DiversityNursing Blog

Cultural Competency: Matters of Modesty

Posted by Pat Magrath

Wed, Mar 22, 2017 @ 03:41 PM

nurse-and-patient-at-home-web.jpgGrowing up, we were taught to be modest. As we became adults and more comfortable with who we are as a person, modesty may have become more important in our lives, or perhaps, less important. It depends on our personal circumstances and beliefs.

Whatever our personal feelings are, as a Nurse, you must always be vigilant and respect your patient’s privacy. You already know this, but are you aware in some cultures, modesty truly is a virtue? For others, there could be a personal trauma, physical disfigurement, or psychological reason that produces tremendous anxiety when disrobing or showing any part of their body.

This article stresses the importance of being sensitive to each patient’s needs in delivering culturally competent care.

Many cultures and religions place a high value on modesty, particularly for women, associating it with honor and virtue. Often modesty is linked to styles of dress and circumstances under which an individual might feel comfortable being uncovered or touched. Yet, there are personal reasons for modesty too, so you’re likely to come across patients, both male and female, who have firm boundaries of privacy—including survivors of sexual assault and transgender patients.

Modesty can be so important to some patients that medical visits cause them a great deal of stress and anxiety. Some will shop around for a clinician of a particular gender or one who makes them feel comfortable—or even forego care completely. As a nurse, your ethical commitment to patient advocacy and patient dignity requires you to demonstrate cultural sensitivity to patients who value modesty. Making accommodations for a patient who values modesty is a form of holistic care, because it recognizes the individual’s emotional well-being.

In general, nurses should always preserve patient privacy, by providing gowns and cover-ups, pulling drapes closed, knocking before entering an exam room, etc. Whenever possible, go the extra mile, by providing scrub pants if a gown doesn’t close in the back or double-gowning a patient who will be leaving his room. Patients may know intellectually that healthcare providers “have seen it all,” but that doesn’t stem their embarrassment. You can also urge your employer to build an environment where patients feel safe, by speaking up about gowns that don’t close all the way or other modesty issues.

Cross-cultural patient encounters can often be challenging in terms of modesty. Muslim women are likely to request female providers only, and these requests might be hard to honor in small facilities or rural areas. They may also prefer to have their husband present during an exam or procedure, and may resist disrobing entirely—or uncovering their hair—for an exam. Women from certain Asian cultures also have a strong preference for female obstetrics staff. Ideally, nurses should be able to anticipate cultural requirements for modesty and make accommodations before patients become anxious or uncomfortable.

While the majority of nurses are female, many mistakenly believe that male patients really don’t care about modesty, but that often is not true. Many hospitals don’t have nearly enough male nurses or technicians on staff, but you should try your best to honor requests for same-gender providers for baths, catheterizations, or other intimate procedures. Always try to be sensitive to modesty concerns—even when it creates an extra step for you or takes more time.

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Topics: cultural competence, modesty

Nurse Uses Her Experience With Brain Tumor To Better Serve Patients

Posted by Erica Bettencourt

Tue, Mar 21, 2017 @ 12:06 PM

Screen Shot 2017-03-21 at 11.56.19 AM-274568-edited.pngYou take care of people in your job every day. However, if the tables are turned because you became ill and now it’s you being taken care of, the situation is bound to introduce you to a different perspective on how things feel. 
In the past, Nurse Kelly Northrip could only sympathize with her patients. Now she can relate to them and identify with things they are going through because she was once in their shoes. See how she pushed through her medical journey to come out the other side stronger and with an even better perspective for her patients. 

The squeak of tennis shoes moving quickly across the linoleum floors adds to the cacophony of alarms and beeps pulling nurses and doctors in every direction on the acute care floor of Florida Hospital Memorial Medical Center.

In the midst of the commotion, nurse Kelly Northrip sits quietly at the bedside of a patient, listening with the kind of intensity that doesn't come natural to most.

"I get told all the time I spend too much time with my patients, so to speak, and I say there is no such thing," said Northrip, a licensed practical nurse. "Each one is a learning experience."

Northrip knows firsthand the impact a few extra moments can have on a patient. If any of her patients doubt her, she might tell them about the golf ball-sized tumor that was discovered on her brain or the surgery she endured, answering doctors' questions while they probed her brain.

Usually, it's enough for Northrip simply to be there for her patients, hearing their concerns and reassuring them that everything will be all right. She's experienced that firsthand as well.


After 18 years in the restaurant industry, Northrip embraced a career change to pursue her dream of becoming a registered nurse. After graduating and starting her career as a licensed practical nurse, Northrip's newly established career was almost sidelined forever when a tumor was discovered in her brain last summer.

Overnight, the career she had worked so hard for was in jeopardy, and so was her life.

Northrip's specialists presented her with three options: do nothing; do a biopsy and determine how to proceed; or, the riskiest option, an awake craniotomy.

"Doing nothing wasn't an option for me, for us," said Northrip, whose husband and two kids supported her decision to go with the most aggressive option.

In an awake craniotomy, the patient is awakened after surgeons open the skull. That way doctors can ask a series of questions while removing the tumor and ensure other areas of the brain aren't damaged.

Sounding just like an eager nursing student, Nothrip described the prospect as "scary and exciting at the same time."

"I was more nervous than she was," said her husband, Steven.

But the surgery is rare — and risky. Her doctors recommended that she seek out surgeons who were specialists in the procedure.

"He said you'd be better off going somewhere where they've done thousands. If it won't bankrupt you, go to Duke," she recounted. On a morning in August 2016, Northrip and her family loaded up into her brother's motor home to drive from Florida to North Carolina so that the drowsy Northrip could sleep during the trip, a symptom of the tumor. After three blown tires, and countless frazzled nerves, the motor home delivered them safely to Duke University Hospital where Northrip would undergo brain surgery the next morning.

Northrip remembers being wheeled into the operating room for the surgery, where a big TV on the wall showed images of her brain. After being put to sleep, Northrip awoke to a bright room full of people and the distinct sensation of pressure in her head.

"I could feel the doctor working in my head," she recalled. "I could feel him working in there and I actually spoke to him and he spoke back. I could feel discomfort, but not great pain."

As the surgical team began to remove Northrip's tumor, they asked a series of questions to ensure they didn't affect other areas of her brain.

"He had me move my feet, wiggle my toes, do a number of things. I just tried to relax, and they tried to keep me calm through the whole thing. I can remember almost everything. I can even remember their faces."

The surreal experience of being conscious during brain surgery left Northrip feeling "very much awake and alive."

The next thing Northrip recalls is waking in a recovery room, feeling like she was being hit in the head with a hammer — proof she had survived the surgery.

The pain subsided when Northrip received the news she had hoped for — the tumor was benign, and she wouldn't have to undergo chemotherapy.

"The only thing I would be required to do was an MRI every year," she said.

Other challenges still lay ahead.


While insurance covered a large portion of the rare surgery, Northrip and her family still had numerous medical bills to pay on top of regular living expenses. Family, friends and coworkers rallied to the family's aid, hosting golf and dart tournaments and online fundraising campaigns.

"It makes you think, 'What did I do to deserve this?' I don't look in the mirror every day and say I'm a wonderful person. I don't think you ever feel deserving," Northrip said. "You're just trying to do your thing, trying to be a good, decent person and do things to the best of your ability."

The outpouring of support continued into Christmas when her family was adopted by the hospital staff, who bought presents for the kids. Northrip's co-workers also provided gift cards for the family.

The financial help allowed Northrip to focus on recovery and her goal of getting back to the job she loved. She pushed herself hard through physical therapy with the goal of coming back to work quickly but learned she couldn't force her body to recover faster than was possible.

The emotions of the recovery caught her off guard.

"I didn't think anything about the after, I just jumped in (to the surgery) with both feet and thought I would deal with it as it came," she said. "It was a very eye-opening, learning experience."

Physical therapist Donna McQuade worked with Northrip and knew the obstacles she would have to overcome to return to the job.

"When you do the job every day, you forget what it takes," McQuade said. "But having had such an extensive surgery, I don't think she was aware how much it affected her emotionally."

True to her persistent nature, Northrip tried to come back ahead of schedule, only to realize she wasn't ready and needed to continue her physical therapy.

"She's been doing it for so long she just didn't realize how much strength it took" to work a nursing shift, McQuade said.

Northrip persisted, and in January she returned to work.

"It's really miraculous, the amount of time from when she found out she was sick to when she was back to work," said McQuade.

While the experience challenged Northrip in more ways than she expected, being on the other side of the bed brought her a rare perspective that changed the way she views her job.

"Prior to this, I could only sympathize with my patients," Northrip said. "But after being hospitalized I can truly empathize and identify their anguish and stress."

To her coworkers, there was little doubt she would return and be a better nurse for her experience.

"We knew she would be back and rise to the challenge," said McQuade. "She's got a good support system here because she's a good support system to us."

Being back at work has also allowed Northrip to pursue her original goal, to become a registered nurse.

After years of applying to a full program, Northrip's application was recently accepted and she started school to become a registered nurse — while also returning to work.

"Ironically, I didn't expect it to be happening my second week back to work. I kind of bit off more than I could chew," Northrip said. "I don't take it lightly. I know it's a privilege for me to be working where I am. I want a better life for me and my family and help others to the fullest extent."

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Topics: Brain Tumor, Serving patients

Nurse Hackathon – Northeastern University on March 24-26, 2017

Posted by Pat Magrath

Fri, Mar 17, 2017 @ 11:58 AM

AHO-DN_3.jpgWe came upon this article and want to share it with you because we didn’t know about it and maybe you don’t either. Have you heard about the Nurse Hackathon? It’s a pretty cool opportunity to share your ideas regarding Nursing innovation. As a Nurse, you see things every day that could be done better to make your job more efficient, help your patients with their healthcare problems or share information.

Perhaps you’ve got an idea for an app? Maybe you can attend the Nurse Hackathon this year. If not, start thinking about it for next year.

When you hear the word “hackathon,” you may not necessarily envision a room full of nurses brainstorming ideas. Traditionally, hackathons were created as a way for computer programmers to gather and collaborate to solve a problem. Participants at a hackathon try to “hack,” or “solve” a challenge. At the “Nurse Hackathon: Nurses Hacking HealthCare” event hosted by Northeastern University, nurses are the ones leading the problem solving, developing solutions to issues in healthcare.

“Nurses are natural innovators, because we are trained to solve problems,” said Rebecca Love, RN, MSN, ANP, director of nurse innovation & entrepreneurship at Northeastern University in Boston, Mass. “Most nurses don’t think about taking their critical thinking skills a step further and actually developing a product or service that can be implemented on a larger scale. Through the Hackathon, we hope to revolutionize nursing education to change the current perceptions around nursing and present nurses as agents of change.”

Love is a nurse entrepreneur and organizer of the Nurse Hackathon. The event is designed to promote collaboration within the healthcare sector and inspire the nursing community to take on a leadership role in evolving new innovations in healthcare. This year, the Nurse Hackathon is scheduled for March 24-26, 2017 and will focus on the evolving field of “telehealth” and healthcare within the “home” for older adults. For more information or to register for the event, visit www.Northeastern.edu.

During the Nurse Hackathon, hundreds of attendees of different disciplines including nurses, web designers, technologists, computer scientists, engineers, designers and others will share their ideas and collaborate during this three-day event. Each teams pitches their inventions/ideas to a panel of judges made up of venture capitalists and chief level healthcare executives who determine the winner. 

Last year, the event hosted more than 200 attendees, and 50-60 nurse entrepreneurs and mentors. Nine multi-disciplinary teams presented their healthcare innovations and competed for cash prizes, mentorship opportunities, business seminars, and other opportunities to build their business ventures. The first-place winner of last year’s hackathon was TeleCode, a telehealth system that automatically links nurses and physicians at the bedside with experts in CPR and codes, who can assist them in delivering care.

Christine O'Brien, MSHI, RN, a nursing informatics specialist at Tufts Medical Center in Boston, Mass., attended the Nurse Hackathon last year. Her team won second place for its idea to create an app that allows school nurses to track and alert parents and public health officials about outbreaks of illness and contagious conditions in their school.

“I realized very quickly that nurses were playing a huge role at the hackathon,” said O’Brien. “The atmosphere was electric. You could look around the room and see that everyone was throwing out ideas and brainstorming. I remember driving home from the first night feeling so proud about my chosen profession and inspired to dream big.”

At the Nurse Hackathon, the range of problems identified and solutions developed was diverse. The third-place team concentrated on mental health, developing a way for students to anonymously seek help for suicidal thoughts or depression through a system called Sharanonymous. This app-based platform allows college students who are feeling depressed to connect anonymously with student counselors who provide emotional support through challenging times to diminish the rates of college suicide.

According to O’Brien, participating in the Nurse Hackathon inspired her to consider a career as a nurse entrepreneur.

“Attending the hackathon inspired me to consider a whole new world where I can create new entrepreneurial opportunities for myself,” she said.

To learn more about O’Brien’s team project and read her advice to nursing entrepreneurs, read the Nursing Notes Nurse Perspective article. You can also follow along during this year’s Nurse Hackathon by using the hashtag #RN_Innovator. 

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Topics: Nursing innovation

Here's What I Learned By Going Back To School

Posted by Pat Magrath

Thu, Mar 16, 2017 @ 02:29 PM

5882146398_7014d39636_o.jpg.736x0_q85.jpgHave you noticed some people were born knowing what they wanted to do for a career? Not me, I didn’t have a clue. One friend in particular, never wavered. He knew from the time he was a young boy, he wanted to be a doctor. He achieved his goal and he’s an excellent one too!
Some people change their career path and have to go back to school. Others go back to school to advance in their current career. Whatever the reason may be, going back to school can be overwhelming and a big deal for many reasons
Jennifer Mensik, PHD, RN, FAAN gives us a personal look at her educational journey and shares with us a few things she learned along the way.
Have you gone back to Nursing school? Maybe started out in a completely different career and switched to Nursing? What’s your experience?
Diversity Education Award

Everyone has a reason for going to nursing school and often different reasons for continuing education beyond that. I am one of the few RNs I know at my age who decided to become a nurse when I was in high school. Living in Washington state at the time, I participated in the Running Start program, which allowed me to take college prerequisite courses at the local community college. The tuition was covered by the high school; I just paid for books. I completed my nursing school prerequisites and applied to the associate’s degree in nursing program my senior year of high school.

As a sophomore in high school, I wanted to be a nurse practitioner. I knew once I was done with my ADN, I would transfer to Washington State University for my BSN. I had even chosen my NP program. I am quite the type A personality and had my life planned in 10th grade! Interestingly, my high school counselor always questioned my decision to go into nursing. And  while progressing through nursing school, I actually did change my mind. Because I have a type A personality, changing my planned path was difficult. It was one that I didn’t fully appreciate at the time, but I am thankful for today. I often reflect and tell others about what I learned along my 12-year journey. Here are the most important pieces of my self-reflection.

Pay attention to what piques your interest

As I started my RN to BSN program, I was still bound and determined to be a nurse practitioner. However, I really didn’t like pathophysiology nor pharmacology. I slugged through the material because I needed to learn it. But then came a leadership course. And as I was reading articles, I fell in love with the content. What I noticed was that many authors, all RNs, had MBAs. This made me pause. This was something I had not considered, primarily because I had never been exposed to it. As I finished my BSN, I decided I was going to get my MBA and not be a nurse practitioner.

Many of us get preconceived ideas of what we want to do based on what we know at the time. And many of us continue down a path because we do not pause to really determine if that is what we should still do. As you think about your next steps and what you want to do, pause and think. What piques your interest? Life is too short to not do what you love.

"Many of us get preconceived ideas of what we want to do based on what we know at the time. And many of us continue down a path because we do not pause to really determine if that is what we should still do.”

You get back what you put into it

During my MBA program, I couldn’t afford the time commitment to be on campus at times, so I chose an online education. At the time, many people were weary of online programs, thinking they lacked rigor and quality. This is where you need to make your own decisions. Regardless of the program type, I have seen students do the minimum work and try to sail through courses, checking off boxes, just to get the degree. As a faculty member, it is so disheartening to see. Why are you selling yourself short? It saddens me every time I overhear nurses say they didn’t learn anything when they went back to school. I am very leery of those individuals.

During my online program, I read everything and worked hard on my papers. I knew this would prepare me to be better at whatever I did. Today, I can tell the difference when I speak with someone who put in great effort to learn compared with the one who did not. It’s difficult to fake knowledge. You either know something or you don’t. So do not just treat this as a hoop to jump or check marks on a to do list. Your time is worth more than that, so spend it learning well. The time and money you are spending on education should make you better — a better nurse, a better person and an example for others. Maybe even an example to your children.

The more you learn, the more you realize you don’t know

Once I graduated with a doctoral degree, I proudly used my new initials after my name. What was interesting is that overnight, many people saw me as an expert. The perception was I had a doctoral degree, so I must know what you I’m talking about. In many ways through my dissertation I had become an expert in a particular area. But cue imposter syndrome! I feared I was really a fraud. I had to remind myself that there was no way I would ever know everything. There is so much to learn! You literally could spend every day of your life reading research articles and never know everything. What I learned wasn’t that I knew more than others; what I learned was the more you learn, the more you realize you don’t know.

So, realize that whatever stage you are at in your career or education or years of experience, there is a world out there much bigger than you or I could ever know!  Pause and think — are you happy with what you are doing and where you are going? Are you taking advantage of learning? And realize that no one knows everything. We are all lifelong learners.

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Topics: nursing school, continuing education

The Top 15 Cities For Nurses In 2017

Posted by Erica Bettencourt

Mon, Mar 13, 2017 @ 04:38 PM

seattle.jpgRecently, Indeed.com – a massive job search platform that greets over 200 million monthly visitors – took a look at which cities in the U.S. pay nurses the most while giving them the biggest bang for their bucks. The west of the U.S. – California especially – was overwhelmingly dominant.

See the list below.

15. Atlanta, Georgia. Average Salary, Adjusted for cost of living: $63,862

14. San Diego, California. Average Salary, Adjusted for cost of living: $65,092

13. Los Angeles, California. Average Salary, Adjusted for cost of living: $65,092

12. San Jose. Average Salary, Adjusted for cost of living: $65,113

11. Oxnard, California. Average Salary, Adjusted for cost of living: $65,402

10. Seattle, Washington. Average Salary, Adjusted for cost of living: $65, 856

9. Houston, Texas. Average Salary, Adjusted for cost of living: $67,101

8. Anchorage, Alaska. Average Salary, Adjusted for cost of living: $68,158

7. Phoenix, Arizona. Average Salary, Adjusted for cost of living: $72, 548

6. Riverside, California. Average Salary, Adjusted for cost of living: $73, 742

5. Portland, Oregon. Average Salary, Adjusted for cost of living: $73, 958

4. Sacramento, California. Average Salary, Adjusted for cost of living: $76, 870

3. Modesto, California. Average Salary, Adjusted for cost of living: $80,368

2. Bakersfield, California. Average Salary, Adjusted for cost of living: $80,731

1. Fresno, California. Average Salary, Adjusted for cost of living: $81,344

In compiling its list, Indeed calculating the average hourly salary for registered nurses in the US from 2015 thru 2016 by metropolitan area and adjusted the annual salaries based on cost of living. The numbers used were those published by the U.S. Bureau of Labor Statistics (BLS).
The city that offers the best wages and standard of living costs, according to the data, was Fresno, California. In that city of roughly half a million, a nurse can expect $81,344 in annual pay, adjusted for cost of living.

In second place we find Bakersfield, California, where nurses make $80,731 in salary, on average. In third place, Modesto, also in California, they make $80,368.

All in all, California cities accounted for nine of the fifteen spots on the list. Others on the charts are Sacramento (4thplace), Riverside (6th), Oxnard (11th), San Jose (12th), Los Angeles (13th), and San Diego (14th).

The one city not in the western half of the U.S. that made the list was Atlanta, Georgia, which ranked 15th. In Atlanta, nurses make an average $63,862.

Indeed’s report notes that it has seen evidence that there is a shortage of nurses in the United States, with many more postings looking for talent than there is interest (see graphic below). Interest in new positions, the job platform says, meets only about one third of demand.

Why are nurses needed so badly now? Two reasons Indeed puts forward are, A) people are living longer, thanks to advancements in healthcare and require more medical services, and B) More people have become insured over the past several years due to the implementation of the Affordable Care Act, which many have taken to calling ‘ObamaCare.’ Better access to medical insurance has led to more people seeking medical attention for their ills and taking preventative measures like getting checkups.

The position of registered nurse is expected to add more than 439,000 new jobs by 2024, according to the BLS, which the Bureau says is a faster leap than is average.
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Topics: best places to work

10 Tips On Providing Culturally Competent Care To LGBTQ Patients

Posted by Pat Magrath

Fri, Mar 10, 2017 @ 12:17 PM

LGBTQ Banner.jpgHow knowledgeable are you about the LGBTQ community and their healthcare issues? Do you know enough about the terms used in this community, such as the word queer? It doesn’t mean what it used to mean. As the LGBTQ community becomes more comfortable coming out and expressing themselves, hopefully they are more comfortable seeking medical care.
This means they should be in an environment free of judgment where they can honestly talk about their medical concerns and receive the help and treatment they need. We hope you find this article helpful and enlightening.

Many healthcare organizations are striving to ensure sensitive and equitable care for individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). Recent societal changes, including the legalization of gay marriage and Caitlyn Jenner’s very public journey to transgender female, have raised public awareness of LGBTQ issues. Yet many nurses find gaps in knowledge when caring for LGBTQ patients. 

Healthcare curricula in colleges and universities are still sadly lacking content regarding the unique needs of, and health risks for, individuals who fall outside the “traditional” heterosexual orientation of society. However, you can prepare for meeting the needs of these individuals by informing yourself, listening, and making some simple and practical adjustments in your nursing practice.

LGBTQ persons experience a number of healthcare disparities for many reasons: discrimination and social pressures, personal sexual behaviors, limited access to health insurance, higher rates of smoking and alcohol/substance misuse, higher rates of anxiety and depression, greater risk of sexually transmitted infections (including HIV), and increased incidence of some cancers. And when nurses encounter LGBTQ individuals in the clinical setting, they may create or contribute to these barriers to quality care due to lack of understanding and personal bias.

1. Expand your knowledge about sexual orientation and gender identity

To understand the needs of LGBTQ patients, nurses must expand their own knowledge on the subjects of sexual orientation (SO) or attraction, and gender identity (GI), or how one identifies with and experiences the world. Sexuality has long been defined as heterosexual by the dominant society, yet in reality, it encompasses a spectrum of needs, desires, and behaviors that can be fluid and changing over time.

2. Know key LGBTQ definitions

You can read about the meanings of asexual, gay, lesbian, bisexual, pansexual, and “queer,” descriptors that fall under the SO umbrella, as pointed out in More than Pink: LGBTQ Breast Health, a report published by Susan G. Komen, Puget Sound. Note that “queer,” formerly considered a derogatory term, is now considered by some to be a more fluid and inclusive descriptor than other words related to sexual orientation. Also, learn the meaning of terms such as agender, cisgender, transgender, gender fluid, and others that typically describe an individual’s gender identity.

3. Deepen your LGBTQ knowledge

Deepening your knowledge base will enrich your understanding of sexuality in general, and increase your nimbleness in identifying potential health risks for patients seeking your care.

Keep your knowledge up-to-date with ongoing training, reading, and learning from others who are skilled in communicating with and caring for these patients. Some good websites that can help you further your understanding include the Centers for Disease Control and Prevention, the GLBT Health Access Project (Community Standards of Practice Section), Trans-Health.com (online magazine), Women’sHealth.gov, and many others, including sources for this article.

4. Create a welcoming environment for LGBTQ patients

LGBTQ individuals have a long history of discrimination at the individual and institutional levels, including the healthcare system. They may “scan” an environment to determine if it is a safe place to reveal personal information, especially about sexuality. Some things an individual may watch for and take note of during their time in your reception or waiting room area:

  • Your organization’s nondiscrimination policy: Is it in a visible location?
  • A rainbow flag, pink triangle, or other symbol of inclusiveness
  • Availability of unisex restrooms
  • Health education literature with diverse images and inclusive language, including information about LGBTQ health
  • Posters announcing days of observance such as World AIDS Day, Pride, and National Transgender Day of Remembrance

5. Use inclusive language

It may take a little practice, but you can shift your vocabulary towards inclusiveness, opening the door for more open healthcare discussions. This can begin right in the waiting room as patients complete required forms. Rather than asking marital status, for example, the form might read, “relationship status: married, partnered, or other.” 

When asking patients to provide their names, include an additional space indicating “Preferred Name,” as a transgender individual may not wish to be called by a name that reflects their gender identity. Including “preferred pronoun” on a form shows understanding that someone may not identify as they appear.

6. Use gender-neutral language

Approach each interaction with open-mindedness, and a nonjudgmental attitude. Remember, your job as a healthcare professional is to assist the person in solving a health concern, or reducing the risk of future health problems. If your patient doesn’t feel comfortable sharing behaviors with you that are relevant, what good is the interaction? Conveying that the information shared in the provider-patient interaction is confidential may alleviate fears your patient has. 

When asking questions about sexual history and behaviors, preface questions with a statement such as, “So that I can best advise you about your health, I’d like to ask some questions related to sexual behaviors that I ask all my patients. ” Or, “It is our standard practice here to take a sexual history for every patient we serve.”

7. Ask open-ended questions

For example, asking, “Is there anything else that would help me ensure you get the most out of this visit?” can help patients share relevant health information.

Do not overwhelm patients with questions unrelated to the reason for their visit, or to enhance your own knowledge about transgender health. Focus on the behaviors impacting health rather than on SO/GI per se, so the conversation can positively influence health and foster acceptance. 

Prevent any “awkward pause” immediately after a patient shares SO/GI information. Practice your response in advance, such as “Thank you for being open with me; this will help me provide better care for you.” Role-playing your response can increase your own comfort with these situations.

8. Reflect the patient’s language

Avoid applying labels such as “gay.” Some people do not self-identify with any particular descriptive label, yet may have sex with partners of more than one sex or gender. Do not presume. For example, lesbian or gay men may have had or have sexual experiences with individuals of the opposite sex, and bisexual individuals may have long periods of monogamy; keep in mind that sexuality can evolve over time.

9. Investigate mental and physical health risks for LGBTQ patients

Be aware of the unique social pressures and health risks of LBGTQ patients. Societal phobias, violence, and hate crimes – and the fear of them -- are all too real for these individuals. Along with the potential for being ostracized from family and other social groups, this can contribute to chronic anxiety and depression.

LGBTQ individuals who are members of minority populations often face a double whammy of discrimination. Those with non-conforming sexual orientation or gender identity may also experience higher risk of suicide, as well as increased likelihood of tobacco use and drug/alcohol misuse.

It’s also important to build your awareness of the specific physical health problems LGBTQ individuals face. Lesbian women are more at risk for certain cancers due to the prevalence of obesity, nulliparity, or later pregnancy. Lesbian women are susceptible to many of the same sexually transmitted infections as heterosexual people and gay men. Thinking that this population isn’t at risk for these STIs can result in lack of appropriate screening and treatment. In addition to HIV infection, gay men may be at higher risk for anal cancer and can be particularly susceptible to body image issues in the desire to be attractive to other men. They may also experience a variety of cancers resulting from increased obesity and use of tobacco and alcohol.

10. Convey respect

Always remember that the LGBTQ patient in front of you has taken a courageous step to be in your office and disclose some of the most personal information about their lives. Having as positive and affirming an experience as possible will make it more likely the individual will seek future care in a timely manner. 

Becoming aware of resources specifically designed for LGBTQ individuals and making referrals as appropriate (e.g., support groups, smoking cessation groups or AA meetings, etc) will convey that you care enough to become informed about their particular needs. The quality of your interaction can truly make a difference in someone’s health -- and life.

Interested in more Diversity and Inclusion to-do's? 

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Topics: LGBTQ, LGBTQ Healthcare

Chief Nursing Officers Suffer Moral Distress in Isolation

Posted by Pat Magrath

Thu, Mar 09, 2017 @ 10:46 AM

work-stress-title-image_tcm7-212368.jpgHave you heard the term “moral distress”? It might be something you deal with occasionally in your job. You might have to go along with a decision made by a patient’s family member or it could be a decision made at you place of employment that makes you uncomfortable. This is moral distress.
We deal with it in our personal  and professional lives. This article talks about moral distress for CNO’s. We hope it’s enlightening.
The concept of moral distress in nursing—the disequilibrium resulting from the recognition of and inability to react ethically to a situation—has been around since the 1980s, and it's been acknowledged that some bedside nurses experience it during challenging situations such as when there is a conflict surrounding end-of-life care.

But what about chief nursing officers? They aren't providing direct care at the bedside, but do they still experience moral distress?

The answer, according to a qualitative study published in the Journal of Nursing Administration in February, is yes. It's just taboo to talk about it.

"There's shame and isolation when you do have the experience, so it can make it very difficult for people to feel like they can openly discuss it," says Rose O. Sherman, EdD, RN, NEA-BC, FAAN, professor and director of the Nursing Leadership Institute at Florida Atlantic University.

Sherman is one of the study's authors. "I think that the other piece of it is, CNOs might not always label it as moral distress. But these are uncomfortable situations where they're making decisions against their values systems."

Through oral interviews, Sherman and her co-author, Angela S. Prestia, PhD, RN, NE-BC, discussed chief nursing officers' experiences of moral distress, including its short and long-term effects. Prestia is corporate chief nurse at The GEO Group.

The study's 20 participants described their experiences of moral distress, and several said they experienced it on more than one occasion. It was often related to issues around staff salaries and compensation, financial constraints, hiring limits, increased nurse-to-patient ratios to drive productivity, counterproductive relationships, and authoritative improprieties.

"For example, a physician went to someone over a CNO's head and said, 'I think you should pay a scrub tech more. She is very valuable to me," Prestia says. "And of course he was a high-admitter, high-profile physician."

The CEO approved the special compensation, creating a salary inequity among the other scrub techs.

In another scenario, six participants reported their CEOs had improper sexual relationships with staff members. Prestia points out that the CNOs did not object to these relationships because of religious or moral beliefs, but because they were harming productivity at the organization.

"In their [the CNOs'] mind' of right and wrong, these people had access to things that they should not have had access to and [those relationships] create barriers to getting the work of the organization accomplished."

Lasting Effects 
The study uncovered six significant themes related to CNO moral distress:

  1. Lacking psychological safety
  2. Feeling a sense of powerlessness
  3. Seeking to maintain moral compass
  4. Drawing strength from networking
  5. Moral residue
  6. Living with the consequences

CNOs reported they often felt very isolated during the experience of moral distress.

"If they pushed back on a decision because they felt it was in conflict with their values they were isolated within the organization and they no longer felt safe. They weren't invited to meetings. They weren't included in decision making," Sherman says.

Even though they took steps to do what they felt was right—documenting meeting minutes, reviewing policies and procedures, and referring to The Joint Commission standards—to maintain their moral compass, those efforts were often unsuccessful.

"What happened was when they were in this situation… they were beat down at every turn," Prestia says. "Then the 'flight' started to set in. 'Maybe I need to leave? Maybe I should resign? Maybe I need to start planning my exit strategy?' Or before they could do that, they were terminated."

Moral Residue
Even once they were out of the situation, many CNOs reported the experience left them with a 'moral residue.'

"It is a lingering effect of the moral distress. I liken it to a fine talc that lingers on your skin and it manifests itself either physically or emotionally," Prestia says. "We actually had several participants say, 'When I get a call about staffing now in my new job, all of a sudden I get this feeling of impending doom.'''

Both Sherman and Prestia hope this research will open up a larger conversation about CNOs and moral distress. They will present their findings at the AONE 2017 conference in March.

"What we found in the work that we did was, clearly, collegial support from a strong network is very important in building one's resiliency and being able to deal with these situations," Sherman says.

"I think that having others who've been through it is very important, which is why forums that allow people to talk about this candidly, when a CNO finds him or herself in this situation, become critical."

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Topics: moral distress, CNO, chief nursing officer, nursing stress

Hospital Nurse Plays Video Games With Patients

Posted by Erica Bettencourt

Wed, Mar 08, 2017 @ 11:00 AM

tommy-sing-conner-quigley-grand-river-hospital-video-game-guy.jpgWhen Nurse Tommy Sing answers a patient's call he has to put his game face on, literally. Sing spends his days pushing different buttons on medical machines as well as game controllers. He may want to keep his actual day job though. His patients seem to always beat him. 
Read more below to see how Nurse Sing puts smiles on his patient's faces.

"No! No! Don't die! You died!"

The shrieks come hurtling down the hallway of the Children's Unit at Grand River Hospital, but don't be alarmed. They are punctuated by laughter — a lot of laughter.

Registered nurse Tommy Sing is playing a video game with 10-year-old patient Conner Quigley, and he's losing badly. 

"I've always liked to play," he says, "I was never good at them, obviously, but I've always enjoyed playing them."

Sing, who has been working on the Children's Unit for almost six years, has been dubbed the unofficial video game guy for the amount of time he spends playing with patients.

"I've played everything from Minecraft – not very well, but I've played Minecraft – all the way to games on the Nintendo Wii, all the way up to playing Call of Duty with some 16 and 17-year-old patients," he said. 

"You know, I'll walk into a patient's room and they'll already have the Xbox or the Nintendo Wii already set up and then we'll start talking video games. Obviously, sometimes, on the floor it's too busy for me to play with them, but if the opportunity presents itself or I finish my shift at 7:00 p.m. I'll stay after work and play a couple of rounds with them."

Although video games often get a bad rap in the health sector, being blamed for everything from poor eating habits to behavioural problems, Sing says they help him build quick rapport with the kids on the unit.

"It gives you one thing definitely that we have in common," he said. "It's so easy to just break the ice by playing the games and it just helps snowball into finding more and more about each other and even having more and more in common with each other."

He says the relationships he's been able to form with the patients makes it easy to crawl out of bed in the morning and come to work, even when his shift starts at 7:00 a.m.

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Topics: nurse plays video games, video games

Crocheted Octopus Dolls Helping Preemies Thrive

Posted by Pat Magrath

Mon, Mar 06, 2017 @ 11:44 AM

octopuses-for-premies-1-tease-today-170208_029cc7ee69d2eaefb9b3bd943944b746.today-inline-large.jpgDo you or someone you know, love to knit or crochet? Perhaps you’d be interested in putting those skills to work for a terrific cause. 
Check out what they’re doing in England and other parts of the world to help preemies thrive. By crocheting an octopus and giving it to the little one, the baby has something soft to hang on to and is comforted. The baby is less apt to pull out their tubes too. The crocheted octopus represents something familiar, comforting and soft. 
How sweet is that, that something so simple can help a little one survive?

One hospital in Dorset, England has stumbled upon an unusual way of making tiny premature babies in the neonatal intensive care unit (NICU) feel safe and comforted: by giving them a tiny handmade octopus to curl up with.


According to Poole Hospital, where the practice of pairing preemies with crocheted cephalopods has become an ongoing ritual, these cuddly crafts do more than just calm the babies.

The idea originally hails from Denmark where Aarhus University Hospital has suggested that the creatures can actually help smaller babies grow and thrive. A spokesperson for Poole hospital stated that the decision to introduce the crocheted crafts to patients wasn’t based on published scientific research but contact with other hospitals who had found they made a noticeable difference to their little patients.

But it can't be just any toy. It must be an octopus.

So why these sea creatures exactly? The design of the crocheted tentacles gives the babies something to hold and squeeze, and that can be a good thing for regulating everything from oxygen intake to heartbeats. What's more, the tentacles might be helpful at keeping the tiny patients from pulling out their tubes.

A number of babies at Poole Hospital took to their new toys especially well. In a feature that in the Daily Echo last fall, it was revealed that premature twin sisters Jasmine and Amber Smith-Leach both benefited from the comfort of their new toys. Their neonatal nurses said they have no doubt these tiny octopuses have helped the girls.

What's more, in response to the story, the hospital's NICU has received a whole new supply of crocheted octopuses for future patients.

“We’ve been overwhelmed by the kind response to our appeal for crochet octopi,” said Daniel Lockyer, matron of neonatal services. “We’ve now received over 200 octopi and have a year’s supply ready and waiting for our little patients! We’re not looking for anymore octopi for a little while so we can use these up.”

“We’ve been overwhelmed by the kind response to our appeal for crochet octopi,” said Daniel Lockyer, matron of neonatal services. “We’ve now received over 200 octopi and have a year’s supply ready and waiting for our little patients! We’re not looking for anymore octopi for a little while so we can use these up.”

Find the Octopus Pattern on our Pinterest!

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Topics: Preemies, Premature Babies

Top 150 Best Places To Work In Healthcare In 2017

Posted by Pat Magrath

Fri, Mar 03, 2017 @ 12:12 PM

bptw-logo*750xx1920-1080-0-0-379845-edited.jpgWith so many choices for Nurses to work including hospitals, schools, hospice, home health care and numerous companies, does your place of employment appear on Becker’s 150 Great Places to Work in Healthcare? Employee development, Mentoring and Leadership opportunities were factors that helped determine who landed on this list.

Other important factors included excellent benefits, high retention rates, commitment to diversity, respect for cultural differences and an overall high employee satisfaction rating. If you’re currently seeking employment, check out the job postings on DiversityNursing.com as well as Becker’s list.

Becker's Healthcare is pleased to release the 2017 edition of its "150 Great Places to Work in Healthcare | 2017" list. The list recognizes hospitals, health systems and organizations committed to fulfilling missions, creating outstanding cultures and offering competitive benefits to their employees.


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Topics: healthcare careers, best places to work

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DiversityNursing.com is a national “niche” website for Nurses from student nurses up to CNO’s. We are a Career Job Board, Community and Information Resource for all Nurses regardless of age, race, gender, religion, education, national origin, sexual orientation, disability or physical characteristics. 

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