DiversityNursing Blog

A generational gap is showing in nurses’ views of the practice, with younger RNs more likely to have a positive opinion of the nurse supply and use of electronic medical records, according to a survey.

The fourth annual survey was conducted by AMN Healthcare, a healthcare workforce and staffing company. Results were based on 3,413 responses from questionnaires emailed to 101,431 RNs during April 2013. 

“In a time of unprecedented change in the healthcare industry, it becomes even more important to study how the nursing workforce is responding to the myriad new systems, requirements and quality measurements that accompany healthcare reform,” Marcia Faller, RN, PhD, chief clinical officer of AMN Healthcare, said in a news release. 

“While the vast majority of nurses remain satisfied with career choice, the younger generation is more optimistic about the profession and more receptive to the changes the industry is experiencing. These are differences that health systems must understand as they work with multiple generations of nurses.”

Despite existing shortages, RNs ages 19-39 are more confident about the supply of nurses and their ability to meet the demands of healthcare reform, according to the survey. Findings show 45% of younger RNs believe the shortage has improved during the past five years, compared with 41% of RNs ages 40-54 and 34% of RNs ages 55 and older. 

The generational differences widened when nurses were asked whether healthcare reform will ensure an adequate supply of quality nurses, with 38% of younger nurses saying they were “very confident” or “somewhat confident,” compared with 29% and 27% of nurses 40-54 and 55 and older, respectively.

Generational differences also appeared in answers about the use of electronic medical records, a requirement of the Affordable Care Act. Younger RNs were more likely to believe their use positively influenced job satisfaction, efficiency and patient care. While 67% of younger nurses agreed or strongly agreed EMRs were a positive influence on job satisfaction, that number fell to 51% for nurses 40-54 and 45% for RNs 55 and older. 

Similarly, more young RNs (60%) agreed EMRs positively influence productivity and time management compared with older RNs (38%), the survey found. 

Other key findings:

• Almost 90% of nurses, regardless of age, are satisfied with their career choice, and 73% are satisfied with their current jobs.

• With the improving economy, approximately 23% of nurses age 55 and older plan to dramatically change their work life, citing retirement, taking a non-nursing job or working part-time as very near-term possibilities.

• Less than half of RNs with an associate’s degree or a diploma plan to pursue any additional education in nursing. However, RNs ages 19-39 are more likely to pursue higher education, with nearly 25% saying they expect to pursue a BSN and 34% planning to obtain an MSN, compared with 22% of RNs ages 40-54 planning to pursue a BSN and 22% eying an MSN.

• Of younger nurses, 21% are certified in their specialty, but 59% expect to seek certification.

• RNs ages 19-39 were less likely to believe the quality of care has generally declined (37%), compared with RNs 40-54 (56%) and RNs 55 and older (66%).

“The potential departure of a significant number of older nurses from the workforce can be concerning, given the unclear supply and demand for nurses in the coming years, but is to be expected as nurses approach retirement age,” Faller said in the news release. 

“Healthcare systems must use innovative approaches to attract and retain their workforce while keeping them effective and satisfied. Innovative workforce solutions could help maintain high standards of patient care and efficiency in the era of dramatic change in the healthcare industry.”

Report (registration required): www.amnhealthcare.com/industry-research/2147484433/1033/

Source: Nurse.com

By Heather Stringer

 

Atkins is not alone. Most nurses throughout the country are feeling the impact of significant national factors, such as the recession and healthcare reform, that are changing the landscape of nursing jobs.

“Nurse salaries — and really salaries for any profession — are generally determined by supply and demand,” said Joanne Spetz, PhD, a noted healthcare and nursing economics researcher and professor at the Institute for Health Policy Studies, University of California, San Francisco. “What we’ve been seeing in California is that the wages of nurses really flattened out and may have even dropped in the past four years after a period of rapid wage growth.”

According to data from a 2012 survey from the California Board of Registered Nursing, the annual salary of nurses in California increased from $45,073 to $81,428 between 1997 and 2008. In the past five years, however, salaries flattened and even dropped between 2010 and 2012. 

 

RNs across the nation are experiencing a similar trend, according to data from the U.S. Bureau of Labor Statistics. Starting in 2009, the median annual wage increases were 2% or less, compared with double or triple that percentage the previous five years. Between 2011 and 2012, the latest data available, the median annual wage for RNs nationally increased only 1%, from $69,110 to $69,935. Data from the American Association of Colleges of Nursing shows that nurse faculty salaries are stagnating as well.

Although many hospitals have become more conservative in hiring nurses, Spetz suggested there are strategies nurses can use to increase their chances of securing a desirable position in the long run. “I know a lot of new graduates like to look for the perfect job, but if the labor market is tight in your area, just get a job because some experience will make you more competitive and help you get that perfect job in the future,” she said. “If you are an associate-degree graduate and can go back to school, do it.”

For Atkins, the willingness to be flexible paid off in the short term. After a year as director of an ED in Louisiana, he was recruited to fill an interim ED director position at a larger hospital system in Missouri. Although the position was short-term, he hoped the experience would help him eventually land a position in California. Then the call came: A traveling company recruited him for an interim position in California. This interim position eventually turned into a full-time permanent role as house and bed control supervisor at Kaiser Permanente in Hayward, Calif., with an annual salary well above any of his previous salaries.

“During my previous director roles, I tried to learn everything possible about budgets, audits and the hospital, such as how to set up an incident command center and emergency response teams,” Atkins said. “Now I absolutely love my job, and my hours allow me to be home with my children in the evening.”

Forces at work

While recessions and salary changes tend to be cyclical, the future is less predictable with the convergence of several national trends.

“The first factor is the real impact healthcare reform will have, and a lot of that is relatively unknown,” said Terry Bennett, RN, MS, CHCR, president of the National Association for Health Care Recruitment, based in Lenexa, Kan. “Organizations are struggling to predict the impact of decreasing physician and Medicare reimbursements, and they are really trying to maintain financial security. They are not giving the same type of market adjustments that they used to [give nurses], and some are decreasing the amount of merit increases given to nurses.”

In addition, the supply of nurses has increased in the past decade as a growing number of nursing school graduates join baby boomers still on the job, Spetz said. “The baby boomers have been more career-focused than any generation preceding them,” she said. “They might not want to fully retire even if the recession lifts.” 

 

However, other factors could increase demand for RNs and drive up salaries. “What we would expect is that as the economy improves and as the Affordable Care Act allows more people with insurance to seek healthcare, we would see demand for nurses go up,” said Spetz. “Also, as baby boomers age and require more healthcare, this could also drive up demand for services.”

Nurse staffing ratio laws also may increase the number of positions available in hospitals, said Brannen Betz, general manager of Aureus Medical Group, a national nurse staffing company. According to the American Nurses Association, 15 states have enacted legislation or adopted regulations to address nurse staffing. “Many states are moving toward mandating nurse-to-patient ratios, and this could be the best thing that happens to nurses,” Betz said. 

 

Maximum trajectory

As healthcare employers prepare for these changes, nurses can position themselves to stand out from their competition.

“We are no longer just putting someone in the job because they have a credential,” said Julie Hill, RN, BSN, CHCR, RACR, recruitment coordinator for Georgetown Hospital System in South Carolina and vice president of NAHCR. “Now we have a larger applicant pool, so we can select the best nurse for the job. Many hospitals use behavioral assessment tools so they can make sure that an individual has the positive service attributes that lead to good hospital consumer assessment scores and less likelihood of turnover.”

Georgetown uses a behavioral assessment tool combined with a separate reference assessment tool, Hill said. Hospitals are looking for nurses who are flexible, customer-focused, compassionate, have a strong work ethic and work well with team members, she said.

Nurses with specialty training also are in higher demand, said Kay Cowling, CEO of Fastaff Travel Nursing, based in Denver. Nurses with experience in ORs, labor and delivery, cardiovascular ICUs or pediatric areas have more options, Cowling said. RNs who know how to use electronic health record systems also have an advantage in the job market, she said. 

Source: Nurse.com

By Joyce Riddle, RN-CPN, BSN

One day, as I was relaxing during some quiet time, it dawned on me that I was a seasoned nurse with the ability to influence some of my younger or less-experienced co-workers. I have worked as an RN for the same organization for 23 years, and I had something to offer them.

Too often, older nurses are seen as being a bit crotchety, negative or uncaring to some of the younger nurses or newbies. That has to change; why make people feel uncomfortable?

Years ago, as a new nurse, I went through an orientation to the unit. Once competent with some skills, I became the team leader for my patients. If I had questions, I knew I could ask my charge nurse, but I never had a mentor or felt there was one particular nurse to whom I could always turn. I knew I wanted to become that go-to person for my younger counterparts. I enjoyed teaching and helping new employees master skills and tasks.

I am a spiritual person with Christian beliefs. This is part of what makes me who I am. On my commute to work, I get motivated for the day by listening to Christian music. I understand others may not share similar beliefs, but I think everyone needs to find what fulfills them and practice it daily before work, whether it is exercising, reading or just spending time alone.

Make it a point to bring your best to work each day. After all, that is what we are getting paid to do. Once at work, acknowledge everyone with a smile, eye contact or a simple "hello." I've seen how acts of inclusion or kindness filter down to others. On occasion, unfamiliar colleagues may come by my unit and I smile at them, furthering the process of encouragement to others. Kindness can be contagious.

My mantra or focus is to encourage young nurses so they will establish themselves at our facility and become great, seasoned nurses. I have watched some start out as new graduate nurses and then continue their education and grow professionally. I have seen many nurses come and go, but others stay and continue with their education. I support my co-workers who decide to go this route.

For the longest time, I talked myself out of obtaining my certification in pediatric nursing. Once I chose to pursue it, I immediately wondered why I waited so long. Now I routinely ask my co-workers, "When are you going to do it?" Supporting them and encouraging their growth adds more satisfaction to my daily work. It will be gratifying when all my immediate co-workers obtain and maintain their CPNs.

We all have different strengths we can bring to work. Some nurses have a soft touch. Others have a friendly smile or a knack for speaking kind words. All of these can be examples of conduct for the young nurse. 

Remember, just like young children who watch and mimic their parents, the newbies are watching our responses toward one another and our patients. Positive expressions are necessary for their growth.

Before speaking or doing something, I ask myself, "Is this going to encourage or discourage?" I want to know I am encouraging someone to be a better nurse. I will not gossip or make any unkind comments toward my co-workers for the newbie to hear. The younger nurses will not overhear derogatory comments from this veteran.

Every day, I tell myself with pride, "I am a seasoned nurse." I will embrace that I am a little older and more experienced, and will welcome opportunities to use that experience. I hope my seasoned co-workers will join me to make our jobs productive by helping our younger nurses. We all have something to contribute to foster hope and encouragement. 

Source: Nurse.com

By Kateri Allard

In the first year of my career as a registered nurse, I continued my education, wrapping up my bachelor's degree in nursing, not yet a requirement to work as an RN but a well-worth-it continuation of a degree to make you a more well-rounded and, to be honest, respected nurse. One of the requirements for this degree was a course called "Professional Issues and Trends." The course explored the profession of nursing, barriers it is facing, and the way that we, as nurses, can change that. I learned many things in that course, but the most important, the thing that has stuck with me the most, was this:

A few days into the course, our professor made one thing very clear: Each and every one of us, from that moment on, needed to remove "just a nurse" from our vocabulary.

"Are you a doctor?"

"No, I'm just a nurse."

I have spent six years since trying to avoid that phrase. More so, I have worked to avoid that feeling. I work hard at what I do, but I am often aware that my friends and family have no concept of what nursing is. I don't bring you to your room at the doctor's office, sit you on the table, and check your normal blood pressure, then go and get the doctor. Instead, I am often in a room with a small child on a ventilator, multiple intravenous medications infusing through central lines keeping the vascular system constricted or dilated. I monitor blood gases and adjust ventilator settings accordingly. If the blood pressure goes too high, I adjust the medications related to these values. I keep my patient adequately sedated and paralyzed, for their safety, without over-medicating them. It is often my responsibility to determine this balance.

Recently, I had a nearly 2-year-old patient who pulled his own breathing tube out in the early morning. We weren't sure whether he would do okay without it, so I monitored his respiratory status closely all morning. By mid-afternoon, he seemed to be doing well enough. By then his sedation had worn off and he had no interest in staying in bed. Concerned that he would harm himself moving around through multiple IV and arterial lines, plus a BiPap machine, and monitor leads, I decided to hold him. He had no family present but needed close to a dozen IV medications over the next five hours. I collected them all and lined them on his bed. I pulled his syringe pump that would be used for the medications off of the IV pole and placed it on the bed in front of me. I lifted him out of bed and onto my lap, into my arms. For five hours we rocked and I held him close. He stared into my eyes, played with my hair with his one arm, tried to suck his thumb through IV sites and arm boards. I gave his medications one by one until the nurse who would relieve me for the oncoming shift came in.

I'm not just a nurse. I am a nurse. I can over the course of the 12-hours shift go from interpreting serial blood gases to comforting a sick child while continuing to monitor vital signs, respiratory status, and administer medications.

I am the eyes, hands, and feet of the physician. I am not their eye candy or their inferior. I don't stand up when they enter to room. I don't follow their orders, I discuss the pathophysiology of the patient's condition with them, and together we make a plan. Often the things I suggest are the course of action we take, and other times I learn something new I had not understood from this doctor. They don't talk down to me; we discuss things together.

I had an experience this weekend, one of the first of its kind for me, and I was surprised by how angry and affected by it I was.

A friend cut their arm and hours later still struggled to stop the bleeding. I assessed the wound and created a pressure dressing out of the supplies you have available in a frat house cottage. I reluctantly informed the friend that the wound would likely need a stitch or glue. It wasn't large, but it was deep and wide and would likely heal poorly, if at all, and even if it didn't become infected would leave a decent scar. I am not one to jump to big medical interventions; if anything, I ride the line of noncompliant and under-concerned.

My opinion was shared but another guest, a doctor, decided it would probably be fine with a Band-Aid and heal without issues. He may be right, or I may be right. But a close family friend who I have known almost my entire life chimed in.

"No offense, Kateri," he said, "But obviously we're going with the doctor over the nurse for this one."

"You're just a nurse," he might as well have said, although he didn't.

I felt like I had been smacked in the back by a two-by-four. My best friend knew this would be my reaction and turned in horror as the color left my face and the posture left my shoulders. Something inside of me sunk.

The following day I struggled to understand why I was still upset. Surely he had no idea what his words had meant, or how they felt. But over lunch the following day, as I discussed my new job with my family, it became clear. My job is so much, and so much of it is misunderstood. And maybe this is no one's fault but my own. Sure, I'm a nurse. Yup, some days are sad. Yeah, blood and poop don't bother me.

But that's all I say. I don't tell you what I really do. And the media definitely doesn't either. Nurse friends, help me out here. Maybe it's time that we stop pretending we are less than we are, that we do less than we do.

I came across the following blurb this morning. I wrote it a few years ago for Nurse's Day, and it rings as true today as it did then. I may not be a doctor, but I am a nurse. And if you are someone whose mind says "just a nurse" please, go ahead and ask the nurse you know best what it is that they do. I think you may be surprised.

I am a nurse. I didn't become a nurse because I couldn't cut it in med school or failed organic chemistry, but rather because I chose this. I work to maintain my patient's dignity through intimate moments, difficult long term decisions, and heartbreaking situations. I share in the joy of newly-born babies and miraculously-cured diseases. I share in the heartbreak of a child taken too soon, a disease too powerful, a life changed forever. My patient is often an entire family. I assess and advocate. Sometimes I wipe bottoms, often I give meds, but that isn't the extent of what I do. There are people above me, and people below. I work closely with both; without them, I could not do what I do well. I chose this profession and love almost every minute of it. I know I am not alone, and I appreciate all of the nurses who work alongside me. Many of them have shaped me into the nurse I am. Someday I will shape others into the nurse they will be. This wasn't my plan B. It was my plan A, and I would gladly choose it again.

This post originally appeared on According to Kateri.

The Healing Power of Dogs

It was a tough case: A five-year-old girl awaiting a bowel and pancreas transplant, who had essentially given up the will to live. She hadn’t spoken a word to anyone in days. But that was before Gracie, all two pounds of her, came to visit. Gracie, a Chihuahua rescue who belongs to Danielle Palmieri, R.N., is a therapy dog in the People Animal Connection Program (PAC) at UCLA. As soon as Gracie entered her room, the five-year-old perked up. A nurse even came in to see what had happened—the patient’s vitals had returned to normal for the first time in days. “She started talking and continued for 20 minutes,” says Palmieri, a high-risk labor and delivery nurse at UCLA. “They had pulled out every toy in that hospital, but nothing worked like Gracie.”

In March, PBS will air an episode of “Shelter Me,” a series looking at the positive impact of adopted shelter pets, that features PAC (see shelterme.com for dates). PAC is one of the largest pet therapy programs in the nation and its dogs make 900 visits a month to critically ill children and adults. It’s a trend that’s growing at healthcare facilities around the country. “There’s a lot of documentation showing that being with pets lowers blood pressure, and normalizes respiration,” says Jack Barron, PAC’s former director. “I’ve even seen people come out of a coma in a dog’s presence. People ask, ‘But how do you know it was the pet?’ and I say, ‘How do you know it wasn’t?’”

Palmieri tours the hospital with Gracie in her off hours, but she’s not the only nurse who supports the program. According to Barron, pet therapy wouldn’t happen without the nurses, who lay the groundwork so that dogs can make the visits. The nurses get some of the benefits, too. PAC dogs are also brought round to visit the nurses, especially those in critical care. “It calms them down and puts smiles on their faces,” says Barron. “It’s rewarding to see the nurses have a few relaxing minutes.”

Sister Act

How many times have you had a brilliant idea, only to shrug it off believing it would be too arduous to pursue? California nurses (and sisters) Terri Barton-Salinas and Gail Barton-Hay also came up with a brilliant idea—only they saw it through to fruition. If things go according to plan, you may be seeing it in your workplace some time soon.

Their patented idea: ColorSafe IV Lines, color-coated tubing designed to prevent medication errors. “When I worked in the ICU, the IV lines were like a big pile of spaghetti,” says Barton-Hay, now an OR nurse at Monterey Peninsula Surgery Center. “We were sitting around telling war stories and Terri said, ‘Wouldn’t it be great if tubing were colored?’ We did some research, went to a lawyer and now here we are.”

The sisters (one other sister and their mom are nurses too) found a manufacturer and even began selling the lines until they hit a bump in the road–the FDA asked for paperwork that it had previously waived. They complied and expect approval soon. “As nurses, we care about our patients and want nothing but the best for them so we’ve just kept plugging away,” says Barton-Salinas, a labor and delivery nurse at Kaiser Permanent in Vallejo. “If we prevent just one medical error it will be worth it.” The duo’s advise to other would-be nurse-inventors: Don’t take no for an answer.

How Sweet It Is

Clever cookie-maker Jaclyn Shaffer devised these medical- themed cookies by getting creative with cutters she already had. Check out jaclynscookies.com, and for instructions click here.

It’s a Mad, Mad World

Even if you’ve never been the target of a scalpel-throwing surgeon, no one has to tell you that physicians can behave badly. But did you know it’s so common that accredited hospitals must have a written policy on how to handle doctors’ disruptive behavior? Anger not only makes the workplace uncomfortable, it can compromise care.

Enter Anderson & Anderson, a certified anger management facilitator that frequently works with physicians, many of them surgeons. Stress, dealing with insurance companies that limit treatments and a perfectionistic nature all contribute to doctor rage, says George Anderson, director of training. “Plus, doctors put in a lot of hours to get their degrees, which means they don’t have as much time in life to develop interpersonal relationships.”

Okay, but how’s that going to help you deal with verbal abuse? When you witness bouts of anger, bring it to the attention of the appropriate department or committee at your hospital—and also try a personal approach. “Ask if you can speak to the doctor privately for a minute,” advises Anderson, “then ask if there’s anything you can do to help.”

Emotional Rescue 

Hospitals are well equipped to deal with medical emergencies, but crises of the spirit? Not so much. Enter Code Lavender, which, like a Code Blue, offers a form of resuscitation—but without the chest compressions. Instead, when a Code Lavender is called—whether the person in need is a patient, family member or someone on staff dealing with an emotional or spiritual crisis—the rapid response team comes armed with a bevy of potential therapies. Depending on the extent and nature of the need, they may provide reiki, healing touch therapy, aromatherapy, guided imagery, nutrition therapy and/or pastoral care.

The brainchild of ExperiaHealth, a company devoted to improving the patient and staff experience, Code Lavender addresses everything from a patient’s fear of an upcoming surgery to a family member’s worry or stress about a loved one and a nurse’s despair over having just lost a patient.

The program had its beginnings in a simple act of collective goodwill. “When a patient was in crisis, everyone on the hospital staff was asked to stop and send a healing intention or prayer to his room,” says Bridget Duffy, MD, chief executive officer at ExperiaHealth. “Eventually, Code Lavender morphed into not only sending intentions, but sending a healing services team to anyone in need, be it patient, family member or staff.”  

Several hospitals around the country now have a healing team in place, including the Cleveland Clinic in Ohio and Joe DiMaggio Children’s Hospital in Hollywood, Fla. And it’s been of particular benefit to healthcare workers: At the Cleveland Clinic, 40 percent of all Code Lavender requests were from employees.

What’s On Nurses’ Nightstands?

Four books worth a read.

Get Motivated! Overcome Any Obstacle, Achieve Any Goal, and Accelerate Your Success with Motivational DNA by Tamara Lowe and Rudolph Giuliani. (Doubleday)

I’m fascinated by how to effectively teach/motivate patients (and myself)
to take charge of their own health. This book looks at how different personalities get motivated and has already been valuable in helping me determine care plans for my patients. –Jonathan Steele, RN, holistic nurse in private practice, Scranton, PA

A Fistful of Collars: A Chet and Bernie Mystery by Spencer Quinn

This is number five in a series of
 private eye novels narrated by a mixed-breed German Shepherd who couldn’t quite make the cut for K-9 duty…
but neither could his 
owner. Great romp of a read for stress-busting after a long day at work. –Coleen Kenny, RN, MS, division of geriatrics, Virginia Commonwealth University Hospital
in Richmond

Maestro: A Surprising Story About Leading by Listening by Roger Nierenberg

This is about how a symphony orchestra solved problems. I picked it up because I felt it would be inspirational and, it is. It’s helping me to become a better listener, something I feel we all need to be reminded of from time to time. –Melina Thorpe, RN, director of Cancer Services, Glendale (CA) Adventist Medical Center

House of Sand and Fog by Andre Dubus III

I like it because the story builds up to something melancholy and tragic, while also giving some insight into human behavior and motivation. –Melanie Lukesh, FNP-BC, family nurse practitioner, Canton Potsdam Hospital

How Soccer Explains the World: An Unlikely Theory of Globalization by Franklin Foer

I am fascinated at how sports, in particular soccer (Futball), meld with society and stretch beyond the pitch (field). –Kimberly Bertini, BSN, RN, RNC, Magnet Program Coordinator, Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, Illinois

By Heather Stringer

By 2043, the U.S. is projected to become a majority-minority nation for the first time in its history, according to the U.S. Census Bureau. Both the Hispanic and Asian populations will more than double between 2012 and 2060, and the black population will increase by 50% during the same time period. These statistics illustrate that nurses will be caring for a progressively diverse patient population and the increasing urgency to build a diverse RN workforce. 

“Patients come with an expectation that the caregiver will understand all of their care needs,” Deidre Walton, RN/PHN, MSN, JD, president and CEO of the National Black Nurses Association based in Silver Spring, Md., said. “When you have a diverse workforce, you have people with knowledge and skills to meet the diverse needs of patients. The patient’s cultural identification, spiritual affiliation, language and gender can all affect the care they need, and it is very important that the nurse understands that.” 

Although Walton said the healthcare community is far from reflecting the demographics of the American population, she has hope as she looks into the future because diversity in the nursing workforce is being highlighted as a critical priority by more than minority nursing organizations. 

“I am excited because organizations such as the Robert Wood Johnson Foundation and AARP have a diversity agenda, and that makes me hopeful that there will be change,” she said.

Increasing diversity in the workforce, as illustrated on the following pages, will take individual and group efforts. 

Job titles of minority nurses

According to the 2008 National Sample Survey of Registered Nurses, the largest sample to date, minority nurses were more likely to hold staff nurse positions than white, non-Hispanic nurses.

Black nurses comprise 5.4% of the RN workforce, and 13.8% are in management positions, which is higher than any other ethnic group. Walton, however, said far more black nurses still are needed in leadership positions because this 13.8% is taken from a small pool of nurses. 

“Some organizations have very active programs to promote diversity in leadership, but the diversity gap in leadership continues,” Walton said. “There is a gap between how many minorities are recruited and how many are actually hired. These minorities in leadership roles are able to participate in making changes to improve the practice environment and outcomes, and this is very important.” 

Can patient ethnicity affect care?

According to a 2012 report from the Agency for Healthcare Research and Quality, racial and ethnic minorities face more barriers to care and receive poorer quality of care when they can get it. Findings from the report included:

Blacks received worse care than whites, and Hispanics received worse care than non-Hispanic whites for about 40% of quality measures.

American Indians and Alaska Natives received worse care than whites for one-third of quality measures.

Blacks had worse access to care than whites for one-third of measures, and American Indians and Alaska Natives had worse access to care than whites for about 40% of access measures.

Hispanics had worse access to care than non-Hispanic whites for about 70% of measures. 

Would a more diverse RN workforce correct some of these disparities? "Absolutely,” Walton said. “Diversity will improve patient-nurse communication, collaboration and clinical practice for patients of all backgrounds. If an African-American woman comes to the ED with abdominal pain, what is the likelihood that she will be diagnosed with a sexually transmitted disease as the cause of the pain rather than [staff] conducting other tests for a definitive diagnosis? When you have a culturally diverse RN workforce, they may not as easily dismiss symptoms and will advocate for a more intense work-up.” 

According to the 2008 National Sample Survey of Registered Nurses, only 0.3% of the RN workforce is American Indian or Alaska Native. This small percentage who are accepted into nursing school, earn their degree and enter the workforce often have overcome significant challenges, Bev Warne, RN, MSN, one of the founders of the Native American Nurses Association based in Phoenix, Ariz., said. “A survey in 2010 showed that 51% of Native American high school students graduate, so the drop-out rate is very high,” Warne said. “There are complex reasons for this. Studies show that many grow up in families that are poverty-stricken, so they suffer from poor nutrition and difficult family situations, and by the time they are in junior high they are already behind.” 

Warne believes the preparation to attain a formal education begins with good prenatal care, proper nutrition and support for parents. Even after Native Americans are accepted into nursing school, there are other challenges they may face.

“There are differences in values among Native people and Western people,” Warne said. “Generally Native Americans are raised in more of an extended family where there is an emphasis on inclusiveness. When they go into the college setting outside the reservation, they may confront Western values that promote individualism and competition, which is often the opposite of how they were raised. To be successful in this new setting, it is important for educators to get involved with students to discuss this new reality.”

It also can be difficult to transition to the Western medicine paradigm, Warne said. “In the Western hospital setting, caregivers tend to look more toward the physical aspects of illness, but from the Native perspective, they are accustomed to a holistic way of viewing a person.” 

Power to promote

Although it may seem difficult to make time to promote nursing to minorities within the community, here are a few simple strategies that are making a difference. 

Celia Besore, executive director and CEO, National Association of Hispanic Nurses: 
“I believe stories are really what lead people to consider nursing. The personal stories of nurses who were maybe the first to go to college in their families and now are very successful are the ones that inspire people. Our chapter members go into the community and do career fairs and visit schools, and that is when nurses can share their stories. There have been times when people have discouraged Hispanic students from going to nursing school because they think the students will not succeed, and our nurses can give them hope. We also tell young people that 30% of our members are student nurses, so they know they will not be alone.

“During these events, we also explain that now is a good time to be a minority in healthcare,” she continued. “We get calls from places that are desperately looking for Latino nurses. The word is starting to get out that it is an asset to understand the culture and language of minority patients, and hospitals want people with this experience.”

Mildred Crear, RN, MA, MPH, chairwoman for nursing and community education, Bay Area Black Nurses Association:
“Our chapter sponsors community health events like blood pressure drives, and this gives people in the community a chance to see us and ask what it takes to be a nurse. We share this information and then invite them to our meetings. We also do a lot of health fairs with churches and black sororities and fraternities where we do presentations about nursing, and this has been a really effective way of promoting the profession.”

Sharon Smith, RN, MSN, FNP-BC, president of the San Diego Black Nurses Association:
“I think it is critical to connect with people when they are young and try to mentor them. You can meet youth through church, in the community or through the events sponsored by your minority association. Our chapter visits high schools to recruit students, and we will go into the tough neighborhoods where it is harder for students to believe that they can do it. I share my own story that I grew up in North Carolina in one of the poorest counties, and I was told I would never finish high school. I told myself, ‘This is your thought, and not mine,’ and I went on to earn a BSN, a master’s degree and now I am pursuing a doctorate. You can do simple things like take them to work or communicate online, and this will show students the positives of a career in nursing.” 

It starts in the schools

Diversity in the nursing workforce is dependent upon a pipeline of diverse students who graduate from nursing school. This much-needed diversity among students, however, requires focus and resources, Julie Zerwic, RN, PhD, FAHA, FAAN, professor and executive associate dean at the University of Illinois at Chicago, College of Nursing, said. “Our school went through a period of time when there was no staff focused on watching diversity, so the number of underrepresented minorities in the program dropped,” she said. “If no one is paying close attention, you can lose momentum.” 

For example, the school recognized that a number of underrepresented minorities were not finishing their applications and would benefit from having a staff member available to receive phone calls and answer questions. The school also started offering application workshops. 

Although Zerwic hopes to see even more diversity among undergraduate nursing students, her institution has had significant success in recruiting graduate minority students. Zerwic credits a National Institutes of Health-funded program, the Bridges to the Doctorate Program, that helps the school to support potential minority doctoral students through mentoring, funding and coursework. 

Like the University of Illinois, diversity became a high priority in the School of Nursing at The University of Texas Health Science Center. “We knew that about 62% of the population in San Antonio was Hispanic, and to provide competent healthcare we needed to increase the number of Hispanic nursing students,” Hilda Mejia Abreu, PhD, MS, BA, associate dean for admissions and student services at UTHSC San Antonio, said. 

During the spring and fall, staff members travel throughout the U.S. to college fairs, schools, nursing association recruitment fairs and other activities to recruit minority students. The local Spanish-language channel also regularly features a 15-minute segment in which Mejia Abreu explains the college preparatory classes needed to apply for nursing school and how to finance an education. 

By comparison, below are the national diversity statistics for nursing schools:

Race/Ethnicity of Students Enrolled in Entry-Level 
Baccalaureate Nursing Programs in the U.S. in 2011
White, non-Hispanic: 72%
Black: 10.3%
Hispanic: 7%
Asian, Native Hawaiian or other Pacific Islander: 8.8%
American Indian or Alaskan Native: 0.5%

(Source: American Association of Colleges of Nursing) 

Overcoming the language barrier

For nurses who have arrived in the U.S. as adults and learned English as a second language, there typically are two distinct challenges they will face when communicating: being understood by Americans and understanding Americans, said Victoria Navarro, RN, MSN, MAS, president of the Philippine Nurses Association of America. 

“In the Philippines, we were colonized by Spain for about 400 years, so the Filipino language (Tagalog) that evolved has root words based in Spanish,” Navarro said. “We pronounce every syllable. In English, you have words with silent syllables or letters, so that in itself is something that we need to learn.” 

In addition to pronunciation, healthcare workers use jargon to communicate, and this is even more complicated when English is a second language. Navarro remembers when a physician told a Filipino nurse to get the “lytes.” The nurse turned off the lights, when in fact he had meant electrolytes. Other communication challenges Filipino nurses confront in the U.S. include:

In Tagalog, there are no long vowels, so it takes time and practice to learn to pronounce these sounds. 

There are no pronouns such as ‘he’ and ‘she’ in Tagalog, and there are no singular or plural verbs. It takes time to know when to say the proper pronoun or verb. Many people make mistakes initially.

Mental processing in the native language happens before responding in English. The literal translation from Tagalog to English could change the intent of the sentence.
In the Philippines, people have high respect for elders and do not speak unless they are asked something directly. For this reason, Filipino nurses may be considered passive by peers or patients. 

Navarro and Joseph Mojares, RN, BSN, president of the Philippine Nurses Association of Northern California, say proficiency can come with practice and time and made the following suggestions:

Do not be embarrassed to ask questions to clarify what others mean so you can learn the correct pronunciation and terminology.

Constantly immerse yourself in English-speaking environments and expose yourself to mainstream media at work and at home. 

Challenge yourself by taking classes in communication, leadership and public speaking so you can improve your English. 

Find mentors and preceptors who can encourage you and give you suggestions about how to present yourself and communicate. 

Tips for scholarship success

Jasmine Melendez, the scholarships and grants administrator at the Foundation of the National Student Nurses Association, has an insider’s view into the world of financial assistance. She has seen hundreds of scholarship applications, and said reviewers are looking for three things from applicants: financial need, high academic achievement and involvement in community health activities. 

“It is important to maintain a high GPA, but students who make time for some form of community service really set themselves apart,” Melendez said. 
Another way to stand out from the competition is to turn in well-crafted, accurate essays. “What I’ve been noticing is that students need to learn to write well,” she said. “When you convey a message, you want to make sure you convey it in a clear, concise manner with no spelling errors or grammar mistakes.” 

Here are other tips she suggests:

Get comfortable with the Internet because most scholarships are found on the Web. Websites that can help minority students find scholarships include: 
DiscoverNursing.com/Scholarships 
MinorityNurse.com/Find-Scholarships 
NursingSociety.org/Career/CareerAdvisor/Pages/Scholarships_opps.aspx 

Check with minority-owned businesses to see whether they offer scholarships, and ask the financial aid office at your school about scholarships and applications.

The hospital association in your state may have access to scholarship information.

Don’t make the mistake of thinking scholarship deadlines are only in the first part of the year. There are scholarships available every quarter of the year.

Don’t disqualify yourself by not applying. Apply for everything and let the committee say no. 

Source: Nurse.com

Shannon Patel, RN, BA, CCRN, CMC, PCCN, manager of the heart failure program at AtlantiCare Regional Medical Center in Galloway, N.J., and an RN-to-BSN student at the Rutgers School of Nursing–Camden (N.J.), led a team at the hospital’s Heart Institute that developed a new smart phone app that helps patients manage heart disease and stay out of the hospital.

The WOW ME 2000mg app helps patients, caregivers and family members identify and manage symptoms of heart failure, according to the release.

"This tool was designed to cross the healthcare continuum and has allowed our organization to deliver very important self-management education," Patel said in the release.

The WOW ME 2000mg app reminds patients to weigh themselves; measure their output of fluids; walk and be active; take their medications; evaluate signs and symptoms; and limit sodium intake to 2,000 mg or less, with 1,500 mg being optimal. The app prompts users with reminders and allows them to enter information about how they are managing their symptoms. It also links them with AtlantiCare’s Heart Failure Resource Team and other providers. Patel said in the release that many heart failure programs around the country are struggling to find ways to successfully teach heart failure self-management techniques. She said there is no standardized approach to reinforcement of the information taught to patients and that oftentimes patients receive differing and conflicting information depending on where they go for treatment.

"This tool standardizes heart failure self-management for patients," Patel said in the release.

Source: Online RN to MSN | University of Arizona College of Nursing

By Lois Gerber, RN, BSN, MPH

It was my first nursing visit to Thad and Larissa. The three of us sat around their kitchen table discussing how to best manage an exacerbation of Thad’s multiple sclerosis. Tears welled in the corners of Larissa’s brown eyes as she twisted a strand of her strawberry blonde hair around her finger. 

"His MS seemed to get worse overnight," Larissa said. "He can’t walk up the stairs anymore without hanging onto the railing for dear life. [Our doctor] says it’s time for a stair lift." 

"I can beat these new problems," Thad replied. "Prayer, persistence and exercise. My sales manager suggested a disability leave, but I refused. Give me a month here at home. I’ll show him." His hands shook as he hitched his belt over his potbelly. "There will be no damn chair lift in my house. Mind over matter." 

I took a deep breath, remembering that the physician referral documented an exacerbation of an aggressive form of MS that limited the chance of significant recovery. Double vision accentuated his mobility problems. 

Hope and unrealistic expectations — a common but difficult scenario I’d often seen in my work as a home healthcare nurse. But how to best help Thad accept his limitations while keeping hope in his heart? And convince Larissa to encourage her husband to be as independent as possible?

First, I needed to do a complete assessment and work with the couple to develop an effective long-term care plan with an overall goal and the individual steps to accomplish it. Without realistic expectations, Thad and Larissa’s fears and anger would further the family dysfunction.

I paused. "Thad, physical therapy can strengthen your muscles and improve your walking. An occupational therapist can teach you ways to deal with small things like brushing your teeth and shaving."

"I’ve already had two stints with them and learned everything I need to know," he said, clenching his fists.

I looked at Thad. "Let’s make a deal. You agree to have physical and occupational therapy for four weeks and I’ll visit twice a week, communicate with the doctor and follow up on any problems you have. Then we’ll talk about the stair lift." 

Over the next month, I counseled Thad and Larissa, individually and as a couple. "I’m scared what will happen to me if Thad dies," Larissa admitted one day while we were alone, reviewing handouts on managing the disease. 

"That’s understandable, but overprotecting him and not letting him do what he can safely do hurts his rehab potential." I highlighted sections in the pamphlets that pertained to caregiving.

She frowned. "I’m angry at him for getting sick and feel guilty about that, too. We’re only 55. If he got hurt, I’d blame myself. That’s why I’m overprotective. I’m scared."

I nodded. "All your feelings are normal. Most caregivers feel the same."

"No one else I know has to deal with MS. I’m alone, depressed."

"The Multiple Sclerosis Society has a caregiver support group that meets every week at the city library. That’s where you’ll find people who feel just like you. Talking with them will help."

Thad’s fear and anger manifested in denial instead of depression. "It’s hard to get the mind and the body working together sometimes," I told him. "With a chair lift, you could save your energy for things that are important and that you enjoy."

"Like going to work?"

"That could be a realistic goal. What about cutting back to three days a week?" 

He smiled. "I can live with that. And Larissa’s right. The stair lift is a good idea."

Helping clients set realistic goals is important to keep hope alive. Unrealistic goals foster fear, denial, anger and depression. But without hope, clients lose the moorings for their lives. 

Source: Nurse.com

By  Jennifer Smola 

Sixty-one years after graduating from Mount Carmel College of Nursing, one of the school’s first black graduates is finally hanging up her stethoscope.

June Todd, 83, retired yesterday from Dr. Charles Tweel’s family-medicine practice on the Northwest Side. Todd graduated from Mount Carmel in 1952, in a class of 52 nurses. All were women, and, for the first time, four were black.

Todd, who lives in Worthington, attended Harding High School in Marion, north of Columbus. She considered studying library science, but her school librarian told her she would have a hard time getting a job in the North because of her race.

“I said, ‘That’s not going to work,’  ” Todd recalled. “So I decided I wanted to become a nurse."

Her race seldom made a difference during her nursing career, she said. And she has fond memories of her time at Mount Carmel.

“I loved the nuns,” she said. “Everybody was so nice.”

Tweel described Todd as a “ball of energy” who never missed work. She’s popular not only among her co-workers but with patients, who “like seeing her more than they like seeing me,” he said.

Enid Patterson, a patient for 10 years, said she was sad to see Todd go.

“She’s not just my nurse,” Patterson said. “She’s my friend.”

When Tweel hired Todd 13 years ago, she planned to stay only a year or two, she said, but she stuck around because she liked the work.

Her co-workers said she brought humor and energy to the office every day.

“She’s the only 80-some-odd-year-old woman that has an opinion on everything from Hillary Clinton to why Chris and Rihanna should not be together,” co-worker Beth Shahan said. “She’s very with-it and hip.”

Though Todd is retired, she says she’s not done working. She plans to volunteer at local nursing homes and perhaps at a Worthington library.