DiversityNursing Blog

11:10AM EDT October 5. 2012 -From USAtoday.com

As Baby Boomers age into retirement by the millions each year, their growing health care needs require more people to administer that care.

That makes fields such as nursing one of the fastest-growing occupations, and hospitals are hiring now to prepare for what's to come.

Central Florida Health Alliance has 140 to 170 open positions a week, and almost 90% of them are for jobs that include registered nurses, pharmacists, physical therapists and pharmacy technicians, says Holly Kolozsvary, human resources director.

The two-hospital system based in Leesburg and The Villages is hiring for its peak season from January to April, when many retirees seek winter refuge in the Florida sun. But it's also managing a trend that requires it to employ more people year-round: More retirees aren't leaving at the end of spring, Kolozsvary says.

"It's kind of a domino effect," she says. "They move here, they're well, they get sick, they're left here through their cancer or heart disease, and we have to take care of them."

Job postings on Monster.com for positions including registered nurses, physical therapists and physician assistants rose 13% from June 2011 through June 2012, according to a 2012 health occupational report by the job site.

The additional demand could be due partly to hospitals preparing for the retirements of many older nurses as the economy gets better, increasing the need for new skilled workers. Scripps Health, a group of five hospitals and 23 outpatient facilities in San Diego, plans to hire about 400 nurses a year over the next three years but might need to increase that by 200 annually because of retirements, says Vic Buzachero, senior vice president for human resources. About 30% of the hospitals' nurses are older than 50.

Jamie Malneritch applied for a part-time job as a registered nurse with Scripps in March and heard from the hospital the same day she submitted her application. She started working a month later.

The 31-year-old, who has worked as a nurse for four years, says the job security and growth opportunities were primary drivers in her decision to go to nursing school in 2006.

"It seems like we always need more hands," she says. "Nursing is flourishing."

With an average salary of $64,690 a year, according to 2010 data from the Bureau of Labor Statistics, registered nursing may be the more desired profession, but lower-paid home health aides are actually in higher demand.

An industry shift that puts more emphasis on outpatient care and home health services makes home health and personal care aides two of the fastest-growing occupations in the country. Employment in both positions, which have an average salary of about $20,000 a year, is expected to grow by about 70% by 2020, BLS data show. Registered nursing is expected to grow 26%.

ResCare HomeCare, a national provider and employer of home health and personal care aides, who work primarily with seniors with chronic illnesses or disabilities, has received 32,000 applications this year, a 23.3% jump from last year, and it hired 6,000 of the people who applied, about 5% more than in 2011, says Shelle Womble, senior director of sales.

Home health and personal care aides are generally the same, providing services such as checking vitals, prepping meals and bathing and grooming the patient. But home health aides are funded by Medicare and, in some states, require more training, while personal care aides are funded privately and may require less training, Womble says.

ResCare, where aides make $22,000 to $30,000 a year, is anticipating the need for more workers in the near future.

"Right now, one of our key positions is that we are hiring the talent before we even get the clients so we can be prepared and have the staff available," Womble says of home health and personal care aides. "There's a lot more competition for that type of employee."

By Shantelle Coe RN BSN - Diversity and Inclusion Consultant

Creating an environment that embraces diversity and equality not only attracts the most qualified nursing candidates, but an inclusive environment also helps to assure that the standards of nursing care include “cultural competency.”  Cultural differences can affect patient assessment, teaching and patient outcomes, as well as overall patient compliance.

Lack of cultural competence is oftentimes a barrier to effective communication amongst interdisciplinary teams, which can often trickle down to patients and their families.

With the increase in global mobility of people, the patient population has become more ethnically diverse, while the nursing forces remain virtually unchanged.  Nursing staff work with patients from different cultural backgrounds.  Consequently, one of the challenges facing nurses is the provision of care to culturally diverse patients.  Hospitals and healthcare agencies must accommodate these needs by initiating diversity management and leadership practices.

According to Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989); these are the 5 essential elements that contribute to an institutions ability to become more culturally competent:

• Valuing diversity

• Having the capacity for cultural self-assessment.

• Being conscious of the dynamics inherent when cultures interact.

• Having institutionalized cultural knowledge.

• Having developed adaptations of service delivery reflecting an understanding of  cultural diversity. 

A culturally competent organization incorporates these elements in the structures, policies and services it provides, and should be a part of its overall vision.

From all levels, the nursing workforce should reflect the diversity of the population that it serves.  A more diverse workforce will push for better care of underserved groups.  It’s important to note that that diversity, inclusion, and cultural awareness isn't just about race or ethnicity.  We must always keep in mind socioeconomic status, gender, and disability in our awareness.

Becoming more inclusive is a shared responsibility between nurses and healthcare agencies.  Becoming an “agent of change” within your facility can inspire awareness and affect attitudes and perceptions amongst your peers. 

Nurses and healthcare workers must not rely fully on the hospital and healthcare systems to institute an environment of cultural awareness.   

Nurses can increase their own cultural competencies by following a few guidelines:                                   

• Recognizing cultural differences and the diversity in our population.

• Building your own self-awareness and examining your own belief systems.

• Describing and making assessments based on facts and direct observation.

• Soliciting the advice of team members with experience in diverse backgrounds.

• Sharing your experiences honestly with other team members or staff to keep communication lines open.  Acknowledging any discomfort, hesitation, or concern.

• Practicing politically correct communication at all times –  avoid making assumptions or stereotypical remarks.

• Creating a universal rule to give your time and attention when communicating.

• Refraining from making a judgment based on a personal experience or limited interaction.

• Signing up for diversity and inclusions seminars.

• Becoming involved in your agencies diversity programs – find out what your resources are - most institutions have something in place.

By incorporating a few of these steps into your daily nursing practice, you are taking steps towards becoming culturally competent.

Inclusive nurses demonstrate that we are not only clinically proficient and culturally competent, but are the essence and spirit of the patients that we care for.

Here is a chart let you know the largest number of healthcare professions which is 2.6 million registered nurses in USA also show how much they earn in different levels.
Nurses have always played a first-rate role in people’s lives. They perform a wide range of clinical and non-clinical functions that are necessary in the delivery of health care
Certified Registered Nurse Anesthetist salary around $135,000
Nurse Researcher salary around $95,000
Psychiatric Nurse Practitioner salary around $95,000
Nurse Practitioner salary around $78,000
Clinical Nurse Specialist salary around $76,000
Gerontological Nurse Practitioner salary around $75,000

Without cultural diversity amongst healthcare providers, it is almost impossible to provide quality nursing care to people from different ethnic and socioeconomic backgrounds. A multicultural representation of nurses, physicians and clinicians is important to ensure the healthcare being delivered is sensitive and meets the physical and holistic needs in our “patient palette”.

In the United States, a rise in the population and increase in minorities further challenges our healthcare system to provide appropriate care to the ever changing population it serves.

Some of the major findings in a study on the changing demographics and the implications for physicians, nurses and other healthcare workers conducted by the US Department of Health and Human Resources are bulleted here:

• Minorities have different patterns of health care use compared to non-minorities. Disparities in access to care account for part of the difference in utilization.
• Demand for health care services by minorities is increasing as minorities grow as a percentage of the population. Between 2000 and 2020, the percentage of total patient care hours physicians spend with minority patients will rise from approximately 31percent to 40 percent.
• Minorities are underrepresented in the physician and nurse workforce relative to their proportion of the total population.  As minorities constitute a larger portion of the population entering the workforce, their representation in the physician and nurse professions will increase. The U.S. will increasingly rely on minority caregivers.
• Minority physicians have a greater propensity than do non-minority physicians to practice in urban communities designated as physician shortage areas. An increase in minority representation in the physician workforce could improve access to care for the population in some underserved areas.

The study also summarizes: “Advocates for increased minority representation in the health workforce argue that increasing the number of minority physicians will improve access to care for minorities and vulnerable, underserved populations. These advocates argue that increased representation of minorities in the health workforce not only will increase equity, but will also improve the efficiency of the health care delivery system”. (HRSA 2000)

Men (of all backgrounds) are also far under-represented in nursing.  Less than 1 percent of the population are male nurses.

As our nursing population lacks diversity, statistics show that the US population is becoming more diverse and will continue on through the decades.

Below are projections for the increase in diversity amongst minorities in the United States:

Source: Modified version of Census Bureau middle series projections.

As our demographics continue to change, one of our greatest challenges is getting hospital organizations along with healthcare administration to realize that, in order to provide the best care and ensure successful patient outcomes, we have to embrace diversity. This is especially challenging to nurses because they will be expected to deliver care that encompasses these differences. Many nursing task force teams and associates have been organized to address this issue of healthcare diversity, such as:

• Asian American/Pacific Islander Nurses Association, Inc. (AAPINA)
• National Alaska Native American Indian Nurses Association, Inc. (NANAINA)
• National Association of Hispanic Nurses, Inc. (NAHN)
• National Black Nurses Association, Inc. (NBNA)
• Philippine Nurses Association of America, Inc. (PNAA)

For nursing care of all cultures and backgrounds, we owe it to our profession to increase our awareness and get involved to ensure delivery of the best care possible. One of the most important steps any of us can take is to first embrace diversity.

In an era in when hospitals compete for patients by boasting the latest clinical technology, the most prestigious physicians and impressive amenities, patient satisfaction is most influenced by human factors, especially superior service-related communication skills between hospital staff and patients, according to the J.D. Power and Associates 2012 National Patient Experience Study released today.

The study measures patient satisfaction across all areas of the inpatient and outpatient hospital experience, including: interactions with healthcare professionals; tests and procedures; admission and discharge; and facility environment. It serves as a benchmark for the J.D. Power and Associates Distinguished Hospital Program. This distinction program acknowledges high levels of performance by a hospital in achieving an “outstanding” inpatient, emergency department, cardiac, maternity or outpatient experience. 

The study finds that recently-hospitalized patients have high levels of overall satisfaction. Overall patient satisfaction with their inpatient hospitalization averages 825 index points on a 1,000-point scale, similar to that of guests at luxury hotels, among whom satisfaction averages 822. In outpatient settings, overall patient satisfaction is higher, averaging 863. However, patient satisfaction dips to 788 for emergency department visits.

“Hospitals may attempt to attract patients and staff by adding equipment or sprucing up their facilities,” says Rick Millard, senior director of the healthcare practice at J.D. Power and Associates. “From the perspective of patients, it might be more worthwhile to invest in finding and keeping staff with superior interpersonal skills.”

Investments in staff can be overlooked, as Millard notes many hospitals have spent a lot of money in recent years to make their facilities look and feel more like hotels. Yet, facility characteristics are more important for hotels than for hospitals.  For upscale hotels, the facility accounts for nearly one-half (48 percent) of guests’ overall satisfaction, while in an inpatient setting the hospital facility represents just 19 percent of patients’ overall satisfaction. 

“Having an appealing hospital facility matters, but an experienced and socially skilled staff has a greater impact on patient satisfaction,” says Millard. “Personal interactions with the staff have a profound impact in both inpatient and outpatient settings.”

Doctors and nurses account for 34 percent of the overall experience ratings for inpatients, and their influence is even higher (43 percent) among patients in emergency settings. Among outpatients, doctors and other healthcare professionals represent 50 percent of their overall experience.

Solid interpersonal skills are especially necessary for handling the types of problems that may arise during hospitalization. When problems do occur, they may jeopardize patient satisfaction. According to the study, staff service and staff attitude are the most common types of problems that patients experience. Patients who say they had any problem with their room or hospital staff rate their overall experience a 5.3 a 10-point scale, compared with 8.7 among patients that did experience any problems.  

“When problems occur, they produce opportunities to demonstrate a genuine interest in the patient’s needs,” says Millard. “Resolving problems is clearly associated with higher ratings by patients. This has become more important as hospital reimbursement is now linked to patient satisfaction as measured by the government through the HCAHPS [Hospital Consumer Assessment of Healthcare Providers and Systems] survey.”

Millard notes that one area where hospitals can learn from hotels is how transitions occur. The admission and discharge process in hospitals is analogous to check-in and check-out in the hotel industry. Among inpatients, 35 percent of the overall patient experience is predicted by the admission and discharge process; yet the impact is much less in emergency and outpatient settings, where it is 19 percent and 12 percent, respectively.

“The first and last impressions are very important for a patient, much like they are for hotel guests,” says Millard. “Getting a patient into a room quickly at the start of their hospital stay, and ensuring a smooth process during discharge, along with a follow-up call once the patient gets home to make sure they’re doing okay, goes a long way toward achieving high satisfaction.”

Nongovernmental, acute-care hospitals throughout the nation are eligible for the J.D. Power and Associates Distinguished Hospital recognition program. Recognition is valid for one year, after which time the hospital may reapply. The service excellence distinction is determined by surveying recently discharged patients regarding their perceptions of their hospital experience and comparing the results to the national benchmarks established in the National Patient Experience Study.

The 2012 National Patient Experience Study is based on responses gathered between December 2011 and March 2012 from more than 10,275 patients who received care in inpatient, emergency or outpatient facilities in the United States.

Source: Infection Control Today