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 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.

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."

The news that some employers have asked for direct access to the Facebook accounts -- including user names and passwords -- of people applying for jobs at their firms has set off a firestorm of controversy.

The reports have raised questions about whether the practice is illegal and if such a policy could expose those employers to potential discrimination lawsuits. The dust-up has even triggered calls by some in Congress for a federal investigation into the practice.

But those recent events only highlight a new reality: The identity that individuals create in the world of social media is quickly becoming an important factor in hiring decisions and in people's broader professional lives.

"The questions around employer access to social network log-ins reflect a broader debate in society about a host of digital privacy issues," says Andrea Matwyshyn, a Wharton professor of legal studies and business ethics. "This is a new concern -- the degree to which employers can gain access to all role identities through one virtual space. There is no parallel to that in the real world."

While the reaction to the practice has been swift and intense, it's hard to predict if it will become a lasting trend.

But, Matwyshyn says, she began hearing about employers requesting access to the Facebook accounts of potential hires as far back as 2008. To date, however, she says, there is no good data on how widespread the practice has become.

The fact that it exists at all is not entirely unexpected: According to Matwyshyn, a number of studies show that most employers look at candidates' online profiles when making hiring decisions, noting a 2011 survey by social-media monitoring service Reppler that found that 91 percent of recruiters report using social-networking sites to evaluate job applicants.

But checking out a publicly available profile on Facebook -- or even asking a job candidate to "friend" someone in human resources at a company where they are applying for a position -- is worlds apart from gaining unfettered access to someone's account through a password.

"If you can take Facebook passwords, what about Gmail passwords?" asks Stuart Soffer, a non-residential fellow at The Center for Internet and Society at Stanford Law School and managing director of IPriori, an intellectual-property consulting firm.

If left unchecked, Soffer says, the practice could expand beyond human resource departments evaluating potential employees.

"What about allowing Facebook access to insurers so they can see what you are saying about your health?" he says. "They could use it as a basis for judging the risk of insuring you."

The request for access to log-in information also raises some serious legal questions.

Clearly concerned about the legal and business implications of privacy breaches, Facebook has come out against the practice, stating that sharing or soliciting a Facebook password is a violation of the company's statement of rights and responsibilities.

"We don't think employers should be asking prospective employees to provide their passwords because we don't think it's the right thing to do," Facebook Chief Privacy Officer Erin Egan says. "But it also may cause problems for the employers that they are not anticipating."

Matwyshyn says employers could be essentially asking job candidates to violate their contract with Facebook if they ask for passwords, creating "an untenable conflict between contract law and employers' perceptions of their own interest in vetting candidates."

In addition, if a Facebook account includes information on an applicant's race or age, for example, that could potentially expose the employer to claims of discriminatory hiring practices. According to Matwyshyn, it is legally hazy whether accessing someone's Facebook account where that information is available is akin to asking it in the interview.

"Arguments can be made that this is a back-door method to gaining information that the prospective employer wouldn't otherwise have access to," she says.

Meanwhile, the issue is getting the attention of Congress. Senate Democrats Charles Schumer and Richard Blumenthal, from New York and Connecticut respectively, have asked the Justice Department and the Equal Employment Opportunity Commission to look into the practice.

But even if it is eventually prohibited or otherwise curbed through legal or legislative channels, Wharton management professor Nancy Rothbard predicts that the use of social media in hiring decisions will continue to be a flashpoint in the years ahead.

"The core of the problem is the blending of personal and professional lives," Rothbard says. "We are still in the infancy of trying to understand how to deal with all this."

Opening the Window -- and Closing a Door?

Just how far employers can legally go to check out job candidates online may not be clear -- but why they are looking for new methods of evaluating applicants is easy to understand, says Wharton management professor Adam Grant.

Research, he says, has shown that the typical job interview is a poor tool for predicting which candidates will succeed. If that does not work, companies need to find something that does.

"Applicants are very motivated to put their best foot forward in an interview," Grant says. "It is very difficult to spot the people who will represent an organization well. But on Facebook, you can see the applicant making day-to-day decisions -- it is a window into how an individual is likely to act."

In fact, recent research has provided evidence that online profiles can be very revealing about specific personality traits.

A paper published recently in the Journal of Applied Social Psychology entitled, "Social Networking Websites, Personality Ratings, and the Organizational Context: More Than Meets the Eye," studied 518 undergraduate students and their Facebook profiles.

The researchers found that the Facebook profiles were a good predictor of the so-called "big five personality traits:" conscientiousness, agreeableness, extroversion, emotional stability and openness. And for a subset of the group where the researchers were able to contact supervisors at companies that had hired those students, there was a correlation between scores on two personality traits -- emotional stability and agreeableness -- and job performance. (SeeHREOnline^TM story here.)

"There is strong evidence that social networking is a valid way of assessing someone's personality," says Donald Kluemper, a professor of management at the Northern Illinois University College of Business and a co-author of the study.

But he says that does not mean there is evidence that an unstructured perusal of a Facebook account will result in better hiring decisions.

"Until a method is validated in a number of ways, including a study of adverse impacts and the legal issues, I wouldn't recommend companies rely on social-networking profiles," Kluemper says.

Now, the use of social-media information is far from fine-tuned, with recruiters typically checking out social media to get a general sense of the person applying for a job or to hunt for any red flags. But it is possible the use of that information could become more sophisticated.

"People are mining that data right now for other purposes, including targeting ads to the right people," says Shawndra Hill, a Wharton operations and information management professor. "It is not out of the realm of possibility to focus that on other outcomes, like how good a match someone is for a job or whether there is a high likelihood they might do something illegal."

While the value of that data may be apparent, it remains to be seen how social media should ultimately fit into some aspects of professional life.

Take the less-controversial practice of managers' friending their colleagues through Facebook. Rothbard says this practice creates numerous potential headaches. Two years ago, she and some colleagues did a series of interviews with 20 people at a variety of levels and in a number of different industries, and found that people were often unnerved friending either bosses or subordinates.

"People felt very uncomfortable with crossing the private and professional boundary when it came to the hierarchy [within an organization]," Rothbard says. "They talked about friending their bosses with similar discomfort and language as they did when they spoke about friending their moms."

Interestingly, Rothbard adds, the rules for social networking in the workplace may differ based on gender.

She led a study of 400 students in which participants were shown Facebook profiles, told that the person was either a boss, a peer or a subordinate, and then asked to rate the individuals based on how likely they were to accept that person's friend request.

The findings: Female bosses with bare-bones profiles were less likely to be accepted than those who revealed more personal information, while the opposite pattern held for male bosses.

"Women who have limited profiles are more likely to be shunned than the women who have a more active presence," Rothbard says. "People see them as cold. But male bosses who reveal less information are more likely to be accepted than those who reveal a lot of information."

The increased scrutiny of people's virtual lives may change the way individuals operate in the social-networking realm.

According to Rothbard, there are essentially four ways of dealing with privacy issues. There are those who control their list of friends carefully, rejecting friend requests from people with whom they don't want to share personal information. Then, there are those who accept virtually all requests, but are very careful about what they post, limiting that content to very safe, less revealing information.

There is also a hybrid approach in which people use privacy settings to share some information with close friends and less-sensitive material with others. And, finally, there is the "let it all hang out" crowd -- those who are comfortable sharing all their information with a large group of close (and not so close) friends.

Grant predicts more people will opt for the more-controlled, filtered approach as they realize their social-media profiles are being scrutinized by potential employers.

"As employers gain this information, so do candidates," Grant points out. "So candidates may use Facebook more carefully and remove the cues that are so valuable [to employers]."

Soffer agrees people will become much more careful about their social-media personas.

"There are ways around this," Soffer says of the unwanted exposure of social-media behavior. "One thing that could happen is people will start having two Facebook accounts." One will be for close friends; the other, a more sanitized version for employers.

But there is always the potential that something posted for viewing by a small group of close friends on Facebook could get out into larger circulation. And for that reason, some argue, the risks of being active in the social-media space outweigh the benefits.

"If you are a CEO, or aspire to be a CEO or director of a public company, I think it makes sense to refrain from social networking," says Dennis Carey, vice chairman at Korn/Ferry International. "There are other ways to communicate with employees and the outside world through properly controlled channels. Some of the messages that are conveyed can be misconstrued or taken out of context by a third party."

The fear of a photo or comment made long ago coming back to haunt you is hardly unfounded. Because sites such as Facebook have been around less than a decade, it is not certain how long someone's social-networking history will remain accessible.

"It is unclear how long the information persists," Hill says. "Firms have different privacy policies, and often privacy policies change over time. While there are policies that allow for deleting data you no longer want on the site, it is hard to guarantee that this information won't live on a database somewhere."

The controversy worries some fans of the social-media revolution.

"I worry that there is already a sense right now that our participation online may come back to haunt us," says Chris Ridder, co-founder of the law firm Ridder, Costa & Johnstone and a non-residential fellow at The Center for Internet and Society at Stanford Law School.

"It inhibits our ability to express ourselves," he says. "If we can only express public relations-like statements, it takes away a good bit of the utility of the Internet. I think it would be a shame if we were to lose the playful aspect of this new technology."

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How would you feel if someone asked for your account information to Facebook or Twitter in an interview? What if your boss did it? Do you think this is a privacy violation? Should there be legislation on this? Let us know in the comments; we want to hear from you!

 

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

Baby boomers are turning 65, and they will need lots of help
By Ilan Kolet and Shobhana Chandra
Businessweek.com

While the economy lost 7.5 million positions during the 18-month recession, the health-care industry added doctors, nurses, and other hospital personnel. Together with the social assistance category, which includes day-care workers, career counselors, and similar positions, the sector will add more than 5.6 million employees and be the biggest job gainer by 2020, according to new projections by the Bureau of Labor Statistics. Manufacturing is forecast to lose 73,000 jobs by then.

“The first baby boomer just turned 65 last year, so when it comes to health-care jobs, we haven’t seen nothing yet,” says Chris Rupkey, chief financial economist at Bank of Tokyo-Mitsubishi UFJ in New York. Almost 87 million Americans, or one in four, will be 65 or older by 2050, according to the Organization for Economic Cooperation and Development. Health services require face time with patients, which means “these jobs are protected from the forces of globalization,” says Rupkey. “We can’t imagine a time when we’ll be able to outsource the job of a home health aide giving a senior a bath or helping with physical therapy.”

Openings in health care are broadly distributed geographically, even in economically distressed small towns where they often are “all that’s left,” says David Card, a director of the Labor Studies Program at the National Bureau of Economic Research. They also provide “pretty good” opportunities, particularly for women, he says. During the recession, health care added almost half a million positions, while construction, which typically employs more men, shed 1.1 million workers.

Sharon Rudolph, 64, is studying to be a registered nurse alongside classmates who had previously worked in real estate and banking, as well as one who owns a nail salon. The Fort Lauderdale resident was a radiologic technologist before she took a break in the 1990s to raise her family. Now she’s in a 27-month training program at the city’s Nova Southeastern University. “I felt I’d become more marketable once I get out,” says Rudolph, who has managed to keep her other licenses in diagnostic medical and cardiac sonography current. “I have to work twice as hard as some of the kids” to keep up with the coursework.

Registered nursing, which requires at least an associate degree, will have the largest growth of all U.S. occupations, according to the Bureau of Labor Statistics, adding 711,900 jobs between 2010 and 2020, reaching a total of 3.4 million. The number of home health aides, who don’t need a high school diploma but require on-the-job training, will increase by 69 percent, to 1.7 million. Hiring of physicians and surgeons will rise by 24 percent, to 859,300, the bureau predicts.

While the additional jobs probably will lift employment, many pay low wages. That means these workers will be less able than employees in higher-paid industries to boost consumer spending. Yet health-care jobs may provide more stability than factory and construction work, which tends to fluctuate with the economy. According to BLS data that are seasonally unadjusted, the unemployment rate for health-services employees was 6 percent in December, compared with 16 percent for construction.

According to Charles Roehrig, director of the Altarum Center for Sustainable Health in Ann Arbor, Mich., every 10 jobs in health care ultimately generate an additional 12 elsewhere in the economy. If he’s right, then without the industry’s recent hiring growth, the unemployment rate would have been 9.5 percent in December, instead of 8.5 percent.

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.

This is a subject matter we are always talking about. You hear the labor projections, but in a way it is a grim and sobering reminder that the healthcare labor force is in for some major gwoing pains. Are you experiencing this in your workplace? What do you think?

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(from Reuters.com) - The graying of America and a booming Hispanic population is driving major changes in the structure of the U.S. workforce and the types of jobs that will be available over the next decade, a new government report shows.

Health care and social assistance jobs will be the fastest-growing sectors, accounting for one quarter of the 20.2 million new jobs the economy is expected to generate by 2020.

Retiring baby boomers will help open up an additional 33.8 million positions for total vacancies of 54 million, the Labor Department said on Wednesday in its biannual Employment Outlook report for job growth between 2010 and 2020.

During the recent recession, employment declined by 7.8 million jobs to a total of 129.8 million in 2010. The report does not estimate by what year those jobs will be replaced.

In addition, the workforce is getting older. Despite the retirement surge, a slowdown in population growth means that the post-World War II baby boomers will make up a quarter of all U.S. workers by 2020, up from 19.5 percent today.

Hispanics, meanwhile, are joining the workforce at a fast pace. They will represent 18.6 percent of overall employment by decade's end, up from 14.8 percent today. In contrast, Asians and African-Americans will see their share in the labor force rise by 1 percentage point or less to 5.7 percent and 12 percent, respectively.

"The labor force is projected to get older, become racially and ethnically more diverse and show a small increase in women as a share of the total," the department said.

Professional and business services will be the second-fastest growing industry, adding 3.8 million positions.

It will be followed by construction, although the 1.8 million new construction jobs will not bring employment in the industry back to levels seen during the housing boom.

SKILLS DIVIDE

The report also spelled out the skills workers of the future will need.

Two thirds of the total job openings will require only a high-school education or less, it said. For example, there will be roughly 70 percent growth in personal care aides and health-care support employment, the fastest-growing occupations. No high school diploma would be required, and workers would get short, on-the-job training.

At the same time, demand for people with master's degrees will increase by 21.7 percent, the Labor Department said.

The manufacturing sector and the federal government will both lose jobs over the next decade.

by Claire Theriot Mestepey

Whether you are interviewing a person with a disability for a job or meeting them for the first time at a party, here are some simple tips that will put you both at ease. It’s so important to remember that no matter what the disability is, whether blindness, deafness or wheelchair-users, they are people. Once you overcome preconceived notions about their outer appearance, it will pave the way to better communications, understanding, and acceptance.

1. When you first meet, always offer to shake hands. Most of us will offer the most controlled limb; it might even be a foot. For instance, because of my cerebral palsy, my left arm’s natural state is folded up, hand sitting on my shoulder. So if I had to extend my left arm to shake yours, it would take 13 minutes. But I can shake your right hand with little or no effort. Let the person with the disability take the lead, but do offer a friendly handshake. I think the first handshake sets the tone of how open one will be in the relationship. In other words, opened hand, opened heart.

2. Often people want to speak louder when they are addressing me. I am not deaf, but even if I was, how would shouting help us communicate better? Always try to talk in a normal tone. I do believe that disability etiquette is a two-way street and if the person with the disability would like you to speak louder they should just ask.

3. Most people are good Samaritans at heart; they like to help. As a woman with cerebral palsy I appreciate immensely when people offer assistance. Sometimes I accept with a nod and a thank you. Other times I don’t want help. I’m extremely independent and if I know the task is doable, however difficult it may seem, I like accomplishing it. On rare occasions overzealous Samaritans try to help, despite my pleas not to. I know people are just trying to help, but it borders on being disrespectful and can sometimes put the person with a disability on defense.

These are just three common disability etiquette tips. Upon reflection, these suggestions works for anyone, disabled or not. Many people want to learn disability etiquette, which is quite admirable. Taking the time to know someone, though, is more important than any etiquette training. Moving beyond stereotypes and learning each person’s limitations (because we all have them) and abilities are essential to understanding what an individual can offer your organization.

 

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Have you ever felt unsure of what to do meeting someone with disabilities? How did you handle the situation?

 

Have you ever tried any of Ms. Mestepey's suggestions? Did it help? Do you have additional behaviors you find helpful?