In the fall of 2017, the #MeToo and TIME’S UP movements began in Hollywood. While lots of organizations were advocating to protect women in a number of fields, they weren’t solely based in health care. On March 1, 2019 that all changed when Time’s Up Healthcare launched.
According to Tiffany A. Love, PhD, FACHE, GNP, ANP-BC, CCA, CRLC, Regional Chief Nursing Officer with Coastal Healthcare Alliance as well as one of the organization’s founders, Time’s Up Healthcare was “established in response to the common experience of power inequity, unsafe work environments, and a lack of inclusion at every level of health care leadership. The aim is to drive new policies and decisions that result in more balanced, diverse, and accountable leadership; address workplace harassment and other types of discrimination; and create equitable and safe work cultures within all facets of the health care industry.”
She took the time to answer our questions about the organization. What follows is an edited version of the interview.
You’re a founding member of the initiative. Why did
you get involved?
I have worked in health care since the age of fifteen. I’ve experienced a lot of harassment and other types of discrimination over the years, and I had accepted it as a normal aspect of working in the health care environment. In more recent years, I decided that I would take a stand to create the change I wanted to see, and Time’s Up Healthcare offered me that opportunity.
What is the mission for Time’s Up Healthcare? What
does the group hope to accomplish?
Our mission is to unify national efforts to bring safety,
equity, and dignity to our workplace. We want to engage and support health care
professionals and organizations from all disciplines to change policy and
practices to support safe, equitable, and inclusive work environments. We want
to raise awareness about the issues that health care professionals face. We
also want to provide support for survivors through the Time’s Up Healthcare Legal
Why is it important for this group to exist? How do
you hope to change healthcare?
Time’s Up Healthcare is important because health care professionals need a group who will advocate for them without expecting anything in return. Time’s Up Healthcare is a 501(c)(3) foundation. Most of the work is done by volunteer health care professionals who donate their time and money to this important initiative.
As health care professionals, we are aware of the
research that has proven patient safety is at risk when health care workers are
forced to work in an environment that is not safe, equitable, or inclusive. The
health of the employees as well as the patients is impacted by these
What do most health care workers not realize about
harassment in the workplace? Or assault?
Many health care workers have been desensitized to harassment because it is so common. Harassment can be in the form of verbal aggression, exclusion, bullying behaviors, and the threat of physical violence. It can also take the form of assault through unwanted touching and even physical violence.
If nurses want to get involved with the group, what
can they do?
We welcome you to join us at https://www.timesuphealthcare.org. You can sign up for our newsletter or purchase a pair of Time’s Up Healthcare scrubs under the shop tab. A portion of the proceeds will assist survivors through the Time’s Up Healthcare Foundation and Legal Defense Fund. You can also become a sponsor or encourage your organization to become a signatory who pledges commitment to align with Time’s Up Healthcare’s core statements.
You can also follow us on social media. We are on Twitter:
@TIMESUPHC, Facebook: Time’s Up Healthcare, and Instagram: timesuphc. Look for
Time’s Up Healthcare. You can also search the hashtags: #TimesUpHealthcare
#TIMESUPHC and #TUHHERO.
When Angela Ferrari-Walczak, WHNP-BC, was an undergraduate, she thought that she wanted to become an OBGYN. As time passed, though, she realized that her passion was nursing. “I knew that eventually I would go for my nurse practitioner degree,” she says.
But after graduation, while she wanted to work on an OB
floor, there were no positions open. So she worked in neurology. Throughout the
years, she retained that interest in women’s health, and after a finding a
program she liked, she pursued her nurse practitioner degree in women’s health.
Today, Ferrari-Walczak works as a Women’s Health Nurse Practitioner (WHNP) at The Institute for Gynecology Care at Mercy in Maryland. She describes a typical day at her job:
“As a WHNP, our typical day is close to a typical day as an OBGYN in the office. We can see patients for their well-woman visits, diagnose and treat issues related to the female population, perform minor procedures, provide education and counseling, answer phone calls and messages, manage diagnostic tests, and overall be the resource to the patients within the practice. I only do GYN; however, I have also trained in OB, so other WHNPs can monitor women throughout their pregnancies as well.”
According to Ferrari-Walczak, one of the biggest
challenges for WHNPs is that most people don’t know that they exist. “There are
not a lot of us out there, but in school, we live and breathe all there is to
know about women’s health. So we are great resources to patients and the
community,” she says.
For nurses looking to become WHNPs, Ferrari-Walczak says
that one problem is that there aren’t a lot of programs for it. While she was
working at Johns Hopkins Hospital, Ferrari-Walczak says that she was initially
looking for into a Master’s program. After taking some classes, she realized
how much she enjoyed them and discovered that women’s health was the program she
wanted to pursue.
In a little over three years, Ferrari-Walczak earned her WHNP
through a program at Drexel University. Back then, she was working full-time as
a staff nurse on a neurology floor, and she was able to work the program around
her schedule. “The first two years were general education classes, and I was
able to listen to lectures on my own time,” she says. “Once I got into the core
classes during the last year and did my clinicals, it was a bit difficult
managing time. But I got through it. The year went so fast, though. It has paid
off in the end.”
Ferrari-Walczak stresses that if you’re interested in pursuing a career in women’s health and are thinking of going back to school, be sure to check with your employer to see if they will offer tuition reimbursement. Drexel offered her a discount since she worked at Hopkins, and Hopkins helped her to pay for it. “It definitely helped me to achieve my dreams,” she says.
“You need a passion for it. If you have found your
passion in women’s health, then this is the perfect position for you.
Being a WHNP is good for those nurses who also do not wish to pursue a midwife
career,” says Ferrari-Walczak.
“The greatest rewards are hearing praises from patients about myself, the physicians that I work for, the office, and the office staff — especially from those women who haven’t found a GYN they liked until they see me,” says Ferrari-Walczak. “The surgeons I work for specialize in endometriosis, and it is amazing to see women come in who have had chronic pain for years and then they get brought to us, get properly diagnosed and treated, and then they are finally pain free.”
To learn more about becoming a WHNP, visit here.
We’ve been profiling various nursing specialties so that you can get more information about what the job entails and what education you would need if you’d like to consider that specialty. Next up—Family Nurse Practitioner (FNP).
According to Miranda “Mandy” Wiggins, CRNP, an FNP with
Main Street Family Care in Alabama, FNPs are responsible for patients from
birth to geriatrics as well as all aspects of that care. They provide
comprehensive treatment and see patients for yearly wellness visits, write
prescriptions for them, order any necessary testing, and follow up to review
results of testing.
In addition, Wiggins says, “We are there for them for acute
illness and management of chronic medical issues.”
She admits that one of the biggest challenges in being an FNP is educating patients. Often, patients don’t understand that FNPs can provide many more services than an RN. They think that nurses and FNPs are the same position.
But there are so many more rewards to this job. “I chose
to be a family practitioner so that I could impact as many demographics as
possible in my practice. I enjoy providing care to patients of all ages and
presentations,” says Wiggins. “I enjoy the interaction with the patients and
the involvement of family members to ensure they are being given the best care
in and out of the office. They will remember that you took time to give them
resources and helped plan for their future needs.”
“The greatest reward is most definitely the continuity of
care we are able to provide from our listening and diagnostic skills to
providing follow-up care and establishing a trusting relationship with those
patients. It’s very rewarding to see them improve in their plan of care and to
be able to care for them over a period of years,” she says.
If you’re thinking of becoming an FNP, Wiggins says that the NP program usually takes two years to complete after earning a bachelor’s degree—if the student attends full-time. This timeframe includes a residency program and leadership/professional practice courses. Certification is also a must.
“If you love your patients and have a desire to serve, go for it!” says Wiggins.
People are often confused by the specialty of progressive care. Isn’t that what ICU is for?
No, not exactly.
Linda M. Bay, DNP, RN, ACNS-BC, PCCN-K, CCRN-K, Nurse Consultant, VA Office of Inspector General as well as a member of the national board of directors, American Association of Critical-Care Nurses (AACN) from 2012-2015, took time to not only explain what progressive care is, but also what PCCN certifications are and how they can help your career.
What is progressive care? What does a nurse in a progressive care unit do?
care is one of the fastest-growing nursing specialties, but remains one of the
least understood. The term “progressive care” describes the increased level of
care and vigilance required by acutely ill patients who are not in an ICU, but
have complex health care needs. These patients are moderately stable with an
elevated risk of instability and are found in settings such as step-down,
intermediate care, progressive care, telemetry, and transitional care.
Progressive care refers more to the acuity and care needs of the patient
population than to a specific location within the hospital.
Many hospitalized patients require complex assessment and
monitoring without the advanced therapies of intensive care. Progressive care
nurses need to have highly developed assessment skills and the knowledge to
monitor and anticipate their patients’ course. This is a specialized patient
population with specialized needs. An experienced progressive care nurse can
intervene and prevent a patient from needing intensive care-level services.
I think of progressive care
nursing as a “gray” area. My experience in hospital settings and conversations
with other nurses indicate that not everyone is familiar with that concept. When
people ask me about progressive care, I ask them to consider the question, “How
can we meet the needs of patients as they progress
through acute or highly acute episodes and steer them clear of needing the
intensity of a critical care unit?”
To me, progressive care
nursing means having enough knowledge of both critical care and acute care to
be agile in our practices to accommodate what happens to patients in the middle.
were the PCCN certifications established? What are they and why are they
- PCCN: AACN has recognized progressive care as a nursing specialty since 2004, when PCCN certification was established to validate the specialized knowledge and competencies needed to provide the best care to acutely ill adult patients in progressive care settings.
- PCCN-K: In 2016, AACN Certification
Corporation launched the PCCN-K credential for progressive care nurses who
influence the care delivered to acutely ill adult patients, but do not primarily or exclusively provide direct care.
AACN Certification Corporation conducts periodic national studies of acute and critical care nursing practice to make sure that certification exams and test plans are grounded in actual practice. These surveys revealed a gap in the care needs of acutely ill patients outside of the ICU. The PCCN credential was created based on the increasing complexity of patients in other areas of the hospital, as well as the need to care for patients who were transferring out of ICUs much sicker than they had been historically.
Adding PCCN-K to the AACN family of nursing certifications reflects evolving roles and changing times in nursing and health care. A growing number of acute care nurses are shifting to positions where they influence patient outcomes by sharing their unique clinical knowledge and expertise rather than providing care directly—essentially becoming nursing “knowledge professionals.” Offering this credential enables a wider range of progressive care nurses to pursue or maintain certification
nearly 20,000 nurses hold PCCN or PCCN-K credentials.
Some of the same types of
patients I once cared for in the ICU are now cared for on progressive care
units. The gap between acute care and critical care continues to narrow, and
the sickest patients are now in hospitals as an inpatient. With hospitals
working at full capacity, the need for the progressive care certification is
even more important today because nurses need the knowledge to care for
patients who are highly acute.
is PCCN-K different from PCCN? How can nurses determine which certification is
PCCN is designed for nurses
who directly care for acutely ill adult patients. These patients are often
found in areas such as intermediate care, direct observation, stepdown,
telemetry, and transitional care units.
PCCN-K is for RNs or APRNs
who influence the care delivered to acutely ill adult patients but do not
primarily or exclusively provide direct care. Nurses working in roles
such as clinical educator, manager/supervisor, director, academic faculty, or
nursing administrator may be eligible.
As a clinical nurse specialist, I worked directly with nurses, patients, and families, which enabled me to obtain PCCN certification. Now in my consultant role, I am doing indirect work, but I want to maintain expert knowledge of progressive care. So, I recently transitioned to the PCCN-K credential.
When nurses want to decide whether the direct care or knowledge professional certification is best for them, they should think about how they care for patients. Does the work they do put them at the point of care, with patients and families? Then PCCN is likely the appropriate credential. Does the work involve influence more than direct care (e.g. educating staff nurses, working with nurses and physicians, indirectly caring for patients)? Then PCCN-K is likely to be the right fit
Nurses who have questions on
which credential is right for them should seek advice from the AACN
certification experts before applying to take an exam. AACN specialists will
help them identify which certification exam is right for them.
did you choose to become PCCN certified?
If I wanted our progressive
care nurses to obtain the PCCN credential, I thought I first needed to “walk
the walk.” PCCN certification gave me pride in knowing that my knowledge and
expertise were validated. Knowing that I validated my knowledge gives me
confidence. My motivation to remain certified is about being recognized for my
expertise and my commitment to the profession by lifelong learning. I feel
connected to others who are certified as well. For me, being certified says to
the world “I know my stuff.”
Nurses who became certified gain a sense of pride—and more importantly, a sense of empowerment—because they have more knowledge. They became more comfortable with advanced cardiac life support, began asserting themselves more effectively with physicians, became more competent in caring for patients who became more critical, and confidently cared for patients right out of the ICU. I am quite proud of those nurses for their courage to get certified and their willingness to grow
can certification help a nurse’s career?
promoting continued excellence in progressive care nursing and helping nurses
stay up-to-date on the latest research and evidence-based practices, certification
as a progressive care nurse acknowledges the valuable clinical specialty
knowledge of these accomplished nurses.
people see that a nurse has board certification and credentials, they see
someone who has exceeded expectations. Certification validates knowledge, but
getting and keeping those credentials shows a commitment to the profession.
Professional journals often
have recruitment advertisements for “certified nurses,” and hospitals are pointing
to their certified nurses as a showcase of nursing excellence. Some organizations
even offer bonuses or raises for certification.
Compassion fatigue and burnout—it’s a popular topic in nursing. It’s tough to know how to maintain a good work/life balance and show compassion for patients while still preserving your own mental and physical health.
Vidette Todaro-Franceschi, PhD, RN, FT, Professor, The College of Staten Island & Graduate Center, both of the City University of New York, is also the author of Compassion Fatigue and Burnout in Nursing. As the second edition of the book recently published, we asked her questions about how things have changed.
What are some of the
biggest changes that you’ve observed regarding compassion fatigue and burnout
in nursing since the first edition of the book?
Since the first edition in 2012, a greater emphasis is being
placed on the relation between nurse well-being and patient care, as evidenced
by the growing body of research and practice literature. There are more studies
being performed in the area of professional quality of life, and the
significance of having a “happy” as well as “healthy” workforce is finally
getting proper attention.
A number of nursing organizations have advanced various programs to foster a healthy work environment and promote work-life balance. For example, in 2013 the American Nurses Association (ANA) launched an initiative with the development of a professional issues panel to address nurse fatigue. Since then other professional issues panels have been formed to focus on moral resilience and workplace violence, among others. In 2017, the ANA began a critical initiative called the Healthy Nurse, Healthy Nation Grand Challenge (HNHN GC), which is geared toward enhancing both nurse well-being and the health of the nation—a win-win for all.
Lastly, years ago I would have been tarred and feathered for
saying that no one coming to work should be asked to leave their baggage at the
door, or that it was ok for a nurse to say, “I need a mental health day” or “I
just cannot do it.” Today, I think,
there is recognition that we—nurses—are human beings; we feel, we hurt, we cry,
and it’s ok.
What are the
biggest challenges for nurses experiencing poor professional quality of life?
The biggest hurdles for nurses who are experiencing professional
quality of life issues (related to: compassion fatigue, moral distress,
incivility, lack of preparedness to care for patients who are dying, death
overload, PTSD, burnout, unhealthy work environment) are: acknowledging that there
is a problem, recognizing that there are choices and actions that they can
take, and lastly, turning toward self and other(s) in ways that foster health and
contentment. These three things form the basis of ART©, a mindful awareness model, which I developed to
assist nurses and other carers to enhance their professional quality of
Mindful awareness is the key to acknowledging how one feels (the A of ART). However, this
can be challenging, since the majority of nurses work in fast-paced, chaotic
places and are not paying much attention to how they feel as they go about their
work. In fact, coworkers, friends, or family members may identify that there is
a problem before the suffering nurse becomes aware. Hence, nurses should engage
in mindfulness at work (and at home) in order to acknowledge both the good and
the bad feelings associated with their work (with the goal to maximize the good
and minimize the bad).
Once a problem has been acknowledged, it is essential to
figure out what choices one has and what actions can be taken to fix whatever
needs fixing. This can be another difficult hurdle for some nurses. A nurse might
think that she/he has no choice(s), or may be fearful of change. Nurses need to
recognize that there are always choices
(doing nothing is a choice), and then intentionally choose and take action to change
their work circumstances (the R of ART).
The last part of ART is turning toward self and other(s) (the T of ART), which entails connecting and/or reconnecting with the things that contribute to health and happiness, whatever those things might be. Nurses need to put the oxygen mask on their own faces first, figure out what makes them happy, and what will contribute to their well-being. Of course, this is easier said than done because nurses are typically self-sacrificing and altruistic. But nothing good can come from self-sacrifice that results in an unhealthy, unhappy person, especially one who is responsible for the health and well-being of others.
Making changes in eating, drinking, sleeping, and
exercise habits can be difficult. Motivating oneself to go out with friends or
family, or even to go out for a walk around the block may seem incredibly daunting
when one is physically or emotionally exhausted and unhappy. Turning towards
self and other(s) has to be taken one small step at a time, mindfully. Eventually,
new good habits can replace old bad ones.
have occurred for nurses who experience professional quality of life issues
such as compassion fatigue and burnout?
With greater awareness of the importance of nurse well-being
for patient care quality, in many settings, health care administration is focusing
efforts on creating a healthier, happier workforce. For example, many
workplaces now have wellness, meaningful recognition, and resiliency programs.
What do you think is
most surprising to people and/or nurses regarding compassion fatigue and
The fact that many individuals are compassion fatigued or burned
out (or other things), without realizing it. Whenever I teach and/or talk about
it, there seems to be this reverberating AHA!
People who work with all
living beings (humans and animals)
should be educated about professional quality of life issues. They should know
how to identify compassion fatigue, moral distress, death overload, PTSD, and
burnout as well as the effects these things can have on their health/well-being,
work productivity, and patient safety.