DiversityNursing Blog

In 2012, the Affordable Care Act introduced a new policy that would help calculate Medicare reimbursement and bonuses to healthcare facilities. More than $1 billion is withheld from hospitals each year, and only facilities that maintain basic care standards and obtain high patient satisfaction survey scores earn money back. The Atlantic adds that top performers collect bonus money from the pool. 

The policy places a lot of weight on patient satisfaction scores — 30 percent of hospitals’ Medicare reimbursement rides on these subjective assessments. As a result, there have already been unfortunate consequences for some hospitals, patients and healthcare workers. But with the right approach, healthcare professionals can take steps to minimize the negative effects and concentrate on providing quality care to patients. 

What Is the HCAHPS? 

Basics the HCAHPS is a 32-question survey from the Centers for Medicare and Medicaid Services (CMS) that measures patients’ perceptions of their hospital stay. The survey is given to patients who receive medical, surgical or maternity care services 48 hours to six weeks after discharge. The survey focuses on nine key topics: 

* Communication with doctors 

* Communication with nurses 

* Responsiveness of hospital staff 

* Pain management 

* Communication about medicines 

* Discharge information 

* Cleanliness of the hospital environment 

* Quietness of the hospital environment 

* Transition of care In 2015, CMS unveiled a new five-star rating system for consumers to compare hospitals online. CMS uses data from HCAHPS surveys to determine a hospital’s star rating, which is updated quarterly. Based on analysis from Modern Healthcare, only 251 of more than 3,500 U.S. hospitals received the highest ranking of five stars in April. 

Financial Consequences of Survey Scores 

The Affordable Care Act mandated that 1 percent of Medicare inpatient payments be withheld from hospitals — approximately $850 million — beginning in fiscal year 2013. For fiscal year 2015, the withholding increased to 1.5 percent. And in fiscal year 2017, The Advisory Board Company explains, this amount maxes at 2 percent. 

Hospitals can lose or earn back the money that is withheld, and a bonus is possible for top performers. For fiscal year 2015, hospitals are rewarded or penalized based on performance in these four domains: 

* Clinical process of care (20 percent) 

* Patient experience of care (30 percent) 

* Outcomes of care (30 percent) 

* Efficiency (20 percent) 

“Patient experience of care” is where HCAHPS scores come into play. The Advisory Board Company states that, by design, approximately half of hospitals receive the financial penalty in a given year. In future years, it will become more difficult for hospitals to do well under this payment model and rise above the break-even mark. 

The Impact of the HCAHPS 

Hospitals 

The HCAHPS puts financial pressure on hospitals. If they are unable to score in the top half of all facilities, they lose income. And as a result, this pressure can lead to solutions that may not be best for healthcare environments. 

Research identifies factors unrelated to quality of care as being more important to patients. A study in ScienceDaily found some of these factors, such as noise in the hospital room or the responsiveness of a nurse, often characterize large, busy urban hospitals that have high caseloads and better medical outcomes. “Based on this study, the hospitals that have the best survival outcomes are not doing the best job of satisfying patients,” said Robert D. Lieberthal, Ph.D., the study’s lead author. 

This has led to hotel-like amenities at hospitals seeking to improve patient satisfaction scores on the HCAHPS. Elisabeth Rosenthal of The New York Times describes a $63 million community hospital outfitted with a stone fireplace and a waterfall in the lobby. Private rooms for patients include couches, flat-screen televisions and picturesque views. While there are some medical arguments for the trend, such as lower infection rates and added rest, Rosenthal argues that “the main reason for the largess is marketing.” Patient satisfaction becomes focused on amenities rather than quality of care, and the added cost is felt on a U.S. healthcare bill that exceeds $3 trillion. 

Patients 

Patient comments on the HCAHPS survey reveal negative perceptions of medical care. The Atlantic documents complaints that range from not enough pastrami on a patient’s sandwich (after undergoing quadruple-bypass surgery) to a hospital that lacked Splenda. Another patient complained about a roommate that was very noisy. These types of comments reinforce the fact that patients are often more concerned about comfort than they are concerned about quality of care. As oncology nurse Theresa Brown writes in The New York Times, “Focusing on what patients want — a certain test, a specific drug — may mean they get less of what they actually need. In other words, evaluating hospital care in terms of its ability to offer positive experiences could easily put pressure on the system to do things it can’t, at the expense of what it should.” If hospitals focus too heavily on what patients want, the patients could suffer in terms of quality care. 

Healthcare Professionals 

To perform well on the HCAHPS, doctors, nurses and other hospital staff must balance what is medically necessary for patients with what a patient likes or dislikes. In some situations, patients’ comfort and happiness are given too much weight. 

The Atlantic points out that in an effort to avoid upsetting patients, some doctors who are reimbursed based on these scores hesitate to refuse requested treatments or bring up difficult discussions about substance abuse, smoking or mental health issues. Medical Scribe Journal adds that this trend is also true for physicians abiding by patients’ requests for unnecessary tests. More than half of physicians in one survey admitted to ordering a test that wasn’t needed. And physicians who inform patients of bad news may not get high marks on patient satisfaction surveys. 

The pressure can also come from the hospital. The Atlantic mentions that because the HCAHPS involves nurses on almost every question, some hospitals now require nurses to undergo unnecessary nonmedical training that can involve scripts designed to score better on patient satisfaction surveys. The magazine points to hospital job postings for nurses that list “good customer-service skills” as the initial qualification. Some staff members are explicitly evaluated in terms of customer satisfaction, and patient satisfaction scores can be a factor in pay or annual bonuses for doctors and nurses. 

Maintaining Quality Care and Patient Satisfaction 

In many cases, healthcare professionals are able to treat patients while ensuring that they are as comfortable as possible. By having the right priorities and maintaining strong communication with patients, providers can do everything possible to meet all of their patients’ needs. The online B.S. Nursing: RN-BS degree program from Rivier University can help nurses keep a proper perspective on both patient satisfaction and patient treatment. It is designed to allow nurses to pursue leadership positions and increase the quality of care provided in any medical environment. The program takes place in a flexible online learning environment that allows students to maintain their work and personal schedule.

Self care is one of the most important facets of being a Nurse. On a daily basis, you encourage others to focus on their health and reduce stress. However, it’s necessary that you incorporate relaxation and practices that are beneficial to your health mainly for self care reasons, but also so you can be healthy for your patients. Nurses spend so much time caring for others that self care may not be at the forefront of your thoughts, but that doesn’t change how important it is.

"Self-care is not selfish. You cannot serve from an
empty vessel." -Eleanor Brownn

Maintain healthy eating habits

Nurses need nutrition to maintain health and reduce stressors that cause cravings of high fat and high sugar foods. Your role can be highly stressful looking after seriously ill patients and working long hours. You may also have a family that depends on you. The laundry list of responsibilities can add up quickly. That is why it is essential for you to put your health first beginning with your nutrition. It may be wise to bring foods to work such as cut fruits, nuts, and prepared salads.

As a Nurse, you promote healthy behavior and nutrition information to your patients. You can be much more effective at getting patients to engage in healthy activities when you lead by example. Reduce inflammation and oxidative stress by consuming high amounts of antioxidants. An antioxidant is any food that inhibits oxidative stress. The most effective antioxidants can be found in fresh fruits, vegetables, nuts, healthy oils, salmon, and unpasteurized fruit juice. Did you know the pasteurization process reduces a great amount of nutrients in juice?

Exercises at work

To reduce stress and tension while increasing energy, practice deep breathing. This is a simple and highly effective activity that can easily be done at work. Practicing deep breathing after a stressful event is very helpful. The “quick calm” breathing exercise is done by taking a deep breath, holding for 3 seconds while thinking about being warm, and exhaling while thinking about being calm. This simple breathing exercise has a powerful effect in the body by using the abdomen to stimulate the vagus nerve. This nerve causes hormones to come into contact with the heart which lowers the heart rate. Sweating, muscle tension, and rapid breathing are all reduced with “quick calm” breathing.

Doing squats in place helps tone the entire body, especially the legs and buttocks. This exercise increases flexibility and strength. Calf raises are another easy exercise that will help tone muscles. Lunges and hamstring curls leaning over a chair can also be done in the workplace.  

There are countless activities you can engage in before or after work such as:

• Yoga
• Cycling
• Running 
• Swimming
• Weight lifting

Caring for the mind and emotions

All individuals need an activity that will bring them happiness, peace, and sense of well-being. Nurses are in a line of work that requires them to be supportive and show genuine interest in their patients. Your mental and emotional state is directly reflected in the quality of care you provide to your patients. There are healthy ways to reduce emotional exhaustion so that you and your patients have the best experience possible.

You have tremendous responsibilities. You should have an enjoyable pastime or hobby. Examples could be playing chess, painting, gardening, or jogging. Be sure to cater to your own emotional health which will allow you to be supportive to your patients. Taking time to spend with a loved one or enjoying an activity can mean all the difference in your happiness. Happy and healthy medical staff promotes a strong climate for patient care.

The concepts of Caring and Nursing are intertwined. While it is necessary for you to care for your patients, it is also necessary for you to receive care as well. It  is important that you take moments throughout the day for nutrition, exercise, and emotional care. Just as there is no substitution for nutrition, there is none for exercise and tending to one’s mental and emotional state. You may experience guilt for taking time for yourself, but it is unnecessary to feel that way. Self care is essential to the livelihood and health of your well being.

Related Article: Work & Life Balance: A Nurse's Impossible Dream?

If you have any questions about Nursing we can help! Just click below and submit your question! 

Nursing is a challenging and rewarding occupation, requiring long hours and a dedicated focus while offering people who answer the call the opportunity to make a real difference in patients' lives. While many Nursing careers are found inside hospital walls, there is a wide range of settings that a Nurse can choose as a workplace.

Home Care

Most hospitals will try to discharge patients within a few days of treatment. Doctors and Nurses may ask patients to follow specific instructions upon their arrival at home, including taking prescriptions, monitoring symptoms or filling out paperwork. Patients who have undergone major surgery or battled with serious conditions may need additional care, beyond the day they are discharged from the hospital.

In the home, Nurses may conduct physical assessments, administer medications and check the patient's understanding of his condition and treatment plan. They can also clear the environment of any obstacles to mobility or physical health. They help the patient and their family to understand the progress of conditions or diseases, giving them advice to effectively treat the disease.

Holistic Health

An emerging field in the healthcare landscape, holistic health involves caring for the "whole person" in order to meet wellness goals. To take on patients in this line of work, Nurses need to account for the body, mind and spirit of a person. This could mean that treatment will include a variety of therapies. or it could mean that the patient will interact with a wide range of healthcare professionals, from therapists to masseuses or acupuncturists.

Nurses in holistic health work with a patient to form a treatment plan for their physical and psychological needs, while taking into account the person's values, environmental concerns, social activities and anything else that may affect that person's quality of life.

Hospice and Palliative Care

Another option for Nurses to work outside of hospital walls is hospice care or palliative care. Focused primarily on the end of life, this work puts Nurses in the home to care for patients who are elderly and near death or for patients who have a serious disease who are approaching the end of their life. In most instances, the goal of this type of Nursing is to make the patient comfortable in their dying days.

Nurses who work in hospice or palliative care may be on-call for 24 hours and they are often primarily concerned with managing pain. They spend a lot of time interacting with families and loved ones about the patient's condition. Hospice care occurs when a patient's condition or disease cannot be cured, so the focus is on managing the symptoms and giving the patient the best quality of life possible through the end of their life.

School and Camp Nurses

Many Nurses are needed to work in public and charter schools, and even on college campuses. The role of the Nurse will differ depending on what type of school they choose, but these Nurses work during the school day to take care of accidents, injuries and health emergencies that happen while a student is at school. In some cases, Nurses may work with special education students, responding to the needs of the student's disability, as well as administering general care in a school setting.

For another chance to interact with students, Nurses can sign up to be camp Nurses, working at camps of every size and style during the warmer months. While some camp Nurses will be focused on daily needs, other Nurses may attend camps that challenge students in high-risk environments, where students could be injured during activities like rock climbing or mountain biking. In order to serve these camps well, Nurses need to be able to handle serious emergencies that happen on camp grounds, which are often located in a remote area.

Insurance Nurses

Insurance companies also hire Nurses, offering careers in a range of positions. Nurses who work at insurance companies may hold positions as a Case Manager, a Nurse Educator or a Consultant, to name a few. In these positions, Nurses work with members of the insurance company to make sure they understand their disease, treatment plan, and the policies and procedures of the insurance company.

Filling the gap between when a patient leaves a hospital and when they arrive home, these Nurses offer guidance and assist with care at every stage in the process. Depending on the position, they may assist with major healthcare decisions, or spend a lot of time with a patient, ensuring they are getting the proper treatment and care.

Outside of the hospital, there are many career options available for qualified Nurses. The positions in these other areas can be just as rewarding, while offering Nurses the opportunity with work with diverse patients in a variety of settings. 

Interested in other Nursing jobs but, want to get more detail and information?  Ask our Nurse Leader or check out our job board for more detailed job openings!

The proliferation of same-day surgery has changed health care in a dramatic way over the past two decades. Not only can same-day surgeries alleviate overcrowding in hospitals, they can also decrease a patient’s health care costs, decrease rehab time, and diminish the financial loss of taking time off from work to have surgery performed.

Before the rise of same-day surgeries, whether it was open-heart surgery, removal of tonsils, or orthopedic scoping procedures, a patient would be relegated to multiple days and multiple costs of hospital care. This is not the case in today’s medical world where immediacy reigns when at all feasible.

The Rise of Immediacy – From Patient to Outpatient

According to the Living Well blog, outpatient surgeries rose from half of all surgeries in 1996 to two-thirds of all surgeries in 2006. Where did this all begin? How did patients transition from three-day stays to arriving home in time for the six o’ clock news?

Laparoscopic (minimally invasive) techniques have altered a medical practitioner’s need for size and space. Therefore, what used to require a large, fully-equipped operating room can now be performed in a much smaller, cost-efficient outpatient care facility.

Precision instruments that have gone from bulky to miniature have also made same day surgeries common. The smallest instruments range from two to ten millimeters and can free doctors from having to make large incisions so they may work within very small ones. Lumbar fusion and removal of damage caused by a herniated disc are two examples of procedures that used to require close to a week’s stay in a hospital and an incision that could be as large as 15 centimeters. A physician also used to have to clear a path to the spine, which could cause pain and damage to the tissue.

Today, microscopes and x-ray imagery control precise modern tools that clear a more direct path to the spine. The same can be said of hip replacements that used to require slicing muscle, a painful procedure. Today, a prosthesis can relieve pain faster while increasing potential mobility at a higher rate and faster pace. The less you have to disrupt the inside of the body, the quicker the possibility for rehab and the smaller the chances of large permanent scarring.

Why are minimally invasive same day surgeries good for patients and practitioners?

• Advancements in anesthesia have meant that patients regain consciousness in a shorter period of time, allowing them to leave the care facility more quickly.

• A doctor’s time, along with their expertise, can be his or her most valuable asset. Same day surgeries allow doctors to spend that asset on patients with more immediate and dire concerns.

• Cost. Follow the money. Less time in the hospital means fewer expenses from hospitalization. Generally healthy – and often young – people don't have to be saddled with financially crippling health care bills that destroy a fiscal future.

• Large, permanent scarring is decreased, thus allowing a patient to maintain a proud sense of self.

• Many people undergoing medical procedures experience a loss in wages. Same day surgeries allow many to return to their place of employment quicker so they do not lose status or wages. They can bank their personal and sick time for situations that demand more attention.

Experts say the rise of same day surgeries has not yet reached its peak. The goals are two-fold: patient care and physician efficiency. For the relationship between health care practitioner and patient to be effective, both parties must feel satisfied with the experience and recovery. Same day surgeries have benefited both greatly.

The Nursing profession is notoriously high-pressure. Many patients that Nurses encounter are in a grave state of need, and Nurses may not always meet their patients' needs, despite their best efforts. With so many individuals needing a coping mechanism, it's no wonder that many people turn to the power of humor and laughter.

The Benefits of Humor

To no one's surprise, humor has shown itself to be a powerful tool in the Nursing profession. Humor can increase a Nurse's happiness in his/her position and help to avoid burnout.

Sociological and psychological studies have shown that humor can diffuse tension in a situation, help lower blood pressure, ease stress and generally produce a feeling of well-being. Laughter and smiling create comparable positive effects.

Inappropriate Humor?

People in the medical profession are often familiar with a kind of dry, morbid humor. Medical professionals deal with matters of life, death and pain, with great immediacy. To give themselves some emotional distance from the matter, many medical professionals utilize this kind of humor among themselves.

But this kind of humor can seem cynical at best. It can alienate or appear disrespectful to patients. It's important to use it with care, if at all, and to remember that all individuals involved are human beings worthy of respect. As a rule of thumb, it's never acceptable to make jokes at a patient or colleague's expense (even if the individual isn't present, or if the humor would go over their head); this is doubly true with the kind of dry humor that can be common in Nursing.

Using Humor with Patients

Maintaining boundaries and being professional is key when engaging with patients and their families. But that doesn't mean that a Nurse isn't able to use humor in these situations.

It's important to use a delicate touch when joking with patients. Nurses may not get to know them or their sense of humor very well, and they're typically involved with patients during times of great emotional vulnerability, including fear or pain. But so long as a Nurse adheres to basic rules of interpersonal sensitivity, caring and respect, a little humor may go a long way to aid in bonding and the creation of empathy between patient and caregiver. It may defuse tension in situations that are otherwise very stressful.

Conclusion

Humor can't solve all problems within a workplace. If a Nurse is having serious problems on the job, or if they're going through a crisis outside of work, humor won't be enough to relieve stress and encourage them to stick around. But as an emotional release valve in a potentially grueling profession, occasional moments of humor can have a surprisingly powerful effect.

Is humor a tool you use often as a Nurse? Let us know in the comments below! 

As the growing baby boomer generation begins their retirement, so too begins a wealth of golden opportunities for investors and job seekers in the senior care industry. Of particularly exciting growth are the providers of in-home health care services. This includes people who specialize in everything ranging from medical assistance to basic health assistance like bathing and grooming, keeping up with housekeeping, and meal preparation.

So just how many of the baby boomers can in-home care providers expect in the coming years? There are an estimated 75 million baby boomers currently alive and contributing to our society, with an estimated 10,000 baby boomers turning 65 and retiring every day (starting 2010 and lasting until 2029).

In a recent survey conducted by NBC News, 89 percent of baby boomers that were age 50 and older stated that they would prefer to stay in their current home as they aged. Additionally, a whopping 95 percent of those surveyed who were 65 and older were adamant that they would rather stay either in their own home or near relatives and hoped they wouldn't need to live in a nursing home.

With such incredible growth in those needing home care services, it should come as no surprise that there's been likewise growth in individuals seeking careers within this industry. In addition to incredible career opportunities, there are also the following benefits of entering the home health care industry:

• Make a real difference in peoples' lives.  A career in home health care services enables you to make a real and meaningful difference in the lives of your clients and their families. Empathic individuals thrive in this profession as they are able to enjoy personal relationships with their clients and enjoy a sense of accomplishment coming from knowing that you are greatly improving another person's quality of life. 
• Work on a flexible schedule.  Not everyone adapts well to a 9 to 5 job. As a home health care Nurse or in-home caregiver you get to enjoy working on a schedule that fits your needs. So whether you want to work part-time or full-time, whether you're also pursuing another degree or raising a family, as a home healthcare employee you can choose the hours that fit your schedule.
• Deliver complex care to relieve the burden on families.  While seniors are a primary component of the growth in home care services, it isn't just aging baby boomers who are calling for a more diverse array of services. From infants with special needs to adults suffering with chronic conditions and those requiring specialized high-tech medical equipment, all of these individuals and their families depend upon home health care professionals for daily and ongoing support. As an in-home health care Nurse or aide, you make it possible for your clients to avoid expensive and potentially embarrassing institutionalization in an outside facility. 
• Specialize your skills.  Just as there is a diverse array of services you can provide within the in-home care industries, you can also choose to focus your care to meet the specialty service of your choice. For instance, if the idea of assisting baby boomers inspires you, then you can opt to build a career designed to work exclusively with geriatric care. This means that you can choose what you love about home health care services and follow that specialty for greater overall career success.

Take advantage of the growing home health care service industry to jump start your own rewarding career or make a change in your current career. 

Related Article: Life in progress: RNs can help baby boomers find funding for promising cancer treatments

Have questions about Home Care Nursing? Ask the Nurse Leader below!

America’s top companies are hiring the best, most qualified candidates, by widening their recruitment efforts and increasingly seeking diverse talent.  Diverse workplaces include employees from different races, ethnicities, gender, education, religions, sexual orientations, socioeconomic backgrounds, geographic locations, and other varying conditions. 

One reason Diversity recruitment is skyrocketing is because of the changing demographics of the United States.  According to the latest census, the ethnic makeup of America is changing more rapidly than anticipated.  Many studies reveal that businesses who have established Diversity and Inclusion initiatives have a competitive edge, particularly in today’s global market.  Following are 6 reasons explaining why businesses should not wait for their CEO to bring up Diversity Recruitment. 

1.  More Creativity

A Diverse workforce promotes creativity and innovation.  When employees of varying qualifications, upbringings, education, and experiences are brought together, they are more capable of coming up with creative ideas that are “out of the box,” and solve problems in novel ways.  According to Roy Y.J. Chua, a Harvard Business School professor, “The more your network includes individuals from different cultural backgrounds, the more you will be creatively stimulated by different ideas and perspectives."

2.  Increased Productivity

Increased productivity is the major reason organizations are choosing to implement Diversity into their workplaces.  Businesses that have incorporated Diversity into their hiring structure have discovered there is increased productivity among all employees, particularly from those groups that have been underrepresented, and underemployed, in the past.  These include many groups including seniors, women, physically handicapped, people of color, and individuals with different sexual orientation.  Increased productivity allows businesses to not only increase profits, nationally and globally, but to edge out their less diversified competition.

3.  Broadening of Language Skills

A huge advantage of workplace Diversity is the broadening of language skills, enabling communication with people from other cultures.  It is almost impossible to build relationships with others if we cannot speak their language or understand the meaning behind their words.  Over the next 4 decades, racial minority groups including Black, American Indian, Hispanic, and Native Hawaiian and Pacific Islanders will come to outnumber non-Hispanics.  With the health care industry in particular, it is essential to have a diverse workforce that accurately represents the population of the U.S., if patients are to receive quality care that promotes satisfaction and healthy outcomes.  All businesses that have plans to compete at a global level will experience benefits by increasing language Diversity in the workplace. 

4.  Greater Agility

Business agility requires an organization to be adaptable, flexible, and respond quickly to alterations in both the internal and external environment.  A Diverse and Inclusive workforce is more capable of bringing together a variety of perspectives that can lead to decisions to bring about the most advantageous results.  Leadership coach, Joseph Santana, states that a Diverse workforce can help to avoid “the blind spots that may exist in any single individual or cultural group lens.”

5.  Increased Loyalty from Employees, Customers, and Communities

The cultural fabric of an organization is enhanced with a Diverse workforce.  Diversification has been found to inspire employees and build loyalty with increasing segments of Diverse populations around the world.  Organizations that have made efforts to increase and improve Diversity in their workplace have found that growth in employee loyalty has long-term internal and external benefits.  One definite advantage is that consumers tend to support organizations that are perceived as Diverse. 

6.  Improved Employee Recruitment and Retention

Every individual of the organization needs to be part of, and “buy into” the Diversity and Inclusion policy.  The message has to be clear to employees and customers. The commitment to Diversity and Equality has to be inviolate. 

• Recruitment

Diversity recruitment substantially broadens the candidate pool. This larger labor force will include those applicants with high-level aptitudes, specific skill-sets, and unique life experiences.  Healthcare related occupations are among the fastest growing industries, and Diversity recruitment is helping to attract the skilled workers necessary to fill positions.  Businesses are much more likely to hire the right people when they select candidates from the broadest, and most Diverse, applicant collection possible. 

• Retention

Organizations that clearly value Diversity and Inclusion enhance employee contentment and stability, which has a direct bearing on employee retention.  For employees who wish to succeed and grow in the organization, there is trust in the company that advancements are awarded because of merit, and not because of race, gender, or background.  The Diversity message is not only communicated to the staff, but also to customers, and the surrounding communities. 

Do your organization a favor and don't wait for your CEO to bring up Diversity recruitment.  The research is in.  Businesses that fail to harness the power of Diversity are destined to decline.   

If your CEO doesn't see how important Diversity and Inclusion is, have them fill out our Diversity checklist to show them where they stand on the scale. 

Have questions about recruiting or diversity? We can help! Just ask this Nurse Leader your toughest questions. Click below.

I was asked to share my thoughts in writing to describe what Inclusion means to me. These thoughts came from my own life experience and from the recent inspiration of discussing this topic in the past few weeks at home and work. So here goes… 

Being different is not a choice. We often forget about this as we go through our day or our life until something happens that causes us to feel it. Being different can feel good and sometimes feel really bad. It all depends on whether we are accepted for this difference.

Think back at your earliest age when you understood what different meant, what it looked like, how it felt. If we today reflect for a minute, we are all very different, and have to remind ourselves of this. We can come from the same country, religion, gender, family and be different and have generalizations casted upon us and cast them upon others without deliberate thought. Further, we sometimes even cast them on ourselves and internalize them, the good and bad.

We go through life, like breathing seeing difference. It helps us navigate life. But like anything if not with consciousness it can lead to unintended consequences. We go through life often gravitating unconsciously and sometimes consciously to those like us. Why is it that? It provides great safety, sometimes ease, speed, a sense of belonging. This is part of being human. Also part of being human is Bias. It’s ever present and “unavoidable” and human. It affects our choices and behavior. And, like any habit, we can set an intention and choose to see different and include.

Inclusion is not about avoiding diversity, difference or being agreeable. It’s not about “fluff” or being “soft” and going with the flow. It’s more about creating a space of safety for you and others to be seen, heard and accepted. Inclusion creates a space for difference to have its voice heard in our relationships, our family, community, at work, in the world. It’s actually about looking at difference with curiosity. Treating people not as you wanted to be treated but as they want to be treated and vice versa.

Exclusion on the other hand separates, it inhibits, limits, shuts down, sometimes oppresses, even suffocates. To be excluded is one of the top five fears that we as humans have. It instills fear by its very nature and can create tremendous anxiety and can lead to conflict. Exclusion is not just harmful to the person, it’s harmful to relationships, families, profit and non-profit organizations and societies. We lose out on who that person is and what that person who is different from us (be it their perspective, their idea, their culture, their age) has to offer. We lose out on what we can learn and on what they/we together can contribute, build, inspire and live.

Imagine a relationship, a family, a workplace, a community, a world if we included. It would be safe, peaceful, inspiring, fun and we would want to belong.

Diversity is the presence of difference. 

Inclusion is a choice. Inclusion gives everyone a voice. 

Thank you all to whom I have interacted with these past two weeks regarding this topic. I was asked to share my thoughts about inclusion. And, in the spirit of inclusion, feel free to share my perspective and yours with anyone.

Related:

Important Questions Regarding Your Diversity, Inclusion and Cultural Proficiency

Strong management is necessary for all work environments, especially those that involve quick decision-making and high-pressure situations. Nursing is a career that, undoubtedly, fits into this category. Quality Nurse Management is vital when creating successful Nursing teams. Nurse Managers have an effect on how their employees relate to each other and their patients. Regardless of the hospital unit the manager works in, he or she must lead with a firm yet compassionate hand, revealing what they expect from the team. What is the importance of strong Nurse Management?

·Creating a healthy work environment

A Nurse Manager sets the tone of working in his/her department, acting as a negative or positive role model for the staff members. If he makes the employees feel like part of team and encourages teamwork, he inspires them to work together instead of competing. If he encourages constant communication, employees will be able to approach him when in need of guidance or to mentor. This creates a healthy work environment where people communicate freely with each other.

·Nurturing teamwork

Strong Nurse Management helps to encourage Nurses to work as units. For Nurses to be successful, they need to have great interpersonal skills. They must be good at communicating with patients, their families, and other members of the staff. Strong communication and teamwork are essential to providing quality patient care. To achieve teamwork, Nurses in management positions should encourage staff members to collaborate and help each other willingly.

·Supporting employee development

Nurses should keep refining their skills and learn new ones if they want to stay up-to-date with medicine. Effective Nurse Managers create environments that support growth and provide Nurses with the resources necessary to strengthen their competency. Additionally, they act as mentors, guiding new members of the staff as they adjust to their roles. When a manager values and encourages professional development, Nurses are more likely to push themselves to try new things.

·Proper organization

Proper organization is essential to the success of a Nursing team. Chaos is likely to ensue in the absence of proper organization – which would be unfortunate in the fast-paced, demanding healthcare world. A strong Nurse Manager needs to be detail oriented, methodical, and skilled at recognizing and solving problems. She should have the ability to tackle many different tasks simultaneously: overseeing patient care, writing shift schedules, and assigning duties to the Nurses.

·Setting department goals

Members of staff usually look to the manager for direction, trusting him/her to help them in understanding their role. The Nurse Manager often interprets the goals set by the hospital, decoding them into specific steps that the Nurses can follow. She must also define clear goals for the team, explaining them in a manner that emphasizes their significance. Managers typically oversee everything from standards of care to departmental budgets. Moreover, they must consider all aspects of the department’s operations before giving the team instructions.

·Encouraging success

Good Nurse Managers promote environments that encourage their staff to be more productive and enthusiastic when working. As the manager, the onus falls on him/her to lead through actions and words – to show that anything below 100% performance is unacceptable. Nurse Managers need to be honest with the team about its performance and issue clear instructions. They should also praise the staff members who do outstanding work and encourage those having a tough time.

·Positive growth

Good Nurse Managers should have the confidence to analyze their work honestly and come up with ways to improve them. When the team’s performance is below par, managers should make changes that improve performance, taking it to the next level. Nurse Managers should influence the staff members to evaluate the things around them and themselves, to find out what works. This will help them to improve their team performance and work environment.

·Smoothing patient relations

When patients and their families have concerns about the quality of care given, they go to the Nurse Manager. They might have questions about the treatment plan or complain about mistreatment from staff. No matter how irate the patient is, Nurse Managers must listen and answer the questions. It is the job of the Nurse Manager to let the patient know that his/her concerns will be taken seriously. During the meeting with the patient or their family, the manager should outline the steps that will be taken to remedy the situation or investigate the complaint.

Nurse Managers usually oversee specific units in the hospital. Therefore, they are responsible for the administrative and clinical aspects, including addressing the concerns of patients and supervising the Nurses. Not only do they require special expertise, but they also need strong communication skills.

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Related links: Being a nurse leader, even without the title

The profession of Nursing is engaged in a consistent conversation about the state of Diversity in Nursing. The way these figures are tallied are by comparing the percentage of individuals of various ethnic or cultural backgrounds in the general population to the relative group percentages in the field of Nursing. Many professional Nursing publications have been observant that Diversity in the Nursing field has improved, but there is still much additional room for continued improvement.

Where we've been

While a century ago the profession was nearly entirely comprised of white females, the increased Diversity enjoyed in the present day still falls short of being an accurate representation of the population breakdowns of society at large. According to 2016 census data, the only minority group meeting their group's needs in terms of proportionate population is Asians, who have actually managed to overrepresent their group by almost 5% when compared to the percentage of Asians in American patient populations.

A changing national demographic

Whites are still over-represented in nearly all Nursing roles while Hispanic and African American Nurses still have ground to make up if they wish to accurately represent the proportion of their respective group populations who enter as patients in health care facilities. By 2044, national Census data aggregators and analysts believe that Americans of European descent will cease to be the majority of the US population, when at that time they are expected to make up 50% or less of the entire population.

Why Diversity should help

The hypothesis that Nurse Diversity is best for the outcome of patients is centered around the idea that minority patients will feel more comfortable. With the added comfort on the part of the patients, the hope is they will be more compliant with recommended medicines, procedures and recommendations of any kind. If the Nurses and doctors serving minority patients are of the same cultural or ethnic background as themselves, many believe that noticeably positive outcomes could result. This is all still theory, of course, and hasn't been able to be borne out in any specific studies or repeatable situations.

While the specifc data hasn't been borne out in scientific studies to explain a known patient benefit for increased minorities in the Nursing field, there is a lot of policy support and governmental approval of the notion. Fortunately for those who have taken on this cause as a personal conquest, the numbers of enrolled Nursing students is starting to include more minorities as well as more males in the field, another group historically greatly underrepresented. A lot of the Diversity increase being noticed in Nursing school enrollment has been unbalanced from state to state. A closer look shows more enrolled Nursing students in Southern states versus Northern ones and more in the West than in the East.

Related: Bringing diversity to the nursing workforce