OCU Kramer School of Nursing education resources

Pamela Stokes:
Hi! I'm! So excited to come to talk to you today, and we're going to talk about nursing rounds. Advancing your career in 2023.

My name is Pamela Stokes, and I'm going to be your host today, and I am just thrilled to talk to you about the nursing profession, and how it's evolving this year, as health care continues to evolve around us as well. I have 2 panelists here, and i'm so excited to talk to them because they bring a wealth of information and experience, and they're going to talk to you a little bit about their careers, but also about where they see nursing headed this year, and I just couldn't be happier to talk to them today. I'm gonna give you a few fun. Facts of why I love these ladies, but then i'm gonna let them speak on their career as well, so they can get to know you just a little bit better.

So our first panelist is Dr. Senay Livingston. She is a doctorally prepared nurse who prides herself on being a lifelong learner. She began as a CNA 10 years prior to college, and worked her way through school while she was raising her 3 daughters. Quite a feat. She's always wanted to teach nursing, and the profession of nursing was a game changer for her. And she believes in education. So that's her way of giving back to our profession. She has experienced herself with asynchronous online learning, and she's passionate about graduate education. So first of all, Dr. Lincoln, Thank you so much for being here today, and before I continue blabbing on myself. I would love for our viewers to get to know you a little bit better. So if you could tell us a little bit about your career and where you are now.

Cene Livingston:
Okay. You gave a bit of a synopsis. I'm a latter student, Obviously, I've been up every run. Had I known that there were ways to skip. Some runs along the way that would have been helpful. but everybody's path is different, which is something that I repeat over and over, because students may have difficulty with one subject or another, and understanding how you can bypass issues going forward is really helpful and more about me.

I've been at Ocu for almost 11 years. I am really excited about the changes that are happening in our graduate programs, and we can't miss out on the undergraduates, because that's where we get our students. So undergraduate nursing is very important. That experience feeds into all of that.

I'm a dog mom. Now my children are grown. So I'm a grandma, a dog mom, which is almost as busy. All right. Yeah. that's fun. That's about it working and and being a dog mom.

Pamela Stokes:
Well, I love that. Thank you first what you've done for our profession, but it's so very important that we have self care right? So Mom is very important. Well, thank you so much for being here. I'm really excited to talk to you. I also want our second panelists to introduce herself. She is Dr. Diane Cannon. Thank you so much for being here. She is a nurse, leader, entrepreneur, educator, consultant, subject matter, expert and content creator. She is the CEO of canon consulting, working within health education technology sector. Dr. Cannon serves as the director of Clinical Education and innovation at Zappy met a global competency management. Software company.

Dr. Cannon, I am just so interested in what you do. Can you tell us a little bit about how consulting has led you to where you are in your career today.

Diane Cannon:
Absolutely so. I've been a nurse since 1997, and took a long and winding path to get here. My first degree is in sociology. And then I got my BS in, and then I decided I needed to learn more about the business side of health care, and got my masters in healthcare administration, and that led me into the education world. I moved around a little bit. I taught for 4 years in Ohio state the Ohio State, the other OU or the other OSU.

So I was there For 4 years. I've taught nursing at Northern Oklahoma College on the campus of the best, in my opinion, Oklahoma State University, the other OSU. And then also have done some teaching for the University of Oklahoma. And through all of that decided it need to be doctorally prepared. I found the DNP program at Oklahoma City University, and just absolutely fell in love with the program and the people. The support online as well as the face to face. So it just fit me very, very well, and I've always been that kind of rebel, outside-of-the-box, not-normal nurse.

I did my doctoral project over medical cannabis, because when I started my my doctor or a doctoral education it had just become legal in Oklahoma, and I was a little hesitant to broach that subject. And the great people at OCU, you know, championed that and really helped me along, and didn't hesitate and shy away from it. So you know, I really, really appreciated that, along that path of being kind of thinking outside the box. When Covid hit we all had to pivot to more online. And so I was one of the ones who created some online learning skills and simulations using virtual reality, started working with some tech companies, and that just really spurred me on to think, Wow! What else can I do. How can I use, you know, Zoom and Teams and technology as someone who lives in rural Oklahoma to really look at all of the options out there, and so that took me down the path of becoming an entrepreneur. Opened my own consulting company, have not looked back, and it's just been really really fabulous, and have found a home in Zappy Man.

And you know, and you and I, we've done some webinars together and things. And so it's just been really really fabulous from a nursing career standpoint.

Pamela Stokes:
Thank you so much for that. I love that so much, Diane, because not only do you speak to like a role that is outside the traditional nursing role that a lot of people wouldn't think of. But your path and kind of evolution through getting your doctorate degree, and working through COVID-19, and looking alternative ways of helping the nursing profession. It's kind of what we're going to speak about today, right? Because, as health care has involved nursing has changed leaps and bounds and let's face it. Ladies nursing is the backbone of health care. We we just really are.

We are the largest group in health care. So i'm going to use that to pivot a little bit, and COVID-19 is the elephant in the room. It's what we're always talking about. It's kind of what changed, how we interact with others and how we use technology and in the face of health care. So i'm gonna head back to you. Dr. Livingston and I'm going to kind of ask about academia, but also nursing since COVID-19. I know that's a huge, broad question, but kind of to just get us started.

Post COVID-19 is where we're at, and so now we have to think about the future, and how that will shape that. So how has your role changed, or what are some thoughts you have since COVID-19, about Academia and nursing?

Cene Livingston:
It's really opened up so many doors to thinking differently as Dr. Cannon alluded to. How can we deliver content in a more dynamic way versus lecture straight, lecture straight>
What the expectation is from someone my age. let's say. And what we're used to. How can we make it more interactive? How can we make what we do more helpful to long-term learning versus memorization and regurgitating information, so we can actually apply it. It has been very challenging on a lot of levels for both student and faculty? Not only are a lot of faculty not prepared technologically, but students.

It's a mix. It's. A mixed bag may not be prepared to use that technology. There are barriers mentally, I think. to wanting to jump in there when the functionality of technology today is so much easier than it has been in the past. and being able to provide care in that manner from my that education is so much better.

You can reach people in rural areas that are not likely to even seek care, because they know that it's not available, or they don't have the means to travel from a nursing perspective from advanced practice perspective. It's very, very helpful. Mental health needs are being addressed more so these days with technology. There's a different skill set to providing care.

Virtually so. Training is necessary, and that is probably the biggest shift, is teaching students how to provide that care virtually versus face to face, I would say.

Pamela Stokes:
That is a great point, because not only have we had to shift a little bit, and how we care for people, but we've also had to learn how to be good educators and how to be good students online as well. So it's kind of just forced us to quickly move through how to provide good online education, but also how to provide tele health and and platforms like that. I love that you mentioned utilizing advanced practice nurses. Don't you feel like.

And and specifically, i'm going to talk about this, because in Oklahoma we've had some legislation lately talking about the independence of advanced practice nurses. Don't you feel like it's just highlighted. The need for graduate education in nursing.

Cene Livingston:
I believe so. Yes, the Independence piece. It's really kind of a misnomer, because medicine is not in care is not delivered ever in isolation. It is always a team effort. We have a piece of paper we have a to have signed by a physician that allows us to have prescriptive authority other than that we can do everything into independently, but it's we. We know that it never is. There's always a question that needs to be asked of someone who knows more, and understanding that, regardless of the level of care that you're providing is incredibly important.

If we hit back with technology, it makes it easier for us to connect with others that are experts in the in the field. Dr. Cannon and I have had conversations about medical cannabis, and we may not have been able to have those conversations had it not been for technology. So yeah, absolutely.

Pamela Stokes:
Absolutely. And Dr. Kan, and I know you for those watching. I want to let the viewers know that you have been nursing faculty as well. You have been an educator yourself prior to partnering with Zappy men and and consulting. So I want to kind of get your take also on technology and what that has meant for you because we're doing tele help, and we're doing online education. But sometimes I don't think people realize what all is involved in what all you can do so, can you highlight a little bit your background with the technology platform and what you do?

Diane Cannon:
Sure. Yeah, I mean to me, technology has just really opened up the realm of possibilities. You know, when I, when I went to nursing school those years ago, I was actually one of the first cohorts that was able to do any online training. And and it was like, you know, how many years ago, 25 years ago. and we've evolved so much in certain ways. But then again, there are all also. You know, some people that don't see the value in it, and that's fine, because you really still have to have both right. You need face to face contact, same thing in health care.

There are certain things you can do with telehealth, and then sometimes you need to lay hands on someone. You need them in the office in in front of you, or you need to watch them walk in in in a different way. So it's. It's just kind of understanding, and that's what we do. So well as nurses. Right, we assess. And we use the whole nursing process to come up with the best solutions. And and that's kind of what I've done with technology. You know it. It makes me think I had a conversation this morning. So the the CEO of Zappy that he's from Australia, I mean I'm working with an Australian company, but he also has a home here in the U.S. So he's here in the U.S.

But we needed to speak with some folks in Israel, right? So there's this great movement of nursing innovation centers, not only in the U.S. But also across the world. And being global and not being afraid of that. There's no difference in me talking to you guys here in Oklahoma via this technology, and me talking to the folks in Tel Aviv. And we were talking the same thing. It was about nursing the nursing shortage. How do we get nurses? What they need to do their job? How do we make sure that technology is meaningful? All of those things are universal.

And if we can understand, and not be afraid of I mean, it's computer. Come on. What are you gonna do You're gonna break it? You can go buy a new one or have your you know your IT guys help you fix it. It's in the hospital. We use technology all the time. Iv. Pumps have evolved. We get training on that, and you know you. You look back, and and you remember oh, I was so scared to use that before. And now you can use it in your sleep since the same thing.

Pamela Stokes:
Yeah. I remember when simulation first started I was in academia as faculty, and we have come a long way, right? So simulation was a very plastic, you know. Non human feeling dummy, that was very hard to interact with, and and we didn't really know how to use it. And to now we have online simulation where you can interact with people all over the world and stop and pause and critically think

Diane Cannon:
and talk through whatever path of this is going on, you know, and really have a moment to connect with other people. It's come a long way since that plastic dummy, you know. And I think that that also opens up
interprofessionalism right? Because we're not just in our silos. Only in one classroom in the nursing building, doing nursing simulation. That's one of the things when I was working with the VR Company helping them create nursing simulations in VR.

It was to be able to allow people to train together remotely in different roles. So you can have nurse practitioners and nurses and CNAs and people all across the country, and really all across the world. There are some great nursing programs who are using VR to educate nursing students in Africa.

Pamela Stokes:
Yes, so if you can dream it. Technology can be the tool to help you create that. Absolutely. Yeah. And Dr. Lewis, and that's mentioned mental health, you know. I think a lot of us, especially in health care, are aware of the mental health crisis that we see across the nation, and when I was in administration we could not bring somebody in. We couldn't afford to bring somebody into a college health setting. We desperately needed a mental health professional, but we couldn't keep one on staff, and so the partnerships that we were able to make so that we could have a telehealth platform just even Prn as as needed to buzz in and help someone in a mental health crisis.

I think it's almost made medicine more integrative. It's made nursing kind. Not the only case manager, you know, for so long. We've done this head to toe care, and we've been the case manager. We've managed all aspects of care which is great, and that's still our focus, and on our approach, right. But I almost feel like technology has aided in the integrative team because we're all talking to one another, and it's easier to find a specialist or or another team member. Do you do you agree with that that we're functioning more as an integrative team?

Cene Livingston:
Absolutely, and using that mindset with students, really prepares them better for the future. And what reality holds for how it all works when they hit the ground.

Pamela Stokes:
Yeah.

Cene Livingston:
it's not quite a shock as it has been in the past. When you don't realize there may be 5 or 6 different specialties that you have to interact with to accomplish what the patient needs. So it really has made it so much better.

Pamela Stokes:
I agree with that. It's we. We are good at what we do, we can become masters of the art that we practice right. And but we've shifted a little bit from like, and i'm going to use this simple example, but you break your you to break your arm. Years ago you go to the AR. You get a cast. Not so much nowadays. We have the technology and the knowledge and the access to let's hold off. Let's talk to a specialist. Let's get an opinion. The nurse will help you get scheduled with Pt. And all of these resources. And so I just love where we're heading.

Pamela Stokes:
So that kind of leads us to our net top next topic, which is talking about global health care and and opportunities for that, Dr. Kennedy. You, I know, working with people in Australia and Israel and all over. What can you tell us about global health care, and where maybe it was when you started and where we are now.

Diane Cannon:
Well, I think when I started I had no concept really of global health care. I remember in nursing school doing a paper about global health care and the difference between socialized medicine and the capitalistic system we have here in the U.S. And fast forward all these years. Hmm. I mean, my mind has been expanding my understanding of how politics and global views and economics and all that play such an important role in health care around the world. And so, you know, with Zapperman we have contracts with the NHS in at the Leeds Teaching Hospital in England, and their delivery of health care is different than working here in the States with our customers here. You know Krista's health in Texas, and then that's a little bit different, though. Then how California is with our customers out there, so it can even differ across. You know the Us with the with the legislative views on nursing and health care, and and it it are there unions involved, are they not? And so when you, when you start kind of talking about global health care, it's important to take a a perspective of.

And again, this is my sociology and degree from the very beginning that I didn't think I was ever going to use it. It. It really really helps me, because I have to understand why things are the way that they are. Why? You know the health care in Israel is how it is, and how do you help nurses? Because the one thing that isn't any different is the nursing part. And how we use our practice now it may be legislated differently from state to state or country to country, but nurses around the world are nurses, and so you know. How do we help them find their voice? I mean it's it's something as simple as how do you help someone
create a business plan, right? They know what they need. They know the platform they need. They know the tool. They know the technology. But how do you convince administration? How do you get the money to buy it? So global health. I think you have to really take a higher level view to understand each of the different nuances. But at the end of the day nursing is nursing.

Pamela Stokes:
I absolutely 100% agree, and I may be on a little bit of a soap box, because yesterday I was at Oklahoma and Nurses day at the capital. So everything you spoke to it. It just brings up those feelings. Yesterday I was so I left inspired and and just really grateful for interacting with passionate nurses, because I think one of the things that i'm grateful for from my own nursing education is that I learned about the piece that wasn't just clinical. I learned about how I could advocate and talk to legislation and learn about policy, because if all the nurses in the world came together as one giant body, we would be huge right, and we could really make some changes. And we have locally here, as i'm sure in other states as well. But I I was wondering Dr. Levin's living since we talk about policy and business plans and legislation.

If you could speak to academia a little bit because I've been in academia. I've been an instructor myself, and so I know a little bit about it, but those that are watching, I can't stress enough how grateful I was to not only have my baccalaureate, but to go on and get my masters and my DNP. Because I learned all those things, could you speak to that, and how we prepare nurses for that piece of the profession?

Cene Livingston:
That is the beauty of higher education, and the more the more you know, the more you learn, the more you can help evolved any situation. I'm a very big proponent of the DNP. But any step that you take to further your education. The more you'll learn about those global health issues, Even so far as national health issues. When you're interacting with patients, we're such a globally mobile society that you don't know the background of the patient you're caring for. You have to have those skills to be able to assess appropriately to understand where that person hold the value in in their health. What their beliefs are. You have to be able to recognize? There's variations, even people from Oklahoma person to person. There's different beliefs and values and views on what health means to them bye. Without that further education your mind is not expanding to include all of those things you have to strive for learning as much as you can to impact change which directly impacts patients on varied levels.

Pamela Stokes:
For sure, I didn't realize when I went to nursing school that I would have a research class and a leadership class and a theory class, and we would talk about health care policy, and and show up to the capital and talk to our legislatures. I just didn't realize it, and I didn't realize what a key role I played in that, and I think a lot of nurses may still not realize that they can talk to their legislature and make it make a huge change because we see it all we right. We take care of the families and all of the individuals that are interacting with the patient. We do the education piece. We assess we keep the team apprised of what's going on, and we're focused on the psychosocial at the same time. So we really see it all. So we we could make a huge difference and policy change, and where health care is headed.

Cene Livingston:
Nurse educators are influential beyond measure. A really good nurse educator can make a huge difference in someone's vision of what it could be like, and how they could use their education to make a difference.
whatever focus they choose.

Pamela Stokes:
Can you speak to that? Because I tell a lot of people who get a nursing education degree it doesn't mean you're the stage on the stage, and you're just at the front of a classroom every day like, what does that look like?

Cene Livingston:
The idea that one person could be a true expert in everything is not feasible. It doesn't happen. Nurse educators learn as much as they can to help students help people. Be that you're teaching them about policy, teaching them about administration, whatever whatever piece there teaching them can help them make significant progress in whatever area they're they're leaning into, and it it's vague. Yes, because there's so many opportunities for nurses. Dr. Cannon is a really excellent example of hey? I want to do this now. Nursing is beautiful in that respect. So even just choosing a path as a nurse educator does not mean that that's the only path that you'll stay on bye. The trickle down of how many people you could impact through. Your voice is astronomical.

Pamela Stokes:
It's huge. Yeah, Dr. Cannon, do you agree? You're not in?

Diane Cannon:
Yeah, I i'm just I mean so many things going through my mind. You know what you you were talking about, the impact that a nurse educator can make on you, and you know Dr. Crawford, Gina Crawford, was my DNP chair, and probably the toughest task master that I ever came across, and and I worked with a lot of really tough nurse leaders throughout my different goals. and I don't know that I would be where I am today without her pushing me. And I may have grumbled, you know, through the process, but I Iknow without a doubt, that I came out better and stronger because she made me call the Board of Nursing multiple times and get their help on policy development and understand the differences in, you know, just roles and and things that nurses can do.

I had to do legal research, and I had to understand a policy. And and how do you create policy and do it within the realm of making it legal for the State of Oklahoma through the Board of Nursing under the Ha, because I worked with Hospice under the House of Hospice. And so it was understanding and being forced, really because she does not take no for an answer. It was through her really pushing me that I realized you know what I can do this. And gee, if I can do this, what else can I do? How else can I use all of my because as nurses, we have so much experience just of not just clinical experience, but understanding people and communication and understanding systems. And you know, design theory and hmm again, I'm here kind of to brag on OCU.

I know that's not just all of the other point of us having this conversation but to find a program that has a well-rounded approach. That was something that I needed, because I needed more than just nursing theory. Yes, nursing theory was part of it, but also all of I mean quantum leadership theory. Hello! That was that was great to understand that. And and what is so funny is that now these conferences that I go to, I mean, I've met Tim Porter O'grady, and we've talked, You know, about it in, and it's not fantasy, and it's not some theory that isn't a appropriate or applicable to to real life. so that you know that's what's helped me. See? Oh, okay, Well and then also think, yeah. But what else can we do?

All the best things come from nurses? I'm telling you all the best inventions and approaches, and it's it's all by a nurse. I say that all the time. And for nurses to get together and and identify problems and come up with solutions. Then you get quite people in the room. I don't know how to. I don't know. I don't write code, for software I don't. I don't know really that much about the software creation world. But I have a seat at the table. Every time we meet I meet with the software, the tech guys because they need my expertise and I need their expertise. And what's what do nurses do? We are great translators, all problems. We will translate medical into real world terms that our patients can understand. That's basically what I do. Right? I translate nursing to the software guys, and I translate software to the nursing people and make sure that there's a good fit. And if something that the software guys are creating isn't going to be meaningful, and nurses aren't going to use it, or they're using the wrong terminology.

A company smart enough to hire a nurse and actually listen to the nurse. I can't tell you how many companies out there have. You know their their nurse figurehead, or whatever you want to call them, their thought leaders. They Don't actually have any input on the creation of the things that nurses are using. And it's obvious when that happens. it's all it is. It is. And I have to tell you guys. So. My background I have kind of a different background as well, and I was in healthcare administration on college campus, and I was also agent faculty, and I was in a creditor as I was there. So I went out to ambulatory health, care, facilities, and and I accredited them.

Pamela Stokes:
And one of the things that happened to me while I was at this university was, I was approached by the Higher Learning Commission, which for those of you who don't know. Our Our big universities are all credited as well to say that they're providing adequate quality education by the Higher learning Commission, and they approached me because they knew I was a healthcare creditor and they said, hey, we always have a nurse on the team always. And I was baffled by that I'm like a nurse, is always on the Higher Learning Commission team. I wouldn't know anything about, you know student affairs and policy and and curriculum writing. Although I was new a little bit, I wouldn't know how to do this, and they're like No, it's it's the way you guys think we always have a nurse help us think through the process. How we could do it better, and how we can relate to people, and that's exactly what they said to me, and I was amazed. I think it's the first time that somebody outside of nursing got it, you know they got who we were. So yeah. Just a little tidbit there. I remember the moment that I decided to get a masters in education, and it was something so simple. I was in LND, and I was being mentored by this nurse, and every time she went into the room
it was like it was the most important job she had. And nothing else at any point in her life was more important than what she was doing right then. And she had the same spiel, and she never changed it. It was the same every single time. But when she sat down to teach that moment and that baby everything they needed to know before they go home. She was so passionate and serious about it, and I was like. I want to do something like that where it's not... It may not be the hardest thing to do, and she has a skill that she says every single time. But she's so passionate she takes it so seriously, and that mama and daddy and partner, and whoever it was that was going home with that baby. They would hug her and shower her with gifts, and they just thought she was the best thing ever, and I was like I want to do that, whether it's to my students or my staff or my patient. I want to educate people and be able to speak in terms They understand and be able to make them feel cared for, and have them walk out of here, knowing everything that I need them to know. I I want to have that feeling, and so I got my masters in education because of that.

Cene Livingston
That's that's very similar to how I feel about nursing education. Empowering people to do more to impact others, help others. Yeah. Domino effect. How many lives can you impact the grand scheme just by being an effective educator and recognizing someone's need or or whatever it is? Yeah.

Pamela Stokes:
So we have some great nurses out there. We have, as you mentioned, Dr. Livingston in your background. You started as a. C. And a. You worked your way all the way up to a doctoral degree, and i'm very similar. I think, Diane, Dr. Cannon, you probably are very similar. We all realize the importance of gaining more knowledge and confidence, and so we just keep going, and we see the difference it makes in our lives.
My question is for those nurses. They're fantastic nurses, whether they'll l pins or at ends or Bs, and they're on the floor. They're great, and we need bedside nurses that are right at what they do. But a lot of people you here say I'm never going to go back to school. I've I've mastered the art and never going to go back to school. And I think that's okay, because there really is an art to nursing. But what would you say to them? Because that's the biggest argument I have like? There's no pay difference there, you know. Why am I going to go back to school? What would you say?

Cene Livingston
Choices? There are more choices if if one area in your life. It's like well, you know I'm kind of tired of this. For, I mean any other reason, or wow, this is really exciting. Let me go. Try this because
that is really something that I am excited about. That would be my biggest reason for furthering education. Aside from being able to impact people because that is huge. But personally, what do I want to do when I grow up? You know, or what it? What if I? What if I decide? I want to do this. Well, I have to have this education. And what will the future bring? Because the sky is the limit? There's so many opportunities to do something different.

Pamela Stokes:
Yeah. How much you, Dr. Cannon?

Diane Cannon:
No, I I completely agree. And I love what you said. Dr. Livingston. The the continuing education that I've gotten, you know, since I graduated High School in 1988. Each step has given me a broader menu of choices and every everything that I've done in nursing. I don't know that I could have done it. Another career. And each role and each job or each step in my education. I did at a different point in my life to move on and evolve to the next step. So when I was a a new nurse, I was newly married. I was working in the ER. I had a new baby. I knew I wanted to move on, you know, so as as I moved through the difference, because you're gonna move through the stages in your life regardless. Whatever you did, you know. I I hear people say, oh, it's 2 years, and so long. Well, you're gonna be alive for 2 years. You may as well, I mean, have a let's better yourself and give you some more opportunities because you you don't know what lies around the corner. I went through a divorce and found myself a single mom of 3 kids. I had the means because I had a nursing degree and experience and education to be able to provide for my family without worry and I've also done it for different schedules, right? So when my kids were little, I worked night shift 3 to 12, so I could be home with them. They didn't have to be in daycare. Those are personal choices that nursing has allowed me to have the the work life balance at the time that I needed it, and it was my choice, and it wasn't regulated, or I mean again, I live on a cattle ranch in the middle of rural Oklahoma, right? If I if I didn't have the the education that I have right now. I would not be having the opportunities
for work as well as personal growth. and and i'm looking to the future. You know we we're I'm not getting any younger. How can I? My goal was to continue to be able to work remotely work from home, but still work. Here's like yourselves. I love to travel. How can I do that? Globally? I'm a keynote. Speaker: how can I travel and get that paid for and make connections and make a difference. So it's, you know, kind of taking a step back and thinking what's important to me. What's the life that I want, and I and I talk to nurses all the time. Who want to know? How do I become a nurse entrepreneur?

Pamela Stokes:
How do I start down the path. You know, Pam, you and I have talked about this. Yes, like that. Actually, I was gonna take a minute to say. You know, Dr. Kahn and I met for the viewers out there years ago because I was a health administrator. She was nursing faculty. We work together on some community initiatives, you know, flu vaccinations and such and clinics, you know, around the area that we worked in. But I remember seeing you because you talk about networking nurses are really good about that, whether it's on Linkedin, or at conferences or things like that. And I remember seeing Zapperman, you know, on your title, and i'm like, what is that? So I started checking it out, and we started talking. And of course, that happened, and I decided that I wanted to make a difference in nursing in some other way, and I didn't know how yet i'd been faculty before, but I didn't know how yet. I just wanted to change what I was doing, and Dr. Kan was kind enough to have a phone call with me and talk to me about how she just took a leap, and I'm gonna give you credit on this national platform, Dr. Kan, because because of you. I took that leap, and and I refreshed my resume, and I realized I did have a lot of experience in multiple areas in arenas. and I put it out there on a resume and Linkedin and I started networking with other nurses, and because of that I now, too, can recruit new nurses to go back to school, which I feel like is the best job in the world, and I'm consulting for companies out there, and I credit health care facilities.

And I write nursing content for like textbooks and other platforms, and I love it because I feel like I have involved, you know, as you were talking about to a place where I can now hopefully inspire
a young nurse like that nurse inspired me to go into education. I hope that I like somebody on fire and help them to realize that we really are as a service procession, just the best calling we we make such a huge difference, not just in hospitals, but nationwide on on multiple platforms. So thank you for letting me go on a tangent, but I have to publicly thank you that it's made my my job in my life really rewarding, and I don't know about you guys. But when somebody says, who are you? How do you describe yourself? I know you're not supposed to say your profession, but I always say nurse first, always. I just can't not identify as that. Don't you agree?

Diane Cannon:
Well, because there's so many ways to be a nurse, and and I think it's. I I think there's something there to that to bring on the next generation of nurses, and and really have them understand that
that's cool. If you want to be a bedside nurse, that's cool. If you want to be an E or nurse, you want to work nice with you. Awesome. You want to be a nurse practitioner. Great. But that is the tip of the iceberg of what's out there that nurses can't do right. I think, using technology especially with these native, you know Gen. Zers and millennials, and and all these other generations who've always grown up with the technology that we have, and it's an expectation. How do you? You know? How can we show them here the things that you can do as a nurse? And here's the difference you can make if you like to go this way, or you like to go that way. I think that's something that we, as nurses and and nurse educators, really need to broaden the possibilities of what a nursing career trajectory could look like.

Pamela Stokes:
Because the sky is the limit for these young faults that have grown up on technology, right? There's no telling what they'll come up with.

Cene Livingston:
The other thing that I always think of is for those nurses who are even considering education. there's so much opportunity to work your education around your life these days versus the other way around. And it's never a good time to go back to school, but it's always a great decision to go back to school, and if you can choose that opportunity that makes it even easier to get to those choices is so huge and given the opportunity to increase our the diversity of the nursing workforce is giant. It is something that we really need to strive for, and that's going to lead to more diverse nurse educators. Eventually, we just need people to take that next step.

Pamela Stokes:
Yeah. So i'm gonna ask you in our last few minutes here a very broad, hard question. If you had to pick the top 3, and I'll say for nursing or health care the the top 3 issues that we could really jump in as a profession and and make a difference. Or or you could even say top 3 opportunities that we have facing us this year like 2023 that are like the hot topics. What 3 would you name? I know? It's broad.

Cene Livingston
I would say diversity. collaboration, and recognition of the importance of all members of the health care team.

Pamela Stokes:
I love that.

Pamela Stokes:
Dr. Cannon.

Diane Cannon:
I would say the paying reimbursement of nursing to get nurses off of the cost side of a hospitals budget sheet, and I think that goes all the way up to Medicare Reimbursement CMS. And so i'm not gonna get into politics. But I think nursing can really really get in there and and use it. Strike by the iron taut. And and right now, I think, is a great time for us as a profession to use that leverage, and really kind of try to regain some of the power that we lost along the way. I also think global health and global nursing to take a global perspective. Because, you know. With airplanes and Zoom the world has just expanded. And so none of us live in a bubble. And so I think, from a global perspective nursing has just unlimited possibilities. And then I think also the use of technology in a meaningful way, not the use of technology for technology's sake, because it's just a tool. I think more nurses need to be on either boards or in the in the design of the the pieces of technology that are coming out, that nurses at the bedside are using. I think there's a huge need out there for that, and there's really some great opportunities. But you also have to have the experience in the education to be able to it. It's one thing to talk the talk, but you also have to walk the walk and and have that when you're gonna go, talk to the C-Suite. Do you want to make sure that you have bullets in your gun, so to speak? Yes, not that i'm shooting any. Well, I don't need it, but like that. But I I think you know a lot of people want to do a lot of things, but you have to have your arsenal well prepared to truly go to toe with some of the difficult issues in in nursing and health care collaboration.

Pamela Stokes:
Yes, yes, I'm gonna repeat a phrase I heard yesterday the capital. So it was. If you're not at a seat at the table, then you're on the menu. That's that's what was repeated yesterday quite a few times. So it sounds like what we're saying, even though we talked about a lot of things is that nurses need to be at the table for all of these things, whether it's policy or education or technology with the it team, or making suggestions and changes. It's really us as a body that can come together and make that happen. I think that's I think that's the key thing. I love these type of collaborations, because that is the key is to is to support each other and hold each other up and and back each other as as women, and not just women in nursing. I know that there are. I've definitely been in a strong supporter of men and nursing. But as a female dominated profession, I think it's so important that we show solidarity and and and back each other up.

Pamela Stokes:
I love it so with that said, I think that I am going to encourage all of you out there that watch this podcast, this message on my message to find your voice right, and so whether that means going back to school, which I think we're all proponents of to give yourself more confidence in a bigger voice, or doing continuing education, or reaching out to one of us or your friends who are nurse leaders and getting involved. I think I think that's what we're encouraging. Right? Yeah. Well, listen. We could talk a lot more, but I want to thank you both for showing up today and just letting your voices be heard and inspiring other nurses. Because I can honestly say, in working with both of you that I've been. I've been inspired. I've been directly inspired by the work that you do. So a big thanks for taking time out of your your busy schedules, and I know we will see wonderful, great things from you guys in the future.

Cene Livingston
Thank you. So nice to see you.

Pamela Stokes:
You guys as well. Thank you all.

Pam Stokes:
Hello, everyone!
My name is Pamela Stokes, and I am here representing Oklahoma City University, Kramer School of Nursing. I apologize. We're having a little bit of slow connectivity today, but we are still going to move on because we're so excited to talk to you today. I am actually coming to you from a hospital where I am awaiting my new nephew. And so I would like to just say a belated, happy nurses week to the panelists on the call today, and also to all of the nurses that are joining us, because you truly keep health care going. So I just want to give a shout out to the nurses a week after nurses week. So, as I mentioned, my name is Pamela Stokes. I am a nurse by trade, and I love the nursing profession. I stay active in organizations, and I love talking to new nurses who want to continue their education, and I am joined today by 2 fantastic panelists that i'd like to introduce to you before we get started.
So first I would like to introduce Dr. Toni Frioux. She is an associate professor at Oklahoma City University, where she teaches in the doctoral program the the NP Program, and she has since 2016. Her specialties include public health, nursing, administration, women's, health and pediatrics. She is very active in her state and national organizations, and she is a wealth of knowledge for us today. Dr. Jalila Abdul Rahim is our second panelist, and she is an OCU graduate, and she currently is the head of nursing and allied health at Redlands Community College, and she also is an adjunct professor at Southwestern Oklahoma State University. So can I just say thank you to both of you ladies for being here today.

Jalelah Abdul-Raheem:
No problem. Happy to be here.

Toni Frioux:
Thank you so much.

Pam Stokes:
We are so excited we're gonna jump right in. Because, let me tell you, we're gonna talk about public health today. We're gonna talk about cultural competency which those are huge things to tackle. But we're gonna define for you what we mean when we say community based public health or community help nursing because a lot of times those terms are used interchangeably. So before we jump into cultural competency, and we start talking about how health care is shifting, Dr. Frioux. I would love to turn it over to you. And have you just kind of define what community health is, what public health is, and how nursing is really taking charge of that.

Toni Frioux:
Thank you, Pamela. It's an honor to be here today and to be able to talk about something that I am very passionate about, and that is public health nursing, and I am a career, public health nurse. and I was, even, I think, a public health nurse. As a child I had the good fortune that my mom was a registered nurse, and she was a she was a public health nurse, so I was oriented to public health from the age of 2. So when I say a lifelong career, I'm serious. But formally, I started my career in public health, even while I was in nursing school, because I went to work for the Cleveland County Health Department here in Oklahoma as a whit clerk. When that program was brand new and being implemented. And and then, upon graduating from Bsn program, I was fortunate enough to be hired as a public health nurse. And so, through my formal public health nursing career. As you mentioned, I have held several different positions from a novice staff nurse and ended my career in an executive leadership position as a Deputy Commissioner for the State Health Department. And during my tenure, I finally retired from the State Health Department after 36 years as a promoting and practicing public health [worker].

And prior to retiring, I started working on my DNP here at Oklahoma City University. And was so impressed with the program when a faculty position became available. I applied for it, and was very fortunate to be hired into that position. So even though I teach at the Doctoral level, it doesn't matter whether I'm teaching in the family nurse practitioner track, or whether I'm actually teaching masters prepared nurses in the doctoral classes. I, somehow or another, seem to always be able to interject public health concepts into my teaching into my curriculum. So basically when we talk about community based public health nursing, you know, through history, there's been a huge debate between what's a community health nurse? What's a public health nurse? And for a long time public health was considered a subcategory of community health nursing. And I was very fortunate in my career. During the time that I was the chief nurse for the State of Oklahoma, for the public health nursing. I held leadership positions on some national organizations, and it was during that time when I was in that position that we decided that public health nurses really were our own specialty area.

And so the national organization that I worked with. The Association of State and Territorial Directors of Nurses, worked with the Court Council. And the Court Council is made up of the 4 major national Public Health nursing representative organizations, and it includes, in addition to the State and Territorial nursing directors, it also includes the nursing section of the American Public Health Association, as well as the Association of Community Health Nurse educators. And then also ANA. So it was during that time that we took that opportunity and worked, approached ANA and said: we think that public health nursing is so important and so critical to the health care of our populations that we should have our own individual scope and standards of practice. And so we were successful in getting that published, developed, and published in 1999. It's been revised a couple of times since then but that is sort of the bible for public health nursing.

One of the really nice things about public health nursing, you know, in nursing we we borrow a a lot of our information from other disciplines, and so public health nursing just takes that one step further, and we actually integrate public health sciences. So it's a melding of nursing theory and public health theory which actually shapes our practice. So it's unique in that. And yes, we're still borrowing social sciences and behavioral scientists. But we get to integrate environmental sciences to a greater death as well as epidemiology and bio statistics in our practice, no matter what level that you're practicing at you're still going to be utilizing those scientific concepts. So it's very exciting, and it's very timely that we're actually talking about this topic today, because what we are seeing on the national level is we are seeing health care being redirected towards a more health promotion, disease prevention.
And so, in fact, the Academy of Medicine, which used to be known as the Institute of Medicine released just this past year the future of nursing 2020-2030 report. And it is all about transitioning to working in multi-sectoral sectors, partnerships and trying to prevent disease, and that makes a lot of sense, because we all know that the vast majority of our health care dollars are spent at end-of-life care and for very expensive acute care procedures, diagnostics, and those kinds of things. And quite frankly it's just not reasonable to expect that we, as a country and a health care system, can sustain that type of cost related to our health care dollars.

So we really do need to be smarter about how we utilize our resources. And so to me it just makes common sense that if we are able, through public policy, and through advocacy, to really redirect those expenditures, and put some of those dollars into health promotion, and disease prevention, and then health maintenance that we should be able to sell save some dollars, you know, on the other end.

But that is easier said than done, particularly when you're looking at financing in health care, and our reimbursement systems are set up to pay for diagnoses and procedures and diagnostics and pharmaceuticals. So we're talking about a significant healthcare culture change from a very high systemic level. So it's definitely not something that's gonna be done overnight. But I'm encouraged because we are seeing some some redirection at the national level with starting to talk about more, put more emphasis on, you know, actually investing our dollars further upstream, so that we can hopefully keep people healthier longer and not have all of these large expenditures.

So that's as you said, Pamela, we're gonna talk a little bit about opportunities and roles related to public health nurses and some of the challenges that we're facing. And and then we're going to talk about some influences around cultural competency and those kinds of things. So I'm going to pause here and let you tell me when to keep going on is I can talk for days about public health.

Pam Stokes:
I thank you for that. I thank you so much for your passion. I hope you guys can hear me. Okay, because I know there is a lag. So my apologies that I learned so much from that little snippet that you just gave us about what happened here in Oklahoma, and how community public health nursing has shifted in Oklahoma. So I thank you so much for that, because what I kept thinking, I kind of went back to my undergraduate days, and I was thinking about when I got my back the Laureate and we used to talk about the population pyramid, and how you you know we used to have all these young people, and not that many old people. And now the Pyramid has flocked, and we've got lots of old people, and not that many young people, and not enough health care workers to take care of them right. And so, as you were talking, I was thinking about Covid and how it's really shined a light on nursing, because when Covid happened, nurses jumped in because we knew that that's just what we had to do right. But there was also all these other people at the table that relied on nurses to do that. And there was no question in anybody's mind that we were going to be at the bedside with the families, finding resources, teaching people. we were in all aspects of their care. So it makes so much sense to me for nurses to have a seat at the table, and I, too, could talk about this forever. So, as we transition, I want to ask you, Dr. Abdulrahim to kind of talk about what you've seen currently like in your practice, and with your students, and just your experiences and thoughts and reaction before we jump into the cultural competency piece.

Jalelah Abdul-Raheem:
Well, in regards to public health prior to Covid, I would say, I've been had the pleasure, I guess I should say, of being an educator in rural populations which has been very, very eye opening. So public health prior to we talk immunization something as basic as that just the requirement of the vaccines that you have to come in with, depending on where you come from your reactions. Things like that that trust within the community where those resources are to actually get a vaccine. That was very eye opening to me, not even students, not even knowing the the resources that they can get from a local health Department. Things like that now, after Covid after Covid, it has been very, very eye opening. because with that shift with the pandemic and the country for a little bit. You you have to stay home that shelter in place, or things like that. Then that kind of set people up, for not really. They already had limited access to some resources, or didn't know of some. So it just made a bigger barrier when it came to that. So it was a lot of education, and I felt like there was a lot of a communication and talks in in regards to the vaccine as well. And I know we're gonna talk about cultural competency coming up. But I feel like there was a bridge between that public health and cultural competency. And what I experienced during the pandemic, especially from my ethnic background, as being someone that minorities in the community could see and rep. I was a representative of their culture. So when it came to treatment of Covid, the vaccine things like that, and that mistrust that was there with health care systems and providers and things like that prior to that exacerbated. So that was a a big piece that kind of came to the forefront post-Covid.

In addition to just being in rural areas and not having access to Internet. Now, that was now, I know, you know, just like we kind of have some issues today with technology, you know, depending on where you're at technology can be spotty and things like that. But I think sometimes when you get so used to technology, too. You don't realize that there's people who don't have it. You know, some areas they may only have access to, maybe one provider and is limited connectivity. So with with Covid that was very eye-opening, and I could see that even in the sense, you know, telehealth and students trying to get to providers to follow up, and things like that, you know, especially with the delay in times, with the distancing and things like that. So those are some of the things that popped up, and then just the general scare as a whole, you know, of of students coming into the program, you know, was that shift for a little bit of, I don't I don't even necessarily know this is if nursing is something that I want to do, because, like you said we were at the forefront, just jumping in.

And then, you know, they see through the media, and from things that they hear, the nurses is getting so burnt out. we we we just, you know, sometimes take care of our patients better than we take care of ourselves, you know. That's, you know, a lot of our nature, you know. So just looking at that, you know, and the impact that it had with students debating on if they wanted to even pursue the field. Or if they can even continue their education, if within the program, because of the constraints, you know. and with getting their family members health care and things like that that had Covid, and had some of those long-lasting effects from Covid that they were working through, you know, trying to figure out those resources of how to help them and bridge that income, gap and things like that. So those are some of the things that I've seen, you know, before and after. So it's, it's definitely been a shift.

Pam Stokes:
No, I love, I love that. That is a great bridge, because my question for you guys, and how we can tie this all together is, it seems like there's a lot of doom and gloom. But we know as nurses that health care is shifting. We can feel it, and we know it, and we know that nurses are at the forefront of that right. And so the good news, and the reason we're here to talk to you guys today is because we can lead some of these changes in some of these charges, and we are leading some of the changes and charges that are happening in the profession, right? And so, as we shift to cultural competency, and you're thinking. You know. How can we tie community health and cultural competency together? I think it's because we're looking at preventative ways, creative ways to reach patients that we may have never reached before. How can we make the population healthier? How can we have a charge in education and healthy lifestyle, so that maybe we're not being reactive to medicine but we're being proactive to medicine. And last but not least, patients want to relate to someone who knows where they're coming from, who looks like them, who eats like them, who knows where to get resources, right? And so I'm going to shift back to Dr. Frioux for a minute here to talk about the good news, and the good news is that nursing is really leading the charge right? And so, Dr. Frioux, how would you kind of talk about community-based public health and cultural competency, and how we're kind of shifting what what we've done in the past, or what you're seeing now?

Toni Frioux:
Well, thank you. You know I...We are currently in the recovery phase post-pandemic. I think one of the major challenges that we're facing in terms of public health nursing is public health, as well as other aspects of the health care system took a huge hit during the pandemic and there... You know, nursing fortunately is one of the most trusted professions. We continuously are seen as a very trustworthy profession, and we, I think, have been able to maintain that. But there is also been a lot of mistrust that was generated because of political influences, and I think some of our culture in the United States, because we're so individualistic rather than collective in terms of our philosophies and our values and our beliefs. So I think it is going to take a few more years for us to bounce back from that and rebuild our trust with the public. And you know, I think social media is a wonderful way to get information out, but if it's used correctly. And I think we suffered a lot from a lot of social media that was not evidence-based. And you know, the public, the the average citizen in the United States may or may not know what is credible information. And just because it comes on the Internet or through social media doesn't mean that it's scientific or that it's been tested, or that it's actually best practices.

So I think that, keeping that in mind and being aware of that, as we move forward, you know public health, we we have always been the gap filler in terms of services to the public. I can think back in my career when I first became a public health nurse. one of my roles that I played in addition to innovations and and other services that we provided through. The clinic was a home, healthcare nurse, and I did that for many years, until the system caught up, and actually Medicare started reimbursing for home health care services. Of course, once there was a funding stream tied to that, then we began to see how health, care agencies, mushroom all over the place, and there really was no longer a need for us to fulfill that gap, because that need was being met somewhere else. Some other gaps that I can think of that I've experienced in my career is we used to provide a lot of child health services because there were not providers, particularly in the rural areas. We also provided maternity care. And we did that until Medicaid started funding and child health services and maternity services for low-income individuals, and so they were able to provide a medical home for those individuals in needs of in need of services. So we got out of the business of that that, but you know what goes around comes around. And so it, you know, interestingly enough in Oklahoma we have, we now are experiencing a gap in terms of maternity services across the State, and so I know the State Health Department has their ramping up, and They're beginning to deliver prenatal care. They're not delivering babies, but they are taking, you know, trying to deliver prenatal care as early as possible, because we know healthier mamas make healthier babies.

And so you know, I think there's just lots of challenges that are facing us. We there's lots of individuals who've suffered ACEs, adverse childhood events, a lot of post-trauma that is still in existence, for whatever reason and related or otherwise. And then another really high priority is food insecurity. And so I think, as we begin to try to provide interventions that affect and try to improve these needs at the individual, the family, the community, the population level, we must keep in mind our premises, our foundation of social justice, our equity, our diversity, and our awareness of cultural differences. You know we all have some thing that are dissimilar, and we all have things that are similar, and I think, trying to find those those areas of common ground. I know for me it it's a continuous learning process as I work with other individuals. And the really big "aha!" For me, I guess, as I to work more diligently and mindfully, to be more culturally competent, and and develop a greater sense of humility. It's just recognizing that I may not share some of those common values, beliefs in in way of life with individuals. But just becoming aware that gives you the opportunity to connect with individuals and to work with them to help them meet their needs on their terms. Of course I always draw the line. If it's something that's unsafe, then, you know I may not go along with it, but if it's something that you know we can do together as a partner, a patient, a provider, partner and I'm kind of talking from my nurse practitioner standpoint right now in terms of treatments. But even as a public health nurse, at the RN level, you're still intervening with patients and working with them in. You know another "aha" that I experienced was becoming aware of microaggressions. And was not even aware that I do that. But once I became aware of it and acknowledged that oh, my gosh! You know I think I just made a statement that actually was a microaggression, you know you build more mindfulness of it and more awareness. And I think that's really the key is working towards being aware, changing your own behavior being open to understanding others' cultural background, their way of life, their values, and then working in partnership with whether it's an individual, a community, or a population to help improve their health status.

Pam Stokes:
Thank you so much for that. I appreciate your viewpoint on that. It is definitely important for us to be lifelong learners, not just as nurses, that as community members right? So Dr. Abdul-Raheem, I would love to hear your thoughts on challenges kind of like Dr. Frioux told us, and what you've experienced, not only in your expansive career, that you have it in the area that you're in as well. You've mentioned living in rural Oklahoma, which... so that would be helpful to hear your point of view as well and your challenges.

Jalelah Abdul-Raheem:
Yeah, well see. I grew up. Now see, I grew up in in in urban areas, you know, as a child, Los Angeles, and then I lived, then we moved here, and it's kind of in that Del City area, Oklahoma City area.

So I was kind of used to urban experiences. And then, as I expanded out into my career and started doing home health and things like that, and experienced that rural population, that lag time and actually getting those medical services, the Internet services that may not necessarily be as reliable, or it may be lack thereof, not really having those close resources of community, not really seeing quite a bit of diversity. You know that that that was a learning curve for me. You know personally, of course you know I've I've dealt with some of the things that come along with being a minority. But it was very eye-opening to experience patient perspectives, my students' perspectives, teaching and rural areas to where, you know, I had someone tell me that they hadn't even seen anyone who looked like me until they were, you know, graduated high school.

Still, at this day and age, you know, based on the location that they were at, you know, really didn't venture too much out of that area. So one of the things that I want to, that was previously mentioned, that I I think that is real big is just being culturally aware, and also giving yourself some grace. As you are becoming culturally aware, I feel like personally. professionally, just with interactions... I feel like, you know, sometimes that cultural awareness when we pick up on our biases and things like that that sometimes when we interact with with other cultures, sometimes they may feel uncomfortable because we feel uncomfortable that we've noticed something that may not be the most positive, so we think. But there, in the reality, I feel like being culturally aware, and giving yourself some grace and learning is really how you relate to those people from different backgrounds and really help bridge those gaps and figure out what those people need in those areas that they may have lack of access or mistrust, or you know, helping them. I think all of you know. A big part of it, too, is helping them be confident, being able, you know, like previously mentioned, finding those credible resources and trusting you to guide them to do that and manage their health care in a way that is doable within their means. Whether it's financially, locally, intellectually. But also just showing one of the big things I do with my students that I experience personally is when people become, you know, aware, and they don't beat their self up or they ask questions. You know things like that, and they don't really look at it like they're you know, on my crap, you know I just say something wrong to you so you might, you know, get upset or be scared at a reaction. But instead, just is open to having that dialogue to learn from, because sometimes I feel like, cultural awareness, you talk with one person from a certain background, you know, and you feel like, okay. Well, I've learned from that. So maybe I can apply that, you know. And so in some ways you can to that next person that may look the same or have similarities, and they can have a lot of different, You know, cultural things within that. You know their family just to shift in their family dynamic can be huge and instrumental, you know, in their thinking, and their receptiveness and things like that. So I feel like cultural awareness and giving yourself some grace definitely makes you more culturally sensitive, I guess I should say, and helps open that that dialogue. You know, that's one of the things that I try to do with the people that I work with. Make them feel comfortable, you know, asking me about whatever, and vice versa, the same with students.

But I learned that even personally, even as a home health nurse, when I'm out in the middle of nowhere, and this is the first time that people are verbalizing that they've seen somebody who look like me, and they don't really know how I react what I know they're they're aware that I'm credentialed to come out to do what it is that I but how receptive am I really going to be? Because maybe the perception that I have from someone who looks like you was from those means that we spoke about before, maybe social media, you know, maybe TV things like that. So me being culturally aware and kind of letting my guard down, because cultural awareness is also, you know, your perceptions of, you know, especially minorities. Sometimes we look at you know we've been through all this, so we're on guard. So in those situations I had to lower a guard, so that those people who you you had very limited, if any, experiences with someone like me. So I have to make sure my guards down so that you can, and that that way we make sure you get the the that you need, and you can open up, you know. So we can link you to the correct things and get you the help that you need. But those are some of the things that you know on both spectrums that I just kind of experienced as a whole when it comes to that.

Pam Stokes:
Yeah, Thank you so much for that. I have a question for both of you. I'm hoping that you both can kind of take a different perspective on it. So when we're talking about cultural competency, I've I've taken away nuggets from what you both said, and there's an aspect of cultural competency that involves providing adequate care, right? And then there's this other aspect of cultural competency that is almost within the workplace and co-worker to co-worker. And in our training and in our education and how we learn. So my question for you guys is kind of a broad one, and you can take it wherever you'd like. I'm just kind of curious. Could you give advice to people who are on the platform today, whether they're a staff nurse, or whether they're an administrator or whether they're thinking about going to school, What advice would you give in making sure that their organization is culturally competent and like, I said, that could be culturally competent care, or, you know, coworker to coworker.

Toni Frioux:
I think just being very mindful and deliberate about trying to interject cultural competency in every aspect of your life, whether it's your professional life, or even your personal life, because I think that we need to make sure that we are improving our cultural competency, whether it's, you know, in the home at the bedside, or whether you know we're developing public policy. Or whether we're teaching, no matter what aspect that we are participating in being sure that we're conscious of that, and we're aware of it. And you know, if we see a situation where perhaps it's not being practiced, you know, being a leader and being a coach, and maybe, you know, interjecting a comment, and turning it around and saying, yes, you know that's that is a legitimate perspective, however. And you know, just just take on that leadership role, that coaching role, that mentorship role with peers or with students as well, maybe as family members, as you know, as we go about our daily lives. So again, I think you know the the first critical step
is understanding what your perspective is, what your biases are.

And it doesn't mean that they're bad. It's just the way we were raised. It was the environment in which we grew up. It's, you know, so much of our understanding of culture and our values and our beliefs. We became that way unintentionally, subconsciously. We weren't even aware of it, because that's just the way it was. But learning that there are other perspectives, other aspects, other ways of doing things is the first step. So I think, seeking to understand whatever that position or perspective or approach is, is the first step, and just being aware that not everybody was raised like you, or look like you, or act like you, or believe like you. And that's okay. That's it. I mean, my gosh, how boring would our world be if we were all exactly the same? We might as well be robots. So you know it's those that that those different perspectives and viewpoints and values that that make life exciting, and that give us opportunities to learn. And just because we've always done something the way that we were taught to do in our in our younger years doesn't mean that that may. It may be what we need to continue to do. Maybe we need to change our perspective and be more open minded. And maybe, you know, I think just a really good basic example of that is, if you just look at our health care in general, you know, here in the US, we've always been very Western medicine-minded. You know, diagnosis and treatment. However, we have been able to see some growth in holistic health care practices, some alternative health care practices, and Eastern medicine being interjected. So I think, as a whole. We're generally speaking, we're a little more open to trying new things, but I still think we have a long ways to go.

Jalelah Abdul-Raheem:
I agree with all that, but what I would say to that is. Just don't be afraid to interact with anyone who is different from you. I feel like that's one of the bigger, biggest unspoken barriers, I guess I should say sometimes in my experiences as a nurse on the floor with patients, co-workers, sometimes we're afraid to interact with those who look different than us, or come from different backgrounds, and how, even outside of race and ethnicity, we find out we have different life experiences. You had different nursing school journeys, you know, you had different experiences from parenting or upbringing things like, and we're afraid to interact, and I feel like that becomes a barrier to increase internal conflict that results to external conflict when the reality of it is anyone who feels different just really wants to be seen and heard. And when you aren't afraid to interact you're letting them know it's okay. And I actually want to know about you, and you find out those different pieces about them, and you learn that much more, and establish that trust with interacting Of course, with my experiences in school, sometimes study groups were siloed to certain certain groups of people you know. So as an educator, and what I also try to do with my staff is, you know, I'm gonna purposely pair you with someone I know is completely different that you might not feel the most comfortable with, because we have to learn how to be open. And just because you have been brought up a certain way, or have certain feelings about things and everything else, you also need to know that that's not wrong. You know, and learn how to be open to hear something different, even if you disagree, you know, getting used to, "Okay. So this is how you do it. I might not necessarily be okay with that. But let's try that." Because guess what when you go out, and you deal with patients, especially out in the community, in their home settings, you know, when they really will cut you off, you know, because "I don't like you. So just get out my house or my environment" versus maybe having to suck it up for a little bit if you're in that acute care environment, because now I'm kind of in your territory.

So just you know, being open to that and pairing them up with different people like that. I remember being a nurse on the floor, and I would have patience that sometimes not only shared my same racial background, but may have been just difficult to handle, you know. And I you know I'm aware of the perceptions of you know, and you know maybe she can deal with it because that's culturally something that may fall in line with her that she can... So I would purposely come into assignments like that, and the reality of it is all I'm doing is just going in the room. Hey, tell me what's going on, and just kind of letting that guard down for them to, and they're upset, mainly because whoever was in there before didn't even try to open up to hear and understand them, and it wasn't they didn't take care of me right or anything like that. They didn't want to learn anything about me. Typically what I find Some of those nurses or co-workers or students, that's not something they're intentionally trying to do. They just are afraid somewhat to interact, and they're a little bit aware of their biases. Not really sure how that was going to translate to that interaction. You know. I feel like, you know, with the way in public health and the community, especially after the pandemic. We all know that there has been some exacerbations with the mental health and things like that. So people are a whole lot more sensitive. So when it comes to, I feel like in my experience, and and from what I'm seeing, when it comes to any potential conflict, people are running the other way, when in reality you not necessarily go into it for a conflict is just you go, let your guard down, and to give that person that opportunity to let their guard down to interact and actually be seen and heard. And surprisingly, I feel like most people probably aren't aware. Once you feel like, you know, someone sees and hears you, you typically get that same energy reciprocated and sort of avoid some that tension. But that's that's one of the biggest things that came to mind when you asked that question, just don't be afraid to interact with others who are different than you in in any way, because I feel like you caring for people or working with people... Some people, you know, work together. I've worked with some people. Someone has some type of breaking point, or maybe for a period of time just needed to vent, let something out and take change your whole perception about their behaviors of what they've been the past 2 years, and it took 2 years, and in the community, you know, as nurses with public health, and we don't have that time, you know, we only have that short amount of time to really establish that, to get that dialogue going, to really give them the things that they need. That's just my two center.

Pam Stokes:
I love your 2 cents. I mean, I think we could talk about this all day, don't you guys, because it's a matter of continuing to learn, continuing to talk, continuing to grow and being open to all that right. And there's lots of resources out there to help us. But I am convinced that nurses can leave the charge as as we become more culturally competent, and we look at more preventative, proactive community care. Okay, as we're running out of time. I'm gonna throw one last question at you guys. Okay. I want to know about the future of community-based public health. Where do you see us headed?

Toni Frioux:
Well. I think the future is community-based public health. We are already seeing many of the services that are provided in the acute care setting already migrating out into the home. You know, way back. When I was a home healthcare nurse the technology was not very extensive. I mean, we didn't even have patients on IVs. The worst I had to deal with was a tray or maybe a catheter. You know we have individuals in the home that that have all types of high-level, acute care that's being done in the -- what I consider acute care -- being done in the home. So I think just again, I think cost and funding is going to continue to drive individuals back into the community setting. You know we we've seen a lot of, or I've seen, a lot of discussion about aging in place at home. And you know we're seeing houses built so that children have a separate or an attached suite for aging parents. I think we're going to continue to see more multi-generational types of home settings, as we continue to age. Because you know, the baby boomers, those in my generation that we're all getting old these days, and so who's gonna take care of this huge aging population? And you know there just aren't enough long-term care facilities. There's not enough monetary assets out there to take care of that. So I think a big role that we're going to be playing in public health is being able to support those in the community and help bring resources to those families that are going to be caring, you know, for their aging relatives within their home.

And I also think that again, we are going to see more services in the community, just because it's less expensive than being within these huge brick and mortar health care systems. So you know, bringing that to the population rather than always having the population come to the big health care systems. I think we're going to continue to see trends in the future. I think by being in public health nursing and being aware of all of the influences, whether it be cultural, or whether it be those social determinants of health, like environment, policy, food, all of those different kinds of things being aware of all of that, and being responsive to that. And again, you know, continuing to work towards trying to interject health in all policies, whether it's a local level policy or a state policy or a federal-level policy, always keeping health in mind. And what is the impact of that going to do on health? And you know, just just sustaining the current systems that we have, like Medicare and social security and those kinds of things. I think changes are going to happen whether we're ready for it or not. And so, I think, by being a public health nurse, being a public health practitioner working within the community, you know, being aware of what the needs are locally. And then, putting on that advocacy hat, and, you know, working towards all the different avenues and possibilities to improve the health care system in the environment, and to help individuals live the healthiest, longest life that they have is is what I think it's so rewarding about public health nursing, because, you know, we touched lives every day, and we may not know the impact that we have on people's lives. But I promise you we've had an impact, and more times than not. It's going to be much, much to the better than to their demise.

Jalelah Abdul-Raheem:
Absolutely, absolutely. I feel like the future, like you were saying, that shift to to public health and community nursing, and I feel like that the accessibility is increasing. For those in the community to receive those services and for people to come to them, and also come to them outside of the normal timeframe than we typically would. Those weekends, those night shifts, those evenings, you know, allowing just more options, you know. I feel like nurses, the way that we're going, you know, including with culture; I feel like we... you know, we're listening to our population, and I feel like the way that we want in the future. Because we are listening. We're shifting, to make sure that our patients can remain independent out in the community. Their families have the resources, they can still band together. They can work around their schedules, you know, to get those needs met. Even with the shortage of the nurses that we have. Because you're absolutely correct, the aging population. That is definitely a concern. There's not gonna be enough people, you know, to come take care of me. So what happens if I need something and no one is available? But I feel like we have... We're doing a great job of just increasing that availability, you know, out in the community, so that they know that there's so many more options. And you, even if you can't get somewhere there's a shortage, or whatever the case may be, there's always a way that somebody can come and make sure that your need is met.

Toni Frioux:
And I think you know, in addition to the aging population, as you mentioned earlier, we're facing a a nursing shortage. And of course you know, a huge aspect of being culturally responsive is having a workforce that is reflective of the population that you're serving. And of course that's that's not gonna happen overnight, either. But I do think there are some strategies that we can engage in that can help us. In the meantime to get there. You know, historically, public health has used community health workers, and while they're not license credential nurses. They are members of the community that work with the nurse and with the patient to kind of bridge that cultural gap. And you know those in my 43 years of of public health nursing experience. When I first entered the profession they were highly used and then over the years they have sort of. They're still present, but they've taken on a very different role. And so what I see futuristically is that I see that concept re-emerging, whether you call it a community health worker or a doula, or whatever title you give to it. I think we're going to be utilizing other personnel to help us carry out. What we need to do is public health nurses to assure that health for our individuals. So you know, like I mentioned earlier, it seems like what goes around comes around. And so this may be one of those things that are going to circle around, and I don't know for sure, but it just sure wouldn't surprise me if we don't see a resurgence of that approach to help us with our individuals that we're we're taking care of in the community.

Pam Stokes:
Yes, I agree with you completely, and I thank you, guys, for that thought, because it just makes me excited for what is to come, and I, I am always glass half-full when it comes to nursing, because nurses solve problems, and we always seem to, right? We're always taking care of that patient in our population. So what I took from this, I took several nuggets about this, and I hope that you guys watching did, too, because we have some great educators on this panel that have really given us some nuggets to walk away with today. But I encourage you guys to be change agents in the field. Get out there and talk to an educator like one of the panelists today. Go back to school, talk to a faculty member or supervisor, or a peer, and network with other nurses, because I really think that we can make some really positive differences in health care and in our patients' care. So I'm going to close by saying, I thank you guys so much. It's always nice to network with other professional nurses who are doing great things, and I love the message of lifelong learning, because just when I think I've got a grasp on something, I hear a couple of new pearls of wisdom from folks like you. So thank you both so much for what you do, and for your time today.

Toni Frioux:
And I would encourage you to get the participants if they have any questions, please contact us, You know I'm always more than happy to, you know. Provide, share what little bit of knowledge I might have, or connect people with resources, or hook them up with someone that I might happen to know. So it's been a pleasure, and thank you for inviting us to participate today.

Pam Stokes:
Absolutely. Absolutely. And so I'm gonna close by just reminding you guys that we're with Oklahoma City University, Kramer School of Nursing. And so please look us up on Linkedin and on social media platforms. Our website. There are several ways that you can find us just by Googling our name, and you can check us out. You can check out the new Community-Based Public Health Masters in Nursing that Kramer is offering, and, like Dr. Frioux said we'd be happy to chat with you. Thank you so much for joining us today.

Toni Frioux:
Thank you.