RSSAuthor Archive for Kenneth Michek

Kenneth Michek is the Associate Editor for nurse management at HCPro.

Include Cultural Diversity Training in Orientation

Healthcare professionals have varied views about what the term cultural diversity means and the actual purpose of cultural diversity training. They may believe that such training is initiated primarily to help them avoid professional and legal problems rather than improve patient care (Nisha et al 2007). Others are genuinely concerned about being culturally sensitive when working with patients and collaborating with colleagues. NPD practitioners know that the primary purposes of cultural diversity education are to improve:

  • Healthcare professional–patient communication
  • Healthcare professional–family communication
  • Communication among healthcare professionals
  • Patient and family outcomes

Cultural diversity education is also a requirement of some accrediting agencies.  However, this is not the primary purpose of such education. Your cultural diversity programming should be practical and based on evidence that directs its design.

It is not easy to add more content to an orientation program. However, cultural awareness will help new employees to assimilate into the organization. Role play, discussion, and distance-learning techniques can all be used to provide basic information. Allow time for in-person discussion as well. Include information about how cultural differences manifest themselves in patients, visitors, and colleagues and present learners with scenarios that require them to make choices based on cultural appropriateness.

What topics should you include as part of diversity education?

It is not possible to include all aspects of multiple cultures in a diversity program. However, if cultural diversity is part of your competency program, you can regularly add material about aspects of various cultures.

The following is information to include in your initial training:

  • How do members of this culture communicate? What significance do body language, gestures, tone of voice, and eye contact have? Which family members take the lead in communicating with people outside of their culture?
  • What specific family/gender issues exist? What is the woman’s role? How are major decisions made?
  • What role does religion play?
  • How is pain expressed?
  • What are common health practices (e.g., alternative medicine, herbal medicine, home
    remedies, etc.)?
  • How do families deal with pregnancy and births?
  • Is there a standard work ethic valued in the culture? How are specific occupations viewed
    in terms of respectability, financial need, and appropriateness?
  • Are there dietary restrictions associated with this culture?
  • Are there specific political beliefs that influence people of this culture?
  • Are there specific conflicts between certain cultural groups that may surface within your organization?

Source: Staff Development Made Simple

Privacy and social media in the nursing unit

We all consider our privacy to be sacrosanct, a cocoon in which we wrap ourselves to feel safe and in control. We value our personal space and believe that others have an obligation to respect our wishes in regard to what is commonly known and what we wish to keep private.

Your role as a manager means you have become the “Privacy Police.” It is your job to protect the privacy of your staff, the hospital, your patients, and yourself. This juggling act is made more difficult by the fact that privacy is a very fragile commodity these days, and we have far less influence than we had previously thought. Large leaks of personal data in the online environment have made privacy a matter of public commentary and personal challenge.

The word “privacy” has been part of our lives back to our earliest moments of awareness, when we were told that “some things are private” or “do not talk about that at school; it is private.” However, as we swept into the 21st century, the term “privacy” began to take on a new meaning or perhaps to lose its meaning entirely. Invasive social media and the unrelenting celebrity-chasing paparazzi have somewhat neutralized the concept of privacy, making it largely a word with diminishing relevance in today’s world. Yet, on your unit, the idea of privacy remains important and fundamental to your staff and patients.

We consider privacy to be freedom from unwanted invasive scrutiny. Young people today hear about hacking and high-level release of private information, and they accept it as a natural part of life. Privacy has become relative to the degree of interest in your business and your ability to keep others out of it. Your young nurses were raised in a world calling for more transparency with decreasing value on personal privacy; these are often the values they bring to your unit when they are hired.

As a manager, you are faced with a boatload of privacy rules and regulations that fall to you for enforcement. You must ensure that your unit protocols are protecting personal health information largely driven by the Health Insurance Portability and Accountability Act of 1996 (HIPAA; U.S Department of Health and Human Services, 2015). HIPAA applies to all healthcare personnel and providers. Your manager role means you must ensure your nursing staff understands and complies with rules about documentation, photography, telephone release of information, and the media’s need to know.

You can help your staff understand release of patient information, for example, by identifying who is nonessential and who is on a “need-to-know” basis. Make sure they understand the boundaries and then ensure that they adhere.

You also need to help Boomers grasp how social media really works. Many of them get on sites in order to keep up with younger family members. They may not understand the insidious seepage of information based on the link provided by these sites. Your younger nurses might provide information to the more senior members, helping them understand the full impact of such platforms as Facebook, Twitter, and others. But do not assume that everyone just naturally knows the privacy limitations on your unit; annual review of current privacy standards is a good time to emphasize how this information helps protect the hospital as well as the individual nurse from legal repercussions.

Frank, open conversations about the right to privacy can move it from a gray area for social media followers into a priority for all activities on the unit.

Source: Managing the Intergenerational Nursing Team

Study: Nurse fatigue on the rise

A new survey indicates that fatigue affects 85 percent of nurses, and more than half of nurses have experienced burnout.

The study, conducted by Kronos Incorporated, surveyed 257 nurses currently working in U.S. hospitals. Nearly all of the respondents (98%) said their work is physically and mentally demanding, and 63 percent reported that their work caused nurse burnout. 44 percent worried that their patient care would suffer because of their exhaustion, and 41 percent considered changing hospitals in the past year because of their burnout.

Nurse fatigue has a number of causes, and can occur during any shift. An excess of fatigue without proper coping mechanism can cause burnout, an exhaustion that can cause your staff feel alienated from their work and cause diminished performance.

The best way to counter burnout in your staff is to create programs that encourage self-care and raise awareness about the symptoms of nurse fatigue. For more tips about coping with burnout, check out the following articles from the Strategies for Nurse Managers’ Reading Room:

Preventing nurse fatigue
Take Five: How renewal rooms revive stressed out nurses
Don’t underestimate damage caused by burned out nurses
Stop requiring nurses to work overtime

Challenges and Opportunities for Nurse Leaders

Looking forward, the difficulties we face include overcoming the bias that nurses are not prepared to lead, especially in interprofessional teams. This is a perception that nursing itself must change, first in the arena of self-image and then in the eyes of other powerful professional groups. If other clinical partners do not see the nurse as pivotal for ushering in change, then they are likely to use that bias to slow the rate or pace of change considerably.

For nurses to see themselves as capable of transforming healthcare, they must see themselves as equal partners at the table, able to negotiate and recommend, influence, and activate change initiatives at the local level and beyond. For some, this is an unimaginable role, but fortunately for others, this is a logical next step in fulfilling the promise of their education and preparation to lead. Stevens (2013) reminds us that there are four skills that the nurse leader must bring to this interprofessional table:

  • The redesign of healthcare systems through creativity and mastery of teamwork
  • Persistence in ensuring the education of nursing’s future workforce, with an eye focused on improving our systems of care
  • Moving beyond our current and comfortable programs of research, and learning to engage systems so that applications to larger platforms are possible
  • Inviting and ensuring multiple voices and perspectives are heard so that the transformation of healthcare is broadly focused on the needs of the larger population

It is our work not only to care for patients and to work diligently to improve the efficiencies and effectiveness of the system where we practice, but also to touch the lives of patients around the world by engaging in a readiness to move evidence-based practices into the mainstream of our thinking and our actions. To embrace change and actively implement those strategies which are best for patient outcomes will keep us focused firmly on the future and prevent us from being stuck in our past.

Source: Critical Thinking: Tools for Clinical Excellence and Leadership Effectiveness

ANA continues to oppose Senate health care bill

The American Nurses Association (ANA) weighed in last week on the potential cuts to Medicaid and Essential Health Benefits in the proposed Senate bill.

In a press conference on June 22, ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN outlined the harmful effects of eliminating the Essential Health Benefits used by millions in the U.S. The draft health care proposal from Senate GOP would make drastic cuts to Medicaid and increase the number of uninsured Americans by 22 million, according to the most recent Congressional Budget Office (CBO) estimate.

“In addition to eliminating the (essential health) benefits, the Senate Republican draft health care bill’s changes to Medicaid would be disastrous for our nation’s most vulnerable,” Cipriano said. “Medicaid is the safety net for tens of millions of children, as well as the poor and disabled. We’re nurses, and we’re here because we are very worried about our patients. We won’t stop fighting for them. We can do better and Americans truly deserve a better plan.”

The ANA has consistently spoke out against cuts to health care and Medicaid, voicing strong opposition to the American Health Care Act passed by the House of Representatives in May. ANA members, area nurses, and nursing students also participated in an “Emergency White Coat Fly-in,” and hopes to meet with Republican senators from key states that would be hurt the most by this bill and persuade them to protect health care.

Find more information on the ANA’s official website.

Nurse managers and the importance of documentation

As a nurse manager (also known as unit leader), regardless of clinical setting, it is your responsibility to assist staff in adhering to both clinical and documentation standards. It is also your responsibility to provide continuing education, ongoing feedback, and input into policy and documentation changes. It is to your advantage to fulfill these responsibilities, because if your staff is involved in a malpractice case, then your ability to manage and meet the quality and risk management standards will be called into question. You may be asked if the staff were following the standards of care based on organizational as well as accreditation or regulatory standards.

As a member of the leadership/management team, you must demonstrate that you have a commitment to providing safe quality patient care. It is your responsibility to ensure that nursing staff comply with up-to-date standards and organizational protocols/policies. The proof for this will be in the medical record. Your role is to support an efficient and effective documentation system and create an expectation that the documentation standards will be followed.

Demonstrate support for this by:

  • Developing or revising an efficient system that meets the requirements of regulatory standards.
  • Analyzing whether the documentation system allows for documentation of critical thinking and the nursing process.
  • Involving the end users in the development or analysis of the system.
  • Emphasizing the importance of documentation through written guidelines, policies, and performance evaluations.

Source: Improving Nursing Documentation and Reducing Risk

Educating staff about compassion fatigue

While many nurses know about compassion fatigue, they might not know exactly what it is, why it happens, or how to identify it in themselves. In a recent blog post, Jennifer Lelwica Buttaccio tackled some of the most common myths associated with compassion fatigue.

Not me!
One of the most common misconceptions about compassion fatigue is that your compassion is a limited resource, and if you can still feel compassion for a patient, it must not pertain to you. More likely, you will experience symptoms in other aspects of your life, such as physical or mental exhaustion, dreading going to work, worrying and dwelling on possible errors, or becoming easily frustrated with coworkers. So even if you feel empathetic while you’re with a patient, you could still be suffering from compassion fatigue.

Work harder! Nurses tend to throw themselves into their job head-first, but that approach can be detrimental when dealing with compassion fatigue; your instinct to work harder to overcome challenges at work will not help you here. It’s important to maintain a work-life balance, and compassion fatigue is often caused by overwork and neglecting yourself.

Patients first! Nurses take great pride in the care they give to their patients, but it should not come at the cost of caring for yourself. The best way to provide consistent and outstanding patient care is to take care of yourself first, by taking time for yourself, away from alarms, patients, and colleagues. Make sure that both you and your staff take their breaks and use their time off.

Check out the articles below for more information about compassion fatigue and solutions to your health and wellness problems.
Preventing nurse fatigue
Take Five: How renewal rooms revive stressed out nurses
Worker Wellness: Fatigue and Burnout

Study: Patients embracing telehealth, video conferencing

A new study suggests that patients are becoming more comfortable with telehealth solutions like video conferencing.

Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia published a series of qualitative interviews with telehealth patients, and the results were overwhelmingly positive. All participants indicated that they were satisfied with their telehealth visit, citing the convenience of receiving consultations from home, skipping office wait times and transportation costs.

One of the study’s authors, Rhea Powell, M.D., M.P.H., said that the video consultations could open up new opportunities for those who face barriers to medical care, and could be particularly useful for patients with chronic conditions such as diabetes and depression. Chronic conditions often don’t require a full exam, but they do require frequent short check-ins, which would be ideal for video conferencing.

The most surprising finding? Patients indicated a preference to receive bad news via video conference from their own homes. This goes against most clinical training, which teaches providers to deliver serious news in-person.

For more information about telehealth and nursing, check out the articles below from the Strategies for Nurse Managers’ Reading Room:

California Program Uses Telemedicine to Reach Medically Underserved

Telehealth provides opportunities to learn, educate and lead

Top RN to BSN Releases 50 Best Online RN to BSN Programs for 2017

Top RN to BSN, an independent online guide that ranks higher education and career options for current and prospective nurses, released their 50 Best Online RN to BSN Programs 2017.

From their press release:

“With the demands of contemporary nursing–some due to an aging and booming population, some from the complexities of the healthcare system, and some from a critical nursing shortage that results in long, stressful hours–many working RNs are returning to school to develop their skills and improve their credentials for promotion. Of course, the extremely demanding hours of most nurses make night school challenging, much less taking an absence to go to an on-campus program full-time. Online RN to BSN bridge or degree completion programs have emerged in recent years to give busy nurses the opportunity to earn their bachelor’s degree on their own time, from every kind of higher education institution. Top RN to BSN has used the most current data and statistics to put together an authoritative, unbiased guide to the best opportunities, combining quality, affordability, and career success to guide prospective BSN students to the best choices for their needs.

Top RN to BSN ranks online programs using three data points: reputation according to US News & World Report ranking; graduate salary according to College Scorecard data; and affordability based on the school’s non-resident tuition rate.

The top three Best Online RN to BSN Programs for 2017 are: 1) CUNY School of Professional Studies in New York, New York; 2) University of Arkansas in Fayetteville, Arkansas; (3) University of Massachusetts at Amherst, Massachusetts.”

You can find the full list here.

FREE Webinar: Fostering Nurse Engagement

Join Adirondack Health’s Chief Nursing Officer, Linda McClarigan, MSHA, BSN, RN, NE-BC, as she explains how the shared governance model has greatly benefited their work environment, in addition to lessons learned, best practices, and innovative projects that can help foster nurse engagement.nurse image

Participants of this webcast will discover:

  • Best practices for assessing your current work environment
  • Methods to encourage C-suite participation in nursing engagement programs

Innovative projects focused on sustaining productivity and a positive work environment.

Save your seat now!