Despite one of the toughest federal funding climates in recent years, the School of Nursing has moved from 8th to 7th place among nursing schools receiving National Institutes of Health (NIH) funding. The total amount of research grant dollars awarded to JHUSON—the smallest nursing school and the youngest research center in the Top 10—reached $5,880,678 in FY2006.
“The #7 ranking is a unique milestone in today’s highly competitive funding arena,” says Gayle Page, DNSc, RN, FAAN, Inde-pendence Foundation Chair and Director of the Center for Nursing Research and Sponsored Projects. “Not only does a research project idea have to be good—no, change that to ‘super’—the application has to be exquisite.”
Adelaide Nutting Chair and Associate Dean for Research Jerilyn Allen, ScD, RN, FAAN, concurs, noting that the growth in funding reflects “an unparallelled commitment to get funded, exceptional talent, great ideas, and—above all—persistence.”
The same persistence (and a dash of good humor) is demonstrated by the School’s newly formed “Un-Scored Society”—a nurse researcher version of the Dead Poet’s Society—whose funding applications received critiques but were not scored by federal reviewers. In today’s ultra-difficult environment of tight federal funding, says Page, “it’s no longer considered fatal to have your funding proposal un-scored. Now it just means it’s time to review, revise, and resubmit.”
The School’s research leadership and Center for Nursing Research and Sponsored Projects are determined to continue moving forward toward funding success, and that means advising researchers throughout the funding process. Page reports that the School’s Scientific Review Committee is giving significant time to reviewing funding proposals before they are submitted, and the researchers are open to and welcome their comments. She gives accolades to the members of the committee (see box below) and to their willingness to add these extra hours to already busy, overloaded schedules, noting, “It’s a team effort, but we all benefit.”
|The school continues to bring in research grants in FY 2007. Recent NIH awards include:
Jerilyn Allen, ScD, RN, FAAN
Allen’s new grant continues funding for a fellowship program-Interdisciplinary Training in Health Disparities Research-which provides training for the next generation of nurse scientists.
Sharon Kozachik, PhD, RN
Kozachik has received a training grant to study two significant public health problems: pain and sleep disturbances.
Accolades to the Johns Hopkins University School of Nursing Scientific Review Committee.
Jacquelyn C. Campbell, PhD, RN, FAAN
Cheryl R. Dennison, PhD, CRNP
Fannie Gaston-Johansson, PhD, RN, FAAN
Maureen George, PhD, MSN, RN
Linda Gerson, PhD, RN
Hae-Ra Han, PhD, RN
Elizabeth Hill, PhD, RN
Miyong Kim, RN, PhD, FAAN
Marguerite Littleton-Kearney, PhD, RN, FAAN
Hayley Mark, PhD, MPH, RN
Victoria Mock, PhD, RN, FAAN
Marie Nolan, PhD, MPH, RN
Gayle G. Page, DNSc, RN, FAAN
Linda Rose, PhD, RN
Benita J. Walton-Moss, DNS, RNCS, FNP
Jennifer Wenzel, PhD, RN, CCM
Kathi White, PhD, RN, CNAA, BC
In this forum for discussing the important issues facing the nursing profession today, we welcome your thoughts and opinions. Check this space in each issue to see how readers answer the questions we pose.
Our question this issue:
How did receiving your nursing education in Baltimore shape you as a nurse?
(A) I ended up settling in Baltimore and now live and work here. (21.8%)
(B) The community health work I did in the area has led me to work with underserved populations. (23.1%)
(C) The diversity of the city’s population prepared me for nursing practice anywhere. (25.6%)
(D) I made great professional contacts in Baltimore that I continue to maintain. (17.9%)
(E) The plethora of hospitals in the area made my job hunt easier. (11.5%)
Total Responses: 78
“I went to school in Baltimore because I grew up in the area. Being in Baltimore, I was exposed to a number of world-class medical sites. I did my practicum work at Johns Hopkins Hospital, and I believe that when you can train in one of the best hospitals in the world, it is a great opportunity! I would not have received that experience anywhere else. Also, since Baltimore is in the proximity of both Washington, DC and Annapolis, MD I had professors and friends involved in the policy and government level of nursing. This helped me to become aware of the policies and governmental implications in nursing, instead of just focusing on direct patient care.”
Marian Grant, MSN ’05, BSN ’00
Palliative Care Consult Service
Johns Hopkins Bayview Medical Center
“I’ve been able to participate in community outreach programs including WIC, which is a Women, Infant, and Children’s Nutrition program. Being in Baltimore has also made me more conscious of community health, as I had no previous desire to work in this area, but now have had great experiences working in the community.”
Courtney Conrad ’08
“In my mind, there’s just something about Baltimore that made it the perfect place to learn about how to be a savvy, confident nurse who is ready for anything. Author Anne Tyler said she likes Baltimore’s ‘gritty, comically feisty personality’-and I think it is this character, together with the many experiences the city has given me, that has helped me grow as both a nurse and a person.”
Megan Hoffmann, BSN ’04, MSN ’09
JHUSON Senior Research Nurse
Each day as I travel through our Baltimore neighborhoods, I’m reminded of how much the people and places of this city shape the education and career possibilities of our students and faculty.
Here on the East Baltimore campus of Johns Hopkins University, we have a community of scholars studying and working on the only campus in the nation where each of the schools of nursing, medicine, and public health are ranked among the top five in their disciplines. And of course we have the #1 hospital in the U.S.
These institutions—clustered in a location I call the “Four Corners of Health Care Excellence”—serve the needs of amazingly diverse populations, in neighborhoods and communities both here and abroad. We do so through exceptionally innovative and multidisciplinary approaches designed by our world-renowned Hopkins faculty, researchers, and clinicians. Many of their initiatives become learning, practice, and investigative opportunities for our baccalaureate and graduate students and our post-doctoral fellows. But, more importantly, these approaches increasingly focus on community outreach that engages the residents of our neighborhoods—a significantly underserved urban population—and addresses their vital health care needs.
In this issue we tell just a few of the hundreds of stories about how the East Baltimore campus and its nearby neighborhoods offer life-changing learning and discovery experiences for each generation of Hopkins nurses and nursing students while serving a community in need. In “Neighborhood Matters,” our students describe the volunteer work they do through SOURCE, the university’s Student Outreach Resource Center, which serves as an essential link between Hopkins students and community organizations and local projects. Our Returned Peace Corps Volunteer (RPCV) fellows add their tales of valued lessons-learned and gratifying hands-on experiences in the School of Nursing’s Community Outreach Program.
“Live from 525,” offers a first-hand account from an RPCV alumna and MSN-MPH student working in Baltimore. In her own words, she describes those experiences as “a challenge, an adventure and a growth opportunity” and notes how the community is shaping her—as a Hopkins nurse.
“A New Kind of School Nurse,” explores our decade-long program of providing health services to an inner-city parochial school and using this and similar sites as an introduction to community health nursing for all baccalaureate students. The article includes an overview of our plans to launch an integrated approach to health care for more East Baltimore children and their families at a new school soon to open near our campus. This too will be a learning environment for our students and will allow them to experience the rewards of community public health nursing.
And in “Second Opinion,” we hear from you—our readers—about how receiving a nursing education in Baltimore shaped you as a nurse. The top answer for those of us who learned our skills and began our careers here was: “The diversity of the city population prepared me for nursing practice anywhere.”
To paraphrase a familiar adage, our responses confirm that, “You can take the Hopkins Nurse out of Baltimore, but you can’t take Baltimore out of the Hopkins Nurse.”
Martha N. Hill, PhD, RN ’64, FAAN
Professor of Nursing, Medicine and Public Health
By Sarah Achenbach
Photos by Frank Klein
The health needs are vast, and resources few, for those living in the communities surrounding Hopkins’ East Baltimore campus. Through course work and as volunteers, Hopkins nursing students are reaching out to make a difference.
Jeane Garcia '08 is one of 10 Hopkins nursing students who provide counseling to patients through HIV Counseling and Testing Training Program. Garcia volunteers at the Chase-Brexton Clinic, one of the three program sites.
There’s a patient that Kaitlin Haws, RN, will never forget. And she makes sure the Hopkins nursing student volunteers she trains won’t forget him, either. Each day at Chase-Brexton Health Services Inc., a Baltimore clinic serving the underserved, HIV-positive, and gay, lesbian and transgendered communities, Haws tests clients for HIV and counsels them on the results, negative or positive. A 2006 graduate of the School of Nursing’s accelerated program, Haws remembers well the first time she had to give a patient a positive test result.
“A young man came in who had been tested before, and the results were always negative,” she recalls. While waiting for the results of the rapid HIV test (typically 20 minutes), Haws did exactly what her training had taught her: She covered the risk factors for contracting HIV, tried to get a sense of what was going on in his life to bring him in that day, and discussed what he would do when he walked out the door—assuming, of course, that the test would be negative again.
“We had a good rapport going,” Haws remembers. “Typically I would have a patient wait in the waiting room while I read the result, but this time I didn’t. I remember looking at the test and seeing two lines, which means it was positive. My heart just dropped and my palms got sweaty. By now I’ve given a lot of positive results, so I can anticipate how a patient might react, but that day it was a matter of me getting out of my own emotion.”
|With relationships with more than 100 community-based organizations, SOURCE has quickly become a one-stop volunteer shop for students and faculty and for the East Baltimore community to call for assistance
Haws shared that story recently during an orientation session for a fresh crop of student volunteers at Chase-Brexton: 10 each from Hopkins’ schools of Nursing, Public Health, and Medicine. Each student recently completed training to provide counseling during HIV testing at Chase-Brexton, the Johns Hopkins Hospital Emergency Room, and at Health Education Resource Organization (HERO). The HIV Counseling and Testing Training Program is co-sponsored by the three schools through SOURCE (Student OUtreach Resource CEnter), the tri-school community service and service learning center.
During the 16 hours of SOURCE training, the 30 students learned counseling techniques including how to use verbal and body language to guide clients in the often angst-ridden moments after they receive their HIV testing results. “Our natural tendency is to give a patient information overload, but you need to allow a patient the time to think after getting a test result,” says Jeane Garcia ’08, who, like Haws, enrolled post-Peace Corps in the JHUSON’s Peace Corps Fellows program, the only undergraduate nursing Peace Corps Fellows program in the country. “During the training course, we role-played our reactions to testing scenarios, and it was a lot more difficult and introspective than I thought it would be.”
SOURCE’s HIV Counseling and Testing Program is just one avenue through which nursing students provide health care to those living in the communities near the school, where such outreach is critically needed. “The good news is that teenage pregnancy rates and infant mortality have decreased over the past few years, but the biggest challenges facing this community are substance abuse, violence, and poverty,” says Lori Edwards, APRN, BC, MPH, who directs the School’s comprehensive Community Outreach program. “The community itself says its number one concern is substance abuse. Historically, one out of 10 people in Baltimore is a substance abuser.”
The School’s Community Outreach program began 13 years ago as a way for Peace Corps Fellows to meet their required community service. By the late 1990s, other nursing students were eager to pursue community health volunteer roles in East Baltimore and throughout the city. To meet the demand, Edwards developed an undergraduate elective and pre-requisite for students interested in community outreach: Community Outreach to Underserved Populations in Urban Baltimore.
Edwards estimates that in 2006-07, at least 107 School of Nursing students volunteered a minimum of 5,200 hours at 22 agencies, such as the Refugee Resettlement Center, Tench Tilghman Elementary School, House of Ruth Maryland, Baltimore City Health Department, Hispanic Apostalate, and the Julie Community Center. That’s 9,500 client interactions—all low-ball figures, says Edwards, who is one of two SON administrative representatives on the SOURCE governing boards. Her office works closely with SOURCE to coordinate nursing students’ volunteer interests.
Associate dean Sandra Angell, who earned her nursing diploma from the School in 1969, describes SOURCE as “a great development.” She adds, “It’s really pulled together all three schools on this campus and it’s made it much easier for community agencies that are trying to seek help for their sites.”
With relationships with more than 100 community-based organizations, SOURCE has quickly become a one-stop volunteer shop for students and faculty and for the East Baltimore community to call for assistance, agrees Seth Christman, SOURCE coordinator. And there are real benefits for the students as well.
“Being able to connect students from the three schools gives students a different view of skills in health education and practice,” notes SOURCE’s Christman. “A nursing student might come to the HIV Counseling and Testing Program from a patient-centered approach, while a public health student might come at it from an education perspective. Sometimes the greatest teachers are your peers.”
Working alongside students from the schools of Public Health and Medicine is a big draw for SON students, particularly returning Peace Corps veterans like Garcia. “From my Peace Corps work in Malawi as a teacher and HIV counselor, all the HIV issues of prevention, advocacy and policy interest me, and the interdisciplinary approach of the training invites that,” Garcia says.
When Kaitlin Haws was completing her baccalaureate nursing degree after serving in the Peace Corps in West Africa, she volunteered with the Women, Infants & Children (WIC) program, a nutritional counseling program offered through the Baltimore County Department of Health. “So many people don’t have access to proper health care,” Haws says. “At WIC, we were trying to provide proper nutrition when often the only access for food was the corner store, which doesn’t offer much produce.”
“Being able to volunteer in the community while going to school reiterated for me why I was in nursing school in the first place,” Haws says. “My work brings together therapeutic communication and health education. The most satisfying and challenging aspect of my work is providing a well-rounded approach to health care for the underserved.”
For the newly minted graduates of the HIV Counseling and Testing Training Program, this is at the heart of what they hope to accomplish in their new volunteer role. “Nursing is care and support,” says Garcia. “To be there for someone one-on-one during one of the most significant moments in his or her life, regardless of the HIV test outcome, is amazing.”
When they’re not caring for patients, taking classes, or doing research, School of Nursing students—past and present—have never needed to range far to enjoy their leisure time…
|It’s no secret that sharing food brings people together. In 1916, nursing students enjoyed a picnic at Fort McHenry, where Francis Scott Key was inspired to write “The Star Spangled Banner.” More than 90 years later, Caroline Bell ’08, Morgan Walker ’08, and Alicia Luna ’08 sip coffee together on Fleet Street in historic Fell’s Point.
|In 1938, students canoed on the Severn River. The outing was part of their visit to Sherwood Forest, near Annapolis, where a cottage had been donated for nursing students’ exclusive use. Today’s students have their fun in the sun closer to home. These returned Peace Corps volunteers gather for a party at the Baltimore home of Alison Anderson, Accel ’08.
|Built in 1892, the Pagoda in Patterson Park is an observation tower that provides a view of Baltimore’s harbor, downtown, and suburbs. This photo from 1954 shows Hopkins nurses posed outside the pagoda. In 2007, students Ashley Wiggins ’09 and Bernice Cheng ’09 explore the pagoda’s interior.
|As players or fans, nursing students love sports! These bicyclists are Hopkins nursing students from 1940. And in 2006, nursing students cheer on Baltimore’s beloved baseball team, the Orioles.
Excellence. At Johns Hopkins it’s more than just a word in our rhetoric; it’s a standard we live by in our teaching, research, practice, and mentoring. Enhancing excellence is the first goal in the School of Nursing strategic plan, yet as we celebrate our many successes in achieving that goal, we also face many challenges.
Each spring, in one of my favorite events, we honor faculty and staff successes. This year, Laura Taylor, PhD, RN, and Shirley Van Zandt, MS, MPH, RN, were the recipients of the Johns Hopkins University Alumni Association Excellence in Teaching Awards. Given annually since 1992, these very special awards recognize faculty members who—according to their students—stand out as both a teacher and a mentor.
Laura, an assistant professor in the Department of Health Systems and Outcomes, received the Baccalaureate Excellence in Teaching Award. Known for her sense of humor and innovative use of technology, she creates “teach-able moments” her students will not soon forget, including a video of herself dancing to simulate heart rhythms.
Shirley, an Instructor in the Department of Community and Public Health, was given the Graduate Excellence in Teaching Award. With a reputation for challenging students, she lives her philosophy that “people learn best when they are least threatened and most confident.” She creates a safe learning environment through thoughtful questioning and unwavering respect for her students.
To recognize staff excellence, we’ve created a new SPOT award for “staff performing over the top.” Our first recip-ient was Public Safety Officer Eugene Mobley (photo above). Eugene is stationed at the front door and is the first face visitors see at the school. He is known for going out of his way to be helpful, even volunteering to help a visitor unload her car—in the pouring rain.
The achievements of these honorees and their colleagues exemplify our standard of excellence. But today, that standard is threatened by new and emerging challenges that force difficult decisions about how we will continue to be successful.
And we are not alone in facing these challenges. I hear daily from my fellow nursing school deans across the country and around the globe about their struggles to maintain their programs and survive the devastating impact of the national and international economic crises. Many are downsizing not only faculty and staff, but student enrollments as well.
Here at Hopkins, the troubled economy has driven us to take a hard look at how we do business and what it’s going to take to maintain our excellence. We know we can’t just make budget cuts here and there. Nor can we just hunker down and wait out the hard times. Instead, we are using this challenge to analyze, innovate, re-engineer, and redesign. We are doing more than simply surviving; we are increasing our efficiency, effectiveness, and productivity to achieve at even higher levels.
Over the past months, we have reorganized specific areas of staff support to enhance the skills and expertise our faculty require as they re-engineer their approaches to teaching excellence and scholarly productivity. And, we have created a new position of Assistant Dean for Information and Technology Integration and recently added two instructional designers to enhance and build our technology capacity in all we do.
So stay tuned: We have embarked on an innovative path that is redefining how we deliver nursing education and creating even more success. I look forward to sharing more news of our accomplishments with you in the coming months.
The editorial alliance “reflects the academic nursing center we’ve created here, a marriage of the school and the hospital,” says Haller. “The re-launch of Hopkins Nurse in the school magazine as a combined publication recognizes and honors that.”
Martha N. Hill, PhD, RN, FAAN, ’64
Professor of Nursing, Medicine and Public Health
By Mandy Young, MSN/MPH ’09
By its nature, nursing is a stressful profession. After all, we care for people in moments of extreme vulnerability and crisis. Learning how to manage stress isn’t just part of a healthy lifestyle for nurses; it is an act of survival.
In our rush to take care of our patients’ needs, we are prone to neglect ourselves, which affects not only our own health but also our ability to care for patients. We need to establish habits and routines with our everyday, on-the-job choices that improve our overall wellness. Just as eating one salad doesn’t suddenly make a junk food diet healthy, getting one massage doesn’t create a stress-free life.
So here are a few tips for survival in the fast lane:
1. Take Five Minutes For Yourself.
Much of my increased efficiency, and lower stress, has resulted from the way I manage my time during a shift. I used to run around trying to “get everything done” before taking a break for myself. This often meant that the entire shift went by without taking a break! I was hungry half the shift and would overeat when I finally got a chance to have a meal. Is it any wonder that I started to put on weight after becoming a nurse?
I now come to work with small prepared meals that can be eaten on-the-go in minutes while charting or double checking meds. I make a point to eat every two to three hours so my blood sugar never drops and my metabolism is burning high with plenty of energy. My mini-meal breaks only last three to five minutes, but they have become a regular “pause button” that allows me to stop, breathe, and reprioritize tasks. While finding the time for a 30 or 45 minute break is challenging, there are very few things that can’t wait just a couple of minutes so you can take care of your own needs.
There is a natural tendency to let stress build up and then blow it off all at once. But research shows that stress is best handled in the moment, by stopping to become conscious with your body and slow your heart rate down. If you have ever taken a yoga class, it is likely that your instructor led you through breathing and/or guided imagery exercise to consciously relax your muscles and remove tension. Yoga is a great tool for developing the ability to consciously relax your body which can then be transferred to the work setting.
The stress we face at work takes a toll on our bodies. Taking care of our bodies through regular exercise counteracts the effects of stress, so much so that you will notice and feel the difference when you are exercising regularly. I confess that I struggle with maintaining this habit of health as much as anyone else. It helps to find fun activities and change them up regularly so I don’t become bored. I’ve also collected quite a list of fitness resources at a variety of price ranges in my community so that I can help my clients find a way to exercise that fits their interests and budgets.
4. Don’t Take It Personally.
It isn’t about you. Really. None of us see the world as it is. We see the world the way we are. We are all operating from different viewpoints based on our experiences, values, cultural norms, etc. And these affect how we treat each other.
When I first became a nurse, if a patient or family member complained to me about something—anything—I would feel like they thought I was a bad nurse. I would get defensive. But their grievance isn’t really about me. Now, I recognize that complaints are really requests in disguise. When patients or families are complaining, they are feeling pain or discomfort and are providing valuable information on how I can help them. When I feel my defenses come up, I take myself out of the equation by reminding myself, “It’s just information.” Then I am able to focus on what they are telling me instead of my feelings.
Perhaps the greater challenge is dealing with the criticism of fellow employees. While we all know, in theory, that feedback is valuable information that can help us become better at our job, it doesn’t change the fact that criticism is hard to take. But remember, the criticism is actually information on how an individual is experiencing the world around them—a mix of your behavior and how they are interpreting what you say and do.
The trick is taking yourself out of the equation so you can then weigh their critique based on its own merit rather than on how it makes you feel. One method is to write it down and then review content later when you can be objective about it. For example, I once belonged to a writers group where we would bring our compositions for feedback from everyone in the group. I always wrote everyone’s comments down but only I could decide which feedback would help me write a better story, poem, or article. When someone critiques your work as a nurse, try to discern what comments will actually help you be a better nurse or co-worker and what comments are just best forgotten.
5. Fun is a Necessity.
There is a reason why “the family that plays together stays together.” Recreation is about reconnecting and redefining relationships. Fun makes us human to each other. It opens opportunity to build understanding and connect on a deeper level.
Having staff parties to build camaraderie is just a first step. Try swapping magazines with your patients or gossiping over the latest movie star scandal while you help them to the bathroom. My personal favorite is to sing a lullaby or favorite song to my patients. Since most are stuck in bed watching television all day, discussing a favorite television show or movie is always easy.
We each have our own unique story for why and how we choose to become nurses. If we aren’t careful, we can let the stress of the job drive us instead of the reasons why we came into this profession. Like many other aspects of health, stress management is a lifestyle. Picking one simple change and building on it is often the best way to approach making a lifestyle change.
Check out more tips from Mandy, and other nurses like her, at www.stressedoutnurses.com.
Learn More Online
• The American Institute of Stress www.stress.org/
• Mayo Clinic www.mayoclinic.com/health/stress-management/MY00435
• National Institute of Health www.nlm.nih.gov/medlineplus/stress.html
• American Holistic Nurses Association www.ahna.org/Resources/StressManagement/tabid/1229/Default.aspx
By David McKay Wilson
At a time when women are flocking to once male-dominated fields like law and medicine, men are slowly discovering the female-dominated field of nursing, with its relatively high pay, job flexibility, and manifold opportunities for advancement.
Students, alumni, and faculty at Johns Hopkins University School of Nursing say American concepts of masculinity, coupled with the power of language and a paucity of high-profile role models, keep men away at a time when demand for nurses remains strong. But those men who do make the leap say they are glad they did, finding a challenging career with the kind of hours that allows time for family and recreational pursuits.
In 2006, Josiah Mueller ’09 found himself considering nursing after becoming dissatisfied with a career in finance at Campbell Soup Company. Preparing the perfect spread-sheet just wasn’t going to do it for him in the long run. Then a nurse who trained with him for triathlons suggested that he shadow her one day at her job.
“At first, it was – ‘Me, a guy? Nurse? I’m not sure about that,’” recalls Mueller, 28, who lives in Baltimore with his wife, Erin. “But then I let my guard down and looked at it in an unbiased way. I really saw the positives. It’s a technical skill that’s highly marketable. I’d be able to go home at night and feel good about what I did. That’s not something everybody can say.”
In 2008-09, when Mueller enrolled in the traditional baccalaureate program, he was among 42 men attending the School of Nursing—six percent of its enrollment. He graduated this May, and in August will begin working as a clinical nurse in the pediatric emergency department at The Johns Hopkins Hospital. Nationwide, about six percent, or 168,000, of the nation’s 2.9 million registered nurses are men, according to the American Nurses Association. That’s up from 147,000 in 2000, and just 45,000 in 1980.
In the wrenching downturn of the American economy, nursing employment remains fairly strong. Mueller will earn about $60,000 in his first job out of school. Nurses with 10 years of experience can earn more than $100,000, and nurses with advanced degrees, such as nurse anesthetists, can earn up to $180,000.
At The Johns Hopkins Hospital, men comprise 10 percent of the nursing staff, and practice throughout the hospital—from intensive-care and acute-care to pediatrics and radiology. Men are featured in hospital recruitment literature and nursing administrators say they often recruit at the School of Nursing and from military installations in the region.
“We are pleased to be above the national average on our recruitment and retention of men,” says Karen Haller, PhD, RN, FAAN, Vice President for nursing and patient care services. “However, we are far from satisfied. Trying to run a profession—nursing—by only drawing on half the population is untenable. It’s one of the root causes of the cyclical nursing shortages.”
Among the recent recruits is Ronald Noecker ’07, who works in an oncology unit at the Sidney Kimmel Comprehensive Cancer Center. Noecker, 51, decided to pursue nursing while living in Guatemala, contemplating his future service to the world after spending 18 years as a priest. In 2003, he volunteered at a hospital where men comprised a significant part of the nursing staff and were respected members of the community. He found Hopkins’ nursing program online, was accepted, and began a professional journey that continues in Baltimore.
“It has been a deep experience at Hopkins,” says Noecker, the lone man on his nursing shift. “I have great respect for my colleagues. A lot of guys aren’t aware of what kinds of abilities are needed to be a critically thinking nurse—at any one time, you could be an engineer, a manager, a shrink.”
Men, such as associate professor Daniel Sheridan, PhD, RN, FAAN, are making breakthroughs into practice areas once reserved solely for women. Sheridan, who became a nurse after working as an operating room technician in the Air Force during the Vietnam War, is one of two men licensed in Maryland to conduct exams of women who have been involved in sexual assault.
Sheridan, who has a doctorate in nursing, says a man can perform such work with caring, empathy, and professionalism.
“I’ve never had a woman say she didn’t want me to do the exam,” says Sheridan.
Others have found jobs with unusual hours that provide breathtaking amounts of free time. Dennis Jones, MS, RN, CFRN, an instructor at SON, serves as a flight nurse on the STAT MedEvac helicopter service at The Johns Hopkins Hospital, where he works just ten 24-hour shifts every 42 days.
Many staff nurses, meanwhile, work 12-hour shifts. At The Johns Hopkins Hospital, that translates into 10 shifts over 21 days. The work settings also provide flexibility for those looking for new opportunities.
“I tell men and women thinking of entering the field that it’s the kind of career where you can change what you do every year and never do the same thing twice,” Jones says. “There are so many options—emergency room, anesthesia, the recovery room, psychiatry, out-patient clinic, the hyperbaric chamber or on a hospital floor.”
Those options, though, have yet to provide a huge draw for American men, who have largely shied away from the field. One problem, men say, is the perception of the job as “women’s work” or serving as handmaiden to an all-powerful physician who gives them orders to carry out. That’s not the reality in many nursing settings, where nurses are on the frontlines in the fight against disease, evaluating patients, making independent decisions on their care, and working on a team with physicians.
There’s also modern culture’s depiction of nurses in television shows and movies. In the 2000 hit movie, Meet the Parents, actor Ben Stiller plays a nurse, whose chosen profession is ridiculed around the dinner table by his girlfriend’s father and family. He’s gay-baited, called “Florence Nightingale,” and questioned by his girlfriend’s father, played by Robert DeNiro, about the dearth of men in the field.
“The image that was projected was pretty negative,” says Assistant Professor Jason Farley, PhD ’08, MPH, CRNP, an adult nurse practitioner at Johns Hopkins HIV/AIDS service. “That’s what we are battling against.”
They also battle against the profession’s name: nurse. Men in nursing bristle at being called a “male nurse,” saying it’s like calling someone a “female doctor” or “female lawyer.”
“It’s an unnecessary distinction,” says SON Clinical Instructor Bernard Keenan ’86, MSN ’93, who works in The Johns Hopkins Hospital Department of Psychiatry. “It portrays men as outliers in the field.”
Keenan was one of three men in the graduating class of 1986 (the first class to graduate from the University-based School of Nursing) and the first to serve as president of the Johns Hopkins Nurses’ Alumni Association.
He’s working to change the stereotypes of nursing, and points to a recent patient in the Emergency Department as an example. “He couldn’t quite conceive of a man working as a nurse,” says Keenan. “What made the situation even more confusing was that my colleague was a female physician, and we were dressed nearly identically. The patient kept calling me ‘Doc’ and referring to her as the nurse.”
Men entering the field must be prepared to deal with the recurring questions from patients and their families: Are you gay? When are going to become a doctor?
“I tell them I’m quite happy being a nurse,” says Keenan. “It’s interesting that the women’s movement exposed women to all the opportunities that were once just for men. But there hasn’t been much in the other direction, saying that it’s okay for men to stay at home with their children, or that men could be nurses.”
Men, meanwhile, are joining together to provide support and recruit other men into the field.
In 2008, Mueller organized the Hopkins Men in Nursing student group, which met monthly over the past year. Topics include how best to recruit men into the field, how to support men already there, and how to deal with issues that arise in classes such as obstetrics/gynecology and labor and delivery.
“A lot of the guys felt it was awkward in those classes,” he recalls. “I didn’t have the same experience.”
After joining The Johns Hopkins Hospital staff, Mueller plans to keep in touch with the men at SON. He’ll be back to meet with the group, to answer questions about what it’s like on the job, encourage the students to shadow him at work, and be available for support.
“There is femininity attached to the title, ‘nurse,’ but the more you learn about nursing, you realize that the job is less gendered than you may have thought,” he says. “My first job is working with children. They are very complex patients. It’s a challenge that I’m really ready to tackle.”
By Elizabeth Heubeck
Photos by Whitney Sherman
Hopkins Nurse are empowering women, throughout their lifespan, to embrace healthier
The birth of a baby. A diagnosis of breast cancer. The frailty that comes with old age. At the Johns Hopkins University School of Nursing (SON), students learn to perceive these and other health-related events as part of the dynamic, complex and ever-changing landscape that makes up a woman’s life span. They also are taught to recognize that the way these life events affect a woman have as much to do with where she grows up as what her genetic makeup looks like.
By looking below the surface at the important yet oft-overlooked subtexts that color women’s health, SON faculty members provide exemplary examples of how intuitive, targeted care leads to the best outcomes for every patient. They do so through the research they conduct, the evidence-based practice guidelines they construct, and the curriculum they design that speak to the health of all women at every phase of life. In turn, they empower the students they teach to practice nursing in a way that benefits the ethnically and socioeconomically diverse populations they serve.
The Early Years
The Middle Years
The Later Years
The Early Years
Stemming the Rising Tide of STDs
A stint as a high school nurse steered the career path of Hayley Mark, PhD, MPH, RN, an assistant professor with the School of Nursing’s Department of Community Public Health. Stunned by the high rates of STDs among the adolescents she worked with, Mark wanted to find a way to reverse it. Subsequently, she has dedicated much of her career to researching ways to improve the prevention, spread, and treatment of STDs among young adults.
“One in every four teenage women has at least one STD,” such as human papillomavirus (HPV), chlamydia, herpes simplex virus, and trichomoniasis, says Mark. The rate of infection among African American young women is even higher, at 48 percent. While more intense screening would seem like a logical part of the solution, Mark has found it to be fraught with barriers.
For example, in a recent study, Mark and colleagues found that screening college students for herpes comes with its own particular set of challenges: the frequency of false-positive results; the expense—approximately $100—of confirmation testing; and the psychological repercussions among students who test positive.
Though nurses may not be able to change the nature or cost of screening for herpes, they can tune into the psychological repercussions that often plague young women who test positive for herpes and other STDs. “Nurses are often in the best position to help patients cope with the psychosocial issues involves,” says Mark.
Better Birthing With Doula Care
After she completed her clinical rotation in obstetrics, Suzette Lee ‘09 knew she wanted to be trained as a doula.
“Through my OB rotation, I became convinced that not all mothers-to-be are equipped to ask all the questions and request all the things they have the right to request,” Lee says.
Via a two-credit elective, SON students working toward their baccalaureate degrees can be trained as doulas—professionals who provide non-medical, emotional, informational, and physical support to women during low-risk childbirth experiences. Currently, about 15 percent of the program’s students opt to take the course. That’s a high percentage of nursing students choosing to learn age-old techniques that lie outside the realm of modern medicine.
Today, labor care in hospitals heavily emphasizes reducing pain, primarily via epidural anesthesia. This pharmacologic intervention isn’t without downsides. It necessitates an intravenous line; weakens women’s legs, making it difficult to get out of bed or effectively push during labor; and prolongs labor. By contrast, doulas use complementary comfort measures and support women’s choices during labor. But misperceptions have unjustly dampened the reputation of doulas.
“The hippie midwife/doula—that’s a myth. Those who are educated are very competent practitioners,” says assistant professor Elizabeth Jordan, DNSc, RNC, who runs the school’s Birth Companions Program with instructor Shirley Van Zandt, MS, RN, MPH, CRNP.
A free service, the Birth Companion Program pairs SON students who have received doula training with pregnant women in the Baltimore metropolitan area who lack a strong support system or access to prenatal care. The student-doulas provide clients with one prenatal and postpartum visit, and attend their labor and birth. The decade-old program, which currently serves approximately 75 women per year, has been collecting some compelling data on the women it serves.
“At a time when cesarean section rates are soaring, the rate for the women in the program is 5 percent lower than that in the community. Plus, the incidence of low birth rate and preterm infants is much lower than in the general population, despite the fact that we serve a vulnerable population,” Jordan says. Chances are it has something to do with the relationships mothers-to-be form with their doulas.
The Middle Years
When Mom Suffers Mental Illness
Motherhood doesn’t come with a manual. Even if it did, chances are it wouldn’t address the societal stresses that impinge on the life-long job: financial strain, an inadequate social support system, and addiction, to name a few. So countless mothers muddle through the job, feeling somewhat powerless and dragging down their children with them.
“When a mother’s mental health is impaired in any way, there are at least two people involved,” says Deborah Gross, DNSc, RN, FAAN, Leonard and Helen Stulman Professor in Mental Health and Psychiatric Nursing.
So Gross set out to develop a parenting program that would have a positive impact on both moms and their children. She chose to focus on a population that had been overlooked in prior data-driven parenting programs: urban Latino and African American families in Chicago neighborhoods. In addition to the challenges that all parents face, a large percentage of this population confronts additional burdens, including economic stress; violence, either domestic or neighborhood-based; and sparse or nonexistent support systems.
Gross, in collaboration with an advisory group of African American and Latino parents, developed The Chicago Parent Program (CPP). It emphasizes:
• Child-centered time
• The importance of family routines and traditions
• The value of praise and encouragement
• Rewards for reducing challenging behavior
• The importance of setting clear limits and following through
• The need to establish consequences
• The use of specific parenting strategies (e.g., ignore, distract, time out)
Gross’s program has met with success. Participants enrolled in the program for a year report using less corporal punishment, issuing fewer commands, and exhibiting more consistent discipline and warmth toward their children. Already, CPP has taken hold in Chicago, and Gross hopes to expand it into Baltimore soon.
But not all mothers who show signs of depression are enrolled in positive parenting classes, and it’s up to nurses to reach them in other ways.
“We may not always focus on the parents when we help their kids. However, clinicians need to take a step back and see holistically what’s going on with the mom, to be on the lookout for the possibility of mental health issues,” says Shelly Eisbach, a post-doctoral fellow who looks to Gross as her mentor in mental health research. She also assists staff at an intensive outpatient treatment center at Johns Hopkins Bayview Medical Center.
Staffing shortages and time constraints force providers to be creative when checking on moms’ mental health status. An increasing number of pediatric providers are conducting quick mental health screenings of mothers who bring their children to the office for care. “You have to look for opportunities to check in with moms. If you’re a nurse taking someone’s blood pressure, that could be the perfect time to communicate,” Eisbach suggests.
Heart Health First
We’ve all heard the refrain before: Girls are raised to take care of everybody but themselves. The negative consequences of this cultural norm—including cardiovascular disease, diabetes, and obesity—start to become apparent around the time women reach middle age.
Faculty members at the SON are working hard to change these cultural patterns, long embedded in communities, and to get women to take care of themselves first and foremost. For Deborah Jones, PhD, RN, and Hae-Ra Han, PhD, RN, it’s as much a professional initiative as it is a personal crusade, as they conduct heart health research within their own minority communities.
Jones, a SON assistant professor, lost her grandmother to heart disease, and she believes her grandmother—like many other African American women—lacked an awareness of risk factors that disproportionately affect a high percentage of African American women. She refers to them as the “deadly quartet”: obesity, hypertension, diabetes, and high triglyceride levels. And she’s determined to see make these disparities disappear.
Jones believes that breaking down barriers to improved health among African American women will require motivation and modeling. “If you sit down and show women what’s actually happening to them, it can motivate them to change. But don’t tell them; motivate them,” Jones says. “In the past, we tried to tell people what to do. It caused more resistance than assistance.”
The same may be true for Korean American women, who often consider their children’s success a stronger motivation than their own health. It’s just one example of how understanding a community’s culture is essential to communicating about lifestyle modifications.
“Korean American women want their children to go to the Ivies [Ivy League colleges],” says SON associate professor Han. “So instead of spending time and money on themselves, they spend it on their children. Their health is not their priority.”
Compounding this problem, explains Han, is the fact that many Korean Americans are small business owners, for whom private health insurance is extremely expensive. Conversely, Korea offers universal health coverage to its citizens. These factors, coupled with language barriers and an American health system that differs greatly from the one they’re accustomed to in Korea, prevent Korean American women from regularly seeing a provider.
Han’s research into hypertension prevention programs targeting Korean Americans reveals that using linguistically- and culturally-appropriate programs which emphasize lifestyle modifications can improve patients’ health outcomes. “We say, ‘Mothers are the backbone of society. You’ve got to be healthy for your dependent family members,’” she says.
The Later Years
Caring For Our Aging Population
Accompanying her great aunt to disappointing doctor appointments motivated Katherine Woodward ‘09 to enter the field of nursing. “Even with me there, she had a hard time speaking up for herself. And she forgot most of what she wanted to say. It’s a problem that’s too prevalent,” Woodward says.
Woodward is one of the 10 percent of SON nursing students who belong to the Geriatric Interest Group (GIG), a student-centered special interest group that addresses issues of special significance to older patients. The GIG hosts expert gerontology guest speakers and performs service projects within the community.
“We’re trying to prepare every nurse who graduates from the SON to care for the aging population. We’re committed to this,” says SON assistant professor Elizabeth “Ibby” Tanner, PhD, MS, RN, who originally formed the GIG in response to student requests.
With a host of other experts, Tanner developed curriculum for a course required by all SON baccalaureate degree-seeking students, “Issues in Aging,” which Woodward describes as “a great introduction to caring for older adults.” Only 23 percent of baccalaureate nursing programs nationwide offer a stand-alone required course in geriatrics, though one in every five American adults will be 65 or older by the year 2030.
This past winter, student GIG members threw an intergenerational “senior prom” for residents of a senior housing complex in Baltimore city, enjoyed by older residents and students alike. “It’s a misperception that all health care happens in a doctor’s office. Social interaction is therapeutic in its own right,” says Woodward, who attended the event.
The prom attendees offer proof. “One older person said to me, ‘I never knew I could have so much fun,’” Woodward says.
How Stress Takes its Toll
Though she admits it isn’t easy to pinpoint the link between stress and poor health, SON assistant professor Sarah L. Szanton, PhD, CRNP is determined to find the connection. Currently, she’s zeroing in on the impact of stress at the cellular level on older adults’ immune, cardiovascular, and endocrine systems.
“Oxidative stress may be the common soil for many things, from diabetes to cardiovascular disease. If we find more evidence of this, it could lead to findings on why some people age earlier,” Szanton says.
Already, Szanton’s research has identified links between older women’s stress levels and their health. A study revealed that community-dwelling women ages 70 to 79 who reported financial strain were almost 60 percent more likely to die within five years than subjects who reported no financial strain.
Armed with the knowledge that stress can adversely affect women’s health, Szanton believes it’s up to nurses to detect and find simple ways to help manage it. “It’s not your traditional nursing role. But it is a nurse’s business to find out about these things,” she says.
Surviving Breast Cancer
More than half of breast cancers occur in women over 65, but not all older women diagnosed with breast cancer have the same mortality rates. Women of certain ethnicities have less favorable survivor rates. SON faculty members are committed to leveling these statistics so that that all women, regardless of their ethnicity, receive culturally competent care that leads to the best possible outcomes.
Fannie Gaston-Johansson, PhD, RN, FAAN is painfully aware that the mortality rate for African American women with breast cancer is 32 percent higher than for Caucasian women. Gaston-Johansson, the director of the SON Center on Health Disparities Research, is finding innovative ways to change that disparity. She has discovered that spirituality and faith—cultural beliefs of great significance to many women in the African American community—can have a positive impact on the physical and emotional well being of African American breast cancer patients during treatment. She now suggests that nurses integrate spiritual and faith-oriented coping strategies as part of comprehensive breast cancer treatment plans for women of diverse ethnic and racial backgrounds.
Similarly unsettling statistics are fueling the research of pre-doctoral SON fellow JingJing Shang, MSN. One is the rising incidence of breast cancer among Asian American women; the other is the disproportionately low rate of Korean American women who receive breast cancer screenings, which can reduce breast cancer mortality by 30 percent.
“In the Asian culture, it’s not acceptable to talk about ‘bad’ things, like cancer. Some Asians, especially the older generation, believe they’ll be discriminated against if people find out they have cancer. Others think it’s contagious,” says Shang. “Cultural beliefs play a big role.”
For all ethnic groups, however, the odds for surviving breast cancer have never been better than they are today. But for the clinicians who treat these survivors, a long-term treatment model still doesn’t exist. SON assistant professor Sharon Olsen, PhD, MS, RN, AOCN is working with Johns Hopkins Breast Center colleagues to change that.
“We’re focused on developing a plan of care that can be as standardized as possible, and communicated to community providers,” she says. Components of such a model would include evidence-based medical care, patient and primary care provider education, surveillance, screening and support mechanisms.”
Olsen believes nurses can play an integral role in this model. She envisions nurses working more closely with oncologists, and a greater number of primary care nurse prac-titioners working independently with breast cancer survivors, especially given the shortage of general practitioners. Ideally, Olsen believes nurses could play a much larger role in breast cancer care management from the beginning stages.
“There’s a whole trajectory of care that nurses can be responsible for, from diagnosis to long-term survivorship management. These are the pieces where nurses shine,” Olsen remarks.
Learn More Online
STD Control and Prevention:
• Centers for Disease Control and Prevention www.cdc.gov/std/treatment/default.htm
• American Social Health Association www.ashastd.org
Midwives and Doulas:
• American College of Nurse Midwives www.acnm.org
• DONA International www.dona.org
• National Alliance on Mental Health www.nami.org
• US Dept of Health and Human Services –
Substance Abuse and Mental Health Services Administration mentalhealth.samhsa.gov
• American Psychiatric Nurses Association www.apna.org
• American Heart Association www.americanheart.org
• Center for Disease Control and Prevention www.cdc.gov/DHDSP
Aging and Geriatrics:
• The National Gerontological Nursing Association www.ngna.org
• The Johns Hopkins Center on Aging and Health www.jhsph.edu/AgingandHealth
• The Geriatric Nursing Project www.aacn.nche.edu/Education/Hartford
• American Society of Clinical Oncology www.asco.org
• Institute of Medicine Cancer Survivorship www.iom.edu
• Oncology Nursing Society www.ons.org
• Susan G. Komen for the Cure, Maryland www.komenMD.org
The online version of the magazine for the Johns Hopkins University School of Nursing and the Johns Hopkins Nurses’ Alumni Association.
Features By Geoff Brown
A Curious Mind
Nurses’ skills in observing and adjusting treatments, medications, and even habits for patients gives nursing research a new and important role in the evolution of healthcare in America. For those on ”a quest for making things better,” says National Institute of Nursing Research Director Patricia Grady, “a curious mind is the thing you most need.”
Discover a Better Way to Care
Nurse researchers excel in investigating techniques to assess, care for, and empower their patients. Whether developing tools for use at the bedside, conducting research with patients in local or global communities, or mentoring the next generation of nurse scientists, Hopkins nurse researchers are committed to discovering a better way to care.
Making Research Relevant
It is the translation of research into action that brings new knowledge to bear on patient care. And who better to ensure that research rapidly be applied to the clinical setting than nurses? “There’s a a long history of public trust of nursing,” says Professor Miyong Kim. “We can make research relevant for people.”
On the Pulse
Executive and alumni mentors, desegregation at Hopkins, Men in nursing, and more.
Bench to Bedside
When staff behave badly, simulations teach safety, and more.
Hopkins nurses in Haiti, news from Korea and St. Croix.
Live from 525
In South Africa, two students learn from people, healthcare, culture, and health disparities.
An OB wedding, 704 infection-free days, a nurse angel and other news from the Johns Hopkins Hospitals.
Faculty, Students, and Staff News
Hopkins Nurses in the News
News from the Johns Hopkins Nurses’ Alumni Associatio