DiversityNursing Blog

from USA Today

COCOA BEACH, Fla. -- Yvonne Yacoub has been a nurse for half a century.

In 50 years, she has seen her profession redefine itself to meet the challenges of change, yet continue to struggle with shortages of new practitioners.

Yacoub, 72, who has worked at Cape Canaveral Hospital here for 36 years, is decades older than the 46-year-old average age of employed registered nurses. Some veteran nurses continue to work, but many more have hung up the scrubs for good or are counting the days until retirement.

"In several years, we will see many nurses semi-retire or retire completely," said Bonnie Rudolph, vice president/chief nursing officer for Holmes Regional Medical Center in Melbourne, Fla., and Health First's chief nursing officer. "Nursing is a very physical job, and many nurses cannot continue to stand, lift patients and continue to work the required shifts."

As baby boomers age, the need for nurses will increase. Even though the number of licensed registered nurses in the United States has grown from 1.7 million in 1980 to 3.1 million today, the total is not enough to meet the expected demand. Registered nurses remain at the top of the list when it comes to employment growth, so hospital systems are being proactive in trying to retain older employees.

Recruiting more male nurses, now only 7 percent of the work force, could help ease the shortage.

Most male nurses, such as baby boomer Jim Carberry, a nurse supervisor in the intensive care unit at Holmes, enter the field as a second career. Carberry was a respiratory therapist for 20 years before becoming a nurse.

"I wouldn't say it's harder to be a nurse today. It's just different," Carberry said.

"With so much specialty nursing, we all have had to learn so many new ways of doing things," he said. "It's not just one nurse doing all of a patient's care in a day. It can be several with special skills."

While nursing schools are graduating highly skilled individuals, the experience of older workers is impossible to teach in a classroom.

Registered nurse Rebecca Madore, 23 on her third day on the job at Wuesthoff Medical Center -- Rockledge, Fla., acknowledges that the reality of nursing can be daunting.

"I learned a lot at school, but it's totally different when you're actually working the floor," she said.

Madore knew she wanted to be a nurse since she was a little girl, but for many of her colleagues, the profession is a career, not a calling.

"Each group's work ethic is different," said Suzanne Woods, vice president and chief nursing officer for Health First's community hospital division.

"The veterans and baby boomers feel almost total responsibility for the workplace and will come in on short notice and cover difficult shifts. This has always been their practice. The Gen X and Millenniums are more cognizant of home-and-life balance and strive to keep this in check."

Each generation also brings different skills, all needed to best serve patients.

"The younger nurses are very technologically advanced, but the older nurses are more connected with the patients," said Rosemary Walter, director of the medical/surgical unit at Wuesthoff in Rockledge.

Technological savvy, a given for new nursing grads and necessary for survival in the health care field today, can be difficult for older nurses to embrace.

"I feel we have an advantage over older generations in the new advancements of paperless systems, computer charting and the new diagnostics," said Michele McCray Miller, 26. "Throughout nursing school, we were constantly using simulated mannequins, computer programs and other electronic devices to master skills such as NG (nasogastric) tubes, catheters and IV skills. Older generations were not as lucky to have those resources in the classroom."

Allison Rogers has been a nurse for two years. Rogers' mother was a nurse. This member of Generation X had no doubts about her career choice.

"I know how important my job is, and I consider it an honor to care for patients the way I would want my family to be taken care of," Rogers said.

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!

 

Nurses are as diverse as the patients they treat.

But that diversity will become grayer for the next few years as more middle-age people are going into nursing as a second career.

That trend can be seen in the class that will graduate May 18 from Heartland Community College's two-year nursing program in Normal. Students graduate with an associate's degree in nursing and then may take the registered nurse licensing exam.

Non-traditional students — those who don't begin college right after high school — are the norm in Heartland's nursing program. But, in this class, none of the 40 students is a traditional student.

“I was pretty surprised when I started,” said second-year nursing student John Cook, 47, of Normal. “There was virtually no one right out of high school. I remember thinking that I'd be the oldest one in there by far and that's not the case.

“It's a huge cross-section of people with bachelor's degrees in other fields, including a lot of moms.”

Students begin clinical rotations at area hospitals and long-term care facilities during their first semester, said professor of nursing Barb McLaughlin-Olson. For every hour that they are in the classroom, in the lab and at clinical sites, they are expected to spend three hours on course work.

The nursing-as-a-second-career trend has been in place for several years, said Deb Smith, vice president and chief nursing officer of OSF St. Joseph Medical Center, Bloomington.

Some people who pursue nursing as a second career take advantage of accelerated, one-year nursing programs for people who already have a bachelor's degree, Smith said. For example, Illinois State University's Mennonite College of Nursing in Normal has an accelerated bachelor of science in nursing program.

Laurie Round, vice president of patient care services and chief nursing executive at Advocate BroMenn Medical Center in Normal, said the recession has driven some people from their original careers into nursing. Both ISU-Mennonite and Illinois Wesleyan University's School of Nursing in Bloomington reported an increase in enrollment last fall.

There is a demand for nurses because nurses work in hospitals, doctors' offices, businesses, insurance companies, long-term care facilities and churches. But second-career nurses also are drawn to the field for altruistic reasons, Smith and Round said.

“They want to do something that's meaningful,” Round said. “They want to touch peoples' lives.”

Middle-age adults going into nursing need to learn a career quickly and need to keep their energy level up.

Some middle-age adults are challenged by all the technology involved with patient care, Round and Smith said.

But the maturity and experience of second-career nurses generally makes up for any challenges.

“I love the energy, the intensity, the maturity and the decision-making skills that they bring to the field,” Round said. “These people are choosing nursing while raising a family and working at the same time and that shows perseverance, commitment and discipline.”

Second-career nurses not only come in with the experience of previous employment and raising a family. They also have social skills and because they are close in age to nurses already in the field — the average age of nurses is 47 — they fit in with other nurses quickly, Smith said.

McLaughlin-Olson said, “They can use their life experiences to help them become better nurses. Because they've lived through life's challenges, they've learned how to critically think when issues come up, and they have empathy and can relate to people having problems.”

But Smith and Round also are impressed with traditional nursing students, who graduate to enter nursing in their early 20s. They are intelligent, energetic and learn quickly, they said.

For that reason, both Round and Smith said middle-age, second-career nurses are not necessarily the new face of nursing.

“I see a great mix across generations,” Round said.

Adds Smith: “It's good to have people entering nursing with a variety of life experiences. That further enriches our profession.”

 

Adapated from a WBUR radio series. Links to Audio can be found below.

 

America's nursing shortage has been compared to a perfect storm gathering in intensity. In just over a decade nearly 80 million baby boomers will be in or reaching retirement, their medical needs placing an immense strain on our health care system. Nurses themselves will be leaving the profession and a younger generation of nurses will not be trained in enough numbers to fill the growing needs of hospitals and patients.

In "Nursing a Shortage: Inside Out," WBUR Special correspondent Rachel Gotbaum reports on how the shortage has come about and why it matters for nurses, hospitals and patients alike. She takes us into hospitals where the longest running nursing shortage in history is already impacting care. She reports on the roots of the problem that encompass not just the changing career choices for young women, the out-dated image of nursing but also the serious difficulties faced by nursing schools trying to find nurse-educators.

Nurses explain the effect of the shortage on their care of patients and how it is influencing their commitment to the profession and whether they stay or leave. Hospital administrators describe what they need to do to recruit and retain nurses in this competitive market , and Gotbaum reports on the growing tensions over whether mandating nurse-patient ratios is an answer to the problem or an impediment.

There have been shortages of nurses in this country since the 1960's but they have always resolved themselves fairly quickly. This nursing shortage began in 1998. Although it has been slightly alleviated it is expected to get worse when considering the increased retirement rates expected in coming years.

80 million baby boomers are slated to retire in the next decade and they will need a lot more medical care. At the same time many experienced nurses will be leaving the profession. The shortage began after managed care ushered in an era of cost cutting in the early 1990s. Nurses were replaced by lesser skilled workers. In Massachusetts 27 percent of hospital nurses were laid off, the largest number in the country. The profession became unattractive to women who began to have many other career choices. But as nurses left the workforce, studies showed that patient care suffered. One study published in the Journal of the American Medical Association found that patients whose nurse cares for 8 or more people have a 30 percent greater chance of dying than if their nurse cares for four patients. The same nurses are also more likely to be burnt out and dissatisfied with their jobs.

As hospitals started experiencing acute shortages of nurses, they responded by raising salaries and offering bonuses to nurses to enter the profession. Media campaigns were launched to extol the attractions of nursing. By 2003 185 thousand registered nurses entered this nation's hospital workforce. But even with this huge influx of nurses the shortage in 2007 still existed, and as demand for nurses increases many agree the gap will steadily grow. The number of registered nurses increased from approximately 2.5 million in 2007 to under 2.7 million in 2011. Despite this increase, some states are fighting about whether to mandate nurse-to-patient ratios. The number of new nurses is influenced by a large number of external factors so pinpointing the cause is difficult, but the significance of the increase is more important. Although 200,000 sounds like a lot of nurses, this is only an 8% increase. Just as important as the number of nurses is the number of patients which rose almost 10% from 2007 to 2008 alone according to the National Healthcare Cost and Utilization Project.

Audio Links Click Here

According to a recent survey conducted by Wolters Kluwer Health’s Lippincott Williams & Wilkins (LWW), 71 percent of nurses are already using smartphones for their job. The survey included responses from 3,900 nurses and nursing students. About 66 percent of those nursing students surveyed said they use their smartphones for nursing school.

Overall, 85 percent of the nurses and nursing students said they want a smartphone app version of LWW’s Nursing 2013 Drug Handbook. Some 87 percent of those surveyed said they would want a smartphone app version of the text as well as a print version.

This month LWW plans to launch its first mobile app version of the handbook. The new forthcoming app includes nearly 900 drug monographs addressing more than 3,000 generic and brand name drugs. The app also offers a dosage calculator, pill images, detailed monographs and weekly drug updates. The app will work on iPhone, iPad, and Android devices once it launches later this month.

Earlier this year the New York Times reported on the effects of the increased adoption of smartphones among students at nursing schools: “The most profound recent change is a move away from the profession’s dependence on committing vast amounts of information to memory. It is not that nurses need to know less, educators say, but that the amount of essential data has exploded,” the Times wrote.

In January Massachusetts General Hospital also announced plans to equip its nurses with iPhones thanks to a recent deal with Voalte. Voalte’s offering combines high-definition voice calls, critical care alarms and presence-based text features and is intended for use by staff in acute care hospitals in the US and Canada — especially nurses. The company has helped a number of healthcare facilities equip their nurses with smartphones, including, Cedars-Sinai, Nebraska Medical Center, Texas Children’s, Heartland Health, Huntington Hospital, and Sarasota Memorial.

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.

(from CNN)

The number of interracial couples in the United States has reached an all-time high, with one in every 10 American opposite-sex married couples saying they're of mixed races, according to the most recent Census data released Wednesday.

In 2000, that figure was about 7%.

The rate of interracial partnerships also is much higher among the unmarried, the 2010 Census showed.

About 18% of opposite-sex unmarried couples and 21% of same-sex unmarried partners identify themselves as interracial.

The term interracial, as it pertains to the study, is defined as members of a couple identifying as of different races or ethnicities.

Analysts suggest the new figures could reflect U.S. population shifts, broader social acceptance of such unions and a more widespread willingness among those polled to be classified as mixed race.

"Identifying as an interracial couple shifts over time," census spokeswoman Rose Kreider said.

Among interracial opposite-sex married couples, non-Hispanics and Hispanics are by far the most frequent combination, making up about 45% of such partnerships, Kreider said.

The second most represented group are those in which at least one person identifies as multiracial, while the third are marriages between whites and Asians.

Marriages between blacks and whites are the fourth most frequent group among married opposite-sex interracial couples.

Having professional translators in the emergency room for non-English-speaking patients might help limit potentially dangerous miscommunication, a new study suggests.

But it hadn't been clear how well professional interpreters perform against amateurs, such as an English-speaking family member, or against no translator at all.

The current findings, reported in the Annals of Emergency Medicine, are based on 57 families seen in either of two Massachusetts pediatric ERs. All were primarily Spanish-speaking.
The research team audiotaped the families' interactions with their ER doctor. Twenty families had help from a professional interpreter and 27 had a non-professional. Ten had no translation help.

It's not clear why some families had no professional interpreter. In some cases, Flores said, there may have been no one available immediately. Or the doctor might not have requested an interpreter.

The findings suggest that professionals can help avoid potentially dangerous miscommunication between patients and doctors, according to Flores and his colleagues.
In one example from their study, an amateur interpreter -- a family friend -- told the doctor that the child was not on any medications and had no drug allergies. But the friend had not actually asked the mother whether that was true.

Cost questions

There are still plenty of questions regarding professional interpreters, according to Flores.
For one, he said studies are needed to compare the effectiveness of in-person professional translators versus phone and video translation services.

There are also questions about what type of translation help families and doctors prefer, and what's most cost-effective. Federal law may require many hospitals to offer interpreters, but it does not compel the government or private insurance to pay for them. Right now, some U.S. states require reimbursement, but the majority do not. So in most states, Flores told Reuters Health, "the hospitals and clinics, and ultimately the taxpayers (because of uncompensated/charity care), are left covering the costs." But the cost-per-patient can be kept down. One study found that when a group of California hospitals banded together to offer translators by phone and video, the cost per patient was $25.

As for national costs, Flores pointed to a 2002 report from the White House Office of Management and Budget. It estimated that it would cost the U.S. $268 million per year to offer interpreter services at hospitals and outpatient doctor and dentist visits.

Another issue is training -- including the question of how much is enough. In the current study, errors were least common when interpreters had 100 hours of training or more: two percent of their translation slips had the potential for doing kids harm. There are numerous training programs for medical interpreters nationwide. But few of them provide at least 100 hours of training, Flores noted.

As for hospitals, it seems that most do not offer their own training programs. And even when they do, the hours vary substantially, Flores said. Based on these findings, he and his colleagues write, requiring 100-plus hours of training "might have a major impact" on preventing translation errors -- and any consequences for patients' health.

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Have you ever used a translator as a nurse or as a patient? How did it go? What is the ideal training program?

By definition...

Cultural competency is having specific cognitive and affective skills that are essential for building culturally relevant relationships between providers and patients. Obtaining cultural competency is an ongoing, lifetime process, not an endpoint. Becoming culturally competent requires continuous self-evaluation, skill development, and knowledge building about culturally diverse groups.

Healthcare disparities are inequalities in healthcare access, quality, and/or outcomes between groups. In the United States, these inequalities may be due to differences in care-seeking behaviors, cultural beliefs, health practices, linguistic barriers, degree of trust in healthcare providers, geographical access to care, insurance status, or ability to pay. Factors influencing these disparities include education, housing, nutrition, biological factors, economics, and sociopolitical power.

Models

Several models of cultural competency exist. In a model called The Process of Cultural Competence in the Delivery of Healthcare Services, by Campinha-Bacote, nurses are directed to ask themselves questions based on the five constructs-awareness, skill, knowledge, encounters, and desire (ASKED)-to determine their own cultural competency. According to this model, nurses need an awareness of their own cultural biases and prejudices, cultural knowledge, and assessment and communication skills. Nurses also need to be motivated to have encounters with culturally diverse groups. In its most recent form, this model suggests that these encounters are the pivotal key constructs in the process of developing cultural competency.

The Giger and Davidhizar Transcultural Assessment Model identifies six cultural phenomena nurses and other healthcare providers assess in their patients: biological variations, environmental control, time, social organization, space, and communication.

Staff should select a model that best fits your specific work setting and patient population.

Beware stereotypes

Discussions about culture in healthcare often focus on race and ethnicity. Taking this approach excludes other factors (biological, psychological, religious, economical, political) that are all aspects of one's cultural experience. When race and ethnicity are overemphasized in conversations about healthcare disparities, the results can be polarizing because nursing remains a White, female-dominated profession. Also, emphasis on racial difference over other equally important differences sets up an "us versus them" dynamic between nurses that may lead to some minority nurses' disengagement from these initiatives. In addition, no one is immune to prejudice. Minorities are just as likely to have room for improvement in cultural competency.

Taking it all in

You can gain helpful information by performing a cultural assessment and using a broad definition of culture that reflects the differences in healthcare besides race and ethnicity. These definitions include age, gender, disability, sexual orientation, immigration status, employment status, socioeconomic status, culture, and religion.

To avoid stereotyping, keep in mind that individuals within a particular group can vary in many respects. For example, among older adults, certain characteristics may be typical but some older adults may demonstrate attributes that differ from the group. Many believe that all older people resist the use of modern technology; however, many people who are elderly enjoy using smartphones, tablets, electronic readers, and other devices. These intracultural differences are important to consider; having group knowledge never justifies predicting behaviors of any individual members. As part of a cultural assessment, determine the specific values, beliefs, attitudes, and health needs of each patient. See Performing a cultural assessment for an example using the Giger and Davidhizar Transcultural Assessment Model.

In the United States, the healthcare system is a cultural entity with its own norms and values. Yet nurses may overlook a facility's institutional culture when they consider the impact culture has on patients' healthcare access and outcomes. Both organizational and hospital unit culture play a role in determining the quality of care a patient receives. When you can determine what interpersonal or institutional barriers exist within a particular institution, clinic, or community setting, you're better able to assist your patients in overcoming them to achieve better healthcare outcomes.

Goals and Considerations of cultural competency

How do you know whether you're providing culturally competent care? Some believe that they've reached the goal of cultural competency as they gain new knowledge or skills, or have encounters with culturally diverse groups. But while providers may meet goals, there is always room for improvement. Helpful questions and considerations when determining cultural competency include:

* What does being culturally competent mean to me and the patients I serve?

* Which cultural competency model and/or assessment tool is most useful to me, given my patient population?

* As I gain cultural knowledge and skills, how can I use that knowledge to improve my patients' healthcare outcomes and assist in reducing healthcare disparities for underserved populations?

* Did the patient demonstrate an understanding of what I was trying to convey or teach?

* What can I do to improve the quality of care I deliver to members of this group?