DiversityNursing Blog

As COVID-19 continues to impact communities around the world, people are coming together to help one another now more than ever.  

Ashley Lawrence, a 21-year-old in Kentucky, noticed that since so much of the population now are opting to wear protective face masks, those who are deaf or hard of hearing and rely on lip reading are struggling to access critical information. 

So she and her mom set to work sewing masks using plastic fabric and bed sheets, experimenting with various attachments for people who use cochlear implants and hearing aids and can’t wrap mask straps around their ears.

On the DHH Mask Project GoFundMe page Lawrence said she would distribute the masks for free to those who request them so they can provide them to their Doctors if they need medical attention.

Nurses, Doctors, EMTs, and other healthcare workers are on the front lines of the COVID-19 battle. Even though they are going through the toughest time right now, they still manage to keep a good sense of humor. 

Take a look at how these healthcare workers are spreading positivity.

Thank you for staying so positive!

What Nurses Need to Know about COVID-19

All Nurses and the health care team must receive the highest level of protection to provide care for the individuals and communities in which they serve. It is essential to develop and educate ALL staff on preparedness plans that provide infection control procedures and protocols used within the health care facility for the early identification, containment, and care of patients with symptoms associated with Coronavirus Disease (COVID-19) to prevent spread within the facility. Here are some tips:

• Develop inpatient, ambulatory, and home care policies and procedures that are in line with current CDC guidelines for COVID-19.
• Provide training to all personnel on screening and isolation procedures.
• Provide updated training and guidelines on the use of Personal Protective Equipment (PPE), including the use of N-95 respirators, gloves, gowns, masks, eye protection, and face shields.
• Display clear signage with instructions for access and use of PPE.
• Ensure consistent use of proper hand hygiene, standard precautions, contact precautions, and airborne precautions, along with the proper use of a National Institute for Occupational Safety and Health (NIOSH)-Approved N-95 respirator or higher.
• Clearly display signage for patients that lists symptoms and instructions to wear a face mask before entering the healthcare facility if symptoms are present.
• Incorporate assessment questions to document a detailed travel and community exposure history when patients present with fever, cough, or respiratory illness. 
• Identify, in advance, airborne infection isolation rooms (AIIR) or negative pressure rooms, for quarantine and screening.
• Outline staffing protocols to facilitate care of patients with COVID-19 to minimize patient-to-patient and patient to health care worker transmission.
• Develop a telephone triage protocol for patients to access from home to minimize community based transmission.
• Have available for immediate notification of Patient’s Under Investigation (PUI) the infection control personnel at your facility and the local and state health department. Click here for additional Recommendations for Reporting, Testing, and Specimen Collection and the fillable COVID-19 PUI case investigation form.
• For Patients Under Investigation (PUI), follow the Criteria to Guide Evaluation of PUI for COVID-19.

Isolation, Quarantine, Monitoring, and Hospitalization

The CDC recommends several steps for identification and maintenance of COVID-19 along with detailed guidelines for isolation precautions to prevent transmission. There should be a clearly displayed flowchart for early identification and assessment of COVID-19.

At this time, the modes of transmission include respiratory droplets from coughs and sneezes and transmission by touching the eyes, nose, or mouth after contact with an infected surface.

 Isolation Precautions to Prevent Transmission Guidelines

• Have masks available for PUI to don before entering the healthcare facility.
• Once identified, isolate the patient to airborne infection isolation rooms (AIIR) or negative pressure room and keep the door closed. Conduct the assessment in this room.
• Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (goggles or a face shield).
• Don Personal Protective Equipment (PPE) before entering the room.
• Have guidelines for the proper use of PPE displayed throughout the healthcare facility.
• Have infection control personnel available to provide just-in-time training on proper PPE use.
• Notify your infection control personnel and the local and state health department of suspected cases.

Per the CDC, it is known that coronavirus is part of a large family of viruses that can cause illness in people and animals. It is known that COVID-19 is spread via respiratory droplets from coughs and sneezes. It is also possible to spread COVID-19 by touching your eyes, nose, or mouth after touching an infected surface. The CDC provides the following guidance to help prevent COVID-19 from spreading among people in homes and communities.

• • STAY HOME except to get medical care, do not use public transportation or taxis if sick.
  • Call first before visiting your healthcare provider. Notify them of your symptoms and the need for evaluation for COVID-19. Follow the instructions provided by your healthcare team.
  • Separate yourself from other people in your home, utilize a separate bathroom.
  • Wear a facemask as instructed if you are sick.
  • Use your elbow to cover your coughs and sneezes.
  • Wash your hands frequently with soap and water for at least 20 seconds.
  • Avoid sharing household items.
  • Monitor your symptoms.
  • For a full list of guidelines and recommended actions for preventing the spread of Coronavirus visit https://www.cdc.gov/coronavirus/2019-ncov/guidance-prevent-spread.html

COVID-19 - Nurses Online and Printable Materials

https://www.nationalnursesunited.org/nurses-response-covid-19-printable-materials

Coronavirus disease (COVID-19) Situation Dashboard

https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd

What To Say To Patients About Coronavirus Video

https://youtu.be/Yk6VX_Bktik

During this global health crisis, telehealth is an effective solution for the prevention and treatment of COVID-19. 

Telehealth allows patients, healthcare providers and health systems to safely communicate. Patients with symptoms, told to stay at home, can communicate with Nurses and Doctors through virtual channels, mobile apps, video conferencing and phone calls to reduce the spread of the virus to mass populations and the medical staff on the frontlines. 

Telemedicine carts are another way hospitals are using technology to help treat patients. The carts allow health staff to roll video cameras and other telemedicine equipment into a patient's room so they can be assessed without Nurses and Doctors physically being at their bedside. 

Dr. Todd Czartoski, Chief Medical Technology Officer at Providence Regional Medical Center Everett, said "We had people outside the room talking to the patient, evaluating them with the electronic stethoscope and keeping those communication lines open. The Hospitalists, Infectious Disease Doctor and other Specialists didn't have to gown up and go in and out of the room multiple times a day." 

This technique also minimizes the use of personal protective equipment (PPE), such as gloves and masks.

The Centers for Disease Control (CDC) recommends using telehealth tools to direct people to the right level of healthcare for their medical needs. They launched a COVID-19 chatbot called the Coronavirus Self-Checker to help screen Americans who are worried about the coronavirus despite not being sick or being at risk. This would free up healthcare resources for those who need them.

Health insurers are giving providers and patients incentives to use telemedicine delivery models. CVS Health said Aetna would waive copays for coronavirus testing, and all telemedicine visits would have a $0 co-pay until June 4, 2020.

Patients can check their provider’s website or check with their health insurer on how to access telehealth services. According to the Wall Street Journal, people can also go directly to sites from Teladoc Health, Amwell, PlushCare, Doctor on Demand and MD Live for virtual visits.

If needed, Doctors can send prescriptions directly to a local pharmacy via telehealth.

According to the New York Times, health systems are racing to adapt and even develop telehealth services that can serve on the front line for patients. “Telehealth is being rediscovered,” said Dr. Peter Antall, the Chief Medical Officer for AmWell, a company based in Boston that is working with health systems across the country. “Everybody recognizes this is an all hands on deck moment,” he said. “We need to scale up wherever we can.”

Nursing is a demanding field and there are many factors that put Nurses at risk for developing problems with substance abuse and addiction.

Research estimates that 10% of Nurses will misuse drugs or alcohol at some time during their career.

Many Nurses in the U.S. have had their licenses suspended or revoked because they either caused harm to a patient, diverted or misappropriated drugs, or couldn’t safely practice because of their addiction.

In the past, Nurses who had addiction problems were dismissed or charged. Now addiction is being recognized as a disease. Thankfully, there has been a shift from disciplining Nurses to helping Nurses get better.

According to the Hazelden Betty Ford Foundation, 43 states have created substance use disorder monitoring programs for Nurses called "alternative-to-discipline" (ATD) programs. Nurses with substance use disorders are three times more likely to admit their problem in states with ATD programs than in states with traditional discipline programs. ATD programs provide Nurses with a structured process for a better outcome: After completing addiction treatment, they go through monitored reintegration into the workforce.

Joan Widmer, Nurse Executive Director of the New Hampshire Nurses Association, said, "Encouraging Nurses to self-report in the early stages of addiction is critical. You want them to recognize their own problem and feel comfortable that they can come forward and address the problem without loss of licensing and a way of making a living."

An article from Kaiser Health News said, instead of revoking the license of an individual who is found to be impaired on the job, these peer-run programs try to get participants back to work with mandated treatment plans that include intensive therapy, monitoring their behavior in and out of the workplace and, of course, drug testing.

Research shows, ATD programs have been successful in treating Nurses with substance use disorders. Also the long-term recovery rate for Nurse licensees undergoing treatment in these programs is high.

“I don’t think you’re ever going to see substance use disorder disappear in the Nursing population; it’s going to be there,” Widmer said. “But if you can at least address it and find a way to do it in a non-stigmatic way, you’re going to keep patients safer, because Nurses are going to self-report."

A Nurse Preceptor is an experienced and competent staff Nurse who serves as a role model and point person to newly employed staff Nurses, student Nurses, or new graduate Nurses, according to Lippincott Solutions.

Nurse Preceptors are a great resource for employees who are making the transition into a new work environment. They provide useful feedback, set learning objectives, teach hospital protocols and encourage critical thinking.

A Nurse transition program will result in better retention rates and improved competency among Nursing staff because it creates a continuous learning environment.

An effective Preceptor program should include:

• Adequate education and preparation in the form of a Preceptor course
• A clear definition of the roles and responsibilities of the Preceptor
• Support from the unit manager. The Preceptor should meet regularly with the manager to discuss the progress of the orientee/student.
• Sufficient time to orient the orientee/student. Ideally, the Preceptor should have a reduced workload during the period when the orientee/student is dependent on the Preceptor to function in his/her assigned role.

A good Nurse Preceptor will:

• Develop a professional working relationship with their preceptee. The relationship will be built in mutual respect, appreciation, and ongoing communication.
• Be patient and understanding. As you know, everyone has to start somewhere and that means mistakes will be made.
• Be clear and specific in the teaching/learning process.
• Ask open-ended questions.
• Share your expectations, the job description and job duties with your preceptee.
• Acquaint the new Nurse to the unit and the unit's unique Nursing culture.

If any concerns surface, the preceptee should complete a written self-assessment of the situation. The Preceptor should seek additional input from their Nurse Manager and other Nurses working with the preceptee.

Preceptor programs that provide the right information and tools are essential for successful transitions of newly employed Nurses into patient care environments. Hospitals have a responsibility to provide Preceptors with the knowledge and skills required to provide instructions and evaluations of their preceptees.

Today's health systems are made of skilled, multigenerational, and culturally diverse work forces. And even though each specialty has a specific focus, you all share a common goal. That goal is to provide the best patient care experience in a positive work environment. The best way to accomplish that goal is with teamwork.

Teamwork requires good communication and a collaborative care strategy. All team members want to feel that their ideas and skills are valued.

Team members should be encouraged to ask questions, share ideas or concerns, and discuss potential solutions. Each person's strengths and skills must be utilized to provide the best possible patient care experience and improve job satisfaction.

According to a report by The Society for Human Resource Management, teamwork is closely associated with higher job satisfaction. And a study published in the National Library of Medicine said, Nurses who are more satisfied with their jobs provide better care.

Trustworthiness is essential for teamwork, and the best way to grow trust is to get comfortable with one another. It’s crucial to build relationships and understand how each member of the team functions.

Team members have their own individual feedback, suggestions, and questions. Therefore, active listening is an important aspect of team operations.

When many health care professionals collaborate and brainstorm about a patient's care, the workload is distributed more evenly and stress is reduced.

Educational institutions are emphasizing the importance of teamwork and communication early to build a stronger foundation for successful healthcare outcomes.

Regis college published an article that said, mutual respect is critical in health care settings, not just within the team but across collaborative departments. Team members who are not feeling respected can become defensive, foster hidden agendas, demonstrate a lack of engagement, and worse. Building mutual respect comes through a common, focused goal; an understanding that each individual’s work is valuable and an acknowledgment of the efforts of others.

Patients must be part of the communication process too. Their early and thorough involvement has been shown to minimize errors and potential adverse events, according to an article published in the National Library of Medicine.

When everyone is working together as a team to accomplish a common goal, patient care improves and job satisfaction increases. Plus, it’s a happier, more cohesive and productive work environment for everyone involved, including your patients!

Millennials will account for 75 percent of the workforce by 2025. So it is important for healthcare organizations to understand what is important to this generation and use strategies to retain them.

HCA Healthcare commissioned a study conducted by the Center for Generational Kinetics to research what drives, engages and motivates Millennial and Gen Z Nurses in their career choices.

In addition to salary and referrals, reputation for having a positive work environment will get Nurses to apply. 

Below are the most important factors in creating a positive work environment for Nurses.

• Team and manager relationships: 44%
• Flexible scheduling: 43%
• Career advancement: 43%
• Communication and clinical decision-making: 42%
• Basic needs (water, breaks, meals): 41%
• Facilities, equipment, and technology: 40%
• Workload (patient to nurse ratio): 39%

Nurses have higher expectations for support now more than ever.

• 46% of Nurses think it is important for a job to offer scheduling that allows them to work as many hours as they want.
• 45% believe having enough staff or equipment to take care of patients is important.
• 45% want their team and/or their boss to care about them personally.
• 45% want someone to step in when they need help.
• 44% think it is important for their employer to provide opportunities to learn or advance their career.
• 43% feel it is important for their voice to be heard by management.

These are the employer benefits that mean the most to Nurses:

• Personal wellness coaching: 38%
• Financial coaching: 38%
• Student loan repayment programs: 37%
• Free snacks and drinks: 37%
• Employer subsidized housing nearby: 35%
• Employer contribution to your 401(k): 34%
• Tuition reimbursement: 34%
• Additional PTO (paid time off): 34%
• Communication training: 13%

The study found, regular supervisor check-ins and access to counseling services would most help Nurses be successful in their careers.

Also Digital platforms are the #1 way Nurses want to communicate with their employer.

Millennial and Gen Z Nurses want recognition and appreciation from supervisors very frequently. The study shows, 83% of Nurses want to receive praise from their supervisors at least monthly or more frequently.

And when it comes to training feedback and career coaching from supervisors, Gen Z wants it daily and Millennials want it weekly.

“The survey results highlight the importance of providing a transparent environment that gives Nurses a sense of belonging while serving a greater purpose,” said Jason Dorsey, President and lead researcher at CGK. “Ultimately every nurse is different, but it’s clear that Nurses’ relationships, ability to be heard and feeling supported in their careers are important to maintaining a positive work environment that will attract and retain talented Nurses.”

To see the full study click here.

Physician shortage concerns has influenced the use of more Nurse Practitioners to provide primary care and fill gaps in rural areas.

According to a new Health Affairs study, the number of Nurse Practitioners grew 109% from about 91,000 to 190,000 from 2010 to 2017.

Even though Nurse Practitioners have filled gaps in the delivery of healthcare, it is creating problems for hospitals. 

The Registered Nurse workforce has been reduced by up to 80,000 RNs nationwide. Also more than one million baby-boom RNs will be retiring soon.

The study says, the growth in NPs was caused by the expansion of education programs that have attracted Millennial Nurses. The number of programs to educate NPs grew from 356 in 2010 to 467 in 2017. These programs now graduate nearly as many new NPs as medical schools do Physicians each year.

Data from the Census Bureau’s American Community Survey for the period 2010–2017 was used in the study and researchers found the growth of NPs occurred in every region of the country, but was particularly rapid in the east south-central region of the country, which includes Alabama, Kentucky, Mississippi and Tennessee.

Also it is projected there will be two NPs for every five Physicians by 2030, compared to less than one NP per five Physicians in 2016. 

The number of Physician Assistants is also one of the fastest-growing in healthcare. According to a report from the National Commission on Certification of Physician Assistants, the number of certified PAs grew over 6% in 2018 and the average salary increased by more than 12% in a four-year span.

Authors of the Health Affairs study said, "As NPs continue to expand their profile in healthcare organizations and achieve greater prominence within the healthcare workforce, the potential loss of RNs to the NP workforce is likely to continue to cause employment ripples, particularly in acute care settings. Thus, even in an era of strong RN workforce growth fueled by Millennials in particular, hospitals must innovate and test creative solutions to contend with tight or fluctuating RN staffing — as they have during past disruptions in their RN labor supply."

In order for a healthcare system to be successful in having high engagement, job satisfaction and retention, the Nursing workforce should be able to combat the stressors of the job and burnout.

Nurses can better accomplish this by having help from peer support groups and mindfulness programs.

According to a report from the National Academy of Medicine (NAM), between 35% and 54% of Nurses and Doctors experience burnout. Among medical students and residents, it is as high as 60%.

Symptoms, the NAM report said, include emotional exhaustion, cynicism, loss of enthusiasm and joy in their work and increasing detachment from their patients and the patients’ ailments. The problem has been linked to higher rates of depression, substance abuse and suicide.

Many institutions are implementing stress management and self-care programs to provide caregivers with easy-to-use tools and resources to build their resilience and help them cope.

The Cleveland Clinic Abu Dhabi implemented a new mindfulness program known as the ‘Compassionate Intension Program.’ The sessions introduce caregivers to mindfulness as a wellness tool they can utilize in both their workplace and personal lives. Currently, there are three sessions in place:

• In Tune Tuesdays: Held biweekly, ‘In Tune Tuesdays’ are 20-minute classes designed to further educate attendees on mindfulness and how to improve mindfulness in their work environment. The classes are held at three different times to accommodate caregiver schedules.
• Mindfulness Rounding: Also a biweekly activity, ‘Mindfulness Rounding’ features a team of mindfulness experts who visit clinical units. The experts conduct learning huddles and one-on-one conversations with caregivers, sharing quick tips. Their pocket cards or guides offer information on easy-to-implement mindfulness techniques.
• Introduction to Mindfulness Workshop: This 8-week workshop, featuring 1-hour weekly sessions, was developed around the evidence-based standards of mindfulness experts, including, Jon Kabit-Zinn, PhD, of the University of Massachusetts Medical School, Center for Mindfulness, and Richard Davidson, PhD, of the University of Wisconsin’s Center for Healthy Minds and Oxford University’s Mindfulness Center. It offers a deeper dive into various mindfulness techniques.

Johns Hopkins Hospital, Pediatric Nurse, Cheryl Connors, RN, MS, created a peer program to provide immediate support for health providers affected by stressful cases.

The Resilience in Stressful Events (RISE) program was developed with a Pediatric Chaplain, a Patient Safety Director, a Doctoral Student, and General Internist Albert Wu, MD, FACP.

According to the American College of Physicians, the RISE program provides a team of 39 peer responders who volunteer their time to support those who call the service. RISE team members include Nurses, Doctors, Nurse Practitioners, Respiratory Therapists, Pastoral Caregivers, and Social Workers. They undergo didactic, video-based, and role-playing training.

The team has been called by more than 700 Johns Hopkins employees. The hospital previously had a program offering free professional counseling but, Ms. Connors said, “They actually prefer somebody who knows what they're going through—another health caregiver who can relate—and when they need it, not a week later.”

As supporters of patients and their families, Nurses deal with a lot of stress. Health systems can help their Nurses by surrounding them with support and offering them the tools to overcome and cope with stress so they can provide the best care for their patients and for themselves.