Nurses See Health Inequities Every Day. Can Doctoral Study Help Them Tackle These Problems?

Jeffrey Fouche-Camargo [00:00 – 00:23] – Our whole philosophy of what it means to be a nurse is really based on viewing people as a holistic being, not as their disease or not anyone or even a combination of whatever their sex, gender, race, you know, those are all part of who they are. But if you really want to help them move toward health and away from illness, then you have to look at that holistically. 

Jasper Nighthawk [00:29 – 02:12] – This is the Seed Field Podcast, the show where Antiochians share their knowledge, tell their stories, and come together to win victories for humanity. I’m your host, Jasper Nighthawk, and today we’re joined by Jeffrey Fouche-Camargo for a conversation about how doctorally prepared nurses can use their unique skill set to promote health equity and social justice for marginalized populations. I’ve long wanted to learn more about doctoral training for nurses. Nurses, as the frontline workers who are spending hours and days in close contact with their patients, are in a powerful position to transform each patient’s encounter with the medical system. But I think for nurses, they often see their work as very practical. They’re helping patients with acute pain or decisions of life or death or negotiating with doctors, all sorts of different case-by-case situations that they’re specifically trained for. And this means that nurses don’t always think about these bigger questions of how they could be contributing to increasing the justice of the medical system as a whole. So this is why I’m really interested in the way that a doctoral degree invites mid-career nurses to come back to school so they can reflect on the experiences they’ve had and the problems that they would like to solve and hopefully become more effective change agents in their field. Let me quickly introduce our guest. Jeffrey is the founding director of the Doctor of Nursing Practice Program here at Antioch University. He holds a Doctor of Nursing Practice. He has extensive experience working as a nurse and as a nurse practitioner, and he has especially focused on women’s health. Jeff, welcome to the Seed Field Podcast. Thanks. 

Jeffrey [2:12 – 02:12] – I’m glad to be here. 

Jasper [02:13 – 02:47] – To start off, I always ask guests to disclose their positionality. I found it’s a good place for us to start a conversation, being open where we’re coming from. So I can go first. I’m white. I’m a cisgendered man. I’m queer. I’m not living with a physical disability, but I do experience anxiety and depression. I have since I was a kid. I have a college degree and a master’s, and I currently have a steady salary job and steady housing. And I also am a parent. I have a two-year-old. All right, I’ll pitch it over to you, Jeff, as much as you’re comfortable sharing where you’re coming from. 

Jeffrey [02:47 – 03:14] – Similar to what Jasper was saying, I am also a white cisgender male. I am gay and I do not have any concerns with food or home security. I also have a salary job, steady income with that and medical coverage. No physical disabilities either. I also have had depression and anxiety for most of my life as well. It’s something that I continue to work with as well. 

Jasper [03:15 – 03:44] – Thank you for sharing that. And yeah, thinking about the access to medical care, insurance coverage, whenever you say it out loud, it forces you to sort of recall that there are millions and millions of people in this country, the richest country in the history of the planet, they say, who don’t have access to those things. So let’s jump into talking about doctoral training for nurses. And I just wanted to ask like the most basic question, which is why do nurses and nurse practitioners. Why do they get doctorates? 

Jeffrey [03:44 – 04:51] – The whole doctor of nursing practice degree was to establish a way for nurses who, before this, the option, if you wanted really a doctoral degree, your only option was to get a PhD, which is a research-focused degree. And the vast majority of practicing nurses, that wasn’t something they were interested in. But the doctor of nursing practice is a practice-oriented degree. And so it’s all about the clinical settings and how we can take those problems that we encounter in our day-to-day work and, you know, come up with solutions on how to fix that. We needed to have a way to take nurses who wanted to make a difference, who wanted to improve outcomes, who wanted to do something about the, you know, the disparities and inequities that they’re seeing every day in their work. How do we fix that? You know, it’s not good enough just to say, I wish it didn’t exist or to say, you know, I wish someone would fix this. So if you want change, then you need to be the ones to do it. And that’s kind of how that whole degree got started was to address that. 

Jasper [04:51 – 05:24] – This got to something as I was learning more about the DNP as a degree where I was thinking, man, before this, my understanding of the medical system was like the people with the highest degree who are getting doctorates are doctors, they’re MDs or DOs. And I wasn’t thinking that that would even be something that nurses would go into. So I guess I’m curious what kind of people are attracted to this type of study? Like who are some of your peers who have gotten DMPs or students who you’ve seen wanting to go for this degree? 

Jeffrey [05:24 – 08:10] – So the students that I’ve had the pleasure of working with during my time and teaching graduate students, almost all of them, they come to this degree program with what I would almost like I was saying earlier, like they see this problem. They know it exists. They know there has to be a solution to it, but they see that the solution is not being done. And so most of these students are coming to these programs to be like, OK, I’m going to have to be the one that fixes this issue because I see it. It’s obvious that this problem can be addressed. How do we do it? And so a lot of that curiosity and desire to make a difference is what drives these practicing nurses back into school to get these degrees because they want to make that difference. Just to give an example, one student that I work with recently, she’s been a nurse practitioner for a number of years. She worked in a clinic that saw a lot of indigent patients that didn’t have health insurance and that a lot of them had diabetes. And one of the complications from diabetes is that you can end up having to need an amputation of a foot. And she kept seeing these patients that would come in, and they weren’t managed well. They had all these issues surrounding access to care and affordability to care. Can they get their medications? Can they follow all these dietary recommendations? And they struggle with that. And then they end up having these amputations. And she was just like, I have to do something. I know there’s a way to decrease the number of patients who are having these amputations. And so that’s what got her started in it. And a lot of these, most of these projects are always centered around a very local setting. And that’s one of the things that’s kind of different about the types of work that DMPs do versus some nurse with a PhD is it’s very localized. We see this local problem. How do we address that? And so that’s kind of what she did. She went through and figured out how, what were these barriers? And then how do we get rid of these barriers? And what she found was one of the key problems was, you know, you would hand patients this booklet or whatever about here’s your diet that you should follow. But no one ever sat down with them and said, you know, what on this list do you eat? What do you not eat? Like, are there alternatives? And that’s what she found. A lot of them were like, I can’t follow this diet. My family doesn’t eat these foods. Like, it’s not the kind of foods that I buy. I don’t have access to fresh fruits and vegetables. Oh, my gosh. she was finding too was like, so her whole idea was to meet these patients where they are. They’re not going to be able to follow this diet. So what can they follow? What can they eat? What can we address? And having those very individualized conversations with patients. 

Jasper [08:10 – 09:05] – Thank you for sharing that. I think that brings up an interesting question of where we draw the edge of the medical system or of medical care. And, you know, for some people who are living unhoused, it can be only when you’re having an acute crisis will you be picked up, brought at great expense to an emergency room, given emergency medicine, and then discharged. And oftentimes we find that there’s more effective money-wise and also outcome-wise to be meeting people where they are, to have community health workers on the streets working with unhoused populations, or perhaps even better, getting housing for those people. Yeah. So it seems like it’s kind of an invitation to think about health more holistically or to approach problems without the blinders of like, I have to get my nurse’s station ready. I have to, you know, see 10 patients in the next hour, but to zoom out, would that be a fair characterization? 

Jeffrey [09:06 – 09:51] – Absolutely. And that’s actually kind of one of the things that make nursing kind of unique in that setting of particularly with nurse practitioners being primary providers is they’re coming to that role from a nursing perspective and nursing background. And our whole philosophy of what it means to be a nurse is really based on viewing people as a holistic being, not as their disease or not anyone or even a combination of whatever their sex, gender, race. You know, those are all part of who they are. But if you really want to help them move toward health and away from illness, then you have to look at that holistically. You have to take into account their mental health. You got to take into account all those social determinants of like where they live. 

Jasper [09:51 – 09:59] – Yeah. Can you give me like the elevator pitch for what makes nursing different from medicine as a discipline? 

Jeffrey [09:59 – 11:04] – Sure. The one key thing is that having that holistic view of the patient. One of the theoretical backgrounds of what we base nursing on is looking at what we call human response patterns. Like we’re interested in how people respond to changes in their health, in their environment. Is that response helping move them toward wellness or is that response keeping them over toward that illness side? And then how do we not just solve it for them, but how do we work with them to come up with common goals? Those very personalized conversations about, you know, what are your goals for this? Because if we can get that patient on board with what we would like for their outcomes to be, then they’re more likely to want to do those things. versus if you just approach it for that very paternalistic view of I’m the expert and I’m telling you, you need to do ABC or you’re going to get sicker and you’re going to die. Like that’s doesn’t feel good on that receiving end because, you know, I have no idea if that patient can do all these things that, you know, I’ve told them to do. So asking them and having those conversations. 

Jasper [11:04 – 11:10] – Oh, I know. I know exactly what you mean. So I wanted to ask you, why did you get a doctorate, Jeff? 

Jeffrey [11:10 – 11:59] – So I was working as a nurse practitioner and also working as another role called a clinical nurse specialist. It’s a whole different topic one day if we want to explore that. But I was working kind of both of those roles in the hospital setting and kind of the same way. Like I, you know, I had in my master’s program, I had some knowledge about how to identify problems and, but it was very regimented, like, you know, do this and do this and do this and didn’t have a lot of broad applications. And so that was one thing that got me thinking like, you know, how to address these problems more broadly. And then also I was doing a lot of training and education for new nurses. And so I got very interested in that teaching piece. And so it was a combination of those two things really that drove me back to get my doctorate. So it was kind of a practical reason and a clinical reason for me that I went back to school. 

Jasper [11:59 – 12:18] – And it obviously has led you to teaching and directing this DNP program yourself. I wanted to ask, I know you have a background in women’s health, and I wanted to ask how that came into your doctoral studies and also into your teaching. 

Jeffrey [12:18 – 13:45] – I was in nursing school, you know, as a junior in college, I had grown up in a very rural area, didn’t have a lot of exposure to anything outside of the area that I lived in. And so when we were in our maternity rotation, I went to one of the big hospitals there in town, and it happened to be a very, very busy day. And I was paired up with a nurse, and she had two patients who were in labor. And then the nurse I was working with says, oh, my other patient wants to get an epidural. Are you okay just kind of staying in here and just kind of talking and getting to know her? I was like, sure, I can do that. So about 10 minutes after that, the patient that I’m in the room with starts telling me that she’s ready to have the baby. And I’m like, no, no, no, no. It’s not time yet. The nurse was just in here like, it’s not time. And she was like, no, no, no, it really is. And I was like, all right. And that whole excitement of everything happening all at once. And then I remember the physician came in the room and kind of like kicked off her shoes and put her gown on really quickly. And like within less than 30 seconds after she was there, the baby was born. And I was like, wow, that was kind of fun. Like, you know, that adrenaline rush. And at the end of that adrenaline rush, look what you got. You got this baby and you see this family that’s getting to bond and this very happy moment. And I was like, I might want to do this. And so that kind of sparked my interest. And I got that’s the day I knew that’s what I wanted to do. And so that’s what I’ve always done. 

Jasper [13:45 – 13:59] – Oh, how sweet. I know my partner and I, when we had our kid, the delivery nurse, we were incredibly fond of. She made it a wonderful experience in a lot of ways. So what was your project, if I could ask, when you did your DNP? 

Jeffrey [13:59 – 15:51] – So my project was focused on, you know, there was a ton of evidence talking about how the importance of having skin-to-skin contact between the mom and the baby in that first hour after birth allows a lot of physiological changes inside the body. It changes chemicals in the brain. And we have evidence that shows that that improves the amount of time that the mom breastfeeds the baby. And so we had worked very hard on that at the hospital I was at, but only for people who were having a vaginal delivery. If they were having a cesarean delivery, the birthing part was kind of way secondary. This was a surgical procedure. You’ve got to follow all the rules of surgery. And it might be an hour and a half, two hours before that mom would ever see her baby, other than a quick little glance, like, here’s your baby, we’re going. And so they missed out on that. And I didn’t think that was, it didn’t seem right to me that these moms who are having this type of delivery, they miss out on something. And why? Just because we have all these rules about what you can’t, like, well, why are the rules there? Do they actually do something? And so my project was we implemented being able to have the mom, you know, in the operating room while the mom is being kind of put back together, she’s holding her baby skin to skin in that operating room. And we even had a couple of times that the baby would do what babies do and go and latch on and start breastfeeding right away kind of thing. And it was just a wonderful experience. And one of the first patients that I had to do this with my project was actually a co-worker of mine. She was pregnant. She happened to come in to deliver the day that we were starting the new process. And so that was even more special. I got to work on my project that meant something to me. And I got to share that with one of my colleagues as well. So I was very glad that we were able to get that done. And so it became kind of the norm that, you know, patients that were having a cesarean birth still got to have skin to skin contact with their baby. 

Jasper [15:51 – 15:59] – What a beautiful project, Jeff. Thank you for sharing that. And did that end up changing the practice at that hospital kind of in a permanent way? 

Jeffrey [16:00 – 16:18] – Yes, it did. And not every single patient was able to for different reasons, like if there were complications or things. And then sometimes the mom may not have that preference that she didn’t, you know, she may not want to, and that’s fine too, but it became the default unless something else occurred that, you know, would prevent that. 

Jasper [16:19 – 16:42] – I feel like people have this feeling like I need to get an A on my birth and that is to be avoided. But it’s like, if possible, that skin to skin contact is so precious. And yeah, I will say for a dad as well, it was really precious. I wanted to ask you to talk a little bit more about how specifically nurses promote health equity and how you think about cultivating that inside of a doctoral program. 

Jeffrey [16:43 – 19:08] – So that’s one of the things that actually drew me to Antioch was learning about the mission of Antioch, hearing about what the Coalition for the Common Good was all about. When I learned about these programs, that totally spoke to me as a professional and as a nurse and as a person. And that’s one thing that kind of makes our program more unique. It’s kind of built in that You can pick whatever topics you want to do your project on, but part of that process must include something along the lines of reducing health disparities, increasing health equity, and looking at things through a social justice lens. And so we kind of purposely and intentionally built the entire curriculum with those concepts threaded throughout it. Because, again, it’s very common for nurses who are working with people and patients every day. They know that people from certain different type of minority groups or vulnerable populations, they’re not going to have as good outcomes as somebody who’s not from one of those groups. And so nurses see that. And so when we talk about things that impact people’s health, a lot of times we need to understand people’s behaviors. And so we talk about terminology around behaviors versus ways people identify themselves. That plays right into a lot of disparities that we see related to gender, related to sexual orientation, gender identity. Like all of these different aspects of what makes people who they are can impact the type of care that they receive. Because unfortunately, even when we have awareness, there’s still a lot of times implicit biases that people may have, they’re unaware of, and patients are experiencing discrimination from providers. And sometimes it’s not even intentional. Like I said, it’s implicit biases that they don’t even know they have until they have to face it. And that’s not a comfortable place for a lot of people to have to face their own biases. And so we work on that, too, to understand how to identify what those are. And we try to do that with compassion. This is going to feel uncomfortable. You may discover things about you that you didn’t know, and you may not like or be proud of, but having that awareness is the first step. That’s how we find out. And then if it does make you uncomfortable, good. That was the goal. I wanted you to get uncomfortable. And now that you’re uncomfortable with it, let’s figure out how to remove those biases so that you don’t have to feel uncomfortable anymore about that. 

Jasper [19:08 – 19:50] – No, that kind of role-playing makes all the sense in the world. And I know, certainly talking about working with LGBTQIA populations, we interviewed earlier this year Rachel Ciccarella, who’s a faculty member in the Doctor of Psychology program on our New England campus. And she was talking about bi plus mental health. And she pointed out that when people go to the doctor, see their, you know, their GP, or maybe see a nurse practitioner in family practice, they oftentimes there is a kind of a standard screening question of like, what is your sexuality? And that the typical answer when you disclose that you sleep with same sex people is, oh, we’re going to want to get some STD checks. 

Jeffrey [19:50 – 19:56] – Oh yeah. I’ve experienced that myself as a patient. 

Jasper [19:57 – 21:02] – Yeah. Yeah. Yeah. And so yeah, me too. And so that’s like, that’s the only response. And her point was, we know that bi+ populations have much heightened rates of severe depression than other sexuality populations. And so you might want to ask a follow-up question, which is how many sexual partners have you had in the last year before you go ordering that test. But there also could be other questions like, how is your mental health? I know people who are, have this characteristic of their identity have a heightened risk of these things. But I think if you’re, if that’s not on your radar, I mean, and me as a, as a non-health professional, I’m learning about these things. It’s like, oh, I do wish that my doctor would ask questions like that rather than just being like, all right, we’re going to run some checks for STDs. And it’s like, if you’ve been monogamous or you know that that’s not a problem, then that’s a kind of irrelevancy and kind of stigmatizing saying like, oh, if you’re queer, if you’re this or that, like, therefore, we think that you’re engaging in sexually more dangerous behavior. Right. 

Jeffrey [21:03 – 22:13] – You mentioned, you said a word that I actually, that has some personal issues with me and And also a case study that I work on, and that’s, you said something about, you know, are you monogamous? And so one of the case studies that we work on is, again, not making assumptions that mutual monogamous relationships are the only safe option. That’s one of the case studies we work on is to understand that, you know, instead of asking somebody or using the term, you know, mutually monogamous, like you can approach it from a better standpoint and understand that people come from different points in their life. And they may be in relationship configurations that you may not understand and you’re not involved in it. So, you know, you don’t know what the rules are, but not making those assumptions can make a big difference. Because, you know, if someone finds out that, you know, you’re not monogamous, you know, that it becomes that same thing of like, oh, you know, well, you must be promiscuous. And so we need to do all this stuff. And I’m like, no, because I mentioned kind of a personal thing. That’s, you know, I am in a quote, a polyamorous relationship is a closed triad where the three of us have that same type of trust. in relationship status of exclusivity between us. So there’s no difference. It doesn’t put any of us at more risk than anybody that’s in a monogamous relationship. 

Jasper [22:14 – 22:44] – Yeah. No, thank you for disclosing that about your own story. And it’s always, I think, powerful to talk about how these things intersect with our own lives rather than just in the abstract. I wanted to turn and talk about the Antioch program in particular. So you’re accepting your first cohort of students in January. Correct. And I was wondering if you could talk a little bit about some of the other choices that you’ve made or places where you’ve emphasized one thing or another as you’ve been designing and thinking about welcoming your first cohort of students. 

Jeffrey [22:44 – 24:12] – So outside of what I was saying earlier with really trying to honor the mission of what Antioch stands for as far as disparities and equity and looking at things with that social justice lens. We also, we have classes about leadership and what does that mean to be a leader? You know, because a lot of people come to that class thinking, well, I don’t need this class because I’m not a nurse manager. I’m not going to be the administrator. And we’re like, well, you know, there’s a difference between managers and leaders. Let’s talk about that first and what it means to be a leader and remind them that they’ve probably been leaders multiple times in their career. They just didn’t have that label. A lot of our classes are geared toward working on those skills, working on leadership skills. And then we also want all of our graduates to graduate, not just be leaders, but we want them to be advocates. We teach them how to interact with policymakers. How do you have that conversation with a city council member? How do you have a conversation with your senator? We want them to be able to do that too, because that’s part of how you make change is figuring out who are the people who have the power to make the changes. How do you engage with them and get them to see what I see? So we want our nurses, our graduates to be able to do that too as a big part of our program is we want you to be a leader. And being a leader also means being an advocate and understanding all the things that impact healthcare because it’s not just one little piece. We’ve got to look at all these pieces to make a difference. And so a lot of our classes will focus on that as well. 

Jasper [24:12 – 24:47] – I love hearing about all of these different ways where in the way I was hearing it is Somebody would come into your program thinking, I know that I want to make a bigger difference, make a bigger impact. And you’re giving them these different tools and approaches and strategies to be able to sort of isolate a problem, conduct a research around it, and advocate for its implementation in ways that are maybe more likely to be effective than kind of an ad hoc taking your best guess. So we’re almost out of time, but I wanted to ask as a last question, what are you most looking forward to when you welcome your first cohort of students in January? 

Jeffrey [24:47 – 25:36] – We’re going to have students from all over the country. And that’s going to be a new thing for me. I have not, you know, I’ve currently I’m in New England, I’m in Connecticut, and I’ve lived in the South most of my life. So I’ve been in a couple of different areas, but like the students are always from there. And so this is going to be a new experience for me, having students all over the country in different time zones, living in different settings all over. And I’m kind of looking forward to that because I think that’s going to give me new skills and new things that I can learn about from just how to operationalize that, but also have that rich variety of experiences from students. That’s one thing I’m definitely looking forward to is having this cohort of students who are going to be kind of all over the country. I think that’s going to be new for me, and I’m excited about it.

Jasper [25:36 – 25:46] – That’s so cool. I hadn’t thought about just what a variety of perspectives and settings and experiences you’re going to have in there. 

Jeffrey [25:46 – 26:16] – Yeah, because the problems that we have here in Connecticut are not the same problems they’re going to have with somebody who’s living in rural Mississippi versus somebody who lives in a very isolated part of New Mexico, for example. So there’s going to be differences there too. So that’s going to be fun. I think it’s great for the students too, because they’re going to hear about these different problems from all these different geographic regions. And they’ll get to see the similarities, because I’m sure there will be some, and then they’ll see some of those unique flavors based upon where their classmates are from. So I’m looking forward to it. 

Jasper [26:16 – 27:40] – That’s great. Well, it’s been such a pleasure talking with you today, Jeff. Thank you. You can learn more about the Doctor of Nursing Practice Program on Antioch’s website. We’ll include a link in our show notes to the program page for the DNP and to the page for the whole Graduate School of Nursing and Health Professions. We’re also going to link to the website for the Coalition for the Common Good. That’s the larger university system that Antioch is a part of, and these nursing programs actually started at our partner university in the Coalition, Otterbein University. Finally, we’ll include a link to the podcast episode we mentioned, my interview on Bi+ Mental Health with Rachel Chickerella. We post these show notes on our website, theseedfield.org, where you’ll also find full episode transcripts, prior episodes, and more. The Seedfield Podcast is produced by Antioch University. I’m your host, Jasper Nighthawk. Our editor is Nastasia Green. Our producer is Karen Hamilton. Danny LaPointe and Liza Wisner are our work-study assistants. We received additional production help from Amelia Bryan, Melinda Garland, and Laurian Alexandre. Thank you for spending your time with us today. That’s it for this episode. We hope to see you next time. And don’t forget to plant a seed, sow a cause, and win a victory for humanity. From Antioch University, this has been the Seed Field Podcast.