DiversityNursing Blog

By: Marilyn Hagerty, Grand Forks Herald

She sets her alarm on weekdays for 5:30 a.m., and she jumps in the shower when it rings. She slips into her green nursing scrubs.

“I always listen to the 6 o’clock news,” says Amanda Lako, a third semester nursing student at UND.

From 8 a.m. until 4 p.m., on a typical day she’s in classes, sometimes at the Public Health Department at the Grand Forks County Office building, sometimes at the College of Nursing and Professional Disciplines at UND and sometimes at Altru Hospital.

In her rush for class, she might bring a baggie with dry cereal in it to eat. “I’m terrible,” she said. She depends on coffee to keep her running. And there are times when she is so tired that she sets her alarm to ring in eight minutes. She gives herself a short, short nap.

The road to a degree as an RN, or registered nurse, is long and challenging.

Amanda Lako is one of 324 students in the undergraduate baccalaureate program at UND. Lako is a junior in her third of five semesters. Beyond that, there will be a semester of practical work in a hospital setting before she graduates in December 2014.

She is passionate about nursing.

“It is a calling,” she told me. “Once you start it you know if it is right for you. There has to be a big desire.”

For Lako, that desire began when she was growing up on a farm near Arthur, N.D. She was 4 when she started shadowing an aunt who was a nurse. She had other aunts who were nurses.

She was smitten with nursing. As a freshman at UND, she became a CAN, or certified nurse assistant. And, she said, “I loved each and every one of the residents I helped.”

Her work as a CNA taught her how to relate to patients. “It was amazing to work on the CNA float pool at Altru. I worked on every floor wearing my light baby blue scrubs,” she said.

Her class of 52 has five male students. And Lako thinks it is awesome for a man to go into the career. “It takes the kind of men who have the biggest hearts and are so kind and gentle.”

In Lako’s mind, nurses are selfless. She admires people who have been her mentors including her school nurse, her church leaders. And she said, “Certain people just push you. I was adopted and I think I learned to be selfless from my parents.”

She isn’t always that serious. She works away at the pages of papers she must keep on patients. And she gets supper around 7 to 8 p.m.

Then there are the times in the evenings when she sits around the kitchen table with four other nursing students. They live together.

“We laugh, we sing, we complain. I depend on them to lighten things up.” 

UND’s nursing program

UND offered non-degree courses of study for nurses beginning in 1909.

In 1949, the first baccalaureate program in nursing was established and a Division of Nursing was created at UND. The same year, the State Board of Higher Education authorized the creation of the College of Nursing as a unit on campus.

The baccalaureate program was fully accredited by the National League for Nursing in 1963 and has remained accredited since that time, according to information provided by Lucy Heintz, clinical assistant professor and director of the Office of Student Services.

In 2013, in addition to the Department of Nutrition and Dietetics, the College of Nursing was joined by the Department of Social Work and the name was officially changed to the College of Nursing and Professional Disciplines.

Currently, the Department of Nursing has 324 students in its undergraduate baccalaureate program. The graduate program with 269 enrolled offers two doctoral programs. Master of Science degrees are available.

The graduate program has an enrollment of 269.

Source: Grand Forks Herald

What is NO MORE?

NO MORE is a new unifying symbol designed to galvanize greater awareness and action to end domestic violence and sexual assault.  Supported by major organizations working to address these urgent issues, NO MORE is gaining support with Americans nationwide, sparking new conversations about these problems and moving this cause higher on the public agenda.

The history of NO MORE

The NO MORE symbol has been in the making since 2009. It was developed because despite the significant progress that has been made in the visibility of domestic violence and sexual assault, these problems affecting millions remain hidden and on the margins of public concern. Hundreds of representatives from the domestic violence and sexual assault prevention field came together and agreed that a new, overarching symbol, uniting all people working to end these problems, could have a dramatic impact on the public’s awareness.

The signature blue vanishing point originated from the concept of a zero – as in zero incidences of domestic violence and sexual assault. It was inspired by Christine Mau, a survivor of domestic violence and sexual abuse who is now the Director of European Designs at Kimberly-Clark. The symbol was designed by Sterling Brands, and focus group tested with diverse audiences across the country who agreed that the symbol was memorable, needed and important.

Who is behind NO MORE?

Every major domestic violence and sexual assault organization in the U.S. – from men’s organizations like A CALL TO MEN and Men Can Stop Rape, to the National Domestic Violence Hotline and the National Alliance to End Sexual Violence, to groups that help teens like Break the Cycle and Futures Without Violence, to organizations that advance the rights of women of Color and immigrants like Casa de Esperanza and SCESA to the U.S. Dept. of Justice’s Office on Violence Against Women – all of them and more are behind NO MORE.

View the complete list of organizations here.

What do we do?

NO MORE is spotlighting an invisible problem in a whole new way. The first unifying symbol to express support for ending domestic violence and sexual assault, NO MORE can be used by anyone who wants to normalize the conversation around these issues and help end domestic violence and sexual assault. Our vision is that NO MORE will be everywhere – on websites, t-shirts, billboards. Organizations and corporations, large and small, will embrace this symbol as their own. When an abuse case makes media headlines, you will instantly see NO MORE being tweeted, discussed on Facebook, worn as jewelry and on t-shirts; made into buttons and posted in classrooms, offices, billboards and grocery stores across the country. NO MORE will help end the stigma, shame and silence of domestic violence and sexual assault. NO MORE will help increase funding to prevent domestic violence and sexual assault.  Like the pink ribbon did for breast cancer and the red ribbon did for HIV/AIDS, NO MORE will help to change behaviors that lead to this violence.

Get the symbol today and start showing your support.

Why should I care?

The next time you’re in a room with 6 people, think about this:

• 1 in 4 women experience violence from their partners in their lifetimes.
• 1 in 3 teens experience sexual or physical abuse or threats from a boyfriend or girlfriend in one year.
• 1 in 6 women are survivors of sexual assault.
• 1 in 5 men have experienced some form of sexual victimization in their lives.
• 1 in 4 women and 1 in 6 men were sexually abused before the age of 18.

These are not numbers. They’re our mothers, girlfriends, brothers, sisters, children, co-workers and friends. They’re the person you confide in most at work, the guy you play basketball with, the people in your book club, your poker buddy, your teenager’s best friend – or your teen, herself. The silence and shame must end for good.

How can I help?

There are hundreds of ways you can spread the word about NO MORE.

Say it: Learn about these issues and talk openly about them. Break the silence. Speak out. Seek help when you see this problem or harassment of any kind in your family, your community, your workplace or school. Upload your photo to the NO MORE gallery and tell us why you say NO MORE.

Share it: Help raise awareness about domestic violence and sexual assault by sharing NO MORE. Share the PSAs. Download the Tools to Say NO MORE and share NO MORE with everyone you know. Facebook it. Tweet it. Instagram it. Pin it.

Show it: Show NO MORE by wearing your NO MORE gear everyday, supporting partner groups working to end domestic violence and sexual assault and volunteering in your community.

Learn more here.

By Debra Anscombe Wood, RN

Psychiatric emergencies can be as serious as a medical condition, but in traditional EDs, mental health patients may wait for treatment. Specialized psychiatric EDs serve that population quickly and efficiently. “They come in with everything from the need for prescription refills to being actively suicidal,” said Brian Miluszusky, RN, BSN, director of nursing in the emergency medicine department at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York. “A suicidal person is as much at risk of dying as someone having an MI (myocardial infarction).” 

As demand for emergency care has increased, so has the number of mental health patients seeking services. A study from the Carolina Center for Health Informatics at the University of North Carolina at Chapel Hill reported in 2013 that nearly 10% of ED visits in North Carolina from 2008-2010 were for mental health diagnoses, and the rate of mental health related visits increased seven times more than overall ED visits. Mental health related ED visits increased by 17.7%, from 347,806 to 409,276 from 2008-2010. Stress, anxiety and depressive disorders were most common. 

A January 2012 American Hospital Association Trendwatch report said, “In 2009, more than 2 million discharges from community hospitals were for a primary diagnosis of mental illness or substance abuse disorder. ... Among children, mental health conditions were the fourth most common reason for admission to the hospital in 2009.”

The report said there were more than 5 million visits to EDs in 2009 by patients who had a primary diagnosis of mental illness or a substance abuse disorder. “Access to [psychiatric] care is not easily found [in the community], but if you are having a mental health crisis, you can walk into our emergency department 24/7 and be seen by a psychiatrist within a couple of hours,” said Jennifer Ziccardi-Colson, RN, MSN, BSW, MHA, vice president for nursing services at Carolinas Medical Center-Randolph, a behavioral health center with a psych ED and 66 inpatient beds in Charlotte, N.C. 

Psych EDs serve patients with acute episodes of behavioral health diagnoses, including feeling suicidal, anxious or depressed or abusing substances. “When patients come to us, they are assessed and seen promptly,” Ziccardi-Colson said. “People can feel comfortable coming to our environment to receive care.” 

Not all patients with mental illnesses receive care in a psych ED. Even at those hospitals with a dedicated psych emergency unit or a stand-alone psychiatric emergency services facility, patients with acute medical conditions, such as an MI or a broken hip, are treated in the regular ED. The ED provider must determine if a medical problem is contributing to mental status changes or if the problem is solely psychiatric in origin. 

Some psych EDs, such as San Francisco General Hospital and Carolinas Medical Center care for children as well as adults. Children and teens receive emergency psych services at Carolinas Medical Center-Randolph. Younger children, ages 3 to 6, come in with situational stress related to family dynamics, such as divorce or custody battles; depression or anxiety, often related to bullying at school or at home; suicidal ideation; conduct disorders; and behavioral issues related to autism or developmental delays. “In the emergency room, it’s crisis stabilization,” said Tez Bertiaux, RN, MSN, nurse manager for the ED at Carolinas Medical. “A lot of these children are followed in the community by a mental healthcare provider.”

The hospital’s social worker will arrange outpatient care for children who do not have a current therapist. Many are admitted to inpatient care. The psych emergency services program treats about 700 children and adolescents monthly, and the hospital admits about an equal number to its inpatient units, said Bertiaux.

Pediatric ED visits tend to increase during the school year, with school staff workers referring students for care. Some of the children are in foster care or are homeless or living in shelters. Some parents and guardians will stay during the stabilization and others do not. “It’s a very complex dynamic, because you are not just treating the patient — the family is involved,” Bertiaux said. 

Bertiaux said many of the mental health issues that bring children into the ED are related to their environment. “And that can be challenging,” she said.

Patients seeking care at a psych ED may be treated and discharged, but others require admission to a psychiatric bed for stabilization. Physicians at NewYork-Presbyterian and San Francisco General admit about 30% of their psych ED patients to the hospital. But treatment begins in the psych ED. “It’s amazing how much we can help people,” said Andrea Crowley, RN-BC, interim nurse manager in psychiatric emergency services at San Francisco General. “Some just need someone to talk to and bring them down from the crisis they are in. It makes you feel you are making a difference, and it’s a visible, tangible thing.” 

Psych care a growing need

Carolinas Medical has seen a steady increase in psych ED volume during the past several years. It treats about 18,500 patients annually with a variety of psych disorders and continuously operates at 100% occupancy. Construction is under way to double the psychiatric hospital’s inpatient beds to 132. 
Johns Hopkins Hospital in Baltimore’s psych ED census has experienced a 30% jump this year. “People are sicker, and there are fewer resources in the community,” said Kate Pontone, RN, MSN, nurse clinician 3 and nursing service line leader for Psychiatric Emergency Services at Johns Hopkins. “Outpatient programs that had space available are no longer options. People are running out of medications or cannot afford transportation. Many of the same reasons emergency departments are crowded.” 

A March 2012 Congressional briefing by the National Association of State Mental Health Program Directors reported, “the economic downturn has forced state budgets to cut approximately $4.35 billion in public mental health spending over the 2009-2012 period,” a trend it expects will continue. While at the same time, there was a 10% increase in consumers receiving state-supported mental health services. 

In July 2012, the Treatment Advocacy Center released the paper “No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals,” which found nationwide, closures of such hospitals “reduced the number of beds available in the combined 50 states to 28% of the number considered necessary for minimally adequate inpatient psychiatric services.” And “in the absence of needed treatment and care, individuals in acute or chronic disabling psychiatric crisis increasingly gravitate to hospital emergency departments, jails and prisons.”

Volume at San Francisco General’s psych ED has jumped from 500 per month to 600 per month. “It could be due to closures in programs,” Crowley said. “We are starting to see a fallout from lack of services in the community.” 

Volume also has increased at NewYork-Presbyterian where, typically, a dozen or more psych patients are waiting in the regular ED for a bed in the psych ED, Miluszusky said. Difficulty transferring patients to an inpatient bed clogs up the EDs. A lack of insurance complicates transfers, and patients may end up boarding in a regular or psych ED. 

Patients may walk in, arrive by ambulance or with a petition for involuntary commitment, because they are deemed dangerous to themselves or others. First responders may take a mental health patient to a psych ED rather than to a community hospital without such specialized services. “This is a growing population, and emergency rooms will have to evolve,” Miluszusky said. “The population is getting so big; we are going to have to think of new ways to handle it.” 

Benefits of a separate psych ED

Psychiatric emergency services programs typically are staffed with behavioral health professionals, allowing mental health interventions to begin quickly, and often the onsite team can stabilize the patient, avoiding a hospitalization, according to the article “Treatment of Psychiatric Patients in Emergency Settings” in the journal Primary Psychiatry. “You don’t have agitated psych patients in the emergency room with all of the sick people,” Crowley said. “It’s a specialized environment where you can begin treatment better.”

Nurses and other members of the psych ED team have a solid understanding about different mental health conditions and their treatment. They can begin therapeutically talking with patients immediately. “Our patients appreciate being cared for by someone who is familiar with their medications and their symptoms and can intervene when they begin to decompensate,” Pontone said. “You get specialized care and the rooms are safe,” said Miluszusky, who adds that improves outcomes. 

Psych EDs often are locked units and feature specially outfitted rooms, with no sharp corners, no cords, nonexposed plumbing and a calm atmosphere. The safety features prevent patients from harming themselves or creating tools to harm others. “Our main priority is patient safety,” Ziccardi-Colson said. “There’s no potential for suicide or other negative outcomes.”

Ziccardi-Colson reported Carolinas Medical’s psych ED operates cost effectively, in part because of its ability to begin treatment and stabilize. “We’re able to process people more quickly than a medical ED,” Ziccardi-Colson said. 

Miluszusky said having a psych ED can be cost effective, because it reduces overtime pay necessitated by providing one-on-one oversight of a psych patient in the medical ED. 

Nurse staffing varies by institution, often with psychiatric nurses providing care, such as at San Francisco General’s psych ED. “It’s an exciting job, where you see a wide variety of people,” Crowley said. “You have a profound effect on people’s lives.”

Emergency nurses, who have received specialized training in the care of mental health patients and de-escalating situations, staff the psych ED at NewYork-Presbyterian. Nurses from a Johns Hopkins inpatient psych unit covers the emergency room, and Pontone describes significant interest from the inpatient staff. The hospital also cross-trains the ED nurses, so they can step in during an emergency. Pontone says nurses who love psychiatric nursing are interested in the management of the acutely ill patient, who needs as much care and support as they can get in a safe environment. “We like to be there when patients are in crisis and need help,” she said. “And we are good in a crisis.”

Ziccardi-Colson said every day presents challenges, but the reward of helping patients to wellness is inspiring and keeps nurses motivated. “Those who like it, love it,” Crowley said. “And for those who are not into it, we are happy to do it for them.” 

Source: Nurse.com

The National Institute of Nursing Research (NINR) awarded $267,732 to the University of South Florida College of Nursing to study ways to reduce HIV/AIDS risk in college-aged black women, who are disproportionately affected by the disease. Rasheeta D. Chandler, PhD, ARNP, FNP-BC, assistant professor of nursing at USF, will lead the study.

"Tailoring an HIV Prevention for College-Aged Black Women" will adapt a previously-tested and effective sexual risk reduction approach, Health Improvement Project for Teens (HIP TEENS), to be culturally relevant and appropriate for college-aged African-American women. The research will test if this program, renamed Health Improvement Project for LADIES (HIP LADIES), helps reduce HIV/AIDS risk.

"This study is timely, and will be the template for future intervention studies conducted with black college women," Dr. Chandler said. "The award gives us the opportunity to improve the health of young black women."

AIDS.gov reports that of the more than 1 million people living with HIV in the United States, 46 percent are African-Americans. In addition, young black women are far more affected by HIV than young women of other races. The rate of new infections among young black females ages 13 to 29 is 11 times as high as that of young white females and four times that of young Hispanic females, according to the Centers for Disease Control and Prevention (CDC). The CDC reports that AIDS is the third leading cause of death among black women ages 25 to 34.

HIP TEENS is a small-group program for young women that uses interactive activities to provide information, motivate and teaches the skills girls need to reduce sexual risk behaviors. It was developed in 2004 by Dianne Morrison-Beedy, PhD, RN, WHNP-BC, FNAP, FAANP, FAAN, senior associate vice president of USF Health and dean of the College of Nursing. A randomized controlled trial led by Dr. Morrison-Beedy and recently published in the Journal of Adolescent Health reported that HIP TEENS significantly reduced sexual risk behavior and pregnancy rates in more than 700 adolescent girls.

"Not only did HIP TEENS reduce sexual risk behavior, we significantly increased sexual abstinence in these girls as well," said Dr. Morrison-Beedy. "HIP LADIES is a critical next step for reducing risk in college-aged young women."

Dr. Chandler's study will specifically target African-American women attending traditional universities and historically-black colleges and universities in the southeastern United States.

"This project is my chance to contribute to reducing the incidence of new HIV cases in young African-American women," Dr. Chandler said. "When you ask why I'm passionate about my research, this is my community, and these are people who've touched my life with their stories."

Provided by University of South Florida

Source: Phys Org

By Melissa Assink, RN, BSN

I was in med/surg for 13 years before moving to hospice, where I have been privileged to work for almost 24 years. At age 5, I was telling people I wanted to be a nurse. I believe it was a vocational passion that God placed in my heart those many years ago. 

A recent loss in my personal life, followed by a visit from a former patient, brought my passion into even clearer focus. 

I had received a phone call from my brother, telling me that moments before our father had suffered a massive heart attack and died. Even though he had been in declining health in recent years, the news felt like it hit me completely out of left field. 

The day of Dad’s memorial service arrived. While the presence of those in attendance was a comfort, it was also overwhelming to greet the many people who joined us to celebrate his life. Some we had not seen for many years, and it seemed they all had stories to share about him. 

One of the first people to approach me after the service was a man who appeared to be maybe 85. He had white hair, was hunched over and used a walker. He came up to me and stood there, staring at me, as if willing me to remember who he was. I drew a blank and asked, "How do I know you?"

His response was amazing: "You were my nurse 30 years ago, when I was in the hospital for five days to have my gall bladder taken out." He said it very matter-of-factly, as though I should remember him out of probably thousands of patients I have cared for over the years. 

Rather flabbergasted, I asked, "Did you know my dad?" He indicated he did not, that he had simply seen the obituary in the paper and wanted to come to the service as a tribute to me, his former nurse.

My mind raced. This dear man had connected me with Dad by recognizing me as a listed survivor in his obituary. It meant that he had to remember my first name and my maiden name from a brief hospital stay more than 30 years ago. 

I wanted to sit down and talk with him about his memories, but he promptly turned, walked out the door and was gone as suddenly as he had appeared. It seemed as if he knew he had accomplished his mission. I was engulfed with people wanting my attention, and it became impossible to follow him.

I have been reflecting on this former patient and his sudden reappearance in my life for several months. It was almost like he was an angel of sorts, sent to remind me how we, as nurses, touch the lives of people in our care at every turn. We sometimes are in good moods, sometimes not so good. We can become distracted by computerized charting, time management and policy and procedure manuals. 

It is easy to sometimes forget that we care for people when they are most vulnerable, sharing in their joys and sorrows in a way we might not always appreciate. We might forget their names by the next day, often as a coping mechanism, allowing us to go forth and care for the next person. We neglect to recognize they often do not forget us so easily. 

This former patient reminded me that we should never take any interaction for granted. We need to be caring and supportive, treating each of our patients with the respect and honor we’d like to experience if we were in their shoes. Our personal issues and circumstances are not important to them. They are watching us at every turn, looking for the light of our knowledge and support to see them through. A hug, a smile, a kind word, a moment of laughter or a shared tear — these are easy to give, but never forgotten. 

I pray I will always remember the responsibility I have to provide love, care and perhaps a moment of joy to the patients and families I interact with every time I put on my name badge. After all, we never know when a white-haired angel with a walker who received our care will cross our path and help us remember why we became nurses in the first place. 

Melissa Assink, RN, BSN, works for Providence Hospice and Home Care of Snohomish County in Everett, Wash. 

Source: Nurse.com

by Carrie Tian 

“Just Ask!” That’s the slogan for a new campaign by the Massachusetts Nurses Association (MNA). The union is encouraging people to ask how many other patients their nurses will be treating that day. The slogan is meant to draw awareness to what the nurses union sees as a growing disconnect between the profit-driven healthcare industry and the quality care of its patients.

The campaign’s goal is to enact minimum mandatory staffing levels, capping the number of patients per nurse. After a similar measure failed to pass the state legislature in 2008, the MNA wants to take the issue directly to voters through a ballot initiative. The union has submitted the text of the Patient Safety Act to the Attorney General’s Office; the act’s terms include limiting nurses to having up to four patients in surgical units and in emergency rooms. Once approved, the union will need to collect 70,000 signatures by November for the Patient Safety Act to appear on the 2014 ballot.

Currently, California is the only state that has mandated nurse-patient ratios. However, this topic may well seem familiar to Mass. voters: state nurses have sought staffing legislation since 1995, and 2011 saw fraught contract negotiations between Tufts Medical Center and its nurses. CommonHealth analyzed how Tufts’ lower nurse ratio affected patient care.

Lynn Nicholas, president of the Massachusetts Hospital Association, alluded to the idea’s long history by calling the current initiative petition a “repeat of an arcane idea that has no merit” in a statement. She said that patients would be better served by having decisions about their care made on a case-by-case basis. Her reactions echoed those of  Michael Sack, President and CEO of Hallmark Health, who wrote an earlier guest post on CommonHealth. “This cookie-cutter approach would completely take away a hospital’s ability to tailor care to specific patient needs,” Sack wrote.

Source: WBUR CommonHealth

by Crystal Loucel

Because minorities are more likely to receive less and lower-quality health care and suffer higher mortality rates from cancer, heart disease, diabetes, HIV/AIDS and mental health illnesses than their Caucasian counterparts, there have long been calls to increase the number of minority providers to reduce these health disparities. Numerous studies have shown that patients are more likely to receive quality preventive care and treatment when they share race, ethnicity, language and/or religious experience with their providers.

The 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health found that a diverse workforce – and the diverse perspective it provides – contributes to enhanced communication, health care access, patient satisfaction, decreased health disparities, improved problem solving for complex problems and innovation. Moreover, the Health Resources and Services Administration (HRSA) has found that minorities could improve access to care in underserved areas more than nonminority providers (see The Rationale for Diversity in the Health Professions: A Review of the Evidence [HRSA, 2006]).

Yet minorities are still under-represented in the health care workforce generally and in nursing in particular. In 1908, when Israel Zangwill popularized the term melting pot to describe the American population, it was 89 percent white, 10 percent black and less than 1 percent Indian, Chinese, Japanese and “others.” Today’s melting pot is considerably more diverse, composed of more than one-third racial and ethnic minorities; moreover, the United States Census Bureau expects that portion to be more than half by 2050.

“Today the nursing workforce does not adequately reflect the diversity in the population including gender,” says Beverly Malone, CEO of the National League for Nursing. Latinos, African Americans, American Indians and Native Alaskans compose only 7.6 percent of the nursing workforce, a dismal figure compared to the 25 percent in the general population. UCSF’s nursing student population is doing a bit better – in 2009, the latest year for which data are available, these same groups composed 16 percent of the UCSF nursing student body – but there is certainly room for improvement. When Asian Americans are included, a 2008 HRSA report showed that minorities make up 35 percent of the total population but only 17 percent of the nursing population.

UCSF has been trying to respond to the 2004 Sullivan Commission Report, titled Missing Persons: Minorities in the Health Professions, which recommended that health profession schools hire diversity program managers and develop plans to ensure institutional diversity, including providing educational support, commitment, role modeling and dedicated recruitment. Currently, Judy Martin-Holland serves as associate dean for Academic Programs and Diversity Initiatives at UCSF School of Nursing, a role in which she recruits minority students, seeks to integrate more diversity in the curriculum, and offers support programs for minority students. In addition, after years of medical student advocacy, Renee Navarro, vice chancellor Diversity and Outreach, created the School’s first Multicultural Resource Center. Though the center currently has no budget, its director, Mijiza Sanchez, hopes to advocate for the types of programs that the commission has recommended, such as the mentoring that Sanchez herself offers students.

It’s also important to remember that minorities often face barriers to financing their education and would benefit from scholarships, loan forgiveness and tuition reimbursement programs.

In addition, universities should link to minority professional organizations to promote enhanced admissions policies, cultural competency training and enhanced minority student recruitment. For example, as volunteer past president of the San Francisco Bay Area chapter of the National Association of Hispanic Nurses (NAHN), I am proactively connecting to the UCSF student group Voces Latinas Nursing Student Association (VLNSA) to do just that. VLNSA is open to students of all ethnicities who are interested in working with the Latino community; the ability to speak Spanish is not required. And organizations like NAHN typically offer reduced student membership and benefits such as mentoring, résumé revision, job postings, volunteer opportunities, networking and more for students, without requiring them to be from any particular racial or ethnic background.

That last point is important, because no matter how diverse your workforce, the goal is to create an environment that is inclusive and allows everyone to express themselves. As minorities, we cannot address our specific health issues alone; rather, this is a challenge for all health care providers. Given what we know about diversity and its importance to health care, we must partner to creatively address and embrace an ever more diverse future.

Crystal Loucel is a second-year master’s student at UCSF School of Nursing and past president of the San Francisco Bay Area chapter of the National Association of Hispanic Nurses. She has a master’s in public health, specializing in global health, from Loma Linda University; has served as an AmeriCorps and Peace Corps volunteer in Honduras; was one of eight RNs chosen in 2012 for a General Electric-National Medical Fellowship in primary care; and is a 2012 scholarship recipient from the Deloras Jones Kaiser Foundation. An earlier version of this piece appeared in the UCSF student newspaper, Synapse.

Faced with a shift in the healthcare landscape toward outcomes-based practices and quality improvements, the American Association of Colleges of Nursing (AACN) sought to update the scope of nursing practice with a new master's prepared role: the clinical nurse leader (CNL).

The first new nursing role in over 35 years, the CNL grew out of the 1999 Institute of Medicine report "To Err is Human" which challenged care providers to reduce medical errors and focus on patient safety. 

Rising to the challenge, the AACN initiated an investigation into the barriers to improved care delivery and in 2005 introduced the new role as a way to prepare nurses to thrive in the changing healthcare system, according to the AACN website. For many, it couldn't have come at a better moment.

"We are at a pivotal time for the role," said Bob LaPointe, MS, MSN, RN, CNL, president, Clinical Nurse Leader Association (CNLA), and MICU staff nurse at Penn Presbyterian Medical Center, Philadelphia. 

"Healthcare is increasingly complex, and we need leaders who are trained in complexity theory to be able to navigate that and understand it to have better patient outcomes and that's what clinical nurse leaders are uniquely trained to do."

CNL

As defined by the CNLA, the CNL is an advanced clinician who serves at the point of care as the lateral integrator, facilitating, coordinating and overseeing care within the unit while also collaborating across the healthcare continuum.¹ The CNL is trained to facilitate evidence based care at the bedside and ensure positive outcomes for even the most complex patients. Such training, especially these days, is a great option for nurses of all kinds looking for a way to make a difference at the bedside.

"The role really is about improving clinical outcomes-improving the care of the patient as well as improving financial outcomes," said Tracy Lofty, MSA, CAE, director, Commission on Nurse Certification (CNC), an autonomous agency of AACN, Washington, DC. "Regardless of practice setting, the ultimate goal is to improve outcomes, so really everyone benefits from the role."

When Veronica Rankin, MSN, CNL, Carolinas Medical Center, Charlotte, N.C., decided to go back to school, she chose to do so through a CNL program after her facility's assistant vice president introduced the role at a town hall meeting. Since graduating in 2011, she and her fellow CNLs have been making a huge difference for patients, colleagues and the hospital as a whole.

"We bring that continuity of care back to the bedside, so that even though the nurses may change every shift every day, you are still going to have the same clinical nurse leader Monday through Friday taking care of that patient," Rankin said. 

"It has given me the opportunity to stand back and see the big picture of my patients' journey. I can get in there and see, 'OK, out of everyone that is involved in this patient's care, we have all these hands in this pot, what are we missing and where are the bridges I need to help connect?'"

Rankin's ability to streamline care and improve both patient and hospital outcomes comes directly from her training, and nurses and facilities across the nation are starting to see the difference CNLs can make on a unit-by-unit basis.

"When you take a policy and implement it in your unit, in your hospital, in this city, with the resources you have available, it can be the best evidence based practice out there," LaPointe emphasized. "But we have to apply it to our patients and our staff as well, and that's really where the clinical nurse leader's role really comes into play. How does this make sense for us as a unit, and for our patients."

Education

Since the pilot program that tested in the fall of 2006, more than 2,500 nurses have earned CNL certification from CNC. Part of the success, according to LaPointe, is the fact that anyone inspired to become a CNL can do so.

"Nursing has always had multiple points of entry, which leads to lots of people being able to do it, but it also leads to lots of variability about the training and preparation," LaPointe said. "There is so much more to know and healthcare is so much more complex, that to have training in complexity theory, change management and in the science of outcomes, that's going to be good for anybody."

To make the CNL educational track available to nurses already practicing as well as those looking to get into the field, the AACN created five different models so that regardless of educational background, there is an entry into a CNL education program. The five models are:

• Model A - Master's degree program designed for BSN graduates
   
• Model B - Master's degree program for BSN graduates that includes a post-BSN residency that awards master's credit
   
• Model C - Master's degree program designed for individuals with a baccalaureate degree in another discipline
   
• Model D - Master's degree program designed for ADN graduates (RN-MSN)
   
• Model E - Post-master's certificate program designed for individuals with a master's degree in nursing in another area of study²

Following graduation of a CNL education program, licensure as a registered nurse, and successful completion of the CNL Certification Exam, candidates may be awarded the CNL credential.

With the role gaining momentum, the CNC decided to revamp the certification exam in 2012 to make sure it reflected the basic competencies of a CNL.

"The new exam is based on a CNL job analysis study that was completed in 2011, so the exam reflects the knowledge, skills and abilities of a competent CNL," Lofty said. "It's all about application, so you may be in an educational program, but then you need to be able to apply the knowledge, and that is demonstrated on the exam."

Integration

As new CNL graduates start the search for the right clinical setting, they need to keep in mind that some healthcare organizations have yet to fully integrated the clinical nurse leader into their staffing model.

"There are many healthcare institutions specifically recruiting to full clinical nurse leader positions," said Lofty. "For other institutions, it may not be that title, there may be a different title like care coordinator, or they are still looking for someone with the same skill set and they are still hiring individuals with those competencies and perhaps applying them to other positions."

But CNLs need not worry about their job prospects, because their CNL skills are valuable in just about every care setting. According to a 2012 survey conducted by the CNC, 96% of the respondents indicated that they apply their CNL knowledge in their current role, 92% feel they are an important member of their team and 87% said they are valued as an employee because they are a CNL.³ LaPointe knows from personal experience just how useful being a CNL can be regardless of job title.

"I am not functioning in a job that is called 'CNL' right now, and that is true for many people who currently have the certification," LaPointe said, who was confident he would still use his training despite not being hired specifically as a CNL. "I helped write our successful Beacon Gold application, I was very involved in our hospital's first Magnet designation, I am on the evidence based practice committee for the hospital, and the chair of our unit-based council as part of the shared governance structure of the MICU, so I am using this stuff all the time."

Next Steps

No matter where CNLs end up, they are sure to improve care coordination, communication and hospital-wide outcomes.

"You are basically in there improving care for nurses, patients, and physicians," Rankin said. "You are improving care delivery and the receiving of care for the patient population, so you are in there with your hands so much."

"Bring evidence based practice to your unit to show what the worth of the role is," Rankin advised nurses considering the CNL role. "In the end we are also taught that the clinical nurse leader is the guardian of the nursing profession, so we have to get in there and be the guardian. I would say, go for it, go hard, and be a guardian for the nursing profession."

Source: Advance for Nurses 

by Mark Downey

One of the questions that I frequently ask my students is, “Do you need to care to be a great nurse?” It’s always interesting to read the expressions on their faces and imagine what they must be thinking, because for the majority of my students it is the wanting to be a nurse and all that it entails that is a motivating factor in studying for their nursing degree.

From “Is he trying to trick me?” to “My teacher is an idiot!”, I can see the cogs and wheels ticking over in their brains. More often than not, I don’t give them an opportunity to answer. Instead, I tell them, “You don’t have to care about people to be a nurse. I consider myself an excellent nurse, but I’m not paid to care”.

Reactions to this vary. The two most common being dumbstruck, tongue tied and not knowing quite what to say or alternatively the hairs on the back of the neck bristle and I am challenged (often quite vigorously). Rarely, if ever, does anyone agree with me.

Let me explain with an example. If you’re a patient in an Accident and Emergency Room or perhaps lying unconscious in an Intensive care bed or on an operating table, is it really going to matter if the nurse gives two hoots about caring for you? Of course not! What is important is that the nurse is clinically competent and understands your health requirements so that every opportunity is afforded in generating a positive health outcome.

A steam train driver doesn’t have to care about his train to drive it, but he does need to understand how it works. As long as the gauges stay within the safe zones and coal is regularly fed to help generate steam to drive the engine, it doesn’t matter if he cares about the train or not. In fact, regardless of his care factor, the end result will never vary as long as he is good at his job. To be a good and great nurse is to know how to do your job right. I know everyone will agree.

Isn’t a nurse just like the train driver? Health outcomes will always be the same regardless of how much caring the nurse gives. It all boils down to the nurse trainings and the skills they have developed and how they are implemented. Nothing more, nothing less. A Cardiac Nurse needs to know about your heart, how it works, what the ECG squiggles mean and what the drugs that have been prescribed for you are going to do, but they don’t need to know your hearts desires or what’s in your heart. Isn’t that the job of the Chaplain?

Another important point is not to confuse advocating for the patient with caring. Advocacy is mandatory if the nurse’s training and experience lead them to believe that an alternative option may deliver a better health outcome for the patient. But really you don’t have to care to advocate as it’s just part of being a good nurse.

My argument is further proven when you consider the nursing process. Although it comes in many forms and guises, it is essentially:

• Assess the situation.
   
• Planning a course of action.
   
• Implement that action plan.
   
• Review the effectiveness of the plan and when necessary returning to step 1 and repeating. 

Nowhere, I repeat, nowhere, in any of the literature I have read, have I ever seen or mentioned that caring was required as part of the nursing process.

So do nurses care about their patients? Of course they do! Don’t be a goose! For the vast majority it’s an integral part of what makes them who they are. Nurses are looking after people, not machines. So, do I care for the people that I look after? I do and with a passion, but I don’t have to and, if couldn’t care for people, I couldn’t do my job.

Earlier on in this post I made the comment “I consider myself to be a great nurse, but I’m not paid to care.” This, I hold, as an absolute truth. When I am nursing, I am not paid to care.  You cannot pay me to care. I will not accept money to care! I choose to care because I want to care and you get that for free.

Source: NurseTogether

By Christina Orlovsky

Ask a young girl what she wants to be when she grows up, and top answers are often a teacher or a nurse, which are professions that have been associated with women throughout history. Ask a young boy the same question and neither answer is likely to be given.

Ask Christopher Lance Coleman, PhD, MS, MPH, FAAN, and he’ll tell you that inequity has to change.

Coleman, an associate professor of nursing and multicultural diversity at the University of Pennsylvania School of Nursing in Philadelphia and the author of Man Up! A Practical Guide for Men in Nursing, is a strong advocate for recruiting males into the nursing workforce and empowering them to pursue leadership roles. His new book serves as a roadmap for men seeking to break into the predominantly female nursing profession.

“I believe men need a guide, a blueprint to use to navigate through the complexity of specialty choice and a culture where, frankly, a gender disparity still exists,” Coleman explains. “This is an opportunity of a lifetime for men not only to change the face of nursing in the 21st century, but also to reshape the public image that nursing is a women’s profession.”

In fact, while the most recent numbers show that men are still a clear minority in the nursing field, an uptick is occurring. According to a 2012 U.S. Census Bureau study, “Men in Nursing Occupations,” which presents data from the 2011 American Community Survey, the percentage of male nurses has more than tripled since 1970, from 2.7 percent to 9.6 percent. Of the 3.5 million employed nurses in 2011, 3.2 million were female and 330,000 were male. It’s a change, but, if you ask Coleman, it’s not enough.

“The startling thing is how underrepresented men still are in areas of leadership,” he says. “While the numbers of RNs has increased, when you look at the profession as a whole--heads of nursing, academia--we are still so far underrepresented. This is significant for males going through school looking for role models and seeing predominantly female leaders. I want men to know this is a viable profession and there are tremendous opportunities out there.”

Coleman believes the greatest opportunities for change are in younger men, who even at the high school level should do their research and start the conversation with their parents about the opportunities that exist for them in nursing. Ethnic minority groups, he adds, are particularly critical.

“Many ethnic minority groups, even today in 2013, still think of nursing as only a woman’s profession,” he says. “That racial disparity needs to be taken away.”

Coleman hopes that his book also opens up a dialogue among current male registered nurses. Empowering male RNs to continue to climb the ladder to leadership roles where they can influence change and serve as a new face of the nursing profession, he says, can encourage them to become the mentors male RNs need to help them succeed.

Another conversation that needs to occur in order to influence a culture shift is one between female nurses who may stereotype their male counterparts as only necessary for heavy lifting or things they “can’t” do.

“That’s a stereotype that hurts women and hurts the profession,” Coleman explains. “We don’t want nursing to be seen as a profession of the weak, we want it to be seen as a profession of the strong, because nurses are strong. We all need to do a better job of marketing ourselves--stop stereotyping and typecasting males and do more education in the hospital setting about gender diversity.”

Many men, after all, possess all the qualities required to be good nurses.

“Passion; someone with a tremendous amount of integrity; leadership skills; with a natural curiosity about the world; someone who is unafraid to take on issues that perhaps have challenged them in the past; someone who could treat someone at the end of the day how they want to be treated; and someone who cares to change the world we live in--those characteristics are essential and they transcend gender,” Coleman concludes. “Those are things I’d like to see in anyone who is interested in entering our noble profession.” 

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