DiversityNursing Blog

Nursing is a profession built around caring for others. Nurses advocate for patients, support families, help coworkers, collaborate with providers, and often step in when someone needs an extra hand.

But there’s a downside to always being the person who helps: it can become difficult to know when to say no.

Whether it’s picking up another shift, staying late, taking on another task, answering messages on your day off, or tolerating behavior that makes you uncomfortable, setting boundaries can sometimes feel selfish.

It isn’t.

Healthy boundaries aren’t about caring less. They’re about making sure you have enough time, energy, and emotional capacity to care without sacrificing yourself in the process.

Why Setting Boundaries Can Be So Difficult for Nurses

Nurses are often expected to be flexible. Staffing shortages, unexpected admissions, emergencies, call-outs, and high patient volumes can make it feel like there is always another reason to stretch yourself a little further.

You may find yourself thinking:

• “My coworkers need me.”
• “If I don't do it, who will?”
• “I don't want anyone to think I'm not a team player.”
• “I should be able to handle it.”
• “It's just one more shift.”
• “I feel bad saying no.”

Over time, these thoughts can make constantly saying yes seem like the responsible thing to do.

But repeatedly ignoring your own limits can contribute to exhaustion, resentment, stress, and burnout.

What Does a Boundary Actually Look Like?

A boundary is simply a limit you establish around what you are, and are not, willing or able to do.

At work, boundaries might look like:

Protecting your time:
Not answering work-related calls, texts, or emails when you're off the clock unless you're actually required to do so.

Protecting your workload:
Speaking up when your assignment or workload has become unsafe or unrealistic.

Protecting your emotional energy:
Recognizing that you can't be everyone's therapist, problem-solver, or emotional support system.

Protecting your personal life:
Declining extra shifts when accepting them would interfere with your rest, family, or personal commitments.

Protecting your professional boundaries:
Addressing inappropriate comments, disrespectful behavior, or requests that fall outside your role.

Boundaries don't have to be dramatic. Sometimes they're as simple as saying, “I’m not available today.”

The Difference Between Being a Team Player and Overextending Yourself

Nurses are team players. That's part of what makes healthcare work.

But being a team player doesn't mean being endlessly available.

There will be times when you genuinely can help, and there will be times when you can't. Both are okay.

A healthy team should allow its members to communicate their limits without making them feel guilty for having them.

Before saying yes to something, try asking yourself:

“Am I saying yes because I genuinely want to help, or because I feel guilty saying no?”

That small pause can tell you a lot.

How to Say No Without Overexplaining

One of the hardest parts of setting boundaries is feeling like you need to provide a detailed explanation.

You don't.

You can be kind, professional, and direct without giving someone your entire personal schedule.

Instead of:

“I’m really sorry, I would normally help, but I have so much going on and I haven't been sleeping well and I have errands and…”

Try:

“I’m not available to pick up that shift.”

Or:

“I’m unable to stay late today.”

Or:

“I won't be able to take on another assignment right now.”

Simple. Clear. Professional.

And if someone pushes back, you don't necessarily need a longer explanation. You can calmly repeat yourself.

“I understand, but I’m still not available.”

That's a boundary.

You Don't Have to Feel Guilty to Set a Boundary

Here's something nurses may need to hear more often:

Feeling guilty doesn't mean you've done something wrong.

If you're accustomed to saying yes, saying no may initially feel uncomfortable. Your brain may interpret that discomfort as guilt or selfishness.

Give yourself time to adjust.

You can care deeply about your coworkers and patients while still recognizing that you have limits.

You can be compassionate without being constantly available.

You can be a good nurse without being the nurse who always picks up the extra shift.

Boundaries Can Actually Make You a Better Nurse

Rest isn't laziness. Time away from work isn't something you have to earn.

Nurses need time to sleep, recharge, spend time with loved ones, pursue hobbies, exercise, travel, or simply do absolutely nothing.

When you consistently push yourself beyond your limits, your ability to be present and engaged can suffer.

Setting boundaries helps protect something that nurses desperately need: capacity.

When you're rested and emotionally regulated, you may be better equipped to communicate, make decisions, advocate for patients, and navigate difficult situations.

Taking care of yourself isn't separate from being a good nurse. It's part of sustaining your ability to practice nursing over the long term.

Five Boundary-Setting Phrases Nurses Can Keep in Their Back Pocket

If you struggle to find the words in the moment, try these:

When asked to pick up another shift:
“I appreciate you asking, but I’m not available.”

When someone asks you to take on another task:
“I don't have the capacity to take that on right now.”

When you're asked to stay late:
“I’m unable to stay past my scheduled time today.”

When someone crosses a professional boundary:
“I’m not comfortable with that. Let’s keep this conversation professional.”

When you're being pressured to change your answer:
“I understand the situation, but my answer is still no.”

You don't need to sound harsh. You just need to be clear.

Start Small

If setting boundaries feels completely foreign, don't try to overhaul your entire life overnight.

Start with one small boundary.

Maybe it's not checking your work email during your days off.

Maybe it's declining one extra shift.

Maybe it's taking your full break.

Maybe it's leaving work on time when your shift ends.

Maybe it's learning to stop saying “sorry” every time you communicate a reasonable need.

Small boundaries build confidence.

And eventually, you may realize something important:

You can say no and still be a caring nurse.

Your Compassion Needs Boundaries, Too

Nursing asks people to give a tremendous amount of themselves. Your compassion, knowledge, time, and energy are valuable, but they aren't unlimited resources.

You don't have to prove that you're dedicated by running yourself into the ground.

You don't have to feel guilty for having a life outside of nursing.

And you don't have to sacrifice your own well-being every time someone needs something from you.

Boundaries aren't walls. They're guardrails.

They help you care for others while remembering that you are a person who deserves care, too.

If you are a nursing student or an international nurse preparing to sit for the NCLEX, you need to mark a critical date on your calendar. For the first time since the year 2000, the National Council of State Boards of Nursing (NCSBN) is adjusting its exam registration pricing.

Effective February 1, 2027, the cost to take the NCLEX-RN and NCLEX-PN will see a noticeable increase across the United States, Canada, and Australia.

Here is everything you need to know about the upcoming fee changes, why they are happening, and how you can strategically plan your timeline to save money.

The New NCLEX Pricing Structure

The upcoming price adjustment impacts both RN and PN candidates, including first-time test-takers and those scheduling a retake.

Here is how the base registration fees will change starting February 1, 2027:

• United States: Increasing from $200 USD to $350 USD
• Australia: Increasing from $200 USD to $350 USD
• Canada: Increasing from $360 CAD to $570 CAD

While the core exam fees are rising, auxiliary fees will remain unchanged. The $150 international scheduling fee, the $50 nursing regulatory body (NRB) change fee, and Canada's REx-PN exam price will stay at their current rates.

Why is the Fee Increasing Now?

It has been over two decades since the NCSBN last adjusted the NCLEX registration fee. The decision to raise prices is driven by twenty-five years of inflation, alongside the escalating costs of modern test administration.

Maintaining a high-stakes licensing exam today requires significant investments. The new pricing structure will directly fund advanced cybersecurity measures, enhanced data protection infrastructure, and the ongoing development of next-generation exam questions to ensure the test remains a secure, accurate measure of nursing competence.

How to Beat the Price Increase: 3 Key Strategies

The good news is that your cost is determined by your registration date, not your actual test date. If you complete your registration and pay through Pearson VUE before February 1, 2027, you will lock in the current, lower rate; even if your actual testing appointment falls later in the year.

If you want to protect your budget, keep these three actionable strategies in mind:

1. Register Early if You Graduate in Late 2026

If you are finishing your nursing program in the Fall or Winter of 2026, do not delay your administrative paperwork. Submit your application to your nursing regulatory body and complete your Pearson VUE registration as soon as you are eligible. Registering before the February deadline will save you $150 USD (or $210 CAD).

2. Budget for the Full Scope of Licensing Costs

Remember that the NCLEX exam fee is only one piece of the financial puzzle. You must still account for your state or provincial board application fees, background checks, and fingerprinting processing. If you anticipate testing on or after February 1, 2027, update your total licensing budget to reflect the new $350 USD / $570 CAD benchmark.

3. Make "One and Done" Your Ultimate Goal

Because retake exams will also be subject to the new pricing structure, failing the exam becomes significantly more expensive after the deadline. Focus heavily on high-quality preparation, adaptive practice exams, and content mastery to maximize your chances of passing on your very first attempt.

While a price hike is never ideal news for a busy nursing student, knowing about this change months in advance gives you a distinct advantage. Talk to your peers, review your graduation timeline, and register as early as your eligibility allows to keep that extra cash in your pocket.

Remote nursing has become an appealing option for nurses looking for more flexibility, less commuting, and a different kind of work-life balance. From telehealth and case management to utilization review, care coordination, and nursing informatics, there are more opportunities to use your nursing expertise outside of a traditional bedside setting.

But working from home as a nurse isn't simply "bedside nursing in pajamas."

There are unique challenges, and some surprising benefits, that aren't always obvious when you're considering your first remote position. Here are some things experienced remote nurses wish they had known before making the switch.

Remote nursing is still nursing

One of the biggest misconceptions about remote nursing is that it will be easy.

You may not be physically running from room to room, but remote nursing can require significant mental and emotional energy. Depending on your position, you may spend hours on the phone, reviewing charts, coordinating care, documenting, educating patients, or making decisions that directly affect patient outcomes.

The environment may be quieter, but the responsibility is still very real.

Before accepting a position, ask what a typical day actually looks like. "Remote" describes where you work, not necessarily what the job feels like.

Your schedule may be less flexible than you expect

Working from home doesn't automatically mean making your own schedule.

Some remote nursing positions have very structured hours, productivity expectations, scheduled calls, or specific times when you must be available. Others may include evenings, weekends, holidays, or rotating shifts.

During an interview, ask:

• What are the expected working hours?
• Are schedules flexible?
• Are weekends or holidays required?
• Is overtime common?
• Are there scheduled breaks?
• How is productivity measured?

A job advertised as "flexible" can mean very different things depending on the employer.

Productivity metrics can be intense

At the bedside, your work is visible. In a remote role, employers often rely on metrics to measure productivity.

That could mean the number of calls completed, charts reviewed, cases handled, messages answered, or documentation completed.

This isn't necessarily a bad thing, but it can take some getting used to.

You may find yourself thinking, "How many cases have I completed today?" rather than "How busy am I?"

Understanding how your performance will be evaluated before accepting the position can help prevent surprises later.

You need to be comfortable working independently

This may be one of the biggest adjustments for nurses coming from a hospital environment.

Remote nursing often requires a high degree of independence. You may not have a coworker sitting a few feet away to quickly answer a question or a charge nurse you can turn to in the moment.

You need to be comfortable:

• Making decisions independently
• Prioritizing competing tasks
• Knowing when to ask for help
• Communicating clearly through technology
• Managing your own time
• Staying organized without constant supervision

If you thrive on the energy and teamwork of a busy unit, remote nursing may feel surprisingly lonely at first.

Communication skills become even more important

When you aren't physically in the same room as your coworkers or patients, communication can become more complicated.

A quick conversation at the nurses' station becomes an instant message. A question you might normally ask in person becomes an email or video call.

You'll need to become comfortable communicating clearly and professionally through multiple platforms.

And remember: tone can be difficult to interpret in written communication. A short message that seems perfectly neutral to you might come across differently to someone else.

Your home becomes your workplace

This sounds wonderful, until your laundry, pets, dishes, deliveries, family members, and household chores start competing for your attention.

One of the biggest lessons many remote nurses learn is the importance of boundaries.

If possible, create a dedicated workspace and establish a routine that signals when you're "at work" and when you're not.

And yes, your cat will eventually decide that your keyboard is the most fascinating object in the entire house.

You may actually miss the social interaction

Remote work can eliminate many of the stressful interactions that come with working in a hospital, but it can also eliminate the spontaneous conversations and relationships that make nursing enjoyable.

You may miss:

• Laughing with coworkers
• Celebrating a patient's progress together
• Having lunch with colleagues
• The feeling of being part of a team
• Simply having another nurse nearby who understands exactly what you're dealing with

If you're transitioning to remote work, make an effort to build relationships with your remote coworkers. Attend virtual meetings, participate in team chats, and get to know the people you work with.

Your technology skills matter

Remote nursing means technology becomes part of your everyday clinical toolkit.

Depending on your position, you may use electronic health records, video conferencing platforms, telephone systems, messaging applications, spreadsheets, databases, and specialized software.

Don't worry if you're not a technology expert. Most employers provide training.

But being willing to learn new technology, and being patient when technology inevitably decides not to cooperate, is essential.

Don't assume remote means less stress

For some nurses, remote work dramatically improves their quality of life.

For others, the stress simply changes.

Instead of dealing with staffing shortages, call lights, alarms, and physically demanding shifts, you may deal with productivity requirements, difficult phone conversations, large caseloads, technology problems, or repetitive computer work.

The question isn't necessarily whether remote nursing is less stressful.

It's whether the type of stress fits you better.

Ask about equipment before you accept the job

Find out exactly what the employer provides.

Some organizations provide a laptop, monitors, headset, phone equipment, and other necessary technology. Others may expect you to provide some of your own equipment.

You should also ask about internet requirements, technical support, workspace requirements, and what happens if your internet or equipment stops working.

Those details matter when your living room suddenly becomes your clinical workplace.

Your nursing experience is still valuable

One of the best things to understand before moving into remote nursing is that your bedside experience doesn't disappear just because you leave the hospital.

Your ability to assess situations, recognize changes in condition, educate patients, prioritize care, communicate with different healthcare professionals, and advocate for patients can be incredibly valuable in remote roles.

You aren't starting over.

You're applying your nursing skills in a different environment.

Read the job description carefully

"Remote nurse" can mean many different things.

A position might involve telehealth, telephone triage, case management, utilization management, insurance, care coordination, clinical documentation, education, informatics, or another specialty entirely.

Two jobs with the exact same title can have completely different responsibilities.

Before applying, look beyond the word "remote." Pay attention to the actual duties, schedule, required experience, productivity expectations, licensure requirements, and qualifications.

Remote nursing can open unexpected career doors

One of the biggest surprises for nurses who move into remote work is how many career paths can become available.

Remote nursing experience can potentially lead to opportunities in areas such as:

• Case management
• Utilization management
• Telehealth
• Care coordination
• Nursing education
• Clinical documentation
• Quality improvement
• Nursing informatics
• Population health
• Healthcare technology
• Insurance
• Clinical content development

Leaving the bedside doesn't necessarily mean leaving nursing.

Sometimes it means discovering an entirely different side of the profession.

Remote nursing isn't perfect and it isn't for everyone.

But for nurses who value flexibility, independence, fewer workplace interruptions, and the ability to work outside of a traditional clinical setting, it can be a rewarding career path.

Before accepting a remote nursing position, don't just ask, "Can I work from home?"

Ask:

"What will my workday actually look like, how will my performance be measured, and will this environment allow me to do my best work?"

The more you understand about the job before accepting it, the less likely you are to discover important details after you've already made the switch.

Remote nursing may look different from the nursing you started with, but your nursing knowledge, experience, and ability to make a difference still come with you.

Healthcare workers are accustomed to dealing with emergencies, but a growing security threat known as swatting presents a different kind of challenge.

Swatting occurs when someone deliberately makes a false report of a serious emergency, such as an active shooter, hostage situation, or armed individual, to trigger a large law-enforcement response. The FBI identifies hospitals, schools, places of worship, and other public locations as potential targets.

While reliable national data on hospital-specific swatting incidents is limited, evidence suggests the broader threat has grown. The International Association for Healthcare Security and Safety Foundation (IAHSSF) cites estimates that swatting incidents increased from about 400 in 2011 to more than 1,000 in 2019. In 2025, the FBI issued a nationwide warning about multiple recent swatting incidents.

Why Are Hospitals Vulnerable?

Hospitals are complex, 24-hour environments with large numbers of patients, visitors, and employees. A false report can quickly create confusion and potentially dangerous circumstances.

A swatting incident may:

• Trigger an armed law-enforcement response
• Disrupt patient care and hospital operations
• Require lockdowns or evacuations
• Put patients, nurses, and other employees at risk
• Divert emergency resources
• Cause significant emotional distress for staff

A 2025 incident at Loma Linda University Medical Center in California illustrates the potential impact. A false report of an armed individual prompted a major law-enforcement response and an evacuation before authorities determined the threat was a hoax.

What Should Nurses Know?

Nurses should never be expected to determine whether a reported threat is real or a swatting attempt. That responsibility belongs to hospital security and law enforcement.

However, nurses play a critical role in protecting patients during an emergency.

Know your hospital's emergency procedures. Be familiar with your facility's policies for active threats, lockdowns, evacuations, and shelter-in-place situations.

Take emergency alerts seriously. Even if a threat seems unusual or may be a hoax, follow your hospital's instructions until authorities determine otherwise.

Know your patients' needs. Nurses may need to protect patients who cannot independently evacuate, including patients requiring oxygen, ventilators, IV medications, or other critical care.

Report concerning behavior. Threats, suspicious activity, or threatening communications should be reported according to hospital policy.

Don't confront a suspected threat. Follow established security and emergency procedures and prioritize your own safety and the safety of your patients.

What Can Health Systems Do?

Swatting should be incorporated into hospitals' broader workplace violence and emergency preparedness plans.

Health systems can:

• Develop specific protocols for suspected swatting incidents
• Establish communication procedures with local law enforcement
• Train security personnel and frontline staff
• Conduct emergency drills that include false active-threat scenarios
• Maintain reliable emergency communication systems
• Review evacuation and shelter-in-place procedures for vulnerable patients
• Provide post-incident support for employees

The IAHSSF recommends that healthcare organizations prepare for swatting as part of their overall security and emergency-management programs.

Preparing for the Unexpected

Swatting is ultimately a reminder that hospital safety extends beyond traditional workplace violence and cybersecurity concerns. A false emergency call can have very real consequences for nurses, patients, families, and first responders.

Nurses don't need to become experts in identifying swatting. They do need to know their hospital's emergency procedures, understand their role in protecting patients, and be prepared to respond when a serious security threat is reported.

Hospitals may not be able to prevent every swatting attempt, but preparedness, communication, training, and coordination with law enforcement can help minimize the impact.

Sources

• International Association for Healthcare Security and Safety Foundation — Mitigating Swatting Events in the Healthcare Sector
• FBI — Threat Actors Use Swatting to Target Victims Nationwide
• OSHA — Workplace Violence in Healthcare
• National 911 Program — Public Safety Information on Swatting
• CBS News Los Angeles — Loma Linda University Medical Center Swatting Incident

The U.S. has grown more diverse with every passing year, and healthcare is feeling that shift directly. Nurses are increasingly caring for patients whose cultural backgrounds, languages, and belief systems differ from their own. Many of these patients — particularly those from African, Latino, and Asian communities — face some of the steepest barriers to healthcare access and carry a disproportionate share of the country's health disparities. Since COVID-19, "disparity" has become a household word, but the underlying problem it names — that race and ethnicity still shape health outcomes across nearly every measure — is far from new.

Nursing sits at the center of this challenge. As the largest group of healthcare providers in the country, nurses show up in every setting where care happens: hospitals, outpatient clinics, rural health centers, detention facilities, and beyond. That reach means nursing education has an outsized role to play in whether the profession helps close health disparities or unintentionally reinforces them.

What Cultural Sensitivity Actually Requires

It's tempting to think of cultural sensitivity as simply knowing that different cultures exist. But real cultural sensitivity goes further — it means understanding and respecting each patient's background, from their religious practices to their family structure to their social circumstances, and letting that understanding shape how nurses communicate, what they recommend, and how they deliver care.

Cultural sensitivity is best understood as one piece of a larger picture that includes cultural competence and cultural humility. Competence is built through education, immersion experiences, and stronger communication skills — but a nurse's age, self-awareness, and training also shape how culturally attuned they become.

Nursing decisions are never made in a vacuum. Every day, nurses draw on core ethical principles — autonomy, justice, non-maleficence, and beneficence — to guide patient care. Cultural sensitivity training helps nurses apply those principles more effectively across diverse patient populations, and it fosters a more collegial workplace for an increasingly diverse nursing workforce.

The Weight of Bias

None of this works without confronting bias directly. Every person carries both implicit and explicit biases — attitudes shaped by upbringing, personal experience, and even social media exposure. Explicit bias is the kind we're consciously aware of holding. Implicit bias is trickier: it operates below conscious awareness, but it still shapes how caregivers treat patients and colleagues, often leading to unintentional discrimination and worse health outcomes.

Left unexamined, these biases calcify into stereotypes that damage both patient care and student-faculty relationships. That's not abstract — it plays out in real careers. Decades ago, as a pre-licensure nursing student struggling through my first college chemistry class, I sought guidance from my faculty advisor. Instead of support, I was told, "Maybe you should be a social worker." I pushed through, passed chemistry that summer, and more than forty years later, I hold a doctoral degree in nursing. I've heard nearly identical stories from other Black nurses — being warned the program "could be tough" for them, or that it "might be financially challenging" given their background. These aren't isolated incidents; they're a pattern underrepresented students still face, which is why mentorship and cultural sensitivity training need to be built into how we prepare the next generation of nurses.

Accrediting bodies have taken notice: The Joint Commission and the American Nurses Credentialing Center's Pathway to Excellence program now require healthcare organizations to assess their diversity, equity, and inclusion efforts. That accountability matters — but only if it's backed by real change in how nursing students are taught.

Take the DiversityNursing.com "Unconscious Bias" Quiz Today

Why Cultural Humility Matters More Than Checklists

At the heart of good nursing care is a simple idea: every patient deserves to be treated with dignity. Cultural humility is what makes that possible in practice, asking nurses to bring empathy and genuine curiosity into every patient interaction rather than imposing their own assumptions.

Cultural humility differs from a rigid, fact-based approach to competence: it treats self-awareness as an ongoing practice, not a box to check, requiring nurses to critically examine their own biases continuously. Done well, this fosters what researchers call cultural fluidity — a seamless exchange between a nurse's own values and those of the patients and colleagues around them.

Research backs this up. Arruzza and Chau (2021) found that nursing students are eager to learn about cultural competence but often start out without a clear sense of their own strengths and gaps; structured education leaves them more satisfied and better able to identify their own learning needs. Antón-Solanas and colleagues (2021) found something more sobering: unaddressed implicit and explicit bias can take a real toll on students' mental health and academic performance. This isn't only about patient outcomes — it directly affects whether nursing students, especially those from underrepresented backgrounds, succeed and stay in the profession.

What the Research Says About Getting This Right

The broader literature reinforces the same conclusion: nursing can genuinely help close healthcare disparities when academic programs fully integrate culturally competent education and invest in training faculty to teach it well. But the training itself has to evolve — early cultural competency education often leaned on stereotypes that have since been discredited, and outdated versions can do more harm than good.

Faculty can't be exempt from this work either. Nurse educators need their own cultural competency training to prepare students for multicultural patient care. Yet studies show students still witness racial stereotyping from academic and clinical staff, creating what researchers describe as pressure to be "exceptional to be considered average." Combine that with reduced social support and a shortage of diverse faculty role models, and it's easy to see how it wears down even capable students. Proposed remedies include focusing more on social determinants of health, building genuinely safe clinical learning spaces, and prioritizing the retention of diverse faculty.

Much of today's thinking traces back to Madeleine Leininger's Transcultural Nursing Theory, which established that nurses must recognize and respect the cultural backgrounds, beliefs, and practices of every patient. Programs built around this theory report stronger empathy, sharper critical thinking, and deeper commitment to the profession. The American Association of Colleges of Nursing has since built on this foundation with its Essentials framework. Not every intervention shows the same staying power, though — unconscious bias training shows mixed long-term results, suggesting deeply ingrained biases don't always shift easily.

There's also a broader accountability question. A health profession school's "social mission" should mean more than teaching science well; it means embedding equity into the curriculum itself. Yet a review by Orbán and colleagues (2021) of nine health profession accreditation standards found that none of the nursing accreditation bodies examined explicitly required curricula to address student diversity or health disparities — a real blind spot in how the profession holds itself accountable.

Moving Forward

Cultural competence is necessary, but it's not sufficient on its own. Real progress requires systemic change across healthcare organizations, academic institutions, and the broader socioeconomic conditions that shape health. Every nurse has a role to play: examining personal biases honestly, collaborating openly with colleagues and students, and creating space for students to speak up when something conflicts with cultural sensitivity — an act of patient advocacy in its own right. Clinical training programs should also make room for real-world exposure: rotations in community health clinics, neighborhood health centers, international clinics, and cultural immersion experiences give students something no textbook can — direct contact with the communities they'll eventually serve.

The goal isn't a nurse who has memorized facts about every culture they might encounter. It's a nurse who walks into any room ready to listen, willing to be corrected, and committed to treating the person in front of them with the dignity they deserve.

References

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Vela, M. B., Erondu, A. I., Smith, N. A., Peek, M. E., Woodruff, J. N., & Chin, M. H. (2022). Eliminating explicit and implicit biases in health care: Evidence and research needs. Annual Review of Public Health, 43(1), 477–501. https://doi.org/10.1146/annurev-publhealth-052620-103528

Vella, E., White, V. M., & Livingston, P. (2022). Does cultural competence training for health professionals impact culturally and linguistically diverse patient outcomes? A systematic review of the literature. Nurse Education Today, 118, 105500. https://doi.org/10.1016/j.nedt.2022.105500

As America's population ages, one healthcare challenge is becoming impossible to ignore: the growing demand for nursing home care. With the oldest Baby Boomers now reaching their 80s, more older adults will require long-term care for dementia, chronic illnesses, and assistance with daily living. Unfortunately, the nursing home system isn't expanding to meet those needs, it's shrinking.

A recent perspective from researchers at Weill Cornell Medicine warns that the United States is heading toward a significant long-term care crisis unless policymakers, healthcare organizations, and providers begin thinking differently about how nursing home care is funded, staffed, and delivered.

The Demand for Long-Term Care Is Rising

Today, more than one million Americans live in nursing homes, but that number is expected to grow dramatically over the next decade. Researchers estimate that the population of adults aged 80 and older will increase by more than 45% by 2036, creating unprecedented demand for skilled nursing services. At the same time, nearly 10% of U.S. nursing homes closed between 2011 and 2021, leaving fewer facilities available to care for a growing number of older adults.

This growing imbalance means many families may struggle to find appropriate long-term care when they need it most.

The Workforce Shortage Is More Than a Staffing Problem

While discussions about nursing homes often focus on the number of available beds, the real issue is the people needed to care for residents.

A facility may technically have licensed beds available, but without enough registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs), those beds cannot safely be occupied. Staffing shortages directly limit access to care, increase workloads for existing staff, and contribute to burnout across the workforce.

For nurses working in long-term care, this reality is already familiar. Many have experienced:

• Higher patient assignments
• Difficulty recruiting and retaining staff
• Increased overtime
• Emotional exhaustion
• Challenges providing the level of individualized care residents deserve

Dementia Care Will Drive Much of the Need

People living with dementia make up a large percentage of nursing home residents, and that number will continue to rise as the population ages.

The researchers emphasize that improving access to quality dementia care should be a national priority. Without adequate nursing home capacity, hospitals may experience longer stays for patients awaiting placement, while families face increasing caregiver responsibilities at home.

Five Strategies That Could Help

Rather than simply calling for more funding, the researchers propose several practical approaches to strengthen long-term care.

1. Invest in the Workforce

Competitive wages, career advancement opportunities, and ongoing education can improve recruitment and retention for nurses, nursing assistants, and other direct care professionals.

2. Modernize Payment Models

Current Medicare and Medicaid reimbursement structures often make it difficult for nursing homes, particularly those serving large Medicaid populations, to remain financially stable. Updating payment models could encourage facilities to invest more in staffing and resident care.

3. Support Rural Nursing Homes

When rural nursing homes close, families may have to travel long distances to visit loved ones, and hospitals can struggle to discharge patients who need long-term placement. Stabilizing these facilities is essential for maintaining access to care in underserved communities.

4. Strengthen Hospital–Nursing Home Partnerships

Cross-training staff, sharing workforce resources, and improving communication between hospitals and long-term care facilities can help create smoother transitions for patients while improving staffing flexibility.

5. Expand Access for People Living With Dementia

Policies that improve funding and coordination for dementia care can help ensure patients receive appropriate services earlier and reduce unnecessary hospitalizations.

What This Means for Nurses

Nurses are central to the future of long-term care.

Whether you work in acute care, rehabilitation, home health, or skilled nursing, you'll likely care for more older adults with increasingly complex needs throughout your career.

Beyond bedside care, nurses can help drive change by:

• Advocating for policies that strengthen the long-term care workforce
• Mentoring new nurses interested in geriatric care
• Supporting quality improvement initiatives
• Participating in interdisciplinary care planning
• Educating families about long-term care options

As demand continues to grow, nursing expertise will be critical in shaping a healthcare system that can provide safe, compassionate, and sustainable care for older adults.

Looking Ahead

America's nursing home challenges cannot be solved overnight. However, addressing workforce shortages, improving reimbursement models, strengthening partnerships, and investing in caregivers can help prepare the healthcare system for the future.

For nurses, this issue extends far beyond nursing homes. It affects hospital capacity, care transitions, patient outcomes, family caregivers, and the overall health of our aging population.

The decisions made today will influence how millions of older adults receive care for decades to come, and nurses will play an essential role every step of the way.

For many patients and their families, leaving the hospital can feel overwhelming. They may receive pages of discharge instructions, medication changes, follow-up appointments, and home care guidance all at once. Even when nurses provide thorough education, patients may still leave unsure about what they need to do next.

That's where health literacy makes all the difference.

A recent nurse-led quality improvement initiative highlighted by the American Association of Critical-Care Nurses(AACN) demonstrated that tailoring discharge education to a caregiver's health literacy level significantly improved understanding, increased satisfaction, and even reduced hospital readmissions.

What Is Health Literacy?

Health literacy is a person's ability to find, understand, and use health information to make informed decisions about their care. It goes beyond simply being able to read. It includes understanding medical terminology, following medication instructions, recognizing warning signs, and knowing when to seek medical attention.

According to research, limited health literacy is associated with poorer health outcomes, increased emergency department visits, and higher hospital readmission rates.

A Nurse-Led Initiative That Made a Difference

Nurses in the Pediatric Cardiothoracic Intensive Care Unit at Loma Linda University Children's Hospital recognized that many caregivers struggled to understand complex discharge instructions following pediatric heart surgery.

Rather than assuming every family needed the same educational materials, the nursing team implemented a personalized approach.

Within 24 hours of admission, caregivers completed a brief health literacy assessment available in both English and Spanish. This helped nurses identify each family's educational needs early in the hospitalization instead of waiting until discharge day.

The results showed that more than one-third of caregivers had limited or low health literacy, reinforcing the need for individualized education.

Personalized Education Improves Understanding

After assessing health literacy, nurses used educational materials designed for different literacy levels. These resources included:

• Plain language instead of complex medical terminology
• Visual aids such as pictures and illustrations
• Step-by-step instructions
• Easy-to-follow take-home packets

Before discharge, nurses reviewed five essential areas of care:

• Medication administration
• Wound care
• CPR basics
• Nutrition
• When to seek additional medical care

Most importantly, nurses used the teach-back method, asking caregivers to explain the information in their own words. This simple communication technique confirms understanding and allows nurses to clarify misconceptions before patients go home.

The Results Speak for Themselves

The initiative produced measurable improvements.

Caregiver satisfaction with nurse communication increased dramatically. In follow-up surveys one week after discharge, families reporting that nurses explained things in an easy-to-understand way improved from 80% to 100% over the course of the project. The hospital also saw a reduction in 30-day readmission rates following pediatric heart surgery.

These findings reinforce what many nurses already know: effective communication is just as important as clinical expertise.

Practical Ways Nurses Can Improve Discharge Education

Whether you work in acute care, outpatient clinics, long-term care, or home health, there are simple strategies that can make discharge teaching more effective.

Use Plain Language

Replace medical jargon with everyday words whenever possible.

Instead of saying:

"Administer this medication twice daily."

Try:

"Take one pill in the morning and one before bed."

Small language changes can dramatically improve understanding.

Don't Ask, "Do You Understand?"

Most patients will say "yes" even if they are confused.

Instead, ask:

• "Can you show me how you'll change this dressing?"
• "Can you tell me when you'll take this medication?"
• "What symptoms would make you call your healthcare provider?"

These questions encourage patients to demonstrate understanding rather than simply agreeing.

Start Education Early

Discharge teaching should not begin the hour before a patient leaves.

Introducing education throughout the hospital stay gives patients and caregivers time to absorb information, ask questions, and practice skills.

Use Visual Resources

Pictures, diagrams, medication schedules, and illustrated handouts often improve comprehension more than text-heavy documents alone.

Include Family and Caregivers

Many patients rely on family members after discharge. Including caregivers in education sessions helps ensure everyone understands the care plan.

Health Literacy Is a Patient Safety Issue

Poor communication can lead to medication errors, missed follow-up appointments, preventable complications, and unnecessary readmissions.

By recognizing that every patient learns differently, nurses can create safer transitions from hospital to home while building confidence in patients and families.

Health literacy isn't about simplifying care. It's about making sure patients have the knowledge and confidence they need to successfully manage their health after discharge.

As this nurse-led initiative demonstrates, a few thoughtful changes in how education is delivered can have a lasting impact on patient outcomes, caregiver satisfaction, and overall quality of care.

Nurses with disabilities take home significantly smaller paychecks than their non-disabled colleagues, even after accounting for hours worked and demographic differences, according to new research.

The Study

The research letter, titled "Wage Gaps Between US Nurses With and Without Disabilities," was authored by Laurin Bixby, K. Jane Muir, Michelle Kephart, and Mihir Kakara. It was published June 27, 2026, in Health Affairs Scholar (Bixby et al., 2026).

The team drew on a large, long-running federal dataset — the American Community Survey — covering 473,850 employed nurses ages 20 to 65 between 2008 and 2023. Within that group, 17,425 nurses, or 3.5%, reported having a disability.

Key Findings

• A 12.2% annual wage gap. Nurses with disabilities earned 12.2% less in annual wages than nurses without disabilities, even after the researchers adjusted for demographic characteristics and hours worked.
• Lower hourly pay and fewer hours. Nurses with disabilities earned 7.4% lower hourly wages and worked roughly 27 fewer hours per year than their non-disabled peers.
• The gap held across roles. Registered nurses with disabilities earned 11.6% less, while advanced practice registered nurses with disabilities earned 6% less than their counterparts without disabilities. The disparity was most pronounced among nurses reporting multiple disabilities, cognitive disabilities, or independent living disabilities.

Why It Matters

The study's authors point to workplace factors including: accommodations, scheduling flexibility, and organizational support, as likely contributors to the disparity and call for further research to pin down the underlying causes.

The findings arrive at a notable moment for the nursing workforce. As the field continues to diversify and age, the number of nurses managing disabilities or activity limitations is expected to grow, making pay equity an increasingly pressing workforce issue.

The Bottom Line

Nearly one in 30 nurses in the sample reported a disability, and those nurses consistently earned less than their peers, a gap that persisted across nursing roles and could not be fully explained by hours worked or demographics alone. The authors' call for more research on workplace accommodations and suggests hospitals and health systems have concrete levers to potentially close this gap.

Source: Bixby, L., Muir, K. J., Kephart, M., & Kakara, M. (2026). Wage Gaps Between US Nurses With and Without Disabilities. Health Affairs Scholar, qxag161. https://doi.org/10.1093/haschl/qxag161

Additional reporting details via: Jeffries, E. (2026, July 13). Nurses with disabilities earn 12% less: 4 study notes. Becker's Hospital Review. https://www.beckershospitalreview.com/quality/nursing/nurses-with-disabilities-earn-12-less-4-study-notes/

For many nursing students, summer break feels like it just began. The longer days, warm weather, and freedom from exams can make the season seem endless. But as July turns into August, the reality of a new semester slowly starts to creep in. Clinical rotations, lectures, care plans, skills check-offs, and study schedules are waiting just around the corner.

The good news is that you do not need to spend the rest of your summer buried in textbooks to be successful. In fact, one of the healthiest things you can do before nursing school starts again is find a balance between preparation and rest. Nursing school is demanding, and taking time to recharge is just as important as getting organized.

Here are a few things nursing students should start thinking about as the semester approaches, while still making the most of summer.

Reflect on Last Semester

Before jumping into preparation mode, take a few minutes to think about what went well and what was challenging during your last semester.

Ask yourself:

• Which study habits actually worked?

• Where did you struggle the most?

• Did you manage your time effectively?

• What would you like to improve this semester?

Reflection can help you start the next term with a clearer plan instead of repeating habits that may not have served you well.

Get Organized Early

A little organization now can save a lot of stress later.

Consider:

• Checking your school email for updates.

• Reviewing your upcoming course schedule.

• Ordering required textbooks.

• Making sure your laptop, tablet, or other study tools are working.

• Updating any clinical requirements such as immunizations, CPR certification, or background checks if needed.

Many nursing students feel overwhelmed during the first week of classes. Handling these tasks ahead of time can make the transition much smoother.

Refresh Key Nursing Concepts

You do not need to spend hours studying every day, but a light review can help ease you back into an academic mindset.

Focus on:

• Basic anatomy and physiology.

• Medical terminology.

• Dosage calculations.

• Vital signs and assessment basics.

• Common medications and safety principles.

Even 20–30 minutes a few times a week can help rebuild confidence before classes begin.

Think About Your Clinical Goals

As you move through nursing school, each semester brings new opportunities to grow.

Consider questions such as:

• What skills do I want to become more confident in?

• How can I improve my communication with patients?

• What type of nursing interests me most right now?

• Are there clinical experiences I want to seek out?

You do not need to have your entire career figured out, but thinking about your goals can make clinical experiences feel more meaningful.

Prepare Financially

Nursing school often comes with expenses that appear all at once.

Try to plan for:

• Textbooks and online access codes.

• Scrubs and clinical shoes.

• Transportation and parking.

• Meals during long clinical days.

• Licensing or testing fees that may arise later.

Creating even a simple budget can reduce financial stress once the semester starts.

Protect Your Mental Health

One of the biggest mistakes nursing students make is treating summer as a race to become “ahead.” Remember that rest is productive, especially before a demanding semester.

Use some of your remaining summer to:

• Spend time with family and friends.

• Go to the beach/pool/lake, hike, travel, or explore your local area.

• Read a book for fun.

• Get consistent sleep.

• Exercise in ways you enjoy.

• Disconnect from school-related stress for a while.

Burnout can begin long before graduation. Taking care of yourself now is an investment in your future nursing career.

Remember Why You Started

As the start of the semester gets closer, it is normal to feel a mix of excitement and anxiety. Nursing school can be challenging, but it is also preparing you for a profession that has the opportunity to make a real difference in people’s lives.

When the stress of upcoming exams and clinicals starts to build, take a moment to remember why you chose nursing in the first place. Whether your motivation is helping patients, supporting your community, pursuing a lifelong dream, or creating a better future for yourself and your family, that purpose can help carry you through the difficult days ahead.

A Simple Summer Checklist for Nursing Students

🔲 Review last semester’s strengths and challenges.

🔲 Check school emails and course schedules.

🔲 Order books and supplies.

🔲 Complete any clinical requirements.

🔲 Refresh basic nursing concepts.

🔲 Set one or two goals for the new semester.

🔲 Create a simple budget.

🔲 Make time for rest, fun, and the people you love.

Summer break is not over yet, and you do not need to choose between being prepared and enjoying yourself. The most successful nursing students are often the ones who learn how to balance responsibility with self-care.

As nursing school slowly gets closer to starting again, take small steps to get organized, refresh your knowledge, and set your goals. Then give yourself permission to enjoy the sunshine, the slower pace, and the moments that help you recharge.

Because once the semester begins, you will be glad you prepared—but you will also be glad you took time to enjoy the summer while it was still here.

Every July, the United States observes National Minority Mental Health Month, a time dedicated to raising awareness about the unique mental health challenges experienced by racial and ethnic minority communities. The observance also highlights the importance of improving access to culturally responsive mental health care and reducing disparities that continue to affect millions of Americans.

Originally established in 2008 and inspired by the legacy of author and mental health advocate Bebe Moore Campbell, National Minority Mental Health Month encourages healthcare professionals, organizations, and communities to recognize the barriers that many people face when seeking mental health support. These barriers may include stigma, discrimination, language differences, financial limitations, and a shortage of culturally competent providers.

Why Mental Health Equity Matters

Mental health is an essential part of overall health. It influences how people think, feel, manage stress, build relationships, and make decisions. Mental health conditions are common and treatable, yet many individuals do not receive the care they need.

According to the Centers for Disease Control and Prevention (CDC), nearly 1 in 4 U.S. adults lives with a mental illness, but people from racial and ethnic minority groups often face greater challenges accessing quality mental health services. These disparities can contribute to delayed diagnoses, untreated conditions, and poorer long term health outcomes.

Understanding Mental Health Disparities

Mental health disparities are influenced by many factors beyond an individual's symptoms. Social determinants of health, historical inequities, and systemic barriers all play important roles in shaping mental health outcomes.

Some common challenges include:

• Limited access to affordable mental health services
• Lack of insurance coverage or financial resources
• Shortages of providers who understand cultural backgrounds and lived experiences
• Language and communication barriers
• Fear of stigma within families or communities
• Experiences of racism, discrimination, and trauma

The National Institute on Minority Health and Health Disparities (NIMHD) notes that National Minority Mental Health Month is an opportunity to recognize these challenges while promoting education, awareness, and emotional well-being across diverse communities.

The Importance of Culturally Responsive Care

Culturally responsive mental health care recognizes that culture, identity, values, and lived experiences influence how individuals experience mental illness and seek treatment.

Healthcare organizations can improve outcomes by:

• Recruiting and supporting a diverse behavioral health workforce
• Offering interpreter and translation services
• Providing culturally informed training for clinicians
• Building trust through community partnerships
• Addressing bias and discrimination within healthcare systems

Patients who feel understood and respected are often more likely to seek care, remain engaged in treatment, and achieve better health outcomes.

Reducing Stigma Through Education

One of the greatest barriers to mental health care remains stigma. In some communities, mental illness may be misunderstood or viewed as a personal weakness rather than a medical condition.

Education plays a critical role in changing these perceptions. Open conversations about anxiety, depression, trauma, substance use disorders, and other mental health conditions can encourage individuals to seek help earlier.

Healthcare professionals, employers, educators, and community leaders all have opportunities to normalize discussions about mental health and promote available resources.

How Nurses and Healthcare Professionals Can Help

Nurses are often among the first healthcare professionals to recognize signs of emotional distress. Their ability to build trusting relationships places them in a unique position to support patients from diverse backgrounds.

Healthcare professionals can make a difference by:

• Screening patients for mental health concerns during routine visits
• Listening without judgment
• Respecting cultural beliefs and preferences
• Connecting patients with community resources and behavioral health specialists
• Advocating for equitable access to mental health services

Small actions can help create healthcare environments where every patient feels safe, heard, and valued.

Supporting Minority Mental Health Beyond July

National Minority Mental Health Month serves as an important reminder that mental health equity requires year round commitment. Expanding access to care, reducing stigma, supporting culturally responsive services, and addressing social barriers are all essential steps toward improving health outcomes for everyone.

By working together, healthcare organizations, providers, policymakers, and communities can help ensure that every individual has the opportunity to receive compassionate, high quality mental health care regardless of race, ethnicity, language, or background.

Resources

• National Institute on Minority Health and Health Disparities: https://www.nimhd.nih.gov/
• Centers for Disease Control and Prevention Minority Mental Health Resources: https://www.cdc.gov/minority-health/features/minority-mental-health.html
• National Institute of Mental Health: https://www.nimh.nih.gov/