DiversityNursing Blog

by Katrina Gravel

This past month, the George Washington University School of Nursing (GW) received a three-year, $1 million grant from the U.S. Health Resources and Services Administration to fund a program that aims to increase the diversity of nursing professionals, according to a press release from GW. The school’s Success in Nursing Education project focuses not only on drawing in African-American, Asian, Hispanic, and Native American students, but also male students and economically disadvantaged students from Washington, D.C., and rural Virginia. A report released by the U.S. Department of Health and Human Services (HHS) in September 2010 showed that men made up less than 10% of employed RNs licensed between 2000 and 2008, while non-white or Hispanic nurses represented only 16.8% of all registered nurses in 2008. While those percentages may have grown in years since the HHS survey, it is unlikely that the gap has become significantly smaller.

The lack of ethnic minorities, males, and economically disadvantaged nursing students does not reflect the immense diversity of the patients these students will soon be treating. As an article in GW’s student newspaper The GW Hatchet cites the school of nursing’s Dean Jean Johnson as saying, “the nursing workforce should reflect what the population at large looks like.”

GW will use the grant to launch a recruitment campaign to reach disadvantage students, as well as students who are changing careers. The program will offer both undergraduate and graduate degrees in nursing, and will utilize retention tools such as mentoring programs. The grant will also create scholarships and financial aid for some students, according to the GW press release.

Has your organization made efforts to diversify its staff? What are your thoughts on the GW program? Leave a comment and let us know!

Originally published by the University of Phoenix

1. Join a nursing society.

"Nursing societies provide a wide variety of ways to stay on the cutting edge of our profession," says Kerrie Downing, RN, MSN, campus college chair of the nursing program at the University of Phoenix Minneapolis/St. Paul Campus. Nursing societies can be large and national in scope, such as the American Nurses Association, or small, as regional associations and specialty societies are. These organizations often offer their members access to publications, online discussion boards and a host of other services, which can include career advice, conferences, conflict resolution, even political advocacy.

"It's always great to have someone else within the profession to connect with, and not just be limited by the people in your workplace," Downing says.

2. Volunteer in your profession.

"I advise nurses to get involved in their [profession's] self-governance," says Juanito C. Torres Jr., MSN, a registered nurse who manages the nursing simulation lab at the University of Phoenix Hawaii Campus. This can include unit practice councils at the hospitals where nurses work, or research committees sponsored by nursing societies, among other opportunities. "Nurses need to get involved in these types of committees to be aware of the latest developments and promote best practices," Torres says. Nurses can even get involved in political action; changes in national policy on seat belt laws and public smoking bans, for instance, owe their enactment in large part to nurses.

3. Attend conferences often.

Conferences offer plenty of opportunities to stay current, whether it's an opportunity to network or hear lectures by leading voices in the profession. "If you've been working in the same area for more than two to three years, your skills are probably stale and you need to get up to speed," says Margi Schultz, RN, PhD, who obtained her BSN and MSN degrees from University of Phoenix and is currently a nurse educator. "Conferences offer you a way to get the latest information so you can keep your nursing practice based on the best available evidence."

4. Read nursing journals.

Torres says that top nursing journals such as American Journal of Nursing and Evidence-Based Nursing publish the latest research. Many hospitals subscribe to these and other journals, and societies frequently make them available at a discount to their members.

5. Step out of your comfort zone.

Shultz recommends that nurses shake up their routines a bit in order to gain new skills. "Go to classes, obtain advanced certifications, maybe shadow a nurse in another specialty," she says. "There's no reason to get bored with the same old thing."

Student at the UCLA School of Nursing start their nursing career with a high tech boost. As part of their ceremony to receive their white coats, this year they were also give iPod Touch devices preloaded with Medication and Diagnosis guides as well as a Spanish language dictionary and translation assistance. UCLA is determined to offer new grad nurses that are ready for "High Touch" care but within a "High Tech" environment.

 Nursing Reimagined. Nursing Redefined.

To read the first part in this article series, please click here

The important things to bridge the differences in the professional nursing practice in the United States are:

1. Develop critical thinking skills. Always ask how, what, when, where, who, and what-if questions. Seek to understand the need for what is not understood. It creates deeper and more meaningful learning when we ask questions and search for answers. It also expands knowledge and leads to future change with less frustration.

• Identify the difference, seek to understand and to assess the situation or question at hand.
• Observe the evidence of practice.
• Develop a self-improvement list for ourselves.
• Analyze content, including the policies and procedures of our facilities.
• Interpret, verify and explain findings to our way of understanding.
• Evaluate for relevant criteria to make a good judgment.
• Apply new ways of thinking and immerse into the new knowledge as our own, using it in new clinical settings.
• Create an action plan. Make a strong personal commitment to act differently in the nursing practice. Commit to doing things in new ways and not slide back into the old way of doing things. Adjust our behaviors again as needed. Apply new action plans to adopt better nursing practices for ourselves.

2. Be true to ourselves. Stay strong, positive, and use positive energy everyday. Do not fall into the trap of negativity. Keep eyes open, mind clear, and refuse to go into a negative pit. There is no room for negativity.

• Build our brand. One simple example to think about branding is to look at a change shift. When a nurse comes in tardy; we hear some people say, “She is never late; she is always on time. Hope she is okay.” But we also frequently hear others say “She is always late. We don’t have to wait for her, let’s get started.” Ask yourself: Who do we want to be? It takes a plan and determination to come to work on time on a consistent basis. Our brand is built by what we do day in and day out. We want to make a conscious decision to align ourselves with true greatness.
• Practice positive self-talk to make self-affirmation a daily habit. Think about how many people are able to excel in another land. We use a different language all day at work, and we work in a people profession – around people, and taking care of people. We are a different breed. We are doing great!  
• Excel in our strengths. When we posses excellent skills, use them. Peripheral IV (PIV) insertion it is a great time-saving skill. Help out where you are most skilled. Hold onto what is good, but assess if there’s a new, better way. Let’s raise the bar for ourselves. 

3. Limit negativity.

• Take pride in our bilingual skills. Being bilingual is a gift. It is not a negative attribute. Speaking bilingual gives us the opportunity to explore understanding of words or phrases that are foreign to us. Volunteer to be an interpreter for patients who speak our native language whenever you can. Never use our cultural background as an excuse for not being an effective communicator. We need to continue to improve speaking English. We can learn to communicate more effectively every day. We can write down our successful sentences and deposit them in a basket. Pick them up to read them again once a while.

• Create ways to help deal with negative people around us. When we distance ourselves from the negativity or person, people may misinterpret our behavior into a negative behavior. Our actions may be interpreted as anti-social. Mingle, but avoid joining in negative talk. It unrealistic for us to expect to never encounter rejection or discrimination in the workplace. That is purely naïve. Rejections and discriminations are likely to happen to us. They happen for many reasons beside cultural differences. We do not appreciate experiencing rejection and discriminations at work. How one deals with the experience is a big lesson to learn. Let’s ask ourselves: What are we going to do if we encounter these things? What can we learn from this encounter?  Do we want to tolerate it? How much can we tolerate it? What is our personal limitation? What can we do to change?  How much time do we want to spend on unhappy events? Is this experience going to affect us one year from now? Five years from now? Ten years from now? At different times, we do different things. Therefore, a flexible plan will be very helpful. It is easier to deal with situations if we already have a thoughtful plan. At the very least, we have a lawful process to resolve discrimination. Always seek to understand. Explore how things can be improved. 
• We also need to find our own ways to deal with whatever we encounter. I will share my own terrible experience. The incident happened just before I was going to a beautiful wedding. I was determined not let the terrible experience ruin a good time at the wedding so I compartmentalized my horrible experience. I went to my secret “P” pocket (I have many words which start with “P” in my mind that I can use to boost my  positive energy when I needed).  I pulled two “P” (Personally and Permanent) words out. I kept telling myself over and over “Don’t take it personally.” “The problem is hers.” “I did what I need to do for my job.” I also told myself again and again that “Nothing is permanent. This shall pass.” I repeated these sentences to myself until I was at peace. That night, I was able to enjoy the wedding. I could think about how to deal with my bad experience after the wedding. 

4. Plan to bridge the differences in our nursing practices in many steps.

• Initial self-assessment and learning to fill the missing pieces of the puzzle for ourselves.
• Find a group to study, to socialize, to make friends, and to learn from each other and the cultures of each one involved.
• Search for a few career mentors for guidance. It will save us a lot of time while we are lost in a maze of professional nursing. In the United States, nursing opportunities are endless; we have a great many options for our advancement. It is not like when we thought nursing jobs were limited to a hospital or clinic.
• Ask for help. Ask for input to clarify any confusion. We want to do it right the first time and we want to do the right thing. We have to triple-check all we do, because patient outcomes are in our hands.
• Past personal beliefs like “Be quiet” and “Silence is a golden” – these don’t have much validity or value here. Not speaking up and not asking questions – these are not appropriate in this country. Do raise questions as appropriate.

Attachment I: Examples of possible solutions and preparation to bridge the differences in changing and adapting our professional nursing practice in the United States.

Attachment II - SBAR

The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient's condition. SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety.

Michael Leonard, MD, Physician Leader for Patient Safety, along with colleagues Doug Bonacum and Suzanne Graham at Kaiser Permanente of Colorado (Evergreen, Colorado, USA) developed this technique. The SBAR technique has been implemented widely at health systems such as Kaiser Permanente.

This tool has two documents:

• SBAR Guidelines (“Guidelines for Communicating with Physicians Using the SBAR Process”): Explains in detail how to implement the SBAR technique
• SBAR Worksheet (“SBAR report to physician about a critical situation”): A worksheet/script that a provider can use to organize information in preparation for communicating with a physician about a critically ill patient

Both the worksheet and the guidelines use the physician team member as the example; however, they can be adapted for use with all other health professionals.

By SBAR Technique for Communication: A Situational Briefing Model

Page Content

Kaiser Permanente of Colorado
Evergreen, Colorado, USA

Attachment III – Read-Back

Read-back is a way to verify of the complete order by the person who receiving the verbal order.  The receiving person will repeat the verbal order back to the ordering clinician, who will verbally confirm that the repeated order is correct. The purpose of “Read-back” is to ensure patient safety.

Contributors:

Mai Tseng -- RN, BSN,MPA,EMBA, NE-BC,CRNI, LNC
Karen Cox -- RN, PHD, FAAN,
Laurie Ellison -- EMBA
Xu Hong Fang -- RN
Hong Guo -- RN
Sufan Sun -- RN

This is the first of a 2-part article and is a follow up to the CAN (Chinese American Nurses) Sisters I published on our blog on August 23, 2011. Click Here to Read the first article in this series.

The article is the collaborative work of a team of Chinese American Nurses (CAN) sisters.  It speaks as “foreign” nurses who have worked in America for a number of years. Our group is very lucky to have CAN meetings twice a month. We have each other’s support. We share our setbacks and clarify our things that might confuse us. Together we provide opportunities to think things through; to have a better understanding of ourselves, to not let fear paralyze us; and to add strengths to face tomorrow with positive thoughts and energy. Go CAN!! Go!!!

Last month, a CAN nurse started to talk about the major differences that we are experiencing in the nursing functions and practices between China and the United States. Everyone joined in the discussion.

Assess and Reassess Our Patients

In USA:
Nurses are expected to know as much as possible about our patients. Nurses have a major responsibility in the assessment and re-assessment of our patients. Most nurses are doing a great job in assessing patients. Nurses are at patients’ bedside 24x7. Physicians are not. We may notice a change first, and take action as the law allows. We can initiate many nursing protocols, especially in an emergency, and then we report the changes to physicians. Physicians come to assess, verify, confirm the changes, and take additional actions.

In China:
The nurse-to-doctor ratio is nearly 1:1 in China. Doctors are just like nurses, at patients’ bedside 24x7. When new patients arrive, doctors perform the first assessments.

Report Abnormal Findings:

In USA:
Nurses report abnormal findings from our own assessments or from the results we receive from other departments or facilities. Most of our current practice is to report the results to nurses first. Nurses are expected and required to report abnormal findings to physicians. We can take actions that are legally allowed. Many nursing protocols are there for us to utilize, especially in an emergency, and then we turn around and report the results to physicians. Physicians come to assess, verify, confirm the changes, and take additional actions.  

In China:
Doctors on the units get reports first. Nurses may not be aware of the results and reports. Therefore, nurses may not be aware of changes or actions needed.

Emergency Responsibilities:

In USA:
Nurses or anyone who witnesses the need can call a code. A nurse is usually the initial emergency responder, until an organized team comes. Teams, including physicians, take over the emergency situation. Organized teams, such as the Rapid Response Team, Code Blue Team, and Trauma Team, have additional training in things like Advanced Critical Life Support and Pediatric Advanced Life Support.

In China:
Doctors are at the patient’s bedside or nearby to respond and initiate emergency actions.

Administering Medications:

In USA:
Nurses are responsible to ensure medications which are taken by mouth (P.O. medications) are swallowed every time, with no exceptions. In the Medication Reconciliation process in some facilities, nurses verify medications on an on-going basis. Verbal and telephone orders are seen often in some facilities.

In China:
In past practice, P.O. medications might be left at the patient’s bedside or with their families, trusting that the patients would take their medications. This is not the right thing to do. It is very dangerous. What if a patient purposely hides his/her medications, and then overdoses on them?  China’s nursing practice is changing; now nurses are watching patients take their medication more often. Doctors are there to verify medications in the Medication Reconciliation process. No verbal orders.

HIPAA Regulations:

In USA:
A patient’s health information is very private, personal property. It totally belongs to the patient. If we don’t have a patient’s written consent, or regulatory permissions, then we cannot give personal information to anyone except the patient. Self-imposed “kindness” such as initiating family or community support for a patient without the patient’s permission is no long allowed. For example, let’s say we go to work at the hospital and see our neighbor who is very sick. Our sick neighbor needs help, especially with child care. We cannot tell another neighbor who we think would be happy to help with the sick neighbor’s child. We have to plan ahead, talk about our intent, and ask the sick neighbor’s permission before we talk to the helpful neighbor. We would be violating the sick neighbor’s confidentiality if we talk to another neighbor without the sick neighbor’s permission.

In China:
Helpfulness and kindness are always welcome as long as it is a sincere act.

Sterile Technique

Performing and maintaining a sterile technique is a big deal in infection control to the nursing practice of both countries. Maintaining sterile technique saves lives, time and money.

In USA:
In some cases, CAN nurses had the perception that a few of their nurse co-workers’ practices were a bit sloppy. When you notice the lack of sterile technique, you must speak up. Express concern about contamination. This is a time to educate our co-workers in a kind way. Often the nurses who are doing the job may not be aware that contamination has occurred. Mentally, we know that it is difficult for us to point out any possible contaminations or any wrong doing. Culturally we were taught to pretend that we did not see; let others do whatever they want to do; we do what we are supposed to do to keep ourselves clean.  “Mind our own business,” is what we learned. But in today’s world we need to prepare a simple and easy phrase or sentence that will help us to gently point out possible contamination. It will save lives. We have a lot to learn about how to be assertive and to be an advocate for our patients.

In China:
The fear of contamination and the strict self-monitoring of sterile techniques are emphasized more. CAN sisters feel that because of our past strict training, sterile technique is branded into our minds.

PIV Insertions:

In USA:
Many facilities prefer to have IV Teams for Peripheral IV insertions to save nursing time, promote patient satisfaction, and decrease line infections. Therefore, nurses’ experiences in starting PIVs are very different. Some nurses do not have to start an IV at all and they have no skill in PIV insertion. For some nurses who start PIVs occasionally, their skill is hit-and-miss. Very few nurses are good at PIV insertion.

In China:
CAN nurses discovered in the support group meeting that most of nurses are good at PIV insertions. We found out that CAN nurses are the “go-to person” for performing PIV insertions. Personally, I have never paid much attention to this as a big difference. It was delightful to find out that this is one of our common strengths.

Salaries & Bonuses:

In USA:
We make good salaries as nurses, even after about 40% is withheld in taxes, income taxes, and sale taxes. On the other hand, if we compare our salaries to physicians’ salaries, we find out a real gap. Physician pay is much higher. Of course, there are good reasons. Physician education and training are much longer and more in depth, and more physically and emotional demanding than nurses’ education. The demand for physicians is greater than the supply of physicians. We have many physician assistants and nurse practitioners who work under physicians and support some of our physician functions and responsibilities.

In China:
Nurses and physicians both have two types of incomes – regular salary and bonus. The nurses’ salaries are much closer to physicians’ salaries in China. Chinese doctors and nurses are equally compensated by the government. It is a perfect system for equal professionals. The differences in their earnings come from their bonuses, which are regulated and paid by the hospital. Currently, no nurse practitioners are working in a hospital or clinic in China.

Nurse to Physician Ratio:

In USA:
The variety of job choices for nurses is huge, including acute hospital care, clinics, nursing homes, home health, insurance, occupational health, schools, law firms, etc. The nursing functions and responsibilities are varied, and it is very different in different health-care and non-health care settings. The physician to nurse ratio ranges from 1:4 to 1:8 or more, depending on the type of facility and the time of day or night. Some nurses function independently.

In China:
Most of nurses are working in hospitals and clinics, the nurse to physician ratio is nearly 1:1. It is a perfect ratio for an equal professionalism. No nurses are function independently.

For us “foreign” nurses, especially those of us who have studied nursing or grown-up abroad, we often find that nursing functions and practices are very similar in some ways and quite different in other ways. This becomes apparent particularly on initial entry into the nursing profession in the USA. Adaptation will ease most barriers. The sooner we can identify the differences, analyze them, and find ways to adjust, the sooner we will adapt to the United States’ way of practice. As we open our hearts and minds to learn new things, we can expand our horizons. Every challenge forces us to learn and to bring out undiscovered talents within us, thereby making us stronger. There is no failure in trying to do the best we can do; the only failure is not trying to change and adapt to a different way of doing things. There are times we have to be brave enough, to have enough self confidence, and to excel on own strengths. We want to keep very strong, solid nursing skills, such as peripheral IV insertion skills. We want to keep the valuable nursing concepts, such as sterile techniques with us. Our skills will be lost if we do not practice constantly. In all, we are excited that we have opportunities to brand ourselves as the best we can be in United States.

Contributors:

Mai Tseng -- RN, BSN,MPA,EMBA, NE-BC,CRNI, LNC
Karen Cox -- RN, PHD, FAAN,
Laurie Ellison -- EMBA
Xu Hong Fang -- RN
Hong Guo -- RN
Sufan Sun -- RN

Please watch for the second half to this article to be published later in December.

Staff Assistant
Hausman Diversity Program at Mass General Hospital

The Hausman Student Nurse Fellowship was created when MGH patient Margaretta Hausman, a social worker and graduate of Brown University, recognized the need for diversity among the top-level nursing staff. The Hausman Student Nurse Fellowship provides an opportunity for minority nursing students enrolled in an undergraduate baccalaureate nursing program to gain experience in patient care across the continuum.

The fellowship allows student nurses between the summer of their junior and senior year in college to experience care at the bedside in both inpatient and outpatient settings.  Under the mentorship of Deborah Washington, R.N., Director of Diversity for Patient Care Services and Bernice McField-Avila MD, Co-Chair of the Fellowship, the recipients have an opportunity to further develop skills required to thrive in a workplace where unique challenge to the minority nurse must be managed.

The first fellowship was awarded to Stevenson Morency in 2007.  The program flourished significantly and in 2011, the fellowship was awarded to 8 minority student nurses, the largest group in the history of the program. The Student Nurses worked on various units such as Endoscopy, Orthopedics, General Medicine, Thoracic Surgery, Cardiac Unit, Neurosurgery Unit, Wang Wound Care, Cancer Center and the Grey IV department.

At the graduation ceremony on August 19, 2011, the Hausman Student Nurses provided feedback about their time in the program. Vicky Yu, a student of UMass and a 2011 recipient, felt honored to be part of the fellowship. She stated she saw many procedures she had only read about in her textbooks: colonoscopy, hip/knee replacements and urinary catheterization. “I got to work with a nurse 1-on-1. I don't get this attention on my school clinical and I loved it!” stated Vicky.   

Jennifer Etienne of Boston College stated: “As a minority nurse, it will be my mission to eliminate health care disparities and use my skills and knowledge to eliminate language barriers and become more culturally competent.”

Marthe Pierre shared: “The Hausman Fellowship is a ladder that provided a stepping-stone to my success. It allowed me to acquire skills, knowledge and confidence. It has also ignited my desire to one day become an extraordinary nurse who is culturally competent and compassionate.”

Jeffrey Jean of UMass Boston expressed that the program has reaffirmed his knowledge and his clinical experience. “Being able to walk in the shoes of a different RN has allowed me to re-invent myself. I have learned an abundance of new skills and techniques and have acquired a vast amount of knowledge. I believe that an important component of being an effective caregiver is to know what my strengths are.”

Sedina Giaff of Simmons College declared “It is with great pride that I introduce myself as a Hausman Fellow. This has been the best summer of my life. My experience as a Hausman Fellow has made me a better nursing student both clinically and intellectually. I have a better understanding and greater interest in the nursing profession. I am confidently looking forward to the coming school year and sharing my experiences with my classmates.”

Lauren Kang-Kim of Linfield College in Oregon had this to say: “Now I am reborn as a Hausman Fellow. For the last 5 weeks I found my own powerful voice and I am now proud of my minority identity. The Fellowship has opened the doors for me to become not just a better nurse, but a better person with a deeper understanding and respect for human beings.

Rosalee Tayag and Anna Diane of UMass Boston and Boston College respectively, stated that the Fellowship enhanced their leadership, critical thinking, assessment and communication skills; and  taught them to be more culturally sensitive. They also emphasized that they learned to work as members of a team more effectively.

Former 2010 Hausman awardees, Jason Villarreal and Penina Marengue, congratulated the Student Nurses on their graduation and cautioned them to use their new-found knowledge to provide competent care to their patients and uphold the good name of the Hausman Fellows.

Former Hausman Fellows include: Frew Fikru, Alexis Seggalye, and Christopher Uyiguosa Isibor 2008.  Chantel Watson and Stephanie Poon 2009.

The Hausman Fellowship is posted by Spring of each year at www.mghcareers.org. Qualified minority candidates should be in good academic standing (3.0 GPA or higher) and entering their senior year of a BSN program in the Fall.

In 2003, a small group of Chinese-American nurses, all working in the Kansas City area, came together to share experiences, learn from one another and encourage each other. Today, the CAN (Chinese American Nurses) Sisters meet twice a month as we continue to share our nursing and American life experiences. Our common denominator is that English is our second language. We feverishly try to improve our listening, writing, and speaking skills in English. We especially want to reduce our translation and response time during conversations. We also have in common that we all work extremely hard; we are reliable, friendly, caring, and happy at work.
  Recently, we met for one of our regular meetings. We sat in a circle in my living room and began with introductions. On that particular night we had three overseas visitors from China who were part of an exchange program at Children’s Mercy Hospitals and Clinics in Kansas City. The evening turned out to be an especially moving night for all of us. We each told the story of our life’s challenges and triumphs. We all talked of our struggles to memorize the names of cells, medications, and tiny germs in English! It was fun night.

After my guests left, I started cleaning the dishes. As I did, I suddenly was struck with the thought: How could I ever take these amazing, beautiful nurses for granted? I am so lucky to know them! At the end of every meeting, we feel charged and ready to face the world together. CAN nurses only need opportunities to prove themselves as great nurses. Here are a few of their stories:

SS – She was a nurse in China. After arriving in the United States, she started studying for the nursing board while also raising a child and working at local restaurants to help support her family. She studied hard and passed the nursing board. She then enrolled at Johnson County Community College for an RN refresher course. She completed her clinical RN training at a local specialty hospital. Her clinical instructor noticed how hard she worked and her solid knowledge of nursing. The instructor’s immediate supervisor then hired her as soon as she completed her clinical training practice. SS has being doing very well at that local specialty hospital for more than five years. Doctors trust her and her nursing judgment. She consistently receives praise from the doctors and other staff members.

FF – She also was a nurse in China. She studied and passed the nursing board soon after SS passed the board. FF went on and studied many more nursing specialties, and earned herself national certification in infusion nursing and wound care. She was a supervisor at a local nursing home with multiple certified nursing skills. She was doing an outstanding job in nursing.

GG – She practiced medicine in China. As soon as she arrived in the United States, she went to nursing school, studied extremely hard, and she passed the nursing board. She does not practice nursing yet; she is still waiting for her green card and permission to work. She is ready to serve.

HH – She was a nursing instructor in China. Right after arriving in the United States, HH started studying for the nursing board, even while she was caring for her premature baby. She passed the nursing board exam, and then went to work at a hospital. For many years, she has been a well liked and well respected weekend night nurse. She turned down a promotion opportunity, as her nurse manager suggested, to become a night charge nurse.

MM – When she arrived in Kansas City, MM was hired as a nurse technician even though she was a RN in China. She was living in an empty apartment so learning English was difficult. A phone book became her best tool to learn conversational English. For eight to 10 hours a day, she would turn the pages and randomly pick a person or a store from the phone book, call them and ask questions;  when she flapped on “W” section and saw a water bed shop, she would ask  “what is water bed? How much cost for a water bed” --- etc. She listened attentively and tried to learn as much as possible. Alone in her apartment, the phone book connected her to her new world; this is how she learned and improved. She wanted to work as a nurse as soon as possible. Eventually, she passed her nursing board, and earned two master degrees and four national nursing and nurse management certifications. She is working at a hospital today as a Hospital Shift Supervisor.

ZZ – She was a nurse in China. Months of hard studies for boards, she passed her nursing board a few months ago. She sent out many applications to many hospitals. She received only one reply, requesting a phone interview. After the phone interview, she never heard from the hospital again. Personally, I believe a telephone interview can be a form of discrimination, especially for a nurse for whom English is her second language. We loss over 50% of effective communication tools in a telephone interviewing. Phone interviews don’t always allow us the opportunity to show how much we can do and how well we can be as a great nurse.

KK – She was an experienced nurse in China. She is now taking care of a child with multiple allergies. She would like to work as a nurse in United States.

DD – In China, DD majored in English. She worked in a non-nursing field in the United States for a while and then decided she wanted to be a nurse. She went to LPN school, and then to an RN bridge program. Soon she became a RN. In her nursing student training, she worked at a telemetry unit. She was well-liked in her nursing practice and she was hired by that unit as soon as she completed her clinical training. The staff in that unit love her, and she loves nursing.

WW – She came to the United States with her husband. At that time, her husband was an owner of a local restaurant. WW did not want to work in the restaurant, she went on to study nursing as a new fresh beginning foreign student, and passed the nursing board. She worked as a nurse at a large local hospital for a few years, and then she earned her advanced nursing degree to become a nurse practitioner. She works as a nurse practitioner as soon as she completed school. She was alone and struggled for a long time in learning what was the nursing about, but she made it.

One of our visitors, Janice, asked, “Was there anyone who did not make it? Did anyone go back China?” Without pause and without knowing who else was going to respond, the CAN sisters answered in one voice in the spirit of our sisterhood:

“No, that  was not an option for us.”

They continued:

“Nobody said it was not hard.”

“We were determined to make it in this world together.”

“We were not going to quit.”

“We appreciate each other.”

“We learn from each other.”

“We are going to be strong, stand up straight, and shine.”

Our visitors were very impressed and encouraged. They also said they were very proud of their countrymen who are “making a difference in their new world.”

CAN, yes we can. CAN, yes we can.

This article was written for DiversityNursing.com by:

Mai Tseng RN, BSN, MPA, EMBA, NE-BC, LNC, CRNI.
Hospital Shift Supervisor
Children's Mercy Hospitals & Clinics
2401 Gillham Road
Kansas City, MO 64108

Thank you to Pilar De La Cruz-Reyes, MSN, RN from the California Institute for Nursing and Healthcare for the content of this video.

Breaking the Barriers is a great compilation of nursing stories put together by the California Institute for Nursing & Health Care that show how everyday people can overcome adversity to follow the career of their dreams. The nurses in this video will inspire you and show to our young people how you really can achieve if you have the desire and passion for a career in nursing.

Once you watch this video, we would love to hear your feedback. Please comment here on our blog when you have a minute.

Four Innovative Initiatives to Attract and Retain Diverse Women

By Tina Vasquez for Evolved Employer

Recently, Working Mother Magazine released its 2011 list of the best places to work for multicultural women – essentially, a survey of the availability and usage of diversity programs, as well as the accountability of the managers who oversee them at top corporations. For the fifth year in a row, Pepsico has been named number one, along with with 23 other companies, all of which are committed to supporting women of color with strong diversity, leadership, and education programs. Here are four of the most innovative initiatives included on 2011 list, that help advance and retain diverse women.

IBM
IBM’s cutting edge Reverse Mentoring pilot program turned mentoring on its head. Ten senior executives were given the opportunity to choose a culture they wanted to learn more about and for 10 months, and multicultural women (who were primarily non-executives) from these cultures acted as their mentors, helping them better understand cultural differences. The need for the program was identified as a key initiative of the Multicultural Women’s Group at the company, whose mission it is to attract, retain, and develop women through mentoring, networking, fostering a sense of community, and exchanging information.

According to Angela Archon, IBM’s VP of systems and technology, the program promoted cultural sensitivity and adaptability and demonstrated the impact of globalization and why culture matters.

“The hallmark of the program was to increase knowledge and sensitivity around cultural differences and continuously improve global collaboration. It helped dispel myths; it provided clarity to issues related to stereotyping; and it increased cultural awareness,” Archon said. “Executive mentees gained knowledge about their mentor’s culture and how business is done in that culture and the multicultural women who served as mentors had the opportunity to build a relationship with an IBM executive and enhance their leadership capabilities.”

Deloitte
It should come as no surprise that the ever impressive Deloitte was featured on Mother’s list for the sixth year in a row.

This year, two of Deloitte’s programs were spotlighted on the list: Navigation to Excellence and the Leadership Acceleration Program. After an internal survey of almost 4,000 multicultural employees, the firm found that multicultural women desired more formal sponsorship, so Deloitte launched its Navigation to Excellence pilot program, a one-year program that matches female managers and senior managers of color with leaders who help them orchestrate a career plan, gain access to key assignments, and enhance their knowledge of what it takes to advance. The 18-month Leadership Acceleration Program even allows female partners and principals to shadow their sponsors on the job, receiving intensive mentoring and coaching.

To continue moving these types of initiatives forward, the firm has quietly invested $300 million towards the creation of a state-of-the-art learning and leadership development center that will open its doors this fall after two years of construction.

According to Barbara Adachi, the National Managing Principal for Deloitte’s award-winning Women’s Initiative, it was never the firm’s intention to be a leader, but awards and recognition such as those given by Working Mother, inspires them to keep moving forward.

“We’re our biggest critics and we’re our biggest motivators. We don’t do this for the publicity. Diversity is a business imperative here. I recently read that half the population will be comprised of minorities in 2050 and I strongly believe that by being diverse, we attract the top talent in the market and we better serve our clients,” Adachi said. “We’re not doing this because it’s the right thing to do, but because this is the way business should be done.”

Chubb Group of Insurance Companies
This is the third time Chubb has been featured on Working Mother’s list, but the company has a long-standing commitment to promoting diversity with decades old programs and initiatives in place. According to Trevor Gandy, Chubb’s chief diversity officer, in order to form lasting business relationships with customers and become a true global leader in the industry, the company must understand its customer’s “diverse cultures and decisional processes- and not merely their languages.” To do so, the company strives to create a diverse workplace through programs such as their Count Me In: A Culture of Inclusion micro inequities program. The program began over 10 years ago and aims to help the company educate their workforce on the often small details and behaviors that help build an atmosphere in which all employees feel they have a voice.

Chubb also has a 29-year-old Minority Development Council whose mission is to advance the company’s business objectives by fostering the career development of people of color into leadership roles. Even more impressive, the company’s Women of Color strategy strengthens the bonds between women of color and their managers by providing them with meaningful feedback and structured development plans. The overriding goal, according to Gandy, is to prepare the company’s female multicultural employees to compete for leadership positions.

CA Technologies
Like Chubb, CA Technologies firmly believes that their business relationships in more than 140 countries drives their commitment to workplace diversity and it enables them to create, support, and sell the best IT management software.

The company’s Women in Technology Mentoring program is geared towards female employees that are in technical and quasi-technical roles within the company’s technology and development organization. The program was established to ensure that female employees are provided with the appropriate environment, knowledge, and sponsorship to achieve their full potential within the company. The company also supports the pursuit of higher education and provides up to $5,250 a year in financial assistance to eligible employees completing undergraduate and graduate level courses. CA Technologies also offers 15,000 online courses that employees can access. An adoption assistance program includes reimbursement of adoption-related expenses up to a maximum of $5,000 per child and $10,000 per family within a two-year period.

CA Technologies also aims to help working parents, so nearly 30 percent of the company’s North American employees participate in a full-time telecommuting or work from home program. The company also has Global Marketing and Finance associate rotation programs that were developed as a way to attract and develop entry level candidates and enable them to jump start their professional career with structured training programs, job shadowing, and access to mentors.

According to CA Technology’s VP of human resources, Beth Conway, the company is focused on fostering diversity both inside and outside the company.

“In addition to our efforts within the company, we’re also an active partner of the Anita Borg Institute for Women and Technology, a nonprofit organization dedicated to increasing the impact of women on all aspects of technology,” Conway said. “We also sponsor ABI’s annual Grace Hopper Celebration of Women in Computing conference in the U.S. and India. We’re dedicated to helping the leaders of tomorrow develop their talents and career paths by providing and encouraging a collaborative working environment.”

This question comes up frequently and is asked quite often by nurses, "Should I carry malpractice insurance?" Many nurses are covered under their own individual liability insurance carrier. Many more are not. I am.......... are you??

Nurses can be sued at any time, for any reason. Often, allegations brought against you are unfounded, but just being named in a lawsuit gives one pause and can be one of the most stressful times in your life. The nurse feels embarrassed and fears damage to a perfect reputation.

Your employer's policy may cover you, but only up to a point. Remember: Your employer's policy is created to fit their specific needs and protects them first.

You may even be told (by your employer HR) that you do not need your own policy. What they do not tell you is that they want you to be represented by their attorneys. They do not want "outside" representation for they know that their best interests will not be first and foremost. Carrying your own policy will ensure you personal attorney representation when you need it and this attorney will be concerned with only protecting YOUR needs and YOUR best interests.

All malpractice insurance policies have limits of liability. If you are only covered by your employer's insurance, other defendants employed at your entity may and probably do share your liability limits under the same policy. If you as well as others are named in a suit, your legal costs, including any settlement, could exceed your employer's shared liability limits. This would mean out-of-pocket expenses for you!!

The following are a few individual carriers:

    Nurses Service Organization (NSO) - www.nso.com - #1 carrier for Nurses with free online quotes
    www.hpso.com
    www.cnahealthpro.com
    www.cmfgroup.com
    Marsh Affinity - www.proliability.com
    www.seaburychicago.com - not in all States
    Liability insurance can also be purchased through CNA by going to the American Nurses Association website - www.nursingworld.org
    And, some Home Owners insurance policies will have stipulations for liability insurance.

It is up to the individual nurse how much liability to carry. $1,000,000/$6,000,000 coverage premiums are approximately $90/year in most States for the RN and $90/year for the LPN - NSO.


Another benefit of carrying individual coverage which extends beyond your employer's limits:

    License Protection

Many Carriers reimburse you up to a certain amount if you are defending disciplinary charges with your Board of Nursing (BON).


And, many policies also address the following (not all inclusive):

    libel
    slander
    charges of confidentiality violation
    assault on the job

So, do you carry your own individual liability insurance??

Small price to pay for peace of mind...