In the past few decades, so much has changed about HIV—for many, it’s no longer a death sentence. Jeffrey Kwong, DNP, MPH, ANP-BC, ACRN, AAHIVS, FAANP, a Professor and Associate Dean for the Division of Advanced Nursing Practice at Rutgers School of Nursing as well as the President of the Association of Nurses in AIDS Care (ANAC), began working with people living with HIV in 1986—initially as a volunteer for a local community organization. In honor of World AIDS Day, he took time to answer our questions about working as a nurse with people with HIV, how it’s changed over the years, and the challenges and rewards he’s experienced.
What made you interested in becoming involved with patients living with HIV?
In 1986, I was a “buddy” who provided basic companionship for people who were diagnosed and often alienated or abandoned by their families/partners/friends because they had HIV. It was a very different time. Professionally, I initially worked as a public health administrator overseeing a Ryan White Program for Alameda County in the San Francisco Bay Area, then I went back to nursing school. I began working as an HIV clinical trials nurse in 1996 and then as a Primary Care Nurse Practitioner in 1997, and I have been in this role ever since. Although I have an academic appointment, I still maintain a clinical practice and take care of patients living with HIV, as well as those at risk of HIV infection.
What initially sparked my interest in HIV was wanting to do something for my community—to help those who were alienated, ostracized, and stigmatized because of their HIV status.
What are some of the biggest surprises you’ve found with working with patients with HIV? What would other nurses be surprised by?
There have been many surprises over the years. However, I think what still strikes me is the resilience; many of my patients have to be able to overcome so many challenges and life “obstacles” and to survive and thrive. One of the great things about being a primary care provider is getting to see patients over time—and some of my patients I have followed for years. As part of that process, they share their life journeys with me, and for some people, it’s amazing to hear all of the things that they have experienced: from battling substance abuse, to overcoming stigma, to being able to go back to school and change careers, to starting families and being successful and happy and living!
I think other nurses would be surprised at how rewarding it is to share the journey of being with a patient who is newly diagnosed and who is in tears because they think that HIV is a “death sentence”—and teaching them, caring for them, getting them on treatment, and watching them regain their hope and do well on HIV treatment and move on with their lives. And now we are watching them age into older adulthood!
What are some of the biggest challenges that you’ve experienced working with this patient population?
I think the biggest challenges have been dealing with stigma. Even today there is still so much stigma around HIV that many people are afraid to talk about it. They don’t want to get tested because they think “it can’t happen to them” (even though the CDC has recommended universal opt-out testing for all individuals 13 to 64 years of age regardless of risk, and the USPSTF also recommends universal testing for ages 15 to 65). The other challenge is that people think “HIV is over” and that because there are highly effective treatments, HIV isn’t a “big deal.” It still is an issue and people still need to know their status, get tested regularly, and take preventive measures.
For those who are doing well on treatment, we still have to educate and remind them of the importance of taking their medications regularly, having regular follow-up with their providers, and doing all of the preventive health interventions that will help them age successfully into older adulthood.
What have been some of your biggest rewards?
One of my favorite moments involves a woman I first met in the late 1990s when she was newly diagnosed with advanced HIV disease. I was her primary care NP for many years, and she shared with me when we first met that her dream was to live long enough to see her daughter graduate from high school. Well, not only did she get to see her daughter graduate from high school, but nearly 20 years later she is now a proud grandmother! And she said to me that all of this was “thanks to me”—but it really wasn’t me. I might have helped “steer the ship” by getting her on treatment and managing her over these years, but it’s moments like that when I’m grateful for the work that I get to do as an HIV provider.
With the progression of the treatments for HIV, I’m sure that the nursing field with these patients has changed as well. How has it? Please explain.
The biggest change and the challenge that I see as a provider is that our patients are aging. Nearly 70% of those living with HIV will be 50 years or older by 2030. Nurses, nurse practitioners, and other providers will need to know how to care for this population. When I think of the field of HIV, many of us initially only did infectious disease or hospice or oncology work. Then as patients started to do well, we had to learn primary care (how to deal with diabetes and hypertension, etc.). Now as patients are aging, we’ll need to learn how to be geriatric specialists. (Remember, geriatrics is its own specialty.) Similarly, geriatric providers will need to learn more about HIV to better care for this population.
Also with the availability of PrEP (HIV pre-exposure prophylaxis), many primary care providers need to be familiar with this intervention to help prevent people from becoming infected with HIV. The CDC estimates that over a million people would benefit from PrEP, but only a fraction of those individuals receive it—in part due to providers who are not willing or unfamiliar with how to prescribe it or manage patients who are on PrEP. This is where general primary care NPs can really make a difference in curbing the epidemic. We now have the tools to end the HIV epidemic. We just have to get providers (nurses, nurse practitioners, physicians, PAs, mental health providers, pharmacists, and the entire health care team) to work together to prevent and manage HIV, and together we can one day see the end of this epidemic.
If nurses want to start working primarily with patients with HIV, what should they do? Any particular training or certification they should get?
For those interested in HIV, I would recommend the Association of Nurses in AIDS Care (ANAC). We’re a professional organization for nurses and other health professionals who are interested in caring for persons living with HIV and those at risk for HIV. The American Academy of HIV Medicine (AAHIVM) is also great. Additionally, there are regional AIDS Education and Training Centers (AETC) across the U.S. that provide education and resources for clinicians wanting to learn more about HIV treatment and prevention.
As for certification, there are a couple of options. The HIV/AIDS Nursing Certification Board (HANCB) offers two types of certifications: the AIDS Certified Registered Nurse (ACRN) certification and the Advanced AIDS Certified Registered Nurse (AACRN) certification. The American Academy of HIV Medicine also offers a certification as an HIV Specialist (AAHIVS).
Is there anything else that you think is important for readers to know?
Nurses and nurse practitioners play a critical role in all aspects of care for persons living with HIV and those at risk for HIV—not only at the direct care level, but also at the public policy and advocacy level. I would encourage nurses from all disciplines and specialties to think about how HIV impacts their jobs, their lives, or their patients’ lives. As one of my mentors said, “Every nurse is an HIV nurse.”
Have you heard about the annual health event called Movember (“Moustache” plus “November”)? Men pledge to grow the facial hair above their upper lips and to get donations from their friends, family, and coworkers to fund efforts to address the men’s health crisis.
In addition to fundraising, the Movember Foundation aims to raise global awareness of male-specific diseases such as prostate and testicular cancer, as well as conditions that often hit men especially hard, such as depression, other mental illnesses, and suicide. Their stated mission is simple: to stop men dying too young.
Since Movember was launched in Australia in 2003, the event has grown into a powerhouse health charity and one of the fastest growing non-government organizations. The founders of Movember were inspired by how women had spearheaded fundraising and research efforts towards finding a cure for breast cancer. They sought to do the same to address male health and longevity disparities, and they have—with good humor and tremendous imagination.
In the last 15 years, the Movember Foundation has invested $200 million in 120 research projects to improve health outcomes for American men. They’ve also funded over 1,200 projects in more than 20 countries, with the financial support of over 5 million men and women.
The Movember Foundation will launch their 50 Million Men campaign in early 2019 to empower 50 million American men to self-manage their health in the next five years. Among other disparities, American women outlive American men by an average of five years.
(Worldwide, health outcomes among men and boys continue to be substantially worse than among girls and women.)
Through free digital resources, trackers, and health promotion initiatives, the organization aims to educate American men about healthy living, and to encourage them to seek preventative care and early treatment.
Movember gives nurses a wonderful opportunity to get involved in the effort to close the gender health gap and ensure that men live long lives, with the support of their peers and families. More healthy men mean healthier communities and ultimately, a healthier world.
November isn’t the only national health observances this month. According to Healthfinder.gov, there are many others. Here are a few that may greatly impact men:
- Lung Cancer Awareness Month
- Pancreatic Cancer Awareness Month
- American Diabetes Month
- Great American Smokeout (American Cancer Society)
- National Child Mental Health Month
Though men may have traditionally been more likely to smoke, drink heavily, or eat convenience foods, that may be changing. With increased awareness, men are starting to be more proactive about taking charge of their own health. By educating men about these issues, whether during Movember or the Great American Smokeout, nurses can help to save 50 Million Men.
To learn more, visit www.movember.com.
As you may know, the American Nurses Association (ANA) designated 2018 as the “Year of Advocacy.” These past 10 months, they’ve encouraged nurses to influence and bring about change at the bedside and beyond by engaging in “moments of everyday advocacy.”
As Election Day approaches, now is the time to end this year of advocacy on a strong note by demonstrating the political leadership skills that are unique to nursing. Make your voice heard! It will go a long way toward benefiting your local community, the nation, and potentially, the entire global community.
Political advocacy and nursing are not mutually exclusive, and every day nurses influence elected officials at the local, state, and federal level. The ANA encourages nurses to stand shoulder to shoulder to defend health care and make a difference on these significant policy issues:
- Set safe staffing levels to save patient lives and reduce nurse attrition at the bedside.
- Support nursing education and specifically, funding for Title V11.
- End the gun violence and restore CDC research on how to stop this epidemic.
- Stop physical and verbal abuse of nurses in all health care settings. Every employee deserves a safe workplace.
Here’s what you, as an individual, can do to make an impact:
Vote! And help get out the vote by encouraging friends, family, and coworkers to do the same. Some clinics have even conducted nonpartisan voter registration drives and reminded patients to cast a ballot. The volunteer providers who run the drives compare helping patients with voter registration to assisting them get insurance coverage.
In addition, write, email, or call national lawmakers and your local representatives to express your views. Or tweet them out. Best of all, show up in person at town halls, congressional meetings, or even on Capitol Hill. Political marches are also effective in persuading lawmakers—elected officials want to keep their constituents happy, and nurses make up a noteworthy voting block.
Sign up for the ANA’s text alerts so that you’re kept in the loop on what’s happening in Washington. You’ll be ready to respond to any pertinent policy developments with this news and information update service.
You might be asking: Can nurses really make a difference in the political process?
This answer is a resounding “Yes!” Governmental representatives and policymakers do value the unique expertise that nurses bring as health care professionals and patient advocates.
In annual opinion polls, nursing almost always rates as the most trusted profession among the general public. That esteem goes a long way toward encouraging decision makers to listen when nurses talk and to take what they say seriously.
Who knows, maybe you’ll decide to run for an elected office yourself or to accept an appointed position. There’s been a groundswell of grassroots political involvement and women and minorities running for office recently, and the field is wide open for new voices.
Regardless of your political party affiliation and where you stand on certain issues, most likely you’re in agreement with other nurses on these challenges to our nation. We all want to protect health care benefits for all (and especially vulnerable populations), cut health care costs and administrative expenses, reduce excessive prescription drug costs, and completely eliminate fraud, waste, and abuse.
Make your voice heard! Get involved at the local, state, or federal level to support or oppose proposed legislation that could affect health care. Advocate for nurses and patients everywhere as a political block through your union, your specialty nursing association, or ANA.
By becoming a nursing champion, you can influence lawmakers to become health care champions that strive to meet the pressing medical needs of our patients and health care staff.
For advocacy tools, visit the ANA website.
Throughout the year, there are days, weeks, and sometimes months that celebrate different facets of the nursing field. September 23-29 is Nursing Professional Development Week. To know why and how nurses celebrate, we interviewed Patsy Maloney, EdD, MSN, RN-BC, NEA-BC, CEN, who works for Nursing and Healthcare Leadership at the University of Washington Tacoma and who also happens to be the President of the Association for Nursing Professional Development (ANPD).
What is Nursing Professional Development Week? Do you know how long it’s been held?
Nursing Professional Development Week has been celebrated for over 20 years. Nursing Professional Development Week celebrates the NPD specialty and the roles that these practitioners assume in improving patient care outcomes through orienting and onboarding, role transition programs, competency management, continuing education, collaborative partnerships, and support of evidence-based practice, quality improvement, and research [Source: Harper, M.G., & Maloney, P. (2016). Nursing professional development: Scope and standards of practice (3rd ed.]. Chicago, IL: Association for Nursing Professional Development].
Why is this celebration important? What do you hope that it brings to different nursing communities?
NPD practitioners are usually the first consulted when there is a practice problem and the first dismissed when there is a budget problem. They are often confused with their academic nurse educator colleagues, but they have different responsibilities. This celebration recognizes NPD practitioners for their critical role in health care.
Why should nurses pay attention to it? What can they learn from it?
A quote attributed to Florence Nightingale: “Let us never consider ourselves finished nurses. We must be learning all of our lives.” This quote reminds all nurses that their education and professional development are not over when they finish their nursing programs. It is a lifelong pursuit. To keep learning, growing, and developing, nurses need the NPD practitioner, who builds on their previous education and works to keep them up to date with the latest evidence for practice in their clinical setting.
What should facilities do as a part of celebrating or highlighting it?
This is the time for NPD practitioners to celebrate their achievements and teach others about their specialty. For managers of NPD practitioners, it is a time to say “thank you” and host celebrations.
The Association for Nursing Professional Development provides NPD departments with a toolkit for activities during NPD week. This toolkit suggests making a video of the NPD department presenting an elevator speech, posting photos of the NPD department celebrating complete with balloons and cake, and most importantly, a template for an article that describes what the NPD department does for the organization
What other information should readers know about NPD Week?
Each September, NPD Week focuses on the NPD specialty and its value to health care organizations and the patients served. But the true challenge is to continue to advocate for the NPD specialty and the nursing profession beyond the days of NPD Week and throughout the year.
Vanderbilt University recently announced the launch of a new interprofessional pilot project involving the School of Nursing, Law School, and Vanderbilt University Medical Center which will help older adults in need of advance care plans and power of attorney documents get them faster and free of charge.
The Medical-Legal Partnership Clinic project uses a team of Vanderbilt nursing and law students to introduce the challenging topic of advance care directives to patients at the Vanderbilt Senior Care Clinic. Student teams meet with seniors at the clinic before or after patients’ medical appointments to provide information and assistance in creating the medical and legal documents needed to assure patients’ wishes are known and carried out in the future.
Carrie Plummer, School of Nursing Assistant Professor and creator of the program, tells News.Vanderbilt.edu, “A 2017 study found that less than a third of adult Tennesseans surveyed reported having an advance directive or power of attorney paperwork completed. At the same time, the majority of health care providers are not comfortable initiating discussions with their patients about end-of-life decisions and/or feel that they don’t have sufficient time to include these discussions in the primary care setting.”
Nursing students are participating in the pilot program as part of their yearlong Enhancing Community and Population Health course. Fourteen students designed and developed the program by reviewing best practices, researching evidence-based literature, conducting site visits, and creating a HIPAA-compliant database for patient data. They also underwent five weeks of training on clinical skills for patients and caregiver discussions on advance directives, power of attorney, health literacy and patient education, end-of-life care and difficult discussions, adult protective services and elder abuse, and Medicare 101.
The School of Nursing feels that this program is an aspect of nursing’s holistic model of care, to recognize and address patient’s other social and environmental needs outside of diagnosing and treating. To learn more about the pilot program between the Vanderbilt School of Nursing and Law School, visit here.
The rate of suicide in the United States has climbed dramatically over the last few decades, including in the healthcare workforce. Suicide accounted for nearly 45,000 deaths in 2016 and the Centers for Disease Control and Prevention (CDC) reports that suicide rates have increased in nearly every state over the past two decades with half of states seeing suicide rates go up more than 30 percent.
According to TheHill.com, an estimated 400 physicians took their lives in 2016. Physicians and nurses commit suicide more often than average Americans, with rates higher for women in both professions. The reasons why healthcare workers are more likely to commit suicide is unknown, but could be related to burnout which has become an epidemic in this population.
The CDC decided to take a comprehensive look at this major public health issue, examining data on suicides from 1999 to 2016. CDC researchers collected data on suicides from every state to better understand the circumstances surrounding suicide and the findings were later published in the CDC’s Morbidity and Mortality Weekly Report.
Principal deputy director of the CDC, Dr. Anne Schuchat, tells NYTimes.com, “Suicide is the tenth leading cause of death in the United States, and one of three that is increasing. The other two are Alzheimer’s disease and drug overdose, in part because of the spike in opioid deaths.”
Dr. Schuchat and Deborah Stone, the lead author of the CDC analysis, have identified effective strategies critical to preventing suicide, which include teaching coping and problem-solving skills to those at risk, establishing more social “connectedness,” and safe storage of pills and guns.
Stone and Schuchat are calling for a comprehensive approach to suicide prevention following the conclusion of their study. The nation currently has no federally funded suicide prevention program for adults even though increasing rates of suicide shows a need for more research and evidence-based prevention protocol.
Schuchat tells NYTimes.com, “Our data show that suicide is more than a mental health issue. We want improved access to care and better diagnostics, but we think that a comprehensive approach to suicide is what is needed.”
More proactive reporting of suicide in the healthcare workforce may help us begin to understand the drivers for suicide among healthcare workers. The healthcare community is in need of access to evidence-based treatment that addresses the warning signs of suicide and how to help prevent it.
To reach the National Suicide Prevention Lifeline, call 1-800-273-TALK (8255).