DiversityNursing Blog

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.

Technology is an integral part of almost every field of work and in order for Health systems to stay on the cutting edge you need a healthcare IT professional on staff. This is where the Nurse informatics specialist comes in.

Demand is growing for Nurse informaticists and according to the Healthcare Information and Management Systems Society, the average salary is more than $100,000 and 95 percent of their survey respondents “view health IT as a strategically critical tool to help healthcare organizations be successful.”

According to Forbes, "The shift to electronic health records has spurred a dramatic change in the way health care professionals work. Nurse informaticists design and maintain processes for how people use electronic records, finding ways to save nurses’ and caregivers’ time. And they test systems rigorously. For example, they must make sure a patient’s vital signs are accurately recorded by heart monitors, and that the data is accurately transferred to electronic health records."

Informatics Nurse isn't a new career choice. Joyce Sensmeier, vice president of informatics at HIMSS says, "The American Nurses Association blessed it as a specialty in the early 1990s." She also goes on to say, “Usually the East and West Coast have quite a few positions. The Midwest as well — Minnesota, Wisconsin, and Illinois. That’s where a lot of the biggest health systems are. To be paying nurses this salary, it takes a strong health system.” But hospitals aren’t the only organizations that need the specialists. Universities and health technology startups do, too.

allnursingschools.com beleives it is a great leadership role opportunity. Because you’ll be responsible for creating strategies, implementing policies and ensuring better patient care, specialists can be a great fit for someone looking to move into advanced nursing. According to the HIMSS survey, 71 percent of healthcare organizations employ a “clinical IT leader” such as a Chief Nursing Informatics Officer.

Sensmeier also told Forbes, "To become a nurse informaticist, you’ll need a nursing degree, project management skills, an understanding of data and the ability to analyze it. The best route is to get a nursing bachelor’s degree to start, then get some real-world experience as a nurse, so you understand the clinical environment. After that, a master’s degree in health or nursing informatics — offered at most major universities—will provide all the education you need, even if you’d like to rise to the level of CNIO. These programs take two years, full time. An alternative is a one-year certificate in informatics. You probably can’t get to the CNIO level without a master’s, but a certificate will give you the core skill set."

Former Fleet Marine Force corpsman, George "Mik" Todd, released a new hip-hop album called Combat Medicine. George raps under the name Doc Todd and his main goal is to help veterans suffering from post-traumatic stress disorder, depression, or substance abuse.

According to NPR, Todd took several years before gettingt help for his PTSD. He was depressed and started drinking heavily. Eventually, he realized what he needed to be doing was helping other veterans. With savings from his job as a money manager and help from his wife, he was able to quit his job. He'd been making music since he was a teenager. Now, he wanted to use his music to help veterans heal. And he had plenty of material for his lyrics.

Some lyrics from his song, Not Alone, Doc Todd urges veterans to take action in their own recovery.

The struggle is real

Found a feast

And lost a soul

Eventually my drinking

It got out of control

There in darkness, I roamed

Struggling to find home

See Suddenly death didn't

Feel so Alone

Take those bottles out, dog

and pour 'em in the sink.

Take the needles out of your arm

And the gun away from your forehead.

It's time, man.

You've been through enough pain.

Stand up.

It's time to stand back up.

Learn more about Doc Todd in his interview here.

Drinks

Have Murse-y Margarita
1 oz. creme de banana
1 oz. gold tequila
1/2 oz. triple sec
3/4 oz. lemon juice
1/4 mashed banana
Apply lemon juice to the rim of a frosted double-cocktail glass and dip into caster sugar. Fill the glass with crushed ice, add the ingredients and blend briefly. Serve with a lemon juice-dipped slice of banana.

Nightingale Old Fashioned
mix 2 oz bourbon
1 1/2 teaspoons simple syrup
2-3 dashes of Angostura bitters
one orange slice, ice, and one maraschino cherry.  

The Night Shifter
1 oz. After Shock Fizzy Orange
1 oz. Sambuca liquor over ice.
Then, top off your glass with chilled Red Bull. 

Gin and Colonic 
6 mint leaves
1/4 lime, sliced
1 1/2 oz gin
and one tablespoon sugar to a shaker and muddle.
Then, add 4 or 5 cucumber slices to the shaker and shake vigorously. Finally, pour the mixture over a glass containing 4 ounces of tonic water and a few ice cubes. Stir, let sit for a few minutes.

Code Brown
1/2 oz. Butterscotch Schnapps
1/2 oz. Whiskey

Hematoma
2 oz. vodka
4 oz. tomato juice
Juice of 1/2 limes
1 1/2 tsp. Worcestershire sauce
6 dashes Tabasco sauce
salt and pepper
1 lime wedge
Add vodka, juices and sauces to a shaker with ice, adding salt and pepper to taste. Shake vigorously. Strain over ice cubes into a highball glass and garnish with lime wedge.

The End-of-Shift Report (aka Irish Coffee)
1½ oz. Irish whiskey
1 tsp. brown sugar
6 oz. hot coffee
Heavy cream
Combine whiskey, sugar and coffee in a mug and stir to dissolve. Float cold cream gently on top. Do not mix.

Desserts

Frosted and sprinkle cookies. Idea from www.iheartsprinklescookies.com

Pretzel sticks dipped in white chocolate with frosting details. Idea from Pinterest

Brain cupcakes! Idea from blog.wantsandwishesdesign.com

Jello shot syringes. Idea from Pinterest

Cookie bandaids! Idea from partysupplies.art-spring.net

If you have any recipes you would like to share, please comment below!

Unique challenges encompass the delivery of quality healthcare in the entire world as a whole. People of all ages are terminally ill -- with approximately half the American population fighting hypertension, diabetes, cardiovascular diseases, arthritis and mental related illness.

As a Nurse, you are required by the healthcare profession to be sensitive, demonstrate cultural awareness and behavioral competence necessary to ensuring healthcare issues are handled effectively. 

Medical professionals worldwide have voiced sentiments on the importance to further diversify the healthcare workforce. This is mainly because the entire healthcare profession is focused on transitioning to a patient-centered healthcare system in which patients demand more personalized care, high level rapport and open communication. 

Discrimination, stereotyping, prejudice and racism are the most common barriers toward achieving diversity in healthcare for patients and Nurses. There are multiple scenarios when you may show lack of sensitivity without even noticing it, unintentionally offending patients. You should for instance:

• Ask the patient how he or she may wish to be addressed or simply addressing him or her by their last name as a show of respect.
• Inquire of the patient’s knowledge on treatments and health problems.
• Forge the patient’s trust so as to establish a formidable nurse-patient relationship.

Diversity awareness in healthcare is however an active, continuous conscious process through which Nurses recognize the differences and similarities within various cultural groupings. As Nurses, we can only achieve diversity in healthcare by carefully evaluating and appreciating cultural group(s) differences.