DiversityNursing Blog

From Advance for Nurses

When a patient enters a hospital, she enters an alien environment. 

Her personal things, even her clothes, are set aside. She is given to wear a billowy gown that is not merely unflattering but starkly revealing if one's free hand isn't vigilant about keeping it cinched.

Inside this linoleum landscape of wheelchairs and rolling beds, where strangers in scrubs politely jab and weigh and probe her, the only haven that offers her a modicum of quiet in which to gather her thoughts and to reclaim herself, to semi-relax, to take stock, or just to escape into the beams of an innocuous sitcom floating overhead - the only personal space in this impersonal world is that humble but all-important retreat, the patient room.

Respecting the sanctity of the patient room is the first lesson Pam White, RN, gives when teaching the basics of relationship-based care (RBC).

"When I talk to nurses, I tell them 'We all have busy lives taking care of many patients, but before you walk across the threshold of a patient's room, pause, take a deep breath, let other things go and prepare to focus on that patient's needs,'" said White, director of nursing administration at Mayo Clinic Health System in Eau Claire, WI. "I always reinforce the need for them to reintroduce themselves to each patient every time they enter the room."

RBC - a philosophy based on honoring and respecting your relationship with your patients, your co-workers and yourself - is fast emerging as the care delivery model of necessity.

Experts say respecting patients will become more and more important as healthcare adopts its new culture of accountability. Reimbursement will hinge, in part, on patient satisfaction.

A Way of Being

RBC as a concept appeared in 2000 and coalesced in 2004 with the publication of Relationship-Based Care: A Model for Transforming Practice by Creative Health Care Management Inc., Minneapolis.

"It's a model, a philosophy, a framework and a way of being," said Mary Koloroutis, RN, who co-authored and edited that text. "RBC creates a methodology for aligning values and operations within a healthcare system so clinicians can establish relationships with patients," Koloroutis explained. 

Finding time to develop relationships with patients isn't easy for nurses, though. 

"Time is a nurse's greatest challenge," Koloroutis acknowledged. 

"You are dealing with large volumes of patients with highly complex medical needs," she said. "We don't have a long time to spend with a patient. It could be just 5 minutes at the bedside to learn about the person and plan their care."

However short, interpersonal time with patients is crucial for a successful outcome. 

"The role of the primary nurse is to understand who this patient is, and what it will take to prepare her and her loved ones to take ownership for her own care after discharge," Koloroutis said.

Family members "will be the village surrounding the patient, so they need to be every bit as supported as the patient is," she added. 

"The likelihood that a plan of care will be followed increases with their learning and understanding."

HCAHPS Survey

Communicating with patients is becoming as vital as vital signs. Officials from the Center for Medicare & Medicaid Services care so much what patients think they instituted the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

HCAHPS asks patients to rate their hospital stays on a scale of one to five through a series of questions such as: How well did doctors and nurses communicate with you? How well was your pain managed? How clean was the hospital? How quiet?

"As of 2013, there will be reimbursement attached to HCAPS scores, so this is a strong push right now and part of why the patient experience is so potent and important," Koloroutis said.

ThedaCare, an integrated care delivery system in northeastern Wisconsin, increased its patient satisfaction scores by working with a firm called Simpler Consulting to adopt Toyota-inspired "lean" initiatives to streamline its processes and allow nurses to spend more time with patients.

For example, it implemented a variation of a Toyota production strategy called "kanban," so nurses have all the supplies they need at their fingertips.

"We have designed patient rooms so that 90 percent of all nursing supplies are stocked by a central stocking person, using the kanban system," said ThedaCare CEO Emeritus John Toussaint, MD. "Nurses are at the bedside nearly all the time. Medications are delivered directly to rooms in portable supply cabinets called nurse servers. There are no central nursing stations. They've all been eliminated."

Thanks to such changes, 95 percent of ThedaCare patients in 2011 gave top approval ratings when asked to assess their stay.

Eye-to-Eye Care

More time spent at the bedside "brings you to the heart of nursing," declared White, who instructs her nurses to sit down when interacting with patients.

"We typically stand up and over a patient," she said. "But research shows if you sit down and speak with them eye-to-eye, patients feel you spend more time with them - even if the amount of time you spend is the same."

She continued: "As a nurse, my needs for the patient are important, but they may differ from the patient's needs. For example, patients need to walk so many times a day, take so many pills. But those are not necessarily the goals of patients. We determine those goals simply by asking them. They could say 'I would like my hair washed,' or 'I would like to call my granddaughter.' Those things are important to them."

For hospitals thinking about instituting RBC, Koloroutis had this advice:

"Recognize that transformation is not a quick fix. It is a cultural evolution. Some aspects of RBC are already alive and well in every organization. Use them and build on that success. Commit to a 3-5 year process."

Healthcare workers, she concluded, "can grow weary of hearing about new programs. They'll ask, 'Is this another flavor of the month?' I say no. This is a way to get back to the basics, back to the care and service of patients."

From nursetogether

Everybody deals with fear and anxiety, however sometimes our anxieties can get the best of us.  Here are 6 tips on stress management and anxiety management in nursing to help you manage your daily challenges easily.

1.    Find a diversion  Often times, nurses get stressed when there is a lot going on all at once, particularly in the workplace. When this happens, take a deep breath and try to find something to do for a few minutes to get your mind off of the problem. You could take a walk, listen to some music, read the newspaper or do an activity that will give you a fresh perspective on things – when time permits.

2.    Positive affirmations work  Another technique that is very helpful is to have a small notebook of positive statements that make us feel good. Whenever you come across an affirmation that makes you feel good, write it down in a small notebook that you can carry around with you in your pocket. Whenever you feel anxious, open up your small notebook and read those statements.

3.    Take it one day at a time  In dealing with your anxieties, learn to take it one day at a time. While the consequences of a particular fear may seem real, there are usually other factors that cannot be anticipated and can affect the results of any situation. We may be ninety-nine percent correct in predicting the future, but all it takes is for that one percent to make a world of difference.

4.    Find gratitude   Sometimes, we can get depressed over a stressful situation. When this happens, take a few minutes to write down all of the things that you are thankful for in your life. This list could include past accomplishments and all the things that you have taken for granted. The next time you feel depressed, review your list and think about the good things that you have in your life.

5.    Think positive  Challenge your negative thinking with positive statements and realistic thinking. When encountering thoughts that make you fearful or anxious, challenge those thoughts by asking yourself questions that will maintain objectivity and common sense.

6.    Divide and conquer  When facing a current or upcoming task that overwhelms you, divide the task into a series of smaller steps and then complete each of the smaller tasks one at a time. Completing these smaller tasks will make the stress more manageable and increases your chances of success.I know that anxieties and stresses can be difficult to manage, particularly for nurses; however, there are many helpful resources available. Managing stress and anxiety in nursing does take some practice but eventually you will improve in time.

From RNCentral.com

I love my computer. I drag it and my iPhone almost everywhere, including to the NANDA-I Conference I attended last week. I take notes while listening to speakers, I use my phone or my digital camera to record the slides the experts use in their presentations, I post conference updates on Twitter and Facebook, and I bring it all together for this blog. I live an e-life it seems.

This is important because it has a direct bearing on healthcare, nursing, and as it would seem, nursing language (what NANDA-I uses to define “the knowledge of nursing”). My vocabulary enlarged last week as I learned a new word, some new phrases, and some new perils to look out for when I am working at the hospital.

E-Iatrogenic

We should all know that “iatrogenic” means “of or relating to illness caused by medical examination or treatment.” One of the terms we see a lot these days is “HAI” or “hospital acquired infection.” This, along with other illnesses and injuries, which happen as a result of other medical care, are no longer being paid for by the Center for Medicare and Medicaid Services (CMS) or by most insurance companies. And, there is new area of concern of which we must be aware: E-iatrogenic issues.

In the simplest way I can explain it, all the computers we’ve come to rely on in healthcare have their own perils and we are really starting to see evidence of that.

Elizabeth Borycki, RN, PhD, is an assistant professor of health information science the University of Victoria, in British Columbia, Canada. While attending NANDA-I she presented a paper on identifying and reducing “technology-induced errors” (one of those new phrases) or e-iatrogenic.

Technology-induced errors are errors that arise from the design and development of technology and the implementation and customization of that technology. In 1995 the U.S. Institute of Medicine endorsed the use of electronic health records (EHRs) as an intervention that could reduce errors. Healthcare organizations around the world ran with it and some follow-up studies reported the systems could replace the number of errors happening each year.

However, 10 years later, journal articles started publishing findings that described how EHRs and component software systems could, in themselves, lead to errors. Some of the types of errors Borycki highlighted included automatic defaults, incorrect medication dosages, and incorrect patient data. She cited some of the factors involved in these technology-induced mistakes:

• Human factors including usability and workflow.
• Organizational behavior such as socio-technical issues and system/organizational fit.
• Software engineering including testing approaches.

While chatting with Borycki, after her presentation, we noted several ways these errors happen to all of us. For example, you put in some data but forget to hit return and “oops,” the patient’s last set of vital signs don’t actually get recorded. Or the drop down box you have to pick from auto-populates an answer if you don’t pick one, or something unusual happens and there is no free-text box to record the event—all of these are situations I’ve actually dealt with as hospital’s I’ve worked in become more automated. These are all potential patient safety issues.

And this brings us to why Borycki presented at NANDA-I. Borycki and her fellow researchers believe that we need to extend the NANDA-I taxonomy to include the emergence of these new patient safety issues. That is, technology-induced errors arising from the widespread implementation of health information systems. We need some new nursing diagnoses.

According to Borycki, examples of potential interventions include:

• Reporting if computer system is not working or is malfunctioning.
• Reporting if computer system causes hazards due to inefficiencies or negatively affects workflow.
• Awareness of limitations of computer systems in nursing.
• Questioning computer generated results that may not appear to match the right patient.
• Recognizing problems in dangerous “work-arounds” due to technology.
• Training on how to proceed in situations where a computer system goes down or is not available.

Nurses I have worked with come from many camps. Some like charting electronically, some miss paper charting (although there are error problems there too) and some want EMRs to work but don’t trust the systems. The reality is EMRs and electronic charting are here to stay. It is our job as nurses to get involved, to point out where entries could be more efficient or easier to use, to learn more about the systems we are given and use every day and to be proactive in finding the best possible means for using them. For that, we need a language because it all comes back to standardized communication techniques are the best ways to keep our patients safe—our primary concern as RNs. NANDA-I has a new challenge, defining the e-knowledge of nursing.

From Nurse.com

Alisa Glaister, RN, credits her opportunity to ascend from new grad to nurse manager to a few key colleagues, including a director from a different unit who advised her as she led a project to treat angioplasty patients on the telemetry floor. “He helped me get my foot in the door for this project, which I believe has led to my current management position,” said Glaister, a nurse manager at St. Mary’s Medical Center in San Francisco.

Glaister met with her mentor weekly to discuss techniques of effective leadership. “He was a tremendous help and guide,” she said. 

Mentoring has gained considerable respect as an essential element for training new nurses, whether they’re fresh out of school or recently transferred from another unit. “The first year [out of school] you have those vulnerable moments all the time, and you forget what you have accomplished,” said Hazel Curtis, RN, BSN, MPH, an education specialist for staff development at Loma Linda (Calif.) University Medical Center. “A great mentor picks you up, dusts you off, gives you a pat on the back and says, ‘You can do it.’” 

Going one on one

Formal mentoring programs hatched in professional associations and hospitals are popping up around the country as researchers and managers find the practice boosts a nurse’s job satisfaction and confidence. 

Cecelia Gatson Grindel, RN, PhD, CMSRN, FAAN, studied the outcomes of Nurses Nurturing Nurses (N3), a mentoring program designed by the Academy of Medical-Surgical Nurses. The year-long program was rolled out to 40 medical institutions across the country in 2002. Grindel, a professor and interim dean at Georgia State University in Atlanta, said data she could gather indicated more than 90% of mentored nurses stayed on the job, compared to attrition rates as high as 30%. Feedback collected throughout the pilot year of the program suggested mentored nurses had more job satisfaction and confidence. 

Yvonne Brookes, RN, director of clinical learning at Baptist Health South Florida in Miami, found similar results after implementing a residency program that included a mentorship component. Previously, turnover among the system’s 4,000 nurses averaged 22%, often because new graduates left the profession or pursued an advanced degree after their first year. Since implementing the program in 2007, the new graduate turnover rate dropped to 6%, she said.

“We realized it wasn’t about the science, it was all that other stuff that goes to the head of a new grad,” she said. 

“Other stuff” can range from implementing unit procedure to dealing with difficult managers or unhelpful preceptors. It can be conflict with patients or their families dealing with the shock of witnessing a death for the first time. “Sometimes you just need to vent,” Brookes said.

A mentor also can help a nurse recover from making a medical error — a potentially traumatic experience — by offering emotional support and emphasizing that one mistake doesn’t make a bad nurse. 

Choosing teams

Matching the mentor who responds to help with complaints, concerns, self-doubts and errors with the nurse who needs to share them is somewhat hit and miss in formal mentorship programs. Both parties have to accept the relationship takes time — not an easy pill to swallow in today’s intense work environment.

N3 guidelines advised managers to look for someone with three- to five-years of experience in the same field who worked outside the nurse’s unit. In a new mentoring program at St. Mary’s, nurse managers help match personalities and proximity, among other factors, Glaister said. “We really take into consideration who we’re matching with whom,” she said.

At Baptist Health, the process was more intuitive, Brookes said. Mentors and mentees gathered in one room to talk one on one and then rotated until every mentee had met every mentor. “It’s sort of a speed-dating situation to find a mentor that will work for you,” she said. 

Programs across institutions vary, but the time commitment can range from trading a text message or two per month to having biweekly meetings for one year. Since many new nurses are assigned to the night shift, a good deal of these conversations happen in the evening. But meetings also can be irregular or precipitated by emergent situations, said Abigail Mitchell, RN, DHEd, MSN, a professor at D’Youville College, Buffalo, N.Y., and a nursing supervisor at Kaleida Health, Buffalo, N.Y. “If they’re in crisis, you have to handle it,” said Mitchell, who runs a private mentoring firm. “You can’t just say, ‘It’s not our date to meet.’”

Generation gaps can present challenges in mentor-mentee relationships. For instance, younger nurses are often more comfortable communicating through texting and email. Nurses from the baby-boomer generation are sometimes reluctant to mentor the next generation. “The work ethic is different,” Mitchell said. Boomers will pick up extra time or stay over their shift to help coworkers, while some younger-generation nurses rather go home and pick up extra hours when it works for them, around holidays, for example, she said.

Sometimes the mentor-mentee relationship just doesn’t work out, but that doesn’t necessarily mean mentoring didn’t work. Anecdotal evidence from the N3 program indicated nurses who’d been assigned a mentor were likely to seek out another if the first relationship wasn’t helpful. Managers also have noticed that mentored nurses go on to mentor their junior colleagues. “The process has fed on itself,” Brookes said. “The more professional their approach, the more they want to contribute to the next group coming in.”

The program’s success has inspired Brookes to extend the model to other levels of the profession. A med/surg nurse with 15 years experience still needs guidance when transferring to a different unit, like critical care, she said. She is mentoring four managers to help them ease into their new roles. “They’re degreed up to the caboozle, but that doesn’t mean they know whom to reach out to,” Brookes said.

At this level, mentoring is more about handling people and situations than about patients and skills. Healthcare management involves evaluating staffing ratios, managing human and fiscal resources and strategic planning. Sometimes advice is just practical: a nurse manager would do well to keep a pressed blazer in the office closet, for example. 

Recently, Curtis convened a small mentor circle for managers. The new managers come together about once a week to ask questions and hear presentations on broad topics of interest, such as the hospital culture. The program has boosted their confidence, she said. 

Educating educators

Academia, too, reaps benefits from mentoring. Shellie Bumgarner, RN, MSN, CEN, EMT, a clinical educator at Lenoir-Rhyne University School of Nursing in Hickory, N.C., sought help to implement an education day for nurses at a small rural hospital. 

She found a mentor at the 2010 national convention of the Emergency Nurses Association, which had started EMINENCE (Establishing Mentors InterNationally for Emergency Nurses Creating Excellence) in 2008. The pair worked together for one year, talking about once a month and trading emails frequently. 

Her mentor helped her with the substance of her topic, which focused on pediatric care in smaller, rural facilities. She also contributed creative ideas to help Bumgarner find a way to cover the shifts of nurses who attended her training. “She advised how to tweak my ideas to better fit the smaller hospital,” she said. 

Retention of nursing faculty is as urgent as the need for unit staff, as professors leave academia for higher paying jobs. The National League for Nursing, which focuses on nursing education, released “The Mentoring of Nursing Faculty Tool Kit” to promote recruitment and retention of nurse faculty (available online at NLN.org/facultydevelopment/mentoringToolkit/index.htm). 

Beyond orientation, mentoring faculty includes the development of teaching and research skills. 

Mitchell has started her own mentoring program targeting faculty. Managing workload and outlining governance procedures are primary topics, she said.

The idea may be slow to grow, but more nurses at all levels are realizing the importance of mentoring, said Brookes. Is it a widespread practice? “No,” she said. “But it should be.”

From SouthtownStar via Chicago Sun-Times

Ray Mendez’s first year of medical school at Loyola University has ended, but there’s no slacking off on his “to-do” list.

Next up is “effect social change.”

Mendez, 26, of Palos Heights, recently was selected for an Albert Schweitzer Fellowship, a program in which fellows design community health initiatives. Mendez was one of just 31 Chicago-area candidates selected.

“This may be one of the most important things I’ve ever done,” Mendez said. “As important as medical school.”

The fellowship, a yearlong program, is designed to develop leaders in community health and give students in health-related fields a unique social and economic perspective on issues they may face as professionals. Recipients can be from a variety of fields, but they have a common goal to improve some aspect of health care in the Chicago area.

“Every fellow creates his own program, and we have to put in 200 hours of work toward it over the next year,” Mendez said.

The projects are varied, ranging from putting together a music therapy program for refugee and immigrant children to one that will provide preventative health care for the homeless.

Mendez’s goal is to increase the presence of minorities in the health care profession.

“There’s an acute (lack of) representation of minorities in the health care field. Less than 9 percent of all physicians are black or Latino, and less than 7 percent for nurses, while they make up 28 percent of the U.S. population,” Mendez said.

He said this is significant because there’s a direct link between low minority representation and a lack of health care support for those minorities.

“One of the most important aspects of the program is making sure students stay in touch afterward so that when they succeed and get out of their communities, they can come back and uplift those same communities,” Mendez said.

He hopes to achieve his goal by expanding on an existing Loyola program that works closely with some Chicago-area high schools. He plans to use motivational speeches, activities and an immersion program with the Loyola School of Medicine to introduce students to the field and to encourage them to pursue careers in health care.

A visit to Cristo Rey Jesuit High School in Chicago as part of a social justice class he took convinced him that putting the idea into action is necessary.

“When I went to Cristo Rey and saw how enthusiastic the students and teachers are about going to school, I thought, ‘Wow, this is what needs to be done,’ ” Mendez said.

As a Latino student, he has realized the difficulty a minority can face pursuing a career in health care.

“I definitely didn’t have a lack of educational opportunities in Palos, but when I was applying to medical schools, it was still really hard. I didn’t have a mentor to look up to and to guide me through the process,” he said.

He said he didn’t understand why more minorities were not applying to medical school, and he feels like it is his responsibility to help change that. So after some reflection and research, he applied for the Schweitzer Fellowship.

“I feel I have the power and time to do it,” Mendez said.

He said he’s prepared for the challenge of balancing medical school and his fellowship work. He said he’s dropped a few extracurricular activities.

“It’s gonna be tough definitely, but I’ve created a pretty good support network of friends who are really interested in this project,” he said. “So I think I can handle it.”

From PRNewswire

Academic Program is First of Its Kind

ATLANTA, May 30, 2012 /PRNewswire/ -- Morehouse School of Medicine today announced the creation of an endowed academic chair devoted to issues related to sexuality and religion.  The Marta S. Weeks and David E. Richards Endowed Chair in Sexuality and Religion will develop innovative health and pastoral services as well as teaching, research and public leadership related to issues that bridge the topics of sexuality, religion and medicine.

"Through this unique chair, Morehouse School of Medicine will provide national and international leadership addressing the challenges of sexuality and sexual health in the worlds of medicine and religion," said David Satcher, M.D. Ph.D., 16th Surgeon General of the United States and founder of Morehouse School of Medicine's Satcher Health Leadership Instituteand its Center of Excellence for Sexual Health.

The Marta S. Weeks and David E. Richards Endowed Chair in Sexuality and Religion is a major accomplishment of more than a decade of work by Satcher, who in 2001 released the Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior. That document outlined a framework of initiatives to strengthen the national dialogue on sexual health. It recognized that sexuality and religion are deeply connected in the United States and that public health would benefit from coordinated efforts of leaders in public health and religion as well as other major constituencies with deeply held beliefs relating to sexuality.

"While the chair will address sexual health issues in all communities, it will place a particular emphasis on underserved populations which is integral to Morehouse School of Medicine's mission," added Satcher. "The continuing disparities in access to quality health care services for minorities, poor people, and other disadvantaged groups results in a weakened public health infrastructure, which ultimately affects everyone."

The endowed chair will focus its efforts on:

• Teaching sexuality and sexual health topics to current theological and medical students;
• Training the next generation of religious and healthcare leaders to meet the sexual health challenges of  both disciplines;
• Bringing together leaders of constituency organizations that have diverse viewpoints for consultations and consensus-building;
• Research directed toward documenting and suggesting ways to overcome disparities in sexual health with a special focus on underserved communities.

For more information on Morehouse School of Medicine and the institution's latest endowed chair in sexuality and religion, please visit www.msm.edu.

From The Associated Press via SouthCoastToday.com

A visit to the emergency department or a physician's office can be confusing and even frightening when you're trying to digest complicated medical information, perhaps while you're feeling pain or discomfort. For the 25 million people in the United States with limited English proficiency, the potential for medical mishaps is multiplied.

A trained medical interpreter can make all the difference. Too often, however, interpreter services at hospitals and other medical settings are inadequate. Family members, including children, often step in, or the task falls to medical staff who speak the required language with varying degrees of fluency.

According to a study published in March, such ad hoc interpreters make nearly twice as many potentially clinically significant interpreting errors as do trained interpreters.

The study, published online in the Annals of Emergency Medicine, examined 57 interactions at two large pediatric emergency departments in Massachusetts. These encounters involved patients who spoke Spanish at home and had limited proficiency in English.

Researchers analyzed audiotapes of the visits, looking for five types of errors, including word omissions, additions and substitutions as well as editorial comments and instances of false fluency (making up a term, such as calling an ear an "ear-o" instead of an "oreja").

They recorded 1,884 errors, of which 18 percent had potential clinical consequences.

For professionally trained interpreters with at least 100 hours of training, the proportion of errors with potential clinical significance was 2 percent. For professional interpreters with less training, the figure was 12 percent. Ad hoc interpreter errors were potentially clinically significant in nearly twice as many instances — 22 percent. The figure was actually slightly lower — 20 percent — for people with no interpreter at all.

It makes sense that trained interpreters, especially those with more experience, would make fewer errors, says Glenn Flores, a professor and director of the division of general pediatrics at UT Southwestern Medical Center and Children's Medical Center of Dallas, who was the study's lead author. Experienced interpreters "know the medical terminology, ethics, and have experience in key situations where you need a knowledge base to draw on," he says.

Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race, color or national origin. Courts have interpreted that to mean that all health-care providers that accept federal funds — because they serve Medicare and Medicaid recipients, for example — must take steps to ensure that their services are accessible to people who don't speak English well, according to the National Health Law Program, a nonprofit that advocates for low-income and underserved people. (Doctors whose only federal payments are through Medicare Part B are exempt from this requirement, however.) The Census Bureau estimates that nearly 9 percent of the population age 5 or older has limited English proficiency, which the bureau defines as people who describe themselves as speaking English less than "very well."

Hospitals and other medical providers are in a tough spot, say experts. The law prohibits them from asking patients to pay for translation services, and they may not receive adequate or in some cases any other reimbursement. "It's a civil rights law, not a funding law," says Mara Youdelman, managing attorney in the Washington office of the National Health Law Program.

A dozen states and the District of Columbia reimburse hospitals, doctors and other providers for giving language services to enrollees in Medicaid, the joint federal-state program for low income people, and in CHIP, a federal-state health program for children, according to Youdelman. Virginia and Maryland do not.

A 2008 survey by America's Health Insurance Plans, an industry trade group, found that 98 percent of health insurers provide access to interpreter services, but providers and policy experts question that figure. According to a survey by the Health Research and Educational Trust, in partnership with the American Hospital Association, 3 percent of hospitals received direct reimbursement for interpreter services, most of that from the Medicaid program.

"Most hospitals that make this a priority make it a budget item," Youdelman says.

Hospitals and other providers realize that offering competent interpreter services can help ensure that they don't miss or misdiagnose a condition that results in serious injury or death, experts say. Trained interpreters can also help providers save money by avoiding unnecessary tests and procedures.

Youdelman cites the example of a Russian-speaking patient in Upstate New York who arrived at an emergency department saying a word that sounded like "angina." The emergency staff ran thousands of dollars' worth of tests, thinking he might be having a heart attack. The real reason for his visit: a bad sore throat.

Like many hospitals, Children's Medical Center of Dallas provides interpreter services around the clock via varying modes of communication — face-to-face, telephone and video — delivered by a mix of trained staff interpreters and outside contractors.

When Nadia Compean, 23, was six months pregnant, her doctor in Odessa, Texas, told her that her baby had spina bifida, a condition in which the spinal cord doesn't close properly, leading to permanent nerve and other damage.

The local hospital wasn't equipped to handle the birth and subsequent surgery that her daughter would require, so Nadia and the child's father traveled to Dallas, about 350 miles away.

Neither speaks much English, but at Children's Medical Center of Dallas, interpreters helped them understand what to expect, Nadia said (through an interpreter).

Nadia says she learned that her daughter, Eva, would be born with a lump on her back and would require immediate surgery. She also learned about problems that Eva may experience walking and using the toilet, she says.

Eva was born March 6. Because of her medical needs and the lack of adequate interpreter services in Odessa, the couple is considering relocating to Dallas, where the father hopes he can find construction work.

This column is produced through a collaboration between The Washington Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.

From Becker Hospital Review

Cultural and gender diversity is a laudable goal, especially for organizations' C-suites, which have traditionally lacked variety in this respect. Many healthcare leaders associate a diverse leadership team with improved patient satisfaction, more successful decision-making, achieved strategic goals, better clinical outcomes and stronger financial performance. Yet, despite the beneficial connections, only about 25 percent of healthcare leaders feel minority executives are well-represented in their organization's management, according to a recent WittKieffer survey.
There seems to be a paradox within healthcare, an antinomy in which executives uphold diversity as a business value, yet fail to ensure its personification in their own team or board. Only 15 percent of professionals felt the diversity gap in healthcare leadership has closed, according to the survey, suggesting a considerable amount of work remains.
So why do CEOs talk-the-talk but slow down when it comes time to walk-the-walk? "You know as well as I the many demands on our health system right now. There are many boards and CEOs who are spiritually and strategically committed to this work, but they have so much on their plate," says Jim Gauss, chairman, Board Services Practice at Witt/Kieffer. "[Diversity] has to fit in the larger context of a health system's or hospital's business case," he says.
Here are five points on how a diverse leadership team, aside from being right in principle, is beneficial for a healthcare organization's business, and three best practices for organizations bolstering their diversification efforts.

Five ways leadership diversity connects to health system or hospital business strategy:

1. Improved patient satisfaction. Roughly 62 percent of healthcare leaders believe cultural differences among healthcare leadership can improve the patient experience. A culturally diverse board and executive team can enhance an organization's public image and improve credibility. A good rule of thumb - and effective conversation-starter - is to compare a hospital's board and leadership team to the population it serves. "The best organizations are doing this: putting mirrors up to themselves and asking if they really reflect the communities they serve," says Mr. Gauss.
2. More vetted decision-making. Sixty-five percent of healthcare CEOs believe understanding cultural differences support successful decision-making, according to the survey. In this realm, the term "diversity" not only refers to demographic attributes, but also diversity in thought, education and skills. "I'm working with boards to bring in diversity of thought and perspective, first and foremost," says Mr. Gauss. "It doesn't always mean we're talking about diversity in the narrow sense."
3. Accomplishment of strategic goals. About 54 percent of healthcare professionals agree that diversity in recruiting allows their organization to reach their strategic goals. A difference in perspectives and cultural understandings unveils new angles for organizations to explore when setting strategic goals, planning for how they will be reached and how they will affect various components of the delivery system and communities served.
4. Improved clinical outcomes. Healthcare systems that have textured and varied understandings of patients' ethnic backgrounds, linguistic needs and other cultural perspectives are associated with more competent care and better clinical outcomes. Forty-six percent of healthcare professionals believed diversity in leadership leads to improved clinical outcomes, according to the survey.
5. Improved bottom line. Nearly 40 percent of survey respondents indicated a diverse leadership team is more likely to improve a healthcare organization's bottom line, due in part to the combination of values previously listed - better outcomes, improved efficiency, greater patient satisfaction and enhanced credibility. "It may still be a few years away before this becomes abundantly clear, but I'd say you'll see a lot more people on the financial side of the house paying attention to [diversity]," says Mr. Gauss.

Three best practices for hospital diversification efforts:

1. Infiltrate values of diversity throughout the entire organization. It's one thing to recruit diverse candidates to a healthcare organization's board and management, but the hard work lies in instilling the value throughout every level of the organization's culture. Some organizations have been successful at this, and Mr. Gauss says those hospitals and health systems are now held in high esteem among healthcare professionals. "Those are 'magnet' organizations for diverse candidates - those that do good work are then sought out by diverse candidates," he says.
2. Rally support from the board and C-suite. The organizations Mr. Gauss deemed most successful in diversifying their leadership are those that aggressively planned programs and goals around the effort. CEOs and boards can solidify ideas and goals about diversity and make them a successful business strategy. "I think the most fundamental issue of all is that those organizations that do the best work in this area undoubtedly have strong board and CEO support," says Mr. Gauss. "Without proper CEO and board support, a lot of things don't happen."
3. Consider what works best for other organizations. Not all diversity initiatives are successful. In the survey, only 37 percent of respondents said their organization's cultural sensitivity programs were effective, whereas 94 percent of respondents agreed that mentoring programs were an effective best practice to cultivate organizational diversity. Diversifying a leadership team or culture can take three to five years as it is, leaving little time or space for hamstrung initiatives. Other practices respondents deemed effective in the survey include seeking ways to move individuals from college and/or healthcare jobs to healthcare administration; obtaining employee feedback on diversity efforts; developing ongoing minority leadership training programs; and networking with diversity organizations.

from USA Today

COCOA BEACH, Fla. -- Yvonne Yacoub has been a nurse for half a century.

In 50 years, she has seen her profession redefine itself to meet the challenges of change, yet continue to struggle with shortages of new practitioners.

Yacoub, 72, who has worked at Cape Canaveral Hospital here for 36 years, is decades older than the 46-year-old average age of employed registered nurses. Some veteran nurses continue to work, but many more have hung up the scrubs for good or are counting the days until retirement.

"In several years, we will see many nurses semi-retire or retire completely," said Bonnie Rudolph, vice president/chief nursing officer for Holmes Regional Medical Center in Melbourne, Fla., and Health First's chief nursing officer. "Nursing is a very physical job, and many nurses cannot continue to stand, lift patients and continue to work the required shifts."

As baby boomers age, the need for nurses will increase. Even though the number of licensed registered nurses in the United States has grown from 1.7 million in 1980 to 3.1 million today, the total is not enough to meet the expected demand. Registered nurses remain at the top of the list when it comes to employment growth, so hospital systems are being proactive in trying to retain older employees.

Recruiting more male nurses, now only 7 percent of the work force, could help ease the shortage.

Most male nurses, such as baby boomer Jim Carberry, a nurse supervisor in the intensive care unit at Holmes, enter the field as a second career. Carberry was a respiratory therapist for 20 years before becoming a nurse.

"I wouldn't say it's harder to be a nurse today. It's just different," Carberry said.

"With so much specialty nursing, we all have had to learn so many new ways of doing things," he said. "It's not just one nurse doing all of a patient's care in a day. It can be several with special skills."

While nursing schools are graduating highly skilled individuals, the experience of older workers is impossible to teach in a classroom.

Registered nurse Rebecca Madore, 23 on her third day on the job at Wuesthoff Medical Center -- Rockledge, Fla., acknowledges that the reality of nursing can be daunting.

"I learned a lot at school, but it's totally different when you're actually working the floor," she said.

Madore knew she wanted to be a nurse since she was a little girl, but for many of her colleagues, the profession is a career, not a calling.

"Each group's work ethic is different," said Suzanne Woods, vice president and chief nursing officer for Health First's community hospital division.

"The veterans and baby boomers feel almost total responsibility for the workplace and will come in on short notice and cover difficult shifts. This has always been their practice. The Gen X and Millenniums are more cognizant of home-and-life balance and strive to keep this in check."

Each generation also brings different skills, all needed to best serve patients.

"The younger nurses are very technologically advanced, but the older nurses are more connected with the patients," said Rosemary Walter, director of the medical/surgical unit at Wuesthoff in Rockledge.

Technological savvy, a given for new nursing grads and necessary for survival in the health care field today, can be difficult for older nurses to embrace.

"I feel we have an advantage over older generations in the new advancements of paperless systems, computer charting and the new diagnostics," said Michele McCray Miller, 26. "Throughout nursing school, we were constantly using simulated mannequins, computer programs and other electronic devices to master skills such as NG (nasogastric) tubes, catheters and IV skills. Older generations were not as lucky to have those resources in the classroom."

Allison Rogers has been a nurse for two years. Rogers' mother was a nurse. This member of Generation X had no doubts about her career choice.

"I know how important my job is, and I consider it an honor to care for patients the way I would want my family to be taken care of," Rogers said.

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.”