There is much discussion about the need for diversity in nursing and the importance of educating a health care workforce that mirrors the population. Recently, Dr. Ernest Grant, president of the American Nurses Association wrote, “A diverse workforce allows us to use our varying cultural perspectives to ensure all patients and populations receive optimal and empathic care, which also may speed up their recovery and reduce the risk of preventable chronic conditions.”
Powerful words – “speed up their recovery and reduce the
risk of preventable chronic conditions” – which are exactly the actions and
goals we should be striving to achieve in an effort to increase the health of
the population and eliminate health disparities.
While contemplating diversity in nursing, a few key population statistics are worth considering. According to the U.S. Census Bureau, 49.2% of the American population are men, 41.5% of the American population are of a race other than Caucasian, and 21.3% of the American population speaks a language other than English at home.
However, according to the 2017 National Nursing Workforce Survey, just over 9% of working RNs are men, and only 19.2% are minorities. While reliable data about the number of nurses who speak a language other than English is scarce, based on the statistics demonstrated above, it’s unlikely this number mirrors the population.
In order to reduce health disparities by addressing inequalities and eliminating care gaps, it is critical to educate a vast and diverse health care workforce. The systems that educate and train nurses should place a focus on increasing the diversity of their nursing student population. Another key step is to make programs increasingly accessible through holistic admissions processes to admit a larger number of qualified nursing students.
Additionally, providing students with exposure to patients of all types of backgrounds and demographics during education and training, will help them achieve a better understanding of patient needs and how they can connect with them to provide quality care and improved experiences. Diversity in all its forms, from innate characteristics including age, race, and mental health to acquired characteristics like religion, education, and language skills, requires an awareness and respect for every person. This helps transition students from viewing their work through a cultural competence to a more inclusive lens of cultural humility.
Building cultural humility begins with a better understanding of the unique challenges every student faces and putting in steps and processes for helping them succeed while in their program. By teaching students that they are cared for, students are able to better focus on providing exceptional care for others. Putting each student at the forefront at each touchpoint and never letting them lose sight of their passion for health care, helps them become an extraordinary nurse who cares for others.
Nursing assessments are taught thoroughly in nursing school and utilized at the bedside every day for many nurses. Nurses use their senses to gather important information regarding the status of their patients. They are trained to pick up on seemingly insignificant changes in the patient’s status and incorporating it into their overall assessment. Whether it is a change in the patient’s complexion, swelling in their ankles, the new onset of a cough, or the slightest change in a patient’s vital signs, nurses process more information that can be caught by a keen observer.
Yet when taken out of the patient room, nurses often feel like a fish out of water. With an increase in technology utilization, nurses are more commonly taken away from the bedside. Telehealth is becoming more common for nurses to utilize in a variety of care settings. Whether you are looking to improve your assessment skills or are considering a job that requires telehealth, below are a few tips for assessing patients over the phone.
Many aspects of a nursing assessment are often contained within the mind. Given the fact that you are on the phone, you must translate the normal assessment at the bedside to a verbal conversation. Nurses often don’t understand how much of their assessment isn’t verbal but is visual at the bedside. When mentally working through your telehealth assessment, start to verbalize your assessment to your patient over the phone, especially regarding assessments of things that you would visualize (e.g., appearance, behavioral changes, swelling).
When assessing a patient over the phone, you must be descriptive. Often patients have difficulty describing things. As a nurse, you have many adjectives that you use that are helpful. Plus, you need to get into the details. You cannot settle for vague generalities such as, “I had a loose bowel movement” or “I’m in pain.” You can facilitate the conversation by asking things like, “Was your pain sharp and stabbing or was it dull and achy?” and, “When you passed blood in your stool was it black and tarry or bright red?” The better you can describe common descriptors relating to what the patient is telling you, the better you can accurately assess what they are actually experiencing.
Listening intently can uncover many valuable details that
otherwise might get overlooked. Since patients can have difficulty explaining
their symptoms, giving them space and time to get out what they are trying to
say can go a long way in understanding what is actually going on. Remember, you
are the assessment expert, not the patient.
You are completely dependent on what you can get from the patient during a telehealth assessment. Be sure to speak out loud, use descriptors, and when all else fails, let the patient talk in order to get a thorough assessment.
Thousands of hospitalized patients die every year and the cause is directly attributed to nurses and their “failure to rescue” the patients within their care. We’ve all heard about that one patient that came in with one issue and died of another. Those of us who have reviewed charts for malpractice cases refer to it as the “snowball effect”—reading the progress notes of a patient who died due to failure to rescue will make you cringe at the glaring errors.
Patients may have one clinical issue, however minor, that if overlooked by the nurse, cascades into a huge mess of concurrent errors and oversights that often leads to the injury or needless death of a patient. Did you ever wonder why this occurs? Short staffing? Maybe. Nurse burnout? Could be. The main contributing factor, though, is that unfortunately there are many nurses who don’t think creatively or innovatively. They don’t act on their assessment findings nor do they follow up on a change in patient condition. They fail to act as advocates for their patient. Nurses who fail to rescue use “traditional thinking” rather than critical thinking.
Failure to rescue always includes four key elements: (1) Omission of care; (2) a failure to recognize a change in patient condition; (3) a failure to communicate a change in patient condition to medical or other staff; and (4) poor or lack of clinical decision making.
Preceptors and nursing instructors, no matter the level of nursing taught (RN, BSN, MSN, NP, or DNP), should review the below list. It contains elements of traditional thinking. Promoting traditional thinking stifles critical thinking.
who don’t think critically:
- Don’t learn from their mistakes or the
mistakes of other nurses.
- Demand that nothing changes and have a
“but we’ve always done it this way” attitude.
- Treat each patient interaction in
- Fail to “connect the dots” from one
interaction to another.
- Fail to learn about cause and effect.
- Do not connect new events with prior
- Do not see what is possible in the future.
- Solve problems in isolation.
- Demand that all things be done their way
and not any other.
- Allow personal dislikes and prejudices to
- Lack self-confidence.
- Have poor verbal and written communication
skills and do not interact well with others.
- Do not further their education or promote education
- Force others to make decisions quickly or
set time limits on when decisions can be made.
The behavior and clinical actions of nursing preceptors and instructors affect a student or new nurse long after their clinical rotation or orientation has ended. In fact, the actions of a preceptor or instructor will influence the new nurse far into their nursing careers.
The following statements, said by a preceptor or any nurse to another nurse, will stifle critical thinking:
- “That’s a dumb idea.”
- “I can’t believe your school didn’t teach
- “Your idea is good, but it won’t work here.”
- “It’s too complicated so I’ll just do it
and you can watch.”
- “You spend too much time talking with your
- “We tried that here on our unit and it
How do you teach critical thinking to your preceptees and students? Let us know in the comments!
Many nurses find that they experience burnout in the profession and want to create an opportunity to work for themselves without the stress and wear-and-tear that they get from working in the hospital setting. Most importantly though, they want more flexibility and control of their work. Here are 3 flexible nurse entrepreneur business ideas to get you thinking about your next nursing opportunity. After all, a nursing practice can take many forms.
What will yours be?
1. Nurse Health Coach
Nurse health coaches have the ability to actualize their patient’s health care goals outside of the hospital setting by helping them develop the healthiest version of themselves. By teaching patients how to take optimal care of themselves, the nurse health coach empowers them for life.
Nurse health coaches work with patients to provide guidance and resources to assist their patients in living a more healthy and balanced lifestyle. In terms of nursing experience, nurse health coaches generally have many years of direct patient care in the hospital setting and have the desire to have a more immediate and positive health impact on their patient’s lives.
Many nurse health coaches are entrepreneurs who work in private practice, although some hospitals and doctor’s offices hire nurse health coaches as well. According to some surveys, nurse coaches can earn similar or even more income than they do working in hospitals.
Nurse health coaches help their patients by
working with them in the following ways:
- Understanding patient’s unique health care dynamics
- Assessing patients’ readiness for change
- Identifying client opportunities and issues for improved health
- Identifying and setting goals to achieve optimal health
- Encouraging and empowering patients to reach their goals
Perks to becoming a nurse health coach:
Nurse health coaches generally have more autonomy in this role than they do in other nursing careers. While nurse health coaches must work very hard to be successful, the career offers flexibility with setting one’s own schedule, work atmosphere, and patients.
2. Legal Nurse Consultant
A legal nurse consultant (LNC) is an RN expert for legal cases involving medical incidents and issues. LNCs are extremely valuable because they bring clinical expertise and medical experience to attorneys in the litigation process.
LNCs clinically analyze and evaluate facts and testimony related to the delivery of nursing and other health care services and outcomes. They also analyze and review the nature and cause of injuries in legal cases.
Legal nurse consultants’ responsibilities vary
depending on the employer and often include:
- Attending medical reviews by independent medical examiners
- Testifying in court as an expert witness
- Reviewing cases to identify strengths and weaknesses
- Preparing chronologies or timelines for medical records
- Working with lawyers to plan health care litigation
- Drafting legal documents in medical cases under the guidance of an attorney
- Educating attorneys and paralegals about health care issues
Perks to becoming a legal nurse consultant:
This option makes for a great nurse entrepreneurial business idea because LNCs have the ability to combine their clinical expertise and medical experience with the law. As business owners, LNCs can work as much or as little as they want and have complete control over what they accomplish. In addition, LNCs can often choose which clients they work with and types of cases they consult on.
3. Nurse Blogger/Freelance Writer
Nurse bloggers and freelance writers create and manage websites containing useful information for readers. They are generally developed based on the creator’s medical and/or personal niche.
A great benefit to becoming a nurse blogger/writer is that each post or article can be written from a completely different perspective. Nurses work in many different specialties with diverse patient populations. Therefore, each nurse has different skill sets and experiences within their career that they can draw unique information from. In other words, nurses can bring a lot of life experience into their writing.
There is a wide range of nurse bloggers on the
internet writing about: nurse mom lifestyle, nursing informatics, nurse
money topics, new graduate nursing, nurse humor, nursing apparel, nursing
specialties… and the list goes on and on.
As a nurse blogger or freelance writer, you can:
- Set your own work hours and schedule
- Have total creative control over your content and products
- Improve and continue to develop your writing skills each time you create a new piece
- Become a better thinker because the writing process forces you to pause and think deeper
- Develop strong opinions about nurse topics that matter
- Discover thoughts and ideas about the nursing profession that you didn’t even know you had
Perks to becoming a nurse blogger or freelance
Nurse bloggers and freelance writers are also entrepreneurs who manage their own businesses. Many often also have full-time positions and do their writing/website design in the evenings or weekends. There is no set schedule, therefore they can decide to work or not work whenever they want.
In 1944, Ingrid Bergman and Charles Boyer stared in the famous movie thriller “Gaslight.” If you like psychological drama, I encourage you to watch this film. If you want to learn what some bosses do to their employees, look up the verb “gaslight.” Just like in the film when Gregory (Boyer) purposefully manipulates information in such a way as to make his wife Paula (Bergman) question reality and her memory, a boss who gaslights you is manipulating and harassing you. If you have a boss who makes you doubt yourself and your reality, then you are the victim of bullying on a whole different level — gaslighting. The boss that uses this technique is fully aware that what they are doing is wrong.
Gaslighting is a subtle technique employed slowly and artfully. Your work life may have started out uneventful; with your boss complimenting you and your work. Your thought your opinion was valued and that you were appreciated. You felt respected.
Bosses who are bullies don’t want you to succeed because they will lose their power over you; they will do anything to impede your success, make you miserable, and block your momentum. But why does a boss gaslight? Because they want you to bend their will, to make you leahttp://minoritynurse.com/why-good-nurses-leave-the-profession/ve your job or to get you fired. If you challenge them, they will make the attacks worse. They employ their tactics to confuse and frustrate you. They want you to be discredited in the eyes of your fellow employees and supervisors. You are not “allowed” to have any ideas, thoughts, or actions different from theirs; your existence at your place of work is a problem for them.
A gaslighter will:
- Pretend not to see you, acknowledge your existence or your work but will then be overgenerous with compliments and concern.
- Change project guidelines, adding extra work and increasing the potential for failure.
- State you are too emotional, your needs don’t matter to the bigger organization, that you are making a “big deal” of things, tells you to move on and forget the issues that concern you — by doing this they are trivializing you and your place in the facility. They do this because they want you to feel that what you are feeling is not reality.
- Invade your privacy, listen in on your conversations, follow you, snoop within your office, monitor your location within the office, and watch who you speak to.
- Withhold important information so that you cannot complete your work.
- Share your private information with other employees.
- Tell you one thing and then later deny it was said.
- Allow work cliques to exist so that you are isolated.
- Publicly humiliate or ridicule you using snide remarks, racist comments, and off-color jokes.
- Not be fair in the treatment of all — different rules for different employees.
- Allow supervisors to mistreat and bully employees.
- Gossip and lie to others regarding your appearance, health, personal life – in order to damage your reputation. The goal of this behavior is to make others believe you deserve the unfair treatment you’re given.
- Attempt to give the appearance that they are listening to you when you speak, when in reality they do not care.
- Take credit for your idea, telling you they had to “fine-tune” your original idea making it, no longer yours. Either this or they take an idea of yours that they had originally openly criticized.
What can you do?
- Document! Trust your feelings that you are being harassed and abused and that you feel overwhelmed, depressed, and anxious. Documenting will be necessary should you choose to contact Human Resources.
- Always have another coworker present when you meet with a gaslighter. If you are alone with a gaslighter, send a follow-up email to any conversation. Copy all employees that should have access to the information.
- Limit your communication to emails and memos and make sure directives and instructions for projects are in writing and are clear and based on facts only.
- Surround yourself with work friends who will reaffirm your talents and skills, because you will begin to doubt your self-worth.
- Set boundaries that you will not let anyone cross, including your boss. If your react emotionally to them, they will merely point out that you are one with the emotional issues and that you are reacting inappropriately. They will make your emotional punishments worse than in the past.
- If you decide to contact Human Resources, be sure that you speak to a representative who you trust and bring your documentation. Be prepared to request a department transfer or search for a new job.
- Some employment specialists recommend that you confront the bully; however, the person who gaslights will not tolerate being confronted, in fact, the aggression will become worse.
It’s no secret that the nursing industry is
facing a serious staffing crisis. According to the American Association of
Colleges of Nursing (AACN), more than 1 million nurses will reach retirement age
within the next ten to fifteen years, and more than fifty-five percent of
registered nurses are reported to be age fifty or older. This crisis is
compounded by the fact that the graduation rate of new nurses is not keeping
pace with the additional 203,700 new RNs needed each year through 2026 to
replace retiring nurses.
The nursing shortage is also fueled by burnout. Between juggling difficult schedules and long shifts, nurses are frequently torn between their passion to care for patients and the rigorous demands of the profession. We may leave our physical work behind when we clock out, but the mental piece of it follows us home. For many of us, flexibility is a precious, practically unattainable commodity. We work our eight or twelve hour shifts when scheduled—no coming in late, leaving early, or switching shifts without jumping through hoops with management. When all these factors combine, it is easy to understand why nurses are burnt-out and leaving the profession in large numbers, either as a result of (early) retirement, career changes, or a shift to part-time to attain some semblance of work-life balance.
One thing I never imagined while earning my BSN was that being a military spouse would make it difficult to maintain my nursing career. After graduation, I found work immediately in Washington state, so I was surprised by my difficulty finding work in Rhode Island when we moved here a year later. While attending my first and only interview, I was told by the hiring manager, “We don’t like to hire military people” because it’s a given that we will move again. I had no idea that I would face this kind of bias when I became a nurse; I had heard about it from other spouses, but I didn’t believe it would actually happen to me, especially since I have a MS and I will begin my PhD at the University of Delaware School of Nursing this fall. After sending out thirty-five resumes with no luck, I considered applying for non-nursing jobs. Just when I was eyeing a cashier position at the local Home Depot, connectRN, a digital platform that gives nurses the opportunity to work per diem shifts when, where, and how often they want to work, contacted me through LinkedIn. Instead of being employed full-time by a single facility, per diem nurses are placed on temporary assignments and can choose where they want to work and the shifts that are most convenient for them. Per diem nurses also receive higher average hourly wages compared to salaried nurses. At a time in my life when I felt constricted in my career, per diem nursing offered a glimmer of hope to help me reclaim ownership of my career.
In 2018, I joined connectRN. Unlike
traditional staffing agencies, connectRN lets members view all available shifts
near them and request the shifts that make the most sense for their individual
schedules. Rather than being employed by a single facility and locked into the
schedule assigned to me, I now work on my own terms and only choose the shifts
that I want. I currently work three to four NOC shifts per week at an acute
care rehab facility less than five minutes from my home, and I couldn’t be
Per diem nursing gives me the opportunity to
work in a field I love, the flexibility that makes sense for my life, the
financial compensation I desire, and the sense of freedom a typical nursing
career lacks. As a per diem nurse, I have gained a sense of empowerment I was
missing earlier in my career. As caregivers, nurses often take care of
themselves last. Per diem nursing has restored my ability to make the best
decisions for me and my family and it has put me back in the driver’s seat of
my career. Best of all, connectRN knows my husband is in the military and
employed me anyway. In fact, I hope to continue working for connectRN whenever
my husband is reassigned to a new base.