Missionary Nursing: A Transcultural Calling
Source: Bettijane Eisenpreis
Amy Roberts, RN, MSN, FNP-C was in her senior year in nursing school when she made an important career decision. "While on a short-term mission trip to Belize, Central America, I had to deliver a baby," she recalls. "I sweated more than that poor mother did, because I was the only healthcare provider around. I already knew that God intended for me to be a missionary nurse, but I discovered that I needed to be more comfortable practicing in the absence of a physician. I decided to become a nurse practitioner." Today, Roberts is a nurse practitioner and helps prepare others for similar roles.
Roberts is Program Coordinator for the Family Nurse Practitioner program at the Baylor University Louise Herrington School of Nursing, Dallas, Texas. As a teen, Roberts, the daughter of a nurse and a pastor, never dreamed of becoming a missionary nurse. "I was at that stage when you just don't want to do what your parents do," she says, "but during mission trips with my church, I came to realize that I had a divine calling toward missionary nursing. It didn't hit me until I was in nursing for a couple of years how much I really enjoyed it."
In 1994, Roberts came to Baylor as a lecturer, teaching undergraduate students. She was instrumental in starting the Family Nurse Practitioner program, one of four tracks in Baylor's Master of Nursing program. Baylor's four graduate degrees offered are: Nursing Administration and Management, Advanced Neonatal Nursing, RN to Masters, and Family Nurse Practitioner (FNP).
"Our FNP track has a special emphasis in preparing those who would like to serve in transcultural settings," Roberts says. "The two-year curriculum is designed for missionary nurses but accepts any qualified student when space is available. Students have the option of doing from six to eight weeks of their clinical rotation in a mission setting during their final semester. Three classes have graduated to date and the fourth class will begin this fall. Baylor graduates have an impressive 100% passing rate on the national certification examination."
Chartered in 1845, Baylor is the largest Baptist university in the world. Its nursing school, once a diploma program of Baylor University Hospital, became a degree-granting school of the university in 1951 and was renamed the Louise Herrington School of Nursing in 1999 in honor of a faithful supporter. For the past three years Baylor has been listed in U.S. News and World Report as one of the top 100 graduate schools and one of the best buys in higher education.
Prior to her arrival at Baylor, Amy Roberts served as a family nurse practitioner and clinic coordinator in Tanzania, East Africa. She wrote a thesis on how to do that type of work while she was completing her Masters in Missions at Southwest Baptist Theological Seminary. Combining practical knowledge and zeal, she helped design the program of which she is the coordinator.
The FNP program attracts nurses who are interested in missions as well as missionaries who want to improve their advanced nursing skills. "Students understand that they are going to get a good dose of transcultural knowledge, along with learning how to start a clinic from scratch, write a business plan and get funding," Roberts says. "For their final semester papers, they have to go out and look for grants for their specific area of interest, whether it is a particular patient population or a location for a prospective clinic. Baylor teaches FNP students that when starting a clinic, you need to start small. A new clinic cannot start with a whole range of services, in order to remain financially viable."
Although not all the graduates go into missionary work, the FNP program at Baylor does include faith in its curriculum. "We train nurses to see the person holistically. We want them to see the physiological, psychological, social, and spiritual aspects and treat the whole person. That's where the blended role comes in," says Roberts. "One of the courses is a healthcare missions course where students learn to know their faith well enough to explain it to somebody else. There is no quantifying factor on what a person's faith is, but he or she has to be able to explain it."
Roberts juggles an impressive array of tasks. "As the coordinator of the FNP track, my day-to-day responsibilities often involve student issues (for example: recruitment, retention, and advisement), curriculum development, preparation for class or teaching, and other administrative duties regarding program development." An average week also includes visiting students at clinical sites, and practicing as a Family Nurse Practitioner one day a week in a faculty practice inner city clinic. Roberts also teaches at this clinic, as all the Baylor students rotate through as part of their clinical experience.
The NP-run clinic, located in Roseland Homes, a city housing project, is a joint effort of the Central Dallas Ministries and Baylor University. The Central Dallas Ministries provide the space, nurses, translators, and office personnel and Louise Herrington School of Nursing faculty members serve as the primary care providers. The clinic is operated through private donations and grant money permitting patients to be treated for a nominal fee of five to fifteen dollars per visit.
"Dr. Lisa Taylor, FNP, another Baylor faculty member, also works one day a week at the clinic," says Roberts. "Dr. Taylor is currently conducting research regarding depression among this patient population. Sixty to seventy percent of the patient population is Spanish-speaking. Most of the patients are hard-working people who do not have health insurance offered at their place of employment."Ê In July 2002 the governor of Texas, Rick Perry, visited the clinic and discussed health care reform with clinic staff. During the visit Governor Perry asked Roberts about the health care initiatives of local agencies.ÊÊ
One of the FNP program's graduates, Charles Kemp, MSN, FNP, has put his transcultural training into practice. Kemp wrote grants to start and operate an East Dallas clinic geared toward meeting the health care needs of the local Asian community. "He is a local community leader, a member of Baylor's school of nursing faculty, and an excellent nurse practitioner," Roberts says. Kemp was recently accepted as a Fellow of the American Academy of Nursing for his outstanding scholarship and leadership in nursing.
At the time of this interview, Roberts was completing her Ph.D. dissertation. Her subject is "faculty practice and how it's reimbursed, both in terms of scholarships and in regard to tenure and merit," she explains. "Nurse practitioner faculty are required to practice approximately one day a week in order to keep up their certification. They need certification in an area in order to teach in that specific area." Roberts is researching what universities are currently doing to include this required faculty practice in their tenure and merit review systems.
After finishing her dissertation, Roberts hopes to be able to spend more time recruiting potential missionary nurses for the Baylor program. Fifty percent of the first graduating class went into some kind of missionary nursing or practicing in under served areas. Subsequent classes had smaller percentages of graduates who went into underserved areas. For many missionaries and potential students the inhibiting factor to enrolling was the tuition. However, now Baylor is able to offer scholarships to qualified individuals, which makes recruitment much easier.
"While the FNP track emphasizes the education of missionary nurses," says Roberts, "we realize that many nurses who are currently in the mission field cannot come to Dallas. The school, therefore, co-sponsors a continuing education conference for missionary nurses. Baylor has sponsored two of these International Nursing Continuing Education Conferences in Nairobi, Kenya, Africa. These conferences provide enough continuing education units to allow the missionary nurses to retain their advanced certification credentials. In March 2002, 112 nurses, representing 24 different countries where they serve, attended the latest conference. Baylor plans to continue sponsorship of continuing education conferences for missionary nurses on a biannual basis.
Roberts served as coordinator for both the 1998 and 2002 conferences. In 2002, she taught physical assessment, zooanotic diseases, nutrition in developing countries, suturing, and management of common respiratory diseases. She selected the faculty, who taught on topics requested by the 1998 conference attendees. Since most of the missionary nurses attending the conference deal with AIDS on a daily basis at family practice clinics, an AIDS update was included in the curriculum. The conference attendees evaluated it highly, partly, as one attendee put it, because "Amy makes the conference so practical. Her experience, both as a missionary nurse from Africa's bush and as a nursing educator, enables her to know what the educational needs of missionary nurses are."
"As the world's population has increasingly become mobile, there has been a need to refresh American health care providers on diagnosis and treatment of some of the increasingly common tropical diseases, which previously were located in the tropical and developing countries," she explains. "In addition to the typical courses found in FNP curricula, students in the Baylor program learn diagnosis and management of tropical diseases as part of their curriculum. They also learn how to identify parasites like malaria in microscopic slides."
After completing her doctorate, Roberts looks forward to staying at Baylor and watching the FNP program grow. She would be "thrilled" to send out ten missionary nurses a year from the FNP program. "Missions are not constrained by the location one serves in," she says. "It is an attitude that people have toward their work. This attitude of service is motivated by the redeeming love of God in one's life. Humbly serving others and helping them heal holistically is what Christ did and what we hope our graduates will do. Whether they do that here or in another country is immaterial." People interested in more information about this program or other degrees offered at Baylor can obtain information, course descriptions, and application forms at www.baylor.edu.
Amy Roberts received her bachelor's degree in nursing from Dallas Baptist University, her MSN from the University of Texas, Arlington, and her MA from Southwestern Baptist Theological Seminary, Fort Worth. She is a graduate of the Walter Reed Tropical Medicine Course and has pursued specialized studies in tropical medicine. From 1987 to 1994, she served on the Foreign Mission Board of the Southern Baptist Convention in Kigoma, Tanzania, East Africa. She is the author of numerous articles in peer-reviewed journals and has presented papers and lectures on a variety of subjects. Recently, she has co-authored a series of articles relating to the clinical diagnosis and management of infectious diseases found in the refugee population and tropical world.
Bettijane Eisenpreis is a freelance writer from New York City, and is on the editorial staff of NEWS-Line for Nurse Practitioners.
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