More than 27 million Americans will soon gain health coverage under the health law. But who will treat them all?
Hebert says that despite doubts from some doctor groups, nurse practitioners are honing their craft in patient care and research to position themselves to help care for this new influx of patients, and they’re doing so without sacrificing the quality of care.
KHN's Alvin Tran sat down recently with Hebert to discuss the changing role nurse practitioners may soon have, as well as some physicians' efforts to stop them.
Here are edited excerpts of that discussion:
Q. As of 2012, 18 states and the District of Columbia allow nurse practitioners to diagnose, treat patients and prescribe medications without a doctor’s involvement. What is the biggest impediment to expanding to other states? How are you planning to expand that to the other states?
Well, the problem is that there are certain states that require physicians' supervision of nurse practitioners or there may well be some kind of restrictive collaborative agreement that is imposed upon the nurse practitioner. Often times, that makes it very difficult for nurse practitioners to practice. Sometimes there may be a physician who is unwilling to supervise. Other times you may have an issue where the physician chooses to not form a collaborative agreement with nurse practitioners. So, part of the issue is that we have anticompetitive regulations in place.
There are a number of things that we want to do at the federal level. We are hopeful that legislation is going to be reintroduced this Congress that will allow nurse practitioners in Medicare to admit patients for home health care. Right now, the admission can only be done by a physician. Given the fact that we've had research indicating that it would be cost effective, we can get people out of nursing homes and hospitals quicker. It really makes good public policy sense. Particularly, if you got a situation in a rural area where the nurse practitioner and the patient is waiting for the physician to sign the order to admit into home health.
Same thing is true on hospice. We've not been able to get legislation passed that allows nurse practitioners to admit to hospice. We’re not currently permitted by statute to formaccountable care organizations on our own. That opens up a lot of possibilities for safe and effective, cost effective health care.
Q. Physicians groups, including the American Medical Association, have opposed efforts to expand the scope of practice of nurse practitioners and raised concerns of patient safety, contending that physicians' extended training makes them more qualified to handle such issues. How do you make sure that patients are protected?
There have been studies over the years that shows that our outcomes are the same or better than primary care physicians. The fact is that it’s a total red herring. Nurse practitioners have been practicing safely and providing great outcomes for decades.
Q. Medicare’s reimbursement rate for NPs is 85 percent of the physician rate for the same services. Should these rates be the same for both providers?
One hopes that, when all is said and done, whether they're working with a physician or billing on their own, it should be 100 percent of what a doctor is paid because the fact is, they're providing the same services that a physician is providing. Quite frankly, it doesn't make any sense.
Q. What role do you think NPs will have once the federal health law takes effect in 2014?
I think that once you have a full implementation of the expanded Medicaid provisions of the ACA, you’re going to see increased demand for primary care. Unless there’s someone there to provide that care, the intent of the ACA will not be fulfilled. You’re going to see a lot of patients who may be insured or have coverage under Medicare and Medicaid, but may not be able to get services.
I think the major challenges will be to look at regulations that artificially restrict a nurse practitioner’s ability to practice within their scope. If patients want to choose a nurse practitioner, they should be free to do so.
Q. Your tenure as CEO began last month, what’s at the very top of your 'to-do list'?
We are looking at rebranding and a more enhanced public relations campaign. We're looking at increasing membership. Right now we’re about 42,000 members and there are 155,000 nurse practitioners in this country. So, we have room for growth. We’re going to be spending some time ramping up our association activities.
Source: Kaiser Health News
By Bobby Shuttleworth
At Calhoun Community College, nursing students are looking forward to the day they get their certification, degree and begin in the work force. While some will end up in a traditional role, others may look forward to adventure.
Brian Soloman is ready to get into a career and be with his children.
"I would like to go on to possibly UAH and consider even pursuing a nurse practitioner," said Soloman.
Takicha Barrett said her goals revolve around the very young.
"My plan is to successfully obtain a job, hopefully in the pediatrics department. I love kids," she said.
Soloman said he's heard of exotic locations, but he wants to stay home with his children. He said those locations are everywhere.
"...On oil rigs, people that are offshore. And there's even contractors that are in the Middle East or in the theatre in Afghanistan and that were in Iraq; some of the companies have also hired out nurses," he said.
Bret McGill is the Dean of the Health Sciences Division at Calhoun Community College. He said the options are almost limitless.
"A couple of jobs that come to mind, one is a school nurse and just about every school has an LPN or an RN that works to take care of children and administer medications," said McGill.
One of the areas people may not be familiar with is in the industrial setting.
Candy Fall is an occupational nurse at BP. She's worked at several industries before honing her skills here with a focus on wellness. She writes articles for the corporate newsletter, an internal TV station, and much more.
"This particular plant, I'm responsible for medical surveillance for each employee that's here," Fall said.
She said BP is big into wellness programs to keep their employees healthy, like flu shots and more.
"We have a fitness center reimbursement program. We have fruit of the day, where we have fruit delivered to the plant three times a week and our employees and our contract employees can have a piece of fruit to keep them from going to the vending machines," she added.
The program at Calhoun is giving nurses an opportunity to pursue a rewarding job, while helping to keep employees healthy.
Copyright 2013 WAFF. All rights reserved.
By Brittney Edwards
Frontier Nursing University has been awarded a grant from the Health Resources and Services Administration’s Scholarship for Disadvantaged Students (SDS) program. This four-year grant totals $1,350,000 and will provide scholarships to 90 students over the grant period.
The purpose of the SDS Program is to increase diversity in the health professions and nursing workforce by providing grants to eligible health professions and nursing schools for use in awarding scholarships to financially needy students from disadvantaged backgrounds. Many of these students are from underrepresented racial and ethnic backgrounds and will help diversify the health workforce. Because 100% of FNU graduates are trained in primary care, the FNU student body is a precise fit with the goals of the SDS program. Not only does Frontier recruit, educate and graduate advanced practice nurses and midwives to work in primary care, but our university targets students from educationally disadvantaged backgrounds and minority groups. With over 60% of FNU students fitting the educationally disadvantaged category and 20% qualifying as economically disadvantaged, FNU has a pool of students who can benefit greatly from this assistance.
“We are thrilled to be able to offer these scholarships to our students who might have had their graduate education goals postponed or unfulfilled because of financial constraints,” said Dr. Susan Stone, FNU President and Dean. “Our mission is to educate nurse-midwives and nurse practitioners to serve women and families with a focus on rural and underserved areas, so the SDS grant is a perfect fit with our institutional goals.”
FNU will award 90 scholarships, valued at $15,000 each, over the four-year grant period. FNU tuition for the entire program, if attending full-time, ranges from $24,000 to $31,000. This low tuition will allow FNU to award nearly full scholarships for tuition with some funding for fees, books and reasonable living expenses. This funding will make the difference to students experiencing financial difficulties and allow them to complete their graduate education.
About Frontier Nursing University:
FNU provides advanced educational preparation for nurses who seek to become nurse-midwives, family nurse practitioners, or women’s health care nurse practitioners by providing a community-based distance graduate program leading to a Doctor of Nursing Practice (DNP), Master of Science in Nursing (MSN) or a post-master’s certificate. For more information about Frontier Nursing University, visit www.frontier.edu.
By Christina Orlovsky, senior writer, and Karen Siroky, RN, MSN, contributor
As the nation’s population becomes more diverse, so do the needs of the patient population that enters U.S. hospitals. As caregivers with direct contact with patients from a wide spectrum of races, ethnicities and religions, nurses need to be aware and respectful of the varying needs and beliefs of all of their patients.
In its position statement on cultural diversity in nursing practice, the American Nurses Association (ANA) states that: “Knowledge of cultural diversity is vital at all levels of nursing practice…nurses need to understand: how cultural groups understand life processes; how cultural groups define health and illness; what cultural groups do to maintain wellness; what cultural groups believe to be the causes of illness; how healers cure and care for members of cultural groups; and how the cultural background of the nurse influences the way in which care is delivered.”
Additionally, the Joint Commission requires that all patients have the right to care that is sensitive to, respectful of and responsive to their cultural and religious/spiritual beliefs and values. Assessment of patients includes cultural and religious practices in order to provide appropriate care to meet their special needs and to assist in determining their response to illness, treatment and participation in their health care.
There are a number of ways to comply with the requirements for providing culturally diverse care.
First, be self-aware; know how your views and behavior is affected by culture. Appreciate the dynamics of cultural differences to anticipate and respond to miscommunications. Seek understanding of your patients cultural and religious beliefs and values systems. Determine their degree of compliance with their religion/culture, and do not assume.
Furthermore, respond to patients’ special needs, which may include food preferences, visitors, gender of health care workers, medical care preferences, rituals, gender roles, eye contact and communication style, authority and decision making, alternative therapies, prayer practices and beliefs about organ or tissue donation.
Kathleen Hanson, Ph.D., MN, associate professor and interim executive associate dean for academic affairs at the University of Iowa, summarized the importance of learning cultural diversity in nursing education.
“Cultural competency is threaded throughout the nursing school curriculum. We teach every course with the idea that there’s content that may need to be explained for a diverse student group,” Hanson said. “In nursing, cultural competency has been around for a long time. I think that’s probably something that the nursing profession recognized maybe a bit before some other disciplines. We’ve always worked in public health, so we have always seen the diversity of America.”
Hanson concluded: “We need to be able to care for diverse populations because our country is growing increasingly diverse. Oftentimes persons who are in minority groups or who are underrepresented have different health care needs. It’s important for us to have a student population that is as equally diverse as our client; we need to prepare a workforce that not only knows how to work with diverse peoples, but also represents them.”
By: Shantelle Coe
Without cultural diversity amongst healthcare providers, it is almost impossible to provide quality nursing care to people from different ethnic and socioeconomic backgrounds. A multicultural representation of nurses, physicians and clinicians is important to ensure the healthcare being delivered is sensitive and meets the physical and holistic needs in our “patient palette”.
In the United States, a rise in the population and increase in minorities further challenges our healthcare system to provide appropriate care to the ever changing population it serves.
Some of the major findings in a study on the changing demographics and the implications for physicians, nurses and other healthcare workers conducted by the US Department of Health and Human Resources are bulleted here:
- Minorities have different patterns of health care use compared to non-minorities. Disparities in access to care account for part of the difference in utilization.
- Demand for health care services by minorities is increasing as minorities grow as a percentage of the population. Between 2000 and 2020, the percentage of total patient care hours physicians spend with minority patients will rise from approximately 31percent to 40 percent.
- Minorities are underrepresented in the physician and nurse workforce relative to their proportion of the total population. As minorities constitute a larger portion of the population entering the workforce, their representation in the physician and nurse professions will increase. The U.S. will increasingly rely on minority caregivers.
- Minority physicians have a greater propensity than do non-minority physicians to practice in urban communities designated as physician shortage areas. An increase in minority representation in the physician workforce could improve access to care for the population in some underserved areas.
The study also summarizes: “Advocates for increased minority representation in the health workforce argue that increasing the number of minority physicians will improve access to care for minorities and vulnerable, underserved populations. These advocates argue that increased representation of minorities in the health workforce not only will increase equity, but will also improve the efficiency of the health care delivery system”. (HRSA 2000)
Men (of all backgrounds) are also far under-represented in nursing. Less than 1 percent of the population are male nurses.
As our nursing population lacks diversity, statistics show that the US population is becoming more diverse and will continue on through the decades.
Below are projections for the increase in diversity amongst minorities in the United States:
Source: Modified version of Census Bureau middle series projections.
As our demographics continue to change, one of our greatest challenges is getting hospital organizations along with healthcare administration to realize that, in order to provide the best care and ensure successful patient outcomes, we have to embrace diversity. This is especially challenging to nurses because they will be expected to deliver care that encompasses these differences. Many nursing task force teams and associates have been organized to address this issue of healthcare diversity, such as:
- Asian American/Pacific Islander Nurses Association, Inc. (AAPINA)
- National Alaska Native American Indian Nurses Association, Inc. (NANAINA)
- National Association of Hispanic Nurses, Inc. (NAHN)
- National Black Nurses Association, Inc. (NBNA)
- Philippine Nurses Association of America, Inc. (PNAA)
For nursing care of all cultures and backgrounds, we owe it to our profession to increase our awareness and get involved to ensure delivery of the best care possible. One of the most important steps any of us can take is to first embrace diversity.
About the Author: Shantelle Coe RN, BSN, has 14 years of nursing experience and is currently a Senior Manager (US Commercialization) for one of the largest international biotechnology sales and education companies. She manages a team of Clinical Nurse Educators that provide medical device training to hospitals and physicians in the US and abroad.
In an era in when hospitals compete for patients by boasting the latest clinical technology, the most prestigious physicians and impressive amenities, patient satisfaction is most influenced by human factors, especially superior service-related communication skills between hospital staff and patients, according to the J.D. Power and Associates 2012 National Patient Experience Study released today.
The study measures patient satisfaction across all areas of the inpatient and outpatient hospital experience, including: interactions with healthcare professionals; tests and procedures; admission and discharge; and facility environment. It serves as a benchmark for the J.D. Power and Associates Distinguished Hospital Program. This distinction program acknowledges high levels of performance by a hospital in achieving an “outstanding” inpatient, emergency department, cardiac, maternity or outpatient experience.
The study finds that recently-hospitalized patients have high levels of overall satisfaction. Overall patient satisfaction with their inpatient hospitalization averages 825 index points on a 1,000-point scale, similar to that of guests at luxury hotels, among whom satisfaction averages 822. In outpatient settings, overall patient satisfaction is higher, averaging 863. However, patient satisfaction dips to 788 for emergency department visits.
“Hospitals may attempt to attract patients and staff by adding equipment or sprucing up their facilities,” says Rick Millard, senior director of the healthcare practice at J.D. Power and Associates. “From the perspective of patients, it might be more worthwhile to invest in finding and keeping staff with superior interpersonal skills.”
Investments in staff can be overlooked, as Millard notes many hospitals have spent a lot of money in recent years to make their facilities look and feel more like hotels. Yet, facility characteristics are more important for hotels than for hospitals. For upscale hotels, the facility accounts for nearly one-half (48 percent) of guests’ overall satisfaction, while in an inpatient setting the hospital facility represents just 19 percent of patients’ overall satisfaction.
“Having an appealing hospital facility matters, but an experienced and socially skilled staff has a greater impact on patient satisfaction,” says Millard. “Personal interactions with the staff have a profound impact in both inpatient and outpatient settings.”
Doctors and nurses account for 34 percent of the overall experience ratings for inpatients, and their influence is even higher (43 percent) among patients in emergency settings. Among outpatients, doctors and other healthcare professionals represent 50 percent of their overall experience.
Solid interpersonal skills are especially necessary for handling the types of problems that may arise during hospitalization. When problems do occur, they may jeopardize patient satisfaction. According to the study, staff service and staff attitude are the most common types of problems that patients experience. Patients who say they had any problem with their room or hospital staff rate their overall experience a 5.3 a 10-point scale, compared with 8.7 among patients that did experience any problems.
“When problems occur, they produce opportunities to demonstrate a genuine interest in the patient’s needs,” says Millard. “Resolving problems is clearly associated with higher ratings by patients. This has become more important as hospital reimbursement is now linked to patient satisfaction as measured by the government through the HCAHPS [Hospital Consumer Assessment of Healthcare Providers and Systems] survey.”
Millard notes that one area where hospitals can learn from hotels is how transitions occur. The admission and discharge process in hospitals is analogous to check-in and check-out in the hotel industry. Among inpatients, 35 percent of the overall patient experience is predicted by the admission and discharge process; yet the impact is much less in emergency and outpatient settings, where it is 19 percent and 12 percent, respectively.
“The first and last impressions are very important for a patient, much like they are for hotel guests,” says Millard. “Getting a patient into a room quickly at the start of their hospital stay, and ensuring a smooth process during discharge, along with a follow-up call once the patient gets home to make sure they’re doing okay, goes a long way toward achieving high satisfaction.”
Nongovernmental, acute-care hospitals throughout the nation are eligible for the J.D. Power and Associates Distinguished Hospital recognition program. Recognition is valid for one year, after which time the hospital may reapply. The service excellence distinction is determined by surveying recently discharged patients regarding their perceptions of their hospital experience and comparing the results to the national benchmarks established in the National Patient Experience Study.
The 2012 National Patient Experience Study is based on responses gathered between December 2011 and March 2012 from more than 10,275 patients who received care in inpatient, emergency or outpatient facilities in the United States.
Source: Infection Control Today
As a resource for Nurses across the country, DiversityNursing.com wants to be sure our community is aware of the following site: The Future of Nursing: Campaign for Action
The Future of Nursing: Campaign for Action, an initiative to ensure that all Americans have access to high-quality, patient-centered health care, with nurses contributing to the full extent of their capabilities. Action Coalitions work with the campaign to implement the recommendations of the landmark Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health. The coalitions are comprised of nursing, other health care, business, consumer and other leaders across the country. 48 states have Action Coalitions involved in this initiative.
The Campaign for Action is a collaborative effort to implement solutions to the challenges facing the nursing profession, and to build upon nurse-based approaches to improving quality and transforming the way Americans receive health care.
Action Coalitions are the driving force of the campaign at the local and state levels. These groups capture best practices, determine research needs, track lessons learned and identify replicable models. Examples of accomplishments to date include:
Texas is collaborating with nursing education leaders to adopt a common menu of core required classes across 106 schools in the state.
New Jersey is advancing practice by disseminating best practice models that demonstrate the benefits of staff nurses working to the full extent of their education and training.
Indiana is working within Indiana University to include inter-professional education into the newly designed curriculum to be used by a number of its health profession programs, including the schools of medicine and nursing.
Virginia is advancing nursing leadership by recognizing and mentoring 40 Virginia registered nurses younger than 40 who positively represent and lead their profession.
To get involved and find out more http://www.thefutureofnursing.org/
From thestarpress.com By Michelle Kinsey
MUNCIE — Indiana University Health Ball Memorial Hospital wants to make sure that every person who walks through their doors gets equal treatment.
That commitment has landed the hospital at the top of a list, as the first in the state to be designated as lesbian, gay, bisexual, transgender (LGBT) friendly by the Human Rights Campaign, the nation’s largest LGBT civil rights organization.
The news came in the form of the HRC’s annual Healthcare Equality Index for 2012, which looks at how equitably healthcare facilities in the United States treat their lesbian, gay, bisexual and transgender patients and employees.
IU Health BMH was one of 234 nationwide — but the only one in the state — recognized as a “Leader in LGBT Healthcare Equality,” meeting all four core policy categories — patient non-discrimination; employment non-discrimination; equal visitation for same-sex partners and parents, and training in LGBT patient-centered care.
“We are proud of the recognition,” said IU Health BMH President and CEO Mike Haley. “It’s the result of a lot of hard work.”
That work began two years ago, after a transgender patient claimed she was mistreated in the hospital’s emergency room.
Transsexual Erin Vaught claimed she was called “it” and “he-she” and eventually denied treatment when she went to the ER on July 18, 2010, for a lung condition that was causing her to cough up blood.
Complaints were filed days later by Indiana Equality and Indiana Transgender Rights Advocacy Alliance and the incident went viral, with the hospital receiving criticism nationwide, and beyond.
Ball Memorial Hospital released a statement saying the hospital was conducting an internal review.
“We failed to meet their needs,” Haley said. “We acknowledged that openly.”
Then they went a step further.
“It’s one thing to apologize,” he said. “It’s another to say, ‘And furthermore, I want this hospital to be considered as a place anyone would want to go if they needed a hospital.’”
Haley issued a challenge to all physicians, employees and volunteers to meet every HRC key indicator.
Ann McGuire, vice president of human resources for IU Health BMH, led the hospital’s efforts. Members of the LGBT community were asked to help.
Jessica Wilch, board member and past president of Indiana Equality, an LGBT rights group, said she was a “believer in what (IU Health BMH was) trying to do” from the first meeting.
“When this went viral, my concern was that BMH would take the stand that this was an isolated incident and just pacify the process,” Wilch said. “Instead they saw it as a teachable moment.”
New policies were drafted and training was developed.
In addition to hospital leaders, anyone a patient would come in contact with was involved in the training, McGuire said, adding that it was about more than just a tutorial. It was about “eye-opening” conversations.
Wilch agreed, saying that face-to-face conversations with the LGBT community were essential.
“We could talk freely about the things we have encountered and then come up with ways, together, to handle it differently,” she said.
Overall, the HRC reports the number of American hospitals striving to treat lesbian, gay, bisexual, and transgender (LGBT) patients equally and respectfully is on the rise.
This year’s survey found a 40 percent increase in rated facilities.
Last year, IU Health BMH was short a few policy additions for the leadership HRC designation, but was still recognized for its efforts.
Wilch said she was not surprised the hospital “hit all of the marks” this year.
“They have become, essentially, one of the leading hospitals in the country, because it really started with them,” she said. “They were the ones who reached out to us and said ‘How can we make this better? How can we do the right thing?’”
Haley said he believed the training and policies developed at IU Health BMH will be used “across IU Health.”
IU Health BMH has also set out to look at other ways to expand their “best practices” when it comes to diversity, McGuire said. The hospital has been hosting Palettes of Diversity events, which have celebrated not only the LGBT community, but other cultures.
“We are making sure we are hard-wiring an environment recognizing and supporting diversity for all who come here,” Haley said.
“It’s about relationships and dignity and respect,” she said. “It is uniqueness that each of us brings that makes us stronger as a community.”
And, McGuire would tell you, as a hospital.
Many tribal cultures don't have a word for "boredom". Sitting under a tree for hours at a time, waiting in line to get water from the well, or walking four days to a nearby village for medical help is just a way of life. But as technological advances penetrate societies all over the globe, impatience is mounting everywhere.
Google slowed down the speed of search results by four tenths of a second to see what impact it would have. The result was eight million fewer searches a day! A quarter of us abandon a webpage if it doesn't load within four seconds. An email that doesn't get a response within 24 hours is considered unresponsive. And one USA Today study found that most North Americans won't wait in line for more than 15 minutes.
But "impatience" + "cross-cultural" don't work well together. Cross-cultural relationships and projects inevitably take more time, more effort, and more patience. Slowing down often goes against the grain of what we're trying to accomplish.
A volunteer construction team from the U.S. traveled to Liberia to put a roof on a Monrovian school. The Liberians were extremely grateful for the N. Americans' generosity but the first day into the project, the Liberians expressed concern about whether the new roof would be well-suited to the Monrovian climate and environment.
When they voiced their concern, the volunteers replied, "Look. You have to trust us. We've worked on buildings like this all over the world. We're only here for six days. So the only way we'll get this done is if we stick with our plan."
Three months later, a monsoon came in off the Atlantic coast and the new roof came crashing down. A couple Liberian students died and several others were injured. Sometimes our "efficient"(impatient!) approach is not so great after all.
Just about everything takes longer when working and relating cross-culturally. Communication, trust-building, and just getting things done requires more effort and perseverance. Whether it's dealing with long queues when traveling, merging different technology systems, or trying to get to the bottom of a conflict, understanding and effectiveness come more slowly when different cultures are involved.
Patience needs to be factored in from the very beginning of any cross-cultural project. Long before the U.S. construction team ever arrived in Liberia, a more thorough process of determining what the need was and how to best meet it would have been valuable.
For a fraction of the cost of shipping a team to Africa, the volunteers could have sent money to have local builders put on a new roof. Or with a deeper level of analysis, they may have concluded that the roof wasn't really the problem but instead, was a symptom of deeper problems of poverty and conflict that could be better addressed by partnering with development experts.
Full disclosure. I'm terribly impatient. I hate waiting in lines, I calculate which driving lane is moving fastest, and I want things to happen quickly and according to plan. But on the rare occasion when I exercise patience, the end result is almost always better: the partnership is richer, the project gains wider acceptance, and the money invested goes further.
In a world of instant information and feedback, it's counterintuitive to step back and move more slowly. But slow is the new fast when you're working across cultures. Take a deep breath and trust that something far bigger and better can be accomplished when you patiently persevere through the hard work of listening, understanding, and discovering the possibilities that may otherwise go unnoticed when rushing to the finish line.
From WorkingNurse.com By Elizabeth Hanink
Work-life balance is more than good time management. It means having a professional life and personal life that are integrated so well that each part enhances the other. That takes self-knowledge and self-discipline—two traits that we need to cultivate if we ever hope to achieve the balance that brings enjoyment along with achievement. It is a life-long process that requires daily fine-tuning.
All sorts of people have trouble with work-life balance. What makes nurses especially vulnerable is that so much of our professional life is beyond our control. We can’t change the fact that most nursing jobs involve tricky schedules, heavy work-loads, and tons of variables that can shift by the hour, yes, even by the minute. Most of us are additionally burdened by wanting to give good care.
But not having the power to manage many aspects of our jobs doesn’t mean we have no control. Nurses can be like the sleeping elephant, unaware of its strength. If you want to make your dreams come true, wake up to your own power, to the role you play in your own life. Taking control is the key. If you live in a constant state of reaction, you give control to someone else. Time management only enters the equation when you use it as your tool to gain control: over a day, a month, a life-time.
Remember Nursing 101
Where to start? You don’t need a new system of thought. What you learned in nursing 101 about nursing process will serve quite well here. Remember how assess, diagnose, plan, implement, and evaluate worked for all nursing problems. It works for the big picture of your life, too and helps you get the minute by minute obstacles out of the way so the bigger pieces fall into place. It does you no good to manage a perfect work day, every day even, if there is nothing left for family or fun or personal growth.
Let’s start with assessment. What do you want—what is important to you? Knowing that, and it can take some time to figure it out, makes all the difference. Do you want, in the next hour, to have all your charting completed or do you want to be sure that all your patients have a clean, neat room with trash picked up and tray tables cleared? Do you want in five years to have an advanced practice degree or do you want weekends free for hobbies? Do you want to own a home or vacation every year in a different country? All of these are commendable goals but which are yours? Only you really know.
The second step is diagnosis. What is keeping you from achieving your ambitions? Are you stuck in the land of “after this happens?” as in I’ll get to my charting after I have rechecked all the rooms. Or I’ll start school after I feel more settled at work? Or could you be like the man in the Chinese proverb waiting for roasted duck to fly into his mouth? You will wait a very, very long time. The important ingredient is taking responsibility for what is lacking. This step does not allow placing blame anywhere but on you.
No time to linger. Now that you know what you want and why you don’t have it, move onto the third step, planning. This involves setting priorities. Out of all the things you want, what is most important? It might be different every day, it might vary by what age you are at a given time, or it might vary by what is realistically possible given your circumstances. If you already have three young children, then the Peace Corps is not feasible.
Your self-knowledge that came through assessment is critical in this step. And because you are employed as a nurse, again, you might not have total control minute by minute. But taking your theoretical goal for today as wanting to get all the charting done on time, how are you going to achieve that with a last minute admission? Take the time to assess where you are and plan. Write it down, even if jotting down will delay you, what 15 seconds. Maybe the new goal will have to be leaving only 15 minutes late instead of the usual hour that a last minute admission would ordinarily require.
Now it’s time to implement and here is where some time management skills can play a part. If you are lacking these, get some. Study the nurses around you who do manage to get it all to happen, because some tricks do not come naturally. Not every experienced nurse is savvy in these skills but most who last in a hectic hospital environment have a clue, and you can learn from them.
There’s a ton of specific information out there.
Kathy Quan, RN, has written a book on time management just for nurses, Tips and Strategies for Effective Time Management for Nurses. You can download it as an ebook. If you are a new graduate, try The Everything New Nurse Book also by Kathy Quan(www. kathyquan.com). Her website and those of others are full of suggestions. If you can get work under control, you will have much more energy left for the rest of life. And don’t wait to get started on that. Life doesn’t wait.
Don’t forget, there are nurses who manage to have long careers meeting interesting challenges and still live interesting lives outside of work. What is the secret, you might ask.
It isn’t a secret says Tilda Shaloff, RN. You have to set priorities (remember planning?). She uses a daily written list (no Blackberry for her) that she often formulates while walking her dog. It contains, every day, day in and day out, 17 items. The number 17 has private significance for her. Your number could be different. The act of writing the list helps her organize what has priority and what can wait.
She also delegates. Her children have always been paid to help around the house and her husband has always been willing to participate fully in chores. She also, and this is key, arranges her clinical work schedule to suit the other important things in her life—her writing and public speaking. Being the author of several books and a very popular motivational speaker, Shaloff says, takes tremendous energy. But these activities are important to her and so she makes the effort to have the time and strength. It is a conscious choice. She can do speaking and writing and work in an ICU but not other things. You need to make the same choices. It might mean saying no to being room mother or working the polls on election day. Or it might mean having a clean as opposed to an immaculate house. Make your life and your job work for you.
Kathleen Singleton, RN, MSN, also makes choices. As the president of the American Association of Medical Surgical Nurses she has a serious obligation on a national stage plus the obligations of her “day job.” For her the secret is, of course, organization, and she is very dependent, she says, on any electronic help she can get. But the real key for her is negotiation and flexibility. Singleton makes her day job work for her.
She has had scads of practice at this; she worked over the years from nursing attendant to MSN all while working full-time. She thinks any nurse can do it. Instead of moaning about them, make the weekend and shift obligations work for you, she says. Take advantage of your ability to trade shifts. Work with your fellow employees and supervisors to have everyone gain. Negotiate your holiday obligations in such a way that the schedule then allows you to do what is vital to your happiness. In Singleton’s case, her employer, an affiliate of the Cleveland Clinics, allows her maximum flexibility in scheduling in exchange for her willingness to be quite flexible in what is required of her.
Keep in mind: achievement without enjoyment is not the way to balance. Taking control is. Plan, choose, and readjust. Balance is achieved both daily and over the long haul and can be different for each of us each day. Adjust as needed, both the goal, and the implementation because there is more than one way to success.
A Jar Full of Rocks
Here’s a strategy to visualize how, without planning and taking control, you can work very hard all day or even all your life and still have no accomplishments and no satisfaction. Picture a large jar like one that old-fashioned delis kept pickles in. Or the type that holds pretzels from Costco. Fill it as full as you can with large rocks. Now fill in the other spaces with small pebbles. Next add sand. Isn’t it amazing how much sand fits into all the nooks and crannies between the rocks and pebbles? Last fill with water. Quite a bit goes in, doesn’t it, despite all those rocks.
But stop. What if you had poured the water in first? It would be impossible to get even one large rock in without spilling everywhere. Now think of all the things you want to do, today and in life. Make sure the large goals, the large rocks, are what you really want from life — to have more education, to write a book, to own a house, to run a business. You choose. Then fill in with the small pebbles. Do they support the rocks? If you took away three pebbles---a ho-hum hobby, a favorite TV show, or say time on Facebook, would you have room for another large rock? And what about the sand in your life? Is it helping you toward your goal or is it just getting between your toes? Are you drowning in all the water that fills up your life? Is the water keeping you from getting any large rocks into the jar?
As for those nurses like Singleton or Shaloff who work, have a rich personal life, and still have time to pursue advanced degrees or run side businesses? Look at what they don’t do. You will probably find they have eliminated those things that don’t move them toward their goals. They don’t know about the latest episode of American Idol. Maybe they don’t have the latest French tips from the manicurist. They dare to bring store-bought to the potluck. They have made the choice that these things matter less than achieving their goals.
You need to do the same. Just remember. To avoid the pickle jar trap or the “as soon as” trap or any other trap that is robbing you of a good work-life balance, you need to take time now to decide what is important (assess),what is keeping me from it (diagnose) how do I get it from here (plan) and execute. Reassess frequently and adjust as needed. Now you have balance.