DiversityNursing Blog

Everyone has a reason for going to nursing school and often different reasons for continuing education beyond that. I am one of the few RNs I know at my age who decided to become a nurse when I was in high school. Living in Washington state at the time, I participated in the Running Start program, which allowed me to take college prerequisite courses at the local community college. The tuition was covered by the high school; I just paid for books. I completed my nursing school prerequisites and applied to the associate’s degree in nursing program my senior year of high school.

As a sophomore in high school, I wanted to be a nurse practitioner. I knew once I was done with my ADN, I would transfer to Washington State University for my BSN. I had even chosen my NP program. I am quite the type A personality and had my life planned in 10th grade! Interestingly, my high school counselor always questioned my decision to go into nursing. And  while progressing through nursing school, I actually did change my mind. Because I have a type A personality, changing my planned path was difficult. It was one that I didn’t fully appreciate at the time, but I am thankful for today. I often reflect and tell others about what I learned along my 12-year journey. Here are the most important pieces of my self-reflection.

Pay attention to what piques your interest

As I started my RN to BSN program, I was still bound and determined to be a nurse practitioner. However, I really didn’t like pathophysiology nor pharmacology. I slugged through the material because I needed to learn it. But then came a leadership course. And as I was reading articles, I fell in love with the content. What I noticed was that many authors, all RNs, had MBAs. This made me pause. This was something I had not considered, primarily because I had never been exposed to it. As I finished my BSN, I decided I was going to get my MBA and not be a nurse practitioner.

Many of us get preconceived ideas of what we want to do based on what we know at the time. And many of us continue down a path because we do not pause to really determine if that is what we should still do. As you think about your next steps and what you want to do, pause and think. What piques your interest? Life is too short to not do what you love.

"Many of us get preconceived ideas of what we want to do based on what we know at the time. And many of us continue down a path because we do not pause to really determine if that is what we should still do.”

You get back what you put into it

During my MBA program, I couldn’t afford the time commitment to be on campus at times, so I chose an online education. At the time, many people were weary of online programs, thinking they lacked rigor and quality. This is where you need to make your own decisions. Regardless of the program type, I have seen students do the minimum work and try to sail through courses, checking off boxes, just to get the degree. As a faculty member, it is so disheartening to see. Why are you selling yourself short? It saddens me every time I overhear nurses say they didn’t learn anything when they went back to school. I am very leery of those individuals.

During my online program, I read everything and worked hard on my papers. I knew this would prepare me to be better at whatever I did. Today, I can tell the difference when I speak with someone who put in great effort to learn compared with the one who did not. It’s difficult to fake knowledge. You either know something or you don’t. So do not just treat this as a hoop to jump or check marks on a to do list. Your time is worth more than that, so spend it learning well. The time and money you are spending on education should make you better — a better nurse, a better person and an example for others. Maybe even an example to your children.

The more you learn, the more you realize you don’t know

Once I graduated with a doctoral degree, I proudly used my new initials after my name. What was interesting is that overnight, many people saw me as an expert. The perception was I had a doctoral degree, so I must know what you I’m talking about. In many ways through my dissertation I had become an expert in a particular area. But cue imposter syndrome! I feared I was really a fraud. I had to remind myself that there was no way I would ever know everything. There is so much to learn! You literally could spend every day of your life reading research articles and never know everything. What I learned wasn’t that I knew more than others; what I learned was the more you learn, the more you realize you don’t know.

So, realize that whatever stage you are at in your career or education or years of experience, there is a world out there much bigger than you or I could ever know!  Pause and think — are you happy with what you are doing and where you are going? Are you taking advantage of learning? And realize that no one knows everything. We are all lifelong learners.

Many healthcare organizations are striving to ensure sensitive and equitable care for individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). Recent societal changes, including the legalization of gay marriage and Caitlyn Jenner’s very public journey to transgender female, have raised public awareness of LGBTQ issues. Yet many nurses find gaps in knowledge when caring for LGBTQ patients. 

Healthcare curricula in colleges and universities are still sadly lacking content regarding the unique needs of, and health risks for, individuals who fall outside the “traditional” heterosexual orientation of society. However, you can prepare for meeting the needs of these individuals by informing yourself, listening, and making some simple and practical adjustments in your nursing practice.

LGBTQ persons experience a number of healthcare disparities for many reasons: discrimination and social pressures, personal sexual behaviors, limited access to health insurance, higher rates of smoking and alcohol/substance misuse, higher rates of anxiety and depression, greater risk of sexually transmitted infections (including HIV), and increased incidence of some cancers. And when nurses encounter LGBTQ individuals in the clinical setting, they may create or contribute to these barriers to quality care due to lack of understanding and personal bias.

1. Expand your knowledge about sexual orientation and gender identity

To understand the needs of LGBTQ patients, nurses must expand their own knowledge on the subjects of sexual orientation (SO) or attraction, and gender identity (GI), or how one identifies with and experiences the world. Sexuality has long been defined as heterosexual by the dominant society, yet in reality, it encompasses a spectrum of needs, desires, and behaviors that can be fluid and changing over time.

2. Know key LGBTQ definitions

You can read about the meanings of asexual, gay, lesbian, bisexual, pansexual, and “queer,” descriptors that fall under the SO umbrella, as pointed out in More than Pink: LGBTQ Breast Health, a report published by Susan G. Komen, Puget Sound. Note that “queer,” formerly considered a derogatory term, is now considered by some to be a more fluid and inclusive descriptor than other words related to sexual orientation. Also, learn the meaning of terms such as agender, cisgender, transgender, gender fluid, and others that typically describe an individual’s gender identity.

3. Deepen your LGBTQ knowledge

Deepening your knowledge base will enrich your understanding of sexuality in general, and increase your nimbleness in identifying potential health risks for patients seeking your care.

Keep your knowledge up-to-date with ongoing training, reading, and learning from others who are skilled in communicating with and caring for these patients. Some good websites that can help you further your understanding include the Centers for Disease Control and Prevention, the GLBT Health Access Project (Community Standards of Practice Section), Trans-Health.com (online magazine), Women’sHealth.gov, and many others, including sources for this article.

4. Create a welcoming environment for LGBTQ patients

LGBTQ individuals have a long history of discrimination at the individual and institutional levels, including the healthcare system. They may “scan” an environment to determine if it is a safe place to reveal personal information, especially about sexuality. Some things an individual may watch for and take note of during their time in your reception or waiting room area:

• Your organization’s nondiscrimination policy: Is it in a visible location?
• A rainbow flag, pink triangle, or other symbol of inclusiveness
• Availability of unisex restrooms
• Health education literature with diverse images and inclusive language, including information about LGBTQ health
• Posters announcing days of observance such as World AIDS Day, Pride, and National Transgender Day of Remembrance

5. Use inclusive language

It may take a little practice, but you can shift your vocabulary towards inclusiveness, opening the door for more open healthcare discussions. This can begin right in the waiting room as patients complete required forms. Rather than asking marital status, for example, the form might read, “relationship status: married, partnered, or other.” 

When asking patients to provide their names, include an additional space indicating “Preferred Name,” as a transgender individual may not wish to be called by a name that reflects their gender identity. Including “preferred pronoun” on a form shows understanding that someone may not identify as they appear.

6. Use gender-neutral language

Approach each interaction with open-mindedness, and a nonjudgmental attitude. Remember, your job as a healthcare professional is to assist the person in solving a health concern, or reducing the risk of future health problems. If your patient doesn’t feel comfortable sharing behaviors with you that are relevant, what good is the interaction? Conveying that the information shared in the provider-patient interaction is confidential may alleviate fears your patient has. 

When asking questions about sexual history and behaviors, preface questions with a statement such as, “So that I can best advise you about your health, I’d like to ask some questions related to sexual behaviors that I ask all my patients. ” Or, “It is our standard practice here to take a sexual history for every patient we serve.”

7. Ask open-ended questions

For example, asking, “Is there anything else that would help me ensure you get the most out of this visit?” can help patients share relevant health information.

Do not overwhelm patients with questions unrelated to the reason for their visit, or to enhance your own knowledge about transgender health. Focus on the behaviors impacting health rather than on SO/GI per se, so the conversation can positively influence health and foster acceptance. 

Prevent any “awkward pause” immediately after a patient shares SO/GI information. Practice your response in advance, such as “Thank you for being open with me; this will help me provide better care for you.” Role-playing your response can increase your own comfort with these situations.

8. Reflect the patient’s language

Avoid applying labels such as “gay.” Some people do not self-identify with any particular descriptive label, yet may have sex with partners of more than one sex or gender. Do not presume. For example, lesbian or gay men may have had or have sexual experiences with individuals of the opposite sex, and bisexual individuals may have long periods of monogamy; keep in mind that sexuality can evolve over time.

9. Investigate mental and physical health risks for LGBTQ patients

Be aware of the unique social pressures and health risks of LBGTQ patients. Societal phobias, violence, and hate crimes – and the fear of them -- are all too real for these individuals. Along with the potential for being ostracized from family and other social groups, this can contribute to chronic anxiety and depression.

LGBTQ individuals who are members of minority populations often face a double whammy of discrimination. Those with non-conforming sexual orientation or gender identity may also experience higher risk of suicide, as well as increased likelihood of tobacco use and drug/alcohol misuse.

It’s also important to build your awareness of the specific physical health problems LGBTQ individuals face. Lesbian women are more at risk for certain cancers due to the prevalence of obesity, nulliparity, or later pregnancy. Lesbian women are susceptible to many of the same sexually transmitted infections as heterosexual people and gay men. Thinking that this population isn’t at risk for these STIs can result in lack of appropriate screening and treatment. In addition to HIV infection, gay men may be at higher risk for anal cancer and can be particularly susceptible to body image issues in the desire to be attractive to other men. They may also experience a variety of cancers resulting from increased obesity and use of tobacco and alcohol.

10. Convey respect

Always remember that the LGBTQ patient in front of you has taken a courageous step to be in your office and disclose some of the most personal information about their lives. Having as positive and affirming an experience as possible will make it more likely the individual will seek future care in a timely manner. 

Becoming aware of resources specifically designed for LGBTQ individuals and making referrals as appropriate (e.g., support groups, smoking cessation groups or AA meetings, etc) will convey that you care enough to become informed about their particular needs. The quality of your interaction can truly make a difference in someone’s health -- and life.

Interested in more Diversity and Inclusion to-do's? 

But what about chief nursing officers? They aren't providing direct care at the bedside, but do they still experience moral distress?

The answer, according to a qualitative study published in the Journal of Nursing Administration in February, is yes. It's just taboo to talk about it.

"There's shame and isolation when you do have the experience, so it can make it very difficult for people to feel like they can openly discuss it," says Rose O. Sherman, EdD, RN, NEA-BC, FAAN, professor and director of the Nursing Leadership Institute at Florida Atlantic University.

Sherman is one of the study's authors. "I think that the other piece of it is, CNOs might not always label it as moral distress. But these are uncomfortable situations where they're making decisions against their values systems."

Through oral interviews, Sherman and her co-author, Angela S. Prestia, PhD, RN, NE-BC, discussed chief nursing officers' experiences of moral distress, including its short and long-term effects. Prestia is corporate chief nurse at The GEO Group.

The study's 20 participants described their experiences of moral distress, and several said they experienced it on more than one occasion. It was often related to issues around staff salaries and compensation, financial constraints, hiring limits, increased nurse-to-patient ratios to drive productivity, counterproductive relationships, and authoritative improprieties.

"For example, a physician went to someone over a CNO's head and said, 'I think you should pay a scrub tech more. She is very valuable to me," Prestia says. "And of course he was a high-admitter, high-profile physician."

The CEO approved the special compensation, creating a salary inequity among the other scrub techs.

In another scenario, six participants reported their CEOs had improper sexual relationships with staff members. Prestia points out that the CNOs did not object to these relationships because of religious or moral beliefs, but because they were harming productivity at the organization.

"In their [the CNOs'] mind' of right and wrong, these people had access to things that they should not have had access to and [those relationships] create barriers to getting the work of the organization accomplished."

Lasting Effects 
The study uncovered six significant themes related to CNO moral distress:

1. Lacking psychological safety
2. Feeling a sense of powerlessness
3. Seeking to maintain moral compass
4. Drawing strength from networking
5. Moral residue
6. Living with the consequences

CNOs reported they often felt very isolated during the experience of moral distress.

"If they pushed back on a decision because they felt it was in conflict with their values they were isolated within the organization and they no longer felt safe. They weren't invited to meetings. They weren't included in decision making," Sherman says.

Even though they took steps to do what they felt was right—documenting meeting minutes, reviewing policies and procedures, and referring to The Joint Commission standards—to maintain their moral compass, those efforts were often unsuccessful.

"What happened was when they were in this situation… they were beat down at every turn," Prestia says. "Then the 'flight' started to set in. 'Maybe I need to leave? Maybe I should resign? Maybe I need to start planning my exit strategy?' Or before they could do that, they were terminated."

Moral Residue
Even once they were out of the situation, many CNOs reported the experience left them with a 'moral residue.'

"It is a lingering effect of the moral distress. I liken it to a fine talc that lingers on your skin and it manifests itself either physically or emotionally," Prestia says. "We actually had several participants say, 'When I get a call about staffing now in my new job, all of a sudden I get this feeling of impending doom.'''

Both Sherman and Prestia hope this research will open up a larger conversation about CNOs and moral distress. They will present their findings at the AONE 2017 conference in March.

"What we found in the work that we did was, clearly, collegial support from a strong network is very important in building one's resiliency and being able to deal with these situations," Sherman says.

"I think that having others who've been through it is very important, which is why forums that allow people to talk about this candidly, when a CNO finds him or herself in this situation, become critical."

"No! No! Don't die! You died!"

The shrieks come hurtling down the hallway of the Children's Unit at Grand River Hospital, but don't be alarmed. They are punctuated by laughter — a lot of laughter.

Registered nurse Tommy Sing is playing a video game with 10-year-old patient Conner Quigley, and he's losing badly. 

"I've always liked to play," he says, "I was never good at them, obviously, but I've always enjoyed playing them."

Sing, who has been working on the Children's Unit for almost six years, has been dubbed the unofficial video game guy for the amount of time he spends playing with patients.

"I've played everything from Minecraft – not very well, but I've played Minecraft – all the way to games on the Nintendo Wii, all the way up to playing Call of Duty with some 16 and 17-year-old patients," he said. 

"You know, I'll walk into a patient's room and they'll already have the Xbox or the Nintendo Wii already set up and then we'll start talking video games. Obviously, sometimes, on the floor it's too busy for me to play with them, but if the opportunity presents itself or I finish my shift at 7:00 p.m. I'll stay after work and play a couple of rounds with them."

Although video games often get a bad rap in the health sector, being blamed for everything from poor eating habits to behavioural problems, Sing says they help him build quick rapport with the kids on the unit.

"It gives you one thing definitely that we have in common," he said. "It's so easy to just break the ice by playing the games and it just helps snowball into finding more and more about each other and even having more and more in common with each other."

He says the relationships he's been able to form with the patients makes it easy to crawl out of bed in the morning and come to work, even when his shift starts at 7:00 a.m.

One hospital in Dorset, England has stumbled upon an unusual way of making tiny premature babies in the neonatal intensive care unit (NICU) feel safe and comforted: by giving them a tiny handmade octopus to curl up with.

According to Poole Hospital, where the practice of pairing preemies with crocheted cephalopods has become an ongoing ritual, these cuddly crafts do more than just calm the babies.

The idea originally hails from Denmark where Aarhus University Hospital has suggested that the creatures can actually help smaller babies grow and thrive. A spokesperson for Poole hospital stated that the decision to introduce the crocheted crafts to patients wasn’t based on published scientific research but contact with other hospitals who had found they made a noticeable difference to their little patients.

But it can't be just any toy. It must be an octopus.

So why these sea creatures exactly? The design of the crocheted tentacles gives the babies something to hold and squeeze, and that can be a good thing for regulating everything from oxygen intake to heartbeats. What's more, the tentacles might be helpful at keeping the tiny patients from pulling out their tubes.

A number of babies at Poole Hospital took to their new toys especially well. In a feature that in the Daily Echo last fall, it was revealed that premature twin sisters Jasmine and Amber Smith-Leach both benefited from the comfort of their new toys. Their neonatal nurses said they have no doubt these tiny octopuses have helped the girls.

What's more, in response to the story, the hospital's NICU has received a whole new supply of crocheted octopuses for future patients.

“We’ve been overwhelmed by the kind response to our appeal for crochet octopi,” said Daniel Lockyer, matron of neonatal services. “We’ve now received over 200 octopi and have a year’s supply ready and waiting for our little patients! We’re not looking for anymore octopi for a little while so we can use these up.”

“We’ve been overwhelmed by the kind response to our appeal for crochet octopi,” said Daniel Lockyer, matron of neonatal services. “We’ve now received over 200 octopi and have a year’s supply ready and waiting for our little patients! We’re not looking for anymore octopi for a little while so we can use these up.”

Find the Octopus Pattern on our Pinterest!

Medical professionals like doctors, nurses, and paramedics devote much of their time and energy to making sure we are safe and healthy. They don’t get a lot of time to themselves, and many would argue that they don’t get the recognition they deserve.

Ashley Bolling is a stylist and mother of three who is letting it be known that these people, particularly nurses, deserve more than just a thank you. She posted a sweet message for nurses everywhere after one came into her salon, Captivate Salon & Spa, and dozed off in her chair. The woman hadn’t slept all night and was clearly exhausted. Ashley gently rested her head against her stomach, but it was her shoes that grabbed her attention. They weren’t worn down or dirty — she was simply amazed by how much weight they carried, both literally and figuratively.

You can read Ashley Bolling’s sweet and moving tribute to nurses below.

I had one of those “stop-you-in-your-tracks,” extremely humbling moments, while working quietly on the hair of a very exhausted, sleeping nurse.

She’d been at work all night and hadn’t been to bed when she landed in my chair, but not before stopping to buy my breakfast on her way.

As she dozed off, I gently rested her head on my stomach and continued to foil her hair…. then I noticed her shoes.

I wondered how many miles those shoes have walked. I wondered what they’d walked through. Blood? Tears? In & out of the countless rooms of the patients she’s cared for? I wondered how many hours they’ve carried her, and all those like her, while they literally save the lives of those we love and hold the hands of the ones who can no longer fight that fight.

But with those shoes propped up in that chair, phone in her lap, I got the chance to take care of her (even if it was just for a few hours) and I felt extremely honored to take care of such a hard working, inspiring woman I’m so lucky to call my friend.

I’ve always respected and valued these amazing superheroes and am proud to be the sister, daughter, niece, friend and hairstylist of so many. Know you are appreciated, know you are irreplaceable, know you are loved!

The nursing profession is the largest segment of the nation’s healthcare workforce, with more than three million nurses practicing across the U.S., according to the American Association of Colleges of Nursing.  Nurses serve as both the backbone of the healthcare industry and on the front lines of developing health solutions. Although most nurses may still head to work in scrubs and comfortable shoes, for many nurses, the day-to-day reality of their job has changed in dramatic ways over the past ten years.

This evolution has been shaped by a changing U.S. population, new technology and the influential 2010 Institute of Medicine (IOM) report, “The Future of Nursing: Leading Change, Advancing Health.”  The report charged nurses to take a greater leadership role in healthcare, noting that nurses should be full partners, with physicians and other healthcare professionals, in redesigning the U.S. healthcare system.

Below, we’ve detailed just a few significant changes in nursing practice within the last decade.

Growth of Nursing Leadership

The IOM report highlighted the unique patient-centric viewpoint of advanced practice nurses and the important role they can play in addressing the shortage in primary-care healthcare providers across the U.S. Advanced practice registered nurses (APRNs) play a critical role in providing access to affordable, quality care. According to the Robert Wood Johnson Foundation, “consumer demand for APRN-provided care is growing thanks to a shortage of primary care physicians, the soaring cost of healthcare, and a population that is aging and living longer with more acute and chronic conditions.”

“We see patients through the full spectrum, from the newborns on up,” said Steve, a rural family nurse practitioner featured below in the Campaign’s “A Day in the Life” video. “With the shortage of family practice providers, ‘midlevels’ such as myself and physician assistants are becoming a much more important part of the of the healthcare delivery model.”

“Wearable devices that can monitor consumers’ health are changing the way our society thinks about providing care,” said Fratzke.

Fratzke was an early leader in the advancement of a nursing mobile app for patient data documentation into electronic health records (EHR). Hospitals can use nursing apps to help nurses more efficiently capture real-time patient assessment documentation, such as vital signs, medicine distribution and pain scales.

Telemedicine’s Impact on Accessibility

Technology has also led to the increase in telemedicine options. According to an article published in the American Journal of Critical Care (AJCC), telemedicine is changing the way patient care is provided in a growing number of intensive care units (ICUs) across the country. The article notes that “the U.S. has approximately 45 tele-ICUs with monitoring capacity” which impacts care for “an estimated 12 percent of ICU patients in the country.”

Benefits of tele-ICUs for nurses, the article states, include increased efficacy in monitoring trends of vital signs, detecting unstable physiological status, providing medical management, enhancing patient safety, detecting arrhythmias and preventing falls.

“In rural areas, it is also possible for tele-health to help fill a void in care,” said Connie Barden RN, MSN, CCRN-E, CCNS, chief clinical officer of the American Association of Critical-Care Nurses, interviewed in the Nursing Notes article, “Tele-ICUs Help Nurses Care for Patients from Afar.” “These remote consults by a nurse specialist result in getting the right care to the patient in a timely manner. Besides being an efficient way of delivering care it may also help to keep the patient in their local area rather than needing a transfer for care hundreds of miles away. So, it can save money and keep the patient with their family – a win-win solution for everyone.”

New Nursing Specialties and Roles

Telemedicine nursing and nursing informatics are just two nursing  specialties that have grown in the past ten years. According to the Bureau of Labor Statistics’ Employment Projections 2012-2022 – released in December 2013 – the registered nurse (RN) workforce is expected to grow to 3.24 million by 2022, an increase of 526,800 or 19 percent since 2012.

As indicated in the IOM report, the half a million new nurses entering the workforce before 2022 will be responsible for shaping the profession, including advancing in-demand specialties, such as home-health nursing and geriatric nursing, for the increase in “Baby Boomers” who are retiring in the next decade.

In addition to new nursing specialties, nurses are also playing new roles in healthcare, The “Modern Nurse” section of Nursing Notes, outlines emerging nursing roles, such as developing simulation technology, flying into emergency situations or establishing a practice in a local libraryas part of a public health initiative.

New specialties, increased leadership opportunities and the use of telemedicine and mobile health are just a few of the ways that nursing has changed in the past ten years. Is there another innovation or idea you think we missed? Tweet us at @DiversityNurse or share a comment on our Facebook Page.