DiversityNursing Blog

By Elizabeth Cohen and John Bonifield

www.cnn.com

Today, because of a CNN story and the generosity of donors from around the world, Kekula wears scrubs bearing the emblem of the Emory University Nell Hodgson Woodruff School of Nursing in Atlanta, where she's learning skills she can take back home to care for her fellow Liberians. 

"It's a surprise -- a young child like me who came from a very poor background coming to the U.S.," she said. "I'm thankful to CNN and I appreciate the people who made donations, and I'm thankful to Emory for accepting me to study."

At Emory, Kekula has asked for special training on certain skills, such as caring for burns, a common type of injury because children in Liberia sometimes fall into the open fires used for cooking. 

One of her instructors, Kelly Fullwood, said Kekula's an excellent student who has taught her teachers a thing or two about how to do procedures without costly equipment, as she's been forced to do in Liberia. 

"She fascinates me every day," Fullwood said. "She gets nursing. She gets what it's about."

Kekula, 23, was just a year away from finishing up her nursing degree in Liberia when Ebola struck and her mother, father, sister and cousin came down with the disease. Hospitals were full and no doctors would visit her home, so with just advice from a physician on the phone, Kekula took care of all four of her relatives at the same time. 

All but her cousin survived -- a high success rate considering that at the time, about 70% of Ebola patients were dying in Liberia.

Kekula couldn't continue her nursing education in Liberia, because the schools had closed. 

A CNN story about Kekula in September prompted donations from around the world to IAM, an organization that raises money to help African natives pay for education. 

David Smith, an associate dean at Emory's nursing school, said they accepted Kekula because they were struck by how both she and Emory each treated four Ebola patients at around the same time last year -- and Emory had dozens of doctors and nurses and millions of dollars in technology while Kekula had nobody and nearly no supplies.

"It was obvious to us that this woman was intelligent and strong and fearless," he said. 

Kekula is scheduled to return to Liberia in August. 

"These things that I have learned here I am going to take back to my fellow nurses," she said. "I love to care for people. I love to save lives."

Heather Stringer

In 2010, the Institute of Medicine issued eight recommendations that dared to transform the nursing profession by 2020. This year marks the midway point for reaching the goals outlined in the report “The Future of Nursing: Leading Change, Advancing Health,” and statistics at halftime offer a glimpse into nursing’s progress so far.

Although the numbers in some areas have altered little in the first few years, infrastructure changes have been set in motion that will lead to more noticeable improvements in the data in the next several years, said Susan Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing. The RWJF partnered with the IOM to produce the report. 

“I am a very impatient person and would like things to move faster, but we have to remember that we are changing social norms with these goals,” Hassmiller said. “We are trying, for example, to convince hospital leaders, nursing students and educational institutions that it is important for nurses to have a baccalaureate degree, and that takes time.”

Hassmiller is referring to Recommendation 4 of the report, which calls academic nurse leaders across all schools of nursing to work together to increase the proportion of nurses with a baccalaureate degree from 50% to 80% by 2020. The most recent data collected from the American Community Survey by the Future of Nursing: Campaign for Action found that the percentage of employed nurses with a bachelor’s degree or higher only climbed 2% between 2010 and 2013. However, Hassmiller suggested the percentage is likely to increase rapidly in coming years because nursing schools have increased capacity to accommodate more students. As a result, the number of nurses enrolled in RN-to-BSN programs skyrocketed between 2010 and 2014, from about 77,000 nurses in 2010 to 130,300 students in 2014, according to the American Association of Colleges of Nursing — a 69% increase. 

New education models

Campaign for Action leaders also are optimistic about the profession’s ability to approach the 80% goal because nursing schools are beginning to experiment with new models of education, such as bringing BSN programs to community colleges. 

Traditionally, students spend at least three years in a community college earning an associate’s degree to become an RN — at least a year for prerequisites and another two to complete the nursing program, Hassmiller said. These RNs may work for a few years before returning to school to earn a BSN — and some may not return at all, said Jenny Landen, MSN, RN, FNP-BC, dean of the School of Health, Math and Sciences at Santa Fe Community College in New Mexico. To avoid losing potential BSN students, leaders from New Mexico’s university and community colleges began meeting to discuss a new paradigm: students who were dually enrolled in a community college and a university BSN program. 

The educators started by forming a common statewide baccalaureate curriculum that would be used by all community colleges and universities, Landen said. The educators also discussed how to pool resources, such as offering university courses online at local community colleges. “This opens the opportunity of earning a BSN to people who need to stay in their communities during school,” she said. “They may have family commitments locally, and they can take the baccalaureate degree courses at the community college tuition fee, which is much less expensive.”

Four community colleges in New Mexico have launched dual enrollment programs within the last year. At Santa Fe Community College, there are far more applicants than the program can hold, Landen said. Community colleges and universities in other parts of the country also are working together to create programs in which nursing students can be dually enrolled. In addition to nursing schools buying into the need for more BSN-prepared nurses, there also is evidence that employers are moving toward this new standard as well. According to a study released in February in the Journal of Nursing Administration, the percentage of institutions requiring a BSN when hiring new RNs jumped from 9% to 19% between 2011 and 2013. 

Beyond the BSN

So far, the national data related to Recommendation 5 — double the number of nurses with a doctorate by 2020 — suggests there have been minimal changes in the number of employed nurses with a doctorate, yet there has been a significant increase in the number of students pursuing this level of education. According to the JONA article, on average about 3.1% of employed nurses in all institutions had a doctorate in 2011. This rose to 3.6% in 2013. This percentage likely will increase in the coming years because of the proliferation of doctor of nursing practice programs since 2010. These programs are geared for advanced practice RNs who are interested in returning to the clinical setting after earning a doctoral degree. Between 2010 and 2013, the number of students enrolled in DNP programs doubled from just over 7,000 students to more than 14,600. There was a lesser increase in the number of students enrolled in PhD programs, up 12% from 4,600 to 5,100, according to the AACN. 

“When the DNP degree became an option, it opened the opportunity of a higher level of education to the working nurse, not the researcher, and that was attractive to many nurses,” said Pat Polansky, MS, RN, director of program development and implementation at the Center to Champion Nursing in America. “Getting a research-based PhD takes longer and not every nurse can do that, so the DNP has become a wonderful option.”

Leaders at the Campaign for Action, however, acknowledge that it is important to find strategies to boost the number of PhD-prepared nurses because the profession needs those nurses in academia and other administrative, research or entrepreneurial roles where they are contributing to the solutions of a transformed healthcare system, Hassmiller said. To encourage more nurses to pursue the path of a PhD, in 2014 the RWJF launched the Future of Nursing Scholars Program, which awards $75,000 per scholar pursuing a PhD. This is matched with $50,000 by the student’s school, and the funds can be used over the course of three years. 

Forging ahead

In December, the nursing profession will have another opportunity to assess progress on the recommendations when the IOM releases findings from a study that is under way to assess the national impact of the Future of Nursing report. The changes happening in areas such as education are remarkable, Hassmiller said, and she is eagerly anticipating the results from the current IOM study. 

“I would never modify the goals because you need something to strive for in order to affect change,” Hassmiller said. “I am extremely encouraged because we have never seen anything like this. For the first time in history, more than half of nurses have a bachelor’s degree, and it is going to keep climbing. The most challenging part has been the number of people that need to be influenced to make the business case as to why it is important, and it is finally happening.” 

Key recommendations from “The Future of Nursing: Leading Change, Advancing Health”

1) Remove scope-of-practice barriers.
2) Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. 
3) Implement nurse residency programs.
4) Increase the proportion of nurses with a baccalaureate degree to 80% by 2020. 
5) Double the number of nurses with a doctorate by 2020.
6) Ensure that nurses engage in lifelong learning.
7) Prepare and enable nurses to lead change to advance health. 
8) Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data.

Source: http://news.nurse.com

By Jen Christensen and Elizabeth Cohen

A young Liberian woman who saved three of her relatives by nursing them back to health after they contracted the Ebola virus is coming to the United States to finish her nursing degree.

The news comes as Time magazine announced Wednesday that its "Person of the Year" honors go to the Ebola fighters, the "unprecedented numbers" of doctors and nurses who responded when Ebola overtook an already-weak public health infrastructure this year in West Africa.

Fatu Kekula is not named in the article, but she definitely holds a place among those being honored.

The 22-year-old, who was in her final year of nursing school earlier this year, single-handedly took care of her father, mother, sister and cousin when they became ill with Ebola beginning in July.

And she did so with remarkable success. Three out of her four patients survived. That's a 25% death rate -- considerably better than the estimated Ebola death rate of 70%.

Kekula stayed healthy, which is noteworthy considering that hundreds of health care workers have become infected with Ebola, and she didn't even have personal protection equipment -- those white space suits and goggles used in Ebola treatment units.

Instead, Kekula invented her own equipment. International aid workers heard about her "trash bag method" and taught it to other West Africans who can't get into hospitals and don't have protective gear of their own.

Every day, several times a day for about two weeks, Kekula put trash bags over her socks and tied them in a knot over her calves. Then she put on a pair of rubber boots and then another set of trash bags over the boots.

She wrapped her hair in a pair of stockings and over that a trash bag. Next she donned a raincoat and four pairs of gloves on each hand, followed by a mask.

It was an arduous and time-consuming process, but she was religious about it, never cutting corners.

UNICEF Spokeswoman Sarah Crowe said Kekula is amazing.

"Essentially this is a tale of how communities are doing things for themselves," Crowe said. "Our approach is to listen and work with communities and help them do the best they can with what they have."

She emphasized, of course, that it would be better for patients to be in real hospitals with doctors and nurses in protective gear -- it's just that those things aren't available to many West Africans.

No one knows that better than Kekula.

Her Ebola nightmare started July 27, when her father, Moses, had a spike in blood pressure. She took him to a hospital in their home city of Kakata.

A bed was free because a patient had just passed away. What no one realized at the time was that the patient had died of Ebola.

Moses, 52, developed a fever, vomiting and diarrhea. Then the hospital closed down because nurses started dying of Ebola.

Kekula took her father to Monrovia, the capital city, about a 90-minute drive via difficult roads. Three hospitals turned him away because they were full.

She took him back to another hospital in Kakata. They said he had typhoid fever and did little for him, so Kekula took him home, where he infected three other family members: Kekula's mother, Victoria, 57; Kekula's sister, Vivian, 28, and their 14-year-old cousin who was living with them, Alfred Winnie.

While operating her one-woman Ebola hospital for two weeks, Kekula consulted with their family doctor, who would talk to her on the phone, but wouldn't come to the house. She gave them medicines she obtained from the local clinic and fluids through intravenous lines that she started.

At times, her patients' blood pressure plummeted so low she feared they would die.

"I cried many times," she said. "I said 'God, you want to tell me I'm going to lose my entire family?' "

But her father, mother, and sister rallied and were well on their way to recovery when space became available at JFK Medical Center on August 17. Alfred never recovered, though, and passed away at the hospital the next day.

"I'm very, very proud," Kekula's father said. "She saved my life through the almighty God."

Her father immediately began working to find a scholarship for Kekula, so she could finish her final year of nursing school. But the Ebola epidemic shut down many of Liberia's schools, including hers.

After a story about Kekula ran on CNN in September, many people wanted to help her.

A non-profit group called iamprojects.org also got involved.

With some help, Kekula applied to Emory University in Atlanta, the campus with the hospital that has successfully cared for American Ebola patients. Emory accepted the young woman so that she could complete her nursing degree starting this winter semester.

In order to attend, iamprojects will have to raise $40,000 to pay for her reduced tuition rate, living expenses, books and her travel and visa so that she can travel between Africa and the United States.

Kekula's father has no doubt that his daughter will go on to save many more people during her lifetime.

"I'm sure she'll be a great giant of Liberia," he said.

Source: www.cnn.com

By Eric Swensen

While 12-hour weekend shifts for nurses are typical, it’s not common to do it while also attending medical school full-time. But that’s what Mazvita Ethel Simoyi did during her first year at the University of Virginia School of Medicine, commuting every weekend to a hospital in Washington, D.C. to help pay for her education.

Now set to earn her M.D. degree from UVA this month, Simoyi laughed when asked how she endured the relentless schedule of work, schoolwork and commuting.

“I honestly do not know how I did it,” she said. “Necessity makes you rise to the occasion.”

Working Toward a Lifelong Dream

Simoyi knew she wanted to be a doctor from the time she was 5 or 6, when her father, Dr. Mike Simoyi, a general practitioner in Zimbabwe, brought her to his clinic to observe a tubal ligation. “I stood on a stool in the operating room, looking at him make the incision,” she said.

As she got older, she helped direct patients at the clinic where her father worked with her mother Regina, a nurse. The time she spent there deepened her commitment to medicine.

“The patients [at my parents’ clinic] are very, very grateful for the help they receive,” she said. “My father is also very involved in public health, and educating people at a time when HIV and AIDS was beginning to get a lot of attention. That’s why I wanted to be a doctor – so I could help people and share my knowledge with them.”

To continue her path toward becoming a doctor, Simoyi came to the U.S. from Zimbabwe at age 17 to attend college. After beginning as a biology/pre-med major at Butler University, she transferred to Howard University in Washington, D.C., earning a nursing degree in 2007. She went into nursing so she could earn a living while taking the remaining pre-requisite classes for medical school and “ensure that medicine was 100 percent what I wanted to do.”

After three years working as a nurse, she entered UVA’s School of Medicine in 2010. But she wasn’t quite done with nursing.

Full-Time Medical Student, Part-Time Nurse

During her first year as a med student, Simoyi worked weekends on a medical/surgical/oncology inpatient unit at Providence Hospital in Washington, D.C. She would leave Charlottesville around 5 p.m. Thursday or Friday for Washington, staying with her sister Nyasha or friends from Howard University when she wasn’t at work. She would return to Charlottesville around midnight Sunday to get some sleep before waking up at 7 a.m. Monday to begin another week of med school classes.

During her second year as a medical student, she worked part-time in Charlottesville as a hospice nurse. She continued working as a nurse until November 2012, when she was no longer able to work weekends due to her medical school clerkship.

“Time management was what really saved me,” she said.

Her commitment both to her education and her jobs impressed her classmates and faculty. “I was blown away by her work ethic,” said Chad Lane, a member of her medical school class.

As a part-time pharmacist during his time in medical school, Simoyi’s residency adviser, Dr. Shawn Pelletier, knows firsthand how tough her balancing act was. “It’s a lot of work,” he said. “While other people are studying or relaxing, you’re spending time working to pay tuition.”

The intelligent way Simoyi approached her dual responsibilities helped her do both successfully, said her adviser, Dr. Christine Peterson. “She knew exactly what she wanted to do. She’s very grounded and very realistic,” Peterson said. “She found nursing jobs that would mesh with the enormous amount of hours required for her studies.”

Simoyi also believes the extra hours she put in as a nurse helped with her medical school class work. “When I was reading information from a textbook, I could translate it to my patients. It helped solidify the concepts because I could apply it right away instead of waiting two years [to begin my clerkship],” she said.

When Simoyi did a four-week rotation in transplant surgery with Pelletier, he saw that “she already had the textbook answers, had digested that and had moved onto the next step.” In some cases, the only reply Pelletier had to her questions was: “That’s a good question – we’re trying to figure out the answer to that.”

While her nursing work left her less time to spend outside of class with her fellow students, Simoyi said she very much enjoyed her time at UVA. Her classmates were very welcoming and inclusive, and she appreciated that she was part of a large group of students who had taken non-traditional journeys to medical school.

“I was happy to see how many people had taken different paths, like IT and working as financial advisers,” she said.

Giving Back to Zimbabwe

This summer, Simoyi will begin a surgical residency at Baystate Medical Center in Springfield, Massachusetts. She chose surgery because she likes to work with her hands, figure out what’s wrong with a patient and quickly see results.

“You fix an artery, and you get to see the effects of your work immediately,” she said.

While she’s not sure whether she will end up practicing medicine in the U.S. or Zimbabwe, Simoyi definitely wants to give back to Zimbabwe. “I want to have some impact in Zimbabwe, even if I’m not there physically. I want to do something to make health care better, either in education or through standards of care for patients.”

Her classmates and teacher believe she is primed to succeed in whatever challenge she takes on next.

“Surgery is physically demanding and it requires mental toughness,” classmate Pranay Sinha said. “You have to be tough to go through what she has gone through.”

Source: University of Virigina Health System