DiversityNursing Blog

In the United States, drug overdose deaths have reached historical rates. From September 2020 to September 2021, more than 104,000 Americans died due to a drug overdose. 

Harm reduction services play a key role in preventing death, injury, disease, overdose, and substance misuse or disorder.

According to DrugPolicy.org, harm reduction is based on acknowledging the dignity and humanity of people who use substances and bringing them into a community of care in order to minimize negative consequences and promote optimal health.

Nurses can assist with different types of harm reduction programs. Some of these programs are:

Needle Exchange Programs

People who inject drugs face a greater risk of contracting HIV and hepatitis C. Research shows that 1 in 23 women and 1 in 36 men who use drugs intravenously will contract HIV at some point during their lifetimes, according to American Addiction Centers.

Sterile syringe access programs, also known as needle exchange programs, help lower these risks by limiting syringe sharing and providing safe disposal options.

These programs also provide disease testing, referrals to drug treatment, detoxification, social services, and primary health care.

According to the CDC, nearly 30 years of research has shown that comprehensive Syringe Services Programs (SSPs) are safe, effective, cost-saving, and do not increase illegal drug use or crime. Research also shows that new users of SSPs are 5x more likely to enter drug treatment and about 3x more likely to stop using drugs than those who don’t use the programs.

Supervised Injection Facilities

Also known as overdose prevention centers, these facilities offer a safe space for people to consume pre-obtained drugs under the supervision of medically trained professionals.

Facility staff members do not assist in consumption or handle any drugs brought in by clients.

Healthcare providers are there to offer sterile injection supplies, test for the presence of fentanyl in drugs, answer questions on safe injection practices, administer first aid if needed, and monitor for overdose.

Years ago, the American Medical Association vouched for these facilities stating, studies from other countries have shown that supervised injection facilities reduce the number of overdose deaths, reduce transmission rates of infectious disease, and increase the number of individuals initiating treatment for substance use disorders without increasing drug trafficking or crime in the areas where the facilities are located.

In 2021, New York City became the first in the nation to open an overdose prevention center.

Some community-based harm reduction examples are:

Naloxone Distribution Programs

Naloxone (also called Narcan®) is an inexpensive, FDA-approved generic drug that works to reverse an opioid overdose, including fentanyl overdose, by restoring breath to unconscious overdose victims. It is simple to administer, making it safe and easy for laypeople to use.

Good Samaritan Laws

The chance of surviving an overdose can depend heavily on how fast medical services are provided. Often, witnesses of an overdose are hesitant to call 911 due to fear of police involvement.

In an effort to prevent this from happening, the majority of US states have passed Good Samaritan laws. Many of these laws provide protection from prosecution for low-level drug offenses, like the sale or use of a controlled substance or paraphernalia, for the person seeking medical assistance as well as the person who overdosed. 

With rising cases of overdoses and drug-related diseases, the US continues to search for new and innovative approaches to drug use, drug treatment, and drug policy based on science and research.

A key tool to reducing health disparities in patient care involves diversifying the Nursing field. The Nursing population should be as diverse as the patient population they serve.

According to research, the majority of Nurses in the US are White/Caucasian at 73.3% and only 7.8% are African American. 

Jennifer Coleman, a Samford University Professor and Pediatric Nurse, is one of several National Black Nurses Association (NBNA) members working toward increasing diversity in Nursing. To help accomplish this goal, the association created a program called NBNA Mini Nurse Academies, which encourages elementary school students of color to consider a career in Nursing. 

"The purpose of this innovative program is to increase student awareness of Nursing as a career option and to provide students with knowledge and skills related to professional Nursing practice," said UAB School of Nursing Associate Professor Loretta Lee, PhD, CRNP, FNP-BC, CNE. "In these academies, students in third through sixth grades from school districts where there are large communities of color will be introduced to the Nursing profession by professional Nurses who share similar backgrounds and lived experiences."

The NBNA represents approximately 200,000 African American Nurses from the USA, Canada, Eastern Caribbean, and Africa, with 115 chartered chapters nationwide. They recognize the need to increase diversity within the Nursing field and are being proactive to do something about it.

The Direct Relief’s Fund for Health Equity awarded the NBNA with a $248,000 grant for the Mini Nurse Academy. The Fund was created to increase access to health care and improve health outcomes for marginalized communities. 

With this grant more mini academies will be able to offer learning modules that include class discussions, guest presentations, interactive hands-on activities and ongoing mentorship. It will also address social determinants of health by educating students about healthy lifestyles, according to the, University of Alabama at Birmingham. 

In a Direct Relief article Lee said, “Students in our communities probably don’t see people who look like them very often as Nurses. I believe you have to role model, meaning if a Black student or Brown student sees a Registered Nurse, has interactions with a Registered Nurse throughout their youth, then they are more apt to become a Registered Nurse if they can get information, if they can know what that profession is about. And they’re more apt to want to emulate what they see.” 

New programs will begin in the Fall of 2022 in Florida, Louisiana, Missouri, Illinois, Connecticut, Oregon, and South Carolina. 

The National Commission to Address Racism in Nursing defines racism as "Assaults on the human spirit in the form of biases, prejudices, and an ideology of superiority that persistently cause moral suffering and perpetuate injustices and inequities."

The Commission surveyed over 5,600 Nurses and found racism to be a significant problem in the field. Results show:

63% of Nurses personally experienced an act of racism in the workplace with the transgressors being either a peer (66%), patients (63%), or a manager or supervisor (60%).

56% of Nurses say racism in the workplace has negatively impacted their professional well-being.

“We are still living through the structural racism that is embedded in America,” says Quanna Batiste-Brown, DNP, RN, Chief Nursing Officer in Ambulatory Care at UCLA Health. “I think addressing it in Nursing is one of the things we can do to move forward.”

Along with addressing the issue, health systems are using various strategies to help eradicate Racism in Nursing.  

Establishing A Task Force

A task force or Council is usually a group consisting of healthcare leaders such as Chief Nursing Officers (CNO), Chief Diversity Officers (CDO), clinical and non clinical staff.

Seattle Children's task force is comprised of Nurses, coaches, Inclusion Network members, Physicians, support staff, scientists and leaders who developed the Health Equity and Anti-Racism Action Plan. 

Nurses at UCLA Health established a council called Unity in Diversity (UID). The primary purpose of UID is to assess, plan, implement and continuously improve actions toward establishing an authentic environment of equity, diversity, and inclusion for patients, trainees, and Nursing staff. 

Karen Grimley, PhD, MBA, RN, Chief Nursing Executive for UCLA Health told Becker's Hospital Review, "That group dovetails into the health system steering committee that's been created by our Chief health, Equity, Diversity and Inclusion Officer. So, we've tried to put a system in place that's going to identify and begin to address cultural norms that may be contributing to systemic bias and racism."

Education And Training

Mount Sinai Health System created the United in Solidarity Resource Guide. This guide is a catalogue of educational articles and resources to learn about racism, prejudice, and bias in America as well as causes to support the fight against injustice. 

Mass General Brigham launched its first system-wide anti-racism educational program, titled Stepping Stones. Stepping Stones was designed to allow viewers to understand how racism exists and functions in our society - and how they can combat it.

RWJ Barnabas Health compiled a list of educational anti-racism resources such as implicit bias tests, white privilege checklist, and a systemic racism video series. 

Diverse Leadership

Hiring Nurses that represent diverse communities is essential. They provide opportunities to administer quality care because of their understanding of various cultures, languages, gender identities, ethnicities, etc. Having diverse Nurses in leadership positions can play a crucial role in breaking down barriers such as discrimination in Nursing.

Staff from diverse backgrounds with histories of discrimination in healthcare may feel reassured when they see people who look like them in leadership positions. They may also feel more comfortable coming forward and reporting an incident of racism or discrimination.

No matter which initiatives a hospital implements, it must start with awareness and identifying any structural biases or barriers.

Marcus Henderson, MSN, RN, lecturer from the University of Pennsylvania’s Department of Family and Community Health, said “To adequately and effectively address health inequities and social determinants of health, Nursing must first look inward to address the inequity, lack of diversity, discrimination, and racism that lies within the profession. It’s not hiding. It has always been in plain sight.”

Men become Nurses for the same reason women do, to take care of people. And even though Male Nurses are becoming more common, they still face constant stereotyping on the job.

In order to provide optimum care and reduce health disparities, our healthcare professionals should be as diverse as the patient population they serve. This means Men must become equally represented in the Nursing field.

Increasing the number of Men in Nursing is seen as difficult because of social stigmas and stereotypes. Some common stereotypes that must be crushed are:

Women's Work

Nursing is viewed as a female dominated profession, but that is changing. Back in the 1960's Men made up about 2% of Nurses in the United States. In 2021, according to the Bureau of Labor Statistics, that number is closer to 13%. 

People tend to associate caregiving and nurturing with women's roles and simply because of their gender, Men are believed to be lacking these things and can't be a good Nurse. This of course isn't true. 

This misconception can dissuade skilled and caring men from entering the field, preventing them from truly helping people.

“In my neighborhood, especially my old friends, they always thought that being a Nurse was a job for females,” said Geovany Ruiz, who plans to work as an Oncology Nurse. “So, I put off being a Nurse for a long time. But when it comes down to doing the job, it doesn’t matter if you’re male or female. We can both do the job.”

Sexual Orientation

Other stereotypes that branch from the field being female dominated is Men's sexual orientation, including the belief that male Nurses are Gay. Or the opposite belief that Men join the profession with a higher female to male ratio with the idea that they have a better chance to achieve relationships.

"It's important to note this stereotype is often fueled by a patient's own insecurities and fears. Don't take it personally; keep calm and be patient with them. Again, educating patients on the evolving role of Nursing and how it's not a gender-specific role can help combat this stereotype," advises George Zangaro, RN, FAAN, Associate Dean at Walden University School of Nursing.

Doctor or Failed Doctor

Some people see a Man in scrubs or with a stethoscope and assume he is a Doctor. Other people assume that when a Male Nurse isn't a Doctor it's because he failed to become one. This harmful stereotype is rooted in the belief that Nurses are inferior to Physicians and that Nurses are Women and Doctors are Men.

Television and movies have a strong influence on society’s perception of Men and Women in healthcare.

Mark Gustin, RN, at Brandon Regional Hospital said, “The worst thing for Men in Nursing was 'Meet the Parents' because it emphasized the social stigma that Women are Nurses and Men are Doctors, Directors, and CEOs.”

A great way to combat these stereotypes is by educating patients that Nursing is not gender-specific and that Women are also entering a number of typically male-dominated fields.

There are large disparities in mental healthcare across races and ethnicities in the U.S. Many factors contribute to the poor mental health outcomes of minority populations. Such as:

• Inaccessible mental healthcare services
• Transportation issues, difficulty finding childcare/taking time off work
• Lacking health insurance coverage
• Cultural stigma regarding mental healthcare
• The lack of Black, Indigenous, and people of color (BIPOC) healthcare professionals
• Racism, bias, and discrimination in healthcare
• Language barriers

Nurses have the first-hand experience needed to advocate for their patients, colleagues, and themselves. They can influence change in their workplace, communities, Nursing organizations, educational institutions, and with policymakers.

Legislators are the experts in drafting laws and regulations, but they often rely on subject matter experts to inform them on changes that must be made. When it comes to healthcare policies, Nurses are those experts. 

Nurses are the largest workforce group in the healthcare industry and the most trusted.

Year after year for 20 straight years, Nurses have led Gallup's annual ranking of professions for having high honesty and ethics.

Here are some ways Nurses can influence change in healthcare policy.

In The Community

On a local level, Nurses can provide fact-based perspectives at town halls and city council meetings, as well as on school boards and in public health departments. They can also run for public office.

Not only can Nurses translate scientific jargon but they can also help raise awareness about what is factual and what is false. They have an important voice in determining public health measures such as mask mandates and stay-at-home orders. 

At Work

Nurse leaders can advocate for their patients and fellow staff at their facility by shedding light on Nursing policies such as patient care standards, safe staffing levels, new technologies, and staff well-being."

Nationally

Many Nurses join National Nursing Organizations which usually have state chapters or societies. These organizations offer a variety of ways Nurses can help them influence national healthcare policies such as writing letters to legislators, campaigning for public support, and organizing events/fundraisers.

By joining these organizations, Nurses can use their collective voice to influence change.

For example, the Oncology Nursing Society (ONS) hosts an Annual Capitol Hill Days event where Nurses from across the nation come together to hear presentations from society leaders and special congressional guests.

These organizations also offer mentoring programs. Nurses can mentor less experienced Nurses about lobbying policymakers, public speaking, campaigning, and fundraising.

Nurses are essential advocates for healthcare policy and their influence is needed at all levels - nationally, locally, and in their place of work.

Times have been challenging for Nurses. Many of you are feeling down and in search of inspiration. A small dose of encouragement can go a long way, so we compiled a collection of inspirational, motivational, and some humorous quotes to lift you up.

1. “Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest accomplishment, or the smallest act of caring, all of which have the potential to turn a life around.” – Leo Buscaglia

2. "Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all." – Dale Carnegie

3. “We may encounter many defeats but we must not be defeated.” —Maya Angelou

4. “As a nurse, we have the opportunity to heal the heart, mind, soul and body of our patients, their families and ourselves. They may forget your name, but they will never forget how you made them feel.” — Maya Angelou

5. "Once a nurse, always a nurse. No matter where you go or what you do, you can never truly get out of nursing. It’s like the Mafia… you know too much." – Deb Gaudlin, RN

6. “America’s nurses are the beating heart of our medical system.” — Barack Obama

7. “Nurses are the heart of healthcare.” — Donna Wilk Cardillo

15. “Knowing is better than wondering, waking is better than sleeping, and even the biggest failure, even the worse, beats the hell out of never trying.” — Grey’s Anatomy

16. “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.” – Margaret Mead

19. “Who inspires me to be a nurse? Every nurse who doesn’t turn their back on nursing students, or graduate nurses, every nurse who acknowledges it’s okay and simply human to make foolish mistakes, every nurse who takes a moment of their time to help when you’re scared, and every nurse who remembers what it’s like to be a beginner.” – Anonymous Nurse

20. "Nurses are there when the last breath is taken, and nurses are there when the first breath is taken. Although it is more enjoyable to celebrate the birth, it is just as important to comfort in death." – Christine Bell

21. “Kindness can transform someone’s dark moment with a blaze of light. You’ll never know how much your caring matters. Make a difference for another today.” ― Amy Leigh Mercree

As we start the new year, we take a look at trends we expect to see in the Nursing field. Many health experts agree staffing has been and will continue to be the top healthcare issue.

Nurse Shortage

Many factors play into the staffing crisis like the pandemic, retiring Nurses, and high rates of burnout.

Rhonda Thompson, DNP, CNO and SVP of Patient Care Services at Phoenix Children's Hospital told Beckers Hospital Review, "The nursing shortage affecting health systems nationwide will continue to be a challenge in 2022. This has a greater impact than just unfilled positions and scheduling sufficient nurses based on a high patient census. It also means our experienced staff nurses are investing a great deal of time onboarding and training newly licensed nurses, in addition to their own daily bedside care responsibilities. To solve this, it will take collaboration and commitment from our health systems, staff, and academic partners."

According to the U.S. Bureau of Labor Statistics, about 194,500 openings for Registered Nurses are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.

Increase In At-Home Healthcare

The COVID-19 pandemic created a demand for at-home healthcare that continues to grow.

According to Forbes, the Home Care Providers industry is among the fastest growing healthcare industries in the United States. "Industry revenue, according to IBISWorld, has grown at an annualized rate of 2.2% to $96.9 billion over the past five years."

At-home healthcare has many benefits. So much so, last year a bill called the Choose Home Care Act 2021 was presented to Congress. If passed, this would give patients the opportunity to leave the hospital and recover at home with a mix of expanded skilled Nursing, therapy, personal care, telehealth services, and more.

Prioritizing The Well-Being Of Healthcare Workers

The pandemic has pushed an already stressed-out career field to its breaking point. Nurses are facing high rates of burnout and compassion fatigue.

Compassion fatigue is the emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events.

According to J. Maben and J. Bridges (2020), the pandemic has led Nurses to experience the highest level of stress that has ever been recorded compared to other professions.

Healthcare organizations and leaders have the opportunity and the responsibility to support and prioritize their staff's mental and physical well-being.

These healthcare workers have given so much of themselves they have nothing left to give and yet they are still showing up day after day under impossible circumstances. But for how much longer?

Nurses want to feel valued and safe in their work environment. Healthcare organizations must ensure Nurses are equipped with resources and the support they need to provide quality care.

Nursing School Online

The pandemic forced Nursing schools to provide their classes online to avoid the spread of the virus. Many institutions have continued the online learning option for some of their programs.

According to a report from Inside Higher Ed, about 60% of colleges and universities do plan to keep some of their undergraduate programs fully online.

Online schools provide a great opportunity for Nurses who are looking to advance further in their education, but don't have the time to physically attend classes between shifts.

Being a Nurse is challenging, but being a Nurse with Attention Deficit Hyperactivity Disorder (ADHD) can feel almost impossible some days.

According to the CDC, there are three different types of ADHD, depending on which types of symptoms are strongest in the individual:

• Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

• Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

• Combined Presentation: Symptoms of the above two types are equally present in the person.

If you haven’t been diagnosed with ADHD, but relate to these symptoms, talk to a healthcare provider about what you’re experiencing. You may benefit from some type of therapy or treatment.  

In addition to therapy techniques and/or medication, here are strategies to help manage your ADHD throughout your shift.

Arrive at work a little early. This gives you an opportunity to get the low down on your patients, take notes, and create some kind of schedule for your shift.

Lists are your best friend. Make lists of anything you need to do during your shift and check them off as you go.

If you are frequently losing or misplacing things like your stethoscope, try using tracker tags. Tile Mate Bluetooth trackers are great tags to help you find lost items.

For smaller items like pens, try using retractable holders and attach to your badge or lanyard. Amazon has lots of options.

Sitting down to chart and feel overwhelmed trying to remember everything from your shift? It may not always be possible, but try to do as much of your charting in present time. Your documentation will be more accurate and you'll use less brain power remembering the details and times you did your assessments.

Find a quiet spot to chart. It can be hard to focus and not get distracted by noises and coworkers. Your charting will be more accurate and done faster if you can find a private nook, cubicle or spot behind the Nurse's station.

During Nurse-to-Nurse handoff, details can get lost in reporting. Using a brain sheet can help you stay organized and save time by efficiently sharing the patient's story. Check out these brain sheets by scrubsmag.com.

Finish working on one patient before moving on to the next. Avoid running back and forth between patients (unless it's an emergency). Instead of visiting one patient multiple times within an hour, cluster your care and get everything done at once. Do your assessments, administer medications, make necessary calls, and document while you're still in the room.

Set an alarm to help you move on to another task. Some people with ADHD tend to hyper focus on one task and end up losing track of time.

Remember your treatment plan. Schedule a routine time to take your medications so they last the duration of your shift or set an alarm to remind yourself to take your medications if you need to take another dose during your shift. 

Outside of work, support groups are a great outlet to connect with others who have similar experiences. These groups often meet regularly to share concerns and achievements, to exchange information and strategies, and to talk with experts.

The National Resource Center on ADHD, a program of Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD®), supported by the Centers for Disease Control and Prevention (CDC), has information and many resources. You can reach this center online or by phone at 1-866-200-8098.

Creating a workplace with a strong Diverse, Equitable and Inclusive culture is not only the right thing, it’s also crucial for your retention and improving patient care.

A study from Press Ganey shows health systems with strong Diversity, Equity, and Inclusion (DEI) values have less risk of staff potentially leaving the organization.

The study also found:

• Healthcare organizations had twice as many employees at risk of leaving if the workforce perceived diversity and equity weren’t prioritized versus work forces that do.  
  
  
• The risk of leaving within 3 years is more than 4 times higher for healthcare workers who believe their organization doesn’t value employees from different backgrounds versus workers who do.  
  
  
• If offered another job, healthcare workers are 4 ½ times more likely to leave an organization if they believe different backgrounds aren’t valued, or if the organization isn’t committed to workforce diversity, versus workers who do.   
  
  
• Perceptions of diversity & equity are a bigger indicator of intent to stay with an organization among security personnel, nurses and physicians than other ancillary staff. 

Having a strong DEI culture allows employees to be comfortable and confident in who they are. This allows them to focus on providing the best patient care possible.

Research shows, 77% of employees and 80% of leaders who are disabled chose not to share their disability in their workplace. For LGBTQ workers, 46% are closeted at their place of work. And across all diverse characteristics, 75% of employees feel the need to mask their differences or downplay them during work.

Employees masking or hiding aspects of themselves during shifts affects their confidence, motivation, feelings of safety and hinders their job performance.

It’s important for healthcare workers to have mentors they can look up to throughout their careers. A lack of diversity can make it difficult for minority healthcare workers to find role models they identify with. This can impact their professional growth and their ability to provide optimal patient care.

A strong DEI culture isn’t something that can be achieved overnight. It requires a leadership who is dedicated to promoting cultural awareness and inclusion. It requires staff who are willing to take the time to learn about and understand each other. It also means being willing to identify and address biases.