Public Health Nursing Needs Recognition

The COVID-19 pandemic has pushed the field of public health into the spotlight. Yet nurses, who often work most closely with the community, have somehow remained largely in the background. (Stories from the Field) 

In the following article: Stories from the Field, public health nurses Susan Blue and Maureen Cava capture the essence of public health nursing. The six podcasts they developed showcase actual public health nurses telling their stories in order to recruit nurses and educate the general public. Canadian public health nursing shares a similar goal with their American counterparts: . . . putting energy and rescores into disease prevention instead of waiting until people get sick to spring into action. As a public health nurse, that means reaching the entire population to maintain and improve people’s health and quality of life. (Susan Blue)

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University of Toronto

September 30, 2021

Stories from the Field: Podcast on public health nursing launched with U of T support 

by Rebecca Biason

Susan Blue and Maureen Cava, both retired public health nurses, created the Stories from the Field podcast to shine a light on the important role public health nursing plays in the health-care system. 

The COVID-19 pandemic has pushed the field of public health into the spotlight. Yet nurses, who often work most closely with the community, have somehow remained largely in the background.

It’s an oversight Susan Blue, an alumna of the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing, and Maureen Cava, who was cross-appointed to the faculty and taught community health nursing, are hoping to rectify.

Both retired public health nurses, the pair decided to create a podcast called Stories from the Field to amplify nursing voices and help students and the wider public learn more about what public health nurses do – perhaps even consider it as a career. 

Stories from the Field’s six episodes (takes) listeners on a journey across Ontario as co-hosts Blue and Cava speak with public health nurses about everything from harm reduction and the opioid crisis to nursing leadership and the COVID-19 pandemic.

“I’ve worked in public health for almost 40 years, and I still get asked what hospital I work in,” (emphasis mine) says Cava, who is also the former president of the Ontario Association of Public Health Nursing Leaders. 

“We are passionate about public health and committed to ensuring the public, as well as other nurses, know what public health nursing means.”

“As a public health nurse, you are taking a preventative approach to the health and wellbeing of the community at large, as well as individuals,” adds Blue, “It’s why we hope to see more nurses in the field.”

The podcast is proudly sponsored by the Lawrence S. Bloomberg Faculty of Nursing’s Verna Huffman Splane Fund, an endowed award named after Verna Splane, a public health nurse who graduated from U of T in 1939 and enjoyed an illustrious career in nursing and health care.

“Maureen and Susan have captured the essence of what makes public health nursing essential and have shone a much-needed light on the work of our public health nurses,” says Linda Johnston, dean of the Lawrence S. Bloomberg Faculty of Nursing. “This podcast will be an important tool for future nurses to see the breadth of expertise that this particular field of nursing has to offer.”

Writer Rebecca Biason recently spoke with Blue and Cava about the importance of giving nurses a voice and what they are hoping the podcast’s listeners will learn.

What is the role of the public health nurse?

Blue: To me, public health nursing means putting energy and resources into disease prevention instead of waiting until people get sick to spring into action. As a public health nurse, that means reaching the entire population to maintain and improve people’s health and quality of life.

The community is our client and that’s something I’m very passionate about. Keeping people out of hospitals can make a real difference in their health.

Cava: Public health nurses play a significant role in policy development – things like food security, basic income, housing and other social determinants of health. That kind of preventative upstream approach is what we focus on to ensure people are healthy, physically fit, have harm reduction strategies and have the resources they need so they don’t end up in emergency rooms or hospitalized for things that are preventable.

It makes sense to put money into prevention, but there has been a chronic lack of funding since we’ve been in the field. Public health gets a small piece of the pie to do an inordinate amount of work in preventing people from getting sick. It is why we are so committed to our work, as we see the value in public health nursing as an investment in the future of society.

What led to the creation of Stories from the Field?

Cava: Public health nursing is not well understood – by nurses, by politicians, by the public. When I was the president of the Ontario public health nursing leaders association, it was one of my goals to ensure people knew about what public health nurses do and the impact they have.

When I worked at Toronto Public Health, many of the student nurses I encountered had no idea about the scope and breadth of all that is involved as a public health nurse. It was such an eye-opening experience for them, as I hope this podcast will be for other nursing students.

Blue: Maureen and I met in 1990 working for the former North York Public Health Department (now Toronto Public Health). So, having known each for other for 30 years, it wasn’t a huge leap to consider embarking on this project together. We both share a drive to ensure public health nursing is understood and valued as a key part of the health care sector and wanting public health nursing to be brought to the forefront.

What were some of the unforeseen challenges in creating the podcast?

Blue: Well, we are novice podcast hosts. We had listened to a few podcasts, but certainly hadn’t developed one. Maureen came across a podcast camp offered through Ryerson University, and we thought it would be a good way to get some knowledge under our belts.

Cava: Following that camp, we thought, “Oh, for sure we could do this!” But it turns out we were a bit naive about the whole process. We had some initial challenges getting funding for the podcast, but eventually after speaking with Dean Johnston of the Lawrence S. Bloomberg Faculty of Nursing, her support and that of the Verna Huffman Splane fund helped get our project off the ground.

Blue: COVID threw a wrench into everything. We thought we would be recording in a studio together, but soon we were met with a steep learning curve of having to set-up equipment and software on our own. We were grateful to the producers at Vocal Fry Studios for assisting us along the way, but it was very tough in the beginning.

Cava: COVID also meant that many of our nursing colleagues who we planned to have as guests were working full tilt, and that took precedence over everything. We were lucky to be able to eventually meet and interview many experienced public health nurses to share their stories. It just goes to show how involved public health nurses are across the health-care spectrum.

Do you have a favourite episode?

Cava: For me, “Episode Three: Frontline in a Pandemic” stands out. It tells a captivating story about the early stages of the pandemic and the work nurses do behind the scenes to get those shots into arms. It shines a light on the role they had across Ontario in a way that hasn’t really been shown throughout the pandemic. Public health nurses were front and centre since the beginning of the pandemic and are continuing to lead in their roles as things are evolving.

Blue: “Episode Two: Harm Reduction Approaches to Opioid Use” is a favourite. Our guest Rhonda Lovell spoke from a personal perspective about being a young mum and how her interactions with public health nurses during that time in her life motivated her to consider this field of practice and move into public health nursing. She shared such great insights and knowledge.

What are you hoping students and the public will take away from this podcast?

Cava: It goes back to why we started the podcast. We want students to be inspired and think about public health as a career choice. We want them to hear from public health nurses who are passionate and excited about what they do, so that they can see the depth and variety of opportunities there are to work with people and communities. And if they do choose public health, or have chosen it already, I hope this also inspires them to advocate and to give back to the field.

Blue: It’s a career where nurses have considerable variety and can move to other areas of practice. Public health nursing offers lots of flexibility, learning and growth opportunities. For the general public, I think just hearing these human-interest stories will change their viewpoints about public health. Hopefully anyone, whether they are a nurse or not, can relate to this content and be informed.

Cava: These are true stories from the field. We hope students, nursing colleagues and those in other disciplines will listen and consider the impact of public health nursing.

Photos of the Patients I wrote about in my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers

This past Saturday, I received a box in the mail filled with old photos. The nurse practitioner who took my place when I left the Senior Center sent this delightful surprise. “Rita Wisniewski” (I changed all names in my book except for my immediate family) said in her note that sending me the pictures of the patients we both took care of was “long overdue.” Rita had read my book but due to illness was unable to come to the various venues in Chicago where I promoted the book 2019. Between ill health and the pandemic, Rita had forgotten about contacting me. 

Rita read my book and recognized many of the patients I wrote about. Thanks to Rita, now I have pictures of those who appeared in my book. 

Molly, a wiry, eighty-year-old woman with an Irish brogue, lived next door to Ms. Henry. She often dropped into the clinic to socialize rather than to seek care. She didn’t take medication, and rarely complained of aches or pains.  P 103

Jerry Johnson, mildly retarded, wiggled between us, (on the dance floor) gyrating and twisting with abandon. It was a raucous moment that transcended age and ability.  (At a retirement party) P 117

Lilly Parks, a strikingly attractive woman in her seventies, stuffed her shawl down the front of her dress, and staggered about the dance floor on her matchstick legs as if she was going into labor. I had heard she kept a silver handgun in her sock but that evening she must have left it at home since her slim ankles were surrounded only by her rolled-down stockings. She waddled around in the center of the room clutching her belly to hoots from an enthusiastic audience (same retirement party) P 117

Stella Bukowski: (Sitting in a wheelchair) A dirty blond wig sat askew on her head. Only one leg, which was covered with a wrinkled cotton stocking, extended past the skirt of her housedress, and her foot was encased in a heavy black orthopedic shoe.  She reeked of a sharp ammonia smell. Urine? P 144

A picture of me that I have never seen before. However, I remember the poster, which was one of my favorites. I don’t remember where the picture was taken. The picture is too faded to read the citation on the bottom of the poster. Maybe one of you older nurses will recognize the poster and get back to me with the answer. 

Health care today is changing

Today we need someone who can help us manage our health care needs in the hospital, the home, the HMO, the school, the workplace, in long term care and in the community. 

Today we need a provider who can teach us how to stay physically and mentally healthy and how to prevent illness and disease. 

Today we need access to specialty practitioners who can provide expert heath care for individuals and their families. 

Today more than ever we need an advocate who can deliver quality cost-effective care throughout all the stages of our lives.

Today, we need a Nurse

Writing More Personal Stories

While it was time consuming, I loved doing the April Alphabet Challenge A to Z. It got me writing new stories, released memories I had forgotten and expanded my writing skills. Going forward with my Blog, I will intersperse more personal tales. 

This is a timely decision since nurses are getting greater attention being on the forefront of the pandemic. Look what nurses do, shout the headlines. Plus, nurses are writing their own stories in essays, news media and books in greater numbers. This is just fantastic. I feel more comfortable cutting a back bit on my emphasis to show how nurses make a difference. 

Also, there seems to be a national movement to grant nurse practitioners the legal authority to practice independently. That is, to practice without physician oversight. While I was busy constructing a daily post for the month of April, a friend emailed me an article about nurse practitioners titled: We trusted nurse practitioners to handle a pandemic. Why not regular care(Lusine Poghosyan, The Niskanen Center Newsletter, March 9, 2021). Before COVID-19, only 22 states allowed NPs to practice independently. Since then, governors of 23 states have signed executive orders to permit NPs to practice without physician agreements. 

Sadly, it took a pandemic to unearth the truth that nurses and NPs do improve patient care and make a difference in the health care system. 

Glass Half-Full

Dominated by political turmoil and the COVID-19 Pandemic, this past year has been a roller coaster ride with few brief moments of slow travel interspersed with deep dives of fright and foreboding. The highs that I have enjoyed come in part from the increased attention given to nurses. I have long complained that the nursing profession has been mostly invisible to the public eye, media and policy making sectors. The increase in visibility and status of nurses in these turbulent times looks to me like a glass half-full. 

I celebrate all the recent recognition direct towards nurses. When have nurses spoken up in great numbers for their profession, their practice, their patients and for their contribution to the world-wide challenge to defeat of the COVID-19 Pandemic? When have nurses received so much positive media awareness? Been frequently appointed to expert panels along with physicians and other health care professionals? Interviewed prominently by the news media? Featured favorably on TV shows? 

How much of a coincidence was it that 2020 was designated by the World Health Organization as the Year of the Nurse and the Nurse Midwife? 

In reviewing my posts of the past year, I have pulled out the ones that show increased focus on the nursing profession. I enjoyed revisiting them and am hopeful that the positive attention showered on the nursing profession continues. 

Nurses Gain the Attention They Deserve

Impressive List of Nurse Experts

United Kingdom Nursing Students Work on the Front Lines of the Pandemic

The Power of Nurses

Nursing Students Provide Insights into the Pandemic Media In-Depth Look at Nurses

Heroic Symbol: A Nursehttps://nursingstories.org/2020/05/26/badass-nurse/

One of the memes circulating on the social media platform Reddit created from a photo of UNC Hospital emergency room nurse Grace Cindric taken by News & Observer photojournalist Robert Willett earlier this week.

What Would Flo Think?  

Why Does It Take a Pandemic to Recognize Nurses? 

Nurses Transform Lives

A Physician’s Story

  

I haven’t posted any stories about what physicians face when working on the front lines during the Covid-19 pandemic. Of course, my Blog is about nursing. In more recent years, the collaboration between nurses and physicians has grown. The professions work together with more mutual respect than when I began my nursing career. And physicians on the front line of the Covid-19 pandemic risk their lives just as nurses do. 

I have reblogged a story written by a physician who is working “extra on-call time” to care for the new admissions at a local hospital.  I read this essay in the online publication: Pulse: Voices from the Heart of Medicine.

I highly recommend reading Pulse, which publishes each Friday. There you will find stories that show the human aspect behind the practice of medicine. 

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In Need of a Prayer

Posted By Jo Marie Reilly On December 16, 2020 @ 10:44 pm In Stories 

The new patient’s name is Emmanuel. He was sent from his nursing home to our emergency room with a cough and fever. The oxygen level in his blood is well below normal, and he’s gasping for air.

It’s my third week in the local community hospital ER. I’ve been putting in extra on-call time during the COVID pandemic. It’s been rough to get back into the emergency setting while continuing my day job as a family doctor and medical educator. I’ve been sharing admissions with the hospitalist, who’s joined me in the on-call room.

“I’ll take him,” I tell my colleague.

“Sure?” he asks, eyebrows arched over his face mask.

The pager blares again.

Continue reading “A Physician’s Story”

United Kingdom Nursing Students Work on the Front Lines of the Pandemic

In my post on September 22: Nursing Students Provide Insights into the Pandemic, I spotlighted the thoughts and experiences of the nursing students from Seton Hall University, New Jersey, as they cared for Covid-19 patients. 

Today’s post has the same focus but this time nursing students from the United Kingdom share their stories about working on the front line of the pandemic.  ITV News from the United Kingdom discusses a new book: Living with Fear: Reflections on Covid-19 that was written by twenty-two nursing students plus other health care providers. The feelings that were expressed by American nursing students are mirrored in the UK nursing stories. The pandemic serves as a backdrop to reinforce the positive impact that nursing has on health care delivery and shows the general public how nursing care makes a difference.

United Kingdom Nursing Students Launch New Book About COVID-19

Video report by ITV News Correspondent Lucy Watson

Wednesday 14 October 2020, 7:16pm

Student nurses who were recruited to work on frontline NHS services to respond the coronavirus crisis have shared their stories in a new book

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The trainees faced the daunting task of being placed in frontline positions at hospitals around the country whilst finishing their studies amid a global pandemic.

Now, some have written about the personal and professional challenges that inspired them to flourish at a time of national crisis. 

Entitled Living with Fear: Reflections on Covid-19, the book tells the stories of 22 nurses and other frontline professionals reflecting on what they experienced and how it impacted them. 

Ikra Majid reads from the book. Credit: ITV News

Student nurse Ikra Majid did placements at various hospitals in London and Hertfordshire during the pandemic. 

She now works at Chase Farm Hospital in Enfield.

“There did get to a point where I thought, why I am I doing this, it’s too much. I didn’t sign up for this pandemic,” she said.

“We have to make the best of it. As people say, when life gives you lemons you make lemonade. I tried to make the sweetest lemonade possible.”

She added: “The pandemic has made me realise even more what an important job we do.”

“This book shows that fear doesn’t define or take away the skills and experience of medical professionals, but rather helps them to grow a new way of thinking and working.

“When our students were called into practice, it gave them a true sense of what nursing is. They helped to saved lives and became superheroes in their local communities.”

Another one of the authors, Estelle Kabia, helped patients at the Hammersmith & Fulham Mental Health Unit during the pandemic.

“Covid taught me to be the nurse I want to be,” she said. “It’s an unbelievable feeling, I don’t think I will ever do anything as big in my whole life.”

Estelle Kabia helped patients at the Hammersmith & Fulham Mental Health Unit.Credit: ITV News

The book also explores the concept of ‘moral injury’ where nurses feel unable to provide the care the patient needs leaving them to question their own ability.

Ms Kabia said: “Sometimes I felt moral injury as we were picking up new practical skills whilst dealing with sick patients coming in, but it would come and then go, because after a few weeks I could see the impact I had.

“In one way, stepping up was nerve-wracking but it also gave me the passion to go out there and help. You’re treated as a professional, not a student. I had no fear when I was on the ward.”

Claudia Sabeta, who finished her postgraduate course specialising in mental health nursing at Buckinghamshire New University this summer, worked at Northwick Park Hospital in Harrow helping vulnerable and elderly mental health patients.

She said: “At first, I felt very overwhelmed by the Covid situation and I was worried about joining. I wondered how I would cope and if I’d put my family at risk. 

“But it was a great experience in the end and an opportunity I will never have again in my life.

“It had a positive impact on my knowledge and training, and boosted my confidence. I learned so fast and it will stay with me forever.”

Credit: ITV News

In July, thousands of student nurses recruited to work on the front line had their placements cut short, plunging some of them into financial despair.

In mid-April, NHS England reported that nearly 15,000 student nurses, midwives and medical students had joined “frontline NHS teams as part of the nationwide coronavirus fightback”.

Proceeds from the book will go to the Central and North West London NHS Foundation Trust (CNWL) Charitable Fund, which supports staff and service users.

Dr Scott Galloway, one of the book’s authors and Chief Clinical Information Officer at CNWL, said: “Every day, frontline healthcare professionals manage the challenges and stress of making difficult and uncomfortable decisions about how to provide the best possible care to patients.

“Sometimes, however, our capacities are so overwhelmed by extraordinary events, such as Covid-19, that we are unable to provide what we know the patient needs.”

One of the book’s editors Margaret Rioga, Associate Head of School in the School of Nursing and Allied Health at Buckinghamshire New University, said: “The Covid-19 pandemic had an impact on everybody and created fear within us like never before.

“This book shows that fear doesn’t define or take away the skills and experience of medical professionals, but rather helps them to grow a new way of thinking and working.

“When our students were called into practice, it gave them a true sense of what nursing is. They helped to saved lives and became superheroes in their local communities.”

The Power of Nurses

The World Health Organization designation of 2020 Year of the Nurse and Nurse Midwife has taken a back seat to the sensational political news alerts that fill our lives as if nothing else is important. This post is just a reminder that nurses still are on the front lines of COVID-19 and make a difference in our lives every day. 

Nursing Students Provide Insights into the Pandemic

The media mainly focuses on the nurses and doctors who are on the front lines of the COVID-19 pandemic. Rarely do we hear what nursing students are experiencing. 

Below is a repost from the Setonian, the official undergraduate newspaper of Seton Hall University.

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Seton Hall nursing students and faculty provide unique insights into pandemic

Posted By Alexander Krukar on Sep 16, 2020

Seton Hall students and faculty in the College of Nursing shared their stories and thoughts on being a future health care worker during the COVID-19 pandemic.

Caroline Pascasio, a sophomore nursing major, said her drive to become a nurse has remained steadfast in the face of the pandemic. She said she always knew she wanted to enter a field where she could help other people and feel as though she was having a direct impact on their lives.

“I remember when we were in the peak of COVID, I would always see on the news that they needed more nurses,” Pascasio said. “I wished I was just a few years older so I would have the proper training to help.”

The pandemic has also highlighted many stories from health care workers. Colleen Osbahr, a sophomore nursing major, worked in a hospital over the summer and said she experienced a situation like this firsthand. 

“One woman was working as a nurse, and her mother tested positive for COVID and was in the same hospital as her,” Osbahr said. “She was not allowed by regulations to go into her mother’s room, and unfortunately, her mother passed away.”

Oshbar said the pandemic has been stressful for nurses working in “understaffed” hospitals with limited resources.

“All nurses are putting the health of not only themselves, but also potentially their families, on the line for the benefit of the greater good,” she said. 

Dr. Katherine Connolly, a clinical assistant professor at Seton Hall, has been teaching nursing students amid the pandemic.

“I had the opportunity to work as a nurse practitioner in the hospital setting during the height of the COVID-19 crisis,” Connolly said. “I was very proud of the leadership and collegiality I observed given the uncertainty of the situation. I will never forget the deserted hallways decorated with beautiful cards of encouragement and thanks coming from school children or the loving support from the surrounding community.”

Some nursing students said they worry about adapting to the lasting changes that the coronavirus could leave on their field.

“This pandemic has definitely made me anxious because I know that our nursing curriculum will be different than anything it has ever been,” Pascasio said. “It’s just a little nerve-wracking because you don’t know what to expect. It’s not like you can ask an upperclassman because they’ve never done a clinical in the era of COVID.”

Connolly said she has heard many pandemic stories from her students.

“These students described feelings of helplessness as they were unable to assist COVID-19 patients due to shortages in PPE, which was reserved for doctors, nurses and respiratory therapists,” Connolly said. “As the supply of PPE improved—allowing many to move into the role of bedside provider—the task that most touched their hearts was assisting patients to FaceTime with family members at home, especially when the patient was not doing well.”

Alexander Krukar can be reached at alexander.krukar@student.shu.edu.

The Trip to the Farmers Market

I drive to the Farmers Market on this dreary Friday. Frankly, it’s nice to have a break from the sunny, humid days. The gray skies impersonate an early Fall and lift my spirits. 

This trip gets me out of the house and into a semblance of normalcy that I remember before the COVID-19 pandemic and stay-at-home orders began.

Since I plan to write this week’s post about the Farmers Market, I park the car near the entrance to take a picture of the main signpost. On my way back to the car, I notice a white face mask on the road. It looks like mine. It is mine. What are the chances it dropped onto a smear of COVID-19 germs? After a brief hesitation, I pick it up and put it on my face. 

When I come to the Farmers Market, I like to start at one end of the Farmers Building (which is 30,000 square feet) and work my way down the main aisle checking produce and prices on either side. Then, I turn around when I reach the end and retrace my steps, this time making purchases. 

Today, all I am going to do is buy peaches and take pictures.

The market organizers have done away with the wide middle lane running north and south. Now, multiple one-way aisles travel east to west, bisecting the individual farm stands and promoting safe-distancing. 

Without the pressure of buying ingredients for a dinner, I am free to enjoy the lovely presentation of produce. I snap pictures as I travel past the arrangements of bright red tomatoes, varieties of eggplant and various chilis categorized according to heat index. 

I stop by one of the many corn stalls. A women is husking corn. Before we moved to North Carolina, I had never seen a trash bin near the corn displays at Farmers Markets or in grocery stores. Shoppers are invited to husk the corn and dump the husks into a trash bin provided by the grocery store or market before purchasing the corn. While this may be more convenient, as my southern neighbors tell me, I adhere to the common knowledge that corn in their husks stay fresh longer. 

I take some pictures of the corn stall only after asking the permission from the woman who is husking corn. She nods and continues to husk, not paying me any mind. As I’m leaving, she tells me the corn season is winding down. At that news, I steel myself not to buy any more corn since my husband and I have had corn in many reiterations and there is a large container of corn and crab chowder in the refrigerator. 

As I turn to leave the corn stand, I see a woman at the other end of the market waving at me. She smiles and points to her head and gives me a thumbs up. She’s commenting on my purple hair. Pandemic purple I call it. I give her a thumbs up, too. When coloring one’s hair was more popular, I kept my white hair. Now it seems I am pretty much an oddity. I like swimming against the current. I may change colors when this hue fades. Maybe a soft blue or intense red will be the next dye. Social isolation has a strange effect on me. 

I leave the Farmers Market carrying one bag of peaches. 

Black bean and corn salad

Original recipe yields 6 servings

Ingredients

  • ⅓ cup fresh lime juice
  • ½ cup olive oil
  • 1 clove garlic, minced
  • 1 teaspoon salt
  • ⅛ teaspoon ground cayenne pepper
  • 2 (15 ounce) cans black beans, rinsed and drained
  • 1 ½ cups frozen corn kernels  ( Use fresh in season)
  • 1 avocado – peeled, pitted and diced
  • 1 red bell pepper, chopped
  • 2 medium whole (2-3/5″ diameter)  tomatoes, chopped
  • 6 medium (4-1/8″ long) green onions, thinly sliced
  • ½ cup chopped fresh cilantro

Directions

  • Step 1

Place lime juice, olive oil, garlic, salt, and cayenne pepper in a small jar. Cover with lid and shake until ingredients are well mixed.

  • Step 2

In a salad bowl, combine beans, corn, avocado, bell pepper, tomatoes, green onions, and cilantro. Shake lime dressing and pour it over the salad. Stir salad to coat vegetables and beans with dressing and serve.

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