DiversityNursing Blog

As a health care giver, you have a responsibility to ensure that they have adequate knowledge in order to provide competent nursing care. Malcolm Gladwell wrote about “rapid cognition,” or our innate sense of “knowing” in his 2005 book, “Blink.” If you haven’t read it, I highly recommend it; it is a fascinating read for all nurses. Of it, Gladwell says:

“You could also say that it’s a book about intuition, except that I don’t like that word. In fact, it never appears in ‘Blink.’ Intuition strikes me as a concept we use to describe emotional reactions, gut feelings -- thoughts and impressions that don’t seem entirely rational. But I think that what goes on in that first two seconds is perfectly rational. It’s thinking -- it’s just thinking that moves a little faster and operates a little more mysteriously than the kind of deliberate, conscious decision-making that we usually associate with ‘thinking.’ In ‘Blink’ I’m trying to understand those two seconds. What is going on inside our heads when we engage in rapid cognition? When are snap judgments good and when are they not? What kinds of things can we do to make our powers of rapid cognition better?”

Within professional nursing, we call this concept “tacit knowledge.” It is not easily shared through lectures or books, but it comes with experience and knowing through repetitive, almost unaware situations and critical thinking. I explicitly learned about tacit knowledge (what an oxymoron) in my undergraduate nursing studies. However, I actually learned tacit knowledge while working with patients alongside more experienced nurses.

I picked it up from colleagues such as the night shift nurse, a LVN with 30 years of experience, who walked back to the desk after assessing a certain patient she’d cared for during the last three days saying, “I’m going to keep my eye on Mr. Second-Door-on-the-Left. I can’t put my finger on it, but I’m going to watch him.” As the oh-so-terribly-young charge nurse, I’d walk in and assess him, too, especially because I knew he was scheduled for discharge some time the next day. Not seeing what my colleague saw nor anything in the chart to cause alarm, I brushed it off only to think, What the…???, as we called a code in the wee hours of the morning -- in between patient rounds because my colleague increased her routine patient checks, “just because.” Similar situations have happened to me numerous times, and I have learned to trust members of the nursing community when they sense something going awry with a patient.

Tacit knowledge is one way to improve patient care, though it’s hard to explain when you know it as well as when you learn it. What a mysterious and fascinating concept and feeling.

Source: NurseTogether

About a month after passing his state licensing exam, Arthur Greenbank was cashing a paycheck in his field.

The University of Akron graduate is not alone: Of all the majors that students can choose, it is nursing that offers the best chance for employment.

“I tell graduates not to worry, that they almost certainly will land a job within a few months of graduating,” UA nursing administrator Cheryl Buchanan said. “If they would go to Florida or Michigan, they would find a job immediately.”

Researchers at the Georgetown University Center on Education and the Workforce examined 2009 and 2010 census data to determine what college majors are most likely to lead to jobs.

“People need to pay attention to this,” center director Tony Carnevale said. “It tells you that if you really want to be an architect, that's fine, but you're going to have to think more about what your plan is.”

“Hard Times, College Majors, Unemployment and Earnings 2013: Not All College Degrees are Created Equal” notes that the unemployment rate for recent nursing graduates is 4 percent. Meanwhile, the typical unemployment rate for majors in many liberal arts fields is double that, and that of architecture and fine arts graduates is more than triple at 13.9 and 11.1 percent, respectively.

What the researchers don't know is whether the graduates were working in their major. Some college majors don't have clear career paths.

That was reflected in the unemployment rates for area ethnic and civilization studies (10.1 percent) and philosophy and religious studies (10.8 percent).

Other majors, such as architecture, have suffered in the economic downturn, although their unemployment rate is gradually improving, Carnevale said.

Only 50 to 54 percent of recent college graduates are working in their majors, Carnevale said.

That means that some “employed” college graduates really might be working in fields once reserved for high school graduates: the proverbial English major driving a cab, for instance.

That can be an expensive outcome, given the cost of college.

“There is lots of pressure now to find out what the value of the college major is,” Carnevale said.

He said that graduates with certificates in heating and air conditioning from a community college can make more than typical graduates with bachelor's degrees.

“It's all about the field of study,” he said.

Buchanan, the UA nursing administrator, said all 55 of the spring 2012 nursing graduates who responded to a UA survey are working in their field or are attending graduate school.

Although nursing might be the fastest route to a paycheck, other majors can eclipse it in salary, according to the Georgetown study.

Electrical engineering ($57,000), mechanical engineering ($58,000) and civil engineering ($50,000) pay more at the start than nursing ($48,000). Same with graduate degrees: Those in nursing earn $81,000 compared with $107,000 for majors in pharmaceutical sciences and administration, $96,000 for chemistry majors and $101,000 for economics majors.

Source: TribLive

By Mable Smith, PhD, JD, MSN, BSN, RN

A diverse nursing student body builds the foundation for a diverse workforce that can become effective in the provision of culturally competent care to patients. Our student body at Roseman University of Health Sciences is reflective of the diversity seen in the population that consists of Caucasians, African Americans, Hispanics, Asians, Native Hawaiian and other Pacific Islanders, to name a few.  This diversity is reflected in the health care system among workers and patients. Students bring a wealth of information that is shared with each other and with faculty.

For example, in a class discussion on nutrition, students from various cultures shared how and what types of foods are used to treat certain illnesses. There were discussions on how food should be presented, such as hot versus cold, raw versus cooked.  Some students shared the significance of family presence during meals even for hospitalized patients. These discussions quickly incorporated religious practices and certain etiquettes to promote “religious correctness” when interacting with various cultural and religious groups. Students also provided insight into generational differences and changes with emphasis on the fact that many in the younger generation have not adopted the strict traditions of their parents and grandparents.

Several students picked up on the stereotyping of religious and cultural classifications.  Two students of the same racial group, but from different parts of the U.S., highlighted the differences in their beliefs, values, health practices, diets and even religion. Both are African American students, with one raised Catholic and the other Baptist.

Students in the College of Nursing are assigned to groups and remain with their group through the program of study. They learn to work with a racially and culturally group of people, address issues, confront problems, and share in successes. They rely on each other during clinical rotations to address the diverse needs of patients. More importantly, this foundation in education provides the tools for them to effectively interact with members of the interprofessional health care team.

The diversity in the College is the strength of the program. Learning from each other promotes collaboration, encourages innovation, and leads to respect.

Nursing is both an art and a science. While the science is fairly uniform, the art is often learned from experiences and interacting with others. These students graduate with a strong knowledge base, but most importantly with a mutual respect and appreciation of individual differences.  Educational policies should promote, not hinder, diversity.

Source: Robert Wood Johnson Foundation

SOURCE: American Sentinel University

By Erica Moss

Georgetown University School of Nursing and Health Studies shares “The American Nurse,” a collection of photographs from Carolyn Jones, exploring the unique lives of nurses from across the country, capturing extraordinary personal stories through photography and interviews.

Here, we present some of our favorite excerpts from this incredible book, which help celebrate the important role of the nurse in the U.S. health care system and shed light on what it really means to practice in this important role. 

By Lois Gerber, RN, BSN, MPH

It was my first nursing visit to Thad and Larissa. The three of us sat around their kitchen table discussing how to best manage an exacerbation of Thad’s multiple sclerosis. Tears welled in the corners of Larissa’s brown eyes as she twisted a strand of her strawberry blonde hair around her finger. 

"His MS seemed to get worse overnight," Larissa said. "He can’t walk up the stairs anymore without hanging onto the railing for dear life. [Our doctor] says it’s time for a stair lift." 

"I can beat these new problems," Thad replied. "Prayer, persistence and exercise. My sales manager suggested a disability leave, but I refused. Give me a month here at home. I’ll show him." His hands shook as he hitched his belt over his potbelly. "There will be no damn chair lift in my house. Mind over matter." 

I took a deep breath, remembering that the physician referral documented an exacerbation of an aggressive form of MS that limited the chance of significant recovery. Double vision accentuated his mobility problems. 

Hope and unrealistic expectations — a common but difficult scenario I’d often seen in my work as a home healthcare nurse. But how to best help Thad accept his limitations while keeping hope in his heart? And convince Larissa to encourage her husband to be as independent as possible?

First, I needed to do a complete assessment and work with the couple to develop an effective long-term care plan with an overall goal and the individual steps to accomplish it. Without realistic expectations, Thad and Larissa’s fears and anger would further the family dysfunction.

I paused. "Thad, physical therapy can strengthen your muscles and improve your walking. An occupational therapist can teach you ways to deal with small things like brushing your teeth and shaving."

"I’ve already had two stints with them and learned everything I need to know," he said, clenching his fists.

I looked at Thad. "Let’s make a deal. You agree to have physical and occupational therapy for four weeks and I’ll visit twice a week, communicate with the doctor and follow up on any problems you have. Then we’ll talk about the stair lift." 

Over the next month, I counseled Thad and Larissa, individually and as a couple. "I’m scared what will happen to me if Thad dies," Larissa admitted one day while we were alone, reviewing handouts on managing the disease. 

"That’s understandable, but overprotecting him and not letting him do what he can safely do hurts his rehab potential." I highlighted sections in the pamphlets that pertained to caregiving.

She frowned. "I’m angry at him for getting sick and feel guilty about that, too. We’re only 55. If he got hurt, I’d blame myself. That’s why I’m overprotective. I’m scared."

I nodded. "All your feelings are normal. Most caregivers feel the same."

"No one else I know has to deal with MS. I’m alone, depressed."

"The Multiple Sclerosis Society has a caregiver support group that meets every week at the city library. That’s where you’ll find people who feel just like you. Talking with them will help."

Thad’s fear and anger manifested in denial instead of depression. "It’s hard to get the mind and the body working together sometimes," I told him. "With a chair lift, you could save your energy for things that are important and that you enjoy."

"Like going to work?"

"That could be a realistic goal. What about cutting back to three days a week?" 

He smiled. "I can live with that. And Larissa’s right. The stair lift is a good idea."

Helping clients set realistic goals is important to keep hope alive. Unrealistic goals foster fear, denial, anger and depression. But without hope, clients lose the moorings for their lives. 

Source: Nurse.com

The Robert Wood Johnson Foundation (RWJF) announced Monday that it is investing $20 million in the new Future of Nursing Scholars program to support some of the country’s best and brightest nurses as they pursue their PhDs. In its landmark nursing report, the Institute of Medicine recommended that the country double the number of nurses with doctorates; doing so will support more nurse leaders, promote nurse-led science and discovery, and put more educators in place to prepare the next generation of nurses. The University of Pennsylvania School of Nursing, which hosted today’s event to launch the new program, will serve as the national program office for the Future of Nursing Scholars program.

“Implementing the Institute of Medicine nursing report is a major priority for RWJF, because we cannot achieve our mission to improve health and health care without a robust, well-educated nursing workforce and many more highly educated nurse leaders,” said John Lumpkin, MD, MPH, RWJF senior vice president and director of the Health Care Group. “The PhD-prepared nurses the Future of Nursing Scholars program supports will help identify solutions to the country’s most pressing health problems, and educate thousands of nurses over the course of their careers. They will be positioned to lead change and inspire the next generation of nurses.”

Fewer than 3,000 of the nation’s more than 3 million nurses have doctoral degrees in nursing, and many of them have DNPs, not PhDs, which prepare nurses to conduct research and teach. The average age at which nurses get their PhDs in the U.S. is 46—13 years older than PhD earners in other fields.

In 2014, schools of nursing will apply to join the Future of Nursing Scholars program, which will support up to 100 PhD nursing candidates over its first two years. The first scholars will begin their PhD studies in 2015. They will receive scholarships, stipends, mentoring, leadership development, and dedicated post-doctoral research support. To expand the new program’s reach, RWJF has developed a strategic philanthropic collaborative to engage other donors.

“Having supported nursing in our region for 10 years, we are very proud to be the first foundation to join this new collaborative, which is bringing together diverse funders to support the PhD-prepared nurse leaders the country needs,” said Lorina Marshall-Blake, president of the Independence Blue Cross Foundation. “We expect the nurse scholars this program supports to transform health care through innovation in their communities and nationwide.” Marshall-Blake said the Independence Blue Cross Foundation is committing $450,000 over three years to support nurses in becoming transformational leaders in education, research, and policy.

The co-directors for the Future of Nursing Scholars program are Susan B. Hassmiller, PhD, RN, FAAN, RWJF’s senior adviser for nursing and Julie Fairman, PhD, RN, FAAN, the Nightingale professor of nursing and director of the Barbara Bates Center for the Study of the History of Nursing at the University of Pennsylvania School of Nursing.
Other speakers at the launch were: Afaf I. Meleis, PhD, DrPS (hon), FAAN, the Margaret Bond Simon Dean of Nursing at the University of Pennsylvania School of Nursing; Elizabeth Galik, PhD, CRNP, an assistant professor at the University of Maryland School of Nursing and an RWJF Nurse Faculty Scholar whose research is helping older adults suffering from dementia; Munira Wells, PhD, RN, an RWJF New Jersey Nursing Scholar whose research focus is New Jersey nurses who were born in India and faced culture shock in the United States; and Maryjoan Ladden, PhD, RN, FAAN, senior program officer at RWJF.
 

About the Robert Wood Johnson Foundation 

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For more than 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter at www.rwjf.org/twitter or Facebook atwww.rwjf.org/facebook.
 

About the Independence Blue Cross Foundation

In October 2011, the Independence Blue Cross Foundation, an independent licensee of the Blue Cross and Blue Shield Association, launched a charitable, private foundation, whose mission is to transform health care through innovation in the communities it serves. The IBC Foundation and Independence Blue Cross, which is celebrating its 75th anniversary this year, are both committed to improving the health and wellness of the people of southeastern Pennsylvania. The foundation targets the following areas of impact:

• Caring for our most vulnerable: Supporting nonprofit community health center clinics that deliver quality, cost-effective primary, medical, and dental care to uninsured and underinsured people.

• Enhancing health care delivery: Strengthening the nursing workforce through education, career development, and research.

• Building healthy communities: Partnering with community leaders and programs to address community health and wellness needs.

Source: Newswise

By  Jennifer Smola 

Sixty-one years after graduating from Mount Carmel College of Nursing, one of the school’s first black graduates is finally hanging up her stethoscope.

June Todd, 83, retired yesterday from Dr. Charles Tweel’s family-medicine practice on the Northwest Side. Todd graduated from Mount Carmel in 1952, in a class of 52 nurses. All were women, and, for the first time, four were black.

Todd, who lives in Worthington, attended Harding High School in Marion, north of Columbus. She considered studying library science, but her school librarian told her she would have a hard time getting a job in the North because of her race.

“I said, ‘That’s not going to work,’  ” Todd recalled. “So I decided I wanted to become a nurse."

Her race seldom made a difference during her nursing career, she said. And she has fond memories of her time at Mount Carmel.

“I loved the nuns,” she said. “Everybody was so nice.”

Tweel described Todd as a “ball of energy” who never missed work. She’s popular not only among her co-workers but with patients, who “like seeing her more than they like seeing me,” he said.

Enid Patterson, a patient for 10 years, said she was sad to see Todd go.

“She’s not just my nurse,” Patterson said. “She’s my friend.”

When Tweel hired Todd 13 years ago, she planned to stay only a year or two, she said, but she stuck around because she liked the work.

Her co-workers said she brought humor and energy to the office every day.

“She’s the only 80-some-odd-year-old woman that has an opinion on everything from Hillary Clinton to why Chris and Rihanna should not be together,” co-worker Beth Shahan said. “She’s very with-it and hip.”

Though Todd is retired, she says she’s not done working. She plans to volunteer at local nursing homes and perhaps at a Worthington library.

The job of nurse anesthetist comes with many attractions. There’s a high level of responsibility, a challenging work environment and the chance to do good for others. There’s also the prospect of virtually assured employment.

“I saw that there was going to be job security. It would pretty much always be there,” said Navy Reserve Lt. j.g. Loren Gaitan.

Gaitan, 33, is working on her master’s degree at Florida International University in a full-time, 2½-year program. A former neonatal nurse, she is looking to the anesthetist specialty as a way to increase her skills and take on more responsibility.

It could be a lucrative move: Salary.com puts median annual pay at nearly $180,000.

Nurse anesthetist is one of several fast-growing nursing specialties. Thanks to changes in national health-care laws, a range of concentrations in the nursing field are rising to the fore. With new mandates requiring employers to insure their workers, the health-care system will see a flood of new patients, said Connie White Delaney, dean of the University of Minnesota School of Nursing. “The opportunities across the nation will be just profound,” she said.

Job options

Any of these growing jobs could be an easy fit for a veteran with training as a military nurse:

Nurse practitioner: This person typically has a master’s degree as well as a certification from one of several national bodies. The practitioner may diagnose illnesses, examine patients and prescribe medication. “They are not just going to treat the symptom. They will say, ‘You need to diet. You need to exercise,’ where a physician might just give you a pill,” said Gerrit Salinas, director of the recruiting agency Snelling Medical Professionals. “A nurse practitioner can help people feel like they are more than just a number.” The American Academy of Nurse Practitioners puts the mean salary at $91,310.

Nurse informatics: With the rise of electronic medical records, the role of the informatics nurse has become increasingly significant. These workers don’t just convert paper into electronic records; they also must be well-versed in patient care, privacy issues and technology. They may work in medical settings but also in home health agencies, insurance companies and other entities involved in the management of digital records. The average salary is $98,702, according to the Health Informatics Forum.

Case management nursing: Here again, changes in health-care law are driving demand. As new care models evolve, providers will be expected to coordinate medical treatments in order to ensure efficient and effective care. That’s a big part of the case management job description. Case management nurses typically coordinate long-term treatment, especially for patients with chronic conditions. The average salary is $73,000, according to job site Indeed.com.

Geriatric nursing: Care for seniors is a fast-growing field as the nation’s aged population swells. Medical issues may include diabetes, respiratory problems, hypertension and other conditions. Geriatric nurses offer treatment, while also offering guidance to patients and families. The average salary for a geriatric nurse is $54,457, according to ExploreHealthCareers.com.

Home health nursing: As the name suggests, home health-care providers deliver services to those whose conditions allow them to stay at home but who still require ongoing medical attention. The field is growing fast, largely on account of the rapidly expanding population of older Americans. Salaries average around $40,000 but can vary widely by geography.

Go anywhere

There are numerous avenues into nursing, including specialized fields. The American Nurses Association,http://www.nursingworld.org/, offers guidance.

To support veterans in the field, the government’s Health Resources and Services Administration makes grants to colleges and universities with expedited curricula that help train vets for careers as physician assistants. The Veterans Affairs Department employs a range of nurses.

“We recognize this as an opportunity to support veterans who have served the nation, and as a chance to help fill some shortages in the health care area. It’s a win-win situation,” said Joan Wasserman, Advanced Nursing Education Branch chief for HRSA’s Bureau of Health Professions.

Many schools offer programs of various lengths for those looking to get into the field. Advocates say it’s worth the effort.

“Nursing is one of the best careers you can get into because it is so flexible,” said Pat Harris, associate director of a program at Arizona State University Online that helps practicing nurses earn the Bachelor of Science in Nursing degree. “No matter what changes are in the wind in health care, you are going to be in a key position. Once you have that license to practice medicine, you can go anywhere.”

Source: Marine Corps Times