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:
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.
- What are your qualifications that make you an effective wellness coach?
- Where did you receive your coach training?
- How long have you been coaching?
- What makes you different from other coaches?
- How do you decide whether you can help me?
- What strategies do you use when you coach someone?
- Can I interview you by phone before I decide to hire you?
- Do you provide a complimentary coaching session before I sign up?
- What happens during a coaching session?
- 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 firstname.lastname@example.org.
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.
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.
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.
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!
Why are we so resistant to exercise? The CDC says 80% of the US population doesn’t get the recommended amount of exercise for health. So which group are you in – the 80% or the 20%? Are these some of your excuses when it comes to exercise?
- I tried it before and I always stop after a few weeks
- I don’t feel better right away and in fact, I hurt all over
- I don’t see the benefits soon enough so why even start again
- I don’t have the time
- I’m too tired at the end of the day
- I’m too busy to fit it in
- I don’t need to exercise because I am on my feet all day
- I’ve gotten this far without exercising so why start now
- I’m too old to start exercising and I might hurt myself
- I have a health condition and can’t exercise
- I’m too lazy
Well guess what. I fall prey to many of those excuses as well, but at one point in my life I realized a huge benefit from regular exercise and I’ve never stopped since. Yes, exercise became my tool to MANAGE STRESS. Now that I use exercise as my stress management prescription, I’m much more motivated and have received huge benefits that continue to keep me coming back for more.
- I get to burn off all the pent up energy that can turn on my body and create pain
- Moving my body immediately changes my attitude from negative to positive
- I get to be around other great women who want to feel better which inspires me
- I feel better being with others
- I’ve gained many new close friends to share feelings and reduce the anxieties of life
- We get to laugh a lot because our instructor is so fun and pumps us up
- My endorphins also get pumped up and I “feel” what others call a “runner’s high”
- I forget about all the day’s irritations and just focus on my body’s movements.
- I get really creative when exercising and come up with cool new ideas for my work
- If I feel any depression at the beginning it all dissipates while I’m working out
- I feel a great sense of accomplishment at the end and feel relaxed and calm
- I sleep better
And oh yes – people ask me how I stay so fit and think I am younger than my age. Now that is the best self-esteem booster of all!
So what are you waiting for? Stop thinking of exercise as a chore, or torture or a waste of time. Start thinking of it as a way to reduce stress (who doesn’t experience this daily) and you don’t have to take any drugs either.
A study published in The Journal of the American Medical Association has found that surgery patients in hospitals with better nursing environments receive better care without drastically increasing costs. Researchers found the 30-day mortality rate for postoperative patients was 4.8% at hospitals with more than 1.5 nurses per bed (NPB), while facilities with less than one NPB had a 30-day mortality rate of 5.8%.
“It wasn’t just the number of nurses that made the difference. Magnet status hospitals recognized for having excellent nursing programs and cultures do better,” study author Linda Aiken, PhD, RN, said in a press release.
While there’ve been numerous studies showing the benefits of a bigger nursing staff, the cost of hiring new staff has been an impediment for many facilities. Despite this, better staffed hospitals actually paid less ($163) overall per patient than understaffed hospitals.
The healthcare industry is facing a shortage of nurses as members of the baby boomer generation retire and the industry expands. The upcoming decades are going to be reliant on new nurses to fill the gaps left by their predecessors. As a manager, what do you know about the people that will make up your staff in upcoming years?
Take a map of the U.S. and point to any town with a population of 100 or more. Odds are that within 30 miles of town center you’ll find a post office, a police station, a bar, and a hospital.
Hospitals and healthcare centers are key facilities and can be found pretty much everywhere. Coupled with a growing healthcare industry and more people getting nursing degrees, you would expect that after getting their license most new nurses would flock to big cities and big states for more job opportunities.
A study done by the RN Work Project found that this wasn’t quite the case. Instead, 88% of new nurses find their first job in the same state they attended high school. In fact, 66% of nurses currently work within 100 miles of their high school, with 35% working less than 15 miles away!
There are several factors that a new nurse needs to consider when thinking about moving. There’s economic factors such as the cost of living and average nursing salary in a given state. It may be more feasible for a new nurse to live with their parents and keep their expenses low while they pay off student debt. Then there’s practical considerations like the number of job openings and competition for those openings, particularly considering the difficulty new nurses have finding work. Finally, there’s the social considerations of moving away from friends and family and starting a new career in a foreign environment.
Given the increasing needs for more nurses, this lack of mobility can be an issue for states with fewer nursing programs and smaller nurse populations. A short term solution is to target your job postings at local nurses. If you haven’t already, making inroads with nearby nursing degree programs can help drive more new applicants to your door.
As for long term, you should create some incentives to encourage out-of-state nurses to move to your area. Scholarships and internships for out-of-state nurses can help you recruit and retain new nurses. Starting an off-hours program where locals show newbies and interns around can help them feel more comfortable in a new town.
One big area to look into is tuition reimbursement. As of 2011, only 69% of healthcare facilities offered tuition reimbursement to first time nurses, down from 86% in 2005. Even offering partial reimbursement can make all the difference for a new nurse deciding where to start his or her career.
The word TRANSITION means the passage from one form, state, style, or place to another – CHANGE! Some of you are cringing thinking about change, but others are thinking – BRING IT ON! How many transitions are you experiencing right now? From holiday over-eating to New Year reckonings about weight? From worrying about money to wondering what else you could do to increase your income? From working in a job that is not a fit for you to wondering what else you could be doing? From leaving the workforce to enter the world of retirement and not knowing how to adjust? Transitions are everywhere at any time and can be perceived as negative or positive. I prefer the latter and have some thoughts to consider.
T – Trust your instincts. Rather than be caught off guard when things change, take the high road and note what your gut is telling you about what it going on. Keep in mind the change you are experiencing might be just what you have been secretly wanting!
R – Reset your eating and exercise program. Have you been stuck and know you want to get healthier but not sure how to make the first move? I’m sure you have dealt with this before, so reflect on what helped you be successful in the past and recreate those steps.
A – Adjust your thinking from I CAN’T to I CAN. See yourself healthy, happy and whole. Send time every day imagining yourself being your best and being grateful for all that you are and have. Hang up pictures to visually represent what your goals look like so you can start living in that body even before you get there.
N – Notice what you need right now. Go outside right now for a walk. Yes – right now! By yourself! Take a notepad and pen along because great ideas are sure to surface while you are walking and you may want to write them down before you lose them. Focus as you walk on what you really need right now to move forward thru this transition. This will be your starting point.
S – Set goals in alignment with your values to create the life you love. Have you ever taken the time to really ask yourself what you want? Yes, you know what your mother wants for you, what your kids want, what your partner wants, and what you “should” want. But what do you really want? Write down 3 dreams you have for a more complete life and post it where you can ponder it.
I – Integrate all your skills into a single focus. By now you have probably acquired a lot of great life and work skills that make you the fantastic talented person you are. During this transition, you might find that it is time to put them all to good use and see what emerges. Write down a list of everything you are great at – write until you can’t think of anything else – at least 30 things.
T – Train yourself for new skills. After I had acquired all the skills I thought I needed in life, I opened up myself to what might be next for me – the key – being open to possibilities. What showed up for me was “wellness coaching”, or some people call it “life coaching”. When I was searching for “what’s next for me”, a friend coached me and after just 2 sessions, I had a new direction, a plan, and I was on my way again. I loved the experience so much, I was trained to be a coach as well as a coach trainer.
I – Invite new opportunities. When I was transitioning out of the workforce and into my own independent wellness business, I needed to figure out how to earn money while still doing the work I am passionate about. Because I remained open to new ideas, I was presented with a way to help people get healthy as well as make passive income that could grow over time. The key was to stay open to new ideas and give them a chance to see if they could work for you.
O – Own up to what is best for you. Not sure what direction to take as you transition? Your guide should be how you “feel” about what you decide to do. As they say, if it feels right – do it?
N – Now is the time to reinvent yourself. I wrote a whole chapter on this in the book Wise Women Speak – Choosing Stepping Stones Along the Path. My gift to you is a free download of this chapter by logging on to my website http://carolebert.com/meet-carol/free-ebook/
Enjoy the process of your transition. Remember, it’s about the journey not the destination. Fun times ahead! Contact me at any time for support – email@example.com.