DiversityNursing Blog

by Courtney H. Lyder

In a recent editorial in The New York Times, Theresa Brown wrote about how clinical hierarchies and the impact of conflict between nurses and physicians can be deadly for a patient. She said "when doctors and nurses don't get along, it's the patient who suffers."

A lot of studies show that poor communication is linked to adverse patient outcomes. For example, of the 1,243 sentinel events reported to the Joint Commission in 2011, communication problems were identified in 60 percent.

By its very nature, healthcare is complicated; it is a rapidly changing environment and unpredictable. Professionals from a variety of disciplines can care for a patient during a 24-hour period, which can limit the opportunities for face-to-face communication.

Physicians and nurses are expected to work together, not only practicing side by side, but interacting to achieve a common goal: the health and well-being of the patient. But there are several factors that can make effective communication between nurses and physicians particularly difficult to achieve, including historic tension; conflicting viewpoints based on education, training, communication style; and terminology and existing communication processes that are inefficient at best.

With the focus of healthcare moving increasingly to the team approach, it becomes even more critical for physicians and nurses to work in collaboration. Higher education institutions including UCLA and the University of Virginia, for example, are working to improve how nurses and physicians work together before they enter the clinical environment.

The University of Virginia now requires interprofessional education for its nursing and medical school curriculums. Courses, training modulus and even faculty members are shared across both disciplines. Medical and nursing students are taught to respect each other's areas of expertise.

In the Fall of 2008, the UCLA School of Nursing and the David Geffen School of Medicine at UCLA, introduced a pilot program to integrate nursing students (in this case advanced practice students) and third-year medical students. The result was an innovative program that focused on content, such as communication with patients, ethics, behavioral medicine and other psychosocial issues. The idea was to get the two groups working together sooner rather than later so students from both schools could develop team-building skills, increase their awareness of each other's roles and get used to working together in making decisions to improve patient outcomes.

Our initial results indicated the students found the experience to be of great value. In addition to assisting students with their clinical decision-making skills, the discussions that took place during the course provided an excellent forum in which the nursing and medical students gained a better mutual understanding.

I believe collaborations like this represent the future of medical and nursing education. No two groups of health professionals are more interrelated in practice, and by starting here, we allow them to understand each other and to grow up together as students.

We are now taking the next step by creating assessment tools to evaluate interprofessional competencies not only in the classroom but in clinical practice settings as well. Tools such as an iPad app will allow instruction leaders to assess actual collaborative practices through observations and walk-throughs in clinical settings. Our ultimate goal is to disseminate the tools with a wider community.

Patient safety needs to be our top priority. Successful delivery of healthcare needs to be interdependent and respect shown for the education and knowledge of each team member. Interprofessional education is an excellent start.

Courtney H. Lyder is dean and professor of the UCLA School of Nursing, professor of Medicine and Public Health as well as Executive Director of the UCLA Health System Patient Safety Institute and Assistant Director of the UCLA Health System.

By DEREK THOMPSON 

Here's what that graph (via Brookings) says. In the last ten years, job growth in America's non-health-care economy has been dreadful. Just 2.1 percent total -- or barely 0.2 percent per year. (Yes, that's point-two percent annual growth.) In that time, the U.S. health care sector has grown more than ten-times faster than the rest of the economy, adding 2.6 million jobs.

There are a couple stories that branch off from this graph. One is the unchecked growth in health care prices over the last few decades, which has made the medical industry the one truly recession-proof job engine of the economy. Two is the concentration of job growth in local service industries shielded from the global supply chain. And three (related) is the sad decline in construction and manufacturing jobs. 

Let's pull back the lens to 1990 and take a picture. Take a look at the growth of health care employment (in red) and the decline in construction and manufacturing employment (in blue).

According to the BLS, the two fastest-growing jobs in the next decade -- by far -- will both be in health care: personal care aides and home health aides.

I'd prefer not to muddy a clear statistical observation here with a provocative claim that health care's relentless, unstoppable employment growth is a goodthing or a bad thing, exclusively, because it's certainly both -- an emergency source of recession-era employment and a symptom of health care inflation. I knew health care had been the most important driver of national employment over the last few years, but I had never seen the case made so starkly.

Source: The Atlantic

Shannon Patel, RN, BA, CCRN, CMC, PCCN, manager of the heart failure program at AtlantiCare Regional Medical Center in Galloway, N.J., and an RN-to-BSN student at the Rutgers School of Nursing–Camden (N.J.), led a team at the hospital’s Heart Institute that developed a new smart phone app that helps patients manage heart disease and stay out of the hospital.

The WOW ME 2000mg app helps patients, caregivers and family members identify and manage symptoms of heart failure, according to the release.

"This tool was designed to cross the healthcare continuum and has allowed our organization to deliver very important self-management education," Patel said in the release.

The WOW ME 2000mg app reminds patients to weigh themselves; measure their output of fluids; walk and be active; take their medications; evaluate signs and symptoms; and limit sodium intake to 2,000 mg or less, with 1,500 mg being optimal. The app prompts users with reminders and allows them to enter information about how they are managing their symptoms. It also links them with AtlantiCare’s Heart Failure Resource Team and other providers. Patel said in the release that many heart failure programs around the country are struggling to find ways to successfully teach heart failure self-management techniques. She said there is no standardized approach to reinforcement of the information taught to patients and that oftentimes patients receive differing and conflicting information depending on where they go for treatment.

"This tool standardizes heart failure self-management for patients," Patel said in the release.

As part of its ongoing mission to eliminate needlestick and sharps injuries in healthcare, the nonprofit organization Safe in Common has issued the "Top 10 Golden Rules of Safety." 

The list (www.safeincommon.org/sites/default/files/field_document/top-10-golden-rules-of-safety.pdf) is predicated on making injuries a "never event," and dictates that personnel using or purchasing sharps consider the following rules:

• The design and activation of the safety mechanism is automatic and will not interfere with normal operating procedures and processes.

• The device is intuitive and requires no additional steps for use compared with an equivalent standard or conventional device.

• The contaminated, non-sterile sharp will be rendered safe prior to removal or exposure to the environment.

• Activation of the safety mechanism does not require the healthcare worker to undertake any additional steps during normal patient care processes or protocols.

• Activation of the safety mechanism will not create additional occupational hazards (such as aerosolization, splatter, exposure to other potentially infectious materials, etc.).

• Activation of the safety mechanism does not cause additional discomfort or harm to the patient.

• The device will be ergonomically designed for comfort, allowing for automatic one-handed use during all stages of patient procedure.

• The safer engineering control is available in sizes and iterations appropriate for all areas of use relevant to patient care needs.

• Disposal of the safety device will not increase waste disposal volumes but instead incorporates designs to reduce waste.

• The used safety device will provide convenient disposal and mitigate any risk of reuse or re-exposure of the non-sterile sharp.

The outline for the Top 10 Golden Rules of Safety was released at the annual Association for Professionals in Infection Control and Epidemiology convention in Ft. Lauderdale, Fla., earlier this month. Safe in Common gauged attendees’ opinions on safety devices during the conference. Of the 27 devices reviewed, only 9% received a perfect 10 and exactly half had a passing grade of 7 or higher. Some 41% had scores of 2 to 4.

Overall, the devices available at APIC scored well on two criteria:

• The safer engineering control is available in sizes and iterations appropriate for all areas of use relevant to patient care needs (95%).

• The used safety device will provide convenient disposal and mitigate any risk of reuse or re-exposure of the non-sterile sharp (86%).

Significant development effort remains in three essential criteria:

• Activation of the safety mechanism does not require the healthcare worker to undertake any additional steps during normal patient care processes or protocols (32%).

• The device is intuitive and requires no additional steps for use compared with equivalent standard or conventional devices (41%).

• The contaminated, non-sterile sharp will be rendered safe prior to removal or exposure to the environment (48%). 

Source: Nurse.com

By Mike Spohr

Today I ran into a Mexican restaurant to grab a quick lunch, and as I ate my meal I came across a table of nurses wearing hospital scrubs. As they chatted amongst themselves I thought about the many nurses my family has interacted with over the last five years, and I found myself filled with such appreciation for what these amazing women and men do for us.

It was in the Neonatal Intensive Care Unit that I initially saw how amazing nurses can be. My first child, Maddie, had been born almost 12 weeks premature, and the hospital staff, upon determining that Maddie's lungs were immature, rushed her to the NICU. There Maddie's life hung in the balance, and though my wife, Heather, and I longed to care for her ourselves, her condition made it so that we couldn't. We had to trust the NICU nurses to take care of our baby for us, and that was incredibly hard -- especially at night when we went home to catch a few hours sleep.

Sleeping was, of course, almost impossible. My sick baby was not with me, and the phone loomed ominously on the nightstand. If it rang before dawn it would do so for only one reason -- to tell us that Maddie had passed away. I can't tell you how scared I was of that phone ringing. Thankfully, it never did.

Each morning I called the NICU at 7:00 a.m. to get an update from the night nurse about how Maddie had done through the night, and the moments waiting for her to pick up the phone were horrible. Was I going to hear Maddie had done poorly and that things didn't look good? Or, if the nurse took a long time to come to the phone, did that mean that she and the other medical staff were desperately fighting to stabilize Maddie at that very moment (something I'd witnessed in person a number of horrible times)? My hands never failed to shake as I waited for the phone to be picked up.

Once the night nurse picked up, though, I began to feel better. She always told us about Maddie's night in great detail even though she'd just finished a long, exhausting shift. The lengths the NICU nurses went for Maddie were incredible. One night, we were told, Maddie wouldn't respond to the ventilator, and the only reason she survived was because the night nurses took turns hand pumping air into her lungs for hours on end until their hands were cramped and throbbing.

As amazing as all that was though, the thing I appreciated the most about the nurses was how they loved and valued Maddie. She wasn't just some nameless baby behind the glass of an isolette obscured by wires, medical tape, and breathing tubes. She was an amazing little girl named Maddie (also "Bunny" or "Little Mama" as they called her), who was beautiful and strong. I could see that they considered my daughter to be amazing and a gift, and to see others felt about her as I did was incredibly meaningful to me.

Maddie was finally released from the NICU, but there were a few times over the next 17 months when she came down with an infection and had to again be hospitalized. Those days in the hospital were both frightening and incredibly dull, and again nurses were wonderful to us. They were always there when we needed them, quick to bring a blanket or to explain what medications Maddie was taking. Like the NICU nurses, these nurses showed Maddie so much love, mooning over how cute she was and making faces at her to keep her entertained.

Though it still hurts to admit, on April 7, 2009, two days after she was hospitalized with a respiratory infection, Maddie passed away. On that horrible day there was a nurse who stayed by Heather's side the whole time, and I am so thankful for her kindness to my wife. There was a nurse that mattered to me that night, too, though she didn't stay by my side, bring me a glass of water or even say a word to me. In fact, I don't think I saw her until the very moment I walked out of the pediatric intensive care unit, but she made a difference nonetheless.

You see, that day my life shattered. I watched my daughter die in front of me, and it was an experience so horrific that even now it seems almost surreal, like, Did that actually happen? To me and my family? But it did, and one of the things I remember most about it was how the key medical personnel there didn't make me feel like they found Maddie to be beautiful and strong or amazing and a gift. The lead doctor may have been under a great deal of stress, but the way he pronounced her dead was not right. It was more like a referee calling the end to a heavyweight fight than the end to a beautiful child's life. Then, as we held our dead child in our arms and kissed her goodbye, doctors stood behind the curtain discussing the specifics of what had happened with about as much feeling as mechanics discussing a broken down car.

It was only as I left the PICU that I felt humanity. There, sitting on a chair with a single tear rolling down her cheek, was my nurse. Her tear told me that she cared. About Heather, about me, and most importantly, about my beautiful Maddie.

That's what nurses do that is so important. In addition to all of their medical expertise, they bring a human element to the cold, sterile world of a hospital. Doctors do great things, but have a heavy case load that means they can only visit each patient briefly each day, but the nurses will hold your hand -- figuratively or literally -- and remind you that you are not alone, and that your life is valued even if it can't be saved.

When the nurses at lunch today finished their meal I wanted to thank them, but I didn't, and I wished I had afterward. I can do one better now though:

To nurses everywhere: You should know that you have made a difference to so many people in this world, my family included, and I cannot thank you enough.

Source: Huffington Post 

By JANE GROSS

View Video Here

Dozens of teachers and health care providers went back to the classroom recently. They attended the I-pad Institute at the University of Cincinnati. 

Local 12's Liz Bonis got to sit in and learn a few things too. From the letter you get by email when you are accepted to nursing school, to no more paper in the classroom. The first thing I learned at the I-pad Institute is that going I- Tech, is likely a heartbeat away from a health care setting near you!

For health care providers or in this case, nurses in training. "We are helping them learn how to use the technology to deliver safe patient care," says Robin Wagner, assistant professor.

Robin Wagner, a nursing instructor, says for example, even if you are sitting here, with the help of iPad learning, you can virtually go inside the doctors office and when it comes to giving hands on care, such as taking a blood pressure, not only can you see how in here, you can see what's happening in the body on this virtual organ because, believe it or not, there's an app for that! "They can actually see what the hearts doing and in the past we would have just described that, this valve opens this one closes. Now, they can actually see that," says Wagner. 

The really exciting part of all this however, is not just what happens here in the teaching and learning environment, it is what happens when you take that to the next level. Perhaps with robotics? In this I-Tech learning lab for students and staff, I got to observe just a few weeks ago, I met Flo-Bot. "They are going to be using the iPad to control Flo-Bot, our robot, so it has an app that will allow the students to drive the interaction with patients," says Chris Edwards. 

As Chris Edwards explains, Flo-Bot is designed for health care providers to be able to better diagnose and assist patients, even at a distance if needed.  

Please view the video in the below link.

Source: Local 12 Cincinnati (Video Available Here)

By Jane Gutierrez

When you think of a nurse, what’s the first image that comes to mind? Chances are, you think of a woman — and for good reason. The vast majority of professional nurses in the U.S. are white women. In fact, only about six percent of nurses are male and, Considering males make up approximately half of the population and minorities are 30 percent, there’s a major disparity in the profession.

That disparity is reflected in equal measure in nursing schools, both in the student population and faculty. Experts argue improving the diversity in nursing education will improve health care by creating a more culturally sensitive healthcare workforce with improved communication abilities, reduced biases and stereotypes and fewer inequities, as well as increasing the diversity of the nurse education faculty.

At a time when the healthcare system is faced with a nursing shortage caused at least partially by a shortage of nurse educators, some argue males and minorities represent an untapped resource for recruiting new educators. They believe that by creating new opportunities to attract traditionally underrepresented populations to the field, we can both solve the shortage and make a measurable improvement to our healthcare delivery system.

Why Diversity Is an Issue

While minorities have made great strides in other traditionally white-dominated fields and women have done the same in traditionally male fields, nursing is one area where diversity initiatives seem to have been ineffective.

In the case of men, much of the resistance to nursing as a profession comes from a cultural perception of nursing being a “female” profession. Men report while they enjoy the care giving aspects of the job, it’s difficult when others ask questions or make comments deriding their career choice. For example, male nurses report being asked why they didn’t choose to become doctors, with the implication that they did not earn adequate grades or were too lazy to become doctors. In addition, men report feeling left out of the profession, with most training and professional development materials referring to nurses as “she” and a female-centric approach to teaching and training.

In the case of minorities, including African-Americans and Latinos, studies attribute the disparity in the nursing profession largely to lower overall academic achievement in those groups. Given that admission to nursing school generally requires at least a moderate level of academic achievement — and earning a

degree in nursing education requires at least a bachelor’s degree and some experience — it’s no surprise that groups that aren’t as academically advanced are lacking in the nursing profession.

Fixing the Problem

Because improving diversity in the nursing profession is a key to solving the nurse shortage — and by extension, the nurse educator shortage — the healthcare field is looking for new ways to recruit, mentor and retain minority nurses, male nurses and educators.

One step is to recruit potential professionals earlier — in some cases, as early as high school. Throughout the country, in the field in exchange for high school credit, with the goal of encouraging them to maintain their academic performance and attend nursing school.

However, academic performance is only part of the equation. The cost of education is another barrier to many potential students, regardless of sex or ethnicity. The cost for a four-year BSN program can be over $100,000 in some cases, while a two-year program generally runs between $5,000 and $20,000. Factoring in the master’s and doctoral degrees required to become nurse educators, and the cost only goes up.

In response, many schools, as well as states and the federal government, have instituted financial assistance programs designed specifically for minorities and males. The Federal Nursing Workforce Diversity program allows minority students to borrow money for school, and have some or all of their loans repaid if they agree to work in specific, undeserved areas. For those who want to become nurse educators, the government’s Nurse Faculty Loan Program offers partial or full repayment of student loans for agreeing to teach for at least two years after graduation.

With the nursing shortage only expected to grow, thanks to increased access to healthcare, reaching out to minorities and males only makes sense. Not only will it solve a serious problem, it will ensure quality, effective health care for future generations.

About the Author: Jane Gutierrez is a nurse educator and a member of her employer’s diversity initiative committee. She visits with local high schools to encourage students to consider careers in health care

By Anna Reisman