DiversityNursing Blog

Strong management is necessary for all work environments, especially those that involve quick decision-making and high-pressure situations. Nursing is a career that, undoubtedly, fits into this category. Quality Nurse Management is vital when creating successful Nursing teams. Nurse Managers have an effect on how their employees relate to each other and their patients. Regardless of the hospital unit the manager works in, he or she must lead with a firm yet compassionate hand, revealing what they expect from the team. What is the importance of strong Nurse Management?

·Creating a healthy work environment

A Nurse Manager sets the tone of working in his/her department, acting as a negative or positive role model for the staff members. If he makes the employees feel like part of team and encourages teamwork, he inspires them to work together instead of competing. If he encourages constant communication, employees will be able to approach him when in need of guidance or to mentor. This creates a healthy work environment where people communicate freely with each other.

·Nurturing teamwork

Strong Nurse Management helps to encourage Nurses to work as units. For Nurses to be successful, they need to have great interpersonal skills. They must be good at communicating with patients, their families, and other members of the staff. Strong communication and teamwork are essential to providing quality patient care. To achieve teamwork, Nurses in management positions should encourage staff members to collaborate and help each other willingly.

·Supporting employee development

Nurses should keep refining their skills and learn new ones if they want to stay up-to-date with medicine. Effective Nurse Managers create environments that support growth and provide Nurses with the resources necessary to strengthen their competency. Additionally, they act as mentors, guiding new members of the staff as they adjust to their roles. When a manager values and encourages professional development, Nurses are more likely to push themselves to try new things.

·Proper organization

Proper organization is essential to the success of a Nursing team. Chaos is likely to ensue in the absence of proper organization – which would be unfortunate in the fast-paced, demanding healthcare world. A strong Nurse Manager needs to be detail oriented, methodical, and skilled at recognizing and solving problems. She should have the ability to tackle many different tasks simultaneously: overseeing patient care, writing shift schedules, and assigning duties to the Nurses.

·Setting department goals

Members of staff usually look to the manager for direction, trusting him/her to help them in understanding their role. The Nurse Manager often interprets the goals set by the hospital, decoding them into specific steps that the Nurses can follow. She must also define clear goals for the team, explaining them in a manner that emphasizes their significance. Managers typically oversee everything from standards of care to departmental budgets. Moreover, they must consider all aspects of the department’s operations before giving the team instructions.

·Encouraging success

Good Nurse Managers promote environments that encourage their staff to be more productive and enthusiastic when working. As the manager, the onus falls on him/her to lead through actions and words – to show that anything below 100% performance is unacceptable. Nurse Managers need to be honest with the team about its performance and issue clear instructions. They should also praise the staff members who do outstanding work and encourage those having a tough time.

·Positive growth

Good Nurse Managers should have the confidence to analyze their work honestly and come up with ways to improve them. When the team’s performance is below par, managers should make changes that improve performance, taking it to the next level. Nurse Managers should influence the staff members to evaluate the things around them and themselves, to find out what works. This will help them to improve their team performance and work environment.

·Smoothing patient relations

When patients and their families have concerns about the quality of care given, they go to the Nurse Manager. They might have questions about the treatment plan or complain about mistreatment from staff. No matter how irate the patient is, Nurse Managers must listen and answer the questions. It is the job of the Nurse Manager to let the patient know that his/her concerns will be taken seriously. During the meeting with the patient or their family, the manager should outline the steps that will be taken to remedy the situation or investigate the complaint.

Nurse Managers usually oversee specific units in the hospital. Therefore, they are responsible for the administrative and clinical aspects, including addressing the concerns of patients and supervising the Nurses. Not only do they require special expertise, but they also need strong communication skills.

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Related links: Being a nurse leader, even without the title

The profession of Nursing is engaged in a consistent conversation about the state of Diversity in Nursing. The way these figures are tallied are by comparing the percentage of individuals of various ethnic or cultural backgrounds in the general population to the relative group percentages in the field of Nursing. Many professional Nursing publications have been observant that Diversity in the Nursing field has improved, but there is still much additional room for continued improvement.

Where we've been

While a century ago the profession was nearly entirely comprised of white females, the increased Diversity enjoyed in the present day still falls short of being an accurate representation of the population breakdowns of society at large. According to 2016 census data, the only minority group meeting their group's needs in terms of proportionate population is Asians, who have actually managed to overrepresent their group by almost 5% when compared to the percentage of Asians in American patient populations.

A changing national demographic

Whites are still over-represented in nearly all Nursing roles while Hispanic and African American Nurses still have ground to make up if they wish to accurately represent the proportion of their respective group populations who enter as patients in health care facilities. By 2044, national Census data aggregators and analysts believe that Americans of European descent will cease to be the majority of the US population, when at that time they are expected to make up 50% or less of the entire population.

Why Diversity should help

The hypothesis that Nurse Diversity is best for the outcome of patients is centered around the idea that minority patients will feel more comfortable. With the added comfort on the part of the patients, the hope is they will be more compliant with recommended medicines, procedures and recommendations of any kind. If the Nurses and doctors serving minority patients are of the same cultural or ethnic background as themselves, many believe that noticeably positive outcomes could result. This is all still theory, of course, and hasn't been able to be borne out in any specific studies or repeatable situations.

While the specifc data hasn't been borne out in scientific studies to explain a known patient benefit for increased minorities in the Nursing field, there is a lot of policy support and governmental approval of the notion. Fortunately for those who have taken on this cause as a personal conquest, the numbers of enrolled Nursing students is starting to include more minorities as well as more males in the field, another group historically greatly underrepresented. A lot of the Diversity increase being noticed in Nursing school enrollment has been unbalanced from state to state. A closer look shows more enrolled Nursing students in Southern states versus Northern ones and more in the West than in the East.

Related: Bringing diversity to the nursing workforce

For more than 100 years, Nursing professionals interested in taking their careers to the next level have been developing their expertise in case management. They worked hard to assess, plan, implement, coordinate, monitor and evaluate the treatment options available to their patients. 

The goal was deliver the best possible care to patients with complicated health needs. 

Up until about 20 years ago, there were no defined criteria for what it meant to be an expert in case management. But as more information about how case management helps lower healthcare costs and improve outcomes, skills and knowledge required to manage patients' social, medical, financial and behavioral needs has become clear. 

Today, there are more than 37,000 board-certified Case Managers working across the United States. These professionals earned their certification from the Commission for Case Management Certification (CCMC). Others earned their certification from the Case Management Society of America and the American Case Management Association. They work in hospitals, clinics and specialty care centers--and an increasing number of employers are requiring board certification as a condition of employment. 

Here is a look at how Nurses can earn their case management certification:

1) Be eligible

Before a Nurse can become a board-certified case manager, he or she must meet the minimum requirements. For the CCMC, this includes holding current, active and unrestricted licensure or certification in a healthcare or human-services profession. 

In addition, the position held by the candidate must create opportunities for the employee to conduct independent patient assessments, or the employee must hold a bachelor's degree or graduate-level degree in social work, Nursing or another field directly related to promoting physical, psychosocial or vocational well-being. 

The candidate for certification must have worked as a case manager for at least 1 year to be considered for certification. 

Nurses who meet these criteria may apply for approval to sit for the certification exam. 

2) Prepare for the exam

Everyone who wishes to become board-certified must pass the certification exam. The exam is "practice-based," which means that every question is based around real-world experience. 

Topics could include financial issues facing patients and practices, patient rights, healthcare systems, care plans, and much more. 

One of the bet ways to prepare for the exam is to take practice tests, which are available on the Commission for Case Manager Certification website. In addition, the commission partners with third parties to provide certification workshops. The Case Management Society of America also offers an array of preparation materials, which are available on the organization's website. 

While it is possible to pass the exam without preparing, It is strongly recommended that anyone interested in achieving certification take steps to prepare for the exam. 

3) Pass the test

The certification exam involves a 3 hour test that includes 180 questions. It is presented on a computer and the total amount of time in the exam center is 4 hours, which includes time to get situated as well as a brief tutorial before the test begins. 

Test takers will need to make sure they are registered for the test, on time and have the proper credentials, which include a government-issued identification card and a confirmation from the testing center. 

Once the test is complete, everyone who has taken the exam receives a preliminary score at the testing center. While not official, the preliminary score is most often accurate. Those who passed the test will receive formal notification from the organization awarding the certification at a later date. Those who did not pass the test are eligible to re-take the exam during the next available testing date. 

A list of exam schedules is available on the Commission for Case Manager Certification website, the American Case Management Association website and the American Case Management Association website. 

Becoming board certified is a great way for Nurses to distinguish themselves as professionals who consistently deliver high-quality care, safe environments for patients, efficiency for their employers and the best possible service to both patients and the practices for which they work. It indicates a commitment to consumer protection, ethical standards and behavior, and scientific and practice-based care for patients across the continuum of care.

There are undoubtedly a number of myths about the Nursing profession. Being a Nurse is as rewarding spiritually as it is financially, but unfortunately, many qualified individuals overlook the Nurse career path due to any number of possible misconceptions. After debunking some of these Nursing myths, it becomes easier to decide whether a career in Nursing makes sense for anyone considering it.

1. Only females choose the Nursing profession: Perhaps the most commonly believed Nursing myth is that only females become Nurses. From 1970 to 2011 alone, the percentage of male Nurses nearly tripled from 2.7 percent to 9.6 percent. Those figures have only risen since then.

2. Nurses are only found in hospitals: Nurses can work in a variety of settings, hospitals being only one of the more common environments typically thought of by the uninformed public. Among RNs, only 63.2 percent are performing in-patient and out-patient services in hospitals. Among LPN's, the numbers are even less tilted toward hospital work settings, with only 29.3 percent working in hospitals.

3. Nurses want to be doctors: The notion that a Nurse is simply a doctor in training or a doctor that didn't make the cut is both incorrect and disparaging to how unique and important a Nurse's work really is.

4. Due to a Nursing shortage, it's simple to get a job: Nobody would think that because there is a shortage of astronauts, pursuing that career path would be easy. Why use that same logic for the career path of becoming a Nurse? According to professional studies and available data, most Nurses must undergo a period of 2-4 years of training to earn entry into an RN or LPN Nursing role.

5. Nurses are all the same: The work performed by a Nurse is going to vary greatly depending on the specific medical setting the Nurse inhabits. Certainly one of the more common Nursing myths, it is hardly the case that Nurses are just simple clones of one another. Not only are there a wide range of potential services regularly performed by qualified Nurses, but there are a vast set of options in terms of Nursing specializations for those seeking specific types of healthcare work.

6. Continuing Education (CE) is only important if you plan to pursue a management position: More than any other field, the Nursing occupation has stringent requirements for continuing education, even when management positions aren't the goal. The extent to which a Nurse is performing their functions properly is shown in how well the services performed are executed. Continuing Education for Nurses is beyond a requirement -- It's a smart career move.

7. Nurses only work crazy hours and shifts: Too often, a Nurse is thought of as a person who has to work very late into the night, or that Nurses must arrive at their work before the crack of dawn. Frankly and fortunately, this is not always the case.

8. Nurses are doctors' assistants: The tasks required of a Nurse are varied and important. Very rarely are Nurses and doctors actually working on the same efforts and tasks. More commonly, Nurses and doctors are performing their own separate and critical functions within a medical or healthcare environment, but these functions rarely overlap or present themselves in a boss/assistant paradigm.

9. Nurses only take care of patients: One of the most long-standing Nursing myths around is the concept that Nurses are just rushing around taking care of patients' needs. Taking temperatures, writing on charts, fluffing pillows and the like are the type of tasks that are conjured up in the minds of those who frankly don't understand the depth of a Nurse's daily efforts.

10. There is no Diversity in a Nursing job: Continuing on the myth that started this list, the misunderstanding about Nursing diversity extends beyond gender. While the cliché that a Nurse is always a Caucasian female, the numbers are starting to tilt drastically towards an ever-increasing diverse workforce of Nurses. This is definitely in the best interest of the diverse patient populations seeking medical care from Nurses.

Choosing a career in Nursing is a very individual choice, but it does pay to consider these Nursing myths. Simple misunderstandings about what it is to be a Nurse can prevent some potentially excellent Nurses from joining the fold. Not everyone is going to be a perfect match for the job of a Nurse. Once these myths are dispelled, the field opens up to many more individuals with an interest in finding a rewarding occupation and the opportunity to focus their efforts on helping the sick and suffering.

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In the 1960's colleges in the United States began to develop software that could be used for electronic medical records.  It took until the 1990's before a usable program was initially implemented.  This article will address the major pros and cons.

PROS

• Information available to medical facilities is very complete including demographics, personal information, billing information, diagnoses, surgeries, allergies, lab results, x-rays, smoking status, vitals, medications prescribed and those discontinued.  
• Medications can be renewed or prescribed directly to the pharmacy for pick up by the patient.  Unusual reactions to medications can be noted and avoided in the future.
• Access to any area of the record can be obtained by using a search word and/or using tabs.
• In case of an emergency records are immediately available to the treating medical team for use in treatment.  This alone can save lives. 
• Limited access by insurance companies for preauthorization of procedures.   
• Legibility is a given and it's no longer necessary to try and read medical personnel handwriting. 
• The reduction of paper files has been a real boost to the ecology.  Disuse of paper files has had a major favorable impact. Paper records for over 340 million patients is a lot of paper.
• Patients have access to appointments, lab results, medications and other information through patient portals.

CONS

• Security is somewhat of an issue as there have been thousands of breeches over the years and with HIPPA in effect good security is mandatory. 
• Power outages affecting computer systems could be a major problem if you don't have a backup generator. Loss of the internet due to sun spots or some other issue could be disastrous.
• Records can be accessible to anyone in the facility with a password.
• Start up, maintenance and training costs are very high. Upwards of $30,000 - $50,000 startup and $8,500 per year maintenance per provider. 
• Patients are seen less often which can depersonalize patient-provider interaction. Also, providers spend so much time looking into records on the computer, that it detracts from patient care and attention.
• There are many electronic medical record systems available and they don't necessarily interact. This means the primary provider may have a different system than the local hospital and the necessary information is not available. This results in having to print out the records and fax or email them.  Leading to a major delay in patient treatment which could make the difference in life or death. It can also lead to incorrect treatment because of unknown diseases, allergies or other issues.
•  If lawyers looking for reasons to bring suit can find a medication entered wrong or some other mistake can give them a distinct advantage.

This is just a basic overview of the Pros and Cons of Electronic Medical Records.  Do you have more to add?

Related Article: Complaints About Electronic Medical Records Increase

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Infections borne by mosquitoes are nothing new, however a new virus has recently gained intense global attention because of its potential link to birth defects.  In the vast majority of cases, the Zika Virus is spread by the bite of infected female mosquitoes of the Aedes genus.  The virus was first isolated in 1947, in the Zika forest located in Uganda.  Before 2015, Zika virus outbreaks had been confirmed only in Africa, Asia, and the Pacific Islands.  In May of 2015, Brazil reported an outbreak of the virus, and since then, the virus has rapidly spread across Central and South America.  The virus has currently been identified in at least 33 countries, and the World Health Organization predicts that 3 to 4 million people will be infected by the virus over the next year. 

Symptoms

Four, out of five people, who contract the illness experience no overt symptoms, and never realize that they are carrying the virus.  Those individuals who do become ill, generally have mild symptoms which may include headaches, conjunctivitis, joint and muscle pain, fever, and a skin rash.  Symptoms appear, approximately 3 to 12 days, after being bitten by an infected mosquito, and normally subside within a week’s time.  Few infected individuals need to go to the hospital, and death is extremely rare.

What makes the Zika virus so frightening, however, is that after the huge Zika virus outbreak in Brazil in 2015, Brazilian mothers are giving birth to babies with microcephaly.  Babies born with microcephaly may have smaller heads than normal because the brain is improperly developed or has stopped growing.  The neurological disorder can cause significant developmental delays, impaired cognitive development, and in some cases, death.  Brazil has confirmed 460 cases of microcephaly in newborns since November, and doctors have reported 4,000 suspected cases.  The clusters of increased microcephaly cases appear to significantly overlap with parts of the country where the Zika virus is flourishing.  The Center for Disease Control and Prevention (CDC) is also investigating a possible link between the Zika virus and increased occurrences of Guillain-Barre syndrome, a rare paralysis disorder. 

How to Avoid Getting It

As no vaccine currently exists to eliminate the disease, the best way to avoid getting the Zika virus is to avoid getting bitten.  Generally, mosquitoes responsible for spreading the virus, bite their victims during the daytime.  The CDC recommends taking the following steps when traveling to countries where the Zika virus has been identified:

• Protect your exposure by wearing long pants and shirts with long sleeves.
• Stay inside as much as possible, in areas that have air conditioning or screens that keep mosquitoes outside.
• Use mosquito bed nets when sleeping outside.
• Use insect repellents.  Environmental Protection Agency (EPA) registered repellents are effective, and can safely be used by pregnant or breast-feeding women.
• Spray clothing and trappings with permethrin, a synthetic insecticide, or buy permethrin-treated gear.
• The CDC’s Travelers Health website posts Zika virus health notices for all countries impacted.

The Zika virus is spread almost exclusively by mosquitoes, but recent research confirms that it can also be transmitted through sexual contact and blood transfusions.  Men who have traveled to active Zika virus areas should wear protection consistently, or abstain from sexual activity, if they have a pregnant partner.  It is not yet clear on how long the risk of transmission should be avoided. 

The available evidence indicates that, for the majority of people, the Zika Virus is a rather benign illness.  The greatest risk involves women who are pregnant, or thinking of becoming pregnant.  These women should take every available caution to avoid contracting this virus.

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Nursing is one of the most stressful occupations in America. Nurses have higher rates of illness and psychiatric problems than other professionals. There are things Nurses and other health professionals can do to minimize the stresses of Nursing. The best way to do this is to look at individual stressors and find ways to minimize or cope with them. 

Long Hours and Shift Work 

Long hours are stressful both physically and mentally. According to USA Today, the long hours Nurses work have become such a problem that the American Nurses Association has made recommendations about how many hours Nurses should work. The recommendations include not allowing Nurses to work more than 12 hours a day. Shift work also causes a lot of stress for Nurses, and the AMA has also made the recommendation to minimize night shifts for Nurses working both day and night shifts. 

Insufficient Resources 

Having insufficient resources makes a nurses' job more stressful, and it makes it harder for them to do their job properly. Insufficient resources take on different forms in different settings. Many times it is a shortage of Nursing personnel, which of course means the Nurses that are working have a higher workload. Other times, it is a lack of the material resources that Nurses need to do their job, whether it is due to budget cuts or oversight. Even small items like tape cause a big inconvenience when a Nurse has to search for it before she can draw blood or place an IV.  

Resources can be improved by improving pay for Nurses and making sure there is enough room in the hospital budget for other necessities. Proper inventory keeping is also important. If a Nurse notices a shortage in a particular area, it is important to mention it. Hopefully items are ordered immediately and put in the appropriate paces.

Poor Reward System 

Nurses are essential to the proper functioning of hospitals, and they work very hard. Yet many facilities don't have any kind of reward system in place, nor do they take the time to tell Nurses they are valued and appreciated. Many times Nurses are taken for granted.  

Studies have proven that rewarding employees for good behavior is essential to them being satisfied with their jobs and to retaining employees. Hospitals should have a rewards system in place. Nurses should also recognize each other for their hard work. 

Bullying and Abuse 

No one should have to endure bullying and abuse in the workplace. The ANA found that 17% of Nurses report being the victim of physical abuse at work, and 57% of Nurses reported being verbally abused or threatened. Physical abuse was usually perpetrated by patients or family members. Verbal abuse and bullying was usually at the hands of coworkers. 

Hospitals should hold educational seminars about what constitutes verbal abuse and bullying. Human Resources employees should be available to mediate and help employees solve conflicts. To protect against violence from patients and their family members, it is a good idea to have some type of security presence in the hospital. 

Lack of Communication  

Lack of communication also causes stress for Nurses. Communication between Nurses and doctors is essential to a hospital running smoothly. Daily or weekly meetings are one way to ensure proper communication. A suggestion box can give employees an anonymous way to communicate suggestions. 

Compassion Fatigue and Burnout 

Compassion fatigue happens when a Nurse stops caring about their job and patients. Sustained stress over a long period of time can lead to compassion fatigue. Burnout occurs when a Nurse becomes depressed, withdraws from others, and feels fatigued. 

To prevent compassion fatigue and burnout, try to take time off to relax. Don’t over extend yourself. Hospitals that have a reward system in place and make Nurses feel appreciated helps combat burnout. Everyone wants to feel appreciated in both our personal and professional lives.

Related articles: Dealing With Depressed Patients

6 Tips on Stress and Anxiety Management in Nursing

Nurses’ Survey Results Show ‘Dangerous’ Stress Levels

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In an environment where moments can mean life or death, it is undeniable that communication greatly matters. If the same message can be conveyed without losing meaning in a shorter or more efficient way, then it's a duty of the messenger, especially in a professional medical setting to optimize their communication skills. Speaking is literally only half of the equation, with great listening skills and information retention skills being able to effectively make repeated statements unnecessary. There are some ways to think critically about a healthcare organization to determine where it stands as a team regarding their communication abilities. Taking this closer look at the state of communication at a given facility is the crucial first step towards improving the communication therein. Increased efficiency in communication will result in saved time and increased focus that can be dedicated to the needs of patients, where it ultimately should.

Determining the state of the team's communication skills:

• Turn culture clash into culture strength: If there was no top-down strategy around cultural diversity as a marker of strength, then little petty fights about minor topics could escalate into all-out cultural clashes among a workforce. By the promotion an ideal of strength through unity, the team as a whole has the chance to get in front of any potential culture clash issue rather than chasing the problem, always trying to put out fires.
• Hold group meetings to discuss the overall state of communication at the facility: Management can play a massive role in putting the correct, positive spin on the topic of diversity in the workplace. The larger part of any staff will often be found to be on the same page about the acceptance, curiosity and positive interest in new cultures being integrated into the workplace at all times. By it being an official part of a corporate brand message and identity, the company embraces the diversity perspective even further.

Starting to help create a positive communication culture:

• Create regular workshops to go over basic principles in communications: Different individuals from diverse backgrounds will have unique perspective to share on the same topics, even if they technically speak the same language. Then, of course, there are the actual boundaries that exist between nations and languages that are completely distinct. If the staff of a healthcare facility can say "Hello" in ten distinct languages, that group brings themselves one step closer to the perfect awareness and diversity in their facility. 
• Hold regular cultural show and tell days within the staff: Each staff member, once they share their true selves, are going to have their own special cultural tale to share. If there is an encouraging environment in this way, it becomes natural and easy to leverage this diversity to enrich the staff with increased knowledge and awareness. Patients come from all over the world and there's never any way to predict who will become a patient next. With these principles in mind, a staff trained in cultural sensitivity and awareness will be better prepared to interact with new international cultures.
• Leverage modern and inexpensive tools: Any healthcare facility staff member is going to be all too familiar with the app store on their smartphone, but sadly quite few have downloaded any translation or language-learning app onto their phone. When these powerful and groundbreaking tools are now available and often for no outright cost, it's usually just a matter of pointing this out and creating a culture of support towards adopting these excellent tools to enable a team to begin using them.

Once the realization hits that communication is mostly a function of awareness, effort, empathy and genuine bonding experiences with groups, it becomes much easier to cultivate this environment of abundant and fruitful communication. If the entire healthcare facility can start to treat the state of communication at their facility as a togetherness exercise and a mission dedicated to a better experience for the patients, then the real results can start to be noticed.

Individual differences can make a group stronger and more powerful or they can also tear groups apart. The key to ensuring a positive outcome is to apply conscious effort around fostering excellent communication in any arena or avenue possible.

Related links:

4 nurse communication startups to improve patient outcomes

Three Tips for Better Nurse–Physician Communication In The Digital Age

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By Dr. Melissa DeCapua, DNP, PMHNP via www.bartonassociates.com

This article about “what’s in a name” caught our attention. We’re sharing it with you to find out if you’ve run in to this situation where you work. If you’re an NP or a PA, we know you’ve worked very hard to accomplish your degree requirements. Where you work, is your position sometimes referred to as “mid-level”? If so, read on and then tell us of your experience. Have you pointed out to Human Resources that this is a confusing term?

I had just graduated from nurse practitioner (NP) school and was on the job hunt. Skimming through a few job descriptions the word “mid-level provider” caught my attention. Having never heard that word, I assumed the job wasn’t meant for an NP. The next time it happened, a recruiter called my cell phone telling me there was an open position for a “physician extender” in rural Colorado. A what? It’s interesting how you can be an extension of someone who isn’t even present.

Then, a naive new-graduate, I didn’t quite grasp the scope of the problem. Although I did know one thing, neither of those titles captured who I was or what I did. As I’ve progressed through my career, I’ve heard myself called a “mid-level provider,” “physician extender”, and “non-physician” over and over again. Now-a-days my jaw tightens, and I gauge whether this is an appropriate situation to explain why these terms are offensive.

The time is now. This post will explore the words “mid-level provider,” “physician extender,” and “non-physician”, describing their historical uses and detailing three key reasons why this vocabulary should be eliminated.

Historical Use

These terms were originally created by physicians, and they are perpetuated by physician-led organizations and physician-centric corporations (Hoyt, 2012). The U.S. Department of Justice’s Drug Enforcement Administration uses “ mid-level practitioner” to describe professionals other than physicians, dentists, veterinarians, or podiatrists who dispense controlled substances. The Centers for Medicare and Medicaid have also referred to NPs and PAs as “physician extenders” but has more recently used the term “ non-physician practitioners.”

Why these terms should be eliminated

• Devalues Expertise

Describing NPs or PAs as “mid-level” doesn’t just imply, it asserts that they are providing something less than “high-level” care. However, ample evidence demonstrates that the services offered by these professionals is just as safe and effective as those provided by their physician colleagues.

Both NPs and PAs earn advanced degrees and undergo exhaustive course work, high-tech patient case simulations, and extensive clinical practice hours. Moreover, both clinicians pass national board certification exams and may specialize in any variety of medical specialities. The terms “mid-level provider,” “physician extender,” and “non-physician” undermine the expertise and contributions of NPs and PAs.

• Confuses Patients

Imagine you are a patient and being told, “The mid-level will see you now.” Naturally, you might wonder, “Who?” Using vague, collective vocabulary to describe NPs and PAs can confuse patients. When receiving healthcare services all patients expect and deserve the highest level care no matter who they are seeing. NPs and PAs are held to the same standard of care as physicians, offering the similar services of assessing, diagnosing, and treating medical conditions. By using more accurate terminology (i. e. NP and PA), patients can be assured they are receiving the best care at all times.

• Impedes Teamwork

In their seminal publication, Crossing the Quality Chasm, the Institute of Medicine called for interdisciplinary collaboration to solve the significant problems facing modern healthcare. Using a term like “mid-level” perpetuates a hierarchical healthcare system which impedes this need for teamwork. Most NPs and PAs dislike the terms “mid-level,” “physician-extender,” and non-physician. When they hear themselves described this way, it decreases morale and divides the team.

Take a Stand

To stop the use of these terms, everyone must take a stand. First, recruiters should remove this language from job descriptions, contracts, and business discussions. Employers and administrators specifically need to demonstrate their respect for NPs and PAs expertise by removing this language from the company website. Other healthcare professionals should stand up for their colleagues if someone uses this degrading language. Finally, both NPs and PAs should never allow someone to call them something that undermines their unique contribution to healthcare.

NPs and PAs Weigh In

I recently started a discussion thread about this topic on the American Association of Nurse Practitioners LinkedIn page. The overwhelming majority agreed that these terms should not be used to describe NPs or PAs. Some of the comments that stood out the most to me:

• I will not apply for jobs using mid level provider, or extenders. It’s insulting to my profession and education. – Nurse Practitioner in Florida
 
• It would be nice if nurse practitioners received the respect and recognition they’ve earned through good patient care. -Nurse Practitioner in New Hampshire
 
• I have been truly blessed to work with MDs that actually appreciate, value, and acknowledge what we do and who we are. -Nurse Practitioner in India
 
• How do you extend a physician? It is suggesting that somehow we are not capable of working independent and we must be attached to a physician. I am a Nurse Practitioner of the highest level, and I am an extension of no one. -Nurse Practitioner in Florida 
 
• I am fairly certain they are not referring to us as mid-level providers to degrade us, but rather they’re unaware of how offensive it can be. -Nurse Practitioner in California 
 
• The term “mid-level ” is often used in a denigratory manner, lessening our worth and contribution to health care. This term should be retired and the contribution to healthcare overall made by all professionals should be recognized and validated. Nurse Practitioner in Texas

Barton Associates also conducted a poll on its Facebook page, asking NPs and PAs which term were most offensive. Approximately 1,380 NPs and PAs weighed in on the discussion. Here are the results:

• Mid-level (487 votes)
 
• Noctor (356 votes)
 
• Physician Extender (335 votes)

The poll also asked which term was the preferred term (other than NP or PA). Here are those results:

• Provider (919 votes)
 
• Healthcare Professional (122 votes)
 
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Let’s be straight; if there is ever a group of people who are called a name that makes them feel disrespected or devalued, the solution is always to stop. If you’re in doubt as to what you should call an NPor a PA just use “NP” and “PA.” Now let’s get back to patient care.

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Depression is a common situation dealt with on a daily basis. Most patients that Nurses find themselves coming in contact with have some form of illness or injury. This makes depression among patients common. Knowing how to spot it and how to react to depressed patients can help you handle the situation properly and deal with it with minimal stress.

What is Depression

Depression is a common disorder that affects many people every day. It affects all age groups, males and females, although females are more likely to suffer from it than males. Stress contributes to depression, making this illness more common in the last few years. The amount of stress an individual handles on a daily basis is on the rise and can contribute to depression.

What Contributes to Depression

There are a number of factors that contribute to depression. Stress is a huge factor. Debt, work and family can weigh heavily on the amount of stress someone experiences today. Age also plays a major role in depression and sickness in the elderly can increase the chances of them suffering from depression. This is a main factor as to why Nurses experience depressed elderly patients the most. Some elderly patients are forced to relocate to a new residence, while others become ill and are unable to live the life they are accustomed to. Some can feel abandoned by their loved ones and find themselves feeling alone. Leaving people without a strong social support network increases the chances of developing depression.

Signs of Depression

There are many warning signs of depression, although some may not be so easy to spot. A feeling of hopelessness or helplessness can lead to depression. Nurses often see this in elderly patients who don't have a lot of family support. A loss of interest in daily activities is another sign of depression. These signs can become apparent when patients are no longer able to get around on their own. Loss of mobility can make a patient no longer want to engage in activities for fear of embarrassment.

Changes in sleep patterns or appetite are another sign of depression. Nurses have to watch this sign as well, because certain medications can interfere with sleep and appetites of patients. Frequent physical complaints or ailments, anger or rage toward others and feelings of anxiety are other signs of depression. Many of these symptoms Nurses experience in their patients frequently. The key is determining when they start happening and ruling out any other possible causes. When there are no other possible causes, depression could be the reason.

How Can Nurses Help or Prevent Depression

Nurses play a vital role in their patient's lives, no matter the age of the patient. There are certain things that Nurses can do to help prevent depression altogether. Encouraging outdoor activities, even when your patient doesn't feel like doing them, is an excellent way to combat depression. A healthy diet and a regular eating schedule helps to recognize any changes in eating patterns. New hobbies help patients realize fun activities they can engage in to be entertained, even though they may not be able to do everything they could once do.

How Nurses Play an Important Role in Depressed Patients

Nurses are the people that patients see the most throughout the day, so it only makes sense that they play an important role dealing with depressed patients. Many things Nurses do can help a depressed patient not feel so worthless, and sometimes even lift their spirits. Talking to patients about their feelings is a good first step in dealing with their depression. Being sympathetic helps them know that you understand their feelings rather than judge them for how they feel.

Be careful about any advice you offer and always refer them to their doctor for specific medical advice. Accept their feelings toward the rest of the world. Trying to reason with them may make it seem like you are just another person who is against them or doesn't care about them. Reassure them of depression treatments and how effective they are. Let them know that treatment has high success rates, and they can work with their doctor to find the best treatment options.

It is common for Nurses to deal with depressed patients on a regular basis. Despite this, it is still important to remember to treat them as if they are all individual cases, and never group them together. A little reassurance could make all the difference in a depressed patient's outlook. The caring compassionate attitude that Nurses are known for could be exactly what a depressed patient needs.

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