DiversityNursing Blog

Work/life balance has been on people’s minds for decades. As individuals and companies strive to improve work/life balance, we want to focus on work/life balance for Nurses. Are you familiar with Dr. Brooks Quality of Nursing Worklife Survey? If not, this article will help you and your place of employment.

Any discussion of quality of life would not be complete without addressing the concept of worklife and specifically nursing worklife, a critical element in healthcare delivery. Developing and retaining the nursing workforce is one of the biggest challenges facing health care employers today. Importantly, the quality of healthcare is frequently judged by the quality of nursing care. The overall quality of care and excellence in nursing is intimately tied to the quality of nurses’ worklife. Quality of nursing worklife is clearly essential to quality care and is an essential component in recruitment and retention of the nursing workforce. Here I make the case for measuring quality of nursing worklife, instead of job satisfaction. 

Historically nursing has focused on measuring job satisfaction and linking job satisfaction to patient outcomes. In practice settings one often hears “satisfied nurses make for satisfied patients.” The relationship between job satisfaction and organizational outcomes has been discussed for so long in the literature that a causal relationship is often inferred, when in fact studies have actually denounced the relationship (Bradfield & Crockett, 1955; Hom & Kinicki, 2001; Iaffaldano & Muchinsky, 1985; Judge, Thoresen, Bono, & Patton, 2001; Organ, 1988). The validity of the concept of job satisfaction and its relationship with organizational and performance outcomes has been questioned for decades (Brayfield & Crockett, 1955; Hom & Kinicki, 2001; Iaffaldano & Muchinsky, 1985; Judge et al., 2001; Organ, 1988). 

In fact, much nursing job satisfaction research linked to patient outcomes found only a correlational relationship not a causal one (Ma, Samuels, & Alexander, 2003). The questionable nature of this relationship might be in part due to questionnaire items (empirical referents) that do not have a strong theory base or unclear and ambiguous conceptual definitions of job satisfaction (Brown, 1999). This leads to inconsistent operational definitions that directly influence how job satisfaction is measured. On the other hand, quality of worklife, and in particular quality of nursing worklife, as the variable of interest does not suffer from the weaknesses in job satisfaction research in job satisfaction research.

Quality of worklife (QWL) has strong theoretical underpinnings that can be traced back to socio-technical systems theory. Socio-technical systems theory maintains one must co-optimize both social (people) and technical (equipment, the environment) subsystems to not only improve worklife, but to also improve the organization's productivity. In fact, going back as far as the 1950s Trist and Bamforth (1951) found a causal link between improved QWL and productivity. In addition, psychologists have found that as much as 30% of the variance in measures of job satisfaction measure personality something an employer has little influence over (Agho, 1993; Judge, 1993; Remus & Judge, 2003). Yet, employers continue to attempt to improve satisfaction in order to improve productivity.

There is increasing conceptual clarity around the construct of QNWL. My dissertation research synthesized years of empirical and conceptual research that studied QWL. A conceptual framework devised by nurse researchers at the University of Toronto was based on many of the principles underlying sociotechnical systems theory. Moreover, measures of QWL take into consideration the balancing act employees do between their worklife and home life. This too made sense for QNWL since nurses, like any employee, balance work and family. The strong theoretical underpinning from socio-technical systems theory (STS), the conceptual framework, and qualitative research exploring the worklife of nurses from the research unit became the basis of Brooks' Quality of Nursing Worklife Survey(C). Requests to use Brooks’ Quality of Nursing Worklife Survey have been received from graduate students and researchers in 30 countries from Greece to Estonia, Canada (Ontario, Quebec), India, Iran, Australia, Malaysia, Turkey, and Taiwan. And, my survey has been translated into 5 languages. 

It's important for organizations to look beyond job satisfaction when attempting to improve the work life of their employees, as well as the productivity of the organization.

Related Article: Nurses Practicing Self Care

Congresswoman Lois Capps of CA is committed to helping people improve their daily lives through better schools, quality health care, and a cleaner environment. During her 20-year tenure as a Nurse and public health advocate, she felt her education and background was needed in Congress to help improve health care in the US and strengthen our Nursing workforce across the country.

We know that the important work of strengthening our health care system is not yet done — it’s far from it. But legislation like this will help get us there.

Chief Diversity Officers can make a hospital a more welcoming place for employees and the patient's they serve. It takes many steps for a CDO to make that possible. Continue reading to learn more about how CDO's can help your healthcare organization. 

Workplace harassment complaints. Recruiting a diverse workforce. Cultural competency training. These are matters that traditionally fall under HR, but healthcare organizations are increasingly relying on professionals with specialized skills to work on these sensitive and important issues.

Enter the chief diversity officer, or CDO.

As the country grows not only more ethnically diverse but more diverse in personal beliefs, regional origin and identification, and disability status, the demand for leaders who specialize in creating dialogues between people with differences will increase, says Oliver B. Tomlin, III, senior partner at search firm Witt/Kieffer and founding member of National Association of Diversity Officers in Higher Education. He has assisted with several CDO searches.

Below are several functions a CDO might play to make a hospital a more welcoming place both to workers and the community they serve:

1. Make Sure Everyone is Heard

Many of us can remember attending a party or other event where we didn't fit in, possibly because of differences between ourselves and others.

A CDO specializes in being the person who makes sure workers don't have to feel uncomfortable about what makes them unique, and that they can bring their "whole selves" to work, says Deborah L. Plummer, PhD, vice chancellor and chief diversity officer at University of Massachusetts Medical School and UMass Memorial Healthcare.

"If everyone feels they can bring their whole self to work and they feel like differences are respected, it can make the workplace richer and stronger," Plummer says.

"Then, we are able to come together and work in diverse teams, and are able to solve challenges with our collective wisdom."

2. Teach Awareness

What's the next step that will lead toward improved patient satisfaction and both clinician and worker retention? Teaching the workforce to be sensitive to and accepting of the differences that are inherent to a diverse organization or in a diverse community.   

Sometimes it's not always easy to gain the trust of people when there are differences involved, especially in light of healthcare disparities members of minority groups often experience, says Tomlin, but educating a workforce can help.

Plummer suggests offering regular inclusion events, hosting employee and community research groups, and familiarizing hospital leadership with hot topics in the workforce and within the community.

She also suggests that CDOs organize training sessions around current topics, such as:

• LGBT-related issues
• Sexual harassment
• Building an inclusive workforce
• Cultural competency education

3. Devise and Implement Inclusion Strategies

Diversity and inclusion aren't easy topics to tackle, says Plummer. "There has to be someone who gets up every morning thinking about the complexity of these differences."

A CDO can fit that bill.

Plummer makes it clear that she believes HR is "necessary and great function. [It keeps] the trains running." But appointing a leader to specialize in diversity makes sense.

"I can say that the space of diversity is more about people strategy and management, while HR is about the employee, and their employment relationship to the organization," she says.

A CDO will be able to prioritize diversity matters above all else; these hot topics will have their full attention. Far from being just another C-suiter, the CDO has potential to be a mediator, a teacher, an outreach coordinator, and someone who helps make your hospital a more comfortable place for everyone.

If you have any questions about Chief Diversity Officers, Diversity and Inclusion, or just a general question, please ask one of our Nurse Leaders by clicking below! 

We usually associate therapy animals with dogs, but many other animals — horses, cats, rabbits and even chickens — can provide assistance with mental and physical health.

Research shows that sick or injured people benefit from interacting with animals.

Therapets do not judge, they don’t stare and gawk and they don’t ask endless questions about how the patient is doing or what the prognosis is. They are there as a companion that patients can talk to or pet.

“There have been studies linking interaction with animals to lower blood pressure; lower heart rate; lower level of stress hormones like cortisol, epinephrine and norepinephrine; less reliance on pain medication; and higher levels of helpful hormones like serotonin, prolactin and oxytocin,” executive director of Therapet, Carianne Sikes said. “Patients report having less fear and anxiety when they interact with animals.”

“We receive a number of great emails and Facebook posts from former patients saying they were feeling discouraged or depressed and were ready to give up until they received a visit from Therapet,” Sikes said. “Many say their mood changed, but often we hear that their recovery turned around – they started getting better after the visit from Therapet.” Patients recovering from joint replacements or illnesses like strokes often stand longer and walk farther and faster with an animal,” Sikes said. “They relax more during their exercises and seem to be more likely to lose track of time and exercise longer.”

Therapets also go into schools to help calm students before a big exam and to let young children read to them as a way to improve their reading skills.

Dogs

Canine Companions for Independence is a non-profit organization that enhances the lives of people with disabilities by providing highly trained assistance dogs and ongoing support to ensure quality partnerships.

CCI trains four types of assistance dogs: service dogs, who help disabled people; skilled companion dogs, who help disabled people with the assistance of another adult; facility dogs, who work in clinics or other professional settings with patients; and hearing dogs, who increase people’s environmental awareness.

The dogs have two modes: rest and work. While at rest, the dogs act like any other dog, but the moment their owner commands them, the dogs instantly go to work and don’t stop until told. Passersby are advised to ask the owner before petting an assistance dog and to address the owner first, not the dog.

Studies of dogs and cancer detection are based on the fact that cancerous cells release different metabolic waste products than healthy cells in the human body. The difference of smell is so significant that dogs are able to detect it even in the early stages of cancer. Dogs are able to identify the chemical traces in the range of parts per trillion. Some studies have confirmed the ability of trained dogs to detect skin cancer melanoma by just sniffing the skin lesions. Furthermore, some researchers have proven that dogs can detect prostate cancer by simply smelling patients’ urine. Dogs may also be able to sniff out the presence of cancerous cells through a human’s breath. Not only does their sense of smell make cancer detection possible, but research suggests that dogs can be trained actively to sniff out the cancer.

Horses

Horses do not see disabilities, said Nancy Tejo, of Merrick, owner of Sky Riding LI at Parkview Stables in Central Islip, NY. They only see people. She works with riders who have conditions ranging from autism to charge syndrome, a rare genetic disorder that causes heart defects and slow physical growth. Occupational therapy is known in horse circles as hippotherapy. Specially trained physical and occupational therapists use this treatment for clients with movement dysfunction. In hippotherapy, the movement of the horse influences the client. The client is positioned on the horse and actively responds to his movement. The therapist directs the movement of the horse; analyzes the client's responses; and adjusts the treatment accordingly. This strategy is used as part of an integrated treatment program to achieve functional outcomes.

Cathy Josephson, of Northport, has a daughter, Erika, with charge syndrome, which has left her deaf and legally blind (she can see only a short distance out of one eye). Erika has trouble sitting up for long periods of time, so her lessons last only 30 minutes. “She’s aware of what’s going on,” Cathy said. “Nancy does a great thing. She sings to her. They play games.” Erika “has gotten so much stronger,” her mother said. “Her upper-body strength has gotten much better.”

Chickens

While many people view chickens as something to be barbecued, there is evidence that chickens have high intelligence and can easily create personal bonds with humans. Chickens also have their very own means of communication. Each sound means something different in “chicken language” and researchers have identified up to 30 different types of vocalizations.

Mountain House, a Santa Barbara-based adult residential facility, has recently implemented a program that uses chickens to help comfort their patients who have been diagnosed with mental illness and high anxiety.

Ellen Levinson, executive director of Life Care Center of Nashoba Valley said, “We deal with agitation a lot on the dementia unit,” Levinson said. “Having that chicken in my arms and holding it against my body was profoundly soothing. The chicken felt wonderful to hold. Something clicked. If I were agitated or upset, this is what I would want.”

For individuals with an ASD or Asperger's syndrome (a form of autism), chicken therapy may be a surprising but effective breakthrough.

"An autistic or Asperger's individual inherently needs to be assisted away from over fixation on the inner self," explains Pet.org.au, which provides support services for "autistic children and parents to find the 'perfect' companion animal."

"This encouragement to outward awareness and not to fear it can be found in the antics and curious jerky head motions that catch the eye made by all chickens," Pet.org.au says. "It is so captivating and funny…"

"Chickens, as with most pets, will coax a special needs child to innately accept that there is fascinating 'chaos' in life and that unpredictable things will occur with fun result."

Research has found that having a pet confers health benefits on most owners, with or without an illness. Studies have shown that being around pets is associated with lower blood pressure and heart rate, and fewer symptoms of anxiety and depression. Therapists and hospital volunteers take advantage of that by using therapy animals to bring comfort and other psychological benefits when visiting patients. No matter what type of animal it is, they all can help humans in a way other humans can’t. Hopefully in the future more types of animal therapy will be a means of healing for patients.  

To be a successful nurse, excellent communication skills are required. The ability to communicate and connect with patients and health care professionals can help build relationships, prevent mistakes and provide a higher level of care.

According to a 2013 study published in the Journal of Patient Safety, as many as 440,000 people die each year from preventable medical errors, representing the third leading cause of death in the U.S. on the list from the Centers for Disease Control and Prevention (CDC). Of deaths due to medical errors, The Joint Commission estimates that 80 percent involve miscommunication. The Joint Commission’s analysis of 2012, 2013 and first-quarter 2014 data revealed that in all three time frames, communication was one of the top three leading causes of sentinel events, a patient safety event unrelated to the patient’s illness or condition that results in death, permanent harm or another qualifying negative outcome.

Increases in nursing communication can lessen medical errors and make a difference in positive patient outcomes. In a 2014 study published by the New England Journal of Medicine, medical error rates in nine children’s hospitals decreased by 23 percent after a handoff program was instituted to enhance and standardize communication. According to Ros Wright, the body of literature in nursing communication points to “increased recovery rates, a sense of safety and protection, improved levels of patient satisfaction and greater adherence to treatment options” as well-documented results of effective communication.

Communication Theories in Nursing

Multiple communication theories are used in nursing to help explain and guide interactions made between nurses and patients, as well as nurses and other health care professionals.

Peplau’s Interpersonal Relations Theory

This theory focuses on the nurse-client relationship and the therapeutic process that takes place. Communication that occurs in this context involves complex factors such as environment, in addition to attitudes, practices and beliefs in the dominant culture. Peplau’s interpersonal relations theory defines four stages of the relationship that achieve a common goal:

• Orientation Phase: The nurse engages the patient in treatment, and the patient is able to ask questions and receive explanations and information. This stage helps the patient develop trust and is where first impressions about the nurse and health care system begin to evolve.
• Identification Phase: The patient and nurse begin to work together. These interactions provide the basis for understanding, trust and acceptance as the patient becomes an active participant in treatment.
• Exploitation Phase: The patient takes advantage of all services offered, exploiting the nurse-patient relationship to address treatment goals.
• Resolution Phase: As a result of effective communication, the patient’s needs are met, and he or she moves toward full independence. The patient no longer needs help, and the relationship ends.

Dyadic Interpersonal Communication Model

The dyadic interpersonal communication model describes the dynamic interactive process that takes place between two people. Based on a sender and recipient — the encoder and decoder — and outside influences such as perception, attitude, content and the emotional and physical elements, the model points to the many factors that can alter the message or the message’s delivery.

As the sender or encoder provides a message, the recipient, or decoder, must process the information. The dyadic interpersonal communication model highlights the importance of clarity and awareness for the many factors that can affect verbal and nonverbal communication.

Other Theories

A number of other theories in communication and specifically in nursing communication have been used in health care. For instance, Jean Ann Seago notes that “Habermas’ critical theory has been used to identify successful nurse-physician collaborative strategies, including a willingness to move beyond basic information exchange and to challenge distortions and assumptions in the relationships.” Also, Seago mentions theories deriving from Foucault, feminism and the aviation industry to understand and enhance communication. In addition to these types of theories, several others could be named, such as those in experiential communication.

Best Practices in Nursing Communication

In order to help patients and work alongside peers, nurses must consider the skills and tools that are involved in effective communication. From being aware of potential barriers blocking effective communication to utilizing integral communication skills, nurses can take steps toward providing better care.

Barriers to Effective Communication

Nurses who are aware of the common barriers to effective communication will be able to anticipate and properly react to any roadblocks. With this focus, nurses can help ensure optimal communication and patient care.

In "Effective Communication Skills in Nursing Practice," Elain Bramhall highlights common barriers to effective communication for the patient and health care providers. Patient barriers include environmental items such as noise, lack of privacy and lack of control over who is present; fear and anxiety related to being judged, becoming emotional or being weak; and other barriers such as an inability in explaining feelings and attempting to appear strong for someone else’s benefit. Health care professional barriers include environmental items such as lack of time or support, staff conflict and high workload; fear and anxiety related to causing the patient to be distressed by talking or responding to questions; and other barriers such as a lack of skills or strategies for coping with difficult emotions, reactions or questions.

Effective Communication Skills

In the Journal of the Academy of Medical Sciences of Bosnia and Herzegovina, Lambrini Kourkouta and Ioanna Papathanasiou highlight three foundational skills in communication:

• Nonverbal Communication: An “ongoing process … characterized by facial expressions, gestures, posture and physical barriers such as distance from the interlocutor,” nonverbal communication must agree with verbal communication. In stressful moments, Kourkouta and Papathanasiou note, changes in these two communication types can be difficult to assess.
• Listening: An important part of communication, listening is a “responsible nursing practice and requires concentration of attention and mobilization of all the senses for the perception of verbal and nonverbal messages emitted by the patient.” By listening, nurses can be attentive to the patient and integrate care according to the patient’s evolving needs.
• Personal Relationships: Marked by kindness, compassion and care, nurses can develop good personal relationships with the ability to “ask questions with kindness and provide information that does not scare, that demonstrates interest, creates feelings of acceptance, trust and a harmonious relationship, especially in modern multicultural society.” This relationship is connected to not only the transmission of information but also the mental and emotional dynamics found in communication.

Further skills can promote effective communication practices in nurses. Bramhall points out that asking open questions, clarification and screening questions can help keep the focus on the patient. For information giving, providing small amounts of information at a time, checking what information the person knows already and pausing before continuing can help. And for listening, summarizing, paraphrasing, empathizing and making educated guesses can demonstrate that the nurse is listening and able to communicate effectively to patients and other health care professionals.

Developing Crucial Communication Skills

It is no secret that communication skills for nurses are essential and difficult to master — and they require proper attention. “Promoting effective communication in health care is demanding, complex and challenging because of the nature of the work environment, which is often stressful and pressurized, providing little time for communication,” Bramhall writes. “If nurses are to meet these challenges in the future, they need to be supported by high-quality, evidence-based training.”

Through education and employment-sponsored training, nurses can advance communication skills that are crucial to improving as effective health care professionals. At Southeastern University, current nursing professionals can enhance their communication skills with an online RN to BSN degree. The program expands on knowledge and skills nurses need to advance into leadership positions.

For nurses, communication comes into play in virtually any context. As nurses cultivate these skills to develop professional relationships with fellow health care professionals, connect to patients and become more well-rounded and effective individuals, education and on-the-job training can maximize the impact improved communication skills will have in the workplace.

As healthcare changes, so do their goals. The latest goal is 80% of the Nurse workforce should have their BSN by 2020. Most hospitals are no longer hiring Nurses with only their Associate’s degree. If they do hire them, the Nurses are expected to sign a contract that they'll get their BSN within a certain time frame. 

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Have questions about getting your BSN or have a general question? Ask one of our Nurse Leaders! 

Pediatric Nurse, Meghan Nesom is an inspiration and a true example of strength. She has received heart breaking news that won't stop her from continuing her passion of healing others. Meghan reminds all of us how amazing Nurses are and no matter what they are going through in their personal lives, they will always try their hardest to stay positive and moving forward. Staying positive is something Meghan has clearly passed on to her son and once you see his response to his mother's diagnosis, you'll completely agree.

Nesom is a wife and mother who has been working as a pediatric nurse. She’s helped heal children with cancer, and has also been there to comfort children in the moments they succumb to the disease.

“There is never a ‘woe is me,’ with kids,” she says, “They just are fighters. They’re wonderful.”

And the same could be said of this brave woman, who, in a cruel twist of fate, has also been diagnosed with cancer.

But rather than feeling sorry for herself, her response is one of utter selflessness: she describes the relief of knowing it’s she, and not her child, that’s been diagnosed.

She underwent surgery and radiation three years ago to kill the cancer; now, however, it has returned in the shape of clear cell sarcoma, for which there is no cure. That also means she’s recently been tasked with telling husband Philip and 4-year-old son Colin about the traumatic procedures she’s about to undergo.

So, Meghan told her son that she was going to have to have her leg cut off — and his response truly proves that some children have a wisdom far beyond their years.

“He told me that all of his friends are going to be jealous because his mommy’s going to have a robot leg,” she proudly recounts.

And, despite already beginning oral chemo, she still continues to work as a nurse and help others. Like the retired nurse who spends her days driving cancer patients to their chemo appointments, Meghan has been tireless in her quest to help others.

Her coworkers have been by her side through it all, even raising a whopping $10,000 to help cover medical costs.

To help this fantastic woman who has devoted her life to helping others, visit her GoFundMe page.

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