DiversityNursing Blog

The Gallup polls are in and for more than two decades, Nurses have achieved the highest ethics rating from Americans.

According to the findings, the 79% of U.S. adults who now say Nurses have “very high” or “high” honesty and ethical standards is far more than any of the other 17 professions rated.

Nurses have topped the list every year except one since they were added to the annual ratings in 1999. That was in 2001, when firefighters earned a record-high 90% rating in the wake of the 9/11 terrorist attacks.

"Nurses have earned the trust of the American people by putting patient safety above all else," said Katie Murphy, a practicing ICU Nurse, and President of the Massachusetts Nurses Association. "The public has seen Nurses give everything to their patients during the COVID-19 pandemic while fiercely advocating for improvements to care quality and access."

Nurses, medical doctors and pharmacists remain the most ethically revered professions of those measured by Gallup.

Professions to earn the lowest ethics ratings were Car salespeople, members of Congress and telemarketers. 

Thinking about changing careers? At any stage in life, Nursing is a great choice because Nurses are always in demand. It's a challenging, but rewarding field and previous education can help you become a Nurse faster.

"I'm a second career Nurse. What's wonderful about Nursing, is that it's very accessible after you've already been to school or college for another type of degree," Telemetry Nurse, Victoria told Johnson and Johnson. 

If you already have a Bachelor’s degree in any field, an accelerated Bachelor of Science in Nursing (ABSN) program is the quickest route. It usually takes less than 2 years. If you don't have a prior Bachelor’s degree, you can become a Registered Nurse (RN) with an Associate’s Degree in Nursing (ADN) or you can enter the workforce even quicker by becoming a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). 

After you earn your Nursing degree, you’ll be eligible to take the National Council Licensure Examination (NCLEX), which is administered by the National Council of State Boards of Nursing (NCSBN).

There are two of the NCLEX exam: The NCLEX-RN is a computerized exam required by all state boards of Nursing to qualify for an RN license. The NCLEX-PN is required to practice as an LPN.

After you pass the NCLEX, you must apply to your state board of Nursing for a license to practice.

If you're asking yourself, "Am I too old to become a Nurse?" The answer is no, it's never too late to join  the Nursing workforce. According to the NCSBN, the median age of working Registered Nurses is 52 years old. 

It's also important to remember this point by Indeed, your career length doesn't reduce the impact you may bring to the unit once you work as a Nurse. Your contribution makes a huge difference regardless of how long you can be active in the field.

"If you are a baby boomer or Gen X, there’s a place in Nursing for you. Your past work experience, dedication and passion are all needed resources within the healthcare arena. As Uncle Sam once said, “We Want You!," wrote Judy McDaniel, RN, MSN in a Nurse.com article.

According to The Department of Labor, The U.S. Bureau of Labor Statistics projects that more than 275,000 additional Nurses are needed from 2020 to 2030, and that employment opportunities for Nurses will grow at 9%, faster than all other occupations from 2016 through 2026.

This high demand is due to a variety of factors such as an increase in chronic conditions, an aging population and a stronger emphasis on preventative care.

Commitment, Conscience, Competence, Compassion, and Confidence

Learning and adapting these concepts will allow you to provide better care and will improve the relationships you have with your patients as well as co-workers.

If you're interested in learning more about different Nursing Specialties, Click Here! 

Healthcare workers, especially Nurses, face more challenges today than ever. Nurses must quickly adapt to fluctuating Nurse-Patient ratios, evolving technology, and the evolutions of healthcare and how it affects the way we provide care to our patients. Medication errors are an unfortunate consequence of overwork, distraction, and system errors. The consequences of medication errors can range from minor to serious. Serious medication errors can even result in death.

Causes of Medication Errors

Medication errors can be the result of any failure to ensure that the correct medication is being administered. Clinicians, pharmacy staff, and Nurses all play a critical role in ensuring patients receive the proper medications. Clinicians must ensure that the correct medications, dosages, and routes are being ordered. Pharmacy staff must double-check the ordering clinician and then input the correct medication, dosage, and route are being entered into the electronic system. Then Nurses must check the information again before administering the medication. Even though errors can occur anywhere along this chain, Nurses carry the ultimate responsibility to check and double-check every medication they administer.

How You Can Prevent Medication Errors

No well-intentioned Nurse wants to make a medication error. Nurses are the front line of healthcare, and it is up to us to prevent errors from occurring whenever possible. Here are some things you can do to keep your patients safe and avoid medication errors.

Avoid Distractions: Avoiding distractions can sometimes be easier said than done. Nurses are constantly juggling the tasks and needs of several different patients at the same time. Distractions that can lead to medication errors can be caused by ringing phones, call lights, IV pump alarms, and interruptions by family members or coworkers.

Nurses tend to work in high-stress situations, which can lead to distraction. Whenever possible, you should avoid distractions while preparing or administering medications. Medications should be prepared in the patient’s room and double-checked to the electronic record to prevent errors from occurring.

Check the Five ‘Rights: The five rights to correct medication administration is a simple, but effective method to ensure that medications are being administered safely and correctly. Before administering any medication, make sure that you verify all five rights.

• Check the name on the order and verify the correct patient using 2 identifiers. Ask the patient their name and date of birth and check that their wrist band displays the same information.

• Check all medication labels and compare them to the original order to ensure they are the same medication. At this time, you could also check the medication’s expiration date and ask the patient if they have any medication allergies.

• Check the ordered dose and compare it to the medication on hand. Confirm that the dose is appropriate for your patient.

• Medications can be administered in many different ways, including but not limited to orally, intravenously, topically, and intramuscularly. Nurses must always ensure that medications are being given via the correct route.

• Check the order and ensure the correct time for the medication. Check the frequency of the medication and the last dose the medication was given.

Double Check Medications with a Coworker: High-alert medications can have serious consequences if not administered correctly. High-alert medications are any medications with a heightened risk of causing significant harm if administered incorrectly. Medications like heparin are considered high-alert medications due to the increased risk of bleeding to patients who receive it. Nurses should double-check all high-alert medications and any medication that can look or sound like other medications with another Nurse to help reduce the risk of medication errors.

Document: Medication administration should always be documented. Bar code scanners on electronic medical records should always be used to ensure medications are not only documented, but have been given correctly.

Speak Out: As Nurses, our priority should always be patient safety. If you identify a potential for medication errors to occur, speak to your supervisor to make a change.

Patient safety should be the number one concern for all healthcare professionals. As Nurses, we play a vital role in preventing medication errors. It may not be possible to avoid every medication error, but as Nurses, we must prioritize safe medication administration to ensure our patients receive safe and effective patient care.

Photo: Forensic Technology Center of Excellence

Bruises are one of the most common injuries observed on victims of violent crime, such as victims of sexual assault and domestic violence, according to the National Institute of Justice (NIJ). 

"Bruise detection and diagnosis are currently conducted by sight, under regular light, and bruises are often difficult to see on victims of violence depending on their skin color and the age of their injury. As a result, individuals with dark skin tones are at a significant disadvantage in having their injuries properly identified and documented. This can have a significant impact on both medical and legal outcomes for victims of violence," said AZO Life Sciences. 

Katherine (“Kat”) Scafide is a tenured Associate Professor, Forensic Nurse and Scientist at George Mason University and she has innovated technology to improve bruise detection on dark skin tones. 

According to NIJ, one particular case inspired Scafide to look to technology to address this challenge. 

"As Scafide was examining the victim, documenting injuries and collecting evidence, the victim exclaimed that the individual bit her on her back. Scafide thought, if I can locate this bite – this bruise – I can swab for DNA evidence. She looked for the bruise using all the tools she had available at the time but could not locate the bite or corresponding bruise on the woman’s dark skin. Without documentation, there was nothing to substantiate the victim’s claim, and when their injuries cannot be documented, women are less likely to report incidents of sexual assault, are less likely to engage in the process, and have worse judicial and medical outcomes."

Dr. Scafide began her journey as a bruise Scientist during her doctoral work at Johns Hopkins where she garnered the name “paintball” lady for her unique method of creating injuries. At George Mason, she collaborated with colleagues at Texas A & M and Georgia State Universities, conducting one of the largest and most diverse bruise studies in modern forensic history. 

They discovered Alternative Light Source (ALS) was 5x better than white light at finding bruises on victims with varying skin tones.

According to NBC Washington, the technology is working in Baltimore, where Mercy Medical Center has started using it, and it has been introduced into court evidence in some domestic violence and assault cases. Scafide is hoping to expand the use of the technology both regionally and nationally.

"Forensic Nursing units haven't necessarily adopted this equipment for a variety of reasons: due to the lack of clinical practice guidelines, the cost of the equipment, the concern that there isn't sufficient research to support its practice, and we're looking to change that," Scafide said.

If you or someone you know is experiencing domestic violence, contact the National Domestic Violence Hotline by calling 1-800-799-SAFE (7233), visiting www.thehotline.org or texting LOVEIS to 22522.

Many people look forward to the holidays, however it can be a stressful time for Nurses working through the holiday season and missing festivities. Here are several tips to help make working through the holidays a little brighter.

Holiday Feast

Take time during a shift to fuel up with some yummy foods. Have everyone bring in their favorite meal or side dish, holiday treat, or order some take out. 

Work Fun

Organize a secret Santa with your unit or you may also consider planning a holiday party outside of your work setting. It’s nice to take the time out to blow off steam and enjoy your co-workers’ company. 

Decorate

With permission from your manager, decorate your work station, the hallways or even yourself with some holiday swag. Hang up paper pumpkins and turkeys. String twinkle lights and set up a holiday tree. Just be sure to be sensitive and inclusive of everyone’s holidays, not just your own. 

Celebrate On A Different Day

If you can't celebrate a holiday on the actual date, pick another day that works for your family or friends. Being with the people you love is what's important, no matter the date. 

Spread Holiday Cheer

This season is all about giving and as you know, giving makes you feel good. Try giving small gifts like scented hand sanitizers, cards, or decorative trinkets to your coworkers. Brighten patient's day with a note, little ornament, or holiday craft. 

Stay Connected

Make the most of your breaks during your shift. If able, FaceTime or Zoom with friends and family, follow their posts on social media, or ask someone to share videos of the holiday gatherings with you. Utilize available technology to stay as connected as possible. 

Silver Lining

Focus on the bright side, there may be benefits to working a holiday shift, such as extra pay or the next holiday off. You may also, hopefully, get to enjoy a slower work pace or less traffic during your commute.

Remember You're Important

Healthcare will always be 24/7 and someone must be there to care for patients. You're saving and changing lives by showing up to work. During the holidays that care can mean the world to a patient especially if their family or friends aren't able to visit or stay long. What you do as a Nurse is so important, don't you forget it! 

Alzheimer Disease (AD) is the most common type of dementia, accounting for at least 2/3 of the cases of dementia in people age 65 and older. AD is a neurodegenerative disease that causes progressive and disabling impairment of cognitive functions including memory, comprehension, language, attention, reasoning, and judgment.

According to Johns Hopkins Medicine, there are over 6 million Americans living with AD with 3 million new cases diagnosed each year. This disease is deadlier than breast cancer and prostate cancer combined. 

Often, early warning signs are dismissed or mistaken for normal aging behaviors such as forgetting or misplacing things. Early detection can help people maintain their independence longer and slow the progression of symptoms.

Ann Kriebel-Gasparro, a faculty member in Walden University's Master of Science in Nursing program emphasizes that Nurses who have training in dementia and AD with Gerontological patients can provide quality medical care to help track and manage symptoms. 

Common warning signs/symptoms include:

• Memory loss that disrupts daily life
• Challenges in planning or solving problems
• Difficulty completing familiar tasks
• Confusion with time or place
• Trouble understanding visual images and spatial relationships
• New problems with words in speaking or writing
• Misplacing things and losing the ability to retrace steps
• Decreased or poor judgment
• Withdrawal from work or social activities
• Changes in mood and personality
  
  

To provide high quality care, it’s important to consider these best practices when treating patients with Alzheimer’s:

Communication

Do not assume a patient can not communicate or express their feelings on their own. Instead, try using these communication techniques: 

• Maintain eye contact and direct one-on-one interaction.
• Be patient and offer assurance when the patient makes mistakes or feels embarrassment.
• Ask clear and simple questions requiring yes or no answers to minimize confusion.
• Do not interrupt or argue.
• Engage in conversations in quiet spaces without distractions.

Create a Daily Care Plan

Having a structured and predictable daily schedule is important for patients. It helps to reduce restlessness, anxiety, episodes of confusion and thought process impairment. This set routine helps them maintain a degree of autonomy in their activities of daily living.

Scheduled care plans usually include:

• Meal times
• Walking or gentle exercises 
• Drawing or painting
• Reading books and magazines
• Watching favorite shows or movies
• Listening to music

Proper Hygiene

People with AD may struggle to maintain their personal hygiene. Some might simply forget  they need to care for themselves, or, in later stages, forget how to do so. 

Some considerations for assisting with personal care:

Fall Prevention

According to the CDC, more than 1 in 4 seniors fall each year. Having Alzheimer's can increase that risk because AD can impact balance and spatial reasoning. 

Knowing that your patients are at greater risk is a crucial first step, but there is more you can do to prevent falls such as:

• Keeping rooms and walkways clear to prevent tripping or stumbling
• Supervising or providing a safety companion to help patients walk 
• Keep patients occupied and entertained so they are less likely to wander or move around unnecessarily
• Promoting safe physical activity to improve balance and coordination
• Providing better lighting so patients can see better
• Offering assistive devices, such as a walker or handrails, when necessary
• Encouraging appropriate clothing and footwear
• Assessing medications, especially if they make patients feel dizzy
  
  

Wandering Prevention

According to the Alzheimer's Association, AD causes people to lose their ability to recognize familiar places and faces. It’s common for a person living with dementia to wander or become lost or confused about their location, and it can happen at any stage of the disease. Six in 10 people living with dementia will wander at least once; many do so repeatedly.

The following tips may help reduce the risk of wandering:

• Provide opportunities for the person to engage in structured, meaningful activities throughout the day
• Identify the time of day the person is most likely to wander (for those who experience “sundowning,” this may be starting in the early evening.) Plan things to do during this time — activities and exercise may help reduce anxiety, agitation and restlessness.
• Ensure all basic needs are met, including toileting, nutrition and hydration. Consider reducing – but not eliminating – liquids up to two hours before bedtime so the person doesn’t have to use and find the bathroom during the night.
• If the person is still safely able to drive, consider using a GPS device to help if they get lost.
• If the person is no longer driving, remove access to car keys — a person living with dementia may not just wander by foot. The person may forget that he or she can no longer drive.
• Place deadbolts out of the line of sight, either high or low, on exterior doors. (Do not leave a person living with dementia unsupervised in new or changed surroundings, and never lock a person in at home.)
• Use night lights throughout the home.
• Install warning bells above doors or use a monitoring device that signals when a door is opened.
• Place a pressure-sensitive mat in front of the door or at the person's bedside to alert you to movement.
• Label all doors with signs or symbols to explain the purpose of each room.
• Store items that may trigger a person’s instinct to leave, such as coats, hats, pocketbooks, keys and wallets.
• Consider enrolling the person living with dementia in a wandering response service.
• Ask neighbors, friends and family to call if they see the person wandering, lost or dressed inappropriately.
• Keep a recent, close-up photo of the person on hand to give to police, should the need arise.
  
  

Final Stages of Care

Nursing care for Alzheimer's patients becomes especially critical during the final stages. Skilled Nurses with extensive AD knowledge not only provide treatment to patients but also help families prepare for end-of-life decisions. They also provide emotional support to family members and provide suggestions for preparing for the final stages.

Click Here For Alzheimer's and Related Dementia Resources for Professionals

Patients with Intellectual or Developmental Disabilities (IDDs) have unique needs. It is important Nurses know how to properly provide  care, and make health care more accessible for this population.

An IDD, includes many severe, chronic conditions that are due to mental and/or physical impairments. It usually lasts throughout a person's lifetime. People who have IDDs have problems with major life activities such as:

• Language
• Mobility
• Learning
• Self-help
• Independent living
  
  

According to the Association of American Medical Colleges (AAMC), IDDs encompass hundreds of diagnoses — autism, cerebral palsy, and Down syndrome among them — that affect about 6.5 million people in the United States.

Research suggests that the attitudes of health care professionals are among the biggest barriers to people with IDDs receiving equitable access to services.

Nurses must provide care that enables people with complex care needs and difficulty with cognitive functioning to live fully with as much physical, emotional, social, and spiritual well-being as possible.

Here are some helpful guidelines for treating patients with mental and/or physical disabilities. 

• Speak directly with the patient, not to any companion that the patient may have.

What is Nursing Ethics?

Ethics in Nursing helps Nurses maintain professional accountability and navigate the complexities of the Nursing profession. Ethics are the moral principles by which people should carry themselves. Ethics is one of the most critical concepts in Nursing as it dictates our role as caregivers.

The Nursing code of ethics consists of 4 main principles. These principles are used to guide Nurses in delivering quality Nursing care while also fulfilling the ethical obligations expected within the profession. The principles include autonomy, beneficence, justice, and non-maleficence.

Four Main Principals of Nursing Ethics  

Autonomy in Nursing refers to the right each patient has to make decisions based on their personal beliefs or values. As Nurses, we are responsible for educating patients on care measures and allowing them to accept or refuse medical interventions.  We must respect the choices of our patients and adapt our care to what best suits their wants. An example of autonomy in Nursing is educating a patient about the side effects of medication and allowing the patient to accept or decline taking it.  

Beneficence is the principle that every action performed by the Nurse should be to promote good. This means that every task a Nurse completes during her shift should be done for the sole benefit of the patient. Simple things we do in Nursing, like holding the hand of a dying patient or taking a patient outside to get fresh air, are considered beneficence.

Justice in the Nursing code of ethics means that patients have the right to impartial treatment. We do not judge our patients in the Nursing profession. Patients must be respected and treated equally regardless of their financial or insurance status, gender, age, or ethnicity. Justice in Nursing is treating all our patients equally and ensuring they receive the best possible care regardless of their situation.

Nonmaleficence is closely related to beneficence but is a different concept altogether. Nonmaleficence means that a Nurse should do no harm to the patient. This principal guides Nurses to maintain their obligation to protect their patients. Nurses should always prevent bad outcomes for their patients whenever possible by removing them from any harm. An example of nonmaleficence in Nursing is preventing medication errors by ensuring the “7 rights” of medication administration are correct or by applying a bed alarm to a patient's bed with dementia to prevent falls.

What are Ethical Dilemmas in Nursing?

The 4 main principles of Nursing ethics prepare us to deal with the ethical dilemmas we encounter while caring for our patients. Ethical dilemmas in Nursing create a conflict between 2 courses of action.  

The competing courses of action are both correct but can create different consequences that must be considered. Ethical dilemmas are important to recognize because, as Nurses, we cannot interject our personal beliefs into the ethical dilemmas at hand. Examples of ethical dilemmas can include:  

• Protecting the privacy of an adolescent
• A parent refusing to vaccinate their child
• End of life decision making
• Informed consent
• Pro-life vs. prochoice
  
  

Becoming an Ethical Nurse

Nursing is consistently regarded as one of the most trusted professions. Nursing ethics are essential to know and understand as it helps guide our everyday Nursing practice. Nurses are thoroughly prepared to deal with the ethical situations they encounter through many years of education and training.

Nurses can continue to learn how to conduct themselves ethically and how to deal with ethical issues through continued work experiences. Every patient interaction can teach us something new about ethical dilemmas and how we can best handle them in the workplace.

Across the entire patient experience, Nurses have a hand in almost every aspect of the patient's healthcare journey. Nurses are compassionate, and dedicated, and work tirelessly to meet the needs of their patients. Because Nurses are at the forefront of every patient interaction, there are many things that we wish our patients knew and understood about how we work and handle our everyday tasks.  

Every Patient is a Priority, but You May Have to Wait 

Nursing is a busy and fast-paced profession. Our days are jam-packed with patient care tasks, documentation, and care coordination. More often than not, it can be challenging to find time to eat, drink water, or even use the bathroom during our shifts. We hate having to make our patients wait for things they may want or need, but sometimes we wish our patients understood that we take great consideration in prioritizing our patient's needs. So, if you are asked to wait or have been waiting for something longer than you think you should have, please understand that your Nurse may have a more pressing matter to attend to, and every patient deserves our complete attention. 

Nurses are People Too 

Nurses often sacrifice their personal needs to care for their patients. As mentioned earlier, we often forgo meals and bathroom breaks to ensure we can complete all our tasks and care for your needs. Nursing can often be a thankless job. Nurses understand that you want the best quality care, and we strive to provide that to every one of our patients. Patience, understanding, and respect are all that we ask for in return. 

We Care More Than You Think We Do 

Nurses are multitaskers. At any given time, we can be juggling more tasks than you may even realize. Sometimes Nurses may come off as flustered or in a hurry, but that does not mean we do not value your wants or needs. Nurses stay late and come in on their days off to ensure their patients receive excellent care. We even think about you long after we've met because you have touched our lives. Patients are what make the Nursing profession so rewarding. We do what we do for you. 

We May Not Know Everything

We encourage our patients to ask questions, but that does not mean we have all the answers. Sometimes we may need to find the answer for you by speaking to a Doctor or collaborating with other Nurses. This does not mean we do not know what we are doing. It simply means that every patient has a different healthcare journey, and often situations arise that we may not have experience with. Our top priority is that you receive the best quality care, so if you ask a question and we do not know the answer, please rest assured that we will do everything within our power to get you the information you are looking for. 

We Do Not Judge  

Nurses do not do their jobs to judge our patients. Please always be honest when answering questions or providing your health history. Withholding information because you may be embarrassed or may not think it relevant can significantly impact the care we can provide. We care about you and want to ensure that you are cared for in the best possible way. Nurses are also prepared to take care of all your personal needs. We do not mind doing ‘gross’ or ‘embarrassing’ tasks. You do not have to say sorry for natural bodily functions. We understand and are ok with it, I promise!

The Nursing profession is a delicate blend of knowledge, compassion, and critical thinking. We strive every day to make a positive impact on the lives of our patients. A strong Nurse-patient relationship improves your healthcare experience and helps us provide you with the best quality care.

A career as a Nurse Case Manager gives you the opportunity to make a huge impact on patient's lives and develop rewarding relationships.

The Case Manager's (CM) role is centered around working with patients and their families to make sure they are provided with appropriate health care providers, resources, and services so they receive the proper care they need. 

Primary responsibilities include:

• Evaluating a patient's medical history

• Acting as a liaison between patients, health care providers, and health insurers

• Creating care plans and scheduling appointments

• Educating patients and their families on relevant health-related matters

• Keeping track of health outcomes and suggesting possible treatment changes

“Because Nurses are trained to work on interdisciplinary teams and understand how to deal with patients’ psychosocial needs, they are the perfect choice to manage their care,” says Tracy Towne, PhD, faculty member at Purdue University Global School of Nursing. “It’s a more holistic approach to care and services, and it is an incredibly valuable role when it comes to supporting those with chronic illnesses.”

You’ll also be able to choose which area you would like to specialize. According to Western Governors University, some of the most common Case Management Nursing specializations are:

• Patient specialty—focuses on a specific patient population such as the elderly (geriatrics) or children (pediatrics).
• Service specialty—focuses on a specific service area such as hospice, home healthcare, or rehabilitation.
• Duration specialty—focuses on the length of patient care such as short-term injury rehabilitation or long-term illness management.
• Disease specialty—focuses on patients suffering from a specific disease or chronic illness such as diabetes, cancer, substance abuse, or mental illness.

Choosing to become a CM is a great choice for Nurses, since it is less physically demanding, has great pay, and is in high demand. 

According to Zippia, CMs in the Nursing field are expected to rise nearly 16% over the next ten years. This increase is due to the growing elderly population as well as a rise in those with chronic illnesses. 

The estimated average salary for a RN Case Manager is $107,568 per year in the United States, according to Glassdoor.

Becoming a Nurse CM requires a Registered Nurse (RN) license. It is more common to switch to case management later on in your RN career.

This role requires experience so it is suggested you advance your career with certification programs. Certifications aren't mandatory for employment, but they can increase your pay and make you more eligible for future job opportunities.

Interested in learning more about Case Management? Check out these resources:

Case Management Society of America

National Association of Case Management

American Case Management Association

The Higher Education Case Managers Association