DiversityNursing Blog

NPR and ProPublica launched an investigation on America's rising maternal mortality rates. More American women are dying of pregnancy-related complications than any other developed country. 

The United States saw a 26.6% increase in maternal deaths from 2000 to 2014, according to a recent study published in Obstetrics & Gynecology.

Racial disparities make these trends even more distressing. According to the Centers for Disease Control and Prevention, African-American women are almost four times more likely to die of pregnancy complications. Maternal mortality is also more common for low-income women and women living in rural areas.

Only about 6 percent of the nation’s Ob–Gyns work in rural areas, according to the latest survey numbers from the American Congress of Obstetricians and Gynecologists (ACOG). Yet 15 percent of the country’s population, or 46 million people, live in rural America. As a result, fewer than half of rural women live within a 30-minute drive of the nearest hospital offering obstetric services. Only about 88 percent of women in rural towns live within a 60-minute drive, and in the most isolated areas that number is 79 percent.

The ProPublica investigation shows, America has not published official maternal mortality statistics in more than a decade. So we are forced to rely on incomplete estimates because the data needed to determine exactly how many women are dying, and from what causes, go uncollected.

Many states have created Maternal Mortality Review Committees (MMRCs). Maternal and public health experts analyze maternal deaths and propose ways to prevent similar deaths. The data from these MMRCs have revealed that more than half of maternal deaths are preventable. 

California created its MMRC in 2006 and reduced its maternal mortality rate by more than 55% to 4.5 per 100,000 live births, far lower than the national average. It was accomplished by using its data to design safety resources and tool kits aimed at the most common causes of maternal death in the state. For example, excessive bleeding and complications of high blood pressure, such as preeclampsia are common causes. Many states have not set up MMRCs due to lack of funding.

There are multiple reasons for a rising maternal mortality rate in the U.S. New mothers are older than they used to be, with more complex medical histories. Half of pregnancies in the U.S. are unplanned, so many women don't address chronic health issues beforehand. Greater prevalence of C-sections leads to more life-threatening complications. The fragmented health system makes it harder for new mothers, especially those without good insurance, to get the care they need. Confusion about how to recognize worrisome symptoms and treat obstetric emergencies makes caregivers more prone to error.

While most developed countries are making strides in preventing maternal-related deaths, the United States is falling behind. Addressing the causes of maternal mortality as well as contributing factors and underlying problems is a national concern. Health care professionals are the first line of defense for reversing this lethal trend.

Do you have any experiences or thoughts you’d like to share on this topic? Perhaps something you practice that would be helpful to other Nurses in a critical delivery situation?

RALEIGH – The North Carolina Nurses Association (NCNA) and its charitable arm, the North Carolina Foundation for Nursing (NCFN) are announcing an emergency campaign to provide support to nurses who have suffered loss or damages from Hurricane Florence. The NCFN - Nurse Recovery Fund seeks tax-deductible donations whose sole purpose is to help nurses get back on their feet sooner; NCNA and NCFN believe that helping nurses return to their normal lives will benefit the entire state.

“It is immensely harder to focus on patient care if you are reeling from your own losses, so we see this as a chance to support our fellow nurses and try to help them get back to normal,” said NCNA President Elaine Scherer, MAEd, BSN, RN. “Caring for each other is a vital part of being a nurse. We saw an opportunity to step up and have a positive impact on a terrible situation. Doing nothing was simply not an option.”

• People interested in donating can click here:
  https://portal.ncnurses.org/donate-now
• Nurses who need to apply for relief aid can click here:
  https://ncnurses.org/foundation/ncfn-nurse-recovery-fund/

All money collected by NCFN for this fund will be given directly to the people in need. NCNA is donating all of the staff time required to set up the campaign’s infrastructure and administer funds.

“We are so grateful to our colleagues at the Texas Nurses Association, who were already offering advice before the storm arrived last week,” said NCNA CEO & NCFN Executive Director Tina Gordon. “They launched a similar campaign in the aftermath of Hurricane Harvey, and the lessons they learned have been invaluable as we prepared to roll out the NCFN - Nurse Recovery Fund.”

Donations to this special fund will be distributed to actively-licensed Registered Nurses in North Carolina who have been impacted by Hurricane Florence. NCNA & NCFN will review applications from affected nurses and determine who receives assistance based on a sliding scale of needs. Funds will be collected for a limited time and distributed on a first-come-first-serve basis.

MEDIA CONTACT
Chris Cowperthwaite, APR
Manager of Communications & Outreach
(919) 821-4250 or chriscowperthwaite@ncnurses.org

ABOUT NCNA
As the leading professional organization for North Carolina’s registered nurses, we equip nurses at all stages to thrive in an ever-changing healthcare environment. NCNA helps keep North Carolina nurses on the cutting edge of nursing practice, policy, education, and more. Join us as we work to advance nursing and ensure high-quality healthcare for everyone. For more information, please visit www.ncnurses.org.

ABOUT NCFN
The North Carolina Foundation for Nursing is a nonprofit, 501(c)(3) corporation. Funding to support the Foundation and its activities comes from individual contributions, business donations, bequests, recognitions, and memorials.

The purpose and goals of the Foundation are to secure and administer funds directed toward:

1. education that assures that registered nurses are prepared to meet the current and changing health care needs of North Carolina citizens;
2. research that identifies the value of registered nurses in health care delivery; and,
3. activities that publicize the value of registered nurses in health care delivery.

Forensic Nurses provide healthcare to those incarcerated in the criminal justice system in a variety of settings such as jails, prisons, and juvenile detention centers. Many Correctional Nurses feel safer in this environment than working in traditional settings where security may be less vigilant.

The inmate patient population has many distinct characteristics to keep in mind when providing care. Although each patient is an individual, the population, as a whole, is likely to have these characteristics that should be taken into consideration when providing care.

• Inmates have a biological age older than their chronological ages. Many experts consider the incarcerated patient to be 10 years older than their chronologic age when it comes to the ravages of age and illness. So, many correctional settings consider elderly inmates to be 55 years and older.
• Less educated and less health-literate than the general population, inmates are more likely to have learning disabilities and have difficulty understanding basic health information.
• More infectious disease, especially HIV, Hepatitis C, sexually transmitted disease, and tuberculosis are found in this patient population.
• Inmates have higher rates of mental illness than the general public, especially depression, mania, and psychotic disorders. Mental illness can contribute to criminality. Borderline personality disorders that lead to poor impulse control, self-injury, and aggression are often present.
• This patient population also has higher rates of traumatic brain injury and post-traumatic stress disorder that can also lead to poor impulse control, erratic behavior, and inability to concentrate or understand health instruction.
• High levels of drug, alcohol, and tobacco use in this population increases the likelihood of withdrawal issues, liver toxicity, and respiratory conditions.
• Increased risk of suicide is found in this patient population as compared to the general population. This is a concern in any stage of the incarceration but especially of concern at entry into the jail and after sentencing when hopelessness, shame, and guilt are at their highest.

Although graduate Nurses have been successful in assimilating into the role of Correctional Forensic Nurse, the autonomous nature of the role and need for excellent assessment skills warrants experience in general Nursing practice before entry into the specialty. In particular, a background in emergency and/or mental health Nursing is helpful. Currently, certification is not required to enter a position as a Correctional Forensic Nurse, however, certification is available through the National Commission on Correctional Health Care (NCCHC) and the American Correctional Association (ACA).

Are you a Correctional Forensic Nurse? If so, what do you believe Nurses should know before considering this specialty? Please comment below!

An active shooter incident is something no nurse wishes to experience. Unfortunately, these situations can, and do, happen at healthcare organizations across the country.

These incidents are becoming more common, and although they are still rare compared with other shooting sites, incidents have increased in health care facilities. Agencies such as the Federal Bureau of Investigation, The Joint Commission, and the Emergency Nurses Association have emphasized that an action plan and training are essential for hospital preparedness.

Here are some resources to help us all be prepared for an active shooter incident.

• Many victims say, “I didn’t know what to do,” or “I was just waiting my turn to be shot.” The important lesson here is to tell people in an active shooter situation to do something. Time is a valuable commodity, and by doing something, one takes some time away from the shooter.
• 63% of active shooter incidents are in commerce or an education environment, but no place is off limits.
• Active shooter incidents typically evolve quickly and end (historically) within 10 to 15 minutes; 36% end before the police arrive.
• Be prepared:
  • Mental preparation – Chaos and panic will occur. As best as you are able, trust your instincts, breathe, and remain calm.
  • Sounding the fire alarm is NOT recommended. The potential negative consequences outweigh the benefit.
    • People are complacent with fire alarms.
    • People won’t think “active shooter.”
  • Role of police – Police officers are there to neutralize the threat, not treat injured.
• Three options (you may have to do all three):
  • Run – If you have an opportunity to escape, do so.
  • Hide – Don’t let anyone in.
  • Fight – Fight for your life with whatever you have. There is power in numbers and the shooter is typically not looking for a fight.

How to react when law enforcement arrives:

• Remain calm, and follow officers’ instructions
• Put down any items in your hands (i.e., bags, jackets)
• Immediately raise hands and spread fingers
• Keep hands visible at all times
• Avoid making quick movements toward officers such as holding on to them for safety
• Avoid pointing, screaming and/or yelling
• Do not stop to ask officers for help or direction when evacuating, just proceed in the direction from which officers are entering the premises

 
Information to provide to law enforcement or 911 operator:

• Location of the active shooter
• Number of shooters, if more than one
• Physical description of shooter/s
• Number and type of weapons held by the shooter/s
• Number of potential victims at the location

A survey by the Journal of Emergency Nursing shows that out of 202 Emergency Nurses and staff members who participated in active shooter training, 92% felt better prepared to respond if a shooting occurred at their facility.

Every healthcare facility is required to have an emergency action plan. Most of them conduct training exercises to prepare staff for emergency situations such as a fire emergency or bomb threats, but when it comes to dealing with an active shooter situation, most Nurses have no idea how to react because they aren't prepared for it. 

We hope this information is helpful and that you never have to use it. If you have anything you’d like to add, please share it here.

The Joint Commission defines a hand-off as a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient-specific information from one caregiver to another, or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care.

Nurses typically take great pride and exert painstaking effort to meet patient needs and provide the best possible care. Unfortunately, too often, this diligence and attentiveness falters when the patient is handed off, or transitioned, to another health care provider for continuing care, treatment or services. A common problem regarding hand-offs is communication. Expectations can be out of balance between the sender of the information and the receiver. 

Please understand we know how incredibly busy you are every minute you are working. We appreciate transitioning patient information to the next caregiver is critical and that you do everything in your power to be clear and concise. These guidelines are meant to be helpful and reinforce what you most likely are already doing to keep communication transparent and smooth.

Abuse occurs in many areas of society and takes many forms. Some examples may involve the abuse of a child by a parent or caregiver; the abuse of a parent by an adult child; or the abuse of a spouse. In addition to the physical aspects, abuse can include emotional battering, financial exploitation and sexual assault. Many of these result in health problems for the victims. Your role in dealing with victims of abuse is multifaceted.

One of the most common and deadly forms of child abuse is not physical violence, but neglect. According to data from the National Child Abuse and Neglect Data System, neglect was a contributing factor in more than 71 percent of child maltreatment fatalities in 2011.

Possible signs of child maltreatment may include:

◗ Developmental delays
◗ Speech disorders
◗ Failure to thrive
◗ Poor hygiene
◗ Inappropriate seasonal clothing
◗ Lack of supervision
◗ Unattended medical needs
◗ Chronic truancy
◗ History of psychological disorders

When assessing a patient, you should be aware of the following physical signs of injuries related to domestic violence:

◗  Black eyes
◗  Bruises in various stages of healing, particularly on breasts or genitalia
◗  Symmetrical bruises on upper arms, wrist or neck
◗  “Bathing-suit pattern” marks that are covered by clothing
◗  Subdural hematomas
◗  Patches of missing hair
◗  Fractured mandibles
◗  Ruptured tympanic membranes
◗  Lacerations around the eyes and lips
◗  Rib fractures
◗  Unexplained venereal disease or genital infections
◗  Recurrent urinary tract infections
◗  Anal or genital bleeding or injury
◗  Marks consistent with the size of objects such as cigarettes or belts
◗  Signs of neglect, such as malnutrition, poor hygiene or skin ulcers
◗  Use of makeup or other methods to hide indicators
◗  Injuries not consistent with explanation of how they occurred

However, it is unlikely the patient will present with a physical injury. They will more likely present with issues such as:

• A stress-related illness
• Anxiety, panic attacks, stress and/or depression
• Drug abuse including tranquilizers and alcohol
• Chronic headaches, asthma, vague aches and pains
• Abdominal pain, chronic diarrhea
• Sexual dysfunction
• Joint pain, muscle pain
• Sleeping and eating disorders
• Suicide attempts, psychiatric illness
• Gynecological problems, miscarriages, chronic pelvic pain

The patient may also:

• Appear nervous, ashamed or evasive
• Describe their partner as controlling or prone to anger
• Seem uncomfortable or anxious in the presence of their partner
• Be accompanied by their partner who does most of the talking
• Give an unconvincing explanation of the injuries
• Be recently separated or divorced
• Be reluctant to follow advice

All Nursing schools include information about how to detect child and domestic abuse within the curriculum, but the practice of detection can be difficult. Most inpatient and outpatient facilities now require questions about personal safety and domestic violence screening questions as part of the intake process. In your role as the attending Nurse, it's important to ask these questions with intent and ensure the patient has enough time to answer. Do not rush the patient as they are most definitely scared. Some practitioners even wear buttons or badges that say, "It's okay to talk with me about domestic violence." Only ask questions about domestic violence when the patient's partner is out of the room.

The following questions may be helpful when assessing a patient for abuse, maltreatment, or neglect: 

• I noticed that you have a number of bruises. Can you tell me how they happened? Has anyone hurt you?
• You seem frightened. Has anyone ever hurt you?
• Have you been hit, slapped, kicked, pushed, shoved, or otherwise physically hurt by someone within the last year?
• Sometimes patients tell me that they've been hurt by someone at home or at work. Could this be happening to you?
• Are you afraid of anyone at home or work, or of anyone with whom you come in contact?
• Has anyone forced you to engage in sexual activities within the last year?
• Has anyone prevented you from seeing friends or other people whom you wish to see?
• Have you signed any papers that you didn't understand or didn't wish to sign?
• Has anyone forced you to sign papers against your will?

In a clinical setting, your most important role is to provide a safe environment for your patient; treat your patient's injuries; and observe, listen, and document the facts. Treatment focuses on the consequences of the abuse and preventing further injury. If the patient is in immediate danger, separate the patient from the perpetrator whenever possible.

Your next important job is to refer your patient to the appropriate authorities and/or agencies. Even if you aren't sure but suspect that your patient is a victim of abuse, report your suspicions. You won't be penalized and you may save your patient's life.

Additional resources are only a phone call away. These include hotlines such as:

* National Domestic Violence Hotline: 1-800-799-SAFE (7233); TTY: 1-800-787-3224

* ChildHelp USA National Child Abuse Hotline: 1-800-4-A-CHILD (422-4453); TDD: 1-800-2-A-CHILD (222-4453)

* National Youth Crisis Hotline: 1-800-442-HOPE (4673)

Substance Use Disorder can affect anyone regardless of age, ethnicity, gender, economic circumstance or occupation. Substance Use Disorder in Nursing is one of the most serious problems facing the profession today.

This disorder is more common in Nursing than many believe. The American Nurses Association (ANA) estimates that 6% to 8% of Nurses have a drug or alcohol problem that impairs their practice. 

Nurses are often handling powerful painkillers and other prescription drugs. This accessibility increases the temptation to use. In fact, a study showed that Nurses who handle drugs are more likely to have an addiction than Nurses who do not.

Any healthcare facility will tell you that when they have great Nurses, they want to hold onto them. Most state Nursing boards understand that addiction is a disease and Nurses should have the opportunity to pursue recovery without worrying about losing their job. 

Non-disciplinary programs are now used by a growing number of state Nursing boards. These programs provide rapid involvement in a rehabilitation or treatment program and remove him/her from providing care until safety to practice can be established and confirmed.

It is not easy for anyone with a substance abuse disorder to ask for help, and that can be especially true for Nurses. However, recognizing that there is a problem and asking for help are the two steps that can truly turn things around. If you or someone you know is struggling with SUD please use the resources below.

RESOURCES

For Nurses with SUD

The National Council of State Boards of Nursing (NCSBN) offers an Alternative to Discipline Programs for Substance Use Disorder directory here for Nurses to locate alternative to discipline programs for SUD in their state if available.

For Nurses Concerned for a Colleague 
This NCSBN online brochure, What You Need to Know About Substance Use Disorder in Nursing, informs nurses of their ethical and professional responsibilities about reporting suspected or know SUD in colleagues.

For Employers
See Chapter 6 of NCSBN’s SUBSTANCE USE DISORDER IN NURSING: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs offers a comprehensive examination of SUD in the healthcare workplace, particularly for Nurse managers.

For Nursing Students
Although not specifically for Nursing students, the NIH’s National Institute of Drug Abuse College-Age & Young Adults’ webpages, contain resources for how and where to get assistance for substance abuse, as well as drug facts, infographics, and more. Currently, there is very little updated guidance for Nursing students with substance use disorder. Nursing students may want to consult their health care provider, college health center, or employee assistance program.

According to Penn State College of Medicine researchers, patients' perceptions of the hospital they're being treated in may be improved by artwork. This could be a low-cost way to help improve patient satisfaction.

"It is relevant to hospital administrators who are under increasing pressure to improve care quality and the patient experience. People often find medical environments stark and uninviting, and artwork is a way to humanize hospital rooms and perhaps make them feel warmer, more inviting, and less 'medical," said Daniel George, associate professor of medical humanities.

Cleveland Clinic emailed former patients, inviting them to respond to a survey about the health system’s art program. Out of the more than 1,000 respondents that had visited Cleveland Clinic within the previous 12 months, 826 (76 percent) remembered noticing the art collection.

Of the 826 respondents who noticed the art, an average of:

• 73 percent said it somewhat or significantly improved their mood. Results were even higher among the subset of respondents treated for breast cancer (78 percent), generalized anxiety (81 percent) and post-traumatic stress disorder (PTSD) (84 percent). Results also were higher the longer the hospital stay. For example, 91 percent of two- and three-day visitors reported that the art improved their mood.
• 61 percent said it somewhat or significantly reduced their stress. Results were even higher among the subset of respondents treated for cancer (65 percent), generalized anxiety (69 percent) and PTSD (81 percent) — as well as among the subset of two- and three-day visitors (72 percent).
• 39 percent said it somewhat or significantly improved their comfort or pain level. Results were even higher among the subset of respondents treated for cancer (43 percent), osteoarthritis (47 percent), generalized anxiety (49 percent) and PTSD (54 percent).

According to research done by Stine Maria Louring Nielsen and professor Michael Finbarr Mullins of Aalborg University in Denmark, patients noted that the mere presence of the artworks inspired confidence that the hospital was well cared-for, leading them to expect a high level of care while staying there.

Arts in Medicine is a national and international program that brings healing arts into healthcare systems. One of the oldest programs is at Duke University, said visiting artist Elizabeth Garlington, which made bringing the program to Haywood, a Duke LifePoint hospital, a logical extension.

Party of 7

Susie Nix, Michelle Moore, Amanda Loye, Natalie Deal, Ashley Davis, Abby Lucas and Katie Jones all work together in Labor and Delivery at Cone Health Women’s Hospital in Greensboro, North Carolina and all seven of them are expecting at the same time! 

The due dates are between August and December this year.

Loye is expecting twin boys, Moore, Deal, Davis and Lucas are expecting boys, while Nix and Jones say they don't want to know the gender until the baby is born.

All of the women will be giving birth at Greensboro hospital, of course. 

Multiple maternity leaves aren’t an issue since they have a full team of 85 Nurses in the unit.

Loey said that being pregnant and working with expecting mothers makes it easy to start a conversation with the patients. “It gives you something to talk about right off the bat!” she said.

"The 6-pack"

Over at Wake Forest Baptist Medical Center in Winston-Salem, N.C. we meet Nina Day, Bethany Stringer, Emily Johnson, Nikki Huth, Sabrina Hudson and Katie Carlton.

According to one report, their patients refer to them as the fabulous "six-pack." 

“Of course, people say, ‘Is there something in the water?’” Carlton said. “It really intrigues people and gives them something to focus on when they are there.”

They are a tight-knit group of Nurses who love that they’re sharing this experience. 

“People being pregnant together may not be a rarity,” Hudson said. “We are just really excited about our babies and being able to share play dates. I don’t think that after the pregnancies are over we will stop sharing milestones together.”

Their due dates range from July to December. Hospital spokeswoman Eryn Johnson reassured those concerned, that the hospital has made plans to continue patient care when the women take maternity leave.

"All of these Nurses have spoken highly about sharing their pregnancy journeys together along with the support, advice and tips they’ve been able to share,"  Johnson said. "Quite the bond that’s been established."

Large job boards like Indeed and Glassdoor compete to display millions of jobs. Niche job boards like our DiversityNursing.com job board, help you reach a more precise audience.. 

Niche job boards are generally smaller job boards that are location or industry focused. Many niche job boards are sponsored and/or maintained by industry leading professional associations. From a recruiter’s perspective, the industry focus of niche job boards helps to target job advertisements toward qualified candidates. 

Healthcare organizations need to look at the importance of the recruiting function, and how, if recruiters are able to bring more high-quality talent into the organization, that level of quality will cascade through everything else employees do, ultimately impacting the delivery of patient care.

Recruiters like posting jobs on niche boards because they know everyone applying is in the right place. Applicants won’t find search results for jobs in other professions so recruiters won't receive resumes that don’t match the job description they posted. This leads to smaller candidate pools, allowing the recruiter more time to consider each application. 

According to a Nurse.com article, smaller job boards are familiar with particular specialties, job titles, certifications and keywords your desired audience uses and requires. They understand and stay up-to-date on the hiring trends for their niche profession. For example, if a large organization is laying off workers, a niche job board can help you target a specific market.

Niche boards offer branding opportunities like job alerts, job board widgets, banner advertisements, and company profile pages like DiversityNursing.com's Employer Profile.

Smaller job boards have staff who know your name and answer your calls and questions. They know your time is precious and good communication is key. That means you're talking to a real person not a voice recording. 

Niche job boards attract the right candidates that have the specialized skills and up-to-date experience that you're looking for. They also receive higher quality and more relevant applications. Therefore, niche job boards are the fastest way to find strong candidates, leading to lower cost-to-fill.