Blog (47)

See How Nurses Are Doing Less Walking And More Caring

Thu, Feb 16, 2017 @ 11:11 AM

Every Nurse I know who works in a hospital, says they are amazed how much walking they do in their 12-hour shift. If you wear a Fitbit or another step tracking device, you know you walk miles during your shift. Here’s a story about a hospital that did a study to see where they could eliminate some steps for Nurses in the design of their new building.

The goal was to give Nurses more time to deliver the best patient care. If you have to walk all over the building to fulfill a medication order, perhaps there is a better way to do it with less steps. Maybe the applesauce or ginger ale could be located closer to where the medicine is dispensed. Please read on for some valuable information.

You don't know what you don't know until you know it.

That's the lesson leaders at ProMedica Toledo Hospital in Ohio learned during the design of its 615,000 square-foot patient tower set to 2019.

As part of the design process, the organization took part in research to identify and refine ways to improve nursing care and efficiencies, including distance traveled during a shift.

Architects from HKS, Inc., the firm designing the building, approached Alison Avendt, OT, MBA, vice president of operations, at ProMedica Toledo Hospital about doing the research.

"We have a building that we opened in 2008, so they wanted to look at how we were using the spaces [there], and get feedback from nursing on how it was working," Avendt says.

"That was really attractive to me because I heard we had issues with the building that we were in and there were many things that we wish we could have done better. I thought if we could do a good design diagnostic and learn something from that, it would really help guide our design work."

An Applesauce Moment
During two days of onsite observation, researchers shadowed ICU nurses and intermediate-level medical-surgical nurses. The researchers assessed the existing floor plan, used a parametric modeling tool, and created heat maps to provide a graphic representation of what a nurse's 12-hour shift looked like in terms of workflow and walking distances.

"One of the big [revelations] was around our whole process of medication passing," says Deana Sievert, RN, MSN, metro regional chief nursing officer and vice president for patient care services at ProMedica.

Observation revealed that a nurse reviewed the patient's medication administration record in the patient's room, walked to the supply room to get the medication from the Pyxis machine, and then often had to stop by the patient refrigerator to get something—like applesauce—to aid in the medication pass before walking back to the patient's room to administer the medication.

"It was something that was just so ingrained in our staff nurses' normal daily activities," Sievert says. "When they did the heat mapping it was like…'Wow. [There's a] big pinch point that we as staff nurses didn't really even realize was there.' "

Avendt says the researcher called this realization "the applesauce moment."

"Nurses are masterful at just making things work. There are a lot of things that the nurses knew were not value-added or were problematic, but they would just make it work," she says.

"It was really good to flesh out what those things were by observing because if you just ask[ed] them, the nurse would often not be able to verbalize what the problem was. But by seeing it, it came to light."

The architects used this information to design a unit that would cut down on walking time. Instead of a long corridor with a common area at one end, the unit was broken up into pods and supplies were located in multiple areas so nurses could get them from the location to which they were closest.

"We were able to take them from a three-mile journey on their shift to 1.5 miles. We cut in half the steps that they were taking," Avendt says.

After the tower opens, more research will be done to see how the design is affecting workflow.

"We've since learned that [field research] is not common for people to do. We paid a little bit of money to do that, but in the scheme of things it was well worth the investment," Avendt says.

"Everybody wants to give the nurse as much time as possible to be with the patient [and] try to take away the things that are not value-added in the nurse's day."

Topics: efficiency, patient care, hospitals, Nurse burnout

A More Diverse America Needs Health Care Adjustments

Posted by Erica Bettencourt

Wed, Feb 15, 2017 @ 04:02 PM

How can you properly care for a patient if you don’t understand their personal needs? Communication is key. Making a patient comfortable goes far beyond providing warm blankets. It is about the patient trusting you and knowing you have things in common that show them you understand how they feel and what they need.

Many healthcare providers are seeing how important diversity and inclusion is to delivering quality patient care. Hospitals are providing language services by hiring a diverse staff, many of whom are bilingual or multilingual. Culturally appropriate care strategies are also key. Religious views may alter the way staff would normally provide care. That means you might assist a patient who needs to move in order to pray or work out special blood testing times to allow the patient to fast. The population is rapidly changing and by 2050, the white population will no longer be the majority.

On any given day at the Salud Clinic, Lucrecia Maas might see 22 patients. They come to the community health center tucked away in an office park here needing cavities filled, prescriptions renewed and babies vaccinated. When they start to speak, it’s rarely in English. Sometimes it’s Hindi. Or Dari. Or Hmong. Or Russian.

Maas is fluent in English and Spanish, but that gets her only so far. She often has to hop on the phone with a medical interpreter, who relays her questions to the patient and then translates the patient’s answers. “It just takes a little more time,” the nurse practitioner said.

The future of American health care looks a lot more like the Salud clinic than Norman Rockwell’s iconic small-town doctor’s office. The country is on course to lose its white majority around 2050. That future is already visible in Sacramento County and neighboring Yolo County, where West Sacramento is located: by 2013 the combined population of Hispanic, black, Asian and other nonwhite residents had edged out whites. In West Sacramento, a historically working-class county across the river from the state capital, more than 2 out of 5 public schoolchildren already speak a language other than English at home.

Sacramento-area hospitals, community health centers and doctor’s offices have had to adapt. They’ve hired more multilingual, bicultural staff. They’ve contracted with interpretation services. The medical school at the University of California, Davis, is trying to figure out how to recruit more Latino students to a profession that remains largely white and Asian. And doctors are being trained to deliver culturally appropriate care to patients of many backgrounds.

When a diabetic pregnant Afghan woman wanted to fast during Ramadan, the Salud Clinic’s nutritionist recalculated the best time of day to measure her blood sugar. If Mexican mothers say they’re rubbing gentian violet on their baby’s umbilical cord area to keep it clean — a harmless natural remedy — doctors encourage them to keep doing so.

Similar stories are playing out across California, which became majority minority in 2000. Health systems are using new data tools to get a better handle on just who they’re serving — and where the trend lines are pointing. County health departments, nonprofits and clinics have invested in recruiting and training bilingual community health workers.

Insurance doesn’t always pay for the extra costs of services like translation. Patient visits take extra time, straining schedules for doctors and nurses. “You can’t really help somebody if you don’t understand how they value health, and how they understand health and the health care system,” says Robin Affrime, CEO of CommuniCare Health Centers, the nonprofit that operates the Salud Clinic.

Immigrants Drive Change

Most of the nation’s population growth since the 1960s has come from the immigration of nearly 59 million people from foreign countries who settled in the U.S. in that time, mostly from Latin America and Asia, according to the Pew Research Center. (The Pew Charitable Trusts funds the Pew Research Center and Stateline.)

Hispanic, black, Asian and multiracial babies in the United States already outnumber white babies. In three years’ time, a majority of U.S. children and teenagers will be some race other than non-Hispanic white. And in about 30 years, whites will cease to be the national majority, demographers say.

A more diverse patient population may mean a different mix of health conditions, because some are linked to country of origin. People who were born in Asia are particularly prone to hepatitis B, for instance. African-Americans are more likely to have sickle cell anemia, an inherited blood disorder more common in Africa, the Middle East, India, and parts of southern Europe and Latin America.

Asians and Hispanics — the groups likely to drive population increase going forward — have longer life expectancies than whites. Hispanics are less likely to suffer from many chronic conditions than whites even though they’re typically poorer and less educated.

Yet second- and third-generation Hispanic-Americans are often less healthy than their immigrant parents. One theory is that with assimilation, younger generations pick up bad American habits such as eating fast food and not getting enough exercise. And health continues to vary by subgroup. For instance, Californians with roots in Mexico are much more likely to be obese than Californians with roots in Puerto Rico, survey data show.

Health Challenges

One of the challenges facing health care providers is obvious: many new immigrants can’t speak English. About 60 million Americans speak a language other than English at home and about 25 million can’t speak English very well, according to the U.S. Census Bureau.

Salud doesn’t typically bring in in-person interpreters, because they’re more expensive. But it does contract with a phone interpretation service, a business that’s growing rapidly across the county. The service provides real-time translation between English and at least 12 other languages. Interpretation of some of the less common languages, like Hmong, needs to be scheduled in advance. And there have been instances in which the interpreter speaks the wrong dialect of a language like Dari, spoken in several countries in Central Asia.

Often a staff member can help. The health center has doctors and nurses who speak Hindi, Urdu, Punjabi, Tagalog and Spanish, and has hired administrative staff and medical assistants who speak Hmong and Mien, a language spoken by some Indochinese refugees who fled to the United States during the Vietnam War.

But Mien has no written language. And some cultures and languages have concepts that defy easy translation. “There are some words where we really cannot use the translator,” said Rubina Saini, a Salud physician who speaks several South Asian languages.

Other clinics don’t do as well as Salud. Under federal civil rights law, hospitals, nursing homes and other providers that receive federal funding must take reasonable steps to accommodate patients who can’t speak English well. But the legal requirement isn’t well-enforced and services can be spotty. “Where people need language services isn’t necessarily where they’re being offered,” says Melody Schiaffino, an assistant professor at San Diego State University’s Graduate School of Public Health.

In a recent study, Schiaffino found that about 30 percent of all hospitals nationwide don’t offer translation services. The share is even larger for public safety-net and for-profit hospitals, even in diverse cities. That’s because the government hospitals can’t afford to do so, she said, and for-profit hospitals tend to serve well-insured patients who speak English.

State policy helps determine who gets interpretation and translation help. Only 15 states directly pay for interpreters needed by Medicaid patients. California isn’t one of them, although a 2009 task force created by the state Department of Health Services recommended the change. (California does require private health insurers to provide — although not necessarily pay for — language services. The state also requires health plans in its state Medicaid program, Medi-Cal, to translate certain written materials into common languages.)

Most Salud Clinic patients have a Medi-Cal insurance plan that will cover the cost of interpretation, Donna Paul, the clinic manager, says. If a patient doesn’t have coverage, CommuniCare Health Centers absorbs the cost.

Then there’s the need to navigate cultural differences. The front-office staff knows that Southeast Asians may be uncomfortable making direct eye contact, and that Russians may speak loud and fast, Paul said. They’ve learned not to take such things personally.

Ethnic Disparities

Treating a more diverse population also means confronting gaps in care that go beyond socioeconomic status. African-Americans, and in some cases Hispanics, tend to receive lower-quality care than whites even after controlling for income, age and symptoms, according to an often cited 2003 report by the Institute of Medicine (now the National Academy of Medicine). Black patients are less likely to be prescribed pain medication than white patients, for instance, and less likely to receive antiretroviral drugs if they’re HIV positive.

There’s no simple reason for the gap in quality, which still persists, although researchers say unconscious bias or stereotyping by physicians, cultural and language gaps, and even geography play a role. “Race and ethnicity matter, whether you like it or not,” says David Acosta, associate vice chancellor for diversity and inclusion at the University of California, Davis, health system.

To erase the gap, medical schools are adopting strategies to better prepare the next generation of doctors. One of these is to recruit and train more minority students. The second is to train all students to examine their own biases and be more sensitive to cultural differences.

In California, where almost 40 percent of residents are Latino, 4 percent of physicians are. Nearly 20 percent of all physicians in the state speak Spanish, but Acosta says bilingualism isn’t enough. As a Latino physician, he says he’s bilingual and bicultural, familiar with his Hispanic patients’ approach to health, such as the folk remedies they might try. That kind of cultural match improves trust between doctors and patients.

Black and Hispanic physicians are also underrepresented in the physician workforcenationwide. Increasing their numbers could also help ease the shortage of primary care physicians, Acosta said, because black and Hispanic physicians are more likely than white and Asian physicians to provide primary care to low-income minority communities desperately short on doctors.

UC Davis launched an effort to recruit more Latino students to health careers last summer, funded by the Permanente Medical Group, a physician group that works with Kaiser Permanente.

The UC Davis program, called Prep Médico, is aimed at undergraduates from northern and central California and starts with a summer session at the UC Davis medical school. Participants get ongoing support from mentors, access to research opportunities, and help studying for the medical school admissions exam.

Once students reach medical school, they need to be trained to treat patients of a different race, ethnicity, culture, sexual orientation or socioeconomic status than their own. Twenty-one states, including California, have adopted health equity standardsthat help guide physician training.

But there’s a debate over how best to teach so-called cultural competency. The concept is often presented to students like another task to master or acronym to memorize, said Jann Murray-García, an assistant adjunct professor at UC Davis’ school of nursing. But it’s not something you can memorize with flashcards. “There’s just no way to master the complexities of other people’s lives and personhoods,” she says. And recognizing one’s own racial biases and stereotypes, and learning how to deliver good care despite them, can be a lifelong process, she says.

Crunching Data

Kaiser Permanente has turned to data, to make sure these new populations are getting the care they need.

For more than a decade, the organization has broken down its quality of care data by race, gender and ethnicity and used it as a guide to drive health care priorities, with a goal of narrowing health care disparities.

For example, African-Americans are more likely than whites to have very high blood pressure and — partly as a result — to suffer from strokes, heart disease and end-stage kidney disease. First, Kaiser’s analysts figured out what the gap looked like for their own patients. Then they created a new set of instructions for care teams, informed partly by patient focus groups.

Among other changes, physicians were asked to prescribe African-Americans medications proven to be more effective for them. Physicians, nurses and other health workers took additional care to listen to patients, follow up, and nudge them to stay on top of their treatment plan. The effort has paid off: Since 2013, Kaiser has cut the high blood pressure control gap between its African-American and white patients in half.

Health systems can use data to improve their language services, too, says Glenn Flores, a physician and chair of health policy research at Medica Research Institute, a nonprofit research group. All it takes is asking new patients a few questions to check their English fluency, and noting what other languages they speak. That way clinics and hospital systems can arrange for in-person interpreters ahead of time for patients who need them and figure out which languages are essential when they are hiring staff or contracting for medical translation services. “Very few hospitals around the country do this,” he says.

Nationally, health data need to more accurately capture racial and ethnic subgroups, says Kathy Ko Chin, president and CEO of the Asian & Pacific Islander American Health Forum. The “Asian and Pacific Islander” category used by the U.S. Census Bureau, for instance, encompasses everyone from third-generation Chinese-Americans to Pakistani engineers to Cambodian refugees. People with origins in the Middle East have no U.S. Census designation of their own, and can self-identify as white, Asian, African or “other.” Without more specific data, it’s hard to know what problems local communities have and what services they need, Ko Chin says.

California policymakers have unusually detailed data at their fingertips thanks to the California Health Interview Survey, conducted by the University of California, Los Angeles. Researchers have been able to tease out findings that can inform better care, such as the fact that Korean women are much less likely to receive mammograms than Japanese women in the state.

Use our free checklist to scale your diversity and inclusion efforts.

Topics: hiring, cultural competence, Diversity and Inclusion

Bill Introduced to Increase Access to Quality Healthcare and Lower Costs

Posted by Chris Cowperthwaite

Tue, Feb 14, 2017 @ 12:19 PM

RALEIGH – Lawmakers at the North Carolina General Assembly have introduced the Modernize Nursing Practice Act, a bill designed to reduce burdensome regulations and allow Full Practice Authority for Advanced Practice Registered Nurses (APRNs). Primary sponsors of HB 88 are Rep. Josh Dobson, Rep. Donny Lambeth, Rep. Sarah Stevens, and Rep. Gale Adcock. Primary sponsors of SB 73 are Sen. Ralph Hise, Sen. Louis Pate, and Sen. Joyce Krawiec.

“This legislation is long overdue for the patients of North Carolina. It allows some of the best nurses in healthcare to do exactly what they’ve been trained to do,” said North Carolina Nurses Association President Mary Graff. “North Carolina has a proud history of innovative nursing leadership, but this is one area where we are in catch-up mode to most of the rest of the country. These types of improved regulations have already proven to be safe and effective in dozens of other states.”

Unlike bills that are being considered for other professions, HB 88/SB 73 does not change the scope of practice of any nurses; it simply removes outdated and superfluous physician supervision requirements. Current regulations do not require physicians to actually “supervise” APRNs from the same city where they practice or even see any of their patients.

Dr. Chris Conover, a health economist at Duke University, conducted research in 2015 showing that APRNs have the potential to improve quality and access to healthcare while saving between $433 million and $4.3 billion per year in North Carolina.

“Modernizing North Carolina’s regulation of APRNs would allow North Carolina residents to enjoy better access to care of equivalent or better quality even as the health system sheds some avoidable costs in the process,” Conover said.

Conover’s conservative estimates conclude that expanding the use of APRNs would save North Carolina more than $430 million annually in health care costs while adding at least 3,800 jobs to the economy.

APRNs are some of the most highly-trained nurses in the profession, and require masters-level education. The four types of APRNs include:

Nurse Practitioners
Certified Nurse-Midwives
Certified Registered Nurse Anesthetists
Clinical Nurse Specialists

A similar version of this bill was introduced in 2015 with bipartisan support in both the House and the Senate. For more information on Dr. Conover’s study through the Center for Health Policy & Inequalities Research at Duke University, visit http://bit.ly/APRNstudy.

Topics: Modernize Nursing Practice Act, Advanced Practice Registered Nurses

Oncology Nurses Are In High Demand

Posted by Pat Magrath

Mon, Feb 13, 2017 @ 04:02 PM

I bet there is a lot you can add to the comments from Oncology Nurses in this article. Perhaps you’re an Oncology Nurse or someone close to you is doing this job. This article will give you a glimpse of the day-today responsibilities, concerns, technological issues, and a perspective on how to answer a patient’s very difficult questions.

As you know, this Specialty isn’t for everyone. If you’re considering becoming an Oncology Nurse or are curious about it, please read this article and let us know what you think.

In the world of cancer care, there's much to celebrate. In the last two years, the FDA has approved dozens of new treatments. The vast majority of those drugs are targeted therapies — the kind that require particularly complex medical care. At the core of that care is the oncology nurse.

The job of the nurse in cancer care is now even more demanding — and in the next few years, that pressure could be compounded by a shortage of oncologists.

David Freudberg is host of the public radio series Humankind, based in Belmont. He's produced a documentary series about the challenges in nursing in today's health care environment called "Resilient Nurses."

Freudberg spoke with WBUR's All Things Considered host Lisa Mullins about what he's learned regarding the pressures nurses face and the care they give. Below are excerpts from that conversation and from Freudberg's interviews with nurses around the country.

DAVID FREUDBERG

On the working conditions nurses face
"They're difficult conditions, with so many baby boomers flooding into our health care system and the new cohort of patients coming in as a result of the Affordable Care Act. And many of them have what's called higher acuity — more difficult-to-treat symptoms. In addition, there are budget difficulties, and you have all the technology that nurses increasingly are responsible for monitoring [with] a patient, and this adds a kind of emotional stress — because nurses truly are in it to care for the individual patients. They want to make a personal connection to the extent that their job limitations permit. And when you're having to mostly focus on machinery and technical measurements and special procedures, that becomes an obstacle to direct care of the patient. And so that's a stressor."

On technology making nurses even more accessible to their patients
"I happened to interview a couple of wonderful nurse practitioners... And they do provide their cell phone and text abilities to their patients, because they really want to be available to them — some [patients] whom are very compromised and extremely worried. In addition, various social media — Facebook, Twitter — become additional means of reaching nurses ... so in some ways the technological pressure has increased in the communications technology, as well ... My impression, having met them, was that they're just deeply warm and caring. It's not to suggest that other nurses who don't want to do it are not warm and caring. But they just wanted to be there for their patients."

On "compassion fatigue"
"... some people would say compassion doesn't fatigue; it's the people who are trying to be compassionate who need to re-frame the way in which they provide their compassion. But it is potentially a serious problem, because people do get tired. They are up against a relentless schedule. Some nurses don't even drink water during the day; they don't go to the bathroom during the day. I heard this over and over in different locations... for every patient they're dealing with, three more have rung the desk and they need to attend to them. And in addition, there are the families who are asking questions. It's just really tough, and the typical shift of a nurse in the United States is about twelve hours. That's a long time to be on your feet, running from patient to patient, not necessarily even getting a break. And this subjects you to medical errors, to a reduction in job performance.

Ashley Weber, oncology nurse at Center for Cancer and Blood Disorders at Children’s Hospital Colorado, on administering cocktails of medications to pediatric cancer patients
"We're working with severely immunocompromised people... if you don't prep the insertion site with alcohol for as long as it needs to be, you could be introducing a bloodstream infection. Some of the medications we give, you'll read the adverse side effects or reasons that we would stop a certain study that a patient's on, and it's death. You're just waiting for that clearing of the throat to be an indicator that your patient's going to stop breathing. And then when we're at home and we see a phone call from work, we think, 'What did I do wrong? Who did I kill? What medication did I not give? What chemo didn't go in right?' And we're looking at patients that each have easily 15 to 30 meds each."

Sherry Goldman, oncology nurse at Cedars Sinai Medical Center, Los Angeles, on providing compassionate care to cancer patients
"I can think of a specific incident where I told a patient some really devastating news. And I just reached out and held her. And we cried together. I don't have an issue with showing my feelings. There may be other clinicians that do. But how can you not, when you're telling a young girl some tragic news? And you see her completely fall apart. It's okay to fall apart with them and hold them, but then give them confidence afterward."

Paulette Manon, oncology nurse at Brigham and Women's Hospital, Boston, on questions she was asked by a terminally ill cancer patient
"I was in his room, and he said, 'What do you think happens to people after they die?' And I said, 'I'm not sure.' He said, 'What is your belief?' And I said, 'I believe that if you believe in God, that you are remembered and he will look after you.' And he said, 'What do you think happens to people that don't believe in God?' I said, 'Well, whether you believe in him or not, he believe in you.' When someone asks you something like that, it's just not a casual question. You can actually feel the pain coming from that person and the fear that that's going to be it for them, no return, nothing. It's not always that you give someone an ABC answer and they're fine."

Topics: nursing shortage, Oncology Nursing, Cancer Care

Your Hiring Approach Should Drive Inclusivity

Posted by Pat Magrath

Fri, Feb 10, 2017 @ 03:37 PM

Recruiting these days is getting more and more difficult, particularly when hiring Nurses. We’re featuring this article because of its creative approach to thinking outside the box. Perhaps it’s time to change your message, how and where you target that message, and maybe even the position requirements.

For this particular company featured in the article, a college degree and sales experience had always been required for its Sales Development Reps (SDR). The author was promoted to Sales Development Manager. He wanted to hire a different type of Sales Rep -- someone with no sales experience or college degree, but was hungry to learn and grow. The Sales Rep job is a tough job and he knew the burnout rate was high.

Once he removed the degree and experience requirements, he found his applicant pool became more diverse. To quote the author “If you have a role at your organization that doesn’t require previous experience, be intentional about your recruiting. Use it as an opportunity to shift the demographic makeup of your company.”

As a Nurse Recruiter, we know you have degree and experience requirements for many of your positions, but perhaps this article will inspire you to make some positive changes to reach your hiring goals. Good luck!

A few weeks into my first year as Jhana’s Sales Development Manager, a realization hit me.

Because I was a hiring manager recruiting for a role that required no previous experience or college degree, I was in a unique position to drive diversity and inclusion at my company.

Almost every corporate job requires a college degree, and many also require previous experience in a similar role—big hurdles for someone from an underserved community. The Sales Development Rep (a.k.a. SDR), however, is one of the few jobs that allow someone without relevant work experience or a college degree to break into corporate America.

College Degree Not Required

SDRs at Jhana fill an entry-level role. They don’t do cold calling but instead use a series of template-based emails to set up introductory sales calls for our Account Executives. Still, many companies require a college degree for the role, whether they state it explicitly or not.

When I first deleted “Bachelor’s Degree” from the job description, it felt a bit radical. It even felt like I was doing something wrong. But as I examined why I had included it in the first place, I realized I couldn’t think of a single good reason.

It was purely reflexive.

Removing “Bachelor’s degree required” was the first step towards attracting a more diverse and inclusive candidate pool.

Why I prefer SDRs With No Previous Experience

Here’s something that I find interesting: Jhana’s current sales development team is the most productive lead-generation team the company has ever had. However, if our current SDRs had applied for the job two years ago, they would have been rejected.

In the past, we required 1 to 2 years of previous SDR experience to qualify for even a phone screening. Thankfully, we’ve since made dramatic changes to our SDR hiring strategy, which have made recruiting not only faster but much more inclusive.

Soon after I was promoted to Sales Development Manager, I argued that we would actually get better SDRs if we recruited candidates with zero SDR experience. It was not a popular idea at the time. Never before had we hired for any role at Jhana and not asked for previous experience.

But anyone who has done the job knows that SDR work is grueling. It’s tedious. It takes perseverance. If a candidate left a company after being an SDR there, I could pretty much bet that he or she wanted to leave not just that company but the SDR role itself. I hypothesized that having 1 to 2 years of previous SDR experience actually hampered motivation and productivity.

So as Jhana’s first Sales Development Manager, I set out to hire a very different type of SDR. I didn’t want people with previous experience in the job.

Instead, I looked for grit. I looked for candidates who had work or life experiences that showed determination. I also looked—very much intentionally—for candidates who could add to Jhana’s diversity.

In 6 months, SDR productivity (as measured by the volume of cold emails sent, meaning emails sent to prospects with whom you’ve had no previous contact) increased by 100% and the number of discovery calls (introductory sales calls between the prospect and an Account Executive) increased by 60%.

Grab the Opportunity to Drive Diversity and Inclusion

By not requiring previous experience or a college degree, you not only dramatically grow your potential candidate pool, but you open up a huge opportunity from a diversity and inclusion perspective.

Let me put it plainly: If you have a role at your organization that doesn’t require previous experience, be intentional about your recruiting. Use it as an opportunity to shift the demographic makeup of your company.

Now, this doesn’t mean that your job as a hiring manager will get easier. In fact, it will probably get harder.

You’ll have to read more resumes.

You’ll have to do more phone screenings.

You’ll have to ask better interview questions.

You’ll have to become excellent at training new SDRs.

You’ll have to build well-oiled processes so that orientation and onboarding happens quickly.

So why do this?

Because you’ll build a better lead-generation engine.

Because you’ll help build a company that’s more diverse.

Because it’s the right thing to do.

As a hiring manager, you are entrusted with the rare opportunity to give jobs. Why not be intentional about how you use that responsibility? Why not think differently about how and who you recruit? Why not try to create social change, one hire at a time?

We can help with your hiring needs!

Topics: hiring, Diversity and Inclusion

First Ever Real-time Efficacy Study on Fertility App Launched

Posted by Erica Bettencourt

Thu, Feb 09, 2017 @ 03:44 PM

Do you worry about family planning with some of your patients? If so, this article about an “app” that helps to avoid unwanted pregnancies may be helpful. “Dot” is the only family planning app that relies solely on period start dates. Health experts believe an estimated 225 million women worldwide are not using effective family planning methods, but want to avoid pregnancy.

The Dot app will be studied over a year. If used correctly, researchers in an earlier study found the app is almost 100% effective at avoiding an unwanted pregnancy. Continue reading below for more details about the study and more information about the Dot app.

Researchers at Georgetown University Medical Center’s Institute for Reproductive Health (IRH) announced the launch of a year–long study to measure the efficacy of a new app, Dot™, for avoiding unintended pregnancy as compared to efficacy rates of other family planning methods. The Dot app, available on iPhone and Android devices, is owned by Cycle Technologies. Up to 1,200 Dot Android users will have the opportunity to participate in the study.

The study, funded by a grant from U.S. Agency for International Development (USAID), will be the first known study to examine how women use a fertility app in real–time and to evaluate its effectiveness at avoiding unintended pregnancy. In a previous study, a research team found that Dot is theoretically 96 to 98 percent effective at avoiding unintended pregnancy if used correctly. As a woman continues to use it, the app increases its individual accuracy.

While there are thousands of menstrual cycle tracking apps on the market, recent research has demonstrated that the majority are not accurate enough to avoid unintended pregnancy or plan a pregnancy. One study evaluated 100 fertility awareness apps. Only six could correctly identify the fertile window. This finding highlights the importance for app–based family planning tools to rely on scientifically–backed methods and to be evaluated thoroughly for their accuracy.

“Our new study is unique because we’re testing the efficacy of Dot as a method to avoid unplanned pregnancy in a real–time situation,” says Rebecca Simmons, PhD, a senior research officer at IRH.

The study will evaluate Dot’s efficacy in avoiding unplanned pregnancies using a protocol that allows researchers to compare the results to known efficacy rates of other family planning options. It will also explore social factors, such as how Dot affects relationships. The researchers will recruit participants through Dot for Android, issue surveys in the app, and interview participants four times during the study. Participants will receive a gift card each time they enter period start date information and each time they complete a survey.

The IRH study could have global significance because multiple studies suggest that the main reason women stop using the birth control pill is side effects. If Dot can help women avoid pregnancy without the pill’s high abandonment rate, it’s a compelling alternative, says Simmons. The app would be especially useful in the developing world, where there is significant unmet family planning need. Global health experts estimate that 225 million women worldwide are not using effective family planning methods but want to avoid pregnancy.

“Dot users have a historical opportunity to advance the science of birth control and family planning,” said Leslie Heyer, president and founder of Cycle Technologies. “No fertility app has undergone such rigorous testing. Users who join our effort can help make free, effective fertility tools accessible to women throughout the world.”

Cycle Technologies developed the science and algorithm behind Dot™ in collaboration with global health experts from Georgetown University, Duke University and The Ohio State University. Dot is the only family planning app that relies solely on period start dates to determine a user’s individual fertile days.

Topics: fertility apps, family planning, Dot app

Your hospital isn't deliberate about diversity in leadership? Meet Antoinette Hardy-Waller, the woman out to change that

Posted by Pat Magrath

Tue, Feb 07, 2017 @ 12:45 PM

DiversityNursing.com would like to share this article with you. It features an interview with Antoinette Hardy-Waller, an extremely knowledgeable leader in the field of healthcare and Nursing. She is “devoted to advancing African Americans in executive, governance and entrepreneurial roles in healthcare.”

While many healthcare organizations have a commitment to diversity, inclusion and cultural competency in their workforce and patient care, her point is, it’s imperative to have diversity in the top ranks where decisions are made. Read on for important details.

Antoinette Hardy-Waller has worked in healthcare for more than 25 years. She's spent time as a nurse, home care business owner, board member for a major national health system, and consultant. Yet of all of her experiences, it is the time and energy she pours into The Leverage Network that she considers "passion work."

Click Here to Continue Article

Becker's Hospital Review is the original producer/publisher of part of this content.

Topics: diversity, Diversity and Inclusion, hospital diversity, leadership diversity

Mom Gives Birth After Surviving Aneurysm and Brain Surgery While Pregnant

Posted by Erica Bettencourt

Mon, Feb 06, 2017 @ 11:23 AM

We need a Wednesday feel good story and this is a terrific one! Anna Weeber suffered frequent headaches since she was 16 years old. Now she's 26 weeks pregnant, 27 years old and this headache is unlike any she's ever had in the past.

The doctor who took on Anna's case had a pregnant wife the same age and was 24 weeks pregnant. Dr. Singer said that 50 percent of patients with Anna's case don't even make it to the hospital alive and of the 50 percent of those patients that do survive, 30 - 50 percent don't recover to their previous level of health and function. See below for details of Anna and her baby’s survival.

Anna Weeber was getting dressed for a bike ride with her husband and 2-year-old son, Declan, one September afternoon last fall when she was struck by a blinding headache.

The 27-year-old mom had suffered from frequent headaches – about three times a week since she was 16, she says – but this was a completely new level of agony.

“It was the most intense headache I’ve ever had in my life,” Anna, who was 26 weeks pregnant at the time, says. “It felt like a balloon was filling with tar in my head.”

The pain was so intense that she began sweating and vomiting. Then, as her husband Nate called 911, the Zeeland, Michigan, mom realized she couldn’t move the left side of her body.

“From that moment on, I don’t remember anything,” she says.

An ambulance arrived and Anna was rushed to the nearest hospital, where a CT scan identified a ruptured brain aneurysm.

An aneurysm is a ballooning of a blood vessel in the brain. When an aneurysm ruptures it releases blood into the spaces around the brain, which can cause a life-threatening stroke.

“About 50 percent of patients who have a ruptured brain aneurysm don’t even make it to the hospital alive,” explains Dr. Justin Singer, Director of Vascular Neurosurgery at Spectrum Health. “Of the 50 percent of those patients that do survive, another 30-50 percent don’t recover to their previous level of health and function.”

After Anna’s aneurysm was identified, she was rushed to Spectrum Health where she was treated by Dr. Singer. Singer says he felt deeply affected by Anna’s case, as she is about the same age as his wife, who was 24 weeks pregnant at the time.

By the time Anna reached Dr. Singer, she was lucky to be alive – but still in a condition that threatened not just her life, but also the life of her unborn child.

A maternal fetal specialist joined the case and together Anna’s medical team and family decided that a brain surgery to insert a clip that would isolate the aneurysm from the circulatory system so it could be removed was the best treatment option.

“I know if my wife was in that position I would want the most definitive treatment option that poses the least risk to the baby,” Dr. Singer tells PEOPLE. “And that’s surgery so that’s what I advised them to do.”

While Anna was in surgery, Nate continued to ask for prayers on Facebook, as he had been doing since the first ambulance ride.

“Hundreds if not thousands of people started praying for us all around the world,” Anna says.

Twenty hours after the nightmarish episode began Anna emerged from the successful surgery. After a day and night of worrying that Anna could suffer lasting effects from the stroke, Nate was elated to find that “she was completely back to herself,” the 33-year-old says.

Anna remained in the hospital so that doctors could look out for vasospasms, a common complication of a brain aneurysm that limits blood flow within the brain and can cause stroke-like symptoms, paralysis or death.

Anna was treated for severe vasospasms and after 18 days she was released from the hospital. “It was so good to be home with our little family again we finally went apple picking and all of the normal fun fall activities,” she says.

The rest of the pregnancy went smoothly and on December 30, Anna and Nate welcomed a healthy baby boy they named Hudson.

“We were just praying that Hudson wouldn’t suffer any effects from the surgery and as far as we can tell he is one perfectly health little boy,” she says.

Still, Anna says she can’t help but feel overwhelmed with emotion when she thinks about all she and Hudson have been through together.

“The first couple of days after Hudson was born, he and I would look at each other and make eye contact and I would just start crying knowing everything we’ve been through together,” she says. “We both knew God got us through this huge miracle.”

Dr. Singer and his wife welcomed a baby girl they named Jordyn the following week and the two families have already gotten together for a play date.

Despite the grim statistics, Anna has only discovered two changes since the surgery. She was thrilled to find that her headaches stopped completely, and less thrilled to learn she has begun snoring. All things considered, she says, even that feels like a blessing.

“My husband is totally fine with the snoring considering that of all the possible outcomes I’m here and alive,” she says.

Topics: aneurysm, brain surgery

FireFighter Marries Boston Bombing Survivor He Rescued

Posted by Pat Magrath

Fri, Feb 03, 2017 @ 03:54 PM

It’s Friday and we thought a feel good story was a good idea. We’d like to share the happy news that a Boston marathon bombing survivor is going to marry the firefighter who took care of her that life-changing and devastating day. He kept coming back to visit her in the hospital. Their friendship and love grew as they got to know each other.

Because a Nurses job is to help people whether it’s caring for their patients, doing research to improve patient care, or educating our future Nurses, a firefighter’s job is to help their community too. Both professions selflessly help people in a variety of situations, some extremely difficult.

As a website devoted to Nurses within Diverse communities, we see many similarities within the 2 professions and we hope you enjoy this story.

When Roseann Sdoia was gravely injured in the Boston Marathon bombings in 2013, Michael Materia, a firefighter, was the responder who took her to the hospital. They were strangers at the time, but he has rarely left her side since.

In December, the two decided to get married. And on Wednesday, they took on an entirely different kind of challenge together: walking up the 1,576 steps to the observation deck of the Empire State Building in Manhattan to raise money for the Challenged Athletes Foundation — an organization that has played a major role in Ms. Sdoia’s recovery.

Just as he had on the day they first crossed paths, Firefighter Materia wore all of his firefighting equipment, including a heavy oxygen tank on his back. She wore a prosthesis, which has replaced the leg she lost on the day of the bombing.

The day they met was among the darkest in Boston’s modern history. After two bombs were detonated on April 15, 2013, smoke billowed across the finish line and the scene erupted into chaos.

Hundreds of people were injured on that Monday, and three people lost their lives. Had it not been for Firefighter Materia, it might have been four.

Ms. Sdoia’s right leg was severely injured in the explosion. A bystander rushed over and fashioned a tourniquet to stop the bleeding. Firefighter Materia, responding with his fire brigade, was put in charge of escorting Ms. Sdoia to the hospital. With no ambulance immediately available, she found herself lying on a metal bench in the back of a police transport vehicle.

Despite her injury, Ms. Sdoia was fully alert as they drove toward the hospital. “He was kneeling on the ground, trying to hold me from sliding, trying to hold himself, and trying to hold the tourniquet,” she said. “And then here I am, telling him to hold my hand! So the poor guy had a lot going on.”

Firefighter Materia stuck with her until they reached the hospital, where Ms. Sdoia’s right leg had to be amputated above the knee. He visited again a few days later to offer assistance, and then again the day after that.

After a couple of months, a friendship between the two bloomed into a romance. “There was an interest growing in each other, kind of quietly, until we talked about it,” Ms. Sdoia said.

Firefighter Materia popped the question on Dec. 4 during a trip to Nantucket. They intend to marry in October or November, according to The New York Post, which reported on the couple this week.

But before they get married, Ms. Sdoia, 48, and Firefighter Materia, 37, decided to take on New York City. On Wednesday evening, Mr. Materia pulled on his fire equipment while Ms. Sdoia explained her strategy for the climb: Go slow and steady, and lead with the left leg.

The couple were among hundreds of runners who made the arduous climb on Wednesday for an annual event called the Empire State Building Run-Up, which is in its 40th year and benefits the Challenged Athletes Foundation.

For months, Ms. Sdoia trained on the steps of Bunker Hill Monument, a towering obelisk just north of Boston commemorating the Battle of Bunker Hill, among the defining moments in the Revolutionary War.

The event at the Empire State Building was a fitting milestone in Ms. Sdoia’s own battle. Along with Firefighter Materia, the lifelong Red Sox fan has become something of a hero for Boston, where friends and family have followed her recovery, celebrated her engagement, and supported her efforts to climb New York City’s third-highest building.

The race ended at the observation deck on the 86th floor of the skyscraper, where Ms. Sdoia smiled and stopped to chat with photographers in the chill winter air while Firefighter Materia, camera-shy, stayed mostly quiet under his firefighter’s helmet.

Ms. Sdoia said she was happy to have his support, which hasn’t wavered since that ride to the hospital nearly four years ago. “We’ve spent a lot of time together,’’ she said, “and from that we got to see each other’s characters and really just bond.”

Topics: first responders, Boston Marathon bombings

A PhD in Nursing Might Be The Best Goal For You

Posted by Pat Magrath

Fri, Feb 03, 2017 @ 03:39 PM

Are you considering furthering your education? Is a PhD a goal of yours? This article will give you good information and some terrific role models. It also encourages you to go for your PhD sooner, rather than later.

As our population continues to grow and people live longer, the need for Nurses with their DNP or PhD must increase as well. Perhaps your goal is to be a Nurse Educator, Researcher, or you want to look at the big picture and design ways to achieve better patient outcomes. There are many paths you can take. It’s up to you.

The Institute of Medicine’s Report, “The Future of Nursing: Leading Change, Advancing Health” states nurses should be encouraged to pursue doctoral degrees early in their careers to maximize the potential value of their additional education. I finished my PhD in nursing when I was 30 years old. Several people told me I didn’t have enough clinical nursing experience to continue with my education. Why some nurses feel the need to hold others back from continuing their education is beyond me.

The fact is, some of the most respected contributors to our profession obtained their PhDs early in their careers. Here is only a partial list of these amazing nurses: Jacqueline Fawcett, PhD, RN, FAAN, of the University of Massachusetts, received her PhD 12 years after completing her BSN. She is internationally known for her metatheoretical work in nursing.

• Jean Watson, PHD, RN, AHN-BC, FAAN, earned her PhD 12 years after earning her initial nursing degree. She is the founder of the Watson Caring Science Institute and is an American Academy of Nursing Living Legend.

• Afaf I. Meleis, PhD, RN, FAAN, of the University of Pennsylvania School of Nursing, earned her PhD seven years after obtaining her BS in 1961. She is an internationally renowned nurse-researcher and an AAN Living Legend.

• Margaret Newman, PhD, RN, FAAN, obtained her BSN in 1962 and her PhD in 1971. She is the creator of the Theory of Health as Expanding Consciousness and an AAN Living Legend.

Are you thinking about going back to school? Has someone encouraged you to consider it? The Future of Nursing report notes that major changes in the U.S. healthcare system and practice environment will require profound changes in the education of nurses. But the report also notes that the primary goal of nursing education remains the same, which is to educate nurses to meet diverse patient needs, function as leaders and advance science from the associate’s degree to the doctorate degree.

One of the recommendations of the Future of Nursing report was to double the number of nurses with doctoral degrees by 2020, and by 2016 that recommendation had been met mainly due to the creation of the DNP or doctor of nursing practice degree. Knowing this, the IOM’s Assessing Progress on the IOM Report the Future of Nursing updated their recommendations in 2015 stating that more emphasis should be placed on increasing the number of PhD-prepared nurses. The DNP has been regarded as the degree for those who want to get a terminal degree in nursing practice while the PhD has been regarded as the degree for those wanting to do research. But the difference is not that simple.

"Several people told me I didn’t have enough clinical nursing experience to continue with my education. Why some nurses feel the need to hold others back from continuing their education is beyond me.”

According to the American Association of Colleges of Nursing, “rather than a knowledge-generating research effort, the student in a practice-focused program generally carries out a practice application-oriented final DNP project.” The AACN further notes key differences between the DNP and PhD programs. PhD programs prepare RNs to contribute to healthcare improvements via the development of new knowledge and scholarly products that provide a foundation for the advancement of nursing science. A richer more reflective understanding of the PhD in nursing is that it is heavily grounded in the science and philosophy of knowledge. DNP programs, on the other hand, prepare nurses at the highest level of nursing practice to improve patient outcomes and translate research into practice. A PhD-prepared nurse can contribute to the profession through research, creating new nursing theories or through a focus on national, global system level change and public policy.

I have had many conversations with nurses looking to go back to school who say they don’t want to do research. However, in further discussion on what they really want to do and the problems they want to solve, it becomes clear that the PhD is the best track for them. Also, you don’t need to be a nurse practitioner to get a PhD; there are many PhD-prepared RNs like myself. For those who want to become a nurse practitioner or other advance practice registered nurse, there are dual DNP/PhD programs just as there are MD/PhD programs for individuals looking for both the practice and research education.

As you can guess, I didn’t listen to the naysayers. I knew as a nurse I could make the largest impact for patients and nurses by getting my PhD in nursing (majoring in health systems and minoring in public administration). Does having a PhD make me a better nurse than anyone else? No. I am a different type of a nurse who knew what I needed to do to make my unique contribution to our profession. I started as an LPN and then became an associate’s degree RN. I worked full time while going to school full time. I also completed a BSN-PhD program, which I started at age 25, four years after I became an RN. I have been an RN for 20 years — PhD-prepared for almost 11 years. Earning my PhD was the best decision in my professional career.

Topics: nursing degree, PHD in Nursing

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Your hospital isn't deliberate about diversity in leadership? Meet Antoinette Hardy-Waller, the woman out to change that

Mom Gives Birth After Surviving Aneurysm and Brain Surgery While Pregnant

FireFighter Marries Boston Bombing Survivor He Rescued

A PhD in Nursing Might Be The Best Goal For You

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