DiversityNursing Blog

by Paul Millard

Our brain is divided into left and right hemispheres. The left is the logical, linear and reasoning side while creative, intuitive and artistic operations reside in the right side. We all use both parts daily, but our culture strongly encourages the exercise of the left hemisphere. Nursing profession especially emphasizes this in all our “ology” classes: Pharmacology, Biology, Psychology, Microbiology to name a few. But it's interesting that common myth states men do better in sciences whilst nursing is traditionally a female pursuit though nature has seen fit to give us equal size in each hemisphere.

Non-scientific beliefs occur almost to everyone. Who hasn't worried about a black cat crossing their path, of the number 13 (many tall buildings won't even allow a floor numbered 13! and of course Friday the 13th!) or the effects of a full moon? All these arise from the mythical thinking of the right brain. However, nurses need to be positive thinkers to be able to render the quality care every patient deserves. 

Before the reader concludes that I'm criticizing this, I must confess that I've always had a problem with math teachers. Given a test, I would go through the test assigning the correct answers to the questions (intuitive, right hemi thinking), then go back and try to put enough stuff on the paper to “show your work.” This leads me in an argument with the teacher “how can you mark these questions wrong when I got the right answers?” to which the teacher retorts “but you can't get that answer with the work you put on the paper” (scientific, left hemi thinking).

Most of my years as a nursing professional, it has been in the desert Southwest. Very interesting culture and hemisphere clashes occur here. Smile at how cute a Hispanic baby is and the mother might start yelling “mal ojo, mal ojo” (evil eye) believing that I am stealing the child’s spirit with my eyes. Soon I learned to always touch a child on the shoulder or head when looking at it to prevent “stealing his spirit.” The Native Americans believe that what we call the soul resides in the person’s hair. If forced to shave or cut hair from a Native American, I always carefully return all the hair so that the owner can dispose of it through the proper ritual. A friend working with the Navajo tells of having treated a woman for a heart attack. Afterwards, the woman would return periodically and insist on being hooked up to the 12 lead EKG machine. Asymptomatic, it wasn't even necessary to do an EKG. She believed that the connection had healing powers.          

All of that said, a recent question on a website about “Energy Bracelets” caught my eye. There were some positive responses, and some claiming “it's a scam.” I hope someday we'll find an easy way to quantify the power of belief. There were so many naysayers of the energy bracelet that I doubt they would all be atheists. Belief in a higher power requires a certain amount of faith in the unprovable (right hemi), yet belief in an energy bracelet is criticized.

Having witnessed three exorcisms, I supposed tolerance is a virtue all nurses should nurture. Belief, generically speaking, is far more powerful than credited. Over the years, I have seen many things that defied scientific explanation and have had to remind myself over and over that the patient's belief plays a larger role in their outcome than is credited. Just as we must always tell people to make their own decisions because our own answers might not be right for them, we must also avoid projecting our beliefs upon our patients.

Science or superstition, nursing profession is still an art that uses a magic touch that helps ill patients heals and recover from their illness.

Nurses and nursing students, if you are interested in sharing your nursing knowledge and experiences with our audience, please click here.

Source: NurseTogether

By Liane Clores

I glance at the wall clock as I finish off my breakfast with the last sip of coffee. 6:14 am. Duty is about to start in about 46 minutes. I have to hurry up, I don’t want to be late for the endorsement. I fix my neatly ironed scrub suit and smock gown, pick up my things, which I prepared last night and head out the door with my game face on. Another day of saving lives is about to start.

“It’s like having a taste of both heaven and hell on earth,” Carmel* tells as she describes what it is like being an ICU nurse. “You get to save lives and be of help to patients who are sick, but what’s depressing about being a nurse in the ICU is seeing a life fading from a person’s eyes from time to time,” she adds.

6:30am. I arrive just in time for the nurses’ endorsement. I warm up and whisper to myself, “I can do this” as I get ready to face anything that may happen within my 8-hour duty shift. I grab the kardex first and try to read through my assigned patient’s information. Next, I take hold of the chart and read thoroughly, asking questions now and then from the outgoing nurse-on-duty, checking every sheet on the chart. We then proceed to bedside endorsement. Icheck if the IV site is patent and is not yet infiltrated, the labels and drips of they are on time, the urine catheters if clogged up or not, machines attached to the patient if functioning well.

“You have to be meticulous though, everything can be significant. You must check everything in the chart, from orders to what medications are to be administered and what has been the status of the patient within the previous shift. You must possess good assessment skills and must never be afraid nor shy to ask questions, or else it will only result to you getting confused, making mistakes, and worse taking your patient’s life at stake,” Rachelle shares.

After all the assessment and baseline vital signs taking, I proceed to checking the stocks and supplies. Once satisfied that the stocks can last the entire shift, I take the medicine cards from the medicine rack and organize them. I plan out my activities for the shift and prioritize them according to urgency, for today is going to be a long day of turning and lifting patients, administering medications, suctioning, monitoring and catering the patient’s needs.

The ICU is where seriously sick persons are admitted and are cared for by specially trained nurses.  They need a higher level of care compared to those patients admitted in wards. They should be monitored intensively and are closely monitored. Even though the ratio of patients and nurses is 1:1, some still consider it stressful being an ICU nurse. Since nurses are assigned to one patient each, each is expected to render comprehensive care to the clientele.

My patient’s BP has dropped from 180/100mmhg to 150/80mmhg. I call the resident doctor on duty to update him on the latest progress and after examining the patient, he orders to decrease the rate of the AC drip in decrements of 5 until the BP reaches 130-140/80mmhg.I decrease the rate from 10 uggts/min to 5uggts/min and recheck the BP 30 minutes later. The attending physician arrives to conduct his daily rounds and I update him regarding my observations on the patient’s current condition. I show the latest vital signs, laboratory findings and assist him as he examines the patient closely. I suggest plans of care which he acknowledges courteously. After which, I carry out the doctor’s orders and prescribe due medicines and supplies while continuing monitoring the patient closely making sure that the patient remains stable.

ICU nurses are trained nurses who are assigned to critically ill patients. Since these patients have unique needs, nurses must be equipped with proper training to handle them more appropriately such as Intravenous Therapy, Basic Life Support and ACLS trainings. They must have critical thinking skills and make snappy decisions. In the battle of life and death, they must come prepared and have a knowing on what to do since by working every day, they know that they are making life and death decisions and one wrong move can make matters worse.

I step out of the unit feeling tired and relieved. My 8-hour shift is now over as I turned my patient over the next nurse-on-duty. I feel fulfilled to know that today, I saved another life. It really is exhausting being a nurse and even the salary isn’t enough compared to all the sacrifices you have made in a day of duty. But sometimes, small things can make a big difference, like for us, nurses, just hearing a simple “Thank You” from either patients or their folks is enough to wipe the stress away.

Source: NursingCrib

The Healing Power of Dogs

It was a tough case: A five-year-old girl awaiting a bowel and pancreas transplant, who had essentially given up the will to live. She hadn’t spoken a word to anyone in days. But that was before Gracie, all two pounds of her, came to visit. Gracie, a Chihuahua rescue who belongs to Danielle Palmieri, R.N., is a therapy dog in the People Animal Connection Program (PAC) at UCLA. As soon as Gracie entered her room, the five-year-old perked up. A nurse even came in to see what had happened—the patient’s vitals had returned to normal for the first time in days. “She started talking and continued for 20 minutes,” says Palmieri, a high-risk labor and delivery nurse at UCLA. “They had pulled out every toy in that hospital, but nothing worked like Gracie.”

In March, PBS will air an episode of “Shelter Me,” a series looking at the positive impact of adopted shelter pets, that features PAC (see shelterme.com for dates). PAC is one of the largest pet therapy programs in the nation and its dogs make 900 visits a month to critically ill children and adults. It’s a trend that’s growing at healthcare facilities around the country. “There’s a lot of documentation showing that being with pets lowers blood pressure, and normalizes respiration,” says Jack Barron, PAC’s former director. “I’ve even seen people come out of a coma in a dog’s presence. People ask, ‘But how do you know it was the pet?’ and I say, ‘How do you know it wasn’t?’”

Palmieri tours the hospital with Gracie in her off hours, but she’s not the only nurse who supports the program. According to Barron, pet therapy wouldn’t happen without the nurses, who lay the groundwork so that dogs can make the visits. The nurses get some of the benefits, too. PAC dogs are also brought round to visit the nurses, especially those in critical care. “It calms them down and puts smiles on their faces,” says Barron. “It’s rewarding to see the nurses have a few relaxing minutes.”

Sister Act

How many times have you had a brilliant idea, only to shrug it off believing it would be too arduous to pursue? California nurses (and sisters) Terri Barton-Salinas and Gail Barton-Hay also came up with a brilliant idea—only they saw it through to fruition. If things go according to plan, you may be seeing it in your workplace some time soon.

Their patented idea: ColorSafe IV Lines, color-coated tubing designed to prevent medication errors. “When I worked in the ICU, the IV lines were like a big pile of spaghetti,” says Barton-Hay, now an OR nurse at Monterey Peninsula Surgery Center. “We were sitting around telling war stories and Terri said, ‘Wouldn’t it be great if tubing were colored?’ We did some research, went to a lawyer and now here we are.”

The sisters (one other sister and their mom are nurses too) found a manufacturer and even began selling the lines until they hit a bump in the road–the FDA asked for paperwork that it had previously waived. They complied and expect approval soon. “As nurses, we care about our patients and want nothing but the best for them so we’ve just kept plugging away,” says Barton-Salinas, a labor and delivery nurse at Kaiser Permanent in Vallejo. “If we prevent just one medical error it will be worth it.” The duo’s advise to other would-be nurse-inventors: Don’t take no for an answer.

How Sweet It Is

Clever cookie-maker Jaclyn Shaffer devised these medical- themed cookies by getting creative with cutters she already had. Check out jaclynscookies.com, and for instructions click here.

It’s a Mad, Mad World

Even if you’ve never been the target of a scalpel-throwing surgeon, no one has to tell you that physicians can behave badly. But did you know it’s so common that accredited hospitals must have a written policy on how to handle doctors’ disruptive behavior? Anger not only makes the workplace uncomfortable, it can compromise care.

Enter Anderson & Anderson, a certified anger management facilitator that frequently works with physicians, many of them surgeons. Stress, dealing with insurance companies that limit treatments and a perfectionistic nature all contribute to doctor rage, says George Anderson, director of training. “Plus, doctors put in a lot of hours to get their degrees, which means they don’t have as much time in life to develop interpersonal relationships.”

Okay, but how’s that going to help you deal with verbal abuse? When you witness bouts of anger, bring it to the attention of the appropriate department or committee at your hospital—and also try a personal approach. “Ask if you can speak to the doctor privately for a minute,” advises Anderson, “then ask if there’s anything you can do to help.”

Emotional Rescue 

Hospitals are well equipped to deal with medical emergencies, but crises of the spirit? Not so much. Enter Code Lavender, which, like a Code Blue, offers a form of resuscitation—but without the chest compressions. Instead, when a Code Lavender is called—whether the person in need is a patient, family member or someone on staff dealing with an emotional or spiritual crisis—the rapid response team comes armed with a bevy of potential therapies. Depending on the extent and nature of the need, they may provide reiki, healing touch therapy, aromatherapy, guided imagery, nutrition therapy and/or pastoral care.

The brainchild of ExperiaHealth, a company devoted to improving the patient and staff experience, Code Lavender addresses everything from a patient’s fear of an upcoming surgery to a family member’s worry or stress about a loved one and a nurse’s despair over having just lost a patient.

The program had its beginnings in a simple act of collective goodwill. “When a patient was in crisis, everyone on the hospital staff was asked to stop and send a healing intention or prayer to his room,” says Bridget Duffy, MD, chief executive officer at ExperiaHealth. “Eventually, Code Lavender morphed into not only sending intentions, but sending a healing services team to anyone in need, be it patient, family member or staff.”  

Several hospitals around the country now have a healing team in place, including the Cleveland Clinic in Ohio and Joe DiMaggio Children’s Hospital in Hollywood, Fla. And it’s been of particular benefit to healthcare workers: At the Cleveland Clinic, 40 percent of all Code Lavender requests were from employees.

What’s On Nurses’ Nightstands?

Four books worth a read.

Get Motivated! Overcome Any Obstacle, Achieve Any Goal, and Accelerate Your Success with Motivational DNA by Tamara Lowe and Rudolph Giuliani. (Doubleday)

I’m fascinated by how to effectively teach/motivate patients (and myself)
to take charge of their own health. This book looks at how different personalities get motivated and has already been valuable in helping me determine care plans for my patients. –Jonathan Steele, RN, holistic nurse in private practice, Scranton, PA

A Fistful of Collars: A Chet and Bernie Mystery by Spencer Quinn

This is number five in a series of
 private eye novels narrated by a mixed-breed German Shepherd who couldn’t quite make the cut for K-9 duty…
but neither could his 
owner. Great romp of a read for stress-busting after a long day at work. –Coleen Kenny, RN, MS, division of geriatrics, Virginia Commonwealth University Hospital
in Richmond

Maestro: A Surprising Story About Leading by Listening by Roger Nierenberg

This is about how a symphony orchestra solved problems. I picked it up because I felt it would be inspirational and, it is. It’s helping me to become a better listener, something I feel we all need to be reminded of from time to time. –Melina Thorpe, RN, director of Cancer Services, Glendale (CA) Adventist Medical Center

House of Sand and Fog by Andre Dubus III

I like it because the story builds up to something melancholy and tragic, while also giving some insight into human behavior and motivation. –Melanie Lukesh, FNP-BC, family nurse practitioner, Canton Potsdam Hospital

How Soccer Explains the World: An Unlikely Theory of Globalization by Franklin Foer

I am fascinated at how sports, in particular soccer (Futball), meld with society and stretch beyond the pitch (field). –Kimberly Bertini, BSN, RN, RNC, Magnet Program Coordinator, Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, Illinois

Source: Scrubs Mag

By Linda Childers

If Martin Schiavenato, RN, PhD, were to gaze into a crystal ball, he would envision a future in which patients no longer experience pain or suffering. 

Schiavenato, who until recently was an assistant professor at the University of Miami School of Nursing and Health Studies, has spent the past several years working with a team of medical engineers to create an orb-like device that has the ability to assess pain in premature infants. The
device, which resembles a crystal ball, uses sensors to monitor a patient’s behavioral and physiological signs of pain. By notifying clinicians of a patient’s pain level, Schiavenato hopes his device will lead to better pain management practices.

"I remember looking at the polygraph test administered by law enforcement professionals and wondering how it was possible that we could detect when a person was lying, but not when they were in pain," he said.
While Schiavenato’s invention still needs to undergo additional testing, it shows great promise detecting pain both in infants and in nonverbal patients, such as intubated patients or those who suffer from cognitive impairment.

"Assessing pain in infants has always been one of the most difficult challenges for clinicians," Schiavenato said. "Premature infant pain responses are unique and different from those of an adult."

As a result, Schiavenato says, pain has often been undertreated in infants, with many clinicians fearing the adverse effects of analgesics, such as morphine, and weighing the risks of these medications against the potential advantages. 

"Until recently, it was believed that neonates didn’t feel pain," Schiavenato said.

While clinicians have walked a fine line as they determine how to treat pain in infants, Schiavenato says there is evidence that failing to treat their pain early can lead to significant and long-lasting physiological consequences. These can include hypersensitivity to pain, a reduced immune system response, and even long-term disabilities and developmental delays. 

Schiavenato’s own interest in how pain is managed in infants began 18 years ago when he was working as a nurse in the NICU of a Tallahassee, Fla., hospital. One of his young patients had a rare and painful genetic disease that caused her skin to blister and slough off. The baby died several days after birth but left a lasting impression on Schiavenato.

"When it was time for me to choose a specialty, I decided to work to alleviate pain in infants," he said.

Schiavenato, who has a PhD in nursing and innovative technologies, joined the faculty at the University of Rochester (N.Y.), where he worked to develop a scale that enables providers to better assess pain in preschool-aged children. In 2009, Schiavenato was awarded an RWJF Nurse Faculty Scholars award to support the invention of his device. 

Today, a patent is pending for the orb device, which uses a computer chip to interpret a patient’s pain signals. Leads are placed over an infant’s chest to calculate heart-rate variability in response to distress, while another sensor is placed in the palm of the hand to record an instinctive finger-splaying response to pain. A third sensor monitors facial responses to pain. The computer then calculates the subject’s pain levels and displays the findings on a glass orb that can turn various colors to reflect the patient’s pain levels.

While Schiavenato noted his device also has the ability to work on non-verbal children and adults, he says the parameters and sensors would vary according to the age and condition of patients. 

Now an associate professor at Washington State University College of Nursing in Spokane, he also is working on fine-tuning many of the device’s characteristics, such as how the orb changes colors based on a patient’s pain levels. 

"Clinicians will be able to set a patient’s baseline color and note changes in color to determine if pain increases," he said.

He continues to test the device, but said he would love to see his device brought to market by a medical supply company.

"Twenty-plus years ago, open-heart surgery was being performed on infants without any pain meds," Schiavenato said. "We’ve come a long way since then, and hopefully in the future, we will have an even better handle on how to effectively manage pain in all patients."  

Source: Nurse.com

By Heather Stringer

By 2043, the U.S. is projected to become a majority-minority nation for the first time in its history, according to the U.S. Census Bureau. Both the Hispanic and Asian populations will more than double between 2012 and 2060, and the black population will increase by 50% during the same time period. These statistics illustrate that nurses will be caring for a progressively diverse patient population and the increasing urgency to build a diverse RN workforce. 

“Patients come with an expectation that the caregiver will understand all of their care needs,” Deidre Walton, RN/PHN, MSN, JD, president and CEO of the National Black Nurses Association based in Silver Spring, Md., said. “When you have a diverse workforce, you have people with knowledge and skills to meet the diverse needs of patients. The patient’s cultural identification, spiritual affiliation, language and gender can all affect the care they need, and it is very important that the nurse understands that.” 

Although Walton said the healthcare community is far from reflecting the demographics of the American population, she has hope as she looks into the future because diversity in the nursing workforce is being highlighted as a critical priority by more than minority nursing organizations. 

“I am excited because organizations such as the Robert Wood Johnson Foundation and AARP have a diversity agenda, and that makes me hopeful that there will be change,” she said.

Increasing diversity in the workforce, as illustrated on the following pages, will take individual and group efforts. 

Job titles of minority nurses

According to the 2008 National Sample Survey of Registered Nurses, the largest sample to date, minority nurses were more likely to hold staff nurse positions than white, non-Hispanic nurses.

Black nurses comprise 5.4% of the RN workforce, and 13.8% are in management positions, which is higher than any other ethnic group. Walton, however, said far more black nurses still are needed in leadership positions because this 13.8% is taken from a small pool of nurses. 

“Some organizations have very active programs to promote diversity in leadership, but the diversity gap in leadership continues,” Walton said. “There is a gap between how many minorities are recruited and how many are actually hired. These minorities in leadership roles are able to participate in making changes to improve the practice environment and outcomes, and this is very important.” 

Can patient ethnicity affect care?

According to a 2012 report from the Agency for Healthcare Research and Quality, racial and ethnic minorities face more barriers to care and receive poorer quality of care when they can get it. Findings from the report included:

Blacks received worse care than whites, and Hispanics received worse care than non-Hispanic whites for about 40% of quality measures.

American Indians and Alaska Natives received worse care than whites for one-third of quality measures.

Blacks had worse access to care than whites for one-third of measures, and American Indians and Alaska Natives had worse access to care than whites for about 40% of access measures.

Hispanics had worse access to care than non-Hispanic whites for about 70% of measures. 

Would a more diverse RN workforce correct some of these disparities? "Absolutely,” Walton said. “Diversity will improve patient-nurse communication, collaboration and clinical practice for patients of all backgrounds. If an African-American woman comes to the ED with abdominal pain, what is the likelihood that she will be diagnosed with a sexually transmitted disease as the cause of the pain rather than [staff] conducting other tests for a definitive diagnosis? When you have a culturally diverse RN workforce, they may not as easily dismiss symptoms and will advocate for a more intense work-up.” 

According to the 2008 National Sample Survey of Registered Nurses, only 0.3% of the RN workforce is American Indian or Alaska Native. This small percentage who are accepted into nursing school, earn their degree and enter the workforce often have overcome significant challenges, Bev Warne, RN, MSN, one of the founders of the Native American Nurses Association based in Phoenix, Ariz., said. “A survey in 2010 showed that 51% of Native American high school students graduate, so the drop-out rate is very high,” Warne said. “There are complex reasons for this. Studies show that many grow up in families that are poverty-stricken, so they suffer from poor nutrition and difficult family situations, and by the time they are in junior high they are already behind.” 

Warne believes the preparation to attain a formal education begins with good prenatal care, proper nutrition and support for parents. Even after Native Americans are accepted into nursing school, there are other challenges they may face.

“There are differences in values among Native people and Western people,” Warne said. “Generally Native Americans are raised in more of an extended family where there is an emphasis on inclusiveness. When they go into the college setting outside the reservation, they may confront Western values that promote individualism and competition, which is often the opposite of how they were raised. To be successful in this new setting, it is important for educators to get involved with students to discuss this new reality.”

It also can be difficult to transition to the Western medicine paradigm, Warne said. “In the Western hospital setting, caregivers tend to look more toward the physical aspects of illness, but from the Native perspective, they are accustomed to a holistic way of viewing a person.” 

Power to promote

Although it may seem difficult to make time to promote nursing to minorities within the community, here are a few simple strategies that are making a difference. 

Celia Besore, executive director and CEO, National Association of Hispanic Nurses: 
“I believe stories are really what lead people to consider nursing. The personal stories of nurses who were maybe the first to go to college in their families and now are very successful are the ones that inspire people. Our chapter members go into the community and do career fairs and visit schools, and that is when nurses can share their stories. There have been times when people have discouraged Hispanic students from going to nursing school because they think the students will not succeed, and our nurses can give them hope. We also tell young people that 30% of our members are student nurses, so they know they will not be alone.

“During these events, we also explain that now is a good time to be a minority in healthcare,” she continued. “We get calls from places that are desperately looking for Latino nurses. The word is starting to get out that it is an asset to understand the culture and language of minority patients, and hospitals want people with this experience.”

Mildred Crear, RN, MA, MPH, chairwoman for nursing and community education, Bay Area Black Nurses Association:
“Our chapter sponsors community health events like blood pressure drives, and this gives people in the community a chance to see us and ask what it takes to be a nurse. We share this information and then invite them to our meetings. We also do a lot of health fairs with churches and black sororities and fraternities where we do presentations about nursing, and this has been a really effective way of promoting the profession.”

Sharon Smith, RN, MSN, FNP-BC, president of the San Diego Black Nurses Association:
“I think it is critical to connect with people when they are young and try to mentor them. You can meet youth through church, in the community or through the events sponsored by your minority association. Our chapter visits high schools to recruit students, and we will go into the tough neighborhoods where it is harder for students to believe that they can do it. I share my own story that I grew up in North Carolina in one of the poorest counties, and I was told I would never finish high school. I told myself, ‘This is your thought, and not mine,’ and I went on to earn a BSN, a master’s degree and now I am pursuing a doctorate. You can do simple things like take them to work or communicate online, and this will show students the positives of a career in nursing.” 

It starts in the schools

Diversity in the nursing workforce is dependent upon a pipeline of diverse students who graduate from nursing school. This much-needed diversity among students, however, requires focus and resources, Julie Zerwic, RN, PhD, FAHA, FAAN, professor and executive associate dean at the University of Illinois at Chicago, College of Nursing, said. “Our school went through a period of time when there was no staff focused on watching diversity, so the number of underrepresented minorities in the program dropped,” she said. “If no one is paying close attention, you can lose momentum.” 

For example, the school recognized that a number of underrepresented minorities were not finishing their applications and would benefit from having a staff member available to receive phone calls and answer questions. The school also started offering application workshops. 

Although Zerwic hopes to see even more diversity among undergraduate nursing students, her institution has had significant success in recruiting graduate minority students. Zerwic credits a National Institutes of Health-funded program, the Bridges to the Doctorate Program, that helps the school to support potential minority doctoral students through mentoring, funding and coursework. 

Like the University of Illinois, diversity became a high priority in the School of Nursing at The University of Texas Health Science Center. “We knew that about 62% of the population in San Antonio was Hispanic, and to provide competent healthcare we needed to increase the number of Hispanic nursing students,” Hilda Mejia Abreu, PhD, MS, BA, associate dean for admissions and student services at UTHSC San Antonio, said. 

During the spring and fall, staff members travel throughout the U.S. to college fairs, schools, nursing association recruitment fairs and other activities to recruit minority students. The local Spanish-language channel also regularly features a 15-minute segment in which Mejia Abreu explains the college preparatory classes needed to apply for nursing school and how to finance an education. 

By comparison, below are the national diversity statistics for nursing schools:

Race/Ethnicity of Students Enrolled in Entry-Level 
Baccalaureate Nursing Programs in the U.S. in 2011
White, non-Hispanic: 72%
Black: 10.3%
Hispanic: 7%
Asian, Native Hawaiian or other Pacific Islander: 8.8%
American Indian or Alaskan Native: 0.5%

(Source: American Association of Colleges of Nursing) 

Overcoming the language barrier

For nurses who have arrived in the U.S. as adults and learned English as a second language, there typically are two distinct challenges they will face when communicating: being understood by Americans and understanding Americans, said Victoria Navarro, RN, MSN, MAS, president of the Philippine Nurses Association of America. 

“In the Philippines, we were colonized by Spain for about 400 years, so the Filipino language (Tagalog) that evolved has root words based in Spanish,” Navarro said. “We pronounce every syllable. In English, you have words with silent syllables or letters, so that in itself is something that we need to learn.” 

In addition to pronunciation, healthcare workers use jargon to communicate, and this is even more complicated when English is a second language. Navarro remembers when a physician told a Filipino nurse to get the “lytes.” The nurse turned off the lights, when in fact he had meant electrolytes. Other communication challenges Filipino nurses confront in the U.S. include:

In Tagalog, there are no long vowels, so it takes time and practice to learn to pronounce these sounds. 

There are no pronouns such as ‘he’ and ‘she’ in Tagalog, and there are no singular or plural verbs. It takes time to know when to say the proper pronoun or verb. Many people make mistakes initially.

Mental processing in the native language happens before responding in English. The literal translation from Tagalog to English could change the intent of the sentence.
In the Philippines, people have high respect for elders and do not speak unless they are asked something directly. For this reason, Filipino nurses may be considered passive by peers or patients. 

Navarro and Joseph Mojares, RN, BSN, president of the Philippine Nurses Association of Northern California, say proficiency can come with practice and time and made the following suggestions:

Do not be embarrassed to ask questions to clarify what others mean so you can learn the correct pronunciation and terminology.

Constantly immerse yourself in English-speaking environments and expose yourself to mainstream media at work and at home. 

Challenge yourself by taking classes in communication, leadership and public speaking so you can improve your English. 

Find mentors and preceptors who can encourage you and give you suggestions about how to present yourself and communicate. 

Tips for scholarship success

Jasmine Melendez, the scholarships and grants administrator at the Foundation of the National Student Nurses Association, has an insider’s view into the world of financial assistance. She has seen hundreds of scholarship applications, and said reviewers are looking for three things from applicants: financial need, high academic achievement and involvement in community health activities. 

“It is important to maintain a high GPA, but students who make time for some form of community service really set themselves apart,” Melendez said. 
Another way to stand out from the competition is to turn in well-crafted, accurate essays. “What I’ve been noticing is that students need to learn to write well,” she said. “When you convey a message, you want to make sure you convey it in a clear, concise manner with no spelling errors or grammar mistakes.” 

Here are other tips she suggests:

Get comfortable with the Internet because most scholarships are found on the Web. Websites that can help minority students find scholarships include: 
DiscoverNursing.com/Scholarships 
MinorityNurse.com/Find-Scholarships 
NursingSociety.org/Career/CareerAdvisor/Pages/Scholarships_opps.aspx 

Check with minority-owned businesses to see whether they offer scholarships, and ask the financial aid office at your school about scholarships and applications.

The hospital association in your state may have access to scholarship information.

Don’t make the mistake of thinking scholarship deadlines are only in the first part of the year. There are scholarships available every quarter of the year.

Don’t disqualify yourself by not applying. Apply for everything and let the committee say no. 

Source: Nurse.com

AMERICA’S hospitals are the most expensive part of the world’s most expensive health system. They accounted for $851 billion, or 31%, of American health spending in 2011. If they were a country, they would be the world’s 16th-largest economy. And they are in the midst of dramatic change, much of it due to the “Obamacare” health reforms.

The most visible change so far is that big hospital companies are getting bigger. In the latest of a string of recent mergers and takeovers, on June 24th Tenet Healthcare said it would buy Vanguard Health Systems for $4.3 billion including debt. The combined group will have 79 hospitals and 157 outpatient clinics.

Others are going further, turning the industry’s business model on its head. In Massachusetts, Steward Health Care Systems is trying to drive patients out of its hospitals and into cheaper clinics. The pace of change varies from one hospital group to the next. But beneath the shift is an argument—by politicians, insurers, patients and some investors—that the old business ways of hospitals are untenable.

America has more than 5,700 hospitals, with non-profits outnumbering for-profits by nearly three to one. Most of these share a familiar business model: sell as many services as possible at the highest price. This bodes ill for those who pay, whether employers, the government or patients themselves. Doctors receive a fee for each treatment, so there are few financial incentives to keep patients well. And since the health market has the transparency of a concrete bunker—patients usually do not know the price of treatment until after they have received it—American hospital stays are unusually expensive (see chart). It is little wonder that health spending overall accounts for nearly a fifth of GDP.

This dysfunctional system will welcome millions of new patients next year. Obamacare requires everyone to have some form of health insurance from 2014. To that end it expands Medicaid, the government’s insurance scheme for the poor, and subsidises private insurance policies which will be offered via new exchanges to be set up in each American state. More people with insurance should mean more patients seeking treatment, so the reforms would seem to herald a golden era for hospitals. Indeed, hospital shares have soared since the Supreme Court upheld the health law’s constitutionality a year ago.

Nevertheless, hospitals face mounting pressure to change. In recent years the volume of patients at most hospitals has been flat at best. The recession is partly to blame, since sacked workers lose their insurance. The shifting of some treatments to outpatient clinics has undercut some hospital revenues. And employers have increasingly required their workers to make out-of-pocket contributions towards the cost of their health care, which makes them a bit less likely to seek treatments.

Obamacare itself is not all good news for hospitals. It will bring revenue from newly insured patients. But it will also cut the rates the government pays for Medicare, the health scheme for the old. By 2019 these will cancel each other out, reckon analysts at Bank of America Merrill Lynch. And the Medicare cuts already announced may not be the last. The reforms may create fewer new patients than expected: some people may ignore Obamacare’s “mandate” to buy insurance, since the penalties are small. State and federal officials are scrambling to get the exchanges ready in time. Some Republican governors are refusing to expand Medicaid.

Obamacare also includes incentives for hospitals to provide quality, rather than quantity, of care for publicly insured patients. Medicare will penalise hospitals that discharge patients only for them to return within 30 days. Groups of doctors and hospitals can apply to be designated as accountable-care organisations, or ACOs, which will be rewarded for keeping the cost of Medicare patients’ treatments below a certain level. (They thus have broadly similar aims to health-maintenance organisations, or HMOs, a type of private health plan that pays a fixed fee to doctors and hospitals for the patient’s care).

Last month the Obama administration opened another line of attack on hospital costs by publishing their price lists. These showed huge variations. In practice, insurers negotiate special rates, and these remain mostly hidden. But scrutiny of prices is likely to intensify, as more members of employers’ health schemes are forced to shop around for treatments.

Physician, know thy costs

The reforms, and the other pressures on the hospitals, have prompted them to launch a big efficiency drive. The well-respected Cleveland Clinic is offering shared medical appointments: a doctor tells several patients how to manage diabetes, rather than counselling them individually. Robert Kaplan and his colleagues at Harvard Business School are helping hospitals measure their costs. Many do a poor job of recording how much each type of treatment costs them in terms of doctors’ and nurses’ time, materials consumed and so on.

Hospitals are also seeking economies through dealmaking. All sorts of combinations are being seen, says Martin Arrick of Standard & Poor’s, a credit-rating agency: big, stockmarket-listed chains like Tenet and Vanguard are merging; Catholic hospitals are getting ecumenical with non-Catholic ones; and non-profit outfits are partnering with for-profits. There were more than 200 such deals in 2011-12, according to Irving Levin Associates, a research firm. This does not include many purchases by hospitals of doctors’ clinics.

The combined Tenet and Vanguard will have hospitals and clinics across 16 states. This will make it easier to standardise clinical practice, get discounted supplies and make the most of investment in new medical technology. Most important, a bigger firm will have more clout in negotiating prices with health insurers.

The most seismic shift, however, is the move away from the fee-for-service model. How can a hospital profit from delivering fewer services, when it is organised to deliver more? HCA, a quoted company with 156 hospitals in 20 states, is all but ignoring the question. Vanguard is one of few listed chains to have started looking for answers, including taking part in ACOs.

Steward, which is only three years old, seems to be the most ambitious in embracing change. It was created when Cerberus, a private-equity firm, bought a struggling chain of Catholic hospitals in 2010. Steward does not aspire to have the best hospitals in America—indeed it sends its most complex cases to a rival medical centre in Boston. What it wants to offer is good, convenient, reasonably priced care. Steward has signed up as a Medicare ACO and also has contracts with private insurers that reward it for keeping patients well as opposed to paying it by quantity of treatments. The company has 11 hospitals, up from six in 2010, and a network of 2,900 affiliated doctors, up from 1,100.

Steward is making efforts to ensure that patients do not suffer expensive relapses: nurses scroll through records to confirm that patients have collected their prescriptions and had their check-ups; more home visits are being made to recently discharged inpatients. But it is unclear overall whether such efforts will boost profits, or indeed lower America’s health spending, let alone both. Large hospital chains, thanks to their clout with insurers, are more likely to raise prices than cut them. Steward’s prices are lower than Massachusetts’s most expensive hospitals, but higher than those of some competitors.

As for ACOs, they have had a good start: more than 250 have been formed so far. But their success is difficult to predict. ACOs are responsible for the costs of a given set of patients, but those patients can seek treatments outside the group of providers that form the ACO. This may make it hard to contain their costs.

George Clairmont, who leads a doctors’ group that partners with Steward, is excited by the prospect of a new era. “We are part of a major change in health care that we haven’t seen since the beginning of the 20th century.” But like a novel treatment for a chronic ailment, the cure for America’s bloated hospital industry will need careful monitoring for side-effects.

by Courtney H. Lyder

In a recent editorial in The New York Times, Theresa Brown wrote about how clinical hierarchies and the impact of conflict between nurses and physicians can be deadly for a patient. She said "when doctors and nurses don't get along, it's the patient who suffers."

A lot of studies show that poor communication is linked to adverse patient outcomes. For example, of the 1,243 sentinel events reported to the Joint Commission in 2011, communication problems were identified in 60 percent.

By its very nature, healthcare is complicated; it is a rapidly changing environment and unpredictable. Professionals from a variety of disciplines can care for a patient during a 24-hour period, which can limit the opportunities for face-to-face communication.

Physicians and nurses are expected to work together, not only practicing side by side, but interacting to achieve a common goal: the health and well-being of the patient. But there are several factors that can make effective communication between nurses and physicians particularly difficult to achieve, including historic tension; conflicting viewpoints based on education, training, communication style; and terminology and existing communication processes that are inefficient at best.

With the focus of healthcare moving increasingly to the team approach, it becomes even more critical for physicians and nurses to work in collaboration. Higher education institutions including UCLA and the University of Virginia, for example, are working to improve how nurses and physicians work together before they enter the clinical environment.

The University of Virginia now requires interprofessional education for its nursing and medical school curriculums. Courses, training modulus and even faculty members are shared across both disciplines. Medical and nursing students are taught to respect each other's areas of expertise.

In the Fall of 2008, the UCLA School of Nursing and the David Geffen School of Medicine at UCLA, introduced a pilot program to integrate nursing students (in this case advanced practice students) and third-year medical students. The result was an innovative program that focused on content, such as communication with patients, ethics, behavioral medicine and other psychosocial issues. The idea was to get the two groups working together sooner rather than later so students from both schools could develop team-building skills, increase their awareness of each other's roles and get used to working together in making decisions to improve patient outcomes.

Our initial results indicated the students found the experience to be of great value. In addition to assisting students with their clinical decision-making skills, the discussions that took place during the course provided an excellent forum in which the nursing and medical students gained a better mutual understanding.

I believe collaborations like this represent the future of medical and nursing education. No two groups of health professionals are more interrelated in practice, and by starting here, we allow them to understand each other and to grow up together as students.

We are now taking the next step by creating assessment tools to evaluate interprofessional competencies not only in the classroom but in clinical practice settings as well. Tools such as an iPad app will allow instruction leaders to assess actual collaborative practices through observations and walk-throughs in clinical settings. Our ultimate goal is to disseminate the tools with a wider community.

Patient safety needs to be our top priority. Successful delivery of healthcare needs to be interdependent and respect shown for the education and knowledge of each team member. Interprofessional education is an excellent start.

Courtney H. Lyder is dean and professor of the UCLA School of Nursing, professor of Medicine and Public Health as well as Executive Director of the UCLA Health System Patient Safety Institute and Assistant Director of the UCLA Health System.

By DEREK THOMPSON 

Here's what that graph (via Brookings) says. In the last ten years, job growth in America's non-health-care economy has been dreadful. Just 2.1 percent total -- or barely 0.2 percent per year. (Yes, that's point-two percent annual growth.) In that time, the U.S. health care sector has grown more than ten-times faster than the rest of the economy, adding 2.6 million jobs.

There are a couple stories that branch off from this graph. One is the unchecked growth in health care prices over the last few decades, which has made the medical industry the one truly recession-proof job engine of the economy. Two is the concentration of job growth in local service industries shielded from the global supply chain. And three (related) is the sad decline in construction and manufacturing jobs. 

Let's pull back the lens to 1990 and take a picture. Take a look at the growth of health care employment (in red) and the decline in construction and manufacturing employment (in blue).

According to the BLS, the two fastest-growing jobs in the next decade -- by far -- will both be in health care: personal care aides and home health aides.

I'd prefer not to muddy a clear statistical observation here with a provocative claim that health care's relentless, unstoppable employment growth is a goodthing or a bad thing, exclusively, because it's certainly both -- an emergency source of recession-era employment and a symptom of health care inflation. I knew health care had been the most important driver of national employment over the last few years, but I had never seen the case made so starkly.

Source: The Atlantic

By Debra Wood 

While among the most rewarding professions, nursing is not without its challenges. Nurses are exposed to numerous risks, sometimes with life-changing or life-ending consequences, such as nurses who died during the SARS outbreak or lost their lives falling asleep at the wheel after a long shift. Most adverse events are more mundane, but a back injury can end a career and a needlestick can pose serious health risks. 

To keep you healthy and safe, NurseZone.com queried a panel of experts who share this list of 10 reminders and tips on how to minimize the chance of nursing job-related injury or illness:

1. Clean your hands 

“Wash your hands to prevent illnesses’ spread,” said Arvella Battick, MSN, RN, PHN, an instructor at Everest College in Anaheim, Calif.

When it comes to illnesses, my number one rule is to wash your hands, agreed Jumi Harris, MHA, MT (ASCP), manager of ancillary services at Levindale Hebrew Geriatric Center and Hospital. It “sounds very basic, but this is the best way to avoid getting sick.”

2. Use the lift and transfer equipment 

My number one way to avoid injuries on the job is to use lift devices instead of trying to lift a patient or resident manually, said Harris, adding, “Sometimes a nurse may think it’s too time consuming to get and use a lift or that the person is not too heavy. However it only takes one wrong move to injure yourself, so my advice is always use a lift device with the proper training and protocols.”

Renee Watson, RN, BSN, CPHQ, CIC, manager of infection prevention and epidemiology at Children’s Healthcare of Atlanta, added that nurses should use the appropriate equipment to lift anything heavy, such as soiled linen bags. 

3. Watch for hazards and practice good body mechanics 

Practice ergonomics and good body mechanics, suggested Watson. 

Battick recommended nurses watch for hazards and keep the environment free of clutter. If there’s something on the floor, pick it up. Don’t just step over it. 

Nurses should wear supportive shoes and watch for fall risks for themselves, not just their patients, advised Nick Angelis, CRNA, MSN, author of How to Succeed in Anesthesia School (And RN, PA, or Med School). Changing positions and muscle movements helps minimize pain and discomfort over time. Rotate tasks between hands, he added, and avoid hunching over to chart or care for a patient; elevate the patient’s bed, or, when documenting, find a place to sit or stand straight. 

4. Speak up and step up 

Whether dealing with a potentially violent patient or just needing a hand to move someone or something, ask a colleague for help. 

“It’s safer to transfer with two people,” said Battick, but she acknowledged that help is not always available. 

On the other hand, step up and offer your assistance to peers, as well.

5. Get vaccinated for the flu 

People working in hospitals, clinics and other care settings are at greater risk of acquiring the flu and of transmitting the disease to patients and peers.

Influenza is a contagious disease that could spread by simply sneezing and coughing, explained Tanielle Sterling, MSN, NP, clinical program manager for employee health at The Mount Sinai Medical Center in New York. “Combating the myth of getting the flu through vaccination is the biggest challenge in improving compliance rates. By getting the flu vaccine, you protect yourself and may avoid spreading influenza to your patients, colleagues and your family.” 

6. Immunize against other pathogens 

Immunize the body and keep good immune health, advised Watson at Children’s Healthcare of Atlanta, which requires nurses stay current with hepatitis B, tetanus and diphtheria, the measles, mumps and rubella series and influenza vaccinations. 

“Hepatitis B infection is an occupational health hazard that is preventable by vaccination,” Sterling said. “All direct-care providers should be screened for hepatitis B surface antibody and offered the vaccine series. Education on the importance of completing the series and infection control practices helps to heighten awareness, change practice and attitudes towards vaccination.”

The Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices recommends health care workers be vaccinated against the highly infectious hepatitis B, a bloodborne pathogen that can remain infectious on surfaces in the environment for at least a week. The vaccine produces a protective antibody response in more than 90 percent of people after the third dose. 

Healthcare workers born in 1957 or later without serologic evidence of immunity or prior vaccination should receive the measles, mumps and rubella series, varicella, and tetanus and diphtheria vaccines. 

7. Practice safe needle handling 

Do not recap needles, and use needless connection systems, advised Watson. 

Each year, hospital-based health care personnel experience 385,000 needlestick- and sharps-related injuries, according to the Occupational Safety and Health Administration (OSHA). This equates to an average of about 1,000 sharps injuries per day in U.S. hospitals.

Mary Foley, PhD, RN, chairperson of the Safe in Common campaign to prevent needlestick injuries, called it essential that nurses and other members of the health care industry work together to raise awareness of these types of injuries and find ways to prevent them in the future. 

“Nurses need to be sure that the safety mechanism on needlesticks is automatic and will not interfere with normal operating procedures and processes,” Foley said. “Activation of the safety mechanism should also not create additional occupational hazards or cause additional discomfort or harm to the patient. Perhaps most importantly, the used safety devices should provide convenient disposal and mitigate any risk of reuse or re-exposure of the nonsterile sharp. Following these rules will help to ensure that nurses are safe from the threat of needlestick injuries so that they can remain healthy and active for their patients.”

8. Don personal protective equipment (PPE) as appropriate 

Take no shortcuts when it comes to protection against bloodborne pathogens. Always select and wear the appropriate gloves, gowns, masks, eye protection and other items to prevent exposure to patients’ body fluids. Such equipment places a barrier between the hazard and the nurse. 

Children’s Healthcare of Atlanta promotes using PPEs when clinicians know or suspect the patient has a communicable disease. Watson advised, “If it’s not your wet, put something between you and it,” and “protect your eyes, nose and mouth from coughing.”

9. Get plenty of sleep 

Multiple studies, including “Fatigue, Performance and the Work Environment: A Survey of Registered Nurses,” published in the Journal of Advanced Nursing in 2011, from the University of Missouri in Columbia, have found that fatigue negatively influences nurse performance. 

In the book, Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Ann E. Rogers, PhD, RN, FAAN, associate professor at the University of Pennsylvania School of Nursing in Philadelphia, warned that “in addition to jeopardizing patient safety, nurses who fail to obtain adequate amounts of sleep are also risking their own health and safety.” She pointed to the risk associated with drowsy driving, the increased chance of accidents of all sorts and that one’s immune system rarely works at peak performance when the body is tired. 

10. Practice good self-care 

Physical health requires overall wellness and staying strong, Watson said. Children’s in Atlanta promotes a holistic approach that includes daily exercise, good nutrition and fitness. It offers fitness classes and unit-based stretch breaks. Buddy coverage often is available for nurses who want to take a quick walk or class. Wellness includes obtaining psychosocial support when needed, particularly after dealing with emotionally taxing situations, such as participating in debriefings after traumatic incidents or seeking professional help through an employee assistance program. 

When you’re sick, stay home and rest, Battick added.  

Angelis recommended “exercising, packing nutrient dense foods for lunch; ingesting probiotics, either as supplements or in foods such as kefir or traditionally cultured vegetables; and staying well rested are all ways nurses can keep their immune systems in great shape against the barrage of germs that assault us daily.”

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