Medical Malpractice is defined as the improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional. Let me help make this a little bit clearer for you and share a few interesting facts and figures about medical malpractice:
- The belief that malpractice suits are filed with the intention of making a lot of money is false. A study done between 51 New York hospitals showed that poor, Medicaid, or uninsured patients are significantly less likely to sue for malpractice.
- The ratio of the number of people that die due to preventable mistakes and the number of people who file a lawsuit is low. According to the Institute of Medicine, about 98,000 die each year due to preventable mistakes, and hundreds of thousands more are injured because of them. However, only one in eight people actually file a lawsuit.
- The states with the highest per capita malpractice payouts are New York, Pennsylvania, New Jersey, Massachusetts, and Connecticut. While the lowest states are North Dakota, Texas, Wisconsin, Mississippi, and Indiana.
- It seems like a no-brainer that medical malpractice is preventable, but it’s the third leading cause of death in America. According to the Journal of the American Medical Association, 80% of events in the healthcare system are the result of human error.
- Malpractice suits usually deal with serious injury, and most people don’t bother suing over small accidents that don’t leave any lasting harm. In 75 different countries, 90% of malpractice suits involved permanent injury or death.
- Although nurses are usually in charge of nursing homes patients, many states have adopted special procedures for nursing home issues that don’t fall under malpractice.
- While the number of doctors has increased, some doctors still feel they’re handling too many patients. According to the Maryland Practice Team, 40% of doctors feel their patient volume can lead to errors.
- America spends $2.2 trillion a year on healthcare, and only $7.1 billion on defending claims and compensating victims. While that seems like a lot, it only accounts for 0.3 percent of healthcare costs.
- There are two common reasons for a malpractice suit. For inpatient errors, 34% of malpractice suits were because of surgical errors. For outpatient errors, 46% of malpractice suits were the result of errors in diagnoses.
- Only 7.6 percent of doctors found guilty in two or more malpractice suits were punished, and only 13 percent of doctors who were guilty in five or more malpractice suits were punished.
Wow, so that was a lot right? Yes it was! These interesting facts and figures may have you wondering how can I avoid being apart of a medical malpractice suit where I am defending my actions as a clinician. Well I am glad you asked! I would like to share 5 tips to help you remain free and clear of being a defendant of a medical malpractice case:
- Document, Document, Document– As a legal nurse consultant, I can’t tell you how many nurse are not documenting properly. Remember the things we were all taught in nursing school ” if it was documented, it wasn’t done!! It is very hard to go before a court and say “Oh I did it, but I forgot to document it”. I can tell you this is a automatic strike against you. Also make sure your documentation is clear and concise. It should paint a very clear picture of exactly what happened while that patient was in your care and not leave anything to the imagination.
- Check Physician Orders a Minimum of 3 Times Before Carrying Them Out- Listen I know how it is to be on a floor with 6 patients, all of them needing IV pushes, 3 of them are on the call light, and the physician is giving you 10 orders; can you say frustrating!! But we have to slow down and verify physician orders and if they do not seem right, don’t be afraid to question the physician on the orders. I have witnessed countless medical malpractice cases where the nurse carried out incorrect orders or orders that should have made a light bulb go off in their head and say ” I don’t think this is right “, and they didn’t verify the order and carried it out which caused serious damages to the patient.
- Write Your Notes Legibly– For some of us we are not yet at a stage where we have the privilege to document on our patients in a computerized charting system through our respective employer. So we are still hand writing our documentation. The barrier with that is that notes can become extremely hard to read at times thus leaving a lot of room for questions should a patient that you ever took care of decides to file a medical malpractice suit. Now while you can definitely explain to a court what the notes says while in the middle of a medical malpractice litigation suit, why send yourself through that headache of having to do that when you can just write legibly.
- Communicate– Communication is key! We know this to be true in every area of our life and this is no different within the healthcare profession. To prevent from making any type of error on a patient that you are caring for, you must communicate with all parties involved in their care and that includes but is not limited to the physician, certified nursing assistant, charge nurse, radiology, social worker etc. Everyone has to be on the same page with what is going on with the patient and notify each other of any critical information that is going on with the patient. I have seen numerous cases where the clinican indicates ” Well I didn’t do xyz because no one communicated this information to me. NOPE, that is not going to fly!! We are licensed professionals that have taken an oath and we must act as so, so we must COMMUNICATE.
- Always be a Student– Like everything around us, healthcare is changing. Which means we must change with it, we must stay updated on the latest and greatest, on the practices that were once in practice that has now been eliminated, etc. Attend conferences, take that class you employer is offering, really pay attention in those continuing education courses. We are ultimately responsible as licensed clinical professionals to provide care that is current, up to date, and the standard for our profession.
Nicole Thomas, RN, MSN, CCM, LNC
The beginning of a new year is a common time to reflect on the previous year, and deciding what goals you would like to accomplish in the next 365 days. This is not a time to be shy about the things that you want in your life. Be bold, intentional, and brave when setting goals for yourself. The sky is not the limit; it is simply the view. Although we tend to start out highly motivated and dedicated to the goals that we have set, we have got be honest with ourselves and realize that often that ambition can fade, and nothing gets accomplished! I want to share with you five methods I utilize to keep myself grounded, motivated, and a realizer of my goals.
Find Yourself a GOAL MATE
What is a GOAL MATE? A goal mate is someone that you have a great connection with that supports, motivates, encourages, and enables you to manifest all of your wildest dreams. It does not matter how far-fetched they may seem, your GOAL MATE will not only hold you accountable but encourage you to jump in and get dirty neck first. Whether you succeed or fail at accomplishing a goal they are there to pick you up if you break your neck for real (just kidding), brush you off, and send you on your awesomely merry way to attempt your next goal. Keep in mind, that in order to be a good GOAL MATE, you need to reciprocate the same energy and tenacity that your partner(s) give to you. It’s important to keep each other focused, interested, and motivated.
Make Clear, Objective, and Achievable goals
Be clear and intentional about the goals you are setting. It is also important to be specific. Think about where you want to be with your finances, health, career, and love life. Self-love included. Be realistic with your timeline and remember that there are only 12 months in a year, but that is a valuable time that can be leveraged to generate a better you.
Make a Vision Board or Host a Vision Board Party
This is an annual tradition of mine. Each year I invite my GOAL MATES, friends, neighbors, co-workers over to craft vision boards. This is inexpensive and so much fun. All you need is magazines, scissors, glue, posters, your imaginations, and perhaps some wine!
Set Mall Quarterly Milestones
Hold yourself accountable. Think about where you want your progress to be after 3,6, and 9 months. I like to review my goals monthly. This keeps it relevant in my mind. You should review your goals quarterly at a minimum. Think about what is working for you, and what you can switch up.
Look at It
If you do not see your goals periodically, or place your vision board somewhere that you can see it every day. I have my goals on my vision board, iPhone, iPad, and posted in my locker at work. Don’t forget the plans you have made for yourself. Utilize these tools, go forth, and prosper!
Jazmin Nicole is a military officer, obstetrics nurse, advisory board member of Black Nurses Rock Inc., and the founder/CEO of Jazmin Nicole & Co.
For more posts/blogs like this follow me on twitter (@jazminweb), Instagram (@therealjazminnicole_, and Facebook (Jazmin Nicole and Co.)
No one can say nursing is a stagnant profession. Even freshly minted grads can feel they are scrambling to keep up with new procedures, technologies, treatments, and processes. If you’re a nurse, you might start to wonder what skills you will need to succeed and stay current in the coming years.
There are a few qualities shared by all successful nurses. Being an excellent multitasker, having empathy, and being nearly obsessed with details never failed a nurse. No matter what your specialty, your location, or your aspirations, experts agree that a few skills in your wheelhouse will not only advance your career, but also help you satisfy your goals of being the best nurse for your patients.
“The first thing you have to have if you want to be the best nurse possible is you have to really want to do it,” says Leigh Goldstein, assistant professor of clinical nursing at the University of Texas at Austin School of Nursing. “You really have to want to be a nurse and not just bring people pills and plump pillows. To get there, you have to put in the hours and put in the study. There’s that little thing in you that tells you, ‘This is it,’” says Goldstein. “It makes learning all the other skills easier.”
LaDonna Northington, DNP, RN, BC, professor of nursing and the director of the traditional nursing program at the University of Mississippi Medical Center, agrees that nurses need a passion for the job. “This is not for the faint of heart,” she says.
Looking ahead, here are some of the essential skills nurses will need to meet job demands at any career juncture.
Develop Critical Thinking/Critical Reasoning
The best nurse thinks outside the box. Adapting to changing situations, unique patient presentations, unusual medication combinations, and a rotating team takes awareness. Assessing and evaluating the whole picture by using the critical thinking developed in school and on the job is essential to success.
“Nursing is not like working in a bank,” says Goldstein. “It’s not 9 to 5. It’s always a unique set of circumstances. You have to tailor and adjust the care you deliver based on the picture the patient is giving you.”
According to Northington, nothing in nursing is static. Nurses can’t usually just treat one patient issue—they have to determine how the patient’s diagnosis or disease has affected them across the lifespan, she says. And nurses have to consider not just the best choice for the patient and the best option for the nurse right now, but they also have to consider those things in light of the city they are in, the timing, and the resources they have at hand or that are available to them.
Make Friends with Technology
Nursing moves fast, but technological advances are sometimes even faster. While new nurses might lack years of direct patient experience, they often have essential technological familiarity. “Most nurses are probably aware that the world of electronics has just taken over,” says Barbara Vaughn, RN, BSN, BS, CCM, chief nursing officer of Baylor Medical Center in Carrollton, Texas. “The more senior nurses who didn’t grow up in the technology world tend to struggle more than nurses who grew up with that.”
With apps that allow nurses to determine medication dosages and interactions and websites that allow patients access to electronic health records, technology is an integral part of modern nursing. “Technology is changing how we practice and will change how nurses function in the future,” says Vaughn.The benefits are incredible. Instead of having to make the time-consuming drive into the ER when needed for an emergency, a specialist might now be able to save precious minutes by first examining a patient remotely with the help of monitors and even robotic devices. Nurses will have to adapt to this new way of doing things.
Nurses have to practice with technology to gain a fluent understanding, says Vaughn. Vaughn, who is studying for her PhD, says she didn’t grow up with online training as the norm, so when her new classes required online work, she wasn’t prepared. Realizing this could be a hindrance, Vaughn asked newer nurses about how to do things, and she practiced navigating the system until she became better at it.
Whether you are accessing patient records, navigating online requirements for a class, or learning a new medication scanning program, technology will improve your work day and help you take better care of your patients. In the meantime, Vaughn just recommends playing around with the computer when faced with something new. In her own department, Vaughn recalls some nurses who were especially stressed out about learning the new electronic health records system. With training and practice, they excelled. “They were later identified as superusers for their unit,” says Vaughn with a laugh.
Adapt to the Broader Picture
With all these developments comes new and greater responsibility.
“As an inpatient nurse, you used to worry about the 4 to 6 days when the patient was under your care,” says Vaughn. “Now if you are in a hospital based setting, you are going to be more involved in patient population health.” That means an inpatient nurse not only has to get the whole story of what happened before the patient arrived at the hospital, but also think about working with the care team to give specific instructions for when patients get home that will be practical.
“The more specialized medicine gets, the more fragmented health care becomes,” says Northington. Technology and that broad view can help reign that all in—and nurses need to know how the puzzle pieces fit together and where and how patients are receiving care.
“More patients will be followed in nontraditional health care settings,” says Vaughn. “Our world and the world we know is going to change,” says Vaughn of the health care industry. With more patients being followed by health care centers in easily accessed sites like Walmart and Walgreens, telemedicine is going to become more important to understand and to navigate.
Practice Effective Communication
Thirty years ago, communication about patient care was effective, but certainly not at today’s level, says Northington. “We have to communicate,” she says. “You have to ask, ‘What do you know that I don’t know that can help this patient?’ or ‘Are these therapies contradictory?’ Nurses are in that integral place to facilitate that interprofessional education and communication.”
Good communication isn’t always easy. Beth Boynton, RN, MS, author of Successful Nurse Communication, says the most effective communication is based in speaking up and in listening.
Especially in fast-paced and dynamic health care settings, the underlying interpersonal relationships can have a huge impact on how colleagues communicate and relate to each other. Nurses need to not only recognize the dynamics at play, but also learn how to work within the environment.
“We all think this is easy,” says Boynton, “but we have to recognize this is harder than meets the eye. Be patient with the learning curve.” Nurses might be assertive about speaking up for their patients’ needs, but not for their own, explains Boynton. So, as nurses look to the future, they should be mindful of not only fine-tuning their ability to speak up, but also listening to both patients and colleagues in return without judgment so everyone can work towards the best possible outcome.
“The nurse of the future has to stay committed to learning,” says Northington. “Take what the research is saying and use the best practices. Ask the questions like, ‘Why are we doing it that way?’ and ‘What can I do differently that will produce a better outcome?’”
To be the best nurse, you must stay current in the newest developments. Take the time to learn new procedures, but also recognize where your skills need updating. For example, if you know you’ll need to deal with chest tubes, don’t just assume you’ll know what to do when the time comes. Make an active effort to gain current experience.
Develop Mentoring Relationships
Every nurse needs a mentor. It doesn’t matter what your role is, how many years of experience you have, or even how many months you have been practicing. If you want to advance and learn the intangible skills needed to excel in nursing, you need to actively cultivate a mentoring relationship. Nurse mentors are often found at work, through networks, or within professional organizations.
Refine Your Personal Compass
A little bit of a thick skin will do wonders for any career nurse. “You have to defend your patient from everyone and take care of them,” says Goldstein. That means when a physician makes a call you disagree with or you overhear an unfriendly comment, you need to speak up when it matters and let it roll when it doesn’t.
And some of the personal work nurses have to do isn’t easy, including reflecting on and adjusting for any personal feelings or prejudices they have about patients in an open and honest manner. “We need to be able to take care of people no matter what their circumstances or color or what they did to get here,” says Goldstein. “You can’t treat patients differently. You need to take care of them and not make a judgment.”
Prepare for the Unexpected
You never know what your day will bring, so lots of personal reflection, discussions with others in your profession, and cultivating skills can help you when you are faced with something you’ve never had to deal with before.
“I think whether you are starting out as a new nurse or you are a seasoned nurse, nursing care is constantly changing, and being fl exible to those changes is paramount,” says Princess Holt, BSN, RN, a nurse in the invasive cardiology department at Baylor Medical Center in Carrollton, Texas. It’s not easy, she says, to constantly adapt to new approaches and new practices, but nurses need to sharpen their focus. “When I get frustrated, I always go back to put myself in the mindset of my patient I am caring for or of my physician who is making this order or of the family I am taking care of to find new ways of looking at it. It grounds me and helps me understand.”
Developing all the coping skills to deal with job stress is a personal approach that nurses will cultivate as they go.
“New nurses don’t always take care of themselves and the emotional baggage you take with you,” says Goldstein. “You have to incorporate those experiences into a coping strategy that you have to develop on your own. Every nurse needs to fi gure out what they need to do to handle that.” And if you aren’t able to really learn how to cope, nurses must have the skills to either recognize that some kind of career shift is necessary (maybe even just moving from the ER to postpartum, suggests Goldstein) or to be open to hearing it when others recognize it.
Recognize Your Private Life Impacts Your Career
Nurses have to realize their career choice is 24/7. And while you have to balance your life and leave the hospital behind, you also have to somehow adapt to always being a nurse first. Family picnics can turn into a mini diagnosis session, neighbors might ask you to look at a child’s rash, and your private life can impact your job very directly in a way that won’t happen in other professions. “Nurses are held to a higher standard than the average citizen,” says Goldstein.
Learn Where to Learn
Yes, nurses in school learn the hands-on nursing skills like hand hygiene and infection control, says Goldstein, but, like any nursing skill, mastering them takes time.
Some hospitals have new nurse orientation programs that help new nurses acclimate to the setting, but if you don’t have that option, rely on your own observations, ask questions, and take classes to help get you up to speed. When you’re on the job, watch others to see how they incorporate things like patient safety into their routine interactions with patients. And Holt, who has worked in departments from ER to interventional radiology, says moving around builds skills. “I have seen it all,” she says, “and there is still more to see.”
Put It All Together
When nurses consider all the skills they need to succeed, some are easier to gain than others. “You need to understand what goes on behind all the mechanics,” says Northington. “It’s the knowledge behind the skills you need. They can teach nurses things. Nurses have the rest of their lives to learn things. We need nurses who know how to think, to problem solve, [and] who know when they are in over their heads to call for help. The most dangerous nurse is one who doesn’t ask a question.”
And nurses must keep moving forward and adapting even when the pace seems relentless. “We’ve come a long way,” says Northington. “And in 20 years, nursing won’t look like it looks now. Nursing is one of the best careers because it’s always evolving.”
Next month, the American Assembly for Men in Nursing holds its 40th annual conference to bring together men in the field, the only such conference for male nurses in the nation. From September 24 to 26, leaders in the field will gather in Minneapolis, Minnesota, to participate in workshops, discussions, and networking events for the men who make up nine percent of the nursing workforce.
The AAMN is a national organization with local chapters throughout the country. The AAMN’s aim is to encourage men to become nurses and to support the men who are working as nurses. Members work to keep issues about men’s health and issues relating to men in nursing in the forefront to help male nurses continue to excel in patient care.
This year’s conference theme focuses on interprofessional practice. Attendees will attend events that will address the role of interprofessional practice in everything from organizations to patient care and outcomes. The conference events will explore why and how inter professional practice benefits a team and patients and will also allow attendees to explore how to learn more about interprofessional practice through continuing education and in nursing education.
The weekend kicks off with a preconference event on reflective practice on September 23. The rest of the weekend brings a welcome reception on September 24 followed by days filled with exhibits, poster presentations, networking opportunities, and panels. Speakers will present on topics including Partnerships: Essential Foundation for Effective Practice; Team Strategies and Tools to Enhance Performance and Patient Safety (STEPPS); Recruiting and Retaining an Interprofessional Workforce for a Global Health Network; Shared Decisions are the Best Decisions: Nurses Leading Interprofessional Shared Governance; and Liberating Structures.
The educational and professional growth opportunities abound during this one-of-a-kind conference, but it’s the networking and camaraderie that bring participants back yearly. Being the minority gender in the nursing field brings up all kinds of issues for male nurses. This conference is the place where they can not only talk about things like discrimination or communication styles, but also learn from others’ experiences.
If you’re a male nurse, this is something worth looking into. If you can’t go, check into your local chapter of AAMN for some great resources and support.
Coping with the potential loss of one’s child is a devastating experience, and cultural influences may further hinder the opportunity for the integration of pediatric palliative care. A 2008 survey published in Pediatrics reported that over 40% of health care providers identified cultural differences as a frequently occurring barrier to adequate pediatric palliative care. Children with life-limiting illnesses deserve a cultural reassessment of how we care for them when the goal of care has changed from curative to palliative.
The concept of cultural competence and its necessity in the treatment of diverse patients
has come to the surface of the medical community within the last decade. Health care providers must demonstrate knowledge and respect of individual as well as group value systems to become effective in providing care to this population. In response to the United States becoming increasingly multicultural, the Institute of Medicine has published two reports that support the need for cross-cultural training: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare and The Future of Nursing: Leading Change, Advancing Health.
According to the American Academy of Pediatrics, the goals of pediatric palliative care are the same goals as adult palliative care, which includes providing support and care for pain, psychological and social stress, physical symptom management, and spirituality. However, the difference regarding pediatric palliative care is that the focus is specifically aimed at serving the needs of the child as well as the family. A challenge specific to pediatric palliative services is that end-of-life care for a child seems inherently unnatural in the mind of many parents and family members who often struggle to accept that nothing more can be done for a child.
The literature frequently references the underutilization of palliative care services among ethnic minorities, including African American, Latino, Native American, Russian, and Vietnamese cultures. The following attributes have been identified in the literature as a source of underutilization: a lack of the family’s familiarity with hospice and palliative care services; language barriers; religious differences; difficulties in accessing insurance; distrust of the health care services; and discomfort with introducing additional health care with professionals not of one’s ethnic or cultural background.
In 2002, the Initiative for Pediatric Palliative Care (IPPC) published recommendations for providing culturally sensitive end-of-life care that utilizes a framework that includes: improving pediatric palliative care by maximizing family involvement; understanding the influence of religion in pediatric palliative care; and understanding how culture influences lifestyle and shapes the universal experiences of illness, pain, and death across the cultural barriers. An appreciation for cultural norms and customs is critical if we are to be successful in supporting the child and the family in reducing suffering and providing comfort and support.
Cultural Influence in Decision Making
As a result of the IPPC recommendations, several organizations have created reference materials and guidelines for clinicians to use. For instance, the University Of California School Of Nursing published Culture and Clinical Care, which discusses culturally competent care across 35 cultural groups. The University of Washington Medical Center (UWMC) offers Culture Clues fact sheets of useful tips when communicating with Latino, Russian, and Vietnamese cultures (among others). The journal Palliative and Supportive Care published an article in 2013 comparing cultural and religious considerations in pediatric palliative care. These resources cited the following cultural differences in end-of-life decision making:
• Many aspects of African American culture today reflect the culture of the general U.S. population.
• The structure in African American families is often nuclear and extended with nonrelated “family” members.
• The family may be matriarchal, although father or mother may take on the decision-making role.
• Family involvement is very important in the Latino culture.
• The family-centered model of decision making is highly valued and may be more important than patient autonomy.
• The mother is typically regarded as the primary caregiver and often will make the decisions regarding care; however, when possible, Latino women will seek permission of the child’s father before a decision is made regarding continuing or discontinuing treatment.
• Often, when language becomes a barrier, the normative hierarchical family structure is waived and deferred to the family spokesperson who speaks the best English.
• Given the importance of family in the Native American culture, the entire family may be included when making decisions and signing documents.
• Native Americans may also desire that information is shared with community leaders so that they can assist in the decision-making process for the child.
• Health care information is shared with family members.
• The entire family makes decisions along with the patient, and the person closest to the patient often has the most influence.
• The doctor—not the nurse—is expected to share the patient’s prognosis with the patient and family, as he or she is typically regarded as the ultimate authority in all medical matters.
• Family has a central role.
• Decisions are often the responsibility of the eldest male, yet older women may also have significant influence.
• Traditionally, the eldest male is the family spokesman; however, the person with the best English often assumes this role.
• Removal of life support may require extensive family discussion, which places the responsibility for the decision on the entire family instead of one individual.
Importance of Faith and Religious Traditions
Faith and religious traditions are held of great importance in the majority of cultures; however, it is important to note that cultural traditions are dynamic and cannot be generalized to all families. While guidelines may offer an approach to religious considerations pertaining to end-of-life care, the provider must perform an individual assessment of the family as to their beliefs and practices. The UWMC’s tip sheets and the 2013 study in Palliative and Supportive Care offer a glimpse of the cultural differences in religious traditions during end-of-life care:
• Death rituals for African Americans vary widely, related to the diversity in religious affiliations, geographic region, education, and economics.
• Emotional expression varies; you are likely to see a mix ranging from public displays of crying and wailing to silent and stoic behavior.
• Death is not viewed as a formal break with life, given the belief that the spirit/soul continues and may be able to interact from the next plane of existence.
• Bereaved African Americans are more likely to seek help from clergy than from health care professionals.
• Depending on their specific cultural beliefs, African Americans might involve a healer or “root worker” whose role is important in orchestrating the natural, spiritual, and relational aspects of life.
• African Americans often rely on the health care team for help with cleaning and preparation of the body.
• African Americans may refuse to stop life-prolonging treatments because of belief in divine rescue.
• Prayer and ritual may be a part of the end-of-life process for the patient and family members.
• Latino families may request that they keep candles burning 24 hours a day as a way of sustaining worship. Since candles are not permissible in hospital settings, the suggestion of using electric candles is often viewed as an appreciated gesture of respecting one’s beliefs.
• The patient and the family may wish to display pictures of saints, as saints have specialized as well as general meanings for Catholics.
• Some Latino families may want to honor their deceased relative by cleansing the body.
• The last rites are often important for Latinos who are Catholic when a person is close to death. If your patient is Catholic, ask about their preference and plans for this ritual.
• Latinos often demonstrate wailing and strong emotions at the time of death, which may be considered a sign of respect.
• Death rituals among the Native American tribes vary widely because they all have different religious and spiritual beliefs. It is important to assess the religious practice of the individual and follow accordingly.
• Native Americans may wish to seek traditional healers for help in restoring harmony of life.
• Herbal remedies may be used in healing ceremonies.
• The medicine man or spiritual leader leads the ritual.
• The circle is symbolic in the ritual, as in the circle of life; therefore, the family and relatives may form a circle around the patient’s bed.
• Native Americans follow the belief that the spirit of the person never dies.
• Silence is highly valued.
• Native Americans may be hesitant to sign advanced directives or other end-of-life documents because of general mistrust related to past misuse of written treaties and documents with the U.S. government.
• Russians may practice different denominations. Depending on the denomination, the family may desire to have a pastor, priest, or rabbi present at the moment of death.
• The family plays a major role in supporting the sick. Usually, there is a family member present at the bedside to attend to the patient at all times.
• Russians who practice their religion may consider prayer an important and powerful healing tool.
• In the Russian culture, relatives and friends are all expected to visit the patient. They frequently bring food and may include gifts for the clinicians as a sign of respect and thanks.
• Wailing and other displays of grief may not be demonstrated as they may be reserved primarily for expression in the home (as opposed to public display).
• Often, the family may have some specific practices for washing the body after the death. It is important to ask about preferences and try to accommodate.
• It is important to note that there are a variety of Vietnamese cultures and religious practices. Most Vietnamese are Buddhist; however, other religious preferences include Catholic, Evangelical Protestant, and Chinese Confucianism.
• Vietnamese who practice the Buddhist faith may call a monk to give blessings. Buddhist patients and family may chant and create an altar for prayer. Vietnamese who are Catholic may ask for a priest for last rites.
• In the Vietnamese culture, white is considered the color for mourning.
• The expression of grief varies in the Vietnamese culture. Families may express grief with either a stoic response or with crying and weeping.
• Upon death, organ transplant and/or autopsies may be accepted by the Vietnamese family with very careful explanation.
• The bereavement process of the Vietnamese culture has an extremely positive impact on family health. There is intensive and extensive community involvement with frequent visits from family and friends when death first occurs and then visits are slowly weaned off over a 2- to 3-year period.
Today’s multicultural society presents health care providers with unique challenges for providing cultural care and competence to the pediatric palliative care population. This article attempts to provide insight to but a few of the cultures that we may come across in our practice. Every person is unique, and clinicians who understand their patients’ cultural values, beliefs, and practices are more likely to have positive interactions with their patients and provide culturally acceptable care.
In nursing school, we were often told by our instructors to “treat the patient as you would want to be treated.” When it comes to treating patients with a different cultural background, this mantra should translate to “treat your patients as they want to be treated instead of how you would want to be treated.”
Karen J. Smith, MSN, CRNP, NP-C, is a doctoral nursing student at Wilkes University in Wilkes-Barre, Pennsylvania. Her background includes hospice and palliative care, and she has written health-related articles for West End Happenings.
At Charles R. Drew University of Medicine and Science, the number of male nursing students seeking a master’s degree is reason to celebrate.
“At the beginning of this semester, a faculty member said, ‘I just did an assessment of our new cohort and 15% of the incoming class are men, and it’s the most we’ve had in a cohort,’” says Sheldon D. Fields, PhD, RN, FNP-BC, AACRN, FNAP, FAANP, dean of the Mervyn M. Dymally School of Nursing.
But gender diversity is just part of the story at the historically black and Hispanic graduate institution based in South Central Los Angeles. “Not only is our male student population up, I also only have minority male students in my program,” says Fields, who previously served as an assistant dean and codirector of the Doctor of Nursing Practice Program in the Nicole Wertheim College of Nursing and Health Sciences at Florida International University. At that Miami school—a historically Hispanic institution—the male nursing enrollment is much higher at 30%.
Such historically diverse schools of nursing are key to getting more men of color into the nursing pipeline, says Fields. “Minority-serving institutions, I think, stand a better chance of attracting men because we are more flexible and we don’t have those historically traditional ways of looking at who should and who could be a nurse.”
Increasing Gender Diversity
Today, one out of 10 nurses is a male. And while more men are resisting stereotypes and increasingly pursuing a career in the most trusted health profession, many more are needed not only to achieve gender parity, but also to reflect the nation’s demographics, says William T. Lecher, RN, DNP, MBA, NE-BC, immediate past president of the American Assembly for Men in Nursing (AAMN).
AAMN has aligned its goals to improve gender diversity with the recommendations of the Institute of Medicine nursing report, which stated that to improve the quality of patient care, more efforts are needed to increase the diversity of the nursing workforce, especially in the areas of gender, race, and ethnicity.
“Our patients and families know the important role men in nursing play in meeting their nursing and health care needs. For example, The DAISY Award is provided by almost 2,000 health care facilities and celebrates and honors the extraordinary compassion and direct care nurses provide to patients and families every day,” says Lecher, senior clinical director at Cincinnati Children’s Hospital Medical Center.
“The DAISY Foundation has found that men are recognized by patients, families, and health team members two to three times the rate they are employed. Or, in other words, the patient and family experience benefits by having men in the nursing workforce. As such, our patients, families, and health care administrators should demand our nursing schools do a better job recruiting and retaining more men in nursing school. It is hard to believe that, in this day and age, men in nursing school only account for 12% of students [as of 2012] and their attrition continues about twice the rate of women in nursing programs,” says Lecher.
According to a report by the American Association of Colleges of Nursing, 2014-2015 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, men comprised 11.7% of students in baccalaureate programs, 10.8% of master’s students, 9.6% of research-focused doctoral students, and 11.7% of practice-focused doctoral students. One of AAMN’s goals is to have men make up 20% of nursing student enrollment by 2020.
To encourage schools of nursing to support its male students, AAMN has created the Excellence in Nursing Education Environments Supportive of Men program, a recognition designed to provide evidence to stakeholders that a specific program is gender-inclusive. Recognition symbolizes excellence in providing male students a positive and equitable educational environment as determined by AAMN.
The program’s goals include increasing awareness of issues that may challenge the success of male student nurses, fostering the recruitment and retention of men as nursing students, and recognizing nursing education programs that have achieved excellence in supporting male students. Recognition is valid for eight years. Schools interested in applying can do so at AAMN.org.
Increasing the gender diversity of students to create a workforce prepared to meet the demands of diverse populations requires schools of nursing to do a better job of recruiting and retaining male students, says Marianne Baernholdt, PhD, MPH, RN, FAAN, professor and director of the Langston Center for Quality, Safety, and Innovation at Virginia Commonwealth University (VCU).
“You won’t find a school of nursing today… that wouldn’t say we do everything we can to increase minorities in nursing and that includes men. If you are not going to put money or specific actions behind [these goals] well, you will just keep doing what you are doing,” Baernholdt says. At VCU, men are 12.5% of the undergraduate nursing school enrollment, she adds.
VCU offers several entryways into nursing, including the RN-to-BSN program, and an accelerated bachelor’s degree program. “Because we have that mix, I think we have a higher proportion of male students. But VCU is known for its diversity, so that’s another reason we also have as many African Americans as we have males. Does that mean we could do better? Of course, we need to do even better,” says Baernholdt.
From 2010 to 2013, the number of male RNs increased from 8% to 10.7%. During that three-year period, an additional 70,000 male nurses entered the workforce, increasing their number to over 300,000. Since the 1970s, the percentage of male nurses has more than tripled.
The profession’s low unemployment, a desire to make a difference, and a shift in how male nurses are viewed are among the reasons men are entering nursing, experts say.
“The increased visibility of AAMN and men in other nursing organizations make it easier for men to see themselves as nurses,” says Lecher. “Furthermore, the recent recession has helped men choose nursing as a way to help others, have purpose and meaning in their work, and earn good income for their families.”
Alexandra Robbins, author of The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital, agrees. “I think they are increasingly drawn to the profession as the stigma and stereotypes wane and as more men realize just how hands-on a nursing career can be,” she says.
Fueling the growth of male nurses are innovative initiatives, including programs that train foreign-educated physicians—who cannot practice in this country—to become nurses, says Fields. The number of returning military veterans is another factor. “There are several medic-to-RN programs around the country, and the VA has put money into continuing education for vets, and a large number of them are coming into nursing,” says Fields, noting that the military is disproportionately higher in men.
While male nurses are the minority, they still earn more money than women in the same role.
A report published earlier this year in JAMA: The Journal of the American Medical Association, found that the average female nurse earns about $5,100 less than her male counterpart—even when researchers controlled for factors such as race, age, marital status, and specialty. The uneven wages also varied significantly by specialty. The highest salary gap was for nurse anesthetists, a role held by many men.
“I don’t think what we’re seeing should surprise anybody because we live in a country that has a pay disparity between men and women, with men making more money,” says Fields. “In nursing, there is a slightly larger number of men who pursue an administrative role, and they tend to work in critical care roles, which requires more credentials and pay more money,” he adds. Men seemed to be promoted quicker, too.
The bottom line? “In America, we have a patriarchal society that says men are worth more,’’ says Fields.
The salary gaps are dismaying but may not be as widespread as the study suggests, says Peter McMenamin, PhD, senior policy fellow and health economist at the American Nurses Association.
The challenge is in the data, which included information that stretched back more than 10 years, when there were fewer male nurses. Also, the wage differences are not explained but may include women who took time off to have children and, so, lost their place in the labor force and never caught up. Or, the data could include male nurses who worked two or more jobs, which meant their total compensation increased, explains McMenamin.
“So there are all these little things that suggest it’s not as simple as taking the average wage for men and women in the same category” because of other issues, including training and experience, says McMenamin. Still, he is dismayed that the differentials exist. “We’d like to live in a world where experience and education were the primary determinant of compensation…but gender alone should not.”
Gender diversity may help to resolve the uneven wages, says Lecher. “Gender occupational segregation does not promote wage advancement in nursing or any other occupation. A more gender-diverse workforce will benefit the wage potential for all nurses.”
While that remains to be seen, gender diversity improves culture competence and outcome for patients, says Elliot Brooks, senior vice president of human resources at MJHS, one of the largest health systems in the greater New York area.
“New York is one of the most diverse cities in the world. At MJHS, we believe that our employee population should reflect, understand, and respect the diversity of this great city. That doesn’t just extend to gender; it also means culture, faith, tradition, ethnicity, sexual orientation, et cetera. Our anecdotal qualitative research shows that our patients, of any background, appreciate receiving care from nurses who are culturally sensitive. This enhances care management, goal setting, and having difficult conversations. But, the benefits go beyond those important things,” Brooks says.
Patients are more likely to open up “about their personal lives, dreams, hopes, and challenges,” Brooks continues. “By extending compassion, dignity, and respect to our patients, we are able to help provide care to the whole person—physically, socially, emotionally, psychologically, and, of course, culturally.”
The nursing community, health care stakeholders, and the public must work together to improve gender opportunity in nursing. “There’s been a huge cultural expectation and assumption shift in the past 40 to 50 years,” says Brooks. “It used to be that most people assumed all nurses were women. Today, fewer people make that assumption. I think the Millennials and future generations will help continue to push for greater gender opportunity in all professions, not just nursing.”
Lecher agrees that more vocal support is needed, particularly from fellow nurses. More men and women nurses need to demand that the profession become more gender diverse and inclusive, he says. “It would be a mistake to think that men can solve gender recruitment and retention by themselves when women dominate the profession,” he adds.
“We have many women in nursing advocates for gender diversity. There are presently five women serving in the role of AAMN chapter presidents. A lot of nurses believe our membership is limited to men, but that is not the case,” says Lecher. “The truth is our women in nursing colleagues need to take a leadership role for such change, or our progress will continue to be glacial.”
Robin Farmer covers health, business, and education as a freelance journalist. Based in Virginia, she contributes frequently to Minority Nurse magazine and website. Visit her at www.RobinFarmerWrites.com.