DiversityNursing Blog

A More Diverse America Needs Health Care Adjustments

Posted by Erica Bettencourt

Wed, Feb 15, 2017 @ 04:02 PM

0209-tiled-flag-of-american-diversity.jpgHow can you properly care for a patient if you don’t understand their personal needs? Communication is key. Making a patient comfortable goes far beyond providing warm blankets. It is about the patient trusting you and knowing you have things in common that show them you understand how they feel and what they need. 

Many healthcare providers are seeing how important diversity and inclusion is to delivering quality patient care. Hospitals are providing language services by hiring a diverse staff, many of whom are bilingual or multilingual. Culturally appropriate care strategies are also key. Religious views may alter the way staff would normally provide care. That means you might assist a patient who needs to move in order to pray or work out special blood testing times to allow the patient to fast. The population is rapidly changing and by 2050, the white population will no longer be the majority.

On any given day at the Salud Clinic, Lucrecia Maas might see 22 patients. They come to the community health center tucked away in an office park here needing cavities filled, prescriptions renewed and babies vaccinated. When they start to speak, it’s rarely in English. Sometimes it’s Hindi. Or Dari. Or Hmong. Or Russian.

Maas is fluent in English and Spanish, but that gets her only so far. She often has to hop on the phone with a medical interpreter, who relays her questions to the patient and then translates the patient’s answers. “It just takes a little more time,” the nurse practitioner said. 

The future of American health care looks a lot more like the Salud clinic than Norman Rockwell’s iconic small-town doctor’s office. The country is on course to lose its white majority around 2050. That future is already visible in Sacramento County and neighboring Yolo County, where West Sacramento is located: by 2013 the combined population of Hispanic, black, Asian and other nonwhite residents had edged out whites. In West Sacramento, a historically working-class county across the river from the state capital, more than 2 out of 5 public schoolchildren already speak a language other than English at home.

Sacramento-area hospitals, community health centers and doctor’s offices have had to adapt. They’ve hired more multilingual, bicultural staff. They’ve contracted with interpretation services. The medical school at the University of California, Davis, is trying to figure out how to recruit more Latino students to a profession that remains largely white and Asian. And doctors are being trained to deliver culturally appropriate care to patients of many backgrounds. 

When a diabetic pregnant Afghan woman wanted to fast during Ramadan, the Salud Clinic’s nutritionist recalculated the best time of day to measure her blood sugar. If Mexican mothers say they’re rubbing gentian violet on their baby’s umbilical cord area to keep it clean — a harmless natural remedy — doctors encourage them to keep doing so.

Similar stories are playing out across California, which became majority minority in 2000. Health systems are using new data tools to get a better handle on just who they’re serving — and where the trend lines are pointing. County health departments, nonprofits and clinics have invested in recruiting and training bilingual community health workers.

Insurance doesn’t always pay for the extra costs of services like translation. Patient visits take extra time, straining schedules for doctors and nurses. “You can’t really help somebody if you don’t understand how they value health, and how they understand health and the health care system,” says Robin Affrime, CEO of CommuniCare Health Centers, the nonprofit that operates the Salud Clinic.

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Immigrants Drive Change

Most of the nation’s population growth since the 1960s has come from the immigration of nearly 59 million people from foreign countries who settled in the U.S. in that time, mostly from Latin America and Asia, according to the Pew Research Center. (The Pew Charitable Trusts funds the Pew Research Center and Stateline.)   

Hispanic, black, Asian and multiracial babies in the United States already outnumber white babies. In three years’ time, a majority of U.S. children and teenagers will be some race other than non-Hispanic white. And in about 30 years, whites will cease to be the national majority, demographers say.

A more diverse patient population may mean a different mix of health conditions, because some are linked to country of origin. People who were born in Asia are particularly prone to hepatitis B, for instance. African-Americans are more likely to have sickle cell anemia, an inherited blood disorder more common in Africa, the Middle East, India, and parts of southern Europe and Latin America. 

Asians and Hispanics — the groups likely to drive population increase going forward — have longer life expectancies than whites. Hispanics are less likely to suffer from many chronic conditions than whites even though they’re typically poorer and less educated.

Yet second- and third-generation Hispanic-Americans are often less healthy than their immigrant parents. One theory is that with assimilation, younger generations pick up bad American habits such as eating fast food and not getting enough exercise. And health continues to vary by subgroup. For instance, Californians with roots in Mexico are much more likely to be obese than Californians with roots in Puerto Rico, survey data show.

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Health Challenges

One of the challenges facing health care providers is obvious: many new immigrants can’t speak English. About 60 million Americans speak a language other than English at home and about 25 million can’t speak English very well, according to the U.S. Census Bureau.

Salud doesn’t typically bring in in-person interpreters, because they’re more expensive. But it does contract with a phone interpretation service, a business that’s growing rapidly across the county. The service provides real-time translation between English and at least 12 other languages. Interpretation of some of the less common languages, like Hmong, needs to be scheduled in advance. And there have been instances in which the interpreter speaks the wrong dialect of a language like Dari, spoken in several countries in Central Asia.

Often a staff member can help. The health center has doctors and nurses who speak Hindi, Urdu, Punjabi, Tagalog and Spanish, and has hired administrative staff and medical assistants who speak Hmong and Mien, a language spoken by some Indochinese refugees who fled to the United States during the Vietnam War.

But Mien has no written language. And some cultures and languages have concepts that defy easy translation. “There are some words where we really cannot use the translator,” said Rubina Saini, a Salud physician who speaks several South Asian languages.

Other clinics don’t do as well as Salud. Under federal civil rights law, hospitals, nursing homes and other providers that receive federal funding must take reasonable steps to accommodate patients who can’t speak English well. But the legal requirement isn’t well-enforced and services can be spotty. “Where people need language services isn’t necessarily where they’re being offered,” says Melody Schiaffino, an assistant professor at San Diego State University’s Graduate School of Public Health.  

In a recent study, Schiaffino found that about 30 percent of all hospitals nationwide don’t offer translation services. The share is even larger for public safety-net and for-profit hospitals, even in diverse cities. That’s because the government hospitals can’t afford to do so, she said, and for-profit hospitals tend to serve well-insured patients who speak English.

State policy helps determine who gets interpretation and translation help. Only 15 states directly pay for interpreters needed by Medicaid patients. California isn’t one of them, although a 2009 task force created by the state Department of Health Services recommended the change. (California does require private health insurers to provide — although not necessarily pay for — language services. The state also requires health plans in its state Medicaid program, Medi-Cal, to translate certain written materials into common languages.)

Most Salud Clinic patients have a Medi-Cal insurance plan that will cover the cost of interpretation, Donna Paul, the clinic manager, says. If a patient doesn’t have coverage, CommuniCare Health Centers absorbs the cost.

Then there’s the need to navigate cultural differences. The front-office staff knows that Southeast Asians may be uncomfortable making direct eye contact, and that Russians may speak loud and fast, Paul said. They’ve learned not to take such things personally.

Ethnic Disparities     

Treating a more diverse population also means confronting gaps in care that go beyond socioeconomic status. African-Americans, and in some cases Hispanics, tend to receive lower-quality care than whites even after controlling for income, age and symptoms, according to an often cited 2003 report by the Institute of Medicine (now the National Academy of Medicine). Black patients are less likely to be prescribed pain medication than white patients, for instance, and less likely to receive antiretroviral drugs if they’re HIV positive.

There’s no simple reason for the gap in quality, which still persists, although researchers say unconscious bias or stereotyping by physicians, cultural and language gaps, and even geography play a role. “Race and ethnicity matter, whether you like it or not,” says David Acosta, associate vice chancellor for diversity and inclusion at the University of California, Davis, health system.

To erase the gap, medical schools are adopting strategies to better prepare the next generation of doctors. One of these is to recruit and train more minority students. The second is to train all students to examine their own biases and be more sensitive to cultural differences.

In California, where almost 40 percent of residents are Latino, 4 percent of physicians are. Nearly 20 percent of all physicians in the state speak Spanish, but Acosta says bilingualism isn’t enough. As a Latino physician, he says he’s bilingual and bicultural, familiar with his Hispanic patients’ approach to health, such as the folk remedies they might try. That kind of cultural match improves trust between doctors and patients.

Black and Hispanic physicians are also underrepresented in the physician workforcenationwide. Increasing their numbers could also help ease the shortage of primary care physicians, Acosta said, because black and Hispanic physicians are more likely than white and Asian physicians to provide primary care to low-income minority communities desperately short on doctors.

UC Davis launched an effort to recruit more Latino students to health careers last summer, funded by the Permanente Medical Group, a physician group that works with Kaiser Permanente.

The UC Davis program, called Prep Médico, is aimed at undergraduates from northern and central California and starts with a summer session at the UC Davis medical school. Participants get ongoing support from mentors, access to research opportunities, and help studying for the medical school admissions exam.

Once students reach medical school, they need to be trained to treat patients of a different race, ethnicity, culture, sexual orientation or socioeconomic status than their own. Twenty-one states, including California, have adopted health equity standardsthat help guide physician training.

But there’s a debate over how best to teach so-called cultural competency. The concept is often presented to students like another task to master or acronym to memorize, said Jann Murray-García, an assistant adjunct professor at UC Davis’ school of nursing. But it’s not something you can memorize with flashcards. “There’s just no way to master the complexities of other people’s lives and personhoods,” she says. And recognizing one’s own racial biases and stereotypes, and learning how to deliver good care despite them, can be a lifelong process, she says.

Crunching Data

Kaiser Permanente has turned to data, to make sure these new populations are getting the care they need.

For more than a decade, the organization has broken down its quality of care data by race, gender and ethnicity and used it as a guide to drive health care priorities, with a goal of narrowing health care disparities.

For example, African-Americans are more likely than whites to have very high blood pressure and — partly as a result — to suffer from strokes, heart disease and end-stage kidney disease. First, Kaiser’s analysts figured out what the gap looked like for their own patients. Then they created a new set of instructions for care teams, informed partly by patient focus groups.

Among other changes, physicians were asked to prescribe African-Americans medications proven to be more effective for them. Physicians, nurses and other health workers took additional care to listen to patients, follow up, and nudge them to stay on top of their treatment plan. The effort has paid off: Since 2013, Kaiser has cut the high blood pressure control gap between its African-American and white patients in half.

Health systems can use data to improve their language services, too, says Glenn Flores, a physician and chair of health policy research at Medica Research Institute, a nonprofit research group. All it takes is asking new patients a few questions to check their English fluency, and noting what other languages they speak. That way clinics and hospital systems can arrange for in-person interpreters ahead of time for patients who need them and figure out which languages are essential when they are hiring staff or contracting for medical translation services. “Very few hospitals around the country do this,” he says. 

Nationally, health data need to more accurately capture racial and ethnic subgroups, says Kathy Ko Chin, president and CEO of the Asian & Pacific Islander American Health Forum. The “Asian and Pacific Islander” category used by the U.S. Census Bureau, for instance, encompasses everyone from third-generation Chinese-Americans to Pakistani engineers to Cambodian refugees. People with origins in the Middle East have no U.S. Census designation of their own, and can self-identify as white, Asian, African or “other.” Without more specific data, it’s hard to know what problems local communities have and what services they need, Ko Chin says.

California policymakers have unusually detailed data at their fingertips thanks to the California Health Interview Survey, conducted by the University of California, Los Angeles. Researchers have been able to tease out findings that can inform better care, such as the fact that Korean women are much less likely to receive mammograms than Japanese women in the state.

Use our free checklist to scale your diversity and inclusion efforts.

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Topics: hiring, cultural competence, Diversity and Inclusion

Your Hiring Approach Should Drive Inclusivity

Posted by Pat Magrath

Fri, Feb 10, 2017 @ 03:37 PM

inclusive.jpgRecruiting these days is getting more and more difficult, particularly when hiring Nurses. We’re featuring this article because of its creative approach to thinking outside the box. Perhaps it’s time to change your message, how and where you target that message, and maybe even the position requirements.

For this particular company featured in the article, a college degree and sales experience had always been required for its Sales Development Reps (SDR). The author was promoted to Sales Development Manager. He wanted to hire a different type of Sales Rep -- someone with no sales experience or college degree, but was hungry to learn and grow. The Sales Rep job is a tough job and he knew the burnout rate was high.

Once he removed the degree and experience requirements, he found his applicant pool became more diverse. To quote the author “If you have a role at your organization that doesn’t require previous experience, be intentional about your recruiting. Use it as an opportunity to shift the demographic makeup of your company.”

As a Nurse Recruiter, we know you have degree and experience requirements for many of your positions, but perhaps this article will inspire you to make some positive changes to reach your hiring goals. Good luck!  

A few weeks into my first year as Jhana’s Sales Development Manager, a realization hit me.

Because I was a hiring manager recruiting for a role that required no previous experience or college degree, I was in a unique position to drive diversity and inclusion at my company.

Almost every corporate job requires a college degree, and many also require previous experience in a similar role—big hurdles for someone from an underserved community. The Sales Development Rep (a.k.a. SDR), however, is one of the few jobs that allow someone without relevant work experience or a college degree to break into corporate America.

College Degree Not Required

SDRs at Jhana fill an entry-level role. They don’t do cold calling but instead use a series of template-based emails to set up introductory sales calls for our Account Executives. Still, many companies require a college degree for the role, whether they state it explicitly or not.

When I first deleted “Bachelor’s Degree” from the job description, it felt a bit radical. It even felt like I was doing something wrong. But as I examined why I had included it in the first place, I realized I couldn’t think of a single good reason.

It was purely reflexive.

Removing “Bachelor’s degree required” was the first step towards attracting a more diverse and inclusive candidate pool.

Why I prefer SDRs With No Previous Experience

Here’s something that I find interesting: Jhana’s current sales development team is the most productive lead-generation team the company has ever had. However, if our current SDRs had applied for the job two years ago, they would have been rejected.

In the past, we required 1 to 2 years of previous SDR experience to qualify for even a phone screening. Thankfully, we’ve since made dramatic changes to our SDR hiring strategy, which have made recruiting not only faster but much more inclusive.

Soon after I was promoted to Sales Development Manager, I argued that we would actually get better SDRs if we recruited candidates with zero SDR experience. It was not a popular idea at the time. Never before had we hired for any role at Jhana and not asked for previous experience.

But anyone who has done the job knows that SDR work is grueling. It’s tedious. It takes perseverance. If a candidate left a company after being an SDR there, I could pretty much bet that he or she wanted to leave not just that company but the SDR role itself. I hypothesized that having 1 to 2 years of previous SDR experience actually hampered motivation and productivity.

So as Jhana’s first Sales Development Manager, I set out to hire a very different type of SDR. I didn’t want people with previous experience in the job.

Instead, I looked for grit. I looked for candidates who had work or life experiences that showed determination. I also looked—very much intentionally—for candidates who could add to Jhana’s diversity.

In 6 months, SDR productivity (as measured by the volume of cold emails sent, meaning emails sent to prospects with whom you’ve had no previous contact) increased by 100% and the number of discovery calls (introductory sales calls between the prospect and an Account Executive) increased by 60%.

Grab the Opportunity to Drive Diversity and Inclusion

By not requiring previous experience or a college degree, you not only dramatically grow your potential candidate pool, but you open up a huge opportunity from a diversity and inclusion perspective.

Let me put it plainly: If you have a role at your organization that doesn’t require previous experience, be intentional about your recruiting. Use it as an opportunity to shift the demographic makeup of your company.

Now, this doesn’t mean that your job as a hiring manager will get easier. In fact, it will probably get harder.

You’ll have to read more resumes.

You’ll have to do more phone screenings.

You’ll have to ask better interview questions.

You’ll have to become excellent at training new SDRs.

You’ll have to build well-oiled processes so that orientation and onboarding happens quickly.

So why do this?

Because you’ll build a better lead-generation engine.

Because you’ll help build a company that’s more diverse.

Because it’s the right thing to do.

As a hiring manager, you are entrusted with the rare opportunity to give jobs. Why not be intentional about how you use that responsibility? Why not think differently about how and who you recruit? Why not try to create social change, one hire at a time?

We can help with your hiring needs! 
Contact Us!

Topics: hiring, Diversity and Inclusion

Health care job growth doubled in February

Posted by Alycia Sullivan

Fri, Mar 15, 2013 @ 05:51 PM

By: The Advisory Board Company

The health care industry added 32,000 jobs in February, accounting for 13.6% of the 236,000 nonfarm jobs created last month, according to preliminary data released Friday by the U.S. Bureau of Labor Statistics (BLS).

In comparison, revised BLS data show that the health industry added just 13,000 jobs in January, partly because the agency now estimates that hospitals lost about 3,100 jobs in January.

Latest report shows hiring across industry

Within the health sector, physician offices and outpatient health centers experienced the biggest gains in February, adding about 14,000 jobs for the month, according to BLS. Meanwhile, ambulatory health care services added 13,700 jobs in February, down from 26,700 in January. 

The agency also found:

  • Hospitals created 8,900 jobs in February;
  • Home health care added 6,100 jobs, up from 5,700 new jobs in January; and
  • Nursing homes added 9,000 new workers.

Overall, the national unemployment rate last month dropped to a four-year low of 7.7% (Selvam, Modern Healthcare, 3/8 [subscription required]; Baker, "Healthwatch," The Hill, 3/8).

Topics: jobs, growth, hiring, nurses, health care

Facebook Seeking Head of Diversity as Hiring Ramped UP

Posted by Wilson Nunnari

Mon, Feb 18, 2013 @ 04:47 PM

By Brian Womack - for Bloomberg

Facebook Inc., operator of the world’s largest social-networking service, is seeking a global head of diversity, as the quickly expanding company’s recruits people from different backgrounds to foster creativity.
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The position includes responsibilities around employee recruitment, development and retention, the company said on its website. The diversity chief will build and manage a team focused on diversity, according to the posting.

Facebook, grappling with large rivals such as Google Inc. is ramping up hiring, growing 44 percent to 4,619 employees in the fourth quarter from a year earlier. Chief Executive Officer Mark Zuckerberg said last month the company plans to “continue to grow our headcount quickly in 2013.”

“We’re a fast-growing company, and this role will help us formalize processes that ensure we scale our diversity at the same rate,” Slater Tow, a spokesman for Facebook, said in an e- mailed statement. “In the past, our diversity and inclusion efforts were decentralized amongst many employees and, given our stage of growth, we are consolidating our work and people into one team.”

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Among Facebook’s efforts is a new search service the company began to roll out last month. The company is also bolstering its mobile offerings, including an upgrade to its application for smartphones based on Google’s Android software.

While Facebook’s staff is growing quickly, it’s still much smaller than some of its rivals. Google, for example, has more than 10 times as many people.

The diversity position will be based at Facebook’s headquarters in Menlo Park, California.

“We’ve always focused on recruiting the very best and brightest,” Tow said. “We are big believers that creativity happens with people who have different perspectives and background.”

Topics: hiring, diversity

Social Media in the Workplace and Interviews

Posted by Wilson Nunnari

Fri, May 11, 2012 @ 10:46 AM

The news that some employers have asked for direct access to the Facebook accounts -- including user names and passwords -- of people applying for jobs at their firms has set off a firestorm of controversy.

The reports have raised questions about whether the practice is illegal and if such a policy could expose those employers to potential discrimination lawsuits. The dust-up has even triggered calls by some in Congress for a federal investigation into the practice.

But those recent events only highlight a new reality: The identity that individuals create in the world of social media is quickly becoming an important factor in hiring decisions and in people's broader professional lives.

"The questions around employer access to social network log-ins reflect a broader debate in society about a host of digital privacy issues," says Andrea Matwyshyn, a Wharton professor of legal studies and business ethics. "This is a new concern -- the degree to which employers can gain access to all role identities through one virtual space. There is no parallel to that in the real world."

While the reaction to the practice has been swift and intense, it's hard to predict if it will become a lasting trend.

But, Matwyshyn says, she began hearing about employers requesting access to the Facebook accounts of potential hires as far back as 2008. To date, however, she says, there is no good data on how widespread the practice has become.

The fact that it exists at all is not entirely unexpected: According to Matwyshyn, a number of studies show that most employers look at candidates' online profiles when making hiring decisions, noting a 2011 survey by social-media monitoring service Reppler that found that 91 percent of recruiters report using social-networking sites to evaluate job applicants.

But checking out a publicly available profile on Facebook -- or even asking a job candidate to "friend" someone in human resources at a company where they are applying for a position -- is worlds apart from gaining unfettered access to someone's account through a password.

"If you can take Facebook passwords, what about Gmail passwords?" asks Stuart Soffer, a non-residential fellow at The Center for Internet and Society at Stanford Law School and managing director of IPriori, an intellectual-property consulting firm.

If left unchecked, Soffer says, the practice could expand beyond human resource departments evaluating potential employees.

"What about allowing Facebook access to insurers so they can see what you are saying about your health?" he says. "They could use it as a basis for judging the risk of insuring you."

The request for access to log-in information also raises some serious legal questions.

Clearly concerned about the legal and business implications of privacy breaches, Facebook has come out against the practice, stating that sharing or soliciting a Facebook password is a violation of the company's statement of rights and responsibilities.

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"We don't think employers should be asking prospective employees to provide their passwords because we don't think it's the right thing to do," Facebook Chief Privacy Officer Erin Egan says. "But it also may cause problems for the employers that they are not anticipating."

Matwyshyn says employers could be essentially asking job candidates to violate their contract with Facebook if they ask for passwords, creating "an untenable conflict between contract law and employers' perceptions of their own interest in vetting candidates."

In addition, if a Facebook account includes information on an applicant's race or age, for example, that could potentially expose the employer to claims of discriminatory hiring practices. According to Matwyshyn, it is legally hazy whether accessing someone's Facebook account where that information is available is akin to asking it in the interview.

"Arguments can be made that this is a back-door method to gaining information that the prospective employer wouldn't otherwise have access to," she says.

Meanwhile, the issue is getting the attention of Congress. Senate Democrats Charles Schumer and Richard Blumenthal, from New York and Connecticut respectively, have asked the Justice Department and the Equal Employment Opportunity Commission to look into the practice.

But even if it is eventually prohibited or otherwise curbed through legal or legislative channels, Wharton management professor Nancy Rothbard predicts that the use of social media in hiring decisions will continue to be a flashpoint in the years ahead.

"The core of the problem is the blending of personal and professional lives," Rothbard says. "We are still in the infancy of trying to understand how to deal with all this."

Opening the Window -- and Closing a Door?

Just how far employers can legally go to check out job candidates online may not be clear -- but why they are looking for new methods of evaluating applicants is easy to understand, says Wharton management professor Adam Grant.

Research, he says, has shown that the typical job interview is a poor tool for predicting which candidates will succeed. If that does not work, companies need to find something that does.

"Applicants are very motivated to put their best foot forward in an interview," Grant says. "It is very difficult to spot the people who will represent an organization well. But on Facebook, you can see the applicant making day-to-day decisions -- it is a window into how an individual is likely to act."

In fact, recent research has provided evidence that online profiles can be very revealing about specific personality traits.

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A paper published recently in the Journal of Applied Social Psychology entitled, "Social Networking Websites, Personality Ratings, and the Organizational Context: More Than Meets the Eye," studied 518 undergraduate students and their Facebook profiles.

The researchers found that the Facebook profiles were a good predictor of the so-called "big five personality traits:" conscientiousness, agreeableness, extroversion, emotional stability and openness. And for a subset of the group where the researchers were able to contact supervisors at companies that had hired those students, there was a correlation between scores on two personality traits -- emotional stability and agreeableness -- and job performance. (SeeHREOnlineTM story here.)

"There is strong evidence that social networking is a valid way of assessing someone's personality," says Donald Kluemper, a professor of management at the Northern Illinois University College of Business and a co-author of the study.

But he says that does not mean there is evidence that an unstructured perusal of a Facebook account will result in better hiring decisions.

"Until a method is validated in a number of ways, including a study of adverse impacts and the legal issues, I wouldn't recommend companies rely on social-networking profiles," Kluemper says.

Now, the use of social-media information is far from fine-tuned, with recruiters typically checking out social media to get a general sense of the person applying for a job or to hunt for any red flags. But it is possible the use of that information could become more sophisticated.

"People are mining that data right now for other purposes, including targeting ads to the right people," says Shawndra Hill, a Wharton operations and information management professor. "It is not out of the realm of possibility to focus that on other outcomes, like how good a match someone is for a job or whether there is a high likelihood they might do something illegal."

While the value of that data may be apparent, it remains to be seen how social media should ultimately fit into some aspects of professional life.

Take the less-controversial practice of managers' friending their colleagues through Facebook. Rothbard says this practice creates numerous potential headaches. Two years ago, she and some colleagues did a series of interviews with 20 people at a variety of levels and in a number of different industries, and found that people were often unnerved friending either bosses or subordinates.

"People felt very uncomfortable with crossing the private and professional boundary when it came to the hierarchy [within an organization]," Rothbard says. "They talked about friending their bosses with similar discomfort and language as they did when they spoke about friending their moms."

Interestingly, Rothbard adds, the rules for social networking in the workplace may differ based on gender.

She led a study of 400 students in which participants were shown Facebook profiles, told that the person was either a boss, a peer or a subordinate, and then asked to rate the individuals based on how likely they were to accept that person's friend request.

The findings: Female bosses with bare-bones profiles were less likely to be accepted than those who revealed more personal information, while the opposite pattern held for male bosses.

"Women who have limited profiles are more likely to be shunned than the women who have a more active presence," Rothbard says. "People see them as cold. But male bosses who reveal less information are more likely to be accepted than those who reveal a lot of information."

The increased scrutiny of people's virtual lives may change the way individuals operate in the social-networking realm.

According to Rothbard, there are essentially four ways of dealing with privacy issues. There are those who control their list of friends carefully, rejecting friend requests from people with whom they don't want to share personal information. Then, there are those who accept virtually all requests, but are very careful about what they post, limiting that content to very safe, less revealing information.

There is also a hybrid approach in which people use privacy settings to share some information with close friends and less-sensitive material with others. And, finally, there is the "let it all hang out" crowd -- those who are comfortable sharing all their information with a large group of close (and not so close) friends.

Grant predicts more people will opt for the more-controlled, filtered approach as they realize their social-media profiles are being scrutinized by potential employers.

"As employers gain this information, so do candidates," Grant points out. "So candidates may use Facebook more carefully and remove the cues that are so valuable [to employers]."

Soffer agrees people will become much more careful about their social-media personas.

"There are ways around this," Soffer says of the unwanted exposure of social-media behavior. "One thing that could happen is people will start having two Facebook accounts." One will be for close friends; the other, a more sanitized version for employers.

But there is always the potential that something posted for viewing by a small group of close friends on Facebook could get out into larger circulation. And for that reason, some argue, the risks of being active in the social-media space outweigh the benefits.

"If you are a CEO, or aspire to be a CEO or director of a public company, I think it makes sense to refrain from social networking," says Dennis Carey, vice chairman at Korn/Ferry International. "There are other ways to communicate with employees and the outside world through properly controlled channels. Some of the messages that are conveyed can be misconstrued or taken out of context by a third party."

The fear of a photo or comment made long ago coming back to haunt you is hardly unfounded. Because sites such as Facebook have been around less than a decade, it is not certain how long someone's social-networking history will remain accessible.

"It is unclear how long the information persists," Hill says. "Firms have different privacy policies, and often privacy policies change over time. While there are policies that allow for deleting data you no longer want on the site, it is hard to guarantee that this information won't live on a database somewhere."

The controversy worries some fans of the social-media revolution.

"I worry that there is already a sense right now that our participation online may come back to haunt us," says Chris Ridder, co-founder of the law firm Ridder, Costa & Johnstone and a non-residential fellow at The Center for Internet and Society at Stanford Law School.

"It inhibits our ability to express ourselves," he says. "If we can only express public relations-like statements, it takes away a good bit of the utility of the Internet. I think it would be a shame if we were to lose the playful aspect of this new technology."

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How would you feel if someone asked for your account information to Facebook or Twitter in an interview? What if your boss did it? Do you think this is a privacy violation? Should there be legislation on this? Let us know in the comments; we want to hear from you!

 

Topics: hiring, Workforce, employment, education, nursing, technology, Articles, Employment & Residency, health, healthcare, nurse, nurses, cultural, social media, communication, mobile, iphone, internet use

Nursing Popular with Older Students

Posted by Wilson Nunnari

Fri, May 11, 2012 @ 10:31 AM

Nurses are as diverse as the patients they treat.

But that diversity will become grayer for the next few years as more middle-age people are going into nursing as a second career.

student nurses get older resized 600
That trend can be seen in the class that will graduate May 18 from Heartland Community College's two-year nursing program in Normal. Students graduate with an associate's degree in nursing and then may take the registered nurse licensing exam.

Non-traditional students — those who don't begin college right after high school — are the norm in Heartland's nursing program. But, in this class, none of the 40 students is a traditional student.

“I was pretty surprised when I started,” said second-year nursing student John Cook, 47, of Normal. “There was virtually no one right out of high school. I remember thinking that I'd be the oldest one in there by far and that's not the case.

“It's a huge cross-section of people with bachelor's degrees in other fields, including a lot of moms.”

Students begin clinical rotations at area hospitals and long-term care facilities during their first semester, said professor of nursing Barb McLaughlin-Olson. For every hour that they are in the classroom, in the lab and at clinical sites, they are expected to spend three hours on course work.

The nursing-as-a-second-career trend has been in place for several years, said Deb Smith, vice president and chief nursing officer of OSF St. Joseph Medical Center, Bloomington.

Some people who pursue nursing as a second career take advantage of accelerated, one-year nursing programs for people who already have a bachelor's degree, Smith said. For example, Illinois State University's Mennonite College of Nursing in Normal has an accelerated bachelor of science in nursing program.

Laurie Round, vice president of patient care services and chief nursing executive at Advocate BroMenn Medical Center in Normal, said the recession has driven some people from their original careers into nursing. Both ISU-Mennonite and Illinois Wesleyan University's School of Nursing in Bloomington reported an increase in enrollment last fall.

There is a demand for nurses because nurses work in hospitals, doctors' offices, businesses, insurance companies, long-term care facilities and churches. But second-career nurses also are drawn to the field for altruistic reasons, Smith and Round said.

“They want to do something that's meaningful,” Round said. “They want to touch peoples' lives.”

Middle-age adults going into nursing need to learn a career quickly and need to keep their energy level up.

Some middle-age adults are challenged by all the technology involved with patient care, Round and Smith said.

But the maturity and experience of second-career nurses generally makes up for any challenges.

“I love the energy, the intensity, the maturity and the decision-making skills that they bring to the field,” Round said. “These people are choosing nursing while raising a family and working at the same time and that shows perseverance, commitment and discipline.”

Second-career nurses not only come in with the experience of previous employment and raising a family. They also have social skills and because they are close in age to nurses already in the field — the average age of nurses is 47 — they fit in with other nurses quickly, Smith said.

McLaughlin-Olson said, “They can use their life experiences to help them become better nurses. Because they've lived through life's challenges, they've learned how to critically think when issues come up, and they have empathy and can relate to people having problems.”

But Smith and Round also are impressed with traditional nursing students, who graduate to enter nursing in their early 20s. They are intelligent, energetic and learn quickly, they said.

For that reason, both Round and Smith said middle-age, second-career nurses are not necessarily the new face of nursing.

“I see a great mix across generations,” Round said.

Adds Smith: “It's good to have people entering nursing with a variety of life experiences. That further enriches our profession.”

 

Topics: disparity, hiring, wellness, baby boomers, diversity, Workforce, employment, education, nursing, diverse, Articles, Employment & Residency, healthcare, nurse, nurses, communication

Nurse Shortage Trends

Posted by Wilson Nunnari

Fri, May 04, 2012 @ 01:47 PM

Adapated from a WBUR radio series. Links to Audio can be found below.

 

America's nursing shortage has been compared to a perfect storm gathering in intensity. In just over a decade nearly 80 million baby boomers will be in or reaching retirement, their medical needs placing an immense strain on our health care system. Nurses themselves will be leaving the profession and a younger generation of nurses will not be trained in enough numbers to fill the growing needs of hospitals and patients.

In "Nursing a Shortage: Inside Out," WBUR Special correspondent Rachel Gotbaum reports on how the shortage has come about and why it matters for nurses, hospitals and patients alike. She takes us into hospitals where the longest running nursing shortage in history is already impacting care. She reports on the roots of the problem that encompass not just the changing career choices for young women, the out-dated image of nursing but also the serious difficulties faced by nursing schools trying to find nurse-educators.

Nurses explain the effect of the shortage on their care of patients and how it is influencing their commitment to the profession and whether they stay or leave. Hospital administrators describe what they need to do to recruit and retain nurses in this competitive market , and Gotbaum reports on the growing tensions over whether mandating nurse-patient ratios is an answer to the problem or an impediment.

There have been shortages of nurses in this country since the 1960's but they have always resolved themselves fairly quickly. This nursing shortage began in 1998. Although it has been slightly alleviated it is expected to get worse when considering the increased retirement rates expected in coming years.

80 million baby boomers are slated to retire in the next decade and they will need a lot more medical care. At the same time many experienced nurses will be leaving the profession. The shortage began after managed care ushered in an era of cost cutting in the early 1990s. Nurses were replaced by lesser skilled workers. In Massachusetts 27 percent of hospital nurses were laid off, the largest number in the country. The profession became unattractive to women who began to have many other career choices. But as nurses left the workforce, studies showed that patient care suffered. One study published in the Journal of the American Medical Association found that patients whose nurse cares for 8 or more people have a 30 percent greater chance of dying than if their nurse cares for four patients. The same nurses are also more likely to be burnt out and dissatisfied with their jobs.

As hospitals started experiencing acute shortages of nurses, they responded by raising salaries and offering bonuses to nurses to enter the profession. Media campaigns were launched to extol the attractions of nursing. By 2003 185 thousand registered nurses entered this nation's hospital workforce. But even with this huge influx of nurses the shortage in 2007 still existed, and as demand for nurses increases many agree the gap will steadily grow. The number of registered nurses increased from approximately 2.5 million in 2007 to under 2.7 million in 2011. Despite this increase, some states are fighting about whether to mandate nurse-to-patient ratios. The number of new nurses is influenced by a large number of external factors so pinpointing the cause is difficult, but the significance of the increase is more important. Although 200,000 sounds like a lot of nurses, this is only an 8% increase. Just as important as the number of nurses is the number of patients which rose almost 10% from 2007 to 2008 alone according to the National Healthcare Cost and Utilization Project.

Audio Links Click Here

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How do you think these numbers compare to what you observe in hospitals and health care facilities? Do you think legislation is the best way to solve nurse-to-patient ratios? This creates a demand for nurses but not necessarily the supply.

Topics: disparity, hiring, Workforce, employment, nursing, Articles, Employment & Residency, healthcare, nurse, nurses, retain, retention

Legislation Setting Nurse to Patient Ratios

Posted by Wilson Nunnari

Wed, Apr 11, 2012 @ 10:27 AM

Legislation in California that set nurse-to-patient ratios added more registered nurses to the hospital staffing mix, not fewer as feared, researchers say.

Lead researcher Matthew McHugh, a nursing professor at the University of Pennsylvania in Philadelphia, says California was the first state to pass legislation setting staffing levels. However, mindful of the ongoing nurse shortage California legislators determined that hospitals could employ licensed practical nurses as well as registered nurses to meet the requirements of the law, McHugh says.

“California’s state-mandated nurse staffing ratios have been shown to be successful in terms of increasing registered nurse staffing,” McHugh says in a statement. “From a policy perspective, this should be useful information to the states currently debating legislation on nurse-to-patient ratios.”

California experienced a more serious nurse shortage than other areas of the country but made up the gap by hiring “travel nurses” — temporary workers who move from hospital to hospital as needed and ae not less educated LPNs, the researchers say.

The study, published in the journal Health Affairs, examined hiring practices from 1997 to 2008, pre- and post-implementation of the legislation, concluding that the increase in nurse staffing did not come at the expense of decreasing RNs.

“Our findings demonstrate that the nurse-to-patient ratio mandate in California was effective in increasing registered nurse staffing in hospitals,” McHugh says.

From monster.com

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Does your state have legislation like this? What do you think? Does it help or hinder you in doing your job? How about your patients? Let us know in the comments!

Topics: hiring, Workforce, nursing, Articles, healthcare, nurse, nurses

Hospital Employment Rises in February

Posted by Wilson Nunnari

Wed, Mar 28, 2012 @ 10:21 AM

Hospital employment climbed by 15,400 in February

Employment at the nation's hospitals increased 0.32% in February to a seasonally adjusted 4,806,600 people, the Bureau of Labor Statistics reported today. That's 15,400 more people than in January and 109,600 more than a year ago. Without the seasonal adjustment, which removes the effect of fluctuations due to seasonal events, private hospitals employed 4,797,600 people in February - 13,300 more than in January and 111,500 more than a year ago. The nation's overall unemployment rate was unchanged in February at 8.3%.

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What are your thoughts? Is your hospital hiring? Growing? Why do you think so?

Topics: hiring, Workforce, employment, nursing, Articles, Employment & Residency, healthcare, nurse, nurses

Healthcare's Jobs Boom

Posted by Pat Magrath

Fri, Feb 17, 2012 @ 11:30 AM

Baby boomers are turning 65, and they will need lots of help
By Ilan Kolet and Shobhana Chandra
Businessweek.com
econ jobs06  01  600
While the economy lost 7.5 million positions during the 18-month recession, the health-care industry added doctors, nurses, and other hospital personnel. Together with the social assistance category, which includes day-care workers, career counselors, and similar positions, the sector will add more than 5.6 million employees and be the biggest job gainer by 2020, according to new projections by the Bureau of Labor Statistics. Manufacturing is forecast to lose 73,000 jobs by then.

“The first baby boomer just turned 65 last year, so when it comes to health-care jobs, we haven’t seen nothing yet,” says Chris Rupkey, chief financial economist at Bank of Tokyo-Mitsubishi UFJ in New York. Almost 87 million Americans, or one in four, will be 65 or older by 2050, according to the Organization for Economic Cooperation and Development. Health services require face time with patients, which means “these jobs are protected from the forces of globalization,” says Rupkey. “We can’t imagine a time when we’ll be able to outsource the job of a home health aide giving a senior a bath or helping with physical therapy.”

Openings in health care are broadly distributed geographically, even in economically distressed small towns where they often are “all that’s left,” says David Card, a director of the Labor Studies Program at the National Bureau of Economic Research. They also provide “pretty good” opportunities, particularly for women, he says. During the recession, health care added almost half a million positions, while construction, which typically employs more men, shed 1.1 million workers.

Sharon Rudolph, 64, is studying to be a registered nurse alongside classmates who had previously worked in real estate and banking, as well as one who owns a nail salon. The Fort Lauderdale resident was a radiologic technologist before she took a break in the 1990s to raise her family. Now she’s in a 27-month training program at the city’s Nova Southeastern University. “I felt I’d become more marketable once I get out,” says Rudolph, who has managed to keep her other licenses in diagnostic medical and cardiac sonography current. “I have to work twice as hard as some of the kids” to keep up with the coursework.

Registered nursing, which requires at least an associate degree, will have the largest growth of all U.S. occupations, according to the Bureau of Labor Statistics, adding 711,900 jobs between 2010 and 2020, reaching a total of 3.4 million. The number of home health aides, who don’t need a high school diploma but require on-the-job training, will increase by 69 percent, to 1.7 million. Hiring of physicians and surgeons will rise by 24 percent, to 859,300, the bureau predicts.

While the additional jobs probably will lift employment, many pay low wages. That means these workers will be less able than employees in higher-paid industries to boost consumer spending. Yet health-care jobs may provide more stability than factory and construction work, which tends to fluctuate with the economy. According to BLS data that are seasonally unadjusted, the unemployment rate for health-services employees was 6 percent in December, compared with 16 percent for construction.

According to Charles Roehrig, director of the Altarum Center for Sustainable Health in Ann Arbor, Mich., every 10 jobs in health care ultimately generate an additional 12 elsewhere in the economy. If he’s right, then without the industry’s recent hiring growth, the unemployment rate would have been 9.5 percent in December, instead of 8.5 percent.

Topics: hiring, baby boomers, Workforce, employment, health, healthcare

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