DiversityNursing Blog

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

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