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Rock Your Health: How to deal with a dilemma

Recently I was faced with a decision to compromise my belief over yielding to conventional thinking that I now know is in question.  For example, we now know that cholesterol is no longer the cause of heart disease. Inflammation is.  But conventional thinkers may not have changed their thinking on this issue because new information takes time to catch up with everyone.

Because it is my job to educate on health issues and keep people informed with the latest scientific evidence, it is not always readily acceptable to the masses. So the challenge is – do you yield to the old paradigm or do you take the risk of telling the new truth and standing out on a limb?

I remember when I entered the field of wellness and when I tried to educate about it in the healthcare system one physician said to me “there is no such word as wellness.” But I of course forged ahead and now look where we are with wellness – front and center!

So how do you handle this? Please email me your comments to carol@carolebert.com.

Nurses bring layers of diversity to hospital leadership

In just about every field, there are discrepancies between leadership positions and the population they represent; health care is no different. The American Hospital Association’s Institute for Diversity conducted a national survey that found that minorities made up 31 percent of the patient population, but only 17 percent of first and mid-level management positions. There’s even less representation in upper management roles, with 14 percent of hospital board members and 12 percent of executive leadership roles filled by minorities.

As the hospitals’ population get more diverse, so should its leadership. This doesn’t just mean racial diversity, but gender, experience, and cultural diversity as well. Hospitals that have a multitude of perspectives will serve their population better and make the hospital more successful.

In terms of diversity of experience, nurses can bring a useful perspective to executive leadership. Many hospital executives come from a business background and don’t have the kind of on the ground experience nurses can bring to the table. Medical staff generally prefer leadership that is familiar with their experience, that can relate to how big-picture decisions can effect day-to-day practices in hospitals. Additionally, nurses have more racial diversity compared to executive leadership, so they would bring that experience to the table as well.

However, there are a lot of barriers to nurses trying to obtain leadership positions. As a nursing student, nurses are much more focused on learning patient care than management techniques. Nurses don’t get much formal training in finance or business, so staying competitive might mean seeking a time-consuming and expensive degree on the side. There is also a possible stigma against nurses from executives, so much so that the American Nursing Association reports that RNs seeking executive work often leave that off their resume. As one nurse told them: “Well, I don’t want to put RN after my name because some people might not think that I know as much about business, or that might be a detractor when I’m competing with others in the C-Suite, especially men in the C-Suite.”

While perspectives are slowly shifting, along with diversity numbers in hospital leadership, nurses taking on larger leadership roles can help hospitals and their patients.

How rethinking reviews can boost staff morale

Performance review time is never easy. Managers have the uncomfortable task of assessing their team, and the staff is uneasy about what a poor review could mean for their career; if a review goes poorly, it can lead to tension and dissatisfaction long after the review. A new study in The Nursing Management Journal proposes a new way of approaching performance reviews that could make the process a little easier on everyone.

A task force of nurse leaders from a Magnet® recognized hospital system sought to make their process more objective after receiving staff feedback that their performance reviews were too subjective. Previously, the nurse manager would evaluate staff based on the fulfillment of their job description, meeting performance outcomes, and following care commitment guidelines. The team revised the RN job description to better fit the staff’s responsibilities, then created performance metrics based around the revised job description. They hoped that this would provide the staff with measurable results for their performance review and tangible goals for improvement.

The staff responded to this new criteria-based model for reviews. The surveyed nurses said that the new system was more transparent and consistent, and they liked that the results were evidence-based and didn’t hinge on personal bias. Overall, 71.7% of the surveyed staff felt the new process accurately reflected their performance, versus the 37.8% under the previous method. So while performance reviews will always be a headache, perhaps moving to a criteria-based model will help ease the pain.

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Combating depression in nurses

Nurses are twice as likely to experience clinical depression than the general population. Why aren’t we talking about it?

The Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) found that 18% of nurses exhibit symptoms of depression, compared to the 9% found in the general public. Nurses are happy to talk about their staff shortages or their back problems, but we almost never see serious discussions about mental health issues.

Minority Nurse suggests that nursing culture exacerbates the depression issue. Nurses take great pride in their survivability and toughness; they often see trials facing new nurses as a proving ground, a way of weeding out those who are not cut out for the job. This leads nurses struggling with depression to bury their feelings and work twice as hard, which will make things worse in the long run.

There’s also the idea that mental health issues are seen as a weakness. Nurses rely on each other to be reliable and trustworthy, and someone who is struggling might be easily dismissed as unreliable. This puts their job at risk, and can affect their relationship with peers. Additionally, the nurse mentality is to put the care of others first; many nurses might not release why their suffering, as they so rarely address their own needs.

If admitting they have a problem or asking for help is often the last thing a nurse wants to do, how do you help them? The process starts with nurse managers. Educating managers about the warning signs of depression, and they in turn train their staff to recognize the condition in themselves and their peers. Coming up with strategies to help depressed nurses that aren’t punitive and making sure their staff have resources available to them can help alleviate the fears associated with mental illness.  Showing the staff that it’s okay to talk about mental illness and that asking for help isn’t a sign of weakness will help change the “tough it out” culture of nursing.

Addressing mental health issues can help improve nurse retention as well. Instead of “weeding out” the weak links, supporting new nurses through a crisis and encouraging them to get help will keep them at their jobs longer, and make them better nurses for the rest of their career.

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Become an HCPro Author

Last summer, we asked you to join our Nursing Book Review Group and the response was overwhelming. We are thrilled with how many of you were eager to share your thoughts and ideas for a variety of our nursing products.

We are looking for enthusiastic nurse managers, nurse leaders, and nurse educators who are willing to become authors and share their experiences, success stories, and lessons learned with fellow colleagues.

We’re currently looking for authors for an upcoming critical thinking text as well as an upcoming nursing program orientation text. If this is something you’re interested in, please email me at mclarke@hcpro.com. You don’t have to be an experienced author, we’ll provide you with the tools and guidance needed.

If you have an idea for a different book than the topics already mentioned, please email us. We’re always looking for new topics that will help you do your jobs better.

Note: If you didn’t have a chance to join our Nursing Book Review Group last year, keep an eye on this spot for an upcoming announcement about the group.

We look forward to hearing from you!

Winter Nursing Roundup: The best and worst of nursing

As the winter winds down, I thought I’d round up some of the best and worst stories from the world of nursing to celebrate the arrival of spring.

Braving the cold

During a winter storm that called for a state of emergency, one brave nurse made the trek to get to her overnight shift at Hebrew Home. Chantelle Diabate, a licensed practical nurse, waked an hour and a half in blizzard conditions to make her shift; she was the only nurse that made it in that night. “As long as my daughter was safe [with a baby-sitter], I knew I had to come back and take care of my second family,” she said. “I knew they needed people and it was an emergency.” (via: The Source)

When winter weather hit the National Institutes of Health (NIH) in Maryland, the nurses there were faced with a different problem. The children of the hospital were eager to get out and build an Olaf of their own, but unable to leave due to their health conditions. One nurse took it upon herself to fill up tubs with fresh snow so the kids could play. The kids were able to build and color their own snowmen, and enjoy the benefits of snow without leaving the comfort of the hospital. (via CBS News)

Feeling the heat

The director of nursing services at Kindred Transitional Care and Rehabilitation Center in Columbus, Indiana was arrested last month. It turns out, she had allegedly been posing as a registered nurse after stealing the identity of another nurse. She oversaw nurses at the center for over a year before being caught, fired and arrested. (via Becker’s Hospital Review)

Meanwhile, a Pennsylvania nurse was arrested for reckless endangerment after showing up to work intoxicated. The nurse spent the afternoon drinking at the casino, forgetting he was on call later that night. He was called for an emergency surgery after 10 p.m. and went to work intoxicated. He was seen on security footage stumbling, and staff members reported that he was having trouble punching in and had slurred speech. He has also been charged with DUI and public drunkenness. (via Outpatient Surgery Magazine)

Do you have a great nursing story that you’re dying to tell? Feel free to send them in to kmichek@hcpro.com, and we might report on it here!

Featured Webcast: Millennial Nurse Retention

Millennial Nurse Retention: Bridging the Generation Gap

In 2015, the number of millennials in the workplace surpassed baby boomers as the largest segment of workers. This future generation of nurses has very different career expectations than the generations before them. Millennials expect more feedback, greater collaboration, interaction with nurse leaders, an 8-hour workday and better work-life balance. Unlike their parents, they rarely intend to stay with one employer for their entire career—or possibly even more than a few years.

The shift in attitude has many organizations struggling to retain millennials and learning to adjust management strategies to accommodate their unique style. Join Kathy Bonser, Vice President of Nursing and CNO at SSM Health DePaul as she discusses the importance of leveraging the differences to create a win-win environment for staff and frontline leaders.

Take part in this live 60-minute webcast to:

  • Uncover how making changes in leadership behaviors can bridge the generation gap
  • Discover new onboarding processes that support the growing millennial workforce
  • Devise a structured approach to providing regular employee feedback
  • Understand the importance and value of engaging millennials early and often

For more details or to register for the webcast, please visit The Health Leaders Media store.

Rock Your Health: When you can’t stop working!

What’s up with working all the time? How did that enter our lives?  What happened to weekends off with a Sunday drive in the country? What happened to Sunday morning church followed by a nice meal out? What happened to evenings sitting outside or kids playing till dark? What happened to all that free time computers were supposed to give us?  Oh wait.  Maybe that’s it. It’s the computers fault. Or is it?

If you are wondering why you are so exhausted, look no further than your own choices about how you are living your life. And if the people around you are in the same boat, maybe it is time for a heart to heart.  So what are you willing to do to bring rest and refreshed energy back into your life?  And how committed are you to making that change?

As a wellness coach I know how successful people make changes in their busy lives and having a coach to hold you accountable is often the best step to get you to where you want to be quicker. Contact me if you want a sample session and maybe you will discover what possibilities exist for you. carol@carolebert.com

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.