DiversityNursing Blog

Alexandra Wilson Pecci

www.healthleadersmedia.com 

Hospitals have a broader responsibility to elderly trauma patients than just the time spent within their walls, and should consider updating their strategies to ensure the best outcomes for these patients, research suggests.

Elderly trauma patients are increasingly likely to be discharged to skilled nursing facilities, rather than inpatient rehabilitation facilities (IRF), finds a study in The Journal of Trauma and Acute Care Surgery published in the April issue.

Discharge to skilled nursing facilities for trauma patients has, however, been associated with higher mortality compared with discharge to inpatient rehabilitation facilities or home.

Researchers wanted to "better characterize trends in trauma discharges and compare them with a population that is equally dependent on post-discharge rehabilitation." They not only examined trauma discharges, but also discharges of stroke patients, who have been taking up more inpatient rehabilitation facility beds.

Using data from 2003–2009 data from the National Trauma Data Bank and National Inpatient Sample, the retrospective cohort study found that elderly trauma patients were 34% more likely to be discharged to a skilled nursing facility and 36% less likely to be discharged to an inpatient rehabilitation facility. By comparison, stroke patients were 78% more likely to be discharged to an inpatient rehabilitation facility.

This is despite the findings of a 2011  JAMA study of patients in Washington State showing that "Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality."

The Journal of Trauma and Acute Care Surgery study notes that "elderly trauma patients are the fastest-growing trauma population," which leads to the question: Where should hospitals be investing their money and time to ensure the best outcomes for these patients?

"I think hospitals should be investing in post-acute care discharge planning," says Patricia Ayoung-Chee, MD, MPH, Assistant Professor, Surgery, NYU School of Medicine, and lead author of the study. "What's the best post-acute care facility for patients? And it may end up needing to be individualized."

She says reimbursement and insurance factors have "played more of a role than anybody sort of thought about" in discharges, rather than what is always necessarily best for patients.

For example, to be classified for payment under Medicare's IRF prospective payment system, at least 60% of all cases at inpatient rehab facilities must have at least one of 13 conditions that CMS has determined typically require intensive rehabilitation therapy, such as stroke and hip fracture.

"I think the unintended consequence is that we may be discharging patients to the best post-acute care setting, but we also may not be," Ayoung-Chee said by email, and that question "is only now being looked at in-depth."

She says hospitals should think about truly appropriate discharge planning upfront.

Proactive Hospitals
For instance, at admission, hospitals can find out who the patient lives with, or what their social support system is like. If they have a broken dominant hand after a fall, will they be able to get help with their groceries? Do they live alone? Will they be able to use the bathroom?

Caring for patients also doesn't end when patients leave the hospital, she adds. Hence the study's title: "Beyond the Hospital Doors: Improving Long-term Outcomes for Elderly Trauma Patients."

Ayoung-Chee says the next step in her research is to look at a more longitudinal picture, following individual patients to see what factors play into their function or lack of function.

But hospitals can do some of that work on a smaller scale, with internal audits to determine which facilities have the best post-acute care outcomes. For instance, they could spend time examining which facilities had fewer readmissions compared to others, as well as how long it took patients to get home and their how satisfied they were with their care.

Other research is also trying to determine which facilities are best for elderly trauma patients. For instance, a second study, also published in The Journal of Trauma and Acute Care Surgery, shows that geriatric trauma patients have improved outcomes when they are treated at centers that manage a higher proportion of older patients.

One of the overarching takeaways from Ayoung-Chee's research is the idea that hospitals have a broader responsibility to patients than just the time spent within their walls.

"What we do doesn't just end upon patient discharge. If we truly want to get the biggest bang from our buck, we're going to have to think about the entire continuum," she says.

That could range from working to prevent falls that can cause elderly trauma, to seeing patients through all of the appropriate care needed to expect a good functional outcome. Good healthcare for elderly trauma patients should extend beyond the parameters of morbidity and mortality, and toward returning patients to their original functional status and, ultimately, independence, says Ayoung-Chee.

"Our long-lasting effect as healthcare providers isn't just what we do in the hospital," she says. "And we have to start thinking outside."

BY SEAN DENT

http://scrubsmag.com 

Pens that don’t work? Socks that cut off your circulation? Cheap key chains? Yep, those sound like some Nurses Week gift failures to me!

I have some suggestions for gifts I think every nurse would appreciate for Nurses Week. Here are two major ones (you can thank me later!):

A real lunch break

• You know, the kind of lunch break that involves leaving the nursing unit, or even leaving the premises all together. The kind where you actually taste your meal instead of inhaling it on the go. Maybe even a full hour-long lunch so we could enjoy the food we eat and take our time getting back on shift.

IOU: A time out

• A certificate that allows you the ability to just call a time out. I’m talking stopping everything, putting your hands in the air and taking a “Calgon moment.” No explanation necessary, just produce the IOU. We should be able to use this IOU whenever the need arises. You could even put an expiration date on it, although I doubt it would take long to use this one up.

Here are a few more random ideas for gifts:

• A valet ticket for parking
• A free lunch (or more than one)
• IOU: One time you get to leave work early
• IOU: One time you get to come to work late
• IOU: One request for a new pot of coffee be made (when the pot is empty)
• IOU: One admission paperwork completion
• IOU: A free breakfast

Don’t get me wrong, I’m always appreciative of the recognition, but I think if we’re going to celebrate all things nursing, then the gifts should be worth the year-long wait!!

Any other suggestions? What would be a great gift for you this Nurses Week?

http://news.nurse.com 

The award-winning documentary “The American Nurse” (DigiNext Films) will be shown at special screening engagements May 6 in honor of National Nurses Week. The film highlights the work and lives of five American nurses from diverse specialties and explores topics such as aging, war, poverty and prisons. 

“At some point in our life each of us will encounter a nurse, whether it’s as a patient or as a loved one,” Carolyn Jones, director and executive producer of the film, said in a news release. “And that one encounter can mean the difference between suffering and peace; between chaos and order. Nurses matter.” 

The American Academy of Nursing recognized Jones, an award-winning filmmaker and photographer, as the winner of its annual Johnson & Johnson Excellence in Media Award for the documentary. The award recognizes exemplary healthcare journalism that incorporates accurate inclusion of nurses’ contributions and perspectives. “I intended to make a film that celebrated nursing,” Jones said in the release. “I ended up gaining deeper insights into some of the social issues we face as a country, through the eyes of American nurses. I’ve grown to believe that nurses are a truly untapped and under-appreciated national resource.” 

The documentary also was awarded a Christopher Award in the feature film category, alongside films “Selma” and “St. Vincent.”

The film, which was made possible by a grant from Fresenius Kabi, is being presented locally through sponsorship by the Future of Nursing: Campaign for Action, a joint initiative of the Robert Wood Johnson Foundation and AARP, together with the American Nurses Foundation and Carmike Cinemas. 

The campaign’s state action coalitions and other campaign partners are expected to host at least 50 screenings of the film. Ten percent of the proceeds will go to help local efforts to advance nursing. A portion of all proceeds from the film will benefit the American Nurse Scholarship Fund.

To find a screening near you or to learn how to host a screening, go to http://americannurseproject.com/national-nurses-day-screenings.

Glenn Llopis

www.huffingtonpost.com

Like many healthcare providers in the Los Angeles area, and well beyond to healthcare organizations throughout the United States, City of Hope has recognized the growing need for clinical professionals and staff that more closely mirror the patients it serves in its catchment area. And with a local population that is nearly half Hispanic, that means recruiting more Hispanics into the industry, as well as providing much needed career development opportunities. But whereas most in the industry are just beginning to acknowledge the need, City of Hope has taken the lead to recruit more Hispanics into the industry and also has started to build a Hispanic talent pipeline for the immediate and not so distant future.

According to Ann Miller, senior director of talent acquisition and workforce development, "Even when people in the industry recognize the need for more Hispanics, or just a more diverse workforce, it can feel overwhelming trying to figure out what actions to take and how to build a strategy around it. But once you see the data laid out in front of you, and see that 46 percent of your primary service area is Hispanic, you realize it would be optimal to figure out how to recruit a workforce that looks more like the population you are serving. Beyond that, it's also important to employ a bilingual staff that can speak the language and understand the culture to best meet the needs of the community being served."

Once you recognize the need, it's time to start asking the questions that will help you fill the gaps:

• How do you find and appeal to the types of people you need to start building relationships with? Who are the influencers and the connectors?
• How do you get your recruitment team looking toward the future and building a pipeline, when limited resources are focused on more immediate needs?
• How do you get buy-in from senior management and enlist other departments throughout the organization?
• How do you partner with others in the industry who recognize the need but have yet to become active in the pursuit of common goals? 

Here's how City of Hope has started to answer these questions as it takes the lead in addressing these timely industry issues. Stephanie Neuvirth, Chief Human Resources and Diversity Officer, has said that it's not easy to build a diverse healthcare or biomedical pipeline of talent, even when you understand the supply and demand of your primary service area and the business case becomes clearer. "Few in the industry are taking the helicopter perspective that is needed to really see the linkage between the different variables that must be factored in to solve the problem," she says. 

Even in healthcare, it's not simple, and it takes time to develop the paths, the relationships and the pipeline to cause real and sustainable change. It takes linking a workforce talent strategy to the broader mission and strategic goals of the organization. And it takes collaboration with the community, schools, government, parents and everyone who touches the pipeline to help achieve the necessary and vital missing pieces of the puzzle.

Talent Acquisition and Workforce Development

What you first have to realize is that there is an immediate but also a long-term gap to fill, which represent two sides of the same coin: talent acquisition and workforce development. We know we can best serve our community by mirroring the community that we serve, and that doesn't stop with the talent that we attract today; it's an imperative that depends on the talent pipeline that we build for the future.

City of Hope's approach has been to start fast and strong with some immediate steps that can then be built upon and cascaded out into a longer term strategy for the future. The good news is that if your goal is to look like the community you serve, you don't have to look far for the talent you need. It's right in your own backyard. But there's still a lot of work to be done in terms of educating people about potential careers in healthcare -- clinical and otherwise -- developing the workforce skills and knowledge that they will need, and planting the seeds in the next generation. 

It's particularly disheartening to hear about the young people graduating from high school and college who can't get jobs, when there are growing shortages in the healthcare industry - the nation's third largest industry, and projected to be its second largest in just seven years. According to a recent report by The Economist, U.S. businesses are going to depend heavily on Latinos - the country's fastest-growing and what it calls "irreversible" population -- to fill the gaps not just in healthcare but across all industries. 

If you look just at nursing, the single largest profession in California, you can see how far we have to go. Only 7 percent of the 300,000 nurses in the state are Hispanic. The clinical gaps extend to doctors, just 6 percent Latino; pharmacists, less than 6 percent; and the list goes on and on.

Teresa McCormac, nurse recruiter, is one of the people at City of Hope working to build the Hispanic talent pipeline, beginning with the need for Spanish speaking nurses. She is responsible for elevating City of Hope's presence in the community through word of mouth referrals and by getting active in broader outreach online, in publications and at local, college and national events, such as the National Association of Hispanic Nurses (NAHN) annual conference taking place in Anaheim, CA this July.

"It's important to have a passionate champion for the candidates, as well as our hiring managers and the organization. My role is to get the word out into the community about City of Hope and connect with the talent we need to fill our current and future openings," she says.

This requires a multi-prong approach to recruitment efforts, where you must act to attract candidates not only for current needs, but down the road five-ten years, and even further into the future. 

This begs the question: how do you get more Hispanics and other diverse students interested in the sciences and considering careers in healthcare? 

Traditionally, recruiters focus on those currently working in healthcare to fill immediate gaps, as well as those working in other industries with transferable skills, who might be interested in working in healthcare in a non-clinical capacity, such as IT or marketing. They also look at colleges with nursing and other clinical programs -- particularly those with high concentrations of Hispanics and other diverse students -- where they can conduct outreach efforts, build partnerships and establish a presence. 

But building a talent pipeline requires that you reach students well before the college years, when they are still in high school, and even earlier as middle and grade-schoolers. It takes time to get the message out there and have it stick, so the bigger and bolder you can go, the better. That was City of Hope's thinking behind the launch of its Diversity Health Care Career Expo in September 2014, which made quite an impact with the community and opened eyes to the variety of career opportunities within healthcare. It also opened City of Hope's eyes to the level of interest from the community when 1500 people showed up for this first of its kind event. 

What started as an idea for a diversity career fair to fill immediate positions quickly grew to encompass a workforce development component to include students, parents, as well as working professionals interested in transitioning into healthcare. The Career Expo brought a level of awareness never seen before in the community -- and did so very quickly. For example, it allowed healthcare professionals to connect the dots between math and science classes students were taking and how this learning applied in the real world of healthcare -- and the different careers these types of classes are helping to prepare them for if they stick with them. It also allowed parents to understand how to help their children prepare for jobs that are available and will continue to be available in the future. They also gained insights into how growing up with smartphones and other electronic devices has given their children a distinct advantage that previous generations didn't have -- enabling them to leverage their everyday use of technology into transferable skills that could lead towards a career in Information Technology, which offers a very promising career path within the healthcare and biomedicine industries. 

Catching students early on to spark their interest and expose them to healthcare careers and professionals who can encourage and support them along the way requires that you go out into the community as well. Toward that end, City of Hope has partnered with Duarte Unified School District and Citrus College on a program called TEACH (Train, Educate and Accelerate Careers in Healthcare).

According to Tamara Robertson, senior manager of recruitment, the TEACH partnership provides students with the opportunity to gain college credit while still in high school by taking college-level classes at no cost. This puts them on the fast track to higher education and career readiness by giving them essential skills and capabilities to enter the workforce soon after graduating high school, or to continue their education with up to one year of college coursework already completed. Eighteen students were accepted into the program in its first year.

Each partner plays a valuable role in the program. City of Hope provides students with opportunities to gain first-hand exposure to healthcare IT by giving overviews of the various areas within IT, providing summer internships, and offering mentoring and development interactions. Duarte High School is the conduit for the program by selecting the students for the program and facilitating the learning, and Citrus College develops the curriculum that enables students to earn college credits and IT certifications. It's ideal for students who may not have the means to continue on to college, but can work for an organization like City of Hope that offers opportunities to start their IT career as a Helpdesk or Technology Specialist. In addition, they can take advantage of tuition reimbursement should they choose to further their education and development.

In today's world, social media must be in the recruitment mix, especially if you want to engage with Hispanics who index higher on time spent on social media than the general population and any other group. Statistically, 80 percent of Hispanics utilize social media compared to 75 percent of African Americans and 70 percent of non-Hispanic whites. It's also a great way to reach not just active candidates in search of a new position, but passive ones employed elsewhere whose interest may be peaked when a more interesting opportunity presents itself. 

This is where Aggie Cooke, branding and digital specialist, comes in -- leveraging social media as a core component of City of Hope's outreach efforts to potential candidates. She takes a three-legged approach to the use of social media for recruitment:

1.  Branding - offering relevant content that portrays the culture and appeals to a candidate's values and broader career aspirations;

2.  Targeting - identifying potential candidates who have skills and experiences that the organization needs today and in the future; and

3.  Engaging - creating a relationship by inviting candidates to dialog with City of Hope.

You can reach more people through social media -- even if they're not active job seekers -- by posting information that is relevant to their field and interests. For example, oncology nurses will be interested in what you have to say about the latest developments in the world of oncology. 

Though it can seem overwhelming with so many messages out there competing for people's attention, you can break through with content that is authentic, timely and purposeful. You can also make an impact by tailoring your content to the medium you are using. For example, a story about a scientific breakthrough at City of Hope would play well on LinkedIn, while pictures of happy employees taking a Zumba class together would engage potential candidates on Instagram. Social media also enables you to expand the reach and prolong the life of live events. For example, attendees of the Career Expo last year engaged online with live tweets and Instagram pictures from the event and later provided comments and feedback about their experience that will be instrumental in planning this year's event.

Going forward, successful programs and events, like TEACH and the Diversity Health Care Career Expo, will be expanded upon, as City of Hope continues to lead the way in talent acquisition, workforce development and creating a talent pipeline for Hispanics and the future of healthcare.

By Tracey Boyd

http://news.nurse.com

Informatics programs that allow med/surg nurses to cut down on documentation and increase patient safety at the touch of a button are becoming more essential in today’s fast-paced healthcare environment.

“Most all nurses use the electronic health record in their daily practice,” said Jill Arzouman, MSN, RN, ACNS-BC, CMSRN, president of the Academy of Medical-Surgical Nurses and clinical nurse specialist in surgical oncology at the University of Arizona Medical Center, Tucson. The university has computer stations inside each patient room for access to charting, she said, and some hospitals are investing in iPads to facilitate charting. Arzouman is a DNP candidate.

Med/surg nurses at New York’s Montefiore Health System in the Bronx use informatics throughout the day to document patients’ electronic medical records and provide direct care to patients, said Maureen Scanlan, MSN, RN-BC, vice president, nursing and patient care services and former director of informatics for the health system. “Electronic documentation has provided us the ability to track and trend patient outcomes data in a more efficient manner. We have the added benefit of decision support alerts to guide practice and documentation. We then can leverage information collected from the records to streamline workflows and improve patient safety.” 

According to a HealthIt.gov study “Benefits of EHRs,” (www.healthit.gov/providers-professionals/improved-diagnostics-patient-outcomes), having quick, up-to-date access to patients’ information can also reduce errors and support better patient outcomes by keeping a record of a patient’s medications or allergies, checking for problems whenever a new medication is prescribed and alerting the clinician to potential conflicts. 

“The ability to clearly read a medication order printed from a computer is vastly different than trying to decipher a handwritten order,” said Arzouman.

In addition, staff can revisit patient information at any time. 

“Many of the systems are very intuitive and allow the entire interdisciplinary team to document and communicate with precision and ease,” she said “A medical/surgical nurse may be busy with another patient but she or he can go back and read documentation from the dietitian who may have visited the patient at the same time.“

A reduction in medication errors was the catalyst for a project using computerized EHRs at Abington (Penn.) Health. When staff realized that patients with heart failure were being readmitted largely because of incorrect medication lists upon discharge, Diane Humbrecht, MSN, RN-BC, chief nursing informatics officer, devised a plan to evaluate the accuracy of such lists. 

Humbrecht, a DNP candidate who is also a chapter director for the American Nursing Informatics Association, has worked in both cardiac and home care during her career and said she had experienced heart failure patients going home with medication lists that were either incorrect or missing information. 

“It was very frustrating for both the patient and the nurse who is trying to follow up,” she said.

As part of her DNP program, Humbrecht decided to focus on transitions of care for this vulnerable population to help correct their discharge medication instructions and reduce their risk for readmission.

“As I began researching, I saw medication errors on medication discharge lists were the main reasons patients were readmitted to the hospital,” she said. •

Her findings were validated, she said, when the transition nurses who were involved in the postop discharge process informed her of problems with patients going home with incorrect medication lists. “Medication reconciliation and discharge instructions are done by the physician, but the nurses are the ones who review them and they were finding these errors after discharge,” she said. 

Humbrecht implemented three changes to remedy the situation. The first step was to bring the pharmacists in on the front end. Pharmacists already performed patient rounding on units, but they were not involved in medication reconciliation at all, she said. The new protocol called for pharmacists to come in within 24 hours of a patient’s admittance to review the co-medications. The input from the pharmacists on the front end was crucial. “The pharmacists had to change about 80% of the lists,” Humbrecht said.

Next, upon discharge, the nurses perform a thorough review of the co-medications list that was corrected by the pharmacist. “If anything needed to be corrected, the nurse then called the physician to tell them they need to change a medication,” Humbrecht said. “Once that was done, it caused the physician to perform medication reconciliation again, automatically updating the entire medication list.” 

The transition nurses were the final piece to the puzzle. Prior to the new protocol, upon calling the discharged patient and finding any errors, the nurse would make notations on paper. If the patient was readmitted, and the change was not transferred onto the patient’s EHR, the incorrect information was still in the system. Now, using the computerized medication list, any errors are updated immediately in the system. 

The changes worked. Since implementation last fall, the transition nurses have found one error on the medication list of a discharged patient, Humbrecht said. 

“We figured if we can get the home medication list correct on the front end by using the pharmacists and double-checked and changed as needed by the nurses on the back end, then the transition nurses should find less errors,” she said.

Besides documentation and patient safety, med/surg nurses are using informatics to enhance patient care. “Our staff nurses provide expert advice when we are defining a new process for delivering patient care,” said Scanlan, who holds board certification in nursing informatics. “A recent implementation of a new lab system that changed the way specimens are collected was successful due to workflow and hardware recommendations from the frontline staff.” 

Scanlan said staff nurses recently have contributed to revising the electronic skin assessment template as well. 

“Although not a clear time saver,” she said, “it has significantly improved the ability to track, trend and communicate hospital-acquired pressure ulcers [and] has supported performance improvement efforts that are led by the nursing staff.”

Arzouman also noted innovative uses. “For a postoperative patient who needs to continue to ambulate and exercise while at home, a medical/surgical nurse can teach the patient how to track his activity using a smart phone app,” she said. “I have had the opportunity to trial an app on my smart phone that translates basic medical information into many different languages without needing to use a translator. For something simple like ‘Hi, my name is Jill and I will be the nurse coordinating your care today,’ it is a very helpful tool.” 

Source: www.trocaire.edu/trailblazer-blog

Historically, both men and women have filled the challenging and rewarding role of a nurse. It wasn’t until the Civil War, when nearly 3 million men filled the ranks of two competing American armed forces, that women began to dominate the field.

Today, over 43 million Americans are aged 65 or older – a number that is expected to double over the next 35 years. A larger elderly population means a greater need for long-term health services, and as a result, the healthcare field is one of the fastest-growing industries.

Why does this matter?

 1. The U.S. is already on the verge of a nursing shortage. 

The American Association of Colleges of Nursing reports that the U.S. is experiencing a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows.

Did you know only 7 percent of nurses are currently men?   According to the latest National Sample Survey of Registered Nurses conducted by the Health Resources and Services Administration, the percentage of male nurses has more than doubled in the past three decades, but still lingers at 7% today. This number is expected to triple within the next few decades as the need for both male and female healthcare professionals continues to grow.

2. A diverse population needs a diverse nursing staff. 

According to the American Association of Colleges of Nursing (AACN), men are enrolling in nursing programs at a higher rate compared to the past. The IOM report states that there still need to be an emphasis on gender diversification and inclusion in the workforce.

The IOM Report also states that the nursing profession “needs to continue efforts to recruit men; their unique perspectives and skills are important to the profession and will help contribute additional diversity in the workforce.”  The increase in men pursuing a nursing career will help create a more diverse healthcare environment. 

3. Discrimination issues must be overcome.

The idea that men cannot be nurses will never be eradicated until men take to the profession in greater numbers. While nursing is seen as a nontraditional career for men today, the stereotype must change -- nursing is simply too important of a job, and too attractive of a career.

“There are just far too many benefits that come along with nursing, such as a flexible schedule, a secure position, and high pay,” notes the website NursingWithoutBorders.org, “and so it’s therefore difficult for anyone to refuse to pursue a field that only continues to grow.”

Source: http://nursingonline.uc.edu

Publisher: http://nursingonline.uc.edu/ (University of Cincinnati Online)

Written by David McNamee

Male registered nurses are earning more than female registered nurses across settings, specialties and positions, and this pay gap has not narrowed over time, says a new analysis of salary trends published in JAMA.

Although the salary gap between men and women has narrowed in many occupations since the introduction of the Equal Pay Act 50 years ago, say the study authors, pay inequality persists in medicine and nursing.

Previous studies have found that male registered nurses (RNs) have higher salaries than female registered RNs. In their new study, researchers from the University of California, San Francisco, sought to investigate what employment factors could explain these salary differences using recent data.

The researchers analyzed nationally representative data from the last six quadrennial National Sample Survey of Registered Nurses studies (1988-2008; including 87,903 RNs) and data from the American Community Survey (2001-13; including 205,825 RNs). In both studies, the proportion of men in the sample was 7%.

During every year, both of the studies demonstrated that salaries for male RNs were higher than the salaries of female RNs. What is more, the researchers found no significant changes in this pay gap - which averaged as an overall adjusted earnings difference of $5,148 - over the study period.

In ambulatory care the salary gap was $7,678 and in hospital settings it was $3,873. The smallest pay gap was found in chronic care ($3,792) and the largest was in cardiology ($6,034). The only specialty in which no significant pay gap between men and women RNs was detected was orthopedics. The salary difference was also found to extend across the range of positions, including roles such as middle management and nurse anesthetists.

Employers and physicians 'need to examine pay structures'

"The roles of RNs are expanding with implementation of the Affordable Care Act and emphasis on team-based care delivery," the authors write. 

They conclude:

"A salary gap by gender is especially important in nursing because this profession is the largest in health care and is predominantly female, affecting approximately 2.5 million women. These results may motivate nurse employers, including physicians, to examine their pay structures and act to eliminate inequities."

The results of a 2010 survey looking at the impact of the economic crisis on nursing salaries published in Nursing Management found that a nurse leader's average salary fell by $4,000 between 2007 and 2010. In the same survey, almost 60% of nurse leaders felt that they were not receiving appropriate compensation for their level of organizational responsibility.

However, that survey found no evidence that workload for nurse leaders had increased. The respondents reported that they were still working the same number of hours per week as they had traditionally and were not responsible for more staff members than before the economic crisis.

"If you thought nursing was immune to the downturn, think again. The poor economy is keeping us working longer than we'd anticipated," said Nursing Management editor-in-chief Richard Hader, "and in addition to wage cuts, organizations are freezing or eliminating retirement benefits, further negatively impacting employee morale."

Source: www.medicalnewstoday.com

BY JENNIFER WALKER

In a Johns Hopkins Outpatient Center exam room, medical interpreter Julie Barshinger is working with a Spanish patient, a woman in her early 40s with a stocky build and a dark ponytail, who is concerned about complications related to her recent nose surgery.

But first, the woman must complete a medical history form. “¿Qué significa vertigo?” (“What is vertigo?”) she asks, as Barshinger goes through the list of symptoms on the form, verbally interpreting them from English to Spanish. Then later, “No sé qué es un soplo cardiac … ” Barshinger interprets the question — “I don’t know what a heart murmur is” — for the nurse who is preparing a nasal spray for the patient that will allow the doctor to look inside her nose.

“If it doesn’t apply to her, don’t answer it,” the nurse says kindly.

“I just want you to know that I have to interpret everything she says,” explains Barshinger, who is one of 18 full-time interpreters in Johns Hopkins Medicine International’s Language Access Services office. Part of Barshinger’s job is educating providers about her role. 

Later, the nurse starts to leave the room to see another patient before the woman has completed her medical history form. “I can’t continue if you’re not in the room with me,” Barshinger says. The patient is consistently giving additional information about her symptoms: She doesn’t see well since her operation; she has some nasal bleeding; she sees the room spinning when she lies down. It’s crucial for Barshinger to communicate these potentially important details to the nurse, who stays in the room, answering questions when needed, until the form is complete.

Throughout the interaction, Barshinger knows little about the full scope of the patient’s health history. But she doesn’t need to know. “I’m not in charge of her care,” she says. “I’m only her voice. I want to make sure her voice is being heard by the right people. I’m also the voice of the provider, so she can communicate the very necessary and important information that she has to the patient.”

While Johns Hopkins, like other hospitals that receive federal funding, has been providing interpretation services for 50 years — since passage of the Civil Rights Act of 1964, which prohibits discrimination based on national origin — requests for interpreters at The Johns Hopkins Hospital have grown dramatically since 2010, jumping from 23,000 to more than 50,000 annually.

This is due in part to the slightly rising limited English proficiency population in Baltimore City, which grew by about 4,000 people between 2000 and 2012, according to the U.S. Census. Today, the hospital also serves more refugees, about 2,500 of whom settled in Baltimore City between 2008 and 2012.

But Susana Velarde, administrator for Language Access Services at Johns Hopkins Medicine International, says the increase in requests is also due to the growing understanding among health care providers that they can do a better job treating their patients with limited English proficiency with the help of interpreters. 

Because they prevent communication errors, certified interpreters improve patient safety. A 2012 study in the Journal of General Internal Medicine found that patients with limited English proficiency who did not have access to interpreters during admission and discharge had to stay in the hospital between 0.75 and 1.47 days longer than patients who had an interpreter on both days. Moreover, when the interpreter has 100 hours of medical interpretation training — a qualification that researchers have found is more important than years of experience — they made two-thirds fewer errors than their counterparts with less training, according to a 2012 Annals of Emergency Medicine study.

The Language Access Services office’s full-time interpreters—who speak Spanish, Chinese-Mandarin, Korean, Russian, Arabic and Nepali — participate in an extensive two-year training program, which includes classes, tests and shadowing. Fifty percent of the team is certified; the rest are working toward certification, if available in their language. The office also has 45 medical interpreter floaters, and interpretation services are available 24/7 in person, over the phone or through a video monitor for patients with limited English proficiency who live in the Baltimore area and international residents who come to Johns Hopkins for treatment.

“We are the conduit, but also the clarifier,” says Spanish interpreter Rosa Ryan. “We are not simply repeating words but making sure the message is understood.”

For example, at the end of her visit on the otolaryngology floor, Barshinger walks to the front desk with the ponytailed Spanish woman to help her make a follow-up appointment. With Barshinger interpreting, the woman learns that she must get a Letter of Medical Necessity from her current insurer or change insurance companies before coming back to Johns Hopkins. When the administrator walks away, Barshinger checks in with the woman to make sure she understands the instructions.

“The patient might nod, but the information might not be registering,’” she says. “I try to check for clarification if I sense there is a disconnect.”  

Interpreters are also cultural brokers. Yinghong Huang, a Chinese-Mandarin interpreter, remembers when a nurse in labor and delivery tried to give a Chinese patient a cup of ice water. “In China, for a woman who has just delivered a baby, we don’t want her to touch anything cold, let alone ice,” Huang explains. This is one of the many rules that Chinese women abide by for a month to help the body recover from childbirth. With Huang present, providers knew to give the patient hot water with her medicine instead.

Despite the increasing demand for interpreters, their expertise too often goes untapped, says Lisa DeCamp, assistant professor of pediatrics at the school of medicine. She is the lead author of a 2013 Pediatrics study that found that 57 percent of pediatricians who completed national surveys in 2010 still reported using family members as interpreters.

This is a bad practice for many reasons, she says. For one thing, family members often don’t have specialized knowledge of medical terminology. Moreover, both patients and family members may censor information. “If you’re talking about something that is intimate or personal and your son is translating for you, you might not want to disclose something about your sexual activity, your drug use or anything else sensitive that could be contributing to your problem,” says DeCamp, who is also a pediatrician at Johns Hopkins Bayview Medical Center.

Even physicians with basic skills in a particular language should use an interpreter to prevent misunderstandings. “I [know] some high school Spanish, but I’m nowhere near fluent, so I need an interpreter,” says Cynthia Argani, director of labor and delivery at Hopkins Bayview, where about 70 percent of her department’s patient population speaks Spanish. “It’s not fair to the patient not to use one. The message can get skewed.”

DeCamp, who has passed a test certifying her as a bilingual physician, offers a real-life example from the literature that shows how this can happen. A pediatrician with limited Spanish language skills instructed parents to use an antibiotic to treat their child’s ear infection. In Spanish, “if you use the preposition, it really means, ‘put in the ear,’” she says. “So the family was putting the specified amount of amoxicillin that should be taken by mouth in the ear. That child is not going to die from an ear infection, but he’s having pain and a fever, and the family doesn’t have clear instructions on how to provide medication.”

On Barshinger’s rounds, after her otolaryngology visit, she walks at an impressively fast pace to The Charlotte R. Bloomberg Children’s Center, where a mother recognizes her and asks her to be her interpreter. The provider who requested Barshinger’s services is not ready yet, so she has time to help.

A doctor carrying a sheaf of papers joins them in a busy hallway. She points to a long list of care instructions translated into Spanish, then begins to explain them to the mother. Because the doctor is verbally giving the instructions, Barshinger interprets. The mother needs to buy an extra-strength, over-the-counter medication and give her daughter a second medication three times a day, which she will need to “swish and spit,” the doctor says. A third medication will be applied to the daughter’s face two times a day, and a special shampoo is needed to wash her hair. Before an upcoming dentist appointment, she’ll also need to give her daughter three amoxicillin. When the doctor steps away, the mother asks Barshinger a question about her daughter’s dental visit, which Barshinger interprets when the doctor returns.

While interpreting, Barshinger stands to the side of the patient’s mother, allowing the doctor and the mother to face each other and communicate directly with one another. This simple tactic encourages providers to develop a rapport with their patients with limited English proficiency.

The goal? “To make the patient feel like the appointment is with him and not with the interpreter,” says Velarde. “The interpreter is just the voice. We want providers to have a bond with their patients, like they do when everyone is speaking English.” 

Bonding Moments

Tapping the expertise of interpreters doesn’t have to complicate things for physicians, says Lisa DeCamp, a bilingual physician at Johns Hopkins Bayview Medical Center. Her advice for colleagues:

• Educate the interpreter about what you’re doing so they’re not going in blind. Say a patient has severe abdominal pain. Providers can quickly explain to the interpreter that the first job is to rule out appendicitis.

• Sit across from the patient, with the interpreter standing at the patient’s side, and talk directly to the patient. The goal is for the provider and the patient to feel like they have a relationship with each other despite language barriers. When possible, use short phrases to help the interpreter keep up with the conversation. 

Found In Translation

Arabic translator Lina Zibdeh remembers the first time she saw the recommendation in a patient education document that leftover medications should be discarded in used cat litter or coffee grounds.

There isn’t a direct translation for this concept in Arabic, a language that is spoken in different dialects by 22 countries but written in one common form. “It can take hours and extensive research to make sure a concept like this is translated correctly,” says Zibdeh, who translates written materials, such as informed consent forms, welcome packets, care instructions, brochures, video scripts and more. In this case, Zibdeh had to add an additional sentence to explain that medications should be disposed of in this way so they are not enticing to children and pets. 

While translation programs like Google Translate are readily available and easy to use, they often produce inaccurate translations, which can confuse patients and lead to poor health outcomes. This is because words in sentences can be organized in different ways from one language to another. Thus, when online programs translate those sentences from, say, English to Chinese, they can change the meaning, says Chinese-Mandarin interpreter and translator Yinghong Huang. Some English words, such as discharge, also have multiple meanings. “It’s very rare for a program to get the right meaning,” Huang says. Even Huang has to use tools, such as her cellphone and an online dictionary, to produce accurate translations.

Along with improving health outcomes, documents that are available in a patient’s own language can make him or her feel more comfortable and secure, says Zibdeh, who organized the American Translators Association’s first webinar for the Arabic Division on Arabic Medical Translation in early 2014. “It helps that patient feel closer to home,” she adds.

Source: www.hopkinsmedicine.org

Heather Stringer

In 2010, the Institute of Medicine issued eight recommendations that dared to transform the nursing profession by 2020. This year marks the midway point for reaching the goals outlined in the report “The Future of Nursing: Leading Change, Advancing Health,” and statistics at halftime offer a glimpse into nursing’s progress so far.

Although the numbers in some areas have altered little in the first few years, infrastructure changes have been set in motion that will lead to more noticeable improvements in the data in the next several years, said Susan Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing. The RWJF partnered with the IOM to produce the report. 

“I am a very impatient person and would like things to move faster, but we have to remember that we are changing social norms with these goals,” Hassmiller said. “We are trying, for example, to convince hospital leaders, nursing students and educational institutions that it is important for nurses to have a baccalaureate degree, and that takes time.”

Hassmiller is referring to Recommendation 4 of the report, which calls academic nurse leaders across all schools of nursing to work together to increase the proportion of nurses with a baccalaureate degree from 50% to 80% by 2020. The most recent data collected from the American Community Survey by the Future of Nursing: Campaign for Action found that the percentage of employed nurses with a bachelor’s degree or higher only climbed 2% between 2010 and 2013. However, Hassmiller suggested the percentage is likely to increase rapidly in coming years because nursing schools have increased capacity to accommodate more students. As a result, the number of nurses enrolled in RN-to-BSN programs skyrocketed between 2010 and 2014, from about 77,000 nurses in 2010 to 130,300 students in 2014, according to the American Association of Colleges of Nursing — a 69% increase. 

New education models

Campaign for Action leaders also are optimistic about the profession’s ability to approach the 80% goal because nursing schools are beginning to experiment with new models of education, such as bringing BSN programs to community colleges. 

Traditionally, students spend at least three years in a community college earning an associate’s degree to become an RN — at least a year for prerequisites and another two to complete the nursing program, Hassmiller said. These RNs may work for a few years before returning to school to earn a BSN — and some may not return at all, said Jenny Landen, MSN, RN, FNP-BC, dean of the School of Health, Math and Sciences at Santa Fe Community College in New Mexico. To avoid losing potential BSN students, leaders from New Mexico’s university and community colleges began meeting to discuss a new paradigm: students who were dually enrolled in a community college and a university BSN program. 

The educators started by forming a common statewide baccalaureate curriculum that would be used by all community colleges and universities, Landen said. The educators also discussed how to pool resources, such as offering university courses online at local community colleges. “This opens the opportunity of earning a BSN to people who need to stay in their communities during school,” she said. “They may have family commitments locally, and they can take the baccalaureate degree courses at the community college tuition fee, which is much less expensive.”

Four community colleges in New Mexico have launched dual enrollment programs within the last year. At Santa Fe Community College, there are far more applicants than the program can hold, Landen said. Community colleges and universities in other parts of the country also are working together to create programs in which nursing students can be dually enrolled. In addition to nursing schools buying into the need for more BSN-prepared nurses, there also is evidence that employers are moving toward this new standard as well. According to a study released in February in the Journal of Nursing Administration, the percentage of institutions requiring a BSN when hiring new RNs jumped from 9% to 19% between 2011 and 2013. 

Beyond the BSN

So far, the national data related to Recommendation 5 — double the number of nurses with a doctorate by 2020 — suggests there have been minimal changes in the number of employed nurses with a doctorate, yet there has been a significant increase in the number of students pursuing this level of education. According to the JONA article, on average about 3.1% of employed nurses in all institutions had a doctorate in 2011. This rose to 3.6% in 2013. This percentage likely will increase in the coming years because of the proliferation of doctor of nursing practice programs since 2010. These programs are geared for advanced practice RNs who are interested in returning to the clinical setting after earning a doctoral degree. Between 2010 and 2013, the number of students enrolled in DNP programs doubled from just over 7,000 students to more than 14,600. There was a lesser increase in the number of students enrolled in PhD programs, up 12% from 4,600 to 5,100, according to the AACN. 

“When the DNP degree became an option, it opened the opportunity of a higher level of education to the working nurse, not the researcher, and that was attractive to many nurses,” said Pat Polansky, MS, RN, director of program development and implementation at the Center to Champion Nursing in America. “Getting a research-based PhD takes longer and not every nurse can do that, so the DNP has become a wonderful option.”

Leaders at the Campaign for Action, however, acknowledge that it is important to find strategies to boost the number of PhD-prepared nurses because the profession needs those nurses in academia and other administrative, research or entrepreneurial roles where they are contributing to the solutions of a transformed healthcare system, Hassmiller said. To encourage more nurses to pursue the path of a PhD, in 2014 the RWJF launched the Future of Nursing Scholars Program, which awards $75,000 per scholar pursuing a PhD. This is matched with $50,000 by the student’s school, and the funds can be used over the course of three years. 

Forging ahead

In December, the nursing profession will have another opportunity to assess progress on the recommendations when the IOM releases findings from a study that is under way to assess the national impact of the Future of Nursing report. The changes happening in areas such as education are remarkable, Hassmiller said, and she is eagerly anticipating the results from the current IOM study. 

“I would never modify the goals because you need something to strive for in order to affect change,” Hassmiller said. “I am extremely encouraged because we have never seen anything like this. For the first time in history, more than half of nurses have a bachelor’s degree, and it is going to keep climbing. The most challenging part has been the number of people that need to be influenced to make the business case as to why it is important, and it is finally happening.” 

Key recommendations from “The Future of Nursing: Leading Change, Advancing Health”

1) Remove scope-of-practice barriers.
2) Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. 
3) Implement nurse residency programs.
4) Increase the proportion of nurses with a baccalaureate degree to 80% by 2020. 
5) Double the number of nurses with a doctorate by 2020.
6) Ensure that nurses engage in lifelong learning.
7) Prepare and enable nurses to lead change to advance health. 
8) Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data.

Source: http://news.nurse.com