DiversityNursing Blog

Meg Beturne MSN, RN, CPAN, CAPA
Denise Colon, RN
Baystate Health System, Springfield, MA

This article was submitted by Meg Beturne RN, MSN, CPAN, CAPA,  Assistant Nurse Manager @ Baystate Orthopedic Surgery Center in Springfield, MA.  Meg became a mentor and participated in "Baystate Health’s Diversity Leadership Initiative, Mentoring Across Differences" Program. A Dimensions of Diversity Exercise (copyrighted in 2011 by Washington Orange Wheeler Consulting firm http://wow4results.com) was offered as part of the Program.

The exercise is a puzzle that shows the complexity of mentoring across differences. Understanding how these differences have impacted us and others helps to create a container for meaningful dialogue. Consider how various differences could impact your mentoring relationship. To participate in this exercise, you identify a few  dimensions of diversity that have had an important role in impacting who you are, how others see you, and how you see the world. You then figure out how the dimensions shaped who you are personally and professionally. Finally, how might these dimensions impact your mentoring relationship? 

Meg, a Caucasian Catholic, mentored Denise who has a Latina background with strong family ties and a culture that is filled with traditions that are vital to her life and that of her family and extended family. Denise is Roman Catholic and she works to maintain a healthy balance between work and home as she has a young family. Here is their mentoring story…

Impact on Differences 

As I began the mentoring relationship with Denise, I realized the importance of recognizing and understanding the differences and similarities that existed between us. Equipped with this knowledge, I felt that we could tackle the complexities of mentoring across differences. The Dimensions in Diversity exercise offered the perfect opportunity to explore key, diverse components that have made us the women and nurses that we are today. To that end, we made this a priority and discussed it at our very first meeting and then confirmed our thoughts and feelings at our next time together.

It was interesting to realize that both of us equally valued traditions and observances, but from a different perspective. We both enjoy sharing the particulars of the holiday traditions through the years and reminisced on who was present, the activities that took place, the photos that were taken and the memories that were made and cherished by future generations. Denise however was vocal that many persons that she has interacted with over time do not have a real understanding of the ethnic backgrounds that are celebrated in the various holidays. That being said, there is a lack of appreciation from culture to culture on the meaning and purpose of observances involving family and relatives. I had to admit that since I had grown up in a small mill town in Connecticut that was homogenous with regard to ethnicity and religion (Caucasian Catholics), I was not exposed to comments, conversations or messages that demonstrated anything but allegiance to the existing cultural observances and inclusion of the small numbers of diverse ethnic and religious populations that resided close by.

Denise chose accent and dialect as another dimension of her diversity. She relayed the fact that many individuals and groups do not make an attempt to understand or accept anyone who speaks in a certain way. This scenario creates feelings of self-doubt. In addition, it allows feelings of rejection to creep in that ultimately results in further retreat into one’s own ethnicity which is considered supportive and safe. As a registered nurse, Denise has encountered many patients and caregivers from all corners of the globe. Working with a team of professionals, Denise has gained acceptance and recognition as a caring and compassionate care giver and over time, interactions and conversations have focused on quality care rather than on accent or dialect.

I then shared that communication was a vital personal and professional dimension that affects my life in so many ways. Even though my communication style is open, friendly and positive, I have learned that being a good listener is actually a more important skill. I found myself connecting with Denise’s story and promised myself to be even more in tune with people I meet on a daily basis who might sound different than me. In my own way, I will seek to eliminate self-doubt by encouraging others to use their native voices to raise questions, contribute ideas and feel reassured that they will be understood.

As I reflect on this meeting with Denise, I am amazed at the information that was willingly shared and the conversation which was free-flowing and enjoyable.  Most importantly, after completion of this exercise, I feel more prepared then ever to be the type of mentor that will enable Denise to move forward in both her professional career and her personal life!

A special thank you to Denise Colon, RN for her participation.

By MICHELLE T. JOHNSON
http://michelletjohnson.com
Special writer to The Kansas City Star

September is Hispanic Heritage Month, which makes me realize how little reliable information — vs. stereotypes and inaccuracies — there is about Hispanics in the workplace.

Unfortunately, what pops into the minds of many when they think about Hispanics in the workplace is “illegal immigrants.” I’ve heard far too many people who should know better make that assumption.

This in part comes about because of what people see on television and the Internet, and because we tend to turn bits of anecdotal evidence into something we “know.”

In truth, Americans of Hispanic descent grapple with the same issues as any other group in the workforce — and like many groups battling stereotypes, their challenges are often greater than average.

For example, a recent study found that Hispanic workers were twice as likely to hold administrative or clerical entry-level jobs as “nondiverse workers,” which the study defined as white males who were not disabled, gay or transgender.

The study also found that 51 percent of the Hispanic workers surveyed were likely to be making less than $50,000 a year, compared with 31 percent for the non-diverse workers.

In terms of demographics, Hispanics have long since passed African-Americans as the largest U.S. ethnic minority, with 50 percent population growth in the last decade alone. And the most recent news is that Hispanics are the largest ethnic minority enrolled in college.

My longtime friend Mary D. Padilla says that one of the biggest misconceptions she thinks people have about Hispanics, especially in the workforce, is that they are all Mexican or of Mexican descent.

An estimated 63 percent of U.S. Hispanics are of Mexican descent, so that leaves more than a third who are not.

Diversity is about the distinctions and not just the differences. Details matter. Different groups have different cultural norms, different histories and different worldviews.

Hispanic Heritage Month is meant to remind us of that — it’s more than just having a fiesta with a feast in the lunchroom. We should recognize, celebrate and become educated about a big segment of our workforce.

Read more: http://www.kansascity.com/2011/09/05/3122994/assumptions-hurt-hispanic-workforce.html

Staff Assistant
Hausman Diversity Program at Mass General Hospital

The Hausman Student Nurse Fellowship was created when MGH patient Margaretta Hausman, a social worker and graduate of Brown University, recognized the need for diversity among the top-level nursing staff. The Hausman Student Nurse Fellowship provides an opportunity for minority nursing students enrolled in an undergraduate baccalaureate nursing program to gain experience in patient care across the continuum.

The fellowship allows student nurses between the summer of their junior and senior year in college to experience care at the bedside in both inpatient and outpatient settings.  Under the mentorship of Deborah Washington, R.N., Director of Diversity for Patient Care Services and Bernice McField-Avila MD, Co-Chair of the Fellowship, the recipients have an opportunity to further develop skills required to thrive in a workplace where unique challenge to the minority nurse must be managed.

The first fellowship was awarded to Stevenson Morency in 2007.  The program flourished significantly and in 2011, the fellowship was awarded to 8 minority student nurses, the largest group in the history of the program. The Student Nurses worked on various units such as Endoscopy, Orthopedics, General Medicine, Thoracic Surgery, Cardiac Unit, Neurosurgery Unit, Wang Wound Care, Cancer Center and the Grey IV department.

At the graduation ceremony on August 19, 2011, the Hausman Student Nurses provided feedback about their time in the program. Vicky Yu, a student of UMass and a 2011 recipient, felt honored to be part of the fellowship. She stated she saw many procedures she had only read about in her textbooks: colonoscopy, hip/knee replacements and urinary catheterization. “I got to work with a nurse 1-on-1. I don't get this attention on my school clinical and I loved it!” stated Vicky.   

Jennifer Etienne of Boston College stated: “As a minority nurse, it will be my mission to eliminate health care disparities and use my skills and knowledge to eliminate language barriers and become more culturally competent.”

Marthe Pierre shared: “The Hausman Fellowship is a ladder that provided a stepping-stone to my success. It allowed me to acquire skills, knowledge and confidence. It has also ignited my desire to one day become an extraordinary nurse who is culturally competent and compassionate.”

Jeffrey Jean of UMass Boston expressed that the program has reaffirmed his knowledge and his clinical experience. “Being able to walk in the shoes of a different RN has allowed me to re-invent myself. I have learned an abundance of new skills and techniques and have acquired a vast amount of knowledge. I believe that an important component of being an effective caregiver is to know what my strengths are.”

Sedina Giaff of Simmons College declared “It is with great pride that I introduce myself as a Hausman Fellow. This has been the best summer of my life. My experience as a Hausman Fellow has made me a better nursing student both clinically and intellectually. I have a better understanding and greater interest in the nursing profession. I am confidently looking forward to the coming school year and sharing my experiences with my classmates.”

Lauren Kang-Kim of Linfield College in Oregon had this to say: “Now I am reborn as a Hausman Fellow. For the last 5 weeks I found my own powerful voice and I am now proud of my minority identity. The Fellowship has opened the doors for me to become not just a better nurse, but a better person with a deeper understanding and respect for human beings.

Rosalee Tayag and Anna Diane of UMass Boston and Boston College respectively, stated that the Fellowship enhanced their leadership, critical thinking, assessment and communication skills; and  taught them to be more culturally sensitive. They also emphasized that they learned to work as members of a team more effectively.

Former 2010 Hausman awardees, Jason Villarreal and Penina Marengue, congratulated the Student Nurses on their graduation and cautioned them to use their new-found knowledge to provide competent care to their patients and uphold the good name of the Hausman Fellows.

Former Hausman Fellows include: Frew Fikru, Alexis Seggalye, and Christopher Uyiguosa Isibor 2008.  Chantel Watson and Stephanie Poon 2009.

The Hausman Fellowship is posted by Spring of each year at www.mghcareers.org. Qualified minority candidates should be in good academic standing (3.0 GPA or higher) and entering their senior year of a BSN program in the Fall.

Mr. W had a heart attack and was in the ICU last week.  While reviewing his discharge medication list, you realize Mr. W unintentionally discontinued his medication for hypertension and dyslipidemia.  Unfortunately, these medications were not on the discharge medication list.  

Jay has been a well controlled diabetic for many years.  Today his A1C is 10.5.  He insists he is taking his medication regularly.  

A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. ¹   Efforts to decrease or prevent medication errors often focus on improving systems and procedures utilized by nurses, physicians and pharmacists during the multistep process of medication administration.  Decreasing medication errors by patients must also be addressed.  

According to the landmark 2006 report "Preventing Medication Errors" from the Institute of Medicine, medication errors injure 1.5 million Americans each year and cost 3.5 billion in lost productivity, wages and additional medical expenses.^​2 1/3 of medication errors occur in outpatient settings.  Patients often unintentionally discontinue medications after a hospitalization or transfer of care.  Numerous studies have shown that patients with chronic conditions adhere only to 50% to 60% of medications as prescribed despite evidence that medical therapy prevents death and improves quality of life.³   Knowledge deficits and poor understanding of drug label directions often result in medication errors initiated by patients. 

How to reduce medication errors by patients:

1. Decrease medication knowledge deficits.  Review with patients in plain language what medications were prescribed, how to take them, discuss side effects and address concerns regarding drug interactions and cost.  Use visuals and show me techniques to ensure patient understanding.  Enlist the help of the PCP and pharmacist for additional education.
2. 2.   An accurate medication list that includes discharge medications and/or chronic care medications is essential.  Learn how to take an accurate medication history.    Use clear communication techniques during conversations with patients.  Provide patient and PCP with discharge medication list.   
3. Monitor for medication adherence.  Ask patients to bring in all of their medications or contact pharmacies for information on most recent refill dates.  Evaluate and address medication knowledge deficits.  Medication reminders, automatic med refills, medication home delivery, assistance of family members or home care services can be utilized to improve adherence.  Call recently discharged patients to ensure they are taking prescribed medications and chronic care medications. 

Stephanie Wilborne, APRN

HealthLit.com:  Clear & Simple Patient Education/ Tools for Chronic Disease Management

¹ National Coordinating Council for Medication Error Reporting and Prevention: http://www.nccmerp.org/aboutMedErrors.html

²Anderson, Pamela, and Terri Townsend. "Medication errors: Don't let them happen to you." American Nurse Today 5.3 (2010): 23-27: http://www.nursingworld.org/mods/mod494/MedErrors.pdf

³ Bosworth, Hayden, Bradi Granger, Stephen Kimmel, Larry Liu, John Musaus, William Shrank, Elizabeth Buono, Karen Weiss, Christopher Granger, Phill Mendys, Ralph Brindis, Rebecca Burkholder, Susan Czajkowski, Jodi Daniel, Inger Ekman, Michael Ho, and Mimi Johnson. "Medication adherence: A call for action." American Heart Journal 162.3 (2011): 412-424. Print.

⁴ Preventing Medication Errors: Quality Chasm Series Committee on Identifying and Preventing Medication Errors, Philip Aspden, Julie Wolcott, J. Lyle Bootman, Linda R. Cronenwett, Editors