The role of the health care professional has seen its fair share of evolution throughout history. Shamans and healers in ancient societies paved the way for modern medical professionals, who have a duty to society as a whole that spans well beyond diagnosis and healing. Medical doctors today are expected to exhibit professionalism as well as effectively communicate with patients and colleagues, and conduct plenty of research.
And for optimal patient care, that research isn’t confined to information directly related to the health care industry. Health care professionals must also remain on top of current events, and be aware of the various societal issues that can shape both medicine and public policy, such as immigration. In this regard, health care workers often double as agents of societal change.
As the Hippocratic oath remains a crucial part of modern medicine, ethical considerations are of paramount importance in the health care arena. Whether you’re a primary care provider, registered nurse, anesthesiologist, or another type of health care worker, you’re in a prime position to advocate for immigrant families. You may be unequipped to help immigrant families in a legal or political capacity, but your direct health care efforts may ultimately catalyze societal change.
Medical Care for Immigrant Families
It’s important to note that the needs of immigrant families may differ drastically based on the citizenship status of family members. And the terminology itself doesn’t necessarily tell the entire story: Children who were born in the U.S. but have at least one foreign-born parent are typically identified as children in immigrant families (CIF). As of 2019, an estimated 1 in 4 children in the U.S. can thus be considered CIF, but their social determinants can vary considerably.
For instance, immigrant family members who are legal U.S. citizens can access the same health care benefits afforded to all Americans, including Medicaid and Medicare. Undocumented immigrants, however, are much less likely to have any type of health coverage. These individuals are subsequently more vulnerable to chronic health issues and contagious viruses including COVID-19.
According to the American Medical Association (AMA), approximately 11 million undocumented immigrants are living in the United States. What’s more, “physicians and other health professionals should be aware of how to advocate for these patients, including through self-education, education of trainees, in the exam room, and on Capitol Hill.” A large number of undocumented immigrants tend to avoid seeking medical care, even if it’s urgent, due to fear of deportation or the intervention of government agencies.
Politically speaking, the subject of illegal immigration is a contentious one. Yet it’s crucial to remember that, for many families and individuals, immigrating isn’t exactly a choice. Many immigrants to the U.S. are refugees seeking asylum, or humanitarian protection, from persecution or war in their home countries. Asylum seekers are subject to a lengthy immigration process, and there is a governmental cap on the number of refugees admitted on an annual basis.
The Importance of Immigrant Health Care Workers
As a health care worker, it may behoove you to learn a little bit about the immigrant families that you serve to better address their needs. But you should also look to your colleagues for guidance and inspiration: Plenty of immigrants are gainfully employed in the health care industry. According to the Migration Policy Institute (MPI), about 2.6 million immigrants are employed in various health care fields, including approximately 1.5 million doctors, registered nurses, and pharmacists.
Unfortunately, immigrant health care workers tend to be underappreciated, yet this segment of the workforce is invaluable in the realm of disaster response. In 2021, disaster response is heavily focused on curbing the spread of COVID-19, but the discipline encompasses much more, notably natural disasters like earthquakes, hurricanes, and wildfires. Within disaster response, the humanitarian side of health care is heavily emphasized, as disaster survivors often require social services — to access food and emergency housing, for example — in addition to medical care.
Similarly, immigrant families may have similar psychological and humanitarian needs, even far removed from disaster response scenarios. Health care professionals from immigrant families are well-equipped to address these sorts of needs among their patients, especially if they have personal experience in seeking legal asylum, or securing stable housing and job opportunities.
Looking to the Future: From Telemedicine to Health Care for All
No matter your background, as a health care professional, you’re likely well-versed in the various social determinants that can influence one’s health and well-being. The conditions and places that one is born and raised in, widely known as social determinants of health, overwhelmingly correlate to individual health, as well as that of entire communities.
Even those social determinants that are directly related to economics and education can have a significant impact on individual health, and the COVID-19 pandemic has only exacerbated the situation. In regards to social determinants, the Centers for Disease Control and Prevention (CDC) reports that “for many people in racial and ethnic minority groups, living conditions may contribute to underlying health conditions and make it difficult to follow steps to prevent getting sick with COVID-19 or to seek treatment if they do get sick.”
The good news is that, as a health care provider, you can help bridge the gaps among your minority and immigrant patients, and telemedicine is an ideal starting point. In a world under the threat of a deadly pandemic, telemedicine has become a crucial component of health care. While you can’t treat serious conditions solely via telehealth, the platform is extremely versatile. Telemedicine can streamline patient monitoring as well as the appointment setting process, reducing the need for multiple visits or a lengthy commute to a hospital or clinic. Further, simple tests such as vision exams can be conducted safely and easily using telehealth.
And signs indicate that telemedicine is likely here to stay, post-pandemic, as it can help generate revenue in health care facilities ranging from major research hospitals to local clinics and private practices.
Although revenue is certainly relevant in every corner of the health care industry, caring for patients is still the ultimate goal. As a health care professional, you may find that advocating for your patients is just as important as administering quality health care. Determining the individual needs of your patients, whether immigrants or natural-born citizens, can ultimately serve to improve public health overall, and give you greater satisfaction that you’re truly making a difference in the world.
At its core, nursing is an inherently humanitarian career path: The job can’t be done without compassion and a willingness to advocate for patients, by any means necessary. As a nursing professional, you’re also likely to be unwittingly thrust into the political arena, treating both injured protesters and law enforcement officials following a violent clash.
Nursing Professionals on the Front Lines of Social Justice
As such, for modern nursing professionals, the lines between individual health care and politics often collide. Along with treating injured protestors at medical facilities and hospitals, many nursing professionals are volunteering their time on the front lines. In many cases, nurses at protests simply show their support to the cause.
But, if a nonviolent protest escalates into a dangerous situation, having a nursing professional on the scene is vital. You may be able to provide emergency care, of course, but even more importantly, nurses on the front lines of protests have a unique insight into police brutality. This sort of information is an invaluable tool for fueling the conversation about systemic racism in the health care industry as well as everyday life.
So, once you’re aware of the current landscape of protests and the tactics used by police, however, what will your next steps be? There are various ways that you can get involved and take a stand against police violence, on both a professional and social level. Here’s what you need to know about the consequences of police violence and how you can help protesters, no matter if you’re on the front lines or working in the ER.
Racism, Police Brutality, and Public Health
The COVID-19 pandemic had already altered daily life around the world long before May 25, 2020. That night, George Floyd lost his life in the hands of law enforcement officials, and U.S. citizens flooded city streets in response. These widespread protests didn’t dissipate overnight — in fact, they only grew larger, and the violence that escalated in several cities left health care workers in a dire situation.
Already under the threat of the pandemic, nurses from all walks of life suddenly found themselves working to balance public health considerations with the reality of police violence. As a patient advocate in these politically charged times, you should thus be aware of the unique needs of your patients. Victims of police violence and brutality, for example, may fear for their safety.
Discretion is a key factor in situations involving institutional racism and police brutality. Further, the provider-patient confidentiality agreement is especially vital if a protestor in your care wishes to pursue legal action against a law enforcement official or organization.
Patient Privacy in the Modern Health Care Landscape
Privacy is an important consideration in 2021, as so much of our everyday lives can be easily found on the internet. Protesters further put themselves on display, and the plethora of camera phones, as well as professional cameras wielded by the media, make anonymity nearly impossible. If you participate in a protest, whether as a curious observer, an active participant, or in a care-related capacity, it should be expected that your image will be captured on camera.
For example, even masks and costumes couldn’t hide the identities of countless right-wing protestors who stormed the U.S. Capitol on January 6. Thanks to the internet and social media, identifying the Capitol rioters was a simple endeavor. While this sort of facial recognition may represent a slippery slope scenario, at least where personal privacy is concerned, the tech proved crucial to holding the rioters responsible.
In the age of telehealth, patients should be afforded more privacy considerations than the protesters, yet various challenges exist when it comes to protecting patient information. To ensure that you’re properly adhering to patient privacy laws, as well as protecting vulnerable patients such as victims of police violence, you must take every possible precaution when collecting, accessing, and storing patient data. You may also want to stay up-to-date on relevant laws and HIPAA regulations, which can change without warning.
There’s No Place for Violence in a Caring Society
As long as police violence remains prevalent, the minority nurses of the future are likely to face unprecedented challenges while on the job. Whether you find yourself in a position of mentor or you’re working directly with patients injured during a protest, your voice is powerful. In the wake of a global pandemic and continued racial disparity, nurses may be inspired to stand up for their patients and actively address police violence, for the sake of both public health and social justice.
There’s no questioning the difficulty of a career as a nurse. You may have to work long hours, deal with a variety of patients each day, and spend most of the time on your feet. You also have to deal with the risk of things like patient violence or the general sadness that comes from losing a patient you’ve been working with. But, nursing can be an incredibly rewarding career when you’re in the right work environment. A toxic work environment, however, is a different story. It can make getting your job done feel nearly impossible. If you come home each day feeling absolutely drained, and perhaps even frustrated or helpless, you might be dealing with a harmful environment at work.
So, how can you know what a toxic work environment looks like? What are your rights, as a nurse, to a healthy environment, and what can you do to make sure those rights are upheld?
What Does a Toxic Work Environment Look Like?
As a nurse, you probably already understand the importance of being able to adapt to different work cultures. If you’re not sure how to learn more about a specific culture or atmosphere within a workplace, there are a few things you can do to get a feel for it quickly, including:
Watching and learning from others
The more you observe and the more questions you ask, the easier it can become to see if you’re dealing with an unhealthy work environment. Bear in mind that if you don’t like your job or you’re not satisfied with your work, that doesn’t automatically mean you’re in a toxic environment. You may need to try a different career path. But, toxicity in the workplace is very different. You can recognize it through some of the following signs:
There is an overall lack of communication
There are cliques, exclusions, or groups
The workers aren’t motivated to do their jobs
Growth is discouraged
Everyone is burnt out
Finally, there’s nothing wrong with going with your gut. If you get a “bad” feeling about your workplace, even if you can’t quite put your finger on it, don’t ignore those feelings.
How Can It Affect You?
A toxic work environment is more than just an inconvenience. It’s more than just something to “trudge through”. In fact, an unhealthy work environment can contribute to a variety of physical and mental health issues. Some of the most common problems include:
High blood pressure
The toll on your mental health is nothing to take lightly, either. You might find yourself constantly feeling stressed and overwhelmed at work. It doesn’t take much for that to carry into your home life if you can’t let the feelings of the day go when you walk in the door. That constant feeling of stress can lead to mental health conditions like anxiety, or even depression. As that continues, you may end up needing to get extra help just to deal with those conditions.
Working every day in a toxic environment can wear you down. So much so, that it can even weaken your immune system, making it easier to get sick. As a nurse, you know the importance of taking care of your mind and body. If you don’t make self-care a priority, it could impact your personal life in a negative way. Your work environment shouldn’t be the thing that compromises your health.
How to Find a Healthier Environment in Your Field
If you find yourself in a toxic work environment, the best thing you can do is leave. An environment that large isn’t likely to change, even if you address the issues. You need to prioritize your needs when it comes to your career and your overall well-being. But, leaving a job isn’t always easy if you need the income.
Waiting to leave until you have another job lined up is always a safer option. Or, you might consider going a more nontraditional route with a remote job. Remote jobs allow you to work from home (or anywhere!), eliminating everything from toxic employees to negative patient interactions. Working remotely can help to reduce your stress levels and offer more flexibility.
Obviously, not all nursing jobs are able to be done remotely, but there are some that will allow you to work from home while still caring for others, including:
Clinical appeals nurse
Telephone triage nurse
Some larger hospitals and even national health care groups are always looking for nurses who can work remotely and fulfill these needs. These particular jobs might be different from what you’re used to, but that could be exactly what you need to break free from a toxic environment. In doing so, you can learn to enjoy your work again, and find fulfillment in helping patients while taking care of yourself, too.
When you decided to become a nurse, you knew it wouldn’t always be easy. You expected the long nights, the grueling shifts, the heartbreak of losing a patient. But something you probably didn’t think much about the possibility of not getting along with your patients. After all, you entered this profession because you wanted to care for your patients, not clash with them.
The fact is, though, that nursing means caring even when it’s hard. It means loving your patients even when you don’t like them. And that’s perhaps the most difficult and most important lesson that nursing school can never teach, the lesson that only your most challenging patients can teach. This article provides tangible strategies for new nurses dealing with difficult patients, without losing your sanity, your health, or your professional passion.
Seeing Through Your Patients’ Eyes
The first step to dealing with a difficult patient is to try to understand what’s causing their behavior. It’s highly unlikely that a patient is going to be difficult just for the fun of it. Chances are far greater that something has gone wrong and that’s fueling the problem.
Many patients’ behavior, for example, may be explained by their particular medical condition. Those with dementia, Alzheimer’s, end-stage renal disease (ESRD), or certain mental health disorders, may react aggressively, irrationally, or non-compliantly simply because their illnesses have impaired their ability to understand their circumstances or respond appropriately.
In addition to physical and mental health challenges, environmental and situational factors may also be driving your patients’ contrarian behaviors. Patients who have been recently diagnosed with a catastrophic or terminal illness may be grieving the loss of their health and function.
Or they may have experienced the loss of a loved one, the loss of a job, a divorce, or some other significant trauma that is causing them to be hyperreactive. Likewise, cultural and language differences may be limiting the patients’ ability to understand, ask questions, or express themselves effectively, and a frustrated patient is far more likely to act out in negative ways.
An important strategy for understanding your patients’ perspective is to practice active and empathetic listening. Ask questions and reflect your patients’ views back to them accurately and without judgment. This will not only ensure your own understanding, but will also reassure your patients that they’re being accepted, heard, and understood.
How to Respond
Once you have a better understanding of your patients’ perspective, you can then begin to formulate a response that is productive and beneficial to the patient and your relationship with them. But that’s going to require you to be self-reflective as well.
After all, nurses are only human, and there’s no such thing as complete, unimpeachable objectivity. Just as with your patients, your own responses may be influenced by factors that you’re not even aware of. We all have our own internal biases, not to mention the ordinary stressors of daily life, that may make us respond in inappropriate or ineffective ways to some patients.
Your patient, for example, might remind you of a contentious relationship in your own life, and you may project negative emotions regarding that person onto your patient. At the same time, if you are feeling overwhelmed by a particularly stressful day, you might find yourself feeling short-tempered, unsympathetic, and ready to lash out at any patient who adds yet more problems to your day. So, when you’re figuring out how to respond to a challenging patient, you have to determine, first, whether it’s the patient or whether it’s you and, above all, try not to take it personally.
Another key to managing difficult patients is to focus on de-escalation. That means focusing on remaining calm and non-defensive and, ideally, on allowing your patient to express themselves freely. This includes giving your patients a safe place to vent when needed.
De-escalation strategies can also be employed at the organizational level. For example, in the wake of the COVID-19 pandemic, health systems nationwide are facing significant reductions in revenues and staffing. That’s leading to a surge in patient wait times and perhaps unprecedented levels of stress on health care providers. Using hospital resource management strategies (HRM) can help your organization run more efficiently in the face of the current crisis and beyond. And that’s going to improve your patients’ experience and decrease your workplace stress.
Another important tool for dealing with tough patients is to help them become more educated about their condition and to feel more empowered to take charge of their health. One of the most significant stressors associated with a difficult diagnosis is the patients’ sense of lost autonomy.
Equipping patients with the resources they need to make informed decisions about their own lives, and their own care, can be a tremendous benefit in reducing negative behaviors. Mobile apps, for instance, can be used to help patients with their meal planning, lifestyle choices, and treatment plans. Connected patients can even access online communities reserved for other patients, their families, and health care providers.
Nursing can be more rewarding than you ever dreamed. But it can also be more challenging than you ever imagined. The key to dealing with difficult patients, though, is to not take it personally, to focus on understanding the roots of their behavior and figuring out a response that is productive for and protective of you both.
There are currently nearly 4 million nurses working within the health care industry of the United States. It is the largest health care profession in the country, and for good reason. Nurses make a difference. They are often the first point of contact for anyone seeking medical attention, and they tend to go above and beyond what is typically asked or required of them.
Even though it is the top health care profession, there is always a growing need for nurses. Thankfully, it’s one of the easiest careers to pursue. Nursing courses are offered almost everywhere, including online, and once you’ve completed your coursework you can enter the workforce quickly. Plus, you can choose your own specialty, depending on your interests or passion.
Nurses also have the opportunity to work almost anywhere in the world, and job security will always be there. But, if you’re already interested in pursuing a career in nursing, you likely already have your own reasons to make it your life’s work.
The better question is, how should you get started? What should you expect as you go through your undergraduate studies, and which career path should you take when it’s time to make that choice?
Getting the Education You Need
The amount of education and training you’ll need to become a nurse depends on what type of nurse you’d like to be. For example, to become a Registered Nurse (RN), you’ll need a minimum of an Associate’s Degree.
If you’re already an RN or if you want to pursue something higher, consider getting your BSN (Bachelor of Science in Nursing) at a four-year university or institution. No matter what degree completion you go through, everyone entering the nursing field needs to complete the NCLEX. This is an exam that is required by the National Council of State Boards of Nursing. You’ll need to apply to take the exam through the state in which you plan on working. A passing grade is required to become an RN, and the categories include:
Safe, effective care environment
Once you are an RN or have received your BSN, you can decide whether you’d like to choose a specialty or continue your education to become a nurse practitioner. Nurse practitioners must complete a Master of Science in Nursing program (MSN). On top of your previous education, the entire timeline can take anywhere from 6-8 years. If you haven’t yet started your educational journey toward becoming a nurse, it’s never too early. Some nursing programs are available online (at least partially). If you know nursing is your passion, you can begin to take courses early and gain experience that will help you once you find yourself in the workforce.
Facing the Realities of Nursing
No matter what level or area of nursing you decide to pursue, there are a few truths you’ll need to understand before you get started. Maybe you’ve been passionate about becoming a nurse since you were a child. Those passions and dreams don’t have to be “squashed,” but knowing as much as possible about the realities of nursing before you break into the field can help you determine if it’s really the right career for you.
First, it’s important to understand that you will always come second. That’s actually one of the reasons many people become nurses: to provide service to others. Doing so can help you to feel fulfilled and satisfied with your work. But, that doesn’t mean it will always be easy. Some potential “drawbacks” to keep in mind about a nursing career include:
If you work in a busy hospital, you may have irregular hours.
Nurses are at a high risk of experiencing workplace burnout.
It can sometimes be a “thankless job”.
Entry-level RNs only make an average of $41,000 per year.
Nursing can be a demanding profession, depending on where you work. But, most people stay in that profession for years because the rewards outweigh any of the disadvantages. It helps to have certain traits and characteristics to enjoy nursing as a long-term career. You have to enjoy working with different types of people every day and be willing to be a major component in a functional team.
How to Land a Great Nursing Job
Once you’ve completed your education and received your certification to become a nurse, the next step is to find the right job. Thankfully, due to the high demand for nurses across the country, your qualifications will often be enough for you to get hired quickly. Nurses are needed in a variety of settings, including:
Local government agencies
Think about the type of setting that would be a good fit for you before applying to different open positions. You may want to start somewhere small to gain experience, especially if you eventually want to continue your training toward a specialty.
Networking is just as important in the health care industry as it is in other business sectors. If you know anyone in the industry, don’t be afraid to reach out to them and market yourself to land a job. Many times, getting the job you want is about “who you know”, so use your connections wisely.
Finally, think about some of the most common questions you could be asked during a job interview. While it’s important to practice your answers for the interview itself, you can also gain more insight into what you really want to achieve out of your career. What are your goals? Why did you want to become a nurse? What are your biggest strengths and weaknesses? By understanding some of those things about yourself, you will have more direction in where you want to take your career.
Nursing is one of the oldest, most stable professions in the country, and it’s still seeing continuous growth. If you are pursuing a career in nursing, keep these ideas in mind to continue your forward progress, and know what to expect as you start your first job.