DiversityNursing Blog

By ABIGAIL ZUGER, M.D.
NYTimes.com

 
When a book is heavy with glossy photographs, you seldom expect too much from its words. In “The American Nurse,” though, it’s the narrative that hits you in the solar plexus.

Take the comments of Jason Short, a hospice nurse in rural Kentucky. Mr. Short started out as an auto mechanic, then became a commercial trucker. “When the economy went under,” he says, “I thought it would be a good idea to get into health care.” But a purely pragmatic decision became a mission: Mr. Short found his calling among the desperately ill of Appalachia and will not be changing careers again.

“Once you get a taste for helping people, it’s kind of addictive,” he says, dodging the inspirational verbiage that often smothers the healing professions in favor of a single incontrovertible point.
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Some of the 75 nurses who tell their stories in this coffee-table book headed into the work with adolescent passion; others backed in reluctantly just to pay the bills. But all of them speak of their difficult, exhilarating job with the same surprised gratitude: “It’s a privilege and honor to do what I do,” says one. “I walk on sacred ground every day.”

They hail from a few dozen health care settings around the country, ranging from large academic institutions like Johns Hopkins in Baltimore to tiny facilities like the Villa Loretto Nursing Home in Mount Calvary, Wis., home to 50 patients and a collection of goats, sheep and other animals on a therapeutic farm. Some nurses are administrators, some staff wards or emergency rooms, some visit patients at home. Many are deeply religious, a few are members of the military, and a handful of immigrants were doctors in their home countries.

All describe unique professional paths in short first-person essays culled from video interviews conducted by the photographer Carolyn Jones. Their faces beam out from the book in Ms. Jones’s black-and-white headshots, a few posing with a favorite patient or with their work tools — a medevac helicopter, a stack of prosthetic limbs or a couple of goats.

But even the best photographs are too static to capture people who never stop moving once they get to work. For a real idea of what goes on in their lives, you have to listen to them talk.

Here is Mary Helen Barletti, an intensive care nurse in the Bronx: “My whole life I’ve marched to a the beat of a different drummer. I used to have purple hair, which I’d blow-dry straight up. I wore tight jeans, high heels and — God forgive me — fur (now I am an animal rights activist). My patients loved it. They said I was like sunshine coming into their room.”

Says Judy Ramsay, a pediatric nurse in Chicago: “For twelve years I took care of children who would never get better. People ask how I could do it, but it was the most fulfilling job of my life. We couldn’t cure these kids, but we could give them a better hour or even a better minute of life. All we wanted to do was make their day a little brighter.”

Says Brad Henderson, a nursing student in Wyoming: “I decided to be a nurse because taking care of patients interested me. Once I started, nursing just grabbed me and made me grow up.”

Says Amanda Owen, a wound care nurse at Johns Hopkins: “My nickname here is ‘Pus Princess.’ I don’t talk about my work at cocktail parties.”

John Barbe, a hospice nurse in Florida, sums it up: “When I am out in the community and get asked what I do for a living, I say that I work at Tidewell Hospice, and there’s complete silence. You can hear the crickets chirping. It doesn’t matter because I love what I do; I can’t stay away from this place.”

The volume is not entirely about selfless service: It was underwritten by Fresenius-Kabi, a German health care corporation and leading supplier of intravenous drugs in the United States. Presumably, crass public relations motives lurk somewhere in the background. But that’s no real reason to be meanspirited about the result, a compelling advertisement for an honorable profession.

Young people with kind hearts and uncertain futures might just sit themselves down with the book, or wander through the Web site featuring its video interviews, www.americannurseproject.com, and see what happens.

by Katrina Gravel

This past month, the George Washington University School of Nursing (GW) received a three-year, $1 million grant from the U.S. Health Resources and Services Administration to fund a program that aims to increase the diversity of nursing professionals, according to a press release from GW. The school’s Success in Nursing Education project focuses not only on drawing in African-American, Asian, Hispanic, and Native American students, but also male students and economically disadvantaged students from Washington, D.C., and rural Virginia. A report released by the U.S. Department of Health and Human Services (HHS) in September 2010 showed that men made up less than 10% of employed RNs licensed between 2000 and 2008, while non-white or Hispanic nurses represented only 16.8% of all registered nurses in 2008. While those percentages may have grown in years since the HHS survey, it is unlikely that the gap has become significantly smaller.

The lack of ethnic minorities, males, and economically disadvantaged nursing students does not reflect the immense diversity of the patients these students will soon be treating. As an article in GW’s student newspaper The GW Hatchet cites the school of nursing’s Dean Jean Johnson as saying, “the nursing workforce should reflect what the population at large looks like.”

GW will use the grant to launch a recruitment campaign to reach disadvantage students, as well as students who are changing careers. The program will offer both undergraduate and graduate degrees in nursing, and will utilize retention tools such as mentoring programs. The grant will also create scholarships and financial aid for some students, according to the GW press release.

Has your organization made efforts to diversify its staff? What are your thoughts on the GW program? Leave a comment and let us know!

2010 may have been the year when enormous healthcare changes began, but 2011 was the year these changes hit nursing. In addition, the Institute of Medicine's landmark Future of Nursing report was released at the end of 2010 and much of this year has been spent digesting its recommendations and searching for ways to put them into practice.

Here's a quick rundown of the most pressing issues for Nursing in 2012:

1. Advanced degrees are no longer optional

The IOM's recommendation for 80% of all RNs to have a baccalaureate degree by 2020 has not veered too intensely into the old ADN vs. BSN quagmire. Instead, the profession is focusing on ways to engage nurses in lifelong learning so that associate degree nurses can find realistic ways to obtain BSN degrees.

In addition, BSN nurses are encouraged to be leaders in evidence-based practice and research and it's becoming more common—and crucially, more expected—for nurses to pursue master's degrees. And the creation of the doctor of nursing practice degree has taken off better than anyone could have expected.

In the last six months, any time nurse executives get together, the conversation always turns to who has already entered a program and how long it's going to take the rest of the group to do so.

 
2. Patient engagement gets real

If you haven't found a way to drive home the importance of patient experience to direct-care nurses, find it now. You know how much reimbursement is at stake, but the rank and file caregivers still don't get it. The term "patient experience" has a way of annoying bedside caregivers. '"We're not Disneyworld," is a common refrain; people don't want to be in the hospital. "I'm here to save patients' lives, not entertain them," is another common complaint.  

Experience isn't about mollycoddling patients, however, or how flashy the in-room entertainment system is and that's what you need to help nurses understand. In fact, the nurse-patient relationship has always been about patient experience.

Your best nurses instinctively know this. They already create a good patient experience. They help patients understand their care, involve families in decision-making, coordinate multidisciplinary care, sit with patients to explain complex diagnoses, and even, occasionally, have time to offer a quick hug or hand to hold. These are the nurses who get letters from patients and families after discharge and these letters are all about the patient experience.

This is how you need to phrase patient experience with nursing staff so they understand it's not just a program, but a way of life. At the same time, nursing needs to own the cause. They may not be responsible for it in isolation, but they are literally at the center of this issue. They should take the lead and drive the agenda.

3. Patient safety

Just as nurses should own patient experience, they need to feel ownership for patient safety as well. It has been written that "quality improvement becomes one more meaningless directive from 'above' unless nurses feel engaged in the process, involved in the plans, and accountable for the results."

Preventing healthcare-associated infections (HAI) is no longer simply the right thing to do, it's become the only financially viable option. Unless nurses are educated and empowered, real progress cannot be made.

4. Cost cutting

Nursing knows that hiring freezes and layoffs are a constant threat and healthcare organizations are forced to put cost cutting at the top of the agenda in 2012. As the largest budget in the organization, nursing is an easy target.

Organizations can get more agile with staffing and scheduling and find creative ways to reduce cost while maximizing efficiency. Embrace change and flexibility to create the mobile, agile workforce healthcare organizations need to adapt to changing economic realities and increases in patient population.

At the same time, staffing budgets can't be viewed in isolation. There are direct links between nurse staffing and length of stay, patient mortality, readmissions, adverse events, fatigue-related errors, patient satisfaction, employee satisfaction, and turnover. This article examines the danger of considering the cost of nurse staffing without looking at everything else. It's important to understand the relationship between length of stay, unreimbursed never events, and nurse staffing to understand the whole picture.

5. Retention

It's been said before, but ignore retention at your peril. The nursing shortage hasn't gone away simply because the recession has eased its immediate effects. We all know the turnover rate for new graduate nurses is always high, so invest in nurse residency programs that have proven results for retention and for increasing the competency of new nurses.

Physicians, nurses, allied health professionals and pharmacists are using social media tools to network with professional colleagues, track down job leads and apply for new positions, according to a new survey.

The survey was conducted by AMN Healthcare, which bills itself as the nation's largest healthcare staffing and workforce solutions company. AMN Healthcare's "2010 Social Media Survey of Healthcare Professionals" was designed to provide healthcare employers and leaders a snapshot of how healthcare professionals are currently using social media and other online applications for networking, job hunting and other career development activities. The survey, which was conducted this fall, received 1,248 responses.

The survey suggests that traditional methods of recruitment such as referrals, online job boards and search engines are not being superseded by social media, whereas social media does surpass other job search methods such as newspaper ads, career fairs and other methods.  At the same time, social networking sites are experiencing tremendous growth, and have become the new frontier in professional networking and career development for physicians, nurses, allied health professionals and pharmacists. Job candidates are spending more time online and experimenting with media sites for job searches, but have thus far found minimal success in securing interviews, job offers and positions.

"It's not surprising that social media and mobile media usage have become additional job sourcing methods for healthcare professionals and a way to network with peers and companies," said Susan Salka, AMN's president and CEO. "What this tells us is that job seekers will add new methods and continue to replace those that don't work as they have access to innovative new resources. As the nation's largest healthcare staffing company, we find this information valuable in being able to connect with top talent in healthcare today. It will be interesting to compare this year's results with those from 2011 and beyond to gauge the search methods and developing preferences of job seekers."

Key survey findings:

    Thirty-eight percent of clinicians surveyed are currently seeking employment, and 12 percent of current job seekers have been looking for more than a year.
    Nurses have had a significantly shorter job search than their fellow professionals, averaging three months, compared to just less than seven months for physicians and allied professionals, and nine months for pharmacists.
    Thirty-seven percent of clinicians reported using social media for professional networking; nurses had the highest use among healthcare workers at 41 percent.
    Ten percent of healthcare professionals are using mobile job alerts, but only 3 percent have received an interview, 2 percent have received a job offer and 1 percent secured a new job.
    Physicians are by far the heaviest users of mobile devices for professional reasons among their medical colleagues; 37 percent used healthcare-related applications and 17 percent used mobile devices for healthcare-related content or jobs.
    Sixty-four percent of the clinicians surveyed would choose Facebook, the clear favorite, if they could choose only one social networking site.

1. Communication Skills

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

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

 

2. Emotional Stability

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

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

3. Empathy

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

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

4. Flexibility

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

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

5. Attention to Detail

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

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

6. Interpersonal Skills

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

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

7. Physical Endurance

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

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

8. Problem Solving Skills

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

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

9. Quick Response

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

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

10. Respect

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

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

Time spent and social sites visited outpace other US internet user groups

US Hispanics are more active on social media than the average US internet user, and are logging in more frequently to a wider variety of social sites.

The February 2012 “American Pulse Survey” from BIGinsight of US adult internet usage found that, while greater percentages of black internet users spent larger blocks of time online than the other groups studied, Hispanic internet users spent more of their online time on social media sites.

On an average day, 26.8% of Hispanic internet users spent six hours or more on social media sites, while 20.4% of black internet users and only 8.5% of total internet users spent that much time on social sites.

Looking specifically at which sites social-savvy Hispanics were using, the survey found US Hispanics were willing to participate in some newer and smaller social sites, logging in more often to networks like Pinterest, foursquare and LinkedIn, for example, than the average US internet user.

In the case of LinkedIn, 15.5% of US Hispanic internet users logged in to that site at least once a day, compared to 10.9% of black internet users and 4.9% of white ones. And, while 85% of white and 82.7% of black internet users reported not having an account on Pinterest, that number dropped to 71.5% among Hispanic internet users.

As marketers work to reach these active Hispanic internet users, data about which social sites Hispanics prefer and their frequency of use can be key to understanding where and when to connect with these consumers.

Corporate subscribers have access to all eMarketer analyst reports, articles, data and more. Join the over 750 companies already benefiting from eMarketer’s approach.

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.

In addition to being a Career Job Board for student Nurses up to CNO's, we are an Information Resource. We hope you find this "Focus on Diversity" story particularly interesting...

Pat Magrath, National Sales Director at DiversityNursing.com recently sat down with Dr. Earlene Avalon, PhD, MPH, Director of Nursing Diversity Initiatives; and Eva Gómez, MSN, RN, CPN, Staff Development Specialist at Children's Hospital Boston to discuss the Nursing Career Lattice Program, Diversity and Cultural Competence, and their roles at Children's Hospital Boston.

 

Dr. Avalon has overseen The Nursing Career Lattice Program (NCLP) at Children's Hospital Boston since the Program started in 2009. The NCLP is an initiative designed to increase the racial and ethnic diversity of Children's nursing staff. Through a generous grant, the NCLP was designed to "address the local shortage of nurses of color as well as to create a workforce that better reflects our patient population's multi-ethnic and multi-racial makeup. The Lattice Program looks for potential nursing students among our current employees-including Clinical Assistants, Surgical Technicians, Administrative Assistants and Food Service staff." The NCLP provides the services and support employees need to complete their education in various nursing schools throughout the Boston area.  

 

Dr. Avalon states, "It is important to note that I am not a nurse by training. My training is in public health and workforce development in healthcare. I have always been interested in ways that we can increase diversity at the provider level (e.g. nursing) and how that impacts patient satisfaction and outcomes."   

 

Dr. Avalon suggests "workforce development programs are a win-win for both the employee and the hospital. In particular, given the significant impact that nurses have on the lives of our patients and their families, we are committed to continuously growing a nursing workforce that is able to successfully meet the needs of our changing patient population."

 

"Our work focuses on looking within our own four walls and developing our employees to their fullest potential," says Dr. Avalon. "One of my responsibilities, and truly one of the best aspects of my job, is the opportunity to sit down with an employee and discuss their aspirations and any challenges they face in pursuit of a career in nursing.  For many, they were forced to put their dream of becoming a nurse on hold.  Oftentimes, employees express that they are the first in their family to attempt college-level courses and they do not have support systems at home. As a result, they often do not know what questions to ask or where to begin and this can negatively impact their success in college. NCLP offers support to our employees that allows them to realize that they are not alone in this process."  

 

The program provides employees with one-on-one mentoring, professional development, academic counseling and the financial support needed to successfully complete nursing school. "My team helps employees to create a semester-by-semester plan that will enable them to pursue their dream of becoming a nurse - even if it is on a part-time basis." Dr. Avalon continues "We also support our employees by providing them with an experienced nurse as a mentor and the opportunity to shadow a nurse in order to have a better understanding of the profession."

 

NCLP is not just an academic resource; they help each employee with tutoring, selecting pre-nursing coursework as well as creating a plan to help balance the demands associated with school, transportation, family and work. NCLP enables Children's Hospital Boston to create a strong multicultural workforce that provides the best family-centered care to their patients and community.

 

Five years ago Ms. Gomez came on board as a Staff Development Specialist to focus the work on Cultural Competence and Diversity. She states, "Among my many roles, I lead the Multi-Cultural Nurses' Forum, the Student Career Opportunities Outreach Program and I provide Cultural Diversity Awareness training to staff throughout the hospital."

 

I asked Ms. Gomez why Healthcare Institutions should have someone like her on their staff. She responded, "Cultural competence and diversity are two essential ingredients in delivering care for all patients and should be assets that are recognized, valued and embraced at every level of any hospital or healthcare institution. Awareness, advocacy and education are essential components of successful diversity and cultural competence initiatives. Having someone in this role can help hospitals remain on track by carrying out the activities that drive these initiatives. This effort will ultimately lead us into providing care for all of our patients in a culturally appropriate and meaningful way."

 

She also states, "The work of diversity is ongoing and evolving. In 5-10 years, we will probably have grown and improved the diversity within the nursing profession. However, I expect we will continue to work so our efforts don't become stagnant and we need to sustain the positive changes achieved thus far. The future is hopeful, but it will require time, dedication and work from all of us."

 

Working together with other Children's Hospital Boston employees, Dr. Avalon and Ms. Gomez have:

• Organized and coordinated The Multi-Cultural Nurses' Forum, which included their first-ever night session. This session was held at 2am in order to better meet the needs of their night nurses. The hospital's CNO and Senior Vice President, Eileen Sporing attended the meeting in order to have a one-on-one conversation with the night time nursing staff who are part of the forum.
• Brought diverse high school students into the nursing profession through their Student Career Opportunities Outreach Program.
• Created a successful nursing mentoring program.