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Dealing with reality: Confronting the global nursing shortageTamara McKinnon: Making international connections by Linda Puffer Live the questions now. Perhaps then, someday far in the future, —Rainer Maria Rilke, Letters to a Young Poet
The vision of the Honor Society of Nursing, Sigma Theta Tau International is to create a global community of nurses who lead in using knowledge, scholarship, service and learning to improve the health of the world’s people. Tamara McKinnon, RN, MSN, an honor society member since 1985, is doing her part to see that vision fulfilled.
Imagine that you are 18. You’ve completed one semester of community college and one EMT class, and your assignment is to serve as the sole “nurse” to inmates of a jail in Tijuana, Baja California, Mexico. McKinnon accepted that mission and began living the questions that would shape her passion for community health and international nursing. She grew up in Southern California, a suburbanite who didn’t want to live the suburban lifestyle. “I wanted something different, so I decided to join the Peace Corps when I graduated from high school. The Peace Corps turned me down, because I needed to have a college degree.” She’s not sure why she was given prison duty in Tijuana. “Maybe they decided since I’d taken the EMT class, that I was a nurse.” In any case, that was the role she was assigned and the experience was, in the words of McKinnon, an eye-opener. “I was no longer a shy, suburban teenager.” When she returned to Camarillo, north of Los Angeles, after completing the internship, she found that her perspectives had also changed. “I was sickened to see the wastefulness, extravagance and huge difference in way of life between what I had experienced in Mexico and what I came home to. There was no way to process that. I felt like, ‘What do I do with this information? I’m a completely different person, and yet I am supposed to just forget that and move on?’ “I decided, ‘Well, I can live in this society and in this culture, but I am not going to be the same. I am going to continue to do international work and, whatever I do, I am going to create opportunities for other people to do this kind of work. I was 19 years old, I think, when I had that epiphany, and I went on to nursing school.” McKinnon graduated in 1985 with a BSN from California State University, Chico and in 1990 with an MSN from San José State University (SJSU). Today, she is a leader and educator in nursing, as well as a compassionate, committed world citizen. In addition to her academic career of 17-plus years, she has been a public health consultant and community health advocate. Currently a clinical instructor and lecturer in community health and nursing leadership and management at San José State, McKinnon is also a faculty leader in the Study Abroad program at SJSU, for which she has been designated a Global Studies Fellow since 2003. It was during her time as an undergraduate student at Chico State that McKinnon found a “wonderful mentor” in the person of Carol Huston, who began a two-year term as president of Sigma Theta Tau International in November. “I really want to give her credit for inspiring me, for encouraging us to believe that anything we put our minds to we can accomplish. Meeting her and being inspired by her allowed me to see that I could continue with developing my goal of focusing on international programs. She’s continued to mentor me for at least 20 years.” McKinnon hasn’t strayed from her goal of facilitating international nursing experiences, and her proposal for an International Service Learning Project (ISLP) was formulated with an eye on how she can personally contribute to the global strategic plans of the honor society. The comprehensive program she has developed, which focuses on opportunities for nursing students, nurses and other health care workers to build international relationships. McKinnon’s fluent Spanish and her connections to Hispanic culture enable her to serve as an effective health care provider in Spanish-speaking communities. She’s especially proud to have received the 2006 SJSU Provost Award for Excellence in Service Learning for her visionary, compassionate work in developing a nurse-managed center for residents of Beach Flats, a small, high-crime, low-income community of underserved farm workers and other residents in the city of Santa Cruz, located in the upper midcoastal region of California, south of San José. Her involvement in the community is an expression of McKinnon’s long-term commitment to providing volunteer health care, even when circumstances have prevented her from fulfilling that commitment internationally. “When my kids were little,” she explains, “I realized that I wasn’t going to be able to pick up and go off to do international programs on a regular basis. What I thought was, ‘Well, we have a subpopulation here that certainly would benefit from intervention by students and would benefit students, in that it is almost a way for them to work in a developing country while doing clinicals here in Santa Cruz.’ “So, I put together a nurse-managed center. We have other nurse-managed centers at San José State, but they primarily serve elder populations. I modeled this after the traditional public health nursing model with home visits to patients, education, referrals and advocacy. Advocacy is a huge piece of what we do.” On most Mondays, McKinnon and a group of 12 students head off to the Nueva Vista Nurse Managed Center, located in a small office in an apartment complex, where their work contributes to a better life for the 60 families living in the area. They do home visits and offer stress reduction classes, support groups and educational programs. “I never imposed our agenda onto this community,” says McKinnon, “and I think that’s the reason we’ve been very successful. I use that same model for Study Abroad, and I carry that over into the ISLP program. You should never go into a community and tell them what they need or want. You go in and ask. You say, ‘This is what we’re capable of doing. Within those parameters, what do you think would be beneficial for your community?’” McKinnon developed her first “Study Abroad—Nursing in Ireland” program in 2004 and had a fortuitous connection to another Sigma Theta Tau International member, Anne-Marie Ryan, chief education officer for An Bord Altranais, the Irish Nursing Board. The honor society’s annual nursing research congress was held in Dublin that year, and McKinnon recognized an opportunity for students from the United States to work and learn in Ireland. She chose Ireland, in part, because there was less of a language barrier. The students who responded spent time in Dublin but also worked alongside nurses in Ireland’s rural northwest hospitals, in Sligo County. The service part of the trip was a continuing education course, requested by Irish nurses. Next year, McKinnon will be adding a Study Abroad program in St. Lucia, West Indies. She is working with the director of Sir Arthur Lewis College School of Nursing, Beverly Lansiquot, in the development of this collaborative project. Based on the experience gained from her service/learning programs, McKinnon has established the following goals for ISL:
To sum it up, McKinnon offers the following mission statement: “ISLP’s mission is to provide a comprehensive program that fosters the development of creative, synergistic and sustainable global partnerships.” Critical to ISLP’s success is development of a Web site and a certification program. The Web site, as envisioned by McKinnon, will provide health care practitioners access to a comprehensive database that includes ISLP data, along with updates and information on other international health programs. “There should never be a nurse or nursing student who says, ‘I’d really like to do international work; I just don’t have any idea of where to go or where to begin,’” she declares. “I hear that so often; I cannot tell you how often. The Web site would create an opportunity for nonprofit organizations, both in developing and developed countries, to announce: ‘Here’s what we’re looking for. We need five RNs and we need them to work in a clinic in Africa providing vaccinations. We can provide room and board, but they have to get themselves here.’ Of course, there would be some preliminary screening.”
The purpose of certification is to provide a more standardized approach to international nursing exchange to ensure consistent program quality, sustainability, and cultural and community relevance. The certification would involve an intensive training program initially offered to school of nursing faculty members and other nurses interested in implementing programs in service/learning and study abroad. Many programs offer international education and experiences to nurses but, according to McKinnon, they have two inherent challenges. No universal theoretical framework guides them, and no single source of information-sharing links the program directors and potential participants. The program that McKinnon envisions incorporates both effective networking and a common theoretical framework—cultural competency. ISLP also includes a holistic focus on collaboration that incorporates the principle of reciprocity. To illustrate, McKinnon recalls an experience from her first Study Abroad program in Ireland. “When we were at a seminar at the Irish Nursing Board, the seminar speaker chose as a topic the history of nursing in Ireland. When we talk about the history of nursing in the United States, we go back 150 years. In Ireland, they go back 1,200 years, and it is just amazing. There wasn’t a dry eye in the room when the speaker finished talking. It made you feel your roots in nursing.” She observes that, although the international programs she has led are for the purpose of service, those who participate feel they get so much more back than they give, and reciprocity between people and cultures is one of the benefits she has built into her International Service Learning Project. “True collaboration is a synergistic, reciprocal and mutually beneficial relationship between two parties,” says McKinnon, “and that reciprocity is also the key to a program’s sustainability, because energy is constantly flowing back and forth between those involved in the program.” The results, she emphasizes, aren’t necessarily determined simply by whether or not a participant continues to actively collaborate with peers around the world. A better way to measure success, McKinnon says, would be to ask these questions: “Ten years from now, are they still feeling that connection to the international community? Are they doing something, even if only in their own community, that demonstrates they’ve been changed by the experience?” RNL Linda Puffer, a past employee of the Honor Society of Nursing, now resides in San Francisco, California, USA. Reference: |
To serve the global community by placing senior and graduate level students and volunteer health care providers under the direct supervision of a clinical instructor to address community health problems that have been identified and prioritized by target communities.