Q&A with Dr. Grace Grau (DNP 2015)

UAB School of Nursing Assistant Professor Grace Grau, DNP, ACNP-BC, CRNP, AACC Advocate for Women’s Heart Health, is a board certified Acute Care Nurse Practitioner and holds a dual-appointment as faculty/instructor at the School of Nursing and CRNP at UAB Medicine in the Department of CVD/Interventional Cardiology. She received her Doctor of Nursing Practice (DNP) from the UAB School of Nursing in 2015. She is also the founding chapter president of the Alabama National Association of Hispanic Nurses (AL-NAHN).

Q: Why did you choose nursing as a career?

I was one of six children, and it seemed there was always someone injured. My mother was resourceful at making butterfly stiches and bandaging us up, so I had an apprenticeship throughout my childhood. At the age of 7, I had to go get stiches myself. I was afraid, but an elderly nurse with white hair, wearing a crisp white uniform and nurse’s cap held my hand during the procedure. She made it all better!

From a career standpoint, there was a need for nurses at the time. I would say the versatility of nursing and the fact it provides secure employment anywhere in the world were what attracted me to it. But the most important reason was my desire to have a meaningful impact on people during the most vulnerable times in their lives. 

Q: Your doctoral studies focused on how heart attack symptoms present in women. What led to this interest and focus?

During my first three years of practice as an NP in cardiology, I began to see a trend of women presenting with acute coronary syndromes with no evidence of blockages on their coronary angiograms. Their presentation and findings were inconsistent with the textbook picture at the time. More important still, I was seeing and reading about these women being told their symptoms were due to anxiety.  When asked by some of my patients to explain, I could not.

In thinking about this, I remembered my mother having been told she had a silent myocardial infarction at the age of 45 and wondered if her situation was similar to what these women were experiencing. As I searched the literature, I became aware that these women were not being treated according to the American Heart Association guidelines, resulting in poor outcomes and increased mortality. Now, anyone that knows me knows I am the type of person that needs to understand the fundamental reasons to account for things. Unfortunately, the answer was nebulous and did not satisfy me, and this is how it began.

Q: As a UAB School of Nursing DNP graduate, how do you think your degree prepared you for your current role?

The curriculum and training at the UAB SON enabled development of skills to lead, conduct and participate in quality improvement initiatives and translate evidence into practice. This skillset is something I use often in my role as an educator and when I serve as chair for students pursuing their DNP degree. An immediate benefit of having the credential was that health team members, particularly physicians, were more likely to hear what I had to contribute during discussions pertaining to patient care. In addition, having a doctoral degree rendered me eligible to advance in rank, teach DNP students, and apply for certain types of funding.

Q: You are founding president of the Alabama Chapter of the National Association of Hispanic Nurses. Talk about the importance of this organization and its impact on health care, students and nurses.

This year has strikingly brought light on pre-existing and longstanding issues with diversity, equity and inclusion. These issues, in many cases were and are well known to members of under-represented groups and served as catalysts to beginning organizations such as ours. The National Association of Hispanic Nurses (NAHN) started when a group of nurses felt their voices were not heard with regard to advancing professional growth and the health of their communities.

While the organization has chapters across the United States, with the exception of Florida, the South East United States lacked state chapters to advocate for and support Hispanic/Latino residents and nurses in those areas. The effort to start the Alabama chapter began in 2012, but logistics would delay the chapter formation until 2016. In 2019, the state of Georgia charted a chapter thereby strengthening representation in the SE United States.

Alabama National Association of Hispanic Nurses (AL-NAHN) is a group of healthcare professionals, including nursing students, who work together to improve the health of the Hispanic community. The collective goal is to create a cadre of highly qualified Hispanic/Latino nurses by advancing educational, professional and leadership skills and opportunities for our members. A major effort is to recruit additional Hispanic/Latinos into the nursing profession because, while Hispanics/Latinos represent 18% of the US population, less than 7% of the nursing workforce is of Hispanic/Latino descent. We provide educational opportunities and mentoring for all chapter members. We also welcome individuals of all ethnic/racial groups and disciplines to join us in our mission and feel the benefit of immersion contributes to improving understanding of alternative perspectives and cultural competence.

AL-NAHN members advocate, educate, volunteer, seek partnerships, conduct programming in Hispanic/Latino communities to improve outcomes, elevate literacy, heighten education, influence policy, and to improve health equity and create a future in which everyone regardless of race or ethnicity has opportunities to be healthy.

Students benefit from this chapter because they receive culturally competent mentoring, professional/leadership development, and a safe space to discuss the challenges that many Hispanic/Latino nurses and nursing students face. We also provide opportunities to network, preparation for joining the workforce and much more.

I’m proud to say that AL-NAHN has funded 10 members to attend Leadership and National Summer Conferences, raised funds for two nursing scholarships, secured five grants from the NIH, and completed several other important projects.

Q: What are some of the biggest challenges facing nursing today?

Under normal circumstances, clinical nursing is physically and emotionally taxing. Given the current state of our world, all boundaries have been stretched. The toll of the current COVID pandemic is rendering nurses physically and mentally exhausted. As I reflected on this, I ventured to guess the conditions might be similar to what military nurses experience during war times.

A great challenge is the shortage of clinical support and necessary resources to remain safe while providing expert care to an increasing number of patients during this COVID crisis. The challenge of competing priorities — family vs. work responsibilities. The challenge of time for self-care and replenishing one’s own wellbeing, the challenge of preserving one’s own health.  

Many of our nation’s nurses are balancing the needs of children being home, spouses’ loss of employment, caring for elderly parents, and limitations associated with their own needs. Professional organizations, State Boards of Nursing, and health institutions are scrambling and advocating for nurses, but this is still not enough. This made me think of Betty Neuman’s System Model and the need for nurses to build up barriers to protect themselves from external stressors.

Neuman’s System Model focuses on the different stressors and ways to relieve the impact from the different stressors. The model also focuses on how the individuals may react to the stress. According to Neuman’s model, the goal is the to keep the system stable throughout the three levels of prevention: Primary prevention is to strengthen and protect the line of defense. Secondary prevention is to strengthen the internal lines of resistance by reducing the reaction. To readapt or return to wellness following treatment is the third level of prevention called tertiary prevention.

On an individual basis, now more than ever nurses need to support professional nursing organizations through membership to enable further advocacy and provide a much-needed network of support. They need to ponder and discern their own priorities and boundaries. Dress yourself with moral courage and define which battles are worth fighting.  Everyone is struggling with similar issues, but everyone has varying degrees of resilience and support systems

Q: 2020 is the Year of the Nurse and Midwife, and nurses obviously are facing challenges, unknowns, etc. this year. What is something you will take away from 2020?

I have felt sad for the people hospitalized and not allowed to have family visit, particularly the elderly or thosegravely ill, those unable to communicate because they have been intubated or lack language proficiency, young children who’s routines have been disrupted but are unable to make sense of it and unable to communicate, and of course my heart aches mostly for those that have died alone.  

This year has been a year to reflect on priorities and be grateful. The most important thing I will take away from this year is the importance of setting aside time to center yourself ….to relax, renew and refresh yourself. For me it was disconnecting, doing something that required no effort….sitting in my back porch taking in the sights and sounds of my garden, or watching movies where I did not have to think, or in some cases served as a reminder of all that I have to be grateful for, including the efforts being made by our leaders, and colleagues.

Q: What advice would you give to future nurses?

Take time to discern your priorities. Being a professional nurse is not just something you become when you graduate from Nursing School. Continue to learn. Do not waste time re-inventing the wheel. Be informed of the history behind an issue, draw from prior efforts, and build on the efforts of those who came before you. Set boundaries. Determine what your specific needs are, make an effort to do your best, provide solutions, but ultimately treat yourself with grace.

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