It is not unusual for nursing and other healthcare professions to run in the family, but sometimes the connections that lead a new generation into nursing can be almost eerie.
Tara Wood, DNP, CRNP, NNP-BC was a NICU nurse when she gave birth to twins Jade and Taylor England. Her newborns weighed less than two pounds and spent their first 87 days in a NICU. At some point, it seems to have been written that at least one daughter was destined to return one day.
“We had central lines,” says Jade England, who is completing her BSN degree at the University of Alabama Birmingham School of Nursing. Both sisters have a permanent souvenir of the constant care they needed from birth: “We still have that scar from where they were placed. It’s just crazy to see that we have actual proof of what we’ve been through.”
That scar is the only physical reminder of their journey. England knows how lucky they are to not have any complications from being born prematurely. Growing up, she saw the pictures of their tiny bodies covered in sensors and tubes. When she decided to become a nurse, she knew she had to return to where her story started—the NICU.
“You have to have compassion for those babies. You just have to be called to do that,” England said. “I want to be able to be that nurse to let the parents know that I was in their child’s place. I just want to provide the best care possible and hopefully sharing my story will make a difference in their stay in the NICU. I don’t want to give them false hope, but I also want them to know that miracles happen.”
“She literally walked me around the entire unit and was telling everybody, ‘this is my baby, I took care of her and her sister.’”
Jade England graduated in April and now works at UAB Hospital in the Regional Neonatal Intensive Care Unit. Her mother, Tara Wood – who is a member of the faculty at UABSON hopes her daughter will be able to give families the comfort she remembered needing.
“They’re going to be told all the bad, but when you can see a living example of success, I think it’s going to be amazing. I can’t wait to see what she does,” Wood said.
England will be working with one of the nurse practitioners who cared for her at the hospital where she was born. During her clinical at UAB, they made the connection.
“She literally walked me around the entire unit and was telling everybody, ‘this is my baby, I took care of her and her sister,’” England said.
“I think I found healing by helping others.”
Wood remembers not being able to hold her children for months. During that time, her lifeline to her girls was the nurses and nurse practitioners.
“My world was rocked,” Wood said. “My babies were really sick. Both of the girls were on the ventilator for weeks. Their organs were premature, and you’re faced with all the things that can go wrong. Just knowing that every minute mattered, it really put you in a constant state of terror and panic, of not really knowing how your babies are going to survive, much less thrive.”
She had planned on becoming a teacher, but the twins’ experience in the hospital changed her life. She realized she wanted to be a nurse so she could care for other families.
After working as a NICU nurse, Wood earned her Master of Science (MSN) in Nursing and Doctor of Nursing Practice (DNP) from the UAB School of Nursing. The journey came full circle for her as well. She’s now an Assistant Professor at the School and the Coordinator for the Neonatal Nurse Practitioner Specialty Track, teaching and preparing nurses to care for infants and families.
“Being a NICU mom 22 years ago we didn’t really talk about post-traumatic stress disorder and things like that that really lingered. I think I found healing by helping others,” Wood said.
Taylor England, Jade’s twin sister, also graduated from UAB this spring with a major in psychology with a minor in legal affairs and a certificate in mental health.
Jade wants to follow in her mother’s footsteps and plans to return to school next year to start the Post-BSN to DNP Nurse Practitioner Pathway to earn her Doctor of Nursing Practice degree. One day, she hopes to teach alongside her mom.
“I’m a proud mom and I want to share them with the world because I think that they were born to do great things,” their mother says. “They have servants’ hearts, and they want to help and do good.”
During the 13-month fellowship, students work to improve the health and well-being of under-resourced populations throughout the state of Alabama.
“As vulnerable populations in our communities face significant obstacles to health and improved quality of life, it is encouraging to see more students rise to the challenge of tackling these issues head-on,” said Executive Director of ASF of Alabama Kristin Boggs. “We are excited to come alongside these students, along with our academic and community site partners, to channel their ideals and grow their commitment to using their knowledge to affect change for under-resourced communities.”
Dorner was inspired to apply for this fellowship following clinical experience at The Foundry’s Changed Lives Mobile Clinic, which serves men at the Changed Lives Christian Center in North Birmingham, a faith-based organization that offers transitional housing in order to break the cycle of homelessness. Through this clinic, CLCC residents can access primary care and resources that aid in overcoming substance misuse.
During his clinical experience, Dorner worked closely with UAB School of Nursing instructors Deborah Bowers, DNP, DMin, MDiv, CRNP, FNP-C and Emily Patton, MSN, CRNP, FNP-C. Bowers will serve as a mentor during this fellowship, and Patton will play an important role through her work at the clinic, Dorner said.
“My decision to apply for this fellowship ties into the passion that Dr. Bowers had in my undergrad classes and community classes,” Dorner said. “I think a lot of students can focus on critical care experience, which is incredible, but it can be easy to overlook community. Those classes spoke to me, however, and provided an opportunity to do a lot of simulations with low-resourced clinics. That really spurred my interest in working with under-resourced populations.”
During the fellowship, Dorner is collaborating with UAB Heersink School of Medicine student Eric Mussell to encourage medication adherence. They will work with residents at CLCC, developing a system to track medication adherence and providing resources between primary care visits. They also will identify barriers and develop interventions that encourage patients to remain diligent while taking medication.
“We want to focus on medications that treat hypertension in order to help improve the health of this patient population,” Dorner said. “Sometimes at the clinic we see patients who have not kept up with their medications and have very high blood pressure. Our goal is to provide an intermittent meeting between primary care appointments in order to encourage medication adherence and hopefully avoid the need for an urgent care visit.”
Dorner and Mussell hope to set up this project so that it will continue with one nursing student and one medical student each year to facilitate that connection. Patients also benefit from this interdisciplinary partnership, Dorner said, as he and Mussell are able to learn from each other and offer a balance of perspectives.
“Eric and I are both volunteers at the clinic, and we chose to enter our project as a team in order to bridge the gap between professions and provide the benefit of interdisciplinary care,” Dorner said. “Due to the COVID pandemic, we did not get as much physician/nurse interaction as students, and I think facilitating a project that can continue a bond between our two schools and benefit the community is so important.”
The project is still in its early stages, Dorner said, and they are compiling resources needed to best support patients.
Alabama patients now have increased access to safe, affordable care with the signing today of HB 268 by Governor Kay Ivey. The law provides that, in addition to physicians and dentists, Certified Registered Nurse Anesthetists (CRNAs) may provide anesthesia care under the direction of or in coordination with a physician, podiatrist, or dentist.
The law further clarifies that the CRNA scope of practice includes ordering of medications and tests before, during, and after analgesia or anesthesia in accordance with the anesthesia plan.
“Removing barriers to CRNA practice will allow Alabama healthcare facilities to maximize their workforce and increase access to safe, affordable care for our patients,” said Wesley Canerday, CRNA, president of Alabama Association of Nurse Anesthetists (ALANA). “By signing this important legislation, Alabama recognizes that CRNAs are qualified to make decisions regarding all aspects of anesthesia care based on their education, licensure, and certification.”
Anesthesia services are provided solely by CRNAs in many of Alabama’s critical access hospitals offering surgical services, and in a majority of its rural hospitals.
The law also specifies that anesthesia care, when an anesthesiologist is not present, is provided by CRNAs “in coordination with” a physician, podiatrist, or dentist, defined as a working relationship in which “each contributes his or her respective expertise in the provision of patient care, which includes the discussion of patient treatment, diagnosis, and consultation.”
“The American Association of Nurse Anesthesiology (AANA) applauds Gov. Ivey for recognizing the important role CRNAs have in delivery of safe anesthesia care to the residents of Alabama,” said AANA President Dina Velocci, DNP, CRNA, APRN. “Increased demand, limited resources, and the rural nature of the state dictate that a system capable of meeting the needs of all Alabama residents be maintained and this law provides that.”
As advanced practice nurses, CRNAs are members of one of the most trusted professions according to Gallup. CRNAs provide anesthesia care across all settings and in all patient populations and are the primary anesthesia providers in rural and underserved areas and on the battlefield in forward surgical teams. Because of their expertise in anesthesia delivery and management of critically ill patients, CRNAs have been a highly sought-after healthcare provider during the COVID-19 pandemic.
One week after Julia York’s 12th birthday, doctors told her parents she had less than a year to live.
“My parents knew it was bad news, but I didn’t know at the time. That’s not something you tell a 12-year-old,” York said.
York had always struggled with migraines, but the symptoms seemed to get worse. A relentless headache sent York to an urgent care clinic, then to a neurologist who ordered an MRI. That’s when her family found out she had a brain tumor.
“I shouldn’t have lived.”
“My tumor is in my brain stem. It’s smack dab in the middle, so I didn’t even have a biopsy done of my tumor because they thought even that would be too dangerous,” York said.
She began radiation therapy—33 rounds of it. Her parents enrolled her in a clinical trial, and she started taking chemotherapy pills.
“I had a really bad reaction to it. I lost all my hair, and I got an infection that put me in the hospital for a couple days, so they had to remove me from the trial,” York said. “My parents were left looking for other options for treatment just because there are so few options for treatment of pediatric brain tumors.”
After months of MRI scans every two weeks, doctors noticed something different. The contrast dye was no longer showing up in the tumor, meaning the blood flow had been cut off.
“I technically still have a brain tumor, it’s just dead,” York said.
Slowly, doctors started backing off the MRI schedule—from once a month to every three months and now once a year. York never showed any more side effects. The tumor didn’t grow.
“My doctors are fascinated with my case because I shouldn’t have lived,” York said. “I hate saying it just because it sounds a little crazy, but it’s truly like a miracle case.”
Because of the chemotherapy, York is immunocompromised. When she was hospitalized in high school for a suspected meningitis infection, York went in for treatment and came out with a newfound passion.
“I was talking with my nurse and decided that nursing was the right path for me. I just kind of had an epiphany that that’s what I’m meant to do with my life and my experience.”
“I got cancer for a reason, and I lived for a reason.”
She realized her journey gave her one of the greatest skills a nurse can have—empathy.
“I just love kids and I want to use my story to help kids who are going through the same thing,” York said. “I have literally been in their shoes, so it’s easier for me to understand what they’re going through and it’s just another way that I can care for patients.”
“Everything just really lined up for me to come to UAB. The School provided me with the support and knowledge I needed to accomplish my goals and pursue my dreams.”
York graduates this spring. On the 10th anniversary of her cancer diagnosis, York interviewed for a nursing position at Children’s of Alabama. She will start in their Hematology-Oncology/Bone Marrow Transplant unit in July.
“I always have had the mindset that everything happens for a reason,” York said. “I got cancer for a reason, and I lived for a reason, and I think it was for me to come to UAB and become a nurse and specifically become an oncology nurse and use all of those experiences for something bigger.”
To support nursing workforce development during the critical nursing shortage and ensure prelicensure students have the resources they need to stay on the path to graduation, the University of Alabama at Birmingham School of Nursing undergraduate program has developed an innovative academic support solution that aids students on the front-end of academic challenges before they become barriers to successfully completing the nursing program.
The new Student Success Champions initiative connects traditional Bachelor of Science in Nursing students and Accelerated Masters in Nursing Pathway students—those from another career path coming into nursing school—who may be facing academic challenges to resources within the School and across campus to provide the support they need to be successful. They also are connected with a Student Success Champion, a faculty member who can develop a personalized plan that not only identifies students’ challenges but also helps develop a pathway to success.
“The nursing shortage certainly is not new, but the COVID-19 pandemic has led to a wider conversation,” said Instructor and AMNP Student Success Champion April Love, MSN, RN, RNC-OB, CNE (BSN 2010, MSN 2013). “COVID gave us a need that was more defined. We heard students emphasize that they are more than just a GPA and want success inside and outside of the classroom. It also encouraged us to create a new approach that is sustainable for our students and our program. These students have made a lot of sacrifices to get where they are, so getting to the end of their program in a timely fashion is important.”
“As a leadership team, we looked at how we could best support and help our students. We know they need, primarily, academic support, but we also recognize that multiple factors affect academic success. This program allows for the early identification of all student needs; implementing a collaborative action plan that can assist with the transition to the student nurse, reducing stress and potential burnout,” said Instructor and BSN Student Success Champion Jennie Alspach, DNP, MSN, RN, FNP-BC (BSN 1996, MSN 1999, DNP 2020).
Steps to foster student success have been in place throughout the School’s history, but the COVID-19 pandemic illuminated the importance of strengthening those resources and intervening early on.
“We thought about what we could do to ensure students are successful in their first and second semester, when they are most vulnerable to academic and other challenges,” said Associate Professor and Associate Dean for Undergraduate and Prelicensure Education Gwendolyn Childs, PhD, RN, FAAN. “Student Success Champions provide us an opportunity to identify early barriers to academic success—is it the transition to nursing school, time management, test-taking skills or working in addition to school? Once we identify those students who are facing challenges, then we can either offer School support or connect them to campus resources.”
This support ranges from reaching out to students after early signs of academic challenges, such as a test grade that puts them at academic risk, to identifying ways to help students be even more successful. A new online course offered by the School free to all students provides access to resources such as scholarship opportunities, counseling, resiliency training and more.
“This goes beyond just pulling resources together. It also involves considering the specific needs of our student population as well as talking with faculty about courses and tools they have in place to help students succeed,” Childs said. “Our Student Success Champions are able to consider how students perform across courses and create a holistic approach to identify challenges.”
It also enables the School to keep students on track in their nursing coursework, helping them enter the field and meet workforce needs in a critical nursing shortage.
“In nursing, that knowledge base is the skeleton of the rest of your career,” Alspach said. “It is important that students master fundamental skills and concepts—critical thinking, pathophysiology and pharmacology—and build on them to connect the dots and apply knowledge to practice at the bedside. By providing this additional support, we not only continue to put nurses into the workforce, we continue to produce nurses who are safe, knowledgeable and can provide the best patient outcomes for our communities.”
The program has already seen encouraging results. Since it launched with Bachelor of Science in Nursing students in the fall 2021 semester, the number of students who had to repeat a course in their first or second semester was cut in half. These numbers are encouraging, Childs said, and show how the foundations of nursing skills and education are supported by this program.
The Student Success Champions program expanded to include the Accelerated Masters in Nursing Pathway during the spring 2022 semester.
“Academic success, especially in nursing, is rarely defined as a GPA-based thing. To go on to be a great nurse, it’s about a compassion for others and your ability to understand people at a different level,” Love said. “From a personal perspective, one of the things that drew me to the hospital and to UAB as a school is the diversity in our student population—and not just in any one aspect, but in lives and life conditions. Our students bring their world view and perspective and experience into the role, which makes it so exciting to help them transition to nursing.”
AMNP students, as well as some students in the BSN program, already have a bachelor’s degree or higher in a non-nursing field, and for most, nursing is a second career. Their life and career experiences are a benefit to the nursing field, Love said, as they approach nursing from a new perspective. But it also means facing potential challenges.
“The Student Success Champions program is very much about sitting down and meeting people where they are, looking at what amazing things they offer to the field, but also looking at the barriers. We help them find resources and a sense of community as they consider, ‘How do I turn this potential challenge into something that helps me be successful in the profession as a whole?’” Love said. “Resources have been set up for a long time, but too often they come in to ‘get you back on track.’ This is an opportunity to be more proactive, to learn skills super early on, so that as you’re moving through the program and they’re no longer an issue.”
The strength of the Student Success Champions comes from the understanding that all students face unique challenges and have different needs, Childs said. And ultimately, this program is one step in a continual conversation.
“This program is one way we can address the magnitude of what is needed, not just from an academic but also from a psychosocial perspective. It allows us to take a step back and look at how we engage with students and how we focus on the tools they need,” Childs said. “From here, we can address ways to further incorporate the new American Association of Colleges of Nursing Essentials, continuing to help our students become more resilient and more strategic as they navigate this education system and their careers.”
In a diverse area in Alabama where 40% of the population is below the poverty line, nursing is a life-changing career path that provides financial stability and promising opportunities. However, in 2018, the University of West Alabama’s Division of Nursing had a 77% NCLEX pass rate, which is below the national average and the minimum for continued program accreditation.
With the students’ nursing careers and the program’s accreditation on the line, the department leaders created a plan to increase UWA’s NCLEX pass rate to continue to provide nursing education and opportunities for their students. In 2021, the UWA Division of Nursing’s first-time NCLEX pass rate rose to 100%.
Incorporating Online Test Prep Played Major Role
To increase UWA’s NCLEX pass rate, department leaders provided students with additional support in the form of mentorship, grants, and adopted online NCLEX online test prep tools from UWorld. A year later, the UWA nursing program’s pass rate rose to 84%, which was a promising start.
Following the initial improvement, the UWA faculty decided to make test prep a program policy rather than just a recommendation. By making the practice questions required, we could help students build essential test-taking habits throughout the semester, while also seeing what the NCLEX questions are like and learning the material. Online test prep became 5% of a student’s overall grade in Advanced Adult Health and Critical Care, a course students take in the final semester of the nursing program. To meet assignment requirements, students had to complete a minimum of 2,000 questions and achieve an overall score of 65% correct. Most students had to take between 3000 and 6000 test items to achieve the benchmark for the percentage of correctly answered questions. Students had five to six weeks to complete this assignment.
Ultimately, every student in the spring 2021 semester passed their NCLEX on the first attempt, making UWA the only program in the state of Alabama to achieve a 100% pass rate.
When students are given the right tools and are incentivized to use them, success stories like this can happen.
Also Essential: Providing Support for Minority and Disadvantaged Students
Universities can take other helpful measures to provide their students with enough support, resources, and opportunities to experience success. At UWA, many steps are taken to give the diverse student body equal and exciting opportunities including scholarships and mentorships to empower students of color.
In summer 2020, the UWA Division of Nursing was awarded a $2.4 million grant from Health Resources and Services Administration (HRSA) for nursing scholarships over five years. With this grant, UWA created Project EARN (Educating Alabama Rural Nurses), which provides invaluable financial aid scholarships for students from disadvantaged backgrounds.
When students have financial support through aid and scholarships, they can spend more time focusing on their education and getting ready to take the licensing exam and less time worried about working to pay bills and support themselves or their families
New Programs
Dr. Mary Hanks, RN, MSN, EdD, the Division of Nursing Chair; and Dr. Chineda Hill, EdD, MSN, CNL, an Associate Professor of nursing at UWA, have also recently developed a new program, Sustah2Sister, that focuses on empowering women of color to build professional relationships and nurture seeds for life-long success. This program is a series of seminars that includes guest speakers to inspire and support women of color at UWA, including nursing students.
The Widespread Impact of Students Passing Their NCLEX
One of UWA’s university-wide missions is to serve the surrounding community. This region in Alabama has a diverse population, with over 40% living in poverty. Just like many places all over the country, surrounding rural hospitals are also in desperate need of more nurses.
When a nursing student passes their NCLEX exam, many opportunities open up for them. The field of nursing is a life-changing career path that brings financial stability to many disadvantaged and minority students.
For UWA nursing students, passing the NCLEX opens up the opportunity for immediate job placement in an industry that has a constant need for more qualified workers. After passing their NCLEX, many UWA graduates decide to stay and work in Alabama, with some going to work in the rural areas that are experiencing a nursing shortage crisis. Since studies show that patients respond better to those that look like them, it’s valuable to the community as a whole that UWA’s diverse nursing students are now entering the workforce.
Increasing the NCLEX pass rate to 100% was an impressive feat, but it also has real-life outcomes that are widespread and optimistic. Ultimately, the UWA Division of Nursing’s success story can be attributed to many factors. With supportive department leaders, hardworking students, university-wide efforts, and the right test prep tools, nursing programs across the country can thrive.
To increase UWA’s NCLEX pass rate, department leaders provided students with additional support in the form of mentorship, grants, and adopted online NCLEX online test prep tools from