DiversityNursing Blog

Research has documented a number of racial disparities in health care, including higher death rates among African-Americans than whites. New government data shows some significant improvements.

The study from the Centers for Disease Control and Prevention found African Americans are living longer. The death rate for African Americans has declined about 25% over 17 years, primarily for those aged 65 years and older.

However, younger African Americans are living with or dying of many conditions typically found in white Americans at older ages.The difference shows up in African Americans in their 20s, 30s, and 40s for diseases and causes of death.

Chronic diseases and some of their risk factors may be silent or not diagnosed during these early years. Health differences are often due to economic and social conditions that are more common among African Americans than whites. For example, African American adults are more likely to report they cannot see a doctor because of cost. All Americans should have equal opportunities to pursue a healthy lifestyle.

According to the 2016 National Healthcare Quality and Disparities Report, some disparities were getting smaller from 2000 through 2014-2015, but disparities persist, especially for poor and uninsured populations in all priority areas:

• While 20% of measures show disparities getting smaller for Blacks and Hispanics, most disparities have not changed significantly for any racial and ethnic groups.
• More than half of measures show that poor and low-income households have worse care than high-income households; for middle-income households, more than 40% of measures show worse care than high-income households.
• Nearly two-thirds of measures show that uninsured people had worse care than privately insured people.

It is important to create opportunities for all Americans to pursue a healthy lifestyle. What can be done?

The Federal government is

• Collecting data to monitor and track health and conditions that may affect health, such as poverty and high school graduation rates, through Healthy People 2020. http://bit.ly/2oDhWV4
• Supporting partnerships between scientific researchers and community members to address diseases and conditions that affect some populations more than others.
• Addressing heart disease, stroke, and other cardiovascular diseases, which disproportionately affect African Americans, by implementing national initiatives such as Million Hearts®. http://bit.ly/2p0Ux0N
• Supporting actions to create healthy food environments and increase physical activity in underserved communities.

Public health professionals can

• Use proven programs to reduce disparities and barriers to create opportunities for health.
• Work with other sectors, such as faith and community organizations, education, business, transportation, and housing, to create social and economic conditions that promote health starting in childhood.
• Link more people to doctors, nurses, or community health centers to encourage regular and follow-up medical visits.
• Develop and provide trainings for healthcare professionals to understand cultural differences in how patients interact with providers and the healthcare system.

Community organizations can

• Train community health workers in underserved communities to educate and link people to free or low-cost services.
• Conduct effective health promotion programs in community, work, school, and home settings.
• Work across sectors to connect people with services that impact health, such as transportation and housing.
• Help people go see their doctor, take all medications as prescribed, and get to follow-up appointments.

Healthcare providers can

• Work with communities and healthcare professional organizations to eliminate cultural barriers to care.
• Connect patients with community resources that can help people remember to take their medicine as prescribed, get prescription refills on time, and get to follow-up visits.
• Learn about social and economic conditions that may put some patients at higher risk than others for having a health problem.
• Collaborate with primary care physicians to create a comprehensive and coordinated approach to patient care.
• Promote a trusting relationship by encouraging patients to ask questions.
  
  

ProPublica and NPR launched a project about maternal deaths and near-deaths in the U.S. In recent months, mothers who nearly died in the hours and days after giving birth have repeatedly told ProPublica and NPR that their doctors and Nurses were often slow to recognize the warning signs that their bodies weren't healing properly.

Discharge materials the hospital sends home with new mothers can be vague and confusing. The reports show the same themes through many of these survivors’ recollections. They frequently said they knew little to nothing beforehand about the complications that nearly killed them. Even when the women were convinced something was terribly amiss, doctors and Nurses were sometimes slow to believe them. Mothers especially lacked information about risks in the postpartum period.

A study by MCN: The American Journal of Maternal/Child Nursing surveyed 372 postpartum Nurses nationwide and nearly one-third of the respondents had masters or doctoral degrees. The survey found that:

• Close to half of the nurses surveyed didn’t know that maternal mortality rates have gone up in the U.S. in recent years. In fact, 19 percent of them thought maternal deaths had declined.

• Only 12 percent of the nurses surveyed knew that most maternal deaths occur in the days and weeks after delivery, and only 24 percent were able to identify heart-related problems as the leading cause of maternal death in the U.S.

• Nurses also admitted in the survey that they are uncomfortable discussing life-threatening complications with new mothers because childbirth is supposed to be a happy time and they don’t want to scare them.

Researchers found that Nurses could be quickly educated with short, targeted information. Using insights from the focus groups, an expert panel developed two standardized tools: a checklist and script that nurses could follow when instructing new mothers and a one-page handout of post-birth warning signs that mothers could refer to after they returned home, with clear-cut instructions for when to see a doctor or call 911.

An estimated 700 to 900 women die every year from pregnancy and childbirth-related causes, according to the Centers for Disease Control and Prevention. The only way to bring this number down is for everyone to be more aware of what the complications are and how to prevent them.

The PRIDE study is the first of its kind. It aims to follow the same large group of LGBTQ people over the span of the next few decades. Enrollement is open to anyone who resides within the United States, identifies as a gender or sexual minority, and is over 18, its enrollment has surpassed 6,000 since launching in May.

We still lack a comprehensive understanding of the ways that being an LGBTQ person can influence one’s overall health, or of health disparities within the LGTBQ community itself. Researchers, Juno Obedin-Maliver and Mitchell Lunn, at the University of California–San Francisco are hoping to close that gap.

“Sexual and gender minorities make up between 2 and 6 percent of the population, however sexual orientation and gender identity are rarely asked about in health studies and they’re not included in fundamental metrics like the Census,” said Juno Obedin-Maliver, one of the principal investigators with the landmark effort, which is aptly titled the Population Research in Identity and Disparities for Equality Study — more simply referred to as the PRIDE Study. “It’s critical we have visibility into the health and health care experiences of these populations so we know where to direct our efforts. Without data, we’re flying blind.”

One of the big barriers we often found trying to encourage people to teach medical students, doctors or other health care providers about LGBTQ+ people was they said, “Well, there wasn’t enough evidence about the health care needs of the community.” And we kept giving lectures and complaining that the studies weren’t being done. We knew that health disparities were there, but we didn’t know how bad, how deep, how broad the problems were, or how comprehensive, because there wasn’t inclusion often in national studies. So Mitch and I said, “We’re both researchers, we’re both clinicians. Let’s stop complaining and do something about it.”

The goal is to eventually enroll about 100,000 people and follow them over the next 30 years, collecting data through an annual questionnaire. Questions will cover a range of health and social topics, such as physical activity, sleep, mental health, quality of life, insurance status, emergency care use, access to care, income, educational attainment, and family and social connections. 

“People are excited — it feels like they’re hungry to be heard and represented,” Obedin-Maliver said. “The PRIDE Study is by and for the community. Yes, it’s academically rigorous, but it’s also a labor of love and a commitment to giving back.”

For more information or to enroll in the PRIDE Study, which is based at the University of California-San Francisco, visit https://pridestudy.org.

Nursing is one of the many professions that is changing rapidly. Lifelong learning for Nurses is essential. As a Nursing professional, it is a requirement of maintaining your license to participate in continuing education (CE). You need to stay up-to-date on patient care, healthcare trends, treatments and techniques.

According to Nurse.org, most states require Nurses to complete some form of continuing education every two to three years as a condition of licensure. Even if your state board does not require any education for continuing competence for renewal, you may still be required by your employer or Nursing association for job-specific certifications (i.e., Nursing specialties, magnet hospitals, etc.). Specialty certifications such as medical-surgical, critical care, neonatal, etc. have specific requirements for continuing education. Make sure to check with your own hospital and any associations to which you may belong to find out if you have further requirements above and beyond that of your state Nursing board.

Nursing Professional Development specialists or NPD specialists are available to advise Nurses about certification and licensing requirements, and they can also address a Nurse’s need for additional instruction. Furthermore, NPD specialists ensure that the Nurses under their supervision always demonstrate competency.

Trisha Coady, HealthStream’s Vice President of Clinical Development, discusses how lifelong learning benefits patients and outcomes. She said, "Nearly 70% of the healthcare workforce is involved in direct patient care. That’s 3.1 million of HealthStream’s 4.5 million subscribers, who complete over one million courses each week. If each of those healthcare professionals could prevent harm or death for only five people in their lifetime as a result of acquired knowledge, over 15 million lives would be saved."

Coady also advises healthcare managers to incorporate and promote a strong focus on learning. Trisha said, "Decisions made after 20 years of experience differ drastically from what we would make in our first year after college. To get there, we’ve likely pursued formal education or courseware, attended conferences, volunteered on committees, leveraged peers and mentors, etc. There will always be a need for mandatory, regulatory or focused training, but I also believe it’s just as critical to offer opportunities for self-development."

 If you have any questions about continuing education feel free to ask one of our Nurse leaders by clicking below!

Healthcare organizations must know in order to be successful, you need a diverse workforce. The key to success in this area is retaining that staff and knowing how to defuse conflicts. This is especially true in settings like hospitals, where mistakes can mean life or death.

Poor communication is one of the leading causes of medical errors, according to the Joint Commission. Medical errors are the 3^rd leading cause of death in the United States—right after heart disease and cancer, and it’s more prevalent than respiratory ailments, stroke and Alzheimer's disease—according to a study out this year from The BMJ. Author Martin Makary, MD, of Johns Hopkins University, and colleagues estimate that 251,000 Americans die each year from such mistakes. Some instances have nothing to do with interpersonal conflict, but employees at odds with one another are less likely to spend time making sure they understand each other during crucial events like a patient hand-off.

Dianne Austin, workforce diversity program manager at Massachusetts General Hospital, told Healthcare Dive, creating robust support networks is key to helping employees identify and deal with tension or potential discrimination from other employees. They also need to be able to talk freely with others who may be in similar situations. “There’s a lot that we do to really try to help employees feel that they have a voice and that they’re important,” she said.

How conflict happens

Susan Woods, a workplace consultant, says there are a few major dynamics in diversity-related conflict, including respect and disrespect, as well as recognition and identity.

1) Respect and Disrespect

Disrespect may be gross and blatant, but it is also subtle, communicated in the little

ways someone is told they don’t belong, are not good enough, are not expected to

achieve, or that they can be overlooked and don’t count.

Remarks like the ones below convey messages about respect.

“Not a bad job, for a woman.”

“You don’t have to worry about your appointment. You’re a minority.”

“That company is very traditional. I’m surprised they even hired you.”

A reasonable person could interpret disrespect in each of these messages. The

harmful message may be unintended and unrecognized by the offending party, even

as it is deeply felt by the offended party.

When disrespect is communicated in unintended and unconscious ways, bringing

this perspective to the surface creates an opening for learning and improved

relations. Regardless of how the incident in question is settled, failure to understand

the dynamics of respect and disrespect from more than one perspective perpetuates

the underlying conflict.

2) Recognition and Identity

A second dynamic often present in diversity-related conflict resolution is

recognition and identity. Recognition and identity are complicated dynamics, full of

opportunity for misunderstanding and tension. These may have a negative effect,

but may not have been communicated with consciously malicious intent.

We hear it below:

“I’m always asked to be in the photo or meet with visitors because I’m one of the few people of color

they have. It has nothing to do with my accomplishments.”

“I hope you’re not asking me to take the minutes because I’m the only woman in the group.”

“You’re not like the others. I feel I can talk with you.”

“Those people …”

The old days of the “great melting pot,” where everyone was expected to conform

to the dominate group, are gone. Hopefully, we’ve moved past assimilation to

realize that inclusion is about recognizing diverse identity. It’s about understanding

individuals as unique persons and, at the same time, as members of groups.

Either/or logic is misleading. This is a both/and phenomenon. The ambiguity can

be unsettling, especially when the challenge is so deeply personal and emotional as

with identity.

Research shows that conflict can be frequent in healthcare organizations because of the high workload volumes, pressures to move quickly and the importance of decisions being made. These conflicts can affect companies in many ways, including high staff turnover rates, reduced productivity and litigation costs.

Dealing with conflicts

The best processes start early and attempt to prevent conflict. Austin said Massachusetts General has an orientation where new employees attend a program on diversity and inclusion and learn about various resources available to employees, such as a citizenship program, careers days and school admissions officers. There are also multiple staff committees focused on improving diversity and inclusion.

Healthcare managers can help ease conflict by listening carefully to employees, quickly addressing the source of the problem, instituting strict and clear policies and educating staff about those policies, she wrote.

Massachusetts General has multiple ways for an employee to bring any concerns to light, including an anonymous hotline, Austin said. The HR department will review whatever is submitted and the relevant department head is told the details. “We really try to pull managers and the appropriate people in so we can get to the bottom of it based on the information provided,” she said.

Sometimes, the problem starts with a patient who refuses to be cared for by a certain nurse or doctor, and may use racial slurs or other inappropriate language. The nurse manager will respond and tell the patient all providers are equally trained and capable. The patient is then told they can go to another hospital if they will not be respectful to all employees. The affected employee can decide whether or not to continue working with the patient.

Diversity is needed at higher ranks

Diversity and inclusion efforts should reach all the way up the ranks to the executives, making sure their C-suites and boardrooms are also diverse and reflective of the surrounding community.

The American Hospital Association's Institute for Diversity in Health Management released a comprehensive report titled Diversity and Disparities: A Benchmarking Study of U.S. Hospitals in 2015. The results of the survey were not exactly positive. In fact, the survey found that minority representation on healthcare boards across this nation stood at just 14%—precisely the same percentage reported in a similar survey two years earlier and a similar study conducted in 2011.

Deborah Bowen, president of the American College of Healthcare Executives said the best ways to remedy poor diversity in C-suites is to start cultivating a diverse group of people who have an interest in leadership early on in their careers. Post-graduate fellowship programs and scholarship for mid-level executives can be helpful. Hospitals should provide leadership development and training as well as other career resources, she said.

“It’s a matter of finding mentors, for example,” she said. “Have a mentorship network to find somebody who has gone through something similar.”

The diversity of people in the US has changed considerably. As stated at the beginning of this article, our hospital and healthcare system employees need to reflect their patient population at all levels within their organization(s). Sensitivity to language, cultural, sexual, and physical differences in both your staff and patients is critical for a harmonious and productive environment.

You might be a recent graduate and are worried about what to do when you get a difficult patient or maybe you are an experienced Nurse and are looking for new tips or ideas to try. We created a list of ways Nurses avoid or diffuse challenging situations with patients.

1. Don’t take it personally

It’s easy to think a difficult patient is upset with you personally, but that’s almost never the case, according to Julianne Haydel, veteran nurse turned nurse consultant at Haydel Consulting Services.

Remember that the patient is dealing with unfortunate circumstances and likely isn’t in the best mood. Continue to do your job and don’t let their negativity get in your head. “Just knowing that the nastiness is not about you is a good start,” says Haydel.

2. Stay Calm

When dealing with trying patients, the best approach is to remain calm. Remember that the patient is not attacking you personally, but rather acting out on feelings of anxiety, a perceived lack of attention or resistance to what has happened to them. Remaining calm will allow you to keep control and address the patient in a way that will defuse the situation.

3. Show that you care

Sometimes difficult patients make a fuss about minor requests because they feel like no one is listening to them. Set aside your frustration with the patient and do what you can to meet their needs, as long as it doesn’t take away from other patients’ level of care.

Nurse Angelis recalls swallowing his pride and getting a second cup of coffee for a particularly irritable patient: “I stayed gracious and her whole demeanor changed. She just wanted to know that someone cared and she wasn’t going to be ignored.”

4. Set Boundaries

When it comes to difficult patients who make seemingly endless or unreasonable demands, a useful approach is to set limits. Let them know you will check on them again in 15 minutes or a half hour, and then follow through. In some situations, you’ll need to set boundaries to keep yourself safe. Doing so can help avoid escalating anger.

5. Realign Your Body Language  

Charlene Berube, chair of the undergraduate nursing program at Simmons School of Nursing and Health Sciences in Boston says, “When I start to get frustrated because I’m not making progress with a patient, I take little breaths." Berube also says, “We both need to refocus at that time. If the patient is becoming demanding, and I’m getting frazzled, those energies need to be refocused. And when you do that, your body language realigns.”

Patients come to nurses with mental health issues, mood disorders, depressions, anxiety and a host of other complications. They have lives or lifestyles that you may not understand or even agree with.  But none of that matters.  Each patient deserves the best nursing care you can give them. Remember that you need to find the calm in yourself, be objective and be honest with them. Showing empathy and giving them your undivided attention and time could make a big difference in their attitude and soften those hard edges.

If you have other tips or advice please comment below we would love to hear what you have to say!

For 14 years, MultiCare hosts a week-long Nurse Camp in the Summer for students who want to work in the medical field. Since there will be a growing demand for Nurses as baby boomers retire and leave the field, this program helps students get a head start on experience and learning.

Puyallup High School junior Adrianna Boyce was confident she wanted to get a job in the medical field.

But it wasn’t until she job shadowed in the emergency department as part of MultiCare Heath System’s Nurse Camp that she knew it was for her.

“Being in the thick of things, it was great,” Boyce said.

Nurse Elise Wilson was in critical but stable condition after being stabbed by a patient at Harrington Hospital in Southbridge last month. Nurses aren't "expecting to encounter violence but they do, every single day of the week," said Elise's husband, Clifton. "They are cursed, spit upon, bitten, punched, kicked, and yes, stabbed."

The Boston Globe said, Elise was treating Connor Oregan, 24, of Southbridge, in the emergency room around 10:15 a.m. when Oregan slashed at her multiple times with a knife before fleeing the hospital.

The nurse was stabilized in the emergency room before being flown to UMass Memorial Medical Center for further treatment. She underwent eight and a half hours of surgery and remained in critical but stable condition, the district attorney’s office said.

Clifton Wilson, and colleagues will testify Wednesday before a committee at the State House in support of legislation proposed by the association “that requires health care employers to develop and implement individualized workplace violence prevention plans,” according to a release. The association has dubbed the legislation “Elise’s Law.”

“The attack against Elise was vicious and left her fighting for her life,” said RN Tracy DiGregorio, who was working in the ER at the time of the assault. “Unfortunately, I cannot say violence against nurses is rare. Nurses and other health care professionals are assaulted every single day at hospitals throughout Massachusetts. We should pass ‘Elise’s Law’ right away to help stop the violence.”

Massachusetts Nurses Association talked about the photo and said, "This is a tough photo to look at. But RN Elise Wilson and her loved ones want the public to see the violence nurses and other health care professionals are experiencing. And they want it to stop. Elise is only smiling because she is grateful her ventilator and feeding tube have been removed." 

The young man allegedly sat in the parking lot sharpening his knife for 20 minutes before entering the emergency room, Clifton Wilson told lawmakers. Conor O'Regan, 24, is accused of the attack. Clifton also said, "She bled out three times and almost died."

Since the attack, Harrington Hospital has beefed up security, and now has a metal detector, he said. They've also hired a Southbridge police officer.

Have you experienced violence from a patient or witnessed it at your place of work? Please share with us in the comments section below. 

For many people, Nursing was all they ever imagined they would be doing as their career. For other people, becoming a Nurse was a second career for them. No matter which stage in life they chose to become a Nurse, these people are passionate about what they do and they are happy they made the switch to a job they love.

John McElroy worked in a local brick factory for about twenty-five years. He lost his job in 2007 after sufferring from a stroke. McElroy wanted to be a Nurse when he was younger and during one of his hopsital visits, his childhood dream was restored. John told CNN, the Nurse thought he would be a fantastic Nurse. She gave him advice and told him, "You will have loads of excuses to not do this, to fail, to quit. But you've got to carry on."

John attended college and even earned $4,000 in scholarships. In 2012 he graduated with a Nursing degree and every day McElroy sees pieces of his own journey reflected in his patients. He educates families on the unique needs of stoke survivors. By sharing his personal story, he hopes his patients will believe that there is life after recovery.

When Bob Evans was 20 years old he took an aptitude test that showed Nursing as a good match for him. Learning news that he was going to become a father Bob decided to take a job in the horticulture business, mostly in sales and customer-service positions in landscaping and lawn care.

In his late 50's, there was a restructuring where he worked. He wasn't sure what he was going to do for work. His wife Lou said, "Remember how you were interested in becoming a nurse when we got married?" I said, "It's too late," but she said, "I don't think so." Bob and his wife attended an information open house at Collin College and decided to go for it. He earned his associate's degree at Collin College in 2013 and a bachelor of science in nursing in 2016 at the University of Texas at Arlington. 

Bob told Dallas News the toughest part about changing careers is, "The transition from expert to novice. I knew that not being the expert on the job anymore would be an adjustment. Assuming the role of novice required a steady flow of swallowing my pride. It has been humbling, but learning and mastering skills that help others is really rewarding."

Laura Callens worked as a school admissions director and was taking care of her husband, Eddy, who had brain cancer. After Eddy passed away in 2011, Laura quit her job and spent some time in Mexico where she had a career epiphany. She heard about a nursing program and realized she had honed relevant traits and skills like compassion and deep listening while caring for her husband. Though hesitant to become a student again, she applied to Nursing school.

According to the NewYork Times, Ms. Callens happily graduated last December and will soon be a neurological nurse. She will work in the Rochester hospital unit where her husband was treated.

Changing careers is always a nerve-racking journey. For people in their 40s and 50s, making a change can be daunting. Experts believe assessing job opportunities, doing some smart skill-matching and getting technical training can help speed the process. But, you also have to love what you do for a living and these people luckily found their calling.