DiversityNursing Blog

Nursing is one of the many professions that is changing rapidly. Lifelong learning for Nurses is essential. As a Nursing professional, it is a requirement of maintaining your license to participate in continuing education (CE). You need to stay up-to-date on patient care, healthcare trends, treatments and techniques.

According to Nurse.org, most states require Nurses to complete some form of continuing education every two to three years as a condition of licensure. Even if your state board does not require any education for continuing competence for renewal, you may still be required by your employer or Nursing association for job-specific certifications (i.e., Nursing specialties, magnet hospitals, etc.). Specialty certifications such as medical-surgical, critical care, neonatal, etc. have specific requirements for continuing education. Make sure to check with your own hospital and any associations to which you may belong to find out if you have further requirements above and beyond that of your state Nursing board.

Nursing Professional Development specialists or NPD specialists are available to advise Nurses about certification and licensing requirements, and they can also address a Nurse’s need for additional instruction. Furthermore, NPD specialists ensure that the Nurses under their supervision always demonstrate competency.

Trisha Coady, HealthStream’s Vice President of Clinical Development, discusses how lifelong learning benefits patients and outcomes. She said, "Nearly 70% of the healthcare workforce is involved in direct patient care. That’s 3.1 million of HealthStream’s 4.5 million subscribers, who complete over one million courses each week. If each of those healthcare professionals could prevent harm or death for only five people in their lifetime as a result of acquired knowledge, over 15 million lives would be saved."

Coady also advises healthcare managers to incorporate and promote a strong focus on learning. Trisha said, "Decisions made after 20 years of experience differ drastically from what we would make in our first year after college. To get there, we’ve likely pursued formal education or courseware, attended conferences, volunteered on committees, leveraged peers and mentors, etc. There will always be a need for mandatory, regulatory or focused training, but I also believe it’s just as critical to offer opportunities for self-development."

 If you have any questions about continuing education feel free to ask one of our Nurse leaders by clicking below!

Healthcare organizations must know in order to be successful, you need a diverse workforce. The key to success in this area is retaining that staff and knowing how to defuse conflicts. This is especially true in settings like hospitals, where mistakes can mean life or death.

Poor communication is one of the leading causes of medical errors, according to the Joint Commission. Medical errors are the 3^rd leading cause of death in the United States—right after heart disease and cancer, and it’s more prevalent than respiratory ailments, stroke and Alzheimer's disease—according to a study out this year from The BMJ. Author Martin Makary, MD, of Johns Hopkins University, and colleagues estimate that 251,000 Americans die each year from such mistakes. Some instances have nothing to do with interpersonal conflict, but employees at odds with one another are less likely to spend time making sure they understand each other during crucial events like a patient hand-off.

Dianne Austin, workforce diversity program manager at Massachusetts General Hospital, told Healthcare Dive, creating robust support networks is key to helping employees identify and deal with tension or potential discrimination from other employees. They also need to be able to talk freely with others who may be in similar situations. “There’s a lot that we do to really try to help employees feel that they have a voice and that they’re important,” she said.

How conflict happens

Susan Woods, a workplace consultant, says there are a few major dynamics in diversity-related conflict, including respect and disrespect, as well as recognition and identity.

1) Respect and Disrespect

Disrespect may be gross and blatant, but it is also subtle, communicated in the little

ways someone is told they don’t belong, are not good enough, are not expected to

achieve, or that they can be overlooked and don’t count.

Remarks like the ones below convey messages about respect.

“Not a bad job, for a woman.”

“You don’t have to worry about your appointment. You’re a minority.”

“That company is very traditional. I’m surprised they even hired you.”

A reasonable person could interpret disrespect in each of these messages. The

harmful message may be unintended and unrecognized by the offending party, even

as it is deeply felt by the offended party.

When disrespect is communicated in unintended and unconscious ways, bringing

this perspective to the surface creates an opening for learning and improved

relations. Regardless of how the incident in question is settled, failure to understand

the dynamics of respect and disrespect from more than one perspective perpetuates

the underlying conflict.

2) Recognition and Identity

A second dynamic often present in diversity-related conflict resolution is

recognition and identity. Recognition and identity are complicated dynamics, full of

opportunity for misunderstanding and tension. These may have a negative effect,

but may not have been communicated with consciously malicious intent.

We hear it below:

“I’m always asked to be in the photo or meet with visitors because I’m one of the few people of color

they have. It has nothing to do with my accomplishments.”

“I hope you’re not asking me to take the minutes because I’m the only woman in the group.”

“You’re not like the others. I feel I can talk with you.”

“Those people …”

The old days of the “great melting pot,” where everyone was expected to conform

to the dominate group, are gone. Hopefully, we’ve moved past assimilation to

realize that inclusion is about recognizing diverse identity. It’s about understanding

individuals as unique persons and, at the same time, as members of groups.

Either/or logic is misleading. This is a both/and phenomenon. The ambiguity can

be unsettling, especially when the challenge is so deeply personal and emotional as

with identity.

Research shows that conflict can be frequent in healthcare organizations because of the high workload volumes, pressures to move quickly and the importance of decisions being made. These conflicts can affect companies in many ways, including high staff turnover rates, reduced productivity and litigation costs.

Dealing with conflicts

The best processes start early and attempt to prevent conflict. Austin said Massachusetts General has an orientation where new employees attend a program on diversity and inclusion and learn about various resources available to employees, such as a citizenship program, careers days and school admissions officers. There are also multiple staff committees focused on improving diversity and inclusion.

Healthcare managers can help ease conflict by listening carefully to employees, quickly addressing the source of the problem, instituting strict and clear policies and educating staff about those policies, she wrote.

Massachusetts General has multiple ways for an employee to bring any concerns to light, including an anonymous hotline, Austin said. The HR department will review whatever is submitted and the relevant department head is told the details. “We really try to pull managers and the appropriate people in so we can get to the bottom of it based on the information provided,” she said.

Sometimes, the problem starts with a patient who refuses to be cared for by a certain nurse or doctor, and may use racial slurs or other inappropriate language. The nurse manager will respond and tell the patient all providers are equally trained and capable. The patient is then told they can go to another hospital if they will not be respectful to all employees. The affected employee can decide whether or not to continue working with the patient.

Diversity is needed at higher ranks

Diversity and inclusion efforts should reach all the way up the ranks to the executives, making sure their C-suites and boardrooms are also diverse and reflective of the surrounding community.

The American Hospital Association's Institute for Diversity in Health Management released a comprehensive report titled Diversity and Disparities: A Benchmarking Study of U.S. Hospitals in 2015. The results of the survey were not exactly positive. In fact, the survey found that minority representation on healthcare boards across this nation stood at just 14%—precisely the same percentage reported in a similar survey two years earlier and a similar study conducted in 2011.

Deborah Bowen, president of the American College of Healthcare Executives said the best ways to remedy poor diversity in C-suites is to start cultivating a diverse group of people who have an interest in leadership early on in their careers. Post-graduate fellowship programs and scholarship for mid-level executives can be helpful. Hospitals should provide leadership development and training as well as other career resources, she said.

“It’s a matter of finding mentors, for example,” she said. “Have a mentorship network to find somebody who has gone through something similar.”

The diversity of people in the US has changed considerably. As stated at the beginning of this article, our hospital and healthcare system employees need to reflect their patient population at all levels within their organization(s). Sensitivity to language, cultural, sexual, and physical differences in both your staff and patients is critical for a harmonious and productive environment.

You might be a recent graduate and are worried about what to do when you get a difficult patient or maybe you are an experienced Nurse and are looking for new tips or ideas to try. We created a list of ways Nurses avoid or diffuse challenging situations with patients.

1. Don’t take it personally

It’s easy to think a difficult patient is upset with you personally, but that’s almost never the case, according to Julianne Haydel, veteran nurse turned nurse consultant at Haydel Consulting Services.

Remember that the patient is dealing with unfortunate circumstances and likely isn’t in the best mood. Continue to do your job and don’t let their negativity get in your head. “Just knowing that the nastiness is not about you is a good start,” says Haydel.

2. Stay Calm

When dealing with trying patients, the best approach is to remain calm. Remember that the patient is not attacking you personally, but rather acting out on feelings of anxiety, a perceived lack of attention or resistance to what has happened to them. Remaining calm will allow you to keep control and address the patient in a way that will defuse the situation.

3. Show that you care

Sometimes difficult patients make a fuss about minor requests because they feel like no one is listening to them. Set aside your frustration with the patient and do what you can to meet their needs, as long as it doesn’t take away from other patients’ level of care.

Nurse Angelis recalls swallowing his pride and getting a second cup of coffee for a particularly irritable patient: “I stayed gracious and her whole demeanor changed. She just wanted to know that someone cared and she wasn’t going to be ignored.”

4. Set Boundaries

When it comes to difficult patients who make seemingly endless or unreasonable demands, a useful approach is to set limits. Let them know you will check on them again in 15 minutes or a half hour, and then follow through. In some situations, you’ll need to set boundaries to keep yourself safe. Doing so can help avoid escalating anger.

5. Realign Your Body Language  

Charlene Berube, chair of the undergraduate nursing program at Simmons School of Nursing and Health Sciences in Boston says, “When I start to get frustrated because I’m not making progress with a patient, I take little breaths." Berube also says, “We both need to refocus at that time. If the patient is becoming demanding, and I’m getting frazzled, those energies need to be refocused. And when you do that, your body language realigns.”

Patients come to nurses with mental health issues, mood disorders, depressions, anxiety and a host of other complications. They have lives or lifestyles that you may not understand or even agree with.  But none of that matters.  Each patient deserves the best nursing care you can give them. Remember that you need to find the calm in yourself, be objective and be honest with them. Showing empathy and giving them your undivided attention and time could make a big difference in their attitude and soften those hard edges.

If you have other tips or advice please comment below we would love to hear what you have to say!

Happy Summer! We hope you’re enjoying your work, perhaps some time off, the weather, and your friends and family. I received this article in my inbox and thought it was perfect for you, our Nursing community, because it’s about how we approach our work and life. It’s about our principles, being appreciated, having balance in our life and more. Sometimes you just need to read something that makes sense and makes you feel good. Enjoy!

This article was written by Ron Culberson

Several years ago in Golf Digest magazine, I read a story about a young golfer named Charlie Siem. He was playing in a tournament and after making the winning putt, he bent down to retrieve his ball from the cup. Immediately, he realized that the ball in the cup was not his. At some point along the course, he had played the wrong ball.

Hitting the wrong ball in a golf tournament is grounds for disqualification. However, in Charlie’s case, no one else knew he had hit the wrong ball. Still, he presented the ball to the tournament officials and was promptly disqualified from a tournament he had just won.

This was a case of a young man’s principles guiding his decision—even though it was not an easy decision to make.

When I think of behavioral principles, I’m reminded of a phrase I heard as a child but had no idea what it meant. The phrase was, “He is worth his salt.”

As someone who cooks quite a bit, I didn’t think being compared to a cheap commodity like salt seemed particularly complimentary, but the phrase supposedly has its origins in ancient Rome where soldiers were paid in salt. At the time, salt was quite valuable.

And in the Christian Bible, there are numerous references to salt. Most use salt as a metaphor about enhancing our lives the same way salt enhances food. Christians are supposed to be the “salt of the earth”, or to bring value to the world. Perhaps salt, like principles, is more valuable than I realized.

In The 7 Habits of Highly Effective People, Stephen Covey said, “Principles are guidelines for human conduct that are proven to have enduring, permanent value.”

Principles are the way we carry ourselves through life and work, and essentially, they are our salt. Our principles are the seasoning that makes life better. So, I thought I would spend the next couple of articles focusing on the principles I have chosen to guide my life and work. Hopefully, by seeing them, you will think more purposefully about your own principles and how they season your life. Then, hopefully, we can all be worth our salt.

Appreciation
One morning, after getting dressed for a presentation, I got my second cup of coffee from the free hotel breakfast bar. As I sat the cup down on the desk in my hotel room, the lid slipped off of the cup. The cup bounced onto the desk back up in the air and then coffee spewed all over me and the floor. I did not have much of an “attitude of gratitude” at that particular moment. In fact, I recall a few “salty” words that were brewing in my head. And yet, after my initial irritation, I realized that there were many things for which I was grateful.

On that particular morning, I was grateful to be working. I was grateful to be in a decent hotel with a free breakfast. I was grateful for my client and the audience who ultimately appreciated my presentation, despite their wondering why the sleeve of my shirt was brown.

Here is the funny thing about appreciation. Sometimes it’s offered too routinely and we fail to recognize the sincerity. Just like the person who salts their food without tasting it, it’s automatic and not purposeful. True appreciation is sincere intentional gratitude for the good things in our lives and by reminding ourselves of this on a regular basis, life tastes a little better.

Balance
The simple truth is that when we have balance, we don’t fall down. And we need balance in most areas of our lives. We need balance between work and play. We need balance between people time and alone time. We need balance between our spiritual, emotional, and intellectual experiences. Otherwise, just as too much salt can mask the flavor of our food, we don’t get to experience the full variety of flavors in our lives.

One year, I had taken on too many volunteer jobs in my Rotary club, my church, and my professional association. I was spending nearly 15-20 hours each week just keeping up with my duties. It was affecting my work, my family life, and my health. So, I had to cut back a bit and become more selective in the roles I took on. This balance helped me to do a better job in each area of my life.

Compassion
There is a common meditation practice called “Loving Kindness” which encourages us to both receive and give compassion. As someone who has a pretty active cynicism gland, this meditation is a wonderful reminder of the importance of compassion. In every situation, a compassionate attitude will give us more success and add substance to our relationships. Whether we’re opening a door for someone, saying “thank you” for a kind gesture, or just offering a smile to a stranger, kindness born out of compassion connects our hearts to others. Whenever I remind myself to consider what someone else might be experiencing, I always feel kinder towards them.

A few days ago, I mentioned to a women tending a hotel buffet that the sausage gravy was really good. And as a southerner, I told her that I know my sausage gravy. Her face lit up as if I had given her a great gift. She worked hard on her buffet items and was grateful that someone noticed.

We live in a world where negativity and aggression get the most attention. We can turn that around with a kind word and a generous spirit. Instead of “give me the salt,” perhaps we can say, “please pass the salt…and thank you.”

Excellence
As the author of Do it Well. Make it Fun., I chose excellence as the foundation of my book. If we seek excellence in everything we do, we create a platform of integrity on which to build our success. But we may not always know what we need to do to achieve excellence.

When I took a motorcycle safety course in 2001, I assumed that I knew everything about riding a motorcycle because I had owned one in college. And since a motorcycle only has two wheels, I couldn’t imagine that there was that much to learn. Once I got into the class however, I discovered there were things I didn’t know I didn’t know. The class opened my eyes to my knowledge deficits.

Unless someone gives us feedback or points out our mistakes, we will never discover where we need to improve on the road to excellence. When I worked as the Director of Quality Service at Hospice of Northern Virginia, we used a 360-degree performance evaluation process. In other words, for my yearly review, I was evaluated by my boss, my peers, and the people I supervised. It was certainly an unnerving process but it was one of the most helpful ways to find out my strengths and where I needed to improve. In all areas of our lives, if we strive to determine where we need to get better as employees, parents, partners, neighbors, etc., then we really can enhance the days of our lives…like salt through the hourglass (a few of you will know that obscure reference!)

Fairness
When I was offered my first management job, I realized that two of the people I would be supervising were my peers from a previous job. In order to manage the department effectively, I needed to make sure I treated them fairly and that the other employees felt they were also being treated fairly. So, we talked about it before I took the job and agreed we could make it work. However, if my other staff had felt that I favored my former colleagues, my ability to supervise would have been compromised.

The concept of justice is based on fairness. None of us wants to be treated unfairly. We don’t want someone else to get a discount at the store when we’re not eligible. We want our children to get the same opportunities as other children. And we don’t like it when people who have more seem to get away with even more. Fairness is the basis for effective organizations and relationships. Every time we make a decision that affects other people, we might ask ourselves, “Is this fair to everyone involved?” It’s an ideal embraced by Rotary International and a good principle for the rest of us. When someone treats us fairly, we believe that they really are worth their salt.

Hopefully, these principles will help you think about your own principles and how you can “walk the talk” in your own life. Please know that my own process of living my principles is a work in progress. But isn’t that what life is all about? We’re on the journey just trying to make the next day a little better…or saltier! 

For 14 years, MultiCare hosts a week-long Nurse Camp in the Summer for students who want to work in the medical field. Since there will be a growing demand for Nurses as baby boomers retire and leave the field, this program helps students get a head start on experience and learning.

Puyallup High School junior Adrianna Boyce was confident she wanted to get a job in the medical field.

But it wasn’t until she job shadowed in the emergency department as part of MultiCare Heath System’s Nurse Camp that she knew it was for her.

“Being in the thick of things, it was great,” Boyce said.

Nurse Elise Wilson was in critical but stable condition after being stabbed by a patient at Harrington Hospital in Southbridge last month. Nurses aren't "expecting to encounter violence but they do, every single day of the week," said Elise's husband, Clifton. "They are cursed, spit upon, bitten, punched, kicked, and yes, stabbed."

The Boston Globe said, Elise was treating Connor Oregan, 24, of Southbridge, in the emergency room around 10:15 a.m. when Oregan slashed at her multiple times with a knife before fleeing the hospital.

The nurse was stabilized in the emergency room before being flown to UMass Memorial Medical Center for further treatment. She underwent eight and a half hours of surgery and remained in critical but stable condition, the district attorney’s office said.

Clifton Wilson, and colleagues will testify Wednesday before a committee at the State House in support of legislation proposed by the association “that requires health care employers to develop and implement individualized workplace violence prevention plans,” according to a release. The association has dubbed the legislation “Elise’s Law.”

“The attack against Elise was vicious and left her fighting for her life,” said RN Tracy DiGregorio, who was working in the ER at the time of the assault. “Unfortunately, I cannot say violence against nurses is rare. Nurses and other health care professionals are assaulted every single day at hospitals throughout Massachusetts. We should pass ‘Elise’s Law’ right away to help stop the violence.”

Massachusetts Nurses Association talked about the photo and said, "This is a tough photo to look at. But RN Elise Wilson and her loved ones want the public to see the violence nurses and other health care professionals are experiencing. And they want it to stop. Elise is only smiling because she is grateful her ventilator and feeding tube have been removed." 

The young man allegedly sat in the parking lot sharpening his knife for 20 minutes before entering the emergency room, Clifton Wilson told lawmakers. Conor O'Regan, 24, is accused of the attack. Clifton also said, "She bled out three times and almost died."

Since the attack, Harrington Hospital has beefed up security, and now has a metal detector, he said. They've also hired a Southbridge police officer.

Have you experienced violence from a patient or witnessed it at your place of work? Please share with us in the comments section below. 

For many people, Nursing was all they ever imagined they would be doing as their career. For other people, becoming a Nurse was a second career for them. No matter which stage in life they chose to become a Nurse, these people are passionate about what they do and they are happy they made the switch to a job they love.

John McElroy worked in a local brick factory for about twenty-five years. He lost his job in 2007 after sufferring from a stroke. McElroy wanted to be a Nurse when he was younger and during one of his hopsital visits, his childhood dream was restored. John told CNN, the Nurse thought he would be a fantastic Nurse. She gave him advice and told him, "You will have loads of excuses to not do this, to fail, to quit. But you've got to carry on."

John attended college and even earned $4,000 in scholarships. In 2012 he graduated with a Nursing degree and every day McElroy sees pieces of his own journey reflected in his patients. He educates families on the unique needs of stoke survivors. By sharing his personal story, he hopes his patients will believe that there is life after recovery.

When Bob Evans was 20 years old he took an aptitude test that showed Nursing as a good match for him. Learning news that he was going to become a father Bob decided to take a job in the horticulture business, mostly in sales and customer-service positions in landscaping and lawn care.

In his late 50's, there was a restructuring where he worked. He wasn't sure what he was going to do for work. His wife Lou said, "Remember how you were interested in becoming a nurse when we got married?" I said, "It's too late," but she said, "I don't think so." Bob and his wife attended an information open house at Collin College and decided to go for it. He earned his associate's degree at Collin College in 2013 and a bachelor of science in nursing in 2016 at the University of Texas at Arlington. 

Bob told Dallas News the toughest part about changing careers is, "The transition from expert to novice. I knew that not being the expert on the job anymore would be an adjustment. Assuming the role of novice required a steady flow of swallowing my pride. It has been humbling, but learning and mastering skills that help others is really rewarding."

Laura Callens worked as a school admissions director and was taking care of her husband, Eddy, who had brain cancer. After Eddy passed away in 2011, Laura quit her job and spent some time in Mexico where she had a career epiphany. She heard about a nursing program and realized she had honed relevant traits and skills like compassion and deep listening while caring for her husband. Though hesitant to become a student again, she applied to Nursing school.

According to the NewYork Times, Ms. Callens happily graduated last December and will soon be a neurological nurse. She will work in the Rochester hospital unit where her husband was treated.

Changing careers is always a nerve-racking journey. For people in their 40s and 50s, making a change can be daunting. Experts believe assessing job opportunities, doing some smart skill-matching and getting technical training can help speed the process. But, you also have to love what you do for a living and these people luckily found their calling.