Nursing career inspires a new view
By Anita Fitzgerald

One by one they walk into the classroom: a young woman in a lab coat pushing a small computer on wheels, an older woman in a flowered scrub top, another in a Dodger cap, a young man in an ROTC uniform, a tall woman in chinos and a blouse.  “Which one of these is a nurse?” comes the question to the audience of middle-schoolers.  Surprisingly the answer is every one of them.

“We are not what is portrayed so many times: the white uniform and carrying bedpans. Those days are over,” says Nilda Peragallo, Ph.D., dean of the school of nursing and health studies at the University of Miami.

“The presidential office has a nurse and even the L.A. Dodgers have a health provider,” adds Maria Elena Ruiz, Ph.D., of the Center for Health Disparities Research and assistant professor at Oregon Health & Science University in Portland, Ore., whose idea it was to present nurses in different attire to make the point that nurses work in many settings.

“Nursing is a rich profession, a beautiful profession.  In nursing you can do anything you want,” says Maria Teresa Villot, the national president of the National Association of Hispanic Nurses (NAHN) and the women veterans program manager at the Philadelphia VA Medical Center.

Educating young people about all that nurses can do is often a very eye-opening for them, says Carmen Ramirez, Ed.D., chair of the department of nursing practice at the University of Arkansas for Medical Sciences. “I just talk to them about what I do, my research in genetics, my teaching, my community service and they all go, ‘Wow, you can really do all that?’  I tell them I am a nurse, and you can really start with that.”  

Technology as the latest tool

Appealing to fans of TV’s “CSI” as well as true believers in human touch, the future of nursing takes place among machines monitoring each heartbeat of a two-pound preemie, inside a lab studying hair strands found at a crime scene, and in the neighborhoods collecting data for research to better care for under-served communities.

Nursing students of the 21st century learn inside labs equipped with highly realistic simulator mannequins who blink and pee and whose stomachs gurgle and pupils constrict. The mannequin speaks (with help from the instructor through a microphone) so that the students know when he is in pain or needs a cup of water. Students administer simulated medications that correct heartbeats, bring down blood pressure, or cause “the patient” to go into cardiac arrest depending on the students’ actions.

Dollar signs, a profession (not a job) and breaking barriers

Money. Does the emotional satisfaction of “helping people” leave nurses’ pocketbooks empty?

Not these days, and especially not for Latinas, who, because of the growing Hispanic population, are among the highest-demand employees in the already high-demand field of nursing. Wages vary from about $52,000 for a new staff nurse in Nashville, Tenn., to about $68,000 for a critical-care nurse in San Francisco, to about $75,000 for a research nurse in New York City to about $139,000 for a certified nurse anesthetist in Minneapolis, according to NurseWeek.com’s salary wizard.

The hurdle is that making money can cost money – for an education.  For some Latino families, financial need or family priorities require new high school graduates to “get a job” rather “get an education.”

And some school counselors, nurses say, are selling the students short – focusing on grade-point averages and forgetting that many of these Latino students have life experience in caring for their families that translates into an aptitude for nursing.

But money, mentoring and inspiring role models are available throughout the country. In Arkansas, Ramirez directs ENS (Essentials for Nursing Success) a federally-funded program that offers scholarships. In Philadelphia, Villot helped see to it that scholarships went to two promising students -- Nina Gonzalez and Nicole Matta – who were engulfed by devastating family hardships and continued on despite being faced with the prospect of quitting. In those cases, as in so many others, it was not only the cash that counted, it was the personal involvement.

In California, Ruiz recalls a student, now a nurse, who had difficulties at home with the family not understanding how a nursing student could be so busy. “We have to educate not only the students but the parents as to what it means,” Ruiz says of class demands. 

Adds Peragallo: “I think we have to ingrain in our communities how important it is to have a degree. And that – different from other degrees you may have when you go to a university – nursing is a field that number one, you will always have a job.”

The antidote to burnout

For many, nursing provides flexibility and job security no matter the setting. “I went into nursing thinking it was a hospital-based job. I was a single parent at that time, so I could work the night shift, I could work the evening shift,” says Oregon’s Ruiz, who had a large family to help her out with her son. “For me it was great, I could be home when he was home, and I could be sleeping when he was at school.”   

Ruiz saw another advantage. “I don’t have to leave my profession if I get overloaded or burned out. Anyone can get burned out. Every few years I’ve changed my role. I worked clinically as a nurse practitioner with pediatrics, with newborns, with adolescents who are incarcerated, with elders.  I’ve worked in psych hospitals, I’ve worked in farm-worker clinics...”

From newborns to psych hospitals to farm workers to … forensics

Ruiz also has experience in a field that takes a page right out of CSI – forensic medicine.

As a forensic nurse, she collects evidence from victims, including swabs, samples and statements, offers counseling and support, full medical care and follow-up visits. Victims can be anyone, from infants to the very elderly, from victims of burglary to domestic violence.  She could be called in at any time, even in the middle of the night to provide care, and at times has to testify in court about what she collected and what was said.

Ruiz recalls a heart-wrenching incident in Los Angeles where a woman, who had been given a drink by a man driving a vehicle, woke up in a public setting and felt she had been sexually violated. Yet initially she had no memory of it. Her disarranged clothes provided evidence. Ruiz says that when victims have been traumatized, they can’t give all the answers. “We have to be really creative and very patient,” she says. When these victims receive good care and support, and their case is resolved, they change so much there is a “glow” about them, Ruiz says. “This is when nursing is so rewarding.”

Forensics is far from the only hot new topic in nursing. Some are careers that nurses may never have envisioned.

There is informatics, where nurses can be involved in software development, program analysis and system management to enhance the art of nursing with the science of technology. There is the field of health disparities, which investigates differences in health and healthcare among ethnic or racial groups. There is parishnursing, where not only can congregations be served but literally mobilized. Ruiz, for example, would love to see churches opening their parking lots for eye care and diabetic screenings as well as offering a place for people to walk to better their health. And there is a creative new view of geriatrics, where nurses can be the critical link in assessing how to provide quality care and allow elders to live safely and independently at home – as the baby-boomer generation reaches its golden years. 

Research as a career and an eye-opener

Research nursing not only can provide insight to cultural competency, but also can pave the way to better health interventions. “Many times Latinos are left out of studies because studies require that you speak English and write English,” Peragallo says. “In my area, in HIV, we have not even made a dent because the majority of the studies include only English-speakers.”

Latino research nurses can bridge the gap to these communities and broaden the scope of care.  “The gain to the person and the community is incredible,” says Peragallo. “Many women have said, ‘We feel so valued that somebody would want our opinion, to know what we think about something, and how we feel about certain issues,’  It was an incredible experience.  We need to continue to do that.”

Genetic counseling

A nurse’s understanding of cultural issues is also vital in genetic counseling. As a member of the International Society of Nurse Geneticists, Ramirez gives counseling and risk assessment for women considering pregnancy. “The counseling is really important.  There are a lot of ethical, moral and legal issues in this arena,” says Ramirez.

But genetics isn’t only counseling. Ramirez also conducts research in the genetic effects of certain hypertensive medications, including testing tissue samples to look for DNA markers that let providers know which medications will work best for a particular patient.

Travel options

One license can take a nurse so many places. In the federal system with the VA hospitals, Villot has seen nurses move throughout the country without losing job status or seniority. In other settings, traveling nurses, employed by a single company with contracts throughout the country can move from state to state in six- to 18-week assignments.

Still other nurses find opportunities throughout the world: The University of Miami’s Peragallo, who has practiced nursing in her native country of Chile, the United States and Germany. Arkansas’ Ramirez regularly returns to Puerto Rico, where she grew up, to conduct research into medical treatments for pain.

Nursing students also often have opportunities to work and learn culture and language in Latin American countries. (See TheLatinaVoz.com’s Travel section for insight into the Texas Woman’s University College of Nursing summer exchange program in Mexico.)  

Speaking Spanish and saving lives

Today’s nurses do not mirror the population. As of 2004, Latinos account for only 1.8% of total RNs in the country while they represent for 13.7% of the total population, according to the National Sample Survey on Registered Nurses. Whites account for 88.4% of all nurses, yet they represent 67.9% of the total population. Even more discouraging to nurses is that the 2004 numbers represent a decrease. Latinos were 2% of all nurses in 2000. 

These disparities have a significant impact on the care Latino patients receive. “Think about who is the largest minority in this country: It’s Latinos,” says Peragallo. “So there is a real need to provide safe and competent care to patients and communities. There is a real need to have nurses from that background or at least to be educated in a culturally competent environment.”  

Villot has seen that from personal experience. She cited the example of her mother, a diabetic, who was reluctant to eat the hospital food and did not understand the English language to communicate with the nurses. “They labeled her as ‘noncompliant,’ that she did not care about her health.  It was not that. It was that she did not have the English to tell them, ‘I don’t like this, bring me something else.’ And she would not eat until we got there.” 

Having a culturally competent Latina nurse will allow that nurse to provide comprehensive health care to the patient. “We have to deal with not just their diabetes; we also have to think about where they are coming from,” Villot says. “Culturally we are able to take care of that patient.”

Being the “first” and “only”

Those Latinas already in the field are blazing a trail for all of nursing, often representing the only Hispanic in an entire institution. Ramirez, for example, remains the only Hispanic nurse in the state of Arkansas with a doctoral degree. Yet, rather than be stymied by being “solo,” she and other nurses have used their unique position as a platform to educate on cultural competency, attract government funding, encourage grants, steer minority commissions, make international presentations and shine a light on discriminatory practices – without losing touch with the bedside.    

Peragallo echoes this experience of being the “lone ranger” in many environments.  “It’s not a happy feeling when you don’t have your peers around you. And it’s true there is racism and there are barriers, but to me when you want something and you really have the drive to do what you want to do and do it well, you can always prove yourself and people cannot push you down. That’s a reality.”

Anita Fitzgerald is a bilingual nurse practitioner based in the Los Angeles area who has worked with Spanish-speaking communities throughout her career, from HIV/AIDS services to elder care to a community clinic. She also teaches at Cal State Long Beach and Mount St. Mary’s College.

Su Conexión*

American Nurses Association: www.nursingworld.org

“Choose Nursing” index to more than 80 career options within nursing: www.choosenursing.com/options/index.html

Discover Nursing’s information on nursing careers, funding and scholarships: www.discovernursing.com/

HRSA (Health Resources and Services Administration) funding programs for nursing education and public service: www.bhpr.hrsa.gov/nursing/scholarship/

International Association of Forensic Nursing: www.forensicnurse.org/

Medi-Smart Nursing Education Resources: www.medi-smart.com/peds.htm

MinorityNurse.com: www.minoritynurse.com/

National Association of Hispanic Nurses: www.thehispanicnurses.org/

National Association of Neonatal Nurses: www.nann.org/i4a/pages/index.cfm?pageid=1

NurseWeek.com, including salary wizard, career advice and career assessment tool: www.nurseweek.com/career/advice.asp

American Association of Nurse Anesthetists: www.aana.com

American Medical Informatics Association: www.amia.org/

Hartford Foundation’s Institute for Geriatric Nursing: www.hartfordign.org/index.html

* All links are provided for informational reasons only; inclusion on this list does not imply endorsement of these organizations, their philosophies or their sponsors.