DiversityNursing Blog

Here's some advice for keeping your cool with difficult visitors.

First Impressions

To start off on the right foot, get to know the visitors in the room by introducing yourself and building rapport. Be proactive and explain what everyone should expect, who else may be assisting in the process, and how often someone will be by to check in. Naturally, family members will worry and feel helpless. It's important to address any questions or concerns they have.

Listen and Acknowledge

When you start to recognize a visitor's behavior shifting in a negative direction, try to get to the root of the problem so you can diffuse the situation. Let them express their feelings and acknowledge their concerns. Try to understand the situation from their perspective.

Remain Calm

If tensions start to rise and the visitor becomes angry or aggressive, it is best to remain calm and keep a physical distance. Try to maintain a composed voice, speak slowly, and use a low volume tone.

It is easy to get defensive, but it is best not to escalate the problem with more negative energy.

Don’t interrupt them. Wait for them to take a break from venting, acknowledge that you’ve heard them and jump in. This gives you the opportunity to take back control of the conversation and guide them to a solution. Master De-escalation Instructor, Myra Golden, calls this ‘the jump rope technique’.

Draw The Line

If inappropriate behavior occurs, it is important to stand up for yourself and set boundaries. If you feel the environment is becoming unsafe, remove yourself and call security.

Not sure what to say? Resilient Nursing has some good examples:

• “I am here to help. I will answer your questions and address your concerns, but I can’t do that if you are yelling at me.”
• “We are in a hospital. I need you to stop. You are disrupting patients and visitors right now.”
• “What you just did/said was not acceptable. If you continue, I will have to ask you to leave.”

Document

If any issues occur on the floor, you should let the Charge Nurse know about it. Also document the event, summarizing what took place and how you handled it. Not only is this good to have for legal reasons, it also makes other healthcare providers aware for the future.

Self-Care

Being involved in a conflict or altercation can take a toll on your stress levels. Be mindful of how you feel and take time to process your feelings. Do what you need to do to feel better. Try talking to a friend or coworker or try journaling.

But most importantly, don't take it personally. You are doing the best you can and are not responsible for someone else's bad reaction to stress. 

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

Even before the start of the COVID-19 Pandemic, it was well-known that the U.S. was facing a health care provider shortage. This trend was verified in a June 2020 report by the Association of American Medical Colleges^, which estimated the U.S. faces a potential physician shortage of 37,800 to 124,000 by 2034.

Partly because of this growing need, nurses are increasingly serving as primary caregivers in hospitals and clinics across the country. There are more than 3.8 million registered nurses in the United States and nurses comprise the largest component of the nation’s healthcare workforce^*.

Necessity is not the only reason more patients are turning to nurses for primary care. Nurse-midwives and nurse practitioners have a core focus on promoting optimal health, not only caring for the sick but also providing guidance to assist in long-term health. This model of care forms a partnership between nurse and patient with a focus on promoting ongoing health in addition to treating illness. The focus on health maintenance is a core characteristic of the practice of nurse-midwives and nurse practitioners. A study on the prevention of chronic disease by Ritsema TS, Bingenheimer JB, Scholting P, et al.⁺ concluded that “across all conditions, NPs provide health education to patients more frequently than physicians.” Midwifery care as defined by the American College of Nurse-Midwives includes health promotion, disease prevention, wellness education and counseling, and full-scope primary care services including maternity care. Midwifery care has been shown to decrease cesarean section rates, decrease interventions and decrease preterm birth^^.

Midwifery and nurse practitioner care do not replace physician care. Health care services are complex and one type of provider cannot provide all services needed. It takes a team of different types of providers to provide the full complement of services needed. One study demonstrated that patients receiving care from primary care physicians received only 55% of recommended chronic and preventive services. The gap is attributed to physicians being overworked. The study further estimated that 50-70% of preventative services and 25%-47% of chronic care services could be done by nurse practitioners or physician assistants. By working together, we can assure that patients receive all of the recommended and preventive and chronic care services^**.

Nurses’ expertise and versatility were brought into focus during the height of the pandemic. As hospitals and clinics overflowed, the healthcare system was stretched to its limit. Nurses were called on to assume additional responsibilities and leadership roles, such as organizing drive-through testing and vaccination sites or directing clinics. Some traveled, leaving their families for weeks or months at a time to care for patients in locations both rural and urban where additional care was most needed.

While provider shortages have been amplified during the pandemic, this shortage was a known issue before the pandemic and will persist after. Most at risk due to the provider shortage are those in underserved populations and rural communities. The previously mentioned report by the Association of American Medical Colleges concluded that “If underserved populations were to experience the same health care use patterns as populations with fewer barriers to access, current demand could rise by an additional 74,100 to 145,500 physicians. This analysis underscores the systematic differences in annual use of health care services by insured and uninsured individuals, individuals in urban and rural locations, and individuals of differing races and ethnicities.”

Frontier Nursing University is proud to be a leader in the changes needed to address healthcare provider shortages. Frontier’s mission is “to provide accessible nurse-midwifery and nurse practitioner education to prepare competent, entrepreneurial, ethical, and compassionate leaders in primary care to serve all individuals with an emphasis on women and families in diverse, rural, and underserved populations.” Our students are graduate-level students seeking advanced nurse practitioner and nurse-midwifery degrees. For many, taking two years off work to pursue an advanced degree is not an option. They must be able to continue to work where they live while pursuing advanced degrees at the same time.

FNU was founded in 1939 in rural Hyden, Kentucky, and our impact, though significant, was limited in scope due to our remote location. In 1989 we introduced a distance learning model that allowed students nationwide to attend FNU from their home communities, requiring only a few trips to campus. Today, 70% of FNU’s more than 2,500 students live in health professional shortage areas (HPSA) as defined by the Health Resources and Services Administration (HRSA), demonstrating the potential impact of FNU graduates within these underserved communities.  

Many of our 8,000 alumni have been serving on the front lines of the pandemic. Some have worked as travel nurses in pandemic hot zones, while others delivered the first vaccine doses by boat to remote villages in Alaska. Some developed procedures to help patients avoid crowded lobbies. Others accomplished the remarkable feat of opening their own clinics during the height of the pandemic. Meanwhile, FNU’s distance learning model allowed the majority of our students to continue their progress without interruption.  

The pandemic has brought to light much of what we already knew. It has further demonstrated the need for change in our healthcare system and proved that nurse-midwives and nurse practitioners must play increased roles in the health and well-being of our communities. The pandemic reminded us that primary care services provided by advanced practice nurses and nurse-midwives are safe and effective. It is now more clear than ever that nurse-midwives, nurse practitioners, and physicians must work together to attain optimum health outcomes for our country.

^ IHS Markit Ltd. The Complexities of Physician Supply and Demand: Projections From 2019 to 2034. Washington, DC: AAMC; 2021.

*Smiley, R.A., Lauer, P., Bienemy, C., Berg, J.G., Shireman, E., Reneau, K.A., & Alexander, M. (October 2018). The 2017 National Nursing Workforce Survey. Journal of Nursing Regulation, 9(3), supplement (S1-S54).

+Ritsema TS, Bingenheimer JB, Scholting P, et al. Differences in the delivery of health education to patients with chronic disease by provider type, 2005–2009. Prev Chronic Dis 2014; 11: 130175. - PMC - PubMed

^^ Loewenberg Weisband Y, Klebanoff M, Gallo MF, Shoben A, Norris AH. Birth Outcomes of Women Using a Midwife versus Women Using a Physician for Prenatal Care. J Midwifery Women’s Health. 2018 Jul;63(4):399-409. doi: 10.1111/jmwh.12750. Epub 2018 Jun 26. PMID: 29944777.

**Altschuler J, Margolius D, Bodenheimer T, Grumbach K. Estimating a reasonable patient panel

size for primary care physicians with team-based task delegation. Ann Fam Med.

2012;10(5):396-400. doi:10.1370/afm.1400

++IHS Markit Ltd. The Complexities of Physician Supply and Demand: Projections From 2019 to 2034. Washington, DC: AAMC; 2021

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.

The Foundation of the National Student Nurses’ Association is delighted to announce the 2022-23 diversity scholarship awards sponsored by Johnson & Johnson. Funding may be used for tuition, fees, and books. Use the same application to apply for all FNSNA scholarships. Students must complete the race/ethnicity question to qualify. There is $500,000 available in scholarships! Scholarships up to $10,000 each. Students complete one application for over 100 scholarships.

Click here for more information: https://www.forevernursing.org/2022-online-scholarship-application-fact-sheet.html

Click here for the application: https://apply.mykaleidoscope.com/scholarships/fnsna2022