DiversityNursing Blog

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

by Mareisha Winters
Let’s talk about work.

There is a lot of attention being paid to our increasingly diverse workplace. There are all types of differences including race, gender, generations and thinking styles, just to name a few. LTAW’s focus this month is on some of the key diversity dimensions and how to navigate them for greater productivity and engagement.

The increasingly diverse global workforce has made cultural competence an imperative to sustain and enhance workplace performance and engagement.  What is culture and what is cultural competence?  Culture is the behavioral interpretation of how a group lives out its values in order to survive and thrive; the set of shared attitudes, beliefs, behaviors, values, goals, and practices that characterizes an institution, organization or group.  Cultural competence is the capability to shift cultural perspective and adapt behavior to cultural commonalities and differences.  Ongoing, continued learning is required for cultural competence.

The three largest minority groups in the US workforce today are: Hispanic/Latino (14.7%), Black/African-American (11.6%), and Asian American (4.6%).  The more different cultures work together, the more cultural competence is essential to avoid problems ranging from miscommunication to actual conflict.  These problems can compromise effective worker productivity and performance.

Developing cultural competence results in an ability to understand, communicate with, and effectively interact with people across cultures.  The purpose of this post is to understand the different barriers and hurdles that minority groups tend to face in the workplace.  Managers must understand that their style cannot necessarily be “one size fits all” if they have a multi-cultural team.  Below are some characteristics of the three main minority groups in the workplace.

Hispanics/Latinos

Hispanic culture tends to be risk adverse and more of a “we” vs. “I” culture.  This can negatively impact them in the workplace if it is not understood.  Their risk avoiding nature may not afford them the same chances to show their abilities and skills.  By not self-promoting as much as others, Hispanics may not be rewarded for their contributions.

Cultural competence can help Hispanics reach their full potential in the workplace.  Many employees make sweeping stereotypes about Hispanics.  Some are criticized for their accents, leading to assumptions on their abilities, level of education, and intelligence.  Hispanics tend to speak Spanish with each other because of comfort, but this can be confusing or seen to be exclusionary by others.

Mentoring can make the difference in retaining Hispanics.  Hispanic mentors serve as role models and better understand some of the cultural nuances of being Latino in the workplace.  Hispanic employees need formal and informal ways to connect with each other in order to maintain the relationship bonds they value.

Blacks/African Americans

Studies tell us that there is greater corporate flight amongst minorities, especially among African Americans.  Research conducted by the WP Carey School of Business showed that the predicted quit rate for whites was 3.73%, compared to 4.79% for African Americans.   Discriminatory environments and micro-behaviors are often cited as reasons African Americans leave an organization.  So what can a company do to make these employees feel more engaged? Based on findings from focus groups conducted by the Future Work Institute, the top five characteristics of an organization that retains African American employees include:

    A climate of inclusion
    Supportive interactions with leaders
    Offer of profit and loss responsibilities
    Opportunities for development and advancement at all levels
    Community involvement and social responsibility

As with Hispanics, mentoring is a key factor in the career development and retention of Blacks/African Americans.  Studies have shown that mentoring of African Americans leads to: increased performance, faster promotion rate, early career rate of advancement, greater upward mobility, higher income, job satisfaction and perceptions of great success and influence in an organization.

African Americans place a high value on interpersonal relationships with supervisors and co-workers, which impacts both job satisfaction and employee commitment.  Supportive work environments for African Americans include: collectivist (focus on group rather than individual outcomes) approaches to work, agreeableness and teamwork.

Asian Americans

The same Future Work Institute focus group study revealed the major hurdles for Asian Americans in the workplace.  The primary reasons that Asian Americans feel excluded in the workplace include:

    Lack of mentors with Asian perspective.  Because of the small number of Asian Americans in the US workforce, mentors with Asian perspective are limited.  Similar to Hispanics and African Americans, Asian Americans would benefit greatly from having mentors in the workplace.
    Glass ceiling.  Asian Americans who wish to move up the career ladder feel limited because they do not see Asian representation at the top.
    Lack of transparency.  The need for constructive feedback is essential for career development.
    Life is out of balance.   Often caught between the demands of kids, parents and work, Asian Americans feel their work and life is out of balance.  According to AARP, 73%of Asian Americans believe that children in their families should care for elderly parents, compared with 49%of the general population.
    Cultural differences.  The sentiment from many Asian Americans is that, “Our culture is very different from the _______ culture.”  There is a lack of cultural understanding which is a barrier for them in the workplace.

It is important to note that the data presented above does not apply to every person within that subgroup and that any generalizations should not be viewed as stereotypes.  We offer this information to provide guidance to leaders on how the differences in values and culture might influence workplace behaviors and needs and why cultural competence is such a vital skill for leaders to effectively manage the increasingly diverse workforce.

Value differences! Live inclusively!

From Human Resource Executive Online By Katie Kuehner-Hebert

It's one thing to be bullied by a co-worker or a boss, but simply witnessing the behavior in the workplace can be enough to make a worker call it quits, according to a study of "ambient" bullying.

Researchers at the University of British Columbia in Vancouver, Canada surveyed 357 nurses in 41 hospital units and found a statistically significant link between working in an environment where bullying was occurring and a desire to leave the organization. The study was published last month in the journal Human Relationsby SAGE.

"We underestimate the power of the impact of just being around bullying in the workplace," says Sandra Robinson, a professor at UBC's Sauder School of Business and one of the authors of the study.

"For those seeking to influence problematic behavior, they need to be sensitive [to the fact] that the impact of such behavior transcends the person or the group . . . actually being bullied, and that there may be other victims who are impacted by the harmful behavior, whether it comes from their supervisor or co-workers," Robinson says.

Marianne Jacobbi, senior editor at Ceridian/Lifeworks EAP programs in Boston, says research has shown that ambient bullying, or "indirect bullying" is pervasive -- 70 percent of employees say they have witnessed other people being bullied or mistreated at work.

"Bullying has a negative effect on team relationships, which creates a toxic work environment," Jacobbi says. "When [people] witnesses bulling, they think, 'This could be me next,' particularly if it's their boss."

Indeed, research has also shown that 72 percent of all bullies are bosses, she says.

HR managers should encourage an environment in which people feel safe to discuss bullying they've witnessed, and assessed that their comments will remain confidential whether they come to their boss, the HR department or the organization's employee-assistance program, Jacobbi says.

"The most important thing is creating a climate where people feel they have someplace to go when they feel uncomfortable," she says.

Ken Zuckerberg, director of training at ComPsych Corp. in Chicago, says HR managers not only have to watch out for employees with low morale after witnessing bullying, but also employees who try to appease the bully and make bad business decisions to avoid getting on their bad side.

When dealing with bullying behavior, organizations should treat it as a performance problem first and foremost, Zuckerberg says. A common mistake that HR managers often make in these situations is to take on the role of a counselor and try to figure out what is going on in the bully's life to cause them to act that way.

"One word of caution ? you want to continue to manage performance, but you don't want to be diagnosing mental-health issues," he says. "Most HR managers are not clinicians and they instead, should refer the bully to their EAP for help in uncovering what might be core issues behind bullying."

Seymour Adler, a partner with Aon Hewitt in New York and an organizational psychologist, says some people who witness bullying in the workplace feel they've been put in "a totally untenable situation of whether or not they need to try to be a hero."

"Who knows what the consequences will be if they do something about it, so they end up being passive about it," Alder says. "That can really be very corroding to their self-esteem, to how they view themselves as human beings."

If top-level managers are bullies, HR managers need to risk confronting them for the sake of the rest of the organization, he says.

"[HR managers have] the responsibility for the motivation, effective use and treatment of all of the human capital within their organizations," Adler says. "They need to be true to their value system, even if it ends up costing them their job."

From the Center for American Progress by Sophia Kerby & Crosby Burns

Our nation and our workforce are both becoming more diverse. The share of people of color in the United States is increasing; more women are entering the labor force; and gay* and transgender individuals are making vital contributions to our economy, while being increasingly open about who they are. To that end, businesses that embrace diversity have a more solid footing in the marketplace than others.

A diverse workforce combines workers from different backgrounds and experiences that together breed a more creative, innovative, and productive workforce. And businesses have learned that they can draw upon our nation’s diversity to strengthen their bottom line. In this way, diversity is a key ingredient to growing a strong and inclusive economy that’s built to last.

Let’s look at the top 10 economic benefits of workplace diversity.

1. A diverse workforce drives economic growth. Our nation’s human capital substantially grows as more women, racial and ethnic minorities, and gay and transgender individuals enter the workforce. A McKinsey & Company study, for example, found that the increase in women’s overall share of labor in the United States—women went from holding 37 percent of all jobs to 47 percent over the past 40 years—has accounted for about a quarter of current GDP.

2. A diverse workforce can capture a greater share of the consumer market. By bringing together individuals from different backgrounds and experiences, businesses can more effectively market to consumers from different racial and ethnic backgrounds, women, and consumers who are gay or transgender. It is no surprise, then, that studies show diversifying the workplace helps businesses increase their market share.

3. Recruiting from a diverse pool of candidates means a more qualified workforce. When companies recruit from a diverse set of potential employees, they are more likely to hire the best and the brightest in the labor market. In an increasingly competitive economy where talent is crucial to improving the bottom line, pooling from the largest and most diverse set of candidates is increasingly necessary to succeed in the market.

4. A diverse and inclusive workforce helps businesses avoid employee turnover costs. Businesses that fail to foster inclusive workplaces see higher turnover rates than businesses that value a diverse workforce because they foster a hostile work environment that forces employees to leave. The failure to retain qualified employees results in avoidable turnover-related costs at the expense of a company’s profits. Having a diverse and discrimination-free work environment helps businesses avoid these costs.

5. Diversity fosters a more creative and innovative workforce. Bringing together workers with different qualifications, backgrounds, and experiences are all key to effective problem-solving on the job. Similarly, diversity breeds creativity and innovation. Of 321 large global enterprises—companies with at least $500 million in annual revenue—surveyed in a Forbes study in 2011, 85 percent agreed or strongly agreed that diversity is crucial to fostering innovation in the workplace.

6. Businesses need to adapt to our changing nation to be competitive in the economic market. Census data tell us that by 2050 there will be no racial or ethnic majority in our country. Further, between 2000 and 2050 new immigrants and their children will account for 83 percent of the growth in the working-age population. Our economy will grow and benefit from these changing demographics if businesses commit to meeting the needs of diverse communities as workers and consumers.

7. Diversity is a key aspect of entrepreneurialism. Our nation’s entrepreneurs are a diverse set of people of color, women, gay, and transgender individuals. According to the Census Bureau, people of color own 22.1 percent of U.S. businesses. Moreover, women own28.8 percent of U.S. businesses, and Latina-owned businesses in particular are the fastest-growing segment of the women-owned business market. According to the National Gay and Lesbian Chamber of Commerce, gay or transgender individuals own approximately 1.4 million (or approximately 5 percent) of U.S. businesses.

8. Diversity in business ownership, particularly among women of color, is key to moving our economy forward. The diversity of our nation’s business owners helps boost employment and grow our economy. For example, women of color own 1.9 million firms. These businesses generate $165 billion in revenue annually and employ 1.2 million people. Latina-owned businesses in particular have total receipts of $55.7 billion since 2002.

9. Diversity in the workplace is necessary to create a competitive economy in a globalized world. As communities continue to grow, it’s important to harness the talent of all Americans. Businesses should continue to capitalize on the growth of women, people of color, and gay and transgender people in the labor force. Our increasing diversity is a great opportunity for the United States to become more competitive in the global economy by capitalizing on the unique talents and contributions that diverse communities bring to the table.

10. Diversity in the boardroom is needed to leverage a company’s full potential.By 2050 there will be no racial or ethnic majority in the United States, and our nation’s boardrooms need to represent these changing demographics. Currently people of color and women only represent about 14.5 percent and 18 percent, respectively, of corporate boards among the senior management of Fortune 500 companies. Recruiting board directors with a breadth of expertise and varied experiences will make companies more proficient.

The news that some employers have asked for direct access to the Facebook accounts -- including user names and passwords -- of people applying for jobs at their firms has set off a firestorm of controversy.

The reports have raised questions about whether the practice is illegal and if such a policy could expose those employers to potential discrimination lawsuits. The dust-up has even triggered calls by some in Congress for a federal investigation into the practice.

But those recent events only highlight a new reality: The identity that individuals create in the world of social media is quickly becoming an important factor in hiring decisions and in people's broader professional lives.

"The questions around employer access to social network log-ins reflect a broader debate in society about a host of digital privacy issues," says Andrea Matwyshyn, a Wharton professor of legal studies and business ethics. "This is a new concern -- the degree to which employers can gain access to all role identities through one virtual space. There is no parallel to that in the real world."

While the reaction to the practice has been swift and intense, it's hard to predict if it will become a lasting trend.

But, Matwyshyn says, she began hearing about employers requesting access to the Facebook accounts of potential hires as far back as 2008. To date, however, she says, there is no good data on how widespread the practice has become.

The fact that it exists at all is not entirely unexpected: According to Matwyshyn, a number of studies show that most employers look at candidates' online profiles when making hiring decisions, noting a 2011 survey by social-media monitoring service Reppler that found that 91 percent of recruiters report using social-networking sites to evaluate job applicants.

But checking out a publicly available profile on Facebook -- or even asking a job candidate to "friend" someone in human resources at a company where they are applying for a position -- is worlds apart from gaining unfettered access to someone's account through a password.

"If you can take Facebook passwords, what about Gmail passwords?" asks Stuart Soffer, a non-residential fellow at The Center for Internet and Society at Stanford Law School and managing director of IPriori, an intellectual-property consulting firm.

If left unchecked, Soffer says, the practice could expand beyond human resource departments evaluating potential employees.

"What about allowing Facebook access to insurers so they can see what you are saying about your health?" he says. "They could use it as a basis for judging the risk of insuring you."

The request for access to log-in information also raises some serious legal questions.

Clearly concerned about the legal and business implications of privacy breaches, Facebook has come out against the practice, stating that sharing or soliciting a Facebook password is a violation of the company's statement of rights and responsibilities.

"We don't think employers should be asking prospective employees to provide their passwords because we don't think it's the right thing to do," Facebook Chief Privacy Officer Erin Egan says. "But it also may cause problems for the employers that they are not anticipating."

Matwyshyn says employers could be essentially asking job candidates to violate their contract with Facebook if they ask for passwords, creating "an untenable conflict between contract law and employers' perceptions of their own interest in vetting candidates."

In addition, if a Facebook account includes information on an applicant's race or age, for example, that could potentially expose the employer to claims of discriminatory hiring practices. According to Matwyshyn, it is legally hazy whether accessing someone's Facebook account where that information is available is akin to asking it in the interview.

"Arguments can be made that this is a back-door method to gaining information that the prospective employer wouldn't otherwise have access to," she says.

Meanwhile, the issue is getting the attention of Congress. Senate Democrats Charles Schumer and Richard Blumenthal, from New York and Connecticut respectively, have asked the Justice Department and the Equal Employment Opportunity Commission to look into the practice.

But even if it is eventually prohibited or otherwise curbed through legal or legislative channels, Wharton management professor Nancy Rothbard predicts that the use of social media in hiring decisions will continue to be a flashpoint in the years ahead.

"The core of the problem is the blending of personal and professional lives," Rothbard says. "We are still in the infancy of trying to understand how to deal with all this."

Opening the Window -- and Closing a Door?

Just how far employers can legally go to check out job candidates online may not be clear -- but why they are looking for new methods of evaluating applicants is easy to understand, says Wharton management professor Adam Grant.

Research, he says, has shown that the typical job interview is a poor tool for predicting which candidates will succeed. If that does not work, companies need to find something that does.

"Applicants are very motivated to put their best foot forward in an interview," Grant says. "It is very difficult to spot the people who will represent an organization well. But on Facebook, you can see the applicant making day-to-day decisions -- it is a window into how an individual is likely to act."

In fact, recent research has provided evidence that online profiles can be very revealing about specific personality traits.

A paper published recently in the Journal of Applied Social Psychology entitled, "Social Networking Websites, Personality Ratings, and the Organizational Context: More Than Meets the Eye," studied 518 undergraduate students and their Facebook profiles.

The researchers found that the Facebook profiles were a good predictor of the so-called "big five personality traits:" conscientiousness, agreeableness, extroversion, emotional stability and openness. And for a subset of the group where the researchers were able to contact supervisors at companies that had hired those students, there was a correlation between scores on two personality traits -- emotional stability and agreeableness -- and job performance. (SeeHREOnline^TM story here.)

"There is strong evidence that social networking is a valid way of assessing someone's personality," says Donald Kluemper, a professor of management at the Northern Illinois University College of Business and a co-author of the study.

But he says that does not mean there is evidence that an unstructured perusal of a Facebook account will result in better hiring decisions.

"Until a method is validated in a number of ways, including a study of adverse impacts and the legal issues, I wouldn't recommend companies rely on social-networking profiles," Kluemper says.

Now, the use of social-media information is far from fine-tuned, with recruiters typically checking out social media to get a general sense of the person applying for a job or to hunt for any red flags. But it is possible the use of that information could become more sophisticated.

"People are mining that data right now for other purposes, including targeting ads to the right people," says Shawndra Hill, a Wharton operations and information management professor. "It is not out of the realm of possibility to focus that on other outcomes, like how good a match someone is for a job or whether there is a high likelihood they might do something illegal."

While the value of that data may be apparent, it remains to be seen how social media should ultimately fit into some aspects of professional life.

Take the less-controversial practice of managers' friending their colleagues through Facebook. Rothbard says this practice creates numerous potential headaches. Two years ago, she and some colleagues did a series of interviews with 20 people at a variety of levels and in a number of different industries, and found that people were often unnerved friending either bosses or subordinates.

"People felt very uncomfortable with crossing the private and professional boundary when it came to the hierarchy [within an organization]," Rothbard says. "They talked about friending their bosses with similar discomfort and language as they did when they spoke about friending their moms."

Interestingly, Rothbard adds, the rules for social networking in the workplace may differ based on gender.

She led a study of 400 students in which participants were shown Facebook profiles, told that the person was either a boss, a peer or a subordinate, and then asked to rate the individuals based on how likely they were to accept that person's friend request.

The findings: Female bosses with bare-bones profiles were less likely to be accepted than those who revealed more personal information, while the opposite pattern held for male bosses.

"Women who have limited profiles are more likely to be shunned than the women who have a more active presence," Rothbard says. "People see them as cold. But male bosses who reveal less information are more likely to be accepted than those who reveal a lot of information."

The increased scrutiny of people's virtual lives may change the way individuals operate in the social-networking realm.

According to Rothbard, there are essentially four ways of dealing with privacy issues. There are those who control their list of friends carefully, rejecting friend requests from people with whom they don't want to share personal information. Then, there are those who accept virtually all requests, but are very careful about what they post, limiting that content to very safe, less revealing information.

There is also a hybrid approach in which people use privacy settings to share some information with close friends and less-sensitive material with others. And, finally, there is the "let it all hang out" crowd -- those who are comfortable sharing all their information with a large group of close (and not so close) friends.

Grant predicts more people will opt for the more-controlled, filtered approach as they realize their social-media profiles are being scrutinized by potential employers.

"As employers gain this information, so do candidates," Grant points out. "So candidates may use Facebook more carefully and remove the cues that are so valuable [to employers]."

Soffer agrees people will become much more careful about their social-media personas.

"There are ways around this," Soffer says of the unwanted exposure of social-media behavior. "One thing that could happen is people will start having two Facebook accounts." One will be for close friends; the other, a more sanitized version for employers.

But there is always the potential that something posted for viewing by a small group of close friends on Facebook could get out into larger circulation. And for that reason, some argue, the risks of being active in the social-media space outweigh the benefits.

"If you are a CEO, or aspire to be a CEO or director of a public company, I think it makes sense to refrain from social networking," says Dennis Carey, vice chairman at Korn/Ferry International. "There are other ways to communicate with employees and the outside world through properly controlled channels. Some of the messages that are conveyed can be misconstrued or taken out of context by a third party."

The fear of a photo or comment made long ago coming back to haunt you is hardly unfounded. Because sites such as Facebook have been around less than a decade, it is not certain how long someone's social-networking history will remain accessible.

"It is unclear how long the information persists," Hill says. "Firms have different privacy policies, and often privacy policies change over time. While there are policies that allow for deleting data you no longer want on the site, it is hard to guarantee that this information won't live on a database somewhere."

The controversy worries some fans of the social-media revolution.

"I worry that there is already a sense right now that our participation online may come back to haunt us," says Chris Ridder, co-founder of the law firm Ridder, Costa & Johnstone and a non-residential fellow at The Center for Internet and Society at Stanford Law School.

"It inhibits our ability to express ourselves," he says. "If we can only express public relations-like statements, it takes away a good bit of the utility of the Internet. I think it would be a shame if we were to lose the playful aspect of this new technology."

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How would you feel if someone asked for your account information to Facebook or Twitter in an interview? What if your boss did it? Do you think this is a privacy violation? Should there be legislation on this? Let us know in the comments; we want to hear from you!

 

Nurses are as diverse as the patients they treat.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

 

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

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

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

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

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

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

Audio Links Click Here

By definition...

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

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

Models

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

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

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

Beware stereotypes

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

Taking it all in

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

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

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

Goals and Considerations of cultural competency

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

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

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

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

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

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

Title: Confident Voices: The Nurses' Guide to Improving Communication & Creating Positive Workplaces

Author: Beth Boynton, RN MS

Amazon Review:

“Confident Voices is a "must read" for every nurse who has had conversations with peers, supervisors, physicians and health care providers that have ended badly or wanted a different outcome. Confident Voices is designed to negotiate health care in the 21st Century and for communicating in a way that leaves everyone feeling included and honored in the process of day-to-day discussions in getting the job done. Beth Boynton's book provides the nurse with conversation tools to navigate difficult situations and provides support and feedback to reframe the situation so all involved win. I appreciate all the work Beth Boynton did in writing this book and the necessity of clear, concise communications in this difficult period we are all facing in the health care today.”

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Have you read Confident Voices? What did you think of it? Has it helped you communicate at work?

Physicians, nurses, allied health professionals and pharmacists are using social media tools to network with professional colleagues, track down job leads and apply for new positions, according to a new survey.

The survey was conducted by AMN Healthcare, which bills itself as the nation's largest healthcare staffing and workforce solutions company. AMN Healthcare's "2010 Social Media Survey of Healthcare Professionals" was designed to provide healthcare employers and leaders a snapshot of how healthcare professionals are currently using social media and other online applications for networking, job hunting and other career development activities. The survey, which was conducted this fall, received 1,248 responses.

The survey suggests that traditional methods of recruitment such as referrals, online job boards and search engines are not being superseded by social media, whereas social media does surpass other job search methods such as newspaper ads, career fairs and other methods.  At the same time, social networking sites are experiencing tremendous growth, and have become the new frontier in professional networking and career development for physicians, nurses, allied health professionals and pharmacists. Job candidates are spending more time online and experimenting with media sites for job searches, but have thus far found minimal success in securing interviews, job offers and positions.

"It's not surprising that social media and mobile media usage have become additional job sourcing methods for healthcare professionals and a way to network with peers and companies," said Susan Salka, AMN's president and CEO. "What this tells us is that job seekers will add new methods and continue to replace those that don't work as they have access to innovative new resources. As the nation's largest healthcare staffing company, we find this information valuable in being able to connect with top talent in healthcare today. It will be interesting to compare this year's results with those from 2011 and beyond to gauge the search methods and developing preferences of job seekers."

Key survey findings:

    Thirty-eight percent of clinicians surveyed are currently seeking employment, and 12 percent of current job seekers have been looking for more than a year.
    Nurses have had a significantly shorter job search than their fellow professionals, averaging three months, compared to just less than seven months for physicians and allied professionals, and nine months for pharmacists.
    Thirty-seven percent of clinicians reported using social media for professional networking; nurses had the highest use among healthcare workers at 41 percent.
    Ten percent of healthcare professionals are using mobile job alerts, but only 3 percent have received an interview, 2 percent have received a job offer and 1 percent secured a new job.
    Physicians are by far the heaviest users of mobile devices for professional reasons among their medical colleagues; 37 percent used healthcare-related applications and 17 percent used mobile devices for healthcare-related content or jobs.
    Sixty-four percent of the clinicians surveyed would choose Facebook, the clear favorite, if they could choose only one social networking site.