DiversityNursing Blog

Nurses are as diverse as the patients they treat.

But that diversity will become grayer for the next few years as more middle-age people are going into nursing as a second career.

That trend can be seen in the class that will graduate May 18 from Heartland Community College's two-year nursing program in Normal. Students graduate with an associate's degree in nursing and then may take the registered nurse licensing exam.

Non-traditional students — those who don't begin college right after high school — are the norm in Heartland's nursing program. But, in this class, none of the 40 students is a traditional student.

“I was pretty surprised when I started,” said second-year nursing student John Cook, 47, of Normal. “There was virtually no one right out of high school. I remember thinking that I'd be the oldest one in there by far and that's not the case.

“It's a huge cross-section of people with bachelor's degrees in other fields, including a lot of moms.”

Students begin clinical rotations at area hospitals and long-term care facilities during their first semester, said professor of nursing Barb McLaughlin-Olson. For every hour that they are in the classroom, in the lab and at clinical sites, they are expected to spend three hours on course work.

The nursing-as-a-second-career trend has been in place for several years, said Deb Smith, vice president and chief nursing officer of OSF St. Joseph Medical Center, Bloomington.

Some people who pursue nursing as a second career take advantage of accelerated, one-year nursing programs for people who already have a bachelor's degree, Smith said. For example, Illinois State University's Mennonite College of Nursing in Normal has an accelerated bachelor of science in nursing program.

Laurie Round, vice president of patient care services and chief nursing executive at Advocate BroMenn Medical Center in Normal, said the recession has driven some people from their original careers into nursing. Both ISU-Mennonite and Illinois Wesleyan University's School of Nursing in Bloomington reported an increase in enrollment last fall.

There is a demand for nurses because nurses work in hospitals, doctors' offices, businesses, insurance companies, long-term care facilities and churches. But second-career nurses also are drawn to the field for altruistic reasons, Smith and Round said.

“They want to do something that's meaningful,” Round said. “They want to touch peoples' lives.”

Middle-age adults going into nursing need to learn a career quickly and need to keep their energy level up.

Some middle-age adults are challenged by all the technology involved with patient care, Round and Smith said.

But the maturity and experience of second-career nurses generally makes up for any challenges.

“I love the energy, the intensity, the maturity and the decision-making skills that they bring to the field,” Round said. “These people are choosing nursing while raising a family and working at the same time and that shows perseverance, commitment and discipline.”

Second-career nurses not only come in with the experience of previous employment and raising a family. They also have social skills and because they are close in age to nurses already in the field — the average age of nurses is 47 — they fit in with other nurses quickly, Smith said.

McLaughlin-Olson said, “They can use their life experiences to help them become better nurses. Because they've lived through life's challenges, they've learned how to critically think when issues come up, and they have empathy and can relate to people having problems.”

But Smith and Round also are impressed with traditional nursing students, who graduate to enter nursing in their early 20s. They are intelligent, energetic and learn quickly, they said.

For that reason, both Round and Smith said middle-age, second-career nurses are not necessarily the new face of nursing.

“I see a great mix across generations,” Round said.

Adds Smith: “It's good to have people entering nursing with a variety of life experiences. That further enriches our profession.”

Having professional translators in the emergency room for non-English-speaking patients might help limit potentially dangerous miscommunication, a new study suggests.

But it hadn't been clear how well professional interpreters perform against amateurs, such as an English-speaking family member, or against no translator at all.

The current findings, reported in the Annals of Emergency Medicine, are based on 57 families seen in either of two Massachusetts pediatric ERs. All were primarily Spanish-speaking.
The research team audiotaped the families' interactions with their ER doctor. Twenty families had help from a professional interpreter and 27 had a non-professional. Ten had no translation help.

It's not clear why some families had no professional interpreter. In some cases, Flores said, there may have been no one available immediately. Or the doctor might not have requested an interpreter.

The findings suggest that professionals can help avoid potentially dangerous miscommunication between patients and doctors, according to Flores and his colleagues.
In one example from their study, an amateur interpreter -- a family friend -- told the doctor that the child was not on any medications and had no drug allergies. But the friend had not actually asked the mother whether that was true.

Cost questions

There are still plenty of questions regarding professional interpreters, according to Flores.
For one, he said studies are needed to compare the effectiveness of in-person professional translators versus phone and video translation services.

There are also questions about what type of translation help families and doctors prefer, and what's most cost-effective. Federal law may require many hospitals to offer interpreters, but it does not compel the government or private insurance to pay for them. Right now, some U.S. states require reimbursement, but the majority do not. So in most states, Flores told Reuters Health, "the hospitals and clinics, and ultimately the taxpayers (because of uncompensated/charity care), are left covering the costs." But the cost-per-patient can be kept down. One study found that when a group of California hospitals banded together to offer translators by phone and video, the cost per patient was $25.

As for national costs, Flores pointed to a 2002 report from the White House Office of Management and Budget. It estimated that it would cost the U.S. $268 million per year to offer interpreter services at hospitals and outpatient doctor and dentist visits.

Another issue is training -- including the question of how much is enough. In the current study, errors were least common when interpreters had 100 hours of training or more: two percent of their translation slips had the potential for doing kids harm. There are numerous training programs for medical interpreters nationwide. But few of them provide at least 100 hours of training, Flores noted.

As for hospitals, it seems that most do not offer their own training programs. And even when they do, the hours vary substantially, Flores said. Based on these findings, he and his colleagues write, requiring 100-plus hours of training "might have a major impact" on preventing translation errors -- and any consequences for patients' health.

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Have you ever used a translator as a nurse or as a patient? How did it go? What is the ideal training program?

Title: Confident Voices: The Nurses' Guide to Improving Communication & Creating Positive Workplaces

Author: Beth Boynton, RN MS

Amazon Review:

“Confident Voices is a "must read" for every nurse who has had conversations with peers, supervisors, physicians and health care providers that have ended badly or wanted a different outcome. Confident Voices is designed to negotiate health care in the 21st Century and for communicating in a way that leaves everyone feeling included and honored in the process of day-to-day discussions in getting the job done. Beth Boynton's book provides the nurse with conversation tools to navigate difficult situations and provides support and feedback to reframe the situation so all involved win. I appreciate all the work Beth Boynton did in writing this book and the necessity of clear, concise communications in this difficult period we are all facing in the health care today.”

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Have you read Confident Voices? What did you think of it? Has it helped you communicate at work?

Are you a nurse who uses an iPhone? The iPhone is especially useful for nurses who are mobile, as this tool can help you stay in touch with medical teams and patients’ needs. Additionally, many new apps have been developed for the iPhone that fit a nurse’s lifestyle and professional requirements. Why carry 15 tools around with you when one will do the work for them all? Many of the iPhone apps listed below are not open source or free. And, many require wireless networks to operate. But, when you consider the cost of the tools you might need to simulate these apps, the app may be worth the investment.

The apps below are linked either to download sites or reviews with a link to the download site. They are listed in alphabetical order, a methodology that shows we don’t favor one app over another.

1. A.D.A.M. Symptom Navigator: If patients are using this app, maybe you should, too – easily find out what to do about any symptoms. Learn self care, when to go to the doctor, and when it is an emergency.
2. Bishop’s Score Calc: This obstetric calculator is used to calculate Bishop’s Score, a score used to assess probability of impending delivery as well as expected success rate if labor is induced. Expectant parents may also find this of use in aiding their obstetrician in determining whether induction of labor is reasonable.
3. Bio Dictionary: Bio Dictionary covers most of general biological terms. Two methods are offered for searching, and terms and their explanations are audible!
4. Cockcroft: Calculate the estimated clearance of creatinine (eCcr) with the creatinine serum rate (in mg/dL or in micromol/L). Weight can be either in kilogram or in pounds.
5. Epocrates Rx: One of the few free iPhone apps, Epocrates Rx includes a drug guide, formulary information and drug interaction checker. This product also includes continual free updates and medical news. Plus, this app resides on your device so you can look for information without wireless connections.
6. Eponyms for the iPhone: Downloadable through the iTunes store and courtesy of Pascal Pfiffner, this app brings the beautiful eponym database from Andrew J. Yee to your iPhone or iPod touch.
7. Glucose Charter: Glucose-Charter is a blood glucose, insulin and medication recording app for any iPhone. Patients can self-monitor, nurses can use it to check patients.
8. iAnesthesia: Case Logs: iAnesthesia: Case Logs allows all anesthesia providers to easily create, manage and backup case logs quickly in the operating room, leaving you with more free time when not at work.
9. iChart: Keep track of patients through this personal medical assistant. It stores everything from patient data to charts and lists of medications in a streamlined, organized fashion.
10. In Case of Emergency (ICE): You may not always practice in a hospital setting. If not, this app can provide you with all the information you need to contact emergency services in your location.
11. iRx: iRx is a pharmaceutical reference tool to get FDA information on specific drugs. This application is currently in beta status, but is fully functional.
12. Lab Tests: This laboratory test database is broken up into categories including, Blood Bank, Clinical Chemistry, Coagulation, Hematology, Serology, Immunology, Tumor Markers, Urinalysis and Therapeutic Drugs. Reference ranges and notes on the clinical significance of the test are given when indicated.
13. Medical Reference: Why memorize medical terminology when you can look it up on your iPhone?
14. Mediquations: Mediquations for the iPhone and iPod Touch brings over 201 common medical calculations and scoring tools to your fingertips with the simplicity and elegance you expect out of an iPhone application.
15. MIM Radiology: The MIM iPhone Application provides multi-planar reconstruction of data sets from modalities including CT, PET, MRI and SPECT, as well as multi-modality image fusion.
16. Mosby’s iTerms Flash Cards for Medical Terminology: Mosby’s iTerms Flash Cards for Medical Terminology, the premier study guide for mastering the prefixes, suffixes, combining forms, and abbreviations used to build medical terms, is now available for the iPhone and iPod touch.
17. NCLEX-RN Medications: Nursing students can cram for their NCLEX exam with this app that will help you study medications and conditions.
18. Netter’s Anatomy Flash Cards: Using outstanding anatomical illustrations from Netter’s hugely popular Atlas of Human Anatomy (4th Edition), Netter’s Anatomy Flash Cards allows you to carry the bestselling reference for human anatomy on your iPhone or iPod touch.
19. Netter’s Musculoskeletal Flash Cards: Master the musculoskeletal anatomy and pathology you need to know with 210 flash cards.
20. Netter’s Neuroscience Flash Cards: Enhance your understanding of key neuroscience concepts with Netter’s Neuroscience Flash Cards for iPhone and iPod touch.
21. Nursing Central: Nursing Central is the complete mobile solution for nursing produced by Unbound Medicine. The app includes premier disease, drug and test information by and for nurses.
22. Pocket First Aid Guide: Do you panic when caring for several people at once? Get a grip with this iPhone app. This is a first-aid guide for your iPhone that will help you treat anything from beestings to burns to eye injuries while you are within range of the Internet.
23. ReachMD: The ReachMD CME iPhone application is an easy-to-use and fully accredited Continuing Medical Education tool that gives healthcare practitioners a convenient way to earn free CME credits through their iPhone or iTouch.
24. ScribbleDoc: If you can’t read the good doctor’s writing, perhaps this app can help. Use your iPhone to scan the problem and ScribbleDoc should convert the image to text.
25. Skyscape Medical Resources: Available from the iTunes Apps Store, this app offers Outlines in Clinical Medicine, Archimedes – Medical Calculator, RxDrugs: Drug Dosing Tool and MedAlert for free with their download.

1. Communication Skills

Solid communication skills are a basic foundation for any career. But for nurses, it’s one of the most important aspects of the job. A great nurse has excellent communication skills, especially when it comes to speaking and listening. Based on team and patient feedback, they are able to problem-solve and effectively  communicate with patients and families.

Nurses always need to be on top of their game and make sure that their patients are clearly understood by everyone else. A truly stellar nurse is able to advocate for her patients and anticipate their needs.

2. Emotional Stability

Nursing is a stressful job where traumatic situations are common. The ability to accept suffering and death without letting it get personal is crucial. Some days can seem like non-stop gloom and doom.

That’s not to say that there aren’t heartwarming moments in nursing. Helping a patient recover, reuniting families, or bonding with fellow nurses are special benefits of the job. A great nurse is able to manage the stress of sad situations, but also draws strength from the wonderful outcomes that can and do happen.

3. Empathy

Great nurses have empathy for the pain and suffering of patients. They are able to feel compassion and provide comfort. But be prepared for the occasional bout of compassion fatigue; it happens to the greatest of nurses. Learn how to recognize the symptoms and deal with it efficiently.

Patients look to nurses as their advocates — the softer side of hospital bureaucracy. Being sympathetic to the patient’s hospital experience can go a long way in terms of improving patient care. Sometimes, an empathetic nurse is all patients have to look forward to.

4. Flexibility

Being flexible and rolling with the punches is a staple of any career, but it’s especially important for nurses. A great nurse is flexible with regards to working hours and responsibilities. Nurses, like doctors, are often required to work long periods of overtime, late or overnight shifts, and weekends.

Know that it comes with the territory. The upside is that a fluctuating schedule often means you’re skipping the 9 to 5, cubicle treadmill. Sounds perfect, right? Run errands, go to the movies, or spend time with the family — all while the sun still shines!

5. Attention to Detail

Every step in the medical field is one that can have far-reaching consequences. A great nurse pays excellent attention to detail and is careful not to skip steps or make errors.

From reading a patient’s chart correctly to remembering the nuances of a delicate case, there’ s nothing that should be left to chance in nursing. When a simple mistake can spell tragedy for another’s life, attention to detail can literally be the difference between life and death.

6. Interpersonal Skills

Nurses are the link between doctors and patients. A great nurse has excellent interpersonal skills and works well in a variety of situations with different people. They work well with other nurses, doctors, and other members of the staff.

Nurses are the glue that holds the hospital together. Patients see nurses as a friendly face and doctors depend on nurses to keep them on their toes. A great nurse balances the needs of patient and doctor as seamlessly as possible.

7. Physical Endurance

Frequent physical tasks, standing for long periods of time, lifting heavy objects (or people), and performing a number of taxing maneuvers on a daily basis are staples of nursing life. It’s definitely not a desk job.

Always on the go, a great nurse maintains her energy throughout her shift, whether she’s in a surgery or checking in on a patient. Staying strong, eating right, and having a healthy lifestyle outside of nursing is important too!

8. Problem Solving Skills

A great nurse can think quickly and address problems as — or before — they arise.

With sick patients, trauma cases, and emergencies, nurses always need to be on hand to solve a tricky situation. Whether it’s handling the family, soothing a patient, dealing with a doctor, or managing the staff, having good problem solving skills is a top quality of a great nurse.

9. Quick Response

Nurses need to be ready to respond quickly to emergencies and other situations that arise. Quite often, health care work is simply the response to sudden incidences, and nurses must always be prepared for the unexpected.

Staying on their feet, keeping their head cool in a crisis, and a calm attitude are great qualities in a nurse.

10. Respect

Respect goes a long way. Great nurses respect people and rules. They remain impartial at all times and are mindful of confidentiality requirements and different cultures and traditions. Above all, they respect the wishes of the patient him- or herself.

Great nurses respect the hospital staff and each other, understanding that the patient comes first. And nurses who respect others are highly respected in return.

Many researchers have studied patient--provider communication and documented the tensions and misunderstandings often seen in this important process. But these concerns are far greater when the patients are minorities or don't understand English well, and when healthcare providers aren't equipped to explain the intricacies of care to people whose cultural beliefs may make American medicine a mystery.

Award-winning filmmakers Maren Grainger-Monsen, M.D., and Julia Haslett explore these issues in a series of films called Worlds Apart, which document the experiences of minority Americans and patients from other countries in the U.S. health care system. This unique project, made with partial support from The Commonwealth Fund, dramatizes communication between patients and their doctors, tensions between modern medicine and cultural beliefs, and the ongoing burdens of racial and ethnic discrimination.

In this film, Alicia Mercado, a 60-year-old Puerto Rican woman, struggles to keep up with her chronic diabetes, hypertension, and asthma after being evicted from her apartment and suffering depression.

For more information on these films, please visit The Commonwealth Fund website at www.cmwf.org