After studying neuroscience and immunohistochemistry at UCLA, Starks apparently realized that she was a definite Type N and decided to become a nurse. Already bursting at the seams with undergraduate degrees, she flew to the East Coast to pursue her studies in nursing. In New York, she went for an accelerated bachelor’s degree program for non-nurses (APNN) at the University of Rochester School of Nursing. Upon graduation, Strong Memorial Hospital snapped her up before she had a chance to go west again and installed her in the adult operating room, where she now works as a skilled vascular surgery nurse and preceptor.
However, Starks does not spend all of her time lollygagging about the OR or burying her nose in a textbook; she wants to effect change and has already created a place for herself among the new generation of upcoming nurse leaders. She is an active member in her local National Black Nurses Association chapter, the Rochester Black Nurses Association (RBNA), a founding member of the local chapter, and the chapter’s first vice president.
But that isn’t all. Stark is paying it forward as the founder and chair of the RBNA mentoring program in partnership with the URSON’s APNN program, where she and other Black nurses mentor nursing students of color. In true Type N fashion, she also manages to make time to participate as a member of the NPA’s Diversity, Equity and Inclusion committee.
After she earns her degree, Starks plans to work as an FNP in primary care. Her passion is caring for those with chronic diseases, especially African American patients. She plans to continue her advocacy for Black patients and students through her continued work in RBNA and other organizations and mentoring programs.
Unlike many students during the pandemic, Starks has been very fortunate with regard to clinicals, and told a reporter that “Luckily, within my program, they didn’t stop us from doing any type of clinical rotation or any type of classes.” In her acceptance speech, the charismatic FNP-to-be graciously thanked everyone who made the award possible and declared her dedication to helping to further NPs’ scope of practice in New York State.
To see an interview with Starks at a local Rochester station, click here. Her acceptance speech is below.
*There are two NPA winners, actually, and we congratulate the Region 7 winner Margaret O’Donnell, DNP, FNP-BC, ANP-BC, FAANP, who will have a post of her own shortly.
One U.S. child loses a parent or caregiver for every four COVID-19 deaths, a new modeling study published today in Pediatrics reveals. The findings illustrate orphanhood as a hidden and ongoing secondary tragedy caused by the COVID-19 pandemic and emphasizes that identifying and caring for these children throughout their development is a necessary and urgent part of the pandemic response – both for as long as the pandemic continues, as well as in the post-pandemic era.
From April 1, 2020 through June 30, 2021, data suggest that more than 140,000 children under age 18 in the United States lost a parent, custodial grandparent, or grandparent caregiver who provided the child’s home and basic needs, including love, security, and daily care. Overall, the study shows that approximately 1 out of 500 children in the United States has experienced COVID-19-associated orphanhood or death of a grandparent caregiver. There were racial, ethnic, and geographic disparities in COVID-19-associated death of caregivers: children of racial and ethnic minorities accounted for 65% of those who lost a primary caregiver due to the pandemic.
Children’s lives are permanently changed by the loss of a mother, father, or grandparent who provided their homes, basic needs, and care. Loss of a parent is among the adverse childhood experiences (ACEs) linked to mental health problems; shorter schooling; lower self-esteem; sexual risk behaviors; and increased risk of substance abuse, suicide, violence, sexual abuse, and exploitation.
“Children facing orphanhood as a result of COVID is a hidden, global pandemic that has sadly not spared the United States,” said Susan Hillis, CDC researcher and lead author of the study. “All of us – especially our children – will feel the serious immediate and long-term impact of this problem for generations to come. Addressing the loss that these children have experienced – and continue to experience – must be one of our top priorities, and it must be woven into all aspects of our emergency response, both now and in the post-pandemic future.”
The study was a collaboration between the Centers for Disease Control and Prevention (CDC), Imperial College London, Harvard University, Oxford University, and the University of Cape Town, South Africa. Published in the Oct. 7 issue of the journal Pediatrics, it was jointly led by CDC’s COVID Response and Imperial College London, and partly funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), as well as Imperial College London.
“The magnitude of young people affected is a sobering reminder of the devastating impact of the past 18 months,” said Dr Alexandra Blenkinsop, co-lead researcher, Imperial College London. “These findings really highlight those children who have been left most vulnerable by the pandemic, and where additional resources should be directed.”
The analysis used mortality, fertility, and census data to estimate COVID-19-associated orphanhood (death of one or both parents) and deaths of custodial and co-residing grandparents between April 1, 2020, and June 30, 2021, for the U.S. broadly, and for every state. “COVID-19-associated deaths” refers to the combination of deaths caused directly by COVID-19 and those caused indirectly by associated causes, such as lockdowns, restrictions on gatherings and movement, decreased access or quality of health care and of treatment for chronic diseases. The data were also separated and analyzed by race and ethnicity, including White, Black, Asian, and American Indian/Alaska Native populations, and Hispanic and non-Hispanic populations.
The study authors estimate that 120,630 children in the U.S. lost a primary caregiver, (a parent or grandparent responsible for providing housing, basic needs and care) due to COVID-19-associated death. In addition, 22,007 children experienced the death of a secondary caregiver (grandparents providing housing but not most basic needs). Overall, 142,637 children are estimated to have experienced the death of at least one parent, or a custodial or other co-residing grandparent caregiver.
“The death of a parental figure is an enormous loss that can reshape a child’s life. We must work to ensure that all children have access to evidence-based prevention interventions that can help them navigate this trauma, to support their future mental health and wellbeing,” said NIDA Director Nora D. Volkow, MD. “At the same time, we must address the many underlying inequities and health disparities that put people of color at greater risk of getting COVID-19 and dying from COVID-19, which puts children of color at a greater risk of losing a parent or caregiver and related adverse effects on their development.”
Racial and ethnic disparities in COVID-related caregiver loss
There were significant racial and ethnic disparities in caregiver deaths due to COVID-19. White people represent 61% of the total U.S. population and people of racial and ethnic minorities represent 39% of the total population. Yet, study results indicate that non-Hispanic White children account for 35% of those who lost a primary caregiver (51,381 children), while children of racial and ethnic minorities account for 65% of those who lost a primary caregiver (91,256 children).
When looking at both primary and secondary caregivers, the study found that findings varied greatly by race/ethnicity: 1 of every 168 American Indian/Alaska Native children, 1 of every 310 Black children, 1 of every 412 Hispanic children, 1 of every 612 Asian children, and 1 of every 753 White children experienced orphanhood or death of caregivers. Compared to white children, American Indian/Alaska Native children were 4.5 times more likely to lose a parent or grandparent caregiver, Black children were 2.4 times more likely, and Hispanic children were nearly 2 times (1.8) more likely.
Overall, the states with large populations – California, Texas, and New York – had the highest number of children facing COVID-19 associated death of primary caregivers. However, when analyzed by geography and race/ethnicity, the authors were able to map how these deaths and disparities varied at the state level.
In southern states along the U.S.-Mexico border, including New Mexico, Texas, and California, between 49% and 67% of children who lost a primary caregiver were of Hispanic ethnicity. In the southeast, across Alabama, Louisiana, and Mississippi, between 45% to 57% of children who lost a primary caregiver were Black. And American Indian/Alaska Native children who lost a primary caregiver were more frequently represented in South Dakota (55%), New Mexico (39%), Montana (38%), Oklahoma (23%), and Arizona (18%).
The current study follows closely in line with a similar study published in The Lancet in July 2021, which found more than 1.5 million children around the world lost a primary or secondary caregiver during the first 14 months of the COVID-19 pandemic. In both the global and US studies, researchers used the UNICEF definition of orphanhood, as including the death of one or both parents6. The definition includes children losing one parent, because they have increased risks of mental health problems, abuse, unstable housing, and household poverty. For children raised by single parents, the COVID-19-associated death of that parent may represent loss of the person primarily responsible for providing love, security, and daily care.
“We often think of the impact of COVID-19 in terms of the number of lives claimed by the disease, but as this study shows, it is critical to also address the broader impact – both in terms of those who have died, and those who have been left behind,” said study co-author Charles A. Nelson III, PhD. who studies the effects of adversity on brain and behavioral development at Boston Children’s Hospital. “We must ensure children who have lost a parent or caregiver have access to the support services they need, and that this additional impact of the COVID-19 pandemic is comprehensively addressed in both our rapid response and our overall public health response.”
There are evidence-based responses that can improve outcomes for children who experience the COVID-associated death of their caregivers:
Maintaining children in their families is a priority. This means families bereaved by the pandemic must be supported, and those needing kinship or foster care must rapidly receive services.
Child resilience can be bolstered via programs and policies that promote stable, nurturing relationships and address childhood adversity. Key strategies include:
Strengthening economic supports to families.
Quality childcare and educational support.
Evidence-based programs to improve parenting skills and family relationships.
All strategies must be age specific for children and must be sensitive to racial disparities and structural inequalities. They must reach the children who need them most.
In the closing words of the paper, “Effective action to reduce health disparities and protect children from direct and secondary harms from COVID-19 is a public health and moral imperative.”
CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.
About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
COVID-19 vaccines are highly effective in preventing symptomatic illness among health care workers in real-world settings.
The study, published in the New England Journal of Medicine, found that health care personnel who received a two-dose regimen of Pfizer–BioNTech vaccine had an 89% lower risk for symptomatic illness than those who were unvaccinated. For those who received the two-dose regimen of the Moderna vaccine, the risk was reduced by 96%.
The researchers also found that the vaccines appeared to work just as well for people who are over age 50, are in racial or ethnic groups that have been disproportionately affected by COVID-19, have underlying medical conditions and have greater exposure to patients with COVID-19.
The vaccines’ effectiveness was, however, lower in immunocompromised people.
“That this study demonstrated the effectiveness of the Pfizer–BioNTech and Moderna COVID-19 vaccines to protect health care workers — people who worked tirelessly and at great potential risk to care for their friends and neighbors — is a major statement to address any remaining skepticism about the importance of everyone getting vaccinated,” said Dr. David Talan, a professor of emergency medicine and of medicine and infectious diseases at the David Geffen School of Medicine at UCLA, and the study’s co-lead author.
The project, Preventing Emerging Infections through Vaccine Effectiveness Testing, or PREVENT, was conducted with researchers from the University of Iowa’s Carver College of Medicine. The study evaluated nearly 5,000 health care workers — 1,482 who had tested positive for COVID-19 and displayed symptoms of the disease and 3,449 who had COVID-19–like symptoms but had tested negative for the disease. The participants were from 33 U.S. academic medical centers, including Olive View–UCLA Medical Center in Sylmar, California.
All of the participants completed surveys covering their demographic information, job type and risk factors for severe disease from COVID-19, as well as their vaccination status.
Other findings include:
A two-dose regimen of either of the mRNA vaccines reduced the risk of illness by 95% among Black and African American people, 89% among Hispanic people, 89% among Asian or Pacific Islander people, and 94% among American Indians and Alaskan Native people, compared to unvaccinated people.
Of all those who received a single dose of either of the two-dose mRNA vaccines, the risk of illness was reduced by 86% among Black and African American people, 82% among Hispanic people, 80% among Asian or Pacific Islander people, and 76% among American Indians and Alaskan Native people compared to unvaccinated people.
For people who are obese or overweight, a two-dose regimen reduced the risk of illness by 91%; among the same group, partial vaccination reduced the risk by 76% among partially vaccinated compared to unvaccinated.
For people who have hypertension, a two-dose regimen of either mRNA vaccine reduced the risk of illness by 92%, and partial vaccination reduced the risk by 83% among partially vaccinated compared to unvaccinated.
For people who have asthma, a two-dose regimen of either mRNA vaccine reduced the risk of illness by 91%, and partial vaccination reduced the risk by 78% among partially vaccinated compared to unvaccinated.
For immunocompromised people, the risk of illness was reduced by 39% whether they received a single dose or two doses of either mRNA vaccine.
Sixty-two people in the study were pregnant at the time they were surveyed. Vaccination was 77% effective in preventing symptomatic COVID-19 illness among pregnant people who had received at least one dose of one of the mRNA vaccines.
Because of the relatively short time period of the study — from December 2020 to May 2021 — the research does not address how long vaccines continue to provide protection against COVID-19. In addition, data was collected before the emergence of the delta variant, so the vaccines’ effectiveness today may be different than they would be against earlier variants.
PREVENT is a collaboration between EMERGEncy ID NET — a CDC-supported network led by Talan that comprises 12 U.S. emergency departments and focuses on studying emerging infectious diseases — and a previously assembled group of sites that worked under Project COVERED, another CDC-funded effort to assess the risk to emergency department providers of acquiring COVID-19 through direct contact with patients and to determine ways to mitigate that risk.
For many, education is a young adult experience that culminates in a diploma and is usually ignored after one enters the “real world.”
But for a nurse, education is an essential, ongoing professional pursuit. RNs must fulfil obligatory contact hours or CEUs, and career advancement in nursing is fueled by attaining certifications, earning an MSN, a DNP, an Ed.D… The options, the possibilities — and the alphabet following your name – may seem to grow every year.
In the new Minority Nurse/DailyNurse Education issue, we look at the nursing profession as it navigates the often-choppy waters of the digital era of information (and misinformation). These articles explore ways in which nurses are using technology to pursue their commitment to lifelong learning, provide comfort to patients and families, and keep those in their care informed and safe.
In this issue:
Julia Quinn-Szcesuil explores how nurses are changing the way they learn. Lectures and presentations are making way for more interactive, tech-based methods that allow nurses to be more actively engaged and fully absorb the information. Some credentialing centers, such as the Board of Certification for Emergency Nursing and the Competency & Credentialing Institute, are even rethinking the way nurses earn and renew their certifications.
Whether it’s enhancing your professional knowledge through certification to succeed in your career or learning to identify your own unconscious biases to help fight systemic racism, it’s important that we continue on our journey of lifelong learning.
To explore the full Education issue on our Issuu site, click here.
The California Nurses Association (CNA) today welcomed Gov. Gavin Newsom’s signature Friday enacting landmark legislation to require implicit bias education and training for nursing students and new graduates in California, an important step in addressing persistent racial disparities, particularly in health care.
CNA-sponsored AB 1407, by Assemblymember Autumn Burke, will require nursing schools and programs to include implicit bias education as part of their curriculum, and hospitals to implement an evidence-based program on implicit bias as part of new graduate training. Additionally, verification of implicit bias training will become part of the licensure requirement for all new California RNs.
California is now believed to be the first state in the nation to require implicit bias training as a graduation requirement for nursing students. Michigan has similarly mandated implicit bias training for all health care workers seeking licensure effective next June.
“Awareness and then education are critical first steps toward eliminating implicit bias,” said CNA Director of Government Relations Stephanie Roberson. “AB 1407 is a preemptive approach, starting with educating our future nursing workforce prior to entry into practice. There is no better way to start.”
“Long-term racial disparities in health care access and treatment continue to be a deplorable stain on our nation,” said CNA President Cathy Kennedy, RN. “Biases, whether intentional or unconscious, directly contribute to those disparities, especially in a context in which we continue to see corporate health care disparities for which health care services are provided, and what services are prioritized.”
Racial gaps in health care have been increasingly documented from maternal and infant mortality to diagnostic procedures to prescription of medication to interactions with medical professionals and institutions generally. A report from the Urban Institute this July, for example, found that Black patients are significantly more likely to suffer dangerous bleeding, infections, and other surgery-related problems than white patients who received care in the same hospital.
“Health care facilities and educators must demonstrate their commitment to ending racial health disparities and working toward health equity by aggressively pursuing strategies that eliminate implicit bias within the health care system. This bill is a part of the solution,” said Roberson.
Hospitals, health care facilities, and health care educators offer very little, if anything, to bring awareness to or address this phenomenon and problem. Even structural characteristics such as an institution’s physical space project how welcoming an institution might be to patients of color. Too often, facilities fail to look at the communities they serve, those communities’ needs, and the resources facilities need to tap to fill those needs.
“The legacy of structural racism in medical care has been deadly, and has contributed to distrust of medical services among medically underserved communities and patients. It is essential that we guarantee that our future health care workforce is fully aware of the debilitating consequences of implicit bias to bring this scourge to an end and ensure equal, high quality medical care for everyone,” Kennedy added.
Some nurses could easily be Nurse of the Week 52 weeks a year, and Lauren Underwood is one of them.
In 2018, Lauren Underwood, BSN, MSN, MPH inspired nurses and women of color everywhere when she became the youngest Black woman to be elected to Congress. Illinois’ 14th District Congressperson had accomplished a great deal prior to her election and has been busy blazing new trails since her swearing-in. Underwood is still a nurse as well, so it was clear from the start that she was not going to be the kind of representative who spends their time vying for social media “Likes.”
Underwood first was drawn to public policy as a teen, and in 2009 earned both her MPH and MSN at Johns Hopkins. Already a vocal advocate of the ACA, in 2014 the Obama administration tapped her to join their team as a policy advisor, and she quickly became an MVP in the push to obtain passage of the ACA. After Obama left office, she found a position as Senior Director of Strategy and Regulatory Affairs at Next Level Health and served as an adjunct instructor at the Georgetown University School of Nursing & Health Studies.
But what prompted her to take on the enormous challenge of running for office? As a promising candidate back in 2018, she told Janice Phillips at Minority Nurse that she had been bitterly disappointed by her predecessor during the ACA repeal frenzy after the end of Obama’s term. At a local League of Women Voters meeting, her own representative “said that he was only going to support a version of Obamacare repeal that allowed people with preexisting conditions to keep their coverage.” As Underwood herself has a heart condition – AND had worked hard to get the ACA passed – she felt invested both professionally and personally in the rep’s promise.
“When I walked into a room, even with people who didn’t share my political point of view, they knew that I was very clear on what was going on in our health care system.”
However, “A week to ten days later he went and voted for the American Health Care Act, which is a version of repeal that did the opposite. It made it cost-prohibitive for people like me to get coverage. But, she stressed, “I was upset not at the vote itself, but because he did not have the integrity to be honest the one time he stood before our community…. A representative is supposed to be transparent, accessible, and honest. And we deserve better. I said, ‘you know what, it’s on! I’m running.’”
Early this summer, Sullivan-Marx asked Underwood, “What was one of the drivers as to why you kept leaping forward beyond the usual kind of candidate?”
“Two things,” Underwood responded: “The number one issue in the election was health care and I brought expertise as a nurse. Someone who worked on the ACA. I was working for a provider—a private company. I’ve been a patient and I understood the law as it was, and I had a greater understanding of the ACA than my opponent, the Congressman, and then all my primary opponents— these six guys –they’re great guys—they just did not have the expertise.
When I walked into a room, even with people who didn’t share my political point of view, they knew that I was very clear on what was going on in our health care system. I had many solutions. They knew that I understood the problem and I understood what was going on with their families and that I had been fighting for years to try to solve it… That enabled us to walk into every room and be taken seriously, even if we didn’t agree on anything. People knew that on this issue, which was important to them, that I had credibility. The second thing is that we were willing to show up everywhere in person to engage people and build connections.
The Most Trusted Profession Meets the Most Mistrusted Profession
Sullivan-Marx also asked Underwood to describe her typical day on Capitol Hill:
Underwood: “In this Congress, I am assigned to two committees—the House Committee on Veterans’ Affairs (VA). I’m on the Health Subcommittee. The VA is an incredible health care system that has its challenges. I focus pretty exclusively on suicide prevention, mental health, and women’s health care. The VA has this unbelievable responsibility for caring for women veterans across the lifespan. I think folks forget that there are still cadet nurse corps members from World War II that are alive and they’re active and they’re getting care in the VA that has been inconsistent at best.
“I think that nurses take for granted that every elected official knows a nurse or has interacted with nurses. We assume that they know about the work that we do.
In my experience that is completely false. They have no clue what happens at schools of nursing. They have no idea the level of expertise that a BSN graduate brings.”
I also serve on a House Committee on Appropriations. The Congress has three core functions: we create programs and we call that authorizing to solve problems. We fund the federal government appropriations, including funding those programs, and then we do Congressional oversight over the executive branch. Within the appropriations committee, I am assigned to the Agriculture Subcommittee, which also has jurisdiction over the Food and Drug Administration. That’s how we fund COVID and tobacco. Trying to make sure that we are curbing the tobacco usage epidemic. And then I serve on the Homeland Security Subcommittee. There we have ICE [U.S. Custom and Immigration Enforcement], immigration, Federal Emergency Management Agency (FEMA), cyber security, and the US–Mexico border and the Canadian border. It’s fascinating and then obviously I still do health care work, too.”
Calling all Nurses…
Toward the end of the interview, Sullivan-Marx asked, “What kind of assistance would be great for nursing to give you? How can we be helpful to you?”
The Congresswoman said, “Nurses have been so helpful for us in terms of gathering and presenting evidence. Many of these problems have a local focus and for us in Congress it is very difficult to get that kind of local data. Evaluation type data demonstrating that an intervention is effective. We can build relationships with nurses, either in our communities or folks who’ve been impacted by these problems. Site visits and testimonial stories are very powerful.
“We [nurses] have got to do better about inviting them [members of Congress] in.”
I think that nurses take for granted that every elected official knows a nurse or has interacted with nurses. We assume that they know about the work that we do. In my experience that is completely false. They have no clue what happens at schools of nursing. They have no idea the level of expertise that a BSN graduate brings. They have no idea what APRNs do. They have no idea what practicing to the full extent of our education and training means. We [nurses] have got to do better about inviting them [members of Congress] in. My colleagues are very familiar with physician education. Their whole advocacy strategy is completely different than how nursing engages members of Congress and we’ve got to step it up.”
Yes, let’s step it up! The full interview with Underwood is a great read. If you have an opportunity, check out Policy, Politics, and Nursing Practice, “Eileen Sullivan-Marx Interview of Representative Lauren Underwood (Democrat-Illinois 14th District)” here.
Thanks to Eileen Sullivan-Marx for graciously sharing her interview with DailyNurse.