DiversityNursing Blog

What Millennial Nurses Look For When Choosing A Job

Posted by Erica Bettencourt

Mon, Feb 17, 2020 @ 11:00 AM

millenialnursesMillennials will account for 75 percent of the workforce by 2025. So it is important for healthcare organizations to understand what is important to this generation and use strategies to retain them.

HCA Healthcare commissioned a study conducted by the Center for Generational Kinetics to research what drives, engages and motivates Millennial and Gen Z Nurses in their career choices.

In addition to salary and referrals, reputation for having a positive work environment will get Nurses to apply. 

Below are the most important factors in creating a positive work environment for Nurses.

  • Team and manager relationships: 44%
  • Flexible scheduling: 43%
  • Career advancement: 43%
  • Communication and clinical decision-making: 42%
  • Basic needs (water, breaks, meals): 41%
  • Facilities, equipment, and technology: 40%
  • Workload (patient to nurse ratio): 39%

Nurses have higher expectations for support now more than ever.

  • 46% of Nurses think it is important for a job to offer scheduling that allows them to work as many hours as they want.
  • 45% believe having enough staff or equipment to take care of patients is important.
  • 45% want their team and/or their boss to care about them personally.
  • 45% want someone to step in when they need help.
  • 44% think it is important for their employer to provide opportunities to learn or advance their career.
  • 43% feel it is important for their voice to be heard by management.

These are the employer benefits that mean the most to Nurses:

  • Personal wellness coaching: 38%
  • Financial coaching: 38%
  • Student loan repayment programs: 37%
  • Free snacks and drinks: 37%
  • Employer subsidized housing nearby: 35%
  • Employer contribution to your 401(k): 34%
  • Tuition reimbursement: 34%
  • Additional PTO (paid time off): 34%
  • Communication training: 13%

The study found, regular supervisor check-ins and access to counseling services would most help Nurses be successful in their careers.

Also Digital platforms are the #1 way Nurses want to communicate with their employer.

Millennial and Gen Z Nurses want recognition and appreciation from supervisors very frequently. The study shows, 83% of Nurses want to receive praise from their supervisors at least monthly or more frequently.

And when it comes to training feedback and career coaching from supervisors, Gen Z wants it daily and Millennials want it weekly.

“The survey results highlight the importance of providing a transparent environment that gives Nurses a sense of belonging while serving a greater purpose,” said Jason Dorsey, President and lead researcher at CGK. “Ultimately every nurse is different, but it’s clear that Nurses’ relationships, ability to be heard and feeling supported in their careers are important to maintaining a positive work environment that will attract and retain talented Nurses.”

To see the full study click here.

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Topics: nursing careeer, millennial nurses, Gen Z Nurses, millennials

Increase in Number of NP’s Could Cause Problems For Hospitals

Posted by Erica Bettencourt

Thu, Feb 06, 2020 @ 12:02 PM

hospitalPhysician shortage concerns has influenced the use of more Nurse Practitioners to provide primary care and fill gaps in rural areas.

According to a new Health Affairs study, the number of Nurse Practitioners grew 109% from about 91,000 to 190,000 from 2010 to 2017.

Even though Nurse Practitioners have filled gaps in the delivery of healthcare, it is creating problems for hospitals. 

The Registered Nurse workforce has been reduced by up to 80,000 RNs nationwide. Also more than one million baby-boom RNs will be retiring soon.

The study says, the growth in NPs was caused by the expansion of education programs that have attracted Millennial Nurses. The number of programs to educate NPs grew from 356 in 2010 to 467 in 2017. These programs now graduate nearly as many new NPs as medical schools do Physicians each year.

Data from the Census Bureau’s American Community Survey for the period 2010–2017 was used in the study and researchers found the growth of NPs occurred in every region of the country, but was particularly rapid in the east south-central region of the country, which includes Alabama, Kentucky, Mississippi and Tennessee.

Also it is projected there will be two NPs for every five Physicians by 2030, compared to less than one NP per five Physicians in 2016. 

The number of Physician Assistants is also one of the fastest-growing in healthcare. According to a report from the National Commission on Certification of Physician Assistants, the number of certified PAs grew over 6% in 2018 and the average salary increased by more than 12% in a four-year span.

Authors of the Health Affairs study said, "As NPs continue to expand their profile in healthcare organizations and achieve greater prominence within the healthcare workforce, the potential loss of RNs to the NP workforce is likely to continue to cause employment ripples, particularly in acute care settings. Thus, even in an era of strong RN workforce growth fueled by Millennials in particular, hospitals must innovate and test creative solutions to contend with tight or fluctuating RN staffing — as they have during past disruptions in their RN labor supply."

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Topics: nurse practitioners, registered nurses, nursing workforce, NPs, RNs

Support Programs To Help Nurses Deal With Stress

Posted by Erica Bettencourt

Thu, Jan 30, 2020 @ 02:46 PM

supportIn order for a healthcare system to be successful in having high engagement, job satisfaction and retention, the Nursing workforce should be able to combat the stressors of the job and burnout.

Nurses can better accomplish this by having help from peer support groups and mindfulness programs.

According to a report from the National Academy of Medicine (NAM), between 35% and 54% of Nurses and Doctors experience burnout. Among medical students and residents, it is as high as 60%.

Symptoms, the NAM report said, include emotional exhaustion, cynicism, loss of enthusiasm and joy in their work and increasing detachment from their patients and the patients’ ailments. The problem has been linked to higher rates of depression, substance abuse and suicide.

Many institutions are implementing stress management and self-care programs to provide caregivers with easy-to-use tools and resources to build their resilience and help them cope.

The Cleveland Clinic Abu Dhabi implemented a new mindfulness program known as the ‘Compassionate Intension Program.’ The sessions introduce caregivers to mindfulness as a wellness tool they can utilize in both their workplace and personal lives. Currently, there are three sessions in place:

  • In Tune Tuesdays: Held biweekly, ‘In Tune Tuesdays’ are 20-minute classes designed to further educate attendees on mindfulness and how to improve mindfulness in their work environment. The classes are held at three different times to accommodate caregiver schedules.
  • Mindfulness Rounding: Also a biweekly activity, ‘Mindfulness Rounding’ features a team of mindfulness experts who visit clinical units. The experts conduct learning huddles and one-on-one conversations with caregivers, sharing quick tips. Their pocket cards or guides offer information on easy-to-implement mindfulness techniques.
  • Introduction to Mindfulness Workshop: This 8-week workshop, featuring 1-hour weekly sessions, was developed around the evidence-based standards of mindfulness experts, including, Jon Kabit-Zinn, PhD, of the University of Massachusetts Medical School, Center for Mindfulness, and Richard Davidson, PhD, of the University of Wisconsin’s Center for Healthy Minds and Oxford University’s Mindfulness Center. It offers a deeper dive into various mindfulness techniques.

Johns Hopkins Hospital, Pediatric Nurse, Cheryl Connors, RN, MS, created a peer program to provide immediate support for health providers affected by stressful cases.

The Resilience in Stressful Events (RISE) program was developed with a Pediatric Chaplain, a Patient Safety Director, a Doctoral Student, and General Internist Albert Wu, MD, FACP.

According to the American College of Physicians, the RISE program provides a team of 39 peer responders who volunteer their time to support those who call the service. RISE team members include Nurses, Doctors, Nurse Practitioners, Respiratory Therapists, Pastoral Caregivers, and Social Workers. They undergo didactic, video-based, and role-playing training.

The team has been called by more than 700 Johns Hopkins employees. The hospital previously had a program offering free professional counseling but, Ms. Connors said, “They actually prefer somebody who knows what they're going through—another health caregiver who can relate—and when they need it, not a week later.”

As supporters of patients and their families, Nurses deal with a lot of stress. Health systems can help their Nurses by surrounding them with support and offering them the tools to overcome and cope with stress so they can provide the best care for their patients and for themselves.

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Topics: peer support, burnout, self-care, mindfulness, managing stress, stressed nurses, support programs, nursing is stressful, nurse retention, stress management

Psychiatric-Mental Health Nurses - The Growing Demand

Posted by Erica Bettencourt

Fri, Jan 24, 2020 @ 09:41 AM

mentalhealthnursingApproximately 56 million American adults are struggling with a mental illness or substance use disorder, according to the American Psychiatric Nurses Association (APNA).

An article from mentalhealth.gov, shows the current mental health workforce shortage is projected to grow and would leave the country 250,000 professionals short by 2025.

Only 44% of adults and 20% of children in the U.S. receive the mental health and substance use care they need because there is a growing shortage of qualified professionals trained to provide timely and effective treatment.

This lack of treatment significantly contributes to one of the leading causes of death in the U.S, suicide.

According to the same mentalhealth.gov article, suicide is the 10th leading cause of death in the United States. It accounts for the loss of more than 41,000 lives each year, more than double the number of lives lost to homicide.

An article in the Journal of the American Medical Association (JAMA) discusses the increase in children under 18 going to emergency departments due to attempts of suicide or suicidal ideation.

According to a Hard Cases article, more than 75% of all U.S. counties have a shortage of any type of mental health worker and 96% of all counties have an unmet need for mental health prescribers. This care gap is most profound in rural states where 111 million Americans live in mental health professional shortage areas.

One reason demand for mental health professionals has increased is because more Americans are gaining health coverage. It's the law per the Affordable Care Act that insurers can no longer deny coverage to people who have diagnosed mental illnesses.

Also fewer medical students are specializing in psychiatry because psychiatry jobs don't pay as well as other fields. Students facing high medical school debt are more likely to pick the jobs offering better pay.

There has also been a surge in substance use disorders and greater public awareness of mental illness. Increased public awareness means more people living with mental illness will seek treatment.

Healthcare providers and the medical community at large need to implement a more supportive environment for the psychiatry profession. There should also be increased compensation for psychiatry jobs and student loan forgiveness or free/low-cost psychiatry schooling.

Policy makers should support and enact quality mental health services that will improve public health, particularly populations who most often have no access to mental health services.

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Topics: mental health, substance use disorder, mental health nursing, psychiatry, mental illness, psychiatric mental health nurse

LGBTQ+ Health Disparities

Posted by Erica Bettencourt

Thu, Jan 16, 2020 @ 12:15 PM

lgbtq+healthdisparitiesLGBTQ+ people of all ages, races and ethnicities, religions, and social classes have experienced health inequalities.

According to the Office of Disease Prevention and Health Promotion (ODPHP) and healthypeople.gov, research suggests that LGBTQ+ individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBTQ+ persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBTQ+ individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBTQ+ individuals.

It is difficult to estimate the number of LGBTQ+ individuals and their health needs because most national or State surveys do not include sexual orientation and gender identity questions.

In order to document, understand, and address the environmental factors that contribute to health disparities in LGBTQ+ communities, we need to increase the number of nationally-representative health-related surveys that collect information on sexual orientation and gender identity (SOGI). This will allow researchers and policy makers to accurately characterize LGBTQ+ health and disparities.

The ODPHP and healthypeople.org research has found,

  • LGBTQ+ youth are 2 to 3 times more likely to attempt suicide.
  • LGBTQ+ youth are more likely to be homeless.
  • Lesbians are less likely to get preventive services for cancer.
  • Gay men are at higher risk of HIV and other STDs, especially among communities of color.
  • Lesbians and bisexual females are more likely to be overweight or obese.
  • Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals.
  • LGBTQ+ populations have the highest rates of tobacco, alcohol, and other drug use.

According to the Aging with Pride: National Health, Aging, and Sexuality/Gender Study, about 2.7 million U.S. adults 50 and older identify as LGBTQ+, including 1.1 million age 65 and older. Those numbers are expected to nearly double by 2060.

And among subgroups within the LGBTQ+ community, some are struggling with their health more than others:

  • Both Hispanic and African-American LGBTQ+ older adults in the project are more likely to report having HIV than their white counterparts.
  • Hispanic LGBTQ+ adults are more likely to report asthma, diabetes and visual impairment.
  • African-American LGBTQ+ older adults are more likely to be obese and have high blood pressure.
  • Native American LGBTQ+ older adults are less likely to report cancer than whites but more likely to report poor physical health, disability, obesity, asthma and cardiovascular disease.
  • Asian/Pacific Islander LGBTQ+ older adults are more likely to have visual impairment.

Along with collecting SOGI information in national surveys and health records, other efforts needed to improve LGBTQ+ health disparities include,

  • Better access to health insurance, employment, and housing
  • More laws protecting against bullying in schools
  • More social programs targeted to and/or appropriate for LGBTQ+ youth, adults, and elders
  • Better access to health care providers who are knowledgeable and culturally competent in LGBTQ+ health
  • Prevention of violence and homicide toward the LGBTQ+ community, and especially the transgender population

It is necessary that efforts are enhanced to improve LGBTQ+ health and eliminate disparities so LGBTQ+ individuals can lead long, healthy lives.

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Topics: LGBTQ, LGBTQ Healthcare, LGBTQ community, LGBTQ health disparities

Poll Shows Nurses Are Trusted More Than Any Other Profession For 18th Year In A Row

Posted by Erica Bettencourt

Tue, Jan 07, 2020 @ 11:37 AM

nursehugAmericans rate the honesty and ethics of Nurses highest among a list of professions for the 18th year in a row according to the National Gallup poll.

Nurses are consistently rated higher in honesty and ethics than all other professions by a wide margin.

Currently, 85% of Americans say Nurses' honesty and ethical standards are "very high" or "high," essentially unchanged from the 84% who said the same in 2018.

"The public trusts Nurses because we put the safety of our patients above all else," Massachusetts Nurses Association President and RN Donna Kelly-Williams said. "Every day across the United States, Nurses strive to provide the highest quality care despite the massive challenges posed by corporate healthcare. We are inspired by our patients to advocate for safe, accessible care and we appreciate their trust and respect."

National Nurses United Executive Director, Bonnie Castillo, RN said, “We are honored by this poll and what it reflects - that our patients, their families and the public know that they can trust and count on Nurses to stand up for them. This year’s results have special meaning for us as we move into 2020, which the World Health Organization has declared the ‘Year of the Nurse and Midwife."

Gallup notes that since Nurses were added to the survey in 1999, they have topped the list of most trusted professions every year except in 2001, when firefighters were recognized shortly after the Sept. 11, 2001 terrorist attacks for their heroism and bravery.

We at DiversityNursing.com know how special, compassionate and giving you are. We are delighted that you consistently receive this recognition from the National Gallup poll. You earn it – every day!

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Topics: Gallup Poll, trusted nurses, nurses are most trusted, nursing trusted profession

Best Practices In Caring For Vision Impaired Patients

Posted by Erica Bettencourt

Fri, Jan 03, 2020 @ 12:17 PM

visionimpaireddogVision impaired patients face many challenges when visiting hospitals for treatment. There are different ways staff and hospital design can help assist patients who are struggling.

According to research from JAMA Ophthalmology, vision-impaired Medicare beneficiaries and commercial health insurance patients had significantly higher healthcare utilization and costs during and immediately after hospitalization. This is happening because vision-impaired patients have difficulty following hospital routines and struggle to read discharge orders and medication instructions. The excess costs were estimated at more than $500 million annually.

Hospital staff can play a major role in helping these patients by being actively engaged with them and their families.

Lisa Allen, PhD, MA, Chief Patient Experience Officer at Johns Hopkins Medicine in Baltimore, which includes the Wilmer Eye Institute, says, "The biggest issue is to ask the patient or the patient's family what they need to keep them safe. We need to ask that question to everybody, but that patient engagement question is the most important piece for visually impaired patients. When we assume there is a one-size-fits-all for the visually impaired, we are making a mistake. In other words, if you are not a braille reader, and many blind people are not braille readers, then having braille is not going to help when you are in the hospital."

According to Health leaders media, Johns Hopkins Medicine and Bascom Palmer Eye Institute shared their best practices for caring for vision-impaired patients which included measures designed for discharge and medication management, patient safety, and special accommodations.

Johns Hopkins provides discharge instructions in large font type and has the capability to audio-record instructions for patients. They also provide discharge instructions in a format that can be used with a screen reader.

Johns Hopkins staff are trained to promote safety. After surgery, all Johns Hopkins patients have a staff member with them when they are getting up for the first time and when they are walking the hallways.

The Americans With Disabilities Act (ADA) says, staff should initiate an introduction to a patient who is blind by addressing the patient by name. They should always identify themselves by name and function and the reason they are there.

At the University of Miami Health System's Bascom Palmer Eye Institute, stairwells are designed to lower fall risk for vision-impaired patients. They lengthened the staircase guard rails so they extend beyond the bottom of the stairs.

Johns Hopkins is implementing a Bluetooth way-finding app that can be used from home and while using public transportation. "We made sure when we bought the program that it had voice capability, so it can tell you to go to an elevator, it can tell you that you are at an elevator, it can tell you what floor button to push, and it can guide you throughout the inside of the hospital", said Allen.

If your health system does not have a bluetooth way-finding app, the ADA recommends being verbally specific. When a visually impaired patient wants to independently find their way with a cane or a guide dog, be sure to use right and left as they apply to the person who is blind. What is on your right is on the left of a person facing you. For example indicate the number of blocks, hallways, or doors to the elevator. Let the patients know exactly how far the bathroom is located outside of their room or where their food is closely located to them inside their room and what the food is. Verbal interaction is key.

It is important to offer assistance in a way that is not demeaning to the patient. With more research and input from patients, the future of health system's best practices should improve to provide even better patient care.

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Topics: blind, blind patients, vision impaired, best practices

Loneliness and Social Isolation Is A Growing Health Concern

Posted by Erica Bettencourt

Mon, Dec 16, 2019 @ 03:19 PM

socialisolationSocial isolation is a growing epidemic. It's becoming increasingly recognized as having critical consequences. According to recent surveys, the percentage of American adults who say they’re lonely has doubled from 20% to 40%, since the 1980s.

Loneliness is a serious health concern. Studies show that elderly people who are socially isolated were twice as likely to die prematurely. According to The New York Times, about one-third of Americans older than 65 now live alone, and half of those over 85 do.

The increased mortality risk is comparable to that from smoking. And loneliness is about twice as dangerous as obesity.

One recent study found that isolation increases the risk of heart disease by 29% and stroke by 32%.

John T. Cacioppo, a psychology professor for the University of Chicago, studies how loneliness and social isolation affect people’s health. He says, "In terms of human interactions, the number of people we know is not the best measure. In order to be socially satisfied, we don’t need all that many people. The key is in the quality, not the quantity of those people. We just need several on whom we can depend and who depend on us in return."

Many programs aimed at reducing social isolation and/or loneliness in older adults may help improve physical, mental (e.g. depression and mental well being), and social (e.g. social support and loneliness) health in older adults who are or are thought to be lonely or socially isolated. These programs include: a psychosocial activity group involving art, discussions, therapeutic writing, group therapy, and exercise that led to new friendships.

Some health systems and payers are making strides linking screenings for social isolation with referral to social and clinical support services.

Both Denmark and Great Britain are devoting more time and energy to finding solutions and staging interventions for lonely people, particularly the elderly.

Even though the internet has possibly contributed to our isolation, it might hold a key to fixing it. According to TIME, online dating statistics show that couples who found each other online and stayed together shared more of a connection and were less likely to divorce than couples who met offline. If these statistics hold up, it would stand to reason friendships could also be found in this way.

To help reduce social isolation, communities should ensure elders have easy access to transportation, through discounted bus passes or special transport services, so they can maintain social connections.

Although there is no one-size-fits-all approach to fixing social isolation and loneliness, addressing these issues and offering support services and group activities for these patients is a step in the right direction.

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Topics: loneliness, social isolation, health concern

Managing Stress During The Holidays

Posted by Erica Bettencourt

Fri, Dec 06, 2019 @ 02:32 PM

holidaystressThe holidays are meant to bring feelings of joy and cheer, but this time of year can also bring a lot of stress. No matter what holiday you celebrate, this season can affect us all. Especially Nurses, who work in an already stressful environment, as you juggle more difficult demands of your time, emotions and patience. 

Most people celebrate the holidays with family and friends at home, but you miss many holidays to take care of your patients. Having celebrations with your coworkers is nice, but nothing feels like home. Some families will try to move dates around so they can all celebrate together.

If you're missing holidays to treat patients, then those patients are missing out on their holiday celebrations too. Spreading extra holiday cheer can make you both feel some joy. Fortunately, you get to go home at the end of the shift.

Another stressor can be financial as people go crazy buying gifts and worry how to pay for them. Try not to overspend. Perhaps you’re crafty and can make some of those gifts.

The loss of loved ones is more difficult this time of year. In your profession, you witness the passing of patients and often you’re coping with your own feelings of loss as you try to console the family. Lean on fellow coworkers and managers to help relieve some of the stress. Don't hold it all in and try to get through it alone.

In colder climates, as the season changes to winter, many people are affected by SAD seasonal affective disorder. With less daylight, spending more time indoors and the sense of isolation it can bring, dealing with the cold, and extreme weather conditions, can be quite depressing unless… you love outdoor winter sports! To combat SAD, try light therapy, exercise, planning social get-togethers, talking to a mental health professional, or using medication to help lighten your mood.

The Mayo Clinic offers more tips to help with holiday stress.

  • Acknowledge your feelings. It's OK to take time to cry or express your feelings. You can't force yourself to be happy just because it's the holiday season.
  • Reach out. If you feel lonely or isolated, seek out community, religious or other social events.
  • Stick to a budget. Before you go gift and food shopping, decide how much money you can afford to spend. Then stick to your budget. Don't try to buy happiness with an avalanche of gifts.
  • Learn to say no. Saying yes when you should say no can leave you feeling resentful and overwhelmed. Friends and colleagues will understand if you can't participate in every project or activity.
  • Don't abandon healthy habits. Don't let the holidays become a free-for-all. Overindulgence only adds to your stress and guilt.
  • Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.
  • Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.

At the end of the day, no one is going to be happy around you if you’re not happy. It’s so important to take care of YOU. We’ve offered some suggestions to help you deal with stress during the holidays. Now it’s up to you to choose what will work for you. Good Luck!

Happy Holidays, Peace and Joy from your friends at DiversityNursing.com!

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Topics: Seasonal affective disorder, holiday stress, stress during the holidays, managing stress, manage stress

2020 Is The Year Of The Nurse

Posted by Erica Bettencourt

Mon, Dec 02, 2019 @ 02:08 PM

2020For the first time in history, the world will unite in celebrating the benefits that Nurses and Midwives bring to the health of the global population. The World Health Organization (WHO), has declared 2020 as The Year of the Nurse and the Midwife (YONM).

It is celebrated in honor of the 200th anniversary of Florence Nightingale's birth. President of the International Council of Nurses (ICN), Annette Kennedy, said "The 20 million Nurses around the world will be thrilled to see their profession recognized in this way. Florence Nightingale used her lamp to illuminate the places where Nurses worked, and I hope the designation of 2020 as the International Year of the Nurse and Midwife will provide us with a new, 20-20 vision of what Nursing is in the modern era, and how Nurses can light the way to universal health coverage and healthcare for all.”

WHO is working with partners such as, the International Confederation of Midwives (ICM), International Council of Nurses (ICN), Nursing Now and the United Nations Population Fund (UNFPA). Their goal for this year-long global focus on Nurses and Midwives is to: 

  • Celebrate the contributions of health workers, with particular focus on Nurses and Midwives, in improving health globally,  
  • acknowledge, appreciate and address the challenging conditions Nurses and Midwives  face while providing care where it's needed most and
  • advocate for increased investments in the Nursing and Midwifery workforce

Lord Nigel Crisp, co-Chair of the Nursing Now campaign said, “The WHO has provided a unique opportunity both for countries to demonstrate how much they appreciate their Nurses and Midwives and to showcase what more Nurses and Midwives can achieve if given the support to do so."

Check out the World Health Organization's video, Nurses and Midwives: Key To Universal Health Coverage

We at DiversityNursing.com are thrilled Nurses and Midwives are receiving recognition for their commitment to the profession and selfless dedication to their patients, families and students.

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Topics: World Health Organization, nurses, midwives, The Year of the Nurse and the Midwife, 2020 year of the Nurse, International Council of Nurses, International Confederation of Midwives, Nursing Now

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