Teaching Students To Be Bold Patient Advocates

Donna Cill oversees student services at Columbia Nursing. Her office assists students with academic and career advice, connects them with mentors, and provides continuing education programs, and social and extracurricular activities.  A graduate of our Family Nurse Practitioner program in 2000, Cill joined the faculty in 2014 with a goal of creating a learning environment where all students will be inspired to be nurse leaders. Prior to her arrival at Columbia Nursing, she was the assistant dean of student affairs at Rutgers University School of Nursing and its director of their continuing education program. Her research on adolescent health and mother/daughter communication can be found here.

1. Having studied the health risk behaviors of adolescents for more than 15 years, what interventions are available to nurses and parents to reduce young people's harmful behaviors?

Research shows that good communication between a child and at least one parent reduces every adolescent health-risk behavior identified by the Centers for Disease Control and Prevention.  Even teenagers who engage in daily general conversations with their parents show a decrease in these behaviors.

Discussing smoking, for example, can be tough, but it’s important to talk about. A mother should explain tobacco risks if she suspects her daughter smokes. She should express why she doesn’t want her to smoke, but say it calmly: My research shows that teenagers say “ranting” is not an effective communication technique. Inviting kids’ friends and their parents to the house can also discourage harmful behaviors. When parents know their kids’ friends, risk factors decrease. 

2. A mentor can be an important factor for a nursing student’s success. Did you have a mentor who played an important role in your professional life and what lessons did you learn?

One of my undergraduate nursing professors, Diane Green, had an especially strong influence on me. I was studying nursing and raising a daughter alone whom I had given birth to as a teenager.  Professor Green encouraged me to volunteer and participate at board meetings at a local organization for teenage mothers. I provided tips on breastfeeding, nutrition, infant positioning and preventing Sudden Infant Death Syndrome.  For the first time in my life, I was valued for my expertise as a nurse and a mother.

I planned to become a nurse anesthetist, but Professor Green pointed me in a new direction. She recognized my strengths communicating with patients and families, and pushed me to become a family nurse practitioner. She encouraged me to apply to the master's program at Columbia.  I keep a painting in my office that she gave me of an angel hovering over a community. It serves as a daily reminder of my strengths and determination to make a difference in people’s lives.

3. Among the skills offered by the school’s Career Development department are leadership training, LinkedIn networking, and resume writing. What is changing in the health care workforce that make these “soft skills” so important?

The nursing job market is very competitive. Hospitals want nurse practitioner candidates who stand out as leaders in addition to having high GPAs and rigorous clinical experience. We encourage our students to participate in student and professional nursing organizations to make them stand out to employers.  And we hope they grow as leaders after they’ve been hired! We want our students to be quickly promoted from staff nurses to positions of leadership such as nurse educators, supervisors, and nurse managers.

Hiring managers look for proactive nurses who communicate effectively with other members of the health care team.  When I worked as a nurse on a telemetry unit, I often alerted the physician when a patient seemed lethargic or their blood pressure dropped. Sometimes I suggested changes in their cardiac medications, if I felt there was cause for concern. Sometimes the doctor appreciated my advice and sometimes they didn’t, but I always tried to advocate for my patients. I push our students to become bold patient advocates.

4. Nurses today have many options available to them beyond the acute care setting. How do you inspire students to think about additional career paths where nurse leaders can make an impact?

I worked in a hospital setting for several years. I enjoyed it, but working in the community suited my personality better. I tell students that nurses make valuable team members in many fields: Public health departments, patient safety, quality assurance, for example.

We are sponsoring a student lobbying trip to Albany this month to demonstrate the impact nurses can have on health policy. Columbia Nursing offers study abroad programs in the Dominican Republic and Spain to provide insights into global health. And many students discover new career paths from volunteer work and clinical placements in non-hospital settings like community health centers.

5. As an advanced practice nurse who participated in a medical mission in Jamaica, and consulted in Guyana, Egypt, and the United Kingdom, what do nursing students gain from experiences abroad and in international volunteer programs?

When students witness firsthand how limited resources affect health care, they gain a deep understanding of health systems in other countries.  In Guyana, I saw two, sometimes three, sick people share a single hospital bed. Providers used bar soap instead of liquid soap as a disinfectant before touching patients. Patients were  resuscitated with the most basic CPR techniques because hospitals lacked ventilators, defibrillators, and emergency cardiac drugs. I helped rural Jamaicans who had waited six months to be treated for coughs and yeast infections. They waited so long because the journey to the clinic was difficult and expensive. On the flip side, I witnessed long wait times to see a provider in resource rich countries in Western Europe.
These global experiences provide valuable insights for nurses working with immigrant populations in the US. A patient might present irreversible congestive heart failure because he waited too long for treatment. But the nurse might refrain from judgment if she understands that he came from a country with poor health infrastructure. Instead, she will focus on educating the patient on the value of preventative health.

6. If you could go back in time and advise your younger self, what would you tell her?

Be bold and fearless. Speak up because your voice matters.