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Dealing with racism in patients

Nurse managers and their staff often face racism in the work place; Minority Nurse reported that almost half of minority nurses said they have experienced barriers in their career because of their race and educational background. In addition to institutional barriers, there is also the problem of patient racism, where patients refuse care based on the race or ethnicity of the provider. As a nurse, you might be put in the unenviable position of deciding how to handle one of these situations. Do you refuse care to the patient? Do you acquiesce to the patient’s unreasonable demand?

The New England Journal of Medicine published an article last week that provides some useful information about how to handle patient racism. The authors point out that there are a number of concerns to take into account, both legally and ethically. The situation pits a number of rights and laws against each other, including the patient’s right to refuse medical care, laws that require hospitals to provide medical care in emergency situations, and employment rights that dictate that hospitals cannot make staff decisions based on race. Nurses that have been reassigned based on a patient’s racial demands have successfully sued their employers, but if a patient doesn’t receive proper medical attention in a timely manner, facilities are equally liable.

The journal lays out five factors to consider when faced with this difficult situation:

  • The patient’s medical condition: If the patient is unstable, treat the patient right away, regardless of the patient’s preference. It is possible that their current condition is impairing their mental faculties.
  • The patient’s decision-making capacity: Try to assess if the patient is capable of making decisions for themselves; psychosis or dementia are important factors to consider. If the patient lacks decision-making capacity, try to persuade the patient to reconsider their request.
  • Reasons for the request: If there are clinical or ethnically appropriate reasons for reassigning staff, that should be taken into consideration. For example, if there are language barriers or religious concerns, it might be reasonable to accommodate the patient.
  • Effect on the provider: Always take into account the effect a decision might have on the employee. “For many minority health care workers, expressions of patients’ racial preferences are painful and degrading indignities, which cumulatively contribute to moral distress and burnout,” according to the article. Always try to support staff when possible, and discuss their preferences when deciding how to respond.
  • Options for responding: In some situations, staffing might dictate your decision. If the department is understaffed and you cannot provide proper coverage by reassigning, try to persuade the patient.

If faced with a non-emergency situation and a patient is deemed capable of making decisions, the article suggests that it may be best to suggest that the patient seek care elsewhere; though that also has its risks depending on the availability of other treatment.

For more information on this difficult issue, including a useful decision-making tool, read the New England Journal of Medicine’s full article.

Ask the expert: Switching nurse specialties

Changing specialties has become an integral part of a nurse’s career growth. We spoke with Elaine Foster, Ph.D., MSN, RN, Associate Dean, Nursing Graduate Programs at American Sentinel University about this trend and what nurses should consider when making a change.

“Nurses have a powerful thirst for knowledge and a stron­g desire to learn and grow, and this often translates into motivation to make a career change. Many will reach a time when they would like to experience different professional opportunities,” says Foster. “In the nursing world, we need to actually help people plan out their career strategies, and it would help new nurses if they received more guidance; we don’t spend a lot of time painting the overall picture of healthcare.”

So where should a nurse considering a career change start? Foster advises that a nurse should start by researching their areas of interest and finding a specialty that fits them. “Read articles, talk to nurses in that field, assess the job market in your area, and learn everything you can about the specialty you are interested in.”

Another important factor to consider is education: does the specialty require more education or certification? Foster notes that in the past, it was more common for nurses to receive on-the-job training and end up in management positions without formal training, but in recent years, nurses require formal education and credentials to advance their careers.

After conducting your research, Foster suggests talking to people currently working in the field. Networking is crucial to making a career shift, and making a connection with an experienced nurse in your field provides plenty of benefits. Shadowing a nurse in your field gives you first-hand experience with the day-to-day demands of the position, and if you do end up pursuing the new specialty, your contact could provide job leads or even become a preceptor in the future.

Finally, before you make a career change, Foster advises that you reflect on the benefits and consider the costs. “Think about how this change will impact you in the future and what you might have to give up now to get that future five years down the road,” she says. “It took ten years to get my PhD; I had to give up a few things, but I’m grateful that I did.”

For more career-shift strategies, check out American Sentinel University’s guide.

Rock Your Health: 6 Excellent ideas to FIRE UP your work

FFind new initiatives that make your job better and healthier. This is the “fuel for your fire” so keep abreast of new trends and bring people together who have passion for making things happen and hand the reins over to them.

IInvest time connecting with staff. Ask as you shall learn what people want. The best ideas generally come from those around us, but we often don’t ask them for advice. Be the manager that asks!

RRenew your commitment to your role on a daily basis. WHY did you take on the role of manager in the first place? WHAT is in it for you? Write that statement down, hang it where you will see it every day and read it out loud to keep your internal fire burning.

EEnergize yourself daily to keep your mind, body, spirit in balance. This is my number one priority because if I don’t take care of myself, no one else will do it for me. When I stopped working for a boss who controlled my time and my schedule and started working for myself, I make exercise my number one priority above all else, and have held to that commitment for the past 10 years and it is paying off every day. How are you keeping your life balanced despite all the stresses and strains of work and life? And how are you encouraging your staff to do the same thing?

UUndo negative self- talk. This will do you in every time. The minute you tell yourself you don’t have time for something new, you don’t have time! It’s that self-fulfilling prophecy. “Whether you think you can or can’t either way you are right.” – Henry Ford 1863-1947.

PPlan, Plan, Plan. Create daily, weekly, monthly, 3-monthly, 6- monthly or a full 12 months in advance. Without a plan, you are lost. Trust me, whenever I have a plan I feel better and have success, when my plan runs out and I haven’t created another one, I “feel” lost.   Select which time frame works for you and get your team creating a masterpiece that will keep the flame burning.

So keep the flame alive, and don’t give up! As author Napoleon Hill said: Quitters Never Win and Winners Never Quit!

Strategies for implementing evidence-based practices: Journal clubs

If you’re looking for ways to get your staff engaged and current on the latest evidence-based practices, then you should consider starting a journal club, a regular meeting of staff members to discuss articles from nursing journals. It’s a great way to improve your staff’s reading habits and critical thinking while promoting cooperation and teamwork.

To start your club, you need to choose someone to select readings. A master’s-prepared nurse specialist or educator would be an ideal candidate to lead the group, but anyone with the proper knowledge or enthusiasm would make a fine choice. They should endeavor to select readings that are informative, relevant, and accessible to encourage nurses of all levels to participate. They should start by selecting a guide to critical reading, so everyone has the tools to discuss the articles. Once they’ve selected the article, make sure the reading is easily obtainable and give plenty of advanced notice to ensure everyone has time to read it.

The biggest hurdle for starting a journal club in a healthcare environment is finding time in your staff’s busy schedule. Ideally, you want to find a time that works for everyone, perhaps during a shared break or change of shift. If this proves too daunting, you can always create a virtual journal club. You could use a hospital intranet, email list, or even a chat forum to discuss the readings.

Once you get everyone together, encourage them to think about the article critically and ask them to evaluate it. Here’s a great list of questions to start discussions and get the group thinking about the reading.

If you find that your group has lost momentum or attendance is waning over time, try providing incentives for attendees. Small perks or competitions can be a great way to encourage attendance and let your group have some fun!

Here are some helpful links to get you started!

Running an effective journal club

From the desk of Adrianne Avillion, DEd, RN

Who should facilitate journal clubs?

Help nurses critique journal articles

Do you have a journal group at your facility? We’d love to hear about your experiences in the comments below!

Creating a transgender-friendly healthcare environment starts with nurses

Nurses are often the face of their hospital; they are typically the first staff member to interact with the patient, and nurses are integral to providing a positive patient experience. In the ever-shifting landscape of culture, healthcare providers need to avoid discrimination and work to make sure patients feel at ease. While we have many resources that address cross-cultural competency (like this article from our Strategies for Nurse Manager’s reading room or the Health and Human Services’ guide), the medical community is just beginning to address how to effectively treat transgender patients. The Association of American Medical Colleges (AAMC) recently released treatment guidelines for transgender patients, and it is vital that nursing staffs help battle unconscious bias and create a safe climate for all of their patients.

In 2010, Lambda Legal found that a staggering 70 percent of transgender people had experienced discrimination in a hospital setting, and a 2011 study by the National Center for Transgender Equality and the National LGBTQ Task Force reported that 19 percent of patients were denied healthcare because of their status (via the New York Times). Because of this, 28 percent of the respondents have postponed medical care when sick and 33 percent don’t pursue preventive care because of their past experiences with medical professionals.

Better nurse education would be a great start to counteract this trend of discrimination and improve the climate for transgender patients; and when it comes to educating your staff, a little can go a long way. Part of the problem is treatment knowledge, but many of the issues could be solved with improved sensitivity training. Basic language education, such as what pronouns to use and asking the patient how they’d like to be addressed, can make a transgender patient feel at ease. Adding a gender and preferred name component to medical records and ensuring that they are up to date can greatly improve the consistency and quality of care as well.

Janis Booth, RN, shares a great example of how hospital staff can help a transgender person feel at ease from one of her readers:

“My new doctor saw my list of meds and knew immediately and opened with, ‘You look great…how long ago did you begin your transition?’ Put me right at ease, immediately, even though my name change had not caught up with their record keeping. I presented new IDs and they updated my info.”

Small things like asking the right questions in a gentle way can open up the patient and make them more comfortable, which will make your job much easier as well. Nurses get to set the tone of the patient’s experience, so properly training your staff on gender issues can make all the difference for a transgender patient in need.

Here are some great training resources on the topic:

  • You can download the full AAMC guide here.
  • WBUR has a list of tips to get you started.
  • Janis Booth’s full article has a lot of great information as well.
  • TransRecord and RAD Remedy are sites dedicated to gathering and sharing data on trans-friendly providers.

Rock Your Health: Ten questions to ask when you are looking for the right coach for you

Are you stuck and don’t know how to move forward with an issue that is bugging you but you never seem to finally do anything about it? This is where having a coach can be a real asset, helps you break thru barriers and gets you into action. But how do you find the right coach for you? Here are some questions to ask your potential coach to help you sort it all out.

  1. What are your qualifications that make you an effective wellness coach?
  2. Where did you receive your coach training?
  3. How long have you been coaching?
  4. What makes you different from other coaches?
  5. How do you decide whether you can help me?
  6. What strategies do you use when you coach someone?
  7. Can I interview you by phone before I decide to hire you?
  8. Do you provide a complimentary coaching session before I sign up?
  9. What happens during a coaching session?
  10. What does a coaching package look like and how much does it cost?

Want to ask me these questions to find out what kind of coach I am? Contact me at carol@carolebert.com.

What to know about New Nurses: Tips for getting and keeping RNs in a rural hospital

The nursing shortage is becoming a major issue again and rural hospitals are being hit hardest. Nurses tend to stay local when possible, so rural hospitals can have a hard time attracting new nurses to move to their area without the benefits and salary of urban hospitals. Below are some suggestions on how to improve your odds of attracting (and keeping) star graduates at your rural hospital.

Moving to a rural hospital can be intimidating for a new nurse, working in relative isolation without the support system of a larger hospital. Provide mentorship and regular training programs to help ease the transition and boost the young nurse’s confidence. Schedule shifts alongside experienced RNs whenever possible to give them a sense of security.

Being a smaller hospital has some benefits as well. Emphasize the intimacy of a small hospital community and offer manageable patient-loads.

Provide leadership opportunities and a clear path for advancement. Residency programs, teaching opportunities, community wellness programs, and tuition reimbursement can be a huge draw for ambitious young nurses.

Developing a strong staff that provides outstanding care will make your hospital even more attractive to new nurses, hopefully leading to a consistent cycle of new talent into your rural facility.

For an in-depth report on the challenges facing rural nursing, check out: Healthcare in the outlands.

Take Five: How renewal rooms revive stressed out nurses

With long shifts, hard work, and close contact with the sick and the dying, it’s unsurprising that many nurses are burnt out. One study found that nearly one-third of oncology nurses exhibit emotional exhaustion and 50% report levels of emotional distress. Despite the fact they might be hurting, nurses are often expected to “tough it out,” hiding their stress from the eyes of others.

Compassion fatigue is a huge issue for us all in bedside nursing, and we as leaders need to look into and address that,” says Jacklynn Lesniak, RN, MS, BSN, senior vice president of patient care services and chief nursing officer at Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center in Zion, IL.

In response, CTCA Midwestern created several “nurse renewal rooms,” with one in each inpatient tower, surgical department, and outpatient care area. The rooms were designed by Jillianne Shriver, RN, BSN, HN-BC who studied relaxation techniques and holistic nursing for three months for the project.

Only one nurse is allowed in the room at a time, giving them much needed private time away from the eyes of patients and coworkers. Each room is laden with relaxation material and décor: aromatherapy and meditation material, a yoga mat, a sand garden, books for reading and journaling, and music therapy.  When a nurse feels he or she needs to step back, they inform their charge nurse that they need to use the room. Then they hand over their communications devices and go into the renewal room for a couple minutes to decompress.

“I decided that I really wanted somewhere for the nurses to take that time to renew, rejuvenate, and recharge,” Shriver says. “To step out of whatever situation they may be in, whether that be a stressful or busy day, and have five to 15 minutes to themselves to be able to focus, ground themselves, take a deep breath, and then step back into practice.”

Not only did the renewal rooms work, they worked well. CTCA Midwestern reported that the first renewal room was used 422 times in the first three months and 96% of nurses said they felt better after using it. Which is pretty impressive when you consider the first renewal room was just a supply area with a massage chair and some relaxing decorations.

To read more in-depth about nurse renewal rooms, check out the original article at HealthLeaders.com.

Rock Your Health: 7 Secrets to Being a Healthy Nurse

So what does it mean to be a healthy nurse?  I am one and am proud of it!  But I latched on to the concept of Wellness early-on.  Right out of nurse’s training I spent 3 years as a Navy Nurse caring for Vietnam casualties and really got a wake-up call about war and how it is not a good thing!  But I learned a lot, grew up a lot, but then entered civilian life again doing the nursing thing at the bedside.  That may have been the turning point for me because I felt the problems I was treating could have been prevented, and it all seemed senseless to me.

So I became a school nurse, got hooked on teaching kids how to stay healthy, and made the shift from treating problems to helping people prevent them. Much more rewarding for me and thus was dubbed “Nurse Wellness.”

What I have learned and “know for sure” (as Oprah would put it) is that there are some core principles that if you adhere to them, all will be well.   Why people don’t is still a mystery to me, but once you get in the groove of these things, it becomes fun, with a huge payoff – like you might live to 100+.  And right now as a Boomer myself, that sounds mighty nice.

So here is my magic formula for staying HEALTHY.

H – Happy Attitude.

E – Exercise Daily.

A – Abundance of Antioxidants.

L – Low Glycemic Foods.

T – Take Time for Yourself.

H – Help Others.

Y – Young at Heart.

What to know about new nurses: Tackling Turnover

Hiring a competent nurse staff is only half the battle. The other half is keeping them. A new study published in Nursing Ethics found the turnover rates for RNs is 16.5%, with each resignation costing a hospital between $44,380 to $63,400 a nurse. Furthermore, newly licensed nurses scored lower on job satisfaction and were more likely to leave their job within two years.

The Nursing Ethics report found that intergenerational conflict was a big part of nurse dissatisfaction; with millennials, Gen Xers, and baby boomers butting heads at the hospital.

“Younger generation nurses feel like they don’t have power over their practice, they’re not in charge, and that is logical because they are novice practitioners,” study author Charleen McNeill said in a press release. “However, they bring a knowledge of technology that seasoned nurses may lack. In turn, more experienced nurses support the clinical learning and professional role formation of new nurses. Successful nurse-leaders find ways to garner the strengths of each generation of nurses to achieve the best patient outcomes.”

McNeill said instead of looking at it as conflict, nurse-leaders need to leverage the strengths of each generation and determine strategies to empower all generations of nurses. Their research suggested a strong correlation between professional values and career development. They also found that both job satisfaction and career development correlated positively with nurse retention.

“The work culture that leaders create – the environment that nurses are working in – is the most important thing related to retention,” McNeill said. “It’s very expensive to hire new nurses. When we have good nurses, we want to keep them so we need to understand what’s important to keep them.”

For more tips on retention, conflict resolution and recruitment, check out the following articles from our Strategies for Nurse Managers site!