babies are born. Women have miscarriages. We need to make a difference in people‘s lives. We thank God, who let us in this country, and we are trying to do something for them.”

People in and around Sivame must walk or bicycle a few miles to receive care. The brothers said a clinic much closer will make a huge difference. Akouete, 34, has worked as a nurse at Trinity since 2008, the year he finished his nursing degree at Chicago State University. Sam, 31, graduated with his nursing degree from Quincy (Ill.) University.

Akouete, Sam and their relatives started the project by setting aside $50 every month to go toward construction. While there may not always be a physician at the clinic, Akouete said staffing it with a nurse, a physician’s assistant or a midwife would be a dramatic change for the people there. Basic essentials such as vaccinations and antibiotics can be administered, and the clinic will provide a cleaner, safer place for women to give birth.

The Kouevi-Gous have received grants from Germany and assistance from a Methodist church in Ireland for the building. Most of the funds collected — which total about $17,000 — have come from family members. The brothers said they eventually will need $76,000 to fund the entire project.

They have been working with the African Ministry of Health to find workers to staff the clinic when it is completed.

Michelle Gaskill, RN, MSN, MHA, Trinity‘s vice president of nursing and clinical operations, said hospital administrators were delighted to provide essentials such as beds and computers to the clinic because the needs in Togo were eye-opening. “We believe in supporting community here, but even more rewarding is to go beyond those boundaries and help other countries,” Gaskill said.

Akouete and Sam are grateful for the assistance and hardly can wait for the day the clinic is opened. “Once it‘s finished, we will be traveling to see how we can help at the clinic,” Akouete said. •

Joe Stevenson is a freelance writer.


Bettye Dacus, RN
Decades of dedication - Bettye Dacus, RN, California Hospital Medical Center

By Linda Childers

When Bettye Dacus, RN, first started working at the California Hospital Medical Center in Los Angeles, she was 20 and had just graduated from nursing school.

Today, Dacus is celebrating 50 years of employment with CHMC and was honored recently as one of the hospital’s Legacy award winners for her dedication to patients.
The Legacy award, given by CHMC’s Legacy Advisory Board, recognizes honorees for their outstanding contributions to the hospital. This year, as CHMC prepares to celebrate its 125th anniversary, four honorees received recognition with Dacus being the only nurse to receive the award. “Bettye truly practices the art of nursing,” said Cliff Hoffman, president of California Hospital Medical Center’s Foundation. “California Hospital is not just a place where she comes to do her job; rather, it’s where she chooses to carry out her life’s calling.”

Dacus was attending elementary school in Beaumont, Texas, when she first decided to pursue a career in nursing. “I remember visiting my cousin in the hospital and being so impressed with the care that she received from the doctors and nursing staff,” Dacus said.

After graduating from high school, Dacus moved with her mom to Los Angeles. She and a friend applied at the L.A. County/USC Hospital Nursing School but were surprised to learn they hadn’t been accepted. “We didn’t realize some nursing schools had an enlistment quota for African-American students,” Dacus said. “Since they had met their quota, our applications were denied.”

Her friend, Barbara, refused to see their dreams derailed and filled out applications for both she and Dacus at the California Hospital School of Nursing. “I was flabbergasted to learn we were accepted into the CHMC nursing program,” said Dacus, who was one of only three black students to graduate from the CHMC three-year nursing program in 1964. “I initially thought I would spend a couple years at CHMC, but I really enjoyed my job and my co-workers,” Dacus said.

Married for 45 years and mom to three grown children, Dacus said many of her patients have become extended family. She has fond memories of one young patient who suffered a gunshot wound in his leg and after several surgeries had to have his leg amputated. “His family didn’t live in the area, and my friend, Gladys [another CHMC nurse] and I became his surrogate moms as we cared for him,” Dacus said. “When he lost his leg, he cried, and we cried, too.”

After he was released from the hospital, Dacus was pleasantly surprised to receive an invitation to his wedding several years later. “To see him walk down the aisle at his wedding using his prosthesis brought both Gladys and I to tears once again,” Dacus said.

At 70, Dacus doesn’t have any plans to retire any time soon, although she hopes the next 50 years will bring about even more advances in health information technology.
“I’d love to see a way for this to be reduced even further to allow nurses to spend more time at the patient’s bedside,” she said.

And at the bedside, her colleagues said, is the place where Dacus truly shines.
“Bettye gives generously of her skills, wisdom, compassion and humor,” Hoffman said. “If you were to imagine the ideal nurse - the type of person you’d want caring for you - that person would be Bettye Dacus.” •

Linda Childers is a freelance writer.


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