The Peer Advisor Program, which pairs upper-class students with first-year students to help them get acclimated to and thrive at U.Va., became her extended family. Students in the program came to rely on her like a mother away from home.
On the occasion of her retirement, Terry sat down for an interview with UVa Today's Anne Bromley and talked about the philosophy behind the Peer Advisor Program and her roles at the University.
UVa Today: Did you feel like you were creating something new here at U.Va., changing its history?
Terry: I didn’t think of it so consciously at that time. I thought of it more as exposing more people, more children, more students about possibilities about college.
The great thing about those sessions is that not only were we talking with high school juniors and seniors, but the families were there. I remember creating a series of leaflets for children. We called it "Steps to College." In it we were suggesting things for them to think about for that particular year.
It makes me feel very proud, being in the Office of Admission for almost 10 years, from 1980 to 1989, and seeing the numbers of black students increase. When I look at the alumni who come back, many of them were students in high school when I met them. That makes me feel older, but it also makes me feel proud because of the things that they are doing.
Those days at admissions laid the foundation in terms of this work for the Peer Advisor Program.
I often tell the story of my second year in admissions when the vice president for student affairs, Ernie Ern, invited me and others to a meeting he was holding of black students. The thing that touched me the most was a young man, and I remember his words: "U.Va. has done everything to get me here, but now that I’m here, nobody seems to care." I never forgot that, because here was a student who had been recruited and who had come, but who was experiencing what I’ll call disappointment, experiencing isolation.
When I left that meeting, I went back to my office and I sat down and I looked at the black student admissions committee that I had organized. One of the things I immediately thought is, I'm going to add a subcommittee to check on students we had had contact with. I assigned members of the committee to the different residence halls, and they picked up where we left off – after two or three weeks, we were gone – but the students were there to check on the welfare of other students, and that was one of the forerunners of the Peer Advisor Program.
I found, probably about a year or two ago, a note that I had written Jean Rayburn, who at the time was dean of admission. She had sent out a note to the staff to ask if any of us had any ideas about ways of retaining students. I actually wrote – and I have it hand-written because we didn't have the computers then – several things, and one of them was what I called a "Big Brother, Big Sister program." I smiled when I read it because number one, I had forgotten about it; number two, when I read it, it was exactly the kinds of things I have done with the Peer Advisor Program.
UVa Today: How did you come over to the Office of African-American Affairs?
Terry: I applied for the position because I wanted to have more time with my children. Did that happen? No. Looking at this office and that it had developed this program that I'd actually proposed, this was something I was excited about. It was the program that attracted me.
Everybody makes sacrifices, and when I look at U.Va. and some of the sacrifices, it's not just been me, it's been my family.
Shawna, when she was real little, she thought every person who was a teenager or a young adult was a peer adviser. I remember being in church one Sunday and U.Va. students talking to me. Shawna got antsy because she'd been good, she had sat through service, and she beckoned me and said, "Mommy, Mommy, can't we go home? Can't you stop talking to all these peer advisers?"
I think in our household, it almost has been that I have three children as opposed to two – the Peer Advisor Program is actually the same age as my son, 24. So they have grown up around peer advisers. I'd have peer advisers over for dinner, we would do things together, so it's just been that other presence in our house.
UVa Today: Have people asked you, "Shouldn't every first-year student have this kind of program?" Are there things that are specific issues or challenges to black students, or has that changed over time?
Terry: The latter part hasn't changed. I have peer advisers do mid-year interviews. We have questions about the disappointments you have experienced, the joys you've had; what is the best academic experience you've had, what is the worst? I do find that students still talk about, sadly, some racial insensitivity. If one asks, "Is this program still needed?", it is still needed, though this program is not about separating, it's about providing support.
Should every student have a peer adviser? I think every student should. The way I have always seen it is every student has a peer adviser through the role of residence life. I think the difference is peer advisers don't have to manage an environment within a dorm setting, so I know peer advisers don't have to enforce rules. With [resident advisers], there are certain rules they have to enforce. RAs are on call 24 hours; so, too, are peer advisers.
Where I see the difference is, if there is some racial insensitivity – it's not to say that an RA cannot address that at all, an RA can – I have additional support here. If I have experienced something, then I can be of more assistance, perhaps, than someone who may not have experienced it.
— By Anne Bromley
To read the first part in this article series, please click here
The important things to bridge the differences in the professional nursing practice in the United States are:
1. Develop critical thinking skills. Always ask how, what, when, where, who, and what-if questions. Seek to understand the need for what is not understood. It creates deeper and more meaningful learning when we ask questions and search for answers. It also expands knowledge and leads to future change with less frustration.
- Identify the difference, seek to understand and to assess the situation or question at hand.
- Observe the evidence of practice.
- Develop a self-improvement list for ourselves.
- Analyze content, including the policies and procedures of our facilities.
- Interpret, verify and explain findings to our way of understanding.
- Evaluate for relevant criteria to make a good judgment.
- Apply new ways of thinking and immerse into the new knowledge as our own, using it in new clinical settings.
- Create an action plan. Make a strong personal commitment to act differently in the nursing practice. Commit to doing things in new ways and not slide back into the old way of doing things. Adjust our behaviors again as needed. Apply new action plans to adopt better nursing practices for ourselves.
2. Be true to ourselves. Stay strong, positive, and use positive energy everyday. Do not fall into the trap of negativity. Keep eyes open, mind clear, and refuse to go into a negative pit. There is no room for negativity.
- Build our brand. One simple example to think about branding is to look at a change shift. When a nurse comes in tardy; we hear some people say, “She is never late; she is always on time. Hope she is okay.” But we also frequently hear others say “She is always late. We don’t have to wait for her, let’s get started.” Ask yourself: Who do we want to be? It takes a plan and determination to come to work on time on a consistent basis. Our brand is built by what we do day in and day out. We want to make a conscious decision to align ourselves with true greatness.
- Practice positive self-talk to make self-affirmation a daily habit. Think about how many people are able to excel in another land. We use a different language all day at work, and we work in a people profession – around people, and taking care of people. We are a different breed. We are doing great!
- Excel in our strengths. When we posses excellent skills, use them. Peripheral IV (PIV) insertion it is a great time-saving skill. Help out where you are most skilled. Hold onto what is good, but assess if there’s a new, better way. Let’s raise the bar for ourselves.
3. Limit negativity.
- Take pride in our bilingual skills. Being bilingual is a gift. It is not a negative attribute. Speaking bilingual gives us the opportunity to explore understanding of words or phrases that are foreign to us. Volunteer to be an interpreter for patients who speak our native language whenever you can. Never use our cultural background as an excuse for not being an effective communicator. We need to continue to improve speaking English. We can learn to communicate more effectively every day. We can write down our successful sentences and deposit them in a basket. Pick them up to read them again once a while.
- Create ways to help deal with negative people around us. When we distance ourselves from the negativity or person, people may misinterpret our behavior into a negative behavior. Our actions may be interpreted as anti-social. Mingle, but avoid joining in negative talk. It unrealistic for us to expect to never encounter rejection or discrimination in the workplace. That is purely naïve. Rejections and discriminations are likely to happen to us. They happen for many reasons beside cultural differences. We do not appreciate experiencing rejection and discriminations at work. How one deals with the experience is a big lesson to learn. Let’s ask ourselves: What are we going to do if we encounter these things? What can we learn from this encounter? Do we want to tolerate it? How much can we tolerate it? What is our personal limitation? What can we do to change? How much time do we want to spend on unhappy events? Is this experience going to affect us one year from now? Five years from now? Ten years from now? At different times, we do different things. Therefore, a flexible plan will be very helpful. It is easier to deal with situations if we already have a thoughtful plan. At the very least, we have a lawful process to resolve discrimination. Always seek to understand. Explore how things can be improved.
- We also need to find our own ways to deal with whatever we encounter. I will share my own terrible experience. The incident happened just before I was going to a beautiful wedding. I was determined not let the terrible experience ruin a good time at the wedding so I compartmentalized my horrible experience. I went to my secret “P” pocket (I have many words which start with “P” in my mind that I can use to boost my positive energy when I needed). I pulled two “P” (Personally and Permanent) words out. I kept telling myself over and over “Don’t take it personally.” “The problem is hers.” “I did what I need to do for my job.” I also told myself again and again that “Nothing is permanent. This shall pass.” I repeated these sentences to myself until I was at peace. That night, I was able to enjoy the wedding. I could think about how to deal with my bad experience after the wedding.
4. Plan to bridge the differences in our nursing practices in many steps.
- Initial self-assessment and learning to fill the missing pieces of the puzzle for ourselves.
- Find a group to study, to socialize, to make friends, and to learn from each other and the cultures of each one involved.
- Search for a few career mentors for guidance. It will save us a lot of time while we are lost in a maze of professional nursing. In the United States, nursing opportunities are endless; we have a great many options for our advancement. It is not like when we thought nursing jobs were limited to a hospital or clinic.
- Ask for help. Ask for input to clarify any confusion. We want to do it right the first time and we want to do the right thing. We have to triple-check all we do, because patient outcomes are in our hands.
- Past personal beliefs like “Be quiet” and “Silence is a golden” – these don’t have much validity or value here. Not speaking up and not asking questions – these are not appropriate in this country. Do raise questions as appropriate.
Attachment I: Examples of possible solutions and preparation to bridge the differences in changing and adapting our professional nursing practice in the United States.
Our Possible Solutions
Assess and re-assess our patients
- Review and review, and review again physical assessment books. Memorize them as much as possible and as needed.
- Bring a handbook that we like such as “SkillMasters 3-Minute Assessment by Spring House 2006” to work for references.
- Bring bilingual dictionary to work for references.
- Practice American way as soon as we learn. Use it frequently.
Report abnormal finding
- Use SBAR for all verbal and written communications. Write down talking points for our verbal communication also.
- Use read-back method for all verbal orders.
- Ask the caller to spell it out or slow it down as needed.
- It is perfectly fine to state the obvious; let the speaker know that English is our second language.
- Ask speaker to listen to us attentively. It takes time to get use to our accent. Remember, listening skills are very important in any conversation.
Learn emergency responses – RRT, Code Blue with education in ACLS and PALS
- Be aware and tell our nurse managers that we did not have experience in these areas.
- Take initiative to attend emergency-related classes in our hospitals as soon as we can and take as many classes as needed.
- Increase our comfort level through self-study, group discussions and simulation labs. Find a preceptor or mentor to practice with us.
Giving P.O. medications and medication reconciliation
- Take time to observe patients taking their medications every time before we move on to the next task.
- Don’t put meds on the bedside table or on an over-bed table.
- Learn to perform medication reconciliation as needed.
Protect patients’ privacy and protect colleagues’ privacies
- Remember patient information is the patient’s private property. We need written permission from the patient, law and regulations, such as our facilities’ policies before we can share it.
- Plan ahead and create a simple sentence such as “I am sorry that I do not have a permission to give that information.”
Attachment II - SBAR
The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient's condition. SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety.
Michael Leonard, MD, Physician Leader for Patient Safety, along with colleagues Doug Bonacum and Suzanne Graham at Kaiser Permanente of Colorado (Evergreen, Colorado, USA) developed this technique. The SBAR technique has been implemented widely at health systems such as Kaiser Permanente.
This tool has two documents:
- SBAR Guidelines (“Guidelines for Communicating with Physicians Using the SBAR Process”): Explains in detail how to implement the SBAR technique
- SBAR Worksheet (“SBAR report to physician about a critical situation”): A worksheet/script that a provider can use to organize information in preparation for communicating with a physician about a critically ill patient
Both the worksheet and the guidelines use the physician team member as the example; however, they can be adapted for use with all other health professionals.
By SBAR Technique for Communication: A Situational Briefing Model
Kaiser Permanente of Colorado
Evergreen, Colorado, USA
Attachment III – Read-Back
Read-back is a way to verify of the complete order by the person who receiving the verbal order. The receiving person will repeat the verbal order back to the ordering clinician, who will verbally confirm that the repeated order is correct. The purpose of “Read-back” is to ensure patient safety.
Mai Tseng -- RN, BSN,MPA,EMBA, NE-BC,CRNI, LNC
Karen Cox -- RN, PHD, FAAN,
Laurie Ellison -- EMBA
Xu Hong Fang -- RN
Hong Guo -- RN
Sufan Sun -- RN
The following is a Diversity Statement written and signed by numerous colleges and universities and taken from the University of Virginia's website for their Office of African American Affairs. It provides good insight into the value that diversity adds in higher education, which almost always applies to professions, like nursing, as well.
On the Importance of Diversity in Higher Education
America's colleges and universities differ in many ways. Some are public, others are independent; some are large urban universities, some are two-year community colleges, others small rural campuses. Some offer graduate and professional programs, others focus primarily on undergraduate education. Each of our more than 3,000 colleges and universities has its own specific and distinct mission. This collective diversity among institutions is one of the great strengths of America's higher education system, and has helped make it the best in the world. Preserving that diversity is essential if we hope to serve the needs of our democratic society.
Similarly, many colleges and universities share a common belief, born of experience, that diversity in their student bodies, faculties, and staff is important for them to fulfill their primary mission: providing a quality education. The public is entitled to know why these institutions believe so strongly that racial and ethnic diversity should be one factor among the many considered in admissions and hiring. The reasons include:
Diversity enriches the educational experience. We learn from those whose experiences, beliefs, and perspectives are different from our own, and these lessons can be taught best in a richly diverse intellectual and social environment.
It promotes personal growth and a healthy society. Diversity challenges stereotyped preconceptions; it encourages critical thinking; and it helps students learn to communicate effectively with people of varied backgrounds.
It strengthens communities and the workplace. Education within a diverse setting prepares students to become good citizens in an increasingly complex, pluralistic society; it fosters mutual respect and teamwork; and it helps build communities whose members are judged by the quality of their character and their contributions.
It enhances America's economic competitiveness. Sustaining the nation's prosperity in the 21st century will require us to make effective use of the talents and abilities of all our citizens, in work settings that bring together individuals from diverse backgrounds and cultures.
American colleges and universities traditionally have enjoyed significant latitude in fulfilling their missions. Americans have understood that there is no single model of a good college, and that no single standard can predict with certainty the lifetime contribution of a teacher or a student. Yet the freedom to determine who shall teach and be taught has been restricted in a number of places, and come under attack in others. As a result, some schools have experienced precipitous declines in the enrolment of African-American and Hispanic students, reversing decades of progress in the effort to assure that all groups in American society have an equal opportunity for access to higher education.
Achieving diversity on college campuses does not require quotas. Nor does diversity warrant admission of unqualified applicants. However, the diversity we seek, and the future of the nation, do require that colleges and universities continue to be able to reach out and make a conscious effort to build healthy and diverse learning environments appropriate for their missions. The success of higher education and the strength of our democracy depend on it.
Meg Beturne MSN, RN, CPAN, CAPA
Denise Colon, RN
Baystate Health System, Springfield, MA
This article was submitted by Meg Beturne RN, MSN, CPAN, CAPA, Assistant Nurse Manager @ Baystate Orthopedic Surgery Center in Springfield, MA. Meg became a mentor and participated in "Baystate Health’s Diversity Leadership Initiative, Mentoring Across Differences" Program. A Dimensions of Diversity Exercise (copyrighted in 2011 by Washington Orange Wheeler Consulting firm http://wow4results.com) was offered as part of the Program.
The exercise is a puzzle that shows the complexity of mentoring across differences. Understanding how these differences have impacted us and others helps to create a container for meaningful dialogue. Consider how various differences could impact your mentoring relationship. To participate in this exercise, you identify a few dimensions of diversity that have had an important role in impacting who you are, how others see you, and how you see the world. You then figure out how the dimensions shaped who you are personally and professionally. Finally, how might these dimensions impact your mentoring relationship?
Meg, a Caucasian Catholic, mentored Denise who has a Latina background with strong family ties and a culture that is filled with traditions that are vital to her life and that of her family and extended family. Denise is Roman Catholic and she works to maintain a healthy balance between work and home as she has a young family. Here is their mentoring story…
Impact on Differences
As I began the mentoring relationship with Denise, I realized the importance of recognizing and understanding the differences and similarities that existed between us. Equipped with this knowledge, I felt that we could tackle the complexities of mentoring across differences. The Dimensions in Diversity exercise offered the perfect opportunity to explore key, diverse components that have made us the women and nurses that we are today. To that end, we made this a priority and discussed it at our very first meeting and then confirmed our thoughts and feelings at our next time together.
It was interesting to realize that both of us equally valued traditions and observances, but from a different perspective. We both enjoy sharing the particulars of the holiday traditions through the years and reminisced on who was present, the activities that took place, the photos that were taken and the memories that were made and cherished by future generations. Denise however was vocal that many persons that she has interacted with over time do not have a real understanding of the ethnic backgrounds that are celebrated in the various holidays. That being said, there is a lack of appreciation from culture to culture on the meaning and purpose of observances involving family and relatives. I had to admit that since I had grown up in a small mill town in Connecticut that was homogenous with regard to ethnicity and religion (Caucasian Catholics), I was not exposed to comments, conversations or messages that demonstrated anything but allegiance to the existing cultural observances and inclusion of the small numbers of diverse ethnic and religious populations that resided close by.
Denise chose accent and dialect as another dimension of her diversity. She relayed the fact that many individuals and groups do not make an attempt to understand or accept anyone who speaks in a certain way. This scenario creates feelings of self-doubt. In addition, it allows feelings of rejection to creep in that ultimately results in further retreat into one’s own ethnicity which is considered supportive and safe. As a registered nurse, Denise has encountered many patients and caregivers from all corners of the globe. Working with a team of professionals, Denise has gained acceptance and recognition as a caring and compassionate care giver and over time, interactions and conversations have focused on quality care rather than on accent or dialect.
I then shared that communication was a vital personal and professional dimension that affects my life in so many ways. Even though my communication style is open, friendly and positive, I have learned that being a good listener is actually a more important skill. I found myself connecting with Denise’s story and promised myself to be even more in tune with people I meet on a daily basis who might sound different than me. In my own way, I will seek to eliminate self-doubt by encouraging others to use their native voices to raise questions, contribute ideas and feel reassured that they will be understood.
As I reflect on this meeting with Denise, I am amazed at the information that was willingly shared and the conversation which was free-flowing and enjoyable. Most importantly, after completion of this exercise, I feel more prepared then ever to be the type of mentor that will enable Denise to move forward in both her professional career and her personal life!
A special thank you to Denise Colon, RN for her participation.
This is the first of a 2-part article and is a follow up to the CAN (Chinese American Nurses) Sisters I published on our blog on August 23, 2011. Click Here to Read the first article in this series.
The article is the collaborative work of a team of Chinese American Nurses (CAN) sisters. It speaks as “foreign” nurses who have worked in America for a number of years. Our group is very lucky to have CAN meetings twice a month. We have each other’s support. We share our setbacks and clarify our things that might confuse us. Together we provide opportunities to think things through; to have a better understanding of ourselves, to not let fear paralyze us; and to add strengths to face tomorrow with positive thoughts and energy. Go CAN!! Go!!!
Last month, a CAN nurse started to talk about the major differences that we are experiencing in the nursing functions and practices between China and the United States. Everyone joined in the discussion.
Assess and Reassess Our Patients
Nurses are expected to know as much as possible about our patients. Nurses have a major responsibility in the assessment and re-assessment of our patients. Most nurses are doing a great job in assessing patients. Nurses are at patients’ bedside 24x7. Physicians are not. We may notice a change first, and take action as the law allows. We can initiate many nursing protocols, especially in an emergency, and then we report the changes to physicians. Physicians come to assess, verify, confirm the changes, and take additional actions.
The nurse-to-doctor ratio is nearly 1:1 in China. Doctors are just like nurses, at patients’ bedside 24x7. When new patients arrive, doctors perform the first assessments.
Report Abnormal Findings:
Nurses report abnormal findings from our own assessments or from the results we receive from other departments or facilities. Most of our current practice is to report the results to nurses first. Nurses are expected and required to report abnormal findings to physicians. We can take actions that are legally allowed. Many nursing protocols are there for us to utilize, especially in an emergency, and then we turn around and report the results to physicians. Physicians come to assess, verify, confirm the changes, and take additional actions.
Doctors on the units get reports first. Nurses may not be aware of the results and reports. Therefore, nurses may not be aware of changes or actions needed.
Nurses or anyone who witnesses the need can call a code. A nurse is usually the initial emergency responder, until an organized team comes. Teams, including physicians, take over the emergency situation. Organized teams, such as the Rapid Response Team, Code Blue Team, and Trauma Team, have additional training in things like Advanced Critical Life Support and Pediatric Advanced Life Support.
Doctors are at the patient’s bedside or nearby to respond and initiate emergency actions.
Nurses are responsible to ensure medications which are taken by mouth (P.O. medications) are swallowed every time, with no exceptions. In the Medication Reconciliation process in some facilities, nurses verify medications on an on-going basis. Verbal and telephone orders are seen often in some facilities.
In past practice, P.O. medications might be left at the patient’s bedside or with their families, trusting that the patients would take their medications. This is not the right thing to do. It is very dangerous. What if a patient purposely hides his/her medications, and then overdoses on them? China’s nursing practice is changing; now nurses are watching patients take their medication more often. Doctors are there to verify medications in the Medication Reconciliation process. No verbal orders.
A patient’s health information is very private, personal property. It totally belongs to the patient. If we don’t have a patient’s written consent, or regulatory permissions, then we cannot give personal information to anyone except the patient. Self-imposed “kindness” such as initiating family or community support for a patient without the patient’s permission is no long allowed. For example, let’s say we go to work at the hospital and see our neighbor who is very sick. Our sick neighbor needs help, especially with child care. We cannot tell another neighbor who we think would be happy to help with the sick neighbor’s child. We have to plan ahead, talk about our intent, and ask the sick neighbor’s permission before we talk to the helpful neighbor. We would be violating the sick neighbor’s confidentiality if we talk to another neighbor without the sick neighbor’s permission.
Helpfulness and kindness are always welcome as long as it is a sincere act.
Performing and maintaining a sterile technique is a big deal in infection control to the nursing practice of both countries. Maintaining sterile technique saves lives, time and money.
In some cases, CAN nurses had the perception that a few of their nurse co-workers’ practices were a bit sloppy. When you notice the lack of sterile technique, you must speak up. Express concern about contamination. This is a time to educate our co-workers in a kind way. Often the nurses who are doing the job may not be aware that contamination has occurred. Mentally, we know that it is difficult for us to point out any possible contaminations or any wrong doing. Culturally we were taught to pretend that we did not see; let others do whatever they want to do; we do what we are supposed to do to keep ourselves clean. “Mind our own business,” is what we learned. But in today’s world we need to prepare a simple and easy phrase or sentence that will help us to gently point out possible contamination. It will save lives. We have a lot to learn about how to be assertive and to be an advocate for our patients.
The fear of contamination and the strict self-monitoring of sterile techniques are emphasized more. CAN sisters feel that because of our past strict training, sterile technique is branded into our minds.
Many facilities prefer to have IV Teams for Peripheral IV insertions to save nursing time, promote patient satisfaction, and decrease line infections. Therefore, nurses’ experiences in starting PIVs are very different. Some nurses do not have to start an IV at all and they have no skill in PIV insertion. For some nurses who start PIVs occasionally, their skill is hit-and-miss. Very few nurses are good at PIV insertion.
CAN nurses discovered in the support group meeting that most of nurses are good at PIV insertions. We found out that CAN nurses are the “go-to person” for performing PIV insertions. Personally, I have never paid much attention to this as a big difference. It was delightful to find out that this is one of our common strengths.
Salaries & Bonuses:
We make good salaries as nurses, even after about 40% is withheld in taxes, income taxes, and sale taxes. On the other hand, if we compare our salaries to physicians’ salaries, we find out a real gap. Physician pay is much higher. Of course, there are good reasons. Physician education and training are much longer and more in depth, and more physically and emotional demanding than nurses’ education. The demand for physicians is greater than the supply of physicians. We have many physician assistants and nurse practitioners who work under physicians and support some of our physician functions and responsibilities.
Nurses and physicians both have two types of incomes – regular salary and bonus. The nurses’ salaries are much closer to physicians’ salaries in China. Chinese doctors and nurses are equally compensated by the government. It is a perfect system for equal professionals. The differences in their earnings come from their bonuses, which are regulated and paid by the hospital. Currently, no nurse practitioners are working in a hospital or clinic in China.
Nurse to Physician Ratio:
The variety of job choices for nurses is huge, including acute hospital care, clinics, nursing homes, home health, insurance, occupational health, schools, law firms, etc. The nursing functions and responsibilities are varied, and it is very different in different health-care and non-health care settings. The physician to nurse ratio ranges from 1:4 to 1:8 or more, depending on the type of facility and the time of day or night. Some nurses function independently.
Most of nurses are working in hospitals and clinics, the nurse to physician ratio is nearly 1:1. It is a perfect ratio for an equal professionalism. No nurses are function independently.
For us “foreign” nurses, especially those of us who have studied nursing or grown-up abroad, we often find that nursing functions and practices are very similar in some ways and quite different in other ways. This becomes apparent particularly on initial entry into the nursing profession in the USA. Adaptation will ease most barriers. The sooner we can identify the differences, analyze them, and find ways to adjust, the sooner we will adapt to the United States’ way of practice. As we open our hearts and minds to learn new things, we can expand our horizons. Every challenge forces us to learn and to bring out undiscovered talents within us, thereby making us stronger. There is no failure in trying to do the best we can do; the only failure is not trying to change and adapt to a different way of doing things. There are times we have to be brave enough, to have enough self confidence, and to excel on own strengths. We want to keep very strong, solid nursing skills, such as peripheral IV insertion skills. We want to keep the valuable nursing concepts, such as sterile techniques with us. Our skills will be lost if we do not practice constantly. In all, we are excited that we have opportunities to brand ourselves as the best we can be in United States.
Mai Tseng -- RN, BSN,MPA,EMBA, NE-BC,CRNI, LNC
Karen Cox -- RN, PHD, FAAN,
Laurie Ellison -- EMBA
Xu Hong Fang -- RN
Hong Guo -- RN
Sufan Sun -- RN
Please watch for the second half to this article to be published later in December.
by Laura Liswood
Co-founder, The Council of Women World Leaders
Diversity and inclusion are instrumental for any organization that seeks innovation, creativity, and engaged employees. We don't need to make the business case for it; it is well accepted that a diverse workforce is essential to staying competitive in the global marketplace. In today's world, problems are complex, communication is global, and the environment is constantly changing. Diversity is no longer a luxury; it is a necessity.
The real question is, "Are we actually reaping the benefits of our diversity efforts?" By the benefits, I mean the advantage of capturing the differing ways people think about issues and experiences and creation of a truly level playing field. Without an even playing field, a real meritocracy that neither subtly advantages some nor disadvantages others, it is my opinion that organizations will never obtain the benefits they seek from their diversity initiatives.
A precondition to obtaining the advantage of diversity is skilled and aware leadership. Awareness means understanding that we all bring our unconscious self to the workplace. And if there is diversity, even a limited amount, that unconscious is the true gatekeeper preventing our ability to unlock the benefits of diversity within an organization.
Our unconscious perspectives, roles, associations, preferences, and archetypes are with us constantly, and we have learned them in a slow and subtle way. So slow and subtle in fact, we are not aware of what has happened to our world view.
Who teaches us about ourselves? Our hidden teachers include our parents, school teachers, peers, religion, the media, our daily experiences and the very myths, fairy tales and fables that were read to us at bedtime. Each whispers silently in our ear about what we 'know' about others and what we deem right and wrong.
In my book, The Loudest Duck (Wiley & Sons, 2010), I reference the old lessons that we learn from our 'hidden teachers' and how these lessons continue to have repercussions and legacies in the workplace. Many Americans, particularly boys, are taught that 'the squeaky wheel gets the grease' which means speak up and you get what you want. The Japanese may be taught that 'the nail that sticks out gets hit on the head' which is completely opposite in its intent. Women around the world hear 'if you can't say anything nice don't say anything at all' and the Chinese are engrained to know that 'the loudest duck gets shot'. The last three are completely and diametrically opposite from the first aphorism, and each is brought to the table in a diverse workforce.
Unfortunately for our diversity efforts in the example above, only one group is easily comfortable raising their hand, speaking out, getting seen as having the knowledge, facts and ideas. The wheel gets the advantage; the nail, duck, and nice are at a disadvantage and the organization doesn't learn much about the ideas of the latter groups.
Obviously, diversity is needed, but so are the tools that unlock that diversity. Let me give you an example. All of us have been on conference calls. You hear the manager of the call say "Anyone out there have any comments?" Most of the time all you get is silence (or clicking of computer keys). What happened to all that cognitive diversity we wanted? We hear mainly from the people who are in the room with the manager. No one else speaks and all of those good ideas, fresh perspectives, and differing global awareness are gone. An easy solution would be to let people on the call know they will be called on and then by name, ask them for their comments. This is not rocket science, but it does require a far greater consciousness about who gets heard and how to ensure that all are included. How we unconsciously react to diversity is the key step that often gets skipped.
Most organizations have realized the business case for diversity and have made good faith attempts to hire people who reflect that business case. But once we get the diversity, we have not yet learned how to create an organization that fully obtains the benefits of it. Often this can be diagnosed by looking at the hierarchy and the numbers of individuals at various levels. In many companies today, it is not an intake problem, it is an upgrade problem. We get people in the door at the lower levels in the pyramid but they do not make it to the top. The heterogeneity gives way to homogeneity. Why? My belief is that we need to move now to Diversity 2.0 and give managers and leaders the training, awareness, skill sets, tools that ensure we engage and capture the full benefit of the diversity we say we are so committed to.
By Laura Raines
If the purpose of nursing school is to prepare students for real-life practice, then it must address the challenges of working with a multicultural population, says Sharon Grason, nursing instructor at Georgia Perimeter College.
“If you work in an urban setting, it’s a rarity that the patient in the bed will come from your same background,” said Grason, MS, RN, CNS. “Cultural diversity is a growing part of nursing.”
Because she believed the nursing curriculum at GPC only skimmed the surface of cultural diversity, in 2010 Grason launched a senior capstone project to make nursing students more culturally aware. It’s now the last course nursing students take before they graduate.
Grason’s experience working with migrant farmers in Moultrie showed her how important multicultural understanding is for nurses.
“Seeing how migrants lived and worked totally opened my eyes and made me look at how to care for them in new ways,” she said.
To be effective, Grason knew she had to earn their trust.
“When you can show that you have some idea of their lives and what is important to them, the patients’ level of trust goes up tenfold,” she said. “They are more apt to listen and you are better able to help them.”
Grason wants nursing students to realize that diverse patient populations have different health care needs and challenges. To be effective nurses, students need to learn how to take those differences into consideration when caring for patients.
In the capstone project, teams of students choose a different culture to research.
“We begin to learn about the traditions, religious beliefs, social norms, common health problems, foods and the indigenous medical remedies of that population,” said Kristina Palmer, a GPC senior nursing student.
Her group is studying Russian and Eastern European cultures, and they have discovered a large population in metro Atlanta.
“Being aware of patients’ backgrounds and understanding the cultural dynamics can help you give better care,” Palmer said. “For example, in some cultures you have to talk to the dominant male in the family if you want medical advice to be followed. We’re not trying to change the culture, but to make patients more comfortable with how we’re trying to help them.”
The groups will present and share their findings — including a list of facts about the culture and answers to frequently asked questions — at an international cultural day at the end of the term.
“Many teams dress in costume, serve native foods, display cultural artifacts and hand out brochures about their cultures, so that students and guests can benefit from their research,” Grason said.
Nursing student Tarra Clark is studying migrant farmers, a mostly Hispanic population.
“We’re seeing how their eating practices are related to common health problems like high blood pressure or diabetes,” Clark said.
She has learned that glucose and blood-pressure screenings, earlier prenatal care and dietary education is helpful in treating many Hispanic patients.
“We all need to be aware that how we deliver health care to a patient makes a difference,” said Karen Feagin, a senior nursing student.
As a volunteer at a free health clinic, Feagin encounters people from all backgrounds. She’s learned that some cultures consider it rude to make eye contact with the patient. Some cultures require a same-sex practitioner and others have a mistrust of Western medicine.
“Sometimes when patients don’t understand what you are saying, they’ll just agree to be polite. When in doubt, it’s better to find a translator,” she said.
Feagin’s group is studying the culture of Koreans, a large and growing population in metro Atlanta.
“They have a higher risk for hypertension, but a diet that’s high in salt because of preserved foods, so that’s a challenge,” she said. “If they mistrust American health care, they will go to a local Korean practitioner or contact their family back home to get local herbs and medicines. If you know that, you can ask about herbs and help them choose ones that won’t interact negatively with the medicines you’ve given them.”
Feagin says the capstone course is enlightening and she looks forward to learning about other cultures from the other teams.
“I didn’t realize how much I didn’t know,” she said. “But you go into nursing to keep people healthy and help them achieve the best quality of life possible. This kind of knowledge will help us provide safer, more-intelligent care.”
Nursing is a second career for Feagin, who spent 10 years in accounting.
“Everyone ends up in the hospital at some point and it’s the nurses that dictate your experience. That’s who the patients remember” she said. “I wanted to be that person who is remembered because she made a difference in someone’s life. This is a great program and I’m thrilled to be in it.”
After three semesters of offering the capstone course, Grason will compile all the cultural information into a manual that the nursing department will give to its clinical partners and hospitals.
“We wanted to do something to give back and we hope that this will be a good resource for their educational departments,” she said.
By Dave Greenslit CORRESPONDENT
WORCESTER — The city is diverse and becoming more so, presenting both challenges and opportunities.
That was the consensus of several speakers today at a forum called “The Changing Face of Worcester,” sponsored by the City Manager's Coalition on Bias and Hate and held at Worcester Public Library.
“Worcester remains a vibrant city made up of people from just about everywhere in the world,” said Edgar Luna, who works in the city's Department of Planning and Regulatory Services and gave an overview of 2010 census data.
That data show Worcester's white population has dropped from 70.8 percent in 2000 to 59.6 percent in 2010, while the Hispanic and black populations have grown from 15.1 percent to 20.09 percent and from 6.2 percent to 10.2 percent, respectively.
Ravi K. Perry, an assistant professor of political science at Clark University, said Worcester has always been a city of immigrants, but today's arrivals are from Southeast Asia, Central America and Africa, instead of Italy, Ireland and Armenia.
Medium-sized cities have been slow to respond to their changing populations, he said, but that doesn't have to be the case in Worcester. Calling the city one of the most diverse in the country, he said, “Worcester has the opportunity to be a model if we pay attention to these local demographics” and learn how minority interests can be represented.
School Superintendent Melinda J. Boone noted that 65 percent of students in Worcester schools are minorities and that 80 different languages are spoken by students in the system. Under a 2009 agreement with the federal Justice Department, all major school documents are translated into several of the major languages.
“We have a very diverse school population, and that's a real asset,” she said, adding that the changing demographics also present a challenge in achievement, especially because so many students are poor.
“We want to expose students to programs and opportunities that will close that gap,” Ms. Boone said. “An undereducated citizenry will cause Worcester to shrink and shrivel.”
Education will break the cycle of poverty by preparing students for the type of jobs that will be available to them, she said.
Mark Bilotta, chief executive officer of the Colleges of Worcester Consortium, said area colleges, with 30 percent minority enrollment, have some catching up to do to match the percentage in the city.
The consortium is working, he said, to retain talent for the regional workforce and to ensure students are prepared to work in a global economy, something enhanced by Worcester's diversity.
Luis G. Perez, a retired juvenile court judge, also stressed the importance of education. He said the dropout rate and the number of minority students expelled eventually results in many people being sent to prison.
“I believe in prevention,” Judge Perez said. “And the most important tool in prevention is education.”
“If the School Department doesn't do their job, where do people turn to? They turn to the courts,” he said.
Also speaking at the forum were Dr. Matilde Castiel of the UMass Memorial Medical Center and Stephen Hill of the city's Department of Neighborhood Services/Economic Development.