DiversityNursing Blog

By RICHARD PÉREZ-PEÑA
New York Times (reprint)

THESE days, when a nursing student at the University of Iowa fields a question about a drug, “the answer is often, ‘I don’t know, but give me a few seconds,’ and she pulls out her phone,” according to Joann Eland, an associate professor there.

In just a few years, technology has revolutionized what it means to go to nursing school, in ways more basic — and less obvious to the patient — than learning how to use the latest medical equipment. Nursing schools use increasingly sophisticated mannequins to provide realistic but risk-free experience; in the online world Second Life, students’ avatars visit digital clinics to assess digital patients. But the most profound recent change is a move away from the profession’s dependence on committing vast amounts of information to memory. It is not that nurses need to know less, educators say, but that the amount of essential data has exploded.

“There are too many drugs now, too many interactions, too many tests, to memorize everything you would need to memorize,” says Ms. Eland, a specialist in uses of technology. “We can’t rely nearly as much as we used to on the staff knowing the right dose or the right timing.”

Five years ago, most American hospital wards still did not have electronic patient records, or Internet connections. Now, many provide that access with computers not just at a central nurse’s station but also at the patient’s bedside. The latest transition is to smartphones and tablet computers, which have become mandatory at some nursing schools.

“We have a certain set of apps that we want nursing students to have on their handheld devices — a book of lab tests, a database of drugs, even nursing textbooks,” says Helen R. Connors, executive director of the Kansas University Center for Health Informatics. Visiting alumni, she says, are shocked to see students not carrying physical textbooks to class.

But technology carries risks as well. So much data is available that students can get overwhelmed, and educators say that a growing part of their work is teaching how to retrieve information quickly and separate what is credible, relevant and up-to-date from what is not. (Hint: look for the seal of approval of Health on the Net.)

They also worry that students rely too much on digital tools at the expense of patient interaction and learning.“There’s a danger that having that technology at the point of care at the bedside creates a misperception that students don’t need to know their stuff,” says Jennifer Elison, chairwoman of the nursing department at Carroll College in Helena, Mont.

“I get worried when I hear about nursing programs that want to replace the person-to-person clinical experience with increased hours with simulation,” she says. “We hear sometimes that it feels to patients that the computers are more important than they are.”

Then there’s the patient privacy issue in the era of blogging, Facebook and Twitter. How to properly use social media has become standard in the curriculum, thanks in part to what is known in nursing circles as “the placenta incident.” Four nursing students at a community college in Kansas posted Facebook photos of themselves with a human placenta. The students were expelled in 2010, and later reinstated, but the episode showed how murky the boundaries of privacy and professionalism can be. The National Council of State Boards of Nursing recently published guidelines on social media.

“That is the new hot issue now,” Ms. Elison says. “That’s been hard, because this is a generation that immediately hits that send button.”

Majority of healthcare professionals say diversity in hospital leadership improves patient satisfaction, according to Witt/Kieffer survey

(HealthNewsDigest.com) - Oak Brook, IL, January 24, 2012 – Less than 15 percent of healthcare professionals believe that hospitals have closed the diversity gap in leadership within the last five years, according to a new national report by Witt/Kieffer, the nation’s leading executive search firm specializing in healthcare and higher education. The report, Diversity As A Business Builder In Healthcare, also reveals that only 35 percent of professionals agree that healthcare organizations consistently hire minority candidates. Witt/Kieffer partnered with Institute for Diversity in Health Management, Asian Health Care Leaders Association, National Association of Health Services Executives and the National Forum for Latino Healthcare Executives to survey 470 experienced professionals on how the state of healthcare diversity leadership is evolving.

With minorities accounting for 98 percent of the population growth in the nation’s largest metropolitan areas during the last decade, this demographic shift has vast implications for healthcare organizations, especially as they adapt to healthcare reform. A majority of industry leaders surveyed feel that diversity in the workplace improves patient satisfaction and clinical outcomes and supports successful decision-making. While healthcare professionals also report that the pool of diverse candidates for leadership positions has grown over the last five years, minority representation is still weak, with perceived barriers to advancement differing based on the respondent’s race and ethnicity.

“It is remarkable that even though a majority of professionals see the value of different cultures in the workplace, there is still not enough happening to close the leadership gap,” said James Gauss, senior vice president and senior advisor to Witt/Kieffer’s CEO. “Healthcare professionals appear to agree on what steps are necessary in order to improve the success of minorities, but there is a falloff when it comes to results. If institutions build and implement an effective diversity strategy, it will benefit their business and their patients, who must come first at healthcare organizations.”

Key findings also include:

• Twenty-four percent of Caucasian professionals believe the diversity gap has been closed, but only 11 percent of minority professionals agree.

• Nearly half of CEOs feel their organization has been effective in closing the diversity gap.

• More than half say the pool of diverse candidates for healthcare leadership positions has grown over the last five years. However, only 38 percent say it has grown in their own organizations.

• Healthcare professionals are more positive about how well minorities are represented within their own organizations compared to the industry as a whole.

• Nearly a quarter surveyed feel that their own management teams had a good representation of cultural diversity, but only 9 percent felt that way about representation across the entire industry.

• However, more than 40 percent of CEOs feel management teams had a good representation of cultural diversity.

• A sharp contrast exists between what Caucasian professionals feel needs to happen in order to achieve diversity in the workplace and what minority professionals see as the barriers to success.

• Caucasian professionals zero in on a lack of diverse candidates, while minority leaders focus on upper management’s lack of commitment to diversity.

• 60 percent of Caucasian leaders see their organizations’ cultural diversity programs as effective, while only 33 percent of minority professionals agree.

• There is a gap between hospitals’ efforts to recruit diverse candidates and how many minorities are actually hired and how well they are trained.

• Fifty-one percent of healthcare professionals agree that organizations take diversity recruiting seriously, but only 38 percent feel that their institutions trained for success in diversity recruiting efforts.

While the survey shows varying viewpoints across race, generation and career title, it is clear that diversity is seen as a valuable business asset, leading to improved patient satisfaction, improved clinical outcomes and more successful decision-making.

Witt/Kieffer is the nation’s eighth largest executive search firm and the only national firm that specializes in healthcare, higher education and not-for-profit organizations. Founded in 1969, our mission is to identify outstanding leadership solutions for organizations committed to improving the quality of life. Clients include hospitals, health systems, academic medical centers, medical schools, physician groups, colleges, universities and community service and cultural organizations. The firm conducts 400 search assignments each year for presidents, CEOs, COOs, CFOs, CIOs, physician executives, medical school deans, clinical chairs and other senior executives. Visit www.wittkieffer.com for more information.

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What do you think? How is your organization compared to the industry? What can organizations do to improve diversity in hiring? For students, what do you think of the diversity the student body? How do you think this relates to hiring and ability to rise in organizations?

In addition to being a Career Job Board for student Nurses up to CNO's, we are an Information Resource. We hope you find this "Focus on Diversity" story particularly interesting...

Pat Magrath, National Sales Director at DiversityNursing.com recently sat down with Dr. Earlene Avalon, PhD, MPH, Director of Nursing Diversity Initiatives; and Eva Gómez, MSN, RN, CPN, Staff Development Specialist at Children's Hospital Boston to discuss the Nursing Career Lattice Program, Diversity and Cultural Competence, and their roles at Children's Hospital Boston.

 

Dr. Avalon has overseen The Nursing Career Lattice Program (NCLP) at Children's Hospital Boston since the Program started in 2009. The NCLP is an initiative designed to increase the racial and ethnic diversity of Children's nursing staff. Through a generous grant, the NCLP was designed to "address the local shortage of nurses of color as well as to create a workforce that better reflects our patient population's multi-ethnic and multi-racial makeup. The Lattice Program looks for potential nursing students among our current employees-including Clinical Assistants, Surgical Technicians, Administrative Assistants and Food Service staff." The NCLP provides the services and support employees need to complete their education in various nursing schools throughout the Boston area.  

 

Dr. Avalon states, "It is important to note that I am not a nurse by training. My training is in public health and workforce development in healthcare. I have always been interested in ways that we can increase diversity at the provider level (e.g. nursing) and how that impacts patient satisfaction and outcomes."   

 

Dr. Avalon suggests "workforce development programs are a win-win for both the employee and the hospital. In particular, given the significant impact that nurses have on the lives of our patients and their families, we are committed to continuously growing a nursing workforce that is able to successfully meet the needs of our changing patient population."

 

"Our work focuses on looking within our own four walls and developing our employees to their fullest potential," says Dr. Avalon. "One of my responsibilities, and truly one of the best aspects of my job, is the opportunity to sit down with an employee and discuss their aspirations and any challenges they face in pursuit of a career in nursing.  For many, they were forced to put their dream of becoming a nurse on hold.  Oftentimes, employees express that they are the first in their family to attempt college-level courses and they do not have support systems at home. As a result, they often do not know what questions to ask or where to begin and this can negatively impact their success in college. NCLP offers support to our employees that allows them to realize that they are not alone in this process."  

 

The program provides employees with one-on-one mentoring, professional development, academic counseling and the financial support needed to successfully complete nursing school. "My team helps employees to create a semester-by-semester plan that will enable them to pursue their dream of becoming a nurse - even if it is on a part-time basis." Dr. Avalon continues "We also support our employees by providing them with an experienced nurse as a mentor and the opportunity to shadow a nurse in order to have a better understanding of the profession."

 

NCLP is not just an academic resource; they help each employee with tutoring, selecting pre-nursing coursework as well as creating a plan to help balance the demands associated with school, transportation, family and work. NCLP enables Children's Hospital Boston to create a strong multicultural workforce that provides the best family-centered care to their patients and community.

 

Five years ago Ms. Gomez came on board as a Staff Development Specialist to focus the work on Cultural Competence and Diversity. She states, "Among my many roles, I lead the Multi-Cultural Nurses' Forum, the Student Career Opportunities Outreach Program and I provide Cultural Diversity Awareness training to staff throughout the hospital."

 

I asked Ms. Gomez why Healthcare Institutions should have someone like her on their staff. She responded, "Cultural competence and diversity are two essential ingredients in delivering care for all patients and should be assets that are recognized, valued and embraced at every level of any hospital or healthcare institution. Awareness, advocacy and education are essential components of successful diversity and cultural competence initiatives. Having someone in this role can help hospitals remain on track by carrying out the activities that drive these initiatives. This effort will ultimately lead us into providing care for all of our patients in a culturally appropriate and meaningful way."

 

She also states, "The work of diversity is ongoing and evolving. In 5-10 years, we will probably have grown and improved the diversity within the nursing profession. However, I expect we will continue to work so our efforts don't become stagnant and we need to sustain the positive changes achieved thus far. The future is hopeful, but it will require time, dedication and work from all of us."

 

Working together with other Children's Hospital Boston employees, Dr. Avalon and Ms. Gomez have:

• Organized and coordinated The Multi-Cultural Nurses' Forum, which included their first-ever night session. This session was held at 2am in order to better meet the needs of their night nurses. The hospital's CNO and Senior Vice President, Eileen Sporing attended the meeting in order to have a one-on-one conversation with the night time nursing staff who are part of the forum.
• Brought diverse high school students into the nursing profession through their Student Career Opportunities Outreach Program.
• Created a successful nursing mentoring program.

To read the first part in this article series, please click here

The important things to bridge the differences in the professional nursing practice in the United States are:

1. Develop critical thinking skills. Always ask how, what, when, where, who, and what-if questions. Seek to understand the need for what is not understood. It creates deeper and more meaningful learning when we ask questions and search for answers. It also expands knowledge and leads to future change with less frustration.

• Identify the difference, seek to understand and to assess the situation or question at hand.
• Observe the evidence of practice.
• Develop a self-improvement list for ourselves.
• Analyze content, including the policies and procedures of our facilities.
• Interpret, verify and explain findings to our way of understanding.
• Evaluate for relevant criteria to make a good judgment.
• Apply new ways of thinking and immerse into the new knowledge as our own, using it in new clinical settings.
• Create an action plan. Make a strong personal commitment to act differently in the nursing practice. Commit to doing things in new ways and not slide back into the old way of doing things. Adjust our behaviors again as needed. Apply new action plans to adopt better nursing practices for ourselves.

2. Be true to ourselves. Stay strong, positive, and use positive energy everyday. Do not fall into the trap of negativity. Keep eyes open, mind clear, and refuse to go into a negative pit. There is no room for negativity.

• Build our brand. One simple example to think about branding is to look at a change shift. When a nurse comes in tardy; we hear some people say, “She is never late; she is always on time. Hope she is okay.” But we also frequently hear others say “She is always late. We don’t have to wait for her, let’s get started.” Ask yourself: Who do we want to be? It takes a plan and determination to come to work on time on a consistent basis. Our brand is built by what we do day in and day out. We want to make a conscious decision to align ourselves with true greatness.
• Practice positive self-talk to make self-affirmation a daily habit. Think about how many people are able to excel in another land. We use a different language all day at work, and we work in a people profession – around people, and taking care of people. We are a different breed. We are doing great!  
• Excel in our strengths. When we posses excellent skills, use them. Peripheral IV (PIV) insertion it is a great time-saving skill. Help out where you are most skilled. Hold onto what is good, but assess if there’s a new, better way. Let’s raise the bar for ourselves. 

3. Limit negativity.

• Take pride in our bilingual skills. Being bilingual is a gift. It is not a negative attribute. Speaking bilingual gives us the opportunity to explore understanding of words or phrases that are foreign to us. Volunteer to be an interpreter for patients who speak our native language whenever you can. Never use our cultural background as an excuse for not being an effective communicator. We need to continue to improve speaking English. We can learn to communicate more effectively every day. We can write down our successful sentences and deposit them in a basket. Pick them up to read them again once a while.

• Create ways to help deal with negative people around us. When we distance ourselves from the negativity or person, people may misinterpret our behavior into a negative behavior. Our actions may be interpreted as anti-social. Mingle, but avoid joining in negative talk. It unrealistic for us to expect to never encounter rejection or discrimination in the workplace. That is purely naïve. Rejections and discriminations are likely to happen to us. They happen for many reasons beside cultural differences. We do not appreciate experiencing rejection and discriminations at work. How one deals with the experience is a big lesson to learn. Let’s ask ourselves: What are we going to do if we encounter these things? What can we learn from this encounter?  Do we want to tolerate it? How much can we tolerate it? What is our personal limitation? What can we do to change?  How much time do we want to spend on unhappy events? Is this experience going to affect us one year from now? Five years from now? Ten years from now? At different times, we do different things. Therefore, a flexible plan will be very helpful. It is easier to deal with situations if we already have a thoughtful plan. At the very least, we have a lawful process to resolve discrimination. Always seek to understand. Explore how things can be improved. 
• We also need to find our own ways to deal with whatever we encounter. I will share my own terrible experience. The incident happened just before I was going to a beautiful wedding. I was determined not let the terrible experience ruin a good time at the wedding so I compartmentalized my horrible experience. I went to my secret “P” pocket (I have many words which start with “P” in my mind that I can use to boost my  positive energy when I needed).  I pulled two “P” (Personally and Permanent) words out. I kept telling myself over and over “Don’t take it personally.” “The problem is hers.” “I did what I need to do for my job.” I also told myself again and again that “Nothing is permanent. This shall pass.” I repeated these sentences to myself until I was at peace. That night, I was able to enjoy the wedding. I could think about how to deal with my bad experience after the wedding. 

4. Plan to bridge the differences in our nursing practices in many steps.

• Initial self-assessment and learning to fill the missing pieces of the puzzle for ourselves.
• Find a group to study, to socialize, to make friends, and to learn from each other and the cultures of each one involved.
• Search for a few career mentors for guidance. It will save us a lot of time while we are lost in a maze of professional nursing. In the United States, nursing opportunities are endless; we have a great many options for our advancement. It is not like when we thought nursing jobs were limited to a hospital or clinic.
• Ask for help. Ask for input to clarify any confusion. We want to do it right the first time and we want to do the right thing. We have to triple-check all we do, because patient outcomes are in our hands.
• Past personal beliefs like “Be quiet” and “Silence is a golden” – these don’t have much validity or value here. Not speaking up and not asking questions – these are not appropriate in this country. Do raise questions as appropriate.

Attachment I: Examples of possible solutions and preparation to bridge the differences in changing and adapting our professional nursing practice in the United States.

Differences	Our Possible Solutions
Assess and re-assess our patients	Review and review, and review again physical assessment books.  Memorize them as much as possible and as needed. Bring a handbook that we like such as “SkillMasters 3-Minute Assessment by Spring House 2006” to work for references. Bring bilingual dictionary to work for references. Practice American way as soon as we learn. Use it frequently.
Report abnormal finding	Use SBAR for all verbal and written communications. Write down talking points for our verbal communication also. Use read-back method for all verbal orders. Ask the caller to spell it out or slow it down as needed. It is perfectly fine to state the obvious; let the speaker know that English is our second language. Ask speaker to listen to us attentively. It takes time to get use to our accent. Remember, listening skills are very important in any conversation.
Learn emergency responses – RRT, Code Blue with education in ACLS and PALS	Be aware and tell our nurse managers that we did not have experience in these areas. Take initiative to attend emergency-related classes in our hospitals as soon as we can and take as many classes as needed. Increase our comfort level through self-study, group discussions and simulation labs. Find a preceptor or mentor to practice with us.
Giving P.O. medications and medication reconciliation	Take time to observe patients taking their medications every time before we move on to the next task. Don’t put meds on the bedside table or on an over-bed table. Learn to perform medication reconciliation as needed.
Protect patients’ privacy and protect colleagues’ privacies	Remember patient information is the patient’s private property. We need written permission from the patient, law and regulations, such as our facilities’ policies before we can share it. Plan ahead and create a simple sentence such as “I am sorry that I do not have a permission to give that information.”

Attachment II - SBAR

The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient's condition. SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety.

Background

Michael Leonard, MD, Physician Leader for Patient Safety, along with colleagues Doug Bonacum and Suzanne Graham at Kaiser Permanente of Colorado (Evergreen, Colorado, USA) developed this technique. The SBAR technique has been implemented widely at health systems such as Kaiser Permanente.

Directions

This tool has two documents:

• SBAR Guidelines (“Guidelines for Communicating with Physicians Using the SBAR Process”): Explains in detail how to implement the SBAR technique
• SBAR Worksheet (“SBAR report to physician about a critical situation”): A worksheet/script that a provider can use to organize information in preparation for communicating with a physician about a critically ill patient

Both the worksheet and the guidelines use the physician team member as the example; however, they can be adapted for use with all other health professionals.

By SBAR Technique for Communication: A Situational Briefing Model

Page Content

Kaiser Permanente of Colorado
Evergreen, Colorado, USA

Attachment III – Read-Back

Read-back is a way to verify of the complete order by the person who receiving the verbal order.  The receiving person will repeat the verbal order back to the ordering clinician, who will verbally confirm that the repeated order is correct. The purpose of “Read-back” is to ensure patient safety.

Contributors:

Mai Tseng -- RN, BSN,MPA,EMBA, NE-BC,CRNI, LNC
Karen Cox -- RN, PHD, FAAN,
Laurie Ellison -- EMBA
Xu Hong Fang -- RN
Hong Guo -- RN
Sufan Sun -- RN

The following is a Diversity Statement written and signed by numerous colleges and universities and taken from the University of Virginia's website for their Office of African American Affairs. It provides good insight into the value that diversity adds in higher education, which almost always applies to professions, like nursing, as well.

 

On the Importance of Diversity in Higher Education

America's colleges and universities differ in many ways. Some are public, others are independent; some are large urban universities, some are two-year community colleges, others small rural campuses. Some offer graduate and professional programs, others focus primarily on undergraduate education. Each of our more than 3,000 colleges and universities has its own specific and distinct mission. This collective diversity among institutions is one of the great strengths of America's higher education system, and has helped make it the best in the world. Preserving that diversity is essential if we hope to serve the needs of our democratic society.

Similarly, many colleges and universities share a common belief, born of experience, that diversity in their student bodies, faculties, and staff is important for them to fulfill their primary mission: providing a quality education. The public is entitled to know why these institutions believe so strongly that racial and ethnic diversity should be one factor among the many considered in admissions and hiring. The reasons include:

Diversity enriches the educational experience. We learn from those whose experiences, beliefs, and perspectives are different from our own, and these lessons can be taught best in a richly diverse intellectual and social environment.

It promotes personal growth and a healthy society. Diversity challenges stereotyped preconceptions; it encourages critical thinking; and it helps students learn to communicate effectively with people of varied backgrounds. 
It strengthens communities and the workplace. Education within a diverse setting prepares students to become good citizens in an increasingly complex, pluralistic society; it fosters mutual respect and teamwork; and it helps build communities whose members are judged by the quality of their character and their contributions. 
It enhances America's economic competitiveness. Sustaining the nation's prosperity in the 21st century will require us to make effective use of the talents and abilities of all our citizens, in work settings that bring together individuals from diverse backgrounds and cultures.

American colleges and universities traditionally have enjoyed significant latitude in fulfilling their missions. Americans have understood that there is no single model of a good college, and that no single standard can predict with certainty the lifetime contribution of a teacher or a student. Yet the freedom to determine who shall teach and be taught has been restricted in a number of places, and come under attack in others. As a result, some schools have experienced precipitous declines in the enrolment of African-American and Hispanic students, reversing decades of progress in the effort to assure that all groups in American society have an equal opportunity for access to higher education.

Achieving diversity on college campuses does not require quotas. Nor does diversity warrant admission of unqualified applicants. However, the diversity we seek, and the future of the nation, do require that colleges and universities continue to be able to reach out and make a conscious effort to build healthy and diverse learning environments appropriate for their missions. The success of higher education and the strength of our democracy depend on it.

 

Meg Beturne MSN, RN, CPAN, CAPA
Denise Colon, RN
Baystate Health System, Springfield, MA

This article was submitted by Meg Beturne RN, MSN, CPAN, CAPA,  Assistant Nurse Manager @ Baystate Orthopedic Surgery Center in Springfield, MA.  Meg became a mentor and participated in "Baystate Health’s Diversity Leadership Initiative, Mentoring Across Differences" Program. A Dimensions of Diversity Exercise (copyrighted in 2011 by Washington Orange Wheeler Consulting firm http://wow4results.com) was offered as part of the Program.

The exercise is a puzzle that shows the complexity of mentoring across differences. Understanding how these differences have impacted us and others helps to create a container for meaningful dialogue. Consider how various differences could impact your mentoring relationship. To participate in this exercise, you identify a few  dimensions of diversity that have had an important role in impacting who you are, how others see you, and how you see the world. You then figure out how the dimensions shaped who you are personally and professionally. Finally, how might these dimensions impact your mentoring relationship? 

Meg, a Caucasian Catholic, mentored Denise who has a Latina background with strong family ties and a culture that is filled with traditions that are vital to her life and that of her family and extended family. Denise is Roman Catholic and she works to maintain a healthy balance between work and home as she has a young family. Here is their mentoring story…

 

Impact on Differences 

As I began the mentoring relationship with Denise, I realized the importance of recognizing and understanding the differences and similarities that existed between us. Equipped with this knowledge, I felt that we could tackle the complexities of mentoring across differences. The Dimensions in Diversity exercise offered the perfect opportunity to explore key, diverse components that have made us the women and nurses that we are today. To that end, we made this a priority and discussed it at our very first meeting and then confirmed our thoughts and feelings at our next time together.

It was interesting to realize that both of us equally valued traditions and observances, but from a different perspective. We both enjoy sharing the particulars of the holiday traditions through the years and reminisced on who was present, the activities that took place, the photos that were taken and the memories that were made and cherished by future generations. Denise however was vocal that many persons that she has interacted with over time do not have a real understanding of the ethnic backgrounds that are celebrated in the various holidays. That being said, there is a lack of appreciation from culture to culture on the meaning and purpose of observances involving family and relatives. I had to admit that since I had grown up in a small mill town in Connecticut that was homogenous with regard to ethnicity and religion (Caucasian Catholics), I was not exposed to comments, conversations or messages that demonstrated anything but allegiance to the existing cultural observances and inclusion of the small numbers of diverse ethnic and religious populations that resided close by.

Denise chose accent and dialect as another dimension of her diversity. She relayed the fact that many individuals and groups do not make an attempt to understand or accept anyone who speaks in a certain way. This scenario creates feelings of self-doubt. In addition, it allows feelings of rejection to creep in that ultimately results in further retreat into one’s own ethnicity which is considered supportive and safe. As a registered nurse, Denise has encountered many patients and caregivers from all corners of the globe. Working with a team of professionals, Denise has gained acceptance and recognition as a caring and compassionate care giver and over time, interactions and conversations have focused on quality care rather than on accent or dialect.

I then shared that communication was a vital personal and professional dimension that affects my life in so many ways. Even though my communication style is open, friendly and positive, I have learned that being a good listener is actually a more important skill. I found myself connecting with Denise’s story and promised myself to be even more in tune with people I meet on a daily basis who might sound different than me. In my own way, I will seek to eliminate self-doubt by encouraging others to use their native voices to raise questions, contribute ideas and feel reassured that they will be understood.

As I reflect on this meeting with Denise, I am amazed at the information that was willingly shared and the conversation which was free-flowing and enjoyable.  Most importantly, after completion of this exercise, I feel more prepared then ever to be the type of mentor that will enable Denise to move forward in both her professional career and her personal life!

A special thank you to Denise Colon, RN for her participation.

By Laura Raines
Pulse editor

If the purpose of nursing school is to prepare students for real-life practice, then it must address the challenges of working with a multicultural population, says Sharon Grason, nursing instructor at Georgia Perimeter College.

“If you work in an urban setting, it’s a rarity that the patient in the bed will come from your same background,” said Grason, MS, RN, CNS. “Cultural diversity is a growing part of nursing.”

Because she believed the nursing curriculum at GPC only skimmed the surface of cultural diversity, in 2010 Grason launched a senior capstone project to make nursing students more culturally aware. It’s now the last course nursing students take before they graduate.

Grason’s experience working with migrant farmers in Moultrie showed her how important multicultural understanding is for nurses.

“Seeing how migrants lived and worked totally opened my eyes and made me look at how to care for them in new ways,” she said.

To be effective, Grason knew she had to earn their trust.

“When you can show that you have some idea of their lives and what is important to them, the patients’ level of trust goes up tenfold,” she said. “They are more apt to listen and you are better able to help them.”

Grason wants nursing students to realize that diverse patient populations have different health care needs and challenges. To be effective nurses, students need to learn how to take those differences into consideration when caring for patients.

In the capstone project, teams of students choose a different culture to research.

“We begin to learn about the traditions, religious beliefs, social norms, common health problems, foods and the indigenous medical remedies of that population,” said Kristina Palmer, a GPC senior nursing student.

Her group is studying Russian and Eastern European cultures, and they have discovered a large population in metro Atlanta.

“Being aware of patients’ backgrounds and understanding the cultural dynamics can help you give better care,” Palmer said. “For example, in some cultures you have to talk to the dominant male in the family if you want medical advice to be followed. We’re not trying to change the culture, but to make patients more comfortable with how we’re trying to help them.”

Group presentations

The groups will present and share their findings — including a list of facts about the culture and answers to frequently asked questions — at an international cultural day at the end of the term.

“Many teams dress in costume, serve native foods, display cultural artifacts and hand out brochures about their cultures, so that students and guests can benefit from their research,” Grason said.

Nursing student Tarra Clark is studying migrant farmers, a mostly Hispanic population.

“We’re seeing how their eating practices are related to common health problems like high blood pressure or diabetes,” Clark said.

She has learned that glucose and blood-pressure screenings, earlier prenatal care and dietary education is helpful in treating many Hispanic patients.

“We all need to be aware that how we deliver health care to a patient makes a difference,” said Karen Feagin, a senior nursing student.

As a volunteer at a free health clinic, Feagin encounters people from all backgrounds. She’s learned that some cultures consider it rude to make eye contact with the patient. Some cultures require a same-sex practitioner and others have a mistrust of Western medicine.

“Sometimes when patients don’t understand what you are saying, they’ll just agree to be polite. When in doubt, it’s better to find a translator,” she said.

Feagin’s group is studying the culture of Koreans, a large and growing population in metro Atlanta.

“They have a higher risk for hypertension, but a diet that’s high in salt because of preserved foods, so that’s a challenge,” she said. “If they mistrust American health care, they will go to a local Korean practitioner or contact their family back home to get local herbs and medicines. If you know that, you can ask about herbs and help them choose ones that won’t interact negatively with the medicines you’ve given them.”

Valuable lessons

Feagin says the capstone course is enlightening and she looks forward to learning about other cultures from the other teams.

“I didn’t realize how much I didn’t know,” she said. “But you go into nursing to keep people healthy and help them achieve the best quality of life possible. This kind of knowledge will help us provide safer, more-intelligent care.”

Nursing is a second career for Feagin, who spent 10 years in accounting.

“Everyone ends up in the hospital at some point and it’s the nurses that dictate your experience. That’s who the patients remember” she said. “I wanted to be that person who is remembered because she made a difference in someone’s life. This is a great program and I’m thrilled to be in it.”

After three semesters of offering the capstone course, Grason will compile all the cultural information into a manual that the nursing department will give to its clinical partners and hospitals.

“We wanted to do something to give back and we hope that this will be a good resource for their educational departments,” she said.

from insideWorcester.com
By Dave Greenslit CORRESPONDENT

WORCESTER —  The city is diverse and becoming more so, presenting both challenges and opportunities.

That was the consensus of several speakers today at a forum called “The Changing Face of Worcester,” sponsored by the City Manager's Coalition on Bias and Hate and held at Worcester Public Library.

“Worcester remains a vibrant city made up of people from just about everywhere in the world,” said Edgar Luna, who works in the city's Department of Planning and Regulatory Services and gave an overview of 2010 census data.

That data show Worcester's white population has dropped from 70.8 percent in 2000 to 59.6 percent in 2010, while the Hispanic and black populations have grown from 15.1 percent to 20.09 percent and from 6.2 percent to 10.2 percent, respectively.

Ravi K. Perry, an assistant professor of political science at Clark University, said Worcester has always been a city of immigrants, but today's arrivals are from Southeast Asia, Central America and Africa, instead of Italy, Ireland and Armenia.

Medium-sized cities have been slow to respond to their changing populations, he said, but that doesn't have to be the case in Worcester. Calling the city one of the most diverse in the country, he said, “Worcester has the opportunity to be a model if we pay attention to these local demographics” and learn how minority interests can be represented.

School Superintendent Melinda J. Boone noted that 65 percent of students in Worcester schools are minorities and that 80 different languages are spoken by students in the system. Under a 2009 agreement with the federal Justice Department, all major school documents are translated into several of the major languages.

“We have a very diverse school population, and that's a real asset,” she said, adding that the changing demographics also present a challenge in achievement, especially because so many students are poor.

“We want to expose students to programs and opportunities that will close that gap,” Ms. Boone said. “An undereducated citizenry will cause Worcester to shrink and shrivel.”

Education will break the cycle of poverty by preparing students for the type of jobs that will be available to them, she said.

Mark Bilotta, chief executive officer of the Colleges of Worcester Consortium, said area colleges, with 30 percent minority enrollment, have some catching up to do to match the percentage in the city.

The consortium is working, he said, to retain talent for the regional workforce and to ensure students are prepared to work in a global economy, something enhanced by Worcester's diversity.

Luis G. Perez, a retired juvenile court judge, also stressed the importance of education. He said the dropout rate and the number of minority students expelled eventually results in many people being sent to prison.

“I believe in prevention,” Judge Perez said. “And the most important tool in prevention is education.”

“If the School Department doesn't do their job, where do people turn to? They turn to the courts,” he said.

Also speaking at the forum were Dr. Matilde Castiel of the UMass Memorial Medical Center and Stephen Hill of the city's Department of Neighborhood Services/Economic Development.

Excerpts of this article are from Shawn Kennedy, MA, RN, Editor-in-Chief for the American Journal of Nursing

At the most recent Sigma Theta Tau International (STTI) biennial meeting in Gaylord Texas, there was a seminar and discussion of the top 10 issues facing nursing, led by STTI’s publications director Renee Wilmeth. The issues were compiled from responses provided by 30 nursing leaders, and were presented in question form:

1) Is evidence-based practice (EBP) helpful or harmful? (Amazing how many interpretations there were of EBP, some of them—as I know from our EBP series—quite incorrect.)
2) What is the long-term impact of technology on nursing?
3) Can we all agree that a bachelor’s degree should be the minimum level for entry into practice? (General agreement here, despite concerns regarding the adequacy of financial support for achieving this goal.)
4) DNP vs PhD: separate but equal? (Not much discussion—I think no one wanted to really get into this.)
5) How do nurses get a seat at the policy table?
6) How do nurses cope with the growing ethical demands of practice? (This generated the most discussion, especially around whether society should provide unlimited costly care to those whose personal choices contribute to their health problems.)
7) How do we fix the workplace culture of nursing?
8) What role do nurse leaders play in the profession?
9) What are we doing about the widening workforce age gap?
10) How do we make the profession as diverse as the population for whom it cares?

What do you think? Would you agree that these are the ‘top 10’ issues? What’s missing? What’s here that shouldn’t be? We would love to hear your opinions, please share them here.

by Pamela Babcock - Freelance Witer
for shrm.org

NEW YORK—Getting diversity and inclusion (D&I) “right” requires strong CEO commitment. But an all-white panel of CEOs who recently won diversity leadership awards said the seeds for their passion were planted long before they entered the corporate ranks.

George Borst, president and CEO of Toyota Financial Services, grew up playing stickball in Hollis, Queens, N.Y., while Michael I. Roth, chairman and CEO of Interpublic Group, was raised in nearby Brooklyn. Michael Howard, COO of the Army and Air Force Exchange Service, lived on military bases because his father was in the Air Force.

Meanwhile, John Edwardson, chairman and CEO of CDW, was raised in a small southern Illinois town that had just one African-American couple but later lived in Hyde Park, a diverse area on Chicago’s South Side. And John B. Veihmeyer, chairman and CEO of KPMG, who has five sisters and two daughters, said he has seen first-hand the career challenges the women in his family have faced.

Personal experiences frame you, Veihmeyer told attendees June 8, 2011, at the CEO Diversity Leadership Awards and CEO Forum, held at Columbia University here. “You’re actually in a position now to try to make a difference about something that has probably been important to you your whole life.”

The 2011 CEO Diversity Leadership Awards were presented by Diversity Best Practices, a New York-based membership group for diversity and inclusion practitioners. In addition, the group recognized diversity officers with its annual Diversity Officers Leadership Award (DOLA).

2011 DOLA winners included Herbertina “Tina” Johnson, senior director of diversity for the Army and Air Force Exchange Service; Melissa Donaldson, director of inclusion practices at CDW; Heide Gardner, chief diversity and inclusion officer at Interpublic Group; Kathy Hopinkah Hannan, national managing partner of diversity and corporate responsibility at KPMG and Joe Husman, corporate manager of corporate social responsibility for Toyota Financial Services.

Carol Evans, CEO of Diversity Best Practices and president of Working Mother Media, said the awards recognize CEOs who are “leading the culture” and diversity officers “who not only have the strategy on their shoulders, but also have to make sure that everything gets implemented.”

The Business Case

During the event, several CEOs explained why diversity is a strategic imperative:

Borst said diversity is key to helping mirror the market his company competes in and said Toyota Financial Services makes more loans to African-Americans, Hispanic-Americans, Asian-Americans and women than does any other captive finance company in North America. “By having an organization and a structure that is diverse, we’re better able to understand this market,” he said.

Toyota supports underserved and underprivileged communities, “which unfortunately are dominated, in a lot of cases, by diversity,” Borst noted. This has had a spillover effect with employees: In the most recent annual associate opinion survey, 96 percent said that they thought that Toyota Financial Services was socially responsible, he added.

Instead of what he called “checkbook charity,” Borst said, the company participates in events at Boys & Girls Clubs of East Los Angeles, where associates “can dig in and volunteer and build relationships both with the community and with one another.”

As a professional services firm, KPMG requires intellectual capital that is as diverse as the clients it serves. Veihmeyer said it’s easy to get passionate about diversity because “it’s the right thing to do, for all the right reasons.”

But if that’s all you view it as, you’re not going to succeed, he said.

“We can’t have our diversity initiatives kind of tucked over to the side as some fifth leg to a stool,” he said. “What we have tried to do is to bake diversity into each of those four strategic priorities: quality growth, professionalism and integrity, being an employer of choice, and maintaining a global mind-set,” Veihmeyer explained.

The company can’t afford to fail to attract or retain a single high performer because it doesn’t believe KPMG is “supportive, committed to and totally focused on their success, irrespective of what their background or other needs may be,” Veihmeyer added. That’s why, among other things, the company has a key accounts rotation program that targets ethnically diverse associates to ensure that, early in their careers, they receive the client exposure and broad range of experience needed to succeed.

Roth of Interpublic, an advertising and marketing giant with 41,000 employees in 130 countries, noted that the advertising industry has “historically been terrible when it comes to diversity and inclusion,” pointing to the television show “Mad Men” as an example. His firm’s diversity initiatives are a differentiator in the marketplace because “If we’re not communicating the message correctly for our clients, we lose our clients.”

Edwardson of CDW, an IT products and services provider, said that shortly after he joined the company, he asked about the company’s target market and was told by its advertising agency that it was “white males between the ages of 26 and 42.” A couple of weeks later, he viewed focus group videos and realized quickly that this wasn’t the case. Changes were made and revenue grew. Diversity is “clearly the right thing to do, but it has been darn good business for CDW as well,” he said.

Bringing the Mission to Life

Borst said recent drama—a global recession, product recalls and a tsunami and earthquake in Japan—could have pushed diversity onto the sidelines at Toyota. However, “What we have tried to do is to make sure it stays as one of the important priorities,” he said. “I try to make sure the behavior I’m trying to model is modeled by the rest of the people on the management committee, and it all cascades down,” he said.

The Army and Air Force Exchange Service, which provide goods and services for the Army and Air Force, has about 43,000 employees in 30 countries. Howard said he likes “helping develop the future.” He spends a couple of hours each week with different diverse groups and asks high performers “what can we do to help you?” Howard said they usually have the hard skills—they know how to do the jobs—but they often lack networking or social skills. “They are very eager to learn,” Howard reflected. “I say ‘well I’ve got half an hour,’ and two hours later we’re still talking.”

At CDW, it’s critical to build the pipeline at all levels of the organization, according to Edwardson. “I spent a lot of time with recruiting to make sure that for every single opening that we have that comes up that we have a diverse list of candidates,” he said.

Roth noted just how influential some diversity groups can be. Interpublic’s Women’s Leadership Network, which has about 10,000 participants globally, sponsored an event in June 2011, titled “Beyond Mad Men: Toward Gender Diversity in Creative Roles,” during the Cannes Lions International Festival of Creativity. Roth will host the event, which will be moderated by CNN anchor Soledad O’Brien and feature a panel that includes Martha Stewart. It will focus on the dearth of women in the most senior creative roles and what can be learned from women who have made inroads in advertising, marketing and media.

In the end, organizers emphasized, it’s important to have a partnership between the chief executive and chief diversity officer. Andrés Tapia, president of Diversity Best Practices, said that without an effective diversity leader, “a CEO’s commitment cannot be turned into the strategies, programs, processes and action plans that bring the mission to life.”

In closing, Gardner of Interpublic offered this thought: “What I am learning is: Inclusion is pretty much the same everywhere,” she said. “It’s not just about making diversity counts but about making diversity count. And that holds true wherever you are.”

Pamela Babcock is a freelance writer based in the New York City area.