Nurses on the Front Lines

From left, Bob Atkins, associate professor of nursing and childhood studies; Sherolde Hackett, program services manager for the Camden Healthy Start program; and School of Nursing–Camden Dean Donna Nickitas are committed to overcoming the daunting challenges of discrimination and disparity in health care.

From left, Bob Atkins, associate professor of nursing and childhood studies; Sherolde Hackett, program services manager for the Camden Healthy Start program; and School of Nursing–Camden Dean Donna Nickitas are committed to overcoming the daunting challenges of discrimination and disparity in health care.

By Sam Starnes

Bob Atkins knows firsthand the Monday morning rush that often confronts school nurses in vulnerable communities. “Everything that happened over the weekend that wasn’t seen by a primary care provider or an emergency department is coming to the school nurse’s office,” said Atkins, who worked for five years in the late ’90s as a school nurse in East Camden before joining the faculty of the Rutgers School of Nursing–Camden. “The school nurse’s office is part of an underground health care system. They are taking care of everything.”

Atkins, an associate professor of nursing and childhood studies who also serves as director of the New Jersey Health Initiative, the statewide grant-making program for the Robert Wood Johnson Foundation, recalls the litany of health concerns that came through his door. “I saw kids with fractures,” he said. “Kids that came in with ear infections and strep throat. All kinds of acute care and dental and vision issues. Being a school nurse is not just putting on Band-Aids and ice packs.”

This high level of need that confronts school nurses in disadvantaged school districts with large populations of minority students is just one indicator of the many inequities of the quality of health care received across diverse populations in America, said School of Nursing–Camden Dean Donna Nickitas.

Nickitas, who became dean in July, emphasizes that nurses must address issues of disparity and discrimination in health care, particularly regarding African Americans and Latinos. She cites a 2018 survey conducted by Harvard, NPR, and the Robert Wood Johnson Foundation that explored discrimination as an indicator of health status. “That survey revealed that every demographic group surveyed felt discriminated against their race or ethnic group,” she said.

She also cites statistics showing that middle-aged African-American males have death rates nearly twice as high as white counterparts, and that the mortality and morbidity rates of black mothers and children have worsened over the past 20 years. This data, she said, pulls the United States’ health ranking down well below other countries. “As one of the wealthiest nations in the world, why are we ranked 32 in the world in health care?” she said. “Our numbers are deplorable.”

Nurses, Nickitas said, can have an impact in helping to rectify this situation. Through the education of nurses at the Rutgers School of Nursing–Camden, she wants graduates to go out into the world as leaders with a focus on preventative care and community engagement. “We have a moral imperative to make sure that nurses understand that we do public good,” she said. “We serve all of society and we don’t get to choose between socioeconomic needs or class. We see the whole person. I want to make sure all individuals have access to health care. We have made public education a right. I believe health care should be a right for everyone.”

Nickitas and Atkins, while acknowledging the issues in health care in America are daunting, cited a number of initiatives underway at the School of Nursing–Camden that address healthcare inequities: partnering with community organizations that have shared goals; educating school nurses; diversifying the nursing workforce; and preparing all nurses to be leaders on health care issues.

Community Partners

School of Nursing–Camden faculty, students, and staff partner with many organizations on initiatives, such as the Southern New Jersey Perinatal Cooperative, a private nonprofit cooperative working in seven counties to improve maternal and child health care. This summer, the agency was awarded $1.1 million from the state to create community-based programs and services that address perinatal and maternal health care for black mothers and babies.

Judy Donlen, the agency’s executive director who also chairs the New Jersey State Health Planning Board, echoed Nickitas’s comments on the role discrimination plays in health care. “Race is undeniably a factor that functions as an intractable barrier for minorities seeing access to quality care,” Donlen said. A doctor of nursing who earned a juris doctorate from Rutgers Law School in Camden in 1998, she said the new grant will help make great strides in an area of serious inequity. “I am very glad for the attention and associated resources being directed toward reducing New Jersey’s black infant mortality rate,” she said.

The Southern New Jersey Perinatal Cooperative is one of more than 120 partners where Rutgers–Camden students work in clinical settings to aid health care organizations while learning. In addition, Patricia Suplee, an associate professor of nursing, serves on the organization’s board. Sherolde Hackett, program services manager for the Camden Healthy Start program, a federal initiative administered by the agency, said that the partnership helps both the school and her program work toward shared goals. “We welcome the opportunity to provide nursing students with real-life learning experiences that yield valuable insights for their future professional practices,” Hackett said. “Lessons learned about diverse populations and health equity serve not only the individual student, but also the greater good of all New Jersey communities. We also appreciate the exceptional research being done by Rutgers faculty that informs and guides our work.”

School Nurse Education

Another avenue for improving health outcomes in children is thoroughly preparing school nurses to be community health leaders. The School of Nursing–Camden received a $200,000 grant from the New Jersey Nursing Initiative of Robert Wood Johnson Foundation in 2016 that enabled the program to expand the scope of topics for school nurses and prepare them to address the wide range of issues that confront them, such as adverse childhood experiences, health equity, and behavioral health.

Tiffany Nelson, who has worked as school nurse for the Burlington County Special Services School District since January, this fall will finish the two-semester certification program at Rutgers–Camden and plans to continue on to earn a master of science in school health services, a new program for school nurses. Nelson said she has been inspired by the program to make a difference by practicing preventative health in the school. “We can do great things in the public health arena by getting out of the hospital and to where the people are,” said Nelson, who lives in Willingboro and has worked as a nurse in a hospital for four years. “If you can educate children and get them started with health habits, you can help them have better, healthier lives.”

Atkins said the school nurse specialty program is one of the only programs of its kind in the state. “Rutgers–Camden is a leader in this space,” he said. “It will serve as a model for other programs, and through our scholarship, we can show that school nurses are a great investment because they ensure students are healthy and ready to learn.”

Diversifying Nursing

Yet another way the School of Nursing–Camden is working to assuage healthcare inequities is through programs focused on diversifying the nursing work force. “It’s still predominantly a white female profession,” Nickitas said.

A program started in 2014 with a grant is enabling frontline medical workers—many of whom are minorities—to earn nursing degrees. The Rutgers–Camden/Cooper Collaborative for Upward Mobility in Nursing allows assistive health care personnel working full time at Cooper University Health Care to earn a bachelor’s degree in nursing from the Rutgers School of Nursing–Camden.

Shantá Rembert, who has been working 10 years as an EMT in the ER at Cooper University Hospital, enrolled in the program in 2015 and plans to earn her nursing degree this academic year. “I thought I would never be able to go back to school,” said Rembert, a resident of Haddon Township, New Jersey, who is married and has four children. “I still have to work full time. It has always been a goal of mine, but I thought there was no way I could finish before I was 75.”

She said while working in health care for a decade in Camden, she has seen firsthand the benefits diversifying the nursing workforce will bring. “If there are more African-American nurses and Hispanic nurses, it will be a good thing for health care,” Rembert said. “You will get a better outcome if patients can see themselves in the nurses treating them.”

Nurses as Leaders

An important thread that runs through the School of Nursing–Camden curriculum is preparing nurses to provide care across the continuum—from acute to primary care. “In the 21st century, nurses are probably not going to be bedside,” Atkins said. “Nurses are going to have a role in the community. We want to make sure nurses are leaders.”

Nurses can be leaders through their everyday interactions with patients, Nickitas said. “A significant and growing body of research shows how day-to-day experiences of nurses, specifically advanced practice registered nurses, have contributed to alleviating the shortcomings of quality, access, and cost-effective, patient-centered care.”

Another way nurses can be leaders is by joining together in addressing health care issues, said Wanda Williams, an assistant professor and nurse practitioner in the School of Nursing–Camden. “Nurses make up the majority of individuals working in health care,” Williams said. “We have to have a voice.”

Posted in: 2018 Fall, Features

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