DiversityNursing Blog

School Nurses have become the main point of contact for any and all things COVID-19 related. They are a key component in making sure schools stay open.

The American Academy of Pediatrics (AAP) recommends that every school have a Nurse on site.

But, according to the National Association of School Nurses, before the pandemic, a quarter of American schools did not have a Nurse.

Now states are scrambling to hire School Nurses as students go back to school.

“Most school Nurses are the only health care experts in their school community able to understand infection control and do disease surveillance,” said Linda Mendonca, president-elect of the National Association of School Nurses (NASN). “But not every school has a Nurse who’s going to look after the children and staff. You need that expertise as a resource to safely reopen schools.”

COVID has made the role of a school Nurse even more complex, adding many challenges and new responsibilities for keeping children and staff safe.

They're responsible for complying with applicable federal, state, and local laws, regulations, ordinances, executive orders, policies, and any other applicable sources of authority, including any applicable standards of practice.

Nurses will also have to create plans for how high-risk students will return to school. They'll also help with screening protocols, creating safe classroom setups, hand washing and sanitation stations, and PPE distribution.

The school Nurse should collect and share school data in compliance with state and federal confidentiality regulations.

Once a coronavirus case is identified, school Nurses and local public health officials will work together to determine which students or staff might have been exposed to the infected person.

Face masks will be one of the main ways of limiting the spread of the virus in schools this fall. However, with younger students there's a risk of children trading masks or not keeping them on.

Social distancing is another key factor in keeping everyone safe, NASN guidelines suggest, staggered start times, small group and outdoor activities, no sharing of musical instruments, and meals in classrooms.

Liz Pray, MSN-Ed, RN, NCSN, School Nurse for the Moses Lake School District in Washington State and President of the School Nurse Organization of Washington said, "If I could offer any words for nurses feeling overwhelmed, I would encourage them to allow themselves and others a little grace. Everyone is struggling. Tempers are short, people are on edge and it’s been very difficult for students, parents and team members to adjust to these changes. Remember to take a step back, take a deep breath and take care of yourself."

Our healthcare system must work hard to increase diversity within their workforce and create an inclusive environment. Diversity and Inclusion (D&I) strategies are necessary for health systems to provide the best care possible to an evolving population.

A sense of Belonging is equally as important. Just because an employee is working in an organization, it doesn't necessarily mean they feel they belong there.

The feeling of belonging is a fundamental human need. It is an extremely powerful force. Without it, your D&I strategy could fail.

The term Diversity, Inclusion and Belonging (DI&B) was created by Pat Wadors. She said, "D&I may capture your head, but belonging captures your heart.”

“When someone is different and insecure and they get to be authentic and are welcomed in a team, we can unlock their super powers and bring out the best—not only in that person, but the team and, therefore, the product, the service, the company, the world,” says Wadors.

Covering or masking is when someone tries to fit in with the dominant culture and downplay who they really are. Research from a Deloitte study of more than 3,000 people found that 61% of people cover at work, even more so if they are Black (79%) or LGBTQ+ (83%).

Neuroscience researchers have found that exclusion lights up the same regions of the brain as physical pain. “Being excluded is painful because it threatens fundamental human needs, such as belonging and self-esteem,” says Dr. Kipling Williams of Purdue University.

When someone feels excluded over a long period of time, and every day they have to return to an environment where they feel like they do not belong, they'll end up leaving.

Dr. Christine Cox of New York University’s Langone School of Medicine has identified six areas that are enhanced by inclusion and worsened by exclusion: intelligent thought and reasoning, self-care and self-improvement, prosocial behavior, self-regulation, a sense of purpose, and well-being. Each of these items represents real financial gains or losses for teams and organizations.

According to Wadors, in order to create a culture of belonging, teams and managers should reflect on three questions:

1. How does your organization celebrate differences?
2. As an employee, do you feel safe if you make a mistake?
3. Does someone at work care about you?

A Forbes article mentions, another way that a sense of belonging can be nurtured is by creating a stronger sense of community.  A sense of community can be nurtured by regular interactions and collaboration. We tend to stereotype people less and are less fearful of difference when we are more familiar with them or spend more time with them.

But most importantly, there must be trust. Employees should have trust in the company's mission, in the leadership's vision and in their goals. Once every employee feels that they belong in the organization, this will lead to a more positive and inclusive workplace.

Clinical trials are necessary to provide evidence for the benefits and safety of new treatments. Racial and ethnic minorities continue to be underrepresented in these clinical trials.

Black or African Americans represent 13.4% of the U.S. population, yet reports show they make up only 5% of clinical trial participants. Hispanic or Latino origin represent 18.1% of the U.S. population but only 1% of clinical trial participants.

The clinical trial population must be diverse enough to represent the patients who will be using the medicine.

According to a ScienceDirect study, Inclusion of diverse participants in clinical research may lead to more robust and complete data that broadens the understanding of racial and ethnic differences in treatment responses that, in turn, may contribute to reduced disparities in outcomes.

Richardae Araojo, who is the FDA Associate Commissioner for Minority Health and Director of the Office of Minority Health and Health Equity said, “There are many different reasons why minorities have been under-represented in clinical trials. One barrier to participation that we all know well is a lack of trust because of past historical abuses. Other barriers to participation may differ based on the population you are seeking to enroll and may include language and cultural differences, health literacy, religion, and a lack of awareness and knowledge about what a clinical trial is and what it means to participate.”

Araojo continued by saying “Some barriers may be due to aspects of the trial design such as inadequate recruitment and retention efforts, accessibility to the site location, frequency of study visits, transportation, participation may conflict with caregiver or family responsibilities, and may cause time away from jobs and other commitments. Often times, there may be a perception that minorities do not want to participate, and they simply aren’t asked.”

Recently, the National Institutes of Health launched the All of Us Research Program. This program is inviting one million people across the U.S. to help build one of the most diverse health databases in history.

The All of Us Research Program is a great example of inclusive research that can help ensure better health outcomes for all.

The Food and Drug Administration (FDA) released a draft guidance on improving the diversity of patient populations in clinical trials.

The draft makes numerous recommendations on how to increase diversity in clinical trials. These recommendations include enrichment, inclusive trial practices and design, and methodological ways to bring in a wider range of patient populations.

The benefits of increased diversity in clinical trials are enormous. Enrolling diverse patients in clinical trials improves the likelihood that they will benefit from research data. Trial results will be more represented and relevant for the entire population.

In our growing diverse society, health care workers need to understand that applying only traditional westernized medical practices isn't appropriate for many patients and families. Health professionals must have an awareness of different cultural practices and spiritual beliefs in order to reduce racial and ethnic disparities in health care.

According to the American Hospital Association, cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients' social, cultural and linguistic needs.

There can be language barriers so make sure you know your patient’s preferred method of communication and arrange an interpreter. Non-verbal communication may differ across cultures. Don’t make any assumptions without knowing the person's customs.

Many cultures have special dietary considerations. Hospital staff should be educated about food culture, which is a term used to describe the non‐nutritive, yet nonetheless significant, aspects of food, such as when food is eaten and how it is served.

For example, Jewish patients do not eat pork or shellfish. Muslim patients also do not consume pork. Muslims will eat only permitted food (halal) and will not eat or drink anything that is considered forbidden (haram). Halal food requires that Allah's name is invoked at the time the animal is killed. Lamb, beef, goat and chicken, for example, are halal as long as a Muslim kills them and offers a prayer. Fish and eggs are also halal. Buddhist are mostly vegetarian, though Buddhists may eat meat if it has not been killed for them specifically.

Health care workers should use effective communication to increase their understanding about the patient's spiritual beliefs and practices. Your workplace should offer spiritual counselors like a chaplain or a rabbi. It is a good idea to have a non-denominational prayer and meditation room which can serve as an inclusive sacred space for staff and patients of all religious backgrounds.

Management should take an active role in promoting culturally competent workplace training courses and resources.

Our calendar of cultural dates is a great tool to assist staff with respectful scheduling and diversity celebrations.

Ingrid Silva, a ballerina of The Dance Theatre of Harlem, is using the current closing of theaters and performance venues to expose racial bias in healthcare. In the past, Ingrid received praise and recognition for creating a line of ballet shoes in an array of skin tones for dancers of all races and cultures.

Silva founded a nonprofit organization called EmpowHer. EmpowHer NY is a social catalyst that ignites the conversation about women who break through the glass ceiling imposed by society and live authentically according to their truth.

Recently EmpowHer and The Bloc teamed up to create a video called 'The Call Project'.

According to Forbes, this project is an experiment where actress Corin Wells made multiple calls to a 24-hour Nurses health hotline. Wells used a white-coded name and voice as well as a Black-coded name and tone. The results showed that 77% of her “black” alias calls ended with a recommendation to go to an urgent care facility, a protocol for minor health issues. However, her “white alias,” using the same script, was advised to go to the ER, which is protocol for any patient with urgent symptoms of an appendicitis.

Empowher believes, "When it comes to getting proper healthcare, it shouldn’t matter what your name is or how you sound like. Your pain shouldn’t be underestimated because of biological myths that are not only scientifically false but also fantastical in nature."

The goal of this experiment is to address racial biases in healthcare and to make unconscious bias training mandatory for hospitals and healthcare to ensure quality healthcare.

Silva said, “It’s been past time for us to speak up on this matter for the black community worldwide. This is our way of saying enough already!”

You can join the movement in the fight for equality in healthcare. EmpowHer is offering a petition to make unconscious bias training a mandatory requirement for hospitals across the country. You can sign the petition here.

Personal Protective Equipment (PPE) is essential for protecting healthcare workers on the frontlines of the COVID-19 pandemic. However, with prolonged use of PPE, comes skin damage.

According to a study by the Journal of American Academy of Dermatology, 97% of staff working in two different COVID-19 units reported PPE-related skin damage. The incidence increased when PPE was worn continuously for longer than six hours, and especially with N95 masks and goggles.

Hand irritation is common when frequently using gloves. The hands become irritated from constant sanitizing and hand washing. Also gloves trap moisture and heat, causing side effects such as eczema and dermatitis on hands. 

Pat hands dry or allow hands to air dry instead of rubbing to avoid further irritation. Also use warm water instead of hot because frequent use of hot water can lead to excessively dry skin. Moisturize but make sure the skin fully absorbs it before putting gloves back on. 

Nurses wearing air tight N95 and N99 masks for many hours often end up with red indentations on their faces. On the other hand, Nurses who wear non airtight masks have reported getting acne and evidence of skin irritation from pressure or chafing of the mask over the bridge of the nose.

Make sure your mask isn't too tight and is fitted comfortably on your face. You should relieve pressure regularly. If possible, try removing your mask, goggles, and or face shield at least every four hours. Relieving pressure for a few minutes to allow for normal blood flow can prevent lasting skin damage.

Filmmaker, Carolyn Jones released The American Nurse in 2012, Defining Hope in 2017, and now In Case of Emergency: Without You, We Don’t Stand A Chance.

Jones teamed up with the Emergency Nurses Association (ENA) to create a documentary that celebrates emergency Nurses and the impact they have on patients across the country.

ENA President Patricia Kunz Howard said, "Emergency Nurses do amazing things every single day. They put their patients first without any thought of reward or recognition. With Carolyn's unique style and approach to storytelling, this documentary will pay a proper tribute to that selflessness by showing the world the complicated, yet rewarding, work that defines emergency Nursing and the people who are committed to care."

“When COVID hit, we realized that it is all nurses that we can’t live without,” said Jones. “The role you play is really critical for us in finding our way to a better way of living. I applaud each and every one of you.”

In another interview discussing her new project, Carolyn said, "I want Nurses to feel elevated and come out of this idea that no one else wants to know what they are doing. The public will never understand it until Nurses tell them what goes on. I hope that some Nurses will rise to the surface and find their voices. They are the best story tellers I’ve ever encountered. That’s what I love about interviewing Nurses – boom, the story is right there.”

In celebration of Emergency Nurses Week, the film will be premiered virtually on October 14, 2020. 

TRAILER In Case of Emergency: Without You, We Don’t Stand A Chance 

Healthcare workers across the country are fighting tirelessly against COVID-19. They're wearing head to toe PPE around the clock. They're hot and frustrated while wearing it, and… they also lose their identity. Patients just see masks, suits, gloves, and goggles. Hospital staff wants this to change.

"Share Your Smile" and the "Button Project" are just 2 examples of a small, but positive movement. To look less intimidating to patients, healthcare heroes are attaching large photos and buttons of their faces, to their PPE.  

The goal of these projects is to eliminate or reduce a level of fear and anxiety for patients, especially children, who find comfort in seeing the smiling faces of healthcare team members.

San Diego respiratory therapist Robertino Rodriguez started the "Share Your Smile" idea. Rodriguez said, “Yesterday I felt bad for my patients in ER when I would come in the room with my face covered in PPE. A reassuring smile makes a big difference to a scared patient. So today I made a giant laminated badge for my PPE so my patients can see a reassuring and comforting smile.”

The movement is catching on amongst health care workers. Peggy Ji, an ER Doctor in Los Angeles, wrote on Instagram, "I was inspired by Robertino Rodriguez who works as a respiratory therapist in this COVID pandemic. I didn’t have a preprinted photo or a color printer so my polaroid will have to do. I wanted to bring a personal touch to caring for patients through my PPE. My hope is that our patients will know there’s a reassuring smile under this mask, and that we’re here for them."

Nurse Derek also posted a photo of himself and fellow coworkers on Instagram saying, "thought it was a beautiful way to bring ease to our patients during this stressful time. Thank you to all the healthcare workers out there for battling on the frontlines."

The Button project holds the same meaning and started at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Adelaide Vienneau, Director of the Children’s Hospital Family Resource Center (FRC) said, “When we were asked to take the lead on this project, I immediately said, ‘yes.' The FRC team likes finding solutions for staff and providing resources to assist patients and families in having the best possible experience during their health care visit. We are delighted with the anecdotal comments on how the photo buttons have been well-received.”

Any time in the hospital as a patient is a scary time for the patient. The personal connection is so important, but difficult to achieve with all of the PPE. What a simple, yet creative way to put patients at ease to feel a more personal connection with the healthcare team.

What is your place of employment doing about this? Please share with our community. Thank you!

Researchers at MIT and Brigham and Women’s Hospital designed a new face mask that is believed to be as effective as N95 masks. 

There has been a dire need for N95 masks in hospitals across the nation. Essential workers were wearing the disposable masks more than once, often weeks at a time. 

Engineers and researchers hope to provide a solution to this shortage by designing a mask that can be safely reused. 

According to CNBC, the new MIT mask is made from silicone, with slots for just two small, disposable disks of the N95 material (which serve as filters). That means the masks themselves can be quickly and easily sterilized and reused.

Adam Wentworth, a Research Engineer at Brigham and Women’s Hospital said, "With this design, the filters can be popped in and then thrown away after use, and you’re throwing away a lot less material than an N95 mask." 

The mask is called iMASC, which stands for Injection Molded Autoclavable, Scalable, Conformable. The iMASC can be sterilized a couple of different ways. You can use a steam sterilize, put it in an oven, or soak them in both bleach and rubbing alcohol. 

In a study researchers had 20 healthcare workers wear the mask and perform a series of movements to see how it stayed in place. High ratings were given for fit and breathability. 

The study also showed the mask successfully filtered out a sugar solution in the air that was used to mimic aerosolized respiratory droplets.

According to FastCompany, researchers are beginning talks with the FDA about emergency use authorization, both for healthcare workers and the general public. The team is currently running both an environmental impact study and a cost-effectiveness study, and has estimated that its mask could cost just $15 and be used up to 100 times, making the cost per use likely less than a quarter, with the filter inserts less than a dollar.

There is no timeline yet as to when these masks will be available. 

One positive thing to come out of the COVID-19 pandemic is the renewed appreciation for healthcare workers, particularly Nurses. This appreciation is leading to an increase in Nursing school applications.

Donna Havens, PhD, RN, FAAN, Dean of Nursing at Villanova University M. Louise Fitzpatrick College said, “For the first time in my career, which has been a long one, folks truly get what Nurses do and they see how important and rewarding a career it is. Some would say Nurses are the glue, especially in hospitals and healthcare organizations." 

Havens believes another reason for the uptick in applications is from the record unemployment that has resulted from the pandemic. People in struggling occupations may look to Nursing as a rewarding and stable profession. 

Widener University spokeswoman Emily A Barrett said, "Historically speaking, economic downturns translate to an increase in Nursing programs due to industry stability and growth, which is projected to rise 15 percent by 2026 according to the U.S. Bureau of Labor Statistics."

Sandra Russo, Chair and Director of the Nursing program at Touro College in New York said, "This year, I have 20 students on a waiting list to get into my program, so the demand is much higher."

Kevin Finn, Dean of Colby-Sawyer School of Nursing and Public Health said, the one thing he sees in common on the applications is a desire to help. 

The incoming Nursing class is 34% larger than last fall's. The college will have 90 students enrolled in its Nursing program in September, an increase from 62 students last year.

The University of Kansas School of Nursing said it’s currently at capacity on applications. In fact, they’ve increased their Salina branch because of so many people who now want to be a Nurse.

Nurses are in demand. Getting into Nursing school was already extremely competitive before the pandemic. Nursing schools may become even more selective with the increase in applications. Future Nurses should focus on boosting their credentials.